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Hladik W, Nasirumbi Muniina P, Familiar I, Kaiser P, Ogwal M, Serwadda D, Sande E, Kiyingi H, Siya Bahinduka C, Dolan C. Sexual and nonsexual violence and mental health among male refugees from the Democratic Republic of Congo residing in Kampala, Uganda: a population-based survey. Med Confl Surviv 2023; 39:389-411. [PMID: 37849278 DOI: 10.1080/13623699.2023.2263730] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/23/2023] [Indexed: 10/19/2023]
Abstract
We conducted a population-based survey in 2013 in Kampala, Uganda, to examine violence and mental health outcomes among self-settled male refugees from the Eastern Democratic Republic of Congo (DRC). Male DRC refugees aged 18+ years were sampled through respondent-driven sampling. Key interview domains included demographics, experiences of sexual and nonsexual violence, social support, PTSD, depression and suicide ideation. Data analysis was weighted to generate population-level estimates. We sampled 718 men (mean age: 33 years), most of whom had lived in North or South Kivu. Nonsexual violence, such as beatings (79.4%) and torture (63.8%), was frequent. A quarter (26.2%) had been raped; 49.9% of rape victims had been raped on multiple occasions, and 75.7% of rape victims had been gang raped. We estimated 52.8% had post-traumatic stress disorder (PTSD); 44.4% reported suicidal ideation. Numerous traumas were significantly (p < 0.05) associated with PTSD such as rape (adjusted odds ratio [aOR] = 1.82), war-related injuries (aOR = 2.90) or having been exposed to >15 traumas (compared to ≤10; aOR = 6.89). Traumata are frequent experiences in this self-settled male refugee population and are often accompanied by adverse mental health outcomes. Screening for trauma and adverse mental health outcomes and providing targeted services are paramount to improve these refugees' lives.
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Affiliation(s)
- Wolfgang Hladik
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, USA
| | | | - Itziar Familiar
- Department of Psychiatry, Michigan State University, East Lansing, Michigan
| | - Peter Kaiser
- Center for Victims of Torture and War, Swiss Red Cross, Bern, Switzerland
| | - Moses Ogwal
- School of Public Health, Makerere University, Kampala, Uganda
| | - David Serwadda
- School of Public Health, Makerere University, Kampala, Uganda
| | - Enos Sande
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Kampala, Uganda
| | - Herbert Kiyingi
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Kampala, Uganda
| | | | - Chris Dolan
- Global Sustainable Development Department, Warwick University, Coventry, UK
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Glenn Fowler M, Aizire J, Sikorskii A, Atuhaire P, Wambuzi Ogwang L, Mutebe A, Katumbi C, Maliwichi L, Familiar I, Taha T, Boivin MJ. Growth deficits in antiretroviral and HIV-exposed uninfected versus unexposed children in Malawi and Uganda persist through 60 months of age. AIDS 2022; 36:573-582. [PMID: 34750297 PMCID: PMC9097628 DOI: 10.1097/qad.0000000000003122] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/27/2022]
Abstract
OBJECTIVE To compare childhood physical growth among antiretroviral drug and maternal HIV-exposed uninfected (AHEU) compared with HIV-unexposed uninfected (HUU) children. DESIGN Longitudinal follow-up of PROMISE trial (NCT01061151) AHEU and age-matched and sex-matched HUU children, enrolled (September 2013 to October 2014) in Malawi and Uganda. METHOD We compared WHO population standardized z-scores [height-for-age (HAZ), weight-for-age (WAZ), weight-for-height (WHZ), head-circumference-for-age (HCAZ) at 12, 24, 36, 48, and 60 months of age]. We evaluated HUU versus AHEU [in-utero combination antiretroviral treatment (cART) versus Zidovudine (ZDV) alone]; stratified by country, using longitudinal linear and generalized linear mixed models. RESULTS Of 466 Malawian and 477 Ugandan children, median maternal age at enrollment was 24.5 years (Malawi) and 27.8 years (Uganda); more than 90% were breastfed through 12 months except Uganda AHEU (64.0%). HAZ scores (adjusted for maternal age, breastfed, and socioeconomic status) were lower among AHEU versus HUU children at every time point, significant (P < 0.05) among Ugandan but not Malawian children. Similar patterns were seen for WAZ but not for WHZ or HCAZ scores. High stunting was observed in both countries, significantly higher in Malawi; and higher among AHEU versus HUU children through 48 months of age, significantly (P < 0.05) among Ugandan but not Malawian children. We found no differences in childhood growth trajectories with in-utero exposures to ZDV compared with cART. CONCLUSION AHEU versus HUU children had lower median LAZ and WAZ scores persisting through 60 months of age. However, proportions of children with stunting or underweight decreased after 24 months of age.
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Affiliation(s)
| | - Jim Aizire
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Alla Sikorskii
- Department of Statistics & Probability, Michigan State University
- Department of Psychiatry, Michigan State University
| | | | | | - Alex Mutebe
- Makerere U.-Johns Hopkins U. Research Collaboration
| | - Chaplain Katumbi
- College of Medicine – Johns Hopkins University Research Project, Blantyre, Malawi
| | - Limbika Maliwichi
- College of Medicine – Johns Hopkins University Research Project, Blantyre, Malawi
| | | | - Taha Taha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Michael J. Boivin
- Department of Statistics & Probability, Michigan State University
- Department of Psychiatry, Michigan State University
- Department of Neurology & Ophthalmology, Michigan State University
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Familiar I, Sikorskii A, Chhaya R, Weiss J, Seffren V, Ojuka JC, Awadu J, Boivin MJ. Early Childhood Vigilance Test (ECVT) of attention in younger HIV-exposed Ugandan children predicts Tests of Variables of Attention (TOVA) at school age. Neuropsychology 2022; 36:185-194. [PMID: 35007091 PMCID: PMC9907227 DOI: 10.1037/neu0000788] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objective: Evaluate a computerized-based attention test in early infancy in predicting neurocognitive school-age performance in human immunodeficiency virus (HIV)-exposed uninfected children. Method: Thirty-eight Ugandan HIV-exposed/uninfected children (17 boys, 21 girls) were evaluated with the Early Childhood Vigilance Test (ECVT) of attention between 3 and 5 years of age, which is a 6-min 44 s animation with colorful animals that greet the child and move across the screen. Attention was proportion of total animation time viewing a computer screen, as well as the proportion of time tracking the moving animal using eye tracking. These children were then again tested at least 2 years later (between 5 and 9 years of age) with the Kaufman Assessment Battery for Children, 2nd Edition (KABC-II) and the visual computerized Tests of Variables of Attention (TOVA). Results: Irrespective of whether scored by webcam video scoring or using automated eye tracking to compute proportion of time viewing the animation, ECVT attention was significantly correlated with all TOVA outcomes for vigilance attention. This was still the case when the correlation was adjusted for type of caregiver training for the mother, child gender, socioeconomic status (SES), and quality of Home Observational Measurement Evaluation (HOME) environment-especially for the TOVA response time variability to signal (p = .03). None of the ECVT attention performance measures correlated significantly with any of the KABC-II cognitive ability outcomes. Conclusion: Attention assessment in early childhood is predictive of school-age computer-based measures of attention and can be used to gauge the effects of factors of early risk and resilience in brain/behavior development in African children affected by HIV. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | | | - Ronak Chhaya
- College of Human Medicine, Michigan State University
| | | | | | | | - Jorem Awadu
- Departments of Psychiatry, Michigan State University
| | - Michael J. Boivin
- Departments of Psychiatry, Michigan State University,Department of Neurology & Ophthalmology, Michigan State University,Department of Psychiatry, University of Michigan
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Zotova N, Familiar I, Kawende B, Kasindi FL, Ravelomanana N, Parcesepe AM, Adedimeji A, Lancaster KE, Kaba D, Babakazo P, Yotebieng M. HIV disclosure and depressive symptoms among pregnant women living with HIV: a cross‐sectional study in the Democratic Republic of Congo. J Int AIDS Soc 2022; 25:e25865. [PMID: 35129301 PMCID: PMC8819634 DOI: 10.1002/jia2.25865] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 12/14/2021] [Indexed: 11/07/2022] Open
Abstract
Introduction Methods Results Conclusions
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Affiliation(s)
- Natalia Zotova
- Division of General Internal MedicineDepartment of MedicineAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Itziar Familiar
- Department of PsychiatryMichigan State UniversityEast LansingMichiganUSA
| | - Bienvenu Kawende
- School of Public HealthUniversity of KinshasaKinshasa, Democratic Republic of Congo
| | | | - Noro Ravelomanana
- School of Public HealthUniversity of KinshasaKinshasa, Democratic Republic of Congo
| | - Angela M. Parcesepe
- Department of Maternal and Child HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Adebola Adedimeji
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Kathryn E. Lancaster
- Division of Epidemiology, College of Public HealthOhio State UniversityColumbusOhioUSA
| | - Didine Kaba
- School of Public HealthUniversity of KinshasaKinshasa, Democratic Republic of Congo
| | - Pélagie Babakazo
- School of Public HealthUniversity of KinshasaKinshasa, Democratic Republic of Congo
| | - Marcel Yotebieng
- Division of General Internal MedicineDepartment of MedicineAlbert Einstein College of MedicineBronxNew YorkUSA
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Glenn Fowler M, Boivin MJ, Familiar I, Nyangoma B. Central Nervous System and Neurodevelopmental Outcomes of HIV+ and HIV exposed children: A Mini Review of Recent Findings and Lessons Learned from the Field. Neurosci Lett 2022; 775:136501. [PMID: 35122932 DOI: 10.1016/j.neulet.2022.136501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 01/11/2022] [Accepted: 01/28/2022] [Indexed: 12/11/2022]
Affiliation(s)
- Mary Glenn Fowler
- Dept of Pathology, Johns Hopkins U. School of Medicine Baltimore MD, USA; Dept of PsychiatryMichigan State U. East Lansing, MI, USA; Makerere U. Johns Hopkins U. Research Collaboration, USA; Kampala Uganda
| | - Michael J Boivin
- Dept of Pathology, Johns Hopkins U. School of Medicine Baltimore MD, USA; Dept of PsychiatryMichigan State U. East Lansing, MI, USA; Makerere U. Johns Hopkins U. Research Collaboration, USA; Kampala Uganda
| | - Itziar Familiar
- Dept of Pathology, Johns Hopkins U. School of Medicine Baltimore MD, USA; Dept of PsychiatryMichigan State U. East Lansing, MI, USA; Makerere U. Johns Hopkins U. Research Collaboration, USA; Kampala Uganda
| | - Betty Nyangoma
- Dept of Pathology, Johns Hopkins U. School of Medicine Baltimore MD, USA; Dept of PsychiatryMichigan State U. East Lansing, MI, USA; Makerere U. Johns Hopkins U. Research Collaboration, USA; Kampala Uganda
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Familiar I, Majumder A, Sikorskii A, Boivin M, Nakasujja N, Bass J. Longitudinal Dyadic Interdependence in Depression Symptoms of Caregivers Living with HIV in Uganda and Their Dependent Children's Neurodevelopment and Executive Behavior Outcomes. AIDS Behav 2021; 25:3828-3835. [PMID: 33606133 DOI: 10.1007/s10461-021-03192-1] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2021] [Indexed: 11/29/2022]
Abstract
We tested a model of dyadic interdependence in depression symptoms experienced by female caregivers living with HIV in Uganda (n = 288) and behavioral problems of their HIV-infected (n = 92) and perinatally HIV-exposed uninfected (HEU) children (n = 196). Three repeated measures of caregiver depression symptoms and child neurodevelopment and behavioral outcomes were related to their own outcomes at a previous time point (actor effects), and the outcomes of the other member of the dyad (partner effects). Caregiver depression and child behavioral problem were interdependent over the 24 months of observation. Caregiver depression at Tn predicted child's behavioral problems at Tn+1 (coefficient = 0.1220, SE = 0.0313, p < 0.01); child behavioral problems at Tn predicted maternal depression at Tn+1 (coefficient = 0.0984, SE = 0.0253, p < 0.01). Results suggest the importance of services addressing behavioral needs of affected children and mental health of their mothers.
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Affiliation(s)
- Itziar Familiar
- Department of Psychiatry, Michigan State University, 909 Wilson Rd. A322, East Lansing, MI, USA.
| | | | - Alla Sikorskii
- Departments of Psychiatry and Statistics, Michigan State University, East Lansing, MI, USA
| | - Michael Boivin
- Departments of Psychiatry and Neurology, Michigan State University, East Lansing, MI, USA
| | - Noeline Nakasujja
- Department of Psychiatry College of Health Sciences, Makerere University, Kampala, Uganda
| | - Judith Bass
- Mental Health Department, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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Flores-Torres MH, Tran A, Familiar I, López-Ridaura R, Ortiz-Panozo E. Perceived Stress Scale, a tool to explore psychological stress in Mexican women. Salud Publica Mex 2021; 64:49-56. [DOI: 10.21149/12499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 07/02/2021] [Indexed: 11/06/2022] Open
Abstract
Objective. To examine the factor structure of the 4- and 10-item Perceived Stress Scale (PSS) among 1 310 Mexican women participating in a prospective cancer cohort study. Materials and methods. We performed exploratory and confirmatory factor analyses in two sub-samples of the Mexican Teachers’ Cohort. We evaluated internal consistency, estimated the correlation between PSS-4 and PSS-10, and assessed their correlation with a depressive symptoms scale. Results. Two-factor models were the solutions with the best fit to the data for both PSS-4 and -10, exhibiting strong factor loadings (0.39 to 0.75) and high internal consistency (Cronbach’s alpha 0.72 and 0.83). The correlation between PSS-4 and PSS-10 was r=0.91 and the correlations of these two scales with a depressive symptoms scale were r=0.41 and r=0.46, respectively. Conclusions. PSS might be an adequate scale to assess perceived stress in this prospective cancer cohort study. PSS-4 may be advantageous due to its simplicity, low cost, and short application time in multicountry studies on stress and cancer.
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Familiar I, Muniina PN, Dolan C, Ogwal M, Serwadda D, Kiyingi H, Bahinduka CS, Sande E, Hladik W. Conflict-related violence and mental health among self-settled Democratic Republic of Congo female refugees in Kampala, Uganda - a respondent driven sampling survey. Confl Health 2021; 15:42. [PMID: 34039400 PMCID: PMC8157662 DOI: 10.1186/s13031-021-00377-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/11/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Violence and traumatic events are highly prevalent among refugees, but less is known about the impact of these experiences among self-settled refugees in the country of asylum. We evaluated the association between traumatic experiences and PTSD and depression symptoms among female Democratic Republic of Congo (DRC) refugees living in Kampala, Uganda. METHODS Participants were recruited using respondent driven sampling in one refugee service center in Kampala, Uganda. Eligibility criteria included: Congolese nationality, age 18+ years, self-settled in Kampala for at least 6 months, refugee status or documentation of application for refugee status. Only data from female participants were included in this analysis. Depression symptoms were screened with the Patient Health Questionnaire-2, and symptom criteria for PTSD and traumatic experiences were evaluated with the Harvard Trauma Questionnaire. Logistic regression models were performed to separately assess associations between mental health outcomes (PTSD and depression), rape and non-sexual violence. RESULTS Five hundred eighty women with a mean age of 33 years were interviewed. Among participants, 73% (95% CI:67-78%) met symptom criteria for PTSD, 57% (95% CI: 51-63%) for depression, and 65% reported thoughts of ending one's life. 79% of women reported experience of rape, for over half (54%) it occurred more than once, and 82% were gang raped. Crude and adjusted odds ratios (ORs) show that PTSD was most strongly associated with being raped (OR = 2.43, p < 0.01), lacking shelter (OR = 2.86, p < 0.01), lacking food or water (OR = 2.53, p = 0.02), lacking access to health care (OR = 2.84, p < 0.01), forced labor (OR = 2.6, p < 0.01), extortion and/or robbery (OR = 3.08, p < 0.01), experiencing the disappearance/kidnapping of a family member or friend (OR = 2.72, p < 0.01), and witnessing the killing or murder of other people (OR = 3.28, p < 0.01). Depression was significantly associated with several traumatic experiences including rape (OR = 2.3, p = 0.01), and experiencing the disappearance/kidnapping of a child or spouse (OR = 1.99, p = 0.01). CONCLUSIONS Refugee women self-settled in Kampala reported high lifetime experiences of violence and traumatic events including rape, as well as high rates of PTSD and depression. Future programming addressing self-settled refugees and their settlement in host countries may benefit from including local and national integration strategies.
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Affiliation(s)
- Itziar Familiar
- Department of Psychiatry, Michigan State University, East Lansing, MI USA
| | | | - Chris Dolan
- Refugee Law Project, School of Law, Makerere University, Kampala, Uganda
| | - Moses Ogwal
- School of Public Health, Makerere University, Kampala, Uganda
| | - David Serwadda
- Department of Disease Control, School of Public Health, Makerere University, Kampala, Uganda
| | - Herbert Kiyingi
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Kampala, Uganda
| | | | - Enos Sande
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Kampala, Uganda
| | - Wolfgang Hladik
- Division of Global HIV and TB, Centers for Disease Control and Prevention, MS E-30, 1600 Clifton Rd, Atlanta, GA-30333 USA
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Familiar I, Boivin M, Magen J, Azcorra JA, Phippen C, Barrett EA, Miller S, Ruisenor-Escudero H. Neurodevelopment outcomes in infants born to women with Zika virus infection during pregnancy in Mexico. Child Care Health Dev 2021; 47:311-318. [PMID: 33332632 DOI: 10.1111/cch.12842] [Citation(s) in RCA: 8] [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: 09/11/2020] [Revised: 12/10/2020] [Accepted: 12/14/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Few studies have assessed neurodevelopmental outcomes in normocephalic infants born to women with Zika virus (ZIKV) infection during pregnancy in Mexico. We sought to evaluate ZIKV exposed infants in Yucatan, Mexico, with performance-based and eye-gaze measures of neurodevelopment, removing observer bias. METHODS We enrolled 60 infants about 6-month old born to women with PCR + test for ZIKV during pregnancy. Infants were normocephalic and asymptomatic. Sixty infants born to women without a history of ZIKV infection were included as comparison. Children were assessed with the Mullen scales of early learning (MSEL), a test with scales in motor, language, and overall cognitive skills development, and the Fagan test of infant intelligence (FTII) using automated eye-tracking instrumentation to evaluate infant visual preference of human faces, where longer gaze lengths to unfamiliar (i.e., new) faces are expected. RESULTS All MSEL subscale scores, except expressive language, were significantly lower among ZIKV exposed children compared to controls, including the overall standard composite (80 ± 10 vs. 87 ± 7.4, respectively; p < 0.001). FTII eye-tracking measures of fixation and gaze length were in the expected direction, with longer times recorded among infants in the control group (i.e., higher attention), but none reached statistical significance. In adjusted linear regressions, the FTII high novelty score (expected preference for a novel face) predicted fine motor (β = 3.61, p = 0.04) and receptive language (β = 2.55, p = 0.03) scores. CONCLUSIONS Nonmicrocephalic children born to women with ZIKV during pregnancy in Mexico merit early neurodevelopmental evaluation to allow for appropriate interventions and clinical follow-up. It is possible that long-term monitoring of cognitive deficits may need to be established for a proportion of affected cases.
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Affiliation(s)
- Itziar Familiar
- Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Michael Boivin
- Department of Psychiatry and Department of Neurology and Ophthalmology, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Jed Magen
- Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
| | | | - Colton Phippen
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Elizabeth Ann Barrett
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Sydney Miller
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Horacio Ruisenor-Escudero
- Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
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Stringer EM, Martinez E, Blette B, Toval Ruiz CE, Boivin M, Zepeda O, Stringer JSA, Morales M, Ortiz-Pujols S, Familiar I, Collins M, Chavarria M, Goldman B, Bowman N, de Silva A, Westreich D, Hudgens M, Becker-Dreps S, Bucardo F. Neurodevelopmental Outcomes of Children Following In Utero Exposure to Zika in Nicaragua. Clin Infect Dis 2021; 72:e146-e153. [PMID: 33515459 PMCID: PMC7935385 DOI: 10.1093/cid/ciaa1833] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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] [Received: 08/30/2020] [Indexed: 12/14/2022] Open
Abstract
Background Neurodevelopmental outcomes of asymptomatic children exposed to Zika virus (ZIKV) in utero are not well characterized. Methods We prospectively followed 129 newborns without evidence of congenital Zika syndrome (CZS) up to 24 months of age. Participants were classified as ZIKV exposed or ZIKV unexposed. The Mullen Scales of Early Learning (MSEL) was administered in the participants’ homes at 6, 12, 15, 18, 21, and 24 months of age by trained psychologists. Sociodemographic data, medical history, and infant anthropometry at birth were collected at each home visit. Our primary outcome was the Mullen Early Learning Composite Score (ECL) at 24 months of age between our 2 exposure groups. Secondary outcomes were differences in MSEL subscales over time and at 24 months. Results Of 129 infants in whom exposure status could be ascertained, 32 (24.8%) met criteria for in utero ZIKV exposure and 97 (75.2%) did not. There were no differences in maternal age, maternal educational attainment, birthweight, or gestational age at birth between the 2 exposure groups. The adjusted means and standard errors (SEs) for the ELC score between the ZIKV-exposed children compared to ZIKV-unexposed children were 91.4 (SE, 3.1) vs 96.8 (SE, 2.4) at 12 months and 93.3 (SE, 2.9) vs 95.9 (SE, 2.3) at 24 months. In a longitudinal mixed model, infants born to mothers with an incident ZIKV infection (P = .01) and low-birthweight infants (<2500 g) (P = .006) had lower composite ECL scores. Conclusions In this prospective cohort of children without CZS, children with in utero ZIKV exposure had lower neurocognitive scores at 24 months.
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Affiliation(s)
- Elizabeth M Stringer
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Evelin Martinez
- Department of Microbiology, Faculty of Medical Science, National Autonomous University of Nicaragua at León, Managua, Nicaragua
| | - Bryan Blette
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Christian Eduardo Toval Ruiz
- Department of Microbiology, Faculty of Medical Science, National Autonomous University of Nicaragua at León, Managua, Nicaragua
| | - Michael Boivin
- Department of Psychiatry, Michigan State University, East Lansing, Michigan, USA
| | - Omar Zepeda
- Department of Microbiology, Faculty of Medical Science, National Autonomous University of Nicaragua at León, Managua, Nicaragua
| | - Jeffrey S A Stringer
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Marlen Morales
- Department of Microbiology, Faculty of Medical Science, National Autonomous University of Nicaragua at León, Managua, Nicaragua
| | - Shiara Ortiz-Pujols
- Division of Endocrinology, New York-Presbyterian Hospital and Weill Cornell Medical Center, New York, New York, USA
| | - Itziar Familiar
- Department of Psychiatry, Michigan State University, East Lansing, Michigan, USA
| | - Matthew Collins
- Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Meylin Chavarria
- Department of Microbiology, Faculty of Medical Science, National Autonomous University of Nicaragua at León, Managua, Nicaragua
| | - Barbara Goldman
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Natalie Bowman
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Aravinda de Silva
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Daniel Westreich
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Michael Hudgens
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sylvia Becker-Dreps
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Filemon Bucardo
- Department of Microbiology, Faculty of Medical Science, National Autonomous University of Nicaragua at León, Managua, Nicaragua
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Flores-Torres MH, Comerford E, Signorello L, Grodstein F, Lopez-Ridaura R, de Castro F, Familiar I, Ortiz-Panozo E, Lajous M. Impact of adverse childhood experiences on cardiovascular disease risk factors in adulthood among Mexican women. Child Abuse Negl 2020; 99:104175. [PMID: 31710961 DOI: 10.1016/j.chiabu.2019.104175] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 07/12/2019] [Accepted: 09/02/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Childhood adversities are prevalent worldwide and might affect adult cardiovascular health. However, in middle-income countries such as Mexico, research on the impact of childhood adversities on cardiovascular disease (CVD) in adulthood is lacking. OBJECTIVE To evaluate the prevalence of adverse childhood experiences (ACEs) and their association with risk factors for CVD in adult Mexican women. PARTICIPANTS AND SETTING The study population comprised 9853 women from the Mexican Teachers´ Cohort. METHODS Participants responded to an online questionnaire including a 10-item instrument on ACEs and questions on CVD risk factors, between 2014 and 2017. Multivariate logistic regression models were used to evaluate the association between ACEs and adult behavioral and medical CVD risk factors. RESULTS About 61% of participants reported at least one ACE and 14% reported four or more. After multivariable adjustment, women who reported ≥4 ACEs had 58% (95%CI 1.37, 1.81) higher odds of having ever smoked and 17% (95%CI 0.69, 0.99) lower odds of being physically active, compared with women who reported no ACEs. Women who reported ≥4 ACEs also had higher odds of hypertension (OR = 1.19; 95%CI 1.00, 1.43), diabetes (OR = 1.49; 95%CI 1.13, 1.96), high cholesterol (OR = 1.49; 95%CI 1.26, 1.75), and obesity (OR = 1.37; 95%CI 1.19, 1.57). In addition, individual ACE components were independently associated with several CVD risk factors. CONCLUSION ACEs are common and associated with CVD risk factors in adult Mexican women.
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Affiliation(s)
- Mario H Flores-Torres
- Center for Research on Population Health, National Institute of Public Health, 7ª Cerrada Fray Pedro de Gante # 50, Mexico City, 14000, Mexico
| | - Erin Comerford
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, United States
| | - Lisa Signorello
- Division of Cancer Prevention, National Cancer Institute, NIH, 9609 Medical Center Drive, Bethesda, MD, 20892-9712, United States
| | - Francine Grodstein
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, United States
| | - Ruy Lopez-Ridaura
- Center for Research on Population Health, National Institute of Public Health, 7ª Cerrada Fray Pedro de Gante # 50, Mexico City, 14000, Mexico
| | - Filipa de Castro
- Center for Research on Population Health, National Institute of Public Health, 7ª Cerrada Fray Pedro de Gante # 50, Mexico City, 14000, Mexico
| | - Itziar Familiar
- Department of Psychiatry, Michigan State University, 220 Trowbridge Rd, East Lansing, MI, 48824, United States
| | - Eduardo Ortiz-Panozo
- Center for Research on Population Health, National Institute of Public Health, 7ª Cerrada Fray Pedro de Gante # 50, Mexico City, 14000, Mexico
| | - Martín Lajous
- Center for Research on Population Health, National Institute of Public Health, 7ª Cerrada Fray Pedro de Gante # 50, Mexico City, 14000, Mexico; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, United States.
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Familiar I, Sikorskii A, Murray S, Ruisenor-Escudero H, Nakasujja N, Korneffel C, Boivin M, Bass J. Depression Symptom Trajectories Among Mothers Living with HIV in Rural Uganda. AIDS Behav 2019; 23:3411-3418. [PMID: 30877579 DOI: 10.1007/s10461-019-02465-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The aim was to identify latent class trajectories of depression symptoms among HIV+ women in Uganda. Depression was assessed at four time points using the Hopkins Symptom Checklist among 288 women caring for a child 2-5 years old. Mixture modeling was used to estimate the number and nature of classes defined by trajectories of depressive symptoms over time. Maternal and child characteristics were explored as predictors of class. Three trajectories of symptoms of depression were identified; (1) stable-low, (2) moderate-subclinical, and (3) chronic-high. About 8% of women reported moderately or highly elevated symptoms at the first assessment and consistently onward (i.e. chronically). Higher anxiety levels, less social support, more functionality problems, and more executive behavior problems in children predicted membership in the moderate-subclinical and chronic-high classes. Identifying patterns of depression trajectories can help target intervention efforts for women who are likely to experience the most chronic and impairing symptomatology.
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Affiliation(s)
- Itziar Familiar
- Department of Psychiatry, Michigan State University, 909 Fee Rd. A322, East Lansing, MI, USA.
| | - Alla Sikorskii
- Departments of Psychiatry and Statistics, Michigan State University, East Lansing, MI, USA
| | - Sarah Murray
- Mental Health Department, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Noeline Nakasujja
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Clinton Korneffel
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Michael Boivin
- Departments of Psychiatry and Neurology, Michigan State University, East Lansing, MI, USA
| | - Judith Bass
- Departments of Psychiatry and Statistics, Michigan State University, East Lansing, MI, USA
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Familiar I, Chernoff M, Ruisenor-Escudero H, Laughton B, Joyce C, Fairlie L, Vhembo T, Kamthunzi P, Barlow-Barlow L, Zimmer B, McCarthy K, Boivin MJ. Association between caregiver depression symptoms and child executive functioning. Results from an observational study carried out in four sub-Saharan countries. AIDS Care 2019; 32:486-494. [PMID: 31462095 DOI: 10.1080/09540121.2019.1659917] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Depressive symptoms among HIV-positive (HIV+) women may negatively impact their health and possibly that of their young children through risk of compromised caregiving. We evaluated how depression symptoms in predominantly (97%) female caregivers relate to neurodevelopmental outcomes in their HIV affected children. Data come from the IMPAACT P1104s Study, an observational cohort across six sites in four countries: Zimbabwe, South Africa, Uganda and Malawi. Participants (n = 611) were 5-11-year-old children with HIV (HIV), HIV exposed uninfected (HEU), or HIV unexposed uninfected (HUU). Primary caregivers were assessed for depression with the Hopkins Symptom Checklist (HSCL) and children with Behavior Rating Inventory for Executive Function (BRIEF) parent-report, Kauffman Assessment Battery for Children II (KABC), Bruininks-Oseretsky Test of Motor Proficiency 2nd Ed. (BOT-2), Test of Variables of Attention (TOVA), Multiple Indicators Cluster Survey, Child Disability and Development scales (MICS-4). Caregivers with higher depression scores (>1.75 mean HSCL score) reported more executive function problems in their children, regardless of HIV status. All executive function scores were significantly (p < 0.001) associated with depressive symptomatology at baseline and across time. Caregiver depressive symptomatology was not associated with other assessed neurocognitive outcomes. These results highlight the potential impact of caregiver depression on child behavioral outcomes.
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Affiliation(s)
- Itziar Familiar
- Department of Psychiatry, Michigan State University, East Lansing, MI, USA
| | - Miriam Chernoff
- Center for Biostatistics in AIDS Research, Harvard University, Boston, MA, USA
| | | | - Barbara Laughton
- Department of Pediatrics and Child Health, Stellenboch University, Tygerberg, RSA
| | - Celeste Joyce
- Perinatal HIV Research Unit (PHRU), Chris Hani Baragwanath Hospital, Johannesburg, RSA
| | - Lee Fairlie
- Wits Reproductive Health and HIV Institute, Shandukani Clinic, Johannesburg, RSA
| | - Tichaona Vhembo
- Harare Family Care CRS, University of Zimbabwe, Harare, Zimbabwe
| | - Portia Kamthunzi
- University of North Carolina-Lilongwe Clinical Research Institute, Lilongwe, Malawi
| | - Linda Barlow-Barlow
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | | | | | - Michael J Boivin
- Departments of Psychiatry and Neurology, Michigan State University, East Lansing, MI, USA
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Ruiseñor-Escudero H, Familiar I, Nyakato M, Kutessa A, Namukooli J, Ssesanga T, Joyce C, Laughton B, Grab J, Chernoff M, Vhembo T, Fairlie L, Kamthunzi P, Boivin M. Building capacity in neurodevelopment assessment of children in sub-Saharan Africa: A quality assurance model to implement standardized neurodevelopment testing. Child Neuropsychol 2019; 25:466-481. [PMID: 30105934 PMCID: PMC6375801 DOI: 10.1080/09297049.2018.1497588] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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] [Received: 10/09/2017] [Accepted: 06/10/2018] [Indexed: 10/28/2022]
Abstract
Compromised neurodevelopment (ND) among infants and children is prevalent in sub-Saharan Africa. Standardized testing of ND is frequently prohibitive in these contexts, as tests require skilled staff for their application. In this paper, we present a quality assurance (QA) model (QualiND) for standardized ND testing, discussing findings and implications from our experience applying the Kaufman Assessment Battery for Children second edition (KABC-II). The QualiND model was implemented within IMPAACT P1104s study, a multisite, prospective study including 615 children affected by HIV. From 2014 to 2016, the QualiND managed 18 testers across 6 sites located in 4 African countries applying the KABC-II in 9 local languages. The QualiND is a multilevel, video-assisted iterative model incorporating remote evaluation, feedback, and supervision roles. Using an ad hoc rubric, videos of test application were evaluated by experienced staff in a centralized QA center. At each study site, testers and supervisors reviewed feedback from videos received via email from the QA center and devised an action plan to address testing errors and deficiencies. There were few instances of invalid tests and few barriers to test completion. Over 97% of KABC-II tests across sites were considered to be valid by the QA center. Overall, the QualiND model was a useful platform for remote supervision to nonspecialist and minimally trained research staff. The QualiND model may be useful to researchers and organizations involved in measuring early child development using standardized tests in low and middle-income countries.
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Affiliation(s)
| | - Itziar Familiar
- a Psychiatry Department , Michigan State University , East Lansing , USA
| | - Mary Nyakato
- b Makerere University-Johns Hopkins University Research Collaboration (MU-JHU) , Kampala , Uganda
| | - Agatha Kutessa
- b Makerere University-Johns Hopkins University Research Collaboration (MU-JHU) , Kampala , Uganda
| | | | | | - Celeste Joyce
- d Chris Hani HIV Unit , University of Witwatersrand , Soweto , South Africa
| | - Barbara Laughton
- e Department of Pediatrics and Child Health , Tygerberg University , Tygerberg , South Africa
| | - Janet Grab
- f Wits Reproductive Health & HIV Institute , Shandukani Clinic , Johannesburg , South Africa
| | - Miriam Chernoff
- g Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health , Harvard University , Boston , USA
| | - Tichaona Vhembo
- h Harare Family Care , University of Zimbabwe , Harare , Zimbabwe
| | - Lee Fairlie
- f Wits Reproductive Health & HIV Institute , Shandukani Clinic , Johannesburg , South Africa
| | - Portia Kamthunzi
- i Lilongwe Clinical Research Institute , Kamuzu Central Hospital , Lilongwe , Malawi
| | - Michael Boivin
- a Psychiatry Department , Michigan State University , East Lansing , USA
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Chernoff MC, Laughton B, Ratswana M, Familiar I, Fairlie L, Vhembo T, Kamthunzi P, Kabugho E, Joyce C, Zimmer B, Ariansen JL, Jean-Philippe P, Boivin MJ. Validity of Neuropsychological Testing in Young African Children Affected by HIV. J PEDIAT INF DIS-GER 2018; 13:185-201. [PMID: 30100780 DOI: 10.1055/s-0038-1637020] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 02/02/2023]
Abstract
Introduction Western-constructed neuropsychological tests have been used in low and middle income countries to assess the impact of HIV/AIDS and other chronic illnesses. We explore using such instruments cross-culturally in a sub-Saharan Africa setting. Methods IMPAACT P1104S was a two-year observational study carried out at six clinical sites (South Africa- 3 sites, Malawi, Uganda and Zimbabwe) to assess and compare neuropsychological outcomes in three cohorts of children 5-11 years of age: HIV-infected (HIV), HIV-exposed but uninfected (HEU) and HIV unexposed and uninfected (HU). Descriptive statistics compared socio-demographic characteristics among children at sites. Instruments included the KABC-II cognitive ability, TOVA attention/impulsivity, BOT-2 motor proficiency tests, and BRIEF executive function problems. Test characteristics were assessed using intraclass and Spearman non-parametric correlations, linear regression and principal factor analyses. Results Of the 611 participants, 50% were male and mean age ranged from 6.6 to 8 years. In Malawi, Uganda and Zimbabwe, substantial proportions of families lived in rural settings in contrast to the South African sites. Intraclass correlation coefficients between weeks 0 and 48 were highest for the KABC scores, ranging between 0.42 to 0.71.Correlations among similar test domains were low to moderate but significant, with positive correlation between KABC Sequential and TOVA scores and negative correlation between BRIEF and KABC scores. TOVA response time scores correlated negatively with the BOT-2 Total points score. Strong and significant associations between individual measures of growth, disability and development with all test scores were observed. Performance-based measures were markedly lower for HIV compared to HEU and HU participants, even after controlling for age, sex and site. Factor analyses confirmed the underlying theoretical structure of the KABC scaled item scores. Conclusion The KABC, TOVA, BRIEF and BOT-2 were valid and reliable tools for assessing the neuropsychological impact of HIV in four sub-Saharan African countries.
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Affiliation(s)
- Miriam C Chernoff
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Barbara Laughton
- Family Clinical Research Unit, Tygerberg Hospital, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, RSA
| | - Mmule Ratswana
- Wits Reproductive Health & HIV Institute (WRHI), Shandukani Clinic, Johannesburg, RSA
| | - Itziar Familiar
- Department of Psychiatry, Michigan State University, East Lansing, MI
| | - Lee Fairlie
- Wits Reproductive Health & HIV Institute (WRHI), Shandukani Clinic, Johannesburg, RSA
| | - Tichaona Vhembo
- Harare Family Care CRS, University of Zimbabwe, College of Health Sciences Clinical Trials Unit, Harare, Zimbabwe
| | - Portia Kamthunzi
- University of North Carolina Project- Lilongwe, Malawi CRS, Malawi
| | - Enid Kabugho
- Makerere University-Johns Hopkins University Research Collaboration (MUJHU CARE LTD) CRS, Kampala, Uganda
| | - Celeste Joyce
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of Witwatersrand, South Africa
| | | | - J L Ariansen
- Clinical Research Management, FHI360, Durham, NC
| | | | - Michael J Boivin
- Department of Psychiatry, Michigan State University, East Lansing, MI.,Department of Neurology and Ophthalmology, Michigan State University, East Lansing, MI.,Department of Psychiatry, the University of Michigan, Ann Arbor, MI
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Murray SM, Familiar I, Nakasujja N, Winch PJ, Gallo JJ, Opoka R, Caesar JO, Boivin MJ, Bass JK. Caregiver mental health and HIV-infected child wellness: perspectives from Ugandan caregivers. AIDS Care 2016; 29:793-799. [PMID: 27951734 DOI: 10.1080/09540121.2016.1263722] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 10/20/2022]
Abstract
Prior studies indicate a substantial link between maternal depression and early child health but give limited consideration to the direction of this relationship or the context in which it occurs. We sought to create a contextually informed conceptual framework of this relationship through semi-structured interviews with women that had lived experience of caring for an HIV-infected child while coping with depression and anxiety symptoms. Caregivers explained their role in raising healthy children as complex and complicated by poverty, stigma, and isolation. Caregivers discussed the effects of their own mental health on child well-being as primarily emotional and behavioral, and explained how looking after a child could bring distress, particularly when unable to provide desired care for sick children. Our findings suggest the need for investigation of the reciprocal effects of child sickness on caregiver wellness and for integrated programs that holistically address the needs of HIV-affected families.
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Affiliation(s)
- S M Murray
- a Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - I Familiar
- b Department of Psychiatry , Michigan State University , East Lansing , MI , USA
| | - N Nakasujja
- c Department of Psychiatry , Makerere University , Kampala , Uganda
| | - P J Winch
- d Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - J J Gallo
- a Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - R Opoka
- e Department of Pediatrics and Child Health , Makerere University , Kampala , Uganda
| | - J O Caesar
- f Global Health Uganda , Kampala , Uganda
| | - M J Boivin
- b Department of Psychiatry , Michigan State University , East Lansing , MI , USA
| | - J K Bass
- a Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
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Familiar I, Murray S, Ruisenor-Escudero H, Sikorskii A, Nakasujja N, Boivin MJ, Opoka R, Bass JK. Socio-demographic correlates of depression and anxiety among female caregivers living with HIV in rural Uganda. AIDS Care 2016; 28:1541-1545. [PMID: 27240825 DOI: 10.1080/09540121.2016.1191609] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 02/07/2023]
Abstract
Women living with HIV are at increased risk for psychosocial distress, especially among social and economically disadvantaged women living in rural areas. Little is known about how social support and wealth impacts the mental health of women caring for young children in low- and middle-income countries. The purpose of this paper was to assess demographic, socio-economic, and social support correlates of depression and anxiety in HIV-infected+ female caregivers living in rural Uganda. Depression and anxiety were assessed using the Hopkins Symptom Checklist (HSCL-25), two-domains of social support (family and community) were measured with the adapted Multidimensional Scale for Perceived Social Support, and wealth was measured using a checklist of material possessions and housing quality among 288 women. Multivariable linear regression models assessed the association of depression and anxiety with demographic and social predictors. Sixty-one percent of women reported clinically significant symptoms of depression or anxiety using the standard HSCL-25 cut-off of >1.75. Lower wealth (p = .01) and family support (p = .01) were significantly associated with more depressive symptoms, with greater family support being more protective of depression in the highest wealth group (top 20%) compared to the lowest. More anxiety symptoms were associated with lower wealth (p = .001), lower family support (p = .02), and higher community support (p = .003). Economic and social support factors are important predictors of caregiver mental health in the face of HIV disease in rural Uganda. Findings suggest that interventions should consider ways to increase economic opportunities and strengthen family support for HIV+ caregivers.
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Affiliation(s)
- Itziar Familiar
- a Department of Psychiatry , Michigan State University , East Lansing , MI , USA
| | - Sarah Murray
- b Mental Health Department , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | | | - Alla Sikorskii
- c Department of Statistics and Probability , Michigan State University , East Lansing , MI , USA
| | - Noeline Nakasujja
- d Department of Psychiatry , College of Health Sciences, Makerere University , Kampala , Uganda
| | - Michael J Boivin
- a Department of Psychiatry , Michigan State University , East Lansing , MI , USA
| | - Robert Opoka
- e Department of Pediatrics and Child Health , College of Health Sciences, Makerere University , PO Box 7072, Kampala , Uganda
| | - Judith K Bass
- b Mental Health Department , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
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Familiar I, Nakasujja N, Bass J, Sikorskii A, Murray S, Ruisenor-Escudero H, Bangirana P, Opoka R, Boivin MJ. Caregivers' depressive symptoms and parent-report of child executive function among young children in Uganda. Learn Individ Differ 2016; 46:17-24. [PMID: 27175052 PMCID: PMC4860739 DOI: 10.1016/j.lindif.2015.01.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Maternal mental health (particularly depression) may influence how they report on their child's behavior. Few research studies have focused on Sub-Saharan countries where pediatric HIV concentrates and impacts child neuropsychological development and caregiver mental health. We investigated the associations between caregivers' depressive symptoms and neuropsychological outcomes in HIV-infected (n=118) and HIV-exposed (n=164) Ugandan children aged 2-5 years. We compared performance-based tests of development (Mullen Scales of Early Learning, Color Object Association Test), to a caregiver report of executive function (Behavior Rating Inventory of Executive Function, BRIEF). Caregivers were assessed with Hopkins Symptom Checklist-25 depression subscale. The associations between all BRIEF indices and caregiver's depression symptoms were differential according to child's HIV status. Caregivers with greater depressive symptoms reported their HIV-infected children as having more behavioral problems related to executive functioning. Assessment of behavior of HIV-infected children should incorporate a variety of sources of information and screening of caregiver mental health.
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Affiliation(s)
- Itziar Familiar
- Department of Psychiatry, Michigan State University, 965 Fee Road, East Fee Hall A227, Lansing MI 48824
| | - Noeline Nakasujja
- Department of Psychiatry, Makerere University College of Health Sciences, Box 7072, Kampala, Uganda
| | - Judith Bass
- Mental Health Department, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway Street, Hampton House Room 861, Baltimore MD 21205
| | - Alla Sikorskii
- Department of Statistics and Probability, Michigan State University, 619 Red Cedar Rd., Wells Hall C423, Lansing MI 48824
| | - Sarah Murray
- Mental Health Department, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway Street, Hampton House Room 861, Baltimore MD 21205
| | - Horacio Ruisenor-Escudero
- Department of Psychiatry, Michigan State University, 965 Fee Road, East Fee Hall A227, Lansing MI 48824
| | - Paul Bangirana
- Department of Psychiatry, Makerere University College of Health Sciences, Box 7072, Kampala, Uganda
| | - Robert Opoka
- Department of Pediatrics and Child Health, College of Health Sciences, Makerere University PO Box 7072, Kampala, Uganda
| | - Michael J. Boivin
- Department of Psychiatry, Michigan State University, 965 Fee Road, East Fee Hall A227, Lansing MI 48824
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Familiar I, Hall B, Bundervoet T, Verwimp P, Bass J. Exploring Psychological Distress in Burundi During and After the Armed Conflict. Community Ment Health J 2016; 52:32-8. [PMID: 26100013 DOI: 10.1007/s10597-015-9902-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 06/13/2015] [Indexed: 11/26/2022]
Abstract
We assessed symptoms of psychological distress among a population-based sample of 9000-plus adults in Burundi during (1998) and after (2007) armed conflict. After exploratory and confirmatory factor analysis to an 8-item, self-report measure, we identified two domains of psychological distress "Depression/Anxiety" and "Functioning" with good fit to data. The questionnaire was invariant in males and females. Depression and Anxiety symptoms during conflict were more frequently reported than Functioning symptoms; all symptoms were more frequently reported by women. Psychological distress was found in 44 % of individuals during conflict and in 29 % 2 years after the conflict. Results call for further research in Burundi that can inform the development of mental health interventions.
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Affiliation(s)
- Itziar Familiar
- Department of Psychiatry, Michigan State University, 965 Fee Road, East Fee Hall, A227, East Lansing, MI, 48824, USA.
| | - Brian Hall
- Global and Community Mental Health Research Group, Department of Psychology, University of Macau, Macau, People's Republic of China
| | | | - Philip Verwimp
- ECARES and Center Emile Bernheim, Solvay Brussels School of Economic and Management, Universite Libre de Bruxeles, Brussels, Belgium
| | - Judith Bass
- Mental Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Ruiseñor-Escudero H, Familiar I, Nakasujja N, Bangirana P, Opoka R, Giordani B, Boivin M. Immunological correlates of behavioral problems in school-aged children living with HIV in Kayunga, Uganda. Glob Ment Health (Camb) 2015; 2:e9. [PMID: 28596857 PMCID: PMC5269635 DOI: 10.1017/gmh.2015.7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 02/18/2015] [Accepted: 04/15/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND HIV can affect the neuropsychological function of children, including their behavior. We aim to identify immunological correlates of behavioral problems among children living with HIV in Uganda. METHODS Children participating in a parent randomized control trial in Kayunga, Uganda were assessed with the Behavior Rating Inventory of Executive Function (BRIEF) and the Child Behavior Checklist (CBCL). We constructed simple and multiple linear regression models to identify immunological correlates of behavioral problems. RESULTS A total of 144 children living with HIV (50% male) with a mean age of 8.9 years [Standard Deviation (s.d.) = 1.9] were included in the analysis. Eighty-two children were on antiretroviral therapy. Mean CD4 cell count % was 35.1 cells/μl (s.d. = 15.0), mean CD4 cell activation 5.7% (s.d. = 5.1), mean CD8 cell activation was 17.5% (s.d. = 11.2) and 60 children (41.7%) had a viral load of <4000 copies/ml. In the adjusted models for the BRIEF, higher scores were associated with higher viral loads (aβ = 16.7 × 10-6, 95% CI -5.00 × 10-6 to 28.4 × 10-6), specifically on the behavioral regulation index. Higher mean CD8 activation % was associated with higher scores on the Externalizing Problems and Total Problems scales of the CBCL (aβ = 0.17, 95% CI 0.04-0.31 and aβ = 0.15, 95% CI 0.00-0.28, respectively). CONCLUSIONS Poorer behavioral outcomes were associated with higher viral loads while higher CD8 activation was associated with poorer emotional and behavioral outcomes. Complete immunological assessments for children living with HIV could include commonly used viral and immunological parameters to identify those at higher risk of having negative behavior outcomes and who would benefit the most from behavioral interventions.
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Affiliation(s)
- H. Ruiseñor-Escudero
- Department of Psychiatry, East Lansing, Michigan State University, Michigan, USA
| | - I. Familiar
- Department of Psychiatry, East Lansing, Michigan State University, Michigan, USA
| | - N. Nakasujja
- Department of Psychiatry, Makerere University, Kampala, Uganda
| | - P. Bangirana
- Department of Psychiatry, Makerere University, Kampala, Uganda
| | - R. Opoka
- Department of Psychiatry, Makerere University, Kampala, Uganda
| | - B. Giordani
- Department of Psychiatry, University of Michigan, Michigan, USA
| | - M. Boivin
- Department of Psychiatry, East Lansing, Michigan State University, Michigan, USA
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Burkey MD, Murray SM, Bangirana P, Familiar I, Opoka RO, Nakasujja N, Boivin M, Bass J. Executive function and attention-deficit/hyperactivity disorder in Ugandan children with perinatal HIV exposure. Glob Ment Health (Camb) 2015; 2:e4. [PMID: 28596852 PMCID: PMC5269636 DOI: 10.1017/gmh.2015.2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 02/09/2015] [Accepted: 02/11/2015] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is among the most commonly diagnosed mental disorders in childhood and is associated with substantial deficits in executive functioning and lost academic and occupational attainment. This study evaluates symptoms of ADHD and their association with neurocognitive deficits in a cohort of rural Ugandan children who were born to HIV-infected mothers. METHODS We assessed ADHD symptoms and executive function (including memory and attention) in a non-clinical sample of children born to HIV-infected mothers in rural eastern Uganda. Analyses included assessments of the psychometric properties, factor structure, and convergent and discriminant validity of the ADHD measure (ADHD-Rating Scale-IV); and executive function deficits in children meeting symptom criteria for ADHD. RESULTS 232 children [54% female; mean age 7.8 years (s.d. 2.0)] were assessed for ADHD and executive function deficits. The ADHD measure showed good internal consistency (α = 0.85.) Confirmatory factor analysis showed an acceptable fit for the diagnostic and statistical manual of mental disorders (DSM-5) two-factor model. Subjects meeting DSM-5 symptom criteria for ADHD had worse parent-rated executive function on six out of seven subscales. CONCLUSIONS Our results demonstrate structural validity of the ADHD measure with this population, strong associations between ADHD symptom severity and poorer executive function, and higher levels of executive function problems in perinatally HIV-exposed Ugandan children with ADHD. These findings suggest that ADHD may be an important neurocognitive disorder associated with executive function problems among children in sub-Saharan African settings where perinatal HIV exposure is common.
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Affiliation(s)
- M. D. Burkey
- Division of Child and Adolescent Psychiatry, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - S. M. Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - P. Bangirana
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - I. Familiar
- Department of Psychiatry, Michigan State University, East Lansing, Michigan, USA
| | - R. O. Opoka
- Department of Pediatrics, Mulago Hospital/Makerere University College of Health Sciences, Kampala, Uganda
| | - N. Nakasujja
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - M. Boivin
- Department of Psychiatry, Michigan State University, East Lansing, Michigan, USA
- Department of Neurology and Ophthalmology, Michigan State University, East Lansing, Michigan, USA
| | - J.K. Bass
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Familiar I, Ruisenor-Escudero H, Giordani B, Bangirana P, Nakasujja N, Opoka R, Boivin M. Use of the Behavior Rating Inventory of Executive Function and Child Behavior Checklist in Ugandan Children with HIV or a History of Severe Malaria. J Dev Behav Pediatr 2015; 36:277-84. [PMID: 25738440 PMCID: PMC4414719 DOI: 10.1097/dbp.0000000000000149] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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: 11/25/2022]
Abstract
OBJECTIVE To assess the structural overlap between the Behavior Rating Inventory of Executive Function (BRIEF) and Achenbach Child Behavior Checklist (CBCL) among children in Uganda. METHODS Caregiver ratings for the BRIEF and CBCL were obtained for 2 independent samples of school-aged children: 106 children (5-12 years old, 50% males) with a history of severe malaria and on 144 HIV-infected children (5-12 years old, 58% males) in Uganda. Exploratory factor analysis was used to evaluate the factor structure of the 8 subscales for the BRIEF and the 8 scales of the CBCL to determine correlation. RESULTS Overall, children in the severe malaria group had higher (increased symptom) BRIEF and CBCL scores than those in the HIV-infected group. Three factors that provided a reasonable fit to the data and could be characterized as 3 specific domains were identified: (1) Metacognition, which consisted of the scales in the BRIEF Metacognition domain, (2) Behavioral Adjustment, which comprised of the scales in the BRIEF Behavioral Regulation domain and the Externalizing Symptoms scales in the CBCL, and (3) Emotional Adjustment, which mainly consisted of the Internalizing Symptoms scales in the CBCL. The BRIEF Behavior Regulation and CBCL Externalizing Symptoms scales, however, did overlap in terms of assessing similar behavior symptoms. These findings were consistent across the severe malaria and HIV-infected samples of children. CONCLUSION The BRIEF and CBCL instruments offer distinct, yet complementary, assessments of behavior in clinical pediatric populations in the Ugandan context, supporting the use of these measures for similar research settings.
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Affiliation(s)
- Itziar Familiar
- *Department of Psychiatry, Michigan State University, Lansing, MI; †Departments of Psychiatry, Neurology, and Psychology, University of Michigan, Ann Arbor, MI; ‡Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda; §Department of Pediatrics and Child Health, Makerere University College of Health Sciences, Makerere University, Kampala, Uganda
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Familiar I, Ortiz-Panozo E, Hall B, Vieitez I, Romieu I, Lopez-Ridaura R, Lajous M. Factor structure of the Spanish version of the Patient Health Questionnaire-9 in Mexican women. Int J Methods Psychiatr Res 2015; 24:74-82. [PMID: 25524806 PMCID: PMC6878506 DOI: 10.1002/mpr.1461] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [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: 01/16/2014] [Revised: 03/05/2014] [Accepted: 05/08/2014] [Indexed: 01/30/2023] Open
Abstract
Structure of the Spanish version of the nine-item Patient Health Questionnaire (PHQ-9) has been inconclusive. We report the factor structure of the PHQ-9 in 55,555 women from the Mexican Teachers' Cohort (MTC). Factor structure of the PHQ-9 was assessed by exploratory and confirmatory factor analyses in two sub-samples (n = 27,778 and 27,777 respectively). A one-factor model of the PHQ-9 was the solution with the best fit to the data, exhibiting strong factor loadings (0.71 to 0.90) and high internal consistency (Cronbach's alpha = 0.89). A prevalence rate of moderate to high severity of depressive symptoms of 12.6% was identified. Results suggest that a global score is an appropriate measure of depressive symptoms and commend the use of the Spanish PHQ-9 as a measure of depression for research and clinical purposes.
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Affiliation(s)
- Itziar Familiar
- Department of Psychiatry, Michigan State University, Lansing, MI, USA
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Familiar I, Murray L, Gross A, Skavenski S, Jere E, Bass J. Posttraumatic stress symptoms and structure among orphan and vulnerable children and adolescents in Zambia. Child Adolesc Ment Health 2014; 19:235-242. [PMID: 25382359 PMCID: PMC4219598 DOI: 10.1111/camh.12050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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] [Accepted: 10/10/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Scant information exists on posttraumatic stress disorder (PTSD) symptoms and structure in youth from developing countries. METHODS We describe the symptom profile and exposure to trauma experiences among 343 orphan and vulnerable children and adolescents from Zambia. We distinguished profiles of posttraumatic stress symptoms using latent class analysis. RESULTS Average number of trauma-related symptoms (21.6; range 0-38) was similar across sex and age. Latent class model suggested three classes varying by level of severity: low (31% of the sample), medium (45% of the sample), and high (24% of the sample) symptomatology. CONCLUSIONS Results suggest that PTSD is a continuously distributed latent trait.
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Affiliation(s)
- Itziar Familiar
- Johns Hopkins School of Public Health, Mental Health, Room 811, 624 N. Broadway ST, Baltimore, MD, 21205, USA
| | - Laura Murray
- Johns Hopkins School of Public Health, Mental Health, Room 811, 624 N. Broadway ST, Baltimore, MD, 21205, USA
| | - Alden Gross
- Harvard Medical School, Institute for Aging Research, Boston, MA, USA
| | - Stephanie Skavenski
- Johns Hopkins School of Public Health, Mental Health, Room 811, 624 N. Broadway ST, Baltimore, MD, 21205, USA
| | | | - Judith Bass
- Johns Hopkins School of Public Health, Mental Health, Room 811, 624 N. Broadway ST, Baltimore, MD, 21205, USA
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Murray LK, Skavenski S, Michalopoulos LM, Bolton PA, Bass JK, Familiar I, Imasiku M, Cohen J. Counselor and client perspectives of Trauma-focused Cognitive Behavioral Therapy for children in Zambia: a qualitative study. J Clin Child Adolesc Psychol 2014; 43:902-14. [PMID: 24400677 PMCID: PMC4087094 DOI: 10.1080/15374416.2013.859079] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This study examined Zambian counselors, children, and caregivers' perceptions of an evidence-based treatment (EBT) for trauma (Trauma-Focused Cognitive Behavioral Therapy [TF-CBT]) utilized in Zambia to address mental health problems in children. Semistructured interviews were conducted with local counselors trained in TF-CBT (N = 19; 90% of those trained; 12 female) and children/caregivers who had received TF-CBT in a small feasibility study (N = 18; 86% of the children and N = 16; 76% of the caregivers) who completed TF-CBT (total completed; N = 21). Each client was asked six open-ended questions, and domain analysis was used to explore the data. Counselors were positive about the program, liked the structure and flexibility, reported positive changes in their clients, and discussed the cultural adaptation around activities and language. Counselors stated the training was too short, and the supervision was necessary. Challenges included client engagement and attendance, availability of location, funding, and a lack of community understanding of "therapy." Children and caregivers stated multiple positive changes they attributed to TF-CBT, such as better family communication, reduction of problem behaviors, and ability to speak about the trauma. They recommended continuing the program. This study brings a critical examination of providers' and clients' perspectives of the implementation of an EBT for children in a low-resource setting. Clinical implications include changing implementation methods based on responses. Research implications include future study directions such as an effectiveness trial of TF-CBT and an examination of implementation factors.
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Affiliation(s)
- Laura K Murray
- a Department of Mental Health , Johns Hopkins University Bloomberg School of Public Health
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Murray LK, Familiar I, Skavenski S, Jere E, Cohen J, Imasiku M, Mayeya J, Bass JK, Bolton P. An evaluation of trauma focused cognitive behavioral therapy for children in Zambia. Child Abuse Negl 2013; 37:1175-85. [PMID: 23768939 PMCID: PMC3823750 DOI: 10.1016/j.chiabu.2013.04.017] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 04/17/2013] [Accepted: 04/23/2013] [Indexed: 05/31/2023]
Abstract
To monitor and evaluate the feasibility of implementing Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) to address trauma and stress-related symptoms in orphans and vulnerable children (OVC) in Zambia as part of ongoing programming within a non-governmental organization (NGO). As part of ongoing programming, voluntary care-workers administered locally validated assessments to identify children who met criteria for moderate to severe trauma symptomatology. Local lay counselors implemented TF-CBT with identified families, while participating in ongoing supervision. Fifty-eight children and adolescents aged 5-18 completed the TF-CBT treatment, with pre- and post-assessments. The mean number of traumas reported by the treatment completers (N=58) was 4.11. Post assessments showed significant reductions in severity of trauma symptoms (p<0.0001), and severity of shame symptoms (p<0.0001). Our results suggest that TF-CBT is a feasible treatment option in Zambia for OVC. A decrease in symptoms suggests that a controlled trial is warranted. Implementation factors monitored suggest that it is feasible to integrate and evaluate evidence-based mental health assessments and intervention into programmatic services run by an NGO in low/middle resource countries. Results also support the effectiveness of implementation strategies such as task shifting, and the Apprenticeship Model of training and supervision.
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Affiliation(s)
- Laura K Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Hampton House, 8th Floor, 624 N. Broadway, Baltimore, MD, 21205, ; ; ;
| | - Itziar Familiar
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Hampton House, 8th Floor, 624 N. Broadway, Baltimore, MD, 21205, ; ; ;
| | - Stephanie Skavenski
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Hampton House, 8th Floor, 624 N. Broadway, Baltimore, MD, 21205, ; ; ;
| | - Elizabeth Jere
- Catholic Relief Services, Zambia, Longolongo Rd. Lusaka, Zambia 10101,
| | - Judy Cohen
- Drexel University College of Medicine, Allegheny General Hospital, Department of Psychiatry, Four Allegheny Center, 8th Floor, Pittsburgh, PA 15212, USA,
| | | | - John Mayeya
- Ministry of Health, City Airport Road, Lusaka, ZAMBIA
| | - Judith K Bass
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Hampton House, 8th Floor, 624 N. Broadway, Baltimore, MD, 21205, ; ; ;
| | - Paul Bolton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, 8 Floor, Baltimore, MD 21205
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Familiar I, Sharma S, Ndayisaba H, Munyentwari N, Sibomana S, Bass JK. Community perceptions of mental distress in a post-conflict setting: a qualitative study in Burundi. Glob Public Health 2013; 8:943-57. [PMID: 23941217 DOI: 10.1080/17441692.2013.819587] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
There is scant documentation of the mental health characteristics of low-income communities recovering from armed conflict. To prepare for quantitative health surveys and health service planning in Burundi, we implemented a qualitative study to explore concepts related to mental distress and coping among adults. Mental distress was defined as problems related to feelings, thinking, behaviour and physical stress. Using free listing and key informant interviews with a range of community members, we triangulated data to identify salient issues. Thirty-eight free list respondents and 23 key informants were interviewed in 5 rural communities in Burundi using 2 interview guides from the WHO Toolkit for Mental Health Assessment in Humanitarian Settings. Based on these interviews, we identified four locally defined idioms/terms relating to mental distress: ihahamuka (anxiety spectrum illnesses), ukutiyemera (a mix of depression and anxiety-like syndrome), akabonge (depression/grief-like syndrome) and kwamana ubwoba burengeje (anxiety-like syndrome). Mental distress terms were perceived as important problems impacting community development. Affected individuals sought help from several sources within the community, including community leaders and traditional healers. We discuss how local expressions of distress can be used to tailor health research and service integration from the bottom up.
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Affiliation(s)
- Itziar Familiar
- a Department of Mental Health, Johns Hopkins Bloomberg School of Public Health , Johns Hopkins University , Baltimore , MD , USA
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Familiar I, Borges G, Orozco R, Medina-Mora ME. Mexican migration experiences to the US and risk for anxiety and depressive symptoms. J Affect Disord 2011; 130:83-91. [PMID: 20934221 DOI: 10.1016/j.jad.2010.09.025] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Accepted: 09/19/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Scant and contradictory information prevails on the risk for common psychiatric disorders in Mexican immigrants to the United States (US). Extension of these results in larger samples is needed to better address treatment needs. This study investigates the association between migration to the US and development of depressive and anxiety symptoms in four urban areas of Mexico. METHODS A cross-sectional survey in 2005 of individuals ages 12-65 from four cities formed a representative sample. Immigration-related experiences and prevalence of depressive and anxiety symptoms were recorded. Respondents were classified into three groups: (i) 'return migrants', (ii) 'relatives of migrants' and (iii) 'non-migrants' in the general population. Depression symptoms were assessed with the Center for Epidemiologic Studies Depression Scale (CES-D) and anxiety was determined using the Beck Anxiety Inventory (BAI). Prevalence of depressive and anxiety symptoms were estimated as the proportion of the entire sample reporting the outcome. Crude and adjusted OR's were estimated in logistic regression models. RESULTS A total of 1630 respondents, represent a 70.5% response rate. Overall prevalence of depressive and anxiety symptoms were both approximately 16%. Increased risk for depressive symptoms (OR=1.49 CI 95%=1.01-2.20) among return migrants and depressive (OR=1.48, CI 95%=1.07-2.05) and anxiety symptoms (OR=1.38, CI 95%=1.08-1.78) in relatives of migrants was found in comparison to those without a migration experience. LIMITATIONS Specific age and timing of migration experiences were not recorded. CONCLUSIONS Migration experiences produce important levels of anxiety and depressive symptoms that could be linked to psychopathology.
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Affiliation(s)
- Itziar Familiar
- Mental Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
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Rasmussen A, Alonso E, Ochoa A, De Biase I, Familiar I, Yescas P, Sosa AL, Rodríguez Y, Chávez M, López-López M, Bidichandani SI. Uptake of genetic testing and long-term tumor surveillance in von Hippel-Lindau disease. BMC Med Genet 2010; 11:4. [PMID: 20064270 PMCID: PMC2822817 DOI: 10.1186/1471-2350-11-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Accepted: 01/12/2010] [Indexed: 11/10/2022]
Abstract
BACKGROUND von Hippel-Lindau (VHL) disease is a hereditary cancer syndrome caused by germline mutations in the VHL gene. Patients have significant morbidity and mortality secondary to vascular tumors. Disease management is centered on tumor surveillance that allows early detection and treatment. Presymptomatic genetic testing is therefore recommended, including in at-risk children. METHODS We tested 17 families (n = 109 individuals) for VHL mutations including 43 children under the age of 18. Personalized genetic counseling was provided pre and post-test and the individuals undergoing presymptomatic testing filled out questionnaires gathering socio-demographic, psychological and psychiatric data. Mutation analysis was performed by direct sequencing of the VHL gene. Mutation-carriers were screened for VHL disease-related tumors and were offered follow-up annual examinations. RESULTS Mutations were identified in 36 patients, 17 of whom were asymptomatic. In the initial screening, we identified at least one tumor in five of 17 previously asymptomatic individuals. At the end of five years, only 38.9% of the mutation-carriers continued participating in our tumor surveillance program. During this time, 14 mutation carriers developed a total of 32 new tumors, three of whom died of complications. Gender, education, income, marital status and religiosity were not found to be associated with adherence to the surveillance protocol. Follow-up adherence was also independent of pre-test depression, severity of disease, or number of affected family members. The only statistically significant predictor of adherence was being symptomatic at the time of testing (OR = 5; 95% CI 1.2 - 20.3; p = 0.02). Pre-test anxiety was more commonly observed in patients that discontinued follow-up (64.7% vs. 35.3%; p = 0.01). CONCLUSIONS The high initial uptake rate of genetic testing for VHL disease, including in minors, allowed the discontinuation of unnecessary screening procedures in non mutation-carriers. However, mutation-carriers showed poor adherence to long-term tumor surveillance. Therefore, many of them did not obtain the full benefit of early detection and treatment, which is central to the reduction of morbidity and mortality in VHL disease. Studies designed to improve adherence to vigilance protocols will be necessary to improve treatment and quality of life in patients with hereditary cancer syndromes.
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Affiliation(s)
- Astrid Rasmussen
- Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Neurogenetics and Molecular Biology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, D.F., Mexico
| | - Elisa Alonso
- Department of Neurogenetics and Molecular Biology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, D.F., Mexico
| | - Adriana Ochoa
- Department of Neurogenetics and Molecular Biology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, D.F., Mexico
| | - Irene De Biase
- Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Itziar Familiar
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Petra Yescas
- Department of Neurogenetics and Molecular Biology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, D.F., Mexico
| | - Ana-Luisa Sosa
- Division of Psychiatry, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, D.F., Mexico
| | - Yaneth Rodríguez
- Department of Neuropsychology and Support Groups, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, D.F., Mexico
| | - Mireya Chávez
- Department of Neuropsychology and Support Groups, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, D.F., Mexico
| | - Marisol López-López
- Department of Biological Systems, Division of Biological and Health Sciences, Universidad Autónoma Metropolitana-Xochimilco, Mexico City, Mexico
| | - Sanjay I Bidichandani
- Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Alonso ME, Ochoa A, Boll MC, Sosa AL, Yescas P, López M, Macias R, Familiar I, Rasmussen A. Clinical and genetic characteristics of Mexican Huntington's disease patients. Mov Disord 2010; 24:2012-5. [PMID: 19672992 DOI: 10.1002/mds.22737] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We report the characteristics of 691 Mexican patients with Huntington's disease (HD). These patients, representing 401 families, constitute the largest series of Mexican HD cases as yet described in the literature. We found the clinical characteristics of these patients to be similar to those of other populations, but we observed a higher frequency of infantile cases, a shorter disease duration and a lower suicide rate. In 626 cases, for which molecular analyses were available, CAG-trinucleotide expansion size ranged from 37-106 repeats. The large number of CAG repeats (19.04 +/- 3.02) in normal alleles and the presence of new mutations suggest that the overall prevalence of HD in the Mexican population could be expected to be within range of, or higher than, that reported for Europeans.
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Affiliation(s)
- María Elisa Alonso
- Department of Neurogenetics and Molecular Biology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Insurgentes Sur 3877, Col. La Fama, Tlalpan, 14269 Mexico, D. F., Mexico.
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Borges G, Benjet C, Medina-Mora ME, Orozco R, Familiar I, Nock MK, Wang PS. Service use among Mexico City adolescents with suicidality. J Affect Disord 2010; 120:32-9. [PMID: 19411113 PMCID: PMC2795075 DOI: 10.1016/j.jad.2009.04.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [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: 04/07/2008] [Revised: 03/31/2009] [Accepted: 04/07/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND We report the lifetime and 12-month prevalence and associations of mental health treatment among Mexican adolescents with suicide-related outcomes (SROs; including ideation, plans, gestures and attempts). METHODS A representative multistage probability household survey of 3005 adolescents aged 12 to 17 years residing in the Mexico City Metropolitan Area was carried out in 2005. Discrete-time survival analyses were used to assess the relationships between SROs and receiving treatment for emotional, alcohol, or drug problems. RESULTS The prevalence of lifetime service use among respondents with SROs was 35% for those with ideation only, 44% for those with ideation and plan, 49% for those with gesture and 50% for those with attempt; the prevalence of 12-month service use was 10%, 24%, 6% and 21%, respectively. Timing between onset of SRO and receiving treatment for emotional, alcohol, or drug problems showed that about 50% of adolescents will have contact with a service provider before developing any SRO. Healthcare professionals were the most likely to be consulted, followed by school-based programs. LIMITATIONS This survey was limited to adolescents living in one of the largest metropolitan areas in the world and the analyses used data on retrospectively reported ages of onset that are subject to recall errors. CONCLUSIONS Most suicidal adolescents do not receive treatment, and many adolescents develop their suicidality in spite of prior contacts with service providers. Interventions to increase treatment, prevention, and monitoring are sorely needed for this vulnerable population.
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López M, Guerrero J, Yescas P, Boll MC, Familiar I, Ochoa A, Rasmussen A, Alonso ME. Apolipoprotein E epsilon4 allele is associated with Parkinson disease risk in a Mexican Mestizo population. Mov Disord 2007; 22:417-20. [PMID: 17230455 DOI: 10.1002/mds.21340] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
We investigated the association between apolipoprotein E (APOE) alleles and genotypes and Parkinson disease (PD) in 229 unrelated Mexican Mestizo PD patients and 229 controls. Results showed that both APOE-epsilon4 allele and APOE epsilon4/epsilon3 genotype are associated with PD (OR = 1.736, P = 0.011; OR = 1.688, P = 0.019, respectively). Mean age at onset of PD was not associated to any APOE allele or genotype, but was significantly earlier in familial PD when compared to sporadic cases (P = 0.025).
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Affiliation(s)
- Marisol López
- Department of Biological Systems, Universidad Autónoma Metropolitana Xochimilco, Mexico City, Mexico
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