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Wainberg ML, Gouveia L, McKinnon K. Generating better implementation evidence to improve mental health care everywhere. Lancet Psychiatry 2024; 11:317-319. [PMID: 38552664 DOI: 10.1016/s2215-0366(24)00090-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 03/04/2024] [Indexed: 04/19/2024]
Affiliation(s)
- Milton L Wainberg
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and New York State Psychiatric Institute, New York, NY 10032, USA.
| | | | - Karen McKinnon
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and New York State Psychiatric Institute, New York, NY 10032, USA
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Yimsaard P, Mootz JJ, Rungnirundorn T, Janamnuaysook R, Samitpol K, Phanuphak N, Wainberg ML. Assessing the acceptability of implementing a Screening, Brief Intervention and Referral to Treatment for alcohol use among transgender women in Bangkok, Thailand: A mixed-method pre-implementation study using the Consolidated Framework for Implementation Research. Addiction 2024; 119:863-874. [PMID: 38168887 PMCID: PMC11009091 DOI: 10.1111/add.16423] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/19/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND AND AIMS Health inequities related to alcohol use exist for transgender individuals. While the Thailand Ministry of Public Health recently published a clinical guideline to implement a Screening, Brief Intervention and Referral to Treatment (SBIRT) in primary care, there has been no study regarding transgender women's (TGW) alcohol use and the acceptability of implementing SBIRT in a Thai context, a gap this study aimed to fill. DESIGN A mixed-method approach was used. In the first phase, TGW service users and health-care providers (HCPs) completed a survey on the acceptability of prospective implementation of SBIRT. TGW service users completed the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C). In the second phase, TGW service users, HCPs, clinic administrators and national-level alcohol, HIV and transgender health policymakers participated in in-depth qualitative interviews. SETTING The Tangerine Clinic, a transgender-led sexual health clinic in Bangkok, Thailand. PARTICIPANTS In the first phase, TGW service users (n = 100) and HCP (n = 8) were surveyed. In the second phase, 22 stakeholders (n = 10 TGW service users; n = 8 HCP; n = 1 clinic administrator; n = 3 policymakers) were interviewed. MEASUREMENTS Simple proportions were calculated for each survey item. Differences in acceptability by various demographic factors were calculated using univariate analysis. The qualitative data were coded using thematic analysis and a deductive approach. The results were mapped to the Consolidated Framework for Implementation Research domains and constructs. The quantitative and qualitative results were triangulated to expand understanding. FINDINGS Fifty per cent of the TGW participants exhibited problematic drinking levels (AUDIT-C ≥ 4). Implementing SBIRT was highly acceptable, as more than 95% of participants reported agreeing or completely agreeing to receive SBIRT for alcohol use. Barriers, such as complexity, time constraint and lack of knowledge and skills, were anticipated. Adaptability, such as tailoring the content of brief intervention to suit TGW health needs and SBIRT to fit with existing clinic procedures, might facilitate successful implementation. CONCLUSION Screening, Brief Intervention and Referral to Treatment (SBIRT) for alcohol use has the potential to be successfully implemented in transgender-led sexual health clinic settings, with some adaptations to overcome anticipated barriers.
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Affiliation(s)
- Pongkwan Yimsaard
- Department of Psychiatry, King Chulalongkorn Memorial Hospital Thai Red Cross Society, Bangkok, Thailand
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jennifer J. Mootz
- Columbia University Department of Psychiatry, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Teerayuth Rungnirundorn
- Department of Psychiatry, King Chulalongkorn Memorial Hospital Thai Red Cross Society, Bangkok, Thailand
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Rena Janamnuaysook
- Institute of HIV Research and Innovation, Bangkok, Thailand
- Center of Excellence in Transgender Health, Chulalongkorn University, Bangkok, Thailand
| | - Kritima Samitpol
- Institute of HIV Research and Innovation, Bangkok, Thailand
- Center of Excellence in Transgender Health, Chulalongkorn University, Bangkok, Thailand
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Grimes KEL, Ebasone PV, Dzudie A, Nash D, Wainberg ML, Pence BW, Barrington C, Pefura E, Yotebieng M, Anastos K, Nsame D, Ajeh R, Nyenti A, Parcesepe AM. Factors influencing integration of mental health screening and treatment at HIV clinic settings in Cameroon: a qualitative study of health providers' perspectives. BMC Health Serv Res 2024; 24:519. [PMID: 38658992 PMCID: PMC11044447 DOI: 10.1186/s12913-024-10775-w] [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] [Received: 05/31/2023] [Accepted: 02/23/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Mental disorders are common among people with HIV (PWH) and are associated with poor HIV outcomes. Despite high unmet mental health needs among PWH, use of evidence-based mental health screening and treatment protocols remains limited at HIV treatment facilities across low-resource settings. Integrating mental health services into HIV care can reduce this gap. This study's objective was to explore factors that influence integration of mental health screening and treatment into HIV clinics in Cameroon. METHODS We analyzed 14 in-depth interviews with clinic staff supporting PWH at three urban HIV treatment clinics in Cameroon. Interviews focused on current processes, barriers and facilitators, and types of support needed to integrate mental health care into HIV care. Interviews were recorded and transcribed. French transcripts were translated into English. We used thematic analysis to identify factors that influence integration of mental health screening and treatment into HIV care in these settings. Ethical review boards in the United States and Cameroon approved this study. RESULTS Respondents discussed a lack of standardized mental health screening processes in HIV treatment facilities and generally felt ill-equipped to conduct mental health screening. Low community awareness about mental disorders, mental health-related stigma, limited physical space, and high clinic volume affected providers' ability to screen clients for mental disorders. Providers indicated that better coordination and communication were needed to support client referral to mental health care. Despite these barriers, providers were motivated to screen clients for mental disorders and believed that mental health service provision could improve quality of HIV care and treatment outcomes. All providers interviewed said they would feel more confident screening for mental disorders with additional training and resources. Providers recommended community sensitization, training or hiring additional staff, improved coordination to manage referrals, and leadership buy-in at multiple levels of the health system to support sustainable integration of mental health screening and treatment into HIV clinics in Cameroon. CONCLUSIONS Providers reported enthusiasm to integrate mental health services into HIV care but need more support and training to do so in an effective and sustainable manner.
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Affiliation(s)
- Kathryn E L Grimes
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaoundé, Cameroon
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
| | - Milton L Wainberg
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York, NY, USA
| | - Brian W Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Marcel Yotebieng
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Denis Nsame
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaoundé, Cameroon
| | | | - Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Fernández Capriles I, Armijos A, Angulo A, Schojan M, Wainberg ML, Bonz AG, Tol WA, Greene MC. Improving Retention in Mental Health and Psychosocial Support Interventions: An Analysis of Completion Rates across a Multi-Site Trial with Refugee, Migrant, and Host Communities in Latin America. Int J Environ Res Public Health 2024; 21:397. [PMID: 38673310 PMCID: PMC11049853 DOI: 10.3390/ijerph21040397] [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] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/15/2024] [Accepted: 03/20/2024] [Indexed: 04/28/2024]
Abstract
Research on mental health and psychosocial support (MHPSS) interventions within refugee and migrant communities has increasingly focused on evaluating implementation, including identifying strategies to promote retention in services. This study examines the relationship between participant characteristics, study setting, and reasons for intervention noncompletion using data from the Entre Nosotras feasibility trial, a community-based MHPSS intervention targeting refugee, migrant, and host community women in Ecuador and Panama that aimed to promote psychosocial wellbeing. Among 225 enrolled women, approximately half completed the intervention, with varying completion rates and reasons for nonattendance across study sites. Participants who were older, had migrated for family reasons, had spent more time in the study community, and were living in Panamá (vs. Ecuador) were more likely to complete the intervention. The findings suggest the need to adapt MHPSS interventions to consider the duration of access to the target population and explore different delivery modalities including the role of technology and cellular devices as reliable or unreliable source for engaging with participants. Engaging younger, newly arrived women is crucial, as they showed lower completion rates. Strategies such as consulting scheduling preferences, providing on-site childcare, and integrating MHPSS interventions with other programs could enhance intervention attendance.
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Affiliation(s)
- Isabella Fernández Capriles
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY 10032, USA;
| | | | | | | | - Milton L. Wainberg
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY 10032, USA;
| | - Annie G. Bonz
- HIAS, Silver Spring, MD 20910, USA; (M.S.); (A.G.B.)
| | - Wietse A. Tol
- Global Health Section, Department of Public Health, University of Copenhagen, 1172 Copenhagen, Denmark;
- Athena Research Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - M. Claire Greene
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY 10032, USA;
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Giusto A, Jack HE, Magidson JF, Ayuku D, Johnson S, Lovero K, Hankerson SH, Sweetland AC, Myers B, Fortunato Dos Santos P, Puffer ES, Wainberg ML. Global Is Local: Leveraging Global Mental-Health Methods to Promote Equity and Address Disparities in the United States. Clin Psychol Sci 2024; 12:270-289. [PMID: 38529071 PMCID: PMC10962902 DOI: 10.1177/21677026221125715] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Structural barriers perpetuate mental health disparities for minoritized US populations; global mental health (GMH) takes an interdisciplinary approach to increasing mental health care access and relevance. Mutual capacity building partnerships between low and middle-income countries and high-income countries are beginning to use GMH strategies to address disparities across contexts. We highlight these partnerships and shared GMH strategies through a case series of said partnerships between Kenya-North Carolina, South Africa-Maryland, and Mozambique-New York. We analyzed case materials and narrative descriptions using document review. Shared strategies across cases included: qualitative formative work and partnership-building; selecting and adapting evidence-based interventions; prioritizing accessible, feasible delivery; task-sharing; tailoring training and supervision; and mixed-method, hybrid designs. Bidirectional learning between partners improved the use of strategies in both settings. Integrating GMH strategies into clinical science-and facilitating learning across settings-can improve efforts to expand care in ways that consider culture, context, and systems in low-resource settings.
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Affiliation(s)
- Ali Giusto
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY 10032, USA
| | - Helen E Jack
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA
| | - Jessica F Magidson
- Department of Psychology, University of Maryland, College Park, 1147B Biology-Psychology Building College Park, MD 20742
| | - David Ayuku
- Department of Mental Health and Behavioural Sciences, College of Health Sciences Moi University, P. O. Box 4606-30100, Eldoret, Kenya
| | - Savannah Johnson
- Department of Neuroscience and Psychology, Duke University. Duke Global Health Institute, Durham, NC, USA
| | - Kathryn Lovero
- Department of Clinical Sociomedical Sciences in Psychiatry, Columbia Mailman School of Public Health, New York, NY, USA
| | - Sidney H Hankerson
- Department of Population Health Sciences & Policy, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Annika C Sweetland
- Department of Psychiatry, Columbia Vagelos College of Physicians & Surgeons/New York State Psychiatric Institute, New York, NY 10032
| | - Bronwyn Myers
- Curtin enAble Institute, Faculty of Health Science, Curtin University, Perth, Australia; Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, South Africa
| | - Palmira Fortunato Dos Santos
- Department of Mental Health, Ministry of Health, Av. Eduardo Mondlane/Av. Salvador Allende P.O. Box 1613, Maputo, Mozambique
| | - Eve S Puffer
- Department of Neuroscience and Psychology, Duke University. Duke Global Health Institute, Durham, NC, USA
| | - Milton L Wainberg
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY 10032, USA
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Waller BY, Giusto A, Tepper M, Legros NC, Sweetland AC, Taffy A, Wainberg ML. Should We Trust You? Strategies to Improve Access to Mental Healthcare to BIPOC Communities During the COVID-19 Pandemic. Community Ment Health J 2024; 60:82-86. [PMID: 37133709 PMCID: PMC10155669 DOI: 10.1007/s10597-023-01124-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 03/25/2023] [Indexed: 05/04/2023]
Abstract
Black, Indigenous, and People of Color (BIPOC) communities have weathered centuries of racism, causing transgenerational mental health consequences and hindering access to quality treatment. In this commentary, we describe the systemic challenges of engaging BIPOC to promote mental health equity during the COVID-19 pandemic. We then describe an initiative that illustrates these strategies, provide recommendations and further readings for academic institutions seeking to partner with community organizations to provide equitable mental health services to populations that have been traditionally overlooked.
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Affiliation(s)
- Bernadine Y. Waller
- Department of Psychiatry, Columbia University Irving Medical Center/New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032 USA
| | - Ali Giusto
- Department of Psychiatry, Columbia University Irving Medical Center/New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032 USA
| | - Miriam Tepper
- Department of Psychiatry, Columbia University Irving Medical Center/New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032 USA
| | - Naomi C. Legros
- Division of Environmental Pediatrics, NYU Langone Health, 403 E. 34Th Street, New York, NY 10016 USA
| | - Annika C. Sweetland
- Department of Psychiatry and Public Health, Columbia University Vagelos College of Physicians & Surgeons/New York State Psychiatric Institute, Columbia Mailman School of Public Health, New York, NY 10032 USA
| | - Amanda Taffy
- Department of Psychiatry, Columbia University Irving Medical Center/New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032 USA
| | - Milton L. Wainberg
- Department of Psychiatry, Columbia University Irving Medical Center/New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032 USA
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Waller BY, Giusto A, Tepper M, Legros NC, Sweetland AC, Taffy A, Wainberg ML. Correction: Should We Trust You? Strategies to Improve Access to Mental Healthcare to BIPOC Communities During the COVID-19 Pandemic. Community Ment Health J 2024; 60:87. [PMID: 37249798 PMCID: PMC10227396 DOI: 10.1007/s10597-023-01144-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Bernadine Y. Waller
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032 USA
| | - Ali Giusto
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032 USA
| | - Miriam Tepper
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032 USA
| | - Naomi C. Legros
- Division of Environmental Pediatrics, NYU Langone Health, 403 E. 34Th Street, New York, NY 10016 USA
| | - Annika C. Sweetland
- Department of Psychiatry and Public Health, Columbia University Vagelos College of Physicians & Surgeons/New York State Psychiatric Institute, Columbia Mailman School of Public Health, New York, NY 10032 USA
| | - Amanda Taffy
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032 USA
| | - Milton L. Wainberg
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032 USA
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Mootz JJ, Chantre C, Sikkema K, Greene MC, Lovero KL, Gouveia L, Santos P, Suleman A, Comé AS, Feliciano P, Uribe-Restrepo JM, Sweetland AC, Shelton RC, Kane J, Mello M, Fumo W, Cadena-Camargo Y, Weissman M, Wainberg ML. Leveraging a Digitized Mental Wellness (DIGImw) Program to Provide Mental Health Care for Internally Displaced People. Psychiatr Serv 2024; 75:98-101. [PMID: 37461818 PMCID: PMC10794516 DOI: 10.1176/appi.ps.202100552] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2024]
Abstract
A local insurgency has displaced many people in the northern Mozambican province of Cabo Delgado. The authors' global team (comprising members from Brazil, Mozambique, South Africa, and the United States) has been scaling up mental health services across the neighboring province of Nampula, Mozambique, now host to >200,000 displaced people. The authors describe how mental health services can be expanded by leveraging digital technology and task-shifting (i.e., having nonspecialists deliver mental health care) to address the mental health needs of displaced people. These methods can serve as a model for other researchers and clinicians aiming to address mental health needs arising from humanitarian disasters in low-resource settings.
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Affiliation(s)
- Jennifer J Mootz
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Mootz, Sweetland, Mello, Weissman, Wainberg) Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven (Chantre, Sweetland); Departments of Sociomedical Sciences (Sikkema, Lovero, Shelton) and Epidemiology (Kane, Weissman), Mailman School of Public Health, Columbia University, New York City; Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City (Greene); Department of Mental Health, Ministry of Health, Maputo, Mozambique (Gouveia, Santos, Suleman, Comé, Feliciano, Fumo); Social and Preventive Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia (Uribe-Restrepo, Cadena-Camargo)
| | - Catherine Chantre
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Mootz, Sweetland, Mello, Weissman, Wainberg) Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven (Chantre, Sweetland); Departments of Sociomedical Sciences (Sikkema, Lovero, Shelton) and Epidemiology (Kane, Weissman), Mailman School of Public Health, Columbia University, New York City; Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City (Greene); Department of Mental Health, Ministry of Health, Maputo, Mozambique (Gouveia, Santos, Suleman, Comé, Feliciano, Fumo); Social and Preventive Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia (Uribe-Restrepo, Cadena-Camargo)
| | - Kathleen Sikkema
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Mootz, Sweetland, Mello, Weissman, Wainberg) Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven (Chantre, Sweetland); Departments of Sociomedical Sciences (Sikkema, Lovero, Shelton) and Epidemiology (Kane, Weissman), Mailman School of Public Health, Columbia University, New York City; Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City (Greene); Department of Mental Health, Ministry of Health, Maputo, Mozambique (Gouveia, Santos, Suleman, Comé, Feliciano, Fumo); Social and Preventive Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia (Uribe-Restrepo, Cadena-Camargo)
| | - M Claire Greene
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Mootz, Sweetland, Mello, Weissman, Wainberg) Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven (Chantre, Sweetland); Departments of Sociomedical Sciences (Sikkema, Lovero, Shelton) and Epidemiology (Kane, Weissman), Mailman School of Public Health, Columbia University, New York City; Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City (Greene); Department of Mental Health, Ministry of Health, Maputo, Mozambique (Gouveia, Santos, Suleman, Comé, Feliciano, Fumo); Social and Preventive Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia (Uribe-Restrepo, Cadena-Camargo)
| | - Kathryn L Lovero
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Mootz, Sweetland, Mello, Weissman, Wainberg) Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven (Chantre, Sweetland); Departments of Sociomedical Sciences (Sikkema, Lovero, Shelton) and Epidemiology (Kane, Weissman), Mailman School of Public Health, Columbia University, New York City; Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City (Greene); Department of Mental Health, Ministry of Health, Maputo, Mozambique (Gouveia, Santos, Suleman, Comé, Feliciano, Fumo); Social and Preventive Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia (Uribe-Restrepo, Cadena-Camargo)
| | - Lidia Gouveia
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Mootz, Sweetland, Mello, Weissman, Wainberg) Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven (Chantre, Sweetland); Departments of Sociomedical Sciences (Sikkema, Lovero, Shelton) and Epidemiology (Kane, Weissman), Mailman School of Public Health, Columbia University, New York City; Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City (Greene); Department of Mental Health, Ministry of Health, Maputo, Mozambique (Gouveia, Santos, Suleman, Comé, Feliciano, Fumo); Social and Preventive Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia (Uribe-Restrepo, Cadena-Camargo)
| | - Palmira Santos
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Mootz, Sweetland, Mello, Weissman, Wainberg) Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven (Chantre, Sweetland); Departments of Sociomedical Sciences (Sikkema, Lovero, Shelton) and Epidemiology (Kane, Weissman), Mailman School of Public Health, Columbia University, New York City; Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City (Greene); Department of Mental Health, Ministry of Health, Maputo, Mozambique (Gouveia, Santos, Suleman, Comé, Feliciano, Fumo); Social and Preventive Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia (Uribe-Restrepo, Cadena-Camargo)
| | - Antonio Suleman
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Mootz, Sweetland, Mello, Weissman, Wainberg) Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven (Chantre, Sweetland); Departments of Sociomedical Sciences (Sikkema, Lovero, Shelton) and Epidemiology (Kane, Weissman), Mailman School of Public Health, Columbia University, New York City; Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City (Greene); Department of Mental Health, Ministry of Health, Maputo, Mozambique (Gouveia, Santos, Suleman, Comé, Feliciano, Fumo); Social and Preventive Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia (Uribe-Restrepo, Cadena-Camargo)
| | - Andrea Simone Comé
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Mootz, Sweetland, Mello, Weissman, Wainberg) Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven (Chantre, Sweetland); Departments of Sociomedical Sciences (Sikkema, Lovero, Shelton) and Epidemiology (Kane, Weissman), Mailman School of Public Health, Columbia University, New York City; Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City (Greene); Department of Mental Health, Ministry of Health, Maputo, Mozambique (Gouveia, Santos, Suleman, Comé, Feliciano, Fumo); Social and Preventive Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia (Uribe-Restrepo, Cadena-Camargo)
| | - Paulino Feliciano
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Mootz, Sweetland, Mello, Weissman, Wainberg) Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven (Chantre, Sweetland); Departments of Sociomedical Sciences (Sikkema, Lovero, Shelton) and Epidemiology (Kane, Weissman), Mailman School of Public Health, Columbia University, New York City; Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City (Greene); Department of Mental Health, Ministry of Health, Maputo, Mozambique (Gouveia, Santos, Suleman, Comé, Feliciano, Fumo); Social and Preventive Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia (Uribe-Restrepo, Cadena-Camargo)
| | - José Miguel Uribe-Restrepo
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Mootz, Sweetland, Mello, Weissman, Wainberg) Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven (Chantre, Sweetland); Departments of Sociomedical Sciences (Sikkema, Lovero, Shelton) and Epidemiology (Kane, Weissman), Mailman School of Public Health, Columbia University, New York City; Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City (Greene); Department of Mental Health, Ministry of Health, Maputo, Mozambique (Gouveia, Santos, Suleman, Comé, Feliciano, Fumo); Social and Preventive Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia (Uribe-Restrepo, Cadena-Camargo)
| | - Annika C Sweetland
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Mootz, Sweetland, Mello, Weissman, Wainberg) Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven (Chantre, Sweetland); Departments of Sociomedical Sciences (Sikkema, Lovero, Shelton) and Epidemiology (Kane, Weissman), Mailman School of Public Health, Columbia University, New York City; Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City (Greene); Department of Mental Health, Ministry of Health, Maputo, Mozambique (Gouveia, Santos, Suleman, Comé, Feliciano, Fumo); Social and Preventive Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia (Uribe-Restrepo, Cadena-Camargo)
| | - Rachel C Shelton
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Mootz, Sweetland, Mello, Weissman, Wainberg) Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven (Chantre, Sweetland); Departments of Sociomedical Sciences (Sikkema, Lovero, Shelton) and Epidemiology (Kane, Weissman), Mailman School of Public Health, Columbia University, New York City; Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City (Greene); Department of Mental Health, Ministry of Health, Maputo, Mozambique (Gouveia, Santos, Suleman, Comé, Feliciano, Fumo); Social and Preventive Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia (Uribe-Restrepo, Cadena-Camargo)
| | - Jeremy Kane
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Mootz, Sweetland, Mello, Weissman, Wainberg) Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven (Chantre, Sweetland); Departments of Sociomedical Sciences (Sikkema, Lovero, Shelton) and Epidemiology (Kane, Weissman), Mailman School of Public Health, Columbia University, New York City; Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City (Greene); Department of Mental Health, Ministry of Health, Maputo, Mozambique (Gouveia, Santos, Suleman, Comé, Feliciano, Fumo); Social and Preventive Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia (Uribe-Restrepo, Cadena-Camargo)
| | - Milena Mello
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Mootz, Sweetland, Mello, Weissman, Wainberg) Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven (Chantre, Sweetland); Departments of Sociomedical Sciences (Sikkema, Lovero, Shelton) and Epidemiology (Kane, Weissman), Mailman School of Public Health, Columbia University, New York City; Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City (Greene); Department of Mental Health, Ministry of Health, Maputo, Mozambique (Gouveia, Santos, Suleman, Comé, Feliciano, Fumo); Social and Preventive Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia (Uribe-Restrepo, Cadena-Camargo)
| | - Wilza Fumo
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Mootz, Sweetland, Mello, Weissman, Wainberg) Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven (Chantre, Sweetland); Departments of Sociomedical Sciences (Sikkema, Lovero, Shelton) and Epidemiology (Kane, Weissman), Mailman School of Public Health, Columbia University, New York City; Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City (Greene); Department of Mental Health, Ministry of Health, Maputo, Mozambique (Gouveia, Santos, Suleman, Comé, Feliciano, Fumo); Social and Preventive Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia (Uribe-Restrepo, Cadena-Camargo)
| | - Yazmin Cadena-Camargo
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Mootz, Sweetland, Mello, Weissman, Wainberg) Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven (Chantre, Sweetland); Departments of Sociomedical Sciences (Sikkema, Lovero, Shelton) and Epidemiology (Kane, Weissman), Mailman School of Public Health, Columbia University, New York City; Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City (Greene); Department of Mental Health, Ministry of Health, Maputo, Mozambique (Gouveia, Santos, Suleman, Comé, Feliciano, Fumo); Social and Preventive Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia (Uribe-Restrepo, Cadena-Camargo)
| | - Myrna Weissman
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Mootz, Sweetland, Mello, Weissman, Wainberg) Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven (Chantre, Sweetland); Departments of Sociomedical Sciences (Sikkema, Lovero, Shelton) and Epidemiology (Kane, Weissman), Mailman School of Public Health, Columbia University, New York City; Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City (Greene); Department of Mental Health, Ministry of Health, Maputo, Mozambique (Gouveia, Santos, Suleman, Comé, Feliciano, Fumo); Social and Preventive Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia (Uribe-Restrepo, Cadena-Camargo)
| | - Milton L Wainberg
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Mootz, Sweetland, Mello, Weissman, Wainberg) Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven (Chantre, Sweetland); Departments of Sociomedical Sciences (Sikkema, Lovero, Shelton) and Epidemiology (Kane, Weissman), Mailman School of Public Health, Columbia University, New York City; Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City (Greene); Department of Mental Health, Ministry of Health, Maputo, Mozambique (Gouveia, Santos, Suleman, Comé, Feliciano, Fumo); Social and Preventive Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia (Uribe-Restrepo, Cadena-Camargo)
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9
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Stockton MA, Mazinyo EW, Mlanjeni L, Nogemane K, Ngcelwane N, Sweetland AC, Basaraba CN, Bezuidenhout C, Sansbury G, Lovero KL, Olivier D, Grobler C, Wall MM, Medina-Marino A, Nobatyi P, Wainberg ML. Validation of a brief screener for broad-spectrum mental and substance-use disorders in South Africa. Glob Ment Health (Camb) 2023; 11:e4. [PMID: 38283876 PMCID: PMC10808975 DOI: 10.1017/gmh.2023.89] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 11/29/2023] [Accepted: 12/13/2023] [Indexed: 01/30/2024] Open
Abstract
In low-resource settings, valid mental health screening tools for non-specialists can be used to identify patients with psychiatric disorders in need of critical mental health care. The Mental Wellness Tool-13 (mwTool-13) is a 13-item screener for identifying adults at risk for common mental disorders (CMDs) alcohol-use disorders (AUDs), substance-use disorders (SUD), severe mental disorders (SMDs), and suicide risk (SR). The mwTool-13 is administered in two steps, specifically, only those who endorse any of the initial three questions receive the remaining ten questions. We evaluated the performance of mwTool-13 in South Africa against a diagnostic gold standard. We recruited a targeted, gender-balanced sample of adults, aged ≥18 years at primary and tertiary healthcare facilities in Eastern Cape Province. Of the 1885 participants, the prevalence of CMD, AUD, SMD, SR, and SUD was 24.4%, 9.5%, 8.1%, 6.0%, and 1.6%, respectively. The mwTool-13 yielded high sensitivities for CMD, SMD, and SR, but sub-optimal sensitivities for AUD and SUD (56.7% and 64.5%, respectively). Including a single AUD question in the initial question set improved the tool's performance in identifying AUD and SUD (sensitivity > 70%), while maintaining brevity, face-validity, and simplicity in the South African setting.
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Affiliation(s)
- Melissa Ann Stockton
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ernesha Webb Mazinyo
- Research Unit, Foundation for Professional Development, Buffalo City Metro, Eastern Cape Province, South Africa
- University of California Global Health Institute, University of California, San Francisco, USA
| | - Lungelwa Mlanjeni
- Research Unit, Foundation for Professional Development, Buffalo City Metro, Eastern Cape Province, South Africa
| | - Kwanda Nogemane
- Buffalo City Metro Health District, Eastern Cape Provincial Department of Health, Bisho, South Africa
| | - Nondumiso Ngcelwane
- Buffalo City Metro Health District, Eastern Cape Provincial Department of Health, Bisho, South Africa
| | - Annika C. Sweetland
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, USA
- New York State Psychiatric Institute, New York, USA
| | - Cale Neil Basaraba
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, USA
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Charl Bezuidenhout
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | | | - Kathryn L. Lovero
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, USA
| | - David Olivier
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Christoffel Grobler
- Faculty of Medicine, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Melanie M. Wall
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, USA
- New York State Psychiatric Institute, New York, USA
| | - Andrew Medina-Marino
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Phumza Nobatyi
- Buffalo City Metro Health District, Eastern Cape Provincial Department of Health, Bisho, South Africa
| | - Milton L. Wainberg
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, USA
- New York State Psychiatric Institute, New York, USA
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10
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Freeman MC, Wainberg ML, Slabbert JD, Mabela S, Wolvaardt G. Persons with severe mental health conditions should be included as a key population in HIV programmes. AIDS 2023; 37:2115-2118. [PMID: 37598396 PMCID: PMC10621635 DOI: 10.1097/qad.0000000000003692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 08/22/2023]
Affiliation(s)
- Melvyn C. Freeman
- Foundation for Professional Development, Pretoria
- University of Stellenbosch, Stellenbosch, Western Cape, South Africa
| | - Milton L. Wainberg
- Columbia University/New York State Psychiatric Institute New York, New York, USA
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11
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Waller BY, Lee SJ, Legros NC, Ombayo BK, Mootz JJ, Green MC, Hankerson SH, Williams SN, Williams JE, Wainberg ML. Interventions Targeting Depression and Posttraumatic Stress Disorder in United States Black Women Experiencing Intimate Partner Violence: A Systematic Review. Trauma Violence Abuse 2023:15248380231206113. [PMID: 37937723 DOI: 10.1177/15248380231206113] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
There is a dearth of evidence indicating the effectiveness of psychological interventions targeting depression and/or posttraumatic stress disorder (PTSD) for Black women in the United States (US) exposed to intimate partner violence (IPV). We searched PubMed, MEDLINE, PsycINFO, EBSCOhost, Social Sciences, Social Sciences Full Text, Social Work Abstracts, and Cochrane databases between September 2021 and October 2022, for original studies of randomized control trials (RCTs) reporting depression and/or PTSD interventions delivered to US Black women with histories of IPV. Of the 1,276 articles, 46 were eligible and 8 RCTs were ultimately included in the review; interventions for depression (four interventions, n = 1,518) and PTSD (four interventions, n = 477). Among Depression and PTSD interventions (one intervention, n = 208), Beck's Depression Inventory II indicated M = 35.2, SD = 12.6 versus M = 29.5, SD = 13.1, <.01, and Davidson Trauma Scale indicated M = 79.4, SD = 31.5 versus M = 72.1, SD = 33.5, <.01, at pre- and post-intervention respectively. Also, some interventions reported severity of depression M = 13.9 (SD = 5.4) versus M = 7.9 (SD = 5.7) < 0.01, and PTSD (M = 8.08 vs. M = 14.13, F(1,117) = 9.93, p < .01) at pre- and post-intervention respectively. Publication bias was moderate and varied between 12 and 17 via the Downs and Black Checklist for Methodological Rigor for RCTs. Psychological interventions targeting depression and/or PTSD for Black women with histories of IPV reflect moderate improvement. Interventions that account for cultural nuances specific to Black women are fundamental for improving outcomes for survivors presenting with depression and/or PTSD.
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Affiliation(s)
- Bernadine Y Waller
- Columbia University Irving Medical Center/New York State Psychiatric Institute, New York, NY, USA
| | - Seung Ju Lee
- Adelphi University School of Social Work, Garden City, NY, USA
| | | | | | - Jennifer J Mootz
- Columbia University Irving Medical Center/New York State Psychiatric Institute, New York, NY, USA
| | - M Claire Green
- Columbia University Mailman School of Public Health, New York, NY, USA
| | | | | | | | - Milton L Wainberg
- Columbia University Irving Medical Center/New York State Psychiatric Institute, New York, NY, USA
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12
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Mootz JJ, Fennig M, Giusto A, Mumey A, Greene CM, Wainberg ML. Interventions addressing family violence and mental illness or substance use in low- and middle-income countries: A systematic review. Glob Ment Health (Camb) 2023; 10:e71. [PMID: 38024805 PMCID: PMC10643256 DOI: 10.1017/gmh.2023.62] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 09/20/2023] [Accepted: 10/06/2023] [Indexed: 12/01/2023] Open
Abstract
Most family violence research has been conducted in high-income countries, although family violence rates are higher in low- and middle-income countries (LMICs), and outcomes more severe. Given the strong associations of family violence with substance use and mental illness, the aim of this systematic review was to examine interventions that targeted familial violence and at least one other condition of substance use or mental illness to determine effective treatments in LMICs. We conducted a systematic review of interventions that addressed family violence and mental illness or substance use. A committee of three researchers independently screened titles and abstracts and conducted full-text eligibility assessments. Two researchers conducted a risk of bias assessment. Data were extracted using a structured spreadsheet and narratively synthesized. Our search identified 29 articles produced from 19 studies conducted in 13 LMICs. Most (n = 15) studies randomized to study condition. Lack of blinding was the most common threat. The external validity of studies was generally poor. Fourteen studies had a primary intervention target of family violence, mental health, substance use, economic improvement, or HIV. None of the studies showed improvements in all intervention areas. Child maltreatment was less likely to be addressed than intimate partner violence (IPV). Targeted interventions for substance and mental health mostly improved primary outcomes, although they were less effective in reducing IPV. Evidence-based treatments must be rigorously evaluated before innovations in implementation can occur. Interventions overwhelmingly addressed IPV victimization and should consider how to work with couples and include men and children.
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Affiliation(s)
- Jennifer J. Mootz
- Department of Psychiatry, Columbia University, New York, USA
- New York State Psychiatric Institute, New York, USA
| | - Molly Fennig
- Department of Psychiatry, Washington University in St. Louis, St. Louis, USA
| | - Ali Giusto
- Department of Psychiatry, Columbia University, New York, USA
- New York State Psychiatric Institute, New York, USA
| | - Audrey Mumey
- Department of Psychology, Columbia University, New York, USA
| | - Claire M. Greene
- Mailman School of Public Health, Columbia University, New York, USA
| | - Milton L. Wainberg
- Department of Psychiatry, Columbia University, New York, USA
- New York State Psychiatric Institute, New York, USA
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13
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Wainberg ML, Wolvaardt GG, Gouveia L, Ferenchick E. World Mental Health Day 2023: We must leave no one behind in the response to HIV and mental health. J Int AIDS Soc 2023; 26:e26183. [PMID: 37814801 PMCID: PMC10562895 DOI: 10.1002/jia2.26183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 10/11/2023] Open
Affiliation(s)
| | | | - Lidia Gouveia
- Department of Mental HealthMinistry of HealthMaputoMozambique
| | - Erin Ferenchick
- Center for Family and Community MedicineColumbia UniversityNew YorkNYUSA
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14
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Sweetland AC, Mann CG, Fernandes MJ, de Menezes Silva FVS, Matsuzaka C, Cavalcanti M, Fortes S, Kritski A, Su AY, Ambrosio JC, Kann B, Wainberg ML. Barriers and Facilitators to Integrating Depression Treatment Within a TB Program and Primary Care in Brazil. Health Promot Pract 2023:15248399231183400. [PMID: 37477124 PMCID: PMC10799967 DOI: 10.1177/15248399231183400] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
Tuberculosis (TB) and depression is common and is associated with poor TB outcomes. The World Health Organization End TB Strategy explicitly calls for the integration of TB and mental health services. Interpersonal Counseling (IPC) is a brief evidence-based treatment for depression that can be delivered by non-mental health specialists with expert supervision. The goal of this study was to explore potential barriers and facilitators to training non-specialist providers to deliver IPC within the TB Control Program and primary care in Itaboraí, Rio de Janeiro state. Data collection consisted of six focus groups (n = 42) with health professionals (n = 29), program coordinators (n = 7), and persons with TB (n = 6). We used open coding to analyze the data, followed by deductive coding using the Chaudoir multi-level framework for implementation outcomes. The main structural barriers identified were poverty, limited access to treatment, political instability, violence, and social stigma. Organizational barriers included an overburdened and under-resourced health system with high staff turnover. Despite high levels of stress and burnout among health professionals, several provider-level facilitators emerged including a high receptivity to, and demand for, mental health training; strong community relationships through the community health workers; and overall acceptance of IPC delivered by any type of health provider. Patients were also receptive to IPC being delivered by any type of professional. No intervention-specific barriers or facilitators were identified. Despite many challenges, integrating depression treatment into primary care in Itaboraí using IPC was perceived as acceptable, feasible, and desirable.
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Affiliation(s)
| | | | | | | | | | | | - Sandra Fortes
- Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Afranio Kritski
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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15
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Waller B, Goddard-Eckrich D, Kagotho N, Hankerson SH, Hawks A, Wainberg ML. Sarah Waller's Help-Seeking Model: Understanding African American Women Intimate Partner Violence Survivors' Help-seeking Process. J Interpers Violence 2023; 38:7170-7192. [PMID: 36583331 PMCID: PMC10634285 DOI: 10.1177/08862605221141869] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
African American women overwhelmingly experience the poorest outcomes resulting from intimate partner violence (IPV) victimization. Despite theoretical advancements, there remain a paucity of theories that explicate this marginalized population's comprehensive help-seeking process that includes the domestic violence service provision system and the Black church. We conducted 30 in-depth, semi-structured interviews with women who self-identified as African American. We utilized sensitizing concepts from the Transtheoretical Model of Change and Intersectionality theories, along with Agency framework and employed constructivist grounded theory methodology. Sarah's Help-Seeking Model emerged from the data and includes nine phases: (1) Awareness, (2) Acknowledgment, (3) Assessment, (4) Enough, (5) Enlist, (6) Escalate, (7) Reject, (8) Resolve, and (9) Restoration. This is the first theory that identifies how this vulnerable and underserved population's mental health and social support-seeking process is partially mediated by mistrust of law enforcement, disappointment in linkage to care and services, fear of death, and willingness to survive.
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Affiliation(s)
- Bernadine Waller
- Columbia University Irving Medical Center/New York State Psychiatric Institute, New York, NY, USA
| | | | | | | | - Alice Hawks
- NYC Family Justice Center, Brooklyn, New York City Mayor’s Office to End Domestic and Gender-Based Violence, Brooklyn, NY, USA
| | - Milton L. Wainberg
- Columbia University Irving Medical Center/New York State Psychiatric Institute, New York, NY, USA
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16
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Lovero KL, Dos Santos PF, Come AX, Wainberg ML, Oquendo MA. Suicide in Global Mental Health. Curr Psychiatry Rep 2023; 25:255-262. [PMID: 37178317 PMCID: PMC10182355 DOI: 10.1007/s11920-023-01423-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE OF REVIEW We review recent research on the epidemiology and etiology of suicide in the global context. We focus on data from low- and middle-income countries (LMIC), with the goal of highlighting findings from these under-researched, over-burdened settings. RECENT FINDINGS Prevalence of suicide in LMIC adults varies across region and country income-level, but is, on average, lower than in high-income countries. Recent gains in suicide reduction, however, have been smaller in LMIC compared to global rates. LMIC youth have much higher rates of suicide attempts than youth from high-income countries. Females as well as people with psychiatric disorders, those living with HIV, those who are LGBTQ + , and those with poor socioeconomic status are highly vulnerable populations in LMIC. Limited and low-quality data from LMIC hinder clear interpretation and comparison of results. A greater body of more rigorous research is needed to understand and prevent suicide in these settings.
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Affiliation(s)
- Kathryn L Lovero
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | | | - Amalio X Come
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Milton L Wainberg
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Maria A Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 200, Philadelphia, PA, 19104, USA.
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17
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Greene MC, Kane J, Alto M, Giusto A, Lovero K, Stockton M, McClendon J, Nicholson T, Wainberg ML, Johnson RM, Tol WA. Psychosocial and pharmacologic interventions to reduce harmful alcohol use in low- and middle-income countries. Cochrane Database Syst Rev 2023; 5:CD013350. [PMID: 37158538 PMCID: PMC10167787 DOI: 10.1002/14651858.cd013350.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND Harmful alcohol use is defined as unhealthy alcohol use that results in adverse physical, psychological, social, or societal consequences and is among the leading risk factors for disease, disability and premature mortality globally. The burden of harmful alcohol use is increasing in low- and middle-income countries (LMICs) and there remains a large unmet need for indicated prevention and treatment interventions to reduce harmful alcohol use in these settings. Evidence regarding which interventions are effective and feasible for addressing harmful and other patterns of unhealthy alcohol use in LMICs is limited, which contributes to this gap in services. OBJECTIVES To assess the efficacy and safety of psychosocial and pharmacologic treatment and indicated prevention interventions compared with control conditions (wait list, placebo, no treatment, standard care, or active control condition) aimed at reducing harmful alcohol use in LMICs. SEARCH METHODS We searched for randomized controlled trials (RCTs) indexed in the Cochrane Drugs and Alcohol Group (CDAG) Specialized Register, the Cochrane Clinical Register of Controlled Trials (CENTRAL) in the Cochrane Library, PubMed, Embase, PsycINFO, CINAHL, and the Latin American and Caribbean Health Sciences Literature (LILACS) through 12 December 2021. We searched clinicaltrials.gov, the World Health Organization International Clinical Trials Registry Platform, Web of Science, and Opengrey database to identify unpublished or ongoing studies. We searched the reference lists of included studies and relevant review articles for eligible studies. SELECTION CRITERIA All RCTs comparing an indicated prevention or treatment intervention (pharmacologic or psychosocial) versus a control condition for people with harmful alcohol use in LMICs were included. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included 66 RCTs with 17,626 participants. Sixty-two of these trials contributed to the meta-analysis. Sixty-three studies were conducted in middle-income countries (MICs), and the remaining three studies were conducted in low-income countries (LICs). Twenty-five trials exclusively enrolled participants with alcohol use disorder. The remaining 51 trials enrolled participants with harmful alcohol use, some of which included both cases of alcohol use disorder and people reporting hazardous alcohol use patterns that did not meet criteria for disorder. Fifty-two RCTs assessed the efficacy of psychosocial interventions; 27 were brief interventions primarily based on motivational interviewing and were compared to brief advice, information, or assessment only. We are uncertain whether a reduction in harmful alcohol use is attributable to brief interventions given the high levels of heterogeneity among included studies (Studies reporting continuous outcomes: Tau² = 0.15, Q =139.64, df =16, P<.001, I² = 89%, 3913 participants, 17 trials, very low certainty; Studies reporting dichotomous outcomes: Tau²=0.18, Q=58.26, df=3, P<.001, I² =95%, 1349 participants, 4 trials, very low certainty). The other types of psychosocial interventions included a range of therapeutic approaches such as behavioral risk reduction, cognitive-behavioral therapy, contingency management, rational emotive therapy, and relapse prevention. These interventions were most commonly compared to usual care involving varying combinations of psychoeducation, counseling, and pharmacotherapy. We are uncertain whether a reduction in harmful alcohol use is attributable to psychosocial treatments due to high levels of heterogeneity among included studies (Heterogeneity: Tau² = 1.15; Q = 444.32, df = 11, P<.001; I²=98%, 2106 participants, 12 trials, very low certainty). Eight trials compared combined pharmacologic and psychosocial interventions with placebo, psychosocial intervention alone, or another pharmacologic treatment. The active pharmacologic study conditions included disulfiram, naltrexone, ondansetron, or topiramate. The psychosocial components of these interventions included counseling, encouragement to attend Alcoholics Anonymous, motivational interviewing, brief cognitive-behavioral therapy, or other psychotherapy (not specified). Analysis of studies comparing a combined pharmacologic and psychosocial intervention to psychosocial intervention alone found that the combined approach may be associated with a greater reduction in harmful alcohol use (standardized mean difference (standardized mean difference (SMD))=-0.43, 95% confidence interval (CI): -0.61 to -0.24; 475 participants; 4 trials; low certainty). Four trials compared pharmacologic intervention alone with placebo and three with another pharmacotherapy. Drugs assessed were: acamprosate, amitriptyline, baclofen disulfiram, gabapentin, mirtazapine, and naltrexone. None of these trials evaluated the primary clinical outcome of interest, harmful alcohol use. Thirty-one trials reported rates of retention in the intervention. Meta-analyses revealed that rates of retention between study conditions did not differ in any of the comparisons (pharmacologic risk ratio (RR) = 1.13, 95% CI: 0.89 to 1.44, 247 participants, 3 trials, low certainty; pharmacologic in addition to psychosocial intervention: RR = 1.15, 95% CI: 0.95 to 1.40, 363 participants, 3 trials, moderate certainty). Due to high levels of heterogeneity, we did not calculate pooled estimates comparing retention in brief (Heterogeneity: Tau² = 0.00; Q = 172.59, df = 11, P<.001; I2 = 94%; 5380 participants; 12 trials, very low certainty) or other psychosocial interventions (Heterogeneity: Tau² = 0.01; Q = 34.07, df = 8, P<.001; I2 = 77%; 1664 participants; 9 trials, very low certainty). Two pharmacologic trials and three combined pharmacologic and psychosocial trials reported on side effects. These studies found more side effects attributable to amitriptyline relative to mirtazapine, naltrexone and topiramate relative to placebo, yet no differences in side effects between placebo and either acamprosate or ondansetron. Across all intervention types there was substantial risk of bias. Primary threats to validity included lack of blinding and differential/high rates of attrition. AUTHORS' CONCLUSIONS In LMICs there is low-certainty evidence supporting the efficacy of combined psychosocial and pharmacologic interventions on reducing harmful alcohol use relative to psychosocial interventions alone. There is insufficient evidence to determine the efficacy of pharmacologic or psychosocial interventions on reducing harmful alcohol use largely due to the substantial heterogeneity in outcomes, comparisons, and interventions that precluded pooling of these data in meta-analyses. The majority of studies are brief interventions, primarily among men, and using measures that have not been validated in the target population. Confidence in these results is reduced by the risk of bias and significant heterogeneity among studies as well as the heterogeneity of results on different outcome measures within studies. More evidence on the efficacy of pharmacologic interventions, specific types of psychosocial interventions are needed to increase the certainty of these results.
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Affiliation(s)
- M Claire Greene
- Program on Forced Migration and Health, Columbia University Mailman School of Public Health, New York, New York, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jeremy Kane
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Michelle Alto
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Ali Giusto
- Department of Psychiatry, Columbia University/NYSPI, New York, New York, USA
| | - Kathryn Lovero
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Melissa Stockton
- Department of Psychiatry, Columbia University/NYSPI, New York, New York, USA
| | - Jasmine McClendon
- Department of Psychiatry, UC Davis Medical Center, Sacramento, CALIFORNIA, USA
| | - Terriann Nicholson
- Department of Psychiatry, Columbia University/NYSPI, New York, New York, USA
| | - Milton L Wainberg
- Department of Psychiatry, Columbia University/NYSPI, New York, New York, USA
| | - Renee M Johnson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Wietse Anton Tol
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Peter C. Alderman Program for Global Mental Health, HealthRight International, New York, USA
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Mandlate FM, Greene MC, Pereira LF, Gouveia ML, Mari JJ, Cournos F, Duarte CS, Oquendo MA, Mello MF, Wainberg ML. Association between mental disorders and adherence to antiretroviral treatment in health facilities in two Mozambican provinces in 2018: a cross-sectional study. BMC Psychiatry 2023; 23:274. [PMID: 37081470 PMCID: PMC10116733 DOI: 10.1186/s12888-023-04782-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 04/13/2023] [Indexed: 04/22/2023] Open
Abstract
INTRODUCTION Lower adherence to antiretroviral treatment (ART) has been found among people with HIV (PWH) who have comorbid mental disorders like depression and alcohol use in Sub-Saharan African. However, there has been less exploration with regards to other mental disorders. METHODS This study assessed the association of multiple mental disorders and adherence to ART based on the data from primary/tertiary health care facilities in Maputo and Nampula, Mozambique. We administered a sociodemographic questionnaire, Mini International Neuropsychiatric Interview (MINI) Plus 4.0.0 adapted for use in Mozambique to assess mental conditions, and a 3-item self-report to measure ART adherence. RESULTS 395 HIV-positive (self-report) participants on ART, with an average age of 36.7 years (SD = 9.8), and 30.4% were male. The most common mental disorders were major depressive disorder (27.34%) followed by psychosis (22.03%), suicidal ideation/behavior (15.44%), and alcohol-use disorder (8.35%). Higher odds of missing at least one dose in the last 30 days (OR = 1.45, 95% CI: 1.01, 2.10) were found in participants with any mental disorder compared to those without a mental disorder. The highest levels of non-adherence were observed among those with drug use disorders and panic disorder. CONCLUSIONS In Mozambique, PWH with any co-occurring mental conditions had a lower probability of ART adherence. Integrating comprehensive mental health assessment and treatment and ART adherence interventions tailored to PWH with co-occurring mental disorders is necessary to attain optimal ART adherence and reach the UNAIDS ART target.
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Affiliation(s)
- Flavio M. Mandlate
- Department of Mental Health, Ministry of Health, Eduardo Mondlane Avenue, nr 1008, Postal Code 264 Maputo, Mozambique
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - M. Claire Greene
- Program on Forced Migration and Health, Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, USA
| | - Luis F. Pereira
- New York State Psychiatric Institute, Columbia University, New York, USA
| | - Maria Lidia Gouveia
- Department of Mental Health, Ministry of Health, Eduardo Mondlane Avenue, nr 1008, Postal Code 264 Maputo, Mozambique
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Jair Jesus Mari
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Francine Cournos
- New York State Psychiatric Institute, Columbia University, New York, USA
| | | | - Maria A. Oquendo
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Marcelo Feijó Mello
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Milton L. Wainberg
- New York State Psychiatric Institute, Columbia University, New York, USA
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Basaraba CN, Stockton MA, Sweetland A, Medina-Marino A, Lovero KL, Oquendo MA, Greene MC, Mocumbi AO, Gouveia L, Mello M, Dos Santos P, Suleman A, Mabunda D, Mandlate F, Xavier A, Fumo W, Massinga L, Khan S, Feliciano P, Kann B, Salem AF, Bezuidenhout C, Mootz JJ, Duarte CS, Cournos F, Wall MM, Wainberg ML. Does It Matter What Screener We Use? A Comparison of Ultra-brief PHQ-4 and E-mwTool-3 Screeners for Anxiety and Depression Among People With and Without HIV. AIDS Behav 2023; 27:1154-1161. [PMID: 36209180 PMCID: PMC10125788 DOI: 10.1007/s10461-022-03852-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2022] [Indexed: 11/01/2022]
Abstract
The burden of depression and anxiety disorders is high in sub-Saharan Africa, especially for people with HIV (PWH). The Patient Health Questionnaire-4 (PHQ-4) and Electronic Mental Wellness Tool-3 (E-mwTool-3) are ultra-brief screening tools for these disorders. We compared the performance of PHQ-4 and E-mwTool-3 for screening MINI-International Neuropsychiatric Interview diagnoses of depression and anxiety among a sample of individuals with and without HIV in two primary care clinics and one general hospital in Maputo City, Mozambique. Areas-under-the-curve (AUC) were calculated along with sensitivities and specificities at a range of cutoffs. For PWH, at a sum score cutoff of ≥ 1, sensitivities were strong: PHQ-4:Depression = 0.843; PHQ-4:Anxiety = 0.786; E-mwTool-3:Depression = 0.843; E-mwTool-3:Anxiety = 0.929. E-mwTool-3 performance was comparable to PHQ-4 among people with and without HIV.
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Affiliation(s)
- Cale N Basaraba
- Area Mental Health Data Science, New York State Psychiatric Institute, New York, USA.
| | | | - Annika Sweetland
- Columbia University Department of Psychiatry/New York State Psychiatric Institute, New York, USA
| | - Andrew Medina-Marino
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
- Research Unit, Foundation for Professional Development, Buffalo City Metro, South Africa
| | - Kathryn L Lovero
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, USA
| | - Maria A Oquendo
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - M Claire Greene
- Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, USA
| | - Ana Olga Mocumbi
- Universidade Eduardo Mondlane School of Medicine, Maputo, Mozambique
| | - Lidia Gouveia
- Universidade Eduardo Mondlane School of Medicine, Maputo, Mozambique
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Milena Mello
- New York State Psychiatric Institute, New York, USA
| | - Palmira Dos Santos
- Universidade Eduardo Mondlane School of Medicine, Maputo, Mozambique
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Antonio Suleman
- Universidade Eduardo Mondlane School of Medicine, Maputo, Mozambique
| | - Dirceu Mabunda
- Universidade Eduardo Mondlane School of Medicine, Maputo, Mozambique
| | - Flávio Mandlate
- Universidade Eduardo Mondlane School of Medicine, Maputo, Mozambique
| | - Amalio Xavier
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Wilza Fumo
- Universidade Eduardo Mondlane School of Medicine, Maputo, Mozambique
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Luciana Massinga
- Universidade Eduardo Mondlane School of Medicine, Maputo, Mozambique
| | - Saida Khan
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Paulino Feliciano
- Universidade Eduardo Mondlane School of Medicine, Maputo, Mozambique
| | - Bianca Kann
- New York State Psychiatric Institute, New York, USA
| | | | - Charl Bezuidenhout
- Department of Global Health, Boston University School of Public Health, Boston, USA
| | | | | | - Francine Cournos
- Clinical Psychiatry (in Epidemiology), Columbia University, New York, USA
| | - Melanie M Wall
- Area Mental Health Data Science, New York State Psychiatric Institute, New York, USA
- New York State Psychiatric Institute, New York, USA
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, USA
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Gorn SB, Saavedra N, Bojorquez I, Reed G, Wainberg ML, Medina-Mora ME. Anxiety among Central American Migrants in Mexico: A Cumulative Vulnerability. Int J Environ Res Public Health 2023; 20:4899. [PMID: 36981807 PMCID: PMC10049226 DOI: 10.3390/ijerph20064899] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/05/2023] [Accepted: 03/07/2023] [Indexed: 06/18/2023]
Abstract
Migration exposes Central American migrants, particularly those who migrate without documents, to a range of incidents, dangers, and risks that increase their vulnerability to anxiety symptoms. In most cases, the poverty, conflict, and violence they experience in their countries of origin are compounded by the unpredictable conditions of their journey through Mexico. The objective of this study was to explore the association between the presence of emotional discomfort and the experience of various vulnerabilities from the perspective of a group of Central American migrants in transit through Mexico. This is a descriptive, mixed-methods study (QUALI-QUAN). During the qualitative phase, thirty-five migrants were interviewed (twenty in Mexico City and six in Tijuana). During the quantitative phase, a questionnaire was administered to 217 migrants in shelters in Tijuana. An analysis of the subjects' accounts yielded various factors associated with stress and anxiety, which were divided into five main groups: (1) precarious conditions during the journey through Mexico, (2) rejection and abuse due to their identity, (3) abuse by Mexican authorities, (4) violence by criminal organizations, and (5) waiting time before being able to continue their journey. The interaction of various vulnerabilities predisposes individuals to present emotional discomfort, such as anxiety. Migrants who reported experiencing three or more vulnerabilities presented the highest percentages of anxiety symptoms.
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Affiliation(s)
- Shoshana Berenzon Gorn
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramon de la Fuente Muñíz, Mexico City 14370, Mexico
| | - Nayelhi Saavedra
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramon de la Fuente Muñíz, Mexico City 14370, Mexico
| | - Ietza Bojorquez
- Departamento de Estudios de Población, El Colegio de la Frontera Norte, Tijuana 22560, Mexico
| | - Geoffrey Reed
- Department of Psychiatry, Columbia University, New York, NY 10032, USA
| | | | - María Elena Medina-Mora
- Centro de Investigación en Salud Mental Global INPRFM, UNAM, Mexico City 14370, Mexico
- Facultad de Psicología, UNAM, Mexico City 04510, Mexico
- Seminario de Estudios Sobre la Globalidad, Facultad de Medicina, UNAM, Mexico City 04510, Mexico
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Giusto A, Jaguga F, Pereira-Sanchez V, Rono W, Triplett N, Rukh-E-Qamar H, Parker M, Wainberg ML. Barriers and Facilitators to Father's Engagement in a Depression and Alcohol Use Intervention in Kenya: Father, Family, and Community Factors. Int J Environ Res Public Health 2023; 20:4830. [PMID: 36981739 PMCID: PMC10048967 DOI: 10.3390/ijerph20064830] [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] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 06/18/2023]
Abstract
In Kenya, there is a treatment gap for depression and alcohol use that is especially large for fathers, which has consequences for families. While treatments exist, there are challenges to implementation. This study aimed to understand barriers and facilitators to implementing a treatment for fathers' depression and alcohol use in Eldoret, Kenya. Guided by the Consolidated Framework for Implementation Research and the Integrated Sustainability Framework, we conducted 18 key informant interviews and 7 focus group discussions (31 total participants) with stakeholders in Eldoret (hospital leaders, policy makers, mental health providers, community leaders, fathers, lay providers, and patients previously engaged in treatment). Interviews were analyzed using the framework method; themes were matrixed by framework domains. Participants identified barriers and facilitators, and opportunities for implementation, in the following domains: innovation, outer setting, inner setting, individual, sustainability, and characteristics of systems. Barriers included a lack of resources, stigma, masculine norms, cost of services, and alcohol dependence. Facilitators included community buy-in, family support, providers with lived experience, government support, and relevant treatment content. Findings will inform implementation strategy development for an intervention for fathers with depression and alcohol use, and family problems with local relevance and scalable potential.
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Affiliation(s)
- Ali Giusto
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY 10032, USA
| | - Florence Jaguga
- Department of Mental Health, Moi Teaching and Referral Hospital, Eldoret P.O. Box 3-30100, Kenya
| | - Victor Pereira-Sanchez
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Wilter Rono
- Department of Mental Health, Moi Teaching and Referral Hospital, Eldoret P.O. Box 3-30100, Kenya
| | - Noah Triplett
- Department of Psychology, University of Washington, Seattle, WA 98195, USA
| | - Hani Rukh-E-Qamar
- Department of Psychology, McGill University, Montreal, QC H3A 0G4, Canada
| | - Mattea Parker
- Department of Psychology, Tuskegee University, Tuskegee, AL 36088, USA
| | - Milton L. Wainberg
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY 10032, USA
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Gouveia L, Mandlate F, Ziebold C, Fumo W, Mabunda D, Lovero KL, Fumo AMT, dos Santos P, Palha AP, Mocumbi AO, Oquendo MA, Wainberg ML, Duarte CS, Mari JJ. Emotional contagion behavior in a group of young girls in a secondary school in Maputo, Mozambique. Int J Soc Psychiatry 2023; 69:447-453. [PMID: 35841157 PMCID: PMC11023688 DOI: 10.1177/00207640221111265] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Emotional Contagion Behavior (ECB), the synchronized expression of emotional symptoms among members of a group, has been observed globally. In Mozambique, there have been numerous reports of ECB in recent years. Since 2010 several girls from a secondary school in Maputo City, Mozambique exhibited ECB which involved repeated fainting spells, sometimes including verbal aggression and threats to colleagues and teachers. We conducted a study to analyze sociodemographic and clinical characteristics associated with ECB. METHODS This cross-sectional study included 154 females aged from 16 to 24 years old. We considered emotional contagion behavior as repeated fainting spells, sometimes including verbal aggression and threats to others (colleagues and teachers). Participants responded to a sociodemographic questionnaire, the Beck Anxiety Scale, and the revised Eysenck Personality Questionnaire (EPQ-R). Bivariate and multivariate logistic regression models analyzed sociodemographic and clinical characteristics associated with EBC. RESULTS Among study participants, 57 presented ECB and 97 did not. The likelihood of ECB was higher among those with previous history of ECB (OR = 8.28, 95% CI [2.51, 27.30]; p ⩽ .001) and extroverted personality profile (OR = 1.15, 95% CI [1.01, 1.30]; p = .038). Having a romantic relationship was related to lower likelihood of having ECB (OR = 0.04, 95% CI [0.01, 0.19]; p = .001). CONCLUSIONS These results suggest that ECB may repeat over time and be related to challenges pertaining to personality development, the presence of sexual life, and close relationships with peers faced by adolescent girls.
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Affiliation(s)
- Lίdia Gouveia
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
- Department of Psychiatry, Universidade Federal de São Paulo, Brazil
| | - Flávio Mandlate
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Carolina Ziebold
- Department of Psychiatry, Universidade Federal de São Paulo, Brazil
| | - Wilza Fumo
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
- Department of Psychiatry, Universidade Federal de São Paulo, Brazil
| | - Dirceu Mabunda
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Kathryn L Lovero
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, NY, USA
| | | | | | | | | | - Maria A Oquendo
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Milton L Wainberg
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, NY, USA
| | - Cristiane S Duarte
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, NY, USA
| | - Jair J Mari
- Department of Psychiatry, Universidade Federal de São Paulo, Brazil
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Erickson BR, Ehrie J, Murray S, Dougherty RJ, Wainberg ML, Dixon LB, Goldman ML. A Rapid Review of "Low-Threshold" Psychiatric Medication Prescribing: Considerations for Street Medicine and Beyond. Psychiatr Serv 2023; 74:282-291. [PMID: 36039554 PMCID: PMC9971341 DOI: 10.1176/appi.ps.20220196] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE No widely accepted clinical guidelines, and scant directly applicable pragmatic research, are available to guide the prescription of psychiatric medications in "low-threshold" outpatient settings, such as street outreach, urgent care, and crisis care, as well as walk-in, shelter, and bridge and transition clinics. Providers frequently prescribe medications in these settings without patients' having firm psychiatric diagnoses and without medical records to guide clinical decision making. Persons who receive medications in these settings often seek help voluntarily and intermittently for mental illness symptoms. However, because of structural and individual factors, such patients may not engage in longitudinal outpatient psychiatric care. The authors reviewed the literature on psychiatric medication prescribing in low-threshold settings and offer clinical considerations for such prescribing. METHODS The authors conducted a rapid literature review (N=2,215 abstracts), which was augmented with up-to-date clinical prescribing literature, the authors' collective clinical experience, and DSM-5 section II diagnostic criteria to provide considerations for prescribing medications in low-threshold settings. RESULTS For individuals for whom diagnostic uncertainty is prominent, a symptom-based diagnostic and treatment approach may be best suited to weigh the risks and benefits of medication use in low-threshold settings. Practical considerations for treating patients with clinical presentations of psychosis and trauma, as well as mood, anxiety, and substance use disorders, in low-threshold settings are discussed. CONCLUSIONS An urgent need exists to invest in pragmatic research and guideline development to delineate best-practice prescribing in low-threshold settings.
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Affiliation(s)
- Blake R Erickson
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Erickson, Ehrie, Wainberg, Dixon); Psychiatry Residency Spokane, Providence Sacred Heart Medical Center, Spokane, Washington (Murray); Division of Medical Ethics, Weill Cornell Medical College, New York City (Dougherty); Department of Psychiatry and Behavioral Sciences, University of California, and San Francisco Department of Public Health, San Francisco (Goldman)
| | - Jarrod Ehrie
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Erickson, Ehrie, Wainberg, Dixon); Psychiatry Residency Spokane, Providence Sacred Heart Medical Center, Spokane, Washington (Murray); Division of Medical Ethics, Weill Cornell Medical College, New York City (Dougherty); Department of Psychiatry and Behavioral Sciences, University of California, and San Francisco Department of Public Health, San Francisco (Goldman)
| | - Samuel Murray
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Erickson, Ehrie, Wainberg, Dixon); Psychiatry Residency Spokane, Providence Sacred Heart Medical Center, Spokane, Washington (Murray); Division of Medical Ethics, Weill Cornell Medical College, New York City (Dougherty); Department of Psychiatry and Behavioral Sciences, University of California, and San Francisco Department of Public Health, San Francisco (Goldman)
| | - Ryan J Dougherty
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Erickson, Ehrie, Wainberg, Dixon); Psychiatry Residency Spokane, Providence Sacred Heart Medical Center, Spokane, Washington (Murray); Division of Medical Ethics, Weill Cornell Medical College, New York City (Dougherty); Department of Psychiatry and Behavioral Sciences, University of California, and San Francisco Department of Public Health, San Francisco (Goldman)
| | - Milton L Wainberg
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Erickson, Ehrie, Wainberg, Dixon); Psychiatry Residency Spokane, Providence Sacred Heart Medical Center, Spokane, Washington (Murray); Division of Medical Ethics, Weill Cornell Medical College, New York City (Dougherty); Department of Psychiatry and Behavioral Sciences, University of California, and San Francisco Department of Public Health, San Francisco (Goldman)
| | - Lisa B Dixon
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Erickson, Ehrie, Wainberg, Dixon); Psychiatry Residency Spokane, Providence Sacred Heart Medical Center, Spokane, Washington (Murray); Division of Medical Ethics, Weill Cornell Medical College, New York City (Dougherty); Department of Psychiatry and Behavioral Sciences, University of California, and San Francisco Department of Public Health, San Francisco (Goldman)
| | - Matthew L Goldman
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Erickson, Ehrie, Wainberg, Dixon); Psychiatry Residency Spokane, Providence Sacred Heart Medical Center, Spokane, Washington (Murray); Division of Medical Ethics, Weill Cornell Medical College, New York City (Dougherty); Department of Psychiatry and Behavioral Sciences, University of California, and San Francisco Department of Public Health, San Francisco (Goldman)
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Martinez-Nicolas I, Basaraba C, Delgado-Gomez D, Lopez-Fernandez O, Baca-Garcia E, Wainberg ML. The Electronic Mental Wellness Tool as a Self-Administered Brief Screening Instrument for Mental Disorders in the General Spanish Population during the Post-COVID-19 Era. Int J Environ Res Public Health 2023; 20:3204. [PMID: 36833900 PMCID: PMC9959534 DOI: 10.3390/ijerph20043204] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/29/2023] [Accepted: 02/03/2023] [Indexed: 06/18/2023]
Abstract
(1) Background: In the "post-COVID-19 era", there is a need to focus on properly assessing and addressing the extent of its well-established mental health collateral damage. The "Electronic Mental Wellness Tool" (E-mwTool) is a 13-item validated stepped-care or stratified management instrument that aims at the high-sensitivity captures of individuals with mental health disorders to determine the need for mental health care. This study validated the E-mwTool in a Spanish-speaking population. (2) Methods: It is a cross-sectional validation study using the Mini International Neuropsychiatric Interview as a criterion standard in a sample of 433 participants. (3) Results: About 72% of the sample had a psychiatric disorder, and 67% had a common mental disorder. Severe mental disorders, alcohol use disorders, substance use disorders, and suicide risk had a much lower prevalence rate (6.7%, 6.2%, 3.2%, and 6.2%, respectively). The first three items performed excellently in identifying any mental health disorder with 0.97 sensitivity. Ten additional items classified participants with common mental disorders, severe mental disorders, substance use disorders, and suicide risk. (4) Conclusions: The E-mwTool had high sensitivity in identifying common mental disorders, alcohol and substance use disorders, and suicidal risk. However, the tool's sensitivity in detecting low-prevalence disorders in the sample was low. This Spanish version may be useful to detect patients at risk of mental health burden at the front line of primary and secondary care in facilitating help-seeking and referral by their physicians.
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Affiliation(s)
- Ismael Martinez-Nicolas
- Faculty of Life Sciences, Catholic University of Murcia (UCAM), 30107 Guadalupe, Spain
- Sistema Español de Notificación en Seguridad en Anestesia y Reanimación (SENSAR), IDEhA Simulation Centre, Fundación Alcorcon University Hospital, 28922 Alcorcon, Spain
| | - Cale Basaraba
- New York State Psychiatric Institute, Columbia University, New York, NY 10024, USA
| | - David Delgado-Gomez
- Department of Statistics, University Carlos III of Madrid, 28903 Getafe, Spain
- Santander Big Data Institute, Universidad Carlos III de Madrid, 28903 Getafe, Spain
| | - Olatz Lopez-Fernandez
- Department of Psychiatry, University Hospital Jimenez Diaz Foundation, 28040 Madrid, Spain
- Faculty of Psychology, Madrid Complutense University, 28049 Madrid, Spain
- Faculty of Psychology, Francisco de Vitoria University, 28049 Madrid, Spain
- Faculty of Psychology, Cardenal Cisneros Centro de Estudios Universitarios, 28223 Madrid, Spain
| | - Enrique Baca-Garcia
- Department of Psychiatry, University Hospital Jimenez Diaz Foundation, 28040 Madrid, Spain
- Department of Psychiatry, University Hospital Rey Juan Carlos, 28933 Móstoles, Spain
- Department of Psychiatry, General University Hospital of Villalba, 28400 Collado Villalba, Spain
- Department of Psychiatry, University Hospital Infanta Elena, 28342 Valdemoro, Spain
- Department of Psychiatry, Madrid Autonomous University, 28049 Madrid, Spain
- CIBERSAM (Centro de Investigacion en Salud Mental), Carlos III Institute of Health, 28029 Madrid, Spain
- Faculty of Psychology, Universidad Catolica del Maule, Talca 3605, Chile
- Department of Psychiatry, Centre Hospitalier Universitaire de Nîmes, 30900 Nîmes, France
| | - Milton L. Wainberg
- New York State Psychiatric Institute, Columbia University, New York, NY 10024, USA
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Gouveia L, Lovero KL, Fumo W, Fumo AMT, Dos Santos P, Mocumbi AO, Oquendo MA, Mari JJ, Wainberg ML, Duarte CS. A Multi-Site Study of Mental Disorders in the Mozambican Health Care System. Adm Policy Ment Health 2023; 50:33-42. [PMID: 36229748 PMCID: PMC10099511 DOI: 10.1007/s10488-022-01221-2] [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: 09/07/2022] [Indexed: 02/04/2023]
Abstract
In Mozambique, human and financial resources for public mental health services are extremely limited. Understanding the mental health needs of those seeking healthcare can inform efficient targeting of mental health services. We examined if the frequency of mental disorders in a health facility varied based on the level of specialization of such facility, from primary care without mental health specialists (PrCMH -), to those with mental health specialists (PrCMH +) and tertiary care (TerC), where both inpatient and outpatient mental health services are available. Participants were adults (convenience sample) seeking health or mental health services at six facilities (2 PrCMH + , 3 PrCMH -, and 1 TerC) in the cities of Maputo and Nampula in Mozambique. Mental disorders were assessed by the MINI International Neuropsychiatric Interview (MINI) 4.0.0. We compared the sociodemographic characteristics and MINI diagnoses across the three types of health facilities. Multiple logistic regression models determined the likelihood that a person seeking services at each type of facility would have any mental disorder, common mental disorders (CMD), severe mental disorders (SMD), substance use disorders (SUD), and moderate-to-high suicide risk, adjusting for sociodemographic factors. Of the 612 total participants, 52.6% (n = 322) were positive for at least one mental disorder: 37.1% were positive for CMD, 28.9% for SMD, 13.2% for SUD, and 10.5% had suicide risk. Presence of any mental disorder was highest in TerC (62.5%) and lowest in PrCMH - (48.4%). Adjusting for sociodemographic covariates, participants in PrCMH + were significantly more likely to have SMD (OR 1.85, 95%CI 1.10-3.11) and SUD (OR 2.79, 95%CI 1.31-5.94) than participants in PrCMH -; participants in TerC were more likely to have CMD (OR 1.70, 95%CI 1.01-2.87) and SUD (OR 2.57, 95%CI 1.14-5.79) than in PrCMH -. Suicide risk was the only condition that did not differ across facility types. As anticipated, people with mental disorders were more likely to be cared for at facilities with mental health specialists. However, our study detected in this convenience sample a remarkably high frequency of mental disorders across different types of facilities within the Mozambican healthcare system. These results, if confirmed in representative samples, suggest a need to increase mental health services at the primary care level.
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Affiliation(s)
- Lidia Gouveia
- Department of Mental Health, Ministry of Health, Av. Eduardo Mondlane/Av. Salvador Allende, P.O. Box 1613, Maputo, Mozambique.
- Department of Psychiatry, Universidade Federal de São Paulo, Rua Major Maragliano, 241, São Paulo, São Paulo, Brasil.
| | - Kathryn L Lovero
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr. Unit #24, New York, NY, USA
| | - Wilza Fumo
- Department of Mental Health, Ministry of Health, Av. Eduardo Mondlane/Av. Salvador Allende, P.O. Box 1613, Maputo, Mozambique
- Department of Psychiatry, Universidade Federal de São Paulo, Rua Major Maragliano, 241, São Paulo, São Paulo, Brasil
| | - Afonso Mazine Tiago Fumo
- Department of Mental Health, Ministry of Health, Av. Eduardo Mondlane/Av. Salvador Allende, P.O. Box 1613, Maputo, Mozambique
| | - Palmira Dos Santos
- Department of Mental Health, Ministry of Health, Av. Eduardo Mondlane/Av. Salvador Allende, P.O. Box 1613, Maputo, Mozambique
| | - Ana Olga Mocumbi
- National Institute of Health, ENI, Bairro da Vila-Parcela nº, 3943, Marracuene, Maputo Province, Mozambique
| | - Maria A Oquendo
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street Suite 200, Philadelphia, PA, USA
| | - Jair J Mari
- Department of Psychiatry, Universidade Federal de São Paulo, Rua Major Maragliano, 241, São Paulo, São Paulo, Brasil
| | - Milton L Wainberg
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr. Unit #24, New York, NY, USA
| | - Cristiane S Duarte
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr. Unit #24, New York, NY, USA
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26
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Ramos-Olazagasti MA, Elkington KS, Wainberg ML, Feng T, Corbeil T, Canino GJ, Bird HR, Scorza P, Wildsmith E, Alegria M, Duarte CS. Does Context and Adversity Shape Sexual Behavior in Youth? Findings from Two Representative Samples of Puerto Rican Youth. Arch Sex Behav 2023; 52:217-231. [PMID: 36169776 PMCID: PMC9868044 DOI: 10.1007/s10508-022-02328-1] [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] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 02/23/2022] [Accepted: 03/12/2022] [Indexed: 06/16/2023]
Abstract
Sexual risk behaviors often co-occur. Understanding the heterogeneity in patterns of sexual behavior among youth and how context of majority and minoritized status may be related to these behaviors can inform targeted STIs/HIV interventions. Data are from the Boricua Youth Study, a longitudinal study of two probability samples of Puerto Rican youth recruited in the South Bronx (SBx) and the metropolitan area in Puerto Rico (PR). We identified patterns of sexual behaviors among young adults (ages 15-24) with sexual experience (N = 1,203) using latent class analysis. Analyses examined context differences and the prospective relationship between adverse childhood experiences (ACEs) (childhood maltreatment/violence, family/parental dysfunction) and patterns of sexual behaviors (age at first sex, number of sex partners, sex with a high-risk partner, condom use, sex while intoxicated, oral sex, anal sex). We identified five classes of sexual behaviors: (1) currently inactive (16.51%); (2) single partner, low activity (13.49%); (3) single partner, inconsistent condom use (32.19%); (4) single partner, sex without a condom (27.65%); and (5) multirisk (10.16%). Young adults from the SBx (minoritized context), those who identified as male, and those with higher child maltreatment/violence ACEs were more likely to be in the multi-risk class relative to the single partner, inconsistent condom use class. Those from the SBx were also more likely to be in the single partner, sex without condom class, relative to the single partner, inconsistent condom use class. Differences in young adults' patterns of sexual behaviors between the two contexts, one representing the minoritized context (SBx) contrasted to the majority context (PR), were not explained by ACEs. Findings highlight the heterogeneity in the patterns of sexual behaviors among Puerto Rican young adults as well as how such patterns vary based on sociocultural contexts. Exposure to child maltreatment/violence ACEs was related to the riskier patterns; however, they did not explain why riskier patterns of sexual behaviors were found in the SBx compared to PR. Results underscore the need for tailored interventions and more in-depth examination of differences across contexts.
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Affiliation(s)
- Maria A Ramos-Olazagasti
- Reproductive Health and Family Formation, Child Trends, 7315 Wisconsin Ave, Ste 1200W, Bethesda, MD, 20814, USA.
- Child and Adolescent Psychiatry, Columbia University, New York, NY, USA.
| | - Katherine S Elkington
- Child and Adolescent Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Milton L Wainberg
- Child and Adolescent Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Tianshu Feng
- New York State Psychiatric Institute, New York, NY, USA
| | | | - Glorisa J Canino
- Medical Sciences Campus, University of Puerto Rico, Rio Piedras, Puerto Rico, USA
| | - Hector R Bird
- Child and Adolescent Psychiatry, Columbia University, New York, NY, USA
| | - Pamela Scorza
- Child and Adolescent Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Elizabeth Wildsmith
- Reproductive Health and Family Formation, Child Trends, 7315 Wisconsin Ave, Ste 1200W, Bethesda, MD, 20814, USA
| | - Margarita Alegria
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Cristiane S Duarte
- Child and Adolescent Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
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27
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Giusto A, Romer A, Lovero K, dos Santos PF, Greene C, Gouveia L, Suleman A, Feliciano P, Oquendo MA, Mootz J, Wainberg ML. Examination of the Factor Structure of Psychopathology in a Mozambican Sample. Clin Psychol Sci 2022; 11:409-424. [PMID: 37181407 PMCID: PMC10181828 DOI: 10.1177/21677026221122773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Factor-analytic studies are needed in global samples to advance understanding of psychopathology. Here, we examined the structure of psychopathology and a general psychopathology (p) factor using data from a cross-sectional study of 971 adults (63% women) from Maputo City, Mozambique. We used confirmatory factor analyses of symptoms from 15 psychiatric disorders to test common models of the structure of psychopathology. Models that included Internalizing, Substance Use, and Thought Disorder factors as well as a general p factor fit the data well. Measurement invariance testing revealed that factor loadings on p differed by gender. Higher levels of p, Internalizing, and Thought Disorder factors were associated with greater suicide risk, psychiatric comorbidity, chronic medical illnesses, and poorer functioning. A general p factor and Internalizing, Substance Use Disorder, and Thought Disorder factors were identifiable in this Mozambican sample. Understanding psychopathology dimensions is a step toward building more scalable mental health service approaches globally.
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Affiliation(s)
- Ali Giusto
- Department of Psychiatry, New York State Psychiatric Institute
- Vagelos College of Physicians and Surgeons, Columbia University
| | - Adrienne Romer
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts
- Harvard Medical School, Harvard University
| | - Kathryn Lovero
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University
| | | | - Claire Greene
- Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University
| | - Lidia Gouveia
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Antonio Suleman
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | | | - Maria A. Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
| | - Jennifer Mootz
- Department of Psychiatry, New York State Psychiatric Institute
- Vagelos College of Physicians and Surgeons, Columbia University
| | - Milton L. Wainberg
- Department of Psychiatry, New York State Psychiatric Institute
- Vagelos College of Physicians and Surgeons, Columbia University
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28
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Mandlate F, Greene MC, Pereira LF, Sweetland AC, Kokonya D, Duarte CS, Cournos F, Oquendo MA, Wainberg ML, Sidat M, Sevene E, Mello MF. Lay HIV counselors' knowledge and attitudes toward depression: A mixed-methods cross-sectional study at primary healthcare centers in Mozambique. Front Public Health 2022; 10:919827. [PMID: 36249253 PMCID: PMC9554257 DOI: 10.3389/fpubh.2022.919827] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/31/2022] [Indexed: 01/22/2023] Open
Abstract
Introduction Depression is the most common mental disorder among people living with HIV/AIDS and has a negative impact on HIV treatment outcomes. Training lay HIV counselors to identify and manage depression may contribute to improved patient access and adherence to treatment, and reduce stigma and discrimination among lay health workers toward both HIV and depression. The purpose of this study was to assess the current knowledge and attitudes of lay HIV counselors toward managing depression in primary care in Mozambique. Methods We conducted a mixed-methods cross-sectional study to assess depression-related knowledge and attitudes among lay HIV counselors in 13 primary healthcare facilities in Mozambique. We used the quantitative Depression Attitude Questionnaire (DAQ) scale, followed by open-ended questions to further explore three key DAQ domains: the nature of depression, treatment preferences, and professional attitudes or reactions. Results The sample included 107 participants (77.6% female, mean age: 32.3 years, sd = 7.4). Most (82.2%) had less than a high/technical school education. Findings suggested that some HIV counselors had knowledge of depression and described it as a cluster of psychological symptoms (e.g., deep sadness, anguish, apathy, isolation, and low self-esteem) sometimes leading to suicidal thoughts, or as a consequence of life stressors such as loss of a loved one, abuse, unemployment or physical illness, including being diagnosed with HIV infection. HIV counselors identified talking to trusted people about their problems, including family and/or counseling with a psychotherapist, as the best way for patients to deal with depression. While acknowledging challenges, counselors found working with patients with depression to be rewarding. Conclusion Lay health counselors identified HIV and psychosocial issues as key risk factors for depression. They believed that the treatment approach should focus on social support and psychotherapy.
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Affiliation(s)
- Flavio Mandlate
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
- Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - M. Claire Greene
- Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Luis F. Pereira
- New York State Psychiatric Institute, Columbia University, New York, NY, United States
| | - Annika C. Sweetland
- New York State Psychiatric Institute, Columbia University, New York, NY, United States
| | - Donald Kokonya
- School of Medicine, Masinde Muliro University of Science and Technology, Kakamega, Kenya
| | - Cristiane S. Duarte
- New York State Psychiatric Institute, Columbia University, New York, NY, United States
| | - Francine Cournos
- New York State Psychiatric Institute, Columbia University, New York, NY, United States
| | - Maria A. Oquendo
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Milton L. Wainberg
- New York State Psychiatric Institute, Columbia University, New York, NY, United States
| | - Mohsin Sidat
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Esperança Sevene
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Marcelo F. Mello
- Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
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Feliciano P, Mootz JJ, Suleman A, Su AY, Khan S, Gouveia L, Santos P, Wainberg ML, Sweetland AC. The impact of COVID-19 on self-reported burnout and health and mental health services in Nampula, Mozambique. Front Public Health 2022; 10:951270. [PMID: 36062081 PMCID: PMC9428787 DOI: 10.3389/fpubh.2022.951270] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/15/2022] [Indexed: 01/24/2023] Open
Abstract
Background The purpose of this study was to examine the impact of the COVID-19 pandemic on self-reported burnout of health workers, quality of care, and perceptions of COVID-19-related stigma in Mozambique. Method We conducted a cross-sectional quantitative assessment of 170 frontline health workers in Nampula District, Mozambique, including 149 (87.6%) primary care providers and 21 (12.4%) mental health specialists. Results Of the 170 frontline workers, only 10.1% of frontline workers were experiencing more professional burnout, whereas 33.3% felt it had lessened. The perceived impact on quality of care also varied, without any significant differences by sex, education level, or mental health training background. Compared to the beginning of the COVID-19 pandemic in March 2020, 42.3 and 38.1% providers felt that their ability to provide mental health and general health care, respectively, had worsened, compared to 57.7 and 61.9% who believed that either there was no change, or that the work had become easier. Likewise, 26.8% of providers felt that their ability to meet patients' needs had gotten more difficult, whereas 43.4% reported no change and 29.8% reported that it was easier. Twenty-two percent of providers reported an overall increase in caseloads since before the pandemic whereas the majority (67.9%) reported a decrease. Providers believed that 57.1% of people in general were afraid of people with COVID-19, 27.5% were afraid of a person recovered from COVID-19, and 39.9% were afraid of a person with family members with COVID-19. The perceived stigma about healthcare professionals was also low; only 27.4% believed that people in general were afraid of healthcare providers who deliver care to people with COVID-19. Conclusion In contrast with other global studies, many healthcare workers in our sample reported a reduction in burnout, which may be associated with the lower overall caseloads seen during this period. Similarly, the quality of care was minimally impacted. More research is needed to determine whether the experience in Mozambique is unique, or similarly observed in other low-resource settings.
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Affiliation(s)
- Paulino Feliciano
- Department of Psychiatry and Mental Health, Psychiatric Hospital of Nampula, Nampula, Mozambique
| | - Jennifer J. Mootz
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, United States
| | - Antonio Suleman
- Department of Psychiatry and Mental Health, Psychiatric Hospital of Nampula, Nampula, Mozambique
| | - Austin Y. Su
- Columbia Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Saida Khan
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Lidia Gouveia
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Palmira Santos
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Milton L. Wainberg
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, United States
| | - Annika C. Sweetland
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, United States
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30
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Lovero KL, Adam SE, Bila CE, Canda ED, Fernandes ME, Rodrigues TIB, Sander MCT, Mellins CA, Duarte CS, Dos Santos PF, Wainberg ML. Validation of brief screening instruments for internalizing and externalizing disorders in Mozambican adolescents. BMC Psychiatry 2022; 22:549. [PMID: 35962378 PMCID: PMC9373392 DOI: 10.1186/s12888-022-04189-3] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mental disorders are the leading cause of disability for youth worldwide. However, there is a dearth of validated, brief instruments to assess mental health in low- and middle-income countries (LMIC). We aimed to facilitate identification of mental disorders in LMIC contexts by adapting and validating measures of internalizing and externalizing disorders for adolescents in Mozambique, an LMIC in southeastern Africa. METHODS We selected instruments with good support for validity in high-income and other LMIC settings: the Patient Health Questionnaire Adolescent (PHQ-A), Generalized Anxiety Disorders 7 (GAD-7), and Strengths and Difficulties Questionnaire (SDQ). Instruments were adapted by local and international mental health specialists followed by cognitive interviews (n = 48) with Mozambican adolescents. We administered the instruments along with the Miniature International Neuropsychiatric Interview for Children and Adolescents (MINI-KID)to 485 adolescents aged 12-19 years attending two secondary schools in Maputo City, Mozambique. One week later, we re-administered instruments to a randomly selected sample of 49 adolescents. RESULTS Participants were 66.2% (n = 321) female and the average age was 15.9 (S.D = 1.7).Internal consistency (alpha = 0.80, PHQ-A; 0.84, GAD-7; 0.80, SDQ) and test-retest reliabilty (ICC = 0.74, PHQ-A; 0.70, GAD-7; 0.77, SDQ) were acceptabe for the PHQ-A, GAD-7, and the full SDQ. The SDQ internalizing subscale showed poor test-retest reliability (ICC = 0.63) and the SDQ externalizing subscale showed poor internal consistency (alpha = 0.65). All instruments demonstrated good sensitivity and specificity (> 0.70). Youden's index identified optimal cutoff scores of 8 for the PHQ-A, 5 for the GAD-7, 10 for the SDQ internalizing and 9 for the SDQ externalizing subscales, though a range of scores provided acceptable sensitivity and specificity. CONCLUSIONS Our data supports reliability and validity of the PHQ-A, GAD-7, and SDQ instruments for rapidly assessing mental health problems in Mozambican adolescents. Use of these tools in other contexts with limited specialists may asist with expanding mental health assessment. Specific instrument and cutoff selection should be based on screening goals, treatment resources, and program objectives.
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Affiliation(s)
- Kathryn L Lovero
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, 722 W. 168th St. 9th Floor, New York, NY, 10032, USA.
| | | | | | - Elda D Canda
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | | | | | - Mariel C Tai Sander
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Claude A Mellins
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- HIV Center for Clinical and Behavioral Health, Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Cristiane S Duarte
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | | | - Milton L Wainberg
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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31
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Come AX, Polanco-Roman L, Dos Santos PF, Fumo W, Mutemba R, Pathare S, Wainberg ML, Oquendo MA, Duarte CS, Mello MF, Lovero KL. Social and Psychiatric Factors of Suicidal Thoughts and Behaviors in Mozambican Adolescents. J Am Acad Child Adolesc Psychiatry 2022; 61:841-844.e1. [PMID: 35452784 PMCID: PMC11013564 DOI: 10.1016/j.jaac.2022.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 02/02/2022] [Accepted: 03/11/2022] [Indexed: 10/18/2022]
Abstract
Globally, suicide is the second leading cause of death for youth ages 10-24 years, and more than 75% of all deaths by suicide occur in low- and middle-income countries (LMIC).1 Suicidal thoughts (ST) and suicidal behaviors (SB), valuable signals for early detection and prevention of suicide deaths, have been associated with a number of different factors in adolescents, including gender and age, socioeconomic status, exposure to childhood adversity, and psychopathology.2 However, research has largely focused on Western, White populations from high-income countries (HIC).2 To lessen the suicide burden among adolescents in LMIC, there is an urgent need to identify contextually relevant risk identification and treatment targets. In Mozambique, the country with the highest suicide rate in southern Africa, this need is particularly dire, as there are fewer than 2 mental health specialists per 100,000 inhabitants,3 and limited resources must be efficiently targeted in youth suicide prevention efforts. We conducted a cross-sectional study at 2 secondary schools in the Mozambican capital Maputo City to identify the social and psychiatric factors associated with ST and SB in Mozambican adolescents.
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Affiliation(s)
| | | | | | - Wilza Fumo
- Mozambican Ministry of Health of Maputo, Mozambique
| | | | - Soumitra Pathare
- Centre for Mental Health Law and Policy of Indian Law Society, Pune, India
| | - Milton L Wainberg
- New York State Psychiatric Institute and the Columbia University Vagelos College of Physicians and Surgeons of New York, New York
| | - Maria A Oquendo
- University of Pennsylvania Perelman School of Medicine of Philadelphia, Pennsylvania
| | - Cristiane S Duarte
- New York State Psychiatric Institute and the Columbia University Vagelos College of Physicians and Surgeons of New York, New York
| | | | - Kathryn L Lovero
- Columbia University Mailman School of Public Health of New York, New York.
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Mootz JJ, Fennig M, Wainberg ML. Barriers and facilitators of implementing integrated interventions for alcohol misuse and intimate partner violence: A qualitative examination with diverse experts. J Subst Abuse Treat 2022; 137:108694. [PMID: 35067398 PMCID: PMC9086116 DOI: 10.1016/j.jsat.2021.108694] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/22/2021] [Accepted: 12/07/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Alcohol misuse and intimate partner violence (IPV) are major public health burdens with a well-established association. These problems are difficult to remedy individually and can exacerbate one another, compounding treatment complexity. Though scarce, integrated alcohol misuse and IPV treatments exist. Yet implementation remains inadequate. Thus, the current study applied the Consolidated Framework for Implementation Research (CFIR) to examine barriers and facilitators of implementing such integrated treatments. METHODS Through purposive sampling, we conducted in-depth interviews with diverse IPV and alcohol treatment experts (n = 21) whose ages ranged from 27 to 72 and who averaged 17 years of experience working in alcohol and IPV treatment. The research team conducted analysis using Grounded Theory Methods. RESULTS Experts identified barriers and facilitators for integrated treatment of alcohol misuse and IPV in three CFIR domains: intervention, inner setting and provider, and outer setting. CONCLUSIONS Leveraging the facilitators of implementation and addressing barriers at multiple organizational and intervention levels through an implementation science lens can help to close the research-to-practice gap for integratively treating alcohol misuse and IPV.
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Affiliation(s)
- Jennifer J Mootz
- Colombia University, Department of Psychiatry, New York State Psychiatric Institute, United States of America.
| | - Molly Fennig
- Washington University in St. Louis, Department of Psychological and Brain Sciences, United States of America
| | - Milton L Wainberg
- Colombia University, Department of Psychiatry, New York State Psychiatric Institute, United States of America
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Abstract
Dispositional capacity assessment, which evaluates a patient's ability for self-care after hospital discharge, is a novel concept with important implications for work in consultation-liaison, inpatient, and emergency psychiatric settings. In this Open Forum, the authors present an illustrative case, review literature relevant to dispositional capacity, and explore social theory that elucidates the concept. Psychiatrists are specifically positioned to provide leadership in this area. Psychiatrists should consider further developing and formalizing criteria for dispositional capacity assessment.
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Affiliation(s)
- Blake R Erickson
- Department of Psychiatry, Columbia University, New York City (Erickson, Pereira, Pope, Wainberg); New York State Psychiatric Institute, New York City (Erickson, Pereira, Wainberg); Jane and Terry Semel Institute for Neuroscience and Human Behavior at University of California, Los Angeles (UCLA) (Bromley); Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, and Center for Health Services and Society, UCLA, Los Angeles (Bromley); Research Foundation for Mental Hygiene, Inc., New York City (Pope)
| | - Joseph Pereira
- Department of Psychiatry, Columbia University, New York City (Erickson, Pereira, Pope, Wainberg); New York State Psychiatric Institute, New York City (Erickson, Pereira, Wainberg); Jane and Terry Semel Institute for Neuroscience and Human Behavior at University of California, Los Angeles (UCLA) (Bromley); Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, and Center for Health Services and Society, UCLA, Los Angeles (Bromley); Research Foundation for Mental Hygiene, Inc., New York City (Pope)
| | - Elizabeth Bromley
- Department of Psychiatry, Columbia University, New York City (Erickson, Pereira, Pope, Wainberg); New York State Psychiatric Institute, New York City (Erickson, Pereira, Wainberg); Jane and Terry Semel Institute for Neuroscience and Human Behavior at University of California, Los Angeles (UCLA) (Bromley); Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, and Center for Health Services and Society, UCLA, Los Angeles (Bromley); Research Foundation for Mental Hygiene, Inc., New York City (Pope)
| | - Leah G Pope
- Department of Psychiatry, Columbia University, New York City (Erickson, Pereira, Pope, Wainberg); New York State Psychiatric Institute, New York City (Erickson, Pereira, Wainberg); Jane and Terry Semel Institute for Neuroscience and Human Behavior at University of California, Los Angeles (UCLA) (Bromley); Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, and Center for Health Services and Society, UCLA, Los Angeles (Bromley); Research Foundation for Mental Hygiene, Inc., New York City (Pope)
| | - Milton L Wainberg
- Department of Psychiatry, Columbia University, New York City (Erickson, Pereira, Pope, Wainberg); New York State Psychiatric Institute, New York City (Erickson, Pereira, Wainberg); Jane and Terry Semel Institute for Neuroscience and Human Behavior at University of California, Los Angeles (UCLA) (Bromley); Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, and Center for Health Services and Society, UCLA, Los Angeles (Bromley); Research Foundation for Mental Hygiene, Inc., New York City (Pope)
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Lovero KL, dos Santos PF, Adam S, Bila C, Fernandes ME, Kann B, Rodrigues T, Jumbe AM, Duarte CS, Beidas RS, Wainberg ML. Leveraging Stakeholder Engagement and Virtual Environments to Develop a Strategy for Implementation of Adolescent Depression Services Integrated Within Primary Care Clinics of Mozambique. Front Public Health 2022; 10:876062. [PMID: 35692315 PMCID: PMC9178075 DOI: 10.3389/fpubh.2022.876062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/27/2022] [Indexed: 11/13/2022] Open
Abstract
Psychiatric disorders are the number one cause of disability in adolescents worldwide. Yet, in low- and middle-income countries (LMIC), where 90% of adolescents reside, mental health services are extremely limited, and the majority do not have access to treatment. Integration of mental health services within primary care of LMICs has been proposed as an efficient and sustainable way to close the adolescent mental health treatment gap. However, there is limited research on how to effectively implement integrated mental health care in LMIC. In the present study, we employed Implementation Mapping to develop a multilevel strategy for integrating adolescent depression services within primary care clinics of Maputo, Mozambique. Both in-person and virtual approaches for Implementation Mapping activities were used to support an international implementation planning partnership and promote the engagement of multilevel stakeholders. We identified determinants to implementation of mental health services for adolescents in LMIC across all levels of the Consolidated Framework for Implementation Research, of which of 25% were unique to adolescent-specific services. Through a series of stakeholder workshops focused on implementation strategy selection, prioritization, and specification, we then developed an implementation plan comprising 33 unique strategies that target determinants at the intervention, patient, provider, policy, and community levels. The implementation plan developed in this study will be evaluated for delivering adolescent depression services in Mozambican primary care and may serve as a model for other low-resource settings.
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Affiliation(s)
- Kathryn L. Lovero
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, United States
| | | | - Salma Adam
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Carolina Bila
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | | | - Bianca Kann
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Teresa Rodrigues
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Ana Maria Jumbe
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Cristiane S. Duarte
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Rinad S. Beidas
- Departments of Psychiatry, Medical Ethics and Health Policy, Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PN, United States
- Penn Medicine Nudge Unit, University of Pennsylvania Health System, Philadelphia, PN, United States
- Penn Implementation Science Center at the Leonard Davis Institute (PISCE@LDI), University of Pennsylvania, Philadelphia, PN, United States
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PN, United States
| | - Milton L. Wainberg
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
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Karyotaki E, Araya R, Kessler RC, Waqas A, Bhana A, Rahman A, Matsuzaka CT, Miguel C, Lund C, Garman EC, Nakimuli-Mpungu E, Petersen I, Naslund JA, Schneider M, Sikander S, Jordans MJD, Abas M, Slade P, Walters S, Brugha TS, Furukawa TA, Amanvermez Y, Mello MF, Wainberg ML, Cuijpers P, Patel V. Association of Task-Shared Psychological Interventions With Depression Outcomes in Low- and Middle-Income Countries: A Systematic Review and Individual Patient Data Meta-analysis. JAMA Psychiatry 2022; 79:430-443. [PMID: 35319740 PMCID: PMC8943620 DOI: 10.1001/jamapsychiatry.2022.0301] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [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: 10/13/2021] [Accepted: 02/02/2022] [Indexed: 01/14/2023]
Abstract
Importance Task sharing, the training of nonspecialist workers with no formal experience in counseling, is a promising strategy for addressing the large gap in treatment for depression in low- and middle-income countries (LMICs). Objective To examine the outcomes and moderators of task-shared psychological interventions associated with depression severity, response, and remission. Data Sources Systematic literature searches in PubMed, Embase, PsycINFO, and Cochrane Library up to January 1, 2021. Study Selection Randomized clinical trials (RCTs) of task-shared psychological interventions compared with control conditions for adults with depressive symptoms in LMICs were included. Data Extraction and Synthesis Two researchers independently reviewed the titles, abstracts, and full text of articles from an existing generic meta-analytic database that includes all RCTs on psychotherapy for depression. A systematic review and individual patient data (IPD) meta-analysis was used to estimate the outcomes of task-shared psychological interventions across patient characteristics using mixed-effects models. Procedures for abstracting data and assessing data quality and validity followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline. Main Outcomes and Measures Primary outcome was reduction in depression symptom severity measured by the 9-item Patient Health Questionnaire (PHQ-9). Response and remission rates were also estimated. Results Of 13 eligible trials, 11 (4145 participants) contributed IPD. Task-shared psychological interventions were associated with a greater decrease in depressive symptom severity than control conditions (Hedges g, 0.32; 95% CI, -0.26 to -0.38). Participants in the intervention groups had a higher chance of responding (odds ratio, 2.11; 95% CI, 1.60 to 2.80) and remitting (odds ratio, 1.87; 95% CI, 1.20 to 1.99). The presence of psychomotor symptoms was significantly associated with the outcomes of task-shared psychological interventions (β [SE], -1.21 [0.39]; P = .002). No other significant associations were identified. Heterogeneity among the trials with IPD was 74% (95% CI, 53%-86%). Conclusions and Relevance In this meta-analysis of IPD, task-shared psychological interventions were associated with a larger reduction in depressive symptom severity and a greater chance of response and remission than control conditions. These findings show potential for the use of task-sharing of psychological interventions across different groups of patients with depression. Further research would help identify which people are most likely to benefit and strengthen larger-scale implementation of this strategy to address the burden of depression in LMICs.
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Affiliation(s)
- Eirini Karyotaki
- Department of Clinical Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
| | - Ricardo Araya
- Center for Global Mental Health and Primary Care Research, Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Ahmed Waqas
- Institute of Population Health Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Arvin Bhana
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Atif Rahman
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Camila T. Matsuzaka
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Clara Miguel
- Department of Clinical Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
| | - Crick Lund
- Center for Global Mental Health and Primary Care Research, Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Emily C. Garman
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Inge Petersen
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Marguerite Schneider
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Siham Sikander
- Human Development Research Foundation, Islamabad, Pakistan
- Health Services Academy, Islamabad, Pakistan
| | - Mark J. D. Jordans
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Melanie Abas
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Pauline Slade
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Stephen Walters
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
| | - Traolach S. Brugha
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Toshi A. Furukawa
- Departments of Health Promotion and Human Behaviour and of Clinical Epidemiology, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | - Yagmur Amanvermez
- Department of Clinical Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
| | - Marcelo F. Mello
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
- Albert Einstein Israelite Hospital, Medicine School, São Paulo, Brazil
| | - Milton L. Wainberg
- Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York
| | - Pim Cuijpers
- Department of Clinical Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
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Spruch-Feiner A, Labouliere CD, Brodsky B, Green KL, Brown GK, Vasan P, Cummings A, Layman D, Monahan MF, Galfalvy H, Rahman M, Kammer J, Wainberg ML, Nicholson T, Leckman-Westin E, Finnerty M, Stanley B. Effects of Patient Suicide on Professional Practice Among Mental Health Providers. J Psychiatr Pract 2022; 28:184-192. [PMID: 35511094 PMCID: PMC9097301 DOI: 10.1097/pra.0000000000000626] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The loss of a patient to suicide has an enormous impact on clinicians, but few studies have examined its effects. METHOD In this retrospective study, we compared clinicians who have and have not experienced a patient suicide using a survey of 2157 outpatient clinicians from 169 New York clinics to determine differences in their suicide prevention knowledge, practices, training, and self-efficacy. RESULTS Approximately 25% of the clinician respondents lost patients to suicide; psychiatrists, nurses/nurse practitioners, and those with more years of experience were disproportionately affected. After controlling for these demographic/professional differences, clinicians who had experienced patient suicide reported feeling that they had insufficient training, despite actually having more suicide prevention training, greater knowledge of suicide prevention practices, and feeling more comfortable working with suicidal patients than clinicians who had not lost a patient to suicide. There were no differences in self-efficacy or utilization of evidence-based clinical practices. CONCLUSIONS Controlling for demographic/professional differences, clinicians who experienced a patient suicide had more training, knowledge, and felt more comfortable working with suicidal patients. It is critical that sufficient training be available to clinicians, not only to reduce patient deaths, but also to help clinicians increase their comfort, knowledge, skill, and ability to support those bereaved by suicide loss.
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Affiliation(s)
| | - Christa D. Labouliere
- New York State Psychiatric Institute, and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Beth Brodsky
- New York State Psychiatric Institute, and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Kelly L. Green
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Gregory K. Brown
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Prabu Vasan
- Bureau of Evidence-Based Services and Implementation Science, New York State Office of Mental Health, Albany, NY
| | - Anni Cummings
- Bureau of Evidence-Based Services and Implementation Science, New York State Office of Mental Health, Albany, NY
| | - Deborah Layman
- Bureau of Evidence-Based Services and Implementation Science, New York State Office of Mental Health, Albany, NY
| | | | - Hanga Galfalvy
- New York State Psychiatric Institute, and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Mahfuza Rahman
- Bureau of Evidence-Based Services and Implementation Science, New York State Office of Mental Health, Albany, NY
| | - Jamie Kammer
- Bureau of Evidence-Based Services and Implementation Science, New York State Office of Mental Health, Albany, NY
| | - Milton L. Wainberg
- New York State Psychiatric Institute, and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Terriann Nicholson
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons
| | - Emily Leckman-Westin
- Bureau of Evidence-Based Services and Implementation Science, New York State Office of Mental Health, Albany, NY
| | - Molly Finnerty
- Bureau of Evidence-Based Services and Implementation Science, New York State Office of Mental Health, Albany, and Department of Psychiatry, New York University, New York, NY
| | - Barbara Stanley
- New York State Psychiatric Institute, and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
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Itzhaky L, Davaasambuu S, Ellis SP, Cisneros-Trujillo S, Hannett K, Scolaro K, Stanley BH, Mann JJ, Wainberg ML, Oquendo MA, Sublette ME. Twenty-six years of psychosocial interventions to reduce suicide risk in adolescents: Systematic review and meta-analysis. J Affect Disord 2022; 300:511-531. [PMID: 34974074 DOI: 10.1016/j.jad.2021.12.094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Received: 08/04/2021] [Revised: 12/10/2021] [Accepted: 12/20/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND During adolescence, suicide risk increases; effective treatments are needed to reduce risk. METHODS Databases were searched (1995-2020) for randomized controlled trials (RCTs) concerning psychosocial treatments for suicide prevention in adolescents (10-18 yrs). Data were extracted from the timepoint closest to 6 months. Cohen's ds were estimated for reducing suicidal ideation (SI), self-harming behaviors (SHB) excluding strictly non-suicidal self-injury, and suicide attempts (SA) and analyzed using generalized least square regression. Meta-analytic innovations included within-person correlations to reflect trait suicidality; annualization to control for exposure; estimated lifetime risk based on ages; and modeling inclusion/exclusion criteria. Alternate approaches included relative risk and comparison of intervention and control treatments to baseline. RESULTS Of 30 RCTs, 6 assessing SHB (4 measuring SA), and 7 assessing SI demonstrated treatment effectiveness. Overall, interventions decreased SI (n = 25) with low effect size (d = 0.08, p = 0.01), non-significant after controlling for publication bias (d = 0.05, p = 0.1); interventions were non-significant for SHB (n = 25, d = 0.001, p = 0.97) or SA (n = 18, d = 0.03, p = 0.52). To prevent one SHB, the number needed to treat (NNT) was 45[26,156]; for SA, NNT=42[24,149]. Non-superiority may relate to effectiveness of control treatments. Thus, experimental and control treatments also were compared to baseline: both reduced SI (p < 0.0001), and effectiveness improved for SHB (NNT=12) and SA (NNT=11). LIMITATIONS Study heterogeneity and inconsistent statistical reporting limited meta-analysis. CONCLUSIONS Psychosocial interventions for suicide risk in adolescents showed little effectiveness compared with control treatments; suicide outcomes improved in both groups compared to baseline. Different approaches may be needed, including precision medicine methodologies and standardized statistical reporting criteria.
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Affiliation(s)
- Liat Itzhaky
- Department of Psychiatry, Columbia University, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, Unit 42, New York, NY, USA; Geha Mental Health Center, Petah-Tikva, Israel
| | - Sara Davaasambuu
- Department of Psychiatry, Columbia University, New York, NY 10032, USA
| | - Steven P Ellis
- Department of Psychiatry, Columbia University, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, Unit 42, New York, NY, USA
| | | | - Katrina Hannett
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 42, New York, NY, USA
| | | | - Barbara H Stanley
- Department of Psychiatry, Columbia University, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, Unit 42, New York, NY, USA
| | - J John Mann
- Department of Psychiatry, Columbia University, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, Unit 42, New York, NY, USA; Department of Radiology, Columbia University, New York, NY, USA
| | - Milton L Wainberg
- Department of Psychiatry, Columbia University, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, Unit 42, New York, NY, USA
| | - Maria A Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - M Elizabeth Sublette
- Department of Psychiatry, Columbia University, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, Unit 42, New York, NY, USA.
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O’Grady MA, Mootz J, Suleman A, Sweetland A, Teodoro E, Anube A, Feliciano P, Bezuidenhout C, Dos Santos PF, Fumo W, Gouveia L, Pinsky I, Mello M, Kann B, Wainberg ML. Mobile technology and task shifting to improve access to alcohol treatment services in Mozambique. J Subst Abuse Treat 2022; 134:108549. [PMID: 34210568 PMCID: PMC8702577 DOI: 10.1016/j.jsat.2021.108549] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/09/2021] [Accepted: 06/15/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Unhealthy alcohol use (UAU) is a major public health challenge, particularly in low- and middle-income countries. Mozambique is the fourth poorest country in the world where half of the population lives below the poverty line. UAU is frequent among drinkers in Mozambique; however, resources and infrastructure to treat UAU are very limited. This paper examines how task-shifting and a provider-facing mobile health application are being used to improve access to care. In this paper, the feasibility, acceptability and appropriateness of a provider-facing mobile health application being used under a task-shifting model to identify UAU and provide a four-session brief motivational interviewing intervention are described. METHOD The study used a sequential exploratory mixed-methods design with a QUAL → quan structure. First, 15 psychiatric technicians and primary care providers in Mozambique's Nampula Province participated in semi-structured interviews. These interviews were recorded and transcribed. Then, 45 providers completed a 12-item quantitative survey on tablets. Quantitative analysis used descriptive statistic calculation and qualitative analysis used thematic analysis. RESULTS Nonspecialized providers found the mobile health app to be acceptable, appropriate, and feasible when delivering a 4-session brief motivational intervention under a task-shifting model. Central benefits of the technology were enhanced standardization and efficiency of sessions as well as feelings of legitimacy when interacting with patients. Main concerns were feasibility of implementing the intervention due to time constraints of workload and internet connectivity issues. CONCLUSIONS Provider-facing technology shows promise in supporting task-shifting models that can expand alcohol intervention services and increase access to care in low- and middle-income countries. Providers without specialized training in behavioral health interventions can provide critical services to patients with UAU and provider-facing mobile health applications may help bring such models to scale.
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Affiliation(s)
- Megan A. O’Grady
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, Corresponding Author: Megan A. O’Grady, Assistant Professor, Department of Public Health Sciences, University of Connecticut School of Medicine, 263 Farmington Ave., Farmington, CT, 06030-6325; ; 860-679-5483
| | - Jennifer Mootz
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY
| | - Antonio Suleman
- Department of Psychiatry and Mental Health, Psychiatric Hospital of Nampula, Mozambique
| | - Annika Sweetland
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY
| | - Eugénia Teodoro
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Anibal Anube
- Department of Psychiatry and Mental Health, Psychiatric Hospital of Nampula, Mozambique
| | - Paulino Feliciano
- Department of Psychiatry and Mental Health, Psychiatric Hospital of Nampula, Mozambique
| | - Charl Bezuidenhout
- Research Unit, Foundation for Professional Development, Pretoria, South Africa
| | | | - Wilza Fumo
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Lidia Gouveia
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Ilana Pinsky
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY
| | - Milena Mello
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY
| | - Bianca Kann
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY
| | - Milton L. Wainberg
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY
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Mootz JJ, Odejimi OA, Bhattacharya A, Kann B, Ettelbrick J, Mello M, Wainberg ML, Khoshnood K. Transactional sex work and HIV among women in conflict-affected Northeastern Uganda: a population-based study. Confl Health 2022; 16:8. [PMID: 35216637 PMCID: PMC8876753 DOI: 10.1186/s13031-022-00441-5] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 02/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Armed conflict and the HIV pandemic are significant global health issues. Evidence of the association between armed conflict and HIV infection has been conflicting. Our objective was to examine the role of mediating risk factors, such as engagement in transactional sex work, to elucidate the relation between armed conflict and HIV infection. METHODS We used multistage sampling across three Northeastern Ugandan districts to randomly select 605 women aged 13 to 49 to answer cross-sectional surveys from January to May of 2016. We used multivariate logistic regression model with R 4.0.3 to examine if exposure to armed conflict has an indirect effect on reporting having an HIV-positive serostatus through engagement in transactional sex work. Age and district residence were included as covariates. RESULTS Exposure to armed conflict β = .16, SE = .04, p < .05, OR = 1.17, 95% [CI .08, .23] was significantly associated with reporting a HIV-positive serostatus. For each 1-unit increase in exposure to armed conflict (i.e., additional type of armed conflict exposure), there was a 17% increase in the odds of reporting a HIV-positive serostatus. Engagement in transactional sex work was not associated with reporting a HIV-positive serostatus β = .04, SE = .05, p = .37, 95% [CI - .051, .138]. We found district of residence, age, and interaction effects. CONCLUSIONS Although exposure to armed was associated with reporting an HIV-positive serostatus, this relationship was not mediated by engagement in transactional sex. Further research is needed on risk factors that mediate this relationship. The likelihood of reporting a HIV-positive serostatus increased with each additional type of exposure to armed conflict. Thus, screening for exposure to multiple traumatic stressors should occur in HIV prevention settings. Healthcare services that are trauma-informed and consider mental distress would likely improve HIV outcomes.
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Affiliation(s)
- Jennifer J Mootz
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA.
- New York State Psychiatric Institute, 1051 Riverside Drive, Kolb 171, New York, NY, 10032, USA.
| | - Omolola A Odejimi
- Educational Psychology, Texas Tech University, 2500 Broadway, Lubbock, TX, 79409, USA
| | | | - Bianca Kann
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, Kolb 171, New York, NY, 10032, USA
| | - Julia Ettelbrick
- The New School, Eugene Lang College, 72 5th Avenue, New York, NY, 10011, USA
| | - Milena Mello
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, Kolb 171, New York, NY, 10032, USA
| | - Milton L Wainberg
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, Kolb 171, New York, NY, 10032, USA
| | - Kaveh Khoshnood
- School of Public Health, Yale University, 60 College St, New Haven, CT, 06510, USA
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Khan S, Scorza P, Lovero KL, dos Santos P, Fumo W, Camara B, Oquendo MA, Wainberg ML, Fejo M, Duarte CS. Women's mental health in Mozambique: is maternity a protective factor? Glob Ment Health (Camb) 2022; 9:38-44. [PMID: 36618727 PMCID: PMC9806954 DOI: 10.1017/gmh.2022.1] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 12/16/2021] [Accepted: 01/02/2022] [Indexed: 01/11/2023] Open
Abstract
Backgroud Globally, women have been shown to have high rates of common mental disorders (CMDs). In low and middle-income countries (LMICs), women face significant challenges related to maternity. However, no study has compared mental health problems among pregnant/post-partum women, childless women of childbearing age, and women with children in a low-income country. We sought to compare the frequency of CMD and suicide risk in a sample of women presenting or accompanying patients in primary care in two Mozambican semi-urban settings. Methods We administered the MINI International Neuropsychiatric Interview to 853 women, of whom 220 (25.8%) were pregnant/post-partum, 177 (20.8%) were non-pregnant and childless, and 456 (53.5%) were non-pregnant and with children more than 1-year-old. Logistic regression models compared the likelihood of a psychiatric disorder across groups, adjusting for sociodemographic and chronic-illness covariates. Results We found a high frequency of CMD and suicide risk among all women in this low-income context sample. In adjusted models, no differences in rates of depression, anxiety, or panic disorder were observed among groups. However, suicide risk was higher in women without children than pregnant/post-partum women. Conclusion The frequency of CMD among women of childbearing age in our study was higher than documented rates in high-income countries and other LMIC. Additionally, we found that motherhood was not protective and that pregnancy and the postpartum period were not stages of increased risk for most disorders. This highlights the need to expand mental health services not only for perinatal women but all women of childbearing age in this and possibly similar settings.
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Affiliation(s)
- Saida Khan
- Department of Mental Health, Ministry of Health, Av. Eduardo Mondlane/Av. Salvador Allende P.O. Box 1613, Maputo, Mozambique
- Department of Psychiatry, Universidade Federal de São Paulo, Rua Major Marrigliano, 241, São Paulo, São Paulo, Brazil
| | - Pamela Scorza
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Dr. Unit #24, New York, New York, USA
| | - Kathryn L. Lovero
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Dr. Unit #24, New York, New York, USA
| | - Palmira dos Santos
- Department of Mental Health, Ministry of Health, Av. Eduardo Mondlane/Av. Salvador Allende P.O. Box 1613, Maputo, Mozambique
| | - Wilza Fumo
- Department of Mental Health, Ministry of Health, Av. Eduardo Mondlane/Av. Salvador Allende P.O. Box 1613, Maputo, Mozambique
- Department of Psychiatry, Universidade Federal de São Paulo, Rua Major Marrigliano, 241, São Paulo, São Paulo, Brazil
| | - Barbara Camara
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Dr. Unit #24, New York, New York, USA
| | - Maria A. Oquendo
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street Suite 200, Philadelphia, Pennsylvania, USA
| | - Milton L. Wainberg
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Dr. Unit #24, New York, New York, USA
| | - Marcelo Fejo
- Department of Psychiatry, Universidade Federal de São Paulo, Rua Major Marrigliano, 241, São Paulo, São Paulo, Brazil
| | - Cristiane S. Duarte
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Dr. Unit #24, New York, New York, USA
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Giusto A, Mootz JJ, Korir M, Jaguga F, Mellins CA, Wainberg ML, Puffer ES. “When my children see their father is sober, they are happy”: A qualitative exploration of family system impacts following men's engagement in an alcohol misuse intervention in peri-urban Kenya. SSM - Mental Health 2021; 1. [PMID: 35647569 PMCID: PMC9137329 DOI: 10.1016/j.ssmmh.2021.100019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Ali Giusto
- New York State Psychiatric Institute, Columbia University, Department of Psychiatry, New York, NY, 10032, USA
- Corresponding author. Columbia University Medical Center/New York State Psychiatric Institute, 40 Haven Ave, #171, New York, NY, 10032. (A. Giusto)
| | - Jennifer J. Mootz
- New York State Psychiatric Institute, Columbia University, Department of Psychiatry, New York, NY, 10032, USA
| | - Mercy Korir
- Moi University Teaching and Referral Hospital, Eldoret, Kenya
| | - Florence Jaguga
- Moi Teaching and Referral Hospital, P.O. Box 3-30100, Eldoret, Kenya
| | - Claude Ann Mellins
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health and Columbia University Medical Center, New York, NY, USA
| | - Milton L. Wainberg
- New York State Psychiatric Institute, Columbia University, Department of Psychiatry, New York, NY, 10032, USA
| | - Eve S. Puffer
- Department of Neuroscience and Psychology, Duke University. Duke Global Health Institute, Durham, NC, USA
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Carlson C, Namy S, Nakuti J, Mufson L, Ikenberg C, Musoni O, Hopson L, Anton-Erxleben K, Naker D, Wainberg ML. Student, teacher, and caregiver perceptions on implementing mental health interventions in Ugandan schools. Implementation Research and Practice 2021; 2. [DOI: 10.1177/26334895211051290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background The vast majority of children and adolescents in low and middle-income countries (LMICs) lack access to interventions for mental health problems. Schools provide a critical platform for evidence-based intervention delivery for young people. However, a significant need exists to understand the implementation context and strategies for delivering school mental health interventions in LMICs. Methods We conducted a focused ethnography to explore students’, teachers’, and caregivers’ perspectives on implementing evidence-based mental health interventions (EBIs) within a widespread violence prevention program in Uganda. Data collection occurred in Kampala, Uganda, using two schools that have previously implemented an evidence-based violence prevention program widely used in Ugandan schools schools, the Good School Toolkit (GST). Trained, local researchers facilitated four focus group discussions (FGDs) with caregivers ( n = 22), four FGDs with teachers ( n = 25), and in-depth interviews with primary school students ( n = 12). Verbatim transcripts were analyzed using a framework analysis approach. Results Participants revealed a school culture that promotes schools’ responsibility to students beyond academics, including positive teacher–student relationships. Participants recommended an implementation process that trains teachers and students in screening and referral, peer group delivery, and is accompanied by a school-wide approach to stigma reduction and mental health literacy. Participants fundamentally agreed that teachers could be trained as intervention facilitators. Conclusions This study highlights the potential advantage of leveraging an existing intervention that already addresses implementation factors, such as school culture, as a fertile platform for implementing interventions for child and adolescent mental health in LMICs. Plain language abstract Despite the growth of implementation research for child and adolescent mental health, the study of implementation science for child and adolescent mental health in low and middle-income countries (LMICs) remains scarce. Schools provide a critical platform for evidence-based intervention delivery for young people. However, a significant need exists to understand the implementation context and strategies for delivering school mental health interventions in LMICs. This study provides rich qualitative data describing the context and influences for the successful implementation of mental health interventions in LMIC schools. We conducted interviews and focus groups with teachers, students, and caregivers to determine their perspectives on implementing evidence-based mental health interventions (EBIs) within a widespread violence prevention program in Uganda. Participants revealed a school culture promoted by the existing program that promotes schools’ responsibility to students beyond academics, including positive teacher–student relationships. Findings suggest the existing program provides fertile ground for the successful implementation of evidence-based mental health interventions in schools.
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Affiliation(s)
| | | | | | - Laura Mufson
- Columbia University College of Physicians and Surgeons, USA
- New York State Psychiatric Institute, USA
| | | | - Olive Musoni
- School of Social Work, University of Alabama, USA
| | - Laura Hopson
- School of Social Work, University of Alabama, USA
| | | | | | - Milton L. Wainberg
- Columbia University College of Physicians and Surgeons, USA
- New York State Psychiatric Institute, USA
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Suleman A, Mootz JJ, Feliciano P, Nicholson T, O’Grady MA, Wall M, Mandell DS, Stockton M, Teodoro E, Anube A, Novela A, Mocumbi AO, Gouveia L, Wainberg ML. Scale-Up Study Protocol of the Implementation of a Mobile Health SBIRT Approach for Alcohol Use Reduction in Mozambique. Psychiatr Serv 2021; 72:1199-1208. [PMID: 34126774 PMCID: PMC8487890 DOI: 10.1176/appi.ps.202000086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Hazardous drinking imposes a major public health burden worldwide, especially in low-income countries such as Mozambique. Implementation of the Screening, Brief Intervention, Referral to Treatment (SBIRT) approach to address problem drinking is recommended. However, evidence regarding the best strategies to implement SBIRT at scale is needed. METHODS Guided by the Reach Effectiveness Adoption Implementation Maintenance model, the authors will conduct a 2-year, cluster-randomized, hybrid type-2 implementation-effectiveness trial in 12 districts in Mozambique evaluating implementation, clinical effectiveness, outcomes, and cost. Eight districts will be randomly assigned to a mobile application-based health SBIRT condition and four to SBIRT-Conventional Training and Supervision. Interventions will be delivered by clinic-based community health workers. The Consolidated Framework for Implementation Research will guide the authors' mixed-methods assessments throughout the study. RESULTS The study arm showing better cost-effectiveness will be scaled up in the other arms' districts. During this 12-month scale-up phase, Ministry of Health personnel will be charged with providing training, clinical activities, and supervision in all 12 districts without research team support. The SBIRT scale-up phase is critical to identify facilitators and barriers for tracking internal and external factors in clinics that continue using the superior arm and those that switch to it. NEXT STEPS In a multistep process with stakeholders from multiple sectors, outcomes and lessons learned from this study will inform the development of an implementation tool kit to guide SBIRT scale-up of community services addressing hazardous drinking in other low- and middle-income countries and low-resource settings in high-income countries.
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Affiliation(s)
- António Suleman
- Department of Psychiatry and Mental Health, Psychiatric Hospital of Nampula, Mozambique
| | - Jennifer J. Mootz
- Department of Psychiatry, Columbia University, New York, NY
- New York State Psychiatric Institute, New York, NY
| | - Paulino Feliciano
- Department of Psychiatry and Mental Health, Psychiatric Hospital of Nampula, Mozambique
| | | | - Megan A. O’Grady
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT
| | - Melanie Wall
- Department of Psychiatry, Columbia University, New York, NY
- New York State Psychiatric Institute, New York, NY
| | - David S. Mandell
- Center for Mental Health, Department of Psychiatry University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Melissa Stockton
- Department of Psychiatry, Columbia University, New York, NY
- New York State Psychiatric Institute, New York, NY
| | | | - Anibal Anube
- Department of Psychiatry and Mental Health, Psychiatric Hospital of Nampula, Mozambique
| | - Ana Novela
- Department of Mental Health, Ministry of Health, Mozambique
| | | | - Lidia Gouveia
- Department of Mental Health, Ministry of Health, Mozambique
| | - Milton L. Wainberg
- Department of Psychiatry, Columbia University, New York, NY
- New York State Psychiatric Institute, New York, NY
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Mootz JJ, Basaraba CN, Corbeil T, Johnson K, Kubanga KP, Wainberg ML, Khoshnood K. Armed conflict, HIV, and syndemic risk markers of mental distress, alcohol misuse, and intimate partner violence among couples in Uganda. J Trauma Stress 2021; 34:1016-1026. [PMID: 34647647 PMCID: PMC8530966 DOI: 10.1002/jts.22740] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 07/29/2021] [Accepted: 07/29/2021] [Indexed: 11/06/2022]
Abstract
Northeastern Uganda has suffered from protracted armed conflict and HIV/AIDS and has some of the highest rates of intimate partner violence (IPV) globally. Little is known about how exposure to conflict and HIV influence individuals' syndemic risk markers or those of their partners. We conducted a population-based study using multistage sampling across three districts in Northeastern Uganda. We randomly surveyed 605 women aged 13-49 years and estimated syndemic problems for currently partnered women (N = 561) who reported for their male partners. Syndemic problems were lower in the low-conflict district than the high-conflict district, p = .009. Conflict exposure was associated with couples' syndemic scores, respondent: β = 0.182, p < .001; partner: β = .181, p < .001. Problem scores were significantly higher among women whose partner was either HIV positive, p = .031, or had an unknown HIV status, p = .016, compared with those whose partner was HIV negative. The total effects of women's, β = .15, p = .034, and men's, β = .137, p = .038, armed conflict exposure on male-to-female IPV were significant. For male partners, there were significant total effects of having an unknown, β = .669, p < .001, or positive, β = 1.143, p < .001, HIV status on experiencing female-to-male IPV. These results suggest that syndemic problems and corresponding treatments should consider couple influences. Addressing mediating problems of mental distress and alcohol misuse may reduce the risk of male-to-female IPV. Providing couple-based HIV psychosocial interventions could reduce men's exposure to IPV.
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Affiliation(s)
- Jennifer J. Mootz
- Department of Psychiatry, Columbia University, New York,
New York, USA
- New York State Psychiatric Institute, New York, New York,
USA
| | | | - Thomas Corbeil
- New York State Psychiatric Institute, New York, New York,
USA
| | - Karen Johnson
- School of Social Work, University of Alabama, Birmingham,
Alabama, USA
| | | | - Milton L. Wainberg
- Department of Psychiatry, Columbia University, New York,
New York, USA
- New York State Psychiatric Institute, New York, New York,
USA
| | - Kaveh Khoshnood
- School of Public Health, Yale University, New Haven,
Connecticut, USA
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Greene MC, Kane JC, Bolton P, Murray LK, Wainberg ML, Yi G, Sim A, Puffer E, Ismael A, Hall BJ. Assessing trauma and related distress in refugee youth and their caregivers: should we be concerned about iatrogenic effects? Eur Child Adolesc Psychiatry 2021; 30:1437-1447. [PMID: 32880725 PMCID: PMC9135458 DOI: 10.1007/s00787-020-01635-z] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 08/26/2020] [Indexed: 11/26/2022]
Abstract
Assessment of potentially traumatic events and related psychological symptoms in refugee youth is common in epidemiological and intervention research. The objective of this study is to characterize reactions to assessments of trauma exposure and psychological symptoms, including traumatic stress, in refugee youth and their caregivers. Eighty-eight Somali youth and their caregivers participated in a screening and baseline interview for a psychological intervention in three refugee camps in Ethiopia. Participants were asked about their levels of distress prior to, immediately after, and approximately two weeks after completing the interview. Other quantitative and qualitative questions inquired about specific reactions to interview questions and procedures. Children and caregivers became increasingly relaxed over the course of the interview, on average. Few children (5.3%) or caregivers (6.5%) who reported being relaxed at the beginning of the interview became upset by the end of the interview. Some children and caregivers reported that certain assessment questions were upsetting and that feeling upset interfered with their activities. Despite some participants reporting persistent negative reactions, most reported liking and benefitting from the interview. While the majority of refugee youth and their caregivers reported positive experiences associated with completing trauma-related assessments, some reported negative reactions. Researchers and practitioners must consider the necessity, risks, and benefits of including questions about potentially traumatic events and related symptoms that are particularly upsetting in screening, survey research, and clinical assessment. When included, it is important that researchers and practitioners monitor negative reactions to these assessments and connect participants who become distressed with appropriate services.
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Affiliation(s)
- M Claire Greene
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, 40 Haven Avenue, New York, NY, USA
| | - Jeremy C Kane
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Paul Bolton
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Laura K Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Milton L Wainberg
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, 40 Haven Avenue, New York, NY, USA
| | - Grace Yi
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amanda Sim
- Department of Psychiatry and Behavioural Neurosciences, Offord Centre for Child Studies, McMaster University, Hamilton, ON, Canada
| | - Eve Puffer
- Department of Psychology and Neuroscience, Duke Global Health Institute, Duke University, Durham, NC, USA
| | | | - Brian J Hall
- Global and Community Mental Health Research Group, New York University (Shanghai), 1555 Century Avenue, Pudong New District, Shanghai, 200122, People's Republic of China.
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Giusto A, Johnson SL, Lovero KL, Wainberg ML, Rono W, Ayuku D, Puffer ES. Building community-based helping practices by training peer-father counselors: A novel intervention to reduce drinking and depressive symptoms among fathers through an expanded masculinity lens. Int J Drug Policy 2021; 95:103291. [PMID: 34107387 PMCID: PMC8530851 DOI: 10.1016/j.drugpo.2021.103291] [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] [Received: 10/20/2020] [Revised: 03/31/2021] [Accepted: 04/27/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Problem drinking and co-occurring depression symptoms affect men at high rates and are associated with increased risk of family violence. In low- and middle-income countries, there is a large treatment gap for services due to a lack of human resources. Moreover, masculine norms are a barrier to men seeking treatment for drinking and depression in healthcare settings. We examined an approach for engaging peer-fathers to deliver an intervention to reduce alcohol use, improve depressive symptoms, and increase family involvement among fathers in Kenya with problem drinking. The intervention-LEAD (Learn, Engage, Act, Dedicate)-combines motivational interviewing, behavioral activation, and masculinity discussion strategies. METHODS Community and religious leaders nominated fathers with no mental health training to serve as counselors (N=12); clients were recruited through community referrals. Nominated fathers completed a 10-day training beginning with treatment principles followed by manualized content. Three counselors were selected after training based on quantitative and qualitative assessments of communication skills, intervention knowledge, willingness to learn, ability to use feedback, and empathy. Supervision was tiered with local supervisors and clinical psychologist consultation. During LEAD delivery, counselor fidelity, delivery quality, and general and intervention-specific competencies were assessed. To evaluate acceptability, qualitative interviews were conducted with lay-counselors and clients (N=11). Descriptive statistics were calculated for quantitative outcomes; interviews were analyzed using thematic analysis. RESULTS Peer-father lay counselors treated nine clients, with eight completing treatment. Counselors reached high rates of fidelity (93.8%) and high to optimal ratings on quality of delivery, clinical competency, and intervention-specific competencies. Qualitative results suggested high acceptability, with counselors expressing satisfaction and empowerment in their roles. Clients likewise described positive experiences with counselors. CONCLUSIONS Findings provide initial support for the acceptability and feasibility of recruitment, selection, and training processes for peer-father lay counselors to deliver LEAD through a lens of masculinity that aligned with clients help-acceptance practices.
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Affiliation(s)
- Ali Giusto
- Columbia University Medical Center, USA.
| | - Savannah L Johnson
- Duke University, Department of Psychology and Neuroscience, Durham, NC, 27705, USA
| | - Kathryn L Lovero
- New York State Psychiatric Institute, Columbia, University, Department of Psychiatry, New York, NY 10032, USA
| | - Milton L Wainberg
- New York State Psychiatric Institute, Columbia, University, Department of Psychiatry, New York, NY 10032, USA
| | - Wilter Rono
- Moi Teaching & Referral Hospital, Eldoret, Rift Valley, Kenya
| | - David Ayuku
- Moi Teaching & Referral Hospital, Department of Behavioral Sciences, Eldoret, Rift Valley, Kenya
| | - Eve S Puffer
- Duke University, Department of Psychology and Neuroscience; Duke Global Health Institute, Durham, NC, 27705, USA
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Greene MC, Yangchen T, Lehner T, Sullivan PF, Pato CN, McIntosh A, Walters J, Gouveia LC, Msefula CL, Fumo W, Sheikh TL, Stockton MA, Wainberg ML, Weissman MM. The epidemiology of psychiatric disorders in Africa: a scoping review. Lancet Psychiatry 2021; 8:717-731. [PMID: 34115983 PMCID: PMC9113063 DOI: 10.1016/s2215-0366(21)00009-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 01/12/2023]
Abstract
This scoping review of population-based epidemiological studies was done to provide background information on the prevalences and distribution of psychiatric disorders in Africa for calls to broaden diversity in psychiatric genetic studies. We searched PubMed, EMBASE, and Web of Science to retrieve relevant literature in English, French, and Portuguese from Jan 1, 1984, to Aug 18, 2020. In 36 studies from 12 African countries, the lifetime prevalence ranged from 3·3% to 9·8% for mood disorders, from 5·7% to 15·8% for anxiety disorders, from 3·7% to 13·3% for substance use disorders, and from 1·0% to 4·4% for psychotic disorders. Although the prevalence of mood and anxiety disorders appears to be lower than that observed in research outside the continent, we identified similar distributions by gender, although not by age or urbanicity. This review reveals gaps in epidemiological research on psychiatric disorders and opportunities to leverage existing epidemiological and genetic research within Africa to advance our understanding of psychiatric disorders. Studies that are methodologically comparable but diverse in geographical context are needed to advance psychiatric epidemiology and provide a foundation for understanding environmental risk in genetic studies of diverse populations globally.
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Affiliation(s)
- M Claire Greene
- Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Tenzin Yangchen
- Division of Translational Epidemiology, Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Thomas Lehner
- New York Genome Center, New York, NY, USA; Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, USA
| | - Patrick F Sullivan
- Center for Psychiatric Genomics, Department of Genetics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Carlos N Pato
- Institute for Genomic Health, SUNY Downstate, Health Science University, Brooklyn, NY, USA
| | - Andrew McIntosh
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
| | - James Walters
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Lidia C Gouveia
- Department of Mental Health, Ministry of Health-Mozambique, Maputo, Mozambique
| | - Chisomo L Msefula
- Pathology Department, College of Medicine, University of Malawi, Chichiri, Blantyre, Malawi
| | - Wilza Fumo
- Department of Mental Health, Ministry of Health-Mozambique, Maputo, Mozambique
| | - Taiwo L Sheikh
- Department of Psychiatry, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Melissa A Stockton
- Division of Translational Epidemiology, Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA; Columbia University Vagelos College of Physicians and Surgeons; New York State Psychiatric Institute, New York, NY, USA
| | - Milton L Wainberg
- Division of Translational Epidemiology, Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA; Columbia University Vagelos College of Physicians and Surgeons; New York State Psychiatric Institute, New York, NY, USA
| | - Myrna M Weissman
- Division of Translational Epidemiology, Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA; Columbia University Vagelos College of Physicians and Surgeons; New York State Psychiatric Institute, New York, NY, USA.
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48
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Lovero KL, Basaraba C, Khan S, Suleman A, Mabunda D, Feliciano P, dos Santos P, Fumo W, Mandlate F, Greene MC, Salem AF, Mootz JJ, Mocumbi AO, Duarte CS, Gouveia L, Oquendo MA, Wall MM, Wainberg ML. Brief Screening Tool for Stepped-Care Management of Mental and Substance Use Disorders. Psychiatr Serv 2021; 72:891-897. [PMID: 33993717 PMCID: PMC8328865 DOI: 10.1176/appi.ps.202000504] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Stepped mental health care requires a rapid method for nonspecialists to detect illness. This study aimed to develop and validate a brief instrument, the Mental Wellness Tool (mwTool), for identification and classification. METHODS Cross-sectional development and validation samples included adults at six health facilities in Mozambique. Mini International Neuropsychiatric Interview diagnoses were the criterion standard. Candidate items were from nine mental disorder and functioning assessments. Regression modeling and expert consultation determined best items for identifying any mental disorder and classifying positives into disorder categories (severe mental disorder, common mental disorder, substance use disorder, and suicide risk). For validation, sensitivity and specificity were calculated for any mental disorder (index and proxy respondents) and disorder categories (index). RESULTS From the development sample (911 participants, mean±SD age=32.0±11 years, 63% female), 13 items were selected-three with 0.83 sensitivity (95% confidence interval [CI]=0.79-0.86) for any mental disorder and 10 additional items classifying participants with a specificity that ranged from 0.72 (severe mental disorder) to 0.90 (suicide risk). For validation (453 participants, age 31±11 years, 65% female), sensitivity for any mental disorder was 0.94 (95% CI=0.89-0.97) with index responses and 0.73 (95% CI=0.58-0.85) with family proxy responses. Specificity for categories ranged from 0.47 (severe mental disorder) to 0.93 (suicide risk). Removing one item increased severe mental disorder specificity to 0.63 (95% CI=0.58-0.68). CONCLUSIONS The mwTool performed well for identification of any mental disorder with index and proxy responses to three items and for classification into treatment categories with index responses to nine additional items.
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Affiliation(s)
- Kathryn L. Lovero
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Cale Basaraba
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York
| | - Saida Khan
- Health Directorate of Maputo City, Ministry of Health, Maputo, Mozambique
- Universidade Eduardo Mondlane School of Medicine, Maputo, Mozambique
| | - Antonio Suleman
- Health Directorate of Nampula Province, Ministry of Health, Nampula, Mozambique
- Nampula Psychiatric Hospital, Nampula, Mozambique
| | - Dirceu Mabunda
- Health Directorate of Maputo City, Ministry of Health, Maputo, Mozambique
- Universidade Eduardo Mondlane School of Medicine, Maputo, Mozambique
| | - Paulino Feliciano
- Health Directorate of Nampula Province, Ministry of Health, Nampula, Mozambique
- Nampula Psychiatric Hospital, Nampula, Mozambique
| | - Palmira dos Santos
- Universidade Eduardo Mondlane School of Medicine, Maputo, Mozambique
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Wilza Fumo
- Universidade Eduardo Mondlane School of Medicine, Maputo, Mozambique
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Flavio Mandlate
- Universidade Eduardo Mondlane School of Medicine, Maputo, Mozambique
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - M. Claire Greene
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Andre Fiks Salem
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | | | - Ana Olga Mocumbi
- Universidade Eduardo Mondlane School of Medicine, Maputo, Mozambique
- National Institute of Health, Marracuene, Mozambique
| | - Cristiane S. Duarte
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Lidia Gouveia
- Universidade Eduardo Mondlane School of Medicine, Maputo, Mozambique
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Maria A. Oquendo
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Melanie M. Wall
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York
| | - Milton L. Wainberg
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York, New York
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49
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McElhiney MC, Rabkin JG, Wainberg ML, Finkel MR, Scodes J. Comparison of counseling methods to promote employment for HIV+ ADULTS. Work 2021; 69:981-995. [PMID: 34219692 DOI: 10.3233/wor-213529] [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] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Despite improved health and during a strong job market (pre-COVID-19), a substantial proportion of HIV+ adults remained unemployed. This study sought to provide time-limited counseling to promote employment goals. OBJECTIVE To determine whether behavioral activation (BA) or supportive counseling (SC), would be more effective in promoting vocational goals (full or part-time, paid or volunteer). METHODS The study included two groups: those with clinically significant fatigue, who were first treated with armodafinil. Once their fatigue diminished, they were enrolled in the counseling program. Those without fatigue were enrolled directly. Both BA and SC interventions were manualized, consisting of eight individual sessions plus a follow-up. RESULTS 116 participants entered counseling, including 87 assigned to BA and 29 to SC. Of these, 79 completed counseling or found a job by session eight. By follow-up, 51%of BA versus 41%of SC participants had found jobs, a non-significant difference either clinically or statistically. CONCLUSIONS Multiple issues contributed to difficulty in employment, including gaps in resumes, loss of contact with former colleagues, and uncertainty about career direction. Ongoing barriers included substance use, housing instability, ambivalence about forfeiting government benefits, as well as inadequately treated depression. Success in employment for about half of participants is, in this context, a reasonable outcome.
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Affiliation(s)
- Martin C McElhiney
- Department of Mood, Anxiety, Eating and Related Disorders New York State Psychiatric Institute New York, NY, USA.,Department of Psychiatry, College of Physicians and Surgeons, Columbia University Medical Center New York, NY, USA
| | - Judith G Rabkin
- Department of Mood, Anxiety, Eating and Related Disorders New York State Psychiatric Institute New York, NY, USA.,Department of Psychiatry, College of Physicians and Surgeons, Columbia University Medical Center New York, NY, USA
| | - Milton L Wainberg
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University Medical Center New York, NY, USA.,Department of Translational Epidemiology New York State Psychiatric Institute New York, NY, USA
| | - Madeline R Finkel
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University Medical Center New York, NY, USA
| | - Jennifer Scodes
- Department of Mental Health Data Science New York State Psychiatric Institute New York, NY, USA
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50
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Loch AA, Diaz AP, Pacheco-Palha A, Wainberg ML, da Silva AG, Malloy-Diniz LF. Editorial: Stigma's Impact on People With Mental Illness: Advances in Understanding, Management, and Prevention. Front Psychol 2021; 12:715247. [PMID: 34305768 PMCID: PMC8299415 DOI: 10.3389/fpsyg.2021.715247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/04/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Alexandre Andrade Loch
- Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Conselho Nacional de Desenvolvimento Científico e Tecnológico, São Paulo, Brazil
| | - Alexandre Paim Diaz
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | | | - Milton L Wainberg
- Department of Psychiatry, Columbia University, New York, NY, United States
| | - Antonio Geraldo da Silva
- Faculdade de Medicina, Universidade Do Porto, Porto, Portugal.,Brazilian Psychiatry Association - Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, Brazil
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