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Johnson JE, Hailemariam M, Zlotnick C, Richie F, Wiltsey-Stirman S. Analysis of implementation processes in a hybrid effectiveness-implementation trial of interpersonal psychotherapy (IPT) for major depressive disorder in prisons: Training, supervision, and recommendations. PLoS One 2024; 19:e0288182. [PMID: 38743716 PMCID: PMC11093331 DOI: 10.1371/journal.pone.0288182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 04/14/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND There are 10 million admissions to U.S. prisons and jails each year. More than half of those admitted have mental health problems. The goal of this article is to inform: (1) implementation of evidence-based mental health treatments in prisons and jails, an important effort that needs more evidence to guide it; (2) psychotherapy and interpersonal psychotherapy (IPT) training efforts, especially in low-resource settings. METHODS A randomized hybrid effectiveness-implementation trial of group IPT for major depressive disorder (MDD) in state prisons found that IPT increased rates of MDD remission and lowered posttraumatic stress disorder symptoms relative to prison treatment as usual. The trial used prison counselors, only some of whom had prior psychotherapy training/experience, to deliver IPT. IPT treatment adherence was high (96%), but trial training and supervision were too costly to be scalable outside the trial. The current article reports results from a planned qualitative analysis of 460 structured implementation and supervision documents in that trial to describe training and supervision processes and lessons learned, inform training recommendations, and facilitate future work to optimize training and supervision for under-resourced settings. RESULTS Themes identified in implementation and supervision process notes reflected: work on psychotherapy basics (reflective listening, focusing on emotions, open-ended questions, specific experiences), IPT case conceptualization (forming a conceptualization, what is and is not therapeutic work, structure and limit setting, structure vs. flexibility), IPT techniques (enhancing social support, role plays, communication analysis), psychotherapy processes (alliance repair, managing group processes), and managing difficult situations (avoidance, specific clients, challenging work settings). Counselors were receptive to feedback; some relied on study supervisors for support in managing stressful prison working conditions. CONCLUSIONS Findings can be used to make future training and supervision more efficient. Based on our results, we recommend that initial and refresher training focus on IPT case conceptualization, steps for addressing each IPT problem area, and reflective listening. We also recommend supervision through at least counselors' first two rounds of groups. More low-cost, scalable training methods are needed to get mental health treatment to individuals who need it most, who are often served in challenging, low-resource settings such as prisons. This is a mental health access and equity issue. TRIAL REGISTRATION The trial was registered at clinicaltrials.gov (NCT01685294).
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Affiliation(s)
- Jennifer E. Johnson
- Charles Stewart Mott Department of Public Health, College of Human Medicine, Michigan State University, Flint, Michigan, United States of America
| | - Maji Hailemariam
- Charles Stewart Mott Department of Public Health, College of Human Medicine, Michigan State University, Flint, Michigan, United States of America
| | - Caron Zlotnick
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island, United States of America
- Butler Hospital, Providence, Rhode Island, United States of America
- University of Cape Town, Cape Town, South Africa
| | - Fallon Richie
- University of North Carolina at Charlotte, Charlotte, North Carolina, United States of America
| | - Shannon Wiltsey-Stirman
- Dissemination and Training Division, National Center for PTSD, Menlo Park, California, United States of America
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Palo Alto, California, United States of America
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Riley-Gibson E, Hall A, Shoesmith A, Wolfenden L, Shelton RC, Doherty E, Pollock E, Booth D, Salloum RG, Laur C, Powell BJ, Kingsland M, Lane C, Hailemariam M, Sutherland R, Nathan N. A systematic review to determine the effect of strategies to sustain chronic disease prevention interventions in clinical and community settings: study protocol. Syst Rev 2024; 13:129. [PMID: 38725053 PMCID: PMC11084058 DOI: 10.1186/s13643-024-02541-0] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/23/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND The primary purpose of this review is to synthesise the effect of strategies aiming to sustain the implementation of evidenced-based interventions (EBIs) targeting key health behaviours associated with chronic disease (i.e. physical inactivity, poor diet, harmful alcohol use, and tobacco smoking) in clinical and community settings. The field of implementation science is bereft of an evidence base of effective sustainment strategies, and as such, this review will provide important evidence to advance the field of sustainability research. METHODS This systematic review protocol is reported in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) checklist. Methods will follow Cochrane gold-standard review methodology. The search will be undertaken across multiple databases, adapting filters previously developed by the research team, data screening and extraction will be performed in duplicate, strategies will be coded using an adapted sustainability-explicit taxonomy, and evidence will be synthesised using appropriate methods (i.e. meta-analytic following Cochrane or non-meta-analytic following SWiM guidelines). We will include any randomised controlled study that targets any staff or volunteers delivering interventions in clinical or community settings. Studies which report on any objective or subjective measure of the sustainment of a health prevention policy, practice, or programme within any of the eligible settings will be included. Article screening, data extraction, risk of bias, and quality assessment will be performed independently by two review authors. Risk of bias will be assessed using Version 2 of the Cochrane risk-of-bias tool for randomised trials (RoB 2). A random-effect meta-analysis will be conducted to estimate the pooled effect of sustainment strategies separately by setting (i.e. clinical and community). Sub-group analyses will be undertaken to explore possible causes of statistical heterogeneity and may include the following: time period, single or multi-strategy, type of setting, and type of intervention. Differences between sub-groups will be statistically compared. DISCUSSION/CONCLUSION This will be the first systematic review to determine the effect of strategies designed to support sustainment on sustaining the implementation of EBIs in clinical and community settings. The findings of this review will directly inform the design of future sustainability-focused implementation trials. Further, these findings will inform the development of a sustainability practice guide for public health practitioners. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022352333.
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Affiliation(s)
- Edward Riley-Gibson
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia.
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia.
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
- Hunter New England Local Health District, Hunter New England Population Health, Newcastle, NSW, 2287, Australia.
| | - Alix Hall
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Local Health District, Hunter New England Population Health, Newcastle, NSW, 2287, Australia
| | - Adam Shoesmith
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Local Health District, Hunter New England Population Health, Newcastle, NSW, 2287, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Local Health District, Hunter New England Population Health, Newcastle, NSW, 2287, Australia
| | - Rachel C Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Emma Doherty
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Local Health District, Hunter New England Population Health, Newcastle, NSW, 2287, Australia
| | - Emma Pollock
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Local Health District, Hunter New England Population Health, Newcastle, NSW, 2287, Australia
| | - Debbie Booth
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Local Health District, Hunter New England Population Health, Newcastle, NSW, 2287, Australia
| | - Ramzi G Salloum
- Department of Health Outcomes & Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA
| | - Celia Laur
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, 76 Grenville StreetOntario, M5S 1B2, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, MO, USA
- Center for Dissemination and Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, MO, USA
- Division of Infectious Diseases, John T. Milliken Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Melanie Kingsland
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Local Health District, Hunter New England Population Health, Newcastle, NSW, 2287, Australia
| | - Cassandra Lane
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Local Health District, Hunter New England Population Health, Newcastle, NSW, 2287, Australia
| | - Maji Hailemariam
- Division of Public Health, College of Human Medicine, Michigan State University, Flint, MI, USA
| | - Rachel Sutherland
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Local Health District, Hunter New England Population Health, Newcastle, NSW, 2287, Australia
| | - Nicole Nathan
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Local Health District, Hunter New England Population Health, Newcastle, NSW, 2287, Australia
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Hailemariam M, Bustos TE, Montgomery BW, Brown G, Tefera G, Adaji R, Taylor B, Eshetu H, Barajas C, Barajas R, Najjar V, Dennis D, Hudson J, Felton JW, Johnson JE. Mental health interventions for individuals with serious mental illness in the criminal legal system: a systematic review. BMC Psychiatry 2024; 24:199. [PMID: 38475800 DOI: 10.1186/s12888-024-05612-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 02/14/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Globally, individuals with mental illness get in contact with the law at a greater rate than the general population. The goal of this review was to identify and describe: (1) effectiveness of mental health interventions for individuals with serious mental illness (SMI) who have criminal legal involvement; (2) additional outcomes targeted by these interventions; (3) settings/contexts where interventions were delivered; and (4) barriers and facilitating factors for implementing these interventions. METHODS A systematic review was conducted to summarize the mental health treatment literature for individuals with serious mental illness with criminal legal involvement (i.e., bipolar disorder, schizophrenia, major depressive disorder). Searches were conducted using PsychINFO, Embase, ProQuest, PubMed, and Web of Science. Articles were eligible if they were intervention studies among criminal legal involved populations with a mental health primary outcome and provided description of the intervention. RESULTS A total of 13 eligible studies were identified. Tested interventions were categorized as cognitive/behavioral, community-based, interpersonal (IPT), psychoeducational, or court-based. Studies that used IPT-based interventions reported clinically significant improvements in mental health symptoms and were also feasible and acceptable. Other interventions demonstrated positive trends favoring the mental health outcomes but did not show statistically and clinically significant changes. All studies reported treatment outcomes, with only 8 studies reporting both treatment and implementation outcomes. CONCLUSION Our findings highlight a need for more mental health research in this population. Studies with randomized design, larger sample size and studies that utilize non-clinicians are needed.
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Affiliation(s)
- Maji Hailemariam
- Charles Stewart Mott Department of Public Health, College of Human Medicine, Michigan State University, Flint, MI, USA.
| | | | | | - Garrett Brown
- Charles Stewart Mott Department of Public Health, College of Human Medicine, Michigan State University, Flint, MI, USA
| | - Gashaye Tefera
- College of Social Work, Florida State University, Tallahassee, USA
| | - Rosemary Adaji
- Department of Epidemiology and Biostatistics, Michigan State University, Flint, MI, USA
| | - Brandon Taylor
- Charles Stewart Mott Department of Public Health, College of Human Medicine, Michigan State University, Flint, MI, USA
| | - Hiywote Eshetu
- Charles Stewart Mott Department of Public Health, College of Human Medicine, Michigan State University, Flint, MI, USA
| | - Clara Barajas
- Dornsife School of Public Health, Health Management and Policy Department, Drexel University, Philadelphia, USA
| | - Rolando Barajas
- Georgetown University School of Medicine, Washington, DC, USA
| | - Vanessa Najjar
- College of Osteopathic Medicine, Michigan State University, Flint, MI, USA
| | - Donovan Dennis
- College of Human Medicine, Michigan State University, Flint, MI, USA
| | - Jasmiyne Hudson
- College of Human Medicine, Michigan State University, Flint, MI, USA
| | - Julia W Felton
- Center for Health Policy & Health Services Research, Henry Ford Health, Detroit, MI, USA
| | - Jennifer E Johnson
- Charles Stewart Mott Department of Public Health, College of Human Medicine, Michigan State University, Flint, MI, USA
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Johnson JE, Ramezani N, Viglione J, Hailemariam M, Taxman FS. Recommended Mental Health Practices for Individuals Interacting With U.S. Police, Court, Jail, Probation, and Parole Systems. Psychiatr Serv 2024; 75:246-257. [PMID: 37933131 DOI: 10.1176/appi.ps.20230029] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
OBJECTIVE Tens of millions of individuals with mental health problems interact with the U.S. criminal legal system (including 911, police, jail detention and sentences, courts, and probation and parole) each year. The authors sought to identify recommended mental health practices for criminal legal system-involved individuals and report the percentages of U.S. counties and of the U.S. population living in counties in which each recommended practice is present. METHODS Recommended practices for criminal legal-involved individuals with mental health problems were identified from meta-analyses, reviews, and best practice recommendations. Up to four respondents per county (i.e., jail, probation, community mental health, and community substance use treatment administrators) from 950 counties were asked whether each recommended practice was present for criminal legal-involved individuals. Weighted percentages of U.S. counties using recommended practices and of the U.S. population living in counties with each recommended practice are reported. RESULTS Fifty-nine recommended practices, including general mental health approaches (e.g., permanent supportive housing, Medicaid continuity) and diagnosis-specific mental health treatments (including medications and psychotherapies), were identified. Weighted data from respondents (N=791 from 519 counties) indicated that each recommended practice was present for criminal legal-involved individuals in only 21.9%-43.0% of U.S. counties. CONCLUSIONS These results inform implementation efforts by indicating the presence of recommended care practices for criminal legal-involved individuals with mental health problems in counties nationwide. Because supportive housing, access to Medicaid reactivation in jails, and psychosocial interventions for physical pain have low presence but high importance for recovery, implementation efforts might first target these approaches.
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Affiliation(s)
- Jennifer E Johnson
- Charles Stewart Mott Department of Public Health, Michigan State University, Flint (Johnson, Hailemariam); Department of Biostatistics, Virginia Commonwealth University, Richmond (Ramezani); Department of Criminal Justice, University of Central Florida, Orlando (Viglione); Schar School of Policy and Government, Center for Advancing Correctional Excellence, George Mason University, Fairfax, Virginia (Taxman)
| | - Niloofar Ramezani
- Charles Stewart Mott Department of Public Health, Michigan State University, Flint (Johnson, Hailemariam); Department of Biostatistics, Virginia Commonwealth University, Richmond (Ramezani); Department of Criminal Justice, University of Central Florida, Orlando (Viglione); Schar School of Policy and Government, Center for Advancing Correctional Excellence, George Mason University, Fairfax, Virginia (Taxman)
| | - Jill Viglione
- Charles Stewart Mott Department of Public Health, Michigan State University, Flint (Johnson, Hailemariam); Department of Biostatistics, Virginia Commonwealth University, Richmond (Ramezani); Department of Criminal Justice, University of Central Florida, Orlando (Viglione); Schar School of Policy and Government, Center for Advancing Correctional Excellence, George Mason University, Fairfax, Virginia (Taxman)
| | - Maji Hailemariam
- Charles Stewart Mott Department of Public Health, Michigan State University, Flint (Johnson, Hailemariam); Department of Biostatistics, Virginia Commonwealth University, Richmond (Ramezani); Department of Criminal Justice, University of Central Florida, Orlando (Viglione); Schar School of Policy and Government, Center for Advancing Correctional Excellence, George Mason University, Fairfax, Virginia (Taxman)
| | - Faye S Taxman
- Charles Stewart Mott Department of Public Health, Michigan State University, Flint (Johnson, Hailemariam); Department of Biostatistics, Virginia Commonwealth University, Richmond (Ramezani); Department of Criminal Justice, University of Central Florida, Orlando (Viglione); Schar School of Policy and Government, Center for Advancing Correctional Excellence, George Mason University, Fairfax, Virginia (Taxman)
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Ng LC, Hook K, Hailemariam M, Selamu M, Fekadu A, Hanlon C. Experience of traumatic events in people with severe mental illness in a low-income country: a qualitative study. Int J Ment Health Syst 2023; 17:45. [PMID: 38053187 PMCID: PMC10699012 DOI: 10.1186/s13033-023-00616-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/22/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND This study describes the trauma experiences of people with severe mental illness (SMI) in Ethiopia and presents a model of how SMI and trauma exposure interact to reduce functioning and quality of life in this setting. METHODS A total of 53 participants living and working in a rural district in southern Ethiopia were interviewed: 18 people living with SMI, 21 caregivers, and 14 primary health care providers. RESULTS Many participants reported that exposure to traumatic and stressful events led to SMI, exacerbated SMI symptoms, and increased caregiver stress and distress. In addition, SMI symptoms and caregiver desperation, stress or stigma were also reported to increase the possibility of trauma exposure. CONCLUSIONS Results suggest it is incumbent upon health professionals and the broader health community to view trauma exposure (broadly defined) as a public health problem that affects all, particularly individuals with SMI.
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Affiliation(s)
- Lauren C Ng
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA.
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA.
- Department of Psychiatry, Boston University, School of Medicine, Boston, MA, USA.
| | - Kimberly Hook
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
- Department of Psychiatry, Boston University, School of Medicine, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Maji Hailemariam
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, MI, USA
- Charles Stewart Mott Department of Public Health, College of Human Medicine, Michigan State University, Flint, MI, USA
| | - Medhin Selamu
- Center for Innovative Drug Development, Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, School of Medicine, College of Health Sciences, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- Center for Innovative Drug Development, Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, School of Medicine, College of Health Sciences, Addis Ababa, Ethiopia
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- Center for Innovative Drug Development, Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, School of Medicine, College of Health Sciences, Addis Ababa, Ethiopia
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Health Service and Population Research Department, Centre for Global Mental Health, King's College London, WHO Collaborating Centre for Mental Health Research and Training, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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Shelton RC, Hailemariam M, Iwelunmor J. Making the connection between health equity and sustainability. Front Public Health 2023; 11:1226175. [PMID: 37822544 PMCID: PMC10562623 DOI: 10.3389/fpubh.2023.1226175] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 09/05/2023] [Indexed: 10/13/2023] Open
Abstract
Sustainability and health inequities are key challenges in public health and healthcare. Research suggests that only about half of evidence-based interventions (EBIs) are sustained over time, and settings and populations experiencing systemic and structural barriers to health (e.g., poverty, racism, stigma, and discrimination) experience even greater challenges to sustainability. In this article, we argue that an enhanced focus on sustainability in the field of implementation science is critical in order to maximize the long-term health benefits and broader societal impacts of EBIs for all populations and settings. From an equity perspective, a focus on sustainability is particularly critical to prioritize among population sub-groups that have not historically received the benefits of health-related EBIs. We discuss how a health equity framing is essential to sustaining EBIs in under-resourced communities, and requires moving away from a deficit mindset that focuses on why EBIs are challenging to sustain, to one that focuses more on identifying and nurturing existing assets within individuals and communities to increase the likelihood that EBIs are sustained. We conclude with a discussion of future directions as well as recommendations and resources (e.g., frameworks, tools) to advance and make progress toward sustainability from a health equity mindset, including: (1) Actively planning early for sustainability alongside key partners; (2) Tracking progress toward enhancing sustainability and being accountable in doing so equitably for all settings and populations; and (3) Focusing on both equity and engagement early and often throughout the research process and all implementation phases.
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Affiliation(s)
- Rachel C. Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Maji Hailemariam
- C. S. Mott Department of Public Health and Department of OBGYN and Reproductive Biology, Michigan State University, Flint, MI, United States
| | - Juliet Iwelunmor
- Behavioral Science and Health Education, College for Public Health and Social Justice, St. Louis University, St. Louis, MO, United States
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Key KD, Carrera J, McMaughan DJ, Lapeyrouse L, Hawa R, Carter A, Bailey S, de Danzine V, Blanchard C, Hall J, Shariff N, Hailemariam M, Johnson J. Advancing Equity Through Centering Societal Values to Operationalize Racism as a Public Health Crisis: The KKey Values Inequities Model. Health Equity 2023; 7:477-486. [PMID: 37731777 PMCID: PMC10507931 DOI: 10.1089/heq.2023.0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 09/22/2023] Open
Abstract
Background The past two decades have been marked by increased efforts to advance equity in various disciplines, including social sciences, public health, environmental health, and medicine. In 2020, a national movement of municipalities declared racism a public health crisis. These efforts have coincided and likely shaped a growing sphere of federal and philanthropic funding for health equity, which frequently calls for practical interventions toward reducing and ultimately eliminating disparities. Disparities in health such as maternal mortality, infant mortality, diabetes, cancer, and stroke have been linked to root causes such as racism. Often, root causes are also linked to disparities in other sectors (i.e., finance/wealth attainment, educational attainment, career attainment, and home ownership). In 2021, in a study published in the New England Journal of Medicine, suggested that racist policies were root causes of U.S. racial health inequities. While racism, sexism, and classism, etc., are characterized as root causes, we posit that there is a deeper driver that has yet to be advanced. This presents a disparity-inequity model that maps disparities and inequities to the societal value system, not root causes. Methods The KKey Values Inequities Disparities Model described in this article combines a case study of the Flint Water Crisis to explore the historic impact of human devaluation and its role in systemic racism and classism, which ultimately creates and exacerbates inequities that produce disparities in communities. The model integrates the value system and its contribution to societal causes (formerly known as root causes). Conclusions A broadly defined values-inequities-disparities model will allow researchers, practitioners, decision makers, lawmakers, and community members to (1) assess the core root of inequities and disparities; (2) identify solutions in the human value domain; (3) design appropriate course corrective programming, interventions, processes, and procedures; and (4) create actions to integrate new systemic procedures and practices in our laws and governance to advance equity.
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Affiliation(s)
- Kent D. Key
- Charles Stewart Mott Department of Public Health, Michigan State University, Flint, Michigan, USA
| | - Jennifer Carrera
- Department of Sociology, Michigan State University, East Lansing, Michigan, USA
| | - Darcy Jones McMaughan
- College of Education and Human Sciences School of Community Health Sciences, Department of Counseling and Counseling Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Lisa Lapeyrouse
- Department of Public Health and Health Sciences, University of Michigan, Flint, Michigan, USA
| | - Roula Hawa
- School of Behavioural and Social Sciences, Brescia University, London, Ontario, Canada
| | | | | | | | - Courtney Blanchard
- Charles Stewart Mott Department of Public Health, Michigan State University, Flint, Michigan, USA
| | | | | | - Maji Hailemariam
- Charles Stewart Mott Department of Public Health, Michigan State University, Flint, Michigan, USA
| | - Jennifer Johnson
- Charles Stewart Mott Department of Public Health, Michigan State University, Flint, Michigan, USA
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Ramezani N, Hailemariam M, Breno AJ, Mackey BJ, Cuellar AE, Johnson JE, Taxman FS. Impact of County-level health infrastructure on participation in a reform effort to reduce the use of jail for individuals with mental health disorders. Health Justice 2023; 11:27. [PMID: 37401987 DOI: 10.1186/s40352-023-00226-9] [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] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/25/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND The national Stepping Up Initiative has attracted over 500 counties interested in reducing the use of jail for individuals with mental health disorders. This paper identifies socioeconomic, criminal legal, and health care factors that predict the likelihood of counties joining Stepping Up. RESULTS After performing variable selection, logistic regression models were performed on 3,141 U.S. counties. Counties designated as medically underserved and/or mental health staffing shortage areas were less likely to participate in this initiative. Logistic regression models showed that larger counties (populations over 250,000) with better health care infrastructure, more mental health providers per capita, higher percent of Medicaid funded drug treatment services, and at least one medical school, were more likely to join Stepping Up. These counties had lower per capita jail populations, higher concentration of police resources, and higher pretrial incarceration rate. CONCLUSIONS County-level health care delivery factors are major contributors to a county's likelihood, or willingness, of engaging in Stepping Up reform efforts to reduce jail population with mental health disorders issues. Therefore, improving availability and accessibility of medical and behavioral health care in different communities, may facilitate efforts to address the unnecessary incarceration of individuals with mental health disorders.
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Affiliation(s)
- Niloofar Ramezani
- Department of Biostatistics, Virginia Commonwealth University, 830 East Main Street, PO Box 980032, Richmond, VA, 23298-0032, USA.
| | - Maji Hailemariam
- Charles Stewart Mott Department of Public Health, College of Human Medicine, Michigan State University, Flint, MI, USA
| | - Alex J Breno
- Center for Advancing Correctional Excellence, Schar School of Policy and Government, George Mason University, Fairfax, VA, USA
| | - Benjamin J Mackey
- Center for Advancing Correctional Excellence, Schar School of Policy and Government, George Mason University, Fairfax, VA, USA
| | - Alison Evans Cuellar
- Department of Health Administration and Policy, George Mason University, Fairfax, VA, USA
| | - Jennifer E Johnson
- Charles Stewart Mott Department of Public Health, College of Human Medicine, Michigan State University, Flint, MI, USA
| | - Faye S Taxman
- Center for Advancing Correctional Excellence, Schar School of Policy and Government, George Mason University, Fairfax, VA, USA
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Moitra M, Owens S, Hailemariam M, Wilson KS, Mensa-Kwao A, Gonese G, Kamamia CK, White B, Young DM, Collins PY. Global Mental Health: Where We Are and Where We Are Going. Curr Psychiatry Rep 2023; 25:301-311. [PMID: 37256471 PMCID: PMC10230139 DOI: 10.1007/s11920-023-01426-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 05/15/2023] [Indexed: 06/01/2023]
Abstract
PURPOSE OF REVIEW To summarize recent findings in global mental health along several domains including socioeconomic determinants, inequities, funding, and inclusion in global mental health research and practice. RECENT FINDINGS Mental illness continues to disproportionately impact vulnerable populations and treatment coverage continues to be low globally. Advances in integrating mental health care and adopting task-shifting are accompanied by implementation challenges. The mental health impact of recent global events such as the COVID-19 pandemic, geo-political events, and environmental change is likely to persist and require coordinated care approaches for those in need of psychosocial support. Inequities also exist in funding for global mental health and there has been gradual progress in terms of building local capacity for mental health care programs and research. Lastly, there is an increasing effort to include people with lived experiences of mental health in research and policy shaping efforts. The field of global mental health will likely continue to be informed by evidence and perspectives originating increasingly from low- and middle-income countries along with ongoing global events and centering of relevant stakeholders.
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Affiliation(s)
- Modhurima Moitra
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, 98195, USA.
| | - Shanise Owens
- Department of Public Health, Department of Obstetrics, Gynecology and Reproductive Biology, Charles Stewart Mott, Michigan State University, East Lansing, USA
| | - Maji Hailemariam
- Department of Global Health, University of Washington, Seattle, USA
| | - Katherine S Wilson
- Department of Health Systems and Population Health, University of Washington, Seattle, USA
| | - Augustina Mensa-Kwao
- Department of Health Systems and Population Health, University of Washington, Seattle, USA
| | - Gloria Gonese
- Department of Health Systems and Population Health, University of Washington, Seattle, USA
| | - Christine K Kamamia
- Department of Health Systems and Population Health, University of Washington, Seattle, USA
| | - Belinda White
- Department of Health Systems and Population Health, University of Washington, Seattle, USA
| | - Dorraine M Young
- Department of Health Systems and Population Health, University of Washington, Seattle, USA
| | - Pamela Y Collins
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, 98195, USA
- Department of Health Systems and Population Health, University of Washington, Seattle, USA
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10
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Moitra M, Owens S, Hailemariam M, Wilson KS, Mensa-Kwao A, Gonese G, Kamamia CK, White B, Young DM, Collins PY. Correction to: Global Mental Health: Where We Are and Where We Are Going. Curr Psychiatry Rep 2023:10.1007/s11920-023-01434-8. [PMID: 37368181 DOI: 10.1007/s11920-023-01434-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Affiliation(s)
- Modhurima Moitra
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, 98195, USA.
| | - Shanise Owens
- Department of Health Systems and Population Health, University of Washington, Seattle, USA
| | - Maji Hailemariam
- Charles Stewart Mott Department of Public Health, Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University, East Lansing, USA
| | - Katherine S Wilson
- International Training and Education for Health (I-TECH), Department of Global Health, University of Washington, Seattle, USA
| | - Augustina Mensa-Kwao
- International Training and Education for Health (I-TECH), Department of Global Health, University of Washington, Seattle, USA
| | - Gloria Gonese
- Zimbabwe Technical Assistance, Training and Education for Health (Zim-TTECH), Harare, Zimbabwe
| | - Christine K Kamamia
- International Training and Education for Health (I-TECH), Department of Global Health, University of Washington, Seattle, USA
- International Training and Education Center for Health (I-TECH), Lilongwe, Malawi
| | - Belinda White
- International Training and Education Center for Health (I-TECH), Port of Spain, Trinidad and Tobago
| | - Dorraine M Young
- Caribbean Training and Education Center for Health (C-TECH), Kingston, Jamaica
| | - Pamela Y Collins
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, 98195, USA
- International Training and Education for Health (I-TECH), Department of Global Health, University of Washington, Seattle, USA
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11
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Riley-Gibson E, Hall A, Shoesmith A, Wolfenden L, Shelton RC, Doherty E, Pollock E, Booth D, Salloum RG, Laur C, Powell BJ, Kingsland M, Lane C, Hailemariam M, Sutherland R, Nathan N. A systematic review to determine the effect of strategies to sustain chronic disease prevention interventions in clinical and community settings: study protocol. Res Sq 2023:rs.3.rs-2333454. [PMID: 37398340 PMCID: PMC10312971 DOI: 10.21203/rs.3.rs-2333454/v1] [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: 07/04/2023]
Abstract
Background The primary purpose of this review is to synthesise the effect of strategies aiming to sustain the implementation of evidenced based interventions (EBIs) targeting key health behaviours associated with chronic disease (i.e., physical inactivity, poor diet, harmful alcohol use and tobacco smoking) in clinical and community settings. The field of implementation science is bereft of an evidence base of effective sustainment strategies, and as such this review will provide important evidence to advance the field of sustainability research. Methods This systematic review protocol is reported in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis Protocol (PRISMA-P) checklist (Additional file 1). Methods will follow Cochrane gold-standard review methodology. The search will be undertaken across multiple databases, adapting filters previously developed by the research team; data screening and extraction will be performed in duplicate; strategies will be coded using an adapted sustainability-explicit taxonomy; evidence will be synthesised using appropriate methods (i.e. meta-analytic following Cochrane or non-meta-analytic following SWiM guidelines). We will include any randomised controlled study that targets any staff or volunteers delivering interventions in clinical or community settings. Studies which report on any objective or subjective measure of the sustainment of a health prevention policy, practice, or program within any of the eligible settings will be included. Article screening, data extraction, risk of bias and quality assessment will be performed independently by two review authors. Risk of bias will be assessed using Version 2 of the Cochrane risk-of-bias tool for randomised trials (RoB 2). A random effect meta-analysis will be conducted to estimate the pooled effect of sustainment strategies separately by setting (i.e. clinical and community). Sub-group analyses will be undertaken to explore possible causes of statistical heterogeneity and may include: time period, single or multi strategy, type of setting and type of intervention. Differences between sub-groups will be statistically compared. Discussion/Conclusion This will be the first systematic review to determine the effect of strategies designed to support sustainment on sustaining the implementation of EBIs in clinical and community settings. The findings of this review will directly inform the design of future sustainability-focused implementation trials. Further, these findings will inform the development of a sustainability practice guide for public health practitioners. Registration This review was prospectively registered with PROSPERO (registration ID: CRD42022352333).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Celia Laur
- University of Toronto Institute of Health Policy Management and Evaluation
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12
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Hailemariam M, Johnson JE, Johnson DM, Sikorskii A, Zlotnick C. Computer-based intervention for residents of domestic violence shelters with substance use: A randomized pilot study. PLoS One 2023; 18:e0285560. [PMID: 37228153 DOI: 10.1371/journal.pone.0285560] [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] [Received: 10/13/2022] [Accepted: 04/25/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Intimate Partner Violence (IPV) is a significant public health problem often associated with serious mental health and physical health implications. Substance use disorders (SUDs) are one of the most common comorbidities among women with IPV, increasing risk of subsequent IPV. METHODS The current study examined the feasibility, acceptability, and preliminary effectiveness of a brief computerized intervention to reduce alcohol and drug use among women with IPV. Fifty women with recent IPV and alcohol and drug use risk were recruited from domestic violence shelters and randomized to the experimental computerized intervention or to an attention and time control condition. The primary outcome was percent heavy drinking or drug using days in 3 month increments over the 6 months after leaving the shelter. Receipt of substance use services and IPV severity were evaluated as secondary outcomes. RESULTS The computerized intervention was feasible and acceptable, with high (n = 20, 80%) completion rates, engagement with the intervention, and satisfaction scores. As expected in this pilot trial, there were no significant differences between conditions in percent heavy drinking/drug using days or receipt of substance use services and large individual differences in outcomes. For example, receipt of substance use services decreased by a mean of 0.05 times/day from the baseline to the 6-month time period in the control condition (range -1.00 to +0.55) and increased by a mean of 0.06 times/day in the intervention condition (range -0.13 to +0.89). There were large decreases in IPV severity over time in both conditions, but directions of differences favored the control condition for IPV severity. CONCLUSION A computerized intervention to reduce the risk of alcohol/drug use and subsequent IPV is feasible and acceptable among residents of a domestic violence shelter. A fully powered trial is needed to conclusively evaluate outcomes.
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Affiliation(s)
- Maji Hailemariam
- Charles Stewart Mott Department of Public Health, Michigan State University, College of Human Medicine, Flint, Michigan, United States of America
- Department of Obstetrics Gynecology and Reproductive Biology, Michigan State University, College of Human Medicine, East Lansing, Michigan, United States of America
| | - Jennifer E Johnson
- Charles Stewart Mott Department of Public Health, Michigan State University, College of Human Medicine, Flint, Michigan, United States of America
- Department of Obstetrics Gynecology and Reproductive Biology, Michigan State University, College of Human Medicine, East Lansing, Michigan, United States of America
| | - Dawn M Johnson
- Department of Psychology, University of Akron, Akron, Ohio, United States of America
| | - Alla Sikorskii
- Department of Psychiatry, Michigan State University, College of Osteopathic Medicine, East Lansing, Michigan, United States of America
| | - Caron Zlotnick
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island, United States of America
- Department of Medicine at Women and Infants Hospital, Providence, Rhode Island, United States of America
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Nathan N, Shelton RC, Laur CV, Hailemariam M, Hall A. Editorial: Sustaining the implementation of evidence-based interventions in clinical and community settings. Front Health Serv 2023; 3:1176023. [PMID: 37033900 PMCID: PMC10080155 DOI: 10.3389/frhs.2023.1176023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/09/2023] [Indexed: 04/11/2023]
Affiliation(s)
- Nicole Nathan
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- National Centre of Implementation Science, Newcastle, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- Correspondence: Nicole Nathan
| | - Rachel C. Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Celia V. Laur
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Maji Hailemariam
- Department of Obstetrics, Gynaecology and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, MI, United States
| | - Alix Hall
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- National Centre of Implementation Science, Newcastle, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, Australia
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14
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Nathan N, Powell BJ, Shelton RC, Laur CV, Wolfenden L, Hailemariam M, Yoong SL, Sutherland R, Kingsland M, Waltz TJ, Hall A. Do the Expert Recommendations for Implementing Change (ERIC) strategies adequately address sustainment? Front Health Serv 2022; 2:905909. [PMID: 36925827 PMCID: PMC10012683 DOI: 10.3389/frhs.2022.905909] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022]
Abstract
Background Sustainability science is an emerging area within implementation science. There is limited evidence regarding strategies to best support the continued delivery and sustained impact of evidence-based interventions (EBIs). To build such evidence, clear definitions, and ways to operationalize strategies specific and/or relevant to sustainment are required. Taxonomies and compilations such as the Expert Recommendations for Implementing Change (ERIC) were developed to describe and organize implementation strategies. This study aimed to adapt, refine, and extend the ERIC compilation to incorporate an explicit focus on sustainment. We also sought to classify the specific phase(s) of implementation when the ERIC strategies could be considered and applied. Methods We used a two-phase iterative approach to adapt the ERIC. This involved: (1) adapting through consensus (ERIC strategies were mapped against barriers to sustainment as identified via the literature to identify if existing implementation strategies were sufficient to address sustainment, needed wording changes, or if new strategies were required) and; (2) preliminary application of this sustainment-explicit ERIC glossary (strategies described in published sustainment interventions were coded against the glossary to identify if any further amendments were needed). All team members independently reviewed changes and provided feedback for subsequent iterations until consensus was reached. Following this, and utilizing the same consensus process, the Exploration, Preparation, Implementation and Sustainment (EPIS) Framework was applied to identify when each strategy may be best employed across phases. Results Surface level changes were made to the definitions of 41 of the 73 ERIC strategies to explicitly address sustainment. Four additional strategies received deeper changes in their definitions. One new strategy was identified: Communicate with stakeholders the continued impact of the evidence-based practice. Application of the EPIS identified that at least three-quarters of strategies should be considered during preparation and implementation phases as they are likely to impact sustainment. Conclusion A sustainment-explicit ERIC glossary is provided to help researchers and practitioners develop, test, or apply strategies to improve the sustainment of EBIs in real-world settings. Whilst most ERIC strategies only needed minor changes, their impact on sustainment needs to be tested empirically which may require significant refinement or additions in the future.
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Affiliation(s)
- Nicole Nathan
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW, Australia
| | - Byron J. Powell
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, MO, United States
- Division of Infectious Diseases, John T. Milliken Department of Medicine, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
- Center for Dissemination and Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, MO, United States
| | - Rachel C. Shelton
- Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, New York, NY, United States
| | - Celia V. Laur
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW, Australia
| | - Maji Hailemariam
- Department of Obstetrics, Gynaecology and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, MI, United States
| | - Sze Lin Yoong
- School of Health Science, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Rachel Sutherland
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW, Australia
| | - Melanie Kingsland
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW, Australia
| | - Thomas J. Waltz
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, United States
| | - Alix Hall
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW, Australia
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15
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Sneed RS, Hailemariam M, Key KD, Jordan T, Miller R, Richie F, Robinson D, Saddler S, Spencer B, Summers M, McCoy White J, Johnson JE. Developing and maintaining intergenerational relationships in an economically vulnerable community: findings from the Flint women's study. J Women Aging 2022; 34:706-718. [PMID: 34905462 PMCID: PMC9208572 DOI: 10.1080/08952841.2021.2015229] [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] [Indexed: 12/16/2022]
Abstract
Few studies describe how community disadvantage impacts intergenerational relationships. Using interviews with women and service providers (n = 100), we explored benefits and challenges of intergenerational relationships in Flint, Michigan, an economically vulnerable community. Women valued relationships that increased social connections and generativity; however, few community resources promoted such relationships. Intergenerational relationships were important for leaving a social legacy in lieu of a meaningful economic legacy. Some middle-aged women are overwhelmed by caregiving, balancing employment while caring for multiple generations. Women desired intergenerational activities that include children and younger adult women. Further, caregiving programs should attend to the needs of middle-aged caregivers.
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Affiliation(s)
- Rodlescia S Sneed
- College of Human Medicine, Michigan State University, Flint, Michigan, USA
| | - Maji Hailemariam
- College of Human Medicine, Michigan State University, Flint, Michigan, USA
| | - Kent D Key
- College of Human Medicine, Michigan State University, Flint, Michigan, USA
- Community Based Organization Partners, Flint, Michigan, USA
| | - Tamara Jordan
- College of Human Medicine, Michigan State University, Flint, Michigan, USA
| | - Raven Miller
- College of Human Medicine, Michigan State University, Flint, Michigan, USA
| | - Fallon Richie
- College of Liberal Arts and Sciences, Health Psychology, University of North Carolina Charlotte, Charlotte, North Carolina, USA
| | | | - Sharon Saddler
- Community Based Organization Partners, Flint, Michigan, USA
- Community Resident, Flint, Michigan, USA
| | - Bryan Spencer
- Community Resident, Flint, Michigan, USA
- My Exceptionality LLC, Flint, Michigan, USA
| | - Monicia Summers
- College of Human Medicine, Michigan State University, Flint, Michigan, USA
| | - Jonne McCoy White
- College of Human Medicine, Michigan State University, Flint, Michigan, USA
| | - Jennifer E Johnson
- College of Human Medicine, Michigan State University, Flint, Michigan, USA
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16
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Hailemariam M, Bustos TE, Felton JW, Key K, Greer D, Jefferson BL, Miller R, Richie F, Summers M, White JM, Johnson JE. Belonging to Something Greater Than Self: Flint Women Giving Back to the Community. Prog Community Health Partnersh 2022; 16:181-191. [PMID: 35662145 DOI: 10.1353/cpr.2022.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Having meaning in life promotes happiness and well-being across the lifespan. METHODS A community-based participatory qualitative study was conducted to understand meaning in life, having a voice and the different ways women give back to their community by serving others. Interviews were held with participants (n = 100) who were community residents, people serving women, or both. RESULTS Participants defined meaning in life as having a sense of significance, a deep connection to their community, and a sense of acknowledgement for their overall contributions. They emphasized the importance of opportunities for women to contribute to something greater than themselves. Participants suggested organizations would be responsive to the needs of women when women have a stronger voice. CONCLUSIONS Women served their community in many roles. However, despite some societal progress, women continue to be underpaid and their contributions undervalued. Rectifying these inequities might contribute to better addressing the needs of women.
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Hailemariam M, Bustos TE, Felton JW, Key K, Greer D, Jefferson BL, Miller R, Richie F, Summers M, White JM, Johnson JE. Belonging to Something Greater Than Self: Flint Women Giving Back to the Community. Prog Community Health Partnersh 2022. [DOI: 10.1353/cpr.2022.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hailemariam M, Zlotnick C, Taft A, Johnson JE. MOSAIC (MOthers’ AdvocateS In the Community) for pregnant women and mothers of children under 5 with experience of intimate partner violence: A pilot randomized trial study protocol. PLoS One 2022; 17:e0267679. [PMID: 35584181 PMCID: PMC9116623 DOI: 10.1371/journal.pone.0267679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 04/22/2022] [Indexed: 11/19/2022] Open
Abstract
Background Pregnancy and motherhood increase the risk for long-term exposure to physical, psychological and sexual intimate partner violence (IPV; sexual or physical violence by current or former partners). Pregnant women and mothers with children under 5 who have experienced IPV exhibit poor physical and mental health and obstetric outcomes. Depression and posttraumatic stress disorder (PTSD) are the two most common mental health consequences of IPV. There is good evidence that women with good social support have better mental health and IPV outcomes. Methods This study will develop MOthers’ AdvocateS In the Community (MOSAIC) Plus intervention for pregnant women and mothers with children under the age of 5. MOSAIC uses trained mentor mothers and has been found to reduce subsequent IPV. This study will blend the original MOSAIC intervention with principles of interpersonal psychotherapy (IPT) to address symptoms of depression, PTSD, and prevent subsequent risk of IPV. We will conduct a pilot randomized trial of the MOSAIC Plus intervention compared to the traditional MOSAIC intervention to determine its feasibility and acceptability. Study samples include focus groups (n = 36), open trial (n = 15), and a randomized pilot trial including 40 pregnant women and mothers with children under 5 who report current/recent of IPV and elevated symptoms of maternal depression and/or PTSD. The study’s primary outcome will be changes in maternal depressive and PTSD symptoms. Secondary outcomes will include reduction in subsequent IPV, improvement in functioning, changes in social support and effectiveness in obtaining resources. Discussion This is a formative study evaluating the feasibility and acceptability of a mentor mother intervention for pregnant women and mothers with children under 5. Promising results of this study will be used for a larger, fully-powered randomized trial evaluating the effectiveness of a mentor mother intervention in preventing subsequent IPV and reducing depressive and PTSD symptoms in this population.
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Affiliation(s)
- Maji Hailemariam
- Department of Obstetrics, Gynaecology and Reproductive Biology, Michigan State University, College of Human Medicine, East Lansing, MI, United States of America
- * E-mail:
| | - Caron Zlotnick
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, United States of America
- Department of Medicine at Women and Infants Hospital, Providence, RI, United States of America
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Angela Taft
- Judith Lumley Centre for Mother, Infant and Family Health Research, Latrobe University, Bundoora, Australia
| | - Jennifer E. Johnson
- Department of Obstetrics, Gynaecology and Reproductive Biology, Michigan State University, College of Human Medicine, East Lansing, MI, United States of America
- Division of Public Health, College of Human Medicine, Michigan State University, Flint, MI, United States of America
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Fekadu A, Demissie M, Birhane R, Medhin G, Bitew T, Hailemariam M, Minaye A, Habtamu K, Milkias B, Petersen I, Patel V, Cleare AJ, Mayston R, Thornicroft G, Alem A, Hanlon C, Prince M. Under detection of depression in primary care settings in low and middle-income countries: a systematic review and meta-analysis. Syst Rev 2022; 11:21. [PMID: 35123556 PMCID: PMC8818168 DOI: 10.1186/s13643-022-01893-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 01/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression is one of the commonest mental disorders in primary care but is poorly identified. The objective of this review was to determine the level of detection of depression by primary care clinicians and its determinants in studies from low- to middle-income countries (LMICs). METHODS A systematic review and meta-analysis was conducted using PubMed, PsycINFO, MEDLINE, EMBASE, LILAC, and AJOL with no restriction of year of publication. Risk of bias within studies was evaluated with the Effective Public Health Practice Project (EPHPP). "Gold standard" diagnosis for the purposes of this review was based on the 9-item Patient Health Questionnaire (PHQ-9; cutoff scores of 5 and 10), other standard questionnaires and interview scales or expert diagnosis. Meta-analysis was conducted excluding studies on special populations. Analyses of pooled data were stratified by diagnostic approaches. RESULTS A total of 3159 non-duplicate publications were screened. Nine publications, 2 multi-country studies, and 7 single-country studies, making 12 country-level reports, were included. Overall methodological quality of the studies was good. Depression detection was 0.0% in four of the twelve reports and < 12% in another five. PHQ-9 was the main tool used: the pooled detection in two reports that used PHQ-9 at a cutoff point of 5 (combined sample size = 1426) was 3.9% (95% CI = 2.3%, 5.5%); in four reports that used PHQ-9 cutoff score of 10 (combined sample size = 5481), the pooled detection was 7.0% (95% CI = 3.9%, 10.2%). Severity of depression and suicidality were significantly associated with detection. CONCLUSIONS While the use of screening tools is an important limitation, the extremely low detection of depression by primary care clinicians poses a serious threat to scaling up mental healthcare in LMICs. Interventions to improve detection should be prioritized. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016039704 .
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Affiliation(s)
- Abebaw Fekadu
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia. .,Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia. .,Department of Global Health & Infection, Brighton and Sussex Medical School, Brighton, UK. .,Center for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London, London, UK.
| | - Mekdes Demissie
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Rahel Birhane
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tesera Bitew
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Debremarkos University, Debremarkos, Ethiopia
| | - Maji Hailemariam
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Division of Public Health, College of Human Medicine, Michigan State University, Flint, MI, USA
| | - Abebaw Minaye
- School of Psychology, College of Education and Behavioral Studies, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kassahun Habtamu
- School of Psychology, College of Education and Behavioral Studies, Addis Ababa University, Addis Ababa, Ethiopia
| | - Barkot Milkias
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Inge Petersen
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Cambridge, MA, USA
| | - Anthony J Cleare
- Center for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London, London, UK
| | - Rosie Mayston
- King's Global Health Institute, King's College London, NE Wing Bush House, 30 Aldwych, London, WC2B 4BJ, UK
| | - Graham Thornicroft
- Centre for Global Mental Health, King's College London, De Crespigny Park, London, SE5 8AF, UK.,Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Atalay Alem
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Centre for Global Mental Health, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Martin Prince
- King's Global Health Institute, King's College London, NE Wing Bush House, 30 Aldwych, London, WC2B 4BJ, UK.,Centre for Global Mental Health, King's College London, De Crespigny Park, London, SE5 8AF, UK
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20
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Masten M, Vega S, Hailemariam M, Kagotho N, Key K, Jefferson B, Muhammad J, Summers M, Spencer B, Sadler S, Robinson D, Richie F, Miller R, McCoy JW, Greer D, Johnson JE. The Flint women's study: community perspectives on contraception and family planning, sexuality education and barriers to reproductive health. Cult Health Sex 2021; 23:961-975. [PMID: 32484423 DOI: 10.1080/13691058.2020.1746401] [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: 06/01/2019] [Accepted: 03/19/2020] [Indexed: 06/11/2023]
Abstract
Teenage pregnancy can have adverse social and health outcomes, and rates are high in Flint, Michigan as compared to the rest of the state and the USA. It is important to understand contributing factors to adolescent pregnancy to be able to better address this issue. This study examined qualitative data from interviews with 100 community members who participated in the Flint Women's Study, a study designed to better understand the hopes, dreams and needs of women in Flint, and their suggestions for how to address identified needs. Using a Community Based Participatory Approach, data were collected and analysed by a team of community members and academic researchers. The paper focuses on the theme of family planning among young women which included attitudes about contraception, sexuality education and bio-medical and structural barriers to accessing reproductive health. Community members emphasised the need for increased access to comprehensive contraception options, improved sexuality education in schools and from health care providers, and ultimately valuing young women.
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Affiliation(s)
- Megan Masten
- College of Human Medicine, Michigan State University, Flint, MI, USA
- Department of Obstetrics and Gynecology, University of Colorado, Aurora, CO, USA
| | - Shayna Vega
- College of Human Medicine, Michigan State University, Flint, MI, USA
| | - Maji Hailemariam
- College of Human Medicine, Michigan State University, Flint, MI, USA
| | - Njeri Kagotho
- College of Social Work, Ohio State University, Columbus, OH, USA
| | - Kent Key
- College of Human Medicine, Michigan State University, Flint, MI, USA
- Flint Community, Flint, MI, USA
| | | | | | - Monicia Summers
- College of Human Medicine, Michigan State University, Flint, MI, USA
- Flint Community, Flint, MI, USA
| | | | | | | | - Fallon Richie
- College of Human Medicine, Michigan State University, Flint, MI, USA
| | - Raven Miller
- College of Human Medicine, Michigan State University, Flint, MI, USA
| | - Jonne White McCoy
- College of Human Medicine, Michigan State University, Flint, MI, USA
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21
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Kola L, Kohrt BA, Hanlon C, Naslund JA, Sikander S, Balaji M, Benjet C, Cheung EYL, Eaton J, Gonsalves P, Hailemariam M, Luitel NP, Machado DB, Misganaw E, Omigbodun O, Roberts T, Salisbury TT, Shidhaye R, Sunkel C, Ugo V, van Rensburg AJ, Gureje O, Pathare S, Saxena S, Thornicroft G, Patel V. COVID-19 mental health impact and responses in low-income and middle-income countries: reimagining global mental health. Lancet Psychiatry 2021; 8:535-550. [PMID: 33639109 PMCID: PMC9764935 DOI: 10.1016/s2215-0366(21)00025-0] [Citation(s) in RCA: 332] [Impact Index Per Article: 110.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 12/30/2022]
Abstract
Most of the global population live in low-income and middle-income countries (LMICs), which have historically received a small fraction of global resources for mental health. The COVID-19 pandemic has spread rapidly in many of these countries. This Review examines the mental health implications of the COVID-19 pandemic in LMICs in four parts. First, we review the emerging literature on the impact of the pandemic on mental health, which shows high rates of psychological distress and early warning signs of an increase in mental health disorders. Second, we assess the responses in different countries, noting the swift and diverse responses to address mental health in some countries, particularly through the development of national COVID-19 response plans for mental health services, implementation of WHO guidance, and deployment of digital platforms, signifying a welcome recognition of the salience of mental health. Third, we consider the opportunity that the pandemic presents to reimagine global mental health, especially through shifting the balance of power from high-income countries to LMICs and from narrow biomedical approaches to community-oriented psychosocial perspectives, in setting priorities for interventions and research. Finally, we present a vision for the concept of building back better the mental health systems in LMICs with a focus on key strategies; notably, fully integrating mental health in plans for universal health coverage, enhancing access to psychosocial interventions through task sharing, leveraging digital technologies for various mental health tasks, eliminating coercion in mental health care, and addressing the needs of neglected populations, such as children and people with substance use disorders. Our recommendations are relevant for the mental health of populations and functioning of health systems in not only LMICs but also high-income countries impacted by the COVID-19 pandemic, with wide disparities in quality of and access to mental health care.
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Affiliation(s)
- Lola Kola
- WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria; BRiTE Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
| | - Brandon A Kohrt
- Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington, DC, USA
| | - Charlotte Hanlon
- Centre for Global Mental Health, Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Siham Sikander
- Global Health Department, Health Services Academy, Islamabad, Pakistan; Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | | | - Corina Benjet
- Division of Epidemiology and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Eliza Yee Lai Cheung
- The Reference Centre for Psychosocial Support, International Federation of the Red Cross and Red Crescent, Hong Kong Special Administrative Region, China; The Red Cross of the Hong Kong Special Administrative Region of China, Hong Kong Special Administrative Region, China
| | - Julian Eaton
- CBM Global and Centre for Global Mental Health, London, UK
| | - Pattie Gonsalves
- Wellcome-DBT India Alliance, Sangath, New Delhi, India; School of Psychology, University of Sussex, Brighton, UK
| | - Maji Hailemariam
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | | | - Daiane B Machado
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Centre for Data and Knowledge Integration for Health, CIDACS-FIOCRUZ, Bahia, Brazil
| | - Eleni Misganaw
- Mental Health Service Users Association Ethiopia, Addis Ababa, Ethiopia; Global Mental Health Peer Network, Pretoria, South Africa
| | - Olayinka Omigbodun
- WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria; Centre for Child and Adolescent Mental Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Tessa Roberts
- Centre for Society and Mental Health, Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tatiana Taylor Salisbury
- Centre for Global Mental Health, Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; WHO Collaborating Centre for Research and Training in Mental Health, Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Charlene Sunkel
- Global Mental Health Peer Network, Johannesburg, South Africa
| | - Victor Ugo
- Mentally Aware Nigeria Initiative, Lagos, Nigeria; United for Global Mental Health, London, UK
| | - André Janse van Rensburg
- Centre for Rural Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; Centre for Health Systems Research and Development, Faculty of Humanities, University of the Free State, Bloemfontein, South Africa
| | - Oye Gureje
- WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Soumitra Pathare
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Shekhar Saxena
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Graham Thornicroft
- Centre for Global Mental Health, Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Centre for Implementation Science, Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Wellcome-DBT India Alliance, Sangath, New Delhi, India
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22
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Johnson JE, Viglione J, Ramezani N, Cuellar AE, Hailemariam M, Rosen R, Breno A, Taxman FS. Protocol for a quasi-experimental, 950 county study examining implementation outcomes and mechanisms of Stepping Up, a national policy effort to improve mental health and substance use services for justice-involved individuals. Implement Sci 2021; 16:31. [PMID: 33781294 PMCID: PMC8006626 DOI: 10.1186/s13012-021-01095-2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/05/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The criminal justice system is the largest provider of mental health services in the USA. Many jurisdictions are interested in reducing the use of the justice system for mental health problems. The national Stepping Up Initiative helps agencies within counties work together more effectively to reduce the number of individuals with mental illness in jails and to improve access to mental health services in the community. This study will compare Stepping Up counties to matched comparison counties over time to (1) examine the effectiveness of Stepping Up and (2) test hypothesized implementation mechanisms to inform multi-agency implementation efforts more broadly. METHODS The study will survey 950 counties at baseline, 18 months, and 36 months in a quasi-experimental design comparing implementation mechanisms and outcomes between 475 Stepping Up counties and 475 matched comparison counties. Surveys will be sent to up to four respondents per county including administrators of jail, probation, community mental health services, and community substance use treatment services (3800 total respondents). We will examine whether Stepping Up counties show faster improvements in implementation outcomes (number of justice-involved clients receiving behavioral health services, number of behavioral health evidence-based practices and policies [EBPPs] available to justice-involved individuals, and resources for behavioral health EBPP for justice-involved individuals) than do matched comparison counties. We will also evaluate whether engagement of hypothesized mechanisms explains differences in implementation outcomes. Implementation target mechanisms include (1) use of and capacity for performance monitoring, (2) use and functioning of interagency teams, (3) common goals and mission across agencies, and (4) system integration (i.e., building an integrated system of care rather than adding one program or training). Finally, we will characterize implementation processes and critical incidents using survey responses and qualitative interviews. DISCUSSION There are few rigorous, prospective studies examining implementation mechanisms and their relationship with behavioral health implementation outcomes in justice and associated community behavioral health settings. There is also limited understanding of implementation mechanisms that occur across systems with multiple goals. This study will describe implementation outcomes of Stepping Up and will elucidate target mechanisms that are effective in multi-goal, multi-agency systems.
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Affiliation(s)
- Jennifer E. Johnson
- Division of Public Health, Michigan State University, 200 East 1st St Room 366, Flint, MI 48502 USA
| | - Jill Viglione
- Department of Criminal Justice, University of Central Florida, 12805 Pegasus Drive, Orlando, FL 32816 USA
| | - Niloofar Ramezani
- Department of Statistics, George Mason University, 4400 University Drive, MS 4A7, Fairfax, VA 22030 USA
| | - Alison E. Cuellar
- Department of Health Administration and Policy, George Mason University, Fairfax, VA 22030 USA
| | - Maji Hailemariam
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, 965 Wilson Road, A631B, East Lansing, MI 48824 USA
| | - Rochelle Rosen
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI USA
| | - Alex Breno
- Center for Advancing Correctional Excellence, George Mason University, 4400 University Drive, Fairfax, VA 22030 USA
| | - Faye S. Taxman
- Schar School of Policy & Government, Center for Advancing Correctional Excellence, George Mason University, 4400 University Drive, Fairfax, VA 22030 USA
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23
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Hailemariam M, Key K, Jefferson BL, Muhammud J, Johnson JE. Community-Based Participatory Qualitative Research for Women: Lessons from the Flint Women's Study. Prog Community Health Partnersh 2021; 14:207-213. [PMID: 33416642 DOI: 10.1353/cpr.2020.0017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The Flint Women's Study is a large community-based participatory qualitative study designed to create and inform community initiatives to serve Flint-area women by exploring their needs, challenges, hopes, dreams, assets, and thoughts about solutions. This article describes the study goals, processes, and lessons learned. METHODS We conducted in-depth qualitative interviews with 100 Flint-area women or human service providers serving area women. Participants represented diverse professional backgrounds, life experiences, ages, races, and ethnicities. Community members participated in developing the qualitative interview guide, participant recruitment, qualitative coding, analysis, publication, and creation of initiatives based on results. LESSONS LEARNED Partnering in discovery and in identifying solutions provides a strong foundation for building trust and mutual capacity. The coding experience helped community partners to hone marketable qualitative research skills, which can elevate community's voice in research. CONCLUSIONS Efforts to benefit women should ensure their representation in every step of the process.
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24
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Affiliation(s)
- Maji Hailemariam
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, MI 48824, USA.
| | - Soumitra Pathare
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
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Felton JW, Hailemariam M, Richie F, Reddy MK, Edukere S, Zlotnick C, Johnson JE. Preliminary efficacy and mediators of interpersonal psychotherapy for reducing posttraumatic stress symptoms in an incarcerated population. Psychother Res 2020; 30:239-250. [PMID: 30857489 PMCID: PMC6739190 DOI: 10.1080/10503307.2019.1587192] [Citation(s) in RCA: 2] [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] [Received: 08/06/2018] [Revised: 01/31/2019] [Accepted: 02/18/2019] [Indexed: 10/27/2022] Open
Abstract
AbstractObjective: Incarcerated individuals have high rates of trauma exposure. IPT reduces posttraumatic stress disorder (PTSD) symptoms in non-incarcerated adults, but has not been examined in prison populations. Moreover, little is known about the mechanisms through which IPT reduces PTSD symptoms. The current study investigated the direct and indirect effects of IPT on PTSD symptoms. We hypothesized that IPT would decrease PTSD symptoms by enhancing social support and decreasing loneliness (theorized IPT mechanisms). Method: A sub-sample of trauma-exposed participants (n = 168) were drawn from a larger randomized trial (n = 181) of IPT for major depressive disorder among prisoners. We examined a series of mediation models using non-parametric bootstrapping procedures to evaluate the indirect effect of IPT on PTSD symptoms. Results: Contrary to hypotheses, the relation between IPT and PTSD symptoms was significantly mediated through improvements in hopelessness and depressive symptoms (mechanisms of cognitive behavioral interventions), rather than through social support and loneliness. Increased social support and decreased loneliness were associated with decreased PTSD symptoms, but IPT did not predict changes in social support or loneliness. Conclusions: IPT may reduce PTSD symptoms in depressed prisoners by reducing hopelessness and depression. (ClinicalTrials.gov number NCT01685294).
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Affiliation(s)
- Julia W Felton
- Division of Public Health, Michigan State University, Flint, MI, USA
| | - Maji Hailemariam
- Division of Public Health, Michigan State University, Flint, MI, USA
| | - Fallon Richie
- Division of Public Health, Michigan State University, Flint, MI, USA
| | - Madhavi K Reddy
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - Sophia Edukere
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - Caron Zlotnick
- Department of Psychiatry, Butler Hospital and Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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26
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Hailemariam M, Felton JW, Key K, Greer D, Jefferson BL, Muhammad J, Miller R, Richie F, Robinson D, Saddler S, Spencer B, Summers M, White JMC, Johnson JE. Intersectionality, special populations, needs and suggestions: the Flint Women's study. Int J Equity Health 2020; 19:18. [PMID: 32005120 PMCID: PMC6995063 DOI: 10.1186/s12939-020-1133-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Equitable access to services that promote health and wellbeing is an important component of social justice. A community-engaged participatory qualitative study was conducted in Flint, Michigan, USA, to understand the needs of special populations (young women, perinatal women and new mothers, older women, women with disabilities, and LGBTQIA women) and elicit their ideas about solutions. METHODS In-depth interviews (n = 100) were conducted. Participants were either women living in the Flint area, human service providers in the area, or both. A team of community and academic coders analyzed the data using an a priori framework. RESULTS Participants identified needs of different groups of women and suggested ways to address them. Access to healthy food, reducing healthcare costs, and improving transportation, job opportunities and affordable quality housing were crosscutting themes across all groups of women. Mentoring support was said to protect vulnerable young women from the risk of human trafficking. Older women were said to gain a sense of purpose, build their social support and reduce their loneliness by engaging in mentoring younger women. Women with disabilities were reported to benefit from infrastructure accessibility and authentic inclusion in all areas of life. Providing help that considers their dignity, pride and self-worth were suggested. LGBTQIA women were reported to have housing needs due to discrimination; mostly turned down as renters and can be rejected from faith-based homeless shelters. LGBTQIA women would also benefit from increased sensitivity among healthcare providers. For all groups of women, streamlining access to social services and other resources, building social support networks and increasing awareness about existing resources were recommended. CONCLUSION Efforts directed towards improving women's health and wellbeing should include perspectives and suggestions of diverse groups of women from the community. Acting on suggestions that emanate from the community's lived experiences may reduce inequalities in health and wellbeing.
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Affiliation(s)
- Maji Hailemariam
- Division of Public Health, College of Human Medicine, Michigan State University, Flint, MI USA
| | - Julia W. Felton
- Division of Public Health, College of Human Medicine, Michigan State University, Flint, MI USA
| | - Kent Key
- Division of Public Health, College of Human Medicine, Michigan State University, Flint, MI USA
- Community Based Organization Partners, Flint, MI USA
| | | | - Bernadel L. Jefferson
- Community Based Organization Partners, Flint, MI USA
- Community resident, Flint, MI USA
| | - Janice Muhammad
- Community Based Organization Partners, Flint, MI USA
- Community resident, Flint, MI USA
| | - Raven Miller
- Division of Public Health, College of Human Medicine, Michigan State University, Flint, MI USA
| | - Fallon Richie
- Combined-Integrated Clinical and Counseling Program, University of South Alabama, Mobile, AL USA
| | | | - Sharon Saddler
- Community Based Organization Partners, Flint, MI USA
- Community resident, Flint, MI USA
| | - Bryan Spencer
- Community resident, Flint, MI USA
- My Exceptionality LLC, Flint, MI USA
| | - Monicia Summers
- Division of Public Health, College of Human Medicine, Michigan State University, Flint, MI USA
| | - Jonne Mc Coy White
- Division of Public Health, College of Human Medicine, Michigan State University, Flint, MI USA
| | - Jennifer E. Johnson
- Division of Public Health, College of Human Medicine, Michigan State University, Flint, MI USA
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Hailemariam M, Fekadu A, Medhin G, Prince M, Hanlon C. Equitable access to mental healthcare integrated in primary care for people with severe mental disorders in rural Ethiopia: a community-based cross-sectional study. Int J Ment Health Syst 2019; 13:78. [PMID: 31890003 PMCID: PMC6935213 DOI: 10.1186/s13033-019-0332-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 12/18/2019] [Indexed: 02/02/2023] Open
Abstract
Background Integration of mental healthcare into non-specialist settings is advocated to expand access to care for people with severe mental disorders (SMD) in low-income countries. However, the impact upon equitable access for disenfranchised members of society has not been investigated. The purpose of this study was to (1) estimate contact coverage for SMD of a new service in primary healthcare (PHC) in a rural Ethiopian district, and (2) investigate equity of access for rural residents, women, people with physical impairments and people of low socio-economic status. Methods Community key informants were trained to identify and refer people with probable SMD in Sodo district, south-central Ethiopia, using vignettes of typical presentations. Records of those referred to the new PHC-based service were linked to healthcare records to identify people who engaged with care and non-engagers over a 6 month period. Standardised interviews by psychiatric nurses were used to confirm the diagnosis in those attending PHC. Non-engagers were visited in their homes and administered the Psychosis Symptom Questionnaire. Socio-economic status, discrimination, disability, substance use, social support and distance to the nearest health facility were measured. Results Contact coverage for the new service was estimated to be 81.3% (300 engaged out of 369 probable cases of SMD identified). Reimbursement for transport and time may have elevated coverage estimates. In the fully adjusted multivariable model, rural residents had 3.81 increased odds (95% CI 1.22, 11.89) of not accessing care, in part due to geographical distance from the health facility (odds ratio 3.37 (1.12, 10.12)) for people living more than 180 min away. There was no association with lower socioeconomic status, female gender or physical impairment. Higher levels of functional impairment were associated with increased odds of engagement. Amongst non-engagers, the most frequently endorsed barriers were thinking the problem would get better by itself and concerns about the cost of treatment. Conclusion Integrating mental healthcare into primary care can achieve high levels of coverage in a rural African setting, which is equitable with respect to gender and socio-economic status. Service outreach into the community may be needed to achieve better contact coverage for rural residents.
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Affiliation(s)
- Maji Hailemariam
- 1Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, WHO Collaborating Centre for Mental Health Research and Capacity-Building, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- 1Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, WHO Collaborating Centre for Mental Health Research and Capacity-Building, Addis Ababa, Ethiopia.,2Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,3Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Girmay Medhin
- 4Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Martin Prince
- 5Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Charlotte Hanlon
- 1Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, WHO Collaborating Centre for Mental Health Research and Capacity-Building, Addis Ababa, Ethiopia.,2Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,5Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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28
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Johnson JE, Hailemariam M, Zlotnick C, Richie F, Sinclair J, Chuong A, Stirman SW. Mixed Methods Analysis of Implementation of Interpersonal Psychotherapy (IPT) for Major Depressive Disorder in Prisons in a Hybrid Type I Randomized Trial. Adm Policy Ment Health 2019; 47:410-426. [PMID: 31797190 DOI: 10.1007/s10488-019-00996-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article describes a mixed methods evaluation of implementation of interpersonal psychotherapy (IPT) in the first fully-powered trial of any treatment for major depressive disorder in an incarcerated population. Assessments in this Hybrid Type I trial included surveys of prison providers and administrators (n = 71), measures of feasibility and acceptability to prison patients (n = 90), and a planned document review (n = 460) to assess potential determinants of implementation. Quantitative and qualitative results indicated that IPT was a good fit for prisoners, and that prisoners and providers were enthusiastic about IPT. Providers were open to feedback, open to learning evidence-based practices, and committed to helping their clients. Limited treatment staff and variable supervision and collegial support may pose implementation challenges. For widespread prison implementation, scalable models for ongoing IPT training and supervision are needed.
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Affiliation(s)
- Jennifer E Johnson
- Division of Public Health, College of Human Medicine, Michigan State University, 200 East 1st Street, Flint, MI, 48502, USA. .,Division of Public Health, College of Human Medicine, Michigan State University, 200 East 1st Street, Room 366, Flint, MI, 48502, USA.
| | - Maji Hailemariam
- Division of Public Health, College of Human Medicine, Michigan State University, 200 East 1st Street, Flint, MI, 48502, USA
| | - Caron Zlotnick
- Butler Hospital and Brown University, 345 Blackstone Blvd, Providence, RI, 02906, USA.,University of Cape Town, Cape Town, South Africa
| | - Fallon Richie
- Division of Public Health, College of Human Medicine, Michigan State University, 200 East 1st Street, Flint, MI, 48502, USA
| | - Joshua Sinclair
- Division of Public Health, College of Human Medicine, Michigan State University, 200 East 1st Street, Flint, MI, 48502, USA
| | - Adam Chuong
- Brown University, 700 Butler Dr, Providence, RI, 02906, USA
| | - Shannon Wiltsey Stirman
- Dissemination and Training Division, Department of Psychiatry and Behavioral Sciences, National Center for PTSD, Stanford University, 795 Willow Road (NC-PTSD 334), Menlo Park, CA, 94025, USA
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Fekadu A, Medhin G, Lund C, DeSilva M, Selamu M, Alem A, Asher L, Birhane R, Patel V, Hailemariam M, Shibre T, Thornicroft G, Prince M, Hanlon C. The psychosis treatment gap and its consequences in rural Ethiopia. BMC Psychiatry 2019; 19:325. [PMID: 31664977 PMCID: PMC6819476 DOI: 10.1186/s12888-019-2281-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 09/10/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND The "treatment gap" (TG) for mental disorders, widely advocated by the WHO in low-and middle-income countries, is an important indicator of the extent to which a health system fails to meet the care needs of people with mental disorder at the population level. While there is limited research on the TG in these countries, there is even a greater paucity of studies looking at TG beyond a unidimensional understanding. This study explores several dimensions of the TG construct for people with psychosis in Sodo, a rural district in Ethiopia, and its implications for building a more holistic capacity for mental health services. METHOD The study was a cross-sectional survey of 300 adult participants with psychosis identified through community-based case detection and confirmed through subsequent structured clinical evaluations. The Butajira Treatment Gap Questionnaire (TGQ), a new customised tool with 83 items developed by the Ethiopia research team, was administered to evaluate several TG dimensions (access, adequacy and effectiveness of treatment, and impact/consequence of the treatment gap) across a range of provider types corresponding with the WHO pyramid service framework. RESULTS Lifetime and current access gap for biomedical care were 41.8 and 59.9% respectively while the corresponding figures for faith and traditional healing (FTH) were 15.1 and 45.2%. Of those who had received biomedical care for their current episode, 71.7% did not receive minimally adequate care. Support from the community and non-governmental organisations (NGOs) were negligible. Those with education (Adj. OR: 2.1; 95% CI: 1.2, 3.8) and history of use of FTH (Adj. OR: 3.2; 95% CI: 1.9-5.4) were more likely to use biomedical care. Inadequate biomedical care was associated with increased lifetime risk of adverse experiences, such as history of restraint, homelessness, accidents and assaults. CONCLUSION This is the first study of its kind. Viewing TG not as a unidimensional, but as a complex, multi-dimensional construct, offers a more realistic and holistic understanding of health beliefs, help-seeking behaviors, and need for care. The reconceptualized multidimensional TG construct could assist mental health services capacity building advocacy and policy efforts and allow community and NGOs play a larger role in supporting mental healthcare.
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Affiliation(s)
- Abebaw Fekadu
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia. .,Global Health & Infection Department, Brighton and Sussex Medical School, Brighton, UK. .,College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Girmay Medhin
- 0000 0001 1250 5688grid.7123.7Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Crick Lund
- 0000 0004 1937 1151grid.7836.aAlan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, Addis Ababa University, University of Cape Town, Cape Town, South Africa ,0000 0001 2322 6764grid.13097.3cCentre for Global Mental Health, Health Service and Population Research Department, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Mary DeSilva
- 0000 0004 0427 7672grid.52788.30The Wellcome Trust, London, UK
| | - Medhin Selamu
- 0000 0001 1250 5688grid.7123.7College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
| | - Atalay Alem
- 0000 0001 1250 5688grid.7123.7College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
| | - Laura Asher
- 0000 0004 1936 8868grid.4563.4Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Rahel Birhane
- 0000 0001 1250 5688grid.7123.7College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
| | - Vikram Patel
- 000000041936754Xgrid.38142.3cDepartment of Global Health & Social Medicine, Harvard Medical School, Boston, USA
| | - Maji Hailemariam
- 0000 0001 1250 5688grid.7123.7College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
| | - Teshome Shibre
- 0000 0004 1936 8200grid.55602.34Department of Psychiatry, Dalhousie University, Horizon Zone 3, Fredericton, NB Canada
| | - Graham Thornicroft
- 0000 0001 2322 6764grid.13097.3cCentre for Global Mental Health, Health Service and Population Research Department, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Martin Prince
- 0000 0001 2322 6764grid.13097.3cCentre for Global Mental Health, Health Service and Population Research Department, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Charlotte Hanlon
- 0000 0001 1250 5688grid.7123.7College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia ,0000 0001 2322 6764grid.13097.3cCentre for Global Mental Health, Health Service and Population Research Department, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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Hailemariam M, Ghebrehiwet S, Baul T, Restivo JL, Shibre T, Henderson DC, Girma E, Fekadu A, Teferra S, Hanlon C, Johnson JE, Borba CPC. "He can send her to her parents": The interaction between marriageability, gender and serious mental illness in rural Ethiopia. BMC Psychiatry 2019; 19:315. [PMID: 31655561 PMCID: PMC6815356 DOI: 10.1186/s12888-019-2290-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 09/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For women in most low- and middle-income countries, the diagnosis with serious mental illness (SMI) leads to stigma and challenges related to starting or maintaining marriages. The purpose of this qualitative study was to explore perspectives on marriage, divorce and family roles of women with SMI in rural Ethiopia. METHODS A qualitative study was conducted in a rural setting of Butajira, South Central Ethiopia. A total of 39 in-depth interviews were carried out with service users (n = 11), caregivers (n = 12), religious leaders (n = 6), health extension workers (n = 4), police officers (n = 2), teachers (n = 2) and government officials (n = 2). Data were analyzed using a thematic approach. RESULTS Three themes emerged. (1) Marriage and SMI: Chances of getting married for individuals with SMI in general was perceived to be lower: Individuals with SMI experienced various challenges including difficulty finding romantic partner, starting family and getting into a long-term relationship due to perceived dangerousness and the widespread stigma of mental illness. (2) Gendered experiences of marriageability: Compared to men, women with SMI experienced disproportionate levels of stigma which often continued after recovery. SMI affects marriageability for men with SMI, but mens' chances of finding a marital partner increases following treatment. For women in particular, impaired functioning negatively affects marriageability as ability to cook, care and clean was taken as the measure of suitability. (3) Acceptability of divorce and separation from a partner with SMI: Divorce or separation from a partner with SMI was considered mostly acceptable for men while women were mostly expected to stay married and care for a partner with SMI. For men, the transition from provider to dependent was often acceptable. However, women who fail to execute their domestic roles successfully were considered inept and would be sent back to their family of origin. CONCLUSION Women with SMI or those married to partners with SMI are at greater disadvantage. Reducing vulnerabilities through stigma reduction efforts such as community outreach and mental health awareness raising programs might contribute for better social outcomes for women with SMI.
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Affiliation(s)
- Maji Hailemariam
- Division of Public Health, College of Human Medicine, Michigan State University, East Lansing, MI, USA. .,College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Senait Ghebrehiwet
- 0000 0001 2183 6745grid.239424.aDepartment of Psychiatry, Boston Medical Center, Boston, MA USA
| | - Tithi Baul
- 0000 0001 2183 6745grid.239424.aDepartment of Psychiatry, Boston Medical Center, Boston, MA USA
| | | | - Teshome Shibre
- 0000 0000 8052 6109grid.428748.5Horizon Health Network, Fredericton, NB Canada
| | - David C. Henderson
- 0000 0001 2183 6745grid.239424.aDepartment of Psychiatry, Boston Medical Center, Boston, MA USA ,0000 0004 0367 5222grid.475010.7Department of Psychiatry, Boston University School of Medicine, Boston, MA USA
| | - Eshetu Girma
- 0000 0001 1250 5688grid.7123.7School of Public Health, Department of Preventive Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- 0000 0001 2150 1785grid.17088.36Division of Public Health, College of Human Medicine, Michigan State University, East Lansing, MI USA ,0000 0001 1250 5688grid.7123.7Center for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia ,0000 0000 8853 076Xgrid.414601.6Department of Global Health & Infection, Brighton and Sussex Medical School, Brighton, UK
| | - Solomon Teferra
- 0000 0001 1250 5688grid.7123.7College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- 0000 0001 1250 5688grid.7123.7College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia ,King’s College London, Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research Department, Centre for Global Mental Health, London, UK
| | - Jennifer E. Johnson
- 0000 0001 2150 1785grid.17088.36Division of Public Health, College of Human Medicine, Michigan State University, East Lansing, MI USA
| | - Christina P. C. Borba
- 0000 0001 2183 6745grid.239424.aDepartment of Psychiatry, Boston Medical Center, Boston, MA USA ,0000 0004 0367 5222grid.475010.7Department of Psychiatry, Boston University School of Medicine, Boston, MA USA
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Ghebrehiwet S, Baul T, Restivo JL, Kelkile TS, Stevenson A, Gelaye B, Fekadu A, Hailemariam M, Girma E, Teferra S, Canelos V, Henderson DC, Borba CPC. Gender-specific experiences of serious mental illness in rural Ethiopia: A qualitative study. Glob Public Health 2019; 15:185-199. [PMID: 31630624 DOI: 10.1080/17441692.2019.1680723] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Considerable variation in the gender-specific prevalence of serious mental illness (SMI) has been reported in low- and middle-income countries (LMICs). In the rural setting of Butajira, Ethiopia, the male-to-female prevalence ratio of schizophrenia was reported to be 5:1. This qualitative study explores gender-specific experiences of SMI and the extent to which sociocultural factors may explain the observed difference in prevalence estimates. Using purposive sampling, 39 in-depth interviews were conducted with community members from Butajira, a rural district in South Central Ethiopia. Transcripts were analysed using thematic analysis to elicit community perspectives on cultural explanatory models of SMI and experiences in this region. Gender-specific experiences were reported to differ due to visibility of symptoms, community responses, and varying levels of family support towards individuals with SMI. Overall, respondents described how various sociocultural factors subject women with SMI to higher levels of physical and social isolation compared to men, greatly affecting community health workers' ability to identify and provide care to women with mental illness. Future case detection methods should involve family members as they interact with women with SMI early on in the development of their symptoms and play an essential role in their path to mental health care.
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Affiliation(s)
| | - Tithi Baul
- Department of Psychiatry, Boston Medical Center, Boston, USA
| | - Juliana L Restivo
- Department of Global Health, Boston University School of Public Health, Boston, USA
| | | | - Anne Stevenson
- Broad Institute, Stanley Center for Psychiatric Research, Cambridge, USA.,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Abebaw Fekadu
- Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.,Global Health & Infection Department, Brighton and Sussex Medical School, Brighton, UK.,Department of Psychological Medicine, Centre for Affective Disorders, King's College London, Institute of Psychiatry, London, UK
| | - Maji Hailemariam
- College of Human Medicine, Division of Public Health, Michigan State University, Flint, USA
| | - Eshetu Girma
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Teferra
- Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - David C Henderson
- Department of Psychiatry, Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
| | - Christina P C Borba
- Department of Psychiatry, Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
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Moore KE, Stein MD, Kurth ME, Stevens L, Hailemariam M, Schonbrun YC, Johnson JE. Risk Factors for Self-stigma among Incarcerated Women with Alcohol Use Disorder. Stigma Health 2019; 5:158-167. [PMID: 33102697 DOI: 10.1037/sah0000182] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Alcohol use disorder (AUD) is a highly stigmatized condition, often associated with negative stereotypes such as being morally weak, incompetent, unpredictable, and aggressive. People with AUD are at risk of experiencing self-stigma, a social-cognitive experience in which people think others hold negative stereotypes about them, expect to be treated unfairly, and/or believe that negative stereotypes are personally accurate. Women in the criminal justice system with AUD in particular are at risk of experiencing self-stigma due to intersecting sources of disadvantage. Given that self-stigma can lead to treatment avoidance and dropout, it is important to understand risk factors for self-stigma to inform prevention and intervention efforts in the justice system. Incarcerated women with AUD (n=185) completed measures of alcohol self-stigma as well as a variety of theoretically relevant risk factors including sociodemographics, baseline levels of stress and depression, and alcohol-related factors (i.e., length of drinking history, frequency/amount of use, consequences of use, physician advice to stop, belief that legal involvement is related to alcohol use, alcohol-related charges, self-efficacy to quit, readiness for treatment, pressures to enter treatment, factors that influence treatment) and other stigmatized conditions (drug use, exchanging sex, and homelessness). Results showed that experiencing more consequences of alcohol use, pressures to enter treatment, and perceived stress were associated with internalized stigma and anticipated/enacted stigma. This study begins to identify which incarcerated women with AUD are most at risk of experiencing self-stigma that may interfere with alcohol treatment.
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Affiliation(s)
- Kelly E Moore
- East Tennessee State University, Department of Psychology, 420 Rogers-Stout Hall P.O. 70649, Johnson City, TN 37614
| | - Michael D Stein
- Butler Hospital, Behavioral Medicine and Addictions Research, 345 Blackstone Blvd. Providence, RI 02906
- Boston University School of Public Health, Department of Health Law, Policy & Management, 715 Albany Street, Boston, MA 02118
| | - Megan E Kurth
- Butler Hospital, Behavioral Medicine and Addictions Research, 345 Blackstone Blvd. Providence, RI 02906
| | - Lindsey Stevens
- Brown University Medical School, Department of Psychiatry and Human Behavior, 345 Blackstone Boulevard, Providence, RI 02906
| | - Maji Hailemariam
- Michigan State University, Division of Public Health, College of Human Medicine, 200 East 1st St., Flint, MI 48502
| | - Yael C Schonbrun
- Butler Hospital, Behavioral Medicine and Addictions Research, 345 Blackstone Blvd. Providence, RI 02906
- Brown University Medical School, Department of Psychiatry and Human Behavior, 345 Blackstone Boulevard, Providence, RI 02906
| | - Jennifer E Johnson
- Michigan State University, Division of Public Health, College of Human Medicine, 200 East 1st St., Flint, MI 48502
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Hailemariam M, Bustos T, Montgomery B, Barajas R, Evans LB, Drahota A. Evidence-based intervention sustainability strategies: a systematic review. Implement Sci 2019; 14:57. [PMID: 31171004 PMCID: PMC6554955 DOI: 10.1186/s13012-019-0910-6] [Citation(s) in RCA: 139] [Impact Index Per Article: 27.8] [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: 01/15/2019] [Accepted: 05/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sustainability of evidence-based interventions (EBI) remains a challenge for public health community-based institutions. The conceptual definition of sustainment is not universally agreed upon by researchers and practitioners, and strategies utilized to facilitate sustainment of EBI are not consistently reported in published literature. Given these limitations in the field, a systematic review was conducted to summarize the existing evidence supporting discrete sustainment strategies for public health EBIs and facilitating and hindering factors of sustainment. METHODS We searched PsychINFO, Embase, ProQuest, PubMed, and Google Scholar. The initial search was run in March 2017 and an update was done in March 2019. Study eligibility criteria included (a) public health evidence-based interventions, (b) conducted in the community or community-based settings, and (c) reported outcomes related to EBI sustainment. Details characterizing the study setting, design, target population, and type of EBI sustained were extracted. RESULTS A total of 26 articles published from 2004 to 2019 were eligible for data extraction. Overall, the importance of sustainability was acknowledged across all of the studies. However, only seven studies presented a conceptual definition of sustainment explicitly within the text. Six of the included studies reported specific sustainment strategies that were used to facilitate the sustainment of EBI. Only three of the studies reported their activities related to sustainment by referencing a sustainment framework. Multiple facilitators (i.e., adaptation/alignment, funding) and barriers (i.e., limited funding, limited resources) were identified as influencing EBI sustainment. The majority (n = 20) of the studies were conducted in high-income countries. Studies from low-income countries were mostly naturalistic. All of the studies from low-income countries reported lack of funding as a hindrance to sustainment. IMPLICATION FOR DISSEMINATION AND IMPLEMENTATION RESEARCH Literature focused on sustainment of public health EBIs should present an explicit definition of the concept. Better reporting of the framework utilized, steps followed, and adaptations made to sustain the intervention might contribute to standardizing and developing the concept. Moreover, encouraging longitudinal dissemination and implementation (D&I) research especially in low-income countries might help strengthen D&I research capacity in public health settings.
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Affiliation(s)
- Maji Hailemariam
- College of Human Medicine, Division of Public Health, Michigan State University, Flint, MI USA
| | - Tatiana Bustos
- Department of Psychology, Michigan State University, East Lansing, MI USA
| | - Barrett Montgomery
- College of Human Medicine, Division of Public Health, Michigan State University, Flint, MI USA
| | - Rolando Barajas
- College of Human Medicine, Division of Public Health, Michigan State University, Flint, MI USA
| | - Luther B. Evans
- College of Human Medicine, Division of Public Health, Michigan State University, Flint, MI USA
- Community-Based Organizational Partners (CBOP), Flint, MI USA
| | - Amy Drahota
- Department of Psychology, Michigan State University, East Lansing, MI USA
- Child & Adolescent Services Research Center (CASRC), San Diego, CA USA
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Hailemariam M, Stein M, Anderson B, Schonbrun YC, Moore K, Kurth M, Richie F, Johnson JE. Correlates of alcoholics anonymous affiliation among justice-involved women. BMC Womens Health 2018; 18:125. [PMID: 29996829 PMCID: PMC6042328 DOI: 10.1186/s12905-018-0614-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 06/22/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Alcohol use disorder (AUD) constitutes a major public health problem and is associated with a substantial amount of disability and premature death worldwide. Several treatment and self-help options including Alcoholics Anonymous (AA) meetings are available. Nevertheless, factors associated with AA affiliation in some disadvantaged groups such as justice-involved women are not well understood. The purpose of this study is to report on previously unexamined correlates of past year AA affiliation among women in pretrial jail detention. METHODS The current study used cross-sectional data from 168 women with DSM-5 diagnosis of AUD in pretrial jail detention. The study examined factors related to women's concept of self and others (i.e., disbelief that others are trustworthy, lack of autonomy to choose who they interact with, experience of violent victimization, low investment in self-care, higher stress levels, and homelessness) as correlates of past-year AA affiliation, controlling for severity of AUD and demographic factors. RESULTS Women who believe that others are inherently trustworthy, women who met less AUD criteria, and women who are older reported more past-year AA affiliation in both univariate and multivariate analyses. CONCLUSION Introducing AA outreach and alternative interventions for younger, less severely addicted women might improve AUD outcomes. Moreover, designing more individualized treatment plan for women who believe others are not trust worthy might help AUD treatment engagement in this population. TRIAL REGISTRATION NCT01970293 , 10/28/2013.
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Affiliation(s)
- Maji Hailemariam
- Division of Public Health, College of Human Medicine, Michigan State University, Flint, MI USA
| | - Michael Stein
- Boston University School of Public Health, Health Law, Policy and Management, Boston, MA USA
- Butler Hospital, Providence, RI USA
| | | | | | - Kelly Moore
- Department of Psychiatry, Yale University, School of Medicine, New Haven, USA
| | | | - Fallon Richie
- Division of Public Health, College of Human Medicine, Michigan State University, Flint, MI USA
| | - Jennifer E. Johnson
- Division of Public Health, College of Human Medicine, Michigan State University, Flint, MI USA
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Hailemariam M, Fekadu A, Prince M, Hanlon C. Engaging and staying engaged: a phenomenological study of barriers to equitable access to mental healthcare for people with severe mental disorders in a rural African setting. Int J Equity Health 2017; 16:156. [PMID: 28851421 PMCID: PMC5576237 DOI: 10.1186/s12939-017-0657-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 08/22/2017] [Indexed: 11/12/2022] Open
Abstract
Background In low-and middle-income countries, integration of mental health into primary care is recommended to reduce the treatment gap. In this study we explored barriers to initial and ongoing engagement of people with severe mental disorders (SMD) in rural Ethiopia after implementing integrated primary mental healthcare services. Methods A qualitative approach was employed. In-depth interviews were conducted with 50 key informants: service users/caregivers engaged with care (n = 17), non-engagers and their caregivers (n = 10), those who had initiated treatment but disengaged and their caregivers (n = 12) and primary healthcare professionals (n = 11). Two focus group discussions were conducted with community health workers (10 per group). Thematic analysis was used. Results Most respondents reported improved access to care, usually equated with medication, and were motivated to remain engaged due to experienced benefits of care. However, four main barriers to engagement emerged. (1) Poverty: resulting in inability to pay for medication and undermining vital social support affected engagement for all respondents. (2) Unreliable medication supplies and lack of second line options for inadequate response or intolerable side-effects. (3) The long-term nature of the illness: expectations of cure, stigma of chronic illness, low awareness about the illness and treatment and declining social support over time. (4) The nature of SMD: difficulty conveying the person when acutely disturbed and no flexibility for proactive outreach or legal frameworks to provide care when patients lacked capacity. In those who never engaged, geographical inaccessibility was an important barrier. Alternative cultural explanations for illness were only mentioned as a barrier only by two of the respondents. Conclusion Economic interventions may be needed to support ongoing engagement in care for people with SMD. Systems of care for chronic illness need to be strengthened in combination with legal frameworks. Expanded options for affordable and effective medication and psychosocial interventions are required for person-centred care. Electronic supplementary material The online version of this article (10.1186/s12939-017-0657-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maji Hailemariam
- Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Abebaw Fekadu
- Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.,Center for Innovative Drug Development and Therapeutic Trials for Africa, Addis Ababa University, Addis Ababa, Ethiopia.,Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Centre for Affective Disorders, King's College London, London, UK
| | - Martin Prince
- Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research Department, Centre for Global Mental Health, King's College London, London, UK
| | - Charlotte Hanlon
- Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.,Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research Department, Centre for Global Mental Health, King's College London, London, UK
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36
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Mall S, Hailemariam M, Selamu M, Fekadu A, Lund C, Patel V, Petersen I, Hanlon C. 'Restoring the person's life': a qualitative study to inform development of care for people with severe mental disorders in rural Ethiopia. Epidemiol Psychiatr Sci 2017; 26:43-52. [PMID: 26961343 PMCID: PMC6998647 DOI: 10.1017/s2045796015001006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 10/29/2015] [Indexed: 11/06/2022] Open
Abstract
AIMS In low-income countries, care for people with severe mental disorders (SMDs) who manage to access treatment is usually emergency-based, intermittent or narrowly biomedical. The aim of this study was to inform development of a scalable district-level mental health care plan to meet the long-term care needs of people with SMD in rural Ethiopia. METHODS The present study was carried out as formative work for the Programme for Improving Mental health CarE which seeks to develop, implement and evaluate a district level model of integrating mental health care into primary care. Six focus group discussions and 25 in-depth interviews were conducted with service planners, primary care providers, traditional and religious healers, mental health service users, caregivers and community representatives. Framework analysis was used, with findings mapped onto the domains of the Innovative Care for Chronic Conditions (ICCC) framework. RESULTS Three main themes were identified. (1) Focused on 'Restoring the person's life', including the need for interventions to address basic needs for food, shelter and livelihoods, as well as spiritual recovery and reintegration into society. All respondents considered this to be important, but service users gave particular emphasis to this aspect of care. (2) Engaging with families, addressed the essential role of families, their need for practical and emotional support, and the importance of equipping families to provide a therapeutic environment. (3) Delivering collaborative, long-term care, focused on enhancing accessibility to biomedical mental health care, utilising community-based health workers and volunteers as an untapped resource to support adherence and engagement with services, learning from experience of service models for chronic communicable diseases (HIV and tuberculosis) and integrating the role of traditional and religious healers alongside biomedical care. Biomedical approaches were more strongly endorsed by health workers, with traditional healers, religious leaders and service users more inclined to see medication as but one component of care. The salience of poverty to service planning was cross-cutting. CONCLUSIONS Stakeholders prioritised interventions to meet basic needs for survival and endorsed a multi-faceted approach to promoting recovery from SMD, including social recovery. However, sole reliance on this over-stretched community to mobilise the necessary resources may not be feasible. An adapted form of the ICCC framework appeared highly applicable to planning an acceptable, feasible and sustainable model of care.
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Affiliation(s)
- S. Mall
- Department for Psychiatry and Mental Health, University of Cape Town, Alan J. Flisher Centre for Public Mental Health, Rondebosch, South Africa
| | - M. Hailemariam
- Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
| | - M. Selamu
- Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
| | - A. Fekadu
- Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Affective Disorders Research Group, SE5 8AF, London
| | - C. Lund
- Department for Psychiatry and Mental Health, University of Cape Town, Alan J. Flisher Centre for Public Mental Health, Rondebosch, South Africa
- Health Services and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, SE5 8AF, London
| | - V. Patel
- London School of Hygiene and Tropical Medicine, Centre for Global Mental Health, WC1E 7HT, London
- Public Health Foundation of India, Centre for Chronic Conditions and Injuries, New Delhi, India
- Sangath Centre, Goa, India
| | - I. Petersen
- School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - C. Hanlon
- Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
- Health Services and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, SE5 8AF, London
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Hailemariam M, Fekadu A, Selamu M, Medhin G, Prince M, Hanlon C. Equitable access to integrated primary mental healthcare for people with severe mental disorders in Ethiopia: a formative study. Int J Equity Health 2016; 15:121. [PMID: 27460038 PMCID: PMC4962424 DOI: 10.1186/s12939-016-0410-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 04/26/2016] [Accepted: 07/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The provision of mental healthcare through integration into primary care is expected to improve access to care, but not all population groups may benefit equally. The aim of this study was to inform delivery of a new primary care-based mental health service in rural Ethiopia by identifying potential barriers to equitable access to mental healthcare and strategies to overcome them. METHODS A qualitative study was conducted as formative work for the PRogramme for Improving Mental healthcarE (PRIME), a project supporting delivery of mental healthcare integrated into primary care in a rural district in south central Ethiopia. In-depth interviews (n = 21) were carried out with stakeholders selected purposively from mental health service users, caregivers, community leaders and healthcare administrators. A focus group discussion (n = 12) was conducted with community health extension workers. Framework analysis was employed using an adapted version of the access framework developed for use in contexts of livelihood insecurity, which considers (1) availability, (2) accessibility and affordability. and (3) acceptability and adequacy dimensions of access. RESULTS Primary care-based mental healthcare was considered as a positive development, and would increase availability, accessibility and affordability of treatments. Low levels of community awareness, and general preference for traditional and religious healing were raised as potential challenges to the acceptability of integrated mental healthcare. Participants believed integrated mental healthcare would be comprehensive and of satisfactory quality. However, expectations about the effectiveness of treatment for mental disorders were generally low. Threats to equitable access to mental healthcare were identified for perinatal women, persons with physical disability, those living in extreme poverty and people with severe and persistent mental disability. CONCLUSION Establishing an affordable service within reach, raising awareness and financial support to families from low socioeconomic backgrounds were suggested to improve equitable access to mental healthcare by vulnerable groups including perinatal women and people with disabilities. Innovative approaches, such as telephone consultations with psychiatric nurses based in nearby towns and home outreach need to be developed and evaluated.
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Affiliation(s)
- Maji Hailemariam
- College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
- Psychology and Neuroscience, Department of Psychological Medicine, Centre for Affective Disorders, King’s College London, Institute of Psychiatry, London, UK
| | - Medhin Selamu
- College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Martin Prince
- Population Research Department, Centre for Global Mental Health, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, Health Services, London, UK
| | - Charlotte Hanlon
- College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
- Population Research Department, Centre for Global Mental Health, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, Health Services, London, UK
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Fekadu A, Medhin G, Selamu M, Shiferaw T, Hailemariam M, Rathod SD, Jordans M, Teferra S, Lund C, Breuer E, Prince M, Giorgis TW, Alem A, Hanlon C. Non-fatal suicidal behaviour in rural Ethiopia: a cross-sectional facility- and population-based study. BMC Psychiatry 2016; 16:75. [PMID: 27000122 PMCID: PMC4802839 DOI: 10.1186/s12888-016-0784-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 10/13/2015] [Accepted: 03/17/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Injury related to self-harm is one of the leading causes of global disease burden. As a formative work for a programme to implement comprehensive mental healthcare in a rural district in Ethiopia, we determined the 12-month prevalence of non-fatal suicidal behaviour as well as factors associated with this behaviour to understand the potential burden of the behaviour in the district. METHOD Population-based (n = 1485) and facility-based (n = 1014) cross-sectional surveys of adults, using standardised, interview-based measures for suicidality (items on suicide from the Composite International Diagnostic Interview), depressive symptoms (the Patient Health Questionnaire) and alcohol use disorders (Alcohol Use Disorder Investigation Test; AUDIT). RESULTS The overall 12-month prevalence of non-fatal suicidal behaviour, consisting of suicidal ideation, plan and attempt, was 7.9 % (95 % Confidence Interval (CI) = 6.8 % to 8.9 %). The prevalence was significantly higher in the facility sample (10.3 %) compared with the community sample (6.3 %). The 12-month prevalence of suicide attempt was 4.4 % (95 % CI = 3.6 % to 5.3 %), non-significantly higher among the facility sample (5.4 %) compared with the community sample (3.8 %). Over half of those with suicidal ideation (56.4 %) transitioned from suicidal ideation to suicide attempt. Younger age, harmful use of alcohol and higher depression scores were associated significantly with increased non-fatal suicidal behaviours. The only factor associated with transition from suicidal ideation to suicide attempt was high depression score. Only 10.5 % of the sample with suicidal ideation had received any treatment for their suicidal behaviour: 10.8 % of the community sample and 10.2 % of the facility sample. Although help seeking increased with progression from ideation to attempt, there was no statistically significant difference between the groups. CONCLUSION Non-fatal suicidal behaviour is an important public health problem in this rural district. A more in-depth understanding of the context of the occurrence of the behaviour, improving access to care and targeting depression and alcohol use disorder are important next steps. The role of other psychosocial factors should also be explored to assist the provision of holistic care.
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Affiliation(s)
- Abebaw Fekadu
- />Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- />Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Centre for Affective Disorders, King’s College London, London, UK
| | - Girmay Medhin
- />Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Medhin Selamu
- />Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tsion Shiferaw
- />Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Maji Hailemariam
- />Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sujit D Rathod
- />Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Mark Jordans
- />Department of Research and Development, HealthNet Transcultural Psychosocial Organisation, Amsterdam, The Netherlands
| | - Solomon Teferra
- />Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Crick Lund
- />Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - Erica Breuer
- />Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - Martin Prince
- />Health Service and Population Research Department, Institute of Psychiatry, King’s College London, London, UK
| | - Tedla W. Giorgis
- />Republic of Ethiopia Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Atalay Alem
- />Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- />Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- />Health Service and Population Research Department, Institute of Psychiatry, King’s College London, London, UK
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Hailemariam M, Petrov D, Muzaffar N, Vance L. CT guided lung biopsy: a lesion’s lobar location and distance from pleura as independent risk factors for pneumothorax. J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Hailemariam M, Fekadu A, Selamu M, Alem A, Medhin G, Giorgis TW, DeSilva M, Breuer E. Developing a mental health care plan in a low resource setting: the theory of change approach. BMC Health Serv Res 2015; 15:429. [PMID: 26416566 PMCID: PMC4587839 DOI: 10.1186/s12913-015-1097-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 09/22/2015] [Indexed: 11/17/2022] Open
Abstract
Background Scaling up mental healthcare through integration into primary care remains the main strategy to address the extensive unmet mental health need in low-income countries. For integrated care to achieve its goal, a clear understanding of the organisational processes that can promote and hinder the integration and delivery of mental health care is essential. Theory of Change (ToC), a method employed in the planning, implementation and evaluation of complex community initiatives, is an innovative approach that has the potential to assist in the development of a comprehensive mental health care plan (MHCP), which can inform the delivery of integrated care. We used the ToC approach to develop a MHCP in a rural district in Ethiopia. The work was part of a cross-country study, the Programme for Improving Mental Health Care (PRIME) which focuses on developing evidence on the integration of mental health in to primary care. Methods An iterative ToC development process was undertaken involving multiple workshops with stakeholders from diverse backgrounds that included representatives from the community, faith and traditional healers, community associations, non-governmental organisations, Zonal, Regional and Federal level government offices, higher education institutions, social work and mental health specialists (psychiatrists and psychiatric nurses). The objective of this study is to report the process of implementing the ToC approach in developing mental health care plan. Results A total of 46 persons participated in four ToC workshops. Four critical path dimensions were identified: community, health facility, administrative and higher level care organisation. The ToC participants were actively engaged in the process and the ToC encouraged strong commitment among participants. Key opportunities and barriers to implementation and how to overcome these were suggested. During the workshops, a map incorporating the key agreed outcomes and outcome indicators was developed and finalized later. Conclusions The ToC approach was found to be an important component in the development of the MHCP and to encourage broad political support for the integration of mental health services into primary care. The method may have broader applicability in planning complex health interventions in low resource settings.
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Affiliation(s)
- Maji Hailemariam
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, PO Box 9086, Addis Ababa, Ethiopia.
| | - Abebaw Fekadu
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, PO Box 9086, Addis Ababa, Ethiopia. .,King's College London, Institute of Psychiatry, Department of Psychological Medicine, Centre for Affective Disorders and Affective Disorders Research Group, London, UK.
| | - Medhin Selamu
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, PO Box 9086, Addis Ababa, Ethiopia.
| | - Atalay Alem
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, PO Box 9086, Addis Ababa, Ethiopia.
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.
| | | | - Mary DeSilva
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK.
| | - Erica Breuer
- Alan Flisher Centre for Public Mental Health, Department of Psychiatry, University of Cape Town, Cape Town, South Africa.
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Selamu M, Asher L, Hanlon C, Medhin G, Hailemariam M, Patel V, Thornicroft G, Fekadu A. Beyond the biomedical: community resources for mental health care in rural Ethiopia. PLoS One 2015; 10:e0126666. [PMID: 25962075 PMCID: PMC4427185 DOI: 10.1371/journal.pone.0126666] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 04/06/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The focus of discussion in addressing the treatment gap is often on biomedical services. However, community resources can benefit health service scale-up in resource-constrained settings. These assets can be captured systematically through resource mapping, a method used in social action research. Resource mapping can be informative in developing complex mental health interventions, particularly in settings with limited formal mental health resources. METHOD We employed resource mapping within the Programme for Improving Mental Health Care (PRIME), to systematically gather information on community assets that can support integration of mental healthcare into primary care in rural Ethiopia. A semi-structured instrument was administered to key informants. Community resources were identified for all 58 sub-districts of the study district. The potential utility of these resources for the provision of mental healthcare in the district was considered. RESULTS The district is rich in community resources: There are over 150 traditional healers, 164 churches and mosques, and 401 religious groups. There were on average 5 eddir groups (traditional funeral associations) per sub-district. Social associations and 51 micro-finance institutions were also identified. On average, two traditional bars were found in each sub-district. The eight health centres and 58 satellite clinics staffed by Health Extension Workers (HEWs) represented all the biomedical health services in the district. In addition the Health Development Army (HDA) are community volunteers who support health promotion and prevention activities. DISCUSSION The plan for mental healthcare integration in this district was informed by the resource mapping. Community and religious leaders, HEWs, and HDA may have roles in awareness-raising, detection and referral of people with mental illness, improving access to medical care, supporting treatment adherence, and protecting human rights. The diversity of community structures will be used to support rehabilitation and social reintegration. Alcohol use was identified as a target disorder for community-level intervention.
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Affiliation(s)
- Medhin Selamu
- Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
- * E-mail:
| | - Laura Asher
- Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Charlotte Hanlon
- Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Institute of Psychiatry, King’s College London, London, United Kingdom
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Maji Hailemariam
- Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Vikram Patel
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Graham Thornicroft
- Centre for Global Mental Health, Institute of Psychiatry, King’s College London, London, United Kingdom
| | - Abebaw Fekadu
- Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Affective Disorders and Affective Disorders Research Group, Department of Psychological Medicine, Institute of Psychiatry, King’s College London, London, United Kingdom
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