Browsing by Subject "Global mental health"

The exposure to chronic interpersonal trauma during developmentally critical periods can have pervasive impacts on social, psychological, biological and cognitive functioning. Interpersonal trauma has been associated with a complex range of risk factors at the individual, family, community, and societal levels. However, little research has focused on the interplay between culture and trauma, especially in low- and middle-income countries. The current study is a qualitative investigation to develop a culturally grounded model of interpersonal trauma in Kenyan adolescents. Fourteen focus groups were conducted in three ethnically diverse communities surrounding Eldoret, Kenya with adolescents ages 12 to 18 (n=67) and caregivers (n=54). Focus Group participants identified community leaders and providers and three additional focus groups were conducted with these key informants (n=28). A grounded theory approach was used for data collection and analysis. A culturally grounded model of interpersonal trauma exploring both exposure and symptomatic presentation is proposed. From this investigation, it is apparent that adolescents who experience chronic interpersonal trauma in these communities experience dysregulation symptoms similar to those described in complex trauma theory. However, poverty, martial conflict, caregiver stress, caregiver substance abuse and favoritism emerged as risk factors for interpersonal trauma and indicate measures and interventions developed for the assessment and treatment of symptoms resulting from interpersonal trauma must be adapted for use in this population.

Objective: Posttraumatic stress due to trauma exposure in childhood disconnects the mind and body, producing a chronic state of anxiety and ill health that worsens into adulthood. In order to mitigate the harmful effects of trauma experienced by children living in low-resource settings worldwide, evidence-based research on the effect of feasible mind-body interventions to reduce trauma-related symptoms among this vulnerable population is needed. The complementary and alternative medicine (CAM) practice of yoga holds promise as a mind-body approach to child mental and physical wellbeing. The purpose of this preliminary study was to evaluate the effectiveness, feasibility, and acceptability of an 8-week yoga intervention to reduce trauma-related symptoms and emotional and behavioral difficulties among children living in orphanages in Haiti.

Methods: The study design is a case-control study with random assignment to yoga or aerobic dance plus a non-randomized wait-list control group. The UCLA PTSD Reaction Index and the Strengths and Difficulties Questionnaire measured trauma-related symptoms and emotional and behavioral difficulties, respectively. A supplementary questionnaire evaluated participants' experience in the yoga program.

Results: Our main findings include that participation in either 8-weeks of yoga or aerobic dance classes predicted a reduction in trauma-related symptoms and emotional and behavioral difficulties, though not statistically significant (p > .05). The average yoga class attendance was 14.65 (SD = 2.17) out of 16 classes. Ninety-two percent of respondents (N = 26) reported being satisfied with the yoga program and all reported positive changes in wellbeing.

Conclusion: Although the reductions in trauma-related symptoms and emotional and behavioral difficulties among children in the yoga and aerobic dance groups were not statistically significant, positive feedback suggests that yoga is a feasible, acceptable, and enjoyable activity with benefits to child mental and physical health. Further research is needed to evaluate the effect of yoga to relieve trauma-related mental illness among Haitian youth and to promote sustained health into adulthood. Yoga programs designed to improve health and resilience to stress are essential social justice approaches for investing in the wellbeing of our global youth and creating peace within the community at large.

Childhood maltreatment is a potent and common form of early trauma that not only produces negative outcomes for individuals during their lifetime, but may also have consequences for the next generation. Mothers who have experienced childhood maltreatment are more likely to have children also exposed to maltreatment, a phenomenon known as the intergenerational transmission of maltreatment. The perinatal period, the earliest point of intersection between generations, may offer an opportunity to interrupt such transmission. This dissertation leveraged two longitudinal studies in diverse global settings to examine how childhood maltreatment influences maternal mental health during the postpartum period, in turn impacting children’s risk for maltreatment exposure and related outcomes. In Study 1, a UK-based longitudinal cohort of 1,116 mothers and their twin children (E-Risk) was used to: (1) explore maternal childhood maltreatment as a risk factor for postpartum depression; (2) test the bridging role of postpartum depression between maternal childhood maltreatment and long-term child outcomes, specifically child exposure to maltreatment, internalizing symptoms, and externalizing symptoms; and (3) examine the intergenerational effects of specific maltreatment subtypes. Structural equation modeling revealed that maternal childhood maltreatment predicted postpartum depression, which in turn predicted child maltreatment exposure between 5 and 12 years and subsequent child internalizing and externalizing symptoms at 12 years. Indirect effects through postpartum depression were significant, robust across twin zygosity and child gender, and persisted after controlling for maternal covariates – though appeared to be carried by later maternal depression when included. In particular, emotional abuse emerged as a significant predictor of this pathway above and beyond other subtypes. In Study 2, similar aims were examined in a sample of 150 South African mothers followed through pregnancy and into the first postpartum year, with more proximal outcomes including maternal-infant bonding, infant development, and infant growth. Again, maternal childhood maltreatment predicted postpartum depression through 6 months, which then predicted child outcomes at 1 year. Indirect effects through postpartum depression were significant and persisted for maternal-infant bonding and infant physical growth after controlling for maternal and child covariates and accounting for antenatal distress. In particular, emotional neglect was a significant predictor of this pathway above and beyond other subtypes. Alterations in maternal emotion processing emerged as a potential explanatory mechanism. Together, findings from this dissertation underscore how postpartum depression may play a role in perpetuating negative outcomes across generations and in different global settings. Identifying and treating postpartum depression, as well as preventing its occurrence/recurrence, may help interrupt the intergenerational transmission of maltreatment and its sequelae.

Adolescent girls in sub-Saharan Africa must transition through puberty in the context of heightened risk for reproductive tract infections and mental illness. At the same time, girls experience menstrual stigma and a lack of resources to manage menstruation. Although menstruation and other puberty-specific stressors may negatively impact girls’ well-being, little is known about the relationships between puberty-specific stressors, coping, mental health, and reproductive health among girls in sub-Saharan Africa. The present dissertation seeks to fill this gap by investigating the types of puberty-specific stressors experienced by adolescent girls and young women in Tanzania, how girls cope with stressors, and the associations between stress and coping and mental health and reproductive health. A qualitative interview study and cross-sectional survey study were conducted to explore stress, coping, and health among adolescent girls in Tanzania. Both studies showed that girls experienced significant and disruptive puberty-specific stressors, with sexual pressure and menstrual pain constituting two of the most common stressors. Stressors were associated with depression, anxiety, and reproductive tract infections. Active coping and avoidant coping showed inconsistent relationships with stressors and mental health. Overall, psychosocial interventions are needed to reduce the negative impact of puberty-specific stressors on mental health and reproductive health among adolescent girls in Tanzania.

Published research on suicide and suicidal behavior has expanded rapidly in recent years and indicates the presence of a growing global public health concern. In Nepal, suicide is the number one of cause of mortality in women of childbearing age, accounting for 16 percent of deaths within this age group. Although treatments and therapies for suicide vary considerably, adapting existing interventions to allow them to remain culturally congruent with the worldviews of ethnic and racial minority groups is becoming an essential practice. In this study, we conducted a cultural adaptation, training, and piloting of manualized dialectical behavior therapy (DBT) in rural Nepal. DBT is a pliable, evidence-based treatment that is proven effective for risk reduction of suicidal behavior and non-suicidal self-injury (NSSI). However, its feasibility and acceptability has yet to be studied in a low-resource, international setting. In this study, the formative process used to guide modification of the standard DBT regimen is outlined. Qualitative research including focus group discussions and key informant interviews aided in incorporation of crucial elements of Nepali ethnopsychology, and a training based on the manualized adaptation with psychosocial counselors was conducted. Culturally adapted DBT (CA-DBT) was then piloted with ten women in a rural district in Northwest Nepal. Preliminary data suggests that, with additional modification and piloting, CA-DBT holds promising potential as a psychological intervention in Nepal. A number of qualitative successes and challenges in implementation are highlighted, as are suggestions for program bolstering and further testing.