Browsing by Subject "Mental health"

Mental illness is prevalent worldwide in all cultures with varying manifestations. Its socioeconomic impact cannot be underestimated. Mental health accounts for as much as 14 percent of the global disease burden (Prince, et al. 2007) and depression is ranked as the fourth leading contributor to the global disease burden. Nevertheless, mental health remains largely ignored worldwide, especially in developing nations.

This cross-sectional study, examines depression in two rural districts in Ghana, West Africa. Ghana, like many African nations, consists of many ethnic groups, with lineage networks that dictate personal and public behaviors. Ghana is unique in that approximately half of the population belongs to the Akan, matrilineal clan. The study hypothesized that by examining two clan groups (the Akan and Ga-Adangbe) that differed in lineage a statistically significant difference in rates of depression would be ascertained.

Upon receipt of ethical board approval from the Duke University Institutional Review Board in Durham, NC and Noguchi Memorial Institute for Medical Research Institutional Review Board in Ghana, researchers using the Depression Anxiety Stress Scales Short form (DASS-21) in a geographically randomly selected sample to measure depression as well as anxiety and stress among the participants and a demographic survey, researchers compared the prevalence of depression between the matrilineal Akan clan and patrilineal Ga-Adangbe clan. Data was analyzed using STATA 11.0.

The results indicate a rejection of the null hypothesis. There is a statistically significant difference in depression score between the women in the Ga-Adangbe clan and Akan clan. This study reports high co-morbidity of anxiety and stress with depression. Further research should expand to include other tribes in Ghana and other mental illnesses.

Friendship has consistently been found to act as a buffer against psychological maladjustment for healthy youth and youth experiencing difficulties including parental divorce and natural disasters. Less known is the role of friendship may have for females coping with a chronic health problem. Therefore, the objective of the current study was to evaluate the health factors and friendship precursors that may influence friendship, and in turn, how those friendships may predict psychosocial adjustment. A sample of chronically ill females (N = 30) was compared to a control group of healthy females (N = 45) on measures of opportunities for social interaction, similarity to their best friend, social capability, friendship quality, and psychological adjustment. Results revealed that health condition and friendship precursors were not associated with friendship quality. However, higher friendship quality was predictive of fewer externalizing symptoms for healthy girls. Additionally, positive parent relationships predicted fewer internalizing symptoms for both groups of females. Notably, chronically ill girls noted their friendships were higher in punishment and lower in companionship than healthy girls. Further assessment, including objective measures, will elucidate the beneficial processes of friendships and parent-child relationships that buffer youth from maladjustment.

Background: In Kenya, approximately 14.5% of children and youth meet criteria for a mental disorder. Despite this high burden, research is very limited related to mental health problems this population. Research is needed on the measurement of child mental health problems and on the risk and protective factors associated with these conditions.

Objectives: (1) Evaluate a set of survey items, chosen from both standardized measures and locally developed items, to identify those that that best differentiate between children with and without mental health problems. (2) Identify and explore important individual- and family-level influences on child mental health.

Methods: Individual surveys and semi-structured interviews were administered to members (1-2 caregivers, 1 child age 8-17) of 22 families living in Eldoret, Kenya. We evaluated differences in survey item endorsement between children with and without mental health problems to identify the best performing items. We used mixed-methods analysis of semi-structured interview transcripts and associated rating scores to explore differences between children with and without mental health problems on a variety of family-level variables.

Results: Following an extensive cultural adaptation process, fourteen of 26 survey items were successful in differentiating between children with and without mental health problems. Successful survey items were all drawn from standardized measures; no locally developed items were successful. All family-level variables (e.g., overall family functioning, couples’ relationship quality, parent-child relationship quality, and caregiver mental health) were strongly associated with child mental health outcomes, evidenced by large effect sizes ranging from 0.86 to 4.16. Subsequent qualitative analysis identified specific components of these variables likely contributing to the large numerical differences in scores.

Conclusions: The results of this study both suggest that standardized measures are appropriate for use in this population and highlight the importance of cultural adaptation before implementing standardized assessment tools. Additionally, the results indicate that the family environment is a promising target for interventions aiming to reduce mental health problems in Kenyan children.

Problem and Purpose: Arab adolescents are considered a particularly vulnerable population to depression. The substantial lack of mental health services and the stigma associated with mental illness on the one hand; and poverty, unemployment, and lack of reasonable hopes for a decent future in the context of corruption of regimes and perceived social injustice on the other, call for establishing committed and effective policies to tackle depression and its associated stigma among Arab adolescents at risk for or diagnosed with depression. However, there is a substantial lack of research that can inform the current profile of adolescent depression in the Arab region. We conducted two systematic reviews on Adolescent depression and mental illness stigma in the Arab region and found that there is currently no solid evidence available on the prevalence of depression among Arab adolescents and its potential associations with depression stigma and help-seeking beliefs and intentions. This gap in the literature makes it difficult to design, implement, and disseminate effective interventions to improve the prevention, diagnosis, and treatment of adolescent depression. Therefore, the overarching purpose of this study was to estimate a prevalence of depression symptoms among Arab adolescents, and determine relationships with depression stigma, depression etiologic beliefs, and likelihood to seek help for depression.

Methods: This study was conducted in Jordan, a Middle Eastern Arab country. A pilot study with a sample of 88 Jordanian adolescents was first conducted to assess the feasibility of collaboration and coordination with the proposed recruitment sites; assess proposed recruitment strategies; confirm the utility of the translated self-reported measures and examining their psychometric properties; and obtaining preliminary findings. Based on the lessons learned from this pilot study, we designed a nationally representative, school-based survey. Data were collected from 2,349 adolescents aged 12-17, using a packet of self-administered questionnaires that included measures on sociodemographic and health history, depression severity, depression stigma, depression etiologic beliefs, and likelihood to seek help for depression. A passive consenting procedure was used to obtain parental consents, while returning the survey questionnaires was considered a tacit assent for the adolescents. The study obtained the needed Institutional Review Board approvals from both Duke University and the University of Jordan. Participants represented all three regions in the country, with 34% from the northern (suburban) region, 43% from the central (urban) region, and 23% from the southern (rural) region.

Results: The majority of the adolescents were females (59%) and 15-17 years old (67%). Almost 14% reported having at least one chronic health problem, 15% reported having a mental health problem, 25% reported having academic difficulties, 8% reported that they had received a psychiatric diagnosis, and 22% reported that they had sought psychological help at some point in the past. The mean total depression score was 16.3 (SD=11.2, 95% CI=15.8 to 16.7), with 34% of the sample reporting moderate to severe depression. Depression was significantly higher among respondents who were female, ages 14-15 years, and living in families with monthly incomes less than JD300 (USD 423); and who reported having a chronic health problem, mental health problem, learning difficulty, a psychiatric diagnosis and/or seeking previous psychological help. Adolescents endorsed multiple etiological factors for depression. The most often reported factors were stressful events in one’s life (72%), social factors (65%), and one’s weak will (56%). On the other hand, the least reported factors were genetic or inherited problems (24%), chemical imbalance (30%), and punishment for wrong doings (35%). Adolescents were more likely to seek help for depression from a family member (57%), followed by a counselor (46%), psychiatrist (43%), religious leader (39%), and general practitioner (28%). In addition, 53% of the adolescents reported they will be willing to take medications for depression, while 50% expressed willingness to seek a therapy, and 25% of the adolescents reported they will not be willing to seek any professional help for depression. Almost half of the adolescents agreed on items that reflect stigmatizing attitudes towards depression. Adolescents reported higher rates of perceived depression stigma than personal depression stigma. Depression stigma was not significantly associated with the adolescent’s severity of depression, but with adolescent’s sex, age, region of residence, parents’ education, and history of mental health problem.

Conclusions: This study revealed alarming results in terms of the current high prevalence and social determinants of adolescent depression in Jordan. The study also shed light on how depression stigma manifests among Jordanian adolescents and how such stigma relates to their beliefs about depression and likelihood to seek professional psychological help. We discuss how healthcare providers, researchers, and educators can focus attention on developing effective and culturally appropriate screening, prevention, and intervention approaches using evidence-based guidelines to promote Jordanian adolescent mental health, particularly for depression. This approach will be important not only for Jordan, but for all of the Arab region, given that many of the Arab countries have been witnessing years of mass violence, armed conflicts, and war. The study also provides important recommendations on when, how, and why to utilize school settings for anti-depression stigma interventions. Overall, findings from this study provide a solid, culturally competent foundation from which to conduct future research to tackle depression and its associated stigma, and reflect the unique characteristics of Arab culture.

Developing nations in Asia are posed to experience a significant increase in the population of older adults living in their respective societies. Over the coming decades, India, the second most populous country in the entire world, is poised to experience a significant increase in its elder population. India's population of adults 60 years of age or older is projected to increase from 8% to 19% of the countries total population by the year 2050. Figures predict that by mid-century, 323 million people in India will be aged 60 years or older, more than the total current U.S. population. As the demographic structure of India is making a dramatic shift, concerns regarding the health and wellbeing of the growing Indian elder population are emerging, as is the growing concern for social policy. In addition, Sri Lanka is the fastest aging nation in South Asia. Multiple factors, including an increase in the number of people considered to be the "oldest old" (80+ years of age), a decrease in the number of working age adults, and increases in disability amongst the elderly, could necessitate an increased need for institutionalization of elderly Sri Lankans into long-term care facilities.

This project aims to study aging in south Asia from two different perspectives. An analysis of existing data from Southern India was done to examine the attitudes and beliefs of Indian elders towards aging and support systems for the elderly. Mental health of Indian elders was assessed and logistic regression analysis was conducted to examine possible correlations between attitudes and beliefs of the elderly and elder mental health. In addition, a qualitative descriptive study of Sri Lankan elder homes was carried out in the southern district of Galle, Sri Lanka. A convenience sampling method was used to identify six elder homes located in the area, and visits were made to each of the homes. During the visits, elder home mangers were interviewed in order to gain general information on the functioning and history of the elder homes, as well as general information on the residents living at the facilities.

Results from the Kerala Aging Survey revealed that psychological distress was present for over one third of elders in Kerala. Rates of psychological distress were higher for women, the poor, and those with advanced age. Elder women appear to be especially vulnerable to psychological distress in old age. Elders believe that children are responsible for supporting parents in their old age; lack of satisfaction with support received from children was associated with the presence of psychological distress amongst elders. For the qualitative study on Sri Lankan elders homes, it was found that both familial and community support are significant factors in the long-term care of elderly Sri Lankans. Though many elder home residents had been diagnosed with a chronic NCD or disability, lack of familial support was consistently identified as the driving force necessitating the elderly to reside at the long-term care facilities. With little or no financial assistance from the government, the facilities themselves all relied heavily on donations from the community to function on a daily basis.

Objective: Few studies have examined the disproportionate use of restraints for Black adults receiving emergency psychiatric care. This study sought to determine whether the odds of physical and chemical restraint use were higher for Black patients undergoing emergency psychiatric care compared with their white counterparts.

Methods: This single-center retrospective cohort study examined 12,977 unique encounters of adults receiving an emergency psychiatric evaluation between January 1, 2014, and September 18, 2020, at a large academic medical center in Durham, North Carolina. Self-reported race categories were extracted from the electronic medical record. Primary outcomes were the presence of a behavioral physical restraint order or chemical restraint administration during the emergency department encounter. Covariates included age, sex, ethnicity, height, time of arrival, positive urine drug screen results, peak blood-alcohol concentration, and diagnosis of a bipolar or psychotic disorder.

Results: A total of 961 (7.4%) encounters involved physical restraint, and 2,047 (15.8%) involved chemical restraint. Models with and without a race covariate were compared by using quasi-likelihood information criterion (QIC) scores; in each instance, the model with race performed better than the model without. Black patients were more likely to be physically (adjusted odds ratio [AOR]=1.35; 95% confidence interval [CI]=1.07–1.72) and chemically (AOR=1.33; 95% CI=1.15–1.55) restrained than white patients.

Conclusions: After adjusting for measured confounders, Black patients undergoing psychiatric evaluation were at higher odds of experiencing physical or chemical restraint compared with white patients, which is consistent with the growing body of evidence revealing racial inequities in psychiatric care.

Researchers have been searching for ways to improve outcomes for orphaned and separated children (OSC) worldwide. OSC have a particularly high rate of mental health disorders and lower emotional wellbeing. Stigma has been shown to be a predictor of mental health disorders and emotional wellbeing for HIV and children in poverty. However, no research has been conducted with OSC examining the relationship between self-stigma and emotional wellbeing. Using Round 10 of the Positive Outcomes for Orphans (POFO) study with 2013 orphans from Kenya, Ethiopia, Tanzania, India, and Cambodia, a linear model was implemented to examine the association between self-stigma and emotional wellbeing. Through the building of a linear regression model, self-stigma was shown to be a strong predictor of emotional wellbeing as measured by the Strengths and Difficulties Questionnaire (SDQ). This indicates that self-stigma may be a significant factor to address when looking at ways to improve emotional wellbeing among orphans.

Background: Despite improved access to HIV testing and medication, AIDS remains a leading cause of death among youth living with HIV (YLWH) in Tanzania. YLWH are prone to worse HIV outcomes than other age groups, which may be caused or mediated by mental health, social determinants of health (SDH), and adverse childhood experiences (ACEs). In this study, the investigators sought to determine if ACEs were correlated with key health variables in hopes of better understanding the factors associated with negative HIV and mental health outcomes among Tanzanian youth. Additionally, the investigators aimed to observe longitudinal trends in virologic suppression to understand the extent to which undetectable = untransmittable or “U=U” messaging applies to the more volatile youth demographic. Finally, the investigators sought to identify patterns and predictors that could aid in understanding risk of virologic failure in this population. Methods: The investigators incorporated and merged secondary data from participants who were enrolled in both of two distinct studies to create a longitudinal database spanning from 2013 to 2020. Participant ACE scores were derived from trauma exposure questionnaires and were compared with data about mental health, stigma, SDH, sexual experiences, self-reported adherence and HIV RNA (viral load). Associations of ACEs and other key variables were performed using linear regression. Results: ACEs were common among YLWH, especially loss of a parent and physical abuse. ACEs were also correlated with both mental health outcomes and virologic failure. Of the 48 participants who were virologically suppressed at the beginning of the study, one third had subsequent virologic failure, which was often associated with changes in ACEs, medication regimen, and SDH. Conclusion: Understanding common ACEs in this vulnerable population has direct relevance for the design of targeted interventions to prevent and treat repercussions of childhood trauma and improve mental health and HIV outcomes. ACEs, experiences with suicide risk, and low social support are important correlates of virologic failure and should be an alert when considering repeat HIV RNA testing and eligibility for supportive services.

Extensive evidence demonstrates how mental illness symptomatology can inhibit perceptions of and actual performance on important tasks. However, receiving treatment from the medical establishment for such symptomatology requires diagnosis, whereby the patient becomes labeled and subject to the stereotypes connected to that label. Mental illness labeling is associated with a variety of negative outcomes including inhibited access to unemployment, housing, health insurance, and marriage and parenthood opportunities and can disrupt interpersonal relationships. However, the repercussions of mental illness labeling for one area of life have remained largely overlooked; that area is task performance. Adults spend a substantial portion of their lives at work engaged in group-based or individual level tasks. This dissertation explores external perceptions of mental illness in task groups and the role of self-internalization of stereotypes about mental illness in individual task performance through two experimental studies.

Previous research has revealed that, on average, task partners with a mental illness are stigmatized and subject to diminished status when they are identified to participants as having been hospitalized for general psychological problems for an extended period of time. Study 1 of this dissertation explores the stigma- and status-based attributions triggered by engaging with a partner in a mutual task who is identified as having a specific mental illness label: none, Generalized Anxiety Disorder (GAD), Major Depressive Disorder (MDD), Attention-Deficit/Hyperactivity Disorder (ADHD), or schizophrenia.

Additionally, research has revealed that members of a group about which negative stereotypes exist may face a situational threat in a domain relevant task--stereotype threat. Race, gender, social class, age, and a variety of other sociodemographic attributes can trigger stereotype threat. However, little research has considered the potential for stereotype threat to emerge on the basis of mental illness labeling. Study 2 of this dissertation focusing on individual-level performance, exploring the potential for ADHD to trigger stereotype threat in test-taking situations.

Results from Study 1 suggest that the specific mental illness labels studied, presented devoid of symptomatology severity, do not trigger stigmatized attributions but may trigger some negative status attributions in the case of a task relevant diagnosis. (ADHD). Study 2 suggests that a task relevant diagnosis may also trigger stereotype threat in a test-taking situation, negatively impacting performance. Taken together, the results indicate that task relevance of one's mental illness label may be a driving factor in negative external and internal perceptions of mental illness.

Young people living with HIV (YPLWH) constitute a growing proportion of the global population of people living with HIV but have less access to HIV testing, diagnosis, treatment, and face heightened mental health challenges. To address these challenges, targeted mental health and medication adherence interventions have been developed, including in Tanzania, which is home to 6% of the world's YPLWH. This study proposes a mathematical model to estimate the health and economic outcomes of mental health HIV adherence interventions targeting YPLWH in Tanzania.We developed a Markov model to predict the long-term health (Disability-Adjusted Life Years (DALY)) and economic outcomes (Value of a Statistical Life Year (VLSY)) of mental health HIV adherence interventions targeting YPLWH. We parameterized the model using outcomes data from the 2016-2020 Sauti ya Vijana randomized control trial (RCT) conducted in Moshi, Tanzania. Cost data were retrieved from a cost analysis of the same RCT and supplemented with data from published literature. The study is conducted from a health payer’s perspective, and the Willingness-To-Pay (WTP) per DALY averted was set to the 2021 Tanzanian GDP per capita (USD 1099.3). Costs and outcomes were modeled for ten years and discounted at an annual rate of 3%. The findings suggest that the Sauti ya Vijana intervention modeled in this study is cost-effective at a WTP of USD 1099.3. The Incremental cost-effectiveness ratio for the intervention compared to the standard of care was USD 637.06 per DALY averted at a 3% discount rate. The benefit-to-cost ratio of the intervention was USD 26.54 in economic productivity for the intervention arm for every dollar spent on the intervention, and the net economic productivity benefit was USD 17,174.74 over a decade. Mental health adherence interventions hold the promise of improving health outcomes amongst YPLWH. The mathematical model developed in this study is a valuable decision-making tool for policymakers regarding mental health adherence interventions targeting YPLWH in Tanzania. The model contributes to the global goal of achieving the UNAIDS 95-95-95 targets for YPLWH.

The life course perspective has long theorized that childhood is a sensitive period for mental, physical, and emotional development, meaning that negative experiences during childhood can have long-lasting impacts on health and wellbeing. Thus, adverse childhood experiences (ACEs), such as parental alcoholism, sexual abuse, and physical neglect, during this sensitive period of the life course may elicit poor mental health both in childhood and as children age into adulthood. Although research on the long term impact of childhood adversity is growing, this research has been somewhat limited in the measurement of childhood adversity, focusing on dichotomous measures (occurred/ did not occur) or the summation of such dichotomous measures. In doing so, this research fails to capture heterogeneity in adversity experience, such as the severity, duration, and context of childhood adversities as well as how specific types of adversities may co-occur, consequently underestimating the impact of negative experiences for those at greatest risk of poor mental health. In this dissertation, I explore how these sources of distinction pattern mental health trajectories, with consequences for mental health disparities across the life course. In broadening the definition of childhood adversity beyond the simple occurrence of negative events, this dissertation provides an analytic blueprint for future research assessing childhood adversity, contributing to stress, life course, and mental health studies. In Chapter 2, I focus on a single adverse experience, parental mental health problems in childhood, to showcase how differences in severity, duration, and context of an adversity correspond to different mental health patterns across adulthood. Using six waves of data from the Panel Study of Income Dynamics (PSID; 2007-2017) and applying growth curve methods I find that more severe and longer exposures to parental mental health problems in childhood correspond to even greater distress in adulthood. The gender of the parent afflicted does not predict differences in adult mental health, but those individuals exposed to both maternal and paternal poor mental health in childhood have the greatest distress in adulthood. Chapters 3 and 4 focus on two other sources of heterogeneity in childhood adversity experience: the number and type of childhood adverse events. These chapters employ latent class analysis (LCA) to capture latent subtypes who are similar in their responses to a set of indicators, essentially estimating adversity classes that capture both the number and type of adversities that co-occur. These classes are then used to predict mental health trajectories across the life course. Before assessing latent classes of childhood adversity, Chapter 3 sets the groundwork for the analytic strategy of predicting outcome trajectories by latent classes. To date, there are several methods for including a distal outcome in latent class models, with no clear analytic strategy for when the outcome of interest is a growth model. Therefore, in Chapter 3, I employ a simulation study assessing the performance of five different methods under 27 different data conditions. Results from this study suggest that a maximum-likelihood (ML) approach best captures the true parameter estimates while maintaining substantive clarity. Chapter 4 uses the identified method in Chapter 3 (ML approach) to assess how latent classes of childhood adversity relate to trajectories of mental health using four waves of data from the National Longitudinal Study of Adolescent to Adult Health (Add Health, Wave I-IV). Findings suggest that in addition to a class represented by low adversity experience, there are two classes with greater experiences of adversity. One adversity class, characterized by household dysfunction, has greater depressive symptoms than the low adversity class in early life, and this gap is maintained into mid-adulthood. The other adversity class, characterized by maltreatment, has both greater depressive symptoms than the low adversity class in early life and becomes increasingly more depressed than this group across the life course. Overall, this dissertation contributes both methodologically and substantively to the study of childhood adversity and life course mental health. Childhood adversity has the ability to shape one’s mental health outcomes for many years after childhood, but this relationship is conditional on the lived experiences of adversity. These findings underscore the importance of severity, duration, context, type, and number of adverse events for patterning which children are at greatest risk for mental health problems in adulthood. Future work should consider these elements in favor over an over-simplified measure that may obscure the life course impact of these negative experiences.

There is increased need for mental health support on college campuses: existing campus resources are increasingly unable to meet the mental health needs of their undergraduate communities. There is also increased preference from students for some forms of emotional support to come from peers. Peer support programs, in which students act as supportive listeners towards their fellow students, are increasingly common on college campuses, but the uptake and utility of these programs is not routinely examined. There is also a need to ensure that the mental health of students providing support is protected. Providing support for peers can be a positive source of meaning and life purpose, but also a source of perceived stress, emotional exhaustion, and, potentially, burnout. If such programs are to be developed and disseminated, it is critical to understand the mechanisms whereby communicating with a peer in a moment of distress can improve mental health outcomes. This dissertation aims to address the critical need of identifying key components for sustainability by providing an updated review of the prevalence and nature of existing undergraduate peer support programs (Study 1), synthesizing research on the impact of providing peer mental health support (Study 2), and evaluating the acceptability and feasibility of a novel text-based peer support program with a sample of undergraduates (Study 3). We found that approximately 10% of institutions affiliated with the American College Health Association have a peer program dedicated to supporting student mental health. Moreover, there has been a recent surge of interest in these programs: over 50% of programs identified were founded in the last 10 years. However, there is limited data collection and even less peer-reviewed research on the impact of these programs for the students receiving and providing support. DukeLine, an innovative text-based peer support program, was designed, implemented, and assessed for sustainability. Peer coaches were trained through a for-credit, semester-long course taught within the Department of Psychology and Neuroscience and committed to providing peer support in two-person shifts for two semesters while enrolled in a practicum course with weekly group supervision. No coach reported experiencing significant emotional exhaustion and, on average, coaches report deriving moderate levels of meaning and purpose from their role as a peer coach. Over a quarter (29.73%) of students who reached out to DukeLine for support did so more than once and 88.89% of texters reported feeling extremely satisfied with the support they received. DukeLine offers a sustainable model for peer support programs targeting undergraduate mental health that is acceptable and feasible, for students who seek and provide support.

Background: Depression-screening tools exist and are widely used in Western settings. There have been few studies done to explore whether or not existing tools are valid and effective to use in sub-Saharan Africa. Our study aimed to develop and validate a perinatal depression-screening tool in rural Kenya.

Methods: We utilized conducted free listing and card sorting exercises with a purposive sample of 12 women and 38 CHVs living in a rural community to explore the manifestations of perinatal depression in that setting. We used the information obtained to produce a locally relevant depression-screening tool that comprised of existing Western psychiatric concepts and locally derived items. Subsequently, we administered the novel depression-screening tool and two existing screening tools (the Edinburgh Postnatal Depression Scale and the Patient Health Questionnaire-9) to 193 women and compared the results of the screening tool with that of a gold standard structured clinical interview to determine validity.

Results: The free listing and card sorting exercise produced a set of 60 screening items. Of the items in this set, we identified the 10 items that most accurately classified cases and non-cases. This 10-item scale had a sensitivity of 100.0 and specificity of 81.2. This compared to 90.0, 31.5 and 90.0, 49.7 for the EPDS and the PHQ-9, respectively. Overall, we found a prevalence of depression of 5.2 percent.

Conclusions: The new scale does very well in terms of diagnostic validity, having the highest scores in this domain compared to the EPDS, EPDS-R and PHQ-9. The adapted scale does very well with regards to convergent validity-illustrating clear distinction between mean scores across the different categories. It does well with regards to discriminant validity, internal consistency reliability, and test-retest reliability- not securing top scores in those domains but still yielding satisfactory results.

Despite numerous studies demonstrating high rates of discrimination and poor mental health among transgender people in Western countries, little research has been conducted on this population in Sri Lanka. As such, the primary objective of this study was to assess the prevalence of discrimination experienced by transgender people in the workplace, health care, and family settings. Additionally, we investigated the potential association between discrimination and adverse mental health outcomes, including current depression, anxiety disorders, and low self-esteem. In Galle, 100 transgender participants were recruited through snowball sampling and then completed the survey through face-to-face interviews. The survey consisted of five sections: sociodemographic information, mental health scales, and discrimination experience in the workplace, health care, and family settings. We reported the prevalence of discrimination and adverse mental health outcomes. We also estimated the prevalence ratios of current depression and anxiety disorder, which are associated with work inaccessibility and workplace discrimination, adjusting for age, education, and gender identity in separate Poisson regression models. The study found that school harassment (67%), workplace insults (63.5%), and work inaccessibility (47.4%) were the most commonly reported types of discrimination among transgender participants. Among them, the prevalence of current depression, anxiety disorder, and low self-esteem were 44%, 38%, and 81%, respectively. Furthermore, work inaccessibility was associated with a 16% increase in the prevalence of depression. Workplace discrimination, as measured by two categories (1 or 2 types of discrimination, ≥3 types of discrimination) was associated with greater prevalence (41%-56%) of depression and anxiety (22% - 46%) than non-discrimination, although all of those associations were not statistically significant. The high prevalence of discrimination against transgender people presented in the study highlights the urgent need for legislative changes to protect their rights. Future studies should aim to identify coping resources and develop evidence-based interventions to minimize the adverse mental health consequences of discrimination. It is expected that the researchers and transgender voluntary groups who had been involved in the study may transform the study results into meaningful real-world interventions.