Journal Article > ResearchFull Text
J. Affect. Disord.. 18 February 2023; Volume 12; 100503.; DOI:10.1016/j.jadr.2023.100503
Carter SE, Sadiq S, Calear AL, Housen TSS, Joshy G, et al.
J. Affect. Disord.. 18 February 2023; Volume 12; 100503.; DOI:10.1016/j.jadr.2023.100503
BACKGROUND
Complex humanitarian emergencies have a significant negative impact on the prevalence and severity of child mental health. The capacity of primary caregivers to provide care to their children is often adversely affected. There is a lack of evidence-based interventions to guide primary caregivers. This study assessed the feasibility and acceptability of implementing and evaluating a caregiver group counselling intervention, and provided an indication of its potential benefits.
METHODS
A single arm pilot study was conducted in Northern Iraq. Primary caregivers of a child aged 8-12 years with concern about their child's mental health attended the caregiver group intervention. Quantitative and qualitative outcome measures were completed by caregivers and children at pre-intervention, post-intervention, and 12-week follow-up.
RESULTS
The intervention was found to be feasible and acceptable to implement. Twelve participants were recruited, of which ten started the intervention and eight completed the intervention. All eight participants reported finding the intervention helpful. Evaluation of the intervention was found to be feasible and acceptable. Indicative results showed potential improvements across child and caregiver mental health.
LIMITATIONS
Limitations are that the small sample size limits the range of perspectives, lack of control group means observed changes could be due to factors other than the intervention, and potential bias exists due to self-completed fidelity monitoring and possible response bias.
CONCLUSIONS
The caregiver group intervention was feasible and acceptable to implement and evaluate in a humanitarian setting, and showed potential to positively impact child and caregiver mental health, warranting further research on its effectiveness.
Complex humanitarian emergencies have a significant negative impact on the prevalence and severity of child mental health. The capacity of primary caregivers to provide care to their children is often adversely affected. There is a lack of evidence-based interventions to guide primary caregivers. This study assessed the feasibility and acceptability of implementing and evaluating a caregiver group counselling intervention, and provided an indication of its potential benefits.
METHODS
A single arm pilot study was conducted in Northern Iraq. Primary caregivers of a child aged 8-12 years with concern about their child's mental health attended the caregiver group intervention. Quantitative and qualitative outcome measures were completed by caregivers and children at pre-intervention, post-intervention, and 12-week follow-up.
RESULTS
The intervention was found to be feasible and acceptable to implement. Twelve participants were recruited, of which ten started the intervention and eight completed the intervention. All eight participants reported finding the intervention helpful. Evaluation of the intervention was found to be feasible and acceptable. Indicative results showed potential improvements across child and caregiver mental health.
LIMITATIONS
Limitations are that the small sample size limits the range of perspectives, lack of control group means observed changes could be due to factors other than the intervention, and potential bias exists due to self-completed fidelity monitoring and possible response bias.
CONCLUSIONS
The caregiver group intervention was feasible and acceptable to implement and evaluate in a humanitarian setting, and showed potential to positively impact child and caregiver mental health, warranting further research on its effectiveness.
Journal Article > ResearchFull Text
Confl Health. 12 December 2019; Volume 13 (Issue 1); DOI:10.1186/s13031-019-0245-6
Housen TSS, Lenglet AD, Shah SK, Sha H, Pintaldi G, et al.
Confl Health. 12 December 2019; Volume 13 (Issue 1); DOI:10.1186/s13031-019-0245-6
Background
The negative psychological impact of living in a setting of protracted conflict has been well studied, however there is a recognized need to understand the role that non-conflict related factors have on mediating exposure to trauma and signs of psychological distress.
Methods
We used data from the 2015 Kashmir Mental Health Survey and conducted mediation analysis to assess the extent to which daily stressors mediated the effect of traumatic experiences on poor mental health outcomes. Outcomes of interest were probable diagnosis of anxiety, depression, or PTSD; measured using the pre-validated Hopkins Symptoms Checklist (HSCL-25) and the Harvard Trauma Questionnaire (HTQ).
Results
Total effect mediated were statistically significant but the proportions of effect mediated were found to be small in practical terms. Financial stress mediated 6.8% [95% Confidence Interval (CI) 6∙0–8∙4], 6.7% [CI 6.2–7∙7] and 3.6% [CI 3∙4–4∙0] of the effect of experiencing multiple traumaticogenic events on symptoms of anxiety, depression and PTSD, respectively. Family stress mediated 11.3% [CI 10.3–13.8], 10.3% [CI 9.5–11.9] and 6.1% [CI 5.7–6.7] of the effect of experiencing multiple traumatogenic events on symptoms of anxiety, depression and PTSD, respectively. Poor physical health mediated 10.0% [CI 9.1–12∙0], 7.2% [CI 6.6–8.2] and 4.0% [CI 3.8,4.4] of the effect of experiencing more than seven traumatic events on symptoms of anxiety, depression and PTSD, respectively.
Conclusion
Our findings highlight that not only do we need to move beyond a trauma-focussed approach to addressing psychological distress in populations affected by protracted conflict but we must also move beyond focussing on daily stressors as explanatory mediators.
The negative psychological impact of living in a setting of protracted conflict has been well studied, however there is a recognized need to understand the role that non-conflict related factors have on mediating exposure to trauma and signs of psychological distress.
Methods
We used data from the 2015 Kashmir Mental Health Survey and conducted mediation analysis to assess the extent to which daily stressors mediated the effect of traumatic experiences on poor mental health outcomes. Outcomes of interest were probable diagnosis of anxiety, depression, or PTSD; measured using the pre-validated Hopkins Symptoms Checklist (HSCL-25) and the Harvard Trauma Questionnaire (HTQ).
Results
Total effect mediated were statistically significant but the proportions of effect mediated were found to be small in practical terms. Financial stress mediated 6.8% [95% Confidence Interval (CI) 6∙0–8∙4], 6.7% [CI 6.2–7∙7] and 3.6% [CI 3∙4–4∙0] of the effect of experiencing multiple traumaticogenic events on symptoms of anxiety, depression and PTSD, respectively. Family stress mediated 11.3% [CI 10.3–13.8], 10.3% [CI 9.5–11.9] and 6.1% [CI 5.7–6.7] of the effect of experiencing multiple traumatogenic events on symptoms of anxiety, depression and PTSD, respectively. Poor physical health mediated 10.0% [CI 9.1–12∙0], 7.2% [CI 6.6–8.2] and 4.0% [CI 3.8,4.4] of the effect of experiencing more than seven traumatic events on symptoms of anxiety, depression and PTSD, respectively.
Conclusion
Our findings highlight that not only do we need to move beyond a trauma-focussed approach to addressing psychological distress in populations affected by protracted conflict but we must also move beyond focussing on daily stressors as explanatory mediators.
Protocol > Research Protocol
Housen TSS, Shah SK, Janes S, Pintaldi G, Lenglet AD, et al.
1 July 2018
Journal Article > ResearchAbstract Only
Transcult Psychiatry. 19 March 2018; Volume 55 (Issue 3); 361-383.; DOI:10.1177/1363461518764487
Housen TSS, Lenglet AD, Ariti C, Ara S, Shah SK, et al.
Transcult Psychiatry. 19 March 2018; Volume 55 (Issue 3); 361-383.; DOI:10.1177/1363461518764487
The present study aimed to culturally adapt, translate, and validate the Hopkins Symptom Checklist-25 (HSCL-25) and the Harvard Trauma Questionnaire-Posttraumatic Stress Symptoms Checklist (HTQ-16) prior to use in a cross-sectional mental health population survey in the Kashmir Valley. Cultural adaptation and translation of the HSCL-25 and the HTQ-16 employed multiple forms of transcultural validity check. The HSCL-25 and HTQ-16 were compared against a "gold standard" structured psychiatric interview, the Mini International Neuropsychiatric Interview (MINI). Interviews were conducted with 290 respondents recruited using consecutive sampling from general medical outpatient departments in five districts of the Kashmir Valley. Receiver operating characteristics (ROC) analysis was used to estimate the cut point with optimal discriminatory power based on sensitivity and specificity. Internal reliability of the HSCL-25 was high, Cronbach's alpha (a) = .92, intraclass correlation coefficient (ICC) = 0.75, with an estimated optimal cut point of 1.50, lower than the conventional cut point of 1.75. Separation of the instruments into subscales demonstrated a difference in the estimated cut point for the anxiety subscale and the depression subscale, 1.75 and 1.57, respectively. Too few respondents were diagnosed with posttraumatic stress disorder (PTSD) during structured psychiatric interview, and therefore the HTQ-16 could not be validated despite the fact that high internal reliability was demonstrated (a = .90). This study verified the importance of culturally adapting and validating screening instruments in particular contexts. The use of the conventional cut point of 1.75 would likely have misclassified depression in our survey, leading to an underestimate of this condition.
Journal Article > ResearchFull Text
BMJ Glob Health. 15 October 2017; Volume 2 (Issue 4); e000419.; DOI:10.1136/bmjgh-2017-000419
Housen TSS, Lenglet AD, Ariti C, Shah SK, Shah H, et al.
BMJ Glob Health. 15 October 2017; Volume 2 (Issue 4); e000419.; DOI:10.1136/bmjgh-2017-000419
BACKGROUND
Following the partition of India in 1947, the Kashmir Valley has been subject to continual political insecurity and ongoing conflict, the region remains highly militarised. We conducted a representative cross-sectional population-based survey of adults to estimate the prevalence and predictors of anxiety, depression and post-traumatic stress disorder (PTSD) in the 10 districts of the Kashmir Valley.
METHODS
Between October and December 2015, we interviewed 5519 out of 5600 invited participants, ≥18 years of age, randomly sampled using a probability proportional to size cluster sampling design. We estimated the prevalence of a probable psychological disorder using the Hopkins Symptom Checklist (HSCL-25) and the Harvard Trauma Questionnaire (HTQ-16). Both screening instruments had been culturally adapted and translated. Data were weighted to account for the sampling design and multivariate logistic regression analysis was conducted to identify risk factors for developing symptoms of psychological distress.
FINDINGS
The estimated prevalence of mental distress in adults in the Kashmir Valley was 45% (95% CI 42.6 to 47.0). We identified 41% (95% CI 39.2 to 43.4) of adults with probable depression, 26% (95% CI 23.8 to 27.5) with probable anxiety and 19% (95% CI 17.5 to 21.2) with probable PTSD. The three disorders were associated with the following characteristics: being female, over 55 years of age, having had no formal education, living in a rural area and being widowed/divorced or separated. A dose-response association was found between the number of traumatic events experienced or witnessed and all three mental disorders.
INTERPRETATION
The implementation of mental health awareness programmes, interventions aimed at high risk groups and addressing trauma-related symptoms from all causes are needed in the Kashmir Valley.
Following the partition of India in 1947, the Kashmir Valley has been subject to continual political insecurity and ongoing conflict, the region remains highly militarised. We conducted a representative cross-sectional population-based survey of adults to estimate the prevalence and predictors of anxiety, depression and post-traumatic stress disorder (PTSD) in the 10 districts of the Kashmir Valley.
METHODS
Between October and December 2015, we interviewed 5519 out of 5600 invited participants, ≥18 years of age, randomly sampled using a probability proportional to size cluster sampling design. We estimated the prevalence of a probable psychological disorder using the Hopkins Symptom Checklist (HSCL-25) and the Harvard Trauma Questionnaire (HTQ-16). Both screening instruments had been culturally adapted and translated. Data were weighted to account for the sampling design and multivariate logistic regression analysis was conducted to identify risk factors for developing symptoms of psychological distress.
FINDINGS
The estimated prevalence of mental distress in adults in the Kashmir Valley was 45% (95% CI 42.6 to 47.0). We identified 41% (95% CI 39.2 to 43.4) of adults with probable depression, 26% (95% CI 23.8 to 27.5) with probable anxiety and 19% (95% CI 17.5 to 21.2) with probable PTSD. The three disorders were associated with the following characteristics: being female, over 55 years of age, having had no formal education, living in a rural area and being widowed/divorced or separated. A dose-response association was found between the number of traumatic events experienced or witnessed and all three mental disorders.
INTERPRETATION
The implementation of mental health awareness programmes, interventions aimed at high risk groups and addressing trauma-related symptoms from all causes are needed in the Kashmir Valley.