Effects of Early-Life Adversities on Neuropsychiatric and Executive Functions in HIV-Positive Adults.

OBJECTIVE: Adverse childhood experiences (ACEs) contribute to elevations in neuropsychiatric and neurocognitive symptoms in HIV+ adults. Emerging data suggest that exposures to threat-related and deprivation-related ACEs may have differential impacts on function, with threat exposure contributing to neuropsychiatric symptoms, and deprivation contributing to executive dysfunction. Yet, it remains unclear how specific types of ACEs impact neuropsychiatric and neurocognitive symptoms in HIV+ adults. Hence, the current study examined whether these two dimensions of adversity contribute differentially to neuropsychiatric symptoms and executive dysfunction in HIV+ adults. METHODS: We included a sample of demographically matched HIV+ (N = 72) and HIV-negative (N = 85) adults. Standardized self-report measures assessed threat-related (interpersonal violence) and deprivation-related (poverty/neglect) ACEs, as well as neuropsychiatric symptoms (depression, anxiety, apathy). A brief battery of neuropsychological tests assessed executive functions. RESULTS: Compared to HIV-negative participants, HIV+ participants reported significantly higher rates of threat exposure (51% vs. 67%, p = .04), while rates of deprivation did not differ significantly (8% vs. 13%, p = .38). In the HIV+ sample, threat exposure was associated with neuropsychiatric symptoms (p < .01) but not executive dysfunction (p = .75). By contrast, deprivation was associated with executive dysfunction, at a trend level (p = .09), but not with neuropsychiatric symptoms (p = .70). CONCLUSIONS: Our data suggest that, relative to HIV-negative samples, HIV+ samples experience higher rates of threat-related ACEs, which contribute to neuropsychiatric symptom elevations. Moreover, our preliminary findings suggest that different types of ACEs could be associated with different profiles of neuropsychiatric and neurocognitive difficulty in HIV+ adults, highlighting the importance of considering dimensions of adversity in future studies.

A cross-sectional analysis of mental health disorders in a mental health services-seeking population of children, adolescents, and young adults in the context of ongoing violence and displacement in northern Cameroon.

BACKGROUND: Displacement and conflict exposure are known risk factors for mental health conditions. Here, we examine the mental health of youth in a conflict-affected region of Cameroon. METHODS: Participants were recruited from among beneficiaries of a project conducted by Univers Psy and the United Nations Population Fund in Cameroon's Far North region. Community health workers conducted sensitization campaigns, following which they referred adolescents and young adults who self-identified as having mental health concerns to clinical psychologists. We ultimately conducted chart reviews of 948 of these youth. Univariate analyses using chi-squared tests were used to assess the relationships among demographics, displacement status, and mental health. Logistic regressions were then performed to determine the odds of having a psychiatric disorder based on displacement status. OUTCOME: Sixty-eight percent of evaluated youth met criteria for a psychiatric disorder. Anxiety disorders were most prevalent at 24.3%, followed by trauma- and stressor-related disorders at 17.0%, and mood disorders at 8.0%. Refugees and IDPs had 0.11 (95% CI 0.06, 0.19) and 0.46 (95% CI 0.29, 0.74) odds, respectively, of any diagnosis compared to the host population. Females had 1.71 (95% CI 1.17, 2.50) odds of an anxiety disorder and 2.18 (95% CI 1.16, 4.10) odds of a mood disorder compared to males. INTERPRETATION: In a youth sample in Cameroon self-identified as having mental health concerns, this study found high rates of psychiatric illness, particularly anxiety disorders. We found a higher prevalence among host population individuals than among displaced individuals and especially in the female population.

Supporting Clinician-Scientist Development in Child Psychiatry: A Four-Domain Model for Individual or Programmatic Self-Reflection.

Background: The Albert J. Solnit Integrated Training Program (AJSP) is a novel educational initiative designed to prepare physician-scientists for independent careers in the investigation and treatment of childhood psychiatric disorders. Methods: We conducted a qualitative study to explore the impact and active components of the AJSP through hour-long individual interviews of its enrollees and graduates. We were specifically interested in identifying individual or programmatic traits for success that could be replicated elsewhere. As components of our theoretical framework, we used sources on Strength, Weakness, Opportunity, and Threat (SWOT) Analysis as applied to healthcare, and on mentorship and career development as pertaining to child and adolescent psychiatry (CAP). Results: Thirty-four individuals matriculated into the AJSP between 2004 and 2020, 33 (97%) of whom participated. Through iterative thematic analysis, we developed a model consisting of quadrants resulting from the intersection of a developmental perspective (spanning professional or personal spheres) and a reflective direction (with outward- or inward-facing vantage points). The model can be of practical utility through putative questions that trainees/program leaders could ask themselves by using the four domains as points of departure: (I) Individual: "Is becoming a clinician-scientist right for me?"/"What traits are we looking for in prospective applicants?"; (II) Program: "Is this the right program for me?"/"What is the right balance between structure and freedom for trainees to thrive in?"; (III) Mentorship: "What is the right number and constellation of mentors for me?"/"How can we optimize our experience and backgrounds toward the benefit of our trainees?"; and (IV) Charting Course: "Who do I want to become?"/"How can we help our charges embrace, find, or reconnect with their true vocation?" Conclusion: Our analytic approach can help identify, refine, and replicate programs that are urgently needed to increase the workforce of clinician-scientists dedicated to improving the well-being and mental health of children and families. The model we describe can be fruitfully applied to the self-reflection by individuals or program leaders. Although based on a single program with very specific goals, the model could also be applied to other training initiatives within psychiatry-and beyond.

Viral time capsule: a global photo-elicitation study of child and adolescent mental health professionals during COVID-19.

OBJECTIVE: To examine, through photo-elicitation, the personal and professional impact of the COVID-19 pandemic on mental health professionals working with children and adolescents around the globe. METHODS: We invited the submission of images collected about the pandemic between May and August 2020. We encouraged participants to yoke personal reflections or voice memos to their images. Using snowball sampling, we began with two invitations, including one to the graduates of a mentorship program continuously hosted since 2004 by the International Association of Child and Adolescent Psychiatry and Allied Professions (IACAPAP). We analyzed de-identified images and anonymized transcripts through iterative coding using thematic analysis informed by rich picture analysis and aided by NVivo software. RESULTS: We collected submissions from child and adolescent mental health professionals (n = 134) working in 54 countries spread across the five continents. We identified four overarching domains with component themes that revealed both the commonality and the uniqueness of the pandemic experience around the globe: (1) Place (adjusting to emptiness and stillness; shifting timeframes; blending of spaces); (2) Person (disruption to life rhythms; emotional toll; positives of the pandemic); (3) Profession (changing practices; outreach efforts; guild pride-and guilt); and (4) Purpose (from pandemic to syndemic; from lamenting to embracing; planning toward a better tomorrow). CONCLUSIONS: Photo-elicitation provided a disarming and efficient means to learn about individual, regional, and global similarities and differences regarding the professionals charged with addressing the mental health needs of children and adolescents around the globe. These findings may help inform practice changes in post-pandemic times.