Lay community mental health workers (cadres) in Indonesian health services: A qualitative exploration of the views of people with mental health problems and their families.

INTRODUCTION: In community-based mental health services, lay workers recruited and trained to support mental health programs, known as mental health cadres, have an important role in supporting the care of families and people with mental disorders. This study aims to explore the experiences of people with mental disorders and their families about the role of mental health cadres in improving mental health and caring for people with mental disorders. METHODS: This study employed a qualitative descriptive design for data gathering. Focus groups were conducted between August 2020 and January 2021 with 19 people with mental health difficulties (people diagnosed with schizophrenia) and 25 family members who are the primary caregivers of people with mental disorders from three provinces in Indonesia: West Java, East Java, and Aceh. Participants were purposively sampled with inclusion and exclusion criteria used were people with mental disorders and their families who regularly interact with mental health cadres. Data were analyzed using inductive thematic analysis through six stages of coding and theme development. RESULTS: Several themes were identified. The most significant theme was emotional support provided by cadres in terms of reception from cadres about people with mental health problems (59.1%), tangible support in which cadres help people with mental disorders get treatment (52.27%), and cadre roles as duties/mandates (51.36%) was factors that facilitated the success. The finding of this study indicated that cadres were considered to provide a range of different support to people with mental health disorders and their families. In carrying out their role, there were factors that participants felt increased success in implementing the role of cadres. The cadre-patient/family relationship was influenced by perceived shame, trust relationship, and stigma. This research also revealed patient and family expectations about cadres' roles. CONCLUSIONS: Exploring the experiences of people with mental disorders and their families who received support from cadres could examine the factor that increases success in implementing cadre roles and barriers to mental health services by cadres, which are shame, mistrust, and stigma in the community. Therefore, paying attention to the expectations of people with mental health problems and their families about the cadre's roles in improving mental health services in the community is essential.

Factors Associated with Caregiver Burden in Caregivers of Older Patients with Dementia in Indonesia.

This cross-sectional study aimed to identify caregiver burden and its determinants in the informal caregivers of older patients with dementia (PWDs) aged ≥ 60 years in Java, Indonesia. Data were collected from 207 caregivers of older PWDs using self-administered questionnaires. The dependent variable was caregiver subjective burden, assessed using the Zarit Burden Interview (ZBI). The independent variables included the socio-demographic characteristics of PWDs and caregivers, the caregiver's perceived social support, and the behavioural and psychological symptoms of dementia (BPSD). Linear regression with a stepwise elimination method was used to identify the factors associated with caregiver burden. This study found that four factors were associated with the caregiver burden, such as the gender of PWDs, the educational level of caregivers, social support, and BPSD (R-squared = 27.78%). Higher burden was reported among the caregivers of female PWDs (ß = 5.58; 95%CI = 2.16; 8.99) and PWDs with higher scores of BPSD (ß = 0.34; 95%CI = 0.25; 0.43). Meanwhile, the caregivers with higher perceived social support (ß = -0.26; 95%CI = -0.42; -0.10) and who completed high school education and above (ß = -6.41; 95%CI = -10.07; -2.74) tended to have lower scores of subjective burden. These findings suggest that BPSD management and maintaining the resources of support may provide an opportunity to minimise caregiver burden and improve the quality of life of caregivers and PWDs.

The effects of acceptance and commitment therapy on psychosocial impact and adherence of MDR-TB patients.

BACKGROUND: The Worldwide resistance prevalence of the first-line TB drug, rifampicin (RR-TB), in 2017 was 7.4 per 100,000 population, and 82% of them experienced multidrug-resistant tuberculosis (MDR-TB). Indonesia is the top 20 country with an MDR-TB burden, and its prevalence is 8.8 per 100,000 population. MDR-TB requires a long-time treatment and has accompanying side effects: biological and psychosocial effects. However, efforts to overcome the psychosocial impacts have not been conducted. This study aims to determine the effect of acceptance and commitment therapy (ACT) on anxiety, depression, suicidal ideation, and treatment adherence in MDR-TB patients. DESIGN AND METHODS: This research employed a quasi-experimental design with a pre-test three post-tests using total sampling. The pre-test was conducted before the standard nursing intervention, post-test 1 was after the standard nursing intervention, post-test 2 was after ACT session 1, and post-test 3 was after ACT session 2. Data were collected by the Hamilton Rating Scale for Anxiety (HAM-A), Beck Hopelessness Scale (BHS), a Scale for Suicide Ideation (SSI), and Morisky Medication Adherence Scale (MMAS). RESULTS: The standard nursing action and ACT reduce anxiety (p = 0.002), reduced depression (p = 0.0001), reduced suicidal ideation (p = 0.008), and increased treatment adherence (p = 0.0001). CONCLUSIONS: The standard nursing action and ACT reduce anxiety, depression, and suicidal ideation. They increase treatment adherence recommended for use in MDR-TB patients.

Effectiveness health education and infant therapeutic group therapy on baby aged 0-6 months to prevent stunting risk factors: mother depression.

BACKGROUND:  Stunting is a global and national problem that can be detected at the age of 2. Therefore, before this age, promotion efforts must be conducted to prevent stunting risk factors in the future. This study aims to determine the effect of health education and infant's Therapeutic Group Therapy on stunting's risk factor: maternal postpartum depression in Indonesia. DESIGN AND METHODS:  This study employed a quasi-experimental design with a pre-test and post-test with a control group. This study employed a purposive sampling technique, with 96 respondents divided into two groups. Intervention group 1 consisted of 48 people who received health education, and group 2 consisted of 48 people who received health education and infant's Therapeutic Group Therapy. The data were collected using the Depression Inventory-II (DI II) questionnaire with a bivariate analysis of the Wilcoxon test and frequency distribution. RESULTS:  The results show that health education and infant's Therapeutic Group Therapy significantly influence the risky factors in stunting: maternal depression. It can be concluded that there were significant changes in maternal postpartum depression in intervention group 1 and intervention group 2, but in intervention group 2 who got Health Promotion and Therapeutic Group Therapy (TKT) for Infants there was a bigger and more significant decrease. CONCLUSIONS:  Nursing action, infants' Therapeutic Group Therapy, and health education are recommended to prevent risk factors for stunting: mother depression. The results of this study are expected to underlie the development of mental health promotion to prevent stunted against maternal depression and preventive programs. In addition, the research is expected to underly provision of curative and rehabilitative programs for stunted.

Effect of Cognitive Behavioral Therapy and Peer Leadership on Suicidal Ideation of Adolescents in Bengkulu.

To determine the effects of cognitive behavioral therapy and peer leadership on suicidal ideation among adolescents in senior high school, this study design used quasiexperimental pre-post testing with control group. Participants (N = 86) were recruited by purposive sampling technique. Data were collected using the Beck Scale for Suicide Ideation and analyzed using the Wilcoxon test, the Friedman test, and the Mann-Whitney test. The results showed that the training received by mental health nurses reduced suicidal ideation among adolescents (p < 0.05). After further cognitive behavioral therapy and peer leadership interventions, suicidal ideation decreased from the lower rate to zero (p < 0.05). A combination of the training received by mental health nurses, cognitive behavioral therapy, and peer leadership are recommended for prevention of adolescent suicidal ideation.

Promoting the Mental Health of Adolescents through Cognitive Behavior Group Therapy and Family Psychoeducation.

The aim of this study was to examine the effects of cognitive behavior group therapy (CBGT) and family psychoeducation (FPE) in promoting and maintaining adolescent mental health. This quantitative study used a quasi-experiment method, pre- and post-testing with a control group design. A total of 86 adolescents were selected using the purposive sampling method and allocated into two groups that were administered different types of intervention. The first intervention group was provided with mental health education and adolescent developmental stimulation only, which was carried out with individual exercises of stimulation. The second intervention group was provided with mental health education and adolescent developmental stimulation in addition to CBGT and FPE. A mental health continuum short-form questionnaire was used to determine mental health scores. The results showed that most of the adolescents received flourishing mental health scores. These scores significantly increased after receiving mental health education and developmental stimulation, as well as CBGT and FPE. Our results indicate that mental health education and developmental stimulation can be used to promote and maintain good mental health. CBGT and FPE can be used not only to treat mental health problems but also to promote flourishing mental health.

Risk Factors of Mental Health in Adolescents: Emotional, Behavioral, Family, and Peer Relationship Problems.

Adolescents are vulnerable to some risk factors in their lives, such as emotional and behavioral problems, problems in the family, and relationship problems within their peer group. This study aimed to describe these risk factors in adolescents. This study used a descriptive statistic design with a cross-sectional approach. The study sample consisted of 292 students in the 8th grade at a junior high school, selected through a purposive sampling technique. The adolescents experienced emotional and behavioral problems, as well as relationship problems with their peers, which within the study was categorized as normal, while problems in the family have the borderline score. It is essential to promote mental health in adolescents in order to maintain good emotional conditions and behaviors, as well as good relationships within their peer group. In the meantime, mental health promotion programs should be given to adolescents and their families to prevent problems among adolescents that will affect their mental health condition.

Comprehending Mental Health in Indonesian's Adolescents through Mental, Emotional, and Social Well-Being.

Many problems occur at the age of adolescence, especially mental health disorders. Teens experiencing life changes could be at risk for mental health disorders. Adolescents with flourishing/good mental health can become adults who are optimistic, independent, creative, and able to adequately contribute to their surroundings by optimally using their capacities. This study aims to describe an overview of the psychological, emotional, and social well-being of adolescents; thus, it can be used to create a national picture of adolescents' mental health in Indonesia. This is a descriptive study with a cross-sectional design. The study sample included 972 adolescents in grades 7 and 8 in public and private junior high schools in Depok, Jakarta, Tangerang, and Denpasar who were selected by stratified random sampling. Adolescents possess a high degree of psychological, emotional, and social well-being, and 46.3% of the adolescents were discovered to have flourishing mental health while the others had moderate and languishing/weak mental health. It is necessary to maintain and enhance the involvement of adolescents' support systems to maintain their mental health. Moreover, adolescents should explore their potential in order to learn adaptive coping mechanisms to help them solve problems appropriately.

Cognitive Behavioral and Family Psychoeducational Therapies for Adolescent Inmates Experiencing Anxiety in a Narcotics Correctional Facility.

Illicit substance use is becoming a major global issue. In Indonesia, inmates imprisoned for illicit substance offences accounted for 40% of the total inmate population. This study aimed to identify the effects of cognitive behavioral and family psychoeducational therapies on inmates' anxiety in the narcotics correctional facility. Quasi-experimental pre-test-post-test with control group was employed in this study. Intervention Group 1 received a general nursing intervention whereas Intervention Group 2 received a combination of general nursing intervention with cognitive behavioral and family psychoeducational therapies. This study involved 31 inmates for each group. Data were collected using the Hamilton Anxiety Rating Scale (HAM-A) and were analyzed using repeated ANOVA and independent t-tests. The study demonstrated that anxiety was significantly lower among those who received the combination of those three therapies compared to those who received general nursing intervention standalone (p < .005). This study suggested the implementation of both general nursing intervention and specialty therapies, particularly cognitive behavioral and family psychoeducational therapies, to address the anxiety problems experienced by adolescent inmates suffering from illicit substance dependence.