Psychological flexibility in South Sudanese female refugees in Uganda as a mechanism for change within a guided self-help intervention.

OBJECTIVE: To examine the role of psychological flexibility as a potential mediator in the relationship between involvement in a guided self-help intervention, Self-Help Plus, and psychological distress in a sample of South Sudanese refugee women living in northern Uganda. METHOD: We conducted secondary analysis of data from a cluster randomized controlled trial conducted in 2018. We used multilevel mediation modeling to explore the relationship of psychological flexibility, as measured by the Acceptance and Action Questionnaire (AAQ-II), as a mediating factor in the relationship between Self-Help Plus involvement and general psychological distress as measured by the Kessler Psychological Distress Scale-6 (K6). RESULTS: We found strong multilevel mediation of decreased K6 scores in the treatment group by AAQ-II scores (multilevel b = -3.28). A more pronounced mediation effect was discovered immediately post intervention (b = -1.09) compared to 3-month follow-up (b = -0.84). This is in line with the current literature that demonstrates the role of psychological flexibility as a primary mechanism of change in ACT-based interventions. CONCLUSIONS: Psychological flexibility is a contributing component in the theory of change for this ACT-based intervention. Identifying the core components of interventions allows for more effective adaptation and implementation of relevant services, especially in low-resource contexts. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Associations between HIV testing and multilevel stigmas among gay men and other men who have sex with men in nine urban centers across the United States.

BACKGROUND: Complex manifestation of stigma across personal, community, and structural levels and their effect on HIV outcomes are less understood than effects in isolation. Yet, multilevel approaches that jointly assesses HIV criminalization and personal sexual behavior stigma in relation to HIV testing have not been widely employed or have only focused on specific subpopulations. The current study assesses the association of three types of MSM-related sexual behavior-related stigma (family, healthcare, general social stigma) measured at both individual and site levels and the presence/absence of laws criminalizing HIV transmission with HIV testing behaviors to inform HIV surveillance and prevention efforts among HIV-negative MSM in a holistic and integrated way. METHODS: We included nine National HIV Behavioral Surveillance (NHBS) 2017 sites: Baltimore, MD; Denver, CO; Detroit, MI; Houston, TX; Long Island/Nassau-Suffolk, NY; Los Angeles, CA; Portland, OR; San Diego, CA; and Virginia Beach and Norfolk, VA. Multivariable generalized hierarchical linear modeling was used to examine how sexual behavior stigmas (stigma from family, anticipated healthcare stigma, general social stigma) measured at the individual and site levels and state HIV criminalization legislation (no, HIV-specific, or sentence-enhancement laws) were associated with past-year HIV testing behaviors across sites (n = 3,278). RESULTS: The majority of MSM across sites were tested for HIV in the past two years (n = 2,909, 95.4%) with the average number of times tested ranging from 1.79 (SD = 3.11) in Portland, OR to 4.95 (SD = 4.35) in Los Angeles, CA. In unadjusted models, there was a significant positive relationship between stigma from family and being tested for HIV in the past two years. Site-level HIV-specific criminalization laws were associated with an approximate 5% reduction in the prevalence of receiving any HIV test in the past two years after individual level stigma and sociodemographic covariate adjustments (PR = 0.94, 95% CI, 0.90-0.99). CONCLUSIONS: Structural barriers faced by MSM persist and ending the HIV epidemic in the US requires a supportive legal environment to ensure effective engagement in HIV services among MSM. Home-based solutions, such as self-testing, used to deliver HIV testing may be particularly important in punitive settings while legal change is advocated for on the community and state levels.

SH+ 360: novel model for scaling up a mental health and psychosocial support programme in humanitarian settings.

We explore multi-sectoral integration as a model for scaling up evidence-based mental health and psychosocial support interventions in humanitarian settings. We introduce Self Help Plus 360, designed to support humanitarian partners across different sectors to integrate a psychosocial intervention into their programming and more holistically address population needs.

Quantitative methods for climate change and mental health research: current trends and future directions.

The quantitative literature on climate change and mental health is growing rapidly. However, the methodological quality of the evidence is heterogeneous, and there is scope for methodological improvement and innovation. The first section of this Personal View provides a snapshot of current methodological trends and issues in the quantitative literature on climate change and mental health, drawing on literature collected through a previous scoping review. The second part of this Personal View outlines opportunities for methodological innovation concerning the assessment of the relationship between climate change and mental health. We then highlight possible methodological innovations in intervention research and in the measurement of climate change and mental health-related variables. This section draws upon methods from public mental health, environmental epidemiology, and other fields. The objective is not to provide a detailed description of different methodological techniques, but rather to highlight opportunities to use diverse methods, collaborate across disciplines, and inspire methodological innovation. The reader will be referred to practical guidance on different methods when available. We hope this Personal View will constitute a roadmap and launching pad for methodological innovation for researchers interested in investigating a rapidly growing area of research.

Brief report: HIV-related healthcare stigma/discrimination and unmet needs among persons living with HIV in England and Wales.

We characterized the prevalence of, and estimated associations between, (1) HIV-related healthcare stigma/discrimination and (2) unmet social, mental, and chronic condition healthcare needs among persons living with HIV (PLHIV) in England and Wales. We used data from Positive Voices 2017, a national, cross-sectional probability survey of PLHIV in England and Wales, in which N = 3,475 PLHIV provided complete data on demographic characteristics (control variables; age, ethnicity, gender, sexual identity), HIV-related healthcare stigma/discrimination (exposures; treated differently from other patients, care was refused/delayed, worried about being treated differently, avoided seeking needed care, all due to HIV status), and unmet needs (outcomes; unmet peer support, psychological care, management of chronic health conditions, and isolation help needs). Modified Poisson regression models with log links and robust variance estimators were used to produce prevalence ratios and 95% confidence intervals for unadjusted and adjusted associations between demographic characteristics, HIV-related healthcare stigma/discrimination (individual items and total scale score), and unmet needs variables. Two in five participants (40%) endorsed at least one HIV-related healthcare stigma/discrimination item; and 474 (14%), 428 (12%), 459 (13%), and 501 (14%) reported an unmet peer support, psychological care, chronic health condition management, and isolation help need, respectively. Each HIV-related healthcare stigma/discrimination item and the summed scale score were significantly, positively associated with all four unmet needs variables in unadjusted and adjusted models. Trainings for all healthcare workers in HIV-competent, non-stigmatizing care, as well as the development of engagement and delivery approaches for psychosocial care for PLHIV, are needed.

Characterizing Cross-Culturally Relevant Metrics of Stigma Among Men Who Have Sex With Men Across 8 Sub-Saharan African Countries and the United States.

Overcoming stigma affecting gay, bisexual, and other men who have sex with men (MSM) is a foundational element of an effective response to the human immunodeficiency virus (HIV) pandemic. Quantifying the impact of stigma mitigation interventions necessitates improved measurement of stigma for MSM around the world. In this study, we explored the underlying factor structure and psychometric properties of 13 sexual behavior stigma items among 10,396 MSM across 8 sub-Saharan African countries and the United States using cross-sectional data collected between 2012 and 2016. Exploratory factor analyses were used to examine the number and composition of underlying stigma factors. A 3-factor model was found to be an adequate fit in all countries (root mean square error of approximation = 0.02-0.05; comparative fit index/Tucker-Lewis index = 0.97-1.00/0.94-1.00; standardized root mean square residual = 0.04-0.08), consisting of "stigma from family and friends," "anticipated health-care stigma," and "general social stigma," with internal consistency estimates across countries of α = 0.36-0.80, α = 0.72-0.93, and α = 0.51-0.79, respectively. The 3-factor model of sexual behavior stigma cut across social contexts among MSM in the 9 countries. These findings indicate commonalities in sexual behavior stigma affecting MSM across sub-Saharan Africa and the United States, which can facilitate efforts to track progress on global stigma mitigation interventions.

Measurement of Parenting Self-efficacy Among Female HIV-Affected Caregivers in Uganda.

OBJECTIVES: Parenting self-efficacy has been associated with positive parenting behaviors, fewer parental mental health problems, less family dysfunction, and better child development outcomes. The parenting sense of competence (PSOC) scale is commonly used to measure parenting self-efficacy in high-resource settings. This study sought to examine the factor structure, internal consistency, and convergent construct validity of the PSOC in a sample of predominantly HIV-infected women in Uganda. METHODS: Using data from 155 HIV-affected caregivers who participated in a randomized controlled trial of a parenting intervention, two and three factor models of a 16-item translated version of the PSOC were tested using confirmatory factor analysis. Multivariable regression models were used to examine relationships between parenting confidence (operationalized using the best-fitting PSOC model), caregiver mental health symptoms (depression and anxiety), social support, family dysfunction, and family wealth, after adjusting for covariates. RESULTS: Neither the two- nor three-factor models of the PSOC demonstrated adequate model fit; however, adequate model fit was demonstrated for a one-factor model that included only items from the PSOC efficacy subscale. Cronbach's alpha was 0.73 for this subscale. Correlates of parenting self-efficacy in this sample included caregiver depression, family dysfunction, and family wealth, but not caregiver anxiety or social support. CONCLUSIONS FOR PRACTICE: These findings lend support for future use of the PSOC efficacy subscale among HIV-affected caregivers of children in low-resource settings such as rural Uganda.

Early Childhood Development Caregiver Training and Neurocognition of HIV-Exposed Ugandan Siblings.

OBJECTIVE: Early childhood development (ECD) programs can enhance neurocognitive development outcomes through caregiver training. This study explores whether school-age siblings benefited from a program provided to HIV-infected caregivers and their preschool-aged target children. METHODS: Siblings of target 2- to 3-year-old children in ECD intervention households were evaluated at school age (5-12 years) on neurocognitive outcomes with the Kaufman Assessment Battery for Children (KABC), computerized Test of Variables of Attention, Behavior Rating Inventory for Executive Function (BRIEF; parent), and attention-deficit/hyperactivity disorder rating inventory (ADHD-R)-IV (parent). Households from 18 geographic clusters in eastern Uganda were randomized to individualized biweekly sessions of either (1) Mediational Intervention for Sensitizing Caregivers (MISC) training emphasizing cognitive stimulation/enrichment or (2) health/nutrition/development [Uganda Community-Based Association For Women & Children Welfare (UCOBAC)] program. Siblings with baseline and at least 1 follow-up assessment (n = 216) were included in the analysis. Three repeated postbaseline measures of sibling neurocognitive outcomes were analyzed using the linear mixed-effects model while adjusting for socioeconomic status and behavioral outcome at baseline. RESULTS: Siblings in the MISC arm had better performance on KABC sequential processing at 6 months (p = 0.02) and simultaneous processing at 12 months (p = 0.03). MISC mothers rated their children as having significantly more problems on the BRIEF and ADHD-RS-IV (p < 0.01) than UCOBAC mothers across all time points. CONCLUSION: Mediational Intervention for Sensitizing Caregivers training resulted in some short-term neurocognitive benefits for school-aged siblings, but these differences were not sustained at 1-year follow-up. Exploring potential impacts of parenting programs on other children in the home is an important development for the field.

Gene-Environment Interactions in Psychiatry: Recent Evidence and Clinical Implications.

PURPOSE OF REVIEW: We identify the recent evidence for gene-by-environment interaction studies in relation to psychiatric disorders. We focus on the key genotypic data as well as environmental exposures and how they interact to predict psychiatric disorders and psychiatric symptomatology. We direct our focus on the psychiatric outcomes that were focused on by the Psychiatric Genetics Consortium. RECENT FINDINGS: Many of the studies focus on candidate gene approaches, with most of the studies drawing upon previous literature to decide the genes of interest. Other studies used a genome-wide approach. While some studies demonstrated positive replication of previous findings, replication is still an issue within gene-by-environment interaction studies. Gene-by-environment interaction research in psychiatry globally suggests some susceptibility to environmental exposures based on genotype; however, greater clarity is needed around the idea that genetic risk may not be disorder specific.

Parenting self-efficacy in the context of poverty and HIV in Eastern Uganda: A qualitative study.

We sought to understand social representations of effective parenting and parenting self-efficacy among female HIV-affected caregivers in rural Eastern Uganda. We conducted in-depth interviews (n = 21) to describe parenting experiences and caregivers' perceptions of their own parenting abilities and to create vignettes for use in directed focus groups. We carried out open focus groups (n = 2) to gain social perspectives on parenting, and directed focus groups (n = 2) concentrated on parenting self-efficacy. Analysis involved memoing and inductive and deductive coding of transcripts. Caregivers' perceptions of their own parenting were grounded in parenting values such as providing children with basic needs, having well-behaved children, and having good relationships with children. Caregivers' perceptions were influenced by challenges, including single parenthood, living with HIV, limited family resources, and mental health problems. When facing challenges, caregivers relied on social support and faith as well as their own parenting confidence. Caregivers' perceptions of their parenting abilities were influenced by how they felt others perceived them, their satisfaction in the parenting role, their perseverance despite challenges, and the extent to which they had a vision for their family. Our findings contextualize parenting self-efficacy within parenting values, challenges, and social perceptions among HIV-affected caregivers in rural Uganda.

Nos propusimos comprender las representaciones sociales de la crianza eficaz y la auto-efectividad en la crianza entre mujeres afectadas con VIH y que prestan cuidados en el área rural del este de Uganda. Realizamos entrevistas profundas (n = 21) para describir las experiencias de crianza y las percepciones de las cuidadoras sobre sus propias habilidades de crianza y para crear esbozos para usar en grupos de enfoque dirigidos. Llevamos a cabo grupos de enfoque a puertas abiertas (n = 2) para conocer las perspectivas sociales acerca de la crianza y dirigimos los grupos de enfoque (n = 2) concentrados en la auto-efectividad de la crianza. Los análisis incluyeron la toma de notas con reflexión y la codificación inductiva y deductiva de las transcripciones. Las percepciones de las cuidadoras acerca de sus propias crianzas se basaron en los valores de la crianza tales como proveerles a los niños las necesidades básicas, tener niños que se comportan bien, así como mantener buenas relaciones con sus niños. Los retos influyeron las percepciones de las cuidadoras; entre ellos se incluyeron el ser una madre sin pareja, vivir con VIH, los limitados recursos familiares y los problemas de salud mental. Cuando se encontraron con retos, las cuidadoras confiaron en el apoyo social y en la fe, así como en la confianza en su propia crianza. Las percepciones de las cuidadoras acerca de sus habilidades de crianza estuvieron influidas por cómo ellas sentían que otros las veían, su satisfacción en el papel de crianza, su perseverancia a pesar de los retos, así como hasta qué punto tenían una visión para su familia. Nuestros resultados contextualizan la auto-efectividad de la crianza dentro de los valores, retos y perspectivas sociales de la misma entre mujeres afectadas por VIH que prestan cuidado en el área rural de Uganda.

Nous avons voulu comprendre la représentation sociale du parentage efficace et de l'auto-efficacité de parentage chez des femmes prenant soin d'enfants et affectées par le VIH dans l'Ouganda rural de l'est. Nous avons conduit des entretiens approfondis (n = 21) afin de décrire les expériences de parentage et les perceptions des personnes prenant soin d'enfants de leurs propres capacités au parentage et afin de créer des vignettes pouvant être utilisées dans des groupes de réflexion et de discussion dirigés (n = 1) se concentrant sur l'auto-efficacité de parentage. L'analyse a inclus l'enregistrement de notes et le codage inductif et déductif des retranscriptions. Les perceptions de personnes prenant soin des enfants de leur propre parentage étaient fondées sur les valeurs de parentage, telles que le fait d'offrir aux enfants les soins de base, d'avoir des enfants sages, et de maintenir de bonnes relations avec les enfants. Les perceptions des personnes prenant soin des enfants étaient influencées par les défis auxquelles elles faisaient face, y compris la monoparentalité, le fait de vivre avec le VIH, les ressources familiales limitées et les problèmes de santé mentale. Quand elles faisaient face à des défis, les femmes prenant soin d'enfants se reposaient sur le soutien social et leur foi, ainsi que sur leur propre confiance de parentage. Les perceptions de leurs capacités de parentage étaient influencées par la manière dont elles pensaient que les autres les percevaient, leur satisfaction dans leur rôle de parentage, leur persévérance en dépit des défis, et le degré auquel elles avaient une vision pour leur famille. Nos résultats contextualisent l'auto-efficacité de parentage au sein des valeurs de parentage, des défis et des perceptions sociales chez les femmes prenant soin d'enfants étant affectées par VIH dans l'Ouganda rural.

A scoping review of health-related stigma outcomes for high-burden diseases in low- and middle-income countries.

BACKGROUND: Stigma is associated with health conditions that drive disease burden in low- and middle-income countries (LMICs), including HIV, tuberculosis, mental health problems, epilepsy, and substance use disorders. However, the literature discussing the relationship between stigma and health outcomes is largely fragmented within disease-specific siloes, thus limiting the identification of common moderators or mechanisms through which stigma potentiates adverse health outcomes as well as the development of broadly relevant stigma mitigation interventions. METHODS: We conducted a scoping review to provide a critical overview of the breadth of research on stigma for each of the five aforementioned conditions in LMICs, including their methodological strengths and limitations. RESULTS: Across the range of diseases and disorders studied, stigma is associated with poor health outcomes, including help- and treatment-seeking behaviors. Common methodological limitations include a lack of prospective studies, non-representative samples resulting in limited generalizability, and a dearth of data on mediators and moderators of the relationship between stigma and health outcomes. CONCLUSIONS: Implementing effective stigma mitigation interventions at scale necessitates transdisciplinary longitudinal studies that examine how stigma potentiates the risk for adverse outcomes for high-burden health conditions in community-based samples in LMICs.

Monitoring and evaluation of mental health and psychosocial support programs in humanitarian settings: a scoping review of terminology and focus.

BACKGROUND: Monitoring and evaluation of mental health and psychosocial support (MHPSS) programs is critical to facilitating learning and providing accountability to stakeholders. As part of an inter-agency effort to develop recommendations on MHPSS monitoring and evaluation, this scoping review aimed to identify the terminology and focus of monitoring and evaluation frameworks in this field. METHODS: We collected program documents (logical frameworks (logframes) and theories of change) from members of the Inter-Agency Standing Committee Reference Group on MHPSS, and systematically searched the peer-reviewed literature across five databases. We included program documents and academic articles that reported on monitoring and evaluation of MHPSS in low- and middle-income countries describing original data. Inclusion and data extraction were conducted in parallel by independent reviewers. Thematic analysis was used to identify common language in the description of practices and the focus of each monitoring and evaluation framework. Logframe outcomes were mapped to MHPSS activity categories. RESULTS: We identified 38 program documents and 89 peer-reviewed articles, describing monitoring and evaluation of a wide range of MHPSS activities. In both program documents and peer-reviewed literature there was a lack of specificity and overlap in language used for goals and outcomes. Well-validated, reliable instruments were reported in the academic literature, but rarely used in monitoring and evaluation practices. We identified six themes in the terminology used to describe goals and outcomes. Logframe outcomes were more commonly mapped to generic program implementation activities (e.g. "capacity building") and those related to family and community support, while outcomes from academic articles were most frequently mapped to specialized psychological treatments. CONCLUSIONS: Inconsistencies between the language used in research and practice and discrepancies in measurement have broader implications for monitoring and evaluation in MHPSS programs in humanitarian settings within low- and middle-income countries. This scoping review of the terminology commonly used to describe monitoring and evaluation practices and their focus within MHPSS programming highlights areas of importance for the development of a more standardized approach to monitoring and evaluation.

Neighborhood physical disorder, social cohesion, and insomnia: results from participants over age 50 in the Health and Retirement Study.

ABSTRACT Background: We determined the association between neighborhood socio-environmental factors and insomnia symptoms in a nationally representative sample of US adults aged >50 years. Methods: Data were analyzed from two waves (2006 and 2010) of the Health and Retirement Study using 7,231 community-dwelling participants (3,054 men and 4,177 women) in the United States. Primary predictors were neighborhood physical disorder (e.g. vandalism/graffiti, feeling safe alone after dark, and cleanliness) and social cohesion (e.g. friendliness of people, availability of help when needed, etc.); outcomes were insomnia symptoms (trouble falling asleep, night awakenings, waking too early, and feeling unrested). Results: After adjustment for age, income, race, education, sex, chronic diseases, body mass index, depressive symptoms, smoking, and alcohol consumption, each one-unit increase in neighborhood physical disorder was associated with a greater odds of trouble falling asleep (odds ratio (OR) = 1.09, 95% confidence interval (CI): 1.04-1.14), waking too early (OR = 1.05, 95% CI: 1.00-1.10), and, in adults aged ≥69 years (adjusting for all variables above except age), feeling unrested in the morning (OR = 1.11, 95% CI: 1.02-1.22 in 2006). Each one-unit increase in lower social cohesion was associated with a greater odds of trouble falling asleep (OR = 1.06, 95% CI: 1.01-1.11) and feeling unrested (OR = 1.09, 95% CI: 1.04-1.15). Conclusions: Neighborhood-level factors of physical disorder and social cohesion are associated with insomnia symptoms in middle-aged and older adults. Neighborhood-level factors may affect sleep, and consequently health, in our aging population.

Polysomnographic features of early-onset depression: a meta-analysis.

BACKGROUND: Undiagnosed major depressive disorder (MDD) is associated with increased morbidity in children and adolescents. This study evaluated features of sleep macro- and microarchitecture assessed by polysomnography (PSG) as diagnostic markers for MDD in children and adolescents. METHODS: MEDLINE, PSYCINFO, EMBASE and PUBMED were searched from their availability dates to March 1st, 2013. The literature search identified 932 abstracts of which 51 studies were retrieved and 28 were included in the analysis. Study design, features of sleep macro- and microarchitecture, demographic and clinical characteristics of study groups were extracted for each study. RESULTS: There were modest differences on sleep macroarchitecture between children and adolescents with MDD and healthy controls. The most robust difference was found in sleep latency, 31% of adolescents with MDD had increased sleep latency. Age, suicidal ideation, suicidal behavior, and psychiatric comorbidities were significant predictors of sleep macroarchitecture. Modest differences were found for sleep microarchitecture, intrahemispheric and interhemispheric temporal coherence was decreased in a third of patients with MDD. Age was a significant predictor of sleep microarchitecture. LIMITATIONS: This meta-analysis is limited by the small number of studies on sleep macroarchitecture in children with MDD and studies on sleep microarchitecture overall and by the heterogeneity in methodology between studies. CONCLUSIONS: This synthetic review of the existing literature is among the largest to quantitatively assess impaired sleep as a diagnostic marker for MDD in children and adolescents. Knowledge of sleep macro- and microarchitecture in early-onset MDD may aid the clinician in developing a treatment strategy for MDD-related sleep symptoms in a subset of patients.

Sleep and quality of life in urban poverty: the effect of a slum housing upgrading program.

STUDY OBJECTIVES: To evaluate the effect of a housing transition on sleep quality and quality of life in slum dwellers, participating in a slum housing upgrading program. DESIGN: Observational before-and-after study with a convergent-parallel mixed method design. SETTING: Five slums located in the metropolitan area of Buenos Aires, Argentina. PARTICIPANTS: A total of 150 slum dwellers benefited by a housing program of the nonprofit organization TECHO (spanish word for "roof"). INTERVENTIONS: Participants moved from their very low-quality house to a basic prefabricated 18 m(2) modular house provided by TECHO. MEASUREMENTS AND RESULTS: The Pittsburgh Sleep Quality Index (PSQI) and World Health Organization Quality of Life brief scale (WHOQOL-BREF) were administered before and after housing upgrading. Data about housing conditions, income, education, sleeping conditions, and cardiovascular risk were also collected. Semistructured interviews were used to expand and nuance quantitative data obtained from a poorly educated sample. Results showed that sleep quality significantly increased after the housing program (z = -6.57, P < 0.001). Overall quality of life (z = -6.85, P < 0.001), physical health domain (z = -4.35, P < 0.001), psychological well-being domain (z = -3.72, P < 0.001) and environmental domain (z = -7.10, P < 0.001) of WHOQOL-BREF were also improved. Interviews demonstrated the importance of serenity for improving quality of life. CONCLUSIONS: A minimal improvement in the quality of basic housing can significantly increase sleep quality and quality of life among slum dwellers. Understanding sleep and daily life conditions in informal urban settlements could help to define what kind of low-cost intervention may improve sleep quality, quality of life, and reduce existent sleep disparity.