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1.
Am J Hum Biol ; 33(6): e23537, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-33190335

RESUMO

OBJECTIVES: Oxidative stress is hypothesized to contribute to age-related somatic deterioration. Both reproductive and ecological context may necessitate tradeoffs that influence this outcome. We examined whether measures of lifetime reproductive effort were related to levels of oxidative stress biomarkers in peri- and post-menopausal women and whether associations were moderated by rural or urban residence. METHODS: We surveyed 263 healthy women (age 62.1 ± 10.0 SD) from rural (N = 161) and urban Poland (N = 102), collecting sociodemographic data and urine samples to analyze biomarkers of oxidative stress (8-oxo-2'-deoxyguanosine, 8-OHdG) and antioxidative defense (copper-zinc superoxide dismutase, Cu-Zn SOD). Linear regression models, adjusted for residence, were used to test for associations between reproductive effort and 8-OHdG and Cu-Zn SOD. RESULTS: Univariate models demonstrated significant associations between gravidity and the biomarkers of oxidative stress (8-OHdG: R2  = 0.042, P ≤ .001; Cu-Zn SOD: R2  = 0.123, P ≤ .001). Multivariate models incorporating potential confounding variables, as well as cross-product interaction terms, indicated that gravidity was associated with 8-OHdG (P < .01, R2 adj  = 0.067) and Cu-Zn SOD (P = .01, R2 adj  = 0.159). Residence (ie, urban vs rural) did not significantly moderate the associations between the biomarkers and reproductive effort. CONCLUSIONS: Higher lifetime reproductive effort contributes to increases in oxidative stress and antioxidative defenses. Our results provide evidence of potential mechanisms underlying the physiological tradeoffs influencing senescence for women with high reproductive effort. We illustrate the value of applying an evolutionary perspective to elucidate variation in human health and senescence.

2.
J Adolesc Health ; 68(3): 580-588, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-32919888

RESUMO

PURPOSE: In situations of adversity, young people draw on individual, relational, and contextual (community and cultural) resources to foster their resilience. Recent literature defines resilience as a capacity that is underpinned by a network of interrelated resources. Although empirical studies show evidence of the value of a network approach, little is known regarding how different country contexts influence which resources are most critical within a resource network and how resources interact for adolescent resilience. METHODS: Network analysis was conducted with data from studies that had used the Child and Youth Resilience Measure. Regularized partial correlation networks of 17 resources were estimated for 14 countries (Botswana, Canada, China, Colombia, Equatorial Guinea, India, Indonesia, Italy, Jordan, New Zealand, the Philippines, Romania, South Africa, and Syrian refugees living in Jordan). The sample size was 18,914 (mean age = 15.70 years, 48.8% female). RESULTS: We observed mostly positive associations between the resources of interest. The salience and strength of associations between resources varied by country. The most central resource across countries was having supportive caregivers during stressful times because this resource had the most and strongest positive associations with other resources. CONCLUSIONS: This study gives first empirical evidence from multiple countries that an interplay of social-ecological resources (such as individual skills, peer, caregiver and community support, and educational aspirations and opportunities) matter for adolescent resilience. Across countries, caregiver support appears to be most central for adolescent resilience. Future resilience interventions might apply this network approach to identify important, contextually relevant resources that likely foster additional resources.


Assuntos
Resiliência Psicológica , Adolescente , Botsuana , Canadá , Criança , China , Colômbia , Feminino , Humanos , Índia , Itália , Masculino , Nova Zelândia , África do Sul
3.
Confl Health ; 14(1): 71, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33292413

RESUMO

Major knowledge gaps remain concerning the most effective ways to address mental health and psychosocial needs of populations affected by humanitarian crises. The Research for Health in Humanitarian Crisis (R2HC) program aims to strengthen humanitarian health practice and policy through research. As a significant portion of R2HC's research has focused on mental health and psychosocial support interventions, the program has been interested in strengthening a community of practice in this field. Following a meeting between grantees, we set out to provide an overview of the R2HC portfolio, and draw lessons learned. In this paper, we discuss the mental health and psychosocial support-focused research projects funded by R2HC; review the implications of initial findings from this research portfolio; and highlight four remaining knowledge gaps in this field. Between 2014 and 2019, R2HC funded 18 academic-practitioner partnerships focused on mental health and psychosocial support, comprising 38% of the overall portfolio (18 of 48 projects) at a value of approximately 7.2 million GBP. All projects have focused on evaluating the impact of interventions. In line with consensus-based recommendations to consider a wide range of mental health and psychosocial needs in humanitarian settings, research projects have evaluated diverse interventions. Findings so far have both challenged and confirmed widely-held assumptions about the effectiveness of mental health and psychosocial interventions in humanitarian settings. They point to the importance of building effective, sustained, and diverse partnerships between scholars, humanitarian practitioners, and funders, to ensure long-term program improvements and appropriate evidence-informed decision making. Further research needs to fill knowledge gaps regarding how to: scale-up interventions that have been found to be effective (e.g., questions related to integration across sectors, adaptation of interventions across different contexts, and optimal care systems); address neglected mental health conditions and populations (e.g., elderly, people with disabilities, sexual minorities, people with severe, pre-existing mental disorders); build on available local resources and supports (e.g., how to build on traditional, religious healing and community-wide social support practices); and ensure equity, quality, fidelity, and sustainability for interventions in real-world contexts (e.g., answering questions about how interventions from controlled studies can be transferred to more representative humanitarian contexts).

4.
Clin Psychol Rev ; 82: 101920, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33126037

RESUMO

Why do humans heal one another? Evolutionary psychology has advanced our understanding of why humans suffer psychological distress and mental illness. However, to date, the evolutionary origins of what drives humans to alleviate the suffering of others has received limited attention. Therefore, we draw upon evolutionary theory to assess why humans psychologically support one another, focusing on the interpersonal regulation of emotions that shapes how humans heal and console one another when in psychosocial distress. To understand why we engage in psychological healing, we review the evolution of cooperation among social species and the roles of emotional contagion, empathy, and self-regulation. We discuss key aspects of human biocultural evolution that have contributed to healing behaviors: symbolic logic including language, complex social networks, and the long period of childhood that necessitates identifying and responding to others in distress. However, both biological and cultural evolution also have led to social context when empathy and consoling are impeded. Ultimately, by understanding the evolutionary processes shaping why humans psychologically do or do not heal one another, we can improve our current approaches in global mental health and uncover new opportunities to improve the treatment of mental illness across cultures and context around the world.


Assuntos
Transtornos Mentais , Saúde Mental , Atenção , Emoções , Empatia , Humanos , Transtornos Mentais/terapia
5.
Disasters ; 2020 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-32779209

RESUMO

Deployment in a crisis zone is a perilous undertaking. Little is known right now about how humanitarian workers relate social and professional goals to lived experiences of high-risk environments. In South Sudan, ranked as the most dangerous country globally for aid workers, 20 international humanitarian staff were interviewed to examine their sense of place, well-being, and vocation, using thematic and interpretative phenomenological analysis. Subjectivities of humanitarian space hinged upon negotiating physical hardships and social relationships: Juba, the capital, was described as a 'prison' and a 'party hotspot'. For expatriate staff, making sense of spatial, social, and professional transience was sharply gendered and rooted in the subjectivities of risk-taking, crisis management, and career-building. Two policy measures are highlighted here to address the implications of transience for human well-being and organisational effectiveness. Efforts to support teams and structure work environments, altering the humanitarian and vocational bubble, will help to develop resilience at the heart of humanitarian systems.

6.
Confl Health ; 14: 40, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32582366

RESUMO

Background: Evidence of 'what works' in humanitarian programming is important for addressing the disruptive consequences of conflict and forced displacement. However, collecting robust scientific evidence, and ensuring contextual relevance, is challenging. We measured the biological, psychosocial, and cognitive impacts of a structured psychosocial intervention, implemented by Mercy Corps with Syrian refugees and Jordanian host-community youth. In this paper, we present a case analysis of this evaluation study and reflect on the scientific contributions of the work, the challenges experienced in its delivery, and the strategies deployed to address them. Discussion: We identified challenges with respect to study design, methods, and dissemination: these included the logistics and acceptability of implementing a randomized controlled trial in a humanitarian context, the selection and refinement of culturally-relevant research tools and community-based practices, and the dissemination of results to multiple stakeholders. We demonstrated beneficial and sustained impacts on self-reports of insecurity, stress, and mental health; developed a reliable and culturally-relevant measure of resilience; experimentally tested cognitive skills; and showed that levels of cortisol, a biomarker of chronic stress, reduced by one third in response to intervention. Using stress biomarkers offered proof-of-concept evidence, beyond self-reported data: interventions targeting mental health and psychosocial wellbeing can regulate physiological stress in the body as well as improve self-reported mental health and wellbeing. We built constructive dialogue between local communities, scholars, humanitarian practitioners, and policy-makers. Conclusions: Our work shows the value of rigorous research in humanitarian settings, emphasizing relevance for local communities and meaningful ways to build research ownership. Findings encourage the adoption of cognitive measures and stress biomarkers alongside self-report surveys in evaluating programme impacts. High-quality scientific research with youth can be feasible, useful, and ethical in humanitarian settings.

7.
Brain Behav Immun ; 87: 207-217, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-30797045

RESUMO

Experiencing childhood adversity has been associated with significant changes in inflammation, cell-mediated immunocompetence, and cortisol secretion. Relatively few studies have examined, longitudinally, alterations to inflammatory processes during adolescence, especially outside Western contexts; none have evaluated biomarker trajectories for at-risk youth in response to a structured behavioral intervention. We conducted a randomized controlled trial evaluating the efficacy of a humanitarian intervention targeting stress-alleviation, with 12-18 year-old Syrian refugees (n = 446) and Jordanian non-refugees (n = 371) living side-by-side in war-affected communities in Jordan. We measured C-reactive protein (CRP), Epstein-Barr virus antibodies (EBV), and hair cortisol concentration (HCC) at three timepoints (pre/post intervention and 11 month follow-up), and assessed three main outcomes (psychosocial stress, mental health, and cognitive function). Using growth mixture models, regressions, and growth curve models, we identified three distinct trajectories for CRP, two for EBV, and three for HCC, and examined their associations with age, gender, BMI, poverty, and trauma. We found associations with BMI for CRP, refugee status for EBV, and BMI and gender with HCC trajectory. In terms of health outcomes, we found associations between rising CRP levels and perceived stress (B =  -2.92, p = .007), and between HCC hypersecretion and insecurity (B = 7.21, p = .017). In terms of responses to the intervention, we observed no differential impacts by CRP or EBV trajectories, unlike HCC. These results suggest that commonly-assayed biomarkers do not associate with health outcomes and respond to targeted interventions in straightforward ways. Our study is the first to examine multiple biomarker trajectories in war-affected adolescents, in order to better evaluate the extent, timing, and malleability of the biological signatures of poverty, conflict, and forced displacement.


Assuntos
Infecções por Vírus Epstein-Barr , Refugiados , Adolescente , Proteína C-Reativa/análise , Criança , Cognição , Infecções por Vírus Epstein-Barr/etnologia , Herpesvirus Humano 4 , Humanos , Hidrocortisona/análise , Jordânia/epidemiologia , Saúde Mental , Síria/etnologia
8.
Child Dev ; 90(6): 1856-1865, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31646618

RESUMO

The impacts of war and displacement on executive function (EF)-what we might call the cognitive signatures of minds under siege-are little known. We surveyed a gender-balanced sample of 12- to 18-year-old Syrian refugees (n = 240) and Jordanian non-refugees (n = 210) living in Jordan. We examined the relative contributions of poverty, trauma exposure, posttraumatic stress, and insecurity to variance in inhibitory control and working memory. We observed associations between poverty and WM, suggesting that, even in populations exposed to substantial violence and fear, poverty is a specific pathway to WM deficit. We did not, however, find associations between EFs and exposures to trauma. Careful distinction between childhood adversities may illuminate which neurocognitive pathways matter for measures of cognitive function.


Assuntos
Experiências Adversas da Infância , Disfunção Cognitiva/fisiopatologia , Função Executiva/fisiologia , Exposição à Violência , Inibição Psicológica , Memória de Curto Prazo/fisiologia , Pobreza , Trauma Psicológico/fisiopatologia , Refugiados , Adolescente , Criança , Disfunção Cognitiva/etiologia , Feminino , Humanos , Jordânia , Masculino , Trauma Psicológico/complicações , Síria
9.
Soc Sci Med ; 239: 112476, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31539783

RESUMO

Grandparents are often a key source of care provision for their grandchildren, yet they are sidelined in caregiving research and policy decisions. We conducted a global, systematic review of the literature to examine the scope and quality of studies to date (PROSPERO database CRD42019133894). We screened 12,699 abstracts across 7 databases, and identified 206 studies that examined how grandparents influence child health and development. Indicators of grandparent involvement were contact, caregiving behaviors, and financial support. Our review focused on two research questions: how do grandparents influence child health and development outcomes, and what range of child outcomes is reported globally? We examined study design, sample characteristics, key findings, and outcomes pertaining to grandchildren's physical health, socio-emotional and behavioral health, and cognitive and educational development.  Our search captured studies featuring grandparent custodial care (n = 35), multigenerational care (n = 154), and both types of care (n = 17). We found substantial heterogeneity in the data provided on co-residence, caregiving roles, resources invested, outcomes, and mechanisms through which "grandparent effects" are manifested. We identified two important issues, related to operationalizing indicators of grandparent involvement and conceptualizing potential mechanisms, leading to gaps in the evidence base. Currently, our understanding of the pathways through which grandparents exert their influence is constrained by limited data on what grandparents actually do and insufficient attention given to interpersonal and structural contexts. We present a conceptual framework to explicitly measure and theorize pathways of care, with a view to inform research design and policy implementation. We underscore the need for more robust data on three indicators of caregiver involvement-contact, behavior, and support-and for careful description of structural and interpersonal contexts in caregiving research.


Assuntos
Cuidadores , Desenvolvimento Infantil , Saúde da Criança , Avós , Relação entre Gerações , Adolescente , Comportamento , Criança , Pré-Escolar , Cognição , Assistência de Custódia , Escolaridade , Saúde Global , Comportamentos Relacionados com a Saúde , Humanos , Renda , Lactente , Fatores Socioeconômicos
10.
PLoS One ; 14(7): e0219385, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31314763

RESUMO

Early childhood trauma can have profound and lifelong effects on adult mental health and psychosocial wellbeing. Nevertheless, responses to trauma are highly variable. Genetic variants may help explain variation in responses to trauma by identifying alleles that associate with changes in mental health measures. Protective factors, such as resilience, likely also play an important role in responses to trauma. The effects of genetic variants, in combination with protective factors, on psychosocial health are not well understood, particularly in non-Western contexts. In this study, we test the relative influence of genetic variants of monoamine oxidase A (MAOA, a gene proposed to influence the impact of childhood trauma on adult violence and antisocial behavior), levels of resilience, and exposure to traumatic events on psychosocial stress and mental health trajectories over time. We use data from a cohort of 12-18-year-old Syrian refugees who were forcibly displaced to neighboring Jordan (n = 399). DNA samples and survey data on trauma exposure, resilience (CYRM-12), and psychosocial stress were collected at three time points: baseline, ~13 weeks, and ~48 weeks. Using multilevel models, we identified an association of MAOA variant, in males only, with symptom scores of psychosocial stress on the Perceived Stress Scale (PSS) over time (p = 8.1 x 10-4). We also found that resilience is strongly associated with PSS (p = 7.9 x 10-9), underscoring the importance of protective factors in influencing levels of psychosocial stress. Furthermore, there was an additive effect wherein the sharpest reductions in perceived psychosocial stress are seen in low-activity MAOA males with low trauma exposure or high resilience levels. Our results highlight the value of studies that integrate genetic and psychosocial factors to better understand complex phenotypes, such as responses to trauma in contexts of high trauma exposure.


Assuntos
Experiências Adversas da Infância , Variação Genética , Monoaminoxidase/genética , Refugiados/psicologia , Resiliência Psicológica , Adolescente , Conflitos Armados , Criança , Feminino , Humanos , Jordânia , Masculino , Fenótipo , Fatores de Proteção , Escalas de Graduação Psiquiátrica , Trauma Psicológico , Estresse Psicológico , Síria/epidemiologia , Violência
11.
Psychoneuroendocrinology ; 89: 138-146, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29358120

RESUMO

Temporal examinations of the biological signature of stress or trauma in war-affected populations are seldom undertaken. Moreover, few studies have examined whether stress biomarkers track biological sensitivity to brief interventions targeting the improvement of psychosocial wellbeing. Our study is the first to prospectively examine, in war-affected adolescents, the associations between hair cortisol concentrations (HCC) and self-reports of stress, insecurity, posttraumatic reactions, and lifetime trauma. We conducted a randomized controlled trial to test the impact of an 8-week intervention based on profound stress attunement. We collected data for a gender-balanced sample of 733 Syrian refugee (n = 411) and Jordanian non-refugee (n = 322) adolescents (12-18 years), at three time-points. We used growth mixture models to classify cortisol trajectories, and growth models to evaluate intervention impact on stress physiology. We observed three trajectories of HCC: hypersecretion, medium secretion, and hyposecretion (9.6%, 87.5% and 2.9% of the cohort, respectively). For every one percent increase in levels of insecurity, adolescents were 0.02 times more likely to have a trajectory of hypersecretion (95% CI: 1.00, 1.03, p = 0.01). For each additional symptom of posttraumatic stress reported, they were 0.07 times less likely to show hyposecretion (95% CI: 0.89, 0.98, p = 0.01). Indeed, stronger posttraumatic stress reactions were associated with a pattern of within-individual cortisol dysregulation and medium secretion. Overall, HCC decreased by a third in response to the intervention (95% CI: -0.19, -0.03, p = 0.01). While the intervention decreased HCC for youth with hypersecretion and medium secretion, it increased HCC for youth with hyposecretion (95% CI: 0.22, 1.16, p = 0.004), relative to controls. This suggests a beneficial regularization of cortisol levels, corroborating self-reports of improved psychosocial wellbeing. We did not find evidence to suggest that gender, resilience, or posttraumatic stress disorder influenced the strength or direction of responses to the intervention. This robust impact evaluation exemplifies the utility of biomarkers for tracking physiological changes in response to interventions over time. It enhances the understanding of trajectories of endocrine response in adverse environments and patterns of stress responsivity to ecological improvement.


Assuntos
Hidrocortisona/análise , Refugiados/psicologia , Estresse Psicológico/metabolismo , Adolescente , Conflitos Armados/psicologia , Biomarcadores , Feminino , Cabelo/química , Humanos , Masculino , Estudos Prospectivos , Fatores Sexuais , Transtornos de Estresse Pós-Traumáticos/metabolismo , Transtornos de Estresse Pós-Traumáticos/psicologia , Estresse Fisiológico , Estresse Psicológico/psicologia
12.
Child Dev ; 89(5): 1803-1820, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-28617937

RESUMO

Validated measures are needed for assessing resilience in conflict settings. An Arabic version of the Child and Youth Resilience Measure (CYRM) was developed and tested in Jordan. Following qualitative work, surveys were implemented with male/female, refugee/nonrefugee samples (N = 603, 11-18 years). Confirmatory factor analyses tested three-factor structures for 28- and 12-item CYRMs and measurement equivalence across groups. CYRM-12 showed measurement reliability and face, content, construct (comparative fit index = .92-.98), and convergent validity. Gender-differentiated item loadings reflected resource access and social responsibilities. Resilience scores were inversely associated with mental health symptoms, and for Syrian refugees were unrelated to lifetime trauma exposure. In assessing individual, family, and community-level dimensions of resilience, the CYRM is a useful measure for research and practice with refugee and host-community youth.


Assuntos
Refugiados/psicologia , Resiliência Psicológica , Inquéritos e Questionários , Adolescente , Criança , Comparação Transcultural , Análise Fatorial , Feminino , Humanos , Jordânia , Masculino , Transtornos Mentais/etnologia , Psicometria , Reprodutibilidade dos Testes , Síria/etnologia
13.
J Child Psychol Psychiatry ; 59(5): 523-541, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-28967980

RESUMO

BACKGROUND: Strengthening the evidence base for humanitarian interventions that provide psychosocial support to war-affected youth is a key priority. We tested the impacts of an 8-week programme of structured activities informed by a profound stress attunement (PSA) framework (Advancing Adolescents), delivered in group-format to 12-18 year-olds in communities heavily affected by the Syrian crisis. We included both Syrian refugee and Jordanian youth. METHODS: We followed an experimental design, comparing treatment youth and wait-list controls over two programme implementation cycles, randomizing to study arm in cycle 2 (ClinicalTrials.gov ID: NCT03012451). We measured insecurity, distress, mental health difficulties, prosocial behaviour and post-traumatic stress symptoms at three time-points: baseline (n = 817 youth; 55% Syrian, 43% female), postintervention (n = 463; 54% Syrian, 47% female), and follow-up (n = 212, 58% Syrian, 43% female). Regression models assessed: prospective intervention impacts, adjusting for baseline scores, trauma exposure, age, and gender; differential impacts across levels of trauma exposure and activity-based modality; and sustained recovery 1 year later. We analysed cycle-specific and cycle-pooled data for youth exclusively engaged in Advancing Adolescents and for the intent-to-treat sample. RESULTS: We found medium to small effect sizes for all psychosocial outcomes, namely Human Insecurity (ß = -7.04 (95% CI: -10.90, -3.17), Cohen's d = -0.4), Human Distress (ß = -5.78 (-9.02, -2.54), d = -0.3), and Perceived Stress (ß = -1.92 (-3.05, -0.79), d = -0.3); and two secondary mental health outcomes (AYMH: ß = -3.35 (-4.68, -2.02), d = -0.4; SDQ: ß = -1.46 (-2.42, -0.50), d = -0.2). We found no programme impacts for prosocial behaviour or post-traumatic stress reactions. Beneficial impacts were stronger for youth with exposure to four trauma events or more. While symptoms alleviated for both intervention and control groups over time, there were sustained effects of the intervention on Human Insecurity. CONCLUSIONS: Findings strengthen the evidence base for mental health and psychosocial programming for a generation affected by conflict and forced displacement. We discuss implications for programme implementation and evaluation research.


Assuntos
Comportamento do Adolescente , Sintomas Comportamentais/terapia , Avaliação de Resultados em Cuidados de Saúde , Trauma Psicológico/terapia , Psicoterapia de Grupo/métodos , Refugiados , Comportamento Social , Transtornos de Estresse Pós-Traumáticos/terapia , Estresse Psicológico/terapia , Adolescente , Criança , Feminino , Seguimentos , Humanos , Jordânia , Masculino , Desenvolvimento de Programas , Escalas de Graduação Psiquiátrica , Síria
14.
Soc Sci Med ; 196: 233-239, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29137936

RESUMO

Conceptually and methodologically, medical anthropology is well-positioned to support a "big-tent" research agenda on health and society. It fosters approaches to social and structural models of health and wellbeing in ways that are critically reflective, cross-cultural, people-centered, and transdisciplinary. In this review article, we showcase these four main characteristics of the field, as featured in Social Science & Medicine over the last fifty years, highlighting their relevance for an international and interdisciplinary readership. First, the practice of critical inquiry in ethnographies of health offers a deep appreciation of sociocultural viewpoints when recording and interpreting lived experiences and contested social worlds. Second, medical anthropology champions cross-cultural breadth: it makes explicit local understandings of health experiences across different settings, using a fine-grained, comparative approach to develop a stronger global platform for the analysis of health-related concerns. Third, in offering people-centered views of the world, anthropology extends the reach of critical enquiry to the lived experiences of hard-to-reach population groups, their structural vulnerabilities, and social agency. Finally, in developing research at the nexus of cultures, societies, biologies, and health, medical anthropologists generate new, transdisciplinary conversations on the body, mind, person, community, environment, prevention, and therapy. As featured in this journal, scholarly contributions in medical anthropology seek to debate human health and wellbeing from many angles, pushing forward methodology, social theory, and health-related practice.


Assuntos
Antropologia Médica/história , Publicações Periódicas como Assunto/história , Medicina Social/história , Ciências Sociais/história , História do Século XX , História do Século XXI , Humanos
15.
Am J Hum Biol ; 29(1)2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27435220

RESUMO

OBJECTIVES: Biocultural research remains a challenge in the field of global mental health. We sought to test associations between blood pressure and idioms of distress in a population survey. METHODS: We drew on a randomly selected sample of 991 adults (498 men, 493 women) in Afghanistan, for whom physiological and psychosocial data were systematically collected. Assessment of mental health (Self-Reported Questionnaire, Afghan Symptom Checklist) included conceptualizations of distress related to pressure (fishar), anxiety, and dysphoria, as well as dimensions of negative affect and aggression. We used principal component analysis to map survey responses to fishar, and multiple regressions to examine associations with systolic/diastolic blood pressure, controlling for age, body mass index, and wealth, and differentiating by gender, mental health, and medication. RESULTS: The Afghan sample averaged 129/80 mmHg, with 27.14% of hypertensive individuals. SBP showed inverse associations with reports of low fishar (ß = -4.58, P < .001) and high fishar (ß = 6.90, P < .001), as did DPB with low fishar (ß = -1.55, P < .001) and high fishar (ß = 3.77, P < .001). Low and high fishar responses accounted for substantial proportions of SBP data variation (R2 = 20% and R2 = 24%), especially in adults on blood pressure medication (R2 = 58% and R2 = 49%). CONCLUSIONS: Subjective reports of fishar map onto physiological blood pressure more robustly than other conceptualizations of mental distress related to anxiety, dysphoria, negative affect, or aggression. Our results point to the utility of mapping biological and cultural measures of stress and distress, advancing biopsychosocial understandings of wellbeing in global mental health surveys.


Assuntos
Ansiedade/psicologia , Pressão Sanguínea , Saúde Mental , Estresse Psicológico/psicologia , Adulto , Afeganistão/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Saúde Global , Humanos , Hipertensão/epidemiologia , Hipertensão/psicologia , Masculino , Pessoa de Meia-Idade , Terminologia como Assunto , Adulto Jovem
16.
Acad Psychiatry ; 40(4): 650-8, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26983416

RESUMO

OBJECTIVE: In the field of global mental health, there is a need for identifying core values and competencies to guide training programs in professional practice as well as in academia. This paper presents the results of interdisciplinary discussions fostered during an annual meeting of the Society for the Study of Psychiatry and Culture to develop recommendations for value-driven innovation in global mental health training. METHODS: Participants (n = 48), who registered for a dedicated workshop on global mental health training advertised in conference proceedings, included both established faculty and current students engaged in learning, practice, and research. They proffered recommendations in five areas of training curriculum: values, competencies, training experiences, resources, and evaluation. RESULTS: Priority values included humility, ethical awareness of power differentials, collaborative action, and "deep accountability" when working in low-resource settings in low- and middle-income countries and high-income countries. Competencies included flexibility and tolerating ambiguity when working across diverse settings, the ability to systematically evaluate personal biases, historical and linguistic proficiency, and evaluation skills across a range of stakeholders. Training experiences included didactics, language training, self-awareness, and supervision in immersive activities related to professional or academic work. Resources included connections with diverse faculty such as social scientists and mentors in addition to medical practitioners, institutional commitment through protected time and funding, and sustainable collaborations with partners in low resource settings. Finally, evaluation skills built upon community-based participatory methods, 360-degree feedback from partners in low-resource settings, and observed structured clinical evaluations (OSCEs) with people of different cultural backgrounds. CONCLUSIONS: Global mental health training, as envisioned in this workshop, exemplifies an ethos of working through power differentials across clinical, professional, and social contexts in order to form longstanding collaborations. If incorporated into the ACGME/ABPN Psychiatry Milestone Project, such recommendations will improve training gained through international experiences as well as the everyday training of mental health professionals, global health practitioners, and social scientists.


Assuntos
Saúde Global , Saúde Mental , Psiquiatria/educação , Competência Clínica , Pesquisa Participativa Baseada na Comunidade , Currículo , Etnopsicologia/educação , Docentes de Medicina , Recursos em Saúde , Humanos , Mentores , Responsabilidade Social , Valores Sociais , Ensino
17.
J Child Psychol Psychiatry ; 56(7): 814-825, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25384553

RESUMO

BACKGROUND: Studies of war-affected youth have not yet examined how trauma memories relate to prospective changes in mental health and to subjective or social experiences. METHODS: We interviewed a gender-balanced, randomly selected sample of Afghan child-caregiver dyads (n = 331, two waves, 1 year apart). We assessed lifetime trauma with a Traumatic Event Checklist, past-year events with a checklist of risk and protective events, and several child mental health outcomes including posttraumatic distress (Child Revised Impact of Events Scale, CRIES) and depression. We examined the consistency of trauma recall over time, identified mental health trajectories with latent transition modeling, and assessed the predictors of posttraumatic distress and depression trajectories with multinomial logistic regressions. RESULTS: From baseline to follow-up, reports of lifetime trauma significantly changed (p ≤ 0.01). A third of the cohort reported no trauma exposure; only 10% identified the same event as their most distressing experience. We identified four CRIES trajectories: low or no distress (52%), rising distress (15%), declining distress (21%), and sustained high distress (12%). Youth with chronic posttraumatic distress were more likely to be girls (OR = 5.78, p ≤ 0.01), report more trauma exposure at baseline (OR = 1.55, p ≤ 0.05) and follow-up (OR = 5.96, p ≤ 0.01), and experience ongoing domestic violence (OR = 4.84, p ≤ 0.01). The risks of rising distress and sustained distress showed a steady increase for youth recalling up to four traumatic experiences. Depression and CRIES trajectories showed weak comorbidity. CONCLUSIONS: Memories of violent events are malleable, embedded in social experiences, and present heterogeneous associations with posttraumatic distress. Our study provides insights on resilience and vulnerability to multiple adverse childhood experiences, highlighting research and clinical implications for understanding trauma in conflict-affected youth.


Assuntos
Campanha Afegã de 2001- , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/psicologia , Países em Desenvolvimento , Rememoração Mental , Refugiados/psicologia , Resiliência Psicológica , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/psicologia , Adolescente , Afeganistão/etnologia , Lista de Checagem , Criança , Feminino , Humanos , Acontecimentos que Mudam a Vida , Modelos Logísticos , Masculino , Modelos Psicológicos , Paquistão , Estudos Prospectivos , Fatores de Proteção , Fatores Sexuais
18.
Med Anthropol Q ; 29(1): 1-23, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25345372

RESUMO

In recent years, anthropologists have become increasingly present in medical humanitarian situations as scholars, consultants, and humanitarian practitioners and have acquired insight into medical humanitarian policy and practice. In 2012, we implemented a poll on anthropology, health, and humanitarian practice in which 75 anthropologists discussed their experiences in medical humanitarianism. Our goal was to move beyond the existing anarchy of individual voices in anthropological writing and gain an aggregate view of the perspective of anthropologists working in medical humanitarian contexts. Responses lead to six inductively derived thematic priorities. The findings illustrate how anthropologists perceive medical humanitarian practice; which aspects of medical humanitarianism should be seen as priorities for anthropological research; and how anthropologists use ethnography in humanitarian contexts.


Assuntos
Altruísmo , Antropologia Médica , Saúde Global , Antropologia/ética , Antropologia/organização & administração , Humanos
20.
Artigo em Inglês | MEDLINE | ID: mdl-25317257

RESUMO

In this paper, inspired by the plenary panel at the 2013 meeting of the International Society for Traumatic Stress Studies, Dr. Steven Southwick (chair) and multidisciplinary panelists Drs. George Bonanno, Ann Masten, Catherine Panter-Brick, and Rachel Yehuda tackle some of the most pressing current questions in the field of resilience research including: (1) how do we define resilience, (2) what are the most important determinants of resilience, (3) how are new technologies informing the science of resilience, and (4) what are the most effective ways to enhance resilience? These multidisciplinary experts provide insight into these difficult questions, and although each of the panelists had a slightly different definition of resilience, most of the proposed definitions included a concept of healthy, adaptive, or integrated positive functioning over the passage of time in the aftermath of adversity. The panelists agreed that resilience is a complex construct and it may be defined differently in the context of individuals, families, organizations, societies, and cultures. With regard to the determinants of resilience, there was a consensus that the empirical study of this construct needs to be approached from a multiple level of analysis perspective that includes genetic, epigenetic, developmental, demographic, cultural, economic, and social variables. The empirical study of determinates of resilience will inform efforts made at fostering resilience, with the recognition that resilience may be enhanced on numerous levels (e.g., individual, family, community, culture).

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