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Front Psychiatry ; 12: 785144, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34970168


Background: Negative symptoms are core features of schizophrenia and very challenging to be treated. Identification of their structure is crucial to provide a better treatment. Increasing evidence supports the superiority of a five-factor model (alogia, blunted affect, anhedonia, avolition, and asociality as defined by the NMIH-MATRICS Consensus); however, previous data primarily used the Brief Negative Symptoms Scale (BNSS). This study, including a calibration and a cross-validation sample (n = 268 and 257, respectively) of participants with schizophrenia, used the Clinical Assessment Interview for Negative Symptoms (CAINS) to explore the latent structure of negative symptoms and to test theoretical and data-driven (from this study) models of negative symptoms. Methods: Exploratory factor analysis (EFA) was carried out to investigate the structure of negative symptoms based on the CAINS. Confirmatory factor analysis (CFA) tested in a cross-validation sample four competing theoretical (one-factor, two-factor, five-factor, and hierarchical factor) models and two EFA-derived models. Result: None of the theoretical models was confirmed with the CFA. A CAINS-rated model from EFA consisting of five factors (expression, motivation for recreational activities, social activities, vocational, and close/intimate relationships) was an excellent fit to the data (comparative fix index = 0.97, Tucker-Lewis index = 0.96, and root mean square error of approximation = 0.07). Conclusions: This study cannot support recent data on the superiority of the five-factor model defined by the NMIH-MATRICS consensus and suggests that an alternative model might be a better fit. More research to confirm the structure of negative symptoms in schizophrenia, and careful methodological consideration, should be warranted before a definitive model can put forward and shape diagnosis and treatment of schizophrenia.

BMC Psychiatry ; 21(1): 468, 2021 09 25.
Artigo em Inglês | MEDLINE | ID: mdl-34563145


BACKGROUND: Implementation of psychosocial interventions in mental health services has the potential to improve the treatment of psychosis spectrum disorders (PSD) in low- and middle-income countries (LMICs) where care is predominantly focused on pharmacotherapy. The first step is to understand the views of key stakeholders. We conducted a multi-language qualitative study to explore the contextual barriers and facilitators to implementation of a cost-effective, digital psychosocial intervention, called DIALOG+, for treating PSD. DIALOG+ builds on existing clinician-patient relationships without requiring development of new services, making it well-fitting for healthcare systems with scarce resources. METHODS: Thirty-two focus groups were conducted with 174 participants (patients, clinicians, policymakers and carers), who were familiarized with DIALOG+ through a presentation. The Southeast European LMICs included in this research were: Bosnia and Herzegovina, Kosovo, (Kosovo is referred throughout the text by United Nations resolution) North Macedonia, Montenegro and Serbia. Framework analysis was used to analyse the participants' accounts. RESULTS: Six major themes were identified. Three themes (Intervention characteristics; Carers' involvement; Patient and organisational benefits) were interpreted as perceived implementation facilitators. The theme Attitudes and perceived preparedness of potential adopters comprised of subthemes that were interpreted as both perceived implementation facilitators and barriers. Two other themes (Frequency of intervention delivery; Suggested changes to the intervention) were more broadly related to the intervention's implementation. Participants were exceedingly supportive of the implementation of a digital psychosocial intervention such as DIALOG+. Attractive intervention characteristics, efficient use of scarce resources for its implementation and potential to improve mental health services were seen as the main implementation facilitators. The major implementation barrier identified was psychiatrists' time constrains. CONCLUSIONS: This study provided important insights regarding implementation of digital psychosocial interventions for people with PSD in low-resource settings by including perspectives from four stakeholder groups in five LMICs in Southeast Europe - a population and region rarely explored in the literature. The perceived limited availability of psychiatrists could be potentially resolved by increased inclusion of other mental health professionals in service delivery for PSD. These findings will be used to inform the implementation strategy of DIALOG+ across the participating countries. The study also offers insights into multi-country qualitative research.

Saúde Mental , Transtornos Psicóticos , Atenção à Saúde , Pessoal de Saúde , Humanos , Transtornos Psicóticos/terapia , Pesquisa Qualitativa
Front Psychol ; 12: 685316, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34367008


Positive Youth Development (PYD) frameworks which describe young people's strengths and their relation to thriving and risk outcomes have gained significance among developmental researchers globally. As these models are being increasingly adopted, concerns remain about their generalizability outside of North America. It has been observed that the distribution and salience of assets differ for young people based on their cultural context. To better understand these varying developmental patterns, this paper studies the distribution of developmental assets and 5 Cs (Competence, Confidence, Character, Caring, and Connection) in youth from various countries and contrasting backgrounds. The total sample consisted of 4,175 students (62.5% females) with age ranging from 15 to 25 years (M = 18.95, SD = 2.49). 981 students were from Ghana (52.5% females), 900 students from Kosovo (66.7% females), 425 students from Norway (73.5% females), 247 students from Portugal (42.1% females), 648 students from Slovenia (63.4% females,), and 974 students from Turkey (68.7% females). Before comparisons of the countries, partial scalar invariance was confirmed. Analyses revealed that all countries differed in at least some internal or external developmental assets and at least in one of the 5 Cs. When considering internal assets, participants from Ghana seemed to have higher levels of internal assets together with participants from Norway who have the highest commitment to learning. Slovenian youth reported the highest levels of external assets of support and empowerment. Regarding the 5 Cs, Ghanaian youth reported having the highest confidence and character, and youth from Ghana, Kosovo, and Turkey are more caring and connected to others. The results uncovered unique patterns of PYD for each included country which are discussed through the lens of its political and social context. Through this focus on cross-national PYD patterns, this study advanced knowledge about the experiences of youth from a wide range of backgrounds and put forth suggestions for better policy measures and more culturally relevant interventions for optimal development of youth embedded in different cultures and countries.

Psychiatr Danub ; 32(3-4): 570-576, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33370768


The COVID-19 pandemic and the measures brought for prevention of infections are associated with considerable psychosocial and psychological morbidity in the general population. Providing continuous mental health services during the pandemics is a challenge worldwide, especially in low- and middle-income countries (LMICs). This paper reports on the strategies and activities taken to protect public mental health during the COVID-19 pandemic in Kosovo. This included establishing online and phone psychological first aid services and developing psychoeducational videos and webinars. The paper concludes with several lessons learned during the process of establishing and maintaining these interventions, such as: initial political endorsement is crucial to gain and maintain the momentum of services; continuous training of volunteers is crucial for both addressing the needs/problems, which arise during the process of work and maintain the motivation of volunteers; promotion of the services is crucial; academic curricula training mental health professionals should include digital mental health related courses and manualization on how to establish this kind of services in midst of crisis is crucial in order to ensure quick operationalization when needed again especially in LMIC settings. The interventions developed provide opportunity for further research especially by evaluating the impact of the services and exploring how online and provision of mental health and psychoeducation services online could help to cover services gap in times of isolation, limited movement and situations similar to pandemics in settings with limited mental health services and resources. The situation with pandemics with COVID 19 is still far from ending. Future waves of infections and restriction could again spike the mental health and psychosocial and psychological strain of the general population, therefore being prepared in provisions of psychological first aid and other mental health services online is crucial.

COVID-19 , Primeiros Socorros , Humanos , Kosovo , Pandemias , SARS-CoV-2 , Telefone
Am J Community Psychol ; 63(3-4): 286-297, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30653277


Teachers' stress is a dynamic combination of the individual teacher's characteristics and characteristics of the classroom and school environment. To date, there are limited studies on teachers' stress in the context of lower-middle-income countries (LMICs), where working conditions as well as general political and economic circumstances might pose a considerable threat for teachers' well-being. This study explores whether certain combinations of individual and environmental experiences of teachers in LMICs may result in stress, assessed as patterns of diurnal cortisol rhythm. Participants were kindergarten teachers in Kosovo and Ukraine, two LMICs in Europe. Latent Profile Analysis identified three subgroups of teachers that significantly differed on teachers' education and experience. Preliminary results of Latent Growth Modeling suggested differences between profiles in baseline waking cortisol and patterns of diurnal decline. Teachers in the profile that was characterized by the longest experience working in the field but the lowest level of education showed blunted cortisol in the morning and a flatter slope; a pattern that could indicate a maladaptive cortisol response. Future directions for studying stress processes among teachers in LMICs and implications for policy and practice on how to support teacher well-being in low-resource contexts are discussed.

Ritmo Circadiano , Hidrocortisona/metabolismo , Professores Escolares/psicologia , Estresse Psicológico/metabolismo , Adulto , Países Desenvolvidos , Escolaridade , Feminino , Humanos , Kosovo/epidemiologia , Análise de Classes Latentes , Pessoa de Meia-Idade , Pobreza/estatística & dados numéricos , Saliva/química , Estresse Psicológico/psicologia , Fatores de Tempo , Uso de Tabaco/epidemiologia , Ucrânia/epidemiologia
Child Dev ; 88(3): 693-709, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28319262


This study examines ethnic, national, familial, and religious identity and well-being of 632 Roma minority and 589 majority adolescents (age: M = 15.98 years, SD = 1.34) in Bulgaria, the Czech Republic, Kosovo, and Romania. Results indicated that Roma showed lower endorsement of national identity but stronger religious identity than their majority counterparts. Path models showed positive associations of familial and religious identities with well-being, whereas Roma identity was negatively associated with well-being, particularly for Roma in Bulgaria and Kosovo (countries with a less active policy toward improving conditions of Roma). In the latter countries, Roma ethnic identity is less relevant and weakly associated with psychological well-being of youth.

Família/etnologia , Grupos Minoritários , Religião e Psicologia , Roma (Grupo Étnico)/etnologia , Identificação Social , Adolescente , Bulgária/etnologia , República Tcheca/etnologia , Feminino , Humanos , Kosovo/etnologia , Masculino , Romênia/etnologia