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This study developed and validated a measure that captures variation in common local idioms of distress and mental health problems experienced by women in South Sudan, a country which has experienced over 50 years of violence, displacement, and political, social, and economic insecurity. This measure was developed during a randomized controlled trial of the Adolescent Girls Initiative (AGI) and used qualitative Free Listing (n = 102) and Key Informant interviews (n = 27). Internal reliability and convergent validity were assessed using data from 3,137 randomly selected women (ages 14-47) in 100 communities in South Sudan. Test-retest and inter-rater reliability were assessed using responses from 180 women (ages 15-58) who completed the measure once, and 129 of whom repeated the measure an average of 12 days (SD = 8.3) later. Concurrent validity was assessed through the ratings of 22 AGI leaders about the presence or absence of mental health symptoms in the 180 women in the test-retest sample. The study resulted in the development of the South Sudan Mental Health Assessment Scale, a 24-item measure assessing six idioms of distress. The scale consisted of one factor and had excellent internal, test-retest, and interrater reliability. The scale also demonstrated good convergent and concurrent validity and performed well psychometrically. Moreover, its development provides an example for other organizations, working in environments where mental health measures have not yet been developed and validated, to create and validate measures relevant to their populations. In this way, the role of mental health in development settings can be more rapidly assessed.

Research on female genital mutilation/cutting (FGM/C) and mental health has largely failed to address the role of disparate experiences of the circumcision event, ongoing health impacts, and unique contexts of western resettlement. This study's objective was to examine how FGM/C and associated stressors related to mental health outcomes among Somali women living in the US state of Arizona. The Refugee Health Screener (RHS-13) was used to assess clinically significant distress in a survey of Somali women (N = 879). Analysis included bivariate logistic regressions and final adjusted multivariate logistic modeling exploring associations between distress and FGM/C-related variables. Over 81% reported FGM/C (n = 687), most commonly the most severe Type III (n = 243). Approximately 16% met the RHS-13 cut-off criteria for clinically significant distress (n = 118). Women with FGM/C reporting adverse experiences related to the FGM/C circumcision event were more likely to meet cut-off criteria for clinically significant distress (OR = 4.29;95%CI 1.68-10.97). Other potentially traumatic experiences (OR = 8.94;95%CI 3.81-20.98) and perceived discrimination against FGM/C by medical providers (OR = 2.90;95%CI 1.20-7.02) were also associated with distress. Among all women, both with FGM/C and not, having undergone FGM/C was found to be negatively associated with current distress (OR = 0.45;95%CI 0.21-0.98). Treatment of FGM/C not as a singular experience, but as a set of experiences related to an individual woman's memory of the event, current sociocultural context, availability of psychosocial support, and sense of belonging are potentially vital in the provision of appropriate FGM/C-related care., Author(s): Georgia J. Michlig [sup.1] , Crista Johnson-Agbakwu [sup.2] , Judith Bass [sup.3] , Karin Wachter [sup.2] , Pamela J. Surkan [sup.1] [sup.3] Author Affiliations: (1) grid.21107.35, 0000 0001 2171 [...]

In the past decade, there has been an increasing focus within scientific research on how to assist people affected by the negative consequences of trauma and crises around the globe. As many countries struggle with a lack of resources to deliver mental health interventions, scalable strategies have been developed to help more people in need. These scalable strategies were the theme of the 39th annual meeting of the International Society for Traumatic Stress Studies (ISTSS). The presidential panel, chaired by Marit Sijbrandij during her ISTSS presidency, brought together a group of experts in the field of scalable interventions: Kenneth Carswell, Syed Usman Hamdani, Judy Bass, and Eirini Karyotaki. The panel highlighted the current state of the evidence on scalable interventions for adults and children and outlined important next steps for research and implementation. These recommendations include further improving the availability of, and evidence for, scalable interventions through increased training and sustained funding; conducting more studies in underrepresented samples, such as children and adolescents; and promoting open access availability of research findings worldwide. In this paper, we provide an overview of the topics discussed in the panel as well as the key takeaways. [ABSTRACT FROM AUTHOR]

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., Author(s): Jura L. Augustinavicius [sup.1] , Sarah M. Murray [sup.2] , Itziar Familiar-Lopez [sup.3] , Michael J. Boivin [sup.4] , Alex Mutebe [sup.5] , Ethan Arima [sup.5] , Judith K. [...]

Idioms of distress communicate suffering via reference to shared ethnopsychologies, and better understanding of idioms of distress can contribute to effective clinical and public health communication. This systematic review is a qualitative synthesis of "thinking too much" idioms globally, to determine their applicability and variability across cultures. We searched eight databases and retained publications if they included empirical quantitative, qualitative, or mixed-methods research regarding a "thinking too much" idiom and were in English. In total, 138 publications from 1979 to 2014 met inclusion criteria. We examined the descriptive epidemiology, phenomenology, etiology, and course of "thinking too much" idioms and compared them to psychiatric constructs. "Thinking too much" idioms typically reference ruminative, intrusive, and anxious thoughts and result in a range of perceived complications, physical and mental illnesses, or even death. These idioms appear to have variable overlap with common psychiatric constructs, including depression, anxiety, and PTSD. However, "thinking too much" idioms reflect aspects of experience, distress, and social positioning not captured by psychiatric diagnoses and often show wide within-cultural variation, in addition to between-cultural differences. Taken together, these findings suggest that "thinking too much" should not be interpreted as a gloss for psychiatric disorder nor assumed to be a unitary symptom or syndrome within a culture. We suggest five key ways in which engagement with "thinking too much" idioms can improve global mental health research and interventions: it (1) incorporates a key idiom of distress into measurement and screening to improve validity of efforts at identifying those in need of services and tracking treatment outcomes; (2) facilitates exploration of ethnopsychology in order to bolster cultural appropriateness of interventions; (3) strengthens public health communication to encourage engagement in treatment; (4) reduces stigma by enhancing understanding, promoting treatment-seeking, and avoiding unintentionally contributing to stigmatization; and (5) identifies a key locally salient treatment target.

Early adolescents (ages 10–14) living in low- and middle-income countries have heightened vulnerability to psychosocial risks, but available evidence from these settings is limited. This study used data from the Global Early Adolescent Study to characterize prototypical patterns of emotional and behavioral problems among 10,437 early adolescents (51% female) living in the Democratic Republic of Congo (DRC), Malawi, Indonesia, and China, and explore the extent to which these patterns varied by country and sex. LCA was used to identify and classify patterns of emotional and behavioral problems separately by country. Within each country, measurement invariance by sex was evaluated. LCA supported a four-class solution in DRC, Malawi, and Indonesia, and a three-class solution in China. Across countries, early adolescents fell into the following subgroups: Well-Adjusted (40–62%), Emotional Problems (14–29%), Behavioral Problems (15–22%; not present in China), and Maladjusted (4–15%). Despite the consistency of these patterns, there were notable contextual differences. Further, tests of measurement invariance indicated that the prevalence and nature of these classes differed by sex. Findings can be used to support the tailoring of interventions targeting psychosocial adjustment, and suggest that such programs may have utility across diverse cross-national settings. [ABSTRACT FROM AUTHOR]

We investigated relations between prosocial behavior, perceived social support, and improvement in depression and anxiety symptoms over 6 months among 102 Acholi adolescent (14-17 years, 58% female adolescents) survivors of war and displacement in Northern Uganda. Adolescents were assessed using a locally developed screener. Regression analyses measured the association between resilience factors and mental health outcomes. Findings indicated that high levels of baseline prosocial behaviors were associated with improvement in anxiety symptoms among adolescents with high symptom improvement. This same trend was seen for depression symptoms ("p" = 0.06). Experiencing caregiver loss modified this association for depression symptoms. Baseline social support was not associated with improvement in depression or anxiety. Results suggest that prosocial behavior is associated with increased resilience. (Contains 4 tables.)