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Parental wellbeing, parenting, and child mental health in families with young children in Arghakhanchi, Nepal

Adhikari, Sirjana; Rana, Hari; Joshi, Mahesh Prasad; Cheng, Sabrina; Castillo, Theresa; Huang, Keng-Yen
BACKGROUND:Children's social-emotional development and mental well-being are critical to adult mental health. However, little is known about the mechanisms or factors that contribute to poor child mental health in low- and middle-income countries. Given the lack of child mental health research to guide interventions or social-emotional learning programs and policy planning, the present study aimed to address these knowledge gaps by examining the psychopathology mechanism involved in the development of childhood mental health problems. METHODS:This cross-sectional study recruited parents (N = 393) whose children attended preschool to primary classes in the Arghakhanchi district of Nepal. Data were gathered through parent interviews. Structural Equation Modeling was used to examine the pathways of the mediational mechanism that examined the influence of parental well-being on parenting and children's mental health outcomes. RESULTS:Approximately 22% of the parents were at risk for moderate to severe mental health problems (anxiety: 24%, depression:19%). Parental mental health problems were higher in families who reported food insecurity, among female parents, less educated parents, and those who perceived themselves on a lower social ladder. Parental mental health, social support, and perceived class were associated with parent-child conflict. Greater parent-child conflict was associated with decreased social competence and increased anger, anxiety, and depression in children. CONCLUSION/CONCLUSIONS:The results partially support the mediational model that Nepali parents' well-being (especially in mental health symptoms, social support, and perception of family's social class domains) is associated with less optimal parenting and, in turn, greater child mental health problems and lower social competence. This study provides new evidence of cross-cultural consistency in child psychopathology and guides the development of evidence-based programs to prevent and promote mental health among Nepali children and families.
PMCID:11702219
PMID: 39762775
ISSN: 1471-2431
CID: 5778312

Reflections on Best Practices for Evidence Synthesis in Youth Mental Health for Low- and Middle-Income Countries [Letter]

Kumar, Manasi; Mugo, Cyrus; Falkenstrom, Fredrik; Hedt-Gauthier, Bethany; Huang, Keng-Yen
We read with interest the paper "Meta-analysis: The Effectiveness of Youth Psychotherapy Interventions in Low- and Middle-Income Countries" by Venturo-Conerly et al. (2023).1 The paper presents results on the effectiveness of youth psychotherapies in low- and middle-income countries (LMICs) from a systematic review and meta-analysis using rigorous, highly regarded methods. The authors should be commended for taking on this important subject. However, we feel that the paper needs to be situated in the backdrop of a few concerns that we believe are important for LMIC geographies. In our reply, we mainly focus on the finding that interventions developed in high-income countries (HIC) were more effective if not adapted to local conditions, suggesting that non-culturally adapted interventions had better outcomes than culturally adapted ones. This, as the authors note, seems counterintuitive.
PMID: 39577489
ISSN: 1527-5418
CID: 5758952

Latinx parent engagement and school readiness

Barajas-Gonzalez, Rita Gabriela; Ursache, Alexandra; Kamboukos, Dimitra; Huang, Keng Yen; Linares Torres, Heliana; Cheng, Sabrina; Olson, Devon; Brotman, Laurie Miller; Dawson-McClure, Spring
Efforts to bolster the school readiness of Latinx children from low-income homes in the United States have focused on fostering parent engagement in children"™s education. Measurement of parent engagement in early childhood however, has been critiqued for having too narrow a focus on school-based involvement and missing other aspects of Latinx parent engagement. Using a recently developed culturally sensitive assessment of Latinx parent engagement, we test for associations between dimensions of Latinx parent engagement in learning and indicators of school readiness in a diverse sample of Latinx families (n = 114). We find significant associations between multiple dimensions of Latinx parent engagement and indicators of child school readiness. In addition to promoting parent-teacher connections, efforts to support Latinx school readiness equitably are encouraged to attend to various culturally relevant aspects of Latinx parent engagement in early childhood. In particular, investing in programing that supports parents"™ well-being and capacity for home-based engagement in learning may be a promising way to support the school readiness of Latinx children living in historically disinvested neighborhoods.
SCOPUS:85185656697
ISSN: 1476-718x
CID: 5700352

Considerations for Addressing Trauma in Muslim Communities

Kumar, Manasi; Huang, Keng Yen
PMID: 39186279
ISSN: 2574-3805
CID: 5697422

Psychotic-like experiences and adverse life events in young people. Does gender matter?

Adjorlolo, Samuel; Awortwe, Victoria; Anum, Adote; Huang, Keng-Yen; Mamah, Daniel
BACKGROUND:Psychotic-like experiences (PLEs) and adverse life events (ALEs) are highly prevalent in sub-Saharan Africa where gendered practices are also common. There is, however, a paucity of data on how the relationship between PLEs and life adversities is influenced by gender. The current study addressed this gap. METHOD/METHODS:Data were collected from 1886 school-based young people (1174 females) in Ghana, West Africa using a cross-sectional survey methodology and analyzed using Chi-square, independent t-test, Pearson correlation, and multivariate regression. RESULTS:The results showed that victimization experiences, school stress and having a family member with mental illness were significantly associated with PLEs in both males and females. In contrast, substance misuse and experiences of head trauma correlated significantly with PLEs in females only. CONCLUSION/CONCLUSIONS:Life adversities constitute major risk factors for PLEs among school-based young people in Ghana, who could benefit from gender neutral and gender-sensitive intervention programming to remediate the effects of life adversities on PLEs.
PMID: 37610125
ISSN: 1475-357x
CID: 5598652

State of the Science of Scale-Up of Cancer Prevention and Early Detection Interventions in Low- and Middle-Income Countries: A Scoping Review

Friebel-Klingner, Tara M; Alvarez, Gloria Guevara; Lappen, Hope; Pace, Lydia E; Huang, Keng-Yen; Fernández, Maria E; Shelley, Donna; Rositch, Anne F
PURPOSE/OBJECTIVE:Cancer deaths in low- and middle-income countries (LMICs) will nearly double by 2040. Available evidence-based interventions (EBIs) for cancer prevention and early detection can reduce cancer-related mortality, yet there is a lack of evidence on effectively scaling these EBIs in LMIC settings. METHODS:We conducted a scoping review to identify published literature from six databases between 2012 and 2022 that described efforts for scaling cancer prevention and early detection EBIs in LMICs. Included studies met one of two definitions of scale-up: (1) deliberate efforts to increase the impact of effective intervention to benefit more people or (2) an intervention shown to be efficacious on a small scale expanded under real-world conditions to reach a greater proportion of eligible population. Study characteristics, including EBIs, implementation strategies, and outcomes used, were summarized using frameworks from the field of implementation science. RESULTS:This search yielded 3,076 abstracts, with 24 studies eligible for inclusion. Included studies focused on a number of cancer sites including cervical (67%), breast (13%), breast and cervical (13%), liver (4%), and colon (4%). Commonly reported scale-up strategies included developing stakeholder inter-relationships, training and education, and changing infrastructure. Barriers to scale-up were reported at individual, health facility, and community levels. Few studies reported applying conceptual frameworks to guide strategy selection and evaluation. CONCLUSION/CONCLUSIONS:Although there were relatively few published reports, this scoping review offers insight into the approaches used by LMICs to scale up cancer EBIs, including common strategies and barriers. More importantly, it illustrates the urgent need to fill gaps in research to guide best practices for bringing the implementation of cancer EBIs to scale in LMICs.
PMCID:10805431
PMID: 38237096
ISSN: 2687-8941
CID: 5625582

The Post-intervention Impact of Amaka Amasanyufu on Behavioral and Mental Health Functioning of Children and Adolescents in Low-Resource Communities in Uganda: Analysis of a Cluster-Randomized Trial From the SMART Africa-Uganda Study (2016-2022)

Ssewamala, Fred M; Brathwaite, Rachel; Sensoy Bahar, Ozge; Namatovu, Phionah; Neilands, Torsten B; Kiyingi, Joshua; Huang, Keng-Yen; McKay, Mary M
PURPOSE/OBJECTIVE:Disruptive behavioral disorders (DBDs) are common among children/adolescents in sub-Saharan Africa. A 16-week manualized multiple family group (MFG) intervention called Amaka Amasanyufu designed to reduce DBDs among school-going children/adolescents in low-resource communities in Uganda was efficacious in reducing symptoms of poor mental health relative to usual care in the short-term (4 months post-intervention-initiation). We examined whether intervention effects are sustained 6 months postintervention. METHODS:We used longitudinal data from 636 children positive for DBDs: (1) Control condition, 10 schools, n = 243; (2) MFG delivered via parent peers (MFG-PP), eight schools, n = 194 and; (3) MFG delivered via community healthcare workers (MFG-CHW), eight schools, n = 199 from the SMART Africa-Uganda study (2016-2022). All participants were blinded. We estimated three-level linear mixed-effects models and pairwise comparisons at 6 months postintervention and time-within-group effects to evaluate the impact on Oppositional Defiant Disorder (ODD), impaired functioning, depressive symptoms, and self-concept. RESULTS:At 6 months postintervention, children in MFG-PP and MFG-CHW groups had significantly lower means for ODD (mean difference [MD] = -1.08 and -1.35) impaired functioning (MD = -1.19 and -1.16), and depressive symptoms (MD = -1.06 and -0.83), than controls and higher means for self-concept (MD = 3.81 and 5.14). Most outcomes improved at 6 months compared to baseline. There were no differences between the two intervention groups. DISCUSSION/CONCLUSIONS:The Amaka Amasanyufu intervention had sustained effects in reducing ODD, impaired functioning, and depressive symptoms and improving self-concept relative to usual care at 6 months postintervention. Our findings strengthen the evidence that the intervention effectively reduces DBDs and impaired functioning among young people in resource-limited settings and was sustained over time.
PMID: 37062581
ISSN: 1879-1972
CID: 5464362

Applied machine learning to identify differential risk groups underlying externalizing and internalizing problem behaviors trajectories: A case study using a cohort of Asian American children

Adhikari, Samrachana; You, Shiying; Chen, Alan; Cheng, Sabrina; Huang, Keng-Yen
BACKGROUND:Internalizing and externalizing problems account for over 75% of the mental health burden in children and adolescents in the US, with higher burden among minority children. While complex interactions of multilevel factors are associated with these outcomes and may enable early identification of children in higher risk, prior research has been limited by data and application of traditional analysis methods. In this case example focused on Asian American children, we address the gap by applying data-driven statistical and machine learning methods to study clusters of mental health trajectories among children, investigate optimal predictions of children at high-risk cluster, and identify key early predictors. METHODS:Data from the US Early Childhood Longitudinal Study 2010-2011 were used. Multilevel information provided by children, families, teachers, schools, and care-providers were considered as predictors. Unsupervised machine learning algorithm was applied to identify groups of internalizing and externalizing problems trajectories. For prediction of high-risk group, ensemble algorithm, Superlearner, was implemented by combining several supervised machine learning algorithms. Performance of Superlearner and candidate algorithms, including logistic regression, was assessed using discrimination and calibration metrics via crossvalidation. Variable importance measures along with partial dependence plots were utilized to rank and visualize key predictors. FINDINGS/RESULTS:We found two clusters suggesting high- and low-risk groups for both externalizing and internalizing problems trajectories. While Superlearner had overall best discrimination performance, logistic regression had comparable performance for externalizing problems but worse for internalizing problems. Predictions from logistic regression were not well calibrated compared to those from Superlearner, however they were still better than few candidate algorithms. Important predictors identified were combination of test scores, child factors, teacher rated scores, and contextual factors, which showed non-linear associations with predicted probabilities. CONCLUSIONS:We demonstrated the application of data-driven analytical approach to predict mental health outcomes among Asian American children. Findings from the cluster analysis can inform critical age for early intervention, while prediction analysis has potential to inform intervention programing prioritization decisions. However, to better understand external validity, replicability, and value of machine learning in broader mental health research, more studies applying similar analytical approach is needed.
PMCID:9983857
PMID: 36867610
ISSN: 1932-6203
CID: 5448552

Understanding depression treatment and perinatal service preferences of Kenyan pregnant adolescents: A discrete choice experiment

Kumar, Manasi; Tele, Albert; Kathono, Joseph; Nyongesa, Vincent; Yator, Obadia; Mwaniga, Shillah; Huang, Keng Yen; McKay, Mary; Lai, Joanna; Levy, Marcy; Cuijpers, Pim; Quaife, Matthew; Unutzer, Jurgen
BACKGROUND:Understanding mental health treatment preferences of adolescents and youth is particularly important for interventions to be acceptable and successful. Person-centered care mandates empowering individuals to take charge of their own health rather than being passive recipients of services. METHODS:We conducted a discrete choice experiment to quantitatively measure adolescent treatment preferences for different care characteristics and explore tradeoffs between these. A total of 153 pregnant adolescents were recruited from two primary healthcare facilities in the informal urban settlement of Nairobi. We selected eight attributes of depression treatment option models drawn from literature review and previous qualitative work. Bayesian d-efficient design was used to identify main effects. A total of ten choice tasks were solicited per respondent. We evaluated mean preferences using mixed logit models to adjust for within subject correlation and account for unobserved heterogeneity. RESULTS:Respondents showed a positive preference that caregivers be provided with information sheets, as opposed to co-participation with caregivers. With regards to treatment options, the respondents showed a positive preference for 8 sessions as compared to 4 sessions. With regards to intervention delivery agents, the respondents had a positive preference for facility nurses as compared to community health volunteers. In terms of support, the respondents showed positive preference for parenting skills as compared to peer support. Our respondents expressed negative preferences of ANC service combined with older mothers as compared to adolescent friendly services and of being offered refreshments alone. A positive preference was revealed for combined refreshments and travel allowance over travel allowance or refreshments alone. A number of these suggestions were about enhancing their experience of maternity clinical care experience. CONCLUSION/CONCLUSIONS:This study highlights unique needs of this population. Pregnant adolescents' value responsive maternity and depression care services offered by nurses. Participants shared preference for longer psychotherapy sessions and their preference was to have adolescent centered maternal mental health and child health services within primary care.
PMCID:9994687
PMID: 36888596
ISSN: 1932-6203
CID: 5432752

Applying technology to promote sexual and reproductive health and prevent gender based violence for adolescents in low and middle-income countries: digital health strategies synthesis from an umbrella review

Huang, Keng-Yen; Kumar, Manasi; Cheng, Sabrina; Urcuyo, Anya Elena; Macharia, Paul
AIM/OBJECTIVE:Adolescents in low-and-middle-income countries (LMICs) are facing numerous developmental, sexual and reproductive health (SRH) challenges including exposure to multidimensional violence. Gender-based violence (GBV) specifically intimate partner violence (IPV) are both highly prevalent in LMICs and are strongly linked with poor SRH outcomes. However, GBV and IPV interventions have not yet been adequately integrated in SRH due to individual, social, cultural, service, and resource barriers. To promote long-term SRH, a more holistic approach that integrates GBV and IPV, and adolescent development needs is imperative. Digital health has the potential to address multiple service setup, provision, and addressing access barriers through designing and providing integrated SRH care. However, there are no guidelines for an integrated digital SRH and development promotion for adolescents in LMICs. METHODS:An umbrella review was conducted to synthesize evidence in three inter-related areas of digital health intervention literature: (i) SRH, (ii) GBV specifically IPV as a subset, and (iii) adolescent development and health promotion. We first synthesize findings for each area of research, then further analyze the implications and opportunities to inform approaches to develop an integrated intervention that can holistically address multiple SRH needs of adolescents in LMICs. Articles published in English, between 2010 and 2020, and from PubMed were included. RESULTS:Seventeen review articles met our review inclusion criterion. Our primary finding is that application of digital health strategies for adolescent SRH promotion is highly feasible and acceptable. Although effectiveness evidence is insufficient to make strong recommendations for interventions and best practices suggestions, some user-centered design guidelines have been proposed for web-based health information and health application design for adolescent use. Additionally, several digital health strategies have also been identified that can be used to further develop integrated GBV-IPV-SRH-informed services to improve adolescent health outcomes. We generated several recommendations and strategies to guide future digital based SRH promotion research from our review. CONCLUSIONS:Rigorous research that focuses on intervention effectiveness testing using a combination of digital health strategies and standardized albeit contextualized outcome measures would be important. Methodological improvement such as adoption of longitudinal experimental design will be crucial in generating evidence-based intervention and practice guidelines for adolescents in LMICs.
PMCID:9675248
PMID: 36401323
ISSN: 1472-6963
CID: 5371772