Early Psychosocial Intervention Research Articles

Psychosocial and mental health disorders among a population-based, case–control cohort of patients with congenital upper eyelid ptosis

Background/AimRecent studies have demonstrated adverse psychosocial and mental health disorders among children with ocular disorders. The mental health burden of children with simple congenital ptosis, however, is unknown. The purpose...

Body image and hopelessness among early-stage breast cancer survivors after surgery in China: A cross-sectional study.

AimTo examine the body image and hopelessness status of early‐stage breast cancer survivors who received a one‐time dressing change after surgery and were ready to be discharged from a hospital in China.DesignA cross‐sectional study.MethodsParticipants were 211 women with breast cancer who had received a one‐time dressing change postsurgery. Spearman's correlation and structural equation modelling were used for data analysis.ResultsParticipants in the 35–45 age group and those who underwent bilateral mastectomy presented higher scores for hopelessness. Married participants showed lower scores for the feelings about the future subscale compared to other subscales. Body image was significantly and positively associated with and had a positive effect on hopelessness. Women with a more positive appraisal of their body image tended to report lower levels of hopelessness. Healthcare providers should evaluate patients’ distress levels after a mastectomy to identify women who may require early psychosocial intervention.

Class of 2020 in Poland: Students' Mental Health during the COVID-19 Outbreak in an Academic Setting.

The COVID-19 pandemic had led universities to introduce lockdowns, which has led to significant shifts in students’ lives. Classes were moved online, students had to leave dorms and move; they had to forgo regular meetings with their peers. Subsequently, a vital demand for examining students’ mental health emerged. The data were collected at a time when universities in Poland were under lockdowns. Participants represented students of many different fields of study. The General Health Questionnaire (GHQ-28) was used. Student’s subjective evaluation of online learning and their adaptation to academic life shifts were reviewed. A total of 1123 participants took part in this study. Relationship analysis included tests, such as U Mann–Whitney, appropriate for specific variables. The impact of variables connected with the pandemic on the GHQ scores was tested using multivariate regression analysis. The results were considered significant at a p-value set at 0.05. Overall, 76.96% of the participants manifested psychopathological symptoms measured by the GHQ. Four demographical variables were possibly associated with the GHQ scores: female sex, living in a big city, necessity to move back home, and being in a relationship. Negative correlations between subjective evaluation of variables concerning e-learning, such as its efficiency or quality, and the GHQ scores were found. Some variables were found to be potential protective factors, whereas others could have contributed to worsened mental health. The study provides data on students’ worsened mental health due to the COVID-19 pandemic and the shifts in academic life it caused. Therefore, recommendations for early psychosocial interventions among students are strongly advised.

Long-Term Mental Health and Quality of Life Outcomes of Neonatal Insults in Kilifi, Kenya

We examined the mental health and quality of life (QoL) outcomes and their correlates of school-aged survivors of neonatal jaundice (NNJ), hypoxic-ischemic encephalopathy (HIE), and a comparison group. The Child Behavior Checklist and the Pediatric Quality of Life Inventory were administered to assess the mental health and QoL of 375 children (134 with NNJ, 107 with HIE, and 134 comparison group) aged 6 to 12 years [Median age 9 (interquartile range 7 to 11)]. The results showed that survivors of NNJ and HIE have mental health problems and QoL similar to the comparison group. Maternal mental health was the predominant covariate of mental health and QoL in survivors of NNJ and HIE. This result could indicate that mothers with mental health problems are more likely to have children with mental health issues, but also that caring for children with these adversities may affect mental health well-being of the caregivers. There is a need for early mental health screening and psychosocial intervention for caregivers and their children to enhance both their mental health and QoL.

The Construction of "Self" in Individuals With Congenital Facial Palsy.

Congenital facial palsy is a rare medical condition that causes paralysis of the facial muscles, lack of facial expression, and an unusual appearance. Findings from developmental psychology suggest that the face plays a central role in the construction of self. Semi-structured interviews were conducted with 14 adults born with congenital facial palsy. Participant's constructions of self across the life span were explored and a grounded theory of this process was constructed. Theoretical sampling was conducted with two parents of children born with the condition. All participants reported "struggling to make connections," "experiencing invalidation," and "struggling to regulate affect," which lead to "constructing a defective sense of self." Alternatively, "making validating connections" facilitated the process of "constructing a validated sense of self." This study provides insight into the unique social and emotional challenges often experienced by those born with congenital facial palsy and highlights the need for early psychosocial intervention.

Patterns and Correlates of Alcohol Use- A Retrospective Study in a Secondary Care Hospital Setting

Introduction: Alcohol use in India has been increasing over the years, and it results in myriad medical and psychosocial problems. Primary and secondary care physicians can play a unique role in the early recognition and treatment of patients with alcohol problems. Aim: To determine the prevalence of different patterns of use of alcohol and factors associated with it among patients presenting to the psychiatry clinic in a secondary hospital. Materials and Methods: A retrospective review of the medical records of patients attending the Psychiatry Department in a secondary care hospital in a semi-urban area of southern India who attended the clinic between 1st January 2016 to 31st December 2016 was made. Data regarding alcohol use and other clinical and socio-demographic details were analysed. Bivariate and multivariate statistics was used to identify factors associated with dependence pattern of alcohol use. Results: A total of 103 charts, which documented substance use were analysed of which 78 documented alcohol use in the subjects. The mean age of the sample was 44.09±13.18 years and majority (97.43%) were males. The prevalence of a dependence pattern of alcohol use was 83.4%. Factors associated with alcohol dependence were being married, greater daily expenditure on alcohol, greater number of days of alcohol use in a month, presence of a co-morbid medical diagnosis, problems with employment and marital discord. Depression was present in 33 (42.3%) individuals and it was the most commonly associated psychiatric morbidity. Conclusion: There is a high prevalence of Alcohol Use Disorders (AUD) in secondary care settings. Tackling this problem requires a combination of strategies including early and effective medical and psychosocial intervention in addition to public health strategies and legislation to regulate the availability and consumption of the substance.

Psychosocial impact of skin diseases: A population-based study.

BackgroundWhile it is well established that skin disease places significant psychosocial burden on a patient’s wellbeing, its effects have rarely been examined in Asian populations.ObjectiveEvaluate the psychosocial burden of skin disease among community-dwelling adults in Singapore.MethodsThis cross-sectional study included 1510 participants interviewed on their history of thirteen skin diseases. The Patient Health Questionnaire (PHQ-9), Lubben Social Network Scale-6 (LSNS-6), University of California Los Angeles (UCLA) Loneliness Scale, and European Quality of Life-5 Dimensions- 5 Level (EQ-5D-5L) were used as measures for depressive symptoms, social isolation, loneliness and quality of life respectively. Multiple linear regression analysis was used to examine the association of skin diseases with each of the four measured outcomes.ResultsParticipants with skin diseases reported significantly higher PHQ-9 and UCLA Loneliness scale scores, and lower LSNS-6 and EQ-5D-5L scores when compared to their healthy counterparts. The presence of skin disease was positively associated with depressive symptoms (B = 0.40, SE = 0.11), and negatively associated with quality of life (B = -0.03, SE = 0.01). As disease severity was not evaluated in this study, we were unable to ascertain the associations between disease severity and measured outcomes.ConclusionParticipants with skin diseases were more likely to have depressive symptoms, social isolation, loneliness and lower quality of life. Unemployed, single and elderly patients were at higher risk of developing depressive symptoms. More emphasis should be placed on the psychosocial aspect of care to reduce the burden of skin disease. Some considerations include monitoring patients for mood-related changes and implementing early psychosocial interventions.

Maternal Mental Health after a Wildfire: Effects of Social Support in the Fort McMurray Wood Buffalo Study.

Objective:Following disasters, perinatal women are vulnerable to developing post-traumatic stress disorder (PTSD)-like symptoms. Little is known about protective factors. We hypothesized that peritraumatic stress would predict PTSD-like symptoms in pregnant and postpartum women and would be moderated by social support and resilience.Method:Women (n = 200) who experienced the 2016 Fort McMurray Wood Buffalo wildfire during or shortly before pregnancy completed the Peritraumatic Distress Inventory (PDI), Peritraumatic Dissociative Experiences Questionnaire, and the Impact of Event Scale-Revised for current PTSD-like symptoms. They also completed scales of social support (Social Support Questionnaire-Short Form) and resilience (Connor-Davidson Resilience Scale).Results:Greater peritraumatic distress (r = 0.56) and dissociative experiences (r = 0.56) correlated with more severe PTSD-like symptoms. Greater social support satisfaction was associated with less severe post-traumatic stress symptoms but only when peritraumatic distress was below average; at more severe levels of PDI, this psychosocial variable was not protective.Conclusions:Maternal PTSD-like symptoms after a wildfire depend on peritraumatic distress and dissociation. Higher social support satisfaction buffers the association with peritraumatic distress, although not when peritraumatic reactions are severe. Early psychosocial interventions may protect perinatal women from PTSD-like symptoms after a wildfire.

Provider Perspectives on Early Psychosocial Interventions after Pediatric Severe Traumatic Brain Injury: An Implementation Framework.

This study created a framework incorporating provider perspectives of best practices for early psychosocial intervention to improve caregiver experiences and outcomes after severe pediatric traumatic brain injury (TBI). A purposive sample of 23 healthcare providers from the emergency, intensive care, and acute care departments, was selected based on known clinical care of children with severe TBI at a level 1 trauma center and affiliated children's hospital. Semistructured interviews and directed content analysis were used to assess team and caregiver communication processes and topics, prognostication, and recommended interventions. Providers recommended a dual approach of institutional and individual factors contributing to an effective framework for addressing psychosocial needs. Healthcare providers recommended interventions in three domains: (1) presenting coordinated, clear messages to caregivers, (2) reducing logistical and emotional burden of care transitions, and (3) assessing and addressing caregiver needs and concerns. Specific family-centered and trauma-informed interventions included: (1) creating and sharing interdisciplinary plans with caregivers, (2) coordinating prognostication meetings and communications, (3) tracking family education, (4) improving institutional coordination and workflow, (5) training caregivers to support family involvement, (6) performing biopsychosocial assessment, and (7) using systematic prompts for difficult conversations and to address family needs at regular intervals. Healthcare workers from a variety of disciplines want to incorporate certain trauma-informed and family-centered practices at each stage of treatment to improve experiences for caregivers and outcomes for pediatric patients with severe TBI. Future research should test the feasibility and effectiveness of incorporating routine psychosocial interventions for these patients.

Risk Factors for the Increase in Frequency and Earlier Manifestation of Depression in Adolescent Population of Today

Objective: depression among adolescents is a serious public problem. The majority of genetic and clinical studies showed that early — onset depressions etiologically may be distinct from adult — onset depressions. Itis possible to assume some differences in aged-dependent risk profile between depressions at adolescence and adulthood.Aim: to study adolescent depressions for identification a number of novel risk factors for increase in frequency and early manifestation of the disorder.Patients and methods: outpatient adolescents registered in one of the Moscow psychoneurological dispensary at 1999–2019 years (total 1704 boys and girls). From the entire cohort we selected all participants appealed for medical aid in connection with depression (F3 of ICD-10) during last decade.Results: the significant increase in the incidence and early manifestation of adolescent depressions during last decade were revealed especially in girls with shift of male/female ratio from 3,1/1 in 2009 year to 1,8/1 in 2019 year. Some specific features of nowadays adolescent depressions are noted: beginning at an earlier age, increasing part of severe depressive episodes, growth of the autoaggressive behavior and suicidal potential. Novel links between adolescent depressions and risk factors are described. Some endocrinological changes resulting from premature pubertal timing and disordered circadian rhythms, social deprivation owing to socio-economic reforms with a lack of social support, low social expectations, absence of positive perspectives leading to low self-esteem and unwarranted self-criticism are turned out to be the most important factors heightening vulnerability to adolescent depressions.Conclusion: identification of pathogenetic mechanisms of adolescent depressions creates an opportunity for early target psychosocial intervention and might help to reduce risk for depression among youth.

Being a mother after a cancer diagnosis during pregnancy: Maternal psychosocial functioning and child cognitive development and behavior.

Up to 51.5% of women diagnosed with cancer during pregnancy experience trauma (eg, intrusive thoughts, avoidance) and 20% report anxiety. Maternal anxiety can negatively affect child behavior among the noncancer population. This study aims to elucidate relationships between maternal distress, parenting style, and child behavior and development among women with cancer during pregnancy. This cross-sectional study of child cognitive, language and motor development analyze child behavior in the context of maternal psychosocial well-being after a cancer diagnosis during pregnancy. A subset of women (N = 69) enrolled in the Cancer and Pregnancy Registry, had children undergo developmental testing. The majority underwent Bayley Scales III (children 6-42 months of age; 0-3.5 years) to assess language, cognitive, and motor performance. Women completed the Basic Symptom Inventory, Impact of Events Scale, Parent Behavior Checklist, and Child Behavioral Checklist. Maternal and child assessments were performed concurrently. Sixty-nine women and 71 children (2 sets of twins) ages 6 months to 12 years participated. Maternal depressive and somatic symptoms were associated with more externalizing behaviors. Among younger children (0-3.5 years), maternal somatic symptoms were associated with poorer language performance. Moderation analysis showed that mothers with fewer somatic symptoms and utilization of less discipline had children with less externalizing behaviors and higher language scores (ie, stronger verbal ability). Given the interplay of psychosocial factors on child behavior and development, findings highlight the importance of early screening and psychosocial intervention and support for mothers diagnosed with cancer in pregnancy.

Clinico-Immunological Status and Neurocognitive Function of Perinatally Acquired HIV-Positive Children on cART: A Cross-Sectional Correlational Study in South Africa.

Despite the undisputed benefits of combination antiretroviral therapy (cART), perinatally acquired human immunodeficiency virus (PHIV) children on treatment often present with a spectrum of neurological deficits known as HIV-associated neurocognitive impairment. Even higher CD4 cell count does not seem to prevent the development of neurocognitive impairment in children with PHIV. While CD4 cell count has shown to have the greatest prognostic value, its association with neurocognitive abilities remains to be clarified. This study aimed at determining the correlation between plasma CD4+ lymphocyte and neurocognitive function in children with PHIV on cART. In total, 152 purposively recruited hospital-based sample of children with PHIV on cART, aged 3 years to 7 years 6 months (mean age, 63.13 months), underwent neurocognitive assessment using the Wechsler Preschool and Primary Scale of Intelligence, Third Edition. Immunological status of each child was based on the plasma CD4+ lymphocyte levels. The mean CD4+ lymphocyte cell count at the time of neurocognitive assessment was 1,259.85 cells/mm3 (mean range, 139–2,717 cells/mm3), with significant age difference on CD4+ lymphocyte count levels [F(2, 149) = 13.58, p = 0.000]. CD4+ lymphocyte counts was significantly correlated with subdomains of neurocognitive function scores of task that measures working memory, processing speed, and perceptual reasoning. Global cognitive ability (Full Scale Intellectual Quotient) had no significant association with immunological status of the children. The findings support an association between immunological status of PHIV infection and executive function task. These neurocognitive faculties are critical for learning, school readiness and success in early childhood, and ultimately treatment adherence in adolescence. The need for early identification of neurodevelopment deficits in children, even when on cART, is crucial because early psychosocial and neurorehabilitative interventions can lead to better outcome for children with PHIV.

Quality of life and psychopathology in candidates to bariatric surgery: relationship with BMI class.

This cross-sectional study aimed at comparing the quality of life (Qol), the prevalence of psychiatric diagnosis and pharmacological treatment in 104 candidates to bariatric surgery according to the degree of obesity (class 2 vs. class ≥ 3 obesity). All surgical candidates underwent a detailed psychiatric interview based on DSM-5 criteria, including sociodemographic, clinical, psychological and psychiatric data. Participants completed the Binge Eating Scale (BES) and the 12-Item Short Form Health Survey (SF-12). Overall, bariatric candidates reported a significant impairment in the physical (PCS 38.8 [95% CI 36.2-41.5]) and mental (MCS 42.2 [95% CI 40.4-43.9]) components of Qol compared to population norms (p < 0.001 for both). Subjects with class 2 obesity scored significantly lower in the MCS compared to those with class 3 (38.7 (8.1) vs. 43.6 (8.4), p = 0.008). No other statistically significant differences were found between the two groups in terms of sociodemographic and clinical variables. These data support the usefulness of Qol assessment in bariatric candidates as a sensible screening parameter, especially in patients with lower BMI, in whom MCS could identify the need for early psychosocial intervention. Level III,case-control analyticstudy.

Can an Integrative Care Approach Improve Physical Function Trajectories after Orthopaedic Trauma? A Randomized Controlled Trial.

Orthopaedic trauma patients frequently experience mobility impairment, fear-related issues, self-care difficulties, and work-related disability []. Recovery from trauma-related injuries is dependent upon injury severity as well as psychosocial factors []. However, traditional treatments do not integrate psychosocial and early mobilization to promote improved function, and they fail to provide a satisfying patient experience. We sought to determine (1) whether an early psychosocial intervention (integrative care with movement) among patients with orthopaedic trauma improved objective physical function outcomes during recovery compared with usual care, and (2) whether an integrative care approach with orthopaedic trauma patients improved patient-reported physical function outcomes during recovery compared with usual care. Between November 2015 and February 2017, 1133 patients were admitted to one hospital as orthopaedic trauma alerts to the care of the three orthopaedic trauma surgeons involved in the study. Patients with severe or multiple orthopaedic trauma requiring one or more surgical procedures were identified by our orthopaedic trauma surgeons and approached by study staff for enrollment in the study. Patients were between 18 years and 85 years of age. We excluded individuals outside of the age range; those with diagnosis of a traumatic brain injury []; those who were unable to communicate effectively (for example, at a level where self-report measures could not be answered completely); patients currently using psychotropic medications; or those who had psychotic, suicidal, or homicidal ideations at time of study enrollment. A total of 112 orthopaedic trauma patients were randomized to treatment groups (integrative and usual care), with 13 withdrawn (n = 99; 58% men; mean age 44 years ± 17 years). Data was collected at the following time points: baseline (acute hospitalization), 6 weeks, 3 months, 6 months, and at 1 year. By 1-year follow-up, we had a 75% loss to follow-up. Because our data showed no difference in the trajectories of these outcomes during the first few months of recovery, it is highly unlikely that any differences would appear months after 6 months. Therefore, analyses are presented for the 6-month follow-up time window. Integrative care consisted of usual trauma care plus additional resources, connections to services, as well as psychosocial and movement strategies to help patients recover. Physical function was measured objectively (handgrip strength, active joint ROM, and Lower Extremity Gain Scale) and subjectively (Patient-Reported Outcomes Measurement Information System-Physical Function [PROMIS®-PF] and Tampa Scale of Kinesiophobia). Higher values for hand grip, Lower Extremity Gain Scale (score range 0-27), and PROMIS®-PF (population norm = 50) are indicative of higher functional ability. Lower Tampa Scale of Kinesiophobia (score range 11-44) scores indicate less fear of movement. Trajectories of these measures were determined across time points. We found no differences at 6 months follow-up between usual care and integrative care in terms of handgrip strength (right handgrip strength β = -0.0792 [95% confidence interval -0.292 to 0.133]; p = 0.46; left handgrip strength β = -0.133 [95% CI -0.384 to 0.119]; p = 0.30), or Lower Extremity Gain Scale score (β = -0.0303 [95% CI -0.191 to 0.131]; p = 0.71). The only differences between usual care and integrative care in active ROM achieved by final follow-up within the involved extremity was noted in elbow flexion, with usual care group 20° ± 10° less than integrative care (t [27] = -2.06; p = 0.05). Patients treated with usual care and integrative care showed the same Tampa Scale of Kinesiophobia score trajectories (β = 0.0155 [95% CI -0.123 to 0.154]; p = 0.83). Our early psychosocial intervention did not change the trajectory of physical function recovery compared with usual care. Although this specific intervention did not alter recovery trajectories, these interventions should not be abandoned because the greatest gains in function occur early in recovery after trauma, which is the key time in transition to home. More work is needed to identify ways to capitalize on improvements earlier within the recovery process to facilitate functional gains and combat psychosocial barriers to recovery. Level II, therapeutic study.

Parent perspectives and psychosocial needs 2 years following child critical injury: A qualitative inquiry

IntroductionTo provide effective care and promote wellbeing and positive outcomes for parents and families following paediatric critical injury there is a need to understand parent experiences and psychosocial support needs. This study explores parent experiences two years following their child's critical injury. MethodsThis multi-centre study used an interpretive qualitative design. Parent participants were recruited from four paediatric hospitals in Australia. Semi-structured interviews were audio recorded and transcribed verbatim. Qualitative data were thematically analysed and managed using NVivo 11. ResultsTwenty-two parents participated. Three themes were identified through analysis: Recovering from child injury; Managing the emotional impact of child injury; Being resilient and finding ways to adapt. ConclusionsA long-term dedicated trauma family support role is required to ensure continuity of care, integration of support and early targeted intervention to prevent long-term adverse outcomes for critically injured children and their families. Early and ongoing psychosocial intervention would help strengthen parental adaptation and address families’ psychosocial support needs following child injury.

Compensatory Cognitive Training for Latino Youth at Clinical High Risk for Psychosis: Study Protocol for a Randomized Controlled Trial.

Background: Early psychosocial interventions targeting cognitive and functional outcomes in individuals at clinical high risk for psychosis are a research priority. An even greater need is the identification of effective interventions in underserved populations. Compensatory Cognitive Training (CCT) is a psychosocial intervention with demonstrated efficacy in chronic schizophrenia and first episode psychosis, but remains to be evaluated in pre-illness phases. The aim of this study was to describe the development and implementation of an ongoing pilot randomized controlled trial investigating the efficacy of group-based, manualized CCT, as compared to recreational therapy (RT), for Latino participants at clinical high risk for psychosis (CHR) in both the United States and Mexico. It is hypothesized that, in comparison to those receiving RT, participants receiving CCT will show significant improvements in neurocognitive performance and functional capacity (co-primary outcomes) and self-rated functioning and clinical symptoms (secondary outcomes).Methods: Latino CHR participants aged 12–30 years will be included in the study. Both CCT and RT will be delivered in either Spanish or English, depending on group preference. Additionally, all assessments will be administered in participants’ preferred language. A comprehensive assessment of neurocognitive and functional performance and clinical symptomatology will be performed at baseline, mid-intervention (4 weeks, 8 weeks), post-intervention (12 weeks) and 3-month follow-up. The primary outcome measures are neurocognition and functional capacity, as assessed by the MATRICS (Measurement and Treatment Research in Cognition in Schizophrenia) Consensus Cognitive Battery and the University of California, San Diego Performance-Based Skills Assessment-Brief, respectively. Furthermore, secondary outcomes measures will be used to examine change in clinical symptoms and self-reported functioning in response to CCT versus RT.Discussion: The evaluation of a novel treatment such as CCT in CHR youth will provide empirical support for a low risk, comprehensive cognitive intervention that could have important implications for public health if it improves neurocognition and functioning.

A Dyadic Perspective on Coping and its Effects on Relationship Quality and Psychological Distress in Couples Living with Chronic Pain: A Longitudinal Study

Dyadic coping is a process of coping within couples that is intended not only to support the patient with chronic pain but also to maintain equilibrium in the relationship. This study aims to investigate the effect of patient-perceived and spouse-reported dyadic coping on both the patient and their partner's relationship quality and anxiety, stress, and depression over time. One hundred thirty-nine couples, with one partner experiencing chronic pain, participated in this study. Spanning three measurements over six months, couples reported on their anxiety, stress, depression, relationship quality, and dyadic coping. Patient-perceived supportive dyadic coping was positively associated with both partners' relationship quality but was negatively associated with spouses' stress over time. Patient-perceived negative dyadic coping was negatively associated with both partners' relationship quality and positively associated with patients' depression and spouses' depression and stress over time. Spouse-reported supportive dyadic coping showed a positive association with their own relationship quality and a negative association with spouses' depression at baseline and patients' depression at three-month follow-up. Spouse-reported negative dyadic coping was negatively associated with their relationship quality at baseline and positively associated with their partner's anxiety and stress at six-month and three-month follow-up, respectively. Similar inference was observed from the findings of growth curve model. As compared with spouse report, patient perception of dyadic coping is a better predictor of both partners' relationship quality and psychological outcomes over time. Both partners may benefit from early psychosocial intervention to improve their dyadic coping, relationship quality, and psychological outcomes.

Does Duration of Residency in the United States Influence Psychological Symptoms and Postmigration Stressors Among Refugees? Potential Implications of Populism for Refugee Mental Health

After relocation, refugees may experience significant difficulty adjusting to a host culture, and this difficulty may persist even after many years following resettlement. However, the influence of time on postmigration living difficulties (PMLD) and psychological distress has not been extensively investigated. In this investigation, we used regression analyses to examine whether length of residence in the United States would moderate the relationship between psychological symptoms and PMLD in a sample of 52 adult East African refugees. The sample was predominantly male (female n = 13) with a mean age of ∼37 years ( SD = 20.91) and mean length of residence in the United States of 9.9 years ( SD = 5.85). The moderating effect of years living in the United States on the depression–PMLD relationship was significant, and explained an additional 9% of variance in PMLD. The relationship between depressive symptoms and PMLD became significantly related at ∼7 years of residence in the United States, and became more positive as values in the sample approached the longest duration in the United States (30 years). No such moderating effect was found for the association between posttraumatic stress disorder symptoms and PMLD. These results highlight the risk of marginalization as well as the need for early and sustained psychosocial interventions for refugee populations in the United States.

The Association of Home Environment and Caregiver Factors With Neurocognitive Function in Pre-school- and School-Aged Perinatally Acquired HIV-Positive Children on cART in South Africa.

Background: Children with perinatally acquired HIV in low resource settings are at risk for neurocognitive impairments not only due to the direct effects of HIV on the brain and in utero ART exposure but also due to factors associated with their environment. Thus, the aim of this study was to examine the association between home environment and caregiver factors and the neurocognitive function of pre-school- and-school-aged HIV-positive South African children from low resource rural communities.Materials and Methods: The Wechsler Preschool and Primary Scale of Intelligence-III was administered to assess the neurocognitive functioning of 152 purposively sampled perinatally acquired HIV-positive children on cART, aged 3 years to 7 years 6 months (mean age 63.13 months). The primary caregivers (n = 152) completed the Home Screening Questionnaire to assess the quality of the home-environment of the children.Results :The results showed that unfavorable environment, caregiver type, and quality of stimulation in the home were negatively associated with the neurocognitive development of perinatally HIV-positive children on cART. Most of the HIV-positive children (n = 95) were under the care of an extended relative. Older HIV-positive boys, reared by biological mothers, who also lived in suboptimal and poor quality home-environments had poorer neurocognitive function when compared to HIV-positive children reared by non-biological (extended relatives) caregivers, [F(2,149) = 14.42, p < 0.001].Conclusion: The child's early home environment is associated with general neurocognitive development, which highlights the need for early psychosocial interventions that can promote better cognitive outcomes among children living with HIV.

The impact of early psychosocial intervention on self-efficacy of care recipient/carer dyads living with early-stage dementia-A mixed-methods study.

To evaluate the effect of a targeted community-based psychosocial intervention on self-efficacy outcomes for care recipient/carer dyads living with early-stage dementia. There is increasing interest in the role of self-efficacy and self-management structures in determining positive outcomes for people with dementia. The assumption is that care recipient/carer dyads who receive early support to identify and adjust to dementia-related changes will cope better in the long term. An explanatory sequential mixed-method design was employed. Primarily quantitative with qualitative data providing a supportive secondary role to expand on and illuminate the quantitative findings. Eighty-eight dyads were recruited and allocated on a regional basis to an intervention or control group. Intervention group dyads received the Early Diagnosis Dyadic Intervention. Control group dyads received two information manuals. Quantitative data were collected at three time points. Qualitative data were collected via evaluation questionnaires and semistructured interviews. Intervention structure, content, and delivery were acceptable to the dyads but few quantitative self-efficacy findings reached statistical significance. Improvements in self-efficacy were evident in the postintervention evaluation qualitative responses where dyads expressed greater confidence in identifying and accessing community support. There is an urgent need for effective psychosocial interventions to help reduce the impact of dementia symptoms on patients, carers, and society. This study makes an important contribution to our understanding of the capacity of psychosocial interventions to improve self-efficacy outcomes for care recipient/carer dyads with early-stage dementia while also illustrating the challenges associated with measuring self-efficacy in the early stages of the condition.