Low-and Middle-income Contexts Research Articles

Evaluating a Movement-Based Mental Health Promotion Intervention for Refugee Children in Uganda: A Quasi-Experimental Study

ABSTRACT Objective Mental health promotion interventions are widely implemented in humanitarian settings and low- and middle-income contexts (LMICs), yet evidence on effectiveness is scarce and mixed. This study evaluated the movement-based mental health promotion intervention “TeamUp” in Bidibidi refugee settlement, in Northern Uganda. Method A quasi-experimental study including four schools (two per arm) assessed the outcomes of 10- to 15-year-old South Sudanese and Ugandan children (n = 549). Randomly allocated, they either participated in up to 11 TeamUp sessions (n = 265) provided by trained facilitators; or belonged to a control group, which continued care as usual (n = 284). Primary outcomes measured psychosocial wellbeing, friendships and attitude to school; secondary outcomes included traumatic distress, depressive symptoms, quality of life, physical health, bullying, interoceptive awareness, and irritability. Data were collected at baseline and endline. Results Children joining TeamUp, showed significantly more improvements on primary outcomes: emotional and psychosocial wellbeing (Mdiff = −1.49, SE = 0.6, p = .01), satisfaction with and attitude toward school (−0.57, SE = 0.2, p = .004); and secondary outcomes: traumatic stress (2.64, SE = 0.8, p < .001), health-related quality of life (−1.56, SE = 0.4, p = .001), physical health (−0.78, SE = 0.3, p = .014) and the TeamUp mechanisms of action scale (−3.34, SE = 0.9, p < .001), specifically the subscales social connectedness (−0.74, SE = 0.3, p = .007) and sense of agency (−0.91, SE = 0.3, p = .005), compared to the control group. No significant differences were found on bullying, interoceptive awareness, irritability and depressive symptoms. Conclusion The results are promising for TeamUp as a mental health promotion intervention for children affected by armed-conflict, displacement and on-going adversity. Further research will need to assess the intervention’s effectiveness.

Applying the Index of Vulnerability approach to understand water insecurity and other social-ecological factors associated with depression among urban refugee youth in Kampala, Uganda

Water insecurity and other social-ecological factors may be associated with depression in low and middle-income contexts (LMICs). This is understudied among urban refugee youth in LMICs, who experience multiple forms of marginalization. We conducted a cross-sectional survey with a peer-driven sample of urban refugee youth aged 16–24 in Kampala, Uganda. We explored: the prevalence of depression (moderate, moderately severe); associations between social-ecological (structural, community, interpersonal, intrapersonal) factors and depression; and associations between an Index of Vulnerability (IoV) comprised of social-ecological stressors and depression. Among n = 335 participants (mean age: 20.8 years, standard deviation: 3.1), in multivariable analyses, longer time in Uganda, water insecurity, lower social support, parenthood, and recent intimate partner violence were associated with moderate depression; and longer time in Uganda, water insecurity, and lower social support were associated with moderately severe depression. IoV scores were associated with moderate depression among men and women, and moderately severe depression among women. The IoV scores accounted for more variance in moderate/moderately severe depression among women than any single indicator; among men, water insecurity was most strongly associated with moderate depression. Future research can explore strategies to address water insecurity and other social-ecological stressors to promote health and wellbeing with urban refugee youth.

Children and young people's beliefs about mental health and illness in Indonesia: A qualitative study informed by the Common Sense Model of Self-Regulation.

Mental illness is a leading cause of disease burden amongst children and young people (CYP). This is exacerbated in low- and middle-income (LMIC) countries which often have embryonic care structures. Understanding and targeting illness beliefs is a potentially efficacious way of optimising the development of health prevention interventions. These beliefs remain relatively underexplored in CYP in LMIC contexts. Aim: To develop an in-depth understanding of CYPs beliefs about mental health and illness in Indonesia. Semi-structured interviews (n = 43) combined with photo elicitation methodology were undertaken with CYP aged 11-15 from Java, Indonesia. Our sample comprised those living with (n = 19) and without (n = 24) high prevalence mental health conditions, specifically anxiety or depression. Data were analysed using framework analysis, informed by the Common Sense Model of Self-Regulation of Health and Illness. Positive mental health and illness were dichotomised in accounts with mental health typically characterised as an absence of mental disturbance. This contributed to attributions of abnormality and the marginalisation of those with mental illness. Mental illness was conceptualised as a single entity, commonly arising from individual failings. This prompted feelings of self-stigma in those with lived experience of mental illness. Analysis identified marked differences in the perceived time dimensions of positive mental health and illness with mental illness conceived as less transient than episodes of positive mental health. Illness beliefs appeared relatively consistent across the two groups of CYP although some nuanced differences were identified. CYP with anxiety and depression were less likely to believe that mental illness could be diagnosed visually, more likely to uphold multiple causal factors and endorse the potential efficacy of professional input. Public health interventions to increase understanding may be necessary to develop healthcare systems to reduce treatment barriers, optimise return on investment and enhance population health effect.

Comparison of clinical outcomes following 2 years of treatment of first-episode psychosis in urban early intervention services in Canada and India.

Purported superior outcomes for treatment of psychosis in low- and middle-income (LMICs) compared with high-income (HICs) countries have not been examined in the context of early intervention services (EIS). To compare 2-year clinical outcomes in first-episode psychosis (FEP) treated in EIS in Chennai (LMIC) and Montreal (HIC) using a similar EIS treatment protocol and to identify factors associated with any outcome differences. Patients with FEP treated in EIS in Chennai (n = 168) and Montreal (n = 165) were compared on change in level of symptoms and rate and duration of positive and negative symptom remission over a 2-year period. Repeated-measures analysis of variance, and logistic and linear regression analyses were conducted. Four patients died in Chennai compared with none in Montreal. Family support was higher for Chennai patients (F = 14.05, d.f. = 1, P < 0.001, ƞp2 = 0.061) and increased over time at both sites (F = 7.0, d.f. = 1.915, P < 0.001, ƞp2 = 0.03). Negative symptom outcomes were significantly better in Chennai for level of symptoms (time × site interaction F = 7.36, d.f. = 1.49, P = 0.002, ƞp2 = 0.03), duration of remission (mean 16.1 v. 9.78 months, t = -7.35, d.f. = 331, P < 0.001, Cohen's d = 0.80) and the proportion of patients in remission (81.5% v. 60.3%, χ2 = 16.12, d.f. = 1, P < 0.001). The site differences in outcome remained robust after adjusting for inter-site differences in other characteristics. Early remission and family support facilitated better outcome on negative symptoms. No significant differences were observed in positive symptom outcomes. Patients with FEP treated in EIS in LMIC contexts are likely to show better outcome on negative symptoms compared with those in HIC contexts. Early remission and family support may benefit patients across both contexts.

PROTOCOL: The Effects of School‐Based Decision Making on Educational Outcomes in Low and Middle Income Contexts: A Systematic Review

PROTOCOL: The Effects of School‐Based Decision Making on Educational Outcomes in Low and Middle Income Contexts: A Systematic Review