scholarly journals Reducing mental health-related stigma among medical and nursing students in low- and middle-income countries: a systematic review

2019 ◽  
Vol 29 ◽  
Author(s):  
E. Heim ◽  
C. Henderson ◽  
B. A. Kohrt ◽  
M. Koschorke ◽  
M. Milenova ◽  
...  
Keyword(s):  
Mental Health ◽  
Nursing Students ◽  
Cultural Adaptation ◽  
Methodological Quality ◽  
Outcome Measure ◽  
Middle Income ◽  
Professional Students ◽  
Middle Income Countries ◽  
Related Stigma ◽  
Health Related

Abstract Aims This systematic review compiled evidence on interventions to reduce mental health-related stigma among medical and nursing students in low- and middle-income countries (LMICs). Primary outcomes were stigmatising attitudes and discriminatory behaviours. Methods Data collection included two strategies. First, previous systematic reviews were searched for studies that met the inclusion criteria of the current review. Second, a new search was done, covering the time since the previous reviews, i.e. January 2013 to May 2017. Five search concepts were combined in order to capture relevant literature: stigma, mental health, intervention, professional students in medicine and nursing, and LMICs. A qualitative analysis of all included full texts was done with the software MAXQDA. Full texts were analysed with regard to the content of interventions, didactic methods, mental disorders, cultural adaptation, type of outcome measure and primary outcomes. Furthermore, a methodological quality assessment was undertaken. Results A total of nine studies from six countries (Brazil, China, Malaysia, Nigeria, Somaliland and Turkey) were included. All studies reported significant results in at least one outcome measure. However, from the available literature, it is difficult to draw conclusions on the most effective interventions. No meta-analysis could be calculated due to the large heterogeneity of intervention content, evaluation design and outcome measures. Studies with contact interventions (either face-to-face or video) demonstrated attitudinal change. There was a clear lack of studies focusing on discriminatory behaviours. Accordingly, training of specific communication and clinical skills was lacking in most studies, with the exception of one study that showed a positive effect of training interview skills on attitudes. Methods for cultural adaptation of interventions were rarely documented. The methodological quality of most studies was relatively low, with the exception of two studies. Conclusions There is an increase in studies on anti-stigma interventions among professional students in LMICs. Some of these studies used contact interventions and showed positive effects. A stronger focus on clinical and communication skills and behaviour-related outcomes is needed in future studies.

scholarly journals Reducing mental health-related stigma in primary health care settings in low- and middle-income countries: a systematic review

2018 ◽  
Vol 29 ◽  
Author(s):  
E. Heim ◽  
B. A. Kohrt ◽  
M. Koschorke ◽  
M. Milenova ◽  
G. Thornicroft
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Cultural Adaptation ◽  
Risk Of Bias ◽  
Middle Income ◽  
Training Interventions ◽  
Middle Income Countries ◽  
Primary Health ◽  
Related Stigma ◽  
Health Related

Abstract Aims This systematic review compiled evidence on interventions to reduce mental health-related stigma in primary health care (PHC) in low- and middle-income countries (LMICs). Studies targeting PHC staff (including non-professionals) were included. Primary outcomes were stigmatising attitudes and discriminatory behaviours. Methods Data collection included two strategies. First, previous systematic reviews were searched for studies that met the inclusion criteria of the current review. Second, a new search was done, covering the time since the previous reviews, i.e. January 2013 to May 2017. Five search concepts were combined in order to capture relevant literature: stigma, mental health, intervention, PHC staff and LMICs. A qualitative analysis of all included full-texts was done with software MAXQDA. Full-texts were analysed with regards to the content of interventions, didactic methods, mental disorders, cultural adaptation, type of outcome measure and primary outcomes. Furthermore, a risk of bias assessment was undertaken. Results A total of 18 studies were included. Risk of bias was rated as high in most included studies. Only six studies had tested their intervention against a control condition, two of which had used random allocation. Most frequently used interventions were lectures providing theoretical information. Many studies also used interactive methods (N = 9), discussed case studies (N = 8) or used role plays (N = 5). Three studies reported that they had used clinical practice and supervision. Results of these studies were mixed. No or little effects were found for brief training interventions (e.g. 1 h to 1 day). Longer training interventions with more sophisticated didactic methods produced statistically significant changes in validated stigma questionnaires. These results have to be interpreted with caution due to risk of bias. Methods for cultural adaptation of interventions were rarely documented. Conclusions More rigorous trials are needed in LMICs to test interventions that target discriminatory behaviours in relationship with patients. Cultural adaptation of stigma interventions and structural/institutional factors should be more explicitly addressed in such trials.

scholarly journals Evaluation of an anti-stigma intervention for Mexican psychiatric trainees

2022 ◽  
Vol 8 (1) ◽  
Author(s):  
Emmeline Lagunes-Cordoba ◽  
Ruth Alcala-Lozano ◽  
Roberto Lagunes-Cordoba ◽  
Ana Fresan-Orellana ◽  
Manuela Jarrett ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Negative Attitudes ◽  
Middle Income ◽  
Self Reflection ◽  
Middle Income Countries ◽  
People With Mental Illness ◽  
Related Stigma ◽  
Health Related ◽  
The Impact

Abstract Background There is research evidence regarding the presence of stigmatising attitudes in psychiatrists towards people with mental illness, but a lack of studies and interventions focused on this issue in low and middle-income countries. Aims To assess the feasibility of implementing an anti-stigma intervention for Mexican psychiatric trainees, and its potential effects. Methods This study comprised a pre-post design with outcome measures compared between baseline and 3-month follow-up. Quantitative outcome measures were used to evaluate the potential effects of the intervention, whilst the process evaluation required the collection and analysis of both quantitative and qualitative data. Results Twenty-nine trainees (25% of those invited) participated in the intervention, of whom 18 also participated in the follow-up assessment. Outcome measures showed the intervention had moderately large effects on reducing stereotypes and the influence of other co-workers on trainees’ own attitudes. The main mechanisms of impact identified were recognition of negative attitudes in oneself and colleagues, self-reflection about the impact of stigma, one’s own negative attitudes and recognition of one’s ability to make change. Participants accepted and were satisfied with the intervention, which many considered should be part of their routine training. However, trainees’ work overload and lack of support from the host organisation were identified as barriers to implement the intervention. Conclusions A brief anti-stigma intervention for Mexican psychiatric trainees is feasible, potentially effective, well accepted and was considered necessary by participants. This study also suggests mechanisms of impact and mediators should be considered for developing further interventions, contributing to reducing the damaging effects that mental health-related stigma has on people’s lives.

scholarly journals A scoping review of health-related stigma outcomes for high-burden diseases in low- and middle-income countries

BMC Medicine ◽  
2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Jeremy C. Kane ◽  
Melissa A. Elafros ◽  
Sarah M. Murray ◽  
Ellen M. H. Mitchell ◽  
Jura L. Augustinavicius ◽  
...  
Keyword(s):  
Scoping Review ◽  
Middle Income ◽  
High Burden ◽  
Middle Income Countries ◽  
Related Stigma ◽  
Health Related ◽  
Low And Middle Income

scholarly journals Mental health, anthropometry and blood pressure among adolescents living in slums of Nashik, India

2015 ◽  
Vol 17 (4) ◽  
Author(s):  
Sushama A. Khopkar ◽  
Suvi M. Virtanen ◽  
Sangita Kulathinal
Keyword(s):  
Mental Health ◽  
Blood Pressure ◽  
Health Management ◽  
General Health Questionnaire ◽  
Mental Wellbeing ◽  
Life Changes ◽  
Cross Sectional ◽  
Middle Income ◽  
Middle Income Countries ◽  
Health Related

 Background: Both hypertension and depression are common disorders and obesity is on the rise in low and middle-income countries. Because early life changes may prove to be precursors to the development of diseases in adult, assessing the mental and physical health of younger population is crucial. This study aimed to determine the association between blood pressure, mental health and anthropometric status of adolescents from urban slums in Nashik, India.  Methods: A cross-sectional observational study was conducted among eligible adolescents during November 2010 and April 2011 in two randomly selected slums of Nashik, Maharashtra, India. A total of 545 adolescents were selected from 276 households. Data on socio-demographic indicators, anthropometry, blood pressure, mental wellbeing, and addictions were collected using pretested structured questionnaires by house visits. Mental wellbeing was examined using the General Health Questionnaire with 12 items (GHQ-12). A higher score indicates more-optimal mental wellbeing. Linear mixed effects models were used to analyse the data. Results: Girls had better mental wellbeing scores than boys. Adolescents with low mental wellbeing score had higher percentage of stunting (22%) compared to high scores. The factors associated significantly with systolic blood pressure (SBP) were age, mid mental wellbeing score, stunting, and thinness. For diastolic blood pressure (DBP), sex, high mental wellbeing score, and father's education were, in addition, also significant. When moving from the low to mid mental wellbeing score, SBP and DBP decreased and the same was observed for high score. The prevalence of prehypertension was 20%.  Conclusion: The findings showed that the adolescents do run a higher risk of substance abuse, health-related problems and higher SBP and DBP if there is an evidence of distress. It brings into focus the importance of mental health management in adolescents. 

scholarly journals Cultural adaptation framework of social interventions in mental health: Evidence-based case studies from low- and middle-income countries

2019 ◽  
Vol 66 (1) ◽  
pp. 41-48 ◽  
Author(s):  
Meredith Fendt-Newlin ◽  
Aarti Jagannathan ◽  
Martin Webber
Keyword(s):  
Mental Health ◽  
Cultural Adaptation ◽  
Health Conditions ◽  
Evidence Based ◽  
Middle Income ◽  
Mental Health Conditions ◽  
Social Interventions ◽  
Middle Income Countries ◽  
Low And Middle Income

Background: Evidence-based strategies for treating mental health conditions need to be scaled up to address the mental health treatment gap in low- and middle-income countries. Most medical and psychological interventions for the treatment of mental health conditions have been developed and evaluated in high-income countries. However, the imperative of scaling up such interventions potentially ignores local realities, and may also discredit or replace local frameworks for responding to distress. Aims: This article aims to develop a framework for the cultural adaptation of social interventions which are developed within, and draw upon, local contexts, to ensure they are acceptable, feasible and effective. Method: A case study approach is used to discuss the feasibility of developing and adapting psychosocial interventions which are embedded in local knowledge, values and practices. Results: The first case study introduces yoga as an alternative and/or complementary, and culturally relevant, approach for people experiencing mental health conditions in India. The second case study is a cross-cultural adaptation of a psychosocial intervention from the United Kingdom to fit the local idioms of distress and service context in Sierra Leone, as the country battled with the Ebola outbreak. We use these case studies to develop a Cultural Adaptation Framework, which recognises that people and their mental health are products of their culture and society, to inform the future development, adaptation and evaluation of sociocultural interventions for people experiencing mental health conditions in low- and middle-income countries. Conclusion: The Cultural Adaptation Framework can be used to ensure interventions are culturally relevant and responsive to local conditions prior to evaluating in experimental studies.

scholarly journals Mental illness stigma after a decade of Time to Change England: inequalities as targets for further improvement

2019 ◽  
Vol 30 (3) ◽  
pp. 497-503 ◽  
Author(s):  
Claire Henderson ◽  
Laura Potts ◽  
Emily J Robinson
Keyword(s):  
Mental Health ◽  
Social Distance ◽  
Mental Illness Stigma ◽  
Simple Random Sample ◽  
Middle Income ◽  
Social Marketing Campaign ◽  
Related Stigma ◽  
Health Related ◽  
Nationally Representative ◽  
Using Data

Abstract Background England’s Time to Change programme to reduce mental health-related stigma and discrimination included a social marketing campaign using traditional and social media, and targeted middle-income groups aged 25–45 between 2009 and 2016. From 2017, the same age group on low to middle incomes were targeted, and the content focused on men’s mental health, by changing the advertising and adapting the ‘key messages’. This study investigates changes in stigma-related public knowledge, attitudes and desire for social distance in England since Time to Change began in 2008–19 and for 2017–19. Methods Using data from a face-to-face survey of a nationally representative quota sample of adults for England, we evaluated longitudinal trends in outcomes with regression analyses and made assumptions based on a simple random sample. The pre-existing survey used a measure of attitudes; measures of knowledge and desire for social distance were added in 2009. Results Reported in standard deviation units (95% CI), the improvement for knowledge for 2009–19 was 0.25 (0.19, 0.32); for attitudes, 2008–19, 0.32 (0.26, 0.39) and for desire for social distance, 2009–19 0.29 (0.23, 0.36). Significant interactions between year and both region and age suggest greater improvements in London, where stigma is higher, and narrowing of age differences. There were significant improvements between 2017 and 2019 in knowledge [0.09 (0.02, 0.16)] and attitudes [0.08 (0.02, 0.14)] but not social distance. Conclusion The positive changes support the effectiveness of Time to Change but cannot be definitively attributed to it. Inequalities in stigma by demographic characteristics present targets for research and intervention.

Depression in the Developing World

2017 ◽  
Author(s):  
Harry Minas
Keyword(s):  
Mental Health ◽  
International Development ◽  
Social Services ◽  
Development Programs ◽  
Middle Income ◽  
Health And Social Services ◽  
Middle Income Countries ◽  
Culturally Informed ◽  
Global Understanding

This chapter provides an overview of what is known about prevalence, social determinants, treatment, and course and impact of depression in developing, or low- and middle-income, countries. The importance of culture in depression and in the construction and application of diagnostic classifications and in health and social services is highlighted, with a particular focus on the applicability of ‘Western’ diagnostic constructs and service systems in developing country settings. The role of international organizations, such as WHO, and international development programs, such as the SDGs, in improving our understanding of depression and in developing effective and culturally appropriate responses is briefly examined. There is both a need and increasing opportunities in developing countries for greater commitment to mental health of populations, increased investment in mental health and social services, and culturally informed research that will contribute to improved global understanding of mental disorders in general and depression in particular.

Health research capacity in Nepal: Analysis of the trend and the role of local researchers

2021 ◽  
pp. 004947552098277
Author(s):  
Madhu Kharel ◽  
Alpha Pokharel ◽  
Krishna P Sapkota ◽  
Prasant V Shahi ◽  
Pratisha Shakya ◽  
...  
Keyword(s):  
Health Research ◽  
Fold Increase ◽  
Research Capacity ◽  
Rapid Review ◽  
Evidence Based ◽  
Middle Income ◽  
Middle Income Countries ◽  
Health Related ◽  
Evidence Based Decision Making

Evidence-based decision-making is less common in low- and middle-income countries where the research capacity remains low. Nepal, a lower-middle-income country in Asia, is not an exception. We conducted a rapid review to identify the trend of health research in Nepal and found more than seven-fold increase in the number of published health-related articles between 2000 and 2018. The proportion of articles with Nepalese researchers as the first authors has also risen over the years, though they are still only in two-thirds of the articles in 2018.

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