scholarly journals Addressing the mental health needs of children affected by HIV in Rwanda: validation of a rapid depression screening tool for children 7–14 years old

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Agnes Binagwaho ◽  
Eric Remera ◽  
Alice Uwase Bayingana ◽  
Darius Gishoma ◽  
Kirstin Woody Scott ◽  
...  
Keyword(s):  
Mental Health ◽  
At Risk ◽  
Open Access ◽  
Children And Adolescents ◽  
Roc Curve ◽  
Screening Tool ◽  
Chronic Illnesses ◽  
Depression Screening ◽  
Resource Constrained ◽  
Living With Hiv

Abstract Background Depression in children presents a significant health burden to society and often co-exists with chronic illnesses, such as human immunodeficiency virus (HIV). Research has demonstrated that 10–37% of children and adolescents living with HIV also suffer from depression. Low-and-middle income countries (LMICs) shoulder a disproportionate burden of HIV among other health challenges, but reliable estimates of co-morbid depression are lacking in these settings. Prior studies in Rwanda, a LMIC of 12 million people in East Africa, found that 25% of children living with HIV met criteria for depression. Though depression may negatively affect adherence to HIV treatment among children and adolescents, most LMICs fail to routinely screen children for mental health problems due to a shortage of trained health care providers. While some screening tools exist, they can be costly to implement in resource-constrained settings and are often lacking a contextual appropriateness. Methods Relying on international guidelines for diagnosing depression, Rwandan health experts developed a freely available, open-access Child Depression Screening Tool (CDST). To validate this tool in Rwanda, a sample of 296 children with a known diagnosis of HIV between ages 7–14 years were recruited as study participants. In addition to completing the CDST, all participants were evaluated by a mental health professional using a structured clinical interview. The validity of the CDST was assessed in terms of sensitivity, specificity, and a receiver operating characteristic (ROC) curve. Results This analysis found that depression continues to be a co-morbid condition among children living with HIV in Rwanda. For identifying these at-risk children, the CDST had a sensitivity of 88.1% and specificity of 96.5% in identifying risk for depression among children living with HIV at a cutoff score of 6 points. This corresponded with an area under the ROC curve of 92.3%. Conclusions This study provides evidence that the CDST is a valid tool for screening depression among children affected by HIV in a resource-constrained setting. As an open-access and freely available tool in LMICs, the CDST can allow any health practitioner to identify children at risk of depression and refer them in a timely manner to more specialized mental health services. Future work can show if and how this tool has the potential to be useful in screening depression in children suffering from other chronic illnesses.

scholarly journals A Modified Alcohol SBI for Use among Older Adults Living with HIV

2020 ◽  
Vol 42 (12) ◽  
pp. 1155-1162
Author(s):  
Annie L. Nguyen ◽  
Jordan E. Lake ◽  
Diane Preciado ◽  
Diana Liao ◽  
Alison A. Moore ◽  
...  
Keyword(s):  
Older Adults ◽  
At Risk ◽  
Alcohol Use ◽  
Risk Evaluation ◽  
Screening Tool ◽  
Hiv Care ◽  
Personalized Feedback ◽  
Evaluation Tool ◽  
Living With Hiv ◽  
Alcohol Risk

Older adults living with HIV may have health conditions that amplify the potentially negative health effects of alcohol use. We adapted the Comorbidity Alcohol Risk Evaluation Tool (CARET) screening tool for at-risk drinking to reflect HIV/AIDS and related conditions, medications, and behaviors. The adapted CARET-HIV along with a brief intervention was administered to 27 older men living with HIV. The CARET-HIV identified the same number of at-risk drinkers as the original CARET (n = 24) but identified more risk domains. Most participants welcomed receiving information about risks associated with their drinking, but some felt “embarrassed” or “guilty” discussing their drinking. This is particularly salient within the context of HIV discourse, which has historically assigned blame of HIV infection on personal choices. The SBI was generally acceptable to participants. The modified CARET can help providers integrate discussion of alcohol use into the context of HIV care for personalized feedback.

scholarly journals 59 Fetal Alcohol Spectrum Disorder in Canada’s Children: Pediatric Advocacy for Optimal Physical and Mental Health

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e24-e25
Author(s):  
Jocelynn Cook ◽  
Ana Hanlon-Dearman ◽  
Kathy Unsworth
Keyword(s):  
Public Health ◽  
Mental Health ◽  
At Risk ◽  
Children And Adolescents ◽  
Fetal Alcohol Spectrum Disorder ◽  
Spectrum Disorder ◽  
Physical And Mental Health ◽  
Fetal Alcohol ◽  
Canadian Population ◽  
Fetal Alcohol Spectrum

Abstract Introduction/Background Fetal Alcohol Spectrum Disorder (FASD) is a diagnostic term used to describe the range of physical and neurobehavioural effects that may result from prenatal exposure to alcohol. With school prevalence figures of approximately 4%, this may represent as many as 224,000 children across Canada. The pediatrician is key to identifying children who may be at risk based on exposure and in providing regular health and developmental surveillance to families caring for these children. To date, information about the range of specific co-morbidities in the paediatric population has not been clearly established for the Canadian population. The Canadian National FASD Dataform has been collecting diagnostic and assessment data from specialty FASD clinics across Canada for the last 6 years. Objectives The purpose of this abstract is to describe the physical and mental health conditions seen in children and adolescents with FASD in Canada. Design/Methods The Canadian National Dataform collects information from 29 Canadian FASD diagnostic clinics. Dataform started in 2011 as a project funded by the Public Health Agency of Canada to provide national clinical information on FASD in Canada. The database is hosted on the RedCap platform. De-identified clinical data collected includes information on FASD diagnoses, other prenatal exposures, brain domains of impairment and physical/mental health co-morbidities. Descriptive and quantitative analyses were used to compare individuals with and without FASD in the sample. Results Of the 1,684 records in the database, 58% had FASD, 11% were designated as At Risk for FASD and 31% did not receive an FASD-related diagnosis. Nine percent (N=152) were between the ages of 0-5 years, 46% (N=780) were 6-12 years and 24% (N=402) were 13-17 years of age. Of all individuals with FASD, 53% were also exposed prenatally to other substances including nicotine (43%), cannabis (29%) and cocaine/crack (18%), which did not significantly differ from the exposures of those who do not have FASD in the sample. Eighty-eight percent of the sample had confirmed prenatal alcohol exposure (PAE). Data show that children and adolescents across all age groups who meet criteria for FASD had significantly more impairment across each of the 10 brain domains measured when compared to those who have PAE but do not meet criteria for an-FASD diagnosis (Figure 1). The children and adolescents with FASD had significantly higher physical and mental health co-morbidities across all age cohorts (Tables 1 and 2). It is important to note that, in most cases, the rates of co-morbidities are higher than in the general Canadian population. Conclusion Children with FASD/PAE are at risk for physical and mental health co-morbidity and on-going risk for developing new and significant health challenges. They should be followed by a community pediatrician. Appropriate anticipatory guidance should be provided to families at check-ups, including referrals for early intervention. A community team to support families caring for complex children optimizes developmental outcomes, reducing the burden of care. Understanding complexities of PAE changes how we consider public health policy/service delivery.

Exploring the Utilization of Structural and Medical Family Therapy With an Incarcerated Mother Living With HIV

2019 ◽  
Vol 63 (4) ◽  
pp. 624-640 ◽  
Author(s):  
Eman Tadros ◽  
Natasha Finney
Keyword(s):  
Mental Health ◽  
Family Therapy ◽  
Integrated Approach ◽  
Chronic Illnesses ◽  
Medical Family Therapy ◽  
Structural Family Therapy ◽  
Case Application ◽  
Incarcerated Population ◽  
Living With Hiv

The incarcerated population is considered an underserved population, specifically in regard to their ability to access and receive mental health services. There is a gap in existing literature addressing the mental health needs of incarcerated individuals who also suffer from chronic illnesses. The purpose of this case study is to provide an exploration of how medical family therapy and structural family therapy can be integrated to inform the treatment of incarcerated individuals and their families who are experiencing a physical health illness. A case application will be provided to highlight how the integrated approach can be utilized to conceptualize and treat those incarcerated and their families. Treatment was shown to be effective as evidenced by the outcomes of an incarcerated mother with HIV and her daughter.

scholarly journals Persistent Food Insecurity Is Associated with Adverse Mental Health among Women Living with or at Risk of HIV in the United States

2019 ◽  
Vol 149 (2) ◽  
pp. 240-248 ◽  
Author(s):  
Emily L Tuthill ◽  
Lila A Sheira ◽  
Kartika Palar ◽  
Edward A Frongillo ◽  
Tracey E Wilson ◽  
...  
Keyword(s):  
Mental Health ◽  
United States ◽  
At Risk ◽  
Depressive Symptoms ◽  
Food Insecurity ◽  
Well Being ◽  
The United States ◽  
Depression Score ◽  
Living With Hiv ◽  
Mental Well Being

Abstract Background Food insecurity and mental health negatively affect the lives of women in the United States. Participants in the Women's Interagency HIV Study (WIHS) provided the opportunity to understand the association of food insecurity with depression and mental well-being over time. Objective We investigated the association between current and persistent food insecurity and depression among women at risk of or living with HIV in the United States. Methods We used longitudinal data from the WIHS, a prospective cohort study in women at risk of or living with HIV from multiple sites in the United States. Participants completed 6 semiannual assessments from 2013 to 2016 on food security (FS; high, marginal, low, and very low) and mental health (i.e., depressive symptoms and mental well-being). We used multiple regression analysis to estimate the association between these variables. Results Among 2551 participants, 44% were food insecure and 35% reported depressive symptoms indicative of probable depression. Current marginal, low, and very low FS were associated with 2.1-, 3.5-, and 5.5-point (all P < 0.001) higher depression scores, respectively. In models adjusting for both current and previous FS, previous marginal, low, and very low FS were associated with 0.2-, 0.93-, and 1.52-point higher scores, respectively (all P < 0.001). Women with very low FS at both time points (persistent food insecurity) had a 6.86-point higher depression score (P < 0.001). In the mental health models, there was a dose-response relation between current FS and worse mental health even when controlling for previous FS (all P < 0.001). Previous low FS was associated with worse mental health. These associations did not differ by HIV status. Conclusions Food insecurity placed women at risk of depression and poor mental well-being, but the risk was substantially higher for women experiencing persistent food insecurity. Future interventions to improve women's mental health call for multilevel components that include addressing food insecurity.

scholarly journals Accuracy of Depression Screening Tools to Detect Major Depression in Children and Adolescents: A Systematic Review

2016 ◽  
Vol 61 (12) ◽  
pp. 746-757 ◽  
Author(s):  
Michelle Roseman ◽  
Lorie A. Kloda ◽  
Nazanin Saadat ◽  
Kira E. Riehm ◽  
Abel Ickowicz ◽  
...  
Keyword(s):  
Systematic Review ◽  
Lower Bound ◽  
Children And Adolescents ◽  
Screening Tool ◽  
Diagnostic Interview ◽  
Small Sample ◽  
Screening Tools ◽  
Depression Screening ◽  
Screening Programs ◽  
Small Sample Sizes

Objective: Depression screening among children and adolescents is controversial, and no clinical trials have evaluated benefits and harms of screening programs. A requirement for effective screening is a screening tool with demonstrated high accuracy. The objective of this systematic review was to evaluate the accuracy of depression screening instruments to detect major depressive disorder (MDD) in children and adolescents. Method: Data sources included the MEDLINE, MEDLINE In-Process, EMBASE, PsycINFO, HaPI, and LILACS databases from 2006 to September 30, 2015. Eligible studies compared a depression screening tool to a validated diagnostic interview for MDD and reported accuracy data for children and adolescents aged 6 to 18 years. Risk of bias was assessed with QUADAS-2. Results: We identified 17 studies with data on 20 depression screening tools. Few studies examined the accuracy of the same screening tools. Cut-off scores identified as optimal were inconsistent across studies. Width of 95% confidence intervals (CIs) for sensitivity ranged from 9% to 55% (median 32%), and only 1 study had a lower bound 95% CI ≥80%. For specificity, 95% CI width ranged from 2% to 27% (median 9%), and 3 studies had a lower bound ≥90%. Methodological limitations included small sample sizes, exploratory data analyses to identify optimal cut-offs, and the failure to exclude children and adolescents already diagnosed or treated for depression. Conclusions: There is insufficient evidence that any depression screening tool and cut-off accurately screens for MDD in children and adolescents. Screening could lead to overdiagnosis and the consumption of scarce health care resources.

scholarly journals Establishing the content validity of an online depression screening tool for South Africa

2021 ◽  
Vol 3 ◽  
Author(s):  
Tasneem Hassem
Keyword(s):  
Mental Health ◽  
South Africa ◽  
Content Validity ◽  
Screening Tool ◽  
Depression Scale ◽  
Mobile Internet ◽  
Depression Screening ◽  
Depression Symptoms ◽  
Measurement Instruments ◽  
Health Measurement

Depression is a global concern as with an estimated 300 million individuals worldwide experiencing depression. In South Africa, the prevalence rate of depression is estimated at 9.7% of the population. With the increase in mobile internet usage in South Africa, an online depression screening tool could provide opportunities for the screening of depression symptoms aiding access to mental health interventions. This project identified an open access tool for screening depression, the Center for Epidemiologic Studies Depression Scale – Revised (CESD-R), and adapted it for online use by the adult South African population. This study followed on from the adaptation phase on the CESD-R and aimed to determine the content validity of the adapted CESD-R for online use in South Africa using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) methodology. The study followed a two-phased design. Study one utilised a qualitative approach, where 50 experts commented on the content validity of the tool. The results were used to further adapt the tool which resulted in a 20-item depression screening tool. Study two followed a quantitative design in order to establish the content validity in terms of determining the Content Validity Ratios, Item-Content Validity Index as well as the Kappa Statistic of the 20 items. Based on these statistics, 19 of the 20 items were retained. Overall, the adapted online depression screening tool displays good content validity and holds potential as a screening tool where access to mental health may be limited.

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