Development and Preliminary Validation of a Comprehensive, International Measure of Beliefs about the Causes of Mental Illness: The Mental Illness Attribution Questionnaire

The study of mental illness attributions, or beliefs about the causes of mental illness, is well-documented and ongoing in the academic literature. Attributions have traditionally been dichotomized along four dimensions based on their locus, controllability, specificity, and stability and have been associated with a wide variety of thoughts, emotions, beliefs, and actions related to mental illness. However, more recent studies have introduced a new cross-cultural model incorporating lay beliefs about the specific biological, emotional, social, and spiritual causes of mental health problems. The present research outlines the design and initial validation of a comprehensive, international measure of causal beliefs using this new model, the Mental Illness Attribution Questionnaire (MIAQ). The four-stage research project included item formulation, piloting, identification of factor structure, qualitative rating tasks, and initial validation with a sample of 680 international students representing 94 nations. Factors captured causes related to supernatural forces, social/stress, lifestyle, physical health, substance use, heredity/biology, and personal weakness. This structure was tested for model fit using confirmatory factor analysis across three vignette conditions – one each describing a man with schizophrenia, depression, or alcoholism – with further examination yielding strong test-retest reliability and promising convergent, discriminant, and cultural validity data. Taken together, these results provide tentative support for the reliability and validity of the MIAQ as a comprehensive measure of seven categories of mental illness attribution. The measure was validated using existing standards for international scale development and has strong potential for understanding attribution and stigmatizing behavior across cultures

Resident Instruction in Social Emergency Medicine

Understanding social determinants of health (SDH) and their intersection with emergency medicine, also known as social emergency medicine (SEM), is an important area of EM training.https://knowledgeconnection.mainehealth.org/lambrew-retreat-2021/1043/thumbnail.jp

Advancing equity in global health: a call for collaborative research partnerships

Addressing global health challenges require collective efforts and equitable partnerships that share knowledge and resources across borders. It also requires equitable partnerships among local researchers and research participants to prevent reproducing decolonization within country. This perspective explores the multifaceted nature of partnerships in global health, examine the benefits of equitable partnerships, highlights challenges like power imbalances but also newer efforts to decolonize global health research. It also advocates for a more ethical approach in global health research to address structural inequities and promote long-term sustainability in global health initiatives across the global South

Examining Associations of Coping Strategies with Stress, Alcohol, and Substance use among College Athletes: Implications for Improving Athlete Coping

Mental health challenges and substance use are common among college athletes, yet few studies have been conducted to understand substance use as a coping strategy. The pressures of collegiate athletics - including commitments to training, travel, and competition - can contribute to maladaptive coping among college athletes, including alcohol and other substance use. An online survey was completed by 188 college athletes competing across NCAA/NJCAA divisions at six institutions in the United States to examine factors associated with substance use coping and whether specific strategies of coping were associated with risk of substance use. Alcohol and drug use were assessed using the CRAFFT Screening Test, NIDA-Modified ASSIST, and Alcohol Use Disorders Identification Test. Coping was assessed with the Coping Orientation to Problems Experienced Inventory, stress was assessed using an adapted Graduate Stress Inventory, athletics-related anxiety was assessed with the Sport Anxiety Scale, and perceived control of stress was assessed using the Perceived Control Questionnaire. Older athletes, men, and those with higher stress were more likely to use substances to cope. Higher behavioral disengagement, higher substance use coping, and lower religious coping were associated with increased likelihood of binge drinking and substance-related risk behaviors. These findings point to the importance of developing targeted interventions aimed at addressing stress and facilitating healthy coping to reduce problematic drinking and substance use among college athletes

A counseling intervention to address HIV stigma at entry into antenatal care in Tanzania (Maisha): study protocol for a pilot randomized controlled trial.

BACKGROUND: HIV-related stigma significantly impacts HIV care engagement, including in prevention of mother-to-child transmission of HIV (PMTCT) programs. Maisha is a stigma-based counseling intervention delivered during the first antenatal care (ANC) visit, complementing routine HIV counseling and testing. The goal of Maisha is to promote readiness to initiate and sustain treatment among those who are HIV-positive, and to reduce HIV stigmatizing attitudes among those who test negative. METHODS: A pilot randomized control trial will assess the feasibility and acceptability of delivering Maisha in a clinical setting, and the potential efficacy of the intervention on HIV care engagement outcomes (for HIV-positive participants) and HIV stigma constructs (for all participants). A total of 1000 women and approximately 700 male partners will be recruited from two study clinics in the Moshi municipality of Tanzania. Participants will be enrolled at their first ANC visit, prior to HIV testing. It is estimated that 50 women (5%) will be identified as HIV-positive. Following consent and a baseline survey, participants will be randomly assigned to either the control (standard of care) or the Maisha intervention. The Maisha intervention includes a video and counseling session prior to HIV testing, and two additional counseling sessions if the participant tests positive for HIV or has an established HIV diagnosis. A subset of approximately 500 enrolled participants (all HIV-positive participants, and a random selection of HIV-negative participants who have elevated stigma attitude scores) will complete a follow-up assessment at 3 months. Measures will include health outcomes (care engagement, antiretroviral adherence, depression) and HIV stigma outcomes. Quality assurance data will be collected and the feasibility and acceptability of the intervention will be described. Statistical analysis will examine potential differences between conditions in health outcomes and stigma measures, stratified by HIV status. DISCUSSION: ANC provides a unique and important entry point to address HIV stigma. Interventions are needed to improve retention in PMTCT care and to improve community attitudes toward people living with HIV. Results of the Maisha pilot trial will be used to generate parameter estimates and potential ranges of values to estimate power for a full cluster-randomized trial in PMTCT settings, with extended follow-up and enhanced adherence measurement using a biomarker.

Study protocol for Sauti ya Vijana (The Voice of Youth): A hybrid-type 1 randomized trial to evaluate effectiveness and implementation of a mental health and life skills intervention to improve health outcomes for Tanzanian youth living with HIV

Objective Young people living with HIV (YPLWH) experience increased morbidity and mortality compared to all other age groups. Adolescence brings unique challenges related to sexual reproductive health, the elevated importance of peer groups, and often, emerging symptoms of emotional distress. Failure to address this unique life stage for YPLWH can lead to worse HIV and mental health outcomes. Herein lies the protocol for a hybrid-type-1 effectiveness-implementation trial designed to evaluate a mental health and life skills intervention that aims to address these needs for YPLWH in Tanzania. Methods This is an individually randomized group-treatment trial designed to evaluate the effectiveness of Sauti ya Vijana (SYV: The Voice of Youth) toward improving viral suppression (HIV RNA <400 copies/mL) and mental health outcomes and to assess implementation including acceptability, feasibility, fidelity, and cost-effectiveness of the manualized intervention. The trial is being conducted across four geographically distinct regions of Tanzania. Peer group leaders (PGL) with lived HIV experience deliver the 10-session group-based intervention and two individual sessions during which participants describe their disclosure narrative (when they learned they live with HIV) and value-based goal setting. Caregiver or chosen supportive adults are encouraged to attend two specific group sessions with their youth. Participants are 10–24 years of age, prescribed antiretroviral therapy for at least 6 months, fully aware of their HIV status, able to commit to session attendance, and able to understand and meaningfully contribute to group sessions. Participant study visits occur at 5 time points for evaluation: baseline, 4-, 6-, 12-, and 18-months post baseline. A single booster session is conducted before the 12-month visit. Study visits evaluate mental health, adverse childhood events, interpersonal violence, resilience, stigma, HIV knowledge, substance use, sexual relationships, ART adherence, and HIV RNA. Implementation outcomes evaluate feasibility and acceptability through attendance, intervention session notes, focus discussion groups and qualitative interviews. Fidelity to the intervention is measured using fidelity checklists by a PGL observer at each group session. Cost effectiveness is calculated using an incremental cost-effectiveness ratio that utilizes a patient cost questionnaire and financial records of study costs. Significance Few mental health interventions for YPLWH have demonstrated effectiveness. Results from this study will provide information about effectiveness and implementation of a peer-led intervention for delivering a mental health and life skills intervention in low-income settings. Trial identifier This trial is registered at clinicaltrials.gov NCT05374109

Factors influencing adherence to hypertension treatment in sub-Saharan Africa

Hypertension (HTN) stands as the primary risk factor for cardiovascular-related fatalities, responsible for 10.8 million deaths worldwide each year, of which 85% of them in low-and-middle-income countries (LMICs). Globally, uncontrolled HTN emerges as the foremost preventable risk factor contributing to these cardiovascular-related deaths. Left untreated, HTN can lead to severe complications including myocardial infarction, heart failure, stroke, and renal failure. Chronic health problems such as HTN demand strict adherence to treatment regimen to achieve better outcomes. However, treatment adherence remains a pervasive global issue, particularly pronounced in LMICs including sub-Saharan Africa (SSA), for a multitude of reasons. Globally, nearly four in every five hypertensive patients who received treatment failed to have their blood pressure controlled. Moreover, there is a dearth of literature addressing strategies to engage individuals in low-resource settings in their HTN prevention and treatment. This scoping review aims to identify the factors affecting HTN treatment adherence in SSA and explore their adverse impact on adherence, as well as strategies employed to mitigate these effects and promote engagement in care for optimal HTN control in SSA