Amanda J. Nguyen

Displaced persons with non-communicable diseases (NCD) face challenges in disease management and increased risk of mental health problems. This randomized controlled trial assessed the impact of psychotherapy treatment (Common Elements Treatment Approach [CETA]) on hypertension and diabetes mellitus medication adherence (primary) and mental and physical health outcomes (secondary) among displaced Myanmar adults with poor medication adherence in a Thai shelter community. Treatment participants received weekly CETA for 4–12 weeks; comparison participants had access to routine psychosocial support. Eligible participants were chronic disease patients with <70% medication adherence over prior month. Data were collected at baseline, 3 and 6 months. Of 650 adults screened, 283 (43.5%) met eligibility criteria and 224 consented (CETA n = 112, comparison n = 112) to participate; 73 (32.6%) reported elevated mental health symptoms. At 6-month follow-up, medication adherence improved in both arms, with greater improvements among CETA participants (MARS-5: 0.55, 95% CI: 0.07 to 1.02, p = 0.023). CETA significantly reduced mental health symptoms among those with elevated symptoms at baseline (−3.06, 95% CI: −5.19 to −0.93, p = 0.005). The high rate of mental health symptoms and the impact of CETA on NCD medication adherence supports integration of mental health services into NCD care systems.

Suicide is a serious global health problem with ~73% deaths by suicide occurring in low- or middle-income countries (LMICs), many of which are among people experiencing humanitarian emergencies. Few guidelines outline specific steps and strategies to tackle suicide risk and manage post-attempt consequences in these settings, leaving program implementers with limited information to translate guidance to practice. This article describes the implementation of the Common Elements Treatment Approach (CETA) suicide safety protocol as part of a randomized controlled trial in northern Thailand for displaced adults from Myanmar with chronic physical health conditions. The CETA safety protocol has been used in many trials and programs to screen for and manage suicide risk, including in a prior CETA effectiveness trial with Myanmar adults. In this article, we describe how this safety protocol was adapted for the study setting, and utilized to effectively screen, assess suicidal thoughts and behaviors, develop and manage action plans for study participants with active suicidal ideation. We present three illustrative case descriptions of individuals with whom we implemented the safety protocol to highlight how suicide risk intersects with physical illness, psychosocial stressors and structural vulnerability. Reflections on feasibility, acceptability and adaptations – such as language translation, culturally grounded referral pathways and training for nonspecialist providers – are shared to inform future implementation. Our findings support the implementation of suicide safety protocols within humanitarian programming and offer practical insights for global health practitioners and policymakers working in similarly complex settings.

Psychosocial programs in low- and middle-income countries (LMIC) often omit cognitive strategies due to perceived difficulty for clients and lay providers. We evaluated the benefit of including “cognitive coping” in a brief, online intervention for conflict-affected Ukrainian veterans and family members with mild to moderate psychosocial distress. Participants were randomized to two treatment conditions based on the Common Elements Treatment Approach Psychosocial Program (CPSS). CPSS-Basic (CPSS-B) included a self-assessment, safety screening and psychoeducation. CPSS-Enhanced (CPSS-E) included these as well as cognitive coping. Distress, functional impairment, alcohol use, aggression, social disconnectedness and conflict resolution were assessed after one month. Participants also evaluated program accessibility, acceptability, appropriateness, feasibility and adoption. Of 1,177 study participants, 788 (67%) completed follow-up. Both conditions significantly improved distress, functional impairment, aggression and social disconnectedness; CPSS-E producing a greater reduction in distress than CPSS-B (ES: d = .22, p = .002). Implementation outcomes were positive across conditions, favoring CPSS-E for appropriateness ( d = .48, 95% CI: .33, .62), feasibility ( d = .15, 95% CI: .00, .29), adoption ( d = .34, 95% CI: .19, .48) and acceptability ( d = .29, 95% CI: .15, .44). Findings support the feasibility and added value of incorporating cognitive techniques into psychosocial programming in LMIC.

Background: This study evaluated the effectiveness of Baby Friendly Spaces (BFS), a psychosocial support program for Rohingya refugee mothers of malnourished young children in Bangladesh. Because BFS was already being implemented, we examined the benefit of enhancing implementation supports. Methods: In matched pairs, 10 sites were randomized to provide BFS treatment as usual (BFS-TAU) or to receive enhanced implementation support (BFS-IE). 600 mothers were enrolled and reported on maternal distress, functional impairment, subjective well-being and coping at baseline and 8-week follow-up. Data were analyzed using multilevel linear regression models to account for clustering; sensitivity analyses adjusted for the small number of clusters. Results: Significant within-group improvements in BFSIE were observed for distres (−.48, p = .014), functional impairment (−.30, p = .002) and subjective well-being (.92, p = .011); improvements in BFS-TAU were smaller and not statistically significant. Between-group comparisons favored BFS-IE for distress (β = −.30, p = .058) and well-being (β = .58, p = .038). Sensitivity adjustments produced p-values above .05 for all between-group comparisons. Discussion: Feasible adjustments to implementation can improve program delivery to increase impact on maternal distress and well-being. Although results should be interpreted with caution, study design limitations are common in pragmatic, field-based research.

Journal analyses have documented the historical neglect of research pertaining to the Majority World in psychological science, and the need for inclusivity is clearly articulated to ensure a science that is comprehensive and globally applicable. However, no systematic efforts have explored the perspectives of researchers working with Majority World communities regarding the challenges they experience in conducting and disseminating research and ways to address them. Our aim was to explore these challenges from the perspective of these researchers using an embedded mixed-methods design. Based on responses of 232 researchers who engage in psychological research with Majority World communities (68.1% from Africa, Asia, or Latin America, remaining from the Minority World), we identified challenges in three areas: (a) stemming from an inherent bias against Majority World research, (b) experienced by all researchers, which nonetheless are heightened for those engaging in research with Majority World populations, and (c) specific to researchers affiliated with Majority World institutions. Based on the findings, we recommend journal editorial teams and funding agencies: (a) acknowledge and address the bias inherent in the publication and funding process, (b) recruit editorial team members, program officers, and reviewers from the Majority World, (c) train editorial team members, program officers, and reviewers from the Minority World to thoughtfully evaluate Majority World research, and (d) provide resources for researchers affiliated with Majority World institutions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Background: Educators in rural schools are uniquely situated to address youth mental health disparities, yet often face challenges in delivering mental health supports. This paper describes the process of adapting the evidence-based Coping Power program, a small group prevention program for youth with aggressive behavior problems, to be a two-tiered (Tier 1 and Tier 2), transdiagnostic intervention to improve fit and feasibility for rural upper elementary and middle schools. Method: Identified challenges with the Coping Power program for rural areas included program length, substantial staffing and resource requirements, lack of universal programming, low caregiver engagement, and co-occurring problems. Initial adaptations included a classroom and small group format implemented by school staff, teacher consultations integrated into coaching and co-facilitation, and a technology-supported caregiver component. Implementer feedback forms, coaching notes, and individual interviews informed the iterative development and feasibility testing process. Results: Between 2019 and 2023, thirteen schools across six rural districts implemented the program. Student curriculum revisions included order and relative emphasis of content, classroom and small group overlap, necessary simplification of concepts, improved contextualization to the rural setting, and the addition of student workbooks. Supports for implementers included fully developed lesson plans and slides, a comprehensive implementation manual, video lesson overviews, action-focused training, and a 3-session coaching model to support implementer preparation and sustain motivation. Teacher and caregiver infographic text “nudges” were improved to promote generalization of concepts across settings. Discussion: By partnering with school-based implementers, the adapted program holds promise to be more feasible and appealing for rural schools than the original model. This fully developed program is now ready for larger-scale testing in rural schools.

Background Psychosocial research in humanitarian settings has been historically dominated by a focus on distress and disorder. As such, there is a need to establish the validity of instruments for a broad range of psychosocial outcomes, particularly among highly affected and under-represented populations. The current study describes the adaptation and testing of multiple psychosocial instruments among displaced Rohingya mothers in Bangladesh. Methods We used baseline data from 600 mothers of malnourished children aged 2 and under enrolled in an intervention study in Cox’s Bazar, Bangladesh. Instruments assessed distress (items from the International Depression Symptom Scale [IDSS] and Kessler-6 [K-6]); functional impairment (World Health Organization Disability Assessment Schedule [WHODAS]); subjective wellbeing (global Satisfaction With Life [SWL] and Personal Wellbeing Index [PWI]; and, coping (items from the Brief COPE and locally developed coping items). Instruments were piloted and refined, then used for data collection by Bangladeshi-Rohingya interviewer pairs. We conducted exploratory factor analysis, evaluated internal consistency, examined construct validity through correlation with other scales, and used regression models to explore demographic factors associated with psychosocial health. Results Both the WHODAS and coping items fit 2-factor models; other scales were unidimensional. Cronbach’s alphas ranged from .76 to .90 for the refined scales. With the exception of coping, scale correlations supported construct validity; separate measures of the same construct were highly correlated, distress and impairment were moderately correlated, and both were inversely correlated with wellbeing. Correlates of poorer psychosocial health included relative socioeconomic disadvantage, current pregnancy, and being unmarried. Conclusions Most of the standard psychosocial assessment tools performed adequately, but they did not appear to fully capture local experiences and included items of little local relevance. Findings highlight the need for further mixed methods research to develop a rich battery of instruments with cross-cultural validity, particularly for positive outcomes such as coping which was particularly challenging to assess.

Exposure to adverse childhood experiences (ACEs) is a well-established metric of cumulative risk associated with later development of behavioral and mental health difficulties. Much of the literature has relied solely on a simple summed score of exposure to different types of ACEs to operationalize the complex construct of cumulative risk, despite a lack of evidence documenting that all ACEs exert an equivalent impact on risk for a particular outcome. To address this issue and examine associations between ACEs and externalizing problems, the present study aimed to (1) measure associations between each individual ACE indicator and three adolescent and adult externalizing outcomes, (2) identify unique patterns of exposure to ACEs, and (3) examine differences in the extent to which unique ACE exposure patterns influence externalizing problems. Data came from a sample of 4185 participants in the National Longitudinal Study of Adolescent and Adult Health (Add Health). Each outcome was first regressed onto all individual ACE indicators. The authors then entered all ACE indicators into a latent class analysis (LCA), fitting models with one to four classes. After identifying the best-fitting model, externalizing outcomes were regressed onto the latent classes while adjusting for demographics. Initial regression analyses identified several individual ACE indicators that uniquely predicted increased odds of reporting externalizing problems after adjusting for other ACEs exposure. Using LCA, the authors identified three distinct ACE classes: (1) Low ACEs (77%), (2) Moderate Multiple ACEs (11%), and (3) Hostile Maltreatment (12%). Compared to the Low ACEs Class, the other two classes were associated with higher levels of externalizing problems overall, with the Moderate Multiple ACEs Class exhibiting the greatest risk of endorsing externalizing outcomes during adolescence and adulthood. Findings generally supported the hypothesis that exposure to multiple different types of ACEs captures a sizable portion of risk; however, certain ACE indicators were also identified as having particularly close links to externalizing problems in adolescence and young adulthood. The present study highlights the importance of considering the operationalization of exposure to ACEs based on both cumulative risk and unique patterns of exposure. Implications for enhanced assessment of individual risk for externalizing problems are discussed.

While growing evidence exists for the effectiveness of mental health interventions in global mental health, the evidence base for psychosocial supports is lacking despite the need for a broader range of supports that span the prevention–treatment continuum and can be integrated into other service systems. Following rigorous evaluation of the Common Elements Treatment Approach (CETA) in Ukraine, this article describes the development and feasibility testing of CETA Psychosocial Support (CPSS), a brief psychosocial prevention and referral program for Ukrainian veterans and their families. CPSS development used evidence-based CETA intervention components and was informed by a stakeholder needs analysis incorporating feedback from veterans and their families, literature review, and expert consultations. The program includes psychoeducation, cognitive coping skill development, and a self-assessment tool that identifies participants for potential referral. After initial development of the program, the intervention underwent: (1) initial implementation by skilled providers focused on iterative refinement; (2) additional field-testing of the refined intervention by newly trained providers in real-world conditions; and (3) a formal pilot evaluation with collection of pre-post mental health assessments and implementation ratings using locally validated instruments. Fifteen CPSS providers delivered 14 group sessions to 109 participants (55 veterans, 39 family members, and 15 providers from veterans’ service organizations). After incorporating changes related to content, process, and group dynamics, data from the pilot evaluation suggest the refined CPSS program is an acceptable and potentially effective brief psychosocial prevention and promotion program that can be implemented by trained veteran providers. Forty percent of participants required safety or referral follow-ups. The iterative, inclusive development process resulted in an appropriate program with content and implementation strategies tailored to Ukrainian veterans and their families. Brief psychosocial programs can fit within a larger multitiered mental health and psychosocial continuum of care that supports further referral.