Most adolescents live in low- and middle-income countries (LMIC), and about 10% of them face mental problems. The mental health provision gap in low- and middle-income countries could be addressed by ...evidence-based practices, however costs are implementational barriers. Digitalization can improve the accessibility of these tools and constitutes a chance for LMIC to use them more easily at a low cost. We reviewed free and brief evidence-based mental health assessment tools available for digital use to assess psychopathology across different domains in youth.
For the current study, instruments from a recent review on paper-based instruments were re-used. Additionally, a systematic search was conducted to add instruments for the personality disorder domain. We searched and classified the copyright and license terms available from the internet in terms of free usage and deliverability in a digital format. In the case that this information was insufficient, we contacted the authors.
In total, we evaluated 109 instruments. Of these instruments, 53 were free and digitally usable covering 11 mental health domains. However, retrieving information on copyright and license terms was very difficult.
Free and digitally adaptable instruments are available, supporting the strategy of using instruments digitally to increase access. The instrument's authors support this initiative, however, the lack of copyright information and the difficulties in contacting the authors and licence holders are barriers to using this strategy in LMIC. A comprehensive, online instrument repository for clinical practice would be an appropriate next step to make the instruments more accessible and reduce implementation barriers.
Evidence-based assessment (EBA) in mental health is a critical aspect of improving patient outcomes and addressing the gaps in mental health care. EBA involves the use of psychometric instruments to ...gather data that can inform clinical decision-making, inform policymakers, and serve as a basis for research and quality management. Despite its potential, EBA is often hindered by barriers such as workload and cost, leading to its underutilization. Regarding low- and middle-income countries (LMIC), the implementation of EBA is recognized as a key strategy to address and close the prevalent mental health treatment gap.To simplify the application of EBA including in LMIC, an international team of researchers and practitioners from Tanzania, Kosovo, Chile, and Switzerland developed the Mental Health Information Reporting Assistant (MHIRA). MHIRA is an open-source electronic health record that streamlines EBA by digitising psychometric instruments and organising patient data in a user-friendly manner. It provides immediate and convenient reports to inform clinical decision-making.The current article provides a comprehensive overview of the features and technical details of MHIRA, as well as insights from four implementation scenarios. The experience gained during the implementations as well as the user-feedback suggests that MHIRA has the potential to be successfully implemented in a variety of clinical contexts and simplify the use of EBA. However, further research is necessary to establish its potential to sustainably transform healthcare services and impact patient outcomes.In conclusion, MHIRA represents an important step in promoting the widespread adoption of EBA in mental health. It offers a promising solution to the barriers that have limited the use of EBA in the past and holds the potential to improve patient outcomes and support the ongoing efforts to address gaps in mental health care.
The current study aims to identify meaningful psychotic patients' profiles by examining certain combinations of patient's demographic and socio-economic variables (sex, age, marital status, number of ...children, cohabitant and level of education). Moreover, we aim to assess whether there is any significant effect of class membership (profile) on negative symptoms, health state, and quality of life among psychotic patients. A convenience sample of 103 patients (age:
,
= 1.75), was drawn from the clinical populations of Kosovo. Demographic and socio-economic data was obtained through individual interviews, meanwhile a battery of questionnaires was used to assess negative symptoms, mental health, and quality of life of patients. The 4-class solution was selected as the best fitting model and used in subsequent analyses. Results indicated a significant effect of class membership on health state, quality of life and negative symptoms. Practical implications are discussed.
Studies consistently show the demand among adolescents for structured career guidance support programmes. This study evaluated the effectiveness of the career guidance workshop intervention by ...examining changes in career self-efficacy, outcome expectations, and career goals with 47 high school students in grades 10-12 (aged 16-18 years). Based on a five-step model including self-awareness, career exploration, school and career paths, real encounters, and decision-making, the career guidance workshop combined lectures, discussions, individual activities, and pair and group work. Data were collected through career self-efficacy, outcome expectation, and career goal questionnaires and analysed using a pre- and post-test design with a single intervention group. Results suggested a significant improvement in participants' career self-efficacy and their career goals. Although the findings on outcome expectations were not significant, the findings also showed an increase after the intervention. Thus, career guidance intervention is considered a valuable basis to improve adolescents' career decision-making skills.
Student victimization by school staff members has important potential consequences for students’ academic achievement and physical and psychological outcomes. Several studies have shown that such ...victimization exists in multiple contexts and there is considerable variation in prevalence among contexts. This study examined the prevalence of student victimization in public schools by staff members and its relationships with other school-related factors in the context of Kosovo. The sample was designed to represent all students from Grades 6–9 in 13 of Kosovo's 38 municipalities. The sample consisted of 12,040 students from 100 schools, 49.2% of whom were female. They were equally divided between Grades 6 to 9. Overall, more than a quarter of the students reported that a staff member victimized them in the last month. The least prevalent victimization type was sexual—touched or tried to touch you in a sexual manner (2.3%). The most prevalent physical behavior was slapping (15.8%); 12.7% reported being offended or humiliated by a staff member and 8.3% indicated that a staff member cursed them. Boys were victimized significantly more than girls for all types of victimization. The strongest predictors of staff victimization of students were students’ involvement in peer-to-peer victimization and risky behaviors, which were correlated with school climate. Future research should examine each type of staff victimization of students (emotional, physical, sexual) separately and test comprehensive models that include multiple predictors, including contextual and school-level variables and staff characteristics.
Rumination, which can be studied through its associated attentional biases, and is a part of the RDoC Negative Valence Systems constructs of Loss, has been proposed as a key transdiagnostic feature ...in depression. The current study uses eye tracking measurements to explore how different levels of brooding and reflection rumination interact with attentional biases in a non-clinical sample of high and low ruminators. Methodology: 123 adults were administered questionnaires of rumination, depression and participated in passive viewing task in which they watched sets of angry, happy, sad and neutral faces, while their eye movements were tracked. Findings indicate greater sustained attention toward sad and angry faces and away from happy faces among non-clinical individuals with high levels of brooding rumination, even when controlling for depression scores. The study adds further evidence that brooding rumination and attentional biases to negative stimuli are associated with one another. Behavioral parameters such as attention bias to help us to distinguish high ruminators among non-clinical sample.
Although mindfulness is effective in reducing anxiety, research on its impact on test anxiety among lower secondary school children in science, technology, engineering, and mathematics (STEM)-related ...disciplines is limited. Using a one-group pre - post-test research design, this pilot study evaluated the impact of classroom mindfulness meditation training on test anxiety in STEM-related disciplines with 197 sixth-grade students (54.3% boys, aged 10-12 years) from public schools in Kosovo. Mindfulness training significantly decreased students' test anxiety levels in STEM-related disciplines. Mindfulness helped students calm down, reduced their academic anxiety, and increased their self-esteem. A significant decrease in test anxiety among participants who reported that the training improved their self-esteem and reduced their academic anxiety and stress was ascertained. Regarding sex differences, meditation activities significantly decreased test anxiety scores among girls. Mindfulness training can be employed as a stress-reduction strategy that can be easily incorporated into classroom pedagogy.
The Brief Psychiatric Rating Scale (BPRS) is a useful tool for measuring the severity of psychopathological symptoms among patients with psychosis. Many studies, predominantly in Western countries, ...have investigated its factor structure. This study has the following aims: (a) to further explore the factor structure of the BPRS-Expanded version (BPRS-E, 24 items) among outpatients with psychotic disorders in Southeast European countries; (b) to confirm the identified model; and (c) to investigate the goodness-of-fit of the three competing BPRS-E factor models derived from previous studies. The exploratory factor analysis (EFA) produced a solution with 21 items grouped into five factors, thus supporting the existence of a fifth factor, i.e., Disorganization. A follow-up confirmatory factor analysis (CFA) revealed a 19-item model (with two items removed) that fit the data well. In addition, the stability of two out of three competing factor models was confirmed. Finally, the BPRS-E model with 5 factors developed in this cross-national study was found to include a greater number of items compared to competing models.
Abstract
Background
Implementation of psychosocial interventions in mental health services has the potential to improve the treatment of psychosis spectrum disorders (PSD) in low- and middle-income ...countries (LMICs) where care is predominantly focused on pharmacotherapy. The first step is to understand the views of key stakeholders. We conducted a multi-language qualitative study to explore the contextual barriers and facilitators to implementation of a cost-effective, digital psychosocial intervention, called DIALOG+, for treating PSD. DIALOG+ builds on existing clinician-patient relationships without requiring development of new services, making it well-fitting for healthcare systems with scarce resources.
Methods
Thirty-two focus groups were conducted with 174 participants (patients, clinicians, policymakers and carers), who were familiarized with DIALOG+ through a presentation. The Southeast European LMICs included in this research were: Bosnia and Herzegovina, Kosovo, (Kosovo is referred throughout the text by United Nations resolution) North Macedonia, Montenegro and Serbia. Framework analysis was used to analyse the participants’ accounts.
Results
Six major themes were identified. Three themes (Intervention characteristics; Carers’ involvement; Patient and organisational benefits) were interpreted as perceived implementation facilitators. The theme Attitudes and perceived preparedness of potential adopters comprised of subthemes that were interpreted as both perceived implementation facilitators and barriers. Two other themes (Frequency of intervention delivery; Suggested changes to the intervention) were more broadly related to the intervention’s implementation. Participants were exceedingly supportive of the implementation of a digital psychosocial intervention such as DIALOG+. Attractive intervention characteristics, efficient use of scarce resources for its implementation and potential to improve mental health services were seen as the main implementation facilitators. The major implementation barrier identified was psychiatrists’ time constrains.
Conclusions
This study provided important insights regarding implementation of digital psychosocial interventions for people with PSD in low-resource settings by including perspectives from four stakeholder groups in five LMICs in Southeast Europe – a population and region rarely explored in the literature. The perceived limited availability of psychiatrists could be potentially resolved by increased inclusion of other mental health professionals in service delivery for PSD. These findings will be used to inform the implementation strategy of DIALOG+ across the participating countries. The study also offers insights into multi-country qualitative research.
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