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Scholarly Works (40 results)

  • Article
  • Peer Reviewed
UCLA Previously Published Works (2023)
It is estimated that 13% of the world's children and adolescents have a mental health disorder.1 Fortunately, psychotherapy interventions are effective at improving mental health symptoms and associated functional difficulties.2 However, while the research literature on the efficacy of youth psychotherapy is robust, it may not be generalizable to all populations and across all contexts, particularly given the limited diversity of the research samples with which they have been tested.
    Cover page: Editorial: Youth Psychotherapy Interventions in Low- and Middle-Income Countries and Throughout the World: Beyond Efficacy, Toward AccessibilityCreative Commons 'BY-NC-ND' version 4.0 license
    • Article
    • Peer Reviewed
    UCLA Previously Published Works (2021)

    Background

    Research consistently reports elevated rates of exposure to traumatic events and post-traumatic stress disorder (PTSD) in people with severe mental illness (SMI). PTSD may be adequately managed with psychotherapy; however, there is a gap when it comes to management in culturally diverse settings like Botswana. This paper describes a study protocol whose aim is to culturally adapt the BREATHE intervention, a brief psychological intervention for people living with comorbid PTSD and SMI that was developed and tested in the USA; assess the feasibility and acceptability of the adapted BREATHE intervention and explore its efficacy.

    Methods

    The study will be conducted in three phases using a mixed methods approach. The first phase will identify and describe the most common traumatic experiences and responses to traumatic experiences, amongst patients with SMI, and patients' and mental health care providers' perceptions about suitable PTSD interventions for Botswana. The second phase will entail cultural adaption of the intervention using findings from phase 1, and the third phase will be a pilot trial to assess the feasibility and acceptability of the culturally adapted intervention and explore its efficacy. Quantitative and qualitative data will be analysed using basic descriptive statistics and thematic analysis, respectively.

    Discussion

    Literature highlights cultural variations in the expression and management of mental illness suggesting the need for culturally adapted interventions. The findings of this feasibility study will be used to inform the design of a larger trial to assess the efficacy of an adapted brief intervention for PTSD in patients with SMI in Botswana.

    Trial registration

    Clinicaltrials.gov registration: NCT04426448 . Date of registration: June 7, 2020.
      Cover page: A culturally adapted brief intervention for post-traumatic stress disorder in people with severe mental illness in Botswana: protocol for a randomised feasibility trial
      • Thesis
      • Peer Reviewed
      UCLA Electronic Theses and Dissertations (2024)

      Marginalized adolescents are disproportionately vulnerable to experiencing psychological distress due to trauma exposure but are less likely to access, engage in, and benefit from existing trauma focused evidence based interventions (EBIs). It is hypothesized that one reason for the disparities in EBI access, engagement, and effectiveness is that current trauma focused EBIs do not effectively account for the contextual conditions that contributed to the onset and maintenance of psychological problems following trauma exposure. Therefore, the goal of this dissertation was to utilize an approach informed by socio-ecological model of health to complete three studies to examine the effect of contextual factors on psychological treatment (1) access, (2) engagement, and (3) effectiveness among marginalized adolescents with trauma exposure. Study one utilized data from a large epidemiological dataset to examine the explanatory power of neighborhood level moderators of the relationship between psychological need and likelihood of adolescents accessing psychological services. I found that neighborhood level inequality negatively impacted adolescents’ ability to access care, even when accounting for psychological need and marginalized identity. Study two utilized a mixed methods approach to determine whether contextual barriers to psychological treatment impacted engagement in a small, randomized control trial for a trauma focused EBI. I found modest preliminary evidence that adolescents anticipated that contextual barriers would impact their ability to engage in care. Study three was a qualitative examination of whether content related to contextual stressors in individual therapy sessions impacted adolescent and provider perceptions of EBI effectiveness. I found that contextual stressors were related to psychological distress, difficulty with engaging in treatment, and decreased intervention acceptability. Results from the dissertation have the capacity to inform novel public health and clinical interventions to eliminate disparities and to improve existing EBIs.

        Cover page: Can Contextual Factors Help Explain Access to, Engagement in, and Effectiveness of Psychological Interventions for Marginalized Adolescents with Trauma Exposure?
        • Article
        • Peer Reviewed
        UCLA Previously Published Works (2019)

        Purpose

        To investigate exposure to traumatic and stressful events and their association with depression, suicidal ideation, and alcohol abuse in people with severe mental disorder (SMD) in Ethiopia.

        Methods

        As part of the Programme for Improving Mental health carE, 300 people with SMD (84% primary psychosis, 11% bipolar disorder, and 16% depression with psychotic features) in a rural district were identified by psychiatric nurses. A cross-sectional assessment included clinical characteristics, experience of being restrained, exposure to stressful events as measured by an adapted version of the List of Threatening Experiences scale, traumatic events as measured by endorsement of 13 locally relevant potentially traumatic events that occurred since the onset of the participant's mental illness, depression symptoms measured by the Patient Health Questionnaire, the Suicidal Behavior Module of the Composite International Diagnostic Interview, and hazardous drinking which was calculated as a sum score of eight or higher on the Alcohol Use Disorders Identification Test.

        Results

        Almost half of participants reported being restrained since becoming ill, which was associated with more suicidal ideation and less hazardous drinking. More than one-third experienced traumatic events since becoming ill, including being assaulted, beaten, or raped. Exposure to traumatic events was associated with hazardous drinking.

        Conclusions

        In this rural Ethiopian setting, people with SMD experienced high levels of traumatic and stressful events which were associated with co-morbid conditions. Greater attention needs to be given to trauma prevention and integration of treatment for trauma sequelae in efforts to expand integrated mental health care.
          Cover page: Trauma exposure, depression, suicidal ideation, and alcohol use in people with severe mental disorder in Ethiopia
          • Article
          • Peer Reviewed
          UCLA Previously Published Works (2017)

          Purpose

          South Sudan is embroiled in a conflict that erupted in December 2013. This study examines what people in South Sudan think is necessary to achieve reconciliation and how trauma exposure and PTSD are associated with those beliefs.

          Methods

          1525 participants (51.0% female) were selected using random and purposive sampling in six states and Abyei. Participants reported on traumatic events, PTSD symptoms, and attitudes towards reconciliation mechanisms.

          Results

          Results indicated that 40.7% met symptom criteria for probable PTSD. Most participants thought reconciliation was not possible without prosecuting perpetrators or compensating victims and did not support amnesty. Participants with probable PTSD were more likely to endorse confessions (OR 2.42 [1.75, 3.35]), apologies (OR 2.04 [1.46, 2.83]), and amnesty (OR 1.58 [1.21, 2.08]), and to report that compensation (OR 2.32 [1.80, 3.00]) and prosecution (OR 1.47 [1.15, 1.89]) were not necessary for reconciliation. The more traumatic events people experienced, the more they endorsed criminal punishment for perpetrators (OR 1.07 [1.04, 1.10]) and the less they endorsed confessions (OR 0.97 [0.95, 0.99]).

          Conclusions

          People with PTSD may prioritize ending violence via opportunities for reconciliation, while those with more trauma exposure may support more punitive mechanisms. Policy makers should take mental health treatment and trauma into account when designing conflict mitigation, peace building, and justice mechanisms.
            Cover page: Posttraumatic stress disorder, trauma, and reconciliation in South Sudan
            • Article
            • Peer Reviewed
            UCLA Previously Published Works (2022)
            Increasingly, lesbian, gay, and bisexual (LGB) individuals are fleeing the 67 countries that criminalize consensual same-sex intimate relationships, seeking asylum in countries such as the United States. Minority stress theory posits that compared with non-LGB refugees and asylum seekers (RAS), LGB RAS are likely to face persecution, rejection, and discrimination and have a higher risk of experiencing posttraumatic stress disorder (PTSD) symptoms. This study assessed differences in sociodemographic characteristics, persecution experiences, and mental health outcomes among 959 RAS persecuted for same-sex behavior (pLGB RAS) who presented for care and social services at the Boston Center for Refugee Health and Human Rights. Data were derived from intake interviews with RAS clients that elicited torture experiences and assessed PTSD symptoms using the Short Screening Scale for PTSD. Over 11% of the total sample were pLGB RAS. Compared with non-pLGB RAS, pLGB RAS reported higher PTSD symptom levels, β = .08, p = .031; more difficulty loving others, d = 0.13, p < .001; and feeling more isolated, d = 0.10, p = .005. pLGB RAS reported more persecution, d = 0.31, p = .002; physical assaults, d = 0.22, p = .029; and psychological assaults, d = 0.20, p = .047; and were more likely to be asylum seekers, d = 0.11, p = .001, and have experienced persecution in Uganda, d = 0.39, p < .001, and other countries that criminalize same-sex acts, d = 0.26, p < .001. More research is needed to understand clinical outcomes and implications of treatment for this population.
              Cover page: Demographic characteristics, torture experiences, and posttraumatic stress disorder symptoms among asylum seekers and refugees persecuted for same-sex behaviors.
              • Article
              • Peer Reviewed
              UCLA Previously Published Works (2024)
              To support implementation of integrated behavioral health care (IBHC) models in local settings, providers may benefit from clinical decision-making support. The present analysis examines perspectives on patient characteristics appropriate or inappropriate for, and currently managed within, IBHC at a large medical center to inform recommendations for provider decision-making. Twenty-four participants (n = 13 primary care providers; n = 6 behavioral health providers; n = 5 administrators) in an IBHC setting were interviewed. Thematic analysis was conducted with acceptable interrater reliability (κ = 0.75). Responses indicated behavioral health symptom and patient characteristics that impact perceptions of appropriateness for management in IBHC, with high variability between providers. Many patients with characteristics identified as inappropriate for IBHC were nonetheless currently managed in IBHC. Interactions between patient ability to engage in care and provider ability to manage patient needs guided decisions to refer a patient to IBHC or specialty care. A heuristic representing this dimensional approach to clinical decision-making is presented to suggest provider decision-making guidance informed by both patient and provider ability.
                Cover page: A Qualitative Investigation of Characteristics Impacting Clinical Decision-Making in Integrated Behavioral Health CareCreative Commons 'BY-NC-ND' version 4.0 license
                • Article
                • Peer Reviewed
                UCLA Previously Published Works (2024)

                Objective

                Exposure to chronic structural stressors (e.g., poverty, community violence, and discrimination) exacerbates posttraumatic stress disorder (PTSD) symptoms and reduces how adolescents benefit from trauma-focused interventions. However, current evidence-based PTSD interventions seldom include concrete guidance regarding how to target chronic structural stressors in care.

                Method

                This study utilized qualitative thematic analysis of audio-recorded PTSD therapy sessions with 13 racially diverse, low socioeconomic status adolescents to elucidate (a) how often adolescents disclose chronic structural stressors in therapy, (b) the types of chronic structure stressors that are disclosed, and (c) the context in which chronic structural stressors are disclosed and the content of these disclosures.

                Results

                77% of adolescents disclosed at least one chronic structural stressor and that the presence of stressors exacerbated psychological distress, reduced treatment engagement, and decreased perceptions of intervention effectiveness.

                Conclusions

                Our findings suggest that there is a missed opportunity to improve the effectiveness of treatment for PTSD by incorporating intervention elements that directly target structural stressors. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
                  Cover page: “Being Who I Am Means Everything Bad Can Happen”: Chronic Structural Stressors in Trauma Focused Therapy Sessions With Marginalized AdolescentsCreative Commons 'BY-NC-ND' version 4.0 license
                  • Article
                  • Peer Reviewed
                  UCLA Previously Published Works (2021)
                    Cover page: Predicting the Contribution of Age at First Substance Use and Post-Traumatic Stress Disorder to Later Addiction Severity in a Clinical Sample from Sub-Saharan Africa: Implications for Prevention and Treatment
                    • Article
                    • Peer Reviewed
                    UCLA Previously Published Works (2021)
                      Cover page: Predicting the Contribution of Age at First Substance Use and Post-Traumatic Stress Disorder to Later Addiction Severity in a Clinical Sample from Sub-Saharan Africa: Implications for Prevention and Treatment
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