Medicine and Health Sciences Commons^™

Understanding Coordinated Specialty Care Best Practice Through Fidelity Practices: A Qualitative Exploration, Halley Read

Doctor of Philosophy in Translational Health Sciences Dissertations

Background: Coordinated Specialty Care (CSC) is a multidisciplinary care model for providing care to youth and young adults having their first episode of psychosis. While outcomes of CSC effectiveness are overwhelmingly positive, and widespread implementation has occurred in all US states and territories, what is CSC best practice regarding components and fidelity to the model is not clear. CSC implementation is well documented from a fidelity to the model standpoint, but the highly variable fidelity practices and versions of the model are not well understood. Nor are the experiences of those who deliver or receive care. Adding to the complexity …

Lifestyle Tools For Men’S Health And Disease Prevention: Well-Being Through Nutrition, Physical Activity, Stress Management, And Connection, Leigh A. Frame

Clinical Research and Leadership Faculty Publications

Mental health is an often-overlooked aspect of overall health and wellness (well-being). Mental illness is increasingly common with 1 in 5 American adults experiencing it annually, and 1 in 20 suffering from a serious mental illness each year [1]. Treatment rates for mental illness are lower in men (37.4%) compared to women (51.2%) [1]. Globally, treatment rates are similar with an estimated cost to the global economy of $1 trillion annually, yet less than 2% of government health expenditure is for mental health worldwide [2]. Despite this, only nine studies have been published specifically targeting men’s mental health through lifestyle …

Treatment Preferences For Pharmacological Versus Psychological Interventions Among Primary Care Providers In Nepal: Mixed Methods Analysis Of A Pilot Cluster Randomized Controlled Trial., Anvita Bhardwaj, Dristy Gurung, Sauharda Rai, Bonnie N Kaiser, Cori L Cafaro, Kathleen J Sikkema, Crick Lund, Nagendra P Luitel, Brandon A. Kohrt

Psychiatry and Behavioral Sciences Faculty Publications

There is increasing evidence supporting the effectiveness of psychological interventions in low- and middle-income countries. However, primary care providers (PCPs) may prefer treating patients with medication. A secondary exploratory analysis of a pilot cluster randomized controlled trial was conducted to evaluate psychological vs. pharmacological treatment preferences among PCPs. Thirty-four health facilities, including 205 PCPs, participated in the study, with PCPs in 17 facilities assigned to a standard version of the mental health Gap Action Programme (mhGAP) training delivered by mental health specialists. PCPs in the other 17 facilities received mhGAP instruction delivered by specialists and people with lived experience of …

Exploring The Role Of Immune Pathways In The Risk And Development Of Depression In Adolescence: Research Protocol Of The Idea-Flame Study., Valeria Mondelli, Annamaria Cattaneo, Naghmeh Nikkheslat, Laila Souza, Annabel Walsh, Zuzanna Zajkowska, Valentina Zonca, Moira Marizzoni, Helen L Fisher, Brandon A. Kohrt, Christian Kieling, Paola Di Meglio

Psychiatry and Behavioral Sciences Faculty Publications

No abstract provided.

Contextualization Of Psychological Treatments For Government Health Systems In Low-Resource Settings: Group Interpersonal Psychotherapy For Caregivers Of Children With Nodding Syndrome In Uganda., Byamah B Mutamba, Brandon A Kohrt, James Okello, Janet Nakigudde, Bernard Opar, Seggane Musisi, William Bazeyo, Joop De Jong

Psychiatry and Behavioral Sciences Faculty Publications

BACKGROUND: Evidence for the effectiveness of psychological treatments in low- and middle-income countries is increasing. However, there is a lack of systematic approaches to guide implementation in government health systems. The objective of this study was to address this gap by employing the Replicating Effective Programs (REP) framework to guide contextualization of a psychological treatment in the Uganda public health system for caregivers of children affected by nodding syndrome, a neuropsychiatric disorder endemic to Sub-Saharan Africa associated with high morbidity and disability.

METHODS: To contextualize a psychological treatment, we followed the four components of the REP framework: pre-conditions, pre-implementation, implementation, …

The Role Of Communities In Mental Health Care In Low- And Middle-Income Countries: A Meta-Review Of Components And Competencies., Brandon A Kohrt, Laura Asher, Anvita Bhardwaj, Mina Fazel, Mark J D Jordans, Byamah B Mutamba, Abhijit Nadkarni, Gloria A Pedersen, Daisy R Singla, Vikram Patel

Psychiatry and Behavioral Sciences Faculty Publications

Abstract

Community-based mental health services are emphasized in the World Health Organization’s Mental Health Action Plan, the World Bank’s Disease Control Priorities, and the Action Plan of the World Psychiatric Association. There is increasing evidence for effectiveness of mental health interventions delivered by non-specialists in community platforms in low- and middle-income countries (LMIC). However, the role of community components has yet to be summarized. Our objective was to map community interventions in LMIC, identify competencies for community-based providers, and highlight research gaps. Using a review-of-reviews strategy, we identified 23 reviews for the narrative synthesis. Motivations to employ community …

Evaluation Of Group Movement Programs (Plié And Paired Plié) For People With Memory Loss, Alzheimer’S Disease Or Dementia, Martin Blanco, Deborah Barnes

GW Research Days 2016 - 2020

Today, one in ten people ages 65 and older have Alzheimer’s dementia. This serious condition often causes great suffering among affected individuals and their families, and there are no medications that stop or slow the disease. It is therefore important to evaluate alternative interventions that may benefit both patients and their care partners. Preventing Loss of Independence through Exercise (PLIÉ) and Paired PLIÉ are group movement programs that combine neuroscience and integrative medicine for individuals with dementia. We analyzed data from [N=39] anonymous evaluation surveys performed as part of two ongoing randomized control trials. Survey data included general questions on …

(Video) Dirty Cotton: Occupational Pesticide Exposure And Elevated Suicide Risk Among Male Cotton Farmers In India, Bethany Natalia Kondavaty

GW Research Days 2016 - 2020

Purpose: The aim of this critical analysis was to examine the association (or lack thereof) of occupational pesticide exposure and elevated suicide risk among male cotton farmers in India.

Methods: A literature review was performed using Scopus, PubMed, and Google Scholar databases. The review included documents published before and after year 2002. Children were excluded from the search as well as women, with exception to research on gender differences in suicide.

Results: Studies outside India show a positive correlation between work-related pesticide exposure and suicide. Animal studies have shown that pesticides, as organophosphates, are toxic, …

A Multivariate Analysis Of Nationwide Changes In Opioid Prescriptions From 2012-2016, Drishti Pillai, Leighton Ku

GW Research Days 2016 - 2020

Background

Between 2012 and 2016, the opioid overdose mortality rate in the U.S. almost doubled from 7.4 to 13.3 per 100,000 population, leading to calls for a national opioid crisis. This crisis has generated interest in Medicaid’s dual role as a health insurance system that provides reimbursement for both prescription opioid analgesics like Oxycodone used to treat chronic pain, which could inadvertently fuel addiction, and prescription opioids used as treatment medication to help people survive and recover from drug abuse, such as Naloxone.

Methods

In this study, we conduct a multi-variate analysis of Medicaid prescription drug utilization data for the …

Active And Passive Stress Management Mechanisms In Physically Active Young Adults, Krista Lepping, Melissa Napolitano

GW Research Days 2016 - 2020

Background: Physical activity and stress are common factors that affect the health and wellness of young adults worldwide. Higher levels of stress in students can lead to increased blood pressure and decreased immune system defenses. Previous studies have found that students who report more physical activity also report lower levels of stress. Perceived stress is subjective, however, and therefore the amount of physical activity that affects stress levels could vary. Additionally, extensive research has yet to be conducted on the different coping mechanisms that physically active students use to relieve stress. These mechanisms may include physical activity as a …

Cross-Sectional Comparison Of Behavioral Risk Factors For Hiv/Hcv In People Who Inject Drugs (Pwid) In Egypt, Sarah Martinez, Amira A. Roess, Monica S. Ruiz, Atef Bakhoum, Ehab El Kharrat

GW Research Days 2016 - 2020

Background

Egypt has the greatest HCV prevalence worldwide at 15% and a concentrated HIV epidemic in male people who inject drugs (PWID) at 6.8%, who are at a high risk for HCV infection as well. Injection drug use is criminalized in Egypt, and there is limited availability of harm reduction programs. Drug-use and sexual risk behaviors between PWID and the general population have not been studied there.

Methods

To address this gap, a cross-sectional HIV/HCV epidemiological study of 632 consenting injection drug users in Cairo and Alexandria was conducted. Bivariate logistic regression analysis was done to evaluate the associations between …

Improving Adolescents’ Driving Behaviors Through A Personal Narrative-Based Psychosocial Intervention In Serbia, Hagere Yilma, Rajiv Rimal, Nargis Ryskulova

GW Research Days 2016 - 2020

Objectives: Road traffic crashes continue to be the leading cause of death among adolescents. While males are more vulnerable to crashes than females, driver education interventions are less likely to succeed among males than females. Some studies suggest that stronger optimistic bias and overconfidence bias in males may be the reason for this.

Methods: In a quasi-experiment conducted in Serbia, forty schools were stratified by size and randomly assigned to watch a road traffic safety presentation utilizing personal narratives or to a control arm. Surveys were administered before the intervention (N=1,449) and again six months later (N=1,072). Data was …

(Video) Reframing Discourse: Using Brfss Data To Deconstruct Influences Of Parenthood On Depression And Lgbtq+ Mental Health, Kate Luxion

GW Research Days 2016 - 2020

Introduction: Rates of depression contribute to the mental health epidemic, with parents in the United States considered a population at greater risk. Framing of mental health and depression has remained centered on cisgender, heterosexual identities (cis-heteronormative) despite diversity in family constellations. This presentation looks to reframe and expand the discussion on LGBTQ+ parents, depression, and mental health. The hypotheses tested look first at the differences in depression diagnosis. Second, the number of poor mental health days per month are examined for differences between the subsamples.

Methods: The study reviewed data from the 2014-2016 BRFSS surveys (n=371,268) focused on parents as …

(Video) Differences In Psychosocial And Behavioral Risk Profiles Of Cigarette Smokers And E-Cigarette Users Among Minnesota Adolescents: 2016, Tara E. Jenson

GW Research Days 2016 - 2020

Background/Objectives: Rates of cigarette smoking among adolescents have been trending downward, however rates of adolescent e-cigarette use rates are now twice those of adolescent cigarette smoking nationally. The objective of this study was to examine the association of demographic, socioeconomic, psychosocial and health behavioral factors as surveyed by the Minnesota Student Survey with cigarette smoking and e-cigarette use among Minnesota adolescents.

Methods: This study analyzed the 2016 Minnesota Student Survey (MSS), an anonymous, school-based, cross-sectional survey of students in grades five, eight, nine and eleven. The 2016 MSS contains a total of 168,733 records, 118,198 of which were …

Resilience Of Children With Chronic Health Conditions: The Impact Of Neuropsychiatric Comorbidities, Sarah Bernstein, Sandra Cushner-Weinstein

GW Research Days 2016 - 2020

BACKGROUND: Resilience, the ability to overcome adversity and effectively recover from stressful experiences, is a complex theory with many contributing factors. Previous studies have shown that condition-specific summer camps for children with chronic health conditions increase resilience and adaptive coping skills, change attitudes toward the illness, and improve quality of life. The aim of this study was to determine how neuropsychiatric comorbid diagnoses such as attention deficit hyperactivity disorder (ADHD), learning disability, and anxiety disorder influence the resilience of children with chronic health conditions.

METHODS: Children with chronic health conditions including autism, epilepsy, cerebral palsy, Tourette’s syndrome, sickle cell anemia, …

Effects Of A Phase Ii Cardiac Rehabilitation Program On Patient Depression, Michael R. Legal, Dnp, Msn-Ed, Rn, Ccrn-K

Doctor of Nursing Practice Projects

Background: Screening for depression upon intake and completion of a Phase II cardiac rehabilitation (CR) program may influence the type of interventions implemented by CR staff and reduce depression.

Objectives: We examined patients before and after a Phase II CR program who self-reported as depressed using the CES-D score and also assessed scores by procedure, gender and age. We further identified the types of interventions used for those who were depressed.

Methods: We conducted a pre-post intervention study. Using a convenience sample, data were collected on CES-D scores before and after the program and by type of procedure, gender, and …

The Effects Of A Structured Teaching Session On Perceived Self-Efficacy Among Mental Health Nursing Supervisors, Pamela Fess, Dnp, Msn

Doctor of Nursing Practice Projects

Background: Specific factors that contribute to nursing supervisors perceived self-efficacy remains unclear. Although several studies have examined the relationship between self-efficacy and mental health nursing supervision most have focused on the impact of client care. To date, there is a dearth of studies to assess the impact of a leadership focused teaching session on the perceived self-efficacy of mental health nursing supervisors. Equipping nurses who are responsible for the supervision of others with the skills needed to fulfill their role responsibilities has the potential to improve their job performance, the work satisfaction, and well-being of staff nurses they supervise as …

Pilot Study Of Anxiety, Depression, And Quality Of Life In Patients With The Diagnosis Of Metastatic Uveal Melanoma, Regine Nshimiyimana, Dnp, Bpharm, Fnp-Bc, Agacnp-Bc, Ocn, Aocnp

Doctor of Nursing Practice Projects

Background: Awareness of a patient’s anxiety, depression, and quality of life (QOL) in those with metastatic uveal melanoma (MUM) can influence care that meets patients’ bio-psychosocial-spiritual needs.

Objectives: To measure the level of anxiety, depression, and QOL in patients with MUM and explore differences by gender, age range, time to metastatic disease, and duration of illness since metastasis.

Methods: We used a descriptive-comparative survey design. Over three months, a convenience sample of 70 patients with MUM aged ≥ 18 years, treated at a Mid-Atlantic hospital were invited to complete a combined survey of the Hospital Anxiety and Depression Scale and …

Assessing Employee Needs To Enhance A Workplace Wellness Program, Paige Herschend, Dnp, Msn, Bsn, Ba

Doctor of Nursing Practice Projects

Background: Workplace wellness programs are increasingly prevalent, but their designs vary dramatically. While successful programs differ, those that are coordinated, comprehensive, and planned intentionally to address specific workplace needs have been found most beneficial.

Objective: This project assessed the perceived health status and wellness needs of employees at one company to determine whether its workplace wellness program could be enhanced.

Methods: This project focused on one site of a large, multi-state company. A retrospective review of data from an employees’ health and wellness survey was performed. Univariate and bivariate statistics were used to analyze the relationships among …

Shelburne And Clark’S Harbour Quit Smoking: A Community-Based Smoking Cessation Initiative Process Evaluation, Georgeann Lois Macdonald Mn: Dnp, Anp, Rn, Accn, Np

Doctor of Nursing Practice Projects

Background: The prevalence of Canadian smokers is 14.6%. Clark’s Harbour and Shelburne’s rate of smoking increased from 15.6% in 2012 to 19.4% in 2015 (Propel Centre for Population Health Impact, 2015). It was imperative that innovative ways be found to reduce the smoking prevalence.

Objectives: 1) Identify a difference in the participants’ Stages of Change before and after completing the smoking cessation program. 2) Determine whether the participants quit smoking 3) Assess whether there was satisfaction with the program.

Methods: In this one group pre and post-test design, the participants completed a series of pre and post program questionnaires. The …

A Retrospective Study: Diagnosis And Treatment Of Depression In Breast Cancer Patients, Cheryl Ann Thaxton, Dnp

Doctor of Nursing Practice Projects

Background: One issue related to breast cancer diagnosis and treatment is the risk of depression.

Objectives: The purpose of this study is to examine ethnic differences and commonalties in the method of diagnosis and treatment of depression for female breast cancer patients.

Specific Aims: The study aims to examine the method of diagnosis and treatment of depression in Caucasian, Latino, and African American breast cancer patients.

Questions/Hypothesis: 1. Does the method of diagnosis and treatment of depression differ based on ethnicity? Hypothesis: Method of diagnosis and treatment will differ for Minorities as compared to Caucasians; 2. What percentage of patients …

Improving Primary Care Utilization For Transgender Patients At An Fqhc, Timothie J. Rochon, Dnp, Rn, Cnm

Doctor of Nursing Practice Projects

Background: Transgender and Gender-Nonconforming (TGNC) populations comprise approximately 6% of the U.S. population. Socially and within the medical treatment system TGNC individuals face widespread stigmatization and discrimination which negatively impacts their mental, physical, and emotional health and contributes to health disparities. Real and perceived barriers to safe and effective healthcare are worsened by the scarcity of primary care providers knowledgeable in caring for these populations.

Objectives: The aim of this quality improvement project was to examine the impact of inclusive gender-affirming integration on the utilization of preventive and primary care services.

Methods: A one group pre- and post-intervention design was …

Prevalence And Correlates Of Depression And Alcohol Use Disorder Among Adults Attending Primary Health Care Services In Nepal: A Cross Sectional Study., Nagendra P Luitel, Emily C Baron, Brandon A Kohrt, Ivan H Komproe, Mark J D Jordans

Psychiatry and Behavioral Sciences Faculty Publications

BACKGROUND: Although depression and alcohol use disorder (AUD) are expected to be common among patients presenting to primary health care setting, there is limited research on prevalence of depression and AUD among people attending primary health care services in low-income countries. The aim of this study was to assess the prevalence of depression and AUD among adults attending primary care facilities in Nepal and explore factors associated with depression and AUD.

METHODS: We conducted a population-based cross-sectional health facility survey with 1474 adults attending 10 primary healthcare facilities in Chitwan district, Nepal. The prevalence of depression and AUD was assessed …

Perceived Access And Barriers To Care Among Illicit Drug Users And Hazardous Drinkers: Findings From The Seek, Test, Treat, And Retain Data Harmonization Initiative (Sttr)., Mika Matsuzaki, Quan M Vu, Marya Gwadz, Joseph A C Delaney, Irene Kuo, Maria Esther Perez Trejo, William E Cunningham, Chinazo O Cunningham, Katerina Christopoulos

Epidemiology Faculty Publications

BACKGROUND: Illicit drug use (DU) and hazardous drinking (HD) among marginalized populations may be associated with greater barriers to care.

METHODS: We used baseline data on the participants of the Seek, Test, Treat, and Retain data harmonization initiative. DU includes use of any illicit drugs within the past 6 months. HD was defined as scores ≥8 for men and ≥ 7 for women on Alcohol Use Disorders Identification Test within the past 12 months. Social support scores were assigned by summing scores from individual questions related to social support. Two outcomes for multivariable regression models and mediation analysis were perceived …

Canadian Network For Mood And Anxiety Treatments (Canmat) And International Society For Bipolar Disorders (Isbd) 2018 Guidelines For The Management Of Patients With Bipolar Disorder., Lakshmi N Yatham, Sidney H Kennedy, Sagar V Parikh, Ayal Schaffer, David J Bond, Robert M Post, +Several Additional Authors

Psychiatry and Behavioral Sciences Faculty Publications

The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, …

Maternal Mental Health Priorities, Help-Seeking Behaviors, And Resources In Post-Conflict Settings: A Qualitative Study In Eastern Uganda., Wietse A Tol, Breeona Ebrecht, Rebecca Aiyo, Sarah M Murray, Amanda J Nguyen, Brandon A Kohrt, Sheila Ndyanabangi, Stephen Alderman, Seggane Musisi, Juliet Nakku

Psychiatry and Behavioral Sciences Faculty Publications

BACKGROUND: Limited knowledge exists to inform the selection and introduction of locally relevant, feasible, and effective mental health interventions in diverse socio-cultural contexts and health systems. We examined stakeholders' perspectives on mental health-related priorities, help-seeking behaviors, and existing resources to guide the development of a maternal mental health component for integration into non-specialized care in Soroti, eastern Uganda.

METHODS: We employed rapid ethnographic methods (free listing and ranking; semi-structured interviews; key informant interviews and pile sorting) with community health workers (n = 24), primary health workers (n = 26), perinatal women (n = 24), traditional and religious healers (n = …

Reducing Stigma Among Healthcare Providers To Improve Mental Health Services (Reshape): Protocol For A Pilot Cluster Randomized Controlled Trial Of A Stigma Reduction Intervention For Training Primary Healthcare Workers In Nepal., Brandon A Kohrt, Mark J D Jordans, Elizabeth L Turner, Kathleen J Sikkema, Nagendra P Luitel, Sauharda Rai, Daisy R Singla, Jagannath Lamichhane, Crick Lund, Vikram Patel

Psychiatry and Behavioral Sciences Faculty Publications

Background

Non-specialist healthcare providers, including primary and community healthcare workers, in low- and middle-income countries can effectively treat mental illness. However, scaling-up mental health services within existing health systems has been limited by barriers such as stigma against people with mental illness. Therefore, interventions are needed to address attitudes and behaviors among non-specialists. Aimed at addressing this gap, REducing Stigma among HealthcAre Providers to ImprovE mental health services (RESHAPE) is an intervention in which social contact with mental health service users is added to training for non-specialist healthcare workers integrating mental health services …

Interpersonal Violence And Suicidality Among Former Child Soldiers And War-Exposed Civilian Children In Nepal., Anvita Bhardwaj, Christine Bourey, Sauharda Rai, Ramesh Prasad Adhikari, Carol M Worthman, Brandon A Kohrt

Psychiatry and Behavioral Sciences Faculty Publications

Background: Suicide risk reduction is crucial for 15-29-year-old youth, who account for 46% of suicide deaths in low- and middle-income countries. Suicide predictors in high-resource settings, specifically depression, do not adequately predict suicidality in these settings. We explored if interpersonal violence (IPV) was associated with suicidality, independent of depression, in Nepal.

Methods: A longitudinal cohort of child soldiers and matched civilian children, enrolled in 2007 after the People's War in Nepal, were re-interviewed in 2012. The Depression Self-Rating Scale and Composite International Diagnostic Interview assessed depression and suicidality, respectively. Non-verbal response cards were used to capture experiences of sexual and …

Feasibility Study Of A Family- And School-Based Intervention For Child Behavior Problems In Nepal., Ramesh P Adhikari, Nawaraj Upadhaya, Emily N Satinsky, Matthew D Burkey, Brandon A Kohrt, Mark J D Jordans

Psychiatry and Behavioral Sciences Faculty Publications

Background: This study evaluates the feasibility, acceptability, and outcomes of a combined school- and family-based intervention, delivered by psychosocial counselors, for children with behavior problems in rural Nepal.

Methods: Forty-one children participated at baseline. Two students moved to another district, meaning 39 children, ages 6-15, participated at both baseline and follow-up. Pre-post evaluation was used to assess behavioral changes over a 4-month follow-up period (n = 39). The primary outcome measure was the Disruptive Behavior International Scale-Nepal version (DBIS-N). The secondary outcome scales included the Child Functional Impairment Scale and the Eyberg Child Behavior Inventory (ECBI). Twelve key informant interviews …

Protocol For A Feasibility Study Of Group-Based Focused Psychosocial Support To Improve The Psychosocial Well-Being And Functioning Of Adults Affected By Humanitarian Crises In Nepal: Group Problem Management Plus (Pm+), M Sangrawla, E Van Hof, N Luitel, E Turner, K Marahatta, Brandon A. Kohrt

Psychiatry and Behavioral Sciences Faculty Publications

Background

The prevalence of common mental disorders increases in humanitarian emergencies while access to services to address them decreases. Problem Management Plus (PM+) is a brief five-session trans-diagnostic psychological WHO intervention employing empirically supported strategies that can be delivered by non-specialist lay-providers under specialist supervision to adults impaired by distress. Two recent randomized controlled trials in Pakistan and Kenya demonstrated the efficacy of individuallydelivered PM+. To make PM+ more scalable and acceptable in different contexts, it is important to develop a group version as well, with 6–8 participants in session. A study is needed to demonstrate the feasibility and …