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The Family Assessment Measure
Abstract
The Family Assessment Measure (FAM) is a self-report instrument that provides quantitative indices of family strengths and weaknesses. FAM is based on a process model of family functioning that integrates different approaches to family therapy and research. The basic concepts assessed by FAM include: task accomplishment, role performance, communication, affective expression, involvement, control, values and norms. FAM consists of three components: (1) a General Scale which focuses on the family as a system, (2) a Dyadic Relationships Scale which examines relationships between specific pairs, and (3) a Self-Rating Scale which taps the individual's perception of his/her functioning in the family. Each scale provides a different perspective on family functioning. FAM takes about 20-30 minutes to administer, and may be used as a clinical diagnostic tool, as a measure of therapy outcome, or as an instrument for basic research on family processes. This article reviews the theoretical model of family functioning, presents data on the reliability and discriminating power of FAM, and describes a case study as an illustration of information provided by FAM.
... In fact, families characterized by poor cohesion and considerable conflicts or isolation are associated with youth with SRB [54,55]. Bernstein et al. [56] found family difficulties on the Family Assessment Measure (FAM; [57]) in the areas of role performance and values and norms in families of children with school refusal. "Role performance" assesses role definition and family members' adaptation to new roles throughout the life cycle, whereas "values and norms" measures the degree of concordance among components of the family's value system and the degree of agreement with the values of the culture in which the family lives. ...
... Each item measures one of five components, respectively, (1) adaptation (family's resources available for dealing with problems; e.g., "I am satisfied with the support I receive from my family when something concerns me"); (2) partnership (sharing of problems and decision-making by the family; e.g., "I am satisfied with how my family discusses issues of common interest and shares the problem solution with me"); (3) growth (the support for and acceptance of change in individual family members; e.g., "My family accepts my desires to promote new activities or make changes in my lifestyle"); (4) affection (the response of family members to the expression of feelings; e.g., "I am satisfied with how my family expresses affection and responds to my feelings of love and sadness"); and (5) resolve (satisfaction with the quality of time that family members spend together; e.g., "I am satisfied with the time my family and I share"). Satisfactory internal consistency reliability (α = 0.80) and test-retest reliability (r = 0.83) have been reported by previous research [57]. Similar results were obtained when translating this measure to Spanish for adolescents and an adult population (α = 0.84 internal consistency reliability; r = 0.75 test-retest reliability) [72]. ...
... In addition, although the family APGAR Scale [49] is an easy-to-administer instrument with satisfactory psychometric properties reported from different countries (e.g., Spain [72], China [78], U.S. [79], Colombia [80], and Peru [81]), only five items compose this measure. Thus, future research should assess family functioning with other measures [57,60] and consider the effects of other family practices, such as parenting styles, since findings suggest the important influence of parent-child relationships on adolescents' psychosocial adjustment [82][83][84]. Some instruments that contemplate parenting styles and could be implemented in future studies are the Parental Socialization Scale (ESPA29) [85] or the Warmth/Affection Scale and Parental Control Scale, both integrated in the Parental Acceptance-Rejection/Control Questionnaire [86]. ...
School attendance problems negatively affect students’ development. This study attempted to identify different school refusal behavior profiles and to examine their relationship with three dimensions of social anxiety (fear of negative evaluation, social avoidance and distress in new situations, and social avoidance and distress that is experienced more generally in the company of peers) and the perception of family functioning. Participants included 1842 Spanish adolescents (53% girls) aged 15–18 years (M = 16.43; SD = 1.05). The School Refusal Assessment Scale—Revised (SRAS-R), the Social Anxiety Scale for Adolescents (SAS-A), and the Family APGAR Scale (APGAR: Adaptation, Partnership, Growth, Affection, and Resolve) were administered. Latent class analysis revealed four school refusal behavior profiles: non-school refusal behavior, high school refusal behavior, moderately low school refusal behavior, and moderately high school refusal behavior. Analyses of variance (ANOVA) indicated that adolescents’ with the profile of high school refusal behavior showed higher scores in all the subscales of social anxiety. In contrast, the non-school refusal behavior group revealed higher scores in the perception of good family functioning, whereas the high school refusal behavior profile obtained the lowest scores in this scale. These findings suggest that students who reject school are at a higher risk of developing social anxiety problems and manifesting family conflicts. These students should be prioritized in order to attend to their needs, promoting self-help to overcome social anxiety and family problems with the purpose of preventing school refusal behaviors.
... At the same time, this has an impact on the growth of each member and is essential for the orderly operation of the social system. McMaster's process-oriented family functioning theory (13-17), and Skinner's process-oriented family functioning theory (18)(19)(20) state that the physical and psychological health of the family is influenced by the process of recognition of various tasks in the family, rather than the family structure. The smoother the process of family features, the better the mental health of the family members. ...
... The decision to confine a family member with mental illness is the implementation of family functions according to McMaster (14, 31, 32) and Skinner et al. (19,20). Families are responsible for improving the physical and psychological health of their members. ...
The mental health literacy gap has resulted in the shackling of people with mental illness by family caregivers. Although shackling violates human rights and impacts physical and psychological health, it still occurs in some countries, such as Indonesia. An in-depth study using the family function approach is needed to distinguish the components behind the application of shackling by families to find solutions to prevent shackling. Thus, this study aims to identify family functions in people with mental disorder (PWMD) care and to create a family care model for PWMD in accordance with the family function approach and recommendations for preventing shackling. This qualitative research used a phenomenological approach, involving eight participants who are family caregivers and live with their patients. Triangulation was conducted by applying interviews with four health cadres to confirm previous information. The process of in-depth interviews and observational data collection methods was carried out until reaching data saturation. The data analysis process used Collaizi's pattern to formulate three main themes, namely confinement as the final solution for the family, the specifics of confinement, and the family's purpose for confinement. The conclusion is that shackling occurs due to a lack of understanding of the impact of shackling and the various limitations experienced, so shackling becomes the last resort when dealing with patients. Peer support is very important for families to prevent the confinement of mentally ill family members. Technological advances are an inherent need in everyday life and must support family caregivers with mental disorders.
... Parents of individuals with DS from more than 50 countries completed a survey that included a consent form, a demographic/family information questionnaire and the following measures: the Family Index of Regenerativity and Adaptation General (FIRA-G) (McCubbin et al., 1996), the Family Problem Solving Communication Index (FPSC) (McCubbin et al., 1996), the Family Member Well-Being Index (FMWB) (McCubbin et al., 1996), the Family Management Measure (FaMM) (Knafl et al., 2011), and the Brief Family Assessment Measure-General (Brief FAM-G; Skinner et al., 1983). These measures (1996) did not develop a specific measure to assess family appraisal. ...
Our current understanding of adaptation in families of individuals with Down syndrome (DS) is based primarily on findings from studies focused on participants from a single country. Guided by the Resiliency Model of Family Stress, Adjustment, and Adaptation, the purpose of this cross‐country investigation, which is part of a larger, mixed methods study, was twofold: (1) to compare family adaptation in 12 countries, and (2) to examine the relationships between family variables and family adaptation. The focus of this study is data collected in the 12 countries where at least 30 parents completed the survey. Descriptive statistics were generated, and mean family adaptation was modeled in terms of each predictor independently, controlling for an effect on covariates. A parsimonious composite model for mean family adaptation was adaptively generated. While there were cross‐country differences, standardized family adaptation mean scores fell within the average range for all 12 countries. Key components of the guiding framework (i.e., family demands, family appraisal, family resources, and family problem‐solving communication) were important predictors of family adaptation. More cross‐country studies, as well as longitudinal studies, are needed to fully understand how culture and social determinants of health influence family adaptation in families of individuals with DS.
... Brief Family Assessment Measure-14 items (Skinner, Steinhauer, Santa Barbara, 1983) Caples et al., 2018 Outcome-influence of family factors on family adaptation J. Choi & Van Riper, 2020 Outcome of family intervention Chulalongkorn Family Inventory-36 items (Trangkasombat, 2008) Pruktarat et al., 2021 Outcome-influence of family factors on family adaptation Family Impact Scale-14 items (Locker et al., 2002) Carrada et al., 2019 Outcome-influence of oral conditions in children/adolescents with DS on family quality of life Beach Family Quality of Life-25 items (Hoffman et al., 2006) Ljubicic et al., 2020 Outcome-association between awakening cortisol indicators, stress perception, depression, anxiety, and family quality of life in five groups of families PedsQL-FIM (Varni et al., 2004) Subscales: ...
Down syndrome (DS) is a chromosomal disorder associated with intellectual and physical disabilities and has historically been viewed by health care providers through a negative lens when considering the effect the condition has on the individual, family, and community. The purpose of this scoping review was to provide an overview of recent research concerning adaptation in families of individuals with DS with a focus on family adaptation rather than individual or dyadic adaptation. Three literature indexes were searched from 2017 to 2022, with 41 articles included. Foci of the studies included strength/resilience, stress/coping, and negative/challenge. Thirteen studies reported using a family framework. Multiple methodological approaches and family measures were used in the studies and are outlined. Findings from this review show there has been a shift in focus when researching families of individuals with DS from a negative and challenging experience to one of strength and resilience.
... Apesar de sua reconhecida validade em ambientes clínicos e de pesquisa como auxiliar na obtenção de informações sobre uso de substâncias psicoativas e exposição a situações de risco, é aconselhável sua utilização com uma entrevista clínica associada 11 . ...
... Една потенциална трудност с такъв ограничен възглед е, че децата също могат да имат важни прозрения за семействата си. В едно проучване, направено с FAM-III, децата са по-склонни да идентифицират проблеми, отколкото родителите им (Skinner et al., 1983). ...
В статията е направен теоретичен анализ на модели за семейно
функциониране и 3 скали за оценка, базирани на тези модели - FACES IV, FAD и FAM
III. Скалите са избрани според популярността си в международни научни статии
в областта на семейните отношения. Целта на този текст е да разгледа
модели и скали за оценка на семейното функциониране и полезността им в
контекста на предназначението им. Поставя се акцент върху необходимостта
от познаване на семейното функциониране като подкрепящ елемент в
изследователската и практическа работа на специалистите в областта
на психологията, педагогиката и социалната работа.
... Measures of family support included family cohesion, perceived child-caregiver support, patterns of family care and relationships, and family communication, all adapted from the Family Environment Scale (Moos & Moos, 1994) and the Family Assessment Measure (Skinner et al., 1983). Family cohesion was measured using 7 items that describe the degree of commitment, help, and support that family members give to each other. ...
Adolescent girls and young women are at a higher risk for HIV infection stemming from barriers to accessing comprehensive sexual health education, unequal cultural, social, and economic statuses, limited access to education and health care services, and gender-based violence. This makes adolescent girls susceptible to high-risk sexual behaviors. This study examines the protective role of family, social support factors and gender norms against sexual risk-taking behaviors among secondary school adolescent girls in Uganda. Baseline data from the National Institute of Mental Health-funded Suubi4Her study were analyzed. A total of 1260 girls aged 14–17 years and enrolled in the first or second year of secondary school were recruited across 47 secondary schools. Hierarchical linear regression models were conducted to determine the role of family, social support factors and gender norms on sexual risk-taking behaviors. Results indicate that traditional gender norms, family care and relationships, and social support were all associated with lower levels of sexual risk-taking intentions—a proxy for engaging in sexual risk behaviors. Findings point to the need to develop family level support interventions to equip adolescent girls with adequate sexual health-related knowledge and skills to facilitate safer sexual practices and reduce high-risk sexual-taking behaviors, as they develop and transition into young adulthood.
... Given this evidence, the assessment of family functioning is central to identifying, preventing, and treating mental health problems. The Family Adaptability and Cohesion Evaluation Scale (FACES I, II, III, IV; Olson, 1991Olson, , 2011Olson et al., 1979Olson et al., , 1982, Family Environment Scale (FES; Moos, 1979), Family Assessment Measure (FAM I, III; Skinner et al., 1983Skinner et al., , 2000, and Systemic Therapy Inventory of Change (STIC; Pinsof et al., 2009) are some examples of the most recognised self-report instruments to achieve that goal. However, the literature emphasises common limitations of the existing family functioning measures, mainly related to their factorial structure, lengthy completions, and lack of responsiveness to family functioning change over time (Hamilton & Carr, 2016). ...
Current literature presents a gap in family functioning assessment instruments directed to children. The Child Systemic Clinical Outcome and Routine Evaluation (C‐SCORE) is a self‐report instrument, based on the original SCORE‐15, that measures different aspects of family functioning from the child's perspective. This study aims to explore the psychometric qualities of the Portuguese version of C‐SCORE using a sample of 119 children, aged 8–11 years, recruited from public (state) schools located in North Portugal. Results showed good internal consistency for the total scale and were consistent with the original factorial structure. Correlation analyses using the Perception Scale of Parenting Communication – Children (COMPA‐C) provided support for convergent validity. This study represents the first psychometric evaluation of the C‐SCORE using a sample of Portuguese children, with exploratory results suggesting that this version presents acceptable psychometric qualities, and may be especially useful to assess family functioning from the child's view.
... Family Assessment Device, construida por Epstein et al. (1983); Self-report Family Inventory, construida por Beavers et al. (1985); Family Assessment Measure, creada por Skinner et al. (1983); Family Environment Scale, creada por Moos y Moos (1981); Family Functioning Index, diseñada por Pless y Satterwhite (1973); Family Functioning Questionnaire, diseñada por Linder-Pelz et al. (1984); Family APGAR, creada por Smilkstein (1978) y FACES III, creada por Olson (1986). ...
Introducción: En la adolescencia se presentan una diversidad de factores de riesgo, sin embargo, el contexto familiar puede brindar factores de protección que pueden disminuir dichos factores de riesgo, de ahí la importancia de conocer el contexto familiar de los adolescentes desde su perspectiva. Es de nuestro interés presentar indicadores de validez y confiabilidad desde la teoría de respuesta al ítem. El objetivo fue generar indicadores de validez y confiabilidad para tres escalas a través del Análisis Factorial Exploratorio con máxima verosimilitud y oblicua, análisis Rasch y Análisis Factorial Confirmatorio. Método: Participaron 1536 estudiantes de secundaria de ambos sexos con edades que oscilan los 12 a 15 años. Resultados: Se obtuvieron cargas factoriales de 0.52 a 0.80, alfas de Cronbach de 0.79 a 0.94, CFI de 0.92 a 0.95, RMSEA de 0.04 a 0.06 y SRMR de 0.02 a 0.05. Conclusiones: Los indicadores fueron óptimos en tres modelos para adolescentes. Estas medidas pueden utilizarse sobre todo cuando requerimos el entendimiento de las variables del hogar para explicar lo que sucede en el contexto escolar.
... Parent Sense of Competence (Johnston & Mash, 1989), Family Empowerment Scale (Koren et al., 1992), etc.]. The family adjustment category included outcomes related to family life and adaptation, including family strengths and challenges and the structure and harmony of the home environment [Family Assessment Measure (Skinner et al., 1983) and Confusion, Hubbub, and Order Scale (CHAOS; Matheny et al., 1995), etc.]. The mental health category included measures of global mental health, depression, anxiety, and happiness [e.g. ...
This meta-analysis examines the impact of parent interventions on outcomes for parents of children with ASD. A systematic review of the literature produced 37 studies that met inclusion criteria. Random-effects models revealed small but significant impacts of intervention on parental outcomes, primarily in parenting confidence and mental health. No improvements were observed in caregiving burden, family adjustment, physical health, or stress. Significant heterogeneity was observed; however, no moderation effects were detected for intervention or sample characteristics. These findings suggest parent interventions improve parenting confidence and, to a lesser degree, mental health. More work is needed to develop interventions that address a wider range of outcomes for parents of children with ASD. Limitations and implications for future research are discussed.
... Marital (or partner) satisfaction has been found to be a predictor of family-level outcomes. Early work by Trute (1990) explored child and parent predictors of family adjustment in 88 families of children with DD, reporting that overall family adjustment (as captured by the Family Assessment Measure III; Skinner, Steinhauer, & Santa-Barbara, 1983) was associated with specific aspects of marital adjustment (dyadic cohesion, and consensus). Trute suggested that strengthening the couple subsystem could assist in maintaining a stable family environment. ...
We explored whether reports of three dyadic relationships (marital/partner, parent-child, sibling) were related to perceptions of family functioning in 467 mothers of children with intellectual disability aged 4–15 years. Structural equation models were fitted to examine associations between relationship indicators and family functioning. The final structural model showed that partner relationship satisfaction, partner disagreement, child-parent conflict, and sibling relationship warmth accounted for the most variance in family functioning, with partner relationship satisfaction having the strongest positive association. Dimensions of dyadic relationships appear to be associated with broader constructs of family functioning in this sample of mothers, signifying the potential for systemic intervention.
... Individual items can be found in the PYS public-use dataset through ICPSR. Both scales were initially developed based on pilot research conducted at the Oregon Social Learning Center (Loeber et al., 1998), literature reviews of the impact of parenting on childhood outcomes, items from existing scales adapted for an urban sample with a substantial minority membership and a range of SES (e.g., Family Environment Scale; Moos, 1994), and the Family Assessment Measure (Skinner, Steinhauer, & Santa-Barbara, 1983), followed by detailed psychometric analyses. Parental supervision was assessed with 4 items (e.g., 'Do you know who your son's companions are when he is not at home?' and 'Do your parents know who you are with when you're away from home?') on a three-point scale (1 = almost never, 2 = sometimes, 3 = almost always). ...
This longitudinal study examines whether early experiences with caregivers between the ages of 10 and 12 are associated with later adolescent personality at age 16 using both parent and child reports. Lower positive parenting was prospectively associated with higher neuroticism and lower extraversion and conscientiousness for both parent and self‐reports of personality, as well as lower openness and agreeableness by parent report. Substantiated maltreatment was prospectively associated with greater neuroticism and lower agreeableness and conscientiousness assessed by parent report. Prospective associations were similar across Black and White participants. Positive parenting and, to a lesser extent, a lack of maltreatment were associated with adaptive personality profiles in adolescents, and associations were stronger for parent reports of personality.
... With the exception of the qualitative aspects of Mittelman and Papayannopoulou's (2018) mixed methods study, all of the performing arts intervention papers reviewed were good quality (>75%) according to the Kmet criteria (Kmet et al., 2004; Abbreviations: ACE-R, Addenbrookes Cognitive Examination -Revised (Mioshi et al., 2006); AD, Alzheimer's disease; ADAS-Cog, Alzheimer's Disease Assessment Scale-cognitive subscale (Rosen et al., 1984); BADLS, Bristol Activities of Daily Living Scale (Bucks et al., 1996); CDR, Clinical Dementia Rating Scale (Morris, 1993); DASS, Depression Anxiety Stress Scales (Crawford & Henry, 2003; DEM-QOL, Dementia Quality of Life Measure (Smith et al., 2005); DEM-QOL-Proxy, Dementia Quality of Life Proxy Measure (Brod et al., 1999); DSM-IV-TR, Diagnostic and Statistical Manual of Mental Disorders 4th ed, text revision (American Psychiatric Association, 2000); FAHW, Questionnaire of General Habitual Well-being (Wydra, 2003); FAM, Family Assessment Measure (Skinner et al., 1983); FTD, frontotemporal dementia; GDS, Geriatric Depression Scale (Sheikh & Yesavage, 1986); Global Deterioration Scale (Reisberg et al., 1982); Kmet, Standard Quality Assessment Criteria (Kmet et al., 2004); Lovibond & Lovibond, 1995); MCI, mild cognitive impairment; MD, mixed dementia; MMSE, Mini Mental State Examination (Folstein et al., 1975); MOS, Medical Outcomes Study social support survey (Sherbourne & Stewart, 1991); NPI, Neuropsychiatric Inventory (Cummings et al., 1994); PDD, Parkinson's disease dementia; PWD, people with dementia; QOL-AD, Quality of Life-Alzheimer's Disease (Logsdon et al., 2002); RSES, Rosenberg self-esteem scale (Rosenberg, 1965); SF-8 (Ware et al., 2001); VD, vascular dementia; WHO-QoL-BREF, World Health Organization Quality-of-Life Scale (Skevington et al., 2004); ZBI, Zarit Burden Interview (Zarit et al., 1980). ...
Dementia is a neurodegenerative syndrome that can lead to profound psychological and social challenges for people with dementia and their informal caregivers. Previous research has found positive effects of arts‐based interventions for people with dementia and caregivers that have been dyadic in nature and the present article sought to review these findings. A systematic literature review was conducted to investigate psychosocial outcomes of dyadic arts interventions. PsychINFO, Medline, Web of Science and ASSIA databases (from journal inception to March 2020) were searched as well as Google Scholar and reference lists of relevant studies were searched. Interventions were delivered to people with dementia and their caregivers in community‐based settings across five countries. Thirteen peer‐reviewed journal articles met the criteria for inclusion in this review, six focusing on performing arts and seven on visual arts. The findings suggested that choral singing and visual arts interventions may have positive effects on psychosocial outcomes for both people with dementia and their informal caregivers. Improved well‐being, quality of life, mood, enhanced identity and decreased social isolation were found in some studies. Importantly, across all studies, participants reported enjoying arts activities. This is the first review to systematically assess dyadic arts activities in a dementia context. These activities offer enjoyable and engaging experiences for many person with dementia and caregivers and were generally found to have positive results but mostly small sample size, lack of control groups and different outcome measures made comparisons challenging. Future research recommendations include further theoretical development, identifying key intervention components, and specifying relevant and measurable theoretically informed outcomes within dyadic interventions for this population.
... For the assessment of family functioning, a Dutch version of the self-report Questionnaire for Family Problems (QFP) was used (Koot, 1997). The QFP questionnaire is based on several sources, including the Family Assessment Measure (Skinner, Steinhauer, & Santa-Barbara, 1983) and the McMaster Family Assessment Device (Miller, Bishop, Epstein, & Keitner, 1985). The QFP consists of 130 items (a = .97 ...
Objectives:
Studies in children of patients affected with bipolar disorder (BD; bipolar offspring) are at high risk to develop mood disorders. Our aim is to investigate how environmental factors such as childhood trauma and family functioning relate to the development of mood disorders in offspring at familial risk for BD.
Design:
The current study is part of a longitudinal prospective cohort study among offspring of parents with BD.
Methods:
The current study is part of the Dutch Bipolar Offspring Study, an ongoing prospective cohort study among adolescent offspring of a parent with BD. Bipolar offspring were psychiatrically evaluated at baseline and at 1-, 5-, and 12-year follow-up. Complete follow-up data over de 12-year follow-up were available for 102 offspring. Childhood trauma was measured with the Childhood Trauma Questionnaire (CTQ) and filled out by the offspring. Family functioning was reported by the mother with the 130-item Questionnaire for Family Problems (QFP).
Results:
Emotional maltreatment was significantly associated (HR = 1.82, CI 1.18-2.82, p = .007) with mood disorder onset in bipolar offspring. No association was found with the family functioning total score (HR = 1.04, CI 0.94-15, p = .085) nor its subscales.
Conclusions:
The current study suggests that emotional maltreatment is associated with mood disorder development in bipolar offspring. Remarkably, the association of offspring-reported emotional maltreatment and mood disorder onset was not reflected in parent-reported family functioning (e.g., support and communication, openness or involvement). Possible explanations are discussed and warrant further study.
Practitioner points:
Offspring of bipolar patients are at increased risk of developing mood disorders across the life-time. Emotional trauma contributes to the likelihood of developing mood disorders in bipolar offspring. In the daily treatment of bipolar patients having children, attention should be given to parental style and difficulties. Further research using multiple informant methods on childhood trauma an family functioning is needed to further disentangle the effects of these variables on the onset of psychopathology in bipolar offspring.
... Skinner, Steinhauer, & Santa-Barbara, 1983), and adaptations of these scales used in the evaluation of the Meet Me at MoMa program byMittelman and Epstein (2006). As a result, the AGNSW evaluation questionnairesused a series of scales further adapted from quality of life (QOL) measures, self-esteem scales, and pictorial self-rating mood scales. ...
Particularly the developers of technical aids are
often confronted with a low level of acceptance
in the field of dementia disease. There is a large
number of products and design artifacts which have
failed to meet the needs of people with dementia,
but why? How can a responsible-orientated design
be realized, and which approaches and methods
for the process of design and design research are
useful? Consequently, which design strategies can
help to develop solutions in the form of artifacts to
support the daily life of people living with dementia?
In collaboration with the Alzheimer Association
Berlin, I am investigating the possibilities of a
sustainable design in consideration of social,
ethical and ecological aspects. In order to facilitate
a needs-oriented and human-centered design of
wearable technologies in my case study spur, the
affected persons and their relatives are included in
the conception, development and design, as well
as conventional experts: medics, therapists and
technologists.
Keywords: Textile-and Surface-Design, InteractionDesign, Wearable Technology
Alcohol and drug use (ADU) poses a significant barrier to optimal HIV treatment outcomes for adolescents and youths living with HIV (AYLHIV). We aimed to investigate the prevalence and correlates of ADU among ALHIV in Ugandan fishing communities, areas characterized by high HIV and poverty rates. AYLHIV aged 18–24, who knew they were HIV-positive, were selected from six HIV clinics. Substance use was determined through self-report in the last 12 months and urine tests for illicit substances. Utilizing a socioecological framework, the study structured variables into a hierarchical logistic regression analysis to understand the multi-layered factors influencing ADU. Self-reported past 12 months substance use was 42%, and 18.5% of participants had a positive urine test for one or more substances, with alcohol, benzodiazepines, and marijuana being the most commonly used. With the addition of individual-level socio-demographics, indicators of mental health functioning, interpersonal relationships, and community factors, the logistic regression analysis revealed greater exposure to adverse childhood experiences increased the odds of substance use (Odds Ratio [OR] = 1.24; 95% Confidence Interval [CI]: 1.03–1.55). Additionally, exposure to alcohol advertisements at community events significantly raised the odds of substance use (OR = 3.55; 95% CI: 1.43–8.83). The results underscore the high prevalence among AYLHIV and emphasize the need for comprehensive interventions targeting individual (e.g., life skills education and mental health supports), interpersonal (e.g., peer support and family-based interventions), community (e.g., community engagement programs, restricted alcohol advertisements and illicit drug access), and policies (e.g., integrated care models and a national drug use strategy), to address ADU.
Background
Music therapy interventions with informal carers of individuals with life-threatening illness at pre- and post-bereavement is an increasingly important clinical area. This systematic review is the first to synthesise and critically evaluate the international evidence associated with music therapy with adult informal carers pre- and post-bereavement. Specifically, the objectives were: i) to describe the characteristics and effectiveness of music therapy interventions which aim to improve health-related outcomes for adult informal carers of adults with life-threatening illness (pre- and post-bereavement), and ii) to describe the experience of music therapy for adult informal carers of adults with life-threatening illness (pre- and post-bereavement).
Methods
Eligibility: adult informal carers of adults at end of life or bereaved; music therapy interventions for improving health-related outcomes; qualitative; mixed-method; and quantitative studies including comparators of any other intervention; published in English from 1998 onwards. Six databases were searched up to July 2022. A JBI mixed-methods systematic review approach was followed throughout, including quality appraisal, data extraction and a convergent segregated approach to synthesis and integration.
Results
A total of 34 studies were included, published between 2003 and 2022. Most were conducted in North America (n = 13), Australia (n = 10), or Europe (n = 8). No studies were conducted in low- and middle-income countries or in the UK. The majority were qualitative (n = 17), followed by quasi-experimental (n = 8), mixed-methods (n = 7) and two RCTs. The majority focused on carers of individuals with dementia (n = 21) or advanced cancer (n = 7). Seventeen studies were purely quantitative or included a quantitative component. During meta-synthesis, findings were aligned to core outcomes for evaluating bereavement interventions in palliative care and previously identified risk factors for complicated grief. Commonly targeted outcomes in quantitative studies included quality of life and mental wellbeing, showing equivocal effectiveness of music therapy with significant and non-significant results. Twenty-two studies either purely qualitative or with a qualitative component underwent meta synthesis and suggested a diverse range of improved pre- and post-bereavement outcomes for informal carers across all core outcomes, and across all risk and protective factors, including psychological, spiritual, emotional, and social outcomes.
Conclusions
Qualitative studies provide moderate to strong evidence for improved health-related outcomes for adult informal carers of adults with life-threatening illness pre-bereavement. Limited studies including those bereaved negates conclusions for the bereavement phase. Comparisons and explanations for effectiveness across quantitative and qualitative studies are equivocal, with a high risk of bias and small samples in the limited number of quantitative studies, demonstrating a need for high-quality RCTs.
Systematic review pre-registration
PROSPERO [CRD42021244859].
Assessment planning in substance use disorder prevention research entails the identification of measurement domains and the selection of corresponding instruments needed to fulfill specific project goals. The study design, developmental periods examined, feasibility constraints, and anticipated statistical analyses are important considerations in optimally designing the assessment protocol. As a conceptual framework to organize the domains considered here as examples, the multifactorial model of complex disorders with elaborations emphasized by the discipline of developmental psychopathology is applied. Risks reviewed include family history, childhood maltreatment, peer relationships, and psychopathology. The substance involvement dimensions germane as outcomes include substance type, consumption quantity and frequency, and substance-related problems. Comprehensive diachronic evaluation over critical developmental periods provides the technical foundation for etiology and intervention research.
Purpose
The aim of this study is to expand the current knowledge on the relationship between poverty, family functioning, and the mental health of adolescent girls in families affected by poverty and HIV/AIDS in southern Uganda. The study investigates the association between family functioning and mental health and examines whether family functioning moderates the intervention effect on adolescent mental health.
Methods
Longitudinal data were collected over the course of 24 months in a cluster randomized controlled trial conducted among N=1,260 girls aged 14–17 years in Uganda. Participants were randomized into control group (n=408 girls from n=16 schools), matched youth development accounts treatment, YDA (n=471 girls from n=16 schools), and integrated intervention combining YDA with multiple family group component (n=381 girls from n=15 schools).
Results
We found a significant positive association between family functioning and mental health of adolescent girls in our sample. Moderator analyses suggests that effect of the intervention on Beck Hopelessness Scale was significantly moderated by family cohesion χ24=21.43;p=.000, frequency of family communication χ24=9.65;p=.047, and quality of child-caregiver relationship χ24=11.12;p=.025. Additionally, the intervention effect on depression was moderated by the comfort of family communication χ2(4)=10.2;p=.037.
Discussion
The study findings highlight the importance of family functioning when examining the link from poverty to adolescent mental health. The study contributes to the scarce evidence suggesting that asset-accumulation opportunities combined with a family strengthening component may improve parenting practices and adolescent mental health in poor households.
Disruptive Behavior Disorders (DBDs) is one of the most common mental health problems among children in Uganda and SSA. Yet, to our knowledge no research has studied parenting stress (PS) among caregivers of children with DBDs, or investigated which risk factors originate from the child, parent, and contextual environment. Using a rigorous analytical approach, we aimed to: 1) identify different types and; 2) examine factors associated with PS and how correlates differ according to the type of stress experienced among caregivers of children with DBDs in low-resourced Ugandan communities. We used data from 633 caregivers of children with DBDs from SMART-Africa Uganda study. PS, was measured using the 36-item Parenting Stress Index-Short Form (PSI-SF). To identify focal correlates related to child/parent/contextual environment, we performed variable importance screening using the Stata command -gvselect- and specified mixed/melogit multilevel modeling with random effects. Secondly, focal correlates were included in the cross-fit partialing out lasso linear/logistic regression (double machine-learning) model. Caregivers mostly experienced stress from parental distress and caring for a child with difficult behavior. As scores increased by one unit on: caregiver mental health distress, PSI-SF increased by 0.23 (95% CI = 0.15, 0.32) (reflecting higher stress levels); Child difficulties, PSI-SF increased by 0.77 (95% CI = 0.52, 1.02). Contrastingly, for every one unit increase in family cohesion scores, PSI-SF decreased by 0.54 (95% CI = -0.84, -0.23). Caregivers with college/diploma/undergraduate/graduate education had less stress than those completing primary only or never attended school [Coefficient = -8.06 (95% CI = -12.56, -3.56)]. Family financial supporters had significantly higher Parental distress than caregivers who were not [Coefficient = 2.68 (95% CI = 1.20, 4.16)]. In low-resource settings like Uganda where mental health support is limited, community-based family-focused and economic empowerment interventions that improve community support systems and address financial barriers can reduce stress levels of caregivers of children with DBDs.
Background
Family functioning is associated with adolescent drug use, alcohol use, cigarette use, and sexual risk behaviors. Assessing adolescents for family functioning, commonly associated with multiple risk behaviors, may help identify adolescents at risk for adverse health outcomes. This study examined whether a latent family functioning construct, encompassing multiple dimensions of family functioning, was associated with adolescents’ substance use and sexual risk behaviors.Method
This study used data harmonization with three intervention trials, including data from 1451 adolescents (M = 13.6, SD = 1.0), to perform a full-information item bifactor analysis on 46 family functioning items from five pre-existing family functioning measures. Regression analysis was used to examine the association between the identified subset of items and the following outcomes: cigarette use, alcohol use, drug use, and condom use.ResultsBifactor analysis identified a 26-item latent family functioning construct. Regression analysis indicated that a 26-item latent family functioning construct was associated negatively with lifetime and past 90-day cigarette use, alcohol use, and drug use.Conclusion
In sum, the multi-dimensional latent family functioning construct may target specific barriers to risk screening in adolescent populations, including time constraint, hesitancy in discussing sensitive health topics, and use culturally appropriate and age-appropriate assessments.
Reviews that synthesize global evidence on the impact of poverty reduction interventions on child and adolescent mental health (CAMH) report inconclusive results and highlight the need to unpack the mechanisms that connect poverty-reduction to CAMH. To address this gap, we examine the proposition that family relations is an important relational factor transmitting effect of poverty on CAMH, and test whether family relations mediate the effect of poverty-reduction intervention on depression, hopelessness, and self-concept among AIDS orphans in Uganda. We use longitudinal data collected over the course of 48 months in a cluster-randomized controlled trial conducted among N = 1410 AIDS orphans from n = 48 schools in Uganda. To examine the relationship between intervention, latent mediator (family relations and support) and CAMH outcomes (Beck Hopelessness Scale (BHS), Tennessee Self-Concept Scale (TSCS), and Depression), we ran structural equation models adjusting for clustering of individuals within schools. Relative to the control group, participants in both treatment arms reported lower levels of hopelessness and depression, and significantly higher levels of self-concept. They also report significantly higher levels of latent family relationship in all three models. In both treatment arms, the direct effect of the intervention on all three outcomes is still significant when the latent family relations mediator is included in the analyses. This suggests partial mediation. In other words, in both treatment arms, the significant positive effect of the intervention on children's depression, hopelessness, and self-concept is partially mediated by their family relationship quality. Our findings support the argument put forward by the Family Stress Model showing that the poverty-reduction program improves children's mental health functioning by improving family relationships. The implications of our study extend beyond the narrow focus of poverty reduction, suggesting that asset-building interventions have broader impacts on family dynamics and child mental health.
Background
Adolescent alcohol and drug use (ADU) is a significant public health challenge. Uganda, one of the poorest countries in Sub-Saharan Africa (SSA), has the second-highest rate of per capita alcohol consumption in SSA, and over one-third of Ugandan adolescents have used alcohol in their lifetime (over 50% of them engage in heavy episodic drinking). These estimates further increase in fishing villages, a key HIV-vulnerable population, where ADU is normative. However, few studies have assessed ADU among adolescents and youths living with HIV despite their increased risk for ADU and its impact on engagement in HIV care. Moreover, data on risk and resilience factors for ADU are scarce as only few studies evaluating ADU interventions in SSA have reported positive outcomes. The majority have been implemented in school settings, potentially excluding adolescents in fishing communities with high school dropout rates, and none have targeted risk factors including poverty and mental health, which are rampant among adolescents and youths living with HIV and their families, undermine their coping skills and resources, and have been associated with increased risk for ADU among them.
Objective
We propose a mixed methods study with a sample of 200 adolescents and youths living with HIV (aged 18-24 years) seen at 6 HIV clinics in southwestern Uganda’s fishing communities to (1) examine the prevalence and consequences of ADU and identify the multilevel risk and resilience factors associated with ADU among them and (2) explore the feasibility and short-term effects of an economic empowerment intervention on ADU among them.
Methods
This study comprises four components: (1) focus group discussions (FGDs) with adolescents and youths living with HIV (n=20) and in-depth qualitative interviews with health providers (n=10) from 2 randomly selected clinics; (2) a cross-sectional survey with 200 adolescents and youths living with HIV; (3) a randomized controlled trial with a subgroup of adolescents and youths living with HIV (n=100); and (4) 2 postintervention FGD with adolescents and youths living with HIV (n=10 per group).
Results
Participant recruitment for the first qualitative phase has completed. As of May 4, 2023, ten health providers from 6 clinics have been recruited, provided written consent to participate, and participated in in-depth qualitative interviews. Two FGDs was conducted with 20 adolescents and youths living with HIV from 2 clinics. Data transcription, translation, and analysis of qualitative data has commenced. The cross-sectional survey will commence shortly after and dissemination of the main study findings is targeted for 2024.
Conclusions
Our findings will advance our understanding of ADU among adolescents and youths living with HIV and inform the design of future interventions to address ADU among them.
Trial Registration
ClinicalTrials.gov NCT05597865; https://clinicaltrials.gov/ct2/show/NCT05597865
International Registered Report Identifier (IRRID)
PRR1-10.2196/46486
While contemporary psychiatry seeks the mechanisms of mental disorders in neurobiology, mental health problems clearly depend on developmental processes of learning and adaptation through ongoing interactions with the social environment. Symptoms or disorders emerge in specific social contexts and involve predicaments that cannot be fully characterized in terms of brain function but require a larger social-ecological view. Causal processes that result in mental health problems can begin anywhere within the extended system of body-person-environment. In particular, individuals’ narrative self-construal, culturally mediated interpretations of symptoms and coping strategies as well as the responses of others in the social world contribute to the mechanisms of mental disorders, illness experience, and recovery. In this paper, we outline the conceptual basis and practical implications of a hierarchical ecosocial systems view for an integrative approach to psychiatric theory and practice. The cultural-ecosocial systems view we propose understands mind, brain and person as situated in the social world and as constituted by cultural and self-reflexive processes. This view can be incorporated into a pragmatic approach to clinical assessment and case formulation that characterizes mechanisms of pathology and identifies targets for intervention.
BACKGROUND AND OBJECTIVES
Our objective is to identify common family functioning measurement tools and assess their compatibility with family-health development and life-course perspectives.
METHODS
Data sources include PubMed, ERIC, CINAHL, Families and Societies Worldwide, PsychInfo, Web of Science, PsychNet, and Health and Psychosocial Instruments. Title and abstract screening and full-text review of articles were conducted by multiple reviewers based on prespecified inclusion criteria. Data extraction focused on features of identified measurements tools, including: (1) name (2) domains of family functioning measured, (3) established psychometric properties, and (4) original context of psychometric evaluation (eg, details about the study sample).
RESULTS
Of the 50 measurement tools identified, 94% measured organizational patterns (eg, flexibility, connectedness, or resources), 46% measured belief systems (eg, making meaning of adversity, or positive outlook), and 54% measured communication processes (eg, open emotional sharing, or collaborative problem-solving).
CONCLUSIONS
Existing measures of family functioning can aid life-course researchers in understanding family processes as contexts for health and well-being. There also remain opportunities to refine or develop measures of family functioning more compatible with a life-course perspective that assess family processes (1) at various life stages; (2) with various backgrounds, identities, structures, and experiences; and (3) embedded in or impacted by various contexts that may facilitate or hinder family functioning.
Background
Sub-Saharan Africa (SSA) is heavily burdened by HIV, with 85% of the global new infections among adolescents happening in the region. With advances in medication and national policies promoting antiretroviral therapy (ART), children < 15 years living with HIV (CLWH) continue to grow with a chronic, highly stigmatized disease. Unfortunately, the stigma they experience results in much lower quality of life, including poor mental health and treatment outcomes. Family members also experience stigma and shame by virtue of their association with an HIV-infected family member. Yet, stigma-reduction interventions targeting CLWH and their families are very limited. The goal of this study is to address HIV-associated stigma among CLWH and their caregivers in Uganda.
Methods
This three-arm cluster randomized control trial, known as Suubi4Stigma, will evaluate the feasibility, acceptability, and preliminary impact of two evidence-based interventions: (1) group cognitive behavioral therapy (G-CBT) focused on cognitive restructuring and strengthening coping skills at the individual level and (2) a multiple family group (MFG) intervention that strengthens family relationships to address stigma among CLWH (N = 90, 10–14 years) and their families (dyads) in Uganda. Nine clinics will be randomized to one of three study arms (n = 3 clinics, 30 child-caregiver dyads each): (1) usual care; (2) G-CBT + usual care; and (3) MFG + usual care. Both treatment and control conditions will be delivered over a 3-month period. Data will be collected at baseline (pre-intervention) and at 3 months and 6 months post-intervention initiation.
Conclusion
The primary aim of the proposed project is to address the urgent need for theoretically and empirically informed interventions that seek to reduce HIV-associated stigma and its negative impact on adolescent health and psychosocial well-being. As several countries in SSA grapple with care and support for CLWH, this study will lay the foundation for a larger intervention study investigating how HIV-associated stigma can be reduced to foster healthy child development—especially for CLWH as they transition through adolescence.
Trial registration
ClinicalTrials.gov: NCT04528732; Registered August 27, 2020
Background:
Experiencing anxiety and depression is very common in people living with dementia and mild cognitive impairment (MCI). There is uncertainty about the best treatment approach. Drug treatments may be ineffective and associated with adverse effects. Guidelines recommend psychological treatments. In this updated systematic review, we investigated the effectiveness of different psychological treatment approaches.
Objectives:
Primary objective To assess the clinical effectiveness of psychological interventions in reducing depression and anxiety in people with dementia or MCI. Secondary objectives To determine whether psychological interventions improve individuals' quality of life, cognition, activities of daily living (ADL), and reduce behavioural and psychological symptoms of dementia, and whether they improve caregiver quality of life or reduce caregiver burden.
Search methods:
We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group's register, MEDLINE, Embase, four other databases, and three trials registers on 18 February 2021.
Selection criteria:
We included randomised controlled trials (RCTs) that compared a psychological intervention for depression or anxiety with treatment as usual (TAU) or another control intervention in people with dementia or MCI.
Data collection and analysis:
A minimum of two authors worked independently to select trials, extract data, and assess studies for risk of bias. We classified the included psychological interventions as cognitive behavioural therapies (cognitive behavioural therapy (CBT), behavioural activation (BA), problem-solving therapy (PST)); 'third-wave' therapies (such as mindfulness-based cognitive therapy (MBCT)); supportive and counselling therapies; and interpersonal therapies. We compared each class of intervention with control. We expressed treatment effects as standardised mean differences or risk ratios. Where possible, we pooled data using a fixed-effects model. We used GRADE methods to assess the certainty of the evidence behind each result.
Main results:
We included 29 studies with 2599 participants. They were all published between 1997 and 2020. There were 15 trials of cognitive behavioural therapies (4 CBT, 8 BA, 3 PST), 11 trials of supportive and counselling therapies, three trials of MBCT, and one of interpersonal therapy. The comparison groups received either usual care, attention-control education, or enhanced usual care incorporating an active control condition that was not a specific psychological treatment. There were 24 trials of people with a diagnosis of dementia, and five trials of people with MCI. Most studies were conducted in community settings. We considered none of the studies to be at low risk of bias in all domains. Cognitive behavioural therapies (CBT, BA, PST) Cognitive behavioural therapies are probably slightly better than treatment as usual or active control conditions for reducing depressive symptoms (standardised mean difference (SMD) -0.23, 95% CI -0.37 to -0.10; 13 trials, 893 participants; moderate-certainty evidence). They may also increase rates of depression remission at the end of treatment (risk ratio (RR) 1.84, 95% CI 1.18 to 2.88; 2 studies, with one study contributing 2 independent comparisons, 146 participants; low-certainty evidence). We were very uncertain about the effect of cognitive behavioural therapies on anxiety at the end of treatment (SMD -0.03, 95% CI -0.36 to 0.30; 3 trials, 143 participants; very low-certainty evidence). Cognitive behavioural therapies probably improve patient quality of life (SMD 0.31, 95% CI 0.13 to 0.50; 7 trials, 459 participants; moderate-certainty evidence) and activities of daily living at end of treatment compared to treatment as usual or active control (SMD -0.25, 95% CI -0.40 to -0.09; 7 trials, 680 participants; moderate-certainty evidence). Supportive and counselling interventions Meta-analysis showed that supportive and counselling interventions may have little or no effect on depressive symptoms in people with dementia compared to usual care at end of treatment (SMD -0.05, 95% CI -0.18 to 0.07; 9 trials, 994 participants; low-certainty evidence). We were very uncertain about the effects of these treatments on anxiety, which was assessed only in one small pilot study. Other interventions There were very few data and very low-certainty evidence on MBCT and interpersonal therapy, so we were unable to draw any conclusions about the effectiveness of these interventions.
Authors' conclusions:
CBT-based treatments added to usual care probably slightly reduce symptoms of depression for people with dementia and MCI and may increase rates of remission of depression. There may be important effect modifiers (degree of baseline depression, cognitive diagnosis, or content of the intervention). CBT-based treatments probably also have a small positive effect on quality of life and activities of daily living. Supportive and counselling interventions may not improve symptoms of depression in people with dementia. Effects of both types of treatment on anxiety symptoms are very uncertain. We are also uncertain about the effects of other types of psychological treatments, and about persistence of effects over time. To inform clinical guidelines, future studies should assess detailed components of these interventions and their implementation in different patient populations and in different settings.
Background
Externalising behaviours are becoming a remarkably prevalent problem during adolescence, often precipitating both externalising and internalising disorders in later adulthood. Psychological treatments aim to increase the social functioning of adolescents in order for them to live a more balanced life and prevent these negative trajectories. However, little is known of the intervening variables and mediators involved in these treatments' change mechanisms. We conducted a systematic review, exploring the available evidence on mediators of psychological treatments for externalising behaviours and symptoms amongst adolescents (10 to 19 years old).
Methods
A systematic search was performed on Medline and PsycINFO databases, which identified studies from inception to February 23, 2020. Eligible studies included randomised controlled trials that enrolled adolescents with externalising symptoms and behaviours as, at least, one of the primary outcomes. A group of 20 reviewers from the COST-Action TREATme (CA16102) were divided into 10 pairs. Each pair independently screened studies for inclusion, extracted information from the included studies, and assessed the methodological quality of the included studies and the requirements for mediators, following Kazdin's criteria. Risk of bias of RCTs was assessed by the Mixed Methods Appraisal Tool. Extracted data from the included studies were reported using a narrative synthesis.
Results
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA), after removing duplicates, 3,660 articles were screened. Disagreements were resolved by consensus. In a second stage, 965 full-text articles were assessed for eligibility. A total of 14 studies fulfilled all inclusion criteria. The majority were related to systemic psychological treatment approaches. Two types of mediators were identified as potentially being involved in the mechanisms of change for better social improvements of adolescents: to increase healthier parent–adolescent relationships and parental discipline. However, there were significant and non-significant results amongst the same mediators, which led to discussing the results tentatively.
Conclusions
Family variables were found to be the largest group of investigated mediators, followed by relational, behavioural, and emotional variables. No cognitive or treatment-specific mediators were identified. Both adequate behavioural control of adolescents' peer behaviour and a better positive balance in their relationships with their parents seemed to buffer the effects of externalising behaviours in adolescents. Several methodological limitations concerning mediation testing design, outcome measures, and mediator selection have been identified.
Ethics and Dissemination
Ethical approval was not required. PROSPERO registration number: CRD42021231835.
Background
Multisystemic Therapy® (MST®) is an intensive, home‐based intervention for families of youth with social, emotional, and behavioural problems. MST therapists engage family members in identifying and changing individual, family, and environmental factors thought to contribute to problem behaviour. Intervention may include efforts to improve communication, parenting skills, peer relations, school performance, and social networks. MST is widely considered to be a well‐established, evidence‐based programme.
Objectives
We assessed (1) impacts of MST on out‐of‐home placements, crime and delinquency, and other behavioural and psychosocial outcomes for youth and families; (2) consistency of effects across studies; and (3) potential moderators of effects including study location, evaluator independence, and risks of bias.
Search Methods
Searches were performed in 2003, 2010, and March to April 2020. We searched PsycINFO, MEDLINE, ERIC, NCJRS Abstracts, ProQuest and WorldCAT dissertations and theses, and 10 other databases, along with government and professional websites. Reference lists of included articles and research reviews were examined. Between April and August 2020 we contacted 22 experts in search of missing data on 16 MST trials.
Selection Criteria
Eligible studies included youth (ages 10 to 17) with social, emotional, and/or behavioural problems who were randomly assigned to licensed MST programmes or other conditions. There were no restrictions on publication status, language, or geographic location.
Data Collection and Analysis
Two reviewers independently screened 1802 titles and abstracts, read all available study reports, assessed study eligibility, and extracted data onto structured electronic forms. We assessed risks of bias (ROB) using modified versions of the Cochrane ROB tool and What Works Clearinghouse standards.
Where possible, we used random effects models with inverse variance weights to pool results across studies. We used odds ratios for dichotomous outcomes and standardised mean differences for continuous outcomes. We used Hedges g to adjust for small sample sizes. We assessed the heterogeneity of effects with χ² and I ². Pairwise meta‐analyses are displayed in forest plots, with studies arranged in subgroups by location (USA or other country) and investigator independence. We provide separate forest plots for conceptually distinct outcomes and endpoints. We assessed differences between subgroups of studies with χ ² tests.
We generated robust variance estimates, using correlated effects (CE) models with small sample corrections to synthesise all available outcome measures within each of nine outcome domains. Exploratory CE analyses assessed potential moderators of effects within these domains.
We used GRADE guidelines to assess the certainty of evidence on seven primary outcomes at one year after referral.
Main Results
Twenty‐three studies met our eligibility criteria; these studies included a total of 3987 participating families. Between 1983 and 2020, 13 trials were conducted in the USA by MST program developers and 10 studies were conducted by independent teams (three in the USA, three in the UK, and one each in Canada, the Netherlands, Norway, and Sweden).
These studies examined outcomes of MST for juvenile offenders, sex offenders, offenders with substance abuse problems, youth with conduct or behaviour problems, those with serious mental health problems, autism spectrum disorder, and cases of child maltreatment. We synthesised data from all eligible trials to test the claim that MST is effective across clinical problems and populations.
Most trials compared MST to treatment as usual (TAU). In the USA, TAU consisted of relatively little contact and few services for youth and families, compared with more robust public health and social services available to youth in other high‐income countries. One USA study provided “enhanced TAU” to families in the control group, and two USA studies compared MST to individual therapy for youth.
The quality of available evidence for MST is mixed. We identified high risks of bias due to: inadequate randomisation procedures (in 9% of studies); lack of comparability between groups at baseline (65%); systematic omission of cases (43%); attrition (39%); confounding factors (e.g., between‐group differences in race, gender, and attention; 43%); selective reporting of outcomes (52%); and conflicts of interest (61%). Most trials (96%) have high risks of bias on at least one indicator.
GRADE ratings of the quality of evidence are low or moderate for seven primary outcomes, with high‐quality evidence from non‐USA studies on out‐of‐home placement.
Effects of MST are not consistent across studies, outcomes, or endpoints. At one year post randomisation, available evidence shows that MST reduced out‐of‐home placements in the USA (OR 0.52, 95% confidence interval [CI] 0.32 to 0.84; P < .01), but not in other countries (OR 1.14, CI 0.84 to 1.55; P = .40). There is no overall evidence of effects on other primary outcomes at one year. When we included all available outcomes in CE models, we found that MST reduced placements and arrests in the USA, but not in other countries. At 2.5 years, MST increased arrest rates in non‐USA countries (OR 1.27, CI 1.01 to 1.60; P = .04) and increased substance use by youth in the UK and Sweden (SMD 0.13, CI −0.00 to 0.27; P = .05). CE models show that MST reducesd self‐reported delinquency and improved parent and family outcomes, but there is no overall evidence of effects on youth symptoms, substance abuse, peer relations, or school outcomes. Prediction intervals indicate that future studies are likely to find positive or negative effects of MST on all outcomes.
Potential moderators are confounded: USA studies led by MST developers had higher risks of bias, and USA control groups received fewer services and had worse outcomes than those in independent trials conducted in other high‐income countries. The USA/non‐USA contrast appears to be more closely related to effect sizes than than investigator independence or risks of bias.
Authors' Conclusions
The quality of evidence for MST is mixed and effects are inconsistent across studies. Reductions in out‐of‐home placements and arrest/conviction were observed in the USA, but not in other high‐income countries. Studies that compared MST to more active treatments showed fewer benefits, and there is evidence that MST may have had some negative effects on youth outside of the USA. Based on moderate to low quality evidence, MST may reduce self‐reported delinquency and improve parent and family outcomes, but there is no overall evidence of effects on youth symptoms, substance abuse, peer relations, or school outcomes.
Introduction
Many adolescents living with HIV in sub-Saharan Africa (SSA) experience poverty and have access to limited resources, which can impact HIV and mental health outcomes. Few studies have analyzed the impact of economic empowerment interventions on the psychosocial wellbeing of adolescents living with HIV in low resource communities, and this study aims to examine the mediating mechanism(s) that may explain the relationship between a family economic empowerment intervention (Suubi+Adherence) and mental health outcomes for adolescents (ages 10-16 at enrollment) living with HIV in Uganda.
Method
We utilized data from Suubi+Adherence, a large-scale six-year (2012-2018) longitudinal randomized controlled trial (N=702). Generalized structural equation models (GSEMs) were conducted to examine 6 potential mediators (HIV viral suppression, food security, family assets, and employment, HIV stigma, HIV status disclosure comfort level, and family cohesion) to determine those that may have driven the effects of the Suubi+Adherence intervention on adolescents’ mental health.
Results
Family assets and employment were the only statistically significant mediators during follow-up (β from -0.03 to -0.06), indicating that the intervention improved family assets and employment which, in turn, was associated with improved mental health. The proportion of the total effect mediated by family assets and employment was from 42.26% to 71.94%.
Conclusions
Given that mental health services provision is inadequate in SSA, effective interventions incorporating components related to family assets, employment, and financial stability are crucial to supporting the mental health needs of adolescents living with HIV in under-resourced countries like Uganda. Future research should work to develop the sustainability of such interventions to improve long-term mental health outcomes among this at-risk group.
Objective
To evaluate the roles of parenting and adolescent characteristics during ages 13 to 16 in connecting family socioeconomic status (SES) during adolescence with adult sleep in Black and White men.
Design
Longitudinal school-based community study beginning in 1987-1988 when participants were enrolled in the first or seventh grade.
Setting
Pittsburgh, PA.
Participants
291 men (54.4% Black, mean age = 33, SD = 2.5) participated in 2012-2014 in a week-long study of sleep measured by actigraphy and diary.
Measures
In adolescence (ages 13-16), measures of family SES based on occupation, education, income and public assistance; parenting based on monitoring, positive expectations for future, warm parent-child relationship, and communication; and adolescent characteristics based on anxiety, hyperactivity/impulsivity, and peer rejection. In adulthood, participant SES, minutes awake after sleep onset (WASO), duration, and diary-assessed sleep quality.
Results
Structural equation modeling confirmed significant indirect pathways: (1) low family SES in adolescence to negative parenting to low adult SES to greater WASO; (2) low family SES in adolescence to adolescent characteristics to low adult SES to greater WASO; (3) Black race to low family SES in adolescence to negative parenting to low adult SES to greater WASO; and (4) Black race to low family SES in adolescence to adolescent characteristics to adult SES to greater WASO. Similar models for duration and quality were not confirmed.
Conclusions
Parenting and adolescent characteristics may have an indirect association with adult sleep continuity. Parenting and mental health interventions in adolescence may improve adult sleep.
This study examined the factors associated with depressive symptoms and post traumatic depressive disorder (PTSD) among economically vulnerable women engaged in commercial sex work (WESW) in southern Uganda. Baseline data from a longitudinal cluster randomized study involving 542 self-identified WESW (18-55 years), recruited from 19 HIV hotspots were analyzed. Hierarchical linear regression modelling was utilized to estimate individual, family-level and economic-level predictors of depressive symptoms and PTSD. Family cohesion, sex work stigma, HIV status, financial distress, household assets, number of children and number of household income earners, were associated with PTSD. Similarly, family cohesion, number of people in the household, HIV status, sex work stigma, financial distress, and household assets, were associated with depressive symptoms. Women engaged in commercial sex work are at a higher risk of HIV and poor mental health outcomes. Sex work stigma and financial distress elevate levels of depressive symptoms and PTSD, over and above an individual's HIV status. Family and economic-level factors have the potential to mitigate the risk of poor mental health outcomes. As such, integrating stigma reduction and economic strengthening components in the programming targeting WESW—a key population, may be critical to address their mental health outcomes.
The objectives of this research paper to study the implication of positive reinforcing interaction between family members and its impact on their health. For this purpose, a sample of 385 respondents was taken randomly and 162 females were selected from Government Degree College for Women and 223 males from Government Degree College for Boys of District Khanewal. The data was collected through a structured questionnaire and collected data was processed through SPSS Software. The data was analyzed through 5 points Likert scale and multiple regression analysis. Our results show that there is close relationship between reinforcing interaction among family members and their emotional and physical health.
Background
In sub-Saharan Africa (SSA), adolescent girls and young women are three times more likely than boys to have depressive disorders. Understanding adolescents’ unique and common vulnerabilities and protective factors is essential for the development of appropriate interventions and programming focused on child and adolescent mental health. This paper examines the prevalence and predictors of depressive symptoms among high school adolescent girls in southern Uganda.
Methods
Baseline data from a longitudinal cluster randomized study involving 1260 adolescent girls (14–17 years), recruited from 47 secondary schools were utilized. Depressive symptoms were estimated using the 21-item Beck’s Depression Inventory. Hierarchical linear regression modelling was utilized to estimate key predictors of depressive symptoms among adolescent girls.
Results
Of the total sample, 16.35% (n = 206) reported severe depressive symptoms and almost one in every three adolescent girls interviewed (29.68%, n = 374) reported moderate symptoms. These symptoms were more prevalent among older adolescents (16 years and above). In addition, family relationships, social support, as well as measures of psychological wellbeing (self-concept and self-esteem) were all associated with lower levels of depressive symptoms. Hopelessness was associated with higher levels of depressive symptoms among adolescent girls.
Conclusion
Findings from this study indicate a high prevalence of depressive symptoms, especially among older adolescent girls. In addition, family support factors and adolescents’ psychological wellbeing were associated with low levels of depressive symptoms –pointing to the need to strengthen family functioning and adolescent’s psychological wellbeing to mitigate risks. Taken together, findings support increasing calls for early screening and detection of depressive symptoms to facilitate timely referral to care and treatment. Findings may also inform the development and incorporation of gender-specific mental health components in programming targeting adolescent girls, in low-resource communities in SSA.
Trial registration
This trial was prospectively registered with ClinicalTrials.gov (registration number: NCT03307226) on 11 October 2017.
The quality of the parent–child relationship is crucial for early childhood development and has consequences for health and well‐being throughout the lifespan. Prevention programs and therapies, such as parent training and systemic family therapy, can lead to improvements in the parent–child relationship, but still tend to be underutilized from a public health perspective. Further, parent–child relationship problems are not consistently screened and assessed across many clinical and public health settings. The purpose of this chapter is to review the current status of assessment of parent–child relationship problems including the assessment in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD) as well as with interviews, questionnaires, and observational measures. Specific recommendations for researchers, clinicians, and public health are provided.
Although self-report questionnaires assessing family relationships are plentiful, all were developed from the perspective of the theorist or researcher.There is no instrument that has as its basis language and constructs developed from an understanding of how family members actually describe and think about themselves.The research presented here was an initial attempt to begin to understand the constructs and dimensions actually used by family members, to compare these constructs and dimensions with those most often used by researchers and theoreticians, and to examine possible intergenerational differences in them.
The aim of this Campbell Systematic Review was to evaluate the effect of multi‐systemic therapy (MST) on adolescents with social, emotional, and behavioural problems based on the best available evidence. The effect is measured by a range of behavioural and psychosocial outcomes, including the number of institutional placements and arrests, the incidence of drug abuse, and personal relationships, social skills, absence from school, etc.
The review is exclusively based on randomised controlled trials in which random allocation between MST and usual treatment has taken place. 266 reports were selected on the basis of title and abstract. Of these 35 were found actually to be effect studies. And finally, eight of the 35 effect studies met the pre‐set quality criteria laid down in the original Campbell/Cochrane review.
The Campbell/Cochrane review concludes that MST does not have consistently better effects than other types of interventions ‐ for example, restrictive institutional placement. On the other hand, nothing indicates that MST has any negative overall effects. All in all, MST does not seem to be any better or any poorer than other treatments. The Campbell/Cochrane review concludes that there are no consistent differences in outcome between the adolescents subject to MST and those subject to alternative treatment. This conclusion is based on the best available evidence on the effectiveness of MST.
Synopsis
Results of eight randomised controlled trials of Multisystemic Therapy (MST) conducted in the USA, Canada, and Norway indicate that it is premature to draw conclusions about the effectiveness of MST compared with other services. Results are inconsistent across studies that vary in quality and context. There is no information about the effects of MST compared with no treatment. There is no evidence that MST has harmful effects.
Abstract
Background
Multisystemic Therapy (MST) is an intensive, home‐based intervention for families of youth with social, emotional, and behavioral problems. Masters‐level therapists engage family members in identifying and changing individual, family, and environmental factors thought to contribute to problem behavior. Intervention may include efforts to improve communication, parenting skills, peer relations, school performance, and social networks. Most MST trials were conducted by program developers in the USA; results of one independent trial are available and others are in progress.
Objectives
To provide unbiased estimates of the impacts of MST on restrictive out‐of‐home living arrangements, crime and delinquency, and other behavioral and psychosocial outcomes for youth and families.
Search strategy
Electronic searches were made of bibliographic databases (including the Cochrane Library, C2‐SPECTR, PsycINFO, Science Direct and Sociological Abstracts) as well as government and professional websites, from 1985 to January 2003. Reference lists of articles were examined, and experts were contacted.
Selection criteria
Studies where youth (age 10–17) with social, emotional, and/or behavioral problems were randomised to licensed MST programs or other conditions (usual services or alternative treatments).
Data collection & analysis
Two reviewers independently reviewed 266 titles and abstracts; 95 full‐text reports were retrieved, and 35 unique studies were identified. Two reviewers independently read all study reports for inclusion. Eight studies were eligible for inclusion. Two reviewers independently assessed study quality and extracted data from these studies.
Significant heterogeneity among studies was identified (assessed using Chi‐square and I ² ), hence random effects models were used to pool data across studies. Odds ratios were used in analyses of dichotomous outcomes; standardised mean differences were used with continuous outcomes. Adjustments were made for small sample sizes (using Hedges g). Pooled estimates were weighted with inverse variance methods, and 95% confidence intervals were used.
Main results
The most rigorous (intent‐to‐treat) analysis found no significant differences between MST and usual services in restrictive out‐of‐home placements and arrests or convictions. Pooled results that include studies with data of varying quality tend to favor MST, but these relative effects are not significantly different from zero. The study sample size is small and effects are not consistent across studies; hence, it is not clear whether MST has clinically significant advantages over other services.
Reviewers' conclusions
There is inconclusive evidence of the effectiveness of MST compared with other interventions for youth. There is no evidence that MST has harmful effects.
Treating adolescent depression effectively requires providing interventions that are optimally suited to patients' individual characteristics and needs. Therefore, we aim to develop an algorithm that matches patients with optimal treatment among cognitive-behavioral therapy (CBT), fluoxetine (FLX), and combination treatment (COMB). We leveraged data from a completed clinical trial, the Treatment for adolescents with depression study, where a wide range of demographic, clinical, and psychosocial measures were collected from adolescents diagnosed with major depressive disorder prior to treatment. Machine-learning techniques were employed to derive a model that predicts treatment response (week 12 children's depression rating scale-revised [CDRS-R]) to CBT, FLX, and COMB. The resulting model successfully identified subgroups of patients that respond preferentially to specific types of treatment. Specifically, our model identified a subgroup of patients (25%) that achieved on average a 16.9 point benefit on the CDRS-R from FLX compared to CBT. The model also identified a subgroup of patients (50%) that achieved an average benefit up to 19.0 points from COMB compared to CBT. Physical illness and disability were identified as overall predictors of response to treatment, regardless of treatment type, whereas baseline CDRS-R, psychosomatic symptoms, school missed, view of self, treatment expectations, and attention problems determined the patients' response to specific treatments. The model developed in this study provides a critical starting point for personalized treatment planning for adolescent depression.
Purpose:
There are well-established associations between parental/peer relationships and adolescent substance use, but few longitudinal studies have examined whether adolescents change their substance use in response to changes in their parents' behavior or peer networks. We employ a within-person change approach to address two key questions: Are changes in parenting and peer factors associated with changes in adolescent marijuana and alcohol use? Are there sensitive periods when changes in parenting and peer factors are more strongly associated with changes in adolescent marijuana and alcohol use?
Methods:
We analyzed longitudinal data collected annually on 503 boys, ages 13-19, recruited from Pittsburgh public schools. Questionnaires regarding parental supervision, negative parenting practices, parental stress, physical punishment, peer delinquency, and peer drug use were administered to adolescents and their caretakers. Alcohol and marijuana use were assessed by a substance use scale adapted from the National Youth Survey.
Results:
Reductions in parental supervision and increases in peer drug use and peer delinquency were associated with increases in marijuana frequency, alcohol frequency, and alcohol quantity. Increases in parental stress were associated with increases in marijuana and alcohol frequency. The magnitudes of these relationships were strongest at ages 14-15 and systematically decreased across adolescence. These associations were not due to unmeasured stable confounders or measured time-varying confounders.
Conclusions:
Reducing or mitigating changes in parenting and peer risk factors in early adolescence may be particularly important for preventing substance use problems as adolescents transition into young adulthood.
This chapter explores the social factors such as family functioning in the lives of adolescents. Family issues play a central role in many adolescent suicide attempts. Prolonged and progressive family disruptions, inadequate family relationships, and ineffective parent–child relationships may result in adolescent suicidal behavior. Multigenerational familial difficulties, such as isolation, abandonment, long-lasting feuds, emotional cutoffs, violence, and abuse, may also result in an adolescent's suicidal behavior. Family influences on the suicidal behavior of adolescents have therefore been investigated from multiple conceptual bases including familial psychopathology, such as a family history of suicidal behavior, family composition, family histories of abuse, and family conflict. Adaptive factors including perceived support, communication, and problem solving have also been studied. Families may have strengths in a variety of areas, such as conflict resolution, communication, parental relationships, or extended family support. Highlighting these areas can be healing and normalizing for the family and set the stage for the difficult work of addressing dysfunctional aspects of the family system. Findings from studies in these areas of family functioning conducted in the past decade are summarized in this chapter.
The quality of the parent–child relationship is crucial for early childhood development and has consequences for health and well‐being throughout the lifespan. Prevention programs and therapies, such as parent training and systemic family therapy, can lead to improvements in the parent–child relationship, but still tend to be underutilized from a public health perspective. Further, parent–child relationship problems are not consistently screened and assessed across many clinical and public health settings. The purpose of this chapter is to review the current status of assessment of parent–child relationship problems including the assessment in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD) as well as with interviews, questionnaires, and observational measures. Specific recommendations for researchers, clinicians, and public health are provided.
HIV-related stigma has been documented as one of the greatest obstacles to reducing HIV spread, engagement in HIV treatment, and poor mental health functioning among people living with HIV (PLWH). Although disclosure is important for people to receive social support, the fear of stigma and discrimination prevents PLWH from disclosing their status. For children and adolescents growing up with HIV –with no opportunity for normal transition through adolescence due to stigma, it is important to identify additional family and community support systems, to improve their acceptance and health outcomes, including mental health functioning. This study examined family communication and social support factors associated with HIV disclosure and HIV-related stigma among children and adolescents living with HIV in Uganda. Baseline data from an NICHD-funded Suubi+Adherence study (N=702) were analyzed. Adolescents (10–16 years) were eligible to participate if they were: 1) HIV positive and knew their HIV status, 2) prescribed antiretroviral therapy, 3) lived within a family, not an institution, and 4) enrolled in one of the 39 health centers in the study area. Multiple regression analyses were conducted to determine family communication (frequency and level of comfort communicating with caregiver), social support (perceived child-caregiver support and social support from classmates, close friends, teachers, and caregivers), associated with HIV disclosure, disclosure comfort, and HIV internalized and anticipated stigma. Results show that level of comfort communicating with a caregiver was significantly associated with how often children discussed their HIV status with other people (B = 0.02, 95% CI = 0.00, 0.03, p = 0.04), and level of HIV disclosure comfort (B = 0.08, 95% CI = 0.04, 0.13, p < 0.01). In addition, support from within the school environment, i.e., from teachers and classmates, was uniquely associated with both HIV disclosure and HIV-related stigma. Findings point to schools as potential for implementing HIV stigma-reduction programs. In addition, programming aimed at improving HIV care and treatment outcomes for adolescents living with HIV should consider incorporating both family communication strengthening and HIV-stigma reduction strategies in their efforts, in order to improve HIV health-related outcomes, including overall mental health functioning of HIV positive adolescents.
Introdução: A família é entendida como o primeiro ambiente de socialização e aprendizagem do ser humano. Contudo, a importância dada a este constructo relativamente ao comportamento infantil contrasta com as investigações realizadas sob o tema, que são escassas. Objetivos: 1) Estudar as associações entre o funcionamento familiar, estilos educativos parentais e capacidades e dificuldades das crianças e adolescentes; 2) Examinar as diferenças no funcionamento familiar e nas capacidades e dificuldades das crianças e adolescentes em função dos estilos educativos parentais; 3) Analisar as diferenças em função de variáveis sociodemográficas (tipo de família, posição na fratria, idade e sexo, habilitações dos pais e rendimentos familiares); 4) Verificar se a amostra regista diferenças em função do tipo de preenchimento do protocolo (em papel ou online).
Metodologia: Participaram 202 mães (M = 40,02 anos; DP = 5,54 anos; Min.-Max. = 26-60 anos) às quais foi pedido que respondessem ao protocolo do estudo constituído por: Questionário Sociodemográfico; Authorotive Parenting Index (API); Systemic Clinical Outcome Routine Evaluation (SCORE-15) e Strenghts and Difficulties Questionaire (SDQ).
Resultados: Observam-se associações negativas na aceitação parental (API) com a disfuncionalidade familiar, comunicação e dificuldades familiares (SCORE-15) e no comportamento pró-social do SDQ com a disfuncionalidade e dificuldades familiares (SCORE-15). O estilo parental que mais contribui para um pior funcionamento familiar e dificuldades nos filhos é o estilo autoritário e o estilo democrático contribui para um melhor funcionamento familiar e habilidades sociais nos filhos. Os pais com habilitações académicas e nível socioeconómico baixos possuem um maior nível de disfuncionalidade e dificuldades familiares. As diferenças em função do tipo de família, idade e sexo dos filhos e quanto ao tipo de preenchimento do protocolo são pouco significativas.
Discussão: Confirma-se a relevância dos estilos educativos parentais na vida familiar e comportamento dos filhos, assim como a importância de algumas variáveis familiares nas dificuldades e capacidades das crianças e adolescentes. Os resultados constituem uma mais-valia para o estado da arte em Portugal e para o apoio à elaboração de programas focados na parentalidade e relações familiares.
Palavras-chave: funcionamento familiar; tipo de família; estilos educativos parentais; dificuldades na infância e adolescência; comportamento pró-social.
Background:
Adolescents living with HIV in sub-Saharan Africa are a vulnerable group at the intersection of poverty and health disparities. The family is a vital microsystem that provides financial and emotional support to achieve optimal antiretroviral therapy (ART) adherence. In this study, we explore the association between family factors and ART adherence self-efficacy, a significant psychological concept playing a critical role in ART adherence.
Methods:
Data from an NIH-funded study called Suubi + Adherence, an economic empowerment intervention for HIV positive adolescents (average age = 12.4 years) in southern Uganda was analyzed. We conducted multilevel regression analyses to explore the protective family factors, measured by family cohesion, child-caregiver communication and perceived child-caregiver support, associated with ART adherence self-efficacy.
Results:
The average age was 12.4 years and 56.4% of participants were female. The average household size was 5.7 people, with 2.3 children> 18 years. Controlling for sociodemographic and household characteristics, family cohesion (β = 0.397, p = 0.000) and child-caregiver communication (β = 0.118, p = 0.026) were significantly associated with adherence self-efficacy to ART.
Conclusion:
Findings point to the need to strengthen family cohesion and communication within families if we are to enhance adherence self-efficacy among adolescents living with HIV.
Trial registration:
This trial was registered with ClinicalTrials.gov (registration number: NCT01790373) on 13 February 2013.
Background:
Acquired brain injury (ABI), such as Parkinson's disease, dementia or stroke, can result in communication difficulties that lead to an impoverished ability to connect meaningfully with others. Choral singing is a complex task that uses multiple brain regions which are also responsible for language and communication skills. The potential therapeutic effects of group singing on communication-related outcomes across ABI aetiologies have not been systematically reviewed.
Aims:
To examine whether participation in group singing over multiple sessions improves speech, voice, language and/or communication skills in individuals with ABI-related communication disorders.
Methods & procedures:
A database search was undertaken according to the PRISMA guidelines. Search terms included: stroke OR Parkinson* OR dementia OR 'acquired brain injury' AND choir OR choral OR singing OR sing OR 'choral sing* ' OR group adj3 singing OR community adj3 singing AND speech OR language OR communication.
Main contribution:
A total of 11 studies were included. Nine were quantitative, including one randomized and one non-randomized control trial, and two were mixed method. Nine studies were scored as level IV (uncontrolled) on the American Academy of Neurology (AAN) Classification of Evidence Matrix and two as level III (e.g., lack of blinded assessors). Eight examined speech and voice skills in Parkinson's disease, two functional communication skills in post-stroke aphasia and one communication between individuals with dementia and a significant other. One level III control trials provided evidence for a therapeutic effect of group singing on communication in individuals with Parkinson's disease.
Conclusions & implications:
Currently, there is only one study providing support for using group singing to improve speech and voice skills in people with Parkinson's disease, and no studies of adequate quality indicating positive effects on language and functional communication abilities in ABI. Further research using more rigorous experimental designs is required to determine whether group singing can influence communication skills in ABI. What this paper adds What is already known on the subject Music activates widespread, bilateral cortical and subcortical brain regions. Group singing is increasingly understood to have positive benefits on quality of life and health-related well-being in both healthy and clinical populations. Given the crossover in neural networks between singing, speech and language, singing activities are also thought to have positive effect of communication impairments secondary to ABI. However, to date, the research evidence supporting the application of group singing for communication impairments in ABI has not been summarized. What this paper adds to existing knowledge A total of 11 studies have looked at communication outcomes after group singing in ABI. For most of these, the quality of evidence was low (AAN level IV). It also highlights that there is a bias in the literature towards the studying individuals with Parkinson's disease (i.e., nine of the 11 studies). What are the potential or actual clinical implications of this work? This review concludes that, currently, there is emerging evidence to support positive effects of a group singing for speech and voice symptoms in individuals with Parkinson's disease, when provided using the Tamplin protocol. However, there is not yet any evidence for communication benefits for individuals with aphasia or dementia.
Adolescents living with HIV in Uganda are impacted by poverty and face a number of health and social challenges including access to medication, health complications, and social stigma. These stressors have been linked to depression, which can lead to lower HIV treatment adherence. This study seeks to determine how social and economic equity, family cohesion, and social supports may be related to depression among adolescents living with HIV. We used baseline data from the Suubi + Adherence study, a 5-year longitudinal randomized controlled trial among adolescents living with HIV in southwestern Uganda (n = 675; ages 10–16 years). Hierarchical logistic regression models were conducted separately among in-school adolescents and out-of-school adolescents to assess the hypothesized associations between economic and social equity, social support, and depression. About half of the participants meet the criteria for depression. Adolescents with depression were found to have fewer economic and social supports. Our findings indicate that social and economic equity [odds ratio (OR) = 0.85, 95% confidence interval (CI) 0.74, 0.99], family cohesion (OR = 0.94, 95% CI 0.91–0.96), and social support from friends (OR = 0.95, 95% CI 0.91–0.998) are associated with depression for in-school HIV infected adolescents and could be protective factors. The results of this study suggest that social and economic equity may play a protective role against depression and other poor mental health outcomes. Potential interventions for adolescents living with HIV should consider these social and familial factors as they may be protective of depression in this population.
Evidence points to a correlation between perceived social support and children’s psychological well-being globally. However, only a few studies have examined the relationship between perceived social support (PSS) from multiple sources and children’s psychological outcomes. Even fewer studies have examined the relationship between perceived social support from multiple sources and the psychological outcomes of children orphaned by HIV/AIDS in Sub-Saharan Africa (SSA). This study examines whether PSS from multiple sources (parents/caregivers, teachers, friends and classmates) and family cohesion are independently and collectively associated with the psychological well-being of children orphaned by HIV/AIDS in Uganda. This study used baseline data from a National Institute of Health (NIH)-funded Suubi-Maka (Hope for families) study, conducted in Southwestern Uganda. A total of 346 child-caregiver dyads from 10 comparable primary schools participated in the study. Multivariate and multivariable regression analyses were conducted to examine: (1) variations in PSS from multiple sources and family cohesion, and (2) the relationship between PSS, family cohesion and children’s psychological outcomes, measured by depression, hopelessness, and self-concept. Controlling for participants’ demographic and household characteristics, the combined measure of PSS from multiple sources was positively associated with self-concept (b = .32, 95% CI = .23, .41, p ≤ .001) and negatively associated with hopelessness (b = −.19, 95% CI = −.29, −.09, p ≤ .001) and depressive symptoms (b = −.13, 95% CI = −.23, −.03, p ≤ .01). PSS from parents/guardians and teachers was a significant predictor. In addition, family cohesion was positively associated with self-concept (b = .37, 95% CI = .15, .58, p ≤ .001) and negatively associated with depressive symptoms (b = −.36, 95%CI = −.59, −.13, p≤ = .01). Findings indicate that family cohesion and perceived social support, especially from parent/caregivers and teachers were associated with better children’s psychological outcomes. In HIV-impacted communities, interventions designed to strengthen family relationships and social support are essential to offset children’s psychological well-being.
Abstract
Particularly the developers of technical aids are
often confronted with a low level of acceptance
in the field of dementia disease. There is a large
number of products and design artifacts which have
failed to meet the needs of people with dementia,
but why? How can a responsible-orientated design
be realized, and which approaches and methods
for the process of design and design research are
useful? Consequently, which design strategies can
help to develop solutions in the form of artifacts to
support the daily life of people living with dementia?
In collaboration with the Alzheimer Association
Berlin, I am investigating the possibilities of a
sustainable design in consideration of social,
ethical and ecological aspects. In order to facilitate
a needs-oriented and human-centered design of
wearable technologies in my case study spur, the
affected persons and their relatives are included in
the conception, development and design, as well
as conventional experts: medics, therapists and
technologists.
Keywords: Textile-and Surface-Design, InteractionDesign, Wearable Technology
A personalized approach to treatment with patients being matched to the best-fit treatment has been proposed as one possible solution to the currently modest treatment response rates for adolescent depression. Personalized treatment involves identifying and characterizing subgroups likely to respond differently to different treatments. We investigated the feasibility of this approach, by focusing on two key risk factors that are the purported treatment targets of cognitive behavioral therapy (CBT) and interpersonal psychotherapy for depressed adolescents (IPT-A): negative unrealistic cognitions and interpersonal relationship difficulties, respectively. We sought to learn whether subgroups high and low on the two risk factors, respectively, might be identified in a large sample of depressed, treatment-seeking adolescents. Latent class analysis (LCA) was conducted on measures of the two risk factors among 431 adolescents (age 12–17) in the Treatment for Adolescents with Depression Study. LCA identified three classes: (1) adolescents with high levels of problems in both family relationships and cognitions (21.6% of sample), (2) adolescents with moderate levels of problems in both domains (52.4%), and (3) adolescents with low levels of problems in both domains (26.0%). These subgroups did not predict treatment outcome with CBT or CBT + fluoxetine (COMB). The results challenge a current assumption about how treatments could be personalized, and they support a multi-causal model of depression rather than a risk-factor-specific model. Strategies other than risk factor-based personalizing for case assignment to CBT vs. IPT-A are discussed.
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