Group Intervention for Adolescent Anxiety and Depression: Outcomes of a Randomized Trial with Adolescents in Kenya

Youth mental health interventions in low-resource communities may benefit from including empirically supported elements, using stigma-free content, and using trained lay-providers. We developed and evaluated such an intervention, targeting adolescent depression and anxiety in Kenya, where mental health care is limited by social stigma and a paucity of providers. Kenyan adolescents (N = 51, ages 14–17, 60.78% female) from a school in an urban slum in Nairobi with self-reported moderate-to-severe symptoms of depression or anxiety were randomized to the 4-week “Shamiri” (“thrive”) group intervention or a study skills control intervention of equal duration. The Shamiri intervention included growth mindset, gratitude, and value affirmation exercises. The content was delivered by recent high school graduates (ages 17–21, 60% male) trained as lay-providers. Participants met in school once-a-week in groups of 9–12 youths (average group size 10). Compared to the study-skills control, Shamiri produced greater reductions in adolescent depression symptoms (p = .038; d = .32) and anxiety symptoms (p = .039; d = .54) from baseline to 4-week follow-up, and greater improvements in academic performance (p = .034; d = .32) from the school-term before versus after the intervention. There were no effects on overall social support or perceived control, but the Shamiri group showed larger increases in perceived social support from friends (p = .028, d = .71). This appears to be the first report that a brief, lay-provider delivered, community-based intervention may reduce internalizing symptoms and improve academic outcomes in high-symptom adolescents in Sub-Saharan Africa. Larger replications with extended follow-ups will help gauge the strength and durability of these effects.     

Parents’ postnatal depressive symptoms and their children's academic attainment at 16 years: Pathways of risk transmission

The aim of the study was to examine whether parents’ increased postnatal depressive symptoms predicted children's academic attainment over time and whether the parent–child relationship, children's prior academic attainment, and mental health mediated this association. We conducted secondary analyses on the Avon Longitudinal Study of Parents and Children data (12,607 mothers, 9,456 fathers). Each parent completed the Edinburgh-Postnatal Depression Scale at 8 weeks after the child's birth (predictor) and a questionnaire about the mother–child and father–child relationship at 7 years and 1 month (mediator). The children's mental health problems were assessed with the teacher version of the Strengths and Difficulties Questionnaire at 10–11 years (mediator). We used data on the children's academic attainment on UK Key Stage 1 (5–7 years; mediator) and Key Stage 4 (General Certificate of Secondary Education 16 years) (outcome). We adjusted for the parents’ education, and child gender and cognitive ability. The results revealed that parents’ depressive symptoms at 8 weeks predicted lower academic performance in children at 16 years. Mothers’ postnatal depressive symptoms had an indirect effect through children's mental health problems on academic outcomes at 16 years via negative mother–child relationship, and prior academic attainment. There was a significant negative indirect effect of fathers’ postnatal depressive symptoms on academic attainment at 16 years via negative father–child relationship on child mental health. The findings suggest that the family environment (parental mental health and parent–child relationship) and children's mental health should be potential targets for support programmes for children of depressed parents.     

Parents’ Experiences of Their Child’s Disclosure of Child Sexual Abuse

A child’s disclosure of sexual victimization is a difficult experience for parents and has been associated with traumatization, disbelief, denial, self-blame, and clinical difficulties. To date, most studies on parents’ responses have been quantitative assessments of the psychological impact of disclosure on parents. A paucity of research has qualitatively explored mothers’ experiences of their child’s disclosure of child sexual abuse (CSA) and fathers’ experiences have been even further neglected. The current study seeks to characterize parents’ experiences of their child’s disclosure of CSA and to uncover the process-oriented nature of parental responses. This qualitative study, using a grounded theory approach to analysis, involved interviews with 10 mothers and four fathers whose children (3–18 years) had experienced sexual abuse. Three themes emerged from the analysis. The first theme—making sense of the abuse in retrospect—captured the process through which parents sought to make sense of their child’s disclosure, focusing on why their child had not disclosed the abuse to them earlier, and how they had noticed something was wrong but misattributed their child’s behavior to other factors. The second theme—negotiating parental identity as protector—reflected how parents’ identity as a protector was challenged, their perception of their world had been forever altered, and they now experienced themselves as hypervigilant and overprotective. The final theme—navigating the services—pertained to parents’ struggle in navigating child protection and police services, and feelings of being isolated and alone. These findings highlight the need for empathy and parental support following child disclosure of sexual victimization.     

Continuum between Relational and Therapeutic Models of Self-help in Mental Health: A Qualitative Approach

Self-help groups are generally described as “group[s] composed of individuals who meet on a regular basis to help one another cope with a life problem” (APA, 2019). Yet, it is challenging to find a univocal definition of self-help groups. Scholars usually use different labels to highlight various features of self-help groups, suggesting the need for further inquiry regarding commonalities and differences. The level of professional involvement is one of the most disputed factors influencing whether a group is considered to belong to the “self-help family.” The present qualitative study aimed to understand how professional support in Tuscany, Italy can influence the organizational choices of these groups (place for meetings, admission criteria, timing, etc.), as well as the personal beliefs of members. The study included 17 self-help groups. During 13 focus groups meetings, 92 participants were interviewed; then, we individually interviewed 19 facilitators and six additional key informants from mental health settings. We used a grounded theory approach, and we discussed the emerging models with participants at a public event. Results show the emergence of two theoretical models to define self-help groups, not to be interpreted as mutually exclusive. The “relational model” refers to self-help groups whose main feature is to guarantee the acquisition of specific skills (social comparison skills, active listening, and empathy), while the “therapeutic model” seems to represent a kind of assimilation of other types of interventions.     

Inward- and Outward-Directed Violence in the Lives of Urban Minority Adults Followed from Middle School into Their Thirties

This study explores connections between inward-directed violence and outward-directed violence using data from the Reach for Health sample, which was originally recruited in the 1990s from three middle schools in economically distressed, predominantly African American neighborhoods of New York City. Now in their thirties, participants (N = 595) completed surveys assessing current suicidal thoughts and behaviors as well as other violence involvements, including intimate partner violence victimization and perpetration. About 10% of males and females reported any suicidal ideation or attempt in the past 12 months. In logistic regression analyses adjusting for sociodemographics, prior reports of feeling blue in middle school (OR: 1.12, CI: 1.02–4.39) and young adult suicidality (OR: 2.54, CI: 1.30–4.95) are significantly related to later suicidality. So are concurrent aggressive behaviors, including reports of physical fighting outside the home (OR: 2.70, CI: 1.29–5.67) and IPV perpetration (OR: 2.09, CI: 1.11–3.94). Neither IPV victimization nor witnessing neighborhood violence is correlated. Findings shed light on the persistence of suicidality in the lives of those who come of age, and often remain, in communities with high levels of poverty, and confirm linkages of suicidality with externally directed aggression. Life-stage interventions are needed to counter the interwoven causes and consequences of multiple forms of violence.     

Comparing the predictive utility of trait affect and average daily affect for the prospective prediction of health outcomes

In preregistered secondary data analyses, we compared the predictive utility of trait affect and average daily affect for predicting three health outcomes across nine years (N = 1,376). Trait positive and negative affect were assessed using a 25-item dispositional questionnaire. Average daily affect was assessed as the mean of eight daily diary reports of the same items. Trait affect and average daily affect both had medium associations with self-reported general health and chronic health conditions. Moreover, both types of affect predicted mortality when adjusting for baseline health and demographics. Effect sizes were comparable for trait compared to daily affect. These findings demonstrate convergent predictive validity of trait and daily affect measures.     

The typology of parricide and the role of mental illness: Data-driven approach

Parricide is a rare type of homicide in which mental illness is often an important factor. The aims of this study were (a) to describe the characteristics of parricide offenders with a focus on mental illness and clinical care and (b) to examine Heide's widely used typology of parricide through a data-driven approach. We analyzed all homicides in England and Wales between 1997 and 2014. Parricide offenders in our sample were most often male, unmarried, and unemployed, with a third of offenders diagnosed with schizophrenia; 28% had been in contact with mental health services before the offense. The latent class analysis resulted in three types of parricide offenders: middle-aged with affective disorder, previously abused, and seriously mentally Ill, which confirmed, to an extent, Heide's typology. Health and social care services should actively engage with carers of people with mental illness and support to those caring for older relatives and victims of abuse.     

Assessing the Intersectionality of Religious and Sexual Identities During the Coming-Out Process

Lesbian, gay, and bisexual (LGB) individuals often experience internalized and/or externalized religious rejection due to their sexual orientation. Initial steps in the coming-out process can be especially difficult and can result in existential crises, including questioning one's place within the religious/spiritual realm. The authors propose a developmental framework for conceptualizing the role of religion and spirituality in the coming-out process. Cass's (1979, 1984) stage model of coming out and Genia's (1995) model of religious development, along with additional literature addressing LGB spirituality, serve as foundations for this framework. Counseling and research implications of the framework are also discussed.