Course Objectives
Upon completion of this course, students will be able to:
- Describe prevalent mental health problems in developing countries and discuss the issues unique to understanding mental health in these contexts
- Illustrate ways that culture can affect mental health conceptualization, identification, and assessment
- Define and compare methods of cross-cultural assessment of mental health problems
- Recognize issues and challenges inherent in adapting strategies for research in developing countries
This course covers the following topics:
- Burden of disease and overview of mental health issues in low-resource countries
- Epidemiology of mental illness and the risk and protective factors unique to populations in low-resource countries and conflict zones
- Strategies for identifying and assessing mental health cross-culturally
- Techniques for instrument development and validation in developing countries
- Cultural issues in developing, modifying, and disseminating mental illness prevention and intervention strategies
- Special attention is paid to cross-cultural challenges in conducting appropriate mental health research in low-resource settings.
Readings
World Health Organization: The World Health Report 2001 - Mental Health: New Understanding, New Hope. Available at http://www.who.int/whr/2001/en/
Course Requirements
This is a three-credit course that runs for eight weeks. The course begins with overview classes on defining mental health and understanding the epidemiology of disorders in the developing world, including risk and resiliency issues. These are followed by a series of classes on cross-cultural research methods, including an introduction to qualitative methods for mental health research, a review of issues related to assessment validity, and a critical review of different prevention and intervention strategies. The course ends with topical classes that bring together the different research issues raised in earlier classes.
Research Proposal
Over the course of the term, each student develops a research protocol on the global mental health topic and population of their own interest. Students are provided with sample proposals from previous years, and they develop the proposal over the 8 weeks to promote learning and applied writing skills. Students are encouraged to work with the instructor to discuss their topics and may request help in developing their proposal ideas.
The sections of the proposal include:
Statement of problem and literature review: Students are expected to obtain relevant background information on a mental health issue of choice. The review can encompass both Western and developing country literature but must focus on the issue as it may present in a low-resource country or conflict zone.
Assessment and study protocol:Â Students are expected to research the assessment of the mental health issue they chose and discuss how they will modify an existing instrument, or if necessary develop a new one, as relevant to the developing country they are proposing to work in. The study protocol will continue to be developed in the context of understanding the cultural and logistical issues of working in these areas.
Intervention strategy and concluding sections:Â For the final piece of the proposal, students are expected to cohesively lay out the major issues surrounding the development, modification, and/or implementation of a prevention or intervention strategy addressing their chosen mental health problem.
Textbooks
World Health Organization:
 Mental health and development: targeting people with mental health conditions as a vulnerable group. Publication Date: 2010.
Available at:Â
http://www.who.int/mental_health/policy/mhtargeting/en/index.html
Session |
Topic |
Readings |
1 |
Introduction: Burden of Disease and Course Administration |
Patel V, Prince M. Global mental health: a new global health field comes of age. JAMA 2010;303(19):1976-1977)
Kessler RC, et al. Lifetime prevalence and age-of-onset distribtions of mental disorders in the World Health Organization World Mental Health Survey Initiative. World Psychiatry 2007;6:168-176
Prince M, et al. No health without mental health. Lancet 2007;370:859-77 |
2 |
Defining Menntal Disorders |
Chapter 2 of WHO Mental Health and Development Report
Patel V. The future of psychiatry in low- and middle-income countries. Psychological Medicine 2009;39:1759-1762
Lund C, et al. Poverty and common mental disorders in low an dmiddle income countries: A systematic review. Social Science & Medicine 2010;71:517-528
Rahman A, Prince M. Mental health in the tropics. Annals of Tropical Medicine & Parasitology. 2009;103:95-110 |
3 |
Mental Health in Complex Emergencies |
Jones L. Responding to the needs of children in crisis. International Review of Psychiatry 2008;20:291-303
Tol WA, et al. Political violence and mental health: A multidisciplinary review of the literature on Nepal. Social Science & Medicine 2010;70:35-44
Almedom AM, Summerfield D. Mental well-being in settings of "complex emergency": An overview. J Biosoc Sci 2004;36:381-388
Allden K, et al. Mental health and psychosocial support in crisis and conflict: report of the Mental Health Working Group. Prehospital and Disaster Medicine 2009;24:s217-s227. |
4 & 5 |
Processes of Risk and Resilience: Youth and Adults, Parts 1 and 2 |
Armenian HK, et al. Risk factors for depression in the survivors of the 1988 earthquake in Armenia. J Urban Health 2002;79:373-382
Wadsworth ME, Santiago CD. Risk and resiliency processes in ethnically diverse families in poverty. Journal of Family Psychology 2008;22:399-410
Patel V, Kleinman A. Poverty and common mental disorders in developing countries. Bull WHO 2003;81:609-615
Sabin M, et al. Factors associated with poor mental health among Guatelamalan refugees living in Mexico 20 years after civil conflict. JAMA 2003;290:635-642
Betancourt TS, Khan KT. The mental health of children affected by armed conflict: Protective processes and pathways to resilience. International Review of Psychiatry 2008;20:317-328
Eytan A, et al. Determinants of postconflict symptoms in Albanian Kosovars. J Nerv Ment Dis 2004;192:664-671 |
6 |
Culture and Mental Health |
Wilk CM, Bolton P. Local perceptions of the mental health effects of the Uganda acquired immunodeficiency syndrome epidemi. J Nerv Ment Dis 2002;190:394-397
Hinton DE, Lewis-Fernandez R. Idioms of distress among trauma survivors: subtypes and clinical utility. Cult Med Psychitry 2010;34:209-218
Bolton P, Tang AM. An alternative approach to cross-cultural function assessment. Soc Psychiatr Epidemiol 2002;37:537-543
Almedom AM, et al. Maternal psychosocial well-being in Eritrea: application of participatory methods and tools of investigation and analysis in complex emergency settings. Bull WHO 2003;81:360-366 |
7 |
Quantitative Methods |
Khawaja NG, et al. Difficulties and coping strategies of Sudanese refugees: A qualitative approach. Transcultural Psychiatry 2008;45:489
Weishaar HB. Consequences of international migration: A qualitative study on stress among Polish migrant workers in Scotland. Public Health 2008;122:1250-1256
Maman S, et al. A comparison of HIV stigma and discrimination in five international sites: The influence of care and treatment resources in high prevalence settings. Soc Sci Med 2009;68:2271-2278
Murray LK, et al. Violence and abuse among HIV-infected women and their children in Zambia: A qualitative study. J Nerv Ment Dis 2006;194:610-615 |
8 |
Instrument Development: Assessment and Translation |
Mullick MSI, Goodman R. Questionnaire screening for mental health problems in Bangladeshi children: a preliminary study. Soc Psychiatry Psychiatr Epidemiol 2001;36:94-99
Zaidi SMH. Problems of translation in cross cultural research. Journal of Cross-Cultural Psychology. 1972;3:41-56
Matias-Carrelo LE, et al. The Spanish translation and cultural adaptation of five mental health outcome measures. Culture, Medicine and Psychiatry 2003;27:291-313 |
9 |
Instrument Development: Adaptation and Validation |
Giang KB, et al. The Vietnamese version of the self-reporting questionnaire 20 (SRQ-20) in detecting mental disorders in rural Vietnam: A validation study. International Journal of Social Psychiatry 2006;52:175
Bass JK, et al. Post-partum depression in Kinshasa, Democratic Republic of Congo: Validation of a concept using a mixed-methods cross-cultural approach. Tropical Medicine and International Health 2008;13:1534-1542
Betancourt TS, et al. Assessing local instrument reliability and validity: a field-based example from northern Uganda. Soc Psychiatry Psychiatr Epidemiol 2009;44:685-692
Lauth B, et al. An Icelandic version of the Kiddie-SADS-PL: Translation, cross-cultural adaptation and inter-rater reliability. Nord J Psychiatry 2008;62:379-385 |
10 |
Psychsocial & Mental Health Interventions: Intervention Selection and Adaptation |
Silove D, Zwi AB. Translating compassion into psychosocial aid after the tsunami. Lancet 2005;365:269
Mance GA, et al. Utilizing community-based participatory research to adapt a mental health intervention for African American emerging adults. Progress in Community Health Partnerships: Research, Education, and Acation 2010;4:131-140
Layne CM, et al. Effectiveness of a schooll-based group psychotherapy program for war-exposed adolescents: A randomized controlled trial. J Am Acad Child Adolesc Psychiatry 2008;47:1048-1062 |
11 |
Vulnerable Populations, A Focus on Children |
Lustig SL, et al. Review of child and adolescent refugee mental health. J Am Acad Child Adolesc Psychiatry 2004;43:24-36
Jones L. Responding to the needs of children in crisis. International Review of Psychiatry 2008;20:291-303
Boris NW, et al. Depressive symptoms in youth heads of household in Rwanda. Arch Pediatr Adolesc Med. 2008;162(9):836-843
Rabaia Y, et al. Violence and adolescent mental health in the occupied Palestinian Territory: A contextual appraoch. Asia Pac J Public Health 2010;22:216S
|
12 |
Severe Mental Disorders |
Kulhara P, et al. Psychoeducational intervention for caregivers of Indian patients with schizophrenia: A randomised-controlled trial. Acta Psychiatr Scand 2009: 119: 472�483
Negash A, et al. Prevalence and clinical characteristics of bipolar I disorder in Butajira, Ethiopia: A community-based study. Journal of Affective Disorders 87 (2005) 193�201
Chien W-T, et al. Evaluation of a Peer-Led Mutual Support Group for Chinese Families of People with Schizophrenia. Am J Community Psychol (2008) 42:122�134
Jones L, et al. Severe mental disorders in complex emergencies. Lancet 2009;374:654-661
|
13 |
Gender and Mental Health |
Wyshak G. Violence, mental health, substance abuse - Problems for women worldwide. Health Care for Women International 2000;21:631-639
Patel V, et al. Women, poverty and common mental disorders in four restructuring societies. Social Science & Medicine 1999;49:1461-1471
Cardozo BL, et al. Mental health of women in postwar Afgahanistan. Journal of Women's Health 2005;14:285-293
Schubert CC, Punamaki R-L. Mental health among torture survivors: cultural background, refugee status and gender. Nord J Psychiatry Online 2010 |