The Shamiri Group Intervention for Adolescent Depression and Anxiety in Sub Saharan Africa: A Randomised Clinical Trial

Akash Wasil, Katherine E. Venturo-Conerly, Sarah Gillespie, Tom L Osborn, and John R. Weisz. Submitted. Using Ideographic Measurement to Complement Standardized Symptom Questionnaires: Assessing Top Problems and Internalizing Symptoms in Kenyan Adolescents. PsyArXiv. Publisher's Version Abstract

Children and adolescents in non-western settings and low-resource environments may experience distinctive problems and psychiatric symptoms. Researchers and policymakers often aim to understand those problems and symptoms using standardized nomothetic assessment tools. These tools tend to be validated on western samples and may “miss” problems that are prevalent and important in non-western cultures. Brief, low-cost, idiographic assessment tools may help identify these concerns, usefully complementing traditional measurements. To examine this idea, we applied the Top Problems Assessment (Weisz et al., 2011) and two standardized measures of depression and anxiety to 100 adolescents from Kibera, a resource-poor urban settlement in Kenya. Data were collected from early June to July of 2018. The Top Problems Assessment asked students to identify their three most important problems. We then a) applied thematic analysis (Braun & Clark, 2006) to identify the most frequently reported types of problems and b) analyzed the depressive and anxiety symptoms most frequently endorsed on the standardized measures. Standardized assessment revealed that worrying and difficulty concentrating were the most commonly reported symptoms. On the Top Problems Assessment, 61% of the sample reported a social problem, 38% a cognitive problem, and 35% an economic problem. By contrast, emotional and behavioral problems assessed via the standardized measures were reported as top problems by only 17% of the sample. The Top Problems Assessment yielded specific problems faced by Kenyan youth that may not have emerged through a routine assessment using standardized measures. Our findings are the first to demonstrate that the Top Problems Assessment can be used to identify locally relevant concerns that may be missed by commonly used standardized measures. Overall, our findings suggest that idiographic assessments like the Top Problems Assessment can produce culturally relevant information and usefully complement standardized measurement tools.

Tom L. Osborn, Akash R. Wasil, Katherine E. Venturo-Conerly, Jessica L. Schleider, and John R. Weisz. 6/1/2020. “Group Intervention for Adolescent Anxiety and Depression: Outcomes of a Randomized Trial with Adolescents in Kenya.” Behavior Therapy, 51, 4, Pp. 601-615. Publisher's Version

osbornshamiri2019_bt.pdf

Tom L Osborn, Arthur Kleinman, and John R. Weisz. In Press. “Complementing Standard Western Measures of Depression with Locally Co-developed Instruments: A Cross-Cultural Study on the Experience of Depression Among the Luo in Kenya.” Transcultural Psychiatry. Publisher's Version Abstract

Our present understanding of depression relies on a Western nosology that might not be generalizable across diverse cultures around the world. As a consequence, current clinical research and practice may not capture culturally salient features of depression. Expanded cross-cultural research that uses ethnographic methods and indigenous instruments may yield information of clinical utility to enhance culturally sensitive research and practice. In this mixed methods study, we used ethno-semantic interview procedures based on the DSM-5’s cultural formulation process to elicit a broad range of depression features reported by the Luo people of Western Kenya. We identified how the Luo conceptualize depression, including idioms of depressive distress, moods associated with persistent negative affect, and other features including context, stressors and support systems. This information informed the co-development of a Luo Depression Questionnaire (LDQ-17). We used the LDQ-17 in a cross-sectional community survey (N=116) to investigate its association with a standard Western instrument (Patient Health Questionnaire-9; PHQ-9). Factor analysis revealed a 1-factor model for the PHQ-9 but not the LDQ-17 for which exploratory factor analysis suggested a 3-factor model including cognitive, affective, and physical symptoms. Psychological, environmental/social, and even supernatural causes of these symptoms were identified, as were support systems. Finally, visualizations through multidimensional scaling approaches showed some overlap between the LDQ-17 and the PHQ-9, but the indigenous LDQ-17 identified salient features the Luo associated with depression that the PHQ-9 missed. Our findings illustrate how simple ethnographic procedures may guide development of indigenous instruments to complement current standardized instruments, potentially enhancing cultural relevance.

Tom L Osborn, Katherine E. Venturo-Conerly, Susana Arango G, Elizabeth Roe, Micaela Rodriguez, Rediet Alemu, Jenny Gan, Akash R. Wasil, Benny Hinn Otieno, David M Ndetei, Christine Wasanga, Jessica L. Schleider, and John R Weisz. Submitted. “The Shamiri Group Intervention for Adolescent Depression and Anxiety in Sub Saharan Africa: A Randomised Clinical Trial”.

Katherine E. Venturo-Conerly, Tom L Osborn, Rediet Alemu, Elizabeth Roe, Micaela Rodriguez, Jenny Gan, Susana Arango G, Akash R. Wasil, Christine Wasanga, and John R Weisz. Submitted. “School-based, Lay-provider-delivered Single-session Interventions Reduced Anxiety in Kenyan Adolescents: Outcomes from A Randomized Controlled Trial”.

Tom L Osborn, Stephanie Campbell, David Ndetei, and John R. Weisz. Submitted. Network Analysis Reveals Central Symptoms of Adolescent Depression and Anxiety in Sub-Saharan Africa. PsyArXiv. Publisher's Version Abstract

Adolescent depression and anxiety—which are linked with many negative life outcomes—are prevalent around the world, particularly in low-income countries such as those in Sub Saharan Africa (SSA). We used network analysis to examine the topology, stability, and centrality of depression and anxiety symptoms. We analyzed data from a large community sample (N = 2,192) of Kenyan adolescents aged 13-18, using the Patient Health Questionnaire and the Generalized Anxiety Disorder Screener. We identified the central symptoms of the depression and anxiety symptom networks, and we compared the structure and connectivity of these networks between low-symptom and elevated-symptom sub-samples. Our findings indicate the most central depression symptoms were “self-blame” and “depressed mood”, while the strongest depression symptom associations were “self-blame” ––“depressed mood” and “trouble concentrating” ––“little interest/pleasure”. Similarly, the most central anxiety symptoms were “too much worry” and “uncontrollable worry”, while strongest anxiety symptom associations were “too much worry” ––“uncontrollable worry” and “trouble relaxing” ––“restlessness”. We found a statistical difference in the network structure between low-symptom and elevated-symptom adolescents. The low-symptom sample had higher network connectivity scores for both depression (global strength difference = 0.30; low-symptom = 0.49; high-symptom = 0.19; p = .003) and anxiety symptoms (global strength difference = 1.04; low-symptom = 1.57; high-symptom = 0.53; p < .001). This is the first report that uses network analysis techniques to identify central symptoms of adolescent depression and anxiety in SSA. Our findings illustrate how network analysis may inform understanding of psychopathology within cultures and suggest promising treatment targets.

Tom L. Osborn

A.B, Psychology (High Honors)
Harvard College Class of 2020

The Shamiri Group Intervention for Adolescent Depression and Anxiety in Sub Saharan Africa: A Randomised Clinical Trial

Citation:

Recent Publications

Tom L. Osborn

A.B, Psychology (High Honors) Harvard College Class of 2020

Citation:

Recent Publications

A.B, Psychology (High Honors)
Harvard College Class of 2020