乌干达“阿玛卡·阿玛萨努富”多家庭小组干预对患有破坏性行为障碍儿童心理健康功能的短期影响。
Short-Term Impact of "Amaka Amasanyufu" Multiple Family Group Intervention on Mental Health Functioning of Children With Disruptive Behavior Disorders in Uganda.
机构信息
Washington University in St. Louis, Missouri.
University of Michigan, Ann Arbor, Michigan.
出版信息
J Am Acad Child Adolesc Psychiatry. 2023 Jul;62(7):777-790. doi: 10.1016/j.jaac.2022.12.028. Epub 2023 Mar 8.
OBJECTIVE
We evaluate the mid-intervention (8 weeks) and short-term (16 weeks) impact of a culturally adapted multiple family group (MFG) intervention, "Amaka Amasanyufu," on the mental health of children with disruptive behavior disorders (DBDs) and primary caregivers in Uganda.
METHOD
We analyzed data from the Strengthening mental health and research training in Sub-Saharan Africa (SMART) Africa-Uganda study. Schools were randomized to the following: a control group; an MFG facilitated by parent peers (MFG-PP); or an MFG facilitated by community health workers (MFG:CHW). All participants were blinded to interventions provided to other participants and study hypotheses. At 8 weeks and 16 weeks, we evaluated differences in depressive symptoms and self-concept among children and in mental health and caregiving-related stress among caregivers. Three-level linear mixed-effects models were fitted. Pairwise comparisons of post-baseline group means were performed using the Sidak adjustment for multiple comparisons and standardized mean differences. Data from 636 children with DBDs and caregivers (controls: n = 243, n = 10 schools; MFG-PP: n = 194, n = 8 schools; MFG-CHW: n = 199, n = 8 schools) were analyzed.
RESULTS
There were significant group-by-time interactions for all outcomes, and differences were observed mid-intervention, with short-term effects at 16 weeks (end-intervention). MFG-PP and MFG-CHW children had significantly lower depressive symptoms and higher self-concept, whereas caregivers had significantly lower caregiving-related stress and fewer mental health problems, than controls. There was no difference between intervention groups.
CONCLUSION
Amaka Amasanyufu MFG intervention is effective for reducing depressive symptoms and improving self-concept among children with DBDs while reducing parental stress and mental health problems among caregivers. Given the paucity of culturally adapted mental health interventions, this provides support for adaptation and scale-up in Uganda and other low-resource settings.
CLINICAL TRIAL REGISTRATION INFORMATION
SMART Africa (Strengthening Mental Health Research and Training); https://clinicaltrials.gov/: NCT03081195.
目的
我们评估了一项文化适应性多重家庭小组（MFG）干预措施“Amaka Amasanyufu”对患有行为障碍障碍（DBD）的儿童及其主要照顾者的心理健康的中期（8 周）和短期（16 周）影响。
方法
我们分析了来自撒哈拉以南非洲加强精神健康和研究培训（SMART）非洲乌干达研究的数据。学校被随机分配到以下组别：对照组；由家长同伴主持的 MFG（MFG-PP）；或由社区卫生工作者主持的 MFG（MFG:CHW）。所有参与者均对其他参与者和研究假设提供的干预措施不知情。在 8 周和 16 周时，我们评估了儿童的抑郁症状和自我概念以及照顾者的心理健康和与照顾相关的压力方面的差异。使用 Sidak 调整多重比较和标准化均数差，拟合了三级线性混合效应模型。使用 Sidak 调整多重比较和标准化均数差，对基线后组均值进行了两两比较。共分析了 636 名患有 DBD 的儿童及其照顾者的数据（对照组：n = 243，n = 10 所学校；MFG-PP：n = 194，n = 8 所学校；MFG-CHW：n = 199，n = 8 所学校）。
结果
所有结果均存在显著的组间时间交互作用，并且在干预中期观察到差异，在 16 周时出现短期效应（干预结束）。MFG-PP 和 MFG-CHW 的儿童的抑郁症状明显降低，自我概念明显提高，而照顾者的与照顾相关的压力和心理健康问题明显减少，与对照组相比。干预组之间没有差异。
结论
Amaka Amasanyufu MFG 干预措施可有效降低患有 DBD 的儿童的抑郁症状和改善自我概念，同时降低照顾者的压力和心理健康问题。鉴于文化适应性心理健康干预措施的匮乏，这为乌干达和其他资源匮乏环境中的适应和扩大规模提供了支持。
临床试验注册信息
SMART 非洲（加强精神健康研究和培训）；https://clinicaltrials.gov/：NCT03081195。
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