Columbia Worldwide Child Mental Health Awareness - Cairo Presentation

Child Mental Health Awareness: A Nine-Country Pilot Study, 2 004-2005 Presented by: Christina W. Hoven For: WPA-WHO Awareness Taskforce Chairperson: Sam Tyano, Israel Members: Theresa Ange Agossou, WHO/AFRO Myron Belfer, Switzerland K. Michael Hong, Korea Christina W. Hoven, USA Du, Yasong, China Danuta Wasserman, Sweden WPA Meetings; Cairo, Egypt September 15, 2005 WPA IACAPAP WHO

WPA Child Mental Health Steering Committee
Chairperson: Ahmed Okasha, Egypt
Vice Chairperson: Norman Sartorius, Switzerland
Scientific Director: Helmut Remschmidt, Germany
Scientific Vice Director: Sam Tyano, Israel
Secretary: Tarek Okasha, Egypt
Members: John H. Heiligenstein, USA
Peter Jensen, USA
Barry Nurcombe, Australia
WHO Representative: Myron Belfer, Switzerland

Armenia
Site Project Director: Maruke Yeghiyan
Project Coordinator: Anna Velitsyan
Other Contributors: ACPP members
Area: One school in the Yerevan district
Azerbaijan (Funded by GIP) Site Project Director: Fuad Ismayilov Project Coordinator: Nadir Ismayilov Co-Investigator: Hadji Agabek Sultanov Project Director: Polad Azizov Other Contributors: Indira Hadjiyeva, Viktoria Magerramova, Nazim Babayev, Tamerlan Radjabov, Vugar Mehtiyev, Sevda Katibli, Zemfira Ismayilova, Shaik Sultanov Area: F our schools: two urban schools in Baku; and, two rural schools in Mardakan and Shuvelan Participating Countries

Brazil Project Coordinator: Luis Augusto Rohde Co-Principal Investigator: Júlia Obst Comassetto Co-Investigator: Rosane Brusius de Moraes Other Contributors: Maycoln L. M. Teodoro, and Clarissa Paim Area: One public school in Porto Alegre, the capital of Brazil’s southernmost state. China Project Director: Du, Yasong Project Manager: Zhao, Zhimin Data Coordinator: Liu, Yi Other Contributors: Wu, Zengquiang Area: Six schools in Shanghai Participating Countries (continued)

Egypt Project Director: Amira Seif El Dine Other Contributors: Mohamed Ramadan, Nagla Fathi, Mohamed Osman, Dalia El Said, Wafaa Saad Area: Four schools in Alexandria Georgia (Funded by GIP) Project Director: Tea Jaliashvili Co-Investigator: Marine Gegelashvili Project Manager: Jan Vorisek Campaign: Four schools: three in Tbilisi and one in Rustavi Participating Countries (continued)

Israel Principal Investigator: Alan Apter Site Project Manager: Gitit Peer candidate Area: Two high schools and one elementary school in a small town in Northern Israel. Russia Principal Investigator: Tatjana Dmitrieva Other Contributors: Andrey Zanozin, Andreyuk, Alexandra Drozdova Area: One school in Nizhny Novgorod. Uganda Principal Investigator: Emilio Ovuga Project Manager: Juliet Nakku Other Contributors: Alexander Bombom Area: Four primary schools and five secondary schools in Kampala City Participating Countries (continued)

International Coordinating Center at Columbia University International Study Director: Christina W. Hoven International Project Coordinator: Thao Doan International Project Data Managers: Fan Bin, George J. Musa Awareness Manual Writing Team: David Wilkin (Team Leader), Thao Doan, Carol Herbig, Mohammad Karim, Chakravarthy Koonapareddy, Donald J. Mandell, Katie Merrill, Awali Samara, Karen Sautter, Cynthia Weinstein Procedure Manual Writing Team: Fan Bin, Donald J. Mandell, George J. Musa, Karen Sautter, Min Tang, Judith Wicks, Data Entry Programming Team: Alex Resto, Bensheng Ouyang

Study Rationale
Psychiatric disorders/symptoms are frequently undetected/untreated.
Awareness is a precondition for symptoms/disorders to be recognized.
To raise awareness while avoiding unrealistic expectations about available services.
Assumption that sound information will contribute to advocacy, thus shorten the time when services become available.

Institutional Review Board Approval
Baseline and follow-up surveys to be anonymous.
Institutional Review Board (IRB) approval obtained at each site.
International Coordinating Center IRB approval obtained before data was submitted.

Study Design
Pre and Post assessment of students, parents and teachers.
Assessment of awareness of signs and symptoms of childhood psychopathology.
Assessment of child psychopathology/ impairment (SDQ), child only.
Assessment of stigma and attribution of symptoms.
Assessment of knowledge and desire for more information about mental illness.

Study Methodology
Countries selected to represent different regions, cultures and languages.
To systematically disseminate accurate information, an Awareness Manual was developed.
Awareness Manual describes signs and symptoms and serves as a resource for educating healthcare professionals, parents, teachers and students.
To insure comparability in implementation and execution, a Procedures Manual was developed, describing all aspects of study, including sampling methods
Data Procedures Manual : Data collection, data entry, etc.

Samples
School children, their parents and their teachers.
Schools were to be randomly selected.
Student ages: 10-11 and 16-17.
Target at least 400 students (200 in each age group) at each site.

Study Procedures
Following Procedures Manual participants completed a baseline questionnaire.
Each site waged an Awareness Campaign, based on the Awareness Manual .
Approximately two weeks after the Awareness Campaign, a follow-up questionnaire was administered.
Data Entry Manual to guide data collect, data entry and data transmission procedures.

Manuals Developed for Study

Overview of Study Design Approval (Highest, Local, and Individual School Authorities) Parent Support Organizations Randomly Select Schools and Classrooms Obtain Parent Consent Pilot Test Procedures Pre-Campaign Survey Post-Campaign Survey Double Data Entry and Data Submission Start Planning Awareness Campaign Conduct Awareness Campaign

Study Website
Dissemination of information and materials (e.g., the Awareness Manual , the Procedures Manual , Site Activity Logs, Survey Questionnaires, Data Entry Programs and Data Entry Manual ).
Email link for asking questions about procedures, which were responded to by the International Coordinating Center.

Pre-Campaign

Questionnaires Administered 236 260 1,954 495 607 2,472 Total 22 73 418 56 149 403 Uganda 15 96 144 26 129 159 Russia 0 0 0 60 31 143 Israel 34 42 364 43 53 432 Georgia 0 0 0 39 94 174 Egypt 115 0 541 114 0 541 China 5 0 106 7 0 119 Brazil 45 49 381 50 51 400 Azerbaijan 0 0 0 100 100 100 Armenia Teachers Parents Students Teachers Parents Students Site Post-Campaign Pre-Campaign

All Sites: Pre-Campaign Student Demographics 2,472 403 159 143 432 174 541 119 400 100 N Female (%) Age (Mean + SD) SITE 60.6 15.1 + 2.60 Israel 57.6 13.9 + 2.88 Russia 54.6 13.6 + 1.62 Egypt 55.0 13.9 + 2.35 Georgia 53.6 13.4 + 3.06 Uganda 53.1 14.2 + 2.73 TOTAL 48.6 15.8 + 1.99 China 53.8 14.0 + 2.81 Brazil 51.5 13.5 + 2.86 Azerbaijan 53.0 13.3 + 3.14 Armenia

All Sites: Pre-Campaign Parent Demographics 518 119 86 27 51 88 NA NA 47 100 N Has at least 1 child w/ MH problem (%) Female (%) SITE NA 63.0 Israel 17.1 83.7 Russia 12.6 51.1 Egypt 12.0 100.0 Georgia 37.5 63.9 Uganda 17.4 69.9 TOTAL China Brazil 6.4 76.5 Azerbaijan 11.0 65.0 Armenia

All Sites: Pre-Campaign Teacher Demographics 477 56 21 54 42 33 114 7 50 100 N Has at least 1 student w/ MH problem (%) Female (%) SITE 94.0 75.9 Israel 90.9 100.0 Russia 74.3 72.7 Egypt 41.0 97.6 Georgia 60.8 53.6 Uganda 54.8 70.6 TOTAL 57.0 64.4 China 100.0 100.0 Brazil 68.0 76.0 Azerbaijan 11.0 65.0 Armenia

All Sites: Pre-Campaign Student Report: SDQ (N = 2,281)

All Sites: Pre-Campaign Mental Health Awareness

Armenia: Pre-Campaign Mental Health Awareness

Azerbaijan: Pre-Campaign Mental Health Awareness

Brazil: Pre-Campaign Mental Health Awareness N/A N/A N/A

China: Pre-Campaign Mental Health Awareness N/A N/A N/A

Egypt: Pre-Campaign Mental Health Awareness

Georgia: Pre-Campaign Mental Health Awareness

Israel: Pre-Campaign Mental Health Awareness

Russia: Pre-Campaign Mental Health Awareness

Uganda: Pre-Campaign Mental Health Awareness

Campaigns

Awareness Campaign Methods Number of Sites

Post-Campaign

All Sites: Post-Campaign Mental Health Awareness *Only asked of those who knew of school MH campaign.

All Sites: Post-Campaign Student Report: “Campaign Changed How Child Feels Talking To …”

All Sites: Post-Campaign Parent Report: “Campaign Changed How …”

All Sites: Post-Campaign Teacher Report: “Campaign Changed How …”

All Sites: Post-Campaign Parent Report: “Campaign Increased Understanding about MH Problems Among …”

All Sites: Post-Campaign Teacher Report: “Campaign Increased Understanding about MH Problems Among …”

Azerbaijan: Post-Campaign Mental Health Awareness *Only asked of those who knew of school MH campaign.

Azerbaijan: Post-Campaign Student Report: “Campaign Changed How Child Feels Talking To …”

Azerbaijan: Post-Campaign Parent Report: “Campaign Changed How …”

Azerbaijan: Post-Campaign Teacher Report: “Campaign Changed How …”

Azerbaijan: Post-Campaign Parent Report: “Campaign Increased Understanding about MH Problems Among …”

Azerbaijan: Post-Campaign Teacher Report: “Campaign Increased Understanding about MH Problems Among …”

Brazil: Post-Campaign Mental Health Awareness *Only asked of those who knew of school MH campaign. N/A N/A N/A N/A N/A

Brazil: Post-Campaign Student Report: “Campaign Changed How Child Feels Talking To …”

Brazil: Post-Campaign Teacher Report: “Campaign Changed How …”

Brazil: Post-Campaign Teacher Report: “Campaign Increased Understanding about MH Problems Among …”

China: Post-Campaign Mental Health Awareness *Only asked of those who knew of school MH campaign. N/A N/A N/A N/A

China: Post-Campaign Student Report: “Campaign Changed How Child Feels Talking To …”

China: Post-Campaign Teacher Report: “Campaign Changed How …”

China: Post-Campaign Teacher Report: “Campaign Increased Understanding about MH Problems Among …”

Egypt: Post-Campaign Mental Health Awareness *Only asked of those who knew of school MH campaign.

Egypt: Post-Campaign Student Report: “Campaign Changed How Child Feels Talking To …”

Egypt: Post-Campaign Parent Report: “Campaign Changed How …”

Egypt: Post-Campaign Teacher Report: “Campaign Changed How …”

Egypt: Post-Campaign Parent Report: “Campaign Increased Understanding about MH Problems Among …”

Egypt: Post-Campaign Teacher Report: “Campaign Increased Understanding about MH Problems Among …”

Georgia: Post-Campaign Mental Health Awareness *Only asked of those who knew of school MH campaign.

Georgia: Post-Campaign Student Report: “Campaign Changed How Child Feels Talking To …”

Georgia: Post-Campaign Parent Report: “Campaign Changed How …”

Georgia: Post-Campaign Teacher Report: “Campaign Changed How …”

Georgia: Post-Campaign Parent Report: “Campaign Increased Understanding about MH Problems Among …”

Georgia: Post-Campaign Teacher Report: “Campaign Increased Understanding about MH Problems Among …”

Russia: Post-Campaign Mental Health Awareness *Only asked of those who knew of school MH campaign.

Russia: Post-Campaign Student Report: “Campaign Changed How Child Feels Talking To …”

Russia: Post-Campaign Parent Report: “Campaign Changed How …”

Russia: Post-Campaign Teacher Report: “Campaign Changed How …”

Russia: Post-Campaign Parent Report: “Campaign Increased Understanding about MH Problems Among …”

Russia: Post-Campaign Teacher Report: “Campaign Increased Understanding about MH Problems Among …”

Uganda: Post-Campaign Mental Health Awareness *Only asked of those who knew of school MH campaign.

Uganda: Post-Campaign Student Report: “Campaign Changed How Child Feels Talking To …”

Uganda: Post-Campaign Parent Report: “Campaign Changed How …”

Uganda: Post-Campaign Teacher Report: “Campaign Changed How …”

Uganda: Post-Campaign Parent Report: “Campaign Increased Understanding about MH Problems Among …”

Uganda: Post-Campaign Teacher Report: “Campaign Increased Understanding about MH Problems Among …”

Principle Investigator Questionnaires

Campaign: Ease of Administration Sites

Website Easy to Use? Informative?

Adequacy of Funds and Reasons for Delays Major Delays?
Main Reason Given for Delays:
Funding (4 sites)
IRB (2 sites)
Translations/ Questionnaires (2 sites)
Sufficient Funding?

Data Entry: Ease and Clarity Instructions Clear? Sites

Local Community Opinion Opinion Change? Opinion Improve?

Intentions to Conduct More Campaigns Local/National? Sites

Recommendations
Revise Awareness Manual according to feedback.
Conduct large-scale, more rigorous study, with controls.
Generate paper and web-based final Awareness Manual in multiple languages.
Make materials available worldwide.

Current Study’s Limitations
Due to time constraints, this project may have been negatively affected by not having sufficient time for adequate Awareness Campaign.
Although translations were requested to be done both forward and backward, this did not always happen.
Translations may not always have been done by individuals who were equally conversant with mental health terminology and English.
For the SDQ, the original algorithm includes parent and teacher questionnaire items in the criteria of hyperactivity disorder. Since the parent and teacher questionnaires did not include the SDQ, these items were excluded from the scoring algorithm and only student items were used (allowed by the SDQ published algorithm).

Current Study’s Limitations (Continued)
Due to time requirements for seeking and obtaining a higher level of Institutional Review Board (Ethics Committee) approval, questionnaires were necessarily anonymous and consequently the follow-up assessments were not necessarily with all the same individuals who participated at baseline.
For a variety of reasons, including distance, language differences, literacy, etc., not all parents were able to participate.
For a variety of reasons, some sites were not able to recruit the proposed sample size.

Columbia Worldwide Child Mental Health Awareness - Cairo Presentation

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Columbia Worldwide Child Mental Health Awareness - Cairo Presentation — Presentation Transcript