Relational Spirituality in Adolescents: Exploring Associations with Demographics, Parenting Style, Religiosity, and Psychopathology

This study sought to investigate the construct of Relational Spirituality through: 1) identifying its correlates among demographic, spiritual, and parenting variables in a large, religiously and ethnically diverse sample of adolescents, and 2) investigating its associations with highly prevalent forms of psychopathology in adolescents. Participants were 615 adolescents representing a broad range of ethnicities (Caucasian, African-American, Asian-American, Latino, and multiracial, and other) and religious denominations (Catholic, Protestant, Jewish, Atheist, Agnostic, Buddhist, and other). The Brief-Multidimensional Measure of Spirituality/Religiosity, the Mysticism Scale, the Beck Depression Inventory and the Beck Anxiety Inventory were used to measure spirituality, depression, and anxiety, respectively, while frequency of alcohol use was ascertained with a single item. Parental relationship quality was measured using the Parental Bonding Instrument and the Parental Transparency Scale. Given that rates of depression, anxiety and spirituality have been demonstrated to be higher in girls than boys, gender differences in patterns of association were examined with respect to each type of psychopathology. Results of stepwise regression analyses revealed that exclusively in females, Relational Spirituality accounted for a significant portion of the variance in depressive symptomatology above and beyond demographic, parenting, and religious variables. Stepwise regression analyses also showed that Relational Spirituality contributed to a significant portion of variance in alcohol use above and beyond other correlated variables in both boys and girls. In contrast, Relational Spirituality did not contribute to the variance in anxiety; rather, the quality of religious social support was protective against anxious symptomatology. Findings suggest that Relational Spirituality is differentially associated with widespread forms of psychopathology in adolescents, and our understanding of these disorders may be enhanced through a spiritual perspective

The COVID-19 pandemic and maternal mental health in a fragile and conflict-affected setting: A cohort study in Tumaco, Colombia

Background: The effects of the COVID-19 pandemic on mental health have been understudied among vulnerable populations, particularly in fragile and conflict-affected settings. We aimed to analyse how the pandemic is related to early changes in mental health and parenting stress among caregivers, many of whom are internally displaced persons (IDP), in a conflict-affected setting in Colombia. Methods: For this cohort study, we used longitudinal data from a psychosocial support programme in which 1376 caregivers were randomly assigned across four sequential cohorts. Recruitment of participants took place in March, 2018, for cohort 1; July, 2018, for cohort 2; March, 2019, for cohort 3; and July, 2019, for cohort 4. Participants completed assessments at baseline, 1-month, and 8-month follow-ups. The 8-month assessment occurred before the COVID-19 pandemic for participants in cohorts 1 and 2 (n=573), whereas those in cohorts 3 and 4 (n=803) were assessed during the early stages of the pandemic, 2–5 weeks after the national lockdown began on March 25, 2020. Primary caregiver anxiety and depression were measured with a scale adapted from the Symptoms Checklist-90-Revised and parenting stress was measured with the short form of the Parenting Stress Index. We estimated how mental health changed by comparing prepandemic and postpandemic 8-month outcomes using lagged-dependent variable models. Findings: Results showed that the likelihood of reporting symptoms above the risk threshold increased by 14 percentage points for anxiety (95% CI 10–17), 5 percentage points for depression (0·5–9), and 10 percentage points for parental stress (5–15). The deterioration in mental health was stronger for IDP, participants with lower education or pre-existing mental health conditions, and for those reporting a higher number of stressors, including food insecurity and job loss. Interpretation: Maternal mental health significantly worsened during the early stages of the pandemic. Considering the vulnerability and pre-existing mental health conditions of this population, the estimated effects are substantial. Policies in fragile and conflict-affected settings targeting IDP and other vulnerable people will be important to mitigate further mental health and socioeconomic problems

Exploring potential mental health spillover effects among caregivers and partners of youth in Sierra Leone: A qualitative study

Given the large mental health treatment gap in low- and middle-income countries (LMICs), particularly in post-conflict settings like Sierra Leone, and the limited healthcare infrastructure, understanding the wider benefits of evidence-based mental health interventions within households is critical. This study explored potential mental health spillover effects – the phenomenon of beneficial effects among nonparticipants – among cohabitating caregivers and partners of youth who participated in an evidence-based mental health intervention in Sierra Leone. We recruited a sub-sample of cohabitating caregivers and partners (N = 20) of youth intervention participants; caregivers had enrolled in a larger study investigating indirect benefits of the evidence-based intervention in Sierra Leone (MH117359). Qualitative interviews were conducted at two time points to explore the following: (a) potential mental health spillover effects and (b) through which mechanisms spillover may have occurred. Two trained coders reviewed transcripts and analyzed qualitative data, assisted by MaxQDA. Qualitative findings suggested that spillover effects likely occurred and supported three potential mechanisms: decreased caregiving burden, behavior changes among Youth Readiness Intervention participants and improved interpersonal relationships. Mental health spillover effects may occur following youth intervention participation in a post-conflict LMIC. Investing in evidence-based services may offer indirect benefits that extend beyond those directly receiving services

Exploring Naturalistic Diffusion of an Evidence-Based Mental Health Intervention across Peer Networks of Youth in Sierra Leone

Background: Understanding the mechanisms by which evidence-based interventions (EBIs) for mental health are naturally diffused among youth in low-and middle-income countries—particularly those with histories of violence and civil unrest—can illuminate which intervention elements are most transferrable and inform scale-up decisions that support youth adjustment. This study explored the diffusion of an evidence-based mental health intervention—the Youth Readiness Intervention (YRI)—among peer networks of Sierra Leonean youth (aged 18–30) who participated in a trial of the intervention as integrated into youth entrepreneurship programs. Methods: Trained research assistants recruited index participants who had completed the YRI integrated within entrepreneurship training (N = 165) and control index participants (N = 165). Index participants nominated three of their closest peers. Nominated peers were recruited and enrolled in the current study (N = 289). A sub-sample of index participants and peers participated in dyadic interviews (N = 11) and focus group discussions (N = 16). Multivariate regression analysis compared YRI knowledge levels among YRI participants’ peers relative to control participants’ peers. Results: Qualitative findings supported the diffusion of several YRI skills and components across peer networks (i.e., progressive muscle relaxation and diaphragmatic breathing). Quantitative findings indicated that YRI knowledge was significantly higher for YRI participants’ peers (β = 0.02, p < 0.00) compared to control participants’ peers. Conclusion: Findings suggest that diffusion of evidence-based intervention components can occur naturally among peers in post-conflict LMIC settings. Developing tools to promote the diffusion of the most transferrable EBI components across peer networks could help maximize the benefits of mental health interventions for youth adjustment and resilience in post-conflict settings

Advancing sustainable implementation of an evidence-based mental health intervention in Sierra Leone’s schools: protocol for a hybrid type 3 implementation-effectiveness trial

Abstract Background Mental health disorders among youth contribute substantially to the global burden of disease, which is exacerbated in low- and middle-income countries (LMICs) due to large mental health treatment gaps. In Sierra Leone, a West African country with a long history of complex adversity, the mental health treatment gap is estimated at 98%. Implementing innovative mental health interventions that can be sustained at scale is a priority. The Youth Readiness Intervention (YRI) is an evidence-based mental health intervention for youth that can be delivered feasibly by lay health workers/nonspecialists. Using mobile-based technologies to assist implementation could improve the reach and sustainability of the YRI in Sierra Leone. This study aims to train teachers to deliver the YRI in Sierra Leone’s secondary schools and test the feasibility, acceptability, cost, and fidelity to the YRI of a mobile-based supervision model compared with standard, in-person supervision. Methods We will conduct a hybrid type 3 implementation-effectiveness cluster randomized trial to assess the feasibility, acceptability, costs and fidelity to the YRI implemented by teachers receiving mobile-based supervision vs. standard supervision. Enrolled schools (N = 50) will be randomized to YRI + mobile supervision (N = 20), YRI + standard supervision (N = 20) or waitlist control (N = 10). We will recruit and enroll four teachers per intervention-condition school (N = 160) and 1200 youth. We will collect data on implementation outcomes among teachers, principals and youth via a mixed methods approach at baseline and post-intervention. We will also collect quantitative data on youth mental health and functioning as secondary outcomes at baseline and post-intervention, as well as cost-effectiveness data at 12-month follow-up. Discussion Study findings have the potential to expand the reach of mental health services among youth in low-resource settings via a teacher workforce. The use of mobile tools, if successful, could support further scale out and sustainment of the YRI to other regions of Sierra Leone and West Africa more broadly, which could help address the mental health treatment gap. Trial registration Clinical Trial Network: NCT05737667