Data-Driven Cutoff Selection for the Patient Health Questionnaire-9 Depression Screening Tool.

Importance: Test accuracy studies often use small datasets to simultaneously select an optimal cutoff score that maximizes test accuracy and generate accuracy estimates.

Objective: To evaluate the degree to which using data-driven methods to simultaneously select an optimal Patient Health Questionnaire-9 (PHQ-9) cutoff score and estimate accuracy yields (1) optimal cutoff scores that differ from the population-level optimal cutoff score and (2) biased accuracy estimates.

Design, Setting, And Participants: This study used cross-sectional data from an existing individual participant data meta-analysis (IPDMA) database on PHQ-9 screening accuracy to represent a hypothetical population.

Social Vulnerability, COVID-19, Racial Violence, and Depressive Symptoms: a Cross-sectional Study in the Southern United States.

Background: In March 2020, the novel 2019 coronavirus disease (COVID-19) was declared a pandemic. In May 2020, George Floyd was murdered, catalyzing a national racial reckoning. In the Southern United States, these events occurred in the context of a history of racism and high rates of poverty and discrimination, especially among racially and ethnically minoritized populations.

Parenting in a conflict-affected setting: Discipline practices, parent-child interactions, and parenting stress in Liberia.

Children in conflict-affected settings are at increased risk for exposure to violence, placing particular importance on caregiving environments. This study first describes parenting in urban Liberia by evaluating parent-child interactions, the use and acceptance of harsh and nonharsh discipline, discipline preferences, and the co-occurrence of positive interactions and harsh discipline. The relationship between parenting stress and harsh discipline attitudes and behaviors is then tested.

Comparing fears about paediatric HIV disclosure to the lived experiences of parents and guardians: a prospective cohort study.

Objective: We aimed to: (1) follow parents and guardians through the process of paediatric HIV disclosure to understand how often pre-disclosure worries are realised; and (2) estimate the effects of disclosure on child, caregiver, and family well-being.

Design: We conducted a 12-month prospective cohort study in Zimbabwe with 123 primary caregivers of children ages 9 to 15 years who were HIV positive but did not know their serostatus at baseline. By the end of the study period 65 caregivers reported that their child learned his or her HIV-positive status.

Predicting healthcare-seeking behavior based on stated readiness to act: development and validation of a prediction model.

A starting point of many digital health interventions informed by the Stages of Change Model of behavior change is assessing a person's readiness to change. In this paper, we use the concept of readiness to develop and validate a prediction model of health-seeking behavior in the context of family planning. We conducted a secondary analysis of routinely collected, anonymized health data submitted by 4,088 female users of a free health chatbot in Kenya.

Is social-ecological risk associated with individual HIV risk beliefs and behaviours?: An analysis of Kenyan adolescents' local communities and activity spaces.

The places where adolescents live, learn, and play are thought to influence behaviours and health, but we have limited tools for measuring environmental risk on a hyperlocal (e.g. neighbourhood) level.

Development of the Family Togetherness Scale: A Mixed-Methods Validation Study in Kenya.

Family functioning is an important target of clinical intervention and research given its close ties with mental health outcomes of both children and adults. However, we lack family functioning measures validated for use in many low- and middle-income country (LMIC) settings. In this mixed-methods prospective diagnostic accuracy study, we first used formative qualitative data to develop an extensive battery of screening items to measure family functioning in Kenya.

Adaptation of the World Health Organization Electronic Mental Health Gap Action Programme Intervention Guide App for Mobile Devices in Nepal and Nigeria: Protocol for a Feasibility Cluster Randomized Controlled Trial.

Background: There is a growing global need for scalable approaches to training and supervising primary care workers (PCWs) to deliver mental health services. Over the past decade, the World Health Organization Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) and associated training and implementation guidance have been disseminated to more than 100 countries. On the basis of the opportunities provided by mobile technology, an updated electronic Mental Health Gap Action Programme Intervention Guide (e-mhGAP-IG) is now being developed along with a clinical dashboard and guidance for the use of mobile technology in supervision.

Family Functioning and Mental Health Changes Following a Family Therapy Intervention in Kenya: a Pilot Trial.

Family-based interventions offer a promising avenue for addressing chronic negative family interactions that contribute to lasting consequences, including family violence and the onset and maintenance of mental health disorders. The purpose of this study was to conduct a mixed-methods, single group pre-post pilot trial of a family therapy intervention ( = 10) delivered by lay counselors in Kenya. Results show that both caregivers and children reported reductions in family dysfunction and improved mental health after the intervention.

Expanding Access to Perinatal Depression Treatment in Kenya Through Automated Psychological Support: Development and Usability Study.

Background: Depression during pregnancy and in the postpartum period is associated with poor outcomes for women and their children. Although effective interventions exist for common mental disorders that occur during pregnancy and the postpartum period, most cases in low- and middle-income countries go untreated because of a lack of trained professionals. Task-sharing models such as the Thinking Healthy Program have shown potential in feasibility and efficacy trials as a strategy for expanding access to treatment in low-resource settings; however, there are significant barriers to scale-up.

A multiple baseline study of a brief alcohol reduction and family engagement intervention for fathers in Kenya.

Objective: To evaluate a lay provider-delivered, brief intervention to reduce problem drinking and related family consequences among men in Kenya. The 5-session intervention combines behavioral activation (BA) and motivational interviewing (MI). It integrates family-related material explicitly and addresses central cultural factors through gender transformative strategies.

Patient Health Questionnaire-9 scores do not accurately estimate depression prevalence: individual participant data meta-analysis.

Objectives: Depression symptom questionnaires are not for diagnostic classification. Patient Health Questionnaire-9 (PHQ-9) scores ≥10 are nonetheless often used to estimate depression prevalence. We compared PHQ-9 ≥10 prevalence to Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID) major depression prevalence and assessed whether an alternative PHQ-9 cutoff could more accurately estimate prevalence.

"What is the best method of family planning for me?": a text mining analysis of messages between users and agents of a digital health service in Kenya.

: Text message-based interventions have been shown to have consistently positive effects on health improvement and behavior change. Some studies suggest that personalization, tailoring, and interactivity can increase efficacy. With the rise in artificial intelligence and its incorporation into interventions, there is an opportunity to rethink how these characteristics are designed for greater effect.

The prevalence and process of pediatric HIV disclosure: A population-based prospective cohort study in Zimbabwe.

Introduction: The objective of this study was to estimate the prevalence of pediatric HIV disclosure in rural Zimbabwe and track the process of disclosure over time.

Methods: We recruited a population-based sample of 372 caregivers of HIV-positive children ages 9 to 15 to participate in a survey about disclosure. Using data from this cross-sectional sample, we then identified a prospective cohort of 123 caregivers who said their HIV-positive child did not know his or her HIV status, and we followed this non-disclosed cohort of caregivers through two additional waves of data collection over the next 12 months.

A traumatic brain injury prognostic model to support in-hospital triage in a low-income country: a machine learning-based approach.

Objective: Traumatic brain injury (TBI) is a leading cause of death and disability worldwide, with a disproportionate burden of this injury on low- and middle-income countries (LMICs). Limited access to diagnostic technologies and highly skilled providers combined with high patient volumes contributes to poor outcomes in LMICs. Prognostic modeling as a clinical decision support tool, in theory, could optimize the use of existing resources and support timely treatment decisions in LMICs.

Expanding Access to Depression Treatment in Kenya Through Automated Psychological Support: Protocol for a Single-Case Experimental Design Pilot Study.

Background: Depression during pregnancy and in the postpartum period is associated with a number of poor outcomes for women and their children. Although effective interventions exist for common mental disorders that occur during pregnancy and the postpartum period, most cases in low- and middle-income countries go untreated because of a lack of trained professionals. Task-sharing models such as the Thinking Healthy Program have shown great potential in feasibility and efficacy trials as a strategy for expanding access to treatment in low-resource settings, but there are significant barriers to scale-up.

Developing a Digital Marketplace for Family Planning: Pilot Randomized Encouragement Trial.

Background: Family planning is an effective tool for preventing death among women who do not want to become pregnant and has been shown to improve newborn health outcomes, advance women's empowerment, and bring socioeconomic benefits through reductions in fertility and population growth. Yet among the populations that would benefit the most from family planning, uptake remains too low. The emergence of digital health tools has created new opportunities to strengthen health systems and promote behavior change.

The impact of school support on depression among adolescent orphans: a cluster-randomized trial in Kenya.

Background: The objective of this study was to determine if a school support intervention for adolescent orphans in Kenya had effects on mental health, a secondary outcome.

Methods: In this paper, we analyzed data from a 4-year cluster-randomized trial of a school support intervention (school uniforms, school fees, and nurse visits) conducted with orphaned adolescents in Siaya County, western Kenya, who were about to transition to secondary school. 26 primary schools were randomized (1:1) to intervention (410 students) or control (425 students) arms.

Developing and validating a perinatal depression screening tool in Kenya blending Western criteria with local idioms: A mixed methods study.

Background: Routine screening for perinatal depression is not common in most primary health care settings. The U.S.

Associations Between Fathers' and Sons' Sexual Risk in Rural Kenya: The Potential for Intergenerational Transmission.

Purpose: Despite high rates of HIV in areas of Sub-Saharan Africa and men's role in driving the epidemic, little is known about whether or how sexual risk-both behaviors and beliefs-may be passed down through generations of males. This study examined associations between sexual risk behaviors and sex-related beliefs of adolescent males and those of their male caregivers in Kenya, as well as the potential moderating effects of parenting characteristics and father-son relationship quality.

Methods: Cross-sectional linear regression analysis was applied to baseline data from a trial of a family- and church-based intervention for families in rural Kenya that followed a stepped-wedge cluster randomized design.

Participatory mapping in low-resource settings: Three novel methods used to engage Kenyan youth and other community members in community-based HIV prevention research.

Understanding the link between health and place can strengthen the design of health interventions, particularly in the context of HIV prevention. Individuals who might one day participate in such interventions - including youth - may further improve the design if engaged in a meaningful way in the formative research process. Increasingly, participatory mapping methods are being used to achieve both aims.

A church-based intervention for families to promote mental health and prevent HIV among adolescents in rural Kenya: Results of a randomized trial.

Objective: To evaluate a family- and church-based intervention for adolescents and caregivers in rural Kenya to improve family relationships, reduce HIV risk, and promote mental health.

Method: The intervention was developed using community-based participatory methods and focused on strengthening family communication. Modules addressed economic, relationship, and HIV-related topics using evidence-based behavioral strategies alongside culturally grounded content.

Do clinical decision-support reminders for medical providers improve isoniazid preventative therapy prescription rates among HIV-positive adults? Study protocol for a randomized controlled trial.

Background: This document describes a research protocol for a study designed to estimate the impact of implementing a reminder system for medical providers on the use of isoniazid preventative therapy (IPT) for adults living with HIV in western Kenya. People living with HIV have a 5% to 10% annual risk of developing active tuberculosis (TB) once infected with TB bacilli, compared to a 5% lifetime risk in HIV-negative people with latent TB infection. Moreover, people living with HIV have a 20-fold higher risk of dying from TB.

Women's entrepreneurship and intimate partner violence: A cluster randomized trial of microenterprise assistance and partner participation in post-conflict Uganda (SSM-D-14-01580R1).

Intimate partner violence is widespread and represents an obstacle to human freedom and a significant public health concern. Poverty alleviation programs and efforts to economically "empower" women have become popular policy options, but theory and empirical evidence are mixed on the relationship between women's empowerment and the experience of violence. We study the effects of a successful poverty alleviation program on women's empowerment and intimate partner relations and violence from 2009 to 2011.

Reconcilable differences? Human diversity, cultural relativity, and sense of community.

Sense of community (SOC) is one of the most widely used and studied constructs in community psychology. As proposed by Sarason in (The Psychological sense of community: prospects for a community psychology, Jossey-Bass, San Francisco, 1974), SOC represents the strength of bonding among community members. It is a valuable component of community life, and it has been linked to positive mental health outcomes, citizen participation, and community connectedness.