'I feel hopeless': Exploring the psychosocial impacts of caring for mentally ill relatives in Cambodia.

BACKGROUND: There is growing recognition of the psychosocial burden of caregiving on relative caregivers of the mentally ill in low-and middle-income countries. Yet there remains limited formal research examining the challenges and psychosocial support needs of these relative caregivers, particularly with sensitivity to understanding caregiver experiences across diverse cultures and contexts. The purpose of this study was to study caregiver burden to inform potential intervention approaches among relative caregivers of treatment-engaged mentally ill patients in Cambodia. METHODS: Participants were all relative caregivers identified through their connection to a non-governmental organization providing psychiatric care. Five focus group discussions were held with 37 participants to explore challenges experienced by relative caregivers. A total of 115 caregivers then completed a mental health assessment consisting of the Patient Health Questionnaire - 9 item scale, Generalized Anxiety Disorder - 7-item scale, and 21-item Depression, Anxiety, and Stress Scale. Internal consistencies ranged from α = .81 to .87 across scales. RESULTS: Five themes emerged from the focus group discussions: financial burden, erratic behavior of patients, social alienation, somatic and emotional symptoms, and barriers to help-seeking. Assessment data indicated the sample was highly symptomatic. Women and those with no employment appeared to be at higher risk of distress, as were those caregivers with a biological relationship to the patient (parents, children, and siblings; relative to spouses or other relationships). DISCUSSION: Findings suggest a need for regular screening and greater psychosocial support for relative caregivers. It is notable that the needs identified within the current study remain prominent even as this is a treatment-engaged sample.

Experimental evaluation of a school-based mental health literacy program in two Southeast Asian nations.

Background: Low mental health literacy (MHL) is a particular challenge in many low and middle-income countries (LMIC). School-based MHL programs hold promise to increase MHL but lack rigorous research assessing their effectiveness in LMIC. The present study evaluated a school-based MHL program, the "Mental Health & High School Curriculum Guide" ("The Guide"), implemented separately in two different contexts in Southeast Asia (Vietnam and Cambodia) following adaptations made by the research team. Methods: Participants were 80 teachers and 2,539 students from 20 schools in Vietnam (Study 1), and 67 teachers and 275 students in one school in Cambodia (Study 2). In Vietnam, teachers/classrooms were randomized to either The Guide MHL program or a treatment-as-usual control condition, with teachers in the intervention condition receiving a 3-day training in The Guide and implementing the 6-module curriculum in their classrooms. In Cambodia, school staff were randomized to either receive The Guide training or to the control condition; four teachers who received the training implemented the curriculum in select classrooms. In both studies, teachers' and students' mental health knowledge and attitudes were assessed at baseline and following completion of the classroom curriculum. Results: In Vietnam, 6 of 7 program effects for teachers were significant with some large effects (e.g., teacher Recognition of Mental Health Disorders, R2=.36); effects for both of the student outcomes were significant, but small. Results were similar in Cambodia, with 6 of 9 program effects significant favoring the treatment group; effect sizes in Cambodia were smaller than in Vietnam for teachers/staff but larger for students. Conclusion: Findings suggest that with limited adaptation, a teacher-delivered MHL intervention can produce measurable increases in MHL among teachers and students in two Southeast Asian countries. These results support the value of school-based MHL training provided via an inexpensive and teacher-friendly program, embedding MHL into classrooms. Some small effect sizes suggest the importance of additional development and research targeting these particular components.

Trauma Stabilisation as a Sole Treatment Intervention for Post-Traumatic Stress Disorder in Southeast Asia.

Southeast Asia contains high numbers of traumatised populations arising from either natural disasters or interpersonal violence. Consequently, the need for empirically based trauma treatments, compromised by insufficiency in appropriately trained clinicians and mental health workers, makes the situation more challenging in addressing traumatic sequelae in local populations. In response, the humanitarian/ trauma capacity building organisation, Trauma Aid Germany, trained 37 therapists in psycho-traumatology, based on EMDR Therapy, which included trauma stabilisation techniques. This research analyses the impact of Trauma Stabilisation as a sole treatment intervention for Post-Traumatic Stress Disorder (PTSD) in adults. Each client was screened for PTSD utilising the Harvard Trauma Questionnaire - pre- and post-treatment. Analysis of the data considered only those interventions focussed on trauma stabilisation, including psychoeducation. Participants receiving trauma confrontation interventions were excluded from the data. Trauma stabilisation - as a sole treatment intervention, was highly effective in alleviating PTSD diagnoses. Results demonstrate PTSD symptoms were reduced in both clinical and sub-clinical trauma groups. The data set suggests trauma stabilisation, as a sole treatment intervention, was safe, effective, efficient and sufficient treatment intervention for PTSD. Furthermore, trauma stabilisation interventions have the advantage of being safe, flexible, and adaptable to the cultural and spiritual context in which they were are applied. The research findings also have implications regarding teaching and learning and the potential utilisation of paraprofessionals, and other allied health professionals in addressing the global burden of psychological trauma.