The experience of Thai adolescents with depression: A qualitative study.

AIM: People who have depression experience a maelstrom of emotion as they attempt to understand what is happening to them. While the experience has been quite extensively documented in adults and older individuals, there is a great deal less information available about adolescent depression experiences and reactions. The purpose of this study was to investigate the experiences of Thai-adolescents suffering from depression. DESIGN: Interpretative phenomenological analysis. METHOD: Fourteen adolescents were recruited from a secondary school in Chiangrai province, Thailand. Semi-structured interviews were carried out. Interviews were analysed using interpretative phenomenological analysis. RESULTS: The following four themes were identified: (1) struggling to make sense of their situation, (2) feeling down and withdrawing, (3) contemplating self-harm and (4) therapy as a last choice. The results point to the continuing significance of promoting psychoeducation for Thai-adolescents with depression as well as parents, school nurses and health providers while eliminating stigma.

Developing a Depression Care Model for the Hill Tribes: A Family- and Community-Based Participatory Research.

A high prevalence of depression has been detected among individuals from the hill tribes in Thailand. However, there are no proper interventions to address this problem. Using a community-based participatory research (CBPR) design, the study team developed a model of depression care for this population. The study involved 45 people in the model development and 65 people in the model testing, who were patients, family members, village health volunteers (VHVs), community and religious leaders, healthcare personnel, NGOs, and local administrative staff. The model development was divided into three phases: understanding the current situation of depression and care, model development, and evaluation of its effectiveness using psychological and relevant outcomes. Questionnaires, observations, focus groups, and in-depth interviews were used for data collection, and content analysis was employed for qualitative data. The Wilcoxon signed-rank test was used to analyze changes in VHVs' knowledge and skills before and after training. The resulting model, "SMILE," consists of stakeholders' readiness (S), external and internal motivations (M), interpersonal relationship (I), life and community assets (L), and empowerment (E). VHVs underwent training on the model, and after training, their knowledge increased significantly from 3.50 ± 1.14 to 8.28 ± 0.81 (p < 0.001). Moreover, their basic counselling and depression screening skills showed improvement from 3.39 ± 1.23 to 7.64 ± 3.76 (p < 0.001). The developed model can be applied to other hill tribe communities in Northern Thailand to improve depression care.

Evaluation of a depression care model for the hill tribes: a family and community-based participatory research.

BACKGROUND: Even though, there is a particularly high prevalence of depression among individuals from the hill tribes in northern Thailand, they are unable to receive appropriate intervention due to cultural, transportation, communication, and legal barriers. Using community-based participatory research (CBPR), a depression care model was developed for the hill tribe population. The effectiveness of this model was examined using questionnaires, observations, focus groups, and in-depth interviews. METHODS: Participants include people with depression (n = 17) who were chosen based on their mild to moderately severe depression scores on the Patient Health Questionnaire 9-item (PHQ-9 scores of 5-19) and their caregivers (n = 5). The in-depth interview was conducted to distinguish the selected participants into two groups. The first group, the self-help group program, consisted of 12 participants endorsing negative thoughts about themselves and inappropriate problems solving. The second group, the family camp program, had ten participants, including five patients with family-related issues and their family members. Subjects separately participated in either the self-help or the family groups over three weeks. They completed the PHQ-9 at the beginning and end of the intervention. Questionnaires, observations, focus groups, and in-depth interviews were used to evaluate the effectiveness of the model. Content analysis was used to examine the qualitative data. Wilcoxon signed-rank test was used to analyze the changes in the severity of depression before and after participation in the intervention. RESULTS: The depression scores on the PHQ-9 of 12 participants improved significantly (11.92 ± 1.08 vs. 3.08 ± 0.51; p = 0.002) following participation in the self-help group. Increased self-esteem and improved interpersonal relationships were reported by participants in the self-help group program during interviews. There was no significant difference in the depression scores of 10 participating in the family camp program (6.00 ± 3.83 to 5.30 ± 3.56; p = 0.161). CONCLUSION: A model for depression care was tested in a hill tribe community, and its effectiveness was clearly observed. The developed model can be applied to other hill tribe communities in northern Thailand to improve depression care.

Parental perceptions, attitudes, and beliefs regarding vaccination of children aged 0-5 years: A qualitative study of hill-tribe communities, Thailand.

The widespread availability and use of vaccines have tremendously reduced morbidity and deaths related to infectious diseases globally. However, in hill-tribe communities in Northern Thailand, vaccination rates remain low, and there is limited literature on parental perceptions, attitudes, and beliefs about vaccination for children under five years of age. We conducted a qualitative study employing semi-structured interviews to understand parents' perceptions, attitudes, and beliefs about vaccinations. A purposive sample was used to recruit participants. Data were analyzed using thematic analysis. 74 hill-tribe parents (14 Akha, 11 Hmong, 12 Lahu, 13 Lisu, 12 Karen, and 12 Yao) were interviewed. Four themes emerged from the interviews: 1) traditional beliefs, and practices 2) traumatic experiences, 3) lack of information and effective communication, and 4) trust and support from the community. Findings highlight that it is crucial to build trust by providing knowledge, appropriate information, and advice about vaccinations in order to improve vaccine coverage in children under five years of age in the hill-tribe context.

Effects of mindfulness-based interventions on psychological outcomes in college and university students during COVID-19 pandemics: A systematic review and meta-analysis.

OBJECTIVE: We synthesized the effects of mindfulness-based interventions (MBIs) on psychological outcomes in college and university students during the COVID-19 pandemic. METHOD: Ten electronic databases were searched from inception to December 2021. We reviewed studies with college and university students receiving MBIs with psychological outcomes. We only reviewed studies written in English. A random-effects model was used to compute the effect size. RESULTS: Overall, MBIs showed a significantly moderate improvement in anxiety (g = 0.612, 95% CI: 0.288-0.936, I2 = 77%); depression (g = 0.372, 95% CI: 0.032-0.713, I2 = 72%); and mindfulness (g = 0.392, 95% CI:0.102-0.695, I2 = 64%) compared with control groups, while these interventions had a small effect in reducing stress, but not a significant one (g = 0.295, 95% CI: -0.088 to 0.676, I2 = 77%) compared with control groups. CONCLUSION: MBIs significantly improved psychological outcomes among college and university students during the COVID-19 pandemic. Clinicians and health providers should consider using MBIs as alternative complementary treatment for improving and preventing anxiety and depression in college and university students during COVID-19. CLINICAL RELEVANCE: The use of MBIs for college and university students is an effective method to decrease anxiety, depressive symptoms, and increase mindfulness. MBIs would become a very useful means of alternative complementary treatment in mental health and clinical psychiatry.

Healthcare service utilization of hill tribe children in underserved communities in thailand: Barriers to access.

BACKGROUND: Hill tribe children, an ethnic minority group in Thailand, experience wide-ranging social and health inequalities. Previous reports indicate that hill tribe children, especially age under 5 years, face social health disadvantages but little is known about the underlying causes. Exploring healthcare utilization among hill tribe children is therefore essential and it may well provide some insight. METHODS: A qualitative study was conducted using purposive sampling techniques to recruit participants based on our criteria. In-depth interviews and focus-group discussions were employed to explore the experiences of parents (n = 20), community leaders (n = 20), and healthcare providers (n = 20) when caring for children aged under 5 years. Interview transcripts were coded, and thematic analysis was then performed. RESULTS: The participants shared their experiences with accessing healthcare services in underserved areas. Barriers to access was the central theme identified. Sub-themes included: (1) distance matters, (2) education and socioeconomic deprivation, (3) lack of cultural sensitivity, (4) communication problems, (5) tradition, beliefs, and differences in cultural practice, (6) lack of child health professionals, and (7) bureaucratic hurdles. CONCLUSIONS: Healthcare services and environments must be transformed to provide healthcare services, education, and information appropriate to the cultures and beliefs prevalent in the hill tribe population.

Feasibility and Acceptability of the HOME Model to Promote Self-Management Among Ethnic Minority Elderly with Type 2 Diabetes Mellitus in Rural Thailand: A Pilot Study.

Introduction: Ethnic minority elderly (EME) people are recognized as a vulnerable group who have higher prevalence of type 2 diabetes mellitus (T2DM) than the majority of the population. The aim of this study was to explore the feasibility, acceptability, and effect of the HOME model (Home intervention; Online monitoring; Multidisciplinary approach; and Equity and education) specifically for enhancing self-management activities, glycemic control, and satisfaction of EME with T2DM in rural areas in Thailand. Methods: In this quasi-experimental study, a single group used a pre-test and post-test, which were conducted as a pilot study to examine the effect of the HOME model. Results: Overall, 23 dyads of EME with T2DM and their family caregivers completed the 12-week intervention. They reported that the HOME model was helpful and motivating, and they reported satisfaction with the service provided. EME with T2DM showed significant reduction of blood glucose level, and significant improvement in self-management activities, happiness, and satisfaction compared with baseline. Family caregivers had also significant improvements in happiness and reported satisfaction with the HOME model. Conclusion: The primary evidence suggested that the HOME model was acceptable and feasible for EME with T2DM and their families in rural Thailand.

Implementation and evaluation of the peer-training program for village health volunteers to improve chronic disease management among older adults in rural Thailand.

Objectives: This study aimed to investigate the effect of a peer-training program for village health volunteers (VHVs) to improve chronic disease management among older adults in rural Thailand. Methods: The study was guided by community-based participatory research (CBPR). The peer-training program was developed by engaging diverse stakeholders, including community organizations, healthcare services, VHVs, older adults with chronic illnesses, and folk scholars in remote communities with high healthcare needs. The peer-training program comprised a three-day training workshop that convened once a week for three weeks with the following six sessions: knowledge sharing, peer support and empowerment, health literacy and health behavior, the general caring procedure for older adults with chronic illnesses, information sharing and communication, and home visit. From January to April 2021, a total of 28 VHVs completed the peer training program in a rural area in Chiang Rai province, Thailand. The Health Literacy and Health Behavior-3E2S (HLHB-3E2S), the Management of Non-Communicable Diseases Questionnaire (MNCDQ), and a self-confidence questionnaire were used to survey pre (week 1) and post-intervention (week 12), respectively. Then VHVs were interviewed to collect attitudes, and opinions about the intervention. Results: After the intervention, the HLHB-3E2S scores (49.39 ± 5.54 vs. 52.35 ± 4.26, P = 0.001), the MNCDQ scores (44.10 ± 6.27 vs. 50.60 ± 4.84, P < 0.001), and the self-confidence questionnaire scores (22.28 ± 2.46 vs. 23.21 ± 1.81, P = 0.01) of VHVs significantly increased. VHVS also reported that the peer-training program enhanced their healthcare services, including health education, chronic disease management, leadership skills, and improving their relationship with healthcare providers. Conclusion: Peer training programs are a practical strategy to improve VHVs' capacities.Healthcare professionals should provide a continuous training program for VHVs with their peers to increase capacities, confidence, and satisfaction in caring for the older adults with chronic diseases in the community.

"Life is Bitter and Sweet": The Lived Experience of Ethnic Minority Elders with Type 2 Diabetes Mellitus in Rural, Thailand.

PURPOSE: The purpose of this study was to describe the lived experience of ethnic minority elders (EME) with type 2 diabetes mellitus (T2DM) to understand an individual's experience, perception, and behaviors connected to T2DM in rural areas where support is limited. METHOD: The hermeneutic phenomenological methodology was used to explore the lived experience of EME with T2DM by using conversational interviews. Twenty EME were interviewed. The data analysis and interpretation followed the thematic analysis by van Manen. RESULTS: Analysis highlighted an overarching theme of "Life is Bitter and Sweet" and three main themes: (1) the struggle of living with diabetes, (2) living with inequalities, and (3) dealing with diabetes that reflects the experiences of EME with T2DM living in underserved areas based on the cultures, beliefs, and spirits. CONCLUSIONS: The finding led to recommendations to strengthen interventions by family members, improve supportive systems and services to improve knowledge, self-management, and maintain physical well-being in order to increase the quality of life for the EME with T2DM.

Prevalence of and factors associated with depression in the hill tribe population aged 40 years and older in northern Thailand.

BACKGROUND: Depression is globally recognized as a major mental health problem in all age categories, particularly among those living in poor economic conditions and with low levels of education, including the hill tribe people in northern Thailand. METHODS: This cross-sectional study aimed to estimate the prevalence of depression and determine the factors associated with depression in the hill tribe population aged 40 and over in northern Thailand. Hill tribe people who lived in the selected villages and met the inclusion criteria were invited to participate in the study. A validated questionnaire and the Patient Health Questionnaire-9 (PHQ-9) were used for data collection. An interview was conducted in a private and confidential room in the selected villages between January and April 2019. Logistic regression was used to determine the factors associated with depression at a significance level of α = 0.05. RESULTS: A total of 601 participants were recruited into the study. More than half (64.23%) were women, 46.76% were Akha, 61.90% were aged 40-59 years, and 76.37% were married. Half of the participants were Christian (57.07%) and had no monthly income (51.25%), and 85% were illiterate. The overall prevalence of depression was 39.10%: 75.74% had mild depression, 17.88% had moderate depression, and 6.38% had severe depression. In the multivariate model, three variables were found to be associated with depression: being female, having a history of substance abuse, and experiencing stress six months prior. Compared to men, women were 2.09 times (95% CI 1.30-3.35) more likely to have depression. Those who had a history of substance abuse were more likely to have depression than those who did not have a history of substance abuse (AOR = 1.97; 95% CI 1.25-3.10). Those who had a history of stress in the prior 6 months were more likely to have depression than those who did not (AOR = 6.43; 95% CI 4.20-9.85). CONCLUSION: Public health screening programs to identify depression in the hill tribe population are urgently needed, particularly for women, those who have abused psychoactive substances, and those who have experienced stress.