Research

Africa Mental Health Foundation

Mental disorders represent an enormous burden in much of Africa. Environmental factors, such as political violence and poverty, increase risk for mental illness in regions that have extremely limited resources to provide care. The Columbia-WHO Center for Global Mental Health’s collaboration with the Africa Mental Health Research and Training Foundation aims to provide ongoing opportunities for research and training. With a focus on exploring innovative strategies to improve mental health services in low-resourced environments, our collaboration promises to provide important discoveries that can be implemented in Africa and North America alike.

The Africa Mental Health Research and Training Foundation

 

Africa Mental Health Research and Training Foundation (AMHF) is a non-governmental organization, operating in Kenya and the entire East African region, dedicated to research for evidence-based policy, practice and promotion of mental and neurological health, and healthy behavior. The Foundation’s primary research area of focus is community mental health with the aim of providing innovative, appropriate, affordable, available and accessible mental health and substance use services to all Kenyans irrespective of their socio-economic status. It is now the premier Mental Health Research and Resource Centre in the region. It works with Multi-stakeholders of various backgrounds who have something to contribute to mental health in Kenya and other low-income countries. Website: www.africamentalhealthfoundation.org

Collaboration Aims

The Columbia-WHO Center for Global Mental Health has partnered with Africa Mental Health Research and Training Foundation since 2011 to support research initiatives that address current special needs for Kenya in the field of mental health. The following areas of research represent the collaboration’s research and training priorities:

  • Mental health and aging
  • Suicide
  • Mental health and human rights
  • Peri-natal mental health
  • Disaster and mental health
  • Gender based violence
  • School mental health
  • Prison mental health
  • Mental health in non-communicable and communicable diseases
  • Mental health systems

Scientific Contributions

The collaboration with the Africa Mental Health Research and Training Foundation has led to significant scientific contributions in the form of scholarly publications. Please see below for a curated list of some joint publications:

Contact Information

For further information on the Columbia Global Mental Health-Africa Mental Health Research and Training Foundation Collaboration, please contact Dr. Tahilia Rebello at [email protected].

Boricua Youth Study

The Boricua Youth Study (BYS) seeks to understand the lived experiences of Puerto Ricans in the US and Puerto Rico. BYS is an epidemiological research study assessing mental health in a community sample of Puerto Rican youth. The study was first launched in 2001 and originally enrolled about 2,500 children between the ages of 5 and 13 in two sites: the South Bronx, NY, and San Juan, PR. The BYS collected 3 waves of data, from 2000 to 2004, that focused on antisocial behaviors and mental health outcomes of children and parents of Puerto Rican descent across both sites.

BYS youth participants are now transitioning into emerging adulthood (ages 16–26), which presents a unique opportunity to understand the development of Latino youth in a critical developmental period. Now in its fourth wave, our team is following up with these same youth and their caregivers to help us understand the unique risk and protective factors faced by the Puerto Rican community across various stages of development.  The fourth wave of this study aims to: 1) better understand the effects of acculturation and environment on mental health outcomes; and 2) explore various risky behaviors (i.e., substance use/abuse, HIV/STI sexual risk behaviors, antisocial behaviors, etc.). Some areas of interest include: depression; anxiety; antisocial behaviors; substance use; neighborhood characteristics; migration; discrimination; acculturation; cultural stress; sexual risk behaviors; marital, peer, and family relationships; social support; ethnic/racial identity; and HIV/STI testing.

For more information on the Boricua Youth Study, please visit its website.

Brazilian HIV Prevention

 

People with mental illness are particularly vulnerable to infection with HIV – a reality reflected in the exceptionally high rates of infection within this population. A number of factors contribute to elevated HIV risk among the mentally ill, including substance abuse, unstable housing, poverty, stigma, engagement in unprotected sex, or unsafe drug injection practices. As a result, people with mental illness have been a focus of HIV research for over 20 years, with particular emphasis placed on the development and evaluation of interventions to reduce HIV-related risk behaviors. In Brazil, which has the highest prevalence of HIV-positive adults in all of South and Central America, the need for effective, culturally-adapted HIV prevention interventions is particularly dire.

Background

Under the leadership of Principal Investigator Dr. Milton Wainberg, this NIMH-funded grant piloted a culturally appropriate HIV prevention intervention in Brazil men and women with severe mental illness, through the adoption and refinement of evidence-based efficacious prevention interventions developed for use with patients in the U.S. with severe mentally illness.

Study Aims

Employing a participatory research model that engages both local providers as well as patients, this initiative aimed to facilitate the transfer and implementation of feasible intervention knowledge that balances fidelity of efficacious research with fit to the new setting’s culture and context.

Following the success of this pilot study, further NIMH funding was secured to test the efficacy of this HIV prevention intervention in all the Rio de Janeiro Municipal clinics providing care for individuals with severe mental illness. Using sites that are representative of outpatient treatment delivery settings across Brazil, the study conducted an RCT to test the long-term efficacy of its Brazilian HIV Prevention Intervention for men and women with severe mental illness.

The Brazilian team has now developed a training program that visits psychiatric sites all over the country with funding from the Brazilian Ministry of Health to train providers.

Related Publications

Wainberg ML, McKinnon K, Mattos PE, Pinto D, Gruber Mann C, Oliveira C, Oliveira-Broxado S, Remien RH, Elkington KS, Cournos F, PRISSMA Project. A model for adapting evidence-based behavioral interventions to a new culture: HIV prevention for psychiatric patients in Rio de Janeiro, Brazil. AIDS and Behavior 2007; 11(6): 872-83.

Wainberg ML, Alfredo Gonzalez M, McKinnon K, Elkington KS, Pinto D, Gruber Mann C, Mattos PE. Targeted ethnography as a critical step to inform cultural adaptations of HIV prevention interventions for adults with severe mental illness. Social Science & Medicine 2007; 65(2): 296-308.

Wainberg ML, McKinnon K, Elkington K, Mattos PE, Gruber Mann C, Souza Pinto D, Otto-Salaj L, Cournos F. HIV risk behaviors among outpatients with severe mental illness in Rio de Janeiro, Brazil. World Psychiatry 2008; 7(3): 166-72.

Elkington KS, McKinnon K, Mann CG, Collins PY, Leu CS, Wainberg ML. Perceived mental illness stigma and HIV risk behaviors among adult psychiatric outpatients in Rio de Janeiro, Brazil. Community Mental Health Journal 2010; 46(1): 56-64.

CHIMERA

CHIMERA is a five-year (2019–2024) HIV, mental health, and implementation science research training program funded by the Fogarty International Center and the National Institute of Mental Health of the US NIH (D43 MPIs Sohn and Wainberg). CHIMERA aims to address the critical need to build capacity among Asia-Pacific clinicians and researchers to study the intersection between HIV and mental health and integrate care for people living with HIV.

For more information on our Fellows and Mentors, please click here.

Cognition in Untreated Psychosis in China

This project builds upon a Chinese government initiative (the “686 Project”) to transform mental health services and offer treatment to most persons with severe mental disorders.

This initiative provides a time-limited opportunity to identify and assess individuals with psychosis who have remained untreated.

The study assesses cognition prior to antipsychotic treatment and compares this group with treated individuals and healthy controls. Recruitment takes place in rural areas in northwestern China.

For more information about this program, contact Dr. Ezra Susser.

Columbia-WHO Center for Global Mental Health

The Columbia-WHO Center for Global Mental Health, formerly the Columbia University Global Mental Health Program, is a center that runs numerous advocacy, research, and training initiatives in global mental health. This center is directed by Dr. Kathleen M. Pike.

The following programs are managed by the Columbia-WHO Center for Global Mental Health:

Research

Advocacy

Training

 

The Columbia-WHO Center for Global Mental Health is supported by an International Advisory Board and Young Professionals Board which contribute philanthropically and programmatically to the center.

To learn more about the Columbia-WHO Center for Global Mental Health, please contact: [email protected]

Council Grants Program

The Columbia University Global Mental Health Council Grants Program is an initiative of the Council for the Advancement of Global Mental Health Research to fund new investigators and new ideas in global mental health. All funds raised through the Council will support Council Grant Program recipients to complete innovative research in the area of global mental health.

Faculty listed on this program are the Core Faculty Review Group of the Council Grants Program.

The Council Grant Review Committee Co-Chairs are: Dr. Tahilia J. Rebello and Dr. Jeremy Kane

The application submission deadline for the 2022-2023 Council Grants Program has now passed. Applications are currently being reviewed and all applicants will be notified via email in August 2022. Questions can be directed to: [email protected]

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2021-2022 Council Grant Recipients

The Call for Proposals for the Council Grants Program was released in February 2021 and closed on April 18th 2021. Four grant proposals were chosen for funding for the 2021-2022 school year:

1. Rogerio Mulumba, MD, Iruma Bello, PhD, Lisa Dixon, MD, MPH, & Milton L. Wainberg, MD: Development of a Recovery-oriented Psychosocial Treatment Model for Individuals with Schizophrenia in Mozambique.

In Mozambique, schizophrenia is the leading cause of hospitalizations in psychiatric units and the second leading cause of seeking psychiatric services. However, the national mental health system is still being developed and expanded. There is an insufficient number of trained mental health providers to meet the mental health needs and a heavy reliance on antipsychotic medication as treatment. Furthermore, cultural attitudes towards mental illness and traditional healing methods lead to the use of mental health services primarily for crisis situations. Given this context, we aim to engage community members in research to 1) identify local attitudes towards treatment of and recovery from schizophrenia; 2) convene a workgroup to develop culturally-resonant psychosocial interventions that can complement medication management; and 3) assess if the intervention is well-received by providers at a local community health center. This data will help to refine the intervention and inform future implementation plans for testing feasibility and acceptability more broadly.

2. Annika Sweetland, DrPH, MPH & Francine Cournos, MD: Exploring Patients’ and Provider’ Perspectives on Managing the Complex Multimorbidities of TB, HIV, Common Mental Disorders and Substance Use Disorders within Primary Care in Mozambique.

Tuberculosis (TB), HIV, and common mental and substance use disorders are frequently co-occurring and negatively synergistic. HIV, mental, and substance use disorders are risk factors for TB; TB and HIV are risk factors for mental and substance use disorders; the combination of having multiple chronic health conditions (multimorbidities) is associated with increased morbidity, mortality, and increased infectious disease transmission. While integrating mental and medical care to address these conditions is considered essential, little is known about addressing these concerns in low- and middle-income countries, as 95% of multimorbidity research comes from high-income countries and has a very different focus on co-occurring, non-infectious diseases in an aging population. This study aims to build on lessons from high-income countries by adapting a multimorbidity framework for low- and middle-income countries. In doing so, an integrated strategy for addressing TB, HIV, and common mental and substance use disorders in Mozambique can be developed.

3. Christina Mehranbod, MPH, Jeremy Kane, PhD, MPH, Kim Hekimian, PhD, & Christopher Morrison, PhD, MPH: Post-war, Mid-pandemic: A Mixed Methods Study of Alcohol Consumption Patterns and Alcohol Use Environment of Young Adults in Yerevan, Armenia.

In 2020, Armenia experienced the compounding impact of a devastating war, the COVID-19 pandemic, and a continued high rate of premature death. Conflict, crises, and instability are often associated with the increased risk of unhealthy alcohol use. Low-and-middle-income countries (LMICs) are disproportionately affected by the consequences of unhealthy alcohol use. The goal of this research is to identify opportunities for preventive intervention to reduce alcohol use and related harms in Armenia. This research project will 1) assess the distribution and density of alcohol outlets and alcohol advertisements in the neighborhoods of Yerevan, the capital city of Armenia; 2) explore youth adults’ perceptions, views, behavioral norms, and cultural contexts related to alcohol use and mental health; and 3) examine health care providers’ views of potential screening and intervention methods to address unhealthy alcohol use in young adults. This research has the potential to inform programming and policies to develop affordable interventions that reduce unhealthy alcohol use and improve mental health.

4. Jennifer Mootz, PhD, & Michael Wessells, PhD: Implementation Mapping of Digitized Mental Health Services for Urban Internally Displaced People in Mozambique.

An escalating religious insurgency in the northern Mozambican province of Cabo Delgado has resulted in almost 2,000 civilian deaths and 674,000 internally displaced people (IDPs) who have migrated to the neighboring Nampula Province and provincial capital. Nampula City, host to the largest number of IDPs in Nampula Province, is the central hub where two federally funded studies, in partnership with the Mozambican Ministry of Health, are taking place to increase comprehensive public mental health care using technology and to tailor mental health care to address social determinants and additional vulnerabilities, such as exposure to intimate partner violence, among IDPs. We propose to leverage these two existing studies and further respond to the unmet mental health needs of urban IDPs in Nampula City. We aim to 1) deepen our understanding of mental health needs and community members’ perceptions of digital mental health services for urban IDPs; and 2) develop a coordinated strategy to implement community-based, digitized mental illness detection and treatment among urban IDPs. The findings from this study will represent a low-cost, community-informed, digitized mental health care strategy that could be relevant for use among urban IDPs in other low- and middle-income countries.

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2020-2021 Council Grant Recipients:

The Call for Proposals for the Council Grant Program was released in May 2020 and closed on July 15th, 2020. Four grant proposals were chosen for funding for the 2020-2021 school year:









 

1. Ali Giusto, PhD & Milton Wainberg, MD: Leveraging Community Strengths to Implement a Task-shifted Alcohol Use and Family Engagement Treatment for Fathers in Kenya

  • Background: Problem drinking disproportionally affects men with disabling individual and family consequences, including couple violence and child mental illness, which can be exacerbated in low- and middle-income countries.
  • Research Goals: This study aims to identify factors that will shape the large-scale implementation of a task-shifted intervention (intervention delivered by non-specialist, lay providers) targeting alcohol use and family engagement among fathers with problem drinking in Kenya. By addressing the burden of alcohol use, this intervention has the potential to improve family relationships and reduce mental distress among fathers, their partners, and their children.
  • Progress and Impact: During 2020-2021, the team completed all focus groups and interviews in Eldoret, Kenya, with key stakeholders, including policy makers, hospital leaders, professional mental health providers, community and peer mental health providers, men experiencing problem drinking (patients), as well as past providers and patients who participated in the pilot trial of the intervention to be implemented. This initial work has revealed diverse perspectives on barriers and facilitators to delivering care to men in this community, but the need for scalable, affordable outpatient services was a common theme from the interviews. Formal analysis of this information will be presented in multi-stakeholder workgroups to develop a plan for implementation of the mental health treatment relevant for men’s engagement. Partnership with Columbia’s Global Center in Kenya has been essential for facilitating this Council-funded project, and the outcomes of this work have informed the team’s submission of a K23 NIMH award for a future project in Kenya.

2. Lola Kola, PhD & Kathleen M. Pike, PhD: Responding to the Challenges of Adolescent Perinatal Depression with Digital Video Intervention

  • Background: Adolescents with perinatal depression have unique needs and are impacted by a variety of barriers (such as low social support and feelings of ostracization) that results in their limited use of health care services and treatment.
  • Research goals: This research project evaluates the feasibility and acceptability of a digital health intervention to improve mental health outcomes for adolescents with perinatal depression in Nigeria. By delivering short videos of evidence-based psychosocial interventions in peer-supported groups (supplementing face-to-face treatment in the context of primary care), this intervention has the potential to improve social support and effectiveness of treatment among adolescent mothers.
  • Progress and Impact: During 2020-2021, the team recruited adolescents with perinatal depression from primary care centers in Ibadan Oyo State, Nigeria, to participate in small groups facilitated by peer leaders who were under 19 years old and had lived experience with perinatal depression. The peer leaders provided group members with social support during group meetings and through regular phone calls. Educational videos developed based on WHO mhGAP guidelines were also used to manage depression among young mothers. Friendships quickly formed as adolescents and peer leaders contacted each other even outside of the group to discuss their experiences and questions. After the fourteen-week intervention concluded, participants reported that this group intervention helped them see that they can still become who they desire to be, despite their unintended pregnancies. The adolescents also expressed that they would recommend the program to other friends in need. The team will continue to analyze data from this intervention and submit publications that demonstrate how digital health technologies and peer-led groups can enhance the capacity of community mental health care in low and middle-income countries. This research also provides the necessary foundation for an NIH R01 application that will evaluate the use of a mobile phone application and a peer-support group intervention utilizing short videos to treat perinatal depression in adolescent mothers.

3. María Elena Medina-Mora, PhD & Geoffrey Reed, PhD: Developing a Methodology for Estimating the Central American Migrant Population in Mexico and Assessing Migrants’ Experiences and Health and Mental Health Status

  • Background: The wellbeing of migrants, who are coming from Central America and traveling through Mexico with the aim of entering the US, is often compromised by extreme poverty or violence in their countries of origin and traumatic circumstances experienced during their journey. Because the vast majority enter Mexico unofficially, little is known about the current size of the migrant population and their physical and mental health needs.
  • Research goals: This research initiative tests a methodology that could allow an accurate estimation of the size of the Central American migrant population in Tijuana, Mexico, as well as to better understand the health and mental health of the migrant population. This study will generate critical information that can be used by the Mexican government to address the needs of this population and prevent additional suffering and disease burden.
  • Progress and Impact: During 2020-2021, a mathematical model was developed to estimate the size of the migrant population based on information from border crossings and shelters in Tijuana, Mexico. Interviews and questionnaires were also developed and pilot-tested at a local shelter with migrants who had recently entered Mexico from El Salvador, Honduras, Guatemala, and Cuba. Based on feedback from these pilot interviews, the final versions of the questionnaires to measure the population size, experiences, and health of migrants were developed. Interviews have also been conducted with key informants, including doctors, psychologists, coordinators, and volunteers from five different shelters. Due to pandemic-related difficulties, the fieldwork has been slightly delayed, and it is expected that the project will be completed in 2022.

4. Sandrine Müller, PhD & Sandra Matz, PhD: The Impact of COVID-19 and Social Distancing on Mental Health Across the World: Using Smartphones for Assessment and Intervention

  • Background: Globally, widespread concerns exist about the mental health consequences of the COVID-19 pandemic and social distancing.
  • Research Goals: This study leverages a unique dataset gathered from over 980,000 users of the mHealth app Moodpath across multiple countries to study the impact of the pandemic on mental health. By comparing and analyzing data from 2019 and 2020, the team can investigate mood and depression trajectories as a function of the global pandemic and diverse social policies and pandemic experiences.
  • Progress and Impact: The team completed the investigation focused on individuals in the US, the UK, and Germany who have provided continuous data throughout 2020 and 2019. The study indicated that people –on average– show high levels of resilience. While the US saw momentary decreases in mood and increases in depression that quickly returned to baseline, Germany and the UK did not experience observable negative effects on mental health. When investigating the impact of social distancing on people’s mental health within-person, there is evidence that social distancing –on average– was associated with a decline in mental health. Funding from the Council Grants Program has allowed this research to be completed and written as a manuscript for publication.

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2019-2020 Council Grant Recipients:

The first Call for Proposals for the Council Grant Program was released in May 2019 and closed on June 30th, 2019. Four grant proposals were chosen for funding for the 2019-2020 school year:









 

1. Catherine Carlson, PhD, MSW; Laura Cordisco Tsai, PhD, MSSW; and Milton Wainberg, MD: Cultural Adaptation of Safety Planning Intervention for Survivors of Human Trafficking in the Philippines

  • Background: Survivors of human trafficking experience higher risk of suicide in comparison to the general population, and in the Philippines, there is a critical need for increasing the capacity of service providers to implement Safety Planning Intervention (SPI) and reduce risk of suicide.
  • Research Goals: The aim is to adapt the existing Safety Planning Intervention (SPI) and create a culturally-informed intervention for Filipino survivors of human trafficking, as well as strengthen the human resource capacity for suicide prevention within an economic empowerment program.
  • Impact and Progress: Throughout 2019-2020 and the COVID-19 pandemic, the team worked with collaborators in the Philippines to complete the culturally-informed adaptation of SPI. The team trained 100% of the staff at the empowerment program, via a 5 month virtual training program, and the staff piloted the new suicide prevention protocol with human-trafficking survivors. During the pilot, there was a decrease in suicidal risk levels for 95% of the participating survivors, and now the team plans to disseminate these findings to improve the capacity of other anti-trafficking organizations to provide suicide prevention interventions for survivors.
  • To read a full summary of this research project, please click here.

2. Manuela Orjuela-Grimm, MD, ScM and Roberto Lewis-Fernández, MD: Coping with Distress in a New Context: Self-coping and Community Resource Utilization Among Migrant Teens in the United States

  • Background: Teens migrating without a parent are frequently exposed to violence and hunger, and they could have elevated risk of PTSD, depression, generalized anxiety, and substance use disorders. However, there is evidence showing that post-migration factors (participation in community groups and clubs) can facilitate coping strategies (e.g. playing sports, praying) that contribute to positive mental wellbeing.
  • Research Goal: This study aims to develop a survey tool to measure the use of community resources and self-coping strategies among a group of 50 teens who migrated from Latin America without a parent, to inform a larger study examining protective factors for migrant teens in the U.S.
  • Impact and Progress: During 2019-2020, the team adapted survey tools and conducted virtual interviews with teens in NYC. Although the pandemic presented challenges in the pace and cost of the project, 52 youth were interviewed using the adapted survey tool, and the team also added a component to capture the impact of the pandemic on the migrant youth. The Council Grant not only helped to provide crucial research data that justified the submission of larger grant applications, but it also helped to facilitate strong partnerships among investigators dedicated to integrating mental health in the vision of migrant health.
  • To read a full summary of this research project, please click here.

3. Tsion Firew, MD; Claire Greene, PhD, MPH; and Milton Wainberg, MD: Developing a Screening and Referral System for Mental Health Problems Among Internally Displaced Persons in Ethiopia

  • Background: Ethiopia is experiencing unprecedented levels of internal displacement countrywide. The government has identified mental health as a priority concern among internally displaced persons (IDPs) and agencies have invested in increased delivery of mental health services, but there has not been systematic monitoring of the availability of care in the communities.
  • Research Goals: This study aims to assess the existing resources available to IDPs and returnees in Ethiopia and develop a screening and referral system for displaced persons to gain access to appropriate mental health care.
  • Impact and Progress: In early 2020, research activities were delayed due to an emergency response focused on the pandemic by government partners in Ethiopia. However, as of February 2021, the team completed 16 in-depth interviews with mental health providers and humanitarian practitioners. The interviews have revealed the challenges to service delivery, but it also revealed promising strategies to increase access to mental health care. The Council Grant helped to provide preliminary data for the team to use in future projects to continue evaluating strategies that improve access to mental health care for displaced persons in Ethiopia.
  • To read a full summary of this research project, please click here.

4. Franco Mascayano, PhD Student; Ezra Susser, MD, DrPH; and Lisa Dixon, MD, MPH: Early Psychosis Identification Program in Chile

  • Background: In the absence of early intervention, psychotic disorders tend to become long-term disabling conditions. If individuals can receive treatment for psychosis shortly after initial contact with a healthcare provider, individuals can have greater improvements in short term and long term functioning. Currently, over 70% of the population in Chile receives health and mental health care via the public health system.
  • Research Goals: Using a technique that models the key dynamics and bottlenecks of the public healthcare system, this study aims to evaluate and then develop an Early Psychosis Identification (EPI) program that will improve the identification and referral pathways of individuals who experience first episode psychosis.
  • Impact and Progress: During 2019-2020, the team completed workshops with community members in Chile to develop the initial model outlining how individuals with early psychosis can obtain care. During the COVID-19 pandemic, a second wave of workshops were held virtually with stakeholders to further discuss the specific factors that hinder and help individuals with first episode psychosis receive care. The initial results, made possible by the Council Grant, help to illustrate the historical and current trends of mental health care for individuals with psychosis in Chile.
  • To read a full summary of this research project, please click here.
  • Photos below are provided by research team, posted with permission and consent from participants.

 


 

Genomics of Schizophrenia in South Africa

This project uses exome sequencing and genome-wide copy number variant (CNV) analysis to identify genes that are enriched for rare or de novo mutations in persons with schizophrenia, compared to controls. For more information, contact Dr. Ezra Susser.