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A Qualitative Study of Mental Health Problems Among Orphaned Children and Adolescents in Tanzania

Dorsey, Shannon PhD*; Lucid, Leah BA*; Murray, Laura PhD; Bolton, Paul MBBS, DTMH, MPH, MSc; Itemba, Dafrosa MSc; Manongi, Rachel MD, PhD§; Whetten, Kathryn PhD

The Journal of Nervous and Mental Disease: November 2015 - Volume 203 - Issue 11 - p 864–870
doi: 10.1097/NMD.0000000000000388
Original Articles

Low- and middle-income countries have a high number of orphans, many of whom have unmet mental health needs. Effective mental health interventions are needed; however, it is necessary to understand how mental health symptoms and needs are perceived locally to tailor interventions and refine measurement of intervention effects. We used an existing rapid ethnographic assessment approach to identify mental health problems from the perspective of orphans and guardians to inform a subsequent randomized controlled trial of a Western-developed, evidence-based psychosocial intervention, Trauma-focused Cognitive Behavioral Therapy. Local Kiswahili-speaking interviewers conducted 73 free list interviews and 34 key informant interviews. Results identified both common cross-cultural experiences and symptoms as well as uniquely described symptoms (e.g., lacking peace, being discriminated against) not typically targeted by the intervention or included on standardized measures of intervention effects. We discuss implications for adapting mental health interventions in low- and middle-income countries and assessing effectiveness.

*Department of Psychology, University of Washington, Seattle, WA; †Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; ‡Tanzania Women Research Foundation and §Kilimanjaro Christian Medical Center, Moshi, Tanzania; and ∥Duke University, Durham, NC.

Send reprint requests to Shannon Dorsey, PhD, University of Washington, Guthrie Hall, Seattle, WA 98195. E-mail: dorsey2@u.washington.edu.

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