The Duke Global Health Institute (DGHI) has awarded grants for two research projects focused on global mental health—one of DGHI’s research priorities. One award was given to Helen Egger, head of the Division of Child and Family Mental Health and Developmental Neuroscience at Duke and co-PI Lauren Franz, assistant professor of psychiatry and global health, and the other to Eve Puffer, assistant professor of psychology and neuroscience and global health.
“We’re excited to further develop our efforts in global mental health research,” said Kathleen Sikkema, professor of psychology and neuroscience and global health and director of the Duke Global Health Institute’s (DGHI’s) global mental health initiative. “Through these pilot grants, DGHI is looking to stimulate interdisciplinary research in global mental health, as well as give investigators an opportunity to obtain preliminary findings and seek larger-scale external funding.”
Building a Partnership to Strengthen Children’s Mental Health
Building on the existing partnership between the Duke Global Health Institute and the University of Cape Town (UCT), Egger and Franz and collaborators at UCT will use Egger’s pilot grant to establish a collaborative partnership between Duke’s Division of Child and Family Mental Health and Developmental Neuroscience and UCT’s Division of Child and Adolescent Psychiatry. The collaboration will encompass research, education, clinical services and social responsibility—areas that are central to the missions of both divisions.
The partners envision sharing local resources, knowledge and challenges and piloting programs with shared aims concurrently in both settings. “We believe these pilots will help us achieve our program’s goals, but they’ll also serve a broader purpose,” Franz said. “They’ll enhance our understanding of how pediatric mental health systems, resources and needs are similar or different across cultures and countries.”
First Project: Autism & Beyond
The Duke-UCT partnership will focus on creating digital tools that are culturally appropriate and useful within each child’s community and then test and disseminate these tools. The initial research collaboration will be the launch of Duke’s Autism & Beyond study in South Africa. Autism & Beyond is a study of young children’s mental health that seeks to better understand and identify risks for development. In the study, geared toward children ages 12 months to 5 years, an iPhone app collects parent-report and video data about children’s social/emotional behavior and development.
The team plans to work together to adapt the app so it’s appropriate and appealing to families in South Africa. They’ll also conduct a simultaneous Durham-Cape Town pilot study to test deployment of the app in clinical and community settings with the goal of reaching families who don’t have access to iPhones.
While the team’s primary focus will be to cultivate the partnership between Duke and UCT, they have a long-term vision of expanding this collaboration model across Africa and beyond.
The UCT side of the partnership will be led by Petrus deVries, professor of child and adolescent psychiatry, and director of Center for Autism Research and the Adolescent Health Research Unit at UCT.
Validating an Observational Measure to Assess Family Functioning
Family environments can have a significant impact on the mental health of children and adolescents. Because of this connection, family-based interventions can help prevent and treat mental health disorders. However, the lack of tools for accurately assessing family functioning makes it difficult to develop and study family-level interventions in low- and middle-income countries.
Eve Puffer and her colleagues have developed a direct observational tool to assess family interaction patterns. In this assessment, families participate in structured activities that are videotaped. The characteristics of their interactions, such as the positive or negative words that they use, are then coded to give an overall picture of family relationships. Puffer will use this pilot grant to assess the validity of this tool by comparing its results with results of surveys and in-depth interviews with 200 families in Eldoret, Kenya, each with a target child between 10 and 17 years old.
Why an observational measure?
While self-report survey measures are useful, they have significant limitations: (1) Respondents may give what seems to be the “right” or “good” answer over the “accurate” answer, and (2) They fail to capture the nuances of interaction patterns that help researchers evaluate changes in family functioning over time. Direct observational measures tend to be more objective and enable researchers to gather more in-depth information on relationships.
“While direct observational assessments have been developed and used in high-income countries, such tools are rarely used in low- and middle-income countries,” Puffer said. “One of the major challenges is that the norms of family dynamics can vary significantly across cultures—what’s considered ‘normal’ or ‘healthy’ in one setting may be perceived very differently in another.”
Puffer and her collaborators hope that this project results in a direct observational measure of family functioning that is feasible and validated in a low-resource setting. If they achieve this goal, they will formalize the assessment materials, including the coding system and adaptation guidelines, with the goal of making it easier to test the measure in other contexts.
Other researchers on this project include co-principal investigator David Ayuku, professor in the department of behavioral sciences at Moi University in Eldoret, Kenya, and co-investigator Eric Green, assistant professor of global health.
- Read about DGHI’s global mental health initiative.
- Read about DGHI’s partnership with the University of Cape Town.