| Author: | Salihu, Dauda |
| Title: | Effect of an African circle dance programme on mental health in internally displaced adults with depressive symptoms in Africa : a quasi-experimental study |
| Advisors: | Kwan, Yiu Cho Rick (SN) Wong, Mi Ling Eliza (SN) |
| Degree: | Ph.D. |
| Year: | 2022 |
| Subject: | Internally displaced persons -- Africa Depression, Mental Dance therapy Hong Kong Polytechnic University -- Dissertations |
| Department: | School of Nursing |
| Pages: | 21, 314 pages : color illustrations |
| Language: | English |
| Abstract: | Introduction : Internally Displaced Persons (IDPs) are a group of people that are forced to flee their place of residence secondary to manmade or natural disasters but remain within the jurisdiction of the national government. The displaced conditions such as poverty, and the lack of social support exposed them to stressors which in turn results in stress with subsequent development of depressive symptoms. Depressive symptoms manifest mental health problems of loss of interest or pleasure, sadness, guilt or low self-worth, disturbed sleep or appetite, tiredness, low concentration and depressed mood, leading to distress and impaired functioning. It was a significant problem for the person, community and society. The global prevalence of depression increases from 43.3 to 70.9 million between 2009 to 2018 of which three quarters were from ten countries (Nigeria inclusive). Depressive symptoms are managed using pharmacological and non-pharmacological interventions. The pharmacological approach was effective but associated with a side effect, high cost, or lack of purchasing power by the IDPs, and non-availability in remote locations. The non-pharmacological care approach was the supportive psychotherapy such as Teaching Recovery Techniques, classroom-based psychosocial interventions; activities with counselling intervention such as the Emotional Freedom Technique, Cognitive Behavioural Therapy, Stepped Care intervention; social investment interventions like the Economic Empowerment programme and physical activity interventions such as tai chi, yoga among others. These non-pharmacological interventions were effective, with some requiring cultural adaptation to be practised in Africa. A growing number of evidence has shown that physical activities were effective in reducing moderate and mild depression; however, it was associated with high attrition rates. Given the high prevalence of depressive symptoms in IDPs, there is a high demand for people's psychological health needs in healthcare and social condition/contexts. Research has shown that artistic activities are particularly well accepted by disadvantaged people. The disadvantaged people refers to a group of persons who experiences a special kind of problem (e.g., displacement) associated with the lack of social and economic support which might impact their mental state. Literature evidence has shown that dance intervention effectively reduces depressive symptoms. However, there is a lack of feasible, culturally sensitive interventions in resource-deprived Africa. African Circle Dance (ACD) may be a culturally accepted intervention since dance intervention effectively reduces depressive symptoms. Dance is not like physical activity, requiring a high intensity of physical training, with mostly meaningless movements. It is an artistic activity that incorporates music and movements, and are well accepted by disadvantaged people due to its fun elements. Due to the cultural relevance of dance, adults might find it motivating and exciting. However, there is no empirical evidence examining the effects of psychosocial interventions/programme using ACD or dance interventions on depressive symptoms among IDPs despite its high prevalence. Methods : The programme was designed in three phases. Before ACD protocol development, we conducted a comprehensive systematic review of the relevant literature to understand the proposed topic, necessary intervention components appropriate to treat depression in adults as well as the evidence supporting the use of dance and underlying mechanism of actions. Review evidence led to the development of the ACD intervention protocol which was validated through a Delphi process (Phase One). In the second phase of the study, the identified outcome measures were translated and validated into the Hausa language for use in the main study (Phase Two). The developed ACD programme was pilot tested using a quasi-experimental design nested with a qualitative interview to test the acceptability, practicality and perceived usefulness of the ACD interventions. Pilot data were analysed using descriptive statistics and qualitative content analysis, after which the full-scale study was implemented. A quasi-experimental design (pre-/post-test) was employed, and this is due to fear of the subject's contamination. Two IDP camps were randomised into the intervention and control groups. Adults aged ≥ 18 years, living in an IDP camp, performed brisk walking, and who scored ≥ 10 on a depressive symptoms subscale were recruited. The intervention group received an 8-week ACD dance intervention and two 1-hour brief health education; the controls only received the brief health education sessions. Brief health education was standard care given to the IDPs in war-affected settings. The intervention dose was from the systematic review evidence via expert's panel validation. Convenience samples were recruited, and sample size were estimated using the Generalised Linear Mixed Model Power and Sample Size (GLIMMPSE). The primary outcomes were the depressive symptoms, and the secondary outcomes were the stress, anxiety, insomnia and coping strategies. Data were collected at three-time points (baseline, post-intervention, and follow-up). A generalised estimating equation was used to test the effects of the interventions, with a 0.05 significance level. Results : 198 IDPs completed the study (ncontrol = 98; nintervention = 100). ACD plus brief health education led to significant interactive effects for depressive symptoms (Cramer's V=.33, p<.001), stress (Cramer's V=.15, p=.008), emotion-focused coping (Cramer's V=.32, p=.003), and dysfunctional-focused (Cramer's V=28, p<.001) coping strategies. On the contrary, ACD does not add additional effects to brief health education in terms of reducing anxiety and insomnia. There were no significant interactive effects for the problem-focused coping (Cramer's V=.20, p=.161). Discussion : This is the first trial showing promising effects of ACD in adult IDPs on mental health and wellbeing. The evidence-based protocol was developed using a systematic review and meta-analysis which was validated by the panel of experts. ACD might augment the effects of brief health education for reducing depressive symptoms, and stress. Further, it promotes coping (emotion and dysfunctional-focused coping). However, ACD does not add additional effects on top of brief health education for insomnia and anxiety. Future studies should investigate whether ACD alone could be independently effective to reduce depressive symptoms and stress, as well as promote coping (emotion and dysfunctional-focused). The developed ACD protocol might be adopted in Africa. Similarly, the validated tools might be used for psychological assessments, while ACD may be adopted clinically as an adjunct strategy to reduce stress, depressive symptoms, and promote coping (emotion and dysfunctional-focused coping). Future studies should investigate whether ACD alone could be independently effective to reduce depressive symptoms and stress/promote coping (emotion and dysfunctional-focused coping). Further, studies should also clarify whether coping is mediated by ACD or not. Conclusion : ACD showed good effects on the mental health and wellbeing of adult IDPs. ACD plus brief health education significantly reduces depressive symptoms and stress; it also promotes coping (emotion and dysfunctional-focused coping). ACD might be adopted clinically as an adjunct care approach on top of brief health education for promoting mental health and well-being. |
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| Access: | open access |
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