Bandy X. Lee

Detecting Depressive Disorder With the Hopkins Symptom Checklist-25 in Tanzania

Background: Assessment of the growing prevalence of depression in developing countries is hampered by a lack of valid diagnostic instruments for the local settings. Aim and method: This study attempted to examine the validity of the 25-item Hopkins Symptom Checklist (HSCL-25) in a special primary care population in Dar es Salaam, Tanzania. Results: 787 antenatal participants were recruited, and their responses revealed good internal consistency, interrater reliability, and test-retest reliability, and the scale was validated using content, construct, and discriminant validation methods. Factor analysis of the depression subscale, however, confirmed the need for a locally developed scale. Conclusions: Integrating universalist and relativist approaches, through the validation and modification of scales, may help in the detection of depression in cross-cultural settings.

Beyond the Prison Paradigm: From Provoking Violence to Preventing It by Creating “Anti-Prisons” (Residential Colleges and Therapeutic Communities)

Abstract: Prisons were supposedly created for the purpose of the tertiary prevention of violence (i.e., reducing the frequency and severity of future violence on the part of people who have already become violent). However, there is much evidence that this method of attempting to prevent violence is often, though not always, either ineffectual or counterproductive, in which case it is either a waste of money or actually exacerbates the problem it was ostensibly intended to solve. This article reviews evidence concerning those questions including an analysis of the effect of punishment (one of the main purposes of prisons) on violent behavior. Punishment—the infliction of pain—will be distinguished from restraint (incapacitation, separation from the community). Successful examples of violence prevention in unconventional prison programs, emphasizing therapy and education rather than punishment, and restorative rather than retributive justice, will be summarized, together with evidence that these programs reduce re‐incarceration rates so substantially that they actually save the taxpayers more money than they cost, in addition to enhancing the safety of the general public. The position is taken that traditional prisons provoke more violence than they prevent and are so fundamentally flawed that they cannot be reformed; we argue that they should instead be abolished and replaced by “anti‐prisons,” that is, locked, secure residential colleges, therapeutic communities, and centers for human development. Prisons will come to be seen as a well‐meaning experiment that failed, rather like the use of leeches in medicine.

Detecting Depressive Disorder With a 19-Item Local Instrument in Tanzania

Background: Based on experience with the Hopkins Symptom Checklist-25 (HSCL-25) in a Tanzanian population, this study attempted to develop a locally specific screen that employs indigenous expressions. Aim and method: Thirty ethnographically derived local idioms were added and the final 47-item questionnaire administered to 787 randomly selected antenatal clinic attendees. Results: Logistic regression identified 19 items for the Dar-es-Salaam Symptom Questionnaire (DSQ), which demonstrated good internal consistency (Cronbachs α = 0.84), interrater reliability (intraclass r = 0.89), and test-retest reliability (intraclass r = 0.82). Positive endorsement overall increased only slightly, but the report of mild symptoms was more frequent with the DSQ (15.0%) than the HSCL-25 (10.8%). Content and discriminant validation of the local scale conformed to expectation, but depressed affect failed to emerge as an important feature. Conclusion: Locally derived expressions may aid in the reporting of illness and illness severity. Further studies are recommended to uncover universal aspects and culturally specific manifestations of illness expression. Declaration of interest: None to report.

Global research priorities for interpersonal violence prevention: a modified Delphi study.

Abstract Objective To establish global research priorities for interpersonal violence prevention using a systematic approach. Methods Research priorities were identified in a three-round process involving two surveys. In round 1, 95 global experts in violence prevention proposed research questions to be ranked in round 2. Questions were collated and organized according to the four-step public health approach to violence prevention. In round 2, 280 international experts ranked the importance of research in the four steps, and the various substeps, of the public health approach. In round 3, 131 international experts ranked the importance of detailed research questions on the public health step awarded the highest priority in round 2. Findings In round 2, “developing, implementing and evaluating interventions” was the step of the public health approach awarded the highest priority for four of the six types of violence considered (i.e. child maltreatment, intimate partner violence, armed violence and sexual violence) but not for youth violence or elder abuse. In contrast, “scaling up interventions and evaluating their cost–effectiveness” was ranked lowest for all types of violence. In round 3, research into “developing, implementing and evaluating interventions” that addressed parenting or laws to regulate the use of firearms was awarded the highest priority. The key limitations of the study were response and attrition rates among survey respondents. However, these rates were in line with similar priority-setting exercises. Conclusion These findings suggest it is premature to scale up violence prevention interventions. Developing and evaluating smaller-scale interventions should be the funding priority.

Physics and the quandaries of contemporary psychiatry : Review and research

Although in physics, quantum mechanical principles have long replaced Newtonian ones, we continue to apply the latter in models of the mind and its diseases. This article discusses the possible theoretical application of quantum principles to mind-brain function. Empirically, this study tested which of these principles practicing psychiatrists found more applicable in clinical practice. Psychiatrists (N = 382) at universities around the United States were asked to answer a questionnaire that contained clinical scenarios reflecting mental, interpersonal, or therapeutic processes corresponding to quantum or classical physical principles. Respondents (N = 191) were significantly more likely to rate scenarios reflecting quantum principles as being consistent with their experience than they were those reflecting classical principles (p < .0005). This effect was significantly greater in more experienced psychiatrists. Quantum physics, a powerful tool in understanding properties of both micro- and macro-level phenomena, may have implications at the human level, invoking the roles of observer, interpersonal relationships, and resources such as resiliency and creativity.

The psychopharmacologic treatment of violent youth.

Abstract: Aggressive violence has been described as the greatest problem and the most frequent reason for referrals in child and adolescent psychiatry. In this country we have only partially emerged from an epidemic of violence that was really an epidemic of youth violence. Thus it is hardly surprising that psychiatrists are being asked more and more frequently whether psychiatric medications might help to diminish the toll from this behavioral plague. Medications are useful and appropriate for only a small minority of the people who commit serious violence. Even when they are indicated, they can never be the sole treatment modality, but should be supplemented by psychological and social therapies. When the violence is a byproduct or symptom of an underlying mental illness, treating that illness is generally the most effective method of preventing future violence on a long‐term basis. However, most violence is not committed by those who are mentally ill, and most of the mentally ill never commit a serious act of violence. That is why many attempts have been made to discover whether there are drugs that diminish the symptom, violence, even when there is no underlying mental illness for which drugs would normally be prescribed. In fact there are several, and their indications and use are reviewed here. Different principles govern the acute short‐term emergency treatment of a violent crisis and the long‐term treatment of those who are chronically and repetitively violent, and these differences are also summarized here.

Transforming Our World: Implementing the 2030 Agenda Through Sustainable Development Goal Indicators.

Abstract The United Nations’ 2030 Agenda for Sustainable Development recognizes violence as a threat to sustainability. To serve as a context, we provide an overview of the Sustainable Development Goals as they relate to violence prevention by including a summary of key documents informing violence prevention efforts by the World Health Organization (WHO) and Violence Prevention Alliance (VPA) partners. After consultation with the United Nations (UN) Inter-Agency Expert Group on Sustainable Development Goal Indicators (IAEG-SDG), we select specific targets and indicators, featuring them in a summary table. Using the diverse expertise of the authors, we assign attributes that characterize the focus and nature of these indicators. We hope that this will serve as a preliminary framework for understanding these accountability metrics. We include a brief analysis of the target indicators and how they relate to promising practices in violence prevention.

Violence, health, and the 2030 agenda: Merging evidence and implementation.

The Guest Editors introduce the Special Issue for the Journal of Public Health Policy on violence, health, and the 2030 Agenda. Emphasizing the importance of collaboration between scholars and practitioners, they outline the process of jointly imagining and designing the next generation of violence prevention strategies. They include representative works of members of the World Health Organization (WHO) Violence Prevention Alliance (VPA), including the World Bank, the United States Centers for Disease Control and Prevention, Prevention Institute, the Danish Institute Against Torture, the University of Cambridge Institute of Criminology, the London School of Hygiene and Tropical Medicine Gender Violence and Health Centre, and the Yale University Law and Psychiatry Division, among others.

Violence and health: implications of the 2030 Agenda for South–North collaboration

Through the 2030 Agenda for Sustainable Development, the United Nations (UN 2015) invited the world to collaborate in an inclusive, long-ranging vision for the future. It highlights our interdependence and collective responsibility for human life on this planet. Preventing violence is at the heart of its ambitious agenda to ‘‘promote peaceful and inclusive societies for sustainable development’’ (UN 2015: Goal 16). Recognizing that violence not just causes death and disability but limits creativity, economic growth, and general well-being, it begins to conceive of a world without violence. In September 2015, the global campaign for violence prevention (GCVP), the World Health Organization (WHO) Violence Prevention Alliance (VPA) meeting, and the first VPA academic meeting converged in Geneva before the launch of the 2030 Agenda to discuss ‘‘Linking Global Violence Prevention with Sustainable Development.’’ The meetings underscored that 90 % of global violence occurs in regions that contribute only 10 % of published research and led to this special issue. Compiling mostly scientific research, this issue complements the policy papers of a companion VPA special issue with the Journal of Public Health Policy (Lee et al. 2016). The core of the WHO VPA’s mission lies in multisectoral collaboration and interdisciplinary integration. Contributions by member networks to this special issue range in discipline as well as research methods to offer cross-geographic and -cultural perspectives. In an invited editorial, Kjaerulf and colleagues of the VPA present an overview of the 2030 Agenda and the need for researchers and interventionists to work boldly toward violence prevention. Eslami and colleagues then report on a large-scale study of European countries of variable income in a neglected area of research even for the Global North: the demographics of elder abuse. For the rest of the issue, articles are divided by 2016 World Bank income classifications, with the most important category coming last. Goodall and colleagues from Scotland, Wathen and colleagues from Canada, and Johansen and Tjørnhøj-Thomsen from Denmark show how intricate data collection in the Global North could be a guide to studies in the Global South. We discover how using a public health framework to monitor alcohol use, distinguishing the different experiences and trajectories of intimate partner violence (IPV), and developing a broader approach to the oft-underestimated consequences of stalking can contribute to a more thorough understanding of violence. This editorial is part of the special issue ‘‘Violence and Health: Implications of the 2030 Agenda for South–North Collaboration’’.

Violence, justice, and health: implications for a multisectoral collaboration

Until recently, criminal justice has been the predominant way by which society has intervened in problematic human violence. Then, there has been the rise of a public health approach, which views human violence as an issue one can research, understand, and prevent. Mental health and the social sciences shed light on how psychological and social dimensions shape human violence. Laws, in turn, protect civil and human rights and set standards for governance. All these different domains have much to gain from collaborating with one another, but there has been insufficient exchange between them. With the United Nations’ 2030 Agenda for Sustainable Development (UN 2015) and its wide-ranging, cooperative goals for sustained security and peace, it is a propitious time to consider how criminal justice and public health, as well as their allied fields, can join forces. Violence is a complex, human construct that cannot be understood outside of social, cultural, political, religious, and structural contexts. Therefore, any endeavor to prevent violence and promote peace requires broad collaboration and sustained commitment to these goals. The World Health Organization (WHO) Violence Prevention Alliance (VPA) continues in its diverse work to build bridges. At first sight, the emphasis on healing in public health and punishment in criminal justice makes such a dialogue seem difficult. However, there are more commonalities than we often recognize. Increasingly, it is understood that the core mission of the police in democratic societies is to reduce crime and violence by using the best evidence on how to achieve these goals. Public health methodologies provide the detailed epidemiological data and experiments to advise criminal justice policy. Often, close cooperation between criminal justice and public health agencies is essential to achieve violence reduction goals. On the other hand, public health approaches to violence prevention require a functioning law enforcement system, thoughtful implementation of laws, and robust mental health services for victims and potential perpetrators. High-quality interdisciplinary research can help to strengthen effective collaboration between the public health and criminal justice systems. For example, research on the mental health interventions that can prevent future perpetration of violence can help to reduce costly imprisonment as well as societal harm (Gilligan and Lee 2004). Similarly, evaluation research on the effectiveness of collaborative service delivery between police, social welfare, mental health, and public health actors in cases of child maltreatment or victims of intimate partner violence can show how different sectors can work together more effectively. Contributions to this issue make important steps toward such an integrated view, incorporating studies from a range of geographic regions and income levels, as in past issues (Lee et al. 2014). First, we offer an example of an innovative, integrative approach to criminal justice, mental health, and family support in Connecticut, USA, by Lee and colleagues. Then, we present a study spanning 28 European countries, in which Sanz-Barbero and colleagues show empirical evidence on how macrosocial policies related to gender equality may help to reduce intimate partner violence. Continuing with the theme of gender violence, De and Murshid highlight how cultural beliefs that justify intimate partner violence affect the extent to which victimization experiences are associated with a higher likelihood screen for depression in Bangladesh. Djikanovic and colleagues reveal that promoting gender equality is important to address beliefs related to wife beating in a young minority This editorial is part of the special issue ‘‘Violence, Justice, and Health: Implications for a Multisectoral Collaboration’’.