ObjectiveEvaluate the reliability and validity of the Youth Self-Report (YSR) as a screening tool for mental health problems among young people vulnerable to HIV in Ethiopia.DesignA cross-sectional assessment of young people currently receiving social services.MethodsYoung people age 15–18 participated in a study where a translated and adapted version of the YSR was administered by trained nurses, followed by an assessment by Ethiopian psychiatrists. Internal reliability of YSR syndrome scales were assessed using Chronbach's alpha. Test-retest reliability was assessed through repeating the YSR one month later. To assess validity, analysis of the sensitivity and specificity of the YSR compared to the psychiatrist assessment was conducted.ResultsAcross the eight syndrome scales, the YSR best measured the diagnosis of anxiety/depression and social problems among young women, and attention problems among young men. Among individual YSR syndrome scales, internal reliability ranged from unacceptable (Chronback’s alpha = 0.11, rule-breaking behavior among young women) to good (α≥0.71, anxiety/depression among young women). Anxiety/depression scores of ≥8.5 among young women also had good sensitivity (0.833) and specificity (0.754) to predict a true diagnosis. The YSR syndrome scales for social problems among young women and attention problems among young men also had fair consistency and validity measurements. Most YSR scores had significant positive correlations between baseline and post-one month administration. Measures of reliability and validity for most other YSR syndrome scales were fair to poor.ConclusionsThe adapted, personally administered, Amharic version of the YSR has sufficient reliability and validity in identifying young vulnerable women with anxiety/depression and/or social problems, and young men with attention problems; which were the most common mental health disorders observed by psychiatrists among the migrant populations in this study. Further assessment of the applicability of the YSR among vulnerable young people for less common disorders in Ethiopia is needed.
I n Ethiopia, the HIV epidemic is increasingly urban and female. An estimated 7.7 percent of the urban population in Ethiopia is HIV-positive compared to less than 1 percent of the rural population, 1 which suggests a generalized urban epidemic and a rural epidemic concentrated among high-risk groups. 2 Nationally, the female-to-male ratio of HIV infection is 3 to 2, reflecting the heightened vulnerability of girls and women to HIV. The imbalance between rural and urban epidemics underscores the need for attention to migration and short-term rural-urban exchanges in HIV prevention efforts. Furthermore, girls who migrate from rural to urban areas may be less protected, more vulnerable to violence and sexual abuse, and less equipped to avoid these abusive situations-all of which may increase HIV risk. A study in low-income areas of Addis Ababa found that 45 percent of adolescent girls had migrated to the area. Among these migrants, 87 percent were in low-status jobs, especially domestic work, which is characterized by poor working conditions, low-pay, and is dominated by girls and women. 3 Domestic workers participating in Population Council research in Addis Ababa reported working an average of 64 hours in the week prior to the survey with an average monthly salary of 52 Birr, or about US$6.00. 4 A more recent Council study of adolescent girls in urban slum areas of Ethiopia found that domestic workers are more likely to be victims of sexual abuse, including non-consensual sex. 5 Furthermore, domestic workers' long working hours and social isolation precludes many from benefiting from mainstream youth programs. 6 'Biruh Tesfa' (Bright Future) Program The former Ethiopia Ministry of Youth and Sports (currently Ministry of Women, Children and Youth) and its Regional Bureaus established the Biruh Tesfa (Amharic for 'Bright Future') program for out-of-school slum-dwelling girls aged 10 to 19, including rural-urban migrants, domestic workers, and orphans. The Population Council provides technical
Ethiopia is experiencing an increasingly urban, female-centered HIV epidemic alongside a rise in rural migration of adolescents to Addis Ababa. Often these migrants are confronted by social challenges such as lack of education, inadequate housing, unstable employment conditions, and physical and sexual abuse. These difficult living circumstances contribute to psychological and mental health problems among these vulnerable adolescents, potentially putting them at greater risk of acquiring HIV. However, knowledge about how targeted mental health interventions can impact HIV-related outcomes worldwide, and in Ethiopia, remains limited. OBJECTIVES The goal of this study was to pilot test a strategy for addressing mental health problems, such as stress, anxiety, depression, and emotional and behavioral issues, as well as measure if the provision of a tailormade psychosocial support intervention can affect HIV-related outcomes among vulnerable migrant adolescents in Addis Ababa, Ethiopia. The specific objectives of this study were to pilot test a targeted psychosocial support counseling intervention and document any changes in : 1) psychological and mental health problems of the target population; and 2) responsiveness to HIV programming and services among the target population. METHODS Study design This was a before and after intervention study comprising a cohort of migrant male and female adolescents aged 15 to 18 years old in Addis Ababa, Ethiopia receiving services from two service delivery organizations-Biruh Tesfa and Retrak. Biruh Tesfa works with migrant young women who are predominantly employed as domestic workers, while Retrak works with young men in Addis Ababa who are often engaged in street labor activities. Participants were screened using the Youth Self-report (YSR) tool and a behavioral survey at baseline, then delivered a three-month psychosocial counseling pilot intervention. The intervention was followed by an endline YSR and behavioral survey. Due to ethical concerns, participants with severe mental health issues at baseline (N=24) were referred to clinical services for appropriate treatment and follow-up care, and thus excluded from the study. Description of the intervention The study intervention consisted of the delivery of a client-driven, psychosocial counseling intervention, administered by trained counselors, which discussed adolescent development, psychological wellbeing, mental health problems, and factors increasing vulnerability of marginalized adolescents. Study counselors administered the targeted counseling intervention, which included both individual and group counseling sessions, such as creative art therapies and music, drama, and dance (MDD), to all consenting enrolled participants from the two Addis Ababa-based service delivery organizations of Biruh Tesfa and Retrak.
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