Bringing Sanitation into the Spotlight

As a child in India, Sunil Bhatia, PhD, used to bike past two slums every day on his way to school. As he did, he would see people defecating openly in the streets because they had no toilet to use.

Today, there are 2.5 billion people in the world who do not have access to a toilet, Bhatia told attendees at a session here honoring him with the 2015 APA International Humanitarian Award for his work bringing sanitation to India’s urban poor. Bhatia has brought “a taboo subject — open defecation — into the spotlight to show how lack of sanitation is connected to psychological constructs of dignity, humiliation and safety,” the award committee said.

Bhatia, a psychology professor at Connecticut College who studies culture and identity in the context of globalization and transnational migration, founded the group Friends of Shelter Associates (FSA) in 2005. The group works with Shelter Associates, an NGO that runs sanitation and other projects in his native Pune, India. To date, Bhatia said, FSA has funded more than 625 toilets that reach 4,000 people, and just received a grant to build 3,000 more toilets.

The toilets — which cost just $250 to $300 — change lives. Exposure to feces spreads diarrhea, cholera, typhoid and other diseases that kill millions of children each year.

“The lack of sanitation wreaks havoc on the physical and psychological health of the urban poor,” Bhatia said.

The hardships go beyond disease. Bhatia told of a woman who was dying of AIDS, who had to walk half a kilometer to defecate behind the railway tracks. “A simple toilet eased her life in her dying days,” he said. And a lack of toilets can lead to fear and physical violence — women have told Shelter Associates that they are scared of going to the bathroom alone, and that they may limit themselves to before sunrise and after sunset because they fear harassment from men.

For these women, and others, “having a toilet represents a ‘life-changing dream,'” Bhatia said.

For more information about Friends of Shelter Associates, visit http://www.friendsofsa.org/.

‘Tweet it Off:’ Leveraging Social Media for Health Behavior Change

More than 72 percent of online adults — and 89 percent of online young adults — belong to at least one social network, according to a 2013 Pew Research Center survey. The average Facebook user spends more than 40 minutes per day surfing the site, according to the company’s CEO.

Given stats like these, the broad reach of Facebook, Twitter and other sites could provide a new tool to help more people lose weight and make other health behavior changes, according to University of Massachusetts Medical School psychologist Sherry Pagoto, PhD, an expert in the behavioral aspects of obesity control and cancer prevention.

iStock_000054305248_MediumPagoto, who presented her research here, was interested in translating an evidence-based weight loss program called the Diabetes Prevention Program (DPP) into something that could be shared via social networks. The DPP trains “lifestyle coaches” to help people at risk for diabetes learn to eat more healthily and increase their physical activity. The Centers for Disease Control and Prevention  runs the program at more than 700 sites throughout the U.S., through a partnership with local organizations like the YMCA.

An online program could potentially treat many more people, according to Pagoto. In an initial study, she organized 45 participants who wanted to lose weight into four groups. One group participated in a traditional 12-week in-person DPP. Another participated in a combined in-person program and Twitter group. A third participated in just a Twitter group. And the fourth also participated in the in-person and Twitter program, but with the additional factor that the participants suffered from depression.

In the Twitter program, trained facilitators logged in daily to tweet links to content from the program, as well as generate discussion among participants. The participants would also support each other – one participant, for example, tweeted a picture of doughnuts from her office kitchen with the caption “look what my office does for Halloween!” and others chimed in to encourage her to resist the temptation.

In the end, Pagoto found that the Twitter program worked for patients who were not depressed — the Twitter-only participants lost as much weight as the in-person and the Twitter-plus-in-person ones – but it was not effective for the depressed patients.

In a follow-up study, Pagoto tested a Facebook version of the program, this time also providing incentives to some participants to post more often. She wanted to see if encouraging these “superusers” would help everyone lose more weight. That study just ended, Pagoto said, but early data suggest that the program did help participants lose weight, though the effect of the superusers was unclear.

So far, all of Pagoto’s studies have used closed, private groups. But one of the advantages of Facebook and Twitter is the way in which popular groups, posts and memes can spread exponentially. So in future research, Pagoto wants to open up her studies and allow her participants to invite friends into the groups throughout the study.

“There are IRB issues to figure out” and methodological ones too, she said. But the payoff could be worth it. “It has the ability to take on a life of its own.”

Is Allison More Likely than Lakisha To Receive an Offer for Mental Health Treatment?

The subtle effects of racism and implicit bias are pervasive. Researchers have long known that people with African-American sounding names are at a disadvantage when applying for jobs. Now, research presented in a poster session at the 2015 APA convention suggests that they may also face discrimination when trying to access mental health services.

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In a well-known 2003 study, two economists sent more than 5,000 identical resumes to companies in Chicago and Boston. The only difference was that some of the resumes had stereotypically white names on top (Emily and Greg) and some had stereotypically African-American names (Lakisha and Jamal). The researchers found that “Emily” and “Greg” received 50 percent more callbacks than “Lakisha” and “Jamal.”

Psychologist Richard Q. Shin, PhD, of the University of Maryland, wondered whether that effect would translate to the mental health area.

Together with graduate students Jamie Welch and Ijeoma Ezeofor, and colleagues at the University of Vermont, he left voicemail messages for 371 Maryland mental health provicers. The messages — recorded by the same woman, using the same wording — purported to be from a prospective client named either Lakisha or Allison, looking for counseling services.

The researchers found that “Lakisha” and “Allison” received calls back from the mental health providers at the same rate. However, “Allison” was significantly more likely (12 percent) to receive an offer of services (as opposed, for example, to being told that the provider wasn’t accepting new clients).

Welch says that psychologists, counselors and others need to be aware of their own implicit biases.

“It’s easy for us to think we’re above the implicit biases that are pervasive in our society,” he says. “But we’re part of that society.”

In future studies, the researchers want to find out whether “Lakisha” faces more discrimination when her voicemail message uses African-American vernacular language. They also want to conduct a larger study with more geographic diversity, and to explore the effects of names from other ethnic backgrounds.

In Lebanon, psychologist helps Syrian refugees cope

Since the Syrian civil war began in 2011, nearly 2 million Syrian refugees have flooded into neighboring Lebanon, straining the resources of a country with a population of only about 4 million.

In addition to basic needs like food and shelter, these refugees — victims of war and trauma — need psychosocial aid, Dr. Brigitte Khoury told attendees at a 2015 APA convention session on working with refugees in international settings. So Khoury, a psychologist at the American University of Beirut, has been working with the United Nations Population Fund (UNFPA) to develop a series of problem-solving and support groups for refugee women, run by local nurses, social workers and midwives.

Map of Syria. A detail from the World Map provided by RAND McNALLY.
Map of Syria. A detail from the World Map provided by RAND McNally.

“There are not enough psychologists to provide help,” Khoury said. “So we have to train others.”

Khoury’s program trains these local nurses and social workers to run a previously validated 12-session group intervention in which refugee women learn problem-solving and stress-management skills. The interventions’ loose structure allows the women to bring up specific problems in their lives and talk through solutions with each other and the group’s leader.

Most of the problems are related to the daily hassles of refugee life — such as finding adequate housing and food — as well as issues with children and parenting, family and in-laws, and financial difficulties, Khoury says.

“It was not really about trauma and PTSD,” she said. “It was about their daily lives and how to survive in these difficult circumstances.”

At first, some of the women were reluctant to participate because they weren’t sure what the point was of coming together “just to talk,” with no concrete reward, Khoury said. The groups faced other serious challenges as well. Occasionally, some of the sites — towns on the border with Syria — would be too dangerous for the facilitators to get to, Khoury said.

But the intervention worked: By the end of the 12 weeks, most of the women said that they felt less depressed and anxious. They also established close and supportive friendships with the other women in the group — friendships that could continue to provide support even after the 12-week program ended. 

Khoury’s pilot program reached 25 trainers and 300 women. This month, she is starting a new training session with another group of nurses and social workers. She said she also hopes to expand it to men, as many of the women in the groups said that their husbands could benefit from similar groups.

What’s Behind the Public Fascination with Hoarding?

In 2010, 17 people were injured and more than 1,200 were displaced when a six-alarm fire gutted a public housing apartment tower in Toronto. The fire was ignited when a resident threw a cigarette butt onto a balcony overflowing with paper.

The incident generated widespread media interest and public anxiety in Toronto about the hazards of hoarding, according to Katie Kilroy-Marac, PhD, an anthropology professor at the University of Toronto Scarborough who studies the history of psychiatric thought.

It also prompted a new line of research for her.

“Over the past 10 to 15 years, hoarding has come to loom large in the public imagination” she said, with popular television shows, books and more devoted to the subject. And mental health professionals are paying attention as well. In 2013, with the publication of the DSM-5, hoarding was for the first time officially classified as its own disorder, rather than a symptom of other diagnoses such as obsessive compulsive disorder or schizophrenia.

“It’s clearly having a moment of sorts. But why?” Kilroy-Marac asked.

She explored that question in a talk at the 2015 APA convention in Toronto entitled “On the recent emergence of hoarding as a mental illness, public health hazard and media spectacle.” The new interest in hoarding, she believes, is just one aspect of a much larger interest in our own relationship with “stuff,” how we acquire it and how we get rid of it.

It dovetails with newfound public interest in minimalist lifestyles like the “tiny house” movement, the rise of professional organizers, and growing concern about of the ecological impact of consumer products, she says.

She offers some thoughts on the subject: