Project ID NS-MH2024_32


Co Supervisor 1A Institute of Psychiatry, Psychology & Neuroscience, School of Mental Health & Psychological Sciences, Department of PsychologyWebsite

Co Supervisor 1B Institute of Psychiatry, Psychology & Neuroscience, School of Mental Health & Psychological Sciences, Department of Biostatistics & Health InformaticsWebsite

Additional Supervisor Dr Merga Feyasa and Dr Nadine Seward

Causal mechanisms underlying the association between poverty, stigma, social exclusion and quality of life among families with children with developmental disabilities in Ethiopia and Kenya

Ethiopian and Kenyan children with developmental disabilities (including intellectual disability and autism) and their caregivers experience severe challenges; most families receive no formal support. The NIHR-funded SPARK project (‘SuPporting AfRican communities to improve mental health in Kids with developmental disabilities’) aims to improve support for these children and their caregivers. SPARK includes a large randomised controlled trial of the World Health Organization‘s Caregiver Skills Training programme. Projected to comprise data from around 540 caregiver-child dyads followed over a time span of 10 months, the SPARK trial will be one of the largest trials conducted in developmental disability research.

Our previous work showed that quality of life of Ethiopian and Kenyan families with a child with a developmental disability is severely compromised, and impacted by financial difficulties, stigma, and social exclusion. For the first time, the longitudinal nature of the trial data will allow us to consider temporal causal mechanisms behind the association between poverty, stigma, lack of social support, and quality of life .

This PhD will focus on disentangling these causal mechanisms using cutting edge methods such as interventional effects applying a robust causal inference framework and machine learning. The supervisory team comprises Dr Rosa Hoekstra (expert in developmental disabilities and SPARK co-PI), Prof Kimberley Goldsmith (biostatistician, expert complex intervention triallist and senior trial statistician in SPARK), with additional supervision from Dr Merga Feyasa (Ethiopian statistician) and Dr Nadine Seward (causal modelling expert).

Skills development during the PhD: longitudinal and causal statistical modelling; systematic reviewing/ cross-cultural validation

Year 1: systematic review or cross-cultural validation study using SPARK trial baseline data; Year 2: training in longitudinal and causal modelling; site visits to Ethiopia and Kenya to understand context and work with Dr Merga Feyasa; Year 3: analysis and paper writing; Year 4: completion of thesis.

Representative Publications

Borissov, A., Bakolis, I., Tekola, B., Kinfe, M., Ceccarelli, C., Girma, F., Abdurahman, R., Zerihun, T., Hanlon, C. & Hoekstra, R.A., 2022. Adaptation and validation of two autism-related measures of skills and quality of life. Autism, 26, pp 1409-1422.

Tekola, B., Girma, F., Kinfe, M., Abdurahman, R., Tesfaye, M., Yenus, Z., WHO CST team, Fekadu, A., Salomone, E., Pacione, L., Servilli, C., Hanlon, C., Hoekstra, R.A., 2020. Adapting and pre-testing the WHO Caregiver Skills Training Programme for autism and other developmental disorders in a very low resource setting: findings from Ethiopia. Autism, 24, pp. 51-63.

Tilahun, D., Hanlon, C., Fekadu, A., Tekola, B., Baheretibeb, Y., Hoekstra, R.A., 2016. Stigma, explanatory models and unmet needs of caregivers of children with developmental disorders in a low-income African country: a cross-sectional facility-based survey. BMC Health Services Research 16, pp 152.

Goldsmith K, Hudson J, Dennison L, Chalder T, Moss-Morris R. How and for whom does supportive adjustment to Multiple Sclerosis cognitive-behavioural therapy work? A mediated moderation analysis. Behavior Research and Therapy, 2020; 128:103594. doi: 10.1016/j.brat.2020.103594.

Argyriou A, Goldsmith K, Tsokos A, Rimes K. Psychosocial mediators of the relations between sexual orientation and depressive symptoms in a longitudinal sample of young people. Psychology of Sexual Orientation and Gender Diversity, 2020; 7(2), 142–153. doi: 10.1037/sgd0000369.

Goldsmith KA, Chalder TC, White PD, Sharpe M, Pickles A. Tutorial: Simplex, latent growth and latent change structural equation models for longitudinal mediation in the PACE trial of treatments for chronic fatigue syndrome. Psychological Methods, 2018; 23(2):191-207. doi: 10.1037/met0000154.