Global Mental Health最新文献

Adolescent girls affected by displacement face substantial mental-health risks. The Sibling Support for Adolescent Girls in Emergencies (SSAGE) is a 12-week, gender-transformative, family-based program designed to improve adolescent girls' mental health in humanitarian settings. This mixed-methods pilot randomized controlled trial (RCT) assessed SSAGE's feasibility, acceptability and potential effects among 186 Venezuelan migrant and Colombian returnee families in Colombia. Adolescent girls aged 13-19 years, their male siblings and caregivers participated in parallel sessions on gender dynamics, communication and relationships. Implementation outcomes drew on the Mental Health Implementation Science Tools (acceptability and feasibility subscales), attendance records and qualitative interviews. Analyses followed an intent-to-treat approach using adjusted linear and logistic regression models. Quantitative analyses did not identify measurable changes in adolescent girls' mental health outcomes at endline; however, attendance was modest, with only ~10% of families meeting the predefined protocol threshold. Implementation findings revealed strong participant satisfaction and high acceptability of SSAGE content and mentor relationships. Engagement was constrained by economic hardship, transportation and venue barriers, and some caregivers' acute emotional distress, which likely limited feasibility and potential impact. SSAGE shows promise as a gender-transformative, family-based approach, but successful delivery in urban migrant settings will require tailored and refined implementation strategies.

People with severe mental illness (SMI) die 10-20 years earlier than the general population, largely due to non-communicable diseases (NCDs) such as hypertension and diabetes and risk factors such as hypercholesterolaemia. This cross-sectional study gathered data from people with SMI from three national mental health institutions in South Asia. Data was collected based on the WHO Stepwise approach to NCD risk factor surveillance and the prevalence of screening, diagnosis and treatment for diabetes, hypertension, and hypercholesterolaemia was assessed. Logistic regression models assessed the associations of sociodemographic characteristics with NCD screening. Three thousand nine hundred and eighty nine participants were recruited. Screening prevalence varied by country and disease, with hypertension being the most commonly screened NCD (Bangladesh = 52.5% [50.0-55.1], India = 43.1% [40.3-45.9], Pakistan = 60.9% [58.2-63.5]), and cholesterol was the least common (Bangladesh = 4.1% [3.2-5.2], India = 14.8% [12.9-17.0], Pakistan = 9.6% [8.1-11.3]). Characteristics such as BMI, age and education level were positively associated with screening, and females were more likely to be screened than males. There are low levels of screening for NCDs among individuals with SMI accessing tertiary institutions in South Asia, with significant sociodemographic disparities. Standardised screening protocols tailored to South Asian populations could mitigate the increased risk of NCDs in this population.

Suicide is a serious global health problem with ~73% deaths by suicide occurring in low- or middle-income countries (LMICs), many of which are among people experiencing humanitarian emergencies. Few guidelines outline specific steps and strategies to tackle suicide risk and manage post-attempt consequences in these settings, leaving program implementers with limited information to translate guidance to practice. This article describes the implementation of the Common Elements Treatment Approach (CETA) suicide safety protocol as part of a randomized controlled trial in northern Thailand for displaced adults from Myanmar with chronic physical health conditions. The CETA safety protocol has been used in many trials and programs to screen for and manage suicide risk, including in a prior CETA effectiveness trial with Myanmar adults. In this article, we describe how this safety protocol was adapted for the study setting, and utilized to effectively screen, assess suicidal thoughts and behaviors, develop and manage action plans for study participants with active suicidal ideation. We present three illustrative case descriptions of individuals with whom we implemented the safety protocol to highlight how suicide risk intersects with physical illness, psychosocial stressors and structural vulnerability. Reflections on feasibility, acceptability and adaptations - such as language translation, culturally grounded referral pathways and training for nonspecialist providers - are shared to inform future implementation. Our findings support the implementation of suicide safety protocols within humanitarian programming and offer practical insights for global health practitioners and policymakers working in similarly complex settings.

Poor mental health is a growing issue among adolescents, with untreated conditions persisting into adulthood and typically increasing in severity. South Africa's mental health legislation faces key barriers to implementation due to limited access to treatment and support, as well as persistent challenges related to stigma, privacy concerns and affordability. Mobile mental health (M-mHealth) could be a sustainable and scalable alternative for reducing unmet needs for psychological services. This study aims to explore adolescents' perceptions, attitudes and intentions regarding M-mHealth interventions. The study involved two phases and used an explanatory sequential mixed-methods approach. 71 adolescents completed the survey in phase 1, while 56 adolescents participated in 9 focus group discussions in phase 2. Qualitative and quantitative data were analysed using thematic and descriptive analyses, respectively. Findings from both phases were integrated using the pillar integration process. Findings show that adolescents have a limited understanding of the broader concept of mental health, and stigma persists through the use of terms like "crazy" and "bewitched." Adolescents view M-mHealth positively because of its low cost, convenience and privacy. However, issues like data costs, smartphone affordability, and limited privacy at home could hinder its use. M-mHealth extends beyond the health sector and is constrained by infrastructural and socio-cultural barriers, including privacy concerns, high data costs, and stigma.

Background: Psychological distress is one of the major public health challenges during the emerging adulthood period, which is a developmental stage characterized by major life transformations and instability. Emerging adults are more vulnerable to psychological distress as they frequently deal with different pressures about relationships, work, education and identity exploration. The rising prevalence of psychological distress can impair physical health and wellbeing along with the initiation of harmful behaviors such as substance use.

Aim: The study aims to explore the prevalence and associated factors of psychological distress among emerging adult students, comparing female and male participants.

Method: Data were collected from 957 emerging adults in 12 institutions under Mangalore University in the Udupi district of Karnataka, India, pursuing bachelor's degrees. Along with the sociodemographic pro forma, the Kessler Psychological Distress Scale (K10) was used to measure psychological distress, the World Health Organization's Alcohol, Smoking and Substance Involvement Screening tool (WHO ASSIST version 3.0) was used to measure substance use, and the Adverse Childhood Experiences Scale was used to identify adverse childhood experiences. Univariate and multivariate regression analysis were employed to understand the determinants of psychological distress among participants.

Results: Female participants reported a higher risk of experiencing psychological distress compared to male participants. Overall, 27.06% of participants experienced psychological distress, with 11.8% likely to have mild, 9.71% moderate and 5.53% severe mental disorders. While adverse childhood experiences were reported to be a major factor associated with psychological distress among both the groups (AOR 6.218, 95% CI (3.546, 10.901), p < 0.001, for female), (AOR 1.965, 95% CI (1.073, 3.601), p = 0.029, for male) substance use pattern during the COVID19 pandemic was also predicted higher psychological distress among male participants.

Conclusion: In the study setting, psychological distress was prevalent among emerging adults, with a higher incidence among females. Adverse childhood events and substance use further elevated vulnerability. These findings highlight the critical need for culturally relevant and gender-sensitive mental health interventions.

Mental health literacy (MHL) strategies are crucial for mental health promotion and prevention. This study aimed to determine the acceptability, feasibility, appropriateness and initial efficacy of an adapted MHL program in a community sample of adults in Kenya. This was a quasi-experimental pre-post study conducted from July 2023 through July 2024. The MHL program contained nine modules delivered over 3 days. Participants were assessed at baseline and immediately after the program. The primary outcomes were mental health knowledge and participants' attitudes on mental health/illness. Secondary outcomes included depressive symptoms, anxiety symptoms, self-perceived social support, self-perceived wellbeing, MHL program acceptability, feasibility and appropriateness. Relative to baseline, we observed statistically significant improvement in mental health knowledge and attitude on mental health/illness postintervention. We also observed significant improvements in all secondary outcomes. The MHL program also emerged as contextually appropriate, acceptable and feasible. The adapted MHL program is acceptable and appropriate and can feasibly be delivered by trained non-specialist facilitators. Also, the MHL program has the potential to increase participants' MHL and attitudes and reduce symptoms of common mental disorders and promote self-perceived wellbeing. Future research should explore how improvements can be sustained over the long term.

Social support is a key coping resource; its specific role for refugees from sub-Saharan Africa in high-income settings remains poorly understood. This systematic review synthesises existing evidence on the sources of social support and how these networks aid coping during resettlement. We applied an optimised search strategy to identify studies examining social support among sub-Saharan African refugees across six academic indexing databases. We then undertook a meta-synthesis of the identified studies. This involved the use of meta-thematic analysis of the interpretations and quotes presented in each study, combining thematic analysis through the reviewer's reflexivity. The PRISMA framework guided the review process to ensure methodological rigour. A total of 22 articles were included in the qualitative meta-synthesis. The synthesis revealed four key sources of social support: 1) family, 2) friends, 3) ethnic and community groups, and 4) cultural and religious supports. These support sources played multiple roles, including enhancing community engagement and reciprocity, providing practical and emotional assistance, offering relief from distress and cultivating cultural continuity and adaptation. However, some individuals distanced themselves from their ethnic community and preferred self-driven coping. Access to social support systems remains a crucial coping resource for many sub-Saharan African refugees in high-income settings, alleviating distress and enhancing resilience. Programs that strengthen informal social support networks through community-driven initiatives can enhance the relevance of social support. Future research should investigate the role of social support across various phases of resettlement in relation to psychosocial well-being.

Maternal-infant bonding is essential for early development and long-term well-being. In low-resource settings like Pakistan, perinatal anxiety, though prevalent, remains under-recognized and can significantly disrupt bonding. While perinatal depression has garnered greater research attention, the cultural and relational dimensions linking anxiety to bonding remain underexplored. This qualitative study examined how maternal distress, sociocultural expectations and healthcare limitations influence bonding. Eighteen pregnant and postnatal women (aged 19-45 years) with clinically significant anxiety (Generalized Anxiety Disorder 7-item scale ≥ 10) were purposively recruited from public hospitals in Rawalpindi and Islamabad. In-depth interviews were conducted in Urdu and analyzed using Braun and Clarke's thematic analysis. Five major themes emerged: (1) emotional vulnerability during the perinatal period, (2) interpersonal and family dynamics, (3) maternal health and role strain, (4) cultural scripts and structural barriers and (5) participant-driven recommendations. Anxiety often delays emotional connection. Judgment, limited autonomy and lack of support worsened distress, while faith, rituals and relational coping offered resilience. This study provides novel qualitative evidence that perinatal anxiety and maternal-infant bonding are co-constructed within the relational and sociocultural ecologies of low- and middle-income countries like Pakistan. Findings challenge purely symptom-focused approaches, underscoring that effective intervention must address not only the emotional invisibility of mothers but also the relational pathways of distress, such as hypervigilance, exhaustion and performance anxiety, which are intensified by a lack of respect, autonomy and validation. A shift toward contextually grounded, relationship-centered care is urgently needed.

Background: Chronic pain represents a major global public health issue. It is associated with wide-ranging psychosocial consequences. Extensive evidence has demonstrated that pain catastrophizing (PC) contributes to the bidirectional association between chronic pain and psychological distress. The present study aims to explore the psychological and cognitive correlates of chronic pain among individuals living in Gaza.

Methods: A cross-sectional study was conducted among 272 adults with chronic musculoskeletal pain. Spearman's correlations assessed associations between pain intensity, catastrophizing and depressive symptoms. Multiple regression and bootstrapped mediation analyses (5,000 resamples and PROCESS macro) evaluated predictors and the mediating role of catastrophizing in the pain-depression relationship.

Results: Pain intensity was positively correlated with depression (r = 0.28, p < 0.001) and catastrophizing (r = 0.39, p < 0.001). A stronger correlation was found between catastrophizing and depression (r = 0.54, p < 0.001). Mediation analysis demonstrated that catastrophizing fully mediated the association between pain intensity and depression (indirect effect = 0.95, 95% confidence interval = [0.65-1.29]).

Conclusion: PC is a key psychological mechanism linking pain intensity and depression among patients with chronic pain in Gaza. Integrating cognitive-behavioral therapy, mindfulness and emotion regulation strategies into pain management may improve mental health outcomes in conflict-affected settings.

Suicide is a significant global public health concern, particularly among adolescents, with substantial implications for economies, societies and individuals' mental well-being. Understanding its patterns and intention and psychosocial determinants in a given context can suggest potential intervention points. This population-based cross-sectional study aimed to document suicidal ideas, behaviors and intensity among youths aged 14 to 25 in the Nairobi metropolitan area and associated socio-economic position, demographic indicators and potential intervention points. A diverse sample of 1,972 participants was recruited from urban and peri-urban settings within the Nairobi metropolitan area. Data analysis included descriptive statistics, chi-square tests and logistic regression. Our findings confirm a high prevalence of suicidal ideas and behavior in the youth (19.9% and 3.6%, respectively), with very few significant differences between the urban and peri-urban areas. The severity of suicidal ideation and behavior reported methods and reasons, and the socio-demographic profile of participants, point to multiple potential intervention targets. These findings ought to be used to design, manage and evaluate suicide prevention programs.