Global Mental Health最新文献

Migrants often experience psychological distress due to pre-, peri- and post-migration stressors. Scalable interventions like Doing What Matters in Times of Stress (DWM) and Problem Management Plus (PM+) have been developed to address these challenges. This study evaluates a stepped-care program combining DWM and PM+ for migrants in Italy, examining its context, implementation, and mechanisms of impact. A mixed-methods process evaluation was conducted alongside a randomized controlled trial (RCT), following the Medical Research Council (MRC) framework. Post-trial qualitative data were collected through individual interviews with intervention participants (n = 10) and stakeholders (n = 10), as well as a focus group with intervention providers (n = 8). Thematic analysis was performed using NVivo. Cultural stigma and practical barriers influenced engagement, while community leaders fostered trust and participation. Interventions were feasible and acceptable. Digital delivery improved accessibility for some but posed challenges for those with low technological literacy or private spaces. The stepped-care approach supported gradual engagement with mental health strategies, enhancing self-care and emotional awareness, while provider relationships were key to sustaining motivation. The stepped-care model alleviated psychological distress and was well-received. Findings underscore the need for cultural sensitivity, digital accessibility and community engagement to optimize migrant mental health support.

[This corrects the article DOI: 10.1017/gmh.2025.39.].

The war in Ukraine has caused widespread destruction, displacement, and distress. Educators are among those significantly affected by the conflict, facing the dual burden of educating youth directly impacted by the conflict while simultaneously dealing with their own psychological stress. This study evaluated the Psychosocial Support for Educators (PSE) program, a virtual intervention designed to improve Ukrainian educators' mental health, knowledge, and readiness to support students. A non-randomized control trial included 881 educators from three Ukrainian regions, with 572 participants in the PSE group and 309 in the control group. Surveys assessed psychosocial support knowledge, readiness, and mental health at baseline, post-intervention, and one-month follow-up. Linear mixed model analyses revealed significant improvements in the PSE group across all measures. PSE participants reported greater increases in knowledge (t = 2.97, p = .003, d = .38) and readiness to support students (t = 6.63, p < .001, d = .85), with sustained gains at follow-up. They also reported greater reductions in stress (t = 2.70, p < .01, d = .35), anxiety (t = 3.20, p = .001, d = .41), and depression (t = 2.00, p < .05, d = .26) compared to the control group. The findings demonstrate that PSE can effectively enhance educators' mental health and their ability to support students in conflict-affected settings, underscoring the importance of accessible, tailored mental health interventions for educators in crisis zones.

Behavioral treatments can help people with human immunodeficiency virus (HIV) improve their quality of life and treatment adherence. In Lesotho, where a fifth of adults live with HIV and depression and harmful alcohol use is prevalent among this group, little is known about the local suitability of established behavioral treatment strategies. We explored preferences regarding two strategies evaluated in other settings: involving phones and trusted individuals in treatment. We thematically analyzed 28 semi-structured interviews with potential service users receiving routine HIV care in the Butha-Buthe and Mokhotlong districts. Key concerns included the feasibility of phone-based treatment in rural areas and issues of limited literacy, electricity and network coverage. Others highlighted potential benefits for younger and working individuals for phone-based treatment, preferring calls over texts. Involving trusted individuals in treatment was favored, as this could foster support and accountability. Behavioral issues related to depression and alcohol use were viewed as complex, requiring face-to-face attention from trusted professionals, such as nurses and counselors, who were seen as knowledgeable and capable of maintaining confidentiality. Peer providers were not favored due to privacy concerns. These findings emphasize the need for face-to-face, confidential and health worker-led approaches for integrating behavioral treatment into HIV care in Lesotho.

The global utility of acceptance and commitment therapy highlights the need for adapting measures that can effectively capture the richness of psychological flexibility. One such instrument is the Comprehensive Assessment of Acceptance and Commitment Therapy Processes (CompACT). We translated the CompACT into Luganda and adapted it for use in Uganda. The original CompACT was translated into the Luganda language and reviewed through a series of evaluations. Nine mental health professionals participated in one-on-one interviews, while a focus group of eight culturally competent laypersons provided further insights. Their feedback resulted in revisions to enhance the instrument's clarity, relevance, acceptability and completeness. The revised version was then cognitively tested with n = 25 trainees at Makerere University. Input from these various groups was synthesized and triangulated to develop the final version. A total of 23 items were adapted to improve the comprehensibility and completeness of the scale. Overall, respondents deemed the tool clear and acceptable. This study highlights the importance of a rigorous adaptation process, including translation, expert review, cognitive testing and feedback triangulation, to ensure psychological measures remain valid and relevant across cultures. Such an approach ensures accuracy in diverse contexts and provides a model for adapting psychological instruments for non-Western populations.

As Nigeria's aging population increases, older adults living in poverty face growing threats to their psychological well-being. This study examines the role of formal social networks such as government programs, non-governmental organizations and faith-based initiatives in alleviating mental stress, defined as persistent psychological distress characterized by anxiety, loneliness and emotional strain, distinct from clinically diagnosed mental illness. Using Social Capital Theory as a guiding framework, the review explores how bonding, bridging and linking social capital influence the ability of formal networks to reduce financial insecurity, social isolation and health-related vulnerabilities. Traditional family caregiving structures are weakening due to rapid urbanization and economic pressures, leaving many older Nigerians unsupported. Although formal initiatives like the National Social Safety Nets Project exist, their effectiveness is limited by delayed disbursements, poor coordination and cultural stigma surrounding mental health. Strengthening the National Senior Citizens Centre as a coordinating body, expanding culturally relevant community-based care and integrating informal support systems are identified as crucial steps forward. Without such reforms, the continued neglect of this population risks worsening mental health outcomes, straining public health resources, and undermining intergenerational solidarity. This review offers actionable insights for improving older adult-care systems in Nigeria and provides guidance for other low-resource settings confronting similar demographic transitions.

People with severe mental illness (SMI) are at greater risk of obesity, cardiovascular disease and diabetes than the general population, due to a higher prevalence of health risk behaviours. Research is needed to inform tailored interventions to improve the health behaviours (diet, physical activity and sleep) of people with SMI in South Asia as these behaviours are closely linked to obesity. The study aimed to explore the barriers and facilitators to healthy diet, physical activity and good sleep among individuals with SMI. A qualitative design was employed using photovoice, semi-structured interviews and focus group discussions. Participants included 16 people with SMI, 16 caregivers and 17 health professionals in Bangladesh and Pakistan. Data were analysed thematically, informed by the socio-ecological framework. A complex interplay of individual, familial and societal factors influenced these health behaviours. Individual factors include knowledge, beliefs and mental health limitations. Caregivers play a crucial role in influencing behaviour. At the societal level, gender expectations, financial constraints and religious influences significantly impact these behaviours. The insights from this research can inform tailored interventions for this vulnerable group and highlight the need for integrated services, financial support and improved urban planning.

This study evaluates mental health treatment in a post-conflict setting with scant mental health resources. The study reports on a randomized crossover control group design with one intervention and two control groups implemented in the Central African Republic (CAR). The intervention's impact on symptoms of depression, anxiety and trauma was analyzed among a sample of 298 participants located in the capital city, Bangui. Participants were screened for elevated levels of anxiety and depression and randomly assigned to one of three groups: control, intervention and active control. Data included an initial interview, measurement following the two intervention workshops and a 3-month post-intervention follow-up. The trauma reduction intervention significantly reduced symptoms of depression, anxiety and trauma compared to the waitlist control. The active control group focused on peace and value education and produced equivalent outcomes to the trauma-reduction intervention group. Further, at 3 months follow-up, the impact of both interventions remained significant, although lower. The two interventions did not differ from one another. The study demonstrates two practical approaches for addressing anxiety, depression and trauma symptoms in post-conflict, low-resource settings. The similar outcome of the two interventions may suggest that they share common therapeutic elements.

Task sharing is endorsed as one of the strategies to address the treatment gap in common perinatal mental health conditions. There is a well-established body of evidence on the effectiveness of psychological interventions delivered by nonspecialist health workers (NSHWs); however, there is a dearth of evidence documenting factors determining the feasibility, acceptability and sustainability of integrating and implementing these interventions. This systematic review aims to synthesize the implementation outcomes and implementation process of NSHWs-delivered psychological interventions for the management of perinatal depression and anxiety using Proctor's implementation science framework outlining eight constructs: feasibility, acceptability, appropriateness, adoption, cost, fidelity, penetration and sustainability. We searched PubMed, Web of Science and Cochrane Center Register of Controlled Trials for studies published in English and between 2000 and 2022 using search terms under five broad categories: (a) "perinatal"; (b) "common mental disorders"; (c) "psychological interventions"; (d) "nonspecialist" and (e) "implementation outcomes." Secondary publications were also hand-searched for data extraction. Two authors independently reviewed abstracts and full-text articles. Data for included articles were extracted using a standard data extraction sheet. A narrative synthesis of qualitative evidence was conducted. Initial searches identified 885 articles of which full text of 128 articles were screened for eligibility, with 56 studies meeting the inclusion criteria. Out of the eight constructs of Proctor's framework, "feasibility," "acceptability," "appropriateness" and "fidelity" were the most evaluated outcomes. None of the studies reported "penetration" and very few reported "sustainability," "adoption" or "cost." None of the studies used any implementation science framework for the study evaluation. Despite the well-established evidence on the effectiveness of psychosocial interventions for perinatal depression and anxiety by NSHWs, these interventions are rarely adopted into the health system. More studies applying systems thinking are needed to explore facilitators, barriers and mechanisms for integrating interventions in the health system. Using implementation science frameworks to design, plan, execute and evaluate psychosocial interventions by NSHWs can address this gap in evidence.

Climate change is exacerbating the frequency and severity of disasters across Africa, with profound psychological consequences for young people. This paper examines the mental health impacts of climate-related events like droughts, floods and extreme weather on African youth. It explores how climate stresses compound existing societal issues, affecting young people's well-being. Studies highlighted indicate events strongly associated with negative emotions, anxiety, post-traumatic stress disorder (PTSD) and depression among youth. Vulnerabilities are due to disrupted community contexts and limited support systems. Challenges in providing adequate care are also reviewed, with African health systems grappling with a shortage of professionals and inadequate youth-focused care. This article proposes solutions centred on integrated disaster response, community resilience programmes and specialised youth services. Recommendations involve prioritising mental health education, establishing accessible services and collaborating with local partners. The overall aim is to comprehensively address African youth mental health needs in climate-changing contexts through holistic multi-stakeholder approaches, building coping skills and promoting wellness.