Global Mental Health最新文献

Youth who are lesbian, gay, bisexual, transgender, queer or questioning, and other diverse sexual and gender identities (LGBTQ+) experience disproportionately high rates of suicidal thoughts and behaviors compared to heterosexual and cisgender peers, yet many face barriers to care. Data came from a national online survey of 18,663 LGBTQ+ youth aged 13-24 years in the United States (September-December 2023). Analyses focused on participants who reported wanting mental health care in the past year and assessed access, barriers, service modalities and suicidal ideation/attempts. Half of LGBTQ+ youth who wanted mental health care did not receive it. The most common barrier was fear of talking about mental health concerns (42%). Among those who received care, one-on-one therapy was most common (69% in-person and 53% online). Suicidal ideation was lower among youth in therapy (46% in-person and 40% online) compared to those using crisis lines (75%). After adjusting for demographics, hotline use remained strongly associated with elevated risk: adjusted odds ratio (aOR) = 3.77 (95% confidence interval [CI]: 3.11-4.56) for suicidal ideation; aOR = 3.21 (95% CI: 2.62-3.94) for attempts. Despite strong willingness to seek care, structural and identity-related barriers leave many needs unmet. Expanding culturally competent services is essential to reducing suicide risk.

Psychological distress can occur even without a depression diagnosis. Many older adults have functional limitations that hinder daily activities, yet their emotional needs often go unrecognized. This study examined whether functional impairment is associated with psychological distress in older adults and whether this relationship varies by depression-diagnosis status. Data came from the 2023 Behavioral Risk Factor Surveillance System for U.S. adults aged 65 and older (N = 95,325). Functional impairment was defined as having 14 or more days in the past month when poor health limited usual activities. Psychological distress was measured by days of poor mental health and a binary indicator of high distress. Survey-weighted regression analyses tested main and interaction effects of functional impairment and depression diagnosis while adjusting for sociodemographic and behavioral factors. Functional impairment was linked to greater distress. Predicted estimates showed the highest distress among those with both impairment and a depression diagnosis (about 11 poor mental health days). Those with impairment only averaged about 6 days, those with a diagnosis only about 8, and those with neither condition about 3. Functional impairment may reveal hidden distress in older adults without diagnosed depression. Adding physical-function indicators to screening could help identify vulnerable individuals earlier.

Implementation science plays a crucial role in effectively translating scientific knowledge into sustainable, evidence-based health practices. This perspective article focuses on some Latin American experiences, highlighting the limitations of applying methodologies developed in the Global North to settings marked by structural inequalities, economic constraints and cultural diversity. The included experiences examine a range of programs, such as the national Breastfeeding and Feeding Strategy, the evaluation of the Triple P-Positive Parenting Program in Chile and the community component of Mental Health Gap Action Programme in Colombia. Other contributions explore professional training initiatives and offer critical reflections on frameworks, such as the Consolidated Framework for Implementation Research and the Reach, Effectiveness, Adoption, Implementation and Maintenance. The reflections call for strengthening local capacities, fostering meaningful South-South and South-North collaborations, and advancing a context-sensitive, equity-oriented approach to implementation science that supports the development of more adaptive, effective and just health systems.

Despite high rates of intimate partner violence (IPV) among women, research on its mental health consequences, particularly PTSD in slum settings, remains scarce. This study assessed PTSD prevalence and determinants among slum-dwelling women in Bangladesh who experienced IPV during the COVID-19 pandemic. A cross-sectional study was conducted between July and October 2022 among 291 women from 5 urban slums in Dhaka, who reported IPV using the World Health Organisation questionnaire. Face-to-face interviews collected sociodemographic data, pandemic-related challenges, gender roles, health information and PTSD symptoms using the validated Post-Traumatic Stress Disorder Checklist-5. Logistic regression identified PTSD predictors. Most women were married before the age of 18 years (87.9%), unemployed (69.3%), had no formal schooling (38.6%) and lived in overcrowded households (38.6%). Over half of their husbands were daily wage earners (57.9%) and had a history of substance misuse (65.9%). PTSD prevalence was 21.16% and was higher among women with non-communicable diseases (adjusted odds ratio [AOR]: 3.29; 95% confidence interval [CI]: 1.6-6.7), concern about COVID-19 infection (AOR: 3.87; 95% CI: 1.12-13.22) and increased marital arguments (AOR: 3.00; 95% CI: 1.57-5.74). IPV in slum settings imposes a significant PTSD burden, highlighting the need for community-based mental health services to support marginalised women.

War in the former Yugoslavia still reverberates in the lives of the generations that lived through it. The aim of this study was to compare a cohort that had direct experience of the war (first generation, G1, n = 89) with those born after the war (second generation, G2, n = 30). All participants stay or live in the Czech Republic. We used an individualized approach, with a structured interview of 91 questions, supplemented by quantitative methods to measure traumatic stress (PCL-5), adverse childhood experiences (ACEs) and centrality of the event (CES). G1 had a higher mean ACE score compared to G2, and the two generations did not differ in centrality of the event and trauma symptom severity, in the rate of psychiatric outpatient care use, psychiatric hospitalizations, diagnosed PTSD, current psychiatric medication use and in illicit drug use. A number of signs were indicative of good resilience, including the ability to move internationally, which implies language proficiency, and the ability to earn a sufficient income. G1 and G2 respondents represent a group of educated individuals with their mental health mostly matching that of the general population, as well as people who have success in their professional and personal lives.

The Syrian government's violent suppression of pro-democracy protests in March 2011 sparked a civil war that resulted in the deaths of hundreds of thousands of people and the displacement of millions. This study focuses on the emotional achievement of 357 Syrian primary and secondary school students who have moved to Türkiye and are under temporary protection. The researchers used the achievement emotion scale to collect data. They conducted a t-test, analysis of variance, correlation analysis and multiple linear regression to examine the sociodemographic factors affecting students' achievement emotions. The results revealed that boy students experienced more negative achievement emotions than girl students, and that the longer the students have been in temporary protection, the more their positive achievement emotions have decreased. The ongoing war in Syria has dire consequences for school-age children who have been forced to flee their homes.

Improving social and emotional well-being (SEWB) for Aboriginal and Torres Strait Islander peoples is central to achieving health equity in Australia. Aboriginal Community Controlled Health Services (ACCHS) deliver SEWB programmes that are culturally grounded and community-led. While service design and delivery have been explored, less is known about how Aboriginal peoples' perceptions of self-efficacy influence their SEWB help-seeking behaviours and self-management. This study re-analysed 22 one-on-one interviews with Aboriginal community members from the Kimberley region of Western Australia. In this context, self-efficacy is understood as an individual's belief in their ability to support their own SEWB, shaping their motivation, persistence and responses to challenges. The findings highlight the importance of family, culture and connection to Country as critical enablers of self-efficacy. The concept of 'strength', grounded in cultural identity, relationships, and personal growth, emerged as an important foundation for SEWB self-management. The study affirms that self-efficacy can be developed over time through mastery experiences, vicarious learning, verbal encouragement, and emotional regulation. It concludes that culturally safe services and environments that nurture self-efficacy are essential to improving SEWB outcomes.

For nearly three decades, the Democratic Republic of the Congo has endured armed conflict that has devastated its population, leaving a staggering number of survivors of sexual violence. This article draws on over a decade of clinical, academic and field experience to explore the psychosocial and public health challenges of caring for these survivors. Despite the high prevalence of post-traumatic disorders - often severe and complex - the mental health system remains gravely under-resourced. The article examines gaps in mental health services, highlights the clinical intricacies of trauma resulting from rape (including complex PTSD and dissociation) and critiques the uncritical export of Western therapeutic models to African contexts. Emphasizing the need for culturally grounded, integrative care, the author advocates for community-based, trauma-informed, inclusive and context-sensitive approaches that bridge clinical science and local healing traditions. This holistic vision is essential for restoring dignity and mental health to survivors and for building a resilient public health infrastructure in the DRC.

Despite reductions in cardiovascular, cancer, and infectious disease, comparable public-health improvements in mental health have not materialized. Global dissemination of trainings and programs have not translated into reduced burden of mental health conditions. Detection in primary care remains uncommon, sustained delivery of psychological services is difficult, few governments prioritize mental health, and reliable data are scarce. A largely unexamined factor is how we talk about suicide. How suicide is discussed shapes whether primary care workers feel able to engage, what organizations incorporate psychosocial programs, and whether mental-health data are accurate and representative. Drawing on three decades of work, this Perspectives piece argues that protocol-heavy, medico-legal framing, such as rigid confidentiality scripts, liability fears, and technical checklists, pulls attention away from the feelings involved in sitting with a person who expresses suicidal thoughts. Logistical, legal, and clinical pushback reflects fear and powerlessness in the face of suicidality. I advocate for making deliberate space for emotional processing by inviting helpers to notice their own reactions, collaborating with people with lived experience of suicidality, and learning from those bereaved by suicide. An empathy-guided approach to suicide can strengthen trainings, program adoption, data quality, and, most importantly, ensure people in distress are not left alone.

Geographic information systems (GIS) are computer-based spatial mapping tools widely used in public health to examine service availability and access disparities and healthcare utilization. While GIS has supported evidence-based health planning in various domains, its application in mental healthcare service delivery remains underexplored. Our scoping review aimed to address this gap by exploring the scope and type of GIS usage in studying three dimensions of mental health (MH) service delivery (availability, accessibility and utilization), across all geographical locations, settings and populations. We conducted a scoping review following the Joanna Briggs Institute methodology. We included peer-reviewed English-language studies using GIS to examine service delivery (availability, accessibility or utilization) for any MH condition diagnosed through standardized criteria or validated tools. Seven databases were searched (Medical Literature Analysis and Retrieval System Online [MEDLINE], PsycINFO, Excerpta Medica Database [Embase], Global Health, Cumulative Index to Nursing and Allied Health Literature [CINAHL], Cochrane Central Register of Controlled Trials [CENTRAL] and Web of Science) between January and April 2024. This review included 58 studies predominantly from high-income countries. A wide range of GIS methods were employed across studies, including hotspot analysis, network analysis and spatial analysis. Six studies explored availability, generally through measures like distribution of facilities across a population, and resource availability within 5-10-mile network buffers. Forty-six studies explored the spatial accessibility of MH services and substance-use treatment facilities using GIS. Six studies examined service utilization patterns. Equity emerged as a recurring theme across all three dimensions. GIS has the potential to emerge as a powerful tool in MH research, particularly in mapping disparities, informing service delivery and identifying high-risk zones. Expanding GIS use in trial design, implementation science and policy advocacy could help bridge critical gaps in MH service delivery, ensuring more equitable and data-driven decision-making.