Global Mental Health最新文献

Anxiety and depressive disorders are global health challenges, placing a significant burden on adults and healthcare systems in low- and middle-income countries (LMICs), such as Ghana. Social determinants of mental health, including poor healthcare access and poverty, may be associated with their prevalence. However, a paucity of prevalence data poses challenges for intervention planning and resource allocation. This review aimed to (1) examine the prevalence of anxiety and depressive disorders and symptoms among adults in Ghana, and (2) explore social determinants of mental health potentially associated with anxiety and depressive disorders and symptoms. We searched electronic databases and secondary sources from inception until September 30, 2024. Meta-analyses were performed to estimate the pooled prevalence. Narrative synthesis explored social determinants potentially associated with anxiety and depressive disorders and symptoms. We included 38 studies (22,587 adults). Pooled point prevalence of anxiety and depressive disorders and symptoms was 40.3% (95% confidence interval [CI]: 31.8-49.4%) and 33.0% (95% CI: 27.7-38.8%), respectively. Most studies (37 studies) reported the prevalence of symptoms and not disorders. Social determinants of mental health, including educational attainment and urban environment, were associated with higher levels of anxiety symptoms, while ethnicity and traumatic experiences were associated with higher levels of depressive symptoms. There was a high degree of heterogeneity, and the majority of studies used self-report screening tools, which may have skewed prevalence estimates. More than a third of adults in Ghana were found to experience anxiety and depressive symptoms, and social determinants of mental health may be associated with prevalence. High-quality research and contextually appropriate interventions targeting the identified social determinants of mental health associated with anxiety and depressive symptoms are needed to reduce disparities and improve the mental well-being of adults in Ghana.

Brief, low-intensity interventions may hold untapped promise for bolstering maternal health in low-resource contexts. The current study used propensity score matching (PSM) to evaluate uptake and differential effectiveness of two low-intensity digital perinatal health (PH) support programs in Lima, Peru. Pregnant women (N = 251) were assigned to one of two conditions (PH vs. trauma-focused PH [TF-PH]) and received weekly psychoeducational content via WhatsApp from a lay paraprofessional for 5 weeks. Conditions were not randomly assigned; PSM was used to improve causal inference of the condition. Women were interviewed before participation (T1), immediately following treatment (T2) and at 3 (T3) and 12 months postpartum (T4). Intimate partner violence had strong negative effects on women's mental health, multisystem resilience and parenting, and single mothers reported higher levels of depression and posttraumatic stress symptoms than did partnered women. Intervention uptake was high, with 77% of women participating in all sessions. There were no significant differences between treatment groups over time, but effect sizes indicated a slight advantage of the TF-PH condition in addressing depression symptoms (d _r = -0.29) and multisystem resilience (d _r = 0.39). Study findings suggest that brief interventions may be well-received and that trauma-focused supports may also confer additional benefits for addressing depression and resilience.

Afro-Colombian adolescents in Tumaco face high mental-health risks due to armed conflict and structural marginalization. We tested the short-term efficacy of the 3C program to strengthen resilience, compassion, and prosocial behavior and to reduce anxiety, depression, and PTSD. Mixed-methods cluster RCT with concurrent triangulation; multilevel mixed-effects models with multiple imputation; assessments at baseline, 6, and 9 months. Resilience increased by 13.14 points at 6 months (large effect, d = 0.89) and remained elevated at 9 months. Anxiety and PTSD screenings were lower in the intervention group across follow-ups. Compassion and prosocial behavior improved at 6 months but attenuated by 9 months. Depression screenings decreased at 6 months and rebounded at 9 months. Qualitative data aligned with these patterns (students reported sustained use of stress-management skills and peer support). 3C demonstrated short-term efficacy for resilience, anxiety, and PTSD but showed limited durability for compassion, prosociality, and depression without ongoing reinforcement. The pattern of effect attenuation-particularly the complete depression rebound-indicates that 3C provides a foundational component requiring integration with booster sessions to sustain socioemotional gains.

Mental illness-related stigma acts as a critical barrier to care by fostering shame, fear of judgment and discrimination, which deters individuals from seeking help, delays treatment and worsens outcomes. This study aimed to investigate the forms, drivers and consequences of mental health-related stigma on help-seeking behavior. A cross-sectional study was conducted from November 2020 to March 2021. Data were collected from 419 participants using structured questionnaires, guided by the Health Stigma and Discrimination Framework and the Attitudes Towards Seeking Professional Psychological Help Scale for validation. Data were analyzed using Statistical Package for the Social Sciences version 22, employing descriptive statistics, chi-square tests and multinomial logistic regression. The average age of participants was 34.5 years. Findings revealed alarmingly high stigma: economic (76.8-80.2%), social (77.1-81.2%) and psychological (71.9-82.8%). Key drivers included stereotypes of dangerousness (58.7%) and systemic healthcare discrimination (65.6%). Multinomial regression confirmed that all stigma forms significantly reduced help-seeking odds. Structural barriers (odds ratio [OR] = 0.48) and internalized shame (OR = 0.53) were the strongest deterrents, with a multiplicative effect for combined economic and psychological stigma (OR = 0.41). This complex, multilayered barrier, driven by socio-cultural beliefs and structural failures, necessitates urgent, multifaceted interventions targeting public education, policy and self-stigma to improve mental health equity in rural Ghana.

The pervasive integration of digital media into daily life is reshaping how individuals encounter and internalize harmful contents. Unrestricted access exposes students to emotionally disruptive materials, including depictions of violence, substance use, and harassment, raising concerns about its impact on well-being. This study examines a serial mediation model linking antisocial media exposure to subjective well-being (SWB) through school-based victimization as sequential pathways. Using data from 326 high school students in Nigeria, we applied partial least squares structural equation modeling to test hypothesized relationships. Results indicate that antisocial media exposure was not directly associated with SWB but significantly predicted experiences of teacher and peer victimization. Peer victimization mediated the relationship between antisocial media exposure and SWB (β = -0.023, 95% CI: [-0.054, -0.004], p < 0.05). Furthermore, antisocial media exposure increased the likelihood of teacher victimization, which facilitated peer victimization, ultimately compromising SWB (β = -0.030, 95% CI: [-0.058, -0.011], p < 0.05). Effects varied by gender and academic level, underscoring intersectional risks linked to media exposure. Findings highlight the need for targeted interventions addressing both teacher and peer victimization in resource-constrained educational contexts.

The Russia-Ukraine war generates fear, depression, loneliness, burnout and substance misuse among civilians. Our study examines mental health among Ukrainian university female students during 3 years of war. A total of 3,467 students were surveyed on three occasions: August to October 2022 (T1, n = 1,416), March to July 2023 (T2, n = 747) and September to November 2024 (T3, n = 1,304). The respondent's average age was 19.3 years, 25.3% identified as secular and 36.9% were married/partnered. The respondents included 81.2% who were not relocated, 10.7% who were internally displaced and 8.1% who were refugees. Valid and reliable survey instruments were used to gather data. One-way analysis of variance (ANOVA) shows a significant decrease in fear of war, depression and burnout in 2023 compared to 2022; however, there was a marked increase in 2024. Regardless of the survey period, one-way ANOVA shows a significant difference in fear of war and burnout scores associated with depression and loneliness levels. Stepwise regression analysis shows fear of war, depression and loneliness associated with burnout. This study provides usable information for mental health services planning and intervention purposes associated with young women affected by war in Ukraine. Additionally, it has relevance for training to address client and service personnel needs, for academic curriculum development and course instruction, and as a reference source for mental health personnel addressing student needs.

International migrant workers (IMWs) may face insecure work and housing, limited access to healthcare and increased risk of psychological problems. Two scalable, evidence-based interventions to support individuals experiencing psychological distress are Doing What Matters in Times of Stress (DWM) and Problem Management Plus (PM+). This study aimed to explore IMWs' problems, daily functioning and help-seeking behaviour, to inform cultural adaptation of the DWM/PM+ stepped-care intervention in the Netherlands. Following the Design, Implementation, Monitoring, and Evaluation (DIME) model, we conducted various qualitative interviews and a focus group discussion with IMWs (n = 30) and professionals (n = 18). Data were analysed thematically, and findings informed adaptations. Participants described problems related to work, housing, administration, finances, healthcare access and the COVID-19 pandemic. Daily routines focused on practical needs. Help-seeking was hindered by stigma, fear of job loss, low trust and reliance on informal or cross-border healthcare. Based on these results, the intervention was adapted to the needs of Polish IMWs in the Netherlands, regarding content and examples, which were tailored to their context; the intervention was offered remotely and collaboration with employers was avoided. These findings highlight the structural vulnerabilities of IMWs and demonstrate how qualitative insights can guide the cultural adaptation of a psychological intervention.

Suicide is a significant global mental health issue and a leading cause of death, with over half a million lives lost annually. The majority of suicide deaths occur in low- and middle-income countries (LMICs), yet there are limited data on suicidal behavior in these regions, particularly in Ethiopia. Given the rising trends of mental health issues worldwide and the alarming rate of suicide in LMICs, this research addresses a critical gap in knowledge regarding suicidal behavior in Eastern Ethiopia, which is essential to inform local public health strategies. Therefore, the study aimed to assess the prevalence and associated factors of suicidal ideation and attempts among adults in the Kersa, Haramaya and Harar Health and Demographic Surveillance System in Eastern Ethiopia in 2022. A community-based cross-sectional study was conducted among 1,411 participants selected using a multistage sampling technique. Binary logistic regression was employed to identify factors associated with suicidal ideation and attempts. The findings revealed that 9.8% and 6.2% of participants reported suicidal ideation and attempts, respectively. A history of mental illness [adjusted odds ratio (AOR) = 6.82, 95% confidence interval (CI): 4.63-10.05] and khat use (AOR = 2.34, 95% CI: 1.48-3.69) were factors significantly associated with suicidal ideation. Similarly, rural residence (AOR = 4.32, 95% CI: 2.17-7.58), a history of mental illness (AOR = 6.02, 95% CI: 3.78-9.60) and khat use (AOR = 2.23, 95% CI: 1.29-3.85) were strongly associated with suicide attempts (p < 0.05). The study highlights that nearly one in 10 individuals in the community experienced suicidal ideation or attempts, underscoring the urgent need for attention to these mental health concerns. In conclusion, suicidal ideation and attempts are prevalent in Eastern Ethiopia and are significantly associated with mental illness, khat use and rural residence. Early screening, detection and management of suicidal behavior at the community level are recommended to address this pressing public health issue.

Due to an increased awareness of the prevalence and impact of trauma, "trauma-informed care" (TIC) was developed as an organisational framework aiming to centre the needs of survivors of trauma. TIC proposes that organisations can reduce trauma exposure by embedding specific principles (e.g., safety and trust) at every level of an organisation, improving the organisation for both service users and providers. Recent reviews of TIC implementation efforts have demonstrated its use in diverse settings; however, studies are overwhelmingly situated in high-income, predominantly English-speaking countries. Rather than reflecting a lack of TIC efforts in low- and middle-income countries (LMICs), these findings may be a result of the newness of the term TIC. To create a more inclusive evidence map, the current review captures efforts conducted in LMICs that may or may not use the label of TIC but align with the organisational approaches and key principles of TIC. A search of four databases and review of relevant references yielded 3,091 results, of which 255 met the inclusion criteria. Implementation efforts took place across 39 LMICs. The vast majority included involvement of another country, most commonly the United States. Approximately 90% of efforts were implemented within medical settings, and 69% focused on the TIC principle of cultural, historical and gender issues. The results of the current review have both theoretical and applied implications for TIC research. They query how and by whom TIC is conceptualised and defined, and how TIC aligns with other global research approaches. Results also highlight the need for organisational TIC interventions to conduct comprehensive baseline assessments of current efforts before implementing new efforts to avoid unintentional duplication. As the adoption of TIC frameworks becomes more widespread, it is imperative to increase research efforts aimed at developing a more thorough and inclusive definition of TIC.

The ENHANCE non-inferiority trial that took place in a deprived setting in Pakistan demonstrated that a technology-assisted digital adaptation of the Technology Assisted Thinking Healthy Programme (THP-TAP) was no different than the face-to-face THP in improving symptoms of perinatal depression. The present study examines the mechanisms through which THP-TAP improved symptoms of perinatal depression (or not) compared to the face-to-face THP. We applied a counterfactual-based approach to mediation - particularly interventional effects - to decompose the total effect of the THP-TAP intervention on symptoms of perinatal depression into the following pre-specified indirect effects: number of sessions attended; behavioural activation; perceived social support; problem-solving and cognitive-restructuring skills; and peer empathy. Mediators were assessed at 3 months post-partum, and depressive symptoms were measured at 6 months using the Patient Health Questionnaire-9 (PHQ-9). Perceived social support in THP-TAP arm mediated an improvement in symptoms of perinatal depression compared to the standard face-to-face THP group (adjusted mean difference in PHQ-9 scores attributable to perceived social support in the technology-assisted digital adaptation of the THP group compared to the World Health Organisation THP group: -0.072, bias-corrected 95% confidence interval: -0.170, -0.018). There was no difference to support the indirect effects for all other mediators. Even in the absence of treatment superiority, our findings suggest that levels of perceived social support were an important feature of the THP-TAP intervention, which resulted in improved symptoms of perinatal depression. From a practical perspective, these findings highlight the importance of social connectedness as a mechanism of change, demonstrating that peer-delivered digital psychosocial interventions can successfully cultivate this relational component.