Global Mental Health最新文献

Although virtual reality (VR) programs are being developed by marginalized groups', a systemic power imbalance still exists. Marginalized groups have a place in digital wellbeing and can lead initiatives to access resources that they desire. To better support these efforts and mobilize knowledge among marginalized stakeholders, we conducted a scoping review of the use of VR for wellbeing. Adopting an equity lens that considers the experiences of intersectional marginalization, our aim was to identify VR programs, their targets, outcomes and equity-related facilitators and barriers. In May 2023, we conducted a comprehensive literature search of MEDLINE, PsycINFO, Embase and Web of Science databases and grey literature for virtual reality and marginalized populations. Eligible research articles since the inception of the databases were those that met our predefined criteria of VR, marginalized populations and wellbeing. We included 38 studies and charted preregistered variables using narrative synthesis, descriptive statistics, and a logic model. The populations were often intersectionally marginalized--primarily individuals with disabilities, underrepresented sexualities and genders, and marginalized older individuals in high-income countries on Turtle Island (North America). The most common race categories were Black or African American (26%) and European or White (53%), but other sociodemographic characteristics were underreported. VR offered diverse support, including social, mental, physical and cultural. We report program outcomes for several subgroups; though heterogeneous, most studies reported improved wellbeing outcomes. VR's flexibility created informal, flexible spaces, with peer support that contributed to mental and social wellbeing. Several factors could hinder marginalized groups' ability to access and participate, such as the lack of free programs, data and program ownership, and intersectional data analyses. This topic reflects a growing literature, with half of the publications being in 2022 or 2023. Many of these studies have limitations like small sample sizes and a lack of mixed-methods or practical significance analyses. Moving forward, researchers should apply more open-access and inclusive practices in their designs and recruitment processes to widen equitable access to marginalized stakeholders. Nevertheless, many marginalized populations created VR programs and benefited from them, contributing to a rebalancing of power over wellbeing.

Sensory Over-Responsivity Disorder (SORD) is characterized by extreme sensitivity to everyday sensory input, which can interfere with children's emotional, behavioral and social development. Despite growing interest, limited research has explored its developmental effects in the absence of other psychiatric diagnoses. This study investigated self-regulation and related clinical features in preschool children with SORD who did not meet diagnostic criteria for autism spectrum disorder, attention-deficit/hyperactivity disorder (ADHD), or obsessive-compulsive disorder. The sample included 15 children with SORD and 15 typically developing controls, matched by age and gender. Diagnoses were made using the Preschool Age Psychiatric Assessment, and comorbidities were excluded using Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood: Revised Edition criteria. Self-regulation was assessed through the Head-Toes-Knees-Shoulders-Revised task. While no significant differences were found in autistic traits, repetitive behaviors or executive functioning, children with SORD demonstrated significantly poorer self-regulation (p < .001). Poorer self-regulation was strongly associated with greater SORD severity, elevated ADHD symptoms, lower social interaction and increased emotional and sensory reactivity. These findings suggest that self-regulation difficulties are a core feature of SORD, even in the absence of comorbid psychiatric disorders. Early identification and interventions targeting self-regulation may help improve long-term outcomes for children affected by SORD.

A burgeoning body of evidence suggests a higher prevalence of nonsuicidal self-injury (NSSI) behaviors among adolescents. This study aimed to examine the comorbid internalizing symptoms and suicidal behaviors, along with associations between dissociative experiences and suicide risk in adolescents attending a psychiatric outpatient unit in Ankara, Türkiye. The study included 81 adolescents aged 12-18 years, who engaged in NSSI and sought treatment at a psychiatric outpatient clinic. Psychiatric evaluations were conducted through semi-structured clinical interviews. NSSI behaviors were assessed using the Inventory of Statements About Self-Injury, and suicide risk was measured using the Suicide Probability Scale. Additionally, internalizing symptoms and dissociative experiences were evaluated using the Revised Children's Anxiety and Depression Scale-Child Version and the Adolescent Dissociative Experiences Scale, respectively. Moderate to high correlations were found among suicide risk, dissociation, NSSI severity, anxiety and internalizing scores. Mediation analysis revealed that NSSI significantly mediated the relationship between dissociation and suicide risk. These findings indicate that assessing both dissociation and NSSI could provide valuable insights into comprehending and addressing adolescent suicide, thereby facilitating the development of targeted interventions to mitigate the effects of dissociative experiences.

Background. Despite the growing recognition of adolescent suicide as a pressing concern, traditional methods for identifying suicide risk often fail to capture the complex interplay of socio-ecological and psychological factors. The advent of machine learning (ML) offers a transformative opportunity to improve suicide risk prediction and intervention strategies. Objective. This study aims to utilize ML techniques to analyze socio-ecological and psychological risk factors to predict suicide ideation, plans and attempts among a nationally representative sample of Ghanaian adolescents. Methods. A cross-sectional survey was conducted with 1,703 adolescents aged 12-18 years across Ghana measuring psychological factors (depression symptoms, anxiety symptoms etc) and socio-ecological factors (bullying, parental support etc) using validated measures. Descriptive statistics were conducted and random forest and logistic regression models were employed for suicide risk prediction, i.e., 'ideation, plans and attempts'. Model performance was evaluated using accuracy, sensitivity, specificity and feature importance analysis. Results. Psychological factors such as depression symptoms (r = .42, p < .01), anxiety (r = .38, p < .01) and perceived stress (r = .35, p < .01) were the strongest predictors of suicide ideation, plans and attempts, while parental support emerged as a significant protective factor (r = -.34, p < .01). The random forest model demonstrated good predictive performance (accuracy = 78.3%, AUC = 0.81). Gender differences were observed. Conclusions. This study is the first to apply ML techniques to a nationally representative dataset of Ghanaian adolescents for suicide risk prediction, i.e., 'ideation, plans and attempts'. The findings highlight the potential of ML to provide precise tools for early identification of at-risk individuals.

The mental health (MH) of adolescents in low- and middle-income countries (LMIC), particularly those in rural areas, has historically been neglected in research and services, despite the documented burden MH problems represent among these populations. Settings where MH stigma is high require strategic research methods. Photovoice is a promising method for MH research in contexts of high stigma, but studies examining its acceptability with rural adolescents in LMIC remain scarce. We explored the acceptability of photovoice for MH research through perspectives of adolescents from rural Mexico who participated in a photovoice project focused on factors affecting their MH. Adolescents (n = 40) participated in focus groups where they discussed what they learned through the MH photovoice project, and the aspects of the method they perceived to be valuable. Focus groups transcripts were thematically analyzed. Participants' satisfaction with the MH photovoice project was tied to: (1) learning about the meaning, nature, and experiences of MH; (2) enjoying relationships, novelty, and fun; and (3) wishing for more time, more play, and continuity. Photovoice is an acceptable method for MH research among rural adolescents in LMIC, sparking reflection and collective dialog that can lead to the development of local initiatives.

We assessed whether higher caregiver depression is associated with increased likelihood of caregivers rating their children as screening positive for developmental disorders-autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder, emotional behavioral disorder, and functional impairment (FI)-among Ugandan children perinatally exposed and unexposed to HIV. Children and their primary caregivers were followed for 12 months. Caregiver depression was measured using the Hopkins Symptom Checklist-25 and categorized as low, moderate, or high based on terciles. Child developmental indices were derived from the Behavioral Assessment System for Children (third edition) at 0, 6, and 12 months. Multivariable linear regression estimated mean differences (MDs) in disorder indices with 95% confidence intervals (CIs) by caregiver depression level. Compared with highly depressed caregivers, those with low depression reported consistently lower ASD risk scores (MD: -0.35 to -0.32; 95% CI: -0.60 to -0.08). Similar trends were observed for FI (MD: -0.56 to -0.31; 95% CI: -0.81 to -0.06). Moderate depression was associated with modestly lower FI risk at baseline and 6 months but not at 12 months. Overall, higher caregiver depressive symptoms were linked to greater perceived child disorder risk. Evaluating caregiver depression alongside child screening may improve interpretation of developmental risk assessments.

International students frequently report suicidal thoughts and behaviours, but often do not seek help. We evaluated the feasibility, acceptability, and preliminary effectiveness of an adapted version of safeTALK suicide prevention training for international students. Eight workshops were delivered in Melbourne, Australia (N = 128; 62.5% female, M age = 23.4). In this single-arm study, surveys were completed pre-, post-, and three months post-training, and 17 participants completed follow-up interviews. The training was rated as acceptable, helpful, and safe. Linear mixed models indicated increased confidence to intervene and stronger intentions to refer individuals to formal help sources, with improvements sustained at follow-up. Suicide stigma showed a small post-training reduction that was not sustained. Suicide literacy only improved three months post-training. Attrition limited inferences about long-term effects. Qualitative feedback supported the training's value but highlighted the need for further cultural adaptation. Findings support adapted gatekeeper training as a promising strategy for suicide prevention among international students.

Bangladesh's handloom weaving industry, a vital cultural and economic asset, employs approximately one million rural workers and generates over 10 billion Bangladeshi taka (~82 million USD) annually. Despite its importance, the mental health of handloom weavers, locally known as Tatis, remains largely unexamined. This perspective article, based on a narrative review of existing literature synthesizing peer-reviewed studies, reports and policy documents on mental health in informal sectors, explores the mental health challenges faced by these workers. Using a syndemics framework, it draws on data on garment workers and the broader informal sector, which indicates heightened risks of stress, anxiety and depression resulting from long working hours, low wages and competition from mechanized looms. These risks are compounded by systemic barriers, including Bangladesh's allocation of only 0.44% of its health budget to mental health (2021), a severe shortage of professionals (0.16 psychiatrists per 100,000 people and 0.34 psychologist per 100,000 people) and pervasive cultural stigma. Additionally, musculoskeletal pain, which affects 82.4% of weavers, places a particularly heavy burden on women, who constitute half of the workforce, further exacerbating mental health vulnerabilities through syndemic interactions with poverty and gender inequities. To address this neglected crisis, the article proposes a novel intervention framework aligned with the Double Diamond design model. The framework integrates community-based mental health hubs, peer-led support networks and digital platforms tailored to Bangladesh's collectivist culture. It calls for increased funding, workplace reforms, stigma reduction campaigns and targeted research, highlighting the dual benefit of improving weavers' well-being and sustaining the long-term future of the industry.

Mental health policies and plans (MHPPs) are powerful tools developed to facilitate real-world changes in mental-health-related prevention, promotion and treatment. This study examined barriers and facilitators to MHPP implementation across the WHO European region. Key informants from 53 countries were contacted and 25 provided in-depth qualitative interviews on MHPP existence, implementation, and evaluation related barriers and facilitators of implementation. We analyzed data via qualitative framework analysis approach aligned with the WHO Comprehensive Mental Health Action Plan 2013-2030. Reported facilitators included active involvement of key stakeholders, ongoing mental healthcare reform, bottom-up approach to implementation, sufficient funding, favorable political receptivity and strong monitoring. Barriers encompassed insufficient funding, workforce shortages, adequate training in psychiatry, missing or insufficient infrastructure in terms of both physical structures and technology for data collection, low political receptivity, stigma and bureaucratic obstables. While notable progress has been made in the development of mental health plans in the European region, substantial gaps remain in information systems, research capacity, and systematic evaluation frameworks on mental health and development of appropriate evaluation plans. Strengthening these components is essential to ensure the effective and sustainable implementation of MHPPs throughout the region.

Adolescent mental health problems are prevalent in low- and middle-income countries, like Kenya, where access to care remains severely limited. Task-shifted, school-based interventions offer solutions but often lack structured protocols for managing risk, such as suicidality or abuse. The Shamiri Risk Management Protocol (Shamiri-RMP) was developed to address this gap through a tiered system for screening, classifying and responding to risk within a stepped-care mental health model. We conducted a mixed-methods implementation study across 149 public high schools in Kenya. Caseworker fidelity and risk classification accuracy were evaluated through a review of 222 student cases. The Consolidated Framework for Implementation Research guided the qualitative analysis of caseworker surveys to identify implementation barriers and facilitators. Of 76,855 students enrolled in the broader Shamiri program, 977 (1.27%) were referred for risk assessment, and 222 (0.28%) were enrolled in the Shamiri-RMP. Among them, 42.71% were low-risk, 35.68% moderate-risk and 21.61% high-risk. Risk reductions occurred in 60.47% of high-risk cases, 56.34% of moderate-risk cases and 51.76% of low-risk cases. Implementation facilitators included supervisory support (50.88% of caseworkers) and protocol clarity (80.70%), while barriers included referral gaps (5.26%) and confidentiality concerns (54.39%). Findings support the feasibility and scalability of the Shamiri-RMP in low-resource school settings.