Global Mental Health最新文献

Background: Since the 1990s, the relocation of psychiatric patients from long-stay institutions to community-based supported living has increased globally. However, most evidence on suitable residential services comes from high-income countries, with little from low- and middle-income contexts. This study explored the experiences of residents and carers in three residential care homes for people living with serious mental illness in Sedibeng District, South Africa.

Methods: Three organisations were purposefully selected as in-depth case studies. Ninety-one face-to-face qualitative interviews were conducted with service providers, residents, and family members between October 2022 and June 2023.

Findings: Residents described severe psychosocial disability when living with families, but improved functioning in residential homes. Organisations 1 and 3 operated small 3-4-roomed houses in township areas, accommodating 21 and 40 residents respectively, who had community access and social interaction. In Organisation 3, residents formed romantic relationships, undertook paid work, and lived semi-independently. Organisation 2, a repurposed school-like building with four large dormitories for 86 residents, imposed strict movement controls; medication was used to manage behaviour, and caregivers reported safety concerns.

Conclusions: Smaller residential homes offer more autonomy and integration than large dormitory-style facilities. Policies and funding should support smaller, community-based supported accommodation for people with serious mental illness.

Mental health interventions, such as Youth Readiness Intervention (YRI), offer an opportunity for improving the mental health of war-affected youth in fragile and conflict-affected regions. The YRI has demonstrated effectiveness in improving mental health outcomes, yet prior analyses have not examined the economic impact of the YRI integrated within with an entrepreneurship (ENTR) program. A costing analysis was conducted using standard activity-based costing methodology to estimate implementation costs. Next, economic benefits (productivity, healthcare offsets and local returns) were estimated, using participant-reported and secondary data. Total benefits were compared with total costs to calculate the return on investment (ROI), taking into consideration varying unemployment rates as a result of the intervention. Results show that the YRI + ENTR implementation cost is $117,289.00 ($305.44 per participant) and the ENTR-alone implementation is $67,279.10 ($177.05 per participant). The ROI for the YRI + ENTR varies from $1.01 to $1.95. The ROI for the ENTR alone varies from $2.53 to $6.92. In one of the ROI pathways - that is, healthcare savings - we find that the YRI + ENTR results in an 8.5-fold larger healthcare saving compared to the ENTR alone. This is one of the first studies to examine the broader economic returns of the YRI and ENTR program and are important to consider in future implementation due to the broad nature of economic benefits.

Teachers in conflict-affected regions face chronic stress and trauma exposure, compromising their mental health and professional identity. This study evaluates the effectiveness of the "Conmigo, Contigo, Con Todo" (3Cs) programme in improving resilience, compassion and prosocial behaviours among Afro-Colombian teachers in Tumaco, Colombia, through a mixed-methods cluster-randomised controlled trial. Thirty-two teachers from eight schools were randomised into intervention (n = 28) and control (n = 4) groups. Quantitative outcomes were assessed at baseline, post-intervention and follow-up using validated scales for resilience (CD-RISC), PTSD symptoms (PCL-C), anxiety, depression, compassion (ECOM) and prosocial behaviour (PPB). Qualitative data were collected through focus groups and analysed thematically. Resilience improved from baseline to follow-up (Hedges' g = 0.23, small effect). PTSD symptoms declined substantially post-intervention (Hedges' g = 0.98, large effect), with partial relapse at follow-up. Anxiety decreased initially but increased over time. Compassion and prosociality remained stable. Qualitative findings revealed perceived improvements in emotion regulation and compassion, although the 94% female sample may influence results. This exploratory study provides preliminary evidence that culturally adapted, school-based interventions may improve resilience and reduce trauma-related symptoms among teachers in high-adversity settings, although findings are limited by small sample size and group imbalance. Larger-scale replication with sustained reinforcement strategies is warranted.

Postnatal depression (PND) is the most prevalent mental health disorder during the postpartum period. Evidence suggests that clinical practice guidelines (CPGs) can improve the mental well-being of women affected by PND. This study aimed to identify the CPGs available globally for the management of PND and to summarize their recommendations. A comprehensive search was performed across five electronic databases (MEDLINE, PsycINFO, CINAHL, TRIP, and Epistemonikos) and four guideline-specific websites (GIN, SIGN, NICE, and WHO) to identify the English language CPGs published between 2012 and 2023. The general characteristics of the CPGs, as well as the reported pharmacological and non-pharmacological recommendations, were extracted. The AGREE-II instrument was used to assess the methodological quality. Nineteen CPGs were included in the review, with only one from a low and middle-income country (Lebanon). Cognitive-behavioral therapy (CBT) was the most frequently recommended psychological therapy. Pharmacological interventions were included by 17 CPGs, predominantly Selective Serotonin Reuptake Inhibitors (SSRIs). Only three CPGs incorporated Patient and Public Involvement and Engagement (PPIE) in the form of an advisory group. Seven CPGs matched the criteria for adequate methodological quality by achieving an overall score of ≥70%. The findings highlight limited methodological quality and underrepresentation of LMICs, which may lead to disparities in the management of PND and undermine equitable mental health care.

Previous research has highlighted the negative impact of the COVID-19 pandemic on healthcare workers' (HCWs) mental health, yet protective factors remain underexplored. Emerging studies emphasize the importance of trust in government and interpersonal relationships in reducing infections and fostering positive vaccine attitudes. This study investigates the relationship between HCWs' trust in the workplace and government and depressive symptoms during the pandemic. The COVID-19 HEalth caRe wOrkErS study surveyed 32,410 HCWs from 22 countries, including clinical and nonclinical staff. Participants completed the Patient Health Questionnaire-9 and ad-hoc questions assessing trust in the workplace and government. Logistic regression and multilevel models examined associations between trust levels and depressive symptoms. High workplace trust (OR = 0.72 [0.68, 0.76]) and government trust (OR = 0.72 [0.69, 0.76]) were linked to lower odds of depressive symptoms, with significant between-country variation. Country-level analyses showed that workplace trust was more protective in more developed countries and under stricter COVID-19 restrictions. Despite cross-country variation, HCWs with higher trust in the workplace and government had ~28% lower odds of experiencing depressive symptoms compared to those with lower trust. Promoting trust may help mitigate the mental health impact of future crises on HCWs.

Peer Refugee Helpers (PRHs) support peers in humanitarian settings, which may influence their own mental health. This longitudinal study examined anxiety and depression trajectories among Afghan, Iranian and Syrian refugees and asylum seekers in Greece, focusing on how PRH status (paid/unpaid) and sense of coherence influence trajectory membership. The study included 176 adult, PRHs and non-helpers. The following scales were administered three times at ~4-month intervals: Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7), Social Provisions Scale (SPS-24), Sense of Coherence (SOC-13), Perceived Ability to Cope With Trauma (PACT) and Brief Trauma Questionnaire (BTQ). Using latent growth mixture modeling, we identified two depression (high and low) and three anxiety (high, moderate and low) trajectories. The adjusted logistic and multinomial regression models indicated that unpaid PRHs were significantly less likely to follow a low depression trajectory (odds ratio [OR] = 0.55, p = 0.037), while paid PRHs were more likely to follow a low anxiety trajectory (OR = 3.17, p = 0.009). Higher SOC was associated with low depression (OR = 1.03, p = 0.012) and low anxiety trajectories (OR = 1.06, p = 0.002). Our findings suggest PRH mental health may be associated with working conditions, including financial compensation.

Drug use among young women has severe consequences for their mental health, increases their developmental vulnerability and highlights the global problem of drug addiction. The purpose of this study was to investigate the socioeconomic and psychological factors influencing drug use among young women in Khyber Pakhtunkhwa, Pakistan. The study used a qualitative research design. We collected data from 12 women aged 18-21 years via in-depth qualitative interviews conducted in Mardan and Peshawar from March to June 2022. Research shows that young women frequently use drugs due to peer pressure, emotional challenges and financial concerns, which significantly impact their lives. The study emphasizes the value of cultural intervention programs for young women, concentrating on the region's mental health services, economic empowerment and gender-specific peer support networks.

This study explored the association between serotonin transporter gene (5HTTLPR) and brain-derived neurotrophic factor gene (BDNF) polymorphisms with mental health disorders in a Chilean primary care population using latent class analysis. The sample included 789 adults genotyped for 5HTTLPR and BDNF, who were assessed for psychiatric diagnoses using the Composite International Diagnostic Interview (CIDI). Two distinct mental health profiles emerged: a high psychiatric comorbidity group, marked by a high prevalence of anxiety and stress-related disorders, and a low comorbidity group. The study found that the L'/L' polymorphism of the serotonin transporter gene was associated with a reduced risk of belonging to the high-comorbidity group, particularly when paired with the GG polymorphism of the BDNF gene. These findings suggest a synergistic interaction between these genes that influences susceptibility to psychiatric disorders. This research underscores the importance of considering genetic interactions in mental health studies and highlights the utility of latent class analysis in identifying clinically relevant diagnostic profiles, which could enhance early detection and intervention strategies in primary care.

Human immunodeficiency virus (HIV) and mental health have complex, bidirectional impacts. Integrated service delivery, especially in low- and middle-income countries (LMICs) where resources are most limited and the burden of HIV is heaviest, may help to improve both HIV and mental health outcomes. While the integration of mental health and HIV services has been studied in various settings, previous reviews on this topic have primarily focused on the integration processes rather than health outcomes. In this systematic review, we evaluated the effectiveness of interventions in LMICs that integrated mental health and HIV services. We searched PubMed, CINAHL, Sociological Abstracts, PsycINFO and EMBASE and conducted backward and forward citation searches. We included studies conducted in LMICs that evaluated the integration of services for HIV and mental health conditions using pre-post or multi-arm study designs, published in a peer-reviewed journal from January 2000 through January 2024. Studies on substance use services were excluded. Risk of bias for included studies was assessed using the Evidence Project tool. We summarized findings narratively, including both mental health-related and HIV-related outcomes. Eighteen studies with a total of 9,729 participants were included in the analysis, among which 17 studies were conducted in sub-Saharan Africa and 10 were randomized controlled trials. Seventeen studies used a task-sharing approach, where nonspecialists provided mental health interventions. The low follow-up rate and lack of random participant selection suggested the increased risk of bias in most studies. Overall, interventions that integrated mental health and HIV services provided greater improvement in recipients' mental health symptoms (e.g., depression and post-traumatic stress disorder) than HIV services alone, often reducing symptom scores by more than 50%. While the evidence on HIV-related outcomes (e.g., antiretroviral therapy adherence, viral suppression and HIV stigma) was more limited, most studies that reported these outcomes showed positive effects of integrated interventions, especially community-based ones. These findings suggest the benefit of the interventions that integrate mental health and HIV services in LMICs, although further evaluations are warranted.

Psychosocial programs in low- and middle-income countries (LMIC) often omit cognitive strategies due to perceived difficulty for clients and lay providers. We evaluated the benefit of including "cognitive coping" in a brief, online intervention for conflict-affected Ukrainian veterans and family members with mild to moderate psychosocial distress. Participants were randomized to two treatment conditions based on the Common Elements Treatment Approach Psychosocial Program (CPSS). CPSS-Basic (CPSS-B) included a self-assessment, safety screening and psychoeducation. CPSS-Enhanced (CPSS-E) included these as well as cognitive coping. Distress, functional impairment, alcohol use, aggression, social disconnectedness and conflict resolution were assessed after one month. Participants also evaluated program accessibility, acceptability, appropriateness, feasibility and adoption. Of 1,177 study participants, 788 (67%) completed follow-up. Both conditions significantly improved distress, functional impairment, aggression and social disconnectedness; CPSS-E producing a greater reduction in distress than CPSS-B (ES: d = .22, p = .002). Implementation outcomes were positive across conditions, favoring CPSS-E for appropriateness (d = .48, 95% CI: .33, .62), feasibility (d = .15, 95% CI: .00, .29), adoption (d = .34, 95% CI: .19, .48) and acceptability (d = .29, 95% CI: .15, .44). Findings support the feasibility and added value of incorporating cognitive techniques into psychosocial programming in LMIC.