Global Mental Health最新文献

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.

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.