Global Mental Health最新文献

There have been no culturally validated measures to screen for depression in Madagascar. In 2022-2023, we conducted qualitative studies in the Bay of Ranobe area in southwestern Madagascar to understand local mental health syndromes specific to this region. We found that the 8-item Patient Health Questionnaire (PHQ-8) shares symptoms with the general distress-like, depressive-like and grief-like syndromes elicited locally. We adapted the PHQ-8 to align with the unique symptoms found in the region that were missing from the measure. We administered the adapted PHQ-8 to 809 participants aged 16 and above. We found that the one-factor (Depression) model (root mean square error of approximation [RMSEA] = 0.046, standardized root mean square residual [SRMR] = 0.053, Comparative Fit Index [CFI] = 0.993 and Tucker-Lewis Index [TLI] = 0.991) had a better fit to our data than the two-factor (Cognitive-Affective and Somatic) model (RMSEA = 0.047, SRMR = 0.052, CFI = 0.994 and TLI = 0.990). The one-factor (Depression) model demonstrated good internal consistency (MacDonald's omega coefficient = 0.81 and ordinal alpha = 0.87). We conducted a multigroup confirmatory factor analysis to establish measurement invariance (MI) across four groups (sex, ethnicity, level of education and age group) and found that all levels of MI were achieved across groups. Our research provides a validated method to assess the probable prevalence of current depression in southwestern Madagascar.

This study aimed to describe changes over time in the prevalence and associated factors of suicidal behaviours among 13- to 15-year-olds in Southeast Asian countries. It is a secondary analysis of cross-sectional data from the Global School-based Student Health Surveys conducted in Indonesia, Myanmar, the Philippines and Thailand in 2007/2008 and 2015/2016. Each survey included a nationally representative sample of students aged 13-15 years. Data on suicidal thoughts, plans, attempts, and associated factors-including health risk behaviours, experiences of physical violence and bullying, social difficulties, and parental supervision-were collected using self-report questionnaires. The population attributable fraction for each risk factor was calculated using multiple logistic regression. The prevalence of suicidal behaviours ranged from 0.7% (Myanmar) to 17.3% (Philippines) in 2007/2008, and from 8.6% (Indonesia) to 20.9% (Thailand) in 2015/2016. Being physically attacked or bullied and experiencing social difficulties were the most consistent and significant risk factors across countries and time points. Female gender, poverty, alcohol consumption, and drug use also contributed to risk at varying levels. Suicidal behaviours have risen alarmingly in several Southeast Asian countries. These findings suggest the urgent need for coordinated action by policymakers, health professionals, educators, and families to prevent adolescent suicidal behaviours.

Refugees and forced migrants are particularly susceptible to trauma-related disorders, due exposure to traumatic events before, during or after displacement. In trauma therapy, the concept of psychological stabilization refers to the improvement of a patient's capacity to manage symptoms and emotions associated with traumatic experiences. While exposure-based therapies are widely recommended for treating posttraumatic stress disorder (PTSD), stabilizing interventions may offer a valuable alternative, particularly given the unique challenges in refugee care. This scoping review aims to provide a comprehensive overview of stabilizing, non exposure-based interventions for traumatized refugees A systematic search identified 31 relevant studies featuring diverse interventions, settings, and outcomes. Most studies showed a significant reduction in PTSD symptoms compared to waitlist (six studies), treatment as usual (three studies) and pre-post analyses (nine studies), though nine studies found no difference between intervention and comparison group. Notably, two studies found the stabilizing approach less effective than the comparison group, and two reported no symptom reduction in pre-post analysis. Heterogenity among the examined interventions as well as living conditions was high and limited the generizability of the results. Further studies should take these environmental factors into consideration.

Approximately three million Venezuelan migrants (VMs) currently reside in Colombia. Many are in need of mental health services but face significant difficulties accessing services. To improve service access and engagement, we culturally adapted and pilot tested an evidence-based mental health intervention integrated within entrepreneurship training in a community setting for VM youth in Colombia. Using participatory research and qualitative methods approaches, we explored the program's acceptability, appropriateness and feasibility. We recruited and enrolled 67 VM youth (aged 18-30) living in Bogotá, Colombia, who participated in piloting the intervention. We conducted semi-structured interviews with a subset of these participants (n = 16) at post-intervention to explore the intervention's acceptability, appropriateness and feasibility. Two bilingual research assistants analyzed qualitative data using thematic network analysis. Findings suggested that VM youth viewed the integrated intervention as acceptable and appropriate, noting that it was helpful to have a "safe space" to discuss difficult emotions. They also noted challenges to engaging in the intervention, including transportation time and balancing other life responsibilities with intervention participation. Findings point to the importance of engaging community member participants in the adaptation and testing process of mental health interventions to increase intervention fit with the target population.

Alcohol consumption among university students poses significant public health challenges, especially in the Association of Southeast Asian Nations (ASEAN) region, where limited research exists. This review aims to synthesize evidence on sociodemographic factors associated with alcohol consumption among university students in ASEAN countries, assess the study quality and identify research gaps. A systematic search across nine databases was conducted in May 2024, using Population, Intervention, Comparator, Outcome, Study Design and Timeframe to define the inclusion criteria. Studies were assessed for quality and risk of bias using the AXIS tool. Data on sociodemographic factors were extracted, and random-effects meta-analyses were performed for frequently reported factors. Heterogeneity was measured using Cochran's Q-test and I-squared statistic, and small-study bias was tested using funnel plots and Egger's test. Fifteen cross-sectional studies involving 35,527 participants met the inclusion criteria. Gender, age and parental alcohol consumption were the most commonly studied factors. Male students had three times the odds of consuming alcohol compared to female students, a result robust to sensitivity analysis. Parental alcohol use and older age were also significantly and positively associated with alcohol consumption, with minimal heterogeneity. Most studies were of high quality, although variability in study design and geographic representation limited the generalizability of the findings. Sociodemographic factors such as gender, age and parental alcohol consumption influence alcohol use among ASEAN college students. However, cross-sectional design and limited country representation highlight the need for further robust research to inform policy and interventions.

Group interpersonal therapy (IPT) was introduced to Senegal to treat depression in people living with HIV (PLWH), using a task-shifting approach. Following successful implementation at a tertiary-level hospital in Dakar, we evaluate IPT's acceptability, feasibility and benefits in primary and secondary-level suburban health facilities. We assess the impact of IPT adaptations and organizational changes and identify sustainability requirements. PLWH with depression received group IPT following the World Health Organization protocol. Acceptability, feasibility and implementation aspects were assessed quantitatively and qualitatively following specific conceptual frameworks. Depressive symptoms severity (PHQ-9) and functioning (WHODAS) were measured pre-, post-treatment and at 3-month follow-up. General linear mixed models were used to describe changes in outcomes over time. Qualitative data were analyzed thematically. Of 84 participants (median age: 45, female>50%), 81 completed group IPT. Enrolment refusal and dropout rates were 7% and 4%. Ninety-seven percent attended at least seven sessions out of eight. Depressive symptoms and functioning significantly improved by therapy's end (β = 12,2, CI 95% [11.6, 12.8] and β = 8.5, CI 95% [7.3, 9.7], respectively) with gains being sustained 3 months later (p = 0.94 and 0.99, respectively). Adaptations and organizational changes proved successful, but depression screening and diagnosis communication to patients remained challenging. Emerging needs included a tailored patient care pathway and confidentiality. Participants advocated for depression care integration into HIV services. Group IPT's successful implementation in various ecological and organizational contexts in Senegal indicates high acceptability and feasibility. Sustainability may be enhanced by addressing specific needs at multiple levels (individual, organizational, systemic). A comprehensive reflection on strategies to sustain and scale up group IPT is the next logical step.

The unavailability of reliable, easy-to-use depression screening tools adapted for Sub-Saharan African children is a significant barrier to the treatment of childhood depression. We thus adapted the Child Depression Screening Tool (CDST) to the South African (SA), Senegalese (S) and Rwandan (R) contexts, as a tool to screen for depression in children suffering from chronic illnesses, trauma and difficulties related to COVID-19, family and community hardships. A DSM-5-based diagnostic interview and the CDST screening measure were administered to 1,001 participants aged between 7 and 16 years. The prevalence of depression ranged between 9.5 and 16.8%. It was more prevalent in youth with chronic illness and those exposed to adverse life events. Older age (R and SA), female sex (S), dislike of school (R and SA) and cannabis use (SA) were also associated with worse depression. Receiver operating characteristic analysis showed satisfactory performance (79-89%) and that sensitivity and specificity were optimized at a CDST cut-point of 5.0. The CDST is a valid tool to screen for depression in the settings assessed. If found to be suitable in other countries and settings, it may offer a clinically sound, sustainable path towards the identification of child depression in Africa.

The global challenge of closing the treatment gap highlights the need for innovative interventions. Problem Management Plus (PM+), developed by the World Health Organization (WHO), is an evidence-based brief psychological intervention designed to address this gap by involving non-specialist helpers. In this study, 'non-specialists' or 'helpers' are individuals without formal training in mental health, who have been trained in and have been delivering individual PM+ for more than 1.5 years. To enhance quality in mental health care, especially with non-specialists, WHO and the United Nations International Children's Emergency Fund (UNICEF) have launched the Ensuring Quality in Psychosocial and Mental Health Care (EQUIP) platform, an open-access resource for competency-based training. This study evaluates the acceptability and preliminary utility of EQUIP assessment tools. Thirteen helpers were assessed using the ENhancing Assessment of Common Therapeutic Factors (ENACT) and the PM+ assessment tool, culturally adapted and translated for Arabic-speaking helpers in Switzerland. The results indicate that the EQUIP tools can identify strengths and areas for improvement, provide valuable feedback for training, and thus have great potential for enhancing mental health care quality.

Community-based collaborative care (CBCC) is an internationally recognised model of integrated care that emphasises multidisciplinary teamwork and care coordination. In South Africa, community psychiatry has been integrated into some primary healthcare (PHC) facilities. This study examines healthcare providers' perceptions of collaboration and its challenges in various integrated care settings. Three main components of CBCC (multidisciplinary teams, communication and case management) were explored through qualitative interviews with 29 staff members in 2 clinics. In Clinic-1, community psychiatry services operate independently in an outbuilding behind the main PHC clinic ("co-located"). In Clinic-2, these services are fully integrated within the PHC clinic ("physically integrated"). Both clinics had multidisciplinary teams, with various staff members conducting case management functions on an ad hoc basis. The physically integrated clinic (due to shared files, physical proximity and a facility manager with mental health experience) had greater levels of communication between the multidisciplinary team. In contrast, the co-located clinic struggled with poor management, unclear reporting structures and reinforced traditional hierarchies, limiting collaboration between the staff members. Integration does not guarantee collaboration. Improving collaboration between mental health and PHC staff requires clear roles, competent managers, CBCC endorsement from PHC clinicians, sufficient human resources and systematic communication channels, such as case review meetings.

Common mental disorders (CMDs) are a leading cause of burden and disability globally. Approximately 75% of those living with CMDs reside in low- and middle-income countries (LMICs), and up to 90% of those needing mental health care do not receive it. The Friendship Bench is a task-sharing mental health intervention delivered by lay health workers (LHWs) that utilizes concepts of Problem-Solving Therapy. The aim of this systematic review is to identify and evaluate the barriers and facilitators to the implementation of research outcomes of the Friendship Bench and understand its systematic uptake to narrow the CMD treatment gap. We conducted a systematic review of articles that reported on the Friendship Bench in LMICs, CMDs, implementation research outcomes, and studies that utilized experimental, observational, or qualitative study designs. We identified articles using medical subject headings and keywords from APA PsycINFO, Cochrane, CINAHL, EMBASE, Global Health, OVID, PubMed/Medline, Science Direct, Web of Science, and Google Scholar in February 2023 and again in December 2023 to capture any additional articles. We screened 641 articles, and a total of 7 articles were included in the final analysis. All studies were conducted in Zimbabwe within the past 8 years, and across all the studies, all implementation research outcomes were reported. There is strong evidence that the Friendship Bench is acceptable, appropriate, and feasible to address the CMD treatment gap in Zimbabwe. Facilitators include that the Friendship Bench is culturally adaptable, utilizes trusted LHWs, and has relatively strong community and political buy-in. Conversely, barriers include a lack of a reliable mental health system, limitations in its ability to treat more serious mental conditions, and mental health stigma. There is an opportunity to explore the application of the Friendship Bench for CMDs in other countries and as a basis for novel task-sharing interventions for other health conditions.