Global Mental Health

Since the beginning of the Syrian conflict in 2011, Syrians have faced violence and displacement causing an increase in mental health issues. The COVID-19 pandemic, the 2023 earthquake, and deteriorating living conditions have exacerbated these issues. Suicide in Syria remains an underresearched topic since accurate data are difficult to obtain. In this study, we aimed to explore the demographics and risk factors of suicide in Syria by performing a retrospective content analysis of selected online news (media) outlets from across Syria. Twelve news outlets from the three regions of Syria were selected and news of suicide cases were searched retrospectively. The age range was between 9 and 79 years old with the average age being 27.1 ± SD 5.9 years. The most reported causes of suicide were harsh living conditions (18.5%) and relationship problems (18.3%). The most common method of suicide was hanging followed by using firearms. More suicides occurred at night and in the summer and spring seasons. Based on our study's results, young adult, male, unmarried, individuals in rural settings and northern governorates were at the highest risk of suicide in Syria. This study highlights the urgent need for mental health interventions that address the unique challenges faced by Syrians. Impact statement This study addresses a significant gap in the literature on suicide in Syria, a country that is still suffering from the consequences of one of the most dreadful conflicts of the century. Due to the lack of a suicide surveillance system in the country, along with the stigma and shame associated with suicide in the Syrian context, suicide is highly underreported and under-researched. Therefore, we aimed in this study to explore the demographics and risk factors of suicide in Syria by performing a retrospective content analysis of selected online news (media) outlets from across Syria. We are using the same approach used by scholars in other settings that also lack reliable suicide surveillance systems or reporting such as Bangladesh and Nigeria. The manuscript will be of interest to readers of the journal, as it presents evidence on a critical consequence of mental health issues at a time when researchers, universities, funders, and policymakers are increasingly interested in strengthening and investing in health systems and health research in areas affected by conflict. Such studies can pave the way for integrating mental health as part of health policies intended for health systems strengthening in such contexts.

BackgroundHealthcare workers (HCWs) have been impacted psychologically due to their professional responsibilities over the prolonged era of the coronavirus disease 2019 (COVID-19) pandemic. The study aimed to identify the predictors of psychological distress, fear, and coping during the COVID-19 pandemic among HCWs.MethodsA cross-sectional online survey was conducted among self-identified HCWs across 14 countries (12 from Asia and two from Africa). The Kessler Psychological Distress Scale, the Fear of COVID-19 Scale, and the Brief Resilient Coping Scale were used to assess the psychological distress, fear, and coping of HCWs, respectively.ResultsA total of 2447 HCWs participated; 36% were doctors, and 42% were nurses, with a mean age of 36 (±12) years, and 70% were females. Moderate to very-high psychological distress was prevalent in 67% of the HCWs; the lowest rate was reported in the United Arab Emirates (1%) and the highest in Indonesia (16%). The prevalence of high levels of fe...

Background Refugees fleeing conflict often experience poor mental health due to experiences in their country of origin, during displacement, and in new host environments. Conditions in refugee camps and settlements, and the wider socio-political and economic context of refugees’ lives, create structural conditions that compound the effects of previous adversity. Mental health and psychosocial support services must address the daily stressors and adversities refugees face by being grounded in the lived reality of refugee’s lives and addressing issues relevant to them. Methods We undertook a rapid qualitative study between March and May 2019 to understand the local prioritisation of problems facing Congolese refugees living in two refugee settings in Uganda and Rwanda. Thirty free list interviews were conducted in each setting, followed by 11 key informant interviews in Uganda and 12 in Rwanda. Results Results from all interviews were thematically analysed following a deductive proces...

Background: Child and adolescent mental health problems are a global public mental health priority. However, there is a lack of evidence-based scalable psychological interventions for adolescents living in low resource settings. This trial was designed to evaluate the feasibility and acceptability of delivering the World Health Organization's Early Adolescent Skills for Emotions (EASE) intervention at public schools in a rural sub-district in Rawalpindi, Pakistan. Methods: A two arm, single blinded, feasibility cluster randomized controlled trial with mixed-methods evaluation was conducted with 59 adolescents and their caregivers from 8 public schools. In the 4 intervention arm schools, 6 non-specialist facilitators delivered the culturally-adapted EASE group sessions to the adolescents (n = 29) and their caregivers with desired fidelity under the supervision of in-country supervisors. Results: The participation rate of adolescents in the intervention sessions was 83%. The intervention strategies were implemented by the adolescents. However, attending biweekly sessions at schools was challenging for caregivers with only 50% caregivers attending the sessions. Conclusions: The results of this study support the feasibility and acceptability of delivering this culturally adapted intervention through non-specialist facilitators in school settings in Pakistan and pave the way to conduct a fully powered cluster randomized controlled trial to test the effectiveness of intervention to improve psychological outcomes in adolescents. Trial registration Trial registered with Clinicaltrials.gov prospectively; NCT04254393.

As part of the process of computerization of the National Health System (NHS) in Cuba there is the need for an IT solution at the lowest cost for the management of health information. The solution must be efficient to allow authorized users to combine information from different modules in the system for Health Information (SISalud) and must be deployed centrally for access from any level of the NHS. To share information with other systems, the Computerized Health Record (RIS) follows a service-oriented architecture and component-based, being part of SISalud structure. Currently available as components of the RIS are geographic nomenclatures, uniformly managing information on the Register of Geographical Location, the Locations Registry and the Registry of the Health Areas, incorporating the strength of the processes defined in the NHS and respecting formal procedures to ensure the confidentiality of health information. We discuss the impact on the sector computerization process from...

Given the large mental health treatment gap in low-and middle-income countries (LMICs), particularly in post-conflict settings like Sierra Leone, and the limited healthcare infrastructure, understanding the wider benefits of evidence-based mental health interventions within households is critical. This study explored potential mental health spillover effectsthe phenomenon of beneficial effects among nonparticipantsamong cohabitating caregivers and partners of youth who participated in an evidence-based mental health intervention in Sierra Leone. We recruited a sub-sample of cohabitating caregivers and partners (N = 20) of youth intervention participants; caregivers had enrolled in a larger study investigating indirect benefits of the evidence-based intervention in Sierra Leone (MH117359). Qualitative interviews were conducted at two time points to explore the following: (a) potential mental health spillover effects and (b) through which mechanisms spillover may have occurred. Two trained coders reviewed transcripts and analyzed qualitative data, assisted by MaxQDA. Qualitative findings suggested that spillover effects likely occurred and supported three potential mechanisms: decreased caregiving burden, behavior changes among Youth Readiness Intervention participants and improved interpersonal relationships. Mental health spillover effects may occur following youth intervention participation in a post-conflict LMIC. Investing in evidence-based services may offer indirect benefits that extend beyond those directly receiving services. Impact statement The mental health treatment gap continues to be a major problem in low-and middle-income countries (LMICs), and individuals who need mental health services struggle to access formal supports. Investigating how participation in mental health services could have a wider societal benefit through indirect pathways (e.g., household spillover effects) could help strengthen the case among government stakeholders to invest in mental health infrastructure and strengthen policies supporting mental health service provision. Spillover effects are the phenomenon of beneficial effects of an intervention experienced by nonparticipants. This article presents a deeper dive into how participation in a mental health intervention might have much wider benefits for society beyond the benefits for individual participants. We conducted interviews with caregivers of youth (aged 18-30) in Sierra Leone who participated in an evidence-based intervention, the Youth Readiness Intervention, to explore whether improvements in youth behavior and functioning helped to alleviate a sense of caregiver burden. Prior research on spillover effects has primarily focused on health effects rather than mental health. Providing evidence for the phenomenon of mental health spillover effects in a rural region of Sierra Leone could help influence decisions among policy makers to increase investments in mental health services in LMICs and other low-resource settings globally. Exploring potential mental health spillover effects among caregivers and Partners of Youth in Sierra Leone: A qualitative study Mental health disorders are one of the largest contributors to the global burden of disease among youth and adults (GBD 2019 Mental Disorders Collaborators, 2022). This burden is compounded in low-and middle-income countries (LMICs) and other low-resource settings due to the widening mental health treatment gap (

Climate change threatens mental health via increasing exposure to the social and economic disruptions created by extreme weather and large-scale climatic events, as well as through the anxiety associated with recognising the existential threat posed by the climate crisis. Considering the growing levels of climate change awareness across the world, negative emotions like anxiety and worry about climate-related risks are a potentially pervasive conduit for the adverse impacts of climate change on mental health. In this study, we examined how negative climate-related emotions relate to sleep and mental health among a diverse non-representative sample of individuals recruited from 25 countries, as well as a Norwegian nationally-representative sample. Overall, we found that negative climate-related emotions are positively associated with insomnia symptoms and negatively related to self-rated mental health in most countries. Our findings suggest that climate-related psychological stressor...

In sub-Saharan Africa, there are limited data on burden of non-alcohol substance abuse (NAS) and depressive symptoms (DS), yet potential risk factors such as alcohol and intimate partner violence (IPV) are common and NAS abuse may be the rise. The aim of this study was to measure the burden of DS and NAS abuse, and determine whether alcohol use and IPV are associated with DS and/or NAS abuse. We conducted a cross-sectional study at five sites in four countries: Nigeria (nurses), South Africa (teachers), Tanzania (teachers) and two sites in Uganda (rural and peri-urban residents). Participants were selected by simple random sampling from a sampling frame at each of the study sites. We used a standardized tool to collect data on demographics, alcohol use and NAS use, IPV and DS and calculated prevalence ratios (PR). We enrolled 1415 respondents and of these 34.6% were male. DS occurred among 383 (32.3%) and NAS use among 52 (4.3%). In the multivariable analysis, being female (PR  =  1...

Recovery is an approach to mental health care that emergedin the 1960s and 70sfromthe United Statesconsumers ́ movements, ex-patients and psychiatric survivors. Currently, a number of recovery oriented mental health services operate in various countries. This approach may contribute to the advancement of mental health reformscurrently undergoing around the world. The interest manifested in the academic field has led to a number of publications that delineate and analyze diverse aspects of recovery internationally. In order to understand how recovery has been treated in the Latin Americanliterature the authors conducted an integrative review that showed a fruitfulscholarly production. However, the number of articles is smaller in Latin America when compared with other countries such as the United States, Australia, New Zealand, United Kingdom, and Hong Kong. The review, conducted in 2019, generated thematic categories that allowedmappingthe themes that attracted more attention of theLatin Americanscholars within the scope of recovery and its relations to mental health and alcohol and drug addiction.Most of the articles found were published in Brazil, and most of them admit that recovery can contribute to the advancement of the Brazilian psychiatric reform.Also, it was found that the approach is being considered to be applied to other social contexts.

The current study aimed to develop a context-specific trauma scale in the Palestinian context. The sample of our study consisted of 490 Palestinian adults, 230 males and 260 females. Our scale ended up with 32 items to measure traumatic symptoms in the Palestinian context. Results of Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) revealed a stable construct of a five-factor structure of the Palestinian specific-context trauma: (1) Re-experiencing Trauma (2) Avoidance and Numbing, (3) Hyperarousal, (4) Somatic Symptoms, and (5) Psychological Symptoms. Reliability of the scale was further established by assessing the testretest and internal consistency of all subscales. Convergent validity for the context-specific trauma scale was conducted by testing the association between the scale and two existing measures; The WHOQOL-BREF, and The Impact of the Event Scale (IES-R). We recommend using our scale in empirical studies incorporating spoken or written disclosure about traumatic experiences, the scale should also be considered when working with clinical and non-clinical groups who have experienced political-related trauma.

BackgroundThe current study was designed to test the correlation between quality of life, depressive symptoms, and hopelessness, and whether sense of belonging and resilience mediating the correlation between quality of life, depressive symptoms, and hopelessness in a society characterized by high level of political violence and prolonged trauma.MethodsStructural equation modeling (SEM) was performed to test the conceptual model, where quality of life was identified as a predictor variable, sense of belonging and resilience as mediating variables, and depressive symptoms and hopelessness as outcome variables. The participants of the study were 437 Palestinian adults: 190 males and 247 females, they were recruited using online methods; emails, Facebook, and Twitter.FindingsResults indicated that quality of life negatively correlated with depressive symptoms (r = −0.603; p < 0.01), and hopelessness (r = −0.453; p < 0.01), and positively correlated with resilience (r = 0.534; p &...

This study examines the delivery components of inclusive mental health services in higher education, centering on international university students. Through interviews with 32 participants at a state university in the United States, including students, counseling staff, and faculty, six key themes emerged: mental health professionals' multicultural self-awareness, focus on reparative services, mainstream mental health theories and approaches, professionals' cultural background, faculty involvement and physical space and confidentiality. These findings underscore the importance of training for professionals, expansive mental health offerings, incorporation of diverse approaches, confidentiality, active faculty participation and suitable physical environments. By addressing these components, universities can enhance the quality of mental health support for international student populations, promoting their overall well-being and academic success. Impact statement By delving into the discussion about mental health services within higher education, with a specific focus on international university students, this research unearths vital insights that extend beyond academic discourse. In an increasingly globalized world, where students from diverse backgrounds converge in pursuit of knowledge and mental health concerns continue to affect students' academic and personal experiences, this research highlights the challenges faced by international students and unveils the essential components for fostering effective and inclusive support systems. The identified pillars of successful mental health delivery, including culturally sensitive approaches, comprehensive services and faculty involvement, present considerations for institutions. However, the transferability of these insights must be approached with an awareness of diverse institutional, cultural and contextual factors. This research contributes to ongoing dialogs on multicultural competency within counseling, offering professionals insights to navigate the complexities of diverse student populations. Rather than providing prescriptive solutions, the study encourages a reflective approach to mental health services, acknowledging the need for tailored strategies that align with the unique contexts of different institutions. While the immediate impact of this research may be most pronounced within the scope of the studied university, the broader conversation it initiates has the potential to influence policy formulation and institutional practices that affect students' overall well-being. By promoting inclusivity, cultural understanding and innovative service delivery, this study offers a catalyst for positive change. It underscores the importance of institutions proactively addressing mental health challenges and investing in comprehensive strategies that accommodate the needs of international students while fostering an inclusive environment for all learners.

Psychotic disorder is considered as a silent epidemic throughout Kenya. However, the stigma and discrimination attributed to mental disorder has made the illness a hidden issue equated to a silent epidemic. Many households in Kenya with psychotic disorder persons conceal for fear of discrimination and exclusion from their communities. The effect of the silence on psychotic disorder is further compounded by inadequate focus at the policy level. Lack of adequate national level interventions in addressing mental health negates the understanding of the issue in the Kenyan context and the available possibilities for care and support. The social environment in many Kenyan communities does not nurture good mental health. Psychotic disorder a form of mental illness is often viewed with distress, and those who suffer from mental illnesses are mocked. This paper intends to demonstrate how the silence on psychotic disorder continues to hurt many Kenyans. The paper also discusses strategies for contextualizing mental health care approaches in Kenya. These include: intervention and protective factors; strengthening community mental health systems, cognitivebehavior therapy, family support and incorporating more culturally responsive intervention and support base. The negative attitude towards mental illness needs to change to pave way for a healthier society.

Faith Healing Practices has got a significant role in the management of people with mental health conditions in India. The present paper explains the concept and construct of faith healing and its different manifestations across the globe and within the Indian context. It looks into the neccessity of including faith healing within clinical practive acknowleding the cultural components of cure and ethical grounds for the best possible clinical outcome for the patient as an adjunct mode of intervention respectively.

ABSTRACT
Introduction: Low research output is hindering efforts to improve health services in Sub-Saharan Africa (SSA). AfriWon Research Group of WONCA Africa has established an online collaborative research mentorship and training programme to boost research capacity among Family Physicians in SSA. This study aims to assess the effectiveness of the programme in achieving this goal. Methodology: A mixed-method descriptive cross-sectional study was used to interview the 54 members of the 2022 SOGER cohort. Structured questionnaires and key informant interviews of 12 members were used to collect data. Quantitative analysis was done using Epi Info version 7.2.5. Descriptive statistics were used to present data using frequencies and percentages. Qualitative analysis was then done by using Nvivo®. Results: The 54 participants practised in 10 SSA countries and were mostly males 28 (51.9%) with a mean age of 41.56 ± 2.04 years. The majority of them 33 (61.1%) have had some form of research experience prior to joining SOGER. Members identified key benefits of the programme as fostering collaboration, mentorship and continuing education 46 (85.2%); and improvement of research skills 33 (61.1%). Barriers identified were poor collaboration and participation among members 37 (68.5%); irregular meeting schedules as a result of the different time zones 18 (33.3%); and poor internet facilities 19 (35.2%). Conclusion: The SOGER programme was rated as very effective in increasing the research capacity of young FPs and helping participants engage with other researchers and develop research skills. Identified areas of improvement were difficulty meeting set group targets, irregular meetings and conflicting work schedules.

Purpose of Review To summarize recent findings in global mental health along several domains including socioeconomic determinants, inequities, funding, and inclusion in global mental health research and practice. Recent Findings Mental illness continues to disproportionately impact vulnerable populations and treatment coverage continues to be low globally. Advances in integrating mental health care and adopting task-shifting are accompanied by implementation challenges. The mental health impact of recent global events such as the COVID-19 pandemic, geo-political events, and environmental change is likely to persist and require coordinated care approaches for those in need of psychosocial support. Inequities also exist in funding for global mental health and there has been gradual progress in terms of building local capacity for mental health care programs and research. Lastly, there is an increasing effort to include people with lived experiences of mental health in research and pol...

Humanitarian emergencies pose a significant global health challenge for children and young people's mental and psychological health. This systematic review investigates the effectiveness of mental health and psychosocial support (MHPSS) programmes delivered to children and young people affected by humanitarian emergencies in low-and middleincome countries (LMICs). Twelve electronic databases, key websites and citation checking were undertaken. Forty-three randomised controlled trials (RCTs) published in English between January 1980 and May 2023 were included in the review. Overall, the findings suggest that cognitive behavioural therapy may improve depression symptoms in children and young people affected by humanitarian emergencies. Narrative exposure therapy may reduce feelings of guilt. However, the impact of the other MHPSS modalities across outcomes is inconsistent. In some contexts, providing psychosocial programmes involving creative activities may increase the symptoms of depression in children and young people. These findings emphasise the need for the development of MHPSS programmes that can safely and effectively address the diverse needs of children and young people living in adversarial environments. Impact statements Mental health and Humanitarian Emergencies are global issues, affecting over 200 million school-aged children and young people, placing them at risk of developing mental health conditions (Wait, 2022; UNICEF, 2023). Mental Health and Psychosocial Support (MHPSS) programmes, aiming to protect, promote, prevent and/or treat mental health conditions, are considered as a key priority by international actors in humanitarian emergencies. In recent years, there have been growing interests to explore the impact of MHPSS on children and young people. Contributing to this effort, we identified 43 randomised controlled trials evaluating different types and modalities of MHPSS on a wide range of outcomes. Overall, MHPSS programmes that explicitly link thoughts, emotions, feelings and behaviour, such as cognitive behavioural programmes, can potentially improve depression symptoms. Additionally, narrative exposure therapy may contribute to the reduction in feelings of guilt. Psychosocial programmes involving creative activities indicate potential unintended effects on depression. However, evidence regarding the impact of other MHPSS modalities remains inconclusive. The lack of clear and consistent findings across MHPSS modalities underscores the importance of gaining an understanding how implementation contexts and socio-cultural dimensions may, directly and indirectly, impact children and young people's mental health and well-being. This systematic review highlights the importance of tailoring MHPSS programmes to diverse needs in order to safely and effectively promote, prevent and treat mental health conditions in children and young people affected by humanitarian crises in low-and middle-income countries.

Mental health conditions, recognized as a global crisis, were further exacerbated by the COVID-19 pandemic. Access to mental health services remains limited, particularly in low-income regions. Task-sharing interventions, exemplified by Problem Management Plus (PM+), have emerged as potential solutions to bridge this treatment gap. This study presents an evaluation of PM+ scale-up in Sub-Saharan Africa and Eastern Europe as part of SOS Children’s Villages NGO's mental health and psychosocial support programming.A mixed-method approach assesses its effectiveness and impact. Quantitative analyses reveal significant reductions in self-reported problems, depression, anxiety, and improved functioning. Qualitative data highlight four main themes: general health, family relationships, psychosocial problems, and daily activities. These thematic areas demonstrate consistent improvements across clients, irrespective of region.The findings underscore the effectiveness of PM+ in addressing ...

Background.Growing evidence supports the use of Western therapies for the treatment of depression, trauma, and stress delivered by community health workers (CHWs) in conflict-affected, resource-limited countries. A recent randomized controlled trial (Bolton et al. 2014a) supported the efficacy of two CHW-delivered interventions, cognitive processing therapy (CPT) and brief behavioral activation treatment for depression (BATD), for reducing depressive symptoms and functional impairment among torture survivors in the Kurdish region of Iraq.Methods.This study describes the adaptation of the CHW-delivered BATD approach delivered in this trial (Bolton et al. 2014a), informed by the Assessment–Decision–Administration-Production–Topical experts–Integration–Training–Testing (ADAPT–ITT) framework for intervention adaptation (Wingood & DiClemente, 2008). Cultural modifications, adaptations for low-literacy, and tailored training and supervision for non-specialist CHWs are presented, along wit...

Humanitarian emergencies pose a significant global health challenge for children and young people's mental and psychological health. This systematic review investigates the effectiveness of mental health and psychosocial support (MHPSS) programmes delivered to children and young people affected by humanitarian emergencies in low-and middleincome countries (LMICs). Twelve electronic databases, key websites and citation checking were undertaken. Forty-three randomised controlled trials (RCTs) published in English between January 1980 and May 2023 were included in the review. Overall, the findings suggest that cognitive behavioural therapy may improve depression symptoms in children and young people affected by humanitarian emergencies. Narrative exposure therapy may reduce feelings of guilt. However, the impact of the other MHPSS modalities across outcomes is inconsistent. In some contexts, providing psychosocial programmes involving creative activities may increase the symptoms of depression in children and young people. These findings emphasise the need for the development of MHPSS programmes that can safely and effectively address the diverse needs of children and young people living in adversarial environments. Impact statements Mental health and Humanitarian Emergencies are global issues, affecting over 200 million school-aged children and young people, placing them at risk of developing mental health conditions (Wait, 2022; UNICEF, 2023). Mental Health and Psychosocial Support (MHPSS) programmes, aiming to protect, promote, prevent and/or treat mental health conditions, are considered as a key priority by international actors in humanitarian emergencies. In recent years, there have been growing interests to explore the impact of MHPSS on children and young people. Contributing to this effort, we identified 43 randomised controlled trials evaluating different types and modalities of MHPSS on a wide range of outcomes. Overall, MHPSS programmes that explicitly link thoughts, emotions, feelings and behaviour, such as cognitive behavioural programmes, can potentially improve depression symptoms. Additionally, narrative exposure therapy may contribute to the reduction in feelings of guilt. Psychosocial programmes involving creative activities indicate potential unintended effects on depression. However, evidence regarding the impact of other MHPSS modalities remains inconclusive. The lack of clear and consistent findings across MHPSS modalities underscores the importance of gaining an understanding how implementation contexts and socio-cultural dimensions may, directly and indirectly, impact children and young people's mental health and well-being. This systematic review highlights the importance of tailoring MHPSS programmes to diverse needs in order to safely and effectively promote, prevent and treat mental health conditions in children and young people affected by humanitarian crises in low-and middle-income countries.

Background.In emergencies and resource-poor settings, non-specialists are increasingly being trained to provide psychosocial support to people in distress, with Psychological First Aid (PFA) one of the most widely-used approaches. This paper considers the effectiveness of short training programmes to equip volunteers to provide psychosocial support in emergencies, focusing particularly on whether the PFA training provided during the Ebola outbreak enabled non-specialists to incorporate the key principles into their practice.Methods.Semi-structured interviews were conducted in Sierra Leone and Liberia with 24 PFA trainers; 36 individuals who participated in PFA training; and 12 key informants involved in planning and implementing the PFA roll-out.Results.Findings indicate that many PFA training-of-trainers were short and rarely included content designed to develop training skills. As a result, the PFA training delivered was of variable quality. PFA providers had a good understanding ...

As the global public health community continues to reflect and recover from the COVID-19 pandemic, noncommunicable diseases (NCDs), and mental health and neurological conditions remains one of the largest unmet gaps in progress towards meeting the Sustainable Development Goals (SDG). People living with these health conditions, particularly among those most marginalized, acutely understand the impact of these failures in global action and investment. Integrating lived experience into the NCD and mental health response can act as an accelerator for action. Through a participatory process to co-create the WHO Framework on Meaningful Engagement on NCDs, and Mental Health and Neurological Conditions, we conducted a mixed methods and semi-structured approach, including informal consultations, focus groups, in-depth interviews, online surveys, and a short film series, that captured the perspectives of 700 individuals from 111 countries, including 386 individuals with lived experience. Working alongside lived experience communities and other relevant stakeholders, we have established and co-created a set of principles, enablers and actions for operationalizing meaningful engagement, related to dignity and respect, power and equity, inclusivity and intersectionality, commitment and transparency, and institutionalization and contextualization. People with lived experience have a right to be equitably included in all levels of policy-setting, design and implementation of programs, and to have a central role in reforming and reorienting the structures and systems intended to address the complex multifactorial challenges that they face. WHO is committed to leveraging its role in global health to further operationalize meaningful engagement within WHO and its Member States.

This paper presents the first systematic case-control study of correlates of mass psychogenic illness (MPI) in an adolescent school population. MPI is generally construed as a dissociative phenomenon spread by social contagion to individuals who are prone to dissociation. We sought to test if the correlates of dissociative experiences most commonly proposed in the literature could predict caseness among students affected by episodes of mass psychogenic illness occurring in schools in Nepal. We assessed 194 cases and 190 controls (N = 384) of ages 11-18 years from 12 public schools. Cases and controls were comparable on all demographic variables, except for family configuration, with nuclear families more common among those affected. In bivariate comparisons, caseness was associated with childhood physical neglect and abuse, as well as living in nuclear families, peritraumatic dissociation, dissociative tendencies, and depressive and post-traumatic stress symptoms. Hypnotizability emerged as the strongest correlate of psychogenic illness among the cognitive and personality trait variables. However, in multivariable logistic regression, the correlates of dissociation did not predict caseness, suggesting that they do not adequately account for the phenomenon of mass psychogenic illness. An ad-hoc Classification and Regression Trees analysis showed that if an adolescent was highly hypnotizable and reported high rates of peritraumatic dissociative experiences, then there was a 73% probability of being a case in a mass psychogenic illness episode. Future studies involving other psychological, social and cultural factors, as well as school-and family-related factors are needed to understand the correlates of mass psychogenic illness and guide prevention and intervention.

Efforts to address global mental health disparities have given new urgency to longstanding debates on the relevance of cultural variations in the experience and expression of distress for the design and delivery of effective services. This scoping review examines available information on culture and mental health in Nepal, a low-income country with a four-decade history of humanitarian mental health intervention. Structured searches were performed using PsycINFO, Web of Science, Medline, and Proquest Dissertation for relevant book chapters, doctoral theses, and journal articles published up to May 2017. A total of 38 publications met inclusion criteria (nine published since 2015). Publications represented a range of disciplines, including anthropology, sociology, cultural psychiatry, and psychology and explored culture in relation to mental health in four broad areas: (1) cultural determinants of mental illness; (2) beliefs and values that shape illness experience, including symptom...

The recent rise in suicide among Bhutanese refugees has been linked to the erosion of social networks and community supports in the ongoing resettlement process. This paper presents ethnographic findings on the role of informal care practiced by relatives, friends, and neighbors in the prevention and alleviation of mental distress in two Bhutanese refugee communities: the refugee camps of eastern Nepal and the resettled community of Burlington, Vermont, US. Data gathered through interviews ( n = 40, camp community; n = 22, resettled community), focus groups (four, camp community), and participant observation (both sites) suggest that family members, friends, and neighbors were intimately involved in the recognition and management of individual distress, often responding proactively to perceived vulnerability rather than reactively to help-seeking. They engaged practices of care that attended to the root causes of distress, including pragmatic, social, and spiritual interventions, al...

Background There are few studies on the impact of out-of-pocket mental health care expenditures and sociodemographic factors on the probability of Mexican households to incur catastrophic healthcare expenditures (CHE). Objective The goal of the present study was to estimate the incidence of CHE and its main determinants among the households of persons with mental disorders (MD) in Mexico. Methods A cross-sectional survey was conducted, including 387 households of persons with MD. The estimation of the CHE was obtained by the health expenditure distribution method. A Logistic Regression (LR) was used to identify the determinants of probability variation of CHE occurrence. Since we expected a proportion of CHE between 20% and 80%, we assume linearity in the probability function, therefore we additionally used an Ordinary Least Squares (OLS) model. Results In our sample, the incidence of CHE was 34.8%. The two mental illnesses most frequently associated with CHE were schizophrenia and ...

The main goal of this article is to describe the formation and development of a Latin-American network for research in psychotherapy and mental health in sexual and gender diversity. Research has shown that psychological well-being and mental health problems of sexual minority individuals are strongly influenced by the particular social and cultural contexts in which people develop and live. Therefore, the development of effective psychological and mental health interventions that meet the specific needs of people of sexual and gender diversity is necessary to deepen the knowledge of the psychosocial and specific contextual-related aspects of mental health of these populations. The Latin-American network for research in psychotherapy and mental health in sexual and gender diversity seeks to reinforce the contextualized study of these topics. This is an ongoing project that has generated collaborative work among researchers from centers in Chile, Brazil, Colombia, Ecuador, and Argentina. The diverse modalities of collaboration that have been developed so far between the centers are described, as well as the specific products that have emerged from these efforts. Finally, there is a discussion of the value of regional collaborative work in the global south that, while emphasizing differences, allows the comparison of different contexts, their histories, and influences on the object of study, as well as the shared cultural similarities derived from a common geographic space and history.

Background Colombia's 6.5 million internally displaced persons (IDPs) have been exposed to trauma, loss, and hardships. Common mental disorders (CMDs) are prevalent in this group, yet there are few evidence-based psychosocial interventions for this population. We assessed the feasibility and acceptability of a stepped-care intervention for women IDPs in Bogota, Colombia. Methods Feasibility to recruit participants for an intervention trial, to screen for CMDs and displacement-related traumas, to refer high-risk cases to professional consultation, to implement evidence-based interpersonal counseling (IPC) for women with diagnosed CMDs, to retain participants in the intervention, and to conduct follow-up assessments was assessed. Assessment instruments were validated. The intervention was delivered by trained outreach personnel. Intervention acceptability was assessed by monitoring session attendance, dropout rates, and satisfaction. Potential efficacy was evaluated with pre- and ...

Background.Although resilience among victims of child abuse is commonly understood as a process of interaction between individuals and their environments, there have been very few studies of how children's individual coping strategies, social supports and formal services combine to promote well-being.Method.For this study, we conducted a multi-phase analysis of a qualitative dataset of 608 interviews with young people from five countries using grounded theory strategies to build a substantive theory of young people's service and support use patterns. We started with an analysis of ten interviews (two from each country) and then compared these findings to patterns found in each country's full dataset.Results.The substantive theory that emerged explains young people's transience between individual coping strategies (cognitive and behavioral), reliance on social supports (family members, peers and teachers), and engagement with formal service providers whose roles are t...

BackgroundAlcohol use is typically established during adolescence and initiation of use at a young age poses risks for short- and long-term health and social outcomes. However, there is limited understanding of the onset, progression and impact of alcohol use among adolescents in India. The aim of this review is to synthesise the evidence about prevalence, patterns and correlates of alcohol use and alcohol use disorders in adolescents from India.MethodsSystematic review was conducted using relevant online databases, grey literature and unpublished data/outcomes from subject experts. Inclusion and exclusion criteria were developed and applied to screening rounds. Titles and abstracts were screened by two independent reviewers for eligibility, and then full texts were assessed for inclusion. Narrative synthesis of the eligible studies was conducted.ResultsFifty-five peer-reviewed papers and one report were eligible for inclusion in this review. Prevalence of ever or lifetime alcohol c...

Key Takeaways

* Eliot Sorel, MD, was a pioneering leader in psychiatry, advocating for global mental health and social justice.
* He was instrumental in integrating primary care with psychiatry, co-founding the APA Caucus on Global Mental Health.
* Sorel's mentorship and leadership left a lasting impact, inspiring colleagues worldwide to pursue social psychiatry.
* His passing was met with widespread condolences, highlighting his unique contributions and irreplaceable qualities.

Lay people's understanding about a health condition and their perceptions of the condition can have far reaching consequences. Where ignorance, and misinformed beliefs about the condition or its causes prevail this may lead to stigma, prejudice and discrimination, and can have negative consequences for help seeking. These processes have been extensively studied in relation to mental illness, particularly schizophrenia and depression. In contrast, in the intellectual disability field empirical investigations have largely concentrated on the study of explicit attitudes. While the primary aim of this thesis was to increase our understanding of lay conceptualisations of intellectual disability and their consequences for stigma associated with intellectual disability, throughout comparisons are drawn with lay responses to schizophrenia to identify generic and disorder specific processes and to relate the findings to a larger body of evidence. A new measure, the Intellectual Disability Literacy Scale (IDLS), was developed. This assesses knowledge, beliefs about causes of, suitable interventions for, and social distance towards an individual presenting with symptoms of intellectual disability. It allows comparison with lay conceptualisations of schizophrenia, using diagnostically unlabelled vignettes. A large scale UK general population survey was conducted using the IDLS and the Community Living Attitude Scale-Intellectual Disability version (Henry, Keys, Balcazar & Jopp, 1996a). Responses by 1002 lay people of working age were examined to assess the relationships between awareness, inclusion attitudes and social distance. Causal and intervention beliefs of 1752 lay people and the association between causal beliefs and social distance were investigated. The sample was ethnically and religiously diverse and close attention was paid throughout to participants' socio-demographic characteristics, with a particular focus on the role of contact, ethnicity and religion. I would also like to thank Professor Peter Fonagy, head of UCL's Research Department of Clinical Educational and Health Psychology, for his support. I am grateful to Professor Chris Hatton for his comments on some of the material presented in this thesis and to Dr John King for his help with statistical issues. I wish to thank my dear colleagues on the Doctorate in Clinical Psychology at UCL for their ample support, encouragement and excellent sense of humour when faced with the stresses of work and life.

This study investigated the enablers of online shopping behaviour among electronics consumers in Anambra State of Nigeria. The study specifically aimed to ascertain the extent attitude, social influence, trust, shopping experience and purchase intention influence online shopping behaviour for electronic products. A survey research design method was adopted for the study. Data were sourced using the questionnaire from the population of online shoppers of electronic products in Awka, Onitsha and Nnewi commercial areas. The sample size was 384 while a convenience sampling technique was used for the study. Multiple Regression analysis statistical technique was used to test the formulated hypotheses at 5% level of significance. The finding showed that attitude towards online shopping of electronics has a significant and positive influence on online shopping behaviour. It was discovered that social influence has a significant and positive effect on online shopping behaviour. The study revealed that trust on online shopping has a significant and positive influence on online shopping behaviour. The study found that consumer online shopping experience has a significant and positive influence on online shopping behaviour for electronics. The study also discovered that consumer purchase intention has a significant and positive influence on online shopping behaviour for e-products. The study recommended among others that business operators and marketers should continue to devote more on these enablers since they elicit positive and significant consumer online shopping behaviour for e-products. Also, it was recommended that online retailers should increase their service delivery strategies for enhanced consumers trust towards online shopping of electronic products in Anambra State.

BackgroundThe present study examined whether subjective accelerated aging moderated the relationship between COVID-19 health worries and COVID-19 peritraumatic distress among older adults.MethodThe sample consisted of 277 older adults (M = 69.58,s.d.= 6.73, range 60–92) who answered an online questionnaire during the outbreak of COVID-19 pandemic in Israel. Participants completed the measures of background characteristics, exposure to COVID-19, COVID-19 health worries, subjective accelerated aging and COVID-19-based peritraumatic distress.ResultsHigher levels of COVID-19 health worries were correlated with higher levels of peritraumatic distress symptoms among older adults. Moreover, those reporting accelerated aging also reported a higher level of peritraumatic distress. Finally, the interaction between COVID-19 health worries and subjective accelerated aging predicted peritraumatic distress, suggesting that COVID-19 worries were associated with peritraumatic distress to a stronger...

This paper presents the delivery of mental health care to a sample of women living in Jimma, rural Ethiopia, and their access to mental health services. A total of 226 psychiatric charts were reviewed for women seen at Jimma University Specialized Hospital. The mental health charts included documentation ranging from one paragraph to a full note. No psychiatric chart recorded medication status, detailed substance abuse history, or a history of violence. Rendering appropriate mental health care for women requires concerted efforts by multiple stake holders. Using our results, we advance concrete and practical suggestions for improving women's mental health in rural Ethiopia. We point out that the health care system needs to be responsive, allowing for change starting with gender rights, so that rural women have access to basic mental health services.

This paper presents the delivery of mental health care to a sample of women living in Jimma, rural Ethiopia, and their access to mental health services. A total of 226 psychiatric charts were reviewed for women seen at Jimma University Specialized Hospital. The mental health charts included documentation ranging from one paragraph to a full note. No psychiatric chart recorded medication status, detailed substance abuse history, or a history of violence. Rendering appropriate mental health care for women requires concerted efforts by multiple stake holders. Using our results, we advance concrete and practical suggestions for improving women's mental health in rural Ethiopia. We point out that the health care system needs to be responsive, allowing for change starting with gender rights, so that rural women have access to basic mental health services.

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Caribbean health research has overwhelmingly employed measures developed elsewhere and rarely includes evaluation of psychometric properties. Established measures are important for research and practice. Particularly, measures of stress and coping are needed. Stressors experienced by Caribbean people are multifactorial, as emerging climate threats interact with existing complex and vulnerable socioeconomic environments. In the early COVID-19 pandemic, our team developed an online survey to assess the well-being of health professions students across university campuses in four Caribbean countries. This survey included the Perceived Stress Scale, 10-item version (PSS-10) and the Brief Resilient Coping Scale (BRCS). The participants were 1,519 health professions students (1,144 females, 372 males). We evaluated the psychometric qualities of the measures, including internal consistency, concurrent validity by correlating both measures, and configural invariance using confirmatory factor analysis (CFA). Both scales had good internal consistency, with omega values of 0.91 for the PSS-10 and 0.81 for the BRCS. CFA suggested a two-factor structure of the PSS-10 and unidimensional structure of the BRCS. These findings support further use of these measures in Caribbean populations. However, the sampling strategy limits generalizability. Further research evaluating these and other measures in the Caribbean is desirable. Impact statement This study addresses the need for culturally relevant and empirically validated measurement tools in mental health research in the Caribbean. Traditionally, the region has depended on psychological measures developed elsewhere, usually in North America or Europe, and relatively few have established psychometric properties for Caribbean populations. By providing support for the use of the Perceived Stress Scale (PSS-10) and Brief Resilient Coping Scale (BRCS) in the Caribbean setting, the current study enables more contextualized and culturally responsive measurement of key indicators of health and wellbeing. Research using these measures is useful to understand the complex dynamics of stress in the Caribbean, including factors such as climate threats, economic challenges, and social and political disruptions, which have been particularly pronounced during the COVID-19 pandemic. A more comprehensive understanding is crucial for creating mental health interventions and policies that address the needs of Caribbean people. These measures have broad application to support the work of health researchers, healthcare providers, policymakers and educational institutions in the region. The focus on health professions students is especially relevant, given their future role in promoting individual and community wellbeing in a region beset with vulnerabilities. More immediately, this study can inform efforts to develop effective mental health resources in Caribbean settings. This research further contributes to the broader conversation on global mental health, underscoring the importance of measures that are culturally valid. The study may be a useful example for other regions with similar needs for tailoring mental health tools to local contexts. In summary, this paper advances research on stress and coping in the Caribbean and contributes to the growing body of culturally responsive measures in global mental health.

umanitarian aid work is demanding, complex, and emotionally charged. Humanitarian workers are often at the frontlines of crises, facing natural disasters, refugee crises, and public health emergencies. It comes with significant mental health challenges. Every 10 th October, globally is dedicated to commemorate the world mental health Day. In light of this, it is imperative to embrace the theme for this year's World Mental Health Day commemoration: "It's time to prioritize mental health in the workplace." The Mental Health Crisis in the Humanitarian Sector Humanitarian aid workers in Uganda, especially those responding to the vast refugee influx in the regions such as West Nile, Western and Northern Uganda including refugee camps like Bidi bidi, Rhino camp, Imvepi, Palabek, Rwamwanja, Kyangwali, Nakivale, Kyaka, Kiryandongo etcetera are particularly vulnerable to mental health issues. They are exposed to the trauma of others, harsh working conditions, long hours, and often personal safety risks which aligns with the global trends among humanitarian workers. This can lead to conditions such as burnout, secondary traumatic stress (STS), and compassion fatigue.

umanitarian aid work is demanding, complex, and emotionally charged. Humanitarian workers are often at the frontlines of crises, facing natural disasters, refugee crises, and public health emergencies. It comes with significant mental health challenges. Every 10 th October, globally is dedicated to commemorate the world mental health Day. In light of this, it is imperative to embrace the theme for this year's World Mental Health Day commemoration: "It's time to prioritize mental health in the workplace." The Mental Health Crisis in the Humanitarian Sector Humanitarian aid workers in Uganda, especially those responding to the vast refugee influx in the regions such as West Nile, Western and Northern Uganda including refugee camps like Bidi bidi, Rhino camp, Imvepi, Palabek, Rwamwanja, Kyangwali, Nakivale, Kyaka, Kiryandongo etcetera are particularly vulnerable to mental health issues. They are exposed to the trauma of others, harsh working conditions, long hours, and often personal safety risks which aligns with the global trends among humanitarian workers. This can lead to conditions such as burnout, secondary traumatic stress (STS), and compassion fatigue.

BackgroundHealthcare workers (HCWs) have been impacted psychologically due to their professional responsibilities over the prolonged era of the coronavirus disease 2019 (COVID-19) pandemic. The study aimed to identify the predictors of psychological distress, fear, and coping during the COVID-19 pandemic among HCWs.MethodsA cross-sectional online survey was conducted among self-identified HCWs across 14 countries (12 from Asia and two from Africa). The Kessler Psychological Distress Scale, the Fear of COVID-19 Scale, and the Brief Resilient Coping Scale were used to assess the psychological distress, fear, and coping of HCWs, respectively.ResultsA total of 2447 HCWs participated; 36% were doctors, and 42% were nurses, with a mean age of 36 (±12) years, and 70% were females. Moderate to very-high psychological distress was prevalent in 67% of the HCWs; the lowest rate was reported in the United Arab Emirates (1%) and the highest in Indonesia (16%). The prevalence of high levels of fe...

Anxiety and depression are common psychological disorders in patients with type 2 diabetes mellitus (T2DM), which was upsurging worldwide amid the COVID-19 pandemic. This study aimed to explore factors associated with anxiety and depression among T2DM patients in Bangladesh during the COVID-19 pandemic. A cross-sectional study was conducted among T2DM patients using face-to-face interviews. Anxiety and depressive symptoms were measured using the CAS and PHQ-9 scales. Outcomes were assessed including sociodemographic, lifestyle, anthropometric, and challenges of getting routine medical and healthcare access-related questions. The prevalence of anxiety and depressive symptoms were 29.8% and 22.7%, respectively. Regression analysis reported that males older than 50 years, illiterate, unemployed or retired, urban residents, below the recommended level of moderate to vigorous physical activity (MVPA), low dietary diversity score (DDS) and obese respondents were associated with higher odds of anxiety and depressive symptoms. Moreover, respondents with transport difficulties, unaffordable medicine, medicine shortages, close friends or family members diagnosed with COVID-19 and financial problems during COVID-19 had higher odds of anxiety and depressive symptoms than their counterparts, respectively. Our study suggests providing psychological support, such as home-based psychological interventions, and highlighting policy implications to ensure the well-being of T2DM patients in Bangladesh during the pandemic. Impact statement The study sheds light on the critical intersection of mental health and chronic illness during a global health crisis. This research identifies significant determinants of anxiety and depression among type 2 diabetes mellitus patients in Bangladesh amid the COVID-19 pandemic. The findings offer valuable insights for healthcare providers, policymakers and researchers, emphasizing the need for integrated care approaches to address the holistic well-being of patients in the context of diabetes management. This approach ultimately leads to improved health outcomes and enhanced quality of life during such challenging times. This study serves as a crucial reference point for future interventions and public health strategies aimed at mitigating the psychological impact of chronic diseases in the backdrop of a pandemic.

Puerto Rico was affected by Hurricane Maria in September 2017, and as of this writing, hundreds of thousands of people are experiencing fear, panic attacks, anxiety, and night terrors as a result of that hurricane. The results of this event is the need in Puerto Rico for an articulation of a disaster plan that includes psychosocial support, and that establishes linkages between the community responders, community health clinics and major hospital. The objective of this article is to propose an outline of a disaster preparedness plan that evolves from community psychosocial needs and uses the community capitals for a tiered intervention. While there is an effort to outline existing strategies to attend to counseling and mental health response, there is no clear articulation of a Disaster Plan that provides for psychosocial support and community mobilization at the initial tear of addressing community psychosocial needs. The data that informs this article were qualitative in nature including interviews to more than 200 persons in the 32 communities directly affected by Hurricane Maria, seventeen focused groups, and personal response by the co-authors during the twelve months after the disaster. Community mobilization, based on the decision-making capacity from the affected community, is responsible for mobilizing the response and recovery activities. The paper made two recommendations: (11) to use the community capitals to plan for preparedness, response and recovery. Two tools suggested are to explore the contributions of community capitals and the benefit of psychosocial first aid as a tool on primary intervention. A community-based psychosocial support structure integrated into the National Disaster Response Plan of Puerto Rico is proposed herein as a planning tool and mechanism to promote hope and well-being amongst the members of the affected communities. The article concludes by proposing a six-step process of engaging the community in disaster planning and proposes that for inclusion of a long-term psychosocial support plan for the community must be part of an instutionalized process including Emergency Management, Department of Health and Mental Health, and Human Services as leads in an island effort to prepare the citizens for a future disaster.