Forced displacement heightens mental health risks for children, including psychological, environmental and economic stressors, yet few interventions address whole-family needs within humanitarian contexts. Family-systemic approaches show promise, but evidence on interventions addressing social determinants of mental health remains limited. We will conduct a single-masked, two-arm randomised controlled trial with 550 families in East Amman, Jordan, to evaluate StrongerTogether, a modular whole-family intervention with a financial literacy component. Families experiencing multiple psychosocial challenges will be randomised 1:1 to receive the intervention or enhanced treatment as usual. The trial employs sequential dual outcomes testing, evaluating effectiveness through: (1) upstream improvements in at least one of three primary outcomes (family functioning, parenting practices and caregiver mental health) and (2) direct improvements in adolescent mental health among those with elevated baseline distress. We will also evaluate two implementation tools: ReachNow for family case detection and FamilyACT for facilitator competency assessment. A mixed-methods process evaluation will examine implementation, effectiveness and potential sustainability of core and optional modules. This will be the first rigorous evaluation of an integrated whole-family intervention addressing social and environmental determinants of mental health in humanitarian settings. Findings will inform evidence-based approaches to family mental health support and contribute validated tools for implementation at scale.

Healthcare professionals in Iraq are exposed to war-related stressors that may undermine psychological well-being. This study examined post-traumatic stress disorder (PTSD) and depression and their association with peace of mind (PoM). In a cross-sectional survey, 174 physicians, nurses, pharmacists and allied health workers from multiple Iraqi regions completed an online questionnaire including demographics and validated Arabic measures of PTSD, depression (BDI) and PoM. Reliability was checked using Cronbach’s alpha, and analyses used descriptive statistics, t-tests, Spearman correlations and stepwise regression. Mild-to-moderate PTSD symptoms were reported by 66.1% of participants, and 39.1% reported at least mild depressive symptoms; 54.0% showed moderate PoM. In regression models, higher PTSD and depression scores significantly predicted lower PoM, whereas years of professional experience predicted higher PoM. These findings indicate a substantial burden of trauma- and depression-related symptoms among Iraqi healthcare workers and suggest that workplace-focused mental health supports and organizational policies are needed to protect well-being in conflict-affected settings.

Suicide is a serious global health problem with ~73% deaths by suicide occurring in low- or middle-income countries (LMICs), many of which are among people experiencing humanitarian emergencies. Few guidelines outline specific steps and strategies to tackle suicide risk and manage post-attempt consequences in these settings, leaving program implementers with limited information to translate guidance to practice. This article describes the implementation of the Common Elements Treatment Approach (CETA) suicide safety protocol as part of a randomized controlled trial in northern Thailand for displaced adults from Myanmar with chronic physical health conditions. The CETA safety protocol has been used in many trials and programs to screen for and manage suicide risk, including in a prior CETA effectiveness trial with Myanmar adults. In this article, we describe how this safety protocol was adapted for the study setting, and utilized to effectively screen, assess suicidal thoughts and behaviors, develop and manage action plans for study participants with active suicidal ideation. We present three illustrative case descriptions of individuals with whom we implemented the safety protocol to highlight how suicide risk intersects with physical illness, psychosocial stressors and structural vulnerability. Reflections on feasibility, acceptability and adaptations – such as language translation, culturally grounded referral pathways and training for nonspecialist providers – are shared to inform future implementation. Our findings support the implementation of suicide safety protocols within humanitarian programming and offer practical insights for global health practitioners and policymakers working in similarly complex settings.

Hearing distressing voices is a strong signal of potential mental health concerns and can lead to negative outcomes. Evidence-based practices to address distressing voice-hearing developed in western clinical settings may not be appropriate in sub-Saharan Africa. This study recruited patients who reported hearing voices at an outpatient clinic in semi-urban Arusha, Tanzania. Forty-three participants consented to the study and reported hearing auditory verbal hallucinations, including 88% (n = 38) reporting distressing hearing voices. The sample was split by gender, representative of a range of ages and included a primarily Maasai-related, Christian and unmarried sample with limited education. Ninety-one percent (n = 39) met criteria for moderate to severe psychopathology (Kessler-10-Swahili). Qualitative interviews (n = 43) revealed how this sample thought about mental health, how they experienced and explained their voices, and their pathways to care for help with mental health concerns that arose from their experiences. People who heard distressing voices typically approached religious healers first, but had a strong preference for biomedical care, attributed both biomedical and social causes to their symptoms, believed that voice-dialoguing practices endorsed in the west could signal participation in witchcraft, and had few resources to engage in multi-session, professional-led or high-tech interventions currently being used in Euroamerican contexts. In this region, patients with psychosis symptoms relied on and trusted family, religious leaders and biomedical treatment providers for support with their mental health needs. Networking the three together for persons experiencing psychotic symptoms could create a sustainable resource for long-term follow-up and mutual support.

Suicide is a significant global public health concern, particularly among adolescents, with substantial implications for economies, societies and individuals’ mental well-being. Understanding its patterns and intention and psychosocial determinants in a given context can suggest potential intervention points. This population-based cross-sectional study aimed to document suicidal ideas, behaviors and intensity among youths aged 14 to 25 in the Nairobi metropolitan area and associated socio-economic position, demographic indicators and potential intervention points. A diverse sample of 1,972 participants was recruited from urban and peri-urban settings within the Nairobi metropolitan area. Data analysis included descriptive statistics, chi-square tests and logistic regression. Our findings confirm a high prevalence of suicidal ideas and behavior in the youth (19.9% and 3.6%, respectively), with very few significant differences between the urban and peri-urban areas. The severity of suicidal ideation and behavior reported methods and reasons, and the socio-demographic profile of participants, point to multiple potential intervention targets. These findings ought to be used to design, manage and evaluate suicide prevention programs.

Online synchronous chat, or ‘Live Chat’, is distinguished by its real-time, anonymous, and text-based nature. There is limited understanding of the characteristics of those who choose Live Chat services compared to Blended Services. This study examined the demographic, psychosocial, and service engagement profiles of young people using the Irish Live Chat service, Jigsaw Live Chat, compared with those attending Jigsaw’s Blended (in-person and/or video) support Service. Routine service-based data were analysed from 1,313 Live Chat and 3,604 Blended Service users. Reasons for attendance among Live Chat users seeking mental health support were analysed using content analysis. Live Chat users were more likely to be gender-diverse, older, and to report higher psychological distress than Blended Service users. Anxiety and low mood were common presenting issues. Attendance reasons varied, with over one-third citing multiple issues and many experiencing persistent distress. A minority attended for information or while waiting for other support. Overall, users reported high satisfaction. Live Chat users waited an average of 2.5 minutes, compared with typical waits of 1–2 months for the Blended Service. These findings highlight Live Chat as a distinct and essential access point for highly distressed and underserved youth, particularly those with minority gender and sexual identities.

Depression is underrecognized in primary care, which is a barrier to treatment. For the last decade, Zimbabwe has invested in increasing access to depression treatment within primary healthcare. This study describes depression recognition by nurses and referral to treatment in four primary care clinics in Zimbabwe. Research staff screened 200 patients after they attended a primary care visit at a study clinic. They assessed depression using the PHQ-9 and assessed depression and/or anxiety using the Shona Symptoms Questionnaire (SSQ-14). Medical records were examined for depression and/or anxiety diagnoses. Positive depression and anxiety screens were compared with nurse documentation. 69.5% of participants were women and 56.5% were living with HIV. 6.0% had a PHQ-9 score ≥11, indicative of depression, and 22.0% had an SSQ score ≥9, indicative of depression and/or anxiety. None of the patients who screened positive for probable depression and/or anxiety were recognized by nurses. Nurses who saw the patients in the sample were surveyed. Most had not received formal training on mental health in primary care (mhGAP) prior to patient data collection. Despite efforts to expand depression treatment in Zimbabwe, individuals with probable depression were unrecognized by nurses, though nurses offered some care for other mental health conditions.

Mental health literacy (MHL) strategies are crucial for mental health promotion and prevention. This study aimed to determine the acceptability, feasibility, appropriateness and initial efficacy of an adapted MHL program in a community sample of adults in Kenya. This was a quasi-experimental pre-post study conducted from July 2023 through July 2024. The MHL program contained nine modules delivered over 3 days. Participants were assessed at baseline and immediately after the program. The primary outcomes were mental health knowledge and participants’ attitudes on mental health/illness. Secondary outcomes included depressive symptoms, anxiety symptoms, self-perceived social support, self-perceived wellbeing, MHL program acceptability, feasibility and appropriateness. Relative to baseline, we observed statistically significant improvement in mental health knowledge and attitude on mental health/illness postintervention. We also observed significant improvements in all secondary outcomes. The MHL program also emerged as contextually appropriate, acceptable and feasible. The adapted MHL program is acceptable and appropriate and can feasibly be delivered by trained non-specialist facilitators. Also, the MHL program has the potential to increase participants’ MHL and attitudes and reduce symptoms of common mental disorders and promote self-perceived wellbeing. Future research should explore how improvements can be sustained over the long term.

Depression among women living with HIV affects their psychological well-being, HIV disease management, and prevention of mother-to-child transmission. A subset of 25 women selected from the intervention arm of the Maternal Depression Treatment in HIV (M-DEPTH) cluster randomized trial were interviewed; they had received either antidepressant therapy (ADT) or problem-solving therapy (PST). Their experiences as new mothers with the effects of depression and treatment on HIV disease and pregnancy management were assessed in a brief qualitative interview conducted in 2022. Seven were treated with ADT, 15 with PST, and three received both treatment modalities; all but two (n=23) responded to depression treatment. Participants reported improved adherence to HIV antiretroviral therapy and described the treatment as being effective in alleviating depressive symptoms. Additionally, the process of treatment helped them to learn a lot about depression, mental health, and its connection to physical and emotional well-being. Participants also reported improvements in parenting and pregnancy management. The results highlight the need for greater prioritization of mental health care for women living with HIV to prevent poor mental health outcomes and enhance overall functioning, including management of HIV disease, pregnancy, and parenting.

This study investigated the independent and interactive effects of dietary behaviors and physical activity on poor sleep quality among 15,059 Chinese adolescents. Using a cross-sectional design, we assessed sleep quality (Pittsburgh Sleep Quality Index, PSQI), dietary habits, and physical activity. Logistic regression and interaction analysis were performed to examine associations, adjusting for covariates. The prevalence of poor sleep quality (PSQI score ≥ 7) was 9.72%. Seven healthy dietary behaviors were identified as protective (e.g., regular diet, abstaining from alcohol; ORs=0.49–0.56). While physical activity showed no independent association, limiting screen-based sedentary screen time(≤2h/day) reduced poor sleep odds by 31% (OR = 0.69). Two significant interactions emerged: abstaining from alcohol combined with limiting sugary beverages synergistically reduced the odds of poor sleep quality by 42% (OR = 0.58), whereas the combination of healthy dining out and high physical activity was associated with a 181% increased odds of poor sleep quality (OR = 2.81). While healthy dietary patterns are strongly associated with better sleep quality, the interplay between behaviors is complex, demonstrating both synergistic protective association and antagonistic outcomes. Findings highlight the need for integrated lifestyle interventions that account for behavioral interactions in promoting adolescent sleep quality.

Mobile health (mHealth) interventions offer promising ways to enhance access and continuity of mental health services in low-resource settings. However, little is known about the perspective of end users in routine primary care in Nigeria regarding the role of mHealth in mental health care. This qualitative study explored the perspectives of patients, caregivers and healthcare providers on the use of mHealth tools to support access to and continuity of mental health care in Nigeria. Seventeen participants, including persons with lived experience of depression (n=7), caregivers (n=3), and primary healthcare workers (n=7), were purposively recruited from nine primary health clinics in Ibadan. Interviews were conducted in Yoruba, transcribed, translated into English, and analysed inductively using NVivo 15. Participants identified phone calls, Short Message Service (SMS) reminders, and audiovisual content as key facilitators of engagement, self-care and adherence. Caregivers valued direct communication with providers, while healthcare workers used mobile tools for reminders, follow-up and patient education. Flexible use of next-of-kin contacts helped overcome digital barriers. The findings demonstrate that user-friendly mHealth tools are feasible for supporting mental health care in Nigeria, but their success depends on coupling technology with human-centred communication to ensure equitable and continuous care.

Gender, as a sociostructural factor, may shape child development through social norms that influence family dynamics. We examined whether more egalitarian parental relationships are associated with better developmental outcomes. Using data from the Pelotas 1993 birth cohort (Brazil), we adapted a population-level gender inequality metric to characterise parental relationships. The Couple’s Gender Inequality Index (CGII) was derived from maternal health, parental education and income. Associations between CGII and educational attainment, quality of life, and depression at age 18 were assessed using linear regression models adjusted for family income, gestational age, birth weight, parental cohabitation and race. The sample comprised 2,852 participants (1,446 women). Higher CGII scores, indicating greater equality within couples, were associated with significantly higher educational attainment in both females and males. Higher quality of life at age 18 was observed in the second and fourth CGII quartiles compared with the most unequal. Greater equality was associated with lower risk of depression at age 18, although this association was not robust to adjustment. Among girls, a similar pattern was observed for emotional symptoms at age 15. Overall, greater couple-level gender inequality was associated with poorer developmental outcomes in offspring.

Continuous traumatic stress (CTS) exposure describes extended and ongoing collective trauma exposure that is associated with potential future danger and threat to the community. CTS has generated debate in the context of current definitions of trauma and posttraumatic stress disorder (PTSD) in the DSM-5. Prevalence data on posttraumatic stress symptoms (PTSS) and PTSD in adolescents aged 10 to 24 years following CTS exposure in Sub-Saharan Africa are lacking. This systematic review and meta-analysis sought to address this gap. We also synthesized evidence on other trauma-related mental disorders and moderators such as mean age, sex, country income, education level, PTSS/PTSD assessment tool, and recruitment method. A systematic literature search covering four databases yielded 460 papers that were screened for eligibility, with 10 studies included. Data were extracted and coded, and a meta-analysis of the pooled prevalence of clinically significant PTSS/PTSD was conducted. Results indicated a pooled prevalence of PTSS/PTSD of 32.0% (95% CI: 20.7% to 46.0%). Country income (World Bank category) and type of assessment (clinician-administered vs. self-report) significantly moderated the prevalence of PTSS/PTSD. Further research is needed to not only measure CTS as an exposure but also as a response separate from PTSS/PTSD among adolescents in Sub-Saharan Africa. Additionally, research is needed to determine the validity, reliability, and cultural relevance of CTS response measures. Such studies will help in better understanding the psychosocial impact of CTS exposure on adolescents and inform the development of future interventions. Detailed data on the prevalence of PTSS/PTSD and moderators thereof following CTS exposure in Sub-Saharan Africa are sparse. Further studies are needed to characterize CTS-related comorbidities and related phenomena in adolescents living under conditions of CTS exposure and to optimize evidence-based interventions.