Psychological distress can occur even without a depression diagnosis. Many older adults have functional limitations that hinder daily activities, yet their emotional needs often go unrecognized. This study examined whether functional impairment is associated with psychological distress in older adults and whether this relationship varies by depression-diagnosis status. Data came from the 2023 Behavioral Risk Factor Surveillance System for U.S. adults aged 65 and older (N = 95,325). Functional impairment was defined as having 14 or more days in the past month when poor health limited usual activities. Psychological distress was measured by days of poor mental health and a binary indicator of high distress. Survey-weighted regression analyses tested main and interaction effects of functional impairment and depression diagnosis while adjusting for sociodemographic and behavioral factors. Functional impairment was linked to greater distress. Predicted estimates showed the highest distress among those with both impairment and a depression diagnosis (about 11 poor mental health days). Those with impairment only averaged about 6 days, those with a diagnosis only about 8, and those with neither condition about 3. Functional impairment may reveal hidden distress in older adults without diagnosed depression. Adding physical-function indicators to screening could help identify vulnerable individuals earlier.

War in the former Yugoslavia still reverberates in the lives of the generations that lived through it. The aim of this study was to compare a cohort that had direct experience of the war (first generation, G1, n = 89) with those born after the war (second generation, G2, n = 30). All participants stay or live in the Czech Republic. We used an individualized approach, with a structured interview of 91 questions, supplemented by quantitative methods to measure traumatic stress (PCL-5), adverse childhood experiences (ACEs) and centrality of the event (CES). G1 had a higher mean ACE score compared to G2, and the two generations did not differ in centrality of the event and trauma symptom severity, in the rate of psychiatric outpatient care use, psychiatric hospitalizations, diagnosed PTSD, current psychiatric medication use and in illicit drug use. A number of signs were indicative of good resilience, including the ability to move internationally, which implies language proficiency, and the ability to earn a sufficient income. G1 and G2 respondents represent a group of educated individuals with their mental health mostly matching that of the general population, as well as people who have success in their professional and personal lives.

Despite high rates of intimate partner violence (IPV) among women, research on its mental health consequences, particularly PTSD in slum settings, remains scarce. This study assessed PTSD prevalence and determinants among slum-dwelling women in Bangladesh who experienced IPV during the COVID-19 pandemic. A cross-sectional study was conducted between July and October 2022 among 291 women from 5 urban slums in Dhaka, who reported IPV using the World Health Organisation questionnaire. Face-to-face interviews collected sociodemographic data, pandemic-related challenges, gender roles, health information and PTSD symptoms using the validated Post-Traumatic Stress Disorder Checklist-5. Logistic regression identified PTSD predictors. Most women were married before the age of 18 years (87.9%), unemployed (69.3%), had no formal schooling (38.6%) and lived in overcrowded households (38.6%). Over half of their husbands were daily wage earners (57.9%) and had a history of substance misuse (65.9%). PTSD prevalence was 21.16% and was higher among women with non-communicable diseases (adjusted odds ratio [AOR]: 3.29; 95% confidence interval [CI]: 1.6–6.7), concern about COVID-19 infection (AOR: 3.87; 95% CI: 1.12–13.22) and increased marital arguments (AOR: 3.00; 95% CI: 1.57–5.74). IPV in slum settings imposes a significant PTSD burden, highlighting the need for community-based mental health services to support marginalised women.

Despite reductions in cardiovascular, cancer, and infectious disease, comparable public-health improvements in mental health have not materialized. Global dissemination of trainings and programs have not translated into reduced burden of mental health conditions. Detection in primary care remains uncommon, sustained delivery of psychological services is difficult, few governments prioritize mental health, and reliable data are scarce. A largely unexamined factor is how we talk about suicide. How suicide is discussed shapes whether primary care workers feel able to engage, what organizations incorporate psychosocial programs, and whether mental-health data are accurate and representative. Drawing on three decades of work, this Perspectives piece argues that protocol-heavy, medico-legal framing, such as rigid confidentiality scripts, liability fears, and technical checklists, pulls attention away from the feelings involved in sitting with a person who expresses suicidal thoughts. Logistical, legal, and clinical pushback reflects fear and powerlessness in the face of suicidality. I advocate for making deliberate space for emotional processing by inviting helpers to notice their own reactions, collaborating with people with lived experience of suicidality, and learning from those bereaved by suicide. An empathy-guided approach to suicide can strengthen trainings, program adoption, data quality, and, most importantly, ensure people in distress are not left alone.

For nearly three decades, the Democratic Republic of the Congo has endured armed conflict that has devastated its population, leaving a staggering number of survivors of sexual violence. This article draws on over a decade of clinical, academic and field experience to explore the psychosocial and public health challenges of caring for these survivors. Despite the high prevalence of post-traumatic disorders – often severe and complex – the mental health system remains gravely under-resourced. The article examines gaps in mental health services, highlights the clinical intricacies of trauma resulting from rape (including complex PTSD and dissociation) and critiques the uncritical export of Western therapeutic models to African contexts. Emphasizing the need for culturally grounded, integrative care, the author advocates for community-based, trauma-informed, inclusive and context-sensitive approaches that bridge clinical science and local healing traditions. This holistic vision is essential for restoring dignity and mental health to survivors and for building a resilient public health infrastructure in the DRC.

Although virtual reality (VR) programs are being developed by marginalized groups’, a systemic power imbalance still exists. Marginalized groups have a place in digital wellbeing and can lead initiatives to access resources that they desire. To better support these efforts and mobilize knowledge among marginalized stakeholders, we conducted a scoping review of the use of VR for wellbeing. Adopting an equity lens that considers the experiences of intersectional marginalization, our aim was to identify VR programs, their targets, outcomes and equity-related facilitators and barriers. In May 2023, we conducted a comprehensive literature search of MEDLINE, PsycINFO, Embase and Web of Science databases and grey literature for virtual reality and marginalized populations. Eligible research articles since the inception of the databases were those that met our predefined criteria of VR, marginalized populations and wellbeing. We included 38 studies and charted preregistered variables using narrative synthesis, descriptive statistics, and a logic model. The populations were often intersectionally marginalized--primarily individuals with disabilities, underrepresented sexualities and genders, and marginalized older individuals in high-income countries on Turtle Island (North America). The most common race categories were Black or African American (26%) and European or White (53%), but other sociodemographic characteristics were underreported. VR offered diverse support, including social, mental, physical and cultural. We report program outcomes for several subgroups; though heterogeneous, most studies reported improved wellbeing outcomes. VR’s flexibility created informal, flexible spaces, with peer support that contributed to mental and social wellbeing. Several factors could hinder marginalized groups’ ability to access and participate, such as the lack of free programs, data and program ownership, and intersectional data analyses. This topic reflects a growing literature, with half of the publications being in 2022 or 2023. Many of these studies have limitations like small sample sizes and a lack of mixed-methods or practical significance analyses. Moving forward, researchers should apply more open-access and inclusive practices in their designs and recruitment processes to widen equitable access to marginalized stakeholders. Nevertheless, many marginalized populations created VR programs and benefited from them, contributing to a rebalancing of power over wellbeing.

Adolescent mental health problems are prevalent in low- and middle-income countries, like Kenya, where access to care remains severely limited. Task-shifted, school-based interventions offer solutions but often lack structured protocols for managing risk, such as suicidality or abuse. The Shamiri Risk Management Protocol (Shamiri-RMP) was developed to address this gap through a tiered system for screening, classifying and responding to risk within a stepped-care mental health model. We conducted a mixed-methods implementation study across 149 public high schools in Kenya. Caseworker fidelity and risk classification accuracy were evaluated through a review of 222 student cases. The Consolidated Framework for Implementation Research guided the qualitative analysis of caseworker surveys to identify implementation barriers and facilitators. Of 76,855 students enrolled in the broader Shamiri program, 977 (1.27%) were referred for risk assessment, and 222 (0.28%) were enrolled in the Shamiri-RMP. Among them, 42.71% were low-risk, 35.68% moderate-risk and 21.61% high-risk. Risk reductions occurred in 60.47% of high-risk cases, 56.34% of moderate-risk cases and 51.76% of low-risk cases. Implementation facilitators included supervisory support (50.88% of caseworkers) and protocol clarity (80.70%), while barriers included referral gaps (5.26%) and confidentiality concerns (54.39%). Findings support the feasibility and scalability of the Shamiri-RMP in low-resource school settings.

Sensory Over-Responsivity Disorder (SORD) is characterized by extreme sensitivity to everyday sensory input, which can interfere with children’s emotional, behavioral and social development. Despite growing interest, limited research has explored its developmental effects in the absence of other psychiatric diagnoses. This study investigated self-regulation and related clinical features in preschool children with SORD who did not meet diagnostic criteria for autism spectrum disorder, attention-deficit/hyperactivity disorder (ADHD), or obsessive-compulsive disorder. The sample included 15 children with SORD and 15 typically developing controls, matched by age and gender. Diagnoses were made using the Preschool Age Psychiatric Assessment, and comorbidities were excluded using Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood: Revised Edition criteria. Self-regulation was assessed through the Head-Toes-Knees-Shoulders-Revised task. While no significant differences were found in autistic traits, repetitive behaviors or executive functioning, children with SORD demonstrated significantly poorer self-regulation (p < .001). Poorer self-regulation was strongly associated with greater SORD severity, elevated ADHD symptoms, lower social interaction and increased emotional and sensory reactivity. These findings suggest that self-regulation difficulties are a core feature of SORD, even in the absence of comorbid psychiatric disorders. Early identification and interventions targeting self-regulation may help improve long-term outcomes for children affected by SORD.

A burgeoning body of evidence suggests a higher prevalence of nonsuicidal self-injury (NSSI) behaviors among adolescents. This study aimed to examine the comorbid internalizing symptoms and suicidal behaviors, along with associations between dissociative experiences and suicide risk in adolescents attending a psychiatric outpatient unit in Ankara, Türkiye. The study included 81 adolescents aged 12–18 years, who engaged in NSSI and sought treatment at a psychiatric outpatient clinic. Psychiatric evaluations were conducted through semi-structured clinical interviews. NSSI behaviors were assessed using the Inventory of Statements About Self-Injury, and suicide risk was measured using the Suicide Probability Scale. Additionally, internalizing symptoms and dissociative experiences were evaluated using the Revised Children’s Anxiety and Depression Scale-Child Version and the Adolescent Dissociative Experiences Scale, respectively. Moderate to high correlations were found among suicide risk, dissociation, NSSI severity, anxiety and internalizing scores. Mediation analysis revealed that NSSI significantly mediated the relationship between dissociation and suicide risk. These findings indicate that assessing both dissociation and NSSI could provide valuable insights into comprehending and addressing adolescent suicide, thereby facilitating the development of targeted interventions to mitigate the effects of dissociative experiences.

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