Adolescent girls affected by displacement face substantial mental-health risks. The Sibling Support for Adolescent Girls in Emergencies (SSAGE) is a 12-week, gender-transformative, family-based program designed to improve adolescent girls’ mental health in humanitarian settings. This mixed-methods pilot randomized controlled trial (RCT) assessed SSAGE’s feasibility, acceptability and potential effects among 186 Venezuelan migrant and Colombian returnee families in Colombia. Adolescent girls aged 13–19 years, their male siblings and caregivers participated in parallel sessions on gender dynamics, communication and relationships. Implementation outcomes drew on the Mental Health Implementation Science Tools (acceptability and feasibility subscales), attendance records and qualitative interviews. Analyses followed an intent-to-treat approach using adjusted linear and logistic regression models. Quantitative analyses did not identify measurable changes in adolescent girls’ mental health outcomes at endline; however, attendance was modest, with only ~10% of families meeting the predefined protocol threshold. Implementation findings revealed strong participant satisfaction and high acceptability of SSAGE content and mentor relationships. Engagement was constrained by economic hardship, transportation and venue barriers, and some caregivers’ acute emotional distress, which likely limited feasibility and potential impact. SSAGE shows promise as a gender-transformative, family-based approach, but successful delivery in urban migrant settings will require tailored and refined implementation strategies.

People with severe mental illness (SMI) die 10–20 years earlier than the general population, largely due to non-communicable diseases (NCDs) such as hypertension and diabetes and risk factors such as hypercholesterolaemia. This cross-sectional study gathered data from people with SMI from three national mental health institutions in South Asia. Data was collected based on the WHO Stepwise approach to NCD risk factor surveillance and the prevalence of screening, diagnosis and treatment for diabetes, hypertension, and hypercholesterolaemia was assessed. Logistic regression models assessed the associations of sociodemographic characteristics with NCD screening. Three thousand nine hundred and eighty nine participants were recruited. Screening prevalence varied by country and disease, with hypertension being the most commonly screened NCD (Bangladesh = 52.5% [50.0–55.1], India = 43.1% [40.3–45.9], Pakistan = 60.9% [58.2–63.5]), and cholesterol was the least common (Bangladesh = 4.1% [3.2–5.2], India = 14.8% [12.9–17.0], Pakistan = 9.6% [8.1–11.3]). Characteristics such as BMI, age and education level were positively associated with screening, and females were more likely to be screened than males. There are low levels of screening for NCDs among individuals with SMI accessing tertiary institutions in South Asia, with significant sociodemographic disparities. Standardised screening protocols tailored to South Asian populations could mitigate the increased risk of NCDs in this population.

Maternal–infant bonding is essential for early development and long-term well-being. In low-resource settings like Pakistan, perinatal anxiety, though prevalent, remains under-recognized and can significantly disrupt bonding. While perinatal depression has garnered greater research attention, the cultural and relational dimensions linking anxiety to bonding remain underexplored. This qualitative study examined how maternal distress, sociocultural expectations and healthcare limitations influence bonding. Eighteen pregnant and postnatal women (aged 19–45 years) with clinically significant anxiety (Generalized Anxiety Disorder 7-item scale ≥ 10) were purposively recruited from public hospitals in Rawalpindi and Islamabad. In-depth interviews were conducted in Urdu and analyzed using Braun and Clarke’s thematic analysis. Five major themes emerged: (1) emotional vulnerability during the perinatal period, (2) interpersonal and family dynamics, (3) maternal health and role strain, (4) cultural scripts and structural barriers and (5) participant-driven recommendations. Anxiety often delays emotional connection. Judgment, limited autonomy and lack of support worsened distress, while faith, rituals and relational coping offered resilience. This study provides novel qualitative evidence that perinatal anxiety and maternal–infant bonding are co-constructed within the relational and sociocultural ecologies of low- and middle-income countries like Pakistan. Findings challenge purely symptom-focused approaches, underscoring that effective intervention must address not only the emotional invisibility of mothers but also the relational pathways of distress, such as hypervigilance, exhaustion and performance anxiety, which are intensified by a lack of respect, autonomy and validation. A shift toward contextually grounded, relationship-centered care is urgently needed.

Social support is a key coping resource; its specific role for refugees from sub-Saharan Africa in high-income settings remains poorly understood. This systematic review synthesises existing evidence on the sources of social support and how these networks aid coping during resettlement. We applied an optimised search strategy to identify studies examining social support among sub-Saharan African refugees across six academic indexing databases. We then undertook a meta-synthesis of the identified studies. This involved the use of meta-thematic analysis of the interpretations and quotes presented in each study, combining thematic analysis through the reviewer’s reflexivity. The PRISMA framework guided the review process to ensure methodological rigour. A total of 22 articles were included in the qualitative meta-synthesis. The synthesis revealed four key sources of social support: 1) family, 2) friends, 3) ethnic and community groups, and 4) cultural and religious supports. These support sources played multiple roles, including enhancing community engagement and reciprocity, providing practical and emotional assistance, offering relief from distress and cultivating cultural continuity and adaptation. However, some individuals distanced themselves from their ethnic community and preferred self-driven coping. Access to social support systems remains a crucial coping resource for many sub-Saharan African refugees in high-income settings, alleviating distress and enhancing resilience. Programs that strengthen informal social support networks through community-driven initiatives can enhance the relevance of social support. Future research should investigate the role of social support across various phases of resettlement in relation to psychosocial well-being.

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.