There have been no culturally validated measures to screen for depression in Madagascar. In 2022–2023, we conducted qualitative studies in the Bay of Ranobe area in southwestern Madagascar to understand local mental health syndromes specific to this region. We found that the 8-item Patient Health Questionnaire (PHQ-8) shares symptoms with the general distress-like, depressive-like and grief-like syndromes elicited locally. We adapted the PHQ-8 to align with the unique symptoms found in the region that were missing from the measure. We administered the adapted PHQ-8 to 809 participants aged 16 and above. We found that the one-factor (Depression) model (root mean square error of approximation [RMSEA] = 0.046, standardized root mean square residual [SRMR] = 0.053, Comparative Fit Index [CFI] = 0.993 and Tucker–Lewis Index [TLI] = 0.991) had a better fit to our data than the two-factor (Cognitive–Affective and Somatic) model (RMSEA = 0.047, SRMR = 0.052, CFI = 0.994 and TLI = 0.990). The one-factor (Depression) model demonstrated good internal consistency (MacDonald’s omega coefficient $ {\omega}_0 $ = 0.81 and ordinal alpha $ {\alpha}_0 $ = 0.87). We conducted a multigroup confirmatory factor analysis to establish measurement invariance (MI) across four groups (sex, ethnicity, level of education and age group) and found that all levels of MI were achieved across groups. Our research provides a validated method to assess the probable prevalence of current depression in southwestern Madagascar.

Adolescents face increased vulnerability to mental health conditions, particularly when exposed to multidimensional poverty and trauma and pronounced treatment gaps. Waves for Change, a Sport for Development (SfD) intervention, employs task-sharing through its ‘5-Pillar Method’ to build resilience and prevent mental health conditions among at-risk adolescents in South Africa. This study assessed the implementation outcomes of this Method using a mixed-methods design, incorporating interviews, focus groups, self-report questionnaires, document reviews and routine site assessments, with 69 stakeholders including staff, peer coaches, mental healthcare providers, social workers, teachers, and adolescents. A thematic analysis revealed key facilitators to successful implementation, including: a year-long preventative approach, creation of safe spaces for learning self-regulation skills, employment of youth coaches from local communities, incorporation of fun, group-based physical activities, modelling and repetition of desired skills, provision of transport and meals, government partnerships, and consistent weekly training and supervision. Implementation challenges included coach capacity, due to their education levels and own trauma experiences, measurement of fidelity to the Method and of adolescents’ emotional experiences, and some concerns around ocean safety. These findings provide valuable insights for implementing community-based SfD interventions for adolescents facing adversity, and contributes towards global evidence supporting task-shared mental health approaches in LMICs.

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

We examine whether decriminalization of suicide in India following the 2017 Mental Health Act corresponds with changes in suicide mortality overall and by level of state development. Our study utilizes counts of suicides from the National Crime Records Bureau (NCRB) across 35 Indian states from 2001 to 2020. The exposure variable is a binary indicator for the decriminalization of suicide following 2018. We use fixed-effect Poisson regression models that include population offsets and adjust for time trends, literacy, gross state domestic product and infant mortality. We find no relation between decriminalization of suicides and overall suicide mortality (Incidence Rate Ratio (IRR): 1.037; 95% CI (0.510–2.107)). Stratification by level of state development shows that less developed states saw an increase in suicide mortality by 1.9 times following decriminalization, compared to prior years (IRR: 1.859; 95% CI (1.028–3.364)). Our findings thus indicate that decriminalization did not coincide with a decline in suicide mortality in the country, thereby highlighting the need for improved mental health infrastructure and support in India, especially in less developed states.

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

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

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

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

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

Mobile health (mHealth) platforms have the potential to increase access to evidence-based interventions in low-resource settings. This study applied a user-centered design (UCD) approach to develop and evaluate an mHealth supervision tool for community health workers (CHWs) delivering an early childhood development intervention in rural Sierra Leone. We engaged CHWs (N=8) and supervisors (N=4) in focus group discussions, user testing sessions and exit interviews to gather feedback on the mHealth supervision tool’s usability and acceptability. Mixed methods findings indicated that the tool was generally well-received and perceived as easy to use, but there were also challenges related to connectivity, phone charging and the need for more comprehensive training and support. Overall, this study suggests that a UCD approach can promote the usability of mHealth tools to support CHWs in delivering evidence-based interventions in low-resource settings, highlighting the importance of addressing contextual challenges and providing adequate training and support to ensure the effectiveness and sustainability of such tools.

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

People with severe mental illness (SMI) are at greater risk of obesity, cardiovascular disease and diabetes than the general population, due to a higher prevalence of health risk behaviours. Research is needed to inform tailored interventions to improve the health behaviours (diet, physical activity and sleep) of people with SMI in South Asia as these behaviours are closely linked to obesity. The study aimed to explore the barriers and facilitators to healthy diet, physical activity and good sleep among individuals with SMI. A qualitative design was employed using photovoice, semi-structured interviews and focus group discussions. Participants included 16 people with SMI, 16 caregivers and 17 health professionals in Bangladesh and Pakistan. Data were analysed thematically, informed by the socio-ecological framework. A complex interplay of individual, familial and societal factors influenced these health behaviours. Individual factors include knowledge, beliefs and mental health limitations. Caregivers play a crucial role in influencing behaviour. At the societal level, gender expectations, financial constraints and religious influences significantly impact these behaviours. The insights from this research can inform tailored interventions for this vulnerable group and highlight the need for integrated services, financial support and improved urban planning.

Migrants often experience psychological distress due to pre-, peri- and post-migration stressors. Scalable interventions like Doing What Matters in Times of Stress (DWM) and Problem Management Plus (PM+) have been developed to address these challenges. This study evaluates a stepped-care program combining DWM and PM+ for migrants in Italy, examining its context, implementation, and mechanisms of impact. A mixed-methods process evaluation was conducted alongside a randomized controlled trial (RCT), following the Medical Research Council (MRC) framework. Post-trial qualitative data were collected through individual interviews with intervention participants (n = 10) and stakeholders (n = 10), as well as a focus group with intervention providers (n = 8). Thematic analysis was performed using NVivo. Cultural stigma and practical barriers influenced engagement, while community leaders fostered trust and participation. Interventions were feasible and acceptable. Digital delivery improved accessibility for some but posed challenges for those with low technological literacy or private spaces. The stepped-care approach supported gradual engagement with mental health strategies, enhancing self-care and emotional awareness, while provider relationships were key to sustaining motivation. The stepped-care model alleviated psychological distress and was well-received. Findings underscore the need for cultural sensitivity, digital accessibility and community engagement to optimize migrant mental health support.

Behavioral treatments can help people with human immunodeficiency virus (HIV) improve their quality of life and treatment adherence. In Lesotho, where a fifth of adults live with HIV and depression and harmful alcohol use is prevalent among this group, little is known about the local suitability of established behavioral treatment strategies. We explored preferences regarding two strategies evaluated in other settings: involving phones and trusted individuals in treatment. We thematically analyzed 28 semi-structured interviews with potential service users receiving routine HIV care in the Butha-Buthe and Mokhotlong districts. Key concerns included the feasibility of phone-based treatment in rural areas and issues of limited literacy, electricity and network coverage. Others highlighted potential benefits for younger and working individuals for phone-based treatment, preferring calls over texts. Involving trusted individuals in treatment was favored, as this could foster support and accountability. Behavioral issues related to depression and alcohol use were viewed as complex, requiring face-to-face attention from trusted professionals, such as nurses and counselors, who were seen as knowledgeable and capable of maintaining confidentiality. Peer providers were not favored due to privacy concerns. These findings emphasize the need for face-to-face, confidential and health worker-led approaches for integrating behavioral treatment into HIV care in Lesotho.

Adverse childhood experiences (ACE) significantly impact physical, mental and social well-being, making them a critical area of research. This study analyzed the emerging trends and intellectual structure of ACE research and identified key contributors, including the most productive nations, journals and authors. Using bibliometric tools and VOSviewer software (version 1.6.20), 1,957 articles from the Scopus database (2004 to March 2024) were systematically analyzed. A notable finding was the surge in ACE-related publications during the COVID-19 pandemic, potentially reflecting increased global attention on childhood adversity amid heightened social and economic challenges. The analysis also revealed a striking dearth of studies from the Global South, with the field predominantly shaped by Western nations, like the United States, the United Kingdom, Australia and Canada. Leading journals, such as the Journal of Interpersonal Violence, and prolific authors, like Kevin T. Wolff, played a central role in advancing the field. Co-citation analysis uncovered four thematic clusters: (1) conceptualization and assessment of ACE, (2) health implications, (3) mental health impacts and (4) juvenile delinquency. These clusters, though distinct, showed significant thematic overlaps, reflecting the interconnected nature of ACE research and its intellectual structure. These findings underscore the need for more regionally diverse and interdisciplinary approaches to understanding global childhood adversity.