Global Mental Health最新文献

Schools play a crucial role in supporting adolescent mental health, especially in low- and middle-income countries (LMICs), where young people face structural and societal challenges. This study explores the feasibility and acceptability of the Health Action in Schools for a Thriving Adolescent Generation (HASHTAG), a multilevel intervention for at-risk adolescents aged 13-14 in South Africa. HASHTAG includes two components: thriving environment in schools (TES), a whole-school approach, and thriving together (TT), a classroom-based programme. Using a mixed-methods design, we assessed feasibility in two Khayelitsha schools through implementation measures (attendance, fidelity and acceptability), focus groups (n = 46), and pre-post surveys (n = 231). Despite COVID-19 disruptions, the intervention was implemented with high fidelity and met all progression criteria. Students and staff found HASHTAG relevant and engaging, particularly appreciating the TT sessions delivered by external facilitators. The TES teacher module also created space for reflection and self-care. Some teachers suggested improved sensitisation could strengthen the programme's impact. Although no significant changes were observed in quantitative outcomes, no harms were reported. These findings support the feasibility and acceptability of HASHTAG and highlight the need for a full-scale trial to evaluate its potential impact on adolescent mental health in LMIC settings.

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.

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.

Background: Chronic pain represents a major global public health issue. It is associated with wide-ranging psychosocial consequences. Extensive evidence has demonstrated that pain catastrophizing (PC) contributes to the bidirectional association between chronic pain and psychological distress. The present study aims to explore the psychological and cognitive correlates of chronic pain among individuals living in Gaza.

Methods: A cross-sectional study was conducted among 272 adults with chronic musculoskeletal pain. Spearman's correlations assessed associations between pain intensity, catastrophizing and depressive symptoms. Multiple regression and bootstrapped mediation analyses (5,000 resamples and PROCESS macro) evaluated predictors and the mediating role of catastrophizing in the pain-depression relationship.

Results: Pain intensity was positively correlated with depression (r = 0.28, p < 0.001) and catastrophizing (r = 0.39, p < 0.001). A stronger correlation was found between catastrophizing and depression (r = 0.54, p < 0.001). Mediation analysis demonstrated that catastrophizing fully mediated the association between pain intensity and depression (indirect effect = 0.95, 95% confidence interval = [0.65-1.29]).

Conclusion: PC is a key psychological mechanism linking pain intensity and depression among patients with chronic pain in Gaza. Integrating cognitive-behavioral therapy, mindfulness and emotion regulation strategies into pain management may improve mental health outcomes in conflict-affected settings.

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.

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.

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.

Mental health is a global issue, and mobile applications, such as chatbots, offer a partial solution by providing improved services through various communication forms. This study aimed to identify chatbots and their technical features in mental health services. This study conducted a systematic review of mental health chatbots and their technical features from 2000 to 2025. A search was performed across databases such as PubMed, Scopus, ProQuest and the Cochrane database. The CASP (Critical Appraisal Skills Programme) appraisal checklist was used to assess the quality of the studies. In the next step, the Braun and Clarke's approach was utilized for conducting thematic analysis on the data. The search yielded 2,921 records, of which 10 were duplicates and removed. After screening for relevance and eligibility, 33 papers met all the requirements. The mean quality score of the included studies was 13.36 (standard deviation = 1.36). The studies had a moderate risk of bias, as they mostly had a clear question, searched for the right type of papers, included all relevant papers and reported the results precisely. The research conducted an analysis of 138 mental health chatbots, categorizing them based on five distinct attributes: the disorder they target, their input and output modalities, the platform they operate on and their method of generating responses. The research emphasized the need for designing chatbots that suit patients' preferences and needs, and also indicated that the digital divide within societies should be taken into account when designing and producing chatbots for mental health services. Although mental health chatbots can assist underserved communities, ethical concerns must be addressed before their deployment.

Adolescent suicidal behavior is a major global public health concern. Risks are often shaped not only by individual behaviors alone but also by broader constellations of health lifestyles. We aim to identify distinct adolescent health lifestyles and assess their associations with suicidal ideation and suicide attempts. Using data from the 2022 Luxembourg Health Behaviour in School-aged Children survey, latent class analysis identified five health lifestyle classes based on seven behaviors (diet, physical activity, substance use and problematic social media use). Hierarchical logistic regression was employed to assess associations with past-year suicidal ideation and suicide attempt. Compared to Class 1 (Healthy behaviors), adolescents in Class 2 (High substance use) had significantly higher odds of suicidal ideation (odds ratio [OR] = 2.5, 95% confidence interval [CI]: 2.0-3.1) and suicide attempt (OR = 2.9, 95% CI: 2.2-3.8). Class 3 (Digital vulnerabilities) also showed elevated odds of ideation (OR = 3.0, 95% CI: 2.2-4.0) and attempt (OR = 2.3, 95% CI: 1.6-3.4). Class 4 (High alcohol use) was associated with suicidal ideation only (OR = 1.4, 95% CI: 1.1-1.8). Class 5 (No substance use) showed no significant associations with either outcome. Our findings underscore the importance of considering multidimensional health lifestyles, including emerging risks such as vaping and problematic social media use in adolescent suicide prevention strategies.

Although the needs of conflict-affected children are well-documented, research on the post-conflict period is limited, particularly in Syria, where the fall of the Assad regime has created a rapidly evolving environment for internally displaced children. This study explores how key informants perceive the mental health needs, daily stressors and coping strategies of internally displaced children during the post-regime period. Online semi-structured interviews were conducted with 10 staff members from a non-governmental organization working in psychosocial support in the Syria camps. Data were analyzed using thematic analysis. Five major themes emerged: (1) stressors in the current camp environment, (2) challenges related to return, (3) observed emotional and behavioral difficulties, (4) children's psychological resources and (5) needs and gaps in support services. Findings highlight the inseparability of children's mental health from basic needs, the role of place-based attachments in return processes and the importance of a holistic approach that considers context-specific stressors and resources in this unique period.