The mental health (MH) of adolescents in low- and middle-income countries (LMIC), particularly those in rural areas, has historically been neglected in research and services, despite the documented burden MH problems represent among these populations. Settings where MH stigma is high require strategic research methods. Photovoice is a promising method for MH research in contexts of high stigma, but studies examining its acceptability with rural adolescents in LMIC remain scarce. We explored the acceptability of photovoice for MH research through perspectives of adolescents from rural Mexico who participated in a photovoice project focused on factors affecting their MH. Adolescents (n = 40) participated in focus groups where they discussed what they learned through the MH photovoice project, and the aspects of the method they perceived to be valuable. Focus groups transcripts were thematically analyzed. Participants' satisfaction with the MH photovoice project was tied to: (1) learning about the meaning, nature, and experiences of MH; (2) enjoying relationships, novelty, and fun; and (3) wishing for more time, more play, and continuity. Photovoice is an acceptable method for MH research among rural adolescents in LMIC, sparking reflection and collective dialog that can lead to the development of local initiatives.

International students frequently report suicidal thoughts and behaviours, but often do not seek help. We evaluated the feasibility, acceptability, and preliminary effectiveness of an adapted version of safeTALK suicide prevention training for international students. Eight workshops were delivered in Melbourne, Australia (N = 128; 62.5% female, M age = 23.4). In this single-arm study, surveys were completed pre-, post-, and three months post-training, and 17 participants completed follow-up interviews. The training was rated as acceptable, helpful, and safe. Linear mixed models indicated increased confidence to intervene and stronger intentions to refer individuals to formal help sources, with improvements sustained at follow-up. Suicide stigma showed a small post-training reduction that was not sustained. Suicide literacy only improved three months post-training. Attrition limited inferences about long-term effects. Qualitative feedback supported the training's value but highlighted the need for further cultural adaptation. Findings support adapted gatekeeper training as a promising strategy for suicide prevention among international students.

Bangladesh's handloom weaving industry, a vital cultural and economic asset, employs approximately one million rural workers and generates over 10 billion Bangladeshi taka (~82 million USD) annually. Despite its importance, the mental health of handloom weavers, locally known as Tatis, remains largely unexamined. This perspective article, based on a narrative review of existing literature synthesizing peer-reviewed studies, reports and policy documents on mental health in informal sectors, explores the mental health challenges faced by these workers. Using a syndemics framework, it draws on data on garment workers and the broader informal sector, which indicates heightened risks of stress, anxiety and depression resulting from long working hours, low wages and competition from mechanized looms. These risks are compounded by systemic barriers, including Bangladesh's allocation of only 0.44% of its health budget to mental health (2021), a severe shortage of professionals (0.16 psychiatrists per 100,000 people and 0.34 psychologist per 100,000 people) and pervasive cultural stigma. Additionally, musculoskeletal pain, which affects 82.4% of weavers, places a particularly heavy burden on women, who constitute half of the workforce, further exacerbating mental health vulnerabilities through syndemic interactions with poverty and gender inequities. To address this neglected crisis, the article proposes a novel intervention framework aligned with the Double Diamond design model. The framework integrates community-based mental health hubs, peer-led support networks and digital platforms tailored to Bangladesh's collectivist culture. It calls for increased funding, workplace reforms, stigma reduction campaigns and targeted research, highlighting the dual benefit of improving weavers' well-being and sustaining the long-term future of the industry.

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.

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 and 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.

Since the 1990s, the relocation of psychiatric patients from long-stay institutions to community-based supported living has increased globally. However, most evidence on suitable residential services comes from high-income countries, with little from low- and middle-income contexts. This study explored the experiences of residents and carers in three residential care homes for people living with serious mental illness in Sedibeng District, South Africa.

Teachers in conflict-affected regions face chronic stress and trauma exposure, compromising their mental health and professional identity. This study evaluates the effectiveness of the "Conmigo, Contigo, Con Todo" (3Cs) programme in improving resilience, compassion and prosocial behaviours among Afro-Colombian teachers in Tumaco, Colombia, through a mixed-methods cluster-randomised controlled trial. Thirty-two teachers from eight schools were randomised into intervention ( = 28) and control ( = 4) groups. Quantitative outcomes were assessed at baseline, post-intervention and follow-up using validated scales for resilience (CD-RISC), PTSD symptoms (PCL-C), anxiety, depression, compassion (ECOM) and prosocial behaviour (PPB). Qualitative data were collected through focus groups and analysed thematically. Resilience improved from baseline to follow-up (Hedges' = 0.23, small effect). PTSD symptoms declined substantially post-intervention (Hedges' = 0.98, large effect), with partial relapse at follow-up. Anxiety decreased initially but increased over time. Compassion and prosociality remained stable. Qualitative findings revealed perceived improvements in emotion regulation and compassion, although the 94% female sample may influence results. This exploratory study provides preliminary evidence that culturally adapted, school-based interventions may improve resilience and reduce trauma-related symptoms among teachers in high-adversity settings, although findings are limited by small sample size and group imbalance. Larger-scale replication with sustained reinforcement strategies is warranted.

Improving social and emotional well-being (SEWB) for Aboriginal and Torres Strait Islander peoples is central to achieving health equity in Australia. Aboriginal Community Controlled Health Services (ACCHS) deliver SEWB programmes that are culturally grounded and community-led. While service design and delivery have been explored, less is known about how Aboriginal peoples' perceptions of self-efficacy influence their SEWB help-seeking behaviours and self-management. This study re-analysed 22 one-on-one interviews with Aboriginal community members from the Kimberley region of Western Australia. In this context, self-efficacy is understood as an individual's belief in their ability to support their own SEWB, shaping their motivation, persistence and responses to challenges. The findings highlight the importance of family, culture and connection to Country as critical enablers of self-efficacy. The concept of 'strength', grounded in cultural identity, relationships, and personal growth, emerged as an important foundation for SEWB self-management. The study affirms that self-efficacy can be developed over time through mastery experiences, vicarious learning, verbal encouragement, and emotional regulation. It concludes that culturally safe services and environments that nurture self-efficacy are essential to improving SEWB outcomes.

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.

The Syrian government's violent suppression of pro-democracy protests in March 2011 sparked a civil war that resulted in the deaths of hundreds of thousands of people and the displacement of millions. This study focuses on the emotional achievement of 357 Syrian primary and secondary school students who have moved to Türkiye and are under temporary protection. The researchers used the achievement emotion scale to collect data. They conducted a -test, analysis of variance, correlation analysis and multiple linear regression to examine the sociodemographic factors affecting students' achievement emotions. The results revealed that boy students experienced more negative achievement emotions than girl students, and that the longer the students have been in temporary protection, the more their positive achievement emotions have decreased. The ongoing war in Syria has dire consequences for school-age children who have been forced to flee their homes.

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.

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 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.

We assessed whether higher caregiver depression is associated with increased likelihood of caregivers rating their children as screening positive for developmental disorders-autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder, emotional behavioral disorder, and functional impairment (FI)-among Ugandan children perinatally exposed and unexposed to HIV. Children and their primary caregivers were followed for 12 months. Caregiver depression was measured using the Hopkins Symptom Checklist-25 and categorized as low, moderate, or high based on terciles. Child developmental indices were derived from the Behavioral Assessment System for Children (third edition) at 0, 6, and 12 months. Multivariable linear regression estimated mean differences (MDs) in disorder indices with 95% confidence intervals (CIs) by caregiver depression level. Compared with highly depressed caregivers, those with low depression reported consistently lower ASD risk scores (MD: -0.35 to -0.32; 95% CI: -0.60 to -0.08). Similar trends were observed for FI (MD: -0.56 to -0.31; 95% CI: -0.81 to -0.06). Moderate depression was associated with modestly lower FI risk at baseline and 6 months but not at 12 months. Overall, higher caregiver depressive symptoms were linked to greater perceived child disorder risk. Evaluating caregiver depression alongside child screening may improve interpretation of developmental risk assessments.

Suicide remains a global public health crisis, claiming over 800,000 lives each year and leaving millions more to struggle with attempts, ideation, or the ripple effect of loss. Traditional prevention strategies often focus on crisis intervention and identifying "warning signs," but these approaches overlook the many who suffer in silence. Drawing on personal experience of suicide loss and a decade-long journey toward suicide literacy, the author argues for a reframing of suicide prevention. She challenges stigma-driven assumptions, underscores the power of honest storytelling, and introduces the concept of "preemptive, protective conversations" as a vital upstream prevention tool. By empowering ordinary people to become suicide prevention advocates equipped with knowledge, compassion, and a willingness to talk openly, we can build stronger connections, dismantle stigma, and create a broader societal safety net. Suicide is preventable, and each of us has a role to play in saving lives.

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 ( < .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.

Despite the growing recognition of adolescent suicide as a pressing concern, traditional methods for identifying suicide risk often fail to capture the complex interplay of socio-ecological and psychological factors. The advent of machine learning (ML) offers a transformative opportunity to improve suicide risk prediction and intervention strategies. This study aims to utilize ML techniques to analyze socio-ecological and psychological risk factors to predict suicide ideation, plans and attempts among a nationally representative sample of Ghanaian adolescents. A cross-sectional survey was conducted with 1,703 adolescents aged 12-18 years across Ghana measuring psychological factors (depression symptoms, anxiety symptoms etc) and socio-ecological factors (bullying, parental support etc) using validated measures. Descriptive statistics were conducted and random forest and logistic regression models were employed for suicide risk prediction, i.e., 'ideation, plans and attempts'. Model performance was evaluated using accuracy, sensitivity, specificity and feature importance analysis. Psychological factors such as depression symptoms ( = .42,  < .01), anxiety ( = .38,  < .01) and perceived stress ( = .35,  < .01) were the strongest predictors of suicide ideation, plans and attempts, while parental support emerged as a significant protective factor ( = -.34,  < .01). The random forest model demonstrated good predictive performance (accuracy = 78.3%, AUC = 0.81). Gender differences were observed. This study is the first to apply ML techniques to a nationally representative dataset of Ghanaian adolescents for suicide risk prediction, i.e., 'ideation, plans and attempts'. The findings highlight the potential of ML to provide precise tools for early identification of at-risk individuals.

Mental health policies and plans (MHPPs) are powerful tools developed to facilitate real-world changes in mental-health-related prevention, promotion and treatment. This study examined barriers and facilitators to MHPP implementation across the WHO European region. Key informants from 53 countries were contacted and 25 provided in-depth qualitative interviews on MHPP existence, implementation, and evaluation related barriers and facilitators of implementation. We analyzed data via qualitative framework analysis approach aligned with the WHO Comprehensive Mental Health Action Plan 2013-2030. Reported facilitators included active involvement of key stakeholders, ongoing mental healthcare reform, bottom-up approach to implementation, sufficient funding, favorable political receptivity and strong monitoring. Barriers encompassed insufficient funding, workforce shortages, adequate training in psychiatry, missing or insufficient infrastructure in terms of both physical structures and technology for data collection, low political receptivity, stigma and bureaucratic obstables. While notable progress has been made in the development of mental health plans in the European region, substantial gaps remain in information systems, research capacity, and systematic evaluation frameworks on mental health and development of appropriate evaluation plans. Strengthening these components is essential to ensure the effective and sustainable implementation of MHPPs throughout the region.

Previous research has highlighted the negative impact of the COVID-19 pandemic on healthcare workers' (HCWs) mental health, yet protective factors remain underexplored. Emerging studies emphasize the importance of trust in government and interpersonal relationships in reducing infections and fostering positive vaccine attitudes. This study investigates the relationship between HCWs' trust in the workplace and government and depressive symptoms during the pandemic. The COVID-19 HEalth caRe wOrkErS study surveyed 32,410 HCWs from 22 countries, including clinical and nonclinical staff. Participants completed the Patient Health Questionnaire-9 and ad-hoc questions assessing trust in the workplace and government. Logistic regression and multilevel models examined associations between trust levels and depressive symptoms. High workplace trust (OR = 0.72 [0.68, 0.76]) and government trust (OR = 0.72 [0.69, 0.76]) were linked to lower odds of depressive symptoms, with significant between-country variation. Country-level analyses showed that workplace trust was more protective in more developed countries and under stricter COVID-19 restrictions. Despite cross-country variation, HCWs with higher trust in the workplace and government had ~28% lower odds of experiencing depressive symptoms compared to those with lower trust. Promoting trust may help mitigate the mental health impact of future crises on HCWs.

Geographic information systems (GIS) are computer-based spatial mapping tools widely used in public health to examine service availability and access disparities and healthcare utilization. While GIS has supported evidence-based health planning in various domains, its application in mental healthcare service delivery remains underexplored. Our scoping review aimed to address this gap by exploring the scope and type of GIS usage in studying three dimensions of mental health (MH) service delivery (availability, accessibility and utilization), across all geographical locations, settings and populations. We conducted a scoping review following the Joanna Briggs Institute methodology. We included peer-reviewed English-language studies using GIS to examine service delivery (availability, accessibility or utilization) for any MH condition diagnosed through standardized criteria or validated tools. Seven databases were searched (Medical Literature Analysis and Retrieval System Online [MEDLINE], PsycINFO, Excerpta Medica Database [Embase], Global Health, Cumulative Index to Nursing and Allied Health Literature [CINAHL], Cochrane Central Register of Controlled Trials [CENTRAL] and Web of Science) between January and April 2024. This review included 58 studies predominantly from high-income countries. A wide range of GIS methods were employed across studies, including hotspot analysis, network analysis and spatial analysis. Six studies explored availability, generally through measures like distribution of facilities across a population, and resource availability within 5-10-mile network buffers. Forty-six studies explored the spatial accessibility of MH services and substance-use treatment facilities using GIS. Six studies examined service utilization patterns. Equity emerged as a recurring theme across all three dimensions. GIS has the potential to emerge as a powerful tool in MH research, particularly in mapping disparities, informing service delivery and identifying high-risk zones. Expanding GIS use in trial design, implementation science and policy advocacy could help bridge critical gaps in MH service delivery, ensuring more equitable and data-driven decision-making.

Peer Refugee Helpers (PRHs) support peers in humanitarian settings, which may influence their own mental health. This longitudinal study examined anxiety and depression trajectories among Afghan, Iranian and Syrian refugees and asylum seekers in Greece, focusing on how PRH status (paid/unpaid) and sense of coherence influence trajectory membership. The study included 176 adult, PRHs and non-helpers. The following scales were administered three times at ~4-month intervals: Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7), Social Provisions Scale (SPS-24), Sense of Coherence (SOC-13), Perceived Ability to Cope With Trauma (PACT) and Brief Trauma Questionnaire (BTQ). Using latent growth mixture modeling, we identified two depression (high and low) and three anxiety (high, moderate and low) trajectories. The adjusted logistic and multinomial regression models indicated that unpaid PRHs were significantly less likely to follow a low depression trajectory (odds ratio [OR] = 0.55, = 0.037), while paid PRHs were more likely to follow a low anxiety trajectory (OR = 3.17, = 0.009). Higher SOC was associated with low depression (OR = 1.03, = 0.012) and low anxiety trajectories (OR = 1.06, = 0.002). Our findings suggest PRH mental health may be associated with working conditions, including financial compensation.

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.