Cambridge Prisms: Global Mental Health

For several years stigma researchers in India have relied on Western instruments or semi-structured stigma scales in their studies. However, these scales have not been rigorously translated and adapted to the local cultural framework. In the current study, we describe the cultural adaptation of six stigma scales with the purpose of using it in the native language (Kannada) based on translation steps of forward translation, expert review and synthesis, cultural equivalence, back translation and cognitive interview processes. Several items were modified in the target language at each stage of the cultural adaptation process as mentioned in the above steps across all scales. Cultural explanations for the same have been provided. Concepts such as “community forest” and “baby sitting" was replaced with equivalent native synonyms. We introduced native cultural and family values such as “joint family system” and modified the item of housing concept in one of the tools. The concept of “privacy” in the Indian rural context was observed to be familial than individual-based and modification of corresponding items according to the native context of “privacy”. Finally, items from each scale were modified but retained without affecting the meaning and the core construct.

The climate change crisis is a complex global challenge that has far- reaching implications for public health and well-being. Rising temperatures and more frequent extreme weather events are impacting physical health, mental well-being, and ecological balance. Vulnerable communities are disproportionately affected, especially in terms of food security. Furthermore, climate-related disasters have profound and lasting effects on mental health, leading to trauma responses and dissociation as coping mechanisms. This perspective delves into the concept of collective dissociation, a subconscious defense mechanism that hinders effective action in the face of the overwhelming climate crisis. Understanding and characterizing this phenomenon is essential to promote meaningful climate action. To combat collective dissociation and facilitate effective collective action, several strategies are proposed. Responsible information management for advocacy, local moral support, strategic policy development, and research on climate trauma processing are highlighted as vital approaches. By addressing the mental health implications of climate change, raising awareness, and prioritizing resilience and cooperation, societies can transcend collective dissociation and work together towards a more sustainable future for both the planet and its inhabitants. This call to action underscores the need for comprehensive and guided measures to safeguard planetary and population health in the face of this pressing crisis.

Sub-Sahara Africa (SSA) children are at high-risk neurodevelopmentally due to the prevalence of infectious disease, nutritional deficiencies and compromised caregiving. However, few mental health screening measures are readily available for general use. The Strengths and Difficulties Questionnaire (SDQ) has been used as a mental health screening measure in the SSA, but its psychometric properties are not well understood. Five hundred and sixty-six mothers completed the SDQ for their 6-year-old children in rural Benin north of Cotonou. These were mothers who had been part of a malarial and intestinal parasite treatment program and micronutrient fortification intervention program during pregnancy for these children. Their study children (N = 519) completed the computerized Tests of Variables of Attention (TOVA-visual) as a performance-based screening assessment of attention deficit and hyperactivity disorders. In evaluating the relationship between the SDQ and TOVA, we controlled for maternal risk factors such as depression, poor socioeconomic status and educational level, along with the child’s schooling status. TOVA measures of impulsivity were significantly related to SDQ emotional and hyperactivity/inattention difficulties. TOVA inattention was related to SDQ emotional difficulties. The triangulation of maternal risk factors (e.g., depression), the SDQ and the TOVA can provide effective screening for mental health issues in SSA children.

Since the turn of the 21st century, we have seen the development of an international movement that works in various ways to ensure that everyone in the world has access to adequate mental health care. There is indeed a great need for action, especially in countries with weak and underfunded health systems. The Movement for Global Mental Health (MGMH) is supported by strong organizations such as the WHO, academic institutions and NGOs. As this movement has gained momentum, however, it has been accompanied by fierce criticism, in particular from scholars of the humanities and social science, who see the global expansion of psychiatry as a medical discipline as a form of power-grabbing, neocolonialism and capitalist expansion. They also consider psychiatry to be a biologistic discipline, the justification of which they question, in continuation of a long anti-psychiatric tradition. This criticism prompted several adaptations of the MGMH and various efforts towards integration, but these have not been widely accepted by the critics. The following text primarily summarizes, classifies and critically engages with the basic arguments of the aforementioned critique. Theoretical misconceptions regarding the practice of psychiatry are clarified. Subsequently a specific project in Côte d’Ivoire is presented that demonstrates how contextual psychiatry can proceed and how unnecessary dichotomies and polarizations can be overcome in the interests of the persons concerned.

Task-sharing approaches that train non-specialist providers (NSPs), people without specialized clinical training, are increasingly utilized to address the global mental health treatment gap. This review consolidates findings from peer reviewed articles on the impact of task-sharing mental health interventions on NSPs at the individual, family and community level. Studies that highlighted facilitators, barriers and recommendations for improving the experiences of NSPs were also included in the review. Fifteen studies, conducted across eight countries, met the inclusion criteria. Seven studies were conducted in Sub-Saharan Africa, six in South and Southeast Asia and two studies were conducted in high-income countries in Europe. Benefits for NSPs included personal application of mental health skills, elevated community status and increased social networks. Challenges include burnout, lack of career progression and difficult workplace environments. Findings indicate that while there were many positive impacts associated with NSPs’ work, challenges need to be addressed. Safety and harassment issues reported by female NSPs are especially urgent. Supervision, certifications, increased salaries and job stability were also recognized as significant opportunities. We recommend future intervention studies to collect data on the impact of intervention delivery on NSPs. Research is also needed on the impact of various supervision and health systems strategies on NSPs.

Increasing mental health issues in India demands for a strong intervention to curb the rise. According to the World Health Organization, roughly around 21 Indians out of 100,000 die by suicide every year. The burden on mental health domain increases due to the existing system as most of the existing services follow a traditional approach and are most sought after but lack reachability and ease of access. This study recognises the need for programmes that help in reachability and ease of access while simultaneously maintaining anonymity, therefore, analyses the impact of chat-based therapy provided online through the platform. The paper analyses the difference in subjective unit of well-being (SUW) pre and post chat-based sessions among 2624 college students and 805 corporate employees. The Wilcoxon signed rank test between pre and post intervention indicates significant results with the p < 0.001 (Z = −44.100a) suggesting and increase in SUW scores post intervention. Further, the Kruskal–Wallis test revealed that the gender of the clients has an association with the SUW scores (p < 0.05). It was also found that the duration of the sessions had a positive relation with the impact scores (p < 0.001).

As part of the formative work of the SUCCEED Africa consortium, we followed a participatory process to identify existing gaps and resources needed for the development and implementation of a rights-based intervention for people with lived experience of psychosis in Malawi, Nigeria, Sierra Leone and Zimbabwe. In 2021, we conducted a desk review of published and grey literature on psychosis in the four SUCCEED countries. Using an adapted version of the PRIME situation analysis template, data were extracted across the five domains of the WHO Community-Based Rehabilitation (CBR) Matrix: health, education, livelihoods, social and empowerment. This was supplemented with insights from personal communications with key stakeholders and the lived and professional experiences of team members. Findings indicate that people with lived experience of psychosis have limited access to services and opportunities across the five CBR domains. Participation in social, religious, empowerment and political activities is restricted due to stigma and a lack of advocacy. People with lived experience of psychosis in SUCCEED countries are not generally able to access support in line with essential components of CBR. There is a need for their greater inclusion in policy and advocacy activities.

Background While early intervention in psychosis (EIP) programs have been increasingly implemented across the globe, many initiatives from Africa, Asia and Latin America are not widely known. The aims of the current review are (a) to describe population-based and small-scale, single-site EIP programs in Africa, Asia and Latin America, (b) to examine the variability between programs located in low-and-middle income (LMIC) and high-income countries in similar regions and (c) to outline some of the challenges and provide recommendations to overcome existing obstacles. Methods EIP programs in Africa, Asia and Latin America were identified through experts from the different target regions. We performed a systematic search in Medline, Embase, APA PsycInfo, Web of Science and Scopus up to February 6, 2024. Results Most EIP programs in these continents are small-scale, single-site programs that serve a limited section of the population. Population-based programs with widespread coverage and programs integrated into primary health care are rare. In Africa, EIP programs are virtually absent. Mainland China is one of the only LMICs that has begun to take steps toward developing a population-based EIP program. High-income Asian countries (e.g. Hong Kong and Singapore) have well-developed, comprehensive programs for individuals with early psychosis, while others with similar economies (e.g. South Korea and Japan) do not. In Latin America, Chile is the only country in the process of providing population-based EIP care. Conclusions Financial resources and integration in mental health care, as well as the availability of epidemiological data on psychosis, impact the implementation of EIP programs. Given the major treatment gap of early psychosis in Africa, Latin America and large parts of Asia, publicly funded, locally-led and accessible community-based EIP care provision is urgently needed.

The European Union receives thousands of unaccompanied irregular migrant minors every year, but little is known about their life experiences during the migration process. The aim of this study is to describe their experiences as minors when they arrived in Spain in small boats, which will help to understand their psychosocial and health needs. A descriptive qualitative study was undertaken. In-depth interviews were conducted with 18 unaccompanied irregular migrants (15 men and 3 women) from different African countries with a mean age of 20.05 years (SD = 2.77). Thematic analysis was used to analyse the data. Three main themes emerged such as (1) unaccompanied irregular migrant minors: risking it all for a better life; (2) redefining your identity as a means of adaptation and (3) obtaining legal status to avoid deportation. Unaccompanied migrant minors risk their lives on the migration journey, but do not always find better conditions in the destination country. The unaccompanied irregular migrant minors are forced to rebuild their lives at a high cost; they experience rejection from the host society and their culture of origin, which has a negative impact on their physical and psychological health over time.

Given the rate of advancement in predictive psychiatry, there is a threat that it outpaces public and professional willingness for use in clinical care and public health. Prediction tools in psychiatry estimate the risk of future development of mental health conditions. Prediction tools used with young populations have the potential to reduce the worldwide burden of depression. However, little is known globally about adolescents’ and other stakeholders’ attitudes toward use of depression prediction tools. To address this, key informant interviews and focus group discussions were conducted in Brazil, Nepal, Nigeria and the United Kingdom with 23 adolescents, 45 parents, 47 teachers, 48 health-care practitioners and 78 other stakeholders (total sample = 241) to assess attitudes toward using a depression prediction risk calculator based on the Identifying Depression Early in Adolescence Risk Score. Three attributes were identified for an acceptable depression prediction tool: it should be understandable, confidential and actionable. Understandability includes depression literacy and differentiating between having a condition versus risk of a condition. Confidentiality concerns are disclosing risk and impeding educational and occupational opportunities. Prediction results must also be actionable through prevention services for high-risk adolescents. Six recommendations are provided to guide research on attitudes and preparedness for implementing prediction tools.

Obesity is related to a wide variety of medical and psychological comorbidities which has short- and long-term effects on children’s mental health. One of the most significant ones is depression. Thus, the current study utilized a descriptive methodology to explore the differences in depressive symptoms among overweight, obese, and normal-weight Palestinian children and adolescents. Data was collected from 270 Palestinian children and adolescents, aged (9–16) years: 85 with normal weight, 95 with over-weight and 90 obese. Findings showed that participants who are over-weight or obese exhibited more depressive symptoms than those with a normal weight. These findings showed that Palestinian children and adolescents who are over-weight or obese do experience depression and thus interventions should take this into account. In particular, it seems that over-weight boys or adolescents need more direct help in losing weight while obese children and adolescents who feel more helpless about their weight need serious psychological interventions. it is critical to offer psychological treatment as part of any weight loss intervention program for children and adolescents. Especially as these adolescents’ families might encourage them to avoid seeking professional help and deal with the problem in the family.

This study aimed to investigate the effects of physical multimorbidity on the trajectory of cognitive decline over 17 years and whether vary across wealth status. The study was conducted in 9035 respondents aged 50+ at baseline from nine waves (2002–2019) of the English Longitudinal Study of Aging. A latent class analysis was used to identify patterns of physical multimorbidity, and mixed multilevel models were performed to determine the association between physical multimorbidity and trajectories of cognitive decline. Joint analyses were conducted to further verify the influence of wealth status. Four patterns of physical multimorbidity were identified. Mixed multilevel models with quadratic terms of time and status/patterns indicated significant non-linear trajectories of multimorbidity on cognitive function. The magnitude of the association between complex multisystem patterns and cognitive decline increased the most as follow-up progressed. Individuals with high wealth and hypertension/diabetes patterns have significantly lower composite global cognitive z scores over time as compared with respiratory/osteoporosis patterns. Physical multimorbidity at baseline is associated with the trajectory of cognitive decline, and the magnitude of the association increased over time. The trend of cognitive decline differed in specific combinations of wealth status and physical multimorbidity.

Background Low- and middle-income countries (LMICs) bear a disproportionate burden of mental illness, with limited access to biomedical care. This study examined pathways to care for psychosis in rural Uganda, exploring factors influencing treatment choices. Methods We conducted a mixed-methods study in Buyende District, Uganda, involving 67 in-depth interviews and 4 focus group discussions (data collection continued until thematic saturation was reached) with individuals with psychotic disorders, family members, and local leaders. Structured questionnaires were administered to 41 individuals with psychotic disorders. Results Three main themes emerged: (1) Positive attitudes towards biomedical providers, (2) Barriers to accessing biomedical care (3) Perceived etiologies of mental illness that influenced care-seeking behaviors. While 81% of participants eventually accessed biomedical care, the median time to first biomedical contact was 52 days, compared to 7 days for any care modality. Conclusions Despite a preference for biomedical care, structural barriers and diverse illness perceptions led many to seek pluralistic care pathways. Enhancing access to biomedical services and integrating traditional and faith healers could improve mental health outcomes in rural Uganda.

One of the most popular instruments used to assess perceived social support is the Multidimensional Scale of Perceived Social Support (MSPSS). Although the original structure of the MSPSS was defined to include three specific factors (significant others, friends and family), studies in the literature propose different factor solutions. In this study, we addressed the controversial factor structure of the MSPSS using a meta-analytic confirmatory factor analysis approach. For this purpose, we utilized studies in the literature that examined and reported the internal structure of the MSPSS. However, we used summary data from 59 samples of 54 studies (total N = 27,905) after excluding studies that did not meet the inclusion criteria. We tested five different models discussed in the literature and found that the fit indices of the correlated 3-factor model and the bifactor model were quite good. Therefore, we also examined both models’ factor loadings and omega coefficients. Since there was no sharp difference between the two models and the theoretical structure of the scale was represented by the correlated three factors, we decided that the correlated three-factor model was more appropriate for the internal structure of the MSPSS. We then examined the measurement invariance for this model according to language and sample type (clinical and nonclinical) and found that metric invariance was achieved. As a result, we found that the three-factor structure of the MSPSS was supported in this study.

This proof-of-concept study evaluated an optimization strategy for the Community Case Detection Tool (CCDT) aimed at improving community-level mental health detection and help-seeking among children aged 6–18 years. The optimization strategy, CCDT+, combined data-driven supervision with motivational interviewing techniques and behavioural nudges for community gatekeepers using the CCDT. This mixed-methods study was conducted from January to May 2023 in Palorinya refugee settlement in Uganda. We evaluated (1) the added value of the CCDT+ in improving the accuracy of detection and mental health service utilization compared to standard CCDT, and (2) implementation outcomes of the CCDT+. Of the 1026 children detected, 801 (78%) sought help, with 656 needing mental health care (PPV = 0.82; 95% CI: 0.79, 0.84). The CCDT+ significantly increased detection accuracy, with 2.34 times higher odds compared to standard CCDT (95% CI: 1.41, 3.83). Additionally, areas using the CCDT+ had a 2.05-fold increase in mental health service utilization (95% CI: 1.09, 3.83). The CCDT+ shows promise as an embedded quality-optimization process for the detection of mental health problems among children and enhance help-seeking, potentially leading to more efficient use of mental health care resources.

Background There is a high prevalence of depression among refugee youth in low- and middle-income countries, yet depression trajectories are understudied. This study examined depression trajectories, and factors associated with trajectories, among urban refugee youth in Kampala, Uganda. Methods We conducted a longitudinal cohort study with refugee youth aged 16–24 in Kampala, Uganda. We assessed depression using the Patient Health Questionnaire-9 and conducted latent class growth analysis (LCGA) to identify depression trajectories. Sociodemographic and socioecological factors were examined as predictors of trajectory clusters using multivariable logistic regression. Results Data were collected from n = 164 participants (n = 89 cisgender women, n = 73 cisgender men, n = 2 transgender persons; mean age: 19.9, standard deviation: 2.5 at seven timepoints; n = 1,116 observations). Two distinct trajectory clusters were identified: “sustained low depression level” (n = 803, 71.9%) and “sustained high depression level” (n = 313, 28.1%). Sociodemographic (older age, gender [cisgender women vs. cisgender men], longer time in Uganda), and socioecological (structural: unemployment, food insecurity; interpersonal: parenthood, recent intimate partner violence) factors were significantly associated with the sustained high trajectory of depression. Conclusions The chronicity of depression highlights the critical need for early depression screening with urban refugee youth in Kampala. Addressing multilevel depression drivers prompts age and gender-tailored strategies and considering social determinants of health.

Background Engaging with personal mental health stories has the potential to help people with mental health difficulties by normalizing distressing experiences, imparting coping strategies and building hope. However, evidence-based mental health storytelling platforms are scarce, especially for young people in low-resource settings. Objective This paper presents an account of the co-design of ‘Baatcheet’ (‘conversation’ in Hindi), a peer-supported, web-based storytelling intervention aimed at 16–24-year-olds with depression and anxiety in New Delhi, India. Methods Development comprised three stages: (1) establishing a logic model through consultations with a Young People’s Advisory Group (N = 11) and a stakeholder reference group (N = 20); (2) elaborating intervention guiding principles and components through focus group discussions and co-design workshops (N = 42); and (3) user-testing of prototypes. Results The developmental process identified key stakeholder preferences for an online, youth-focused mental health storytelling intervention. Baatcheet uses an interactive storytelling website containing a repository of personal stories about young people’s experiences of depression and anxiety. This is offered alongside brief support from a peer. Conclusions There are few story-based interventions addressing depression and anxiety for young people, especially in low-resource settings. Baatcheet has the potential to deliver engaging, accessible and timely mental health support to young people. A pilot evaluation is underway.

Youth living in low- and middle-income countries (LMICs) have an increased vulnerability to mental illnesses, with many lacking access to adequate treatment. There has been a growing body of interventions using task sharing with trained peer leaders to address this mental health gap. This scoping review examines the characteristics, effectiveness, components of peer delivery and challenges of peer-led mental health interventions for youth aged 10–24 in LMICs. A key term search strategy was employed across MEDLINE, Embase, Web of Science, Global Health and Global Index Medicus. Eligibility criteria included young people aged 10–24 and a peer-led component delivered in any setting in an LMIC. Study selection and extraction were conducted independently by the first and second authors, with discrepancies resolved by the senior author. Study characteristics were summarised and presented descriptively. The search identified 5,358 citations, and 19 studies were included. There were 14 quantitative, four qualitative and one mixed methods study reporting mental health outcomes. Types of interventions were heterogenous but fell within three broad categories: (1) peer education and psychoeducation, (2) peer-led psychotherapy and counselling and (3) peer support. All studies reported improved mental health outcomes as a result of the peer-led interventions. Peer-led interventions are versatile in terms of both the types of interventions and mode of delivery. Lived experience, mutual respect and reduced stigma make this method a highly unique and effective way to engage this age group. However, implementing peer-led youth interventions is not without challenges. Adequate training, supervision, cultural appropriateness and support from established institutions are critical to safeguarding and ensuring the sustainability of such programs. Our findings suggest that peer-led models are a valuable intervention strategy that policymakers can leverage in current and future efforts to address youth mental health in LMICs. Future areas of research should expand to include the perspectives of other key stakeholders involved in the implementation of peer-led mental health interventions, focusing on factors including fidelity, feasibility and acceptability to enhance implementation insights.

Psychosocial rehabilitation and psychosocial disability research have been a longstanding topic in healthcare, demanding continuous exploration and analysis to enhance patient and clinical outcomes. As the prevalence of psychosocial disability research continues to attract scholarly attention, many scientific articles are being published in the literature. These publications offer profound insights into diagnostics, preventative measures, treatment strategies, and epidemiological factors. Computational text mining as a subfield of artificial intelligence (AI) can make a big difference in accurately analyzing the current extensive collection of scientific articles on time, assisting individual scientists in understanding psychosocial disabilities better, and improving how we care for people with these challenges. Leveraging the vast repository of scientific literature available on PubMed, this study employs advanced text mining strategies, including word embeddings and large language models (LLMs) to extract valuable insights, automatically catalyzing research in mental health. It aims to significantly enhance the scientific community’s knowledge by creating an extensive textual dataset and advanced computational text mining strategies to explore current trends in psychosocial rehabilitation and psychosocial disability research.