The Lancet Commission on global mental health and sustainable development

Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND

Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic.

METHODS

The GBD 2021 disease and injury burden analysis estimated years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries using 100 983 data sources. Data were extracted from vital registration systems, verbal autopsies, censuses, household surveys, disease-specific registries, health service contact data, and other sources. YLDs were calculated by multiplying cause-age-sex-location-year-specific prevalence of sequelae by their respective disability weights, for each disease and injury. YLLs were calculated by multiplying cause-age-sex-location-year-specific deaths by the standard life expectancy at the age that death occurred. DALYs were calculated by summing YLDs and YLLs. HALE estimates were produced using YLDs per capita and age-specific mortality rates by location, age, sex, year, and cause. 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws. Uncertainty was propagated at each step of the estimation process. Counts and age-standardised rates were calculated globally, for seven super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations), and 811 subnational locations, from 1990 to 2021. Here we report data for 2010 to 2021 to highlight trends in disease burden over the past decade and through the first 2 years of the COVID-19 pandemic.

FINDINGS

Global DALYs increased from 2·63 billion (95% UI 2·44-2·85) in 2010 to 2·88 billion (2·64-3·15) in 2021 for all causes combined. Much of this increase in the number of DALYs was due to population growth and ageing, as indicated by a decrease in global age-standardised all-cause DALY rates of 14·2% (95% UI 10·7-17·3) between 2010 and 2019. Notably, however, this decrease in rates reversed during the first 2 years of the COVID-19 pandemic, with increases in global age-standardised all-cause DALY rates since 2019 of 4·1% (1·8-6·3) in 2020 and 7·2% (4·7-10·0) in 2021. In 2021, COVID-19 was the leading cause of DALYs globally (212·0 million [198·0-234·5] DALYs), followed by ischaemic heart disease (188·3 million [176·7-198·3]), neonatal disorders (186·3 million [162·3-214·9]), and stroke (160·4 million [148·0-171·7]). However, notable health gains were seen among other leading communicable, maternal, neonatal, and nutritional (CMNN) diseases. Globally between 2010 and 2021, the age-standardised DALY rates for HIV/AIDS decreased by 47·8% (43·3-51·7) and for diarrhoeal diseases decreased by 47·0% (39·9-52·9). Non-communicable diseases contributed 1·73 billion (95% UI 1·54-1·94) DALYs in 2021, with a decrease in age-standardised DALY rates since 2010 of 6·4% (95% UI 3·5-9·5). Between 2010 and 2021, among the 25 leading Level 3 causes, age-standardised DALY rates increased most substantially for anxiety disorders (16·7% [14·0-19·8]), depressive disorders (16·4% [11·9-21·3]), and diabetes (14·0% [10·0-17·4]). Age-standardised DALY rates due to injuries decreased globally by 24·0% (20·7-27·2) between 2010 and 2021, although improvements were not uniform across locations, ages, and sexes. Globally, HALE at birth improved slightly, from 61·3 years (58·6-63·6) in 2010 to 62·2 years (59·4-64·7) in 2021. However, despite this overall increase, HALE decreased by 2·2% (1·6-2·9) between 2019 and 2021.

INTERPRETATION

Putting the COVID-19 pandemic in the context of a mutually exclusive and collectively exhaustive list of causes of health loss is crucial to understanding its impact and ensuring that health funding and policy address needs at both local and global levels through cost-effective and evidence-based interventions. A global epidemiological transition remains underway. Our findings suggest that prioritising non-communicable disease prevention and treatment policies, as well as strengthening health systems, continues to be crucially important. The progress on reducing the burden of CMNN diseases must not stall; although global trends are improving, the burden of CMNN diseases remains unacceptably high. Evidence-based interventions will help save the lives of young children and mothers and improve the overall health and economic conditions of societies across the world. Governments and multilateral organisations should prioritise pandemic preparedness planning alongside efforts to reduce the burden of diseases and injuries that will strain resources in the coming decades.

FUNDING

Bill & Melinda Gates Foundation.

Depression, Anxiety and Poor Sleep Quality are Associated with Chronotype and Financial Wellness in University Students

Background: Evidence suggests the importance of a person's chronotype in predicting various aspects of an individual's physical and mental health. While the effect of depression on sleep is well established, the impact of a person's specific sleep timing and chronotype on the prevalence of both depression and anxiety has yet to be fully understood, especially among university students, vulnerable to mental health problems. In addition, other factors also seem to influence the occurrence of depression and anxiety among students as well as their quality of sleep, one of which being the students' financial wellness. The objective was to evaluate the association between chronotype and the severity and prevalence of depression among Lebanese university students, while also taking into account the possible connection between chronotype and financial wellness and both anxiety and sleep quality. Methods: This cross-sectional study was conducted between December 2021 and February 2022; 330 Lebanese university students was included (mean age 21.75 ± 2.43; 67.3% females). Results: The majority of the Lebanese university students in our sample were found to have an intermediate typology (63.0%), followed by the evening typology, which appeared to constitute 28.2% of the sample, while only 8.8% possessed a morning typology. In this study, having an intermediate or evening typology compared to a morning one was significantly associated with higher depression and worse sleep quality. In addition, having an evening chronotype compared to a morningness propensity was significantly associated with more anxiety. Conclusion: This study found a positive association between an evening typology (chronotype) and higher depression and anxiety and poorer quality of sleep. Although preliminary and based on cross-sectional data, this research could help provide a better understanding of the different chronotypes among university students, and of the possible increased susceptibility of some of these typologies (i.e., evening-type) to mental health problems.

Effectiveness of combining prevention psychological interventions with interventions that address the social determinants of mental health in low and middle-income countries: protocol of a systematic review and meta-analysis

INTRODUCTION

Common mental health conditions (CMHCs), including depression, anxiety and post-traumatic stress disorder (PTSD), are highly prevalent in low and middle-income countries (LMICs). Preventive strategies combining psychological interventions with interventions addressing the social determinants of mental health may represent a key strategy for effectively preventing CMHCs. However, no systematic reviews have evaluated the effectiveness of these combined intervention strategies for preventing CMHCs.

METHODS AND ANALYSIS

This systematic review will include randomised controlled trials (RCTs) focused on the effectiveness of interventions that combine preventive psychological interventions with interventions that address the social determinants of mental health in LMICs. Primary outcome is the frequency of depression, anxiety or PTSD at postintervention as determined by a formal diagnostic tool or any other standardised criteria. We will search Epistemonikos, Cochrane Controlled Trials Register (CENTRAL), MEDLINE, Embase, PsycINFO, CINAHL, Global Index Medicus, ClinicalTrials.gov (Ctgov), International Clinical Trials Registry Platform (ICTRP). Two reviewers will independently extract the data and evaluate the risk of bias of included studies using the Cochrane risk of bias tool 2. Random-effects meta-analyses will be performed, and certainty of evidence will be rated using the Grading of Recommendations Assessment, Development and Evaluation approach.

ETHICS AND DISSEMINATION

This study uses data from published studies; therefore, ethical review is not required. Findings will be presented in a published manuscript.

TRIAL REGISTRATION NUMBER

CRD42023451072.

Misunderstood and underappreciated: a critical review of mental health advocacy and activism in low- and middle-income countries

Mental health advocacy and activism have been highlighted as important in the effort towards creating environments for better mental health. However, relevant research in low- and middle-income country settings remains limited and lacks critical exploration. We seek to contribute to filling this gap by exploring driving factors behind mental health advocacy and activism efforts in low- and middle-income country settings. This review uses a critically informed thematic analysis employing conceptual frameworks of productive power to analyse peer-reviewed articles on mental health advocacy or activism over the last 20 years. We suggest that the current body of research is marred by superficial explorations of activism and advocacy, partly due to a lack of cohesion around definitions. Based on our findings, we suggest a conceptual framework to guide deeper explorations of mental health advocacy and activism. This framework identifies 'legitimacy', 'context' and 'timing' as the main dimensions to consider in understanding activism and advocacy efforts. The fact that they remain misunderstood and underappreciated creates missed opportunities for meaningful inclusion of lived experience in policy decisions and limits our understanding of how communities envision and enact change.

A Curriculum on Digital Psychiatry for a US-Based Psychiatry Residency Training Program: Pilot Implementation Study

BACKGROUND

Digital psychiatry, defined as the application of health technologies to the prevention, assessment, and treatment of mental health illnesses, is a growing field. Interest in the clinical use of these technologies continues to grow. However, psychiatric trainees receive limited or no formal education on the topic.

OBJECTIVE

This study aims to pilot a curriculum on digital psychiatry for a US-based psychiatry residency training program and examine the change in learner confidence regarding appraisal and clinical recommendation of digital mental health apps.

METHODS

Two 60-minute sessions were presented through a web-based platform to postgraduate year 2-4 residents training in psychiatry at a US-based adult psychiatry residency program. Learner confidence was assessed using pre- and postsession surveys.

RESULTS

Matched pre- and postsession quizzes showed improved confidence in multiple domains aligning with the course objectives. This included the structured appraisal of digital mental health apps (P=.03), assessment of a patient's digital health literacy (P=.01), formal recommendation of digital health tools (P=.03), and prescription of digital therapeutics to patients (P=.03). Though an improvement from baseline, mean ratings for confidence did not exceed "somewhat comfortable" on any of the above measures.

CONCLUSIONS

Our study shows the feasibility of implementing a digital psychiatry curriculum for residents in multiple levels of training. We also identified an opportunity to increase learner confidence in the appraisal and clinical use of digital mental health apps through the use of a formal curriculum.

Investigating the spatiotemporal patterns and clustering of attendances for mental health services to inform policy and resource allocation in Thailand

BACKGROUND

Mental illness poses a substantial global public health challenge, including in Thailand, where exploration of access to mental health services is limited. The spatial and temporal dimensions of mental illness in the country are not extensively studied, despite the recognized association between poor mental health and socioeconomic inequalities. Gaining insights into these dimensions is crucial for effective public health interventions and resource allocation.

METHODS

This retrospective study analyzed mental health service utilization data in Thailand from 2015 to 2023. Temporal trends in annual numbers of individuals visiting mental health services by diagnosis were examined, while spatial pattern analysis employed Moran's I statistics to assess autocorrelation, identify small-area clustering, and hotspots. The implications of our findings for mental health resource allocation and policy were discussed.

RESULTS

Between 2015 and 2023, mental health facilities documented a total of 13,793,884 visits. The study found anxiety, schizophrenia, and depression emerged as the top three illnesses for mental health visits, with an increase in patient attendance following the onset of the COVID-19 outbreak. Spatial analysis identified areas of significance for various disorders across different regions of Thailand. Positive correlations between certain disorder pairs were found in specific regions, suggesting shared risk factors or comorbidities.

CONCLUSIONS

This study highlights spatial and temporal variations in individuals visiting services for different mental disorders in Thailand, shedding light on service gaps and socioeconomic issues. Addressing these disparities requires increased attention to mental health, the development of appropriate interventions, and overcoming barriers to accessibility. The findings provide a baseline for policymakers and stakeholders to allocate resources and implement culturally responsive interventions to improve mental health outcomes.

Cultural concepts of distress among Albanian young adults living in Switzerland - a qualitative study

Objectives

Existing research recognizes the critical role that social, sociodemographic, and acculturative processes play in increasing vulnerability for experiencing psychological distress among second-generation migrants. However, to date, far too little attention has been given to the study of psychological distress in this social group. The main objective of this study is to examine cultural identities, as well as expressions and causes of psychological distress among second-generation Albanian-speaking migrants in Switzerland.

Methods

Semi-structured qualitative interviews were conducted with 13 Albanian-speaking participants between 19 and 35 years of age using the interview of the Barts Explanatory Model Inventory. Data were analyzed by qualitative content analysis using MAXQDA-2018 software.

Findings

Study participants showed bicultural identities, which caused value conflicts and a feeling of being "caught" between Swiss and Albanian culture. Some participants experienced the fear of disappointing their parents. Others find it difficult to deal with conflicting norms and values. Parentification was another important cause within their cultural concept of distress. At the same time, (implicit) social support, i.e., spending time with the family and the community, was an important coping mechanism.

Conclusion

Second-generation immigrants are exposed to specific risk factors for psychological distress. A better understanding of these risk factors and their coping mechanisms is essential for providing them with meaningful support services, both in prevention and psychotherapy.

The trends of mental disorders mortality in China over a 33-year period

OBJECTIVES

We investigated the variations in the trends of mental disorders mortality by age, period, and cohort, over a 33-year period from 1987 to 2020, to reveal the relationship between age, period, cohort, and mental disorders mortality, as well as providing guidance for resource allocation to prevent mental disorders-related deaths in vulnerable target populations.

METHODS

The data of mental disorders mortality 1987-2020 were from five administrative organizations, which collected from the National Health Commission in China with national monitoring by sex and age, covering 31 provinces in China. The International Classification of Diseases (ICD), its 9th Revision (ICD-9) and its 10th Revision were used to code the mental diseases. From 1987-2002, ICD-9 was used, and ICD-10 was used from 2003 to 2020. The age standardized mortality rates (ASMRs) were calculated using the World Standard Population as the reference. We used joinpoint models to assess the trends of mental disorders mortality in China for the period 1987-2020. And the age-period-cohort models were employed to estimate the age-period-cohort effect on mental disorders mortality.

RESULTS

The age-standardized overall mental disorders mortality rate (ASMR) showed a downward trend from 1987 to 2020. Further, the ASMR of individuals in urban was higher than that in rural from 1987 to 2001, but, post-2002, this urban-rural disparity in ASMR showed a less clear pattern, with urban areas occasionally surpassing rural areas and vice versa. ASMR is less prevalent among females compared to males overall. The contribution of age effects to mental disorders mortality gradually increases with advancing age, the period effects of mental disorders mortality gradually decrease over time. The cohort effect's contribution to mental disorders mortality decreases in the newly born population, while in the older birth cohorts, the cohort effect's contribution to the mortality rate of mental disorders increases.

CONCLUSIONS

The ASMR exhibits a decreasing trend from 1987 to 2020, and these change trend showed urban-rural and sex differences. The primary factors contributing to this overall decline are period effects and cohort effects. Our results provide valuable information for shaping mental health policies, designing targeted interventions, and preparing for future changes in disease mortality rates. The focus on different demographic factors allows for a nuanced and tailored approach to mental health promotion and intervention strategies.

Association between maternal mental health-related hospitalisation in the 5 years prior to or during pregnancy and adverse birth outcomes: a population-based retrospective cohort data linkage study in the Northern Territory of Australia

Background

Mental health conditions prior to or during pregnancy that are not addressed can have adverse consequences for pregnancy and birth outcomes. This study aimed to determine the extent to which women's mental health-related hospitalisation (MHrH) prior to or during pregnancy was associated with a risk of adverse birth outcomes.

Methods

We linked the perinatal data register for all births in the Northern Territory, Australia, from the year 1999 to 2017, to hospital admissions records to create a cohort of births to women aged 15-44 years with and without MHrH prior to or during pregnancy. We used Modified Poisson Regression and Latent Class Analysis to assess the association between maternal MHrH and adverse birth outcomes (i.e., stillbirth, preterm birth, low birth weight, and short birth length). We explored a mediation effect of covariates on theoretical causal paths. We calculated the adjusted Population Attributable Fraction (PAF) and Preventive Fractions for the Population (PFP) for valid associations.

Findings

From 72,518 births, 70,425 births (36.4% for Aboriginal women) were included in the analysis. The Latent Class Analys identified two classes: high (membership probability of 10.5%) and low adverse birth outcomes. Births to Aboriginal women with MHrH were around two times more likely to be in the class of high adverse birth outcomes. MHrH prior to or during pregnancy increased the risk of all adverse birth outcomes in both populations with risk ranging from 1.19 (95% CI: 1.05, 1.35) to 7.89 (1.17, 53.37). Eight or more antenatal care visits and intrauterine growth restriction mostly played a significant mediation role between maternal MHrH and adverse birth outcomes with mediation effects ranging from 1.04 (1.01, 1.08) to 1.39 (1.14, 1.69). MHrH had a low to high population impact with a PAF ranging from 16.1% (5.1%, 25.7%) to 87.3% (14.3%, 98.1%). Eight or above antenatal care visits avert extra adverse birth outcomes that range from 723 (332-765) stillbirths to 3003 (1972-4434) preterm births.

Interpretation

Maternal MHrH is a modifiable risk factor that explained a low to moderate risk of adverse birth outcomes in the Northern Territory. The knowledge highlights the need for the development and implementation of preconception mental health care into routine health services.

Funding

The Child and Youth Development Research Partnership (CYDRP) data repository is supported by a grant from the Northern Territory Government.

Editorial: Equity/inequality, diversity and inclusion in child and adolescent mental health - a perspective from the South Asian region

Over 1.8 billion people, about a quarter of the world's population live in the seven countries of South Asia: Afghanistan, Bangladesh, Bhutan, India, Nepal, Pakistan, and Sri Lanka. The population is characterized by a significant demographic youth bulge, with over 40% under the age of 18. This young population poses challenges related to ensuring their well-being and development. Issues such as poverty, undernutrition, lack of early stimulation, limited access to quality education and health care, and gender disparities persist in large parts of South Asia, affecting the lives of many children and adolescents. The promotion of child and adolescent mental health remains a challenge. Accumulating evidence suggests that early interventions can provide long-term health and socioeconomic benefits by prevention of the onset of mental health problems and their development into chronic disorders. This needs to be coupled with specialist services that can cater to the needs of children with greater needs, and support the community and schools-based non-specialist led services. Addressing child and adolescent mental health in South Asia presents a window of opportunity, because this regional youth bulge can contribute significantly to the global economy of the future.

Factors that impact mental health help-seeking in Australian adolescents: a life-course and socioecological perspective

BACKGROUND

Help-seeking provides opportunities for early prevention and intervention of mental health problems. However, little is known about factors that impact help-seeking from a life-course and socioecological perspective. This study aimed to examine factors that impact adolescents' formal and informal help-seeking in three population groups: the whole population, adolescents with depressive symptoms and adolescents with anxiety symptoms.

METHODS

We drew on data from the Longitudinal Study of Australian Children birth cohort. Participants were followed from birth to 14-15 years. Based on previous literature and life-course and socioecological models, we measured a range of factors at individual and family, interpersonal and community levels at three time points (0-1 year, 4-5 years and 12-13 years). Outcomes at 14-15 years were help-seeking behaviours divided into three categories (formal help from health professionals, close informal help from friends and family members and broad informal help from other sources). Generalised linear models with logit-binomial links were used.

RESULTS

There were varying and common patterns of influencing factors across the three population groups and sources of help-seeking. In the whole population, five common factors (female, previous depressive or anxiety symptoms, discrimination and bully victimisation) were associated with all three sources of help-seeking. Among adolescents with depressive or anxiety symptoms, four common barriers to help-seeking were male adolescents, speaking a language other than English, having poor relationships with peers and less social support.

CONCLUSION

Both intrinsic and extrinsic barriers exist for adolescents' mental health help-seeking. There are priority groups of adolescents with mental health problems who are unlikely to seek support and warrant attention. There is a need for multisector collaborations to address barriers to mental health care and promote help-seeking among adolescents.

Do the elderly and those with comorbid chronic physical conditions have improved access to outpatient psychotherapy post structural reforms in Germany? Results of the ES-RiP study

Background

In 2017, a reform of the German outpatient psychotherapy guideline was carried out, aiming to reduce waiting times and facilitate low-threshold access. This study analyzes the extent to which the implementation of the two new service elements 'psychotherapeutic consultation times' and 'acute short-term psychotherapeutic interventions' improved psychotherapeutic care for patients with mental disorders and chronic physical conditions (cMPs), for patients with mental disorders without chronic physical conditions (MnoP), and elderly patients.

Methods

In a quantitative secondary analysis, we analyzed health insurance data of patients with psychotherapy billing codes obtained from the National Association of Statutory Health Insurance Physicians (KBV) for the years 2015-2019, evaluating descriptive statistical parameters for specific patient groups and care services.

Results

Between 2015 and 2019, the number of mentally ill receiving psychotherapy at least once in the corresponding year increased by 30.7%. Among these, the proportion of cMPs-patients increased from 26.8% to 28.2% (+1.4%), while that of MnoP-patients decreased from 68.3% to 66.4% (-1.9%). The number of elderly people receiving treatment also increased.

Conclusion

Since increases and decreases in the percentage shares occur evenly over the years investigated, it is questionable whether the reform in 2017 has had a direct influence on these changes.

Study registration

ID DRKS00020344, URL: https://www.bfarm.de/DE/Das-BfArM/Aufgaben/Deutsches-Register-Klinischer-Studien/_node.html.

Enhancing mental health and well-being in adults from lower-resource settings: A mixed-method evaluation of the impact of problem management plus

Mental health conditions, recognised as a global crisis, were further exacerbated by the COVID-19 pandemic. Access to mental health services remains limited, particularly in low-income regions. Task-sharing interventions, exemplified by Problem Management Plus (PM+), have emerged as potential solutions to bridge this treatment gap. This study presents an evaluation of the PM+ scale-up in Sub-Saharan Africa (Ethiopia and Benin) and Eastern Europe (Croatia and Bosnia and Herzegovina) as part of a mental health and psychosocial support programming including 87 adult participants. A mixed-method approach assesses the impact of the intervention. Quantitative analyses reveal significant reductions in self-reported problems, depression, anxiety and improved functioning. Qualitative data highlight four main themes: general health, family relationships, psychosocial problems and daily activities. These thematic areas demonstrate consistent improvements across clients, irrespective of the region. The findings underscore the impact of PM+ in addressing a broad spectrum of client issues, demonstrating its potential as a valuable tool for mitigating mental health challenges in diverse settings. This study contributes to the burgeoning body of evidence supporting PM+ and highlights its promise in enhancing mental health outcomes on a global scale, particularly for vulnerable populations.

Studies on neurobehavioural properties of Caralluma dalzielii N.E Br. aqueous aerial parts extract in mice

ETHNOPHARMACOLOGICAL RELEVANCE

Caralluma dalzielii (Asclepiadiaceae) is a shrub used in folkloric medicine to treat epilepsy, pain and infertility in sub-Saharan Africa. Previous studies demonstrated its analgesic, antiulcer, anticonvulsant, and anti-inflammatory activities.

AIM

This study aimed to determine the neurobehavioural properties of Caralluma dalzielii aqueous aerial parts extract (CDAE) in mice using standard experimental models.

MATERIALS AND METHODS

Neurobehavioural activities of CDAE were evaluated (100, 200, and 400 mg/kg) in Swiss Albino mice using the beam walk, staircase, hole board, object recognition, open field assay, Y-maze and forced swimming tests. Phytochemical constituents were analysed using GC-MS.

RESULTS

CDAE significantly increased the mean number of head dips, recognition index and spontaneous alternation in hole board (14.03 at 400 mg/kg and 6.01 in distilled water group; p < 0.05), object recognition (68.16% at 400 mg/kg compared with 51.66% of distilled water group) and Y maze (9.16 at 400 mg/kg as against 4.66 of distilled water group; p < 0.05) tests respectively. It decreased the rearing counts as well as the peripheral and central square crossing in the staircase (4.2 at 400 mg/kg as against 7.87 of the distilled water group; p < 0.05) and open field tests (central, 0.81; peripheral, 1.66 at 400 mg/kg as against central, 5.23; peripheral 11.83 of the distilled water control group; p < 0.05), respectively. There were no significant effects on beam walk assays and forced swim tests. The GC-MS analysis identified a hundred compounds in CDAE. Some compounds which have been reported to possess neurobehavioural activity that were identified include 3,5-Dimethylpyrazole, 2-Amino-5-methylbenzoic acid, Acetophenone, and Tetrahydropyran.

CONCLUSION

CDAE demonstrated anxiolytic, anti-hyperactivity, and memory-improving effects in mice. The extract may possess GABAergic and glutamatergic properties. More studies are needed to confirm this. Isolation of the bioactive compounds is currently ongoing to unravel the bioactive constituents present in C. dalzielii extract.

Midfrontal conflict theta and parietal P300 are linked to a latent factor of DSM externalising disorders

Psychiatric illnesses form spectra rather than categories, with symptoms varying continuously across individuals, i.e., there is no clear break between health and disorder. Dimensional measures of behaviour and brain activity are promising targets for studying biological mechanisms that are common across disorders. Here, we assessed the extent to which neural measures of the sensitivity of the three biological systems in the reinforcement sensitivity theory (RST) could account for individual differences in a latent general factor estimated from symptom counts across externalising disorders (EXTs). RST explanatory power was pitted against reduced P300, a reliable indicator of externalising per previous research. We assessed 206 participants for DSM-5 EXTs (antisocial personality disorder, conduct disorder, attention-deficit/hyperactivity disorder, intermittent explosive disorder symptoms, alcohol use disorder, and cannabis use disorder). Of the final sample, 49% met diagnostic criteria for at least one of the EXTs. Electroencephalographic measures of the sensitivities of the behavioural activation system (BAS), the fight/flight/freeze system, and the behavioural inhibition system (BIS), as well as P300 were extracted from the gold bar-lemon and stop-signal tasks. As predicted, we found that low neural BIS sensitivity and low P300 were uniquely and negatively associated with our latent factor of externalising. Contrary to prediction, neural BAS/"dopamine" sensitivity was not associated with externalising. Our results provide empirical support for low BIS sensitivity and P300 as neural mechanisms common to disorders within the externalising spectrum; but, given the low N involved, future studies should seek to assess the replicability of our findings and, in particular, the differential involvement of the three RST systems.

Prevalence and social determinants of anxiety and depression among adults in Ghana: a systematic review and meta-analysis protocol

INTRODUCTION

Anxiety and depression pose a significant global health challenge, especially affecting adults in low-income and middle-income countries. In many low-income and middle-income countries, including those in sub-Saharan Africa, social determinants such as access to affordable health services, conflict, food insecurity, and poverty may be associated with the prevalence of anxiety and depression, further contributing to health disparities. To mitigate the burden of anxiety and depression in sub-Saharan Africa, it is essential to develop country-level tailored mental health policies and strategies. For example, Ghana is working towards improving mental health via its 12 year Mental Health policy launched in 2021. However, the prevalence of anxiety and depression among adults in Ghana, along with associated social determinants remains largely unknown, posing challenges for mental health planning, resource allocation and developing targeted interventions. This systematic review seeks to (1) examine the prevalence of anxiety and depression among adults in Ghana and (2) explore social determinants potentially associated with anxiety and depression.

METHODS AND ANALYSIS

Electronic databases (eg, African Index Medicus, CINAHL, EMBASE, MEDLINE, and PsycINFO) will be searched with all screening steps conducted by two independent reviewers. Secondary search strategies, including grey literature searches, will be used. Studies reporting on the prevalence of anxiety, depression and/or a combined symptom measure (ie, psychological distress) among adults in Ghana, using validated instruments will be included. If data allows, random-effects-meta-analyses will be performed to estimate pooled prevalence rates of anxiety and depression. Potential clinical and methodological moderators will be examined using subgroup analyses and meta-regression. A narrative synthesis will explore social determinants potentially associated with anxiety and depression among adults in Ghana.

ETHICS AND DISSEMINATION

Ethical approval is not required as no primary data will be collected. Results will be disseminated via a peer-reviewed publication and presentations at academic conferences. Plain language summaries will be provided to relevant non-governmental organisations working in Ghana.

PROSPERO REGISTRATION NUMBER

CRD42023463078.

Support Groups Versus Primary Mental Healthcare on Disability and Continuity of Care: Community Trial [Support Groups for Recovery]

Based on the need to implement strategies to reduce recovery gaps in mental health with the community as axes of recovery, the objective of the present study was to assess the impact on psychosocial disability and care continuity in individuals with suicidal behavior, of the clinical and community components of the Mental Health Gap Action Program (mhGAP), versus exclusive psychiatric care. For this, a controlled community trial carried out in 2023 was conducted, comprising intervention groups: Support Group (SG), mhGAP Group (mhGAPG) and a Control Group (CG). Self-report measurements were collected pretest and posttest, utilizing the Psychosocial Disability Scale and the Alberta Continuity of Care Scale. The study involved the participation of 94 individuals with a history of suicidal behavior, with 30 individuals in the SG, 34 in the mhGAP group, and 30 in the CG. Categorical variables were summarized using frequency distribution tables. Descriptive statistics were used to examine participants' characteristics at the study outcome and estimate treatment compliance. The Mann-Whitney U Test examined differences in sociodemographic variable frequencies. The Jarque-Bera test confirmed a normal distribution for psychological variables, warranting the use of parametric tests. Differences in mean values across groups, each with two measurements per individual, were assessed using a type II repeated measures ANOVA. There were significant differences based on the intervention, with the effect being greater in the SG across all domains. Significant improvement was observed in all domains of the disability and continuity of care scale within the intervention groups. Both groups showed improvement, with better results for the SG. In conclusion, a methodology is proposed for implementing support groups based on core components, which effectively enhances psychosocial disability and the continuity of mental health care, especially in suicidal behavior.

Differential trends and patterns of sociodemographic disparities in burden of mental disorders, substance use disorder and self-harm across age groups: ecological study in 204 countries using the Global Burden of Disease Study 2019

BACKGROUND

It is well-known that socioeconomic status is associated with mental illness at both the individual and population levels, but there is a less clear understanding of whether socioeconomic development is related to poor mental health at the country level.

AIMS

We aimed to investigate sociodemographic disparities in burden of mental disorders, substance use disorders and self-harm by age group.

METHOD

Estimates of age-specific disability-adjusted life years (DALY) rates for mental disorders, substance use disorders and self-harm from 1990 to 2019 for 204 countries were obtained. The sociodemographic index (SDI) was used to assess sociodemographic development. Associations between burden of mental health and sociodemographic development in 1990 and 2019 were investigated, and sociodemographic inequalities in burden of mental health from 1990 to 2019 by age were estimated using the concentration index.

RESULTS

Differential trends in sociodemographic disparities in diseases across age groups were observed. For mental disorders, particularly depressive disorder and substance use disorders, DALY rates in high SDI countries were higher and increased more than those in countries with other SDI levels among individuals aged 10-24 and 25-49 years. By contrast, DALY rates for those over 50 years were lower in high SDI countries than in countries with other SDI levels between 1990 and 2019. A higher DALY rate among younger individuals accompanied a higher SDI at the country level. However, increased sociodemographic development was associated with decreased disease burden for adults aged ≥70 years.

CONCLUSIONS

Strategies for improving mental health and strengthening mental health system should consider a broader sociocultural context.

Identification of factors associated with hospitalization in an outpatient population with mental health conditions: a case-control study

Introduction

Addressing relevant determinants for preserved person-centered rehabilitation in mental health is still a major challenge. Little research focuses on factors associated with psychiatric hospitalization in exclusive outpatient settings. Some variables have been identified, but evidence across studies is inconsistent. This study aimed to identify and confirm factors associated with hospitalization in a specific outpatient population.

Methods

A retrospective monocentric case-control study with 617 adult outpatients (216 cases and 401 controls) from a French community-based care facility was conducted. Participants had an index outpatient consultation between June 2021 and February 2023. All cases, who were patients with a psychiatric hospitalization from the day after the index outpatient consultation and up to 1 year later, have been included. Controls have been randomly selected from the same facility and did not experience a psychiatric hospitalization in the 12 months following the index outpatient consultation. Data collection was performed from electronic medical records. Sociodemographic, psychiatric diagnosis, historical issues, lifestyle, and follow-up-related variables were collected retrospectively. Uni- and bivariate analyses were performed, followed by a multivariable logistic regression.

Results

Visit to a psychiatric emergency within a year (adjusted odds ratio (aOR): 13.02, 95% confidence interval (CI): 7.32-23.97), drug treatment discontinuation within a year (aOR: 6.43, 95% CI: 3.52-12.03), history of mental healthcare without consent (aOR: 5.48, 95% CI: 3.10-10.06), medical follow-up discontinuation within a year (aOR: 3.17, 95% CI: 1.70-5.95), history of attempted suicide (aOR: 2.50, 95% CI: 1.48-4.30) and unskilled job (aOR: 0.26, 95% CI: 0.10-0.65) are the independent variables found associated with hospitalization for followed up outpatients.

Conclusions

Public health policies and tools at the local and national levels should be adapted to target the identified individual determinants in order to prevent outpatients from being hospitalized.

How much do adverse childhood experiences contribute to adolescent anxiety and depression symptoms? Evidence from the longitudinal study of Australian children

This study aims to: (i) examine the association between adverse childhood experiences (ACEs) and elevated anxiety and depressive symptoms in adolescents; and (ii) estimate the burden of anxiety and depressive symptoms attributable to ACEs.Data were analyzed from 3089 children followed between Waves 1 (age 4-5 years) and 7 (16-17 years) of the Longitudinal Study of Australian Children. Logistic regression was used to estimate the associations between ACEs and child-reported elevated anxiety and depressive symptoms at age 16-17. Anxiety and depressive symptoms were measured using the Children's Anxiety Scale and Short Mood and Feelings Questionnaire, respectively. The punaf command available in STATA 14 was used to calculate the population attributable fraction (PAF).Before the age of 18 years, 68.8% of the children had experienced two or more ACEs. In the analysis adjusted for confounding factors, including co-occurring ACEs, both history and current exposure to bullying victimisation and parental psychological distress were associated with a statistically significant increased likelihood of elevated anxiety and depressive symptoms at age 16-17. Overall, 47% of anxiety symptoms (95% CI for PAF: 35-56) and 21% of depressive symptoms (95% CI: 12-29) were attributable to a history of bullying victimisation. Similarly, 17% (95% CI: 11-25%) of anxiety and 15% (95% CI: 4-25%) of depressive symptoms at age 16-17 years were attributable to parental psychological distress experienced between the ages of 4-15 years.The findings demonstrate that intervention to reduce ACEs, especially parental psychological distress and bullying victimisation, may reduce the substantial burden of mental disorders in the population.

Assessing causality between chronic obstructive pulmonary disease with depression: A bidirectional Mendelian randomization study

PURPOSE

Our investigation utilized a two-sample Mendelian randomization approach to explore the ambiguous bidirectional relationship between Chronic Obstructive Pulmonary Disease (COPD) and depression, furthering insights from existing observational studies.

METHODS

In this study, we conducted a bidirectional Mendelian randomization using genome-wide association studies (GWAS) datasets. We initially analyzed depression data from the Psychiatric Genomics Consortium and the UK Biobank (n = 500,199), alongside COPD data from the FinnGen Consortium (n = 329,552). The second phase involved comparing depression data from FinnGen (n = 372,472) with COPD data from the UK Biobank (n = 361,194). Our Mendelian analysis employs various methods to guarantee a comprehensive and rigorous investigation.

RESULTS

In the initial analytic phase utilizing the inverse variance weighted (IVW) method, COPD does not significantly contribute to the incidence of depression (IVW odds ratio (OR) = 0.989, 95 % confidence interval (CI) = 0.895 to 1.092, P = 0.824). Conversely, the data suggested a statistically significant association where depression may precipitate the development of COPD, with a notable increase in risk (IVW OR = 1.421, 95 % CI = 1.149 to 1.756, P = 0.001). Subsequent validation through a second-step analysis reinforced the hypothesis that depression elevates the likelihood of COPD onset (IVW OR = 1.002, 95 % CI = 1.0003 to 1.0046, P = 0.028).

CONCLUSION

Our study, utilizing Mendelian randomization analysis, determined that COPD does not escalate the risk of depression. Conversely, our analysis suggests that depression may elevate the risk of developing COPD. This insight underscores the importance of enhancing prevention, screening, and treatment strategies for COPD in individuals with depression.

Long-term effects on depressive symptoms among Ugandan mothers - Findings from a follow-up of a cluster-randomized education trial in a rural low-resource setting

INTRODUCTION

Depression is increasingly affecting mothers in poor countries such as Uganda. Various interventions have been implemented to tackle this problem, but their sustainability is under-researched. Here we present follow-up data on maternal depression six years after a cluster-randomized controlled maternal education trial in rural Uganda.

METHODS

The intervention lasted six months and consisted of nutrition, hygiene, sanitation and child stimulation education, delivered to 511 mothers of 6 to 8 months' old children. Six years later we assessed maternal depressive symptoms using two psychometric tools; the Beck Depression Inventory II (BDI-II) and Center for Epidemiologic Studies Depression scale (CESD).

RESULTS

For this follow-up study, data was available from 307/511 (60 %) mothers. Intention-to-treat analyses adjusting for clustering showed that the intervention mothers had non-significantly less depression symptoms (absolute score difference - 2; 95 % CI -5 to 0; p = 0.07) on BDI-II, and borderline significantly less depression symptoms (absolute score difference - 3; 95 % CI -5 to 0; p = 0.05) on CES-D compared to the controls. For categorized depression scores, the control mothers had significantly higher proportion of women classified in the worse depression categories for both BDI-II and CESD. We did not find any baseline characteristics associated with maternal depression.

LIMITATIONS

The BDI-II and CES-D tools are both self-reported and we cannot rule out the possibility of social desirability bias in reporting of depression symptoms.

CONCLUSION

Six years after the maternal education trial, some benefits on maternal mental health were sustained. More studies are warranted on sustainability and scale-up of such interventions.

Global burden of self-harm and interpersonal violence and influencing factors study 1990-2019: analysis of the global burden of disease study

INTRODUCTION

Widespread concern exists in today's world regarding self-harm and interpersonal violence. This study to analyze the changes in temporal trends and spatial patterns of risk factors and burdens of self-harm and interpersonal violence using the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019.

METHODS

Temporal trends in self-harm and interpersonal violence were initially summarized using the estimated annual percentage change (EAPC). Data were compiled and visualized to delineate changes in disease burden and factors influencing self-harm and interpersonal violence from 1990 to 2019, stratified by gender, age and GBD region.

RESULTS

In 2019, the DALY rates of self-harm were 424.7(95% UI 383.25, 466.93). Over the period from 1999 to 2019, self-harm exhibited an overall decreasing trend, with the EAPC of -1.5351 (95% CI -1.6194, -1.4507), -2.0205 (95% CI -2.166, -1.8740) and -2.0605 (95% CI -2.2089, -1.9119), respectively. In contrast, the incidence rate of interpersonal violence was significantly higher than self-harm, with a rate of 413.44 (95% UI 329.88, 502.37) per 100,000 population. Mortality and DALYs of interpersonal violence were lower than those of self-harm, at 5.22 (95% UI 4.87, 5.63) and 342.43 (95% UI 316.61, 371.55). Disease burden of self-harm and interpersonal violence varied by gender, age groups and region. Specific risk factors showed that alcohol use, high temperature and drug use were the main risk factors for self-harm, while alcohol use, intimate partner violence and high temperature were associated with interpersonal violence. Low temperature was a common protective factor for both self-harm and interpersonal violence. The burden of self-harm and interpersonal violence was attributed to different factors influences in different SDI regions.

CONCLUSIONS

The study explored temporal trends and spatial distribution of the global disease burden of self-harm and interpersonal violence, emphasizing the significant impact of factors such as alcohol use, temperature, and drug use on disease burden. Further research and policy actions are needed to interpret recent changes of disease burden of self-harm and interpersonal violence, and dedicated efforts should be implemented to devise evidence-based interventions and policies to curtail risk factors and protect high-risk groups.

Food insecurity and perinatal depression among pregnant women in BUNMAP cohort in Ethiopia: a structural equation modelling

OBJECTIVE

To assess the effect of food insecurity on perinatal depression in rural Ethiopia.

DESIGN

We used a prospective cohort in which food insecurity was considered as primary exposure and perinatal depression as an outcome. Food insecurity at baseline (in the period of 8-24 weeks of pregnancy) was measured using the Household Food Insecurity Access Scale (HFIAS), and perinatal depression at follow-up (in 32-36 weeks of pregnancy) was measured using a Patient Health Questionnaire (PHQ-9). We used multivariable regression to assess the effect of food insecurity on the prevalence of perinatal depression. We explored food insecurity's direct and indirect impacts on perinatal depression using structural equation modelling (SEM).

SETTING

This paper used data from the Butajira Nutrition, Mental Health and Pregnancy (BUNMAP) cohort established under the Butajira Health and Demographic Surveillance Site (BHDSS).

PARTICIPANTS

Seven hundred and fifty-five pregnant women.

RESULTS

Among the study participants, 50 % were food-insecure, and about one-third were depressed at 32-36 follow-up. In SEM, higher values of baseline food insecurity, depressive symptoms and state-trait anxiety (STA) were positively and significantly associated with perinatal depression. The direct impact of food insecurity on perinatal depression accounts for 42 % of the total effect, and the rest accounted for the indirect effect through baseline depression (42 %) and STA (16 %).

CONCLUSION

The significant effect of food insecurity at baseline on perinatal depression and the indirect effect of baseline food insecurity through baseline anxiety and depression in the current study implies the importance of tailored interventions for pregnant women that consider food insecurity and psychosocial problems.

Gender differences in the prevalence of anxiety and depression and care seeking for mental health problems in Nepal: Analysis of nationally representative survey data

Background

Assessing gender disparity in mental health is crucial for targeted interventions. This study aims to quantify gender disparities in mental health burdens, specifically anxiety and depression, and related care-seeking behaviors across various sociodemographic factors in Nepal, highlighting the importance of gender-specific mental health interventions.

Methods

Data from the 2022 Nepal Demographic and Health Survey was utilized, employing the Generalized Anxiety Disorder 7 scale (GAD-7) and Patient Health Questionnaire (PHQ-9) scales for anxiety and depression symptoms, respectively. Multiple logistic regression models assessed gender associations with these conditions and care-seeking behaviors.

Results

Women had a higher point prevalence of anxiety (21.9% vs. 11.3%) and depression (5.4% vs. 1.7%) than men. Large variations were noted in gender disparities in the prevalence of anxiety and depression, influenced by age, geographical areas, level of education and household wealth. After adjustment for sociodemographic factors, women were more likely to experience anxiety (adjusted odds ratio (aOR) = 2.18, 95% confidence interval [CI]: 1.96-2.43) and depression (aOR = 3.21, 95% CI: 2.53-4.07). However, no difference was observed in the rates of seeking care for anxiety or depression (aOR = 1.13, 95% CI: 0.91-1.40).

Conclusions

Our findings show a higher point prevalence of mental health issues among women than men, influenced by sociodemographic factors, underscoring the need for gender-focused mental health interventions in Nepal and globally.

Experiences of integrating a psychological intervention into a youth-led empowerment program targeting out-of-school adolescents, in urban informal settlements in Kenya: A qualitative study

INTRODUCTION

Depression, anxiety and behavioural disorders are the leading causes of illness and disability in adolescents. This study aims to evaluate the feasibility of integrating mental health services into a youth-led community-based intervention targeting out-of-school adolescents, residing in Kariobangi and Rhonda informal settlements in Kenya.

METHOD

Youth mentors were trained on the Bridging the Gaps (BTG) curriculum that integrated a modified version of the World Health Organization's (WHO) Problem Management Plus (PM+) psychological intervention into a sexual health, life-skills and financial education curriculum. Community lay mentors facilitated 72 weekly group sessions for 469 adolescent boys and girls, augmented with five enhanced one-on-one treatment sessions for those displaying signs of psychological distress. Adolescents displaying severe signs of psychological distress were referred directly to a primary health facility or connected to specialist services. A qualitative survey took place between February and March 2022, around four months before the end of the program. In-depth interviews were carried out with 44 adolescents, 7 partners, 19 parents and 11 stakeholders. Four focus group discussions were carried out with 17 mentors. Respondents were purposively selected to be interviewed based on their level of exposure to the intervention and ability to provide in-depth experiences. Themes focused on the program's perceived effectiveness, ability to develop the capacity of lay mentors to address mental health issues, and increased access to mental health services.

RESULTS

Adolescents reported that the intervention was able to improve their confidence in speaking up about their problems, equip them with essential first-aid skills to manage and treat anxiety or mild depression, provide them access to free one-on-one psychological help sessions, and increase their social network. Mentors were able to adhere to the core principles of psychological intervention delivery, providing preventative and treatment-focused psychosocial services. Furthermore, parents reported experiencing improved adolescent receptivity to parental suggestions or advice leading to improved parent-adolescent relationships. Mentors referred adolescents for a variety of reasons including severe mental illness, rape, and alcohol and substance use however, the high cost of transport was the main barrier limiting adolescents from following through with their referrals.

CONCLUSION

The findings demonstrate that integration of mental health services into community-based interventions is feasible and has benefits for adolescents, parents, and mentors.

Thirty-year trends of anxiety disorders among adolescents based on the 2019 Global Burden of Disease Study

Background

Anxiety disorders are the most common psychiatric problems, affecting approximately 1 in 12 children and 1 in 4 adolescents. Understanding the incidence, burden and correlated risks of anxiety disorders among children and adolescents can help identify areas of success, stagnation and emerging threats, thereby facilitating effective improvement strategies.

Aims

To estimate the incidence and burden trends of anxiety disorders in children and adolescents from 1990 to 2019 in 204 countries and compare the incidence and disease burden in different countries. To examine the association between anxiety disorders and social indicators (healthcare access and quality of life).

Methods

Data were obtained from the Global Burden of Disease Study 2019. The age-standardised incidence rates (ASIRs) and disability-adjusted life years (DALYs) were reported to assess the burden of anxiety disorders, and the estimated annual percentage change was calculated to quantify the temporal trends. Pearson's correlation was used to investigate country-level risk factors for incidence and DALYs.

Results

Globally, there were 932 million incident cases of anxiety disorders in children and adolescents, 739.29 per 100 000 ASIRs and 380.62 million DALYs in 2019. From 1990 to 2019, the estimated annual percentage change of incidence of anxiety disorders decreased by 2.2%. Significant variations were observed in the age-standardised burden rate and the changing trend of anxiety disorders among countries. Portugal reported the highest ASIR of anxiety disorders, while Mexico had the largest increase rate of ASIR. In 2019, Portugal reported the highest number of DALYs (1001.71 million), and India (212.09 million) reported the lowest number of DALYs. The burden of anxiety disorders was positively correlated with the average number of psychiatrists, psychologists and nurses in the mental health sector (per 100 000), and quality of life and the correlation coefficients were 0.58, 0.67, 0.43 and 0.53, respectively.

Conclusions

The incidence and global burden of anxiety disorders in adolescents have continued to decrease over the past 30 years. However, the incidence and disease burden in developed countries are still increasing steadily. Policymakers should design and implement mental health strategies for adolescents based on their specific developmental status, as well as the cultural and regional characteristics of each country.

Evaluating a Movement-Based Mental Health Promotion Intervention for Refugee Children in Uganda: A Quasi-Experimental Study

OBJECTIVE

Mental health promotion interventions are widely implemented in humanitarian settings and low- and middle-income contexts (LMICs), yet evidence on effectiveness is scarce and mixed. This study evaluated the movement-based mental health promotion intervention "TeamUp" in Bidibidi refugee settlement, in Northern Uganda.

METHOD

A quasi-experimental study including four schools (two per arm) assessed the outcomes of 10- to 15-year-old South Sudanese and Ugandan children (n = 549). Randomly allocated, they either participated in up to 11 TeamUp sessions (n = 265) provided by trained facilitators; or belonged to a control group, which continued care as usual (n = 284). Primary outcomes measured psychosocial wellbeing, friendships and attitude to school; secondary outcomes included traumatic distress, depressive symptoms, quality of life, physical health, bullying, interoceptive awareness, and irritability. Data were collected at baseline and endline.

RESULTS

Children joining TeamUp, showed significantly more improvements on primary outcomes: emotional and psychosocial wellbeing (Mdiff = -1.49, SE = 0.6, p = .01), satisfaction with and attitude toward school (-0.57, SE = 0.2, p = .004); and secondary outcomes: traumatic stress (2.64, SE = 0.8, p < .001), health-related quality of life (-1.56, SE = 0.4, p = .001), physical health (-0.78, SE = 0.3, p = .014) and the TeamUp mechanisms of action scale (-3.34, SE = 0.9, p < .001), specifically the subscales social connectedness (-0.74, SE = 0.3, p = .007) and sense of agency (-0.91, SE = 0.3, p = .005), compared to the control group. No significant differences were found on bullying, interoceptive awareness, irritability and depressive symptoms.

CONCLUSION

The results are promising for TeamUp as a mental health promotion intervention for children affected by armed-conflict, displacement and on-going adversity. Further research will need to assess the intervention's effectiveness.

Mental health literacy in children and adolescents in low- and middle-income countries: a mixed studies systematic review and narrative synthesis

Mental illnesses are the leading cause of disease burden among children and young people (CYP) globally. Low- and middle-income countries (LMIC) are disproportionately affected. Enhancing mental health literacy (MHL) is one way to combat low levels of help-seeking and effective treatment receipt. We aimed to synthesis evidence about knowledge, beliefs and attitudes of CYP in LMICs about mental illnesses, their treatments and outcomes, evaluating factors that can enhance or impede help-seeking to inform context-specific and developmentally appropriate understandings of MHL. Eight bibliographic databases were searched from inception to July 2020: PsycInfo, EMBASE, Medline (OVID), Scopus, ASSIA (ProQuest), SSCI, SCI (Web of Science) CINAHL PLUS, Social Sciences full text (EBSCO). 58 papers (41 quantitative, 13 qualitative, 4 mixed methods) representing 52 separate studies comprising 36,429 participants with a mean age of 15.3 [10.4-17.4], were appraised and synthesized using narrative synthesis methods. Low levels of recognition and knowledge about mental health problems and illnesses, pervasive levels of stigma and low confidence in professional healthcare services, even when considered a valid treatment option were dominant themes. CYP cited the value of traditional healers and social networks for seeking help. Several important areas were under-researched including the link between specific stigma types and active help-seeking and research is needed to understand more fully the interplay between knowledge, beliefs and attitudes across varied cultural settings. Greater exploration of social networks and the value of collaboration with traditional healers is consistent with promising, yet understudied, areas of community-based MHL interventions combining education and social contact.

Long-term trajectories of densely reported depressive symptoms during an extended period of the COVID-19 pandemic in Switzerland: Social worries matter

Previous mental health trajectory studies were mostly limited to the months before access to vaccination. They are not informing on whether public mental health has adapted to the pandemic. The aim of this analysis was to 1) investigate trajectories of monthly reported depressive symptoms from July 2020 to December 2021 in Switzerland, 2) compare average growth trajectories across regions with different stringency phases, and 3) explore the relative impact of self-reported worries related to health, economic and social domains as well as socio-economic indicators on growth trajectories. As part of the population-based Corona Immunitas program of regional, but harmonized, adult cohorts studying the pandemic course and impact, participants repeatedly reported online to the DASS-21 instrument on depressive symptomatology. Trajectories of depressive symptoms were estimated using a latent growth model, specified as a generalised linear mixed model. The time effect was modelled parametrically through a polynomial allowing to estimate trajectories for participants' missing time points. In all regions level and shape of the trajectories mirrored those of the KOF Stringency-Plus Index, which quantifies regional Covid-19 policy stringency. The higher level of average depression in trajectories of those expressing specific worries was most noticeable for the social domain. Younger age, female gender, and low household income went along with higher mean depression score trajectories throughout follow-up. Interventions to promote long-term resilience are an important part of pandemic preparedness, given the observed lack of an adaptation in mental health response to the pandemic even after the availability of vaccines in this high-income context.

Priorities for research promoting mental health in the south and east of Asia

Progress in promoting mental health, preventing mental illness, and improving care for people affected by mental illness is unlikely to occur if efforts remain separated from existing public health programs and the principles of public health action. Experts met recently to discuss integrating public health and mental health strategies in the south and east of Asia, especially in low- and middle-income countries. Areas of research identified as high priority were: 1) integrating mental health into perinatal care; 2) providing culturally-adjusted support for carers of people with mental and physical disorders; 3) using digital health technologies for mental health care in areas with limited resources and 4) building local research capacity. Selection of these areas was informed by their relative novelty in the region, ease of implementation, likely widespread benefit, and potential low costs. In this article, we summarise available evidence, highlight gaps and call for collaborations with research centres, leaders and persons with lived experience within and beyond the region.

Mutual Aid Groups for Loneliness, Psychosocial Disability, and Continuity of Care

The objective of the present study was to evaluate the effectiveness of mutual help groups in continuity of care, loneliness and psychosocial disability in a Colombian context. For this, a quasi-experimental design is used, with pre- and post-intervention assessments due to non-randomized participant allocation. The study involved 131 individuals with mental disorders. The Psychosocial Disability Scale, The Alberta Scale of Continuity of Services in Mental Health, the UCLA Scale and the Zarit Caregiver Burden Scale were employed. The intervention was based on the core components of mutual aid groups. Significant differences (p < 0.001) were observed for the study variables, particularly in Loneliness, Continuity of Care, and various domains of psychosocial disability. A large effect size was found for these variables after the intervention. Most variables exhibited a moderate to large effect. This study demonstrates the effectiveness of mutual groups facilitated by mental health personnel at the primary care level.

Socioeconomic and gender inequalities in mental disorders among adolescents and young adults

BACKGROUND

Socioeconomic status (SES) and gender play a key role in mental health. The objective of this study was to assess socioeconomic and gender mental health inequalities in adolescents and young adults using a population-based registry.

MATERIALS AND METHODS

We conducted a lifetime follow-up study of all residents in the Basque Country between 1 and 30 years old (n=609,381) as of 31 December 2018. Primary care, specialized outpatient, and hospital care records were searched for diagnoses. SES was assessed based on household income. We estimated disaggregated lifetime prevalence of substance use, behaviour, anxiety, depression, psychosis, and attention deficit hyperactivity disorder. The local Institute of Statistics validated the mortality data. The likelihood of risks was estimated using logistic regression.

RESULTS

Overall, 96,671 individuals (15.9%) had a diagnosed mental disorder, with clear gradients by gender and SES. Females of medium-to-high SES had the lowest prevalence of all mental disorders, except anxiety and depression. This group was followed by males of the same SES and females of low SES, while the highest prevalence of mental disorders was observed in low-SES males. The lower income categories had higher risks of psychiatric admission (adjusted odds ratio [AOR]: 3.64 for females; 6.66 for males) and death (AOR: 5.42). People with a mental health diagnosis had higher mortality (AOR: 2.38).

CONCLUSIONS

Our work evidenced important SES and gender inequalities in the mental health and premature mortality of adolescents and young adults, findings that should drive the development and implementation of early preventive interventions.

Research on psychotherapy for refugees in Germany: A systematic review on its transdisciplinary and transregional opening

Recently, an increasing amount of research has focused on adapting psychotherapy concepts for refugees moving to Germany. For a long time, research from disciplines like anthropology and cultural studies has problematized the eurocentrism of psychology's theoretical premises and methodologies. Currently, scholarship around Global Mental Health and decolonization emphasizes how knowledge production from various disciplines and regions relates to this topic and could contribute to improving respective approaches. Consequently, this review aims at evaluating the actual transdisciplinary and transregional opening of studies on psychotherapeutic interventions for refugees in Germany. It provides a theoretically as well as empirically informed basis for looking at disciplinary premises, practices, and boundaries as well as the regional locatedness of respective research. Fourteen relevant studies, published between January 1, 2007 and March 4, 2022, were identified by systematically searching the databases PubPsych and Web of Science. The studies were reviewed regarding study design, choice and characterization of target groups, regional origin and target group specific adaptations of the therapeutic concepts, integration of elements from and connections to other disciplines, and use of references to scholarship from the Global South. The findings show a pronounced focus on the development of trauma therapy approaches and moreover a broad variety of concept adaptations in response to the assumed characteristics, situations, and needs of the target groups. While the findings reveal a complex transregional pattern of development and adaptation of the therapeutic concepts, transdisciplinary opening and reference to the Global South appear scarce.

Depression and Global Mental Health in the Global South: A Critical Analysis of Policy and Discourse

Over the past two decades, depression has become a prominent global public health concern, especially in low- and middle-income countries (LMICs). The World Health Organization (WHO) and the Movement for Global Mental Health have developed international guidelines to improve mental health services globally, prioritizing LMICs. These efforts hold promise for advancing care and treatment for depression and other mental, neurological, and substance abuse disorders in LMICs. The intervention guides, such as the WHO's mhGAP-Intervention Guides, are evidence-based tools and guidelines to help detect, diagnose, and manage the most common mental disorders. Using the Global South as an empirical site, this article draws on Foucauldian critical discourse and document analysis methods to explore how these international intervention guides operate as part of knowledge-power processes that inscribe and materialize in the world in some forms rather than others. It is proposed that these international guidelines shape the global discourse about depression through their (re)production of biopolitical assumptions and impacts, governmentality, and "conditions of possibility." The article uses empirical data to show nuance, complexity, and multi-dimensionality where binary thinking sometimes dominates, and to make links across arguments for and against global mental health. The article concludes by identifying several resistive discourses and suggesting reconceptualizing the treatment gap for common mental disorders.

Neurosurgical neuromodulation therapy for psychiatric disorders

Psychiatric disorders are among the leading contributors to global disease burden and disability. A significant portion of patients with psychiatric disorders remain treatment-refractory to best available therapy. With insights from the neurocircuitry of psychiatric disorders and extensive experience of neuromodulation with deep brain stimulation (DBS) in movement disorders, DBS is increasingly being considered to modulate the neural network in psychiatric disorders. Currently, obsessive-compulsive disorder (OCD) is the only U.S. FDA (United States Food and Drug Administration) approved DBS indication for psychiatric disorders. Medically refractory depression, addiction, and other psychiatric disorders are being explored for DBS neuromodulation. Studies evaluating DBS for psychiatric disorders are promising but lack larger, controlled studies. This paper presents a brief review and the current state of DBS and other neurosurgical neuromodulation therapies for OCD and other psychiatric disorders. We also present a brief review of MR-guided Focused Ultrasound (MRgFUS), a novel form of neurosurgical neuromodulation, which can target deep subcortical structures similar to DBS, but in a noninvasive fashion. Early experiences of neurosurgical neuromodulation therapies, including MRgFUS neuromodulation are encouraging in psychiatric disorders; however, they remain investigational. Currently, DBS and VNS are the only FDA approved neurosurgical neuromodulation options in properly selected cases of OCD and depression, respectively.

The burden of mental disorders in Asian countries, 1990-2019: an analysis for the global burden of disease study 2019

Mental disorders are the leading contributors to the globally nonfatal burden of disease. This study was aimed to estimate the burden of mental disorders in Asian countries. Based on GBD 2019, the prevalence and disability-adjusted life of years (DALYs) rates with 95% uncertainty intervals (UI) were estimated in Asian countries. Predictions for the future burden of 8 selected countries, ranks of the burden of mental disorders and correlations with Sociodemographic Index (SDI) were also estimated. During the past 3 decades, while the number of DALYs of mental disorders increased from 43.9 million (95% UI: 32.5-57.2) to 69.0 million (95% UI: 51.0-89.7), the age-standardized rates of DALYs of mental disorders remained largely consistent from 1452.2 (95% UI: 1080.16-1888.53) per 100,000 population in 1990 to 1434.82 (95% UI: 1065.02-1867.27) per 100,000 population in 2019, ranked as the eighth most significant disease burden in Asia in 2019. Depressive disorders (37.2%) were the leading contributors to the age-standardized DALY rates of mental disorders in Asia, followed by anxiety disorders (21.5%). The age-standardized DALY rates in females were higher than their male counterparts, both peaked at 30-34 years. The age-standardized DALY rates were predicted to remain stable, with the number of DALYs presented an upward trend in the future. There was no significant correlation between the burden of mental disorders and SDI. All mental disorders ranked higher in 2019, compared in 1990. To reduce this burden, urgent measures for prevention, treatment, and rehabilitation for mental disorders need to be taken by Asian governments.

Long-term depressive symptom trajectories and related baseline characteristics in primary care patients: Analysis of the PsicAP clinical trial

BACKGROUND

There is heterogeneity in the long-term trajectories of depressive symptoms among patients. To date, there has been little effort to inform the long-term trajectory of symptom change and the factors associated with different trajectories. Such knowledge is key to treatment decision-making in primary care, where depression is a common reason for consultation. We aimed to identify distinct long-term trajectories of depressive symptoms and explore pre-treatment characteristics associated with them.

METHODS

A total of 483 patients from the PsicAP clinical trial were included. Growth mixture modeling was used to identify long-term distinct trajectories of depressive symptoms, and multinomial logistic regression models to explore associations between pre-treatment characteristics and trajectories.

RESULTS

Four trajectories were identified that best explained the observed response patterns: "recovery" (64.18%), "late recovery" (10.15%), "relapse" (13.67%), and "chronicity" (12%). There was a higher likelihood of following the recovery trajectory for patients who had received psychological treatment in addition to the treatment as usual. Chronicity was associated with higher depressive severity, comorbidity (generalized anxiety, panic, and somatic symptoms), taking antidepressants, higher emotional suppression, lower levels on life quality, and being older. Relapse was associated with higher depressive severity, somatic symptoms, and having basic education, and late recovery was associated with higher depressive severity, generalized anxiety symptoms, greater disability, and rumination.

CONCLUSIONS

There were different trajectories of depressive course and related prognostic factors among the patients. However, further research is needed before these findings can significantly influence care decisions.

The impact of food insecurity on mental health among older adults residing in low- and middle-income countries: A systematic review

Over the past few years, food insecurity has been increasing globally due to the COVID-19 pandemic, climate change, economic downturns and conflict and a number of other intersecting factors. Older adults residing in low- and middle-income countries are more vulnerable to food insecurity. While the impacts of food insecurity on physical health outcomes have been thoroughly researched, the effect on mental health outcomes remains under-researched, especially among older adults. Hence, this systematic review aims to investigate existing literature to assess how food insecurity impacts the mental health of older persons residing in LMICs. A systematic search of six databases and Google for studies was conducted. The search was limited to studies written in English and published between 2000 to the present. We identified 725 studies, out of which 40 studies were selected for a full-text review and 12 studies were included for a final analysis. The significant finding in all the included studies was that food insecurity is associated with the worsening mental health of older adults. We also found a complex interplay of factors such as gender, age, rural/urban and health conditions associated with the aggravation of several mental health outcomes. The findings of this study illuminate the need for improved food programs to improve food security and, consequently, mental health among older adults.

Accessibility and Perceived Impact of a Group Psychosocial Intervention for Women in Ecuador: A Comparative Analysis by Migration Status

There is increasing guidance promoting the provision of mental health and psychosocial support programs to both migrant and host community members in humanitarian settings. However, there is a lack of information on the respective experiences and benefits for migrant and host community members who are participating in mental health and psychosocial support programming. We evaluated a community-based psychosocial program for migrant and host community women, Entre Nosotras, which was implemented with an international non-governmental organization in Ecuador in 2021. Data on participant characteristics and psychosocial wellbeing were collected via pre/post surveys with 143 participants, and qualitative interviews were conducted with a subset (n = 61) of participants. All quantitative analyses were conducted in STATA, and qualitative analysis was done in NVivo. Attendance was higher for host community members. Specifically, 71.4% of host community members attended 4-5 sessions, whereas only 37.4% of migrants attended 4-5 sessions (p = 0.004). Qualitative analysis shows that the intervention was less accessible for migrants due to a variety of structural barriers. However, this analysis also demonstrated that both groups of women felt a greater sense of social connectedness after participating in the program and expressed gratitude for the bonds they formed with other women. Some migrant women described negative experiences with the host community because they felt as though they could not confide in host community women and speak freely in front of them. These results underscore how the migratory context influences the implementation of mental health and psychosocial support (MHPSS) programs. As humanitarian guidelines continue to emphasize the integration of host community members and displaced persons, it is critical to account for how the same intervention may impact these populations differently.

Digital psychiatry in low-and-middle-income countries: New developments and the way forward

Low- and middle-income countries (LMICs) bear the greater share of the global mental health burden but are ill-equipped to deal with it because of severe resource constraints leading to a large treatment gap. The remote provision of mental health services by digital means can effectively augment conventional services in LMICs to reduce the treatment gap. Digital psychiatry in LMICs has always lagged behind high-income countries, but there have been encouraging developments in the last decade. There is increasing research on the efficacy of digital psychiatric interventions. However, the evidence is not adequate to conclude that digital psychiatric interventions are invariably effective in LMICs. A striking development has been the rise in mobile and smartphone ownership in LMICs, which has driven the increasing use of mobile technologies to deliver mental health services. An innovative use of mobile technologies has been to optimize task-shifting, which involves delivering mental healthcare services in community settings using non-specialist health professionals. Emerging evidence from LMICs shows that it is possible to use digital tools to train non-specialist workers effectively and ensure that the psychosocial interventions they deliver are efficacious. Despite these promising developments, many barriers such as service costs, underdeveloped infrastructure, lack of trained professionals, and significant disparities in access to digital services impede the progress of digital psychiatry in LMICs. To overcome these barriers, digital psychiatric services in LMICs should address contextual factors influencing the delivery of digital services, ensure collaboration between different stakeholders, and focus on reducing the digital divide.

More reliable biomarkers and more accurate prediction for mental disorders using a label-noise filtering-based dimensional prediction method

The integration of neuroimaging with artificial intelligence is crucial for advancing the diagnosis of mental disorders. However, challenges arise from incomplete matching between diagnostic labels and neuroimaging. Here, we propose a label-noise filtering-based dimensional prediction (LAMP) method to identify reliable biomarkers and achieve accurate prediction for mental disorders. Our method proposes to utilize a label-noise filtering model to automatically filter out unclear cases from a neuroimaging perspective, and then the typical subjects whose diagnostic labels align with neuroimaging measures are used to construct a dimensional prediction model to score independent subjects. Using fMRI data of schizophrenia patients and healthy controls (n = 1,245), our method yields consistent scores to independent subjects, leading to more distinguishable relabeled groups with an enhanced classification accuracy of 31.89%. Additionally, it enables the exploration of stable abnormalities in schizophrenia. In summary, our LAMP method facilitates the identification of reliable biomarkers and accurate diagnosis of mental disorders using neuroimages.

Transcranial Magnetic Stimulation-Electroencephalography for Biomarker Discovery in Psychiatry

Current diagnosis and treatment of psychiatric illnesses are still based on behavioral observations and self-reports, commonly leading to prolonged untreated illness. Biological markers (biomarkers) may offer an opportunity to revolutionize clinical psychiatry practice by helping provide faster and potentially more effective therapies. Transcranial magnetic stimulation concurrent with electroencephalography (TMS-EEG) is a noninvasive brain mapping methodology that can assess the functions and dynamics of specific brain circuitries in awake humans and aid in biomarker discovery. This article provides an overview of TMS-EEG-based biomarkers that may hold potential in psychiatry. The methodological readiness of the TMS-EEG approach and steps in the validation of TMS-EEG biomarkers for clinical utility are discussed. Biomarker discovery with TMS-EEG is in the early stages, and several validation steps are still required before clinical implementations are realized. Thus far, TMS-EEG predictors of response to magnetic brain stimulation treatments in particular have shown promise for translation to clinical practice. Larger-scale studies can confirm validation followed by biomarker-informed trials to assess added value compared to existing practice.

Community-based rehabilitation for people with psychosocial disabilities in low- and middle-income countries: a systematic review of the grey literature

BACKGROUND

Community based rehabilitation (CBR) aims to promote the inclusion and participation of people with disabilities, particularly in low- and middle-income countries (LMICs). Yet people with psychosocial disabilities are often excluded from CBR programmes. The restrictive inclusion criteria used by previous reviews make it difficult to identify promising examples that could otherwise help to inform the uptake of CBR for people with psychosocial disabilities. We aim to address this gap using gold standard methods for the review and synthesis of grey literature on CBR for people with psychosocial disabilities in LMICs.

METHODS

Our search strategy was developed in consultation with an expert advisory group and covered seven grey literature databases, two customised Google Advanced searches, 34 targeted websites and four key reports. A single reviewer screened the search results and extracted relevant data using a standardised format based on the World Health Organisation's CBR matrix. The included programmes were then checked by a second reviewer with experience in CBR to ensure they met the review's criteria. A narrative synthesis with summative content analysis was performed to synthesise the findings.

RESULTS

The 23 CBR programmes identified for inclusion spanned 19 countries and were mostly located in either rural areas or urban areas where a large proportion of the population was living in poverty. 13 were classified as livelihood programmes, eight as empowerment programmes, seven as social programmes, seven as health programmes and four as education programmes. Only two addressed all five of these components. 12 of the included programmes reported challenges to implementation, with stigma and lack of resources emerging as two of the most prominent themes.

CONCLUSION

This grey literature review identified several CBR programmes and synthesised key learning that would have otherwise been missed by a more traditional review of the published literature. However, as evaluation by implementing organisations is not always conducted to a high standard, the quality of this evidence is generally poor. A flexible monitoring and evaluation framework for CBR programmes could help to reduce heterogeneity in terms of the quality and content of reporting.

Mapping the evidence on psychosocial interventions for migrant populations: Descriptive analysis of a living database of randomized studies

Migrant mental health is a pressing public health issue with wide-ranging implications. Many randomized controlled trials (RCTs) have been conducted in this population to assess the effects of psychosocial interventions. However, the available evidence is characterized by controversy and fragmentation, with studies focusing on different migrant populations, interventions, outcomes, delivery modalities and settings. Aiming to promote systematic reviews of the effectiveness of psychosocial interventions in different migrant groups, we have developed a living database of existing RCTs. The development of the database provides an opportunity to map the existing RCT evidence in this population. A total of 135 studies involving 24,859 participants were included in the living database. The distribution of studies by year of publication aligns with the increasing global migrant population in recent years. Most studies focus primarily on adult participants, with a limited representation of children and adolescents, and a prevalence of female participants, which is consistent with epidemiological data, except for older adults, who are underrepresented in research. Studies predominantly focus on refugees and asylum seekers, likely due to their elevated risk of mental health issues, despite the substantial presence of economic migrants worldwide. While studies mainly involve migrants from the Middle East and East Asia, epidemiological data suggest a broader geographic representation, with migrants coming from Eastern Europe, Latin America and South Asia. The present descriptive analysis of RCTs on mental health and psychosocial interventions for migrant populations provides valuable insights into the existing research landscape. It should be used to inform future research efforts, ensuring that studies are more representative of the global migrant population and more responsive to the mental health needs of migrants in different contexts.

Inverting the deficit model in global mental health: An examination of strengths and assets of community mental health care in Ghana, India, Occupied Palestinian territories, and South Africa

Global mental health [GMH] scholarship and practice has typically focused on the unmet needs and barriers to mental health in communities, developing biomedical and psychosocial interventions for integration into formal health care platforms in response. In this article, we analyse four diverse settings to disrupt the emphasises on health system weaknesses, treatment gaps and barriers which can perpetuate harmful hierarchies and colonial and medical assumptions, or a 'deficit model'. We draw on the experiential knowledge of community mental health practitioners and researchers working in Ghana, India, the Occupied Palestinian Territory and South Africa to describe key assets existing in 'informal' community mental health care systems and how these are shaped by socio-political contexts. These qualitative case studies emerged from an online mutual learning process convened between 39 academic and community-based collaborators working in 24 countries who interrogated key tenets to inform a social paradigm for global mental health. Bringing together diverse expertise gained from professional practice and research, our sub-group explored the role of Community Mental Health Systems in GMH through comparative country case studies describing the features of community care beyond the health and social care system. We found that the socio-political health determinants of global economic structures in all four countries exert significant influence on local community health systems. We identified that key assets across sites included: family and community care, and support from non-profit organisations and religious and faith-based organisations. Strengthening community assets may promote reciprocal relationships between the formal and informal sectors, providing resources for support and training for communities while communities collaborate in the design and delivery of interventions rooted in localised expertise. This paper highlights the value of informal care, the unique social structures of each local context, and resources within local communities as key existing assets for mental health.