Introduction:Suicide is a critical public health issue worldwide. Risk factors are exacerbated by cultural stigma, socioeconomic hardship, and limited mental healthcare access. However, few studies have examined the lived experiences of suicide attempt survivors in Africa to probe the underlying drivers. Objectives:To explore the lived experiences and perceived drivers of suicide attempts in rural Uganda among individuals with lived experience, their families, healthcare providers, and community health workers. Methods:We conducted in-depth qualitative interviews in Buyende District, Uganda from June to August 2023 with a purposive sample of 54 participants aged 23 to 70: people who had survived a suicide attempt (n = 18) and their family members (n = 17), healthcare providers (n = 10), and community health workers (n = 9). Interviews were recorded, transcribed, translated, and analyzed using a thematic framework method. Results:Four main themes emerged as critical factors leading to suicide attempts: (1) familial and spousal conflict, involving relationship breakdown, resource denial, and social isolation; (2) financial stress, including chronic poverty, acute debts, and perceived socioeconomic failure; (3) mental illness and substance use, notably depression, psychotic symptoms, and alcohol use complicating existing psychological distress; and (4) religious and spiritual influences on the attribution of suicidal thoughts. Conclusion:In this qualitative study from rural Uganda, suicide attempts across were perceived to result from intertwined interpersonal, economic, mental health, and spiritual factors. Participants rarely framed suicide as the result of a single cause, but rather as a response to cumulative and unresolved distress. Moments of missed support suggest opportunities for targeted intervention.
There is a lack of high-quality evidence on cash transfers as an intervention to support young people with first-episode psychosis (FEP) in Africa. To address this gap, we conducted a pilot randomized controlled trial (RCT) with a 3-month follow-up period to assess the feasibility and acceptability of an unconditional cash transfer (UCT) intervention among FEP. We enrolled 60 unemployed young adults (18-29 years) with FEP from three public hospitals in KwaZulu-Natal, SA, and allocated participants into the intervention (n = 30) or the control arm (n = 30) using simple randomization. The intervention arm participants received a monthly transfer of R1,350 for three consecutive months. All 30 participants in the intervention arm completed the three-month follow-up, and 24 (80%) completed follow-up in the control arm. Although the effect of UCT on clinical and social outcomes is not the primary focus of this RCT, we observed significantly greater quality of life (p < 0.05) and medication adherence (p < 0.02) in the intervention group as compared to control group at the 3-month follow-up period. Although personal/social functioning challenge (p = 0.24) and cumulative relapses (p = 0.10) were greater in the control group, no statistically significant group differences were observed. Our study contributes the first evidence on UCT feasibility and acceptability for FEP.
Introduction: Suicide is a major public health burden globally, and cultural and social factors have been found to substantially impact how suicidal ideation manifests. However, little research on these impacts has been conducted, particularly in low-and-middle income countries, which often face higher mental health burdens and limited access to care. In Cambodia, trauma exposure is high and cultural beliefs, particularly stemming from religious views of trauma, may increase experiences of shame and guilt. This research seeks to identify how trauma and cultural variables may interact with each other and serve as mechanisms of risk for the development of negative outcomes like suicidal ideation in Cambodia. Methods: This secondary analysis of cross-sectional data used the PCL-5 and the shame and guilt subsections of the DES-IV to examine contributions of PTSD severity, shame, and guilt as individual and interactive determinants of suicidal ideation in a sample of 191 Cambodian individuals. A series of ordinal logistic regressions were conducted to identify how these variables contribute to increased severity of suicidal ideation. Results: Forty percent of the sample endorsed severe suicidal ideation and suicidal ideation was significantly related to PTSD severity (r = 0.65, p < .001), shame (r = 0.64, p < .001), and guilt (r = 0.65, p < .001). The best-fitting ordinal logistic regression model found that shame and guilt were significantly related to suicidal ideation, but PTSD severity was not. Conclusion: These results suggest guilt and shame are important cultural and religious factors associated with trauma exposure and subsequent symptoms. Future research should investigate these mechanisms further, particularly with a focus on the development or refinement of existing trauma interventions to emphasize the constructs of shame and guilt within a culturally sensitive framework in Khmer individuals.
The high prevalence and comorbidity of anxiety/depression (A/D) disorders in children negatively impact their quality of life. The Unified protocol for Transdiagnostic treatment of Emotional Disorders in Children (UP-C) improves children's emotional symptoms by addressing the underlying factors of A/D disorders, thereby enhancing children's quality of life. The present study investigated whether UP-C could improve emotional symptoms and quality of life in children aged 8 to 12 by focusing on transdiagnostic factors, rather than addressing specific symptoms of A/D disorders. 38 Children (21 girls) with A/D disorders were randomly assigned to two experimental and control groups. The experimental group received 15 sessions of the UP-C, while the control group received the Progressive Muscle Relaxation. The results showed that the UP-C effectively improved symptoms of depression, separation anxiety, panic, social anxiety, and overall quality of life. However, there was no significant reduction in symptoms of generalized anxiety and obsessive-compulsive disorder compared to the control group at both post-test and follow-up. -The findings suggested that individual UP-C treatment improved children ' s ability to regulate their emotions and enhanced their overall quality of life. It is recommended that future studies involve a larger sample size, use parental versions of Revised Children Anxiety and Depression and PedsQL, and extend the follow-up period.
The increasing prevalence of mental health issues among students has serious implications. This study aimed to determine the prevalence of mental health issues, associated factors, and demand for mental health support among pharmacy students at a university at Ho Chi Minh city. A cross-sectional study was conducted from April to May 2024, using an anonymous, self-administered survey. Of 1,609 respondents, 74.4% experienced symptoms of at least one of three mental health conditions: stress, anxiety, or depression. Notably, 94.4% expressed the need for mental health support services. Financial difficulties significantly increased the risk of stress (OR = 1.09; 95% CI: 1.03-1.14), anxiety (OR = 1.59; 95% CI: 1.28-1.97), and depression (OR = 1.84; 95% CI: 1.49-2.27). Poor academic performance was also associated with stress (OR = 1.13; 95% CI: 1.03-1.25), anxiety (OR = 2.06; 95% CI: 1.33-3.18), and depression (OR = 4.22; 95% CI: 2.75-6.46). LGBTQIA+ students had higher odds of stress (OR = 1.19; 95% CI: 1.08-1.30) and anxiety (OR = 2.54; 95% CI: 1.64-3.95) compared to male students. Living alone raised the risk of stress (OR = 1.10; 95% CI: 1.02-1.18) and depression (OR = 1.76; 95% CI: 1.27-2.42). These findings underscore the urgent need for mental health services to support pharmacy students' well-being.
Around 70% of Africa's population is under 30, yet many young people face challenges which contribute to psychological distress. Studies have shown gender, financial status, and religiosity can serve as both risk and protective factors depending on the biological, psychological, social, and spiritual factors young adults are exposed to. However, research in the area tends to focus primarily on adolescence. This study investigated the presence of anxiety, depression, and post-traumatic stress symptoms among young adults in South Africa investigating the influence of gender, perceived financial status, and religiosity on anxiety, depression, and post-traumatic stress. Data from 729 South African young adults in the Africa Long Life Study were analyzed. Measures included the International Mental Health Assessment (IMHA) anxiety, depression, and PTS subscales, self-reported gender and financial status and the Duke University Religion Index (DUREL). While anxiety, depression and PTS level were low, commonly endorsed symptoms included excessive worry, decision-making difficulties, and intrusive memories. The strongest predictor of anxiety, depression, and post-traumatic stress was gender, followed by perceived financial status and organizational religious activity. Financial insecurity and identifying as female were linked to greater psychological distress, while higher organizational religious activity served as a protective factor across anxiety, depression, and post-traumatic stress. Findings highlight the urgent need for targeted, contextually relevant mental health interventions, particularly for young women and financially insecure individuals. Results also support integrating a biopsychosocial-spiritual framework into mental health services to address the complex needs of South African youth.
Depression is linked to negative interpretations of ambiguous events, which can reinforce symptoms. Cognitive bias modification-interpretation (CBM-I) is an experimental paradigm adapted to create a class of digital interventions to address negative interpretations, though its training materials can be resource-intensive to develop. Here, we used Generative AI to produce CBM-I training materials and compared them with human-generated materials. The aims were: (1) to test whether adults with lived experience of depressive symptoms consider AI-generated materials comparable to human-generated materials in representing depressive experiences, as measured by readability, relevance, and emotional valence; and (2) to evaluate the overall ratings of AI-generated materials independent of human benchmarks. We created 100 raw scenarios and adapted them into standard CBM-I format, with half of the items generated by AI and half by adults with lived experience of depressive symptoms. Separate groups of participants (N = 30 each) rated the raw and CBM-I items. Results showed that, apart from emotional valence ratings, ratings of human-generated and AI-generated items were statistically nonequivalent and different. These differences, however, were small (range 0.03-0.41). Furthermore, both sources produced ratings in the same direction, consistent with the intended emotional content of the materials, with more polarized ratings of AI-generated items. Future studies are needed to determine whether these statistical differences impact training outcomes and to ascertain the reliability and validity of AI-generated materials.
The WHO's Mental Health Gap Action Programme (mhGAP) offers an evidence-based framework to integrate mental health into primary health care (PHC), especially in low- and middle-income countries (LMICs). In Lagos State, Nigeria, the mhGAP-Intervention Guide (mhGAP-IG) was delivered to over 850 PHC workers across 57 facilities through the Mental Health in Primary Care (MeHPriC) initiative. This study explores the implementation experiences of frontline workers and stakeholders three months post-training. We conducted 12 focus group discussions and 10 key informant interviews with a purposive sample of PHC workers and system actors, analyzing data using the Consolidated Framework for Implementation Research (CFIR). Five major themes emerged: enhanced provider confidence and role expansion; attitudinal shifts and stigma reduction; supervision and peer support as enablers; systemic barriers such as medication shortages and infrastructure gaps; and grassroots adaptations to sustain delivery. WhatsApp-based peer networks and provider-led innovations were key facilitators. While mhGAP training improved competencies and reduced stigma, systemic constraints hindered sustainability. Strengthening supervision, medication supply chains, and acknowledging provider agency are critical for successful scale-up. These findings inform future efforts to embed mental health into PHC systems in LMICs through locally grounded and system-sensitive implementation strategies.
BackgroundDepression remains a widespread mental health disorder with significant impacts on individuals' well-being and social functioning. Traditional treatments often have limited efficacy, especially in treatment-resistant cases. Recently, intranasal esketamine has emerged as a novel therapeutic option, offering rapid symptom relief. This study aims to systematically review the benefits, challenges, and future recommendations regarding the clinical use of intranasal esketamine for patients diagnosed with depression.MethodWe conducted this scoping review following Arksey and O'Malley's framework and in accordance with PRISMA guidelines. We performed a comprehensive search of multiple electronic databases to identify relevant studies published between 2018 and 2024. Two reviewers independently extracted and analyzed the data using thematic analysis to ensure reliability, while peer debriefing helped us maintain the rigor of our review process. Additionally, we registered the study protocol in the PROSPERO database (CRD42024629649).ResultsForty-seven studies were included, revealing key benefits such as efficacy in reducing depressive symptoms, rapid onset of antidepressant action, safety and tolerability profile, durability of antidepressant effects, comparative effectiveness with other treatments, and impact on suicidal ideation. Challenges identified include regulatory hurdles, lack of clinical experience, long-term safety concerns, insurance coverage issues, patient noncompliance, and adverse psychological reactions. Future recommendations emphasize enhanced provider training, longitudinal safety studies, improved access and coverage, integration into comprehensive treatment plans, patient education, and standardization of protocols.Discussion and ConclusionIntranasal esketamine presents a promising advancement in depression treatment, especially for resistant cases. Addressing regulatory, clinical, and safety challenges is crucial for broader adoption.
This study explores the psychopathological dimensions and emotional regulation challenges in adults with probable Attention-Deficit/Hyperactivity Disorder (ADHD). A large-scale anonymous survey was conducted among members of an association of people suffering from ADHD (HyperSupers TDAH France). The survey, divided into two parts, collected data from 510 participants on ADHD-specific questionnaires and 394 participants on comorbid conditions including addictions, anxiety, depression, and perceived stress. The findings reveal that adults with probable ADHD exhibit significant levels of anxiety (64.7%), depression (38.3% with moderate to severe levels), and difficulties in emotional regulation. Additionally, there is a high prevalence of comorbid psychiatric disorders, with 42.3% experiencing depression, 46.8% anxiety disorders, and substantial rates of substance and behavioral addictions. Correlations between ADHD symptoms and emotional dysregulation were especially correlated with anxiety, depression and stress. All findings are cross-sectional and should be interpreted as associations rather than causal effects. The study provides a domain-specific map linking discrete emotion-regulation processes to functional impairment in adults with probable ADHD, independent of depressive symptoms, anxiety, and perceived stress. This simultaneous modeling clarifies which regulation processes represent plausible, modifiable targets for intervention.
Despite the increasing recognition of peer support in mental health services, standardization of training programmes remains underdeveloped, with limited consensus on essential training elements. This co-created study aimed to establish consensus on elements of peer support training. The study was conducted by researchers and members of peer support associations. A review of 64 peer support training programmes informed the development of a preliminary list of training elements and features. Then 73 stakeholders were invited to two rounds of Delphi consultations to rate the importance of training elements and related factors. Delphi consultations highlighted essential topics for training, i.e. self-disclosure practices and boundary-setting. Educational institutions were strongly endorsed as accrediting bodies for training programmes. Key attributes for peer support workers to be hired were identified, although none reached formal consensus. Recommended duration of training was 27 training sessions on average, with considerable variation in session duration. The study provides a comprehensive framework for peer support training, recommending structured, modular, and accredited training programmes to professionalize and sustain peer support services. Future research should validate these findings in diverse cultural and healthcare contexts and explore the long-term impact of such training programmes on peer support practice and outcomes.
