Dementia is a global public health concern with increasing prevalence, especially in low- and middle-income countries (LMICs) where care is primarily provided by informal family caregivers. This study identified the specific training needs of informal caregivers of persons with dementia in rural southwestern Uganda to inform the development of contextually appropriate caregiver training interventions. We conducted 20 in-depth interviews with 17 caregivers and 3 key informants affiliated with Reach One Touch One Ministries (ROTOM), a community-based organization supporting older persons in Rukiga District, Uganda. Interviews were audio-recorded, transcribed verbatim, and analyzed thematically using an inductive approach. Caregivers demonstrated limited knowledge of dementia, often attributing it to normal aging, spiritual causes, or stress. They faced substantial physical, emotional, and financial burdens, and relied on faith, social support, and adaptive caregiving strategies. All expressed willingness to attend group-based, in-person training focused on practical skills, including communication, managing dementia-related behaviors, personal hygiene, nutrition, and medication administration. Key informants highlighted the importance of community awareness to address misconceptions. Informal caregivers in rural Uganda experience high caregiving burden and unmet training needs. The identified training priorities closely align with World Health Organization (WHO) iSupport domains, supporting adaptation of the program for rural Ugandan caregivers.
This study evaluated 1) foundational helping competencies for Non-Specialist Providers (NSPs) trained in a transdiagnostic CBT-based intervention (PRO-ACT) for adolescents with anxiety and depression in Nairobi, Kenya and 2) preliminary clinical outcomes for adolescents receiving PRO-ACT. Seventeen NSPs were trained and assessed using role plays at pre-training, post-training, and post-supervision using the Enhancing Assessment of Common Therapeutic Factors (ENACT) tool, via a pre-post design (no control group). Eighteen adolescents were enrolled, received 4-6 PRO-ACT sessions, and assessed using the Patient Health Questionnaire-9 (PHQ-9) and Revised Children's Anxiety and Depression Scale (RCADS-25). There were no significant changes in NSPs' competencies from pre- to post-training. From pre-training to post-supervision, NSPs' Level 1 (Potentially harmful) scores significantly decreased (-1.12 items; 95% CI: -2.10, -0.15; p = 0.026) and Level 3 or 4 ("Basic" or "Advanced competency") significantly increased (2.12; 95% CI: 1.21, 3.04; p < 0.001). Adolescents had no significant change in mean PHQ-9 scores. RCADS scores decreased significantly for depression (-3.00 points; 95% CI: -5.45, -0.55; p = 0.020) and anxiety (-3.39 points; 95% CI: -6.17, -0.61; p = 0.020). NSPs' foundational helping competencies improved significantly during clinical supervision. Client outcomes were promising, warranting a larger rigorous trial.
Mental health outcomes, such as depression and stress, are shaped by various factors, including childhood abuse, emotional and physical awareness deficits like alexisomia and sociodemographic influences. This study aimed to investigate the mediating role of alexisomia in the relationship between childhood abuse and mental health outcomes, specifically depression and stress, among Lebanese adults. A cross-sectional study was conducted in July 2024, enrolling 1,205 participants via a snowball sampling technique from various Lebanese regions. Higher childhood abuse was significantly associated with greater alexisomia, depression and stress. Mediation analyses with adjustment for covariates (gender, smoking, socioeconomic status, etc.) revealed that alexisomia mediated the association between childhood abuse and both depression (Beta = 0.018; Boot CI: 0.002-0.034) and stress (Beta = 0.005; Boot CI: 0.001-0.009). Higher childhood abuse was significantly associated with higher alexisomia and directly associated with higher depression/stress. Higher alexisomia was significantly associated with higher depression/stress. The findings suggest the need for greater clinical focus and targeted interventions to enhance emotional and physical awareness and improve mental health outcomes, particularly for individuals with a history of trauma.
As trauma-informed care (TIC) becomes more integrated into healthcare systems, consistent and meaningful evaluation remains limited. Educational interventions are central to implementation, yet outcome measures vary widely. This scoping review systematically mapped outcome measures used to evaluate TIC educational interventions in healthcare settings to identify current practices, methodological gaps and opportunities for more coherent and context-sensitive assessment. The review followed PRISMA-ScR guidelines. Five databases (MEDLINE, EMBASE, PsycINFO, CINAHL, ERIC) were searched from database inception to October 2024. Eligible studies described TIC educational interventions for healthcare providers and reported at least one outcome related to knowledge, attitudes, confidence, competence, or behavior. Two reviewers independently screened and extracted data on study design, participants, intervention characteristics and outcome measures. Outcomes were categorized using Moore's Expanded Outcomes Framework, which includes seven hierarchical levels from participation to patient or community health outcomes. Twenty-eight studies met inclusion criteria, most published after 2020 and conducted in the United States. Outcome measurement was dominated by self-reported data, primarily custom pre-post surveys assessing knowledge, confidence or attitudes. Only eight studies used validated tools, most commonly the ARTIC-35 or ARTIC-45. Few assessed behavioral or system-level change, and none directly measured patient outcomes. Educational formats ranged from brief online modules to multi-session interdisciplinary trainings. A small subset explored relational or equity-oriented outcomes such as empathy or cultural humility, often using qualitative methods. This review highlights the field's reliance on short-term, self-reported outcomes and limited use of validated or standardized measures. Developing accessible, equity-informed tools that capture behavioral and system-level change is essential to advance research, guide policy and sustain trauma-informed transformation across healthcare systems.
Gender-based violence (GBV) is a global public health crisis exacerbated in fragile settings by gender inequalities, displacement, and resource scarcity. While mental health and psychosocial support (MHPSS) interventions aim to support people with experience of GBV, research on their effectiveness across diverse fragile contexts remains limited. In this review, we answer the following questions: (1) What type(s) of MHPSS interventions are commonly implemented with survivors of GBV in humanitarian/fragile settings? (2) What outcome(s) are targeted by MHPSS interventions implemented for those exposed to GBV in fragile settings? (3) What is the reported effectiveness of these interventions in addressing these specified outcomes? Seven electronic databases (PubMed, PsycINFO, Cochrane, CINAHL, ERIC, ProQuest, and Web of Science) and grey literature were searched for studies published up to July 2024. Following screening of 2,268 titles and abstracts, 157 full texts were screened (20% independently), with included studies analysed using narrative synthesis. Quality of studies was assessed using the Quality Assessment with Diverse Studies (QuADS). Forty-seven studies are included in this review. MHPSS interventions addressed four broad categories of outcomes: mental health, incidences of GBV, social and community outcomes, and women's economic empowerment. MHPSS interventions for GBV survivors in fragile settings show promising mental health benefits, with the highest quality evidence found for cognitive behavioural therapy-based approaches in reducing post-traumatic stress, depression, and anxiety. Economic and psychosocial empowerment interventions also led to reduced incidences of intimate partner violence, enhanced financial autonomy, and shifts in social norms, though some interventions yielded mixed or non-significant effects. While many MHPSS interventions for people who had experienced GBV led to meaningful improvements in mental health, GBV reduction and economic empowerment, variability in effectiveness highlights the need for culturally adapted, context-specific approaches and further research on long-term effects in fragile settings.
Substance use and mental health symptoms frequently co-occur among youth in Nairobi's informal settlements, yet scalable interventions remain limited. This pilot study evaluated the Youth Empowerment Digital Intervention (YEDI), a brief group cognitive-behavioral therapy model supported by mobile reinforcement. A clustered-community randomized pilot study enrolled 94 adolescents and young adults aged 15-24 years (treatment = 49; control = 45). The intervention group received seven weekly 1-hour manualized group cognitive-behavioral therapy sessions supplemented by mobile skill reinforcement, while control participants received standard health materials. Alcohol, cannabis, and tobacco use risk, along with depression, anxiety, and stress symptoms, were assessed at baseline, 3 months, and 6 months using linear mixed-effects models. YEDI demonstrated promising short-term reductions in alcohol risk, cannabis risk, and depressive symptoms at 3 months, although these differences were not sustained at 6 months. Tobacco risk did not differ between groups, and stress showed counterintuitive relative effects due to reductions in the control group. Delivering YEDI in informal settlements is feasible and provides a proof of concept for brief, early mental health support. Preliminary findings indicate that brief, skill-based models alone cannot offset severe structural stressors. Multi-level interventions integrating behavioral strategies with ongoing community support are required. .
Mental disorders are major contributors to the global burden of disease and may show correlated incidence patterns across countries. We characterized the country-level ecological network of age-standardized incidence rates for 10 mental disorders, identified statistically central disorders and examined how individual countries influenced estimated network connectivity. Data for 204 countries and territories, including Sociodemographic Index values, were obtained from the Global Burden of Disease Study 2023. A regularized network model using the mgm framework estimated conditional associations among country-level variables. Strength centrality and case-deletion delta-centrality analyses assessed disorder connectedness and country influence, with bootstrap procedures evaluating stability. Approximately 400 million incident cases of the studied disorders were estimated globally in 2023. Anorexia nervosa and bipolar disorder had the highest strength centrality, indicating broader conditional connections with other disorders. Australia, the United States, Iran, China and Finland showed relatively large delta-centrality values, suggesting greater influence on estimated centrality than most countries. Strength centrality stability was acceptable but modest. These findings provide a descriptive, hypothesis-generating view of how modeled incidence rates covary across countries and should not be interpreted as individual-level comorbidity, causal influence or direct policy priority.
People with physical disabilities in low- and middle-income countries experience elevated rates of psychological distress. This study explored the impact of a peer support intervention ('friendship group') for people with disabilities attending prosthetic and orthotic clinics in Cambodia. A total of 462 individuals were screened using the Kessler Psychological Distress Scale (K10), 47 met inclusion criteria (scores 20-29). Of these, 27 enrolled in the intervention, while 20 did not participate. Psychological distress was assessed across four domains of the K10 (nervousness, agitation, fatigue and negative affect). Intervention participants were measured at three time points (2 baseline measures and 1 follow-up), non-participants contributed baseline data only. Quantitative data were analysed using linear mixed-effects models, qualitative data from post-intervention focus groups (n = 21) were analysed thematically. Reductions in K10 scores were observed across all domains following the intervention (p < 0.001). Qualitative findings highlighted perceived benefits including restored family and community roles, emotional relief and improved self-regulation. Given the pre-post design without a full comparator group, findings should be interpreted cautiously. This exploratory study suggests that peer support may offer a feasible and culturally acceptable route to support people with disabilities in low-resource settings.
Adolescent involvement in mental health prevention research remains limited in low-resource settings. This study examined the feasibility, acceptability, processes and perceived impacts of adolescent advisory groups (AAGs) within the ALIVE research in Colombia, Nepal and South Africa. Using a convergent mixed-methods design, we analysed data collected between October 2022 and August 2025 using surveys with adolescents (t1: n = 33; t2: n = 26), focus group discussions (n = 6 with adolescents; n = 2 with caregivers), interviews (n = 8 with adolescents; n = 5 with facilitators), process documents (n = 58) and post-session feedback (n = 7). Participation was highly valued by most adolescents, who were motivated by altruism, peer connection, skill development and project incentives. Most adolescents strongly agreed they could express their views freely (t1: 79%; t2: 81%) and felt listened to (t1:76%; t2: 81%, respectively). Participants reported experiences of trust, confidence and collective agency; challenges included stigma, unequal participation and logistical barriers. Facilitators' relational and adaptive support appeared central to sustaining engagement. Adolescent members contributed in important ways to the ALIVE research. Adolescent involvement in prevention research in low-resource settings is feasible and can be experienced by participants as valuable.
Cancer stigma, both underaddressed and understudied, remains a pervasive challenge in sub-Saharan Africa. Currently, the region is experiencing rising cancer incidence alongside some of the lowest cancer survival rates worldwide. With complex and multifaceted sociocultural factors contributing to this stigma and subsequent lack of screening, low treatment adherence and poorer health outcomes, it is critical to implement effective interventions in the region, at both the clinical and policy levels. To achieve a path forward, it is necessary to create targeted efforts that incorporate existing infrastructure and key cultural contexts.
Displaced persons with non-communicable diseases (NCD) face challenges in disease management and increased risk of mental health problems. This randomized controlled trial assessed the impact of psychotherapy treatment (Common Elements Treatment Approach [CETA]) on hypertension and diabetes mellitus medication adherence (primary) and mental and physical health outcomes (secondary) among displaced Myanmar adults with poor medication adherence in a Thai shelter community. Treatment participants received weekly CETA for 4-12 weeks; comparison participants had access to routine psychosocial support. Eligible participants were chronic disease patients with <70% medication adherence over prior month. Data were collected at baseline, 3 and 6 months. Of 650 adults screened, 283 (43.5%) met eligibility criteria and 224 consented (CETA n = 112, comparison n = 112) to participate; 73 (32.6%) reported elevated mental health symptoms. At 6-month follow-up, medication adherence improved in both arms, with greater improvements among CETA participants (MARS-5: 0.55, 95% CI: 0.07 to 1.02, p = 0.023). CETA significantly reduced mental health symptoms among those with elevated symptoms at baseline (-3.06, 95% CI: -5.19 to -0.93, p = 0.005). The high rate of mental health symptoms and the impact of CETA on NCD medication adherence supports integration of mental health services into NCD care systems.
Cognitive impairment affects over 75% of young people with first-episode psychosis (FEP), yet cognitive rehabilitation is rarely available within public mental health services in sub-Saharan Africa. This implementation gap reflects both limited intervention availability and insufficient planning for local service realities. This article describes the participatory development of a Theory of Change (ToC) for the CognIFiEd study, a task-shifted Compensatory Cognitive Training intervention for young adults with FEP across three tertiary psychiatric hospitals in South-West Nigeria. Guided by WHO ExpandNet, RE-AIM, the Consolidated Framework for Implementation Research and established ToC methods, 25 stakeholders, including young people with lived experience, caregivers, clinicians, facilitators, administrators, policymakers and implementation scientists, co-produced and validated an implementation logic model through five workshops. The ToC identifies four core inputs: trained non-specialist facilitators, culturally adapted manuals, low-technology SMS and print reinforcement systems, and stakeholder engagement structures. These support weekly group sessions, caregiver psychoeducation, digital reinforcement, supervision and outpatient integration. Immediate outputs include cognitive strategy use, retention, social reintegration and caregiver skill development, while proximal outcomes include neurocognition, functional capacity, self-efficacy and caregiver strain. The model also specifies assumptions, LMIC-specific barriers, mitigation pathways and an accountability ceiling for distinguishing pilot outcomes from longer-term system impacts.
We assessed the prevalence of probable depression and anxiety among young people in Ghana to inform evidence-based responses to youth mental health needs. This subnational high-risk population survey was conducted among 602 young people (YP) aged 13-24 years across three ecological zones of Ghana. Screening was done using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder (GAD-7) tools. Demographic, social and economic indicators were assessed. Logistic regression was used to generate adjusted relative risk (aRR) with 95% confidence intervals (CIs). There was evidence of probable depression and anxiety among participants surveyed. In total, 8.6% (95% CI, 6.5-11.2) of the participants met criteria for probable depression, 5.9% (95% CI, 4.2-8.2) for probable anxiety and 2.8% (95% CI, 1.6-4.5) for comorbid depression and anxiety (cDA). Correlates of cDA included living in a household enrolled in two or more social protection programs (aRR: 3.70; 95% CI, [1.00-13.66]; anxiety: 3.63 [1.57, 8.4]; depression:1.93 [1.00, 3.71]) and being currently in school (aRR: 2.82; 95% CI, 0.78-10.10). The burden of probable depression or anxiety evidenced in this study underscores the need to integrate mental health promotion and screening into existing social protection schemes and school-based interventions to enhance early detection and support for youth mental health in Ghana and similar LMIC settings.
Task-sharing psychological treatment to non-specialist providers, including lay health workers (LHWs), is central to WHO guidance in low- and middle-income countries (LMICs). LHWs are community members without formal mental health qualifications who are trained to deliver low-intensity psychological interventions (LIPIs) for depression and anxiety. Although trials show LHW-delivered LIPIs can reduce symptoms, less is known about LHWs' experiences or the relational and emotional demands of delivery. This review synthesised qualitative evidence on LHWs' experiences of delivering LIPIs in LMICs. We searched CINAHL, Embase, PsycINFO, MEDLINE, Cochrane Central, ASSIA and ProQuest Dissertations & Theses Global to June 2025, supplemented by grey-literature searches. We included qualitative, mixed-methods studies reporting interview or focus group data from LHWs delivering LIPIs for adults with depression and/or anxiety. Data were synthesised using meta-ethnography; quality and confidence were assessed using CASP and GRADE-CERQual. Thirty-three publications representing 28 studies from Africa, Asia and Latin America were included. Four themes were generated: doing more than psychological therapy; embedded in the community yet precariously held by the system; growing in the role; and the hidden cost of caring. Task-shifting redistributes not only technical tasks but also relational and emotional labour to LHWs, requiring support through training, supervision, safety and remuneration.
Understanding correlates and potential causes of mental illness stigma in community-based settings in low- and middle-income countries (LMICs) is important for developing effective interventions to reduce stigma and demand-side barriers for treatment. This study analyzed data from structured questionnaires administered to 178 respondents in the Buyende district in Eastern Uganda to investigate sociodemographic and clinical factors correlated with mental illness stigma. Factor analysis of 33 items revealed a single dominant factor reflecting mental health stigma. Bivariate and multivariate analyses of sociodemographic and clinical correlates were used to identify factors associated with stigma in the entire sample and separately within the subgroups with evidence of mental illness. In the entire sample, female gender was the only independent correlate of stigma. Analysis of the mental illness subgroup also showed that women had high levels of mental illness stigma. These findings suggest that female gender appears to be a more important correlate of mental health stigma than clinical factors. Nevertheless, effective destigmatizing interventions are needed for the entire population, with additional approaches specifically tailored to women.
Climate-related worry is increasingly recognized as a mental health concern and a potential correlate of pro-environmental behavior (PEB). However, little is known about these associations in the Global South or the potential role of mindfulness. This crosssectional study examined relationships among climate change anxiety, psychological distress, mindfulness, and PEB in 340 university students (aged 19-25 years) from Islamabad and Rawalpindi, Pakistan. Data were collected between January and June 2024 using validated measures of climate change anxiety (Climate Change Anxiety Scale), psychological distress (DASS-21), dispositional mindfulness (MAAS), and PEB. Analyses included bivariate correlations, block-wise linear regression, and mediation models (PROCESS Model 4; 5,000 bootstrap resamples). Climate change anxiety was positively correlated with psychological distress (r = .47, p < .001) and indirectly associated with lower PEB through distress (ab = -.09, 95% CI [-.15, -.04]). Regression analyses showed that mindfulness was positively associated with PEB (β = .27, p < .001), whereas distress (β = -.22, p = .002) and climate change anxiety (β = -.18, p = .018) were negatively associated with PEB. Mindfulness was indirectly associated with higher PEB through lower distress (ab = .11, 95% CI [.05, .19]) and lower climate change anxiety (ab = .08, 95% CI [.02, .15]), while also showing a direct positive association with PEB. These findings highlight mindfulness as a relevant factor for understanding climate-related distress and environmental engagement among young adults.
This qualitative study explores how women survivors of intimate partner violence (IPV) cope with abuse and reconstruct well-being and meaning in their lives. The study was conducted with 16 women aged between 27 and 51 living in three cities in the southeastern region of Türkiye. Participants were recruited through women's shelters and non-governmental organizations (NGOs) using purposive and snowball sampling. Data were collected through semi-structured interviews and analyzed using thematic analysis. The findings indicate that women's experiences of violence were shaped by sociocultural gender norms and included physical, psychological, sexual, and economic abuse. Participants described multiple coping strategies, including seeking social support, emotional expression, religious coping, and resisting stigmatization. Women's pathways toward well-being involved gaining economic independence, developing healthier communication patterns, and investing in personal development. Meaning-making processes included redefining self-identity, motherhood, reconnecting with positive experiences, and interpreting survival as a source of strength. The findings highlight survivors' agency and resilience and underline the importance of social, psychological, and economic support mechanisms in facilitating recovery following IPV.
Suicide is a significant global public health concern, and conventional clinical risk assessment is constrained by workforce availability, scalability, and clinician variability. The classic suicidality risk evaluation is largely dependent on clinical judgment, which, although helpful, can demonstrate a ceiling effect in its predictive validity. AI-driven chatbots, conversational systems that engage users in real-time natural language dialog, have emerged as candidate tools for augmenting suicide risk detection and prevention. This narrative review aimed to: evaluate the performance of AI-driven chatbots in detecting and assessing suicidal ideation relative to clinical benchmarks; examine the effectiveness of chatbot-based interventions for suicide prevention; and identify ethical, cultural, and implementation challenges limiting clinical translation. Six electronic databases were searched, with the initial search conducted in 2024 and updated in 2026 through targeted monitoring, with no upper cutoff date applied. A thematic narrative synthesis approach was applied across five domains. Eleven primary studies met eligibility criteria and were included in the synthesis. Chatbot-based risk assessment showed adequate response alignment with expert judgment at the extremes of suicide risk, but consistently failed to distinguish intermediate risk levels across multiple model families. Across 29 tested commercial chatbot agents, none met the criteria for an adequate suicidal crisis response. A clinically designed, framework-anchored chatbot achieved high efficacy across six outcome domains. Three percent of social chatbot users reported halted suicidal ideation, and a purpose-built clinical chatbot in emergency department settings significantly improved evidence-based care delivery. Systematic risk severity underestimation and the absence of cross-cultural evaluation were identified across all studies. AI-driven chatbots show potential as adjunctive tools across the suicide care continuum. Clinically designed, evidence-anchored chatbots demonstrate feasibility and meaningful benefit; commercially deployed chatbots without clinical validation demonstrate near-universal crisis response inadequacy. Mandatory clinical validation prior to public release, clinician oversight, and crisis system integration are prerequisites for responsible deployment.
