Mental health disorders affect around one in seven adolescents globally. In India, home to one-fifth of the world's adolescent population, attention to adolescent mental health is increasing, but access to care remains limited, particularly for Adivasi (Indigenous) adolescents. Understanding how Adivasi adolescents conceptualise psychosocial distress and the kinds of support they value is essential to design supportive interventions. We conducted a qualitative study in rural West Singhbhum, Jharkhand. Using purposive sampling, we recruited 88 participants: 53 adolescents aged 10-19 years, 13 teachers, 11 parents, three community health workers, and eight mental health programme staff aged 18-25 years. Trained peer interviewers conducted semi-structured interviews and group discussions with adolescents in the Ho Adivasi language. A team including experienced Ho researchers and peer interviewers analysed data using the Framework approach. Adolescents, parents, and teachers used variations of the Ho root word "udu" to describe distress. "Udu" denoted thoughts or worries, depending on context. Sources of "udu" included family responsibilities and societal expectations that grew with age: girls were expected to do household work and received less support for school, while boys described income-earning pressures and a lack of emotional outlets. Other "udu" causes included violence at home, school, and public spaces, as well as family separation through migration, remarriage, or parental loss. Impacts of severe "udu" ranged from social withdrawal and strained relationships to early marriage, migration for work, and suicide attempts. Adolescents experiencing "udu" preferred informal support from friends, siblings, or teachers, while those with experience of help from respectful community health workers or trusted, trained older peers valued these. Group-based support was widely acceptable. Strengthening access to early care, alongside measures supporting family livelihoods and social protection, could improve Ho and broader Adivasi adolescent mental health.

In India, an estimated 41% of women report experiencing domestic violence in their lifetime and up to 28% report violence during pregnancy. Our study aims to understand local perceptions/attitudes towards GBV and lived experiences of GBVvictimisation and perpetration in marital relationships in rural Rajasthan. We conducted a focus group discussion with community health workers (n = 7) and interviews with young married men (n = 17) and women (n = 21), and local government officials (n = 2). The data was analysed using thematic analysis with triangulation conducted across methods and researchers. Our findings reveal that women experience multiform violence, including physical, sexual, and economic violence. In the continuum of GBV, violence stems from everyday conditions of disempowerment produced through early marriage and reproduction, norms of hegemonic masculinity, and community norms that normalise violence against women. These conditions of disempowerment lead to women's isolation through control of mobility and surveillance through technology, setting the stage for further violence to occur. Violence prevention efforts in the region must follow a multi-level approach to reduce child marriage through community education and improved enforcement of legislation, enhance reporting and identification alongside help-seeking behaviours through formal or informal channels, transform rigid gender norms, and leverage key actors in the family system such as the in-laws or matchmakers as potential agents of change.

Illicit drug use is a growing concern in India, with a treatment gap of 73%. Explanatory models can offer valuable insights into patients’ understanding of their condition and inform help-seeking and treatment strategies. This study aims to develop an explanatory model to identify barriers and facilitators for help-seeking, desired resources, and treatment strategies among adolescents struggling with illicit substance misuse. Semi-structured interviews were conducted with 23 adolescents seeking treatment for drug use and 25 healthcare providers across three Indian sites. Thematic analysis revealed barriers to help-seeking, such as stigma, lack of awareness, and financial constraints. Family awareness was crucial for recovery, and adolescents sought personalized, comprehensive treatment. Healthcare providers emphasized the need for more government funding and flexible treatment options. These findings provide valuable insights into help-seeking behaviors and treatment preferences, which could enhance treatment engagement and outcomes for adolescents with drug use disorders.

Understanding the experiences of Intimate Partner Violence (IPV) in adolescent dating relationships is critical to addressing its physical and psycho-social impacts. Intervention research on IPV in dating relationships often focuses on high-income contexts. To address this gap, we conducted a systematic review of qualitative studies on dating violence among adolescents and young people aged 10 to 25 years in Low-and-Middle-Income Countries (LMICs). Twelve databases were systematically searched last in March 2023. Twenty-three publications describing 22 qualitative studies across 13 countries met the inclusion criteria. Thematic synthesis of the included study findings led to five themes: experiences of violence, causal attributions, impact, help-seeking and expectations of support. Findings revealed cross-regional experiences of physical violence, sexual coercion, control, and emotional violence both offline and online, associated with physical harm and adverse psycho-social effects. Traditional gender norms were key drivers of dating violence, maintained and normalised by myths of romantic love. Help-seeking was limited to informal sources, unless medical attention was necessary. Our findings highlight the severity of harms associated with dating violence and the limited resources available for adolescents in low-resource settings. We make a case for developing prevention interventions that address risk factors at multiple levels - individual, interpersonal, social and cultural - and that overcome the barriers identified by adolescents and young people from LMIC settings. The review protocol was registered prospectively on PROSPERO (ID: CRD42021267236).

Our mixed-methods study evaluated the acceptability and feasibility of a lay-counselor-delivered low-intensity psychosocial intervention for women who experienced intimate partner violence in India. We found statistically significant improvements in mental health outcomes like depression and anxiety. Participants also reported positive changes in thoughts, behavior, emotional management, relationships, self-care, and daily functioning. The use of lay-counselors offers a scalable solution in resource-limited settings, addressing a critical need in low- and middle-income countries. This approach highlights a novel and effective strategy for supporting IPV survivors in culturally diverse contexts.

Objectives: Strict social distancing and lockdown measures imposed to curb transmission during the early phase of the outbreak of the COVID-19 pandemic posed challenges to people's psychological wellbeing, limited access to social support, and disrupted routine mental health service delivery. In response, a consortium of mental health stakeholders from Goa, India launched the COVIDAV program, which provided pro-bono virtual psychiatric and counselling consultations across India through an online platform. This study describes the acceptability and feasibility of the program from the perspective of various stakeholders. Methods: Data were collected via a survey with clinicians who had volunteered on COVIDAV (n = 40), in depth interviews of the clinicians (n = 14), and focus group discussion with key collaborators (n = 1). Process data were mapped at various stages during the online platform's development and use. The qualitative and quantitative data was analysed using thematic analysis and a descriptive analysis respectively. Results: Over 17 months, 63 clinicians conducted 2245 online sessions through the COVID platform, primarily accessed by youth across the country. The clinicians acknowledged the online platform's ability to enhance access and reduce stigma. Challenges included session time constraints, connectivity issues, and user interface inconsistencies that interfered with clients' accessibility to the services. High satisfaction rates amongst the service providers were reported, with 79.3% content with the service provision and 82.8% with pro bono contributions through the platform. Conclusions: This study illustrates the feasibility, flexibility, and applicability of a rapidly designed pro-bono online platform for delivering mental health care services through the collaboration of stakeholder groups in the mental health care, private, social, and governmental sector. Our findings highlight the potential of rapidly deployed digital platforms, developed via cross-sector partnerships, to meet mental health care needs during unprecedented global emergencies such as the COVID-19 pandemic.

Illicit drug use is a growing concern in India, with a high treatment gap of 73%. Explanatory models can provide valuable insights into the patient’s conception of disease and inform help-seeking, treatment, and recovery. Of the studies that examine adolescent drug misuse in India, none have developed a socio-cultural explanatory model. The aim of our study was to develop an explanatory model to better understand the causal beliefs, social context, and self-perception of illicit drug misuse amongst adolescents in India. We conducted semi-structured interviews with 23 adolescents seeking treatment for drug use disorders and 25 healthcare providers recruited across three sites in India. Thematic analysis was used to analyse data. Most adolescent participants reported using multiple drugs, often in combination with cannabis. Frequent usage was reported i.e., daily at multiple times. Causes of initiation and continued use were peer influence, curiosity and pleasure, psychosocial stressors, family conditions, and systemic risk factors (e.g. socioeconomic instability). Drugs were acquired from various sources, including fellow users and pharmacies. Adolescent participants perceived negative impacts of drug use on physical and mental health, family relationships, and everyday functioning. Our findings on common reasons of drug use initiation, importance of peer relationships in continuation of use, impact of use on various aspects of life and the relationship of illicit drug use with socioeconomic status are consistent with previous research done in India on the subject. Understanding how adolescents and caregivers perceive drug use can help inform patient-clinician rapport, improve treatment compliance and understand intervention effectiveness. Such an explanatory model holds crucial implications for shaping interventions and clinical approaches to address adolescent drug use in India.

Background. Despite the high prevalence of intimate partner violence (IPV) against women in India (33%), there are persistently low rates of disclosure and help-seeking amongst survivors. The aim of this study was to explore both coping strategies employed by survivors and the perceived barriers and facilitators to seeking support from informal and formal resource networks. Methods. We conducted semistructured, in-depth qualitative interviews with thirty-five women survivors of IPV in Goa, India, in secure, private locations, utilizing flipcharts and vignettes to elicit deeper insights into efficacies of support resources. The data were transcribed, translated, and analyzed utilizing qualitative content analysis. Results. The most common coping mechanisms cited by survivors involved passive resistance, such as self-distraction, keeping quiet during violent outbursts, and leaving the home temporarily. Generally, survivors sought support from informal support networks (the natal family, in-laws, neighbors/community members, and close friends) before approaching formal support structures (medical/legal professionals, professors, police, and nongovernment organizations). In fact, informal structures were often facilitators of formal help-seeking. Survivors sought help at various stages of their marital relationship. Primary deterrents to help-seeking included the normalization of IPV by survivors and providers alike, resulting in the stigmatization of disclosing experiences of IPV and ostracism of survivors and close relatives; another barrier was a general lack of awareness of existing support resources. Conclusion. Our findings reveal that there are numerous barriers to help-seeking and shortcomings of support resources. Survivors' evaluations of support resources reveal that robust, community-level, and meso-level structural changes are required to promote help-seeking behaviors, including the destigmatization of IPV amongst providers and broader society and raising awareness of available support resources.

Technology-enabled interventions are often recommended to overcome geographical barriers to access and inequitable distribution of mental healthcare workers. The aim of this study was to examine the acceptability and feasibility of an assisted telepsychiatry model implemented in primary care settings in India. In-depth interviews were conducted with patients who received telepsychiatry consultations. Data were collected about domains such as experience with communicating with psychiatrists over a video call and feasibility of accessing services. Data were analysed using a thematic analysis approach. Patients recognized that technology enabled them to access treatment and appreciated its contribution to the improvement in their mental health condition. They reported that the telepsychiatry experience was comparable to face-to-face consultations. They had a positive experience of facilitation by counsellors and found treatment delivery in primary care non-stigmatizing. While some adapted easily to the technology platform because of increased access to technology in their daily lives, others struggled to communicate over a screen. For some, availability of care closer to their homes was convenient; for others, even the little travel involved posed a financial burden. In some cases, the internet connectivity was poor and interfered with the video calls. Patients believed that scale could be achieved through adoption of this model by the public sector, collaboration with civil society, enhanced demand generation strategies and leveraging platforms beyond health systems. Assisted telepsychiatry integrated in routine healthcare settings has the potential to make scarce specialist mental health services accessible in low resource settings by overcoming geographical and logistical barriers.

AbstractBackgroundAlcohol use is typically established during adolescence and initiation of use at a young age poses risks for short- and long-term health and social outcomes. However, there is limited understanding of the onset, progression and impact of alcohol use among adolescents in India. The aim of this review is to synthesise the evidence about prevalence, patterns and correlates of alcohol use and alcohol use disorders in adolescents from India.MethodsSystematic review was conducted using relevant online databases, grey literature and unpublished data/outcomes from subject experts. Inclusion and exclusion criteria were developed and applied to screening rounds. Titles and abstracts were screened by two independent reviewers for eligibility, and then full texts were assessed for inclusion. Narrative synthesis of the eligible studies was conducted.ResultsFifty-five peer-reviewed papers and one report were eligible for inclusion in this review. Prevalence of ever or lifetime alcohol consumption ranged from 3.9% to 69.8%; and prevalence of alcohol consumption at least once in the past year ranged from 10.6% to 32.9%. The mean age for initiation of drinking ranged from 14.4 to 18.3 years. Some correlates associated with alcohol consumption included being male, older age, academic difficulties, parental use of alcohol or tobacco, non-contact sexual abuse and perpetuation of violence.ConclusionThe evidence base for alcohol use among adolescents in India needs a deeper exploration. Despite gaps in the evidence base, this synthesis provides a reasonable understanding of alcohol use among adolescents in India and can provide direction to policymakers.

Sub-Saharan Africa (SSA) has the fastest growing adolescent population in the world. In addition to developmental changes, adolescents in SSA face health and socioeconomic challenges that increase their vulnerability to mental ill-health. This paper is a narrative review of adolescent mental health (AMH) in SSA with a focus on past achievements, current developments, and future directions in the areas of research, practice and policy in the region. We describe the status of AMH in the region, critical factors that negatively impact AMH, and the ways in which research, practice and policy have responded to this need. Depression, anxiety and post-traumatic stress disorders are the most common mental health problems among adolescents in SSA. Intervention development has largely been focused on HIV/AIDS service delivery in school or community programs by non-specialist health workers. There is a severe shortage of specialised AMH services, poor integration of services into primary health care, lack of a coordinated inter-sectoral collaboration, and the absence of clear referral pathways. Policies for the promotion of AMH have been given less attention by policymakers, due to stigma attached to mental health problems, and an insufficient understanding of the link between mental health and social determinants, such as poverty. Given these gaps, traditional healers are the most accessible care available to help-seeking adolescents. Sustained AMH research with a focus on the socioeconomic benefits of implementing evidence-based, contextually adapted psychosocial interventions might prove useful in advocating for much needed policies to improve AMH in SSA.

Abstract Background Tele-psychiatry is an increasingly acceptable and feasible platform to deliver mental health care with the potential to increase access to care in low-resource settings. We aim to examine the acceptability and preliminary impact of the delivery of assisted tele-psychiatry services in primary healthcare settings in Goa, India. Methods Before-after uncontrolled treatment cohort study. In total, 161 adults with either a mental or alcohol use disorder were provided tele-consultation by psychiatrists through a customised video conferencing platform, along with medication or counselling (via trained lay counsellors) or both as needed. Data on socio-demographics, clinical outcomes and process indicators were collected at baseline and 3 months post-baseline. Paired t tests were used to assess clinical outcomes pre- and post-treatment using the General Health Questionnaire-12 (GHQ-12) and World Health Organisation Disability Adjustment Schedule (WHODAS) 2.0, and logistic regression was used to find associations between changes in these scores and various factors. Results The most common diagnosis was depression (35%). Post-treatment, there was a significant reduction in both GHQ-12 and WHODAS 2.0 scores. Participants showed high satisfaction with the tele-psychiatry services and technology platform. Improvement in GHQ-12 score was associated with being employed [OR 8.74 (1.92–39.75, p = 0.005)] and being a homemaker [OR 6.42 (CI 1.61–25.57, p = 0.008)]. Conclusion Treatment of mental disorders through a tele-psychiatry platform appears to be highly acceptable and is associated with improved clinical outcomes. Considering its potential for scalability, a model of assisted tele-psychiatry integrated into primary care can be an important strategy to increase access to mental healthcare in low-resource settings.

SUMMARYInternet gaming disorder (IGD) is a condition in which the individual is preoccupied with playing online video games and unable to regulate this behaviour, resulting in adverse physical and psychological consequences. Although there is some debate about whether IGD is an addiction or a coping mechanism, global evidence indicates that the condition is increasing in prevalence with recent advances in technology and its higher penetration into routine life. Male children and adolescents located in East Asian countries are at higher risk than others in the world. Attention-deficit hyperactivity disorder, depression and anxiety are typically associated with IGD. Given the continuing ambiguity regarding the diagnosis and screening tools for the disorder, it has become all the more relevant for mental health practitioners and academics to attend to this condition and develop evidence-based treatments. This review summarises both the existing evidence for the disorder and the debates that surround it.

Background: The treatment gap for alcohol use disorders (AUD) in India is the highest among all mental health and substance use disorders. Despite evidence of the cost effectiveness of brief interventions (BIs) for hazardous drinking, implementation in low- and middle-income countries (LMICs) is rare due to several human resource-related barriers. This paper describes the processes and outputs of a study aimed at systematically developing a mobile phone-delivered BI to overcome such barriers. Methods: This is a mixed methods study with four steps: (1) Review of existing relevant evidence base by extracting data from studies cited in two recent, relevant and high-quality systematic reviews; (2) In-depth interviews (IDIs) with 11 national experts in addictions research and practice, and 22 hazardous drinkers; (3) Delphi survey (2 rounds) to identify components for the intervention package through consensus building; and (4) Content and intervention development workshops with a range of stakeholders to develop the intervention package. Results: The research team sourced 72 journal articles from two selected systematic reviews. Key content areas extracted from the studies included facts and statistics about health related to drinking behavior, self-reflection, goal-setting messages, motivational messages, and skills to manage risky situations. The IDIs with experts and hazardous drinkers endorsed most of these content areas as well. The Delphi survey achieved consensus on 19 content areas, which included targeted recommendations, personalized feedback and information, goal management, and coping skills. The content and intervention development workshops resulted in an intervention package delivered over 8 weeks, with the following seven themes guiding the content of the weekly messages: safe drinking/health education, alcohol reduction, drinking and risk management, drinking alternatives, situational content, urge management, and maintenance and relapse prevention. Conclusion: The research team designed this study to consider contextual factors while developing the intervention, which is important to ensure acceptability and feasibility of the intervention. Interestingly, the contextually informed intervention components had several commonalities with BIs developed and tested in highincome countries.