PurposeThis paper aims to assess daily fluctuations in grief reactions among Vietnamese bereaved. Although grief is a universal experience, current understanding of the progression and predictive factors of bereavement-related distress predominantly originates from Western settings. Research indicates cultural variations in the development of grief over time. Notably, there has not been a study investigating how bereavement-related distress manifests in Vietnam. Design/methodology/approachExperience sampling method (ESM) can provide detailed, real-time data on daily reactions. Hundred Vietnamese bereaved adults (>18 years old) who lost a loved one in the last 6 months will complete a 2-week ESM assessment app (mPath) every 3 months for 6 months. The app sends daily reminders to complete a questionnaire about grief reactions and daily life context. Participants will complete a baseline mental health assessment before each ESM period. FindingsData collection for ESM assessments began in June 2025 and will end in December 2025. As of September 2025, 91 participants have been enrolled. A mix of longitudinal and fine-grained data will reveal daily fluctuations of grief reactions, long-term trajectories and associated contextual outcomes. Originality/valueThis study represents the inaugural research endeavor to digitally monitor grief trajectories among Vietnamese bereaved individuals. This study holds substantial potential to contribute to the development of more nuanced, culturally sensitive and technologically advanced bereavement support.

Mental health difficulties affect nearly one billion people globally. Many of these emerge during youth, making early intervention crucial. Vietnam and Cambodia both have young populations, recent histories of conflict and ongoing vulnerabilities, including poverty and urban-rural inequality. Although many children and young people (CYP) experience common mental disorders, access to care is limited by stigma, low mental health literacy and reliance on medicalised, urban-centred services. Building the capacity of community-based stakeholders to deliver mental health interventions offers a promising strategy for health systems strengthening in low- and middle-income countries (LMICs). The Mental health capacity Building and stRengthening In Global HealTh systems (M-BRIGHT) study seeks to build capacity for delivery of a youth mental health intervention in Vietnam and Cambodia. This protocol outlines the intervention phase (phase 3) of the study. This cluster-randomised controlled feasibility trial aims to assess the feasibility, acceptability and potential effects of a co-adapted school-based mental health literacy intervention delivered to adolescents in Cambodia and Vietnam. Seven secondary schools in each country (five intervention, two control) will participate. We aim to recruit ≥175 adolescents in grades 10-11 (aged around 14-18 years at recruitment) per arm in each country (≥700 adolescents overall), along with one parent/guardian per adolescent and ten trained intervention providers per country. The intervention will be delivered over one school year by providers trained in an earlier phase of the study. The intervention combines indoor psychoeducation sessions and peer-led outdoor activities. A mixed methods approach will be used to assess its feasibility, acceptability, fidelity and potential effects. Quantitative measures will be collected through questionnaires at baseline, endline and three months follow-up, including mental health literacy, mental health, wellbeing and parent-reported behaviour. Qualitative interviews and focus groups with adolescents, parents/guardians and intervention providers will explore intervention acceptability. Feasibility criteria include recruitment ≥85%, retention ≥70%, an average of 70% attendance at sessions and ≥70% of sessions delivered as planned. Recruitment took place from September-December (Vietnam) and in November (Cambodia) 2025. Baseline data collection took place in October (Vietnam) and November (Cambodia) 2025; 746 participants were enrolled at baseline across all sites and arms. The intervention will run until May 2026 (Vietnam) and August 2026 (Cambodia), with final follow-up outcome measures expected to be collected by September 2026 (Vietnam) and December 2026 (Cambodia). This study will assess whether a co-adapted, school-based mental health literacy intervention is feasible and acceptable in Cambodia and Vietnam and will explore its potential effects. Findings may inform a future clinical trial and contribute to the evidence base for youth mental health systems strengthening in LMICs. ISRCTN, ISRCTN66038422; https://www.isrctn.com/ISRCTN66038422

Background Mental health is increasingly recognized as a public health priority yet remains under-addressed in Southeast Asia. Digital interventions offer scalable support, but evidence on culturally adapting and evaluating preventive programs in Southeast Asian universities remains limited. This study, conducted within the Erasmus+ MentalHigh project, aimed to culturally adapt and evaluate an online resilience-based program for university students in Vietnam and Cambodia. Methods A mixed-methods design guided the cultural adaptation. Quantitative ratings from the Cultural Relevance Questionnaire (CRQ) were integrated with qualitative feedback from focus groups involving professionals and students. Expert evaluation, iterative qualitative refinement, and end-user validation informed adaptations to language, content, activities, and contextual examples to enhance cultural resonance within local contexts. Results Experts rated the initial adapted version highly across functional, conceptual, and linguistic equivalence (M >4), although lower ratings emerged in more abstract modules. Qualitative feedback highlighted the need for contextualized examples, simplified language, and greater alignment with students’ academic and socioeconomic realities. Following refinements, end users evaluated the revised version positively, with high equivalence ratings across all dimensions (M = 4.34–4.57), supporting its clarity, cultural relevance, and acceptability. Improvements were particularly evident in conceptually complex modules. Discussion Findings support the value of combining standardized cultural relevance assessment with iterative qualitative refinement and end-user validation when adapting digital mental health interventions. This structured approach offers a potentially replicable model for culturally adapting internet-delivered preventive interventions in low- and middle-income settings and may facilitate scalable implementation of mental health promotion programs in Southeast Asian universities.

Purpose: Prolonged Grief Disorder (PGD), recently included in the DSM-5-TR and ICD-11, involves a strong yearning for the deceased, fixation on death, denial, avoidance, negative emotions, and disengagement from daily life, lasting at least six months. However, most studies focus on Western settings, leading to underdiagnosis, inadequate care, and a growing mental health burden in Viet Nam. Design: Experience sampling method (ESM) can provide detailed, real-time data on daily symptoms due to the wave-like nature of grief and its psychological sequelae. 100 Vietnamese bereaved individuals who lost a loved one in the last 6 months will complete a 2-week ESM assessment app (mPath) every 3 months for 6 months. The app sends daily reminders to complete a questionnaire about PGD symptoms and daily life context. Participants will complete a baseline mental health assessment before each ESM period. Findings: Data collection for ESM assessments began in June 2025 and will end in December 2025. As of September 2025, 91 participants have been enrolled. A mix of longitudinal and finegrained data will reveal daily fluctuations and chronicity of PGD symptoms, identify prodromal symptoms predicting onset and severity, unique core symptoms to the Vietnamese bereaved, and factors predicting onset. Originality: This study will be the first to not only digitally screen for mental health distress in Viet Nam, but also the first to study the newly defined condition PGD in Viet Nam.Keywords: grief; experience sampling method; ecological momentary assessment; digital screening; digital mental health; Viet Nam ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The author Clare Killikelly is funded by the Swiss National Science Foundation Starting Grant: TMSGI1_218018 ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethical approval was obtained from the ethics committee of Viet Nam National University, University of Education (No. 25.05/HDDD-DHGD). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors

Telehealth has been proven to be an effective means of delivering psychotherapy, yet there is a lack of evidence in Vietnam where access to psychotherapy is limited. We conducted a study to evaluate the feasibility, acceptability, and preliminary efficacy of Tele-SSM—a mobile health-supported self-management intervention for depression in Vietnam. This was a pre-post, mixed-methods study. Adults aged between 18 and 64 years old with symptoms of depression were recruited and participated in 10 individual weekly sessions delivered remotely by mental health para-professionals. Feasibility was assessed by recruitment capacity, retention, and participant compliance; acceptability by participant satisfaction ratings and in-depth interviews; and preliminary efficacy by changes in depression, anxiety, stress, suicidal ideation, self-esteem, and perceived social support scores from baseline to endline. Seventy-five adults with depression were enrolled and 58 of those completed the intervention. Feasibility was adequate as recruitment, retention, and compliance all exceeded the predefined progression criteria. Recruitment reached 93.75

Objectives: Among adolescents, suicide is a critical global concern, yet research is limited in low- and middle-income countries. The primary aim of this study is to investigate the interrelations among suicide-related factors (specifically, suicidal ideation, suicide literacy, attitudes toward suicide, and intended help-seeking sources) when experiencing suicidality in Vietnam. Additionally, it examines sex differences across these factors and identifies significant predictors of help-seeking intention for suicidality.Methods: A sample of 2 976 Vietnamese adolescents (mean age = 16.0 years, SD = 1.35 years; female = 50.6%) completed self-report measures as part of their annual school screenings.Results: More than one in four adolescents experienced some level of suicidal ideation. Overall, suicide literacy was low, particularly among males, who also reported higher levels of stigmatisation toward suicide. Low suicide literacy was linked to increased stigmatisation of suicidal individuals. Adolescents most commonly sought help from family and friends, rather than from professionals. Contrary to our hypothesis that females, those with lower stigma, and those with higher suicidal ideation would be more likely to seek help, it was found that males, those with higher stigma, and those with lower suicidal ideation demonstrated stronger help-seeking intentions. Additionally, male adolescents exhibited a polarised pattern, reporting both high intentions to seek and not seek help.Conclusion: These findings highlight the need for culturally sensitive and sex-based suicide prevention and intervention for Vietnamese adolescents, as cultural factors and sex roles may shape their perceptions and approaches to addressing suicide.

This article assesses a 10-month co-created universal school-based mental health (SBMH) promotion initiative for adolescents (10-19). The study combined quantitative and qualitative components. Pre- and post-intervention surveys were conducted in four schools in Tanzania (n = 400 baseline, 488 endline, with 100 intervention participants at both) and eight schools in Vietnam (n = 1,036 baseline, 893 endline and 436 in panel). In each country, ~90 qualitative interactions (interviews and focus groups) were held at baseline and endline with adolescents, parents, teachers and service providers (total = ~180). In Tanzania, multivariate analysis indicated significant gains among intervention participants relative to peers. Emotional literacy rose 9.5% (p = 0.007; d = 0.57). Attitudes toward help-seeking (p = 0.021; d = 0.50) and prosocial behaviors (p = 0.043, d = 0.38) also improved Active coping increased 15.6% (p = 0.006; d = 0.55). In Vietnam, emotional literacy increased 5.3% (p = 0.012, η 2 = .019), and positively, emotion-focused coping declined 14.4% (p = 0.032, η 2 = .015). Qualitative evidence reinforces these findings, and suggested spillover effects for nonparticipants. Overall results indicate that co-created universal SBMH initiatives can improve adolescent well-being and offer viable alternatives to limited adolescent-focused mental health services in LMICs.

Adverse Childhood Experiences (ACEs) are generally associated with impaired life functioning, including mental health. Prevalent globally, ACEs’ effects vary across cultural settings and groups. The present study assessed horizontal and vertical individualism and collectivism – key cultural dimensions – as moderators of ACEs’ relations to adolescent aggressive behavior. The study was conducted in Vietnam, a Southeast Asian nation with high levels of collectivism but with levels of individualism increasing with globalization. The cross-sectional study included 644 high-school students (mean age = 16.6 years; 54

Depression presents a substantial world-wide public health burden. Although evidence-based treatments exist, the majority of individuals with depression do not receive evidence-based treatments, particularly in low-and-middle-income countries, due to (a) scarcity of mental health professionals, and (b) mental health-related stigma. One approach addressing these issues is task-shifting, transfer of service provision from fully-trained mental health professionals to non-mental health professionals and lay people receiving focused training in a specific mental health service. Effective task-shifting providers can be trained in a few months, addressing personnel scarcity, and mental health task-shifting services generally occur outside formal mental health sites, reducing stigma. Mindfulness-based interventions such as MBCT are evidence-based treatments for depression. Mindfulness-based interventions are derived from Buddhist meditation but are secular, focused on enhancing emotional and cognitive functioning rather than spiritual growth. The first study goal was to adapt MBCT for use in Buddhist pagoda in Vietnam, a Southeast Asian low- and middle-income country. The second goal is to conduct a cluster-randomized clinical trial of MBCT-VN, implemented in Vietnamese Buddhist pagoda. A cluster-randomized clinical trial design will compare treatment (MBCT-VN) and control (treatment-as-usual: Buddhist Meditation) conditions, with pagoda the cluster unit. Because group assignment occurs at the pagoda-level, assessment and assignment to condition will be non-blinded. There will be five longitudinal assessments: Screening, and T1, T2, T3, and T4 across four months from baseline. One hundred and sixty participants will be recruited for eight Buddhist pagoda (four treatment; four control) around Hanoi, Vietnam. The primary outcome is depression (PHQ-9), the secondary outcome quality of life (Q-LES-Q). Several Implementation Science constructs such as Treatment Acceptability and Program Attitudes will be assessed. This study has several limitations. To reduce cross-group contamination, randomization occurs at the pagoda-level, significantly reducing the number of randomization units, and requiring participants and data collectors to be non-blind to condition. Also, no long-term follow-up assessment is currently planned. Nonetheless this study, one of the first to assess mindfulness-based interventions implemented in Buddhist pagoda, should provide at least preliminary information regarding the potential value of pagoda as a task-shifting site for implementation of mindfulness-based intervention for depression. ClinicalTrials.gov: NCT06598579. 25-Mar-2025.

BACKGROUND:Despite the high burden of depression in Vietnam, little is known about the knowledge, attitudes, beliefs, and practices among Vietnamese people with depression in contemporary society. The study aims to explore in depth knowledge, attitudes, and practices related to depression among those with depressive symptoms of depression in contemporary Vietnamese society. METHODS:This is a qualitative study with 40 adults, 18-64 years old, with symptoms of depression. In-depth interviews were conducted to explore knowledge (symptoms, causes, treatment), attitudes, and practices to seek support or care for depression. RESULTS:Participants demonstrated relatively adequate literacy regarding depression symptoms and treatment. Most people with depression know about psychotherapy and pharmacological treatment. Stigma related to depression seems lesser compared to that in the past. People with depression receive support from family and friends. A significant knowledge-practice gap was found, concealment of illness is common, access to care is limited, medicines are frequently discontinued, and praying and offering to altars to treat mental illness still exist. Based on analysis guided by the 'glocalization theory' we offer an explanatory account of the current state off knowledge, attitudes, and practices toward depression amongst people living with depression in Vietnam. This analysis recognizes the co-existence of global and local influences. People are creating and adapting their "glocal" views, attitudes, and norms around depression as well as mental illness. This explanatory model recognizes the co-existence of global and local influences, the influence of "glocal" dynamics to rationales the knowledge, attitudes and practices of people related to depression, therefore, it helps better explain and sharpen the responses to depression in Vietnam. CONCLUSIONS:Societal changes have influenced the knowledge, attitudes, and behaviors towards depression in Vietnam in positive ways; however, historical, cultural challenges continue, while new challenges are emerging. Our findings point to the need for renewed, continued efforts to improve mental health related awareness, while simultaneously improving the availability, accessibility, and responsiveness of mental health services. These efforts should take into account both global and local influences on how people in Vietnam think and act regarding mental health issues. TRIAL REGISTRATION:Clinicaltrials.gov, NCT06456775. Registered June 13, 2024 - Retrospectively registered, https://clinicaltrials.gov/study/NCT06456775?cond=depression%26intr=Tele-SSM%26rank=1 .

Worldwide, the majority of youth reside in low- and middle-income countries (LMIC). School-based mental health (SBMH) services are particularly important in LMIC, in part because of LMIC's limited mental health infrastructure. Among the challenges to developing SBMH in LMIC are limited implementation science (IS) capacity, critical for identifying barriers to evidence-based intervention (EBI) use and dissemination, etc., specific to the local country context. A key step in IS capacity development is conducting a needs assessment, to identify barriers (and their solutions) to IS development itself within the local context. The present study conducted an IS needs assessment focused on SBMH in the Southeast Asian LMIC of Vietnam. Seventy-five Vietnamese mental health professionals in SBMH-related fields participated in a mixed-methods study. Vietnamese SBMH researchers and practitioners most likely to have experience and/or interest in IS were selected for study recruitment. Professionals' formal understanding of and experience with IS as a scientific field was highly limited. However, after reading a brief but detailed description of IS, participants' interest in IS training was high, and their mean rating of its potential utility for Vietnam to develop SBMH was 4.7 on a 1-5 scale. Participants also reported on barriers and potential solutions for EBI use in SBMH in Vietnam. Contrary to expectations, the most frequent and severe barriers were not financial but related to limited stakeholder engagement. Overall, these and other study results provide some suggestions how IS capacity to support SBMH may be most efficiently developed in settings such as Vietnam. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Suicide is a significant concern globally, although research among adolescents in low- and middle-income countries remains scarce. This study aims to investigate gender differences and the factors that can contribute to Vietnamese adolescents’ intention to seek help when experiencing suicidal thoughts. A total of 2,976 adolescents reported their level of suicidal ideation, suicide literacy, attitudes toward suicidal individuals, and preferred sources of help. One third of them experienced suicidal ideation. Mean suicide literacy was generally low but was lower in males. Low suicide literacy also correlated with higher level of suicide stigmatization, and males reported more stigmatization towards suicidal individuals. As expected, adolescents sought help from families and friends more than from professionals. Contrasting to our hypothesis, being male, having more stigma, and less suicidal ideation predicted more help seeking intention. The results of this study highlight the importance of careful suicide prevention and intervention strategies for this population.

School setting is an effective environment for primary mental health care for students. There have been many mental health support programs in schools for students, most of which are predesigned. The objectives of this paper are: i) To introduce the co-creation approach; and ii) To narratively describe the process of co-creating a mental health promotion program for 04 secondary schools and 04 high schools in Nghe An and Khanh Hoa, Vietnam. Students, teachers, parents and local authorities were the involved stakeholders. Mixed methods including narrative research, observations, open-ended and closed-ended questionnaires were used. The results show that using co-creation approach to develop a mental health promotion program is feasible and applicable in Vietnam. Challenges, learnt lessons and discussion about feasibility of the co-creation process to develop the school-based mental health promotion program are also mentioned in the paper.

Psychopathology is defined in part by its impacts on life functioning (e.g., fulfillment of daily responsibilities at work or school, in family relationships). Relations to life functioning are particularly important in the validation of culture-specific syndromes (patterns of mental health symptoms specific to a particular culture), to demonstrate that culture-specific symptom patterns do in fact represent pathology. The current study's goal was to assess the construct validity of the Cambodian Somatic Symptom and Syndrome Inventory (CSSI). The study focused on the statistically unique effects of the CSSI on life functioning (i.e., effects of the CSSI on life functioning, controlling for Western psychopathology syndromes), to determine whether the CSSI contributes information beyond standard Western measures, which would support CSSI culture-specific convergent validity. Because adolescence is a key period when psychopathology often develops, study participants were 391 high-school students in one urban and one rural area of Cambodia. Participants completed the CSSI, the Western psychopathology surveys Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder questionnaire (GAD-7), and life functioning measures assessing functional impairment, quality of life, and help-seeking. Results indicated strong CSSI concurrent validity (canonical correlation = 0.75) with the PHQ-9 and GAD-7, and CSSI total effects convergent validity on life functioning indicators. All CSSI statistically unique effects (controlling for the PHQ-9 and GAD-7) on life functioning measures were non-significant indicating that the CSSI, shown to be a valid assessment measure in the current study, does not add predictive information beyond standard Western measures. A key limitation that should be considered in interpretation of these results is that the life functioning measures, although reviewed by Khmer psychologists, were Western-based, thus potentially inflating relations with Western psychopathology measures.

Introduction:Traffic accidents are a leading cause of death globally, with substantial economic impact particularly in low-and-middle-income countries (LMIC). Adolescents are at particular risk, partly due to their tendency to engage in risky driving. However, most research designed to identify potential causes of risky adolescent driving has been conducted in Western, high-income countries, which often have substantial cultural differences from LMIC that potentially influence risky adolescent driving.Methods:The present study, one of the first focused on this topic in Southeast Asia, cross-sectionally assessed 425 adolescent motorbike drivers in the Southeast Asian LMIC Cambodia. Adolescents' (a) beliefs about peers' driving (social norms) and (b) driving risk perception were assessed as predictors of four risky driving behaviors: aggressive driving; distracted driving; intoxicated driving; violating driving laws.Results:Canonical correlation analysis identified a general relation between (a) beliefs about peers' driving, and (b) all four risky driving behaviors, with R2 = 0.35 indicating over one-third of the variance in risky driving was explained by perceptions of peers' driving. Risk perception was not involved in the significant canonical relation, however. Gender moderated two of the underlying relations, with females showing larger relations between perceptions of friends' driving, and distracted driving and violating driving laws.Discussion:These findings provide useful directions for future research (e.g., assessing the accuracy of Cambodian adolescents' perceptions of peers' driving) useful for helping stakeholders tailor road safety programs (e.g., providing adolescent drivers with accurate information regarding their peers' actual driving behaviors) for adolescent motorcyclists in Cambodia and similar countries.

Opinion statement While videoconferencing has become a common tool for remote communication in health-related services such as psychotherapy, scientific evidence for its outcomes is scarce in the population of youth with problematic anxiety. This paper reviews the primary and secondary outcomes of cognitive behavioral therapies (CBT) delivered via videoconferencing for youth with subclinical or clinical anxiety. Quantitative and qualitative studies focusing on youth (aged 7 to 20), anxiety, CBT, and videoconferencing were systematically searched on Embase, PubMed, PsycINFO, and ERIC databases. Eight studies met the inclusion criteria, of which seven were extracted for quantitative data. Out of the seven studies, only one study was quasi-experimental with an in-person CBT comparison group, while another study was a small-scaled randomized controlled trial with a waitlist control group. The pooled sample size was 213 children and adolescents. Significant changes in primary (i.e., anxiety symptoms and severity) and secondary outcome measures (e.g., global functioning and life interference) at post-treatment of videoconferencing-based CBT were reported, but lacking a control group in a majority of the studies reduces the finding’s validity. Satisfaction, treatment completion rate, and therapist’s fidelity were rarely reported but found to be high in some studies. None of the studies reported negative effects specific to videoconferencing-based CBT. The current evidence for this topic is somewhat limited in terms of quantity and quality. Replication studies in low- and middle-income countries are also lacking. More well-designed trials are needed to provide more conclusive evidence for the videoconferencing modality, which may help scale up psychological interventions for a highly prevalent problem such as youth anxiety in remote or low-income areas.

Mental health in young people is a public health challenge worldwide, with around one-fifth of university students suffering from a 12-month mental disorder. In low- and middle-income countries (LMICs) of Southeastern Asia, resources for mental health are limited and counseling services are not regularly established at universities. This review aims to determine the prevalence of mental health problems among university students in six ASEAN (Association of Southeast Asian Nations) countries (Cambodia, Laos, Malaysia, Myanmar, Thailand, and Vietnam) and to identify the determinants of mental health. A systematic database search (PubMed, CINAHL, PsycINFO, PubPsych, and Scopus) for peer-reviewed, English language articles, published 2010-2020, reporting prevalence data based on standardized screening instruments resulted in 335 articles; 108 were eligible for full-text analysis, of which 34 could be included in the review. Median point prevalence was 29.4% for depression, 42.4% for anxiety, 16.4% for stress, and 13.9% for disordered eating. Current suicidality was present in 7% to 8% of students. There was a high rate of psychiatric comorbidity. Despite the high prevalence of mental health problems, the willingness to seek professional help was comparatively low. Implications for mental health promotion and prevention in university settings are discussed.