BACKGROUND:Although psychiatric comorbidities are common among trauma-exposed individuals with PTSD, their patterns and covariates among refugee adolescents in low-resource settings remain understudied. This study aimed to identify distinct patterns of psychiatric comorbidities and their associated factors among adolescent refugees with PTSD in Nakivale refugee settlement, Uganda. METHODS:In this cross-sectional study, 325 refugee youth were assessed on various PTSD psychiatric comorbidities and covariates of (age, gender, war trauma, post-migration stressors) using MINI International Neuropsychiatric Interview 7.02 and standardized measures of war trauma and post-migration stressors. Latent class analysis (LCA) was used to identify patterns and covariates of comorbidity. RESULTS:Of 269 adolescents with PTSD, 97% had at least one comorbid disorder: panic disorder (88.9%), generalized anxiety disorder (84%), agoraphobia (75.1%), depressive disorder (62.8%), obsessive compulsive disorder (60.6%), attention deficit disorder (43.9%), oppositional defiant disorder (40.9%), conduct disorder (33.8%), and alcohol use disorder (10.8%). LCA revealed three classes: low-moderate comorbidity (n = 66, 24.5%), high internalizing comorbidity (n = 101, 37.5%) with high probabilities of depression and anxiety disorders, and high overall comorbidity (n = 102, 37.9%) with relatively high probabilities of all disorders. The high overall comorbidity class had more girls than the other two classes. Both high comorbidity classes had higher war trauma and post-migration stressors than the low-moderate comorbidity class. CONCLUSIONS:Adolescent refugees with PTSD exhibit high psychiatric comorbidity that clusters in distinct patterns. These findings highlight the need for interventions that address the identified comorbidity patterns, consider gender disparities, and account for cumulative trauma and post-migration stressors to effectively support traumatized youth.

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. .

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.

Alcohol and substance use disorders (ASUD) are highly prevalent among adolescents in sub-Saharan Africa and co-occur with mental health disorders. This study aimed to understand adolescents’ awareness of and attitudes toward ASUD and their mental health literacy, with the long-term goal of informing the development of a preventive intervention. An exploratory qualitative study included 144 adolescents (aged 15–19) in 12 focus group discussions (FGDs). Participants were purposely sampled from three informal settlements in Nairobi and Kiambu counties, Kenya. Separate FGDs were conducted for boys and girls in two age groups (15-17 and 18-19). FGDs were audio-recorded, transcribed, and translated into English as needed, and analyzed using deductive thematic content analysis. Themes were identified to guide the results from the data, including “mental health knowledge”, “Alcohol and Substance Use knowledge”, “predictors of mental health,” and “predictors of ASU usage”. Adolescents identified ASUDs as significant community problems, but at the same time, perceived that some substances like shisha (Hookah) were harmless. They also acknowledged that environmental factors, like financial and social pressures, increase the risk of ASUD. Adolescents made the connection that family members’ alcohol and substance use (ASU) and easy accessibility of alcohol and other substances of abuse in the community present a further risk for substance use. Adolescents highlighted that future interventions should include mental health and substance use education (risks and coping strategies) and access to non-stigmatizing support, including community-based support and virtual engagement via mobile technology. The findings showed that adolescents are aware of ASUD in their communities and its dangers, highlighting the critical need for effective ASU prevention and intervention among adolescents. They identified a combination of community-based support and virtual engagement via mobile technology.

Background:Kenya faces a significant mental health crisis, with 1.9 million reported cases of depression and 10.6% prevalence of post-traumatic stress disorder (PTSD). The economic burden of mental health conditions was 62.2 billion Kenyan shillings in 2021, accounting for 0.6% of GDP. This study performed a cost-benefit analysis (CBA) of Interpersonal Psychotherapy (IPT) and fluoxetine (FLX) for treating depression and PTSD in a primary care setting. Methods:The SMART-DAPPER project in western Kenya (Kisumu County Referral Hospital) employed a Sequential, Multiple Assignment Randomized Trial design to train non-specialist providers in administering IPT and FLX for adult depression and PTSD. A cost-benefit analysis (CBA) compared intervention costs with income gains from increased productivity, using micro-costing for treatment expenses and the World Bank's Living Standards Measurement Study to assess productivity. The benefit-cost ratio was calculated over one and ten years with annual relapse rates of 10%, 25%, and 50%). This study adhered to CONSORT guidelines. Results:The study enrolled 1,918 participants: 986 received IPT and 932 received FLX. Remission was achieved after the first round of therapy by 782 and 798, respectively. IPT averaged 11.5 sessions of 60 minutes, costing in total 5,050 KES ($42.79); FLX averaged 5.3 sessions of 20 minutes, costing 2,511 KES ($21.28), including the medication. Both treatments increased income, with IPT participants gaining 16,242 KES and FLX participants 13,239 KES in the first year. Benefit-cost ratios were 3.2:1 for IPT and 5.3:1 for FLX. Over ten years, FLX showed higher CBA ratios (10 to 31:1) than IPT (6 to 18:1). Conclusion:This study found productivity gains greater than primary care-based treatment costs for IPT and FLX for depression and PTSD in Kenya. FLX demonstrated a more favorable benefit-to-cost ratio. Future research should address the capacity of government health care to sustain delivery of psychological and pharmacological therapy. Ethics registration:The study was approved by the UCSF Institutional Review Board (IRB), the Kenyatta National Hospital-University of Nairobi Ethics and Research Committee, and the Kenya Pharmacy and Poison's Board. It was registered on ClinicalTrials.gov (NCT03466346), registration date 2018-03-15, https://clinicaltrials.gov and conducted by Human Subjects Protections (HSP) and Good Clinical Practice (GCP). The trial was monitored by the United States National Institutes for Health (NIH) through PPD.

IntroductionGlobally, children and adolescents exposed to Adverse Childhood Experiences (ACEs) face an increased risk of developing mental health disorders. The prevalence of these mental disorders is further amplified by the lack of access to specialised mental health treatment especially in low resource settings. There is an urgent need for scalable mental health interventions that can effectively address the needs of these vulnerable populations. Non-specialist-delivered interventions, such as PROACT (Psychoeducation, Relaxation, Problem-solving, Activation, and Cognitive Coping Therapy), represent a promising scalable approach that could help bridge the existing mental health treatment gap in low-resource settings.ObjectivesThis study aimed to assess changes in depression, anxiety, and post-traumatic stress symptoms among children and adolescents exposed to adverse childhood experiences following participation in the PROACT intervention delivered by trained social workers in Nairobi, Kenya.MethodologyMixed-methods pre-post study design was employed. Twenty purposively selected sites across Nairobi County each contributed one social worker (N = 20), who received training to deliver the intervention. A total of 40 children participated and received 4–6 PROACT sessions. Quantitative data were analysed using STATA version 17. Paired t-tests were used to compare baseline and endline scores, while mixed-effects linear regression models with participant ID as a random effect were fitted to estimate changes in outcomes over time and account for repeated measures. Statistically significant improvements were observed across all mental health outcomes. Mean anxiety scores decreased from 6.2 at baseline to 2.7 at endline (mean difference: −3.5; 95% CI: −4.7 to −2.2; p < 0.001), while mean depression scores decreased from 6.4 to 2.9 (mean difference: −3.6; 95% CI: −4.9 to −2.3; p < 0.001). Mean PTSD scores decreased from 16.7 (95% CI: 12.8–20.5) at baseline to 7.3 (95% CI: 4.4–10.1) at endline (mean difference: −9.4; 95% CI: −14.6 to −9.3; p < 0.001). Mixed-effects linear regression analyses corroborated these findings, demonstrating significant reductions in PTSD (β = −9.44), anxiety (β = −3.48), and depression (β = −3.59) symptoms (all p < 0.001).ConclusionThe PROACT intervention was feasible and acceptable when delivered by social workers in Nairobi primary healthcare facilities and was associated with improvements in mental health outcomes among children and adolescents. These findings highlight the potential of task-sharing approaches to expand access to mental healthcare in low- and middle-income countries (LMICs) and warrant further evaluation in controlled studies.

Objective: The prevalence of post-traumatic stress disorder (PTSD) and its risk factors among adult refugees in the context of war-related forced migration is well established. However, reliable data are lacking on war-related trauma among refugee children and adolescents residing in refugee settlements. This study estimated the magnitude of PTSD and its associated factors among children and adolescents in Nakivale refugee settlement, south-western Uganda.Method: We conducted a cross-sectional quantitative study among 325 adolescent (10-19-year-old) refugees, who were selected using a simple random sampling approach. The presence of PTSD was assessed by the Mini-International Neuropsychiatric Interview for Children and Adolescents. The main predictor variables were assessed by structured checklists for war trauma and post-migration using Kobol collect software. Data were exported to Stata 23 for analysis. The prevalence of PTSD was computed using descriptive statistics. Bivariate and multivariate logistic regression analyses were used to determine factors associated with PTSD.Results: The prevalence of PTSD in our study was 83% (269/325, 95% CI 0.782-0.867). Factors associated with PTSD included post-migration difficulties (OR = 4.11, 95% CI 2.52-8.43, p < .001) and exposure to war-related trauma (OR = 2.23, 95% CI 1.16-4.261, p = .016).Conclusion: The high prevalence of PTSD in our sample of refugee children and adolescents is associated with both war trauma and post-migration difficulties. This information is important for the psychological assessment and treatment of the children and adolescents living in the refugee settlement. Identification of potentially modifiable factors in post-migration conditions and acknowledgement of the effects of conflicts on health are of high priority from both societal and global perspectives.

Alcohol and Substance Use (ASU) and mental ill-health among youths is today a global public health concern especially among the urban poor. This pilot study examined the prevalence, patterns and mental health associations of ASU among youths in urban slums. Baseline cross-section data were collected from 94 participants aged 15-24 in two informal settlements in Nairobi. Descriptive statistics analyzed demographic, substance use and mental health variables. Bivariate analyses of associations between ASU scores, sociodemographic factors and mental health symptoms were done. Seventy-eight per cent of participants reported having used alcohol in the preceding 3 months, while 68% and 35% respectively reported cannabis and tobacco use. Concerning frequency of use, 43% used alcohol while 47% used cannabis frequently. Alcohol use was associated with age, depressive symptoms and socio-economic independence. Tobacco use was more common among participants with depression, anxiety and low education levels. Cannabis use was higher in participants living independently, with depression, anxiety and stress and in men. In conclusion the study found prevalent ASU associated with multiple sociodemographic and psychological vulnerabilities. These findings may reflect sample characteristics not generalizable to the population, but they provide preliminary evidence for the need of future studies of integrated preventive interventions.

The global shortage of trained mental health workers disproportionately impacts mental health care access in low- and middle-income countries. In Kenya, effective strategies are needed to scale-up the workforce to meet the demand for depression and post-traumatic stress disorder treatment. Task-shifting – delegating specific tasks to non-specialist workers – is one workforce expansion approach. However, non-specialist workers remain underutilized in Kenya due to a paucity of research on how to scale-up and sustain such service models. Purposive sampling was used to recruit experts from policy, healthcare practice, research, and mental health advocacy roles in Kenya (N = 30). Participants completed concept mapping activities to explore factors likely to facilitate or hinder a collaborative Ministry of Health-researcher training of the mental health non-specialist workforce. Participants brainstormed 71 statements describing determinants and implementation strategies, sorted and rated the importance and changeability of each. Multidimensional scaling and hierarchical cluster analysis quantified relationships between statements. The Exploration, Preparation, Implementation, and Sustainment (EPIS) framework guided cluster interpretation activities. Twelve determinant clusters were identified: 1) Current workforce characteristics, 2) Exploration considerations, 3) Preparation considerations, 4) Sustainment considerations, 5) Inner context implementation processes and tools, 6) Local capacity and partnerships, 7) Financing for community health teams, 8) Outer context resource allocation/policy into action, 9) Workforce characteristics to enhance during implementation, 10) Workforce implementation strategies, 11) Cross-level workforce strategies, and 12) Training and education recommendations. Cluster 8 was rated the most important and changeable. Concept mapping offers a rapid, community-engaged approach for identifying determinants and implementation strategies to address workforce shortages. Organizing results by EPIS phases can help prioritize strategy deployment to achieve implementation goals. Scale-up and sustainment of the non-specialist workforce in Kenya requires formal partnerships between the Ministry of Health and community health worker teams to distribute financial resources and collaboratively standardize training curriculum.

Suicide is a leading cause of death among young people globally. Although suicidality has been studied in various populations, limited research has focused on refugee youth in low and middle-income countries. This study aimed to assess the prevalence of suicidal ideation, suicide attempts, and methods of attempted suicide among refugee children and adolescents in southwestern Uganda. We also examined risk factors associated with suicidal ideation in this population. We conducted a cross-sectional study of 325 refugee children and adolescents selected through simple random sampling in Nakivale Refugee Settlement, southwestern Uganda. Suicidal behavior and post-traumatic stress disorder (PTSD) were assessed using the Mini International Neuropsychiatric Interview for Children and Adolescents, version 7.02 (MINI-KID). Additional variables—including war-related trauma and post-migration experiences were measured using structured checklists administered through KoboCollect. The data were then exported to STATA 17 for analysis. Descriptive statistics were used to calculate the prevalence of suicidal ideation, attempts, and means, while bivariate and multivariate logistic regression analyses were conducted to identify factors associated with suicidal ideation. Of 325 participants, 129 (40

Adolescents and young adults with HIV (AYH) are at greater risk for mental health conditions. Provision of mental health services to AYH is limited by an overburdened and untrained workforce, and psychological interventions ill-adapted for adolescent HIV care. Brief, transdiagnostic psychological interventions delivered in the HIV clinics may address some of these challenges. We will evaluate the PRO-ACT intervention in a hybrid type 1 cluster randomized clinical trial (NCT06247527) in 30 HIV clinics in 3 counties in Kenya. PRO-ACT is a cognitive behavioral therapy with 5 modules: Psychoeducation, Relaxation, prOblem-solving, behavioral Activation and Cognitive coping, delivered to AYH by trained health providers without specialist mental health training in 4-6 sessions within 6 months. We performed stratified randomization with matching to balance for county and facility size to assign 5 intervention (PRO-ACT) and 5 control (standard of care) clinics in each of the 3 counties. Screening of AYH ages 16-24 years will be conducted using the 9-item patient health questionnaire (PHQ-9). Up to 300 AYH with psychological distress (PHQ-9 score>4) will be enrolled in each arm. Further assessments will include the 5-item ASK suicide screening questions (ASQ), 7-item Generalized Anxiety Disorder (GAD-7), 20-item Child and Adolescent Trauma Screen (CATS)/PTSD Checklist for DSM-5 (PCL-5), self-reported treatment adherence, and HIV viral loads. Follow-up assessments will be conducted at month 3, 6, 9 and 12. Mixed methods will be used to measure implementation outcomes, cost-effectiveness, and characterize determinants of implementation. Primary analysis of PRO-ACT effectiveness will be conducted at month 6 (near term treatment effect), and month 12 (treatment effect sustainability) comparing PHQ-9 mean scores between treatment and control groups. Secondary analyses will compare GAD-7, CATS/PCL-5, adherence and viral suppression between the groups. The study will inform integration efforts of holistic mental health services in HIV care.

PURPOSE:This study investigates associations of childhood adversities (CAs) with lifetime prevalence, 12-month prevalence, and 12-month persistence of mental disorders in a large cross-national sample of university students. METHODS:Data came from epidemiologic surveys carried out by the World Mental Health International College Student (WMH-ICS)Initiative across 18 countries (n=60,719). The web-based surveys screened for lifetime and 12-month prevalence and age-of-onset of common DSM-5 disorders (Major Depressive Disorder, Bipolar I/II Disorder, Generalized Anxiety Disorder, Panic Disorder, Posttraumatic Stress Disorder, Alcohol and Drug Use disorders, Attention-Deficit/Hyperactivity Disorder) and five types of CAs (family dysfunction, emotional abuse, physical abuse, sexual abuse, neglect). Multivariable Poisson regression models estimated associations of CA type, number, and frequency with disorders. RESULTS:The majority of incoming students reported exposure to at least one CA (64.9%), including 50.0 % family dysfunction, 42.2 % emotional abuse, 21.2 % physical abuse, 18.8 % neglect, and 5.0 % sexual abuse. Lifetime and 12-month disorders were significantly associated with CAs in multivariable models, although associations with disorder persistence were weaker. Population attributable risk proportions of 12-month disorders associated with CAs were in the range of 40.7-61.0 % for anxiety and mood disorders and 13.5-55.2 % for substance use disorders. CONCLUSION:Six out of ten university students arrive at university having been exposed to CAs. These students have substantially higher risk of mental disorders than other students, primarily due to associations with lifetime risk rather than persistence. Given the considerable distress and impairment caused by mental disorders, these results underscore the need for primary and secondary prevention efforts.

Adverse childhood experiences (ACEs), such as abuse, neglect, and household dysfunction, are linked to adverse mental health outcomes, particularly among adolescents and young adults living in informal urban settlements, where poverty, unemployment, and exposure to violence exacerbate early life adversity. Despite this, research on ACEs and mental health in these contexts remains limited, especially among youth living in informal urban settlements in Nairobi, Kenya. Between September and December 2024, we conducted a community-based study involving 94 youth aged 15 - 24 years living in two informal settlements in Nairobi. Participants were recruited through peer-driven sampling if they had used alcohol or drugs in the past 30 days prior to the study. Data were collected using tablet-based surveys administered in English or Swahili on mental health outcomes of depression (using PHQ - 9), anxiety (assessed by GAD - 7), stress (assessed by stress scale), and ACEs (evaluated by the ACEs scale). We conducted generalized linear models to examine the relationship between ACEs (0 - 2 vs. 3+ experiences) and mental health outcomes. The median age was 21. Most participants were male (54%) and reported three or more ACEs (56%). Even though depression and anxiety scores were low, youth with 3+ ACEs had significantly higher depression and anxiety scores than those with fewer ACEs, but no significant association with stress symptoms was observed. There is a need for early identification of ACEs and the integration of psychosocial support into community-based youth services to prevent the long-term effects of childhood adversity.

Globally, there has not been a standardised approach to ensure that the growing number of people who are not licensed clinicians but are delivering psychological interventions and mental health services have the competencies to deliver those interventions and services safely. Therefore, WHO and UNICEF developed Ensuring Quality in Psychosocial and Mental Health Care (EQUIP). EQUIP is a free resource with a digital platform that can be used to guide competency assessment. We describe EQUIP's 5-year development (2018-23) and the rationale supporting its contents and use. Development phases included establishing consensus for competency-based strategies; selecting foundational competencies; evaluating feasibility of assessments, role plays, and technology; piloting EQUIP when training non-specialists; and public dissemination and ongoing adaptations to increase scalability. From the public launch in March, 2022, through to March, 2024, EQUIP's digital platform has been used in 794 training programmes in 36 countries with 3760 trainees resulting in 10 001 competency assessments.

OBJECTIVE:To investigate the associations of demographic variables, childhood adversities (CAs), and mental disorders (MDx) with onset, transition, and persistence of suicidal thoughts and behaviors (STB) among first-year university students. METHOD:Poisson regression models within a discrete-time survival framework were constructed using web-based self-report survey data from 72,288 incoming university students across 18 countries (response rate=20.9%; median age=19 years, 57.9% female, 1.4% transgender, 21.0% non-heterosexual). These models examined the associations of four demographic variables, five CAs, and eight MDx with STB outcomes. RESULTS:Lifetime prevalence of suicidal ideation, plans, and attempts was 47.0%, 26.0%, and 9.6%, respectively; 12-month estimates were 30.6%, 14.0%, and 2.3%. In unadjusted analyses, associations were strongest between lifetime onset of suicidal ideation and CAs (RR range 4.4-7.0), particularly parental psychopathology (relative risk [RR]=7.0 [95% CI 6.5-7.7]), followed by MDx (RR range 1.3-3.0). Of the demographic subgroups, transgender students had highest risk of STB (lifetime ideation onset RR=2.4 [2.3-2.6]; ideation-to-attempt transition RR=1.5 [1.3-1.8]). In fully adjusted models, strongest predictors of lifetime ideation onset were emotional abuse (RR=2.1 [1.9-2.2]), major depressive disorder (RR=2.0 [1.9-2.1]), and bipolar disorder (RR=1.8 [1.6-2.0]). Ideation-to-attempt transition remained most strongly associated with panic disorder (RR=1.5 [1.3-1.7]), bipolar disorder (RR=1.4 [1.2-1.7]), and sexual abuse (RR=1.4 [1.2-1.7]). Most predictors were significantly but weakly associated with persistence of ideation and plan, while only physical abuse remained associated with repeated suicide attempts (RR=1.3 [1.0-1.8]). CONCLUSION:CAs and MDx are strong predictors of both onset of and transition within the STB spectrum, underscoring the importance of implementing early-life prevention interventions.

This study describes an alternative to face-to-face training method for community health volunteers (CHVs) as used by a collaborative group from the University of Nairobi, University of Washington and the Nairobi Metropolitan Mental Health Team during the COVID-19 lockdown in Kenya. This qualitative study describes the experiences of 17 CHVs enrolled in a training study, required to utilize different digital platforms (Google Meet or Jitsi) as a training forum for the first time. Verbatim extracts of the participants' daily experiences are extracted from a series of write-ups in the group WhatsApp just before the training. Daily failures and success experiences in joining a Google meet or Jitsi are recorded. Then, 17 participants, 10 women and 7 men, aged between 21 and 51 years (mean = 33), owning a smartphone, were enrolled in the study. None had used Jitsi or Google meet before. Different challenges were reported in login to either and a final decision to use Jitsi, which became the training platform. Training CHVs to deliver a psychosocial intervention using smartphones is possible. However, the trainer must establish appropriate and affordable methods when resources are constrained.

SMART DAPPER is an implementation science study responding to mental health treatment gaps for depression and trauma-related disorders in Sub-Saharan Africa (SSA). We report on patient experiences in a study using a Sequential, Multiple Assignment Randomized Trial (SMART) design to test first and second line non-specialist treatment using psychotherapy (Interpersonal Psychotherapy [IPT] or medication (fluoxetine [FLX]), integrated within public sector primary care in western Kenya. An embedded qualitative study conducted in-depth interviews (n = 17) and three (n = 3) focus group discussions with participants (May to October 2021). Audio-recorded interviews were transcribed and translated into English; we deductively and inductively analyzed transcripts guided by grounded theoretical approaches and content analysis. We drew on the health belief model and socio-ecological framework to present findings, including perceived severity (motivations for taking part in the intervention), impacts of the intervention at the individual, interpersonal, and community and health systems levels as well as barriers and facilitators. Participants discussed family and marital conflict, loss of a child, loss of income or a job, and traumatic events such as a death or illness. Impacts at the individual level included reduced headaches, improved appetite and weight management, increased energy, improved sleep, better self-efficacy, and improved concentration, which was reported to lead to increased economic opportunities. At the interpersonal level, participants noted a reduction in conflict, better conflict management and resolution, increased harmony with family and community members, and improved relationships with their partners and children. Perceived challenges included balancing the intervention with livelihoods, preference for traditional medicines, actual or anticipated side effects with medication (FLX), mental health stigma, major life events, and perceived inadequate counseling and challenges with providers. The findings demonstrate the potential of the SMART DAPPER intervention for depression and trauma-related disorder treatments and underscore the challenges and barriers that must be addressed when scaling similar interventions. Trial registration: ClinicalTrials.gov identifier: NCT03466346.

Background The use of feedback to address gaps and reinforce skills is a key component of successful competency-based mental health and psychosocial support intervention training approaches. Competency-based feedback during training and supervision for personnel delivering psychological interventions is vital for safe and effective care. Aims For non-specialists trained in low-resource settings, there is a lack of standardised feedback systems. This study explores perspectives on competency-based feedback, using structured role-plays that are featured on the Ensuring Quality in Psychosocial and Mental Health Care (EQUIP) platform developed by the World Health Organization and United Nations Children’s Fund. Method Qualitative data were collected from supervisors, trainers and trainees from multiple EQUIP training sites (Ethiopia, Kenya, Lebanon, Peru and Uganda), from 18 key informant interviews and five focus group discussions (N = 41 participants). Qualitative analysis was conducted in Dedoose, using a codebook with deductively and inductively developed themes. Results Four main themes demonstrated how a competency-based structure enhanced the feedback process: (a) competency-based feedback was personalised and goal-specific, (b) competency-based feedback supported a feedback loop, (c) competency-based feedback supported a comfortable and objective feedback environment, and (d) competency-based feedback created greater opportunities for flexibility in training and supervision. Conclusions A better understanding of the role of feedback supports the implementation of competency-based training that is systematic and effective for trainers and supervisors, which ultimately benefits the learning process for trainees.

BackgroundScalable PTSD screening strategies must be brief, accurate and capable of administration by a non-specialized workforce.MethodsWe used PTSD as determined by the structured clinical interview as our gold standard and considered predictors sets of (a) Posttraumatic Stress Checklist-5 (PCL-5), (b) Primary Care PTSD Screen for the DSM-5 (PC-PTSD) and, (c) PCL-5 and PC-PTSD questions to identify the optimal items for PTSD screening for public sector settings in Kenya. A logistic regression model using LASSO was fit by minimizing the average squared error in the validation data. Area under the receiver operating characteristic curve (AUROC) measured discrimination performance.ResultsPenalized regression analysis suggested a screening tool that sums the Likert scale values of two PCL-5 questions—intrusive thoughts of the stressful experience (#1) and insomnia (#21). This had an AUROC of 0.85 (using hold-out test data) for predicting PTSD as evaluated by the MINI, which outperformed the PC-PTSD. The AUROC was similar in subgroups defined by age, sex, and number of categories of trauma experienced (all AUROCs>0.83) except those with no trauma history- AUROC was 0.78.ConclusionIn some East African settings, a 2-item PTSD screening tool may outperform longer screeners and is easily scaled by a non-specialist workforce.