BACKGROUND:Suicidal ideation is a key mental health concern and a strong predictor of suicide attempts. While loneliness is a well-established correlate of suicidal ideation, few studies have explored how this association varies across sociocultural groups, especially among migrants. OBJECTIVES:The study examines the relationship between migrant status, loneliness, and suicidal ideation among adults aged 18-64 residing in the provinces of Barcelona and Madrid. Specifically, it investigates: (1) whether Latin American immigrants report higher loneliness than native-born Spaniards; (2) whether immigrant status is linked to increased suicidal ideation; and (3) whether the association between loneliness and suicidal ideation differs by migration status. METHODS:Data were drawn from the 2019 'Edad con Salud' cohort, comprising 1724 participants born either in Spain or Latin America. Suicidal ideation and major depressive disorder were assessed using the CIDI 3.0, while loneliness was measured with the 3-item UCLA Loneliness Scale. Ordered and binary logistic regression models were used to estimate associations, including interaction effects between loneliness and migration status. RESULTS:Latin American immigrants reported significantly higher levels of loneliness but not higher rates of suicidal ideation. Loneliness was associated with suicidal ideation only among native-born Spaniards. Depression and poor self-rated health were strong predictors of suicidal ideation across the full sample. CONCLUSIONS:The mental health impact of loneliness appears to be moderated by sociocultural context. Among Latin American immigrants, factors such as familism and the healthy migrant effect may protect against the psychological consequences of loneliness, despite its higher prevalence.

BackgroundMigrants are at increased risk for mental health problems due to stressors before, during, and after migration. However, evidence on the factors associated with migrant mental health in Spain remains limited.ObjectivesTo examine how four domains– (1) sociodemographic and psychological characteristics, (2) migration-related factors, (3) social and occupational conditions, and (4) health-related quality of life factors–are associated with post-traumatic stress disorder (PTSD), anxiety, and depression among migrants.MethodsA cross-sectional survey was conducted between June 2021 and October 2022 among 509 adult migrants residing in Spain. PTSD, anxiety, and depression were assessed with the Post-Traumatic Stress Disorder Checklist for DSM-5 (PCL-5), the 7-item Generalized Anxiety Disorder Scale (GAD-7), and the Composite International Diagnostic Interview (CIDI), respectively. Multivariable logistic regression and Tobit models were used to examine associations between the four domains and mental health outcomes.ResultsWomen reported higher anxiety and depression, whereas younger age was associated with higher anxiety. Migrants from the Americas reported higher anxiety and depression, whereas those from Europe exhibited greater PTSD symptomatology, although this finding should be interpreted with caution given the very small European subsample. Childhood trauma was positively associated with PTSD, anxiety, and depression. Regarding migration-related factors, frequent acculturative stress and longer length of stay in Spain were associated with higher anxiety, whereas travelling alone was associated with higher depression. Within the post-migration social environment, perceived discrimination was positively associated with both PTSD and anxiety. Regarding pandemic-related factors, COVID-19-related stress was positively associated with PTSD but inversely associated with depression, whereas general stress was consistently associated with all three mental health outcomes. Lower physical quality of life was associated with higher anxiety and depression, while lower mental quality of life was associated with worse PTSD, anxiety, and depression.ConclusionThe findings support a multifactorial understanding of migrant mental health, highlighting the combined influence of pre-migration adversities, migration-related experiences and post-migration conditions. Interventions targeting modifiable factors, particularly acculturative stress, perceived discrimination, and quality of life, may contribute to improving mental health among migrant populations.

Introduction Migrant populations, especially women, are often more susceptible to poor mental health and they face healthcare access barriers. This study aims to develop and evaluate a community-based mental health intervention through a participative research process to promote mental health and prevent psychiatric disorders among migrant women in Barcelona city. The intervention is built upon two evidence-based guidelines: Group Problem Management Plus (Group PM+) and Self-Help Plus (SH+). Methods “Self-Care Among Women” is a mixed-methods process evaluation study for the development of a community-based psychological pilot intervention. A participatory approach will be employed to adapt the content agenda of the community mental health intervention. Process indicators on context, implementation and mechanisms of change will be assessed through an intersectionality lens to explore the way in which the intervention is developed and implemented. The contextual fit, acceptability and feasibility of the proposed psychological intervention will be examined through participants' and facilitators' perceptions of the intervention. Further, women's clinical mental health condition and wellbeing will be assessed before and after the intervention, through standardized and culturally-validated instruments. Ethics and dissemination Ethical approval of the research protocol has been obtained by the Research Ethics Committees of Hospital Clínic, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol) and Parc Sanitari Sant Joan de Déu. Written informed consent will be requested from all research participants for inclusion in the study. The study results will be published in peer-reviewed journals and communicated to congresses.

This study aims to assess the contextual fit, acceptability and feasibility of the “Self-Care Among Women” community-based group psychological intervention, inspired by Group Problem Management Plus, targeting migrant women in Barcelona, Spain. A mixed-methods process evaluation study was conducted from November 2023 to December 2024 to evaluate the pilot implementation of the intervention. Eligibility for participation was assessed through GHQ-12, WHODAS 2.0 and clinical observations. Process outcome measures were collected through structured observation and logsheets, as well as focus group discussions with women and interviews with facilitators – community psychologists and intercultural mediators. Clinical outcomes were measured at three time points. A grounded theory approach was employed to analyse the qualitative data. A total of 30 migrant women participated in four multicultural intervention groups, with a retention of 90%. Our results showed that the intervention addressed the diverse needs of migrant women through an intersectional lens, providing resources to cope with adversity while genuinely promoting social ties among women with diverse cultural backgrounds. Clinical outcomes showed a considerable improvement. Mechanisms of change suggested the need for integrating intercultural mediators in the facilitation of such interventions to bridge communication and cultural perspectives, and generate bonds. However, this requires strong institutional commitment to ensure their presence at public services. Further, established community-based referral networks can facilitate migrant women’s navigation through relevant resources. In a highly culturally diverse urban context, community-based mental health can enhance reachability. Such approaches can amplify migrants’ perspectives of wellbeing while breaking stereotypes around women’s position in certain communities. Within the framework of prevention of psychiatric disorders and?mental health promotion, “Self-Care among Women” proposes mechanisms of innovative change in migrant mental health.

BACKGROUND:Non-suicidal self-injury (NSSI) is associated with mental disorders, yet work regarding the direction of this association is inconsistent. We examined the prevalence, comorbidity, time-order associations with mental disorders, and sex differences in sporadic and repetitive NSSI among emerging adults. METHODS:We used survey data from n = 72,288 first-year college students as part of the World Mental Health-International College Student Survey Initiative (WMH-ICS) to explore time-order associations between onset of NSSI and mental disorders, based on retrospective age-of-onset reports using discrete-time survival models. We distinguished between sporadic (1-5 lifetime episodes) and repetitive (≥6 lifetime episodes) NSSI in relation to DSM-5 mood, anxiety, and externalizing disorders. RESULTS:We estimated a lifetime NSSI rate of 24.5%, with approximately half reporting sporadic NSSI and half repetitive NSSI. The time-order associations between onset of NSSI and mental disorders were bidirectional, but mental disorders were stronger predictors of the onset of NSSI (median RR = 1.94) than vice versa (median RR = 1.58). These associations were stronger among individuals engaging in repetitive rather than sporadic NSSI. While associations between NSSI and mental disorders generally did not differ by sex, repetitive NSSI was a stronger predictor for the onset of subsequent substance use disorders among females compared to males. Most mental disorders marginally increased the risk for persistent repetitive NSSI (median RR = 1.23). CONCLUSIONS:Our findings offer unique insights into the temporal order between NSSI and mental disorders. Further work exploring the mechanism underlying these associations will pave the way for early identification and intervention of both NSSI and mental disorders.

Abstract Research has shown that traveling alone, suffering adverse stressful experiences, and living separately from family are risk factors for mental health problems in youth migrants. Against this background, unaccompanied minor migrants (UMMs) are one of the most vulnerable migrant populations. However, further investigation is needed to identify the factors related to the migration process that can impact the health of this population in Spain. This chapter aims to identify the relevant social determinants of health among newly arrived UMMs, encompassing factors before, during, and after migration. This aim is accomplished using a qualitative methodology to identify the voices of UMMs. Specifically, 15 semi-structured interviews were conducted as part of the national action-research Migrasalud project (II IN 190517 EN 162 FA 01). The interviews were transcribed, translated (from Arabic to Spanish), and analyzed through content analysis. The results showed that UMMs perceived themselves as having good health before the migration process. They often had unrealistic expectations before migrating, experienced adverse experiences during the journey, and, after arrival, had to cope with post-migration risk stressors such as socio-labor difficulties and discrimination, which affected their well-being and mental health. The findings also underline some relevant health and social challenges, such as the need to assess mental health care, considering the specific stages of the migratory cycle in the UMM population from a person-centered approach, the promotion of cross-cultural mental healthcare models, and the development of policies and services to address the effects of discrimination in Spain.

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.

Introduction Research has shown that factors related with the migratory process (such as travelling alone, living away from family, and discrimination after arrival) considerably increase the risk of mental health problems in young migrants. Moreover, they are among the most vulnerable migration groups with a high risk of social exclusion. Objectives To identify coping strategies and behavioural changes used to deal with perceived discrimination and its impact on the emotional well-being and mental health of newly arrived young migrants in Spain. Methods A subsample of 15 audio-recorded in-depth qualitative interviews were analysed from the national action-research Migrasalud project (II IN 190517 EN 162 FA 01). The interviews were transcribed, translated from Arabic to Spanish, and analysed through content analysis. Results Most participants were males (93.3%; n=14), ranging from 18 to 20 years, and from Morocco (93.3%; n=14). All participants were from foster care placements in Barcelona and arrived to Spain as minors. Newly arrived young migrants reported that they perceived themselves as being healthy before the migratory process. Adverse experiences during the journey and discrimination after arrival impacted their well-being and mental health. Specifically, they reported perceived discrimination in their daily life due to culture, language, or origin. This negatively impacted their well-being and mental health, increasing their emotional distress response and ‘undervalued or inferior’ and ‘vulnerable’ feelings about themselves. Concerning coping with discrimination, they reported using internalised coping strategies such as ‘ignoring’ or ‘not responding’ for fear of having their legal documents revoked or not obtaining them. Their behavioural changes often occurred when they perceived unfair treatment or prejudice towards their migrant status or their socioeconomics, culture or religion. These changes were motivated by being more accepted by the local community by ‘westernisation or cultural assimilation’ and by ‘creating a good image’ of oneself and its culture. Conclusions Findings establish that the cumulative experience of post-migration stressors (such as discrimination) negatively impacts their mental health and well-being in the long term. This suggests the need for specific policies and services to address this population’s effects of post-migration risk factors. Further research is needed to explore the causes and effects of perceived discrimination on mental health more closely and to develop more targeted and effective interventions. Disclosure of Interest None Declared

ObjectiveThis study explored the extent to which within-patient changes in processes targeted in Acceptance and Commitment Therapy (ACT) and Behavioral Activation Therapy for Depression (BATD) are associated with changes within-patient in pain intensity and depressed mood and evaluated the extent that process-outcome relationships differed between patients.MethodsAn idiographic analysis embedded within a randomized controlled trial comparing ACT, BATD, and treatment-as-usual (TAU) was conducted to examine the strength of the relationship between outcomes and process variables in patients with chronic low back pain (CLBP) plus depressive symptoms. Based on data from ecological momentary assessment in patients (n = 82), the level of heterogeneity and the pooled effects of these relationships during the intervention period (70 days) were explored.ResultsOverall, a high level of heterogeneity was identified in the relationship between pain intensity or depressed mood and psychological inflexibility or behavioral activation. Individual differences in the relationships between outcomes and process variables were identified in individual people during the intervention period. These individual differences appear independent of the group (ACT, BATD, and TAU) and other definable differences (responders/non-responders, completers/non-completers, and clinical depression/non-clinical depression).ConclusionsThese findings suggest the potential utility of personalizing psychological interventions according to the therapeutic needs of these patients.

Abstract Introduction The present study investigates the courses of loneliness following the national state of emergency in Spain due to the COVID-19 pandemic, including a curfew due to a rise in COVID-19 cases, associated risk factors, and the effect of loneliness on symptoms of depression and anxiety. Methods Data of 2,000 adults in Spain which were interviewed by telephone at the first follow-up of the MINDCOVID project (February-March 2021) and of whom 953 were interviewed nine months later (November-December 2021) were analyzed. Group-based trajectories and mixed models were constructed. Results Three courses of loneliness were detected: (1) invariant low loneliness (42.6%), (2) decreasing medium loneliness (51.5%), and (3) fairly invariant high loneliness (5.9%). Loneliness courses were associated with the severity and variability of symptoms of depression and anxiety. In contrast to the majority of pre-pandemic studies, younger adults more frequently reported loneliness compared to middle-aged and, particularly, older individuals. Other risk factors for loneliness were being female, being unmarried, and, notably, having pre-pandemic mental disorders. Conclusions Future studies should validate whether the newly observed loneliness patterns across age groups persist and assess the evolution of loneliness courses and their impact on mental health, with particular attention given to young adults and individuals with pre-existing mental disorders. Key messages • In contrast to the majority of pre-pandemic studies, younger adults more frequently reported loneliness compared to middle-aged and, particularly, older individuals. • Risk factors for loneliness were being female, being unmarried, and, notably, having pre-pandemic mental disorders.

ABSTRACT Objective Older adults may be at lower risk of common mental disorders than younger adults during the coronavirus disease 2019 (COVID-19) pandemic. Previous research has shown shown differences by age in psychosocial well-being during the pandemic and have highlighted the moderating effect of prepandemic mental disorders on that association. In this line, we examined the association of age with self-reported symptoms of loneliness, depression, anxiety, and posttraumatic stress, as well as potential roles of loneliness symptoms and prepandemic mental disorders on the association between age and mental disorder symptoms. Methods Cross-sectional data of 2000 adults in Spain interviewed by telephone during the COVID-19 pandemic (February–March 2021) were analyzed. Depression, anxiety, and posttraumatic stress were measured with the eight-item Patient Health Questionnaire, the seven-item Generalized Anxiety Disorder Scale, and the four-item checklist for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition), respectively. Loneliness was measured with the three-item University of California at Los Angeles Loneliness Scale. Several regression models were constructed to assess factors related to loneliness and mental disorders. Results According to cutoff points used, 12.4% of participants revealed depression, 11.9% revealed anxiety, and 11.6% revealed posttraumatic stress. Age was negatively related to mental disorder symptoms and loneliness. Loneliness was associated with higher levels of mental disorder symptoms. This association was stronger in younger adults without prepandemic mental disorders and in older adults with them. The association between age and loneliness was stronger in those with prepandemic mental disorders. Loneliness mediated the association of age with mental disorder symptoms. Conclusions Interventions focused on loneliness could alleviate the impact of the COVID-19 pandemic on mental health.

INTRODUCTION:The present study aims to investigate the courses of loneliness following a national state of emergency including a curfew due to a rise in COVID-19 cases, associated risk factors, and the effect of loneliness on symptoms of depression and anxiety.METHODS:Data of 2,000 adults in Spain which were interviewed by telephone at the first follow-up of the MINDCOVID project (February-March 2021) and of whom 953 were interviewed nine months later (November-December 2021) were analyzed. Group-based trajectories and mixed models were constructed.RESULTS:Three courses of loneliness were detected: (1) invariant low loneliness (42.6%), (2) decreasing medium loneliness (51.5%), and (3) fairly invariant high loneliness (5.9%). Loneliness courses were associated with the severity and variability of symptoms of depression and anxiety. In contrast to the majority of pre-pandemic studies, younger adults more frequently reported loneliness compared to middle-aged and, particularly, older individuals. Other risk factors for loneliness were being female, being unmarried, and, notably, having pre-pandemic mental disorders.CONCLUSIONS:Future studies should validate whether the newly observed loneliness patterns across age groups persist and assess the evolution of loneliness courses and their impact on mental health, with particular attention given to young adults and individuals with pre-existing mental disorders.

OBJECTIVES:To explore how perceived discrimination impacts the emotional well-being and mental health of newly-arrived migrants in Spain; and to identify the coping strategies and behavioral changes used to deal with perceived discrimination. DESIGN:102 individual audio-recorded in-depth qualitative interviews were conducted. The interviews were transcribed and analyzed through content analysis. RESULTS:Negative emotions related to perceived discrimination included disgust, sadness, fear, loneliness, humiliation, sense of injustice, rage, feeling undervalued or vulnerable, and mixed emotions. Change in behaviors due to perceived discrimination comprised westernization or cultural assimilation, creating a good image, avoiding going out or leaving alone, hypervigilance, stop participating in politics, self-sufficiency, a positive adaptation, and paradoxically, becoming an oppressor. The identified coping strategies to deal with perceived discrimination were ignoring or not responding, isolation, self-medication, engagement in intellectual activities, leisure and sport, talking or insulting the oppressor, denouncement, physical fight or revenge, seeking comfort, increasing solidarity with others, crying, or using humor. Discrimination-related stress and related mental health problems were conveyed, as challenges related to substance abuse and addictive behaviors, mood, and anxiety. CONCLUSIONS:Findings establish initial evidence of the great impact of perceived discrimination on the health, emotional well-being, and behavior of newly-arrived migrants in Spain, alerting to the need for targeted policies and services to address the effects of discrimination in this population. Further research is needed to explore more closely the causes and effects of perceived discrimination on mental health, to develop more targeted and effective interventions.

Purpose: We describe the design and development of the European Platform to Promote health and wellbeing in the workplace (EMPOWER) digital intervention that provides an integrative user programme meeting the needs of employees and employers in addressing work stress. Results: A user-centred design process was followed from January 2020 until November 2021. A tailored algorithm was developed to provide support at the individual employee level and the company level. Each element of the digital intervention was developed in English and then translated in Spanish, English, Polish and Finnish. The digital intervention consists of a website and a mobile application (app) that provides algorithm-based personalised content after assessing a user's somatic and psychological symptoms, work functioning, and psychosocial risk factors for work stress. It has a public section and an employer portal that provides recommendations to reduce psychosocial risks in their company based upon clustered input from employees. Usability testing was conducted and showed high ease of use and completion of tasks by participants. Conclusion: The EMPOWER digital intervention is a tailored multimodal intervention addressing wellbeing, work stress, mental and physical health problems, and work productivity. This will be used in a planned RCT in four countries to evaluate its effectiveness.

Substance use disorder is on the rise; it has increased massively during the COVID-19 lockdown and has been found as a risk factor for depressive symptoms and major depressive disorder. Less is known about the hypothetical moderating effect of social support in that association. Three thousand five hundred Spanish adults were interviewed by phone during the COVID-19 lockdown (May-June 2020). The 8-item Patient Health Questionnaire Depression Scale (PHQ-8) was used to measure the symptoms of depression. The CAGE Adapted to Include Drugs (CAGE-AID) questionnaire was used to assess substance use disorder during the previous month. Social support was measured through the Oslo Social Support Scale (OSSS-3). Regression models were constructed to assess factors related to depressive symptoms. People with substance use disorder (alcohol and drugs) showed considerable high levels of depressive symptoms, particularly among those with low levels of social support, which reported levels above major depressive disorder cut-off.

During the COVID-19 pandemic, anxiety and depressive symptoms, as well as problems related to social relationships, such as available social support and feelings of detachment from others, have worsened. These factors are strongly associated with suicidal thoughts and behaviours (STB). The effects of feelings of detachment on mental health and on STB have been scarcely studied, together with the relation that it may have with available social support. Therefore, the aim of the present study was to assess potential pathways connecting these conditions. A nationally representative sample of Spanish adults (N = 3305) was interviewed during the COVID-19 pandemic (June 2020). STB, social support, and depressive and anxiety symptoms were measured with the C-SSRS (modified version), OSSS-3, PHQ-8, and GAD-7 scales, respectively. Multivariable logistic regression models and mediation analyses were performed. Social support and some of its components (i.e., social network size and relations of reciprocity) were associated with lower odds of STB. Detachment significantly mediated (22% to 25%) these associations. Symptoms of emotional disorders significantly mediated the association between social support components (29% to 38%) - but not neighbourhood support - with STB, as well as the association between detachment and higher odds of STB (47% to 57%). In both cases, depressive symptoms were slightly stronger mediating factors when compared to anxiety symptoms. Our findings suggest that interventions aimed at lowering depressive and anxiety symptoms, and STB should provide social support and help tackle the feeling of detachment in a complementary way.

Background There is limited research examining the impact of risk and protective factors on late-life depression using large population-based datasets, particularly those examining differences among older migrants and non-migrants in Europe countries. Thus, the first aim was to analyze differences between migrants and non-migrants regarding socioeconomic status, depression, multimorbidity, healthy aging, and lifestyle behaviors. The second aim was to examine the impact of healthy aging on late-life depression in older migrants compared to their counterparts without a history of international migration in extensive and harmonized data from different population-based cohort studies. Materials and methods We analyzed cross-sectional, predominantly nationally representative, community-based data from European participants in the Aging Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) cohort. The descriptive analyses included sociodemographic variables, somatic comorbidities, multimorbidity, healthy aging, and lifestyle behaviors according to migration status. The effects of these variables on late-life depression were examined in a multivariate logistic regression model, including migration status and years since migration as predictors. Results Data of 122,571 individuals aged ≥ 50 years were analyzed, of which 11,799 (9.60%) were migrants. The descriptive analyses indicated that compared to non-migrants, migrants showed a higher prevalence of diabetes (25.6%), hypertension (38.0%), coronary artery disease (49.4%), stroke (4.9%), and depression (31.1%). Healthy aging was also better in non-migrants (51.7; SD = 9.7) than in migrants (39.6; SD = 18.2). The results of the logistic regression showed that migration status [OR = 1.231 (CIs: 0.914–1.547)] and increased number of years since migration in the host country [OR = 0.003 (CIs: 0.001–0.005)] were associated with greater levels of depressive symptoms. Concerning health variables, multimorbidity was associated with higher levels of depressive symptoms [OR = 0.244 (CIs: 0.211–0.278)], whereas better healthy aging was associated with fewer depressive symptoms [OR = -0.100 (CIs: -0.102 to -0.098)]. The interaction between migration and healthy aging status was also significant [OR. = -0.019 (CIs: -0.025 to -0.014)]. Conclusion Migrants reported higher risks for worse health outcomes compared to non-migrants. Significantly, worse healthy aging was associated with a greater risk of depressive symptoms in migrants than in non-migrants. Shedding light on migration and aging processes is essential for promoting a cross-cultural understanding of late-life depression in Europe.

Abstract Background: The aim of the present study was to follow different language adaptation steps towards conceptual equivalence to guarantee the cross-cultural applicability of an instrument that explored the relationship between migration, and mental health barriers and protective factors. The procedures followed during the process may provide practical guidance for intercultural research designs. Methods: A translation protocol based on a cross-cultural study aiming (+18) migrants who arrived in Barcelona in the last 5 years –most frequently Pakistani, Arabic, Chinese, English but also Latino or Spanish-speaking communities- was developed consisting on four stages -1) translation; 2) back-translation; 3) synthesis and 4) pre-testing- and applied to individuals in a sample representative of the 5 target languages-. Team-based translation experts, multicultural translators and a systematically constructed method for translation and back-translation from source and target languages where some of the strategies for transparency and reproducibility of scientific methods. Discussion: The present work implied the translation and back-translation of the instrument and was comprehensively conducted to achieve concept equivalence between the original questionnaire version with the translated version in detecting mental health deterioration or empowerment in the context of international migration. Trial registration: not applicable