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BACKGROUND: Major depressive disorder (MDD) is the leading cause of disability globally, with moderate heritability and well-established socio-environmental risk factors. Genetic studies have been mostly restricted to European settings, with polygenic scores (PGS) demonstrating low portability across diverse global populations. METHODS: This study examines genetic architecture, polygenic prediction, and socio-environmental correlates of MDD in a family-based sample of 10 032 individuals from Nepal with array genotyping data. We used genome-based restricted maximum likelihood to estimate heritability, applied S-LDXR to estimate the cross-ancestry genetic correlation between Nepalese and European samples, and modeled PGS trained on a GWAS meta-analysis of European and East Asian ancestry samples. RESULTS: We estimated the narrow-sense heritability of lifetime MDD in Nepal to be 0.26 (95% CI 0.18-0.34, p = 8.5 × 10-6). Our analysis was underpowered to estimate the cross-ancestry genetic correlation (rg = 0.26, 95% CI -0.29 to 0.81). MDD risk was associated with higher age (beta = 0.071, 95% CI 0.06-0.08), female sex (beta = 0.160, 95% CI 0.15-0.17), and childhood exposure to potentially traumatic events (beta = 0.050, 95% CI 0.03-0.07), while neither the depression PGS (beta = 0.004, 95% CI -0.004 to 0.01) or its interaction with childhood trauma (beta = 0.007, 95% CI -0.01 to 0.03) were strongly associated with MDD. CONCLUSIONS: Estimates of lifetime MDD heritability in this Nepalese sample were similar to previous European ancestry samples, but PGS trained on European data did not predict MDD in this sample. This may be due to differences in ancestry-linked causal variants, differences in depression phenotyping between the training and target data, or setting-specific environmental factors that modulate genetic effects. Additional research among under-represented global populations will ensure equitable translation of genomic findings.

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INTRODUCTION: Engaging youth in mental health research and intervention design has the potential to improve their relevance and effectiveness. Frameworks like Roger Hart's ladder of participation, Shier's pathways to participation and Lundy's voice and influence model aim to balance power between youth and adults. Hart's Ladder, specifically, is underutilized in global mental health research, presenting new opportunities to examine power dynamics across various contexts. Drawing on Hart's ladder, our study examined youth engagement in mental health research across high- and middle-income countries using Internet-based technologies, evaluating youth involvement in decision-making and presenting research stages that illustrate these engagements. METHODS: We conducted a directed content analysis of youth engagement in the study using primary data from project documents, weekly AirTable updates and discussions and interviews with youth and the research consortium. Using Hart's Ladder as a framework, we describe youth engagement along rungs throughout different research stages: cross-cutting research process, onboarding, formative research and quantitative and qualitative study designs. RESULTS: Youth engagement in the MindKind study fluctuated between Rung 4 ('Assign, but informed') and Rung 7 ('Youth initiated and directed') on Hart's Ladder. Engagement was minimal in the early project stages as project structures and goals were defined, with some youth feeling that their experiences were underutilized and many decisions being adult-led. Communication challenges and structural constraints, like tight timelines and limited budget, hindered youth engagement in highest ladder rungs. Despite these obstacles, youth engagement increased, particularly in developing recruitment strategies and in shaping data governance models and the qualitative study design. Youth helped refine research tools and protocols, resulting in moderate to substantial engagement in the later research stages. CONCLUSION: Our findings emphasize the value of youth-adult partnerships, which offer promise in amplifying voices and nurturing skills, leadership and inclusiveness of young people. Youth engagement in project decision-making progressed from lower to higher rungs on Hart's Ladder over time; however, this was not linear. Effective youth engagement requires dynamic strategies, transparent communication and mutual respect, shaping outcomes that authentically reflect diverse perspectives and mental health experiences. PATIENT OR PUBLIC CONTRIBUTION: There was substantial patient and public involvement in this study. This paper reports findings on youth engagement conducted with 35 young people from India, South Africa and the United Kingdom, all of whom had lived experience of mental health challenges. Youth engagement in the MindKind study was coordinated and led by three professional youth advisors (PYAs) in these contexts, who were also young people with lived experience of mental health challenges. Each of the three study sites embedded a full-time, community-based PYA within their study team to inform all aspects of the research project, including the development of informational materials and the facilitation of Young People's Advisory Group (YPAG) sessions referenced in this paper. Each PYA also consulted with a site-specific YPAG that met bi-monthly throughout the project, shaping the formation of study materials and serving as a test group in both the quantitative and qualitative studies. Youth participants in this study also contributed extensively, engaging in data collection and manuscript writing. The following youth advisory panels members (J.B., L.B., D.O.J., M.V.) and all PYAs (E.B., S.R., R.S.) in the MindKind study contributed to the writing of this manuscript and are acknowledged as co-authors.

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Impactful research on refugee mental health is urgently needed. To mitigate the growing refugee crisis, researchers and clinicians seek to better understand the relationship between trauma, grief and post-migration factors with the aim of bringing better awareness, more resources and improved support for these communities and individuals living in host countries. As much as this is our intention, the prevailing research methods, that is, online anonymous questionnaires, used to engage refugees in mental health research are increasingly outdated and lack inclusivity and representation. With this perspective piece, we would like to highlight a growing crisis in global mental health research; the predominance of a Global North-centric approach and methodology. We use our recent research challenges and breakdowns as a learning example and possible opportunity to rebuild our research practice in a more ethical and equitable way.

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INTRODUCTION: Creating Futures initiative has established a network of mental health professionals, researchers, and community members from the Pacific Island Nations (PIN), Australia, and New Zealand to address the growing challenges of mental health conditions compounded by the climate change crisis. The enormous amount of work done in Global Mental Health can be particularly helpful to improve population-level mental health. However, translation of this evidence base into practice poses several challenges. OBJECTIVE: This perspective paper discusses the role of local culture and health systems context in determining the feasibility and acceptability of implementing and scaling up evidence-based interventions designed in an American-European context. The paper also advocates development (and evaluation) of mental health interventions in the PIN communities particularly and Global South generally and exporting these interventions to the rest of the world. CONCLUSIONS: COVID-19 crisis underlined the role of global cooperation as well as national level 'self-reliance'. In this post COVID-19 world, it will be desirable for the mental health community to cooperate and collaborate to scale up evidence-based interventions through rigorous contextualization and at the same time main-stream mental health interventions developed in the Global South by incorporating them in the Global Mental Health discourse.

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BACKGROUND: Mental and neuropsychological disorders make up approximately 14% of the total health burden globally, with 80% of the affected living in low- and middle-income countries (LMICs) of whom 90% cannot access mental health services. The main objective of the TREAT INTERACT study is to adapt, implement, and evaluate the impact of a novel, intersectoral approach to prevent, identify, refer, and treat mental health problems in children through a user centred task-sharing implementation of the TREAT INTERACT intervention, inspired by the World Health Organization (WHO) Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) for primary school staff in Mbale, Uganda. Health care personell will be trained in the mhGAP-IG. METHODS: This is a pragmatic mixed-methods hybrid Type II implementation-effectiveness study utilizing a co-design approach. The main study utilize a stepped-wedged trial design with six starting sequences, randomizing three schools to the intervention at each interval, while the remaining act as "controls". Other designs include a nested prospective cohort study, case control studies, cross-sectional studies, and qualitative research. Main participants' outcomes include teachers' mental health literacy, stigma, and violence towards the school children. Implementation outcomes include detection, reach, sustainability, and service delivery. Child and caregiver outcomes include mental health, mental health literacy, and help-seeking behaviour. DISCUSSION: Based on the results, we will develop sustainable and scalable implementation advice on mental health promotion and draft implementation guidelines in line with current WHO guidelines. This project will generate new knowledge on the structure, organization, delivery, and costs of mental health services in a LMIC setting, as well as new knowledge on the implementation and delivery of new health services. TRIAL REGISTRATION: ClinicalTrials, NCT06275672, 28.12.2023, retrospectively registered.

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Stigma has been pointed out as a barrier to mental healthcare in sub-Saharan Africa. Among the manifestations of stigma, the use of physical restraints is condemned as a form of violation of basic human rights. Research on this phenomenon is limited in West Africa and more particularly in Burkina Faso. This study explores the phenomenon of stigma of individuals experiencing mental disorders in Bobo-Dioulasso (Burkina Faso). As part of 8 months of socio-anthropological fieldwork, we interviewed 94 informants (7 focus groups and 25 individual interviews) to document exclusionary practices, their perceptions, and justifications. Exclusionary practices can be divided in five subgroups: ignoring, physically and sexually abusing, abandoning, banning, and restraining. Some practices were linked to a lack of financial and material resources, while others were justified by an inferior moral status. We observed differences in the type of exclusion experienced between men and women. Restrictive, abusive, and exclusionary measures are common in Bobo-Dioulasso. These practices can either be understood as part of families' adaptative strategies when dealing with chronic conditions, as part of security measures in the case of patients with aggressive behaviors, or as part of punitive measures when transgressions are committed. We conclude the article by addressing the tensions between local and global meanings of stigma.

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Background: As the field of global mental health grows, many psychotherapy trainees will work across cultures in low-resource settings in high-income countries or in low- and middle-income countries. Faculty members and mentors may face several challenges in providing supervision for psychologists in low-resource settings. As such, there is a need to develop best practices for psychotherapy supervision in global mental health. Methods: We describe the common challenges and potential strategies in psychotherapy supervision based on our research, clinical, and academic partnerships between academic institutions, a nonprofit organization, and the Nepali government. Results: The strategies and considerations we have found helpful include focusing on therapies with strong behavioral and interpersonal (rather than emotional or cognitive) components and using locally validated therapies or standard manuals that have been endorsed by the WHO for low-resource settings. Other strategies include providing psychotherapy training for local psychiatrists who may be in supervisory roles and gaining competence in navigating different expectations of social structures and family dynamics. Conclusion: Supervisors face many challenges while supporting trainees and early psychologists in global mental health settings. While ensuring local adaptation, key considerations can be developed into best practices to support psychiatrists, supervisors, and trainees based in low- and middle-income countries.

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Global Burden of Disease (GBD) estimates have significant policy implications nationally and internationally. Disease burden metrics, particularly for depression, have played a critical role in raising governmental awareness of mental health and in calculating the economic cost of depression. Recently, the World Health Organization ranked depression as the single largest contributor to global disability. The main aim of this paper was to assess the basis upon which GBD prevalence estimates for major depressive disorder (MDD) were made. We identify the instruments used in the 2019 GBD estimates and provide a descriptive assessment of the five most frequently used instruments. The majority of country studies, 356/566 (62.9%), used general mental health screeners or structured/semi-structured interview guides, 98/566 (17.3%) of the studies used dedicated depression screeners, and 112 (19.8%) used other tools for assessing depression. Thus, most of the studies used instruments that were not designed to make a diagnosis of depression or assess depression severity. Our results are congruent with and extend previous research that has identified critical flaws in the data underpinning the GBD estimates for MDD. Despite the widespread promotion of these prevalence estimates, caution is needed before using them to inform public policy and mental health interventions. This is particularly important in lower-income countries where resources are scarce.

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Introduction: In South Africa (SA), community-oriented primary care (COPC) teams work to re-engage out-of-care people with HIV (PWH) in treatment, many of whom have substance use (SU) concerns. SU stigma is high among these teams, limiting care engagement efforts. Integrating peer recovery coaches (PRCs) into COPC teams could shift SU stigma and improve patients' engagement in care. The PRC role does not exist in SA and represents a workforce innovation. To enhance acceptability, feasibility, and appropriateness for the local context, we engaged multiple stakeholder groups to co-design a PRC role for COPC team integration. Methods: We used a five-step human-centered design process: (i) semi-structured interviews with healthcare worker (HCW, n = 25) and patient (n = 15) stakeholders to identify priorities for the role; (ii) development of an initial role overview; (iii) six ideation workshops with HCW (n = 12) and patient (n = 12) stakeholders to adapt this overview; (iv) refinement of the role prototype via four co-design workshops with HCW (n = 7) and patient (n = 9) stakeholders; and (v) consultation with HIV and SU service leaders to assess the acceptability and feasibility of integrating this prototype into COPC teams. Results: Although all stakeholders viewed the PRC role as acceptable, patients and HCWs identified different priorities. Patients prioritized the care experience through sharing of lived experience and confidential SU support. HCWs prioritized clarification of the PRC role, working conditions, and processes to limit any impact on the COPC team. A personal history of SU, minimum 1 year in SU recovery, and strong community knowledge were considered role prerequisites by all stakeholders. Through the iterative process, stakeholders clarified their preferences for PRC session structure, location, and content and expanded proposed components of PRC training to include therapeutic and professional work practice competencies. Service leaders endorsed the prototype after the addition of PRC integration training for COPCs and PRC mentoring to address community and COPC dynamics. Conclusion: Stakeholder engagement in an iterative HCD process has been integral to co-designing a PRC role that multiple stakeholder groups consider acceptable and that COPC teams are willing to implement. This offers a methodological framework for other teams designing SU workforce innovations.

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[This corrects the article DOI: 10.1017/gmh.2024.11.].

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OBJECTIVE: Mental health problems are prevalent among African adolescents, but professional treatment capacity is limited. Shamiri, an efficient lay provider-delivered intervention, has significantly reduced depression and anxiety symptoms in previous randomized controlled trials (RCTs). This trial investigated effects of the full Shamiri intervention and its components (growth-only, gratitude-only, and values-only) against a study skills control. METHOD: In a 5-group RCT with adolescents from Kenyan high schools, anxiety, depression, and well-being were self-reported through 8-month follow-up. The RCT occurred immediately after an unanticipated government-mandated COVID-19 shutdown forced 3 years of schoolwork into 2 years, escalating academic pressures. RESULTS: Participants (N = 1,252; 48.72% female) were allocated to: growth (n = 249), gratitude (n = 237), values (n = 265), Shamiri (n = 250), and study skills (n = 251) conditions. Longitudinal multilevel models showed that, across all conditions, anxiety scores significantly improved at midpoint (B = -0.847), end point (B = -2.948), 1-month (B = -1.587), 3-month (B = -2.374), and 8-month (B = -1.917) follow-ups. Depression scores also improved significantly at midpoint (B = -0.796), end point (B = -3.126), 1-month (B = -2.382), 3-month (B = -2.521), and 8-month (B = -2.237) follow-ups. Well-being scores improved significantly at midpoint (B = 1.73), end point (B = 3.44), 1-month (B = 2.21), 3-month (B = 1.78), and 8-month (B = 1.59) follow-ups. Symptom reduction with Shamiri matched that of pre-COVID-19 trials, but symptom reduction with study skills far outpaced that of trials before the COVID-19-related school shutdown (31% greater anxiety reduction and 60% greater depression reduction). Thus, in contrast to previous RCTs, this COVID-19-era trial showed no significant differences between outcomes in any intervention and active control groups. CONCLUSION: Our RCT conducted during a post-COVID-19 period of heightened academic pressure produced unexpected results. Improvements in youth-reported anxiety and depression were consistent with previous trials for Shamiri, but markedly larger than in previous trials for study skills. Control interventions teaching life skills may produce mental health benefits when they convey skills of particular contextual relevance. PLAIN LANGUAGE SUMMARY: A large five-group randomized controlled trial involved comparing the Shamiri Intervention to its component interventions (growth mindset, gratitude, and values affirmation) and a study-skills control. In contrast to previous studies of Shamiri, similar effects were observed across all groups (p<.05). This trial was conducted right after an unanticipated government-mandated COVID shutdown forced three years of schoolwork into two. Benchmarking analyses against previous trials showed approximately equal effects of Shamiri over time, but a 31% greater anxiety reduction and 60% greater depression reduction for the study-skills condition; this highlights the potential of interventions teaching highly relevant life-skills for improving mental health. CLINICAL TRIAL REGISTRATION: Five-Arm Shamiri Trial; https://pactr.samrc.ac.za/; PACTR202104716135752.

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There are few human tragedies that stir sympathy and concern more deeply than seeing children suffer secondary to war, displacement, and increasingly frequent epidemics of violence around the world. Falling witness or victim to acts of war and terrorism and subsequent fleeing of millions of children across the world stirs an array of powerful human emotions. Such circumstances by definition involve destruction, pain, and death. It is, paramount that we all work collaboratively, to provide psychological assistance, training, and education and work with various stakeholders to decrease the psychological impact of displacement secondary to war, terrorism, and other social factors.

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Displacement exerts an ongoing negative impact on people's mental health. The majority of displaced populations are hosted in the global south, yet there is a paucity of evidence synthesis on the implementation of mental health and psychosocial support (MHPSS) programmes in those contexts. We undertook a systematic review of factors influencing the delivery and receipt of MHPSS programmes for displaced populations in low- and middle-income countries to address this gap. A comprehensive search of 12 bibliographic databases, 25 websites and citation checking were undertaken. Studies published in English from 2013 onwards were included if they contained evidence on the perspectives of adults or children who had engaged in, or programmes providers involved in delivering, MHPSS programmes. Fifteen studies were critically appraised and synthesised. Studies considered programme safety as a proxy for acceptability. Other acceptability themes included stigma, culture and gender. Barriers to the accessibility of MHPSS programmes included language, lack of literacy of programme recipients and location of services. To enhance success, future delivery of MHPSS programmes should address gender and cultural norms to limit mental health stigma. Attention should also be given to designing flexible programmes that take into consideration location and language barriers to ensure they maximise accessibility.

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Mental health conditions, recognised as a global crisis, were further exacerbated by the COVID-19 pandemic. Access to mental health services remains limited, particularly in low-income regions. Task-sharing interventions, exemplified by Problem Management Plus (PM+), have emerged as potential solutions to bridge this treatment gap. This study presents an evaluation of the PM+ scale-up in Sub-Saharan Africa (Ethiopia and Benin) and Eastern Europe (Croatia and Bosnia and Herzegovina) as part of a mental health and psychosocial support programming including 87 adult participants. A mixed-method approach assesses the impact of the intervention. Quantitative analyses reveal significant reductions in self-reported problems, depression, anxiety and improved functioning. Qualitative data highlight four main themes: general health, family relationships, psychosocial problems and daily activities. These thematic areas demonstrate consistent improvements across clients, irrespective of the region. The findings underscore the impact of PM+ in addressing a broad spectrum of client issues, demonstrating its potential as a valuable tool for mitigating mental health challenges in diverse settings. This study contributes to the burgeoning body of evidence supporting PM+ and highlights its promise in enhancing mental health outcomes on a global scale, particularly for vulnerable populations.

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Stress is a challenge among non-specialist health workers worldwide, particularly in low-resource settings. Understanding and targeting stress is critical for supporting non-specialists and their patients, as stress negatively affects patient care. Further, stigma toward mental health and substance use conditions also impacts patient care. However, there is little information on the intersection of these factors. This sub-analysis aims to explore how substance use and mental health stigma intersect with provider stress and resource constraints to influence the care of people with HIV/TB. We conducted semi-structured interviews (N=30) with patients (n=15) and providers (n=15, non-specialist health workers) within a low-resource community in Cape Town, South Africa. Data were analyzed using thematic analysis. Three key themes were identified: (1) resource constraints negatively affect patient care and contribute to non-specialist stress; (2) in the context of stress, non-specialists are hesitant to work with patients with mental health or substance use concerns, who they view as more demanding and (3) stress contributes to provider stigma, which negatively impacts patient care. Findings highlight the need for multilevel interventions targeting both provider stress and stigma toward people with mental health and substance use concerns, especially within the context of non-specialist-delivered mental health services in low-resource settings.

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The increasing number of losses and damages caused by the climate crisis has rendered the psychometric assessment of the climate crisis more important than ever, specifically in developing countries, such as Turkey. The aim of this study was to examine the psychometric properties of the Turkish version of the Hogg Eco-Anxiety Scale (HEAS-13), using exploratory structural equation modeling (ESEM) on the cross-sectional data collected from 445 adults (286 females and 159 males; Mage = 29.76, range 18-65). The results supported the four-factor solution of the original version in the Turkish sample. Further analysis confirmed the invariance of the HEAS-13 across genders. The results demonstrated significant correlations of the HEAS-13 subscales with the Brief Symptom Inventory (BSI) and the Anthropocentric Narcissism Scale (ANS), except for that between the behavioral symptoms subscale of the HEAS-13 and the ANS. Both the total and the subscale scores of the HEAS-13 were also found to be reliable, given the internal consistency and test-retest reliability values. The Turkish version of the HEAS-13 can expand the scientific understanding of eco-anxiety, which can help develop mental health services to mitigate the negative mental health impacts of the environmental crisis.

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Concerned with sustainably alleviating mental distress and promoting the right to health worldwide, global mental health (GMH) is practised across various contexts spanning the humanitarian-development-peace nexus. The inherently intersectoral and multidisciplinary nature of GMH calls for competency frameworks and training programmes that embody diversity, decolonisation and multiprofessionalism. Existing competency frameworks have failed to capture the multi-sectoral, inter-professional nature of contemporary GMH practice. In response to these needs, a qualitative content analysis of relevant job advertisements was conducted to distil a comprehensive set of professional competencies in contemporary GMH practice. Approximately 200 distinct skills and competencies were extracted from 70 job advertisements and organised into four meta-dimensions: 'skills', 'sector', 'self' and 'subject'. The first known systematic attempt at a multi-sectoral GMH competency framework, it offers a springboard for exploring vital yet overlooked professional competencies such as resilience, self-reflection, political skills and entrepreneurialism. On this basis, recommendations for building a competent, agile and effective GMH workforce with diversified and future-proof skillsets are proposed. The framework can also inform inter-professional training and curriculum design, and capacity-building initiatives aimed at early-career professional development, particularly in low- and middle-income settings.

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Migrant mental health is a pressing public health issue with wide-ranging implications. Many randomized controlled trials (RCTs) have been conducted in this population to assess the effects of psychosocial interventions. However, the available evidence is characterized by controversy and fragmentation, with studies focusing on different migrant populations, interventions, outcomes, delivery modalities and settings. Aiming to promote systematic reviews of the effectiveness of psychosocial interventions in different migrant groups, we have developed a living database of existing RCTs. The development of the database provides an opportunity to map the existing RCT evidence in this population. A total of 135 studies involving 24,859 participants were included in the living database. The distribution of studies by year of publication aligns with the increasing global migrant population in recent years. Most studies focus primarily on adult participants, with a limited representation of children and adolescents, and a prevalence of female participants, which is consistent with epidemiological data, except for older adults, who are underrepresented in research. Studies predominantly focus on refugees and asylum seekers, likely due to their elevated risk of mental health issues, despite the substantial presence of economic migrants worldwide. While studies mainly involve migrants from the Middle East and East Asia, epidemiological data suggest a broader geographic representation, with migrants coming from Eastern Europe, Latin America and South Asia. The present descriptive analysis of RCTs on mental health and psychosocial interventions for migrant populations provides valuable insights into the existing research landscape. It should be used to inform future research efforts, ensuring that studies are more representative of the global migrant population and more responsive to the mental health needs of migrants in different contexts.

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PURPOSE: This study examined time trends in significant child and adolescent psychological symptoms and explored the association of frequent and problematic social media use with these symptoms. METHODS: Time trends in psychological symptoms were assessed using data from five waves of the international survey of Health Behavior in School-aged Children (HBSC), conducted between 2001 and 2018 (N = 1,036,869). The associations of frequent and problematic social media use with significant psychological symptoms were assessed by hierarchical multinomial logistic regression using data from 2001-2002 and the 2017-2018 survey waves. The direction of effect between social media use variables and psychological symptoms was explored using Linear Non-Gaussian Acyclic Models (LiNGAM). RESULTS: Prevalence of more severe psychological symptoms increased from 6.7% in 2001-2002 to 10.4% in the 2017-2018 survey waves. The increase was especially large among 15-year old and older girls: from 10.9 to 19.1%. The higher prevalence of more severe psychological symptoms in 2017-2018 compared with 2001-2002 was eliminated after adjusting the model for problematic social media use. LiNGAM analysis supported the direction of effect going from social media use and problematic social media use to psychological symptoms. CONCLUSIONS: The findings suggest that frequent and problematic use of social media contribute to the increasing trend of psychological symptoms in adolescents in recent years.

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