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BACKGROUND: Mental health problems are high among refugees due to their traumatic experiences of fleeing war and witnessing disasters and deaths due to violence and conflict. Refugees are exposed to various socio-cultural stressors during their migration journey before, during, and after arriving at the host country, which may increase their risk of mental health problems. Strength-based interventions may be beneficial to address their socio-cultural and psychological stressors by strengthening individual's strengths to address their problems. AIMS: This study evaluated the effect of a Social and Emotional Wellbeing intervention on mental health (stress, anxiety, and depression) and emotional health outcomes (coping, self-efficacy, social support, and conflict resolution) among Ukrainian refugees in Massachusetts. METHODS: We implemented intervention (once-weekly/5-week) among 31 Ukrainian refugees with pre-and post-assessment of mental and emotional health outcomes (2022-2023). The intervention consisted 5-module: managing stress and mind-body exercise, strengthening communication and social networking, problem-solving, and creating a healthy family environment. Validated scales were used to measure mental and emotional health outcomes, such as the Hopkins-Symptom-Checklist-25 for anxiety and depression and the Cohen-Perceived-Stress scale for stress. Paired t-test was used for data analysis. RESULTS: The pre versus post-intervention proportion reduced for anxiety (61.29% vs. 22.58%) and depression (58.06% vs. 22.58%). The mean scores significantly decreased from pre- to post-intervention by 6.26 points for stress, by 7.07 points for anxiety, and by 6.29 points for depression (both p's < .01). The mean scores significantly increased for coping (by 15.71), emotion-focused engagement (4.48), problem-focused engagement (4.80), social support (8.77), problem-focused coping self-efficacy (14.93), stop unpleasant emotions and thoughts (12.74), and friends networking (3.48; all p's < .01). CONCLUSIONS: The stress, anxiety, and depression were reduced, and coping, self-efficacy, and social support networking skills were improved among Ukrainians after intervention. This program should be replicated in the larger community for a wider benefit.

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INTRODUCTION: Mental health professionals, teachers, families, and public administrators are concerned about suicide rates among young people, particularly in the university context. For every ten college students worldwide, three attempt suicide in their lifetime, and two experience suicidal ideation. Reducing these rates requires interventions that recognize the problem in terms of risk factors and protective factors. OBJECTIVE: The general aim of the study was to map the protective factors for suicide among college students, as perceived by them, mental health professionals, and coordinators of undergraduate courses in a public university in the North of Brazil. METHODS: The study followed an exploratory, mixed-method design. Data were collected through interviews and the application of a questionnaire with 54 participants, including college students (n = 20), mental health professionals (n = 22), and course coordinators (n = 12). Data were analyzed using Content Analysis and simple descriptive statistics. RESULTS: The findings show that the protective factors for suicide most cited among the three groups were social support, strengthening of internal resources, institutional support, and finding meaning about the change to enter the university. Although the three audiences did not converge, the protective factors also frequently reported were psychological treatment, leisure activities, religious engagement, medical treatment, civic engagement, employability, opportunities for social ascension offered by the university, and quality family relationships. CONCLUSION: It is suggested that these protective factors are considered when formulating policies to promote mental health and suicide prevention in the university environment.

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BACKGROUND: Technology use may be one strategy to promote mental health and wellbeing among young adults in post-secondary education settings experiencing increasing distress and mental health difficulties. The JoyPop™ app is mobile mental health tool with a growing evidence base. The objectives of this research are to (1) evaluate the effectiveness of the JoyPop™ app in improving emotion regulation skills (primary outcome), as well as mental health, wellbeing, and resilience (secondary outcomes); (2) evaluate sustained app use once users are no longer reminded and determine whether sustained use is associated with maintained improvements in primary and secondary outcomes; (3) determine whether those in the intervention condition have lower mental health service usage and associated costs compared to those in the control condition; and (4) assess users' perspectives on the quality of the JoyPop™ app. METHODS: A pragmatic, parallel arm randomized controlled trial will be used. Participants will be randomly allocated using stratified block randomization in a 1:1 ratio to the intervention (JoyPop™) or control (no intervention) condition. Participants allocated to the intervention condition will be asked to use the JoyPop™ app at least twice daily for 4 weeks. Participants will complete outcome measures at four assessment time-points (first [baseline], second [after 2 weeks], third [after 4 weeks], fourth [after 8 weeks; follow-up]). Participants in the control condition will be offered access to the app after the fourth assessment time-point. DISCUSSION: Results will determine the effectiveness of the JoyPop™ app for promoting mental health and wellbeing among post-secondary students. If effective, this may encourage more widespread adoption of the JoyPop™ app by post-secondary institutions as part of their response to student mental health needs. TRIAL REGISTRATION: ClinicalTrials.gov NCT06154369 . Registered on November 23, 2023.

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There is limited research on the factors that impact mental distress among Korean American (KA) church leaders even though their unique social situation can create many barriers to seeking mental health assistance. This study compared factors impacting mental distress and help-seeking behaviors between KA church leaders (CLs) and church members (CMs) in the greater Los Angeles area. The respondents (N = 243) were mostly female, married, educated, first-generation immigrants with a mean age of 47.9 years (SD = 19.7). The Hopkins Symptoms Checklist 10 was used to measure anxiety and depression. Hierarchal linear regressions showed that health status exerted the strongest effect on both anxiety and depression among CLs and CMs. Beyond health status, education (only for depression), informal resource use, and resiliency impacted mental distress scores for CLs. Only resiliency and religious coping predicted depression scores among CMs. To effectively reach this population, community-based organizations and behavioral health specialists should consider collaborating with churches to promote and provide essential mental health support. Our findings also highlight that the needs of church leaders (CLs) and church members (CMs) differ, which should guide the development of culturally tailored interventions that build on the resilience of both groups.

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Emotional regulation involves managing attention, affect, and behavior, and is essential for long-term health and well-being, including positive school adjustment. The purpose of this secondary data analysis from the Durham Child Health and Development Study was to explore how parent and teacher reported emotional regulation behaviors related to school adjustment outcomes (social skills, academic performance, and academic achievement) during early childhood. Parent and teacher reports on emotional regulation behaviors showed mixed concordance, however they correlated with critical aspects of school adjustment. Clinical and practical implications are discussed, including the role of psychiatric nurses in promoting positive emotional regulation and school adjustment outcomes across settings.

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The significant rise in the prevalence of mental health disorders among school children and adolescents in Lebanon and conflict zones necessitate immediate interventions. Despite this elevated prevalence, such communities currently lack effective programs which clearly identify the concepts of mental health promotion and prevention among school children. Addressing this gap, our paper aims to propose a contextual model and framework for educators, researchers and policy-makers. The proposed model includes 3-levels comprising set of actions and interventions. Interventions adopted at each level should be fine-tuned to produce a caring and supportive learning environment that effectively incorporates the three essential domains of student's mental health: promoting mental health protective factors, notably social and emotional learning (SEL) and resilience, as well as preventing mental health disorders (MHD). Interventions set at each level are elaborated in the framework and linked to the corresponding segments present in the school environment to include teachers, family, community, media, and policymakers. The framework also extends these interventions to encompass the core competencies of SEL, resilience, as well as the prevention of the most prevalent mental health disorders in conflict zones.

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This essay is an introduction to the thematic issue of Transcultural Psychiatry in honor of the work of Michael Chandler and Christopher Lalonde, developmental psychologists who made essential contributions to the study of identity and wellness among Indigenous youth in Canada and internationally. We outline their major contributions and illustrate the ways their innovative theory and methods have inspired decades of research, including the recent work presented in this issue, which addresses four broad themes: (1) the importance of a developmental perspective in mental health research; (2) the role of individual and collective continuity of identity in suicide prevention and mental health promotion; (3) Indigenous perspectives on trauma and resilience; and (4) Indigenous knowledge and values as a basis for culturally adapted and culturally grounded mental health services and interventions.

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Introduction: Brazilian Primary Health Care (PHC) is responsible for all-sanitary actions for a community-based population, including health promotion and mental health care. Mindfulness Based Health Promotion (MBHP) is an intervention that can promote self-care and psychosocial support in PHC. Objective: To discuss the effects of mindfulness based psychosocial group interventions for health promotion in primary care units in Rio de Janeiro, Brazil. Methods: The intervention was based on the MBHP model adapted for SUS. Nine groups were held in Rio de Janeiro. A quali-quanti research was held with two parts: (a) quantitative study, pre and after the 8 weeks intervention, evaluating the effect on mindfulness and self-compassion and their association with levels of anxiety, depression, and quality of life. (b) Qualitative research using Focus Groups with the participants to investigate their experience at the end of the mindfulness groups. Results and discussion: Sixty-two participants finished the 9 groups where 86% were women, mostly between 30 and 59 years of age and low income, and around 80% under regular medical care in PHC in SUS. In the studied sample 80% had at least one chronic health condition under treatment, including 42% with anxiety and 35% with depression. The effects included significant improvement in Anxiety and Depression and in Quality of Life, mainly in the psychological but also in the physical and interrelation domains. The qualitative study showed that most patients joined the group on the recommendation of health professionals for managing physical and mental health symptoms. Patients reported being able to use the practices taught in the sessions to manage symptoms such as insomnia and emotionally distressing situations in their daily lives. Including family members in mindfulness practices was a strategy to negotiate not only a space at home to meditate, but also to obtain a different approach to health problems. Participants pointed to mindfulness as a complementary therapeutic option to medication and psychotherapy. Conclusion: Mindfulness-Based Intervention have shown to be a feasible, well-accepted and efficacious method of offering psychosocial support and promoting well-being for low-income patients in primary care in LAMIC.

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BACKGROUND: Mental illnesses and mental health challenges have become increasingly pervasive among Chinese university students. However, the utilization rate of mental health services is low among students. AIMS: We aimed to explore Chinese university students' help-seeking behaviors to understand how they deal with mental health challenges and use the results to inform the development of effective mental health promotion initiatives. METHODS: In this study, we conducted 13 focus group interviews with students in six universities in Jinan, China, including 91 (62%) female students and 56 (38%) male students. We drew on the Theory of Planned Behaviors to guide our thematic analysis to gain a contextual understanding of participants' accounts on help-seeking. RESULTS: Our results have depicted the help-seeking patterns of Chinese university students and show that there are four major behaviors which are self-reliance, seeking support from peers and families, seeking professional support, and accessing virtual mental health care. CONCLUSION: Results from this study can be used to inform the development of mental health literacy programming for students in universities that share similar contexts, and the study has also opened up a new space for using qualitative approaches to study mental health needs and access to care in diverse populations.

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Although there is considerable evidence showing that the prevention of mental illnesses and adverse outcomes and mental health promotion can help people lead better and more functional lives, public mental health remains overlooked in the broader contexts of psychiatry and public health. Likewise, in undergraduate and postgraduate medical curricula, prevention and mental health promotion have often been ignored. However, there has been a recent increase in interest in public mental health, including an emphasis on the prevention of psychiatric disorders and improving individual and community wellbeing to support life trajectories, from childhood through to adulthood and into older age. These lifespan approaches have significant potential to reduce the onset of mental illnesses and the related burdens for the individual and communities, as well as mitigating social, economic, and political costs. Informed by principles of social justice and respect for human rights, this may be especially important for addressing salient problems in communities with distinct vulnerabilities, where prominent disadvantages and barriers for care delivery exist. Therefore, this Commission aims to address these topics, providing a narrative overview of relevant literature and suggesting ways forward. Additionally, proposals for improving mental health and preventing mental illnesses and adverse outcomes are presented, particularly amongst at-risk populations.

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This article emphasized the urgency of promoting LGBTQ+ mental health in the Philippines, a nation known for its friendly attitude toward LGBTQ+ individuals. Despite this, a significant portion of the population maintains negative attitudes, fostering persistent stigmatization and discrimination against gay men and lesbians. These adverse social conditions, coupled with the absence of comprehensive LGBTQ+ rights protection, exacerbate mental health disparities among LGBTQ+ individuals. Recognizing the pivotal role of educational institutions, this article explores the integration of an elective course, "LGBT+ Mental Health," within an applied behavioral science program. The curriculum was based on international reports and local studies, employing frameworks like Minority Stress and Intersectionality to scrutinize factors influencing LGBTQ+ mental health disparities. The course's blended approach encourages student engagement through discussions, group work, and assessments. Insights from the course reveal students' capacity to develop organizational programs and policies that promote mental health and inclusivity. Recommendations include expanding LGBTQ+ mental health integration beyond health-related degrees, providing support and resources, fostering a cultural shift toward acceptance within educational institutions, and tailoring the course to better respond to local LGBTQ+ needs. Moreover, the paper emphasizes the critical role of educational institutions in addressing LGBTQ+ mental health disparities, serving as a model for future progress and inclusivity. Overall, this integration of LGBTQ+ mental health promotion in a non-health academic degree program can serve as a model for institutions to advance the well-being of LGBTQ+ individuals and dismantle systemic barriers.

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BACKGROUND: Recognizing the positive or negative effects of students' mental health promotes personal development, well-being, and academic success. Academic life exposes college students to multiple adjustments, demands, and vulnerabilities that can cause stress and mental health problems. This study aims to identify psychological well-being and psychological distress effects on college students' mental health. METHODS: A correlational study was designed involving a non-probabilistic 560 sample of students (446 women) aged 18 to 41 years (M = 19.6; SD = 1.68). An online self-report questionnaire was used including demographic, relational, academic, and health behaviors variables, and the measures: Mental Health Inventory; Satisfaction with Social Support Scale; Academic Life Satisfaction Scale; and Psychological Vulnerability Scale. RESULTS: Regression analyses indicate that male students, dating, good academic performance, exercise, sleeping seven hours, satisfaction with social support, and academic life satisfaction were significant correlates (p < 0.05) of psychological well-being, with the last two having great weight in the model. Females, low income, aged 21-24 years, sleeping less than 6 h, moderate psychological vulnerability, and perception of vulnerability were significant (p < 0.05) negative effects of psychological distress. CONCLUSIONS: This study addresses the positive and negative effects of psychological well-being and distress in college students. Specific mental health promotion and morbidity prevention programs can improve students' mental health literacy and resilience.

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BACKGROUND: The current understanding of the relationship between physical activity involvement and flourishing, as well as the underlying psychological mechanisms, remains limited. Building upon the basic psychological need theory, this study investigates whether and how engaging in physical activities, either as a spectator (e.g., in sports events such as the World Cup) or a participant, explains individual differences in flourishing. METHODS: A total of 1201 Hong Kong-based Chinese adults (Mage = 42.90, SD = 11.40; 54% female) completed an anonymous online survey from the quarter-final to final stages of the 2022 FIFA World Cup in December 2022. RESULTS: Findings showed that spectator (World Cup) involvement and participant involvement were positively correlated. Moreover, both types of involvements were correlated with flourishing. In addition to the hypothesized positive association with relatedness satisfaction, spectator (World Cup) involvement was also demonstrated significant associations with autonomy and competence satisfaction. Path analysis indicated that associations between physical activities and flourishing were partially mediated by the satisfaction of all three basic psychological needs. CONCLUSIONS: This study is the first to apply the basic psychological need theory in the context of physical activity and supports its relevance in understanding individual differences in flourishing. Different stakeholders are encouraged to recognize the benefits of both spectator and participant involvements in physical activities, which may help them develop supportive strategies (e.g., physical activities with parents, sports events for spectators and participants, and funding for media/communities) in mental health promotion.

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The present study aimed to investigate whether the strength of mental health competencies and the severity of mental disorder symptoms, and their interaction, differ in the strength of their associations with several dimensions of well-being in Hungarian adult psychiatric and non-clinical samples. All respondent in the psychiatric sample (129 patients (44 male, 85 female)) and in the non-clinical community sample (253 adults (43 male, 210 female)) completed the Mental Health Test, six measures of well-being and mental health, and the Symptom Checklist-90-Revised. Including both mental health competencies and mental disorder symptoms in a regression model in both samples can predict patients' well-being even more accurately. Mental health competencies were positively related; mental disorder symptoms were negatively related to subjective well-being. In all models and in both samples, mental health competencies were found to be stronger determinants of well-being than mental disorder symptoms. The interaction of mental health competencies and mental disorder symptoms is no more predictive of well-being in either psychiatric or non-clinical samples than when the effects of each are considered separately. The assessment of mental health competencies has an important predictive value for well-being in the presence of psychopathological symptoms and/or mental disorders.

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BACKGROUND: Estimating program costs when planning community-based mental health programs can be burdensome. Our aim was to retrospectively document the cost for the first year of planning and implementing Healthy Minds Healthy Communities (HMHC), a mental health promotion and prevention multi-level intervention initiative. This Program is among the first to use the Community Initiated Care (CIC) model in the US and is aimed at building community resilience and the capacity for communities to provide mental health support, particularly among those disproportionately impacted by COVID-19. Our objective is to share our methods for costing a program targeting 10 zip codes that are ethnically and linguistically diverse and provide an example for estimating the cost of a mental health prevention and promotion programs consisting of multiple evidence-based interventions. METHODS: We used a semi-structured interview process to collect cost data through the first year of program planning, start-up and initial implementation from key staff. We calculated costs for each activity, grouped them by major project categories, and identified the cost drivers of each category. We further validated cost estimates through extensive literature review. The cost analysis was done from the provider's perspective, which included the implementing agency and its community partners. We delineated costs that were in-kind contributions to the program by other agency, and community partners. Sensitivity analyses were conducted to estimate uncertainty around parameters. RESULTS: For the first year of the development and implementation of the program, (funded through program and in-kind) is estimated at $1,382,669 (2022 US$). The costs for the three main activity domains for this project are: project management $135,822, community engagement $364,216 and design and execution $756,934. Overall, the cost drivers for the first year of this intervention were: hiring and onboarding staff, in-person community building/learning sessions, communications and marketing, and intervention delivery. CONCLUSION: Implementation of community-based mental health promotion and prevention programs, when utilizing a participatory approach, requires a significant amount of upfront investment in program planning and development. A large proportion of this investment tends to be human capital input. Developing partnerships is a successful strategy for defraying costs.

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Schools are an important component in the mental health system of care for youths. Teachers and other school staff have unique opportunities to promote emotional wellness and prevent mental health conditions. Although numerous programs are available, identifying evidence-based and effective options is a significant challenge. This introduction lays out the rationale and methodology of the Assessing the Evidence Base (AEB) series, a collection of systematic reviews of school-based mental health promotion and prevention approaches recommended by the National Academies of Sciences, Engineering, and Medicine for students in kindergarten through grade 12. Authors of the current AEB series used the rating criteria derived from the 2014 AEB series, which provided systematic reviews of a wide spectrum of interventions for mental and substance use disorders. Like its predecessor, the current series upholds a high standard of scientific rigor while ensuring that the information is easily accessible to various stakeholders in education, behavioral health, and communities. It describes the universal features included in each systematic review, such as a rating of the level of evidence for interventions, intervention program components, identification of interventions that have yielded positive outcomes for students from underserved populations, and a review of cost data. The AEB systematic reviews will serve as an important tool for decision makers involved in managing limited resources for various programs in school-based mental health services by synthesizing large bodies of research for use by leaders in education and behavioral health.

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BACKGROUND: Compromised well-being and mental health problems pose a significant threat to individuals and societies worldwide. Resource-intensive psychological treatments alone cannot alleviate this burden. There is a need for low-cost, evidence-based interventions aimed at preventing illness and promoting well-being. Five activity domains appear to be linked with well-being promotion across populations: connecting with others, being active, taking notice, learning, and being generous/giving. The activities mentioned are part of the Five Ways to Wellbeing framework and the web-based intervention Five Ways to Wellbeing for All (5waysA). OBJECTIVE: This randomized controlled trial aims to test the effects of the 5waysA intervention, a web-based, low-cost, well-being-promoting measure targeting the general population. To date, the Five Ways to Wellbeing framework has not been tested in this specific format. The 5waysA intervention comprises 2 webinars and SMS text message reminders delivered over a 10-week period. METHODS: In 2021, a total of 969 study participants from various regions across Norway were openly recruited through a web page. They were then randomly assigned to either an intervention group or 1 of 2 waiting list control groups, namely, active or passive. Self-reported life satisfaction (Satisfaction With Life Scale [SWLS]), flourishing (Flourishing Scale [FS]), positive emotions, anxiety, and depression symptoms (Hopkins Symptom Checklist-8 [HSCL-8]) were assessed before the intervention, at 4 weeks into the intervention, and 1-2 weeks after the intervention (over 10 weeks). Data analysis was conducted using linear mixed (multilevel) models. RESULTS: After 10 weeks, 453 participants (171 in the intervention group and 282 in the waiting list control group) were assessed on outcome variables, with a dropout rate of 53.2% (516/969). Results revealed a significantly greater increase in the intervention group compared with the controls for SWLS (b=0.13, 95% CI 0.03-0.23; P=.001), FS (b=0.19, 95% CI 0.08-0.30; P=.001), positive emotions (b=0.43, 95% CI 0.27-0.60; P<.001), and these factors combined into a global well-being measure (b=0.28, CI 0.16-0.39; P<.001). Effect sizes (Cohen d) for the well-being outcomes ranged from 0.30 to 0.49. In addition, a significant decrease in anxiety and depressive symptoms was observed (b=-0.17, 95% CI -0.30 to -0.04; P=.001) with an effect size (Cohen d) of -0.20. CONCLUSIONS: The findings suggest that the web-based 5waysA intervention could serve as an effective approach for enhancing well-being and mental health within the general population. This study offers individuals, policy makers, and local stakeholders an accessible and potentially cost-effective well-being intervention that could be easily implemented. TRIAL REGISTRATION: ClinicalTrials.gov NCT04784871; https://clinicaltrials.gov/study/NCT04784871.

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Effective school-based mental health promotion and prevention interventions in low-and middle-income countries (LMICs) can positively impact the mental health and well-being of large numbers of young people. This scoping review aimed to investigate the implementation of effective mental health promotion and prevention interventions in LMIC schools. A scoping review of the international literature was conducted and followed the Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews guidelines. Medline, PsycInfo, Scopus, Embase, CINAHL and Cochrane were searched for peer-reviewed literature published from 2014 to 2022. PsycExtra, Google Scholar and the websites of key organisations were searched for relevant grey literature. Study selection focussed on mental health promotion interventions, including the development of social and emotional skills and mental health literacy, and prevention interventions, including anti-bullying and skill-based interventions for "at-risk" students. Twenty-seven studies evaluating 25 school-based interventions in 17 LMICs were included in the review. Fifteen interventions were developed in the implementing country and 10 were adapted from high-income countries (HICs) or other settings. Findings from the studies reviewed were generally positive, especially when interventions were implemented to a high quality. Universal life-skills interventions were found to increase social and emotional skills, decrease problem behaviours and positively impact students' mental health and well-being. Mental health literacy interventions increased mental health knowledge and decreased stigma among students and school staff. Outcomes for externally facilitated anti-bullying interventions were less positive. All 19 effective studies reported on some aspects of programme implementation, and 15 monitored implementation fidelity. Eleven studies outlined the programme's underpinning theoretical model. Only four studies reported on the cultural adaptation of programmes in detail. Including young people in the adaptation process was reported to facilitate natural cultural adaptation of programmes, while input from programme developers was considered key to ensuring that the core components of interventions were retained. The review findings indicate increasing evidence of effective mental health interventions in LMIC schools. To facilitate the sustainability, replication and scaling-up of these interventions, greater attention is needed to reporting on intervention core components, and the processes of implementation and cultural adaptation in the local setting.