Youth living in low- and middle-income countries (LMICs) have an increased vulnerability to mental illnesses, with many lacking access to adequate treatment. There has been a growing body of interventions using task sharing with trained peer leaders to address this mental health gap. This scoping review examines the characteristics, effectiveness, components of peer delivery and challenges of peer-led mental health interventions for youth aged 10–24 in LMICs. A key term search strategy was employed across MEDLINE, Embase, Web of Science, Global Health and Global Index Medicus. Eligibility criteria included young people aged 10–24 and a peer-led component delivered in any setting in an LMIC. Study selection and extraction were conducted independently by the first and second authors, with discrepancies resolved by the senior author. Study characteristics were summarised and presented descriptively. The search identified 5,358 citations, and 19 studies were included. There were 14 quantitative, four qualitative and one mixed methods study reporting mental health outcomes. Types of interventions were heterogenous but fell within three broad categories: (1) peer education and psychoeducation, (2) peer-led psychotherapy and counselling and (3) peer support. All studies reported improved mental health outcomes as a result of the peer-led interventions. Peer-led interventions are versatile in terms of both the types of interventions and mode of delivery. Lived experience, mutual respect and reduced stigma make this method a highly unique and effective way to engage this age group. However, implementing peer-led youth interventions is not without challenges. Adequate training, supervision, cultural appropriateness and support from established institutions are critical to safeguarding and ensuring the sustainability of such programs. Our findings suggest that peer-led models are a valuable intervention strategy that policymakers can leverage in current and future efforts to address youth mental health in LMICs. Future areas of research should expand to include the perspectives of other key stakeholders involved in the implementation of peer-led mental health interventions, focusing on factors including fidelity, feasibility and acceptability to enhance implementation insights.

In recent years the evidence base for psychological interventions in low- and -middle-income countries (LMIC) has rapidly accrued, demonstrating that task-shifting models result in desired outcomes. Next, it is important to look at how this evidence translates into practice. In doing so, this paper argues that the field of global mental health might benefit from applying a system theory or system science perspective. Systems thinking aims to understand how different components are connected and interdependent within a larger emergent entity. At present much of the research efforts into psychological interventions in LMIC are focusing on single interventions, with little focus on how these interventions sit in, or influence, a larger system. Adopting systems theory and system dynamics tools can help in; (i) better analyzing and understanding the key drivers of mental health problems and services, (ii) optimizing mental health services; and (iii) understanding the organization of people, institutions and resources required for rolling out and scaling-up mental health services. This paper reflects on some of these merits of a systems perspective, as well as provides some examples.

This proof-of-concept study evaluated an optimization strategy for the Community Case Detection Tool (CCDT) aimed at improving community-level mental health detection and help-seeking among children aged 6–18 years. The optimization strategy, CCDT+, combined data-driven supervision with motivational interviewing techniques and behavioural nudges for community gatekeepers using the CCDT. This mixed-methods study was conducted from January to May 2023 in Palorinya refugee settlement in Uganda. We evaluated (1) the added value of the CCDT+ in improving the accuracy of detection and mental health service utilization compared to standard CCDT, and (2) implementation outcomes of the CCDT+. Of the 1026 children detected, 801 (78%) sought help, with 656 needing mental health care (PPV = 0.82; 95% CI: 0.79, 0.84). The CCDT+ significantly increased detection accuracy, with 2.34 times higher odds compared to standard CCDT (95% CI: 1.41, 3.83). Additionally, areas using the CCDT+ had a 2.05-fold increase in mental health service utilization (95% CI: 1.09, 3.83). The CCDT+ shows promise as an embedded quality-optimization process for the detection of mental health problems among children and enhance help-seeking, potentially leading to more efficient use of mental health care resources.

The climate change crisis is a complex global challenge that has far- reaching implications for public health and well-being. Rising temperatures and more frequent extreme weather events are impacting physical health, mental well-being, and ecological balance. Vulnerable communities are disproportionately affected, especially in terms of food security. Furthermore, climate-related disasters have profound and lasting effects on mental health, leading to trauma responses and dissociation as coping mechanisms. This perspective delves into the concept of collective dissociation, a subconscious defense mechanism that hinders effective action in the face of the overwhelming climate crisis. Understanding and characterizing this phenomenon is essential to promote meaningful climate action. To combat collective dissociation and facilitate effective collective action, several strategies are proposed. Responsible information management for advocacy, local moral support, strategic policy development, and research on climate trauma processing are highlighted as vital approaches. By addressing the mental health implications of climate change, raising awareness, and prioritizing resilience and cooperation, societies can transcend collective dissociation and work together towards a more sustainable future for both the planet and its inhabitants. This call to action underscores the need for comprehensive and guided measures to safeguard planetary and population health in the face of this pressing crisis.

Intensifying storms and inter-annual El Niño events may increase psychological stress and worsen mental health. This study examines the relationship between flood exposure and long-term mental health symptoms among adolescents and young people in Peru, the world’s most affected country by El Niño. We analyzed community and self-reported survey data from the Young Lives Study to contrast mental health in 2016 among youth who lived in communities that experienced or did not experience flooding between 2013 and 2016. We pre-processed data on 1344 individuals in 93 communities, using optimal full matching on Mahalanobis distance with a propensity score caliper, and estimated relative risks to mental health scores in the general population of young people and among gender-stratified groups via quasi-Poisson regression. Exposure to floods did not yield conclusive differences in mental health scores in this sample. Further evidence is needed on mental health patterns over time, the influence of exposure severity, and the impact of disaster relief on symptomology in mounting an effective global health response.

Sub-Sahara Africa (SSA) children are at high-risk neurodevelopmentally due to the prevalence of infectious disease, nutritional deficiencies and compromised caregiving. However, few mental health screening measures are readily available for general use. The Strengths and Difficulties Questionnaire (SDQ) has been used as a mental health screening measure in the SSA, but its psychometric properties are not well understood. Five hundred and sixty-six mothers completed the SDQ for their 6-year-old children in rural Benin north of Cotonou. These were mothers who had been part of a malarial and intestinal parasite treatment program and micronutrient fortification intervention program during pregnancy for these children. Their study children (N = 519) completed the computerized Tests of Variables of Attention (TOVA-visual) as a performance-based screening assessment of attention deficit and hyperactivity disorders. In evaluating the relationship between the SDQ and TOVA, we controlled for maternal risk factors such as depression, poor socioeconomic status and educational level, along with the child’s schooling status. TOVA measures of impulsivity were significantly related to SDQ emotional and hyperactivity/inattention difficulties. TOVA inattention was related to SDQ emotional difficulties. The triangulation of maternal risk factors (e.g., depression), the SDQ and the TOVA can provide effective screening for mental health issues in SSA children.

Increasing mental health issues in India demands for a strong intervention to curb the rise. According to the World Health Organization, roughly around 21 Indians out of 100,000 die by suicide every year. The burden on mental health domain increases due to the existing system as most of the existing services follow a traditional approach and are most sought after but lack reachability and ease of access. This study recognises the need for programmes that help in reachability and ease of access while simultaneously maintaining anonymity, therefore, analyses the impact of chat-based therapy provided online through the platform. The paper analyses the difference in subjective unit of well-being (SUW) pre and post chat-based sessions among 2624 college students and 805 corporate employees. The Wilcoxon signed rank test between pre and post intervention indicates significant results with the p < 0.001 (Z = −44.100a) suggesting and increase in SUW scores post intervention. Further, the Kruskal–Wallis test revealed that the gender of the clients has an association with the SUW scores (p < 0.05). It was also found that the duration of the sessions had a positive relation with the impact scores (p < 0.001).

A history of psychologically traumatic experiences can impact health outcomes for pregnant people and their infants. The perception and prevalence of traumatic experiences during pregnancy may differ by geographical region. To better understand trends in how and what kinds of psychological trauma are assessed globally, we conducted a secondary analysis on a larger systematic review examining psychological trauma measurement in pregnancy. Through a systematic literature review conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, completed between July 2021 and September 2023 using Ovid MEDLINE, Ovid EMBASE, Scopus, Web of Science, PsycInfo and Cochrane, we identified 576 research studies assessing psychological trauma during pregnancy that were conducted across nine geopolitical regions. Most of these studies took place in North America, followed by sub-Saharan Africa, Europe, Asia, the Middle East or Northern Africa, Oceania, South America, and Central America. The fewest number of studies was conducted across multiple regions. We found that most studies measuring psychological trauma in pregnancy across the nine geopolitical regions assessed interpersonal trauma, and the fewest number of studies assessed healthcare trauma. Moreover, for each type of psychological trauma assessed, the greatest number of studies was conducted in North America. We also found that Central America, Oceania, sub-Saharan Africa, Asia, Middle East or Northern Africa, Europe, and studies conducted across multiple regions had one-third or more studies that only used in-house assessments, rather than previously validated assessments of psychological trauma. The results of this review emphasize the need for regionally specific and culturally appropriate measures of psychological trauma for pregnant people, which prioritize the types of psychological trauma that are most common in a given region. Newly developed measures can be used for screening and treatment of patients using trauma-informed obstetric care.

For several years stigma researchers in India have relied on Western instruments or semi-structured stigma scales in their studies. However, these scales have not been rigorously translated and adapted to the local cultural framework. In the current study, we describe the cultural adaptation of six stigma scales with the purpose of using it in the native language (Kannada) based on translation steps of forward translation, expert review and synthesis, cultural equivalence, back translation and cognitive interview processes.

Several items were modified in the target language at each stage of the cultural adaptation process as mentioned in the above steps across all scales. Cultural explanations for the same have been provided. Concepts such as “community forest” and “baby sitting" was replaced with equivalent native synonyms. We introduced native cultural and family values such as “joint family system” and modified the item of housing concept in one of the tools. The concept of “privacy” in the Indian rural context was observed to be familial than individual-based and modification of corresponding items according to the native context of “privacy”. Finally, items from each scale were modified but retained without affecting the meaning and the core construct.

Virtual reality (VR) for mental health promotion remains understudied in low-income humanitarian settings. We examined the effectiveness of VR in reducing depression with urban refugee youth in Kampala, Uganda. This randomized controlled trial assessed VR alone (Arm 1), VR followed by Group Problem Management Plus (GPM+) (Arm 2) and a control group (Arm 3), with a peer-driven and convenience sample of refugee youth aged 16–25 in Kampala. The primary outcome, depression, was measured with the Patient Health Questionnaire-9. Secondary outcomes included: mental health literacy, mental health stigma, self-compassion, mental well-being and adaptive coping. Analyses were conducted at three time points (baseline, 8 weeks, 16 weeks) using generalized estimating equations. Among participants (n = 335, mean age: 20.77, standard deviation: 3.01; cisgender women: n = 158, cisgender men: n = 173, transgender women: n = 4), we found no depression reductions for Arms 1 or 2 at 16 weeks compared with Arm 3. At 16 weeks, mental health literacy was significantly higher for Arm 2 compared with Arm 3, and self-compassion was significantly higher in Arm 1 and Arm 2 compared with Arm 3. VR alongside GPM+ may benefit self-compassion and MHL among urban refugee youth in Kampala, but these interventions were not effective in reducing depression.

Empathy plays a crucial role in psychosocial and psychological interventions, greatly impacting rapport building, patient adherence, and satisfaction with treatment. Empathetic interactions enhance patient’s self-reflection and the delivery of more personalized therapeutic interventions tailored to the unique needs of each patient, thereby improving the overall quality of care. Despite empathy being central to psychosocial interventions, there are currently no valid and reliable patient-centered tools that assess the lay-therapist empathy that they show and/or exhibit toward their patients.

In this study, the patient-rated Empathy Scale for Lay Therapists was developed to assess empathy in community health workers delivering psychosocial interventions. Psychometric validation was based on a cross-sectional study embedded in a non-inferiority cluster randomized trial of the Thinking Healthy Programme for perinatal depression in Pakistan.

Community testing with perinatal women confirmed the scale’s understandability and logical structure, highlighting its face validity. Among the 980 trial participants, a high level of agreement with the Empathy Scale for Lay Therapists (mean score 2.616) was observed, indicating effective communication and empathy from health workers. The scale demonstrated excellent internal consistency (Cronbach’s alpha 0.96). Exploratory Factor Analysis revealed a unidimensional structure, capturing 87.81% of the total variance, with strong factor loadings.

In low- and middle-income countries like Sierra Leone, there is a significant gap in the treatment of perinatal mental health disorders such as anxiety, depression and somatization. This study explored the feasibility, acceptability and preliminary effectiveness of a culturally adapted Problem-Solving Therapy – Friendship Bench Intervention (PST-FBI) delivered by nonspecialists, mother-to-mother support groups (MMSGs), to perinatal women experiencing psychological distress. MMSGs provide 4 weeks of home-based, individual PST-FBI, followed by a peer-led group session called col at sacul (circle of serenity). The intervention targeted peri-urban pregnant women and new mothers screened for psychological distress. This was a two-armed, pre–post, waitlist-controlled study that employed the Sierra Leone Perinatal Psychological Distress Scale (SLPPDS) to screen and measure their outcomes. Feasibility and acceptability were examined through in-depth interviews using the Consolidated Framework for Implementation Research, analyzed thematically, while preliminary effectiveness was evaluated with chi-squared analysis for categorical and t-test for continuous variables. Twenty of the 25 women completed all four PST-FBI sessions delivered by five MMSGs. The individual PST and the peer-led session were viewed as beneficial for problem-sharing and skill building. The SLPPDS scores significantly dropped by 58.9% (17.1–8.4) in the intervention group, while the control group showed a 31.6% (18.0–12.3) decrease. The intervention’s effect size was d = 0.40 (p < 0.05). The MMSG-led PST-FBI, including the col at sacul session, proved feasible, acceptable and with preliminary effectiveness in improving the mental health of peri-urban pregnant women and new mothers in Sierra Leone. Further randomized-controlled trials are recommended before nationwide implementation.

Wearable technology and daily diaries offer insights into everyday behaviors that can further health research and treatment globally. However, the use of these methodologies outside of high-income settings has been limited. We conducted two pilot studies that enrolled 60 young women in the urban slums of Kampala, Uganda to understand design considerations associated with using wearable technology and daily diaries in this context. Each participant in the pilot studies was asked to wear a wearable activity tracker and complete daily diary questionnaires for 5 days. Based on our experiences, we identified several lessons that may be beneficial to others interested in implementing wearable technology and daily self-reports in their research and interventions, particularly when working in low-resource contexts. We discuss the importance of designing solutions tailored to the available resources, building validation for the most critical measures, investing in data management efforts and providing transparent and culturally accessible information to participants. Examples from our study are provided. These lessons may reduce the barriers and improve data quality for future researchers and practitioners interested in using these data collection methods globally.

Interpersonal Psychotherapy (IPT) is an evidence-based treatment for adolescent depression. However, since it does not work for all adolescents in all settings, more research on its heterogeneous effects is needed. Using a realist approach, we aimed to generate hypotheses about mechanisms and contextual contingencies in adolescent group IPT in Nepal. We analysed 26 transcripts from qualitative interviews with IPT participants aged 13–19, facilitators, supervisors and trainers. We analysed data using the Framework Method. The qualitative analytical framework was based on the VICTORE checklist, a realist tool to explore intervention complexity. Sharing, problem-solving, giving and receiving support, managing emotions and negotiating emerged as mechanisms through which adolescents improved their depression. Participants perceived that girls and older adolescents benefitted most from IPT. Girls had less family support than boys and therefore benefitted most from the group support. Older adolescents found it easier than younger ones to share problems and manage emotions. Adolescents exposed to violence and parental alcoholism struggled to overcome problems without family and school support. We formulated hypotheses on group IPT mechanisms and contextual interpersonal and school-level factors. Research is needed to test these hypotheses to better understand for whom IPT works and in what circumstances.