Mental health literacy (MHL) strategies are crucial for mental health promotion and prevention. This study aimed to determine the acceptability, feasibility, appropriateness and initial efficacy of an adapted MHL program in a community sample of adults in Kenya. This was a quasi-experimental pre-post study conducted from July 2023 through July 2024. The MHL program contained nine modules delivered over 3 days. Participants were assessed at baseline and immediately after the program. The primary outcomes were mental health knowledge and participants’ attitudes on mental health/illness. Secondary outcomes included depressive symptoms, anxiety symptoms, self-perceived social support, self-perceived wellbeing, MHL program acceptability, feasibility and appropriateness. Relative to baseline, we observed statistically significant improvement in mental health knowledge and attitude on mental health/illness postintervention. We also observed significant improvements in all secondary outcomes. The MHL program also emerged as contextually appropriate, acceptable and feasible. The adapted MHL program is acceptable and appropriate and can feasibly be delivered by trained non-specialist facilitators. Also, the MHL program has the potential to increase participants’ MHL and attitudes and reduce symptoms of common mental disorders and promote self-perceived wellbeing. Future research should explore how improvements can be sustained over the long term.

Depression among women living with HIV affects their psychological well-being, HIV disease management, and prevention of mother-to-child transmission. A subset of 25 women selected from the intervention arm of the Maternal Depression Treatment in HIV (M-DEPTH) cluster randomized trial were interviewed; they had received either antidepressant therapy (ADT) or problem-solving therapy (PST). Their experiences as new mothers with the effects of depression and treatment on HIV disease and pregnancy management were assessed in a brief qualitative interview conducted in 2022. Seven were treated with ADT, 15 with PST, and three received both treatment modalities; all but two (n=23) responded to depression treatment. Participants reported improved adherence to HIV antiretroviral therapy and described the treatment as being effective in alleviating depressive symptoms. Additionally, the process of treatment helped them to learn a lot about depression, mental health, and its connection to physical and emotional well-being. Participants also reported improvements in parenting and pregnancy management. The results highlight the need for greater prioritization of mental health care for women living with HIV to prevent poor mental health outcomes and enhance overall functioning, including management of HIV disease, pregnancy, and parenting.

This study investigated the independent and interactive effects of dietary behaviors and physical activity on poor sleep quality among 15,059 Chinese adolescents. Using a cross-sectional design, we assessed sleep quality (Pittsburgh Sleep Quality Index, PSQI), dietary habits, and physical activity. Logistic regression and interaction analysis were performed to examine associations, adjusting for covariates. The prevalence of poor sleep quality (PSQI score ≥ 7) was 9.72%. Seven healthy dietary behaviors were identified as protective (e.g., regular diet, abstaining from alcohol; ORs=0.49–0.56). While physical activity showed no independent association, limiting screen-based sedentary screen time(≤2h/day) reduced poor sleep odds by 31% (OR = 0.69). Two significant interactions emerged: abstaining from alcohol combined with limiting sugary beverages synergistically reduced the odds of poor sleep quality by 42% (OR = 0.58), whereas the combination of healthy dining out and high physical activity was associated with a 181% increased odds of poor sleep quality (OR = 2.81). While healthy dietary patterns are strongly associated with better sleep quality, the interplay between behaviors is complex, demonstrating both synergistic protective association and antagonistic outcomes. Findings highlight the need for integrated lifestyle interventions that account for behavioral interactions in promoting adolescent sleep quality.

Mobile health (mHealth) interventions offer promising ways to enhance access and continuity of mental health services in low-resource settings. However, little is known about the perspective of end users in routine primary care in Nigeria regarding the role of mHealth in mental health care. This qualitative study explored the perspectives of patients, caregivers and healthcare providers on the use of mHealth tools to support access to and continuity of mental health care in Nigeria. Seventeen participants, including persons with lived experience of depression (n=7), caregivers (n=3), and primary healthcare workers (n=7), were purposively recruited from nine primary health clinics in Ibadan. Interviews were conducted in Yoruba, transcribed, translated into English, and analysed inductively using NVivo 15. Participants identified phone calls, Short Message Service (SMS) reminders, and audiovisual content as key facilitators of engagement, self-care and adherence. Caregivers valued direct communication with providers, while healthcare workers used mobile tools for reminders, follow-up and patient education. Flexible use of next-of-kin contacts helped overcome digital barriers. The findings demonstrate that user-friendly mHealth tools are feasible for supporting mental health care in Nigeria, but their success depends on coupling technology with human-centred communication to ensure equitable and continuous care.

Gender, as a sociostructural factor, may shape child development through social norms that influence family dynamics. We examined whether more egalitarian parental relationships are associated with better developmental outcomes. Using data from the Pelotas 1993 birth cohort (Brazil), we adapted a population-level gender inequality metric to characterise parental relationships. The Couple’s Gender Inequality Index (CGII) was derived from maternal health, parental education and income. Associations between CGII and educational attainment, quality of life, and depression at age 18 were assessed using linear regression models adjusted for family income, gestational age, birth weight, parental cohabitation and race. The sample comprised 2,852 participants (1,446 women). Higher CGII scores, indicating greater equality within couples, were associated with significantly higher educational attainment in both females and males. Higher quality of life at age 18 was observed in the second and fourth CGII quartiles compared with the most unequal. Greater equality was associated with lower risk of depression at age 18, although this association was not robust to adjustment. Among girls, a similar pattern was observed for emotional symptoms at age 15. Overall, greater couple-level gender inequality was associated with poorer developmental outcomes in offspring.

Continuous traumatic stress (CTS) exposure describes extended and ongoing collective trauma exposure that is associated with potential future danger and threat to the community. CTS has generated debate in the context of current definitions of trauma and posttraumatic stress disorder (PTSD) in the DSM-5. Prevalence data on posttraumatic stress symptoms (PTSS) and PTSD in adolescents aged 10 to 24 years following CTS exposure in Sub-Saharan Africa are lacking. This systematic review and meta-analysis sought to address this gap. We also synthesized evidence on other trauma-related mental disorders and moderators such as mean age, sex, country income, education level, PTSS/PTSD assessment tool, and recruitment method. A systematic literature search covering four databases yielded 460 papers that were screened for eligibility, with 10 studies included. Data were extracted and coded, and a meta-analysis of the pooled prevalence of clinically significant PTSS/PTSD was conducted. Results indicated a pooled prevalence of PTSS/PTSD of 32.0% (95% CI: 20.7% to 46.0%). Country income (World Bank category) and type of assessment (clinician-administered vs. self-report) significantly moderated the prevalence of PTSS/PTSD. Further research is needed to not only measure CTS as an exposure but also as a response separate from PTSS/PTSD among adolescents in Sub-Saharan Africa. Additionally, research is needed to determine the validity, reliability, and cultural relevance of CTS response measures. Such studies will help in better understanding the psychosocial impact of CTS exposure on adolescents and inform the development of future interventions. Detailed data on the prevalence of PTSS/PTSD and moderators thereof following CTS exposure in Sub-Saharan Africa are sparse. Further studies are needed to characterize CTS-related comorbidities and related phenomena in adolescents living under conditions of CTS exposure and to optimize evidence-based interventions.

Mental health legislation across Africa has evolved significantly from colonial-era frameworks. An adapted version of the FOSTREN* (Fostering and Strengthening Approaches to Reducing Coercion in European Mental Health Services) instrument, which is a comprehensive assessment tool based on the World Health Organisation Mental Health Legislation Checklist and the United Nations Convention on the Rights of Persons with Disabilities, was used to analyse mental health laws from Nigeria, Egypt, Ghana, Cabo Verde and Kenya. The comparative analysis showed varying alignment with international human rights standards, reflecting complex interactions between global frameworks and local realities. All the mental health laws analysed show movement towards rights-based approaches, although implementation challenges related to resource constraints, service delivery capacity and cultural integration remain significant barriers. Ghana’s formal integration of complementary and alternative medicine into its mental health framework, which requires cooperation between the Mental Health Authority and Traditional and Alternative Medicine Council, and the inclusion of people with lived experience of mental health conditions in review panels are examples of innovative approaches that show promise for regional adoption. While some form of supported decision-making is available, none of the countries offer advanced care directives. The study highlights that legislative reform alone is insufficient without addressing contextual factors like poverty, healthcare financing and integration of traditional healing practices in developing rights-based mental health care systems.

Brief, low-intensity interventions may hold untapped promise for bolstering maternal health in low-resource contexts. The current study used propensity score matching (PSM) to evaluate uptake and differential effectiveness of two low-intensity digital perinatal health (PH) support programs in Lima, Peru. Pregnant women (N = 251) were assigned to one of two conditions (PH vs. trauma-focused PH [TF-PH]) and received weekly psychoeducational content via WhatsApp from a lay paraprofessional for 5 weeks. Conditions were not randomly assigned; PSM was used to improve causal inference of the condition. Women were interviewed before participation (T1), immediately following treatment (T2) and at 3 (T3) and 12 months postpartum (T4). Intimate partner violence had strong negative effects on women’s mental health, multisystem resilience and parenting, and single mothers reported higher levels of depression and posttraumatic stress symptoms than did partnered women. Intervention uptake was high, with 77% of women participating in all sessions. There were no significant differences between treatment groups over time, but effect sizes indicated a slight advantage of the TF-PH condition in addressing depression symptoms (dr = −0.29) and multisystem resilience (dr = 0.39). Study findings suggest that brief interventions may be well-received and that trauma-focused supports may also confer additional benefits for addressing depression and resilience.

The ENHANCE non-inferiority trial that took place in a deprived setting in Pakistan demonstrated that a technology-assisted digital adaptation of the Technology Assisted Thinking Healthy Programme (THP-TAP) was no different than the face-to-face THP in improving symptoms of perinatal depression. The present study examines the mechanisms through which THP-TAP improved symptoms of perinatal depression (or not) compared to the face-to-face THP.

We applied a counterfactual-based approach to mediation – particularly interventional effects – to decompose the total effect of the THP-TAP intervention on symptoms of perinatal depression into the following pre-specified indirect effects: number of sessions attended; behavioural activation; perceived social support; problem-solving and cognitive-restructuring skills; and peer empathy. Mediators were assessed at 3 months post-partum, and depressive symptoms were measured at 6 months using the Patient Health Questionnaire-9 (PHQ-9).

Perceived social support in THP-TAP arm mediated an improvement in symptoms of perinatal depression compared to the standard face-to-face THP group (adjusted mean difference in PHQ-9 scores attributable to perceived social support in the technology-assisted digital adaptation of the THP group compared to the World Health Organisation THP group: −0.072, bias-corrected 95% confidence interval: −0.170, −0.018). There was no difference to support the indirect effects for all other mediators.

Even in the absence of treatment superiority, our findings suggest that levels of perceived social support were an important feature of the THP-TAP intervention, which resulted in improved symptoms of perinatal depression. From a practical perspective, these findings highlight the importance of social connectedness as a mechanism of change, demonstrating that peer-delivered digital psychosocial interventions can successfully cultivate this relational component.

During the perinatal period, women in low- and middle-income countries experience high rates of common mental disorders (CMDs). We aimed to estimate CMD prevalence at 6 and 12 months postpartum in Rahim Yar Khan (RYK), Pakistan, and identify factors associated with postpartum mental health. We conducted secondary analysis of a longitudinal birth cohort study, which was nested within the control arm of a community-based, cluster-randomized trial that enrolled pregnant women in their third trimester (n = 2,122). Mental health was assessed using the Self-Reporting Questionnaire. Factors associated with postpartum mental health were explored using mixed-effects linear regression, and associations between preconception, antenatal and postpartum CMDs were assessed using robust Poisson regression. The prevalence of CMDs was 16% and 17% at 6 and 12 months postpartum, respectively. Women who reported that their husbands were unhappy had poorer postpartum mental health, whereas high social support was associated with improved postpartum mental health. History of antenatal CMDs was associated with increased risk of CMDs at 6 and 12 months postpartum (adjusted risk ratio = 2.60 and 1.90, 95% confidence interval: 1.69–4.01 and 1.40–2.58, respectively). Mothers with identified risk factors may benefit from targeted mental health support during the perinatal period.

This study focuses on the national and subnational estimation of prevalence, incidence, disability-adjusted life years (DALYs) related to self-harm and suicide mortality in Iran. These indicators of disease burden were analyzed over the period from 1990 to 2021, with stratifications based on sex, age and geographic location. Additionally, the percentage change observed between 1990 and 2021 was documented. The age-standardized prevalence rate (per 100,000) of self-harm decreased from 173.92 (95% UI: 146.13–208.75) in 1990 to 131.2 (95% UI: 110.55–156.67) in 2021, reflecting a percentage change of −0.25% over the period. In terms of self-harm prevalence in 2021, males had a higher rate (137.62 per 100,000) compared to females (124.82 per 100,000). The findings of the current study revealed that, despite significant challenges such as demographic shifts, economic instability and the impacts of war, the trends in self-harm incidents and suicide mortality rates in Iran have generally been on the decline. Additionally, it was observed that suicide-related deaths were more prevalent among males when compared to females. However, when examining self-harm behaviors over previous decades, these acts appeared to be more frequent among females.

The aim of the present study was to develop short and very short forms of the Children’s Test Anxiety Scale (CTAS) using the ant colony optimization (ACO) algorithm. The item selection algorithm for the short form was applied to Sample 1 (N = 570), and the best-fitting short form was identified based on validity and reliability evidence. These analyses were then replicated with Sample 2 (N = 825) to confirm the findings. Children’s Perceived Academic Self-Efficacy Scale used for convergent validity. Also measurement invariance tested by gender. Additionally, a very short form of the scale (CTAS-VS) was developed using a subset of the same sample. Across all three studies, consistent results were found in terms of model fit, factor structure and validity. Overall, findings suggest that both the 14-item short form (CTAS-S) and the 3-item very short form (CTAS-VS), developed via the ACO algorithm, possess strong psychometric properties.

Mental illness-related stigma acts as a critical barrier to care by fostering shame, fear of judgment and discrimination, which deters individuals from seeking help, delays treatment and worsens outcomes. This study aimed to investigate the forms, drivers and consequences of mental health-related stigma on help-seeking behavior. A cross-sectional study was conducted from November 2020 to March 2021. Data were collected from 419 participants using structured questionnaires, guided by the Health Stigma and Discrimination Framework and the Attitudes Towards Seeking Professional Psychological Help Scale for validation. Data were analyzed using Statistical Package for the Social Sciences version 22, employing descriptive statistics, chi-square tests and multinomial logistic regression. The average age of participants was 34.5 years. Findings revealed alarmingly high stigma: economic (76.8–80.2%), social (77.1–81.2%) and psychological (71.9–82.8%). Key drivers included stereotypes of dangerousness (58.7%) and systemic healthcare discrimination (65.6%). Multinomial regression confirmed that all stigma forms significantly reduced help-seeking odds. Structural barriers (odds ratio [OR] = 0.48) and internalized shame (OR = 0.53) were the strongest deterrents, with a multiplicative effect for combined economic and psychological stigma (OR = 0.41). This complex, multilayered barrier, driven by socio-cultural beliefs and structural failures, necessitates urgent, multifaceted interventions targeting public education, policy and self-stigma to improve mental health equity in rural Ghana.