University and college students are vulnerable to developing depressive symptoms. People in low-income countries are disproportionately impacted by mental health problems, yet few studies examine routes to accessing clinical services. Examining motivation and barriers toward seeking clinical mental health services in university students in Bangladesh is important.

Using a cross-sectional survey (n = 350), we assess the relationship between the constructs of autonomy, relatedness, and competency toward using clinical mental health practices (i.e. using professional resources, taking medication) with (1) positive views, (2) perceived need, and (3) use of clinical mental health services among Bangladeshi university students.

Results showed that the perceived need for mental health support was the predictor of the largest magnitude (aOR = 4.99, p = 0.005) for using clinical services. Having a positive view of clinical services was predictive of clinical service use (aOR = 2.87, p = 0.033); however, that association became insignificant (p = 0.054) when adjusting for the perceived need for mental health care. Of the SDT constructs, social influences were predictive of perceiving a need for mental health support, and mental health knowledge was predictive (aOR = 1.10, p = 0.001) of having a positive view of clinical mental health care.

Our findings show that knowledge of mental health is associated with positive views of mental health services, and that higher levels of stress and the presence of people with mental health problems are associated with the perception of a need for mental health care, which is ultimately responsible for using the services.

The Global Burden of Disease attributable to psychotic disorders in African countries is high and has increased sharply in recent years. Yet, there is a scarcity of evidence on effective, appropriate and acceptable interventions for schizophrenia and other psychotic disorders on the continent.

We carried out a systematic review and narrative synthesis of peer-reviewed literature evaluating the impact of non-pharmacological interventions for adolescents and adults (10–65 years) in African countries. Two reviewers independently double-screened all articles and performed data extraction and quality appraisal using standardized tools.

Of the 8529 unique texts returned by our search, 12 studies were identified for inclusion, from seven countries: Egypt, Ethiopia, Ghana, Kenya, Nigeria, South Africa and Sudan. They evaluated a range of interventions with one or more clinical, psychological or psychosocial, education or awareness or traditional or faith-based components, and were delivered by either mental health specialists or non-specialist health workers. Ten of the 12 included studies reported significant, positive effects on a range of outcomes (including functioning, symptoms and stigma). Nearly half of the interventions were based out of health facilities. Based on quality appraisals, confidence in these studies' findings is only rated low to medium.

Further research is needed to develop and evaluate interventions that meet the diverse needs of people with psychosis, within and beyond the health sector.

Stigma against persons with mental illness is a universal phenomenon, but culture influences the understanding of etiology of mental illness and utilization of health services.

We validated Kiswahili versions of three measures of stigma which were originally developed in the United Kingdom: Community Attitudes Toward the Mentally Ill Scale (CAMI), Reported and Intended Behaviors Scale (RIBS) and Mental Health Awareness Knowledge Schedule (MAKS) and evaluated their psychometric properties using a community sample (N = 616) in Kilifi, Kenya.

Confirmatory factor analysis confirmed the one-factor solution for RIBS [root mean-squared error of approximation (RMSEA) < 0.01, comparative fit index (CFI) = 1.00, Tucker–Lewis index (TLI) = 1.01] and two-factor solution for MAKS (RMSEA = 0.04, CFI = 0.96, TLI = 0.95). A 23-item, three-factor model provided the best indices of goodness of fit for CAMI (RMSEA = 0.04, CFI = 0.90, TLI = 0.89). MAKS converged with both CAMI and RIBS. Internal consistency was good for the RIBS and acceptable for CAMI and MAKS. Test–retest reliabilities were excellent for RIBS and poor for CAMI and MAKS, but kappa scores for inter-rater agreement were relatively low for these scales. Results support validity of the original MAKS and RIBS scale and a modified CAMI scale and suggest that stigma is not an enduring trait in this population. The low kappa scores are consistent with first kappa paradox which is due to adjustment for agreements by chance in case of marginal prevalence values.

Kiswahili versions of the MAKS, RIBS and a modified version of the CAMI are valid for use in the study population. Stigma against people with mental illness may not be an enduring trait in this population.

Studies have identified high rates of mental disorders in refugees, but most used self-report measures of psychiatric symptoms. In this study, we examined the percentages of adult refugees and asylum seekers meeting diagnostic criteria for major depressive disorder (MDD), post-traumatic stress disorder, bipolar disorder (BPD), and psychosis.

A systematic literature search in three databases was conducted. We included studies examining the prevalence of MDD, post-traumatic stress disorder, BPD, and psychosis in adult refugees according to a clinical diagnosis. To estimate the pooled prevalence rates, we performed a meta-analysis using the Meta-prop package in Stata (PROSPERO: CRD42018111778).

We identified 7048 records and 40 studies (11 053 participants) were included. The estimated pooled prevalence rates were 32% (95% CI 26–39%; I2 = 99%) for MDD, 31% (95% CI 25–38%; I2 = 99.5%) for post-traumatic stress disorder, 5% (95% CI 2–9%; I2 = 97.7%) for BPD, and 1% (95% CI 1–2%; I2 = 0.00%) for psychosis. Subgroup analyses showed significantly higher prevalence rates of MDD in studies conducted in low-middle income countries (47%; 95% CI 38–57%, p = 0.001) than high-income countries studies (28%; 95% CI 22–33%), and in studies which used the Mini-International Neuropsychiatric Interview (37%; 95% CI 28–46% p = 0.05) compared to other diagnostic interviews (26%; 95% CI 20–33%). Studies among convenience samples reported significant (p = 0.001) higher prevalence rates of MDD (35%; 95% CI 23–46%) and PTSD (34%; 95% CI 22–47%) than studies among probability-based samples (MDD: 30%; 95% CI 21–39%; PTSD: 28%; 95% 19–37%).

This meta-analysis has shown a markedly high prevalence of mental disorders among refugees. Our results underline the devastating effects of war and violence, and the necessity to provide mental health intervention to address mental disorders among refugees. The results should be cautiously interpreted due to the high heterogeneity.

People with severe mental illness (SMI) are more likely to have obesity and engage in health risk behaviours than the general population. The aims of this study are (1) evaluate the effectiveness of interventions that focus on body weight, smoking cessation, improving sleeping patterns, and alcohol and illicit substance abuse; (2) Compare the number of interventions addressing body weight and health risk behaviours in low- and middle-income countries (LMICs) v. those reported in published systematic reviews focusing on high-income countries (HICs).

Intervention studies published up to December 2020 were identified through a structured search in the following database; OVID MEDLINE (1946–December 2020), EMBASE (1974–December 2020), CINAHL (1975–2020), APA PsychoINFO (1806–2020). Two authors independently selected studies, extracted study characteristics and data and assessed the risk of bias. and risk of bias was assessed using the Cochrane risk of bias tool V2. We conducted a narrative synthesis and, in the studies evaluating the effectiveness of interventions to address body weight, we conducted random-effects meta-analysis of mean differences in weight gain. We did a systematic search of systematic reviews looking at cardiometabolic and health risk behaviours in people with SMI. We compared the number of available studies of LMICs with those of HICs.

We assessed 15 657 records, of which 9 met the study inclusion criteria. Six focused on healthy weight management, one on sleeping patterns and two tested a physical activity intervention to improve quality of life. Interventions to reduce weight in people with SMI are effective, with a pooled mean difference of −4.2 kg (95% CI −6.25 to −2.18, 9 studies, 459 participants, I2 = 37.8%). The quality and sample size of the studies was not optimal, most were small studies, with inadequate power to evaluate the primary outcome. Only two were assessed as high quality (i.e. scored ‘low’ in the overall risk of bias assessment). We found 5 reviews assessing the effectiveness of interventions to reduce weight, perform physical activity and address smoking in people with SMI. From the five systematic reviews, we identified 84 unique studies, of which only 6 were performed in LMICs.

Pharmacological and activity-based interventions are effective to maintain and reduce body weight in people with SMI. There was a very limited number of interventions addressing sleep and physical activity and no interventions addressing smoking, alcohol or harmful drug use. There is a need to test the feasibility and cost-effectiveness of context-appropriate interventions to address health risk behaviours that might help reduce the mortality gap in people with SMI in LMICs.

Policy measures to slow the spread of coronavirus disease 2019 (COVID-19), such as curfews and business closures, may have negative effects on mental health. Populations in low- and middle-income countries (LMICs) may be particularly affected due to high rates of poverty and less comprehensive welfare systems, but the evidence is scarce. We evaluated predictors of depression, anxiety, and psychological distress in Uganda, which implemented one of the world's most stringent lockdowns.

We conducted a mobile phone-based cross-sectional survey from December 2020 through April 2021 among individuals aged 18 years or over in Uganda. We measured depression, anxiety, and psychological distress using the Patient Health Questionnaire (PHQ)-2, the Generalized Anxiety Disorder (GAD)-2, and the PHQ-4. We applied linear regression to assess associations between experiences of COVID-19 (including fear of infection, social isolation, income loss, difficulty accessing medical care, school closings, and interactions with police) and PHQ-4 score, adjusted for sociodemographic characteristics.

29.2% of 4066 total participants reported scores indicating moderate psychological distress, and 12.1% reported scores indicating severe distress. Distress was most common among individuals who were female, had lower levels of education, and lived in households with children. Related to COVID-19, PHQ-4 score was significantly associated with difficulty accessing medical care, worries about COVID-19, worries about interactions with police over lockdown measures, and days spent at home.

There is an urgent need to address the significant burden of psychological distress associated with COVID-19 and policy responses in LMICs. Pandemic mitigation strategies must consider mental health consequences.

In addition to risking their physical well-being, frontline physicians are enduring significant emotional burden both at work and home during the coronavirus disease 2019 (COVID-19) pandemic. This study aims to investigate the levels of anxiety and depressive symptoms and to identify associated factors among Bangladeshi physicians during the COVID-19 outbreak.

A cross-sectional study using an online survey following a convenience sampling technique was conducted between April 21 and May 10, 2020. Outcomes assessed included demographic questions, COVID-19 related questions, and the Hospital Anxiety and Depression Scale (HADS).

The survey was completed by 412 Bangladeshi physicians. The findings revealed that, in terms of standardized HADS cut-off points, the prevalence of anxiety and depressive symptoms among physicians was 67.72% and 48.5% respectively. Risk factors for higher rates of anxiety or depressive symptoms were: being female, physicians who had experienced COVID-19 like symptoms during the pandemic, those who had not received incentives, those who used self-funded personal protective equipment (PPE), not received adequate training, lacking perceived self-efficacy to manage COVID-19 positive patients, greater perceived stress of being infected, fear of getting assaulted/humiliated, being more connected with social media, having lower income levels to support the family, feeling more agitated, less than 2 h of leisure activity per day and short sleep duration. All these factors were found to be positively associated with anxiety and depression in unadjusted and adjusted statistical models.

This study identifies a real concern about the prevalence of anxiety and depressive symptoms among Bangladeshi physicians and identifies several associated factors during the COVID-19 pandemic. Given the vulnerability of the physicians in this extraordinary period whilst they are putting their own lives at risk to help people infected by COVID-19, health authorities should address the psychological needs of medical staff and formulate effective strategies to support vital frontline health workers.

In low- and middle-income countries (LMICs), most parents of children with mental health problems receive limited support from social and health services while caring for their children. However, research on the quality of life (QOL) of these parents in LMICs is limited. This study aimed to investigate the association between maternal QOL and children's mental health problems, and other related factors in Mongolia.

A cross-sectional analysis of children aged 4–17 years who lived in Ulaanbaatar and visited the National Mental Health Centre in Mongolia and their mothers was conducted. The mothers' QOL was assessed using the WHOQOL-BREF, and the severity of children's mental health problems was assessed using the Strengths and Difficulties Questionnaire (SDQ). Multivariate linear regression analyses were performed using the mothers' WHOQOL domain scores as dependent variables and the children's SDQ scores and demographic and socioeconomic factors as explanatory variables.

A total of 242 child-mother dyads were included in this study, and 231 dyads were included in the multivariate regression analyses. Children's SDQ internalising scores were negatively associated with all four maternal QOL domain scores, while their externalising scores were negatively associated with maternal physical and psychological domain scores. Non-cohabitation of fathers was negatively associated with physical, social, and environmental domain scores, and non-cohabitation of grandparents was associated with psychological and environmental domain scores.

In Mongolia, maternal QOL is influenced by the severity of children's mental health problems and family member support. These findings highlight the importance of developing systems to support all families.

The changes experienced during the transition to first-time or subsequent fatherhood are mainly positive; however, fathers can also experience adverse mental health outcomes such as stress, anxiety, and depression. The aim of this study was to investigate the prevalence and associated factors of paternal stress, anxiety, and depression symptoms in the early postnatal period.

A quantitative, descriptive correlational design was used. Data were collected using a self-administered questionnaire comprising of the Perceived Stress Scale, the State-Trait Anxiety Inventory, and the Edinburgh Postnatal Depression Scale.

A total of 336 fathers were included in the study. The prevalence rates were 41.1% (n = 138) for moderate/high stress symptoms, 20.8% (n = 70) for state anxiety symptoms, 25.9% (n = 87) for trait anxiety symptoms, and 13.4% (n = 45) for depression symptoms. In the multivariable analysis, several factors were associated with increased stress, anxiety, and depression symptoms including being a subsequent father (p = 0.009), not living in a house (p = 0.009), having a history of adverse mental health (p = 0.008), and having a partner with a history of anxiety (p = 0.040).

The findings suggest that fathers are at risk of adverse mental health in the early postnatal period which is a pivotal time for fathers in terms of bonding with their infant and redefining their relationship with their partner.

This study investigated whether subjective unrest-related distress was associated with probable depression during and after the 2019 anti-ELAB movement in Hong Kong.

Population-representative data were collected from 7157 Hong Kong Chinese in four cross-sectional surveys (July 2019–July 2020). Logistic regression examined the association between subjective unrest-related distress and probable depression (PHQ-9 ⩾ 10), stratified by the number of conflicts/protests across the four timepoints.

Unrest-related distress was positively associated with probable depression across different numbers of conflicts/protests.

Unrest-related distress is a core indicator of probable depression. Public health interventions should target at resolving the distress during seemingly peaceful period after unrest.

Healthcare workers (HCWs) have been impacted psychologically due to their professional responsibilities over the prolonged era of the coronavirus disease 2019 (COVID-19) pandemic. The study aimed to identify the predictors of psychological distress, fear, and coping during the COVID-19 pandemic among HCWs.

A cross-sectional online survey was conducted among self-identified HCWs across 14 countries (12 from Asia and two from Africa). The Kessler Psychological Distress Scale, the Fear of COVID-19 Scale, and the Brief Resilient Coping Scale were used to assess the psychological distress, fear, and coping of HCWs, respectively.

A total of 2447 HCWs participated; 36% were doctors, and 42% were nurses, with a mean age of 36 (±12) years, and 70% were females. Moderate to very-high psychological distress was prevalent in 67% of the HCWs; the lowest rate was reported in the United Arab Emirates (1%) and the highest in Indonesia (16%). The prevalence of high levels of fear was 20%; the lowest rate was reported in Libya (9%) and the highest in Egypt (32%). The prevalence of medium-to-high resilient coping was 63%; the lowest rate was reported in Libya (28%) and the highest in Syria (76%).

COVID-19 has augmented the psychological distress among HCWs. Factors identified in this study should be considered in managing the wellbeing of HCWs, who had been serving as the frontline drivers in managing the crisis successfully across all participating countries. Furthermore, interventions to address their psychological distress should be considered.

The Connor–Davidson Resilience Scale (CD-RISC) and the Brief Resilience Scale (BRS) are two scales widely used to measure resilience. Although both scales seek to assess an individual's ability to recover from and adapt to disruptions or stressful events, they can capture different aspects of resilience. While the CD-RISC focuses on resources that can help individuals to recover from and adapt to disruptions or stressful events, the BRS directly measures one's ability to bounce back or be resilient. The aim of this study is to better understand resilience through empirically examining the differences between the CD-RISC and the BRS.

Samples (a pooled sample N = 448 and two subsamples N = 202 and 246) consisting of undergraduate students from Taiwan were used. Confirmatory factor analysis (CFA) was performed to examine the relationship between the CD-RISC and BRS. Regression analysis was conducted to examine predictive effects of the CD-RISC and BRS on depression and life satisfaction.

The results of CFA using different samples consistently show that the CD-RISC and the BRS are highly correlated but still distinct. The results of regression analyses using different samples also consistently show that the CD-RISC and the BRS have unique predictive effects regarding depression and life satisfaction.

The research findings suggest that the CD-RISC and the BRS capture different aspects of resilience. For future research on resilience, researchers should pay closer attention to the differences between these scales and choose the one that most closely fits their research purpose.

Despite the growth of psychotherapy trials in low- and middle-income countries, there have been limited follow-up studies of more than 2 years. This study follows up female sexual violence survivors approximately 6 years after completing a 12-session group cognitive processing therapy (CPT) program in the eastern Democratic Republic of Congo.

Baseline trial data were collected in December 2010 from 134 women in 7 study villages randomly allocated to CPT. Study women were over 18 years, reported personally experiencing or witnessing sexual violence, and reported elevated depression, anxiety and/or posttraumatic stress symptoms. Women were followed up (1) post-treatment (6-months after baseline); (2) 6 months later; (3) 12 months later; and (4) in March 2017 (6.3 years after baseline). At the long-term follow-up, 103 women (77%) in 6 of 7 CPT villages were re-assessed; one village was not visited due to ongoing insecurity.

We found strong continued intervention effects; nearly all women maintained treatment impacts over the first two years; at long-term follow-up, approximately half continued to maintain low symptom scores. Relapse rates for probable PTSD and probable depression and anxiety were 20%.

This study extends prior research to show that treatment impacts can be maintained for several years despite experiences of ongoing trauma. The women described continuing to meet with the women in their therapy group and using the skills they learned in the psychotherapy, providing evidence of the potential for these programs to provide valuable social supports and skills that people use as they continue to face adversity.

The COVID-19 pandemic caused considerable burden on mental health worldwide. To address this emergency in Peru, Socios en Salud (SES) implemented an innovative digital system for the diagnosis and psychological therapy in vulnerable populations. We describe the development, implementation, and participant outcomes of this intervention.

We conducted an intervention in a general population of Lima, Peru using a digital tool, ChatBot-Juntos, incorporating the abbreviated Self-Reporting Questionnaire (SRQ) to screen psychological distress. Participants positive for psychological distress received remote Psychological First Aid (PFA) and grief therapy if needed. Participants with a mental health condition or safety concern were referred to mental health services. SRQ scores were collected 3 months after PFA sessions. Differences between screening and follow-up scores were compared using Wilcoxon sign-rank test.

In total, 2027 people were screened; 1581 (77.9%) screened positive for psychological distress. Nine hundred ninety-seven (63%) people with psychological distress received PFA, and 320 (32.1%) of those were also referred for mental health care. At 3 months after follow-up, SRQ scores were collected for 579 (58%) participants. Significant reduction in SRQ scores was observed 3 months after PFA [median SRQ score changed from 9 to 5 (p < 0.001)], and after PFA plus referral to mental health services [median SRQ score changed from 11 to 6 (p < 0.001)].

Digital technology can be used to screen for psychological distress and deliver mental health support for populations affected by the COVID-19 pandemic. More research is needed to determine whether technology contributes to improved mental health outcomes.

The COVID-19 pandemic has captured the mental health discussion worldwide. Examining countries' representation in this discussion could prove instrumental in identifying potential gaps in terms of ensuring a truly global conversation in times of global crisis.

We collected mental health and COVID-19-related journal articles published in PubMed in 2020. We focused on the corresponding authors' countries of affiliation to explore countries' representation. We also examined these articles' academic impact and correlations with their corresponding authors' countries of affiliation. Additional journals and countries' indicators were collected from the Web of Science and World Bank websites, respectively. Data were analyzed using the IBM SPSS Statistics and the VOSviewer software.

In total, 3492 publications were analyzed. Based on the corresponding author, high-income countries produced 61.9% of these publications. Corresponding authors from Africa, Latin America and the Caribbean, and the Middle East combined accounted for 11.8% of the publications. Europe hosted corresponding authors with the most publications and citations, and corresponding authors from North America had the largest mean journal impact factor.

The global scientific discussion during the COVID-19 pandemic saw an increased contribution of academics from developing countries. However, authors from high-income countries have continued to shape this discussion. It is imperative to ensure the active participation of low- and middle-income countries in setting up the global mental health research agenda, particularly in situations of global crisis, such as the ongoing pandemic.