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Globally, too many people die prematurely from suicide and the physical comorbidities associated with mental illness and mental distress. The purpose of this Review is to mobilise the translation of evidence into prioritised actions that reduce this inequity. The mental health research charity, MQ Mental Health Research, convened an international panel that used roadmapping methods and review evidence to identify key factors, mechanisms, and solutions for premature mortality across the social–ecological system. We identified 12 key overarching risk factors and mechanisms, with more commonalities than differences across the suicide and physical comorbidities domains. We also identified 18 actionable solutions across three organising principles: the integration of mental and physical health care; the prioritisation of prevention while strengthening treatment; and the optimisation of intervention synergies across social–ecological levels and the intervention cycle. These solutions included accessible, integrated high-quality primary care; early life, workplace, and community-based interventions co-designed by the people they should serve; decriminalisation of suicide and restriction of access to lethal means; stigma reduction; reduction of income, gender, and racial inequality; and increased investment. The time to act is now, to rebuild health-care systems, leverage changes in funding landscapes, and address the effects of stigma, discrimination, marginalisation, gender violence, and victimisation.

The coronavirus disease 2019 (COVID-19) pandemic is having a profound effect on all aspects of society, including mental health and physical health. We explore the psychological, social, and neuroscientific effects of COVID-19 and set out the immediate priorities and longer-term strategies for mental health science research. These priorities were informed by surveys of the public and an expert panel convened by the UK Academy of Medical Sciences and the mental health research charity, MQ: Transforming Mental Health, in the first weeks of the pandemic in the UK in March, 2020. We urge UK research funding agencies to work with researchers, people with lived experience, and others to establish a high level coordination group to ensure that these research priorities are addressed, and to allow new ones to be identified over time. The need to maintain high-quality research standards is imperative. International collaboration and a global perspective will be beneficial. An immediate priority is collecting high-quality data on the mental health effects of the COVID-19 pandemic across the whole population and vulnerable groups, and on brain function, cognition, and mental health of patients with COVID-19. There is an urgent need for research to address how mental health consequences for vulnerable groups can be mitigated under pandemic conditions, and on the impact of repeated media consumption and health messaging around COVID-19. Discovery, evaluation, and refinement of mechanistically driven interventions to address the psychological, social, and neuroscientific aspects of the pandemic are required. Rising to this challenge will require integration across disciplines and sectors, and should be done together with people with lived experience. New funding will be required to meet these priorities, and it can be efficiently leveraged by the UK's world-leading infrastructure. This Position Paper provides a strategy that may be both adapted for, and integrated with, research efforts in other countries.

Recent opposing trends towards earlier physical maturation and later social maturation present a conundrum of apparent biological–social mismatch. Here we use life history analysis from evolutionary ecology to identify forces that drive these shifts. Together with findings in developmental science, our life history analysis indicates that adolescence is a distinctive period for biological embedding of culture. Ethnographic evidence shows that mass education is a novel feature of the globalizing cultural configurations of adolescence, which are driven by transformations in labour, livelihood and lifestyle. Evaluation of the life history trade-offs and sociocultural ecologies that are experienced by adolescents may offer a practical basis for enhancing their development.

To evaluate the effect of home visits by community health workers (CHWs) on maternal and infant well being from pregnancy through the first 6 months of life for women living with HIV (WLH) and all neighborhood mothers.

Current epidemiologic models concerning the fetal origins of later health risk are evaluated from the perspectives of evolutionary and developmental biology. Claims of adaptive value for and biological status of fetal programming are critically examined. Life history theory is applied to identify key trade‐offs in adaptive strategies that constrain developmental design to use information from the environment to guide ontogeny and establish cost–benefit trade‐offs that weigh early survival advantage against remote or unlikely future costs. Expectable environments of evolutionary adaptedness, particularly of gestation, are characterized and their impact on human adaptive design discussed. The roles of neuroendocrine mechanisms in scaffolding life course development, negotiating ongoing cost–benefit trade‐offs, and mediating their long‐term impacts on function and health are reviewed in detail. Overviews of gestational biology and the postnatal physiologic, cognitive‐affective, and behavioral effects of gestational stress identify a shared central role for the hypothalamic–pituitary–adrenal (HPA) axis. Rather than merely mediating stress responses, the axis emerges an agent of resource allocation that draws a common thread among conditions of gestation, postnatal environments, and functional and health‐related outcomes. The preponderance of evolutionary and developmental analysis identifies environments as agents on both sides of the health risk equation, by influencing vulnerabilities and capacities established in early and later life course development, and determining exposures and demands encountered over the life course. Am. J. Hum. Biol. 17:95–112, 2005. © 2004 Wiley‐Liss, Inc.

This study was designed to pursue three objectives: 1) investigate the impact of culture change on children and adolescents in Western Samoa; 2) introduce a cross‐cultural perspective to studies of psychosocial stress and immune function; and 3) evaluate the utility of minimally invasive methods for assessing immune function. Seven hundred sixty individuals between the ages of 4 and 20 years were recruited from three distinct geographic regions within Western Samoa that differ in degree of westernization. Finger prick samples of whole blood were collected from each individual and analyzed for antibodies against the Epstein‐Barr virus (EBV; an indirect marker of cell‐mediated immune function) and C‐reactive protein (a nonspecific marker of current infection). After controlling for age, sex, and current infection, EBV antibody levels were significantly elevated in urban Apia and rural Upolu, indicating lower levels of cell‐mediated immune function. The results suggest a higher degree of psychosocial stress in these regions, possibly due to exposure to westernizing influences. Am. J. Hum. Biol. 12:792–802, 2000. © 2000 Wiley‐Liss, Inc.

This study was designed to pursue three objectives: 1) investigate the impact of culture change on children and adolescents in Western Samoa; 2) introduce a cross-cultural perspective to studies of psychosocial stress and immune function; and 3) evaluate the utility of minimally invasive methods for assessing immune function. Seven hundred sixty individuals between the ages of 4 and 20 years were recruited from three distinct geographic regions within Western Samoa that differ in degree of westernization. Finger prick samples of whole blood were collected from each individual and analyzed for antibodies against the Epstein-Barr virus (EBV; an indirect marker of cell-mediated immune function) and C-reactive protein (a nonspecific marker of current infection). After controlling for age, sex, and current infection, EBV antibody levels were significantly elevated in urban Apia and rural Upolu, indicating lower levels of cell-mediated immune function. The results suggest a higher degree of psychosocial stress in these regions, possibly due to exposure to westernizing influences. Am. J. Hum. Biol. 12:792–802, 2000. © 2000 Wiley-Liss, Inc.

Evolutionary principles inform central design features of human immune defenses and provide key insights into this complicated host defense system. This article explores the selection pressures and adaptive responses that have elaborated the immune system over the course of evolution and discusses their implications for understanding contemporary immune development and function. Special attention is given to the challenges posed by diverse, rapidly evolving pathogens and the mammalian response to these challenges. The process of lymphocyte diversity generation and subsequent clonal selection is quintessentially Darwinian: pathogens provide selection pressure that drives differential replication of host immune cell lines, resulting in changes in genetic frequencies within an individual's population of lymphocytes. The immune system also incorporates nongenetic transgenerational processes in the transfer of antibodies from mother to offspring through the placenta and breast milk. The consequences of these observations for human development, health, and the ecology of immune function are considered throughout the life cycle. Specifically, evolutionary processes provide insight into autoimmunity, thymic function, lymphocyte development, infectious disease risk, and lactation. While much work in evolutionary medicine focuses on the discordance between evolved biology and rapidly changing cultural environments, with respect to the immune system, evolutionary processes may be most revealing when applied within individuals. Am. J. Hum. Biol. 11:705–717, 1999. © 1999 Wiley‐Liss, Inc.

Evolutionary principles inform central design features of human immune defenses and provide key insights into this complicated host defense system. This article explores the selection pressures and adaptive responses that have elaborated the immune system over the course of evolution and discusses their implications for understanding contemporary immune development and function. Special attention is given to the challenges posed by diverse, rapidly evolving pathogens and the mammalian response to these challenges. The process of lymphocyte diversity generation and subsequent clonal selection is quintessentially Darwinian: pathogens provide selection pressure that drives differential replication of host immune cell lines, resulting in changes in genetic frequencies within an individual's population of lymphocytes. The immune system also incorporates nongenetic transgenerational processes in the transfer of antibodies from mother to offspring through the placenta and breast milk. The consequences of these observations for human development, health, and the ecology of immune function are considered throughout the life cycle. Specifically, evolutionary processes provide insight into autoimmunity, thymic function, lymphocyte development, infectious disease risk, and lactation. While much work in evolutionary medicine focuses on the discordance between evolved biology and rapidly changing cultural environments, with respect to the immune system, evolutionary processes may be most revealing when applied within individuals. Am. J. Hum. Biol. 11:705–717, 1999. © 1999 Wiley-Liss, Inc.

BACKGROUND: The Great Smoky Mountains Study of youth focuses on the relationship between the development of psychiatric disorder and the need for and use of mental health services. METHODS: A multistage, overlapping cohorts design was used, in which 4500 of the 11 758 children aged 9, 11, and 13 years in an 11-country area of the southeastern United States were randomly selected for screening for psychiatric symptoms. Children who scored in the top 25% on the screening questionnaire, together with a 1 in 10 random sample of the rest, were recruited for 4 waves of intensive, annual interviews (n=1015 at wave 1). In a parallel study, all American Indian children aged 9, 11, and 13 years were recruited (N=323 at wave 1). RESULTS: The 3-month prevalence (±SE) of any DSMIII-R axis I disorder in the main sample, weighted to reflect population prevalence rates, was 20.3%±1.7%. The most common diagnoses were anxiety disorders (5.7%±1.0%), enuresis (5.1%±1.0%), tic disorders (4.2%±0.9%), conduct disorder (3.3%±0.6%), oppositional defiant disorder (2.7%±0.4%), and hyperactivity (1.9%±0.4%). CONCLUSIONS: The prevalence of psychiatric disorder in this rural sample was similar to rates reported in other recent studies. Poverty was the strongest demographic correlate of diagnosis, in both urban and rural children.

This study of two natural fertility Nepali groups, the Tamang and Kami, identifies biological and behavioral factors associated with population differences in fertility. Previous research had established that Tamang experience longer interbirth intervals than Kami despite similarly intense nursing practices, and bear considerably higher energy expenditure due to workload. This cross-sectional study of 71 breastfeeding women includes prolactin determinations on three blood spot samples collected 5, 30, and 50 minutes following a timed nursing bout, and data on maternal age, BMI, menstrual status, previous birth interval, parity, infant age, nursing bout length, and durations of supplementation and postpartum amenorrhea. The findings show that Tamang breastfeeding mothers have higher average prolactin levels than Kami for as long as 22 months postpartum. Tamang mothers sustain average prolactin levels above those of nonpregnant, nonlactating women for nearly 2 years postpartum, whereas prolactin levels among Kami breastfeeding mothers are the same as this latter group after 1 year postpartum. Furthermore, the findings indicate that Tamang mothers have higher average prolactin levels regardless of maternal age, physical status (BMI, weight, or height), or infant age, and the rate of decline in prolactin from 5 to 50 minutes after suckling is significantly greater for Kami than Tamang. Since factors associated with prolactin levels differ by group, the findings also emphasize that populations vary not only in the strength of effects that proximate determinants have on fertility regulation, but also in the pathways by which they exert their effects (direct physiological versus indirect behavioral). Am. J. Hum. Biol. 10:191–210, 1998. © 1998 Wiley-Liss, Inc.

This study of two natural fertility Nepali groups, the Tamang and Kami, identifies biological and behavioral factors associated with population differences in fertility. Previous research had established that Tamang experience longer interbirth intervals than Kami despite similarly intense nursing practices, and bear considerably higher energy expenditure due to workload. This cross‐sectional study of 71 breastfeeding women includes prolactin determinations on three blood spot samples collected 5, 30, and 50 minutes following a timed nursing bout, and data on maternal age, BMI, menstrual status, previous birth interval, parity, infant age, nursing bout length, and durations of supplementation and postpartum amenorrhea. The findings show that Tamang breastfeeding mothers have higher average prolactin levels than Kami for as long as 22 months postpartum. Tamang mothers sustain average prolactin levels above those of nonpregnant, nonlactating women for nearly 2 years postpartum, whereas prolactin levels among Kami breastfeeding mothers are the same as this latter group after 1 year postpartum. Furthermore, the findings indicate that Tamang mothers have higher average prolactin levels regardless of maternal age, physical status (BMI, weight, or height), or infant age, and the rate of decline in prolactin from 5 to 50 minutes after suckling is significantly greater for Kami than Tamang. Since factors associated with prolactin levels differ by group, the findings also emphasize that populations vary not only in the strength of effects that proximate determinants have on fertility regulation, but also in the pathways by which they exert their effects (direct physiological versus indirect behavioral). Am. J. Hum. Biol. 10:191–210, 1998. © 1998 Wiley‐Liss, Inc.