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Most robots are designed to operate in environments that are either highly constrained (as is the case in an assembly line) or extremely hazardous (such as the surface of Mars). Machine learning has been an effective tool in both of these environments by augmenting the flexibility and reliability of robotic systems, but this is often a very difficult problem because the complexity of learning in the real world introduces very high dimensional state spaces and applies severe penalties for mistakes. Human children are raised in environments that are just as complex (or even more so) than those typically studied in robot learning scenarios. However, the presence of parents and other caregivers radically changes the type of learning that is possible. Consciously and unconsciously, adults tailor their action and the environment to the child. They draw attention to important aspects of a task, help in identifying the cause of errors and generally tailor the task to the child's capabilities. Our research group builds robots that learn in the same type of supportive environment that human children have and develop skills incrementally through their interactions. Our robots interact socially with human adults using the same natural conventions that a human child would use. Our work sits at the intersection of the fields of social robotics (Fong et al., 2003; Breazeal and Scawellan, 2002) and autonomous mental development (Weng et al., 2000). Together, these two fields offer the vision of a machine that can learn incrementally, directly from humans, in the same ways that humans learn from each other. In this article, we introduce some of the challenges, goals, and applications of this research [ABSTRACT FROM PUBLISHER]

Beyond its physical health impact, the COVID-19 pandemic also resulted in grief from loss of loved ones, isolation due to social distancing, stress, fear, and economic distress-all of which impacted mental health. How Right Now/Qué Hacer Ahora (HRN) is an award-winning, national campaign that provides emotional support to people disproportionately affected by COVID-19. We conducted a theory-based, culturally responsive evaluation to assess the campaign's effect on coping behaviors and resiliency between summer 2020 and spring 2021. We surveyed HRN's priority audiences (older adults/caregivers and those with preexisting health conditions, experiencing violence, or economic distress) in English and Spanish using NORC's national probability panel, AmeriSpeak, over three waves. We also analyzed social media data and monitored HRN website traffic and triangulated these data to understand the campaign's full impact. Campaign exposure was associated with people who were experiencing higher levels of stress and were more likely to seek information to support their emotional well-being. Campaign exposure was also positively associated with increased feelings of resilience and confidence in using coping strategies, especially for people experiencing violence or economic distress and people from racial and ethnic groups. Findings demonstrate the campaign's success in reaching its intended audiences with the mental health support they needed. Additionally, the HRN evaluation's design illustrates how the use of multiple data sources can elucidate a deeper understanding of campaign impact. Findings underscore that culturally responsive health communication interventions-like HRN-can provide needed mental health support and resources to disproportionately affected communities. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Poverty is associated with poorer mental health in early adulthood. Cash transfers (CTs) have been shown to improve child health and education outcomes, but it is unclear whether these effects may translate into better mental health outcomes as children reach young adulthood. Using a quasi-experimental approach that exploits variation across countries in the timing of national CT programme introduction, we examine whether longer exposure to CTs during childhood (0-17 years) reduces depressive symptoms in early adulthood (18-30 years). Based on harmonized data from Colombia, Mexico and South Africa (N= 14 431) we applied logistic regression models with country- and birth-cohort fixed effects to estimate the impact of cumulative years of CT exposure on mental health, educational attainment and employment outcomes. Our findings indicate that each additional year of CT exposure during childhood is associated with a 4% reduction in the odds of serious depressive symptoms in early adulthood (OR = 0.96, 95% CIs: 0.93 to 0.98). We find no consistent effect of years of exposure on completion of secondary school (OR = 1.01, 95% CIs: 0.99, 1.03), and a negative effect on the probability of employment in early adulthood (OR = 0.90, 95% CIs: 0.88, 0.91). These results suggest that longer exposure to CTs may contribute to modest but meaningful reductions in population level depressive symptoms during early adulthood., (© The Author(s) 2024. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.)

Background: HIV is characterised by high rates of comorbidity with mental health conditions including depression, as such, the detection and treatment of comorbid depression is critical to achieve viral load suppression. This study evaluated the effectiveness of a collaborative care intervention for depression among adults with comorbid depression symptoms receiving ART in primary health care (PHC) facilities., Methods: We conducted a pragmatic cluster-randomised trial in 40 clinics in the North West province of South Africa. PHC clinics were stratified by sub-district and randomised in a 1:1 ratio. Participants were ≥ 18 years, receiving ART, and had depression symptoms indicated by Patient Health Questionnaire-9 (PHQ-9) score ≥ 9. Intervention clinics received: i) supplementary mental health training and clinical communication skills for PHC nurses; ii) workshops for PHC doctors on treating depression; and iii) lay counselling services. Using mixed effects regression models, we assessed co-primary outcomes of PHQ-9 response at 6 months (≥50 % reduction in baseline PHQ-9 score) and viral load suppression at 12 months (viral load<1000 copies/mL)., Results: The intervention had no effect in PHQ-9 response (49 % vs 57 %, risk difference (RD) = -0.08, 95 % CI = -0.19; 0.03, p = 0.184) or viral load suppression (85 % vs 84 %, RD = 0.02, 95 % CI = -0.01; 0.04, p = 0.125). Nurses referred 4298 clinic patients to counsellors, however, only 66/1008 (7 %) of intervention arm participants were referred to counsellors at any point during the study., Limitations: The highly pragmatic approach of this trial limited exposure to the counselling component of the intervention and referral to doctors for initiation of antidepressant treatment was extremely low., Conclusion: The trial showed no effect of a district-based intervention to strengthen collaborative care for depression. The trial revealed the extent of the treatment gap in the context of scaling up mental health services., Trial Registration: ClinicalTrials.gov (NCT02407691); Pan African Clinical Trials Registry (201504001078347)., Competing Interests: Declaration of competing interest All authors declare no competing interests., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Introduction: Promoting mental health, preventing and treating mental disorders are critically important in public health, and many randomised controlled trials (RCTs) evaluate intervention strategies for these objectives. However, distinguishing promotion from prevention and from treatment RCTs is challenging. A tool to place studies along the promotion-to-treatment continuum in mental health research does not exist, leaving it to researchers and policymakers to decide on how to classify individual RCTs, which hinders evidence synthesis., Methods and Analysis: We present a protocol for the development of a new tool to assist researchers in distinguishing RCTs along the promotion-to-treatment continuum. We will establish a Tool Development Group, and use the Population, Intervention, Comparison and Outcome framework to define constructs. We will generate, define, categorise and reduce the items in the tool using qualitative methods, including cognitive interviews and a Delphi exercise. Psychometric evaluation-including unidimensionality, local independence, monotonicity and item homogeneity-will include data collection, scoring, internal consistency checks and factor analysis of the tool's indicators for available RCTs. We will use standard Cohen's kappa statistics to assess the reliability of the tool., Ethics and Dissemination: This study involves data collection from the already published literature. However, this protocol has been approved by the ethics committee of the Università della Svizzera Italiana (CE 2024 04). The results of the present project will be disseminated in peer-reviewed journals and at international and national scientific meetings. Training materials for the application of the tool will also be developed and disseminated to the scientific community. The tool and all related implementation materials will be published on a website and will be freely accessible to the public., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Adolescence is a critical time for mental health promotion and prevention and establishing healthy behaviours. Implementing universal, school-based psychosocial interventions can improve short- and long-term health trajectories for adolescents. While these interventions may offer important opportunities for fostering skills and relationships, few school-based interventions have been developed for and tested in low- and middle-income countries (LMICs) where adolescent mental health needs may be significant and under-served. This manuscript details the development of a multi-component, universal school-based intervention, Health Action in ScHools for a Thriving Adolescent Generation (HASHTAG), for adolescents aged 12-15 years in Nepal and South Africa., Methods and Results: We describe HASHTAG's development over four phases, combining methods and results as each phase was iteratively conducted between 2018 and 2021. Phase 1 included a systematic review and components analysis, building from WHO guidelines for adolescent mental health. Seven components were strongly supported by the evidence: emotional regulation, stress management, mindfulness, problem-solving, interpersonal skills, assertiveness training, and alcohol and drug education. Phase 2 encompassed site selection, theory of change development, and formative research engagements; research teams in each site engaged adolescents and key adult stakeholders to identify priorities for intervention. Stakeholders voiced preferences for external facilitators and key content and delivery for intervention sessions. These findings informed Phase 3, a draft manual of HASHTAG, including a whole-school component, called Thriving Environment in Schools, and a classroom-based, six-session component, Thrive Together. In Phase 4, participants engaged in consultative workshops to review and contextualise content by country, preparing HASHTAG for implementation in a feasibility trial. Minor adaptations were made in Nepal, including using school nurses and adjusting take-home materials; both country's workshops identified practical considerations for implementing activities., Conclusions: HASHTAG was designed around core evidence-based components to increase translatability across LMICs, while enabling country-specific tailoring to enhance feasibility. Future research will test whether this multi-component, whole-school approach can improve adolescent mental health., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 Published by Elsevier Ltd.)

Globally, mental disorders account for almost 20% of disease burden and there is growing evidence that mental disorders are socially determined. Tackling the United Nations Sustainable Development Goals (UN SDGs), which address social determinants of mental disorders, may be an effective way to reduce the global burden of mental disorders. We conducted a systematic review of reviews to examine the evidence base for interventions that map onto the UN SDGs and seek to improve mental health through targeting known social determinants of mental disorders. We included 101 reviews in the final review, covering demographic, economic, environmental events, neighborhood, and sociocultural domains. This review presents interventions with the strongest evidence base for the prevention of mental disorders and highlights synergies where addressing the UN SDGs can be beneficial for mental health.

Introduction: Common mental health conditions (CMHCs), including depression, anxiety and post-traumatic stress disorder (PTSD), are highly prevalent in low and middle-income countries (LMICs). Preventive strategies combining psychological interventions with interventions addressing the social determinants of mental health may represent a key strategy for effectively preventing CMHCs. However, no systematic reviews have evaluated the effectiveness of these combined intervention strategies for preventing CMHCs., Methods and Analysis: This systematic review will include randomised controlled trials (RCTs) focused on the effectiveness of interventions that combine preventive psychological interventions with interventions that address the social determinants of mental health in LMICs. Primary outcome is the frequency of depression, anxiety or PTSD at postintervention as determined by a formal diagnostic tool or any other standardised criteria. We will search Epistemonikos, Cochrane Controlled Trials Register (CENTRAL), MEDLINE, Embase, PsycINFO, CINAHL, Global Index Medicus, ClinicalTrials.gov (Ctgov), International Clinical Trials Registry Platform (ICTRP). Two reviewers will independently extract the data and evaluate the risk of bias of included studies using the Cochrane risk of bias tool 2. Random-effects meta-analyses will be performed, and certainty of evidence will be rated using the Grading of Recommendations Assessment, Development and Evaluation approach., Ethics and Dissemination: This study uses data from published studies; therefore, ethical review is not required. Findings will be presented in a published manuscript., Trial Registration Number: CRD42023451072., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Background: Global evidence on psychosis is dominated by studies conducted in Western, high-income countries. The objectives of the Study of Context Of Psychoses to improve outcomes in Ethiopia (SCOPE) are (1) to generate rigorous evidence of psychosis experience, epidemiology and impacts in Ethiopia that will illuminate aetiological understanding and (2) inform development and testing of interventions for earlier identification and improved first contact care that are scalable, inclusive of difficult-to-reach populations and optimise recovery., Methods: The setting is sub-cities of Addis Ababa and rural districts in south-central Ethiopia covering 1.1 million people and including rural, urban and homeless populations. SCOPE comprises (1) formative work to understand care pathways and community resources (resource mapping); examine family context and communication (ethnography); develop valid measures of family communication and personal recovery; and establish platforms for community engagement and involvement of people with lived experience; (2a) a population-based incidence study, (2b) a case-control study and (2c) a cohort study with 12 months follow-up involving 440 people with psychosis (390 rural/Addis Ababa; 50 who are homeless), 390 relatives and 390 controls. We will test hypotheses about incidence rates in rural vs. urban populations and men vs. women; potential aetiological role of khat (a commonly chewed plant with amphetamine-like properties) and traumatic exposures in psychosis; determine profiles of needs at first contact and predictors of outcome; (3) participatory workshops to develop programme theory and inform co-development of interventions, and (4) evaluation of the impact of early identification strategies on engagement with care (interrupted time series study). Findings will inform development of (5) a protocol for (5a) a feasibility cluster randomised controlled trial of interventions for people with recent-onset psychosis in rural settings and (5b) two uncontrolled pilot studies to test acceptability, feasibility of co-developed interventions in urban and homeless populations., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Hanlon et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Stigma exacerbates power imbalances and societal disparities, significantly impacting diverse identities and health conditions, particularly for low and middle-income countries (LMICs). Though crucial for dismantling harmful stereotypes, and enhancing healthcare utilisation, existing research on anti-stigma interventions is limited with its condition-focused approach. We aimed to thoroughly evaluate peer-reviewed and non-peer-reviewed literature for a comprehensive review of anti-stigma interventions for diverse identities and all health conditions in LMICs., Methods: This review systematically explored peer-reviewed and non-peer-reviewed literature, in ten electronic databases up to January 30, 2024, covering all anti-stigma interventions across various stigmatised identities and health conditions in LMICs. Quality assessment for this systematic review was conducted as per Cochrane Collaboration's suggested inclusions. The review was registered with PROSPERO (Registration: 2017 CRD42017064283)., Findings: Systematic synthesis of the 192 included studies highlights regional imbalances, while providing valuable insights on robustness and reliability of anti-stigma research. Most studies used quasi-experimental design, and most centred on HIV/AIDS or mental health related stigma, with very little work on other issues. Certain high-population LMICs had no/little representation., Interpretation: The interventions targeted diverse segments of populations and consequently yielded a multitude of stigma-related outcomes. However, despite the heterogeneity of studies, most reported positive outcomes underscoring the effectiveness of existing interventions to reduce stigma., Funding: This study is supported by the UK Medical Research Council Indigo Partnership (MR/R023697/1) award., Competing Interests: None to declare., (© 2024 Published by Elsevier Ltd.)

Purpose: Calls for "mutuality" in global mental health (GMH) aim to produce knowledge more equitably across epistemic and power differences. With funding, convening, and publishing power still concentrated in institutions in the global North, efforts to decolonize GMH emphasize the need for mutual learning instead of unidirectional knowledge transfers. This article reflects on mutuality as a concept and practice that engenders sustainable relations, conceptual innovation, and queries how epistemic power can be shared., Methods: We draw on insights from an online mutual learning process over 8 months between 39 community-based and academic collaborators working in 24 countries. They came together to advance the shift towards a social paradigm in GMH., Results: Our theorization of mutuality emphasizes that the processes and outcomes of knowledge production are inextricable. Mutual learning required an open-ended, iterative, and slower paced process that prioritized trust and remained responsive to all collaborators' needs and critiques. This resulted in a social paradigm that calls for GMH to (1) move from a deficit to a strength-based view of community mental health, (2) include local and experiential knowledge in scaling processes, (3) direct funding to community organizations, and (4) challenge concepts, such as trauma and resilience, through the lens of lived experience of communities in the global South., Conclusion: Under the current institutional arrangements in GMH, mutuality can only be imperfectly achieved. We present key ingredients of our partial success at mutual learning and conclude that challenging existing structural constraints is crucial to prevent a tokenistic use of the concept., (© 2023. The Author(s).)

Psychological interventions have demonstrated effectiveness in treating perinatal depression (PND), but understanding for whom, how and under what conditions they improve symptoms in low- and middle-income countries (LMICs) is largely unknown. This review aims to synthesise current knowledge about predictors, moderators and mediators of psychological therapies to treat PND in LMICs. Five databases were searched for studies quantitatively examining the effects of at least one mediator, moderator or predictor of therapies for PND in LMICs. The review sampled seven publications evaluating findings from randomised trials conducted in Asia and sub-Saharan Africa. The small number of included studies limited generalisability of findings. Analyses of trials with acceptable quality suggest that patient activation in Pakistan and social support in both India and Pakistan may mediate psychotherapy effectiveness, higher baseline depression severity may moderate treatment response in South Africa, and shorter depression duration at baseline may moderate intervention response in India. This review highlights current gaps in evidence quality and the need for future trials exploring PND psychotherapy effectiveness in LMICs to follow reporting guidelines to facilitate appropriate predictor, moderator and mediator analyses., Competing Interests: The authors declare no competing interests exist., (© The Author(s) 2024.)

Aims: Depression and anxiety are the leading contributors to the global burden of disease among young people, accounting for over a third (34.8%) of years lived with disability. Yet there is limited evidence for interventions that prevent adolescent depression and anxiety in low- and middle-income countries (LMICs), where 90% of adolescents live. This article introduces the 'Improving Adolescent mentaL health by reducing the Impact of poVErty (ALIVE)' study, its conceptual framework, objectives, methods and expected outcomes. The aim of the ALIVE study is to develop and pilot-test an intervention that combines poverty reduction with strengthening self-regulation to prevent depression and anxiety among adolescents living in urban poverty in Colombia, Nepal and South Africa., Methods: This aim will be achieved by addressing four objectives: (1) develop a conceptual framework that identifies the causal mechanisms linking poverty, self-regulation and depression and anxiety; (2) develop a multi-component selective prevention intervention targeting self-regulation and poverty among adolescents at high risk of developing depression or anxiety; (3) adapt and validate instruments to measure incidence of depression and anxiety, mediators and implementation parameters of the prevention intervention; and (4) undertake a four-arm pilot cluster randomised controlled trial to assess the feasibility, acceptability and cost of the selective prevention intervention in the three study sites., Results: The contributions of this study include the active engagement and participation of adolescents in the research process; a focus on the causal mechanisms of the intervention; building an evidence base for prevention interventions in LMICs; and the use of an interdisciplinary approach., Conclusions: By developing and evaluating an intervention that addresses multidimensional poverty and self-regulation, ALIVE can make contributions to evidence on the integration of mental health into broader development policy and practice.

Aim: to assess the efficacy of psychosocial interventions delivered through task-sharing approaches for preventing perinatal common mental disorders among women in low- and middle-income countries., Methods: We conducted a systematic review of randomized controlled trials following a prespecified protocol registered in the Open Science Framework (osf.io/qt4y3). We searched MEDLINE, Web of Science, PsycINFO, and Cochrane Central Register of Controlled Trials (CENTRAL) through June 2022. Two reviewers independently extracted the data and evaluated the risk of bias of included studies using the Cochrane risk of bias tool. We performed random-effects meta-analyses and rated the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach., Results: We included 23 studies with 24,442 participants. At post-intervention, task-shared psychosocial interventions, were effective in preventing the development of mental disorders in general (RR 0.57, 95% CI [0.35, 0.91]), and specifically depression (RR 0.51, 95% CI [0.35, 0.75]), but not anxiety disorders (RR 0.46, 95% CI [0.06, 3.33]). Similarly, psychosocial interventions reduced psychological distress (SMD -1.32, 95% CI [-2.28, -0.35]), and depressive symptoms (SMD -0.50, 95% CI [-0.80, -0.16]), and increased parenting self-efficacy (SMD -0.76, 95% CI [-1.13, -0.38]) and social support (SMD -0.72, 95% CI [-1.22, -0.22]). No effect was detected for anxiety symptoms at post-intervention. At follow-up the beneficial effects of interventions progressively decreased., Conclusions: Psychosocial interventions delivered through the task-sharing modality are effective in preventing perinatal common mental disorders and fostering positive mental health among women in low- and middle-income countries. However, our findings are tentative, due to the low number of preventative intervention strategies considering outcomes as the incidence of mental disorders, especially in the long-term. This evidence supports calls to implement and scale up psychosocial prevention interventions for perinatal common mental disorders in low- and middle-income countries., Competing Interests: Conflict of interestThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: There is a significant research gap in the field of universal, selective, and indicated prevention interventions for mental health promotion and the prevention of mental disorders. Barriers to closing the research gap include scarcity of skilled human resources, large inequities in resource distribution and utilization, and stigma., Objectives: To assess the effectiveness of delivery by primary workers of interventions for the promotion of mental health and universal prevention, and for the selective and indicated prevention of mental disorders or symptoms of mental illness in low- and middle-income countries (LMICs). To examine the impact of intervention delivery by primary workers on resource use and costs., Search Methods: We searched CENTRAL, MEDLINE, Embase, CINAHL, Global Index Medicus, PsycInfo, WHO ICTRP, and ClinicalTrials.gov from inception to 29 November 2021., Selection Criteria: Randomized controlled trials (RCTs) of primary-level and/or community health worker interventions for promoting mental health and/or preventing mental disorders versus any control conditions in adults and children in LMICs., Data Collection and Analysis: Standardized mean differences (SMD) or mean differences (MD) were used for continuous outcomes, and risk ratios (RR) for dichotomous data, using a random-effects model. We analyzed data at 0 to 1, 1 to 6, and 7 to 24 months post-intervention. For SMDs, 0.20 to 0.49 represented small, 0.50 to 0.79 moderate, and ≥ 0.80 large clinical effects. We evaluated the risk of bias (RoB) using Cochrane RoB2., Main Results: Description of studies We identified 113 studies with 32,992 participants (97 RCTs, 19,570 participants in meta-analyses) for inclusion. Nineteen RCTs were conducted in low-income countries, 27 in low-middle-income countries, 2 in middle-income countries, 58 in upper-middle-income countries and 7 in mixed settings. Eighty-three RCTs included adults and 30 RCTs included children. Cadres of primary-level workers employed primary care health workers (38 studies), community workers (71 studies), both (2 studies), and not reported (2 studies). Interventions were universal prevention/promotion in 22 studies, selective in 36, and indicated prevention in 55 RCTs. Risk of bias The most common concerns over risk of bias were performance bias, attrition bias, and reporting bias. Intervention effects 'Probably', 'may', or 'uncertain' indicates 'moderate-', 'low-', or 'very low-'certainty evidence. *Certainty of the evidence (using GRADE) was assessed at 0 to 1 month post-intervention as specified in the review protocol. In the abstract, we did not report results for outcomes for which evidence was missing or very uncertain. Adults Promotion/universal prevention, compared to usual care: - probably slightly reduced anxiety symptoms (MD -0.14, 95% confidence interval (CI) -0.27 to -0.01; 1 trial, 158 participants) - may slightly reduce distress/PTSD symptoms (SMD -0.24, 95% CI -0.41 to -0.08; 4 trials, 722 participants) Selective prevention, compared to usual care: - probably slightly reduced depressive symptoms (SMD -0.69, 95% CI -1.08 to -0.30; 4 trials, 223 participants) Indicated prevention, compared to usual care: - may reduce adverse events (1 trial, 547 participants) - probably slightly reduced functional impairment (SMD -0.12, 95% CI -0.39 to -0.15; 4 trials, 663 participants) Children Promotion/universal prevention, compared to usual care: - may improve the quality of life (SMD -0.25, 95% CI -0.39 to -0.11; 2 trials, 803 participants) - may reduce adverse events (1 trial, 694 participants) - may slightly reduce depressive symptoms (MD -3.04, 95% CI -6 to -0.08; 1 trial, 160 participants) - may slightly reduce anxiety symptoms (MD -2.27, 95% CI -3.13 to -1.41; 1 trial, 183 participants) Selective prevention, compared to usual care: - probably slightly reduced depressive symptoms (SMD 0, 95% CI -0.16 to -0.15; 2 trials, 638 participants) - may slightly reduce anxiety symptoms (MD 4.50, 95% CI -12.05 to 21.05; 1 trial, 28 participants) - probably slightly reduced distress/PTSD symptoms (MD -2.14, 95% CI -3.77 to -0.51; 1 trial, 159 participants) Indicated prevention, compared to usual care: - decreased slightly functional impairment (SMD -0.29, 95% CI -0.47 to -0.10; 2 trials, 448 participants) - decreased slightly depressive symptoms (SMD -0.18, 95% CI -0.32 to -0.04; 4 trials, 771 participants) - may slightly reduce distress/PTSD symptoms (SMD 0.24, 95% CI -1.28 to 1.76; 2 trials, 448 participants)., Authors' Conclusions: The evidence indicated that prevention interventions delivered through primary workers - a form of task-shifting - may improve mental health outcomes. Certainty in the evidence was influenced by the risk of bias and by substantial levels of heterogeneity. A supportive network of infrastructure and research would enhance and reinforce this delivery modality across LMICs., (Copyright © 2023 The Authors. Cochrane Database of Systematic Reviews published by John Wiley & Sons, Ltd. on behalf of The Cochrane Collaboration.)

This paper makes the case for expanding the field of global mental health to give more attention to the social determinants of mental health. It does so by describing challenges and opportunities for intervening to address these social determinants, and by presenting some potential approaches to the choice, design and evaluation of such interventions, especially in low and middle-income countries. Challenges include distal interventions, limits to the modifiability of some social and economic determinants, poorly understood mechanisms, difficulty defining the boundaries of such interventions, the need for inter-disciplinary and inter-sectoral collaboration, limited datasets in LMIC, sample size challenges for prevention interventions, ethical issues and siloed research funding. Potential approaches include the development of more robust causal models, trial designs that allow for analysis of mechanisms and the pooling of data across diverse settings to explore the role of contextual variables. Several criteria can inform the selection of interventions that target social determinants and these include the need for plausible mechanisms, feasibility, acceptability, cultural validity of moderator, mediator and outcome variables, generalizability and sustainability. These approaches require a high level of inter-sectoral and inter-disciplinary cooperation and data sharing across sites internationally. Examples are provided from ongoing research in LMIC., Competing Interests: Declaration of competing interest I declare that I have no conflicts of interest., (Copyright © 2023. Published by Elsevier Ltd.)

A burgeoning mental health crisis is emerging globally, regardless of each country's human resources or spending. We argue that effectively responding to this crisis is impeded by the dominant framing of mental ill health through the prism of diagnostic categories, leading to an excessive reliance on interventions that are delivered by specialists; a scarcity of widespread promotive, preventive, and recovery-oriented strategies; and failure to leverage diverse resources within communities. Drawing upon a series of syntheses, we identify five principles to transform current practices; namely, address harmful social environments across the life course, particularly in the early years; ensure that care is not contingent on a categorical diagnosis but aligned with the staging model of mental illness; empower diverse front-line providers to deliver psychosocial interventions; embrace a rights-based approach that seeks to provide alternatives to violence and coercion in care; and centre people with lived experience in all aspects of care. We recommend four policy actions which can transform these principles into reality: a whole of society approach to prevention and care; a redesign of the architecture of care delivery to provide a seamless continuum of care, tailored to the severity of the mental health condition; investing more in what works to enhance the impact and value of the investments; and ensuring accountability through monitoring and acting upon a set of mental health indicators. All these actions are achievable, relying-for the most part-on resources already available to every community and country. What they do require is the acceptance that business as usual will fail and the solutions to transforming mental health-care systems are already present within existing resources., Competing Interests: Declaration of interests VP has received grant funding from the National Institute of Mental Health (NIMC), Grand Challenges Canada, and the Medical Research Council (MRC). VP receives book royalties from Oxford University Press and Cambridge University Press. VP has received consulting fees from Modern Health and Google. HH has received support for attending meetings from the World Psychiatric Association. HH also has leadership roles with Orygen Australia, citiesRISE New York, and Kindred Collaborative Australia. LK has received grant funding from the NIMH. CK has received grant funding from the National Institute of Health, the MRC, MQ: Transforming Mental Health (UK), Royal Academy of Engineering (UK), Academy of Medical Sciences (UK), Conselho Nacional de Desenvolvimento Científico e Tecnológico (Brazil), and Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul (Brazil). CK has received consulting fees from UN Children's Fund. CK is the founder of a digital mental health platform, Wida. SS has received consulting fees from McKinsey Health Institute for work related to mental health. All other authors declare no competing interests., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

The objective of this rapid review was to explore the current evidence base for mental health and disability research in Ghana. The PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist was followed. Online databases were used to identify primary studies, systematic reviews, meta-analyses, rapid reviews, or guidelines published between 2010 and 2020. All relevant published (both peer-reviewed articles and grey literature) on mental health and/or disability research conducted in or on Ghana between 2010 and 2020 were included in this review. 4,791 articles were identified in the initial search. After the removal of duplicates, followed by title and abstract screening, 930 articles were selected for full-text review. An additional 8 articles identified from reference lists of included articles were also included in full-text review. After review, 375 articles were selected for inclusion; 234 (62%) were on mental health while the remaining 141 (38%) were on disability. There is an increasing trend in the absolute number of mental health and/or disability studies. Most of the mental health studies included in this review were either observational quantitative studies (n=132; 56%) or observational qualitative studies (n=79; 34%). There were very few interventional studies (n=6; 3%). A similar finding was noted for the disability studies. External funding accounted for 51% of mental health articles. Although there was a steady year-on-year increase in the absolute number of mental health and/or disability studies conducted between 2010 to 2020, there is a need for more intervention studies to evaluate what mental health and/or disability interventions work, for whom, and under what circumstances. These should include evaluations of the cost, benefits, effectiveness, and acceptability of various interventions for policy and planning. Further, there is a need for the Ministry of Health to prioritize research funding for mental health and disability and enhance technical and methodological capacity of researchers to conduct disability and mental health research in Ghana., Competing Interests: The authors declare no competing interests., (Copyright: Grace Mwangi et al.)

In South Africa, symptoms of common mental disorders (CMDs) such as depression and anxiety are highly prevalent during the perinatal period and linked to experiences of domestic violence. However, limited routine detection and treatment is available to pregnant women with these problems, even though evidence suggests that screening and treating CMDs during pregnancy improves the health and economic outcomes of mothers and their children, and has been suggested as a key approach to improving the health of perinatal women and children. We investigated facilitators and barriers of service-providers and service-users in detecting and treating pregnant women with symptoms of CMDs and experiences of domestic violence. This study was conducted in four midwife obstetric units (MOUs) in Cape Town, South Africa, and in the non-profit organisations providing community-based support in the communities surrounding the MOUs. Service-provider perspectives were informed by qualitative interviews with 37 healthcare workers providing care to pregnant women. Qualitative interviews with 38 pregnant women attending the same MOUs for their first antenatal care visit provided service-user perspectives. Facilitators identified included the availability of a mental health screening questionnaire and the perceived importance of detection and treatment by both service-providers and -users. Barriers contributing to the low detection rates included service-users concerns about the lack of confidentiality and feelings of shame related to experiences of domestic violence as well as service providers discomfort in dealing with mental health issues, their limited time available and heavy patient load. In addition, service-providers highlighted the lack of standardised referral pathways and the poor uptake of referrals by women with symptoms of depression and anxiety, or experiences of domestic violence. While the system-level barriers need to be addressed at a policy level, the patient- and provider-level barriers identified indicate the need to strengthen health systems by training antenatal care nurses to detect symptoms of CMDs and experiences of domestic violence in pregnant women, developing standardised referral pathways and training lay healthcare workers to provide treatment for mild symptoms of depression and anxiety., (© 2023. The Author(s).)

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., Competing Interests: Declaration of interests AKL reports grants from the American Foundation for Suicide Prevention, US National Institute of Justice, US National Institute of Health, Robert Wood Johnson Foundation, and WK Kellogg Foundation. AKL reports reviewer honoraria from the US National Institute of Health. ARP is an equity owner of SafeSide Prevention, which receives fees for consultation and educational programmes provided to health, military, and government organisations. SafeSide pays royalties to the University of Rochester, NY, USA, which acknowledges this financial interest. CMW is a Trustee and Science Council Member of MQ Mental Health Research and board member of Healthy Brains, Healthy Lives, but receives no remuneration for these roles. CMW reports grants from the Foundation for Psychocultural Research, consulting fees from the Center for the Developing Adolescent and Health Policy Research Scholars Program, and has received occasional fees and travel reimbursement for invited addresses from the Institute of Evolutionary Medicine (University of Zurich), Senckenberg Institute (Frankfurt), Center for the Developing Adolescent, and Foundation for Psychocultural Research. CYM receives royalties from Cambridge University Press and has received occasional consultancy fees from Merck and Otsuka. DK reports grants from the UK National Institute for Health and Care Research (NIHR) and the UK Medical Research Council, and has received an honorarium for an invited address from Royal College of General Practitioners. DO is supported by the University College London Hospitals NIHR Biomedical Research Centre and the NIHR North Thames Applied Research Collaboration. These funders had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The views expressed in this article are those of the authors and not necessarily those of the National Health Service, the NIHR, or the Department of Health and Social Care. JD has received payments for their role as a lived experience expert from MQ Mental Health Research. JP reports grants from the National Health and Medical Research Council. KCK reports grants from the Robert Wood Johnson Foundation, the Kaiser Family Foundation, the Harvard Center on the Developing Child, the Stanley Center for Psychiatric Research at the Broad Institute of MIT and Harvard, the National Institute of Health, One Mind, the Anonymous Foundation, and Cohen Veterans Bioscience. KCK has received payments as a consultant for Baker Hostetler, Discovery Vitality, and the Department of Justice; as external reviewer for the Chan Zuckerberg Foundation, the University of Cape Town, and Capita Ireland. KCK has received occasional fees for invited addresses from the American Psychological Association, European Central Bank, Sigmund Freud University—Milan, Cambridge Health Alliance, and Coverys. KCK receives royalties from Guilford Press and Oxford University Press. LFC is the third Vice President of the International Association for Suicide Prevention and is a permanent member of the Malaysian Technical Working Group for Suicide Prevention, but receives no remuneration for these roles. LFC reports a grant from the Centre for Pesticide Suicide Prevention (University of Edinburgh), has received honorarium from Johnson & Johnson as a consultant and speaker, and, through her institution, has received industry-sponsored medication sampling (compassionate patient programme) for clinical use for medication samples of esketamine (Johnson & Johnson), brexpiprazole (Lundbeck), Abilify Maintena (Lundbeck), and Trinza (Johnson & Johnson). LV reports grants from Grand Challenges of Canada. OJK is a member of the Samaritans Research Ethics Board, but receives no reimbursement for this role. OJK receives an annual honorarium for role as an Open Science Advisor to the journal Clinical Psychological Science paid to KU Leuven. OJK reports grants from Research Foundation Flanders and the King Baudouin Foundation (Belgium) outside the submitted work and receives travel and accommodation support for attending meetings in her capacity as a commissioner for the Lancet Commission on Self-Harm. PT is the founder of the charity The William Templeton Foundation for Young People's Mental Health and is employed by, and is a director of, IfM Engage, which was contracted by MQ Mental Health Research to provide the roadmapping services conducted as part of this project. PB reports grants from the National Health and Medical Research Council, the Medical Research Future Fund, and Australian Department of'Veterans' Affairs. RM is a member of the Data and Safety Monitoring Board for the Patient Centered Outcomes Research Institute and reports grants from the National Institute of Mental Health. RCO'C is a Trustee and Science Council Member of MQ Mental Health Research, President of the International Association for Suicide Prevention, co-Chair of the Academic Advisory Group to the Scottish Government's National Suicide Prevention Leadership Group, and a board member of the International Academy of Suicide Research. RCO'C was a member of the National Institute for Health and Care Excellence's guideline group for the management of self-harm and reports grants from the Medical Research Foundation, the Mindstep Foundation, Chief Scientist Office, Medical Research Council, Public Health Scotland, Scottish Government, NIHR, Shout 85258, Scottish Association for Mental Health, Zoetis Foundation, Jonathan's Voice, ADHD UK, and the Barfil Charitable Trust. All other authors declare no competing interests., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Water insecurity and inadequate sanitation have adverse impacts on the mental health of individuals., Objective: To review and synthesize evidence on the relationship between water insecurity, inadequate sanitation, and mental health globally., Data Sources: Relevant studies were identified by searching PubMed, PsycINFO, and EMBASE databases from inception up to March 2023., Study Eligibility Criteria: Only quantitative studies were included. The exposure was water insecurity and or inadequate sanitation. The outcome was common mental disorders (CMD: depression or anxiety), mental distress, mental health or well-being. There was no restriction on geographical location., Participants: General population or people attending health facilities or other services., Exposure: Water insecurity and/ or inadequate sanitation., Risk of Bias: The effective Public Health Practice Project (EPHPP) assessment tool was used to assess quality of selected studies., Synthesis of Results: A meta-analysis was conducted using a random effects statistical model., Results: Twenty-five studies were included, with 23,103 participants from 16 countries in three continents: Africa (Kenya, Ethiopia, Ghana, Uganda, South Africa, Malawi, Mozambique, and Lesotho), Asia (Nepal, Bangladesh, India, and Iran) and the Americas (Brazil, Haiti, Bolivia and Vietnam). There was a statistically significant association between water insecurity and CMD symptoms. Nine studies reported a continuous outcome (5,248 participants): overall standardized mean difference (SMD = 1.38; 95% CI = 0.88, 1.87). Five studies reported a binary outcome (5,776 participants): odds ratio 5.03; 95% CI = 2.26, 11.18. There was a statistically significant association between inadequate sanitation and CMD symptoms (7415 participants), overall SMD = 5.36; 95% CI = 2.51, 8.20., Limitations: Most of the included studies were cross-sectional which were unable to examine temporal relationships., Conclusions: Water insecurity and inadequate sanitation contribute to poorer mental health globally., Implications of Key Findings: Interventions to provide basic water, sanitation and psychosocial support, could substantially contribute to reducing the burden of CMD alongside other health and social benefits., Trial Registration: PROSPERO registration number: CRD42022322528., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Kimutai et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Access to quality mental health services in Ghana remains poor, yet little is known about the extent of the access gaps and provision of mental health services at the district level in Ghana. We aimed to conduct an analysis of mental health infrastructure and service provision in five districts in Ghana., Methods: A cross-sectional situation analysis was conducted using a standardised tool to collect secondary healthcare data, supplemented by interviews with key informants, across five purposively selected districts in Ghana. The Programme for Improving Mental Health Care (PRIME) situation analysis tool was adapted to the Ghanaian context and used for data collection., Results: The districts are predominantly rural (>60%). There were severe challenges with the provision of mental healthcare: there were no mental healthcare plans, supervision of the few mental health professionals was weak and unstructured, access to regular supplies of psychotropic medications was a major challenge, and psychological treatments were extremely limited given the lack of trained clinical psychologists. There were no available data on treatment coverage, but we estimate this to be <1% for depression, schizophrenia, and epilepsy across districts. Opportunities for mental health systems strengthening include: the commitment and willingness of leadership, the existence of the District Health Information Management System, a well-established network of community volunteers, and some collaboration with traditional and faith-based mental health service providers., Conclusion: There is poor mental health infrastructure across the five selected districts of Ghana. There are opportunities for strengthening mental health systems through interventions at the district healthcare organisation, health facility, and community levels. A standardised situation analysis tool is useful for informing district-level mental healthcare planning in low-resource settings in Ghana and potentially other sub-Saharan African countries., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Weobong et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Few studies have examined the prevalence of mental, neurological and substance use (MNS) conditions, case detection and treatment in primary healthcare in rural settings in Africa. We assessed prevalence and case detection at primary healthcare facilities in low-resource rural settings in Ghana., Methods: A cross-sectional survey was conducted at the health facility level in three demonstration districts situated in Bongo (Upper East Region), Asunafo North (Ahafo Region) and Anloga (Volta Region) in Ghana. The study participants were resident adult (> 17 years) out-patients seeking healthcare at primary care facilities in each of the three demonstration districts. Data were collected on five priority MNS conditions: depression, psychosis, suicidal behaviour, epilepsy and alcohol use disorders., Results: Nine hundred and nine (909) people participated in the survey. The prevalence of probable depression was 15.6% (142/909), probable psychotic symptoms was 12% (109/909), probable suicidal behaviour was 11.8% (107/909), probable epilepsy was 13.1% (119/909) and probable alcohol use disorders was 7.8% (71/909). The proportion of missed detection for cases of depression, self-reported psychotic symptoms, epilepsy and alcohol use disorders (AUD) ranged from 94.4 to 99.2%, and was similar across study districts. Depression was associated with self-reported psychotic symptoms (RR: 1.68; 95% CI: 1.12-1.54). For self-reported psychotic symptoms, a reduced risk was noted for being married (RR: 0.62; 95% CI: 0.39-0.98) and having a tertiary level education (RR: 0.12; 95% CI: 0.02-0.84). Increased risk of suicidal behaviour was observed for those attending a health facility in Asunafo (RR: 2.31; 95% CI: 1.27-4.19) and Anloga districts (RR: 3.32; 95% CI: 1.93-5.71). Age group of 35 to 44 years (RR: 0.43; 95% CI: 0.20-0.90) was associated with reduced risk of epilepsy. Being female (RR: 0.19; 95% CI: 0.12-0.31) and having a tertiary education (RR: 0.27; 95% CI: 0.08-0.92) were associated with reduced risk of AUD., Conclusions: Our study found a relatively high prevalence of probable MNS conditions, and very low detection and treatment rates in rural primary care settings in Ghana. There is a need to improve the capacity of primary care health workers to detect and manage MNS conditions., (© 2023. The Author(s).)