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Globally, child and youth mental health needs are largely unmet, especially in resource-constrained settings. Youth are uniquely placed to provide mental health support, but there is limited evidence on what their role should involve. The aim of this study was to establish how youth themselves conceptualized the peer support worker role. We captured the perspectives of 45 youth from Pakistan and South Africa. Focus group discussions were analyzed through a thematic codebook framework. Key findings indicated how youth can improve their mental health care, as well as those of their peers, by recognizing early signs of mental health concerns, developing adaptive coping mechanisms, strengthening social relationships, and mobilizing additional resources through advocacy and mediation. Peer support can be enhanced by skills such as lack of judgement, empathy, encouragement and good communication. Peer support workers can play an important role in promoting children’s mental health, particularly in resource-constrained settings. Such posts should be clearly defined, incorporated within existing service systems, and provided with adequate funding, training and supervision.

Abstract Background The involvement of young people as peer researchers, especially with lived experience, is increasingly considered important in youth mental health research. Yet, there is variation in the understanding of the role, and limited evidence on its implementation across different research systems. This case study focusses on the barriers and enablers of implementing peer researcher roles within and across majority world countries contexts. Methods Based on an international youth mental health project involving different levels of peer researchers and participants from eight countries, peer researchers and a co-ordinating career researcher reflect on lessons regarding enabling and challenging factors. These reflections are captured and integrated by a systematic insight analysis process. Results Building on existing international networks, it was feasible to actively involve peer researchers with lived experience in a multi-country mental health study, who in turn recruited and engaged young participants. Identified challenges include the terminology and definition of the role, cultural differences in mental health concepts, and consistency across countries and sites. Discussion Peer researchers’ role could be strengthened and mainstreamed in the future through ongoing international networks, training, sufficient planning, and active influence throughout the research process. Trial registration: Not applicable.

Background: The experience of trauma during childhood is due to decrease in children's psychosocial functions, which continues during adulthood. Children's coping and reactions play the important role in adapting to traumatic events and can lead to post-traumatic disorder or post-traumatic growth. Previous research studies have quantitatively and sporadically shown some of the factors affecting coping styles, but so far, focus as depth research in this area, especially on Iranian children, has been influenced. Aims: The present study evaluated the contextual factors in selecting the effective coping strategies by children exposed to the Kermanshah earthquake in 2017 Methods: This research was the qualitative type with an approach to conventional content analysis. The participants consisted of 23 girls aged 10 to 12 years who were selected by purposive sampling, and semi-structured interviews. Data were analyzed by the 5-step method of Graneheim, & Lundman (2004). Results: The results indicated four main categories and fourteen Subcategories as the contexts of selecting coping styles. These categories include a) influence (previous life experiences, modeling), b) individual skills (responsibility to others "external commitment" and "commitment to oneself," time management, emotion control, tolerating failure and compassion with others), c) family members' relationship with the child (intimacy with family members, support of family members and how parents deal) and d) social skills (trust in peers, valuing relationships and the level of ability to make and maintain friendships). Conclusion: The findings demonstrate the effect of intrapersonal and interpersonal factors in selecting various strategies among children encountered with earthquake trauma.

Abstract The objective was to establish how stakeholders in low- and middle-income countries (LMIC) conceptualize child mental health impact. Semi-structured interviews were conducted with 18 stakeholders from disadvantaged urban communities in Kenya, South Africa, Turkey and Brazil. Participants represented education, welfare and health care agencies; as well as community and religious groups. Data were analysed through a thematic approach and three related themes were identified. Impact was defined as a process of change, with child-centred outcomes and measures that were broader than mental health symptoms improvement. Beneficiaries were identified at child, family, community and service level. Participants wished to see strategies that ensured sustainability of impact, namely child mental health policy, stakeholder engagement, interdisciplinary working, and capacity-building for all stakeholder groups. Child mental health service transformation in LMIC, especially in areas of deprivation, needs to build on existing resources and strengths by co-producing psychosocial outcomes with a range of professional and community stakeholders. Impact on children’s mental wellbeing can be achieved through a co-ordinated strategy that involves designated policy, capacity-building, and interdisciplinary networks with meaningful community involvement.

Abstract Background Exposure to traumatic events in childhood is associated with the development and maintenance of various psychiatric disorders, but most frequently with posttraumatic stress disorder (PTSD). The aim of this study was to evaluate the types of traumatic events experienced and the presence and predictors of PTSD symptoms among adolescents from the general population from ten low- and middle-income countries (LMICs). Methods Data were simultaneously collected from 3370 trauma-exposed adolescents (mean age = 15.41 [SD = 1.65] years, range 12–18; 1465 (43.5%) males and 1905 (56.5%) females) in Brazil, Bulgaria, Croatia, Indonesia, Montenegro, Nigeria, the Palestinian Territories, the Philippines, Romania, and Serbia, with Portugal, a high-income country, as a reference point. The UCLA PTSD Reaction Index for the DSM-5 (PTSD-RI-5) was used for the assessment of traumatic events and PTSD symptoms. Results The most frequently reported traumatic events were death of a close person (69.7%), witnessing violence other than domestic (40.5%), being in a natural disaster (34.4%) and witnessing violent death or serious injury of a close person (33.9%). In total, 28.5% adolescents endorsed two to three DSM-5 PTSD criteria symptoms. The rates of adolescents with symptoms from all four DSM-5 criteria for PTSD were 6.2–8.1% in Indonesia, Serbia, Bulgaria, and Montenegro, and 9.2–10.5% in Philippines, Croatia and Brazil. From Portugal, 10.7% adolescents fall into this category, while 13.2% and 15.3% for the Palestinian Territories and Nigeria, respectively. A logistic regression model showed that younger age, experiencing war, being forced to have sex, and greater severity of symptoms (persistent avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity) were significant predictors of fulfilling full PTSD criteria. Conclusions Nearly every third adolescent living in LMICs might have some PTSD symptoms after experiencing a traumatic event, while nearly one in ten might have sufficient symptoms for full DSM-5 PTSD diagnosis. The findings can inform the generation of PTSD burden estimates, allocation of health resources, and designing and implementing psychosocial interventions for PTSD in LMICs.

The research aimed to establish how psychosocial supports are experienced by children who lived on the streets, juxtaposed with caregivers’ views. Semi-structured interviews were conducted with seven children aged 12-16 years recruited from a shelter in Delhi who had lived on the streets, four parents, and five professionals. The data were analysed using thematic analysis. Three themes were identified: 1) children’s psychosocial needs, 2) risk factors, and 3) protective factors and supports. Inter-linked risk factors were deprivation of basic needs, exploitation, maltreatment, antisocial activities and substance abuse. Emotional and physical safety was a priority before instigating resilience-building strategies. These consisted of developing peer and staff relationships, education, sports and creative activities. Counselling was viewed as important, but integral to other supports.The multiple and complex psychosocial needs of street children require a co-ordinated, interdisciplinary and scaled care approach. This should prioritize protection strategies, followed by integrated resilience-building interventions.

Abstract Background Stress-related situations play a significant role in children’s lives and result in different reaction in children. Among various methods of evaluating the stressful environment of children, 54-item Children’s Coping Strategies Checklist-Revision1 (CCSC-R1) has been developed as one of the most powerful tools for assessing different aspects of coping in children. The purpose of the present study is to find the psychometric properties of Persian CCSC-R1 and to identify the coping strategies used by Iranian children. Method Subjects included 401 female students aged between 9 and 13 who were subjected to the Sarpol-e-Zahab earthquake (in Northeast of Iran). Construct and convergence validities were examined with confirmatory factor analysis and correlated with Children’s Coping Behavior Questionnaire (CCBQ). Reliability was obtained by internal consistency. Using repeated analysis of variance, the status of coping strategies in children were achieved. Results Confirmatory factor analysis showed a good model fit to the four-factor structure, active coping, distracting action/distraction, avoidance, and support seeking strategies. The results also demonstrated that there was a strong relationship between four-factors of CCSC-R1 including their subscales and CCBQ. Internal consistency (Cronbach’s Alpha) for the four dimensions were in the range of 0.76 to 0.88. The findings also showed that Iranian children use active coping, especially optimism, more than other strategies in order to deal with their stressful situations. Conclusions It is concluded that CCSC-R1 is a valid and reliable instrument which could be employed for Iranian children. Furthermore, in the face of traumatic events, Iranian children acted same as people in individualistic cultures.

Research demonstrates that young people value mental health support that is tailored to their needs and preferences, rather than a "one size fits all" offer, which is often not equitably accessible (National Children's Bureau, 2021). Understanding young people's lived experiences across different sociocultural contexts is important. The aim of this research was to conduct an international qualitative study on the views of young people with lived experience and professionals, on proposed aspects of personalised support for anxiety and/or depression. Participatory action focus groups were conducted with N = 120 young people with lived experience of anxiety and/or depression (14-24 years) and with N = 63 professionals in Brazil, India, Kenya, Pakistan, Portugal, South Africa, Turkey, and the United Kingdom. Data were analysed using the rigorous and accelerated data reduction (RADaR) technique. Overall, although some country-specific differences were found in terms of what aspects of support young people found to be most important, individual preferences were considered stronger, furthering the view that support should be personalised to the needs of the individual young person. Young people experiencing anxiety and/or depression should be able to choose for themselves which aspects of support they would prefer in their own care and support plans, with families and mental health professionals providing guidance where appropriate, rather than removing the young person from the decision-making process altogether. It should also be ensured that the aspects of personalised support can be understood by young people and professionals from different contexts, including marginalised and minoritised groups and communities.

Abstract Child and adolescent psychiatry is in a unique position to respond to the growing public health challenges associated with the large number of mental disorders arising early in life, but some changes may be necessary to meet these challenges. In this context, the future of child and adolescent psychiatry was considered by the Section on Child and Adolescent Psychiatry of the World Psychiatric Association (WPA CAP), the International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP), the World Association for Infant Mental Health (WAIMH), the International Society for Adolescent Psychiatry and Psychology (ISAPP), the UN Special Rapporteur on the Right to Health, representatives of the WHO Department of Mental Health and Substance Abuse, and other experts. We take this opportunity to outline four consensus priorities for child and adolescent psychiatry over the next decade: increase the workforce necessary for providing care for children, adolescents and families facing mental disorders; reorienting child and adolescent mental health services to be more responsive to broader public health needs; increasing research and research training while also integrating new research finding promptly and efficiently into clinical practice and research training; Increasing efforts in advocacy.

The wellbeing of disadvantaged children in low-income countries (LIC) is often compromised by a range of environmental risk factors, as well as by limited access to supports and services. The aim of this exploratory study was to understand service provision barriers for children's wellbeing in an urban informal settlement in Dhaka, Bangladesh, by complementing stakeholder perspectives with a spatial method and a knowledge exchange framework. The research literature and official records informed interviews with 19 stakeholders, who identified interdisciplinary services. Visual geospatial analysis mapped services in relation to child wellbeing. These maps informed a knowledge exchange participatory workshop with 21 stakeholders, who co-produced recommendations related to child-centeredness and safety, community involvement, and accessible resources. Such a participatory approach combining stakeholder perspectives with geospatial analysis can be a useful tool in low-resource contexts.

The concept of resilience is increasingly influential in the development of interventions and services for young people, yet there is limited knowledge of how resilience-building strategies are conceptualized by young people across different cultures, particularly in low- and middle-income countries. The aim of this study was to capture 274 young people’s voices in disadvantaged communities in Kenya, Turkey, Pakistan, and Brazil through participatory research methods. Young people defined strategies in response to 4 adversity scenarios reflecting socioecological systems (young person, family, school, and community). Template analysis, underpinned by thematic design, was used to establish three broad themes of intrapersonal (self-management, cognitive re-appraisal, agency), interpersonal (social engagement, informal supports, formal supports), and religious resources. Proposed strategies were largely similar across the sites, with some contextual differences depending on the scenario (stressor) and cultural group. The findings support an ecological systems approach to resilience, which is consistent with the development of multimodal interventions for vulnerable youth and their families in disadvantaged communities in low- and middle-income countries.

Background: Children and adolescents are often exposed to traumatic events, which may lead to the development of posttraumatic stress disorder (PTSD). It is therefore important for clinicians to screen for potential symptoms that can be signs of PTSD onset. PTSD in youth is a worldwide problem, thus congruent screening tools in various languages are needed. Objective: The aim of this study was to test the general psychometric properties of the Traumatic Stress Disorder Reaction Index for children and adolescents (UCLA PTSD) Reaction Index for DSM-5 (PTSD-RI-5) in adolescents, a self-report instrument intended to screen for trauma exposure and assess PTSD symptoms. Method: Data was collected from 4201 adolescents in communities within eleven countries worldwide (i.e. Brazil, Bulgaria, Croatia, Indonesia, Montenegro, Nigeria, Palestine-Gaza, Philippines, Portugal, Romania, and Serbia). Internal consistency, discriminant validity, and a confirmatory factor analysis of a four-factor model representing the main DSM-5 symptoms of the PTSD-RI-5 were evaluated. Results: The PTSD-RI-5 total score for the entire sample shows very good reliability (α = .92) as well as across all countries included (α ranged from .90 to .94). The correlations between anxiety/depressive symptoms and the PTSD-RI-5 scores were below .70 indicating on good discriminant validity. The four-factor structure of the scale was confirmed for the total sample and data from six countries. The standardized regression weights for all items varied markedly across the countries. The lack of a common acceptable model across all countries prevented us from direct testing of cross-cultural measurement invariance. Conclusions: The four-factor structure of the PTSD-RI-5 likely represents the core PTSD symptoms as proposed by the DSM-5 criteria, but there could be items interpreted in a conceptually different manner by adolescents from different cultural/regional backgrounds and future cross-cultural evaluations need to consider this finding.

The qualitative community embraces transparent dialogue through sharing knowledge to improve rigour and develop new initiatives. In this paper, we recognise there are many complexities within qualitative research, leading to important debates. We explore the benefits and challenges, as well as the practicalities and technicalities, of conducting research that 1) employs multiple methods within the qualitative paradigm, 2) is interdisciplinary, and 3) examines a sensitive research topic 4) with a vulnerable group of participants. Specifically, when research is also 5) cross-cultural and 6) utilises participatory techniques. Through our discussion, we draw upon an existing project and examine the complexity of designing and completing intra-paradigmatic mixed methods research with children from different sociocultural contexts, underpinned by interdisciplinary perspectives, in a complex area like mental health.

Refugee children and young people have high levels of unmet mental health needs. A trauma‐informed service transformation framework was applied with 14 professionals in Turkey. Through participatory focus groups, professionals co‐produced service plans and considered enabling and challenging factors for implementation. Data were analysed through a thematic codebook approach. Established themes suggested that implementation should concurrently address societal barriers, agency fragmentation, lack of contextual interventions and sustainability. These led to the development of a Theory of Change. A trauma‐informed and scaled service model of collaborative care can holistically meet refugee children and young people's complex needs, while maximising sparse resources. [ABSTRACT FROM AUTHOR]