Postpartum anxiety and depression are significant public health issues, negatively impacting maternal and child well-being and placing a substantial economic burden on society and healthcare systems. The Happy Mother Healthy Baby (HMHB) program has proved effective for improving outcomes for both mother and child in women with antenatal anxiety. This study assesses the economic viability of HMHB by comparing health care expenditures between the intervention (HMHB) and control groups, assessing statistical significance with T-tests. Results showed generally higher maternal healthcare costs for the HMHB group, with significant differences in provider visits (p = 0.01) and total costs (p = 0.02) during the third trimester, as well as marginally significant medication costs (p = 0.08) during the postnatal period. Postpartum healthcare costs for children in the HMHB group trended lower for provider visits, hospital stays and overall costs, though these results were not statistically significant. Subgroup analyses by education level showed similar results. Implementation costs for the full intervention were estimated at 10,641 Pakistani rupees per mother. Results suggest that implementing HMHB may be justified based on improved outcomes for mothers and children in conjunction with the low implementation costs and the potential for long-term cost savings associated with HMHB.

Human Immunodeficiency Virus (HIV) has been widely associated with comorbid depression. This study examined the prevalence of depression by HIV status and its relationship to mental health service use in rural eastern Uganda using structured questionnaires. Participants with HIV (n = 150) were recruited from local HIV clinics, while participants with negative or unknown HIV status (n = 154) were randomly sampled from nearby villages. Participants were assessed for depression using the Patient Health Questionnaire-9, loneliness using the UCLA 3-item Loneliness Scale and general mental health status using a Likert-type self-report scale. Symptomatic HIV, asymptomatic HIV and HIV negative subgroups were compared on demographics, clinical characteristics and prior service use from traditional, religious and biomedical providers. The symptomatic HIV+ group reported significantly greater depressive symptoms, loneliness and poorer self-rated mental health than other groups, but no increase in mental health service use. Furthermore, among this group, more severe depressive symptoms were associated with decreased likelihood of mental health service use, possibly due to competing demands and limited mental health service availability. Religious leaders were the most common source of care with notable overlap between providers. This study highlights the importance of utilizing existing religious and biomedical pathways to increase access to mental health services.

Extreme weather events (EWEs) and resource insecurities are associated with adverse mental health outcomes, yet little is known about their impacts on older adults in climate-affected settings. We conducted a community-based cross-sectional survey 250 randomly sampled older adults from the Prospective Urban Rural Epidemiology cohort in Moshi, Tanzania (mean age 60.6 years, SD 11.1). Multivariable linear regression examined resource insecurity (food, water, sanitation), EWE exposure, social support, and resilience associations with depressive and anxiety symptoms. In adjusted analyses, low food security (aβ=0.86, 95% CI: 0.54, 1.18), very low food security (aβ=1.07, 95% CI: 0.73, 1.41), sanitation insecurity (aβ=0.05, 95% CI: 0.01, 0.09p = 0.022 e), and past-year EWE exposure (aβ=0.39, 95% CI: 0.07, 0.70) were associated with higher depressive symptoms. Low food security (aβ=0.51, 95% CI: 0.22, 0.79), very low food security (aβ=0.62, 95% CI: 0.32, 0.93), and water insecurity (aβ=0.53, 95% CI: 0.02, 1.03) were associated with higher anxiety ssymptoms, while resilience was associated with lower anxiety symptoms (aβ= −0.07, 95% CI: −0.14,−0.01). Findings highlight interconnected environmental and resource insecurity-related mental health vulnerabilities among older adults, underscoring the importance of integrating resource security and mental health into climate adaptation strategies for older adults in climate-affected low and middle-income settings.

Women’s empowerment is a key social determinant of health; however, its association with mental health, evaluated in this study through symptoms of anxiety and depression, remains insufficiently explored across low- and middle-income countries (LMICs). This study aimed to estimate the prevalence of depression and anxiety among ever-married women aged 15–49 years, examine their associations with women’s empowerment and assess cross-country inequalities in five LMICs. We analyzed nationally representative Demographic and Health Survey data from Bangladesh, Lesotho, Mozambique, Nepal and Zambia. Women’s empowerment was measured across three Survey-based Women’s Empowerment domains: attitude toward violence, social independence and decision-making autonomy. Survey-weighted descriptive statistics and multivariable logistic regression models were used, adjusting for sociodemographic and household covariates. The prevalence of depression and anxiety was low (~4–6%) and showed minimal variation across empowerment levels. In adjusted analyses, decision-making autonomy was consistently associated with lower odds of both depression and anxiety. In contrast, social independence was associated with higher odds of mental health symptoms in Bangladesh, Mozambique and Nepal. Attitudes toward violence showed limited and inconsistent associations. Country-specific analyses revealed substantial heterogeneity, with Mozambique indicating significant associations with autonomy, Nepal demonstrating mixed associations across domains and Bangladesh showing increased depression with higher social independence. These findings reveal how various components of women’s empowerment are associated with depression and anxiety across various sociocultural settings. In Mozambique, policy efforts should be prioritized for strengthening decision-making autonomy and social independence. In Addition, social independence and attitudes toward violence should be enhanced in Bangladesh; however, every domain of women empowerment needs to be improved in Nepal. These strategies are essential for improving women’s mental health and advancing Sustainable Development Goals 3 and 5 in LMICs.

Worldwide, suicide remains a major public health challenge, with a disproportionate burden in low- and middle-income countries. Despite growing evidence on suicidal behavior in Uganda, little is known about how community stakeholders perceive its burden, drivers and opportunities for prevention in rural settings. We aimed to explore stakeholders’ perspectives on suicidal behavior, its perceived drivers and opportunities for suicide prevention in Ntungamo District, southwestern Uganda. We conducted a qualitative study involving 19 face-to-face in-depth interviews and three focus group discussions with purposively selected stakeholders. Interviews were audio-recorded, transcribed verbatim and analyzed using rapid qualitative thematic analysis. Three themes emerged: (1) suicidal behavior was perceived as an increasingly visible community and public health concern; (2) participants identified interacting drivers of suicidal behavior, including access to lethal means, socioeconomic adversity, demographic vulnerabilities, and harmful alcohol and substance use; (3) participants identified community-informed opportunities for suicide prevention and to promote awareness, reduce stigma and encourage early help-seeking. Stakeholders perceived suicidal behavior as a significant community concern driven by interacting social, economic, demographic and environmental influences. Community-informed suicide prevention strategies that strengthen existing community structures and trusted local actors could inform policy and practice in Uganda and similar rural settings across sub-Saharan Africa.

Depression in later life is a substantial yet under-recognized public health concern in low- and middle-income countries, including Nigeria, where rapid population aging heightens vulnerability. Evidence from community settings remains limited, particularly in southeastern Nigeria. This study examined the prevalence and sociodemographic factors associated with severe depressive symptoms among community-dwelling adults aged 60 years and older. A cross-sectional survey was conducted from June 2024 to August 2025 across 30 rural and urban communities in five southeastern states, using multistage purposive sampling to recruit 718 eligible participants. Data were collected through interviewer-administered questionnaires incorporating the Geriatric Depression Assessment Questionnaire and the Geriatric Depression Scale – Short Form. Severe depressive symptoms were highly prevalent. Advanced age, female gender, Christian religious affiliation, being married and living with family were significantly associated with higher odds of severe depressive symptoms, while educational level showed no association. Several associated sociodemographic factors contradicted widely held assumptions about the protective nature of traditional social structures, highlighting the need for further investigation into the quality and context of social relationships in later life. These findings underscore the urgent need for routine geriatric mental health screening, community-based support strategies and culturally responsive interventions within Nigeria’s primary care and social welfare systems.

Severe mental illnesses (SMIs), including schizophrenia, bipolar disorder and major depressive disorder with psychotic features or severe functional impairment, are chronic psychiatric disorders associated with substantial disability, impaired functioning and premature mortality. Relapse, the recurrence or worsening of psychiatric symptoms after a period of remission, is a common feature of these disorders and contributes to repeated hospitalization, poor functional outcomes and increased healthcare utilization. Despite its clinical and public health importance, evidence on the lifetime occurrence of relapse and its associated factors remains limited in sub-Saharan Africa, particularly in Ethiopia. Therefore, this study aimed to determine the lifetime prevalence of relapse and identify factors associated with relapse among patients with SMI receiving outpatient psychiatric care in Northwest Ethiopia. An institution-based cross-sectional study was conducted among patients with SMI at the University of Gondar Hospital, Northwest Ethiopia, from April 10 to May 24, 2025. A total of 535 patients with SMI were included using systematic random sampling. Lifetime relapse was assessed using a semistructured interviewer-administered questionnaire supported by medical record review. Data on sociodemographic, clinical, treatment-related and psychosocial characteristics were collected. Binary logistic regression analysis was performed to identify factors associated with lifetime relapse. Variables with a p-value <0.20 in the bivariable analysis were entered into the multivariable model, and statistical significance was declared at p < 0.05. The lifetime prevalence of relapse was 61.5% (95% CI: 57.0%–66.0%). In the multivariable binary logistic regression analysis, lifetime relapse was significantly associated with unemployment (adjusted odds ratio [AOR] = 1.65; 95% CI: 1.07–2.55), bipolar disorder (AOR = 3.71; 95% CI: 1.92–7.19), schizophrenia (AOR = 2.73; 95% CI: 1.68–4.46), previous psychiatric hospitalization (AOR = 3.62; 95% CI: 2.26–5.80), two or more prior psychiatric admissions (AOR = 2.32; 95% CI: 1.27–4.23), illness duration of more than 10 years (AOR = 2.04; 95% CI: 1.07–3.88), comorbid medical illness (AOR = 2.41; 95% CI: 1.27–4.58) and experiencing one or two (AOR = 1.81; 95% CI: 1.03–3.18) or three or more stressful life events (AOR = 2.16; 95% CI: 1.16–4.05). Lifetime relapse affected nearly two-thirds of patients with SMI. Factors associated with relapse included unemployment, bipolar disorder, schizophrenia, previous psychiatric hospitalization, multiple prior admissions, longer illness duration, comorbid medical illness and stressful life events. These findings highlight the importance of targeted clinical monitoring and interventions for individuals with characteristics associated with relapse, alongside strengthened continuity of care and integrated mental health services to support relapse prevention and improve long-term outcomes.

Interventions for older adults with NCDs and depression should be relevant to the risk factors for NCDs in non-WEIRD populations. We conducted a single-group pilot study of the Ziba Ufa intervention, consisting of problem-solving therapy and health education over 6 weekly sessions delivered by lay counsellors; there was no control group. Participants were opportunistically sampled through outpatient NCD clinics in four sites in Kilimanjaro, Tanzania. We conducted exploratory analyses of the clinical relevance of the health education using self-report survey data, and perceived relevance using qualitative interviews. Thirty-two participants enrolled (88% with hypertension and 44% with type 2 diabetes). Of the 21 participants with height and weight data, 12 (57%) were obese. Advice on weight loss, a sleep routine, and increasing fruit and vegetable consumption may be clinically relevant, but alcohol and tobacco consumption, levels of physical activity and consumption of processed foods with added sugar or salt were self-reported as meeting recommendations; therefore, they may be less clinically relevant. Participants reported acting on the sleep advice more than on the dietary and physical activity advice. This may indicate that sleep advice was perceived as relevant, but dietary and physical activity advice was not.

Coordinated, multicomponent care models improve outcomes in early psychosis in high-income settings, but how coordinated care can be adapted for rural, pluralistic, low-resource systems remains poorly understood. We aimed to co-design a locally feasible coordinated care model for people with severe mental illness (SMI) in rural Uganda and identify feasible delivery agents, role divisions, engagement with pluralistic care pathways, and anticipated implementation barriers. We conducted three iterative co-design workshops with 18 participants across parallel churchand mosque-based series in Buyende District, Uganda. Participants included biomedical and mental health workers, Village Health Team members, religious leaders, traditional healers, local leaders, people with lived experience of SMI, and caregivers. Transcripts were translated and analyzed using the Framework Method. Four themes emerged. Participants described sequential help-seeking across a pluralistic care landscape with directional referral asymmetries. They proposed distributing psychosocial support and medication follow-up across a tiered workforce, with relational trust as a key feasibility condition. Reintegration was framed through administrative endorsement and community economic institutions. Family psychoeducation was viewed as foundational and deliverable through task-shifting and peer caregivermentorship. Participants articulated a coordinated care model preserving core functions while redesigning delivery around a community-extended, task-shared workforce.

Women from ethnic minorities in high-income countries face higher perinatal mental health challenges and encounter substantial barriers to accessing timely, culturally sensitive mental health services. Peer support interventions are seen as a promising strategy to reduce these disparities, but there is limited evidence comparing the effectiveness of digital versus non-digital delivery methods for this group. This systematic review evaluates the effectiveness, facilitators and implementation challenges of both digitally delivered and non-digitally delivered peer support interventions for the ethnic minority women experiencing perinatal mental health difficulties living in high-income countries. This systematic review used a mixed-methods approach, following PRISMA 2020 guidelines and registered with PROSPERO (CRD42025644255). It searched six electronic databases: MEDLINE, PubMed, Embase, Web of Science, CINAHL and Scopus, as well as grey literature sources, covering publications from 2000 onwards. The study designs included were randomised controlled trials (RCTs), non-RCTs, quantitative studies, mixed-methods research and qualitative studies. The quality assessment employed the ROB2 tool, the CASP checklist and the MMAT. Quantitative results were summarised narratively, while qualitative findings were analysed thematically based on the Thomas and Harden (2008) framework. Nineteen studies from seven high-income countries met the inclusion criteria. Non-digitally delivered interventions showed greater consistency and statistical significance. Digitally delivered interventions were reported to be effective for high-risk subgroups. Qualitative analysis revealed that digital interventions improved accessibility, flexibility, peer engagement and cost-effectiveness, but also faced barriers such as digital literacy gaps, connectivity issues, privacy concerns and cultural-linguistic disparities. Non-digital interventions offered stronger emotional bonds, cultural grounding and trust-building but encountered logistical, workforce and sustainability challenges. An equity paradox was identified: digital interventions aimed at increasing access sometimes inadvertently excluded individuals with limited digital skills, disproportionately impacting the ethnic minority women the interventions were intended to serve. Both modalities showed significant benefits in reducing perinatal mental health symptoms among the ethnic minority women; they operate through different mechanisms and face unique implementation challenges. No single approach was universally effective. Hybrid models appear particularly promising and warrant further research. Future studies should focus on direct comparative trials, community-co-designed cultural adaptations, long-term outcome assessments and strategies to address digital inequity in perinatal mental health care.