Mental health care in low- and middle-income countries is constrained by a shortage of trained professionals. To address this gap, a ten-module online training program based on the WHO Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) was developed and evaluated across four Ethiopian public universities. A pre-post mixed-methods study was conducted among 494 students from four programs. Knowledge, attitudes, and clinical skills were assessed using standardized instruments, including the Mental Illness Clinicians’ Attitudes (MICA-2) scale and Enhancing Assessment of Common Therapeutic Factors (ENACT) tool. Post-training assessment showed statistically significant improvements: mean knowledge scores increased from 72.2% (SD 22.7) to 88.3% (SD 20.3), t (494) = 13.95, 95% CI [13.9, 18.4], (P < .001). Attitudes improved significantly, from a mean MICA score of 44.4 (SD 9.8) to 41.9 (SD 11.1), t (213) = -4.120, 95% CI [-3.7, -1.3], (P < .001). Clinical skills of students showed significant gains with a mean ENACT score increasing from 29.8 (SD 2.9) to 38.4 (SD 6.4) with a large effect size (P < .001, Cohen’s d = 1.24). The training improved knowledge, clinical skills, and attitudes, demonstrating potential as a feasible, sustainable, and scalable approach to strengthening mental health capacity among non-specialist health professionals.

Young people (YP) face numerous challenges that can lead to mental health difficulties, yet mental health systems worldwide are often unprepared to support those affected. Club Synergy, a low-threshold, trauma-informed digital and face-to-face service for YP aged 14–25 with emotional and/or behavioural difficulties, was established in Georgia in 2019. This study examined the characteristics, clinical effectiveness and outcome predictors of YP presenting to Synergy. Quantitative data, including clinical outcome measures and treatment details, were collected pre- and post-treatment and at three-month follow-up over a 21-month period (November 2019–July 2021). Of 266 YP who completed treatment, most were female (66.9%; mean age 19.95, SD 3.13). Common presenting difficulties included emotional instability (77.1%), anxiety and restlessness (63.5%), interpersonal problems (53%) and low mood (48.5%). Among 144 who completed the ACEs measure, 57.6% reported four or more adverse childhood experiences. Most (67.7%) received transdiagnostic programmes; 74.1% of these completed the Emotional Regulation module (mean 7.18 sessions, SD 7.23). Significant reductions in depression and anxiety, and improved functioning, were observed post-treatment and at follow-up (p < 0.01). Quality-of-life gains were not sustained at follow-up (p = 0.14). Satisfaction was high (94.8%). Trauma-informed, transdiagnostic services grounded in a biopsychosocial model appear acceptable and potentially beneficial for YP at risk of or experiencing common mental health symptoms.

Eco-anxiety, characterised by persistent or intense anxiety about environmental crises, is a growing global mental health concern. Yet, the design, effectiveness and implementation of interventions specifically targeting eco-anxiety lack a comprehensive synthesis. This systematic review examined peer-reviewed studies published between 2010 and 2025 that reported on interventions designed to prevent, manage or reduce eco-anxiety or closely related climate-related psychological distress, defined as sustained emotional, cognitive or functional impairment linked to environmental change. Searches were conducted across CINAHL, PsycINFO, MEDLINE, Scopus, ProQuest Environmental Science Collection and the Cochrane Central Register of Controlled Trials. Twenty-two studies met the inclusion criteria from an initial 1,259 records. Most were published between 2017 and 2025, primarily in high-income Western countries, and encompassed a broad range of interventions including educational programmes, messaging strategies, cognitive-behavioural and mindfulness-based therapies, group resilience training, nature-based approaches and community participation initiatives. Cognitive-behavioural and mindfulness-based interventions showed the most consistent positive findings within the current evidence base, including repeated reports of reductions in eco-anxiety or climate-related distress and, in some studies, maintenance of improvements at short-term follow-up. Educational and community-focused interventions were more likely to be associated with emotional engagement, agency and peer support rather than solely increasing knowledge, with some approaches increasing concern or emotional engagement without reducing distress. However, substantial heterogeneity in outcome measures, short intervention durations and limited follow-up periods constrained comparison across studies and assessment of longer-term impact. Implementation challenges included issues of scalability, cultural relevance and the predominance of researcher-led, time-bound interventions. Within the limited literature to date, interventions integrating emotional resilience training with group or community engagement appeared to show promising findings. Further research using standardised outcome measures, longer follow-up periods and more culturally diverse and participatory designs is required to strengthen the evidence base and inform scalable, context-sensitive responses to eco-anxiety.

Cross-cultural supervision (CCS) in mental health and psychosocial support (MHPSS) services occurs when supervisors and supervisees are from different cultures or contexts. In CCS, cultural differences intersect with supervisory power asymmetries, making supervisees vulnerable to culturally unsafe supervision practices. Despite CCS becoming more common in MHPSS, there remains limited understanding of how to practice culturally safe supervision. Further, this growing literature has not been synthesised. This scoping review explores how and by whom CCS is framed, what processes are involved, and how CCS may support MHPSS services, guided by an epistemic injustice framework. The search of academic and grey literature identified 45 papers on CCS in MHPSS. Most CCS studies were based in Western Educated Industrial Rich and Democratic (WEIRD) countries and used WEIRD paradigms, raising questions about generalisability and culturally safe application of CCS in non-WEIRD contexts. Studies in WEIRD countries often framed CCS using ethnocentric language, and inconsistent terminology when discussing culture. There was also a wide range of types of cross-cultural supervisory relationships, which we conceptualised as a broad spectrum whereby supervisory relationships differ in the extent of cultural difference between supervisors and supervisees. Common factors addressed in CCS literature were supportive relational processes, challenges in communication, culturally responsive practices and power dynamics. Culturally responsive supervision occurs through supervisor cultural humility, self-reflection on power, reciprocal learning attitudes and supervisors encouraging multicultural discussions. Culturally safe supervision benefits MHPSS services through enhanced supervisee clinical skills, increasing disclosures of client case information, increasing cultural humility and adapting Western models of therapy to suit clients. Based on these findings, we recommend that researchers and practitioners: acknowledge WEIRD paradigm dominance and White normativity; seek definitional clarity of CCS concepts; initiate supervisor-led multicultural discussions that recognise power dynamics; practice cultural humility; proactively seek peer and supervisor support; prioritise locally-led supervision and education research in non-WEIRD and humanitarian settings; and develop new models of CCS processes and configurations. This review has implications for CCS practice and research, raising questions about the underrepresentation of non-WEIRD scholarship and privileging of WEIRD paradigms, and highlighting a need for development of epistemically just and culturally safe CCS models.

Rapid modernisation can compress the pace of social, institutional and cognitive change within a single generation. In high-income Gulf states such as Qatar, rising mental health awareness coexists with persistent treatment gaps, delayed help-seeking and uneven service utilisation. Rather than attributing this divergence to cultural resistance or informational deficit, this article advances a theory-building integrative synthesis to conceptualise the phenomenon as a form of cultural–structural lag: a temporal misalignment between cognitive liberalisation, normative negotiation, and institutional absorption capacity. Drawing on Qatar-based epidemiological data (including the World Mental Health Qatar Study; Khaled et al. [2024a, International Journal of Methods in Psychiatric Research 33(S1), e2008]), policy documents and peer-reviewed qualitative and quantitative literature from 2015 to 2024, we identify a sequential dynamic in which public awareness expands more rapidly than stigma declines, stigma shifts faster than trust in formal services consolidates, and trust outpaces workforce capacity and system integration. We further introduce the concept of awareness-without-literacy, describing situations in which individuals recognise symptoms yet lack sufficient service navigation knowledge or perceived institutional legitimacy to engage formal care. The cultural–structural lag framework is explicitly differentiated from existing treatment gap literature, stigma-to-utilisation models, and health systems absorption frameworks: it is temporal and sequential rather than synchronic and accounts for the empirically observed paradox in which attitudes improve but service use does not proportionately follow. Qatar, a high-income society undergoing compressed modernisation, serves as the primary analytic case – not as a regional curiosity, but as one that may serve as an early indicator of dynamics likely to emerge across a range of rapidly transforming economies. Treatment gaps in rapidly modernising contexts may reflect phased system development rather than static cultural resistance. Policy implications emphasise synchronising literacy development, institutional trust-building and service expansion to reduce temporal misalignment. The framework offers a mid-range theoretical contribution applicable to other high-growth settings experiencing accelerated socioeconomic transformation.

Youths experience mental health challenges which are associated with their biopsychosocial development. However, this has been exacerbated by technological advances and their attendant challenges. Therefore, there is a need to periodically screen youths’ mental health using psychometrically valid scales so as to offer appropriate preventive and interventional programmes for them. This study examined the preliminary psychometric properties of eight mental health scales and their relationships among youths in Hong Kong. A total of 428 youths were conveniently recruited to respond to measures on depression, anxiety, somatic symptoms, smartphone application-based addiction, obsessive–compulsive symptoms, internet addiction, insomnia, life satisfaction, stress and cognitive fatigue. Data were analysed using Confirmatory factor analysis (CFA) and Pearson’s r. Generally, CFA fits (comparative fit index >0.9, Tucker–Lewis index >0.9, root mean square error of approximation <0.08 and standardised root mean square residual <0.08), average variance extracted (ranging between 0.531 and 0.724), composite reliability (ranging between 0.875 and 0.946) and internal reliability (Cronbach’s α = 0.834–0.918 and McDonald’s ω = 0.860–0.925) for the scales were acceptable. Correlations were significant among all measures (ps < 0.001). The CFA indices and correlational analyses suggest that all eight mental health measures have acceptable reliability and construct–convergent validity. Health and research professionals can use these scales to promote mental health activities among youths in Hong Kong.

The field of global mental health (GMH) is in transition. Following its emergence in the mid-2000s, the field is currently grappling with critiques concerning the presumed universality of its concepts and approaches; the focus on treatments rather than addressing social determinants of mental health; and a lack of equity between actors in the Global North and South. With the field at this junction, we describe three ways in which structural injustice (SI) theories can respond to calls for change within GMH. Following a brief discussion of key characteristics of SI theories, such as those put forward by Powers and Faden (2006, Social Justice: The Moral Foundations of Public Health and Health Policy. New York: Oxford University Press; 2019, Structural Injustice: Power, Advantage, and Human Rights. New York: Oxford University Press) and Young (2011, Responsibility for Justice. Oxford: Oxford University Press), we first discuss how they can contribute to GMH by strengthening often-called-for inter- and transdisciplinarity, using well-being as a boundary object or bridging concept. Second, we argue that SI theories can inform data collection and analysis by offering a theoretical lens for analyzing the role of social context in well-being. Third, we discuss the potential benefits of the normative dimensions of SI theory. Engagement with normative dimensions may assist in addressing unfair knowledge practices in GMH. In addition, attention to normative dimensions of SI theories may help to make GMH research more responsive to the deeper-rooted structural determinants of mental health and multi-sectoral strategies to remedy these. We posit that, in this time of transition, SI theories provide a versatile resource to engage in much-needed transformations in the field of GMH.

Suicide attempts arise from an environment of many interconnected psychosocial and other factors. Yet, the relationships between these factors have not been studied widely in low- and middle-income countries, where an estimated 73% of suicides occur. We aimed to identify the patterns and complexrelationships between the factors associated with suicide attempts. We conducted a network analysis on data from 25,761 school-going adolescents across12 low- and lower middle-income countries (LLMICs), obtained from the Global School-based Health Survey. Using Ising network analysis, we examined theinterrelationships between past-year suicide attempts and several factors; we estimated centrality measures and examined network stability usingbootstrapping. Suicide attempt prevalence was 11.8%. The network analysis identified three clusters: mental health, physical harm and behavioral factors. Suicide attempts showed strong conditional associations with drug use, bullying and worrying, while having close friends was a prominent protective factor.Behavioral factors: alcohol use, drug use and smoking were the most central nodes, showing the highest expected influence. This study provides novel insightsinto the interplay between factors associated with adolescent suicide attempts in LLMICs. Comprehensive interventions could focus on clustered risk factors,while empowering protective factors and addressing behavioral factors could conditionally attenuate other associations in the network.

Bede (“river gypsy”) communities in Bangladesh live with recurrent flooding, riverbank erosion, and displacement, alongside entrenched stigma and service exclusion, placing them at high risk of climate-related mental distress. We conducted a hermeneutic phenomenological study to examine how environmental hazards, social exclusion, and access barriers affect mental health and coping among Bede communities living along the Jamuna River in Sirajganj district. Seven in-depth interviews and one focus group discussion were carried out with adult community members. Data were analysed using reflexive thematic analysis, informed by Conservation of Resources (COR) theory, structural stigma theory, and a patient-centred access framework. Four interconnected domains were identified. First, environmental shocks and resource loss: hydro-climatic events (flooding, erosion, forced moves) triggered cumulative losses of shelter, assets, income, and schooling (hydro-climatic shocks → resource loss → demoralisation; COR loss spiral). Second, sleep disruption and persistent arousal: unsafe, damp sleeping spaces and anticipatory fear of future floods generated chronic insomnia, fatigue, and irritability (resource loss → unsafe sleep → persistent arousal). Third, gatekeeping and structural exclusion: stigmatising labels, lack of fixed address and documentation led to denial of water, exclusion from relief and social protection, and humiliating encounters in services (structural gatekeeping → disrupted ability to seek, reach and engage with care). Fourth, coping repertoires and collective strategies: prayer, quiet reflection, family pooling of resources, community solidarity, and pluralistic help-seeking from biomedical and traditional healers provided important but fragile buffers. Mental distress among Bede communities arises from the interaction of cumulative resource loss, sleep disruption and structural exclusion. Disaster-risk-reduction and health policies for mobile, climate-vulnerable populations should secure safe dry sleeping spaces, lighting, food and small assets; introduce portable ID and flexible registration; implement low-threshold, co-designed mental health and psychosocial support through outreach-based primary care; and reduce stigma at initial point of contact.

Restraint and seclusion (R/S) are used in psychiatric settings to manage aggression and agitation. Because these practices can cause psychological harm, physical injury and death, guidelines designate them as last-resort measures, yet their use frequently extends beyond psychiatric emergencies. In this study, we explored how R/S are understood, experienced and enacted within psychiatric care in Tanzania, focusing on their application, perceived impacts and future directions for training and intervention. We observed practices and conducted qualitative interviews with 20 doctors, nurses, clinical attendants and security guards involved in psychiatric care at a single Tanzanian hospital. We analyzed observational notes and data using applied thematic analysis. Seclusion rooms were used frequently and for extended periods. Physical restraint, such as physically holding patients or using bedsheets to cover their heads, was employed to facilitate chemical restraint or seclusion. While participants acknowledged physical restraint was potentially harmful, several expressed support for increasing chemical restraint and seclusion. Staff experienced a tension between their intentions to provide care and the potential for harm that was further compounded by the resource-limited context. To ensure patient safety and well-being, there is a need for safer, more humane standards and training in alternative aggression management techniques, including verbal de-escalation.