Medication non-adherence remains a persistent hurdle in the management of Major Depressive Disorder. Understanding patient preferences is essential for promoting patient-centered care and enhancing treatment outcomes. This study aimed to quantify patient preferences for antidepressant attributes among Chinese patients using a best-worst scaling experiment via face-to-face surveys in seven psychiatric institutions. Six attributes were assessed: remission rate, sleep disorders, risk of headache or dizziness, risk of gastrointestinal adverse reactions, risk of liver or kidney injury and monthly out-of-pocket costs. A total of 331 participants completed seven choice tasks. Conditional logit, mixed logit and generalized multinomial logit models were applied, with the mixed logit providing the best fit. Patients most strongly preferred higher remission rates (80%, β = 6.06; 55%, β = 3.12), followed by lower risks of liver or kidney injury (1%, β = 1.65) and lower out-of-pocket costs (100 CNY, β = 1.64). Higher risks of gastrointestinal adverse reactions (60%, 35%) and insomnia were least desirable. Remission rate, risk of gastrointestinal adverse effects and sleep disorders were the most influential attributes. In conclusion, these findings highlight key factors shaping antidepressant choice and emphasize the role of patient preferences in guiding treatment selection, thereby supporting more individualized healthcare and improving clinical outcomes.

Addressing stigma among primary care providers (PCPs) is critical for scaling mental healthcare and improving access to care. We conducted a multi-country, mixed-methods study to assess the feasibility, acceptability and pilot effectiveness of an intervention to reduce mental health stigma among PCPs. The intervention integrated PhotoVoice narratives from people with lived experience of mental health conditions (PWLEs) and aspirational figures in PCPs’ mental health training. It was implemented across seven sites in five countries. Mixed-methods data (qualitative interviews and quantitative measures on stigma knowledge, attitudes, intended behaviours and clinical competencies) were collected at baseline, immediately post-training and at the 3-month follow-up. The intervention was feasible across all sites, though PWLE recruitment and retention required contextual adaptation and logistical and psychosocial support. Acceptability of aspirational figures varied by setting. A descriptive trend suggested an increase in PCPs’ scores in stigma knowledge, attitudes and competency from pre- to post-training and remained elevated in the 3-month follow-up. PWLEs involved reported enhanced self-confidence, identity transformation and improved family relationships. Integrating lived experience photo-narratives into PCP training is feasible, acceptable and shows promise for reducing stigma and improving competency in diverse settings. Controlled trials are needed to assess effectiveness, cost-effectiveness and sustainability.

Humanitarian settings in Pakistan face major gaps in mental health service delivery, with limited specialist resources and a high burden of untreated conditions. Though the World Health Organization’s mhGAP-Humanitarian Intervention Guide aims to strengthen the capacity of primary care physicians to identify and manage common mental health conditions, the evidence for multidimensional training outcomes remains limited. This study evaluated the effectiveness of mhGAP-HIG training outcomes in terms of knowledge, skills, attitudes and confidence among physicians across different humanitarian contexts in Pakistan. As part of implementing an evidence-based digital MHPSS service model, seven mhGAP-HIG workshops were held across two provinces and a federal area. We conducted a quasi-experimental, mixed-methods evaluation where a total of 149 physicians completed standardized assessments of knowledge (mhGAP-HIG), therapeutic skills (ENhancing Assessment of Common Therapeutic Factors), attitudes (Mental Illness: Clinician’s Attitudes Scale-v4) and confidence, before and after the training. Paired sample t-tests and ANCOVA were used to assess within-group and between-group changes, respectively. Quantitative feedback and qualitative reflections were also evaluated. We found significant improvements across the domains of knowledge, skills, confidence and a modest improvement in attitude. The participants from Khyber Pakhtunkhwa showed greater gains in knowledge, while participants from Baltistan showed greater gains in skills, as compared to other provinces. Participants expressed a high level of satisfaction, reporting improvements in knowledge, confidence and ability to identify and manage common mental health conditions. Systematic efforts to adapt and implement mhGAP-HIG may lead to significant improvements across multidimensional competencies of physicians.

Despite their substantial influence in the society, studies on the engagement of priests in suicide prevention in low- and middle-income countries (LMICs) is limited. We investigated Nigerian Catholic clergy’s preparedness, training needs and perceived responsibility regarding suicide prevention as well as their awareness of national suicide prevention policy. Participants were 323 Catholic priests drawn from eight Catholic dioceses in Southeast Nigeria. Self-report data was obtained using items from the Professional Suicide Knowledge and Skill Survey. We found that fewer priests reported prior suicide prevention training (26.3%), but many of them affirmed their duty to assist suicidal persons (75.2%), necessity of suicide prevention education (93.8%), need for additional suicide prevention skills training (92.9%), and willingness to learn more about suicide prevention (91.3%). While only 16.7% were aware of national suicide prevention policy, 98.1% of the priests endorsed the inclusion of priests in national suicide prevention initiatives. Suicide prevention training of priests and perceived need for further training were also associated with greater perceived responsibility for suicide prevention, awareness regarding suicide prevention policy and support for clergy involvement in suicide prevention initiatives. Implementing structured suicide prevention training may strengthen community detection and referral, especially in LMICs where faith leaders are highly accessible.

Medical students frequently experience psychological distress due to intense academic demands and high-stakes assessments. Scalable psychological interventions such as Self-Help Plus (SH+) may support student well-being, contextual adaptation is required to ensure its relevance to medical education. The aim of research is to adapt SH+ intervention culturally and contextually for medical students while maintaining the core principles of Acceptance and Commitment Therapy (ACT). The adaptation followed Bernal’s framework. Modifications aligned the intervention with the academic and clinical realities of medical training while preserving fidelity to the original SH+ model. The core structure and therapeutic components of SH+ were largely compatible with the medical education context and required no major structural changes. Key adaptations included simplifying psychological terminology and contextualizing ACT concepts through experiences common in medical training, such as, Objectively Structured Practical Examination anxiety, ward rotations and professional identity formation. major adaptation involved removing the pre-recorded audio format, which students perceived as time-consuming and less engaging, and replacing it with facilitator-led interactive sessions. Peer support elements were incorporated to enhance engagement, reflection and shared learning. The adapted SH+ intervention preserved therapeutic fidelity while improving contextual relevance and feasibility for medical students, offering a scalable strategy to support stress management in medical education.

This study examines the implementation outcomes of Parceros Creadores, a municipal government program in Medellín, Colombia, which deployed novice psychologists to deliver a cognitive-behavioral therapy (CBT) protocol to youth aged 14–28 years in neighborhoods controlled by local gangs. Twelve psychologists wrote reflective essays about their implementation experience. We analyzed the essays using reflexive thematic analysis and organized findings around 4 implementation outcomes: acceptability, feasibility, appropriateness, and fidelity, with workforce-capacity development examined as a precondition for sustainability. Providers reported high acceptability driven by therapeutic bond formation in a context of institutional distrust. Feasibility obstacles included youth distrust of government programs, dropout linked to competing survival needs and bureaucratic barriers to psychiatric referrals. Psychologists perceived that youth adopted CBT techniques in daily life, which they read as evidence for the appropriateness of the protocol. Providers adapted the protocol for neurodivergent participants, incorporated family psychoeducation and adjusted session modality. The experience generated professional competencies that constitute workforce capacity for sustained service delivery. Psychologists also perceived a reduction in mental health stigma among participants. The findings position novice professionals as a distinct implementer category in the task-shifting literature and identify design features that may transfer to similar urban settings in low- and middle-income countries.

Dementia is a global public health concern with increasing prevalence, especially in low- and middle-income countries (LMICs) where care is primarily provided by informal family caregivers. This study identified the specific training needs of informal caregivers of persons with dementia in rural southwestern Uganda to inform the development of contextually appropriate caregiver training interventions. We conducted 20 in-depth interviews with 17 caregivers and 3 key informants affiliated with Reach One Touch One Ministries (ROTOM), a community-based organization supporting older persons in Rukiga District, Uganda. Interviews were audio-recorded, transcribed verbatim, and analyzed thematically using an inductive approach. Caregivers demonstrated limited knowledge of dementia, often attributing it to normal aging, spiritual causes, or stress. They faced substantial physical, emotional, and financial burdens, and relied on faith, social support, and adaptive caregiving strategies. All expressed willingness to attend group-based, in-person training focused on practical skills, including communication, managing dementia-related behaviors, personal hygiene, nutrition, and medication administration. Key informants highlighted the importance of community awareness to address misconceptions. Informal caregivers in rural Uganda experience high caregiving burden and unmet training needs. The identified training priorities closely align with World Health Organization (WHO) iSupport domains, supporting adaptation of the program for rural Ugandan caregivers.

Substance use and mental health symptoms frequently co-occur among youth in Nairobi’s informal settlements, yet scalable interventions remain limited. This pilot study evaluated the Youth Empowerment Digital Intervention (YEDI), a brief group cognitive-behavioral therapy model supported by mobile reinforcement. A clustered-community randomized pilot study enrolled 94 adolescents and young adults aged 15–24 years (treatment = 49; control = 45). The intervention group received seven weekly 1-hour manualized group cognitive-behavioral therapy sessions supplemented by mobile skill reinforcement, while control participants received standard health materials. Alcohol, cannabis, and tobacco use risk, along with depression, anxiety, and stress symptoms, were assessed at baseline, 3 months, and 6 months using linear mixed-effects models. YEDI demonstrated promising short-term reductions in alcohol risk, cannabis risk, and depressive symptoms at 3 months, although these differences were not sustained at 6 months. Tobacco risk did not differ between groups, and stress showed counterintuitive relative effects due to reductions in the control group. Delivering YEDI in informal settlements is feasible and provides a proof of concept for brief, early mental health support. Preliminary findings indicate that brief, skill-based models alone cannot offset severe structural stressors. Multi-level interventions integrating behavioral strategies with ongoing community support are required. .

Mental disorders are major contributors to the global burden of disease and may show correlated incidence patterns across countries. We characterized the country-level ecological network of age-standardized incidence rates for 10 mental disorders, identified statistically central disorders and examined how individual countries influenced estimated network connectivity. Data for 204 countries and territories, including Sociodemographic Index values, were obtained from the Global Burden of Disease Study 2023. A regularized network model using the mgm framework estimated conditional associations among country-level variables. Strength centrality and case-deletion delta-centrality analyses assessed disorder connectedness and country influence, with bootstrap procedures evaluating stability. Approximately 400 million incident cases of the studied disorders were estimated globally in 2023. Anorexia nervosa and bipolar disorder had the highest strength centrality, indicating broader conditional connections with other disorders. Australia, the United States, Iran, China and Finland showed relatively large delta-centrality values, suggesting greater influence on estimated centrality than most countries. Strength centrality stability was acceptable but modest. These findings provide a descriptive, hypothesis-generating view of how modeled incidence rates covary across countries and should not be interpreted as individual-level comorbidity, causal influence or direct policy priority.

Cancer stigma, both underaddressed and understudied, remains a pervasive challenge in sub-Saharan Africa. Currently, the region is experiencing rising cancer incidence alongside some of the lowest cancer survival rates worldwide. With complex and multifaceted sociocultural factors contributing to this stigma and subsequent lack of screening, low treatment adherence and poorer health outcomes, it is critical to implement effective interventions in the region, at both the clinical and policy levels. To achieve a path forward, it is necessary to create targeted efforts that incorporate existing infrastructure and key cultural contexts.