Transdiagnostic psychosocial interventions to promote mental health in forcibly displaced persons: a systematic review and meta-analysis

People forced to leave their homes, such as refugees and internally displaced persons, are exposed to various stressors during their forced displacement, putting them at risk for mental disorders. In view of the Russian military offensive in Ukraine, this review aimed at summarizing the evidence on the efficacy of transdiagnostic psychosocial interventions to promote mental health and/or to prevent mental symptoms in forcibly displaced persons of all ages. Four electronic databases and reference lists were searched for randomized controlled trials on interventions in this population from inception to March 11, 2022. Thirty-six studies were eligible, 32 were included in random-effects multilevel meta-analyses. Results on mental symptoms, M(SMD) = 0.26, p = .075, and positive mental health indicators like wellbeing, M(SMD) = 0.41, p = .182, provided no evidence for an effect favoring transdiagnostic interventions over control conditions in children/adolescents and adults. After excluding studies at risk of bias, meta-analyses on adult samples provided evidence for a small effect on mental symptoms and positive mental health, while analyses on children/adolescents yielded unchanged results. Heterogeneity was considerable, and certainty of evidence was very low. Future research should combine the imperative of humanitarian aid in face of major crises with studying forcibly displaced persons’ diverse needs to improve future interventions.

Many societies have been recently exposed to humanitarian and health emergencies, which have resulted in a large number of people experiencing significant distress and being at risk to develop mental disorders such as depression, anxiety and post-traumatic stress disorder. The World Health Organizationhas released a series of scalable psychosocial interventions for people impaired by distress in communities exposed to adversities. Prominent among these is a low-intensity transdiagnostic psychosocial intervention, Problem Management Plus (PM+), and its digital adaptation Step-by-Step (SbS). This systematic review is the first to summarize the available evidence on the effects of PM+ and SbS. Up to March 8, 2023, five databases were searched for randomized controlled trials examining the effects of PM+ or SbS on distress indicators (i.e., general distress; anxiety, depressive or post-traumatic stress disorder symptoms; functional impairment, self-identified problems) and positive mental health outcomes (i.e., well-being, quality of life, social support/relationships). We performed random-effects multilevel meta-analyses on standardized mean differences (SMDs) at post-intervention and short-term follow-up assessments. Our search yielded 23 eligible studies, including 5,298 participants. We found a small to medium favorable effect on distress indicators (SMD=-0.45, 95% CI: -0.56 to -0.34) and a small beneficial effect on positive mental health outcomes (SMD=0.31, 95% CI: 0.14-0.47), which both remained significant at follow-up assessment and were robust in sensitivity analyses. However, our analyses pointed to substantial between-study heterogeneity, which was only partially explained by moderators, and the certainty of evidence was very low across all outcomes. These results provide evidence for the effectiveness of PM+ and SbS in reducing distress indicators and promoting positive mental health in populations exposed to adversities, but a larger high-quality evidence base is needed, as well as research on participant-level moderators of the effects of these interventions, their suitability for stepped-care programs, and their cost-effectiveness.

BackgroundPregnancy and parenthood are known to be high-risk times for mental health. However, less is known about the mental health of pregnant adolescents or adolescent parents. Despite the substantial literature on the risks associated with adolescent pregnancy, there is limited evidence on best practices for preventing poor mental health in this vulnerable group. This systematic review therefore aimed to identify whether psychosocial interventions can effectively promote positive mental health and prevent mental health conditions in pregnant and parenting adolescents.MethodsWe used the standardized systematic review methodology based on the process outlined in the World Health Organization’s Handbook for Guidelines Development. This review focused on randomized controlled trials of preventive psychosocial interventions to promote the mental health of pregnant and parenting adolescents, as compared to treatment as usual. We searched PubMed/Medline, PsycINFO, ERIC, EMBASE and ASSIA databases, as well as reference lists of relevant articles, grey literature, and consultation with experts in the field. GRADE was used to assess the quality of evidence.ResultsWe included 17 eligible studies (n = 3245 participants). Interventions had small to moderate, beneficial effects on positive mental health (SMD = 0.35, very low quality evidence), and moderate beneficial effects on school attendance (SMD = 0.64, high quality evidence). There was limited evidence for the effectiveness of psychosocial interventions on mental health disorders including depression and anxiety, substance use, risky sexual and reproductive health behaviors, adherence to antenatal and postnatal care, and parenting skills. There were no available data for outcomes on self-harm and suicide; aggressive, disruptive, and oppositional behaviors; or exposure to intimate partner violence. Only two studies included adolescent fathers. No studies were based in low- or middle-income countries.ConclusionDespite the encouraging findings in terms of effects on positive mental health and school attendance outcomes, there is a critical evidence gap related to the effectiveness of psychosocial interventions for improving mental health, preventing disorders, self-harm, and other risk behaviors among pregnant and parenting adolescents. There is an urgent need to adapt and design new psychosocial interventions that can be pilot-tested and scaled with pregnant adolescents and adolescent parents and their extended networks, particularly in low-income settings.

<p>本研究目的在了解正負向指標篩檢心理健康型態集群分佈情形，是否符合Keyes主張以主觀幸福感與憂鬱症狀雙指標區分的完整心理健康模式。研究設計以心理健康BMI幸福感問卷、病人健康狀況憂鬱問卷，做為正負向指標篩檢工具，架構完整心理健康模式；以問卷調查法立意取樣739份樣本，經群集分析法作統計分群。結果能區分出有意義的四群集，包括擁有高幸福低憂鬱之完整圓滿心理健康型態的「心盛型」群集（46.28%）、不完整心理健康型態三個群集:「冷靜型」（低幸福低憂鬱之不完整心理亞健康型態，31.94%）、「奮戰型」（高幸福高憂鬱之不完整心理健康型態，11.10%）、「混沌型」（低幸福高憂鬱之不完整心理健康型態，10.69%）。低憂鬱者佔全體 78.22%，其中59.17%擁有高幸福而處於完整圓滿心理健康型態；高憂鬱者佔全體21.78%，其中50.93%擁有高幸福感。驗證了幸福感、憂鬱傾向作為正負向心理健康指標，篩檢完整或不完整心理健康型態。建議:（1）高憂鬱者參照「奮戰型」這群人高幸福感來源，藉由參與社團獲得人際支持、找到工作及收入來增加自我價值感；（2）「冷靜型」不能單看低憂鬱的心理健康篩檢，需提升「友善人際支持 正念情緒平穩 認同自我價值意義」之正向心理健康BMI幸福感，以獲得完整心理健康；（3）未來研究可依據正負向心理健康指標去發展心理健康素養能力，作為心理健檢與自主管理完整心理健康之用。</p> <p> </p><p>This study aimed to understand the cluster distribution of positive and negative indicators for screening mental health patterns and whether they conform to Keyes’ claim that positive and negative indicators should be included in the complete mental health state model. The positive mental health indicators included social, emotional, and psychological well-being, which should be measured using the Mental Health Continuum Short Form (MHC-SF). Negative indicators measure the level of symptoms of mental illness concurrently, serving as a complete assessment of whether the individual is in a healthy state of positive and negative mental health indicators. Keyes employed these to distinguish four clusters of people with four mental health modes, of which the incomplete mental health cluster was in the state. Even if they have a negative mental illness, they could have positive mental health and well-being. Although some people do not have negative mental illness, they cannot have positive mental health and well-being. Therefore, Taiwanese scholar Li corresponded to these three well-being developments and selected three operational mental health skills: ""Befriend-Mindfulness-Identity"" as the Mental Health BMI Well-Being Index questionnaire (mBMI). After using them to evaluate 739 people, it was evident that the scores of the above two questionnaires were significantly correlated, and the mBMI questionnaire total score and Questions B, M, and I could effectively predict the total score, social, emotional, and psychological well-being of the MHC-SF, with a total explanatory power of 30.3%. This test should be used as a simple screening for well-being and as a positive mental health screening tool. Additionally, a Depression Scale Screening Tool for Negative Mental Health Depression was combined to explore the complete mental health state model of Taiwanese people. </p> <p> Therefore, in this study, the mBMI questionnaire was selected as a simple tool to measure positive mental health well-being, and the patients’ health questionnaire for depression was used as a screening tool for negative mental health indicators. These are used as positive and negative indicators to test whether a complete or incomplete mental health state model fits. The questionnaire survey method was used to deliberately sample the data from 739 valid samples, and the cluster analysis method was used for statistical grouping to verify its suitability. According to the results of the aforementioned positive and negative indicators, four meaningful clusters were distinguished, including one complete and three incomplete mental health models. One cluster was ""Flourishing type""(46.28%) of high well-being and low depression, which belonged to the complete mental health state model. The other three clusters were incomplete mental health state models. ""Fighting type"" (31.94%) of high well-being and high depression, ""Calm type"" (11.10%) of low well-being and low depression, and ""Chaos type"" (10.69%) of low well-being and high depression could fight for high well-being. It was verified that well-being and depression could be used as positive and negative mental health indicators to screen for complete or incomplete mental health state models. When we identified people with high depression, we encouraged them to refer to the source of high well-being of the ""fighting type"" group and increase their sense of self-worth by participating in clubs to obtain interpersonal support, find jobs, and earn income. We reminded the ""calm type"" people with low depression to promote their high well-being to have a complete mental health state. Finally, we monitored positive and negative indicators of mental health using screening tools of the Mental Health BMI Well-Being Index and the Patient Health Questionnaire (PHQ-9) to screen for complete or incomplete mental health states as a reference for promoting positive and negative mental health. The befriend-mindfulness-identity skills should be improved to promote well-being and adjust depression to achieve complete mental health.</p> <p> </p>

County-Level Estimates of Need for Mental Health Professionals in the United States

Applied public mental health: bridging the gap between evidence and clinical practice.

BackgroundBecause of wars, conflicts, persecutions, human rights violations, and humanitarian crises, about 84 million people are forcibly displaced around the world; the great majority of them live in low‐ and middle‐income countries (LMICs). People living in humanitarian settings are affected by a constellation of stressors that threaten their mental health. Psychosocial interventions for people affected by humanitarian crises may be helpful to promote positive aspects of mental health, such as mental well‐being, psychosocial functioning, coping, and quality of life. Previous reviews have focused on treatment and mixed promotion and prevention interventions. In this review, we focused on promotion of positive aspects of mental health.ObjectivesTo assess the effects of psychosocial interventions aimed at promoting mental health versus control conditions (no intervention, intervention as usual, or waiting list) in people living in LMICs affected by humanitarian crises.Search methodsWe searched CENTRAL, MEDLINE, Embase, and seven other databases to January 2023. We also searched the World Health Organization's (WHO) International Clinical Trials Registry Platform and ClinicalTrials.gov to identify unpublished or ongoing studies, and checked the reference lists of relevant studies and reviews.Selection criteriaRandomised controlled trials (RCTs) comparing psychosocial interventions versus control conditions (no intervention, intervention as usual, or waiting list) to promote positive aspects of mental health in adults and children living in LMICs affected by humanitarian crises. We excluded studies that enrolled participants based on a positive diagnosis of mental disorder (or based on a proxy of scoring above a cut‐off score on a screening measure).Data collection and analysisWe used standard Cochrane methods. Our primary outcomes were mental well‐being, functioning, quality of life, resilience, coping, hope, and prosocial behaviour. The secondary outcome was acceptability, defined as the number of participants who dropped out of the trial for any reason. We used GRADE to assess the certainty of evidence for the outcomes of mental well‐being, functioning, and prosocial behaviour.Main resultsWe included 13 RCTs with 7917 participants. Nine RCTs were conducted on children/adolescents, and four on adults. All included interventions were delivered to groups of participants, mainly by paraprofessionals. Paraprofessional is defined as an individual who is not a mental or behavioural health service professional, but works at the first stage of contact with people who are seeking mental health care. Four RCTs were carried out in Lebanon; two in India; and single RCTs in the Democratic Republic of the Congo, Jordan, Haiti, Bosnia and Herzegovina, the occupied Palestinian Territories (oPT), Nepal, and Tanzania. The mean study duration was 18 weeks (minimum 10, maximum 32 weeks). Trials were generally funded by grants from academic institutions or non‐governmental organisations.For children and adolescents, there was no clear difference between psychosocial interventions and control conditions in improving mental well‐being and prosocial behaviour at study endpoint (mental well‐being: standardised mean difference (SMD) 0.06, 95% confidence interval (CI) −0.17 to 0.29; 3 RCTs, 3378 participants; very low‐certainty evidence; prosocial behaviour: SMD −0.25, 95% CI −0.60 to 0.10; 5 RCTs, 1633 participants; low‐certainty evidence), or at medium‐term follow‐up (mental well‐being: mean difference (MD) −0.70, 95% CI −2.39 to 0.99; 1 RCT, 258 participants; prosocial behaviour: SMD −0.48, 95% CI −1.80 to 0.83; 2 RCT, 483 participants; both very low‐certainty evidence). Interventions may improve functioning (MD −2.18, 95% CI −3.86 to −0.50; 1 RCT, 183 participants), with sustained effects at follow‐up (MD −3.33, 95% CI −5.03 to −1.63; 1 RCT, 183 participants), but evidence is very uncertain as the data came from one RCT (both very low‐certainty evidence).Psychosocial interventions may improve mental well‐being slightly in adults at study endpoint (SMD −0.29, 95% CI −0.44 to −0.14; 3 RCTs, 674 participants; low‐certainty evidence), but they may have little to no effect at follow‐up, as the evidence is uncertain and future RCTs might either confirm or disprove this finding. No RCTs measured the outcomes of functioning and prosocial behaviour in adults.Authors' conclusionsTo date, there is scant and inconclusive randomised evidence on the potential benefits of psychological and social interventions to promote mental health in people living in LMICs affected by humanitarian crises. Confidence in the findings is hampered by the scarcity of studies included in the review, the small number of participants analysed, the risk of bias in the studies, and the substantial level of heterogeneity. Evidence on the efficacy of interventions on positive mental health outcomes is too scant to determine firm practice and policy implications. This review has identified a large gap between what is known and what still needs to be addressed in the research area of mental health promotion in humanitarian settings.

PurposeThe purpose of this study is to systematically review how positive mental health literacy has been conceptualised and measured over the last 20 years. Positive mental health recognises the benefits of feeling good and functioning effectively. Developing clarity around conceptualisation and knowledge (or literacy) of what constitutes positive mental health is an area of continued development, and an important step in measuring the impact of mental health promotion.Design/methodology/approachA systematic review of literature was performed to investigate how positive mental health literacy has been conceptualised and measured over the last 20 years. Databases searched included EDS, Scopus, ERIC, PsycINFO, CINAHL and SocIndex with fulltext. Search terms relating to positive mental health were combined with proximity operators within four words denoting knowledge, competence or literacy.FindingsA total of 464 records were assessed on title level, with six articles included for final review. The final studies included three measures assessing participants’ knowledge of positive mental health, some of which included more distal themes such as awareness of coping strategies and emotional awareness. One measure, the Mental Health Promoting Knowledge – 10, stood out as the most fitting measure of positive mental health literacy.Research limitations/implicationsOur review approaches an under reported area of study, highlighting an area in need for further development with a few limitations. When building the search strategy, care was taken to line it up with literacy around positive mental health and its synonyms. The word “mental health” without positive specification was omitted in the final search strategy, increasing the risk of it also omitting potential articles of interest.Practical implicationsOur findings therefore highlight a knowledge gap in relation to conceptualisations and measures of positive mental health literacy, unfolding an area for further development. A more harmonised understanding of what is meant by positive mental health is an important step towards clarifying the concept and facilitating future study of the topic. Measures of positive mental health literacy could be an important indicator for mental health promotion.Social implicationsNew ways of measuring positive mental health literacy can be a useful way to establish benefits of mental health promotion, taking a salutogenic approach to mental health.Originality/valueThese findings expose an apparent knowledge gap in relation to conceptualisations and measures of positive mental health literacy, highlighting an area in need for further development. Measures of positive mental health literacy could be an important indicator for mental health promotion.

The current umbrella review aimed to assess and summarise evidence on universal, selective and indicated interventions for mental health at the workplace. This umbrella review forms one of the evidence...

P-1007 - Positive maternal mental health: promoting resilience and wellbeing in perinatal women

Physical activity represents a modifiable behaviour which may be associated with increased likelihood of experiencing positive mental health. The aim of this study was to examine the association between self-rated physical activity and subjective indicators of both positive and negative mental health in an Irish adult population. Based on data from a population-based, observational, cross-sectional study, participants were categorised using the International Physical Activity Questionnaire (IPAQ) into those who reported that they did and did not meet recommended physical activity requirements. Self-reported positive and negative mental health indicators were assessed using the Energy and Vitality Index (EVI) and the Mental Health Index-5 (MHI-5) from the SF-36 Health Survey Instrument, respectively. Binary logistic regression was used to identify variables independently associated with self-reported positive and negative mental health. A total of 7539 respondents were included in analysis. Overall, 32% reported that they met recommended minimal physical activity requirements. Self-reported positive and negative mental health were reported by 16 and 9% of respondents, respectively. Compared with those who reported meeting-recommended physical activity requirements, those performing no physical activity were three times less likely to report positive mental health (adjusted odds ratio (OR) 0.39, 95% confidence interval (CI) 0.28-0.55) and three times more likely to report negative mental health (OR 3.27, 95% CI 2.38-4.50). Compared with those who do not, those who report meeting-recommended physical activity requirements are more and less likely to report experiencing positive and negative mental health, respectively. Future policy development around physical activity should take cognisance of the impact of this activity on both physical and mental health outcomes.

BackgroundThe link between mental illness and mental health is gaining focus in research and practice. This study aimed to investigate the association of mental disorders with positive mental health (PMH), overall health and quality of life. In addition, the role of PMH in mediating the relationships between mental disorders and health outcomes was assessed.MethodsThe study sample comprised 2270 residents aged 18 years and above who participated in a nationally representative, cross-sectional survey estimating the lifetime prevalence of mood, anxiety and alcohol use disorders, and health outcomes (self-reported overall health, quality of life and PMH) in Singapore. The Positive Mental Health Instrument was used to estimate the level of Total PMH among the respondents with and without mental disorders. Associations between mental disorders and health outcomes were assessed through regression models. Path analyses were conducted to investigate mediating role of PMH.ResultsTotal PMH (Mean ± SD) was significantly lower among individuals having any of the studied lifetime mental disorders (4.23 ± 0.64 versus 4.50 ± 0.67 among those without these disorders). Although having a mood or anxiety disorder was associated with significantly lower Total PMH even after controlling for socio-demographic characteristics, similar relationship was not observed for alcohol use disorders. History of any mental disorders was also associated with lower overall health and quality of life. Total PMH mediated the relationships between mental disorders and overall health and quality of life by reducing the effect sizes for the associations between mental disorders and these health outcomes.ConclusionsMental disorders were associated with poor health outcomes in affected individuals. This study showed that PMH can mediate the relationships between mental disorders and health outcomes, and act as an underlying mechanism to improve overall health and quality of life in individuals with mental disorders. Findings thus highlight the significance of incorporating mental health promotion and interventions in clinical populations.

Factors related to mental health of inpatients with COVID-19 in Wuhan, China

Evidence Evaluation Process and Management of Potential Conflicts of Interest: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.

Psychosocial interventions for women with polycystic ovary syndrome: a systematic review of randomized controlled trials