South Asia has a unique geographical profile, with the mighty Himalayas in the north and a long coastline in the south along its eastern and western borders. In the past few decades, with human population growth, and increasing urbanisation and industrialisation, the climate has been a casualty, with an adverse impact on physical health and well-being and on mental health. There have been certain initiatives on the part of local governments in the form of action plans on climate change, but the effects of these initiatives are yet to be seen. Research from South Asia on the impact of climate change on mental health is still at preliminary level.

Mental health advance directives are one mechanism to enable individuals to have a voice in their treatment at a time when most legislative systems would consider them to lack the capacity to make informed choices. This honours their will and preferences while at the same time recognising the difficulties of the legislative framework. In this review we consider the use of such advance directives in New Zealand, in the form of a specialised advance agreement known as a mental health advance preference statement (MAPS). By evaluating their development and considering their ethics and cultural components we offer insights into one approach to the creation and implementation of MAPS for other jurisdictions.

The substantial progress in bringing perinatal mental health to the forefront is undeniable. However, progress towards integrated care shows staggering disparities across countries. It is impeded by barriers and emerging threats along the care pathway. Perinatal mental disorders are common complications of childbirth that impose significant short- and long-term effects. These affect mental and physical health, relationships and socioeconomic status, having a profound impact on women’s overall functionality and quality of life. Their rising prevalence and disease burden signal a need for action and policy reform. This editorial sheds light on the status of perinatal mental health, highlights progress and existing roadblocks, and charts the way ahead for policy and practice.

Background Menopausal transition is a period of psychological vulnerability, yet suicidality remains underassessed. Hormone replacement therapy (HRT) may influence mood symptoms, but its mental health effects – particularly regarding suicidality – are poorly understood. Aims To evaluate changes in depressive symptoms, menopause-related distress and suicidality among menopausal women attending a specialist clinic, and explore whether outcomes differed across HRT regimens and baseline risk factors. Method We analysed routinely collected data from 957 women attending a UK menopause clinic. All participants received some form of treatment following their initial consultation. Participants completed the Patient Health Questionnaire-9 (PHQ-9) and Menopause Depression Rating Scale (MENO-D) at baseline and follow-up (2–6 months later). Mixed-design analyses of variance assessed changes over time, including interaction effects for HRT type and baseline risk factors (body mass index (BMI), smoking, suicidality, antidepressant use). Results Depressive symptoms and menopause-related psychological distress significantly declined over time (around 46% reduction on average). The largest improvements were observed among women receiving oestrogen–progesterone–testosterone combinations, although similar gains were also seen in oestrogen–progesterone and oestrogen–testosterone groups. Suicidality (PHQ-9 item 9) decreased by 92% among those with baseline ideation, but this was not moderated by HRT type. Self-worth (MENO-D item 4) also improved, but similarly showed no significant moderation by HRT regimen. Higher BMI was associated with worse baseline mental health, but did not moderate treatment outcomes. Conclusions Combined HRT, including formulations with testosterone, was associated with substantial improvements in mental health outcomes. Suicidality was a distinct symptom profile, often underdetected by general depression scores. However, findings are exploratory and should be interpreted cautiously because of the lack of a control group, observational design and small sample sizes in some subgroups. These results highlight the need for menopause-sensitive mental health assessments and integration of psychological screening into routine menopausal care.

Substance use disorder (SUD) is a rapidly growing public health challenge in developing countries across socioeconomic divides. In sub-Saharan Africa, the situation of SUD is particularly concerning and largely unexplored, with projections indicating a worsening trend. This study seeks to fill the gap by generating insights into the multifaceted nature of alcohol and drug use disorders among a young adult population in Nigeria. This is a cross-sectional survey of 192 current students at a university of a metropolitan city in North-Western Nigeria, using the NIDA-Modified ASSIST version 2.0, adapted from the Alcohol, Smoking and Substance Involvement Screening Test. About half of the participants (49.7%) were heavy drinkers, 36.5% and 56.8% reported past year tobacco smoking and use of prescription drugs for non-medical reasons, but only 7.4% had used illegal drugs daily in the past year. Cannabis and sedatives were the most used substances in the lifetime (56.2% and 47.9%, respectively) and past 3 months (52.4% and 51.1%, respectively). Men had greater odds of substance use in their lifetime (odds ratio 4.167, 95% CI 1.61-10.77; d.f. = 1, P = 0.003) and past three months (odds ratio 6.059, 95% CI 2.20-16.69; d.f. = 1, P ≤ 0.001), compared with women. The burden of SUD remains a major public health concern in Nigeria despite existing legislation, regulations and policies in the country. There is an urgent need improve diagnostic, treatment and preventative resources by engaging a massive public health campaign to alert the public of the dangers of SUD.

It is estimated that, worldwide, a new case of dementia develops every 3 s. Around 60% of cases occur in low- and middle-income countries such as Egypt, with this number expected to rise to 71% in the next 25 years. Egypt is the most populous Arabic-speaking country, containing one-quarter of the world’s Arab population. However, a majority of tools for assessing cognitive impairment have not been standardised, normed and validated according to International Test Commission guidelines, nor have they been culturally adapted, for the Egyptian population. We gathered insight from doctors and clinicians practising in Egypt to learn how they assess patients suspected of cognitive impairment. The majority reported that they used Western-made screening tools (e.g. the Montreal Cognitive Assessment), but were overwhelmingly of the view that such assessments should be standardised and adapted for Egyptians. This lack of consistent standards can lead to misclassification of cases in this lower middle-income country.