Determinants Of Poor Mental Health Research Articles

Mental Health Research Among Tribal Population in India

Tribals are the most marginalized social category in the country. There is little and scattered information on the actual burden and pattern of illnesses they suffer from. Tribal communities in general and primitive tribal groups are prone to disease. Also, they do not have required access to basic health facilities. They are most exploited, neglected, and highly vulnerable to diseases with a high degree of malnutrition, morbidity, and mortality. Research on the mental health of tribal people is not much in numbers. Few studies made on them have produced inconsistent results. This study aims to assess the mental health status of tribal communities. It was found that due to a lack of appropriate mental health services in rural areas, the tribal population is unable to access the needful services and treatment. There is a need to develop a psychosocial care program for tribal to promote positive social, physical, psychological, and emotional well-being. This study is the first of its kind to review research on mental health among STs. Mental health research conducted among STs in India is limited and is mostly of low-to-moderate quality. Determinants of poor mental health and interventions for addressing them need to be studied on an urgent basis.

Associations of nuptiality perceptions, financial difficulties, and socio-demographic factors with mental health status in Australian adults: Analysis of the Household, Income and Labour Dynamics in Australia (HILDA) survey.

This study examined the association of nuptial/relationship factors, financial difficulties, and socio-demographic factors with the mental health status of Australian adults. Cross-sectional quantitative study design. Using data from the Household, Income and Labour Dynamics in Australia (HILDA) survey wave 19, 6846 adults were included in the analysis. Mental health was measured using the mental component summary (MCS) subscale of the Short-Form Health Survey SF-36. Hierarchical multiple linear regressions were used to examine the predictors of mental health status. Overall, 7.1% of the participants reported poor mental health status. Individual financial difficulty factors explained 3.2% (p<0.001) of the variance in mental health scores. In addition, financial difficulties were negatively associated with mental health status. Nuptiality and relationship factors accounted for 9.8% (p<0.001) of the variance in mental health status. The study suggests negative marital or relationship perceptions and financial difficulties are significant factors accounting for poor mental health. This finding suggests the need for more policy attention toward the social determinants of poor mental health especially nuptiality or relationship perceptions which have received less policy and research attention in Australia.

How co-locating public mental health interventions in community settings impacts mental health and health inequalities: a multi-site realist evaluation

BackgroundPublic mental health interventions are non-clinical services that aim to promote wellbeing and prevent mental ill health at the population level. In England, the health, social and community system is characterised by complex and fragmented inter-sectoral relationships. To overcome this, there has been an expansion in co-locating public mental health services within clinical settings, the focus of prior research. This study evaluates how co-location in community-based settings can support adult mental health and reduce health inequalities.MethodsA qualitative multi-site case study design using a realist evaluation approach was employed. Data collection took place in three phases: theory gleaning, parallel testing and refining of theories, and theory consolidation. We collected data from service users (n = 32), service providers (n = 32), funders, commissioners, and policy makers (n = 11), and members of the public (n = 10). We conducted in-depth interviews (n = 65) and four focus group discussions (n = 20) at six case study sites across England, UK, and two online multi-stakeholder workshops (n = 20). Interview guides followed realist-informed open-ended questions, adapted for each phase. The realist analysis used an iterative, inductive, and deductive data analysis approach to identify the underlying mechanisms for how community co-location affects public mental health outcomes, who this works best for, and understand the contexts in which co-location operates.ResultsFive overarching co-location theories were elicited and supported. Co-located services: (1) improved provision of holistic and person-centred support; (2) reduced stigma by creating non-judgemental environments that were not associated with clinical or mental health services; (3) delivered services in psychologically safe environments by creating a culture of empathy, friendliness and trust where people felt they were being treated with dignity and respect; (4) helped to overcome barriers to accessibility by making service access less costly and more time efficient, and (5) enhance the sustainability of services through better pooling of resources.ConclusionCo-locating public mental health services within communities impacts multiple social determinants of poor mental health. It has a role in reducing mental health inequalities by helping those least likely to access services. Operating practices that engender inter-service trust and resource-sharing are likely to support sustainability.

The impact of employment loss on mentally unhealthy days among LGBTQ+ cancer survivors during the COVID-19 pandemic: Findings from the OUT National Survey.

Lesbian, Gay, Bisexual, Transgender, Queer, and all other sexual and gender minority (LGBTQ+) populations made up 7.1% of the US population in 2021. LGBTQ+ cancer survivors face a variety of economic and mental health disparities; however, the determinants of poor mental health among LGBTQ+ cancer survivors are understudied. This analysis utilized the OUT National Survey which consists of N=2233 LGBTQ+ cancer survivors (complete cases). Multivariable negative binomial and logit regression models were used to generate predicted values, predicted probabilities, and average marginal effects (AME) to assess the association between COVID-19 related employment loss and mentally unhealthy days (MUDs) and frequent mental distress among LGBTQ+ cancer survivors. Predicted values and marginal effects were generated with interaction terms (demographics interacted with employment loss) to explore the heterogeneity of the effect of employment loss among LGBTQ+ sub-populations. In bivariate analyses employment loss was associated with a higher number of MUDs (10.3, SD=9.9 vs. 8.4, SD=9.6; p-value<0.001) and frequent mental distress (34% vs. 26%; p-value=0.001). AME from a multivariable negative binomial model revealed that employment loss was associated with 1.42 more MUDs (95%CI: 0.33-2.86). Demographic factors such as some sexual orientations, cis-female and non-binary gender, younger age, and a current cancer diagnosis were also associated with significant expected increases in the number of MUDs. Whenassessing the heterogeneity of the effect of employment loss some sub-populations experienced changes in the number of MUDs that pushed them overthe threshold of frequent mental distress while others did not. Furthermore, identifying with multiple sexual orientations (AME: 0.19, 95%CI: 0.11-0.27), cis-female and non-binary genders (AME: 0.07, 95%CI: 0.2-0.12; AME:0.18, 95%CI: 0.07-0.28), American Indian and Alaska Native race (AME: 0.17, 95%CI: 0.03-0.31), and a current cancer diagnosis (AME: 0.14, 95%CI: 0.09-0.19) were associated with an increase in the probability of experiencing frequent mental distress. COVID-19 related employment loss negatively impacted the mental health of LGBTQ+ cancer survivors. LGBTQ+ specific supportive services as well as equity-based employment and income interventions are needed.

Determinants of Poor Mental Health of Medical Students in Portugal-A Nationwide Study.

Medical students are a population that is vulnerable to the development of anxiety, depression, and burnout. This observational cross-sectional study sought to assess the levels of distress and identify precipitating factors in all students enrolled in a Portuguese medical school during the academic year of 2022/23. Students (n = 768) were surveyed via validated instruments to measure anxiety, depression, and burnout. Sociodemographic information was also collected through a questionnaire. The study indicated that almost half of this population had depressive symptoms. No differences were found in distress levels between medical schools, and when comparing curricular years, higher levels of distress were found in the pre-clinical years in comparison to the clinical ones. Burnout, being a woman, the existence of physical health problems, homo- and bisexual orientations, affective family problems, problems with relationships in the academic community, difficulties in academic performance, and daily organization were identified as predictors of distress. On the other hand, satisfaction with the social support received and with academic ratings were identified as protective factors. In conclusion, there is a high prevalence of distress in medical students, which is associated with personal, physical, social, economic, and academic factors. The identification of predictive factors of distress may allow for the early identification of vulnerable students and for intervention and prevention strategies to be defined.

A narrative historical review of psychiatric epidemiology in Brazil: Focus on social and cultural determinants of mental health

Psychiatric research in Brazil has had a strong focus on social and cultural variables related to mental health. In the present narrative review, we provide historical context to the theoretical and methodological roots of psychiatric epidemiology in the country, from the era of proto-epidemiologic studies to the emergence of population neurosciences, showing the contribution of the field to approach social and cultural determinants of mental health. A periodization is proposed, including a proto-epidemiological phase and three subsequent generations. The available epidemiological data show extraordinary consistency and stability in terms of the prevalence of mental disorders in Brazil, which is very high as compared to other settings. Especially affected are vulnerable groups such as women, migrants, illiterates, low social class, unskilled workers, unemployed, people living in deteriorated urban sites, individuals exposed to violence, and in the socially excluded. Social inequalities and violence in Brazil play a noteworthy role as social determinants of poor mental health.

The Future of Public Mental Health: Challenges and Opportunities.

Policy Points Social policies such as policies advancing universal childcare to expand Medicaid coverage of home- and community-based care for seniors and people with disabilities and for universal preschool are the types of policies needed to address social determinants of poor mental health. Population-based global budgeting approaches like accountable care and total cost of care models have the potential to improve population mental health by incentivizing health systems to control costs while simultaneously improving outcomes for the populations they serve. Policies expanding reimbursement for services delivered by peer support specialists are needed. People with lived experience of mental illness are uniquely well suited to helping their peers navigate treatment and other support services.

Abstract A045: Investigating the biological determinants of poor mental health among ethnically diverse Black prostate cancer survivors: An iCCaRE consortium for prostate cancer in Black men project

Abstract Background: Black men across the world continue to bear the burden of prostate cancer (PCa). Although several factors account for this, studies have demonstrated that the adaptive constitutive biological factors associated with African ancestry contribute to the risk of disease development, disease aggression, and poor disease outcomes in Black men. However, the limited inclusion of Blacks in cancer biology studies limits the understanding of the extent to which biology influence outcomes among Blacks. Furthermore, beyond White-Black dichotomous disparity, there exists an under-exploited within-group geographical and ancestral disparities in the burden, clinical presentation, and outcomes of PCa among Black men globally. Aside from urological and sexual problems, Black PCa survivors experience poor mental health, with a concomitant reduction in the quality of life and overall survival. Hence, improving the overall well-being of PCa survivors requires an understanding of the biological determinants of mental health among diverse groups of Black PCa survivors. Methods: Structured questionnaires are being used to access fatigue, pain, depressive symptoms, health-related quality of life, and PCa-specific symptoms burden among within a cohort of ethnically diverse Black PCa survivors in Africa. This is linked with the salivary biomarkers of inflammation, hypothalamic-pituitary-adrenal axis activity, and tryptophan-kynurenine pathway in our studies population. Results: Data from fifty PCa survivors across different African ethnic groups (including, Yoruba, Igbo, Hausa) will be presented. This study will measure biological variables (e.g, inflammatory markers, cortisol, tryptophan, kynurenine, and serotonin) and survivors self-reported (e.g. health-related quality of life and psychoneurological symptoms) measures to better examine the interconnectedness between cancer-associated biomarkers and poor mental health. Conclusion: This study will lay an essential foundation for understanding the extent to which cancer associated-biological determinants contribute to the poor mental health of PCa survivors, unravels the within-group disparities in the mental health of Black PCa survivors, establish the contribution of genetics to poor mental health in Black PCa survivors and provide the opportunity for pharmacogenomic intervention that will improve the quality of life. Citation Format: Solomon O. Rotimi, Folakemi Odedina, Roxana Dronca, Kimlin Ashing, Ernest Kaninjing, Che Ngufor, Arnold Merriweather, Jennifer Crook, Manisha Salinas, Fathi Parisa, Sha’Reff Rashad, John McCall, Ebenezer Erefah, Ayinde Yahaya. Investigating the biological determinants of poor mental health among ethnically diverse Black prostate cancer survivors: An iCCaRE consortium for prostate cancer in Black men project [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A045.

Policing sexuality: Sexual minority youth, police contact, and health inequity

Police contact is increasingly recognized as an adverse childhood experience and determinant of poor mental health. While targeting of LGBTQ sex and community spaces by law enforcement has a long precedent in US history—and while LGBTQ people continue to protest unfair police treatment—little population-level research has examined police contact disparities by sexual orientation or gender identity. We test whether sexual minority (SM) youth have higher risk of police contact through young adulthood. We analyze a nationally representative cohort of >15,000 US young adults who were in middle/high school in the mid-1990s, with police contact histories collected at age 18–25. Using four different, equally reasonable approaches to coding youth-reported sexual orientation, we identified ∼500–1900 SMs. Compared to heterosexual youth, SM youth had 1.86 times the odds of ever being stopped by police (95% CI = 1.56–2.22, p < 0.001), were stopped 1.60 times as often (CI = 1.38–1.86, p < 0.001), and were stopped at younger ages (survival time ratio = 0.91, CI = 0.88–0.93, p < 0.001). Inequities were particularly driven by SM women, among whom disparities were severe (ever stopped OR = 2.18, stop count ratio = 2.44, survival time ratio = 0.87). For men, inequities only emerged once a broad definition of SM was adopted, suggesting that young SM men who do not identify as LGB (or who are reticent to report themselves as such) may be at particular risk. Results were robust to adjustment for race/ethnicity and parental nativity, though small cells meant models stratified by race/ethnicity were underpowered.Given substantially heightened police contact among SM youth (particularly, young SM women), care providers and educators working with them should explicitly combat homophobic and criminal legal system stigma and screen for police contact and its psychological sequelae. More data on LGBTQ communities’ criminal legal system contact throughout life is essential for preventing the causes and consequences of related sexual orientation-based health inequities.

Association of childhood trauma, and resilience, with quality of life in patients seeking treatment at a psychiatry outpatient: A cross-sectional study from Nepal.

Quality of life is defined by the World Health Organization as "Individuals' perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns". It is a comprehensive measure of health outcome after trauma. Childhood maltreatment is a determinant of poor mental health and quality of life. Resilience, however, is supposed to be protective. Our aim is to examine childhood trauma and resilience in patients visiting psychiatry outpatient and investigate their relations with quality of life. A descriptive cross-sectional study was conducted with a hundred patients with trauma and visiting psychiatry outpatient. Standardized tools were applied to explore childhood trauma, resilience, quality of life and clinical diagnoses and trauma categorization. Sociodemographic and relevant clinical information were obtained with a structured proforma. Bivariate followed by multivariate logistic regressions were conducted to explore the relation between childhood trauma, resilience, and quality of life. Poor quality of life was reported in almost one third of the patients. Upper socioeconomic status, emotional neglect during childhood, current depression and low resilience were the determinants of poor quality of life in bivariate analysis. Final models revealed that emotional neglect during childhood and low resilience had independent associations with poor quality of life. Efforts should be made to minimize childhood maltreatment in general; and explore strategies to build resilience suited to the cultural context to improve quality of life.

Narrative Therapy in a post-pandemic world: A fictional case study of a client living with depression

ABSTRACT Models of counselling and psychotherapy indicated for diagnoses of depression include brief, goal-oriented interventions such as Cognitive Behavioural Therapy (CBT) or Interpersonal Psychotherapy (IPT), and are favoured by state funded mental health services. Whilst effective in addressing low mood these modalities provide little scope to consider the effect of structural and social inequalities that contribute to the known determinants of poor mental health, which have been exacerbated as a result of Covid-19. Using a fictional case study, this article seeks to explore the impact of oppressive, gendered, societal discourse on Simone’s mental wellbeing during the Covid-19 outbreak. Using Narrative Therapy Principles, this article considers how Simone might use this therapeutic framework to reframe and re-author her experience, asking the question ‘what’s happened to me?’ instead of ‘what’s wrong with me?’ With the psychosocial legacy of Covid-19 predicted to be far reaching, opportunities exist for providers of counselling and psychotherapy to review the availability of therapeutic modalities that acknowledge the role and impact of social inequality and oppression on the lives of our clients.

High levels of poor mental health among young men in urban informal settlements in South Africa: a community-based study of social determinants

ABSTRACT Informal settlements (high population density areas at the outskirts of urban areas characterized by lack basic amenities) in South Africa are consequences of apartheid regime’s discriminatory migrant labour and spatial policy and continue to grow. Living in informal settlements accompanies a mire of social/health challenges that threatens upward mobility, but few studies exist that document drivers of mental health challenges in these settings. We investigated the prevalence and social determinants of poor mental health for young men in informal settlements adjacent to one of the largest cities that is at the heart of HIV endemic in South Africa. This study involved a cross-sectional study with cluster sampling design of 674 young men aged 18–30 years residing in eThekwini informal settlement communities. We assessed the prevalence, and social determinants, of significant depressive (i.e., depression) and post-traumatic stress (i.e., PTS) symptoms using logistic regression. Given the complex survey design of the study, all analyses were adjusted for clustering. The prevalence of depression and PTS in the sample was 46.8% and 14.4% respectively. Results of the multivariable analyses indicated that severe food insecurity (aOR = 2.98, 95% CI:1.70–5.22), crime perpetration (aOR = 1.51, 95% CI:1.05–3.80), severe adverse childhood event (aOR = 2.00, 95% CI: 1.05–3.80), traumatic event exposures (aOR = 2.43, 95% CI:1.56–3.80) and problematic alcohol use (aOR = 1.73, 95% CI:1.20–2.49) were significantly associated with depression. While incomplete secondary education (aOR = 0.45, 95% CI:0.22–0.92), moderate food insecurity (aOR = 2.51, 95% CI:1.04–6.06), traumatic event exposures (aOR = 2.19, 95% CI:1.32–3.64) and problematic alcohol use (aOR = 2.15, 95% CI: 1.24–3.73) were significantly associated with PTS. Our study highlights the exceedingly high levels of poor mental health among young men in informal settlements, with depression and PTS being driven by economic/social conditions. Multilevel interventions that address the individual, interpersonal, and social variables that contribute to poor mental health are needed.

Asian Indians in the United States and Posttraumatic Stress Disorder Interventions: A Narrative Literature Review

Topic. Limited research has examined trauma and posttraumatic stress disorder (PTSD) among Asian Indians in the U.S. Thus, we (1) synthesize literature on trauma, PTSD, disparities in treatment for PTSD, the burden of untreated PTSD, and culturally-adapted (CA) PTSD interventions; and (2) discuss recommendations for clinicians/researchers working with this population. Method. We searched two databases using keywords related to Asian Indians, PTSD, and interventions. Of 238 identified articles, we used content from 26 articles to inform our review. Findings. Asian Indians report traumatic experiences before, during, or after immigration to the U.S. and consequential PTSD symptoms. Further, Asian Indians in the U.S. are disproportionately impacted by socio-cultural and economic determinants of poor mental health (e.g., shame/stigma associated with seeking mental health services, few culturally-responsive services), which may contribute to the under-reporting of PTSD and (interpersonal) traumas and less willingness to seek treatment. Additionally, CA PTSD interventions tailored to Asian Indians in the U.S. have not been developed. Socio-cultural considerations that can inform CA PTSD interventions for Asian Indians include: causal conditions (e.g., culturally-rooted beliefs about trauma/PTSD), intervening conditions/barriers (e.g., emotional inhibition), and mitigating/coping strategies (e.g., religious/spiritual practices, cultural idioms of distress). These considerations influence clinician/treatment preferences (e.g., solution-oriented and structured therapy, less emotional exposure). Lastly, we outline recommendations for clinicians/researchers: (1) need for national studies on trauma, PTSD, treatment utilization, and the burden of untreated PTSD; (2) consideration of immigration-related experiences influencing PTSD; (3) consideration of socio-cultural elements for CA PTSD interventions; and (4) need for culturally-valid PTSD assessments.

Using the Stay Strong App for the Well-being of Indigenous Australian Prisoners: Feasibility Study.

BackgroundThe gap between mental health needs and resources for Aboriginal and Torres Strait Islander people, the Indigenous people of Australia, is most marked in the prison population. Indigenous people are overrepresented in Australian prisons. In prison, this group experiences mental disorders to a greater degree than non-Indigenous prisoners. This group has also been found to experience mental disorder at a higher rate than Indigenous people in the community. In addition to pre-existing determinants of poor mental health, these high prevalence rates may reflect poor engagement in mainstream interventions or the efficacy of available interventions. In community populations, the use of digital mental health resources may help to increase access to well-being support. However, culturally appropriate digital tools have not been available to Indigenous people in prisons. The absence of feasibility and efficacy studies of these tools needs to be addressed.ObjectiveThe aim of this study is to determine the feasibility of the Stay Strong app as a digital well-being and mental health tool for use by Indigenous people in prison.MethodsDual government agency (health and corrective services) precondition requirements of implementation were identified and resolved. This was essential given that the Stay Strong app was to be delivered by an external health agency to Indigenous prisoners. Then, acceptability at a practice level was tested using postuse qualitative interviews with clients and practitioners of the Indigenous Mental Health Intervention Program. All Indigenous Mental Health Intervention Program practitioners (10/37, 27%) and client participants who had completed their second follow-up (review of the Stay Strong app; 27/37, 73%) during the study period were invited to participate.ResultsOwing to the innovative nature of this project, identifying and resolving the precondition requirements of implementation was challenging but provided support for the implementation of the app in practice. Acceptability of the app by clients and practitioners at a practice level was demonstrated, with nine themes emerging across the interviews: satisfaction with the current Stay Strong app, supported client goal setting, increased client self-insight, improved client empowerment, cultural appropriateness, enhanced engagement, ease of use, problems with using an Android emulator, and recommendations to improve personalization.ConclusionsThe Stay Strong Custody Project is a pioneering example of digital mental health tools being implemented within Australian prisons. Using the app within high-security prison settings was found to be feasible at both strategic and practice levels. Feedback from both clients and practitioners supported the use of the app as a culturally safe digital mental health and well-being tool for Aboriginal and Torres Strait Islander people in prison.

Significantly Increased Public Interest in Major Depressive Disorder During the COVID-19 Pandemic: Insights From a Google Trends Analysis.

BackgroundAs early as before the coronavirus disease 2019 (COVID-19) pandemic, nearly one billion people worldwide suffered from mental health problems. Of all the mental health conditions, major depressive disorder (MDD) is the leading cause of global health-related burden. During the COVID-19 pandemic, many uncertain factors affecting mental health accumulated, such as virus transmission, blockade and ban, public transport restrictions, closure of schools and enterprises, and reduction of social interaction, which led to an increase in the potential risk of MDD, further increasing the global health-related burden.MethodologyTo better clarify the public interest in major depressive disorder during the COVID-19 pandemic, a Google Trends analysis was employed with data from December 2019 to December 2021, taking the cumulative diagnosis rate and cumulative mortality rate of COVID-19 as the reference standard, The changes in public interest and behavior in online searching for major depressive disorder in the three countries most affected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus (i.e. the United States, Brazil, and India) were evaluated.ResultsWe observed that during the COVID-19 pandemic, public interest in major depressive disorder increased significantly on the Internet. At the same time, compared with the United States, this upward trend is more prominent in India and Brazil. The study found that the major depressive disorder search index of the United States reached the maximum at the end of September 2021, the major depressive disorder search index of Brazil reached the maximum at the beginning of July 2021, and the major depressive disorder search index of India reached the maximum at the beginning of June 2021. The above time nodes are the first turning point of decline after the continuous surge of COVID-19 confirmed cases in the United States, Brazil, and India, indicating that there is an important time correlation between the surge of COVID-19 cases and the public online search term major depressive disorder.ConclusionThe Google Trends analysis shows that public interest in major depressive disorder is on the rise under the COVID-19 pandemic and that COVID-19 may be associated with MDD. These findings deserve further exploration, especially as a growing body of research reports suggests that the COVID-19 pandemic has led to a surge in the prevalence of MDD. The epidemic alerts the vast majority of countries to urgently strengthen mental health systems and provide patients with the necessary interventions based on the determinants of poor mental health.

Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic

SummaryBackgroundBefore 2020, mental disorders were leading causes of the global health-related burden, with depressive and anxiety disorders being leading contributors to this burden. The emergence of the COVID-19 pandemic has created an environment where many determinants of poor mental health are exacerbated. The need for up-to-date information on the mental health impacts of COVID-19 in a way that informs health system responses is imperative. In this study, we aimed to quantify the impact of the COVID-19 pandemic on the prevalence and burden of major depressive disorder and anxiety disorders globally in 2020.MethodsWe conducted a systematic review of data reporting the prevalence of major depressive disorder and anxiety disorders during the COVID-19 pandemic and published between Jan 1, 2020, and Jan 29, 2021. We searched PubMed, Google Scholar, preprint servers, grey literature sources, and consulted experts. Eligible studies reported prevalence of depressive or anxiety disorders that were representative of the general population during the COVID-19 pandemic and had a pre-pandemic baseline. We used the assembled data in a meta-regression to estimate change in the prevalence of major depressive disorder and anxiety disorders between pre-pandemic and mid-pandemic (using periods as defined by each study) via COVID-19 impact indicators (human mobility, daily SARS-CoV-2 infection rate, and daily excess mortality rate). We then used this model to estimate the change from pre-pandemic prevalence (estimated using Disease Modelling Meta-Regression version 2.1 [known as DisMod-MR 2.1]) by age, sex, and location. We used final prevalence estimates and disability weights to estimate years lived with disability and disability-adjusted life-years (DALYs) for major depressive disorder and anxiety disorders.FindingsWe identified 5683 unique data sources, of which 48 met inclusion criteria (46 studies met criteria for major depressive disorder and 27 for anxiety disorders). Two COVID-19 impact indicators, specifically daily SARS-CoV-2 infection rates and reductions in human mobility, were associated with increased prevalence of major depressive disorder (regression coefficient [B] 0·9 [95% uncertainty interval 0·1 to 1·8; p=0·029] for human mobility, 18·1 [7·9 to 28·3; p=0·0005] for daily SARS-CoV-2 infection) and anxiety disorders (0·9 [0·1 to 1·7; p=0·022] and 13·8 [10·7 to 17·0; p<0·0001]. Females were affected more by the pandemic than males (B 0·1 [0·1 to 0·2; p=0·0001] for major depressive disorder, 0·1 [0·1 to 0·2; p=0·0001] for anxiety disorders) and younger age groups were more affected than older age groups (−0·007 [–0·009 to −0·006; p=0·0001] for major depressive disorder, −0·003 [–0·005 to −0·002; p=0·0001] for anxiety disorders). We estimated that the locations hit hardest by the pandemic in 2020, as measured with decreased human mobility and daily SARS-CoV-2 infection rate, had the greatest increases in prevalence of major depressive disorder and anxiety disorders. We estimated an additional 53·2 million (44·8 to 62·9) cases of major depressive disorder globally (an increase of 27·6% [25·1 to 30·3]) due to the COVID-19 pandemic, such that the total prevalence was 3152·9 cases (2722·5 to 3654·5) per 100 000 population. We also estimated an additional 76·2 million (64·3 to 90·6) cases of anxiety disorders globally (an increase of 25·6% [23·2 to 28·0]), such that the total prevalence was 4802·4 cases (4108·2 to 5588·6) per 100 000 population. Altogether, major depressive disorder caused 49·4 million (33·6 to 68·7) DALYs and anxiety disorders caused 44·5 million (30·2 to 62·5) DALYs globally in 2020.InterpretationThis pandemic has created an increased urgency to strengthen mental health systems in most countries. Mitigation strategies could incorporate ways to promote mental wellbeing and target determinants of poor mental health and interventions to treat those with a mental disorder. Taking no action to address the burden of major depressive disorder and anxiety disorders should not be an option.FundingQueensland Health, National Health and Medical Research Council, and the Bill and Melinda Gates Foundation.

\u201cI Found Out I was Pregnant, and I Started Feeling Stressed\u201d: A Longitudinal Qualitative Perspective of Mental Health Experiences Among Perinatal Women Living with HIV

Globally, depressive symptoms among pregnant and postpartum (i.e., perinatal) women living with HIV (WLWH) are alarmingly high and associated with poor outcomes such as suboptimal adherence to antiretroviral therapy (ART), and early cessation of exclusive breastfeeding (EBF). Few qualitative studies have described the experience of perinatal depression among WLWH to identify the underlying social-structural determinants of poor mental health and potential strategies to intervene. We conducted a longitudinal qualitative study applying semi-structured interviews with 30 WLWH at three timepoints (28–38 weeks pregnant, 6-weeks postpartum and 5–7 months postpartum) to understand mental health experiences of perinatal WLWH in western Kenya. Financial insecurity emerged as the central theme impacting the mental health of women across time. Financial insecurity was often attributed to the loss of employment, related to pregnancy and the demands of breastfeeding and caring for an infant, as well as a lack of support from male partners. The loss of income and subsequent financial strain contributed to worsening levels of food insecurity and relationship stress and challenged engagement in HIV care. In this way, increased financial strain during the perinatal period negatively impacted the mental health of perinatal WLWH. Our findings suggest support to meet basic needs and remain engaged in HIV care during pregnancy and postpartum could improve perinatal mental health for WLWH in this setting.

Exploring the impact of a complex intervention for women with depression in contexts of adversity: A pilot feasibility study of COURRAGE-plus in South Africa.

Background:Depression is a leading cause of disease burden worldwide but is often undertreated in low- and middle-income countries. Reasons behind the treatment gap vary, but many highlight a lack of interventions which speak to the socio-economic and structural realties that are associated to mental health problems in many settings, including South Africa. The COURRAGE-PLUS intervention responds to this gap, by combining a collective narrative therapy (9 weeks) intervention, with a social intervention promoting group-led practical action against structural determinants of poor mental health (4 weeks), for a total of 13 sessions. The overall aim is to promote mental health, while empowering communities to acknowledge, and respond in locally meaningful ways to social adversity linked to development of mental distress.Aim:To pilot and evaluate the effectiveness of a complex intervention – COURRAGE-PLUS on symptoms of depression as assessed by the Patient Health Questionnaire (PHQ-9) among a sample of women facing contexts of adversity in Gauteng, South Africa.Methods:PHQ-9 scores were assessed at baseline, post collective narrative therapy (midline), and post social intervention (endline). Median scores and corresponding interquartile ranges were computed for all time points. Differences in scores between time points were tested with a non-parametric Friedman test. The impact across symptom severities was compared descriptively to identify potential differences in impact across categories of symptom severity within our sample.Results:Participants’ (n = 47) median depression score at baseline was 11 (IQR = 7) and reduced to 4 at midline (IQR = 7) to 0 at endline (IQR = 2.5). The Friedman test showed a statistically significant difference between depression scores across time points, (2) = 49.29, p < .001. Median depression scores were reduced to 0 or 1 Post-Intervention across all four severity groups.Conclusions:COURRAGE-PLUS was highly effective at reducing symptoms of depression across the spectrum of severities in this sample of women facing adversity, in Gauteng, South Africa. Findings supports the need for larger trials to investigate collective narrative storytelling and social interventions as community-based interventions for populations experiencing adversity and mental distress.

Understanding mental health and its determinants from the perspective of adolescents: A qualitative study across diverse social settings in Indonesia.

Poor mental health is a leading contributor to the burden of disease experienced by adolescents, including in resource constrained settings. However, little is known about how adolescents in these countries conceptualise mental health and its determinants which is essential to informing effective responses. This study aimed to explore how adolescents in Indonesia (a populous and rapidly developing country) conceptualise mental health and what they identify as important determinants. Eight focus group discussions (FGDs) were conducted with 86 Indonesian adolescents (aged 16-18 years), sampled from schools and community settings from Jakarta and South Sulawesi. FGDs were recorded, transcribed, translated and thematically analysed. Mental health was recognised as a significant concern by adolescents in Indonesia. Good mental health was conceptualised as emotional wellbeing and happiness. By contrast, poor mental health was predominantly described in terms of substantial mental illness manifesting as behavioural and physical disturbance. Further, poor mental health only happened to 'other' people, with stigmatising views prevalent. Absent from the discussions were common symptoms of poor mental health (stress, loneliness, poor sleep) and common mental disorders (e.g. depression, anxiety) or a conceptualisation that reflected poor mental health to be a normal human experience. Discussions around determinants of poor mental health suggested that family connections (particularly with parents), school pressures, and adverse exposures on social media were important drivers of poor mental health, with religion also surfacing as an important determinant. In highlighting mental health as an important issue for Indonesian adolescents, this study provides a foundation for targeted responses.

Mental health research on scheduled tribes in India.

Background:The burden of mental illness among the scheduled tribe (ST) population in India is not known clearly.Aim:The aim was to identify and appraise mental health research studies on ST population in India and collate such data to inform future research.Materials and Methods:Studies published between January 1980 and December 2018 on STs by following exclusion and inclusion criteria were selected for analysis. PubMed, PsychINFO, Embase, Sociofile, Cinhal, and Google Scholar were systematically searched to identify relevant studies. Quality of the included studies was assessed using an appraisal tool to assess the quality of cross-sectional studies and Critical Appraisal Checklist developed by Critical Appraisal Skills Programme. Studies were summarized and reported descriptively.Results:Thirty-two relevant studies were found and included in the review. Studies were categorized into the following three thematic areas: alcohol and substance use disorders, common mental disorders and sociocultural aspects, and access to mental health-care services. Sociocultural factors play a major role in understanding and determining mental disorders.Conclusion:This study is the first of its kind to review research on mental health among the STs. Mental health research conducted among STs in India is limited and is mostly of low-to-moderate quality. Determinants of poor mental health and interventions for addressing them need to be studied on an urgent basis.