Global Mental Health Research Articles

How to prevent suicidal behavior and non-suicidal self-injury? An analysis of adolescent typologies

Non-suicidal self-injury (NSSI) and suicidal behavior in adolescence are global mental health concerns. These behaviors are often interconnected, but can also manifest independently. This study aimed to assess the predictive abilities of neuroticism, emotional competencies, and the school social climate on four typologies based on the presence of NSSI and levels of suicidal behavior. The study included 713 participants aged 11–16 years who completed questionnaires assessing suicidal behavior, NSSI, neuroticism, emotional competencies, and the school social climate. The data were analyzed using logistic regression techniques. The findings revealed that adolescents with high levels of neuroticism and emotion perception, low levels of emotion expression and regulation and an inadequate school social climate were more likely to belong to typologies characterized by NSSI and/or high suicidal behavior. This study underscores the importance of enhancing the school social climate as a crucial step toward reducing the likelihood of NSSI and suicidal behavior.

Integrated models for concurrent disorders from a Public Mental Health lens: a Systematic Review

Abstract Concurrent disorders (COD), historically defined by the World Health Organization as the simultaneous presence of a psychoactive substance use disorder and another psychiatric disorder within the same individual, pose a significant challenge to public mental health. In today’s global landscape of mental health services, the prevalence of COD is on the rise, underscoring the need for an integrated approach to management. This review aims to provide an overview of existing global models and the evaluation approaches. This systematic review examined research evidence in PubMed, Scopus and Web of Science up to 2023 regarding integrated management systems for COD. Following PRISMA guidelines, we included articles describing specific models and evaluating the effectiveness of integrated versus non-integrated approaches. Quality assessment was conducted using the appropriate scales. Out of 7700 screened articles, 18 were included, all of fair or good quality. A diverse array of patient care models, programs, and interventions addressing comorbidities between mental health and substance use disorders emerged. The majority of studies focused on clinical outcomes, particularly alcohol and drug dependence, with global mental health consequences also under examination. Psychodiagnostics and social outcomes were also considered in a significant portion of the research, shedding light on health services utilization patterns. The integrated model for concurrent disorders in psychiatry stands as an effective approach, yet its implementation encounters challenges. This study showcases successful integration examples, providing valuable insights for policymakers and healthcare professionals to enhance existing models or develop new ones, particularly within European healthcare reforms like Italy’s restructuring of primary care, where they could serve as a criterion for the setting and organization of community houses. Key messages • COD, involving both substance use and psychiatric disorders, present a significant challenge to public mental health. Rising prevalence underscores the need for integrated management approaches. • Insights from successful integration examples offer valuable guidance for healthcare professionals and policymakers, particularly within healthcare reforms like Italy’s restructuring of primary care.

Smartphone addiction among medical students in the University of Monastir, Tunisia

Abstract Background Smartphone addiction is a global mental health issue with diverse psychological and socioeconomic concerns. The aim of this study was to determine the prevalence of smartphone addiction and its associated factors among medical students in the university of Monastir, Tunisia. Methods We conducted a cross-sectional survey among medical students of the faculty of medicine of Monastir in October 2020. The data were collected through a self-administered anonymous questionnaire that included the SAS-SV scale to assess smartphone addiction levels. A multivariate logistic regression model was employed to identify associated factors. The threshold of statistical significance was set at p < 0.05. Results A total of 626 medical students participated in this study, with an average age of 21.76 ± 3.12 years and a sex ratio of 0.41. The prevalence of smartphone addiction was 30.2% (95% CI: 26.0% - 33.79%). Associated factors with smartphone addiction included academic repetition(OR = 4.30; 95% CI [1.38 - 13.42]), fast food consumption scores (OR = 1.55; 95% CI [1.21 - 2.00]),addiction to the Facebook social network (OR = 6.36; 95% CI [1.92 - 21.07]), cohabitation with colleagues (OR = 2.13; 95% CI [1.03- 4.43]), cohabitation with family members(OR = 2.10; 95% CI [1.01 - 4.36]) and stress level (OR = 1.13; 95% CI [1.07 - 1.18]). Conclusions This study identified associations between smartphone overuse and other behavioral and mental health indicators. Based on these findings, several interventions should be undertaken to address this growing concern. Key messages • The prevalence of smartphone addiction among medical students in the University of Monastir was 30.2% (95% CI: 26.0% – 33.79%). • The main associated factors with smartphone addiction were academic repetition, fast food consumption, addiction to Facebook, cohabitation with colleagues and with family members and stress level.

“It happened to be the perfect thing”: experiences of generative AI chatbots for mental health

The global mental health crisis underscores the need for accessible, effective interventions. Chatbots based on generative artificial intelligence (AI), like ChatGPT, are emerging as novel solutions, but research on real-life usage is limited. We interviewed nineteen individuals about their experiences using generative AI chatbots for mental health. Participants reported high engagement and positive impacts, including better relationships and healing from trauma and loss. We developed four themes: (1) a sense of ‘emotional sanctuary’, (2) ‘insightful guidance’, particularly about relationships, (3) the ‘joy of connection’, and (4) comparisons between the ‘AI therapist’ and human therapy. Some themes echoed prior research on rule-based chatbots, while others seemed novel to generative AI. Participants emphasised the need for better safety guardrails, human-like memory and the ability to lead the therapeutic process. Generative AI chatbots may offer mental health support that feels meaningful to users, but further research is needed on safety and effectiveness.

Towards democratised psychiatry: building metacommunities for inclusive and equitable global mental health

Through their study, George Ikkos & Nick Bouras reveal that the responsibilities of the psychiatric community are increasingly complex, especially amid the onslaught of globalisation and the confines of neoliberalism. ‘Metacommunity’ in this context refers not only to the history of psychiatrists but their role in strengthening and influencing mental health policies. A number of challenges continue to emerge in the public sphere, highlighting the need for psychiatry to adapt to society's evolving demands for inclusivity, equity and ethical governance. These challenges emphasise the importance of shaping the future of psychiatry that is responsive to the complexities of mental health care and aligned with democratic principles that prioritise transparency and social accountability. We have added several aspects that could complement psychiatrists' future theory and practice, including a more collaborative and evidence-based approach to dealing with increasingly complex mental health issues.

'Impaired in life': Analyzing people's accounts of depression in Ethiopia - Implications for a cultural-eco social approach to global mental health.

Depression is a global crisis and a major concern in mental health interventions, particularly in low- and middle-income countries (LMICs), where it significantly impacts disability, quality of life, and economic stability. These chronic stressors have been used to argue for scaling up the detection and treatment of depression as a public health and development priority. This study aimed to explore illness narratives of depression among patients' and to gain insights into multifaceted suffering, its impact on persons' lives, and help seeking. This study is part the broader study which examined global mental health, biopolitics, and depression in Ethiopia, conducted in hospice setting to explore the conception of depression in Bahirdar city, Northern Ethiopia, among patients and health care providers. In this study, we focus on patients' accounts of depression. We employed an ethnography method using in-depth interviews, fieldnotes, and observation to collect the data. A thematic analysis was used to analyze the data. Drawing from cross-cultural and critical psychiatry perspectives, we situate depression within its cultural-eco social framework. The study revealed that patients' experiences and conception of depression are deeply intertwined with Ethiopia's sociocultural, economic, and spiritual context. Depression was often described as a state of being 'impaired in life', reflecting the complex interplay of individual struggles and societal pressures. Integrating quotes from patients, we demonstrated in this analysis the ways in which biographically specific challenges, societal pressures, and mental well-being are understood by study participants in accordance with Ethiopian cultural and religious norms. The study suggests moving beyond narrow interpretative frameworks in GMH praxis to understand and address the complex dimensions of depression in Ethiopia and similar contexts. The study advocates for a cultural-ecosocial approach to depression, emphasizing the need for mental health interventions that consider the broader social and cultural factors contributing to mental distress.

Achieving universal health coverage inSub-Saharan Africa through the reformation of mental health financing

Insufficient financing is limiting mental health services for universal health coverage (UHC) in sub-Saharan Africa (SSA). Without ambitious steps to enhance mental health services, UHC will fall far below its historical agenda; however, adequate mental health financing could strengthen governments’ capacity to provide additional budgetary resources. This paper aims to identify potential strategies for more equitable and sustainable mental health financing in SSA. Using Uganda as a key example, we provide a contextual analysis and highlight current gaps. We draw parallels with successful countries and discuss recommendations for engagement from the global mental health community. This perspective focuses on health systems, mental disease burden, and macro-fiscal situation. Drivers of fiscal space for health indicate prospects to boost mental health budgets for socioeconomic development. Governments should conduct consistent mental health investment cases and expedite fiscal space for aggressive taxation to health reforms.

Systems modelling and simulation to guide targeted investments to reduce youth suicide and mental health problems in a low–middle-income country

BackgroundDespite suicide’s public health significance and global mental health awareness, current suicide prevention efforts show limited impact, posing a challenge for low- and middle-income countries. This study aimed to develop a dynamic simulation model that could be used to examine the potential effectiveness of alternative interventions for reducing youth mental health problems and suicidal behavior in Bogotá, Colombia.MethodsA system dynamics model was designed using a participatory approach involving three workshops conducted in 2021 and 2022. These workshops engaged 78 stakeholders from various health and social sectors to map key mental health outcomes and influential factors affecting them. A model was subsequently developed, tested, and presented to the participants for interactive feedback, guided by a moderator. Simulation analyses were conducted to compare projected mental health outcomes for a range of intervention scenarios with projections for a reference scenario corresponding to business-as-usual.ResultsA total of 6670 suicide attempts and 347 suicides are projected among 7 − 17-year-olds from January 1, 2023, to early 2031 under the business-as-usual scenario. Mental health issues among 12 − 17-year-olds are projected to increase from 18.9% (2023) to 27.8% (2031), and substance use issues from 2.29 to 2.49% over the same period. School-based suicide prevention and gatekeeper training are the most effective strategies, reducing total numbers of suicide attempts and suicides by more than 20% (i.e., compared to business-as-usual). However, discontinuous funding significantly hinders these effective suicide prevention efforts.ConclusionsSystems modelling is an important tool for understanding where the best strategic financial and political investments lie for improving youth mental health in resource-constrained settings.

Global Climate Change, Mental Health, and Socio-Economic Stressors: Toward Sustainable Interventions across Regions

Global climate change’s pervasive impacts extend beyond the environment, significantly affecting mental health across diverse regions. This study offers a comprehensive multi-regional analysis spanning Asia, Africa, Oceania, Europe, and the Americas, addressing three critical gaps in existing research: (i) the necessity of a global scope given climate change’s widespread impact, (ii) the under-researched mental health dimension compared to general health effects, and (iii) the integration of climate and mental health data. Using data from 1970 to 2020, we found a strong correlation between climate change and rising mental disorders globally. Regional patterns emerged, with Asia, Africa, and Oceania showing broader associations with various mental health issues, while Europe and the Americas saw increases in anxiety and depression. This study contributes to a more comprehensive understanding of the interconnectedness between climate change, mental health, and sustainability. By addressing the mental health impacts of climate change, we can identify sustainable solutions that promote both environmental well-being and human well-being. Our findings highlight the urgent need for global action to mitigate climate change’s mental health effects and provide insights for tailored interventions and public health strategies. Additionally, socio-economic factors like unemployment, urbanisation, GDP growth, and globalisation are incorporated to explore the intricate interplay between climate change, mental health, and societal contexts, offering a clearer understanding of the mechanisms at play.

Time trends in anxiety disorders incidence across the BRICS: an age-period-cohort analysis for the GBD 2021.

Anxiety disorders are a significant global mental health concern, contributing to substantial disability-adjusted life years (DALYs) and imposing considerable social and economic burdens. Understanding the epidemiology of anxiety disorders within the BRICS nations (Brazil, Russian Federation, India, China, and South Africa) is essential due to their unique socio-economic landscapes and ongoing transformations. This study utilized data from the Global Burden of Disease (GBD) 2021 database to evaluate anxiety disorder incidence trends in BRICS countries from 1992 to 2021. The Age-Period-Cohort (APC) model with an intrinsic estimator (IE) algorithm was employed to disentangle the effects of age, period, and cohort on incidence rates. Data were categorized into 5-year age groups, and 95% uncertainty intervals (UIs) were calculated to account for data variability. From 1992 to 2021, the global number of anxiety disorders cases increased by 73.44%, with age-standardized incidence rates rising by 21.17%. Among BRICS nations, India experienced the largest increase in cases (113.30%), while China had the smallest increase (2.79%). Globally, young (15-49 years) and oldest (80-94 years) age groups showed predominantly positive local drift values, indicating rising incidence rates. Brazil and India mirrored this trend, while China and South Africa mostly exhibited negative local drift values. Russia Federation had mixed trends with younger groups showing negative and older groups positive local drift values. The incidence of anxiety disorders exhibited an "M-shaped" age pattern with peaks at 10-14 and 35-39 years. Period effects were stable globally but varied in BRICS countries, with Brazil showing a decline and India an increase. Cohort effects were stable globally but showed increasing trends in Brazil and India post-1955-1959 cohort. This study highlights a significant increase in anxiety disorders incidence globally and within BRICS nations over the past three decades, with marked variations across countries. The distinct trends observed in age, period, and cohort effects call for age-specific and gender-sensitive mental health policies. Continuous monitoring, research, and tailored public health strategies are essential to address the rising burden of anxiety disorders and improve mental health outcomes in these rapidly evolving regions.

Prevalence and correlates of mental disorders among women: results from the Saudi National Mental Health Survey

BackgroundMental disorders account for a significant proportion of the world’s disease burden and are more significant among females than males. However, most global mental health research is sex neutral, including in the Kingdom of Saudi Arabia. This study, therefore, estimated the prevalence of mental disorders and investigated the sociodemographic correlates, sex disadvantage factors, and treatment-seeking in Saudi women concerning lifetime and 12-month mental disorders.MethodThe Saudi National Mental Health Survey is a stratified multistage clustered area probability design. Lifetime and 12-month mental disorders were assessed through the Composite International Diagnostic Interview (CIDI 3.0). The correlates considered for this study included age-at-interview, education, marital status, employment status, socioeconomic status (SES), any chronic condition and household characteristics (region, urbanicity, and income), as well as domestic violence, age at marriage and in a polygamous marriage. Data was analysed using PROC SURVEYFREQ procedure as well as logistic regression in SAS 9.2.ResultsOverall, 24.7% and 35.9% of Saudi women experienced at least one of the disorders in the prior 12 months and at least once in their lifetime, respectively. Anxiety disorders were the most frequently reported 12-month and lifetime disorders, followed by mood disorders. The region, urbanicity, chronic conditions, employment status, as well as certain sex disadvantage factors were significantly associated with both 12-month and lifetime disorders. Most women did not seek treatment for 12-month mental disorders (86.2%) and lifetime disorders (73.8%).ConclusionOur study confirms that mental health issues, particularly anxiety and mood disorders, are highly prevalent among Saudi women, influenced by chronic conditions and sex-related factors like domestic violence and polygamy. Future research should focus on improving mental health literacy, using rigorous study designs to explore female-specific variables, and investigating genetic and environmental factors.

Program Pendidikan Kecakapan Hidup Bagi Anak Usia Fase A

Imam Al-Ghazali defined that education is the perfection of life in this world and the hereafter. Thus, humans who want to achieve perfection in life in this world and the afterlife must have religious knowledge. Religious knowledge is so important for provision in life, without religious knowledge humans can be said to be far from perfection. Apart from religious knowledge, life skills education is also very important for provisions in life. However, it is very unfortunate that many children who are teenagers or are about to enter puberty do not yet have mature life skills in terms of personal skills and social skills. From KPAI (Indonesian Child Protection Commission) data during January - November 2023, 37 children ended their lives. Self-harm behavior and attempts to end life are major global mental health problems due to their increasing frequency. This case occurred at a vulnerable age (grade 5-6 of elementary school), grade 1 or 2 of junior high school, grade 1.2 of high school. Another case related to juvenile delinquency is the incident involving the death of a student in Bogor which sadistically adds to the number of delinquencies among students. It also leaves a red report card for the world of education, because the sadistic incident was carried out by students. From this background, it is necessary to have a program that will strengthen children's life skills education from pre-adulthood, especially phase A, so that class children can be ready to live life in the next phases. This research uses the Research and Development (R&D) method with the ADDIE model, namely Analyze, Design, Development, Implementation, Evaluation. The program needs analysis was carried out by creating a Google form with a closed questionnaire which was distributed randomly to ten respondents. After the needs analysis, the researcher analyzed previous programs. There were two programs that the researcher used as a reference, namely the entrepreneurship program and the self-help program in an effort to increase independence. then the next step is to design the program, the programs prepared by the researchers are as follows: cookies (cooking with kids), market day, BTS (Bed Time Sirah), PKS (Student Independence Habits), PMO (Habits of Helping Parents) and CLMH (Love of the Environment and Living Creatures). After the program was prepared, it was validated by several experts including Islamic religious education experts, language experts and also child psychology experts. After going through expert validation, the program is implemented to users. After implementation, the final stage is to test the feasibility through evaluation. The feasibility test is carried out by experts by providing an assessment of the program being prepared. From the results of this feasibility test, it was found that this program was good and suitable to be applied to pre-age children, especially in phase A in the life skills education process.

Volunteering in Global Mental Health: A Practical Guide for Clinicians

Volunteering in Global Mental Health: A Practical Guide for Clinicians

Living Donor Candidates’ Self-reported Health and Health Perceptions and Completion of Donor Evaluation: A Cohort Study

Rationale & ObjectiveGiven the organ shortage in the US, increasing living donation is vital to improving access to kidney transplantation, but many donor candidates do not complete the donor evaluation. Our objective was to understand potential living donors’ perceived health and its association with the likelihood of completing the donor evaluation process. Study DesignPotential donors’ self-reported health was ascertained using the Patient Reported Outcomes Measurement Information System (PROMIS) global physical and mental health and the Davies and Ware health perceptions surveys. Setting & ParticipantsPotential living donors who expressed interest in donation at a single medical center were recruited prospectively between 2017-2022. OutcomesCompletion of the donor evaluation. Analytical ApproachAdjusted linear and logistic regression models were used to examine the association between self-reported health and health perceptions with outcomes. Results1,347 individuals were included for study; 46% (N=613) were <40 years of age, 71% (N=951) female, 22% (N=294) were Hispanic, and 16% (N=215) completed the donor evaluation. Mean PROMIS global physical health (17.0 ± 1.9) and mental health (15.5 ± 2.7) raw scores were higher among donor candidates proceeding to completion of the donor evaluation compared with those who withdrew early in the process (16.3 ± 2.2 for physical health and 14.9 ± 3.1 for mental health). Every z-score change in the PROMIS physical health score was associated with 1.48-fold higher odds of completing the donor evaluation (95% CI 1.19-1.85). Fully adjusted models incorporating the PROMIS scores for predicting the completion of donor evaluations had a c-statistic of 0.70. Potential donors’ Davies and Wares health perceptions did not predict the likelihood of completing the donor evaluation in fully adjusted models. LimitationsData are derived from a single center and may not generalize to the donor evaluation process at other transplant centers. ConclusionsDonor candidates’ self-reported physical health may serve as a predictor of the likelihood of completing the donor evaluation process and a potential avenue for future interventions.

Alcohol exposure induces cortical activity change during quiescent state

Alcohol Use Disorder (AUD) is a significant global mental health issue that impacts both the central and peripheral systems, leading to widespread cognitive and motor dysfunctions. The primary motor cortex (M1) plays a critical role in motor planning, control, and execution, yet the effects of chronic alcohol exposure on M1 remain underexplored, particularly during quiescent states. This study investigates the functional changes in M1 due to chronic alcohol exposure using high-resolution Neuropixels electrode recordings in a mouse model. Our findings reveal alterations in neuronal firing mode, particularly in layer V, highlighting disruptions in the excitatory/inhibitory (E/I) balance. Despite similar overall firing rates, changes in firing interval distributions suggest altered temporal dynamics of neuronal activity due to alcohol exposure. These results align with existing literature on cortical disruptions caused by alcohol and provide new insights into the specific neuronal dynamics within M1, especially in quiescent states.

Tofacitinib prevents depressive-like behaviors through decreased hippocampal microgliosis and increased BDNF levels in both LPS-induced and CSDS-induced mice.

Depressive disorders are a global mental health challenge that is closely linked to inflammation, especially in the post-COVID-19 era. The JAK-STAT pathway, which is primarily associated with inflammatory responses, is not fully characterized in the context of depressive disorders. Recently, a phase 3 retrospective cohort analysis heightened that the marketed JAK inhibitor tofacitinib is beyond immune diseases and has potential for preventing mood disorders. Inspired by these clinical facts, we investigated the role of the JAK-STAT signaling pathway in depression and comprehensively assessed the antidepressant effect of tofacitinib. We found that aberrant activation of the JAK-STAT pathway is highly conserved in the hippocampus of classical depressive mouse models: LPS-induced and chronic social defeat stress (CSDS)-induced depressive mice. Mechanistically, the JAK-STAT pathway mediates proinflammatory cytokine production and microgliosis, leading to synaptic defects in the hippocampus of both depressive models. Remarkably, the JAK inhibitor tofacitinib effectively reverses these phenomena, contributing to its antidepressant effect. These findings indicate that the JAK/STAT pathway could be implicated in depressive disorders, and suggest that the JAK inhibitor tofacitinib has a potential translational implication for preventing mood disorders far beyond its current indications.

Using a Community-Engaged Survey to Describe Prison Environments and Measure the Mental Health Status of Correctional Staff and Incarcerated Individuals

The United States has the highest incarceration rate in the world. Incarceration is associated with significant negative mental health implications for both the corrections staff who work in prisons and the individuals incarcerated in them. Despite their scale and impacts, prisons are one of the country’s least transparent and most understudied public institutions. Where research on prisons does exist, it is often focused on either the corrections staff population or the incarcerated population. Moreover, the perspectives of those most directly affected, incarcerated populations and correctional staff are rarely included in the process. In this study, we sought to focus on understanding the entire prison ecosystem, measuring the mental health status of corrections staff and incarcerated individuals, and describing potential interrelated factors in the prison environment that may affect these outcomes. We used a community-engaged process to develop a prison survey to measure the prison environment in a pilot facility in rural Vermont, incorporating the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Mental Health 2a instrument to measure the mental health status of the corrections staff and incarcerated individuals. Focus groups and interviews were conducted to inform survey development and understand factors affecting the mental health of these populations. Surveys were administered at three time points.

Exploring The Role of Shirodhara In Alleviating Post-Covid Psychological Symptoms.

The COVID-19 pandemic has profoundly impacted global mental health, leading to an increased prevalence of psychological symptoms such as - anxiety, depression, and insomnia. This review explores the potential role of Shirodhara, an ancient Ayurvedic therapy, in alleviating post-COVID psychological symptoms. A comprehensive literature search was conducted across PubMed, Scopus, and Google Scholar, up to May 2024, using terms such as “Shirodhara,” “post-COVID,” “insomnia,” “anxiety,” “stress,” “oil dripping therapy,” and “depression.” The findings indicate that Shirodhara may significantly promote mental well-being through its calming effects. Despite the promising results, further research, including Randomized controlled trials (RCTs), is needed to validate these findings and integrate ‘Shirodhara therapy’ into mainstream mental health treatment protocols. Tackling the psychological consequences of COVID-19 necessitates a multifaceted strategy, with Shirodhara potentially being key to improving the well-being of those impacted.

We Have Spent Time, Money, and Effort Making Self-Help Digital Mental Health Interventions: Is Anyone Going to Come to the Party?

Although efficacious psychotherapies exist, a limited number of mental health care providers and significant demand make their accessibility a fundamental problem. Clinical researchers, funders, and investors alike have converged on self-help digital mental health interventions (self-help DMHIs) as a low-cost, low-burden, and broadly scalable solution to the global mental health burden. Consequently, exorbitant financial and time-based resources have been invested in developing, testing, and disseminating these interventions. However, the public's assumed desirability for self-help DMHIs by experts has largely proceeded without question. This commentary critically evaluates whether self-help DMHIs can, and will, reach their purported potential as a solution to the public burden of mental illness, with an emphasis on evaluating their real-world desirability. Our review finds that self-help DMHIs are often perceived as less desirable and credible than in-person treatments, with lower usage rates and, perhaps accordingly, clinical trials testing self-help DMHIs suffering from widespread recruitment challenges. We highlight two fundamental challenges that may be interfering with the desirability of, and engagement in, self-help DMHIs: (1) difficulty competing with technology companies that have advantages in resources, marketing, and user experience design (but may not be delivering evidence-based interventions) and (2) difficulty retaining (vs initially attracting) users. We discuss a range of potential solutions, including highlighting self-help DMHIs in public mental health awareness campaigns; public education about evidence-based interventions that can guide consumers to appropriate self-help DMHI selection; increased financial and expert support to clinical researchers for marketing, design, and user experience in self-help DMHI development; increased involvement of stakeholders in the design of self-help DMHIs; and investing in more research on ways to improve retention (versus initial engagement). We suggest that, through these efforts, self-help DMHIs may fully realize their promise for reducing the global burden of mental illness.

Exploring Moderation Dynamics: Callous-Unemotional Traits, Parental Practices and Conduct Problems in JuvenileDelinquency.

Callous-unemotional (CU) traits, parental practices and conduct problems (CP) have been consistently identified across numerous studies as significant predictors of the severity and persistence of juvenile delinquency. This study seeks to investigate the moderation dynamics underlying the relationships between these variables among Arab incarcerated youth. Specifically, the study aims to (1) explore whether parental practices moderate the relationship between CU traits and CP among incarcerated youth in Jordan and (2) examine the bidirectional moderating influence of CU traits in shaping the dynamic relationship between parental practices and CP within the context of Arab juvenile delinquency. An observational survey design was employed, gathering data from 184 incarcerated youth across 11 rehabilitation centres in Jordan. Latent profile analysis identified three parental practice classes: more positive, balanced and more negative. Moderation analyses indicated significant associations between CU traits, parental practices and CP. Parental practices, especially positive ones, moderated the relationship between CU traits and CP, highlighting the protective influence of balanced parenting. Furthermore, bidirectional moderation effects were observed: CU traits moderated the link between parental practices and CP, while CP influenced parenting practices, particularly in the presence of elevated CU traits. The findings of this study underscore the vital role mental health nurses can play in addressing the behavioural and psychological challenges faced by youth involved in the justice system and their families. Specifically, mental health nurses can aid in ameliorating mental distress by supporting parents in understanding and managing CU traits and CP. Nurses can provide targeted educational programmes that empower parents with strategies to reinforce positive parenting practices and reduce negative interactions. Furthermore, nurses can facilitate access to community resources and therapy options, helping families build a supportive environment conducive to the mental well-being of the youth. These interventions are crucial not only for the direct treatment of juveniles but also in providing holistic support to their families, thereby enhancing the overall efficacy of mental health care in juvenile delinquency. This study highlights the essential role that mental health nurses play in managing behavioural issues among youth, emphasising the significance of implementing culturally sensitive interventions. Mental health nurses possess a pivotal position in early detection and intervention, which enables them to guide families in fostering positive parenting practices, essential for preventing delinquent behaviours. Their efforts to promote understanding and responsiveness within family dynamics make a significant contribution to the mental well-being of individuals, highlighting the necessity of their role in global mental health.