Health Treatment Research Articles

A Review of Chatbots Application on Supporting International Students’ Mental Health

International students face distinctive challenges, including acculturative stress, homesickness, language barriers, and heightened academic expectations. As a result, their mental health and overall well-being have become subjects of growing concern and significance in academic and support communities worldwide. The emergence of AI technologies, like ChatGPT, opens new avenues for international student mental health interventions. However, no specific Chatbot has been approved as effective for this population. This study aims to comprehensively summarize Chatbot applications in mental health counseling and analyze the challenges of applying them to international students. The study found that prominent Chatbots could demonstrate efficacy in reducing symptoms of depression and anxiety through techniques such as cognitive behavioral therapy (CBT). Chatbots are becoming integral to mental health care, providing accessible and evidence-based interventions and psychoeducation. Compared with traditional in-personal mental health counselling, a Chatbot is more functioning in providing personalized therapy sessions, essay accessibility, real-time responses, and suitable assistance, which could solve current challenges and unmet mental health counselling needs of international students. Despite their potential, ethical considerations and privacy challenges must be addressed to ensure reliable and secure use. Continued refinement is needed for international students’ application to enhance multicultural sensitivity, the accuracy of cross-language interpretation, and personalization. The evolution of Chatbots holds significant promise for enhancing mental health support, particularly for international students navigating and coping with their unique challenges.

Digital Mental Health Interventions for Adolescents in Low- and Middle-Income Countries: Scoping Review.

Digital mental health interventions (DMHIs) are increasingly recognized as potential solutions for adolescent mental health, particularly in low- and middle-income countries (LMICs). The United Nations' Sustainable Development Goals and universal health coverage are instrumental tools for achieving mental health for all. Within this context, understanding the design, evaluation, as well as the barriers and facilitators impacting adolescent engagement with mental health care through DMHIs is essential. This scoping review aims to provide insights into the current landscape of DMHIs for adolescents in LMICs. The Joanna Briggs Institute scoping review methodology was used, following the recommendations of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). Our search strategy incorporated 3 key concepts: population "adolescents," concept "digital mental health interventions," and context "LMICs." We adapted this strategy for various databases, including ACM Digital Library, APA PsycINFO, Cochrane Library, Google Scholar (including gray literature), IEEE Xplore, ProQuest, PubMed (NLM), ScienceDirect, Scopus, and Web of Science. The articles were screened against a specific eligibility criterion from January 2019 to March 2024. We analyzed 20 papers focusing on DMHIs for various mental health conditions among adolescents, such as depression, well-being, anxiety, stigma, self-harm, and suicide ideation. These interventions were delivered in diverse formats, including group delivery and self-guided interventions, with support from mental health professionals or involving lay professionals. The study designs and evaluation encompassed a range of methodologies, including randomized controlled trials, mixed methods studies, and feasibility studies. While there have been notable advancements in DMHIs for adolescents in LMICs, the research base remains limited. Significant knowledge gaps persist regarding the long-term clinical benefits, the maturity and readiness of LMIC digital infrastructure, cultural appropriateness, and cost-effectiveness across the heterogeneous LMIC settings. Addressing these gaps necessitates large-scale, co-designed, and culturally sensitive DMHI trials. Future work should address this.

Depression and its risk factors in a conflict-affected population: findings from a nationwide survey

Abstract Introduction The impact of armed conflict and war on mental health is well documented, with limited data on populations living in unrecognized states. In this study, we examined the prevalence and risk factors of symptoms of depression among the Nagorno-Karabakh population during a ceasefire period, prior to a blockade, full-scale military attack, and their forced displacement. Methods A total of 1023 women, aged 18-49 years, from all regions of Nagorno-Karabakh, participated in a population-based household survey in 2022, which included the Center for Epidemiologic Studies-Depression (CES-D) 16-item scale to assess their depression symptoms. Simple and multivariable linear regression analyses explored the socio-demographic factors associated with CES-D score. Results The mean CES-D score was 8.90 (SD = 8.93), and 13.1% of the respondents had a score >18 (presence of depressive symptoms). The adjusted linear regression showed that CES-D score was higher among divorced (2.66, SE = 1.15, p-value=0.021) or widowed (3.09, SE = 1.57, p-value=0.049) vs. married, and among those having war-related deaths in the household in the previous 2 years (8.60, SE = 1.65, p-value<0.001) vs. not having. Conversely, a vocational/university level (-2.33, SE = 0.70, p-value=0.001) or post-graduate education (-3.81, SE = 1.72, p-value=0.027) vs less than secondary/secondary level, and 3-5 members in the household (-2.71, SE = 1.16, p-value=0.020) vs.1-2 members were significantly associated with lower CES-D score. Conclusions Our findings suggest that depression symptoms are highly prevalent among women in conflict-affected areas, with specific socio-demographic factors increasing the risk of depression symptoms. These results highlight the importance of providing mental health support and interventions for women in conflict-affected areas, particularly for those who experienced loss in the family due to war, are divorced or widowed, live in small households, and have lower education. Key messages • Depression symptoms are highly prevalent among women of reproductive age in areas affected by armed conflict and war. • Mental health intervention is recommended for women in conflict-affected areas who experienced loss due to war, are divorced or widowed, live in small households and/or have lower education.

Co-creating stigma-prevention strategies for mental health interventions with migrant populations

Abstract Background The ADVANCE project aims to address mental health disparities among people in a situation of vulnerability in Europe. Through a co-creation approach, workshops were conducted to devise stigma prevention strategies during the implementation of mental health promotion interventions for migrant populations in Italy and Denmark. Methods The methodology involved two rounds of scenario-based workshops, a participatory method that elicit expert opinions to solve local problems and anticipate future ones. Round 1 included two separate workshops with (1) end-users and umbrella organizations, and (2) healthcare practitioners and decision-makers, to ensure diverse perspectives and minimize the impact of power imbalances. Participants brainstormed strategies to minimize stigma and optimize the intervention scenario. In Round 2, a mixed-group workshop was held to refine the strategies. Workshops occurred in Copenhagen and Verona in March 2024. Content analysis of the data was carried out. Results In Denmark, discussions emphasized tailored presentation of the intervention promoting shared experiences and normalizing mental health challenges, language sensitivity, participation through self-identification, and attention to relational aspects in intervention delivery to combat stigma effectively and enhance acceptability and engagement with the intervention. In Italy, proposed strategies included group exercises to raise awareness and promote open dialogue about cultural differences, language barriers, and discrimination. Discussions also considered the intersectionality of stigma, including factors like gender, socioeconomic status, and sexual orientation. Common themes included language sensitivity, facilitator training, and inclusive and safe spaces. Conclusions Scenario-based workshops can be a valuable tool to facilitate the co-creation of stigma-prevention strategies while involving all stakeholders in promoting effective mental health interventions. Key messages • Co-creation approach fostered stakeholder collaboration, yielding tailored strategies that promote inclusivity, acceptability and engagement with mental health interventions for migrant populations. • Context-specific approaches that emphasize trust, confidentiality and cultural sensitivity were prioritised to tackle stigma when implementing interventions and promoting mental health equity.

Estimated lifetime impact of a school-based intervention for mental health: A microsimulation study

Abstract Background The prevalence of childhood mental health problems is increasing. School-based interventions have the potential to reduce poor mental health and mental health inequalities. Our aim was to estimate the long-term costs and benefits of the Incredible Years Teacher® Classroom Management (IY-TCM) intervention in primary schools compared to no intervention. Methods LifeSim, an existing microsimulation model, was used to estimate the lifetime costs and benefits of IY-TCM by linking short-term changes in SDQ based on a previous trial in primary schools (Cluster RCT: 2075 children aged 4-9 years with a 30-month follow-up) to long-term health, social, economic and wellbeing outcomes. Benefits were measured in quality adjusted life years and wellbeing adjusted life years. We examined subgroup based on deprivation, conduct scores and parental depression. Results Microsimulation modelling estimated small gains in lifetime outcomes including reduced conduct disorder in adolescence and depression in adulthood. Estimates indicate IY-TCM could be cost-effective with a large amount of uncertainty (Net monetary benefit (NMB)=£21, Estimated CI = -£195, £240). IY-TCM was estimated to be more cost-effective for those with high deprivation (NMB = £231, Estimation CI - -£99, £231) and high conduct problem scores (NMB=£315, Estimated CI = £45, £483). Total net social benefit for a typical year size group was estimated to be £111m. Conclusions IY-TCM could be cost-effective compared to no intervention with a large estimated social benefit supporting wider implementation of IY-TCM, but results indicate a large amount of uncertainty. Greater benefits and higher certainty of cost-effectiveness for children with conduct problems and those living in a deprived area suggest IY-TCM has the potential to reduce mental health inequalities and may be more cost-effective for schools with higher deprivation and/or a high prevalence of conduct problems. Key messages • The Incredible Years Teacher Classroom Management intervention for mental health in primary schools could be considered cost-effective but there is a large amount of uncertainty. • Greater benefits for children with conduct problems and those living in a deprived area indicates the intervention has the potential to reduce mental health inequalities.

Evaluating mental health care initiatives after Ghana’s mental health act: a systematic analysis

Abstract Mental health disorders affect 970 million people worldwide. Particularly in Africa, mental health is a growing concern, as it faces poverty and limited healthcare services. The Ghana Mental Health Act (GMHA 2012) marked a significant milestone in the development of a legislative framework supporting the provision of mental healthcare. However, evidence of progress since then is scarce. This systematic review examines the mental health initiatives that have been implemented since GMHA. Bronfenbrenner’s Socio-Ecological and Vygotsky’s Sociocultural Theory are used as frameworks to organize the interventions by ecological layers and cultural practices. All peer-reviewed articles published since the GMHA were retrieved from PubMed, Cochrane and Science Direct, using “mental health interventions,” “-collaborations,” “-health programs” and “Ghana” as keywords. The search yielded 3839 articles. Next, publications that were not conducted in Ghana or did not focus on mental health were excluded yielding a final sample of 69 articles for the review. Consistent with the GMHA’s guidelines interventions were conducted in communities (n = 56; 81%) rather than hospitals (n = 13; 19%). Most of them focused on institutional ecological levels (i.e., schools, health centers, traditional healing conventions; n = 29; 42%), followed by interpersonal (n = 14; 20%) and community-level (n = 14; 20%) approaches. Half (n = 33; 48%) entailed some form of cultural responsiveness, such as adapting educational tools to cultural contexts or accounting for spiritual beliefs. Only 23% (n = 16) of the interventions targeted children or adolescents. The findings of this review suggest three implications for future mental health research. First, stigma reduction and mental health literacy need to become a stronger focus. Second, research on children and adolescents needs to be increased. Third, interventions led by European partners must be tailored carefully to the Ghanaian beliefs system. Key messages • Assessing the community-based approach of mental health interventions following the Mental Health Act’s legalization in Ghana. • European partners need to understand the context and the local culture before planning to research or implement intervention materials. Adaptation is key in the effectiveness of the intervention.

Equal, equitable or exacerbating inequalities: patterns and predictors of social prescribing referrals in 160 128 UK patients.

Social prescribing is growing rapidly globally as a way to tackle social determinants of health. However, whom it is reaching and how effectively it is being implemented remains unclear. To gain a comprehensive picture of social prescribing in the UK, from referral routes, reasons, to contacts with link workers and prescribed interventions. This study undertook the first analyses of a large database of administrative data from over 160 000 individuals referred to social prescribing across the UK. Data were analysed using descriptive analyses and regression modelling, including logistic regression for binary outcomes and negative binomial regression for count variables. Mental health was the most common referral reason and mental health interventions were the most common interventions prescribed. Between 72% and 85% of social prescribing referrals were from medical routes (primary or secondary healthcare). Although these referrals demonstrated equality in reaching across sociodemographic groups, individuals from more deprived areas, younger adults, men, and ethnic minority groups were reached more equitably via non-medical routes (e.g. self-referral, school, charity). Despite 90% of referrals leading to contact with a link worker, only 38% resulted in any intervention being received. A shortage of provision of community activities - especially ones relevant to mental health, practical support and social relationships - was evident. There was also substantial heterogeneity in how social prescribing is implemented across UK nations. Mental health is the leading reason for social prescribing referrals, demonstrating its relevance to psychiatrists. But there are inequalities in referrals. Non-medical referral routes could play an important role in addressing inequality in accessing social prescribing and therefore should be prioritised. Additionally, more financial and infrastructural resource and strategic planning are needed to address low intervention rates. Further investment into large-scale data platforms and staff training are needed to continue monitoring the development and distribution of social prescribing.

Acceptability of Digital Mental Health Interventions for Depression and Anxiety: Systematic Review.

Depression and anxiety disorders are common, and treatment often includes psychological interventions. Digital health interventions, delivered through technologies such as web-based programs and mobile apps, are increasingly used in mental health treatment. Acceptability, the extent to which an intervention is viewed positively, has been identified as contributing to patient adherence and engagement with digital health interventions. Acceptability, therefore, impacts the benefit derived from using digital health interventions in treatment. Understanding the acceptability of digital mental health interventions among patients with depression or anxiety disorders is essential to maximize the effectiveness of their treatment. This review investigated the acceptability of technology-based interventions among patients with depression or anxiety disorders. A systematic review was performed based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and PROSPERO (International Prospective Register of Systematic Reviews) guidelines. We searched PubMed, Web of Science, and Ovid in May 2022. Studies were included if they evaluated digital interventions for the treatment of depression or anxiety disorders and investigated their acceptability among adult patients. Studies were excluded if they targeted only specific populations (eg, those with specific physical health conditions), investigated acceptability in healthy individuals or patients under the age of 18 years, involved no direct interaction between patients and technologies, used technology only as a platform for traditional care (eg, videoconferencing), had patients using technologies only in clinical or laboratory settings, or involved virtual reality technologies. Acceptability outcome data were narratively synthesized by the direction of acceptability using vote counting. Included studies were evaluated using levels of evidence from the Oxford Centre for Evidence-Based Medicine. The risk of bias was assessed using a tool designed for this review and GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). A total of 143 articles met the inclusion criteria, comprising 67 (47%) articles on interventions for depression, 65 (45%) articles on interventions for anxiety disorders, and 11 (8%) articles on interventions for both. Overall, 90 (63%) were randomized controlled trials, 50 (35%) were other quantitative studies, and 3 (2%) were qualitative studies. Interventions used web-based programs, mobile apps, and computer programs. Cognitive behavioral therapy was the basis of 71% (102/143) of the interventions. Digital mental health interventions were generally acceptable among patients with depression or anxiety disorders, with 88% (126/143) indicating positive acceptability, 8% (11/143) mixed results, and 4% (6/143) insufficient information to categorize the direction of acceptability. The available research evidence was of moderate quality. Digital mental health interventions seem to be acceptable to patients with depression or anxiety disorders. Consistent use of validated measures for acceptability would enhance the quality of evidence. Careful design of acceptability as an evaluation outcome can further improve the quality of evidence and reduce the risk of bias. Open Science Framework Y7MJ4; https://doi.org/10.17605/OSF.IO/SPR8M.

Prediction of mental health risk in adolescents via a smartphone app: a feasibility pilot study

Abstract Background The prevalence of mental health problems in adolescents is a global public health concern. Machine learning (ML) can analyse multidimensional data collected by phone sensors (passive tracking) and symptom self-reporting (active tracking) to model and predict mental health states. However, research in adolescents is lacking. This study investigated the feasibility of using ML to predict mental health in a non-clinical population of adolescents from active and passive data collected through the Mindcraft mobile app. Methods We recruited 103 secondary students (aged 14-18) who first completed the Strengths and Difficulties Questionnaire (SDQ) and then used the Mindcraft app for two weeks. The app integrates sensor data (location, steps, noise, light, battery, app usage) and self-reports. We extracted 85 sensor-based features and 19 from questionnaires to develop a gradient-boosted ensemble ML model. This model identifies students with abnormal SDQ scores and was evaluated using leave-one-out cross-validation. Results All students completed the active questionnaires; 67 also provided passive sensor data. 31 had abnormal SDQ scores. Using passive data, the ML model reached a balanced accuracy of 0.64 and an AUC score of 0.57. Incorporating both data types improved accuracy to 0.67 and AUC to 0.70. Feature importance scores showed step count and questionnaire on racing thoughts and hopefulness as most significant. Conclusions Our findings affirm the potential of integrating passive and active data collection to monitor mental health in real-world settings. Our ML model demonstrated moderate accuracy in predicting adolescents’ mental health risk measured with a behavioural screening questionnaire. This study will guide the development of a ML-driven, personalised mobile intervention for early symptom detection and mental health self-management, which might constitute an innovative and scalable tool for mental health prevention and intervention in adolescents. Key messages • This study shows the feasibility of using active and passive data to predict mental health risk in adolescents. • This study informs the development of a personalised machine learning-driven mobile intervention.

1.O. Scientific session: Trans & Gender-Diverse Individuals’ Mental & Behavioral Health Risks & Intervention Needs

Abstract Transgender and gender-diverse (TGD) individuals are at a greater risk for various poor mental and behavioral health outcomes than cisgender individuals, including higher rates of suicide, psychiatric diagnoses, and behavioral health problems. For example, research has documented a seven-fold increased risk for lifetime suicide attempts among young TGD people, compared with the general population. Less is known about the age of onset of such mental and behavioral health disparities and how these disparities may vary across other intersectional socio-demographic variables. It has been well-documented that trans and gender-diverse individuals often encounter discrimination and transphobia across various social, educational, professional, administrative, and healthcare settings. This discrimination, as highlighted in the literature, frequently poses obstacles to accessing both general and trans-specific healthcare services due to experiences of discrimination (e.g., misgendering, refusal of care, lack of adequate services). The right and ability to self-determine and the accessibility to gender-affirming care without discrimination are key to closing the gap in TGD individuals’ mental and behavioral health outcomes, and for them to live authentically and thrive. Tailored and affirming mental and behavioral health interventions to reduce these health inequities are pivotal for TGD individuals to achieve the highest attainable standard of physical and mental health: a key fundamental human right. Considerable gaps in the literature remain concerning the onset and determinants of gender identity-based health disparities and healthcare approaches that are respectful, inclusive, non-pathologizing, and grounded in human rights principles for TGD individuals. This workshop intends to address these knowledge gaps by delving into the mental and behavioral health needs of TGD individuals. The workshop seeks to further foster dialogue on strategies to overcome resistance to implementing approaches that uphold the human rights and well-being of these communities. Dr. Richard Bränström (Karolinska Institutet) will present a study that explores the age at which gender identity-based disparities in psychiatric diagnoses and treatment can be first identified. Dr. Gonzales (Vanderbilt University) will examine disparities in mental health and social determinants of health among TGD individuals with private insurance. Dr. Moleiro (Lisbon University Institute) will review TGD persons’ ways of identifying with the choices and trajectories in social, legal, and affirmative healthcare processes in Portugal. Dr. Lelutiu-Weinberger (Columbia University School of Nursing) will present findings from a study that assessed tobacco use and cessation attitudes, facilitators, and barriers to quitting, and intervention components and delivery modality acceptability among TGD individuals, as well as sexual minority individuals, in Romania to inform a tailored and affirming smoking cessation intervention. Key messages • Transgender and gender-diverse are at increased risk for a variety of poor mental and behavioral health compared with the general public. • There is a critical need to foster healthcare services for transgender and gender-diverse individuals that are tailored and affirming.

Investigating the Mental Health Outcomes and Treatment Gap Among Sexual Minorities in Czechia: A National Cross-Sectional Study

Abstract Aims This study aims to (1) estimate the prevalence and relative risk of mental disorders, (2) assess the severity of mental health symptoms, and (3) investigate the treatment gap for mental disorders within SM. Methods Data from a cross-sectional, nationally representative survey of 3,063 Czech adults (response rate = 58.6%) were utilized. The Mini-International Neuropsychiatric Interview was employed to screen for mental disorders. In those identified with mental disorders, help-seeking behaviors over the past 12 months were examined. The severity of mental health symptoms was evaluated using the 9-item Patient Health Questionnaire and the 7-item Generalized Anxiety Disorder scale. Prevalence rates of mental disorders associated treatment gaps, and relative risks of mental disorders were calculated. Results The prevalence of mental disorders among heterosexual, gay or lesbian, bisexual, and more sexually diverse individuals was 18.9% (17.4-20.3), 52.3% (36.9-67.6), 33.3% (19.5-47.2), and 25.9% (13.9-38), respectively. Suicidal thoughts and behaviors were reported in 5.7% (4.9-6.6) of heterosexual individuals compared with 25.0% (11.7-38.3) in gay or lesbian, 22.9% (10.6-35.3) in bisexual, and 11.1% (2.5-19.8) in more sexually diverse individuals. After adjusting for confounders, gay or lesbian individuals demonstrated an increased risk of having at least one current mental disorder compared with heterosexual people (OR = 3.5 95% CI(1.8-6.8)). Bisexual and more sexually diverse individuals demonstrated risks consistent with a null effect. No substantial differences in treatment gap were detected between heterosexuals and SM who scored positively for at least one current mental disorder. Conclusions The findings underscore the urgent need for systemic changes to improve the mental health outcomes of Czech SM. Addressing structural stigma and ensuring sensitive care are imperative to mitigate the health disparities faced by Czech SM.

Mental health symptoms and treatment for common mental disorders among sexual minority immigrants in Sweden – a national population-based study

Abstract Background Although sexual minorities are at greater risk of poor mental health, less is known about mental health among dual minority statuses individuals based on sexual orientation and migration status. The current study investigated disparities in mental health symptoms and psychiatric treatment for common mental disorders among Swedish-born and immigrant heterosexuals and sexual minorities. It further explored the role played by interpersonal and social stress in explaining these disparities. Methods Participants (n = 104,652) were drawn from the Swedish Public Health Survey in 2018. Six groups were compared based on sexual orientation (heterosexual, sexual minority) and migration status (Swedish-born, European-born, non-European). The survey was complemented with information on psychiatric treatment from nationwide registries. Odds ratios were calculated using logistic regression. Results Compared to Swedish-born heterosexuals, Swedish-born and non-European sexual minorities had the greatest risk of mental health symptoms (odds ratios [OR]=2.20, 95% confidence intervals [CI]: 1.89-2.57, and OR = 2.10, 95% CI 1.34-3.29, respectively). Swedish-born sexual minorities had greater risk of psychiatric treatment (OR = 2.58, 95% CI 2.20-3.01), while non-European heterosexuals had lower risk (OR = 0.61, 95% CI 0.52-0.72). No differences in psychiatric treatment was found for non-European sexual minorities (OR = 0.82, 95% CI 0.46-1.48). Interpersonal and social stress factors mediated the associations between migration status and mental health symptoms and psychiatric treatment differently depending on sexual orientation. Conclusions No excess risk of mental health symptoms was found among sexual minority immigrants compared to their Swedish-born counterparts. Key message • Non-European sexual minority immigrants’ risk of mental health symptoms was equally high to the risk among Swedish-born sexual minorities, but they received less psychiatric treatment.

Strengthening youth mental health capacities in Albania: Training primary healthcare professionals

Abstract Background Addressing mental health issues among children and adolescents globally is crucial, necessitating interventions at the primary healthcare (PHC) level. The training programme in Albania equipped PHC professionals with skills for early identification, support, and referral for youth mental health issues. Given the global prevalence of such challenges, our intervention serves as a valuable model for enhancing mental health services in communities. Objectives The training aimed to develop the capacities of Albanian PHC professionals in improving mental health and psychosocial wellbeing among youth. Through innovative training sessions using participatory action methods, it was sought to answer key questions: How can Albanian PHC professionals better identify and support youth mental health issues? What innovative approaches can enhance mental health training for Albanian healthcare personnel? How can community engagement be strengthened to support youth mental health initiatives in Albania? Results Following the programme, 525 healthcare professionals in Albania received training, showing improved knowledge and skills in youth mental health support. They emphasized the importance of community engagement, standardized documentation, and specialized mental health services. Preliminary results indicate increased awareness and readiness among Albanian PHC professionals to address youth mental health needs. Conclusions The programme underscores the significance of equipping Albanian PHC professionals with comprehensive skills to tackle youth mental health challenges. Lessons learned have broader implications for strengthening mental health services globally, emphasizing collaboration, standardized protocols, and targeted interventions. Key messages • Strengthening PHC capacity in Albania improves early identification and support for youth mental health, enhancing overall wellbeing. • Tailored training and community engagement are vital for effective mental health interventions at the grassroots level in Albania.

Carving out space for co-creation in implementation of evidence-based mental health interventions

Abstract Background Mental health is identified as a pressing public health priority for European countries challenged by societal changes. The ADVANCE project aims to strengthen our understanding of mental health promotion and prevention in seven countries in Europe. In Denmark, the research project sets out to understand how WHO’s stress management intervention Self Help Plus can be embedded within social and integration programmes for adults who have experienced migration. Methods We are using a common methodology across the 7 country projects oriented by co-creation with end users and relevant stakeholders to initially develop implementation scenarios and stigma reduction strategies. We will present findings from this process and reflect on the tension and potential of the co-creation methodology in the implementation of evidence-based mental health interventions. Results In the first project phase of problem analysis and co-creation, the project’s society advisory group discussed 10 tailored intervention scenarios. Then, a Delphi survey and two rounds of scenario-based workshops with additional involvement of 16 end users/actors resulted in a final implementation scenario and stigma reduction strategies. We identified and reflected on questions around ownership of the project, boundaries of the proposed intervention, alignment of expectations, and intervention sustainability within the parameters of the ADVANCE project. Conclusions Even when interventions are pre-selected in response to funding calls, co-creation can facilitate the development of acceptable and sustainable implementation strategies. However, meaningful co-creation requires time, flexibility, and negotiation, which is not always guaranteed. Key messages • Co-creation creates productive tension and potential for the implementation of ADVANCE. • Space for co-creation was negotiated with collaborators to ensure meaningful engagement.

Engaging co-creators network in a public mental health intervention: MENTBEST

Abstract Background MENTBEST, a 5-year EU-funded project, addresses mental health challenges among vulnerable groups using community-based interventions and innovative technologies. It aims to mitigate adverse impacts, focusing on migrants, older individuals, younger individuals, long-term unemployed individuals, and those with mental disorders in Albania, Germany, Spain, Denmark, Greece, Ireland and Estonia. MENTBEST seeks to provide tailored support to vulnerable populations, promoting mental well-being and resilience through two interventions (a) Mentina a mobile app and (b) a complex community intervention based upon the European Against Depression 4-level intervention. Methods A Participatory Action Approach has been employed through each research stage of MENTBEST where stakeholders across Europe have become part of the research team and provide input towards designing and evaluating the two interventions mentioned above. The PRODUCES framework was used to establish the Co-creators Network, ensuring inclusivity and relevance through: stakeholder mapping, prioritization, and engagement strategies. An online platform has been established for the network to collaborate as a community of practice, but also as means of upskilling co-creators through MOOCs and brief courses. Results The Co-creators Network comprises 24 diverse members strategically distributed among vulnerable groups through all participating Mentbest countries. Engagement activities include workshop participation on taking decisions on a range of research topics such as designing content, evaluation of the interventions, implementation of the interventions etc. Conclusions The Co-creators Network represents a milestone for MENTBEST, ensuring a collaborative approach to public mental health intervention. Innovative strategies highlight the project’s commitment to addressing the mental health needs of vulnerable populations. Key messages • Collaborative approach in MENTBEST fosters inclusive public mental health interventions. • Co-creators Network drives innovative strategies to address mental health needs of vulnerable groups.

Heterogeneity of postpartum bonding and maternity blues among mothers three days after delivery

Abstract Background Findings about risk factors for postpartum depression (PPD) are often inconsistent. The variability could be due to the heterogeneity of characteristics of mothers at risk for PPD in certain populations, which has important mental health implications. We examined the heterogeneity of sociodemographic, pregnancy and labor characteristics in postpartum women referred to follow-up care on the third day after delivery. Methods We performed a nested cross-sectional latent profile analysis (LPA) on a convenience sample of women in a tertiary community hospital in Split, Croatia in 2020. Participants completed the first subscales of Postpartum Bonding and Maternity Blues questionnaires, as well as five subscales of the Questionnaire of Family Functioning According to Parents and 12 sociodemographic, pregnancy and childbirth-related variables. LPA identified profiles of mother-infant bonding and postnatal blues, and multinomial regression analysis was used to determine the influence of different profiles. Results Of the 318 participants, the best-fitting model had three latent profiles. First (n = 76, 24% of participants) and second (n = 216, 68% of participants) latent profiles showed good postpartum bonding, while second profile showed higher primary blues. Third profile (n = 80, 25% of participants) was characterized by poorer postpartum bonding and elevated primary blues. Only good youth experiences of mothers with their parents (relative risk [RR] 0.26; 95% CI 0.12-0.57; p = 0.001) and good present-day relationships with partners (RR 0.26; 95% CI 0.13-0.52; p < 0.001), significantly decreased the risk for third latent profile classification. Conclusions Postpartum bonding and primary blues of women who gave birth three days prior were heterogeneous. This heterogeneity could result in the well-documented heterogeneity of postpartum depression in women, and therefore, be the focus of mental health interventions in similar settings. Key messages • We found heterogeneity of sociodemographic, pregnancy, and labor characteristics in postpartum women after delivery, highlighting the variability in risk factors for postpartum depression. • This heterogeneity could result in the well-documented heterogeneity of postpartum depression in women, and therefore, be the focus of mental health interventions in similar settings.

The role of the organisational context in the implementation of a complex mental health intervention

Abstract Introduction The 2021 framework for complex interventions introduced by the UK Medical Research Council highlights context as one of the core elements. In the implementation phase, context is considered especially critical as it affects the intervention’s effect, sustainability, and transferability. However, in public health implementation research, there is a lack of understanding of the interrelatedness between intervention and context conditions. This study aimed to explore the role of the organisational context in implementing a complex mental health intervention. Methods The study was designed as an ethnographic case study. This design enabled a comprehensive exploration of the relation between the case and its context by providing insights into the process of change implied in the implementation and how this collides with the organisational norms, culture, and structure. Four general practices participating in The Healthy Mind Intervention were included as cases. One-person interviews with clinic owners, focus group interviews with personnel, and observations of intervention activities and everyday life in the practices were used to collect data. Results Three themes were identified. First, existing organisational norms, ideals, and values were replicated in the implementation process and either inhibited or facilitated the process of change. Second, different narratives of both implementation and context existed among some of the professional groups, which complicated the collaborative efforts in the implementation. Last, conflicts in the organisations were actualised in the implementation process, which enabled a discussion and improvement of these issues. Conclusions Ethnographic case studies provide extensive insights into the role of the organizational context in implementing complex interventions, which is critical for the implementation to be effective, qualified, and sustainable.

Scoping Review of Health Literacy Interventions among Migrant Communities in Europe

Abstract Background The increase in migration trends in Europe has brought attention to the significant health disparities between migrant and native populations, which are largely rooted in social determinants of health such as economic difficulties, language barriers, and limited access to services. Tailored health literacy (HL) interventions can serve as an intermediate factor between social determinants of health and health outcome, thereby holding great potential for addressing these disparities. Despite a growing body of research on migrant health, there remains a gap in our understanding of effective HL interventions for this population. Methods A scoping review was conducted following the Joanna Briggs Institute (JBI) updated guidelines and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. Electronic searches were carried out across five databases (PubMed, SCOPUS, Web of Science, PsychINFO, and CINHAL) and supplemented by a manual search. We included European studies on migrant HL interventions, conducted between 2011 and 2023, and published in English or Portuguese language. Results Out of 1018 records, 7 studies met eligibility criteria. Predominantly situated in Northern and Western Europe (85.5%), interventions primarily targeted female migrants (71.4%) through in-person courses (42.9%). Identified intervention strengths included culturally adapted content, migrant engagement, and access to written materials. Gaps included mental health interventions and community outreach. Conclusions This scoping review provides a comprehensive overview of HL interventions targeting migrant populations, highlighting their characteristics, strengths, and gaps. These findings serve as a foundational step towards developing guidelines for effective HL interventions within migrant communities. Key messages • Most European health literacy interventions for migrants target women and are conducted in North or West Europe. • Cultural adaptation and community engagement are key strengths of migrant health literacy interventions, yet gaps remain in mental health support and community outreach efforts.

Flooding and Mental Health interventions for vulnerable groups

Abstract Issue/Problem The UK is increasingly vulnerable to flooding due to climate change, which significantly affects mental health. Vulnerable populations are disproportionately impacted, experiencing stress, anxiety, and other severe mental health issues, requiring effective intervention strategies. Description of the problem The UK’s third Climate Change Risk Assessment (CCRA) highlights flooding as a key challenge, with mental health impacts representing a major health burden. Effective interventions are crucial for these communities. Results UKHSA’s flooding and mental health guidance is incorporated into flooding and health advice documents for the public and frontline responders. It includes assessment and support strategies for health and social care staff, emergency responders, and local authorities. It focuses on those most at risk and promotes a phased approach to care-from immediate safety and shelter to long-term psychological support. This strategy accommodates the prolonged nature of mental health recovery, requiring adaptable and sustained interventions. Lessons Addressing the mental health impacts of flooding demands a comprehensive, multi-phase strategy that adapts to the evolving needs of affected populations. Early intervention and long-term support are vital to mitigate the extensive psychosocial damage. Key messages • Flooding severely affects mental health, necessitating structured, long-term interventions. • Flexible support strategies that evolve over time are crucial for effective recovery, ensuring that interventions meet the changing needs of those impacted by flooding.

Conversational Agent Utilization Patterns of Individuals with Autism Spectrum Disorder

AbstractIndividuals with autism spectrum disorder (ASD) face unique challenges in their social interactions. The use of conversational agents (CA) can provide support and help reduce barriers to care. However, research on CA’s by individuals with ASD is limited. The present study sought to better understand CA utilization patterns by users with ASD. A subset of data was collected from users of Wysa, a mental health CA. Engagement with the CA, utilization of offered mental health interventions (CA tools), collection of energy scores, depression (PHQ-9), and anxiety (GAD-7) outcomes were gathered and analyzed. Users engaged with Wysa on average 8.59 days and had a median of 97 conversational exchanges. Almost half of the users utilized at least one of the 230 tools offered. The most frequently used interventions focused on mindfulness, thought recording, sleep, grounding, and social support. Energy scores were reported on average 10.59 times, and the mean energy score was 42.77 out of 100. Mean baseline PHQ-9 and GAD-7 scores were 10.34 and 8.81, respectively. Overall, the current findings show that users with ASD engaged regularly with a CA, despite its targeted design for other mental health concerns such as depression and anxiety, rather than ASD. If users with ASD engage with these types of resources, this could become a new avenue of support to a population facing multiple challenges to accessing treatment.