Mental Health Experts Research Articles

Adherence to guideline creation recommendations for suicide prevention in the emergency department: A systematic review.

Suicide rates in the United States rose 35.2% from 1999-2018. As emergency department (ED) providers often have limited training in management of suicidal patients and minimal access to mental health experts, clinical practice guidelines (CPGs) may improve care for these patients. However, clinical practice guidelines that do not adhere to quality standards for development may be harmful both to patients, if they promote practices based on flawed evidence, and to ED providers, if used in malpractice claims. In 2011, the Institute of Medicine created standards to determine the trustworthiness of CPGs. This review assessed the adherence of suicide prevention CPGs, intended for the ED, to these standards. Secondary objectives were to assess the association of adherence both with first author/organization specialty (ED vs non-ED) and with inclusion of recommendations on substance use, a potent risk factor for suicide. This is a systematic review of available suicide-prevention CPGs for the ED in both peer-reviewed and gray literature. This review followed the PRISMA standards for reporting systematic reviews. Of 22 included CPGs, the 7 ED-sponsored CPGs had higher adherence to quality standards (3.1 vs 2.4) and included the highest-rated CPG (ICAR2E) identified by this review. Regardless of specialty, nearly all CPGs included some mention of identifying or managing substance use. Most suicide prevention CPGs intended for the ED are written by non-ED first authors or organizations and have low adherence to quality standards. Future CPGs should be developed with more scientific rigor, include a multidisciplinary writing group, and be created by authors working in the practice environment to which the CPG applies.

Key service components for age-appropriate mental health service planning for young adults.

To identify and describe key service components that should be incorporated into age-appropriate integrated mental health care for young adults aged 18-24 years. Key service components were identified through a mixed-methods approach including targeted examinations of the literature and structured discussions with experts in youth mental health. Seven key components were identified as important for providing age-appropriate mental health care to young adults. Two were classified as clinical service components (structured psychological therapies; care coordination and liaison), three were classified as non-clinical service components (vocational support; youth development; peer support) and two as integrated non-clinical and clinical service components (lifestyle interventions and family and network support). Example service models for each of these key service components were identified and described. This is the first study to identify and describe key service components for age-appropriate mental health care for young adults. The findings provide mental health service planners with a framework of services that should be considered when planning and resourcing services for this age range.

Comparison of the Effect of Transcranial Direct Current Stimulation, Neurofeedback, and Neuro-Linguistic Programming on Reducing the Rate of Depression, Anxiety, and Stress

Background: Depression, anxiety, and stress are the most common mental disorders almost experienced by human beings. Nowadays, due to the coronavirus outbreak, people are becoming more vulnerable to these disorders. Objectives: The present study aimed to investigate the comparison of the effect of 3 treatment methods, named neuro-linguistic programming (NLP), transcranial direct current stimulation (tDCS), and neurofeedback (NFB), on patients suffering from disorders mentioned above. Methods: The research design selected for the present investigation was a quasi-experimental method consisting of pretest and posttest given to 3 experimental groups [i.e., NFB (n = 15), tDCS (n = 15), and NLP (n = 15)] and 1 control group (n = 15). The statistical population was included patients who had been referred to mental health experts at comprehensive health service centers in Zahedan, Iran (2020). The sampling procedure was based on a simple random method with a population of 68 subjects (60 main samples and 8 alternatives). Following the completion of the Depression Anxiety Stress Scales-21 (DASS-21) questionnaire, data were collected and then analyzed step by step using SPSS version 23. Results: The results of the multivariate analysis of covariance (MANCOVA) test showed that there would be significant decrease in the mean scores of depressions, anxiety, and stress between the pre-and posttest scores of the subjects in the treatment groups (P < 0.0001). Conclusions: NLP, tDCS, and NFB were significantly effective in the treatment of depression, anxiety, and stress. Considering the importance of the findings, non-pharmacological methods could be effective in the treatment of depression, anxiety, and stress.

Young users' social media addiction: causes, consequences and preventions

PurposeSocial media addiction has been an ongoing topic of debate for platform developers, well-being and mental health experts. There is a limited understanding of the factors leading to the addiction of young social media users, the consequences of experiencing addiction, and the measures/mechanisms used by parents and platform providers to limit/prevent problematic social media use amongst young users. This systematic review aims to provide a comprehensive overview of the literature concerning these issues.Design/methodology/approachThe Preferred Reporting Items for Systematic Reviews (PRISMA) protocol was used to evaluate and present the results. A total of 45 studies were screened and independently reviewed against predetermined criteria for eligibility.FindingsThe results revealed four categories of young users' addiction to social media networks (social, technological, behavioural and mental). Several prevention approaches directed at parents and platform providers were discussed.Originality/valueThis study offers important insights for health policy makers, platform providers, parents and researchers on designing interventions addressing social media addiction amongst young users. It also provides an in-depth understanding of the conceptualization of social media addiction and suggestions on possible actions to prevent it.

Development and validity of the Value-based Stigma Inventory (VASI): a value-sensitive questionnaire for the assessment of mental health stigma

BackgroundIt has been hypothesized that mental illness stigma differs according to what matters most to people, and that this results in value-based differences in stigma within societies. However, there is a lack of stigma measures that account for a broad range of values, including modern and liberal values.MethodsFor the development of the Value-based Stigma Inventory (VASI) a preliminary item-pool of 68 VASI-items was assembled by mental health and stigma experts. For psychometric evaluation, we tested the VASI in an online sample of the general population (n = 4983).ResultsBased on item-characteristics as well as explorative and confirmatory factor analyses, a final version of the VASI was developed, comprising 15 items and 5 subscales. The VASI shows good psychometric properties (item difficulty = 0.34 to 0.67; mean inter-item correlation r = 0.326; Cronbach’s α = 0.879). Medium to high correlations with established stigma scales (SDS, SSMI), medium associations with instruments assessing personal values (PVQ, KSA-3) and small to no associations with a social desirability scale (KSE-G) attest to good convergent and discriminatory validity of the new instrument. Normative values for the VASI subscales are presented.ConclusionsThe developed VASI can be used to assess public stigma of mental illness including personal stigma-relevant value orientations.

Impact of worries associated with COVID-19 on diabetes-related psychological symptoms in older adults with Type 2 diabetes

This study examined the associations between worries associated with COVID-19, diabetes-specific distress, and depressive symptoms in older adults with type 2 diabetes (T2D), who are particularly vulnerable to COVID-19 and its psychological impacts. A cross-sectional online survey was conducted with 84 older adults with T2D from June to December 2020. Participants had little to moderate worries associated with COVID-19, with the greatest worries about the economy recession, followed by a family member catching COVID-19, lifestyle disruptions, and overwhelmed local hospitals. Bivariate correlation and tobit regression revealed that increases in worries associated with COVID-19 were associated with increased diabetes distress and depressive symptoms. Specifically, worries associated with COVID-19 increased diabetes-specific emotional burden and physician-related and regimen-related distress. Increased diabetes distress and depressive symptoms worsened by COVID-19 may ultimately lead to poor glucose control. Additional assessment by mental health experts should be considered for older adults with T2D during and after infectious disease pandemic.

Reading minds: A study of deictic shifts in translated written interaction between mental-health professionals and their readers

The practice of knowledge mediation in written texts relating to the health sciences has hitherto received limited attention within Translation Studies. The overall aim of this study is to explore writer-reader interaction in a bilingual corpus of medical leaflets published on the website of the Royal College of Psychiatrists (UK). In order to do this, a comparative analysis of English source texts and Spanish target texts was conducted to identify shifts in personal reference, which served to contrast patterns in knowledge transfer processes between mental health experts and their target audiences. The study is underpinned by Thompson and Thetela’s (1995) tenet that interactive and interactional features have to be considered in conjunction. It seeks to make a contribution to the relatively understudied field of how interaction patterns differ across cultural and linguistic settings. The corpus is of special interest due to the sensitivity of its subject matter, the varied constituency it addresses and the fact that the translated texts were produced and revised by mental health professionals.

Optimal design for a psychosocial intervention on severely acute malnourished children in humanitarian settings: results of an expert survey

Background: Common psychosocial interventions focus on feeding, stimulation, emotional responsiveness and childcare and parenting. Inclusion of such a component in the outpatient management of severe acute malnutrition (SAM) children is recommended. However, clinical assessment of such interventions is tedious in humanitarian settings and modalities evidence on the impact of psychosocial interventions alongside nutrition protocol for SAM is scarce. This survey aimed to gather expert opinions on the optimal design of a combined psychosocial and nutrition intervention feasible in humanitarian settings. Methods: From March to May 2018, an online survey was emailed to international experts in nutrition and mental health and psychosocial support, mainly from academia and international non-governmental organisations (INGOs). It included multiple choices questions on the key components of an optimal combined intervention. Results: Of the 76 experts targeted, 20 responded. 11 (55%) belonged to INGOs, 2 (10%) to academia, and 4 (20%) to international organizations and donors. For most respondents, a combined intervention should be provided in weekly 45-minuites counselling sessions, provided individually (rather than in a group) and at home (rather than at a health center). None of the proposed ideal duration (two, four or six months) gained the majority of votes. Experts thought that 35% staff training should be in “Active listening for psychosocial support”, and 30% in “Early child development”, 25% in “Maternal depression” and 9% in “Anthropometric measurements”. They estimated that a combined intervention could improve SAM recovery rate by 10% (min-max: 0-19%) vs. the nutritional protocol alone. Qualitative results highlighted the importance of tailoring the intervention to the individual, the population and the settings; as well as considering feasibility and scalability at the design stage. Conclusion: These findings could guide further research on the impact of psychosocial interventions on SAM children’s health and development, and help designing innovative approaches to treat undernutrition.

The Virtual Team Member: Remote Engagement of Medical Students in COVID-19 Care.

BackgroundMedical education abruptly changed in the setting of the COVID-19 pandemic, impacting experiential learning in clinical clerkship as medical students were removed from direct patient interactions and care team participation. Re-configuring a hospital clinical rotation using virtual care platforms allowed students to re-engage in the clinical environment and actively participate in patient care.MethodsDuring the height of the pandemic, we implemented a 4-week “virtual team member” (VTM) inpatient medicine elective for medical students in their second year and above to participate in acute patient care during the height of the COVID-19 pandemic. Tasks included providing daily updates to patients and family members along and care coordination. Faculty experts in infectious disease, mental health, ethics, and patient safety incorporated weekly didactic video talks throughout the elective. Student feedback was obtained anonymously through pre-, mid-, and post-elective questionnaires.ResultsA total of 26 students enrolled in the two 4-week blocks, with 85% in the 2nd year. Survey response rates for the pre, mid, and post-rotation questionnaires were 96%, 77%, 58% respectively. Of the 15 students who completed the post-survey, the majority strongly and somewhat agreed that the elective met expectations (12/15, 80%), was worthwhile (14/15, 93%) and met goals (12/15, 80%). Best parts of the elective most frequently cited by students were patient care and teamwork. Working remotely was the greatest challenge.ConclusionsDesigning a virtual role for students successfully allowed students to re-engage in the acute care setting and connect with patients and participate in COVID-19 care.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40670-021-01422-8.

Connect 2 Care, a Novel Community Outreach Program for Vulnerably Housed Patients With High Acute Care Use: A Mixed-Methods Study Protocol.

Introduction: Vulnerably housed individuals, especially those experiencing homelessness, have higher acute care use compared with the general population. Despite available primary care and social services, many face significant challenges accessing needed services. Connect 2 Care (C2C) is a novel transitional case management program that includes registered nurses and health navigators with complementary expertise in chronic disease management, mental health and addictions, social programs, community health, and housing, financial, transportation and legal resources. C2C bridges acute care and community services to improve care coordination.Methods and Analysis: We will perform a mixed-methods evaluation of the C2C program according to the Donabedian framework of structure, process and outcome, to understand how program structure and process, coupled with contextual factors, influence outcomes in a novel intervention. Eligible patients are homeless or unstably housed adults with complex health conditions and high acute care use. Change in emergency department visit rate 12-months after program enrolment is the primary outcome. Secondary outcomes include 12-month post-enrolment hospital admissions, cumulative hospital days, health-related quality of life, housing status, primary care attachment and substance use. Qualitative methods will explore experiences with the C2C program from multiple perspectives and an economic evaluation will assess cost-effectiveness.Discussion: Academic researchers partnered with community service providers to evaluate a novel transitional case management intervention for vulnerably housed patients with high acute-care use. The study uses mixed-methods to evaluate the Connect 2 Care program according to the Donabedian framework of structure, process and outcome, including an assessment of contextual factors that influence program success. Insights gained through this comprehensive evaluation will help refine the C2C program and inform decisions about sustainability and transferability to other settings in Canada.

Emergency Department Initiated Mental Health Interventions for Young People: A Systematic Review.

Young people (10-24 years old) with mental health concerns are increasingly presenting to hospital emergency departments (EDs). The purpose of this review was to identify the core components and outcomes of mental health interventions for young people that are initiated in the ED, such that they are delivered in the ED and/or by ED health workers. Six electronic databases were systematically searched. Primary peer-reviewed qualitative or quantitative studies describing an ED-initiated mental health intervention for young people published between 2009 and 2020 were included. Nine studies met the inclusion criteria. The included studies demonstrated that compared with traditional ED care, ED-initiated mental health interventions lead to improved efficiency of care and decreased length of stay, and a core component of this care was its delivery by allied health practitioners with mental health expertise. The studies were limited by focusing on service efficiencies rather than patient outcomes. Further limitations were the exclusion of young people with complex mental health needs and/or comorbidities and not measuring long-term positive mental health outcomes, including representations and whether young people were connected with community health services. This systematic review demonstrated that ED-initiated mental health interventions result in improved service outcomes, but further innovation and robust evaluation are required. Future research should determine whether these interventions lead to better clinical outcomes for young people and staff to inform the development of best practice recommendations for ED-initiated mental health care for young people presenting to the ED.

APA App Advisor: Working With Patients to Use Apps

APA App Advisor: Working With Patients to Use Apps

PIVOTING WITH THE PANDEMIC: CHALLENGES AND SUCCESSES OF CHILD PSYCHIATRY ACCESS PROGRAMS NATIONWIDE

A nationwide shortage of behavioral healthcare services has prompted primary care providers (PCPs) to fill the gap in providing behavioral health care. Pediatric behavioral health needs have further increased during the pandemic. However, PCPs often lack specialized training and resources to meet the behavioral health needs of their patients. Child Psychiatry Access Programs (CPAPs) augment mental healthcare resources through collaborative care models based on peer-to-peer consultation, ongoing psychiatry education for PCPs, and other services. To date, CPAPs have been developed in 40 states, scaffolded by the National Network of Child Psychiatry Access Programs including 21 programs with funding from the Health Resources and Services Administration. Informed by community-engaged collaborations, CPAPs have leveraged their child behavioral health expertise in creative ways such as integration of peer specialists for families, telemedicine partnerships with Tribal Health Centers and schools, expanded child psychiatry fellowship education programs, and novel research networks. Diverse programs from 4 different states—Connecticut, Michigan, Mississippi, and Texas—will describe innovative strategies to implement and expand their programs, and lessons learned during the global pandemic. Furthermore, the discussant will provide an overview of CPAP functioning and innovation during the pandemic, including a focus on the Massachusetts program. CPAPs have leveraged mental health expertise in various states, allowing more children from rural and other underserved communities to access mental health care in their relatively low-cost primary care setting, schools, or local communities. As these collaborative care programs are all virtual, implementation has continued forward even in the face of the COVID-19 pandemic. Child and adolescent psychiatrists can partner with CPAPs in their state and with primary care providers to improve the care for children. Nationwide, CPAP programs are transforming mental health care through this model of consultation, resource/referral coordination, ongoing medical education, research, and training opportunities.

Cultural adaptation of a scalable psychological intervention for Burundian refugee adolescents in Tanzania: a qualitative study

BackgroundThere is an urgent need for evidence-based, scalable, psychological interventions to improve the mental health of adolescents affected by adversity in low-resource settings. Early Adolescents Skills for Emotions (EASE) was developed by the WHO as a brief, transdiagnostic, group intervention for early adolescents exhibiting internalising problems, delivered by trained and supervised lay providers. This study describes the cultural adaptation of EASE for Burundian adolescents living in Mtendeli refugee camps in Tanzania.MethodsA phased approach to adaptation of the EASE intervention and its implementation, was adopted and comprised of: (1) a desk review to synthesize existing research on mental health issues in conflict-affected Burundian communities, (2) a rapid qualitative assessment involving free listing and key informant interviews with multiple stakeholders, (3) cognitive interviews with end users, and (4) a two-part adaptation workshop involving the implementing partner staff, members of the refugee community and mental health experts. We applied the Bernal framework to systematically document and track adaptations across eight dimensions of the intervention.ResultsProblems associated with worry, stress, sadness, shame and fear were identified as amongst the most critical mental health concerns, alongside a range of experiences of different forms of violence (such as gender-based violence, violence when fleeing from their homes) and associated problems. Problems associated with violence that included past experiences of fleeing as well as ongoing problems of gender-based violence in the camp. The most significant adaptations that were required included providing options for low literacy of participants, safety planning to address the high prevalence of sexual violence, simplification of strategies for the benefit of the end users and of lay facilitators, and implementation changes to consider involvement of refugee incentive workers. A majority of changes were across dimensions of language, people, metaphors, content, methods and context, while there were fewer changes regarding the goals and concepts of EASE.ConclusionsThe approach to adaptation of a psychological intervention suggested both minor and major required changes. Adaptations based on the findings of this study are anticipated to enhance relevance and acceptability of the EASE intervention and its delivery for camp-residing Burundian refugees in Tanzania.

Promoting and Protecting Mental Health: A Delphi Consensus Study for Actionable Public Mental Health Messages

Purpose: Public health campaigns are still relatively rare in mental health. This paper aims to find consensus on the preventive self-management actions (i.e. “healthy behaviors”) for common mental health problems (e.g. depression and anxiety) that should be recommended in mental health campaigns directed at the general public. Approach: A 3-round Delphi study Participants: 23 international experts in mental health and 1447 members of the public, most of whom had lived experience of mental health problems. Method: The modified Delphi study combined quantitative and qualitative data collection: 1) online qualitative survey data collection thematically analyzed, 2) recommendations rated for consensus, 3) consensus items rated by public panel on a Likert scale. Results: Expert consensus was reached on 15 behaviors that individuals can engage in to sustain mental health. Eight were rated as appropriate by more than half (50%) of the public panel, including: avoiding illicit drugs (80%, n = 1154), reducing debt (72%, n = 1043), improving sleep (69%, n = 1000), regulating mood (65%, n = 941), having things to look forward to (60%, n = 869). Conclusions: A series of healthy behaviors for the promotion and protection of mental health received expert and public consensus. To our knowledge, this is the first study to offer a set of actions for public health messaging for the prevention of poor mental health. Future research should focus on evaluating effectiveness of these actions in a universal primary prevention context.

The development of a Community Mental Health Education and Detection (CMED) tool in South Africa

BackgroundLow demand for mental health services in sub-Saharan Africa is driven by poor mental health literacy, stigma, and poor service availability. ObjectiveTo develop a Community Mental Health Education and Detection (CMED) Tool for adults for use by community health teams in South Africa aligned with their roles of health promotion, screening and linkage to care. MethodsFormative evaluation methods involving four processes: (1) Ongoing engagement with the KwaZulu-Natal Department of Health (KZN DoH) to ensure co-creation of the CMED tool and alignment with routine community health team activities; (2) Adaptation of the CMED tool from the Community Informant Detection Tool (CIDT), used to promote help-seeking of people with mental health problems in Nepal; (3) Review of the CMED vignettes and illustrations by a panel of local and international mental health care experts to establish accuracy and contextual and cultural relevance; (4) Process mapping and focus group discussions (FGDs) with community health teams in one district to establish cultural and contextual appropriateness as well as coherence and compatibility with existing community-based services. ResultsThe resulting CMED tool consists of five case vignettes and related illustrations to facilitate psychoeducation and the detection of possible depression, anxiety, psychosis, harmful alcohol use, and drug use by community health teams. Based on prototype matching, it includes two structured questions to guide the community health teams in the detection and referral process. The tool was acceptable, culturally and contextually appropriate, and helpful for the services provided by community health teams. Challenges of working in households and the importance of self-care were highlighted as important considerations when developing training content and piloting the tool. ConclusionExtensive consultation with the KZN DoH, community health teams, and the expert mental health panel resulted in developing a tool that was perceived to be culturally sensitive and relevant to the community package of services.

In Case You Haven't Heard…

Earlier this year, the Journal of Abnormal Psychology announced a change to its name because, as Editor‐in‐Chief Angus MacDonald III wrote, “Names matter.” The spectrum of diagnoses considered “abnormal” includes amnesias and depressions, sleep issues and hallucinations, and many, many more, The Washington Post reported Sept. 11. MacDonald wrote that by referring to people with such a wide range of mental health conditions as “abnormal,” the journal was “contributing to stigma of people with mental illness.” The publication's new name, beginning next year, is the Journal of Psychopathology and Clinical Science. “Since first being diagnosed with depression and generalized anxiety in my early 20s, I felt the stigma of being considered ‘abnormal,’” wrote Steven Petrow, journalist and author. “Back then, I regularly heard friends use pejorative words like ‘nuts,’ ‘psycho,’ ‘schizo,’ ‘insane’ and ‘looney tune’ as general insults to anyone for any transgression. Mental health experts often point to how ‘people with cancer’ or ‘people with AIDS’ have forcefully advocated to be referred to that way, rather than as a ‘cancer victim’ or ‘AIDS sufferer.’ I've learned that lesson, as well: I am a son, a brother, an uncle, a dog dad and a person who suffers from depression, But I am not ‘a depressive.’ … My mom, who died four years ago, surely would have agreed with the experts today who say that openly talking about mental health can break down the stigma associated with different conditions.”

Assessing Professionals' Adoption Readiness for eMental Health: Development and Validation of the eMental Health Adoption Readiness Scale.

BackgroundThe last few decades have witnessed significant advances in the development of digital tools and applications for mental health care. Despite growing evidence for their effectiveness, acceptance and use of these tools in clinical practice remain low. Hence, a validated and easy-to-use instrument for assessing professionals’ readiness to adopt eMental health (EMH) is necessary to gain further insights into the process of EMH adoption and facilitate future research on this topic.ObjectiveThe aim of this study is to develop and validate an instrument for assessing mental health care professionals’ readiness to adopt EMH.MethodsItem generation was guided by literature and inputs from mental health care professionals and experts in survey development. Exploratory factor analyses were conducted on an initial set of 29 items completed by a sample of mental health care professionals (N=432); thereafter, the scale was reduced to 15 items in an iterative process. The factor structure thus obtained was subsequently tested using a confirmatory factor analysis with a second sample of mental health care professionals (N=363). The internal consistency, convergent validity, and predictive validity of the eMental Health Adoption Readiness (eMHAR) Scale were assessed.ResultsExploratory factor analysis resulted in a 3-factor solution with 15 items. The factors were analyzed and labeled as perceived benefits and applicability of EMH, EMH proactive innovation, and EMH self-efficacy. These factors were confirmed through a confirmatory factor analysis. The total scale and subscales showed a good internal consistency (Cronbach α=.73-.88) along with acceptable convergent and predictive relationships with related constructs.ConclusionsThe constructed eMHAR Scale showed a conceptually interpretable 3-factor structure having satisfactory characteristics and relationships with relevant concepts. Its ease of use allows for quick acquisition of data that can contribute to understanding and facilitating the process of adoption of EMH by clinical professionals.

Development of a psychological intervention for people with bipolar disorder in rural Ethiopia

Background Evidence from high- and middle-income countries indicates that psychological interventions (PSIs) can improve the well-being of people with bipolar disorder. However, there is no evidence from low-income countries. Cultural and contextual adaptation is recommended to ensure that PSIs are feasible and acceptable when transferred to new settings, and to maximise effectiveness. Aims To develop a manualised PSI for people with bipolar disorder in rural Ethiopia. Method We used the Medical Research Council framework for the development and evaluation of complex interventions and integrated a participatory theory-of-change (ToC) approach. We conducted a mental health expert workshop (n = 12), four independent ToC workshops and a final workshop with all participants. The four independent ToC workshops comprised people with bipolar disorder and caregivers (n = 19), male community leaders (n = 8), female community leaders (n = 11) and primary care workers (n = 21). Results During the workshops, participants collaborated on the development of a ToC roadmap to achieve the shared goal of improved quality of life and reduced family burden for people with bipolar disorder. The developed PSI had five sessions: needs assessment and goal-setting; psychoeducation about bipolar disorder and its causes; treatment; promotion of well-being, including sleep hygiene and problem-solving techniques; and behavioural techniques to reduce anxiety and prevent relapse. Participants suggested that the intervention sessions be linked with patients’ monthly scheduled healthcare follow-ups, to reduce economic barriers to access. Conclusions We developed a contextually appropriate PSI for people with bipolar disorder in rural Ethiopia. This intervention will now be piloted for feasibility and acceptability before its wider implementation.

Expanding the international conversation with fathers' mental health: toward an era of inclusion in perinatal research and practice.

Paternal mental health is beginning to be recognized as an essential part of perinatal health. Historically, fathers were not recognized as being at risk for perinatal mental illnesses or relevant to maternal and infant health outcomes. The purpose of this paper is to provide an overview of paternal perinatal mental health, leading tools to assess paternal depression and anxiety, the impact of paternal mental health on mother and child health, and future directions for the field. An international team of paternal perinatal mental health experts summarized the key findings of the field. Fathers have an elevated risk of depression and anxiety disorders during the perinatal period that is associated with maternal depression and can impact their ability to support mothers. Paternal mental health is uniquely associated with child mental health and developmental outcomes starting from infancy and continuing through the child lifespan. Tailored screening approaches for paternal mental health are essential to support fathers early in the perinatal period, which would offset health risks for the family. Recommendations on paternal mental health are provided on four key areas to support father perinatal mental health: (1) intervention research, (2) clinical training, (3) national policy, and (4) the inclusion of fathers in the focus of the International Marcé Society for Perinatal Mental Health.