World Mental Health Research Articles

A longitudinal investigation of non-suicidal self-injury persistence patterns, risk factors, and clinical outcomes during the college period.

Although non-suicidal self-injury (NSSI) is known typically to begin in adolescence, longitudinal information is lacking about patterns, predictors, and clinical outcomes of NSSI persistence among emerging adults. The present study was designed to (1) estimate NSSI persistence during the college period, (2) identify risk factors and high-risk students for NSSI persistence patterns, and (3) evaluate the association with future mental disorders and suicidal thoughts and behaviors (STB). Using prospective cohorts from the Leuven College Surveys (n = 5915), part of the World Mental Health International College Student Initiative, web-based surveys assessed mental health and psychosocial problems at college entrance and three annual follow-up assessments. Approximately one in five (20.4%) students reported lifetime NSSI at college entrance. NSSI persistence was estimated at 56.4%, with 15.6% reporting a high-frequency repetitive pattern (≥five times yearly). Many hypothesized risk factors were associated with repetitive NSSI persistence, with the most potent effects observed for pre-college NSSI characteristics. Multivariate models suggest that an intervention focusing on the 10-20% at the highest predicted risk could effectively reach 34.9-56.7% of students with high-frequency repetitive NSSI persistence (PPV = 81.8-93.4, AUC = 0.88-0.91). Repetitive NSSI persistence during the first two college years predicted 12-month mental disorders, role impairment, and STB during the third college year, including suicide attempts. Most emerging adults with a history of NSSI report persistent self-injury during their college years. Web-based screening may be a promising approach for detecting students at risk for a highly persistent NSSI pattern characterized by subsequent adverse outcomes.

10‐year‐plus national movement launched to combat MH stigma

In observance of World Mental Health Day on Oct. 10, more than 175 organization leaders from around the country gathered to announce the launch of “Stop Stigma Together,” a national movement to end the stigma around mental health and substance use disorders. The event kicked off a three‐day summit for organizations representing various industries and sectors to create strategic actions to end stigma.

Adherence to aerobic and muscle-strengthening components of the physical activity guidelines and mental health.

Despite a clear distinction between aerobic and muscle strengthening (MS) components in the physical activity guidelines, public health surveillance has largely focused only on aerobic components, limiting the reach of epidemiological research on the physical activity guidelines. Hence, this study investigated the association between adherence to both components (i.e. aerobic and muscle-strengthening) of the World Health Organization's physical activity guidelines and mental health among the college student population. A cross-sectional study was conducted among a nationally representative sample of Irish college students (7088 participants, M age: 23.17 years; 50.9% female). Participants were categorized as meeting both components of the guidelines (n = 41%), only the aerobic component (n = 25.3%) or the MS component (n = 7.3%), and neither (n = 26.4%). Group membership effects on mental health was determined through mixed univariate ANOVAs, with a Bonferroni correction for post hoc analyses to assess multiple comparisons. Results revealed that meeting both components of the guidelines was significantly (all p < 0.01) associated with greater self-reported happiness, body image and general health, and less mental ill-being, relative to all other respective groupings. Meeting aerobic or MS components in isolation was significantly (p < 0.05) associated with better happiness, general health and body image compared to not meeting either component. To conclude, 59% of the college-aged population are insufficiently active, and adherence to both guideline components is positively associated with mental health. Co-produced, evidence-based, physical activity interventions are needed in students and could contribute to mental health promotion.

The Trevor Project announced Janelle Monáe as the recipient of its 2022 Suicide Prevention Advocate of the Year Award

The Trevor Project, the world's largest suicide prevention and mental health organization for lesbian, gay, bisexual, transgender, queer &amp; questioning (LGBTQ) young people, announced Janelle Monáe as the recipient of its 2022 Suicide Prevention Advocate of the Year Award. The award recognizes influential public figures for their unwavering commitment to LGBTQ mental health awareness, the celebrity news website, Look to the Stars, reported Sept. 27. The Trevor Project's second annual award marks September as National Suicide Prevention Awareness Month and amplifies its mission to end suicide among LGBTQ young people. The Grammy nominated singer‐songwriter, actor, and author has been a longtime champion for the LGBTQ community and supporter of conversations around mental health. A fierce advocate and activist, Monáe has consistently used their platform to elevate the voices and experiences of marginalized people.

The WHO World Mental Health Report 2022: a new standard of care is emerging.

The WHO World Mental Health Report 2022: a new standard of care is emerging.

A lived experience perspective on the new World Mental Health Report

A lived experience perspective on the new World Mental Health Report

The World Mental Health Report: transforming mental health for all.

The World Mental Health Report: transforming mental health for all.

Use of mental health services and perceived barriers to access services among college students with suicidal ideation

Suicide is an important public health issue in France, where the suicide rate is among the highest in Europe. While suicidal thoughts and behaviors are prevalent among young adults including college students, an important gap exists between the presence of psychological difficulties and the use of mental health services. Using data drawn from the French portion of the World Mental Health International College Student survey initiative (WMH-ICS), the current study investigates the use of mental health services among college students with 12-month suicidal ideation and examines the barriers identified by students who did not receive care, and include cohorts enrolled pre-pandemic and during the pandemic. Only one quarter received services and among those who did not, one half reported a perceived need. Prior services use, any anxiety disorder, depressive disorder, and suicide attempt were associated with the use of services in the past 12 months. The most frequently reported barriers were wanting to handle the problem on their own, being unsure of where to go or who to see, and being too embarrassed. The pandemic context was associated neither with services use nor with greater reported barriers. These findings underline the gap in mental health services use among college students despite the accessibility of mental health services in France. Identifying the barriers which restrict the use of mental health services among students could contribute to identifying specific targets for prevention, and facilitate access to appropriate services.

One-year incidence, predictors, and accuracy of prediction of suicidal thoughts and behaviors from the first to second year of university.

Research is scarce on the prospective predictors of first onset suicidal thoughts and behaviors (STB) and the accuracy of these predictors in university students, particularly in low-and-middle income countries. Therefore, we assessed the 1-year incidence of STB among first-year students, a broad range of prospective predictors of STB incidence, and evaluated the prediction accuracy of a baseline multivariate risk prediction model to identify students at highest risk for STB onset over the subsequent 12 months. Students (n = 3238) from 13 universities in Mexico completed an online survey developed for the World Mental Health International College Student Surveys in their first year and again 12 months after. We ran generalized linear models and receiver operator curves. The 1-year incidence of suicidal ideation, plan and attempt was 8.53%, 3.75%, and 1.16%, respectively. Predictors in final models were female sex (ideation only), minority sexual orientation (ideation only), depression, eating disorders, ADHD (ideation and plan), ongoing arguments or breakup with a romantic partner (ideation only), emotional abuse (ideation only), parental death (ideation, plan), not Catholic/Christian (ideation, plan), not having someone to rely on, psychotic experiences (plan only), and insufficient sleep (attempt only). Prediction accuracy for ideation, plan and attempt was area under the curve = 0.76, 0.81 and 0.78, respectively. Targeting the top 10% of students at highest risk could reduce STB in the subsequent year up to 36%. By assessing these risk/protective factors in incoming students we identified students at greatest risk for developing STB to whom suicide prevention strategies could be targeted.

Perceived stigma and discrimination among persons with mood and anxiety disorders: Results from the WHO World Mental Health Survey Portugal

Background and objectivesThe stigma attached to mental disorders remains a public health challenge, represents an important barrier to healthcare and widens existing social inequalities.This study aimed to characterize the association between perceived stigma and mental disorders. The two main objectives were to estimate the association between perceived stigma and 12-month anxiety and mood disorders, and to assess the factors associated with perceived stigma among persons with these mental disorders. MethodsA nationally representative sample of the Portuguese population was used. Participants were Portuguese-speaking adults, aged 18 or above and residing in permanent dwellings in the country's mainland. The survey was administered by trained lay interviewers using a computer assisted personal interview (CAPI) on a face-to-face setting. ResultsThe results showed a two-fold increase in the likelihood of experiencing stigma among individuals with 12-month anxiety and mood disorders, slightly higher in the latter, when compared with individuals without. Among the sub-sample with these mental disorders, participants retired (or others), with psychiatric comorbidity and with co-occurrence of psychiatric and physical disorders had higher odds of reporting perceived stigma. ConclusionsThe findings of this study highlight the need to consider stigma as a public health priority in Portugal and to develop policies to create awareness and promote the social inclusion of persons with mental disorders.

The World Mental Health International College Student Survey in Canada: Protocol for a Mental Health and Substance Use Trend Study.

BackgroundThe World Health Organization World Mental Health International College Student (WMH-ICS) initiative aims to screen for mental health and substance use problems among postsecondary students on a global scale as well as to develop and evaluate evidence-based preventive and ameliorative interventions for this population. This protocol paper presents the Canadian version of the WMH-ICS survey, detailing the adapted survey instrument, the unique weekly cross-sectional administration, the multitiered recruitment strategy, and the associated risk mitigation protocols.ObjectiveThis paper aims to provide a methodological resource for researchers conducting cross-national comparisons of WMH-ICS data, as well as to serve as a useful guide for those interested in replicating the outlined cross-sectional methodology to better understand how mental health and substance use vary over time among university students.MethodsThe online survey is based on the WMH-ICS survey instrument, modified to the Canadian context by the addition of questions pertaining to Canadian-based guidelines and the translation of the survey to Canadian French. The survey is administered through the Qualtrics survey platform and is sent to an independent stratified random sample of 350 students per site weekly, followed by two reminder emails. Upon survey closure every week, a random subsample of 70 nonresponders are followed up with via phone or through a personal email in an effort to decrease nonresponder bias. The survey is accompanied by an extensive risk mitigation protocol that stratifies respondents by the level of need and provides tailored service recommendations, including a facilitated expedited appointment to student counseling services for those at increased risk of suicide. The anticipated sample size is approximately 5500 students per site per year.ResultsIn February 2020, the Canadian survey was deployed at the University of British Columbia. This was followed by deployment at Simon Fraser University (November 2020), McMaster University (January 2021), and the University of Toronto (January 2022). Data collection at all 4 sites is ongoing. As of May 6, 2022, 29,503 responses have been collected.ConclusionsBased on international collaboration, the Canadian version of the WMH-ICS survey incorporates a novel methodological approach centered on the weekly administration of a comprehensive cross-sectional survey to independent stratified random samples of university students. After 27 months of consecutive survey administration, we have developed and refined a survey protocol that has proven effective in engaging students at four Canadian institutions, allowing us to track how mental health and substance use vary over time using an internationally developed university student survey based on the criteria from the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition).International Registered Report Identifier (IRRID)RR1-10.2196/35168

Increased risks for mental disorders among LGB individuals: cross-national evidence from the World Mental Health Surveys

PurposeLesbian,gay, and bisexual (LGB) individuals, and LB women specifically, have anincreased risk for psychiatric morbidity, theorized to result from stigma-baseddiscrimination. To date, no study has investigated the mental healthdisparities between LGB and heterosexual AQ1individuals in a largecross-national population-based comparison. The current study addresses thisgap by examining differences between LGB and heterosexual participants in 13cross-national surveys, and by exploring whether these disparities wereassociated with country-level LGBT acceptance. Since lower social support hasbeen suggested as a mediator of sexual orientation-based differences inpsychiatric morbidity, our secondary aim was to examine whether mental healthdisparities were partially explained by general social support from family andfriends.MethodsTwelve-monthprevalence of DSM-IV anxiety, mood, eating, disruptive behavior, and substancedisorders was assessed with the WHO Composite International DiagnosticInterview in a general population sample across 13 countries as part of theWorld Mental Health Surveys. Participants were 46,889 adults (19,887 males; 807LGB-identified).ResultsMaleand female LGB participants were more likely to report any 12-month disorder (OR2.2, p < 0.001 and OR 2.7, p < 0.001, respectively) and most individualdisorders than heterosexual participants. We found no evidence for anassociation between country-level LGBT acceptance and rates of psychiatricmorbidity between LGB and heterosexualAQ2 participants. However, among LBwomen, the increased risk for mental disorders was partially explained by lowergeneral openness with family, although most of the increased risk remainedunexplained.ConclusionThese results provide cross-national evidence for an association between sexual minority status and psychiatric morbidity, and highlight that for women, but not men, this association was partially mediated by perceived openness with family. Future research into individual-level and cross-national sexual minority stressors is needed.

Social anxiety disorder and childhood adversities in Portugal: Findings from the WHO world mental health survey initiative

Social anxiety disorder (SAD) is one of the most underrecognized and undertreated common mental disorders. This study aimed to describe its epidemiology and to understand the association between childhood adversities and SAD in the context of Portugal's collectivist culture. Data about SAD, childhood adversities, socio-demographic variables were collected from a nationally representative sample using well-validated scales employed for the World Mental Health Survey. Logistic and linear regression models were carried out to explore the association between childhood adversities and SAD prevalence and age of onset. The estimated lifetime prevalence of SAD was 4.68% and the 12-month prevalence was 3.14%. The mean age of onset was 13.6 ± 8.79. People with a college education had 3.42 higher odds of having SAD compared to people with no education or a primary school education. Most childhood adversities significantly increased the odds of a lifetime prevalence of SAD. Parental Maladjustment increased the odds of SAD when gender, age, and education were adjusted. The study findings show a relatively high prevalence of SAD in Portugal and confirms that females, younger people, students, and single people are more likely to have SAD. The study highlights the need to address experiences of parental maladjustment in interventions for people with SAD in Portugal.

The associations between traumatic experiences and subsequent onset of a substance use disorder: Findings from the World Health Organization World Mental Health surveys

AimExposure to traumatic events (TEs) is associated with substance use disorders (SUDs). However, most studies focus on a single TE, and are limited to single countries, rather than across countries with variation in economic, social and cultural characteristics. We used cross-national data to examine associations of diverse TEs with SUD onset, and variation in associations over time. MethodsData come from World Mental Health surveys across 22 countries. Adults (n = 65,165) retrospectively reported exposure to 29 TEs in six categories: “exposure to organised violence”; “participation in organised violence”; “interpersonal violence”; “sexual-relationship violence”; “other life-threatening events”; and those involving loved ones (“network traumas”). Discrete-time survival analyses were used to examine associations with subsequent first SUD onset. ResultsMost (71.0%) reported experiencing at least one TE, with network traumas (38.8%) most common and exposure to organised violence (9.5%) least. One in five (20.3%) had been exposed to sexual-relationship violence and 26.6% to interpersonal violence. Among the TE exposed, lifetime SUD prevalence was 14.5% compared to 5.1% with no trauma exposure. Most TE categories (except organised violence) were associated with increased odds of SUD. Increased odds of SUD were also found following interpersonal violence exposure across all age ranges (ORs from 1.56 to 1.78), and sexual-relationship violence exposure during adulthood (ORs from 1.33 to 1.44), with associations persisting even after >11 years. ConclusionSexual and interpersonal violence have the most consistent associations with progression to SUD; increased risk remains for many years post-exposure. These need to be considered when working with people exposed to such traumas.

Depression Among Health Workers: A Study at the Ho Teaching Hospital in Ghana

Objective: The current study is an effort to examine the level of depression and associated factors among health workers in Ghana.Methodology: The Patient Health Questionnaire 9 (PHQ- 9) was used to screen 127 health workers of the Ho Teaching Hospital. These were participants who presented themselves for screening at the facility during the 2019 world mental health celebration in Ghana.Results: Descriptive analysis revealed that over 30% of participants experience moderate level of depression with females experiencing higher levels than males. However, inferential analysis revealed that differences in the levels of depression are not significant withregards to gender and department/job description, as well as no significance age impact on depression. However, married health worker reported significantly lower level of depression compared to health workers who are not married.Conclusion: Health workers experience depression. Some factors determine the levels of these condition, thereby requiring further investigations.

Identifying eating disorders in adolescents and adults with overweight or obesity: A systematic review of screening questionnaires.

ObjectiveThis review aimed to examine the validity of self‐report screening questionnaires for identifying eating disorder (ED) risk in adults and adolescents with overweight/obesity.MethodFive databases were searched from inception to September 2020 for studies assessing validation of self‐report ED screening questionnaires against diagnostic interviews in adolescents and adults with overweight/obesity. The review was registered with PROSPERO (https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=220013).ResultsTwenty‐seven papers examining 15 questionnaires were included. Most studies validated questionnaires for adults (22 of 27 studies), and most questionnaires (12 of 15) screened for binge eating or binge‐eating disorder (BED). The Eating Disorder Examination Questionnaire (sensitivity = .16–.88, specificity = .62–1.0) and Questionnaire on Eating and Weight Patterns (sensitivity = .07–1.0, specificity = .0–1.0) were most frequently validated (six studies each). Five studies of three questionnaires were in adolescents, with the Adolescent Binge‐Eating Disorder Questionnaire having highest sensitivity (1.0) but lower specificity (.27). Questionnaires designed to screen for BED generally had higher diagnostic accuracy than those screening for EDs in general.DiscussionQuestionnaires have been well validated to identify BED in adults with overweight/obesity. Validated screening tools to identify other EDs in adults and any ED in adolescents with overweight/obesity are lacking. Thus, clinical assessment should inform the identification of patients with co‐morbid EDs and overweight/obesity.Public SignificanceIndividuals with overweight/obesity are at increased risk of EDs. This review highlights literature gaps regarding screening for ED risk in this vulnerable group. This work presents possibilities for improving care of individuals with overweight/obesity by reinventing ED screening tools to be better suited to diverse populations.

What can we learn about polytrauma typologies by comparing population-representative to trauma-exposed samples: A Nepali example

BackgroundPotentially traumatic events (PTEs) are common and associated with detrimental outcomes over the life-course. Previous studies exploring the causes and consequences of PTE-exposure profiles are often from high-income settings and fail to explore the implications of sample selection (i.e., population-representative versus PTE-restricted). MethodsAmong individuals in the Nepal Chitwan Valley Family Study, latent class analyses (LCA) were performed on 11 self-reported PTEs collected by the Nepali version of the World Mental Health Consortium's Composite International Diagnostic Interview 3.0 from 2016 to 2018, in a population-representative sample (N = 10,714), including a PTE-restricted subsample (N = 9183). Multinomial logistic regressions explored relationships between sociodemographic factors and class membership. Logistic regressions assessed relationships between class membership and psychiatric outcomes. ResultsOn average, individuals were exposed to 2 PTEs in their lifetime. A five-class solution showed optimal fit for both samples; however, specific classes were distinct. No single sociodemographic factor was universally associated with PTE class membership in the population-representative sample; while several factors (e.g., age, age at incident PTE, education, marital status, and migration) were consistently associated with class membership in the PTE-subsample. PTE class membership differentiated psychiatric outcomes in the population-representative sample more than the PTE-subsample. LimitationsPrimary limitations are related to the generalizability to high-income settings, debate on LCA model fit statistic usage for final class selection, and cross-sectional nature of data collection. ConclusionsAlthough population-representative samples provide information applicable to large-scale, population-based programming and policy, PTE-subsample analyses may provide additional nuance in PTE profiles and their consequences, important for specialized prevention efforts.

Early menarche and adult major depressive disorder among Japanese women: The role of childhood traumatic experience and socioeconomic conditions in young adulthood.

The aim of this study is to examine the long-term impact of early menarche with adult depression, and to assess whether this association was explained by childhood traumatic experience and socioeconomic condition in early adulthood. The data were derived from World Mental Health Survey Japan Second, a cross-sectional survey conducted among Japanese community residents between 2013 and 2015. We used the data of female respondents aged 20-75 years (N = 1171). Hazard ratio (HR) of the onset of major depression up to 40 years was calculated for an early-menarche group and a non-early-menarche group, respectively. Kaplan-Meier curve and log-rank statistics were used to examine the difference in failure. Cox proportional hazard models were administered for the association of major depression with early-menarche and early-life psychosocial factors. Risk for major depressive disorders were three to four times higher in an early-menarche group, and the differences in survival functions were significant (p < 0.001). HR of early menarche was 2.79 (95% CI = 1.29-6.02), and was slightly changed when childhood traumatic experience and socioeconomic conditions in young adulthood were added in the model (HR = 2.88, 95% CI = 1.30-6.38; HR = 3.19, 95% CI = 1.41-7.21). Early menarche was significantly associated with increased risk for depression by the age of 40 years. Childhood trauma and socioeconomic hardship in early adulthood did not account for the association. Both physical and psychosocial risk factors in early life need to be addressed for preventing women's depression.

Enhancing Hopeful Resilience Regarding Depression and Anxiety with a Narrative Method of Ordering Memory Effective in Researchers Experiencing Burnout

Depression and anxiety are prevalent, persistent, and difficult to treat industrialized world mental health problems that negatively modify an individual’s life perspective through brain function imbalances—notably, in the amygdala and hippocampus. Primarily treated with pharmaceuticals and psychotherapy, the number of individuals affected plus the intensity of their suffering continues to rise post-COVID-19. Decreasing depression and anxiety is a major societal objective. An approach is investigated that considers depression and anxiety consequences of the particular method people adopt in ordering their memories. It focuses on narrative development and the acceptance of different perspectives as uniquely necessary in creating safe protection from research burnout. The method encourages thoughtful reconsideration by participants of the negative assessments of their circumstances that can lead to depression and anxiety. The aim is to determine if the method of ordering developed is helpful in reducing burnout. This is considered through inspecting and comparing group members’ feedback form results, both pre- and post-COVID-19 restrictions. The method found useful to participants in reducing research burnout through developing hopeful resilience is comparable to authentic leadership. The conclusions offered encourage psychological and neurological research with respect to this method of promoting hopeful resilience for burnout to diminish depression and anxiety.

Determinants of effective treatment coverage for major depressive disorder in the WHO World Mental Health Surveys

BackgroundMost individuals with major depressive disorder (MDD) receive either no care or inadequate care. The aims of this study is to investigate potential determinants of effective treatment coverage.MethodsIn order to examine obstacles to providing or receiving care, the type of care received, and the quality and use of that care in a representative sample of individuals with MDD, we analyzed data from 17 WHO World Mental Health Surveys conducted in 15 countries (9 high-income and 6 low/middle-income). Of 35,012 respondents, 3341 had 12-month MDD. We explored the association of socio-economic and demographic characteristics, insurance, and severity with effective treatment coverage and its components, including type of treatment, adequacy of treatment, dose, and adherence.ResultsHigh level of education (OR = 1.63; 1.19, 2.24), private insurance (OR = 1.62; 1.06, 2.48), and age (30–59yrs; OR = 1.58; 1.21, 2.07) predicted effective treatment coverage for depression in a multivariable logistic regression model. Exploratory bivariate models further indicate that education may follow a dose—response relation; that people with severe depression are more likely to receive any services, but less likely to receive adequate services; and that in low and middle-income countries, private insurance (the only significant predictor) increased the likelihood of receiving effective treatment coverage four times.ConclusionsIn the regression models, specific social determinants predicted effective coverage for major depression. Knowing the factors that determine who does and does not receive treatment contributes to improve our understanding of unmet needs and our ability to develop targeted interventions.