Mental Health Prevention and Promotion-A Narrative Review

Beyond the Unitary: Direct, Moderated, and Mediated Associations of Mindfulness Facets with Mental Health Literacy and Treatment-Seeking Attitudes

BACKGROUND AND OBJECTIVES

Psychological disorders are prevalent and distressing. Early treatment initiation can prevent adverse outcomes and reduce healthcare system impacts. Improving mental health literacy (MHL)-one's knowledge regarding psychological disorders-and treatment-seeking attitudes (TSAs) is key in early treatment initiation. Examining the facets of dispositional mindfulness-the capacity to pay attention to present-moment experiences with acceptance-may offer more granular insights into understanding MHL and TSAs. This study examined (a) associations between mindfulness facets and MHL and TSAs, (b) facets' prediction of MHL and TSAs beyond demographics, (c) moderation of the MHL-TSA relationship by mindfulness facets, and (d) mediation of mindfulness-TSA relationships via general self-efficacy (GSE).

METHODS

A community sample of 299 adults was recruited online (TurkPrime) and completed demographic questions and self-report measures: Five-Facet Mindfulness Questionnaire-15, Mental Health Literacy Scale, Mental Help-Seeking Attitudes Scale, and General Self-Efficacy Scale.

RESULTS

Describe, Non-Judgment, and Act with Awareness were modestly associated with MHL; all five facets correlated with TSAs. Hierarchical regressions controlling for demographics showed that Describe and Non-Reactivity predicted MHL, while Act with Awareness uniquely predicted TSAs. Non-Reactivity moderated the MHL-TSA relationship, with higher Non-Reactivity amplifying the relationship. GSE fully mediated relationships between Observe and Non-Judgment with TSAs, suggesting self-efficacy is a key mechanism of these facets.

CONCLUSIONS

Interventions cultivating Non-Reactivity, Describe, and Act with Awareness may improve the translation of mental health knowledge into treatment-seeking behaviors. Future research should explore how mindfulness facets independently and interactively foster early intervention and treatment engagement.

Long-term effectiveness of the Mindful Self-Compassion programme compared to a Mindfulness-Based Stress Reduction intervention: a quasi-randomised controlled trial involving regular mindfulness practice for 1 year

Introduction

This study compares the Mindful Self-Compassion (MSC) programme with the Mindfulness-Based Stress Reduction (MBSR), a well-established intervention, and a control group, and includes 1 year of continuous practice.

Methods

A longitudinal quasi-RCT was conducted with measurements at baseline, post-training, 6 months and 1 year. A total of 170 individuals (75.9% female) were randomly assigned to the MSC (n = 48) and MBSR (n = 65) groups, with a non-fully randomised wait-list CG (n = 57).

Results

Using intention-to-treat (ITT) and per-protocol (PP) analysis strategies, results consistently indicated that standard 8-week MSC and MBSR trainings produced benefits on anxiety, depression, perceived stress, and positive and negative affect, as well as on variables related to psychological flexibility, compared with CG. These gains were maintained over a year of continuous practice in both training groups. Overall, the two programmes, MSC and MBSR, showed a similar trajectory over the measurement periods.

Discussion

The 8-week MSC programme and the regular practice of mindfulness and self-compassion appear to be an effective intervention for promoting mental health in the general population, with benefits similar to those derived from the practice of exercises from well-known mindfulness programmes such as MBSR.

A Study Protocol of Primary Prevention Interventions for Substance Use and Suicide Prevention Among Youth in Kashmir: Development, Administration, and Evaluation

Background

Given the unique geopolitical positioning of Kashmir and its susceptibility to addiction and suicide, we present a protocol study that aims to design culturally tailored primary prevention for youth in Kashmir.

Novelty

This study is the first attempt in the region to design and test a culturally tailored primary prevention intervention for youth mental health in Kashmir.

Objectives

It aims to design culturally tailored primary prevention for youth in Kashmir and test it on the high-risk population.

Methods

The study has three stages. (a) estimating risk factors for substance-use disorders (SUDs) and suicide in Kashmir among youth (16-24 years of age), (b) adapting an existing primary prevention intervention and psycho-social interventions to the culture-specific risk factors operating in Kashmir, (c) screening the at-risk youth in schools and colleges, (d) selecting suitable sample for pre/post-evaluation design, (e) administering a culturally-tailored primary-prevention intervention to the selected sample, and (f) evaluating the outcome variables which include parameters of symptom reduction and improved well-being. Data shall be analyzed utilizing both qualitative and quantitative methods. Risk factors will be estimated using thematic analysis. A culturally tailored primary prevention intervention will be designed by adapting an existing dialectical behavioral therapy skill training module to the Kashmir context. The effectiveness of the designed intervention will be evaluated through pre-and post-tests.

Expected Outcomes

The study will provide a solid foundation for the mental health curriculum in schools and colleges. It is expected to reduce the number of mental disorders and contribute to a sustainable, mentally healthy Kashmir.

Culturally Tailored Community Brain Health Education for Chinese Americans Aged 50 or Above: A Mixed-Methods Open Pilot Study

Background: Chinese Americans, the largest Asian American subgroup in the U.S., face linguistic, cultural, and socio-economic barriers to dementia prevention. To promote brain health in this population, a culturally tailored community approach is essential. This study evaluates a culturally tailored community brain health education program to enhance brain health knowledge and motivate lifestyle changes to prevent the risk of dementia among Chinese Americans aged 50 or older. Methods: The program was developed and evaluated in four phases. First, we assessed participants' interests in brain health topics, availability, and preferred delivery modes. Next, experts on the identified topics developed educational content and outcome assessments. The third phase focused on implementing a six-session program covering general knowledge about Alzheimer's disease and related dementias, diet, sleep, physical exercise, health checks, and mindfulness. Finally, we evaluated the program's feasibility and effectiveness using pre-post surveys, feedback questionnaires, and focus groups. Results: Seventy-seven participants registered for the program, and sixty-nine (90%) attended at least four sessions. The quantitative results, based on paired t-tests, showed significant increases in brain health knowledge, sleep quality, and behavioral motivation for lifestyle changes, and a decrease in depressive symptoms, with two-tailed p-values lower than 0.05. The qualitative results further revealed promising feasibility and acceptability, as well as the perceived benefits of the program. Conclusions: The findings highlight the feasibility, acceptability, and potential effectiveness of a culturally tailored community education approach for promoting brain health and lifestyle changes. Sustained community outreach and education efforts among Chinese Americans are needed.

A Scoping Review of Prevention Classification in Mental Health: Examining the Application of Caplan's and Gordon's Prevention Frameworks (2018-2024)

Mental health prevention is a global priority owing to the increasing burden of mental disorders exacerbated by global crises such as the COVID-19 pandemic, climate change, economic instability, and armed conflicts. These crises have heightened the need for effective preventive strategies addressing mental health across different life stages and populations. To structure and classify such strategies, Caplan's and Gordon's frameworks have been widely used, with one focusing on disease progression and the other on population risk. Although both frameworks are frequently used in mental health prevention, their application in clinical trials remains unexplored. This review addresses this gap by examining how Caplan's and Gordon's frameworks have been applied in mental health prevention, identifying research gaps, and exploring their potential for their combined application to enhance prevention strategies. A scoping review was conducted following PRISMA-ScR guidelines. Studies were selected based on predefined criteria and the data were synthesized. The search spanned PubMed, Scopus, APA PsycArticles, and PubPsych, covering peer-reviewed clinical trials, including randomized controlled trials, published between 2018 and 2024 in English or German. Eligible studies classified interventions based on Caplan's framework, which focuses on disease stage (primary, secondary, tertiary), or Gordon's framework, which categorizes prevention by population risk (universal, selective, indicated). Studies had to focus on mental health prevention, include populations relevant to mental health and well-being, and report mental health or well-being outcomes. Of the 40 included studies, six applied Caplan's framework, 30 applied Gordon's framework and three used a modified classification based on Gordon's approach. One study applied both frameworks, highlighting that their complementary use is rare. Studies were conducted in 19 countries, with the highest number from Germany (n = 8), the USA (n = 8), and the Netherlands (n = 6), across four continents (Asia, n = 5; Australia, n = 5; Europe, n = 22; North America, n = 8). Gordon's framework was applied more frequently, particularly in universal (n = 15) and indicated prevention (n = 12), while Caplan's framework was used mainly in primary prevention (n = 4). Depression (n = 25), anxiety (n = 21), stress (n = 8), and general mental health (n = 8) were the most frequently assessed outcomes. The studies targeted diverse populations, including children (n = 7), adolescents (n = 8), children and adolescents (n = 1) parents and their children or adolescents (n = 2), university students (n = 6), working adults (n = 7), older adults (n = 1), and adults without specifying (n = 8). This review highlights the underutilized potential of integrating Caplan's and Gordon's frameworks in mental health interventions. Two application examples illustrate how these frameworks can be combined to structure prevention strategies more effectively. Future research should explore combining these frameworks to enhance prevention strategies and address the emerging global health challenges.

Promoting mental health in the age of new digital tools: balancing challenges and opportunities of social media, chatbots, and wearables

The promotion of mental health is essential for global health, affecting millions with disorders such as anxiety and depression. Although stigma and discrimination hinder progress, these conditions are often preventable or manageable at minimal cost. The adoption of digital tools in mental health promotion, including telemedicine, online therapy, social media, and wearables, offers promising new avenues to address these issues. This review proposes a framework that focuses on the use of digital tools to enhance health literacy, foster behavioral change, and support sustained positive health behaviors. Platforms such as TikTok, Facebook, and Instagram can effectively disseminate health information, increase awareness, and enhance social accountability. Artificial intelligence-driven virtual agents offer personalised mental health interventions, providing motivational support and customised advice. Additionally, wearable technology (e.g., fitness trackers and smartwatches) enables real-time monitoring of vital health metrics, encouraging ongoing healthy activities. Nonetheless, these technologies introduce challenges including privacy issues, data security, and equitable access to digital resources, raising a new class of rights to protect mental privacy, guard against algorithm bias, and prevent personality-changing manipulations. The absence of human interaction in fully digital solutions also raises concerns about a lack of empathy and emotional connection. For optimal use of digital tools in mental health, integration with conventional care practices and adaptation to diverse cultural and social backgrounds are necessary. The results of this review suggest that digital tools, when carefully implemented, can significantly improve mental health outcomes by making care more accessible, tailored, and effective, especially for underserved communities.

BePresent Universal Internet-Based Parenting Intervention: Single-Arm Pre-Post Intervention Study

BACKGROUND

Internet-based parenting programs have great potential to promote positive parent-child relationships as well as to reach and engage parents.

OBJECTIVE

This study aimed to assess the universal internet-based BePresent parenting intervention for families with 3-year-old children and how it influences the child's behavior and daily-life situations assessed by parents. The first aim of the study was to assess the change from baseline to follow-up in child hyperactivity and conduct problems, affective reactivity, and daily activities. The second aim was to assess intervention completion rates. The third aim was to evaluate parent satisfaction with the intervention. The fourth aim was to assess all outcomes by comparing those who completed the intervention and those who did not.

METHODS

We conducted a single-arm pre- and postintervention study. Parents attending their child's 3-year health check-up were recruited from children's health clinics. The intervention was an unguided internet-based parenting program consisting of 5 modules. Self-reported measures were collected at baseline and at an 8-week follow-up. Linear mixed-effects models were used to analyze the changes from baseline to follow-up.

RESULTS

Altogether, 752 parents registered, and 515 started the intervention. Of those, 36% (n=183) completed the intervention. Parents reported high satisfaction with the intervention: the majority (68.8%-84.9%) were satisfied with various aspects of the program, and 89.9% said the intervention provided information about positive parenting skills. The findings show significant decreases with small effect sizes in parents' ratings of child hyperactivity (P=.03; d=0.12) and conduct problems (P=.001; d=0.20) between baseline and the 8-week follow-up. A similar finding was observed in the parent ratings of child irritability (P≤.001; d=0.27) using the Affective Reactivity Index. Parents reported improvement in the daily functioning of their child when it was measured with a questionnaire adapted from the Barkley Home Situations Questionnaire (P=.01; d=0.14).

CONCLUSIONS

Universal digital interventions have the potential to be implemented widely in community settings to improve knowledge and positive parenting skills. However, there is a need to assess the efficacy of digital universal interventions using randomized controlled designs and to examine additional ways to increase adherence to universal programs.

Next stop - mental health: a qualitative study of healthcare journeys from the perspective of young adults in Sweden

BACKGROUND

Help-seeking for mental health problems is a complex process that involves handling both personal challenges and dealing with the organizational structure of the healthcare system. The healthcare system is siloed and fragmented, but it is unclear how the challenges are experienced by the young adults and what their healthcare journeys look like. Therefore, the aim of this study was to explore experiences of young adults' healthcare journeys in the context of help-seeking for common mental health problems.

METHODS

In total, 25 young adults (16 women and 9 men) from a student healthcare centre at a Swedish university seeking help for common mental health problems, such as anxiety and depression, were interviewed. A qualitative thematic analysis with an inductive approach was done, and results were abstracted and presented in terms of journey-related metaphors.

RESULTS

The healthcare journeys of young adults were described as Taxi Riding, Commuting, Sightseeing, and Backpacking. Taxi riding and Commuting are defined by going in a straightforward and smooth way in the healthcare system, without major obstacles to care. In contrast, Sightseeing and Backpacking are characterized by more diffuse and negative experiences, where the young adults are not satisfied with the help received from healthcare providers. Help-seeking is not conformant with the design of the healthcare system but steered by a range of factors, including individual experiences and young adults' agency, the available resources at the various healthcare providers, and interaction with healthcare professionals.

CONCLUSIONS

Young adults' healthcare journeys in the context of help-seeking for common mental health problems are related to individual, relational, and organizational factors. Some journeys run smoothly, epitomizing a functioning healthcare system that accommodates a rational help-seeker. Other journeys depict a rigid healthcare system, where the success and nature of the journey primarily depend on individual agency and on not becoming discouraged by obstacles. There is a need for more knowledge on how to support young adults' mental health help-seeking. However, we also need more insights into how the healthcare system can become more receptive and accommodating toward the needs of young adults with common mental health problems.

Digital intervention for tokophobia: a randomized controlled trial of internet-based cognitive behavioral therapy on fear of childbirth and self-efficacy among Egyptian pregnant women

BACKGROUND

Tokophobia affects up to 14% of pregnant women globally and is linked to high cesarean rates, particularly in Egypt. This study evaluated the efficacy of a culturally adapted Internet-based Cognitive Behavioral Therapy program on fear of childbirth and maternal self-efficacy among Egyptian pregnant women.

METHODS

A randomized controlled trial was conducted in Damanhur City, Egypt, involving 96 pregnant women with moderate to severe tokophobia. Participants were randomly assigned to an intervention group (n = 48) receiving a six-week program via WhatsApp or a control group (n = 48) receiving routine antenatal care. The intervention included cognitive restructuring, exposure therapy, relaxation techniques, and psychoeducation grounded in Bandura's Self-Efficacy Theory. Outcomes were assessed using the Childbirth Attitude Questionnaire and Childbirth Self-Efficacy Inventory at baseline and post-intervention.

RESULTS

Post-intervention, the intervention group demonstrated a significant reduction in fear of childbirth scores (mean decrease: 14.32 ± 5.55; p < 0.001) and an increase in maternal self-efficacy (mean increase: 38.3 ± 35.7; p < 0.001). Large effect sizes were observed for both fear reduction (η²=0.876) and self-efficacy enhancement (η²=0.600). The control group showed no significant changes.

CONCLUSION

The culturally adapted Internet-based Cognitive Behavioral Therapy program significantly reduced tokophobia and enhanced maternal self-efficacy, supporting its integration into perinatal care. These findings align with Bandura's Self-Efficacy Theory and suggest the potential of digital interventions in improving psychological outcomes, especially in resource-limited settings.

IMPLICATIONS FOR PRACTICE

Integrating the program into routine antenatal care could provide accessible, cost-effective support for women experiencing tokophobia, potentially reducing unnecessary cesarean sections and informing health policy regarding the effectiveness of the ICBT program. Future research should assess long-term outcomes and generalizability in diverse populations.

TRIAL REGISTRATION

The study was registered on ClinicalTrials.gov under the identifier (NCT06640608) on October 15, 2024.

Evaluating the Acceptability and Impact of an Online, Lifestyle-Based Mental Well-Being Initiative Targeting School Communities in New York State - Lifting the School Community Project

PURPOSE

To determine the acceptability and impact of an online, lifestyle-based mental well-being initiative in a school-based setting.

APPROACH

A post-program evaluation survey was administered after the intervention.

SETTING

Fifty-seven New York State school districts.

PARTICIPANTS

Participating school districts invited all employees and community members to register for the intervention. A total of 4083 individuals participated, with 1060 (26%) responding to the post-program survey.

INTERVENTION

The 7-week intervention (The Lift Project) incorporated strategies from lifestyle medicine, positive psychology and neuroscience literature. The ten lessons included online, video-based content and related experiential learning exercises.

METHODS

The post-program survey included Likert items that evaluated the participants' perceived program acceptability, mental health enhancement, self-efficacy, and skill acquisition. Inductive thematic qualitative analysis assessed the participants' likes and dislikes concerning the initiative.

RESULTS

A high percentage of respondents indicated that the program improved their well-being (85%), enhanced their well-being-related self-efficacy (92%), and provided them with skills for supporting their long-term mental well-being (82%). Respondents liked the evidence-based, engaging content and design elements and the focus on personal well-being, community connection, and practical applicability. Some respondents desired more social connection, disliked certain design elements, lacked time and experienced technical issues.

CONCLUSION

The initiative was acceptable and impactful, indicating that school districts may serve as an effective network for addressing the mental health epidemic.

Trauma Informed Care: Practical Application for Pediatric-Focused Advanced Practice Registered Nurses

Trauma-informed care (TIC) is an essential holistic framework for pediatric-focused advanced practice registered nurses (APRNs) to understand, recognize, and respond to children and families who have experienced trauma while resisting re-traumatization. TIC allows APRNs to engage with children with an understanding of how trauma impacts well-being. Universal adoption of TIC is prudent; it assumes all patients experience some degree of trauma and disclosure is limited. The National Association of Pediatric Nurse Practitioners Partners for Vulnerable Youth published an evidence-based TIC toolkit online for pediatric-focused ARPNs as a clinical guide for TIC application. This article reviews toolkit elements and demonstrates practical application of TIC.

Socioeconomic disparities in depression risk: Limitations of the moderate effect of physical activity changes in Korea

This study investigates the influence of changes in physical activity (PA) patterns on depression risk across different socioeconomic statuses (SES) in Korea. Utilizing National Health Insurance Data (NHID) from over 1.2 million individuals during 2013-2016, we matched medical aid beneficiaries with health insurance beneficiaries, excluding those with prior depression or incomplete PA data. Changes in moderate-to-vigorous PA (MVPA) were categorized into 16 groups, and depression incidence was tracked from 2019 to 2021. After adjustment, medical aid beneficiaries consistently showed higher risks of depression compared to health insurance enrollees with the same physical activity (PA) change patterns. For those consistently inactive, the risk was 1.68 times higher (aOR, 1.68; 95% CI, 1.37-2.05). Those who increased PA from inactivity to moderate-to-vigorous activity 3-4 times per week had a 3.33 times higher risk (aOR, 3.33; 95% CI, 1.72-6.43). Additionally, the risk was 2.64 times higher for those increasing from 1-2 times to ≥5 times per week (aOR, 2.64; 95% CI, 1.35-5.15), and 2.83 times higher for those consistently engaging in PA 3-4 times per week (aOR, 2.83; 95% CI, 1.35-5.94). Across the overall PA patterns, medical aid beneficiaries consistently faced higher depression risks, with risk increases of 1.80 times for increased activity, 1.68 times for continuous inactivity, and 1.34 times for decreased activity compared to health insurance beneficiaries with the same PA change patterns. However, in the consistently very active group, no significant difference in the risk of depression was observed between the two groups. Limitations include potential bias in self-reported PA and the NHIS data not fully capturing depression severity. The findings underscore the significant impact of SES on mental health, with consistently high PA levels potentially mitigating SES-related depression risk.

Depression in Pulmonary Hypertension: A Systematic Review of Clinical Outcomes, Treatment Interactions, and Emerging Technologies

Background: Pulmonary hypertension (PH) is characterized by elevated pulmonary artery pressure, often leading to right heart failure and poor prognosis. Depression, a common comorbidity in PH, significantly affects the quality of life. However, mechanistic insights into the bidirectional relationship between PH and depression and specific treatment interactions remain scarce. Objective: The object was to examine the clinical and therapeutic implications of depression in PH, focusing on its impact on patient outcomes and cost efficiency. Methods: A systematic review of Medline and Google Scholar was conducted to identify studies on depression in PH, emphasizing evidence-based interventions, clinical outcomes, and cost efficiency. Special consideration was given to potential drug interactions between PH medications and depression treatments and to the role of emerging technologies in managing PH-related depression. Results: While depression reduces the quality of life and exacerbates disease severity in PH, depression treatment improves outcomes, particularly when tailored to PH-targeted therapies, considering potential drug-drug interactions. Emerging technologies, including telemedicine, offer innovative approaches to manage depression in PH, enhancing access to care and improving adherence to treatment regimens. Conclusions: Depression in PH must no longer be neglected and should be acknowledged as both a critical comorbidity and a significant driver of disease progression. Interdisciplinary treatment approaches are necessary, considering potential pharmacological interactions and incorporating emerging technologies like telemedicine to improve patient care. Further research is needed to assess the long-term outcomes of depression treatment in different groups of PH.

The Effects of Universal Educational Interventions in Improving Mental Health Literacy, Depression, and Anxiety Among Adolescents: A Systematic Review and Meta-Analysis

Adolescents are susceptible to developing depression and anxiety, and educational interventions could improve their mental well-being. This systematic review aimed to evaluate the effectiveness of universal educational prevention interventions in improving mental health literacy, depression, and anxiety among adolescents. Eight electronic databases were searched until June 2024: Cochrane Library, PubMed, EMBASE, CINAHL, PsycINFO, Scopus, Web of Science, ProQuest Dissertations, and Theses Global. Since the included studies assessed various aspects of mental health literacy, the results for mental health literacy were synthesized narratively. In contrast, a meta-analysis using a random-effects model was applied to the depression and anxiety outcomes. Heterogeneity was examined using I2 statistics and Cochran's Q Chi-squared test. The Cochrane risk of bias tool and the GRADE approach conducted quality appraisal at the study and outcome levels, respectively. The review was reported according to the PRISMA guidelines. This review included 34 randomized controlled trials. Universal education prevention interventions were found to be promising in improving adolescents' mental health literacy but showed limited effects on individual mental health literacy components and on reducing depression (SMD = -0.06, 95%CI: [-0.11, -0.02], Z = 2.58, p = 0.01, I2 = 45%) and anxiety (SMD = -0.00, 95%CI: [-0.06, 0.06], Z = 0.07, p = 0.94, I2 = 58%) at post-intervention. Future trials should consider using a hybrid delivery model utilizing health care and the non-health care professionals. These interventions must incorporate skills-based sessions to develop emotional regulation strategies, complemented by extended follow-up periods that include booster sessions to reinforce learning. Given the very low quality of evidence as rated by the GRADE approach, current findings need to be interpreted with caution.

Mental Health and Well-Being in the Modern Era: A Comprehensive Review of Challenges and Interventions

A critical global concern in the modern era is mental health and well-being, where rapid socioeconomic change, technological advancements, and lifestyle shifts have significantly impacted individuals' psychological health. Primary stressors today include urbanization, digital dependency, social isolation, and economic pressures, alongside the escalating prevalence of mental health disorders such as depression, anxiety, and burnout. The COVID-19 pandemic has further exacerbated global mental health crises, increasing the vulnerability of populations during times of uncertainty and instability. This paper critically examines emerging connections between mental health and lifestyle factors such as sleep, diet, and exercise. Interventions are discussed from a multidimensional perspective, encompassing pharmacological treatments, psychotherapy, digital mental health tools, and community-based programs. Special attention is given to the rise of telemedicine and mobile mental health apps, offering innovative solutions to bridge gaps in mental healthcare accessibility. Furthermore, the review underscores the importance of preventive approaches, promoting mental health literacy, reducing stigma, and fostering resilience through mindfulness, cognitive behavioral techniques, and social support systems.

Exploring Barriers, Facilitators, and Needs Related to Mental Health Promotion for Police Officers: A Qualitative Approach

Police officers are vulnerable to psychological distress and trauma since they are constantly exposed to significant physical and mental violence. Poor mental health can lead to increased healthcare costs for individuals, organizations, and nations and negatively impacts public safety. Mental health interventions tailored to the nature of police work are needed; however, a research gap exists regarding understanding the mental health of police officers. This study aimed to explore the barriers, facilitators, and needs for mental health promotion among police officers. This study adopted a qualitative approach in South Korea. Twelve police officers working in a metropolitan city were recruited using purposive sampling methods. One-on-one interviews were conducted with open-ended questions regarding barriers, facilitators, and needs for improving mental health. Content analysis was used to derive relevant themes. The participants included 3 women and 9 men, with an average age of 37.8 years and working experience of 12.6 years. Three themes and 9 subcategories emerged. The theme related to barriers was "difficulty accessing resources"; the theme related to facilitators was "supportive environment for mental health prevention and management"; and the theme related to needs was "education and policies to promote mental health." Considering the occupational and organizational characteristics of the police profession, individual and organizational interventions and policies are needed to adequately manage the mental health of police officers.

The Relationship Between Body, Mind, and Social Characteristics in a Sample of a Training Program for Developing Social and Personal Resources: A Network Analysis

In this cross-sectional study, the interactions between demographic characteristics and the body, mind, and social dimensions among participants of a holistic training program for social and personal development were examined and compared to a control group. The sample involved 223 adults from Austria, Germany, and Switzerland, with 80 (37.2%) participants in the training group already having finished the training. To explore the variable relationships and compare group structures, advanced network analyses and a network comparison test were applied. The network analysis identified the training as a central variable, being linked to aspirations for societal impact and personal growth (0.31), aspirations for the pursuit of fame and wealth (0.29), transcendence (0.19), the desire to improve the quality of relationships (0.19), aspirations for personal wellbeing and relationships (0.15), and the presence of social resources (0.13). The group comparison revealed that the control group primarily connected through the "Sense of Coherence-Meaning in Life" axis, whereas the training group showed more complex linkages involving wellbeing, life satisfaction, meaning in life, and transcendence, underlining the training program's positive effect on personal growth, societal impact aspirations, and transcendence. Overall, the network comparison test revealed significant differences in network structure and overall connectivity between the training and the control group.

Reach, uptake, and psychological outcomes of two publicly funded internet-based cognitive behavioural therapy programs in Ontario, Canada: an observational study

BACKGROUND

Access to traditional mental health services in Canada remains limited, prompting exploration into digital alternatives. The Government of Ontario initiated access to two internet-based cognitive behavioral therapy (iCBT) programs, LifeWorks AbilitiCBT and MindBeacon TAiCBT, for adults with mental health issues.

METHODS

An uncontrolled observational study utilizing secondary retrospective program data was conducted to evaluate the reach, uptake, and psychological symptom changes among participants engaging with either iCBT program.

RESULTS

Between May 2020 and September 2021, 56,769 individuals enrolled in LifeWorks AbilitiCBT, and 73,356 in MindBeacon TAiCBT. However, substantial exclusions were made: 56% of LifeWorks participants and 68% of MindBeacon participants were ineligible or failed to initiate treatment. Consequently, 25,154 LifeWorks participants and 23,795 MindBeacon participants were included in the analysis. Of these, 22% of LifeWorks and 26% of MindBeacon participants completed over 75% of iCBT treatment. On average, LifeWorks participants received 13 ± SD 7.1 therapist messages and sent 5 ± SD 10.3 messages, while MindBeacon participants received 25 ± SD 20.7 therapist messages and sent 13 ± SD 16.4 messages. LifeWorks included synchronous therapist contact averaging 1.4 ± SD 1.9 h per participant, while MindBeacon was purely asynchronous. Baseline severity of anxiety (37%) and depression symptoms (22%) was higher for LifeWorks participants compared to MindBeacon participants (24% and 10%, respectively). Clinically significant changes in anxiety and depression scores were observed: 22% of LifeWorks and 31% of MindBeacon participants exhibited reliable recovery in PHQ-9 scores, while 26% of LifeWorks and 25% of MindBeacon participants demonstrated reliable recovery in GAD-7 scores.

CONCLUSION

In conclusion, iCBT programs show promise for engaged participants with varying levels of severity in anxiety and depression symptoms. Future iterations of iCBT should consider adopting a broad entry criterion to iCBT programming to increase accessibility, especially for those with severe symptoms, alongside integrated intake care pathways, and potential payment structure adjustments for iCBT service providers. Taken all together, these factors could temper high dropout rates post-intake assessment. This evaluation underscores the potential and value of digital mental health interventions for individuals with mild to severe anxiety or depression symptoms, emphasizing the importance of addressing participant dropout.

Depression, Anxiety, and Stress Symptoms Among Students in Croatia During the COVID-19 Pandemic: A Systematic Review

Background: The COVID-19 pandemic has led to an increased fear of infection, social isolation, financial concerns, and feelings of loneliness and uncertainty. Studies reveal that the pandemic has had a significant negative impact on mental health. This systematic review aimed to investigate the prevalence of depression, anxiety, and stress symptoms among students in Croatia during the COVID-19 pandemic. Methods: A systematic review was conducted following PRISMA guidelines. A literature search was performed on August 5, 2024, using the electronic databases Scopus, PubMed, Web of Science, and PsycINFO. The search utilized the Boolean logical operator expression ('depression' AND 'anxiety' AND 'stress' AND 'COVID-19' AND 'Croatia' AND 'student'). Results: Out of one hundred and fifty-four identified studies, five met the inclusion criteria and were included in the review. The studies used the Generalized Anxiety Disorder 7-item scale (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), and the Depression, Anxiety, and Stress Scale-21 (DASS-21) to assess mental health. The results indicate a high prevalence of symptoms of depression, anxiety, and stress among students in Croatia during the pandemic. Conclusion: A high prevalence of negative affective emotions was observed among students in Croatia during the pandemic. This finding underscores the importance of developing effective strategies for the early identification and management of mental disorders among students, irrespective of the pandemic's conclusion.

Using Digital Media to Improve Adolescent Resilience and Prevent Mental Health Problems: Protocol for a Scoping Review

BACKGROUND

Global databases show a high prevalence of mental health problems among adolescents (13.5% among those aged 10-14 years and 14.65% for those aged 15-19 years). Successful coping depends on risk and protective factors and how their interaction influences resilience. Higher resilience has been shown to correlate with fewer mental health problems. Digital mental health interventions may help address these problems.

OBJECTIVE

This protocol serves as a framework for planning a scoping review to map the types of digital communication media and their effectiveness in increasing resilience in youths.

METHODS

The Joanna Briggs Institute guidelines will be used: defining the research questions; identifying relevant studies; study selection (we will select articles based on titles and abstracts); charting the data; collating, summarizing, and reporting the results; and consultation. The synthesis will focus on the type of digital media used to increase adolescent resilience skills and the impact they have on adolescent resilience skills. Quantitative and qualitative analyses will be conducted.

RESULTS

The study selection based on keywords was completed in December 2023, the study screening and review were completed in February 2024, and the results manuscript is currently being prepared. This scoping review protocol was funded by the Center for Higher Education Funding and the Indonesia Endowment Fund for Education.

CONCLUSIONS

The results of the study will provide a comprehensive overview of commonly used digital media types and their effectiveness in increasing youth resilience. Thus, the results of this scoping review protocol can serve as foundational evidence in deciding further research or interventions. This study may also be used as a guideline for mapping and identifying the type and impact of communication media used to increase adolescents' resilience skills.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/58681.

Knowledge and Perception Towards Psychotropic Drugs Among the General Population in Saudi Arabia

Background

Mental health is crucial to overall well-being. Despite an increase in mental disorders over the past few decades, public awareness remains slow-growing, and stigmatization towards psychotropic medications persists. Therefore, this study aimed to identify knowledge and perceptions of psychotropic drugs among the general population in the Makkah Region, Saudi Arabia.

Methods

A questionnaire-based cross-sectional study was conducted among adults aged 18 years old and older, living in the Makkah Region, Saudi Arabia, from 1 January to 30 April 2024. Descriptive statistics were used to describe participants' characteristics, and categorical variables were reported as frequencies and percentages. A Chi-square test was used to examine the relationships between variables.

Results

A total of 717 participants were involved in the study: (52%) were from Jeddah, (25.9%) were from Taif, and (22%) were from Makkah. The mean age was 33.9 years, and 67.1% were females. Among the participants, (20.8%) had experienced a psychiatric illness, (41.7%) had a member of the family who suffered from a psychiatric illness, (39.5%) had a family member who used a psychiatric drug, and only 25 (7%) had a child suffering from a psychiatric illness. Specifically, 20.8% of those with a psychiatric illness demonstrated good knowledge (P=0.001), 16.1% of those with a family history of psychiatric illness had good knowledge (P=0.007), 16.3% with family use of psychiatric drugs had good knowledge (P=0.006), and 24.5% of those who used psychiatric drugs had high knowledge (P=0.001). Overall, (40.6%) of participants had a low level of knowledge and perception about psychotropic drugs, (47.8%) had a moderate knowledge and perception level, and only (11.6%) had high knowledge and perception.

Conclusion

Psychological well-being is crucial for health, but misconceptions persist, acting as barriers that impede people from seeking and accepting necessary psychiatric care. The findings highlight the need for targeted public education and healthcare professional training to improve Confirmed understanding and reduce stigma around psychotropic drugs in Saudi Arabia. A multifaceted approach involving policy development, community outreach, and ongoing research is essential for enhancing mental health outcomes and treatment accessibility.

Identifying contextual barriers and facilitators in implementing non-specialist interventions for mental health in Sri Lanka: A qualitative study with mental health workers and community members

Non-specialist mental health interventions serve as a potential solution to reduce the mental healthcare gap in low- and middle-income countries, such as Sri Lanka. However, contextual factors often influence their effective implementation, reflecting a research-to-practice gap. This study, using a qualitative, participatory approach with local mental health workers (n = 9) and potential service users (n = 11), identifies anticipated barriers and facilitators to implementing these interventions while also exploring alternative strategies for reducing the mental healthcare gap in this context. Perceived barriers include concerns about effectiveness, acceptance and feasibility in the implementation of non-specialist mental health interventions (theme 1). The participants' overall perception that these interventions are a beneficial strategy for reducing the mental healthcare gap was identified as a facilitating factor for implementation (theme 2). Further facilitators relate to important non-specialist characteristics (theme 3), including desirable traits and occupational backgrounds that may aid in increasing the acceptance of this cadre. Other suggestions relate to facilitating the reach, intervention acceptance and feasibility (theme 4). This study offers valuable insights to enhance the implementation process of non-specialist mental health interventions in low-and middle-income countries such as Sri Lanka.

A conceptual framework for psychiatric nurses to facilitate medication compliance among adults living with depression

BACKGROUND

 Medication non-compliance is a significant healthcare issue that is widespread. Extensive research has identified factors that contribute to medication non-compliance in different healthcare settings. As a result, there was a need to develop a conceptual framework to facilitate medication compliance among adults living with depression.

OBJECTIVES

 The purpose of this study was to develop a conceptual framework for psychiatric nurses to facilitate medication compliance among adults living with depression.

METHOD

 A qualitative, exploratory, descriptive and contextual research design was utilised to investigate the experiences of adults living with depression who are non-compliant with medication. The study consisted of three phases: an empirical phase, a classification of concepts and a development phase. Following the empirical phase, a conceptual framework was developed based on the classified concepts.

RESULTS

 Three sets of results were merged for the cross-validation analysis, combining findings from the systematic review, the researcher's previously conducted and published minor dissertation and the current study.

CONCLUSION

 A conceptual framework was developed to assist psychiatric nurses in effectively promoting an internal locus of control among adults living with depression. The resulting conceptual framework provides valuable insights and serves as a valuable tool for future research endeavours aimed at enhancing medication compliance among adults living with depression.Contribution: This framework serves as a valuable guide for future studies that aim to explore medication compliance among adults living with depression, specifically by focussing on the concept of internal locus of control.

Neurobiology and medico-legal aspects of suicides among older adults: a narrative review

The task of preventing suicide in older adults is an important social burden as older adults aged above 65 are exposed to singular psychological aspects that increase suicide risks. Moreover, when an older adult corpse is found, the medico-legal inspection represents a fundamental tool to identify the exact cause of death, classifying or excluding it as suicide. In this scenario, this review aims to explore the neurobiological factors that could be related to suicidal behavior in older adults. A further goal of this review is the exploration of the medico-legal aspects surrounding older adult suicides, clarifying the importance of forensic investigation. Particularly, this review examines issues such as neurotransmitter imbalances, cognitive impairment, neuroinflammation, psychosocial factors related to geriatric suicide, and neurodegenerative diseases. Additionally, medico-legal aspects such as policy considerations, legal frameworks, mental health assessments, ethical implications and forensic investigation were explored. Considering the importance of this phenomenon, especially in western countries, a need has emerged for focused screening tools on suicidal behavior among older adults, in order to contain it. Therefore, this review makes an exhaustive appraisal of the literature giving insights into the delicate interplay between neurobiology as well as mental health in relation to older adult suicide within a medico-legal context. The comprehension of different aspects about this complex phenomenon is fundamental to propose new and more effective interventions, supporting tailored initiatives such as family support and improving healthcare, specifically towards vulnerable ageing societies to reduce older adult suicide risks.

The Power of Thought: The Role of Psychological Attentiveness and Emotional Support in Patient Trajectories

In modern healthcare, the influence of a patient's mindset on health outcomes is an often neglected yet vital component of holistic care. This review explores the significant impact of positive and negative mindsets on disease progression and recovery, emphasizing the need to integrate mental wellness practices into conventional medical care. Drawing from a wide array of studies, it demonstrates how fostering a positive mindset can enhance patient trajectories across various medical specialties. The article advocates for training healthcare providers to adopt a more empathetic and patient-centered approach, bridging the gap between mind and body. By presenting compelling evidence on the correlation between patient mindset and health outcomes, this review highlights the potential benefits of incorporating psychological support and holistic strategies into standard care protocols. Practical strategies for implementing mindset-focused interventions are also proposed, including training programs for healthcare professionals and the development of interdisciplinary treatment plans. Ultimately, this article underscores the need for a paradigm shift in medical practice, advocating for a comprehensive approach that recognizes the power of thought in promoting patient wellness.

Exploring the impact of subjective well-being on medication adherence: A cross-sectional study among individuals with multiple chronic diseases

Background

Medication non-adherence is a significant barrier to optimal treatment goals. The study explores the association between subjective well-being (SWB) and medication adherence among Lebanese individuals with multiple chronic diseases and identifies additional factors that may influence adherence in this population.

Methods

An exploratory, cross-sectional study was conducted for three months at six community pharmacies. Adherence was assessed using the Adherence to Refills and Medication Scale Arabic Lebanese Version (ARMS-A). The SWB was measured using the Arabic Scale of Happiness (ASH), Love of Life Scale (LLS), Arab Hope Scale (AHS), and Satisfaction with Life Scale (SWLS). Spearmen's Rho correlation analyzed the association between ARMS-A and SWB constructs. Binary logistic regression identified predictors of adherence among individuals with chronic diseases and on multiple chronic medications.

Results

Of 400 participants, 106 (26.5 %) with a 95 % CI, 0.22-0.31, were adherent. Lower medication adherence (reflected in higher ARMS-A scores) was associated with lower SWB (p = 0.01). Multivariate analysis showed that lower education (OR = 2.21, 95 % CI, 1.01-4.81), lack of a specific diet (OR = 1.64, 95 % CI, 1.01-2.69), and frequent hospital and/or emergency visits (OR = 3.29, 95 % CI, 1.75-6.17 for 2 visits; OR = 2.71, 95 % CI, 1.43-5.14 for ≥3 visits) significantly increased the odds of non-adherence to chronic treatment. However, higher income (OR = 0.06, 95 % CI, 0.01-0.38), healthcare provider occupation (OR = 0.42, 95 % CI, 0.21-0.48), and having diabetes mellitus (OR = 0.59, 95 % CI, 0.36-0.96) correlated with better adherence.

Conclusion

A significant portion of participants failed to adhere to their prescribed chronic medications, influenced by multicomplex socioeconomic, psychological, and health-related factors. These findings demonstrate the need for culturally-tailored, pharmacist-led interventions to improve medication adherence and overall health outcomes.

Characteristics of quality improvement interventions to improve physical healthcare in mental health settings: a scoping review protocol

INTRODUCTION

Mental health concerns globally impact millions of people, resulting in significant financial impact and adverse health outcomes. People living with mental health concerns are at higher risk of developing physical health issues, which can lead to a shortened life expectancy. Barriers to physical healthcare, such as limited service capacity, low help seeking and stigma, contribute to health disadvantage. Quality improvement (QI) interventions can address these challenges by addressing staff-level and service-level factors to improve the focus on physical healthcare in mental health settings. The aim of this scoping review is to describe studies of QI interventions to improve physical healthcare in mental health settings.

METHODS AND ANALYSIS

The proposed scoping review will be conducted in accordance with guidance for scoping reviews from the Joanna Briggs Institute Manual and in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. A systematic review search for peer-reviewed and published articles will be conducted across eight databases: PubMed, MEDLINE (Ovid), Web of Science, CINAHL (EBSCOhost), ProQuest Central, PsycINFO (Ovid), Scopus and Embase (Elsevier). Two independent reviewers will screen the titles, abstracts and full text using Covidence. Any disagreement will be resolved through discussion or with a third reviewer. Data collection will be facilitated using Microsoft Excel. The details of included studies will be extracted by two authors independently.

ETHICS AND DISSEMINATION

No ethical approval is required for the scoping review. The results of this review will be presented at conferences and published in a peer-reviewed scientific journal. This review will also inform the development of a QI strategy to influence mental health staff practices in the provision of physical healthcare in Australian mental health settings.

Group-format, peer-facilitated mental health promotion interventions for students in higher education settings: a scoping review protocol

INTRODUCTION

Young people in higher education face various stressors that can make them vulnerable to mental ill-health. Mental health promotion in this group therefore has important potential benefits. Peer-facilitated and group-format interventions may be feasible and sustainable. The scoping review outlined in this protocol aims to map the literature on group-format, peer-facilitated, in-person interventions for mental health promotion for higher education students attending courses on campuses in high and low/middle-income countries.

METHODS AND ANALYSIS

Relevant studies will be identified through conducting searches of electronic databases, including Medline, CINAHL, Scopus, ERIC and PsycINFO. Searches will be conducted using Boolean operators (AND, OR, NOT) and truncation functions appropriate for each database. We will include a grey literature search. We will include articles from student participants of any gender, and published in peer-reviewed journals between 2008 and 2023. We will include English-language studies and all study types including randomised controlled trials, pilot studies and descriptive studies of intervention development. A draft charting table has been developed, which includes the fields: author, publication date, country/countries, aims, population and sample size, demographics, methods, intervention type, comparisons, peer training, number of sessions/duration of intervention, outcomes and details of measures.

ETHICS AND DISSEMINATION

No primary data will be collected from research participants to produce this review so ethics committee approval is not required. All data will be collated from published peer-reviewed studies already in the public domain. We will publish the review in an open-access, peer-reviewed journal accessible to researchers in low/middle-income countries. This protocol is registered on Open Science Framework (https://osf.io/agbfj/).

'No health without mental health': where are we now?

Mental health services are under unprecedented pressure with overwhelming referrals and a current waiting list of 1.2 million people of all ages. The cross-government White Paper 'No health without mental health' was launched 12 years ago detailing the importance of wellbeing services in the creation of mentally healthy communities through health promotion and illness prevention. While primary care, community services and psychiatry are pivotal in the treatment of mental Illness/disorder, mental health care per se is on a continuum, and a great deal of work can be undertaken in communities by wellbeing services to prevent avoidable referrals. This paper proposes a broad framework of education and training for wellbeing/positive mental health services, primary and community care, and nurses working in Community Mental Health Treatment Teams and Home Treatment Teams to ensure all those working with potentially vulnerable adults and children are regulated and meet national standards for mandatory mental health education and training.

Factors Associated With Distress Related to Perceived Dignity in Patients With Rheumatic Diseases

BACKGROUND

The loss of perceived dignity is an existential source of human suffering, described in patients with cancer and chronic diseases and hospitalized patients but rarely explored among patients with rheumatic diseases (RMDs). We recently observed that distress related to perceived dignity (DPD) was present in 26.9% of Mexican patients with different RMDs. The study aimed to investigate the factors associated with DPD.

METHODS

This cross-sectional study was performed between February and September 2022. Consecutive patients with RMDs completed patient-reported outcomes (to assess mental health, disease activity/severity, disability, fatigue, quality of life [QoL], satisfaction with medical care, and family function) and had a rheumatic evaluation to assess disease activity status and comorbidity. Sociodemographic variables and disease-related and treatment-related variables were retrieved with standardized formats. DPD was defined based on the Patient Dignity Inventory score. Multivariate regression analysis was used.

RESULTS

Four hundred patients were included and were representative of outpatients with RMDs, while 7.5% each were inpatients and patients from the emergency care unit. There were 107 patients (26.8%) with DPD. Past mental health-related comorbidity (Odds Ratio [OR]: 4.680 [95% Confidence Interval [CI]: 1.906-11.491]), the number of immunosuppressive drugs/patient (OR: 1.683 [95% CI: 1.015-2.791]), the physical health dimension score of the World Health Organization Quality of Life-Brief questionnaire (WHOQOL-BREF) (OR: 0.937 [95% CI: 0.907-0.967]), and the emotional health dimension score of the WHOQOL-BREF (OR: 0.895 [95% CI: 0.863-0.928]) were associated with DPD.

CONCLUSIONS

DPD was present in a substantial proportion of patients with RMDs and was associated with mental health-related comorbidity, disease activity/severity-related variables, and the patient QoL.

Promoting mental health and preventing mental health problems in child and adolescent refugees and asylum seekers: A systematic review on psychosocial interventions

BACKGROUND

According to the United Nations Commissioner for Refugees (UNHCR), children and adolescents represent 41% of all forcibly displaced individuals. They have to deal with conflicts, violence, and the many difficulties of flight and resettlement during a critical stage of their emotional, social, cognitive, and physical development. They are more likely to experience mental health problems during migration. Despite the several known risk factors, it is frequently challenging for refugees and asylum seekers to get mental health care. In this paper we review available studies on interventions aimed at promoting mental health and at preventing common mental disorders in immigrant adolescents and children.

METHODS

The relevant PubMed, Scopus, PsychINFO and Web of Science databases were searched for papers published until March 21, 2023, using ("immigrants" OR "migration" OR "asylum seekers" OR "refugees") AND ("promotion" OR "prevention") AND ("mental health" OR "mental disorders" OR "psych*") AND ("children" OR "adolescents" OR "young adults") as search string. Fourteen articles qualified for the detailed review.

RESULTS AND CONCLUSIONS

The majority of available interventions, although highly heterogeneous in format and content, showed significant improvement in several psychopathological dimensions, including trauma-related symptoms, psychological stress, anxiety, depressive and cognitive symptoms. Available studies on interventions for the prevention of mental disorders and the promotion of mental health in refugees and asylum seekers children and adolescents indicate that provided interventions were associated with a global improvement for participants. Implementation strategies to improve their scalability are highly needed.

The future of cervical cancer prevention: advances in research and technology

This article provides an informative overview of the current situation and future trends in cervical cancer prevention. Cervical cancer remains a significant public health concern worldwide and is characterized by notable variations in both incidence and mortality rates between developed and developing countries. This underscores the importance of understanding the pathophysiology of cervical cancer, stressing the involvement of high-risk HPV types. The presence of supplementary risk factors facilitates the transition from infection to cancer. This review examines current preventive methods, including the success of HPV vaccines such as Gardasil and Cervarix, and the effectiveness of screening techniques, from cytology to HPV DNA testing. It noted the limitations faced by primary and secondary preventive measures, particularly in low-resource settings, which include access to vaccines and effective screening procedures. Emerging technologies in cervical cancer prevention, such as liquid-based cytology, molecular testing, and AI, promise to improve early detection and diagnosis accuracy and efficiency. The potential of precision medicine to customize treatment based on individual risk factors was discussed. It explores the innovation in genetic editing techniques, such as CRISPR/Cas9, in targeting HPV oncoproteins, the advent of immunotherapy, the role of tumor-infiltrating lymphocytes, and the prospects of biomarkers in improving early detection. Research and technological advancements are leading to transformative changes in cervical cancer prevention. These developments suggest a path toward improved screening, diagnosis, and treatment that could significantly reduce the global burden of the disease. However, realizing the full potential of these advances requires inclusive research and international collaboration to overcome access disparities, particularly in resource-limited settings.

Evaluation of mental health of students in healthcare education programs at Qatar University

Introduction

Mental health issues among undergraduate health-care students are a growing concern. This research aims to explore the frequency of mental health issues among health-care students in medicine, dentistry, pharmacy, nutrition, biomedical sciences, nursing, and public health at Qatar University.

Methods

Ethics approval was obtained from the institutional review board. A total of 1,378 health-care students were invited to participate. Data were collected online using two validated questionnaires including the Patient Health Questionnaire (PHQ-9) to assess symptoms of depression, and Depression, Anxiety, and Stress Scale (DASS-21), and two open-ended questions investigating risk factors and recommendations for enhancing institutional support.

Results

A total of 270 health-care students completed the survey; 227 female, and 43 male students. According to PHQ-9 cut-off values, 37.7% of students had mild depression symptoms, 25.5% moderate, 14.8% moderately severe and 10% severe symptoms. DASS-21 responses revealed 34.7% displayed severe to extremely severe anxiety symptoms, 15.4% severe to extremely severe stress symptoms and 21% severe to extremely severe depression symptoms. Students aged 18-21 years had significantly higher depression (p=0.03) and stress scores (p=0.05). Qatari students had significantly higher anxiety scores (p=0.05). Responses to open-ended questions were categorized into sub-themes and grouped together into broader themes. Most students reported exam stress and workload as key factors contributing to their negative mental health. Participants' recommendations included reducing academic workload through better curricular planning, providing training to faculty to better support students with mental health issues, and improving mental health services.

Conclusion

This study showed a significant percentage of respondents reported symptoms of stress, anxiety, and depression during undergraduate studies. Participants represent the future healthcare force for the country and there is a need to identify and support students with mental health issues through close monitoring, and work with all stakeholders to improve student support services.

The influence of the gut-brain axis on anxiety and depression: A review of the literature on the use of probiotics

This review aims to argue how using probiotics can improve anxiety and depressive behaviour without adverse effects, also exploring the impact of postbiotics on it. Specifically, probiotics have drawn more attention as effective alternative treatments, considering the rising cost of antidepressant and anti-anxiety drugs and the high risk of side effects. Depression and anxiety disorders are among the most common mental illnesses in the world's population, characterised by low mood, poor general interest, and cognitive or motor dysfunction. Thus, this study analysed published literature on anxiety, depression, and probiotic supplementation from PubMed and Scopus, focusing on the last twenty years. This study focused on the effect of probiotics on mental health as they have drawn more attention because of their extensive clinical applications and positive impact on various diseases. Numerous studies have demonstrated how the gut microbiota might be critical for mood regulation and how probiotics can affect host health by regulating the gut-brain axis. By comparing the different works analysed, it was possible to identify a strategy by which they are selected and employed and, at the same time, to assess how the effect of probiotics can be optimised using postbiotics, an innovation to improve mental well-being in humans.

Implementation of an internet-based stress management program in micro- and small-sized enterprises: a study protocol for a pre-post feasibility study of the effectiveness-implementation hybrid type 2 trial

BACKGROUND

Although internet-based stress management programs are proven effective in improving mental health among workers, micro- and small-sized enterprises (MSEs), lacking in occupational healthcare services, face challenges implementing them. To address this gap, this study will develop the program with stakeholders at MSEs to aim for real-world implementation.

OBJECTIVES

This paper describes a study protocol for a pre-post feasibility study of an effectiveness-implementation hybrid type 2 trial of text-based internet-based programs ("WellBe-LINE") in MSEs with less than 50 employees. This feasibility study primarily aims to evaluate trial methods for future effectiveness-implementation hybrid type 2 trials.

METHODS

For this study protocol, an internet- and text-based self-care intervention program using the LINE app (a popular message tool in Japan) will be prepared according to evidence-based psychoeducational topics. Based on our online survey findings, personalized algorithms will be implemented according to employees' gender, age, and psychological distress levels. A personalized program using a popular pre-existing text app is expected to reduce employees' burdens and be attractive to them, resulting in successful implementation outcomes and mental health benefits. A pre-post design feasibility study will be conducted on ten companies to evaluate trial methods (e.g., recruitment and procedures). The primary outcome will involve individual-level penetration, defined as the proportion of the number of employees who register for the program divided by the total number of invited employees at the company. The progression criterion to go next trial specifies that more than 50% of the recruited companies obtain 60% individual penetration, which is set based on the findings of the prior survey of employees at MSEs and of interviews of stakeholders involved in this study, and will be measured by LINE system. Finally, acceptability, appropriateness, and feasibility will be measured using internet-based questionnaires and interviews.

DISCUSSION

This pre-post feasibility study for future effectiveness-implementation hybrid type 2 trials will provide in-depth knowledge about the successful implementation of text-based, semi-personalized, self-care mental health interventions in real-world settings using both quantitative and qualitative data.

CONCLUSIONS

This feasibility study will help validate the effectiveness of text-based interventions using a widely used social networking service (SNS) tool for employees in MSEs.

TRIAL REGISTRATION

UMIN clinical trial registration, UMIN000046960. Registered on February 21, 2022. https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000053570.

A comparative study of anxiety and depression among healthcare workers and non-healthcare workers in Johor, Malaysia during the Covid-19 era

The outbreak of Coronavirus disease 2019 (Covid-19) has a significant impact on the mental health of the global population. Updates are needed regarding the mental health status among the local population since limited studies were done so far. This research compared the prevalence of anxiety and depression symptoms among HCWs and non-HCWs. We also evaluated the factors associated with anxiety and depression symptoms among these 2 groups. This was a cross-sectional study conducted between September to December 2022. Online questionnaire was distributed to HCWs from 2 tertiary government hospitals. Non-HCWs from various occupational fields were recruited randomly. Generalised Anxiety Disorder 7 (GAD-7) and Patient Health Questionnaire 9 (PHQ-9) were used to screen for anxiety and depression symptoms respectively. Data were analyzed using IBM SPSS version 28.0. 200 questionnaires were distributed to HCWs and non-HCWs respectively. The response rate was 74.5% from HCWs and 82.5% from non-HCWs (P = .07). A total of 236 individuals (105 HCWs and 131 non-HCWs) were included in the study. Majority were female, married, highly educated and worked more than 8 hours per day. There was no significant difference for the prevalence of anxiety (37.2% vs 44.3%, P = .34) and depression symptoms (37.3% vs 35.1%, P = .75) between HCWs and non-HCWs. Among HCWs, poor workplace support (P = .009) and low income (P = .04) were associated with anxiety symptoms. Younger age (P = .02), single status (P = .01) and poor workplace support (P = .006) were associated with depression symptoms. More non-HCWs with a higher educational level were having anxiety and depression symptoms. Single status (P = .03), working away from home (P = .02), poor family support (P = .03) and quarantine as Covid-19 close contact (P = .04) were also associated with depression symptoms among non-HCWs. There is no significant difference between HCWs and non-HCWs experiencing possible anxiety or depressive symptoms in this study. However, attention should be paid to address associated factors identified among each group to promote good mental health.

Evolution of Primary Research Studies in Digital Interventions for Mental Well-Being Promotion from 2004 to 2023: A Bibliometric Analysis of Studies on the Web of Science

Research into digital interventions for mental well-being promotion has grown in recent years, fuelled by the need to improve mental health prevention strategies and respond to challenges arising from the coronavirus (COVID-19) pandemic. This bibliometric analysis provides a structured overview of publication trends and themes in primary research studies reporting an array of digital interventions indexed at WoS from 2004 to 2023. Bibliometric data were collected on a sample of 1117 documents and analysed using the Biblioshiny package. Supplemental network visualisation analysis was conducted using VosViewer. The study, based on Web of Science and Scopus databases, indicates a marked increase in publications post-2020. There were seven groups of research themes clustered around "Mindfulness", "Anxiety", "COVID-19", "Acceptance and Commitment Therapy", "Depression", "Web-based", and "Positive Psychology". Further, results demonstrated the growth of specific themes (e.g., mindfulness, mhealth), the defining impact of COVID-19 studies, and the importance of both randomised controlled trials and formative research. Overall, research in the field is still early in its development and is expected to continue to grow. Findings highlight the field's dynamic response to societal and technological changes, suggesting a future trajectory that leans increasingly on digital platforms for mental health promotion and intervention. Finally, study limitations and implications for future studies are discussed.

Mental Health Promotion and Illness Prevention in Vulnerable Populations

Several cases of social and health inequity have occurred in recent centuries [...].

Distributed Medical Education (DME) in psychiatry: perspectives on facilitators, obstacles, and factors affecting psychiatrists' willingness to engage in teaching activities

BACKGROUND

Distributed Medical Education (DME), a decentralized model focused on smaller cities and communities, has been implemented worldwide to bridge the gap in psychiatric education. Faculty engagement in teaching activities such as clinical teaching, supervision, and examinations is a crucial aspect of DME sites. Implementing or expanding DME sites requires careful consideration to identify enablers that contribute to success and barriers that need to be addressed. This study aims to examine enablers, barriers, and factors influencing psychiatrists' willingness to start or continue participating in teaching activities within Dalhousie University's Faculty of Medicine DME sites in two provinces in Atlantic Canada.

METHODOLOGY

This cross-sectional study was conducted as part of an environmental scan of Dalhousie Faculty of Medicine's DME programs in Nova Scotia (NS) and New Brunswick (NB), Canada. In February 2023, psychiatrists from seven administrative health zones in these provinces anonymously participated in an online survey. The survey, created with OPINIO, collected data on sociodemographic factors, practice-related characteristics, medical education, and barriers to teaching activities. Five key outcomes were assessed, which included psychiatrists' willingness to engage in (i) clinical training and supervision, (ii) lectures or skills-based teaching, (iii) skills-based examinations, (iv) training and supervision of Canadian-trained psychiatrists, and (v) training and supervision of internationally trained psychiatrists. The study employed various statistical analyses, including descriptive analysis, chi-square tests, and logistic regression, to identify potential predictors associated with each outcome variable.

RESULTS

The study involved 60 psychiatrists, primarily male (69%), practicing in NS (53.3%), with international medical education (69%), mainly working in outpatient services (41%). Notably, 60.3% lacked formal medical education training, yet they did not perceive the lack of training as a significant barrier, but lack of protected time as the main one. Despite this, there was a strong willingness to engage in teaching activities, with an average positive response rate of 81.98%. The lack of protected time for teaching/training was a major barrier reported by study participants. Availability to take the Royal College of Physicians and Surgeons of Canada Competency by Design training was the main factor associated with psychiatrists' willingness to participate in the five teaching activities investigated in this study: willingness to participate in clinical training and supervision of psychiatry residents (p = .01); provision of lectures or skills-based teaching for psychiatry residents (p < .01); skills-based examinations of psychiatry residents (p < .001); training/supervision of Canadian-trained psychiatrists (p < .01); and training and supervision of internationally trained psychiatrists (p < .01).

CONCLUSION

The study reveals a nuanced picture regarding psychiatrists' engagement in teaching activities at DME sites. Despite a significant association between interest in formal medical education training and willingness to participate in teaching activities, clinicians do not consider the lack of formal training as a barrier. Addressing this complexity requires thoughtful strategies, potentially involving resource allocation, policy modifications, and adjustments to incentive structures by relevant institutions.

Views of German mental health professionals on the use of digital mental health interventions for eating disorders: a qualitative interview study

INTRODUCTION

Digital mental health interventions (DMHIs) are getting increasingly important for mental health care. In the case of eating disorders (EDs), DMHIs are still in early stages. Few studies so far investigated the views of mental health professionals for EDs on the integration of DMHIs in routine care.

OBJECTIVE

To gain insights into the experiences, perspectives, and expectations of mental health professionals for EDs regarding DMHIs and to identify requirements for the future integration of DMHIs into routine care.

METHODS

Semi-structured qualitative telephone interviews with 24 German mental health professionals treating patients with EDs were conducted. A content analysis following a deductive-inductive approach asked for experiences, advantages and chances, disadvantages and boundaries, desired functions and properties, target groups, and general conditions and requirements for DMHIs for patients with EDs.

RESULTS

Only few professionals reported experiences with DMHIs besides video-based psychotherapy during the pandemic. From the therapists' point of view, DMHIs have the potential to deliver low-threshold access for patients with EDs. Useful functionalities were seen in digital meal records, skills training, and psychoeducation. However, a stable therapeutic alliance was reported as an important prerequisite for the successful integration into care. Therapists expressed concerns in case of severe anorexia nervosa or suicidality. The participants felt to be informed inadequately on recent developments and on the evidence base of DMHIs.

CONCLUSIONS

Mental health professionals for EDs show positive attitudes towards DMHIs, however many barriers to the integration in routine care were observed. The highest potential was seen for the use of DMHIs in addition to outpatient care and in aftercare. Specific requirements for DMHIs are related to different areas of the healthcare spectrum and for the different symptom profiles in anorexia nervosa, bulimia nervosa and binge eating disorder. Targeted DMHIs are needed and appropriate especially for concepts of blended care.

Development, piloting and evaluation of an app-supported psychosocial prevention intervention to strengthen participation in working life: a study protocol of a mixed-methods approach

INTRODUCTION

Rates of incapacity to work due to mental disorders have increased in many European countries. The consequences of persistent stress can impact individuals' physical and psychological well-being and gradually develop into chronic stress. Mental disorders or symptoms of burn-out syndrome can have severe consequences. Mental disorders leading to work incapacity significantly burden the health system. Prevention interventions can protect against burn-out, depression, anxiety and other mental health disorders. Digital health is a promising approach to increase the utilisation of effective prevention interventions. This mixed-methods study evaluates a newly developed app-supported psychosocial prevention intervention called 'RV Fit Mental Health' to strengthen participation in working life.

METHODS AND ANALYSIS

The study uses a three-stage parallel mixed-methods design. This study accompanies the development (stage 1), piloting (stage 2) and evaluation (stage 3) of the new intervention. Within the stages, there is a quantitative as well as a qualitative research strand. Employed persons with an incipient mental disorder will be included. Additionally, experts within the project or connected areas will be included. Quantitative data will be analysed using multifactorial variance analyses in a pre-post design. Qualitative data will be analysed using qualitative content analysis. The study is a comprehensive research approach to investigate the development, piloting and evaluation of an app-supported psychosocial app-based prevention intervention. The rigour of the study will be achieved through data triangulation.

ETHICS AND DISSEMINATION

All participants will receive detailed study information and give written informed consent before data collection. Ethical approval was obtained from the Technical University of Munich Ethics Committee. All data collection will follow all legislative rules regarding data protection, also following the Declaration of Helsinki. The study results will be disseminated in peer-reviewed journals and presented at international conferences.

TRIAL REGISTRATION NUMBERS

DRKS00030818 and DRKS00033080.

Effectiveness of Cognitive Behavioral Therapy (CBT) on Psychological Distress among Mothers of Children with Autism Spectrum Disorder: The Role of Problem-Solving Appraisal

Mothers of children with autism spectrum disorder (ASD) face considerable psychological distress. Cognitive behavioral therapy (CBT) has shown promise in reducing caregiver burden, but evidence in the Arab world is lacking. Problem-solving appraisal training may optimize CBT's benefits. This study evaluated a tailored CBT program emphasizing the role of problem-solving appraisal in managing distress through the process of CBT. Sixty mothers were randomly allocated in a 1:1 ratio to either the CBT intervention group or the control group. The CBT group received 3-month sessions incorporating problem-solving appraisal training within a CBT curriculum from October 2022 to April 2023. Problem-solving techniques are focused on equipping individuals with the skills to identify, approach, and effectively resolve problems, leading to a reduction in stress levels and an improved capacity to cope with difficult situations. All mothers completed assessments of socio-demographics such as age, level of education, marital status, occupation, and adequacy of family income, the Depression Anxiety Stress Scale (DASS-21) and the Problem-Solving Inventory (PSI) before and after the program. The CBT group showed significant pre-to-post reductions in depression, anxiety, stress, and general psychological distress compared to controls (all p < 0.05). They also exhibited significant improvements in problem-solving confidence, approach-avoidance style and personal control (all p < 0.05). The customized CBT program markedly improved psychological well-being for mothers of children with ASD in Egypt. Incorporating problem-solving techniques may optimize CBT's benefits cross-culturally. These findings have implications for the implementation of evidence-based support programs for families impacted by ASD worldwide.

Using science as a differentiator in a crowded digital mental health market

The digital mental health industry has seen remarkable growth in recent years. However, within this crowded landscape, many companies overlook a critical factor for gaining a competitive edge: the integration of science. In this context, "science" refers to the strategic collection and analysis of information (i.e., data) at digital mental health companies, aimed at guiding business decisions and achieving business objectives. This paper demonstrates that science is integral, yet underutilized in the digital mental health industry, with common misconceptions about its role. When science is integrated within a company, it enables them to (1) innovate, (2) understand customers, (3) make informed decisions, and (4) drive revenue. Digital mental health companies recognizing the multifaceted value of science may be better equipped for sustainable growth and success amid the crowded digital health market.

Effective elements of eHealth interventions for mental health and well-being in children and adolescents: A systematic review

Background

Mental health problems among children and adolescents increased in recent years, while mental health services are overburdened with long waiting lists. eHealth interventions, that is, interventions delivered digitally via apps or websites, offer a promising approach to prevent and efficiently treat emerging mental health problems in youth. Over the past years, rapid technological progress has led to diverse eHealth interventions for youth mental health. However, a structured overview of effective eHealth elements and mechanisms through which interventions aim to improve mental health is lacking. The aim of this pre-registered systematic review is to identify elements of eHealth interventions that improve mental health and well-being in children and adolescents aged 10-25 from both clinical and general populations.

Methods

This systematic review conducted in April 2023 in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines identified 108 studies and 103 distinct interventions between 2011-2023. The overall sample size was 33,435 participants (30.7% male, mean age = 18.4 years, SD = 2.5). Most studies (64.8%) were randomized controlled trials (RCTs) to test the interventions. The remaining studies utilized a pre-post or group-comparison design (non-RCTs).

Results

The interventions were heterogeneous in design, method of delivery, target group and outcome measures. Overall, 77.7% of the studies showed a positive significant association between eHealth intervention and mental health or well-being. Elements that were often related to improved mental health and well-being were cognitive behavioural therapy (CBT) or self-monitoring as therapeutic principles, blended approaches combining eHealth with traditional therapy, peer/parental involvement and technological gamification elements, such as rewards.

Conclusions

Elements of youth eHealth interventions that appear to positively impact mental health or well-being are (a) CBT-based, (b) self-monitoring (c) blended interventions, (d) peer or parental involvement or (e) gamification. Future directions for the development and implementation of eHealth interventions for youth are discussed.

Cognitive reappraisal in mHealth interventions to foster mental health in adults: a systematic review and meta-analysis

Background

An increasing number of mHealth interventions aim to contribute to mental healthcare of which interventions that foster cognitive reappraisal may be particularly effective.

Objectives

To evaluate the efficacy of mHealth interventions enhancing cognitive reappraisal to improve mental health in adult populations.

Methods

The literature search (four databases) yielded 30 eligible randomized controlled trials (comprising 3,904 participants). We performed a multi-level meta-analysis to examine differences between intervention and comparator conditions at post-intervention assessment. Moderator analyses were conducted for potential moderator variables (e.g., type of comparators).

Results

Most interventions were CBT-based with other training components in addition to cognitive reappraisal. We found preliminary evidence for a small to medium effect favouring mHealth interventions to enhance cognitive reappraisal over comparators, M(SMD) = 0.34, p = .002. When analysing single symptoms, there was evidence for a small to medium effect of mHealth interventions on anxiety and depressive symptoms, but not for psychological distress and well-being. All analyses showed substantial heterogeneity. Moderator analyses revealed evidence for more favourable effects in studies with passive comparators. There was an overall high risk of bias in most of the studies.

Conclusions

We found preliminary evidence for a small to medium effect of mHealth interventions including a cognitive reappraisal component to improve mental health. However, most of the interventions were complex (i.e., reappraisal was provided alongside other components), which prevents us from examining reappraisal-specific effects beyond general mental health promotion in mHealth. Dismantling studies examining the effects of single intervention components are warranted to corroborate these promising results.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=142149, identifier [CRD42019142149].

Strengthening Mental Health and Resilience Through Schools: Protocol for a Participatory Design Project

BACKGROUND

Mental health problems are a main contributor to the global burden of disease in children and young people within urban environments. In response, the potential of both school- and sport-based mental health promotion interventions has been advocated. However, there exists limited insights into how sport-based interventions can be integrated within school environment. Moreover, there is a need to consider children and young people's specific needs, challenges, and motivations when designing novel mental health promotion interventions.

OBJECTIVE

The Strengthening Mental Health and Resilience Through Schools (SMARTS) project aims to co-design an evidence-informed school-sport-based mental health promotion program. Specific objectives include (1) co-designing a multicomponent program, integrating sport sessions with class-based sessions, and complementing with educational modules for teachers and parents; (2) exploring how the mental health program can be implemented most effectively within the Brussels school system; and (3) conducting preliminary process and outcome testing of the program.

METHODS

A participatory design framework will be adopted to develop the program. This framework involves end users throughout the entire study process, from problem identification to intervention delivery and evaluation, while at the same time ensuring program development remains directly informed by the available scientific evidence.

RESULTS

Participant recruitment will commence in September 2023. The full project will be completed by March 2027.

CONCLUSIONS

With this intervention, we aim to provide a direct contribution to the promotion of children and young people's mental health within the Brussels school context. At a broader level, conducting and documenting this large participatory design project can, hopefully, inspire other researchers to tailor their mental health programs to specific populations.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/49670.