Social Psychiatry and Psychiatric Epidemiology

Background: Girls are more likely than boys to experience psychological distress during adolescence. Drivers of this gender gap remain under-studied, despite its large impact on later life and outcomes, especially for women. Explanatory factors can be gendered in their prevalence (differential exposure) and/or in their impact (differential susceptibility). We developed a multi-domain framework of explanatory factors for distress and applied it in four low- and middle-income countries. Methods: We first proposed a framework of explanatory factors for psychological distress grouped into seven domains (biological, cognitive, psychological, behavioural, social, environmental and broader societal). We applied this framework to identify explanatory variables assessed in childhood and adolescence in the Young Lives longitudinal cohort studies in Ethiopia (N=908), India (N=952), Peru (N=634) and Vietnam (N=887). Distress symptoms at 18-19 years were measured with the Strengths and Difficulties Questionnaire Emotional Symptoms scale. Gendered prevalence of each explanatory factor was tested with Mann-Whitney tests, and gendered impact with country-specific linear regressions including a gender-by-factor interaction term. Exploratory boosted-tree machine-learning models, interpreted with SHAP values and permutation feature importance, examined the contribution of these factors to the gender gap in each country. Results: Distress was higher in girls than boys in every country, the gap ranging from 0.62 points in Ethiopia and Vietnam to 1.76 in India and 2.45 in Peru. Some explanatory factors were consistently gendered in prevalence (e.g. girls experienced greater role overload in each country), while others were gendered only in some countries (e.g. study amount was higher for girls in Peru and Vietnam, but not Ethiopia or India). Gendered impacts on distress displayed more variability across countries. For example, higher self-esteem was more protective for boys than girls in India, Peru and Vietnam, but more protective for girls in Ethiopia. The machine-learning models identified important predictors across all framework domains, though their salience varied by country. Conclusions: Our findings underscore the importance of considering multi-domain explanations for mental-health outcomes and observed inequalities in mental health. Large cross-country differences in the gender gap and in the prevalence and influence of explanatory factors caution against generalising drivers of mental-health outcomes and inequalities across contexts.

Child maltreatment (CM) is a global phenomenon, yet its prevalence, acceptability, and psychosocial consequences vary across cultures. This study examined self-reported CM, its perceived acceptability, and associations with psychosocial outcomes among 1,617 adults (Mage = 25.21, SD = 6.74) across 13 countries and regions. Participants completed an online survey assessing physical neglect, physical abuse, emotional maltreatment, sexual abuse, and witnessing domestic violence, alongside perceived acceptability, post-traumatic growth, resilience, perceived social support, post-traumatic symptoms, and psychological distress. Country/region differences were tested via mixed-effects; whether CM-outcome associations varied by country/region was tested via fixed-effects interaction models. Significant cross-country/region variability emerged for most CM subtypes, especially for emotional maltreatment. Witnessing domestic violence rates did not differ significantly, though its acceptability still varied significantly, as did all other types. Greater CM exposure was linked to poorer mental health for several subtypes and to greater acceptability of maltreatment, raising concerns about intergenerational normalisation. CM-outcome associations were largely consistent across countries/regions, with only isolated, exploratory exceptions. Findings show that while CM's adverse psychosocial impact shows little cross-national variation, its prevalence and normative framing are culturally shaped, underscoring the need for culturally sensitive assessment and intervention.

Background. Population-representative evidence on social inequalities in youth mental health from an intersectional perspective is limited. We investigated inequalities across multiple mental health outcomes among young adults and examined whether measures operated equivalently across social and intersectional groups. Methods. Cross-sectional analyses were conducted with 9,675 participants aged 23 years from the nationally representative UK Millennium Cohort Study (born 2000-2002). Self-reported outcomes included psychological distress (Kessler-6), probable serious psychological distress/'caseness' (Kessler-6 score [≥]13), psychological wellbeing (Short Warwick-Edinburgh Mental Well-Being Scale; SWEMWBS), past-year self-harm, and lifetime suicide attempts. Measurement invariance analyses assessed comparability of the Kessler-6 and SWEMWBS across groups. Intersectional MAIHDA examined inequalities by sex assigned at birth, ethnic identity/background, sexual identity, and childhood poverty. Young people with lived experience of mental ill-health and/or social discrimination contributed to study design, interpretation, and reporting. Findings. Large inequalities were observed across all outcomes, with the largest disparities by sexual identity, followed by sex assigned at birth, childhood poverty history, and ethnic identity/background. Across intersectional strata, predicted psychological distress ranged from -0.27 to 1.32 SDs, and psychological wellbeing from -0.54 to 0.11 SDs. Predicted prevalence varied 6.99-fold (9.81% to 68.55%) for psychological distress 'caseness', 6.84-fold (8.60% to 58.79%) for self-harm, and 22.10-fold (1.96% to 43.32%) for suicide attempts. Young people at the intersection of sexual minority status, female birth sex, childhood poverty, and some ethnic minority identities/backgrounds experienced particularly poor outcomes. Most inequalities showed cumulative patterns consistent with additive expectations, although some intersectional groups experienced better or worse outcomes than expected. Accounting for measurement differences revealed inequalities that were otherwise undetected. Interpretation. Findings highlight the large extent of mental health inequalities when multiple dimensions of social (dis)advantage are considered, and the need to address both the social conditions generating these inequalities and the methodological assumptions shaping how they are measured and understood.

Background: The decline of mental health among adolescents in the UK over the past two decades has occurred amidst many societal and technological changes making it difficult to identify drivers of these trends. We aimed to identify which aspect of life showed the most rapid deterioration in satisfaction in the UK since 2009 and which aspects have become increasingly correlated with mental health. Methods: Between 2009 and 2024, 15,829 adolescents aged 10-15 rated their satisfaction with life as well as five aspects of life (family, friends, school, schoolwork, appearance), via the UK Household Longitudinal Study. Population-weighted regressions were used to estimate annual summary statistics on these items (means, proportions) and the relative associations between satisfaction items and socioemotional difficulties, as measured by the Strengths and Difficulties Questionnaire (SDQ). Meta-regressions estimated linear changes over time, with interactions testing for heterogeneity across sexes, age-groups, and household income. Results: Mean satisfaction with life dropped over the 16 years of study (B=-0.028, 95% CI=-0.034, -0.022), as did satisfaction with all five aspects of life. Satisfaction with school declined most rapidly (B=-0.027, 95% CI=-0.034,-0.020), becoming accelerated in the most recent 5-year window (2020-24; B=-0.139, 95% CI=-0.178,-0.099). The proportion of dissatisfied individuals rose most rapidly for schoolwork, particularly for females. Satisfaction with appearance became increasingly associated with general life satisfaction (B=0.009, 95% CI=0.005, 0.013, p<.001) and socioemotional difficulties (B=-0.051, 95% CI=-0.073,-0.029, p<.001) over time. Conclusions: Our findings add to international evidence for academic pressure and school environments as plausible drivers of recent declines in life satisfaction, particularly among female adolescents. Future studies should aim to identify the specific aspects of school life that are influencing adolescent mental health and the impact of existing educational policies on student wellbeing should be evaluated.

Those leaving military service frequently present with complex psychosocial problems, but military veterans are often reluctant to engage with statutory healthcare provision. Specialist mental health services have recently been established in the UK to specifically support military veterans with their psychological and social wellbeing. We explored the treatment and support provided by the London branch of a military veterans mental health and wellbeing service (Op COURAGE) from the perspectives of the multidisciplinary service team and their partner organisations and collaborators. We conducted semi-structured interviews with multidisciplinary service staff and members of their partner organisations and external agencies. Qualitative data were analysed using framework analysis.?A total of 16 professionals participated in this study, comprising five service staff, eight collaborators and three partner agency participants. Five themes with subthemes were identified, including (1) blended networks, (2) staff inclusivity and sensitivity, (3) spectrum of psychosocial interventions and holistic support, (4) referral mechanisms, and (5) (in)visibility of the service and advertising. Our evaluation highlighted the advantages of a multidisciplinary team and collaborative partnerships to meet the psychosocial needs of veteran and their significant others. We have proposed that service improvement could include increasing advertisement about this specialist service, deepening knowledge about veterans among staff and further involving veterans and key stakeholders in service decisions.

Background: Unpaid caregiving is a recognised social determinant of health, yet most research treats it as a fixed exposure measured at a single time point, and little is known about how patterns of caregiving transitions relate to health behaviours. Methods: Secondary analysis of the UK Household Longitudinal Study (waves 2 to 13, approximately 2010 to 2023; n=25,049). Latent class analysis was applied to binary caregiving status across 12 waves to identify caregiving trajectories. Associations between trajectories and four health behaviours (physical inactivity, fruit and vegetable consumption, problematic drinking, current smoking) at waves 7 to 13 were estimated using logistic and linear regression, adjusting for sociodemographic, health and baseline behavioural confounders. Results: An eight-class solution identified a non-caregiving class comprising 62.9% (n=15,760) of the sample. Among caregivers (n=9,289), trajectories were Temporary (20.0%), Former-short (20.2%), Former-long (10.9%), Emerging-short (15.4%), Emerging-long (11.6%), Long-term (15.7%) and Recurrent (6.3%). In fully adjusted models, Recurrent caregivers had higher odds of smoking (OR=1.67, 95%CI: 1.17 to 2.40) compared with non-caregivers but lower odds of physical inactivity (OR=0.65, 95%CI: 0.53 to 0.81) and problematic drinking (OR=0.75, 95%CI: 0.59 to 0.94). Associations for other trajectory classes were largely attenuated after adjustment. Conclusion: The pattern and timing of caregiving transitions are an under-explored dimension of the caregiving experience. Recurrent caregivers had a distinctive profile, with elevated smoking but lower physical inactivity and problematic drinking. Recurrent caregiving should be recognised alongside intensity and duration, and support systems better equipped for people who move into and out of care repeatedly.

Financial well-being (FWB) encompasses objective and subjective financial status and may influence health. We developed and validated a parsimonious FWB index using data from 23,006 Health and Retirement Study (HRS) participants aged 50 years and older from 2006 to 2022. The FWB-5 Index was derived using correlated two-factor confirmatory factor analysis accounting for household clustering. Indicators included household wealth, household income-to-poverty ratio, monthly financial strain, satisfaction with one's financial situation, and perceived financial mastery. We assessed convergent and discriminant validity using the Consumer Financial Protection Bureau Financial Well-Being (CFPB-FWB) Scale and Satisfaction with Life Scale, respectively. Associations with pre-baseline socioeconomic factors and subsequent depressive symptoms and health conditions were examined to assess construct and predictive validity. Model fit indices supported the two-factor structure (robust comparative fit index = 0.99; robust root mean square error of approximation = 0.05). Correlations were stronger with the CFPB-FWB Scale (Spearman P = 0.80) than with life satisfaction (Spearman P = 0.43). Associations with socioeconomic factors and subsequent health outcomes were in the hypothesized directions. These findings support the FWB-5 Index as a parsimonious measure for examining financial well-being and its associations with health across HRS waves, including those predating the CFPB-FWB Scale.

Background: Childhood experiences contribute to health and wellbeing across the life course, yet research from low- and middle-income countries has largely focused on a few outcomes rather than broader patterns of adult wellbeing, behaviors, and social and financial circumstances. Methods: In this cross-sectional analysis, we used a nationally representative sample of adults in India (N = 12,765; aged [&ge;] 18 years) from the Global Flourishing Study (GFS) Wave 1 (2023) to examine associations between eight retrospectively reported childhood experience items, 45 adult outcomes, and two composite flourishing indices. Survey-weighted linear, logistic, and proportional-odds models adjusted for age, gender, education, and residential setting, with Bonferroni correction were used to assess associations and effect modification by gender. Findings: Although the breadth and strength of associations differed across childhood experiences, less favorable childhood experiences were generally associated with poorer wellbeing and flourishing, greater odds of adverse health outcomes, and reduced access to resources and safety in adult life. However, outcomes related to prosocial behaviors showed a different pattern: childhood abuse (physical or sexual) was associated with greater odds of volunteering (OR 1.31, 95% confidence interval or CI [1.13,1.51]), feeling like an outsider in one's family with greater odds of donating (OR 1.80, 95% CI [1.52,2.13]), volunteering (OR 1.53, 95% CI [1.28,1.82]), and helping a stranger (OR 1.49, 95% CI [1.27,1.74]). Associations were broadly similar between females and males, with little evidence of gender differences. Interpretation: Associations of childhood adversity with poorer health and increased prosocial behavior in adult life may reflect unmeasured social, cultural, or dispositional factors and heterogeneous life-course responses. Nevertheless, these findings support strengthening child-protection, financial assistance programs, and mental health services in India.

Background: Autistic people experience substantially higher rates of mental health conditions and are overrepresented in mental health services. However, most interventions and service models have been developed for non-autistic people, and evidence is needed as to whether there are disparities in outcomes. This systematic review aimed to compare outcomes between autistic and non-autistic people receiving the same mental health interventions or services. Methods: We conducted a systematic review following PRISMA guidelines (PROSPERO: CRD420251021068). We searched academic databases (MEDLINE, Embase, PsycINFO, PubMed, CINAHL), a grey literature database (HMIC), a trial registry (ISRCTN), preprint servers (medRxiv and PsyArXiv), Google, and Google Scholar, to identify relevant papers published 01/01/1992-30/04/2026. We conducted backwards and forwards citation searching and contacted experts. Study quality was assessed using a modified Critical Appraisal Skills Programme Cohort Study Checklist and the Autism-Inclusive Research Assessment (AIRA). Data were synthesised narratively, with random effects meta-analyses where appropriate. Results: Thirty-nine studies were included, comprising 4787730 participants, assessing outcomes of psychological therapies (n = 17) and multi-component or service-level approaches (n = 22). Nearly half (46.2%) were UK-based, and under a quarter (23.1%) included people with intellectual disabilities. Ten studies (25.6%) were rated low quality, twenty-two (56.4%) medium quality, and seven (17.9%) high quality. AIRA ratings highlighted concerns about research inclusiveness for autistic people, including limited involvement of autistic people and lack of validated or adapted outcome measures. Findings varied by intervention: for some, multiple large, higher-quality studies showed less favourable outcomes for autistic people (e.g., less improvement in symptoms or functioning, or higher rates of restrictive practices or acute service use). For other interventions, comparable or mixed outcomes were found across studies, with interpretation often limited by small samples. Conclusions: Mental health treatment outcomes for autistic versus non-autistic people varied across interventions and outcome types. Where significant differences were observed, these usually showed poorer outcomes for autistic people, although they generally reflected smaller improvements rather than a lack of benefit. Action is needed to improve the accessibility and appropriateness of mental health care for autistic people, supported by more high-quality, co-produced research across a broader range of countries and service contexts.

While Artificial intelligence (AI) is increasingly being integrated into psychotherapy, little is known about how prospective patients evaluate different levels of AI involvement. Participants (n = 1,003) with depression evaluated vignettes describing psychotherapy options, from treatment delivered without AI integration (Human therapist) to treatments involving different degrees of AI integration (Assistive, Collaborative, Fully Autonomous AI). Participants consistently evaluated Human therapists more favorably, reporting a greater likelihood of seeking treatment, less hesitancy, and greater treatment acceptability. Economically, compared with a Human therapist, participants were willing to pay 31.6% less for therapists using Assistive or Collaborative AI and 57.2% less for Fully Autonomous AI. 18-19% of participants indicated that they would refuse treatment involving Assistive or Collaborative AI, compared with 31% for Fully Autonomous AI. Preference for Human over AI therapists was particularly pronounced at higher levels of therapist experience (doctoral/masters vs. peer/trainee). Overall, participants valued psychotherapy delivered by Human therapists more highly than AI integrated psychotherapy. These findings suggest that, despite increasing AI integration in mental health care, prospective patients continue to view psychotherapy as a distinctly human endeavor.

Humans often communicate meaningfully during existential transition, yet the structure of final communications before death remains poorly understood. Suicide notes provide rare behavioral records, but two questions remain unresolved: whether note-leavers represent the broader population of suicide decedents, and whether notes follow systematic narrative structures. We analyzed a nationwide police-investigated registry of 102,922 suicide deaths in South Korea from 2013 to 2020, including 38,044 notes. Note-leavers differed systematically from non-leavers across demographic, situational and behavioral characteristics, indicating that note production reflects a selective communicative act within the suicidal process. Modeling notes as sequential narratives, we identified consistent patterns across opening, middle and closing sections, organized around apology and shame, love and gratitude, and practical directives concerning post-mortem affairs. Emotional trajectories also varied by age and gender. These findings provide population-scale evidence that suicide notes are structured final communications shaped by social relationships and demographic context under extreme circumstances.

Borderline personality disorder (BPD) has traditionally been viewed as one of the most chronic psychiatric disorders. Although longitudinal studies have demonstrated promising rates of symptomatic remission, recovery and other clinical outcome measures often remain comparatively low. Qualitative research offers an important perspective on how individuals with BPD may extend a more representative view of improvement and change. We collected narratives from 41 participants with a self-reported diagnosis of BPD and analyzed them using thematic analysis. Its national, virtual recruitment approach enabled a relatively large qualitative sample diverse in gender identity, age, U.S. geographic region, treatment history, and current clinical severity, extending the range of perspectives represented in prior work. Three central themes were identified. The first, Differing attitudes toward language, reflected participantsexperiences of recovery language as paradoxically both validating and stigmatizing. While individual language preferences varied, participants generally converged on a sharedunderstanding of what recovery meant to them. The second, Recovery as a dynamic and relational process, described recovery as nonlinear, effortful, and closely tied to interpersonal experiences. The third, Crossroads and uneven change over time, highlighted the role of personal agency, critical decision points in seeking treatment, and the persistence of internal distress even as behavioral symptoms improve. Findings from this study both replicate and extend existing qualitative research by discussing how individuals with BPD understand recovery in ways that may not be captured by traditional clinical outcome measures. These results emphasize the importance of incorporating lived-experience perspectives when defining recovery and setting treatment goals.

Abstract Background: The 52-item Ontario Child Health Study Emotional Behavioural Scales (OCHS-EBS) has demonstrated reliability and validity evidence in Canadian population-based samples. This study evaluated an adapted item set of the Ontario Child Health Study Emotional Behavioural Scales (OCHS-EBS-A) intended to measure selected mental disorder symptoms while reducing respondent burden in population-based research. Methods: A prespecified candidate set of 21 items from selected OCHS-EBS disorder scales assessed depression (4 items), generalized anxiety (4 items), oppositional behaviour (6 items), and attention-deficit/hyperactivity (7 items). The 2023 Longitudinal Canadian Health Survey on Children and Youth (L-CHSCY; ages 5-21 years; n= 22,740) provided calibration and internal-validation samples. The Ontario Provincial Assessment and Tracking of Child and Family Health Study (ONPATH; Wave 5: n=719 parent and n=116 youth respondents) provided an independent sample for further evaluation. Analyses examined factorial validity, internal consistency reliability, convergent and discriminant validity, and measurement invariance across sex assigned at birth within age/informant groups. Findings: The analyses supported a refined 20-item OCHS-EBS-A with three correlated factors representing internalizing, oppositional behaviour, and inattention/hyperactivity symptoms. Prespecified criteria for internal consistency reliability and convergent and discriminant validity were met within the reported L-CHSCY age/informant groups. Measurement invariance across sex assigned at birth was supported in the L-CHSCY groups and for children and parents in and youth-reported internalizing symptoms in ONPATH. However, not for ONPATH youth-reported oppositional behaviour symptoms. Interpretation: Results from these population-based samples provide factorial-validity, internal-consistency, and convergent- and discriminant-validity evidence for scores from the 20-item OCHS-EBS-A among children, youth, and emerging adults aged 5-21 years.

Childhood experiences are important antecedents of adult flourishing, yet gender patterns in these experiences are under-studied in large global samples using a common survey instrument and population-based study design. From the Global Flourishing Study Wave 1 data (2022-2024), we analyzed responses from 203,430 adults (51% female, 49% male) in nationally representative samples from 21 nations on eight childhood-related items: experiencing physical or sexual abuse, feeling like an outsider in the family, feeling loved by one's mother or father, quality of relationship with one's mother or father, health growing up, and perceived family financial situation. Greater negative experiences were noted in more affluent nations (as measured by gross domestic product (GDP) per capita), with negative experiences generally reported more often among females than males, again especially in more affluent nations. Gender differences were more pronounced when it came to relationships with mothers compared to fathers. Perceptions regarding health and family finance while growing up did not show appreciable gender differences and had weaker correlations with other items.

Background: Substance use during pregnancy can substantially increase risk for postpartum depression and anxiety symptoms, which can have lasting effects on family functioning and child development. However, substance use is often conceptualized as a binary exposure, limiting our understanding of whether specific patterns of use are associated with maternal mental health in the perinatal period. Here, we examined longitudinal patterns of prenatal alcohol use and smoking in relation to maternal depressive and anxiety symptoms across pregnancy and the first two years postpartum. Methods: We analyzed prospective data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a population-based cohort from the UK. Alcohol and cigarette use were assessed across all three trimesters and modeled as longitudinal patterns (abstained, persistent, intermittent, discontinued). Maternal depressive and anxiety symptoms were measured from the second trimester through 21 months postpartum using the Crown-Crisp Experiential Index. Results: Persistent alcohol use was associated with higher depressive and anxiety symptoms and slower symptom declines over time, while women with intermittent or discontinued use had symptom profiles similar to abstainers. By contrast, persistent, intermittent, and quitting smoking patterns were associated with higher symptom levels overall, with persistent smoking additionally associated with steeper declines in symptoms over time. Conclusion: Our findings highlight the importance of considering the persistence and cessation of substance use during pregnancy in the context of maternal mental health, pointing to patterns of persistent substance use as a potential target to inform screening and early intervention for women at higher risk for perinatal psychological distress.

Background: People with severe mental illness (SMI) report poorer oral health outcomes than the general population, are less likely to attend regular dental check-ups, and may require additional support to visit a dentist. Our previous research showed that interventions tailored to their needs and support from the mental health care system are needed to improve oral health outcomes in people with SMI. Although there is some provision of urgent dental care for people with SMI, there are currently limited available interventions that integrate dental and mental health care and provide dental support in a mental healthcare setting. To address this gap, the aims of the SMILE project are to 1) co-develop and 2) test the feasibility and acceptability of an oral health intervention for people with SMI, delivered by mental health professionals in secondary community mental health care settings. This paper describes the protocol for the feasibility and acceptability testing of the SMILE intervention. Methods: This is a single-arm, non-randomised feasibility trial assessing the feasibility and acceptability of an intervention to support the oral health of mental healthcare service users with SMI. The intervention was co-produced with service users, carers, mental health and dental health professionals, and includes advice on maintaining good oral hygiene and lifestyle habits to maintain good oral health. The main aim of the study is to assess the feasibility and acceptability of delivering the intervention, using quantitative data collected at baseline, three and six-month follow-up, and qualitative interviews with participants and mental health staff involved in delivering the intervention. Results: The study results will determine whether the intervention can be successfully delivered in secondary community mental health care settings and inform the most appropriate primary and secondary outcomes for a future trial. Conclusion: The findings of this study will inform the feasibility of progression to the pilot stage of a randomised controlled trial to assess the clinical and cost effectiveness of delivering an oral health intervention in a mental healthcare setting.

Objective: Mindfulness is a robust predictor of mental health, yet the psychometric properties of the short-form Five Facet Mindfulness Questionnaire (FFMQ-15) have not been examined in Iranian populations. This study evaluated the psychometric properties, factor structure, and diagnostic utility of the FFMQ-15 among medical sciences students. Participants: A total of 348 students (178 females, 170 males) from Kermanshah University of Medical Sciences participated. Methods: Participants completed the FFMQ-15, Penn State Worry Questionnaire (PSWQ), Difficulties in Emotion Regulation Scale (DERS), and Emotion Regulation Questionnaire (ERQ). Data were analyzed using exploratory and confirmatory factor analyses, composite reliability, and ROC curve analysis. Results: Both EFA and CFA supported the five-factor model, revealing a culturally unique item loading pattern. The FFMQ-15 demonstrated strong convergent and discriminant validity. ROC analysis indicated acceptable diagnostic accuracy for distinguishing high- and low-worry groups (AUC = 0.72, 95% CI: 0.66-0.78). Conclusions: The FFMQ-15 demonstrated acceptable psychometric properties in Iranian medical students. The non-reactivity facet exhibited cultural variability, suggesting that cross-cultural adaptation is essential. The instrument shows promise for screening in high-stress educational settings.

Introduction: Adolescents experience high rates of depression and anxiety, yet globally 80% of adolescents and almost all in low-and middle-income countries (LMICs) lack access to adolescent-friendly treatments. The African Youth in Mind (Y-MIND) set out to adapt the youth version of the Friendship Bench and assess its feasibility for delivery in Ghana. Methods: In this feasibility cluster randomised controlled trial, we recruited participants aged 15 to18 years with probable diagnosis of moderate to severe depression ascertained with the Patient Health Questionnaire (PHQ-9) total score > 9 from six Senior High Schools in Navrongo, Ghana. Schools were randomly allocated (1 to 2) to enhanced usual care (EUC) alone or EUC combined with Y-MIND, prior to recruitment of participants. Primary outcomes were feasibility (intervention delivery; conducting a fully powered trial). Secondary outcomes were intervention appropriateness, acceptability, and probable depression symptom severity and remission on the PHQ-9. Results: Between July and August 2024, we enrolled and allocated 67 participants (43 [64%] to the EUC plus Y-MIND group and 24 [36%] to the EUC alone group), of whom 64 (95.5%) completed the 5-month primary outcome assessment (41 [95.3%] in the EUC plus Y-MIND group and 23 [95.8%] in the EUC alone group). The feasibility of delivering the Y-MIND intervention from the perspective of adolescents had a mean score of 4.3 (0.5). Therapy quality score was 94.8% (95% CI: 93.0, 96.6), while therapy competence was 86.6% (95% CI: 81.2, 92.2). We observed initial clinical benefits, including lower severity of depressive symptoms among adolescents in the Y-MIND group as compared to those in the EUC group, with most participants achieving symptomatic remission at the month 5 follow-up. Conclusion: The Y-MIND school-based psychological treatment model demonstrated good acceptability and feasibility, with high recruitment, retention, treatment adherence, and provider competence. While preliminary findings indicate potential improvements in depressive symptoms, the study was not designed to establish effectiveness. These findings justify progression to a fully powered trial to determine clinical effectiveness, cost-effectiveness, and the scalability of the intervention within routine school settings in LMICs. Trial registration: Clinicaltrials.gov (NCT06740084).

Background: Adolescents frequently consult online resources regarding sensitive health topics, including suicide. Although content analyses demonstrate that online platforms contain both suicide-preventive and pro-suicide material, they rarely incorporate subjective data from adolescents at elevated suicide risk. Aims: This exploratory study examined associations between reasons for seeking suicide-related information online and the digital media used to access such content among adolescents with suicidal ideation. Method: Over one year, 131 adolescents aged 13 to 18 with current or past suicidal ideation were recruited from the Emergency Department of an urban pediatric hospital to complete a cross-sectional survey. Participants reported whether they had sought suicide-related information online, the type of information sought, and the online locations used. Mixed-effects regression models examined associations between reasons for online searches and digital media used. Results: Of 131 enrolled adolescents, 113 completed the survey; 69 (61.1%) reported ever seeking suicide-related information online. Searches were more often intended to assist with acting on suicidal thoughts than to reduce suicidal thoughts (63.7% vs. 55.1%). Social media were used for help-seeking searches slightly more often than professional health organization websites (42.1% vs. 31.6%). Among adolescents who used social media for their searches, discussion forums were significantly more likely to be used when seeking information to act on suicidal thoughts (OR=7.0, p=.02). Conclusion: The majority of adolescents with suicidal ideation may seek out suicide-related content online, particularly to facilitate suicide planning. Social media may be used as frequently as professional mental health websites like 988 or The Trevor Project for suicide-related searches.

Abstract Objective: The Nationwide Quality of Life Scale (NQLS) is a brief, public-domain, youth self-report measure designed for quality of life (QoL) reporting in measurement-based care (MBC). Preliminary psychometric support comes from a sample of treatment-seeking youth, but its use in a population-based sample has not been evaluated. This study examined the NQLS psychometric performance in a U.S. nationally representative sample and develops national norms, score interpretation guidance, and clinical significance benchmarks. Method: A nationally representative sample of 1,008 youth ages 12-18 completed the NQLS as part of a larger survey battery. Analyses included exploratory and confirmatory factor analysis, reliability, validity, item response theory, and generalized additive models for location, scale, and shape (GAMLSS) norming. We integrated these results with clinical data from 1,200 youth seeking treatment at a large Midwestern children's hospital to estimate clinical significance benchmarks and compare between groups. Results: One- and two-factor solutions were evaluated. The NQLS demonstrated good internal consistency and convergent validity, with distinguishable 'life' and 'school' factors. Normative percentiles were generally stable across age, with modest narrowing at the youngest and oldest ages. Normative-sample youth showed raw score and latent trait estimates significantly higher than clinical-sample youth. Conclusions: The NQLS provides reliable and valid measurement of QoL in a nationally representative sample. Although two structural factors were identified, the composite score is recommended for clinical decision-making. National norms and clinical significance benchmarks may facilitate MBC applications of the NQLS. Future research should evaluate its performance across additional care settings. Keywords: Quality of life, assessment, psychometrics, youth, measurement-based care, norms