Thach Tran

Residential early parenting services in Australia provide psychoeducational programs for unsettled infant behaviour, which is reported by up to 35% of parents in their child’s first year and can negatively affect parenting self-efficacy. This study aimed to evaluate changes in infant behaviour and parenting self-efficacy following a five-night residential early parenting program and to identify demographic, social, and psychological predictors of parenting self-efficacy. An observational pre-post study using routinely collected medical record data from parents and infants aged up to 24 months was analysed. Parenting self-efficacy was assessed pre-admission and post-discharge using seven items from the Karitane Parenting Confidence Scale. Infant sleeping and cry/fuss behaviour was measured at pre-admission, pre-discharge, and at the 6-week follow-up using study-specific questions. N = 1243 completed the program and provided pre-admission and pre-discharge data. N = 540 provided follow-up data. Overall, improvements were observed following participation. Infant sleeping and cry/fuss behaviour improved pre-discharge and remained largely stable at follow-up. Parenting self-efficacy increased from pre-admission to follow-up. An older maternal age, infants aged ≤ 4 months, and the reporting of more borderline personality disorder symptoms were associated with lower improvements in parenting self-efficacy. Residential early parenting programs improve infant behaviour and parental self-efficacy, though targeted follow-up services are indicated to sustain outcomes for vulnerable subgroups.

Introduction: Parents are crucial as providers of nurturing care for their children to grow and thrive. A community-based multicomponent intervention for women’s health and early childhood health and development was conducted in rural Vietnam, spanning from mid-pregnancy through the first postpartum year. A cluster-randomised controlled trial of the programme conducted between 2018 and 2021 found that children aged 2 years whose parents were in the intervention group and had received the programme had higher cognitive, language and motor development than those in the control group who had received the usual standard of care. The intervention was also found to be cost-effective and improve equity. The aim of this follow-up study is to examine the mid-term effects of the intervention and describe the views of caregivers, service providers and policymakers on the programme, the evidence of its impact and its translation into policies and practice. Methods and analysis: This is a follow-up study of participants in a cluster-randomised controlled trial to examine the mid-term effects of the intervention when children are 7 and 9 years old in Vietnam. We will re-enrol mother–child dyads from the original trial (622 women and their children in the intervention; 546 dyads in the control group). The primary outcome is children’s intellectual ability. Secondary outcomes include children’s emotional and behavioural development, quality of life, anthropometric indices, health conditions, health behaviour and education and parenting, maternal mental health, maternal quality of life, cardiovascular health and biomarkers of ageing together with women’s and children’s experiences of family violence. Outcomes will be measured using culturally and linguistically adapted standardised tools and study-specific structured questions. Differences in outcomes between trial groups will be assessed using mediation analyses and mixed-effects models, including a fixed effect for the trial group and adjusting for cluster effects as a random effect based on the intention-to-treat principle. An economic evaluation will estimate the cost-effectiveness of the intervention in improving child development at ages 7 and 9 years from healthcare and societal perspectives. A qualitative study will be conducted alongside the follow-up study using purposive sampling to describe the perspectives of caregivers, service providers and policymakers on the intervention, the evidence about its impact and its integration into national policies and services. Ethics and dissemination: Ethics approval was obtained from the Monash University Human Research Ethics Committee (2025–46034-125952). Study findings will be disseminated through multiple channels, including peer-reviewed publications, national and international conference presentations, seminars, policy briefings, lay language summaries to communes and media reports. Trial registration number: ACTRN12625001113448.

Background: Informal carers are essential in supporting people with cancer yet often experience unmet supportive care needs. Aims: The aim of this study was to examine (a) access to supportive care services (b) perceived barriers to accessing services, and (c) the potential influence of carer health literacy on access and barriers to supportive care among carers across three priority population groups (rural‐remote‐dwelling, LGBTIQA+ and culturally and linguistically diverse (CALD)). Methods: Cross‐sectional online survey of Australian adult cancer carers. Supportive care use, access barriers, and health literacy (Health Literacy of Caregivers Scale – Cancer (HLSC‐C)) were assessed. Logistic regression examined differences across priority groups, and mediation analyses explored the role of health literacy. Results: Among 1154 carers, 61.9% accessed some supportive care (46.7% formal services), yet 86.6% reported at least one barrier, with 71.0% reporting two or more. Common barriers were time constraints, service availability, and long wait times. Compared to non‐priority population carers, rural/remote carers had higher odds of reporting limited local availability and services not available when needed (aOR = 5.08 for both). CALD carers had higher odds of reporting a barrier (aOR = 1.81), including long wait times, cost, and lack of culturally appropriate services (aOR = 33.03). Health literacy significantly mediated the association between CALD status and reported barriers. Conclusions: Cancer carers have limited access to supportive care and face systemic barriers. Inequities remain, particularly for carers from rural/remote areas and those from CALD backgrounds. To improve equity, there is a need for co‐designed, accessible interventions that address health literacy and the diverse geographic, cultural, and linguistic needs of carers. Patient or Public Contribution: People with lived experience of cancer caregiving were included on this study's advisory committee. In this role, their expertise informed the study design, including the development of the questionnaire, the Participant Information and Consent Form (PICF), and recruitment processes. They were also invited to contribute to data interpretation and the preparation of this manuscript. The lead consumer representative (NR) is listed as a co‐author on this manuscript.

Background/Objectives: Across geographical and cultural contexts, how individuals identify, communicate and help-seek for distress is often shaped by how mental health itself is understood. Insight into how adolescents and adults in their routine environment, such as teachers, understand mental health is crucial for developing context-specific mental health promotion strategies to young people. Sri Lanka, a country that navigates the dual legacies of pre-and-post-colonial mental health frameworks, has this need. The aim was to explore Sri Lankan school-going adolescents’ and their teachers’ perspectives of mental health and its determinants. Methods: Semi-structured interviews were conducted with 28 school-going adolescents in grades 10–12/13 and 14 of their school teachers, from seven secondary schools in Gampaha District, Sri Lanka. Interviews were transcribed, translated, coded inductively and analysed thematically. Results: All participants drew on culturally meaningful language that is rooted in Buddhist perspectives to conceptualise mental health. Causes and risk factors of poor mental health were attributed to individual, immediate environmental and structural factors. School environment played a central role in exacerbating other risk factors. Adolescents exhibited more knowledge of informal care avenues for mental health-related concerns. Conclusions: Findings highlight several implications including opportunities to leverage culturally contextualised language/frameworks when promoting mental health to Sri Lankan adolescents, diversifying mental health research and initiating school-based mental health programmes that integrate mental health promotion into routine educational practice to transform learning institutions across Sri Lanka to become mental health-promoting schools.

Background: Optimal early childhood development predicts lifelong health and well‐being. A child's immediate environment, especially the home, shapes cognitive, physical, language, motor, social and emotional development. Contextually relevant data on the proximal settings that support preschool‐aged children are lacking in low‐ and middle‐income countries (LMICs) across the East Asia and Pacific region. This systematic review synthesises evidence on associations between home‐based learning opportunities and caregiving experiences and the cognitive and overall development of children aged 2–5 years in LMICs of the East Asia and Pacific region. Methods: We searched Medline, Embase, PsycINFO, Emcare and Global Health for studies published between January 1990 and January 2025. The search strategy used subject headings and free text terms using the condition, context and population (CoCoPop) framework to capture studies on cognitive or overall development (condition), home‐based learning opportunities and responsive caregiving (context) and children aged 24–59 months in LMICs in the East Asia and Pacific region (population). Data were independently extracted and appraised using the Joanna Briggs Institute Critical Appraisal Tools risk of bias and quality assessment checklists. The findings were summarised using narrative syntheses. Results: Studies were from lower and upper middle‐income countries in East Asia, and the study quality ranged from medium to high. Eighteen of the 19 included studies reported significant positive associations between home‐based learning opportunities and caregiving and higher child development. The strongest effects were linked with psychosocial stimulation, academic‐focused caregiving and enriched home learning environments. Measures of learning opportunities and caregiving varied widely. Conclusions: The review findings suggest that home‐based learning opportunities and responsive caregiving experiences may be associated with improved developmental outcomes among 2‐ to 5‐year‐old children. Although these patterns are consistent with broader evidence, the heterogeneity of measures and limited representation mean that conclusions should be interpreted with caution. Future research could prioritise underrepresented settings, including low‐income countries and Pacific Island nations, to ensure policy reflects regional diversity. The heterogeneity in measures highlights the need for standardised tools to better capture associations between child development and the home environment.

The mental health of Sri Lankan adolescents is of growing concern, given the decades of internal conflict and socio-political instability in Sri Lanka. This aims were to examine the prevalence and determinants of symptoms of common mental health problems (MHP) experienced by school-going adolescents in Sri Lanka. A cross-sectional survey was conducted among school-going adolescents in grades 10–12/13 from seven schools in Gampaha District, Sri Lanka. Depressive/psychological distress symptoms measured using the PHQ-9 /K10, were analysed using mean scale scoring. Psychosocial determinants were measured using JVQ/PBI/AESI/study-specific questions. Associations between MHPs and psychosocial determinants were examined using multiple linear regression models. 24.11% of 1,045 adolescents who completed the surveys reported clinically significant symptoms of depression, and 60.10% reported psychological distress. Higher age, being female, lesser physical activity, smoking, daily social media use, violent victimisation, not living with both birth parents, having ≥2 siblings, low maternal/paternal education, having an overprotective paternal figure, increased academic stress and rural living were associated with higher MHPs. We identified a high prevalence of MHPs among Sri Lankan adolescents, which was multifactorially determined. Modifiable risk factors addressed through public health policies, research and programmes, as well as less-modifiable risk factors addressed through national-level policy changes, are all essential to addressing mental health burdens in this population.

This study aimed to describe changes over time in the prevalence and associated factors of suicidal behaviours among 13– to 15–year–olds in Southeast Asian countries. It is a secondary analysis of cross-sectional data from the Global School-based Student Health Surveys conducted in Indonesia, Myanmar, the Philippines and Thailand in 2007/2008 and 2015/2016. Each survey included a nationally representative sample of students aged 13–15 years. Data on suicidal thoughts, plans, attempts, and associated factors—including health risk behaviours, experiences of physical violence and bullying, social difficulties, and parental supervision—were collected using self-report questionnaires. The population attributable fraction for each risk factor was calculated using multiple logistic regression. The prevalence of suicidal behaviours ranged from 0.7% (Myanmar) to 17.3% (Philippines) in 2007/2008, and from 8.6% (Indonesia) to 20.9% (Thailand) in 2015/2016. Being physically attacked or bullied and experiencing social difficulties were the most consistent and significant risk factors across countries and time points. Female gender, poverty, alcohol consumption, and drug use also contributed to risk at varying levels. Suicidal behaviours have risen alarmingly in several Southeast Asian countries. These findings suggest the urgent need for coordinated action by policymakers, health professionals, educators, and families to prevent adolescent suicidal behaviours.

Objective This study aims to evaluate the cost-effectiveness of a school-based mental health prevention program in a limited income context to inform investment decisions. Methods The Resourceful Adolescent Program, an evidence-based resilience intervention designed for adolescents, was culturally adapted as Happy House (HH) in a two-arm, controlled trial in selected high schools in Vietnam. A Markov model assessed HH’s cost-effectiveness in preventing depression compared with doing nothing from a societal perspective over 5-year, 10-year, and lifetime horizons. The model underwent face, internal, and cross-validation with experts in health economics, mental health, and education. Effect size was drawn from the HH trial, utility values from an EuroQol 5-Dimension 5-Level (EQ-5D-5L) survey of 1004 adolescents and systematic reviews, and costs from the HH trial and Vietnam data. Incremental cost-effectiveness ratios (ICERs) were expressed in 2020 Vietnamese dong (VND) per quality-adjusted life year (QALY) gained, with costs and benefits discounted at 3%. Sensitivity analyses and a scenario on nationwide HH scaling were also conducted. Results Compared with do-nothing, HH had ICERs of 43.8 million VND (US $5512), 30.4 million VND (US $3831), and 22.9 million VND (US $2886) per QALY gained over 5-year, 10-year, and lifetime horizons, respectively. Nationwide scaling reduced ICERs to 27.6 million VND (US $3470), 18.8 million VND (US $2370), and 13.5 million VND (US $1698) per QALY over the same periods. ICERs were sensitive to changes in effect size, disease incidence, and intervention costs. Sensitivity analyses demonstrated that the results were robust despite parameter uncertainty and variations in key assumptions Conclusions Investing in a universal school-based mental health prevention program is cost-effective compared with doing nothing in a limited income context such as Vietnam. Scaling up HH implementation amidst rising depression incidence further enhances the cost-effectiveness of this investment.

Objectives This study aimed to estimate the prevalence of individuals experiencing financial hardship and to examine the relationship between their experiences of financial hardship and psychological distress during and after the COVID-19 lockdowns. Design This is a secondary analysis of data from four repeated state-wide surveys conducted in 2020 and 2022. Setting Victoria, Australia. Participants and outcome measures All Victorian residents aged 18 years and above were eligible. Psychological distress was assessed using the Kessler Psychological Distress Scale-6 Item version (K6), while financial hardship was assessed using a nine-item scale. Relationships between experiencing any form of financial hardship and experiencing high psychological distress (K6≥19) were evaluated using an autoregressive and cross-lagged model that used data from all four surveys. Results A total of 2000, 2000, 2349 and 2444 individuals responded to surveys 1, 2, 3 and 4, respectively. The proportion of people experiencing at least one form of financial hardship increased from 23.5% in 2020 (the first year of the pandemic) to 38.5% in 2022 (the third year of the pandemic). The most vulnerable groups facing financial hardship included young people, Aboriginal & Torres Strait Islanders, individuals with disabilities and those with low income. The proportions of individuals experiencing high psychological distress followed a quadratic trajectory, with the peak occurring between the first and third years of the pandemic. Experiencing financial hardship was consistently associated with high psychological distress at each time point in this study. However, there was no evidence of a longitudinal relationship between financial hardship and high psychological distress. Conclusions The data from this study confirmed a significant increase in the proportion of individuals facing financial hardship among the adult population in Victoria from the first to the third year of the COVID-19 pandemic. This study does not ascertain a longitudinal effect of financial hardship on psychological distress during the pandemic. Further research is warranted to confirm this finding.