Keng-Yen Huang

Adolescent mental health is a high priority in low- and middle-income countries (LMICs), yet perspectives may differ among youth and adult providers responsible for supporting mental health within schools. These differences may create challenges for designing contextually appropriate school-based preventive strategies. This qualitative study compared adolescent and school guidance and counseling coordinator (GCC) perspectives on factors influencing adolescent mental health and support in all 12 public senior high schools in Tamale, Ghana. GCC data were collected through semi-structured interviews informed by the Consolidated Framework for Implementation Research, and adolescent data was through human-centered design workshops. Data were analyzed using rapid qualitative analysis and organized using the Social Ecological Model. At the individual level, adolescents linked emotional distress, stress, and substance use to mental health challenges, whereas GCCs more commonly framed these as behavioral or academic challenges. At the interpersonal level, both groups identified peer relationships and confidentiality as important influences on help-seeking; adolescents emphasized trusted peer relationships, while GCCs described challenges implementing peer counseling approaches within schools. At the organizational level, adolescents emphasized teacher attitudes and punitive school responses to student distress, while GCCs emphasized staffing shortages, limited infrastructure, and insufficient institutional support. At the community level, both groups identified stigma and gendered social norms as barriers to mental health support. Adolescents and GCCs identified similar concerns but differed in how they understood adolescent mental health and support within schools. Integrating both youth and provider perspectives may strengthen multilevel school-based preventive strategies in resource-constrained settings.

Adolescents in low- and middle-income countries (LMICs) face significant mental health challenges, yet their perspectives are often underrepresented in the design of preventive strategies. Co-design approaches, such as human-centered design (HCD), offer a promising way to tailor interventions and implementation strategies to adolescents’ needs and local context. In LMICs, these methods require careful adaptation to address resource constraints, limited design literacy, and cultural norms. This study documents how HCD was adapted to engage adolescents in northern Ghana as co-designers of school-based mental health preventive strategies. Guided by the first two phases of HCD, we conducted two workshops with 24 students from 12 public senior high schools in Tamale, Ghana. Workshop 1 (Inspiration) used structured, case-based discussions informed by the Consolidated Framework for Implementation Research (CFIR) to explore adolescents’ perspectives on mental health. Workshop 2 (Ideation) used interactive choice-based activities to elicit youth-generated strategies. To align with cognitive and sociocultural factors, we incorporated scaffolded facilitation, hands-on activities, and peer-led engagement. Qualitative data from facilitator notes, artifacts, and audio-confirmed summaries were synthesized using structured rapid qualitative analysis. Adolescents identified key mental health concerns, including stigma, peer and family influences, and fears about confidentiality. Gender-specific discussions revealed culturally rooted concerns, such as peer pressure and substance use among boys and limited support-seeking among girls. Adolescents prioritized five school strategies: teacher training, curricular integration, mentorship programs, activities that promote positive thinking and mindfulness, and entertainment-based mental health education. Youth demonstrated a conceptual shift from viewing mental health as an individual problem to a shared responsibility across schools and communities. Formation of an Adolescent Advisory Board reflected youth interest in sustained leadership and co-design. Contextualized co-design methods can meaningfully engage adolescents in LMIC settings and support the development of culturally grounded, feasible, and youth-prioritized mental health strategies. Structured facilitation enhances both the inclusivity and authenticity of adolescent engagement. This study contributes to implementation science by presenting a replicable co-design framework with policy relevance and providing a foundation for multilevel intervention development in resource-constrained educational systems.

Background/Objectives: This study aims to understand gaps and strategies in Chinese Americans’ utilization of SDOH services in the pediatric primary care context in Sunset Park, Brooklyn, from a patient–provider partnership perspective. Methods: The study was guided by an integrated Patient–Provider Partnership, Engagement, and Collaboration (PEC) framework that influenced patient–provider interaction during the provision of SDOH services. A qualitative study design was applied, and eight quality improvement interviews with healthcare providers were conducted to understand the existing community and health service system context. Six in-depth interviews were conducted with Mandarin-speaking Chinese American caregivers. Interviews were transcribed and coded in Mandarin and then translated into English. Results: Consistent with the PEC framework, we identified cognitive, affective, and communication gaps from both the patient and provider. Caregivers reported unaddressed needs in food, financial security, and mental health. Providers identified gaps in patient workflow, staffing, and the intake form process. Conclusions: Addressing social determinants of health among Chinese American immigrant populations is crucial for mitigating poor health outcomes in children and families. Multi-level community-engaged strategies are needed to alleviate the challenges facing this community. Recommendations for future research should consider the importance of language and cultural affinity, digital intake forms translated into the patient’s language, and regular on-site staffing during SDOH screenings.

Background: Adolescent depression is highly prevalent in low- and middle-income countries (LMICs). Identifying top key risk factors is necessary to inform effective prevention program design. Machine learning (ML) offers a powerful approach to analyze complex multidomain of data to identify the most relevant predictors and estimate risks for mental health problems. This paper applies ML to study risks for adolescent depression to enhance adolescent depression prevention efforts in LMICs. Methods: Six ML approaches (e.g., Explainable Boosting Machine, random forests, and XGBoost) were applied to study the risks of depression. Data were drawn from a digital health intervention study conducted in Kenya (year 2024–2025, n = 269). Multiple domains of childhood and adolescent adversity and stress experiences were used to predict adolescent depression (using PHQ9-A). Findings: We found that ML was a valuable approach in the early identification of adolescents at risk for depression. Among the six ML approaches applied, the random forest approach outperformed other ML approaches, especially when multiple domains of risks were included. We also found that childhood adversity or home adversity alone were not strong predictors for depression. Adding adolescent stress experiences and community school adversity experiences significantly improves the accuracy and predictability of depression. Using the top-15 and top-20 ranking factors, we achieved 74.8% and 75.1% accuracy in depression prediction, which was similar to the accuracy when all 49 adverse/stress factors were included in the predictive model (78.3%). Conclusions: Innovative ML and modern predictive modeling approaches have the potential to transform modern preventive mental health care by better utilizing multidomain data to identify individuals at risk for developing depression early and identify top risk factors (for targeted individuals and/or populations). Findings from ML can inform tailored intervention design to better mitigate risks in order to prevent depression problem development. They can also inform the better utilization of resources to target high-need cases and key determinants, which is particularly useful for LMICs and low-resource settings. This paper illustrates an example of how to move toward this direction. Future research is needed to validate the approach.

Background: Loneliness is emerging as a key risk factor for child and adolescent mental health. Exacerbated by lack of support, busy routines, continuous adversities, and poor social networks, it is a public health concern. Sleep is essential for healthy development and emotional regulation, critical for modulating risk‑taking, and determines optimal learning and mental health. However, the connection between loneliness and sleep and their impact on mental health and educational outcomes is not well known in low‑ and middle‑income countries (LMICs) like Kenya, where a large portion of the population is young.

Background: Peripartum adolescents experience significant interpersonal transitions in their lives. Depression and emotional distress are often exacerbated by adolescents’ responses to these interpersonal changes. Improved understanding of pregnancy-related social changes and maladaptive responses to these shifts may inform novel approaches to addressing the mental health needs of adolescents during the perinatal period. The paper aims to understand the sources of psychological distress in peripartum adolescents and map these to Interpersonal Psychotherapy’s (IPT) problem areas as a framework to understand depression. Method: We conducted interviews in two Nairobi primary care clinics with peripartum adolescents ages 16–18 years (n = 23) with experiences of depression, keeping interpersonal psychotherapy framework of problem areas in mind. We explored the nature of their distress, triggers, antecedents of distress associated with an unplanned pregnancy, quality of their relationships with their partner, parents, and other family members, perceived needs, and sources of support. Results: We found that the interpersonal psychotherapy (IPT) framework of interpersonal problems covering grief and loss, role transitions, interpersonal disputes, and social isolation was instrumental in conceptualizing adolescent depression, anxiety, and stress in the perinatal period. Conclusion: Our interviews deepened understanding of peripartum adolescent mental health focusing on four IPT problem areas. The interpersonal framework yields meaningful information about adolescent depression and could help in identifying strategies for addressing their distress.

Background: Children in low-and-middle-income countries (LMICs) are facing tremendous mental health challenges. Numerous evidence-based interventions (EBIs) have been adapted to LMICs and shown effectiveness in addressing the needs, but most EBIs have not been adopted widely using scalable and sustainable implementation models that leverage and strengthen existing structures. There is a need to apply implementation science methodology to study strategies to effectively scale-up EBIs and sustain the practices in LMICs. Through a cross-sector collaboration, we are carrying out a second-generation investigation of implementation and effectiveness of a school-based mental health EBI,ParentCorps Professional Development (PD),to scale-up and sustain the EBI in Uganda to promote early childhood students’ mental health. Our previous studies in Uganda supported that culturally adaptedPDresulted in short-term benefits for classrooms, children, and families. However, our previous implementation ofPDwas relied on mental health professionals (MHPs) to providePDto teachers. Because of the shortage of MHPs in Uganda, a new scalable implementation model is needed to providePDat scale.Objectives: This study tests a new scalable and sustainablePDimplementation model and simultaneously studies the effectiveness. This paper describes use of collaboration, task-shifting, and Train-the-Trainer strategies for scaling-upPD,and protocol for studying the effectiveness-implementation ofParentCorps-PDfor teachers in urban and rural Ugandan schools. We will examine whether the new scale-up implementation approach will yield anticipated impacts and investigate the underlying effectiveness-implementation mechanisms that contribute to success. In addition, considering the effects ofPDon teachers and students will influence by teacher wellness. This study also examines the added value (i.e. impact and costs) of a brief wellness intervention for teachers and students.Methods: Using a hybrid-type II effectiveness-implementation cluster randomized controlled trial (cRCT), we will randomize 36 schools (18 urban and 18 rural) with 540 teachers and nearly 2000 families to one of three conditions:PD + Teacher-Wellness (PDT), PDalone (PD), and Control. Primary effectiveness outcomes are teachers’ use of mental health promoting strategies, teacher stress management, and child mental health. The implementation fidelity/quality for the scale-up model will be monitored. Mixed methods will be employed to examine underlying mechanisms of implementation and impact as well as cost-effectiveness.Discussion: This research will generate important knowledge regarding the value of an EBI in urban and rural communities in a LMIC, and efforts toward supporting teachers to prevent and manage early signs of children’s mental health issues as a potentially cost-effective strategy to promote child population mental health in low resource settings.Trial Registration: This trial was registered with ClinicalTrials.gov (registration number: NCT04383327;https://clinicaltrials.gov/ct2/show/NCT04383327) on May13, 2020.

More than 61,000 persons below the age of 18 are living on the streets in the Greater Accra region in Ghana. Street children is a hidden vulnerable population and a global public health issue in the world, but little is known about their mental health and health needs, and mechanisms that contribute to their poor health. With a lack of mental health research to guide intervention or psychoeducation programme and policy planning, this study aimed to address these research gaps by examining prevalence of mental health problems and a set of associated risk factors (i.e. Perceived quality of life, and social connection). In addition, we examined whether the associations between risk factors and mental health problems were moderated by demographic and contextual factors (i.e., gender, age, work status, reason for living on street, number of years in street). Two hundred and seven children between age 12 and 18 who lived on the street in three cities (Accra, Sekondi Takoradi, and Kumasi) were recruited. Data were gathered through adolescent survey/interviews. Multiple regression was utilized to examine risk factors and moderation effects. Results support high mental health needs among street children. Approximately 73% street children experienced moderate to severe mental health problems, and 90% experienced poor quality of life. Perceived quality/happiness of life was the strongest predictor for street children’s mental health. Social connection was associated with children’s mental health only in certain subgroups and contexts. This study adds new epidemiological evidence for street children, an extremely vulnerable population, in Ghana and global child and adolescent mental health.