Katherine Sorsdahl

Adolescent and young people’s substance use is deeply embedded within family systems, yet the experiences and needs of family members are often overlooked, with greater emphasis typically placed on their role in supporting treatment. Drawing on the stress–strain–coping–support model, this study explored how families experience and respond to youth substance use in a low-resource setting. An exploratory qualitative design was employed, with 19 family members of individuals under the age of 24 receiving treatment for substance-related conditions at a tertiary mental health facility in Harare, Zimbabwe purposively recruited. In-depth semi-structured interviews were conducted in Shona or English, audio-recorded, and transcribed verbatim. Data were analysed using codebook thematic analysis in NVivo 12. Participants described youth substance use as both a family and community issue, shaped by broader social and structural contexts. Families experienced chronic stress and strain across multiple domains, including financial hardship, relational conflict, and emotional distress. Responses to these challenges were complex and dynamic, ranging from active engagement and support to tolerance and withdrawal. While many participants reported feelings of helplessness, others described developing adaptive coping strategies over time. Participants also highlighted unmet support needs and offered recommendations for more responsive prevention, treatment, and rehabilitation services. These findings underscore the significant and multifaceted impact of youth substance use on family systems and highlight the importance of family-centred, contextually grounded interventions that address both individual and systemic factors in low- and middle-income African settings.

Background: Poverty is associated with depression and anxiety among adolescents, but evidence of interventions that prevent adolescent depression and anxiety among adolescents living in poverty is weak. Interventions either focus on reducing poverty or addressing depression and anxiety, but an approach that combines both may offer larger benefit. This multi-site parallel pilot cluster randomised controlled trial (cRCT) evaluates the feasibility and acceptability of a selective preventive intervention for depression and anxiety that simultaneously intervenes on both poverty and self-regulation among adolescents living in urban poverty. Methods: The study takes place in Bogotá (Colombia), Kathmandu (Nepal) and Cape Town (South Africa). The pilot cRCT has four arms: (i) self-regulation intervention, (ii) economic intervention, (iii) combined (self-regulation + economic) intervention, and (iv) control group (care as usual). Interventions consist of 20 weekly group sessions with adolescents, and 6 monthly group sessions with their caregivers. The self-regulation intervention for adolescents includes psychological activities (mindfulness breathing, problem solving, biofeedback and goal setting) and a physical activity. The economic intervention includes three dimensions (financial training, negotiation training, education information) and a monthly cash transfer. In each site, the aim was to recruit 240 adolescents and their caregivers across eight schools (clusters), with two schools randomised to each arm. Adolescents residing in areas at risk of multidimensional poverty and who had symptoms of depression or anxiety, but who did not meet thresholds indicating depression and anxiety disorders, were considered for enrolment. Recruitment into the study is complete: a total of 628 adolescents and 536 caregivers were enrolled. Participants will be assessed four times: at enrolment, post-intervention and at 12 and 18 months post-enrolment. Primary outcomes include feasibility and acceptability criteria for study and intervention delivery procedures (i.e. randomisation, masking, recruitment, retention, missingness, fidelity, attendance, adverse events) defined as traffic light criteria to assess progression to an adequately powered trial. Secondary outcomes include self-report instruments, physiological measures and neuropsychological tasks. Discussion: The effectiveness of combining self-regulation and anti-poverty interventions remains untested. This study will establish the feasibility and acceptability of delivering such an intervention, as well as test the trial procedures to inform a future adequately powered trial. Trial registration: ISRCTN 14601588. Retrospectively registered. Date: 19 May 2024.

Background: While the onset of most mental health conditions occurs in later childhood or adolescence, the early years present an important window for prevention. Worldwide, universal school-based prevention interventions have been shown to be effective in promoting child mental health. Nevertheless, little is known about universal school-based prevention programs targeting children aged 6 to 9 years in low- and middle-income countries (LMICs). Objective: This scoping review aims to identify promising, potentially feasible, and possibly evidence-based school-based universal prevention mental health programs for children aged 6 to 9 years in LMICs. Methods: This scoping review is planned according to the Joanna Briggs Institute framework developed by Arksey and O’Malley, with enhancements proposed by Levac et al. Eligible studies will focus on universal prevention school-based mental health interventions with feasibility and/or mental health outcomes that include children aged 6 to 9 years. Additional inclusion criteria are peer-reviewed published and unpublished studies, including gray literature such as theses and dissertations, preprints, conference proceedings and papers, and government reports and publications. There are no limits to the date of publication, but only studies published in English and conducted in LMICs will be included. The search strategy was iteratively developed and finalized, following which major databases, namely, PubMed (MEDLINE), Scopus (Embase), EBSCOhost (PsycInfo, CINAHL, PsycArticles, ERIC, Teacher Reference Center, Academic Search Premier, and SocINDEX), CENTRAL, ProQuest, the Open Science Framework, and the International Clinical Trials Registry Platform, were searched. Titles and abstracts are being screened in addition to manual searches of the reference lists of previous reviews. Experts will be consulted for further study suggestions, and reference mining will be conducted with the included studies. A descriptive and numerical summary will reflect basic program characteristics. A preliminary data extraction chart curated around the research questions will be used for deductive and inductive data analysis. The entire scoping review will be reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Results: In November 2025, the search strategy was finalized. All database searches were completed by early December 2025, yielding 7511 records. After removing duplicates (n=3022), 4489 records underwent title and abstract screening. Of these, 25 records met the criteria for full-text review, which is currently ongoing. Data extraction and analysis should take place between April and May 2026. The scoping review findings will be submitted to a relevant peer-reviewed journal by July 2026 and presented at conferences. Conclusions: This review will provide a description of feasible and potentially effective school-based universal mental health programs specific to children aged 6 to 9 years living in LMICs. The findings may assist with efficient insight into available programs for implementation or adaptation among the stipulated population in the future.

Resting‐state heart rate variability (HRV) has been proposed by some researchers as a potential transdiagnostic measure of psychopathology. It is often found to be reduced across a range of mental health conditions and is thought to reflect self‐regulatory processes, which are often impaired in these conditions. However, most existing evidence is derived from high‐income countries with limited ethnic variation. This leaves a critical gap in understanding whether these associations generalize to low‐ and middle‐income countries (LMICs) or to individuals from under‐represented ethnic backgrounds. In this cross‐sectional study, we examined the relationship between resting‐state HRV, self‐regulation, and psychopathology in a large, diverse sample of 1107 adolescents aged 13–15 years living in urban poverty across Colombia, Nepal, and South Africa. We tested seven pre‐registered hypotheses across two domains: self‐regulation (emotional regulation, inhibitory control, and delay discounting) and psychopathology (anxiety, depression, externalizing symptoms). We used linear mixed models for the confirmatory analyses and complemented them with exploratory equivalence testing. Contrary to our hypotheses based on the neurovisceral integration (NVI) model, HRV was not significantly associated with any outcomes, except for a small effect on externalizing behavior in the opposite direction of our hypothesis. Equivalence testing further indicated that the observed estimates were statistically equivalent, which suggests a meaningful effect is absent. These findings challenge the assumption that HRV–psychological associations are universal and point to the importance of considering contextual, cultural, developmental, and methodological factors in psychophysiological research. This study aims to contribute to a broader rethinking of HRV's role in mental health research, especially in populations that have been under‐represented in the literature.

[Please Note: This work is now published in Psychophysiology; please refer to the peer-reviewed version: doi.org/10.1111/psyp.70184]Resting-state heart rate variability (HRV) has been proposed by some researchers as a potential transdiagnostic measure of psychopathology. It is often found to be reduced across a range of mental health conditions and is thought to reflect self-regulatory processes, which are often impaired in these conditions. However, most existing evidence is derived from high-income countries with limited ethnic variation. This leaves a critical gap in understanding whether these associations generalize to low- and middle-income countries (LMICs) or to individuals from underrepresented ethnic backgrounds. In this cross-sectional study, we examined the relationship between resting-state HRV, self-regulation, and psychopathology in a large, diverse sample of 1,107 adolescents aged 13–15 years living in urban poverty across Colombia, Nepal, and South Africa. We tested seven pre-registered hypotheses across two domains: self-regulation (emotional regulation, inhibitory control, and delay discounting) and psychopathology (anxiety, depression, externalizing symptoms). We used linear mixed models for the confirmatory analyses and complemented them with exploratory equivalence testing. Contrary to our hypotheses based on the neurovisceral integration (NVI) model, HRV was not significantly associated with any outcomes, except for a small effect on externalizing behavior in the opposite direction of our hypothesis. Equivalence testing further indicated that the observed estimates were statistically equivalent, which suggests a meaningful effect is absent. These findings challenge the assumption that HRV–psychological associations are universal and point to the importance of considering contextual, cultural, developmental, and methodological factors in psychophysiological research. This study aims to contribute to a broader rethinking of HRV’s role in mental health research, especially in populations that have been underrepresented in the literature.

There has been a dramatic rise in the scale and scope of collaborative global health research, including health psychology. Increasingly, for many large health psychology projects, community, policy stakeholders, and team members from a range of fields are required. These fields include epidemiology, statistics, data science, anthropology, psychiatry, and nursing, in addition to the traditional fields of health psychology and behavioural medicine. These collaborations and partnerships are essential to ensure that complex research questions are well-conceptualised and properly executed. However, the literature on collaborative health research globally suggests that in many instances, research collaborations reproduce relationships and conditions which disproportionately favour high-income countries and institutions. In this chapter, we will first highlight the importance of health partnerships for the improvement of health via health psychology. Next, the current challenges in achieving equitable and fair health partnerships in global health research more generally that are applicable to the field of health psychology will be described. Finally, we reflect on and offer recommendations on how researchers and health-care workers (both locally and internationally), community stakeholders, policy, and other decision-makers can form health partnerships for the improvement of health via health psychology.

Objectives: In this context the MASC study aimed to: (1) identify the consequences of the pandemic for mental health services and people with pre-existing mental health conditions (MHCs) in 6 low- and middle-income countries; and (2) identify good practice to mitigate these impacts. Design: An observational study, using a mixed-methods convergent design triangulating data from (1) semi-structured interviews or focus groups and/or a self-completed survey; (2) routine service utilization data; (3) local grey literature; and (4) expert consultation. Setting: The study was conducted in Chile, Ethiopia, Georgia, Nigeria, South Africa and Sri Lanka. Participants: 121 key informants. Results: We found clear evidence in all sites that the pandemic exacerbated pre-existing disadvantages experienced by people with MHCs and led to a deterioration in the availability and quality of care, especially for psychosocial care. Alongside increased vulnerability to COVID-19, people with MHCs faced additional barriers to accessing prevention and treatment interventions compared to the general population. To varying extents, sites showed accelerated implementation of digital technologies, but with evidence of worsening inequities in access. Where primary care-based mental health care was more developed or prioritised, systems seemed more resilient and adaptive. Conclusion: Our findings have the following implications. First, mental health service reductions are clear examples of ‘structural stigma’, namely policy level decisions in healthcare which place a low priority upon services for people with MHCs. Second, integration of mental health care into all general health care settings is key to ensuring accessibility and parity of physical and mental health care. Third, digital innovations should be designed to strengthen and not fragment systems. We discuss these findings in terms of anticipating such challenges in future and preparing layers of resilience. Methodological Strengths and Limitations of this Study: The MASC study used a mixed-methods convergent design , incorporating both quantitative and qualitative data, which allowed for a nuanced understanding of the COVID-19 pandemic impact on mental health services across multiple countries. This design enabled our study to triangulate data capturing both numerical trends and in-depth perspectives, increasing the validity and reliability of the findings. The study covered six diverse low- and middle-income countries across five continents , enabling cross-country comparisons and insights into varied socio-cultural and economic contexts. This geographic diversity strengthens the study’s generalisability to other settings with similar resource constraints. A mixture of online and in-person data collection in local languages was employed, overcoming pandemic-related barriers and enhancing accessibility for participants across the regions, which minimised data collection disruptions. The study faced limitations in obtaining comparable quantitative data across countries , with concerns about the accuracy and reliability of routine data. Reliance on national experts may have introduced potential biases if experts were not fully representative of the wider mental health context.

Severe mental health conditions (SMHCs) significantly contribute to the global disease burden. In low-and-middle-income countries (LMICs) like South Africa, the long-term impact of SMHCs on individuals and their families is serious. However, mental health services focus on clinical recovery, with little attention given to the personal recovery needs of mental health service users (MHSUs) and their caregivers. The CHIME framework outlines five domains characterising personal recovery: connectedness, hope and optimism about the future, identity, meaning in life, and empowerment. This qualitative, descriptive study sought insights from male MHSUs and their caregivers on their perspectives of personal recovery from SMHCs. Four male MHSUs and three of their caregivers were purposively selected from Cape Flats communities in the Western Cape. Data were collected using visual participatory methods, including photovoice, life graphs, community maps, and photo-elicitation interviews with MHSUs. In addition, semi-structured interviews were held with caregivers. Data were thematically analysed, and two main themes emerged: Finding meaningful participation and affirming agency. These themes describe how diverse contextual, socioeconomic, political, demographic, cultural, and spiritual factors help and hinder personal recovery. MHSUs and their caregivers sought support from mental health non-profit organisations (MH-NPOs) because of stigmatising attitudes from their communities. MH-NPOs provided MHSUs with long-term relational support and opportunities to build their capacities which helped them access living, learning, working and socialising opportunities. Understanding the diverse needs of MHSUs and including MH-NPOs in scaling up community-based mental health services in LMICs will enable more accessible services that support personal recovery.

Brief interventions could reduce adolescents’ risk of depression and alcohol-related harms, but evidence of their feasibility and acceptability for low-and middle-income countries is lacking. To ad...

Although evidence indicates that task-shared psychological interventions can reduce mental health treatment gaps in resource-constrained settings, systemic barriers have limited their widespread im...