Emily Claire Garman

Background: Randomised trials evaluating psychological interventions for perinatal depression (PND) in low- and middle-income countries (LMICs) frequently provide conflicting findings. To optimise global maternal mental health interventions, we applied robust causal inference and causal machine learning approaches to individual participant data (IPD) to identify underlying causal mechanisms and responsive subgroups.Methods: We searched MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and the Cochrane Library from inception to November 19, 2025, for trials assessing the effectiveness of psychological interventions to treat PND. Using IPD, we assessed treatment effect heterogeneity using causal forests, and evaluated causal mechanisms using interventional effects for individual trials and across relevant pooled datasets.Findings: Seven of 11 eligible studies provided IPD, yielding a pooled sample of 3,154 participants (1,700 intervention, 1,454 control). Heterogeneity analyses of all trials demonstrated top responders presented with higher baseline depression and lower education. A four-study subset incorporating social determinants revealed those with lower perceived social support and education responded best. This four-study subset comprised two two-trial subsets: one delivered by community health workers (CHWs) and one by peers. In the CHW-delivered subset, top responders were similar to the four-study subset; however, within the peer-delivered subset, this effect was negligible. Causal mediation analyses of the four trials revealed social support mediated a 15% symptom reduction. The two-trial CHW subset indicated social support and reduced food insecurity mediated 15% and 3% improvements, respectively. Furthermore, a specific two-trial subset indicated behavioural activation and social support mediated improvements of 32% and 17%.Interpretation: Despite interventions effectively targeting perceived social support, trials capturing food insecurity demonstrated minimal impact. The failure of peer-delivered interventions to reach vulnerable women, unlike CHW-delivered trials, suggests highly disadvantaged populations benefit least from a lower-cadre workforce. Optimising global maternal mental health requires assertively targeting socioeconomic determinants such as food insecurity and deploying CHWs to support the most vulnerable populations.

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.

Introduction: Adolescents employ various coping strategies to manage stress, which can impact their short and long-term mental health. Economically disadvantaged adolescents are more prone to developing maladaptive coping mechanisms due to the persistent stressors associated with poverty. In Nepal, there is a lack of research on how adolescents experiencing or at risk of depression and anxiety cope with adverse situations. This study aims to explore how adolescents affected by poverty and at risk of experiencing mental health problems navigate difficulties within their homes, peer groups, and school environments. Methods: The study focused on adolescents aged 11 to 19 residing in informal squatter settlements in Kathmandu, Nepal. In-depth narrative interviews were conducted with 30 adolescents experiencing or at risk of depression and/or anxiety. In addition, journal entries documenting their experiences were collected weekly for 3–5 weeks post-interviews. Thematic and plot analysis were employed to identify the coping strategies utilised by adolescents in this context, which were then categorised according to coping theory. Results: The results indicated that adolescents employed a combination of adaptive and maladaptive coping strategies across different settings (home, school, and peer interactions), with variation in coping strategies used within each setting. Problem solving emerged as the most prevalent coping strategy across all settings. Adolescents tended to exhibit more submission and helplessness at home, more isolation and opposition among peers, and more accommodation and opposition at school. Adolescents aged 14–16 displayed more maladaptive coping strategies compared to younger (11 to 13 years) and older adolescents (17 to 19 years). While girls and boys utilised similar adaptive and maladaptive coping strategies, girls leaned more towards avoidance-escape and helplessness , whereas boys favoured opposition and isolation . Conclusion: The results highlight the range of adaptive and maladaptive coping strategies used by adolescents to manage stress in circumstances of urban poverty in Nepal. The study recommends focused psychological interventions which equip adolescents with adaptive coping strategies and stress appraisal techniques that help them manage difficulties effectively.

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.

HIV self-disclosure is an important challenge affecting the physical and psychological health of adolescents living with HIV. The study’s aim was to explore the perspectives of HIV-infected adolescents on self-disclosure. Using purposive sampling, 20 adolescents aged 12–19 years were recruited from a HIV care clinic at a tertiary hospital in Harare, Zimbabwe. All were vertically-infected with HIV (HIV transmitted from mother). In depth interviews were conducted to determine participants’ views and experiences of self-disclosure. Interviews were analysed using the framework approach to identify main codes and themes relating to self-disclosure. Adolescents identified stigma and discrimination from peers, as well as lack of HIV knowledge as important barriers to status disclosure. They suggested that community resources such as support groups, media and religion assist them in the disclosure process. HIV status self-disclosure is a challenging task for adolescents, which is affected by individual, interpersonal and social factors. These must be borne in mind to assist with disclosure and facilitate the wellbeing of HIV-positive adolescents.

The aim of this study was to investigate the prevalence of depressive symptoms in secondary school students in Kampala, Uganda, and assess associations with demographic characteristics and living arrangements. In this cross-sectional study, 14- to 17-year-olds were recruited from six randomly selected schools in Kampala. Participants completed a questionnaire, covering demographic questions and the affective problems subscale of the Youth Self-Report (YSR) – a depression screening tool for minors. Scores range from 0 to 26; a minimum score of 9 and 8 for female and male participants, respectively, suggests depressive symptoms in the clinical range, according to standard (non-local) norms. Unadjusted logistic regressions were used to assess demographic (e.g., age, gender, religion, parental education) and family-related characteristics (e.g., living arrangements, household size) associated with symptoms of depression in the clinical range. In total, 503 participants were recruited, of which 26.6% had depressive symptoms in the clinical range (female: 32.5%, male: 18.1%; risk ratio [RR] = 1.79, 95% confidence interval [CI] [1.28, 2.51]). Those who reported living with only one parent (RR = 1.62, 95% CI [1.14, 2.30]) or another family member/friend (RR = 1.98, 95% CI [1.14, 2.30]) were at increased risk of depressive symptoms above clinical threshold compared with participants living with both parents. A quarter of urban low-risk school-going adolescents had depressive symptoms in the clinical range in Kampala; girls and adolescents not living with their parents were particularly vulnerable. It recommended that school staff be equipped with skills to identify students who may be at risk for depression and make appropriate referrals.