Faculty Bibliography

IMPORTANCE/UNASSIGNED:Group interpersonal psychotherapy (IPT-G) is effective across diverse populations and adaptable to low-resource settings. OBJECTIVE/UNASSIGNED:To assess whether shortened 4-session mini IPT-G vs full IPT-G delivered by lay health care workers reduces depression and improves family functioning among perinatal adolescents. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This pilot randomized clinical trial of group IPT for depression used a 3-arm longitudinal type 1 implementation-effectiveness design between May 13, 2022, and April 1, 2024, at 2 primary care maternal and child health clinics in Nairobi, Kenya. The study applied a collaborative care approach within the World Health Organization (WHO) Mental Health Gap Action Programme framework for training a nonspecialist workforce, where trained nurses screened participants and supervised group sessions delivered by community health promoters collaboratively with psychologists. Participants included perinatal adolescents, aged 13 to 18 years, in their first to second trimester of pregnancy. INTERVENTION/UNASSIGNED:Participants were randomized to treatment as usual (TAU [n = 44]), mini IPT-G (n = 38), or full IPT-G (n = 40). TAU involved information sheets; mini IPT-G was culturally adapted; and full IPT-G followed the WHO protocol. MAIN OUTCOMES AND MEASURES/UNASSIGNED:Primary outcomes included depression measured by the 9-item Patient Health Questionnaire (PHQ-9) and functional impairment within 1 week post intervention and at 6-month follow-up. Secondary outcomes were posttraumatic stress disorder, psychological distress, disability, and self-efficacy. Linear mixed models were used to evaluate the preliminary effectiveness of the interventions. RESULTS/UNASSIGNED:Among the 122 adolescents included in the analysis (median age, 17 [IQR, 17-18] years), 97 (79.5%) were single, and 91 (74.6%) had at least a secondary education level. Retention included 101 participants (82.8%) at 1 week post intervention and 91 (74.6%) at 6-month follow-up. Both IPT arms demonstrated significantly greater reductions in depression than the TAU arm post intervention. Mean (SD) PHQ-9 score decreased from 12.38 (5.90) at baseline to 2.15 (1.94) in the full IPT-G arm (β vs TAU = -5.79; 95% CI, -7.67 to -3.91; P < .001), from 11.58 (4.93) to 3.94 (2.81) in the mini IPT-G arm (β vs TAU = -3.97; 95% CI -5.83 to -2.10; P < .001), and from 11.00 (4.97) to 7.94 (3.71) in the TAU arm. At 6 months, effects were attenuated. Scores in the full IPT-G arm remained significantly lower than in the TAU arm (β = -2.22; 95% CI, -4.25 to -0.18; P = .03) but not in the mini IPT-G arm (β = -1.38; 95% CI, -3.25 to 0.48; P = .15). CONCLUSIONS AND RELEVANCE/UNASSIGNED:In this trial, IPT-G delivered by nonspecialists was feasible, acceptable, and effective. Mini IPT-G improved completion rates, while full IPT-G showed more sustained benefits at follow-up. These findings support task-sharing of mental health interventions for perinatal adolescents in low-resource settings. TRIAL REGISTRATION/UNASSIGNED:Pan African Clinical Trial Registry Identification: PACTR202501888041900.

BACKGROUND:Climate anxiety describes emotional responses such as worry or distress related to climate change. While it is common and linked to mental health in the general population, little is known about its relevance for individuals with pre-existing mental disorders. METHODS:A nationwide cross-sectional online survey was conducted in Germany between March and July 2025 among adults with at least one self-reported mental disorder. Participants provided socio-demographic and clinical information and completed four items assessing dimensions of climate-related distress: general concern, perceived impact on mental well-being, perceived effects of climatic events on psychological symptoms, and interference with everyday functioning. Group differences were examined using non-parametric tests, and associations with age were analyzed using Spearman correlations with Bonferroni correction. RESULTS:The sample included 427 participants (mean age 36.5 years; 73% female). Reported climate-related distress levels were relatively low across all dimensions within this sample, with minimal interference with daily functioning. Gender differences were found only for perceived effects of climatic events on psychological symptoms, with women reporting higher impact. Associations with age were weak and not significant after correction. Exploratory analyses indicated some variation across diagnostic groups, but most differences were small and did not remain significant after correction. DISCUSSION/CONCLUSIONS:Climate-related distress among individuals with mental disorders appears present but generally modest and rarely functionally impairing. Weak and inconsistent associations with sociodemographic and diagnostic factors suggest that climate-related distress is not strongly structured by specific diagnoses, supporting its consideration within broader clinical and psychological contexts.

BACKGROUND:The current generation of 1.3 billion adolescents (10-19-year-olds), most of whom live in low- and middle-income countries, face large and growing mental health problems. Collective action that could lead to significant improvement in adolescent mental health and well-being (AMH) remains limited. We analyse the factors shaping the global prioritization of AMH for funding and action and reflect on a way forward. METHODS:We triangulate data from interviews with key informants knowledgeable in AMH; focus group discussions with youth representatives who are mental health advocates, some with lived experience of mental ill-health; and document review. We collected the qualitative data from 2021 to 2023, followed by thematic analysis and stakeholder consultations. RESULTS:We identify four themes which shape the global prioritization of AMH. First, prevailing interpersonal and institutional stigma and discrimination directed against adolescents with mental health problems hamper attention to AMH. Second, limited data on the burden of mental health problems and evidence of what works have led to the perception among decision-makers that AMH is an intractable problem. Third, diverse ways of framing AMH are often viewed as a sign of weak alignment rather than as opportunities for coalition-building. Fourth, a wide variety and increasing number of stakeholders are involved in AMH, while the stakeholder landscape remains fragmented, inhibiting coalition-building for AMH. CONCLUSIONS:To overcome the barriers that currently impede the prioritization of AMH, we recommend that (1) stakeholders conduct an adolescent-led consultative process to develop an "umbrella framing", supported by common metrics, (2) advocates use existing global platforms to shape the political priority for AMH, (3) decision-makers, funders and research partners invest in meaningful engagement of adolescents (with lived experience), researchers and implementing partners (4) identify a leadership, governance and accountability structure for a global coalition that could transform AMH and (5) conduct context-specific analyses to inform coalition-building nationally.

Female sex workers (FSWs) encounter increased risk of negative health consequences, including common mental health conditions (CMCs) in Tanzania. The prevalence and association of the CMCs with social, structural, and violence-related factors remains to be fully understood. We assessed the prevalence of CMCs and associations with socio-structural risk factors among FSW. We used Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Harvard Trauma Questionnaire-17 (HTQ-17), World Health Organization violence against women Instrument, Alcohol Use Disorder Identification Test (AUDIT), and a two-item questionnaire to measure depression, anxiety, post-traumatic stress disorder (PTSD), violence, alcohol use risks, and suicidal behavior, respectively. Descriptive statistics and logistic regression were used in data analyses, with a significance level set at 0.05. The prevalence of depression, anxiety, and PTSD was 49.2%, 40.4% and 20.2%, respectively. Thirty-five percent had ever had suicidal thoughts, and 7.7% had ever attempted suicide. Being raped by a gang of men was significantly associated with depression, anxiety, and PTSD. Non-intimate partner violence (non-IPV) was significantly associated with depression, anxiety, and suicidal behavior, while both non-consensual sex at sexual debut and duration since last vaginal sex were significantly associated with PTSD and suicidal behavior. Some factors were condition-specific: religion and client volume in the past seven days were associated with anxiety; living with three or more children and sex work mobility were associated with increased PTSD; while place of residence, extra source of income, and engagement in anal sex in the past six months were significantly associated with suicidal behaviors. Alcohol use partially and fully mediated the relationship between non-IPV and anxiety and PTSD, respectively, whereas sex work mobility showed no moderation effect on the relationship between non-IPV and any CMC. Innovative and integrative mental health care targeting critical risk factors among FSWs is essential to mitigate the increasing prevalence of CMCs.

Mental health conditions are a major public health concern in the African region, where women experience a high prevalence of maternal mental health conditions and limited access to adequate care. This issue is particularly severe among women living with HIV (WLHIV), who face a heightened risk of depression and anxiety. Despite the well-documented association between male partner-related factors and maternal/child health outcomes, their impact on perinatal mental health from the perspective of women is not well understood. We conducted semi-structured interviews and focus group discussions with women affected by HIV. Thematic analysis revealed common sources of mental distress they experienced. Relationship with male partners was identified as an area needing further interrogation to better understand how gender inequities exacerbate maternal mental health outcomes. Male partners emerged as the most significant source of stress for postpartum women, often due to relationship instability, inadequate financial support, and in some cases, verbal or physical abuse. Additionally, women noticed signs of mental health challenges in their male partners, such as anger and chronic stress, and observed that these men often lacked support to address these issues. Other sources of stress included pregnancy-related changes, fear of acquiring HIV among those on HIV PrEP (Pre-Exposure prophylaxis) and fear of transmitting HIV to their babies among those living with HIV. Strategies for coping with perinatal mental health challenges included praying, singing, listening to music, taking walks, social interaction, and participating in church or community-based support groups. Recognizing the significant influence men have on women's mental health and the interconnectedness of men's stress and women's mental well-being, family-oriented mental health programs could be instrumental in improving perinatal mental health.

Adolescents and young adults with HIV (AYH) are at greater risk for mental health conditions. Provision of mental health services to AYH is limited by an overburdened and untrained workforce, and psychological interventions ill-adapted for adolescent HIV care. Brief, transdiagnostic psychological interventions delivered in the HIV clinics may address some of these challenges. We will evaluate the PRO-ACT intervention in a hybrid type 1 cluster randomized clinical trial (NCT06247527) in 30 HIV clinics in 3 counties in Kenya. PRO-ACT is a cognitive behavioral therapy with 5 modules: Psychoeducation, Relaxation, prOblem-solving, behavioral Activation and Cognitive coping, delivered to AYH by trained health providers without specialist mental health training in 4-6 sessions within 6 months. We performed stratified randomization with matching to balance for county and facility size to assign 5 intervention (PRO-ACT) and 5 control (standard of care) clinics in each of the 3 counties. Screening of AYH ages 16-24 years will be conducted using the 9-item patient health questionnaire (PHQ-9). Up to 300 AYH with psychological distress (PHQ-9 score>4) will be enrolled in each arm. Further assessments will include the 5-item ASK suicide screening questions (ASQ), 7-item Generalized Anxiety Disorder (GAD-7), 20-item Child and Adolescent Trauma Screen (CATS)/PTSD Checklist for DSM-5 (PCL-5), self-reported treatment adherence, and HIV viral loads. Follow-up assessments will be conducted at month 3, 6, 9 and 12. Mixed methods will be used to measure implementation outcomes, cost-effectiveness, and characterize determinants of implementation. Primary analysis of PRO-ACT effectiveness will be conducted at month 6 (near term treatment effect), and month 12 (treatment effect sustainability) comparing PHQ-9 mean scores between treatment and control groups. Secondary analyses will compare GAD-7, CATS/PCL-5, adherence and viral suppression between the groups. The study will inform integration efforts of holistic mental health services in HIV care.

This short communication advocates for the strategic implementation of Routine Outcome Monitoring (ROM) systems within Kenya's specialized mental health institutions, especially teaching and referral hospitals. The proposed shift aims to transform these institutions into learning health systems, dynamic structures that systematically capture and utilize data from everyday clinical practice to drive continuous improvement in care quality, accountability, and population mental health outcomes. Kenya's mental health system, while advancing in policy and infrastructure, still faces a critical gap in routine, data-driven practices that support outcome-based care. ROM offers a practical and scalable solution to bridge this divide. We emphasize that this transition requires more than technological adoption. It demands a systemic reorientation: establishing digital standards for outcome tracking, allocating protected time for data reflection, strengthening referral pathways, and aligning local practices with national health indicators. These changes can help institutions become national exemplars, where evidence from clinical encounters informs policy, enhances training, and fosters research capacity. ROM is framed not as a technical add-on but as a transformative tool capable of reshaping how care is delivered, evaluated, and improved over time. It can anchor Kenya's mental health care in real-time learning, ensuring that services adapt responsively to the needs of patients and communities. With political will, stakeholder collaboration, and thoughtful implementation, Kenya has the opportunity to lead among LMICs in establishing a mental health system that is evidence-informed, equitable, and sustainable.