Mental health is just an Addendum: Assessing stakeholder's perceptions on COVID-19 and mental health services provision in Malawi.

INTRODUCTION: The World Health Organization declared COVID-19 as a pandemic in March 2020. COVID-19 has since caused a significant increase in mental health problems at national and global levels. This study assessed the views of key mental health stakeholders regarding the state of mental health service provision in Malawi and the pandemic's impact on the sector. METHODS: The study utilised a qualitative approach through key informant interviews (KIIs) conducted using a semi-structured interview guide. The interviews were audio recorded in English language and were manually transcribed for thematic analysis by generating codes re-classified into themes, sub-themes and quotes. RESULTS: The results are categorised into five themes. Firstly, the availability of mental health services. All experts confirmed the lack of availability of the mental health services especially at the lower levels of care. Currently, only 0.3% of facilities offer mental health services in Malawi. Moreover, although mental health services are part of the essential health care package and, therefore, are supposed to be provided for free in public facilities at all levels, the services are centralised and only functional at a tertiary level of care in public facilities. Secondly, funding sources for mental health in public and private facilities. We learnt that public facilities depend on donor sources and there is lack of prioritisation in budget allocation for mental health services. Whereas private facilities, their major source of funding is user fees. Thirdly, government's response in the provision of mental health services during COVID-19. Almost all experts echoed that government took a proactive approach to address the mental health needs of its population during the pandemic. There was increased collaboration between the government and the private sector to provide psychosocial and counselling services to health workers working directly with COVID-19 patients in isolation centres. Furthermore, to increase awareness of the general population on where to seek counselling services. Lastly, challenges in the provision of mental health services were highlighted and how the pandemic acerbated the challenges including shortage in human resources for health and inadequate funding. CONCLUSION: This study underscores the urgency of addressing mental health challenges in Malawi. Policymakers must prioritize the decentralization of mental health services, explore funding opportunities, and build on the successful collaboration with the private sector. These measures will not only enhance the accessibility and quality of mental health services but also ensure that mental well-being is a central component of public health efforts in Malawi.

The mental health toll among healthcare workers during the COVID-19 Pandemic in Malawi.

The COVID-19 pandemic has affected the mental health of healthcare workers worldwide, with frontline personnel experiencing heightened rates of depression, anxiety, and posttraumatic stress. This mixed-methods study aimed to assess the mental health toll of COVID-19 on healthcare workers in Malawi. A cross-sectional survey utilising the Generalized Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-9), and Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) was conducted among 109 frontline healthcare workers. Additionally, in-depth interviews were conducted with 16 healthcare workers to explore their experiences and challenges during the pandemic. The results indicated a high prevalence of COVID-19-related depression (31%; CI [23, 41]), anxiety (30%; CI [22, 40]), and PTSD (25%; CI [17, 34]) among participants. Regression analysis revealed significantly higher rates of depression, anxiety, and PTSD among healthcare workers in city referral hospitals compared to district hospitals. Qualitative findings highlighted the emotional distress, impact on work and personal life, and experiences of stigma and discrimination faced by healthcare workers. The stress process model provided a valuable framework for understanding the relationship among pandemic-related stressors, coping resources, and mental health outcomes. The findings underscore the urgent need for interventions and support systems to mitigate the mental health impact of COVID-19 on frontline healthcare workers in Malawi. Policymakers should prioritise the assessment and treatment of mental health problems among this critical workforce to maintain an effective pandemic response and build resilience for future crises.

Knowledge, attitudes and demographic drivers for COVID-19 vaccine hesitancy in Malawi.

This study assessed the association among knowledge, attitudes and uptake of COVID-19 vaccine in Malawi, examining demographic factors influencing these variables. The study employed a quantitative research design. It thus sampled 394 participants from Malawi's three districts of Zomba, Dowa and Nkhatabay. Results showed that 163 (41.4%) participants had low levels of knowledge of COVID-19 vaccine, 231 (58.6%) had high levels of knowledge, 237 (60.2%) had a positive attitude, and 156 (39.8%) had a negative attitude towards the COVID-19 vaccine. On vaccine uptake, the study found that only 29 (17%) male and 52 (23%) female participants had received the vaccine. Further, participants with low levels of knowledge and a positive attitude towards the vaccine were 5.9 times more likely (p-value = 0.001) to be vaccinated than those with low levels of knowledge and negative attitudes towards the vaccine. On the other hand, those with high knowledge and a positive attitude towards the vaccine were 8.2 times more likely (p-value < 0.001) to be vaccinated compared to those with low knowledge and negative attitudes towards the vaccine. The findings highlight the importance of vaccine-related knowledge and attitudes in shaping uptake and reveal disparities across demographic groups. To improve vaccination coverage in Malawi, targeted interventions focusing on enhancing COVID-19 vaccine knowledge, addressing attitudinal barriers, and countering misinformation are needed. Strategies should be tailored to reach populations with lower uptake, such as males, younger adults, and those with lower education levels. Strengthening public health messaging, engaging community leaders, and building trust in healthcare systems are crucial for promoting widespread acceptance and uptake of COVID-19 vaccines in Malawi.

Cultural persistence and change in university students' social networking motives and problematic use.

This cross-cultural study assessed the problematic use and motivations of social networking sites (SNS) among university students in China, Malawi, and the UK. A sample of 975 students completed the 10-item WeChat Excessive Use Scale and 20-item measure of SNS motivations across friendship, convenience, social support, information, and entertainment dimensions. Results showed that SNS problematic use was significantly lower in the individualistic UK compared to collectivistic China and Malawi. Critical cultural differences also emerged in usage motivations. Chinese and Malawian youth scored higher on social motivations like friendship and support compared to the UK. However, the entertainment motive was associated with the problematic use of SNS across all groups, reflecting the globalised digital culture. While Malawi's collectivism ordinarily emphasises social cohesion, this sample showed weaker associations between problematic SNS use and social support motivations. Material constraints limiting access may reduce online social reliance compared to China. Findings reveal both persisting and evolving cultural dynamics as new technologies spread globally. Uses and gratification theory helps explain these nuances. Ultimately, universal and culturally specific facets of social networking motivations must be considered in addressing the global problematic use of social media.

Umunthu, Covid-19 and mental health in Malawi.

This paper investigates the centrality of Umunthu in mental health conception and treatment in Malawi. Umunthu is an African philosophical worldview which stresses that an individual is human as they relate to others, as in the saying I am because we are. Its communitarian approach contrasts with a predominantly western individualistic worldview; I think therefore I am. There are spelling variations of the word across Bantu languages, including bomoto (Congo), gimuntu (Angola); umunthu (Malawi); vumutu (Mozambique); vumuntu, vhutu (South Africa); humhunu/ubuthosi (Zimbabwe); bumuntu (Tanzania); and umuntu (Uganda). Literature shows that if embraced and advocated for, Umunthu plays a positive and influential role in mainstreaming and dealing with mental health issues in communitarian societies where the Umunthu ideals are part of the social fabric. However, in the case of Covid-19 and mental health in Malawi, the paper argues that Covid-19 preventive measures, particularly self-isolation when Covid-19 positive; maintaining social distance at all times; and reducing the number of people gathered at funerals, challenge Umunthu ideals, which have in the past been crucial in reducing stress, trauma and anxiety. This original paper bases its arguments on empirical data collected in a study conducted in Mangochi, Blantyre, Karonga and Lilongwe. Based on the study's findings, the paper highlights that although Covid-19 preventative measures have been globally embraced, it is also a limiting factor in the quest for mental health in societies with communitarian value systems.

The world is coming to an end! COVID-19, depression, and anxiety among adolescents in Malawi.

Introduction: This paper assessed the effects of Covid-19 on adolescent mental health in Malawi. There is minimal research on adolescent mental health in Africa, Malawi in particular. The study shows a link between the pandemic and mental health. Some factors that may have contributed to this link include; Covid-19 preventive measures, media exposure and the increase in unemployment. Methods: The study used a mixed methods approach, quantitative and qualitative methods. It was conducted in Malawi's four districts (Blantyre, Mangochi, Lilongwe and Karonga). Results: Overall 22%, 21%, and 23% of the respondents had depression, anxiety and post-traumatic stress disorder, respectively. The Chi-square test showed that significantly more adolescents with secondary education (28%) had anxiety than those with primary education (14%). Further, regression analysis revealed that adolescents with anxiety were 18 [95%CI: 9.34, 35.8] times more likely to have depression compared to those who did not have anxiety. The study found no significant differences in the proportions of adolescents with the three outcomes when comparing different groups within the explanatory variable. The ratio of female and male adolescents with depression and anxiety was the same. Discussion: The adolescents expressed that Covid-19 affected their social, academic, and financial status. These effects had a significant bearing on their mental health in that they led to depression, anxiety, fear of the unknown, and stress. During the Covid-19 pandemic, adolescents' mental health diminished and posed a considerable risk to productivity of adolescents. As a result, adolescents may not fully realize their potential, form and maintain good relationships, contribute to their community and become resilient. These effects have devastating consequences for this young generation without proper coping strategies.

Preparation of Multi-Motive Grid Questionnaire for Social Networking Sites Use.

This study draws on previous studies to develop the Social Networking Sites Use Multi-Motive Grid Questionnaire (SNSU-MMG) and test its reliability and validity. The results show that social networking sites use motivation includes four factors: cognitive motivation, emotional motivation, leisure motivation and herding motivation. Confirmatory factor analysis, reliability and validity tests show that the questionnaire has good structural validity, internal consistency and split-half reliability. The SNSU-MMG can be used as a measurement tool for users' social networking sites use implicit motivation.

Psychometric properties of Young's Internet Addiction Test (IAT) in Urdu language.

Internet Addiction Disorder is characterized by excessive or poorly controlled obsessions, cravings, or manners regarding Internet use that lead to real life conflicts. In this study assessed psychometric properties of Internet Addiction Scale in Urdu. Data were collected from 506 participants and were analyzed using SPSS v23. We found 4 factors which were named; salience, conflict, tolerance and mood modification. These factors showed strong correlation among them. Further the items in the factors are comparable to other studies. The IAT was found to be psychometrically sound for measuring internet addiction among Urdu speaking population.

Weibo or WeChat? Assessing Preference for Social Networking Sites and Role of Personality Traits and Psychological Factors.

Research trying to understand individual difference in the use of different social networking sites (SNSs) is minimal. In the present study, we collected data from 714 college students in China (273 males) to assess how personality traits and psychological factors relate to excessive use of WeChat and Weibo. We found that excessive use of Weibo and WeChat correlated positively with neuroticism, loneliness, and external locus of control and negatively with agreeableness, social support, and social interaction. Furthermore, people that scored high on loneliness, lack of social support, and poor social interaction skills excessively used Weibo more than WeChat. These results entail that by fulfilling different needs, WeChat and Weibo attract different kinds of people; significant lesson for future development of SNSs.

Received View of Addiction, Relapse and Treatment.

It is important to highlight that attempts at understanding and explaining addiction have been made for centuries. It is, however, just five decades ago, with the growth of science and technology that more interest has been observed in this field. This chapter examines different views and theories that have been posited to understand and explain addiction. More attention will be given to prominent views that seem to draw consensus among researchers and medical practitioners. The first section of the chapter introduces the addiction debate, the different theories that have been provided to explain it from different perspectives and disciplines such as neurosciences, philosophy and psychology. Then, the chapter discusses different views on the role of relapse and what it entails in understanding addiction. The second section discusses different proposed and used forms of treating addiction. Thus, the chapter discusses the received view of addiction, the understanding of relapse as a critical element in addiction and treatments.

Excessive use of WeChat, social interaction and locus of control among college students in China.

In China, the number of college students using mobile phone based messaging and social networking applications like WeChat is increasing rapidly. However, there has been minimal research into the addictive nature of these applications and the psychological characteristics associate with their excessive use. There is also no published scale available for assessing excessive use of WeChat and similar applications. In the current study, we collected data from 1,245 college students in China (715 females) and developed the WeChat Excessive Use Scale (WEUS). We then assessed the relationship between excessive use of WeChat and excessive use of a social networking application-Weibo, problematic use of mobile phones, external locus of control, and social interaction skills. Our 10-item scale featured three factors, namely- "mood modification," "salience" and ''conflict"- critical factors in assessing different forms of addiction. The WEUS was found to be a reliable instrument in assessing excessive use of WeChat as it showed good internal consistency and correlated with other measures of problematic use social networking and mobile phone addiction. Our results showed that excessive users of WeChat are more likely to excessively use Weibo than they are to problematically use mobile phones. Our study also showed that greater excessive use of WeChat is associated with higher external locus of control and greater online social interaction skills. These results reveal that WeChat has unique and strong appeal among college students in China. Further, practitioners should consider dealing with malleable factors like locus of control and real life social skills in treating people with problematic messaging and social networking.

Altered Resting-State Signals in Patients with Acute Stroke In or Under the Thalamus.

Previous studies have suggested that cortical functional reorganization is associated with motor recovery after stroke and that normal afferent sensory information is very important in that process. In this study, we selected patients who had a stroke in or under the thalamus, with potentially impaired afferent sensory information and analyzed the differences between these patients and healthy controls at three levels: brain regions, the functional connectivity between brain areas, and the whole-brain functional network. Compared with healthy controls, regional homogeneities in the left middle temporal gyrus decreased and functional connectivity between the left middle temporal gyrus and the stroke area increased in the patients. However, there was no significant change in the whole-brain functional network. By focusing on stroke located in or under the thalamus, our study contributes to wider inquiries into understanding and treating stroke.

Cue-induced Behavioral and Neural Changes among Excessive Internet Gamers and Possible Application of Cue Exposure Therapy to Internet Gaming Disorder.

Internet gaming disorder (IGD) may lead to many negative consequences in everyday life, yet there is currently no effective treatment for IGD. Cue-reactivity paradigm is commonly used to evaluate craving for substance, food, and gambling; cue exposure therapy (CET) is applied to treating substance use disorders (SUDs) and some other psychological disorders such as pathological gambling (PG). However, no study has explored CET's application to the treatment of IGD except two articles having implied that cues' exposure may have therapeutic effect on IGD. This paper reviews studies on cue-induced behavioral and neural changes in excessive Internet gamers, indicating that behavioral and neural mechanisms of IGD mostly overlap with those of SUD. The CET's effects in the treatment of SUDs and PG are also reviewed. We finally propose an optimized CET paradigm, which future studies should consider and investigate as a probable treatment of IGD.

How Does Adult Attachment Affect Human Recognition of Love-related and Sex-related Stimuli: An ERP Study.

In the present study, we investigated the relationship among three emotion-motivation systems (adult attachment, romantic love, and sex). We recorded event-related potentials in 37 healthy volunteers who had experienced romantic love while they viewed SEX, LOVE, FRIEND, SPORT, and NEUTRAL images. We also measured adult attachment styles, level of passionate love and sexual attitudes. As expected, results showed that, firstly, response to love-related image-stimuli and sex-related image-stimuli on the electrophysiological data significantly different on N1, N2, and positive slow wave (PSW) components. Secondly, the different adult attachment styles affected individuals' recognition processing in response to love-related and sex-related images, especially, to sex-related images. Further analysis showed that voltages elicited by fearful attachment style individuals were significantly lower than voltages elicited by secure and dismissing attachment style individuals on sex-related images at frontal sites, on N1 and N2 components. Thirdly, from behavior data, we found that adult attachment styles were not significantly related to any dimension of sexual attitudes but were significantly related to passionate love scale (PLS) total points. Thus, the behavior results were not in line with the electrophysiological results. The present study proved that adult attachment styles might mediate individuals' lust and attraction systems.

The link between impaired theory of mind and executive function in children with cerebral palsy.

The aim of the study was to explore the relationship between theory of mind (ToM) deficits and executive function (EF) impairments in children with cerebral palsy (CP), 42 CP with children and 42 typically developing (TD) children, acting as controls, were assessed on the tasks of ToM (false belief and faux pas) and EF (inhibition, updating and shifting). Results showed that CP children had deficits both in ToM and EF tasks. The correlation analyses showed that two EF components (inhibition and updating) were strongly related to false belief and faux pas in both two groups. We also found correlation between shifting and false belief and faux pas. However, this correlation was only found in TD children and not in children with CP. These findings suggest that children with CP lag behind TD children in both ToM and EF. Further, the results reveal, interestingly, that ToM deficits in CP children might be related to their inhibition and updating impairments, but not to shifting impairments.