Determinants of mental illness and care seeking behaviours in Northern Haiti: an assessment of demographic, social, and religio-cultural factors among patients at the first mental health clinic in the region.

Populations in countries such as Haiti demonstrate a high level of need for mental health care despite a lack of services and trained professionals. In addition to the dearth of biomedical services, local belief systems and explanatory models contribute to a majority of the population relying on traditional medicine as their first option for care. Using a mixed-methods approach, we aim to characterise mental illness at the first mental health clinic in the region - Sant Sante Mantal Mòn Pele (SSMMP) - by interviewing 96 patients with a demographic questionnaire as well as Anxiety, Depression, and Functionality Scales. Multivariate logistic and linear regression models were conducted examining the impact of demographic variables on whether patients believed their illness was caused by sent spirits or previously visited a Vodou priest for treatment, as well as Depression, Anxiety, and Functionality Scale scores. Factors associated with mental illness in this sample included sex, number of traumatic events, physical health status, and number of sessions attended at SSMMP. Factors which impacted traditional beliefs or practices related to mental illness included sex, age, and income.

Feasibility and outcomes of using DIALOG+ in primary care to improve quality of life and mental distress of patients with long-term physical conditions: an exploratory non-controlled study in Bosnia and Herzegovina, Colombia and Uganda.

INTRODUCTION: The management of long-term physical conditions is a challenge worldwide, absorbing a majority resources despite the importance of acute care. The management of these conditions is done largely in primary care and so interventions to improve primary care could have an enormous impact. However, very little data exist on how to do this. Mental distress is frequently comorbid with long term physical conditions, and can impact on health behaviour and adherence, leading to poorer outcomes. DIALOG+ is a low-cost, patient-centred and solution-focused intervention, which is used in routine patient-clinician meetings and has been shown to improve outcomes in mental health care. The question arises as to whether it could also be used in primary care to improve the quality of life and mental health of patients with long-term physical conditions. This is particularly important for low- and middle-income countries with limited health care resources. METHODS: An exploratory non-controlled multi-site trial was conducted in Bosnia and Herzegovina, Colombia, and Uganda. Feasibility was determined by recruitment, retention, and session completion. Patient outcomes (quality of life, anxiety and depression symptoms, objective social situation) were assessed at baseline and after three approximately monthly DIALOG+ sessions. RESULTS: A total of 117 patients were enrolled in the study, 25 in Bosnia and Herzegovina, 32 in Colombia, and 60 in Uganda. In each country, more than 75% of anticipated participants were recruited, with retention rates over 90% and completion of the intervention exceeding 92%. Patients had significantly higher quality of life and fewer anxiety and depression symptoms at post-intervention follow-up, with moderate to large effect sizes. There were no significant improvements in objective social situation. CONCLUSION: The findings from this exploratory trial suggest that DIALOG+ is feasible in primary care settings for patients with long-term physical conditions and may substantially improve patient outcomes. Future research may test implementation and effectiveness of DIALOG+ in randomized controlled trials in wider primary care settings in low- and middle-income countries. TRIAL REGISTRATION: All studies were registered prospectively within the ISRCTN Registry. ISRCTN17003451, 02/12/2020 (Bosnia and Herzegovina), ISRCTN14018729, 01/12/2020 (Colombia) and ISRCTN50335796, 02/12/2020 (Uganda).

Prevalence of depressive disorder in the adult population of Latin America: a systematic review and meta-analysis.

Background: Depressive disorder is one of the leading causes of disability worldwide; however its prevalence and association with inequality and crime is poorly characterised in Latin America. This study aimed to: i. systematically review population-based studies of prevalence of ICD/DSM depressive disorder in Latin America, ii. report pooled regional, country, and sex-specific prevalence estimates, and iii. test its association with four country-level development indicators: human development (HDI), income (Gini) and gender inequality (GII), and intentional homicide rate (IHR). Methods: We conducted a systematic review and meta-analysis of population-based studies reporting primary data on the prevalence of ICD/DSM depressive disorder in Latin America from 1990 to 2023, irrespective of language. We searched PubMed, PsycINFO, Cochrane Library, SciELO (regional database), LILAC (regional database), and available grey literature. Study quality was assessed using JBI's critical appraisal tools. We generated pooled estimates using random-effects meta-analysis; heterogeneity was assessed using the I2 statistic. Meta-regression analyses were used to test associations of depression prevalence with indicators of inequality and human development. The study was registered with PROSPERO (CRD42019143054). Findings: Using data from 40 studies in Latin America, lifetime, 12-month, and current prevalence of ICD/DSM depressive disorder were calculated at 12.58% (95% CI 11.00%-14.16%); 5.30% (4.55-6.06%), and 3.12% (2.22-4.03), respectively. Heterogeneity was high across lifetime, 12-month, and current prevalence, sex, and countries. 12-month and current prevalence was associated with higher Gini and GII, 12-month prevalence with lower HDI, and current prevalence with higher IHR. Interpretation: We found a high prevalence of ICD/DSM depressive disorders in Latin America, and a statistically significant association with inequality and development indicators. The high heterogeneity found across prevalence periods and the major gaps in country representation underscore the need to escalate efforts to improve mental health access and research capabilities in Latin America. Systematic, comparable prevalence estimates would inform more effective decision-making in the region. Funding: Pfizer Independent Medical Education Grant.

The mental wellbeing of female prisoners in Chile.

OBJECTIVE: To measure and understand mental wellbeing among women prisoners in Chile, as part of a larger study. RESULT: Sixty-eight sentenced prisoners in a women's prison participated in a survey, giving a response rate of 56.7%. Using the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS), the mean wellbeing score of participants was 53.77 out of maximum score of 70. Whilst 90% of the 68 women felt useful at least some of the time, 25% rarely felt relaxed, close to others or able to make up their own minds about things. Data generated from two focus groups attended by six women offered explanations for survey findings. Thematic analysis identified stress and loss of autonomy due to the prison regime as factors which negatively affect mental wellbeing. Interestingly, whilst offering prisoners an opportunity to feel useful, work was identified as a source of stress. Interpersonal factors linked to a lack of safe friendships within the prison and little contact with family had an adverse impact on mental wellbeing. The routine measurement of mental wellbeing among prisoners using the WEMWBS is recommended in Chile and other Latin American countries to identify the impact of policies, regimes, healthcare systems and programmes on mental health and wellbeing.

Living the Process: Examining the Continuum of Coercion and Care in Tijuana's Community-Based Rehabilitation Centers.

In Mexico, community-based, non-biomedical treatment models for substance use are legally recognized in national drug policy, monitored by state-level Departments of Health, and in some cases publicly funded. Academic research on centers that utilize these forms of treatment have focused primarily on documenting their rapid spread and describing their institutional practices, particularly human rights abuses and lack of established biomedical efficacy. In Tijuana, these community-based therapeutic models are shaped by conceptions of health and illness from the local cultural context of the United States-Mexico border zone in ways that do not cleanly match western, biomedical notions of the illness "addiction." In this article, I examine treatment ethics by exploring the contextually understood need for coerced treatment (i.e., why centers are locked) along with experiences of compulsion in a women's 12 Step center. These discussions highlight the contested therapeutic value of coercion from multiple perspectives. Utilizing engaged listening around local care practices marks a path for global mental health researchers to understand and sit with difference in order to communicate across opposing viewpoints in the service of mental health equity and best care practices.

OnTrack Chile for people with early psychosis: a study protocol for a Hybrid Type 1 trial.

BACKGROUND: Substantial data from high-income countries support early interventions in the form of evidence-based Coordinated Specialty Care (CSC) for people experiencing First Episode Psychosis (FEP) to ameliorate symptoms and minimize disability. Chile is unique among Latin American countries in providing universal access to FEP services through a national FEP policy that mandates the identification of FEP individuals in primary care and guarantees delivery of community-based FEP treatments within a public health care system. Nonetheless, previous research has documented that FEP services currently provided at mental health clinics do not provide evidence-based approaches. This proposal aims to address this shortfall by first adapting OnTrackNY (OTNY), a CSC program currently being implemented across the USA, into OnTrackChile (OTCH), and then examine its effectiveness and implementation in Chile. METHODS: The Dynamic Adaptation Process will be used first to inform the adaptation and implementation of OTCH to the Chilean context. Then, a Hybrid Type 1 trial design will test its effectiveness and cost and evaluate its implementation using a cluster-randomized controlled trial (RCT) (N = 300 from 21 outpatient clinics). The OTCH program will be offered in half of these outpatient clinics to individuals ages 15-35. Usual care services will continue to be offered at the other clinics. Given the current COVID-19 pandemic, most research and intervention procedures will be conducted remotely. The study will engage participants over the course of 2 years, with assessments administered at enrollment, 12 months, and 24 months. Primary outcomes include implementation (fidelity, acceptability, and uptake) and service outcomes (person-centeredness, adherence, and retention). Secondary outcomes comprise participant-level outcomes such as symptoms, functioning, and recovery orientation. Over the course of the study, interviews and focus groups with stakeholders will be conducted to better understand the implementation of OTCH. DISCUSSION: Findings from this study will help determine the feasibility, effectiveness, and cost for delivering CSC services in Chile. Lessons learned about facilitators and barriers related to the implementation of the model could help inform the approach needed for these services to be further expanded throughout Latin America. TRIAL REGISTRATION: www. CLINICALTRIALS: gov NCT04247711 . Registered 30 January 2020. TRIAL STATUS: The OTCH trial is currently recruiting participants. Recruitment started on March 1, 2021, and is expected to be completed by December 1, 2022. This is the first version of this protocol (5/12/2021).

Trauma-focused cognitive behavioral therapy with Puerto Rican youth in a post-disaster context: Tailoring, implementation, and program evaluation outcomes.

PURPOSE: Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) has not yet been systematically evaluated in the Caribbean context, particularly with Hispanic youth exposed to multiple disasters. The objective of this project was twofold: 1) to train mental health providers in Puerto Rico in TF-CBT as part of a clinical implementation project within the largest managed behavioral health organization (MBHO) on the island, and 2) to conduct a program evaluation to determine the feasibility of implementation and the effectiveness of the treatment. METHOD: Fifteen psychologists were trained in TF-CBT. These psychologists then provided TF-CBT to 56 children and adolescents, ages 5-18, in community-based mental health clinics and one primary care clinic with a co-located psychologist in Puerto Rico. The mean number of traumatic events reported by youth referred for TF-CBT was 4.11. RESULTS: Thirty-six out of 56 children enrolled in the project (64.3%) successfully completed all components of TF-CBT. Results demonstrated large effect sizes for reduction in youth-reported posttraumatic stress symptoms (PTSS) (Cohen's d = 1.32), depressive symptoms (Cohen's d = 1.32), and anxiety symptoms (Cohen's d = 1.18). CONCLUSIONS: These results suggest that it was feasible to train providers in TF-CBT, that providers were able to deliver TF-CBT in community-based settings both in person and via telehealth (due to the COVID-19 pandemic), and that TF-CBT was an effective treatment option to address trauma-related concerns for youth in Puerto Rico in a post-disaster context. This project is an important first step in the dissemination and implementation of evidence-based trauma-focused treatment for Hispanic youth and disaster-affected youth in the Caribbean.

Understanding mental distress in Arcahaie, Haiti: Heterogeneous uses of idioms of distress in communicating psychological suffering.

Research on mental health in specific communities requires careful attention to cultural context and language. Studies on global mental health have increasingly analyzed idioms of distress, or culturally situated ways of conceptualizing, experiencing, and expressing distress. This study examines how idioms of distress are used and understood in Arcahaie, Haiti. The goal was to enrich current understanding of mental health conceptualization and communication by exploring the heterogeneity of common idioms of distress. Interviews with community members (N = 47) explored meanings and perceived causations of 13 idioms of distress. Major themes included pervasiveness of poverty, ruminative thinking, effects of Vodou and Christian belief systems, embodied distress, and the behavior of "crazy" people (moun fou). The findings suggest some specific pathways for potential community engagement projects, including training lay-leaders in cognitive behavioral therapy using existing socioreligious infrastructure and expanding access to social engagement activities. This research contributes to a small but growing body of literature on mental illness in Haiti and to methods for studying idioms of distress.

Negotiating human rights narratives in Global Mental Health: Autism and ADHD controversies in Brazil.

Promoting evidence-based treatments and the human rights of people living with mental illness are the two pillars of Global Mental Health (GMH). Critics counter that human rights narratives must also include social justice frameworks. We draw on the cases of autism and ADHD in Brazil to discuss the role of human rights in mental health in the context of GMH. A human rights perspective involves citizenship rights for individuals living with mental distress and provides a framework to problematise the logic of GMH centred on individual rights and rights to treatment. We begin with an overview on human rights discussions in GMH and examine the introduction of human rights discourses in the Brazilian psychiatric reform. We then explore how autism and ADHD became priorities of GMH interventions as well as the constitution of two styles of activism and mobilisation of human rights around these conditions. One follows the universal public health logic and promotes health as a social right. The other follows the logic of parents' associations that redefined those conditions as forms of disability to advocate for specialised services and interventions. Finally, we discuss these forms of human rights mobilisation and their implications for Brazilian mental health and GMH.

Feasibility, experiences and outcomes of using DIALOG+ in primary care to improve quality of life and mental distress of patients with chronic conditions: an exploratory non-controlled trial in Bosnia and Herzegovina, Colombia and Uganda.

BACKGROUND: DIALOG+ is a resource-oriented and evidence-based intervention to improve quality of life and reduce mental distress. While it has been extensively studied in mental health care, there is little evidence for how to use it in primary care settings for patients with chronic physical conditions. Considering that DIALOG+ is used in existing routine patient-clinician meetings and is very low cost, it may have the potential to help large numbers of patients with chronic physical conditions, mental distress and poor quality of life who are treated in primary care. This is particularly relevant in low- and middle-income countries (LMICs) where resources for specialised services for such patients are scarce or non-existent. METHODS: An exploratory non-controlled trial will be conducted to primarily assess the feasibility and acceptability and, secondarily, outcomes of delivering DIALOG+ to patients with chronic physical conditions and poor quality of life in primary care settings in Bosnia and Herzegovina, Colombia and Uganda. Thirty patients in each country will receive DIALOG+ up to three times in monthly meetings over a 3-month period. Feasibility will be assessed by determining the extent to which the intervention is implemented as planned. Experiences will be captured in interviews and focus groups with care providers and participants to understand acceptability. Quality of life, symptoms of anxiety and depression, objective social situation and health status will be assessed at baseline and again after the three-session intervention. DISCUSSION: This study will inform our understanding of the extent to which DIALOG+ may be used in the routine care of patients with chronic physical conditions in different primary care settings. The findings of this exploratory trial can inform the design of future full randomised controlled trials of DIALOG+ in primary care settings in LMICs. TRIAL REGISTRATION: All studies were registered prospectively (on 02/12/2020 for Uganda and Bosnia and Herzegovina, and 01/12/2020 for Colombia) within the ISRCTN Registry. ISRCTN17003451 (Bosnia and Herzegovina), ISRCTN14018729 (Colombia) and ISRCTN50335796 (Uganda). Protocol version and date: v2.0; 28/07/2020 (Bosnia and Herzegovina), v0.3 02/08/2020 (Colombia) and v1.0, 05/11/2020 (Uganda).

Sociodemographic Analysis of Suicide Rates Among Older Adults Living in Ecuador: 1997-2019.

Background: Despite most suicides occurring in low-and-middle-income countries (LAMICs), limited reports on suicide rates in older adults among LAMICs are available. In Ecuador, high suicide rates have been reported among adolescents. Little is known about the epidemiology of suicides among older adults in Ecuador. Aim: To examine the sociodemographic characteristics of suicides among older adults living in Ecuador from 1997 to 2019. Methods: An observational study was conducted using Ecuador's National Institute of Census and Statistics database from 1997 to 2019 in Ecuadorians aged 60 and older. International Classification of Diseases 10th Revision (ICD-10) (X60-X84)-reported suicide deaths were included in addition to deaths of events of undetermined intent (Y21-Y33). Sex, age, ethnicity, educational level, and method of suicide were analyzed. Annual suicide rates were calculated per 100,000 by age, sex, and method. To examine the trends in rates of suicide, Joinpoint analysis using Poisson log-linear regression was used. Results: Suicide rates of female older adults remained relatively stable between 1997 and 2019 with an average annual percentage increase of 2.4%, while the male rates increased between 2002 and 2009, 2014 and 2016, and maintained relatively stable within the past 3 years (2017-2019). The annual age-adjusted male suicide rate was 29.8 per 100,000, while the female suicide rate was 5.26 per 100,000 during the study period. When adding deaths of undetermined intent, the annual male rate was 60.5 per 100,000, while the same rate was 14.3 for women. The most common suicide method was hanging (55.7%) followed by self-poisoning (26.0%). The highest suicide numbers were reported in urban districts, men, and those with lower education status. Conclusion: This study contributes to building the baseline for further studies on suicide rates of older adults in Ecuador. Results highlight priority areas of suicide prevention. By examining suicide trends over 23 years, findings can help inform policy and future interventions targeting suicide prevention.

Global mental health and the DIADA project.

The DIADA project, understood as a mental healthcare implementation experience in the context of a middle-income country like Colombia, promotes a necessary discussion about its role in the global mental health framework. The following article outlines the main points by which this relationship occurs, understanding how the project contributes to global mental health and, at the same time, how global mental health nurtures the development of this project. It reflects on aspects like the systematic screening of patients with mental illness, the use of technology in health, the adoption of a collaborative model, the investigation on implementation, a collaborative learning and the Colombian healthcare system. These are all key aspects when interpreting the feedback cycle between the individual and the global. The analysis of these components shows how collaborative learning is a central axis in the growth of global mental health: from the incorporation of methodologies, implementation of models, assessment of outcomes and, finally, the dissemination of results to local, regional and international stakeholders.

Barriers and facilitators to the diagnosis and treatment of depression in primary care in Colombia: Perspectives of providers, healthcare administrators, patients and community representatives.

INTRODUCTION: Depression represents a major disease burden in Colombia. To better understand opportunities to improve access to mental healthcare in Colombia, a research team at Javeriana University conducted formative qualitative research to explore stakeholders' experiences with the integration of mental healthcare into the primary care system. METHODS: The research team conducted 16 focus groups and 4 in-depth interviews with patients, providers, health administrators and representatives of community organisations at five primary care clinics in Colombia, and used thematic analysis to study the data. RESULTS: Themes were organised into barriers and facilitators at the level of patients, providers, organisations and facilities. Barriers to the treatment of depression included stigma, lack of mental health literacy at the patient and provider level, weak links between care levels, and continued need for mental health prioritization at the national level. Facilitators to the management of depression in primary care included patient support systems, strong patient-provider relationships, the targeting of depression interventions and national depression guidelines. DISCUSSION: This study elucidates the barriers to depression care in Colombia, and highlights action items for further integrating depression care into the primary care setting.

Evaluating clinical outcomes of routinely delivered task-shared care for depression in rural Haiti.

BACKGROUND: There is a growing literature in support of the effectiveness of task-shared mental health interventions in resource-limited settings globally. However, despite evidence that effect sizes are greater in research studies than actual care, the literature is sparse on the impact of such interventions as delivered in routine care. In this paper, we examine the clinical outcomes of routine depression care in a task-shared mental health system established in rural Haiti by the international health care organization Partners In Health, in collaboration with the Haitian Ministry of Health, following the 2010 earthquake. METHODS: For patients seeking depression care betw|een January 2016 and December 2019, we conducted mixed-effects longitudinal regression to quantify the effect of depression visit dose on symptoms, incorporating interaction effects to examine the relationship between baseline severity and dose. RESULTS: 306 patients attended 2052 visits. Each visit was associated with an average reduction of 1.11 in depression score (range 0-39), controlling for sex, age, and days in treatment (95% CI -1.478 to -0.91; p < 0.001). Patients with more severe symptoms experienced greater improvement as a function of visits (p = 0.04). Psychotherapy was provided less frequently and medication more often than expected for patients with moderate symptoms. CONCLUSIONS: Our findings support the potential positive impact of scaling up routine mental health services in low- and middle-income countries, despite greater than expected variability in service provision, as well as the importance of understanding potential barriers and facilitators to care as they occur in resource-limited settings.

Experiences and outcomes of group volunteer befriending with patients with severe mental illness: an exploratory mixed-methods study in Colombia.

BACKGROUND: Improving care for patients with severe mental illness in Latin America requires effective strategies that are low-cost. One such strategy is a volunteering scheme, referred to as befriending, which seeks to support the social integration of patients. Despite positive reports in other world regions, this intervention has not been studied in Latin America. Whilst befriending programmes commonly form patient-volunteer dyads, group arrangements may be an alternative with some benefits. Here, we aim to explore the feasibility, experiences and outcomes of a group volunteer befriending intervention for patients with severe mental illness in Colombia. METHODS: In this exploratory non-controlled study, 10 groups of five individuals were formed, each consisting of three individuals with schizophrenia or bipolar disorder and two volunteers from the community in Bogotá, Colombia. Each group was encouraged to participate together in social activities within their community over a 6-month period. Patients' quality of life, objective social outcomes, symptom levels and internalised stigma were assessed before and after the intervention. Patients' and volunteers' experiences were explored in semi-structured interviews which were analysed using inductive content analysis. RESULTS: Outcomes were available for 23 patients. Whilst their objective social situation had significantly improved at the end of the intervention, other outcomes did not show statistically significant differences. The interviews with participants revealed positive experiences which fell into five categories: 1) stigma reduction; 2) personal growth; 3) formation of relationships; 4) continuity and sustainability of befriending; 5) acceptability and feasibility of befriending. CONCLUSIONS: A volunteer befriending programme in small groups of two volunteers and three patients is feasible and associated with positive experiences of participants. Such programmes may also improve the objective social situation of patients. This low-cost intervention may be useful for patients with severe mental illnesses in Latin America. TRIAL REGISTRATION: ISRCTN72241383 (Date of Registration: 04/03/2019, retrospectively registered).

Sobre a importância da cultura e da experiência no cuidado em saúde mental / On the importance of culture and experience in mental health care / Sobre la importancia de la cultura y la experiencia en el cuidado de la salud mental

Esta pesquisa buscou estudar, por meio de uma revisão bibliográfica, de que modo as considerações feitas sobretudo por Lawrence Kirmayer, Arthur Kleinman e Joan Kleinman podem trazer contribuições ao campo da saúde mental no Brasil. Com a finalidade de trazer um referencial da saúde global que enriqueça as estratégias utilizadas pela Rede de Atenção Psicossocial (RAPS), foi revisto como o cuidado em saúde mental envolve um problema interpretativo, especialmente à luz da diversidade cultural. Como conclusão, verificou-se como essa exploração permitiu a elucidação de características fundamentais para a noção de território, que a fazem se expandir para uma compreensão mais ampla do que a de mera localidade geográfica.

This research aimed to study, through a bibliographical review, how the considerations made mainly by Lawrence Kirmayer, Arthur Kleinman and Joan Kleinman can contribute to the field of mental health in Brazil. For the purpose of bringing a global health referential that would enrich the strategies used by the Psychosocial Care Network (RAPS), it was reviewed how mental health care involves an interpretative problem, especially in the light of cultural diversity. As a conclusion, it was seen how this exploration allowed some light to be shed on fundamental characteristics of the notion of territory, that broadens its comprehension to beyond mere geographic locality.

Esta investigación buscó estudiar, por medio de una revisión bibliográfica, como las consideraciones hechas sobre todo por Lawrence Kirmayer, Arthur Kleinman y Joan Kleinman pueden aportar contribuciones al campo de la salud mental en Brasil. Con el fin de traer un referencial de la salud global que enriquezca las estrategias utilizadas por la Red de Atención Psicosocial (RAPS), se revisó como el cuidado en salud mental involucra un problema interpretativo, especialmente cuando a la luz de la diversidad cultural. Como conclusión, se verificó como esa explotación permitió la elucidación de características fundamentales a la noción de territorio, que la hacen expandirse hacia una comprensión más amplia que la de una mera localidad geográfica.

The role of Community Mental Health in a new architecture of World psychiatry and Global Mental Health / Papel de la Salud Mental Comunitaria en una nueva arquitectura de la Psiquiatría Mundial y de la Salud Mental Global

Abstract Introduction The influx of new knowledge and scientific contributions into contemporary world psychiatry has counted on a vigorous dissemination through technology-inspired means. This process has led to the realities of Global Mental Health (GMH) inspired by "a new epistemology" of mostly positivistic roots. Objective To explore the basis of these realities and the resulting homogenization attempts of psychiatry as a medical, clinical, and research discipline. Discussion and conclusion The need for "a new architecture" of contemporary psychiatry is discussed as a reflection of a correct epistemological exercise and a renewed pact between professionals and communities, materialized in and enriched by the re-emerging Community Mental Health (CMH) movement. The essential bases of the movement are presented, and its mutually collaborative, multidisciplinary, integrated, and realistic nature, as reflected in national efforts like Peru's in Latin America, is described.

Resumen Introducción El flujo de nuevos conocimientos y contribuciones científicas surgido en la psiquiatría mundial contemporánea ha contado con una vigorosa diseminación mediada por recursos tecnológicos. Este proceso ha conducido a las realidades de la Salud Mental Global (SMG) inspiradas por una "nueva epistemología" de raíces fundamentalmente positivistas. Objetivo Explorar las bases de esta nueva realidad y los resultantes intentos de homogenización de la psiquiatría como disciplina médica, clínica y de investigación. Discusión y conclusión Se discute la necesidad de "una nueva arquitectura" de la psiquiatría contemporánea como reflejo de un correcto ejercicio epistemológico y de un pacto renovado entre profesionales y comunidades que se han materializado y enriquecido por el reemergente movimiento de la Salud Mental Comunitaria (SMC). Se presentan las bases esenciales del movimiento y su naturaleza de mutua colaboración multidisciplinaria, integrada y realista, reflejada en esfuerzos nacionales como es el caso del Perú en América Latina.

Intergenerational effects of childhood maltreatment and malnutrition on personality maladaptivity in a Barbadian longitudinal cohort.

Childhood adversities are linked with mental health problems throughout the life course, including personality pathology. Less is known about consequences in the next generation, particularly in non-Western populations. In the Barbados Nutrition Study, we assessed associations of two parental (G1) childhood adversities- (1) maltreatment history using the Childhood Trauma Questionnaire-Short Form (CTQ-SF), and (2) clinically ascertained infant malnutrition limited to the first year of life-on PD symptoms in their G2 offspring, using NEO FFM PD prototypes. In linear regression models clustered by family and adjusted for other G1 childhood adversities and family socioeconomic status, we found that G1 parental history of childhood maltreatment was significantly associated with increased G2 offspring Borderline, Histrionic, Narcissistic, and Dependent PD scores. When G1 childhood malnutrition was the exposure of interest, we found a significant association with Schizoid PD scores. When the sample was restricted to offspring of G1 mothers, even more extensive associations with G2 personality pathology were observed. This study supports a link between parental exposure to childhood adversities and increased personality maladaptivity in the next generation, with some specific patterns worthy of further exploration.

How coloniality shapes the making of Latin American psychologists: ethnographic evidence from Ecuador.

This paper provides ethnographic evidence on how coloniality shapes the making of Latin American psychologists. A critical ethnography was conducted at a psychology training institution in Ecuador, consisting of twelve months of participant observation; forty-one semi-structured interviews; and analysis of academic discourse, photos, videos and relevant social media content. The research was guided by the tradition of Critical Psychology - specifically Liberation Psychology - and Critical Discourse Analysis. Findings suggest the pervasiveness of coloniality in the making of Ecuadorian psychologists and, hypothetically, of others in Latin America and the wider Global South. Interpretations also highlight the non-essentialist, non-dichotomist, 'messy' nature of such processes, a consideration which may advance current ethical and analytical debates on decolonisation. Echoing ongoing critical arguments, authors suggest that a 'help-as-war' metaphor is a category with potential value to contribute to such advancement, an approach that has important theoretical and pragmatic implications for researchers and practitioners.

Development of a comprehensive, sustained community mental health system in post-earthquake Haiti, 2010-2019.

Between 2010 and 2019 the international health care organization Partners In Health (PIH) and its sister organization Zanmi Lasante (ZL) mounted a long-term response to the 2010 Haiti earthquake, focused on mental health. Over that time, implementing a Theory of Change developed in 2012, the organization successfully developed a comprehensive, sustained community mental health system in Haiti's Central Plateau and Artibonite departments, directly serving a catchment area of 1.5 million people through multiple diagnosis-specific care pathways. The resulting ZL mental health system delivered 28 184 patient visits and served 6305 discrete patients at ZL facilities between January 2016 and September 2019. The experience of developing a system of mental health services in Haiti that currently provides ongoing care to thousands of people serves as a case study in major challenges involved in global mental health delivery. The essential components of the effort to develop and sustain this community mental health system are summarized.