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BackgroundFollowing the genocide, millions of Rwandans are likely living with posttraumatic stress disorder (PTSD). Le Centre Psychothérapeutique Icyizere provides the only specialized treatment for PTSD in the Rwandan healthcare system.MethodsDemographics, diagnosis, treatment, outcomes, and scores on assessments of functioning and PTSD were recorded from clinical charts of all patients receiving care between October 2013 and 2014. Descriptive statistics and within-group t tests comparing functional impairment and PTSD symptoms at intake to discharge and follow-up were calculated.ResultsA total of 719 patients (55.08% male) received care. Patients were more educated, more likely to live in the capital, and less likely to be married than the general population. Patients reported high desire for, and strong satisfaction with, care. Most patients (55.60%) were still in care by the end of the program evaluation. Functioning improved from intake to discharge (p < 0.001), and improvements were sustained at follow-up (p < 0.001). Most adults were diagnosed with psychotic disorders, substance use disorders, or depression. Only 20 patients were diagnosed with PTSD, and symptoms were improved at discharge (p = 0.003).ConclusionsThis program evaluation demonstrated the utility of a low-resource information management system to provide clarity about the patient population and outcomes. Results suggest that services are effective and sustainable, although people with PTSD were not the primary recipients of care. Disparities in care by diagnosis, education, marital status, and geography are discussed. Results have contributed to changes in service delivery and care and efforts to increase access to care.

Background: There is a strong link between trauma exposure and serious mental health conditions (SMHCs), such as schizophrenia and bipolar disorder. The majority of research in the field has focused on childhood trauma as a risk factor for developing an SMHC and on samples from high-income countries. There is less research on having an SMHC as a risk factor for exposure to traumatic events, and particularly on populations in low- and middle-income countries (LMICs).This scoping review aimed to synthesize the nature and extent of research on traumatic events that adults with SMHCs face in LMICs. It was conducted across five databases: PubMed, Embase, PsycINFO, Web of Science Core Collection and Africa-Wide Information/NiPad in December 2023 and by hand searching citation lists., Findings: The database search returned 4,111 articles. After removing duplicates and following a rigorous screening process, 51 articles met criteria for inclusion. There was one case study, one mixed methods study, 12 qualitative studies and 37 quantitative studies. Ten countries were represented, with the most studies from India (n = 19), Ethiopia (n = 9) and China (n = 6). Schizophrenia was the most studied type of SMHC. Of the trauma exposures, more than 76% were on interpersonal violence, such as sexual and physical violence. Of the studies on interpersonal violence, more than 23% were on physical restraint (e.g., shackling) in the community or in hospital settings. There were no studies on man-made or natural disasters., Implications: Much of our data in this population are informed by a small subset of countries and by certain types of interpersonal violence. Future research should aim to expand to additional countries in LMICs. Additional qualitative research would likely identify and contextualize other trauma types among adults with SMHCs in LMICs., Competing Interests: None., (© The Author(s) 2024.)

The great challenge of reducing soil nutrient depletion and assuring agricultural system productivity in low-income countries caused by limited synthetic fertilizer use necessitates local and cost-effective nutrient sources. We estimated the changes of the nitrogen budget of agricultural systems in the East African Community from 1961 to 2018 to address the challenges of insufficient nitrogen inputs and serious soil nitrogen depletion in agricultural systems of the East African Community region. Results showed that total nitrogen input increased from 12.5 kg N ha -1 yr -1 in the 1960s to 21.8 kg N ha -1 yr -1 in the 2000s and 27 kg N ha -1 yr -1 in the 2010s. Total nitrogen crop uptake increased from 12.8 kg N ha -1 yr -1 in the 1960s to 18.2 kg N ha -1 yr -1 in the 2000s and 21.8 kg N ha -1 yr -1 in the 2010s. Soil nitrogen stock increased from -2.0 kg N ha -1 yr -1 in the 1960s to -0.5 kg N ha -1 yr -1 in the 2000s and 0.3 kg N ha -1 yr -1 in the 2010s. Our results allow us to substantiate for the first time that soil nitrogen depletion decreases with increasing input of nitrogen in agricultural systems of the East African Community region. This suggests that increases in nitrogen inputs through biological nitrogen fixation and animal manure are the critical nitrogen management practices to curb soil nitrogen depletion and sustain agricultural production systems in the East African Community region in order to meet food demand for a growing population., Supplementary Information: The online version contains supplementary material available at 10.1007/s13593-023-00881-0., Competing Interests: Competing interestsThe authors declare no competing interests., (© INRAE and Springer-Verlag France SAS, part of Springer Nature 2023, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Objective: Although studies have examined the association between adverse childhood experiences (ACE) and health and mental health outcomes, few studies have investigated the association between ACE and household food insecurity among children aged 0-5 years in the USA. The objective of this study is to investigate the association between ACE and household food insecurity among children aged 0-5 years., Design: The data used in this study came from the 2016-2017 National Survey of Children's Health. Data were analysed using multinomial logistic regression with household food insecurity as the outcome variable., Setting: United States., Participants: An analytic sample of 17 543 children aged 0-5 years (51·4% boys)., Results: Of the 17 543 respondents, 83·7% experienced no childhood adversity. About one in twenty (4·8%) children experienced moderate-to-severe food insecurity. Controlling for other factors, children with one adverse childhood experience had 1·43 times the risk of mild food insecurity (95 % CI 1·25, 1·63) and 2·33 times the risk of moderate-to-severe food insecurity (95 % CI 1·84, 2·95). The risk of mild food insecurity among children with two or more ACE was 1·5 times higher (95 % CI 1·24, 1·81) and that of moderate-to-severe food insecurity was 3·96 times higher (95 % CI 3·01, 5·20), when compared with children with no childhood adversity., Conclusion: Given the critical period of development during the first few years of life, preventing ACE and food insecurity and early intervention in cases of adversity exposure is crucial to mitigate their negative impact on child development.

Clients' perceptions of continuous support during the transition from hospital to the community have been understudied. The present study evaluated clients' perceptions of the benefits and potential adjustments to the implementation of a transitional discharge model (TDM), an intervention for community integration of clients with mental health issues. A focused ethnography methodology was used to investigate the effectiveness of the TDM. Data were collected using two sets of focus groups which involved 87 clients with mental illness seeking care from nine hospitals across the Province of Ontario, Canada. One focus group was conducted at six months and another at the one-year time point of the study. Data analysis followed a four-step ethnographic approach proposed by Leininger (1985) for thematic analysis in qualitative research. Four main themes emerged: (i) clients' perceived benefits of the TDM. These came in the form of reassurance about transitioning from hospitalization to community, reduced feelings of isolation, and enhanced continuity of care and recovery, (ii) TDM for community integration; clients believed that the intervention offered suitable friendships, was a tool for social connectedness, and helped to reduce stigma, (iii) encountered challenges, which included issues with trust, perceiving peer supporters as intruders, issues with communication, and initial fears about discharge and (4) suggestions for improving the TDM, such as, more in-person interactions, formalizing the TDM and raising awareness about community resources. The TDM implementation may facilitate the transition from hospital to the community by offering social support that enhances recovery., (© 2020 Australian College of Mental Health Nurses Inc.)

The concept of brain health has been inconsistently used across disciplines. This concept analysis sought to clarify brain health and construct a unified definition that may lead to consistent use of this concept. The analysis used Walker and Avant's framework to identify scholarly reports on the concept of brain health from various electronic databases. Building on the identified data sources, brain health can be understood as the brain's ability to optimally adapt to internal and external human conditions through cognitive and emotional responses across one's lifespan, which result in sustainable positive changes in brain structures and functional features. This analysis emphasized that maintaining brain health has positive implications on an individual's lifelong quality of health, independence, and delaying cognitive decline. By clarifying uses and definitions of the concept of brain health, this concept analysis may enable researchers and clinicians to evaluate and interpret the concept related data consistently.

[This corrects the article DOI: 10.1371/journal.pmed.1003090.].

Research has demonstrated the benefits of mental healthcare interventions that ensure a safe transition of clients throughout the discharge and community integration process. This paper reports on qualitative data from focus groups with health professionals collected as part of a larger a mixed method study designed to examine the effectiveness and sustainability of implementing the transitional discharge model. Data collection involved two sets of focus groups, which were held at six months and one-year post-implementation. There were 216 health professional participants from nine (9) hospitals across the Province of Ontario, Canada. Data analysis used a four-step ethnographic framework by Leininger (1985) to identify descriptors and recurrent and major themes. The study identified four major themes, including healthcare professionals' roles and positive experiences in implementing the transitional discharge model; perceived benefits of the model; challenges to implementing the model; and suggestions for sustaining the model's implementation. Healthcare professionals felt that the implementation of the transitional discharge model has the potential for increasing their awareness of the process of clients' integration, serving as a framework for discharge planning, and reducing hospital readmissions. The study findings may provide healthcare providers with information on pragmatic ways to plan clients' discharge, to bridge the gap between hospital and community care, and to positively impact client health outcomes., (© 2019 Australian College of Mental Health Nurses Inc.)

Globally, individuals with psychiatric disorders experience an increased risk for homelessness and frequent migration. The present qualitative study used intersectionality and thematic analysis to examine how male and female psychiatric survivors experienced the phenomenon of frequent migration in Canada. The study findings underscored aspects of frequent migration, including negative experiences associated with poverty, as well as increased risks for homelessness and mental health, stigma, and discrimination. The present findings call for bespoken services and programs to address male and female psychiatric survivors' specific needs; thereby alleviating pathways to frequent migrations among psychiatric survivors.

Background: People living in sub-Saharan Africa (SSA) are disproportionately exposed to trauma and may be at increased risk for posttraumatic stress disorder (PTSD). However, a dearth of population-level representative data from SSA is a barrier to assessing PTSD. This manuscript sought to calculate pooled PTSD prevalence estimates from nationally and regionally representative surveys in SSA., Methods and Findings: The search was conducted in PubMed, Embase, PsycINFO, and PTSDpubs and was last run between October 18, 2019, and November 11, 2019. We included studies that were published in peer-reviewed journals; used probabilistic sampling methods and systematic PTSD assessments; and included ≥ 450 participants who were current residents of an SSA country, at least 50% of whom were aged between 15 and 65 years. The primary outcomes were point prevalence estimates of PTSD across all studies, and then within subgroups. The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (registration number CRD42016029441). Out of 2,825 unique articles reviewed, 25 studies including a total of 58,887 eligible participants (54% female) in 10 out of the 48 countries in SSA were identified. Most studies enrolled any adult aged 18 years or older. However, some studies only enrolled specific age brackets or persons as young as 15 years old. Six studies were national surveys, and 19 were regional. There were 4 key findings in the meta-analysis: (1) the overall pooled prevalence of probable PTSD was 22% (95% CI 13%-32%), while the current prevalence-defined as 1 week to 1 month-was 25% (95% CI 16%-36%); (2) prevalence estimates were highly variable, ranging from 0% (95% CI 0%-0%) to 74% (95% CI 72%-76%); (3) conflict-unexposed regions had a pooled prevalence of probable PTSD of 8% (95% CI 3%-15%), while conflict-exposed regions had a pooled prevalence of probable PTSD of 30% (95% CI 21%-40%; p < 0.001); and (4) there was no significant difference in the pooled prevalence of PTSD for men and women. The primary limitations of our methodology are our exclusion of the following study types: those published in languages other than English, French, and Portuguese; smaller studies; those that focused on key populations; those that reported only on continuous measures of PTSD symptoms; and unpublished or non-peer-reviewed studies., Conclusions: In this study, PTSD symptoms consistent with a probable diagnosis were found to be common in SSA, especially in regions exposed to armed conflict. However, these studies only represent data from 10 of the 48 SSA countries, and only 6 studies provided national-level data. Given the enormous heterogeneity expected across the continent, and also within countries and regions, this review cannot speak to rates of PTSD in any regions not included in this review. Thus, substantial gaps in our knowledge of PTSD prevalence in SSA remain. More research on population-level prevalence is needed to determine the burden of trauma symptoms and PTSD in SSA and to identify acceptable and feasible approaches to address this burden given limited mental healthcare resources., Competing Interests: C.H. is a member of the Editorial Board of PLOS Medicine.

Background: Over the last three decades, there has been worldwide recognition of peer support contributions to improve mental healthcare provision. However, in the current literature, little attention has been paid to exploring perspectives of peer supporters on their involvement in mental health services provision. The purpose of the present study was to examine peer supporters' perspectives on the implementation of a transitional discharge model (TDM), an intervention for the community integration of people with mental illness., Methods: This paper represents ethnographic qualitative data collected as part of a study that used mixed methods to evaluate the implementation of TDM across nine hospitals from the Province of Ontario, in Canada. The study involved a sample of 66 peer supporters, who were recruited from participating Consumer/Survivor Initiative Organizations and Peer Support Programs. The study collected data using two sets of focus groups, which were held at 6 months and 1-year post implementation. Data analysis used an ethnography model of qualitative analysis., Results: Peer supporters expressed that their involvement in mental healthcare enhanced clients' autonomy and hope about their recovery, as well as established a safety net and reduced hospital readmissions. Peer supporters articulated that they assumed several roles to facilitate clients' transition from hospital to the community. These roles included: assisting clients in building their capacity and developing healthy routines; attending regular on-ward and community meetings; accompanying clients to their appointments; and working with clients to set goals for their recovery. The study showed hindrances to effective implementation of peer support programs, such as a lack of understanding and appreciation of peer supporter roles, lack of careful allocation of peer supporters to clients, and an absence of appropriate protocols for ensuring the safety and supervision of the peer supporters., Conclusions: Results of the TDM implementation demonstrated that involving peer supporters in mental healthcare delivery may benefit clients by enhancing autonomy and hope about their recovery, as well as establishing a safety net and reducing hospital readmissions. Results from the study have the potential to inform healthcare professionals and managers of strategies for developing effective peer support programs., Competing Interests: Competing interestsThe authors declare that they have not competing interests., (© The Author(s) 2020.)

Depression has been identified as the single largest contributor to poor health and functioning worldwide. Global estimates indicate that 4.4% of the world's population lives with depression, equating to about 322 million individuals. Research demonstrates that telehealth interventions (i.e. delivering therapy by phone or videoconferencing) have potential for improving mental health care among community-based older adults. This review analyses scholarly literature on telehealth interventions among older adults with depressive symptoms. Following PRISMA guidelines, a systematic search of peer-reviewed papers was conducted using the following key terms: telemedicine, telepsychogeriatrics, telepsychiatry, eHealth, mental health, depression, and geriatric. The review included nine articles examining telehealth for mental health care, published in English between 1946 and 26 September 2017. Telehealth for mental health care among older adults demonstrates a significant impact on health outcomes, including reduced emergency visits, hospital admissions, and depressive symptoms, as well as improved cognitive functioning. Positive or negative influences on the use of telehealth among older adults are identified. This review highlights keys aspects to consider in using telehealth interventions, including levels of education, cognitive function, and prior technology experience. The review highlights vital factors for designing interventions which aim to capitalize on the benefits of the use of telehealth for mental healthcare service delivery, especially in older adults with depressive symptoms., (© 2019 Australian College of Mental Health Nurses Inc.)