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Background Engagement with community adolescent treatment supporters (CATS) improves adherence, psychosocial well-being, linkage and retention in care among adolescents living with HIV. However, there is an urgent need for empirical evidence of the effectiveness of this approach, in order to inform further programmatic development, national and international policy, guidelines and service delivery for adolescents living with HIV. This study set out to determine the effectiveness of CATS services on improving linkage to services and retention in care, adherence and psychosocial well-being among adolescents living with HIV in Zimbabwe. Methods A randomised trial was conducted in Gokwe South district, Zimbabwe over a period of 12 months. Ninety-four HIV-positive adolescents, 10–15 years old, on antiretroviral therapy were recruited to the study. 47 participants received standard of care from the Ministry of Health and Child Care and 47 received the same standard of care plus CATS services. Data collection involved a questionnaire which was administered at baseline then repeated at three, six, nine and twelve months for all participants. Survey questions on confidence, self-esteem and self-worth had a three-point Likert scale. Stigma, quality of life and the linkages to services and retention questions had a five-point Likert scale. Results Survey questionnaires were completed with response rates of 40 out of 47 (85%) for the intervention arm, and 28 out of 47 (60%) for the control arm, at end-line. The intervention group were 3.9 times more likely to adhere to treatment compared to the control group. Linkage to services and retention in care within the intervention group increased compared with a decrease in the control arm. The intervention group reported a statistically significant increase in confidence, self-esteem, self-worth ( p  < 0.001) and quality of life compared ( p  = 0.028) with a decrease in the control arm. Conclusions This study found that adolescents receiving the CATS service had improved linkage to services and retention in care, improved adherence and improved psychosocial well-being compared to adolescents who did not have access to such services. Trial registration PACTR201711002755428 . Registered 11 November 2017. Retrospectively registered.

In an increasingly urbanised world where mental health is currently in crisis, interventions to increase human engagement and connection with the natural environment are one of the fastest growing, most widely accessible, and cost-effective ways of improving human wellbeing. This study aimed to provide an evaluation of a smartphone app-based wellbeing intervention. In a randomised controlled trial study design, the app prompted 582 adults, including a subgroup of adults classified by baseline scores on the Recovering Quality of Life scale as having a common mental health problem (n = 148), to notice the good things about urban nature (intervention condition) or built spaces (active control). There were statistically significant and sustained improvements in wellbeing at one-month follow-up. Importantly, in the noticing urban nature condition, compared to a built space control, improvements in quality of life reached statistical significance for all adults and clinical significance for those classified as having a mental health difficulty. This improvement in wellbeing was partly explained by significant increases in nature connectedness and positive affect. This study provides the first controlled experimental evidence that noticing the good things about urban nature has strong clinical potential as a wellbeing intervention and social prescription.

Background Deep-rooted racial residential segregation and housing discrimination have given rise to housing disparities among low-income Black young adults in the US. Most studies have focused on single dimensions of housing instability, and thus provide a partial view of how Black young adults experience multiple, and perhaps overlapping, experiences of housing instability including homelessness, frequent moves, unaffordability, or evictions. We aimed to illuminate the multiple forms of housing instability that Black young adults contend with and examine relationships between housing instability and mental health outcomes. Methods Using baseline data from the Black Economic Equity Movement (BEEM) guaranteed income trial with 300 urban low-income Black young adults (aged 18–24), we conducted a three-stage latent class analysis using nine housing instability indicators. We identified distinct patterns by using fit indices and theory to determine the optimal number of latent classes. We then used multinomial logistic regression to identify subpopulations disproportionately represented within unstable housing patterns. Finally, we estimated associations between housing experience patterns and mental health outcomes: depression, anxiety, and hope. Results We found high prevalence of housing instability with 27.3% of participants reporting experiences of homelessness in the prior year and 39.0% of participants reporting multiple measures of housing instability. We found the 4-class solution to be the best fitting model for the data based on fit indices and theory. Latent classes were characterized as four housing experience patterns: 1) more stably housed, 2) unaffordable and overcrowded housing, 3) mainly unhoused, and 4) multiple dimensions of housing instability. Those experiencing unaffordable and overcrowded housing and being mainly unhoused were more than four times as likely to have symptoms of depression (Unaffordable: aOR = 4.57, 95% CI: 1.64, 12.72; Unhoused: aOR = 4.67, 95% CI:1.18, 18.48) and more than twice as likely to report anxiety (Unaffordable: aOR = 2.28, 95% CI: 1.03, 5.04; Unhoused: aOR = 3.36, 95% CI: 1.12, 10.05) compared to the more stably housed pattern. We found that hope scores were similarly high across patterns. Conclusions High prevalence of housing instability and mental health challenges among low-income Black young adults demands tailored interventions to reduce instability, given widening racial disparities and implications for future well-being into adulthood.

Background Dog ownership is suggested to improve mental well-being, although empirical evidence among community dog owners is limited. This study examined changes in human mental well-being following dog acquisition, including four measures: loneliness, positive and negative affect, and psychological distress. Methods We conducted an eight-month controlled study involving three groups ( n  = 71): 17 acquired a dog within 1 month of baseline (dog acquisition); 29 delayed dog acquisition until study completion (lagged control); and 25 had no intentions of acquiring a dog (community control). All participants completed the UCLA Loneliness Scale (possible scores 0–60), Positive and Negative Affect Schedule and Kessler10 at baseline, three-months and eight-months. We used repeated measures ANCOVAs to analyse data with owner age and sex included as covariates. Post-hoc tests were performed for significant effects ( p  < 0.05). Results There was a statistically significant group by time interaction for loneliness ( p  = 0.03), with an estimated reduction of 8.41 units (95% CI -16.57, − 0.26) from baseline to three-months and 7.12 (95% CI -12.55, − 1.69) from baseline to eight-months in the dog acquisition group. The group by time interaction for positive affect was also significant ( p  = 0.03), although there was no change in the dog acquisition group. Conclusions Companion dog acquisition may reduce loneliness among community dog owners. Our study provides useful direction for future larger trials on the effects of dog ownership on human mental well-being. Trial registration This trial was retrospectively registered on 5th July 2017 with the Australian New Zealand Clinical Trials Registry ( ACTRN12617000967381 ).

Background Substantial mental health disparities between lesbian, gay and bisexual (LGB) individuals compared with heterosexuals have been identified. The aim was to examine potential sexual orientation-based disparities in mental health treatment in a prospectively analysed population-based sample in Sweden and to explore potential moderators and mediators. Method 30 730 individuals from the Stockholm Public Health Cohort were followed up with questionnaires and registry-based health record data on psychiatric healthcare visits and prescription drug use between 1 January 2011 and 31 December 2011. Results In adjusted analyses, gay and lesbian individuals were more likely to receive treatment for anxiety disorders (adjusted ORs (AOR)=3.80; 95% Cl 2.54 to 5.69) and to use antidepressant medication (AOR=2.13; 95% Cl 1.62 to 2.79); and bisexuals were more likely to receive treatment for mood disorders (AOR=1.58; 95% Cl 1.00 to 2.48), anxiety disorders (AOR=3.23; 95% Cl 2.22 to 4.72) and substance use disorders (AOR=1.91; 95% Cl 1.12 to 3.25), and to use antidepressant medication (AOR=1.91; 95% Cl 1.12 to 3.25) when compared with heterosexuals. The largest mental health treatment disparities based on sexual orientation were found among bisexual women, gay men and younger lesbian women. More frequent experiences of victimisation/threat of violence and lack of social support could partially explain these disparities. Conclusions This study shows a substantially elevated risk of poor mental health among LGB individuals as compared with heterosexuals. Findings support several factors outlined in the minority stress theory in explaining the mechanisms behind these disparities.

Adolescents living with HIV have poor virological suppression and high prevalence of common mental disorders (CMDs). In Zimbabwe, the Zvandiri adolescent peer support programme is effective at improving virological suppression. We assessed the effect of training Zvandiri peer counsellors known as Community Adolescent Treatment Supporters (CATS) in problem-solving therapy (PST) on virological suppression and mental health outcomes. Sixty clinics were randomised 1:1 to either normal Zvandiri peer counselling or a peer counsellor trained in PST. In January to March 2019, 842 adolescents aged 10 to 19 years and living with HIV who screened positive for CMDs were enrolled (375 (44.5%) male and 418 (49.6%) orphaned of at least one parent). The primary outcome was virological nonsuppression (viral load ≥1,000 copies/mL). Secondary outcomes were symptoms of CMDs measured with the Shona Symptom Questionnaire (SSQ ≥8) and depression measured with the Patient Health Questionnaire (PHQ-9 ≥10) and health utility score using the EQ-5D. The adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were estimated using logistic regression adjusting for clinic-level clustering. Case reviews and focus group discussions were used to determine feasibility of intervention delivery. At baseline, 35.1% of participants had virological nonsuppression and 70.3% had SSQ≥8. After 48 weeks, follow-up was 89.5% for viral load data and 90.9% for other outcomes. Virological nonsuppression decreased in both arms, but there was no evidence of an intervention effect (prevalence of nonsuppression 14.7% in the Zvandiri-PST arm versus 11.9% in the Zvandiri arm; AOR = 1.29; 95% CI 0.68, 2.48; p = 0.44). There was strong evidence of an apparent effect on common mental health outcomes (SSQ ≥8: 2.4% versus 10.3% [AOR = 0.19; 95% CI 0.08, 0.46; p < 0.001]; PHQ-9 ≥10: 2.9% versus 8.8% [AOR = 0.32; 95% CI 0.14, 0.78; p = 0.01]). Prevalence of EQ-5D index score <1 was 27.6% versus 38.9% (AOR = 0.56; 95% CI 0.31, 1.03; p = 0.06). Qualitative analyses found that CATS-observed participants had limited autonomy or ability to solve problems. In response, the CATS adapted the intervention to focus on empathic problem discussion to fit adolescents' age, capacity, and circumstances, which was beneficial. Limitations include that cost data were not available and that the mental health tools were validated in adult populations, not adolescents. PST training for CATS did not add to the benefit of peer support in reducing virological nonsuppression but led to improved symptoms of CMD and depression compared to standard Zvandiri care among adolescents living with HIV in Zimbabwe. Active involvement of caregivers and strengthened referral structures could increase feasibility and effectiveness. Pan African Clinical Trials Registry PACTR201810756862405.

Housing First (HF) is being widely disseminated in efforts to end homelessness among homeless adults with psychiatric disabilities. This study evaluates the effectiveness of HF with Intensive Case Management (ICM) among ethnically diverse homeless adults in an urban setting. 378 participants were randomized to HF with ICM or treatment-as-usual (TAU) in Toronto (Canada), and followed for 24 months. Measures of effectiveness included housing stability, physical (EQ5D-VAS) and mental (CSI, GAIN-SS) health, social functioning (MCAS), quality of life (QoLI20), and health service use. Two-thirds of the sample (63%) was from racialized groups and half (50%) were born outside Canada. Over the 24 months of follow-up, HF participants spent a significantly greater percentage of time in stable residences compared to TAU participants (75.1% 95% CI 70.5 to 79.7 vs. 39.3% 95% CI 34.3 to 44.2, respectively). Similarly, community functioning (MCAS) improved significantly from baseline in HF compared to TAU participants (change in mean difference = +1.67 95% CI 0.04 to 3.30). There was a significant reduction in the number of days spent experiencing alcohol problems among the HF compared to TAU participants at 24 months (ratio of rate ratios = 0.47 95% CI 0.22 to 0.99) relative to baseline, a reduction of 53%. Although the number of emergency department visits and days in hospital over 24 months did not differ significantly between HF and TAU participants, fewer HF participants compared to TAU participants had 1 or more hospitalizations during this period (70.4% vs. 81.1%, respectively; P=0.044). Compared to non-racialized HF participants, racialized HF participants saw an increase in the amount of money spent on alcohol (change in mean difference = $112.90 95% CI 5.84 to 219.96) and a reduction in physical community integration (ratio of rate ratios = 0.67 95% CI 0.47 to 0.96) from baseline to 24 months. Secondary analyses found a significant reduction in the number of days experiencing problems due to alcohol use among foreign-born (vs. Canadian-born) HF participants at 24 months (ratio of rate ratios = 0.19 95% 0.04 to 0.88), relative to baseline. Compared to usual care, HF with ICM can improve housing stability and community functioning and reduce the days of alcohol related problems in an ethnically diverse sample of homeless adults with mental illness within 2-years. Controlled-Trials.com ISRCTN42520374.

Improving mental healthcare using mobile apps might be an effective way to increase interest in mental health and respond to the demand for better psychological health. However, few studies have investigated the effectiveness of app-based stress-management programs. This study aimed to assess the efficacy of an app-based stress-management program. A non-equivalent comparison group pretest-posttest design was used. Participants were randomized into the experimental (n = 26) and control (n = 30) groups. The experimental group used an application developed for workers for four weeks. The results indicated that stress, emotional labor, self-efficacy, and well-being were significantly different in the experimental group, but the control group’s average scores did not change significantly. On average, the Perceived Stress Scale scores decreased by 1.5 points (p = 0.035) and the Korean Occupational Stress Scale scores decreased by 0.87 points (p = 0.4). However, depression and anxiety were not significantly different. Emotional labor decreased by 0.16 points (p = 0.027), and well-being and self-efficacy mean scores increased by 0.492 (p = 0.005) and 0.162 (p = 0.025), respectively. These findings support the developed application’s value for promoting mental health and healthy lifestyles. Further research and supplementation are needed for the application’s sustainability.

There is a close relationship between urban green space and the physical and mental health of individuals. Most previous studies have discussed the impact of the structure of green space and its elements. This study focused on the emotional changes caused by common behaviors in urban green space (walking and sitting). We recruited 40 college students and randomly assigned them to walking and sitting groups (20 students per group). The two groups performed the same 8-min high-pressure learning task indoors and then performed 8-min recovery activities in a simulated urban green space (a bamboo-lawn space). We used the Emotiv EPOC+ EEG headset to dynamically measure six neural emotional parameters: “engagement,” “valence,” “meditation,” “frustration,” “focus,” and “excitement.” We conducted a pretest and posttest and used analysis of covariance (ANCOVA) to analyze the posttest data (with the pretest data as covariates). The results of the comparison of the two behaviors showed that the “valence” and “meditation” values of the walking group were higher than those of the sitting group, which suggests that walking in urban green space is more favorable for stress reduction. The sitting group had a higher “focus” value than did the walking group, which suggests that sitting in urban green space is better for attention restoration. The results of this study can provide guidance for urban green space planning and design as well as health guidance for urban residents.