Background: The lack of public knowledge and the burden caused by mental-health issues’ effect on developing and implementing adequate mental-health care for young and adolescent in low- and middle-income countries (LMIC). Primary health care could be the key in facing the challenge, but it suffers from insufficient resources and poor mental health literacy. This study’s aim was to adapt the content validity of the Mental Health Literacy Scale (MHLS) developed by O’Connor & Casey (2015) with researchers and primary health-care workers in low- and middle-income contexts in South Africa (SA) and in Zambia.Objectives: The study population comprised two expert panels (N = 21); Clinical Experts (CE) (n = 10) from Lusaka, Zambia and Professional Research Experts (PE) (n = 11) from the MEGA project management team were recruited to the study.Methods: MHLS was validated in a South African and a Zambian context using a heterogeneous expert-panel method. Participants were asked to rate the 35 MHLS items on a 4-point scale with 1 as not relevant and 4 as very relevant After the rating, all 35 MHLS items were carefully discussed by the expert panel and evaluated according their relevance. The data were analyzed using an item-level content validity index (I-CVI) and narrative and thematic analyses.Results: All 35 items ranked by the PREs met the cutoff criteria (≥0.8), and ten (n = 10) items were seen as relevant by CE when calculating I-CVIs. Based on the results of ratings and discussion, a group of sixteen (n = 16) of all items (n = 35) were retained as original without reviewing. A total of nineteen (n = 19) items were reviewed.Conclusion: This study found the MHLS to have sufficient validity in LMICs’ context but also recognized a gap between professional researchers’ and clinical workers’ knowledge and attitudes related to mental health.

The South African Society of Psychiatrists (SASOP) Treatment Guidelines for Psychiatric Disorders have been developed in order to address the local need for guidelines in our unique clinical setting.

Background/Objective The most recent versions of the two main mental disorders classifications—the World Health Organization's ICD-11 and the American Psychiatric Association's DSM–5—differ substantially in their diagnostic categories related to transgender identity. ICD-11 gender incongruence (GI), in contrast to DSM-5 gender dysphoria (GD), is explicitly not a mental disorder; neither distress nor dysfunction is a required feature. The objective was compared ICD-11 and DSM-5 diagnostic requirements in terms of their sensitivity, specificity, discriminability and ability to predict the use of gender-affirming medical procedures. Method A total of 649 of transgender adults in six countries completed a retrospective structured interview. Results Using ROC analysis, sensitivity of the diagnostic requirements was equivalent for both systems, but ICD-11 showed greater specificity than DSM-5. Regression analyses indicated that history of hormones and/or surgery was predicted by variables that are an intrinsic aspect of GI/GD more than by distress and dysfunction. IRT analyses showed that the ICD-11 diagnostic formulation was more parsimonious and contained more information about caseness than the DSM-5 model. Conclusions This study supports the ICD-11 position that GI/GD is not a mental disorder; additional diagnostic requirements of distress and/or dysfunction in DSM-5 reduce the predictive power of the diagnostic model.

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A significant proportion of the TGNC community present with mental health concerns. Clinicians should screen appropriately for these concerns. Gender affirming interventions generally have an efficacious effect.

The treatment guideline draws on several international guidelines: (<div style="left: 477.479px; top: 324.52px; font-size: 15.45px; font-family: serif;">i</div><div style="left: 481.424px; top: 324.72px; font-size: 15.45px; font-family: serif; transform: scaleX(0.955);" data-canvas-width="8.595">)</div><div style="left: 70.8662px; top: 344.72px; font-size: 15.45px; font-family: serif; transform: scaleX(1.00294);" data-canvas-width="422.63399999999984">Practice Guidelines of the American Psychiatric Association (APA)</div><div style="left: 70.8662px; top: 364.72px; font-size: 15.45px; font-family: serif; transform: scaleX(0.962449);" data-canvas-width="420.28950000000003">for the Treatment of Patients with Major Depressive Disorder, Second</div><div style="left: 70.8662px; top: 384.72px; font-size: 15.45px; font-family: serif; transform: scaleX(0.945309);" data-canvas-width="47.068499999999986">Edition;</div><div style="left: 117.785px; top: 385.947px; font-size: 9.00733px; font-family: serif; transform: scaleX(0.974443);" data-canvas-width="10.231649999999998">[1]</div><div style="left: 128.017px; top: 384.72px; font-size: 15.45px; font-family: serif; transform: scaleX(1.42167);" data-canvas-width="12.794999999999998">(</div><div style="left: 140.663px; top: 384.52px; font-size: 15.45px; font-family: serif; transform: scaleX(0.913981);" data-canvas-width="7.844999999999999">ii</div><div style="left: 148.358px; top: 384.72px; font-size: 15.45px; font-family: serif; transform: scaleX(1.03879);" data-canvas-width="346.0034999999999">) Clinical Guidelines for the Treatment of Depressive</div><div style="left: 70.8662px; top: 404.72px; font-size: 15.45px; font-family: serif; transform: scaleX(0.982156);" data-canvas-width="420.8129999999999">Disorders by the Canadian Psychiatric Association and the Canadian</div><div style="left: 70.8662px; top: 424.72px; font-size: 15.45px; font-family: serif; transform: scaleX(1.06015);" data-canvas-width="374.1000000000001">Network for Mood and Anxiety Treatments (CANMAT);</div><div style="left: 445.018px; top: 425.947px; font-size: 9.00733px; font-family: serif; transform: scaleX(0.996097);" data-canvas-width="10.45902">[2]</div><div style="left: 455.592px; top: 424.72px; font-size: 15.45px; font-family: serif; transform: scaleX(1.52833);" data-canvas-width="13.754999999999999">(</div><div style="left: 469.386px; top: 424.52px; font-size: 15.45px; font-family: serif; transform: scaleX(0.930874);" data-canvas-width="11.985">iii</div><div style="left: 481.424px; top: 424.72px; font-size: 15.45px; font-family: serif; transform: scaleX(0.955);" data-canvas-width="8.595">)</div><div style="left: 70.8662px; top: 444.72px; font-size: 15.45px; font-family: serif; transform: scaleX(0.92219);" data-canvas-width="346.4745">National Institute for Clinical Excellence (NICE) guidelines;</div><div style="left: 417.194px; top: 445.947px; font-size: 9.00733px; font-family: serif; transform: scaleX(0.974443);" data-canvas-width="10.231649999999998">[3]</div><div style="left: 427.426px; top: 444.72px; font-size: 15.45px; font-family: serif; transform: scaleX(0.8725);" data-canvas-width="7.852499999999999">(</div><div style="left: 435.128px; top: 444.52px; font-size: 15.45px; font-family: serif; transform: scaleX(0.867244);" data-canvas-width="10.425">iv</div><div style="left: 445.402px; top: 444.72px; font-size: 15.45px; font-family: serif; transform: scaleX(0.885045);" data-canvas-width="44.031">) Royal</div><div style="left: 70.8662px; top: 464.72px; font-size: 15.45px; font-family: serif; transform: scaleX(0.960345);" data-canvas-width="420.4709999999999">Australian and New Zealand College of Psychiatrists Clinical Practice</div><div style="left: 70.8662px; top: 484.72px; font-size: 15.45px; font-family: serif; transform: scaleX(0.952181);" data-canvas-width="276.6284999999999">Guidelines Team for Depression (RANZCAP);</div><div style="left: 347.341px; top: 485.947px; font-size: 9.00733px; font-family: serif; transform: scaleX(0.974443);" data-canvas-width="10.231649999999998">[4]</div><div style="left: 357.572px; 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