A working alliance (WA) is a multidimensional construct signifying a collaborative relationship between a client and a therapist. Systematic reviews of therapies to treat depression and anxiety, almost exclusively in adults, show WA is essential across psychotherapies. However, there are critical gaps in our understanding of the importance of WA in low-intensity therapies for young people with depression and anxiety. Here, we describe an initiative to explore the effect of WA on anxiety and depression outcomes in youth aged 14–24 years through a scoping review and stakeholders’ consultations (N = 32). We analysed 27 studies; most were done in high-income countries and evaluated one-on-one in-person therapies (18/27). The review shows that optimal WA is associated with improvements in: relationships, self-esteem, positive coping strategies, optimism, treatment adherence, and emotional regulation. Young people with lived experience expressed that: a favourable therapy environment, regular meetings, collaborative goal setting and confidentiality were vital in forming and maintaining a functional WA. For a clinician, setting boundaries, maintaining confidentiality, excellent communication skills, being non-judgmental, and empathy were considered essential for facilitating a functional WA. Overall, a functional WA was recognised as an active ingredient in psychotherapies targeting anxiety and depression in young people aged 14–24. Although more research is needed to understand WA’s influence in managing anxiety and depression in young people, we recommend routine evaluation of WA. Furthermore, there is an urgent need to identify strategies that promote WA in psychotherapies to optimise the treatment of anxiety and depression in young people.

Objective: Smartphones are an invaluable daily tool, with over a third of the world having mobile access to the internet. There has been a concurrent upsurge in smartphone use among university students, and despite these benefits, excessive use of smartphones is highly prevalent. Smartphone addiction/problematic mobile phone use is a behavioural addiction that leads to severe impairment and distress. The ongoing COVID-19 pandemic has led to an exponential increase in smartphone usage, further exacerbating the burden of smartphone addiction. This study aims to determine the prevalence of smartphone addiction and its associated risk factors among Zimbabwean university students. Data were collected from 380 undergraduate students and analyzed through descriptive statistics, bivariate statistics, and binary logistic regression.Results: The prevalence of smartphone addiction in our study population was 54.2%. After controlling for potential covariates, social media usage (OR 2.7: CI 1.2 – 5.9), using a smartphone for entertainment (OR 2.2: CI 1.2 – 4.0), the experience of coronavirus-induced anxiety (OR 1.1: CI 1.0 – 3.2) and an experience of an adverse event (OR 1.8) were associated with increased smartphone addiction. The use of smartphones for academic work was protective against smartphone addiction (OR .38: CI .19 - .77).

Objective: HIV remains a global burden, with the Sub-Saharan Africa (SSA) region reporting the largest number of people living with HIV/AIDS (PLHIV). An exponential improvement in the accessibility and uptake of antiretroviral treatment across SSA has significantly improved outcomes for PLHIV. Hence, HIV care goals have shifted from reducing mortality and morbidity to improving health-related quality of life (HRQoL). This study uses generic and condition-specific HRQoL outcomes to holistically determine the HRQoL of Zimbabwean adult PLHIV and associated factors. HRQoL is a dynamic subject construct that warrants continuous evaluation to provide meaningful feedback to various stakeholders. We enrolled 536 adults PLHIV in Zimbabwe. Collected data were analyzed through descriptive statistics and multivariate binary logistic regression. Results: Our study shows a high HRQoL perception by Zimbabwean PLHIV. Anxiety, depression, and poor environmental health were widely reported domains influencing HRQoL. Also, being aware of HIV status for over a year, not experiencing an adverse event, being married, having adequate finances and food security and having higher educational status were associated with higher HRQoL. It is essential to integrate mental health care into routine HIV care to improve treatment outcomes and HRQoL. Last, implementing bespoke multisectoral HRQoL-enhancement interventions is paramount.

Objective: Despite the well-documented benefits of regular physical activity (PA), many university students are physically inactive. Multiple factors, including perceived barriers and benefits and environmental factors (e.g., availability of exercise facilities), predict PA engagement behaviours in university students. This study primarily evaluated the barriers and facilitators to PA engagement in Zimbabwean undergraduate students using the Exercise Benefits and Barriers Scale. We also evaluated the correlates of exercise barriers and benefits to PA levels, mental health disorders and health-related quality of life (HRQoL). We recruited 465 university students. Data were analysed through descriptive statistics and logistic regression using SPSS Version 27. Results: The mean perceived benefits and barriers to PA were 95±11.4 and 28.6±5.4, respectively. The most perceived benefits were in the physical performance and life enhancement domains, while lack of exercise infrastructure and physical exertion were the most perceived barriers. Food insecurity and the risk of CMDS were associated with increased odds of experiencing barriers to exercise. Not using substances and a higher self-rated HRQoL were associated with increased odds of a high perception of exercise benefits. It is needful to improve access to on-campus exercise facilities and campus-wide health promotional interventions to enhance PA amongst university students.

Background: A working alliance (WA) is a multidimensional construct signifying a collaborative relationship between a client and therapist. Systematic reviews of therapies to treat depression and anxiety, almost exclusively in adults, demonstrate that WA is essential across psychotherapies. A functional WA predicts greater uptake of interventions, client engagement, adherence to treatment, and symptoms reduction. Conversely, ruptured and/or low WA reduces the effectiveness of known-efficacious treatments. However, there are critical gaps in our understanding of the importance of WA in low-intensity therapies for young people with depression and anxiety. We sought to understand the following research questions in young persons aged 14-24 years: 1) the role of working alliance in the ongoing management of anxiety and depression? 2) how do the different working alliance elements influence treatment outcomes?3) the client/therapist characteristics deemed essential in forming and maintaining a working alliance? Methods: We conducted a scoping review to summarise and synthesise the findings collaboratively with young people with lived experiences of anxiety/depression. Then, we conducted key stakeholders' consultations with clinicians [lay health counsellors (n=6), clinical psychologists (n=2), occupational therapists (n=2), and psychiatrists (n=2)], and young people with lived experiences (n=20). Finally, we convened workshops to triangulate/synthesise findings from the scoping review and stakeholder consultations to develop the mechanistic framework, hypothesising pathways by which WA may influence treatment outcomes. Results: We analysed 27 studies; most were done in high-income countries. Cognitive behavioural therapy was the most common treatment modality (16/27). Most therapy sessions were conducted one-to-one (18/27), with only two (2/27) studies utilising digital therapy platforms. A functional working alliance was recognised as an active ingredient in psychotherapies targeting anxiety and depression in young persons aged 14-24 years. Previous research has theorised that improvements in the working alliance are associated with improvements in relationships, self-esteem, positive coping strategies, optimism, adherence to treatments, and emotional regulation. During the stakeholders’ consultations, young people with lived experience expressed that; a favourable therapy environment, regular meetings, collaborative goal setting and confidentiality were vital in forming and maintaining a functional WA. For a clinician, ssetting boundaries, maintaining confidentiality, excellent communication skills, and being non-judgmental and empathic were considered important for facilitating a functional WA.Conclusions: Although more research is needed to understand WA's influence in managing anxiety and depression in young people, we recommend routine evaluation of WA. Furthermore, there is an urgent need to identify strategies that promote WA in psychotherapies to optimise the treatment of anxiety and depression in young people.