SMILE

People with certain immutable biological characteristics that different from prevailing expectations have been documented in every region of the world, but knowledge is lacking about their mental health (MH). Little is known about the effect of changes in policies and environs on the mental health (MH) of those who experience abuse and harm. Even less is known about the development of appropriate MH treatment interventions for these persons. Evidence-based treatments (EBTs) addressing poor MH are being implemented in resource environs around the world, including low resource areas of the United States, using appropriate, affordable and sustainable delivery modalities (e.g. lay providers, mHealth). These advances create opportunities to provide MH care not previously possible. To develop and implement EBTs, longitudinal research is necessary to inform us of the unique MH needs, determinants and treatment preferences of these populations. Pilot data for this study suggest that: people with these immutable biological characteristics can be identified and recruited in low-resource settings; prevalence of depression, anxiety, suicidal ideation, and posttraumatic stress disorder among these people is extremely high; and there are variations in MH symptomatology and determinants by groups and countries. There is an urgent need for longitudinal cohort studies with people with immutable biological characteristics from heterogeneous cultures to understand the influence of culture and context on MH needs, predictors and EBT preferences, and to develop locally sustainable EBTs and methods for generalizability. The SMILE study represents paradigm-shifting research by defining abused and harmed persons based on immutable biological characteristics rather than any particular behavior. The SMILE study aims are: • Aim 1: Estimate prevalence of anxiety, depression, PTSD, suicidal ideation and substance abuse symptomatology among participants in 3 culturally diverse places. • Aim 2: Identify cultural, contextual, interpersonal and individual determinants of MH over time, by and across biological characteristic and country. • Aim 3: Determine MH intervention preferences. To accomplish these aims we will use media and outreach campaigns to develop a cohort of at least 3,000 study participants who will complete online surveys to assess MH symptomology, determinants, and treatment preferences.