The Central African Republic (CAR) is a country with a long history of violent conflict, extreme poverty, and little to no mental health infrastructure for a population with profound exposure to ongoing trauma. In 2015, 70% of the population was displaced internally or to surrounding countries, and 80% had witnessed violence. An empirical study of mental health in CAR found that 50% to 80% of the population reported clinically significant anxiety or depression. Such epidemiological data suggest extremely high levels of distress, yet more culturally relevant information is needed to better understand contextual responses to trauma, and associated mental health needs. To address this empirical gap, the present study engaged in a collaborative partnership with humanitarian organizations and local religious groups in CAR to conduct a series of focus groups with community members. Qualitative exploratory research methodology was used, as it can inform the development and delivery of intervention, and shape policy initiatives to increase mental health endeavors that promote healing from trauma. Focus group discussions were recorded, transcribed, and then coded, resulting in 3 primary themes: safety/disarmament and reestablishing education; traumatic experiences of physiological arousal and generalized distress; and subsequent idioms of distress and lack of mental health treatment or availability of services. These themes illustrate the importance of further developing and maintaining systems that provide safety, education, and mental and physical health care services to the general population in CAR. Ongoing conflict jeopardizes the formation of new systems, and investment in established systems that need improvements and resources. Without government and political support, these endeavors will continue to languish until peace and stability is widespread throughout the country.

that this vulnerable population be encouraged, not deterred, from accessing mental health services. As highlighted by the three deaths by suicide within days of its announcement, the expansion of the public charge policy will inevitably have a considerable negative effect on the physical and mental safety of the most vulnerable individuals in our country.We declare no competing interests.

Suicide in the Arab World is grossly understudied. This study sought to understand suicidality among Arabic-speaking individuals visiting an online depression screener. A large sample (N = 23,201) from the Arab World was recruited online. 78.9% (n = 17,042) reported suicidality (thoughts of death or suicide, or a suicide attempt) and 12.4% reported a suicide attempt in the past 2 weeks. Binary logistic regressions indicated that women tended to report more suicidality, and that suicidality tended to decline with age (all ps < 0.001), across all levels of suicidality. Comparing countries with n ≥ 1000 (Algeria, Egypt, Jordan, Morocco, and Saudi Arabia), several 3-way (gender * age * country) and 2-way interactions indicated that some countries departed from the usual pattern of responses. For instance, in Algeria, neither gender nor age differences were observed in reported attempts. Women and younger adults in the Arab World may be at higher risk of suicidality. Differences between and within countries warrant further exploration.

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