Global Research in primary Care & Mental Health

Publication 1 

Front Med (Lausanne) . 2025 Nov 27:12:1679133.  

doi: 10.3389/fmed.2025.1679133. eCollection 2025.  

Global educational initiative for managing major depressive disorders in primary care: the MDD minds project  

Christopher Dowrick^#  1 , Mary Ales^#  2 , Abdullah AlKhathami^#  3 , Dewanto Andoko^#  4 , Adekunle Joseph Ariba^#  5 , Ryuki Kassai^#  6 , Cindy Lam^#  7 , Christos Lionis^{#  8   9} , Joy Mugambi^#  10 , Sankha Randenikumara^#  11 , Shelly Rodrigues^#  2 , André Tavares^#  12 , Ana Bertha Perez Villalva^#  13  

Affiliations  

Affiliations  

• ¹ Department of Mental Health and Primary Care, University of Liverpool, Liverpool, United Kingdom. 

• ² Mosaica Solutions LLC, Madison, WI/Kansas City, MO, United States. 

• ³ Postgraduate Medical Education, Dammam, Saudi Arabia. 

• ⁴ Faculty of Medicine, Pelita Harapan University, Tangerang, Indonesia. 

• ⁵ Department of Family Medicine, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. 

• ⁶ Department of Community and Family Medicine, Fukushima Medical University, Fukushima, Japan. 

• ⁷ Department of Family Medicine and Primary Care, School of Clinical Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China. 

• ⁸ Laboratory of Health and Society, School of Medicine, University of Crete, Crete, Greece. 

• ⁹ Department of Psychology, University of Limassol, Limassol, Cyprus. 

• ¹⁰ Kenya Association of Family Physicians, Nairobi, Kenya. 

• ¹¹ College of General Practitioners of Sri Lanka, Colombo, Sri Lanka. 

• ¹² Faculty of Medicine, University of Porto, Porto, Portugal. 

• ¹³ Institute of Social Security and Services for State Workers (ISSSTE), Family Medicine Clinic, Mexico City, Mexico. 

• PMID: 41393145  

• PMCID: PMC12696672  

• DOI: 10.3389/fmed.2025.1679133  

Abstract  

Depressive disorders are common and disabling, and a substantial treatment gap exists particularly in low-resource settings. Family doctors are well-placed to bridge this gap but often lack the confidence, knowledge and skill to do so. The World Organization of Family Doctors (WONCA) and its collaborators designed the MDD Minds project to improve care for major depressive disorders delivered by family doctors in Africa/Middle East (Kenya, Nigeria, and Saudi Arabia), Asia (Indonesia, Japan, and Sri Lanka) and Latin America (Brazil, Mexico, and Peru). The MDD Minds organizational structure included a steering committee, a design and measurement team and a group of master faculty composed of primary mental health care experts from participating countries. Project delivery was in three phases: MDD Minds 101, an online programme with seven modules; Train-the-Trainer, a group-based approach combining online and real-time elements and leading to delivery of in-country educational activities; and Performance- in-Practice, focused on enhanced depression screening for patients with diabetes. Recruitment was conducted by WONCA in collaboration with national primary care organizations. Project delivery began in October 2023 and was completed in December 2024. Enrollment and completion rates were tracked: 2,892 family doctors enrolled in MDD Minds 101; 581 (20%) completed the course. In Train-the-Trainer 210 scholars enrolled; 126 (60%) completed the program, delivering 143 educational sessions to 1,697 other healthcare professionals in their respective regions. Nine primary care teams in Brazil, Kenya, Japan and Nigeria participated in the Performance-in-Practice program; among 1,592 diabetes patients screened, 26.6% were diagnosed with depression and promptly managed. Strategic alignment between partnering organizations, in combination with world-wide expertise in mental health, ensured effective participation. Language and cultural adaptation were important to serving the diverse range of learners, as was ease of access to online platforms and enhanced use of social media. Our online course completion rate exceeded our expectations. The MDD Minds project demonstrates WONCA’s ability to deliver high-quality educational programming at scale, as well as the benefits of localized frameworks that support family doctors, primary care teams, and patients in improving the care of those with major depressive disorder. It offers a replicable and sustainable approach to enhancing mental healthcare in diverse primary care settings.  

Publication 2 

Eur Heart J . 2025 Nov 3;46(41):4156-4225.  

doi: 10.1093/eurheartj/ehaf191.  

2025 ESC Clinical Consensus Statement on mental health and cardiovascular disease: developed under the auspices of the ESC Clinical Practice Guidelines Committee  

Héctor Bueno¹ , Christi Deaton² , Marta Farrero¹ , Faye Forsyth² , Frieder Braunschweig³ , Sergio Buccheri³ , Simona Dragan⁴ , Sofie Gevaert⁵ , Claes Held³ , Donata Kurpas⁶ , Karl-Heinz Ladwig⁷ , Christos D Lionis⁸ , Angela H E M Maas⁹ , Caius Ovidiu Merșa⁴ , Richard Mindham² , Susanne S Pedersen¹⁰ , Martina Rojnic Kuzman¹¹ , Sebastian Szmit⁶ , Rod S Taylor² , Izabella Uchmanowicz⁶ , Noa Vilchinsky¹² ; ESC Scientific Document Group  

Collaborators, Affiliations  

Note:  

Publication 3 

Editorial Adv Clin Exp Med. 2025 Oct;34(10):1607-1610.  

doi: 10.17219/acem/208659.  

Family medicine: Discovering new fields for research and clinical care in the current world  

Christos Lionis^1   2  

Affiliations  

• ¹ Laboratory of Health and Society, School of Medicine, University of Crete, Greece. 

• ² Department of Psychology, University of Limassol, Cyprus. 

• PMID: 40788000  

• DOI: 10.17219/acem/208659  

Free article  

Abstract  

Strengthening primary healthcare (PHC) research is vital to address the demands of a rapidly changing health landscape. Leadership, infrastructure, and sufficient funding have been discussed as key factors in expanding PHC research capacity. This editorial aims to highlight emerging research priorities in a world increasingly affected by crises such as war, conflict, and climate change. Research on suffering, meaning, hope, and compassion represents a promising and necessary new frontier in PHC. This field urgently needs the attention of academic institutions and funding bodies committed to strengthening primary care and family medicine.  

Publication 4 

Front Med (Lausanne) . 2025 Sep 22:12:1696813.  

doi: 10.3389/fmed.2025.1696813. eCollection 2025.  

Editorial: The impact of primary care on cancer screening program performance: strategies to increase uptake and effectiveness  

Cecilia Acuti Martellucci¹ , Enrique Quintero² , Christos Lionis^3   4  

Affiliations  

  Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.  

  ² Department of Gastroenterology, Hospital Universitario de Canarias, Instituto Universitario de Tecnologías Biomédicas, Universidad de La Laguna, Tenerife, Spain.  

  ³ Laboratory of Social and Family Medicine, School of Medicine, Clinic of Social and Family Medicine, University of Crete, Heraklion, Greece.  

  ⁴ Department of Psychology, School of Social Sciences and Humanities, University of Limassol, Limassol, Cyprus. 

• PMID: 41058633  

• PMCID: PMC12497694  

• DOI: 10.3389/fmed.2025.1696813  

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Publication 5  

The role of health-care professionals and stakeholders. The Lancet. 

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00212-6/fulltext?dgcid=raven_jbs_etoc_email

Christos Lionis, lionis@uoc.gr 

Lab of Health and Society, School of Medicine, University of Crete, Heraklion 71003, Greece; Department of Psychology, School of Social Sciences and Humanities, University of Limassol, Nicosia, Cyprus 

Publication 6 

BMC Prim Care. 2026 Feb 16. doi: 10.1186/s12875-026-03213-9. Epub ahead of print. PMID: 41699492. 

Implementing systematic depression screening in primary care: lessons from the MDD Minds global quality improvement pilot 

Ales M, Dowrick C, Ariba A, Mugambi J, Tavares ALB, Kassai R, Lionis C, Rodrigues S. .  

Affiliations  

• ¹ Mosaica Solutions, LLC, 2 S Eau Claire Ave, Madison WI/Kansas City, MO, 53705, USA. mary.ales@mosaicasolutions.com. 

• ² Department of Mental Health and Primary Care, University of Liverpool, Liverpool, United Kingdom. 

• ³ Department of Family Medicine, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. 

• ⁴ Kenya Association of Family Physicians, Nairobi, Kenya. 

• ⁵ Faculty of Medicine, University of Porto, Porto, Portugal. 

• ⁶ Department of Community and Family Medicine, Fukushima Medical University, Fukushima, Japan. 

• ⁷ Laboratory of Health and Society, School of Medicine, University of Crete, Crete, Greece. 

• ⁸ Department of Psychology, University of Limassol, Limassol, Cyprus. 

• ⁹ Mosaica Solutions, LLC, 2 S Eau Claire Ave, Madison WI/Kansas City, MO, 53705, USA. 

Abstract  

Background: Depression remains underdiagnosed in primary care, particularly in low- and middle-income countries (LMICs). Despite advocacy for mental health integration into primary care, evidence on practical implementation strategies in diverse international settings is limited. This study evaluated the feasibility of implementing practice-driven systematic depression screening among adult patients with diabetes mellitus (DM) across primary care practices in four countries. Methods: The Major Depressive Disorder Management in Primary Care (MDD Minds) initiative implemented a 12-week quality improvement pilot across nine primary care practices in Brazil, Japan, Kenya, and Nigeria. Practices received local coaching, educational resources, and adaptable workflow tools to screen adult patients with DM for depression during routine care visits. Data on screening rates, depression identification, and resource provision were collected using standardized forms. Results: Among 1,592 adult patients with diabetes seen during the 12-week implementation period, 582 (36.6%) were newly screened for depression. Practices without baseline depression documentation identified depression in 54.9% of screened patients, compared to 12.2% in practices with existing documentation, demonstrating substantial under-detection in settings without systematic screening. Of those screened, 105 (18.0%) had positive screens indicating depressive symptoms. An additional 211 patients (13.3%) had prior documented depression diagnoses. In total, 326 patients (19.6%) were diagnosed with depressive symptoms. Conclusions: This multi-country implementation study demonstrates that systematic depression screening integrated into routine diabetes care is feasible across diverse primary care settings when supported by adaptable workflows and structured coaching. Findings highlight the importance of local ownership and context-specific implementation strategies for integrating mental health screening into chronic disease management in global primary care.