Background

In Iraq, an estimated 20% of the population lives with a mental disorder, yet approximately 90% do not receive treatment. To address this treatment gap, primary healthcare workers (PHCWs) are essential; however, their involvement is hindered by stigma and a lack of training.

Objective

This study aims to assess the effect of brief mental health training on the behavioral intentions of PHCWs.

Methods

We conducted a randomized controlled trial in a conflict-affected region between November 2024 and August 2025. A total of 174 PHCWs were randomly assigned to either receive four days of intensive mental health training (n = 87) or continue their usual clinical work without additional training (n = 87). We measured participants’ behavioral intentions (willingness to engage with people experiencing mental health problems) using the validated Reported and Intended Behaviour Scale at baseline and three months after the intervention.

Results

By the end of the study, 162 participants remained (n = 81 per group; 6.9% dropped out). Those who received training reported significantly stronger intentions to support people with mental health conditions (median = 16) compared to the control group (median = 15; p = 0.007; moderate effect size [r = 0.30]). Within-group analysis revealed large improvements in the intervention group (p < 0.001, r = 0.52) but no significant change in controls (p = 0.218). The proportion achieving high intended behavior increased from 30.9% to 56.8% in the intervention group versus 33.3% to 46.9% in controls.

Conclusion

This randomized controlled trial provides preliminary evidence that brief mental health training significantly improves behavioral intentions among PHCWs in post-conflict settings. Because behavioral intentions explain approximately 30–50% of behavioral variance, these findings support the need for larger trials evaluating actual clinical practice changes and patient outcomes.