Background: The demanding requirements of nursing education impose great stress on students, which can adversely affect their health and well-being in terms of academic and clinical performance. Aims: This study aimed to determine the level of stress and the main causes of stress among medical and nursing students. Methods: This cross-sectional study was conducted with medical and nursing students in Pakistan via a convenience sampling method. Sources of stress-associated factors were assessed using online questionnaire. The data were collected between July 1 and August 31, 2024. A total of 302 medical and nursing students participated in the research. Descriptive statistics (frequency, mean) and inferential statistics were used to analyze the collected data. Results: According to the findings, medical and nursing students experience stress from multiple sources, with financial difficulties, academic workload, clinical practice, and environmental factors being the primary contributors. The most common stressors were insufficient income, pressure from clinical instructors and staff, and unfamiliarity with patient diagnoses and treatments. Multifactor logistic regression analysis revealed that stress from assignments and workload was significantly associated with fear of poor grades (p=0.046), while clinical practice quality also showed a significant effect (p=0.029). Additionally, dealing with patients with physio-psychosocial issues (p=0.039) and unfamiliarity with clinical conditions (p=0.012) were significant predictors of stress. These findings highlight the complex and multifaceted nature of student stress. Conclusion: This study revealed that medical and nursing students experience significant levels of stress related to finances, clinical practice, and academics, which affects their performance. Medical and Nursing Implications: Educational administrators must establish policies that assist medical and nursing students. Some of these policies could include evaluating the workload of Medical and nursing students, refining curriculum design, providing financial support, and providing scholarships to students facing challenging circumstances.

Mental health problems among adolescents with HIV (AWH) serve as a significant barrier to achieving optimal HIV health outcomes, but the mental health treatment gap for AWH remains large, particularly in the highest HIV-burden settings. We examined perceptions of mental health problems, influences on mental health, and barriers and facilitators to mental health care for AWH in Mozambique, a lower-resource, high HIV-burden context. We conducted focus groups with AWH (N = 7) and caregivers (N = 5) and key informant interviews with mental health and primary care providers (N = 9) and mental health and HIV policymakers (N = 5). Semi-structured guides were based on a tailored Socioecological Model. We analyzed data by the best fit framework approach. Participants highlighted depression and anxiety as priority mental health problems. Both positive and negative influences on AWH mental health were found at the community-, family-, and individual-levels. Barriers to care included the low policy-level priority of mental health, limited accessibility and resources of clinics, and low mental health awareness. Facilitators included the increased awareness of association between mental health and HIV-related outcomes, mental health care integrated with HIV services and in community settings, and providers with attentive and empathic disposition. Findings suggest that multilevel interventions focusing on both risk and resilience factors may be most effective at improving AWH mental health. Moreover, alternative intervention delivery methods should be considered, including community-based services and peer providers. Along with informing Mozambican policy and programming, these findings may be applicable in other high HIV-burden settings to promote AWH mental health and HIV outcomes.

Older adults (65+) make up 60% of cancer diagnoses and 70% of deaths related to cancer (Marosi & Köller, 2016). Although this age group experiences significant distress, behavioral studies investigating distress tend to be overrepresented by younger populations, leaving a gap in the knowledge about the distress needs of older adults (Chang et al., 2020). To bridge this gap, Dr. Katherine Ramos and Dr. Timothy Strauman of Duke University's Psychology Department conducted a pilot study that found two major themes related to distress in older adults: identity and resilience. The purpose of this study is to investigate the psychological impact of identity and resilience on the distress experienced by older adults with cancer. Using the two qualitative themes, identity and resilience, the researchers of this study conducted a narrative synthesis of contemporary literature surrounding identity, resilience, and their psychological impact on distress in older adults with cancer. Following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRIMSA) guidelines, the study found nine eligible articles. The study conducted a thematic analysis of the articles in this synthesis and found six themes: (1) reconstructing identity after diagnosis, (2) experiencing anxiety due to uncertainty of cancer outcomes, (3) needing to "push along" through a cancer diagnosis, (4) having access to social support increases resilience, (5) experiencing low resilience leads to demoralization, and (6) navigating cancer requires redefining oneself to confront cancer challenges. Future directions and clinical implications include adapting Self-System Therapy (SST) as a mental health intervention for older adults with cancer.

This paper examines the evolution and current challenges of the Brazilian Psychosocial Care Centers for Alcohol and other Drugs (CAPS-ADs), central to Brazil's mental health reform. Established within the broader Psychosocial Care Network (RAPS) in 2002, CAPS-AD represents a shift from hospital-centric to community-based care for mental health and substance dependency. Synthesizing 39 peer-reviewed articles, the study explores CAPS-AD's operational characteristics, effectiveness and limitations. The model is distinguished by its interdisciplinary approach, open-door policy, and focus on social reintegration, providing continuous access to specialized care. Key features include singular therapeutic plans, harm reduction strategies and integration with primary care. The CAPS-AD III modality, offering 24-hour care, highlights the model's adaptability. Despite its strengths, the CAPS-ADs face challenges such as user dissatisfaction with rigid therapeutic activities, limited autonomy and inadequate participation in care planning. Structural deficiencies, particularly in resource-limited regions and the persistence of traditional biomedical approaches further hinder quality care. Additional barriers include insufficient attention to gender-specific needs, age-appropriate care and the stigmatization of substance users and professionals. Addressing these challenges through structural reforms, enhanced training, and a more integrated, personalized, and stigma-free approach is essential to fully realize the potential of CAPS-AD and advance equitable mental health care in Brazil.

Evidence from South Africa shows a high burden of mental health conditions and a large treatment gap for uninsured people with common mental disorders. For young people seeking mental healthcare, the primary care and community settings are potentially more accessible and appropriate, but public sector mental health services in the country are mostly hospital-based. We undertook a scoping review of needs and preferences for primary care-based and community youth mental health services as well as evaluations of mental health interventions for youth in South Africa. A PubMed search using relevant search terms was conducted, and articles were evaluated based on a set of inclusion and exclusion criteria. Of the 405 publications from the search, 29 articles met criteria for inclusion. Two additional papers were included from searching reference lists. Youth emphasized stigma as a barrier to seeking mental healthcare and highlighted the importance of considering local context when developing mental health interventions. The evaluations of community-based and digital interventions identified in the review demonstrated feasibility and acceptability as well as efficacy. This review provides a foundation on which to base future implementation research and to advocate for youth mental health polices and services.

After the reform of mental health care system approved in 1978, the structure and organization of Italian mental health care has represented an innovative model of care, shifting from the asylum-based system to the community-based model, with the gradual closure of all mental hospitals. According to the 2023 Mental Health Report, issued every year by the Italian Ministry of Health, more than 700.000 Italian people is suffering from severe mental disorders. The burden on mental health services is highly demanding, with an estimate of more than 9 million of health services provided to patients. With the shift to community-based care, the responsibility for healthcare was moved to regional level. Therefore, a significant heterogeneity and variation in the provision of care has been observed, which is still one of main reasons for concern. In this review we aim to provide an overview on the quality of care in Italy, highlighting the main benefits of the mental healthcare system as well as limitations and pitfalls.

This study aimed to explore the perception of barriers to accessing mental health services within the general population of Paraguay using the Barriers to Access to Care Evaluation (BACE) scale. The barriers were categorized into three types: attitudinal, instrumental, and stigma-related. The sample comprised 321 participants, the majority of whom were women (82.9%). Among the participants, 62.9% reported experiencing mental ill-health, with the most common disorders being anxiety (37.4%), depression (30.5%), and sleep disorders (20.6%). Of the participants, 157 (48.9%) reported significant attitudinal barriers, which include beliefs and perceptions about mental health treatment, among others; 87 (27.1%) reported significant stigma-related barriers, which involve prejudices and stereotypes associated with mental disorders; and 189 (58.9%) experienced significant instrumental barriers, including financial constraints and limited availability of services. Mental ill-health was significantly associated with all types of barriers. In conclusion, significant barriers to accessing mental health services persist among the Paraguayan population. These barriers must be addressed through evidence-based public policies to improve the quality-of-life of both individuals with mental ill-health and the broader general population.

This article discusses the critical issues of mental health in Pakistan, highlighting the significant burden of mental disorders in the country, and limitations of mental health services which are under-addressed. In particular, the authors discuss the under-reporting of the epidemiological rates of mental disorders and the scarcity of mental health professionals and facilities, with only about 500 psychiatrists serving a population of over 244 million. Cultural stigma, economic challenges, and insufficient government funding exacerbate this critical scenario, all limiting access of population to mental health services. Despite some government initiatives and the involvement of Non-governmental Organizations, the mental health infrastructure remains inadequate to meet the demand for care. The authors recommend increasing governmental funding, expanding the mental health literacy in the general population, training healthcare providers, and integrating traditional healers into the formal mental health system to reduce stigma and improve access to care.

Suicide is a public health concern and represents one of the increasing causes of mortality worldwide. In Pakistan, the severity of suicide is worsened by the lack of a national prevention program and adequate mental health facilities. This study, through 16 in-depth interviews with clinicians, aimed to identify prevention strategies. Two main categories emerged: community-level strategies (eg raising awareness, psychoeducation, restricting access to lethal means) and clinician-level strategies (eg training programs, safety plans, fundraising, tele-counseling). Effective prevention requires comprehensive policies to overcome existing barriers.

Acute psychiatric services are crucial for immigrants who face barriers in accessing outpatient mental healthcare due to socio-economic, cultural, and linguistic challenges. This study compared psychiatric hospitalization characteristics between immigrants and native Italians at the University of Foggia from 2004 to 2019. A total of 536 inpatients, equally divided between immigrants and natives, were analysed for sociodemographic and clinical variables. Findings revealed that immigrants were hospitalized through emergency departments for severe psychiatric disorders such as psychosis, while natives were more often admitted for mood disorders. Immigrants showed a higher incidence of substance abuse and suicidal attempts and a lower number of prior hospitalizations compared to natives, with higher incidence of first episodes of mental illness. Despite presenting with severe psychopathology, natives exhibited better clinical outcomes, longer hospitalizations and higher functioning improvements. We also found that natives received more psychotropic medications but experienced fewer adverse effects compared to immigrants. Differences in pharmacological treatments and hospital outcomes suggested that culturally tailored interventions could improve the effectiveness of psychiatric care for migrants. These findings emphasized the necessity for systemic changes in mental health services to address disparities and improve care for migrant populations.