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Mental Health and Health Care in Vulnerable Contexts

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A special issue of Healthcare (ISSN 2227-9032).

Deadline for manuscript submissions: 31 January 2027 | Viewed by 17689

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Special Issue Editors

Dr. Juan Manuel Moreno-Manso

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Guest Editor

Department of Psychology, University of Extremadura, 06006 Badajoz, Spain
Interests: child abuse; intimate partner violence; family violence; mental health; psychopathology
Special Issues, Collections and Topics in MDPI journals

Dr. Carlos Barbosa-Torres

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Guest Editor

Department of Psychology, University of Extremadura, 06006 Badajoz, Spain
Interests: neuroscience; mental health

Special Issue Information

Dear Colleagues,

With the rise in mental health problems in recent years, this topic has been attracting scientific, social, and clinical interest. This situation has brought mental health into the public eye. However, despite progress, the statistics on these problems remain concerning. Mental health research is crucial to understanding and improving care for individuals with or without mental disorders, as it plays a fundamental role in overall well-being.

This Special Issue aims to address the integration of mental health into services not directly related to mental health in particularly vulnerable populations, such as in children; the elderly; people with disabilities, physical or psychiatric illnesses, and psychological problems; people in situations of social exclusion; and/or anyone in a state of special vulnerability. Therefore, this Special Issue explores how systems not directly related to healthcare can better integrate mental health services. A good example of this are social institutions and NGOs (child protection centers or foster homes, third sector entities, and institutions dedicated to combating violence against minors and intimate partner violence) and educational institutions (schools, sports, and leisure centers), where policies to improve mental health are implemented, despite not being health institutions, to ensure that people have a better quality of life.

Early detection of these problems and the implementation of preventive and intervention measures are key elements to protect people with mental health problems and prevent them from becoming chronic.

For this Special Issue, we invite you to submit articles on original research with primary and/or secondary data, with high-quality systematic reviews also being welcome.

We look forward to receiving your contributions.

Dr. Juan Manuel Moreno-Manso
Dr. Carlos Barbosa-Torres
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

mental health
research
health systems
healthcare
institutional care
family care
therapy

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Published Papers (7 papers)

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Research

14 pages, 1767 KB

Open AccessArticle

Graphic Novel for Patients Affected by Pancreatic Lesions Undergoing Endoscopic Ultrasound with Fine Needle Biopsy: A Pilot Randomized Study

by Giacomo Emanuele Maria Rizzo, Giuseppe Infantino, Fabio Tuzzolino, Mario Traina, Giovanni Di Piazza, Daniele La Milia, Gabriele Rancatore, Lucio Carrozza, Dario Quintini, Dario Ligresti, Margherita Pizzicannella, Nicoletta Belluardo, Elio D’amore, Giuseppe Rizzo, Cinzia Di Benedetto, Ugo Palazzo and Ilaria Tarantino

Healthcare 2026, 14(6), 699; https://doi.org/10.3390/healthcare14060699 - 10 Mar 2026

Viewed by 493

Abstract

Background/Objectives: Endoscopic Ultrasound with Fine Needle Biopsy (EUS-FNB) of pancreatic lesions often induces patient anxiety. Graphic medicine, an emerging health communication tool, could potentially mitigate this. This pilot study aimed to explore the feasibility of a graphic novel in reducing anxiety in adult patients awaiting EUS-FNB. Methods: This prospective, single-center, randomized pilot study was conducted from June 2024 to March 2025 in patients aged 18–89 years. The intervention group received a comic panel detailing the EUS-FNB routine, while controls had standard care. Anxiety was measured using the Beck Anxiety Inventory (BAI) and modified DASS-21 (mASS-14). Results: Overall, 65 patients (33 “Graphic Novel”, 32 “Control”) were included. Mean BAI was 4.88 (graphic novel) vs. 7.25 (controls, p = 0.092), and mASS-14 was 4.97 vs. 6.22 (p = 0.261). Anxiety prevalence was low (4.6% BAI, 13.8% mASS-14). Controls were more symptomatic (69.2%) and had a higher rate of pancreatic cancer (n = 20) compared to the graphic novel group (n = 6). Subgroup analyses showed that BAI was slightly lower for patients with children and no prior surgical experience when using graphic novels. Trends for lower anxiety appeared in those on chronic medication, under surveillance, or with solid/suspected metastatic lesions. Conclusions: This pilot study suggests that a graphic novel may help to reduce anxiety and stress scores in patients undergoing diagnostic procedures for pancreatic lesions. However, it needs confirmation in larger, adequately powered trials. Full article

(This article belongs to the Special Issue Mental Health and Health Care in Vulnerable Contexts)

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18 pages, 387 KB

Open AccessArticle

The Mediating Role of Resilience in the Relationship Between Anticipatory Grief and Quality of Life in Caregivers of People with Dementia: A Cross-Sectional Study

by Violeta Clement-Carbonell, Cristian A. Alcocer-Bruno and Nicolás Ruiz-Robledillo

Healthcare 2026, 14(1), 57; https://doi.org/10.3390/healthcare14010057 - 25 Dec 2025

Cited by 2 | Viewed by 1091

Abstract

Background/Objectives: Caring for dementia patients involves a significant emotional burden for family caregivers, who confront anticipatory grief (AG) processes that can negatively affect their health-related quality of life (HRQoL). This study examines the mediating role of resilience in the relationship between AG and HRQoL. Methods: A cross-sectional study was conducted with 144 family caregivers of people with dementia in the province of Alicante (Spain). Validated instruments were applied to measure AG (Caregiver Grief Scale), HRQoL (SF-12), and resilience (Brief Resilient Coping Scale). Descriptive analyses, Pearson correlations, and hierarchical regressions were used, as well as a mediation model based on Hayes’ PROCESS macro. Results: AG was negatively associated with resilience (r = −0.19, p = 0.025) and with both mental (r = −0.24, p = 0.004) and physical (r = −0.22, p = 0.009) components of HRQoL, whereas resilience was positively associated with mental HRQoL (r = 0.35, p < 0.001). In regression analyses, AG (B = −3.36, p = 0.006) and resilience (B = 1.16, p < 0.001) were significant predictors of mental HRQoL, explaining 30.4% of the variance (R² = 0.30). Mediation analyses showed a significant indirect effect of AG on mental HRQoL through resilience (B = −1.28, 95% bootstrapped CI [−2.31, −0.84]), indicating partial mediation. Conclusions: Although AG negatively impacts HRQoL, resilience emerges as a relevant protective resource, especially for caregiver mental health. Therefore, it is crucial to promote resilient coping strategies in interventions that target this vulnerable population. Full article

(This article belongs to the Special Issue Mental Health and Health Care in Vulnerable Contexts)

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16 pages, 320 KB

Open AccessArticle

by Alejandro Oliva-Muñoz, Manuel Fernández-Alcántara, Nicolás Ruiz-Robledillo, Borja García-Sousa, Hortensia Ballester-Galiana and Silvia Delgado-García

Healthcare 2025, 13(22), 2916; https://doi.org/10.3390/healthcare13222916 - 14 Nov 2025

Viewed by 641

Abstract

Background/Objectives: Breast cancer is the most common cancer among Spanish women. Carriers of certain genetic variants are at increased risk, which can significantly impact their quality of life. The main objective of the present research was to describe the health-related quality of life in women with breast cancer-associated genetic risk variants, distinguishing between those who had already developed cancer and those who did not. Additionally, we aimed to identify the variables influencing the decision to undergo risk-reducing surgery. Methods: Descriptive using the questionnaires BREAST-Q, SF-12 and DASS-21. Results: A total of 63 women participated, with a mean age of 43.38 years. In the 38.1% the genetic variant was identified during the diagnosis of breast cancer, while the rest did not have cancer. We found significantly lower scores for women with breast cancer in the BREAST-Q modules Satisfaction with breasts (p = 0.035) and Physical well-being: chest (p = 0.007), as well as in the physical component of SF-12 questionnaire (p = 0.005). Anxiety scores with DASS-21 were significantly higher in breast cancer patients (p = 0.017). A total of 55.6% of the patients decided to undergo bilateral prophylactic mastectomy, while 60.31% bilateral adnexectomy. These rates were significantly higher in breast cancer patients (p = 0.003), older women (p = 0.001), those with at least one child (p = 0.002) and those who were already menopausal (p = 0.0021). Women who underwent bilateral prophylactic mastectomy reported significantly lower scores in the BREAST-Q modules Satisfaction with breasts (p = 0.033) and Physical well-being: chest (p = 0.025), compared to the ones who decided to undergo a follow-up. Conclusions: Health-related quality of life is significantly lower in women with pathogenic genetic variants who have developed breast cancer. This may contribute to a higher rate of risk-reducing surgeries in this group. Full article

(This article belongs to the Special Issue Mental Health and Health Care in Vulnerable Contexts)

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11 pages, 258 KB

Open AccessArticle

Perceived Needs of People with Intellectual Disabilities Undergoing the Ageing Process

by Elena Felipe-Castaño, Matilde Vivas, Ana Isabel González-Contreras and Raquel Braga-Santos

Healthcare 2025, 13(21), 2728; https://doi.org/10.3390/healthcare13212728 - 28 Oct 2025

Viewed by 774

Abstract

Background/Objectives: Ageing in people with intellectual disabilities is a social reality that poses challenges for the individual, their family and social environment, and the direct care services. The main objective of this study was to identify the perceived needs of a sample of people with intellectual disabilities currently undergoing the process of ageing. Methods: Cluster random sampling was used to select the 211 individuals with intellectual disabilities who took part in the study. The participants were aged between 42 and 75 years (M = 56.18; SD = 8.60; Mdn = 55), of whom 55.9% (n = 118) were women and 43.6% (n = 92) were men. Part of the sample completed the Interview for the Needs Evaluation of Ageing People with Disabilities interview by themselves, while the rest did so with support. Results: All the participants identified needs across all the areas assessed, and differences were found according to sex (δ = 0.24–δ = 0.26), age group (δ = 0.20), living arrangements (δ = 0.16–δ = 0.26) and severity of intellectual disability (ε² = 0.03–ε² = 0.08). No differences were found between those who completed the interview independently and those who did so with assistance. Conclusions: The perceived needs of people with intellectual disabilities undergoing the ageing process are complex and multidimensional. Understanding these needs could potentially be useful when designing person-centred needs-based programmes and service models. Full article

(This article belongs to the Special Issue Mental Health and Health Care in Vulnerable Contexts)

13 pages, 267 KB

Open AccessArticle

Psychopathological Symptomatology and Sleep Quality in Chronic Primary Musculoskeletal Pain: A Comparison with Healthy Controls

by Alejandro Arévalo-Martínez, Carlos Barbosa-Torres, María Elena García-Baamonde, César Luis Díaz-Muñoz and Juan Manuel Moreno-Manso

Healthcare 2025, 13(16), 1965; https://doi.org/10.3390/healthcare13161965 - 11 Aug 2025

Cited by 1 | Viewed by 1408

Abstract

Background/Objectives: Chronic musculoskeletal pain without a clearly identifiable medical cause is characterised by significant emotional distress and/or functional disability. Given the relatively limited research specifically addressing chronic primary musculoskeletal pain (CPMP), as defined in the latest revision of the International Classification of Diseases (ICD-11), the present study aimed to examine its psychopathological and sleep-related implications, and to explore whether pain intensity is associated with psychological distress and poor sleep quality. Methods: This observational study included 60 adult participants, comprising 30 patients diagnosed with CPMP and 30 healthy controls without any diagnosis. Participants completed the Numeric Pain Rating Scale (NPRS), the Symptom Checklist-90-R (SCL-90-R), and the Pittsburgh Sleep Quality Index (PSQI). Results: Patients with CPMP exhibited significantly higher levels of psychopathological symptomatology on the SCL-90-R and poorer sleep quality on the PSQI compared to controls (p < 0.05 for most dimensions). Greater pain intensity on the NPRS was strongly associated with psychological distress (e.g., GSI: r = 0.838, p < 0.01) and poor sleep quality (r = 0.785, p < 0.01). Hierarchical regression analyses revealed that pain intensity may play a meaningful role in both psychological distress and sleep quality (p < 0.05 across all models), even after statistically controlling for sex, age, and pain duration. Conclusions: These findings suggest that pain intensity is not only a key physical symptom, but also a relevant factor in understanding the broader psychological vulnerability in patients with CPMP. The present study contributes to a deeper understanding of the psychopathological and functional impact of CPMP and underscores the need for tailored psychological interventions to address the comorbid symptoms associated with this condition. Full article

(This article belongs to the Special Issue Mental Health and Health Care in Vulnerable Contexts)

16 pages, 610 KB

Open AccessArticle

The Mediating Role of Active Coping Strategies in the Relationship Between Academic Stressors and Stress Responses Among University Students

by Cristina Ruiz-Camacho, Margarita Gozalo and Inmaculada Sánchez Casado

Healthcare 2025, 13(14), 1674; https://doi.org/10.3390/healthcare13141674 - 11 Jul 2025

Cited by 3 | Viewed by 10117

Abstract

Background/Objectives: Academic stress is a major factor affecting university students’ psychological well-being and overall functioning. This study examined whether three active coping strategies—positive reappraisal, social support seeking, and strategic planning—mediate the relationship between academic stressors and self-reported stress responses. Methods: A quantitative, cross-sectional, non-experimental design was employed. The sample comprised 1014 students from the University of Extremadura (M_age = 20.56, SD = 3.50). Three subscales of the Academic Stress Questionnaire (CEA) were administered: Academic Stressors (E-CEA), Stress Responses (R-CEA), and Coping Strategies (A-CEA). Descriptive statistics, correlation analyses, and a multiple mediation model using structural equation modeling (SEM) tested direct and indirect effects, controlling for gender, study year, and academic field. Results: (1) Academic stressors were inversely related to positive reappraisal (β = −0.34, p < 0.001), planning (β = −0.12, p < 0.001), and social support seeking (β = −0.09, p < 0.01). (2) All three coping strategies were significantly associated with fewer stress symptoms, with positive reappraisal showing the strongest effect (β = −0.13, p < 0.001), followed by social support seeking (β = −0.06, p < 0.05) and planning (β = −0.03, p < 0.05). (3) Stressors had a strong positive direct effect on stress responses (β = 0.54, p < 0.001). (4) Coping strategies partially mediated the stressor–symptom link (total indirect effect: β = 0.12, p < 0.001, 95% CI [0.08, 0.16]). Conclusions: Active coping partially buffers the negative effects of academic stressors on perceived distress. Findings underscore the importance of enhancing students’ coping skills and implementing institutional policies that reduce structural stress and support psychological well-being. Full article

(This article belongs to the Special Issue Mental Health and Health Care in Vulnerable Contexts)

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24 pages, 366 KB

Open AccessArticle

Triadic Perspectives on Decision Making in Psychiatry: A Qualitative Study on Service Users, Caregivers and Healthcare Professionals in Latvia

by Solvita Olsena, Inese Stars, Elza Eliza Rozenberga, Karina Konstantinova and Ksenija Baidina

Healthcare 2025, 13(12), 1416; https://doi.org/10.3390/healthcare13121416 - 13 Jun 2025

Cited by 2 | Viewed by 2177

Abstract

Background/Objectives: Decision making is fundamental to personal autonomy and person-centered, rights-based psychiatric care. This study explored the perceptions and experiences of decision making in psychiatric care from the perspectives of service users, caregivers, and healthcare professionals, identifying contexts that facilitate or hinder these practices. Methods: An exploratory–descriptive qualitative design was applied, using semi-structured interviews with eight service users, six caregivers, and seven healthcare professionals (21 interviews in total). Data were transcribed verbatim and analyzed through inductive content analysis. Results: Four main categories were identified: (1) antecedents for decision making, (2) challenges in decision making, (3) consequences of decision making, and (4) recommendations for improvement. Conclusions: This study provides insight into how decisions in psychiatric care are made in Latvia, highlighting the legal, personal, and institutional factors influencing these processes. Participants offered valuable perspectives, identifying both facilitators and barriers to autonomous decision making, as well as suggesting necessary improvements. The findings suggest the need for legal reform and systemic improvements in practices that favor agency in decision making. Additionally, they underscore the importance of strengthening individual capacities to support meaningful collaboration among service users, caregivers, and healthcare professionals in making healthcare decisions that enhance the quality of care and well-being of people with mental health difficulties. Full article

(This article belongs to the Special Issue Mental Health and Health Care in Vulnerable Contexts)

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