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Mental Health Care: Pandemic and Beyond

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A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Psychiatry".

Deadline for manuscript submissions: closed (31 July 2025) | Viewed by 10016

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Special Issue Editor

Dr. Soumitra Das

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Guest Editor

1. Emergency Mental Health, Sunshine Hospital, Western Health, Melbourne, Australia
2. Tutor for Master of Psychiatry Program, Department of Psychiatry, University of Melbourne, Melbourne, Australia
Interests: emergency psychiatry; youth mental health; developmental psychiatry; social psychiatry

Special Issue Information

Dear Colleagues,

In light of the significant challenges and transformations observed in the delivery of mental health services during the recent global pandemic, this Special Issue seeks to delve deep into the innovations, adaptations, and resilience of mental health service providers and systems. The aim is not just to document the changes during the pandemic but to draw valuable lessons and insights from them that can shape the future of emergency mental health service delivery.

We believe that your expertise and insights in this field would greatly benefit our readers and contribute significantly to this body of knowledge.

Key topics include (but are not limited to) the following:

Innovations in mental health delivery during the pandemic;
Challenges and barriers faced by service providers;
Studies showcasing adaptability and resilience;
Long-term implications and strategies for future preparedness;
Studies on the COVID-19 outbreak, preventive measures, etc.;
Studies related to leadership and clinical governance;
Special sections: youth mental health, neuropsychiatry, etc.

Dr. Soumitra Das
Guest Editor

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 100 words) can be sent to the Editorial Office for announcement on this website.

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. Medicina is an international peer-reviewed open access monthly 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 2200 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

emergency mental health
pandemic
service delivery
precautions

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Published Papers (7 papers)

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Research

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15 pages, 525 KB

Open AccessArticle

Improving the Mental Health of Nursing Staff Seen from the Perspective of Staff a Preliminary Study

by Rudina Çerçizaj, Fatjona Kamberi, Emirjona Kiçaj, Vasilika Prifti, Sonila Qirko, Erlini Kokalla and Liliana Rogozea

Medicina 2025, 61(9), 1573; https://doi.org/10.3390/medicina61091573 - 31 Aug 2025

Abstract

Background: During the COVID-19 pandemic, nurses faced enormous emotional challenges and profound physical fatigue, as well as constant concerns about whether they would receive genuine support in the workplace. Objectives: This study aimed to assess the long-term impact of the COVID-19 pandemic on the mental health of nurses and to identify key challenges, coping strategies and needs for institutional support. Methods: It was conducted in Albania and followed a mixed-methods design in two interconnected phases, using a mixed-methods approach. Phase I included a quantitative survey of 288 nurses from regional hospitals in Fier and Vlora using a structured questionnaire covering five domains: workplace challenges, stress and work–life balance, health effects and burnout, coping mechanisms, and suggestions for improvement. Data were analyzed using descriptive statistics. Phase II consisted of a reflective seminar with 47 nurses selected from the initial sample. Participants shared their post-pandemic experiences, coping strategies, and proposals for improving mental well-being. SWOT analysis was used to structure the reflections and identify internal and external factors influencing nurses’ mental health. Results: The results showed that nurses continue to face high workload, insufficient psychological support, and that 37.5% reported their work–life balance had worsened since the pandemic (21.9% sometimes; 15.6% most of the time). Participation in the reflective seminar had a positive impact on increasing professional awareness. Conclusions: These findings highlight the need for structured and sustainable interventions within healthcare institutions to protect and promote nurses’ mental health in post-crisis contexts. Full article

(This article belongs to the Special Issue Mental Health Care: Pandemic and Beyond)

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22 pages, 1383 KB

Open AccessArticle

The Association Between Borderline Personality Disorder Symptoms and Social Behaviour Among University Students

by Andreea Sălcudean, Iustin Olariu, Mădălina-Gabriela Cincu, Ramona Amina Popovici, Iuliana Comșulea, Cristina-Raluca Bodo, Dora-Mihaela Cîmpian and Elena-Gabriela Strete

Medicina 2025, 61(8), 1465; https://doi.org/10.3390/medicina61081465 - 14 Aug 2025

Viewed by 322

Abstract

Background and Objectives: Borderline personality disorder (BPD) is a complex psychiatric condition characterized by emotional instability, impulsivity, a fluctuating self-image, and persistent difficulties in maintaining close interpersonal relationships. Among university students, these traits may be associated with social adjustment and academic functioning difficulties. The present study aimed to examine the prevalence of borderline traits within a Romanian student population and to investigate the associations between these traits and interpersonal difficulties encountered in family life, romantic relationships, and academic environments. Materials and Methods: This cross-sectional study included a total of 151 undergraduate students enrolled in higher education institutions across Romania. Data were gathered through an online questionnaire available between March and May 2025. The instrument comprised items addressing socio-demographic characteristics, diagnostic criteria for borderline personality traits according to the DSM, as well as self-reported social behaviour patterns. Statistical analysis was performed using GraphPad Prism 9, version 9.3.1 for Windows, employing Fisher’s exact test and the odds ratio (OR), with a significance threshold set at p < 0.05. Results: Most participants reported experiencing affective instability (71.5%) and distorted self-image (58.9%). Fear of abandonment was present in 29.4% of the respondents, while impulsivity was identified in 37.7%. Borderline personality traits were significantly associated with a range of social difficulties, including relational anxiety, outbursts of anger, peer conflicts, social withdrawal, and dissociative symptoms. Individuals who exhibited impulsivity, self-injurious behaviours, or dissociative episodes demonstrated a markedly increased risk of social dysfunction, with odds ratios ranging from 3 to 10 (p < 0.0001). Conclusions: The findings reveal a high prevalence of borderline traits within the analysed sample, along with statistically significant associations with social and emotional difficulties. These results underscore the importance of implementing psychological screening programs in universities, as well as early intervention strategies focused on the mental well-being of young adults. Establishing a supportive academic environment and fostering collaboration between faculty members and mental health professionals may play a key role in preventing symptom escalation and in promoting healthy personal and relational development. Full article

(This article belongs to the Special Issue Mental Health Care: Pandemic and Beyond)

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22 pages, 1269 KB

Open AccessArticle

Pre- and Post- COVID-19 Pandemic Pneumonia Rates in Hospitalized Schizophrenia Patients

by Ana-Aliana Miron, Petru Iulian Ifteni, Alexandra-Elena Lungu, Elena-Luiza Dragomirescu, Lorena Dima and Andreea Teodorescu

Medicina 2025, 61(7), 1251; https://doi.org/10.3390/medicina61071251 - 10 Jul 2025

Cited by 1 | Viewed by 517

Abstract

Background and Objectives: Schizophrenia is a disabling psychiatric condition, affecting around 1% of people worldwide. It has been ranked among the ten most disabling conditions globally. Alongside the psychological and social burdens imposed on individuals suffering from this disease, there are also serious complications regarding the physical health of these patients. Pneumonia is a significant cause of death in patients with schizophrenia. This group of patients also has a higher risk of developing pneumonia and all-cause mortality compared to those without schizophrenia, along with an increased overall mortality rate. A retrospective study revealed that advanced age, underweight, smoking, and the use of high-dose atypical antipsychotics increase the risk of pneumonia-related mortality in hospitalized patients. Our study aims to examine differences in factors associated with pneumonia in hospitalized patients with schizophrenia, before and after the COVID-19 pandemic, as well as to identify potential changes in clinical characteristics and outcomes. Materials and Methods: This is an observational, retrospective analysis, based on the review of medical records of psychiatric inpatients diagnosed with schizophrenia according to the DSM-5 criteria. Patients were selected according to the following criteria: both schizophrenia and pneumonia diagnoses, hospitalized in Spitalul Clinic de Psihiatrie si Neurologie Brasov during 1 March 2018–1 March 2020, and 1 March 2022–1 March 2024, respectively. Results: A total of 27 patients met the inclusion criteria; 13 patients (48%) were in the pre-pandemic group and 14 patients (52%) in the post-pandemic group. Contrary to other reports, our results showed relatively low pneumonia rates in hospitalized schizophrenia patients (1.02% pre-pandemic and 1.63% post-pandemic), and rates were higher in female patients (61.54% pre-pandemic and 71.43% post-pandemic). Post-pandemic, most cases (42.86%) were registered during summer, in a schizophrenia population with mostly urban residence and with lower smoking rates than the pre-pandemic group. Physical restraints were, however, more frequently utilized in the post-pandemic group. Conclusions: Pneumonia risk factors might register a change in the post-pandemic years. Polypharmacy and physical restraints are probably underestimated risk factors for pneumonia in schizophrenia patients, while a multidisciplinary approach and preventive measures might exert a protective role. Full article

(This article belongs to the Special Issue Mental Health Care: Pandemic and Beyond)

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14 pages, 846 KB

Open AccessArticle

From Anxiety to Hopelessness: Examining Influential Psychological Processes Affecting Mental Health Status of Spanish Nurses During the COVID-19 Pandemic

by Cecilia Peñacoba-Puente, Fernanda Gil-Almagro, Fernando José García-Hedrera and Francisco Javier Carmona-Monge

Medicina 2025, 61(2), 236; https://doi.org/10.3390/medicina61020236 - 28 Jan 2025

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Abstract

Background and Objective: to test a model aimed at delving into the psychological processes that lead to hopelessness in Spanish nurses two years after a stressful work situation. The model proposed starts with the anxiety experienced at the beginning of the COVID-19 pandemic and includes cognitive fusion and emotional exhaustion, evaluated six months after the end of the confinement, as possible contributing factors to development of hopelessness. Design: prospective study with three data collection periods, May to June 2020 (period 1), January to April 2021 (period 2), April to July 2022 (period 3). Materials and Methods: The sample (n = 131 Spanish nurses) was selected by non-probabilistic convenience sampling. The inclusion criteria were as follows: being female, over 18 years of age, and working as a nurse in direct contact with COVID-19 patients. Results: The model proposed was statistically significant (B = 0.34, SE = 0.07, t = 5.15, p < 0.001, 95% CI = [0.21, 0.47]), contributing to the explanation of 28% of the variance of hopelessness, finding that the direct anxiety–hopelessness effect was equally significant (B = 0.19, SE = 0.08, t = 2.46, p = 0.014, 95% CI = [0.04, 0.34]). An effect of anxiety on cognitive fusion and on emotional exhaustion was observed. In turn, cognitive fusion had a significant effect on emotional exhaustion but not on hopelessness. Finally, emotional exhaustion had a significant effect on hopelessness. In this final model, years of experience had a significant effect (p = 0.004) on hopelessness. Conclusions: Cognitive fusion and emotional exhaustion are shown to be relevant psychological processes upon which to intervene to contribute to the improvement of the mental health of nurses regarding the COVID-19 pandemic. Full article

(This article belongs to the Special Issue Mental Health Care: Pandemic and Beyond)

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18 pages, 521 KB

Open AccessArticle

A Preliminary Investigation into the Use of Cannabis Suppositories and Online Mindful Compassion for Improving Sexual Function Among Women Following Gynaecological Cancer Treatment

by Samantha Banbury, Hannah Tharmalingam, Joanne Lusher, Simon Erridge and Chris Chandler

Medicina 2024, 60(12), 2020; https://doi.org/10.3390/medicina60122020 - 7 Dec 2024

Cited by 3 | Viewed by 3754

Abstract

Background and Objectives: The impact of gynaecological cancer and its treatments on sexual intimacy can be profound on female sexuality. However, very few registered clinical trials have addressed sexual intimacy among this cohort. Materials and Methods: This preliminary randomised control trial (RCT) and content analysis assessed the effectiveness of a brief online mindful compassion group intervention adjunct with cannabis suppositories. Eighty-three participants aged between 18 and 50+ years who were at least six months post-cancer treatment were randomly allocated to one of four groups, depending on whether they were already using cannabis suppositories. These included a cannabis-only group (CO), a mindful-compassion group (MC), a combined mindful-compassion and cannabis suppositories group (COCM) and a care-as-usual group (CAU). Measurements of sexual function, sexual self-efficacy, mindful compassion, well-being and quality of life were taken at weeks 0, 4 and 12. Results: Sexual function, including arousal, lubrication and orgasms, improved for both the MC p = 0.002 and COCM p ≤ 0.001 groups; in addition, sexual pain was reduced in the COCM p = 0.008 and CO p ≤ 0.001 groups compared to the CAU and MC groups, where p ≥ 0.05. Feedback suggested that cannabis mediated the effects of mindful compassion and supported well-being, sexual self-efficacy, and quality of life. Participants also voiced a preference for cannabis suppositories when using dilators as part of their treatment and the use of sex toys instead of dilators, suggesting that dilators had negatively impacted their sexuality. Conclusions: These preliminary and exploratory outcomes look promising and provide a foundation for future research to develop varied healthcare options to improve mental health service delivery and quality of life for this cohort. Full article

(This article belongs to the Special Issue Mental Health Care: Pandemic and Beyond)

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10 pages, 338 KB

Open AccessArticle

Psychometric Properties of the Anxiety Measure: Stress and Anxiety to Viral Epidemics-6 (SAVE-6) for Spanish Medical Students

by Aziz Sarhani-Robles, María Guillot-Valdés, Cristina Lendínez-Rodríguez, María Auxiliadora Robles-Bello, David Sánchez-Teruel and Nieves Valencia Naranjo

Medicina 2024, 60(11), 1803; https://doi.org/10.3390/medicina60111803 - 3 Nov 2024

Cited by 1 | Viewed by 1273

Abstract

Backgroud and Objective: The aim of this study was to evaluate the psychometric properties of SAVE-6 in the medical student population and assess its gender invariance. Subjects and Methods: The sample consisted of 320 medical students aged 18–23 years (153 men and 167 women) who completed an anonymous online questionnaire. Data collection took place in June 2024. To assess the scale structure, a descriptive analysis of the items was carried out, followed by a confirmatory factor analysis (CFA). To analyze whether there were differences in the invariance of the measure by gender, a multigroup CFA was performed. Results: SAVE-6 showed high internal consistency, α = 0.89 and ω = 0.92, a minimum score of 12, a maximum score of 22, an unifactorial structure, and adequate convergent validity. Specifically, the following were found: the positive and significant relationship with HADS was 0.98 for the full scale, 0.76 for depression, and 0.91 for anxiety, and there was a negative and significant convergent validity with resilience (−0.82) and resilience to suicide attempts (−0.88). Regarding the gender invariance, relevant data is that the factor loadings between each item and the SAVE-6 factor were not the same, so women present a higher level of anxiety than men (Δχ 2 (6) = 42.53). Discussion: The results showed good internal reliability of SAVE-6 and good suitability. Data also revealed that they were not equal in relation to gender. Specifically, the scalar invariance revealed significant differences by items between men and women in anxiety. Conclusions: This scale can be applied to medical students as a reliable and valid instrument to assess the anxiety response to disease contagion in future health professionals. Full article

(This article belongs to the Special Issue Mental Health Care: Pandemic and Beyond)

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28 pages, 3325 KB

Open AccessSystematic Review

Clozapine and Pneumonia: Synthesizing the Link by Reviewing Existing Reports—A Systematic Review and Meta-Analysis

by Victor Zhao, Yiting Gong, Naveen Thomas and Soumitra Das

Medicina 2024, 60(12), 2016; https://doi.org/10.3390/medicina60122016 - 6 Dec 2024

Cited by 1 | Viewed by 2055

Abstract

Background and Objectives: Clozapine is a highly effective antipsychotic used for treating treatment-refractory psychotic and mood disorders. However, clozapine also has a serious risk of side effects leading to mortality, particularly its potentiated risk of leading to pneumonia. This review aims to overview the demographic and health-related risk factors leading to pneumonia to better inform risk assessment for clozapine users and to summarise current theories on the mechanisms for clozapine-associated pneumonia. This paper will highlight the need to prioritise pneumococcal vaccination in this population group. Materials and Method: We conducted a literary search of five online databases conforming to PRISMA. Our review includes all peer-reviewed papers with original data that discuss clozapine and pneumonia and excludes case reports. Baseline information of participants, pneumonia-related information and information regarding risk factors and mechanisms causing pneumonia were also extracted. Results: Clozapine was found to have an increased risk of pneumonia compared to other antipsychotic medications. Factors included comorbidities, higher clozapine dosages, and concurrent use of other antipsychotic medications. Key mechanisms for clozapine-associated pneumonia include clozapine-induced hyper sedation, sialorrhea and neutropoenia. Conclusions: While clozapine improves overall mortality for patients, our review confirms clozapine has the highest risk of pneumonia of all antipsychotics. The review also highlights the prevalent underuse of pneumococcal vaccines among clozapine users and the urgent need to increase uptake. Full article

(This article belongs to the Special Issue Mental Health Care: Pandemic and Beyond)

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