Background/Objectives: The COVID-19 pandemic disrupted social structures, healthcare access, and psychological well-being, potentially intensifying substance use and suicidal behavior. Although both phenomena have been independently studied, their co-occurrence during the pandemic has not been systematically synthesized. To evaluate the prevalence and patterns of suicidal behavior among individuals with substance use during the COVID-19 pandemic through a systematic review and random-effects proportions meta-analysis. Methods: A systematic search of PubMed, Scopus, Web of Science, and EBSCO Host was conducted from 11 March 2020 to 15 October 2022 for studies published between March 2020 and October 2022. Eligible studies included observational designs reporting substance use and suicidal behavior in adults during the pandemic. Risk of bias was assessed using National Institutes of Health tools. Proportional meta-analyses were performed using a random-effects model with Freeman-Tukey double arcsine transformation. Heterogeneity was quantified using the I² statistic. Results: Twenty studies comprising 70,684 individuals were included. Substance use during the pandemic was reported in 24.6 percent of participants, while 30.7 percent exhibited suicidal behavior. A total of 16.1 percent presented with both substance use and suicidal behavior. The pooled prevalence of any suicidal behavior among individuals with substance use was 33.8 percent (95 percent CI, 22.8 to 45.7), with substantial heterogeneity. Alcohol showed a pooled prevalence of 36.2 percent, cannabis 48.1 percent, and tobacco 11.5 percent. Suicidal ideation was the most frequent outcome, with a pooled prevalence of 36.8 percent among substance users. Most studies reported an increased association between substance use and suicidal behavior compared with pre-pandemic periods. Conclusions: Substance use and suicidal behavior frequently co-occurred during the COVID-19 pandemic, particularly suicidal ideation and alcohol use. These findings highlight the need for integrated mental health and substance use interventions during public health crises.

Mental health problems are increasing among young people in South Africa due to diverse determinants such as, poverty, social shame, and lack of proper access to health services. Although physical activity is a low-cost and non-medical way to help improve mental health, its effects in rural areas are still not clearly understood. A scoping review was carried out following the PRISMA-ScR guidelines. We systematically searched three online databases (PubMed, CINAHL, and Google Scholar) for studies published from 2014 through 2025. Studies met eligibility criteria if they targeted youth aged 14-35 years living in rural South Africa and reported on physical activity interventions designed for mental health. Two reviewers independently carried out data extraction and came up with the overall result. Overall, 42,384 records were identified, of which only 12 studies met all the specified criteria. The findings of the study were that participation in organised forms of physical activity (including school-based aerobic sessions, community-based walking groups, and charity training programmes) was associated with reductions in mental health issues. Even with these issues, the findings show that physical activity can be a useful, efficient, and practical way to support mental health among rural South African youth. To improve the evidence, strong trials, community-based plans, and sessions at schools and clinics are needed. In addition, policy cooperation across health, education, and sports sectors is essential for lasting impact.

Mental health disorders affect nearly one billion people worldwide, yet treatment gaps exceed 75% in low- and middle-income countries. Teletherapy has emerged as a scalable solution, but its adoption differs sharply by economic context. This comparative ecological policy analysis used secondary aggregate data from WHO, World Bank, ITU, and national reports to examine teletherapy adoption in low-income (Nigeria, Kenya), middle-income (South Africa, India), and high-income countries (Norway, Canada). Descriptive statistics and simple linear regression were applied, with findings interpreted through the Consolidated Framework for Implementation Research (CFIR), Technology Acceptance Model (TAM), and Diffusion of Innovations theory. High-income countries achieved widespread adoption (>70%), enabled by universal broadband, comprehensive regulation, and strong reimbursement. Middle-income countries showed moderate uptake (15-30%), constrained by rural-urban digital divides and inconsistent policies. Low-income countries reported minimal integration (<5%), limited by unreliable internet, severe workforce shortages, high data costs, and sociocultural barriers. Digital infrastructure, regulatory maturity, and mental health workforce density explained 78% of the cross-country variance in adoption rates (R² = 0.78). Equitable scale-up of teletherapy directly supports SDGs 3, 9, 10, and 17. Targeted investment and cross-income collaboration are essential to prevent digital mental health solutions from exacerbating existing inequities.

The much higher rate of premature mortality from cancer among people with mental ill-health is a major contributor to 20-year reduction in life expectancy for this population, relative to the broader population. Under-screening and delays in screening for cancers are recognized as significant issues contributing to this health inequality. This thematic review explored the common barriers to delayed cancer screening, facilitators to overcome those barriers, and the associated recommendations to improve screening rates for people with mental ill-health. Inclusion criteria were peer-reviewed quantitative, qualitative or mixed methods studies and reviews, available in English, involving adults with mental ill-health (experiencing mental distress or with diagnosed mental disorder), living in the community and in contact with primary, secondary or tertiary mental health services, exploring their screening experiences for any type of cancer. The reviewed literature from 37 studies that met the inclusion criteria highlighted key themes contributing to the health disparity experienced by this population, including social determinants of health, comorbidities, and health system factors. Facilitators such as trust, support, self-care, and interventions at a health system level were also highlighted. Study quality was appraised using the MMAT v.18 and CASP tools. All studies that met the inclusion criteria, regardless of quality, were included in the review to provide a comprehensive analysis of the existing literature on this topic. Building upon this literature, further recommendations are presented on how to reduce the cancer screening inequality experienced by people with mental ill-health.

The mental health of people living in farming communities has been identified as an important public health issue. Cumulative exposure to a range of situational factors contributes to heightened risk of poor mental health and suicide. Access to evidence-based psychological treatments is limited by the availability of skilled mental health professionals. The aim of this trial-co-designed by members of the farming community-is to establish the feasibility of conducting randomised controlled, trial-testing, peer-worker-delivered Behavioural Activation in the farming community. We will undertake a single-blind, parallel group, randomised controlled feasibility trial in rural Australia. People living in farming communities aged over 15 years and experiencing moderate to moderately severe depression symptoms will be included in the trial. Participants will be randomly allocated on a 1:1 ratio to 10 sessions of peer-worker-delivered behavioural activation (Back-on-Track) or a self-help workbook (Managing Stress on the Farm). Peer workers are members of the farming community that have completed training in behavioural activation and demonstrated competence. Feasibility outcomes include establishing recruitment rates, willingness to be randomised, dropout rate from trial, acceptability of peer delivered behavioural activation, and willingness to complete trial measures. The trial will contribute high quality evidence of the feasibility of undertaking a full-scale, randomised controlled trial of peer-delivered Behavioural Activation in farming communities in rural Australia.

Young caregivers, defined as individuals under 25 years of age who provide unpaid care to a family member(s) with illness, disability, or age-related needs, remain significantly underrecognized in Canada despite their valuable contributions to the healthcare system. Limited awareness, fragmented services, and adult-centred caregiving infrastructures leave them vulnerable to social isolation, disrupted education, and poor mental health. Unlike the United Kingdom and Australia, Canada lacks a coordinated national strategy to identify and support young caregivers. This qualitative study examines caregiving organizations across multiple Canadian provinces, exploring current practices, barriers, and future visions for supporting young caregivers. Group interviews were conducted with 18 service providers from caregiving organizations in Alberta, BC and Nova Scotia. Four themes emerged through analysis: (1) The Landscape of Existing Caregiving Organizations, (2) Barriers and Challenges to Supporting Young Caregivers, (3) Navigating a Pandemic, and (4) a Journey and Vision Worth Supporting. Organizations reported a strong interest in expanding support for young caregivers with a vision for cross-sector collaboration and school-based outreach. However, challenges such as inadequate funding and a lack of formal recognition limits their capacity in building youth programs. Findings from the study highlight the need for systemic reform, including early intervention models, sustainable funding, and formal recognition of young caregivers within policy frameworks. Addressing these gaps will not only uplift young caregivers, but also strengthen Canada's broader caregiving and healthcare ecosystem.

Mental illness and related health inequities are disproportionately concentrated in economically disadvantaged urban neighborhoods. The COVID-19 pandemic has been associated with a rise in mental illness prevalence, with women generally at greater risk than men. Urban areas facing multiple structural and socioeconomic challenges may have limited capacity to meet the mental healthcare needs of residents, leading to increased reliance on emergency departments (EDs) for acute care. This ecological study uses data over four years (2018-2021) and examines spatial variations in ED utilization at the census tract level, focusing on geographic areas with women of reproductive age diagnosed with mental illness to compare patterns before and during the COVID-19 pandemic. Of the 22,565 ED visits in the four-year period, 12,832 occurred before COVID-19 and 9733 during COVID-19. Our findings highlight persistent structural disparities in mental healthcare access across census tracts characterized by high concentrations of vulnerable women of reproductive age. Understanding these spatial disparities allows for geographically targeted interventions and the prioritization of resources for neighborhoods identified as most underserved.

Francophone populations outside Quebec were disproportionately affected by the COVID-19 crisis. Despite French being one of Canada's official languages, access to information and services in French remains limited. This study examined Francophone families' (FF) post-pandemic health and well-being needs (PPHW) in the Canadian Prairie provinces. An online survey assessed PPHW needs among 319 FF in Alberta (AB), Saskatchewan (SK), and Manitoba (MB). Respondents ranked PPHW needs from a predefined list; logistic regression analyzed socio-demographic influences. Divided into AB/SK and MB cohorts, sociodemographic profiles were statistically distinct for many variables, but with similarities found in gender of respondents (women: 73% in AB/SK, 79% in MB), marital status (married: 81% in AB/SK, 88% in MB), area of residence (urban: 86% in AB/SK, 81% in MB), and number of children (2 children: 49% in AB/SK, 41% in MB). Three high-priority needs were shared across provinces: (1) access to recreational, athletic, and artistic activities in French for children (variations by child gender); (2) access to French healthcare professionals (variations by education level and language difference); and (3) social activities in French for families. AB/SK respondents prioritized mental health services in French for adults and youth. MB families prioritized belonging to a Francophone community (variations by gender of children) and education services in French (variations by age of children). Understanding these common and province-specific priorities can inform policy and service planning.

Parental stress is a critical yet understudied dimension of childhood total blindness, a condition that imposes substantial developmental, emotional, and functional challenges on families. This cross-sectional study assessed parenting stress, maternal health symptoms, and children's functional vision-related quality of life in 81 mothers of children aged 0 to 12 years with total congenital blindness. Parenting stress was assessed in the full sample using the Parenting Stress Index-Fourth Edition (PSI-4). Children's functional vision-related quality of life was evaluated in age-specific subsamples using the Quality of Family Vision Impact (QFVI-3 for children aged 0-3 years and QFVI-7 for children aged 3-7 years). All participants also completed a sociodemographic and maternal health survey. Total Parent Stress showed moderately elevated percentile scores (mean ≈ 67), with the highest PSI-4 subdomains in Adaptability, Depression, and Health. Approximately 21% of mothers scored within the clinical range for high stress. Maternal symptoms including sadness, insomnia, headaches, forgetfulness, and musculoskeletal pain were significant (all p < 0.01). QFVI global scores indicated moderate impairments in functional vision-related quality of life across age groups. Life Stress demonstrated a small-to-moderate negative correlation with QFVI-7, suggesting that cumulative environmental stressors may adversely affect children's functional outcomes. Several factors were associated with more favorable outcomes. Among children under three years of age, maternal engagement in physical activity was associated with higher QFVI scores, whereas among children aged 3-7 years, school attendance was associated with higher functional vision-related quality of life scores. In contrast, sociodemographic disadvantage, limited access to educational adaptations, and reduced maternal participation in work or leisure activities were associated with higher levels of parental stress. These findings highlight the importance of multidisciplinary, family-centered care incorporating psychosocial assessment, early stimulation, orientation and mobility support, and maternal mental health interventions in pediatric ophthalmology.

High-need populations face substantive barriers to accessing primary care, leading to disproportionately poor health outcomes. This descriptive, observational study details the implementation of a Federally Qualified Health Center (FQHC) program designed to improve engagement in care and enabling services by leveraging mobile health units (MHUs) to provide comprehensive, low-barrier primary care services to residents who were previously unable or unwilling to engage with the traditional healthcare system. The program sought to overcome common access challenges such as lack of transportation, lack of insurance, and mistrust of healthcare institutions. We describe the operational framework of this program, examine the types of care delivered, and offer recommendations from the perspective of a large multi-site FQHC experienced in reengaging people back to the healthcare system but new to providing mobile health care. We describe our program's focus on prioritizing patient engagement and access and its consideration of operational and technical infrastructure. Based on our FQHC's experience, we provide recommendations on how to address patients' health and social needs. FQHCs have the potential to implement MHUs, drawing on their existing infrastructure and community relationships. Our MHU program is well-aligned with our FQHC's commitment and priority to deliver essential care and foster continuity within hard-to-reach communities, strengthening the local healthcare safety net and improving healthcare for high-need populations.