Volume Articles

Person-Centered Health Services Research: Policy Implications

The Association between Mental Health and Stressful Life Events among Undergraduate Students in Cyprus: A Descriptive Correlational Study

Background: Previous studies have indicated a causal link between stressful life experiences and mental health. However, little is known about the impact of the frequency and seriousness of recent stressful life events on clinical mental discomfort among university students. This study explored the mental health status of undergraduate students in Cyprus. It examined the association between the number and severity of stressful life events and clinical symptoms of mental distress.

Methods: This was a cross-sectional, descriptive, correlational study conducted using convenience sampling, with a total of 1,500 undergraduate students participating. Descriptive statistics for sociodemographic characteristics, mental distress symptoms, and life events of the participants were calculated and expressed in frequencies, mean values, and standard deviations. One-way analysis of variance and independent sample t-tests were conducted to compare the General Health Questionnaire – 28 (GHQ-28) subscales with groups based on the number of events and total score in Life Events Scale for Students (LESS).

Results: After adjusting for sociodemographic characteristics using logistic regression analysis, gender remained the only variable significantly associated with mental distress symptoms before and after controlling for stressful life events, with women being 1.6 times more likely to report clinical levels of distress than men (95% CI: 0.98–2.46). However, a statistically significant association was observed between gender and mental distress symptoms. Specifically, women had a higher level of mental distress than men.

Conclusion: Individual characteristics, stress, negative life events, and psychological distress were interconnected. Collaboration among teachers, students, parents, and mental health professionals is essential to create a supportive and nurturing school environment.

Depression in Youth: Investigating the Impact of Obesity, Inflammation and Sleep: A Narrative Review

Background: Depressive disorders in children and adolescents have been associated with lifelong health implications and risk factors. Concurrently, rates of depression, overweight and obesity in pediatrics have markedly worsened since the COVID-19 pandemic. Sleep and inflammation have also been described as altered in depressive and overweight or obese status, suggesting an intertwined relationship. This clinical practice review examines these intertwined roles while exploring health care disparities, holistic care, and interdisciplinary approaches.

Methods: The methodology of this review followed a narrative format by examining and summarizing trends related to pediatric depression with existing literature and expert synthesis.

Results: Selected articles provided a broad overview of key concepts contributing to a deeper understanding of research topics. Relevant clinical insights into the complex and interwoven concepts of pediatric depression, obesity, and inflammation answered the research question by informing clinical practice with a culturally sensitive, holistic, and integrated health care approach.

Conclusions: Significant findings underscored the need for healthcare providers to understand the complex relationships between depression, obesity, inflammation, and sleep, to avoid healthcare disparities and risk for negative lifelong consequences. This article is intended for all the disciplines involved in the care of pediatric populations.

Minds in Crisis: How the AI Revolution is Impacting Mental Health

The rapid rise of generative AI systems, particularly conversational chatbots such as ChatGPT and Character.AI, has sparked new concerns regarding their psychological impact on users. While these tools offer unprecedented access to information and companionship, a growing body of evidence suggests they may also induce or exacerbate psychiatric symptoms, particularly in vulnerable individuals. This paper conducts a narrative literature review of peer-reviewed studies, credible media reports, and case analyses to explore emerging mental health concerns associated with AI-human interactions. Three major themes are identified: psychological dependency and attachment formation, crisis incidents and harmful outcomes, and heightened vulnerability among specific populations including adolescents, elderly adults, and individuals with mental illness. Notably, the paper discusses high-profile cases, including the suicide of 14-year-old Sewell Setzer III, which highlight the severe consequences of unregulated AI relationships. Findings indicate that users often anthropomorphize AI systems, forming parasocial attachments that can lead to delusional thinking, emotional dysregulation, and social withdrawal. Additionally, preliminary neuroscientific data suggest cognitive impairment and addictive behaviors linked to prolonged AI use. Despite the limitations of available data, primarily anecdotal and early-stage research, the evidence points to a growing public health concern. The paper emphasizes the urgent need for validated diagnostic criteria, clinician training, ethical oversight, and regulatory protections to address the risks posed by increasingly human-like AI systems. Without proactive intervention, society may face a mental health crisis driven by widespread, emotionally charged human-AI relationships.

Evaluating the Impact of Multidisciplinary Care on Opioid Use Disorder: A Retrospective Study of Buprenorphine/Naloxone-Assisted Treatment in a Family Medicine Residency

Background: Medications for Opioid Use Disorder (MOUD) with buprenorphine/naloxone improves opioid-use-disorder (OUD) outcomes, yet sustaining engagement is challenging. Pharmacist integration within MOUD teams enhances safety and adherence. We evaluated a pharmacist-augmented MOUD model embedded in a family-medicine residency clinic.

Methods: Adults with OUD treated between October 2020 and July 2024 formed a retrospective cohort. Eligibility required ≥ 1 clinic visit; polysubstance use excluded. Descriptive statistics summarized cohort characteristics; single-sample t-tests compared local outcomes with a published physician–pharmacist trial (Wu et al.). Variables included demographics, psychiatric comorbidities, induction site, Clinical Opiate Withdrawal Scale scores, urine drug screens (UDS), visit cadence, and retention rate.

Results: Fourteen of 30 screened patients met criteria (50% male; mean age 43 y). A clinical pharmacist participated in all MOUD visits. Induction was on-site for 78.6%, and 85.7% had ≥ 1 psychiatric comorbidity. Negative-UDS consistency was 85.7% versus 95.1% in Wu et al. (p = 0.21). The retention rate was 35.7% versus 88.7% in Wu et al. (p < 0.0001) but lay within the wider U.S. range of 19–64%. Two patients (14.3%) achieved remission after a median of six visits; three (21.4%) remained engaged ≥ 3 months.

Conclusions: Embedding pharmacists in a residency-based MOUD program yielded high medication adherence and UDS consistency comparable to collaborative-care trials, but retention lagged. Enhanced behavioral-health integration and provider continuity may bolster long-term engagement while preserving pharmacist-driven safety benefits.

Mini-Review: A Superior Treatment for Clozapine-induced Sialorrhea

Clozapine is the only antipsychotic with demonstrated efficacy for treatment-resistant schizophrenia and mania, and aggression, suicide, or psychogenic polydipsia related to schizophrenia. Sialorrhea, a common adverse effect, is frequently a barrier to clozapine treatment. Anticholinergic agents have limited efficacy and increase risk for constipation, bowel impaction, or ileus. Interval injection of select salivary glands with botulinum neurotoxin (BT) has proven to be a superior alternative treatment for clozapine-induced sialorrhea (CIS). This mini-review describes the viability and logistics for establishing a successful botulinum treatment clinic, including adequate staff, training, educating treatment providers about the availability and effectiveness of botulinum treatment for sialorrhea, and development of a clinic protocol (e.g., procedural elements and relevant rating scales). Finally, botulinum treatment was determined to be cost-effective. Evidence for botulinum treatment of CIS includes Level I data.

Beyond Acceptance: Utilizing Empathy to Diagnose and Treat Internalized Homophobia in LGBTQ+ Clients

This article asserts that effective therapy with LGBTQ+ clients should evolve beyond basic "gay friendly" practices to require deeper clinical engagement. It argues that therapists can actively cultivate precise empathy, which is predicated on a more detailed familiarity with the client's unique experiences, particularly those shaped by internalized homophobia. This skillful approach involves refining a therapist's cognitive complexity and utilizing relevant diagnostic tools to accurately diagnose and treat the often-subtle, debilitating impact of minority stress. Ultimately, this targeted, empathetic strategy is vital for establishing and strengthening the therapeutic alliance.