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Healthcare
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Advancing Mental Well-Being and Health Equity in Marginalized Communities
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Advancing Mental Well-Being and Health Equity in Marginalized Communities

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Mental Health and Psychosocial Well-being".

Deadline for manuscript submissions: closed (15 May 2026) | Viewed by 17335

Special Issue Editor

Dr. Yok-Fong Paat

E-Mail Website
Guest Editor
Department of Social Work, The University of Texas at El Paso, El Paso, TX 79968, USA
Interests: health behavior; health promotion; violence; child well-being; community health

Special Issue Information

Dear Colleagues,

Advancing mental well-being and equity is vital for effectively addressing systematic health disparities in the quality of care and health outcomes in marginalized communities. Vulnerable and at-risk communities—such as economically disadvantaged groups, racial-ethnic minorities, gender minorities and LGBTQ+ communities, immigrants and refugees, formerly incarcerated individuals, homeless individuals, survivors of violence, and uninsured or underinsured individuals—frequently confront disproportionate mental health challenges owing to the cumulative effects of greater stress exposure, perpetuating structural inequalities, discrimination, trauma, violence, stigma, and poverty. These adverse experiences can elevate their risks for post-traumatic stress disorders, depression, anxiety, social isolation, loneliness, and other mental health challenges. At-risk populations also face structural barriers in accessing culturally and linguistically competent mental health care and services, further perpetuating the cycle of disadvantages and marginalization. Advancing mental health equity entails addressing the broader social determinants of mental health and reducing systemic barriers to care. Through greater understanding of the marginalized communities and effective implementation of culturally responsive mental health promotion strategies, we can empower our communities to thrive and cultivate a society that fosters resilience.

In this Special Issue, original research articles, systematic reviews, meta-analyses, and conceptual papers are welcome. Research areas may include (but are not limited to) the following:

  • Understanding the impact of social determinants of mental health;
  • Risk and protective factors of community mental health;
  • Cultural competence in mental health care and services;
  • Innovative strategies for enhancing mental health equity;
  • Mental health of vulnerable and at-risk populations;
  • Different mental health challenges that marginalized communities face;
  • Promoting recovery and resilience.

I look forward to receiving your contributions. 

Dr. Yok-Fong Paat
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 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 promotion
  • psychological disorders
  • mental health disparities
  • social determinants of mental health
  • at-risk and vulnerable populations
  • marginalized communities

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Published Papers (7 papers)

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Research

Jump to: Review, Other

13 pages, 334 KB  
Article
Classism, Perceived Stress, and Mental Health Symptoms: Cross-Sectional Evidence from a Census-Matched U.S. Sample
by David G. Figueroa, Monica Chen, Matthew Phillipi, Jordan E. Parker, Jeffrey M. Hunger and A. Janet Tomiyama
Healthcare 2026, 14(9), 1205; https://doi.org/10.3390/healthcare14091205 - 30 Apr 2026
Viewed by 374
Abstract
Background/Objectives: Classism, or discrimination based on social class, is associated with higher levels of depression and anxiety symptoms. However, limited research has examined the psychological processes that may help explain these associations. The present study tested whether perceived stress statistically mediated the associations [...] Read more.
Background/Objectives: Classism, or discrimination based on social class, is associated with higher levels of depression and anxiety symptoms. However, limited research has examined the psychological processes that may help explain these associations. The present study tested whether perceived stress statistically mediated the associations between experienced and anticipated classism and mental health symptoms. Methods: A U.S. census-matched sample on age, gender, race/ethnicity, income, and census region (n = 1993) was analyzed. Missing data were addressed using Bayesian multiple imputation, and mediation models estimated total, direct, and indirect effects. Results: Results indicated that perceived stress statistically accounted for the associations between both experienced and anticipated classism and higher depression and anxiety symptoms, even after adjusting for income and education. In exploratory analyses, individuals living at or below the federal poverty line reported a higher likelihood of experiencing classism, and perceived stress significantly mediated the association between experienced classism and mental health symptoms within this population. Conclusions: These findings provide preliminary evidence that perceived stress is a statistical mediator of the association between classism and mental health symptoms. Future prospective and experimental work is required to establish potential causal relationships between the constructs. Full article
(This article belongs to the Special Issue Advancing Mental Well-Being and Health Equity in Marginalized Communities)
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19 pages, 596 KB  
Article
What You Can Do: A Qualitative Study on Black Maternal Mental Health and Equity
by Amittia Parker
Healthcare 2026, 14(1), 61; https://doi.org/10.3390/healthcare14010061 - 26 Dec 2025
Viewed by 1037
Abstract
Background/Objectives: Maternal mental health concerns are a leading cause of maternal morbidity and mortality, disproportionately impacting Black mothers in the United States. Structural racism and social determinants of health contribute to increased risks of perinatal mental health issues, limited access to formal [...] Read more.
Background/Objectives: Maternal mental health concerns are a leading cause of maternal morbidity and mortality, disproportionately impacting Black mothers in the United States. Structural racism and social determinants of health contribute to increased risks of perinatal mental health issues, limited access to formal services, and adverse health outcomes for Black mothers. While formal mental health services are underutilized, Black mothers employ a variety of culturally relevant and context-specific strategies to support their mental health. This study seeks to understand the barriers, preferences, and experiences that guide their decision-making and inform culturally responsive care. Methods: This qualitative study employed thematic analysis of in-depth interviews conducted with 12 Black mothers aged 20–39 residing in a midwestern metropolitan area. The research explored individual experiences, preferences for support, and perspectives on healthcare to identify pathways for advancing mental health equity. Results: Three major themes emerged: (1) Expanding conceptions of mental health support beyond traditional services, emphasizing preferences for culturally congruent, convenient, and stress-decreasing interventions; (2) The salience of past experiences and identities in shaping support preferences and decisions; (3) What healthcare professionals can do, the knowledge and skills healthcare professionals can gain, and the actions that they can to become more helpful to Black mothers. The importance of healthcare professionals embodying nonjudgmental, patient, and caring attributes, as well as strengths-based, culturally responsive approaches in care. Conclusions: Advancing mental health equity for Black mothers requires increased awareness of existing disparities, barriers to care, and the strengths embedded within their communities. This research provides actionable insights for healthcare providers, policy makers, and researchers to identify, assess, and respond to the unique needs of Black mothers through culturally responsive and participatory approaches. Findings have implications for intervention design, theory development, and policy reform to improve mental health outcomes. Full article
(This article belongs to the Special Issue Advancing Mental Well-Being and Health Equity in Marginalized Communities)
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20 pages, 752 KB  
Article
Healing Bodies, Healing Communities: A Community-Based Qualitative Study of Adult Survivors of Childhood Sexual Trauma in South Africa
by Leona Morgan, Sarojini Nadar and Ines Keygnaert
Healthcare 2025, 13(20), 2601; https://doi.org/10.3390/healthcare13202601 - 15 Oct 2025
Cited by 1 | Viewed by 1771
Abstract
Background: While sexual trauma is inherently an embodied experience, research on psychological interventions that is cognisant of geographic and socio-political community contexts within which embodied, therapeutic interventions occur remains limited. Decolonial, African and feminist community psychologies have noted this epistemic–ethical gap. Objectives: This [...] Read more.
Background: While sexual trauma is inherently an embodied experience, research on psychological interventions that is cognisant of geographic and socio-political community contexts within which embodied, therapeutic interventions occur remains limited. Decolonial, African and feminist community psychologies have noted this epistemic–ethical gap. Objectives: This paper explores the co-development of trauma-informed care pathways for adult survivors of childhood sexual trauma (CST) in under-resourced communities in Cape Town, South Africa. The study aimed to integrate intergenerational community knowledge, embodied therapeutic practices and collaborative approaches into locally relevant models of care. Methods: Drawing on feminist mental health frameworks, this qualitative study engaged 13 adult female survivors who identify as “coloured”. Embodiment was central in guiding the deconstructive therapeutic praxis, informing both the co-development of care pathways and the conceptualization of integrative trauma-informed care (ITIC) beyond pathologizing, deficit-based narratives. The cultivation of trust and the situated lived realities of survivors were foregrounded to illustrate the relational dimensions of trauma recovery. Results: Establishing relational safety emerged as the foundation for therapeutic engagement, supported by non-directive therapeutic probing. Grounding practices, affective regulation and embodied awareness enabled participants to process trauma at their own pace. Somatic engagement allowed the integration of dissociative experiences while strengthening relational resilience. Recovery was a continuous process, with participants reporting increased peace, authenticity and capacity for social connection despite structural barriers to community support. Conclusions: The development of care pathways was embedded within the research process itself, offering an approach that is culturally sensitive and responsive to survivors’ lived experiences. ITIC accounted for temporal, intergenerational and embodied trauma and should be adaptable across age and community-specific needs. The ITIC approach offers a transferable framework for co-developing de-pathologizing, culturally responsive interventions that can be adapted across diverse global contexts to support sustainable trauma integration. Full article
(This article belongs to the Special Issue Advancing Mental Well-Being and Health Equity in Marginalized Communities)
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21 pages, 242 KB  
Article
Mental Health Outcomes Among Female Ukrainian Refugees in Germany—A Mixed Method Approach Exploring Resources and Stressors
by Adekunle Adedeji, Stella Kaltenbach, Franka Metzner, Viktoriia Kovach, Stefan Rudschinat, Isabel Marin Arrizabalaga and Johanna Buchcik
Healthcare 2025, 13(3), 259; https://doi.org/10.3390/healthcare13030259 - 28 Jan 2025
Cited by 5 | Viewed by 3407
Abstract
Background: Mental health outcomes among female refugees are complex and multifaceted. This study examines the mental health outcomes and coping resources of female Ukrainian refugees in Germany using a mixed methods approach with qualitative focus groups and quantitative assessments. Methods: This study employs [...] Read more.
Background: Mental health outcomes among female refugees are complex and multifaceted. This study examines the mental health outcomes and coping resources of female Ukrainian refugees in Germany using a mixed methods approach with qualitative focus groups and quantitative assessments. Methods: This study employs a mixed methods approach, combining qualitative and quantitative methodologies. Three focus group discussions with fifteen participants were conducted in Hamburg in April 2023. A stepwise qualitative data analysis was done using a deductive coding technique. The quantitative analysis focused on descriptive statistics to summarize the data and provide an overview of participants’ mental health and well-being. Results: Our findings show that 43% of participants reported anxiety symptoms, and 21% showed signs of depression—many experienced isolation and disconnection and were struggling with cultural adaptation and the emotional toll of displacement. Despite challenges, participants utilized various coping strategies, such as staying active, volunteering, and seeking community support. However, significant barriers to accessing mental health services, especially for children, were identified. Conclusions: The study underscores the need for tailored interventions, including language support, accessible mental health resources, and community engagement, to foster resilience and well-being. It highlights the importance of comprehensive support systems for refugee populations in host countries, such as active lifestyles, social support, volunteer work, and successful integration. Full article
(This article belongs to the Special Issue Advancing Mental Well-Being and Health Equity in Marginalized Communities)
20 pages, 1011 KB  
Article
Mental Health Challenges and Barriers to Veterans’ Adjustment to Civilian Life on the U.S.–Mexico Border
by Yok-Fong Paat, Angela V. Dorado, Nathan W. Myers, Andie Martinez and Shawna Scully
Healthcare 2025, 13(3), 220; https://doi.org/10.3390/healthcare13030220 - 22 Jan 2025
Cited by 6 | Viewed by 6380
Abstract
Background: Seeking mental health care is crucial for supporting effective reintegration among veterans. The U.S.–Mexico border presents a compelling and urgent case for study due to its proximity to economically marginalized and medically underserved areas, where the availability and accessibility of services are [...] Read more.
Background: Seeking mental health care is crucial for supporting effective reintegration among veterans. The U.S.–Mexico border presents a compelling and urgent case for study due to its proximity to economically marginalized and medically underserved areas, where the availability and accessibility of services are often limited. Objective: This study explored veterans’ mental health challenges and factors that hindered their adjustment to civilian life on the U.S.–Mexico border. Methods: A total of 36 veterans were recruited using purposive sampling from a mental health agency located in Southwestern Texas on the U.S.–Mexico border between November 2023 and May 2024 to complete an in-depth semi-structured interview and a brief survey. Results: Using thematic analysis, we found six themes associated with our study: (1) mental health struggles, (2) enduring military-influenced mindset, (3) adjustment to civilian life, (4) strained family relationships, (5) past victimization and discrimination, and (6) barriers to opportunities and mental health care. Conclusion: Understanding veterans’ mental health well-being and their prospects for integration into the civilian world is critical for identifying risk and protective factors that can inform the development of targeted health promotion initiatives, strengthen the implementation of equitable health care efforts, and support strategies for enhancing treatment access that address the unique needs of veterans in the border region. Policy and practice implications are discussed. Full article
(This article belongs to the Special Issue Advancing Mental Well-Being and Health Equity in Marginalized Communities)
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Review

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14 pages, 282 KB  
Review
Digital Mental Health Through an Intersectional Lens: A Narrative Review
by Rose Yesha, Max C. E. Orezzoli, Kimberly Sims and Aviv Y. Landau
Healthcare 2026, 14(2), 211; https://doi.org/10.3390/healthcare14020211 - 14 Jan 2026
Viewed by 1859
Abstract
For individuals with mental illness who experience multidimensional marginalization, the risks of encountering discrimination and receiving inadequate care are compounded. Artificial intelligence (AI) systems have propelled the provision of mental healthcare through the creation of digital mental health applications (DMHAs). DMHAs can be [...] Read more.
For individuals with mental illness who experience multidimensional marginalization, the risks of encountering discrimination and receiving inadequate care are compounded. Artificial intelligence (AI) systems have propelled the provision of mental healthcare through the creation of digital mental health applications (DMHAs). DMHAs can be trained to identify specific markers of distress and resilience by incorporating community knowledge in machine learning algorithms. However, DMHAs that use rule-based systems and large language models (LLMs) may generate algorithmic bias. At-risk populations face challenges in accessing culturally and linguistically competent care, often exacerbating existing inequities. Creating equitable solutions in digital mental health requires AI training models that adequately represent the complex realities of marginalized people. This narrative review analyzes the current literature on digital mental health through an intersectional framework. Using an intersectional framework considers the nuanced experiences of individuals whose identities lie at the intersection of multiple stigmatized social groups. By assessing the disproportionate mental health challenges faced by these individuals, we highlight several culturally responsive strategies to improve community outcomes. Culturally responsive strategies include digital mental health technologies that incorporate the lived experience of individuals with intersecting identities while reducing the incidence of bias, harm, and exclusion. Full article
(This article belongs to the Special Issue Advancing Mental Well-Being and Health Equity in Marginalized Communities)

Other

Jump to: Research, Review

12 pages, 364 KB  
Brief Report
Exploring Emotional Self-Efficacy as a Mediator of Positive Leisure Experience and Subjective Well-Being Among Elementary School-Age Children in a Marginalized Community
by Mei-Ling Lin
Healthcare 2025, 13(22), 2982; https://doi.org/10.3390/healthcare13222982 - 20 Nov 2025
Viewed by 699
Abstract
Background: Prior research has established a positive relationship between emotional self-efficacy and life satisfaction in elementary school-age children. However, less is known about the direct impact of positive leisure experience on subjective well-being and the potential mediating role of emotional self-efficacy. Objectives [...] Read more.
Background: Prior research has established a positive relationship between emotional self-efficacy and life satisfaction in elementary school-age children. However, less is known about the direct impact of positive leisure experience on subjective well-being and the potential mediating role of emotional self-efficacy. Objectives: This study examined whether emotional self-efficacy mediates the association between overall leisure enjoyment and life satisfaction among elementary schoolchildren. It was hypothesized that both direct and indirect effects are statistically significant. Methods: A quantitative, cross-sectional design was used with 100 fifth- and sixth-grade students from a U.S.–Mexico border community. Participants completed the Children’s Assessment of Participation and Enjoyment (CAPE), the emotional subscale of the Self-Efficacy Questionnaire for Children (SEQ-C), and the Student Life Satisfaction Scale (SLSS). Mediation analysis was conducted in R with bootstrapping (500 simulations). Results: Overall leisure enjoyment was positively associated with life satisfaction (β = 0.54, 95% CI [0.23, 0.90], p = 0.004). The direct effect remained significant after accounting for emotional self-efficacy (β = 0.41, 95% CI [0.15, 0.73], p = 0.004). The indirect effect through emotional self-efficacy was also significant (β = 0.13, 95% CI [0.03, 0.29], p = 0.016), accounting for approximately 25% of the total effect. Conclusions: Emotional self-efficacy partially mediated the relationship between overall leisure enjoyment and life satisfaction, suggesting that positive leisure experience enhances children’s emotional coping confidence and subjective well-being. These findings underscore the importance of promoting accessible and enjoyable leisure opportunities within marginalized communities that simultaneously foster children’s emotional self-efficacy and well-being. Full article
(This article belongs to the Special Issue Advancing Mental Well-Being and Health Equity in Marginalized Communities)
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