Prescribing of medicinal cannabis (MC) for mental health conditions has expanded rapidly in primary care, often in the absence of regulatory approval or established clinical guidance. Although randomised controlled trials (RCTs) remain the cornerstone of therapeutic evaluation, their feasibility and applicability in this context are constrained by ethical, regulatory, and methodological factors. Clarifying the strengths and limitations of existing RCT evidence is therefore essential to informing complementary real-world evidence approaches relevant to primary care.To synthesise and characterise RCT evidence on medicinal cannabis for mental health and substance use disorders, and to examine its implications for generating real-world evidence to support primary care practice.A scoping review using a systematic approach was conducted. PubMed, Web of Science, and PsycINFO were searched for RCTs published between 1980 and 2024 investigating MC-based products for DSM-5 mental health or substance use disorders. Data were extracted on study design, populations, interventions, outcomes, and adverse events. Findings were synthesised descriptively due to substantial clinical and methodological heterogeneity.Twenty-eight RCTs were identified across 12 DSM-5 conditions. Trials were predominantly small (median sample size 42), short in duration (median follow-up six weeks), and highly heterogeneous in cannabinoid composition, dosing, and outcomes. Evidence of benefit was inconsistent and largely limited to short-term symptom outcomes in selected conditions, including cannabis use disorder, autism spectrum disorder, and schizophrenia. No trial demonstrated sustained long-term effectiveness, and reporting of adverse events and treatment discontinuation was variable. Overall, the RCT evidence was insufficient to inform real-world prescribing decisions regarding long-term safety, dose optimisation, or interactions with commonly prescribed psychotropic medicines.The RCT evidence base highlights a structural mismatch between trial methodologies and contemporary prescribing of MC. Trials were conducted under highly controlled conditions with narrow eligibility criteria and short follow-up, whereas real-world prescribing commonly involves long-term use, multimorbidity, polypharmacy, and heterogeneous patient populations.While RCTs provide important foundational evidence, they are insufficient to address many clinically relevant questions related to MC use in mental health. High-quality real-world evidence, using longitudinal electronic medical record data, is urgently needed to monitor outcomes, detect harms, and inform safe, evidence-based policy and practice in primary care.

Suicide is a significant cause of premature death in patients with bipolar disorder. Family physicians are usually the first to see these patients, and it is critical for them to identify patients at risk of suicide.This study aimed to estimate the prevalence of suicide attempts among patients with bipolar disorder and to identify associated risk factors relevant to primary care practice.We performed a cross-sectional analytic study of 281 patients with bipolar disorder (types I and II) treated for four years in a psychiatric hospital. Sociodemographic, clinical, psychosocial and treatment information were also obtained. Patients were divided into two groups according to the presence or absence of a history of suicide attempts. Univariate and multivariate logistic regression analyses were performed to identify factors associated with suicide attempts.The prevalence of suicide attempts was 22.8%. Among patients with a previous attempt, 71.4% had experienced recurrence. Multivariate analysis identified depressive polarity of bipolar disorder (OR = 19.23), family history of suicide attempts (OR = 6.00), and poor insight (OR = 7.01) as independent risk factors. Older age at disease onset and treatment with atypical antipsychotics were found to be protective factors. Sociodemographic characteristics showed weak or no significant association with suicide attempts.Several determinants of suicide risk identified in this study are accessible to family physicians during routine consultations, including family history, illness trajectory, and current mood polarity. The high recurrence rate highlights the importance of systematic risk assessment even outside psychiatric settings.Family physicians play a role in early detection of suicide risk among bipolar patients. Integrating structured screening of psychiatric history into primary care may improve prevention and timely referral.

Recent estimates suggest that 10–20% of adolescents globally experience mental health conditions (MHCs), with many cases going undiagnosed and untreated. Youth MHCs are associated with long-term personal and financial challenges, not only for the young person, but also for their family and friends. Youth mental health is influenced by complex and interconnected factors at multiple levels, yet few studies have explored these influences systematically across contexts.This qualitative study aimed to identify perceived risk and protective factors for youth mental health from the perspectives of youth, parents, and stakeholders in five European countries, using the Social Ecological Model as an analytical framework.Focus group discussions were conducted with youth (ages 15–24), parents, and stakeholders working with youth in Belgium, Germany, Israel, Poland, and Serbia. A grounded theory approach was used to analyze the data, and findings were categorized across five levels: individual, interpersonal, organizational, community, and societal.Participants described a range of factors affecting youth mental health. At the individual level, identity development, emotional regulation, and coping behaviors were central. The interpersonal level highlighted the importance of family dynamics, generational gaps, peer support, and school-based relationships. Organizational contexts such as schools, workplace, youth movements and informal education were seen as both stressors and sources of support. Community-level influences included social norms, and exposure to community-stressors. Societal-level concerns included the influence of social media and geopolitical instabilities.The study highlights that youth perceive peer relationships and social media as the most influential factors on their mental health, while parents and stakeholders place greater emphasis on family influence. It reveals that youth across countries are deeply affected by geopolitical concerns—such as war, political instability, and climate change—which are often underrecognized by adults.This study highlights the importance of multi-level, context-sensitive approaches to youth mental health promotion. Findings can inform the development of interventions that strengthen protective factors and address structural challenges in diverse settings.

Mental health services have been integrated into primary health care (PHC) in Ukraine since 2022. However, despite the specific communication needs of patients with mental disorders, the standard allocated consultation time in many facilities remains unchanged, potentially compromising care quality.To determine PHC doctors’ opinions regarding the optimal consultation duration for patients with mental health issues.A cross-sectional study using a mixed-methods approach was conducted from March to April 2025 at City Polyclinic No. 1 in Chernivtsi, Ukraine. The quantitative component involved an anonymous online survey of 41 doctors  (representing 82% of the PHC doctors). The qualitative component included semi-structured interviews with 5 doctors. Quantitative data were analyzed using IBM SPSS Statistics.Currently, the maximum allocated time for a consultation is 20 minutes. Only 9.8% of respondents consider this sufficient for mental health cases. Meanwhile, 36.6% deemed it insufficient, and 53.7% stated sufficiency depends on the clinical case. Regarding optimal duration: 46.3% of doctors suggested 30 minutes, while 29.3% and 17.1% advocated for 40 minutes and 50-60 minutes, respectively.  Qualitative data reinforced these findings, with respondents emphasizing that empathy, psychoeducation, and active listening require time beyond the standard slot:  “Patients require detailed explanations, empathy, and reassurance to ensure treatment adherence; this process is inherently time-consuming” (Respondent 1). “Patients need to be heard. When the next patient is knocking, it is ethically difficult to interrupt a distressing consultation and ask them to return later” (Respondent 3).The majority of respondents (46.3%) identified 30 minutes as the optimal balance for gathering information, to provide psychoeducation, and to support the patient. This suggests a need for flexible scheduling mechanisms.The findings highlight a conflict between the administrative standardization of consultation slots and the clinical reality of mental health care.  The discrepancy between allocated and necessary time requires management interventions, such as introducing double booking slots for primary mental health consultations to ensure quality of care.

Anxiolytics, hypnotics, and antidepressants are overused drugs in some European countries. They cause numerous adverse effects and are often used in ways that do not comply with their marketing authorization. Various measures have been implemented by XXXX health authorities to regulate their use, but little data has been published recently to assess their impact. The specifics of their prescription by general practitioners (GP) are also poorly documented, as is the existence of possible regional disparities in their consumption.To quantify the annual deliveries of anxiolytics, hypnotics and antidepressants prescribed by GPs in the XXXX region for patients who consulted them at least once during the year between 2016 and 2023, and characterise these prescriptions.Cross-sectional study of reimbursement data from XXXX health database, analysed sequentially by year and by GPs practising in outpatient settings in XXXX between 2016 and 2023. All XXXX GPs with a predefined minimum activity during the period were included. The data analysis was purely descriptive.Prescriptions issued by 2,779 GPs were analysed for 3,601,397 different patients seen (year 2023). On average, hypnotic deliveries decreased from 22 +/- 16 to 12 +/- 10 dispenses per 100 patients seen per GP per year between 2016 and 2023. More antidepressants were introduced during the period (2.05% +/- 1.22% of patients in 2023 vs. 1.67% +/- 1.24% in 2016). Anxiolytic prescriptions remained stable. Benzodiazepines were prescribed for a duration in line with guidelines for 77.5% +/- 17.9% of hypnotics and 90.2% +/- 7.8% of anxiolytics in 2023.Compared to recent national data on mental health, the increase in antidepressant prescriptions seems consistent, while the stability of anxiolytic consumption in XXXX is a new finding, suggesting regional specificities. The reduction in hypnotic prescriptions suggests that health authorities' efforts in this area have been effective. This study is based on a large volume of objective data but is limited by the approximations required to convert reimbursements into prescription data.This study has provided a better understanding of GP practices and their determinants, paving the way for effective measures to combat the overuse of psychotropic drugs.

Despite presenting greater medical and social vulnerabilities than men with substance use disorders (SUD), women with SUD remain underrepresented in addiction care structures in France. They account for only 20–30% of patients in specialized addiction centers (Centres de Soins, d’Accompagnement et de Prévention en Addictologie – CSAPA) and up to 50% in primary care “microstructures” offering multidisciplinary and coordinated medical, psychological, and social support.The Calliope study aims to explore and compare healthcare needs and satisfaction with healthcare among women with SUD according to the type of healthcare structure they attend (CSAPA vs microstructures).Calliope is a prospective, multicenter, mixed-methods study combining quantitative and qualitative approaches. Participants were women aged ≥18 years, receiving medical follow-up for at least six months for SUD in an addiction care structure, and living in one of four French regions (Occitanie, Grand Est, Île-de-France, Provence-Alpes-Côte-d’Azur).Between November 2024 and June 2025, 120 women were included in the quantitative phase: 85 in CSAPA (71%) and 35 in microstructures (29%). Compared with those in CSAPA, women in microstructures were older (median age 51 vs 43 years; p=0.01), more frequently single (71% vs 45%; p<0.001), and more often lived in personal housing (94% vs 66%; p<0.001). Women in CSAPA reported higher use of opioids (39% vs 20%; p=0.047), opioid antagonists (44% vs 21%; p=0.034), and cannabis (38% vs 17%; p=0.028), and tended to use more benzodiazepines (49% vs 31%). Satisfaction with care did not differ significantly between groups (CSQ-8 median score: 26 [24–26] in CSAPA vs 26 [25–27] in microstructures; p=0.2). Lifetime sexual violence was more frequent among women in CSAPA (72% vs 50%; p=0.024).These preliminary quantitative findings provide new insights into the profiles and care experiences of women with SUD in France, particularly those followed in microstructures, for whom few data were previously available. While satisfaction with care was high across all settings, differences in profiles and care pathways emerged.The ongoing qualitative phase will further explore these findings and will shed light on women’s lived experiences and on the perspectives of healthcare teams.

General practitioners in France face growing demands in mental health care despite limited access to psychologists, long psychiatric waiting times, and fragmented coordination between professionals. Community health centers (centres de santé, CDS) employ salaried multidisciplinary teams and may represent an underused tool to address these structural barriers, yet their contribution to mental health integration remains insufficiently documented.We describe the Centre de Santé de Belleville (CSB), a CDS in Paris bringing together GPs, psychologists, and a psychiatrist within the same organization. Using internal activity data (2023–2025), annual reports, and national policy documents, we examined how the CSB organizes mental health access, referral pathways, and coordination. A structured SWOT reflection was used to identify system-level strengths and limitations. This single-case analysis is illustrative rather than generalizable.For general practice, the CSB illustrates how multidisciplinary structures can facilitate access and organizational coordination for patients whose care pathways are often fragmented. The case also shows the constraints faced by centers relying on short-term financial envelopes and administrative flexibility, making long-term planning difficult. For GPs, CDS may represent a potential organizational alternative, but one highly dependent on policy choices and funding stability.This experience underscores the tension between the policy goals repeatedly expressed at national level—equity, coordination, integration—and the structural features of the French system that limit the diffusion of salaried, team-based primary care. The CSB case suggests that CDS can operationalize aspects of integrated care, but their contribution is shaped less by clinical performance than by institutional factors: financing models, professional power dynamics, and the historical weight of “liberal medicine.” Scaling similar models would require clearer national frameworks, dedicated funding, and recognition of CDS as legitimate actors in mental health pathways.Community health centers can serve as platforms for integrating mental and primary care within primary care settings, but their broader role depends on supportive policies and sustained investment.