"It's more than just physical care": a systematic review and qualitative meta-synthesis of nurses' evolving role in providing mental health care within primary health care systems

Abstract

Background: Mental health disorders contribute significantly to the global disease burden. Integrating mental health services into primary health care (PHC) systems is a promising solution, with nurses playing a critical yet under-explored role due to their proximity to communities and holistic care approach. This study aimed to systematically review and synthesize qualitative and mixed-methods evidence.

Methods: A systematic review and meta-synthesis were conducted, adhering to PRISMA 2020 and ENTREQ guidelines. Six databases (PubMed/MEDLINE, Scopus, Web of Science, CINAHL, PsycINFO, Embase) were searched from inception to June 2025, supplemented by grey literature searches. Inclusion criteria, guided by the SPIDER framework, focused on qualitative and mixed-methods studies exploring nurses' roles in PHC mental health care. Study quality was assessed using the CASP Qualitative Checklist, and data were synthesized using thematic meta-synthesis, facilitated by NVivo 14.

Results: 34 studies from 18 countries were included, revealing four overarching themes: (1) Nurses' mitigation of multilevel stigma through empathy, education, and advocacy; (2) Challenges in navigating structural barriers, including resource scarcity, training gaps, workload pressures, and access inequities; (3) Adaptive psychosocial intervention practices using holistic assessments, empowerment strategies, technology, and cultural adaptations; and (4) Leadership in interprofessional patient-centered care through collaboration, trust-building, recovery-oriented frameworks, and systemic advocacy.

Conclusion: Nurses are instrumental in advancing mental health equity in PHC systems by addressing stigma, overcoming barriers, delivering tailored interventions, and leading collaborative care. Enhancing their impact requires mandatory mental health training, resource allocation, interprofessional frameworks, and further research in diverse global contexts.

Keywords: Interprofessional care; Mental health; Meta-Synthesis; Nurses; Primary health care; Stigma.