Determinants of mental health in earthquake survivors: Trauma memories, cognitions, identity and safety-seeking behaviours in PTSD and CPTSD models.

Canada has experienced a substantial rise in the prevalence of people living with mental disorders over the past decade, with rates of generalized anxiety disorder and major depressive disorder approximately doubling during this period (). In Canada, mental illnesses and substance use disorders are among the leading causes of disability and impose a substantial economic burden on the health system and society, imposing an estimated 51 billion dollars in annual costs through lost productivity, healthcare utilization, and reduced health-related quality of life (). Despite this growing burden, service provision has not kept pace with need. Data from the 2022 Mental Health and Access to Care Survey indicate that only 48.8% of individuals reporting a mental illness had consulted a healthcare professional, and although 58.8% expressed a need for counselling, just 43.8% received such services (). These gaps highlight a critical mismatch between population mental health needs and the available workforce and services. Within this context, nurses hold key positions in the mental healthcare system. They provide comprehensive mental health assessments, deliver psychoeducation, establish and sustain therapeutic relationships, and offer ongoing counselling and support to individuals and families (; ; ). Through close and sustained contact with service users, nurses are uniquely placed to advocate for equitable access to care and to challenge stigma and discriminatory practices within healthcare settings and the wider community (; ; ). However, the potential of nursing to respond to escalating mental health needs is constrained by significant workforce shortages. Globally, mental health nurses represent only 1.03% of the nursing workforce, with an average of 3.8 mental health nurses per 100,000 population, underscoring a substantial shortfall in specialist provision (). A key driver of this shortage is the persistent lack of interest among undergraduate nursing students in pursuing careers in mental health nursing (MHN), with multiple studies reporting MHN as one of the least preferred specialties at graduation (; ; ; ; ). This pattern has frequently been linked to negative or ambivalent attitudes toward MHN and toward people living with mental illness, including stereotypical views, fear, and discomfort (; ). These attitudes are shaped by a complex interplay of personal beliefs, societal stigma, and the nature and quality of mental health content and clinical experiences within undergraduate curricula. Understanding the factors that influence nursing students’ attitudes and career intentions in relation to MHN is therefore crucial to informing educational strategies and workforce planning aimed at strengthening the future MHN workforce.