Differential P3 reactivity to pornographic versus natural rewards as a neural marker of reward imbalance in problematic pornography use in young heterosexual men.

Mental illness (MI) represents a major public health challenge worldwide, contributing significantly to the overall burden of disease and disability. According to global estimates, nearly half of the population will experience an MI at some point in their lives, making it one of the leading causes of ill health (World Health Organization ). The implications of this are far-reaching and extend beyond individuals affected by MI to their families, communities, and have an impact on healthcare provision. Considering this, all healthcare professionals, regardless of their area of practice, are increasingly likely to encounter patients living with MI in clinical practice (Gyllensten et al. ; Vancampfort et al. ). Physiotherapists, traditionally recognised for their role in the physical rehabilitation of patients, are no exception. Physiotherapists are frequently required to treat patients whose physical conditions are accompanied or complicated by co-existing (undiagnosed or known) mental health (MH) concerns. Anxiety, depression, and stress-related conditions, for instance, may influence recovery trajectories in musculoskeletal rehabilitation, adherence to exercise programmes, and overall health outcomes (Stults-Kolehmainen & Sinha ). Therefore, physiotherapists require not only the skills to treat patients’ physical conditions such as respiratory, critical injury and neurological conditions (Liu et al. ; Saida et al. ; Yohannes & Alexopoulos ), but also the competence, knowledge, attitudes, and behaviours that allow them to manage patients holistically by integrating the physical and psychological dimensions of care (Hooblaul, Cobbing & Daniels ). Globally, there is increasing recognition of the need to integrate MH competencies into physiotherapy curricula. Initiatives in some countries have focused on embedding MH modules, interprofessional training, or clinical placements in psychiatric settings (Connaughton & Gibson ; Gyllensten et al. ; Hooblaul et al. ; Probst & Peuskens ). These efforts aim to ensure that graduates enter practice with the ability to support patients whose recovery is shaped by psychosocial as well as physical factors. However, research suggests that physiotherapists often feel inadequately prepared for this aspect of their professional role (Connaughton & Gibson ; Hooblaul et al. ). This lack of preparedness is partly rooted in physiotherapy education, where MH is often given limited attention compared with other areas of practice. Students, in particular, may feel uncertain about their ability to appropriately manage patients with MI. Inadequate training, combined with negative societal attitudes and stigma, has been found to undermine students’ confidence and limit the quality of care they deliver (Gunduza, Lord & Keller ). Therefore, the educational preparation of physiotherapy students to manage patients with MI emerges as a critical area for investigation and development. In the South African context, this is also a significant challenge. With one in every six South Africans currently struggling with an MI, a need for comprehensive and holistic care has become essential (Booysen, Mahe-Poyo & Grant ). Physiotherapists, as part of the country’s broader rehabilitation workforce, occupy an important position in addressing these challenges. However, their preparedness to manage patients with MI has not been well documented. Research suggests that physiotherapy education in South Africa has historically prioritised biomedical aspects of care, with limited emphasis on MH (Gunduza et al. ). Students on clinical rotations may therefore encounter patients with co-existing MI while feeling inadequately equipped to manage their needs. This lack of preparedness is problematic for both patient outcomes and students’ professional development. Furthermore, the lack of preparedness can contribute to missed or delayed identification of psychological symptoms, suboptimal patient–provider communication, and fragmented care, ultimately compromising patient outcomes and continuity of care (Hooblaul et al. ). At the same time, students may experience uncertainty or reduced confidence in their clinical decision-making, which can hinder their professional growth and limit their ability to provide holistic, patient-centred care. From a patient care perspective, insufficient confidence and limited understanding of MI may negatively influence therapeutic engagement, communication, adherence to treatment, and overall rehabilitation outcomes. This is particularly significant where psychological factors significantly shape recovery trajectories (Stults-Kolehmainen & Sinha ; Vancampfort et al. ). From an educational perspective, students who feel unprepared may experience increased anxiety, uncertainty, and avoidance behaviours in clinical encounters. This can hinder the development of clinical reasoning, professional identity, and confidence in managing complex patients (Connaughton & Gibson ; Gunduza et al. ). A