Psychiatry Int., Volume 7, Issue 3 (June 2026) – 42 articles

The objective of the study was to examine longitudinal associations between cybervictimization and mental health and suicidal behavior among youth. Data for 4930 youth were drawn from the Canadian Health Survey on Children and Youth (CHSCY), a nationally representative cohort survey with collection waves in 2019 and 2023. Logistic regression models predicted self-reported mental health outcomes in 2023 (depression, anxiety, suicidal ideation and suicide attempt) from cybervictimization in 2019, adjusting for baseline mental health, socio-demographic covariates, frequency of online activities, and experience of traditional bullying victimization. Fully adjusted models suggested that cybervictimization in 2019 was significantly associated with youth depression (OR: 2.41, 95%CI: 1.68, 3.45), anxiety (OR: 1.33, 95%CI: 1.05, 1.68), and suicidal ideation (OR: 1.95, 95%CI: 1.12, 3.39) four years later. The association with suicide attempt was positive but not statistically significant in adjusted models (OR: 1.77, 95%CI: 0.99, 3.16). These results suggest that youth who experience cybervictimization in adolescence are at elevated risk of mental health problems lasting into young adulthood, an association which appears to be independent of the experience of traditional face-to-face victimization. Bullying prevention programs targeted towards reducing cybervictimization may warrant further study, with the aim of informing approaches to improve adolescent mental health. Full article

Workplace violence and hetero-aggressive behavior represent significant occupational hazards in mental health settings, particularly for psychiatry and psychology trainees who are frequently exposed yet often insufficiently prepared. This scoping review aimed to map and critically describe existing educational approaches to violence risk assessment, prevention, and management in mental health training programs, with a focus on psychiatry and psychology education. A scoping review identified 17 eligible studies examining curricular content, pedagogical modalities, and training outcomes related to violence education. Included studies encompassed surveys, curricular descriptions, and educational interventions employing didactic, simulation-based, and blended learning formats. Overall, the literature revealed variability and fragmentation in training, with most programs lacking structured or longitudinal curricula. Didactic approaches improved conceptual understanding but were consistently perceived as insufficient for skill acquisition and confidence. In contrast, blended and simulation-based modalities, particularly those using standardized patients and structured debriefing, were associated with greater gains in applied skills, confidence, and perceived clinical readiness. Core competencies emphasized across curricula included de-escalation strategies, violence risk assessment frameworks, communication skills, and, less consistently, legal and institutional considerations. These findings highlight persistent educational gaps and support the integration of experiential, longitudinal, and system-informed training models to better prepare mental health trainees for violence-related clinical challenges. Full article

Background: Problematic social media use (PSMU) has been increasingly conceptualized as a form of behavioral addiction, characterized by loss of control and continued engagement despite negative consequences. Adolescents with psychiatric disorders may represent a particularly vulnerable group, yet clinical evidence remains limited. This study examined the prevalence of PSMU in help-seeking adolescents and investigated how psychological vulnerabilities influence social media (SM) engagement, platform selection, and content preferences. Methods: A cross-sectional study was conducted on 265 adolescents (12–18 years) undergoing psychiatric evaluation. Participants completed validated measures of PSMU (Social Media Disorder Scale-9) and perceived stress, along with items assessing screen time, platform usage, engagement style (active vs. passive), and content preferences. Diagnostic data were retrieved from clinical assessments. Results: PSMU prevalence was 14.4%, rising to 19.2% among adolescents with internalizing disorders. Female and gender-diverse adolescents showed significantly higher PSMU scores. PSMU was associated with greater screen time (OR = 2.41) and nearly threefold higher odds of intensive TikTok use. Overall, SM engagement was predominantly passive, particularly among adolescents with depressive disorders, while those with neurodevelopmental disorders more frequently engaged actively. Higher stress levels were linked to greater SM use, especially on TikTok and Instagram. Conclusions: PSMU appeared to be relatively prevalent among adolescents receiving psychiatric care, particularly those with mood and anxiety disorders and high stress levels. Findings highlight the importance of assessing PSMU in these groups of adolescents and analyzing qualitative patterns of SM engagement to identify at-risk youth and inform targeted clinical interventions. Full article

Psychotherapy is an effective treatment for a wide range of mental disorders, yet treatment outcomes remain highly variable across patients. The emerging field of precision psychotherapy seeks to address this variability by tailoring interventions to the characteristics and needs of individual patients. Recent advances in artificial intelligence (AI) have accelerated this effort by enabling predictive models that identify patients at risk for treatment non-response and support personalized treatment selection. However, most current approaches to precision psychotherapy focus primarily on predicting outcomes or stratifying patients into subgroups, while offering limited tools for supporting clinical decision-making within the therapeutic process itself. This paper proposes that advancing precision psychotherapy may benefit from conceptual frameworks capable of representing therapeutic interactions as they unfold within clinical sessions. Psychotherapy is fundamentally a communicative process in which psychological change is understood to emerge through the evolving dialogue between therapist and patient. To help structure this process, we introduce a dimensional framework that conceptualizes mental activity as organized across five hierarchical dimensions: action, thought, emotion, experience, and being. These dimensions provide a structured representation of the forms in which psychological activity appears in therapeutic dialogue and may allow therapeutic interaction to be described as a sequence of dimensional transitions between therapist and patient. Such a representation could serve as a conceptual basis for the future development of computational tools aimed at analyzing therapeutic dialogue and identifying patterns that may be associated with therapeutic processes such as change, rupture, or shifts in interaction. Integrated with AI-based analysis of psychotherapy sessions, this framework may inform the design of systems intended to support the analysis of therapeutic processes, such as monitoring patterns of interaction or identifying potential shifts in patient experience, while preserving the central role of clinical judgment. By providing a formalized representation of therapeutic dialogue, this approach is intended as a conceptual and methodological step toward the development of more precise, process-informed approaches to psychotherapy. Full article

Background: Procrastination is a voluntary and irrational delay in taking action despite negative consequences. We aimed to conceive/suggest a definition of procrastination, assess the behavior, and determine its psychopathological features (within the contexts of attention-deficit/hyperactivity disorder and obsessive–compulsive disorder. Method: In this scoping study, we systematically reviewed original research studies with conceptual and clinical data related to procrastination. Data were extracted regarding definitions, populations, instruments used, and psychopathology. Results: A total of 387 studies were included. Only 13% utilized clinical/subclinical populations. Definitions of procrastination showed no single consensus. The most cited elements involved irrational delay, awareness of consequences, task aversiveness, and self-regulation failure. The most frequently used assessment tool was Lay’s General Procrastination Scale. A considerable number of studies identified associations between procrastination and clinical constructs such as impulsivity, perfectionism, executive dysfunction, low self-esteem, and mood instability. Few studies directly assessed procrastination in formal diagnostic categories, suggesting that procrastination shares neurocognitive and emotional regulation deficits with these disorders, especially in domains involving task initiation, inhibitory control, and intolerance of discomfort. Conclusions: Procrastination is a transdiagnostic construct rather than a unitary behavioral trait. Its multifactorial nature calls for further clinical investigation, particularly in structured diagnostic settings. A unified definition is needed to distinguish between normative delay and clinically relevant procrastination. Full article

Rates of suicide among children and adolescents have increased significantly in the past two decades, especially among minoritized youth. Identification of modifiable factors associated with suicidality in diverse samples is important for informing targeted prevention and intervention efforts. Toward this end, this study utilized a multi-informant approach to examine the association between aggression and suicide risk in an urban pediatric sample. Children and adolescents (N = 136; 69% Black or African American) between the ages of 6 and 17 (M_age = 11.4 ± 3.0) were recruited while attending a well-child visit at a Baltimore City pediatric primary care clinic. Pediatric participants and their caregivers completed measures of aggressive behavior and depressive problems. Suicide risk was derived from parent-, youth-, and clinician-reports of pediatric participants experiencing suicidal thoughts and behaviors. After controlling for demographic variables, results of stepwise logistic regressions revealed that parent- and youth-reported aggressive behavior were significantly associated with suicide risk (OR = 1.18, p = 0.005 and OR = 1.23, p = 0.006, respectively). When depressive problems were added to the model, depressive problems were significantly associated with suicide risk (parent-report OR = 1.34, p = 0.015 and youth-report OR = 1.28, p = 0.025), but aggressive behavior was no longer significantly associated. Findings from this study suggest that aggression could be an important indicator of suicide risk, but not above and beyond the influence of depressive symptoms. In this sample, aggressive behavior may be at least partially explained by depressive symptoms and a manifestation of internal distress. Full article

Kazakhstan has one of the highest suicide rates globally, yet little is known about how suicide-related content is structured and expressed on VKontakte, the country’s widely used social network. This study aimed to qualitatively analyze VKontakte communities associated with suicide, depression, and self-harm, with a focus on naming conventions, thematic characteristics, and potential indicators relevant for digital prevention strategies. A qualitative content analysis was conducted on 50 public VKontakte communities selected from a larger dataset of 2353 communities collected between December 2021 and March 2025. Communities were included if suicide- or self-harm-related references appeared in their names, descriptions, posts, or visual elements and if they had at least one subscriber with a probable connection to Kazakhstan. Textual and visual content was examined manually at the community level. Six naming typologies were identified: explicitly suicidal, self-harm-focused, depressive, ironic, supportive, and non-related. Community content ranged from direct expressions of suicidal ideation to aestheticized or romanticized representations of pain and death. Some communities contained material that encouraged or normalized self-harm with minimal moderation, while others combined supportive interactions with potentially harmful content. Overall, VKontakte communities linked to users from Kazakhstan represent a heterogeneous digital environment in which supportive and risk-related elements may coexist. These findings highlight challenges for automated detection and suggest that patterns of engagement with specific community types may serve as descriptive indicators for future ethically guided research. Full article

Background: Substance Use Disorder (SUD) is more prevalent among individuals with psychotic disorders than in the general population and is associated with poorer functioning, treatment adherence, and outcomes. Understanding motives for substance use in this group is essential for targeted interventions. Methods: Motives were assessed using the 26-item Reasons for Substance Use Questionnaire in 118 male patients admitted for a psychotic episode between October 2024 and September 2025. Results: In total, 20.3% of the participants were first-admission patients. Enhancement motives were most frequently endorsed, followed by coping and social motives; conformity and relief were least endorsed. In exploratory unadjusted analyses, patients with multiple hospital admissions reported greater relief related motives, including alleviating positive symptoms and medication side effects. Motives varied by primary substance used. Conclusions: Mood enhancement and coping were predominant motives; relief motives appeared to be stronger in patients with multiple admissions. Further research is needed to improve treatment strategies. Full article

Importance: Evidence regarding the organization of civilian health care systems in active war zones is limited, yet critical for maintaining services for vulnerable populations. Objective: To describe the operational challenges and adaptive strategies implemented by an opioid agonist therapy (OAT) clinic to ensure continuity of care for patients maintained on methadone and buprenorphine during a period of prolonged armed conflict. Design: A descriptive case study of clinical, logistical, and regulatory adaptations following the escalation of conflict in Israel beginning 7 October 2023, through the 12-day Israel-Iran war in June 2025. Setting: A hospital-based ambulatory methadone maintenance treatment (MMT) clinic in the Tel Aviv region. Participants: A vulnerable population of patients with opioid use disorder (OUD) receiving daily or supervised OAT. Exposure(s): National emergency conditions, including mass evacuations, fluctuating missile threats from multiple fronts (Gaza, Lebanon, Yemen), and direct regional strikes in 2024 and 2025. Main Outcome(s) and Measure(s): The primary focus was maintaining treatment continuity through rapid protocol modifications and expanded take-home dose (THD) regulations. Results: The conflict necessitated immediate departures from standard clinical protocols. Key adaptations included the rapid expansion of THD eligibility to mitigate the risks associated with travel to the clinic during active shelling and the reallocation of resources. Regulatory frameworks were iteratively revised as the security situation evolved, shifting from daily supervised dosing to flexible, safety-oriented dispensing models. Conclusions and Relevance: Findings suggest that during national emergencies, decentralizing OAT through expanded THD regulations is essential to prevent treatment interruption and relapse. These adaptive strategies offer a framework for health policy in other conflict-affected regions to protect high-risk populations. Full article

Subthreshold depression (SD) is a significant risk factor for major depressive disorder. However, individuals with SD often do not seek professional help. This study aimed to identify a consensus-based list of self-help and “acts of kindness” (AK) strategies that are both helpful and feasible for individuals with SD while clarifying the perception gaps between clinical experts and individuals with lived experience. A three-round e-Delphi process was conducted with 51 clinical psychologists and 191 individuals with SD. The participants evaluated 187 initial strategies for helpfulness and feasibility using a 5-point Likert scale. After three rounds, five self-help strategies (e.g., “getting fresh air”) and one AK strategy reached a consensus for helpfulness. Conversely, 10 self-help and 11 AK strategies were endorsed for feasibility. A significant perception gap was identified: experts reported higher helpfulness than the SD panel, whereas the SD panel rated the feasibility of AK strategies significantly higher than the experts. These findings highlight a discrepancy between professional expectations and lived experience, suggesting that AK may serve as accessible, low-threshold options for mood improvement in clinical settings. Full article

Background: Psychiatric disorders, including skin-picking disorder (SPD), may be conceptualized as manifestations of a dysregulated behavioral immune system or maladaptive emotion schema, in which disgust—typically elicited by external threats—is directed toward the self. Method: A total of 147 females (mean age = 32 years) with SPD completed disorder-specific measures of automatic and focused skin-picking, as well as scales assessing self-disgust and disgust sensitivity. Correlation and path analyses were conducted to examine whether misdirected disgust toward one’s own body (self-disgust) and difficulties in regulating disgust (disgust sensitivity) are associated with pathological skin picking. Results: Self-disgust was substantially correlated with focused skin-picking. The path analysis indicated a direct path from self-disgust to focused skin-picking and an indirect path from disgust sensitivity, mediated by self-disgust, to focused skin-picking. Similar associations were not present for automatic skin-picking. Limitations: Due to the cross-sectional design of the study, the results should be interpreted as associative rather than causal and do not allow conclusions about temporal or directional mediation processes. Conclusions: Assessment of both disgust-related traits should be integrated into the diagnostic process for SPD. Disgust regulation training, as well as compassion-based strategies, may be beneficial in modifying pathological skin-picking. Full article

Research on burnout has been a consistent and increasingly popular topic since the 1970s when it was first defined. The focus of publications regarding burnout spans studies of various occupations, countries, age groups, social groups, and effects. A recent development is the documenting of brain changes associated with burnout. This review aims to investigate the peer-reviewed publications on this topic published in 2025. Although not a scoping review because it is limited to one year and peer-reviewed reports, this study follows the standardized PRISMA-ScR guidelines for scoping reviews as the methodology. The search was of five relevant databases: Google Scholar, OVID, PubMed, Scopus, and Web of Science. Brain changes AND burnout AND 2025 are the keywords searched. The keywords were limited to these to identify those articles where researchers themselves connected a relationship between brain changes and burnout during 2025. The results were several perspectives that investigated burnout, and the brain changes were various. The findings differ depending on the measurement tools used for burnout assessment, as discussed. The purpose of conducting the review is to aid psychiatrists in identifying the most recent research to enhance patient treatment options by considering current information on this developing topic. Full article

Schizophrenia is a chronic, progressive, and multifactorial disorder that leads to significant disability and social maladaptation in patients. Although considerable progress has been made in research, the etiology and pathogenesis of schizophrenia remain incompletely understood. However, the involvement of genetic factors in the development of this disease has been established. Using the GWAS catalog, we identified variants within the TCF4 gene that showed a significant association with schizophrenia. The GWAS catalog lists 30 variants within the TCF4 gene associated with schizophrenia. Among these, 12 variants demonstrate a specific association with schizophrenia in the absence of reported comorbidities. The presence and allele frequencies of these variants were subsequently analyzed in two population databases: Database of Population Frequencies of Genetic Variants in the Russian Federation (DPF) and gnomAD. For the functional annotation of the genetic variants, we utilized specialized tracks within the UCSC Genome Browser. The CpG Islands track served to identify potential regulatory regions. The GeneHancer database was used to predict SNP localization within enhancer regions and their potential target genes. To characterize the epigenetic landscape and functional chromatin states, the ENCODE Regulation and ENCODE cCREs tracks were utilized. Comparative analysis revealed significant heterogeneity in the allele and genotype frequencies of TCF4 polymorphisms between the Russian population and other global cohorts. This observed inter-ethnic variability may partly explain the discrepant genetic association findings for schizophrenia reported across different ancestral groups. Therefore, further functional studies are essential to define the precise mechanisms by which TCF4 variants contribute to disease pathogenesis. Full article

Suicidal behavior includes completed suicides and suicide attempts, which reflect different risk profiles and require joint analysis. In the Republic of Kazakhstan, recent data that simultaneously assess temporal trends, regional heterogeneity, and the probability of a fatal outcome remain limited. This study aimed to comprehensively assess the dynamics of completed suicides and suicide attempts in the Republic of Kazakhstan in 2023–2024, describe regional and age differences, and identify factors associated with a higher likelihood of completed suicide versus an attempt. A nationwide retrospective population-based observational study was conducted using anonymized officially registered data on suicidal behavior in Kazakhstan for 2023–2024. All registered episodes were included (n = 15,478), including completed suicides (n = 7102) and attempts (n = 8376). Age strata were 5–14, 15–24, 25–34, 35–44, 45–54, 55–64, 65–74, and 75+. Rates per 100,000 population, the attempt-to-completed ratio, and the proportion of completed suicides among all episodes were calculated. Associations were assessed using odds ratios (ORs) with 95% confidence intervals (reference group: 15–24 years) and the Cochran–Armitage χ² test for trend (p < 0.05). In 2024 versus 2023, the number of completed suicides decreased from 3694 to 3408 (−7.7%), and attempts from 4340 to 4036 (−7.0%). Among minors, completed cases decreased (−14.2%), while attempts increased (+20.5%). The completed suicide rate declined from 18.6 to 17.2 per 100,000, and the attempt rate from 21.9 to 20.4 per 100,000. Across regions in 2024, completed suicide rates ranged from 11.7 to 28.8 per 100,000, attempt rates from 5.0 to 46.5 per 100,000, and the attempt-to-completed ratio from 0.3 to 3.6. Age showed a stable lethality gradient, with the proportion of completed suicides among all episodes increasing from 26.4% (15–24) to 67.7% (75+). The risk of completed suicide versus an attempt was highest in the 75+ group (OR = 5.86; 95% CI 5.15–6.67; p < 0.001) and increased sharply after age 45. In 2024, the likelihood of a fatal outcome was significantly higher for episodes with unestablished circumstances (OR = 2.29; 95% CI 2.08–2.52; p < 0.001) and severe somatic diseases (OR = 2.64; 95% CI 1.91–3.65; p < 0.001), whereas family/relationship conflicts were more common among attempts (e.g., conflict with parents OR = 0.12; 95% CI 0.06–0.21; p < 0.001). Similar patterns were observed in 2023 (unestablished circumstances OR = 1.92; severe somatic diseases OR = 2.22; conflict with parents OR = 0.17; all p < 0.001). In 2023–2024, Kazakhstan showed a decline in registered completed suicides and attempts; however, the structure of suicidal behavior is becoming more complex. Attempts among minors are increasing, high regional heterogeneity persists, and there is a pronounced age-related increase in the probability of a fatal outcome, especially after age 45. Prevention priorities should include targeted measures for older age groups and patients with severe somatic pathology, strengthening programs for early identification and support of minors, and improving the quality of registration and interagency analysis of the circumstances of fatal outcomes. Full article

The rapid expansion of digital technologies has created an unprecedented level of increased connectivity, yet the neurobiological mechanisms underlying these changes remain incompletely understood. This systematic review synthesizes the currently available evidence on neurobiological findings related to problematic internet use, problematic smartphone/social media use, and internet gaming disorder, with a focus on reward processing, attentional control, and emotional regulation. Across the included studies, recurrent findings suggested the involvement of fronto-striatal circuitry, salience- and reward-related regions, and executive-control networks. Alterations in large-scale brain networks, including the default mode, salience, and frontoparietal systems, were also reported, although the evidence base was heterogeneous and consisted largely of cross-sectional studies with modest sample sizes. Overall, the findings support a provisional neurobiological framework linking reward-related processing, inhibitory-control difficulties, and large-scale network alterations, but better-standardized studies are needed to draw conclusions. Full article

Coronavirus anxiety is defined as a psychological contrast characterized by excessive fear, obsessive thoughts, and reassurance-seeking behaviors associated with COVID-19. As current scales have been tested primarily in North American populations, we aimed to translate and culturally adapt three measures of dysfunctional coronavirus anxiety—the Coronavirus Anxiety Scale (CAS), the Obsession with COVID-19 Scale (OCS), and the Coronavirus Reassurance-Seeking Behaviors Scale (CRBS)—for the first time in Greek-speaking populations. To translate existing scales, we followed best practices for cross-cultural comparisons using forward translation (English to Greek) and backward translation (Greek to English) with expert translation review, prior to conducting pilot testing and confirmatory factor analysis in a bespoke survey population. A total of 405 adults from Cyprus participated in this study. The results indicated that the Greek versions of these measures demonstrated adequate reliability (Cronbach’s alphas > 0.70) and strong factor structure, as supported through confirmatory factor analysis. However, only the CAS exhibited evidence of both convergent and divergent validity. Our study makes several innovative contributions which have broad implications for crisis preparedness, including providing a framework for mental health interventions in future pandemics or Black Swan events. Full article

Coal mining is a hazardous occupation that can adversely affect both the physical and mental health of workers. This study aimed to estimate the pooled prevalence of various mental health outcomes and job burnout among coal miners and to summarize available intervention strategies addressing these conditions. A systematic search of scientific databases, including Scopus, Embase, PubMed and Cochrane Central, was conducted for studies published from 2000 onwards. The study protocol was registered in PROSPERO [CRD42024536144]. Methodological quality of the studies was evaluated using AXIS, ROBINS-I and RoB 2 tools. A random-effects model was applied to estimate pooled prevalences. Of the 14,048 studies identified, 34 studies were included, comprising a total of 38,996 coal miners. The pooled prevalence of job burnout was 53.75% (95% CI: 50.64–56.86%), while depressive symptoms were observed in 35.35% of coal miners (95% CI: 16.43–54.28%; I² = 97.41%). The pooled prevalence estimates were calculated with substantial heterogeneity (I² > 90%) and wide prediction intervals indicate considerable variability across studies. These findings should be interpreted with caution due to substantial heterogeneity across studies, which may limit the reliability of pooled estimates. A limited number of studies reported interventions, including an Integrated Approach of Yoga Therapy (IAYT) and peer-based mental health and suicide prevention programs with supervisor training, which demonstrated potential benefits; however, these findings are based on limited and methodologically heterogeneous evidence, and the overall certainty remains low. The findings highlight a substantial burden of mental health problems among coal miners and suggest important policy implications, particularly for integrating mental health screening into periodic occupational health assessments. Addressing personal, social, and work-related determinants through comprehensive workplace strategies may help improve mental well-being and support workforce sustainability in the mining sector. Full article

Background: Anorexia nervosa (AN) commonly emerges during adolescence and disproportionately affects girls. In recent years, problematic social media use (PSMU) has been identified as a potential sociocultural risk factor for eating disorder symptoms; however, the psychosocial pathways linking PSMU to AN symptomatology remain insufficiently understood. This study examined the associations between PSMU and AN symptoms in adolescent girls and explored the roles of perceived parenting style and childhood traumatic experiences as explanatory pathways. Methods: A cross-sectional, school-based survey was conducted with 463 adolescent girls aged 13–18 years in İstanbul, Türkiye. Participants completed validated self-report measures assessing AN symptoms (Eating Attitudes Test–26), problematic social media use (Social Media Disorder Scale), perceived parenting style (Parenting Styles and Dimensions Questionnaire), and childhood trauma (Childhood Trauma Questionnaire). Structural equation modeling was used to examine direct and indirect associations between PSMU and AN symptoms, controlling for age, body mass index, and socioeconomic indicators. Indirect effects were tested using bias-corrected bootstrapping. Results: Problematic social media use was directly associated with greater AN symptom severity (β = 0.18, p < 0.001). Significant indirect associations were also observed via perceived parenting style (β = 0.06, 95% CI [0.03, 0.11]) and childhood traumatic experiences (β = 0.07, 95% CI [0.04, 0.12]). Childhood trauma accounted for a larger proportion of the indirect association, while parenting style contributed a smaller but significant pathway. When both pathways were included simultaneously, the direct association between PSMU and AN symptoms remained significant, indicating partial mediation. Model fit indices indicated good overall fit. Conclusions: Problematic social media use is meaningfully associated with anorexia nervosa symptoms among adolescent girls, both directly and through indirect pathways involving parenting context and childhood trauma. Childhood trauma may be interpreted as a variable showing a significant indirect statistical association with both problematic social media use and anorexia nervosa symptoms, rather than a causal determinant within the present design. These findings underscore the importance of integrated, trauma-informed and family-sensitive prevention strategies that address adolescents’ digital environments alongside broader psychosocial vulnerabilities. Full article

Pediatric psychiatric emergency department (ED) visits have increased globally, yet many children do not receive timely outpatient follow-up. Although South Korea provides universal health coverage through its National Health Insurance (NHI), additional financial barriers may impede the continuity of mental health care. This study examined whether supplemental private insurance is associated with improved outpatient mental health follow-up after pediatric psychiatric ED visits within a universal coverage system. A retrospective cohort study was conducted at a tertiary children’s hospital in South Korea including 520 psychiatric ED visits (480 unique patients aged <18 years) from 2016 to 2024. The primary outcome was attendance at an outpatient mental health visit within 30 days of ED discharge. Multivariable logistic regression was used to assess the association between insurance type (NHI-only versus NHI plus supplemental private insurance) and follow-up, adjusting for age, sex, clinical presentation, and prior mental health care. Overall, 53.7% of patients attended a 30-day follow-up visit. Patients with supplemental private insurance had significantly higher follow-up rates than those with NHI alone (58.8% vs. 45.5%, p = 0.019). In adjusted analysis, supplemental private insurance was independently associated with increased follow-up (adjusted odds ratio 1.50, 95% confidence interval 1.10–2.05, p = 0.02). A significant interaction was observed between insurance type and prior mental health care (p_interaction = 0.03): the insurance effect was pronounced among patients without prior outpatient mental health treatment (45.6% vs. 38.8%) but negligible among those with prior treatment (71.9% vs. 72.5%). Prior outpatient mental health treatment (adjusted odds ratio 2.00, 95% confidence interval 1.30–3.10) and suicidal presentation were also significant predictors. Even within a universal health coverage system, supplemental private insurance is associated with better outpatient follow-up after pediatric psychiatric emergencies, particularly among patients new to the mental health system. Reducing financial barriers, expanding community-based mental health services, and strengthening care coordination are essential to ensure equitable continuity of care for all children. Full article

Background: This study aims to synthesise available evidence on positive psychology interventions for enhancing resilience among university students, based on randomised controlled trials (RCTs). Methods: A comprehensive search was conducted in Scopus, CINAHL, PsycINFO, and PubMed from the inception of positive psychology interventions until July 2025. The search terms included “PPI” or “positive psychology intervention” and “resilience” or “psychological resilience”; “university students”, “freshmen”, “higher education students”, “adolescents”, or “adolescent” or “teenagers”; and “resilience training”, “resilience enhancement”, or “positive psychology intervention (PPI)” and “resilience reinforcement”. The Preferred Reporting Items for Systematic Review and Meta-Analyses 2020 guidelines were followed for conducting and reporting this review. Results: The systematic search identified 2346 records. After the removal of duplicates and the screening of titles and abstracts, 32 full-text articles were assessed for eligibility, and four RCTs were included in the final analysis. The risk of bias was analysed for the studies using RoB-2 for Cochrane reviews, and studies deemed to be at high risk of bias were excluded from the final review. Overall, all included studies demonstrated an improvement in resilience scores in the intervention group compared to those in the control group. In this review, Cohen’s d was calculated to standardise the mean differences across the studies, even when their outcome measures differed. Conclusions: This review suggests that resilience interventions could enhance resilience and associated psychological constructs, providing preliminary guidelines for developing and implementing resilience enhancement interventions for university students. The review protocol is registered under PROSPERO with the ID CRD420251138034. Full article

(1) Background: Social media addiction (SMA) is conceptualized as a behavioral addiction linked to emotional dysregulation. This study investigates whether multidimensional state boredom mediates the relationship between the quest for significance and SMA, exploring the moderating role of age cohorts. (2) Methods: A cross-sectional study was conducted with 316 Spanish participants (aged 18–68) divided into Generation Z, Millennials, and Generation X. Standardized measures (BSMAS, SQS, MSBS) were analyzed using a multiple moderated mediation model (PROCESS Model 14), controlling for gender. (3) Results: Boredom dimensions correlated positively with both quest for significance and SMA. The final model explained 53.5% of SMA variance. High-arousal boredom and inattention were positively associated with SMA, while low-arousal boredom showed a negative association. Notably, the quest for significance was indirectly associated with SMA through high-arousal boredom exclusively among Generation Z, with no significant indirect effects found in older cohorts. (4) Conclusions: The findings highlight high-arousal boredom as a key link between existential motives and SMA, particularly in younger individuals. These results underscore the importance of age-specific emotional and motivational processes in designing prevention and intervention strategies for problematic social media use. Full article

Suicide is commonly approached through clinical and psychological frameworks centred on the individual, alongside social explanations emphasising collective conditions. These perspectives offer complementary leverage for understanding and preventing suicidal behaviour. Between these levels, a clinically decisive segment can be specified with greater precision for psychiatric practice, namely the processes through which suffering becomes speakable, socially legitimate and clinically actionable, or is displaced into self-censorship, isolation and delayed help-seeking. This paper advances a service-facing biosemiotic model of suicide risk that formalises this segment as a communicative infrastructure and links it to the public circulation of suicide narratives across media and digital environments. The model comprises two coupled modules. The first, the communicative-classification module, characterises labelling and delegitimation operations that allocate epistemic credibility to crisis talk, foster self-stigma and increase the social cost of disclosing suffering. The second, the public-feedback module, specifies how media representation and repetition regulate the symbolic availability of narrative scripts, with closure- and openness-oriented configurations positioned along the Werther–Papageno continuum. Coupling the modules yields testable propositions concerning mediation via anticipated sanction and moderation by stigma and speakability and identifies conditions under which protective content may show limited translation into help-seeking behaviour. Implications are outlined for how the model may inform therapeutic risk assessment, continuity of care, and prevention. These implications are framed as hypotheses and implementation-relevant considerations derived from the model, with emphasis on (i) operationalising speakability as a clinically evaluable dimension, (ii) identifying institutional conditions that may reduce the communicative cost of help-seeking, and (iii) aligning public communication strategies with international reporting standards. The model is intended to support future empirical testing rather than to establish effectiveness at this stage. Full article

Background: Data on early changes in body composition during acute-phase treatment in adolescents with major depressive disorder (MDD) remain limited. In particular, the utility of novel anthropometric indices reflecting central and visceral adiposity has not been explored in this population. This study therefore aimed to examine short-term clinical outcomes alongside detailed anthropometric measures in drug-naïve adolescent inpatients receiving fluoxetine-based pharmacotherapy. Methods: Prospective, clinician-directed, non-randomized inpatient study. Drug-naïve adolescents with severe MDD (n = 23) received fluoxetine 20 mg/day, with some patients additionally receiving low-dose quetiapine (100 mg/day) based on clinical indication for six weeks. Depressive symptomatology was evaluated by questionnaires Montgomery–Åsberg Depression Rating Scale (MADRS) and Children’s Depression Inventory (CDI). Conventional and novel anthropometric indices (BMI, WHtR; BRI, AVI, ABSI, BAI) were examined using the objective bioimpedance-derived method for body composition. Results: Depressive symptom severity decreased over the six-week treatment period, with significant improvements observed on both MADRS and CDI (time effect p < 0.001). Response and remission rates increased over time in the overall sample. No statistically significant changes were observed in conventional or novel anthropometric indices across the study period. Conclusions: In this prospective pilot cohort of adolescent inpatients with MDD, six weeks of fluoxetine-based pharmacotherapy was associated with improvement in depressive symptoms. No short-term changes were observed in anthropometric indices; however, given the small sample size and limited follow-up, these findings should be interpreted cautiously and cannot be considered definitive evidence of cardiometabolic safety. Full article

Attention-Deficit/Hyperactivity Disorder (ADHD) is frequently associated with working-memory (WM) weaknesses that affect learning and everyday functioning. This systematic review examined the extent to which technology-delivered interventions improve WM in children and adolescents with ADHD, with primary emphasis on standardized objective WM outcomes and secondary consideration of rating-based or in-app measures. Following PRISMA 2020 guidelines, we searched PubMed, PsycINFO, Web of Science, Scopus, ERIC, and IEEE Xplore and identified 22 eligible studies spanning PC-based training, mobile interventions, AI-adaptive programs, wearables, and neurofeedback. Across modalities, the clearest near-transfer signal emerged from process-specific PC-based interventions and some AI-adaptive programs evaluated with standardized objective WM tests. Mobile and neurofeedback approaches appeared promising in some studies, but the evidence was more heterogeneous and was more often supported by ratings, in-app composites, or less rigorous designs. Overall, current evidence suggests that technology-assisted WM interventions are most promising when they are process-specific, adaptive, and delivered at a sufficient dose, although conclusions remain constrained by heterogeneity in study design, outcome type, and methodological rigor. Full article

Background: The immediate postpartum period is a critical window for maternal mental health, with many women experiencing transient depressive disturbances that can predispose them to perinatal depression. Protective factors such as social support and religiosity may mitigate these depressive symptoms, yet their combined role in the early days after childbirth remains insufficiently explored. This study aimed to assess the relationship between perceived social support, religiosity, and postpartum blues during the first three days postpartum. Methods: A cross-sectional study was conducted with 294 postpartum women (mean age 30.2 ± 5.02 years) at the University Hospital Centre Osijek, Croatia. Participants completed the Edinburgh Postnatal Depression Scale (EPDS), Religiosity Scale (RS), and Social Support Scale (SSS). Nonparametric tests, correlation analyses, and linear regression were used to identify predictors of postpartum blues. Results: Depressive disturbances (EPDS > 10) were observed in 28.2% of participants, while 8.2% had scores suggestive of clinically significant depression. Higher perceived social support correlated with lower EPDS scores (ρ = −0.130, p < 0.05). Religiosity showed modest inverse associations with depressive symptoms. Caesarean section was associated with higher EPDS scores compared to vaginal delivery (p = 0.029). Conclusions: Social support and religiosity appear to be protective factors against depressive disturbances in the early postpartum period. Early screening and culturally sensitive interventions that integrate psychosocial and spiritual dimensions may promote maternal mental well-being. Full article

Background: Previous research has suggested a potential association between low serum cholesterol levels and aggressive or violent behavior; however, findings across studies have been inconsistent, and meta-analytic evidence remains limited. Objectives: To meta-analyze the association between serum cholesterol levels and aggression, and to examine whether study design, population characteristics, and biological sex moderate this relationship. Methods: A meta-analysis of peer-reviewed English-language studies was conducted. Web of Science, APA PsycInfo, APA PsycArticles, PubMed, and Ovid Medline were searched up to September 2025. Eligible studies examined the relationship between serum cholesterol and aggression using either experimental–control group designs or one-group correlational designs. Risk of bias was assessed indirectly through study design characteristics and heterogeneity analyses. Random-effects meta-analyses with restricted maximum likelihood estimation were performed separately for each design type. Results: Twenty-nine studies comprising 6285 participants were included. In experimental–control group studies (15 comparisons; n = 3345), lower cholesterol levels were significantly associated with higher aggression (b = −0.56, SE = 0.15, p = 0.002), although heterogeneity was substantial (I² = 91.0%). In contrast, one-group correlational studies (17 samples; n = 2940) showed no significant association between cholesterol and aggression (b = 0.07, SE = 0.05, p = 0.160; I² = 90.8%). Differences in psychiatric status and sex distribution between study designs were pronounced and may partially explain discrepant findings. Limitations: The evidence base was characterized by high heterogeneity, variable operationalizations of aggression, and a predominance of older studies. Risk of bias could not be formally assessed using standardized tools. Conclusions: This meta-analysis indicates that lower cholesterol levels are associated with increased aggression primarily in studies comparing aggressive and non-aggressive groups, particularly within psychiatric populations. The absence of this association in correlational studies suggests that population characteristics, measurement methods, and sex distribution critically influence observed effects. Future research should clarify underlying biological mechanisms and address methodological heterogeneity. Full article

Background: Problematic smartphone use has been increasingly reported among university students, including nursing students, yet the availability of brief, culturally appropriate, and psychometrically sound assessment instruments in Greece remains limited. Aim: This study aimed to translate and culturally adapt the Greek version of the Smartphone Addiction Scale—Short Version (SAS-SV) and to evaluate its psychometric properties, including internal structure, reliability, and convergent validity with the Mobile Phone Problem Use Scale-10, among nursing students in Greece. Methods: In a cross-sectional study, nursing students from multiple departments across Greece (N = 331) completed the Greek SAS-SV, distributed online via official university forums, student groups, and institutional social media pages, between September 2025 and November 2025. We conducted exploratory and confirmatory factor analyses using polychoric correlations, examined convergent validity, performed exploratory comparisons across demographic characteristics, and estimated the reliability of the SAS-SV. Results: Confirmatory factor analysis was consistent with a one-factor structure and showed acceptable model fit. Internal consistency was high (Cronbach’s α was 0.862 and McDonald’s omega was 0.891), with supportive evidence of convergent validity through its correlation with the MPPUS-10 (Spearman’s ρ = 0.772, p < 0.001). Conclusions: The Greek SAS-SV showed acceptable psychometric properties among nursing students and seems appropriate for research purposes in Greece. Full article

Background: Inadequate management of emotional responses, limited access to emotion regulation strategies, and difficulties in emotion regulation may co-occur with alexithymic traits and interoceptive inaccuracy or confusion. These dimensions may influence lifetime eating disorder spectrum manifestations. Objective: To assess, in a general population sample without Axis I psychiatric disorders, alexithymic traits, interoceptive confusion/inaccuracy, and difficulties in emotion regulation, and to explore their associations with eating disorder spectrum manifestations. Method: In this cross-sectional observational study, fifty-two participants aged 18–30 years, recruited via a university bulletin board, were assessed online using the Toronto Alexithymia Scale (TAS-20), Interoceptive Accuracy Scale (IAS), Interoceptive Confusion Questionnaire (ICQ), Eating Attitude Test (EAT-26), and Difficulties in Emotion Regulation Scale (DERS) (protocol #01/2025). Results: Interoceptive confusion (ICQ) showed significant positive correlations with TAS-20, DERS, and EAT-26 total scores. ICQ scores were associated with TAS-20 subscales ‘difficulty identifying feelings’ (DIF) and ‘difficulty describing feelings’ (DDF). Participants with TAS-20 scores > 51 (n = 35; 67.3%) had significantly higher EAT-26 scores on ‘dieting’ (p = 0.043) and ‘bulimia’ (p = 0.017), as well as higher ICQ (p = 0.001) and DERS (p = 0.001) total scores, with smaller differences in the DERS ‘impulse’ subscale (p = 0.037). Conclusions: Preliminary findings suggest a pattern of co-occurring traits characterized by alexithymia, interoceptive confusion, emotional dysregulation, impulsivity, and eating disorder spectrum features, supporting the study hypothesis. Full article

Although recent studies report elevated rates of post-traumatic stress disorder (PTSD) among Ukrainian refugees, data from military hospitals and rehabilitation centers within Ukraine remain scarce. Numerous studies have described that interactions with therapy dogs help mitigate PTSD symptoms by providing emotional support, reducing hypervigilance, encouraging social engagement, and facilitating physiological de-arousal. However, the potential role of dog-assisted interventions (DAIs) in therapeutic settings during ongoing conflict has not yet been investigated. In this study, saliva samples pre- and post- a 20 min DAI were gathered from soldiers and other military service personnel with diagnosed PTSD in Kyiv, Ukraine. Salivary cortisol was assessed as a biomarker to parallel acute physiological strain. The findings revealed a decrease in salivary cortisol from pre- to post-DAIs in both men and women. Of note, men exhibited higher salivary cortisol levels than women both pre- and post-DAIs. The present findings suggest that people with PTSD benefit from canine support due to reduced acute arousal in a war environment. Limitations include the small sample size and the lack of a control group. In order to mitigate against the high prevalence of psychophysiological distress in at-risk populations such as military personnel, further research is warranted. Full article

Background: Emotional awareness is a core component of professional competence in healthcare, influencing therapeutic communication, stress regulation, and relational effectiveness. Alexithymia, defined as difficulty identifying and describing emotions, may interfere with the development of these skills during nursing education. Objective: This study aimed to evaluate the prevalence of alexithymic traits in Italian nursing students and to examine differences according to gender and academic year. Methods: A multicenter cross-sectional design was adopted. A total of 232 undergraduate nursing students from several Italian universities completed the Toronto Alexithymia Scale (TAS-20) via an anonymous online survey. Descriptive statistics, independent samples t-tests, and one-way ANOVA were performed. Results: The mean TAS-20 total score was 60.36 (SD = 11.22), approaching the clinical cutoff. Approximately 26% of students met the criteria for alexithymia. No statistically significant differences emerged across gender or academic year. A near-significant trend was observed for the Difficulty Identifying Feelings subscale (p = 0.053). Conclusions: A substantial proportion of nursing students reported elevated alexithymic traits. These findings highlight the need to strengthen emotional competence within nursing curricula to support professional development and resilience. Full article