Psychiatry International doi: 10.3390/psychiatryint7020064

Authors: Hezekiah Agboji Joseph Obanye Aderonke Agboji

Background/Objectives: Attention-deficit/hyperactivity disorder (ADHD) frequently persists into adulthood and is characterized by heterogeneous clinical presentations influenced by gender, demographic and psychosocial factors. Although gender-related differences in adult ADHD have been reported, individuals residing in rural settings remain underrepresented in empirical research. Guided by Gender-Based Analysis Plus (GBA+) framework, this study examined gender differences and psychosocial correlates of ADHD subtypes among adults in a rural Canadian population. Methods: A cross-sectional study was conducted using de-identified medical record data collected between February 2021 and January 2024 from a rural outpatient clinic in Northern British Columbia, Canada. The sample comprised 660 adults aged 19 years and older with a documented ADHD diagnosis. The combined presentation was the most common (67.0%), followed by the inattentive presentation (30.3%), while the hyperactive/impulsive presentation was rare (2.7%). In bivariate analyses, ADHD presentation was not significantly associated with gender, age group, employment status, or marital status. Prescribed ADHD medication differed across presentations (χ2 (1) = 12.36, p < 0.001), with a higher proportion of individuals with the inattentive presentation reporting pharmacological treatment. In the pooled logistic regression model, prescribed ADHD medication was the only variable independently associated with presentation (OR = 0.54, 95% CI 0.38–0.77, p = 0.001). In gender-stratified models, this association remained evident among women, whereas no stable inferential conclusions could be drawn for men or gender-diverse participants. Conclusions: Within a GBA+ perspective, the findings suggest that gender may shape recognition and entry into care, rather than the clinical subtype identified at assessment, underscoring the need for a comprehensive assessment in rural clinical practice.

Psychiatry International doi: 10.3390/psychiatryint7020063

Authors: Fumiya Miyano Nobuyuki Mitsui Shuhei Ishikawa Ryo Okubo Takahiro A. Kato

This study aimed to examine the differences in self-compassion (SC) subcomponents between anorexia nervosa (AN) subtypes, the restricting type (ANR) and binge-eating/purging type (ANBP), with a focus on perceived isolation and self-judgment. This retrospective exploratory study included 40 patients with AN at a Japanese tertiary hospital. The participants completed the Self-Compassion Scale, Patient Health Questionnaire-9, and Eating Disorder Examination Questionnaire. Between-group comparisons were conducted using t-tests, and logistic regression was used to examine associations with the AN subtype. Compared with the ANR group, the ANBP group was older at the time of assessment, had a longer illness duration, and showed significantly more depressive symptoms, more severe eating pathologies, and lower SC scores. Specifically, patients with ANBP had significantly higher scores on the negative SCS subscales of self-judgment and isolation, indicating greater self-criticism and perceived isolation. In logistic regression analyses adjusting for the EDE-Q mean score, higher isolation scores were significantly associated with the ANBP subtype (odds ratio = 3.28, 95% confidence interval: 1.37–9.63, p = 0.01). In this exploratory sample, perceived isolation was more prominent in ANBP and may reflect affective and interpersonal difficulties related to this subtype. These findings should be interpreted as hypothesis-generating and warrant replication in larger (ideally multi-site and longitudinal) samples. If replicated, targeting these self-compassion dimensions may inform the development of subtype-sensitive interventions.

Psychiatry International doi: 10.3390/psychiatryint7020062

Authors: Shoko Edo Kyoko Goda Eiji Takigawa Ryuichi Tanioka Kazuyuki Matsumoto Hirokazu Ito Yoshihiro Mifune Kaito Onishi Krishan Soriano Allan Paulo Blaquera Leah Bollos Seiji Kaganoi Yueren Zhao Kazushi Mifune Tetsuya Tanioka

The rising prevalence of physical comorbidities among patients with mental illness has increased the relevance of physical rehabilitation within psychiatric care. However, specific physical rehabilitation practices in specialized psychiatric hospitals in Japan remain insufficiently documented. This exploratory and descriptive study aimed to characterize the rehabilitation content provided and to categorize patient characteristics and comorbidities in a single specialized psychiatric hospital using an expert-led consensus approach. Clinical data from 150 patients (median age 71.0 years) who received physical rehabilitation were retrospectively analyzed. Patient categorization was conducted through a multidisciplinary consensus-building process involving an expert panel of physical therapists, occupational therapists, psychiatrists, and nurses, each with over 10 years of clinical experience. Using a hierarchical rule set based on International Classification of Diseases, 10th Revision (ICD-10) codes and clinical referral data, five distinct categories were identified: Disuse Syndrome (41%), Neurologic Disorders (20%), Lower Limb Lesions (18%), Parkinson’s Syndrome (15%), and Upper Limb Lesions (6%). Across all categories, rehabilitation interventions focused on foundational motor therapies, such as range of motion (27%) and strength training (23%). Mobility-oriented interventions were selectively provided to patients with high bedridden status based on clinical potential. Overall, practices in this setting primarily targeted disuse syndrome and maintenance of basic motor function and were delivered with input from multiple professional disciplines; such practices may inform future research on structured multidisciplinary rehabilitative approaches, especially for aging psychiatric populations.

Psychiatry International doi: 10.3390/psychiatryint7020061

Authors: Allison Uvelli Clizia Cincidda Fabiana Gino Francesco Mancini Andrea Parlato Alessandra Ciolfi Stefania Fadda Francesco Mancini Federica Visco-Comandini

In recent years, imaginative techniques have effectively addressed the growing demand for brief, evidence-based treatments applicable in various contexts. Among these, Imagery with Rescripting (ImRs) was developed within the Schema Therapy model. ImRs can be applied individually or in combination with other protocols, demonstrating significant outcomes even after just one session. This narrative review aims to provide an overview of the applications of ImRs, with a specific focus on its effectiveness in trauma-related disorders. The search string used was “(‘imagery with Rescripting’) AND ((‘Trauma’ OR ‘PTSD’ OR ‘dissociation’))”. The following databases were utilized: PubMed, Scopus, Web of Science, Medline, Embase, and PsychInfo. The research included English-language and Italian-language studies, encompassing experimental and observational designs, case reports, and case series. Samples consisted of healthy participants or clinical populations aged 18 years and older, with no temporal limitations. A total of 56 articles were selected. The results highlight the efficacy of this intervention, whether administered individually or as part of combined protocols, across a wide range of diagnostic categories, including healthy samples, post-traumatic stress disorder (PTSD), borderline personality disorder (BDP), sleep disorders, psychotic spectrum disorders, chronic pain, anxiety disorders, depression, and eating disorders. The studies also support hypotheses about the mechanisms underlying the technique: ImRs facilitates the reprocessing of the meaning associated with mental representations and reduces the occurrence of negative intrusive images related to past events. This process alters and rewrites the individual’s negative memories and images. The narrative review supports the effectiveness of ImRs in treating various psychopathological disorders, both trauma-related and non-trauma-related. In addition to highlighting the effectiveness of ImRs when appropriately integrated with other techniques, the review emphasizes the importance of conducting efficacy studies on larger samples to evaluate ImRs as a standalone intervention model.

Psychiatry International doi: 10.3390/psychiatryint7020060

Authors: Amos En Zhe Lian Shubashini Mathialagan

Fairbairn’s structural theory of mind is an effective framework in Object Relations Psychotherapy for understanding the internal organization of Object Relations structures. However, traditional Object Relations psychotherapy relies heavily on verbal intervention. This raises a critical hypothesis: can these frameworks be effectively integrated with non-verbal expressive therapies, and can artistic output symbolize internal Object Relations structures? This study integrates Fairbairn’s theories with the Expressive Therapies Continuum (ETC) to address this gap. This integration is particularly vital for non-verbal populations where mental health constraints or emotional overwhelm hinder verbalization. This paper presents a detailed case study of a 20-year-old Malaysian male diagnosed with schizophrenia, who presented with severe trauma and profound Alogia. Following one year of integrated Object Relations Expressive Psychotherapy, the client’s progress is analyzed. Seven of his paintings are presented to illustrate how shifts in his object relations were symbolized and processed through his expressive work.

Psychiatry International doi: 10.3390/psychiatryint7020059

Authors: Boróka Gács Bernadett Makkai Ildikó Greges Anna Tóth-Benedek Ádám Keresztes Krisztina Pálfi Rebeka Jávor

Background: Attention-Deficit/Hyperactivity Disorder (ADHD) has been less frequently and extensively investigated in university students than in children, despite substantial evidence demonstrating its significant impact on academic performance and negative affect, such as anxiety. We conducted two studies to address this gap. Methods: The objective of our first study (n = 233) was to assess the prevalence of subclinical ADHD among medical students and examine its associations with comorbid mental health conditions, such as Depression, Anxiety and Stress (DASS-21). In the second pilot intervention study (n = 16), we compared the ratio of negative and positive emotions (PANAS) and anxiety (STAI-S-5) before and after neurofeedback-based relaxation training in two groups of students: one with high scores and another with low scores on the Adult ADHD Self-Report Scale (ASRS). Results: According to our results, more than 50% of students showed risk for ADHD symptoms, and linear regression analyses revealed a strong association between ADHD symptoms and the prevalence of negative affect. Interestingly, no significant differences were found in ADHD and DASS scale scores between students who were falling behind and those progressing in line with the curriculum. Further results of the second study were inconclusive in several areas. In the examined group, a significant increase was observed in one of the core symptoms of ADHD—mind wandering—by the end of the intervention, compared to the baseline. Additionally, frustration levels were significantly higher at the second measurement point among participants with higher ASRS scores. Conclusions: Compared to the literature, it can be concluded that while longer interventions tend to be effective, two sessions are insufficient to reduce symptom.

Psychiatry International doi: 10.3390/psychiatryint7020058

Authors: Mihaela Moise Lucia-Emanuela Andrei Ilinca Mihailescu Alexandra-Mariana Buică Elma-Maria Mînecan Ilinca Olteanu Anca Colita Iuliana Dobrescu Florina Rad

Objective: This study aimed to compare the parent-reported quality of life (QoL) of children and adolescents diagnosed with a chronic mental health disorder to that of those with a chronic somatic disorder. Methods: A comparative analysis was conducted between two clinical groups: one comprising patients with psychiatric diagnoses and the other with somatic diagnoses. QoL was assessed using the CHIP-CE/PRF questionnaire completed by caregivers. Statistical analyses evaluated differences across domains such as well-being, self-esteem, peer relationships, family engagement, and academic performance. Results: Parents of children with somatic conditions reported significantly higher scores in the domains of health and well-being (U = 799.50, p = 0.002), peer relations (U = 872.50, p = 0.009), and academic performance (U = 445.50, p < 0.001). No significant differences were observed in emotional and somatic symptoms or behavior at home. Conclusions: The findings suggest that, from a parental perspective, psychiatric disorders are associated with lower perceived quality of life in several key areas of functioning. These results emphasize the need for targeted support strategies and coordinated care for families of children with mental health conditions.

Psychiatry International doi: 10.3390/psychiatryint7020057

Authors: Luciano Garcia Lourenção Fernando Braga dos Santos Thiago Roberto Arroyo Evellym Vieira Márcio Andrade Borges

Background: Military police officers are exposed to occupational stressors associated with mental health, coping strategies, and work engagement. This study examined mental health indicators and their associations with coping strategies and work engagement among military police officers in the pre-pandemic period. Methods: A quantitative, cross-sectional, descriptive, and correlational study was conducted in 2018 with 773 Brazilian military police officers from São Paulo (n = 506) and Paraná (n = 267). Participants completed the Work Stress Scale (WSS), Maslach Burnout Inventory (MBI-HSS), Utrecht Work Engagement Scale (UWES), and the Scale of Problem Coping Modes (EMEP). Results: The prevalence of occupational stress was 30.2%, with high proportions of Emotional Exhaustion and Depersonalization. Burnout was interpreted dimensionally (MBI-HSS subscales), with 17.6% (n = 134) joint prevalence of the high Emotional Exhaustion + high Depersonalization + low Personal Accomplishment profile, alongside frequent mixed profiles (e.g., 38.3% with high Depersonalization + low Personal Accomplishment). In the multivariable model, the 6 h shift was associated with higher odds of stress (OR = 7.76; 95% CI: 1.02–58.79), while the absence of self-reported health/quality-of-life issues was associated with lower odds (OR = 0.60; 95% CI: 0.39–0.94), along with Emotional Exhaustion (OR = 1.15; 95% CI: 1.10–1.20) and Depersonalization (OR = 1.12; 95% CI: 1.04–1.20). In sensitivity analysis, work shift was not associated with stress (aOR = 1.20; 95% CI: 0.66–2.21). Stress and burnout dimensions were negatively correlated with work engagement (r = −0.52), problem-focused coping, and social support and positively correlated with emotion-focused coping. São Paulo officers reported higher engagement and greater use of problem-focused coping and social support, whereas those in Paraná reported greater reliance on emotion-focused coping. Conclusions: Stress and burnout dimensions may coexist with high engagement, supporting the need for integrated institutional strategies that address organizational stressors (e.g., workload schedules) and strengthen potentially protective coping repertoires, while accounting for contextual differences between units. The high prevalence of burnout profiles underscores the urgency of preventive interventions to mitigate syndromic manifestations in high-stress occupations.

Psychiatry International doi: 10.3390/psychiatryint7020056

Authors: Martin Bystad Lars Lien Sanja Krvavac Rolf Wynn

Suicide is a serious and global health problem, with important consequences for individuals and for society. Understanding health workers’ perspectives is important for understanding how clinicians think about this topic and their attitudes toward and adherence to current guidelines. These findings can also have implications for future directions in guideline development and suicide-prevention policy. The purpose of this study was to investigate health workers’ experiences with and perceptions of suicide risk assessments. We conducted an electronic survey in which we asked health workers (N = 183) 18 questions about their experiences with and opinions about suicide risk assessments, suicide prevention, risk factors for suicide, and questions relating to the Norwegian guidelines for suicide risk assessment. The health workers in this study consisted of psychologists, doctors, nurses, and social workers from three different Norwegian hospitals. We found that the professional groups differed significantly in their responses. We also found significant differences between staff at the different hospitals in how they perceived the risk factors and standardized questions. In general, the respondents were skeptical regarding the emphasis on standardized suicide risk assessments. Furthermore, respondents perceived suicide as at least partly preventable. There were some differences between professions and hospitals. This may be due to cultural and educational aspects. Suicide risk prevention is complex, involving a variety of factors. Methodological limitations should be taken into consideration. Future research should further explore health workers’ concerns about standardized suicide risk assessments.

Psychiatry International doi: 10.3390/psychiatryint7020055

Authors: Derek S. Falk Christian E. Vazquez Swasati Handique

Marijuana use in the United States (U.S.) has diversified alongside expanding legalization, yet little is known about the psychosocial factors that distinguish medical from recreational use. This study examined whether psychological distress mediates the association between perceived social isolation (i.e., loneliness) and marijuana use type among U.S. adults. We analyzed cross-sectional, nationally representative data from the 2024 Health Information National Trends Survey (HINTS, cycle 7). Marijuana use was categorized as medical (including medical and both medical/recreational) versus recreational. Perceived social isolation was measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) Social Isolation t-score, and psychological distress was assessed with the Personal Health Questionnaire (PHQ)-4. Survey-weighted descriptive analyses and a weighted structural equation mediation model accounting for the complex sampling design were conducted. Medical marijuana users reported significantly higher levels of psychological distress and perceived social isolation than recreational users. Greater social isolation was strongly associated with higher psychological distress, and higher distress was associated with a greater likelihood of medical (vs. recreational) marijuana use. The indirect effect of social isolation on marijuana use type through psychological distress was statistically significant, while the direct effect of social isolation was not significant after accounting for distress. Overall, greater perceived social isolation predicted medical marijuana use primarily through elevated psychological distress. These findings suggest that medical marijuana use among U.S. adults may reflect coping with psychological distress linked to social disconnection, underscoring the importance of integrating mental health and social context into clinical and public health approaches to cannabis use.

Psychiatry International doi: 10.3390/psychiatryint7020054

Authors: Adriana Camelia Neagu Iuliana-Anamaria Trăilă Lavinia Palaghian Dana Tabugan Catalina Giurgi-Oncu Ana-Cristina Bredicean

(1) Background: The families of military personnel preparing for deployment are exposed to anticipatory stressors that may adversely affect their psychological well-being. This study aimed to examine the associations between anxiety, psychological resilience, and trait hope among the family members of military personnel during the pre-deployment period. (2) Methods: A cross-sectional online survey was conducted between 20 September and 20 December 2025 and included 73 Romanian adult participants. From a psychiatric perspective, anxiety during the pre-deployment phase represents a clinically relevant form of anticipatory distress that may benefit from early identification and preventive intervention. Anxiety was assessed using the Generalized Anxiety Disorder 7-item scale (GAD-7), psychological resilience with the Brief Resilience Scale (BRS), and trait hope with the Adult Hope Scale (Agency and Pathways subscales). Pearson correlation analyses, multivariable linear regression, and hierarchical regression models were applied. (3) Results: Participants reported moderate anxiety levels (GAD-7 mean 7.52 ± 4.98). Anxiety was strongly negatively correlated with psychological resilience (r = −0.75, p < 0.001) and moderately negatively correlated with total hope (r = −0.67, p < 0.001), Agency (r = −0.61, p < 0.001), and Pathways (r = −0.64, p < 0.001). Psychological resilience emerged as a significant negative predictor of anxiety (β = −0.64, p < 0.001). Hierarchical regression showed that trait hope explained additional variance in anxiety severity beyond resilience and sociodemographic variables (ΔR2 = 0.07, p < 0.001). (4) Conclusions: Psychological resilience and trait hope were independently and jointly associated with lower pre-deployment anxiety in military families, underscoring their relevance to preventive and community psychiatry as modifiable resources for early screening and non-pharmacological intervention.

Psychiatry International doi: 10.3390/psychiatryint7020053

Authors: Larisa-Mihaela Holbanel Ruxandra Stefania Dragota Mihaela Popescu Daniela Gabriela Glavan Mihail Cristian Pirlog Adina Turcu-Stiolica

Background: The relationship between maternal thyroid function and psychiatric morbidity remains inconclusive, particularly regarding the association with antepartum depression (APD). This meta-analysis aimed to precisely quantify the association between the three primary maternal thyroid hormone concentrations—thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3)—measured in late pregnancy and in the presence of APD. Methods: We conducted a systematic review and meta-analysis of observational studies identified through comprehensive database searches (PubMed, Web of Science, Scopus). Four exploratory studies were ultimately included, enrolling a total of 689 participants. We used random-effects models to pool the mean difference (MD) in hormone concentrations between depressed and non-depressed cohorts. Subgroup analyses were performed based on the study population (general versus hypothyroid), and publication bias was assessed using Begg’s and Egger’s tests. Results: None of the pooled hormone concentrations demonstrated a statistically significant association with APD. The overall MDs were non-significant for TSH (MD = −0.07, 95% CI: [−0.32, 0.18], p = 0.59), FT4 (MD = −0.11, 95% CI: [−1.14, 0.92], p = 0.83), and FT3 (MD = 0.53, 95% CI: [−0.20, 1.25], p = 0.15). Substantial and significant heterogeneity was detected across all models (I2 ranging from 70% to 94%). This heterogeneity was largely driven by conflicting directional findings (some studies linking APD to hypothyroid trends, others to hyperthyroid trends), masking a potential non-linear or categorical effect. Statistical tests found no significant evidence of publication bias for TSH (p = 0.33), FT4 (p = 0.12), or FT3 (p = 0.33). Conclusions: The absolute mean concentrations of TSH, FT4, and FT3 in late pregnancy are not robust concurrent biomarkers for antepartum depressive symptoms. The high heterogeneity suggests that APD may be associated with categorical dysfunction (i.e., TSH levels at the extreme high or low ends of the reference range) rather than linear changes in hormone concentration. Future research should prioritize investigating categorical risks, the influence of thyroid autoimmunity, and employing gold-standard diagnostic interviews to better delineate the complex endocrinological risk factors for APD. Due to the limited number of studies, these results should be considered hypothesis-generating rather than confirmatory. PROSPERO registration: CRD420251233154.

Psychiatry International doi: 10.3390/psychiatryint7020051

Authors: Noor Ali Hasan Hala Raad Mahmood Laith Thamer Al-Ameri

Background: Medical students often face substantial psychological stress, which can increase the risk of substance use, professional detriment, and insufficient patient care. However, substance use in medical students remains understudied in Iraq. This study highlights the prevalence, patterns, risk factors, and negative effects of substance use among medical students at the University of Baghdad. A cross-sectional study involving 414 medical students at the University of Baghdad was conducted. The questionnaire included sociodemographic variables and the Alcohol, Smoking, and Substance Involvement Screening Test to screen for psychoactive substance use. The lifetime prevalence of substance use was 38.9%. Among substance users, 42.8% used nicotine, 22.3% used sedatives, 4.3% used inhalants, and 3.1% used amphetamines, with only 27.3% reporting polysubstance use. Through multivariate logistic regression, it was identified that males are approximately 2.8 times more likely to use substances compared to females (OR: 2.8, 95% CI: 2.1–5.2, p-value < 0.001), and students with a positive family history of substance use are approximately 3.1 times more likely to use substances compared to those without (OR: 3.1, 95% CI: 2.8–7.5, p-value < 0.001). These findings underscore the importance of implementing early preventive strategies, targeted mental health interventions, and substance use awareness programs within Iraqi medical institutions.

Psychiatry International doi: 10.3390/psychiatryint7020052

Authors: Alejandro Borrego-Ruiz Juan J. Borrego

Individuals living with inflammatory bowel disease are at a heightened risk of developing certain psychiatric disorders and the gut–brain axis has been proposed as a potential contributor. In the context of the relationship between inflammatory bowel disease and psychiatric disorders, this comprehensive review examines the influence of the gut–brain axis by addressing (i) psychiatric comorbidity, (ii) the role of the gut microbiome and its metabolites, (iii) therapeutic approaches for depression and anxiety, and (iv) psychosocial stressors and microbiome interactions. There is a bidirectional relationship between inflammatory bowel disease and psychiatric conditions, particularly anxiety and depression, which arises from a complex interplay of genetic susceptibility, dysregulation of the gut–brain axis, and neuroimmune processes. Disturbances in gut microbiome composition represent a core mechanism underlying psychiatric comorbidities related to inflammatory bowel disease, although a substantial body of the current knowledge is derived from preclinical models. The integration of microbiome-based therapies into routine clinical practice is still in its early stages, which highlights the need for further research to establish their safety and effectiveness. A deeper understanding of the differences between Crohn’s disease and ulcerative colitis is also pivotal for interpreting therapeutic responses. Ultimately, innovations in nutritional psychiatry and precision medicine hold promise for improving the lives of patients affected by these physical and mental comorbid conditions.

Psychiatry International doi: 10.3390/psychiatryint7020050

Authors: Alexander J. Smith Stefanie Hachen Dinesh Bhugra Albert Persaud Julio Torales Antonio Ventriglio Ana Buadze Michael Liebrenz

Background: Psychiatrists operate at the interface of clinical care, legal frameworks, and governmental power, where external pressures and insufficient safeguards can potentially engender ethical vulnerabilities. Supranational instruments and wider professional standards notwithstanding, the extent to which national-level psychiatric associations articulate protections against torture and abusive practices in their ethical codes remains underexplored. Methods: A cross-sectional documentary audit was conducted of all 145 World Psychiatric Association (WPA) Member Societies, representing ≈250,000 psychiatrists globally. National-level psychiatric ethical codes were located via systematic web searches and examined for clauses specifically referencing torture or analogous abuses and for any associated enforcement procedures. Results: Only nineteen (13.1%) WPA Member Societies maintained publicly accessible ethical codes, with ten (6.9%) containing explicit provisions proscribing torture and associated abuses. These predominantly originated from high-income countries or jurisdictions with documented histories of human rights violations. Most codes invoked broad principles without directly addressing such abuses, and fewer than half delineated any enforcement mechanisms. Conclusions: Gaps persist in ethical governance and human-rights safeguards amongst WPA Member Societies. Although beneficence and non-maleficence provide moral foundations for psychiatric practice, generic commitments alone may prove inadequate under duress. Strengthening anti-torture prohibitions within national-level psychiatric codes could therefore help support ethical resilience and accountability in situations of institutional or political coercion.

Psychiatry International doi: 10.3390/psychiatryint7020049

Authors: Said Hossaibi Mustapha Jaouhari Chaimae El Harrak Moulay Laarbi Ouahidi

Amblyopia is the most common cause of unilateral visual impairment in childhood. Occlusion therapy remains the gold standard for treatment as its psychosocial and functional consequences may affect both children and their parents, potentially compromising treatment adherence. This cross-sectional study included 36 children (aged 3–9 years) undergoing occlusion therapy for amblyopia and 18 parents who completed a mirrored version of the same questionnaire. Each instrument consisted of 18 items distributed across three domains: Psychosocial (Q1–Q6), Daily and School Activities (Q7–Q12), and Physical and Treatment Acceptance (Q13–Q18). Responses were coded on 0–3 or 0–1 scales, and total scores ranged from 0 to 26, with higher scores reflecting greater psychosocial impact. The mean total score reported by children was 15.3 ± 2.5 (range 10–22), compared to 16 ± 2.7 (range 10–21) for parents. No significant difference was found between the two groups (p = 0.31), indicating a generally consistent perception of treatment impact. Among children, girls (15.5 ± 2.4) scored slightly higher than boys (15 ± 2.5) (p = 0.51). Among parents, mothers (17 ± 2.5) reported significantly greater perceived impact than fathers (14 ± 3.0) (p = 0.03). Age-based comparison revealed no significant differences between age groups (3–4, 5–6, and 7–9 years; F = 0.14; p = 0.87), although younger children (3–6 years) showed slightly higher psychosocial scores than older ones (7–9 years) (p = 0.75). Occlusion therapy exerts a moderate psychosocial impact on amblyopic children, affecting emotional well-being, school performance, and treatment acceptance. While parents generally recognize the burden of therapy, mothers perceive it more strongly than fathers, and younger children appear slightly more emotionally affected. These findings emphasize the importance of including both child self-reports and parental perspectives in clinical assessments and support the need for psychological and educational interventions to improve comfort and adherence during treatment.

Psychiatry International doi: 10.3390/psychiatryint7020048

Authors: Syndel Samara Ferreira da Silva Ricardo Alexandre Rodrigues Santa Cruz Gabriel Vitor Acioly Gomes Guilherme José Silva Ribeiro André de Araújo Pinto

Body image (BI) dissatisfaction has been associated with psychological distress and common mental disorders. This study aimed to estimate the prevalence of BI dissatisfaction within a community-based sample and examine its association with symptoms of depression, anxiety, and stress. A cross-sectional exploratory study was conducted with 255 adults aged 20–59 years recruited through non-probabilistic snowball sampling. BI dissatisfaction was assessed using the Stunkard Figure Rating Scale, and symptoms of depression, anxiety, and stress were evaluated using the DASS-21. Associations were examined using binary logistic regression models adjusted for sociodemographic covariates. In the study sample, the prevalence of BI dissatisfaction was (87.1%), predominantly related to perceived excess weight (75.1%), especially among women (81.0%). Dissatisfaction related to thinness was less frequent (12.0%) and more common among men (20.9%). After adjustment, dissatisfaction related to perceived excess weight was associated with higher odds of anxiety (OR = 4.54; 95% CI 1.63–10.70) and depression (OR = 4.24; 95% CI 1.60–10.24). No statistically significant association was observed with stress. BI dissatisfaction, particularly dissatisfaction related to perceived excess weight, was associated with depressive and anxiety symptoms in this adult sample. These findings contribute to understanding the relationship between BI dissatisfaction and emotional symptoms in adults, within the context of a cross-sectional, non-probabilistic design.

Psychiatry International doi: 10.3390/psychiatryint7020047

Authors: Konrad Jurczakowski Sławomir Murawiec

Background: The efficacy of pharmacotherapy for attention-deficit/hyperactivity disorder (ADHD) has been confirmed in numerous controlled studies. However, in clinical practice, pharmacological treatment is heavily dependent upon the parents or guardians of patients. Parental attitudes are shaped not only by medical knowledge but also by parental beliefs about the use of pharmacotherapy and psychoactive substances, including ADHD pharmacotherapy. Parental beliefs about the safety and possible side effects of pharmacotherapy significantly influence their decision to accept or reject pharmacotherapy. This study aimed to explore parental beliefs and attitudes toward ADHD pharmacotherapy and their association with parental treatment acceptance and treatment-related decision-making. Methods: The cross-sectional online survey included 506 parents of children diagnosed with ADHD, recruited through closed social media groups. Parental treatment acceptance and decisions regarding initiation of pharmacotherapy were examined. Results: Parents of children with experience of pharmacotherapy more frequently considered pharmacotherapy safe (83.4% vs. 39.7%, p < 0.001) and expressed readiness to start treatment immediately (73.8% vs. 32.5%, p < 0.001). In this group, 72.6% of parents indicated that the benefits of pharmacotherapy outweigh potential risks. However, concerns about addiction were similar in both groups (49.4% vs. 45.3%, p = 0.400). In a gendered analysis, fathers were more likely than mothers to consider pharmacotherapy unnecessary for treating ADHD (35.3–22.4%; p = 0.002; V = 0.142) or disbelieve in ADHD treatment (25.7–15.1%; p = 0.005; V = 0.132). Furthermore, fathers were more likely than mothers to support limiting the use of pharmacotherapy for treating ADHD to those over 18 (41.3% vs. 26.5%; p < 0.001; V = 0.156), and to report parental opposition (28% vs. 8.1%; p < 0.001; V = 0.264), with a minimal to moderate effect size. Conclusions: Parental treatment acceptance decisions were associated with more favorable parental beliefs, although subjective concerns about addiction remained. Given the study’s cross-sectional and exploratory nature, causal interpretations should be avoided. Parental gender was associated with differences in beliefs and attitudes toward the use of pharmacotherapy for treating children diagnosed with ADHD, especially regarding necessity, consent and age-specificity. In our surveyed sample, fathers tended to be more restrictive or cautious than mothers. The findings also highlight the importance of psychoeducation and partnership-based communication between clinicians and families as key factors that may help support treatment acceptance-related decision-making in ADHD.

Psychiatry International doi: 10.3390/psychiatryint7020046

Authors: Rodrigo Ramirez-Rodriguez Ángel Alberto Puig-Lagunes Rafael Fernández-Demeneghi Ana Karina Ceja-Venegas Yuliana Yessy Gomez-Rutti Miriam Betzabe Tecamachaltzi-Silvarán

Background: Although trauma can adversely affect body esteem, the specific impact of complex post-traumatic stress disorder (CPTSD) remains underexplored among Mexican women. Objective: This study examined body esteem among trauma-exposed controls and women with either PTSD or CPTSD in a sample of female Mexican university students. Method: Using a cross-sectional design, we recruited 657 cisgender Mexican women (aged 18–66) who completed the Body Esteem Scale (BES), International Trauma Questionnaire (ITQ), and Adverse Childhood Experiences-International Questionnaire (ACE-IQ). Participants were classified into three groups: trauma-exposed controls (n = 526), PTSD (n = 68), and CPTSD (n = 63). Results: Total BES scores differed significantly across groups. Participants with CPTSD reported lower overall body esteem (M = 99.48, SD = 21.32) compared to those with PTSD (M = 114.24, SD = 26.68) and controls (M = 119.38, SD = 24.93). Significant group differences also emerged in the Sexual & Physical Attractiveness and Physical Condition & Weight Concern subscales. Furthermore, the negative correlation between BES scores and trauma symptoms was more pronounced in the CPTSD group (rho = −0.40) than in the PTSD group (rho = −0.25). Conclusions: CPTSD is associated with significantly diminished body esteem in this population. These findings underscore the critical need for culturally sensitive, trauma-informed interventions that address both the psychological and somatic dimensions of body image.

Psychiatry International doi: 10.3390/psychiatryint7020045

Authors: Archana Chhetri Samrat Singh Bhandari Sonam Ongmu Lasopa Sanjiba Dutta

Childhood anxiety is a significant mental health concern in India. Although the Revised Children’s Manifest Anxiety Scale-Second Edition (RCMAS-2) is widely used internationally, its psychometric performance in Indian populations is underexplored. This study evaluated the reliability, validity, and preliminary normative data of the RCMAS-2 in a large Indian school sample. A total of 1001 children (52.4% boys; ages 7–10, M = 8.45, SD = 1.17) completed the RCMAS-2 and Beck Anxiety Inventory (BAI). After excluding 117 for high Defensiveness (>7) or Inconsistent Responding (>6), analyses on 884 children examined descriptive statistics, intercorrelations, convergent validity, age/gender differences, and Receiver operating characteristic (ROC) analysis using RCMAS-2 Total T > 60. Mean Total Anxiety T-score was 52.75 (SD = 9.53), with 28.5% of children scoring in the elevated range (T > 60). Subscale intercorrelations and structural analyses closely replicated U.S. normative patterns. The RCMAS-2 Total score showed moderate convergent validity with the BAI (r = 0.498). The BAI demonstrated acceptable classification accuracy against the RCMAS-2 threshold (AUC = 0.612). No significant gender differences emerged; older children (9–10 years) reported higher anxiety than younger children (Cohen’s d = 0.38). The RCMAS-2 shows good psychometric properties like other validated anxiety measures in India and is recommended for screening 7–10-year-olds, with further validation needed in different regions. The high anxiety levels underscore the need for targeted mental health programs in Indian schools.

Psychiatry International doi: 10.3390/psychiatryint7010044

Authors: Ridhima R Shirodkar Manjusha Warrier

Aim: This scoping review aimed to synthesize the quality of life (QoL) and perceived burden among caregivers of patients with Obsessive–Compulsive Disorder (OCD). Background: The QoL and burden among caregivers of patients with OCD is an important but under-researched topic, given that OCD can significantly impair the QoL of both patients diagnosed with OCD and their caregivers. Method: A scoping review approach was used to identify articles published in peer-reviewed journals between the years 2010–2024. The search yielded a total of 511 articles from 5 databases, namely, Science Direct, PsycInfo, PubMed, JSTOR, and Google Scholar. Ten articles that fit the inclusion criteria were selected. All the articles followed a quantitative approach; the mean age of caregivers was approximately 48 years, the number of caregivers ranged from 50 to 120, and the majority of the articles had samples with more female caregivers, mostly spouses/parents of the patient. Results: The four themes derived through the synthesis included caregiver support priorities, illness trajectory and caregiver strain, detrimental caregiver response, and socioeconomic disparities and QoL. Conclusion & Implications: Synthesizing the existing literature can guide the development of evidence-based strategies to alleviate the burden among and enhance the QoL of caregivers.

Psychiatry International doi: 10.3390/psychiatryint7010043

Authors: Mariana Ribeiro Paula Saraiva Carvalho Ana Torres Dário Ferreira

Perinatal loss affects 23 million pregnancies worldwide each year, representing a painful experience that disrupts expectations and impacts emotional, physical, social, and spiritual well-being. This cross-sectional observational study assessed symptoms of anxiety, depression, self-judgment (self-criticism, isolation, over-identification), and shame in women who experienced perinatal loss, as well as their predictive value for psychopathology. Participants were 501 women, divided into five groups according to time since loss: 0–6 months, 7–18 months, 19–30 months, 31–42 months, and more than 43 months. Findings showed that women 7–18 months post-loss reported the highest psychopathology levels, with significant differences in anxiety. Isolation and shame were the strongest predictors of depressive and anxiety symptoms. Although symptoms decreased over time, they remained elevated years after the loss. These results underscore the lasting psychological impact of perinatal loss and the importance of sustained recognition, assessment, and intervention to support women’s mental health.

Psychiatry International doi: 10.3390/psychiatryint7010042

Authors: Hasan Ildiz Markus Quirin Thomas Suslow Stephan Köhler Uta-Susan Donges

In our longitudinal study, we examined self-reported or explicit basic emotions, i.e., happiness, sadness, anxiety, and anger, in depressed patients during acute illness and inpatient treatment. For exploratory purposes, we also assessed implicit emotions. We analyzed how changes in emotional clarity relate to changes in emotions and depressive symptoms. A sample of depressed inpatients (n = 52) was examined at admission and on average after seven weeks of multimodal psychiatric treatment. A healthy control group (n = 52) was tested at the same time interval. Basic emotions were measured via the Differential Emotions Scale and a discrete-emotions variant of the Implicit Positive and Negative Affect Test. Emotional clarity was measured with the WEFG scales. Patients reported lower explicit happiness and heightened explicit sadness, anxiety, and anger compared to healthy controls, regardless of time of measurement. Across groups and time points, implicit happiness was greater than implicit sadness, anxiety, and anger, with no group differences. Patients’ emotional clarity improved and correlated with improvements in depressive symptoms, explicit happiness, sadness, and implicit anger. In summary, depressed patients experience heightened anxiety and anger, suggesting broader alterations of negative emotions beyond sadness. Increased emotional clarity during treatment was found to be correlated with changes in explicit and implicit affectivity.

Psychiatry International doi: 10.3390/psychiatryint7010041

Authors: Ana Beatriz Zanardo Mion Emanuele Seicenti de Brito Igor de Oliveira Reis Carla Aparecida Arena Ventura

The protection and promotion of the human rights of individuals with mental disorders is a critical global priority, and initiatives such as the WHO QualityRights program aim to strengthen rights-based mental health care. We aimed to investigate the impact of the QualityRights core training on promoting knowledge and practices among healthcare professionals regarding the human rights of individuals with mental disorders, and to assess whether this training can reduce the stigma associated with mental disorders among these professionals. A quasiexperimental pre–post study was conducted with 26 primary healthcare professionals. Of these, 14 provided complete paired data, enabling direct comparison before and after the intervention. Participants completed standardized questionnaires assessing attitudes toward people with mental health conditions and psychosocial disabilities. Data were analyzed using paired statistical tests for pre–post comparisons, followed by multiple linear regression to examine factors associated with changes in scores. The training produced meaningful improvements in several items related to autonomy, legal capacity, coercion, and rights-based practices. Higher educational level was associated with greater attitudinal change. The WHO QualityRights training positively influenced healthcare professionals’ attitudes toward human rights in mental health. Future research should include larger samples and long-term follow-up to strengthen the evidence base and evaluate the sustainability of these changes across diverse care settings.

Psychiatry International doi: 10.3390/psychiatryint7010040

Authors: Carmen M. Galvez-Sánchez Julio A. Camacho-Ruiz Rosa M. Limiñana-Gras

Background: This narrative review examines the relationship between gratitude and flourishing in adults from the perspective of Positive Psychology. It departs from the traditional emphasis of psychology on mental illness, highlighting instead a comprehensive understanding of mental health that includes well-being and personal strengths. Methods: This study provides a narrative review of empirical studies published, integrating the principal theoretical and methodological contributions in this field. Relevant studies were identified through searches in PubMed, Scopus, and Web of Science. Results: The available evidence suggests that gratitude functions as a psychological resource that supports human flourishing by fostering greater life satisfaction, positive affect, and healthier physical and mental functioning. Its association with better outcomes in groups facing significant stressors (e.g., emerging adults, older adults, people with chronic pain, depression, or disabilities, forced migrants, etc.) and the promising results of gratitude-based interventions indicate that it is not only a dispositional trait but also a modifiable target for clinical and preventive programs. In addition, the findings underscore that the empirical literature on the relationship between gratitude and flourishing remains scarce and fragmented. Conclusions: Gratitude is intimately connected to flourishing, as it functions as a positive emotion-focused coping strategy that supports and enhances overall well-being. Further research is required to clarify the mechanisms involved, to examine its long-term effects on flourishing, and to determine how best to integrate gratitude and flourishing into culturally and gender-sensitive, scientific evidence-based clinical practices.

Psychiatry International doi: 10.3390/psychiatryint7010039

Authors: Carla Nascimento Eliana Sousa Helena Martins Eduardo Santos Ana Ramos

Background: The master’s thesis defense requires students to demonstrate research maturity, a high-stakes phase often causing significant stress. Understanding student challenges and the process of emotional regulation is crucial to improving pedagogical support, promoting academic well-being, and reducing the associated anxiety. Aim: To explore master’s nursing students’ experiences of the interplay between mental well-being and emotion regulation, during their thesis defense preparation. Methods: A qualitative study, conducted in accordance with COREQ guidelines, explored the perceptions of 29 master’s nursing students (average age of 35.62 years) in Portugal. Data was collected through four face-to-face focus groups, each comprising six to eight students, between October and November 2024, and was analyzed using Braun and Clarke’s systematic thematic analysis. Results: We found three main themes: (i) the pervasive nature of performance anxiety, characterized by significant fear of judgment and cognitive blocks; (ii) preparedness as a central strategy for fostering mental well-being, which included emotional regulation strategies such as researching the jury and practice sessions to manage uncertainty; and (iii) institutional support as a key mediator of well-being, which highlighted a demand for clearer information and formal training in oral communication skills to mitigate anxiety. Conclusions: The findings suggest that relying solely on students’ informal emotional regulation strategies creates vulnerability. To reduce defense-related anxiety and enhance mental well-being, structured institutional support, including clear guidelines, simulated rehearsals, and communication training focused on emotional regulation, is essential to transform the defense process into an opportunity for professional growth and academic well-being.

Psychiatry International doi: 10.3390/psychiatryint7010038

Authors: Tomoko Omiya Tomoko Sankai Wakaba Sato Atsushi Matsunaga Kumiko Nakano Yukari Hara Megumu Iwamoto Thomas Mayers

In white-collar workplaces, individuals with autism spectrum disorder (ASD) traits may experience psychological strain and reduced productivity. This study examined structural relationships among ASD traits, social camouflaging, psychological distress, and work functioning impairment, with a focus on gender differences using a secondary analysis of data from an online survey of 543 Japanese white-collar workers (284 men, 259 women). Validated instruments were used to assess ASD traits, camouflaging, psychological distress, and work functioning impairment. Multi-group structural equation modeling by gender was applied using a NIOSH-inspired model. Men scored higher on the Imagination subscale of ASD traits, whereas women scored higher on Attention Switching and Assimilation. ASD traits were indirectly associated with work impairment through psychological distress, while the direct path between ASD traits and work impairment became negative when distress was controlled, indicating a statistical suppression pattern that was more pronounced among women. Assimilation was significantly associated with psychological distress in women but not in men, although the gender difference was at the trend level. The findings indicate a cross-sectional, context-dependent association between ASD traits and work functioning and highlight the importance of considering both gender and workplace context in non-clinical working populations.

Psychiatry International doi: 10.3390/psychiatryint7010037

Authors: Dario Davì Claudia Prestano Nicoletta Vegni

Although therapist responsiveness is a crucial factor in the effectiveness of psychotherapy, its role in group settings remains under-explored. This narrative review examines therapist responsiveness in group psychotherapy, exploring its theoretical basis, empirical evidence and practical implications. A narrative literature review was conducted using major academic databases, including PubMed, ProQuest, APA PsycArticles, ScienceDirect and PMC. The 11 included studies are primarily small-scale qualitative projects, including case studies, clinical vignettes, and thematic analyses. This inevitably limits the generalizability of the results. A cross-cutting thematic synthesis of these studies reveals five dimensions of group therapist responsiveness: empathy; creating a welcoming atmosphere; paying attention to subjective experience; personalizing interventions within the group context; and facilitating reflectivity and mentalization. The main limitations of the present study’s methodology are its unregistered status and the exclusion of grey literature. Future research should focus on developing validated measurement tools, conducting experimental studies, exploring cultural variations, and assessing therapist responsiveness in online group therapy settings. This narrative review emphasizes the importance of responsive therapeutic approaches in psychiatric settings and group psychotherapy, and highlights the need for further empirical research to refine theoretical models and enhance clinical applications.

Psychiatry International doi: 10.3390/psychiatryint7010036

Authors: José Vicente Viguer Martha Martín Amelia Díaz

Paradoxical interventions involve asking patients to maintain or exaggerate the symptoms they wish to eliminate, with the aim of reducing them. These techniques received empirical support, particularly in the treatment of sleep-onset insomnia, during the 1980s. However, changes in sleep habits over recent decades warrant further research on their current applicability. This article reports a pilot study involving 26 women (aged 40–70) with significant difficulty initiating sleep, who were randomly assigned to either a paradoxical or a non-paradoxical treatment; a prior waiting period was also used as a waitlist control. Both treatments produced statistically significant improvements in insomnia scores between pre- and post-treatment, with no significant differences between groups. These findings suggest that paradoxical interventions may be effective for the current treatment of sleep-onset insomnia and support the need for randomized clinical trials with larger samples.

Psychiatry International doi: 10.3390/psychiatryint7010035

Authors: Natalia Covili Arevalo Camilo Aramburú-Navarro Eduardo Sandoval-Obando Felipe Caamaño-Navarrete Carlos Arriagada-Hernández Paulo Etchegaray-Pezo Gerardo Fuentes-Vilugrón

Introduction: University students often describe their academic years as a period of continuous personal change, which may increase vulnerability to unhealthy lifestyle habits. These habits can influence body composition and are associated with both physical conditions (e.g., overweight, sedentary behavior) and psychological well-being, including suicide risk. Method: A quantitative, non-experimental, cross-sectional, descriptive–comparative–correlational design was employed, using a non-probabilistic intentional sample of 174 university students. Data were collected using the OMRON 514C body composition monitor, the Difficulties in Emotional Regulation Scale (DERS-E), and Plutchik’s Suicide Risk Scale. Statistical analyses included descriptive statistics, independent samples t-tests for gender comparisons, Pearson’s correlation analyses, and multiple linear regression analyses to examine whether the observed bivariate associations remained significant after controlling for gender. Results: Descriptive analyses showed variability in body composition, emotional dysregulation, and suicide risk. Gender comparisons indicated that men presented higher weight, height, skeletal muscle mass, visceral fat level, and basal metabolic rate, whereas women reported higher body fat percentage, greater emotional dysregulation, and higher suicide risk. Correlation analyses revealed that suicide risk was negatively associated with skeletal muscle mass (r = −0.24, p = 0.002), basal metabolic rate (r = −0.21, p = 0.006), height (r = −0.27, p < 0.001), emotional rejection (r = −0.24, p = 0.001), and emotional confusion (r = −0.22, p = 0.004). Multiple regression analyses, controlling for gender, indicated that the associations between body composition indicators (skeletal muscle and basal metabolism) and suicide risk did not remain statistically significant (p > 0.05). In contrast, emotional dysregulation dimensions, particularly emotional rejection, maintained significant associations with suicide risk after adjustment for gender. Additionally, negative associations were found between BMI and emotional dysregulation, and between height and emotional clarity, even after controlling for gender. Discussion: The findings highlight emotional dysregulation as a central and robust factor associated with suicide risk in university students, whereas body composition indicators appear to play a more limited and gender-dependent role. The fact that associations between physical markers (skeletal muscle, basal metabolism) and suicide risk were mediated by gender underscores the importance of considering sociodemographic factors when interpreting body–mental health relationships. These results support the need for integrated biopsychosocial prevention strategies that address emotional regulation within the university context, while considering the differential impact of gender on both physical and psychological risk factors.

Psychiatry International doi: 10.3390/psychiatryint7010034

Authors: Maureen Murdoch Barbara Ann Clothier Siamak Noorbaloochi

Background: Administrative data help managers monitor and manage health care enrollees’ health. Of the few available administrative measures of psychiatric illness severity, however, most either commingle sociodemographics and medical comorbidities or lack ordinal properties. Objective: To assess construct, concurrent, and predictive validity of a novel, 6-item, administrative measure of psychiatric severity, the Manifestations of Psychiatric Severity Index (MoPSI). Methods: A panel study of 960 gender-stratified, nationally representative, post-9/11 US Veterans with pending disability claims for posttraumatic stress disorder (PTSD). MoPSI scoring was based on the joint probability density (JPD) method and a JPD linear approximation. Results: The JPD MoPSI score and its linear approximated score had a correlation of 0.999. Relative to their counterparts, unmarried Veterans, Veterans with low income, and Veterans with serious mental illness or PTSD had higher MoPSI scores (Ps: <0.0001–0.03). Higher MoPSI scores predicted cigarette and street drug use and PTSD and depression/anxiety symptoms six months later, and disability award approximately 1 year later (Ps: 0.01–0.02). Conclusions: In this sample, the MoPSI had evidence of construct, concurrent, and predictive validity.

Psychiatry International doi: 10.3390/psychiatryint7010033

Authors: Bumani Solomon Manganye Lufuno Makhado Jabu Tsakani Mabunda

Background: Management of Mental Health Care Users is a critical component of the overall health care system, yet it is not given the serious attention it deserves due to stigma and discrimination against those living with mental health challenges. These results in mental health care users being readmitted to the hospital frequently, despite the poor resources and overburdened health care system. Aim: The aim of this study was to explore and describe the experiences of Psychiatric Nurses regarding the care of Mental Health Care Users in the selected hospitals in Limpopo Province, South Africa. Methods: A qualitative study was followed, where explorative, descriptive, and contextual designs were used. The researcher purposefully selected thirty-four Psychiatric Nurses who have been working in mental health units. Data was collected through unstructured interviews. Thematic analysis was utilized to analyze the data. Results: The study revealed significant challenges, such as poor mental health structures or no mental health unit at all, and this forces Psychiatric Nurses to mix critically ill medical patients with psychotic patients. Furthermore, there is a shortage of staff and treatment to manage users. Conclusions: In conclusion, the study showed that psychiatric nurses face serious emotional and resource-related challenges in caring for mental health care users. This highlights the urgent need for support from institutions, ongoing training, and better working conditions to improve the quality of mental health care. The success of the care, treatment, and rehabilitation of mental health care users depends on the support of MHCUs by family and management.

Psychiatry International doi: 10.3390/psychiatryint7010032

Authors: Cheila Llorens Ayden Dunn Pedro Soto Avanthi Puvvala Victoria Reis Erik Miron Christine Kamm Isabella Abraham Lea Sacca

Background: Tobacco smoke exposure in the home remains common among U.S. families and has been increasingly associated with adverse mental health outcomes, including anxiety and depression, among children and adolescents. Rising rates of youth anxiety and depression, coupled with evidence that secondhand smoke and related psychosocial stressors may disrupt emotional development, underscore the importance of examining household smoking exposures as a modifiable risk factor for youth mental health. This study examines associations between exposure to smoke in households and the likelihood of caregiver-reported anxiety and depression in US children and adolescents aged 6–17 years, using data from the 2022–2023 National Survey of Children’s Health (NSCH). Methods: A retrospective analysis of NSCH data for two age cohorts, children (6–11 years) and adolescents (12–17 years), for the years 2022–2023 was conducted. Descriptive statistics were generated for the selected sample by frequencies and counts for each of the dependent and independent variables, followed by binary logistic regressions for each measured mental health variable based on current diagnosis, severity levels (not severe, mild, moderate, severe) and household tobacco use. Results: This study found significant associations between parental smoking and increased odds of caregiver-reported anxiety and depression in both children and adolescents. Specifically, children living with parents who smoke had 1.55 times the odds of severe anxiety, while adolescents had 1.38 times the odds of currently experiencing anxiety and 1.31 times the odds of currently experiencing depression. Smoking inside the household was not significantly associated with caregiver-reported anxiety or depression. These findings suggest that parental smoking serves as a marker for broader psychosocial and environmental stressors that contribute to youth mental health outcomes. Conclusions: Parental smoking is a significant, modifiable risk factor for anxiety and depression among US children and adolescents. These results emphasize the need for targeted, evidence-based interventions to reduce parental smoking, improve awareness of associated mental health risks, and address social determinants of health. Policies promoting smoke-free households, integrated cessation support, and culturally tailored education programs are essential to mitigate the impact of parental smoking on child and adolescent mental health.

Psychiatry International doi: 10.3390/psychiatryint7010031

Authors: Simona Manuela Bida Florin Razvan Curca Oana Maria Butnaru Roxana Chirita

Background: Schizophrenia is strongly associated with severe oral health deterioration, driven by cognitive deficits, behavioral dysfunction, and medication-related biological changes. Objective: To examine how neurocognitive dysfunction in schizophrenia, particularly cognitive deficits, is associated with poorer oral hygiene control, motivation, and self-regulation, contributes to oral health decline by disrupting everyday oral hygiene behaviors and dental care engagement, and to discuss the implications of this framework for interdisciplinary prevention strategies. Methods: This manuscript follows a narrative review design aimed at conceptually integrating evidence on neurocognitive mechanisms underlying oral health decline in schizophrenia. To identify relevant literature, a targeted search of PubMed/MEDLINE, Scopus, and Web of Science was conducted, covering publications from 2000 to 2025. The search strategy was used to support thematic exploration and conceptual synthesis, rather than to perform a systematic study selection or quantitative evidence aggregation. This narrative review summarizes findings from 90 peer-reviewed studies selected from the available literature. Results: Executive dysfunction, attentional deficits, and low motivation impair routine oral hygiene and delay dental care-seeking. Antipsychotic-induced xerostomia, metabolic disturbances, oxidative stress, immune dysregulation, and oral microbiome dysbiosis accelerate periodontal breakdown and caries progression. These interacting processes generate a self-reinforcing cycle of inflammation, tissue destruction, and treatment avoidance. Epidemiological data show markedly elevated DMFT/DMFS indices and up to a three-fold higher risk of edentulism compared with the general population. Emerging evidence suggests that integrated psychiatric–dental care models may be associated with improvements in oral health and care engagement, although current findings are largely preliminary and based on small or heterogeneous study populations, including related neurocognitive disorders. Conclusions: Unlike existing epidemiological syntheses, this review highlights oral health deterioration in schizophrenia as a functionally mediated consequence of neurocognitive impairment, underscoring the need for preventive approaches aligned with patients’ cognitive and motivational capacities.

Psychiatry International doi: 10.3390/psychiatryint7010030

Authors: Luís Loureiro Joel Araújo Ana Teresa Pedreiro Rosa Simões

Introduction: Mental health literacy is an emerging topic that has implications for individuals’ health and well-being. Objective: To assess Mental Health Literacy (MHL) regarding depression among Portuguese public security police officers. Methods: Quantitative, descriptive, cross-sectional study using the QualisMental Questionnaire, which includes a vignette describing a case of depression, and the Personal Stigma Scale. Results: The sample comprises 253 professionals. Only 36.36% of respondents correctly identified the case as depression (95% CI: 30.40; 42.33). The distress was predominantly classified as “stress” (34.78%) or “anxiety” (32.81%), suggesting a defense mechanism that opts for socially less stigmatizing labels. Although the majority reject the belief that depression is a “personal weakness,” revealing low explicit stigma, the perceived usefulness of hierarchical figures in help-seeking is low (38.7% useful). High confidence is observed in informal networks (friends: 95.7% useful) and in mental health professionals, but there is marked distrust of psychopharmacology (antidepressants: 40.7% harmful). Conclusions: A paradox is observed between low personal stigma and low recognition of depression. MHL interventions should focus on neutralizing organizational stigma and increasing competencies for managing mental health crises arising from first aid, namely direct approaches to topics such as suicide.

Psychiatry International doi: 10.3390/psychiatryint7010029

Authors: Paulo Alejandro Ayón-Delgado Diana Emilia Martínez-Fernández David Fernández-Quezada

Virtual reality (VR) has emerged as a powerful tool in neuroscience and psychiatry, providing immersive and ecologically valid environments to investigate human cognition. Stress is known to disrupt core cognitive functions, particularly learning and memory, which are critical for mental health. While classical paradigms such as the radial arm maze have yielded fundamental insights into animal research, their application in humans has been limited. The aim of this study was to develop NeuroHM, a VR-based radial arm maze, to evaluate spatial learning and memory in adults under experimentally induced stress. A total of 100 participants were recruited and randomly assigned to either a control group (n = 50) or a stress group (n = 50). Participants navigated the virtual radial arm maze from a first-person perspective, relying on distal planetary landmarks to maintain spatial orientation and recall spatial locations. The primary dependent variables were working memory errors, reference memory errors, and latency. Salivary cortisol levels were collected to validate the stress induction protocol and to examine the relationship between stress and cognitive performance. Participants in the stress group showed increased latency and higher reference memory errors compared to controls, with working memory exhibiting the most pronounced impairment. Our findings show that acute stress significantly disrupts cognition and highlight NeuroHM as a promising tool for cognitive assessment in mental health research.

Psychiatry International doi: 10.3390/psychiatryint7010028

Authors: Johannes Gjerstad Kristin Klemmetsby Solli Lars Tanum Bente Weimand Ann-Christin Sannes

Background: Previous research has linked opioid use disorder (OUD) to neuronal reward systems and impulsivity. The aim of this study was to examine the influence of COMT rs4680 Val158Met polymorphism on impulsivity, hyperactivity and inattention (IHI) in patients with OUD. Methods: Open-label, cross-sectional cohort study was conducted involving individuals, 18 to 65 years, with OUD who either were included in opioid agonist treatment (OAT)—or same group of individuals who were awaiting induction on extended-release naltrexone (XR-NTX). Adult ADHD Self-Report Scale 18-item version was used to score IHI, and saliva samples were collected for genotyping (TaqMan assays). Logistic regression models were used to analyze the data. Results: The data of the entire cohort (n = 206) showed that carriers of one or two Val alleles had a negative association with IHI compared to Met/Met carriers (Val/Met OR = 0.43, p-value = 0.017, and Val/Val OR = 0.29, p-value = 0.005). Individuals included in OAT not waiting for XR-NTX (n = 120) exhibited the same pattern as observed in the entire cohort (Val/Met OR = 0.33, p-value = 0.019, and Val/Val OR = 0.18, p-value = 0.004), but not those who chose XR-NTX (Val/Met OR = 0.60, p-value = 0.353, and Val/Val OR = 0.47, p-value = 2.779). Conclusions: The present study revealed that individuals with OUD carrying the COMT rs4680 Val allele had lower IHI scores than Met/Met carriers. Hence, in individuals with OUD, the COMT rs4680 Met allele is associated with higher IHI symptom burden.

Psychiatry International doi: 10.3390/psychiatryint7010027

Authors: Joana Henriques-Calado Martin M. Schumacher João Gama-Marques

Background: Both borderline personality disorder (BPD) and schizoaffective disorder (SAD), as well as their potential connection, remain controversial diagnoses. To explore whether BPD may be part of the spectrum of SAD, we conducted a longitudinal study of a large clinical cohort of patients with BPD. Methods: We assessed the diagnostic trajectories of 402 patients with BPD in a 20-year retrospective study based on electronic clinical records from a psychiatric hospital using ICD-9 diagnoses. Data were descriptively examined on concurrent and sequential diagnoses in patients with BPD. For the classification of SAD, a proxy diagnosis was used. Results: The study population showed a high prevalence of affective disorders and a high frequency of concurrent diagnoses of affective–BPD. Together, stable BPD, stable affective disorder sequences and transitions from affective disorders to BPD represented 79% of all longitudinal trajectories. Conclusion: These findings should be considered exploratory and do not allow confirmation or refutation of the hypothesis that BPD serves as a precursor, prodrome, or component within the spectrum of SAD.

Psychiatry International doi: 10.3390/psychiatryint7010026

Authors: Eleni Troubouni Hera Antonopoulou Sofia Kourtidou Evgenia Gkintoni Constantinos Halkiopoulos

Background/Objectives: Teacher burnout represents a complex cognitive-emotional syndrome characterized by the interplay between mental exhaustion and emotional dysregulation, threatening educational sustainability during crisis periods. This study employed comprehensive behavioral data analysis to investigate burnout syndrome patterns among Greek teachers during the COVID-19 educational crisis, aiming to identify risk factors and resilience patterns through multiple analytical approaches that capture the syndrome’s multidimensional nature. Methods: A cross-sectional study examined primary and secondary school teachers in Western Greece during the autumn of 2021. Stratified random sampling ensured representativeness across school levels, geographic locations, and employment types. Participants completed the Greek-adapted Maslach Burnout Inventory for Educators, which measured emotional exhaustion, depersonalization, and personal accomplishment. Behavioral data analysis integrated traditional statistical methods with advanced pattern recognition techniques, including classification trees for non-linear relationships, association analysis for behavioral patterns, and cluster analysis for profile identification. Results: The majority of teachers experienced high stress with inadequate coping capabilities. Classification analysis achieved high accuracy in predicting burnout severity, identifying emotional exhaustion as the primary predictor. Deputy teachers demonstrated severe cognitive-emotional strain compared to permanent colleagues across all dimensions, with dramatically reduced personal accomplishment and minimal resources. Association analysis revealed that combined low support and high workload more than doubled burnout risk. Three distinct profiles emerged: Resilient teachers, characterized by older age and permanent employment; At-Risk teachers, showing early warning signs; and Burned Out teachers, predominantly young and in precarious employment. Remote teaching, exceeding half of the workload, significantly increased strain. Multiple regression confirmed emotional exhaustion as the dominant syndrome predictor. Conclusions: Behavioral data analysis revealed complex cognitive-emotional patterns constituting burnout syndrome during educational crisis. Employment precarity emerged as the fundamental vulnerability factor, with young deputy teachers facing dramatically higher syndrome probability compared to supported senior permanent teachers. The syndrome manifests through cascading processes where cognitive overload triggers emotional exhaustion, subsequently reducing personal accomplishment. These findings provide an evidence-based framework for early syndrome identification and targeted interventions addressing both cognitive and emotional dimensions of teacher burnout.

Psychiatry International doi: 10.3390/psychiatryint7010025

Authors: Seshadri Sekhar Chatterjee Adesh Agrawal Soumitra Das Mallika Roy Barikar C. Malathesh Sydney Moirangthem

Background: Mental illness stigma among healthcare professionals can adversely affect patient care and recovery. While attitudes are shifting globally, limited data exist on stigma among non-psychiatrist doctors (NPDs) in India. This study aimed to assess the attitudes of NPDs toward mental illness and psychiatry using the Mental Illness Clinicians’ Attitudes Scale (MICA-4), and to explore associated sociodemographic and clinical factors. Methods: A cross-sectional online survey was conducted across India over six months in 2022, following ethics approval. The survey link was distributed via professional social media platforms using convenience and snowball sampling. Non-psychiatrist doctors with at least an MBBS degree were eligible. The MICA-4 scale assessed stigma across five domains. Descriptive statistics, correlation analyses, and multiple regression analysis were conducted. Results: A total of 102 responses were analysed. The mean MICA-4 score was 48.37, indicating moderately positive attitudes. Domain-wise analysis revealed higher stigma in knowledge/misconception and self-disclosure domains, while attitudes towards ethics and patient care were more favourable. No significant differences were found by gender, specialty, or practice setting. Weekly psychiatric caseload was not associated with reduced stigma. Internal consistency of the scale was low (Cronbach’s α = 0.46), raising concerns about cultural fit. The regression model was statistically significant F (5, 96) = 661.95, p < 0.001, explaining 97.18% of the variance in overall attitudes toward mental illness. Among the five domains, Respect for Psychiatry and Knowledge and Misconceptions emerged as the strongest predictors, highlighting their critical role in shaping positive professional attitudes in the public sector. Conclusions: Stigma toward mental illness persists among NPDs, particularly around misconceptions and help-seeking attitudes. These biases are culturally embedded and may not be significantly influenced by clinical exposure alone. While stigma was generally moderate, persistent misconceptions and self-stigma point to the importance of further developing culturally adapted tools and systemic interventions to promote reflective practice and ethical parity in clinical settings.

Psychiatry International doi: 10.3390/psychiatryint7010024

Authors: Francesco Sacchini Federico Biondini Giovanni Cangelosi Sara Morales Palomares Stefano Mancin Mauro Parozzi Gabriele Caggianelli Sophia Russotto Alice Masini Diego Lopane Fabio Petrelli

Background: Depression remains a major global mental health concern, significantly intensified during the COVID-19 pandemic. As social media usage surged during this period, it emerged as a valuable source for identifying early signs of depression. Artificial intelligence (AI) offers powerful tools to analyze large volumes of user-generated content, enabling timely and effective detection of depressive symptoms. This review aims to preliminarily explore and compare evidence on the use of AI models for detecting depression in social content across the pre-, during, and post-pandemic phases, assessing their effectiveness and limitations. Methods: A narrative literature review was conducted using PubMed and Scopus, following the SANRA guidelines to ensure methodological quality and reproducibility. The study was pre-registered in the OSF database and employed the PICOS framework for the strategy. Inclusion criteria comprised studies in English from the past 10 years that analyzed depression detection via AI, machine learning (ML), and deep learning (DL) applied to textual data, images, and social metadata. This review addresses the following four research questions: (1) whether AI models improved effectiveness in detecting depression during/after the pandemic vs. pre-pandemic; (2) whether textual, visual, or multimodal data approaches became more effective during the pandemic; (3) whether AI models better addressed technical challenges (data quality/diversity) post-pandemic; and (4) whether strategies for responsible AI implementation improved during/after the pandemic. Results: Out of 349 identified records, nine primary studies were included, as most excluded articles had a predominantly technical focus and did not meet the clinical relevance criteria. AI models demonstrated strong potential in detecting depression, particularly through text-based classification and social content analysis. Several studies reported high predictive performance, with notable improvements in accuracy and sensitivity during and after the pandemic, although evidence remains limited. Conclusions: Our preliminary analysis suggests that AI-based depression detection on social media shows potential for clinical use, highlighting interdisciplinary collaboration, ethical considerations, and patient-centered approaches. These findings require confirmation and validation through larger, well-designed systematic reviews.

Psychiatry International doi: 10.3390/psychiatryint7010023

Authors: Suzana Turcu Cristiana Susana Glavce Liviu Florian Tatomirescu

Background/Objectives: Family caregivers of individuals with dementia frequently experience substantial psychological distress, yet their emotional responses are heterogeneous. Depression, anxiety and psychological well-being may co-occur in distinct patterns, and socio-economic resources such as education and income are often hypothesized to buffer caregiver distress. This study aimed to identify latent psychological profiles among dementia caregivers and to examine whether education and income moderate the association between affective symptoms and well-being. Methods: A cross-sectional study was conducted with 73 family caregivers of dementia patients attending the Neurology–Psychiatry Department of C.F.2 Clinical Hospital, Bucharest (November 2023–April 2024). Participants completed the PHQ-9 (depression), the COVI Anxiety Scale and Ryff’s Psychological Well-Being Scales. Care recipients’ cognitive status was extracted from medical records using the MMSE. Gaussian Mixture Modeling was used for latent profile analysis (LPA). Between-profile differences were examined using one-way ANOVAs and Tukey post-hoc tests and Pearson correlations were used to assess associations between affective symptoms and psychological well-being, and examined whether education and income were associated with profile membership and psychological well-being. Results: LPA supported a three-profile solution: (1) lower depressive symptoms with moderate anxiety (33%), (2) severe combined depression and anxiety (18%) and (3) moderately severe depression with severe anxiety (49%). Profiles differed significantly in depressive symptom severity, whereas anxiety severity did not differ significantly across profiles. Caregivers in Profile 3 (moderately severe depression–severe anxiety) reported significantly higher overall psychological well-being than those in Profile 1 (moderate depression–moderate anxiety). In contrast, caregivers in Profile 2 (severe depression–severe anxiety), who exhibited the highest affective symptom burden, showed intermediate levels of overall well-being, with comparatively lower scores on specific dimensions such as purpose in life. Depressive symptoms were weakly but significantly associated with autonomy and self-acceptance, whereas anxiety symptoms showed no significant associations with psychological well-being. Education level and household income were not significantly associated with profile membership or psychological well-being. Conclusions: Family caregivers of individuals with dementia can be meaningfully described as forming three exploratory psychological profiles characterized by different configurations of depressive and anxiety symptoms. These findings indicate that caregiver distress does not follow a simple severity gradient and that psychological well-being is not solely determined by symptom burden. Socio-economic characteristics did not account for differences in caregiver adjustment, underscoring the importance of individualized psychological assessment and tailored interventions to support caregiver mental health.

Psychiatry International doi: 10.3390/psychiatryint7010022

Authors: Soccalingam Artchoudane Meena Ramanathan Ananda Balayogi Bhavanani Muruganandam Partheeban

Background: Autism Spectrum Disorder (ASD) involves social, emotional, and behavioral challenges, and conventional therapies show limited effectiveness. Aims: To evaluate the effect of Yoga Therapy (YT) on neurophysiological regulation and behavioral functioning in individuals with ASD. Methods: Thirty-six autistic individuals, aged 6 to 25 years and with Childhood Autism Rating Scale (CARS) scores above 15, were randomly assigned to yoga (YG) and control (CG) groups. YG received 60 min YT sessions twice weekly for six months alongside a regular school routine, while CG followed only a regular school routine. Handgrip strength (HGS), visual reaction time (VRT), systolic (SBP) and diastolic (DBP) blood pressure, heart rate (HR), and CARS scores were assessed at pre-, mid-, and post-intervention. Repeated measures ANOVA and Pearson’s correlation were used for statistical analysis. Results: The study showed an increase in HGS (Δ = 3.27 kg) and a reduction in VRT (Δ = −523.86 ms) with a marked decrease in total CARS score (Δ = −5.67), p < 0.01 in YG. There was a mild, non-significant reduction in cardiovascular (CV) dysfunction in YG, while CG showed no significant changes across all measures. Conclusion: Biweekly YT sessions over six months enhanced neurophysiological regulation, improving sensorimotor integration and accelerating cognitive, emotional, and behavioral outcomes in individuals with ASD.

Psychiatry International doi: 10.3390/psychiatryint7010021

Authors: Natalya Rakhalskaya Nurlan Jainakbayev Maria Kostousova Timur Tastaibek Almagul Mansharipova Saida Yeshimbetova

Background: Depressive symptoms are frequent sequelae of COVID-19 and may remain unrecognized in older outpatients, particularly those with post-COVID syndrome. The objective of the current study was to assess the under-detection of depressive symptoms in older ambulatory patients and to examine its relationship with post-COVID syndrome status. Methods: We conducted an observational outpatient cohort study of adults aged 60–89 years with prior SARS-CoV-2 infection (N = 85), recruited at two city polyclinics. Depressive symptoms were assessed through three detection channels: spontaneous complaint during the visit, a standardized direct question about current depressive symptoms, and the 15-item Geriatric Depression Scale (GDS-15). Agreement between complaint and direct question was evaluated using Cohen’s κ and McNemar’s test. Screening performance of complaint and direct question was assessed against GDS-15 thresholds (≥5; sensitivity analysis ≥ 6). Associations between post-COVID syndrome status and binary depressive-symptom indicators were expressed as risk ratios (RRs). Results: Spontaneous complaints missed a substantial proportion of cases: among complaint-negative patients, 18.3% (15/82) reported depressive symptoms on the direct question (κ = 0.149; McNemar p = 0.00052). Against GDS-15 ≥ 5, complaint sensitivity was 10.3% with specificity 100.0% (F1 = 0.19), whereas the direct question showed higher sensitivity (34.5%) with specificity 87.5% (F1 = 0.43). Using the alternative threshold GDS-15 ≥ 6, complaint sensitivity was 15.0% with specificity 100.0% (F1 = 0.26), and direct question sensitivity was 45.0% with specificity 87.7% (F1 = 0.49). A positive response to the direct question was more frequent in patients with post-COVID syndrome than in controls (RR = 2.70 (1.04–7.00)); stratified estimates suggested higher RRs in patients ≤ 75 years (RR = 4.55 (1.08–19.10)) and in women (RR = 2.67 (1.04–6.83)), with limited precision due to sparse events. Conclusions: In older post-COVID outpatients, reliance on spontaneous complaints leads to marked under-detection of GDS-15 screen-positive depressive symptoms. A standardized direct question improves initial case-finding but does not replace a validated screening scale; a stepped approach (brief direct question followed by a scale when indicated) may be warranted.

Psychiatry International doi: 10.3390/psychiatryint7010020

Authors: Alberto Pérez Arenas Eduardo Díaz Herráiz Raquel Bartolomé-Gutiérrez

Background: School bullying, be it in its traditional form or as cyberbullying, is a worldwide phenomenon, with significant impacts on schoolchildren’s wellbeing, and its accurate evaluation is thus key in prevention and intervention. The aim of the present study was to validate the Spanish version of the Zurich Brief Bullying Scales (ZBBS), a brief and effective instrument to measure school bullying victimisation and perpetration in different settings. Method: The sample comprised 2125 students of secondary education (11–17 years) in Spain. A confirmatory factor analysis (CFA) was performed to evaluate the structure of the scale. Results: We examined the scale’s reliability (α > 0.7 in all the subscales) and correlations to test its construct validity and its concurrent validity with the Kidscreen-52 victimisation and self-esteem scales, and with cyberbullying scales (European Cyberbullying Intervention Project Questionnaire). The confirmatory factor analysis confirmed two independent factors: victimisation and perpetration. Conclusions: The results supported the psychometric soundness of the ZBBS, evidencing its applicability in measuring school bullying and cyberbullying in different age groups and genders. We discuss the implications for its use in research and educational practice, underscoring its potential as a brief and valid instrument for monitoring school bullying and cyberbullying across early to late adolescence in Spanish-speaking educational contexts.

Psychiatry International doi: 10.3390/psychiatryint7010019

Authors: Giuseppa Minutolo Veronica Gallinoro Valentina De Nicolò Marta Caminiti Fabrizio Cedrone Nausicaa Berselli Alessandro Catalini Vincenza Gianfredi

Background: Depression and eating disorders (EDs) represent significant and often multiple public health concerns. Healthcare workers, including medical residents, were affected by several stressors that the COVID-19 pandemic has engendered and amplified, potentially exacerbating mental health issues. Despite this, limited evidence is available regarding the association between depressive symptoms and possible EDs among Public Health Residents (PHRs). Methods: A nationwide cross-sectional study, the ‘Public Health Residents Anonymous Survey in Italy (PHRASI),’ was conducted between June and July 2022. A total of 379 PHRs participated in this study, filling in a self-administered questionnaire which included the PHQ-9 for assessing depressive symptoms and the SCOFF (Sick, Control, One, Fat, Food) test as a screening tool for possible EDs. Multivariable logistic regression evaluated associations between sociodemographic and training/work-related factors, depressive symptoms, and EDs. Results: Overall, 40.6% of respondents screened positive for possible EDs. Depressive symptoms had a positive association with possible EDs (aOR = 2.76; 95% CI = 1.55–4.93). Other factors associated with higher ED odds included region of residence (aOR = 1.92; 95% CI = 1.06–3.47), intention to repeat the test for another postgraduate course (aOR = 3.22; 95% CI = 1.25–8.3), and working more than 40 h per week (aOR = 1.91; 95% CI = 1.19–3.07). Conversely, having more than one child (aOR = 0.32; 95% CI = 0.13–0.78) was associated with lower odds. Conclusions: The findings highlight a significant association between depressive symptoms and positive screening for possible EDs, underscoring the need for integrated mental health support and preventive interventions within medical residency programmes, especially in the context of public health crises.

Psychiatry International doi: 10.3390/psychiatryint7010018

Authors: Renae A. Merrill Chunhua Cao

Background: Longitudinal studies demonstrate an association between social media use and anxiety. However, the mechanism of this association in terms of emotional support is not completely understood. Methods: We used survey data among a national sample of 2403 individuals aged 18–30. Primary measures included the 4-item Patient-Reported Outcome Measurement Information System (PROMIS) scale to assess anxiety, self-reported emotional support derived from social media (SMES), and the 10-item Big Five Inventory (BFI-10) to determine personality structure. We performed factorial analysis of variance (ANOVA) and multiple regression analyses to examine the associations among these variables while controlling for age and sex. Results: SMES was associated with decreased anxiety. These associations were more pronounced among females. Personality traits of high openness to experience, high extraversion, high agreeableness, and low conscientiousness were associated with increased SMES. Limitations: Due to the cross-sectional research design and observation data, causal relationship could not be established. Conclusions: Emotional support derived from social media (SMES) may be linked to reduced anxiety, especially among females. SMES may also be linked with specific personality characteristics. Future research should investigate these associations longitudinally.

Psychiatry International doi: 10.3390/psychiatryint7010017

Authors: Mohammed A. Aljaffer Ahmad H. Almadani Abdulmalik H. Alshathry Mohammed A. Alrobeia Faisal A. Abu Ghanim Fahad M. Alotaibi Ali A. Alaskar Malik E. Aleidan Ayedh H. Alghamdi

Background: Eating disorders (EDs) are important mental illnesses that are often associated with depression and anxiety, leading to significant negative consequences. However, research on this topic in Saudi Arabia remains limited. This study aims to examine the risk of EDs among male and female medical students at King Saud University (KSU) and assess their risk factors and association with anxiety and depression. Methods: A cross-sectional study involving 425 participants was conducted, using a convenience sampling method. The study tools consisted of a questionnaire developed by the research team, the Eating Attitudes Test-26 (EAT-26), the Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder-7 scale (GAD-7). Results: Almost half (49.6%) were classified as high risk for EDs. Obesity was much higher among high-risk students than low-risk students (p < 0.001). Anxiety and depression were greater among high-risk students than low-risk ones. A higher body mass index (BMI) and depression greatly increased the risk of EDs (p < 0.001). Conclusions: The findings support the notion that medical students have a significant likelihood of developing EDs, especially if they have a high BMI and are depressed. The results show the importance of early identification and offering appropriate interventions to this vulnerable group.

Psychiatry International doi: 10.3390/psychiatryint7010016

Authors: Metin Çınaroğlu Eda Yılmazer Esra Noyan Ahlatcıoğlu

Ericksonian hypnotherapy (EH), a client-centered hypnotic approach characterized by indirect suggestion, individualized flexibility, collaboration, and the principle of Utilization, has seen increased interest as a therapeutic modality across diverse clinical settings. This systematic review and meta-analysis aimed to evaluate the efficacy of EH by synthesizing evidence from randomized controlled trials (RCTs) published between 2015 and 2025. Eight eligible RCTs (N = 676) were identified, spanning conditions such as acute pain, depression, grief, irritable bowel syndrome, disordered eating, and alcohol use. EH interventions consistently produced significant symptom reductions compared to waitlists or standard care, with a pooled standardized mean difference of 1.17 (95% CI: 0.70–1.64), indicating a large effect. Moreover, trials comparing EH to active treatments (e.g., CBT, motivational interviewing) revealed comparable efficacy, with pooled estimates supporting non-inferiority. Sensitivity analyses confirmed the robustness of these findings. Notably, some trials suggested that the indirect and personalized nature of EH may confer advantages in domains like grief and hypervigilance. Although evidence remains limited by sample size and heterogeneity, this review provides initial empirical support for EH and supports its inclusion in the evidence-based repertoire for both physical and psychological conditions. Future research should examine mechanisms of change and individual predictors of response to optimize the use of this distinctive hypnotic style.

Psychiatry International doi: 10.3390/psychiatryint7010015

Authors: Leonardo Massoni

Amyotrophic Lateral Sclerosis is a neurodegenerative disease characterized by progressive muscular impairment resulting in death, mainly from respiratory failure. Interest has recently grown around the clinical and prognostic aspects of cognitive and psychiatric dysfunctions in Amyotrophic Lateral Sclerosis. In fact, about 50% of Amyotrophic Lateral Sclerosis individuals have cognitive impairment, which may affect ALS patients’ quality of life. In this review, we carried out a literature search focusing on neuropsychiatric symptoms of Amyotrophic Lateral Sclerosis and on their relationship with the prognostic aspects of the disease. We pointed out that cognitive impairment in Amyotrophic Lateral Sclerosis as well as psychiatric symptomatology could have a significant effect on disease global outcome, also impacting motor impairment progression. Further studies are needed to shed new light on the biological and neurophysiological basis of cognitive functions and psychological problems in Amyotrophic Lateral Sclerosis and on their impact on disease prognosis.

Psychiatry International doi: 10.3390/psychiatryint7010014

Authors: Selina Kit Yi Chan Kelvin K. F. Tsoi Terry Cheuk Fung Yip Vivien Wei Jun Liew Wai Kwong Tang

Background: This study investigated whether individuals with kleptomania (KTM) are at higher risk of engaging in self-harm behaviors than individuals without KTM. Methods: In this matched cohort study, we analyzed the electronic health records of all patients admitted, for any indication, to public hospitals in Hong Kong between 1 January 1993 and 31 December 2022. We selected a KTM cohort consisting of 152 patients and a comparison cohort comprising 152 subjects. Participants were observed until they received a self-harm diagnosis, died from other causes, or reached the end of 2023, whichever occurred first. The Cox proportional hazards regression model was used to calculate the self-harm risk since KTM onset. Results: Over a 30-year study period, the number of individuals who engaged in self-harm in the KTM and comparison groups was ten (6.6%) and eight (5.3%), respectively. Both groups showed similar proportions of individuals who inflicted self-harm (χ2 = 0.49, p = 0.834). The self-harm incidence was 48.4 and 44.5 per 10,000 person-years in the KTM and comparison groups, respectively. The adjusted hazard ratio for self-harm in the KTM group was 0.49 (95% confidence interval, 0.16–1.48) relative to the comparison group. Conclusions: KTM is not associated with an increased self-harm risk. Future studies should replicate our findings and further delineate any distinct risk factors for self-harm in these patients.

Psychiatry International doi: 10.3390/psychiatryint7010013

Authors: Meer Zakirulla Faisal Ali Bin Abbooud AlQhtani Zuhair Motlak Alkahtani Abdullah M. Alsubaie Muath S. Al Asaarah Mohammed S. Asiri Rayan H. Alqahtani Lujain S. Alshareif Jaber A. Alwaymani

Background: Burnout, a syndrome of emotional exhaustion, cynicism, and reduced personal accomplishment, is a significant concern among dental students because of the intense demands of their academic and clinical training. This study aimed to determine the prevalence of burnout and its related dimensions among dental students at King Khalid University, Abha, Saudi Arabia. Methods: A cross-sectional study was conducted among 300 dental students (147 males, 153 females) from the 4th year to the internship level, selected via simple random sampling. A 12-item survey called the Burnout Clinical Subtype Questionnaire-12-Student Survey (BCSQ-12-SS) was validated for use with students. Burnout was assessed across three domains—Overload, Lack of Development, and Neglect. Descriptive statistics, Mann–Whitney U tests, and Kruskal–Wallis analyses were employed to explore gender- and year-based differences. Results: Overload and Lack of Development were the most prominent burnout dimensions, with more than half of participants reporting excessive academic pressure, personal sacrifices, and dissatisfaction with developmental opportunities. Neglect demonstrated the lowest prevalence. Female students exhibited significantly higher total burnout scores (p = 0.005). Burnout varied across academic years, peaking among fourth-year students (p < 0.001). Internal consistency for all domains was acceptable to excellent (α = 0.62–0.89). Conclusions: Burnout is highly prevalent, particularly in the domains of Overload and Lack of Development. Female and mid-program students represent high-risk groups. Institutional reforms, curricular enhancement, workload redistribution, structured support systems, and early mental-health interventions are crucial to mitigate burnout and promote student well-being.

Psychiatry International doi: 10.3390/psychiatryint7010012

Authors: Roqia S. Maabreh Anwar M. Eyadat Abdallah Ashour Mohammad N. Al-Shloul Raya Y. Alhusban Dalal B. Yehia Hanan Abusbaitan Sabah Alwedyan Naser A. Alsharairi

Background/aim: Despite the fact that qualitative research on postpartum depression (PPD) has been extensively researched globally, women’s perceptions of PPD misconceptions are mostly ignored in developing countries like Jordan. Thus, this study aims to explore Jordanian women’s sociocultural perceptions and misconceptions about PPD using the descriptive phenomenological design. Methods: Fourteen women who had either a normal or caesarean (C-section) delivery and resided in Irbid, Northern Jordan, participated in semi-structured in-depth interviews, which lasted 15 to 25 min in May 2025. Data were gathered via field note transcriptions of interviews, and analysis followed Colaizzi’s data analysis methodology. Results: Among participants, five women (all C-section deliveries) reported a PPD diagnosis, while the remaining normal delivery women reported experiencing depression before giving birth. The women’s sociocultural perceptions and misconceptions about PPD were found to be reflected in a number of themes. The theme “perceiving PPD as normal baby blues” captures the general lack of awareness regarding this disorder. Three important themes—“myths”, “psychological”, and “spiritual and religious failure”—show how little is known about the causes. The two primary themes that are impacted by sociocultural perspectives are “stigma” and “mistrust of professional care services”. The accuracy and misconceptions around this disorder are summed up in four basic themes: “emotional misconceptions”, “cultural misconceptions”, “false beliefs about health”, and “think of PPD as indolence”. Conclusions: Jordanian women have limited understanding and misconceptions of PPD. Adopting culturally relevant awareness campaigns is essential to disseminating the knowledge required to facilitate improved treatment pathways.

Psychiatry International doi: 10.3390/psychiatryint7010011

Authors: Giovana Kátia Viana Nucci Elaine Silva de Pádua Melo Marta Aratuza Pereira Ancel Danusa Cespedes Guizzo Kleber Francisco Meneghel Vargas Marcelo de Oliveira Marcelo Luiz Brandão Vilela Valter Aragao do Nascimento

Lithium carbonate is one of the most prescribed mood stabilizers worldwide and remains the first-line pharmacological treatment for bipolar disorder (BD). Its therapeutic efficacy is well established; however, lithium (Li) has a narrow therapeutic index, and prolonged or excessive intake can cause renal, neurological, or endocrine toxicity. In Brazil and globally, lithium-based formulations are widely commercialized; however, only Brazil adopts a specific regulatory classification distinguishing reference, generic, and similar medicines. Despite its extensive clinical use, studies monitoring the actual Li concentration in pharmaceutical products are extremely scarce. This study quantified Li concentrations in different formulations available in Brazil to evaluate their chemical uniformity, estimated daily intake, and potential health risks. Samples were digested and analyzed using Inductively Coupled Plasma Optical Emission Spectrometry (ICP OES). Statistical analysis with the Kruskal–Wallis test revealed significant differences among formulations (p = 0.012), confirming non-uniform Li content. Measured concentrations ranged from 245.47 to 315.24 mg/kg, with generic products showing the highest values. The calculated daily intake (DI) and chronic daily intake (CDI) increased with therapeutic dose (600–1800 mg/day), and higher-dose regimens frequently exceeded the permitted daily exposure (PDE) value for Li established by International Council for Harmonisation Guideline for Elemental Impurities (Revision 2) (ICH Q3D (R2) (0.55 mg/day). Moreover, hazard quotient (HQ) values above 1 in some scenarios indicated potential health risks associated with excessive or long-term Li exposure. As one of the first studies to quantify Li in marketed formulations, this work underscores the need for systematic monitoring and stricter quality control to ensure therapeutic safety.

Psychiatry International doi: 10.3390/psychiatryint7010010

Authors: Jennifer Jazmine Pérez-Sandoval Hector Adrian Limón-Fernández María Fernanda Ortega-Morfín Jaime Briseño Ramírez Edgar Alfonso Rivera-León Sergio Sánchez-Enríquez

Mental disorders have significantly increased worldwide, with depression affecting over 280 million people. Up to 60% of individuals with major depressive disorder experience concurrent anxiety, both of which can lead to suicide. While social and cultural factors contribute to mental disorders, recent studies link these conditions to genetic, neurophysiological, and biochemical factors, including serum lipid levels. This study investigates the association between serum lipid levels and depressive symptoms in the Los Altos Sur region of Jalisco, Mexico. Forty-two participants with depressive symptoms and eighty-four controls were recruited. Participants underwent psychometric assessments and lipid profile assays. The results showed significant differences between cases and controls in total cholesterol, triglycerides, LDL, and VLDL levels. Cases had higher rates of hypocholesterolemia and more frequent depressive and anxiety symptoms, as well suicidal risk. Hypocholesterolemia was significantly associated with depressive symptoms. Differences for cases grouped by depressive symptoms and hopelessness were found in HDL. Physical activity was found as a protective factor for depressive and anxiety symptoms. This study demonstrates the association of serum lipid levels with mental health conditions, suggesting that cholesterol levels are related to increased vulnerability to depression and hopelessness. Understanding these associations can aid in early identification and intervention for at-risk populations.

Psychiatry International doi: 10.3390/psychiatryint7010008

Authors: Margarita L. Martinez-Fierro Lorena Avila-Carrasco Joselin M. Basconcelos-Sanchez Isabel Peralta-Trejo Yolanda Ortiz-Castro María Elena Luna-Morales Leticia A. Ramirez-Hernandez Maria C. Martinez-Vazquez Mentali Mental Health Collaborative Network Mentali Mental Health Collaborative Network Idalia Garza-Veloz

Background: Bullying in university settings is a significant yet understudied contributor to psychological distress. Differentiating the sources of victimization, may reveal distinct risk profiles associated with mental health and substance use outcomes. Objective: To evaluate the frequency and risk factors associated with bullying victimization among medical students, and to identify associations with mental disorders and substance use. Methods: A nested case–control cohort study was conducted with 124 medical students. Participants completed nine validated psychometric instruments evaluating neurobehavioral traits, emotional distress, substance use, and scholar bullying. Bivariate and multivariate regression models were used to estimate coefficients and odds ratios for key outcomes. Results: 42.7% of the students reported victimization, with teacher harassment (37.1%) more frequent than peer harassment (27.4%); 22.6% experienced both. Teacher harassment was primarily characterized by intentional harm (78%); peer harassment involved abuse of authority (63%). ADHD, severe stress, and substance use were associated with teacher-related victimization, while peer victimization was linked to ADHD, stress, impulsivity, and suicide risk. Childhood abuse, high stress levels, and non-heterosexual orientation as predictors of teacher harassment (p < 0.05). Notably, students with a non-heterosexual orientation were over six times more likely to report teacher harassment, highlighting the disproportionate vulnerability of sexual minorities within academic power dynamics. Conclusions: Teacher- and peer-related harassment are prevalent and often co-occur, with teacher-perpetrated bullying emerging as both more frequent and more strongly associated with mental health and identity-based vulnerabilities. Students with ADHD, high stress levels, and non-heterosexual orientation are at significantly greater risk. These findings emphasize the need for institutional accountability, inclusive academic policies, and targeted mental health support to protect vulnerable students and prevent harm within educational environments.

Psychiatry International doi: 10.3390/psychiatryint7010009

Authors: Giuseppe Marano Claudia d’Abate Ilaria Ianes Eugenia Costantini Francesco Maria Lisci Gianandrea Traversi Eleonora Gaetani Daniele Napolitano Marianna Mazza

Endometriosis is a chronic, estrogen-dependent inflammatory condition associated with severe pelvic pain and infertility. Beyond its somatic manifestations, it is increasingly recognized as a disorder with significant psychological sequelae. This review examines the bidirectional relationship between endometriosis-related chronic pain and mental health disorders, with the aim of highlighting the importance of integrated, multidisciplinary management strategies. Relevant literature was synthesized to explore the pathophysiology of endometriosis, mechanisms of pain chronification, and the prevalence and impact of psychiatric comorbidities, including depression, anxiety, body image disturbance, and sexual dysfunction. Chronic pain and diagnostic delays contribute substantially to psychological distress in patients with endometriosis. High rates of affective disorders have been consistently reported, with significant repercussions on social functioning, intimate relationships, and overall quality of life. Although treatment traditionally focuses on symptom control, evidence supports the efficacy of approaches that concurrently address mental health needs. Endometriosis represents a paradigmatic example of the interplay between chronic somatic illness and mental health. Future research should prioritize the integration of psychological assessment and intervention within endometriosis care pathways, alongside the development of targeted, biopsychosocial treatment models.

Psychiatry International doi: 10.3390/psychiatryint7010007

Authors: Bettina F. Piko

There is a global documented rise in depressive symptoms among adolescents. The cross-sectional assessments in representative samples of adolescents would help explore their correlates, which may serve as resources for intervention. Our cross-sectional survey entitled “Békés County Youth Study 2024” involved a representative sample of grade-9 high school students (N = 1590, aged 15–17 years, 56.4% females) from public high schools in the region, Hungary. Besides depressive symptoms (measured by a validated, shortened version of the Children’s Depression Inventory, CDI), a set of psychosocial variables (psychosomatic symptoms, internet addiction, future orientation, social support from family and friends, marks, gender, school satisfaction, and religiosity) was included in the survey. Gender differences in the summary score for CDI were significant: t(1588) = −12.062, p < 0.001, showing a higher rate of females. A total of 22.6% (males: 13% and females: 30%) belonged to the group at risk of depression. All potential predictors proved significant, with the strongest contribution of psychosomatic symptoms (Beta = 0.306, p < 0.001), and the most relevant protective role of family support (Beta = −0.265, p < 0.001). Other than further exploring contextual factors that increase risk for and protect against adolescent depression, mental health promotion in schools should include well-being training.

Psychiatry International doi: 10.3390/psychiatryint7010006

Authors: Irene Cappadona Maria Pagano Anna Anselmo Davide Cardile Rosaria De Luca Antonino Todaro Rocco Salvatore Calabrò Francesco Corallo

Background: Schizophrenia is a chronic disorder characterized by positive and negative symptoms, cognitive deficits, and brain alterations, primarily affecting the frontal and temporal lobes. Traumatic events, such as head injury, may worsen these deficits. Objective: The aim of this study is to describe the application of an integrated rehabilitation program, including cognitive and emotional–motivational interventions, in a patient with head trauma and a history of schizophrenia, highlighting the multidimensional nature of the rehabilitation process. Methods: We described the case of a 34-year-old patient. The program included a baseline cognitive and psychological assessment, a 12-month rehabilitation training with three weekly sessions (two cognitive and one emotional–motivational, each lasting 60 min), and a follow-up to assess long-term outcomes. Change significance between baseline and follow-up was assessed using the Reliable Change Index (RCI). Values of RCI ≥ 1.96 indicated a statistically reliable improvement or decline at p < 0.05. Results: The patient showed significant cognitive and emotional recovery, with improvements confirmed by RCI and p-values: attention (RCI = +2.45, p = 0.014), working memory (RCI = +2.85, p = 0.004), executive functions (RCI = +2.18, p = 0.029), depression (RCI = +2.10, p = 0.036), anxiety (RCI = +1.95, p = 0.052), and insight (RCI = +2.20, p = 0.028); mild long-term memory deficits persisted. Conclusions: Integrated rehabilitation promoted cognitive, psychosocial, and occupational recovery, improving daily functioning and reducing maladaptive thoughts, emphasizing the importance of a multidimensional approach in schizophrenia.

Psychiatry International doi: 10.3390/psychiatryint7010005

Authors: Rosa Angela Fabio Alessia Di Pietro Rossella Suriano

Mental health among university students is an issue of growing global concern, impacting both psychological well-being and academic outcomes. This study investigated the relationships between sleep quality, perceived stress, anxiety, and depression, examining the mediating role of perceived stress and the protective effects of optimism and critical thinking. A sample of 363 Italian university students (mean age = 22.67 ± 4.64 years) completed standardized self-report questionnaires assessing the main psychological variables of interest. Data were analyzed using structural equation modeling (SEM) with bootstrapping to evaluate mediating and moderating effects. SEM analyses showed that perceived stress partially mediated the effect of sleep disturbances on anxiety (β = 0.27, 95% CI [0.18, 0.37]) and depression (β = 0.24, 95% CI [0.16, 0.33]). Moreover, the impact of sleep problems on perceived stress was attenuated among students with higher levels of optimism (β = −0.18, p = 0.003) and critical thinking (β = −0.14, p = 0.01), confirming the protective role of these personal resources. These findings highlight the importance of considering both risk factors and protective resources in understanding and preventing psychological distress in university populations, suggesting interventions aimed at improving sleep quality and enhancing individual resources.

Psychiatry International doi: 10.3390/psychiatryint7010004

Authors: Gerald Young

Introduction: The Diagnostic and Statistical Manual of Mental Disorders has been criticized for its reliability and validity, including for the major psychological injuries [Posttraumatic Stress Disorder (PTSD), chronic pain-related disorders, and neurocognitive disorders, pertinent for mild traumatic brain injury (MTBI)/persistent post-concussion syndrome (PPCS)]. Methods: This review article examines both the mental health/psychiatric and legal literature on the DSM-5 and its criticisms. The DSM-5 uses a polythetic approach, which leads to many complicating ways of expressing disorders (e.g., PTSD). Disorders related to chronic pain refer to somatic symptom disorders (e.g., with predominant pain), which leads to less focus on the chronic pain itself. The neurocognitive disorder diagnosis includes minor and major classifications, but excludes moderate ones. The international diagnostic system (International Classification of Diseases (ICD-11)) and alternate approaches to psychiatric nosology [the Research Domain Criteria (RDoC) and Hierarchal Taxonomy of Psychopathology (HiTOP)] do not help resolve these issues. Results: The comprehensive literature review undertaken indicates the limitations of the DSM-5 clinically and in court, especially for psychological injuries. The article includes tables and boxes that complement the text with specificities related to the issues raised. Conclusions: The article recommends supplementary diagnostic criteria for the three major psychological injuries (PTSD, chronic pain, and MTBI) for forensic use. This paper is an original contribution to improving the diagnostics/description and forensic use of the major psychological injuries: aside from the paper’s clinical contributions, these disorders/conditions are contentious in court, and their better specification in diagnosis, as attempted herein, is important to undertake forensically.

Psychiatry International doi: 10.3390/psychiatryint7010003

Authors: Mikie Ebihara Noriko Sato Neteru Masukawa Kumiko Ando Tomoko Omiya

This pilot exploratory qualitative study used the Modified Grounded Theory Approach (M-GTA) and the Realist Evaluation (RE) framework to clarify the interrelationships between nursing support and Peer Support (PS) in the creation and utilization of Crisis Plans (CPs) in Japan. Findings revealed that nursing support, constrained by psychiatric ward institutions, struggled with internal conflict while seeking to bridge risk and recovery. In contrast, PS support, rooted in lived experience, reframes crisis and risk, actively fostering patient self-determination and growth, and transforming. We propose an exploratory Context–Mechanism–Outcome (CMO) model that maps the distinctive contributions and interactions of nursing and PS support. This model provides provisional insights to inform the development of more robust, recovery-oriented CP support systems.

Psychiatry International doi: 10.3390/psychiatryint7010002

Authors: Suellen Alves da Silva Giovana Kátia Viana Nucci Elaine Silva de Pádua Melo Diego Azevedo Zoccal Garcia Marta Aratuza Pereira Ancel Valter Aragão do Nascimento

Fluoxetine and carbamazepine are widely prescribed psychotropic drugs, yet few studies have quantified metal(loid) impurities in these medicines, which may pose health risks to patients. This study aimed to determine concentrations of As, Cd, Cr, Cu, Fe, K, Mg, Mn, P, Pb, Se, and Zn in brand, similar, and generic samples of fluoxetine and carbamazepine marketed in Campo Grande, Brazil. Drug samples were purchased from local pharmacies, digested with acid, and analyzed by Inductively Coupled Plasma Optical Emission Spectrometry (ICP OES). Results showed that arsenic was detected only in fluoxetine samples, with concentrations ranging from 0.068 to 0.217 mg/kg, all below national and international limits. Phosphorus presented the highest levels, especially in fluoxetine, reaching up to 14,000 mg/kg, and up to 93 mg/kg in carbamazepine. Other elements such as Fe (0.07–3.03 mg/kg), Mg (0.21–259 mg/kg), K (up to 45 mg/kg), Se (up to 1.5 mg/kg), and Zn (up to 4.2 mg/kg) were also quantified, while Cd, Cr, Cu, and Pb were below detection limits. The hazard index (HI) exceeded 1 for all carbamazepine samples and for one brand, two similar, and three generic fluoxetine samples, indicating that the intake of these medications may pose potential health concerns. These findings underscore the need for stricter monitoring of metal(loid) impurities in psychotropic drugs to protect patient safety and ensure regulatory compliance.

Psychiatry International doi: 10.3390/psychiatryint7010001

Authors: Yi Ling Tan Guocan Ma Roger S. McIntyre Kayla Teopiz Christine E. Dri Soon-Kiat Chiang Dewen Zhou Fengyi Hao Zhifei Li Zhisong Zhang Boon Ceng Chai Roger C. Ho

Background: Clinical practice suggests that objective assessment tools are needed to assess adults with inattention or hyperactivity, informed by the underlying pathophysiology of attention-deficit and hyperactivity disorder (ADHD). This systematic review comprehensively evaluates the current objective assessment methods as an adjunct diagnostic tool for these adults. Methods: We conducted a systematic review of studies investigating various objective diagnostic methods to assess adults with ADHD and healthy controls. The database search occurred from its inception to 23 December 2024. Results: Our search yielded 46 studies that reported on various objective methods to assess adults with ADHD. The MOXO-distracted Continuous Performance Test (MOXO-d-CPT), eye-tracker with MOXO-d CPT, Conners’ Continuous Performance Test—3rd edition (CCPT-3), and oculomotricity can differentiate between true and feigned ADHD or other diagnostic possibilities. The Quantified Behavior Test (Qb Test+) can detect hyperactivity and differentiate it from other psychiatric disorders. Mono-d, CCPT-3, Qb Test+, Test of Variables and Attention (TOVA), Integrated Visual and Auditory Continuous Performance Test (IVA-CPT), and oculomotricity can monitor pharmacotherapy response. Functional near-infrared spectroscopy (fNIRS) offers more promise than structural imaging and demonstrates a moderate level of sensitivity and specificity to differentiate adults with and without ADHD by performing the verbal fluency test. Notwithstanding, electroencephalography (EEG)/event-related potential (ERP) shows potential in diagnosis and treatment monitoring (e.g., neurofeedback training). In addition, transcriptome-based biomarkers have also been explored as diagnostic tools. Conclusion: The diagnosis and monitoring of ADHD in adults come with a unique set of challenges due to psychiatric comorbidity, including depression and anxiety; fluctuation of symptoms over time; and lack of consensus among clinicians and professional organizations to adopt objective tests in the diagnostic process. Our findings support the notion that a combination of clinical assessment and objective biomarkers targeting distinct pathophysiological aspects may enhance the accuracy of ADHD diagnosis.

Psychiatry International doi: 10.3390/psychiatryint6040157

Authors: Mónica Valente Maria João Carapeto Anabela Pereira

Several studies worldwide have shown that adolescents have low levels of mental health literacy (MHL). This is a worrying situation, given the significant prevalence of mental health disorders among adolescents and the role of MHL in identifying these problems early and seeking help. This study aims to characterize MHL in Portuguese adolescents according to sociodemographic variables. The participants were 608 adolescents from the 7th to 12th grade, who filled in questionnaires on sociodemographics, MHL, and positive MHL. Bivariate analysis and hierarchical logistic regression models were conducted. A high level of adequate beliefs was found to be more likely in girls and in those whose mothers had higher levels of education. High rates of knowledge about self-help strategies were related to older age, having a mother who had a high level of education, greater subjective socioeconomic status (SSES), and better self-perception of mental health (SPMH). Help-seeking/first-aid skills were predicted by higher SSES, and lower SPMH predicted high levels of knowledge about mental health problems. Different MHL dimensions were related to diverse sociodemographic variables, and SPMH played a key role in enhancing the models’ ability to explain variation in MHL—particularly in knowledge on self-help strategies. Those topics require further research. These results can be useful in the development of MHL programs tailored to the specific knowledge needs of different adolescent groups.

Psychiatry International doi: 10.3390/psychiatryint6040158

Authors: Solange A. Valente Isabel Iborra Marmolejo Juan J. Mora Ascó

Child sexual abuse (CSA) has consequences beyond the direct victim, affecting non-offending mothers, who may experience psychological, physical, and social symptoms after disclosure. This systematic review examined the impact of CSA on these mothers and the variables that influence coping and recovery. Searches were run in EBSCOhost (MEDLINE, PsycInfo, CINAHL) following PRISMA 2020 and a PEO framework. Three reviewers screened 128 records in Rayyan (Cohen’s κ = 0.73), and 17 empirical studies met the inclusion criteria. Risk of bias was appraised with ROBINS-E. Distress, anxiety, depression, and secondary traumatic stress were the most frequently reported symptoms. These consequences were associated with factors such as maternal history of abuse, perceived social support, coping style, and cultural or religious beliefs, highlighting potentially modifiable cognitive and contextual targets for support. A key contribution of this review is the identification of modifiable cognitive variables that are clinically relevant. Methodological limitations of the evidence base warrant cautious interpretation–comprising seven qualitative, nine quantitative cross-sectional, and one mixed-methods study, with heterogeneity that precluded meta-analysis and limited causal inference. Overall, the findings highlight the need for comprehensive, trauma-informed interventions that address not only the child’s recovery but also the well-being and resilience of their mothers.

Psychiatry International doi: 10.3390/psychiatryint6040156

Authors: Mohammad A. Sakarneh Obaid A. Sabayleh Firas D. Alsoleihat Mamduh B. Al Zaben Alia M. Al-Oweidi Tala Maragha Rima A. Alkhrissat

Numerous studies have investigated the relationship between autism spectrum disorders (ASD) and the use of Assisted Reproductive Technology (ART). However, the results have been inconclusive. This review aims to explore this association via the meta-analysis of existing studies. PubMed, Web of Knowledge, SCOPUS, and Embase databases were searched up to December 2023. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using random or fixed effect models to explore the association between ART and ASD. A total of 20 records of cohort and case–control studies were analyzed and diagnosed with Autism Spectrum Disorder (ASD) published between 2013 and 2023. Children between the ages of 2–12 years were included in these studies via a census method. The results of the studies revealed a significant correlation between ART and ASD (RR = 1.43, 95% CI: 1.13–1.71, p = 0.006). Some subgroups revealed statistically significant relationships based on study location, design, and quality. The results suggest that using assisted reproductive technology elevates the susceptibility of children to develop ASD, but more large-scale and prospective studies are required to corroborate this conclusion, particularly in light of the divergent outcomes of some reviewed studies.

Psychiatry International doi: 10.3390/psychiatryint6040155

Authors: Jelena Kostic Iva Binic Žilijeta Krivokapić Andrea Milijic Sofija Stevanović Milan Petković

Introduction: Adverse Childhood Experiences (ACEs) refer to traumatic events occurring before the age of 18 that can negatively impact physical and mental health, often disrupting development. Numerous studies have shown associations between ACEs and the onset or severity of psychotic disorders. The aim of this study was to assess the prevalence of ACEs among patients with psychotic disorders and to examine an association between ACEs and the sociodemographic and clinical characteristics of psychosis. Material and Methods: The study was conducted at the Center for Mental Health and the Psychiatric Clinic of the University Clinical Center Nis, from March to July 2025. The sample included adult patients of both sexes diagnosed with psychotic spectrum disorders based on ICD-10 criteria. The Adverse Childhood Experiences Questionnaire (ACE-Q), along with sociodemographic and clinical data from medical records, was used. Results: The sample included 60 patients, with a mean age of 36.7 years. The average ACE-Q score was 2.57 ± 1.98, with one-third of patients reporting high exposure (≥4 ACEs) to childhood adversity. Patients with high ACEs exposure (≥4 ACEs) differed significantly from those with low to moderate or no exposure (<4 ACEs) in terms of economic status, family history of psychiatric disorders, substance use, and treatment adherence. Conclusion: Despite the small sample size, our results point to a potential link between childhood adversity and certain sociodemographic and clinical characteristics in patients with psychotic disorders. Integrating systematic assessments of trauma history into routine clinical practice may support the development of more effective treatment strategies.

Psychiatry International doi: 10.3390/psychiatryint6040154

Authors: Hyunjoong Kim

The global opioid crisis necessitates innovative non-pharmacological interventions for pain management and addiction recovery. This comprehensive narrative review synthesizes evidence from approximately 75 studies supporting manual therapy’s modulation of endogenous opioid systems and explores potential applications in addiction treatment. Manual therapy interventions, including massage and joint manipulation, demonstrate significant neurochemical effects, with controlled studies showing 16% increases in plasma β-endorphin levels (p = 0.025) persisting approximately one hour following treatment. These effects appear mediated through periaqueductal gray-rostral ventromedial medulla descending pathways, with naloxone reversibility studies confirming opioid-mediated mechanisms. The endogenous opioid system undergoes profound dysregulation during addiction, creating therapeutic opportunities for interventions capable of stimulating natural opioid release without exogenous substances. Clinical applications in addiction recovery may include withdrawal symptom management, craving reduction, and restoration of dysregulated reward pathways. Manual therapy’s demonstrated safety profile, accessibility, and compatibility with existing treatment modalities position it as an ideal complementary intervention for comprehensive addiction programs. However, significant methodological limitations in existing studies necessitate cautious interpretation. Rigorous randomized controlled trials specifically examining manual therapy’s effects in addiction recovery populations represent the highest research priority. Manual therapy as an endogenous opioid modulator represents a promising frontier in addiction medicine but warrants rigorous scientific investigation before potential clinical integration into evidence-based treatment protocols.

Psychiatry International doi: 10.3390/psychiatryint6040153

Authors: Bartosz Bogusz Colinso Weronika Hariasz Dawid Konieczko Antonina Wiktoria Trzaskoma Aureliusz Andrzej Kosendiak

Mental health problems are widespread in prison populations and can negatively affect inmates’ well-being. Although physical activity (PA) is known to benefit mental health in the general population, less is known about this relationship in correctional settings. This study examined the association between PA levels, symptoms of anxiety and depression, as well as coping strategies among 130 male prisoners at Prison No. 1 in Wroclaw, Poland. Data were collected using validated self-report tools: the International Physical Activity Questionnaire (IPAQ), the Hospital Anxiety and Depression Scale (HADS), and the Mini-COPE inventory. Inmates who met the criteria for Health-Enhancing Physical Activity (HEPA) reported fewer symptoms of anxiety and depression than less active participants. Individuals showing signs of mental health difficulties were also more likely to rely on avoidant coping strategies, though no clear link was found between coping style and activity level. Cluster analysis further supported the observed association between low PA and higher psychological distress. These findings suggest a potential role for PA in supporting mental health in prison settings. They also highlight the importance of identifying individuals who may be at risk due to maladaptive coping strategies. Given its exploratory nature, the study’s findings should be interpreted with caution and verified in future research with larger and more diverse samples.

Psychiatry International doi: 10.3390/psychiatryint6040152

Authors: Evangelia Karali Konstantina Briola Alkinoos Emmanouil-Kalos Symeon Sidiropoulos Alexandros Ginis Athanassios Vozikis

Problematic smartphone use (PSU) is increasingly recognized as a behavioral concern among university students, with consequences for well-being, risky behaviors, and academic outcomes. However, evidence from Greece remains limited. This study assessed the prevalence and correlates of PSU among students at the University of Piraeus and interpreted findings through Griffiths’ components model of addiction. A cross-sectional survey was conducted between March and June 2023 with 1743 participants, who provided socio-demographic, lifestyle, and health information and completed the Smartphone Addiction Scale–Short Version (SAS-SV). Nearly half of the students (49.2%) exceeded the proposed SAS-SV thresholds for PSU (50.5% men; 48% women). Regression analysis showed that alcohol consumption (p < 0.001), weekly screen time (p < 0.001), younger age (p < 0.001), female sex (p < 0.001), size of household (p < 0.033), and anxiety/depression (p = 0.019) were significant predictors of higher SAS-SV scores, while smoking, BMI, exercise, and academic performance were not associated. For the independent statistical tests, the Benjamini–Hochberg correction was applied to control the false discovery rate. Group comparisons confirmed greater alcohol use (p < 0.001), screen exposure (p < 0.001), and anxiety/depression (p = 0.004) among PSU students. Item-level responses reflected components of tolerance, salience, withdrawal, and conflict. These findings place Greek students at the higher end of international prevalence estimates and highlight the importance of integrating digital-well-being initiatives within student health services in universities.

Psychiatry International doi: 10.3390/psychiatryint6040151

Authors: Bianca Daniela Crecan-Suciu Patricea Iulia Huluba Adela Melania Hanga Olivia Verișezan Roșu Ramona Liana Păunescu

Introduction: Huntington’s disease is a genetic disorder, also known as an autosomal dominant neurodegenerative disease, that has typical manifestations such as motor disturbances, cognitive decline, and psychiatric symptoms. Neurologists initially classified it as a movement disorder because the diagnosis is primarily based on the presence of extrapyramidal motor symptoms. However, after careful examination of several cases, it was revealed that chorea was only one type of motor dysfunction and that tics and myoclonus were also present. Regarding psychiatric symptoms, studies have shown that patients presenting psychosis-related symptoms have a worse evolution with poor prognosis, and it was concluded that they present distinct clinical, imaging, and biological characteristics. Case presentation: The present case report aims to describe the onset of a particular case of Huntington’s disease, taking into consideration the fact that early psychotic symptoms, very similar to those identified in schizophrenia, could represent indicators of Huntington’s disease onset. An interesting aspect of this case was that our patient had no family history of neurological conditions but had a clinical picture characterized by delusions and hallucinations. These symptoms were considered criteria for schizophrenia. Moreover, chorea motor movements appeared several years after the onset of psychosis, determining the need for the diagnosis to be changed from schizophrenia to Huntington’s disease. Conclusion: We need to point out that psychiatric symptoms could represent the only initial visible change in the clinical picture, being also considered as indicators of Huntington’s disease onset. These features could help patients be easily and faster identified, allowing for proper medical interventions to be provided.

Psychiatry International doi: 10.3390/psychiatryint6040150

Authors: Valentina Baldini

Suicide remains one of the leading causes of death worldwide, yet psychiatry continues to assess risk primarily through suicidal ideation. This narrow focus overlooks a critical factor: sleep. A growing body of evidence demonstrates that insomnia, nightmares, and circadian disruption are consistent and potentially modifiable correlates of suicidal behavior across various diagnoses and age groups, supported primarily by longitudinal and prospective studies. Despite this, structured sleep assessment is seldom integrated into routine psychiatric care, predominantly due to cultural inertia and inadequate training. This perspective necessitates a shift: sleep assessment should be regarded alongside mood and cognition in every evaluation of suicide risk. Brief questionnaires and targeted interventions are readily accessible and feasible for implementation, thereby presenting concrete opportunities for prevention. By incorporating sleep evaluation into standard practice and future predictive models, psychiatry can advance toward more precise, actionable, and timely suicide prevention. To continue neglecting sleep is to overlook one of the most accessible and effective means of saving lives.

Psychiatry International doi: 10.3390/psychiatryint6040149

Authors: Valentina Baldini

Traumatic experiences are among the strongest predictors of suicidal thoughts and behaviors, but the mechanisms that account for this association are still debated. Sleep disturbances, particularly insomnia, nightmares, and fragmented sleep, are highly prevalent after trauma and have been shown to predict suicidality independently of depression and other psychiatric comorbidities. This narrative mini-review synthesizes evidence from epidemiological, clinical, and experimental studies to examine whether sleep may represent a pathway linking trauma and suicidality. Among the proposed mechanisms, alterations in REM sleep regulation, dysregulation of the hypothalamic–pituitary–adrenal axis, and impaired prefrontal control of emotional reactivity have received empirical support, although findings remain inconsistent across populations. Importantly, trauma-related nightmares and persistent insomnia appear to be especially strong markers of elevated suicide risk. Clinically, these observations suggest that routine sleep assessment could add value to suicide risk evaluation in trauma-exposed individuals. Interventions such as cognitive behavioral therapy for insomnia, imagery rehearsal therapy, and REM-modulating pharmacological treatments have shown promise, but their specific impact on suicidality requires further testing in controlled trials. Future research should prioritize longitudinal designs, incorporate both subjective and objective sleep measures, and include culturally diverse samples to clarify causal mechanisms and refine prevention strategies.

Psychiatry International doi: 10.3390/psychiatryint6040148

Authors: Gisselle Campoverde Cristina Sacaquirín Vanessa Quito-Calle Andrés Ramírez

Adolescents with Type 1 Diabetes Mellitus (T1DM) face a significantly increased risk of developing disordered eating behaviors (DEBs), a phenomenon that includes the deliberate omission of insulin, commonly referred to as diabulimia. The aim of this systematic review and meta-analysis was to determine the prevalence of diabulimia in adolescents with T1DM and consolidate the scientific evidence on this issue. Following PRISMA guidelines, observational studies published in English and Spanish involving adolescents aged 10 to 19 were identified through comprehensive searches in SCOPUS, LILACS, PubMed, Web of Science, and PsycINFO. After rigorous screening and eligibility assessment, 13 studies were included. Data were extracted independently, and meta-analyses were performed using random-effects models. Reported prevalence rates of DEB in T1DM varied widely among studies, ranging from 20.8% to 48%. The pooled prevalence in the final meta-analytic model was 11% (95% CI: 9–13%), with prevalence substantially higher in females (45%) than males (26%). These findings highlight not only the elevated risk of DEB and diabulimia among adolescents with T1DM but also considerable gender differences likely shaped by psychological, sociocultural, and biological factors. The lack of standardized diagnostic criteria for diabulimia remains a barrier to clinical management. Early detection and gender-sensitive preventive strategies are crucial for reducing complications and improving the quality of life in this vulnerable population.

Psychiatry International doi: 10.3390/psychiatryint6040147

Authors: Seham Eldeeb Ammar Shahtou Hesham Alrefaey Fahd Almesned Hassan Alqureshah Saleh Alhawkash Nasser Alhawkash Ashraf Alsahag Hidar Alqudhaya

Background: The public harbors adverse perceptions of individuals with mental illness. The global prevalence of mental health illnesses has consistently risen. Untreated mental illness in high school adolescents can result in social, behavioral, and academic problems. Methods: A respondent-driven sample of 716 high school teachers working in Najran city was surveyed. The participants completed questionnaires assessing their mental health knowledge and Perceived Devaluation and Discrimination. Results: Almost two-thirds of participants had adequate knowledge. The highest knowledge scores were found in the items related to the effectiveness of medication and psychotherapy. Schizophrenia was the most recognized mental health condition, followed by bipolar disorder and depression (mean scores 4.3, 4.0, 3.9, respectively). Almost two-thirds of the study participants (73.6%) had high perceived stigma in the total score of the PDD scale. The highest scores of perceived stigma were found in the scale items related to hiring a qualified person with severe mental illness (86.3%) and being close friends with a person with severe mental illness (85.6%). Participants with adequate knowledge had more perceived social stigma than those with inadequate knowledge (77% versus 66%). There were statistically significant associations between Stigma-related mental health knowledge and socio-demographic characteristics of the study participants (p < 0.05). Conclusions: This study found that, despite the foundational level of knowledge, particularly regarding treatment effectiveness, gaps exist in understanding help-seeking behaviors. Socio-demographic factors play a role in shaping mental health literacy among high school teachers in Najran city.

Psychiatry International doi: 10.3390/psychiatryint6040146

Authors: Antonio Del Casale Liliana Bronzatti Jan Francesco Arena Giovanna Gentile Carlo Lai Paolo Girardi Maurizio Simmaco Marina Borro

Mental disorders affect nearly one billion persons worldwide, having a substantial burden on individuals, families, and healthcare systems. Current diagnostic and therapeutic approaches could fail to reach optimal outcomes, highlighting the need for more effective and personalized interventions. Precision psychiatry aims to address this challenge by integrating multidimensional data, ranging from genomics and epigenomics to neuroimaging and psychometric assessments, through advanced computational tools such as machine learning and artificial intelligence. This transdisciplinary approach could allow the study of biologically informed endophenotypes, improve diagnostic accuracy, and support individualized treatment strategies. Emerging technologies, including pharmaco-neuroimaging, virtual histology, and large-scale consortia, are advancing the field by elucidating the molecular and circuit-level correlates of mental disorders. Although significant progress has been made, the translational gap between research and clinical practice remains a critical issue. Effective implementation will require the systematic integration of bioinformatic tools, big data analytics, and clinician-guided interpretation, in a context in which the evolving landscape of precision psychiatry continues to prioritize therapeutic alliance and individualized patient care.

Psychiatry International doi: 10.3390/psychiatryint6040145

Authors: Rebeca Santamaría-Gutiez Eva María González-Albors Francisco González-Sala Laura Lacomba-Trejo

Surrogacy involves a surrogate carrying a baby to transfer to the intended parents after birth. This study examines how surrogacy impacts attachment patterns compared to traditional pregnancies or assisted reproductive technologies. Using PRISMA guidelines, a systematic review of databases like Scopus and PubMed identified nine relevant studies from 806 initial records, involving 1317 participants (115 pregnant women and 118 children). Key variables included maternal–fetal attachment, depression, anxiety, and somatization in surrogates, alongside intended parents’ support and children’s exploration of their origins. Findings reveal the complexity of attachment dynamics in surrogacy, emphasizing the need for psychological support and preparation to foster secure attachments among surrogates, children, and intended parents.

Psychiatry International doi: 10.3390/psychiatryint6040144

Authors: Špela Golubović Jelena Radonjić Mirjana Djordjević Sonja Golubović

Children with developmental disabilities (DD) require early and coordinated services, yet parents often face obstacles in accessing adequate support. This study examined parents’ experiences with early intervention in Serbia to identify barriers, supports, and context-specific challenges. Semistructured interviews were conducted with 15 parents of children aged ≤ 6 years. Interviews (30–50 min) were audio-recorded, transcribed verbatim, and thematically analyzed in line with the Consolidated Criteria for Reporting Qualitative Studies. Seven themes emerged: recognition of concerns, first steps in seeking help, complexity of procedures, information gaps, emotional and practical challenges, collaboration with professionals, and recommendations for improvement. Parents typically noticed developmental delays, especially in language and motor skills, by age two but encountered lengthy and fragmented referral pathways, long waiting lists, and insufficient guidance. Parents emphasized the value of empathetic professionals and peer networks while also reporting stigma and social isolation. This study contributes new evidence on how structural barriers and cultural attitudes in Serbia shape families’ access to early intervention. Findings highlight the need for streamlined referral systems, transparent and accessible information for families, and interdisciplinary training for professionals. Addressing these issues could reduce delays, alleviate parental stress, and promote better developmental outcomes for children with DD.

Psychiatry International doi: 10.3390/psychiatryint6040143

Authors: Invención Fernández-Quijano Ivan Herrera-Peco Fidel López-Espuela Carolina Suárez-Llevat Raquel Moreno-Sánchez Carlos Ruíz-Núñez

Background: Artificial intelligence (AI) has been proposed as a transformative tool in suicide prevention, yet most evidence remains observational. To provide a rigorous benchmark, we systematically reviewed randomized controlled trials (RCTs) evaluating AI-based interventions targeting suicidal thoughts, behaviours, or help-seeking. Methods: Following PRISMA 2020 guidelines, MEDLINE, Web of Science, and Scopus were searched to 31 May 2025. Eligible studies were RCTs in humans that incorporated AI or machine learning for risk prediction, automated intervention, or treatment allocation. Methodological quality was assessed with the PEDro scale and certainty of evidence with GRADE. Results: From 1101 screened records, six RCTs (n = 793) met all criteria. Three studies tested machine learning risk prediction, two evaluated fully automated interventions (a transformer-based recommender and a digital nudge), and one examined AI-assisted treatment allocation. Risk-prediction models stratified short-term suicidal outcomes with accuracies of up to 0.67 and AUC values around 0.70. Digital interventions reduced counsellor response latency or increased crisis-service uptake by 23%. Algorithm-guided allocation reduced the occurrence of suicidal events when randomisation aligned with model recommendations. Methodological quality was moderate to high (median PEDro = 8/10), but GRADE certainty was low due to small samples and imprecision. Conclusions: AI can enhance discrete processes in suicide prevention, including risk stratification, help-seeking, and personalized treatment. However, the current evidence is limited, and larger multisite RCTs with longer follow-up, CONSORT-AI compliance, and equity-focused design are urgently required.

Psychiatry International doi: 10.3390/psychiatryint6040142

Authors: Zanele R. S. Mthembu Sadiyya Haffejee Sophie Plagerson Catherine O. Egbe

Electronic cigarettes have become increasingly popular, especially among young people when compared to other demographic groups. This study explored young South African women’s experiences of using e-cigarettes. Age of initiation, patterns and reasons for using e-cigarettes, the financial impact and the experience of quitting were explored. This qualitative study used an interpretive research paradigm. Data were collected from three focus groups that were guided by a discussion guide. The total sample comprised 11 young women aged between 18 and 25 years who had used or were using e-cigarettes. Data were analysed using thematic analysis with the aid of NVivo version 12. Findings revealed five key themes: (1) age of e-cigarette initiation ranged from pre-adolescence to adolescence, and in adulthood; (2) patterns of use included occasional and daily use, concurrent use with tobacco products (dual use) and use with tobacco products and alcohol. Participants reported using e-cigarettes at social events, with other peers and alone; (3) reasons for use included emotional regulation (easing stress, boredom), peer pressure, experimentation, the appeal of e-cigarettes’ designs and flavours, ease of access and enhanced social media presence; (4) the impact of e-cigarette use weighed on financial and familial issues; (5) concerning quitting, only one participant reported successfully quitting while some participants had tried to quit but had been unsuccessful and advocated for more cessation support. Interventions to address how to better manage peer pressure, boredom and stress as well as policies to regulate the design and flavours of e-cigarettes are needed to help young women not to get initiated into a lifetime of nicotine addiction. Cessation support is also needed to assist young people (especially women) who wish to quit using e-cigarettes.

Psychiatry International doi: 10.3390/psychiatryint6040141

Authors: Ekaterina Ossadchaya Roza Tatayeva Zhibek Sembayeva Akmaral Nursafina Mira Zhakenova Gaukhar Slamkhanova

This research represents the first in the Republic of Kazakhstan focusing on Afghan war veterans identified as being at risk for Post-Traumatic Stress Disorder (PTSD). A comprehensive investigation was undertaken regarding the comorbidity of PTSD symptoms, somatic diseases (cardiovascular and others), and mental disorders. The study’s sample comprised 293 Afghan war veterans, while the control group consisted of 149 males without combat experience. The research methodology incorporated data extracted from medical records, a demographic questionnaire, the Mississippi PTSD Scale (military and civilian versions), the Spielberger–Khanin Anxiety Inventory, the Beck Depression Inventory (BDI), and the SCL-90-R questionnaire. Subclinical symptoms indicative of chronic PTSD were identified in 25.2% of veterans, as assessed by the Mississippi PTSD Scale. According to the Spielberger–Khanin questionnaire, veterans with subclinical PTSD exhibited a moderate level of situational (44.96 ± 6.39 points) and personal anxiety (44.14 ± 5.49 points), which were significantly higher than those observed in the control group (29.87 ± 6.50, p2 < 0.001, 36.13 ± 6.82, p2 = 0.003). Furthermore, based on the BDI, these veterans demonstrated an elevated level of depression (13.32 ± 1.36) in comparison to veterans without PTSD (8.61 ± 0.65, p < 0.001) and the control group (4.06 ± 0.75, p < 0.0001). The findings indicate that veterans exhibiting a high level of PTSD are characterized by a more pronounced manifestation of psychopathological indicators, as assessed by the SCL-90-R questionnaire. Compared to the control group, veterans exhibiting PTSD symptoms were found to have a comorbidity with somatic diseases: stage 3 hypertension in 45.2% vs. 21.3% (p2 < 0.001), coronary heart disease in 45.5% vs. 13.4% (p2 < 0.001), and type 2 diabetes mellitus in 20.3% vs. 6.1% (p2 = 0.001). Consequently, Afghan war veterans should be regarded as a high-risk group for cardiovascular diseases (including hypertension and coronary heart disease), cerebrovascular diseases, and mental health disorders. Accordingly, a comprehensive approach is necessary to identify PTSD symptoms alongside concomitant anxiety–depressive disorders and somatic diseases in individuals who have experienced traumatic events.

Psychiatry International doi: 10.3390/psychiatryint6040140

Authors: Yoshihiro Mifune Hirokazu Ito Krishan Soriano Leah Anne Bollos Toshiya Akiyama Kyoko Osaka Hidehiro Umehara Itsuro Endo Rick Yiu Cho Kwan Anson Chui Yan Tang Kazushi Mifune Tetsuya Tanioka

Patients with schizophrenia face high mortality from physical comorbidities; nonetheless, the gradual physiological decline preceding death is not well characterized. This retrospective study investigated temporal changes in key biomarkers among 64 inpatients with schizophrenia who died between 2014 and 2022. We analyzed data on body mass index (BMI), serum albumin (ALB), blood urea nitrogen/creatinine ratio (BCR), blood urea nitrogen/ALB ratio (BAR), and estimated glomerular filtration rate (eGFR) collected at five time points: 3, 2, and 1 year, 6 months before death, and prior to death. We hypothesized that these markers would exhibit significant changes during the last 3 years of life. BMI and ALB significantly decreased, while BCR and BAR increased (all p < 0.001). This pattern was also noted in the pneumonia subgroup, the leading cause of death (47%). A high BCR concomitant with low eGFR was attributable to chronic kidney failure in only 6% of patients, suggesting the elevated ratio was mostly driven by non-renal factors such as dehydration or sarcopenia. Therefore, the concurrent decline in BMI and ALB and rise in BCR and BAR represent a pattern of terminal physiological decline among patients with schizophrenia, supporting the need for timely risk assessment.

Psychiatry International doi: 10.3390/psychiatryint6040139

Authors: Marina Culo Celina Ha Amanda Wong Rebecca Alley Shu-Ping Chen

Background: Social media has become a space for sharing personal experiences and shaping public opinion. This study explored how people respond to substance misuse recovery journeys shared on TikTok. Methods: The researchers collected 3583 comments from 350 TikTok videos under the hashtags #wedorecover, #recovery, and #sobertok using a scraper tool. A discourse analysis categorized comments into Narrative Strategies, Rhetorical Strategies, Linguistic Features, and Power Relationships, each with subcategories revealing public perceptions of substance use and recovery. A correlation analysis was also conducted to examine the role of emojis across narrative and linguistic features. Results: Most comments (94%) expressed support or positivity toward recovery videos. The heart emoji was the most common (93.35% of all emojis), symbolizing connection, encouragement, and solidarity. Four themes emerged reflecting public attitudes: encouragement and positive messaging, acknowledgment of struggle, the culture of sharing, and the influence of broader social narratives. Conclusions: These results provide insight into public responses to recovery content on TikTok, suggesting that peer support may be facilitated through the platform’s algorithmic design. While TikTok shows promise as a supportive digital space, further research is needed to understand its broader implications for substance use recovery support.

Psychiatry International doi: 10.3390/psychiatryint6040138

Authors: Phyllis Chua Ingrid Ozols Kirsty Pope Michelle Kehoe

Background: Many workers in non-health settings interact with people with living experiences of mental ill-health but have little knowledge about the symptoms, the mental health system, or may hold stigmatising views. Aims: This study evaluated the impact of an online mental health course. It was hypothesised that an increase in mental health literacy would reduce stigmatising beliefs. Methods: Students were invited to complete an online survey pre- and post-course completion as part of a quasi-experimental study with a pre-test–post-test design. Questions were related to demographic data, knowledge on mental ill-health and mental health care, and beliefs towards mental illness. The independent sample t-test, Shapiro–Wilks test for normality, and a Mann–Whitney U-test were used to analyse the data. Results: This study found that there was a significant change, with a large effect size, in self-reported knowledge about mental health and the mental health system. There was a small but significant reduction in Belief Towards Mental Illness scores (rank-biserial correlation = 0.2). The results indicated improved perceptions of those with mental ill-health. Conclusions: A specialised online course can effectively educate the non-clinical community workforce and reduce the stigma associated with mental ill-health. This enables people to assist those experiencing mental health distress from a well-informed and less fearful position.

Psychiatry International doi: 10.3390/psychiatryint6040137

Authors: Michèle Preyde Andre Watkis Shrenik Parekh

Psychiatric illness during childhood and adolescence is a growing concern, placing increased pressure on psychiatric services. Reliance on an evidence-based assessment tool may facilitate the identification and management of symptoms and may facilitate accountability. The purposes for this study were to characterize the psychiatric symptoms of a sample of pediatric patients accessing outpatient psychiatry using the DSM Level 1 Cross-Cutting Measure (CCSM), compare patient and caregiver ratings (CCSM), and explore patients’ acceptability of using the CCSM. The sample consisted of 51 patients (mean age 14 years) and 46 caregivers (mean age 43 years). Patient and caregiver ratings suggested problems with sleep, inattention, depression, irritability/anger, and anxiety. The most common discordance concerned suicide ideation. Most patients (34 of 38) reported that the assessment tool was easy to complete. The CCSM may be a useful, evidence-based, standardized, transdiagnostic assessment tool aligned with the DSM-5 that can be used in a variety of mental health settings to identify symptoms, inform treatment planning, and track progress.

Psychiatry International doi: 10.3390/psychiatryint6040136

Authors: Ryuichi Tanioka Kaito Onishi Feni Betriana Leah Bollos Rick Yiu Cho Kwan Anson Chui Yan Tang Yueren Zhao Yoshihiro Mifune Kazushi Mifune Tetsuya Tanioka

Prolonged hospitalization contributes to a decline in physical function and immobilization. This narrative review aims to explore physical rehabilitation approaches that address the specific characteristics of physical dysfunction in patients with schizophrenia. A literature review was conducted following an electronic search of PubMed for English-language articles published between January 2014 and January 2025. Based on the findings, a framework was constructed to categorize symptoms and physical challenges into three domains: (1) movement disorders and obesity induced by antipsychotic medications, which alter motor performance and lead to compensatory movements; (2) negative symptoms and cognitive impairments, which promote sedentary behavior and result in dysphagia, dynapenia, sarcopenia, and frailty; and (3) accelerated brain aging and disuse syndrome by schizophrenia, which impair neuromotor and cognitive function and increases the risk of physical dependency. These interconnected factors emphasize the need for targeted physical rehabilitation to maintain independence and reduce the risk of hospitalization. This review proposes a multidisciplinary approach involving psychiatrists, physical therapists, and occupational therapists, along with individualized nutritional support, as essential components of comprehensive rehabilitation strategies aimed at improving physical outcomes and reducing early mortality in this population.

Psychiatry International doi: 10.3390/psychiatryint6040135

Authors: Filipe Prazeres

Background: Dispelling myths is crucial for policy and health communication because misinformation can directly influence public behavior, undermine trust in institutions, and lead to harmful outcomes. This study aims to assess the effectiveness and differences between OpenAI’s ChatGPT and Google Gemini in dispelling myths about children’s and adolescents’ mental health. Methods: Using seven myths about mental health from the UNICEF & WHO Teacher’s Guide, ChatGPT-4o and Gemini were asked to “classify each sentence as a myth or a fact”. Responses of each LLM for word count, understandability, readability and accuracy were analyzed. Results: Both ChatGPT and Gemini correctly identified all 7 statements as myths. The average word count of ChatGPT’s responses was 60 ± 11 words, while Gemini’s responses averaged 60 ± 29 words, a statistically non-significant difference between the LLMs. The Flesch–Kincaid Grade Level averaged 11.7 ± 2.2 for ChatGPT and 10.2 ± 1.3 for Gemini, also a statistically non-significant difference. In terms of readability, both ChatGPT and Gemini’s answers were considered difficult to read, with all grades exceeding the 7th grade level. The findings should nonetheless be interpreted with caution due to the limited dataset. Conclusions: The study adds valuable insights into the strengths of ChatGPT and Gemini as helpful resources for people seeking medical information about children’s and adolescents’ mental health, although the content may not be as easily accessible to those below a college reading level.

Psychiatry International doi: 10.3390/psychiatryint6040134

Authors: Francisco Javier Lievanos-Ruiz Bertha Fenton-Navarro

Treatment-resistant depression (TRD) affects 20–30% of patients with major depressive disorder and presents a significant clinical challenge due to its biological diversity. This review highlights standard mechanisms that contribute to treatment resistance beyond traditional monoaminergic models. Evidence supports serotonergic dysregulation, including 5-HT1A autoreceptor dysfunction and “serotonin flooding” as well as dopaminergic deficits linked to anhedonia and an imbalance between glutamate and GABA that impair synaptic plasticity. Changes in neurotrophic signaling, such as reduced BDNF and VEGF activity, complicate recovery by limiting neural repair and regeneration. Chronic inflammation and oxidative stress contribute to neuronal dysfunction, while HPA axis dysregulation may exacerbate depressive symptoms and resistance to antidepressants. Emerging evidence suggests that obesity and gut microbiota imbalance reduce the production of short-chain fatty acids by bacteria and increase intestinal permeability, thereby influencing neuroinflammatory and neurochemical processes in TRD. Neuroimaging studies reveal hyperconnectivity within the default mode network and impaired reward circuits, both of which are associated with persistent symptoms and a poor treatment response. By combining evidence on inflammation, oxidative stress, neuroendocrine disturbances, microbiome changes, and brain connectivity issues, this review develops a comprehensive framework for understanding TRD. It emphasizes the importance of biomarker-based subtyping to guide personalized future treatments.

Psychiatry International doi: 10.3390/psychiatryint6040133

Authors: Naseem Abdulmohi Alhujaili Oyedeji Ayonrinde

Background: Youth and young adults with early psychosis frequently use cannabis, yet the reliability of self-reported use is uncertain in clinical practice. We examined the concordance between self-reported cannabis use and urine toxicology among patients enrolled in an Early Psychosis Intervention (EPI) program in Southeast Ontario, Canada. Methods: We conducted a cross-sectional chart review of 116 EPI patients (2016–2019). Demographics, self-reported cannabis use (yes/no), concurrent substance use, and urine toxicology results from the initial clinical assessment were extracted. Diagnostic indices (sensitivity, specificity, positive/negative predictive values, and accuracy) were calculated using urine toxicology as the reference. The clinical panel used a 50 ng/mL threshold for THC-COOH; the specific assay platform (immunoassay vs. confirmatory GC-/LC-MS) was not specified in records and is noted as a limitation. Results: Overall, 82.8% (96/116) self-reported cannabis use. Self-report showed high sensitivity (88.4%) but very low specificity (20.3%), with PPV 39.2%, NPV 75.0%, and accuracy 45.30%, indicating limited concordance with urine toxicology. Self-reported cannabis use was significantly associated with self-reported cocaine and MDMA use, while associations with methamphetamine, opioids, and benzodiazepines were not significant. Conclusions: In this EPI cohort, self-reports overestimated cannabis use relative to urine toxicology (high sensitivity, low specificity, and accuracy <50%). These findings support cautious clinical interpretation of self-report and the complementary value of biological verification, especially when use is infrequent or the testing window/threshold may miss exposure. Future work should incorporate use frequency, potency, and timing relative to testing, and clearly specify toxicology assay methods.

Psychiatry International doi: 10.3390/psychiatryint6040132

Authors: Hewa Zrar Jaff Banaz Adnan Saeed

The increasing prevalence of Autism Spectrum Disorder (ASD) is a significant health concern influenced by both genetic and environmental factors. However, limited data exist on the socio-demographic and clinical characteristics associated with ASD in our region. This cross-sectional study assessed 200 children (155 boys and 45 girls) diagnosed with ASD at Hawler Psychiatric Hospital in Erbil city between January and December 2023. The Childhood Autism Rating Scale-Second Edition (CARS-2) was used for diagnosis and severity assessment. The mean age of participants was 4.6 ± 1.8 years, with males representing 77.5% of the sample. Cesarean section was the most common mode of delivery. The average parental ages were 34.8 years for mothers and 38.5 years for fathers. The first signs of autism were noticed at a mean age of 25.7 ± 9.7 months, with the first medical consultation at 34.6 ± 15.4 months and diagnosis at 42.4 ± 15.5 months. Delayed speech was the most common reason for seeking medical help. Statistically significant associations were found between severe autism symptoms and several factors, including older child age, younger age at first assessment, delayed speech, parental consanguinity, paternal age over 40, lower paternal education, and lower socioeconomic status. These findings emphasize the critical role of early detection and the influence of both socio-demographic and clinical factors on ASD symptom severity, highlighting the need for targeted early intervention strategies to improve outcomes in affected children.

Psychiatry International doi: 10.3390/psychiatryint6040131

Authors: Josivaldo de Souza-Lima Paula Ortiz-Marholz Gerson Ferrari Maribel Parra-Saldias Daniel Duclos-Bastias Andrés Godoy-Cumillaf Eugenio Merellano-Navarro José Bruneau-Chávez David Peris-Delcampo Claudio Farias-Valenzuela Pedro Valdivia-Moral

Background/Objectives: Subjective well-being (SWB) in children is a key indicator of healthy development, influenced by physical activity and sports, with physical literacy (PL) as a potential mediator. Traditional linear models overlook non-linear and heterogeneous effects in diverse populations. This study uses causal machine learning (ML) to examine PL’s mediating role between sports participation and SWB in a multinational cohort. Methods: Data from the International Survey of Children’s Well-Being (ISCWeB) (n = 128,184 children aged 6–14, 35 countries) were analyzed. SWB was a composite (six items, α = 0.85); PL was a proxy (three items excluding sports frequency, α = 0.70); sports participation was continuous (0–5). Confounders were age, gender, parental listening, and school satisfaction. CausalForestDML estimated the effects; GroupKFold and bootstrap were used for robustness; SHAP/PDP was used for interpretability. Results: Total ATE = 0.083 (95% CI [0.073, 0.094]); indirect via PL = 0.055 (CI [0.049, 0.061]); direct = 0.028 (CI [0.020, 0.038]); mediation proportion = 0.660. Sensitivity with lean PL (2 items) was as follows: indirect = 0.045 (CI [0.040, 0.050]). For SHAP, school satisfaction was (+0.28), and parents were (+0.20) top. For PDP, there was a non-linear rise at PL 4–6 (+1.2 units) and a plateau ~9.2. The cross-cultural mean ATE = 0.083 ± 0.01 (from within-country meta-analysis); this was stronger in older children (CATE 0.30 for 12–14). For Rho sensitivity at 0.1, it was indirect −0.129; at Rho sensitivity of 0.2, it was −0.314 (robust to low confounding). Conclusions: The findings, grounded in SDT/PYD, support interventions targeting PL through sports to enhance SWB, addressing inactivity. Limitations are its cross-sectional nature and proxy measures; we recommend longitudinal studies.

Psychiatry International doi: 10.3390/psychiatryint6040130

Authors: Simone Pardossi Claudia Del Grande Beatrice Campi Andrea Bertolini Barbara Capovani Andrea Fagiolini Riccardo Zucchi Alessandro Saba Alessandro Cuomo Grazia Rutigliano

N-Acetylaspartate (NAA) plays a critical role in neuronal function, metabolism, and neurotransmitter release. Evidence from magnetic resonance spectroscopy indicates diminished NAA levels in individuals diagnosed with schizophrenia and bipolar disorder; however, this process is time-consuming, expensive, and not viable in individuals with acute illness exacerbation. In order to address these limitations, we developed a novel method for the quantification of plasma NAA based on tandem mass spectrometry coupled to liquid chromatography (HPLC-MS). Our study aimed to assess whether plasma NAA levels change during hospitalization and whether these changes correlate with symptomatic improvement in patients experiencing acute psychiatric exacerbations. We recruited 31 inpatients with acute symptoms of psychotic (48.39%) and/or mood (51.61%) disorders. Symptom severity was assessed using the brief psychiatric rating scale, Positive and Negative Syndrome Scale, and Clinical Global Impression Scale. Plasma NAA was measured at admission and discharge. We observed a significant decrease in symptom scores and a significant increase in plasma NAA levels between admission and discharge. The initiation of therapy with lithium salts significantly influenced plasma NAA changes. Our study shows that our HPLC-MS method can detect clinically meaningful changes in plasma NAA levels. These results might lay the groundwork for future research exploring the relationship between plasma NAA levels and cerebral NAA levels measured by MRS.

Psychiatry International doi: 10.3390/psychiatryint6040129

Authors: Rebeca Robles-García Geoffrey M. Reed María Elena Medina-Mora Eduardo A. Madrigal-de León

The Clinical Descriptions and Diagnostic Guidelines (CDDG) for Mental, Behavioral, and Neurodevelopmental Disorders (MBND) in the International Classification of Diseases 11th Revision (ICD-11) are a substantial improvement over their equivalent in the ICD-10. This study evaluates the usefulness of the synchronous and asynchronous modalities of an online training course on the ICD-11-CDDG-MBND to increase readiness to implement it in routine clinical practice among Spanish-speaking clinicians. A convenience sample of psychiatrists, psychologists, and general practitioners completed online evaluations of one of the two course modalities. Acquired knowledge was evaluated through a multiple-choice questionnaire. Readiness to implement the ICD-11-CDDG-MBND was evaluated before and after the course, using an instrument based on the transtheoretical model of stages of change: precontemplation, contemplation, preparation and action. A total of 310 clinicians completed either the asynchronous (n = 176) or synchronous course (n = 134). Prior to the course, most participants were at the precontemplation stage. By the end of the course, participants reported a moderate level of knowledge. The percentage of clinicians at the preparation and action stages was higher than before the courses, with no differences being observed between course modalities. Online training was associated with increased knowledge and motivation to implement the ICD-11-CDDG-MBND.

Psychiatry International doi: 10.3390/psychiatryint6040128

Authors: Jiamei Lian Yueqing Su Nagesh Pai Chao Deng

Olanzapine and clozapine, two of the most efficacious second-generation antipsychotic drugs (SGAs), are known to cause serious metabolic side effects. Despite their clinical utility, the epigenetic basis of these metabolic side-effects remains poorly understood. This exploratory study investigated whether histone methylation is associated with metabolic disorders following chronic SGA treatment. Rats were treated with olanzapine or clozapine for 9 weeks and then sacrificed 2 h after the final treatment. After evaluating the metabolic parameters, Chromatin immunoprecipitation (ChIP)-deep sequencing was conducted on liver tissue pooled from twelve samples per group to quantify histone H3K4me2 methylation and transcriptional changes. Gene ontology term enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis were used to explore shared functional pathways of genes with differential histone methylation. Key findings revealed that both olanzapine and clozapine induced widespread changes in hepatic histone methylation, particularly hypermethylation at H3K4me2 across genes involved in lipid and glucose metabolism, insulin signalling, and adipogenesis. Olanzapine- and clozapine-treated rats displayed increased H3K4me2 levels at numerous gene loci and at distinct genomic regions. These findings suggest the importance of monitoring metabolic parameters in psychiatric patients and potential novel strategies to mitigate SGA-induced metabolic side effects.

Psychiatry International doi: 10.3390/psychiatryint6040127

Authors: María Alcalá-Cerrillo Mirian Santamaría-Peláez Josefa González-Santos Jerónimo J. González-Bernal Ana Gómez-Martín

Background: Poisoning is a frequent cause of emergency department (ED) visits. The COVID-19 pandemic may have influenced its epidemiology and clinical profile. Objective: To analyze and compare the characteristics of poisonings treated in the ED before and after the COVID-19 pandemic. Methods: A retrospective observational study was conducted including all patients who attended for acute poisoning in a Spanish tertiary hospital from January 2018 to December 2022. Sociodemographic variables, toxic agents, clinical features, psychiatric history, intentionality, and outcomes were analyzed. Results: A total of 170 cases were recorded. Medicinal agents were the most frequent toxicants, followed by ethanol. After the onset of the pandemic, there was an increase in poisonings due to medicinal agents and in cases with psychiatric comorbidity, particularly intentional overdoses. Hospital admissions and ICU referrals also increased, although mortality remained low. Conclusions: The COVID-19 pandemic was associated with relevant changes in the epidemiology and clinical profile of poisonings treated in the ED, highlighting the growing importance of intentionality and psychiatric disorders.

Psychiatry International doi: 10.3390/psychiatryint6040126

Authors: Luis Villalobos-Gallegos Salvador Trejo Diana Mejía-Cruz Aldebarán Toledo-Fernández Diana Alejandra González García

We tested the longitudinal invariance of seven short versions of the Center for Epidemiological Studies Depression Scale (CES-D) in maternal caregivers, following recent analytic recommendations for ordered categorical responses. Data for this study were drawn from the Longitudinal Studies in Child Abuse and Neglect (LONGSCAN) consortium, based on responses from 427 maternal caregivers across five waves corresponding to their children’s ages: 4, 6, 12, 14, and 16 years. We employed a comprehensive approach using differences in two approximate fit indices (CFI and RMSEA), the chi-square difference test (χ2), and a sensitivity analysis based on predicted response differences. Only one version demonstrated full invariance across all levels, while the others showed only partial evidence for loading or threshold invariance. These findings highlight concerns regarding the use of brief CES-D versions in longitudinal research, particularly over extended time periods. They also underscore the need to reassess whether item content aligns with current definitions of depressive syndrome. Our results suggest that evaluating the longitudinal invariance of short depression measures is essential to ensure the validity of conclusions about changes over time.

Psychiatry International doi: 10.3390/psychiatryint6040125

Authors: Sajid Ali Sheraz Fazid Basharat Hussain Ihtesham Ul Haq Nasser M. Aldekhail Zia Ul Haq

The global prevalence of type 2 diabetes is alarmingly high, and a considerable proportion of diabetes patients suffer from anxiety and depression. The presence of anxiety and depression worsens the prognosis of diabetes; it increases non-compliance to the treatment and mortality rate. A cross-sectional study of adults ages 20 years or older was conducted in 24 districts of Khyber Pakhtunkhwa (KP). Individuals diagnosed by a certified medical doctor with type 2 diabetes were recruited using multistage stratified cluster sampling. The Agha Khan University Anxiety and Depression Scale (AKUADS) was used for assessment. Chi-square and logistic regression were used to assess the association between depressive disorder and characteristics of the study participants. The results showed that 31.64% of type 2 diabetic patients suffered from anxiety and depression. Prevalence was higher in individuals aged ≤40 years (37.75%), females (40.58%) compared to males (26.48%), individuals without formal education (38.48%), and underweight participants (55%). Anxiety and depression were also prevalent among housewives (38.04%), rural residents (34.76%), and current smokers (43.14%). Multivariate logistic regression indicated significantly higher odds of anxiety and depression among individuals with primary education (OR = 4.73, p-value = 0.03), underweight individuals (OR = 4.46, p-value = 0.001), and those reporting pain (OR = 2.82, p-value < 0.001). The high prevalence of anxiety and depression in the known diabetic population in the KP province of Pakistan requires the development of strategies for screening, awareness related to the contributing factors, and treatment of co-morbid depression at community level.

Psychiatry International doi: 10.3390/psychiatryint6040124

Authors: Stipe Vidović Dunja Degmečić Ines Drenjančević Irena Labak Ana Pešikan Ena Kolak Stela Kraštek Marija Heffer

Mental health issues and insufficient physical activity (PA) among students pose significant public health concerns. This study aimed to examine the prevalence of depression, anxiety, and stress symptoms, alongside PA levels, among Croatian medical students, with a focus on sex-specific differences and associations between these variables. A cross-sectional study was carried out during May and June 2025 among medical students at the University of Osijek, Croatia. Participants completed a self-reported questionnaire consisting of three sections: sociodemographic characteristics, the Depression, Anxiety, and Stress Scale-21 (DASS-21), and the International Physical Activity Questionnaire-Short Form (IPAQ-SF). The study included 244 students (70 males, 174 females) with a median age of 21 years (IQR: 20–23). Symptoms of depression, anxiety, and stress were reported by 33.1%, 48.4%, and 42.6% of participants, respectively. According to IPAQ-SF, 39.7% of students reported PA levels below current recommendations. Female students reported significantly higher depression (p = 0.009), anxiety (p < 0.001), and stress scores (p < 0.001), lower levels of moderate (p = 0.009) and vigorous PA (p < 0.001), and more time spent sitting (p = 0.006) compared to their male counterparts. Furthermore, significant positive correlations were identified between sitting time and depression (ρ = 0.17, p = 0.01), anxiety (ρ = 0.18, p = 0.006), and stress (ρ = 0.26, p < 0.001). Conversely, higher PA—particularly vigorous activity—was associated with lower levels of depression (ρ = −0.21, p = 0.001) and anxiety (ρ = −0.15, p = 0.018). Croatian medical students demonstrated a substantial prevalence of depression, anxiety, and stress symptoms, combined with inadequate levels of PA. These findings highlight the importance of implementing strategies aimed at supporting mental health and fostering regular PA among future healthcare professionals.

Psychiatry International doi: 10.3390/psychiatryint6040123

Authors: Maria Dagla Panagiota Brani Eirini Tomara Artemisia Kokkinari Sevasti Louverdi

This study investigated the impact of maternal psychological factors—specifically anxiety and depression—on breastfeeding outcomes in women with high-risk and low-risk pregnancies. A total of 157 postpartum women were assessed using the State-Trait Anxiety Inventory (STAI) and the Edinburgh Postnatal Depression Scale (EPDS) at multiple time points: 3–4 days, 3 months, and 6 months postpartum. Breastfeeding duration and exclusivity were the primary outcomes. Correlation analyses showed significant negative associations between STAI scores and breastfeeding duration in both groups, with stronger effects in the low-risk group (e.g., r = −0.546, p < 0.001 at 3 months). Similarly, EPDS scores were inversely correlated with breastfeeding duration, particularly at 3 and 6 months postpartum (r = −0.272, p < 0.001 and r = −0.248, p = 0.001, respectively, in the high-risk group). Logistic regression identified EPDS scores at 3 months (p = 0.046, Exp(B) = 0.844) and STAI scores at 3–4 days postpartum (p = 0.006, Exp(B) = 0.861) as significant predictors of early breastfeeding cessation. The model explained 64.9% of the variance in the low-risk group. These findings highlight the significant influence of postpartum anxiety and depressive symptoms on breastfeeding outcomes and suggest that early screening and support for these specific psychological factors may enhance breastfeeding duration and exclusivity, particularly after high-risk pregnancies.