Psychiatry International doi: 10.3390/psychiatryint7030139

Authors: David Desatnik Moshe Shmueli Nofar Tsur Ariel Pollock Star Norm O’Rourke

Background: As understanding of addiction extends beyond substance misuse, various behavioral disorders may emerge as recognized mental health conditions, including social media use disorder (SMUD). To date, however, empirical research supporting SMUD as a distinct disorder is limited and inconsistent. The present study set out to compare the relative prevalence of elevated symptoms suggestive of SMUD between those with no mental health history and affective disorders (both unipolar depression and bipolar disorder). Methods: Participants were recruited online and completed questionnaires measuring social media use (SMU), symptoms of SMUD, depression and various psychosocial factors associated with social media use (i.e., loneliness, social support). Among those with affective disorders, we set out to identify sociodemographic and clinical features that distinguish those with comorbid SMUD (i.e., above the cut-off on the SMUD screening measure). Results: Five main findings emerged from our analyses: (1) SMUD appears unrelated to known forms of SMU; (2) Among those with no mental health history, SMUD does not present independently of elevated depressive symptoms; (3), No sociodemographic or clinical features distinguish those with clinical depression reporting comorbid SMUD; (4), Among those with bipolar disorder (BD), symptoms of hypo/mania do not distinguish those also reporting elevated SMUD symptoms; (5) And SMUD symptoms no longer differ across clinical groups after adjusting for depressive symptoms. Conclusions: Our findings suggest that SMUD is unrelated to active or passive SMU. Symptoms suggestive of SMUD may instead be a contemporary manifestation of depressive symptomology. These findings do not support the existence of SMUD as a bona fide mental health condition.

Psychiatry International doi: 10.3390/psychiatryint7030138

Authors: İbrahim Karakaya İbrahim Gündoğmuş Alişan Burak Yaşar

This study aimed to examine the relationship between post-traumatic stress symptoms following cryptocurrency loss and early maladaptive schemas in physicians. This cross-sectional study was conducted using a relational screening model and included 94 physicians across Türkiye who reported financial loss in cryptocurrency markets between 15 April and 15 July 2022. Data were collected online using a sociodemographic information form, the Young Schema Questionnaire–Short Form 3, and the Impact of Event Scale-Revised. Participants with an Impact of Event Scale–Revised total score of 33 or higher were classified as having elevated IES-R symptoms, reflecting elevated event-related distress according to a screening cutoff rather than a clinical diagnosis of PTSD. Eighteen participants (19.1%) were classified into this group. While no significant differences were found in age, marital status, employment status, or investment duration, the proportion of savings allocated to crypto was higher among participants with elevated IES-R symptoms. The elevated IES-R symptom group had higher scores in Failure, Pessimism, Dependence/Enmeshment, Punitiveness, Defectiveness, and Vulnerability to Harm, and additional correlation analyses showed that the IES-R total score was positively associated with Pessimism, Punitiveness, Dependence/Enmeshment, and Failure after false discovery rate correction. However, in the exploratory logistic regression analysis, none of these variables independently predicted elevated IES-R symptom status. These findings suggest that cryptocurrency loss may represent not only a financial stressor but also a significant experience associated with post-traumatic stress symptoms and maladaptive schema patterns in physicians.

Psychiatry International doi: 10.3390/psychiatryint7030137

Authors: Angel Labra-Lorenzana Dania Nimbe Lima-Sánchez Christian Alejandro Delaflor-Wagner Diana Martínez-Hernández Christian Ramos-Jiménez Christian Gabriel Toledo-Lozano

Background: This systematic review and meta-analysis evaluates the efficacy and safety of psilocybin-assisted psychotherapy (PAP) for adults with major depressive disorder (MDD). Methods: A PROSPERO-registered search (CRD42024561979) of CENTRAL, Scopus, PsycINFO, and MEDLINE (2010–2024) identified clinical trials assessing PAP. Risk of bias was assessed using RoB 2 for randomized controlled trials (RCTs), while non-randomized studies were appraised separately. Evidence certainty was evaluated using GRADE. Results: Ten trials were included; eight provided quantitative data. PAP was associated with large short-term reductions in depressive symptom severity. The overall pooled effect was large (d = 1.15, 95% CI 0.83–1.48), though within-subject designs yielded larger estimates (d = 1.63) than between-subject controlled comparisons (d = 0.96). Adverse events were transient and manageable, with no increased risk of serious adverse events on dosing days. Primary risk-of-bias concerns included functional unblinding. Conclusions: PAP may produce clinically meaningful, large short-term reductions in depressive symptoms. However, long-term efficacy remains understudied, and the overall certainty of evidence is low to moderate. Larger, rigorously blinded trials are required.

Psychiatry International doi: 10.3390/psychiatryint7030136

Authors: Karine Santana de Azevedo Zago Raissa Pereira Dutra Clesnan Mendes-Rodrigues Amanda Viana Hortêncio Analicy Rodrigues Xavier Sarah Campos Moura Rabelo Gustavo Henrique Borges de Souza Felipe Rodrigues Torres Polyana Alvarenga Matumoto Mônica Rodrigues da Silva Hélder Eterno da Silveira Elaine Saraiva Calderari Tiago Rocha Pinto Ricardo Wagner Machado da Silveira Cynthia Daniela Figueiredo de Souza Tatiana Benevides Magalhães Braga Marciana Gonçalves Farinha Luiza Pereira Silva Assis Beatriz da Silva Vieira Fabiola Alves Gomes

This study aimed to assess the self-reported depressive symptomatology of university students during their first therapeutic online consultation and intervention at PROTEGER-SE Project, using the Patient Health Questionnaire-9 (PHQ-9) as a screening instrument. A cross-sectional, retrospective, and analytical study was conducted with 350 records of university students from 2020–2023 collected immediately after their first appointment. Many students presented moderate to severe depressive symptoms, with one-third classified as severe. Logistic regression showed that female sex was associated with higher symptomatology severity, while lower PHQ-9 scores and Humanities field of study enrollment predicted perceived improvement after consultation. Findings reinforce the importance of university-based mental health support, gender-sensitive approaches, and the systematic use of PHQ-9 for early screening and continuous monitoring.

Psychiatry International doi: 10.3390/psychiatryint7030135

Authors: Michèle Preyde Regina Markle Andre Watkis Melissa Aguto Shrenik Parekh John Heintzman

Background: The rising rate of referrals to outpatient psychiatry is difficult to manage. To explore intake and pre-assessment strategies to reduce strain related to the high volume of referrals, two intake tools and two caregiver symptom rating tools were trialled in a child and adolescent outpatient mental health clinic in Ontario, Canada. Methods: Intake personnel completed two tools in addition to the routine intake procedure in a feasibility study. Caregivers completed two symptom-rating tools, and feedback on the use of the tools was sought with a survey. Results: There were statistically significant differences between priority groups (i.e., determination as usual with high, medium, or low priority) on both intake tools, but no statistically significant differences between either caregiver rating tool were found. Conclusions: Standardizing the assessment process may facilitate care. Caregiver ratings did not align with triage priorities; however, these ratings may inform clinical assessments.

Psychiatry International doi: 10.3390/psychiatryint7030134

Authors: Felix Kruse Arvid Nagel

Problematic social media use is associated with adolescents’ mental health, yet mechanisms remain underexplored. This study tested whether dispositional mindfulness mediates associations between problematic social media use and symptoms of depression, anxiety, and stress. In a school-based sample of 892 students aged 10–14 years in Switzerland, participants completed an anonymous online classroom survey. Problematic social media use, mindfulness, and symptoms of depression, anxiety and stress were examined using structural equation modeling with robust maximum likelihood estimation and cluster-robust inference for nested data structure. Model fit was acceptable (CFI = 0.921; RMSEA = 0.052). PSMU predicted lower mindfulness (β = −0.50, p < 0.001), and mindfulness was negatively related to depression (β = −0.54), anxiety (β = −0.60), and stress (β = −0.63; all ps < 0.001). Indirect effects of PSMU via mindfulness were significant for all outcomes (β = 0.27–0.32, ps < 0.001). Direct effects of PSMU remained for anxiety (β = 0.18, p < 0.001) and stress (β = 0.14, p = 0.002) but not depression (β = 0.07, p = 0.161). Overall, findings suggest mindfulness might be an important pathway linking dysregulated social media engagement to adolescent distress. Longitudinal and experimental research is needed to clarify temporal ordering.

Psychiatry International doi: 10.3390/psychiatryint7030133

Authors: Savannah M. Stidhams Kristen M. Pedersen Logan C. Mattingly Annika H. Barsy Mavis Tsai

Mental health disparities among LGBTQ+ individuals remain elevated and have been exacerbated by sociopolitical stressors following the COVID-19 pandemic. This embedded, mixed-methods pilot study examined the feasibility of a four-session Awareness, Courage, and Love (ACL) group intervention adapted for LGBTQ+ community members. The two-hour intervention sessions targeted (1) contact with the authentic self, (2) self-acceptance and self-compassion, (3) value alignment, and (4) presence. Seven LGBTQ+ adults participated in intervention (n = 3) and control (n = 4) conditions. Participants completed quantitative measures evaluating facets of well-being, including social connection and self-acceptance, and provided qualitative feedback. Findings provide preliminary support for the feasibility of ACL interventions in conjunction with existing community-building strengths among LGBTQ+ individuals. Implications for interdisciplinary behavioral health settings, including psychiatric contexts, are discussed.

Psychiatry International doi: 10.3390/psychiatryint7030132

Authors: Stevanovic Milena Latas M. Marko Latas Milan Milic Marija Milic Milic Kisic Darija Pavlovic Zorana

Refugees are exposed to cumulative pre-migration, migration, and post-migration stressors that increase vulnerability to depressive disorders and impaired quality of life. This study assessed the prevalence and severity of depressive symptoms among adult refugees in Serbia and examined associations with sociodemographic characteristics, traumatic experiences, social support, and Health Related Quality of Life (HQoL). The study included 324 refugees residing in four reception centers in Serbia. Data were collected between April 2023 and November 2024 using self-report questionnaires. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9), while HQoL was evaluated using the SF-36 Health Survey. The mean PHQ-9 score indicated mild-to-moderate depressive symptomatology. Clinically significant depressive symptoms were present in 41.4% of participants, while more than 70% reported at least mild symptoms. Depressive symptom severity was negatively associated with energy/fatigue, emotional well-being, social functioning, general health, and pain. The Energy/Fatigue domain emerged as the most prominent independent correlate of depressive symptom severity. Depressive symptoms were highly prevalent and were associated with impaired quality of life and psychosocial stressors. These findings highlight the importance of systematic mental health screening and psychosocial support among refugees.

Psychiatry International doi: 10.3390/psychiatryint7030131

Authors: Daniel Carvalho de Matos Ellen Neide Cutrim Nazareno Rafisa Pereira Costa Fabrício Brito Silva Pollianna Galvão

Background: Children diagnosed with autism spectrum disorder (ASD) commonly show impairment in skills. Research has investigated procedures that may teach a skill and establish others through emergence, without direct instruction. A given procedure corresponds to instructive feedback (IF) with definition of secondary target during the teaching of a primary target. IF information may be presented in the consequent portion of a contingency. Research has shown that this procedure may produce acquisition of multiple targets in some learners. Methods: The current study directly taught a primary target, simple tact, with IF in three children with ASD. In addition, the effects of training with IF were assessed on the emergence of four secondary targets, that is, listener responding according to category, tact according to category, arbitrary visual matching-to-sample and intraverbal according to category. Results: The children acquired all targets. They had no previous experience with IF and data provided further evidence of its effectiveness with this population. In addition, the effects of training with IF were long-lasting, as high performance maintained 2 weeks later in probes. Limitations were discussed, and recommendations for future investigations were presented. Conclusions: Training with IF established primary and secondary targets for all children involved.

Psychiatry International doi: 10.3390/psychiatryint7030130

Authors: Gniewko Więckiewicz

Glucagon-like peptide-1 (GLP-1) receptor agonists, originally developed for type 2 diabetes and obesity, have recently attracted interest as potential modulators of addictive behavior. This narrative review summarizes current knowledge on the neurobiological basis, randomized controlled trials, and psychiatric relevance of GLP-1 analogs in substance use disorders. English-language articles available at the time of the search were reviewed between February and April 2026, with emphasis on topics most relevant to psychiatric practice. The literature suggests that GLP-1 signaling influences reward processing, cue reactivity, stress responses, relapse vulnerability, and executive control through actions in the gut–brain axis and mesocorticolimbic circuitry. Early clinical findings are most encouraging in alcohol-related outcomes, including reductions in alcohol cue reactivity, craving, alcohol self-administration, and some measures of heavy drinking, whereas evidence in nicotine dependence is mixed and appears more consistent for limiting post-cessation weight gain than for improving abstinence itself. Evidence for other substance use disorders remains preliminary. Across randomized controlled trials, interpretation is limited by small sample sizes, short follow-up, heterogeneous endpoints, and selective populations. In addition, psychiatric and behavioral safety requires careful attention, particularly regarding rapid weight loss, excessive appetite suppression, restrictive eating, dehydration, and psychological destabilization in vulnerable individuals. At present, GLP-1 receptor agonists should be regarded as promising but unproven adjunctive candidates in addiction psychiatry, warranting further rigorous trials, structured monitoring, and interdisciplinary collaboration.

Psychiatry International doi: 10.3390/psychiatryint7030129

Authors: Maria Teresa Moreira Andreia Lima Diana Ribeiro Martins Maria Inês Guimarães Inês Lopes Cardoso Carla Sílvia Fernandes Telmo Lima da Costa Salomé Ferreira

Background: Alcohol use disorder (AUD) is a major public health concern frequently associated with anxiety and depressive disorders, highlighting the need for innovative and personalised mental health interventions. Virtual reality (VR) has emerged as a digital tool that may support cognitive behavioural therapy (CBT) by enabling immersive and controlled exposure to relevant stimuli. Methods: This scoping review aimed to map how VR is integrated into CBT-oriented interventions for adults with AUD, with a focus on therapeutic mechanisms and their potential relevance for precision digital mental health. The review followed Joanna Briggs Institute methodology and PRISMA-ScR guidelines. Searches were conducted in PubMed, CINAHL, and Psychology and Behavioural Sciences Collection for studies published in the last ten years in English, Portuguese, or Spanish. Two independent reviewers performed screening and data extraction. Results: Eight studies were included, encompassing approaches such as cue exposure, simulation of high-risk environments, and covert sensitisation. The studies explored mechanisms including craving induction and regulation, identification of individual triggers, emotional processing, and enhancement of self-efficacy. The evidence base was characterised by small sample sizes, heterogeneous designs, and limited longitudinal data. Conclusions: This review provides a structured mapping of current applications of VR within CBT frameworks for AUD and highlights key therapeutic mechanisms that may have transdiagnostic relevance. However, the existing evidence remains preliminary, and findings should be interpreted with caution. The results support the exploration of VR within emerging precision digital mental health approaches, while underscoring the need for further rigorous and standardised research.

Psychiatry International doi: 10.3390/psychiatryint7030128

Authors: Mitchell L. Doucette D. Luke Macfarlan Mark Kasabuski Junella Chin Emily Fisher

Introduction: Medical cannabis is increasingly used to manage post-traumatic stress disorder (PTSD), a condition frequently linked to high healthcare utilization, particularly for acute services. Methods: We conducted a retrospective cohort study using data from Leafwell among patients with PTSD who either used medical cannabis for at least one year (treated group) or were cannabis-naïve (untreated group). The primary outcomes were urgent care, emergency department (ED), or hospitalization visits in the past six months. We applied inverse probability weighting with regression adjustment (IPWRA) to estimate the average treatment effect (ATE) of medical cannabis exposure, adjusting for demographics, PTSD severity, and other health factors. Sensitivity analyses were performed to assess robustness. Results: Out of 1946 participants, 1261 were in the treated group and 685 in the untreated group. The treated group had a 35.6% lower probability of urgent care visits (coefficient = −0.024, SE = 0.0117) and a 35.1% lower probability of ED visits (coefficient = −0.027, SE = 0.0124). Although hospitalization rates were 26.3% lower, this difference was not statistically significant. Findings remained consistent across multiple ATE estimation methods, and adjusting the IPWRA model’s tolerance levels strengthened these associations. Fewer than 2% of the treated group reported adverse events. Conclusions: Medical cannabis use among patients with PTSD was associated with reduced urgent care and ED visits. These results were robust across analytical methods, supporting the potential role of medical cannabis in lowering acute healthcare needs. Further longitudinal research is warranted to assess causality and clarify effects on hospitalization.

Psychiatry International doi: 10.3390/psychiatryint7030127

Authors: Mila Kingsbury Nicole Dryburgh Leanne C. Findlay

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

Psychiatry International doi: 10.3390/psychiatryint7030126

Authors: Désirée Muller-Mallet Béatrice Ouellon Lionel Cailhol Stéphanie Borduas Pagé Alexandre Hudon

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

Psychiatry International doi: 10.3390/psychiatryint7030125

Authors: Sara Romano Dario Esposito Giorgia Di Iorio Fabiola Panvino Benedetta Altomonte Dario Calderoni Giulia Conte Maria Pia Casini Arianna Terrinoni

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

Psychiatry International doi: 10.3390/psychiatryint7030124

Authors: Shlomo Mendlovic

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

Psychiatry International doi: 10.3390/psychiatryint7030123

Authors: Mariana Schettini Martins Barbosa Enrico Lázaro Guidugli Gabriela Schettini Martins Barbosa Maria Eduarda Gonzales Melati Nicole Brunello Pagliarin Pedro Bortoluzzi Escobar da Silva Pedro Henrique Paesi Dutra Vitor Ritt Xavier Eugênio Horácio Grevet Ygor Azeno Ferrão

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

Psychiatry International doi: 10.3390/psychiatryint7030122

Authors: Andrea S. Young Emily T. O’Gorman Eleanor G. Wu Laura Prichett Robert Yolken Emily Severance Juleisa Badio Destini Carmichael Tina Kumra

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

Psychiatry International doi: 10.3390/psychiatryint7030121

Authors: Torekhan Bex Aidana Tautanova Nursultan Seksenbayev Gediminas Merkys Daiva Bubeliene Zhannur Kaligozhin Alexandr Antipin Gulnara Temirova Lazzat Zhamaliyeva

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

Psychiatry International doi: 10.3390/psychiatryint7030120

Authors: Cristiana Țăpoi Emmanuel Chimdiebere Ogamdi

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

Psychiatry International doi: 10.3390/psychiatryint7030119

Authors: Shaul Schreiber Marsha Weinstein Yali Abramsohn Anat Sason Miriam Adelson Einat Peles

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

Psychiatry International doi: 10.3390/psychiatryint7030117

Authors: Anne Schienle Albert Wabnegger

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

Psychiatry International doi: 10.3390/psychiatryint7030118

Authors: Nanako Hanai Satsuki Fujieda Yuki Hongo Kenichi Asano

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

Psychiatry International doi: 10.3390/psychiatryint7030116

Authors: Carol Nash

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

Psychiatry International doi: 10.3390/psychiatryint7030115

Authors: Elena S. Sokruto Nikolay A. Skryabin Svetlana A. Ivanova

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

Psychiatry International doi: 10.3390/psychiatryint7030114

Authors: Gulnara Altynbekova Bakhyt Iskakova Gaziz Sattarov Kuanysh Altynbekov Asset Izdenov Nabi Yessimov Shynar Tanabayeva Ildar Fakhradiyev

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

Psychiatry International doi: 10.3390/psychiatryint7030113

Authors: Rebeca-Isabela Molnar Otilia-Rodica Butiu Adriana Mihai

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

Psychiatry International doi: 10.3390/psychiatryint7030112

Authors: Maria Bakola Konstantina Soultana Kitsou Varvara Angelidou Argyris Giannakopoulos Maria Drakopoulou Konstantinos Argyropoulos Constantinos Petropoulos George Charalambous Philippos Gourzis Eleni Jelastopulu

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

Psychiatry International doi: 10.3390/psychiatryint7030111

Authors: Indranil Saha Joydeep Majumder Bhavani Shankara Bagepally Saibal Das Manoj Kalita Devaraja Munikrishnappa Uday Mondal Devi Das Taneir Lubana Siddiqui Neha Dahiya Asim Saha Amit Chakrabarti

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

Psychiatry International doi: 10.3390/psychiatryint7030110

Authors: Eda Yılmazer Metin Çınaroğlu

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

Psychiatry International doi: 10.3390/psychiatryint7030109

Authors: Hyunjin Kyung Hyuksool Kwon

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

Psychiatry International doi: 10.3390/psychiatryint7030108

Authors: Divya Kuzhivilayil Yesodharan Judie Arulappan Santhi Subramanyam Sabari Sridhar O T

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

Psychiatry International doi: 10.3390/psychiatryint7030107

Authors: Ginevra Tagliaferri Clarissa Cricenti Andrea Civera-Antony Carlos González-Manzanares Manuel Martí-Vilar

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

Psychiatry International doi: 10.3390/psychiatryint7030106

Authors: Enrique Fernández-Vilas Juan R. Coca

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

Psychiatry International doi: 10.3390/psychiatryint7030105

Authors: Tomas Kukucka Zuzana Visnovcova Nikola Ferencova Veronika Kovacova Andrea Macejova Igor Ondrejka Timea Furdekova Ingrid Tonhajzerova

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

Psychiatry International doi: 10.3390/psychiatryint7030104

Authors: Aikaterini Doulou Pantelis Pergantis Charalabos Skianis Athanasios Drigas

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

Psychiatry International doi: 10.3390/psychiatryint7030103

Authors: Jakov Milić Vera Plužarić Mirta Kadivnik Maja Miškulin Katarina Dodig Ćurković Iva Milić Vranješ

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

Psychiatry International doi: 10.3390/psychiatryint7030102

Authors: Mario Miniati Rebecca Ciacchini Laura Lazzarotti Graziella Orrù Giorgia Papini Aleandra Viti Laura Palagini Silvio Presta Giulia Conversano Angelo Gemignani Ciro Conversano

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

Psychiatry International doi: 10.3390/psychiatryint7030101

Authors: Sandra Foltin Svitlana Kostenko Lisa Maria Glenk

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

Psychiatry International doi: 10.3390/psychiatryint7030100

Authors: Michele Viciconte Vincenzo Andretta Luisa Gorrese Antonietta Pacifico Carlo Sorrentino Luna Carpinelli Carolina Amato Alessandro Vertullo Annamaria Sorrentino Giulia Savarese

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

Psychiatry International doi: 10.3390/psychiatryint7030099

Authors: Michael Fritz Maya Wittkowski Manuela Dudeck Judith Streb

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

Psychiatry International doi: 10.3390/psychiatryint7030098

Authors: Georgios Manomenidis Savvato Karavasileiadou Konstantinos Pafis Elena Vasileiou

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

Psychiatry International doi: 10.3390/psychiatryint7030097

Authors: Ana-Maria Dădulescu Cristiana Glavce Suzana Turcu

Adolescence constitutes a developmental stage marked by increased vulnerability to the adoption of consumption behaviors shaped by individual, social, and contextual determinants. This study aimed to examine the association between cumulative psychosocial vulnerability and the consumption of alcohol, coffee, and energy drinks among adolescents in Romania, employing a composite behavioral score designed to capture personal, social, and contextual stability. This cross-sectional study included 521 adolescents, with data collected during the COVID-19 pandemic when schooling was entirely online. Alcohol, coffee, and energy drink consumption were analyzed using Pearson correlations and binary logistic regressions. The composite behavioral score was constructed as the mean of standardized indicators, with higher values reflecting lower levels of psychosocial vulnerability. Results indicate that the composite behavioral score is negatively and significantly associated with alcohol consumption (r = −0.150, p = 0.001; OR = 0.51, 95% CI [0.33–0.80], p = 0.002), indicating a lower likelihood of consumption among adolescents with more stable psychosocial profiles. In contrast, the score was not significantly associated with coffee or energy drink consumption. Analyses also revealed significant differences in the composite behavioral score by gender (Cohen’s d = −0.82), with boys exhibiting higher vulnerability, and by residential environment (Cohen’s d = −1.15), with adolescents from rural areas—particularly boys—showing higher levels of psychosocial vulnerability. A secondary composite score, excluding demographic variables, was also computed to assess the robustness of the observed associations, with only area of residence remaining a significant predictor. In conclusion, the findings are consistent with the hypothesis that cumulative psychosocial vulnerability is relevant for explaining alcohol consumption in adolescence but not for coffee or energy drink use. These results highlight the need for a conceptual distinction between consumption behaviors with a normative status and those more clearly associated with psychosocial risk, as well as the importance of prevention interventions tailored to the specific characteristics of each type of consumption.

Psychiatry International doi: 10.3390/psychiatryint7030096

Authors: Andrés Vega-Rosas Naomi G. Santos-Jacinto Sergio Martinez-del Angel Andrea Granados-Juárez

Background: Severe, treatment-resistant Obsessive–Compulsive Disorder (OCD) remains a major clinical challenge. When conventional pharmacological and psychotherapeutic strategies fail, neuromodulatory interventions such as repetitive transcranial magnetic stimulation (rTMS) and psychosurgical approaches are increasingly considered. Although both modalities target nodes within the cortico-striato-thalamo-cortical (CSTC) circuit, their relative effectiveness has not been examined within a unified analytical framework. Objective: We aimed to compare responder rates between rTMS and psychosurgical interventions in adults with treatment-resistant OCD through a systematic review and meta-analysis. Methods: A PRISMA-guided search of PubMed and Scopus (2015–2025) identified clinical studies reporting treatment response. Pooled responder rates were estimated separately for each modality using random-effects models. Between-study heterogeneity and publication bias were systematically assessed. Results: Fourteen studies met inclusion criteria, including 10 rTMS studies (416 participants) and four lesion-based psychosurgical studies (142 participants). Both modalities demonstrated clinically meaningful responder rates. Pooled analyses suggested higher responder proportions in psychosurgical cohorts (RR = 3.06, 95% CI 1.43–6.54); however, this finding was accompanied by substantial heterogeneity (I2 = 63%) and signals of publication bias. Follow-up duration differed markedly between modalities (mean 2.4 months for rTMS vs. 33.0 months for psychosurgery), reflecting fundamentally different study designs and outcome assessment timepoints. Conclusions: Differences in pooled responder rates should be interpreted as exploratory rather than as evidence of comparative efficacy. The lack of a shared comparator, differences in patient selection, and large discrepancies in follow-up limit direct comparisons between modalities. These findings support a stepped-care framework for neuromodulation in treatment-resistant OCD and highlight the need for methodologically harmonized studies to better define the role of each intervention across distinct clinical profiles of treatment resistance.

Psychiatry International doi: 10.3390/psychiatryint7030095

Authors: José Germán Arranz-López Francisco H. Machancoses Jorge Pérez-Corrales

Currently, mental health diagnoses are associated with a negative connotation in society, leading to discriminatory and rejecting behaviours towards individuals with mental health conditions and their families. This hinders access to specialised resources, education and employment. This stigma is based on erroneous knowledge and discriminatory attitudes and behaviours within the population, which are closely linked to the concepts of stereotype, prejudice, and discrimination. These factors create situations that affect the quality of life and recovery processes of individuals with diagnoses. A quantitative, cross-sectional, analytical–descriptive study was conducted to identify knowledge, attitudes and behaviours relating to individuals with mental health diagnoses in a large community-based sample of the Spanish population. The S3 scale was used to identify the necessary factors associated with lower levels of stigma from a structural perspective. The sample consisted of 563 participants, with an average age of 35.81 years, predominantly women (n = 381, 65.2%). Notably, 87.0% (n = 490) of the sample had contact with at least one person diagnosed with a mental health condition during their lifetime. The most significant findings revealed that individuals without training and those with central or conservative ideologies exhibited significantly higher levels of stereotypes, stigmatising attitudes, and discriminatory behaviours than their counterparts. Based on these results obtained, it is recommended that existing personal and economic resources be expanded and focused to provide specific mental health training to the Spanish population, as well as to promoting the creation of spaces for contact and inclusive participation with individuals diagnosed with mental health conditions.

Psychiatry International doi: 10.3390/psychiatryint7030094

Authors: Cássio de Figueiredo Marc-Alexandre Tareau Haroun Zouaghi François Lair Cyril Rousseau Vincent Bobillier Mathieu Nacher

Indigenous peoples in Amazonia face major mental health inequities, including high rates of suicidal behaviour among adolescents and young adults in some settings. We conducted a scoping review of the peer-reviewed literature on community health workers (CHWs) and equivalent cadres involved in Indigenous and remote contexts, with a focus on their roles in relation to mental health, psychosocial support, and suicide prevention among Indigenous populations in Amazonia and the Guiana Shield. We reported this review in line with PRISMA-ScR. Searches (September–November 2025) were conducted in PubMed/MEDLINE, Scopus, Web of Science and SciELO, complemented by targeted searches in major publisher platforms and JSTOR. We included English, French, Spanish and Portuguese publications that (i) described CHWs or functionally equivalent cadres in Indigenous/remote contexts and/or (ii) reported CHW-related roles, models, or experiences relevant to mental health, psychosocial support or suicide prevention in Amazonian settings. Global documentation of CHW designations used in Indigenous/remote contexts was compiled; we compiled evidence from Amazonia and the Guiana Shield on CHW roles, programme models, implementation conditions and reported outcomes. Data were charted into a structured template (cadre designation, setting, population, study type, functions, programme features and reported mental health/suicide-related outcomes) and synthesised descriptively and thematically. CHWs commonly function as cultural and linguistic brokers between Indigenous communities and biomedical systems, supporting early detection of distress, psychosocial accompaniment, referral navigation and dialogue with local healing practices. Reported programme models differ markedly: Brazil’s institutionalised Indigenous Health Agents (AIS) offer stability and formal recognition, whereas French Guiana relies more heavily on project-based mediation with innovative practices but greater funding fragility. The available literature remains heterogeneous and uneven across countries, with limited evaluative designs and substantial reliance on descriptive reports. Future work should prioritise stronger implementation and impact evaluation, alongside Indigenous-led governance and sustainable support for CHW cadres.

Psychiatry International doi: 10.3390/psychiatryint7030093

Authors: Rianne Heath-Watt Panagiota Tragantzopoulou Alison Fixsen

The therapeutic alliance is widely recognized as a central mechanism of change in psychotherapy; however, much existing research risks reifying it as a measurable and static construct, obscuring its fluid, co-constructed nature and the ways it is shaped by power, identity, and social context. This study aimed to explore how psychotherapists understand, construct, and enact the therapeutic alliance in their everyday practice, with particular attention to diversity, anxiety, rupture, and the reciprocal impact of the therapeutic relationship on the therapist. Using a qualitative design, semi-structured interviews were conducted with 14 psychotherapists primarily working in private practice, and the data were analyzed using reflexive thematic analysis. Six interrelated themes were identified: moving from technique to relational presence; diversity as relational negotiation; anxiety as a co-created relational process; rupture as inevitable and generative; therapist transformation through the therapeutic relationship; and navigating professional role and human authenticity. The findings suggest that effective therapeutic work relies less on rigid adherence to technique and more on reflexivity, emotional attunement, and a willingness to engage with discomfort, difference, and relational rupture. The study highlights the need for psychotherapy training to prioritize relational, ethical, and reflexive capacities alongside technical skills, and contributes a more process-oriented understanding of the therapeutic alliance from therapists’ lived perspectives.

Psychiatry International doi: 10.3390/psychiatryint7030092

Authors: Symeon Dimitrios Daskalou Theodoros N. Sergentanis Nikolaos Gerosideris Christina Ouzouni Elpida Stratou Ioanna Giannoula Katsouri

Background: Preterm birth is a significant early-life stressor associated with increased psychiatric vulnerability and long-term functional impairments in school-aged children. Objective: To compare behavioral–emotional outcomes and functional competence between school-aged preterm and term-born children, examining perinatal, cognitive, and socioeconomic predictors. Methods: 140 children aged 6–10 (70 preterm, 70 age-matched controls) were assessed using the Child Behavior Checklist (CBCL) and Strengths and Difficulties Questionnaire (SDQ). Functional competence—defined as participation in daily activities, social interactions, and school performance—was examined alongside behavioral–emotional outcomes. Predictors included gestational age, birth weight, SES, and cognitive ability. Results: Preterm birth was associated with higher SDQ scores in emotional problems, hyperactivity, and peer problems. CBCL results showed lower total functional competence scores, specifically in activities, social participation, and school performance. Longer NICU stay predicted higher internalizing problems and lower social participation. Cognitive ability was linked to lower SDQ externalizing and internalizing scores. SES was not a significant predictor. Conclusions: Preterm birth and prolonged NICU hospitalization are linked to persistent behavioral–emotional and functional vulnerabilities. These findings underscore the need for early, integrated developmental monitoring within a preventive psychiatry framework to identify psychiatric vulnerability and support functional participation.

Psychiatry International doi: 10.3390/psychiatryint7030091

Authors: Joana Proença Becker Rui Paixão Liliana Bizarro

Previous studies indicate that the main predictors of stress-related disorders in firefighters are pre- and post-trauma factors, rather than intensity or type of traumatic event. This study aimed to identify risk and protective factors contributing to the development of Post-Traumatic Stress Disorder (PTSD) and other stress-related conditions in Portuguese firefighters who battled the 2017 forest fires. To assess the prevalence of PTSD and related conditions, a set of self-report measures—including PHQ-15 (somatic symptoms), PCL-5 (PTSD), PSQI (sleep quality), and DASS-21 (depression, anxiety, stress)—was completed by 96 firefighters and 96 individuals from the general population, who served as a comparison group. In addition, semi-structured interviews were conducted with 79 firefighters, focusing on their perceptions of PTSD, exposure to duty-related traumatic events, and coping strategies employed to manage stress. Findings indicated that firefighters reported higher levels of somatic symptoms, sleep disturbance, and PTSD than the general population. Organizational support, working conditions, professional experience and training were identified as protective factors, while a sense of belongingness and peer relationship were considered resources for managing stress reactions. Firefighters also associated social and media pressures with the development or exacerbation of stress-related symptoms. Collectively, these results highlight the relevance of both subjective and contextual factors and may inform prevention, intervention, and treatment strategies for stress-related psychopathologies.

Psychiatry International doi: 10.3390/psychiatryint7030090

Authors: Kasetchai Laeheem

This study developed and validated a specialised emotional intelligence (EI) scale for youth in the conflict-affected southern border provinces of Thailand. The primary objective was to establish a psychometric instrument tailored to this unique multicultural and sensitive context. Utilizing a sample of 500 local youth leaders, the instrument’s quality was rigorously evaluated through Second-order Confirmatory Factor Analysis (CFA) using Maximum Likelihood estimation. The final validated model comprises 25 indicators categorized into five dimensions: Self-Awareness, Self-Regulation, Self-Motivation, Social Awareness/Empathy, and Relationship Management. Results indicated an excellent model fit with empirical data (χ2 = 284.15, df = 265, p = 0.198, CFI = 0.99, GFI = 0.97, RMSEA = 0.02). Factor loadings ranged from 0.72 to 0.92, while composite reliability (CR) and average variance extracted (AVE) values exceeded 0.88 and 0.61, respectively, confirming high internal consistency and construct validity. Social Awareness/Empathy emerged as the most significant dimension (B = 0.91). This study suggests that the scale is a robust tool for assessing EI in conflict zones, providing a critical foundation for targeted psychosocial interventions and sustainable peace-building initiatives among youth in the region.

Psychiatry International doi: 10.3390/psychiatryint7030089

Authors: Ahmed M. S. Al Ansari Haitham A. Jahrami Muna Ahmed Almohri Nabeel A. Suleiman Raja Hejair Mahmoud A. Alfaqih Mohamed K. Almedfa Randah R. Hamadeh

Background: This study aimed to estimate the prevalence and associated demographic factors of autism spectrum disorder (ASD) in children aged 3 to 6 years in Bahrain, as well as to identify co-occurring developmental disorders. Methodology: The study sample comprised 500 children who attended eight health centers across four governorates (Group A) in Bahrain. A second group (Group B) consisted of all children who completed their diagnosis at the Child and Adolescent Psychiatric Unit for ASD from June 2023 to May 2024 to identify associated developmental disorders (n = 232). Group A mothers were interviewed using the M-CHAT-R. For Group B, we used children’s files, the General Intelligence Scale (Stanford-Binet), the M-CHAT-R, the CARS, Conners’ Form, and the Zarit Burden Interview to assess family burden. Additionally, a file review was conducted to determine the presence of intellectual disability (ID) in Group B cases. The Conner-3 Short Forms Test was administered to all cases aged 6 years or older (n = 64), and family burden was assessed using the Zarit Burden Interview Scale for reachable cases (n = 176). Results: Group A findings indicated an overall screen-based/at risk prevalence of ASD of 2.6%, with a higher prevalence in males (1.6%) compared to females (1%). In Group B, there was a78% prevalence of ID and a 17.2% prevalence of attention-deficit/hyperactivity disorder (ADHD). The study also found that the impact of having a child with ASD on the family varied based on the nature and severity of the disorder or disability, with moderate to severe burden reported at approximately 38%. Conclusions: The prevalence of ASD among young children was notably high, particularly among males. The most common comorbidities were ID followed by ADHD. The family burden associated with ASD was significant, with more than one third reporting moderate to severe burden. These data are essential for informing health education and social service planning.

Psychiatry International doi: 10.3390/psychiatryint7030088

Authors: Aglaia Katsiroumpa Zoe Katsiroumpa Evmorfia Koukia Polyxeni Mangoulia Ioannis Moisoglou Petros Galanis

Our objective was to investigate the relationship between problematic TikTok use and levels of anxiety, depression, and sleep quality. We also explored differences across sex and generational groups. A cross-sectional study was conducted in Greece using a convenience sample. Participants were classified into three generational groups: Generation Z (1997–2012), Millennials (1981–1996), and Generation X (1965–1980). Problematic TikTok use was assessed with the TikTok Addiction Scale, while anxiety and depression were measured using the Patient Health Questionnaire-4. Sleep quality was evaluated with the Sleep Quality Scale. To account for potential confounding factors, we performed multivariable linear regression analyses. Our results showed a positive association between problematic TikTok use and both anxiety and depression. Multivariable analysis revealed a negative association between problematic TikTok use and sleep quality. In summary, our findings indicate that problematic TikTok use is linked to higher levels of anxiety and depression, as well as poorer sleep quality. These results highlight the need for policymakers, stakeholders, and healthcare professionals to develop and implement targeted interventions aimed at mitigating the negative effects associated with problematic TikTok use.

Psychiatry International doi: 10.3390/psychiatryint7030087

Authors: David Octavio Rangel-Carrero Lina Díaz-Castro German Guerra Jose Carlos Suarez-Herrera

Mental health interventions in rural areas often face systemic and governance barriers that limit their implementation. This study analysed how governance dimensions at the municipal, state, and federal levels influence the perceived feasibility of implementing the Primary Care and Psychiatry Model (MAP-PSI), an early intervention strategy targeting adolescent depression in rural Mexico. A descriptive–interpretative qualitative design was employed, using semi-structured interviews and hybrid (deductive–inductive) content analysis. Participants were purposively selected institutional stakeholders involved in MAP-PSI implementation, including local health managers, state and federal decision-makers, and community-based actors. The coding process was collaboratively developed and validated through consensus and critical reflection among researchers. Five interrelated governance dimensions were identified: local leadership, intersectoral coordination, resource mobilisation, community participation, and institutional adaptability. These dimensions converge in a multilevel governance framework that illustrates how governance capacities across levels can enable or constrain community-based mental health interventions. The findings provide an empirically grounded framework to inform the design, adaptation, and future evaluation of community-based mental health strategies in underserved rural contexts.

Psychiatry International doi: 10.3390/psychiatryint7030086

Authors: Nachiket Mor

Background: Lay counsellor-delivered psychosocial interventions are increasingly used to address workforce shortages in mental health care. While randomised trials commonly report mean improvements, explicit assessment of clinical deterioration is rare. This secondary analysis evaluated whether a lay counsellor intervention for early psychosis was associated with evidence of deterioration compared with usual care. Methods: Patient-level data from a randomised controlled trial in Thailand (n = 255) were analysed. Deterioration was defined as worsening between baseline and the 6-month follow-up across functional, behavioural, and service utilisation domains. Risk differences were estimated using Newcombe confidence intervals, and risk ratios were calculated using standard methods with the Haldane–Anscombe correction applied, where required. Analyses were conducted for the full sample (UC n = 125; LICM n = 130) and stratified by baseline severity (none/borderline: UC n = 103, LICM n = 103; mild-to-severe: UC n = 22, LICM n = 27). Results: In the full sample, deterioration rates were similar across most domains. A statistically significant reduction in deterioration related to disturbing or aggressive behaviour was observed in the LICM arm (risk difference −14.1%; 95% CI −26.8% to −0.6%; risk ratio 0.45; 95% CI 0.26 to 0.79). No statistically significant excess deterioration was observed in other domains. In severity-stratified analyses, no subgroup showed a statistically significant increase in deterioration attributable to the intervention. However, among participants with mild-to-severe baseline illness, although no statistically significant harm signal was detected, the adverse risk differences and risk ratios observed in socially useful activities, self-care, regular outpatient follow-up visits, and medication adherence among participants with greater baseline severity underscore the importance of careful monitoring in higher-risk subgroups. Conclusions: No statistically significant evidence of excess deterioration was observed in either the full sample or subgroup analyses between the intervention and control arms. However, the adverse absolute difference observed in multiple patient-related domains, among participants with mild-to-severe baseline illness, suggests that lay-counsellor interventions may require a stepped-care approach to safely address the mental health needs of patients with higher levels of severity. Psychosocial trials should routinely report deterioration and subgroup analyses alongside mean improvements.

Psychiatry International doi: 10.3390/psychiatryint7020085

Authors: Yobet Perez-Perez Roberto J. Morales-Silva Genesis N. Rodriguez-Torres Rafael III Ruiz-Villalobos Jose C. Rivera-Velez Edgardo G. Arlequin-Torres Elaine M. Vera-Torres Lenin J. Godoy-Muñoz Serena I. Fazal Nilenid Rivera-Aviles Sofia Neira Marian T. Sepulveda-Orengo

Background/Objectives: Research has shown a high prevalence of co-occurring trauma-related disorders and cocaine use disorder (CUD). However, there remains a need for preclinical studies to determine how traumatic event exposure influences vulnerability to CUD development and relapse. In this study, we assessed the impact of traumatic event exposure using a threat conditioning (TC) paradigm, which models traumatic event exposure through associative threat learning on cocaine-seeking behavior in adult male and female rats. Methods: Adult male and female rats were exposed to a single TC session. After TC, the rats underwent cocaine self-administration (SA), extinction training, cue-primed reinstatement, and cocaine-primed reinstatement testing. A parallel cohort was subjected to a sucrose SA cohort to assess whether TC altered non-drug reward seeking in the form of sucrose SA. Results: In the cocaine cohort, stressed male rats exhibited greater cue- and cocaine-primed reinstatement relative to non-stressed males, whereas no reinstatement differences emerged in female rats. In the sucrose cohort, stressed females displayed increased sucrose pellet delivery during self-administration compared to non-stressed females, but no differences were observed during sucrose reinstatement in either male or female rats. Conclusions: These findings indicate that trauma exposure prior to cocaine use influences cocaine relapse-related behavior, as well as non-drug reward reinforcement earning, in a sex-specific manner. Overall, these results highlight the value of associative stress models such as TC for studying trauma–addiction comorbidity and the need to investigate the neurobiological mechanisms driving these sex-specific outcomes.

Psychiatry International doi: 10.3390/psychiatryint7020084

Authors: Robert Zgarbura Leea Cristescu Rizea Alexandru Pavel Catalina Tudose

Background: Migraine is a chronic neurological disorder with a high prevalence of psychiatric comorbidity, including anxiety and depression, which compound functional impairment and reduce health-related quality of life (HRQoL). Repetitive transcranial magnetic stimulation (rTMS) is a non-pharmacological neuromodulatory intervention targeting both pain and affective circuits; however, predictors of HRQoL improvement following rTMS remain poorly characterized. Methods: In this exploratory observational study, 32 adults with migraines underwent 10–40 rTMS sessions. Quality of life was assessed using the WHOQOL-BREF and Migraine-Specific Quality of Life Questionnaire (Migraine-QoL). Psychiatric burden, headache impact, and disability were evaluated using HAMA, HAMD, HIT-6, and MIDAS at baseline and post-intervention. Paired t-tests, Spearman correlations, and linear regression identified predictors of QoL change. Results: Both WHOQOL-BREF and Migraine-QoL improved significantly following rTMS (p < 0.001). Antipsychotic use was associated with greater overall QoL improvement (p = 0.026). Given the very small subgroup size (n = 7), this finding should be interpreted with extreme caution and considered hypothesis-generating only. Higher baseline HIT-6 and HAMA correlated with greater Migraine-QoL gains (p = 0.001 and p = 0.013). In multivariate regression, higher headache severity independently predicted Migraine-QoL improvement (R2 = 0.514, p < 0.001). Conclusions: rTMS produced clinically meaningful QoL improvements in migraine. Headache burden emerged as an independent predictor, while associations with anxiety severity and antipsychotic use should be considered exploratory.

Psychiatry International doi: 10.3390/psychiatryint7020083

Authors: Munteanu Alina Mihaela Turcu Suzana Stan Cristina Petrescu Monica

Impulsivity is a core transdiagnostic construct in adolescent psychiatry, associated with emotional dysregulation, behavioral disorders, and increased vulnerability to mental health problems. Adolescents engaged in performing arts education may experience heightened psychosocial stressors that challenge self-regulatory capacities during a critical neurodevelopmental period. Methods: This mixed-methods study examined psychosocial and family-related factors associated with impulsivity in adolescent students enrolled in drama programs. Two focus groups with 28 upper-grade students (grades 11–12) explored subjective experiences of stress, emotional overload, and family communication. Based on these findings, a 77-item questionnaire was developed and administered to 90 ninth-grade students. Impulsivity was assessed using the Barratt Impulsiveness Scale (BIS). Results: An exploratory stepwise multiple linear regression analysis identified perceived school-related stress (β = 0.370, p < 0.001), conflictual parental communication (β = 0.273, p = 0.013), and discomfort during school discussions at home (β = 0.331, p < 0.001) as significant predictors of higher impulsivity scores. Conclusions: The findings highlight the interaction between neurodevelopmental vulnerability and environmental stressors in shaping impulsivity during adolescence. These results are clinically relevant for child and adolescent psychiatry, emphasizing the importance of early psychosocial interventions targeting stress regulation and family communication to prevent the escalation of impulsivity-related psychopathology.

Psychiatry International doi: 10.3390/psychiatryint7020082

Authors: Anees Bahji

Debates regarding involuntary treatment for substance use disorders have intensified in the context of escalating overdose mortality and system-level strain. These proposals raise fundamental questions in psychiatric ethics concerning decisional capacity, agency, proportionality, and the justification for liberty restrictions. Addiction presents a distinctive challenge: decisional capacity may appear intact at discrete moments, while agency remains predictably unstable across time in conditions of chronic risk. This Perspective argues that addiction exposes limitations in strictly moment-based applications of the capacity doctrine. Drawing on ethical theory, clinical reasoning, and selected empirical literature, the manuscript evaluates involuntary addiction treatment primarily through normative criteria of justification rather than relying solely on outcome estimation. It identifies evidentiary limitations in the current literature and articulates heightened substantive and procedural thresholds that must be satisfied for coercive interventions to be ethically defensible. These include demonstrable impairment linked to near-term serious harm, exhaustion of less restrictive alternatives, clearly defined therapeutic objectives, and independent oversight with outcome monitoring. This paper does not advocate for categorical endorsement or rejection of involuntary treatment; rather, it proposes structured guardrails to guide psychiatric engagement under conditions of uncertainty.

Psychiatry International doi: 10.3390/psychiatryint7020081

Authors: Noemi M. Mereu Diego Primavera Sonia Marchegiani Antonella Denti Michela Atzeni Giulia Cossu Viviana Forte Elisa Cantone

Background: COVID-19 increased psychological distress among healthcare workers. Italian studies have suggested lower distress levels among mental health professionals compared to hospital-based colleagues. Methods: In May 2025, we conducted a cross-sectional observational study in community mental health centers and non-psychiatric hospital outpatient departments in Sardinia, Italy, involving 101 professionals from three community mental health centers and 97 staff members from four non-psychiatric hospital outpatient departments. The SF-12 was used to assess health-related quality of life (HRQoL) and the PHQ-9 was used to assess depressive symptoms. Results were also compared with pre-pandemic community samples. Results: Mental health professionals reported fewer depressive symptoms and better quality of life than hospital-based colleagues: PHQ-9 ≥ 10: 10.9% vs. 35.0% (11/101 vs. 34/97) (OR = 0.23; 95%CI 0.11–0.47; p < 0.001); PHQ-9 ≥ 9: 14.8% vs. 38.1% (OR = 0.31; 95%CI 0.16–0.60; p < 0.001). Mean PHQ-9 score: 4.45 ± 3.51 vs. 8.35 ± 3.95 (p < 0.001). Low HRQoL (SF-12 ≤ 36): 34.6% vs. 62.9% (35/101 vs. 61/97) (OR = 0.31; 95%CI 0.19–0.52; p < 0.001). No significant within-group differences were found by sex, age, or professional role. Compared with pre-pandemic community data, the well-being of mental health professionals remained stable. Limitations: Cross-sectional design and convenience sampling limit causal inference and generalizability. Conclusions: The organizational structure, operational flexibility, and peer collaboration typical of community-based services may contribute to the sustained psychological well-being of mental health professionals. The community-based model deserves consideration for future reforms aimed at improving staff well-being.

Psychiatry International doi: 10.3390/psychiatryint7020080

Authors: Rui Martins Pinhel Irina Gorgal Carvalho Francisco Coutinho Martim Luz Rita Dionísio Rui Vilarinho Palmira Coya

Schizoaffective disorder is a complex psychiatric condition that often requires specialized treatment, particularly when resistant to standard therapies. Comorbidities like chronic inflammatory diseases can complicate the diagnosis, suggesting shared pathophysiological mechanisms. This case study examines the role of chronic systemic inflammation in psychiatric disorders, focusing on a patient with treatment-resistant schizoaffective disorder, psoriasis, and hypophysitis. The 40-year-old male patient, admitted for psychopathological decompensation, was initially treated with clozapine, which was effective but discontinued due to severe sialorrhoea. He was then switched to olanzapine, showing continued improvement in his psychiatric symptoms and good tolerability. Following optimization of antipsychotic treatment, the patient’s delusional thoughts diminished, verbalization stopped, and associated distress reduced. Interestingly, the psoriatic lesions also improved. This case highlights the potential connection between severe, treatment-resistant psychosis, endocrine dysfunction caused by hypophysitis, and psoriasis, suggesting that chronic systemic inflammation may be a shared underlying factor. The overlap between these conditions underscores the importance of considering inflammation’s role in psychiatric illnesses and emphasizes the need for an interdisciplinary approach when managing psychosis with somatic comorbidities.

Psychiatry International doi: 10.3390/psychiatryint7020079

Authors: Surilena Hasan Clara Rosa Pujiyogyanti Ajisuksmo Hans Christian Ivany Lestari Goutama Lukas Arya Kusuma Jolene Budiono Josephine Retno Widayanti

Psychological factors such as depression, anxiety, and loneliness significantly affect sleep quality, particularly among elderly individuals living in nursing homes. This study aimed to examine the relationship between sleep quality and depression, anxiety, and loneliness among elderly residents of nursing homes in Indonesia, as well as to explore the underlying pathway mechanisms. A quantitative cross-sectional design was used to assess correlational relationships among elderly individuals residing in nursing homes in Jakarta and Tangerang. Data were analyzed using JASP statistical software through descriptive, bivariate, and path analyses. The results demonstrated significant associations between poorer sleep quality and higher levels of loneliness, anxiety, and depression. Path analysis revealed a significant chain mediation pattern, in which loneliness was associated with higher anxiety levels, anxiety was associated with depressive symptoms, and depressive symptoms were associated with poorer sleep quality (β = −0.040, p = 0.045). These findings indicate that sleep disturbances in the elderly are statistically associated with interconnected psychological factors, highlighting the importance of comprehensive psychosocial interventions to improve sleep quality in this population.

Psychiatry International doi: 10.3390/psychiatryint7020078

Authors: Alan E. Kazdin

The majority of people with mental disorders in low-, middle-, and high-income countries do not receive any intervention for their symptoms, despite enormous advances in developing evidence-based psychosocial treatments and medications. The perspective and viewpoint article discusses and illustrates digital and technology-based interventions and activities in everyday life that have been shown to reduce symptoms of mental disorders. The article begins with background on the treatment gap and a discussion of why treatments do not reach people in need. Digital and technology-based interventions and everyday activities are presented to complement current treatments with the goal of scaling interventions to serve more people in need and to circumvent many of the usual barriers that preclude people from seeking or receiving traditional mental health services. Interventions in each of the categories are illustrated. The challenge is to integrate such interventions in mental health practices, to better promote these at the population level, and to monitor their impact.

Psychiatry International doi: 10.3390/psychiatryint7020077

Authors: Mark A. Ferro Melissa Elgie Karina Tamkee

This study modeled the factor structure of the Generalized Anxiety Disorder-7 (GAD-7), quantified its internal consistency, tested for longitudinal invariance, and estimated associations with measures of depression, parent stress, family functioning, and child psychopathology. Data were from 200 parents enrolled in an on-going study of children with chronic health conditions recruited from a pediatric hospital. Exploratory and confirmatory factor analysis (CFA) modeled the GAD-7 factor structure, and multiple-group CFA tested longitudinal invariance over 48 months. A one-factor model showed the best fit to the data, and the omega hierarchical was 0.89 and 0.88 at baseline and 48 months, respectively. The GAD-7 demonstrated longitudinal invariance. Internal consistency was good at both assessments (α > 0.75). Correlations with other measures were significant and at least small in magnitude. Known-group validity (parents with vs. without depression) showed very large effects (d > 2.0). The GAD-7 is psychometrically robust in parents of children with chronic health conditions.

Psychiatry International doi: 10.3390/psychiatryint7020076

Authors: Mayra Evelise dos Santos Kariny Realino Ferreira Sérgio Fonseca Gabriela Lopes Gama Michelle Almeida Barbosa Alexandre Carvalho Barbosa

Background: Major Depressive Disorder (MDD) is increasingly recognized as involving psychomotor slowing and impaired cortical timing. Objective vibrotactile assessments can quantify sensory and cognitive integration, potentially identifying mechanistic biomarkers of depression. Objective: To determine whether tactile performance metrics from the Brain Gauge system differentiate individuals with depression from healthy controls and to identify the most predictive domains using cross-validated modeling. Methods: Eighty-two adults (43 with depression, 39 controls) completed the Brain Gauge battery assessing reaction time (RT), RT variability, amplitude and duration discrimination, temporal order judgment, accuracy, and cortical plasticity. Results: After FDR correction, participants with depression showed significantly slower and more variable tactile responses (FDR-adjusted p < 0.05). Speed and RT variability remained independent predictors (OR = 4.14; OR = 0.015), yielding an AUC = 0.86 (sensitivity = 0.87; specificity = 0.77). These findings suggest reduced cortical stability and efficiency in depression. Conclusions: Tactile timing measures—particularly Speed and RT variability—objectively capture psychomotor and temporal instability in MDD. Cross-validated logistic modeling supports their potential as non-invasive digital biomarkers for depression phenotyping and monitoring. These findings suggest tactile timing instability as a clinically relevant neurofunctional dimension of major depressive disorder, with potential applications in psychiatric phenotyping, objective symptom monitoring, and future precision-guided treatment strategies.

Psychiatry International doi: 10.3390/psychiatryint7020075

Authors: Sydney Sun Christine DeJuliis Margaret S. Chisolm

Substance use disorder (SUD) undermines social connection, identity, and well-being. While art therapy is formally incorporated into clinical treatment, far less is known about how informal, group-based creative activities contribute to recovery. This qualitative study examines whether and how participation in a creative arts group fosters social support and human flourishing among individuals with SUD. We conducted semi-structured, individual interviews of eight adults enrolled in SUD outpatient treatment at the Johns Hopkins Broadway Center for Addiction who voluntarily participated in a creative arts class. Recordings were transcribed and analyzed using an iterative, thematic approach. Analysis revealed four themes: (1) Social connectedness and support—artmaking fostered camaraderie, accountability, and peer encouragement; (2) Holistic and supportive environment—the group offered a safe, nonjudgmental space that affirmed participants beyond their addiction; (3) Emotional renewal through art—creative engagement reduced anxiety, promoted joy, and provided a constructive outlet for emotions; and (4) Reclaiming agency through artistic expression—participants experienced autonomy, skill development, and identity building, which fostered hope and personal growth. Overall, participants viewed artmaking as a catalyst for relational and personal transformation. These exploratory findings generate hypotheses for future research on the role of informal creative arts groups within recovery-oriented care settings.

Psychiatry International doi: 10.3390/psychiatryint7020074

Authors: Mariagiulia Galluzzo Inês Carvalho Relva Margarida Simões

The mental health of children/adolescents is closely related to family functioning. However, there are factors that impair family functioning, such as parental psychopathology, parenting styles, and beliefs about physical punishment, which may require intervention by psychology and psychiatry. Given the lack of literature, the main objectives of this research are: to explore the association between parenting styles and the personality traits that constitute the Dark Triad, to analyze the association between beliefs about physical punishment and the personality traits that make up the Dark Triad, and to test the mediating effect of beliefs about physical punishment between the traits of the Dark Triad and parenting styles. The sample consisted of 290 parents of school-age children/adolescents between 7 and 16 years old, consisting of 231 female and 59 male participants. The main results suggest that Machiavellianism and narcissism are positively associated with authoritarian and permissive parenting styles and psychopathy with authoritarian; personality traits are associated with beliefs about physical punishment, and beliefs about physical punishment influence the relationship between the Dark Triad and parenting styles. In short, parental psychopathology seems to have an influence on the way parents educate their children and on their beliefs about physical punishment.

Psychiatry International doi: 10.3390/psychiatryint7020073

Authors: Zeliha Yelda Özer Ayşe Nur Topuz İlker Ünal Hatice Kurdak Sevgi Özcan

We aimed to investigate factors associated with post-earthquake coping strategies and to examine the relationship between coping styles and post-traumatic stress disorder (PTSD) symptom levels. This multicenter cross-sectional study was conducted among individuals presenting to 22 primary health centers in the Adana and Osmaniye provinces of Türkiye between 13 and 17 March 2023. Data were collected using a structured sociodemographic form, the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), and the Coping with Earthquake Stress Scale. The mean age of the participants (n = 434) was 38.27 ± 13.84 years, and 63.4% were female. The prevalence of probable PTSD was 32.95%. A weak negative correlation was found between PCL-5 scores and positive reappraisal scores (r = −0.192, p < 0.01), whereas no significant associations were observed between PTSD symptom scores and other coping strategies. Positive reappraisal scores were positively correlated with both religious coping (r = 0.248) and seeking social support (r = 0.316) (p < 0.01). Individuals who experienced family-related losses reported higher religious coping scores. These findings suggest that positive reappraisal may be associated with lower PTSD symptom levels in the early post-disaster period, highlighting the potential importance of adaptive cognitive coping strategies in primary care settings.

Psychiatry International doi: 10.3390/psychiatryint7020072

Authors: Raihan K. Khan Md Towfiqul Alam Madalynn Nofplot Sojib Bin Zaman Catherine L. Zeman

Evidence on whether music listening supports academic performance, particularly among students with attention deficit and hyperactivity disorder (ADHD), remains mixed. We explored associations between music listening while studying and academic performance (GPA: grade point average) among college students, and to evaluate whether the associations differed by ADHD status. We analyzed cross-sectional survey data from college students and conducted linear regression models with self-reported GPA as the dependent variable. Models were adjusted for sex, academic level, college affiliation, primary study location, weekly study hours, and preferred genre of music. A total of 541 students participated. Most of the students were at undergraduate level (84%), with a mean age of 20.78 years and mean GPA of 3.50. Among students with ADHD, listening to music while studying was associated with higher GPA (β = 0.42; p < 0.01), whereas preferring country music was associated with lower GPA (β = −0.33; p < 0.01). Undergraduate students with ADHD were associated with lower GPA (β = −0.31; p = 0.033). Among students without ADHD, preferring rap was associated with higher GPA (β = 0.30; p < 0.001), and CHBS affiliation (β = −0.15; p = 0.034) and listening to jazz (β = −0.16, p = 0.03) were associated with lower GPA. Associations between music listening and GPA differed by ADHD status and by preferred genre, suggesting the potential value of individualized recommendations rather than one-size-fits-all guidance.

Psychiatry International doi: 10.3390/psychiatryint7020071

Authors: Iara Teixeira Felipe Alckmin-Carvalho Alice Jones Bartoli Guilherme Welter Wendt

Psychopathy is a complex personality trait involving emotional and behavioral deficits that often overlap with alexithymia and reduced empathy. While it is reasonable to assume that the cognitive and behavioral traits associated with this construct may be influenced by specific sociocultural factors, research examining these cross-cultural variations remains scarce. In this cross-sectional study, we examined the relationship between psychopathy traits, empathy, and alexithymia in Brazilian (n = 171) and British (n = 167) adults. Participants completed the Levenson Self-Report Psychopathy Scale, the Basic Empathy Scale, and the Toronto Alexithymia Scale. British participants scored significantly higher on primary, secondary, and total psychopathy, as well as on difficulties describing feelings, compared to Brazilians. Regression analyses indicated that affective empathy and alexithymia dimensions were statistically associated with psychopathy scores in both groups. The regression models accounted for substantially more variance in primary psychopathy, marked by narcissism, grandiosity, and emotional detachment, in the British group than in the Brazilian one (36.4% vs. 13.4%, p < 0.05). Our findings are consistent with sociocultural differences in psychopathy traits and highlight the importance of investigating these constructs from a cross-cultural perspective to better characterize contextual differences and refine assessment and intervention.

Psychiatry International doi: 10.3390/psychiatryint7020070

Authors: Vladimir Janjic Danijela Djokovic Maja Muric Ermin Fetahovic Branimir Radmanovic Stevan Barac Sofija Colovic Olivera Radmanovic Nemanja Muric

Insomnia is the most prevalent sleep disorder worldwide, affecting up to 30% of the population, and is frequently accompanied by cognitive complaints and measurable cognitive impairments. Chronic insomnia is characterized by persistent hyperarousal across physiological, cognitive, and neurobiological domains, which may compromise multiple cognitive systems. This review synthesizes current evidence on the impact of insomnia on major cognitive domains, including attention, language, memory and learning, executive functions, perceptual–motor skills, and social cognition. We critically evaluate methodological factors contributing to heterogeneous findings across studies, such as variability in diagnostic criteria, insomnia phenotypes, cognitive assessments, and sample characteristics. Additionally, we summarize emerging evidence on neuroanatomical and molecular correlates of insomnia-related cognitive impairment, including alterations in hippocampal and prefrontal brain structures, amyloid-β accumulation, dysregulation of brain-derived neurotrophic factor, neurotransmitter imbalance, neuroinflammation, and disrupted signaling pathways. Insights from preclinical studies show mechanistic links between sleep loss, synaptic dysfunction, oxidative stress, and memory decline. Despite substantial advances, the precise pathophysiological mechanisms underlying cognitive dysfunction in insomnia remain incompletely understood, suggesting that cognitive impairment arises from the convergence of multiple biological processes rather than a single causal pathway. A deeper mechanistic understanding is essential for developing targeted interventions for preventing cognitive decline in individuals with insomnia.

Psychiatry International doi: 10.3390/psychiatryint7020069

Authors: Tindara Caprì Rosa Angela Fabio

Background: The present study investigated automatic and intentional inhibitory control processes in children with Attention-Deficit/Hyperactivity Disorder (ADHD) within the framework of the dual-process theory, comparing their performance with that of typically developing children in ocular motor tasks. The aim was to determine whether deficits in ADHD involve both controlled and automatic inhibitory mechanisms. Methods: 104 children (M = 10.92, SD = 1.97) divided into three groups (ADHD-Inattentive, ADHD-Combined, and control) were tested using the Delayed Ocular Response (DOR) task, which measures intentional inhibitory control by requiring the suppression of reflexive saccades toward peripheral stimuli, and the Saccadic Interference (SI) task, which evaluates automatic inhibitory control by assessing susceptibility to distractor interference during goal-directed saccades. Results: In the DOR task, ADHD groups exhibited a higher number of premature saccades, fewer correct saccades, and lower accuracy compared to controls, with no differences between ADHD subtypes, indicating an impairment in intentional inhibitory control. Performance on the SI task did not differ significantly among groups, suggesting preserved automatic inhibitory control in children with ADHD. Conclusions: These findings indicate that ADHD is characterized by deficits in intentional inhibitory processes rather than in automatic inhibitory mechanisms, contributing to a more differentiated understanding of inhibitory control dysfunctions in this disorder.

Psychiatry International doi: 10.3390/psychiatryint7020068

Authors: Waqar Husain Haitham Jahrami

(1) Background: While anticipatory anxiety is well-established in the psychological literature, the specific phenomenon of distress experienced during waiting for positive, rationally certain outcomes remains under-theorized and clinically under-recognized. (2) Methods: This paper presents a conceptual analysis and theoretical proposal introducing ‘Waiting Anxiety,’ defined as a hypothesized pattern of anticipatory distress characterized by heightened cognitive rumination, physiological arousal, and emotion regulation failure during periods of delayed resolution, specifically when the awaited outcome is positive and rationally certain (e.g., an approaching wedding, confirmed promotion, or approved visa). (3) Results: Distinct from traditional anticipatory anxiety tied to threat perception, waiting anxiety is proposed as a paradoxical form of distress that emerges despite primary outcome certainty. The construct is theoretically grounded in emotion regulation failures, temporal perception distortions, and impatience mechanisms, and is illustrated through five clinical cases. (4) Conclusions: This paper argues for waiting anxiety as a hypothesized psychological pattern warranting empirical investigation. Future psychometric, epidemiological, and neurobiological research is needed to establish its validity, prevalence, and clinical utility. If validated, integration into clinical frameworks could improve understanding of affective experience during positive life transitions.

Psychiatry International doi: 10.3390/psychiatryint7020067

Authors: Guadalupe Martín-Mora-Parra Jessica Morales-Sanhueza Ismael Puig-Amores

Suicidal behavior among adolescents and young adults represents a growing public health concern due to its high prevalence and its negative impact on psychological well-being. The aim of this study was to examine the associations between emotional regulation, attachment styles, cyberviolence, and suicidal ideation among Chilean university students. A descriptive cross-sectional design was employed with a sample of 1083 participants, using the Suicidal Ideation Frequency Inventory, the Close Relationship Experience Questionnaire (ECR-R), the Spanish Modified Version of the Trait Meta-Mood Scale (TMMS-24) and the Cyber Dating Violence Instrument for Teens (CyDAV-T). Bivariate analyses and binary logistic regression were conducted to identify significant predictors of suicidal ideation. The results revealed a high prevalence of suicidal ideation, particularly among women (19.06%; p < 0.001). Difficulties in emotion regulation were strongly associated with a higher likelihood of suicidal ideation (p < 0.001), whereas adequate (p < 0.001) or excellent (p < 0.01) regulation functioned as a significant protective factor. In addition, a disorganized attachment style was identified as a risk factor (p < 0.05), especially among women (p < 0.01). In conclusion, emotion regulation emerges as a key protective factor against suicidal ideation, underscoring the importance of implementing socioemotional training programs within university settings.

Psychiatry International doi: 10.3390/psychiatryint7020066

Authors: Gloria Tomás-Gallego Esther Gargallo-Ibort Josep María Dalmau-Torres Javier Ortuño-Sierra

Background: The Strengths and Difficulties Questionnaire (SDQ) has largely been used in adolescents to screen for mental health difficulties and prosocial capabilities. The objective is to analyze the psychometric properties of the Spanish version of the SDQ in university students. Methods: This work included a large sample (N = 1256), 64.6% women with a mean age of 22.96 years (SD = 6.15). Results: The confirmatory factor analysis indicated that a six-factor solution was the most tenable. The study of measurement invariance (MI) revealed strong measurement invariance both by gender and age. The study of relations with other variables indicated that the SDQ subscales were statistically significantly correlated with indicators of self-esteem, emotional well-being, stress, and emotional regulation. Finally, the internal consistency of the scores for the Total Difficulties Score was 0.763. Conclusions: These results allow confirming the psychometric properties of the Spanish version of the SDQ for its use in university students.

Psychiatry International doi: 10.3390/psychiatryint7020065

Authors: Jaewon Lee Jennifer Allen

Artificial intelligence (AI) technologies are becoming increasingly integrated into the everyday lives of children, influencing how they learn, communicate, and develop emotionally. As AI assumes a more central role in children’s digital ecosystems, AI literacy—the ability to understand, engage with, and make informed decisions about AI systems—is no longer a luxury but a developmental necessity. This review explores how AI literacy intersects with children’s mental health, particularly through the lens of socioeconomic status. Drawing on Digital Capital Theory and Cumulative Advantage/Disadvantage Theory, the paper examines how inequalities in access to AI-related resources shape the emotional and psychological experiences of children. It argues that while AI literacy can enhance well-being across all social groups, its impact is especially transformative for children from low-income backgrounds. Children from middle- and high-income families often experience modest emotional gains from AI engagement, having already benefited from consistent digital exposure and support. In contrast, low-income children—who often begin with limited access and lower confidence—stand to gain disproportionately in terms of emotional resilience, self-esteem, and digital confidence when their AI literacy improves. The review concludes with policy and practice recommendations that prioritize equitable access and tailored interventions, especially for underserved populations who have the most to gain from both the cognitive and emotional benefits of AI literacy.

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.