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.

Psychiatry International doi: 10.3390/psychiatryint7010039

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

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

Psychiatry International doi: 10.3390/psychiatryint7010038

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

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

Psychiatry International doi: 10.3390/psychiatryint7010037

Authors: Dario Davì Claudia Prestano Nicoletta Vegni

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

Psychiatry International doi: 10.3390/psychiatryint7010036

Authors: José Vicente Viguer Martha Martín Amelia Díaz

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

Psychiatry International doi: 10.3390/psychiatryint7010035

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

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

Psychiatry International doi: 10.3390/psychiatryint7010034

Authors: Maureen Murdoch Barbara Ann Clothier Siamak Noorbaloochi

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

Psychiatry International doi: 10.3390/psychiatryint7010033

Authors: Bumani Solomon Manganye Lufuno Makhado Jabu Tsakani Mabunda

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

Psychiatry International doi: 10.3390/psychiatryint7010032

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

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

Psychiatry International doi: 10.3390/psychiatryint7010031

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

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

Psychiatry International doi: 10.3390/psychiatryint7010030

Authors: Luís Loureiro Joel Araújo Ana Teresa Pedreiro Rosa Simões

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

Psychiatry International doi: 10.3390/psychiatryint7010029

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

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

Psychiatry International doi: 10.3390/psychiatryint7010028

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

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

Psychiatry International doi: 10.3390/psychiatryint7010027

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

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

Psychiatry International doi: 10.3390/psychiatryint7010026

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

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

Psychiatry International doi: 10.3390/psychiatryint7010025

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

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

Psychiatry International doi: 10.3390/psychiatryint7010024

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

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

Psychiatry International doi: 10.3390/psychiatryint7010023

Authors: Suzana Turcu Cristiana Susana Glavce Liviu Florian Tatomirescu

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

Psychiatry International doi: 10.3390/psychiatryint7010022

Authors: Soccalingam Artchoudane Meena Ramanathan Ananda Balayogi Bhavanani Muruganandam Partheeban

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

Psychiatry International doi: 10.3390/psychiatryint7010021

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

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

Psychiatry International doi: 10.3390/psychiatryint7010020

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

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

Psychiatry International doi: 10.3390/psychiatryint7010019

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

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

Psychiatry International doi: 10.3390/psychiatryint7010018

Authors: Renae A. Merrill Chunhua Cao

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

Psychiatry International doi: 10.3390/psychiatryint7010017

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

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

Psychiatry International doi: 10.3390/psychiatryint7010016

Authors: Metin Çınaroğlu Eda Yılmazer Esra Noyan Ahlatcıoğlu

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

Psychiatry International doi: 10.3390/psychiatryint7010015

Authors: Leonardo Massoni

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

Psychiatry International doi: 10.3390/psychiatryint7010014

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

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

Psychiatry International doi: 10.3390/psychiatryint7010013

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

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

Psychiatry International doi: 10.3390/psychiatryint7010012

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

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

Psychiatry International doi: 10.3390/psychiatryint7010011

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

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

Psychiatry International doi: 10.3390/psychiatryint7010010

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

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

Psychiatry International doi: 10.3390/psychiatryint7010008

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

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

Psychiatry International doi: 10.3390/psychiatryint7010009

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

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

Psychiatry International doi: 10.3390/psychiatryint7010007

Authors: Bettina F. Piko

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

Psychiatry International doi: 10.3390/psychiatryint7010006

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

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

Psychiatry International doi: 10.3390/psychiatryint7010005

Authors: Rosa Angela Fabio Alessia Di Pietro Rossella Suriano

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

Psychiatry International doi: 10.3390/psychiatryint7010004

Authors: Gerald Young

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

Psychiatry International doi: 10.3390/psychiatryint7010003

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

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

Psychiatry International doi: 10.3390/psychiatryint7010002

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

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

Psychiatry International doi: 10.3390/psychiatryint7010001

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

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

Psychiatry International doi: 10.3390/psychiatryint6040157

Authors: Mónica Valente Maria João Carapeto Anabela Pereira

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

Psychiatry International doi: 10.3390/psychiatryint6040158

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

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