Search Results (522)

Objectives: This study assessed the effectiveness of a cognitive behavioral therapy (CBT)-based fine dust education program, grounded in the Health Belief Model (HBM), on elementary students’ fine dust knowledge, related behaviors, and mental health (depression, anxiety, stress, sleep quality). Methods: From September to November 2024, 95 students (grades 4–6) living near a coal-fired power plant in midwestern South Korea were assigned to either an intervention group (n = 44) or a control group (n = 51). The intervention group completed a three-session CBT-based education program; the control group received stress management education. Assessments were conducted at weeks 1, 2, 4, and 8 using standardized mental health and behavior scales (PHQ: Patient Health Questionnaire, GAD: Generalized Anxiety Disorder Assessment, PSS: Perceived Stress Scale, ISI: Insomnia Severity Index). Results: A chi-square test was conducted to compare pre- and post-test changes in knowledge and behavior related to PM2.5. The intervention group showed significant improvements in seven fine dust-related knowledge and behavior items (e.g., PM2.5 awareness rose from 33.3% to 75.0%; p < 0.05). The control group showed limited gains. Regarding mental health, based on a mixed-design ANCOVA, anxiety scores significantly declined over time in the intervention group, with group and interaction effects also significant (p < 0.05). Depression scores showed time effects, but group and interaction effects were not significant. No significant changes were observed for stress, sleep, or group × PM2.5 interactions. Conclusions: The CBT-based education program effectively enhanced fine dust knowledge, health behaviors, and reduced anxiety among students. It presents a promising, evidence-based strategy to promote environmental and mental health in school-aged children. Full article

Maternal mental illness significantly impacts caregiving, influencing both mothers and their children. This narrative review examines the challenges faced by mothers with conditions such as depression, anxiety, bipolar disorder, and schizophrenia, which often disrupt caregiving routines, emotional stability, and social integration. These difficulties can hinder secure attachments and contribute to adverse developmental outcomes in children, including heightened risks of anxiety, depression, behavioral issues, and cognitive impairments. Children of mothers with mental illnesses are 1.8 times more likely to develop emotional or behavioral problems and face a 2.7 times higher risk of suicidal ideation during adolescence. Intergenerational transmission of mental illness is also prevalent, with affected children showing a 2.5 times greater likelihood of developing mental illnesses in adulthood. Effective interventions include cognitive behavioral therapy (CBT), family-based approaches, and community programs integrating parenting education and mental health resources. These strategies have demonstrated improvements in maternal well-being and child resilience. The review highlights the need for comprehensive policies addressing maternal mental health, early intervention for children, and culturally sensitive support systems to break cycles of intergenerational mental illness. Future research should prioritize evaluating long-term intervention effectiveness and exploring innovative tools like digital mental illnesses solutions to support affected families. Full article

Background/Objectives: Muscle dysmorphia (MD), a subtype of body dysmorphic disorder, is prevalent among males who engage in the non-medical use of anabolic–androgenic steroids (AASs) and performance-enhancing drugs (PEDs). These individuals often experience severe psychopathology, including mood instability, compulsivity, and a distorted body image. Despite its clinical severity, no randomized controlled trials (RCTs) have evaluated structured psychological treatments in this subgroup. This study aimed to assess the efficacy of a manualized cognitive behavioral therapy (CBT) protocol in reducing MD symptoms and associated psychological distress among male steroid users. Results: Participants in the CBT group showed significant reductions in MD symptoms from the baseline to post-treatment (MDDI: p < 0.001, d = 1.12), with gains sustained at follow-up. Large effect sizes were also observed in secondary outcomes including depressive symptoms (PHQ-9: d = 0.98), psychological distress (K10: d = 0.93), disordered eating (EDE-Q: d = 0.74), and exercise addiction (EAI: d = 1.07). No significant changes were observed in the control group. Significant group × time interactions were found for all outcomes (all p < 0.01), indicating CBT’s specific efficacy. Discussion: This study provides the first RCT evidence that CBT significantly reduces both core MD symptoms and steroid-related psychopathology in men engaged in AAS/PED misuse. Improvements extended to mood, body image perception, and compulsive exercise behaviors. These findings support CBT’s transdiagnostic applicability in addressing both the cognitive–behavioral and affective dimensions of MD. Materials and Methods: In this parallel-group, open-label RCT, 59 male gym-goers with DSM-5-TR diagnoses of MD and a history of AAS/PED use were randomized to either a 12-week CBT intervention (n = 30) or a waitlist control group (n = 29). CBT sessions were delivered weekly online and targeted distorted muscularity beliefs, compulsive behaviors, and emotional dysregulation. Primary and secondary outcomes—Muscle Dysmorphic Disorder Inventory (MDDI), PHQ-9, K10, EDE-Q, EAI, and BIG—were assessed at the baseline, post-treatment, and 3-month follow-up. A repeated-measures ANOVA and paired t-tests were used to analyze time × group interactions. Conclusions: CBT offers an effective, scalable intervention for individuals with muscle dysmorphia complicated by anabolic steroid use. It promotes broad psychological improvement and may serve as a first-line treatment option in high-risk male fitness populations. Future studies should examine long-term outcomes and investigate implementation in diverse clinical and cultural contexts. Full article

Background/Objectives: With the rapid progression of technology, applications have been proposed as a promising alternative to conventional psychotherapeutic treatment. Nonetheless, research on unguided self-help applications for binge eating remains scarce, with most existing studies utilizing cognitive behavioral therapy (CBT) principles. Therefore, this paper presents the protocol for a randomized controlled trial designed to evaluate the efficacy and acceptability of eMOTE, a standalone application designed specifically for women in Portugal who binge eat. eMOTE, adapted from dialectical behavior therapy (DBT), is unique in that it focuses on teaching emotion regulation skills while also integrating core CBT strategies. Methods: At least 68 females who self-report binge eating episodes will be randomized into an intervention group with access to eMOTE for eight weeks or a delayed waitlist, which will have access to eMOTE after the T1 assessment. Assessments will be conducted at baseline (T0), post-intervention (T1), and at 2-month follow-up (T2). The primary outcomes will include objective and subjective binge eating frequency and binge eating symptomatology, while secondary outcomes will assess global levels of ED psychopathology, shape concern, weight concern, eating concern, dietary restraint, compensatory behaviors, mindfulness, emotion regulation difficulties, intuitive eating, psychological distress, and body mass index. Conclusions: This study will contribute to the limited literature on the use of smartphone technology as an alternative to traditional psychotherapy. Furthermore, this standalone application will offer insights into the use of emotion regulation and food monitoring components designed for adult females experiencing binge eating episodes. Full article

Background/Objectives: The application of shear wave elastography (SWE) for the assessment of placental disease is still unproven and there is limited data correlating placental biomechanical properties with aberrations in fetal growth. This study investigated changes in placental shear wave velocity (SWV) in early and late fetal growth restriction (FGR). Methods: We analyzed three study cohorts: Pregnancies with appropriate growth for gestational age (AGA) and those with early (<32 weeks’) and late (>32 weeks’) FGR. Mean SWV at two time points was compared in the following cohorts: all FGR vs. AGA, early FGR vs. late FGR, early FGR vs. AGA, and late FGR vs. AGA. Results: The study comprised 222 women—79 (35.6%) FGR and 143 (64.4%) AGA. Of the FGR pregnancies, 37 (46.8%) were early and 42 (53.2%) were late. On multivariate analysis mean, SWV was not increased in FGR compared to AGA placentae (β 0.21, 95% CI −0.17–0.60, p 0.28). It was also not increased in early FGR compared to late FGR or AGA placentae (β 0.36, 95% CI −0.06–0.77, p 0.09). We observed an effect measure modification by pre-eclampsia, increasing mean SWV to a greater extent in AGA compared to FGR cases. Conclusions: Although previous studies have shown an association between placental SWV and FGR, our study showed no difference between cases and controls. The interaction of pre-eclampsia indicated that SWE may have a greater role in pre-eclampsia than in FGR alone. Further investigation of the influence of increased maternal vascular pressure on placental stiffness would be beneficial. Full article

Loneliness is a recognized public health risk factor associated with increased morbidity and mortality. However, the effectiveness of interventions targeting loneliness remains unclear—particularly in relation to baseline severity. This systematic review and meta-analysis assessed intervention effectiveness and the influence of baseline severity and intervention characteristics. A total of 25 studies were included, of which 16 randomized controlled trials (RCTs; k = 21) were meta-analyzed. Interventions produced a moderate pooled effect at post-intervention (Hedge’s g = 0.65, 95% CI [0.05, 1.26], p = 0.037), though with high heterogeneity. Sensitivity analyses confirmed a moderate effect (g = 0.55, 95% CI [0.22, 0.88], p = 0.003). Higher baseline loneliness predicted greater intervention effects (b = 0.04, 95% CI [0.02, 0.07], Z = 3.36, p < 0.001), with cognitive-behavioral therapy (CBT) showing the largest effect size (g = 0.73). No significant effects were observed at follow-up. These findings underscore the need for dual strategies: targeted psychological interventions (e.g., CBT) for individuals with severe loneliness, and universal, context-based approaches for the broader population. This aligns with Geoffrey Rose’s distinction between individual-level treatment and population-level prevention and highlights the urgency of embedding loneliness interventions into public health frameworks and policy agendas focused on promoting social connectedness and equity. Full article

Artificial intelligence (AI)-powered mental health chatbots have evolved quickly as scalable means for psychological support, bringing novel solutions through natural language processing (NLP), mobile accessibility, and generative AI. This systematic literature review (SLR), following PRISMA 2020 guidelines, collates evidence from 25 published, peer-reviewed studies between 2020 and 2025 and reviews therapeutic techniques, cultural adaptation, technical design, system assessment, and ethics. Studies were extracted from seven academic databases, screened against specific inclusion criteria, and thematically analyzed. Cognitive behavioral therapy (CBT) was the most common therapeutic model, featured in 15 systems, frequently being used jointly with journaling, mindfulness, and behavioral activation, followed by emotion-based approaches, which were featured in seven systems. Innovative techniques like GPT-based emotional processing, multimodal interaction (e.g., AR/VR), and LSTM-SVM classification models (greater than 94% accuracy) showed increased conversation flexibility but missed long-term clinical validation. Cultural adaptability was varied, and effective localization was seen in systems like XiaoE, okBot, and Luda Lee, while Western-oriented systems had restricted contextual adaptability. Accessibility and inclusivity are still major challenges, especially within low-resource settings, since digital literacy, support for multiple languages, and infrastructure deficits are still challenges. Ethical aspects—data privacy, explainability, and crisis plans—were under-evidenced for most deployments. This review is different from previous ones since it focuses on cultural adaptability, ethics, and hybrid public health incorporation and proposes a comprehensive approach for deploying AI mental health chatbots safely, effectively, and inclusively. Central to this review, symmetry is emphasized as a fundamental idea incorporated into frameworks for cultural adaptation, decision-making processes, and therapeutic structures. In particular, symmetry ensures equal cultural responsiveness, balanced user–chatbot interactions, and ethically aligned AI systems, all of which enhance the efficacy and dependability of mental health services. Recognizing these benefits, the review further underscores the necessity for more rigorous academic research into the development, deployment, and evaluation of mental health chatbots and apps, particularly to address cultural sensitivity, ethical accountability, and long-term clinical outcomes. Full article

This study presents a high-order shear deformation theory (HSDT)-based model for evaluating the energy harvesting performance of functionally graded material (FGM) beams integrated with a piezoelectric layer and subjected to a moving concentrated load at constant velocity. The governing equations are derived using Hamilton’s principle, and the dynamic response is obtained through the State Function Method with trigonometric mode shapes. The output voltage and harvested power are calculated based on piezoelectric constitutive relations. A comparative analysis with homogeneous isotropic beams demonstrates that HSDT yields more accurate predictions than the Classical Beam Theory (CBT), especially for thick beams; for instance, at a span-to-thickness ratio of h/L = 12.5, HSDT predicts increases of approximately 6%, 7%, and 12% in displacement, voltage, and harvested power, respectively, compared to CBT. Parametric studies further reveal that increasing the load velocity significantly enhances the strain rate in the piezoelectric layer, resulting in higher voltage and power output, with the latter exhibiting quadratic growth. Moreover, increasing the material gradation index n reduces the beam’s effective stiffness, which amplifies vibration amplitudes and improves energy conversion efficiency. These findings underscore the importance of incorporating shear deformation and material gradation effects in the design and optimization of piezoelectric energy harvesting systems using FGM beams subjected to dynamic loading. Full article

Road traffic accidents (RTAs) are a leading cause of physical injury worldwide, but they also frequently result in post-traumatic stress disorder (PTSD). This systematic review examines the prevalence, predictors, comorbidity, and treatment of PTSD among RTA survivors. Four electronic databases (PubMed, Scopus, EBSCO, and ProQuest) were searched following PRISMA 2020 guidelines. Articles were included if reporting on the presence of post-traumatic stress disorder as a result of a road traffic accident in adults aged 18 years and older. Including peer-reviewed journal articles and awarded doctoral theses across all publication years, and written in English, Macedonian, Serbian, Bosnian, Croatian, and Bulgarian, identified 259 articles, and using Literature Evaluation and Grading of Evidence (LEGEND) assessment of evidence 96 were included in the final review, involving 50,275 participants. Due to the heterogeneity of findings, quantitative data were synthesized thematically rather than through meta-analytic techniques. Findings are reported from Random Control Trial (RCT) and non-RCT studies. PTSD prevalence following RTAs ranged widely across studies, from 20% (using Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, DSM-5 criteria) to over 45% (using International Classification of Diseases, 10th Revision, ICD-10 criteria) within six weeks post-accident (non-RCT). One-year prevalence rates ranged from 17.9% to 29.8%, with persistence of PTSD symptoms found in more than half of those initially diagnosed up to three years post-RTA (non-RCTs). Mild or severe PTSD symptoms were reported by 40% of survivors one month after the event, and comorbid depression and anxiety were also frequently observed (non-RCTs). The review found that nearly half of RTA survivors experience PTSD within six weeks, with recovery occurring over 1 to 3 years (non-RCTs). Even minor traffic accidents lead to significant psychological impacts, with 25% of survivors avoiding vehicle use for up to four months (non-RCT). Evidence-supported treatments identified include Cognitive Behavioural Therapy (CBT) (RCTs and non-RCTs), Virtual Reality (VR) treatment (RCTs and non-RCTs), and Memory Flexibility training (Mem-Flex) (pilot RCT), all of which demonstrated statistically significant reductions in PTSD symptoms across validated scales. There is evidence for policy actions including mandatory and regular psychological screening post RTAs using improved assessment tools, sharing health data to better align early and ongoing treatment with additional funding and access, and support and interventions for the family for RTA comorbidities. The findings underscore the importance of prioritizing research on the psychological impacts of RTAs, particularly in regions with high incident rates, to understand better and address the global burden of post-accident trauma. Full article

Coronary artery disease (CAD) and mental health disorders, particularly depression and anxiety, exhibit a complex, bidirectional relationship that adversely influences clinical outcomes and mortality. Mental illnesses account for approximately 8 million deaths annually, while cardiovascular diseases, including CAD, contribute to about 17 million deaths, with CAD alone responsible for one-third of deaths among individuals aged ≥35 years. This review offers a structured synthesis of current knowledge focusing on the (1) epidemiology, emphasizing the reciprocal risk between CAD and psychiatric conditions; (2) pathophysiological insights, including inflammation, neurohormonal dysregulation, platelet hyperactivation, and shared genetic determinants; and (3) therapeutic approaches, encompassing pharmacological management, psychotherapeutic interventions, and integrated care models. Selective serotonin reuptake inhibitors (SSRIs) remain the pharmacologic agents of choice in patients with CAD and depression due to their favorable cardiac profile, while cognitive behavioral therapy (CBT) offers psychological benefit. However, evidence for mortality reduction remains limited. Emerging research highlights the importance of biomarker-driven care, gut–brain–heart axis modulation, and AI-enabled clinical integration. Full article

Background: Optimal coping with chronic pain (CP) has a positive impact on minimizing the barriers to patients’ quality of life. Mindfulness-based approaches have been shown to improve emotional regulation and coping strategies in CP management, promoting a greater acceptance of pain and reducing psychological distress. Given that personality traits may influence the adjustment to chronic pain, this study aimed to investigate whether specific personality dimensions, based on Cloninger’s model of temperament–character dimensions, affect the enrolment and the response to pain treatment in an innovative hybrid arts-based CBT-CP group intervention for patients with non-malignant CP. Methods: A pre-and-post assessment design was implemented in a non-randomized control trial. A total number of 100 outpatients at a University Pain Management Unit were allocated through self-selection in either an arts-based CBT-CP group intervention (N = 50) or a treatment-as-usual (TAU) control group (N = 50). All participants completed the Brief Pain Inventory (BPI), the Orbach and Mikulincer Mental Pain Scale (OMMP), the Tolerance for Mental Pain Scale (TMPS), and the Temperament and Character Inventory (TCI-140). The assessment took place at baseline and at the end of the intervention, after a 10-week period. The statistical analyses included a t-test for independent samples, Chi-square, and linear regression analyses. Results: At baseline, the arts-based CBT-CP intervention group had a higher score in the novelty seeking character dimension (M = 64.04; SD = 9.56), whereas the TAU group was found to have higher scores in self-directedness (M = 74.34; SD = 11.22) and self-transcendence (M = 51.42; SD = 6.61). The arts-based CBT-CP group reported a lower loss of control (M = 22.94; SD = 6.70) and higher belief in the ability to cope with pain (M = 21.10; SD = 3.76) after the intervention, compared to the control group. Self-transcendence was found to be a significant predictor of average pain as well as of patients’ belief in their ability to cope with pain. Conclusions: The current study provides practice-based evidence suggesting that an arts-based CBT-CP group intervention is a promising treatment for non-malignant CP. Personality dimensions affect patients’ enrolment and response to pain treatment. Furthermore, integrating mindfulness-based strategies within such interventions may further enhance treatment outcomes by fostering acceptance, improving coping mechanisms, and reducing the emotional burden associated with chronic pain. Full article

Since the 2018 Farm Bill legalized hemp, semi-synthetic cannabinoids, typically derived from hemp-extracted CBD, have been marketed as offering a “legal high”, raising concerns about consumer safety, labeling, and regulation. Consequently, the potency analysis of these compounds has become increasingly important. To address this need, an LC-DAD method was developed for the quantification of seventeen cannabinoids, selected based on the synthetic pathways of semi-synthetic cannabinoids. These included naturally occurring compounds, semi-synthetic derivatives, and byproducts (CBC, CBD, CBDV, CBG, CBN, CBN-O-acetate, CBT, 9(R)-HHC, 9(S)-HHC, 9(R)-HHC-O-acetate, 9(S)-HHC-O-acetate, Δ⁸-THC, Δ⁹-THC, Δ^9,11-THC, Δ⁸-THC-O-acetate, Δ⁹-THC-O-acetate, and Δ⁹-THCV), using abnormal CBD as an internal standard. The method was validated according to ISO 17025 guidelines, demonstrating a linear calibration range from 0.1 to 50 µg/mL. The method was further applied to the potency analysis of one Δ⁸-THC, two THC-O-acetate, two HHC, and one HHC-O-acetate vaping oil sample. Using an innovative method to recover the contents of vaping cartridges, cannabinoids were extracted using methanol, diluted to a concentration of 50 µg/mL, and analyzed using the validated LC-DAD method, which provided a quantifiable range of 0.1 to 100% (w/w). Method specificity was evaluated using ESI/TOFMS and showed minimal interference, despite the presence of other isomers of the semi-synthetic cannabinoids in the samples. Full article

Background and Objectives: Psychological distress is a pervasive yet often undertreated aspect of the cancer experience, contributing to reduced quality of life, poorer treatment adherence, and worse health outcomes. This systematic review and meta-analysis evaluated the efficacy of non-pharmacological, evidence-based psychological interventions on distress, depression, anxiety, coping capacity, and quality of life in adult cancer patients. Interventions were grouped into three domains: structured psychotherapeutic therapies (e.g., Cognitive Behavioral Therapy [CBT], Acceptance and Commitment Therapy [ACT], Meaning-Centered Psychotherapy [MCP]); mindfulness and stress reduction programs (e.g., Mindfulness-Based Stress Reduction [MBSR], Mindfulness-Based Cognitive Therapy [MBCT]); and coping and resilience-enhancing modalities (e.g., Promoting Resilience in Stress Management [PRISM], expressive writing). Materials and Methods: Following PRISMA guidelines, 42 randomized controlled trials published between 2015 and 2025 were included. A stratified meta-analytic approach calculated pooled standardized mean differences for each intervention class and outcome. Heterogeneity, subgroup, and moderator analyses explored drivers of effect variability. Results: Structured psychotherapeutic interventions yielded the largest effects, especially for depression. Mindfulness-based interventions produced moderate but significant improvements in distress and emotional regulation. Coping and resilience programs provided smaller yet statistically significant gains in adaptive coping. Between-study heterogeneity was moderate, partly explained by intervention type, delivery modality, and cancer subtype. Conclusions: These findings support integrating psychosocial care into standard oncology protocols and endorse its routine implementation as a core component of comprehensive cancer treatment. Full article

The COVID-19 pandemic prompted the use of telehealth interventions for treating depression in older adults. We conducted a pilot study of a telephone-based brief psychological intervention, Behavioral Activation with Mental Imagery (BA-MI), for the treatment of depression in isolated older adults during the COVID-19 pandemic. We achieved promising results regarding a reduction in depressive symptoms. The purpose of the present study was to investigate the participants’ experiences of the intervention and provide insight into how the intervention could be improved. Fourteen participants aged 67–85 years that completed the BA-MI intervention were purposively selected and interviewed. The interviews were analyzed using thematic analysis with a descriptive phenomenological approach. BA was experienced as a good way of increasing activities and improving mood, but the opinions on MI were divided. Telephone delivery reduced barriers due to pandemic restrictions but felt less personal and lacking non-verbal communication. Being recognized and talking to a therapist every week was described as healing. When using manual-based psychological interventions, one should aim to make them as person-centered as possible by making room for the patients as individuals with both a past and a present, rather than just focusing on intervention delivery. Full article

Background/Objectives: Right ventricular (RV) dysfunction and circulatory collapse are considered to play a major role in mortality in patients suffering from pulmonary embolism (PE). Catheter-based therapies (CBTs) have been shown to improve RV hemodynamics. The aim of this study was to present available data for CBTs in acute PE and investigate whether CBTs offer mortality benefit and better safety outcomes over anticoagulation (AC) in patients with intermediate-risk PE. Methods: PubMed was searched from inception until February 2024 for studies that investigated treatment strategies in patients with confirmed PE. We initially investigated the crude incidence of mortality and major bleeding for individual interventions in patients with either intermediate or high-risk PE. We then directly compared CBT to AC for intermediate-risk PE, for which the effectiveness endpoint was comparative short-term (30-day or in-hospital) and midterm (90-day or 1-year) all-cause mortality and the safety outcomes included minor bleeding, major bleeding, and intracranial hemorrhage (ICH). Results: In all, 59 studies (4457 patients) were eventually included in our study. For the prevalence study, we described the crude incidence for mortality and major bleeding for interventions like catheter-directed thrombolysis (CDT), mechanical thrombectomy (MT), AC, and systemic thrombolysis (ST) in patients with either intermediate or high-risk PE. Our data synthesis comparing CBT to AC included 1657 patients (11 studies) with intermediate-risk PE. Our results indicate that CBT is associated with a lower risk of both short-term (RR 0.43; 95% CI [0.24–0.79], I² = 0%) and midterm all-cause mortality (RR 0.38; 95% CI [0.23–0.62], I² = 0%) compared to AC. Major bleeding and ICH did not differ between the two groups. Conclusions: In patients with intermediate-risk PE, our meta-analysis of the current literature suggests that CBT offers better outcomes in terms of short-term and midterm mortality compared to AC alone, with no difference in safety outcomes. Further RCTs are needed to explore and validate these findings. Full article