Search Results (58)

Background: Patients with obesity seeking bariatric surgery often display high rates of depressive symptoms, which are linked to worse clinical and surgical outcomes. A comprehensive evaluation of depression-related features in this population is lacking. Therefore, this study investigated clinical and psychopathological factors associated with depressive symptoms’ severity in 946 outpatients with obesity undergoing pre-surgical evaluation. Methods: The sample (45.1 ± 12 years) was subdivided according to Patient Health Questionnaire-9 (PHQ-9) into ‘absent’, ‘mild’, and ‘moderate-to-severe depression’ groups, which were compared for sociodemographic characteristics, childhood trauma, and emotional dysregulation. Assessments included the Childhood Trauma Questionnaire-Short-Form (CTQ-SF) and Difficulties in Emotion Regulation Scales (DERS). Inflammatory levels were evaluated through the Systemic Immune-inflammatory Index (SII). Multinomial logistic regression and correlations were performed to evaluate predictors of depression severity and their interrelationship. Results: Beyond sociodemographic and clinical differences, patients with moderate-to-severe depression displayed higher childhood trauma, emotional dysregulation, and inflammatory levels. Logistic regression with 95% confidence intervals showed that higher CTQ-SF scores were significantly associated with moderate-to-severe vs. absent depression (p = 0.005, 95% CI: 1.02–1.09), while elevated DERS scores were a risk factor for both moderate-to-severe vs. mild (p < 0.001, 95% CI: 1.04–1.11) and vs. absent depression (p < 0.001, 95% CI: 1.11–1.18). Additionally, PHQ-9 was significantly correlated with CTQ-SF, DERS, and SII. Conclusions: A worse clinical picture was observed in patients with moderate-to-severe depression, and significant interactions were found between psychopathology and inflammatory indexes. Emotional dysregulation was primarily associated with depression severity. These preliminary results support the implementation of rigorous pre-operative screening to identify and deliver targeted psychotherapeutic/pharmacological interventions aimed at improving clinical and post-surgical outcomes. Full article

Background and Objectives: We investigated whether early psychological trauma can contribute to the development of dysfunctional personality traits and emotional dysregulation. Personality disorders (PDs) are often characterized by using immature defense mechanisms and maladaptive coping strategies. Materials and Methods: We evaluated the relationship between early traumatic experiences, PDs, defense mechanisms, and coping strategies. A total of 90 patients aged between 18 and 70 with PDs were studied to detect different subtypes of early trauma, along with the defensive mechanisms and the prevailing coping strategies. Correlation and regression analyses aimed at establishing if specific trauma subtypes were associated with specific defense mechanisms and coping strategies. The Childhood Trauma Questionnaire—Short Form (CTQ-SF), the Defense Style Questionnaire 40 (DSQ-40), and the Coping Orientation to Problem Experienced (COPE) were used as psychodiagnostic tools. Results: Our findings determine emotional abuse, emotional neglect, and physical neglect as the most represented subtypes of trauma and underline the use of immature defense mechanisms in PD patients, while adaptive coping strategies, such as social support and positive aptitude were used. Conclusions: Early trauma, such as abuse and neglect, can be associated with dysfunctional defense mechanisms and coping strategies. This may have significant implications for managing not only pathological areas of the patient but also the functional ones. Moreover, being aware of these aspects can be useful for psychotherapy, reinforcing therapeutic alliance and reducing symptoms. Full article

This study aimed to examine the role of childhood sexual abuse in attachment styles and involvement in BDSM (bondage, discipline, dominance, submission, and sadomasochism) practices in adult intimate relationships. A model was built to test the predictive value of factors for involvement in BDSM practices. This study included 318 participants. Demographic data were collected and three questionnaires were used: the Childhood Trauma Questionnaire (CTQ) identified past sexual abuse, the Adult Attachment Scale (RSQ) assessed attachment style in adulthood, and the Sadomasochism Checklist (SMCL) assessed interest in masochistic practices. The results show that childhood sexual abuse is associated with practicing and enjoying BDSM, positively with submissiveness, negatively with dominance, and positively with a composite score measuring both submissiveness and dominance. It is also linked to fearful and preoccupied attachment styles in adulthood, but not dismissive attachment. Men exhibit higher levels of submissiveness and dominance in BDSM compared to women. Older individuals are more inclined to engage in BDSM. Urban residents show higher involvement in BDSM compared to those in other environments. Homosexual or bisexual individuals in open relationships are more frequently involved in BDSM. These findings highlight the complexity of connections between past experiences, sexual preferences in BDSM, and secure attachment in intimate relationships. Full article

Objective: The present investigation sought to examine the interrelationships between early-life adverse experiences, dissociative symptoms, suicidal ideation, and depressive manifestations among metropolitan firefighters screened with post-traumatic stress disorder (PTSD), and to elucidate the potential mediating effects of these psychological variables on both the presence and severity of PTSD symptomatology in this high-risk occupational cohort. Methods: A cross-sectional investigation was performed to assess psychological conditions among 760 metropolitan male firefighters, employing conditional process analysis with multiple mediation modeling (PROCESS macro Model 6). The investigative protocol employed validated psychometric instruments including the PTSD Checklist (PCL-5); the Childhood Trauma Questionnaire (CTQ-33); the Dissociative Experiences Scale (DES); the Suicidal Behaviors Questionnaire (SBQ-4); and the Patient Health Questionnaire (PHQ-9). Bootstrap resampling (n = 5000) generated bias-corrected 95% confidence intervals, enabling interrogation of complex trauma response mechanisms. Results: Conditional process analysis demonstrated that childhood trauma functions as a significant mediator (indirect effect = 0.142, 95% CI [0.086, 0.198]), with emotional abuse pathways revealing significant mediational effects (β = 0.285, p < 0.001). Stratifying participants using a PCL-5 ≥ 33 threshold (non-PTSD: n = 543, 71.5%, median PCL-5: 22; PTSD: n = 217, 28.5%, median PCL-5: 39), the investigation elucidated serial mediation mechanisms, particularly through childhood trauma to dissociative experiences (serial indirect effect = 0.168, 95% CI [0.092, 0.244]), collectively explaining nearly half of PTSD variance through complex psychological interaction pathways. Conclusions: Conditional process analysis revealed childhood trauma as a pivotal mediator, with emotional abuse pathways demonstrating significant mediational effects, while dissociative experiences emerged as a significant secondary mechanism, collectively explaining a substantial portion of PTSD variance through interactions between occupational trauma exposure and intrinsic psychological vulnerabilities. Full article

Objective: The literature concerning the association between coronary slow flow (CSF) and anxiety and depression is controversial. Furthermore; there is no existing data in the literature on the potential association between CSF and adverse childhood experiences or alexithymia. Methods: The participants underwent coronary angiography through femoral access. Coronary artery blood flow rate was evaluated quantitatively for each coronary artery according to the Thrombolysis in Myocardial Infarction frame count (TFC) method. CSF was diagnosed as a corrected TFC value >27 in at least one coronary artery during the imaging. Symptoms of anxiety and depression were assessed through the Hospital Anxiety and Depression Scale (HADS). Alexithymia and ACE were evaluated by the Twenty-item Toronto Alexithymia Scale (TAS-20) and the Childhood Trauma Questionnaire (CTQ). Results: The study participants were categorized into two groups: normal coronary flow (n = 58) and CSF (n = 18). Total HADS score; HADS anxiety subscale (HADS-A) score; and HADS depression subscale (HADS-D) score were determined as significant factors associated with CSF in univariate logistic regression analysis. However; the TAS-20 and CTQ scores showed no significant association with CSF. Multivariate regression analysis performed in separate models demonstrated that total HADS score (OR: 1.27; 95 CI%: 1.08–1.50; p = 0.003); HADS-A score (OR: 1.25; 95 CI%: 1.03–1.51; p = 0.019); and HADS-D score (OR: 1.36; 95 CI%: 1.06–1.74; p = 0.014) were independently associated with CSF in multivariate logistic regression analysis. Conclusions: Neither alexithymia nor ACE was associated with CSF. On the other hand; measures of both anxiety and depression assessed through HADS were independently associated with CSF. Future studies should address the major limitations of this study; such as the limited sample size; lack of structured diagnostic interview by a psychiatrist; and the lack of establishment of causality Full article

Background: This research aimed to investigate the mediating and moderating effects of psychological resilience (PR) on the association between childhood trauma (CT) and the development of depression. Methods: This study included 94 cases who consecutively applied to the outpatient psychiatry clinic of Rize Recep Tayyip Erdoğan University Training and Research Hospital in Turkey between 1 June 2023 and 1 December 2023 and were diagnosed with Major Depressive Disorder (MDD). In addition, 83 healthy individuals (control group) were also included. Participants administered the Hamilton Depression Rating Scale (HDRS), the Resilience Scale for Adults (RSA), and the Childhood Trauma Questionnaire (CTQ). Results: In the context of this research, the mediating effect of PR between CT and depression development was investigated. When examining the mediating role of PR on the association between CT and depression, it was found that CT statistically significantly influenced disease severity directly (B = 0.158, SE = 0.0398, z = 3.98, p < 0.001, 95% CI [0.0759, 0.232]), while it also influenced disease severity indirectly through PR (B = 0.193, SE = 0.028, z = 6.88, p < 0.001, 95% CI [0.1343, 0.244]). It was revealed that PR mediated the association between CT and depressive symptoms partially. Conclusions: This study demonstrates that PR has a mediating effect on the relationship between CT and MDD. These results provide new contributions to the existing literature. Interventions that increase psychological resilience may positively contribute to the treatment of patients with MDD who have suffered from CT. Full article

The Six Sigma methodology for quality improvement enabled a high degree of process compliance and enhanced process capability. This research develops a new model for optimizing the offset printing process based on the Six Sigma approach, with the aim of reducing process variability and achieving stable, predictable production outcomes. Special focus was placed on defining Critical Product Characteristics (CPCs) and Critical to Quality (CTQs) points and analysing their impact on process output quality, defined by the sigma level. Based on the research, variability limits of production parameters were defined to ensure consistency and high product quality. The integration of Artificial Intelligence (AI) within the Six Sigma framework allowed for additional automation and model adaptation to changing production conditions. The use of the Random Forest model enabled efficient analysis of critical variability points, prediction of potential deviations, and real-time process adjustment. AI is utilized to improve precision and efficiency in quality management, which further enhances process stability and optimization in line with the dynamic demands of modern production. The proposed model represents an innovative approach that facilitates maintaining stable production results and provides a sustainable foundation for future process optimizations in the printing industry. Full article

In recent years, self-injury attempts have accounted for 46.2% of emergency room visits by teenagers and young adults. This study aimed to explore the prevalence of non-suicidal self-injury (NSSI) among Korean college students, compare the mean number of NSSI risk factors between those with a history of NSSI and a control group with no history of thoughts or experiences of self-injury, and identify which factors have a greater influence on NSSI. The participants consisted of 403 Korean college students aged 18–29 who were divided into a subject group with a history of NSSI (n = 198) and a comparison group (n = 205) with no history of NSSI. The Functional Assessment of Self-Mutilation (FASM), Childhood Trauma Questionnaire (CTQ-SF), Social Experience Questionnaire (SEQ), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder 7-item scale (GAD-7), Difficulties in Emotion Regulation Scale—16 item version (DERS-16), Experiences in Close Relationship Questionnaire-Revised (ECR-R), Rosenberg Self-Esteem Scale (RSES), Parents as Social Context Questionnaire-Kids (PSCQ-KA), and Barratt Impulsiveness Scale-11-Revised (BIS-11). The collected data were analyzed using SPSS 25.0. Before a regression analysis, a MANOVA was performed to examine the mean difference between groups of each dependent variable, and a multiple regression analysis was performed to confirm the influence. The mean difference in all risk factors in the subject group compared with the comparison group was found to be statistically significant, with an effect size of 0.8 or greater. As a result of examining the relative influence of each variable on NSSI, emotional dysregulation (t = 2.481, p = 0.014), anxiety (t = −2.109, p = 0.036), and adult attachment (t = 2.004, p = 0.046) were found to significantly influence NSSI (p = 0.05). These findings will serve as fundamental data for screening clients at risk of self-injury in counseling and treatment settings, in addition to providing preventive and therapeutic interventions. Full article

This study investigates the transformation of e-commerce warehouse operations by integrating Lean Six Sigma tools to enhance efficiency and sustainability. Beginning with Value Stream Mapping (VSM) to identify inefficiencies, followed by a Hoshin Kanri plan to align improvement initiatives with strategic objectives, the study implemented measures such as pallet pooling, process standardization, automation in inspection and picking, layout optimization, and Kanban systems for continuous improvement. A case study of a local e-commerce warehouse specializing in medical devices and healthcare products identified 29 activities across receiving, inspection, storing, picking, packing, and shipping, highlighting inefficiencies addressed through Lean-driven initiatives. These efforts resulted in a 23% reduction in total lead time, doubled value-added time, and significant improvements in inspection, picking, packing, and automation, reducing delays, lowering costs, and enhancing workflow. The study fills a gap in the literature by integrating multiple Lean tools and utilizing the Critical to Quality (CTQ) matrix to ensure sustainable improvements in e-commerce warehousing, emphasizing the strategic value of Lean Six Sigma in creating efficient, customer-focused operations. Full article

The modern economic landscape, now more competitive than ever, compels companies to create increasingly innovative, cutting-edge, and cost-effective products. In this regard, the design and development phases play a crucial role, as they closely determine the final satisfaction of the customers. It follows from this the need for a structured approach to product development, which allows companies to identify product key characteristics, also useful when there is the need for carrying out the redesign of an existing product. This work provides the application of the Design For Six Sigma (DFSS) methodology to a real redesign case study, based on the improvement in a specific mountain bike model (baseline product). The final target is identifying the main criticalities and intervention areas for the bicycle, to provide valuable suggestions to designers and developers for creating a new product alternative characterised by an extended horizon to various markets. DFSS is applied to identify and optimise Critical-To-Quality (CTQ) features, aiming at making the project as responsive as possible to customers’ needs. More specifically, two main tasks are addressed. The first one is the application of the identify phase of the IDOV approach (Identify, Design, Optimise, Validate) to identify the most pertinent Voice of the Customers (VOCs) to be implemented in the product. The second main task is the analysis of the integrated product development process carried out through the Six Sigma (SS) methodology, to transform the VOCs into CTQs via the Quality Function Deployment 1 (QFD1) and to prioritise the CTQ to achieve design excellence. The identified improvement strategies are presented and critically discussed in relation to their potential to reduce the environmental impact of the overall Life Cycle (LC) of the product. Full article

Curl propensity is a critical-to-quality (CTQ) property of paper, as it causes severe problems during printing and other final conversion operations. The main papermaking factor causing the curl phenomenon is the existence of a fiber orientation (FO) gradient across the thickness direction (or ZD), also known as two-sidedness. Therefore, a methodology that characterizes the FO across the ZD is fundamental for papermakers. In this work, we propose and validate an efficient and cost-effective protocol based on sheet splitting and image analysis. Besides assessing the level of FO two-sidedness, the methodology also provides insights into the flow dynamics in the draining zone of the forming section of the paper machine and the drying stresses built into the paper. This information is relevant for monitoring, optimizing, and troubleshooting activities in the paper industry. Full article

Currently, there are no known human biomonitoring studies that concurrently examine biomarkers of dicamba and 2,4-D. We sought to compare biomarkers of exposure to herbicides in pregnant women residing in the US Midwest before and after the adoption of dicamba-tolerant soybean technology using urine specimens obtained in 2010–2012 from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (N = 61) and in 2020–2022 from the Heartland Study (N = 91). Specific gravity-standardized concentration levels for each analyte were compared between the cohorts, assuming data are lognormal and specifying values below the LOD as left-censored. The proportion of pregnant individuals with dicamba detected above the LOD significantly increased from 28% (95% CI: 16%, 40%) in 2010–2012 to 70% (95% CI: 60%, 79%) in 2020–2022, and dicamba concentrations also significantly increased from 0.066 μg/L (95% CI: 0.042, 0.104) to 0.271 μg/L (95% CI: 0.205, 0.358). All pregnant individuals from both cohorts had 2,4-D detected. Though 2,4-D concentration levels increased, the difference was not significant (p-value = 0.226). Reliance on herbicides has drastically increased in the last ten years in the United States, and the results obtained in this study highlight the need to track exposure and impacts on adverse maternal and neonatal outcomes. Full article

Childhood abuse is a significant risk factor for suicidal ideation. However, the underlying mediation mechanism necessitates further exploration. This study investigated the mediating role of core self-evaluation and negative emotions in the relationship between childhood abuse and suicide ideation in young adults. A sample of 3103 college students from 11 universities across 8 provinces in China was analyzed. Childhood abuse, core self-evaluation, negative emotions, and suicidal ideation were assessed using the Childhood Trauma Questionnaire (CTQ-CF), Core Self-Evaluation Scale, Affect Scale, and Beck Suicidal Ideation Scale (BSI-CV), respectively. Data analysis was conducted using SPSS 19.0 and SPSS Macro Process. We found that high scores for childhood abuse were associated with elevated levels of suicidal ideation, whereas low scores for core self-evaluation were closely linked to heightened levels of negative emotions and suicidal ideation. Furthermore, core self-evaluation and negative emotions mediated the relationship between childhood abuse and suicidal ideation through three significant paths. The results demonstrate that childhood abuse can directly impact suicidal ideation in young adulthood and indirectly influence suicidal ideation by affecting core self-evaluation and negative emotions. They suggest that addressing core self-evaluation and negative emotions in individuals who have experienced childhood abuse may help prevent or treat suicidal ideation. Full article

People with obsessive compulsive disorder (OCD) are at increased risk of developing psychotic disorders; yet little is known about specific clinical features which might hint at this vulnerability. The present study was aimed at elucidating the pathophysiological mechanism linking OCD to psychosis through the investigation of childhood trauma experiences in adolescents and adults with OCD. One hundred outpatients, aged between 12 and 65 years old, were administered the Yale–Brown Obsessive Compulsive Scale (Y-BOCS) and its Child version (CY-BOCS), as well as the Childhood Trauma Questionnaire (CTQ); Cognitive–Perceptual basic symptoms (COPER) and high-risk criterion Cognitive Disturbances (COGDIS) were assessed in the study sample. Greater childhood trauma experiences were found to predict psychotic vulnerability (p = 0.018), as well as more severe OCD symptoms (p = 0.010) and an earlier age of OCD onset (p = 0.050). Participants with psychotic vulnerability reported higher scores on childhood trauma experiences (p = 0.02), specifically in the emotional neglect domain (p = 0.01). In turn, emotional neglect and psychotic vulnerability were found higher in the pediatric group than in the adult group (p = 0.01). Our findings suggest that childhood trauma in people with OCD may represent an indicator of psychotic vulnerability, especially in those with an earlier OCD onset. Research on the pathogenic pathways linking trauma, OCD, and psychosis is needed. Full article

Many studies have identified that adverse childhood experiences (ACEs) are associated with non-suicidal self-injury (NSSI) and suicidality. However, most studies have been restricted to a few types of ACEs. This study aims to investigate the association of 13 common types of ACEs with NSSI, suicidal ideation (SI), and suicide attempts (SA), as well as the mediation of depressive and anxiety symptoms therein. A total of 1771 (994 male, 777 female) students aged 11–16 (12.9 ± 0.6) years who participated in the baseline survey of the Chinese Adolescent Health Growth Cohort study were included in the analysis. ACEs, including childhood maltreatment, other common forms of ACEs, and smoking, were measured via the Chinese version of the Child Trauma Questionnaire (CTQ) and a series of valid questionnaires that were derived from previous studies. NSSI was measured using the Chinese version of the Functional Assessment of Self-mutilation. SI and SA were measured using questions derived from the Global School Based Student Health Survey. Depressive symptoms were measured via the Chinese version of the Center for Epidemiologic Studies Depression Scale, and anxiety symptoms were measured via the General Anxiety Disorder-7. Of the included participants, 92.0% reported one or more category of ACEs. Smoking, parent–child separation, emotional abuse, physical abuse, and being bullied were positively associated with NSSI; smoking, parent–child separation, emotional abuse, physical abuse, emotional neglect, and being bullied were positively associated with SI; smoking, emotional abuse, and being bullied were positively associated with SA. The associations of ACEs with NSSI, SI, and SA were each partially or completely mediated through depressive and anxiety symptoms. Children and adolescents who had experiences of smoking, physical abuse, and being bullied during childhood are consistently and independently associated with NSSI and suicidality, and these associations may be largely mediated through depressive and anxiety symptoms. In conclusion, not all the types of ACEs are independently associated with NSSI, and suicidality and other associations may mediate through depressive and anxiety symptoms. Target interventions for adolescents’ NSSI and suicidality should focus on those who have a history of ACEs and depressive and anxiety symptoms. Full article