Search Results (534)

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

Background and Objectives: This study aimed to examine the level of depression in children who had undergone pediatric liver transplantation and to evaluate the potential role of liver enzymes as biomarkers of depression. Materials and Methods: The study was conducted with 50 pediatric liver transplant recipients followed at the Liver Transplantation Institute of İnönü University, and data were collected through face-to-face interviews. The Personal and Transplant Information Form, Child Revised Impact of Event Scale, and Patient Health Questionnaire–Depression were used as data collection tools. In addition to descriptive statistics, Student’s t-test, Mann–Whitney U test, correlation analyses, and regression analyses were performed. Results: The median PHQ-9 score was 1.00 (Q1–Q3: 0.00–5.00), indicating generally low levels of depression. A significant positive correlation was found between CRIES and PHQ-9 scores (r = 0.414, p < 0.01). In contrast, no consistent significant associations were observed between liver enzyme levels and depression scores in multivariate analyses, although bilirubin showed a modest negative correlation with PHQ-9 scores. In the multivariate analysis, although the overall regression model was not statistically significant, the CRIES score showed an individual association with PHQ-9 scores within the model (B = 0.117, p = 0.037). Conclusions: Liver enzymes cannot be considered strong biomarkers of depression in pediatric liver transplant recipients; however, post-traumatic stress symptoms may be an important clinical indicator for assessing psychological adjustment. Full article

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

Background/Objectives: Climate change worry is an emerging concern in youth mental health, but little is known about how it is associated with positive psychological functioning among university students. This study examined whether climate change worry was associated with flourishing and whether this association showed a cross-sectional statistical indirect effect through anxiety and depressive symptoms, with physical activity specified as a first-stage boundary condition. Methods: A cross-sectional anonymous survey was conducted in 2026 using convenience sampling among students from four universities located in three provincial-level regions of China, covering southern, western, and central areas. After predefined quality control procedures, 2826 valid responses were included. Climate change worry, anxiety and depressive symptoms, flourishing, and physical activity were assessed using the Climate Change Worry Scale (CCWS), the Patient Health Questionnaire-4 (PHQ-4), the Flourishing Scale (FS), and the Physical Activity Rating Scale-3 (PARS-3), respectively. Pearson correlations and conditional process analyses were conducted using the PROCESS macro, with 5000 bootstrap samples. Results: Climate change worry was positively associated with anxiety and depressive symptoms (r = 0.331, p < 0.001) and negatively associated with flourishing (r = −0.193, p < 0.001). Anxiety and depressive symptoms were negatively associated with flourishing (r = −0.486, p < 0.001). The cross-sectional statistical indirect effect through anxiety and depressive symptoms was significant (indirect effect = −0.1277, 95% bootstrap CI: [−0.1441, −0.1123]). Physical activity was statistically associated with a weaker first-stage association between climate change worry and anxiety/depressive symptoms (B = −0.0014, p < 0.001; ΔR² = 0.0064). The index of moderated mediation was significant (0.0014, 95% bootstrap CI: [0.0008, 0.0020]). Conclusions: Climate change worry was statistically associated with lower flourishing, primarily through higher anxiety and depressive symptoms. Physical activity was associated with a weaker first-stage association, but the moderation effect was small in practical magnitude. Given the cross-sectional and self-report design, these findings should be interpreted as conditional statistical associations rather than causal or protective effects. Full article

Background/Objectives: Limited data exist on care delivery, engagement, and clinical outcomes among rural populations accessing telehealth mental health services, particularly within integrated psychotherapy-and-psychiatry models. This retrospective observational 12-week cohort study aimed to examine access, engagement, and preliminary clinical outcomes for rural and non-rural patients receiving services through a national outpatient telehealth mental health program. Engagement and clinical outcomes were expected to be comparable among rural and non-rural patients. Methods: Descriptive and inferential analyses were conducted to examine access to care, engagement, and changes in depressive symptoms, anxiety symptoms, and suicidal ideation among rural and non-rural patients receiving telehealth mental health services over a 12-week treatment period. Clinical outcomes were evaluated using the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7). The full sample included 8354 rural and 177,864 non-rural patients and was used to assess access and engagement in treatment. A clinical sample (rural n = 2096; non-rural n = 43,067) that included patients who completed 12 weeks of care was further examined to assess symptom improvement outcomes. Results: Rural patients demonstrated greater baseline symptom severity and medical complexity relative to non-rural patients. Mean time to first appointment was 5.2 days among rural patients and 5.5 days among non-rural patients, with comparable engagement across groups and rural patients averaging approximately 1–2 touch points per week in care. Patient satisfaction ratings averaged 4.9 out of 5. Within the clinical sample, rural patients demonstrated clinically meaningful symptom improvement across depression and anxiety outcomes. Mean PHQ-9 scores improved by 7.0 points (95% CI: 6.72–7.28), and mean GAD-7 scores improved by 6.1 points (95% CI: 5.83–6.37). Additionally, 70.5% of rural patients achieved a minimal clinically important difference in PHQ-9 or GAD-7 scores, and 66.7% of patients reporting suicidal ideation at baseline no longer endorsed suicidal ideation at endline. Conclusions: These findings support the feasibility and preliminary effectiveness of large-scale virtual mental health care models for rural populations. Rural patients demonstrated engagement and clinical outcomes comparable to non-rural patients despite greater baseline severity and medical complexity. Full article

This study aimed to develop and internally validate a predictive model of perceived stress among first-year military male students to examine the predictive contribution of personality traits, depressive symptoms, and psychological well-being. Understanding these psychological predictors may support interventions for students at elevated risk of stress during military and academic transition. A cross-sectional web-based survey included 274 first-year male students at the Military Technological College in Oman. Outcome measures included the Perceived Stress Scale (PSS-10), the Patient Health Questionnaire (PHQ-9) for depressive symptoms, the WHO-5 Well-being Index, and the Big Five Inventory assessing personality traits. All variables were analyzed as continuous measures. Predictive modeling was performed using Least Absolute Shrinkage and Selection Operator (LASSO) linear regression with repeated 70/30 train–test splitting across 100 iterations and 10-fold cross-validation for internal validation. The final analytic sample included 266 participants after exclusion of incomplete responses. Across the 100 internal validation runs, the LASSO model accounted for approximately 40% of the variance in perceived stress (training R² = 0.44 ± 0.04; test R² = 0.40 ± 0.08). Neuroticism (β = 0.35) and depressive symptoms (β = 0.15) showed positive associations with perceived stress, whereas psychological well-being showed a negative association (β = −0.32). PHQ-9, WHO-5, and neuroticism were selected in 100% of the repeated LASSO models, which showed the most stable predictive contribution. Model performance on the test datasets showed stable predictive accuracy (MSE = 20.24 ± 2.48; RMSE = 4.49 ± 0.28; MAE = 3.61 ± 0.23). These findings demonstrate that personality traits, depressive symptoms, and psychological well-being collectively contribute to the statistical modeling of perceived stress among military students. The internally validated associative model may support institutional interventions for students vulnerable to elevated stress, informing targeted preventive mental health strategies within military training environments. Full article

Background/Objectives: Oral behaviors are increasingly considered relevant within the biopsychosocial framework of temporomandibular disorders, yet their relationship with emotional symptoms remains insufficiently characterized in general adult populations. This study investigated the association between the frequency of oral behaviors and the severity of anxiety and depression symptoms in adults. Methods: This observational, cross-sectional, multicenter study included 460 adults recruited from private dental practices. Oral behaviors were assessed using the Oral Behaviors Checklist (OBC-21), while anxiety and depression were evaluated using Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9). Associations were examined using Spearman correlations and generalized linear models with negative binomial distributions, adjusted for age, sex, and area of residence. Results: OBC-21 scores were positively associated with GAD-7 (R = 0.469, p < 0.001) and PHQ-9 (R = 0.432, p < 0.001). In adjusted models, OBC-21 remained significantly associated with anxiety symptoms (IRR = 1.0292, 95% CI: 1.0187–1.0399, p < 0.001) and depressive symptoms (IRR = 1.0293, 95% CI: 1.0187–1.0400, p < 0.001). Male sex was associated with lower anxiety scores, while age and area of residence were not significant. GAD-7 and PHQ-9 scores were strongly correlated. Conclusions: In this sample of adults attending private dental practices, a higher frequency of oral behaviors was associated with increased anxiety and depression symptoms, independently of age, sex, and area of residence. These findings support the clinical relevance of assessing oral behaviors as part of a biopsychosocial evaluation in dental practice. Full article

Web-based repeated-measures cohorts enable remote, scalable, and temporally structured monitoring of health-related outcomes in naturalistic settings. This paper presents the DiCoBENE study, a web-based cohort of healthcare-track university students, and reports evidence-informed instrument selection together with protocol features and pilot baseline findings. A structured review was used to inform the web-based administration of patient-reported outcome measures (PROMs) covering sleep quality, perceived stress, anxiety symptoms, depressive symptoms, and quality of life. In the pilot baseline sample, 442 students constituted the analytic dataset and 370–372 completed the core PROM battery, depending on the instrument. Poor sleep quality, anxiety symptoms, depressive symptoms, and perceived stress were common. Internal consistency was good to excellent for the Generalized Anxiety Disorder 7-item scale (GAD-7), the Patient Health Questionnaire 9-item depression module (PHQ-9), and the 10-item Perceived Stress Scale (PSS-10), and moderate for the Pittsburgh Sleep Quality Index (PSQI). Exploratory multivariate analyses, including latent profile analysis, principal component analysis, and partial-correlation network analysis, suggested that baseline heterogeneity was more parsimoniously summarized as a graded multidimensional burden continuum than as sharply separated phenotypes. Taken together, these findings position DiCoBENE as a methodologically explicit framework for web-based repeated outcome assessment in student well-being research. Full article

Introduction: Problematic internet use has been increasingly associated with depression, anxiety and other psychiatric symptoms; however, its impact on attentional functioning has not been thoroughly researched. This cross-sectional study was conducted in Târgu Mureș, Romania, and aimed to examine the associations between problematic internet use, attentional control, and symptoms of depression and anxiety in adults, and to determine whether problematic internet use independently predicts attentional control after accounting for emotional symptoms. Methods: A cross-sectional study was conducted on 224 adults who completed an anonymous online survey between 1 January 2026 and 1 April 2026. Problematic internet use was assessed using the Compulsive Internet Use Scale-14 (CIUS-14), attentional control using the Attentional Control Scale (ACS), depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9), anxiety symptoms using the Generalized Anxiety Disorder-7 scale (GAD-7), and eating disorder risk using the SCOFF questionnaire. Descriptive statistics, internal consistency analyses, Pearson correlations, group comparisons according to the CIUS-14 screening threshold, and multiple linear regression analyses were performed. Results: Problematic internet use was significantly associated with lower attentional control (r = −0.493, p < 0.001), higher depressive symptoms (r = 0.408, p < 0.001), and higher anxiety symptoms (r = 0.467, p < 0.001). In the regression model, problematic internet use remained the only significant independent predictor of attentional control (B = −0.597, p < 0.001), whereas depressive and anxiety symptoms were not significant after adjustment. Participants above the CIUS-14 screening threshold reported significantly lower attentional control and higher depression and anxiety scores than those below the threshold. Conclusions: Problematic internet use was associated with poorer attentional control and greater emotional symptom severity in Romanian adults. These findings suggest that problematic internet use may be linked to a broader cognitive–emotional vulnerability profile. However, because of the cross-sectional design, self-report measures, convenience sampling, and lack of detailed information on specific online activities, the findings should be interpreted cautiously. Longitudinal studies using objective cognitive measures and more detailed assessment of digital behaviors are needed. Full article

Background: Sexual health is a fundamental pillar of well-being during the perinatal period. However, many studies suffer from scoring bias associated with zero values by failing to distinguish between women who are sexually inactive and those with physiological dysfunction. This study aimed to identify the distinct sociodemographic and psychological determinants of sexual inactivity versus sexual dysfunction quality in a Romanian perinatal cohort. Methods: An observational, cross-sectional study was conducted with 100 women (52% sexually active, 48% inactive). Participants were evaluated using the Female Sexual Function Index (FSFI), Patient Health Questionnaire-9 (PHQ-9), RSES (Rosenberg Self-Esteem Scale), and Generalized Anxiety Disorder-7 (GAD-7). Data were analyzed using binary logistic regression for activity status and multiple linear regression for functional quality. Results: Among sexually active women, 84.6% met the clinical criteria for sexual dysfunction (median FSFI = 21.6). Binary logistic regression revealed that self-esteem (RSES) was the sole independent predictor of sexual activity status (aOR = 1.144; 95% CI: 1.028–1.217, p = 0.016). Conversely, multiple linear regression showed that depression (PHQ-9) was the only significant independent predictor of functional quality (B = −0.73, p = 0.006). Maternal age, residence, and obstetric history did not significantly predict either outcome. Conclusions: Based on the findings of our preliminary, exploratory study, we propose a conceptual interpretation, framing perinatal sexuality as a potential two-stage process, where self-esteem appears to serve as a primary behavioral barrier for the resumption of intimacy, while depression serves as the primary disruptor of functional quality. Clinical interventions may benefit from moving beyond physical recovery to include psychological screening for body image and mood disorders to restore sexual quality of life. Full article

Background: Parents of children undergoing liver transplantation face substantial caregiving demands that may adversely affect their mental health across multiple domains. Systematic evaluation of psychosocial outcomes in this population remains limited, particularly in settings that include immigrant families. Method: This was a single-center, cross-sectional study including the parents of 50 children after liver transplantation. Major sociodemographic variables included parental age, sex, education, chronic disease, and immigration status. We also recorded children’s demographics, transplant-related data, follow-up findings, and mental health status. Instruments for psychiatric assessment included the Generalized Anxiety Disorder 7-item scale (GAD-7; anxiety), Patient Health Questionnaire-9 (PHQ-9; depression), Perceived Stress Scale-10 (PSS-10; stress), and Pittsburgh Sleep Quality Index (PSQI; sleep quality). Results: We enrolled 50 parents of 50 pediatric liver transplant recipients (43 Turkish citizens, 7 Syrian immigrants; 28 fathers, 22 mothers; mean age: 40.10 ± 6.65). Time since transplantation showed weak negative correlation with PHQ-9 and GAD-7. Stress (PSS) levels had weak to strong positive correlation with PSQI, PHQ-9, and GAD-7. Sleep quality (PSQI) was positively correlated with PHQ-9 and GAD-7. Depressive findings (PHQ-9) were strongly and positively correlated with GAD-7. In Firth-penalized multivariable models, high PHQ-9 scores were independently associated with shorter time since transplantation (p = 0.001) and high PSS (p = 0.003). High GAD-7 scores were independently associated with shorter time since transplantation (p = 0.025) and high PSS (p = 0.001). Conclusions: The parents of pediatric liver transplant recipients experience high levels of stress, sleep issues, depression, and anxiety, which demonstrate multiple correlations. Full article

Background/Objectives: Non-celiac gluten sensitivity (NCGS) is a syndrome characterized by intestinal and extraintestinal symptoms triggered by gluten ingestion. Although anti-gliadin IgG antibody (AGA IgG) has been proposed as a potential biomarker for NCGS, its sensitivity and specificity in real-world clinical settings remain unclear. This study aimed to evaluate the clinical utility of AGA IgG in NCGS and to characterize its clinical features, including psychological distress and physical quality of life (QOL), in patients with clinically suspected NCGS attending a specialized outpatient unit in Japan, where patients reported symptoms related to the ingestion of gluten-containing grains (primarily wheat). Methods: We evaluated plasma AGA IgG levels in 45 patients with suspected NCGS based on clinical presentation and in 83 age- and sex-matched healthy controls. Plasma AGA IgG was measured using ELISA. Clinical symptoms and QOL were assessed using validated scales, including the 36-Item Short Form Health Survey (SF-36), Patient Health Questionnaire (PHQ-9 and PHQ-15), Generalized Anxiety Disorder-7 (GAD-7), and the Japanese version of the Irritable Bowel Syndrome Quality of Life measure (IBS-QOL-J). Results: The AGA IgG positivity rate was significantly higher in the suspected NCGS group (33.3%) than in the control group (13.3%; p < 0.01). Using clinical suspicion as the reference, the sensitivity and specificity of AGA IgG were 33.3% and 86.7%, respectively. Patients with suspected NCGS exhibited significantly lower physical and mental QOL and higher scores for depressive, anxiety, and somatic symptoms compared to controls. No significant clinical differences were found between AGA IgG-positive and IgG-negative individuals within the suspected NCGS group. Conclusions: AGA IgG demonstrated a specificity of 86.7% and a sensitivity of 33.3% for suspected NCGS, indicating its limited utility as a standalone biomarker. These findings suggest that suspected NCGS involves significant somatic and psychological burdens regardless of serological status. Future studies should explore whether a multi-marker panel could improve the identification of “True NCGS” in diverse clinical populations. Full article

Background/Objectives: Diet and mental health constitute two significant modifiable factors affecting Inflammatory Bowel Disease (IBD). The present exploratory study explores potential interrelationships between mental health and eating patterns in IBD patients in Greece. Methods: A mixed-methods approach was followed. Two hundred and eighty-three individuals living with IBD in Greece (n = 110 UC, n = 173 CD) participated in an online questionnaire survey examining demographic characteristics, anxiety, depression, and dietary attitudes. Fourteen semi-structured interviews explored the lived experiences of diet, mental health, and disease among IBD patients. Results: Quantitative study revealed that 45.77% of patients scored above the clinical cutoff for anxiety (GAD-7 ≥ 10) and 48.37% for depression (PHQ-9 ≥ 10). Patients with UC exhibited a significantly higher prevalence of moderate to severe anxiety (54.5% vs. 37.0%, p = 0.004) and depression (54.5% vs. 42.2%, p = 0.042) compared to CD. Disordered eating attitudes were present in 27.22% of the total sample, with no significant differences between diagnostic groups (p = 0.985). Thematic analysis revealed three overarching themes, namely (a) ‘life in two phases: IBD impact on health’, (b) ‘mental health and diet interplay—their perceived impact on IBD’ and (c) ‘coping strategies for managing IBD’. Conclusions: Our findings highlight the dynamic interplay among diet, mental health, and IBD experience. The study underscores the importance of developing holistic biopsychosocial interventions integrating medical, dietary, and psychological components for IBD management. Full article

Background: Disruptions in social and circadian rhythms are increasingly recognized as key contributors to depressive symptomatology and impaired quality of life, particularly in older adults, for whom daily regularity represents a crucial determinant of psychological and functional stability. Understanding the interplay between rhythm dysregulation, mood disturbances, and perceived well-being may inform preventive strategies in aging populations. Objective: This study aimed to examine the association between social rhythm dysregulation, depressive symptoms, and perceived quality of life in a sample of community-dwelling older adults. Methods: A cross-sectional observational study was conducted among 119 older adults (mean age 72.26 ± 4.72 years) enrolled in an active aging program. Social rhythms were assessed using the Brief Social Rhythm Scale (BSRS), depressive symptoms with the Patient Health Questionnaire-9 (PHQ-9), and health-related quality of life with the SF-12 Health Survey. Pearson correlation analyses and multiple linear regression models were applied. Results: Greater social rhythm dysregulation was significantly associated with higher depressive symptom levels (r = 0.41, p < 0.001) and lower perceived quality of life (r = −0.39, p < 0.001). In multivariate analyses, both rhythm dysregulation (β = −0.1863, p < 0.001) and depressive symptoms (β = −0.2885, p = 0.037) independently predicted poorer quality of life. Conclusions: In community-dwelling older adults, irregular social rhythms and depressive symptoms are independently and jointly associated with reduced quality of life. These findings highlight social rhythm regulation as a relevant and potentially modifiable target for preventive and supportive interventions aimed at promoting mental well-being and resilience in later life. Full article

Background: Wrist pain is frequently reported among housewives and linked to repetitive household tasks, yet the drivers of pain-related disability remain unclear. Beyond physical load, psychosocial factors such as catastrophizing, mood symptoms, and self-efficacy may shape severity and functional impact. Purpose: To evaluate the severity of wrist pain and wrist-related disability in Turkish housewives and to identify the psychosocial and symptom-related factors associated with these outcomes. Methods: This cross-sectional study was conducted with 92 Turkish housewives reporting wrist pain ≥ 3/10 on the Numeric Pain Rating Scale (NPRS) and who have been married for at least 1 year and performing at least 1 h of housework, via Google Forms. Fatigue and wrist pain were measured using the Numeric Rating Scale (NRS), as well as the Patient-Rated Wrist Evaluation–Turkish version (PRWE-T), Pain Self-Efficacy Questionnaire (PSEQ), Patient Health Questionnaire-4 (PHQ-4), and Pain Catastrophizing Scale (PCS). Sociodemographic data were also collected. Associations were analyzed with Spearman’s correlation, and simple linear regression identified factors explaining wrist pain severity and disability. Results: PRWE-T total scores showed strong positive correlations with pain catastrophizing (p < 0.001), PHQ-4 depression (p < 0.001), and PHQ-4 anxiety (p < 0.001), while correlating negatively with pain self-efficacy (p < 0.05). PCS was also strongly correlated with PHQ-4 anxiety (p < 0.001) and PHQ-4 total (p < 0.001), but negatively with PSEQ (p < 0.001). Multivariable regression analyses have shown that PCS and fatigue may be predictory of wrist pain and disability. Additional factors included fatigue severity (p = 0.002), PHQ-4 depression (p < 0.001), and PHQ-4 anxiety (p = 0.001). Conclusions: These findings highlight the multidimensional nature of wrist symptoms in this population. Full article