Search Results (459)

Background/Objectives: Emotional eating (EE) is an emerging public health concern among university students, a population exposed to heightened academic demands, psychosocial stressors, and lifestyle changes that may promote maladaptive coping behaviors. EE has been linked to psychological distress, particularly depressive and anxiety symptoms, as well as sociodemographic, lifestyle, and anthropometric factors; however, findings remain heterogeneous and insufficiently integrated within comprehensive analytical frameworks. This study aimed to examine the association between EE and depressive and anxiety symptoms in university students, while assessing the independent contributions of sociodemographic, academic, lifestyle, and anthropometric determinants. Methods: A cross-sectional survey was performed among 1279 university students from 10 regions in Greece. Sociodemographic, academic, lifestyle, and anthropometric data were collected using validated instruments and standardized procedures. Depressive and anxiety symptoms were assessed by the use of the Beck Depression Inventory-II (BDI-II) and the six-item State-Trait Anxiety Inventory (STAI-6), respectively. EE was evaluated utilizing the EE subscale of the Three-Factor Eating Questionnaire–Revised 18 (TFEQ-R18). Multivariable ordinal logistic regression models were applied to examine independent associations. Results: In fully adjusted models, depressive and anxiety symptoms were the strongest correlates of higher EE levels, each associated with more than twofold increased odds. Female sex, Greek nationality, rural residence, enrollment in biomedical sciences, later academic years, and regular smoking were also positively associated with EE. Higher physical activity was inversely associated with EE levels. Overweight, obesity, and increased waist circumference and waist-to-hip ratio were consistently linked to higher EE, with several associations exceeding twofold increased odds. Conclusions: EE in university students is strongly associated with psychological distress and clusters with adverse lifestyle and anthropometric characteristics. These findings support the need for integrated interventions targeting mental health, lifestyle behaviors, and obesity-related risk factors. Longitudinal studies are warranted to clarify causal pathways and underlying mechanisms. Full article

Background: Pain during orthodontic debonding is a common clinical concern. Although previous studies have mainly focused on mechanical approaches to reduce discomfort, the influence of emotional characteristics of patients on pain perception remains insufficiently explored. In this study, we aimed to evaluate the association between pain perception, emotional affect, and anxiety during orthodontic bracket removal using different clinical protocols. Methods: A prospective observational comparative study was conducted at Rey Juan Carlos University (Madrid, Spain). A total of 140 orthodontic patients underwent bracket removal according to four routine clinical protocols determined by clinical scheduling: ligated with interocclusal cotton rolls (used for tooth stabilization), non-ligated with cotton rolls, ligated without cotton rolls, and non-ligated without cotton rolls. Pain intensity was assessed using a Visual Analog Scale (VAS) immediately before (T0) and after (T1) bracket removal. Baseline pain (T0) was recorded to control for pre-existing discomfort. Anxiety and emotional affect were measured using the State–Trait Anxiety Inventory (STAI) and the Positive and Negative Affect Schedule (PANAS), respectively. Statistical analyses included ANOVA, factorial ANCOVA adjusted for baseline pain, and multivariable regression models. Results: No significant baseline differences were observed among groups. The highest post-debonding pain scores were found in the group without cotton rolls and without ligatures. ANCOVA revealed a significant main effect of cotton roll use, with lower adjusted pain scores in patients treated with cotton rolls, whereas ligation showed no statistically significant independent effect. In multivariable regression analyses, baseline pain, age, and negative affect were independently associated with higher post-debonding pain. Conclusions: Within the limitations of a non-randomized design, cotton roll use was associated with lower post-debonding pain, whereas ligation appeared to have a limited influence. Patient-related factors—particularly negative affect, age, and baseline pain—were also associated with pain perception, supporting a biopsychosocial perspective. These findings should be interpreted as exploratory evidence rather than causal effects. Full article

The dimensionality of the Ego-Resilience Scale (ER89) remains contested, and little is known about the performance of the original and revised versions of the scale in South Africa. This study examined the psychometric properties of the 14-item ER89 and the 10-item ER89-R in 337 undergraduate students from a university in the Western Cape province of South Africa. Participants completed the ER89, the Sense of Coherence Scale, the Center for Epidemiological Studies Depression Scale, and the trait scale of the State-Trait Anxiety Inventory. The scales were evaluated using classical test theory, confirmatory factor analysis, bifactor modeling, parallel analysis, Mokken scale analysis, and Rasch analysis. For both versions, bifactor models fit better than one-factor models, but the specific factors showed anomalous loadings and accounted for little reliable variance. Parallel analysis and Rasch analysis supported an essentially unidimensional interpretation of both instruments. Although both versions showed acceptable internal consistency and expected associations with sense of coherence, depression, and anxiety, several findings raised concerns about their broader psychometric adequacy. Overall, both scales appeared to reflect a broad general factor of ego-resilience, but their performance in this context was mixed and, in important respects, problematic. Further refinement and validation are needed before either instrument can be recommended for confident use in South African research and practice. Full article

Objective: This study aimed to evaluate the associations between dental anxiety–fear, state–trait anxiety, and pain in patients requiring endodontic treatment and to explore the role of preoperative pain intensity in these associations. Methods: This cross-sectional study included 253 adults scheduled for endodontic treatment. Sociodemographic characteristics and relevant clinical data were recorded. Pain intensity and psychological variables were assessed using the Numerical Rating Scale (NRS), Modified Dental Anxiety Scale (MDAS), Dental Fear Survey (DFS), and the State Anxiety and Trait Anxiety subscales of the State–Trait Anxiety Inventory (STAI-S and STAI-T). Associations were analyzed using group comparison tests and correlation analyses, and mediation analyses were performed using Hayes’ PROCESS macro-4. Results: Significant correlations were found among all psychological parameters (p < 0.05). The observed associations were consistent with a potential partial mediating role of pain in the relationship between state–trait anxiety and dental anxiety. Higher anxiety levels were present in patients with anterior teeth requiring either primary treatment or retreatment compared with posterior teeth (p < 0.05). Conclusions: Preoperative pain may contribute to the association patterns identified between dental anxiety and state–trait anxiety. Further studies with larger sample sizes and adjusted analytical models are needed to better clarify these relationships. Full article

Nursing students in their training process often suffer from anxiety due to stressful situations, and emotional intelligence can help them to manage these situations. The aim of this study is to analyse the associations between the dimensions of perceived emotional intelligence and anxiety in students undergoing their training cycles in different special services in order to check if there are differences between them. It is an observational, cross-sectional and correlational study with a sample of 85 nursing students who had not received training in emotional intelligence. Two measurement instruments were used: the Trait-State Anxiety Inventory (STAI) to assess anxiety and the Trait Meta-Mood Scale (TMMS-24) to measure EI. Data were analysed using Pearson’s coefficient when the distribution was normal, and Spearman’s coefficient in the non-normal distribution. The results showed in the group—ER-Emergency and Oncology—there was a significant negative relationship between state and trait anxiety and emotional understanding and regulation. In contrast, in the Primary Care setting there was also a positive relationship between emotional perception and trait anxiety. The study concludes that nursing students who understand and manage their emotions may have a lower risk of anxiety. Furthermore, if they identify emotions appropriately, the risk of suffering from anxiety in the long term may be lower. This finding was observed when the student did the internship in Primary Care. So there is a difference depending on the clinical context. Full article

Background/Objectives: Preoperative anxiety is common in adult patients undergoing oral and dentoalveolar surgical procedures under local anesthesia and may impair cooperation, physiological stability, and overall treatment experience. While intravenous sedation and general anesthesia provide effective anxiolysis, they increase anesthetic exposure and recovery demands. Targeted preoperative anxiolysis offers a less invasive strategy to reduce anxiety while preserving responsiveness. However, approaches vary and standardized protocols are lacking. This systematic review evaluated the efficacy and safety of preoperative anxiolytic interventions—including both pharmacological and non-pharmacological strategies—in adult patients undergoing oral surgical procedures under local anesthesia without general anesthesia or deep sedation. Methods: The review adhered to the PRISMA 2020 guidelines and was prospectively registered in PROSPERO (CRD420261281592). Randomized and quasi-randomized controlled trials published between 2016 and 2026 were identified through structured searches of PubMed/MEDLINE, ScienceDirect, and Springer Nature Link. Eligible studies included adult patients undergoing oral surgery under local anesthesia and evaluated preoperative anxiolysis using validated instruments such as the Dental Anxiety Scale (DAS), State–Trait Anxiety Inventory (STAI), and Visual Analog Scale for Anxiety (VAS-A). Risk of bias was assessed using the Cochrane RoB 2 tool. Owing to methodological heterogeneity, results were synthesized narratively. Results: Eight trials (n = 617) met the inclusion criteria. Interventions included oral benzodiazepines, melatonin, pregabalin, herbal agents, nitrous oxide, and auriculotherapy. Benzodiazepines consistently reduced anxiety scores (p < 0.05) without significant interagent differences. Pregabalin at a dose of 150 mg significantly lowered STAI-S and VAS-A scores (p < 0.001). Passiflora incarnata was comparable to midazolam and superior to placebo, whereas Erythrina mulungu showed no effect. Melatonin results were inconsistent. Hemodynamics remained stable, and adverse events were mild. Conclusions: Preoperative anxiolysis under local anesthesia effectively reduces anticipatory anxiety in oral surgery, with benzodiazepines demonstrating the most consistent efficacy. Further standardized trials are warranted. Full article

Background: Preoperative anxiety and postoperative pain are prevalent and are frequently associated with poor postoperative functional outcomes. Comprehensive postoperative management, including both pharmacological and psychological components, is essential for proper postoperative care and better recovery. While the analgesic effect of traditional non-pharmacological intervention, such as cognitive behavior therapy, has been investigated by other trial studies, the newer innovative methods for delivering psychological interventions for reducing anxiety and pain are extensively being investigated. Virtual reality (VR) has emerged as a novel and promising technology that offers opportunities to mitigate patient perception and cognitive responses, and has been shown to be associated with lower levels of anxiety and pain. The aim of this randomized clinical trial (RCT) is to determine whether delivering the psychological content through virtual reality (VR) along with the standard preoperative and postoperative care results in better anxiety and pain relief outcomes than standard care in patients undergoing spinal surgery. Methods: This study protocol outlines a parallel-group RCT to be conducted in the Department of Neurosurgery at the University Clinical Hospital of Medical University of Lodz. The objective is to assess the efficacy of immersive VR environments in reducing preoperative anxiety and postoperative pain intensity in the following day after surgery. Adult patients (18–70) will be randomly assigned to either (1) standard care before surgery (control group), (2) VR exposure simulating the hospital environment alongside standard care, or (3) VR-based exposure to calming natural landscapes accompanied by soothing background sound along with standard care. In each group, a minimum of 50 patients will be recruited. The primary outcome is the change in preoperative anxiety measured using the State-Trait Anxiety Inventory-State (STAI-S) scale from baseline to immediately after intervention. Secondary outcomes include postoperative pain measured using the Visual Analogue Scale (VAS), postoperative analgesic consumption, patient satisfaction, and VR-related adverse effects. To facilitate a comprehensive understanding of the VR intervention’s impact, the primary outcome will be complemented with measures of the adverse effects, level of immersion, and level of presence in the VR environment. Secondary outcomes of self-reported satisfaction scores and postoperative analgesics from patients’ medical charts will be assessed. Conclusions: This trial will evaluate whether VR-based interventions may reduce preoperative anxiety and postoperative pain in patients undergoing spine surgery. This study may provide evidence supporting the future implementation of VR as a non-pharmacological adjunct in perioperative care. This intervention may hold significant clinical relevance clinically, particularly in patients with high level of preoperative anxiety, by offering an alternative method to pharmacological anxiolytics in the future. Full article

The use of smartphones and social media has become an increasing feature of daily life among university students. Although technology use can offer benefits, growing evidence links heavier engagement to poorer mental health outcomes. This study examined the associations between social media use and indices of psychological distress among South African university students, and it tested whether smartphone addiction represents a pathway linking social media use to distress. Participants (n = 491) were students who completed the Social Media Use Integration Scale, the Smartphone Application-Based Addiction Scale, the Center for Epidemiological Studies Depression Scale-10, the Posttraumatic Stress Disorder Checklist for DSM-5, the Beck Hopelessness Scale-9, and the trait scale of the State-Trait Anxiety Inventory-5. Mediation analyses with the PROCESS macro was conducted to examine smartphone addiction as a possible pathway between social media use and indices of psychological distress. The results of the mediation analysis indicated that social media use and smartphone addiction had significant positive direct effects on depression, PTSD, and anxiety, but not on hopelessness. In addition, social media use had significant indirect effects via smartphone addiction on depression, PTSD, and anxiety, pointing to the partial mediating role of smartphone addiction. The results highlight the importance of incorporating targeted support within student mental health services. Interventions aimed at reducing distress may benefit from targeting problematic smartphone engagement alongside broader efforts to promote healthier social media practices. Full article

Background: Subclinical psychological symptoms—such as low mood, perceived stress, and poor sleep—affect a large portion of the population and can impair quality of life despite remaining below clinical thresholds. The gut–brain axis has emerged as a promising target for interventions that support emotional and psychological resilience. Probiotics and postbiotics are gaining attention for their potential to modulate mood and stress via microbiome-related mechanisms, but human evidence remains limited, particularly in non-clinical populations. Objectives: We aimed to assess the effects of a two-strain combination of live microorganisms alongside a two-strain combination of heat-treated inactivated microorganisms on outcomes associated with anxiety, mood, perceived stress, and quality of life in healthy adults experiencing mild stress. Methods: This study was conducted in two parts. In Part I, a randomized, double-blind, placebo-controlled study, 100 participants were randomized to receive either a blend of live microorganisms (Bifidobacterium longum CECT 7347 and Lactobacillus rhamnosus CECT 8361) or an identical placebo once daily for 12 weeks. In Part II, a pilot feasibility study, a subset of eight placebo non-responders from Part I received the heat-inactivated preparation of the same bacterial strains in a 6-week trial extension phase. For Parts I and II, the primary outcome was the change in the Hamilton Anxiety Rating Scale (HAM-A). Secondary outcomes included measures of mood (Beck Depression Inventory (BDI); Patient Health Questionnaire-9 (PHQ-9)), stress (state and trait anxiety inventory (STAI); Perceived Stress Scale (PSS)), sleep (Pittsburgh Sleep Quality Index (PSQI)), quality of life (36-item Short Form Survey (SF-36)), gastrointestinal symptoms (Gastrointestinal Symptom Rating Scale (GSRS)), salivary cortisol and microbiome modulation. Results: In Part I, there were no significant effects of the live blend on the HAM-A, indicating that the primary endpoint was not met. In addition, no significant effects were seen on the STAI or PSS scores when compared to the placebo. However, participants consuming the live blend trended toward a reduction in total PHQ-9 scores compared to placebo (p = 0.089), whilst preliminary exploratory analyses suggested an improvement in anhedonia (p = 0.045). Furthermore, there was a significant improvement in the vitality domain of the SF-36 compared to placebo (p = 0.017). On microbiome analysis, it was noted that consumption of the live blend was linked to the preservation of butyrate-producing bacteria, particularly members of the Pseudoflavonifractor genus and the Clostridium SGB6179 species. Furthermore, the abundance of B. longum species was found to be inversely associated with the total PSS Scores. In Part II, supplementation with the inactivated preparation resulted in significant within-group improvements for the vitality (p = 0.006) and social functioning (p = 0.010) domains of the SF-36 and improvements in PSS scores compared to baseline (p = 0.050). Conclusions: Supplementation with either the dual-strain live or inactivated formulations was associated with significant improvements in the vitality domain of the SF-36, whilst participants receiving the inactivated formulation demonstrated lower perceived stress and improved social functioning compared to baseline. Overall, the findings from this pilot study suggest that these two biotic consortia are well-tolerated and may be associated with improvements in measures of vitality in individuals with subclinical psychological symptoms. The subtle observations detected for stress and anhedonia suggest that further well-powered trials are needed to better characterize these findings, potentially in populations with greater baseline symptomatology. Full article

Background/Objectives: Research comprehensively analyzing the psychological characteristics and factors related to smartphone addiction in Korean children and adolescents at risk for depression remains scarce. This study utilized large-scale cohort data to examine the differences in psychological characteristics between an at-risk group for depression and a control group, and to identify the specific factors influencing smartphone addiction within the at-risk group. Methods: Data were obtained from the school-based cohort of internet and smartphone users conducted by the National Center for Mental Health (NCMH), involving a total of 2294 children and adolescents (1009 in the at-risk for depression group and 1285 in the control group). Assessment tools included the Children’s Depression Inventory (CDI), State-Trait Anxiety Inventory for Children (STAIC/TAIC), Self-Esteem Scale (SES), Self-Control Scale, Aggression Questionnaire (K-AQ), School Bullying (SB) scale, and the Smartphone Addiction Scale-Short Form (SAS-SV). Results: Analysis of Covariance (ANCOVA) revealed that the at-risk group exhibited significantly higher levels of anxiety, aggression, involvement in school bullying, and smartphone addiction compared to the control group, while showing lower levels of self-esteem and self-control. Furthermore, multiple regression analysis indicated that higher anxiety and lower self-control were significant predictors of increased smartphone addiction levels. Conclusions: These findings support the Interaction of Person-Affect-Cognition-Execution (I-PACE) model, which posits that emotional vulnerability and deficits in executive functions lead to addictive behaviors. The results suggest that reducing anxiety and enhancing self-control are critical factors in the prevention of smartphone addiction among children and adolescents. Full article

Hybrid cognitive behavioral therapy (CBT), combining group and individual sessions, for treating obsessive–compulsive disorder (OCD) has rarely been examined in routine clinical practice. This prospective observational study preliminarily evaluated the feasibility and acceptability of a hybrid CBT program implemented in Japan. The program consisted of one pre-treatment individual session, eight group sessions, and one post-treatment individual session. Feasibility and acceptability were assessed using dropout rates and written questionnaire feedback. Twenty-eight individuals (mean age = 36.1 ± 14.0 years) participated, with two dropouts. Seven participants reported that the program duration was too short, whereas the remaining participants considered it appropriate. Nineteen participants indicated their willingness to participate in a similar program. Open-ended feedback highlighted the importance of group composition and program content. Self-Rating Yale–Brown Obsessive Compulsive Scale scores decreased at Session 8 (estimate = −2.74, p = 0.002) and post-treatment (estimate = −4.16, p < 0.001) according to a linear mixed-effects model. Reductions were also observed in Sheehan Disability Scale, State–Trait Anxiety Inventory, and Clinical Global Impressions Scale scores, whereas Center for Epidemiologic Studies Depression Scale scores showed no significant change. These findings suggest the feasibility and acceptability of the program and may inform future program development. Full article

In competitive sport, an athlete’s success is often linked to their physical strength, skill, and overall athletic ability. However, physical talent alone does not fully account for sporting success, as psychological and other personal factors also play a crucial role in achieving high performance. Thus, the present cross-sectional study aimed to examine the relationships between perfectionistic personality characteristics, achievement goal orientations, and trait anxiety among young football players using correlation and regression analyses. Participants consisted of 152 male U16 football players (M = 15.67, SD = 0.54) competing in the official league organized by the Cyprus Turkish Football Federation (CTFF). Data were collected using the Sport Multidimensional Perfectionism Scale (SMPS), the 2 × 2 Achievement Goals Questionnaire for Sport (AGQ-S), and the State Trait Anxiety Inventory (STAI). Pearson’s correlation analyses and simple linear regression models were conducted to examine relationships among variables and to identify significant predictors of trait anxiety. Correlation analyses revealed that trait anxiety was positively associated with concern over mistakes (r = 0.28, p < 0.01), perceived parental pressure (r = 0.17, p < 0.05), and mastery-avoidance goals (r = 0.37, p < 0.01), whereas it was negatively associated with mastery-approach goals (r = −0.18, p < 0.05). Regression analyses indicated that concern over mistakes significantly predicted trait anxiety (β = 0.25, p = 0.003), while perceived parental pressure was not a significant direct predictor (β = 0.10, p = 0.21). In addition, mastery-avoidance goals significantly predicted trait anxiety (β = 0.43, p < 0.001), whereas mastery-approach goals were negatively associated with trait anxiety (β = −0.28, p < 0.001). In conclusion, the findings indicate that perfectionistic concerns and mastery-avoidance goals are key factors associated with higher trait anxiety, whereas mastery-approach orientations may serve as a protective factor among young football players. Full article

Background/Objectives: Postpartum depression affects 10–20% of women and may have long-term consequences for mental health. This study examines the association between postpartum depressive symptoms and women’s depression and anxiety symptoms 11 and 15 years after childbirth. Methods: Data were drawn from the Rhea Mother–Child Cohort in Crete, Greece. A total of 1079 women completed the Edinburgh Postnatal Depression Scale (EPDS) at approximately 8–10 weeks postpartum. Of these, 516 participated in follow-up assessments at 11 and 15 years, which included measures of anxiety (State-Trait Anxiety Inventory, Trait version [STAI-Trait]) and depressive symptoms (Beck Depression Inventory [BDI]). Multivariable linear mixed-effects models were used to assess the relationship between postpartum depressive symptoms (EPDS) and later anxiety (STAI-Trait) and depression (BDI) outcomes, adjusting for sociodemographic and family-related characteristics and psychosocial factors. Results: Higher postpartum EPDS scores were associated with greater anxiety (STAI-Trait) and depressive symptoms (BDI) across follow-up assessments. Associations remained significant after adjusting for maternal baseline characteristics and follow-up factors. An interaction with time suggested that the association between postpartum depressive symptoms and anxiety levels strengthened over time, with a stronger association at the 15-year follow-up, indicating a higher long-term mental health burden. Conclusions: Postpartum depressive symptoms are associated with higher levels of depressive and anxiety symptoms 11 and 15 years after childbirth. The association with depression appeared relatively consistent across follow-up assessments, while the relationship with anxiety was stronger at the 15-year follow-up. These findings suggest that postpartum depression is an early marker of long-term vulnerability to mood and anxiety disorders, highlighting the importance of early screening, intervention, and long-term mental health support for mothers to reduce the risk of enduring psychological difficulties. Full article

Stress can cause many disorders, including mental and physical ones, if it persists. To take timely and effective early intervention measures, mental stress levels must be carefully monitored. This study investigates the rapidly growing topic of mental stress detection, focusing on the primary goals and mechanisms of existing detection frameworks. The main objectives and mechanisms will be highlighted. This study examines physiological sensors, stressors, algorithms, monitoring methods, and validation tools used to assess and classify mental stress. The study targets physiological sensors. Wearable sensors are becoming more popular because they can continuously monitor physiological responses in human-like environments. This allows them to reveal relevant stress patterns across various work environments. Numerous physiological sensors are used regularly. Galvanic skin response (GSR), electrocardiogram (ECG), photoplethysmography (PPG), electroencephalography (EEG), and pupil diameter camera systems are examples of these sensors. The combination of these sensors provides a wealth of cognitive and autonomic response data for stress detection. This review examines AI-based methods for interpreting complex physiological data. Machine learning and ensemble models are emphasized for improving stress classification accuracy and reducing incorrect classifications. In addition, this article discusses stressors used to induce reliable physiological responses. Validated self-report instruments are being reviewed as benchmarking tools for objective sensor-based measurements. STAI and PSS-10 are examples. These instruments demonstrate a strong correlation between stress and anxiety and physiological health outcomes. In conclusion, this review discusses future research avenues, focusing on advanced artificial intelligence-driven approaches and sophisticated sensors. These developments aim to better define stress levels and physiological factors that have not been thoroughly studied. Full article

Introduction: Psychosocial functioning and body image are key dimensions of mental well-being and performance. Among professional dancers, competitive environments, aesthetic demands, and physical–emotional overload contribute to increased anxiety, stress, and mood disturbances, potentially impairing performance and heightening injury risk. Objective: To investigate longitudinal variations in psychosocial and emotional indicators among professional dancers throughout a season of rehearsals and performances. Methods: Thirteen dancers (9 women and 4 men) from a professional company were assessed across eight time points using the Brunel Mood Scale (BRUMS), State–Trait Anxiety Inventory (STAI-State), Recovery–Stress Questionnaire for Athletes (REST-Q 76 Sport), and Body Shape Questionnaire (BSQ). Data was analyzed using repeated-measures ANOVA with Bonferroni post hoc tests (p < 0.05). Results: Negative mood dimensions progressively increased (p < 0.01; η²p = 0.46, large), while vigor decreased (p = 0.03; η²p = 0.29, medium), indicating an inversion of the typical “iceberg” profile. Overall stress levels increased (p = 0.02; g = 0.53, power = 0.81) and perceived recovery declined (p = 0.04; g = 0.41, power = 0.78). State anxiety rose consistently (p < 0.01; η²p = 0.42), and body dissatisfaction, assessed via the BSQ, increased from “no concern” to “high concern” classifications (p = 0.03; g = 0.59, power = 0.84). Conclusions: Overall, the findings indicating a longitudinal pattern of increased psychometric strain indicators, inferred exclusively from psychometric trends, and conceptually consistent with a possible imbalance between perceived demands and perceived recovery, rather than reflecting objectively measured workload or recovery processes. Full article