Search Results (294)

Depressive disorders are strongly influenced by personality organization, attachment style, and defensive functioning. This study examined the associations between depression severity, defense mechanisms, and adult attachment styles, and explored potential moderating effects of gender. A community sample completed standardized measures assessing depressive symptoms, defense mechanisms (mature, neurotic, immature), and attachment dimensions (anxious, avoidant). Correlational and regression analyses indicated that higher depressive severity was negatively associated with denial and dissociation, while no significant links emerged for projection or mature defenses. Anxious attachment predicted greater use of projection (B = 4.65, p = 0.040), but depression did not moderate this association. Cluster analysis identified two distinct profiles: one with moderate depression and higher denial, and another with severe depression and markedly lower denial. Men reported higher dysfunctional defenses overall, whereas a significant depression × gender interaction suggested that depressive severity was associated with reduced dysfunctional defenses among women (B = −0.58, p = 0.002). These findings challenge prevailing evidence that depressive severity correlates with greater immature defense use, instead suggesting a possible defensive collapse at high symptom levels. The study contributes novel insights into how attachment and gender shape defensive functioning in depression, emphasizing the need for longitudinal and clinical replication. Full article

Recent studies indicated a connection between trace amine-associated receptor 5 (TAAR5) and emotional behaviors related to anxiety and depression; however, the neurobiological basis of this link is still unclear. Using mutant TAAR5 knockout (TAAR5-KO) mice, we explored the consequences of receptor deletion on dopamine (DA) dynamics in the ventral striatum and stress-related behaviors. Voltammetric measurements of DA in the nucleus accumbens (NAc) coupled with electrical stimulation of the ventral tegmental area (VTA) revealed that mice lacking TAAR5 display a greater DA release, while its reuptake is not affected. Behaviorally, mutants were significantly less anxious in the elevated plus maze (EPM) and consumed more sucrose in comparison with wild-type (WT) controls. The new object recognition test (NOR) did not uncover a difference between these genotypes. During predator (rat) stress exposure, mutant and WT mice showed quite distinct responses versus the behavior observed in stressless conditions. Control animals demonstrated a substantial increase in “freezing” (a sign of passive coping), while “running” and “exploring” patterns (signs of active coping) were significantly extended in mice lacking TAAR5. Short-term consequences of stress were explored 24 h following the predator exposure. The absence of TAAR5 did not prevent or reduce stress-induced anxiety in the EPM. In fact, the level of anxiety in mutants reached that observed in control mice. Furthermore, activity in NOR was significantly decreased in mice lacking TAAR5 but not in WT animals. On the other hand, predator exposure resulted in impaired NOR in the WT control, whereas mutants’ performance was not altered. These findings indicate that TAAR5 deletion leads to significant DA imbalance, which might at least partly explain the better stress-coping strategy and other stress-induced behavioral consequences observed in mutant animals. Full article

Development of new therapeutic approaches and strategies for common neuropsychiatric disorders, including Major Depressive Disorder, anxiety disorders, and Post-Traumatic Stress Disorder, represent a significant global health challenge. Recent research indicates that emotional dysregulation and persistent inflammation are closely linked and serve as key pathophysiological features of these conditions. Emotional dysregulation is mechanistically coupled to locus coeruleus and norepinephrine (LC-NE) or noradrenergic system activity. Stemming from chronic stress, persistently elevated activity of the LC-NE system leads to hypervigilance, anxious states, and depressed mood. Concurrently, these symptoms are marked by systemic inflammation as indicated by elevated pro-inflammatory cytokines, and central neuroinflammation indicated by microglial activation in brain regions and networks involved in mood regulation and emotional control. In turn, chronic inflammation increases sympathetic tone and LC-NE activity resulting in a vortex of psychoneuroimmunological dysfunction that worsens mental health. Transcutaneous auricular vagus nerve stimulation (taVNS) in a non-invasive neuromodulation method uniquely positioned to address both noradrenergic dysfunction and chronic inflammation in neuropsychiatric applications. Evidence spanning the past decade demonstrates taVNS works via two complementary mechanisms. An ascending pathway engages vagal afferents projecting to the LC-NE system in the brain stem, which has been shown to modulate cortical arousal, cognitive function, mood, and stress responses. Through descending circuits, taVNS also modulates the cholinergic anti-inflammatory pathway to suppress the production of pro-inflammatory cytokines like TNF-α and IL-6 mitigating poor health outcomes caused by inflammation. By enhancing both central brain function and peripheral immune responses, taVNS has shown significant potential for recalibrating perturbed affective-cognitive processing. The present article describes and discusses recent evidence suggesting that taVNS offers a promising network-based paradigm for restoring psychoneuroimmunological homeostasis in common neuropsychiatric conditions. Full article

Background: Hearing loss is a prevalent sensory impairment with substantial psychosocial consequences. This cross-sectional study investigated the relationship between audiometric hearing loss and mood disturbances in adults aged 18–65 years who reported hearing difficulties for at least six months. Methods: Objective hearing level was assessed using the better-ear pure-tone average (PTA), and subjective hearing handicap was measured with the Hearing Handicap Inventory for Adults (HHIA). Standardized mood assessments included the Beck Depression Inventory-II (BDI-II) and the Beck Anxiety Inventory (BAI). Results: The study found that higher HHIA scores, indicating greater perceived hearing handicap, were strongly correlated with more severe depression and anxiety (ρ ≈ 0.45 and 0.38, respectively; p < 0.001). In contrast, objective PTA showed weaker associations with mood scores. Regression analyses, adjusted for age and gender, confirmed that perceived hearing handicap (HHIA) was the strongest independent predictor of both depression (standardized β ≈ 0.37, p < 0.001) and anxiety (β ≈ 0.33, p < 0.01), accounting for about 30% of the variance in mood scores. Nearly one-third of participants had clinically significant depression (BDI-II ≥ 20), which is substantially higher than community norms. The cross-sectional design and potential selection bias are limitations. Conclusions: Even mild-to-moderate hearing loss can result in significant depressive and anxious symptoms when individuals perceive themselves as handicapped. Early identification of hearing problems, routine psychosocial screening (e.g., a simple two-question survey), and integrated care are essential for improving quality of life. Full article

Anxiety symptoms are highly prevalent in major depressive disorder (MDD) and are associated with greater severity, functional impairment, and poorer treatment outcomes. Bupropion is widely used in clinical practice and is generally considered to have a favorable tolerability profile, but its effects on comorbid anxiety remain uncertain. We conducted a PRISMA-guided systematic review of randomized controlled trials, pooled analyses, and open-label comparative studies evaluating bupropion in adults with MDD and clinically significant anxiety symptoms. Searches of PubMed, Scopus and Web of Science were performed through August 2025. Outcomes included validated measures of anxiety and depressive symptoms and reported tolerability. Risk of bias was assessed using RoB 2 and ROBINS-I, and certainty of evidence was evaluated using GRADE. Six studies (n ≈ 3700) met inclusion criteria. Anxiety was a predefined secondary outcome in some trials and a post hoc or exploratory measure in others. Across designs, bupropion was generally associated with improvements in anxiety and depressive symptoms on secondary or exploratory anxiety measures. In pooled patient-level analyses, SSRIs showed a modest advantage over bupropion in patients with high baseline anxiety, whereas individual randomized and open-label studies found no significant between-group differences. None of the included studies reported a clear signal of anxiety worsening with bupropion on the anxiety measures used. Tolerability findings indicated a lower risk of sexual dysfunction with bupropion compared with SSRIs, while insomnia occurred more frequently but was generally manageable. Low-certainty evidence suggests that bupropion may provide clinically relevant improvement in anxiety symptoms in adults with MDD, with generally comparable efficacy to SSRIs in most presentations but a modest SSRI advantage in highly anxious subgroups. Interpretation should consider that anxiety outcomes were often secondary or exploratory and that several studies were at risk of bias. Well-designed randomized trials with anxiety as a primary endpoint are needed. Full article

Young adulthood is a critical period for preventing alcohol-related harm, as heavy drinking and mental health challenges often peak, yet preventive counseling remains underused. This study examined associations between depressive and anxious symptoms and receipt of alcohol-related advice from healthcare providers among U.S. young adults aged 18–29, with attention to differences across sexual identity groups. Data were drawn from the 2022 National Health Interview Survey, with a final analytic sample of participants aged 18–29 (N = 2256). Weighted logistic regressions estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Overall, 49.0% of participants reported receiving alcohol advice. Odds were higher among lesbian/gay participants (aOR = 1.81; 95% CI: 1.03–3.18) and those with severe anxiety symptoms (aOR = 2.10; 95% CI: 1.11–3.94). Interaction effects indicated disparities by sexual identity, with plurisexual males showing the lowest predicted probability of receiving advice when meeting the clinical threshold for anxiety (20.9% vs. 62.4% for monosexual individuals). The findings underscore the need to strengthen alcohol-related counseling and integrate mental health screening in preventive care for diverse young adult populations. Full article

Objectives: Chronic dermatoses are extremely prevalent and can manifest in various forms across genders and ages. Faced with the symptoms experienced by these conditions and the patient’s perception of the disease and its manifestation, it often leads to isolation and difficulty in emotional regulation. All these symptoms are associated with low quality of life, resulting in depressive and anxious symptomatology. Methods: This systematic literature review aims to study psychosocial interventions with an impact on the treatment of patients with chronic dermatoses. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, guiding a systematic search across PubMed, Google Scholar, and PsycNet databases. The considered studies reported the impact of interventions when applied to patients with chronic dermatoses. All the studies found were published in peer-reviewed journals. Results: The analysis revealed that interventions based on mindfulness, self-compassion, and self-help showed promise, with several studies reporting reductions in disease-related suffering and improvements in quality of life. However, the results were heterogeneous, with some interventions showing no significant benefit over control conditions for specific outcomes like anxiety or appearance-related distress. Conclusions: The development of research lines to enhance knowledge in this field will allow for significant improvements in therapeutic care for patients with chronic dermatoses, aiming to support professionals in the development of integrative therapeutic strategies for these patients in their clinical practice. Full article

Background: Depression and anxiety disorders impact millions globally. In recent years, low-intensity focused ultrasound (LIFU), characterized by its high precision, deep penetration, and non-invasive nature, has garnered significant interest in neuroscience and clinical practice. To enhance understanding of its effects on mood, therapeutic availability in treatment of depression/anxiety disorders, and potential mechanisms, a systematic review of studies investigating the emotional impact of LIFU on depressive/anxious-like animal models, healthy volunteers, and patients with depression or anxiety disorders has been undertaken. Methods: Relevant papers published before 15 July 2025 were searched across four databases: Web of Science, PubMed, Science Direct, and Embase. A total of 28 papers which met the inclusion and exclusion criteria are included in this review. Results: Our findings indicate that LIFU reversed the depressive/anxious-like behaviors in the animal models and showed antidepressant/anti-anxiety effects among the state-of-art clinical studies. For example, immobility time in FST or TST is reduced in depressive animal models, and HRSD/BAI scales are improved in human studies. Key molecules such as BDNF/5-HT are found restored in animal models, and FC between key brain areas related to depression/anxiety is modulated after LIFU treatment. Notably, no brain tissue damage was observed in animal studies, and only mild adverse effects (such as dizziness and vomiting) were noted in a few human studies. Conclusions: The studies using LIFU to treat depression and anxiety remain in the preliminary stage. The mechanisms underlying LIFU’s mood effects—such as activation or inhibition of specific brain regions or neural circuits, anti-inflammatory effects, alterations in functional connectivity, synaptic plasticity, neurotransmitter levels, and BDNF—remain incompletely understood and warrant further investigation. Nevertheless, the LIFU technique holds promise for regulating both cortical and subcortical brain areas implicated in depression/anxiety disorders as a precise neuromodulation tool. Full article

The aim of this paper is to contribute to the further development of a coherent theory of music performance anxiety (MPA) and its treatment. I have previously proposed three forms of MPA-focal, MPA with social anxiety, and MPA with panic and/or depression. An attachment disorder was proposed as a possible underlying psychopathology for this third type of MPA. Accordingly, open-ended in-depth assessment interviews of three professional musicians presenting with severe MPA that included panic attacks and depressed mood were analyzed from an attachment theory perspective. Two of these musicians participated in short-term psychodynamic psychotherapy. It was hypothesized that the musical performance setting re-triggers unprocessed feelings related to early attachment trauma, and that performance anxiety can be a manifestation of the emergence into consciousness of these powerful early feelings. As hypothesized, severely anxious musicians suffered both early and current relational trauma that was expressed through symptomatology in their MPA manifestations. The assessment interview of the first musician demonstrated how MPA can arise in the midst of other challenging current life circumstances that re-trigger feelings about early attachment failures and the importance of taking a full life history from severely performance-anxious musicians. Excerpts from the two musicians’ short-term psychodynamic psychotherapy demonstrated resolution of their severe MPA. Failure to identify and treat underlying attachment disorders in severely anxious musicians may render other forms of treatment ineffective or short-lived. Full article

Background/Objectives: Comorbid insomnia and sleep apnea (COMISA) in children is poorly documented. This study aimed to evaluate the frequency of COMISA and to explore its clinical and polysomnographic characteristics in children referred for polysomnography (PSG) for any sleep complaint. Methods: All patients with a complete insomnia sub-score on the Sleep Disturbance Scale for Children (SDSC; for children from 6 months to 16 years old) who underwent a night PSG in a pediatric sleep unit (2018–2024) were included in this retrospective study. Pathological SDSC insomnia sub-score defined insomnia and obstructive apnea-hypopnea index ≥ 2/h on PSG defined OSA. Questionnaires regarding sleepiness, depression, anxiety, and hyperactivity were also collected. Results: Children had isolated insomnia in 11.5% of cases, isolated OSA in 37.5%, and COMISA in 13.5%. Insomnia frequency was not different between patients with and those without OSA (26.5% vs. 23.5%). COMISA was more frequent in patients under 4 years old than in older ones (39.1% vs. 5.8%). No polysomnographic or clinical characteristic of COMISA was identified, except that OAHI was higher in children with isolated OSA. Patients with COMISA or isolated insomnia were more anxious than those with isolated OSA. Conclusions: Unlike in adults, the present findings do not support a mutual association between OSA and insomnia in children. OSA severity was lower in children with COMISA. Anxiety levels were higher in children with insomnia, regardless of the presence of OSA, suggesting that anxiety should be assessed in all children with OSA. Full article

Introduction: The mental health of nursing professionals is an escalating global concern, particularly due to the inherently challenging work conditions they frequently encounter. This study aimed to investigate the prevalence of Minor Mental Disorders (MMD) and resilience levels among nursing professionals, analyzing the relationship between these constructs and identifying resilience’s potential protective role. Methods: This was a quantitative, descriptive, correlational, and cross-sectional study. The sample consisted of 203 nursing professionals (including nursing assistants, technicians, and nurses) from two healthcare institutions in the interior of São Paulo, Brazil. Data were collected between August and October 2019. Instruments utilized included a sociodemographic and professional questionnaire, the Self-Report Questionnaire (SRQ-20) for MMD screening, and the Wagnild & Young Resilience Scale. Results: The overall prevalence of MMD in the studied sample was 31.0%. Mean scores for the SRQ-20 domains were observed as follows: Depressive/Anxious Mood (1.33), Somatic Symptoms (1.63), Reduced Vital Energy (1.77), and Depressive Thoughts (0.39). A key finding indicated that resilience did not demonstrate a significant direct predictive role on MMDs when the effect of quality of life was controlled. However, resilience showed a significant positive correlation with Quality of Life (QoL) (coef. = 0.515; p < 0.001). Furthermore, QoL emerged as a robust and statistically significant negative association with all dimensions of MMD. Discussion: These findings suggest that resilience may function as an indirect moderator or precursor to QoL, with QoL, in turn, exerting a more direct and substantial influence on the reduction of MMDs. This integrated perspective aligns with the understanding that resilience contributes to a more adaptive assessment of stressors and, consequently, to better QoL, thereby minimizing the detrimental effects of stress on mental health. Conclusion: This study reaffirms the high prevalence of Minor Mental Disorders among nursing professionals, highlighting Quality of Life as a primary target for interventions aimed at promoting mental well-being. It also emphasizes resilience as a valuable individual resource that indirectly supports mental health by enhancing QoL. A holistic understanding of occupational stressors, psychosocial, and biological mechanisms is crucial for developing effective and targeted support strategies for these essential professionals. Full article

Background: Major depression is a significant source of suffering and economic loss. Despite efforts to understand this condition and find better treatments, the burden imposed by this disease continues to rise. Most approved pharmacological treatments for depression focus on controlling the availability of monoamines in synapses. However, accumulating evidence suggests that neuroinflammation, oxidative stress, and reduced hippocampal neurogenesis play key roles as causal factors in the development of major depression symptoms. Therefore, preclinical testing of pharmacological approaches targeting these factors is essential. Mesenchymal stem cells (MSCs) are known for their potential as powerful antioxidants and anti-inflammatory agents, exerting neuroprotective actions in the brain. They produce various therapeutic molecules in a paracrine manner, collectively known as secretome. Methods: In this work, we evaluated the antidepressant potential of repeated intranasal administration of MSC-derived secretome in an animal model of major depressive disorder induced by chronic mild unpredictable stress. Results: We observed that intranasal administration of MSC-derived secretome reduced the appearance of some of the behavioral parameters commonly associated with major depression, including anhedonic, apathetic, and anxious behaviors, inducing a strong reduction in the overall depression score compared to vehicle-treated animals. At the structural level, secretome administration prevented increased astrocyte density and the atrophy of astrocyte processes observed in vehicle-treated stressed animals. Additionally, secretome administration induced an increase in myelin levels and oligodendroglia in the cortex. Conclusions: Our data suggests that intranasal administration of MSC-derived secretome may represent a potential therapeutic alternative to current treatments for this devastating pathology. Full article

Background/Objectives: Patient-reported outcome measures (PROMs) are widely used tools in orthopedic surgery for evaluating clinical outcomes, guiding research, and supporting value-based care. However, the optimal timing for collecting baseline PROMs, whether in clinic prior to surgery or on the day of surgery, remains uncertain. This study investigated whether the clinical setting (preoperative clinic vs. day of surgery) affects baseline PROMs in patients undergoing anterior cervical discectomy and fusion (ACDF). Methods: Patients undergoing elective, primary ACDF at a single institution between August 2019 and June 2021 were prospectively enrolled. Inclusion criteria included age over 18, English literacy, and eligibility for primary ACDF. Participants completed PROMIS domains, Neck Disability Index (NDI), Modified Japanese Orthopaedic Association (mJOA) score, and Visual Analog Scale (VAS) at two time points: during the preoperative clinic visit and again in the perioperative area on the day of surgery. A subgroup analysis was performed for patients with anxiety, defined as a PROMIS anxiety score ≥ 59.4. Results: A total of 63 patients were enrolled, with 48 completing both sets of surveys. The average time between the two assessments was 7.9 days (95% CI: 6.4–9.3). After Bonferroni correction (α = 0.005), no significant differences were observed in any PROMs across the two time points, including PROMIS physical function (p = 0.398), pain interference (p = 0.682), fatigue (p = 0.019), social satisfaction (p = 0.331), anxiety (p = 0.047), depression (p = 0.042), NDI (p = 0.072), mJOA (p = 0.566), VAS neck pain (p = 0.054), or VAS overall pain (p = 0.335). Subgroup analysis of anxious patients similarly revealed no statistically significant changes between settings. Conclusions: PROM scores were not meaningfully different between the preoperative clinic and the day of surgery in patients undergoing ACDF. These results are most applicable when baseline PROMs are collected within about one week of ACDF. These findings support flexibility in workflow design for PROM collection, as the timing and setting do not significantly impact baseline responses. Full article

Background/Objectives: Depression, anxiety and apathy are often associated with subjective cognitive complaints (SCCs) in people with Parkinson’s disease (PwPD) without cognitive impairment. Cognitive reserve (CR) enhances emotional resilience, allowing people to better cope with stress and emotional challenges, factors affecting quality of life. We aimed to explore the relationship between CR and mood/anxiety in cognitively intact PwPD with and without SCCs. Methods: In this cross-sectional study we enrolled 133 PwPD and normal cognitive function (age 59.8 ± 6.7 years; disease duration 9.0 ± 5.5 years; male/female 84/49). We assessed cognitive reserve (CR scale), subjective cognitive complaints (with PD-CFRS), QoL (PDQ8), mood, anxiety and apathy (BDI-II; STAI, PAS, Apathy scales). We used a t-test to compare groups (with/without SCC; M/F); correlations and moderation analysis to evaluate the relation between CR and behavioral features and the interplay between CR, behavioral discomfort and QoL. Results: The group with SCCs had significantly (p < 0.05) higher scores in PDQ8, Apathy, STAI, PAS-C and BDI-II scales than those with no SCCs. Males with SCCs had higher scores in PDQ8, Apathy scale and BDI-II while females differed in PDQ8 and Apathy scale scores. In the SCC group, late-life CR was negatively correlated with PAS-C (avoidance behavior) and BDI-II; correlations were confirmed in the male group where CR also correlated with PDQ-8 and PAS persistent anxiety. Conclusions: PwPD and SCCs are more depressed and anxious compared to people without SCCs. Furthermore, we found a relationship between depressive symptoms, anxiety and CR: PwPD with SCCs may rely on cognitive reserve to better cope with the feeling of anxiety and depression, especially in male gender. Full article

Background/Objectives: Despite medical advances, stigma remains a major challenge for people living with HIV (PLWH). This study examined clinical, sociodemographic, and psychological predictors of HIV-related stigma, and explored whether affective temperament moderates the impact of depression on stigma. Methods: This cross-sectional observational study included 97 PLWH attending a tertiary infectious disease unit in Rome, Italy. Participants completed a battery of validated psychometric instruments assessing depressive symptoms, anxiety, manic symptoms, mixed affective states, general psychopathology, impulsivity, and affective temperament. HIV-related stigma was evaluated using the Berger HIV Stigma Scale, which measures personalized stigma, disclosure concerns, negative self-image, and concerns with public attitudes. Descriptive statistics were used to characterize the sample. Univariate linear regressions were conducted to explore associations between clinical, psychometric, and sociodemographic variables and each stigma subdimension, as well as the total stigma score. Variables significant at p < 0.05 were included in five multivariate linear regression models. Moderation analyses were subsequently performed to assess whether affective temperaments moderated the relationship between significant psychopathological predictors and stigma. Bonferroni correction was applied where appropriate. Results: Higher depressive symptom scores are significantly associated with greater internalized stigma (B = 0.902, p = 0.006) and total stigma (B = 2.603, p = 0.008). Furthermore, moderation analyses showed that anxious temperament significantly intensified the relationship between depressive symptoms and both negative self-image (interaction term B = 0.125, p = 0.001) and total stigma (B = 0.336, p = 0.002). Conclusions: Depressive symptoms and anxious temperament are associated with HIV-related stigma. Integrating psychological screening and targeted interventions for mood and temperament vulnerabilities may help reduce stigma burden in PLWH and improve psychosocial outcomes. Full article