Search Results (210)

With the increasing competition in elite sports, pre-competition anxiety has become increasingly prevalent among high-level competitive athletes, and high levels of such anxiety may impair sports performance and threaten athletes’ psychological health. Traditional psychological interventions (e.g., cognitive-behavioral therapy) are often poorly accepted and costly; however, pre-competition anxiety in these athletes may be alleviated through multiple pathways of traditional mind–body exercises like Tai Chi. Yet, the psychological mechanism by which mind–body exercises such as Tai Chi training influence pre-competition anxiety remains insufficiently explored, particularly the chain-mediating effect of the “flow experience → mental toughness” pathway. This study thus aimed to investigate the impact of Tai Chi training on pre-competition anxiety in high-level competitive athletes and verify the chain-mediating role of the “flow experience → mental toughness” pathway, thereby providing a theoretical basis and practical reference for sports psychology interventions. Using a randomized controlled experimental design, 86 high-level competitive athletes were randomly divided into an experimental group (n = 43) and a control group (n = 43). The experimental group received standardized Tai Chi training for 8 weeks, while the control group maintained their regular training regimen. Data were collected at baseline, week 4, and week 8 of the intervention using the Competition State Anxiety Inventory-2 (CSAI-2), Flow State Scale-2 (FSS-2), and Sport Mental Toughness Questionnaire (SMTQ), and chain-mediating effects were tested via hierarchical regression analysis and the bootstrap method with 5000 resamples. The results indicated that Tai Chi training could reduce pre-competition anxiety levels (β = −0.30, p < 0.5), and both flow experience (β = 0.38, p < 0.5) and mental toughness (β = 0.21, p < 0.5) exerted significant mediating effects. The chain mediation model further revealed that Tai Chi training alleviated pre-competition anxiety by enhancing flow experience and improving mental toughness sequentially (β = 0.01, 95% CI [0.00, 0.03]), accounting for 78.9% of the total mediated effect. In conclusion, Tai Chi training is associated with reduced pre-competition anxiety in high-level competitive athletes, and this relationship is statistically mediated by the sequential pathway of flow experience and mental toughness. These findings offer a new theoretical basis and practical direction for mind–body interventions in sports psychology. It should be noted that future research could further optimize and refine the intervention protocol, and explore the underlying mechanism of mind–body interventions at the neurobiological level. Full article

Background/Objectives: Peripheral arterial disease (PAD) is a common yet often unrecognized complication in patients receiving peritoneal dialysis (PD). Considering that ankle–brachial index (ABI) can be difficult to interpret in this population, additional vascular biomarkers are needed. Selenoprotein P (SePP) is a major selenium transport protein with antioxidant and metabolic regulatory functions and may reflect vascular stress relevant to PAD. We investigated the association of circulating SePP levels with ABI-defined PAD in patients on PD. Methods: In this cross-sectional analysis of 98 patients on PD, ABI was assessed using an automated oscillometric device, and ABI < 0.9 was defined as ABI-defined PAD. Serum SePP levels were measured using enzyme-linked immunosorbent assay. Results: ABI-defined PAD was identified in 20 patients (20.4%). Compared with patients with normal ABI, those with ABI-defined PAD were older (p = 0.014) and had significantly higher prevalence of diabetes mellitus (p = 0.033), longer PD vintage (p = 0.036), higher fasting glucose (p = 0.005) and C-reactive protein (p = 0.003) levels, and lower SePP concentrations (p < 0.001). Low SePP level remained independently associated with ABI-defined PAD after multivariate adjustment (odds ratio 0.930, 95% confidence interval 0.771–0.997; p = 0.032) and consistently across reinforced bootstrap resampling. SePP correlated positively with ABI on the left (p = 0.001) and right (p = 0.002) sides. Conclusions: Among patients undergoing PD, a low serum SePP level was independently associated with ABI-defined PAD and positively associated with ABI, suggesting that SePP may serve as an associative biomarker reflecting vascular vulnerability rather than a diagnostic indicator in this population. Full article

Background/Objectives: Medical device-related pressure injury (MDRPI) is a significant patient safety issue associated with increased morbidity, prolonged hospitalization, and healthcare costs. Although evidence-based guidelines for MDRPI prevention exist, nurses’ prevention performance remains suboptimal, and the mechanisms linking workload to preventive practice remain insufficiently elucidated. Within a patient safety and quality improvement framework, this study aimed to examine whether occupational coping self-efficacy (OCSE) is statistically consistent with an indirect association linking nurses’ workload and MDRPI prevention performance across the nursing practice continuum. Methods: This descriptive correlational study used a mediation model with data from 181 registered nurses working in intensive care units, general wards, and integrated nursing care wards in South Korea. Workload, OCSE, and MDRPI prevention performance were measured using validated instruments. Mediation was tested using hierarchical regression and bootstrapped analysis (PROCESS macro Model 4, 5000 resamples), controlling for demographic and work-related variables. Results: Higher workload was associated with lower OCSE, while higher OCSE was associated with better MDRPI prevention performance. When OCSE was included in the model, the direct association between workload and prevention performance was no longer significant. Bootstrapping confirmed a significant indirect association through OCSE, consistent with a full mediation pattern. Conclusions: Nurses’ workload appears to be indirectly associated with MDRPI prevention performance through OCSE. These findings suggest that strengthening nurses’ coping self-efficacy, alongside organizational strategies, may be essential for sustainable MDRPI prevention and patient safety improvement. Full article

This study examines the tension between “substance” and “form” in standardized sustainability reporting within an emerging market context. Using 21,964 firm-year observations from Chinese A-share listed companies (2018–2023), we investigate whether the adoption of the Global Reporting Initiative (GRI) framework enhances substantive Environmental, Social, and Governance (ESG) and creates firm value. While baseline regressions suggest a positive link between GRI and ESG performance, rigorously applying Propensity Score Matching (PSM) reveals a critical nuance: the effect of mere framework adoption attenuates after controlling for selection bias, whereas independent assurance remains a robust driver of substantive governance quality. Furthermore, mediation analysis using bootstrap resampling documents a distinct “Labeling Effect”: GRI adoption directly enhances market valuation (Tobin’s Q), yet the indirect path via ESG scores is statistically insignificant. This indicates that investors utilize GRI as a heuristic signal of legitimacy rather than pricing granular performance metrics. We also identify a “Valuation Latency”, where substantive ESG improvements significantly boost operational profitability (ROA) but are not yet fully incorporated into stock prices. Heterogeneity analysis shows these effects are stronger for non-state-owned enterprises (Non-SOEs), supporting the view that private firms leverage standardized reporting and verification to mitigate legitimacy deficits. These findings provide empirical evidence for regulators and investors to distinguish between the “label” of adoption and the “substance” of verification. Full article

Background: Left ventricular systolic dysfunction (LVSD) is a major determinant of prognosis in patients with ischemic heart disease. Electrocardiography (ECG) is widely available, inexpensive, and may aid in identifying patients at risk. We hypothesized that a composite score derived from multiple established ECG markers could improve the detection of LVSD in patients with stable angina. Methods: In this single-center, cross-sectional study, 177 patients undergoing elective coronary angiography for stable angina were included. Patients were classified as LVSD-negative (n = 123) or LVSD-positive (n = 54) based on echocardiographic ejection fraction. ECG parameters, including fragmented QRS, pathologic Q waves, R-wave peak time, QRS duration, and frontal QRS–T angle, were assessed. Independent predictors of LVSD were identified using multivariate logistic regression. A composite ECG score was constructed by assigning one point to each abnormal parameter. Model robustness was evaluated using bootstrap resampling (1000 iterations) and 10-fold cross-validation. Results: Multivariable analysis identified prior stent implantation, fragmented QRS, pathological Q waves, R-wave peak time, frontal QRS–T angle (log-transformed), and QRS duration as independent predictors of LVSD. ROC analysis demonstrated good discriminatory performance for R-wave peak time (AUC 0.804), QRS duration (AUC 0.649), and frontal QRS–T angle (AUC 0.825) measurements. The composite ECG score showed a stepwise association with LVSD: a score of ≥2 yielded high sensitivity (88%) and negative predictive value (97%), whereas a score of ≥3 provided high specificity (100%) and positive predictive value (100%). Bootstrap resampling and cross-validation confirmed model stability and strong discriminatory performance (mean AUC, 0.964; accuracy, 0.91). Conclusions: A simple composite ECG score integrating multiple established ECG markers is associated with the robust detection of LVSD in patients with stable angina. Although not a substitute for echocardiography, this score may support early risk stratification and help identify patients who warrant further imaging evaluations. External validation in larger and more diverse populations is required before routine clinical implementation of this model. Full article

This study re-evaluates ROC-AUC for binary classification under severe class imbalance (<3% positives). Despite its widespread use, ROC-AUC can mask operationally salient differences among classifiers when the costs of false positives and false negatives are asymmetric. Using three benchmarks, credit-card fraud detection (0.17%), yeast protein localization (1.35%), and ozone level detection (2.9%), we compare ROC-AUC with Matthews Correlation Coefficient, F2-score, H-measure, and PR-AUC. Our empirical analyses span 20 classifier–sampler configurations per dataset, combined with four classifiers (Logistic Regression, Random Forest, XGBoost, and CatBoost) and four oversampling methods plus a no-resampling baseline (no resampling, SMOTE, Borderline-SMOTE, SVM-SMOTE, ADASYN). ROC-AUC exhibits pronounced ceiling effects, yielding high scores even for underperforming models. In contrast, MCC and F2 align more closely with deployment-relevant costs and achieve the highest Kendall’s τ rank concordance across datasets; PR-AUC provides threshold-independent ranking, and H-measure integrates cost sensitivity. We quantify uncertainty and differences using stratified bootstrap confidence intervals, DeLong’s test for ROC-AUC, and Friedman–Nemenyi critical-difference diagrams, which collectively underscore the limited discriminative value of ROC-AUC in rare-event settings. The findings recommend a shift to a multi-metric evaluation framework: ROC-AUC should not be used as the primary metric in ultra-imbalanced settings; instead, MCC and F₂ are recommended as primary indicators, supplemented by PR-AUC and H-measure where ranking granularity and principled cost integration are required. This evidence encourages researchers and practitioners to move beyond sole reliance on ROC-AUC when evaluating classifiers in highly imbalanced data. Full article

The development of cross-border hydrogen energy value chains involves complex interactions between technological, regulatory, and logistical subsystems. Static assessment models often fail to capture the dynamic response of these coupled systems to external perturbations. This study addresses this gap by proposing the Dual Carbon Cooperation Index (DCCI), a data-driven framework designed to quantify the synergy efficiency of the China–Korea hydrogen ecosystem. We construct a dynamic state estimation model integrating three coupled dimensions—Technology Synergy, Regulatory Alignment, and Supply Chain Resilience—utilizing an adaptive weighting algorithm (Triple Dynamic Response). Based on multi-source heterogeneous data (2020–2024), the model employs Natural Language Processing (NLP) for vectorizing unstructured regulatory texts and incorporates an exogenous signal detection mechanism (GPR). Empirical results reveal that the ecosystem’s composite synergy score recovered from 0.38 to 0.50, driven by robust supply chain resilience but constrained by high impedance in technological transfer protocols. Crucially, the novel dynamic weighting algorithm significantly reduces state estimation error during high-volatility periods compared to static linear models, as validated by bootstrapping analysis (1000 resamples). The study provides a quantitative engineering tool for monitoring ecosystem coupling stability and proposes a technical roadmap for reducing system constraints through secure IP data architectures and synchronized standard protocols. Full article

Background: Rotating and night-including shifts disrupt circadian alignment, impair sleep, and may reduce nurses’ physiological recovery. Objectives: This study aimed (1) to compare sleep quality and physical well-being across four shift schedules among hospital nurses and (2) to examine whether the association between rotating shifts and physical well-being was statistically consistent with an indirect association via sleep quality. Methods: In this cross-sectional study, 173 nurses from a tertiary hospital in Zagreb, Croatia, completed validated measures of sleep quality and physical well-being. Four shift patterns were analyzed—fixed morning, morning–afternoon, extended 12-h, and rotating three-shift—using Welch ANOVA and regression models. A bootstrapped mediation analysis (10,000 resamples; BCa method), interpreted as a statistical decomposition, estimated an indirect association consistent with sleep quality. Results: Rotating-shift nurses reported the poorest sleep (PSQI = 10.2 ± 2.6; p = 0.003). Physical well-being did not differ significantly across shift types (p = 0.08), although rotating-shift nurses had the lowest mean physical scores (24.3 ± 4.4). The rotating-shift subgroup was small (n = 16), limiting precision. The mediation analysis was statistically consistent with an indirect association between rotating shifts and physical well-being via sleep quality (ACME = −1.85, 95% CI −3.05 to −0.88; p < 0.001), while the proportion of the total association was imprecisely estimated. Conclusions: In this single-site cross-sectional sample, rotating night shifts were associated with poorer sleep and, on average, lower physical well-being; patterns were statistically consistent with an indirect association via sleep quality. Because exposure, mediator, and outcome were measured concurrently, these findings are hypothesis-generating and do not establish causality. Full article

Physical activity often remains low after hospitalisation for acute exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD). Although post-hospitalisation rehabilitation has shown to support recovery, its impact on daily activity levels in the early post-exacerbation phase is unclear. This study describes the changes in physical activity (PA) and clinical outcomes during an 8-week rehabilitation following hospitalisation for AECOPD. This prospective observational cohort study included patients recently discharged after AECOPD from Aalborg University Hospital, Denmark. Participants received municipality-delivered post-hospitalisation rehabilitation consisting of tailored physiotherapy and occupational therapy of individually determined frequency. PA was assessed using thigh-worn triaxial accelerometers measuring 24 h/day over 8 weeks. Clinical outcomes included lung function (FEV1% predicted), dyspnoea scores, health-related quality of life (EuroQol 5-dimension, 5-level (EQ-5D-5L); EuroQol visual analogue scale (EQ-VAS)), frailty (Clinical Frailty Scale (CFS)), functional status (Short Physical Performance Battery (SPPB)), and symptom burden (COPD Assessment Test (CAT); St. George’s Respiratory Questionnaire (SGRQ)). Changes from baseline to 8 weeks were analysed using linear mixed-effects models and bootstrap resampling. Forty-three participants with a mean age 73.4 years, 67.4% female, and moderate frailty (CFS 5.4 ± 1.3) were included. Physical activity remained largely unchanged. Gait speed and total SPPB declined, whereas self-perceived health improved (EQ-VAS Δ +7.8, p = 0.008). Lung function, dyspnoea, and health related quality of life scores showed no significant change. In this frail, recently admitted COPD population, physical activity did not increase during the rehabilitation period, and some functional parameters declined. The improvement in self-perceived health suggests a divergence between subjective and objective outcomes. These findings highlight the need for long-term, tailored, and flexible approaches to support recovery after AECOPD. Full article

Background: Chinese adolescents face a dual burden of malnutrition, yet the weight-status-specific mechanisms underlying physical activity (PA) participation remain underexplored. Methods: We conducted a cross-sectional study among 1573 adolescents (aged 9–15 years) in Shangrao City, China. Validated scales measured social-ecological factors (family/peer support, physical environment), psychological factors (stage of change, self-efficacy, decisional balance), and PA participation. Data preprocessing utilized full information maximum likelihood to handle missing values. Confirmatory factor analysis was performed to validate the measurement model, followed by multi-group structural equation modeling to analyze pathway configurations across underweight (n = 187), normal-weight (n = 1070), and overweight/obese (n = 316) groups. Mediation effects were tested using bootstrapping with 5000 resamples. Results: Clear weight-specific patterns emerged. Normal-weight adolescents presented a fully functional comprehensive model where PA was predicted by the stage of change (β = 0.211, p < 0.001), friend support (β = 0.120, p < 0.001), self-efficacy (β = 0.092, p < 0.05), and perceived benefits (β = 0.095, p < 0.01). Underweight adolescents primarily relied on internal readiness driven by stage of change (β = 0.270, p < 0.001) and self-efficacy (β = 0.164, p < 0.05), with family support only indirectly influencing participation via psychological mediators. In contrast, overweight/obese adolescents showed a “socially dependent” pattern: friend support directly predicted PA levels (β = 0.136, p < 0.05), significantly enhanced self-efficacy (β = 0.370, p < 0.01), and effectively lowered perceived barriers (β = −0.165, p < 0.05). Additionally, the physical environment strongly impacted perceived benefits (β = 0.471, p < 0.01) but did not translate into action. Conclusions: These findings underscore the significant differences in PA determinants across the spectrum of malnutrition, necessitating targeted public health interventions to support the Healthy China 2030 initiative. Full article

Background/Objectives: Personal values shape appraisal of stress and life satisfaction. We examined the relationship between perceived stress and life satisfaction among uniformed personnel in outpatient mental health care, and the role of a personal values hierarchy in this context. Methods: Cross-sectional study of 183 uniformed personnel (34 females, 149 males, age 30–66 years, M = 44.72, SD = 5.84) diagnosed with bodily distress disorder or post-traumatic stress disorder at a mental health clinic. Participants completed standardized questionnaires assessing perceived stress, satisfaction with life, coping styles, and personal values. For the Personal Value List, each value not selected by a participant was coded as 0 to avoid missing data; scores regarding symbols of happiness were not used. Reliability was evaluated via repeated measurement; two parts of a key instrument showed test–retest correlations of approximately 0.78 and 0.76. For assessing statistical significance, the bootstrap method was used (1000 resamples). Analyses were conducted in jamovi 2.3.28 using snowLatent (latent profile analysis) and medmod 1.1.0 (moderation analysis). Results: Perceived stress was negatively associated with satisfaction with life (B = −0.36, 95% CI [−0.48; −0.24], p < 0.001). Latent profile analysis extracted two personal values hierarchy profiles (AIC = 4237; BIC = 4587). Profile membership was not a significant predictor of satisfaction with life (p = 0.595) and did not moderate the relationship between perceived stress and satisfaction with life (p = 0.907). Distraction seeking was significantly higher in profile 1 (p = 0.010). Conclusions: In treated uniformed personnel, higher perceived stress is linked to lower life satisfaction. The personal values hierarchy did not moderate this relationship and was not associated with satisfaction with life; however, the personal values hierarchy was related to coping, specifically distraction seeking. Full article

Objective: To investigate long-term prognosis and impact factors in children with vasovagal syncope (VVS) receiving metoprolol therapy. Methods: This retrospective study included children with VVS who underwent metoprolol therapy at the Pediatric Syncope Unit of Peking University First Hospital between January 2012 and November 2023. Baseline demographic data, pre-treatment indices, including head-up tilt test (HUTT) and 24 h Holter monitoring, were collected. All participants received standardized metoprolol therapy for a minimum duration of one month. Follow-up was conducted between June and July 2025, with syncope recurrence as the primary endpoint. Multivariable Cox proportional hazards regression analysis was performed to identify independent impact factors of prognosis and to construct a Prognostic Risk Score (PRS) model. The model’s performance was rigorously validated through receiver operating characteristic (ROC) curve analysis, decision curve analysis (DCA), and Bootstrap resampling (1000 iterations). Furthermore, children were stratified into high- and low-risk groups based on median PRS values. Kaplan–Meier survival analysis was then performed to assess the model’s discriminative efficacy. Results: This study included 97 children diagnosed with VVS. The median duration of metoprolol therapy was 2.5 months (interquartile range [IQR]: 2.0–3.0 months), with a median follow-up period of 59 months (IQR: 25.5–72 months). During follow-up, syncope recurrence was observed in 37 patients, while 60 patients remained symptom-free. COX regression analysis showed that time-domain indices of heart rate variability (HRV), including the standard deviation of all NN intervals (SDNN) and the triangular index (TR), as well as the frequency-domain index of HRV very low frequency (VLF), were relative factors of the long-term prognosis in children with VVS treated with metoprolol. Based on the above three identified factors, the PRS model was calculated as: PRS = 0.03 × SDNN − 0.02 × VLF − 0.1 × TR. ROC showed that the area under the curve (AUC) for discriminative power related to long-term prognosis was 0.808 (p < 0.01). The cumulative recurrence rate of symptoms in the high-risk score group was significantly higher than that in the low-risk score group (p < 0.01). The DCA curve demonstrated the clinical applicability of the model. Bootstrap internal verification indicated high stability, with the bias-corrected and accelerated (Bca) confidence interval (CI) of the C index ranging from 0.71 to 0.89. Conclusions: After metoprolol treatment, 38.1% of children with VVS experienced syncope recurrence during a median follow-up period of 59 months. Baseline HRV index, SDNN, TR, and VLF were identified as factors associated with the long-term prognosis of children with VVS treated with metoprolol. The PRS model based on the above indices demonstrated good value in linking to the individual long-term prognosis. Full article

Background/objectives: Psoriatic disease (PsD) encompasses psoriasis (PsO) and psoriatic arthritis (PsA) and is associated with heterogeneous cardiometabolic risk. Integrating immunogenetic markers such as HLA-Cw6 into data-driven analyses may refine phenotyping and uncover clinically meaningful endotypes. We aimed to identify cardiometabolic phenotypes across PsD, integrating HLA-Cw6 and exploring disease-specific heterogeneity and predictors of high-risk profiles. Methods: In a cross-sectional study of 572 PsD patients (401 PsO, 171 PsA), eight demographic and clinical variables, including HLA-Cw6, were entered into k-means clustering (k = 4). Cardiometabolic risk factors were profiled post hoc. Cluster validity was assessed by Gaussian Mixture Models and principal component analysis (PCA). Stratified analyses (k = 3) were conducted separately for PsO and PsA. Predictors of the high-risk phenotype were examined using bootstrap-resampled logistic regression. Results: Four cardiometabolic phenotypes were identified, ranging from younger patients with active PsO and low cardiometabolic burden to a small, high-risk subgroup (~6%) combining older age, universal cardiovascular disease, and a clustering of hypertension, diabetes, and dyslipidemia. Disease-stratified analyses showed that high-risk phenotypes were present in both PsO and PsA. In stratified analyses, HLA-Cw6 showed opposite associations—enriched in high-risk PsO (OR 2.0, 95% CI 1.3–3.1) but depleted in high-risk PsA (OR 0.24, 95% CI 0.11–0.52). Conclusions: Incorporating HLA-Cw6 into clustering identified reproducible cardiometabolic phenotypes with distinct genetic signatures. The inverse HLA-Cw6 risk patterns in PsO and PsA suggest disease-specific patterns that may have differing cardiometabolic implications, which should be tested in longitudinal studies. Full article

Background/Objectives: This paper presents the results of predicting chronological age from psychophysiological tests using machine learning regressors. Methods: Subjects completed a series of psychological tests measuring various cognitive functions, including reaction time and cognitive conflict, short-term memory, verbal functions, and color and spatial perception. The sample included 99 subjects, 68 percent of whom were men and 32 percent were women. Based on the test results, 43 features were generated. To determine the optimal feature selection method, several approaches were tested alongside the regression models using MAE, $R^2$, and $CV\text{\_}{R}^2$ metrics. SHAP and Permutation Importance (via Random Forest) delivered the best performance with 10 features. Features selected through Permutation Importance were used in subsequent analyses. To predict participants’ age from psychophysiological test results, we evaluated several regression models, including Random Forest, Extra Trees, Gradient Boosting, SVR, Linear Regression, LassoCV, RidgeCV, ElasticNetCV, AdaBoost, and Bagging. Model performance was compared using the determination coefficient ($R^2$) and mean absolute error (MAE). Cross-validated performance ($CV\text{\_}{R}^2$) was estimated via 5-fold cross-validation. To assess metric stability and uncertainty, bootstrapping (1000 resamples) was applied to the test set, yielding distributions of MAE and RMSE from which mean values and 95% confidence intervals were derived. Results: The study identified RidgeCV with winsorization and standardization as the best model for predicting cognitive age, achieving a mean absolute error of 5.7 years and an $R^2$ of 0.60. Feature importance was evaluated using SHAP values and permutation importance. SHAP analysis showed that stroop_time_color and stroop_var_attempt_time were the strongest predictors, followed by several task-timing features with moderate contributions. Permutation importance confirmed this ranking, with these two features causing the largest performance drop when permuted. Partial dependence plots further indicated clear positive relationships between these key features and predicted age. Correlation analysis stratified by sex revealed that most features were significantly associated with age, with stronger effects generally observed in men. Conclusions: Feature selection revealed Stroop timing measures and task-related metrics from math and campimetry tests as the strongest predictors, reflecting core cognitive processes linked to aging. The results underscore the value of careful outlier handling, feature selection, and interpretable regularized models for analyzing psychophysiological data. Future work should include longitudinal studies and integration with biological markers to further improve clinical relevance. Full article

Background/Objectives: Childhood trauma is a well-established risk factor for adult psychopathology, yet the underlying neuropsychiatric mechanisms remain unclear. Therefore, this study examined whether resilience mediates the relationship between childhood trauma and depressive and anxiety symptoms, and whether this pathway is moderated by harm avoidance (HA). Methods: A total of 218 Korean adults (aged 19–50 years; 79 men and 139 women) completed validated measures of childhood trauma (Childhood Trauma Questionnaire (CTQ)-Short Form), harm avoidance (Temperament and Character Inventory–Harm Avoidance subscale), resilience (Brief Resilience Scale), depression (Patient Health Questionnaire-9), and anxiety (Generalized Anxiety Disorder-7). Mediation and moderated mediation models were tested using structural equation modeling, and indirect effects were estimated via bootstrapping with 5000 resamples. Results: Childhood trauma was associated with lower resilience, an effect moderated by HA. Resilience was strongly inversely associated with depression and anxiety. Indirect effects of trauma through resilience were significant for both outcomes, with stronger effects at higher HA. Conclusions: The associations between childhood trauma and both depression and anxiety were mediated by resilience, and this indirect pathway was amplified by HA. These findings suggest a neuropsychiatric mechanism whereby early-life stress and temperament jointly shape effective neural vulnerability, leading to depression- and anxiety-associated outcomes. Full article