Search Results (585)

Postoperative cardiovascular complications remain a leading cause of morbidity and mortality after noncardiac surgery, yet current risk models do not incorporate psychosocial stress. With over 300 million noncardiac surgeries performed annually worldwide and a substantial burden of perioperative cardiovascular complications, preoperative chronic stress is increasingly recognized as a potentially modifiable risk factor. Chronic stress produces HPA axis dysregulation, glucocorticoid resistance, sympathetic activation, inflammation, endothelial dysfunction, and hypercoagulability. These pathways overlap with the mechanisms underlying perioperative myocardial injury, arrhythmogenesis, and venous thromboembolism. Prospective data demonstrated that preoperative psychological distress independently predicted 30-day cardiovascular complications and 1-year mortality after noncardiac surgery. Allostatic load studies in noncardiac surgery patients showed that high preoperative physiological burden was associated with up to twofold increases in postoperative mortality and elevated rates of myocardial infarction and venous thromboembolism. Epidemiological evidence further supports that anxiety and depression independently increase cardiovascular risk. Converging evidence suggests that preoperative psychological distress is a relevant perioperative cardiovascular risk factor. However, no randomized controlled trial has evaluated whether targeted preoperative stress reduction can decrease postoperative cardiovascular events, representing a critical gap warranting prospective investigation. Full article

Women with endometriosis experience chronic cyclic pelvic pain (CCPP) or chronic persistent pelvic pain (CPPP), both of which may be incapacitating even after treatment. Emotional dysregulation in endometriosis impedes patient recovery. This study evaluated the relationships among emotional state, pain perception, and inflammatory biomarkers (IL-1β, IL-6, and TNF-α) in women with endometriosis presenting with CCPP or CPPP. An exploratory, observational, descriptive, cross-sectional, comparative with repeated sampling study was conducted with 52 women diagnosed with endometriosis and experiencing either CPPP or CCPP. Participants completed a psychometric battery including the State-Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI-II), Goldberg General Health Questionnaire (GHQ-30), Hospital Anxiety and Depression Scale (HADS), and Mini-Mental State Examination (MMSE). Pain perception was assessed using the Wong–Baker Pain Rating Scale (FACES). Saliva samples were collected at baseline, during stressor and recovery phases, and concentrations of IL-1β, IL-6, and TNF-α were determined by ELISA. Fifty-two women with endometriosis were included (CPPP: n = 33; CCPP: n = 19). No significant between group differences were observed in emotional state (HADS: p = 0.682; BDI: p = 0.842), anxiety (STAI-State: p = 0.086; STAI-Trait: p = 0.615), general distress (GHQ-30: p = 0.730), or pain intensity (FACES: p = 0.705). The prevalence of depressive symptoms did not differ between groups (CPPP: 69.7% vs. CCPP: 73.7%; χ² = 0.093, p = 0.760). Salivary cytokine levels (IL-1β, IL-6, TNF-α) were comparable between groups across all measurement conditions. Spearman correlations revealed uncorrected significance between TNF-α and emotional distress: basal TNF-α correlated inversely with HADS (ρ = −0.292, p = 0.031) and BDI (ρ = −0.278, p = 0.041); TNF-α under stress correlated with HADS (ρ = −0.329, p = 0.014) and GHQ-30 (ρ = −0.271, p = 0.046); and TNF-α during recovery correlated with GHQ-30 (ρ = −0.363, p = 0.006). These findings indicate that CPPP and CCPP were not associated with statistically significant differences in emotional states or salivary cytokine profiles at the group level. Exploratory pos hoc analyses suggested that pain pattern may moderate the association between TNF-α and psychological burden, particularly in the CCPP subgroup; however, these findings require confirmation in larger studies with prespecified analyses. Exploratory analyses suggested patterns between salivary inflammation and psychological burden; however, these findings should be interpreted cautiously because of the small subgroup size, multiple comparisons, and lack of a matched healthy control group. Full article

Background and Objectives: Glaucoma is a group of conditions of the eye that can damage the optic nerve, leading to optic neuropathy. Nevertheless, due to its chronic characteristics, it could also be the background for psychoneurotic disorders based on the psychological and emotional stress that it causes. The presented study aimed to examine the characteristics and the occurrence of obsessionality and hysteria, as well as Open-Angle Glaucoma (OAG) in glaucoma patients. Materials and Methods: A cross-sectional study was conducted in the Clinic for Eye Diseases at the Clinical Hospital Center Osijek on 200 patients with different stages of OAG progression from December 2023 to December 2024. A Crown–Crisp Experiential Index (CCEI) was used to observe the influence of different degrees of OAG damage on the severity of obsessionality and hysteria. Results: The obsessionality score was higher in women than in men (Mann–Whitney U test, p < 0.001). Multivariate logistic regression (stepwise method) indicated a significant model for predicting hysteria, consisting of one predictor: female sex (odds ratio = 2.9). According to CCEI, using bivariate and multivariate logistic regression to predict obsessionality, no significant predictors or models were observed. Conclusions: The psychological toll of coping with glaucoma could exacerbate glaucoma. Further investigations are necessary to help us understand OAG personality traits and establish a stable methodology for extending appropriate care to glaucoma patients. Full article

Background/Objectives: Women working in the informal sector are frequently exposed to multiple layers of vulnerability and trauma, yet their mental health experiences remain insufficiently explored. Methods: This qualitative study examined the mental health implications of trauma experienced by female scrap collectors in Qumbu, Eastern Cape. Guided by resilience theory, the study explored how these women navigate and cope with the challenges associated with their daily work. A total of 13 female scrap collectors were selected through convenience sampling and participated in semi-structured interviews. The data were analysed thematically. Results: The findings revealed that women engaged in scrap collection face perpetual insecurity and gendered vulnerability in informal workspaces, enduring public degradation with significant psychological consequences, experience persistent stress due to insufficient earnings and navigate informal relations with truck drivers that act as sites of economic exploitation and psychological insecurity. These experiences may contribute to chronic stress, fear, feelings of worthlessness and mental exhaustion, which significantly affect their psychological wellbeing. Conclusions: Based on these findings, the study recommends the implementation of targeted psychosocial support interventions, such as trauma-informed counselling and peer support groups, to enhance coping mechanisms and strengthen resilience. Furthermore, a multidisciplinary facilitative healthcare approach and advocacy efforts aimed at addressing the mental health needs of female scrap collectors are essential for strengthening their agency, promoting psychosocial wellbeing and reducing their exposure to harm within the informal working environment. Full article

Background: Chronic obstructive pulmonary disease (COPD) is frequently accompanied by psychological distress, but the relationship between GOLD stage, dyspnea, functional limitation, and depression/anxiety symptoms remains incompletely defined. This study examined clinical and psychological profiles across GOLD stages, with particular attention to GOLD stages 3 and 4. Methods: This multicenter observational study included 285 adults with spirometry-confirmed COPD evaluated in Romania between 2023 and 2026. COPD severity was classified according to GOLD stages. Clinical assessment included FEV1, peripheral oxygen saturation, smoking exposure, the COPD Assessment Test (CAT), and the modified Medical Research Council dyspnea scale (mMRC). Psychological and well-being measures included DASS depression, anxiety, and stress scores; WHO-5; major depressive disorder score, and generalized anxiety disorder score. Descriptive analyses were performed across GOLD stages, and GOLD 3 was directly compared with GOLD 4. Results: GOLD 3 was the largest subgroup (n = 106, 37.2%), followed by GOLD 4 (n = 81, 28.4%), GOLD 2 (n = 69, 24.2%), and GOLD 1 (n = 29, 10.2%). GOLD 3 patients showed marked dyspnea and symptom burden, with mean mMRC = 2.92 and CAT = 24.44. DASS depression, anxiety, and stress scores were higher in GOLD 3 than GOLD 2, but did not increase further in GOLD 4. Direct GOLD 3 versus GOLD 4 comparisons showed no significant differences in DASS depression or DASS anxiety, whereas GOLD 4 had a significantly higher mMRC, major depressive disorder score, and generalized anxiety disorder score. Conclusions: GOLD 3 COPD was associated with substantial dyspnea, functional limitation, and measurable psychological distress. However, depression and anxiety patterns varied by instrument, suggesting that psychological burden in COPD is multidimensional and not explained by spirometric severity alone. Full article

Background/Objectives: Occupational burnout remains a major concern among healthcare professionals and is closely linked to chronic workplace stress. Exposure to patient death may represent a death-related psychosocial occupational burden that is emotionally and existentially demanding but still insufficiently examined in relation to burnout. This study aimed to examine associations between exposure-related burden of patient death, death anxiety, and occupational burnout among healthcare professionals, and to explore whether the observed pattern of results was consistent with an indirect statistical association involving death anxiety. Associations between coping strategies, burnout, and death anxiety were also examined. Methods: The study included 60 healthcare professionals representing various healthcare occupations. Data were collected using an anonymous online survey comprising a preliminary author-developed measure of exposure-related burden of patient death, a brief preliminary author-developed measure of death anxiety, the Burnout Assessment Tool (BAT-PL), and the Brief COPE inventory. Statistical analyses included descriptive statistics, Pearson correlation analyses, linear regression, and exploratory indirect effect analysis using Hayes’ PROCESS macro. Results: In the sample of 60 healthcare professionals, exposure-related burden of patient death was positively associated with occupational burnout (r = 0.53, 95% CI [0.32, 0.69], p < 0.001) and death anxiety (r = 0.30, 95% CI [0.05, 0.51], p = 0.022). Death anxiety was positively associated with occupational burnout (r = 0.54, 95% CI [0.33, 0.70], p < 0.001). The exploratory indirect effect analysis yielded a pattern of results consistent with an indirect statistical association involving death anxiety (B = 0.12, 95% CI [0.0001, 0.282]). The overall model accounted for 44.6% of the variance in occupational burnout (R² = 0.446). Avoidant coping strategies were associated with higher levels of death anxiety and burnout, whereas emotion-focused coping strategies were associated with lower levels of death anxiety. Conclusions: The findings suggest that death-related emotional and existential burden may be relevant to understanding occupational burnout among healthcare professionals. Death anxiety may be one psychological factor involved in this association. However, because of the cross-sectional design, small convenience sample, and use of preliminary author-developed measures, the results should be interpreted cautiously and should not be considered evidence of causal mechanisms. These findings highlight the need to consider death-related experiences in occupational burnout prevention and worker well-being strategies in healthcare settings. Full article

Background/Objectives: Lifestyle-related behaviors and chronic stress are key determinants of metabolic health, psychological well-being, and biological aging. Structured behavioral interventions that enhance self-awareness and self-regulation may promote sustained improvements across multiple health domains. This study aimed to evaluate the effects of a six-week Pythagorean Self-Awareness Intervention (PSAI) on dietary habits, anthropometric and psychological outcomes, and biomarkers of oxidative stress and telomere length in adults. Methods: This quasi-experimental pre–post intervention study included 30 apparently healthy adults. Participants underwent baseline assessments followed by a six-week Pythagorean Self-Awareness Intervention (PSAI) and were reassessed post-intervention. Outcomes included Mediterranean diet adherence (MedDiet Score), anthropometric and body composition measures, validated psychological questionnaires (PSS-14, DASS-21, RSES, HLPCQ, HLC, STAXI, SSGS, PSQI), cognitive performance (SDMT, CVLT-II, BVMT-R), serum oxidative stress and antioxidant capacity, and leukocyte telomere length (T/S ratio). Statistical analyses were performed using paired-samples Student t-tests or Wilcoxon signed-rank tests, with significance set at p < 0.05. Results: Significant improvements were observed in Mediterranean diet adherence (p = 0.001), along with reductions in body weight, BMI, waist and hip circumference, and intermuscular adipose tissue (all p < 0.05). Psychological outcomes improved significantly, including reduced perceived stress (PSS-14, p = 0.004) and depressive symptoms (DASS-21, p = 0.005), and improved self-esteem (RSES, p = 0.003) and sleep quality (PSQI, p < 0.001). Cognitive performance improved across all domains, including information processing speed, verbal learning, and visuospatial memory (all p < 0.05). Regarding biological markers, oxidative stress decreased (p = 0.023), and antioxidant capacity (p = 0.009), and leukocyte telomere length increased (p < 0.001), indicating improved redox balance and cellular aging profiles. Conclusions: The six-week Pythagorean Self-Awareness Intervention (PSAI) was associated with significant improvements in dietary habits, anthropometric and psychological outcomes, cognitive performance, and biomarkers of oxidative stress and telomere length. These findings suggest that participation in a structured self-awareness-based intervention was associated with multidomain improvements in this cohort. However, given the quasi-experimental design without a control group, these findings should be considered preliminary and require confirmation in adequately powered randomized controlled trials. Full article

Background: Chronic psychological stress drives metastasis in triple-negative breast cancer (TNBC), yet the underlying mechanisms remain poorly understood and effective interventions are lacking. Stress-induced expansion of myeloid-derived suppressor cells (MDSCs) and subsequent immune remodeling play critical roles, with aberrant myeloid differentiation of hematopoietic stem and progenitor cells (HSPCs) serving as a major source of MDSCs. This study investigates whether epicatechin gallate (ECG) suppresses stress-driven TNBC growth and lung metastasis by regulating HSPC myeloid differentiation. Methods: A mouse model of chronic unpredictable mild stress (CUMS) followed by 4T1 tumor implantation was used to evaluate the anti-tumor effects of ECG. CETSA-WB, molecular docking, HSPC differentiation assays, and MDSC functional validation assays, along with immunohistochemistry, immunofluorescence, and flow cytometry, were performed to elucidate how ECG modulates glucocorticoid (GC)/glucocorticoid receptor (GR) signaling and HSPC differentiation. Results: ECG dose-dependently alleviated depressive-like behaviors, reduced serum corticosterone (Cort), and inhibited tumor growth and lung metastasis. Notably, ECG decreased lung metastatic foci by 76.9% relative to the CUMS group. Mechanistically, chronic stress activated GR and induced its nuclear translocation in HSPCs, promoting aberrant HSPC-to-MDSC differentiation. ECG directly bound GR, blocked its nuclear translocation, and suppressed the myeloid differentiation of HSPCs into MDSCs, which was accompanied by downregulation of S100A8/A9, fibronectin, and MMP-2, as well as increased CD8⁺ T cell infiltration. Supernatants from ECG-pretreated and differentiated HSPCs reversed Cort-induced epithelial–mesenchymal transition (EMT) in 4T1 cells. Conclusions: ECG acts as a natural GR signaling blocker that directly targets GR to block chronic stress-driven abnormal myeloid differentiation of HSPCs, thereby remodeling the pulmonary immune microenvironment, suppressing EMT, and reducing breast cancer lung metastasis. These findings identify ECG as a promising GR signaling blocker and a potential adjuvant therapy for cancer patients under high-stress conditions. Full article

Background/Objectives: Psoriasis is a chronic immune-mediated dermatosis with an important psychodermatologic burden, in which psychological stress, perceived disease impact, stigma, and attitudes toward mental health care may influence patient support needs. Although psychological and psychiatric interventions are increasingly discussed in dermatology, patient openness to different forms of supportive care, including music therapy, remains insufficiently characterized. This study aimed to characterize psychodermatologic burden and support-related attitudes among patients with psoriasis, with particular emphasis on openness to psychological counseling, psychiatric care, and music therapy-based support, and to explore the factors associated with these attitudes. Methods: In this single-center cross-sectional study, 102 adults with cutaneous or nail psoriasis completed an original self-administered questionnaire between July 2023 and January 2025. Results: Most participants perceived stress as related to psoriasis onset or worsening (86.3%) and considered dermatologist guidance toward psychological or psychiatric support beneficial (80.4%). Psychological counseling was the most accepted supportive intervention (75.5%), followed by music therapy (54.9%) and psychiatric consultation (48.0%), while previous psychological or psychiatric care was reported by 22.5%. Willingness to seek psychological support was independently associated with perceived psoriasis impact, whereas willingness to seek psychiatric support was associated with perceived stress impact. Awareness of music therapy was associated with higher educational level. Willingness to try music therapy was associated with high perceived stress impact, higher educational level, music listening, and awareness of music therapy. Conclusions: Patients with psoriasis frequently perceive stress as relevant to their disease and show variable openness to supportive care. These findings support an individualized psychodermatologic approach in which dermatologists may help identify patients receptive to psychological, psychiatric, or music therapy-based interventions. Full article

Introduction: Suicide rates among individuals working in agriculture remain disproportionately high in the United States. Although farming-related stressors and coping strategies are documented, gaps remain in understanding how farmers sustain themselves psychologically amid chronic stress and why elevated suicide risk persists despite apparent resilience. Purpose: This study sought to explore the major stressors of farming, coping strategies used by farmers, and their barriers to help-seeking, with the goal of informing suicide prevention and mental health interventions. Methods: Fourteen semi-structured interviews were conducted with Kentucky farmers recently receiving a suicide prevention intervention. Participants were purposively sampled and interviewed via telephone or Zoom. Interviews were transcribed, modified verbatim, and then analyzed using reflexive thematic analysis. Results: Farmers described chronic stressors, including financial volatility, time scarcity, uncontrollable weather, loneliness, and feeling misunderstood or undervalued by the general public. Despite these stressors, many participants initially denied being stressed. Their coping strategies centered on meaning-making rather than stress elimination, including faith, gratitude, nature-based reflection, occupational pride, and community ties. However, prominent barriers to help-seeking included stigma, self-reliance, and privacy concerns. Conclusions: The findings suggest that farmer resilience is primarily enacted through their resourcefulness, including enduring stressors and reframing their thoughts, which enabled their continued functioning despite chronic stress. However, their resourcefulness often obscures their distress and delays help-seeking. These findings may help explain why elevated suicide risk persists among farmers even with strong coping narratives. Interventions that leverage existing strengths while addressing stigma, trust, and structural stressors are needed to better support farmer mental health and suicide prevention. Full article

Psychological stress arises when individuals perceive demands as exceeding their capacity to cope. Social stress can be acute, such as giving a presentation, producing transient increases in heart rate, blood pressure, and neuroendocrine activation, or chronic, in which stressors persist over extended periods. Chronic psychosocial stress disrupts immune homeostasis and contributes to anxiety, depression, and post-traumatic stress, while also increasing risk for infections, inflammatory and autoimmune diseases, cardiovascular disease, metabolic dysfunction, and cancer. Persistent stress engages interconnected neuroendocrine–immune networks, including the hypothalamic–pituitary–adrenal axis, the sympathetic–adrenomedullary system, and the gut microbiota–brain–immune axis, leading to sustained glucocorticoid and catecholamine signaling, gut dysbiosis, impaired barrier integrity, and altered microbial metabolite profiles. In this review, we summarize the molecular and cellular mechanisms by which these axes remodel innate and adaptive immunity and shape disease susceptibility. Using social defeat and social isolation in mice as model systems, we highlight how chronic social stress reprograms immune responses in key tissues, including the lung, brain, and gut. Full article

Lipedema is a chronic disorder characterized by the abnormal and disproportionate accumulation of painful subcutaneous adipose fat, primarily affecting the lower limbs and occurring almost exclusively in women. The aim of this controlled cross-sectional study was to compare body image, psychological distress, and psychological well-being in women with (n = 77) and without lipedema (n = 32). Psychological functioning was assessed using validated measures of depressive symptoms (PHQ-9), eating attitudes (EAT-26), perceived stress (PSS), medically unexplained symptoms (M.U.S.), psychological well-being (WHO-5), life satisfaction (SWLS), psychological flexibility (AAQ-II), pain intensity (VAS), together with measures of body image, lifetime psychological burden, maladaptive cognitive beliefs, symptom severity, and anthropometric parameters. Compared with controls, women with lipedema reported significantly greater body image dissatisfaction, perceived distress, M.U.S., depressive symptoms, disordered eating attitudes, and pain, together with lower psychological well-being, life satisfaction, and psychological flexibility (all p < 0.001). Within the lipedema group, PHQ-9 scores were significantly predicted by M.U.S. scores, maladaptive cognitions, and pain intensity (VAS), whereas EAT-26 scores were predicted by PHQ-9 scores and maladaptive cognitions. These findings indicate that lipedema is associated with a substantial psychological burden and support integrating psychological assessment and intervention into multidisciplinary care. Full article

This pilot study examined longitudinal changes in psychological distress and biomarkers related to stress, inflammation, and biological aging during the first inpatient rehabilitation after Spinal Cord Injury (SCI). We analyzed data from 120 participants in the SwiSCI inception cohort at two timepoints: the beginning of the first post-injury rehabilitation and discharge. A subset of 50 participants representing four distress patterns (high chronic, low, transient, increasing distress) underwent biomarker analyses, including measurements of immune and inflammatory proteins and whole-blood transcriptomic profiling. The results showed that psychological distress, depression, and protein carbonyl content decreased significantly by discharge. In contrast, cortisol levels and telomere length showed no significant changes. Proteomic analyses revealed a broad downregulation of inflammatory proteins (e.g., IFN-γ, IL-10, LIF) at discharge, whereas transcriptomic profiles did not differ between timepoints. The high chronic distress group showed lower expression of six genes involved in adaptive immunity, neural development and apoptosis. Psychological distress was not linearly associated with global biomarker profiles. However, CXCL1 and IL-7 showed low-to-moderate correlations with depression and anxiety, respectively. This pilot study demonstrates the feasibility of integrating psychological and molecular data to investigate biological response following SCI. The findings are exploratory and need validation in larger studies with longer follow-up periods. Full article

Background: Prenatal maternal stress is increasingly recognized as a critical determinant of fetal programming, with potential consequences for early physical growth and neurodevelopment. Although a growing body of evidence links maternal psychological stress to adverse perinatal and developmental outcomes, most studies originate from high-income Western settings, rely predominantly on self-reported stress measures, and rarely incorporate biological stress markers. Evidence from post-Soviet regional contexts remains limited. Methods: A two-phase study was conducted in Tbilisi, Georgia. Phase I employed a cross-sectional observational design involving 398 pregnant women recruited from maternity homes and women’s consultations. Maternal psycho-emotional stress was assessed using a study-specific pregnancy stress questionnaire, and salivary cortisol was measured in a subsample of women reporting chronic stress (N = 95). Phase II used a prospective cohort design to follow infants born to stress-exposed mothers (N = 95) and non-stressed controls (N = 95) from birth to 12 months. Infant outcomes included anthropometric measurements evaluated using World Health Organization Child Growth Standards and neurodevelopmental screening using the Ages & Stages Questionnaires, Third Edition (ASQ-3), at 1–3, 5–7, and 11–13 months. Statistical analyses were made by SPSS 23.0. Results: Salivary cortisol assessment in the stress-exposed subsample provided supportive biological evidence of elevated stress levels but was not used for direct comparison with the control group. Children born to stress-exposed mothers showed significantly poorer physical growth and lower ASQ-3 scores across all developmental domains during the first year of life (all p < 0.05). Conclusions: This study provides novel evidence from an underrepresented regional context and supports early developmental surveillance and preventive strategies to improve maternal and child health outcomes. Full article

Background: Irritable bowel syndrome (IBS) is a chronic disorder of brain–gut interaction closely linked to psychological stress and highly prevalent among university student populations, yet data from Bahrain remain scarce. This study estimated the frequency of self-reported IBS-like symptoms among university students in Bahrain and examined their associations with sex, age, qualification level, body mass index (BMI), psychological stress, and lifestyle behaviors. Methods: A cross-sectional, online questionnaire-based survey was conducted among 310 students at the University of Bahrain in October 2021. A self-administered 16-item instrument, based on the Rome III symptom domains and used as a symptom-screening rather than a diagnostic tool (face validity only; no formal psychometric validation was performed), assessed sociodemographic characteristics, self-reported IBS-like symptoms, stress and anxiety, and lifestyle behaviors. Data were analyzed using chi-square tests and one-way ANOVA; effect sizes were quantified using Cramér’s V (chi-square) and partial eta-squared (η², ANOVA); the significance threshold was α = 0.05 (two-tailed). Results: Self-reported IBS-like symptoms were common: 52.9% (95% CI 47.3–58.4) reported recurrent abdominal pain, 58.1% (95% CI 52.5–63.4) abdominal bloating, and 80.3% (95% CI 75.5–84.4) reported interference with academic activities. Most participants perceived their mental state (84.8%) and examinations (73.2%) to worsen symptoms, yet only 48.7% correctly identified IBS. Exploratory subgroup analyses suggested differences by qualification level, with diploma-level students reporting higher rates of abdominal pain (p < 0.001; Cramér’s V = 0.22), bloating (p < 0.05; Cramér’s V = 0.13), and perceived psychological impact on symptom severity (p < 0.001; Cramér’s V = 0.19) compared with bachelor- and master-level counterparts. The substantial female over-representation (79%) precluded formal sex-based inference; all findings should be interpreted in this context. Conclusions: Self-reported IBS-like symptoms were commonly endorsed, and participants frequently perceived psychological stress to worsen symptoms. Diploma-level students may represent a previously unrecognized potentially at-risk subgroup warranting further investigation and, if confirmed, targeted stress-focused health-promotion strategies, particularly through brief psychoeducation modules integrated within diploma-program curricula, and dedicated prospective research. Future studies should incorporate validated Rome IV diagnostic criteria, multivariable regression modeling, and biomarker assessment to elucidate underlying brain–gut mechanisms. Full article