Search Results (7,817)

As smartphones become progressively embedded in students’ social, academic, and personal lives, concerns have been raised about the emotional consequences of nomophobia (no-mobile-phone phobia). Although previous research has shown an overall correlation between nomophobia and increased mental health symptoms, little is known about whether its main dimensions exerted differential associations with different mental health symptom dimensions or whether sleep quality can influence these relationships. Addressing these gaps, this research tested the associations between four dimensions of nomophobia—Not Being Able to Communicate (NBAC), Losing Connectedness (LC), Not Being Able to Access Information (NBAI), and Giving Up Convenience (GUC)—and three mental health symptoms: depression (Dprtn), anxiety (Enzt), and stress (Strs), while testing the moderating role of sleep quality (SQ) among university students. Drawing upon Conservation of Resources (COR) Theory and Self-Determination Theory (SDT), a quantitative cross-sectional survey was conducted among 980 university students. The proposed research model was analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM). The results demonstrated that the psychological consequences of nomophobia are dimension-specific rather than homogeneous. LC emerged as the most consistent predictor, showing significant positive associations with depression, anxiety, and stress. In contrast, NBAC was not significantly associated with any of the three mental health outcomes. NBAI showed mixed effects, with a significant positive association with depression, a significant negative association with anxiety, and no significant association with stress. GUC was significantly and positively associated with depression, anxiety, and stress. Furthermore, sleep quality functioned as a selective moderator, with significant interaction effects for SQ × NBAC on depression and anxiety, SQ × NBAI on depression, and SQ × GUC on depression and stress. No significant moderation effects were observed for the remaining hypothesized interactions. These findings highlight the dimension-specific nature of nomophobia and indicate that the role of sleep quality varies across the specific nomophobia dimension and the mental health outcome considered. Full article

The COVID-19 pandemic affected adolescent mental health. However, the concurrent associations among adolescents’ preventive practices, parent–child conflict, and depressive symptoms during the initial lockdown remain unclear. This cross-sectional study included 2558 adolescents (48.75% girls; M age = 13.06 years) from Zhengzhou, China, of whom 2543 were included in the analytic sample after cases missing age or class identifiers were excluded. All focal constructs were assessed once by adolescent self-report. Latent moderated mediation analyses showed that preventive practices were directly and negatively associated with depressive symptoms. A significant indirect association was observed through parent–child conflict such that greater engagement in preventive practices co-occurred with less parent–child conflict and fewer depressive symptoms. The negative direct association between preventive practices and depressive symptoms was stronger for boys, whereas the positive association between parent–child conflict and depressive symptoms was stronger for girls. However, these interaction terms added only ΔR² = 0.003 and 0.004 in observed-score sensitivity models and were not statistically significant in the subsample sensitivity analysis. These findings identify parent–child conflict as a concurrent correlate of the association between preventive practices and depressive symptoms during the pandemic. Full article

Background: Neuropsychiatric symptoms (NPSs) are among the most clinically disruptive manifestations of major neurocognitive disorder (MND) and major contributors to caregiver distress. However, the differential contribution of specific neuropsychiatric domains to caregiver burden and sleep quality has remained insufficiently characterized. Methods: This single-center retrospective observational study included 164 patient–caregiver dyads. Patients were diagnosed with MND according to DSM-5 criteria. NPS were assessed using the Neuropsychiatric Inventory (NPI-Q). Caregiver burden and sleep quality were evaluated using the 12-item Zarit Burden Interview (ZBI-12) and the Pittsburgh Sleep Quality Index (PSQI), respectively. Beta and logistic regression models were applied to investigate associations between NPS severity and caregiver outcomes after adjustment for cognitive and functional status. Additional analyses explored the relative contribution of individual NPI-Q subdomains. Results: Greater overall NPS severity was significantly associated with both increased caregiver burden (β = 0.163, p < 0.001) and altered caregiver sleep quality (OR = 1.32, 95% CI: 1.12–1.59, p = 0.002). Clinically significant sleep disturbances (PSQI > 5) were observed in 61.6% of caregivers. Among NPS, delusions showed the strongest association with caregiver burden (β = 0.329, p < 0.001), followed by depressive symptoms (β = 0.156, p = 0.004) and irritability (β = 0.147, p = 0.005); furthermore, sleep and night-time behavior disorders emerged as the strongest contributors to altered caregiver sleep quality (p < 0.001). Conclusions: Greater NPS severity may be associated with increased caregiver burden and poorer sleep quality in caregivers of patients with MND. Different NPSs appear to be differentially associated with caregiver outcomes, despite the lack of caregiver-level covariates, supporting the need for multidimensional and caregiver-centered approaches in dementia care. Given the exploratory nature of these analyses, these findings should be interpreted as descriptive rather than confirmatory. Full article

Background/Objectives: Obsessive–compulsive disorder (OCD) is a chronic and disabling condition. Despite first-line treatment with cognitive behavioral therapy (CBT) including exposure and response prevention (ERP) and selective serotonin reuptake inhibitors (SSRIs), many patients remain severely symptomatic. This highlights the need for further research into innovative multimodal treatment strategies for OCD. We report two inpatients with severe OCD, comorbid depressive symptoms, and insufficient response to previous pharmacological and psychotherapeutic treatments. Methods: Both patients completed 30 multimodal treatment units over six weeks consisting of sequential multi-target repetitive transcranial magnetic stimulation (rTMS) targeting the left dorsolateral prefrontal cortex (DLPFC), right DLPFC, and supplementary motor area (SMA), combined with a modified, largely self-administered, clinician-supervised exposure and response prevention protocol. Results: Both patients demonstrated large observed reductions in OCD symptom severity. Y-BOCS total scores decreased from 29 to 11 in Patient 1 and from 29 to 10 in Patient 2, corresponding to reductions of 62.1% and 65.5%, respectively, with improvements apparent after approximately four weeks and largely maintained at follow-up. Depressive symptoms also improved, and no clinically relevant adverse effects were observed. Conclusions: These cases provide an initial description of the feasibility and tolerability of this specific protocol architecture but do not establish efficacy, long-term durability, or the contribution of individual components. The protocol-level novelty lies in integrating a repeated three-target TBS schedule with a response-limited, cue-terminated exposure procedure, a combination not previously described in the OCD neuromodulation literature. Full article

The ongoing overdose crisis has created a widespread but understudied population of bereaved individuals at elevated risk for adverse mental health outcomes. This study examines cognitive, emotional, and interpersonal factors associated with symptom severity of prolonged grief disorder (PGD), major depressive disorder (MDD), generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD) among 115 adults who lost a loved one to drug overdose. Participants completed an online survey assessing continuing bonds, centrality of the death event, integration of the loss, unfinished business, resilience, and social support. Multivariable linear regression was used to estimate associations between these factors and severity of mental health outcomes, adjusting for relevant covariates. Results indicated that greater centrality of the death event was consistently associated with higher PGD, MDD, and GAD symptoms, while unfinished business, particularly surrounding unfulfilled wishes, was associated with higher MDD and PTSD symptoms. Continuing bonds were also linked to higher PGD and GAD symptoms. In contrast, greater integration of the loss and higher resilience were associated with lower symptom severity across multiple outcomes, and greater social support was associated with lower depressive symptoms. Findings highlight the multidimensional nature of overdose bereavement and identify potentially modifiable factors that warrant further investigation in longitudinal and intervention research. Full article

Background/Objectives: Repetitive head impacts (RHI) from contact and collision sports have been associated with later-life cognitive and neurobehavioral impairments, as well as neurodegenerative conditions such as chronic traumatic encephalopathy (CTE). RHI-associated clinical sequelae among female former soccer players, specifically, are not well understood. This cross-sectional study aimed to examine the relationship of RHI exposure proxies (e.g., total years of soccer play, concussion history, highest level of play, and estimated cumulative heading frequency) with clinical measures (e.g., subjective cognitive complaints, objective cognitive performance, behavioral dysregulation, and depressive symptoms) among 2732 women, aged 40 years or above, enrolled in the Head Impact and Trauma Surveillance Study (HITSS), all of whom formerly played organized soccer. Methods: HITSS participants completed an online battery that elicited self-reported cognitive and behavioral complaints and depressive symptoms and that assessed cognitive performance via computerized tests. Multivariable linear regression models estimated associations between soccer-related RHI proxies and outcome measures, adjusting for age and education. Results: Among the former soccer players, longer duration of soccer play, higher level of play, greater estimated cumulative heading frequency, and concussion history were significantly associated with worse self-reported cognitive functioning, greater behavioral dysregulation, and elevated depressive symptom severity. Apart from a single association between concussion history and visual learning and episodic memory performance, we found no other associations between RHI proxies and objective cognitive test performance. Conclusions: Among middle-aged women who played organized soccer, cumulative RHI exposure corresponded to a higher degree of subjective cognitive complaints, worse behavioral functioning, and more severe depressive symptoms. Continued monitoring of this large cohort of female former soccer players offers a more comprehensive understanding of long-term health consequences of soccer play. Full article

Background/Objectives: Low serum 25-hydroxyvitamin D [25(OH)D] has been proposed as a modifiable risk factor for depression, but the shape of the exposure–response relationship and its independence from sleep disturbance have not been characterised in a large occupational cohort with repeated measures. Methods: We analysed 246,751 health examinations of 62,989 Korean adults over 12 annual waves (2014–2025). Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CES-D) and sleep quality with the Pittsburgh Sleep Quality Index (PSQI). Hierarchical linear and logistic regressions with cluster-robust standard errors (228,520 complete-case observations from 60,403 individuals) modelled serum 25-hydroxyvitamin D [25(OH)D], both continuously and categorically; restricted cubic splines tested non-linearity, and a random-intercept model estimated the intraclass correlation coefficient (ICC). Results: Mean 25(OH)D was 21.08 ± 8.71 ng/mL; 51.3% were deficient (<20 ng/mL) and 10.5% scored CES-D ≥ 16. The exposure–response relationship was non-linear (p = 0.001 for non-linearity). Relative to sufficiency (≥30 ng/mL), only severe deficiency (<10 ng/mL) was independently associated with depression (adjusted odds ratio [OR] 1.20, 95% confidence interval [CI] 1.09–1.32); deficiency (OR 1.05) and insufficiency (OR 1.02) were not. The per-1 ng/mL association was small (OR 0.996, 95% CI 0.993–0.999). PSQI score was the dominant predictor (OR 1.372 per point). The ICC was 0.743, and the within-person correlation (r = −0.008) was one-sixth of the between-person correlation (r = −0.046). Conclusions: The vitamin D–depression association is confined to severe deficiency rather than graded across the normal range, is small in absolute terms, and is substantially exceeded by that of sleep disturbance. Screening and repletion should target the severely deficient minority. Full article

Objectives: This study aimed to evaluate the prevalence of pathological anxiety and to identify clinical, functional, and surgical factors associated with anxiety disorders in adults who underwent hypospadias repair during childhood. Patients and Methods: This cross-sectional analysis included adult males (≥18 years) previously treated surgically for hypospadias in childhood who underwent clinical evaluation and completed validated questionnaires assessing anxiety (State–Trait Anxiety Inventory, STAI-Y1/Y2), depression (Beck Depression Inventory-II), urological function (uroflowmetry and International Prostate Symptom Score), sexual function, and genital perception. Pathological anxiety was defined as STAI-Y1 ≥ 40. Patients with and without anxiety were compared using univariate analyses, and variables reaching statistical significance were entered into a binary logistic regression model to identify clinical variables independently associated with anxiety. Results: A total of 302 patients who underwent hypospadias surgery between 1975 and 2005 were included in this study. Of the 302 traced patients, 113 (37.4%) were contacted successfully, and a total of 36 adult male patients met the inclusion criteria for this study (mean age at assessment 23.6 years). Pathological anxiety was present in 14 patients (38.9%). Compared with non-anxious individuals, anxious patients were younger at assessment (p = 0.012), showed more impaired voiding dynamics, with lower flow index values (p = 0.060), and reported more severe urinary symptoms (p = 0.050). Depressive symptoms were significantly higher in the anxiety group (BDI-II: 9.5 vs. 3.1; p < 0.001) and were independently associated with pathological anxiety on multivariable analysis (OR 1.84, 95% CI 1.16–2.92; p = 0.01). Postoperative complications were more frequent and more severe among anxious patients, although this did not reach statistical significance. Subjective and objective aesthetic outcomes did not differ between groups. Conclusions: This study demonstrates that anxiety in adults treated for hypospadias during childhood is more closely related to functional urinary impairment, surgical complications, and depressive symptoms than to aesthetic outcomes. These findings emphasise the need for long-term, multidisciplinary follow-up incorporating routine mental health assessment. Early psychological screening and targeted supportive interventions may be associated with better functional and psychosocial outcomes, supporting a holistic, integrated model of care for hypospadias patients. Full article

Mental health problems represent a growing public health burden, particularly in middle-income countries where population-based evidence remains limited. This study aimed to analyze the risk profiles and heterogeneity of symptoms compatible with depression, suicidal ideation, and panic in the adult population of Paraguay. A cross-sectional study was conducted using nationally representative data from the 2022 STEPS survey. The presence of symptoms compatible with depression, panic, and suicidal ideation was assessed using self-reported dichotomous screening questions. Associations with sociodemographic, behavioral, and clinical variables were analyzed using multivariate models, estimating adjusted odds ratios (aOR) with 95% confidence intervals, and the analyses accounted for the complex sampling design. The prevalence of symptoms compatible with depression was 35.8%, panic 22.4%, and suicidal ideation 8.0%. Higher odds were observed in women, younger age groups, urban residents, and individuals reporting daily smoking as well as those with diabetes mellitus. Associations varied across outcomes, reflecting heterogeneous risk patterns. Symptoms compatible with depression, panic, and suicidal ideation are highly prevalent and unequally distributed in the adult population of Paraguay. These findings highlight the need for targeted prevention strategies, early detection, and the integration of mental health into public health and noncommunicable disease policies and management. Full article

Frailty, cognitive impairment, depression, functional dependency, low physical performance, and undernutrition are highly prevalent in older adults referred for cancer treatment, cardiovascular interventions, neurological therapies, and orthopaedic surgery, and each independently predicts treatment toxicity, post-procedural complications, and mortality. Comprehensive Geriatric Assessment (CGA) is the most accurate predictor of treatment outcomes in older patients, yet it remains structurally absent from most speciality pathways, contributing to overtreatment of biologically frail patients and undertreatment of biologically robust ones. In this Viewpoint, we propose and operationalise the FIT–FRAIL–DISABLE multidimensional geriatric stratification model as a conceptual framework for translating CGA findings into proportional, speciality-specific treatment recommendations across oncology, cardiology, neurogeriatrics, and orthogeriatrics. The model integrates six validated CGA instruments—the Mini-Mental State Examination (MMSE), the 15-item Geriatric Depression Scale (GDS-15), basic and instrumental Activities of Daily Living (ADL, IADL), the Short Physical Performance Battery (SPPB), and the Mini Nutritional Assessment Short Form (MNA-SF)—into three actionable categories (FIT, FRAIL, DISABLE) aligned with full-intensity, risk-adapted, and symptom-focused care, and is explicitly positioned in relation to the deficit-based frailty paradigm and the WHO Intrinsic Capacity (ICOPE) framework, which it complements rather than replaces. We specify a provisional, a priori decision rule for combining domain scores and describe how each stratification category should inform—but not dictate—goal-concordant treatment intensity within a shared decision-making process. FIT–FRAIL–DISABLE is presented as a proposed, hypothesis-generating framework: its composite thresholds and domain weighting have not yet been empirically derived, and the model has not undergone prospective validation. Retrospective calibration on existing CGA cohorts and prospective multicentre validation are being designed within the GERIA-NET research consortium. If validated, the framework has the potential to reduce both overtreatment-related harm and undertreatment-related therapeutic deprivation in older adults undergoing active treatment. Full article

Adolescence is marked by significant emotional changes, which may be intensified by the presence of a rare respiratory disease. The purpose of this study was to explore the psychological outcomes and challenges associated with these conditions during adolescence. Following the PRISMA guidelines, a systematic review was conducted in Web of Science, ProQuest and Scopus databases, identifying 677 articles. Following screening, 18 studies met the inclusion criteria and three additional eligible studies were identified through manual snowball searching, resulting in 21 studies included in the final synthesis. Most studies focused on symptoms of anxiety and depression as key psychological variables. Some also assessed health-related quality of life, psychological comorbidities, treatment adherence, disease knowledge and perceived self-efficacy. Most studies focused on adolescents with cystic fibrosis, whereas evidence concerning primary ciliary dyskinesia was considerably more limited (20 studies included participants with cystic fibrosis and 3 with primary ciliary dyskinesia; 1 study included both conditions). Findings regarding anxiety, depressive symptoms, and health-related quality of life were heterogeneous across studies. Despite the adequate methodological quality of these studies in general, the findings highlight inconsistent conclusions in the literature, with no clear consensus on the extent or nature of the psychological impact. There is a clear need for further high-quality research to better understand the psychological difficulties and consequences associated with rare respiratory diseases during adolescence. Regular psychological assessment may be considered part of multidisciplinary care to identify psychological difficulties and support the well-being of adolescents with CF and PCD. The main limitations were the heterogeneity of study populations and methodologies, the predominance of cross-sectional designs, and the restriction of the search to three databases. Full article

Background/Objectives: Evidence linking plant-based diets with mental health is mixed. One reason may be that dietary labels do not always reflect habitual food intake and often coincide with other lifestyle characteristics. Methods: We conducted a cross-sectional secondary analysis of 158 Polish adults: 105 omnivores and 53 participants who identified as following plant-based diets (34 vegetarians and 19 vegans). Habitual intake frequencies for 33 food groups and diet-quality indices were derived from KomPAN. Anxiety and depressive symptoms were assessed with HADS-M, empathy with the EQ-Short/SSIE, and physical activity with IPAQ. Self-identified dietary pattern was the primary exposure; meat/fish-abstention definitions were examined in sensitivity analyses. Results: Compared with omnivores, plant-based participants had lower BMI and nHDI scores, higher DQI values, and, among those with valid IPAQ data, higher physical activity. Nineteen of 33 food groups differed after false-discovery-rate correction. We found no statistically significant association between dietary identity and HADS-A or HADS-D in crude, minimally adjusted, or broader sensitivity models; the confidence intervals, however, were too wide to establish equivalence or rule out an association. Of the 53 self-identified plant-based participants, 36 (67.9%) met the meat/fish-abstention criterion and 17 (32.1%) did not. IPAQ analyses included 120 participants, and inverse-probability-weighted sensitivity analyses produced similar HADS estimates. No individual food-frequency variable was associated with HADS-A or HADS-D after multiplicity correction. In exploratory analyses, more frequent vegetable consumption was positively associated with empathy. Conclusions: Dietary identity corresponded to clear differences in habitual food consumption, diet quality, and selected lifestyle characteristics, but we did not detect a statistically significant association with anxiety or depressive symptoms. The observed mismatch between dietary identity and reported behavior highlights the value of measuring both in studies of plant-based diets and psychological outcomes. Full article

Background/Objectives: Fibromyalgia (FM) is a nociplastic pain syndrome characterized by chronic widespread pain, fatigue, sleep disturbance, cognitive dysfunction, and heightened sensitivity to somatic and environmental stimuli. Depressive symptoms and major depressive disorder (MDD) frequently co-occur with FM and are associated with greater disability, pain catastrophizing, sleep disruption, and poorer treatment response. Although pharmacological treatments can reduce symptoms in some patients, many individuals experience persistent functional and affective burden, highlighting the need for mechanism-based adjunctive strategies. Mindfulness-based interventions (MBIs), particularly mindfulness-based stress reduction (MBSR), have shown promise for improving functional impact, pain catastrophizing, perceived stress, depressive symptoms, sleep-related burden, and quality of life in FM. However, the effects of MBIs on pain intensity and biomarkers are less consistent. Methods: This narrative mechanistic review develops a hypothesis-generating multisystem neurobehavioral framework to explain how MBIs may influence pain–mood coupling in FM with depressive symptom burden. We define pain–mood recalibration as a reduction in the extent to which pain intensity, bodily vigilance, and interoceptive threat appraisal automatically drive depressive symptoms, rumination, avoidance, and functional disengagement. Results: Fibromyalgia-specific evidence most strongly supports cognitive–emotional mechanisms, including reduced catastrophizing, psychological inflexibility, rumination, perceived stress, and avoidance. Interoceptive, neural-network, autonomic, immune-inflammatory, and sleep-fatigue-behavioral pathways remain exploratory and require prospective mediation and moderation testing. Conclusions: Future trials should prioritize active controls, ecological momentary assessment, longitudinal biomarkers, neuroimaging, interoceptive tasks, and formal mediation/moderation models to determine which patients benefit, through which mechanisms, and under what biological and psychological conditions. Full article

Background: Preconception screening traditionally focuses on physical health indicators and diagnosed psychopathology, potentially overlooking subclinical psychological vulnerabilities that could predict perinatal mental health outcomes. This study examined whether transdiagnostic psychological assessment before pregnancy provides information beyond childhood adversity and current symptom severity. Methods: In this prospective cohort study, 170 healthy nulliparous women attempting natural conception underwent preconception assessment and were followed through postpartum. Preconception measures included childhood adversity, transdiagnostic psychological processes (emotional dysregulation, learned helplessness, and dissociation), and psychiatric symptoms (depression, anxiety and post-traumatic stress disorder). Postpartum outcomes included maternal bonding, birth-related trauma symptoms, depression and anxiety levels. Exploratory factor analysis (EFA), structural equation modeling (SEM), and hierarchical linear regressions were used to characterize associations between preconception dimensions and postpartum outcomes. Results: Standard trauma screening cutoffs identified 19.3% of women with significant childhood adversity, and over 90% scored below clinical thresholds for current psychopathology. Analyses identified three distinct dimensions: childhood adversity (Risk), transdiagnostic psychological processes (Vulnerability), and current symptoms (Symptoms). Risk was indirectly associated with Symptoms through Vulnerability (β = 0.24), while the direct association between Risk and Symptoms was not significant. Risk and Vulnerability were the primary predictors of maternal bonding (R² = 0.21), whereas Symptoms was the dominant predictor of postpartum anxiety (R² = 0.30), depression (R² = 0.20), and birth-related trauma symptoms (R² = 0.32). Conclusions: In a cross-sectional preconception analysis, transdiagnostic psychological vulnerability structurally linked childhood adversity to current symptoms. In a prospective analysis extending from preconception to postpartum, Vulnerability independently predicted postpartum outcomes, including maternal bonding and anxiety. These findings support further investigation of modifiable vulnerabilities, such as emotion dysregulation and learned helplessness, as potential targets for preconception assessment and preventive research. Full article

Introduction: The high prevalence of anxiety and depression in adults affects their overall functioning. Within Relational Frame Theory, psychological inflexibility is theoretically associated with avoidance of private events and has been linked to greater anxiety and depressive symptoms and lower resilience. However, the integration of these constructs into explanatory models remains limited, restricting the understanding of their interrelationships and potentially relevant protective resources. Objective: To examine the indirect association between psychological inflexibility and psychological distress through resilience within a theoretically specified cross-sectional model. Methods: A cross-sectional design with latent variables was employed using a quantitative approach. The sample consisted of 950 Peruvian adults (64% women), recruited in Metropolitan Lima, who completed a sociodemographic questionnaire and psychological measures. Statistical analyses were conducted using structural equation modeling. Results: The proposed model demonstrated adequate fit (robust CFI = 0.94, robust RMSEA = 0.05, 90% CI [0.050, 0.057], SRMR = 0.04). Psychological inflexibility showed a strong positive direct association with psychological distress (β = 0.803, p < 0.001) and a significant indirect association through resilience (β = 0.073, p < 0.001]). This pattern was consistent with complementary mediation within the specified cross-sectional model. Conclusions: Higher psychological inflexibility was associated with lower resilience and greater psychological distress. Resilience statistically accounted for a small but significant portion of the association between psychological inflexibility and distress, whereas the direct association remained predominant. Given the cross-sectional design, these findings should not be interpreted as evidence of temporal or causal relationships. Longitudinal research is required to examine the directionality of these associations. Full article