Search Results (24,285)

Background: Nurse managers’ trust and inclusive leadership are critical factors that influence staff nurses’ motivation, engagement, and work effectiveness. Understanding how these elements interact can help improve organizational performance and patient care in hospital settings. Therefore, this study aimed to examine the relationship between nursing managers’ trust, inclusive leadership styles and staff nurses’ work effectiveness in Saudi Arabian hospitals. Purpose: This study aimed to examine the relationship between nursing managers’ trust, inclusive leadership styles and staff nurses’ work effectiveness in Saudi Arabian hospitals. Methods: A descriptive, correlational cross-sectional design was conducted. Data were collected by distributing questionnaires (workplace effectiveness questionnaire II, the inclusive leadership scale, and the trust in the leader scale) among 487 nurses using convenience sampling from 10 hospitals in Saudi Arabia. Results: The work-effectiveness factors of opportunity, access to support, and access to information (means: 3.43, 3.23, and 3.15, respectively) were moderately empowering. Most participants perceived the availability and accessibility (means: 3.43 and 3.23, respectively) of inclusive leadership. Meanwhile, in the trust in the leader scale, integrity and benevolence (means: 3.31 and 3.27, respectively) were more highly rated than predictability and competence (means: 2.79 and 2.81, respectively). Significant differences (p < 0.05) between nursing managers and their staff were observed across all three dimensions. Conclusions: Trust in nursing managers, inclusive leadership, and staff nurses’ work effectiveness were significantly associated, but the cross-sectional design does not support causal inference. Full article

Background: Mental health problems are common among people living with HIV (PLWH); however, the use of mental health services remains inadequate in many low- and middle-income countries. Objectives: This study aimed to explore the perspectives of health professionals on the provision of mental health services for PLWH presenting with mental health problems in primary health care in Lesotho. Methods: A qualitative descriptive approach was adopted, involving semi-structured interviews with 50 health professionals who were purposely selected, including nurses and medical officers, each with a minimum of 2 years’ primary health care experience in the Maseru district. Data were collected between December 2022 and January 2023, audio-recorded, and transcribed verbatim. Data collection continued until thematic saturation was achieved, and analysis was conducted using a thematic framework analysis. Results: The analysis revealed two main themes: (1) limited knowledge of mental health problems, encompassing an inadequate understanding of signs and symptoms, diagnosis, and management, and (2) barriers to the management of mental health problems. Key subthemes included the shortage of qualified mental health specialists and psychiatric medications, the absence of dedicated counselling services for the prevention of mental health problems, lack of a mental health department, time constraints within clinical practice, and limitations in clinical infrastructure. Cultural beliefs, stigma, and discrimination, both among health professionals and in the broader community, were also identified as significant impediments. Participants described a substantial treatment gap, driven by insufficient training and limited resources, which undermines the effective delivery of mental health services. Conclusions: The findings revealed that health professionals working in primary health care in Lesotho experience considerable knowledge gaps and systemic constraints that hinder the provision of adequate mental health services for PLWH who have mental health problems. These challenges can be mitigated through targeted capacity building, the integration of MHS into primary care, improved resource allocation, and strategies to reduce stigma, thereby enhancing health outcomes. Full article

Adolescence is a critical developmental period marked by the interaction of health behaviors, psychosocial functioning, and peer relationships. This scoping review mapped quantitative evidence on the associations between health behaviors, emotional and behavioral problems, and peer-related factors among adolescents, accounting for sociodemographic characteristics. An electronic literature search was conducted in November 2025 using the ProQuest Summon Discovery Service, in line with PRISMA-ScR reporting guidance. Studies published between 2015 and 2025 that focused on adolescent populations and examined at least two key variables were considered; the included samples collectively spanned ages 10–18 years. Thirteen studies met the inclusion criteria. Across the included studies, health behaviors, particularly physical activity, diet, sleep, and screen use, were examined both individually and as co-occurring lifestyle patterns. Less favorable behavioral patterns were generally associated with poorer mental health and psychosocial indicators, whereas healthier patterns were associated with better well-being and quality of life. Associations with screen and internet use varied according to the type and intensity of digital engagement, with evidence of dose–response patterns for internet use and divergent associations across different screen activities. Peer relationships and related social factors were most often operationalized through social support, friendship quality, bullying, or victimization rather than through direct measures of peer attachment security. Within this limited and heterogeneous evidence base, supportive peer contexts were generally associated with more favorable behavioral and emotional outcomes, whereas bullying and victimization were associated with poorer outcomes. The mapped evidence is consistent with a biopsychosocial perspective but remains predominantly cross-sectional, underscoring the need for longitudinal research and more precise measurement of peer attachment processes. Full article

Background/Objectives: Time perspective and resilience are both relevant to adolescent mental health, yet their association has rarely been examined in clinical adolescent populations. This study investigated associations between resilience and time perspective and tested their independent associations with depressive, anxiety, and PTSD symptoms beyond trauma-related variables. Methods: A total of 105 adolescents aged 14 to 20 years were recruited from a child and adolescent psychiatric outpatient department. Participants completed self-report measures of resilience, time perspective, trauma exposure, and PTSD, depressive, and anxiety symptoms. Discrepancy from the optimal balanced time-perspective profile was quantified using the revised Deviation from a Balanced Time Perspective coefficient (DBTP-r). Spearman correlations and linear regression models were computed using DBTP-r alone, DBTP-r plus resilience, and extended models including trauma-related variables. Results: Higher DBTP-r was associated with lower resilience. Higher resilience was associated with higher Future and Past Positive scores and lower Past Negative scores. DBTP-r accounted for substantial variance in symptom severity. When resilience was added, both DBTP-r and resilience were independently associated with depressive, anxiety, and PTSD symptoms. In the extended models, DBTP-r and resilience remained significant for all three outcomes. Of the trauma-related predictors, physical sexual abuse was associated with PTSD symptoms in the extended model, but this association was no longer significant after controlling for biological sex. The cumulative number of other potentially traumatic experiences was not independently associated with symptom severity in the extended models. Conclusions: Time perspective and resilience appear to be related but distinguishable constructs. Both were independently associated with symptom levels of depression, anxiety, and PTSD in adolescents. Full article

Collective intergenerational trauma is a complex phenomenon affecting descendants and families exposed to the enduring effects of collective traumatic events, such as forced displacement, genocide and war. This systematic review aimed to explore the mechanisms through which collective trauma is transmitted across generations, examine its consequences for children and families, and critically analyse interventions employed by health professionals and social workers. A systematic review was conducted using ScienceDirect, Wiley Online Library and PubMed. Studies published between 2016 and 2026 were screened for eligibility, resulting in the inclusion of 22 studies. The indexing terms “collective intergenerational trauma”, “collective transgenerational trauma”, “trauma transmission”, “transmission mechanisms”, “consequences”, “intergenerational trauma interventions”, “Social Care”, and “Health Professionals”, were used, along with the Boolean operators AND and OR. The included studies were synthesised using thematic analysis. The findings indicate that collective intergenerational trauma is transmitted through interacting family, communicative, sociocultural and biological mechanisms. Its consequences include psychological and psychosocial difficulties among descendants, disruptions in family relationships and adverse effects on family functioning. Existing interventions primarily focus on individual trauma, with limited attention to its collective and intergenerational dimensions. The findings highlight the need for culturally responsive, trauma-informed and family-centred interventions addressing collective intergenerational trauma within a systemic framework. Health professionals and social workers can play an important role in promoting mental health, strengthening resilience, mitigating the long-term effects of trauma and supporting affected children, families and communities. Full article

Background/Objectives: Depression is a frequently overlooked but clinically important complication following surgical treatment of benign prostatic hyperplasia (BPH). This study aimed to compare the risk of new-onset postoperative depression following transurethral resection of the prostate (TURP) and holmium laser enucleation of the prostate (HoLEP) in patients with BPH. Methods: We conducted a retrospective cohort study using the Korean Health Insurance Review and Assessment database. Patients diagnosed with BPH between 2013 and 2022 who underwent TURP or HoLEP and had no prior diagnosis of a psychiatric disorder were included (n = 30,878 and n = 21,521, respectively). The primary outcome was a diagnosis of depression within one year after surgery. Multivariable logistic regression and propensity score matching were used to adjust for covariates, including age, comorbidities, medication use, geographic region, and hospital level. Sensitivity analyses were conducted using follow-up periods of one, three, six, and nine months. Results: In the unadjusted model, HoLEP was associated with higher odds of postoperative depression compared with TURP (odds ratio [OR] = 1.338, 95% confidence interval [CI]: 1.245–1.438; p < 0.0001). This association remained significant after multivariable adjustment (OR = 1.350, 95% CI: 1.255–1.451; p < 0.0001) and propensity score matching (OR = 1.364, 95% CI: 1.259–1.476; p < 0.0001). The association was observed across alternative follow-up windows in the sensitivity analyses. Conclusions: HoLEP is associated with higher odds of new-onset postoperative depression compared with TURP. These findings may inform perioperative mental health assessment for patients undergoing surgical treatment for BPH, and warrant further evaluation to establish causality or clarify the underlying mechanism. Full article

In an increasingly urbanized world, green spaces provide Cultural Ecosystem Services (CES) that support human well-being and are often perceived as the most valued benefits in cities. Yet, their perception and co-occurrence remain underrepresented in Latin American regions. In this study, we assess the diversity and bundling of CES perceived by visitors across five urban parks in the Mexican city of Xalapa, Veracruz, and examine how park identity (synthesizing park-specific ecological and structural characteristics) and sociodemographic factors influence these perceptions. Using a mixed-methods approach, we analyzed 373 surveys using general linear models. We identified 13 CES, with an average of three services per park. ‘Recreation’, ‘Mental health’, ‘Physical health’, and ‘Contact with nature’, the most frequently mentioned services, together with ‘Social relations’, consistently formed a dominant CES bundle, suggesting patterns in how cultural benefits are co-experienced. Park identity, visitor Age, and Gender were key predictors of CES perception variation, highlighting joint spatial and social influences. By integrating CES bundles with park-specific characteristics and sociodemographic drivers, this study advances current understanding of CES perception comprehensively and demonstrates that CES are not uniformly experienced across urban green spaces, underscoring the need for context-sensitive planning and management that account for both place identity and user diversity. Full article

Emotion recognition is essential for social adaptation and mental health. However, existing measures still rely on limited stimulus materials or simplified task formats, which restricts ecological validity. The present study aimed to construct a localized multimodal emotion expression database in the Chinese context and to develop a multimodal emotion recognition ability test integrating emotion category and intensity recognition. In Study 1, a multimodal emotion expression database was established through actor performances, expert evaluation, and participant validation. The final database contained 2160 videos representing six basic emotions, five levels of emotional intensity, and two expression modes (vocal and non-vocal). In Study 2, 90 videos were selected under three recognition conditions (vocal-expression, muted vocal-expression, and muted non-vocal-expression). An integrated scoring approach combining emotion category and intensity was used to develop the test. A total of 236 valid participants completed the test. The results indicated that, after 61 video clips were retained, the test demonstrated good reliability and item discrimination. Evidence for criterion-related validity and construct validity was also obtained. Overall, the findings suggest that the present measure is a reliable and valid tool for assessing multimodal emotion recognition ability in the Chinese cultural context and offers the first empirical evidence that integrating category and intensity recognition can better capture the multidimensional nature of this ability. Full article

Background: People with schizophrenia are one of the most stigmatized social groups. The purpose of this study was to assess stigma, quality of life, social anxiety and illness insight in a sample of first-episode psychosis (FEP) patients and to investigate possible correlations between these variables and psychopathology/socio-demographic factors of the study group. Methods: This observational cross-sectional study included 90 patients (55 males, 35 females) with a mean age of 31.8 ± 8.6 years (18–52) experiencing a first episode of psychosis. The mean ± SD duration of untreated psychosis was 13.4 ± 6.2 weeks. The medications used were risperidone (n = 24; 26.7%), clozapine (n = 34; 37.8%), and olanzapine (n = 32; 35.6%). The tools used for this study were the Internalized Stigma for Mental Illness Scale (ISMI), World Health Organization Quality of Life Assessment-BREF (WHOQoL-BREF), Liebowitz Social Anxiety Scale (LSAS-SR), Schedule for the Assessment of Insight—Expanded version (SAI-E), and Positive and Negative Syndrome Scale (PANSS). Results: The mean ISMI total score was 50.9 ± 7.9 (range: 29–84), with 56.6% of patients scoring greater than 50, indicative of internalized stigma. Mean PANSS total scores improved from 76.1 ± 7.2 at baseline to 44.9 ± 6.3 after six months of follow-up (p < 0.001). Patients demonstrated insight of (mean ± SD) 20.3 ± 4.5, measured by SAI-E, and moderate-to-good quality of life across WHOQOL-BREF domains. The results of this study indicated that the ISMI scale showed statistically significant linear correlations with the LSAS-SR [anxiety (r = 0.399, p < 0.001) and avoidance (r = 0.421, p < 0.001)], with positive correlations and approximately medium associations. In the multivariable analyses, ISMI was inversely associated with all WHOQoL-BREF domains (physical health: −0.72 units 95% CI: −1.09 to −0.35, p < 0.001; mental health:−1.04, 95% CI: −1.45 to −0.63, p < 0.001; social relationships: −0.79, 95% CI: −1.39 to −0.18, p = 0.012; environmental health: −0.70, 95% CI: −1.00 to −0.39, p < 0.001). Multivariable models were adjusted for age, gender, medication, marital status, having children, employment, residence, DUP, SAI-E, ISMI, and LSAS-SR. Conclusions: Stigma is positively correlated with social anxiety. Higher stigma levels were independently linearly associated with lower levels of quality of life, even after adjusting for other predictor variables. Our results also indicated an association between higher insight levels and elevated odds of high internalized stigma. Stigma in first-episode psychosis patients is negatively associated with quality of life and positively associated with social anxiety/avoidance. Full article

Background: Depression and anxiety disorders remain among the leading contributors to global disability and represent a major public health challenge. Although evidence-based psychotherapies are available, access to treatment remains limited due to structural, economic, geographical, and workforce-related barriers. Digital mental health interventions have emerged as scalable approaches to reducing this treatment gap, with artificial intelligence (AI)-guided cognitive behavioral therapy (CBT) representing a rapidly developing and clinically relevant extension of digital psychotherapy. Objective: This review aims to synthesize current evidence on digital and AI-guided CBT interventions for depression and anxiety, with a focus on clinical utility, scalability, mechanisms of change, safety considerations, and public health relevance. In addition, the review proposes a clinically oriented conceptual framework for understanding the role of AI-guided CBT within contemporary digital psychiatry. Methods: A focused narrative review was conducted using PubMed, Scopus, and Google Scholar databases, covering publications from 2010 to 2025. Relevant peer-reviewed studies, systematic reviews, meta-analyses, and conceptual papers addressing digital CBT, AI-assisted CBT, conversational agents, symptom monitoring, and digital mental health implementation were identified and analyzed qualitatively. Results: Existing evidence suggests that internet-delivered CBT, mobile applications, and AI-based conversational agents may reduce depressive and anxiety symptoms, particularly in individuals with mild to moderate conditions. However, the evidence base remains heterogeneous, with limitations including short follow-up periods, variability in intervention quality, reliance on self-reported outcomes, and insufficient data on long-term effectiveness, safety, and real-world implementation. Emerging concepts such as digital therapeutic alliance, continuous symptom monitoring, adaptive intervention delivery, and AI-driven personalization may represent key factors influencing engagement and clinical outcomes. Conclusions: AI-guided CBT represents a promising but still evolving component of modern mental health care. These technologies have the potential to improve accessibility, optimize resource allocation, and support stepped-care and hybrid models of treatment. Future research should prioritize rigorous clinical validation, long-term outcome evaluation, transparent safety protocols, ethical governance, and integration into real-world health systems. AI-guided CBT should not be understood as a replacement for clinicians, but as a complementary and scalable extension of evidence-based psychotherapy. Full article

Background: Individuals with intellectual and/or developmental disabilities (IDDs) experience persistent health inequities, exacerbated by the systemic lack of education of health care professionals about their care. In response to a 2020 call from the Administration for Community Living in the United States, five institutions formed the IDD Health Equity Consortium to develop a suite of educational materials and practice experiences to improve the education of health care professionals in the health and health care of individuals with IDDs. Methods: The Collective Impact Model, designed to align organizations and stakeholders around a shared agenda for system change, was used to organize IDD Health Equity Consortium programs. Backbone infrastructure included a cross-sector steering committee, an Advocate Advisory Committee, and three Consortium Action Networks focused on communication, measurement, and education, practice, and policy. A scoping review of the literature was conducted, and a Participatory Planning and Decision-Making process engaged individuals with IDDs, family members, students, faculty, and professionals in identifying important themes for developed materials. Results: Learning modules, case studies, service-learning experiences, and simulation experiences were developed across Consortium institutions and were disseminated across multiple other institutions, with beginning alignment with interprofessional and disability competencies. Mixed-methods evaluation strategies assessed learner outcomes, including knowledge checks and pre and post evaluations using established measures of skills, comfort levels, and approach; and interprofessional socialization, valuing, and collaborative practice behaviors. Conclusions: By involving individuals with IDDs in curriculum development and building multi-institution and cross-sector infrastructure, the Consortium developed scalable materials that address longstanding gaps in health care professional education. The developed suite of educational materials and practice experiences and early evaluation findings provided a foundation for further program refinement and future empirical studies examining long-term effects on practice and clinical outcomes. Full article

Background/Objectives: Adolescent mental health is a growing public health concern in Thailand, with high rates of stress and depressive symptoms among secondary school students. This study aimed to (1) quantitatively examine changes in resilience, perceived stress, and depressive symptoms associated with participation in the Changing Minds, Changing Lives (CMCL) strength-based resilience program and (2) qualitatively explore participants’ experiences of the program, at a private single-sex secondary school in Bangkok, Thailand. Methods: A quasi-experimental, single-group, pre–post–follow-up mixed-methods design, without a control group, was employed. Twenty-six students aged 15–18 years, enrolled in a single-sex boys’ secondary school, were recruited using convenience sampling. The Thai Connor–Davidson Resilience Scale (Thai CD-RISC), Thai Perceived Stress Scale (T-PSS-10), and Thai Patient Health Questionnaire-9 (PHQ-9) were administered at baseline (T₁), immediately post-intervention (T₂), and one-month follow-up (T₃). The CMCL program comprised six sessions delivered over three weeks. Repeated measures ANOVA with Bonferroni post hoc correction was used for quantitative analysis. Qualitative data from reflective writings and final presentations were analyzed using conventional content analysis. Results: All outcomes showed significant within-group change over time. Resilience increased from pre-intervention (T₁: M = 64.00) to post-intervention (T₂: M = 76.46) and one-month follow-up (T₃: M = 78.19; F_(2,50) = 75.63, p < 0.001, η² = 0.752). Perceived stress decreased from pre-intervention (T₁: M = 20.62) to post-intervention (T₂: M = 13.04) and one-month follow-up (T₃: M = 9.62; F_{(1.567,39.17)} = 105.03, p < 0.001, η² = 0.808). Depressive symptoms also declined from pre-intervention (T₁: M = 7.27) to post-intervention (T₂: M = 5.81) and one-month follow-up (T₃: M = 4.88; F_(2,50) = 14.74, p < 0.001, η² = 0.371). Qualitative findings supported these results, highlighting three themes: Self-Understanding, Stress Management, and Understanding Others. Conclusions: Participation in the CMCL strength-based resilience program was associated with increased resilience and reduced perceived stress and depressive symptoms among Thai secondary school students, with changes maintained at one-month follow-up. Given the single-group design and small sample, these findings are preliminary. The program appears feasible and promising as a school-based preventive mental health intervention for adolescents in Thailand, and warrants evaluation in controlled studies with larger and more diverse samples. Full article

Introduction: Epidemiological data indicate that over half of people who consume cannabis report anxiety reduction as a reason for use. Anxiety is frequently cited as a primary motivation for cannabis use among both medical and recreational consumers. The lifetime prevalence of anxiety disorders in the United States is approximately 34% with more recent data suggesting that the figure may be as high as 43%. Methods: Using a mixed methods design, we collected quantitative data through psychosocial assessment tools and demographic questionnaires from a sample of adult cannabis consumers (n = 30). These data were integrated with qualitative findings from semi structured interviews to contextualize consumers’ experiences and perceptions related to anxiety and cannabis use. Results: Medical cannabis consumers (n = 19) reported significantly more frequent consumption, averaging 28.95 days per month, as compared to recreational consumers (n = 11), averaging 23.55 days per month. Scores on the State-Trait Anxiety Inventory indicated clinically significant anxiety symptoms in both groups (39.95 for medical; 38.55 for recreational), with medical consumers more likely to endorse elevated anxiety. Qualitative analyses revealed nuanced and individualized interpretations of anxiety that extended beyond traditional binary diagnostic criteria revealing the Research Domain Criteria (RDoC) as a framework to better understand the relationship between anxiety and cannabis use. Discussion: The value of this work is its use of the RDoC framework to provide a new way to examine the relationship between anxiety and cannabis consumption. Currently the diagnosis of anxiety is binary based on DSM-5-TR criteria. This limitation makes it challenging to study the complex range of outcomes that occur when examining anxiety and cannabis use. Therefore, the opportunity to understand anxiety from a transdiagnostic framework such as RDoC enables researchers to study for whom and under what circumstances cannabis induces and/or reduces anxiety. Full article

Background/Objectives: To examine the association between caffeine intake and mental health- and sleep-related outcomes, including anxiety, sleep duration, and perceived stress, in a nationally representative sample of Korean adults. Methods: We analyzed 20,504 participants from the Korea National Health and Nutrition Examination Survey (KNHANES) 2021–2024. Caffeine intake was categorized into six groups, and mental health- and sleep-related outcomes included clinically significant anxiety symptoms (GAD-7 ≥ 10), sleep duration, and perceived stress. Survey-weighted multivariable logistic regression models and restricted cubic spline analyses were used to evaluate associations between caffeine intake and mental health- and sleep-related outcomes, adjusting for demographic, socioeconomic, behavioral, dietary, and clinical factors. Results: The prevalence of clinically significant anxiety symptoms was 4.7%. Restricted cubic spline analyses demonstrated a non-linear association between caffeine intake and anxiety (p-overall = 0.010; p-nonlinear = 0.016). Higher caffeine intake was associated with progressively increasing odds of short sleep duration (<6 h/day), indicating a clear dose–response relationship (p-overall < 0.001; p-nonlinear < 0.001). Higher caffeine intake was also associated with increased perceived stress (p-overall = 0.025), although evidence for a nonlinear relationship was weaker (p-nonlinear = 0.062). These findings were generally consistent across multivariable-adjusted models. Conclusions: Caffeine intake is differentially associated with mental health- and sleep-related outcomes, with excessive intake related to adverse effects on sleep and stress. Full article

Background: University students are particularly vulnerable to elevated stress, anxiety, and reduced psychological well-being, especially in the post-pandemic period. Immersive virtual reality (VR) has emerged as a promising technology-supported approach for relaxation and stress reduction; however, evidence regarding its short-term psychophysiological effects in academic populations remains limited. Objective: The aim of this study was to evaluate the effects of a short-term immersive VR relaxation intervention on perceived stress and autonomic nervous system activity in university students. Methods: A randomized controlled study with repeated measures was conducted among university students from Opole, Poland. Participants were allocated to an immersive VR group or a non-immersive screen-based control group. Both groups received identical relaxation content for 10 min daily over five consecutive days, differing only in the level of immersion. Heart rate variability (HRV) was recorded continuously during four consecutive 5-minute epochs within each session. Perceived stress was assessed using the Perceived Stress Scale-10 before and after the intervention. Cybersickness symptoms were assessed in the VR group. Results: Immersive VR elicited more pronounced favourable changes in HRV parameters than non-immersive exposure, including increased lnRMSSD, SDNN, and PNS index values, together with reduced mean heart rate, SNS index, and Stress index. Both groups showed significant reductions in perceived stress; however, the reduction was significantly greater in the VR group (p = 0.009, Cohen’s d = 0.78). Cybersickness symptoms were low and decreased across the intervention period. Conclusions: Short-term immersive VR relaxation may represent a feasible and well-tolerated approach for reducing perceived stress and supporting autonomic regulation in university students under controlled experimental conditions. However, the findings should be interpreted with caution due to the short intervention period and the absence of follow-up. Furthermore, adequately powered randomized controlled trials with longer observation periods are required to confirm these preliminary findings. Full article