Search Results (2,668)

Background: This scoping review maps and synthesizes the scientific evidence on the epidemiological profile and determinants of sick leave and work-related accidents in Brazil, with an emphasis on studies using data from the Brazilian Federal Medical Expert Service of the Ministry of Social Security. Methods: Following the PRISMA-ScR guidelines and the JBI Manual for Evidence Synthesis, eight databases (SciELO, PubMed/MEDLINE, Scopus, Web of Science, LILACS, CINAHL, PsycINFO, Embase) were searched for quantitative observational studies published between 2000 and 2025. Out of the 218 studies identified, 18 met the eligibility criteria. Results: Cross-sectional designs (66.7%) and ecological/time-series designs (22.2%) predominated. The findings identified musculoskeletal disorders as the leading cause of work absence; mental disorders were the third leading cause, exhibiting an upward trend; and a significant influence of institutional factors, especially the Social Security Technical Epidemiological Nexus, on the observed patterns. Determinants operate at the individual, occupational/organizational, and institutional levels. Conclusions: Empirical research on work disability in Brazil remains fragmented, providing limited capacity for causal inference. The findings support five priority areas: sectoral risk management, workplace mental health, territorial strategies for musculoskeletal disorders, sick leave trajectory policies, and data governance, all of which necessitate longitudinal and quasi-experimental studies to evaluate interventions and the impact of institutional changes. Full article

Background and Clinical Significance: This report investigates the complex intersection of macrostructural neuroprotection and cortical hyperexcitability during long-acting atypical antipsychotic maintenance. We present a novel clinical case demonstrating an apparent absence of detectable cerebellar vermis atrophy progression during long-acting injectable (LAI) aripiprazole maintenance, which temporally coincided with the emergence of a potential epileptogenic risk in an adolescent with bipolar disorder (BD) and cannabis use disorder. Beyond motor precision, the vermis modulates emotional-cognitive networks; deficits in these circuits impair impulse control, frequently driving comorbid substance use in youth. Case Presentation: A 16-year-old female with BD and cannabis use disorder presented with pronounced cerebellar and vermis atrophy on brain CT during an acute behavioral crisis. Following diagnostic reformulation, maintenance therapy was initiated via off-label monthly LAI aripiprazole (400 mg) alongside lithium. At 9-month follow-up, psychiatric relapses and cannabis use remitted completely. Repeat CT suggested macrostructural stability with zero apparent atrophy progression. However, during the 9th month, she abruptly developed daily generalized myoclonus. An awake electroencephalogram (EEG) revealed intense cortical hyperexcitability, documenting frequent interictal and ictal epileptiform discharges with generalized 3–4 Hz spike-wave complexes synchronized with the clinical myoclonus. Introduction of levetiracetam (500 mg BID) and cessation of adjunct methylphenidate led to complete clinical and neurophysiological remission. Conclusions: LAI aripiprazole may favorably influence the macrostructural trajectory of the cerebellum/vermis in adolescent BD, suggesting volume stabilization. However, clinicians must monitor for a drug-induced lowering of the seizure threshold, where macrostructural volume preservation coexists with microstructural electrical destabilization. Full article

Background: Emergency medical service (EMS) personnel and volunteers are frequently exposed to traumatic events, placing them at elevated risk for psychological distress, including post-traumatic stress symptoms (PTSSs), depression, and dissociation. This study examined the relationships among PTSS, depression, and dissociation in Israeli EMS personnel, with a particular focus on whether dissociation mediates the association between depression and PTSS. Methods: A cross-sectional study was conducted with 60 EMS personnel in Israel, including 7 paid employees, 37 volunteers, and 16 participants who did not report their employment status. PTSSs were assessed using the Impact of Event Scale-Revised (IES-R), depressive symptoms were measured with the Depression, Anxiety, and Stress Scale (DASS-21), and dissociative experiences were evaluated using the Dissociative Experiences Scale-II (DES-II). Correlational analyses and mediation analyses were performed. Results: Significant positive correlations were found among PTSS, depression, and dissociation. However, mediation analysis indicated that dissociation did not significantly mediate the relationship between depression and PTSS. Conclusions: Although depression and dissociation were both strongly associated with PTSS, dissociation did not account for the association between depression and PTSS in this sample of EMS personnel. These findings suggest that other psychological mechanisms may underlie the relationship between depression and trauma-related symptoms in emergency responders. Further research is warranted to identify these mechanisms and to inform targeted interventions aimed at promoting the mental health and resilience of EMS personnel. Full article

Many law enforcement agencies operate crisis service models that utilize the expertise of mental health professionals in assisting law enforcement officers (LEOs) when interacting with people experiencing a mental health crisis. This study examines three agencies with two different types of established crisis service models in the same geographical area to answer three research questions: (1) Does the type of crisis service model affect facilitators of success for the model? (2) Does the type of crisis service model affect how practitioners personally measure the success of the model they use? (3) What patterns exist in involuntary psychiatric examination rates before and after the implementation of the crisis service models? Sixteen practitioners representing two crisis service models responded to a survey investigating the first two questions. Participants were recruited through email. The analysis used inferential and descriptive statistics to examine their responses. A before-and-after design using descriptive statistics of publicly available data about involuntary psychiatric examinations was employed to investigate the third research question. Results showed variation across the model participants’ choices of facilitators important for model success and metrics, but only differences between the responses from members of two models in choosing the facilitator of clear policies and procedures (e.g., clearly written protocols) and the metric of use of force were at statistically significant levels. The practitioners of the models are the experts. Understanding how they judge the success of their work and what facilitates that success is vital for allocating resources effectively and adjusting policies as needed. The study determined that involuntary psychiatric examinations decreased concurrently with the use of crisis service models, but it is not possible to establish causation. More investigation is needed. Full article

Background/Objectives: Endometriosis is a chronic gynecological condition affecting approximately 10% of women of reproductive age and is associated with chronic pain, fatigue, infertility, and reduced quality of life. Beyond its physical burden, delayed diagnosis, healthcare dismissal, and inadequate support may contribute substantially to psychological distress. In line with growing efforts to promote mental health and wellbeing within healthcare settings, this study explored women’s experiences of healthcare services and the psychological impact of living with endometriosis. Methods: A qualitative study was conducted using thematic analysis of 2500 publicly available Twitter/X posts shared by accounts self-presenting as women discussing experiences of endometriosis. Results: Three overarching themes were identified: (1) Institutional Invalidation of Women’s Endometriosis Experiences, (2) Living with the Multidimensional Burden of Endometriosis, and (3) Reimagining Endometriosis Care. Participants described chronic pain, reproductive uncertainty, and significant emotional distress that were frequently intensified by delayed diagnosis and experiences of not being believed or taken seriously within healthcare settings. Accounts suggested that suffering was shaped not only by disease symptoms but also by interactions with healthcare systems that undermined the legitimacy of women’s experiences. Conversely, validation, empathy, and collaborative communication were associated with improved wellbeing and engagement with care. Participants advocated for greater awareness of endometriosis, earlier diagnosis, and more integrated models of support. Conclusions: Endometriosis should be understood as a biopsychosocial condition whose impact extends beyond physical symptoms alone. The narratives analyzed highlight how psychological distress may be amplified by experiences of invalidation, delayed recognition, and fragmented care. Improving outcomes requires timely diagnosis, patient-centered healthcare interactions, and the integration of psychological support within multidisciplinary endometriosis services. Full article

Background/Objective: Family caregivers of individuals with serious mental illness and substance use disorders experience substantial psychological burden. However, emerging evidence suggests many develop resilience and post-traumatic growth despite adversity. This integrative review synthesizes evidence on resilience, coping strategies, post-traumatic growth, and protective factors among these caregivers. Methods: The Whittemore and Knafl integrative review framework guided this synthesis. A systematic literature search was conducted across PubMed, CINAHL, and PsycINFO databases for peer-reviewed articles examining resilience, coping mechanisms, and post-traumatic growth in family caregivers of individuals with serious mental illness and substance use disorders. Qualitative, quantitative, and mixed-methods studies were included. Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT). Data were extracted and analyzed using thematic synthesis to identify common patterns. Results: Multiple protective factors facilitate resilience and post-traumatic growth, including cultural values, family connectedness, religious faith, and emotional intelligence. Individual characteristics such as personality traits and decision-making styles influence adaptation outcomes. Structured interventions including psychoeducation, mindfulness practices, and peer support show initial evidence of enhancing caregiver resilience and psychological well-being, based on a single randomized controlled trial and cross-sectional associations. The caregiving experience provides opportunities for meaningful personal transformation despite significant burden. Conclusions: Family caregivers of individuals with serious mental illness and substance use disorders possess substantial capacity for positive psychological change. Healthcare professionals should implement strength-based, family-centered interventions acknowledging caregiver resilience. Future research employing longitudinal designs and investigating intervention mechanisms is essential to advance caregiver-focused mental health services. Full article

Chronic non-cancer pain (CNCP) is a complex and highly prevalent condition among older adults that contributes to suffering and disability. It is frequently underestimated and normalized as part of aging. This scoping review aimed to identify and describe the consequences of CNCP on the daily lives of older adults. A scoping review was conducted following the Arksey and O’Malley framework and the PRISMA-ScR reporting guidelines. Searches were performed in five databases (CINAHL, Scopus, Web of Science, Embase, and PubMed) and in grey literature between January and February 2026. The protocol was registered in the Open Science Framework (OSF). The level of evidence was appraised using the Center for Evidence-Based Medicine criteria. Forty-four articles were included that met the established inclusion criteria. CNCP exerted a multidimensional negative impact. Physically, it was associated with increased frailty, higher risk of falls, and disability in activities of daily living. Psychologically, it correlated with anxiety, depression, and sleep disturbances. Socially, it contributed to isolation and created financial barriers that limited access to health services. CNCP represents a critical barrier to older adults’ wellbeing. Nursing should prioritize early detection and avoid the normalization of pain in clinical practice. Knowledge gaps remain regarding gender perspectives and mental health outcomes. Full article

Digital ecosystems, misinformation exposure, mental-health vulnerability and unequal access to care create distinctive challenges for young people. Although youth participation in health governance is increasingly advocated internationally, structured evidence from youth deliberative processes remains limited in Portugal. This study synthesises priorities expressed in two Portuguese deliberative initiatives coordinated by the Sociedade Portuguesa de Literacia em Saúde: the Mini-Assemblies of Health 2022–2023, with particular attention to the 3rd Mini-Assembly on Fighting Health Misinformation, and the Youth Health Choices Forum 2024. Both processes used a structured nominal-group logic to support idea generation, clarification, recording and prioritisation. The analysis used low-inference cross-session thematic aggregation to preserve propositional integrity and remain close to participants’ formulations. Five priority domains were identified: digital health communication and information credibility; curriculum-integrated and peer-mediated health literacy; low-friction mental-health access and stigma reduction; equity and functional service accessibility and governance, accountability and youth participation. Participant quotations are retained, in translated form, to preserve youth voice and to show how recommendations emerged from concrete deliberative formulations. The findings suggest that nominal group technique (NGT)-based youth deliberation can generate operational recommendations for policy and practice, including credibility mechanisms for digital health information, school-based health-literacy integration, autonomy-preserving access routes for mental-health support, and permanent youth participation structures. The findings support recognising young people not only as vulnerable recipients of health information but also as interpreters of digital health ecosystems and contributors to the design of more responsive health governance. Full article

Background/Objectives: The mental health of university students is a global public health priority. While pathological narcissism is increasingly recognized as a source of significant psychological suffering, its developmental and somatic correlates remain insufficiently explored. This study examines the sociodemographic, familial, and health-related correlates of pathological narcissism and its association with global psychological distress. Methods: A cross-sectional study was conducted with 888 university students (M = 21.3 years; 78.5% female) recruited from three faculties—Humanities and Social Sciences, Civil Engineering, and Medicine. Participants completed the Pathological Narcissism Inventory (PNI), Brief Symptom Inventory (BSI), and sociodemographic, familial, and health-related characteristics, including trauma exposure. Multivariable linear regressions and hierarchical regression analyses were conducted. Results: Pathological narcissism was robustly and positively associated with global psychological distress (r = 0.636, p < 0.001). Multivariable regression models identified chronic fatigue as the strongest somatic correlate of narcissistic pathology, consistent with an ego-depletion account of self-regulatory failure. Additional significant correlates included trauma history, insomnia, and prior use of psychological services. Students from the Faculty of Humanities and Social Sciences reported significantly higher narcissism scores than medical students. Poorer perceived family relationship quality was associated with higher narcissism scores. The full models accounted for 14.4% to 16.9% of the variance in narcissistic dimensions. Conclusions: These cross-sectional findings suggest that pathological narcissism is not merely a personality trait but a clinically relevant construct deeply intertwined with psychological distress and somatic exhaustion. The strong association between narcissism and chronic fatigue points to a substantial physiological cost of sustained self-regulatory effort. Findings highlight the need for integrated screening protocols in university counseling services that account for somatic symptoms (fatigue, insomnia), traumatic experiences, and family dynamics, alongside efforts to destigmatize help-seeking, given that fewer than 1% of students turn to faculty for support. Full article

Interdisciplinary dialogue between religion and psychoanalysis has long been regarded as an important approach to addressing modern psychological suffering. Erich Fromm sought to integrate Zen Buddhist practice with psychoanalytic reflections on integration of the unconscious, self-awareness, and personality, proposing a framework that links spiritual cultivation with psychological growth. However, this framework’s explanatory power and limitations in the contemporary Chinese context remain insufficiently explored through empirical research. Drawing on semi-structured interviews with 14 Chinese Zen practitioners in China, this study employs thematic analysis to examine their practices, psychological changes, and understandings of the relationship between Zen and mental health. Most participants regarded Zen practice as a long-term process involving cognitive reorientation, emotional regulation, and behavioral transformation, broadly resonant with Fromm’s integrative framework. However, the framework should not be treated as a directly applicable model of psychological intervention, as its practical relevance depends on sustained cultivation, community support, situated understanding, and clear professional and ethical boundaries. These qualitative findings underline potential risks when Zen cultural resources are introduced into contemporary mental health services, including decontextualization, instrumentalization, and an orientation toward immediate results. Therefore, within clearly defined ethical boundaries, a limited and responsible form of collaboration between Zen teachers and mental health professionals may be worth further exploration. Full article

Students who are neurodivergent may be at risk of experiencing one or more basic needs insecurities (BNIs). Experiencing BNI, generally, can also increase symptoms of mental illness. The current study examined BNI experiences between students who were neurodivergent and neurotypical and tested whether experiencing BNIs was associated with symptoms of depression and anxiety. Data were collected from n = 507 college students via a cross-sectional, web-based survey. Neurodivergent status, experiencing six BNIs (i.e., food, finance, healthcare, housing, transportation, hygiene), and symptoms of depression and anxiety were measured. Logistic and linear regression models tested main effects after adjusting for sociodemographic factors. Overall, 90.4% of neurodivergent students experienced one or more BNIs, with food (68.3%) and financial (76%) insecurity most common. Odds of experiencing hygiene insecurity were two times greater (OR [95%] = 2.07 [1.09, 3.91]) among neurodivergent students. Experiencing food, financial, or healthcare insecurity was associated with increased depression (p’s ≤ 0.006) and anxiety (p’s ≤ 0.027) symptoms among neurodivergent students. BNIs are common in neurodivergent students, and neurodivergent students who experience BNIs are more likely to experience symptoms of depression and anxiety. Universities should consider implementing proactive policies, such as care coordination through health services, food options to accommodate non-traditional schedules, and affordable hygienic products and services. Full article

Suicidal ideation among college students is a multicausal public health concern shaped by individual, family, social, and academic factors. Although prior research has consistently documented associations between psychological distress and suicide risk in this population, most studies analyze risk factors in isolation, leaving the joint contribution of variables across ecological levels insufficiently understood. The present study, framed within Bronfenbrenner’s ecological model of human development and Joiner’s interpersonal theory of suicide, examined the simultaneous influence of clinical, protective, academic, and victimization variables on suicidal ideation in college students. A cross-sectional design was employed with a sample of 553 undergraduate and graduate students (68.9% women; mean age = 20.93 years, SD = 3.81) from the University of Málaga (Spain), recruited through snowball and convenience sampling. Participants completed validated self-report measures of suicidal ideation (Paykel Suicide Scale), depression and anxiety (HADS), eating disorders (CBCAR), self-esteem (RSE), academic stress (SISCO), academic procrastination (APS-SF), bullying, cyberbullying, and social exclusion (QAEU), social support (QFSSS), family satisfaction, healthy habits, and family history of mental illness. Data were analyzed through Pearson and Spearman correlations and a robust multiple linear regression (ordinary least squares with HC3 robust standard errors and bias-corrected and accelerated bootstrap confidence intervals from 5000 resamples), complemented by an ordinal regression as a sensitivity analysis. The regression model accounted for 44.1% of the variance in suicidal ideation, with depression, anxiety, eating disorders, family history of mental illness, and bullying showing significant positive associations and self-esteem the strongest protective association. An ordinal regression sensitivity analysis yielded a consistent pattern, supporting the robustness of these findings. Family and social support, although correlated with lower ideation, lost statistical weight in the multivariate models, suggesting that their contribution operates indirectly, mainly through depression and self-esteem. Findings support the integration of clinical, social, and personal-resource components into college prevention programs, prioritizing early detection of psychopathology, anti-bullying protocols, interventions to strengthen self-esteem, and greater visibility of campus psychological services. Full article

Background/Objectives: Psychological well-being is an important indicator of occupational mental health among special education teachers, as it is closely associated with work engagement, professional performance, and attitudes toward students with disabilities. Despite its importance, limited research has examined factors associated with psychological well-being among special education teachers in Arab contexts. Therefore, this study examined the level of psychological well-being among special education teachers and investigated the relative contributions of mindfulness and empathy. In addition, the study tested the mediating role of empathy in the relationship between mindfulness and psychological well-being. Methods: A cross-sectional quantitative predictive correlational design was employed with a sample of 259 special education teachers in Riyadh, Saudi Arabia. Data were collected using an Arabic-adapted version of Ryff’s Psychological Well-Being Scale, the short form of the Five-Facet Mindfulness Questionnaire, and the Empathy Scale for Teachers. Path analysis was conducted to test a partial mediation model examining the mediating role of empathy in the relationship between mindfulness and psychological well-being. Results: The findings indicated high levels of psychological well-being among special education teachers. Mindfulness and empathy accounted for significant variance in psychological well-being, and path analysis showed that empathy partially mediated the relationship between mindfulness and psychological well-being. Conclusions: These findings highlight the potential importance of mindfulness and empathy in relation to the psychological well-being of special education teachers and suggest the value of giving greater attention to these dimensions in pre-service preparation and ongoing professional support programs. The study also contributes context-specific evidence from Saudi Arabia to the literature on teacher well-being in special education. Full article

Depression, anxiety disorders and sleep disorders are becoming increasingly prevalent among college students. While psychotherapy and pharmacotherapy remain important interventions, their practical implementation in university settings may be constrained by factors including limited service accessibility, scheduling constraints, privacy concerns, stigma, and poor long-term adherence. As a low-threshold supportive intervention that can be readily integrated into campus environments, art healing offers a complementary approach to promoting college student mental health. This review includes 20 studies retrieved from the Web of Science and PubMed databases. These studies provide evidence for the mental health benefits of auditory art, visual art, and integrated art healing. The findings indicate that music-based interventions (the primary form of auditory art) have relatively robust supporting evidence for alleviating stress and anxiety; visual art and integrative art healing also yield measurable positive mental health outcomes. However, existing research is limited by heterogeneous intervention delivery protocols, small sample sizes, short follow-up periods, and substantial variation in methodological quality. Current evidence supports art healing as a complementary strategy for mental health promotion in higher education settings, rather than an alternative treatment modality. Future work should test standardized protocols in multi-site student samples. Long-term follow-up designs to further clarify its target populations, underlying mechanisms, and sustained efficacy. Full article

Background/Objectives: The transition to early parenthood is a pivotal phase influencing maternal mental health. Although parenting competence may support maternal adjustment, it is often treated as a unitary construct. This study examined the associations among foundational caregiving competence, developmental parenting and interaction competence, and eudaimonic parental well-being in first-time mothers. Methods: A cross-sectional survey was conducted with 372 first-time mothers whose young children attended licensed infant daycare centers in northern Taiwan. Participants completed questionnaires regarding the three study constructs and demographic characteristics. Data were analyzed using descriptive statistics, Pearson correlations, and partial least squares structural equation modeling. Results: Foundational caregiving competence was strongly associated with developmental parenting and interaction competence, which was positively associated with eudaimonic parental well-being. The direct association between foundational caregiving competence and eudaimonic parental well-being was not statistically significant after developmental parenting and interaction competence was included in the model. However, a significant indirect association was observed through developmental parenting and interaction competence. Conclusions: Relational, developmental, and role-oriented parenting competence was more closely associated with mothers’ experiences of meaning, fulfillment, and relational satisfaction than practical caregiving competence alone. Given the cross-sectional design and modest explanatory power, the findings represent preliminary associations rather than causal evidence. They may inform future parenting-support services that distinguish practical caregiving capacities from relational and developmental parenting competencies. Full article