Search Results (5,067)

Academic stress is one of the main challenges affecting the psychological well-being of university students due to its impact on mental health, academic performance, and quality of life. The aim of this study was to analyze and model the factors associated with academic stress by integrating unsupervised and supervised machine learning techniques. The study was conducted with a sample of 605 students from the Universidad Nacional de San Martín (Peru), who completed validated psychometric instruments, including the PSS-10, LASSI, MBI-SS, PSQI, and A-CEA. In the first stage, dimensionality reduction and clustering techniques were applied to identify latent profiles, resulting in four distinct groups reflecting different levels of adaptation and psychological vulnerability. In the second stage, eight supervised regression models were evaluated: Linear Regression, Ridge, Lasso, Elastic Net, Random Forest, Gradient Boosting, XGBoost, and CatBoost. Lasso and Elastic Net showed virtually equivalent performance, achieving coefficients of determination (R²) close to 0.61 on the independent test set. Variable importance analysis revealed that academic burnout, sleep quality, and coping strategies were the main factors associated with perceived stress, together with contextual variables with lower relative importance. Overall, the results confirm the multidimensional nature of academic stress and show that integrating unsupervised and supervised approaches provides a more comprehensive understanding of the phenomenon in university settings. Full article

Digital interventions can increase the reach and continuity of physical activity promotion, but evidence remains fragmented across mental health and addictive behaviors. We conducted a comprehensive integrative review supported by structured searches (2015–2026) in biomedical, psychological, multidisciplinary and technology-oriented databases, complemented by backward/forward snowballing. Eligible studies included digital interventions in which physical activity (or sedentary reduction) was a core component and those that reported mental health outcomes (e.g., depression, anxiety, stress, and well-being) and/or addiction-related outcomes (e.g., craving, consumption, lapses/relapse, and treatment retention). We synthesized findings thematically by intervention typology (apps, wearables, hybrid models with human support, and adaptive approaches) and by key active ingredients (goal setting, self-monitoring, feedback, reinforcement, planning, and engagement strategies). Overall, most studies targeted mental health outcomes and used app-based multicomponent programs, sometimes complemented by wearables, with generally short follow-up and heterogeneous engagement metrics. Evidence in addictions was more context-specific and concentrated in alcohol treatment and opioid agonist therapy settings, supporting feasibility and a plausible role for physical activity as a coping strategy. Advanced personalization frameworks (EMA/EMI/JITAI) provide a clear implementation pathway but are less consistently operationalized when physical activity is the central therapeutic component. This review highlights practical design recommendations and research priorities for scalable, safe, and equity-oriented digital physical activity interventions in mental health promotion and relapse prevention. Full article

Mental well-being has been considered a fundamental contributor to overall academic success and psychological stability. Based on the Transactional Theory of Stress and Coping, this study examined the mediating role of academic resilience in the relationship between perceived academic support and mental well-being of Kenyan TVET trainees. A quantitative cross-sectional design was employed, with a sample of 1933 trainees (M_age = 22.87 years; 57.7% male) from 239 public TVET institutions in Kenya. The following measures were administered: Perceived Academic Support Questionnaire, Academic Resilience Scale, and the Short Warwick–Edinburgh Mental Well-Being Scale. Correlation analysis demonstrated that perceived academic support showed a strong positive association with mental well-being, whereas academic resilience indicated a moderate association. Consistent with the hypothesized model, parallel mediation analysis indicated that academic resilience partially mediated the relationship between academic support and mental well-being. The indirect effects observed across resilience dimensions indicated that emotional response was the dominant mediating pathway, while perseverance showed a small positive indirect effect, and adaptive help-seeking demonstrated a small but significant negative indirect effect. These findings contribute to the growing but limited literature on well-being in vocational training and suggest that while academic resilience serves as a key mediating mechanism, perceived academic support may also function as a direct protective factor, underscoring the importance of embedding structured emotional coping support within TVET academic environments. Full article

Background: Artificial Intelligence (AI) and Machine Learning (ML) technologies, such as conversational agents, are becoming increasingly essential tools across multiple industries, particularly in healthcare. This paper presents a scoping review (PRISMA-ScR) of conversational agents (CAs) in mobile health coaching systems (MHCS). It examines existing applications of MHCS, focusing on development strategies, usage contexts, impacts on users, benefits, and research gaps, emphasizing the ability of explainable artificial intelligence (XAI) in making health guidance and decision-support recommendations transparent, trustworthy, and interpretable, if properly integrated. This scoping review identifies opportunities to maximize the use of conversational agents, explainable AI, and mobile technologies to make mobile health coaching systems more accessible and trustworthy, as well as further research gaps worth exploring. Objective: This scoping review maps the evidence on CAs and XAI-enabled technologies in MHCS, identifies trust-related design criteria, categorizes reported outcomes, and highlights opportunities for explainable conversational agents (XCA) in a mobile health context, especially in tackling general medical conditions pertinent in underserved settings. Eligibility criteria: Reported eligible resources evaluated, designed, or conceptually analyzed existing CAs, XAI techniques, and MHCS, AI-supported medical dialogue systems, e-coaching systems, and mobile health applications. We considered sources only relevant to healthcare, health coaching, trust, explainability, or patient engagement that were published between 2006 and 2025. Sources of Evidence: Searches were conducted in IEEE Xplore, Google Scholar, Springer, ScienceDirect/Elsevier, ProQuest, and ACM Digital Library, supplemented by targeted web searches and backward citation checks. Charting methods: Data were charted by system type, communication mode, health context, operational mode, technology used, XAI/trust features, degree of automation, study designs and outcome classification. We applied a revised outcome classification: generated desired outcome (GDO) and partially generated desired outcome (P-GDO), and did not generate desired outcome (DN-GDO). Results: A total of 201 resources were collected. Charted studies clustered around CAs in health, MHCS for chronic diseases and stress management, XAI methods such as LIME, SHAP, Prospector, and counterfactual explanations, and trust-related elements such as voice quality, communication style, appearance, social intelligence, privacy, and performance quality. Most health CAs and MHCS addressed chronic diseases, mental health, or behavior change; fewer addressed general medical diagnosis or autonomous mobile-based primary care support. Conclusions: Existing evidence suggests that CAs and MHCSs can support engagement, coaching, education, and selected decision-support tasks, but evidence for safe, autonomous, explainable general practice functionality remains limited. Future work should prioritize clinically supervised XCA designs, core safety assessment, interfaces with transparent explanation, data protection, culturally and linguistically responsive implementation, and future-oriented review in underserved mobile health settings. Full article

Positive teacher–student relationships in early childhood predict stronger academic and social–emotional outcomes, whereas conflictual or dependent relationships contribute to children’s stress and behavioral and academic difficulties. While prior research emphasizes teachers’ observable relational behaviors, fewer studies explore the internal emotional and cognitive processes that shape these relationships. This mixed-methods study examined how preschool teachers’ emotion socialization practices (i.e., emotion coaching and dismissing) and their classroom expressions of positive and negative emotions relate to their mental representations of their relationships with students. Quantitative analyses tested whether teachers’ emotional expressiveness moderated associations between their emotion socialization practices and relational representations. Complementing these analyses, qualitative narrative interviews with an independent teacher sample explored how educators described their emotional expressiveness, emotion-related practices, and perceived relationships with students. Informed by emotion socialization theory, attachment theory, and the prosocial classroom model, findings highlight the interplay of teachers’ emotional beliefs, regulation, and relational schemas in shaping classroom climate. Our integration of quantitative and qualitative insights provides a more comprehensive understanding of teachers’ emotional functioning and underscores the importance of supporting educators’ relational and emotional competencies to enhance classroom quality and student well-being. Full article

Inflation, recognized as a social determinant of health (SDOH), significantly affects the daily lives of individuals through the rising costs of food, housing, and other basic needs, all of which are public health concerns. Since the COVID-19 pandemic, inflation has become a prominent concern in the U.S. and has been linked to increased stress and poor mental health among adults. While data on inflation is tracked routinely, how it is discussed publicly is understudied. Social media platforms provide insights into how inflation is framed and experienced by the public, and these assessments may be used to determine public health needs and policy advocacy. In this study, we conducted a time-bound, platform-specific case study of inflation-related discourse on X (formerly Twitter). Analysis revealed a predominance of negative sentiments (68.5%) including frustration and distrust. Posts primarily concerned monetary policy/government spending (31.6%), Federal Reserve interest rates/financial markets (24.5%), and U.S. presidential politics (12.9%). The users did not explicitly discuss personal-level hardships, and the discussions largely focused on macro-level issues framed in polarized political perspectives. These patterns matter for public health because institutional trust shapes support for social and health policies. Our study findings suggest a fragmented social environment that may exacerbate community-wide anxiety and challenge health promotion efforts and the need for public health surveillance through surveys or personal interviews to identify and address the psychological burden of inflation. Full article

Background: Neuroinflammation and gut–brain axis (GBX) dysregulation are key pathological drivers of stress-related neuropsychiatric disorders. Zhi-Zi-Chi Decoction (ZZCD), a classic Traditional Chinese Medicine (TCM) formula, has been clinically used to alleviate mental disturbances via the TCM principle of “clearing heat and relieving restlessness.” Still, its modern neuroprotective mechanisms, especially its links to gut microbiota and central signaling pathways, remain incompletely elucidated. Purpose: This study aimed to systematically investigate the therapeutic effects of ZZCD on chronic restraint stress (CRS)-induced neurodysfunction in mice and clarify its mechanisms from the perspectives of TCM theory, material basis, gut microbiota–metabolite axis, and central signaling pathways. Method: CRS mice were treated with ZZCD or protocatechuic acid. Behavioral tests evaluated depression- and anxiety-like behaviors. UHPLC-Q-TOF/MS identified ZZCD’s chemical constituents; 16S rRNA sequencing and untargeted metabolomics analyzed gut microbiota and metabolite changes. Western blot, immunofluorescence, and proteomics examined neuroinflammation, microglial polarization, and signaling pathway activity (PI3K/Akt/mTOR, AMPK). Results: ZZCD reversed CRS-induced depression- and anxiety-like behaviors and suppressed neuroinflammation. Mechanistically, UHPLC-Q-TOF/MS identified 424 ZZCD constituents, with prenol lipids, organooxygen compounds, and flavonoids as the most abundant. ZZCD reversed CRS-induced imbalance in gut microbiota, reducing pro-inflammatory Prevotella and enriching beneficial Lactobacillus, and mediated the enrichment of the prebiotic metabolite PCA in colonic and serum samples, which crossed the blood–brain barrier (BBB) to exert neuroprotection. Additionally, ZZCD and PCA normalized the PI3K/Akt/mTOR pathway and activated AMPK, promoting M2 microglial polarization and restoring synaptic plasticity. Conclusions: ZZCD exerts antidepressant effects by a gut-microbiota-dependent modulation of PCA-PI3K/Akt/mTOR and AMPK dual axes that converts microglia from M1 to M2, providing ethnopharmacological evidence and a mechanistic rationale for its clinical application in major depressive disorder. Full article

Introduction: The work-related quality of life affects employee satisfaction and organizational effectiveness, with a direct impact on the quality of healthcare. This study aims to investigate the work-related quality of life (WRQoL) among nurses in tertiary healthcare, as perceived by the nurses themselves, in relation to their demographic and professional characteristics. At the same time, it seeks to highlight the way in which the individual dimensions of WRQoL influence their sexual and mental health. Materials and Methods: A descriptive cross-sectional study was conducted in 2023 in a General Hospital in Greece. Data were collected using structured questionnaires assessing sociodemo-graphic and occupational characteristics, WRQoL, mental health (Depression, Anxiety and Stress Scale—DASS-21), and female sexual function (Female Sexual Function Index—FSFI-19). Pearson correlation analysis and multiple linear regression analysis were performed. The regression model was adjusted for age, marital status, number of children, and work experience. Results: The results demonstrated a significant negative association between depression and sexual function (β = −0.388, p = 0.029), while stress was positively associated with sexual function (β = 0.371, p = 0.038). The overall regression model was statistically significant (p = 0.001), explaining 18.6% of the variance in sexual function. Conclusions: The findings highlight the close interrelationship between work-related quality of life, mental health, and sexual function among nurses. Poorer psychological well-being was associated with reduced sexual function, emphasizing the impact of occupational and emotional burden on nurses’ overall health. These results underline the importance of supportive workplace environments and targeted interventions to promote mental and sexual well-being among healthcare professionals. Full article

Research on trauma in autistic individuals has proliferated in recent years. This scoping review aims to (1) provide a comprehensive overview of the literature on trauma and autism, (2) identify and synthesize key themes, and (3) highlight gaps to inform future research. Following Arksey and O’Malley’s (2005) methodological framework and the PRISMA-ScR guideline and checklist (Tricco et al. 2018), we included articles published after 2000 in French or English that explicitly addressed trauma in autistic individuals. Four databases were searched: PsycINFO, Medline, ERIC, and Web of Science. A two-phase selection process yielded 199 eligible studies. Descriptive analyses and collaborative theme development were conducted to map the field. Findings show that most studies were published between 2018 and 2024, with the United States contributing the largest proportion. Four major themes were identified: (1) the relationship between autism and trauma, including prevalence, vulnerability, and consequences; (2) trauma-related symptoms and clinical manifestations; (3) assessment practices; and (4) intervention strategies. This review offers a critical synthesis of current knowledge, emphasizing the need for approaches that use broader definitions of trauma and reflect the diversity and lived experiences of autistic individuals. It also identifies significant methodological and conceptual gaps, calling for future research that addresses subgroup diversity and promotes equitable, trauma-informed practices for autistic individuals. Full article

Background/Objectives: Parenting stress and life satisfaction are important indicators of family well-being and parent mental health in families of children with disabilities. However, limited empirical attention has been given to how these outcomes differ among parents whose children receive adapted physical activity (APA) services within South Korea’s Developmental Rehabilitation Service system. This cross-sectional study examined subgroup differences in parenting stress and life satisfaction according to sociodemographic, disability-related, and service-utilization characteristics among parents of children receiving APA services. Methods: Data were collected from 295 parents of school-aged children with disabilities enrolled in APA services at child development centers. Welch-type tests, Welch’s ANOVA or one-way ANOVA, Pearson correlation analyses, Benjamini–Hochberg FDR adjustment, and supplementary analyses of covariance (ANCOVA) were used to examine group differences and the stability of selected associations after adjustment for prespecified covariates. Confirmatory factor analysis and gender-based measurement invariance testing were also conducted for the adapted parenting stress scale. Results: Parenting stress subdomains were positively correlated with one another (r = 0.19–0.53) and negatively correlated with life satisfaction (r = −0.28 to −0.40). Female parents reported higher social and psychological stress than male parents. Household income showed the largest association with economic stress, and significant differences were also observed according to parental age, education level, disability severity, and selected service-utilization characteristics. Some associations remained after ANCOVA adjustment, whereas others were attenuated or emerged only after adjustment. Conclusions: The findings indicate subgroup differences in parenting stress and life satisfaction among parents of children receiving APA services. Because the study used a cross-sectional, self-reported design with convenience sampling and an adapted instrument, the results should be interpreted as preliminary associative evidence rather than evidence of causal or service-specific effects. Future longitudinal, comparative, and service-level research is needed to clarify how APA service contexts relate to caregiver well-being over time. Full article

Background/Objectives: Survival rates after pediatric liver transplantation have improved substantially over recent decades, yet the psychiatric consequences for recipients remain a concern that warrants closer attention. We sought to map the psychiatric symptom burden across multiple domains in this population and to determine which symptom clusters carry the greatest impact on health-related quality of life (HRQOL). Materials and Methods: Fifty liver transplant recipients between the ages of 8 and 18 were enrolled at a single center. Children and their parents completed four psychiatric measures—the CBCL, CDI, SCARED, and CRIES-13—alongside the parent-proxy PedsQL to capture HRQOL across physical, emotional, social, and school functioning domains. Correlations between instruments were calculated, and linear regression was used to determine which psychiatric variables independently predicted PedsQL Total scores. Results: Across all psychiatric measures, higher symptom scores were associated with lower HRQOL, with school functioning recording the lowest absolute PedsQL domain score, while emotional functioning demonstrated the strongest and most consistent inverse correlations with all psychiatric symptom measures across instruments. CBCL Total (r = −0.607), SCARED Total (r = −0.557), and CRIES-13 Total (r = −0.548) scores all correlated meaningfully with overall HRQOL. When entered into multivariable analysis, anxiety symptoms measured by the SCARED (β = −0.295, p = 0.032) and post-traumatic stress symptoms measured by the CRIES-13 (β = −0.400, p = 0.004) stood out as the two independent predictors of worse PedsQL Total scores. Conclusions: Even in medically stable recipients, anxiety and post-traumatic stress symptoms were independently associated with lower daily functioning scores and overall quality of life. These findings suggest that routine psychosocial screening and trauma-informed approaches may warrant integration into post-transplant care protocols, and that prospective, adequately powered studies are needed to confirm and extend these associations. Full article

Background: Mental illness constitutes one of the greatest worldwide health burdens. The use of artificial intelligence (AI) and virtual reality (VR) is becoming increasingly relevant in mental health. Nevertheless, evidence regarding their integrated application remains sparse. This scoping review identified existing evidence on AI-integrated VR in mental health care, including clinical applications, reported outcomes, and future research directions. Methods: The Population, Concept, and Context framework was used as the eligibility criteria. The mental health-related studies considered were original studies that addressed explicit AI integration using VR systems or workflows and had at least one outcome or clinical or implementation finding. PubMed, Scopus, Web of Science, and PsycINFO were searched to retrieve English-language studies published between January 2020 and February 2026. Results: The available evidence is heterogeneous, generally small, and primarily focused on feasibility or predictive modeling. The focus of applications is on the assessment or prediction of anxiety spectrum conditions, trauma and post-traumatic stress disorders, stress, and panic disorder/agoraphobia. Most of the research examines immersive VR with multimodal inputs and machine-learning-based prediction models. However, the field remains largely in an early stage, with a lack of standardization, implementation readiness, safety reporting, and real-world validation. Conclusions: AI-integrated VR can be considered as a promising but emerging field, and further development requires stricter, more clinically based, and implementation-focused studies that can help establish safe, effective, and scalable implementation in mental health care. Furthermore, pragmatic, multicenter research directly investigates whether AI-integrated VR has additional clinical value compared to regular VR or regular care in mental health care. Full article

Background: Infertility affects millions of people causing grave societal and health consequences (poor physical and mental wellbeing). Aims: To translate and validate the COMPI scale in Serbian and examine associations of infertility-related stress, coping strategies and evaluation of care with medically assisted reproduction (MAR) outcomes in female Serbian infertility patients. Methods: The study included patients undergoing MAR for four months. Participants completed a socio-demographic and gynecologic questionnaire, the Serbian-translated COMPI scale, Beck Anxiety Inventory (BAI) and Zung Self-Rating Depression scale (ZDS). Serbian COMPI was validated in the classic manner. Associations between COMPI scores and pregnancy outcomes were analyzed by Spearman’s correlation and multivariable regression. Results: A total of 107 women participated and 24.3% achieved pregnancy. The Serbian COMPI demonstrated high internal consistency (Cronbach alpha = 0.838). Compared with reference COMPI data, personal, social and marital stress scores were higher, while meaning-based coping and marital benefit scores were lower. Regression analysis showed that higher marital stress, partner communication difficulties and meaning-based coping were associated with higher pregnancy likelihood. Conclusions: Serbian patients undergoing MAR reported high infertility-related stress and predominantly used active coping strategies. Patients who applied meaning-based coping were more likely to achieve pregnancy. Full article

Background/Objectives: Mental health problems are common among university students and are more consistently associated with dissatisfaction with academic performance than with low grades alone. This study examined the prevalence and determinants of perceived stress, depressive symptoms, and low psychological well-being among university students in Punjab, Pakistan, and assessed their association with academic performance. Methods: A cross-sectional survey was conducted among students aged 15 to 29 years at three public universities in Punjab, Pakistan. A total of 1308 questionnaires were completed, yielding a response rate of 91.4%. This study uses data collected in 2015 as a pre-COVID historical baseline, providing valuable insights into student mental health before the global pandemic. This temporal context offers a benchmark for future comparative studies, especially when assessing the mental health impact of COVID-19 on university students. Data were analyzed using SPSS with descriptive statistics, chi-square tests, binary logistic regression, and multinomial logistic regression. Results: The findings revealed that perceived stress and depressive symptoms were prevalent, with 54.9% of students reporting high levels of stress (mean PSS score = 27.6, SD = 8.3), and 44.2% experiencing depressive symptoms (mean M-BDI score = 33.8, SD = 16.2). Female students exhibited higher stress and depressive symptoms compared to male students. Year of study was also a factor, with second- and third-year students experiencing more stress than their final-year counterparts (p < 0.05). Financial strain was associated with poorer mental health outcomes; 62% of students who reported inadequate financial support also reported higher stress levels (p < 0.05). In contrast, students with sufficient financial resources had lower odds of experiencing stress and depressive symptoms (AOR = 0.55, p < 0.05). Additionally, students living in university or private hostels reported better psychological well-being than those living at home (AOR = 0.47, p < 0.01). Mental health issues, particularly high stress and depression, were more strongly linked with academic dissatisfaction than low grades alone, with students in the “low grades and unsatisfied” group exhibiting higher odds of mental health problems (AOR = 2.30, p < 0.05). Conclusions: Mental health problems were common among university students and were associated with poorer academic experiences, particularly dissatisfaction with academic performance. Universities should strengthen accessible mental health support through counseling services, stress-management programs, and stigma-reduction initiatives. Full article

Background/Objectives: Given that post-traumatic stress disorder (PTSD) and post-traumatic growth (PTG) are separate constructs that can co-occur following adversity, we examined how prior adversity and current functioning difficulties may relate to the likelihood of meeting criteria for PTSD and scoring above the cutoff for PTG among individuals who reported being impacted by their prior adversity. Methods: Participants (n = 2112) in this international sample completed online measures assessing their adversity history, current functioning difficulties (i.e., negative world assumptions and autonomic reactivity), PTSD symptomatology, and PTG. Results: Chi square analyses suggested a trend toward an association between meeting criteria for PTSD and scoring above the cutoff for PTG, although not statistically significant (p = 0.061). Multivariable logistic regression analysis found that individuals most impacted by caregiver abuse and certain specific adversities (i.e., parent with a mental health problem, caregiver and non-caregiver sexual abuse, and being held captive) were more likely to meet the criteria for PTSD. Whereas those most impacted by life-threatening situations and the specific adversities of being impacted by a life-threatening illnesses or injury, were more likely to meet the criteria for PTG. However, the strongest predictor of the likelihood of PTSD was increased autonomic reactivity, and the strongest predictor of the likelihood of PTG was fewer negative world assumptions. Conclusions: Our research suggests the need to assess the perceived impact of adversity history, as well as the potential negative consequences of autonomic reactivity and negative world assumptions, as these may be associated with PTSD symptomatology and PTG. Full article