Search Results (1,093)

With the arrival of an aging society and the continuous extension of the human lifespan, the quality of life has not improved in a corresponding manner. People’s demand for happiness and health is increasing. As a result, a model emerged that integrates tourism and medical services, which is health tourism. This growing demand has prompted many service providers to see it as a business opportunity and enter the market. Tourism can help travelers release work stress and restore physical and mental balance; meanwhile, health check-ups and disease treatment can help them regain health. Consumers have long favored health and medical tourism because it helps relieve stress and promotes overall well-being. As people age, some consumers experience a gradual decline in physical functions, making it difficult for them to participate in regular travel services provided by traditional travel agencies. Therefore, this study aims to explore the service needs of health and medical tourism customers (tourists/patients) and the interrelationships among these service needs, so that health and medical tourism service providers can develop more customized and diversified services. This study identifies four key drivers of medical tourism services: medical services, medical facilities, tour planning, and hospitality facilities. This study uses the APA (attention and performance analysis) method to assess each dimension and criterion and utilizes the DEMATEL method with the NRM (network relationship map) to identify network relationships. By combining APA and NRM techniques, this study develops the APA-NRM technique to evaluate adoption strategies and identify suitable paths for health tourism services, providing tailored development strategies and recommendations for service providers to enhance the service experience. Full article

Post-traumatic stress disorder (PTSD) is a chronic mental health condition resulting from exposure to traumatic events. It is associated with long-term neurobiological changes and disturbances in emotional regulation. Understanding the sociodemographic profiles, biomarkers, and emotional control in patients with PTSD helps to better comprehend the impact of the disorder on the body and its clinical course. An analysis of biomarkers such as Interleukin-18 (IL-18), Inositol-Requiring Enzyme 1 (IRE1), Phosphorylated Extracellular Signal-Regulated Kinase (pERK), and Activating Transcription Factor–6 (ATF-6) in PTSD patients with varying durations of illness (≤5 years and >5 years) and a control group without PTSD revealed significant differences. Patients with recently diagnosed PTSD (≤5 years) showed markedly elevated levels of inflammatory and cellular stress markers, indicating an intense neuroinflammatory response during the acute phase of the disorder. In the chronic PTSD group (>5 years), the levels of these biomarkers were lower than in the recently diagnosed group, but still significantly higher than in the control group. An opposite trend was observed regarding the suppression of negative emotions, as measured by the Courtauld Emotional Control Scale (CECS): individuals with chronic PTSD exhibited a significantly greater suppression of anger, depression, and anxiety than those with recent PTSD or healthy controls. Correlations between biomarkers were strongest in individuals with chronic PTSD, suggesting a persistent neuroinflammatory dysfunction. However, the relationships between biomarkers and emotional suppression varied depending on the stage of PTSD. These findings highlight the critical role of PTSD duration in shaping the neurobiological and emotional mechanisms of the disorder, which may have important implications for therapeutic strategies and patient monitoring. Full article

Introduction: Sexual minority men (SMM) are at increased risk for psychosocial stressor exposure, substance use, and poor mental health relative to heterosexual men. While the burden of mental health is growing in the United States, among SMM these trends are increasing at a greater rate, driving health disparities. Methods: Framed within a minority stress framework, these analyses examine how stressors explain substance use and poorer mental health over time. Participants were asked questions on stressor exposure (stigma, discrimination, internalized homophobia, perceived stress), mental health (anxiety, depression, PTSD), and substance use (alcohol to intoxication, club drugs, poly club drugs) over 36 months among 528 SMM in NYC. Results: Perceived stress increased frequency of all substance use, whereas discrimination decreased days of club and poly club drug use. Depression severity predicted increased days of club drug and poly club drug use. PTSD severity predicted increased days of club drug and poly club drug use. Conclusion: We are able to expand on the literature with granular substance use data to highlight associations with stressors and mental health. These findings support an increased need for systematic policy solutions and public health interventions to address drivers of substance use disparities among young SMM. Full article

Social trust has been linked to the development and severity of depression, but trust is a complex, multidimensional construct. This study examines the extent to which two distinct forms of trust, general trust and specific trust, predict depressive symptoms. Drawing on longitudinal data from the Directorate of Health’s national surveys conducted in 2007 and 2009, the analysis includes responses from 3211 Icelanders selected through a stratified random sample. Depressive symptoms were assessed using the Depression, Anxiety, and Stress Scale (DASS), while specific trust captured trust in close relationships, and general trust measured broader perceptions of trustworthiness in others. The two forms of trust together explained 7.6% of the variance in depressive symptoms, with specific trust contributing a substantially greater share. Both remained significant predictors after controlling for prior depression and physical health. These findings highlight the protective role of specific trust and suggest that general trust, an indicator of broader social capital, may also help buffer against depression. The results underscore the relevance of trust as a public health resource and support continued research into social determinants of mental health in Iceland. Full article

The intersection of sports and natural forests and green spaces represents an emerging interdisciplinary field with implications for public health, environmental science, and sustainable land management and refers to the variety of cultural ecosystem services demanded by people from ecosystems. This manuscript presents a systematic bibliometric and thematic analysis of 148 publications for the period 1993–2024 identified through Web of Science and Scopus, aiming to evaluate the current state of research on sports activities conducted in natural forest environments. Findings indicated a marked increase in scientific interest of this topic over the past two decades, with key contributions from countries such as England, Germany, China, and the United States. Researchers most frequently examined sports such as hiking, trail running, mountain biking, and orienteering for their capacity to provide physiological and psychological benefits, reduce stress, and enhance mental well-being. The literature analysis highlights ecological concerns, particularly those associated with habitat disturbance, biodiversity loss, and conflicts between recreation and conservation. Six principal research themes were identified: sports in urban forests, sports tourism, hunting and fishing, recreational sports, health benefits, and environmental impacts. Keyword and co-authorship analyses revealed a multidisciplinary knowledge base with evolving thematic focuses. In conclusion, the need for integrated approaches that incorporate ecological impact assessment, stakeholder perspectives, and adaptive forest governance to ensure sustainable recreational use of natural forest ecosystems is underlined. Full article

Background: International migration is a growing global phenomenon involving diverse groups, such as labor migrants, international marriage migrants, refugees, and international students. International migrants face unique mental health challenges influenced by adversities such as social isolation and limited access to mental health services. This study employs bibliometric methods to systematically analyze the global body of literature on international migrants’ mental health. Methods: The literature on the mental health of international migrants published until October 2024 was searched using the Web of Science database. The search terms included (‘International migrants’ OR ‘migrant workers’ OR ‘international students’ OR ‘refugees’ OR ‘asylum seekers’ OR ‘smuggled migrants’) AND ‘mental health’. VOSviewer was used to conduct bibliometric analysis, focusing on co-authorship patterns, keyword co-occurrence, and citation networks. Results: Over the past four decades, research on the mental health of international migrants has grown substantially, with major migration destinations such as the United States, Europe, and Australia playing prominent roles in this field. ‘Post-traumatic stress disorder (PTSD)’ was the most frequent keyword in publications, with strong links to ‘trauma’ and ‘depression’. In recent years, with the impact of global socioenvironmental changes and emergencies such as the COVID-19 pandemic, the research focus has gradually shifted towards social support, service accessibility, and cultural adaptation. Conclusions: International migration is a far-reaching global phenomenon, and addressing the mental health of migrant populations is essential for advancing public health, social cohesion, and sustainable development. This study provides the first bibliometric overview of research in this domain, mapping its thematic evolution and collaborative structure. The findings offer valuable insights into the field’s development and may support future interdisciplinary collaboration and the formulation of culturally informed, evidence-based approaches in migrant mental health. Full article

(1) Background: Physical activity (PA) plays a crucial role in preserving and enhancing mental health, particularly in the aftermath of major health crises such as the COVID-19 pandemic. However, the specific levels and domains of physical activity that have the greatest impact on alleviating symptoms of anxiety, depression, and stress in the post-COVID-19 period remain unclear. The aim of this study was to examine the influence of different levels and domains of PA on mental health parameters, specifically symptoms of anxiety, depression, and stress, in individuals who had recovered from COVID-19. (2) Methods: The study included initial measurements (2–4 weeks post-recovery) and final measurements (14–16 weeks post-recovery). The sample comprised 288 participants aged 20 to 60 years (M = 47.06; SD = 12.41), with 95 men and 193 women. PA was assessed using the long version of the IPAQ questionnaire, while mental health was evaluated using the long version of the DASS scale. (3) Results: Stepwise regression analysis revealed that low- (p = 0.010) and moderate-intensity (p = 0.022) PA was significantly associated with reductions in anxiety symptoms as well as lower stress levels (low PA: p = 0.014; moderate PA: p = 0.042). Total PA (p < 0.001) and vigorous-intensity PA (p = 0.008) emerged as significant predictors of reduced depression levels. Among the domains of PA, home-based activities had a statistically significant impact on all three mental health components: anxiety (p = 0.005), depression (p = 0.002), and stress (p = 0.041). Transport-related PA was significantly associated with anxiety (p = 0.011) and stress (p = 0.022), but not with depression. (4) Conclusions: The results suggest that a combined model incorporating different levels and domains of PA may represent an effective approach to improving mental health in individuals recovering from COVID-19. Further longitudinal studies are needed to establish more precise causal relationships. Full article

Mental health difficulties in university students are an increasing concern, especially after the COVID-19 global crisis. This study used a cross-sectional design to analyze the effect of psychological factors on students’ psychological well-being. Participants were 190 university students enrolled in undergraduate or graduate programs at a public university. Based on previous research and grounded theoretical models, a conceptual model was proposed to analyze the influence of affect states/experiences (emotion regulation difficulties, anxiety and depression, perceived stress, self-compassion, gratitude, and satisfaction with life) on psychological well-being, including the indirect effect of emotions (negative emotions, positive activation emotions, self-efficacy emotions, prosocial emotions, and serenity emotions), using a path analysis. Multigroup analyses were also performed to test the moderating effect of gender and education level. Findings indicated that self-efficacy emotions had an indirect effect on the relationship between anxiety and depression, self-compassion, and psychological well-being. Both prosocial and self-efficacy emotions indirectly impacted the relationship between gratitude, satisfaction with life, and psychological well-being. Being a female and a bachelor student played a moderating role in the final model. The findings suggest that psychological interventions focused on self-efficacy and prosocial emotions are needed to increase psychological well-being in university students. Full article

Background/Objectives: Both traumatic and stressful events, including major life changes, may contribute to post-traumatic stress symptoms (PTS), often associated with anxiety and depression. Feelings of loneliness may influence these relationships, whilst social support seems to mitigate the effects of stressful events on mental health. Our study thus aimed to evaluate the mediating role of loneliness in the relationships between PTS and both anxiety and depressive symptoms among university students. Methods: The data were from the CAMPUS study (0058642/21; FHMS 20-21 157), a survey on university students’ mental health in Italy and the UK. Using a logit model, mediation analyses were carried out to test whether the relationships between PTS and both anxiety and depressive symptoms might be mediated by loneliness. A path analysis was then performed to jointly test the associations between the Impact of Event Scale—Revised (IES-R)’s subscales and clinical domains. Results: Positive associations were found between PTS and both anxiety (p < 0.001) and depressive symptoms (p < 0.001). However, loneliness mediated approximately 22% of the effect of the PTS on anxiety symptoms (indirect effect: 1.04, 95% CI: 0.59; 1.48, p < 0.001) and approximately 33% of the effect of the PTS on depressive symptoms (indirect effect: 1.81, 95% CI: 1.22; 2.39, p < 0.001). Furthermore, the path analysis indicated associations between the IES-R’s hyperarousal subscale and both anxiety (coeff.: 0.34, p < 0.001) and depressive symptoms (coeff.: 0.27, p < 0.001). Conclusions: Along with the associations between PTS and both anxiety and depressive symptoms, our findings highlight the key role of loneliness in both these associations. Targeted interventions to reduce loneliness, especially for students exposed to traumatic events, may ultimately improve their mental health. Full article

Objectives: Saffron, a traditional Chinese medicine, is renowned for its pharmacological effects in promoting blood circulation, resolving blood stasis, regulating menstruation, detoxification, and alleviating mental disturbances. Trans-crocetin, its principal bioactive component, exhibits significant anti-hypoxic activity. The clinical development and therapeutic efficacy of trans-crocetin are limited by its instability, poor solubility, and low bioavailability. Conversion of trans-crocetin into trans-sodium crocetinate (TSC) enhances its solubility, stability, and bioavailability, thereby amplifying its anti-hypoxic potential. Methods: This study integrates network pharmacology with in vivo and in vitro validation to elucidate the molecular targets and mechanisms underlying TSC’s therapeutic effects against high-altitude acute lung injury (HALI), aiming to identify novel treatment strategies. Results: TSC effectively reversed hypoxia-induced biochemical abnormalities, ameliorated lung histopathological damage, and suppressed systemic inflammation and oxidative stress in HALI rats. In vitro, TSC mitigated CoCl₂-induced hypoxia injury in human pulmonary microvascular endothelial cells (HPMECs) by reducing inflammatory cytokines, oxidative stress, and ROS accumulation while restoring mitochondrial membrane potential. Network pharmacology and pathway analysis revealed that TSC primarily targets the EGFR/PI3K/AKT/NF-κB signaling axis. Molecular docking and dynamics simulations demonstrated stable binding interactions between TSC and key components of this pathway. ELISA and RT-qPCR confirmed that TSC significantly downregulated the expression of EGFR, PI3K, AKT, NF-κB, and their associated mRNAs. Conclusions: TSC alleviates high-altitude hypoxia-induced lung injury by inhibiting the EGFR/PI3K/AKT/NF-κB signaling pathway, thereby attenuating inflammatory responses, oxidative stress, and restoring mitochondrial function. These findings highlight TSC as a promising therapeutic agent for HALI. Full article

Air traffic controllers (ATCOs) make a significant contribution to ensuring flight safety, making this profession a highly stressful job globally. Job demands–resources (JDR) theory proposes a health impairment process stemming from job demand (complexity) to mental workload, which causes job stress, resulting in compromised flight safety. This vicious cycle is evident among ATCOs and is recognized as an unsustainable management practice. To curb this process, we propose intra-functional flexibility as a conditional factor. Intra-functional flexibility refers to the flexibility in the reallocation and coordination of resources among team members to help in urgent times. This is a relatively new concept and is yet to be empirically tested in the ATCO context. ATCOs work in a dynamic environment filled with sudden surges of urgent jobs to be handled within short time limits. Intra-functional flexibility allows standby crews to be called to ease these tensions when needed. To ascertain the role of intra-functional flexibility in mitigating health impairment among ATCOs, a questionnaire was administered to 324 ATCOs distributed across Saudi Arabia. Partial Least Squares Structural Equation Modeling (PLS-SEM) analysis exhibited two critical findings: First, the study revealed the prevalence of a vicious cycle of health impairment among Saudi ATCOs, whereby job complexity leads to increased mental workload, resulting in elevated levels of job stress. Secondly, the presence of intra-functional flexibility weakened this vicious cycle by mitigating the influence exerted by mental workload on job stress. That is, the mediation-moderated model proposed in this study provides empirical evidence supporting the applicability of intra-functional flexibility in mitigating the dire suffering of ATCOs. This study discusses limitations and future research directions in the end. Full article

Climate change disrupts lives globally and poses significant challenges to mental health. Although several scales assess climate anxiety, many either conflate symptoms with coping responses or fail to adequately capture the core symptomatology of anxiety. Hence, this study aimed to develop and validate the Brief Anxiety Scale for Climate Change (BACC), a self-report measure designed to assess symptoms of climate anxiety. A preliminary pool of 21 items was generated based on the diagnostic criteria for generalized anxiety disorder and climate-related stress. Study 1 (n = 300) explored the factor structure via an exploratory factor analysis while Study 2 (n = 400) independently validated the structure via a confirmatory factor analysis (CFA). Analyses of the internal consistency, content validity, and discriminant validity helped refine the scale to a final 13-item version with two factors: cognitive and functional impairment. The CFA results indicated that all the fit indices met the recommended thresholds, and the final version demonstrated excellent internal consistency (Cronbach’s α = 0.92). Additionally, latent correlations revealed that climate anxiety was moderately associated with generalized anxiety and depression. The BACC was developed to identify individuals in the community who experience climate anxiety beyond an adaptive level, thereby promoting sustainable mental health in the context of climate change. These findings suggest that the BACC is a promising tool for assessing climate anxiety. With better identification, mental health professionals, community practitioners, and policymakers can utilize the scale to develop climate-sensitive public health programs and tailored intervention strategies. Full article

Providing long-term care for a person with Alzheimer’s disease is associated with chronic stress and emotional overload. One of the key predictors of emotional burden is the amount of time devoted to caregiving, which intensifies the experienced stress. Additional risk factors include the stage of the illness, difficulties in the care recipient’s activities of daily living, the caregiver’s neglect of their own needs, and challenging behaviours exhibited by the person receiving care. Therefore, it is essential to identify the psychological protective resources of caregivers that can buffer the impact of stress. Background/Objectives: The objective of the study was to explore the psychological mechanisms underlying the involvement of caregivers supporting individuals with Alzheimer’s disease. A moderated mediation model was employed, in which stress indirectly affects caregiver involvement through a sense of coherence, and the strength of this relationship is moderated by the amount of time devoted to caregiving. Methods: The bootstrapping method was applied using 5000 resamples within a 95% bias-corrected confidence interval. The analysis accounted for variables such as stress levels, sense of coherence, involvement in caregiving, duration of care, education, gender, age, and stage of the illness. Results: The sense of coherence mediated the relationship between stress and involvement in caring (B = 0.0063, SE = 0.0031, 95% CI [0.0012, 0.0135]), and this indirect effect was contingent upon the amount of time devoted to helping. The relationship between sense of coherence and involvement in caring was significant at the mean level (B = 0.005, SE = 0.002, 95% CI [0.0004, 0.0101]) and became stronger at high levels of time devoted to caring (+1 SD; B = 0.009, SE = 0.003, 95% CI [0.0030, 0.0148]). These results indicate that the positive association between sense of coherence and caregiver involvement increases with the amount of time spent caring. Conclusions: The results highlight the importance of strengthening caregivers’ resilience resources—such as a sense of coherence—in preventing overload. The model may serve as a foundation for developing interventions aimed at supporting caregivers’ mental health. Full article

Background/Objective: Frontline healthcare staff who contend diseases and mitigate their transmission were repeatedly exposed to high-risk conditions during the COVID-19 pandemic. They were at risk of mental health issues, in particular, psychological stress, depression, anxiety, financial stress, and/or burnout. This study aimed to investigate and evaluate the occupational stress of medical doctors, nurses, pharmacists, physiotherapists, and other hospital support crew during the COVID-19 pandemic in Saudi Arabia. Methods: We collected both qualitative and quantitative data from a survey given to public and private hospitals using methods like correspondence analysis, cluster analysis, and structural equation models to investigate the work-related stress (WRS) and anxiety of the staff. Since health-related factors are unclear and uncertain, a fuzzy association rule mining (FARM) method was created to address these problems and find out the levels of work-related stress (WRS) and anxiety. The statistical results and K-means clustering method were used to find the best number of fuzzy rules and the level of fuzziness in clusters to create the FARM approach and to predict the work-related stress and anxiety of healthcare staff. This innovative approach allows for a more nuanced appraisal of the factors contributing to work-related stress and anxiety, ultimately enabling healthcare organizations to implement targeted interventions. By leveraging these insights, management can foster a healthier work environment that supports staff well-being and enhances overall productivity. This study also aimed to identify the relevant health factors that are the root causes of work-related stress and anxiety to facilitate better preparation and motivation of the staff for reorganizing resources and equipment. Results: The results and findings show that when the financial burden (FIN) of healthcare staff increased, WRS and anxiety increased. Similarly, a rise in psychological stress caused an increase in WRS and anxiety. The psychological impact (PCG) ratio and financial impact (FIN) were the most influential factors for the staff’s anxiety. The FARM results and findings revealed that improving the financial situation of healthcare staff alone was not sufficient during the COVID-19 pandemic. Conclusions: This study found that while the impact of PCG was significant, its combined effect with FIN was more influential on staff’s work-related stress and anxiety. This difference was due to the mutual effects of PCG and FIN on the staff’s motivation. The findings will help healthcare managers make decisions to reduce or eliminate the WRS and anxiety experienced by healthcare staff in the future. Full article

Introduction: Unruptured intracranial aneurysms (UIAs) can induce psychological stress, leading to anxiety, depression, and impaired quality of life (QoL). Most studies on this topic are limited by small sample sizes, cross-sectional designs, and a focus on treated rather than untreated cases, leaving a gap in the literature. We aimed to conduct a systematic review and meta-analysis to evaluate mental health and QoL outcomes in patients with untreated UIAs. Methods: A systematic search was conducted up to 30 November 2024 using PubMed, Scopus, and Cochrane Central for studies comparing patients with untreated UIAs to a control group. The outcomes of interest included anxiety, depression, and QoL. Statistical analysis was performed using RevMan 5.1.7 and R 4.3.1. Heterogeneity was assessed using I² statistics and the Cochrane Q test. Risk ratios (RR) and standardized mean differences (SMD) were computed using a frequentist random-effects model. Results: We included five studies with 417,152 patients, of whom 85,668 (20.53%) had untreated UIAs. In the pooled analysis, patients with untreated UIAs had significantly higher anxiety levels (SMD 0.66; 95% CI [0.16; 1.17]; p = 0.01; I² = 76%) and lower QoL (SMD −0.82; 95% CI [−1.12; −0.53]; p = 0.01; I² = 56%) compared to the control group However, no statistically significant differences were found in depression (RR 0.94; 95% CI [0.52; 1.72]; p = 0.84; I² = 88%) between groups. Conclusions: This meta-analysis indicates a potential association between untreated UIAs and increased anxiety levels and reduced QoL. Regarding depression, no significant differences were observed between groups. Full article