Search Results (73)

Objectives: This study assessed the effectiveness of a cognitive behavioral therapy (CBT)-based fine dust education program, grounded in the Health Belief Model (HBM), on elementary students’ fine dust knowledge, related behaviors, and mental health (depression, anxiety, stress, sleep quality). Methods: From September to November 2024, 95 students (grades 4–6) living near a coal-fired power plant in midwestern South Korea were assigned to either an intervention group (n = 44) or a control group (n = 51). The intervention group completed a three-session CBT-based education program; the control group received stress management education. Assessments were conducted at weeks 1, 2, 4, and 8 using standardized mental health and behavior scales (PHQ: Patient Health Questionnaire, GAD: Generalized Anxiety Disorder Assessment, PSS: Perceived Stress Scale, ISI: Insomnia Severity Index). Results: A chi-square test was conducted to compare pre- and post-test changes in knowledge and behavior related to PM2.5. The intervention group showed significant improvements in seven fine dust-related knowledge and behavior items (e.g., PM2.5 awareness rose from 33.3% to 75.0%; p < 0.05). The control group showed limited gains. Regarding mental health, based on a mixed-design ANCOVA, anxiety scores significantly declined over time in the intervention group, with group and interaction effects also significant (p < 0.05). Depression scores showed time effects, but group and interaction effects were not significant. No significant changes were observed for stress, sleep, or group × PM2.5 interactions. Conclusions: The CBT-based education program effectively enhanced fine dust knowledge, health behaviors, and reduced anxiety among students. It presents a promising, evidence-based strategy to promote environmental and mental health in school-aged children. Full article

The insular cortex has emerged as a key region implicated in a wide array of cognitive, emotional, and sensory processes. The anterior part of the insula (AIC) is central to emotional awareness, decision-making, and interoception, while the posterior insula (PIC) is more associated with somatosensory processing. The insula acts as a functional hub within the salience network and integrates homeostatic, affective, and cognitive information; thus, its role in different mental disorders seems to be prominent. Altered structure and connectivity of the insular cortex are evident in several psychiatric conditions. In schizophrenia, reductions in insular volume—especially on the left—correlate with hallucinations, emotional dysregulation, and cognitive deficits. Bipolar and major depressive disorders exhibit AIC volume loss and aberrant connectivity patterns linked to impaired affect regulation and interoceptive awareness. Anxiety disorders show functional hyperactivity of the insula, especially in response to fear-inducing stimuli, though findings on structural changes are mixed. Overall, growing evidence underscores the insular cortex’s central role in psychiatric pathophysiology and highlights its potential as a target for future diagnostic and therapeutic strategies. Full article

Background/Objectives: The use of digital technologies among children and adolescents has been increasing exponentially, raising concerns about the potential impacts on physical, mental, cognitive, educational, and social development. Understanding these effects is key to informing clinical and educational practices and public policies that promote digital wellbeing in childhood and adolescence. The main objective of this study was to map the latest available scientific evidence on the patterns of digital technology use by children and adolescents and its main impact, identifying risk factors, opportunities, and strategies for promoting digital wellbeing. Methods: A rapid review was carried out following the Joanna Briggs Institute (JBI) guidelines. Quantitative, qualitative, and mixed studies published between 2020 and 2025, in Portuguese or English, that addressed the use of digital technologies by children and adolescents were included. The assessment of methodological quality was based on JBI’s Critical Appraisal Tools. Results: Ten studies from diverse contexts showed an association between excessive screen time and risks of sedentary lifestyles, sleep disorders, anxiety, depression, attention difficulties, and low academic performance. Occasional benefits arose with adult mediation and educational use; parental mediation and socioeconomic background were key factors. Conclusions: The use of digital technologies is a complex and multifactorial phenomenon that requires integrated approaches; the promotion of digital literacy, public policies for equitable access to quality digital resources, and longitudinal and intercultural studies are recommended to clarify causal relationships and adapt interventions to local contexts. Full article

Objective: This study aims to investigate the feasibility of an online music therapy protocol for individuals previously diagnosed with COVID-19, focusing on their perceptions of their respiratory symptoms and the intervention’s impact on psychosocial measures. Methods: A within-subject experimental design was applied to examine an eight-week weekly online music therapy protocol, including singing, wind instrument playing, and music visualizations. All self-report data were collected bi-weekly throughout the 16-weeks study period, including baseline and post-tests. The measures for respiratory symptoms included the Medical Research Council’s Dyspnea Scale (MRC Dyspnea), Chronic Respiratory Questionnaire-Mastery Scores (CRQ Mastery), and Visual Analogue Scale for breathlessness. The measures for the secondary psychosocial outcomes were the Beck Depression Inventory-Short Form, the Generalized Anxiety Disorder 7-item, the Hospital Anxiety and Depression Scale, the Fatigue Severity Scale, the Epworth Sleepiness Scale, the EuroQol 5-Dimension 5-Level, and the Connor-Davidson Resilience Scale. Results: Twenty-four participants were enrolled. The participants perceived a reduction in respiratory symptoms, and shortness of breath (MRC Dyspnea). Planned comparisons showed significant decreases in MRC from baseline to post-treatment (p = 0.008). The mixed-effects model, including pre-baseline and post-treatment, was significant (p < 0.001). Significant changes in Breathing VAS were consistent with improvements in MRC Dyspnea, showing a significant baseline-to-post difference (p = 0.01). The CRQ Mastery showed significant improvements from baseline to Week 12 (p < 0.001). No significant changes were observed in other secondary measures. Conclusions: Our preliminary findings suggest that this protocol is feasible, and as a result, may help individuals previously diagnosed with COVID-19 to cope with lasting respiratory symptoms and improve their perception of shortness of breath. Live music-making, including playing accessible wind instruments and singing, may contribute to an increase sense of control over breathing. As this was a feasibility study, we conducted multiple uncorrected statistical comparisons to explore potential effects. While this approach may increase the risk of Type I error, the findings are intended to inform hypotheses for future confirmatory studies rather than to draw definitive conclusions. Full article

Opioid use disorder (OUD) and posttraumatic stress disorder (PTSD) frequently co-occur. However, there are no psychotherapy treatments intentionally designed for this comorbidity, nor designed to be augmented with medications for OUD. In this open-label pilot trial, we tested Helping Opioid Use Disorder and PTSD with Exposure (HOPE), a novel integrated, trauma-focused treatment for individuals (N = 6) with OUD/PTSD who were stabilized on medications for OUD. HOPE was delivered weekly for 10–12 sessions, and one follow-up visit was conducted ~1-month post-treatment. Primary outcomes included urine drug screens, the Timeline Followback, Desire for Drugs Questionnaire, Clinician-Administered PTSD Scale-5 (CAPS-5), and PTSD Checklist-5 (PCL-5). Boot-strapped linear mixed effect models and generalized estimating equations showed that PTSD symptoms (CAPS-5: B = −7.16, SE = 1.24, p < 0.01; PCL-5: B = −2.04, SE = 0.26, p < 0.01), desire for opioids (B = −0.56, SE = 0.15, p < 0.01), depression symptoms (B = −0.43, SE = 0.09, p < 0.01), and anxiety symptoms (B = −0.50, SE = 0.08, p < 0.01) decreased significantly over time. Client satisfaction increased throughout the study (B = 0.18, SE = 0.08, p = 0.02), and 83.3% of participants completed the therapy and follow-up visit. There were no significant changes in opioid or other substance use from baseline to follow-up. Although preliminary, results show high acceptability and feasibility of the HOPE therapy and demonstrate significant improvements in PTSD and associated symptoms with an integrated, trauma-focused treatment. Full article

Background: Somatic symptom disorder (SSD) in children may be influenced by stress reactivity and psychosocial factors. The glucocorticoid receptor (GR), encoded by NR3C1, is a key mediator of stress responses. However, the relationship between NR3C1 methylation and SSD remains unclear. Methods: We analyzed NR3C1 exon 1F methylation in cell-free DNA from saliva in 34 children with SSD and 29 age- and sex-matched controls using bisulfite amplicon sequencing. Psychological assessments included the Beck Depression Inventory-II (BDI-II) and KINDL questionnaires to evaluate associations with methylation patterns. Results: Methylation levels showed age-related differences. In children under 13, CpG sites displayed mixed methylation, and specific sites correlated with KINDL and BDI-II scores. KINDL physical and total well-being scores negatively correlated with CpG30 and positively with CpG35; BDI-II scores negatively correlated with CpG32 and CpG35. In children aged 13 or older, CpG sites showed uniformly high methylation with no correlation to psychological measures. The SSD group showed significantly higher average methylation across the exon 1F region than controls in the older age group. These children also had more cases of orthostatic dysregulation and longer illness duration. Conclusions: This study suggests age-dependent epigenetic regulation of NR3C1 in SSD. While younger children showed CpG-specific correlations with psychological symptoms, older children demonstrated uniformly high methylation and potentially reduced gene expression, potentially reflecting cumulative stress, autonomic dysfunction, and internalizing disorders such as anxiety and depression. Full article

Background/Objectives: Anxiety disorders are the most prevalent mental illnesses worldwide and in Portugal, often resulting in chronicity and disability. The objective of this study is to evaluate the sociodemographic and health-related factors associated with anxiety in the Portuguese adult population. Methods: This study included participants aged 18 to 65 years from the nationwide, population-based EpiDoC cohort, who were followed from 2011 to 2021 (n = 2927). Anxiety was assessed using the Hospital Anxiety and Depression Scale (HADS). A mixed logistic regression analysis was performed using a prospective analytical approach. Two strategies were used to adjust the mixed models: (i) model with only complete observations (n = 1950) and (ii) model with imputation of the category “No” in missing self-reported diseases (n = 2554). Results: The proportion of anxiety symptoms decreased from 2011–2013 to 2021 (12.5% vs. 8.5%). Experienced anxiety symptoms were positively associated (OR > 1, p < 0.05) with being female; having a high school, 2nd and 3rd cycle (6–9 years of studies), or primary/no education; being unemployed; seeking the first job; and not working or being temporarily unable to work. Additionally, anxiety symptoms were positively associated (OR > 1, p < 0.05) with smoking daily, lack of physical exercise, and medication use. Digestive diseases, multimorbidity, and region were also positively associated (OR > 1, p < 0.05) with anxiety symptoms. Moreover, age was negatively associated (OR < 1, p < 0.05) with experiencing anxiety symptoms. Conclusions: Some determinants are modifiable and preventable through economic, social, and health policies. Measures to promote healthy lifestyles, like physical exercise, reduce substance abuse, prevent chronic diseases, increase employability, and increase schooling and health literacy, are necessary to reduce the anxiety rate in Portugal. Full article

Background: Screening for substance use disorder (SUD) is a critical step to address the ongoing opioid crisis in the U.S., but fewer than 10% of people at risk screen. Technology may play a role in substantially increasing screening by making screening accessible through artificially intelligent (AI) chatbots. Methods: This was a single-arm mixed-methods pilot study to establish the system usability of an AI chatbot delivering information about substances, substance use disorder, and treatment options, and implementing self-screening for anxiety, depression, and substance use disorder. Participants were asked to engage with the AI chatbot for seven days and could self-select to screen. Results: Of the 92 participants enrolled, 91 engaged with the system at least once, and 29 (32%) completed at least one screener. Those who screened were given a referral if they exhibited moderate or severe anxiety, depression, and/or SUD. Over three-quarters (83%) of those screened received a referral for treatment, and 50% of those referred made an appointment for care. Users indicated that they found the system helpful and informative, and they felt comfortable screening. Conclusions: While other AI systems that share information about mental health and substance use exist, we know of no other AI chatbot that is being deployed specifically to facilitate SUD screening and referral. The system we describe here shows potential to support self-screening. Users generally find the system acceptable to use. AI technology may allow for improved access to SUD screening and treatment referrals, a critical step in responding to the opioid crisis. Full article

Background: Depression is one of the leading causes of disability worldwide. Among pharmacological treatments, fluvoxamine—an early SSRI with a distinct pharmacological profile—has been recently reappraised for its broader clinical relevance. Objective: To assess the efficacy of fluvoxamine in the treatment of depression compared to placebo and other antidepressants through a comprehensive overview of systematic reviews and meta-analyses. Methods: A systematic search was conducted in MEDLINE and the Cochrane Central Register of Controlled Trials, including systematic reviews and meta-analyses of randomized controlled trials evaluating fluvoxamine’s efficacy. Reviews were eligible if they included adults diagnosed with depressive disorders based on the DSM or ICD criteria. Reviews focusing on other psychiatric disorders, comorbidities, tolerability, or economic evaluations were excluded. Data extraction included effect size measures and methodological quality assessments using the AMSTAR-2 tool. Results were synthesized by comparing fluvoxamine to placebo, tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and other antidepressants. Results: A total of 74 reviews were identified, of which 14 systematic reviews met the inclusion criteria after screening and full-text analysis. These reviews, published between 1994 and 2021, predominantly involved nine pairwise meta-analyses and five network meta-analyses, comparing fluvoxamine with placebo and various antidepressants. Fluvoxamine demonstrated consistent superiority over placebo in achieving treatment response and remission outcomes. Comparisons with imipramine, clomipramine, amitriptyline, dothiepin, paroxetine, fluoxetine, citalopram, mianserin, nortriptyline, and moclobemide generally revealed no significant differences in efficacy. However, some reviews indicated that venlafaxine and mirtazapine were superior to fluvoxamine in certain outcomes, while fluvoxamine demonstrated greater efficacy than desipramine in one review. Sertraline and milnacipran showed mixed or review-quality-dependent results, with one low-quality review favoring milnacipran. Most reviews assessed outcomes over a median follow-up of six weeks using standardized depression rating scales. Conclusions: Fluvoxamine is a robust and effective antidepressant, demonstrating consistent efficacy comparable to other antidepressants and superior to placebo. While no single antidepressant was universally superior, fluvoxamine’s unique pharmacological profile and favourable safety characteristics support its clinical utility. Further research is needed to explore its role in personalized treatment strategies and emerging therapeutic contexts, such as comorbid anxiety and post-traumatic stress disorder. Full article

Psychiatric disorders are a major cause of illness in the world. Unfortunately, many patients are resistant to treatment and present serious complications. Schizophrenia is refractory to treatment in about one-third of patients. Antidepressants are effective in about half of patients. Suicidal ideation is an increasing issue in patients with mixed features in bipolar disorder (BD). Therefore, there is a need to develop and test new drugs or new indications of available medications for the treatment of psychiatric disorders through evidence-based investigations. This narrative review aims to present the molecules approved by the main drug agencies, the Food and Drug Administration (FDA) and the European Medicines Agency (EMA), from 2018 to date, along with new indications and new formulations of existing medications. We searched PubMed for new drugs approved for schizophrenia, BD, major depressive disorder (MDD), anxiety disorders, and obsessive-compulsive disorder (OCD). We evaluated their clinical benefits, safety, and tolerability profiles. Finally, we considered studies on the main molecules that have shown initial evidence of efficacy and are in the process of obtaining approval. Our search suggested that a new antipsychotic, lumateperone, and two drug combinations, olanzapine/samidorphan (OLZ/SAM) and xanomeline/trospium (KarXT), were approved for schizophrenia. In addition, some new methods of administration—monthly risperidone administration, subcutaneous risperidone administration, and transdermal asenapine administration—obtained approval from the main drug agencies. Lumateperone and OLZ/SAM were also approved in BD. Esketamine, a compound that modulates glutamatergic transmission, was approved to treat treatment-resistant depression and acute suicidal ideation. The dextromethorphan/bupropion combination was approved for MDD. Two new agents, brexanolone and zuranolone, were approved for treatment of postpartum depression. On the other hand, no new drugs received approval for anxiety disorders or OCD. In summary, some new psychotropic medications have been developed, in particular with the aim to improve the symptoms of resistant patients and to decrease the incidence of adverse effects. It is necessary to continue testing the effectiveness of new compounds in methodologically rigorous studies. Full article

Mental health disorders have a high prevalence in Latin America (LATAM), with an estimated 6.7% of the population suffering from anxiety and 4% from depression. Digital mental health interventions (DMHIs) have been implemented to address these issues. However, there has yet to be a clear picture of these interventions in the region. This scoping review aims to analyze DMHIs’ characteristics and the barriers and facilitators for their implementation in five LATAM countries (Brazil, Chile, Colombia, Mexico, and Peru). To achieve this goal, four databases (PubMed, APA PsycNet, Scielo, and LILACS) were searched using relevant search terms in English, Spanish, and Portuguese. A total of 484 references were identified and narrowed down to 15 articles included in the final analysis. The studies mostly consisted of RCTs and mixed-methods studies. Most of the DMHIs were designed for individuals, with a focus on targeted communication and personal health tracking. Interventions targeting healthcare professionals were less common, primarily focusing on decisional support. The most prominent barriers to the successful implementation of DMHIs included insufficient healthcare professional training (40%) and resistance from clinicians and organizational culture (40%), while common facilitators included easy access to the interventions (46.7%) and increased training and support for clinical teams (46.7%). Positive outcomes were reported in terms of both effectiveness (33.3%), with many interventions showing results equal to or better than traditional methods (33.3%), and patient satisfaction (33.3%). Full article

This study employed Linguistic Inquiry and Word Count (LIWC-22) software, a language analysis tool, to examine Spanish-language pro-NSSI Tumblr posts. Pro-NSSI, or “pro non suicidal self-injury”, refers to online content that normalizes or supports self-harming behaviors. Given the strong associations between NSSI and conditions such as post-traumatic stress disorder (PTSD), anxiety, and depression, understanding how these behaviors are discussed online can help improve interventions. A year’s worth of public posts were collected, focusing on captions and hashtags that included NSSI-related terms. Using Linguistic Inquiry and Word Count (LIWC) software, we analyzed linguistic and psychological markers. Log-likelihood ratio tests revealed significantly higher frequencies of words related to negative emotions, sadness, health, and death compared to standard blog norms. Mixed-language posts showed notable code-switching, suggesting a possible emotional distancing mechanism when discussing self-harm. The findings indicate that Spanish-speaking adolescents engaging in pro-NSSI communities exhibit unique linguistic and psychological characteristics, with important implications for clinical assessment and intervention. Mental health counselors and educators can use these insights to develop culturally and linguistically responsive strategies for prevention and support. Full article

Background: Rescue teams and emergency services face high levels of mental health problems due to their frequent exposure to traumatic situations. Critical incident stress debriefing (CISD) is widely used as a psychological intervention for emergency responders and military personnel exposed to traumatic events. However, its effectiveness remains controversial, with systematic reviews yielding mixed results and some evidence of negative and harmful outcomes. This systematic review, conducted according to PRISMA guidelines, evaluates the evidence on the efficacy of CISD in mitigating psychological distress and preventing post-traumatic stress disorder (PTSD). Methods: A systematic search was conducted in PubMed and PsycINFO from inception to November 2024. Eligibility criteria included randomized controlled trials (RCTs) and cohort studies assessing the impact of CISD on PTSD, anxiety, depression, and psychological distress. Two independent reviewers screened studies, extracted data, and assessed the risk of bias using the PEDro scale. Data narrative synthesis was applicable. Results: A total of 6 out of 371 studies were included, comprising 4751 participants. The PEDro scale showed that one study was of high methodological quality, four were of acceptable quality, and two had deficiencies. The findings revealed mixed outcomes: while some studies reported a reduction in PTSD symptoms, others found no significant effect or even potential harm. Heterogeneity in intervention implementation, population characteristics, and study quality influenced the results. Risk of bias was moderate to high in several studies, with limitations in sample size and follow-up duration. No specific effects have been studied in mountain rescue teams. Conclusions: Current evidence does not unequivocally support the efficacy of CISD in preventing PTSD and psychological distress. Given methodological concerns and potential adverse effects, alternative debriefing methods, such as Battlemind debriefing, warrant further exploration. Future research should focus on well-powered RCTs with standardized intervention protocols to enhance reliability. Full article

Background and Objectives: Mental health disorders, including major depressive disorder and adjustment disorder with mixed anxiety and depressed mood, present a significant global burden, with early onset and progression leading to substantial individual and social impacts. While pharmacotherapy remains the standard treatment, many patients experience inadequate symptom relief or intolerable side effects. In this context, transcranial magnetic stimulation (TMS) has emerged as a non-invasive, well-tolerated neuromodulation technique offering an alternative treatment option. Although its clinical efficacy is well-documented, limited research exists on patient perceptions, decision-making processes and barriers to TMS utilization in private healthcare settings, particularly in Romania. This study explores patients’ experiences with TMS, factors influencing their treatment choices and comparative views on its acceptability relative to pharmacological interventions. Materials and Methods: A qualitative research design was employed, using semi-structured interviews with 20 patients diagnosed with MDD or AD who had undergone TMS therapy as part of two pilot studies which were non-randomized in Romanian private practices. Data were collected via interviews and analyzed thematically to identify patterns in patient perceptions, decision-making factors and treatment experiences. Results: Participants reported predominantly positive perceptions of TMS, citing improvements in mood, anxiety reduction, and enhanced daily functioning. The most common motivations for seeking TMS included dissatisfaction with pharmacotherapy, recommendations from physicians or peers and information obtained via online sources. TMS was perceived as a safer and more tolerable alternative to medication, particularly due to its lack of systemic side effects. However, barriers such as high treatment costs, limited insurance coverage and logistical challenges in accessing TMS services were noted as significant deterrents. Conclusions: The study highlights the strong preference for TMS among patients who seek alternatives to pharmacotherapy, with key motivators including efficacy, tolerability and non-invasiveness. However, systemic barriers to access remain a critical challenge in private healthcare settings. Future research should focus on expanding accessibility, improving patient education and integrating TMS into broader mental healthcare frameworks to optimize treatment outcomes. Full article

Background and Objectives: Recent research has focused on exploring the relationships between various factors associated with headaches and understanding their impact on individuals’ psychological states. Utilizing statistical methods and machine learning models, these studies aim to analyze and predict these relationships to develop effective approaches for headache management and prevention. Materials and Methods: Analyzing data from 398 patients (train set = 318 and test set = 80), we investigated the influence of various features on outcomes such as depression, anxiety, and headache intensity using machine learning and linear regression. The study employed a mixed-methods approach, combining medical records, interviews, and surveys to gather comprehensive data on participants’ experiences with headaches and their associated psychological effects. Results: Machine learning models, including Random Forest (utilized for Headache Impact Test-6, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7) and Support Vector Regression (applied to Migraine Disability Assessment), revealed key features contributing to each outcome through Shapley values, while linear regression provided additional insights. Frequent analgesic medication emerged as a significant predictor of poorer life quality (Headache Impact Test-6, root mean squared error = 7.656) and increased depression (Patient Health Questionnaire-9, root mean squared error = 5.07) and anxiety (Generalized Anxiety Disorder-7, root mean squared error = 4.899) in the Random Forest model. However, interpreting the importance of features in complex models like supportive vector regression poses challenges, and determining causality between factors such as medication usage and pain severity was not feasible. Conclusions: Our study underscores the importance of considering individual characteristics in optimizing treatment strategies for headache patients. Full article