Search Results (18,395)

Metabolic syndrome (MetS), characterized by a cluster of interrelated metabolic abnormalities including central obesity, elevated blood pressure, dysglycemia, hypertriglyceridemia, and reduced high-density lipoprotein cholesterol (HDL-C), substantially increases type 2 diabetes and cardiovascular disease risk. Conventional genome-wide association studies (GWASs) analyze individual traits or a dichotomized MetS status, only partially capturing its heritability and potentially overlooking variants with shared (pleiotropic) effects across correlated traits. Here, we performed a multiple-trait GWAS using data from the Korean Genome and Epidemiology Study. Using the Korea Biobank Array (K-Chip), we analyzed a discovery cohort from the Ansan and Ansung studies (1490 cases and 3856 controls) and validated the findings in CAVAS (3620 cases and 4461 controls) and HEXA (15,257 cases and 41,807 controls) cohorts. We jointly modeled six MetS-related traits using the complementary multivariate frameworks Multiple Phenotype Association Tests and Genome-wide Efficient Mixed Model Association, alongside a baseline logistic regression. Whereas logistic regression detected 2 APOA5 variants (rs662799 and rs2075291), the multivariate analyses identified 79 significant single-nucleotide polymorphisms; all were replicated in the HEXA cohort. Functional annotation prioritized 27 high-risk variants mapping to 12 genes, whereas pathway analysis (DAVID) implicated eight Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathways related to lipid metabolism. Our findings demonstrate that multivariate analysis substantially improves the identification of pleiotropic susceptibility loci for MetS in the Korean population and indicates candidate genes for early detection and management. Full article

Insufficient sleep is highly prevalent among adolescents and young adults and has well-documented effects on neural systems underlying decision-making and risk-taking behavior. While prior research has linked sleep deprivation to poorer decision-making broadly, less is known about how specific features of sleep architecture contribute to risk-taking behavior, or whether the cortisol awakening response (CAR), shaped in part by the preceding night’s sleep, represents an independent hormonal pathway linking sleep physiology to morning behavioral outcomes. The present study used a cross-sectional design to examine associations among objective sleep architecture, the CAR, and next-morning risk-taking behavior in a community sample of adolescents and young adults. We predicted that (1) greater rapid eye movement (REM) sleep percentage would be associated with better overall task performance, and (2) greater N2-N3 sigma power would be associated with reduced risk-taking under uncertainty. The role of the CAR was examined exploratorily. Fifty-five adolescents and young adults (aged 15–34; mean age = 18.9 years, SD = 3.08 years, 86% female) completed overnight sleep monitoring using a wearable EEG device, provided morning saliva samples to index the CAR (n = 28), and completed the Balloon Emotional Learning Task (BELT) to assess risk-taking behavior. Primary sleep variables of interest included REM sleep percentage and Non-REM sleep (N2-N3) sigma power. Behavioral outcomes included overall task performance and risk-taking under uncertainty. Linear regression models with age as a covariate were used for all primary analyses. Higher REM sleep percentage was associated with greater overall task performance, while higher N2-N3 sigma power was associated with reduced risk-taking under uncertainty, consistent with predictions. Greater CAR was independently associated with poorer task performance but did not moderate sleep-behavior associations, nor was it significantly associated with objective sleep measures. These findings highlight the stage-specific contributions of sleep architecture to next-morning risk-taking behavior in adolescents and young adults, with sleep physiology and cortisol responsivity emerging as distinct physiological contributors to behavioral outcomes. Full article

Background: The classification of metabolic risk solely based on body mass index (BMI) fails to acknowledge the heterogeneity inherent in obesity. Soluble urokinase plasminogen activator receptor (suPAR) has been proposed as a stable biomarker of chronic inflammation; however, its behaviour across metabolic obesity phenotypes defined jointly by adiposity and insulin resistance remains uncertain. Methods: In this cross-sectional study, 190 adults aged 18 to 60 years attending internal medicine outpatient clinics were stratified by BMI (≥30 kg/m²) and homeostasis model assessment of insulin resistance (HOMA-IR ≥ 2.5) into four phenotypes: non-obese insulin-sensitive (NOIS, n = 64), non-obese insulin-resistant (NOIR, n = 50), obese insulin-sensitive (OIS, n = 33), and obese insulin-resistant (OIR, n = 43). Serum suPAR, interleukin-6 (IL-6), and C-X-C motif chemokine ligand 10 (CXCL10) were measured using enzyme-linked immunosorbent assays. Group comparisons, rank-based two-factor analyses, correlation analyses, logistic regression, and receiver operating characteristic (ROC) analyses were performed. Results: Serum suPAR did not differ across the four phenotypes (p = 0.19) and was not correlated with HOMA-IR (ρ = −0.09, p = 0.24). IL-6 was lower in the OIR group than in the NOIS group (p = 0.012). CXCL10 was higher in both obese phenotypes than in both non-obese phenotypes (p < 0.001), and rank-based two-factor analysis attributed this difference to obesity (p < 0.001) rather than insulin resistance (p = 0.71). CXCL10 correlated with BMI (ρ = 0.29, p < 0.001) and remained associated with obesity after adjustment for age, sex, and C-reactive protein (odds ratio per 10 ng/L, 1.12; 95% confidence interval, 1.06 to 1.18). CXCL10 discriminated obesity with an area under the ROC curve of 0.74 (95% CI, 0.66 to 0.81). None of the three biomarkers discriminated insulin resistance (areas under the curve, 0.43 to 0.50). The association between CXCL10 and obesity was consistent in both sexes and unchanged with alternative HOMA-IR cutoffs of 2.0 and 3.0. Conclusions: In this cohort, circulating CXCL10 tracked adiposity rather than insulin resistance, whereas suPAR and IL-6 did not separate metabolic obesity phenotypes. These findings do not support suPAR as a marker of insulin resistance independently of body fat. Full article

Background: Heart failure with reduced ejection fraction (HFrEF) may be caused by various factors. The etiology of HFrEF may influence prognosis and further management. Objectives: In this study we aimed to assess differences between ischemic and non-ischemic etiology in the context of clinical features, hemodynamic evaluation, and left ventricular (LV) and left atrial (LA) remodeling in a selected cohort of patients referred for device implantation. Methods: This prospective single-center study included 86 patients with HFrEF in sinus rhythm, without a history of atrial fibrillation, referred for ICD or CRT implantation. All patients underwent comprehensive echocardiography, electrocardiography, impedance cardiography and laboratory testing. This was a cross-sectional analysis without clinical follow-up. The pre-specified question was whether the two etiological groups differed in LV remodeling and LA function. All regression analyses were exploratory. Guideline-directed medical therapy was recorded in all patients. Results: Among 86 patients, 58 had ischemic and 28 had non-ischemic HFrEF. Patients with ischemic etiology were older, had worse renal function, and had higher N-terminal pro–B-type natriuretic peptide levels. They also exhibited lower left ventricular mass index (LVMI), left atrial reservoir strain (LASr), left atrial emptying fraction (LAEF), and higher left atrial stiffness index (LASI). Among myocardial work parameters, only global wasted work (GWW) differed significantly, with higher values in the non-ischemic group. Patients with ischemic HFrEF also had a higher Heather index (HI) in impedance cardiography. The two groups did not differ in guideline-directed medical therapy. In univariable logistic regression, older age, lower LVMI, reduced LASr and LAEF, higher LASI, higher HI, and lower eGFR were associated with ischemic HFrEF etiology. In the multivariable model, older age, lower LVMI, and reduced LASr remained independently associated with ischemic HFrEF (area under the ROC curve 0.82). Conclusions: Patients with ischemic and non-ischemic HFrEF referred for device implantation differ in LV remodeling and LA function. The between-group differences were small in absolute terms, with widely overlapping distributions, and the study was not designed to test whether echocardiography can replace established methods of establishing HFrEF etiology. These exploratory findings are hypothesis-generating and require confirmation in larger, independent cohorts. Full article

Background: The prognostic value of preoperative inflammatory and nutritional biomarkers in colorectal cancer has been extensively investigated, but their association with metastatic lymph node burden remains insufficiently explored. This study evaluated whether routinely available biomarkers are associated with the number of metastatic lymph nodes in patients undergoing colorectal cancer resection. Methods: We retrospectively analyzed 935 consecutive patients who underwent colorectal cancer surgery between 2020 and 2024. Preoperative hemoglobin, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and Prognostic Nutritional Index (PNI) were assessed. Negative binomial regression was used to model metastatic lymph node count, with sensitivity analyses accounting for surgical setting and total lymph node yield. Results: In the fully adjusted primary model, tumor location (p = 0.021), PNI (adjusted IRR 1.024; p = 0.045), mucinous component (adjusted IRR 1.768; p = 0.026), and lymphovascular invasion (adjusted IRR 2.197; p = 0.012) were associated with metastatic lymph node burden, whereas NLR and PLR were not. After additional adjustment for total lymph node yield, the associations with PNI, mucinous component, and tumor location were attenuated, while lymphovascular invasion remained independently associated with greater nodal burden (adjusted IRR 2.376; p = 0.007). Conclusions: Lymphovascular invasion showed the most robust association with metastatic lymph node burden. Although PNI showed a modest association in the primary model, it provided no significant incremental improvement in model fit, while tumor-location associations were sensitive to model specification. These findings require validation in independent cohorts. Full article

Background and Objectives: Comprehensive physical profiling is important for monitoring athletic development in youth soccer players (YSP), yet integrated data from competitive South American players remain limited. This study aimed to characterize the anthropometric profile, neuromuscular performance, and cardiorespiratory fitness of competitive Chilean YSP and explore associations among these components. Methods: This cross-sectional study included 24 male YSP from a Chilean professional club academy. Participants underwent anthropometric assessment, bilateral quadriceps isometric strength testing, vertical jump testing (Squat Jump [SJ], Countermovement Jump [CMJ], and Abalakov Jump [ABK]), and maximal cardiopulmonary exercise testing. The primary analysis was an integrated characterization of anthropometric, neuromuscular performance, and cardiorespiratory fitness. Secondary exploratory analyses included correlations with false discovery rate adjustment and multiple linear regression. Results: Participants had a median age of 13.5 years (IQR: 13.0–14.0) and a BMI of 21.1 ± 1.6 kg·m⁻². Mean bilateral quadriceps strength was 406.1 ± 70.0 N, while mean jump heights were 24.6 ± 4.2 cm for SJ, 28.4 ± 3.7 cm for CMJ, and 33.4 ± 5.3 cm for ABK. The average relative VO₂peak was 55.0 ± 4.7 mL·kg⁻¹·min⁻¹, while absolute VO₂peak was slightly higher than predicted. Bilateral quadriceps strength was positively associated with all three jumps before FDR adjustment; after FDR correction, the associations with CMJ and ABK remained statistically significant, whereas the association with SJ did not. Relative VO₂peak was not associated with CMJ performance. Conclusions: This study provides an integrated characterization of physical performance within this cohort of youth soccer players. Quadriceps strength was associated with vertical jump performance, whereas relative VO₂peak was not associated with CMJ, supporting assessment of neuromuscular and cardiorespiratory capacities. Full article

Resistance to BRAF inhibitors (BRAFi), alone or with MEK inhibitors (MEKi), limits durable responses in BRAF-mutant melanoma. To characterize resistance-associated cell-state evolution, we analyzed 674 melanoma cells from six mice bearing tumors from a single patient-derived BRAF V600E-mutant melanoma xenograft (PDX) lineage before treatment, during initial regression, at minimal residual disease, and at resistant regrowth. Unsupervised clustering based on a BRAF-centered network feature set comprising 2506 candidate genes identified six transcriptional states, which were characterized using transcriptomic analyses. Cluster 4 was detected exclusively at resistant regrowth, a phase marked by MAPK pathway reactivation, and exhibited enhanced JAK-STAT/interferon signaling and increased STAT1, STAT2, IRF7, IRF9, and RELB regulon activities. Network inference predicted STAT1-BRAF and IRF7-MET regulatory links, suggesting candidate routes to MAPK reactivation through BRAF overexpression and MET-mediated bypass signaling. External analyses partially recapitulated the resistance-associated transcriptional program in independent melanoma cell-line datasets and yielded limited, inconclusive evidence for the predicted STAT1-BRAF association in public perturbation datasets. Cluster 2 represented a pre-existing proliferative state whose signature was associated with shorter progression-free survival in pretreatment clinical cohorts. Together, these findings distinguish a therapy-associated acquired-resistance state from a pre-existing proliferative resistance-associated state and nominate the predicted STAT1-BRAF and IRF7-MET links for functional validation. Full article

Background: Tooth loss and periodontal disease have been linked to cardiovascular disease; however, the role of posterior occlusal support remains unclear, especially among older adults. This study examined the association between posterior occlusal support and a history of cerebral or myocardial infarction in 88-year-old institutionalized older adults. Methods: This cross-sectional study included 88-year-old adults who underwent dental examinations at long-term care facilities. Posterior occlusal support was categorized as “no,” “partial,” or “complete support” based on the Eichner classification. The outcome was a self-reported history of cerebral or myocardial infarction. Logistic regression analyses were adjusted for sex, obesity, diabetes mellitus, smoking history, periodontal pocket status, and number of remaining teeth. Results: Compared to participants with no occlusal support, those with partial occlusal support had lower odds of infarction history after adjusting for cardiovascular risk factors (OR: 0.21, 95% CI: 0.05–0.99). Complete occlusal support exhibited a similar direction, although the association was not statistically significant after adjusting for cardiovascular risk factors (OR: 0.40, 95% CI: 0.11–1.50). Conclusions: Preserved posterior occlusal support was associated with lower odds of a history of cerebral or myocardial infarction in 88-year-old institutionalized older adults. The findings of this exploratory study suggest that posterior occlusal support was associated with a history of myocardial or cerebral infarction independently of tooth count. However, these findings should be interpreted cautiously because of the cross-sectional design, small reference group, self-reported outcomes, and the possibility of residual confounding, and require confirmation in larger prospective studies. Full article

This study explored whether engaging in volunteering predicted subjective wellbeing and loneliness, above and beyond known sociodemographic predictors. Secondary data from 7146 adults from the Taking Part 2019–2020 survey (UK household survey of participation in culture and sport) were analysed. Hierarchical regressions were used to explore whether engaging in volunteering (yes/no) predicts subjective wellbeing variables (a sense that life is worthwhile, happiness, life satisfaction and anxiety) and loneliness. Gender, age group, Index of Multiple Deprivation (IMD), health and employment status were included as covariates. Volunteering significantly and positively predicted a sense that life is worthwhile, although with small variance explained, and was also unexpectedly associated with greater anxiety. These relationships were observed above and beyond the variance explained by the known sociodemographic predictors. Our study provides some support for the idea that volunteering may be linked to greater wellbeing, in terms of life being worthwhile, but offers a note of caution about the potential negative relationship with anxiety. Based on our findings, we suggest that volunteering is not necessarily linked to greater hedonic wellbeing but may instead be linked to greater eudaimonic wellbeing, that is, a sense that life is worthwhile. Full article

Background/Objectives: Vaccine hesitancy remains a significant public health challenge in Japan, particularly following the HPV vaccine suspension (2013–2022) that severely damaged vaccination trust. Although prior studies have linked individual social capital to vaccination behavior in Japan, whether and how personal vaccination beliefs modify this association remains poorly understood. This study examined associations between individual social capital (resources accessed through personal social networks) and COVID-19 vaccination intention, and how these associations interact with personal vaccination beliefs based on the 7C model. Methods: A nationwide web-based survey (January 2024) included 7210 participants aged 20–69. Individual social capital was measured using civic participation, social cohesion (community trust), and reciprocity (mutual helping). Personal beliefs were assessed via the 7C model (psychological vaccination determinants framework) and factor-analyzed. Logistic regression examined associations; interaction analyses tested whether social capital effects differed across belief patterns. Results: Overall, 73.1% expressed intention to receive COVID-19 vaccination for 2024–2025. All social capital components positively associated with vaccination intention: social cohesion (adjusted OR = 1.80, 95% CI:1.58–2.04), reciprocity (adjusted OR = 1.64, 95% CI:1.33–2.02), and civic participation (adjusted OR = 1.29, 95% CI:1.10–1.51). Factor analysis identified three belief domains: individual and collective health responsibility, trust in vaccination systems, and safety concerns. Health responsibility beliefs substantially reduced social capital–vaccination associations when included in models. Safety concerns moderated effects of social cohesion (p < 0.001) and reciprocity (p = 0.011), with stronger effects among those with lower concerns. Civic participation was associated with vaccination intention mainly among those with higher institutional trust. Conclusions: Individual social capital was significantly associated with vaccination intention through complex belief interactions. Safety concerns act as crucial moderators. Multifaceted strategies addressing social capital, safety concerns, and institutional trust may be needed to increase vaccine uptake. Full article

Background: Psychological flourishing is a key indicator of optimal mental health and professional well-being, particularly among psychologists who are routinely exposed to emotionally demanding clinical environments. Although self-compassion has consistently been associated with positive psychological outcomes, few studies have integrated traditional statistical methods with machine learning approaches to predict psychological flourishing among psychologists. Objective: This study aimed to examine the relationship between self-compassion and psychological flourishing among psychologists in Saudi Arabia, identify the unique contribution of self-compassion dimensions, evaluate the predictive performance of supervised machine learning models, and compare their performance with traditional multiple linear regression. Methods: A cross-sectional correlational design was employed, involving 224 psychologists practicing in Saudi Arabia. Participants completed the Self-Compassion Scale and the Flourishing Scale. Descriptive statistics, Pearson’s correlation, and multiple linear regression analyses were performed using IBM SPSS Statistics version 29.0. In addition, Random Forest Regression and Support Vector Regression (SVR) models were implemented in Python using scikit-learn version 1.8.0 to predict psychological flourishing based on self-compassion dimensions together with demographic and professional characteristics. Model performance was evaluated using the coefficient of determination (R²), root mean square error (RMSE), and mean absolute error (MAE). Results: Overall, self-compassion was positively associated with psychological flourishing (r = 0.627, p < 0.001). Multiple linear regression showed that self-kindness had a significant positive independent association with psychological flourishing (β = 0.292, p = 0.001), whereas over-identification had a significant negative independent association (β = −0.206, p = 0.009). The regression model explained 40.5% of the variance in psychological flourishing (R² = 0.405, p < 0.001). In the held-out test-set comparison using the same predictor set, predictive performance was similar across multiple linear regression (R² = 0.273; RMSE = 3.583; MAE = 2.849), Random Forest Regression (R² = 0.282; RMSE = 3.562; MAE = 2.771), and Support Vector Regression (R² = 0.272; RMSE = 3.587; MAE = 2.768), with no substantial predictive advantage of the machine-learning models over the linear benchmark. Conclusions: Self-compassion, particularly self-kindness and over-identification, was significantly correlated with psychological flourishing among psychologists. Machine-learning models demonstrated predictive performance comparable to traditional regression, with no substantial predictive advantage over the linear benchmark, indicating that increased model complexity did not improve out-of-sample prediction in the present sample. Full article

Background/Objectives: Chronic low back pain (LBP) is a multifactorial condition in which biological, psychological, and physical factors are associated with pain persistence and reduced health-related quality of life (HRQoL). Although central sensitization, pain catastrophizing, functional disability, and body composition have each been associated with CLBP, their relative contributions to HRQoL remain incompletely understood. This study investigated the relationships among these factors and identified factors associated with physical and mental HRQoL in multivariable analyses. Methods: In this cross-sectional observational study, 97 adults with CLBP undergoing rehabilitation were consecutively recruited from a tertiary rehabilitation department. Participants underwent standardized clinical evaluation, psychometric assessment using the Central Sensitization Inventory-9 (CSI-9), Pain Catastrophizing Scale (PCS), Roland–Morris Disability Questionnaire (RMDQ), and Italian Chronic Pain Classification (ICDS), whole-body bioelectrical impedance analysis (BIA), and HRQoL assessment using the 36-Item Short Form Health Survey (SF-36). Correlation analyses, group comparisons according to pain chronicity, and multivariable linear regression analyses were performed to evaluate factors associated with the SF-36 Physical Component Summary (SF-36 PCS) and SF-36 Mental Component Summary (SF-36 MCS) scores after adjustment for the variables included in the models. Results: Greater central sensitization, pain catastrophizing, and functional disability were associated with poorer HRQoL, whereas the evaluated BIA-derived body-composition measures showed weak or non-significant associations. Patients with higher degrees of pain chronicity demonstrated significantly higher central sensitization, pain catastrophizing, and disability, together with lower physical and mental HRQoL, but did not differ significantly in body composition. In multivariable analyses, central sensitization and pain catastrophizing remained associated with both SF-36 PCS and SF-36 MCS scores after adjustment for the other variables included in the models, whereas body composition parameters were not significantly associated with HRQoL. Conclusions: Psychological pain-related factors, particularly central sensitization and pain catastrophizing, are more strongly associated with HRQoL than the evaluated BIA-derived body-composition measures in patients with CLBP. Assessment of these factors may help inform patient stratification and personalized biopsychosocial rehabilitation planning; however, whether interventions specifically targeting them improve HRQoL requires prospective evaluation. Full article

Background: Non-nutritive sweeteners (NNS) are chemical substances developed by the food industry to reduce sugar and calories while preserving sweetness. Epidemiological studies have indicated a potential increased risk of certain cancers, including breast cancer (BC), associated with NNS consumption. However, the evidence has exclusively relied on self-reported dietary information rather than objective measurements of NNSs. We examined the association of urinary concentrations of NNS with BC risk in women from the large Moli-sani Study. Methods: Using a case-cohort design, a sample of 988 middle-aged women (mean age 55 ± 12 y) was randomly selected as a sub-cohort and compared to 272 women with incident BC (38 premenopausal and 234 postmenopausal). A total of 6 commonly used NNSs (i.e., aspartame, acesulfame, saccharin, sucralose, cyclamate, and steviol glycosides) were measured through liquid chromatography–mass spectrometry in spot urine samples (creatinine-adjusted concentrations; µg/mg) collected at baseline (2005–2010). The multivariable hazard ratios (HRs) were estimated using weighted Cox regression models for the case-cohort design, with each NNS modelled as a binary variable (i.e., presence vs. absence). The sum of these values produced a total urinary NNS score, which could range from 0 to 6, and was further categorised as low (0–1) or high (2–5). Results: The predominant NNS detected in urine was saccharin (E954), contributing to 77% of total NNSs, followed by steviol glycosides (E960;11%). In multivariable-adjusted Cox analyses, neither individual NNSs nor total NNS urinary concentrations were associated with overall BC risk (HR = 1.09; 95% CI 0.80–1.48 for high vs. low). However, the presence of sucralose (E955) was directly linked to premenopausal BC (HR = 5.90; 95% CI 1.44–24.20; p = 0.014), although this estimate was based on only 38 cases and was imprecise. Conclusions: Urinary NNS concentrations were not associated with overall BC risk. The observed association between urinary sucralose and premenopausal BC should be considered exploratory and hypothesis-generating and requires independent replication. Full article

This study proposes a source-study-aware validation framework to estimate the shear capacity of stirrup-free steel-fiber-reinforced concrete corbels and assess the reliability and generalizability of machine-learning models in structural engineering. A database of 108 specimens, compiled from seven independent studies, was analyzed using linear regression, ridge regression, and hyperparameter-optimized XGBoost. The evaluation combined standard specimen-level five-fold cross-validation, predefined source-study holdout evaluation, exhaustive partition-sensitivity analysis, and specimen-level out-of-bag bootstrap uncertainty analysis. In the predefined source-study hold-out evaluation, with hyperparameters selected exclusively from the training portion via an inner group-aware search, the models achieved test R² values of 0.842, 0.866, and 0.912, respectively, with XGBoost providing the highest point estimate of performance. However, an exhaustive sensitivity analysis of source-study partitions, in which hyperparameters were re-selected independently within the training portion of each partition, indicated that this ranking was not maintained: Linear Regression achieved the highest mean and median R² and the narrowest interquartile range, whereas XGBoost exhibited the lowest mean and median R², the widest interquartile range, and the highest incidence of negative R² values and large prediction errors among the three models; this reflects instability introduced by re-tuning under limited, group-diverse training data. The specimen-level out-of-bag bootstrap uncertainty analysis also favored the linear models in terms of mean performance and confidence-interval width. Standardized coefficients and SHAP analyses consistently identified the shear span-to-effective-depth ratio, the longitudinal reinforcement ratio, and the fiber ratio as the dominant predictors. This study provides a transparent and uncertainty-aware framework for determining when predictive performance is transferable across independent experimental studies and when caution is required in engineering applications. Full article

This study examined direct and indirect associations of Machiavellianism, narcissism, psychopathy, and sadism with suicidal ideation through depression, anxiety, and stress in psychiatric patients. A cross-sectional sample of 210 patients completed the Short Dark Tetrad (SD4), Depression Anxiety Stress Scales-21 (DASS-21), and Suicidal Ideation Attributes Scale (SIDAS). Regression paths were estimated using robust maximum likelihood, whereas indirect effects were evaluated using 10,000 bootstrap resamples. Because 92 participants (43.8%) had SIDAS = 0, two-part sensitivity analyses separated the occurrence from the severity of suicidal ideation; additional analyses excluded the two smallest diagnostic groups. Depression, stress, and anxiety correlated with SIDAS (r = 0.560, 0.509, and 0.466, respectively). The sadism–stress–SIDAS indirect effect was significant in the primary model (B = 0.147; 95% bootstrap CI [0.037, 0.291]), after covariate adjustment (B = 0.126; 95% bootstrap CI [0.016, 0.266]), and after excluding psychotic and bipolar groups (B = 0.115; 95% CI [0.006, 0.259]). In two-part analyses, depression was associated with SIDAS occurrence, whereas stress and sadism were associated with severity among participants with SIDAS > 0. The findings support a stress-related indirect association between sadism and suicidal ideation, but causal interpretation is not warranted. Full article