Search Results (241)

Background/Objectives: The rising prevalence of severe adolescent obesity has increased the number of young patients referred for bariatric surgery. The psychiatric and psychosocial profiles of adolescents and of adult women undergoing this treatment remain insufficiently characterized. This study compared preoperative and postoperative psychiatric, psychosocial, and metabolic profiles of adolescents and adult women undergoing bariatric surgery. Methods: This prospective cohort study recruited 77 consecutive female patients (32 adolescents aged <18 years; 45 adult women aged 18–25 years) at a single bariatric center in Poland between December 2022 and December 2023. All participants underwent comprehensive preoperative and one-year postoperative assessments including laboratory testing, standardized psychiatric interviews, and psychometric screening with the Beck Depression Inventory (BDI) and the Patient Health Questionnaire-9 (PHQ-9). Results: Preoperatively, adolescents were more severely affected for their age (median BMI-for-age z-score 3.53) and waited longer between the first obesity clinic visit and surgery. Adolescents more frequently reported self-harm behaviors and moderate-to-severe depression on the BDI, whereas adult women more often reported psychoactive substance use. Both groups achieved comparable improvements in laboratory and comorbidity outcomes at one year, although relative weight loss was greater in adult women (median total weight loss 37.6% vs. 28.4%, p < 0.0001). Postoperatively, a greater proportion of adolescents than adult women improved with respect to social anxiety (50.0% vs. 13.3%, p = 0.0007) and BDI depression severity (53.1% vs. 24.4%, p = 0.02), whereas a greater proportion of adult women improved with respect to psychoactive substance use (46.7% vs. 12.5%, p = 0.003). Generalized anxiety and suicidal ideation declined within both groups, but the extent of improvement did not differ significantly between them. These differences persisted, and for several outcomes became larger, after adjustment for the reduction in BMI, which was smaller in adolescents. Conclusions: In this observational cohort, bariatric surgery was associated with distinct psychiatric and psychosocial outcome profiles in adolescents compared with adult women. Because the study was uncontrolled and included no non-surgical comparison group, these findings are hypothesis-generating and cannot establish a causal effect of surgery or of its timing; confirmation in larger, multicenter studies with appropriate comparison groups is required. Comprehensive multidisciplinary perioperative care and tailored postoperative psychological support appear important for both age groups. Full article

Background: Burnout, defined by emotional exhaustion, depersonalization, and reduced personal accomplishment, is a major occupational health concern among healthcare professionals. Burnout has been linked to depression, anxiety, and medical errors, but its association with suicidality in healthcare settings remains insufficiently explored. Objective: To investigate the association between burnout dimensions and suicidality among healthcare professionals, and to identify occupational and demographic factors influencing this relationship. Methods: A cross-sectional study was conducted among 195 healthcare professionals in Romania, recruited through voluntary participation in an anonymized online survey. Burnout was assessed using an adapted tool inspired by the Maslach Burnout Inventory, while suicidality outcomes included suicidal ideation, self-harm, and suicide attempts. Descriptive statistics were calculated for demographic and professional variables. Pearson correlations and multivariable linear regression analyses, adjusted for age, professional experience, and shift work, were performed to evaluate associations between burnout dimensions and suicidality. Results: Emotional exhaustion (r = 0.42, p < 0.001) and depersonalization (r = 0.37, p < 0.001) were positively correlated with suicidality, while reduced personal accomplishment was negatively correlated (r = −0.29, p = 0.002). In multivariable regression, emotional exhaustion remained the only statistically significant independent predictor of suicidality after adjustment for demographic and occupational characteristics. Younger age and rotating/night-shift work were associated with higher suicidality in unadjusted analyses but were not independent predictors after multivariable adjustment. Strong correlations between burnout dimensions and physical symptoms highlighted the interplay between psychosocial strain and somatic health. Conclusions: Burnout, particularly emotional exhaustion, was independently associated with suicidality among healthcare professionals, while depersonalization demonstrated a significant unadjusted association that did not remain statistically significant after multivariable adjustment. Younger clinicians, shift workers, and those with less experience appear especially vulnerable. These findings emphasize that burnout is a multifactorial construct with both psychological and somatic dimensions, shaped by systemic workplace stressors. These findings support further evaluation of systematic screening, organizational reforms, mentorship programs, and confidential mental health support as potential components of suicide-prevention strategies for healthcare professionals. Full article

Background: This study aimed to investigate whether individuals with trichotillomania (TTM) are at a higher risk of engaging in self-harm behaviors compared to those without TTM. Methods: In this matched cohort study, we analyzed electronic health records of all patients admitted to public hospitals in Hong Kong from 1 January 1993 to 31 December 2022. We identified a TTM cohort of 285 patients and a comparison cohort of 285 individuals. All participants were followed up until they received a diagnosis of self-harm, died from other causes, or until the end of 2023, whichever came first. To assess the risk of self-harm following TTM onset, Cox proportional hazards regression models were applied. Results: Throughout the 30-year study period, the number of individuals who exhibited self-harm behavior in the TTM and comparison groups was 8 (2.8%) and 8 (2.8%), respectively. The TTM and comparison groups had similar proportions of subjects who inflicted self-harm (χ² = 0.00, p = 0.977). The incidence of self-harm was 26.00 and 26.92 per 10,000 person-years in the TTM and comparison groups, respectively. Compared with the comparison group, the adjusted hazard ratio for self-harm in the TTM group was 1.44 (95% confidence interval, 0.45–4.61). Conclusions: TTM is not associated with an increased risk of self-harm. Future research is necessary to replicate our findings and more fully elucidate the potential unique risk factors for self-harm in these patients. Full article

Background/Objectives: While there is an existing body of quantitative data on the psychological and mental burden of suicide-bereaved parents, further qualitative research is needed to explore suicide-bereaved mothers’ living experiences in specific sociocultural contexts, especially in Southern Europe and the Eastern Mediterranean. Given the persistent stigma surrounding suicide in these societies, and the fact that previous research has often overlooked mothers’ perspectives in favor of broader samples of bereaved parents, we explored the psychosocial needs of Greek-speaking suicide-bereaved mothers in the Republic of Cyprus, and their experiences in accessing formal mental healthcare support. Methods: An inductive, secondary content analysis of qualitative data collected through personal semi-structured interviews with ten suicide-bereaved mothers was employed. Results: Participants’ psychosocial needs centered around a “persistent orientation towards protection,” encompassing three interconnected domains: (1) self-protection and the need for acceptance by shielding themselves from stigma, social judgment, and emotional disintegration, (2) ensuring a safe and protective environment for the surviving family by safeguarding the psychological well-being and cohesion of surviving family members, and (3) protecting the posthumous dignity and memory of the deceased child. Rather than seeking formal support, participants overwhelmingly avoided mental health services, citing a lack of empathy, cultural misunderstanding, and fear of further stigmatization. Mental health professionals were often perceived as inadequate or even harmful, undermining participants’ need for protective attitudes, self-reliance and self-respect during bereavement. These responses reflected how stigma and gendered social expectations surrounding suicide shaped participating bereaved mothers’ disengagement from the healthcare system, despite their intense psychological needs. Conclusions: These findings underscored how gendered social expectations, combined with the stigma surrounding suicide, created significant psychosocial barriers to mental health care for women navigating traumatic grief, particularly in sociocultural contexts where suicide remains highly stigmatized. Full article

Non-suicidal self-injury (NSSI) is a significant public health concern among university students. Accumulating evidence suggests that deficits in executive function (EF) are associated with NSSI; however, little is known about how specific EF components relate to the specific psychological functions that motivate self-injury. This study aimed to investigate the fine-grained associations between EF dimensions and NSSI functions in university students with past-year NSSI using network analysis. Altogether, 1078 Chinese university students (82.6% female; Mage = 19.07, SD = 1.03) who had engaged in at least one NSSI behavior in the past year were enrolled. Executive function was assessed using the Adolescent Executive Function Scale, which measures three dimensions: inhibitory control, cognitive flexibility, and working memory. NSSI functions were assessed using the 19-item function subscale of the Adolescent Non-Suicidal Self-Injury Assessment Questionnaire. A Gaussian graphical model was used to estimate the network. Expected influence (EI) and bridge expected influence (BEI) were computed to identify core nodes and bridge nodes, respectively. Of the 231 possible edges, 117 (50.65%) were non-zero, with the strongest within-community edge linking “coping with sadness and disappointment” (F3) and “expressing despair and hopelessness” (F4). Across communities, the most prominent edge was between “inhibitory control” and “having a desire to harm myself and cannot stop”. The three highest EI values were observed for “having a desire to harm myself and cannot stop,” “letting others make changes,” and “self-punishment”. “Inhibitory control” showed the highest BEI in the EF community, while “having a desire to harm myself and cannot stop” showed the highest BEI in the NSSI function community. Both EI and BEI demonstrated excellent stability (CS coefficients = 0.75). In university students with past-year NSSI, inhibitory control and the uncontrollable urge to self-injure function as critical bridge nodes linking executive dysfunction to NSSI functions, while self-punishment and interpersonal influence motives emerge as central drivers in the network. These findings highlight inhibitory control, the uncontrollable urge to self-injure, self-punishment, and interpersonal influence as promising targets for precision interventions aimed at disrupting the maladaptive cycle maintaining NSSI in this population. Full article

Firefighters experience elevated suicide risk; however, factors influencing this risk remain understudied among this frontline population. Distress overtolerance (DO), or enduring high emotional distress, may represent a novel risk factor in the fire service, where occupational norms reinforce persistence under stress. The present study examined whether DO subfactors (Capacity for Harm [CH]: persisting through distress despite harm to one’s well-being; Fear of Negative Evaluation [FNE]: persisting through distress to avoid negative judgment) predicted variance in suicidal ideation and suicide risk. Firefighters (N = 79) were recruited from a U.S.-based national first responder service agency and completed self-report measures at baseline and follow-up as part of a larger study of mental health among first responders during the COVID-19 pandemic. Hierarchical regression models using baseline data indicated that CH accounted for significant variance in suicidal ideation (ΔR² = 0.13) and suicide risk (ΔR² = 0.16), while FNE accounted for variance only in suicide risk (ΔR² = 0.07). Longitudinal models indicated that both CH and FNE were significantly and preliminarily associated with suicide risk, but only CH was significantly associated with suicidal ideation. Findings suggest that DO may represent a clinically meaningful suicide risk factor in firefighters, with implications for assessment and prevention efforts. Full article

This systematic review, following PRISMA 2020 guidelines, analyzes scientific literature on bullying and cyberbullying among adolescents (aged 12–16) in educational settings, focusing on ICT, smartphone hyperconnectivity, and emotional education. An exhaustive search across Web of Science, Scopus, PubMed, Dialnet, CSIC, SciELO, and Google Scholar identified 34 empirical studies. A narrative synthesis was performed due to methodological heterogeneity. The synthesized evidence suggests that cyberbullying frequently acts as a persistent extension of school violence, where continuous digital exposure makes it difficult for victims to emotionally disconnect. Empirical data indicate a concerning correlation between prolonged bullying and psychosocial distress, including self-harming behaviors and suicidal ideation. Furthermore, results highlight systemic gaps: heightened vulnerability is reported among girls and LGBTQ+ students, alongside disparities between public and state-subsidized schools regarding institutional involvement and emotional support resources. Educational implications suggest reactive protocols are insufficient. Evidence supports that systematic emotional education, enhancing socio-emotional skills like impulse control, empathy, self-esteem and emotional regulation, acts as a key protective factor. Consequently, fostering “digital emotional intelligence” emerges as a promising preventive educational strategy to protect adolescents’ well-being in hyperconnected environments. Full article

Kazakhstan has one of the highest suicide rates globally, yet little is known about how suicide-related content is structured and expressed on VKontakte, the country’s widely used social network. This study aimed to qualitatively analyze VKontakte communities associated with suicide, depression, and self-harm, with a focus on naming conventions, thematic characteristics, and potential indicators relevant for digital prevention strategies. A qualitative content analysis was conducted on 50 public VKontakte communities selected from a larger dataset of 2353 communities collected between December 2021 and March 2025. Communities were included if suicide- or self-harm-related references appeared in their names, descriptions, posts, or visual elements and if they had at least one subscriber with a probable connection to Kazakhstan. Textual and visual content was examined manually at the community level. Six naming typologies were identified: explicitly suicidal, self-harm-focused, depressive, ironic, supportive, and non-related. Community content ranged from direct expressions of suicidal ideation to aestheticized or romanticized representations of pain and death. Some communities contained material that encouraged or normalized self-harm with minimal moderation, while others combined supportive interactions with potentially harmful content. Overall, VKontakte communities linked to users from Kazakhstan represent a heterogeneous digital environment in which supportive and risk-related elements may coexist. These findings highlight challenges for automated detection and suggest that patterns of engagement with specific community types may serve as descriptive indicators for future ethically guided research. Full article

Prospection bias (PB) plays a crucial role in the development and maintenance of depression. However, the symptom-level mechanisms linking specific depressive symptoms to distinct PB components remain unclear, limiting the precision of targeted interventions. This study employed a network analysis approach to elucidate the intricate symptom-level relationships between depression and PB in a large sample of 1162 university students (453 males and 709 females; mean age = 19.47 years, SD = 1.45). Participants completed self-report assessments of depressive symptoms and prospection bias. The network demonstrated high stability. Central symptoms within the depression–PB framework were identified as “suicidal ideation”, “blurry future imagery”, “lack of energy”, and “catastrophic negative future thinking”. Critically, “suicidal ideation”, “future imaginations of self-harm/suicide”, and “guilt” served as the pivotal bridge symptoms connecting depression and PB. The Network Comparison Test revealed no significant gender differences in network structure. These findings highlight that current suicidal ideation and future-oriented suicidal imagery may serve as key nodes in the network of depressive symptoms and prospection bias. The results may help inform early identification and targeted intervention among at-risk university students. Full article

Adolescent self-harm, particularly non-suicidal self-injury (NSSI), is increasingly understood as a multidetermined behavior shaped by emotional, cognitive, and interpersonal processes. This focused, non-systematic narrative review examines cognitive–affective correlates of adolescent non-suicidal self-injury, while drawing on broader self-harm and suicidality-related evidence only where relevant to the cognitive–affective formulation. Particular attention is given to executive functioning, emotional processing, and social–emotional and interpersonal cognition. The evidence is strongest for emotional processing, especially difficulties in emotion regulation, rumination, cognitive reappraisal, alexithymia, and the identification and modulation of internal states. Executive functioning also appears clinically relevant, but the current findings support a selective rather than global impairment account, with the clearest evidence involving inhibitory control, impulsivity-related regulation, and decision-making under affective pressure. Social–emotional and interpersonal cognition is treated as an emerging and indirectly supported domain; much of the available evidence concerns interpersonal and relational constructs, such as interpersonal sensitivity, relational interpretation, emotional communication, and family–emotional context, rather than direct measures of theory of mind, social inference, or emotion recognition accuracy. Overall, adolescent self-harm is best understood as emerging from the interaction of emotional dysregulation, weakened behavioral control under distress, and difficulties in social–emotional meaning-making during a developmentally sensitive period. A cognitively informed developmental framework may help refine theory, improve clinical formulation, and guide future mechanism-oriented research. Full article

Non-suicidal self-injury (NSSI) is a major concern in adolescent mental health, yet the psychometric properties of the Inventory of Statements About Self-Injury (ISAS) have not previously been examined in a Greek adolescent inpatient sample. This preliminary study evaluated the internal consistency, factorial structure, and construct validity evidence of the ISAS in 95 Greek adolescents receiving inpatient psychiatric care (mean age = 14.69 years, SD = 1.30; 86.3% female). Data were obtained retrospectively from clinical records. Psychometric evaluation included Cronbach’s alpha coefficients, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and correlations with the Youth Self-Report (YSR). The ISAS showed satisfactory internal consistency at the higher-order factor level, with alpha coefficients of 0.82 for the interpersonal factor and 0.85 for the intrapersonal factor, although Autonomy and Interpersonal Boundaries showed weak reliability. EFA supported a broad two-factor intrapersonal–interpersonal structure. CFA findings were exploratory and mixed. The original CFA models showed inadequate fit, whereas exploratory modified and post hoc sensitivity models showed improved but non-definitive fit. Convergent validity evidence was modest and was supported by associations between the original broad ISAS intrapersonal score and YSR self-harm behavior, suicidal ideation, internalizing-related dimensions, and Total Problems. Discriminant-pattern evidence was limited. Overall, the findings provide preliminary support for the clinical usefulness of the ISAS as an adjunctive assessment tool in this population, but they do not constitute definitive validation. Further prospective validation in larger, more diverse, and independent samples is needed. Full article

Background/Objectives: Hypothyroidism, including subclinical hypothyroidism, may affect mental health in children and adolescents through disturbances of neurotransmission and dysregulation of the hypothalamic–pituitary–thyroid and stress axes. Anxiety disorders are common in this population and frequently coexist with somatic symptoms overlapping those of hypothyroidism, complicating diagnosis and treatment. This study aimed to evaluate the association between levothyroxine treatment for hypothyroidism and the need for psychiatric interventions in children and adolescents with anxiety disorders. Methods: A retrospective cohort study was performed using data from the TriNetX global research network. Patients aged 5–18 years with diagnoses of hypothyroidism (ICD-10: E03) and anxiety disorders (ICD-10: F41) were included. Two propensity score–matched cohorts were analysed: patients treated with levothyroxine (n = 1861) and untreated patients (n = 1861). Outcomes included psychiatric hospitalisations, use of selective serotonin reuptake inhibitors and tricyclic-like antidepressants, frequency of psychiatric and psychotherapeutic consultations, and the occurrence of suicidal ideation and self-harm. Results: Levothyroxine treatment was associated with lower odds of SSRI use (OR = 0.58; p < 0.001), fewer psychiatric consultations (OR = 0.48; p < 0.001), and lower recorded use of psychotherapy (OR = 0.75; p = 0.029). Suicidal ideation and self-harm were recorded less frequently in the treated group (OR = 0.53; p = 0.001). No significant differences were observed in psychiatric hospitalisation rates. Use of tricyclic-like antidepressants was uncommon and did not differ significantly between groups. Conclusions: Among children and adolescents with comorbid anxiety disorders, levothyroxine treatment for hypothyroidism is associated with lower recorded utilization of certain psychiatric services and lower recorded rates of suicidal ideation and self-harm. Due to the retrospective design, causal inferences cannot be made, and the findings should be considered hypothesis-generating, requiring confirmation in prospective studies with standardised psychiatric outcome measures. Full article

Background and Objectives: The COVID-19 pandemic has led to an unprecedented mental health crisis among workers in the healthcare field, with average burnout rates increasing from about 32% before the pandemic to 46–52% during peak times and post-traumatic stress disorder (PTSD) affecting 24–34% of frontline staff. The primary objective of this article is to synthesize evidence on the prevalence of burnout and PTSD among healthcare workers before and during the COVID-19 pandemic. The secondary objectives are: (a) to examine the mechanisms and empirical evidence linking clinician mental health to medical errors and patient safety outcomes and (b) to analyze the medico-legal implications of this relationship, including malpractice liability, institutional responsibility, and opportunities for policy reform. Materials and Methods: We conducted a narrative review searching PubMed (November 2025–January 2026) using predefined keyword combinations. Inclusion criteria comprised original research, systematic reviews, and meta-analyses examining mental health outcomes or patient safety among clinical staff. Data were synthesized narratively across five thematic domains. Results: Burnout prevalence increased from approximately 32% pre-pandemic to 46–52% during peak periods, with emotional exhaustion reaching 67.5% in some settings. PTSD rates rose to 24–34% among frontline staff, exceeding pre-pandemic levels of 15–20%, with ICU staff particularly affected (27–40%). Substantial overlap exists between conditions (86–98% comorbidity). Physician burnout is associated with 2.72 times higher odds of self-reported errors (95% CI: 2.19–3.37), with each point increase in emotional exhaustion raising the error risk by 5–11%. Mechanisms include cognitive impairment (reduced executive function, g = −0.39; impaired working memory, g = −0.36) and sleep disturbance. Malpractice litigation compounds psychological harm, increasing depression and suicidal ideation. Conclusions: This review, synthesizing data from over 500,000 healthcare workers, demonstrates bidirectional relationships among burnout, PTSD, and medical errors with significant medico-legal ramifications. Addressing this crisis requires systemic interventions including workload management, psychological support, blame-free reporting cultures, and policy reforms balancing accountability with recognition of system-level contributors to error. Full article

Background and objectives: Suicide attempts and self-harm are critical issues in adolescence, often leading to serious and irreversible consequences. These behaviours frequently co-occur and share common biopsychosocial risk factors. Identifying these factors enables a more comprehensive assessment of suicide and self-harm risk, helping specialists recognize high-risk individuals and implement effective preventive measures. This study aimed to examine the association between suicide attempts, self-harm and psychosocial factors among hospitalized adolescents. Materials and methods: A retrospective data analysis was performed using the database of the University Department of Children and Adolescents of the Republican Vilnius Psychiatric Hospital. The study covered patients’ records from December 2022 to February 2025. Information on gender, age, suicide attempts, self-harm, adverse events (bullying, psychological abuse, physical violence within the family, and sexual abuse) and unhealthy habits (smoking, harmful alcohol consumption, and psychoactive substance use), was selected and analyzed in this study. A Chi-square test was used to assess the difference between groups. Results were considered statistically significant when p < 0.05. Results: The study included 599 hospitalized adolescents (26.9% boys; mean age 15.1 ± 1.4 years), of whom 70.8% reported at least one episode of self-harm and 37.8% at least one suicide attempt. Rates of self-harm and suicide attempts were significantly higher in girls than in boys (self-harm: 81.3% vs. 42.2%, $\varphi =0.381$, $p<0.001$; suicide attempts: 45.5% vs. 16.5%, $\varphi =0.304$, $p<0.001$), and adolescents with self-harm had a significantly higher prevalence of suicide attempts than those without self-harm (46.7% vs. 15.8%, $\varphi =0.308$, $p<0.001$). Adverse childhood experiences and unhealthy behaviours were significantly more frequent in adolescents with self-harm and suicide attempts, although effect sizes were small to moderate ($\varphi$ range 0.086–0.230, all $p<0.05$). In multivariable models, female gender ($\beta =0.355$, $p<0.001$) and smoking ($\beta =0.330$, $p<0.001$) were the strongest predictors of self-harm, whereas alcohol use ($\beta =0.337$, $p<0.001$) and self-harm ($\beta =0.232$, $p<0.001$). Conclusions: Exposure to adverse childhood experiences and engagement in unhealthy habits were associated with higher rates of both self-harm and suicide attempts. A comprehensive assessment and early detection of self-harm behaviours and adverse psychosocial circumstances are crucial elements of effective suicide prevention strategies and prompt intervention among high-risk adolescents. Full article