Search Results (925)

Background/Objectives: Dental fear and anxiety (DFA) in children can negatively affect oral health behaviors and dental care utilization. Family-related factors, particularly parental anxiety, parenting styles, and socioeconomic characteristics, may be associated with DFA. This study aimed to investigate the association between family-related factors and DFA among children aged 6–8 years in Jakarta, Indonesia. Methods: A cross-sectional study was conducted among 294 child–parent pairs recruited from 10 primary schools using multistage cluster sampling. Children’s DFA was assessed using the Children’s Fear Survey Schedule–Dental Subscale (CFSS-DS), whereas parental dental anxiety was measured using the Modified Dental Anxiety Scale (MDAS). Sociodemographic and family-related characteristics, including parenting styles, were collected using self-administered questionnaires. Data were analyzed using chi-square tests and multivariable logistic regression. Results: Overall, 34.7% of the children were classified as having DFA. Maternal employment was significantly associated with children’s DFA, with children of formally employed mothers having higher odds of DFA (aOR = 2.01, 95% CI: 1.05–3.85; p = 0.034). Parental dental anxiety was associated with children’s DFA. Children whose fathers and mothers reported high levels of dental anxiety had 4.68-fold (95% CI: 1.64–13.33; p = 0.004) and 2.50-fold (95% CI: 1.10–5.74; p = 0.029) higher odds of experiencing DFA, respectively. Dental drilling and injections were the most frequently reported fear-provoking stimuli. The final regression model explained 13% of the variance in children’s DFA. Conclusions: Parental dental anxiety and maternal employment were significantly associated with DFA among children aged 6–8 years. Family-centered preventive strategies and early identification of at-risk children may help reduce DFA and promote positive dental experiences and oral health outcomes. Full article

Background and Objectives: Appendectomy during pregnancy is associated with preterm birth, but downstream neonatal outcomes, neonatal intensive care resource use, and caregiver-reported psychological symptom burden remain insufficiently characterized. We aimed to compare neonatal infection rates, NICU resource utilization, and caregiver psychosocial outcomes between preterm infants born after maternal appendectomy during pregnancy and preterm controls frequency-matched by gestational-age strata without antecedent non-obstetric surgery. Methods: In this single-center prospective cohort study (March 2023–December 2025), 121 preterm infants were enrolled: 54 born after maternal appendectomy during pregnancy (31 laparoscopic, 23 open) and 67 non-surgical preterm controls. Neonatal outcomes included culture-confirmed infection, death, or major neonatal morbidity, and neonatal intensive care resource metrics. Caregiver outcomes were assessed near discharge using the 36-Item Short Form Survey, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7 scale, and Hospital Anxiety and Depression Scale. Group comparisons used normality-guided parametric or non-parametric tests and multivariable logistic regression; subgroup and mediation analyses were exploratory. Mediation analyses explored indirect pathways. Results: Culture-confirmed infection was numerically more frequent in appendectomy-group neonates than in controls (35.2% versus 20.9%; p = 0.078), but this difference was not statistically significant. NICU length of stay was significantly longer (47.3 ± 14.8 vs. 41.2 ± 12.6 days; p = 0.014), and caregiver Patient Health Questionnaire-9 depressive symptom scores were higher (12.4 ± 4.3 vs. 9.6 ± 3.8; p < 0.001). Open appendectomy and negative histopathology subgroups showed the strongest adverse signals. Exploratory mediation analysis suggested that a substantial portion of the appendectomy-caregiver depression association statistically co-varied with prolonged hospitalization (Sobel p = 0.008); this exploratory pathway analysis does not establish a causal mediation pathway. Conclusions: Preterm infants born after maternal appendectomy during pregnancy showed non-significant numerical increases in infection outcomes, significantly higher neonatal intensive care resource use, and higher caregiver-reported psychological symptom scores compared with non-surgical preterm controls, with open surgery and negative appendectomy representing clinically complex subgroups with less favorable exploratory signals. Full article

The dimensionality of the Ego-Resilience Scale (ER89) remains contested, and little is known about the performance of the original and revised versions of the scale in South Africa. This study examined the psychometric properties of the 14-item ER89 and the 10-item ER89-R in 337 undergraduate students from a university in the Western Cape province of South Africa. Participants completed the ER89, the Sense of Coherence Scale, the Center for Epidemiological Studies Depression Scale, and the trait scale of the State-Trait Anxiety Inventory. The scales were evaluated using classical test theory, confirmatory factor analysis, bifactor modeling, parallel analysis, Mokken scale analysis, and Rasch analysis. For both versions, bifactor models fit better than one-factor models, but the specific factors showed anomalous loadings and accounted for little reliable variance. Parallel analysis and Rasch analysis supported an essentially unidimensional interpretation of both instruments. Although both versions showed acceptable internal consistency and expected associations with sense of coherence, depression, and anxiety, several findings raised concerns about their broader psychometric adequacy. Overall, both scales appeared to reflect a broad general factor of ego-resilience, but their performance in this context was mixed and, in important respects, problematic. Further refinement and validation are needed before either instrument can be recommended for confident use in South African research and practice. Full article

Background: Uterine fibroids are among the most common benign tumors affecting women of reproductive age and may substantially impair health-related quality of life (HRQL). Although anxiety and stress are frequently reported by affected women, their contribution to HRQL remains unclear. This study aimed to evaluate the relationships between symptom severity, anxiety, stress, and HRQL in women with uterine fibroids. Methods: A cross-sectional study was conducted among 107 women hospitalized for uterine fibroid treatment. Symptom severity and HRQL were assessed using the Uterine Fibroid Symptom and Quality of Life (UFS-QoL) questionnaire. Anxiety and information needs were evaluated using the Amsterdam Preoperative Anxiety and Information Scale (APAIS), while subjective anxiety and stress levels were measured with the Visual Analog Scale (VAS). Associations between variables were analyzed using non-parametric tests, Spearman’s correlations, and multiple regression analysis. Results: Clinically significant anxiety was observed in 41.1% of participants. The mean HRQL score was 57.4 ± 22.3 points. In multivariate analysis, symptom severity was the only independent predictor of HRQL (β = −0.67, p < 0.001), explaining approximately 45% of its variance. Anxiety, stress, and sociodemographic factors were not independently associated with overall HRQL. However, higher levels of anxiety and stress were significantly associated with poorer sexual functioning. Women living in rural areas and those with higher body weight reported poorer outcomes in selected quality-of-life domains. Conclusions: Symptom severity is the primary determinant of HRQL in women with uterine fibroids. Although anxiety and stress do not independently predict overall quality of life, they may adversely affect sexual functioning. These findings support a comprehensive management approach that combines symptom-oriented treatment with psychological and educational support. Full article

This study conducted an initial psychometric evaluation of the Japanese version of the Social Safeness and Pleasure Scale (SSPS-J). In Study 1 (N = 477), exploratory factor analysis supported a single-factor structure with excellent internal consistency (alpha = 0.95, omega = 0.95). Significant correlations with depression (r = −0.53), anxiety (r = −0.26), stress (r = −0.36), life satisfaction (r = 0.67), and social support (r = 0.47–0.52) demonstrated robust convergent validity. In Study 2, confirmatory factor analysis (N = 262) confirmed the reproducibility of the single-factor model with an acceptable overall fit (CFI = 0.943, SRMR = 0.036, RMSEA = 0.108). Test–retest reliability over a three-week interval (N = 113) was also high (ICC = 0.88). These results suggest that the SSPS-J is a reliable and valid preliminary measure for assessing social safeness in the Japanese general population. Full article

Background and Objectives: Quality of life (QoL) has become an essential outcome in patients with metastatic prostate cancer, particularly in the era of androgen receptor (AR)-targeted therapies. Although these agents improve survival, their differential impact on QoL and the role of psychological factors remain incompletely understood. This study aimed to evaluate QoL, functional outcomes, and psychological status, and to identify factors associated with poor QoL in a real-world cohort. Materials and Methods: This prospective cross-sectional, single-center observational study included 130 patients with metastatic prostate cancer receiving AR-targeted therapies (abiraterone, enzalutamide, or apalutamide/darolutamide). QoL was assessed using the EORTC QLQ-C30 questionnaire, and psychological status was evaluated using the Hospital Anxiety and Depression Scale (HADS). Patients were stratified according to treatment groups, and comparisons were performed using appropriate statistical tests. Logistic regression analyses were conducted to determine factors independently associated with poor QoL. Results: Exploratory differences in global QoL were observed among treatment groups (p = 0.007), with lower global QoL scores in the abiraterone group and numerically higher emotional and cognitive functioning scores in the enzalutamide group. Symptom analysis demonstrated higher nausea/vomiting scores in the abiraterone group (p = 0.022), whereas other symptom domains were comparable across treatment groups. In multivariable analysis, anxiety (odds ratio [OR]: 6.62) and depression (OR: 3.40) were independently associated with poor QoL, while treatment type was not independently associated with poor QoL after multivariable adjustment. Conclusions: Although unadjusted QoL scores differed across AR-targeted therapy groups, psychological factors—particularly anxiety and depression—were significantly associated with poorer QoL in patients with metastatic prostate cancer. These findings highlight the importance of integrating routine psychosocial assessment and supportive care strategies into clinical practice to optimize patient-centered outcomes. However, given the cross-sectional and exploratory nature of the study, the findings should be interpreted cautiously. Full article

Objective: This study aimed to evaluate the associations between dental anxiety–fear, state–trait anxiety, and pain in patients requiring endodontic treatment and to explore the role of preoperative pain intensity in these associations. Methods: This cross-sectional study included 253 adults scheduled for endodontic treatment. Sociodemographic characteristics and relevant clinical data were recorded. Pain intensity and psychological variables were assessed using the Numerical Rating Scale (NRS), Modified Dental Anxiety Scale (MDAS), Dental Fear Survey (DFS), and the State Anxiety and Trait Anxiety subscales of the State–Trait Anxiety Inventory (STAI-S and STAI-T). Associations were analyzed using group comparison tests and correlation analyses, and mediation analyses were performed using Hayes’ PROCESS macro-4. Results: Significant correlations were found among all psychological parameters (p < 0.05). The observed associations were consistent with a potential partial mediating role of pain in the relationship between state–trait anxiety and dental anxiety. Higher anxiety levels were present in patients with anterior teeth requiring either primary treatment or retreatment compared with posterior teeth (p < 0.05). Conclusions: Preoperative pain may contribute to the association patterns identified between dental anxiety and state–trait anxiety. Further studies with larger sample sizes and adjusted analytical models are needed to better clarify these relationships. Full article

Objective: Traumatic brain injury (TBI) is disproportionately prevalent in incarcerated populations, yet the potential impact on cognitive functioning remains underexplored. This study examined the relationship between TBI history and cognitive performance in a male prison population. Method: Sixty-three participants from Tongariro Prison completed a comprehensive neuropsychological assessment including measures of executive function, memory, processing speed, and perceptual reasoning, with embedded performance validity metrics. TBI history was assessed using the Ohio State University TBI Identification Method (OSU-TBI ID), premorbid function was assessed using the Speed and Capacity of Language Processing (SCOLP) Spot-the-Word task, mood was assessed using the Depression, Anxiety and Stress Scales (DASS-21), and alcohol and substance use were measured using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Regression analyses explored the relationship between TBI history and cognitive functioning, controlling for premorbid function, mood, alcohol and substance use, and ethnicity. Results: Contrary to hypotheses, TBI frequency and severity were not associated with poorer cognitive performance in this population. However, a self-reported history of pervasive TBI—defined as repeated head impacts over a narrow time frame—was significantly associated with reduced performance on the Color–Word Interference Test (CWIT) inhibition task, indicating links to greater cognitive disinhibition. Conclusions: Findings suggest that experiencing at least one period of pervasive TBI may be associated with an impact on inhibition (but not other aspects of executive functioning) in men in prison. These results underscore the importance of nuanced TBI history assessment and highlight inhibition as a potential target for rehabilitation in incarcerated individuals exposed to repetitive head trauma. Full article

Background/Objectives: Valid and time-efficient measurement instruments for the assessment of perinatal distress beyond depressive symptoms are yet to be determined. The main objective was to analyse the psychometric measurement properties of the Depression Anxiety Stress Scales (DASS) short forms in Swedish pregnant women during the third trimester. The secondary objective was to analyse the measurement properties of DASS short forms for the postnatal period. Methods: Data from the Scania Birth Cohort study including 78 women followed prospectively from the third pregnancy trimester to one year postpartum were used. The DASS-21, DASS-12, DASS-9 (two versions), and the 12-item Mini-DASS were analysed using confirmatory factor analysis (CFA), inter-item analysis, and Spearman’s rho subscale cross-correlations. Postnatal analysis at infant ages 1, 6, and 12 months was performed using CFA and inter-item analysis. Results: When used with third-trimester pregnant women, the DASS-9 version 1 and the Mini-DASS exhibited overall acceptable psychometric properties in terms of internal consistency (McDonald’s ω ≥ 0.77) and structural and discriminant validity (e.g., CFI > 0.90 and SRMR < 0.08 for all DASS-9 two- and three-factor models; and CFI > 0.95 and SRMR < 0.08 for one-factor models of the Mini-DASS subscales - including a modified anxiety scale - and for the Mini-DASS depression and anxiety two-factor model). Support for these DASS short forms postpartum was also indicated. Conclusions: Although preliminary, the current results support the DASS-9 and the Mini-DASS as parsimonious tools for the assessment of perinatal distress and its subtypes. Further validation in the perinatal context is warranted. Full article

Background/Objectives: Parents of children with autism spectrum disorder (ASD) often face sustained emotional, practical, and social demands. However, evidence from Romania remains limited, particularly regarding the combined assessment of caregiver burden, emotional distress, and coping strategies of parents. This exploratory study compared these outcomes between parents of children/adolescents with ASD and parents of typically developing children and examined whether coping patterns varied according to selected sociodemographic characteristics. Methods: We conducted a cross-sectional comparative study in Târgu-Mureș, Romania, between 2024 and 2025. The sample included 92 parents: 46 parents of children/adolescents with clinician-confirmed ASD and 46 parents of typically developing children. Participants completed a demographic questionnaire, the Caregiver Burden Inventory (CBI), the Depression Anxiety Stress Scales-21 (DASS-21), and the Strategic Approach to Coping Scale (SACS). DASS-21 data were available for 44 ASD caregivers and 46 controls. Between-group comparisons were performed using t-tests, Mann–Whitney U tests, chi-square tests, or Fisher’s exact tests, as appropriate. Results: The groups were comparable in sex, age, residence, number of children, and household size, but differed significantly in marital status and educational level. Clinically relevant caregiver burden (CBI ≥ 36) was more frequent among parents of children with ASD than among controls (30% vs. 17%), although this difference was not statistically significant. Parents of children with ASD showed trend-level higher depressive and anxiety symptoms, with small effect sizes, whereas stress scores were similar between groups. Coping patterns varied according to sociodemographic characteristics. Marital status was associated with aggressive coping, urban residence was associated with indirect and aggressive coping, and number of children was associated with seeking social support. Conclusions: Parents of children with ASD showed a higher proportion of clinically relevant caregiver burden and trend-level elevations in depressive and anxiety symptoms, while stress scores were comparable between groups. Exploratory adjusted analyses suggested that ASD caregiver status remained associated with caregiver burden and depressive symptoms after controlling for educational level and marital status. Coping strategies appeared heterogeneous and context-dependent. Given the exploratory design, modest sample size, and multiple comparisons, these findings should be interpreted as preliminary and hypothesis-generating. Full article

Background/Objectives: Children’s mental health and positive development are shaped by family, environmental, and individual factors. Although neurodevelopmental disabilities (NDDs) are well-established correlates of poorer mental health outcomes, few national-scale studies have simultaneously modeled positive (flourishing) and negative (anxiety, depression) outcomes within a unified ecological framework. This study examined how parent mental health, peer victimization, neighborhood and school context, and four NDD diagnoses (autism spectrum disorder [ASD], attention-deficit/hyperactivity disorder [ADHD], developmental delay, and learning disability) are associated with flourishing, current anxiety, and current depression in a national sample of U.S. children aged 6–17 years. Methods: Cross-sectional data from the 2023–2024 National Survey of Children’s Health (NSCH; N = 71,172) restricted to ages 6–17 with complete data (unweighted n = 64,263; weighted population estimate ≈ 44.6 million children) were analyzed using Complex Sample logistic regression (SPSS 30), accounting for stratified design (state × stratum), household clustering, and sampling weights. Three hierarchical models were estimated for each outcome. NDD-stratified subgroup analyses (n = 13,971; weighted ≈ 8.6 million) triangulated moderation findings. Multiple imputation (m = 5) sensitivity analyses confirmed robustness. Results: Weighted prevalence was 60.7% for flourishing, 13.2% for current anxiety, and 5.1% for current depression. In Block 2 models, poorer parent mental health and more frequent bullying victimization were robustly associated with all outcomes (flourishing OR = 0.62 and 0.65; anxiety OR = 1.64 and 1.63; depression OR = 1.95 and 1.75; all p < 0.001). Supportive neighborhood (flourishing OR = 1.40, depression OR = 0.80) and safe school (flourishing OR = 1.20, anxiety OR = 0.87) were protective. ADHD was the strongest disability-specific correlate (flourishing OR = 0.29; anxiety OR = 4.69; depression OR = 4.27). Three of the twelve interaction terms were significant, all involving ADHD. Relative to children without any NDD, subgroup analyses suggested attenuated associations of parent mental health and bullying with anxiety and depression among children with any NDD (e.g., bullying on anxiety: no-NDD aOR = 1.73 vs. Any-NDD 1.52); however, formal interaction tests identified ADHD as the only significant moderator of these associations. On the absolute-risk scale, however, the increase in internalizing problems with more frequent bullying was larger in children with ADHD. Conclusions: Family mental health support and bullying prevention are universally relevant levers for improving children’s mental health and flourishing. Although attenuation of the odds-ratio associations was observed primarily in ADHD-related analyses, specifically for the internalizing outcomes (anxiety and depression), universal anti-bullying and parent mental health interventions remain relevant for children with NDDs, supporting integration into pediatric clinical and public-health programs alongside disability-specific support pathways. Full article

We evaluated the psychometric fitness of divine forgiveness measures alongside measures of depression, anxiety, and well-being among mental health (MH) clinicians and trainees enrolled in accredited MH United States programs (N = 226). We hypothesized that forgiveness measures would meet psychometric standards and show positive associations with well-being and religiosity, and negative associations with depression and anxiety. Using a secondary data analysis, participants’ responses to the Fincham and May’s Divine Forgiveness Scale (DF), the Fetzer Divine Forgiveness Scale (FDF), and measures of religiosity, flourishing, depression, and anxiety were analyzed with reliability testing, correlations, t-tests, chi-squares, and linear and curvilinear regressions. The DF demonstrated excellent internal consistency (α = 0.96) and both FDF and DF showed strong positive correlations with religious involvement, and salience of religious beliefs (r = 0.49–0.62, p < 0.001). Religious affiliation predicted higher forgiveness scores (DF; d = 2.85; FDF: d = 0.99, p < 0.001). Additionally, higher levels of religious importance and belief in God were significantly associated with higher DF and FDF scores (p < 0.001). Regression analyses showed a positive linear association between flourishing and measures of divine forgiveness (FDF; β = 0.22, p < 0.001, 95% CI [1.11, 4.20]; DF scores (β = 0.22, p < 0.001, 95% CI [1.172, 4.387]), but neither scale related significantly to depression or anxiety. Curvilinear analysis revealed a quadratic relationship for FDF (β = 1.27, p = 0.004, 95% CI [0.96, 5.002]) and lower levels of depression (β = −0.98, p = 0.03, 95% CI [−0.37, −0.02]) and anxiety (β = −1.15, p = 0.01, 95% CI [−0.52, −0.07]). However, no curvilinear effects were observed for the DF scale. Findings support the reliability and validity of both measures and suggest divine forgiveness may serve as a protective factor for clinician well-being. Full article

Public health crises may profoundly affect college students, but there is a lack of instruments specifically designed to assess their perceptions of such events. This study aimed to develop and preliminarily validate the College Students’ Perceived Public Health Crisis Scale (CSPHCS), a measure designed to assess college students’ perceptions of public health crises. The scale development followed a multistage process including item generation through literature review and student interviews, expert review, cognitive interviewing, pilot testing, and psychometric evaluation using exploratory and confirmatory factor analyses. Data were collected using an electronic questionnaire administered to college students. Exploratory factor analysis supported a three-factor, 16-item structure comprising: (1) perceived impact and personal anxiety, (2) perceived likelihood of crisis occurrence and infection, and (3) confidence in preparedness and information trust. Confirmatory factor analysis provided partial support for the three-factor model, with acceptable RMSEA and SRMR but CFI and TLI slightly below conventional thresholds. Internal consistency was acceptable for the overall scale and its subscales (Cronbach’s α = 0.758–0.804). The CSPHCS provides preliminary evidence of content validity, internal consistency, and construct validity as a measure of college students’ perceptions of public health crises. Further studies are needed to refine the scale and examine its stability, predictive utility, and applicability across diverse contexts. Full article

Smartphones are now deeply embedded in daily life, but excessive dependence may increase the risk of nomophobia, which is associated with anxiety, sleep disruption, and reduced productivity. Existing screening methods mainly rely on self-reported questionnaires, which are subjective and difficult to scale for continuous monitoring. This study proposes a privacy-preserving federated deep learning framework for three-level nomophobia risk prediction (Normal, Mild, and Severe) using smartphone usage logs while keeping raw user data on local devices. The proposed pipeline uses a publicly available secondary dataset with 1000 original records and expands it to 100,000 records through constraint-aware synthetic augmentation. A continuous risk score is computed from standardized smartphone usage indicators and then converted into three classes using tertile-based thresholds. Several local architectures, including CNN, MLP, ResMLP, Wide & Deep, and a lightweight TabNet-style gated model, are evaluated under FedAvg. In the reported experiments, differential privacy is enabled through DP-SGD with gradient clipping and Gaussian noise. To protect update transmission, the framework applies protected update sharing through encrypted transport of masked updates. Each client masks its local update and encrypts the masked payload before transmission. This mechanism improves communication confidentiality and reduces the direct exposure of client updates. Under a fixed federated setup with five clients and 25 communication rounds, tabular models achieved near-ceiling performance on the constructed test set. The MLP achieved 99.12% accuracy, 99.12% F1-score, 0.9868 MCC, and 0.9997 AUC, while Wide & Deep achieved 98.95% accuracy, 98.95% F1-score, 0.9843 MCC, and 0.9997 AUC. In contrast, sequential models such as RNN and LSTM showed near-random performance, suggesting that the current aggregated feature representation is better suited to tabular learning than temporal modeling. These results indicate that the proposed federated pipeline can effectively learn the constructed nomophobia risk labels while preserving local data ownership. However, because the labels are derived from usage features rather than clinical or psychometric assessment, the findings should be interpreted as proof-of-concept results for constructed risk labels rather than evidence of clinical diagnostic validity. Full article

This study aimed to describe the pre–post changes in intrinsic motivation observed following the implementation of a parkour-based Adventure Education (AE) program in primary school students, and to examine the role of enjoyment, self-confidence, and resilience as variables statistically associated with intrinsic motivation, considering differences according to time (pre-test–post-test) and gender. The sample consisted of 492 fifth- and sixth-grade primary education students (249 boys and 243 girls) with a mean age of 10.67 years, enrolled in 12 Spanish schools. A quasi-experimental design with pre-test and post-test measures was used following the implementation of a seven-session program based on the Pedagogical Model of Adventure Education. Data were collected using instruments validated in the Spanish population: the intrinsic motivation subscale of the Perceived Locus of Causality Scale, the Physical Activity Enjoyment Scale to measure enjoyment, the self-confidence subscale of the Competitive State Anxiety Inventory, and the Connor–Davidson Resilience Scale to assess resilience. Statistical analysis was performed using SPSS 28.0 software, conducting descriptive analyses, correlations, and hierarchical multiple linear regressions to examine the statistical associations among the variables at each measurement point, along with a 2 × 2 repeated-measures ANOVA (time × gender). Post-test scores were significantly higher than pre-test scores for intrinsic motivation, enjoyment, self-confidence and resilience. Enjoyment was the variable most strongly statistically associated with intrinsic motivation, followed by self-confidence and resilience. The ANOVA showed a significant main effect of time, while no significant time × gender interaction was detected, meaning that the study found no evidence that the pre–post change differed between boys and girls. Given the single-arm pre–post design and the absence of a control group, these findings should be interpreted as preliminary descriptive evidence of pre–post change and associations, and not as a causal test of the program’s effectiveness. Full article