Psychiatry International doi: 10.3390/psychiatryint7050215

Authors: Waylon Wing-Lun Chan Harvey Hung Christina Lam Koi Man Cheng Jack Lee Maria Lai Noel Tang Benny Chung-Ying Zee

Background: Schizophrenia is a debilitating disorder that exacts a heavy burden on sufferers and carers alike. Despite improvements in neuroimaging techniques in the past decades, schizophrenia has lacked a clear definition at the neuroanatomical level. The presence of diagnostic markers may lead to breakthroughs with our current phenomenological approach to schizophrenia, assisting with diagnosis and monitoring of the disease. Prior study findings suggest structural retinal changes in schizophrenia, including retinal-layer thinning and microvascular changes. Aim: We aim to evaluate whether retinal imaging, in combination with machine-learning approaches, can facilitate diagnostic classification of schizophrenia. Furthermore, we characterise retinal structural features in individuals with schizophrenia compared with healthy controls, and examine whether these retinal measures are associated with disease status, clinical severity, functional outcomes, and other key clinical variables. Method: This study recruited 64 individuals with schizophrenia and 64 healthy controls. Participants in the schizophrenia group completed standardized clinical rating scales to assess symptom severity and functional status. Additional clinical variables, including demographic characteristics, duration of untreated psychosis, and antipsychotic medication dosage, were recorded. All participants underwent fundus photography, and retinal images were processed using the Automated Retinal-Imaging Analysis (ARIA) system developed at the Chinese University of Hong Kong (CUHK). Extracted retinal parameters were used to train machine-learning models to classify schizophrenia cases versus controls. Using a cross-sectional design, we compared retinal characteristics between groups while adjusting for relevant confounders, and evaluated associations between retinal measures and clinical variables within the schizophrenia cohort. Results: Our machine-learning model successfully distinguished individuals with schizophrenia from healthy controls, achieving high sensitivity (96.9%) and specificity (92.2%). Consistent with prior literature, we observed reductions in some measures of retinal thickness in the schizophrenia group, along with some novel alterations in venular microvascular structure. No associations between retinal measurements and symptom severity or illness-related variables were statistically significant. Conclusions: The strong discriminatory performance of our machine-learning (ML) model underscores the potential value of ML-based retinal analysis as an adjunct to existing diagnostic and risk-stratification approaches for schizophrenia. Our findings suggest retinal-layer alterations in schizophrenia and novel microvascular changes that have not been examined in earlier work. Together, these results highlight promising directions for future large-scale investigations into retinal biomarkers in schizophrenia.

Psychiatry International doi: 10.3390/psychiatryint7050214

Authors: Kapilraj Ravendran Ashwini Priyadarshini Singh Jugal Kishore Yohan Joe Roy Yeshaa Mirani Hussain Nawaz Madiha Nissar Aleeha Azhar Katyayani Singh

Background: Medical students experience substantially higher rates of anxiety and depressive symptoms than similarly aged members of the general population. Academic, financial, and social pressures, together with concerns about stigma, may discourage timely engagement with conventional mental health services. Artificial intelligence (AI)-enabled conversational agents delivering cognitive behavioural therapy (CBT) may provide an accessible and scalable form of psychological support, although evidence among international medical students remains limited. Objective: This study evaluated the feasibility and preliminary clinical effectiveness of an AI-supported conversational agent delivering CBT-based interventions for reducing symptoms of anxiety and depression in international medical students. Methods: A two-week pilot randomized feasibility trial was conducted among international medical students with clinically relevant symptoms of anxiety and/or depression. Participants were randomized to either an AI conversational CBT intervention or a psychoeducational self-help control. Feasibility and changes in anxiety and depressive symptoms were assessed following the intervention. Results: Of 228 screened students, 138 were randomized, with 74.6% retained at two weeks. Study completion was substantially higher in the intervention group. ANOVA demonstrated a significant effect of the intervention on post-intervention depressive symptoms, with participants receiving the conversational agent reporting significantly lower scores than controls. Anxiety symptoms also showed a significant intervention effect, with moderate-to-large treatment effects observed after two weeks. Conclusions: AI-supported conversational CBT appears feasible and acceptable for international medical students and may reduce short-term symptoms of anxiety and depression. The significant ANOVA findings provide preliminary evidence of clinical effectiveness. Larger multicentre randomized controlled trials with longer follow-up are warranted to confirm these findings and determine the potential role of AI-based interventions within university mental health services.

Psychiatry International doi: 10.3390/psychiatryint7050213

Authors: Luís Loureiro Hugo Neves Ana Teresa Pedreiro

Background: Mental Health Literacy (MHL), originally conceptualised by Jorm as knowledge and beliefs that facilitate the recognition, management, and prevention of mental disorders, has expanded to encompass Positive Mental Health Literacy (PMHL), incorporating constructs such as well-being, resilience, and flourishing. This conceptual expansion has raised concerns regarding conceptual ambiguity, redundancy with established well-being science, and the blurring of the distinction between knowledge and outcomes. Methods: A bibliometric analysis was conducted to map the conceptual evolution of the field. Records were retrieved from Web of Science, Scopus, MEDLINE (via PubMed), and CINAHL (via EBSCO), harmonised, deduplicated, and restricted to articles and reviews, yielding a corpus of 2443 documents published between 2000 and 2026. The data were analysed using the bibliometrix package and VOSviewer. Co-citation analysis and bibliographic coupling were not performed, as complete cited-reference data were unavailable; the keyword co-occurrence, thematic map, and thematic evolution analyses were conducted on a merged Web of Science and Scopus subset (n = 2059) rather than on the full corpus (n = 2443). Results: Scientific output was heavily concentrated in recent years, with approximately 72% of the corpus published from 2020 onwards. The field was dominated by a foundational Australian tradition centred on Jorm and the Mental Health First Aid network. Keyword co-occurrence analysis identified two asymmetric thematic poles: a dominant classical cluster organised around stigma, help-seeking, and disorder recognition, and a smaller, emerging cluster focused on well-being and mental health promotion. The most highly cited publications belonged to the classical core. Conclusions: These findings indicate that the expansion towards PMHL has diversified the periphery of the field without displacing its conceptual core, while also revealing terminological overlap that warrants clearer conceptual boundaries and more rigorous construct operationalisation.

Psychiatry International doi: 10.3390/psychiatryint7050212

Authors: Vie Cheong Thong Nicholas Tze Ping Pang Assis Kamu Umberto Volpe Laura Orsolini Sota Kyuragi Kuok Tiung Lee Chong Mun Ho Takahiro Kato

Background: Modern-type depression (MTD), first described in Japan, reflects a sociocultural form of depression characterized by avoidance of social roles, complaint tendencies, and low self-esteem. While increasingly recognized across Asian societies, no Malay-language adaptation of the TACS-22 has previously undergone psychometric evaluation. Objectives: This study aimed to translate and culturally adapt the Tarumi’s Modern-Type Depression Trait Scale (TACS) into Malay and to evaluate the reliability, factorial structure, discriminant validity, and convergent associations of the Malay version among Malaysian adults. Methods: Following standardized forward and backward translation and expert review, the TACS-22-Malay was administered to convenience sample of 250 predominantly young Malaysian adults together with the Malay Depression, Anxiety, and Stress Scale. Internal consistency was examined using Cronbach’s alpha, ordinal McDonald’s omega, and the Greatest Lower Bound (GLB). Because the TACS items comprise five ordered-response categories and multivariate nonnormality was present, the primary confirmatory factor analysis used the weighted least squares mean and variance-adjusted estimator with ordered indicators. The complete 22-item-correlated three-factor model was evaluated, with robust maximum likelihood and conventional maximum likelihood models used as sensitivity analyses. A one-factor model was also examined. Convergent associations were evaluated using Spearman’s ρ with bootstrap confidence intervals. Results: Internal consistency was high for the total score (alpha = 0.804, ordinal omega = 0.839, GLB = 0.877), but varied across Avoidance of Social Roles (alpha = 0.617, omega = 0.677), Low Self-Esteem (alpha = 0.711, omega = 0.760), and Complaint (alpha = 0.412, omega = 0.496). The primary three-factor WLSMV model showed poor fit, chi square (206) = 794.922, p < 0.001, CFI = 0.587, TLI = 0.537, RMSEA = 0.117, 90% CI [0.110, 0.125], SRMR = 0.108, and produced an inadmissible latent covariance matrix. Latent correlations were 0.748, 0.959, and 1.050, with the Low Self-Esteem and Complaint correlation exceeding 1. The one-factor WLSMV model also fit poorly. Robust and conventional maximum likelihood sensitivity analyses led to the same substantive conclusion. All TACS scores were positively associated with DASS 21 Depression, Anxiety, and Stress, with Spearman’s ρ ranging from 0.235 to 0.644. Conclusions: The Malay TACS-22 demonstrates useful internal consistency at the total score level and meaningful associations with psychological distress, but the hypothesized three-factor measurement model was not supported and discriminant validity between factors was inadequate. The poor fit of the one-factor model also indicates that high total score reliability should not be interpreted as evidence of unidimensionality. The present findings therefore support the Malay version as a provisional adaptation requiring further item refinement and independent validation rather than as a fully validated instrument.

Psychiatry International doi: 10.3390/psychiatryint7050211

Authors: Maria Teresa Sindelar Bruno Sales

Autism interventions are commonly evaluated at the level of treatment packages and intervention fidelity, whereas the therapist’s moment-to-moment embodied and interactional contribution is less often specified or directly measured. This work advances a more specific, testable hypothesis: therapist characteristics may be clinically relevant environmental inputs within a therapeutic dyad. We define co-regulation as a reciprocal, time-varying process in which each partner’s signals and responses are contingently adjusted in relation to the other’s state. This process is distinct from therapist-driven regulation, autonomic synchrony, or treatment response. We define a privileged environment as a recurrent therapeutic context whose observable interpersonal properties—such as predictability, contingency, sensory intensity, and responsiveness—are deliberately individualized to support a specific child’s participation and learning. Existing intervention studies demonstrate treatment-associated behavioral and neural changes, but generally do not isolate therapist autonomic state, prosody, posture, respiration, or other embodied features as independent causal mechanisms. Accordingly, the model should be read as a framework for measurement and hypothesis testing. The article outlines candidate mechanisms, specifies moderators, and proposes designs capable of separating therapist-specific effects from intervention, child, and contextual influences.

Psychiatry International doi: 10.3390/psychiatryint7050210

Authors: Felicia Cañete Andrés Ávalos Alberto Barcelo Ethel Santacruz

Mental health problems represent a growing public health burden, particularly in middle-income countries where population-based evidence remains limited. This study aimed to analyze the risk profiles and heterogeneity of symptoms compatible with depression, suicidal ideation, and panic in the adult population of Paraguay. A cross-sectional study was conducted using nationally representative data from the 2022 STEPS survey. The presence of symptoms compatible with depression, panic, and suicidal ideation was assessed using self-reported dichotomous screening questions. Associations with sociodemographic, behavioral, and clinical variables were analyzed using multivariate models, estimating adjusted odds ratios (aOR) with 95% confidence intervals, and the analyses accounted for the complex sampling design. The prevalence of symptoms compatible with depression was 35.8%, panic 22.4%, and suicidal ideation 8.0%. Higher odds were observed in women, younger age groups, urban residents, and individuals reporting daily smoking as well as those with diabetes mellitus. Associations varied across outcomes, reflecting heterogeneous risk patterns. Symptoms compatible with depression, panic, and suicidal ideation are highly prevalent and unequally distributed in the adult population of Paraguay. These findings highlight the need for targeted prevention strategies, early detection, and the integration of mental health into public health and noncommunicable disease policies and management.

Psychiatry International doi: 10.3390/psychiatryint7050209

Authors: Mokgadi Rosinah Nkgaphela Gsakani Olivia Sumbane Lina Sebolaisi Hlahla Leshata Winter Mokhwelepa

Fathers play a vital role in caring for children with Autism Spectrum Disorder (ASD). Fathers of children with ASD today have moved far beyond the “occasional helper” role. They are deeply involved in daily caregiving routines, supporting their families financially and emotionally. The involvement of the father in raising a child with ASD reduces stress levels for both parents and strengthens family ties. The study explored and described the roles that fathers play in the care of children with ASD. A qualitative, explorative, descriptive, and contextual research design was used to gain a detailed understanding of the role’s fathers play in the care of children with ASD. Non-probability purposive sampling was used to recruit 15 fathers of children with ASD. Data were collected through semi-structured interviews and analysed using Tesch’s eight data analysis steps. The findings revealed that fathers play a variety of roles in the care of their children with ASD. These include participating in meeting the needs of their children with ASD, protecting them from harm, promoting their emotional well-being, and supporting the overall operation of the family. The experiences of fathers in this study also reflect the difficulties of raising a child with ASD, such as financial expenses, safety concerns, and community stigma. It is necessary to create father-inclusive guidelines in maternal and child health services formally to integrate fathers into every aspect of children’s care, switching from a mother-centred approach to a family-centred one. As a result, fathers will routinely participate in the consultation, decision making, and treatment of their children with ASD.

Psychiatry International doi: 10.3390/psychiatryint7050208

Authors: Saba Ghayas Ayesha Abdullah Simone Varrasi Pakeeza Ishfaq Kainat Giuseppe Alessio Platania Claudia Savia Guerrera Francesco Maria Boccaccio Vittoria Torre Maria Principato Trosso Daniele Milton Concetta Pirrone Sabrina Castellano Memoona Shehzadi Faisal Abbas

Vicarious War Trauma (VWT) refers to psychological distress arising from indirect exposure to war-related suffering through media, social media, news reports, images, videos, or communication with affected individuals. Grounded in theories of vicarious traumatization and secondary traumatic stress, this study aimed to develop and validate the Vicarious War Trauma Scale (VWTS) for the Pakistani population. A cross-sectional design was employed across three studies. In Study I, an initial pool of 40 items was generated through literature review and interviews and refined to 34 items through expert evaluation. Exploratory factor analysis with maximum likelihood extraction and Promax rotation was conducted using data from 311 participants, yielding a 15-item scale with four factors: Shaky Beliefs, Empathic Distress, Hopelessness, and Anxiety, explaining 48.48% of the variance. In Study II, confirmatory factor analysis in an independent sample (N = 200) provided preliminary support for the proposed multidimensional structure. A post hoc revised second-order model with four first-order factors including two theoretically interpretable within-factor residual covariances showed acceptable fit, χ2(84) = 162.83, χ2/df = 1.94, CFI = 0.94, TLI = 0.92, and RMSEA = 0.07. Study III provided validity evidence for the provisional VWTS total score based on relations with external variables, showing positive associations with intolerance of uncertainty, empathy, depression, stress, and anxiety, and a negative association with resilience. Factor-specific validity based on relations with external variables was not examined. The scale is a psychometrically promising research instrument for assessing self-reported multidimensional psychological distress associated with indirect exposure to war-related suffering. Its potential utility as a screening measure requires further evaluation through longitudinal and predictive studies and external replication. It is not intended to assess posttraumatic stress disorder or to serve as a diagnostic measure of trauma-related disorders.

Psychiatry International doi: 10.3390/psychiatryint7050207

Authors: Tommaso Barlattani Giorgio Sernia Chiara D’Amelio Silvia Maritato Davide Gabriele Antony Bologna Filippo Trebbi Valerio Ricci Carmine Tomasetti Vassilis Martiadis Fabiola Raffone Alessandro Rossi Francesca Pacitti Domenico De Berardis

Background: Evidence for repeated intranasal esketamine in obsessive–compulsive disorder (OCD) remains preliminary, particularly when OCD co-occurs with treatment-resistant depression (TRD). Methods: We report a 58-year-old woman treated with intranasal esketamine in routine clinical care for TRD; change in obsessive–compulsive symptoms was followed as a secondary observational outcome. Her history aligned with the eligibility framework of a 2026 prospective intranasal esketamine series: primary Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) OCD, baseline Yale–Brown Obsessive Compulsive Scale (Y-BOCS) score of 33, a comorbid major depressive episode with a Montgomery–Åsberg Depression Rating Scale (MADRS) score of 38, sequential inadequate response to two high-dose selective serotonin reuptake inhibitor (SSRI) trials, clomipramine 250 mg/day for 6 months, eight cognitive-behavioral therapy (CBT) sessions incorporating exposure and response prevention (ERP), and brexpiprazole augmentation. The CBT/ERP course was time-limited and did not overlap with esketamine. Esketamine was administered at 56 mg initially and 84 mg thereafter, twice weekly for 4 weeks, weekly in month 2, and every 2 weeks during months 3–6. Results: MADRS/Y-BOCS scores were 23/18 at month 1, 19/15 at month 3, and 17/14 at month 6, corresponding to reductions of 55.3% and 57.6%. The OCD response threshold was met from month 1 and the depression response threshold from month 3. Adverse effects were transient and required no medical intervention or treatment discontinuation. Conclusions: During 6 months of routine-care intranasal esketamine augmentation for TRD, obsessive–compulsive improvement accompanied antidepressant improvement. The observation is hypothesis-generating and cannot distinguish a direct anti-obsessional effect from improvement related to depression, ongoing oral treatment, repeated clinical contact, or other nonspecific factors.

Psychiatry International doi: 10.3390/psychiatryint7050206

Authors: Marlee Gieselman Courtney N. Wiesepape Jessica Garrelts

Suicide is a serious public health concern and a major cause of premature mortality among individuals with psychotic disorders. Although several risk factors for suicide have been established, much remains unknown about how these factors generalize to populations experiencing psychosis. Existing literature has described an “insight paradox,” whereby improvements in insight have been associated with increased emotional distress. However, the extent to which insight is associated with suicide-related outcomes across psychotic disorders has not been comprehensively synthesized. This scoping review aimed to examine the relationship between insight and suicidality in psychosis, identify patterns and gaps within the literature, and summarize potential mechanisms underlying this association, with secondary consideration of illness stage. A scoping review was conducted following PRISMA-ScR guidelines, with 26 studies meeting inclusion criteria. Overall, greater insight was more frequently associated with increased suicidality than with null findings, although considerable heterogeneity existed across insight domains, suicide-related outcomes, and study methodologies. Notably, no study identified greater insight as a protective factor against suicidality. Findings suggest that interventions promoting insight should also address accompanying emotional and psychosocial challenges, such as self-stigma and hopelessness, and remain cognizant of associated suicidality risk. Future research should further clarify the mechanisms underlying the insight paradox.

Psychiatry International doi: 10.3390/psychiatryint7050205

Authors: Berrak Varhan Yakup Cemel Arzu Abalay Saadet Ufuk Yurdalan Huseyin Cat Yasin Genc

Background: Electroconvulsive therapy (ECT) is an effective treatment for major depressive disorder but may cause transient neurological and motor side effects. Limited evidence exists regarding acute balance disturbances following treatment. Therefore, this study aimed to evaluate short-term changes in balance following the first ECT session in patients with Major Depressive Disorder (MDD). Methods: In this prospective observational repeated-measures study, twenty-two participants diagnosed with MDD were enrolled according to the inclusion criteria, such as being between the ages of 18–65, being diagnosed with major depression, and receiving ECT for the first time. The exclusion criteria were a diagnosis of any vestibular or neurological disease. The balance of the participants was evaluated with the Berg Balance Scale (BBS). The same physiotherapist performed the assessments before, at the 1st hour after ECT, and at the 24th hour after ECT. Results: Mean BBS scores were 55.04 ± 1.78 before ECT, 40.22 ± 2.54 at 1 h, and 54.86 ± 1.64 at 24 h after treatment. Balance decreased significantly at 1 h compared with baseline (mean difference: +14.82 points, p < 0.001) and improved significantly by 24 h (mean difference: −14.64 points, p < 0.001). No significant difference was observed between baseline and 24-h measurements (p = 0.640). Conclusions: These findings demonstrate a transient impairment in balance performance during the first hour following electroconvulsive therapy. Although fall risk was not directly assessed, careful monitoring and patient-safety precautions may be considered during early post-treatment mobilization.

Psychiatry International doi: 10.3390/psychiatryint7050204

Authors: Zeynep Akkuş Çutuk Ayşe Esra Aslan Selman Çutuk Pablo Prieto-González Jason Perez

Background: Nomophobia is increasingly common and may impair daily functioning, academic performance, and social relationships. Although neuroticism has been linked to nomophobia, the role of digital stress in this association remains unclear. This study examined the indirect association between neuroticism and nomophobia through digital stress and whether emotion management skills moderated the digital stress–nomophobia association. Methods: Data were obtained from 434 undergraduate students using self-report measures. Hypotheses were tested with PROCESS Macro Model 14 in SPSS, controlling for gender and using bootstrap confidence intervals. Results: Neuroticism was associated with higher digital stress, and higher digital stress was associated with greater nomophobia. A significant statistical indirect effect of neuroticism on nomophobia through digital stress was observed, whereas the direct association between neuroticism and nomophobia was not statistically significant after digital stress was included in the model. Emotion management skills showed a small but statistically significant moderating effect on the digital stress–nomophobia association; however, the observed pattern was not protective. The association between digital stress and nomophobia was slightly stronger among students with higher emotion management skills. Conclusions: The findings support a statistical indirect association between neuroticism and nomophobia involving digital stress. Because the data were cross-sectional, the results do not establish temporal ordering or a causal mediation mechanism.

Psychiatry International doi: 10.3390/psychiatryint7050203

Authors: Sandu Camelia Molnar Rebeca Isabela Marchean Horia Grebenisan Lorena Mihaela Mihai Adriana

Mental health is shaped by multiple psychological, social, cultural, and spiritual factors. This narrative review aimed to synthesize the available evidence on the relationship between spirituality, religiosity, and mental health across the lifespan, with particular emphasis on psychological well-being, coping, resilience, and help-seeking behaviors, while considering both beneficial and potentially adverse associations. A narrative review was conducted using PubMed, Scopus, and Web of Science databases. Studies published between 2000 and 2026 were screened according to predefined eligibility criteria. A total of 52 publications, including quantitative and qualitative studies, systematic reviews, meta-analyses, and narrative reviews, were included. The evidence was synthesized according to three life stages (childhood and adolescence, adulthood, and older adulthood), with an additional section examining help-seeking behaviors and access to mental health care across the lifespan. The reviewed evidence identified both beneficial and adverse mental health outcomes in relation to spirituality and religiosity. Beneficial outcomes included lower levels of depression, anxiety, substance use, and suicidal behaviors, as well as higher levels of resilience, emotional support, and life satisfaction. In contrast, negative religious coping and spiritual struggles were associated with higher levels of depression and anxiety, as well as delayed help-seeking behavior. Overall, the findings varied across study designs, populations, and cultural contexts. Spirituality and religiosity can influence mental health in both positive and negative ways throughout life. Understanding these relationships may help support more sensitive and individualized approaches to mental health care.

Psychiatry International doi: 10.3390/psychiatryint7050202

Authors: Georgios Manomenidis Tânia Morgado Kostantinos Pafis Elena Vasileiou Thalia Bellali

Workplace phubbing (being ignored during an interaction because a colleague is attending to a mobile phone) is increasingly common in clinical settings and may function as a subtle interpersonal stressor relevant to nursing teamwork, occupational well-being, and cooperative functioning. This cross-sectional survey examined associations between perceived workplace phubbing and self-reported job performance (overall, in-role, and extra-role). It tested whether resilience and perceived phubbing norms were related to performance. Nurses and nurse assistants from six public hospitals in Northern Greece provided eligible questionnaires (N = 338). In the primary overall-score models, being phubbed was positively associated with total and in-role performance but not with extra-role performance. In secondary dimension-level models, perceived phubbing norms were positively associated with all three performance outcomes, whereas feeling ignored and interpersonal conflict were not independent predictors. Resilience was positively associated with total, in-role, and extra-role performance. The GSBP total × resilience interaction was statistically significant only for in-role performance; however, simple-slope interpretation indicated attenuation of a positive association at higher resilience rather than buffering of an adverse association. Overall, resilience appeared to function as an independent correlate of perceived work performance rather than as evidence of the hypothesized buffering of a negative phubbing–performance association. These findings suggest that workplace phubbing should be understood as a context-dependent interpersonal phenomenon rather than a uniform performance risk. Clarifying digital-attention norms and protecting inclusive communication during key clinical interactions may support teamwork, psychosocial climate, and occupational well-being among nurses.

Psychiatry International doi: 10.3390/psychiatryint7050201

Authors: Shiori Ogawa Chieko Yoshihara Satoshi Suyama Rika Nakajima Satoshi Sumi

Background: Problematic gaming has been linked to reduced well-being, but associations between student life satisfaction and gaming-related risk among students remain relatively untested. This pilot cross-sectional study applied the Japanese version of the Gaming Disorder Scale for Adolescents (GADIS-A) on an exploratory basis to a university student sample to examine gaming-related risk classifications and their associations with gaming time and student life satisfaction. Methods: In December 2021, 320 university students in Aichi, Japan, completed an anonymous online survey including the Japanese GADIS-A and five student life satisfaction items. Participants were classified using operational criteria based on the previous GADIS-A scoring framework: gaming disorder (GD), elevated symptoms, and problem frequency. Prevalence estimates were based on the full sample, whereas logistic regression analyses were restricted to current gamers (gaming time > 0 h; n = 244). Results: In the full sample, 35 students (10.9%) met the operational criteria for GD, and 106 (33.1%) had elevated symptoms. Among current gamers, longer gaming time was associated with increased incidence of GD, elevated symptoms, and problem frequency. Conversely, better student life satisfaction was associated with decreased incidence of GD. Conclusions: These results indicate that student life satisfaction may help explain gaming-related risk among university students. Follow-up longitudinal and psychometric studies are required.

Psychiatry International doi: 10.3390/psychiatryint7050200

Authors: Antonello Pinna Charles Prendergast Artur Pałasz

Trace amines (TAs) are endogenous biogenic amines present at low concentrations in the brain and were historically considered byproducts of monoamine metabolism. The discovery of trace amine-associated receptors (TAARs), a family of G protein-coupled receptors, has redefined their physiological and pharmacological relevance. TAAR1 regulates dopaminergic, serotonergic, and glutamatergic signaling and is increasingly implicated in neuropsychiatric disorders. Preclinical studies show that TAAR1 agonists normalize dopaminergic function and improve cognitive deficits in schizophrenia models. Early clinical evidence suggests potential antipsychotic efficacy with a favorable extrapyramidal and metabolic safety profile. However, the failure of subsequent phase III trials to meet their primary efficacy endpoints highlights the need to identify responsive patient subgroups, optimize trial design, and clarify the clinical settings in which TAAR1 agonism may provide the greatest therapeutic benefit. In depression, TAAR1 activation produces antidepressant-like effects in preclinical models, whereas findings in anxiety are variable and context-dependent. TAAR1 may also modulate reward-driven feeding and metabolic parameters. Mechanistically, TAAR1 agonists differ in their effects on dopamine transporter function and monoaminergic neuron activity, indicating that their pharmacological effects are compound-specific rather than class-wide. These properties distinguish TAAR1-targeting compounds from classical D2 receptor antagonists and may underlie their clinical profile. Further translational studies are required to confirm their efficacy across symptom domains and establish long-term clinical benefit.

Psychiatry International doi: 10.3390/psychiatryint7050199

Authors: Camelia Raluca Răchieru Sofia Mihaela David Andra Irina Bulgaru-Iliescu Simona Irina Damian Tatiana Iov

(1) Background: Communication barriers may complicate forensic psychiatric assessment of deaf or hard-of-hearing individuals. (2) Methods: This retrospective descriptive case series reviewed 450 unique adults with institutional and forensic psychiatric records at a high-security hospital in Iasi County, Romania (2015–2025). Six individuals (N = 6; 6/450, 1.33%) met the record-based criteria for profound bilateral hearing loss with severe speech or spoken-language impairment. No examination was performed specifically for the study. (3) Results: Four of six individuals had documented congenital or prelingual profound bilateral hearing loss, and two had profound bilateral coexisting conductive and sensorineural hearing-loss components. Four had no formal schooling, and two had partial compulsory schooling; all six lacked documented standardized sign-language competence. Initial records did not document effective communication access or audiological confirmation, and psychiatric formulations were inconclusive or changed over time. Forensic discernment was recorded as absent in 5/6 individuals (83.3%). (4) Conclusions: Communication limitations may have contributed to assessment uncertainty alongside educational, cognitive, psychiatric, and social factors. The series does not confirm misdiagnosis, causation, or population prevalence.

Psychiatry International doi: 10.3390/psychiatryint7050198

Authors: Jelena Kovačević Vedrana Lanc Čurdinjaković Mato Matić Ivan Miškulin Ivana Kotromanović Šimić Nika Lovrinčević Pavlović Mirjana Grebenar Čerkez Dragana Bekić Branka Bardak Maja Miškulin

Background: Road traffic accidents (RTAs) present a significant public health problem and economic burden. The aim of the study was to determine mental health outcomes and health-related quality of life (HRQOL) of RTA victims 6 months following a road trauma and factors associated with mental and physical components of HRQOL; Methods: A cohort of 200 RTA victims was followed during a 6-month period and a wide range of sociodemographic, health-related, RTA-related, injury-related, psychological and victim-related factors associated with the HRQOL scores were explored using multiple regression analyses; Results: Lower physical component summary score was associated with pre-existing chronic disease, self-perceived life threat, surgical treatment, amnesia following an RTA, permanent pain, increase in pain intensity or frequency and depression symptoms (p < 0.05); lower mental component summary score was associated with irreligiousness, rehabilitation procedure, depression symptoms, anxiety symptoms, permanent pain and increase in medication use (p < 0.05); Conclusions: HRQOL measurement after an RTA should provide holistic assessment of physical, mental and social consequences throughout an extended period of recovery. Together with evaluation of predictors of poorer HRQOL and recovery, this could enable an individual approach to individual needs of RTA victims.

Psychiatry International doi: 10.3390/psychiatryint7050197

Authors: Betty Kollia Eleni Anastasia Fantaoutsaki Panagiota Moraiti Eleni Tzormabatzaki Vicky Nanousi Voula C. Georgopoulos

Parents of children with autism spectrum disorder (ASD) and other communication-related conditions may experience substantial emotional demands, yet depressive symptoms have been underexamined in Greek families. This exploratory cross-sectional study assessed depressive symptoms in 164 Greek parents using the Greek-language Beck Depression Inventory-II (BDI-II). Of the participants, 117 reported having a child with ASD, and 47 reported having a child with another communication-related condition. Mean BDI-II scores were significantly higher among parents of children with ASD than among parents of children with other communication-related conditions (17.65 vs. 9.36; Welch’s t(140.19) = 5.73, p < 0.001, Cohen’s d = 0.80). This association remained significant after adjustment for parent-reported functional-speech status and available parent characteristics (B = 8.27, 95% CI [4.73, 11.80], p < 0.001). Parent-reported functional-speech status was also associated with the distribution of BDI-II symptom-severity categories (exact p = 0.002); however, the continuous-score difference and adjusted association for absence of functional speech were not statistically significant (p = 0.086 and p = 0.080, respectively). These findings suggest that parent-reported ASD status was more consistently associated with depressive-symptom severity than functional-speech status in this exploratory sample. Cross-sectional design, convenience sampling, parent-reported child characteristics, and limited measurement of potential confounders warrant cautious interpretation.

Psychiatry International doi: 10.3390/psychiatryint7050196

Authors: Claudiu-Ionut Vasile Emmanuel Chimdiebere Ogamdi Bianca Balas-Maftei Carmen-Elena Florea Alexandra Rotaru Ioana Adelina Stoian Patricia Lorena Abudanii Mihaela Camelia Vasile Carmen Doina Manciuc

Mood disorder symptoms represent an important but understudied mental health concern among physicians in Romania, with potential implications for quality of life and suicide risk. This cross-sectional study included 104 medical doctors. Validated self-report instruments were used to assess depressive symptoms, manic and cyclothymic symptoms, bipolar risk, suicidal behaviour, and quality of life. Pearson correlation analyses and multiple linear regression models were conducted to examine associations and identify predictors of quality of life and suicide risk. Overall, 33% of participants screened positive for depressive symptoms, 21% for manic symptoms, 71% for cyclothymic symptoms, 12% for suicide risk, and 2% for bipolar risk. Depression, cyclothymia, and suicide risk were negatively correlated with quality of life, whereas manic symptoms showed a positive association. In multivariate analyses, cyclothymia predicted poorer quality of life (β = −0.43, p < 0.001) and manic symptoms seemed to predict better quality of life (β = 0.26, p = 0.008), while depressive symptoms uniquely predicted greater suicide risk (β = 0.24, p = 0.048). These findings indicate a high prevalence of mood disorders among Romanian physicians and suggest distinct patterns linking mood symptoms to quality of life and suicide risk. The results highlight the importance of early identification, stigma reduction, and targeted mental health interventions to support physician well-being and healthcare system sustainability.

Psychiatry International doi: 10.3390/psychiatryint7050195

Authors: Kanika Seth Amita Vyas Nitasha Nagaraj

Acculturative family distancing (AFD), characterized by communication gaps and cultural value differences between immigrant parents and their children, has been identified as a potential contributor to mental health disparities among Asian American populations. However, limited research has examined its role among South Asian Americans. This study aimed to assess the association between AFD and symptoms of depression, anxiety, and self-harm in this population. A cross-sectional, anonymous survey was administered to 673 South Asian female college students across the United States. Validated measures included the PHQ-9 for depression, GAD-7 for anxiety, and an adapted AFD scale focusing on communication. Multivariable regression models with a single outcome variable and logistic regression models were used to examine associations between AFD and mental health outcomes, adjusting for demographic factors. Higher AFD scores were significantly associated with increased depressive scores (β = 0.122, p < 0.001), anxiety symptoms (β = 0.102, p < 0.001), and greater odds of self-harm (OR = 1.064, p < 0.001). These findings suggest that AFD represents a meaningful form of psychological disconnection that is associated with increased vulnerability to mental health challenges. Interventions addressing emotional connection within families may be critical for improving mental health outcomes among South Asian American women.

Psychiatry International doi: 10.3390/psychiatryint7050194

Authors: Mara Lastretti Mirko Manchia Matteo Fraschini Andrea Faa Ferdinando Coghe Pasquale Paribello Martina Pinna Ekta Tiwari Jasjit S. Suri Luca Saba Massimo Rugge Ulker Isayeva Andrea Cicoli Lorenzo Campedelli Ettore D’Aleo Gavino Faa

Background: Artificial intelligence (AI)-driven conversational systems are increasingly capable of simulating empathy, adapting to individual users, and fostering emotional bonds that blur the boundary between tool and companion. This scoping review maps the extent and nature of published evidence regarding psychological mechanisms underlying emotional reliance on AI chatbots and associated mental health implications. Methods: Conducted in accordance with PRISMA-ScR guidelines, we systematically searched PubMed/MEDLINE, PsycINFO, Web of Science, Scopus, and IEEE Xplore from database inception to March 2026. Two independent reviewers screened records and extracted data using the PCC (Population, Concept, Context) framework. Thematic synthesis was performed to map evidence across psychological, clinical, and developmental domains. Results: Of 1847 records identified, 46 studies met inclusion criteria. Key themes included: (1) the ELIZA effect as a foundational mechanism of human–AI attachment, with documented cases of severe dependency including fatal outcomes; (2) anthropomorphization and artificial intimacy fostered by adaptive, personalized AI design; (3) proposal of Generative AI Dependency (GAID) as a conceptual framework mapping onto behavioral addiction components, pending empirical validation; (4) particular vulnerability of adolescents and lonely individuals to exclusive affective bonds with AI; and (5) potential erosion of human relational capacities, empathy development, and tolerance for interpersonal complexity. Significant gaps were identified in longitudinal research, validated screening tools, and intervention protocols. Conclusions: Emotional reliance on AI represents an emerging clinical phenomenon with addiction-like features requiring specific diagnostic frameworks, evidence-based interventions, and ethical design guidelines. Future research should prioritize longitudinal studies examining developmental impacts and neurobiological investigations of AI-mediated reinforcement mechanisms.

Psychiatry International doi: 10.3390/psychiatryint7050191

Authors: Seyed Mohammad Mahdi Moshirian Farahi Craig Leth-Steensen

Autistic traits have been associated with enhanced perceptual processing, attention to detail, and systemizing, all of which may be linked to numerical cognition. However, little is known about whether these traits are related to symbolic numerical processing. This study examined the association between autistic traits and numerical comparison performance in adults. Data were collected online from N = 463 participants who performed some numerical tasks and then responded to a number of psychological questionnaires. Of major concern to the current study was whether two types of numerical processing effects (distance and size), as well as an overall processing efficiency measure derived from a single-digit numerical comparison task, were potentially related to self-reported measures of autistic traits and systemizing levels, as well as to performance on a double-digit arithmetic performance task. Although currently available numerical and autistic processing theories would suggest that such relations should indeed exist, none were evident in the results, even though both robust distance and size effects were obtained. However, robust sex and academic major differences were observed for both distance and size effects (smaller for both males and those majoring in STEM).

Psychiatry International doi: 10.3390/psychiatryint7050193

Authors: Ivana Živoder Mateja Znika Anica Kuzmić Marija Arapović Nikolina Zaplatić Degač Vesna Hodić Goran Knežević

Introduction: Prolonged sitting, computer work and digital workload are associated with frequent occurrence of pain in the spine and upper extremities, as well as increased stress and mental problems. Some difficulties often arise from static strain caused by long hours of computer work and inappropriate ergonomic working conditions. The aim of this study was to assess the occurrence of the difficulties described in non-teaching staff in an academic environment. Methods: The cross-sectional design of this study included 34 non-teaching employees of University North. Demographic data and the Nordic Musculoskeletal Questionnaire and Questionnaire on depression, anxiety and stress (The Depression, Anxiety and Stress Scale—DASS-21) were used. Results: The results presented a moderate level of stress in 32.4% of participants, while 29.4% had a normal level of stress. A normal level of anxiety was observed in 44.1% of participants, whereas 23.5% reported extremely severe anxiety. A statistically significant difference was found between troubles in the shoulders during the last 12 months and stress levels. Also, a statistically significant difference was found between troubles in the wrists/hands during the last 12 months and depression. Conclusions: Given the relatively small sample size and the large number of statistical comparisons performed, these findings may represent either true associations or chance findings and therefore require confirmation in larger longitudinal studies specifically designed to investigate the relationship between psychological factors and musculoskeletal complaints.

Psychiatry International doi: 10.3390/psychiatryint7050192

Authors: Jimmie Manning

Unspecified Sexual Dysfunction is a residual diagnostic category within the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) used when symptoms characteristic of a sexual dysfunction cause clinically significant distress but do not meet criteria for a specific sexual dysfunction and the clinician does not specify the reason, including situations in which insufficient information is available for a more specific diagnosis. This narrative literature review examines diagnostic classification and clinical assessment in such presentations and considers how systemic perspectives can complement psychiatric assessment and intervention. A literature search using Google Scholar and citation-network mapping identified 34 peer-reviewed sources addressing sexual dysfunction classification, assessment, biopsychosocial and relational aspects of sexual distress, and treatment. The literature supports a distinction between diagnostic classification and comprehensive clinical formulation. Biological, psychological, relational, sociocultural, and developmental aspects do not constitute diagnostic criteria for Unspecified Sexual Dysfunction but may provide clinically relevant information for understanding sexual distress and selecting appropriate interventions. Systemic and relational assessment may therefore complement DSM-5-TR diagnosis by identifying interpersonal and contextual aspects relevant to treatment planning without redefining the diagnosis itself. Integrating diagnostic evaluation with broader clinical formulation may support individualized treatment and interdisciplinary collaboration across psychiatry, sexual medicine, psychosexual therapy, and relational or systemic care.

Psychiatry International doi: 10.3390/psychiatryint7050190

Authors: Damian Swieczkowski Michal Pruc Lukasz Szarpak Aleksander Kwaśny Wiesław Jerzy Cubała

Major depressive disorder (MDD) and treatment-resistant depression (TRD) continue to drive interest in ketamine-family compounds and psilocybin, but antidepressant efficacy alone does not establish whether these interventions can be evaluated reliably or implemented responsibly. We conducted a structured narrative review using targeted PubMed/MEDLINE searches through 21 July 2026, hand-searching of reference lists, and review of current regulatory documents. Six studies conducted by the authors formed the empirical foundation, covering trial protocols, dose–response relationships, treatment context reporting, regulatory alignment, participant diversity, and informed-consent readability. Findings were synthesized across regulatory, internal methodological, contextual, external, ethical, and implementation domains. The six studies identified recurring weaknesses in protocol design, dose and endpoint selection, masking and expectancy assessment, safety monitoring and long-term follow-up, reporting of psychological support and treatment setting, participant representativeness, and consent comprehensibility. The wider literature broadly supports these conclusions. Ketamine has a more mature evidence and implementation base, whereas psilocybin remains at an earlier stage of clinical development. Responsible translation into clinical practice therefore requires integrated evidence addressing efficacy, causal validity, safety, treatment context, diversity, informed consent, durability, and service delivery, while clearly distinguishing legal requirements, regulatory guidance, evidence-based methodological practices, and the authors’ recommendations.

Psychiatry International doi: 10.3390/psychiatryint7050189

Authors: Eirini Karakasidou Georgia Raftopoulou Anna Papadimitriou Katerina Chotzoglou Christiana Koundourou

Background/Objectives: State self-compassion, a temporary and situationally specific form of responding to oneself with compassion, has been increasingly examined in relation to emotional distress, yet most studies have examined anxiety and depression as parallel outcomes rather than exploring how self-compassion relates to depressive symptoms while accounting for anxiety severity. The present study examined whether state self-compassion is independently associated with depressive symptoms after controlling for anxiety severity and demographic variables, and whether anxiety moderates the associations between state self-compassion and depressive symptoms as well as positive affect. Methods: A community sample of 581 Greek adults aged 18–65 years completed the State Self-Compassion Scale–Long Form (SSCS-L), the Depression Anxiety Stress Scales–21 (DASS-21), and the Positive and Negative Affect Schedule (PANAS). Hierarchical multiple regression analyses were conducted controlling for age, gender, and education, and interaction terms between centered state self-compassion and anxiety severity were entered to test moderation. Separate models were estimated for depressive symptoms and positive affect. Results: State self-compassion was significantly associated with lower depressive symptoms and higher positive affect after controlling for anxiety severity and demographic variables. Anxiety severity was positively associated with depressive symptoms. A small but statistically significant interaction indicated that the negative association between state self-compassion and depressive symptoms was slightly stronger at higher levels of anxiety. No moderation effect was observed for positive affect. Conclusions: Findings indicate that state self-compassion was independently associated with lower depressive symptoms and higher positive affect. Self-compassion with psychological functioning is largely consistent across anxiety levels. The results do not support a strong protective role for self-compassion; the association with lower depressive symptoms held broadly across anxiety levels. Future research should include longitudinal or intervention-based studies to enhance the role of self-compassion in helping people manage the difficult emotions.

Psychiatry International doi: 10.3390/psychiatryint7050188

Authors: Sergey A. Yuchshuk Aleksei B. Ilichev Olga A. Ponamareva Marina Yu. Lyubchenko Vladimir Yu. Ivantsov Dana S. Shaymerdenova Sayn T. Zhanbyrbaeva Laura Y. Alipbaeva Tatiana A. Stupina Lyubov V. Kopylova

Formal thought disorder (FTD) is classically associated with schizophrenia-spectrum disorders, but speech disorganization may also occur in other acute psychotic conditions. This study compared eight prespecified FTD phenomena between operationally defined primary and secondary psychotic disorders. In this single-center cross-sectional study, 93 adults admitted with an acute psychotic state to three psychiatric inpatient departments were classified as having primary psychotic disorders (F20/F23.2; n = 51) or secondary psychotic disorders (F06.2/F10.5/F15.5; n = 42). Eight phenomena derived from Andreasen’s descriptions were rated using study-specific 0–2 ordinal anchors. Item-level distributions were analyzed using exact tests with Benjamini–Hochberg correction and covariate-adjusted ordinal regression; composite and diagnostic-subgroup analyses were exploratory. Higher ratings in the primary group were observed for derailment, tangentiality, incoherence, neologisms, and clanging, whereas loss of goal, circumstantiality, and perseveration did not differ statistically. Adjusted models supported the same item-level pattern, and sensitivity analyses supported several principal findings. The exploratory composite was also higher in the primary group (median 10 [8–10.5] vs. 7 [6–8]; p < 0.001). These findings support cautious, descriptive phenomenon-level assessment across acute psychotic disorders but do not validate the framework as a diagnostic instrument or establish disorder-specific FTD profiles.

Psychiatry International doi: 10.3390/psychiatryint7040187

Authors: Ehsan Jozaghi

Rapid innovation-driven transitions have, across successive eras, been associated with increased psychological distress, substance use, and suicide when social and economic change outpaces the adaptive capacity of individuals, communities, institutions, and governments. The early artificial intelligence (AI) economy is emerging at an unprecedented pace, reshaping education, employment, and social organization in ways that may intensify these risks, particularly among young people. This perspective argues that school-based mental health nursing, working collaboratively with school psychologists, counsellors, physicians, and other interdisciplinary professionals, represents a practical upstream response to AI-era disruption. Drawing on historical evidence from the Industrial Revolution, population mental health research, and the contemporary mental health nursing literature, the paper examines the mechanisms through which rapid socio-economic change may contribute to psychological distress and substance-use problems. It further distinguishes AI as both a source of socio-economic disruption and a clinical tool that can support—but not replace—relationship-based nursing practice. Strengthening school-based mental health nursing within interdisciplinary systems offers a practical, prevention-oriented strategy to promote resilience, facilitate early intervention, and mitigate downstream mental health and substance-use harms during the AI transition.

Psychiatry International doi: 10.3390/psychiatryint7040186

Authors: Julien Lochmann Klaus Patzke Stefan Wahl Fabian Renger Attila Czirfusz

The digital transformation of work has increasingly blurred the temporal, spatial, and psychological boundaries between professional and personal life. As a result, structural conditions have emerged that are associated with an elevated risk of burnout. This narrative review draws on literature identified through searches of Web of Science, Scopus and PubMed covering publications from 2004 to early 2026, which yielded 36 included studies, supplemented by further sources identified outside that search. It integrates key theoretical perspectives, including boundary theory, the Areas of Worklife model, the Job Demands-Resources framework and Conservation of Resources theory. Across diverse occupational contexts, three pathways recur: rising work-family conflict, reduced ability to psychologically detach from work during non-work time and the gradual depletion of personal resources. Structural drivers, comprising organisational availability norms, leadership behaviour, technology and platform design, workload, and economic precarity, are treated as the conditions under which exposure arises, and the review argues that responses pitched at individual coping are correspondingly limited. The public health implications extend beyond mental health, encompassing cardiovascular risk associated with long working hours, strain on healthcare systems, productivity losses and widening health inequities along gendered and socioeconomic lines. Addressing these challenges requires multilevel interventions, including organisational job redesign, leadership development, enforceable right-to-disconnect policies and greater recognition of recovery as a public health priority. At the same time, there remains a need for more longitudinal and intervention-based research, particularly in non-Western contexts.

Psychiatry International doi: 10.3390/psychiatryint7040185

Authors: Germano Vera Cruz Clarice Da Rosa

Background: Problematic smartphone use (PSU) and problematic social media use (PSMU) are common among university students, but little is known about whether distinct patterns of use exist. This study identified profiles of smartphone and social media use among French university students and examined factors associated with profile membership. Methods: An online survey was completed by 973 students from two French universities. K-means cluster analysis was conducted using smartphone use frequency, problematic smartphone use, social media use frequency, and problematic social media use. Multinomial logistic regression identified sociodemographic, social, psychological, mental well-being, and academic predictors of profile membership. Results: Three profiles emerged: low-risk (36.6%), moderate-risk (44.5%), and high-risk (18.9%). Compared with the low-risk profile, the moderate- and high-risk profiles were associated with younger age, higher neuroticism, greater positive urgency impulsivity, more attentional difficulties, and greater smartphone-related academic interference. Higher conscientiousness is consistently associated with likelihood of belonging to higher-risk profiles. Greater commitment in intimate relationships and stronger future-self continuity significantly predicted membership in the low-risk profile. Conclusions: PSU and PSMU comprise distinct behavioral profiles. Modifiable factors, including impulsivity, conscientiousness, future-self continuity, and academic digital habits, may help identify and support students at greater risk.

Psychiatry International doi: 10.3390/psychiatryint7040184

Authors: Malinda Desjarlais Kayla Le Téa Schlegel

Social media increases opportunities for appearance-based social comparison, which may negatively impact body image and affective well-being. However, limited research has addressed how individual characteristics, such as depressive symptoms and dispositional mindfulness, influence susceptibility to these effects. Guided by the Differential Susceptibility to Media Effects Model (DSMM), the present study examined a framework connecting depressive symptoms, facets of mindfulness, appearance-based social comparison, body image positivity, and affective well-being. This study explored depressive symptoms and acting with awareness in relation to appearance-based social comparison. Additionally, it evaluated whether nonjudgment moderates the association between appearance-based social comparison and body image positivity. A total of 341 undergraduate students at a Canadian university participated in a cross-sectional online survey. In line with the DSMM, depressive symptoms and acting with awareness were indirectly associated with affective well-being. Higher depressive symptoms were associated with increased appearance-based social comparison, which was associated with lower body image positivity and, in turn, poorer affective well-being. Greater acting with awareness was related to reduced appearance-based social comparison. Nonjudgment did not moderate the relationship between appearance-based social comparison and body image positivity. These findings enhance understanding of individual differences in appearance-based social comparison on social media and suggest directions for future research on interventions that promote healthier social media experiences.

Psychiatry International doi: 10.3390/psychiatryint7040183

Authors: Mehmet Ali Tekiner İlker Karakoyunlu Aybüke A. İsbir Turan

Digital technologies have become an essential part of modern workplaces, improving communication, efficiency, and organisational processes. However, excessive and uncontrolled use of digital technologies may negatively affect employees’ well-being and workplace productivity. This narrative literature review examines the relationship between digital addiction and workplace productivity by focusing on the individual, social, and organisational consequences of problematic digital technology use. The study first defines the concepts of digital addiction and workplace productivity to establish a conceptual framework. It then discusses how problematic digital technology use, including excessive internet use, social media use, smartphone use, screen use, gaming disorder, and online gambling, may influence productivity through distraction, reduced concentration, poor time management, stress, health problems, and impaired work–life balance. The review highlights that digital technologies are not inherently harmful; rather, productivity problems arise from uncontrolled and problematic patterns of use. The study concludes by suggesting organisational and individual-level interventions, including digital awareness training, responsible technology use policies, improved time management practices, and supportive workplace environments to reduce the negative effects of digital addiction.

Psychiatry International doi: 10.3390/psychiatryint7040182

Authors: Tiago Zamora Machado Iara Teixeira Guilherme Welter Wendt Henrique Pereira Felipe Alckmin-Carvalho

Loneliness and social isolation are related but distinct experiences, and their relative contributions to mental health among men who have sex with men (MSM) remain insufficiently studied in Portugal. This cross-sectional online survey of 641 cisgender MSM (age 18–74 years; M = 38.51, SD = 12.83) examined associations among loneliness, objective connectivity, interpersonal belonging, LGBTQIA+ community belonging, social-network composition, negative affect, and psychological distress, using the UCLA Loneliness Scale, the Social Isolation Scale, the Depression Anxiety Stress Scales-21, and a short Portuguese Positive and Negative Affect Schedule. LGBTQIA+ community belonging and LGBTQIA+ network representation were assessed with single items. Correlations, multiple regressions, and two moderation models were estimated with heteroscedasticity-consistent standard errors and sensitivity analyses. Loneliness was the strongest independent correlate of psychological distress (β = 0.509, p < 0.001, R2 = 0.353) and negative affect (β = 0.398, p < 0.001, R2 = 0.193). Interpersonal belonging showed a small, borderline inverse association with distress (β = −0.10, p = 0.050) that did not survive covariate adjustment. Neither LGBTQIA+ community belonging nor LGBTQIA+ network representation moderated the loneliness–distress association. Subjective loneliness was more closely tied to distress than objective connectivity or broad community integration. These cross-sectional findings are consistent with the value of examining interventions that address the quality and reciprocity of close relationships alongside affirming community resources.

Psychiatry International doi: 10.3390/psychiatryint7040181

Authors: Fanglin Meng Decha Tamdee Zsuzsanna Kövi Nahathai Wongpakaran Justin Ross DeMaranville Tinakon Wongpakaran

Early parental loss may increase depression risk among orphaned university students, yet evidence from low- and middle-income countries such as Thailand remains limited. This cross-sectional study examined depressive symptoms and their associations with attachment insecurity, resilience, inner strength, and perceived social support among 226 Thai university students aged ≥20 years who had lost one or both biological parents before age 18. Participants completed validated Thai versions of the Outcome Inventory–Depression subscale, the Experiences of Close Relationships–Revised 10-item version, the 9-item Resilience Inventory, the Inner Strength-Based Inventory, and the revised Thai Multidimensional Scale of Perceived Social Support. Multiple linear regression identified factors associated with depressive symptoms. The mean depression score was 6.62, with no significant difference between single and double orphans. Attachment anxiety (β = 0.176, p = 0.002) was significantly and positively associated with depressive symptoms, whereas resilience (β = −0.322, p < 0.001), inner strength (β = −0.192, p < 0.003), and perceived social support (β = −0.156, p = 0.022) were significantly and negatively associated with depression. In contrast, attachment avoidance (β = 0.110, p = 0.068) did not reach statistical significance. Among orphaned students, depressive symptoms were more closely linked to psychosocial factors than to the specific type of parental loss (single vs. double orphanhood).

Psychiatry International doi: 10.3390/psychiatryint7040180

Authors: Vasiliki Tsoulou Areti Stavropoulou Angeliki Stamou Maria Polikandrioti

Introduction: Nurses in hospital settings frequently experience anxiety, which may adversely affect both their psychological well-being and professional functioning. In this context, Professional Quality of Life (ProQoL) and Meaning in Life are recognized as key factors influencing nurses’ mental health outcomes. Aim: The aim of the present study was to explore the level of anxiety among nursing personnel in hospital settings and to assess its association with ProQoL and Meaning in Life. Materials and Methods: A cross-sectional study was conducted in a convenience sample of 200 nursing personnel in a public hospital. Data were collected using the Zung Self-Rating Anxiety Scale (SAS), the Professional Quality of Life Scale-5 (ProQoL-5), and the Meaning in Life Questionnaire (MLQ) which also included characteristics of nursing personnel. Results: Anxiety levels were low to mild (39.8 ± 8.7). ProQoL dimensions indicated moderate to high Compassion Satisfaction (35.5 ± 7.3) and moderate levels of Burnout (27.6 ± 5.7) and Secondary Traumatic Stress (26.5 ± 6.1). Regarding Meaning in Life, participants reported high levels of Presence of Meaning (27.1 ± 4.8) and moderate levels of Search for Meaning (21.7 ± 6.7). A statistically significant negative correlation was observed between anxiety and Compassion Satisfaction (r = −0.532, p < 0.001), as well as between anxiety and Presence of Meaning (r = −0.387, p < 0.001). In contrast, anxiety was positively correlated with Burnout (r = 0.652, p < 0.001) and Secondary Traumatic Stress (r = 0.534, p < 0.001). In the multivariable analysis, the self-rating of daily work experience score was associated with increased anxiety levels by 0.9 units for each unit increase (95% CI: 0.2 to 1.7, p < 0.011). Compassion Satisfaction was associated with a decrease in anxiety by 0.4 units (95% CI: −0.6 to −0.2, p < 0.001), while Burnout and Secondary Traumatic Stress were associated with an increase in anxiety by 0.5 (95% CI: 0.2 to 0.8, p < 0.001) and 0.4 units (95% CI: 0.2 to 0.6, p < 0.001), respectively. Conclusions: Self-rated daily work experience, Burnout, and Secondary Traumatic Stress were positively associated with anxiety, whereas Compassion Satisfaction was negatively associated with anxiety. These results illustrate the importance of targeted interventions aimed at reducing anxiety, strengthening ProQoL, and promoting Meaning in Life to support nursing personnel’s well-being.

Psychiatry International doi: 10.3390/psychiatryint7040179

Authors: Vanja Bosic Mesi Mina Cvjetkovic Bosnjak Iva Bosic Miljevic Dusan Kuljancic Aleksandra Dickov Teodora Inic Igor Kelecevic Jovan Milatovic

Background: Mental health is the main factor of the overall quality of life of both individuals and the community. In contemporary society, mental health is gaining more and more significance, although there is still an insufficient level of awareness among people about what factors can affect our mental health and why it is of such importance for daily functioning. Material: The research used an anonymous questionnaire created by a team of doctors from the Clinic for Psychiatry in Novi Sad with the aim of assessing how the ongoing social situation in Serbia affects the mental health of the population. Results: It was shown that there is a statistically significant link between levels of feeling tense and following the news about the ongoing protests. The research has shown that there are statistically significant differences in emotional response in relation to gender and age resulting from the current situation. A statistically significant association between sleep problems and the use of anxiolytic therapy has been proven. Most of the respondents declared that the current situation in which we live has a negative impact on mental health. Conclusions: The results of the research indicate that social circumstances in Serbia significantly affect the psychological functioning of the population.

Psychiatry International doi: 10.3390/psychiatryint7040178

Authors: Anna Anselmo Francesco Corallo Maria Pagano Davide Cardile Rocco Salvatore Calabrò Irene Cappadona

Background: Hospitalization and incarceration are distinct institutional experiences, but both may involve reduced autonomy, externally regulated routines, uncertainty, restricted privacy, and disruption of meaningful social relationships. This systematic review examined shared and setting-specific psychological outcomes and associated factors across the two environments. Methods: PubMed, Scopus, Web of Science and the Cochrane Library were searched from database inception to 30 January 2026. Of 1149 identified records, 22 studies met the eligibility criteria. Methodological quality was assessed using the Mixed Methods Appraisal Tool 2018, and findings were synthesized narratively because substantial clinical and methodological heterogeneity precluded meta-analysis. Results: Ten studies examined incarcerated populations and twelve examined hospitalized populations. Across incarceration studies, reported estimates ranged from 14.9% to 72.6% for depressive symptoms or mood disorders and from 23.3% to 77.8% for anxiety symptoms or disorders. Across hospitalization studies, corresponding estimates ranged from 5.1% to 41.0% and from 5.8% to 60.0%, respectively. These ranges reflect heterogeneous screening instruments, diagnostic procedures, populations, and outcome definitions and were not statistically pooled. In both settings, poorer psychological outcomes were associated with reduced perceived control, disrupted routines, uncertainty, limited social support, and individual vulnerability. Setting-specific factors included prison climate, coping style, shame, and sentence-related circumstances in incarceration, and illness severity, functional impairment, prognostic uncertainty, isolation precautions, and prolonged or repeated admission in hospitalization. Findings concerning exposure duration were inconsistent in both settings. Conclusions: Hospitalization and incarceration should not be regarded as psychologically equivalent. Nevertheless, they may share experiential conditions associated with distress, particularly when autonomy, privacy, predictability, and social connectedness are reduced. Because the evidence was heterogeneous and predominantly observational, causal conclusions and direct quantitative comparisons cannot be made.

Psychiatry International doi: 10.3390/psychiatryint7040177

Authors: Federica Visco-Comandini Giulia Marselli Andrea Gobbo Sabina Arcieri Simona Abagnale Maria Autuori Rosalia De Biase Riccardo De Pastina Benedetta Del Forno Rachele Grimaldi Mariapina Manzi Hamida Sadikhova Benedetta Senzasono Anais Tropeano Stefania Fadda Francesco Mancini Alessandra Ciolfi

Trauma is a condition that overwhelms an individual’s capacity to cope, disrupting emotional regulation, cognitive functioning, and the sense of safety. Complex trauma, characterized by prolonged and interpersonal adverse experiences, is associated with significant psychological distress, including anxiety, dissociation, and difficulties in self-regulation. Neurobiological research highlights how trauma is encoded not only cognitively but also within the body, through autonomic nervous system dysregulation and procedural memory processes, often resulting in states of hyperarousal or hypoarousal and a narrowed window of tolerance. The aim of this narrative review is to synthesize and critically examine the current literature on somatic-based interventions for the treatment of trauma, with a particular focus on Sensorimotor Psychotherapy, Somatic Experiencing, and related body-oriented approaches. In this context, somatic-based interventions offer a bottom–up approach that directly targets physiological and sensorimotor processes. Modalities such as Sensorimotor Psychotherapy and Somatic Experiencing aim to restore autonomic balance, enhance body awareness, and support the integration of traumatic experiences. This narrative review synthesizes current evidence, suggesting that these approaches can improve emotional regulation, dissociation, and overall trauma-related symptoms, particularly in individuals with complex trauma. Despite promising findings, the literature is limited by methodological variability and a lack of rigorous trials. Further research is needed to strengthen the evidence base and clarify mechanisms of change. Overall, somatic interventions represent a valuable complement to traditional trauma therapies, supporting a more integrated and embodied approach to treatment.

Psychiatry International doi: 10.3390/psychiatryint7040176

Authors: Carolina Pinci Tommaso Barlattani Riccardo Santini Irene Sferra Marika De Simone Simonetta Della Scala Francesca Pacitti Cinzia Niolu

Gambling disorder (GD) is associated with severe psychosocial impairment, impulsive dyscontrol, affective instability, and increased suicidal risk. Pharmacological options remain limited, particularly for patients whose presentation is dominated by transdiagnostic dimensions such as impulsivity, emotional dysregulation, and suicidal vulnerability. Lithium may be relevant because of its anti-suicidal properties and potential effects on affective instability and behavioral dyscontrol. We describe a 40-year-old man with sports-betting-related GD who presented after a suicidal crisis in the context of financial collapse and marital conflict. He entered a structured multimodal program including psychiatric care, lithium carbonate, individual psychotherapy, psychoeducational and self-help groups, family intervention, and social support. During multimodal treatment, which included lithium carbonate titrated to 600 mg/day, the patient was observed to show progressive affective stabilization, remission of suicidal ideation, reduced gambling urges, and sustained abstinence, with one brief lapse that was rapidly contained. Psychometric reassessment showed selective improvement across gambling-related and functional domains, including reduced functional impairment and markedly reduced gambling-related cognitive distortions; however, global psychopathological distress remained substantially stable, and the GPQ subtype shift was interpreted only descriptively. Although causal inference is limited by the single-case design and multimodal treatment context, this case raises the hypothesis that lithium may have contributed, within a multimodal intervention, to the stabilization of core vulnerability dimensions in selected GD presentations, particularly impulsivity, affective dysregulation, and suicidality.

Psychiatry International doi: 10.3390/psychiatryint7040175

Authors: Tergel Khuyag Bayarsukh Narmandakh Bodula Ider Amartuvshin Khaltar Oyuntugs Byambasukh Khishigsuren Zuunnast

(1) Background: Depression, anxiety, and diabetes-related distress commonly coexist in adults with diabetes and may contribute to cumulative psychosocial burden. This study examined the prevalence of multi-psychosocial burden and its association with chronic diabetes-related complications. (2) Methods: A cross-sectional study was conducted among 172 adults with diabetes using the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Diabetes Distress Scale. Multi-psychosocial burden was defined as the presence of at least two positive psychosocial conditions. Sociodemographic and clinical data were collected through structured assessment and medical record review. (3) Results: The mean age was 58.3 ± 10.4 years, and 57.6% were female. Overall, 16.9% of participants met criteria for multi-psychosocial burden. Chronic diabetes-related complications were present in 47.7% of participants. Each additional chronic complication was independently associated with higher odds of multi-psychosocial burden (adjusted OR 1.92, 95% CI 1.21–3.05; p = 0.005). The prevalence of multi-psychosocial burden increased from 8.9% among participants without complications to 37.9% among those with two or more complications, demonstrating a dose-dependent pattern. (4) Conclusions: Chronic complication burden was independently associated with concurrent psychosocial conditions in adults with diabetes, supporting the importance of routine psychosocial screening in patients with chronic complications, while future longitudinal studies are needed to clarify causal pathways.

Psychiatry International doi: 10.3390/psychiatryint7040174

Authors: Adela Magdalena Ciobanu Ana Voichita Tebeanu Vlad Tau Anca Ana Chendea Eduard Dan Franti Catalin Niculae Claudiu Ionut Vasile George Florian Macarie Liliana Neagu Monica Dascalu Cristian Ioan Stoica Marius Moga Gabriela Iorgulescu

Background/Objectives: Suicide remains a major public health concern, with over 700,000 deaths annually worldwide. Current risk assessment is limited by the tendency of at-risk patients to deny suicidal ideation, with denial rates of approximately 50% among ideators and up to 78% among inpatient suicide decedents. Methods: This proof-of-concept study investigated whether deep learning applied to patient speech could distinguish psychiatric inpatients admitted following a recent suicide attempt from patients with severe depression without documented suicidal ideation. A multi-scale two-dimensional convolutional neural network with residual connections and spatial attention (Multi-Scale CNN) was trained on mel-spectrograms generated exclusively from patient speech extracted by automatic speaker diarization followed by manual verification. The dataset comprised recordings from 88 psychiatric inpatients (59 suicide attempters and 29 patients with severe depression without suicidal ideation). Model performance was evaluated using repeated patient-level stratified five-fold cross-validation, ensuring complete separation of participants between folds. Additional female-only, exploratory male-only, and repeated sex-matched analyses were performed to evaluate the potential influence of sex imbalance. Results: Repeated patient-level five-fold cross-validation yielded a mean classification accuracy of 72.7 ± 6.4% with a mean ROC-AUC of 0.824 ± 0.054, a sensitivity of 88.3 ± 9.5%, and a specificity of 41.3 ± 25.0%. Female-only analysis maintained good discriminative performance (ROC-AUC 0.866 ± 0.123), whereas repeated sex-matched analyses produced lower performance (ROC-AUC 0.621 ± 0.156), indicating that sex imbalance contributed to, but did not fully explain, the observed discrimination. The male-only analysis was considered exploratory because of the limited number of male patients in the depression group. Conclusions: These findings support the feasibility of voice-based patient-level analysis as a complementary objective approach for suicide risk assessment. Although the study remains exploratory because of the limited sample size and the absence of external validation, the revised validation strategy and sex-controlled analyses provide a substantially more robust estimate of model performance. Further multicenter prospective studies are required before clinical implementation.

Psychiatry International doi: 10.3390/psychiatryint7040173

Authors: Hélder António Sara Albuquerque Maria Vieira de Castro Stéphane Bouchard Pedro Gamito Ricardo J. Pinto

Background: Police and security professionals are routinely exposed to potentially traumatic events as part of occupational duties, placing them at increased risk for post-traumatic stress and broader psychological difficulties. This study aimed to identify latent classes of proximal traumatic exposure among Portuguese police/security professionals and examine their associations with PTSD symptoms and general psychological distress. Methods: A cross-sectional online survey was conducted with Portuguese police/security professionals (N = 644). Latent class analysis (LCA) was applied to 17 indicators of potentially traumatic events coded as directly experienced or witnessed, derived from the Life Events Checklist for DSM-5. PTSD symptoms were assessed using the PTSD Checklist for DSM-5, and general psychological distress was assessed using the Brief Symptom Inventory. Exploratory receiver operating characteristic (ROC) analyses examined whether counts of proximal traumatic events could approximate the LCA-derived classes. Results: A three-class solution was identified, comprising low proximal exposure (37.3%), moderate proximal exposure (40.7%), and high proximal/cumulative exposure (22.0%) classes. The classes reflected a graded cumulative pattern of exposure across traumatic event categories, rather than clearly distinct qualitative configurations defined by specific event types. Higher exposure classes were associated with progressively higher PTSD symptoms and psychological distress, and these associations remained significant after adjustment for sociodemographic and occupational variables. Exploratory receiver operating characteristic (ROC) analyses showed that a simple count of proximal traumatic event categories closely approximated the empirically derived class structure within the present sample. However, the resulting thresholds are sample-specific, exploratory, and should not be interpreted as validated screening cutoffs. Conclusions: Proximal traumatic exposure among police/security professionals appears to follow a graded cumulative structure associated with increased PTSD symptoms and psychological distress. The person-centered analysis provided an empirical test of whether exposure was organized according to qualitatively distinct event configurations or primarily along a cumulative gradient. In this sample, cumulative exposure burden emerged as the dominant organizing dimension. The count-based approximation requires external validation before any screening or decision-making application can be considered.

Psychiatry International doi: 10.3390/psychiatryint7040172

Authors: Selina Kit Yi Chan Kelvin K. F. Tsoi Terry Cheuk Fung Yip Vivien Wei Jun Liew Wai Kwong Tang

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.

Psychiatry International doi: 10.3390/psychiatryint7040171

Authors: Cirilo H. García-Cadena Oscar Manuel Lara-Pinales Ana Karen Gutiérrez-Martínez Francisco Javier Barreto Trujillo Iván V. Martínez Alanís

Most instruments used to assess depression have been developed in sociocultural contexts that differ substantially from those of Spanish-speaking Latin American populations. To address this limitation, the present study developed and evaluated a new brief measure of depressive symptomatology for use in northeastern Mexico. The study included 414 participants (Mage = 27.37 years, SD = 13.72). An initial pool of 23 items, grounded in interbehavioral psychology, was developed and subsequently evaluated by a panel of 58 expert judges. Based on content-validity analyses, the instrument was reduced to 15 items. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) supported a final four-item, one-factor solution. The final model demonstrated adequate fit to the data (χ2/df = 0.281, AGFI = 0.993, NNFI = 1.015, CFI = 1.000, RMSEA = 0.000, 90% CI [0.000, 0.094], and SRMR = 0.008). Evidence of discriminant and convergent validity was supported by a negative correlation with the Subjective Happiness Scale (r = −0.294, p < 0.01) and a positive correlation with the seven-item version of the Center for Epidemiologic Studies Depression Scale (CESD-7; r = 0.273, p < 0.01). Construct reliability was satisfactory (H = 0.841). Overall, the findings provide preliminary evidence supporting the reliability and validity of the proposed instrument as a brief screening measure of depressive symptomatology in a Mexican sample, mostly from Nuevo León.

Psychiatry International doi: 10.3390/psychiatryint7040170

Authors: Stanley Wong Jason Baek Melanie Zhang Nicholas Fabiano Carl Zhou Elliott Kyung Lee Marco Solmi Ishrat Husain Michael S. B. Mak

There is growing evidence on the use of pitolisant for the treatment of residual excessive daytime sleepiness (EDS) in adults with obstructive sleep apnea (OSA) treated with continuous positive airway pressure (CPAP). We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing pitolisant to a placebo in adults with OSA and residual EDS despite CPAP use. The primary outcome was a change in subjective sleepiness measured on any validated scale. Secondary outcomes included all-cause discontinuation and treatment-emergent adverse events (TEAEs). A random-effects model was used to calculate standardized mean differences (SMDs) and pooled Log risk ratios (Log RRs). Three RCTs (N = 721) were included. Pitolisant significantly reduced Epworth Sleepiness Scale scores (SMD = −0.90, 95% CI = −1.29 to −0.50; low certainty). There were no significant differences between pitolisant and a placebo for all-cause discontinuation (Log RR = −0.27, 95% CI = −1.60 to 1.06; low certainty) or TEAEs (Log RR = 0.04, 95% CI = −0.19 to 0.27; low certainty). The most common adverse events reported while using pitolisant were headache and insomnia. These findings show emerging potential for pitolisant as a therapeutic option in this population. Future studies should include larger sample sizes and objective measures of sleepiness.

Psychiatry International doi: 10.3390/psychiatryint7040169

Authors: Gerald Young

This article proposes a general integrative model focusing on psychological control and psychological reserve. The former refers to internal psychological control and external psychological control. Internal psychological control refers to the management of physiological processes associated with arousal and panics. Here, the concept of internal psychological control is differentiated into two components: cognitive control/executive function and self-control/emotional regulation. External psychological control refers to the sense the person has of being able to manage, have agency in, and otherwise not be overwhelmed by the external context in which one is adapting functionally. Here, the concept of external psychological control is differentiated into two major sub-components: managing reactivity to external events, such as to daily stressors or extreme events, e.g., natural disasters, and proactively taking steps to have agency in and using predictive processing to adjust to context by mitigating the probability of experiencing overwhelming events. Psychological reserve refers to the fluid state reservoir of mental, cognitive, emotional, motivational, and stress management/coping space that is available for use in confronting ongoing and new stressors, challenges, or difficulties. Here, this article differentiates psychological reserve into phases of depletion and recovery. This article examines prior work on psychological control and reserve, demonstrating how they can be understood or modified based on the present sub-component differentiation of the concepts involved. The revised model is applied to understanding psychotherapeutic change mechanisms, a biopsychosocial model of the mechanisms, an integrated functional adaptational model, posttraumatic stress disorder, a unified model for psychotherapy and psychology generally, and clinical recommendations.

Psychiatry International doi: 10.3390/psychiatryint7040168

Authors: Alejandra Santana Ellie Mitova Julie Hall Steven L. Berman

Research on autistic features and identity development has indicated that autistic traits are positively associated with disturbances in identity development. Characteristic attributes of autism, such as circumscribed interests and differences in social relatedness, align with self-rumination and challenges in navigating the components of identity formation. Nonetheless, research on this topic remains scarce. The present study examined the association between autistic features and identity formation processes in a non-clinical population while accounting for sociocultural factors, specifically social camouflaging and gender conformity. The sample consisted of college students enrolled in a large metropolitan city (N = 427) who completed an anonymous online survey battery. Autistic features were positively associated with both ruminative identity exploration and identity distress. Social camouflaging mediated these relationships, suggesting that the concealment of autistic traits may contribute to maladaptive identity formation rather than autistic traits themselves. Gender conformity further moderated the effect, with higher levels of conformity to traditional gender roles weakening the relationship between autistic features and social camouflaging. These findings signify the relevant role of social camouflaging in the relationship between autistic features and identity disturbances, highlighting the need for interventions and assessments that consider its prevalence and manifestation.

Psychiatry International doi: 10.3390/psychiatryint7040167

Authors: Clarice S. Madruga Katia Isicawa de Sousa Martha Canfield Aline Correa de Araujo Danilo Seabra Ronaldo Laranjeira Quirino Cordeiro

Background: Access to substance use disorder (SUD) treatment remains a concern in Brazil, particularly among socioeconomically disadvantaged populations affected by cocaine and crack-cocaine use. Community-based services such as the HUB de Cuidados em Crack e Outras Drogas (HUB) in São Paulo aim to engage vulnerable individuals but often face a “revolving door” pattern of repeated admissions. Evidence on predictors of readmission in community-based support services, particularly gender differences, remains limited. This study examines gender-specific predictors of readmission to the HUB within 12 months and changes in clinical characteristics over time. Methods: This is a retrospective observational design study. Records from all individuals who sought treatment for their alcohol and/or drug use in HUB between June 2024–2025 were analysed (number of records = 13,645; number of service users = 6528). This timeframe refers to the study period during which data were collected. Results: Among 6528 service users, most were men (92.6%), with higher readmission rates than women (53.4% vs. 38.6%). Homelessness and synthetic cannabinoid use predicted readmission for both genders. Among men, younger age, substance use patterns, and greater clinical severity were associated with readmission. Among women, recent crack-cocaine use was linked to lower readmission. Over time, men showed worsening substance use and clinical indicators, while women showed reduced stimulant use but increased psychotic symptoms and help-seeking. Conclusions: The “revolving door” pattern of repeatedly entering and leaving services without continuity of care is common in community-based support services like HUB. Risk profiles differ between men and women. The limited predictors identified for women suggest that routine clinical assessments may overlook important social and structural vulnerabilities. These findings highlight the need for gender-sensitive approaches that account for distinct emotional and cognitive pathways and the service needs of men and women.

Psychiatry International doi: 10.3390/psychiatryint7040166

Authors: Hicham Lafhal Ahmed Omar Tohami Ahami Siham Goutou Atmane Rochdi

This study examined visuomotor performance and selected psychometric characteristics of the Bender–Gestalt Test using the Koppitz developmental scoring system in Moroccan children aged 7 to 11 years. A cross-sectional study was conducted with 200 children enrolled in public primary schools in the Rabat region, Morocco. Performance was assessed using the Koppitz developmental scoring system. Statistical analyses included descriptive statistics, factorial analyses of variance, post hoc comparisons, inter-rater reliability, and test–retest reliability. The results revealed significant age-related differences in total error scores, with older age groups obtaining lower mean error scores than younger age groups, F(4, 190) = 29.965, p < 0.001, ηp2 = 0.387. Designs 3 and 7 produced the highest mean error scores, which may reflect their greater visuospatial and perceptual-motor complexity. Inter-rater reliability demonstrated good agreement (ICC = 0.805, 95% CI [0.669, 0.887], p < 0.001), while test–retest reliability demonstrated excellent temporal stability (single-measure ICC(A, 1) = 0.913, 95% CI [0.772, 0.960], Pearson’s r = 0.928, p < 0.001). These findings support the reproducibility and temporal stability of the Koppitz developmental scoring system. Overall, the findings support its use for the assessment of visuomotor performance in Moroccan school-aged children from the Rabat region and provide preliminary regional reference data that may contribute to the development of future national normative standards.

Psychiatry International doi: 10.3390/psychiatryint7040165

Authors: Enrico Adhitya Rinaldi Retna Siwi Padmawati Yayi Suryo Prabandari

Disclosing a schizophrenia diagnosis presents significant ethical dilemmas due to stigma, caregiving burdens, and cultural norms. This study explored psychiatrists’ ethical considerations when disclosing this diagnosis to family members in Indonesia. Using a qualitative phenomenological approach, we conducted in-depth interviews with eight psychiatrists at a single-site private psychiatric hospital in Jakarta. Data underwent inductive thematic analysis. Four themes emerged: (1) preparing for truth-telling by assessing family readiness, roles, and cultural beliefs; (2) negotiating clinical uncertainty and emotional pacing through staged disclosure; (3) balancing ethical duties of honesty and patient confidentiality against safety risks and severe stigma; and (4) extending disclosure into continuous care via psychoeducation and crisis support. Overall, psychiatrists approach diagnostic disclosure not as a single declarative act, but as an ethically negotiated, relational, and continuous process. While practices like staged disclosure preserve therapeutic alliances, they require critical reflection to avoid paternalism. Adopting culturally responsive, family-inclusive approaches is essential to strengthen the ethical delivery of psychiatric diagnoses and ensure continuing care.

Psychiatry International doi: 10.3390/psychiatryint7040164

Authors: Elena Plaza-Montero Miguel Ángel Álvarez-Mon Miguel Ortega Óscar Fraile-Martínez Cielo García-Montero María-Elena Brenlla Irene Caro-Canizares Melchor Álvarez-Mon Javier Domingo-Espineira

Background/Objectives: Bipolar disorder (BD) is a chronic psychiatric condition associated with substantial emotional and psychosocial burden. Social media platforms provide an opportunity to examine how BD is discussed and emotionally framed outside clinical settings. Although Spanish-language public discourse on BD remains underexplored, this gap is particularly relevant given that linguistic and cultural factors may influence how mental health conditions are expressed, perceived, and communicated. Understanding these differences is essential for developing culturally sensitive public health strategies, improving mental health literacy, and addressing stigma in diverse populations. Methods: A retrospective observational study was conducted using Spanish-language tweets referring to BD posted between 2007 and 2023. After preprocessing, 170,411 unique tweets were analyzed. Latent Dirichlet Allocation (LDA) was applied to identify dominant thematic domains, and emotional tone was classified using a RoBERTa-based model adapted from Ekman’s basic emotions. Statistical analyses were performed to examine associations between topics, emotional categories, and the presence of clinical terminology. Results: Tweet activity related to BD remained low until 2019, followed by a marked increase peaking in 2020 and remaining elevated thereafter. Topic modeling identified seven main themes, predominantly centered on symptoms, illness-related life crises, social anxiety, help-seeking, and the impact of BD on romantic relationships, while diagnosis- and treatment-related topics were less frequent. Emotional analysis showed a clear predominance of sadness across all topics, accounting for approximately 75% of tweets. Anger, joy, and optimism were present at lower frequencies and varied across thematic domains. Clinical terminology was significantly more common in diagnosis- and treatment-related topics, whereas experiential and affective narratives dominated the remaining themes. Conclusions: Spanish-language discourse on BD on Twitter is largely characterized by emotional expression and lived experience rather than biomedical language. These findings highlight cultural relevance of social media as a complementary source for understanding public perceptions of BD and underscore the importance of culturally and linguistically specific analyses in digital mental health research.

Psychiatry International doi: 10.3390/psychiatryint7040163

Authors: Taimur Khan Karan Varshney

Psychiatry is a medical specialty where vacancies have consistently remained unfilled. To facilitate recruitment, it is important to identify what motivates trainees to choose psychiatry. This study aimed to explore the reasons regarding the choice of psychiatry as a career specialty among core and higher psychiatry trainees in Scotland. This was a mixed-methods study based on a questionnaire that included open-text and Likert-type scale responses. All psychiatry trainees in Scotland were approached via NHS Education for Scotland to participate in the study. Eighty-three trainees (46 core and 37 higher psychiatry trainees) with a mean age of 31.87 years returned completed questionnaires. Trainees provided their views by selecting responses to indicate the extent of importance of the statements in their decision-making process. The reasons to choose psychiatry were diverse, covering the specialty-specific, training, personal and social aspects of life as a trainee. Important reasons were personal interest, satisfaction associated with patients’ recovery, good work–life balance, influence of supportive supervisors and mentors and availability of subspecialty options. More than 90% of the respondents planned to continue working as psychiatrists in the future. These findings may offer utility in addressing psychiatry training vacancies and in helping to recruit clinicians to the specialty within Scotland.

Psychiatry International doi: 10.3390/psychiatryint7040162

Authors: Francielle Assumpção Gabriela Oltramari Gabriel Henrique Bomfim de França Natália Martins Dias Fernanda Machado Lopes

The increasing prevalence of anxiety, depression, and stress has intensified the demand for scalable, evidence-based psychological interventions that can be delivered across traditional and digital modalities. University students represent a high-risk group due to academic demands and developmental transitions, making them a relevant population for evaluating flexible, technology-mediated interventions. Cognitive-behavioral therapy (CBT)-based psychoeducation offers a structured approach that may accommodate variability in accessibility, preferences, and delivery contexts. This quasi-experimental pre–post study evaluated a CBT-based psychoeducation protocol delivered in group settings in both online and in-person formats. A total of 104 undergraduate and graduate students participated and completed the intervention. Symptom severity was assessed using the Depression, Anxiety and Stress Scale (DASS-21), the Hamilton Anxiety Rating Scale (HAM-A), and the Beck Depression Inventory–II (BDI-II). Significant reductions in anxiety, depression, and stress symptoms were observed over the intervention period, with moderate to large effect sizes. DASS-21 scores decreased from moderate to mild severity levels, and reductions were also observed in BDI-II and HAM-A scores. No significant differences were found between delivery modalities. These findings support the potential of CBT-based group psychoeducation as a scalable intervention. Similar patterns of symptom change were observed across delivery formats, contributing to the expansion of accessible and digitally informed mental health care.

Psychiatry International doi: 10.3390/psychiatryint7040161

Authors: Ivy Le Yi Ong Amos En Zhe Lian Boon Tao Chew

Background: Childhood trauma has been associated with long-term neurophysiological alterations; however, evidence in non-clinical populations remains limited. This study investigated differences in brainwave activity between individuals with and without childhood trauma using quantitative electroencephalography (qEEG) in a young adult non-clinical sample. Methods: Thirty young adults completed the Childhood Trauma Questionnaire-Short Form (CTQ-SF) and underwent qEEG recording under standardized resting-state conditions, including eyes-closed (EC) and eyes-open (EO). Only resting-state EEG data were included in the final analysis. Principal Component Analysis (PCA) was applied across seven frequency bands (Delta, Theta, Alpha, Low Beta, Beta, High Beta, and Gamma) for dimensionality reduction, followed by independent-sample t-tests to examine group differences between participants with no childhood trauma and those with severe childhood trauma. Results: Significant group differences were observed in several qEEG-derived components, particularly within the Alpha, Low Beta, Beta, High Beta, and Gamma frequency bands. These differences were most prominent in frontal, central, temporal, and parietal regions, suggesting variations in cortical activation patterns between trauma and non-trauma groups. Conclusions: The findings suggest that childhood trauma exposure is associated with distinct patterns of resting-state brainwave activity in young adults without a formal PTSD diagnosis. However, these results should be interpreted as exploratory, and further research with larger and more balanced samples is required to validate these findings and improve generalizability.

Psychiatry International doi: 10.3390/psychiatryint7040160

Authors: Sana Čoderl Dobnik Sinja Babič Miloševič Jurij Bon

Background: Depression is among the most prevalent psychiatric conditions and markedly disrupts everyday functioning. Its origins are multifactorial, with biological, psychological, and contextual influences jointly shaping the course of recovery and the response to treatment. Personality has been proposed as a relatively stable factor that may reflect developmental influences on emotional and cognitive functioning and may be associated with long-term clinical outcomes in depression. The present study aimed to examine the association between implicit personality characteristics in women hospitalized for depressive disorder and their long-term psychosocial functioning, using a performance-based measure of personality (the Rorschach Inkblot Method, RIM). Subjects and Methods: At baseline (T1), 58 women hospitalized for depressive disorder completed the Beck Depression Inventory (BDI-II) and the Rorschach Inkblot Method (RIM); Rorschach protocols were scored using the Ego Impairment Index—second revision (EII-2), a behaviorally derived index spanning perceptual accuracy, executive integrity, and social cognition. Demographic and clinical information was abstracted from medical records, and an independent rating of functioning was obtained with the Global Assessment of Functioning scale (GAF). Four years later (T2), patients were re-administered the BDI-II and the GAF, and major life events occurring during the follow-up interval were quantified with the Social Readjustment Rating Scale (SRRS). Results: Baseline implicit personality organization showed a significant association with psychosocial functioning four years after the index hospitalization. Among the variables examined, personality structure at admission outperformed both initial depressive symptom severity and the burden of intervening life events in predicting later functional status. In particular, EII-2 accounted for an additional 10.3% of the variance (ΔR2 = 0.103, p < 0.05) over and above age, chronicity, stress, and depressive symptom severity when predicting four-year GAF-rated functioning. Among the predictors examined, age was the most influential variable in the final model (β = 0.442), indicating that demographic factors carry substantial weight alongside personality functioning in shaping long-term outcomes. Conclusions: Our findings are consistent with the view that a patient’s personality may influence the course of recovery and suggest that personality-level factors deserve attention when planning care for this clinically complex disorder. The present results indicate that implicit cognitive–perceptual features—assessed through performance-based methods that bypass conscious self-report—may be associated with long-term psychosocial functioning in women hospitalized for depression. These findings suggest that performance-based personality assessment deserves further study as a potential prognostic aid, although replication in larger and more diverse samples is needed before clinical application.

Psychiatry International doi: 10.3390/psychiatryint7040159

Authors: Sabine Finlay Gideon Vos Imre Földesi Diána Kata Oyelola Adegboye Donna Rudd Brett McDermott István Szendi Mostafa Rahimi Azghadi Zoltan Sarnyai

Introduction: Schizotypal traits (unusual perceptual experiences and cognitive-perceptual differences) and cyclothymic traits (mood instability and affective fluctuations) represent subclinical personality dimensions observed in non-clinical populations. Allostatic load (AL), reflecting cumulative multisystem physiological stress, may provide insight into biological processes associated with these traits. This study examined whether individuals with elevated schizotypy or cyclothymic traits show distinct AL-related biomarker patterns. Methods: Three groups were defined using validated psychometric measures: 30 individuals with schizotypy traits (PSF), 25 with cyclothymic traits (CF), and 30 control participants (CGs). Machine learning (ML) analyses included a Random Forest model with leave-one-subject-out cross-validation to examine differences in biomarker profiles between groups, and Shapley Additive exPlanations (SHAP) analysis was applied to determine the relative importance of biomarkers. The highest-ranking biomarkers were subsequently used to construct a reduced AL index. Results: Significant differences among groups were observed in oxidative stress system markers (p = 0.014). SHAP analysis identified creatinine, diastolic blood pressure, uric acid, and low-density lipids as key features for the CF group, and heart rate, TSH, uric acid, and glucose for the PSF group, with uric acid emerging as the strongest shared biomarker. A reduced biomarker panel selected using SHAP achieved subject-level classification accuracy of 63.6% (95% CI 50.9–76.4) and AUC of 0.625 (95% CI 0.469–0.768) and showed comparable performance to the full model. However, label-permutation testing yielded a borderline result (p = 0.055), indicating that these findings should be considered exploratory. The AL index derived from the top-ranked biomarkers was significantly lower in the CF than in the CG group (p = 0.007), whereas differences between the PSF and CG groups did not remain significant after correction. Findings are exploratory and require validation in an independent cohort. Conclusions: Distinct biomarker patterns associated with schizotypal and cyclothymic traits were identified in a non-clinical population, highlighting differences in stress-related physiological processes. ML-based feature-importance analysis identified a reduced set of biomarkers associated with trait-related biological profiles; however, these findings remain exploratory and require external validation.

Psychiatry International doi: 10.3390/psychiatryint7040158

Authors: Malthe Brændholt Stefan Bjerrum

Background: Optimising medication for Attention Deficit Hyperactivity Disorder (ADHD) is often hindered by the lack of practical physiological indicators that can inform treatment effects. Electrooculography (EOG) has been suggested as a low-burden marker of neurophysiological processes relevant to ADHD, but its responsiveness to medication within routine clinical settings is not well established. Methods: We analysed anonymised clinical records from adults with ADHD receiving stable, ongoing medication who underwent closed-eye EOG recordings immediately before and after taking their scheduled dose during standard consultations. Recordings were obtained using clinical EEG equipment. Heart rate and blood pressure, measured after each EOG session, were included as contextual indices of physiological state. Pre–post changes were assessed using paired t-tests and binomial tests, with effect sizes and confidence intervals reported for the main pre–post comparisons, with Pearson correlations used to evaluate associations between EOG and cardiovascular measures. Results: Both mean and peak EOG power showed consistent within-session reductions, with the majority of individuals exhibiting a decrease across measures. Cardiovascular parameters showed no systematic pre–post change, and differences in cardiovascular measures did not correlate with changes in EOG activity. Conclusions: Closed-eye EOG showed systematic within-session modulation in adults with ADHD on stable treatment. These preliminary findings suggest that EOG is sensitive to short-latency physiological changes occurring within a clinical timeframe. However, the present design does not establish pharmacological specificity, and further controlled studies are needed to determine whether such changes are specifically medication related and whether they have relevance for treatment monitoring and titration.

Psychiatry International doi: 10.3390/psychiatryint7040157

Authors: Liliana Haro Sánchez Ysabel Yvonne Marquez Rondan Mónica Graciela Palacios Poma Isaac Alex Conde Rodríguez Carlos D. Abanto-Ramírez Josué E. Turpo-Chaparro

The study sought to examine the relationship between procrastination and anxiety as predictors of social media addiction among Peruvian university students. The research employed a cross-sectional predictive methodological design. A sample of 335 students, aged 21 to 69 years, comprising both females and males from private and public university management, was selected through non-probabilistic sampling. The instruments utilized included the Social Media Addiction Questionnaire, the Academic Procrastination Scale, and General Anxiety Disorder-7 (GAD-7). The findings indicated that anxiety (β = 0.52, p < 0.001) and academic procrastination (β = 0.17, p = 0.040) significantly predicted social media addiction. The study concluded that there is a significant relationship between procrastination and anxiety as predictors of social media addiction in Peruvian university students.

Psychiatry International doi: 10.3390/psychiatryint7040156

Authors: Maria Monika Nowosadko Piotr Przymuszała Aleksandra Jędryszek Patrycja Marciniak-Stępak Michał Nowicki

Background: Medical training is characterized by high academic demands, repeated performance evaluation, and sustained exposure to emotionally demanding situations. Although medical student distress has been widely investigated, fewer studies have examined how broad personality traits relate to multidimensional, eudaimonic psychological well-being (PWB), particularly in Central and Eastern European medical student populations. This study examined associations between Big Five personality traits and Ryff’s PWB dimensions among Polish medical students. Methods: A cross-sectional, anonymous paper-and-pencil survey was conducted among 169 Polish medical students. Personality was assessed using the Polish adaptation of the NEO Five-Factor Inventory (NEO-FFI), and PWB was measured using the 84-item Ryff Psychological Well-Being Scales. Descriptive statistics, reliability analyses, normality checks, and bivariate Spearman correlations were used. Results: The global PWB total score was 352.69 (SD = 45.55; observed range 235–450). Among PWB domains, the highest mean score was observed for personal growth (M = 62.86, SD = 8.04), followed by purpose in life (M = 61.76, SD = 10.31), positive relations with others (M = 61.25, SD = 10.94), self-acceptance (M = 57.00, SD = 11.67), autonomy (M = 55.85, SD = 10.58), and environmental mastery (M = 53.97, SD = 10.03). Internal consistency was acceptable to excellent for all PWBS domains (Cronbach’s alpha = 0.796–0.906). Neuroticism was negatively associated with all PWB domains, most strongly with environmental mastery (rho = −0.620) and self-acceptance (rho = −0.618). Conscientiousness was strongly positively associated with environmental mastery (rho = 0.627) and purpose in life (rho = 0.570). Extraversion showed positive associations with self-acceptance, positive relations, environmental mastery, purpose in life, and personal growth. Openness was positively associated with personal growth and negatively associated with environmental mastery, whereas Agreeableness was positively associated with self-acceptance, positive relations, and personal growth, but negatively associated with autonomy. Conclusions: Big Five traits showed domain-specific associations with PWB among Polish medical students. The findings support a differentiated, trait-informed perspective on student well-being, but the cross-sectional design precludes causal inference. Future longitudinal and multi-center studies should clarify temporal relationships and evaluate whether universal or optional well-being supports are differentially useful for students with distinct personality profiles.

Psychiatry International doi: 10.3390/psychiatryint7040155

Authors: Cristina-Gabriela Schiopu Cristina Elena Dobre Ovidiu Alexinschi Dan-Catalin Oprea Alexandra Boloș Oriana-Maria Onicescu Carmen Gabriela Lupusoru Adriana Gurbet Marcel-Alexandru Gaina Cristinel Stefanescu

Pediatric acute-onset neuropsychiatric presentations occurring in the context of prior streptococcal exposure remain clinically important but diagnostically inconclusive, particularly at the interface between Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS). This cross-sectional observational study examined whether serological, psychometric, and electroencephalographic findings converged within a clinically referred pediatric psychiatric cohort at the index assessment. Children and adolescents evaluated for neuropsychiatric symptoms in the context of caregiver- or record-supported history suggestive of prior streptococcal exposure were recruited over a 12-month period through inpatient and outpatient child psychiatric services. Out of 154 screened cases, 96 with analyzable index assessment data were retained and stratified by antistreptolysin O (ASO) status. Symptom burden was quantified using the Pediatric Acute-onset Neuropsychiatric Syndrome 31-Item Symptom Rating Scale (PANS-31) which was treated primarily as a continuous dimensional outcome and examined in relation to ASO titers, time since the last reported streptococcal infection, electroencephalography (EEG) findings, and selected developmental and clinical-history variables. Higher ASO values were associated with greater PANS-31 symptom burden, whereas a shorter interval since the last reported streptococcal infection was associated with both higher ASO titers and higher symptom scores. PANS-31 showed good total scale internal consistency and meaningful domain-level convergence with age-appropriate Child Symptom Inventory-4 (CSI-4) and Adolescent Symptom Inventory-4 (ASI-4) domains. Exploratory within-cohort stratification using an operational PANS-31 threshold and alternative post hoc thresholds suggested that higher symptom burden subgroups were largely confined to the ASO-positive stratum; however, these threshold-based patterns were interpreted descriptively and not as diagnostic performance or predictive classification. These findings do not support a disease-specific biomarker model, but suggest that higher anti-streptococcal serology, more recent streptococcal exposure, and greater neuropsychiatric burden may cluster as a clinically interpretable association pattern in a selected real-world psychiatric sample.

Psychiatry International doi: 10.3390/psychiatryint7040154

Authors: Ellen Keefe Robin Neuhaus Shana DeVlieger Erin O’Connor

Though perinatal mental health has been frequently examined in the context of maternal depression, research has minimally explored the degree to which a partner’s perinatal mental diagnosis influences perinatal mood and anxiety disorder incidence. Drawing on Bowen’s Family Systems Theory, we examine co-occurring symptoms of postpartum depression and anxiety (PPD/A) and support dynamics within couples through a cross-sectional mixed-methods study. In the summer of 2024, birthing and non-birthing caregivers (n = 907) across the United States completed a survey including a modified Edinburgh Postnatal Depression Scale (EPDS) and additional questions about partner support, screening, and communication. Post-survey interviews (n = 17) revealed further insight into the relational dynamics of co-occurring PPD/A symptoms among couples. Survey analyses indicated correlations between birthing and non-birthing partner experiences of PPD/A. Further, co-occurrence was associated with diminished emotional support and increased distress for birthing parents. Participants who desired more partner support or felt afraid to express their feelings had significantly higher EPDS scores. Qualitative findings reinforced these patterns, highlighting the roles of relational strain, gender norms, and lack of systemic support for perinatal mental health. Findings suggest couple-based screening practices and interventions that recognize the bidirectional emotional impact of PPD/A may hold promise for improving outcomes across the entire family system.

Psychiatry International doi: 10.3390/psychiatryint7040153

Authors: Damian Rocks Christopher Sharpley Ian Evans

While psychological resilience (PR) is critical for adaptive stress responses, its neurophysiological substrates remain unclear. Given that gamma activity (30–130 Hz) is implicated in the sensory integration and cognitive control necessary for emotion regulation, this study utilized multimodal EEG and psychometric assessments (N = 100) to evaluate resting-state eyes-open (EO) and eyes-closed (EC) oscillatory dynamics in three experimental stages. Resilience was quantified using the Connor–Davidson Resilience Scale (CDRISC-25). Following a hierarchical signal-discovery protocol, a whole-head survey was conducted to identify sites of interest, providing independent data for hypothesis formation. Following rigorous artifact control (EOG-verified ICA; 90% mean epoch retention) and statistical adjustment for multiple comparisons (Benjamini–Hochberg FDR), a robust spectral cluster was identified at the left frontopolar site (FP1), showing consistent inverse correlations with resilience across 30–50 Hz, 50–70 Hz, and 70–90 Hz sub-bands (all p FDR = 0.043). Crucially, findings were strictly lateralized, with the adjacent FP2 site remaining non-significant. Results highlight a lateralized neurophysiological signature of resilience at the left frontal pole, arguing against diffuse myogenic contamination. Next, source localization (eLORETA) and functional connectivity (Lagged Linear Coherence) were utilized to characterize spatial dynamics. Source analysis revealed noteworthy activity near the left anterior cingulate and medial prefrontal cortex. Furthermore, functional connectivity analysis showed significant coherence correlates across nodes linked with the default mode network (DMN). Notably, the 70–90 Hz sub-band emerged as a consistent correlate across all three experimental stages. Prioritizing statistical parsimony over complex mediation, these preliminary, hypothesis-generating findings suggest that site-dependent and frequency-specific gamma activity may provide neurophysiological insight toward adaptive flexibility. In particular, the 30–90 Hz spectral cluster at the left frontopolar region appears to be associated with the resting-state profile of resilient individuals in complex, as-yet-unspecified ways. These pilot data suggest further investigation is warranted, potentially providing a foundational target for future longitudinal research into the oscillatory signatures of adaptive flexibility.

Psychiatry International doi: 10.3390/psychiatryint7040152

Authors: Felipe Alckmin Carvalho Guilherme Welter Wendt Iara Teixeira Maria Cristina Triguero Veloz Teixeira Márcia Helena da Silva Melo

Anorexia nervosa (AN) in adolescence is associated with substantial morbidity and complex family processes. Family-based approaches are the best-established psychosocial treatments, but remission rates remain modest and broader family and emotional processes are often only partly addressed. This case series describes the development and preliminary evaluation of a behavior-analytic family intervention combining parent-led refeeding with structured work on parental socioemotional and educational skills. Eight families were screened, five entered treatment, and four completed a 20-session outpatient protocol delivered weekly over approximately six months, with assessments at baseline, post-treatment, and three-month follow-up. Outcomes included anthropometric indicators, menstrual status, eating-disorder psychopathology, adolescent and caregiver functioning, parenting style, perceived family support, and parent satisfaction. Among completer families, attendance was 100%. Mean BMI increased from 16.72 at baseline to 18.91 post-treatment and 19.03 at follow-up; mean EDE-Q total score decreased from 4.25 to 1.40 and 0.73, respectively. All four adolescents achieved physiological remission and reliable EDE-Q improvement by follow-up; three also met multidimensional remission criteria. The intervention was feasible, acceptable, and clinically promising, but larger studies with independent assessment and comparison conditions are needed.

Psychiatry International doi: 10.3390/psychiatryint7040151

Authors: Max J. Marshall Kesaan Kandasamy Lixia Yang

In the context of the COVID-19 pandemic, the relationship between academic motivation and mental health remains unclear among Canadian undergraduate students. This study examined associations between academic motivation and mental health, sociodemographic, and COVID-related factors in Canadian undergraduate students during the period of returning back to in-person learning (third stage of the pandemic from January–March 2022). A sample of 1868 undergraduates across British Columbia, Ontario, and Quebec completed a cross-sectional online survey in Winter 2022. Regression models revealed that depression was associated with lower academic motivation (βs ≥ 0.12, ps < 0.001), whereas stress and resilience were associated with higher academic motivation (βs ≥ 0.07, ps ≤ 0.001), controlling for related sociodemographic or COVID-related factors. Results also identified some sociodemographic (e.g., year of study, gender, English as first language status) and COVID-related factors (e.g., preference for in-person vs. online learning) for academic motivation. Results highlight factors associated with the academic motivation of students when returning back to in-person learning.

Psychiatry International doi: 10.3390/psychiatryint7040150

Authors: Cornelia Rada Robert-Andrei Lunga

(1) Background. Substance use disorders are frequently associated with difficulties in emotion regulation and the use of ineffective coping strategies. (2) Methods. A total of 201 participants undergoing specialized treatment for substance use disorders in Romania completed the Difficulties in Emotion Regulation Scale (DERS) and the Strategic Approach to Coping Scale (SACS). Statistical analyses included independent samples t-tests, Pearson correlations, path analysis, and linear regression. (3) Results. Participants with more severe substance use (history of hospitalization, detoxification treatment, and polysubstance use) exhibited significantly higher levels of emotion regulation difficulties. The latent factor DIFFICULTY was predicted by two correlated SACS predictors: Assertive Action (AA) and Antisocial Action (AS). Substance type differentially influenced DERS dimensions. The strongest correlation with the total DERS score was observed for antisocial action. (4) Conclusions. Emotion regulation and coping optimization are key targets in the treatment of substance use disorders, reflecting persistent difficulties in effectively managing emotions despite cognitive awareness. Social support may function as both an adaptive and maladaptive mechanism in this clinical context.

Psychiatry International doi: 10.3390/psychiatryint7040149

Authors: Yuka Kumagai Naoko Kudo Tomomi Suda Yoshimi Narita Masato Yoshioka

Background/Objectives: Cortisol, a stress-related protein found in saliva, is occupying an increasingly crucial role in stress research. While stress was previously assessed solely using psychological scales, the addition of cortisol as a biomarker has enabled more accurate stress assessment. Previously, stress among shift workers was evaluated both subjectively and objectively using psychological scales and cortisol levels. However, the variety of available psychological scales led to a lack of consensus on which ones should be used. This study reviewed papers investigating the relationship between cortisol and psychological scales to determine which ones should be used together. Methods: We searched for original research papers examining the relationship between psychological scales and cortisol levels among shift workers during a 20-year period from 1 January 2006 to 31 December 2025. The data were organized using psychological scales. Results: In total, 308 papers were selected, and after excluding those that met the exclusion criteria, 19 were chosen. Across the 19 studies, 10 different psychological scales were associated with cortisol. The most frequently associated psychological scales with cortisol were the Maslach Burnout Inventory (MBI), which appeared in four out of seven studies, followed by the Visual Analog Scale and Zung Self-Rating Depression Scale, which appeared in one out of two studies. Conclusions: We believe that the MBI is the most appropriate stress scale to evaluate in conjunction with cortisol; however, further evaluation is needed, particularly research that measures salivary cortisol and stress-related psychological scales using appropriate sampling methods.

Psychiatry International doi: 10.3390/psychiatryint7040148

Authors: Milagros Molero-Zafra María Jesús Hernández-Jiménez Olga Fernández-García Marián Pérez-Marín

Background: Childhood sexual abuse (CSA) is associated with long-term psychological and somatic consequences in adulthood. However, detailed clinical characterisations of female survivors remain limited from a public health perspective. Methods: This exploratory cross-sectional study was conducted in Spain (March 2022–June 2023) with 31 adult women (18–58 years) with a history of CSA. Participants were recruited through non-probabilistic sampling from clinical services and a survivors’ association. Sociodemographic and clinical variables were assessed using validated instruments, including the EGS-R, SCL-90-R, DERS, DES, RSE, and PID-5-BF, administered in structured online guided sessions. Descriptive statistics, Pearson correlations, and independent samples t-tests were performed. Results: The sample reported early-onset CSA (mean age = 7.17 years), predominantly intrafamilial, repeated, and prolonged, with high rates of revictimization and low disclosure. Participants reported clinically relevant levels of post-traumatic, psychological, and dissociative symptoms. The mean DES score was 11.89 (SD = 7.75). Women reporting a current somatic illness showed significantly higher levels of post-traumatic symptoms, general psychological distress, and dissociation, together with lower self-esteem. Earlier age of CSA onset and younger current age were associated with several indicators of greater symptom severity. Conclusions: In this exploratory clinical sample, adult female survivors of childhood sexual abuse reported substantial psychological distress, dissociative symptoms, and frequent somatic illness. The observed associations between trauma-related variables and clinical outcomes should be interpreted cautiously and require replication in larger and more diverse samples. Nevertheless, the findings support the potential relevance of trauma-informed and multidisciplinary approaches when working with clinically vulnerable survivors of childhood sexual abuse.

Psychiatry International doi: 10.3390/psychiatryint7040147

Authors: Sara Guidotti Alice Fiduccia Daniele Chirco Emma Carli Carlo Pruneti

Perseverative cognition—frequently expressed through obsessive–compulsive symptoms—is a recognized trans-diagnostic risk factor for psychopathology, with documented links to depression and suicidal ideation. While the literature suggests that altered autonomic arousal in depression may relate to suicidal risk, the conditional architecture linking these variables remains insufficiently explored. This study examined whether suicidal ideation mediates the association between depression and autonomic arousal and whether obsessive–compulsive symptoms moderate the initial pathways within this mechanism. A sample of 120 university students (61.8% female; Mage = 28.6, SDage = 10.71) completed the Symptom Checklist-90-Revised (SCL-90-R), from which the depression, obsessive–compulsive, and suicidal ideation scores were derived; notably, the suicidal ideation score was calculated from specific items (15 and 59) embedded within the depression subscale. All participants underwent a psychophysiological evaluation to record baseline Electrodermal Activity (EDA) as an index of tonic autonomic arousal. Results indicated that depression significantly predicted suicidal ideation (B = 0.05, SE = 0.006, p < 0.001, 95% CI [0.03, 0.06]), which, in turn, was a significant predictor of autonomic arousal (B = 0.17, SE = 0.08, p = 0.03, 95% CI [0.02, 0.33]). Additionally, the mediation analysis revealed that depression showed an indirect statistical association with autonomic arousal through suicidal ideation (Bootstrapped 95% CI [0.01, 0.12]). Concurrently, obsessive–compulsive symptoms significantly moderated the psychological link between depression and suicidal ideation (B = 0.20, SE = 0.04, p < 0.001, 95% CI [0.04, 0.37]), accounting for 38.40% of the variance (F (4, 115) = 22.17, p < 0.001). Sensitivity analyses, conducted by re-calculating the models after excluding items 15 and 59 from the depression score, confirmed the robustness of these findings against potential psychometric overlap. However, the formal Index of Moderated Mediation was not statistically significant (0.0000 (95% Boot CI [−0.0001, 0.0001]), explicitly demonstrating that this psychological moderation did not translate into a significant conditional indirect effect on peripheral autonomic arousal. These findings suggest that while obsessive cognitive patterns significantly intensify the psychological burden of depression into thoughts of death, their concurrent association with peripheral physiological parameters remains strictly exploratory in non-clinical cohorts, underscoring a nuanced underscoring a nuanced ‘blocking’ effect—both emotional and behavioral—where obsessive rigidity functions as a mechanism of paralysis that, while generating profound subjective distress, fails to translate into a corresponding reactive physiological response of the autonomic nervous system.

Psychiatry International doi: 10.3390/psychiatryint7040146

Authors: José-Rufino García-Sánchez Francisco-Javier Gago-Valiente Andrés Arana-Rodríguez Emilia Moreno-Sánchez

The scientific literature was reviewed to systematically identify and characterize validated scales measuring homophobia, lesbophobia, biphobia, and transphobia, as well as the biopsychosocial consequences derived from these attitudes in sexual and gender minority (SGM) populations. The search was conducted in the WOS, Scopus, and Medline databases, limited to studies published between January 2015 and January 2024. This review was registered in the International Prospective Register of Systematic Reviews, and its quality was evaluated using the Effective Public Health Practice Project instrument. The criteria of the PRISMA declaration for systematic reviews were applied. Among the 78 articles initially selected, 9 met the established eligibility criteria. In these 9 articles, 13 validated scales were identified, covering attitudes toward sexual and gender minorities, internalised stigma, minority stress and resilience, parental acceptance, and experiences of bullying and cyberbullying in SGM populations. The findings reveal substantial fragmentation in the available measurement landscape, with most instruments lacking cross-cultural validation, measurement invariance testing, and construct coverage beyond Western, English- or Spanish-speaking contexts. These results should be interpreted with caution given the limited number of included studies and the absence of meta-analytic quantification. This review proposes the development of a novel intermodular measurement system as a priority research agenda and identifies key implications for specialized psychiatric and clinical practice, public health surveillance, and future research.

Psychiatry International doi: 10.3390/psychiatryint7040145

Authors: Ana Muiño Tato Albert Marquès-Donoso Juan Carlos Sánchez-Huete

(1) Background: ASD diagnostic and screening instruments were historically developed on predominantly male samples, raising concerns about their differential validity across sexes. (2) Objective: This meta-analysis quantified the magnitude of gender bias in ASD diagnostic and screening tools and examined its consistency across instruments, age groups, and clinical contexts. (3) Method: A systematic search was conducted in APA PsycINFO, ERIC, Dialnet, and PsicoDoc (2015–2025) following PRISMA 2020 guidelines. Fourteen empirical studies were included (N = 55 to ~3,000,000). Effect sizes were computed as Fisher r-to-z transformed coefficients and pooled using a random-effects model. Heterogeneity was assessed via Cochran’s Q and I2; methodological quality was assessed via the CRF-QS. (4) Results: The pooled effect size was μ^ = 0.29 (95% CI: 0.11–0.47, z = 3.11, p = 0.001), indicating systematic bias favoring detection of externalizing, prototypically male profiles. Substantial heterogeneity was observed (I2 = 99.93%, Q(13) = 11,417.61, p < 0.001, τ2 = 0.11), with a prediction interval of −0.40 to 0.97. Funnel plot asymmetry suggested possible publication bias (p = 0.01). (5) Conclusions: ASD diagnostic instruments systematically underperform in identifying female presentations of autism. Bias operates across screening and formal evaluation stages, is not corrected by specialist assessment, and is associated with diagnostic delay and increased psychopathological burden. Revision of diagnostic tools and clinical training is urgently warranted.

Psychiatry International doi: 10.3390/psychiatryint7040144

Authors: Mateusz Grajek Paweł Juraszek Joanna Kobza Mariusz Geremek Beata Nowak Tomasz Jurys Mateusz Rozmiarek

Alcohol and psychoactive substance use disorders are major public health challenges in Poland. The COVID-19 pandemic affected both mental health and the organization of addiction treatment services. This study assessed changes in the utilization of publicly funded addiction treatment services in Poland before, during, and after the pandemic, with attention to regional differences. National Health Fund data from 2018 to 2023 were analyzed for alcohol use disorder treatment and treatment of other substance use disorders. Indicators included the number of patients, services provided, and total financial value of services. ANOVA, linear regression, and Pearson correlation analyses were performed. In 2020, the number of patients and services declined, particularly for non-alcohol substance treatment, followed by gradual recovery in 2021–2023. Significant regional differences were observed (p < 0.001), while differences between years were not significant. The financial value of services increased significantly over time, and strong positive correlations were found between patients, services, and costs. The pandemic temporarily reduced access to addiction treatment services in Poland. Although service utilization recovered over time, regional inequalities and increasing treatment costs persisted, highlighting the need to improve accessibility and resilience of addiction care systems.

Psychiatry International doi: 10.3390/psychiatryint7040142

Authors: Sonja Golubović Jovan Milatović Milana Okanović Nikola Glogonjac Slobodan Šajinović Danilo Medin Ivana Đuran Violeta Knežević Boris Golubović

Background and Aims: Cognitive impairment (CI) and depression are frequent comorbidities in chronic hemodialysis (HD) patients with substantial impact on health-related quality of life (HRQoL). This study examined their prevalence, predictors, and independent associations with HRQoL. Methods: A cross-sectional study enrolled 70 adult maintenance HD patients. Cognitive functioning was assessed with the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA); depressive symptoms with the Beck Depression Inventory (BDI); and HRQoL with the Kidney Disease Quality of Life instrument (KDQOL-SF). Logistic regression, multiple linear regression, and mediation analysis were applied. Results: CI (MoCA ≤ 24) was present in 54.3% of patients; clinically significant depressive symptoms (BDI ≥ 14) were present in 44.4%. BDI was not correlated with MoCA (p = 0.656) or MMSE (p = 0.880), confirming independence of the two dimensions in cross-section. Older age (OR = 1.106, p = 0.001) and male sex (OR = 4.523, p = 0.022) were independent predictors of CI. BDI significantly correlated with 15 of 19 KDQOL domains and was the dominant predictor across 10 domains in multiple linear regression (Adj. R2 up to 0.358). MoCA correlated with only two KDQOL domains. Mediation analysis confirmed that MoCA does not mediate the BDI–HRQoL relationship (indirect effect: −0.004, 95% bootstrap CI: −0.106 to +0.097). Conclusions: CI and depression are highly prevalent and clinically distinct dimensions in HD patients, though subtle longitudinal interactions cannot be excluded. Depression is the dominant determinant of impaired HRQoL, acting through a direct, cognitively independent pathway, and represents the primary modifiable target for improving quality of life in this population.

Psychiatry International doi: 10.3390/psychiatryint7040143

Authors: Ryusuke Matsumoto Yuki Ito Tomoka Oka Eishi Motomura Motohiro Okada

National crude suicide mortality rates (CMRs) in Japan trended downward throughout the 2010s, yet the CMR for the youth population moved in the opposite direction, rising from the mid-2010s onwards. To clarify the risk groups and underlying mechanisms of increasing student suicides, the temporal fluctuations of CMRs of students in middle school, high school, special vocational school, and university were analyzed by joinpoint regression analysis, and identification of high CMR groups were detected by a linear mixed-effect model using government suicide databases. CMRs of female students in all school categories increased from the mid-2010s. CMRs of male students in middle and high schools increased, whereas those in university and special vocational school moved from a decreasing to a stable level. Among the average of CMRs from 2022 to 2025, the highest CMR was observed in part-time high school students, which was approximately fivefold higher than the average of all students overall. The major leading suicide motives for all student subgroups were concerned with underachievement and career-path-associated problems within school-related problems. Family-related problems, such as conflict with parents and parental reprimands, were leading suicide motives for middle school students, but these impacts attenuated with age. Instead, the impacts of psychiatric disorders, including depression and other psychiatric disorders, enhanced with age. Student suicides attributed in the government suicide database to these leading suicide motives showed an upward inflexion, moving from a decreasing or stable pattern to a rising one, beginning in the mid-2010s. Taken together, these patterns indicate that mental health concerns among students have re-emerged as a substantial motive behind student suicide from the mid-2010s.

Psychiatry International doi: 10.3390/psychiatryint7040141

Authors: Shirlyn Ming Hui Lee Shazli Ezzat Ghazali Noraziah Mohamad Zin Shanthi Krishnasamy Choy Qing Cham Ching Sin Siau

Background: Suicide is a major mental health concern, particularly among university students facing unique stressors. Understanding their attitudes toward suicide is essential for effective prevention, yet the existing literature lacks a systematic review on this population. This review synthesises and evaluates the literature on attitudes toward suicide among university students. Methods: A systematic search was conducted on four databases (MEDLINE, Web of Science, Scopus, and PubMed) using Medical Subject Headings terms and keywords identified from previous studies. The search, conducted in February 2024, included studies published between 2014 and 2024. One researcher screened the titles and abstracts, while two independent researchers extracted the data. Twenty-one articles (N participants = 13,424) were selected for further assessment. Quantitative designs were the most common (n = 18), followed by qualitative (n = 2) and mixed-method designs (n = 1), spanning multiple regions. Themes were derived by organising findings into thematic categories based on recurring patterns across the studies. Results: Two core themes emerged: Factors associated with attitudes toward suicide and their associations with suicide outcomes. Conclusions: The review underscores the need for culturally sensitive approaches to address negative attitudes toward suicide and promote help-seeking among university students, highlighting the importance of further research in this area.

Psychiatry International doi: 10.3390/psychiatryint7030140

Authors: Esteban Zavaleta-Monestel Luis Guillermo Herrera-Jiménez José Miguel Chaverri-Fernández Sebastián Arguedas-Chacón Jeaustin Mora-Jiménez Ricardo Millán-González

Major depressive disorder (MDD) is clinically heterogeneous, and peripheral inflammatory biomarkers may help clarify early biological mechanisms before illness chronicity or pharmacologic treatment confound interpretation. This systematic review synthesized evidence on peripheral inflammatory biomarkers in first-episode, drug-naïve major depressive disorder (FEDN-MDD) compared with healthy controls and examined associations with clinical severity. Following PRISMA 2020, searches of PubMed/MEDLINE, Embase, PsycINFO, and Scopus from inception to 19 March 2026 identified 313 records; after screening, 16 publications were included in qualitative synthesis. Studies varied in age group, biological matrix, assay platform, and statistical reporting, precluding meta-analysis. The most frequently assessed biomarkers were IL-1β, TNF-α, IL-6, and CRP/hs-CRP. IL-6 showed the clearest recurrent tendency toward elevation in FEDN-MDD, whereas CRP/hs-CRP findings were partially positive but methodologically limited. TNF-α and IL-1β findings were mixed, and clinical correlations with depressive severity were sparse and inconsistent. Overall, the evidence supports heterogeneous early immune dysregulation in a subset of patients with FEDN-MDD rather than a single reproducible inflammatory signature. Peripheral inflammatory biomarkers should currently be considered research tools for biological stratification and mechanistic hypothesis generation, pending larger standardized longitudinal studies.

Psychiatry International doi: 10.3390/psychiatryint7030139

Authors: David Desatnik Moshe Shmueli Nofar Tsur Ariel Pollock Star Norm O’Rourke

Background: As understanding of addiction extends beyond substance misuse, various behavioral disorders may emerge as recognized mental health conditions, including social media use disorder (SMUD). To date, however, empirical research supporting SMUD as a distinct disorder is limited and inconsistent. The present study set out to compare the relative prevalence of elevated symptoms suggestive of SMUD between those with no mental health history and affective disorders (both unipolar depression and bipolar disorder). Methods: Participants were recruited online and completed questionnaires measuring social media use (SMU), symptoms of SMUD, depression and various psychosocial factors associated with social media use (i.e., loneliness, social support). Among those with affective disorders, we set out to identify sociodemographic and clinical features that distinguish those with comorbid SMUD (i.e., above the cut-off on the SMUD screening measure). Results: Five main findings emerged from our analyses: (1) SMUD appears unrelated to known forms of SMU; (2) Among those with no mental health history, SMUD does not present independently of elevated depressive symptoms; (3), No sociodemographic or clinical features distinguish those with clinical depression reporting comorbid SMUD; (4), Among those with bipolar disorder (BD), symptoms of hypo/mania do not distinguish those also reporting elevated SMUD symptoms; (5) And SMUD symptoms no longer differ across clinical groups after adjusting for depressive symptoms. Conclusions: Our findings suggest that SMUD is unrelated to active or passive SMU. Symptoms suggestive of SMUD may instead be a contemporary manifestation of depressive symptomology. These findings do not support the existence of SMUD as a bona fide mental health condition.

Psychiatry International doi: 10.3390/psychiatryint7030138

Authors: İbrahim Karakaya İbrahim Gündoğmuş Alişan Burak Yaşar

This study aimed to examine the relationship between post-traumatic stress symptoms following cryptocurrency loss and early maladaptive schemas in physicians. This cross-sectional study was conducted using a relational screening model and included 94 physicians across Türkiye who reported financial loss in cryptocurrency markets between 15 April and 15 July 2022. Data were collected online using a sociodemographic information form, the Young Schema Questionnaire–Short Form 3, and the Impact of Event Scale-Revised. Participants with an Impact of Event Scale–Revised total score of 33 or higher were classified as having elevated IES-R symptoms, reflecting elevated event-related distress according to a screening cutoff rather than a clinical diagnosis of PTSD. Eighteen participants (19.1%) were classified into this group. While no significant differences were found in age, marital status, employment status, or investment duration, the proportion of savings allocated to crypto was higher among participants with elevated IES-R symptoms. The elevated IES-R symptom group had higher scores in Failure, Pessimism, Dependence/Enmeshment, Punitiveness, Defectiveness, and Vulnerability to Harm, and additional correlation analyses showed that the IES-R total score was positively associated with Pessimism, Punitiveness, Dependence/Enmeshment, and Failure after false discovery rate correction. However, in the exploratory logistic regression analysis, none of these variables independently predicted elevated IES-R symptom status. These findings suggest that cryptocurrency loss may represent not only a financial stressor but also a significant experience associated with post-traumatic stress symptoms and maladaptive schema patterns in physicians.

Psychiatry International doi: 10.3390/psychiatryint7030137

Authors: Angel Labra-Lorenzana Dania Nimbe Lima-Sánchez Christian Alejandro Delaflor-Wagner Diana Martínez-Hernández Christian Ramos-Jiménez Christian Gabriel Toledo-Lozano

Background: This systematic review and meta-analysis evaluates the efficacy and safety of psilocybin-assisted psychotherapy (PAP) for adults with major depressive disorder (MDD). Methods: A PROSPERO-registered search (CRD42024561979) of CENTRAL, Scopus, PsycINFO, and MEDLINE (2010–2024) identified clinical trials assessing PAP. Risk of bias was assessed using RoB 2 for randomized controlled trials (RCTs), while non-randomized studies were appraised separately. Evidence certainty was evaluated using GRADE. Results: Ten trials were included; eight provided quantitative data. PAP was associated with large short-term reductions in depressive symptom severity. The overall pooled effect was large (d = 1.15, 95% CI 0.83–1.48), though within-subject designs yielded larger estimates (d = 1.63) than between-subject controlled comparisons (d = 0.96). Adverse events were transient and manageable, with no increased risk of serious adverse events on dosing days. Primary risk-of-bias concerns included functional unblinding. Conclusions: PAP may produce clinically meaningful, large short-term reductions in depressive symptoms. However, long-term efficacy remains understudied, and the overall certainty of evidence is low to moderate. Larger, rigorously blinded trials are required.

Psychiatry International doi: 10.3390/psychiatryint7030136

Authors: Karine Santana de Azevedo Zago Raissa Pereira Dutra Clesnan Mendes-Rodrigues Amanda Viana Hortêncio Analicy Rodrigues Xavier Sarah Campos Moura Rabelo Gustavo Henrique Borges de Souza Felipe Rodrigues Torres Polyana Alvarenga Matumoto Mônica Rodrigues da Silva Hélder Eterno da Silveira Elaine Saraiva Calderari Tiago Rocha Pinto Ricardo Wagner Machado da Silveira Cynthia Daniela Figueiredo de Souza Tatiana Benevides Magalhães Braga Marciana Gonçalves Farinha Luiza Pereira Silva Assis Beatriz da Silva Vieira Fabiola Alves Gomes

This study aimed to assess the self-reported depressive symptomatology of university students during their first therapeutic online consultation and intervention at PROTEGER-SE Project, using the Patient Health Questionnaire-9 (PHQ-9) as a screening instrument. A cross-sectional, retrospective, and analytical study was conducted with 350 records of university students from 2020–2023 collected immediately after their first appointment. Many students presented moderate to severe depressive symptoms, with one-third classified as severe. Logistic regression showed that female sex was associated with higher symptomatology severity, while lower PHQ-9 scores and Humanities field of study enrollment predicted perceived improvement after consultation. Findings reinforce the importance of university-based mental health support, gender-sensitive approaches, and the systematic use of PHQ-9 for early screening and continuous monitoring.

Psychiatry International doi: 10.3390/psychiatryint7030135

Authors: Michèle Preyde Regina Markle Andre Watkis Melissa Aguto Shrenik Parekh John Heintzman

Background: The rising rate of referrals to outpatient psychiatry is difficult to manage. To explore intake and pre-assessment strategies to reduce strain related to the high volume of referrals, two intake tools and two caregiver symptom rating tools were trialled in a child and adolescent outpatient mental health clinic in Ontario, Canada. Methods: Intake personnel completed two tools in addition to the routine intake procedure in a feasibility study. Caregivers completed two symptom-rating tools, and feedback on the use of the tools was sought with a survey. Results: There were statistically significant differences between priority groups (i.e., determination as usual with high, medium, or low priority) on both intake tools, but no statistically significant differences between either caregiver rating tool were found. Conclusions: Standardizing the assessment process may facilitate care. Caregiver ratings did not align with triage priorities; however, these ratings may inform clinical assessments.

Psychiatry International doi: 10.3390/psychiatryint7030134

Authors: Felix Kruse Arvid Nagel

Problematic social media use is associated with adolescents’ mental health, yet mechanisms remain underexplored. This study tested whether dispositional mindfulness mediates associations between problematic social media use and symptoms of depression, anxiety, and stress. In a school-based sample of 892 students aged 10–14 years in Switzerland, participants completed an anonymous online classroom survey. Problematic social media use, mindfulness, and symptoms of depression, anxiety and stress were examined using structural equation modeling with robust maximum likelihood estimation and cluster-robust inference for nested data structure. Model fit was acceptable (CFI = 0.921; RMSEA = 0.052). PSMU predicted lower mindfulness (β = −0.50, p < 0.001), and mindfulness was negatively related to depression (β = −0.54), anxiety (β = −0.60), and stress (β = −0.63; all ps < 0.001). Indirect effects of PSMU via mindfulness were significant for all outcomes (β = 0.27–0.32, ps < 0.001). Direct effects of PSMU remained for anxiety (β = 0.18, p < 0.001) and stress (β = 0.14, p = 0.002) but not depression (β = 0.07, p = 0.161). Overall, findings suggest mindfulness might be an important pathway linking dysregulated social media engagement to adolescent distress. Longitudinal and experimental research is needed to clarify temporal ordering.

Psychiatry International doi: 10.3390/psychiatryint7030133

Authors: Savannah M. Stidhams Kristen M. Pedersen Logan C. Mattingly Annika H. Barsy Mavis Tsai

Mental health disparities among LGBTQ+ individuals remain elevated and have been exacerbated by sociopolitical stressors following the COVID-19 pandemic. This embedded, mixed-methods pilot study examined the feasibility of a four-session Awareness, Courage, and Love (ACL) group intervention adapted for LGBTQ+ community members. The two-hour intervention sessions targeted (1) contact with the authentic self, (2) self-acceptance and self-compassion, (3) value alignment, and (4) presence. Seven LGBTQ+ adults participated in intervention (n = 3) and control (n = 4) conditions. Participants completed quantitative measures evaluating facets of well-being, including social connection and self-acceptance, and provided qualitative feedback. Findings provide preliminary support for the feasibility of ACL interventions in conjunction with existing community-building strengths among LGBTQ+ individuals. Implications for interdisciplinary behavioral health settings, including psychiatric contexts, are discussed.

Psychiatry International doi: 10.3390/psychiatryint7030132

Authors: Stevanovic Milena Latas M. Marko Latas Milan Milic Marija Milic Milic Kisic Darija Pavlovic Zorana

Refugees are exposed to cumulative pre-migration, migration, and post-migration stressors that increase vulnerability to depressive disorders and impaired quality of life. This study assessed the prevalence and severity of depressive symptoms among adult refugees in Serbia and examined associations with sociodemographic characteristics, traumatic experiences, social support, and Health Related Quality of Life (HQoL). The study included 324 refugees residing in four reception centers in Serbia. Data were collected between April 2023 and November 2024 using self-report questionnaires. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9), while HQoL was evaluated using the SF-36 Health Survey. The mean PHQ-9 score indicated mild-to-moderate depressive symptomatology. Clinically significant depressive symptoms were present in 41.4% of participants, while more than 70% reported at least mild symptoms. Depressive symptom severity was negatively associated with energy/fatigue, emotional well-being, social functioning, general health, and pain. The Energy/Fatigue domain emerged as the most prominent independent correlate of depressive symptom severity. Depressive symptoms were highly prevalent and were associated with impaired quality of life and psychosocial stressors. These findings highlight the importance of systematic mental health screening and psychosocial support among refugees.

Psychiatry International doi: 10.3390/psychiatryint7030131

Authors: Daniel Carvalho de Matos Ellen Neide Cutrim Nazareno Rafisa Pereira Costa Fabrício Brito Silva Pollianna Galvão

Background: Children diagnosed with autism spectrum disorder (ASD) commonly show impairment in skills. Research has investigated procedures that may teach a skill and establish others through emergence, without direct instruction. A given procedure corresponds to instructive feedback (IF) with definition of secondary target during the teaching of a primary target. IF information may be presented in the consequent portion of a contingency. Research has shown that this procedure may produce acquisition of multiple targets in some learners. Methods: The current study directly taught a primary target, simple tact, with IF in three children with ASD. In addition, the effects of training with IF were assessed on the emergence of four secondary targets, that is, listener responding according to category, tact according to category, arbitrary visual matching-to-sample and intraverbal according to category. Results: The children acquired all targets. They had no previous experience with IF and data provided further evidence of its effectiveness with this population. In addition, the effects of training with IF were long-lasting, as high performance maintained 2 weeks later in probes. Limitations were discussed, and recommendations for future investigations were presented. Conclusions: Training with IF established primary and secondary targets for all children involved.

Psychiatry International doi: 10.3390/psychiatryint7030130

Authors: Gniewko Więckiewicz

Glucagon-like peptide-1 (GLP-1) receptor agonists, originally developed for type 2 diabetes and obesity, have recently attracted interest as potential modulators of addictive behavior. This narrative review summarizes current knowledge on the neurobiological basis, randomized controlled trials, and psychiatric relevance of GLP-1 analogs in substance use disorders. English-language articles available at the time of the search were reviewed between February and April 2026, with emphasis on topics most relevant to psychiatric practice. The literature suggests that GLP-1 signaling influences reward processing, cue reactivity, stress responses, relapse vulnerability, and executive control through actions in the gut–brain axis and mesocorticolimbic circuitry. Early clinical findings are most encouraging in alcohol-related outcomes, including reductions in alcohol cue reactivity, craving, alcohol self-administration, and some measures of heavy drinking, whereas evidence in nicotine dependence is mixed and appears more consistent for limiting post-cessation weight gain than for improving abstinence itself. Evidence for other substance use disorders remains preliminary. Across randomized controlled trials, interpretation is limited by small sample sizes, short follow-up, heterogeneous endpoints, and selective populations. In addition, psychiatric and behavioral safety requires careful attention, particularly regarding rapid weight loss, excessive appetite suppression, restrictive eating, dehydration, and psychological destabilization in vulnerable individuals. At present, GLP-1 receptor agonists should be regarded as promising but unproven adjunctive candidates in addiction psychiatry, warranting further rigorous trials, structured monitoring, and interdisciplinary collaboration.

Psychiatry International doi: 10.3390/psychiatryint7030129

Authors: Maria Teresa Moreira Andreia Lima Diana Ribeiro Martins Maria Inês Guimarães Inês Lopes Cardoso Carla Sílvia Fernandes Telmo Lima da Costa Salomé Ferreira

Background: Alcohol use disorder (AUD) is a major public health concern frequently associated with anxiety and depressive disorders, highlighting the need for innovative and personalised mental health interventions. Virtual reality (VR) has emerged as a digital tool that may support cognitive behavioural therapy (CBT) by enabling immersive and controlled exposure to relevant stimuli. Methods: This scoping review aimed to map how VR is integrated into CBT-oriented interventions for adults with AUD, with a focus on therapeutic mechanisms and their potential relevance for precision digital mental health. The review followed Joanna Briggs Institute methodology and PRISMA-ScR guidelines. Searches were conducted in PubMed, CINAHL, and Psychology and Behavioural Sciences Collection for studies published in the last ten years in English, Portuguese, or Spanish. Two independent reviewers performed screening and data extraction. Results: Eight studies were included, encompassing approaches such as cue exposure, simulation of high-risk environments, and covert sensitisation. The studies explored mechanisms including craving induction and regulation, identification of individual triggers, emotional processing, and enhancement of self-efficacy. The evidence base was characterised by small sample sizes, heterogeneous designs, and limited longitudinal data. Conclusions: This review provides a structured mapping of current applications of VR within CBT frameworks for AUD and highlights key therapeutic mechanisms that may have transdiagnostic relevance. However, the existing evidence remains preliminary, and findings should be interpreted with caution. The results support the exploration of VR within emerging precision digital mental health approaches, while underscoring the need for further rigorous and standardised research.

Psychiatry International doi: 10.3390/psychiatryint7030128

Authors: Mitchell L. Doucette D. Luke Macfarlan Mark Kasabuski Junella Chin Emily Fisher

Introduction: Medical cannabis is increasingly used to manage post-traumatic stress disorder (PTSD), a condition frequently linked to high healthcare utilization, particularly for acute services. Methods: We conducted a retrospective cohort study using data from Leafwell among patients with PTSD who either used medical cannabis for at least one year (treated group) or were cannabis-naïve (untreated group). The primary outcomes were urgent care, emergency department (ED), or hospitalization visits in the past six months. We applied inverse probability weighting with regression adjustment (IPWRA) to estimate the average treatment effect (ATE) of medical cannabis exposure, adjusting for demographics, PTSD severity, and other health factors. Sensitivity analyses were performed to assess robustness. Results: Out of 1946 participants, 1261 were in the treated group and 685 in the untreated group. The treated group had a 35.6% lower probability of urgent care visits (coefficient = −0.024, SE = 0.0117) and a 35.1% lower probability of ED visits (coefficient = −0.027, SE = 0.0124). Although hospitalization rates were 26.3% lower, this difference was not statistically significant. Findings remained consistent across multiple ATE estimation methods, and adjusting the IPWRA model’s tolerance levels strengthened these associations. Fewer than 2% of the treated group reported adverse events. Conclusions: Medical cannabis use among patients with PTSD was associated with reduced urgent care and ED visits. These results were robust across analytical methods, supporting the potential role of medical cannabis in lowering acute healthcare needs. Further longitudinal research is warranted to assess causality and clarify effects on hospitalization.

Psychiatry International doi: 10.3390/psychiatryint7030127

Authors: Mila Kingsbury Nicole Dryburgh Leanne C. Findlay

The objective of the study was to examine longitudinal associations between cybervictimization and mental health and suicidal behavior among youth. Data for 4930 youth were drawn from the Canadian Health Survey on Children and Youth (CHSCY), a nationally representative cohort survey with collection waves in 2019 and 2023. Logistic regression models predicted self-reported mental health outcomes in 2023 (depression, anxiety, suicidal ideation and suicide attempt) from cybervictimization in 2019, adjusting for baseline mental health, socio-demographic covariates, frequency of online activities, and experience of traditional bullying victimization. Fully adjusted models suggested that cybervictimization in 2019 was significantly associated with youth depression (OR: 2.41, 95%CI: 1.68, 3.45), anxiety (OR: 1.33, 95%CI: 1.05, 1.68), and suicidal ideation (OR: 1.95, 95%CI: 1.12, 3.39) four years later. The association with suicide attempt was positive but not statistically significant in adjusted models (OR: 1.77, 95%CI: 0.99, 3.16). These results suggest that youth who experience cybervictimization in adolescence are at elevated risk of mental health problems lasting into young adulthood, an association which appears to be independent of the experience of traditional face-to-face victimization. Bullying prevention programs targeted towards reducing cybervictimization may warrant further study, with the aim of informing approaches to improve adolescent mental health.

Psychiatry International doi: 10.3390/psychiatryint7030126

Authors: Désirée Muller-Mallet Béatrice Ouellon Lionel Cailhol Stéphanie Borduas Pagé Alexandre Hudon

Workplace violence and hetero-aggressive behavior represent significant occupational hazards in mental health settings, particularly for psychiatry and psychology trainees who are frequently exposed yet often insufficiently prepared. This scoping review aimed to map and critically describe existing educational approaches to violence risk assessment, prevention, and management in mental health training programs, with a focus on psychiatry and psychology education. A scoping review identified 17 eligible studies examining curricular content, pedagogical modalities, and training outcomes related to violence education. Included studies encompassed surveys, curricular descriptions, and educational interventions employing didactic, simulation-based, and blended learning formats. Overall, the literature revealed variability and fragmentation in training, with most programs lacking structured or longitudinal curricula. Didactic approaches improved conceptual understanding but were consistently perceived as insufficient for skill acquisition and confidence. In contrast, blended and simulation-based modalities, particularly those using standardized patients and structured debriefing, were associated with greater gains in applied skills, confidence, and perceived clinical readiness. Core competencies emphasized across curricula included de-escalation strategies, violence risk assessment frameworks, communication skills, and, less consistently, legal and institutional considerations. These findings highlight persistent educational gaps and support the integration of experiential, longitudinal, and system-informed training models to better prepare mental health trainees for violence-related clinical challenges.

Psychiatry International doi: 10.3390/psychiatryint7030125

Authors: Sara Romano Dario Esposito Giorgia Di Iorio Fabiola Panvino Benedetta Altomonte Dario Calderoni Giulia Conte Maria Pia Casini Arianna Terrinoni

Background: Problematic social media use (PSMU) has been increasingly conceptualized as a form of behavioral addiction, characterized by loss of control and continued engagement despite negative consequences. Adolescents with psychiatric disorders may represent a particularly vulnerable group, yet clinical evidence remains limited. This study examined the prevalence of PSMU in help-seeking adolescents and investigated how psychological vulnerabilities influence social media (SM) engagement, platform selection, and content preferences. Methods: A cross-sectional study was conducted on 265 adolescents (12–18 years) undergoing psychiatric evaluation. Participants completed validated measures of PSMU (Social Media Disorder Scale-9) and perceived stress, along with items assessing screen time, platform usage, engagement style (active vs. passive), and content preferences. Diagnostic data were retrieved from clinical assessments. Results: PSMU prevalence was 14.4%, rising to 19.2% among adolescents with internalizing disorders. Female and gender-diverse adolescents showed significantly higher PSMU scores. PSMU was associated with greater screen time (OR = 2.41) and nearly threefold higher odds of intensive TikTok use. Overall, SM engagement was predominantly passive, particularly among adolescents with depressive disorders, while those with neurodevelopmental disorders more frequently engaged actively. Higher stress levels were linked to greater SM use, especially on TikTok and Instagram. Conclusions: PSMU appeared to be relatively prevalent among adolescents receiving psychiatric care, particularly those with mood and anxiety disorders and high stress levels. Findings highlight the importance of assessing PSMU in these groups of adolescents and analyzing qualitative patterns of SM engagement to identify at-risk youth and inform targeted clinical interventions.

Psychiatry International doi: 10.3390/psychiatryint7030124

Authors: Shlomo Mendlovic

Psychotherapy is an effective treatment for a wide range of mental disorders, yet treatment outcomes remain highly variable across patients. The emerging field of precision psychotherapy seeks to address this variability by tailoring interventions to the characteristics and needs of individual patients. Recent advances in artificial intelligence (AI) have accelerated this effort by enabling predictive models that identify patients at risk for treatment non-response and support personalized treatment selection. However, most current approaches to precision psychotherapy focus primarily on predicting outcomes or stratifying patients into subgroups, while offering limited tools for supporting clinical decision-making within the therapeutic process itself. This paper proposes that advancing precision psychotherapy may benefit from conceptual frameworks capable of representing therapeutic interactions as they unfold within clinical sessions. Psychotherapy is fundamentally a communicative process in which psychological change is understood to emerge through the evolving dialogue between therapist and patient. To help structure this process, we introduce a dimensional framework that conceptualizes mental activity as organized across five hierarchical dimensions: action, thought, emotion, experience, and being. These dimensions provide a structured representation of the forms in which psychological activity appears in therapeutic dialogue and may allow therapeutic interaction to be described as a sequence of dimensional transitions between therapist and patient. Such a representation could serve as a conceptual basis for the future development of computational tools aimed at analyzing therapeutic dialogue and identifying patterns that may be associated with therapeutic processes such as change, rupture, or shifts in interaction. Integrated with AI-based analysis of psychotherapy sessions, this framework may inform the design of systems intended to support the analysis of therapeutic processes, such as monitoring patterns of interaction or identifying potential shifts in patient experience, while preserving the central role of clinical judgment. By providing a formalized representation of therapeutic dialogue, this approach is intended as a conceptual and methodological step toward the development of more precise, process-informed approaches to psychotherapy.

Psychiatry International doi: 10.3390/psychiatryint7030123

Authors: Mariana Schettini Martins Barbosa Enrico Lázaro Guidugli Gabriela Schettini Martins Barbosa Maria Eduarda Gonzales Melati Nicole Brunello Pagliarin Pedro Bortoluzzi Escobar da Silva Pedro Henrique Paesi Dutra Vitor Ritt Xavier Eugênio Horácio Grevet Ygor Azeno Ferrão

Background: Procrastination is a voluntary and irrational delay in taking action despite negative consequences. We aimed to conceive/suggest a definition of procrastination, assess the behavior, and determine its psychopathological features (within the contexts of attention-deficit/hyperactivity disorder and obsessive–compulsive disorder. Method: In this scoping study, we systematically reviewed original research studies with conceptual and clinical data related to procrastination. Data were extracted regarding definitions, populations, instruments used, and psychopathology. Results: A total of 387 studies were included. Only 13% utilized clinical/subclinical populations. Definitions of procrastination showed no single consensus. The most cited elements involved irrational delay, awareness of consequences, task aversiveness, and self-regulation failure. The most frequently used assessment tool was Lay’s General Procrastination Scale. A considerable number of studies identified associations between procrastination and clinical constructs such as impulsivity, perfectionism, executive dysfunction, low self-esteem, and mood instability. Few studies directly assessed procrastination in formal diagnostic categories, suggesting that procrastination shares neurocognitive and emotional regulation deficits with these disorders, especially in domains involving task initiation, inhibitory control, and intolerance of discomfort. Conclusions: Procrastination is a transdiagnostic construct rather than a unitary behavioral trait. Its multifactorial nature calls for further clinical investigation, particularly in structured diagnostic settings. A unified definition is needed to distinguish between normative delay and clinically relevant procrastination.

Psychiatry International doi: 10.3390/psychiatryint7030122

Authors: Andrea S. Young Emily T. O’Gorman Eleanor G. Wu Laura Prichett Robert Yolken Emily Severance Juleisa Badio Destini Carmichael Tina Kumra

Rates of suicide among children and adolescents have increased significantly in the past two decades, especially among minoritized youth. Identification of modifiable factors associated with suicidality in diverse samples is important for informing targeted prevention and intervention efforts. Toward this end, this study utilized a multi-informant approach to examine the association between aggression and suicide risk in an urban pediatric sample. Children and adolescents (N = 136; 69% Black or African American) between the ages of 6 and 17 (Mage = 11.4 ± 3.0) were recruited while attending a well-child visit at a Baltimore City pediatric primary care clinic. Pediatric participants and their caregivers completed measures of aggressive behavior and depressive problems. Suicide risk was derived from parent-, youth-, and clinician-reports of pediatric participants experiencing suicidal thoughts and behaviors. After controlling for demographic variables, results of stepwise logistic regressions revealed that parent- and youth-reported aggressive behavior were significantly associated with suicide risk (OR = 1.18, p = 0.005 and OR = 1.23, p = 0.006, respectively). When depressive problems were added to the model, depressive problems were significantly associated with suicide risk (parent-report OR = 1.34, p = 0.015 and youth-report OR = 1.28, p = 0.025), but aggressive behavior was no longer significantly associated. Findings from this study suggest that aggression could be an important indicator of suicide risk, but not above and beyond the influence of depressive symptoms. In this sample, aggressive behavior may be at least partially explained by depressive symptoms and a manifestation of internal distress.

Psychiatry International doi: 10.3390/psychiatryint7030121

Authors: Torekhan Bex Aidana Tautanova Nursultan Seksenbayev Gediminas Merkys Daiva Bubeliene Zhannur Kaligozhin Alexandr Antipin Gulnara Temirova Lazzat Zhamaliyeva

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.

Psychiatry International doi: 10.3390/psychiatryint7030120

Authors: Cristiana Țăpoi Emmanuel Chimdiebere Ogamdi

Background: Substance Use Disorder (SUD) is more prevalent among individuals with psychotic disorders than in the general population and is associated with poorer functioning, treatment adherence, and outcomes. Understanding motives for substance use in this group is essential for targeted interventions. Methods: Motives were assessed using the 26-item Reasons for Substance Use Questionnaire in 118 male patients admitted for a psychotic episode between October 2024 and September 2025. Results: In total, 20.3% of the participants were first-admission patients. Enhancement motives were most frequently endorsed, followed by coping and social motives; conformity and relief were least endorsed. In exploratory unadjusted analyses, patients with multiple hospital admissions reported greater relief related motives, including alleviating positive symptoms and medication side effects. Motives varied by primary substance used. Conclusions: Mood enhancement and coping were predominant motives; relief motives appeared to be stronger in patients with multiple admissions. Further research is needed to improve treatment strategies.

Psychiatry International doi: 10.3390/psychiatryint7030119

Authors: Shaul Schreiber Marsha Weinstein Yali Abramsohn Anat Sason Miriam Adelson Einat Peles

Importance: Evidence regarding the organization of civilian health care systems in active war zones is limited, yet critical for maintaining services for vulnerable populations. Objective: To describe the operational challenges and adaptive strategies implemented by an opioid agonist therapy (OAT) clinic to ensure continuity of care for patients maintained on methadone and buprenorphine during a period of prolonged armed conflict. Design: A descriptive case study of clinical, logistical, and regulatory adaptations following the escalation of conflict in Israel beginning 7 October 2023, through the 12-day Israel-Iran war in June 2025. Setting: A hospital-based ambulatory methadone maintenance treatment (MMT) clinic in the Tel Aviv region. Participants: A vulnerable population of patients with opioid use disorder (OUD) receiving daily or supervised OAT. Exposure(s): National emergency conditions, including mass evacuations, fluctuating missile threats from multiple fronts (Gaza, Lebanon, Yemen), and direct regional strikes in 2024 and 2025. Main Outcome(s) and Measure(s): The primary focus was maintaining treatment continuity through rapid protocol modifications and expanded take-home dose (THD) regulations. Results: The conflict necessitated immediate departures from standard clinical protocols. Key adaptations included the rapid expansion of THD eligibility to mitigate the risks associated with travel to the clinic during active shelling and the reallocation of resources. Regulatory frameworks were iteratively revised as the security situation evolved, shifting from daily supervised dosing to flexible, safety-oriented dispensing models. Conclusions and Relevance: Findings suggest that during national emergencies, decentralizing OAT through expanded THD regulations is essential to prevent treatment interruption and relapse. These adaptive strategies offer a framework for health policy in other conflict-affected regions to protect high-risk populations.

Psychiatry International doi: 10.3390/psychiatryint7030117

Authors: Anne Schienle Albert Wabnegger

Background: Psychiatric disorders, including skin-picking disorder (SPD), may be conceptualized as manifestations of a dysregulated behavioral immune system or maladaptive emotion schema, in which disgust—typically elicited by external threats—is directed toward the self. Method: A total of 147 females (mean age = 32 years) with SPD completed disorder-specific measures of automatic and focused skin-picking, as well as scales assessing self-disgust and disgust sensitivity. Correlation and path analyses were conducted to examine whether misdirected disgust toward one’s own body (self-disgust) and difficulties in regulating disgust (disgust sensitivity) are associated with pathological skin picking. Results: Self-disgust was substantially correlated with focused skin-picking. The path analysis indicated a direct path from self-disgust to focused skin-picking and an indirect path from disgust sensitivity, mediated by self-disgust, to focused skin-picking. Similar associations were not present for automatic skin-picking. Limitations: Due to the cross-sectional design of the study, the results should be interpreted as associative rather than causal and do not allow conclusions about temporal or directional mediation processes. Conclusions: Assessment of both disgust-related traits should be integrated into the diagnostic process for SPD. Disgust regulation training, as well as compassion-based strategies, may be beneficial in modifying pathological skin-picking.

Psychiatry International doi: 10.3390/psychiatryint7030118

Authors: Nanako Hanai Satsuki Fujieda Yuki Hongo Kenichi Asano

Subthreshold depression (SD) is a significant risk factor for major depressive disorder. However, individuals with SD often do not seek professional help. This study aimed to identify a consensus-based list of self-help and “acts of kindness” (AK) strategies that are both helpful and feasible for individuals with SD while clarifying the perception gaps between clinical experts and individuals with lived experience. A three-round e-Delphi process was conducted with 51 clinical psychologists and 191 individuals with SD. The participants evaluated 187 initial strategies for helpfulness and feasibility using a 5-point Likert scale. After three rounds, five self-help strategies (e.g., “getting fresh air”) and one AK strategy reached a consensus for helpfulness. Conversely, 10 self-help and 11 AK strategies were endorsed for feasibility. A significant perception gap was identified: experts reported higher helpfulness than the SD panel, whereas the SD panel rated the feasibility of AK strategies significantly higher than the experts. These findings highlight a discrepancy between professional expectations and lived experience, suggesting that AK may serve as accessible, low-threshold options for mood improvement in clinical settings.

Psychiatry International doi: 10.3390/psychiatryint7030116

Authors: Carol Nash

Research on burnout has been a consistent and increasingly popular topic since the 1970s when it was first defined. The focus of publications regarding burnout spans studies of various occupations, countries, age groups, social groups, and effects. A recent development is the documenting of brain changes associated with burnout. This review aims to investigate the peer-reviewed publications on this topic published in 2025. Although not a scoping review because it is limited to one year and peer-reviewed reports, this study follows the standardized PRISMA-ScR guidelines for scoping reviews as the methodology. The search was of five relevant databases: Google Scholar, OVID, PubMed, Scopus, and Web of Science. Brain changes AND burnout AND 2025 are the keywords searched. The keywords were limited to these to identify those articles where researchers themselves connected a relationship between brain changes and burnout during 2025. The results were several perspectives that investigated burnout, and the brain changes were various. The findings differ depending on the measurement tools used for burnout assessment, as discussed. The purpose of conducting the review is to aid psychiatrists in identifying the most recent research to enhance patient treatment options by considering current information on this developing topic.