Psychiatry International

Mental health among higher education students is a growing public health concern in Chile, where 58 universities host a diverse student population facing significant academic and emotional challenges. This study aimed to determine the prevalence of suicidal risk, ideation, and attempts, as well as associated risk factors in Chilean university students. A cross-sectional study was conducted with 1511 participants (72.3% women, 27.7% men; mean age = 25.7 ± 7.82 years), using a digital self-administered questionnaire that included the Okasha’s Suicidality Scale (OSS), Depression, the Anxiety, and Stress Scale—21 items (DASS-21), the Emotional Exhaustion Scale (ECE), and sociodemographic variables. Logistic regression identified key factors associated with suicide attempts, such as being female (OR = 1.418, 95% CI [1.037, 1.939]), belonging to sexual minorities (OR = 2.539, 95% CI [1.899, 3.396]), being aged 26–30 (OR = 1.952, 95% CI [1.344, 2.836]), and being in the third year of university (OR = 1.483, 95% CI [1.097, 2.005]). Depression (OR = 7.065, 95% CI [5.307, 9.407]) and anxiety (OR = 1.895, 95% CI [1.400, 2.565]) were the strongest predictors, while substance use, including marijuana (OR = 2.107, 95% CI [1.620, 2.740]), cocaine (OR = 1.575, 95% CI [1.193, 2.078]), and non-prescribed antidepressants (OR = 6.383, 95% CI [1.524, 26.733]), significantly increased risk. These findings highlight the urgent need for targeted mental health interventions and policy actions in Chilean higher education to address post-pandemic increases in suicide-related behaviors. Full article

Background: Overparenting describes a developmentally inappropriate and excessive parental involvement in a child’s life. It is predominantly measured in contemporary research by using emerging adults’ reports. Objective: The current study briefly reports on the adaptation and validation process of the overparenting short-form scale (OP-SF) with parents of early adolescents. The scale is among the sole instruments for evaluating overparenting within a general setting from the parental perspective. However, to date, its structure and psychometric properties remain untested among parents of pre-adults. Method: A cohort of 316 parents, including 159 mothers and 157 fathers (Mage = 44.07, SD = 5.08), provided online assessments regarding their overparenting behaviours, alongside a battery of related parental instruments used for validation. Results: The results showed that the OP-SF with three dimensions (i.e., Anticipatory Problem Solving, Affect Management, and Risk Aversion) fitted the data well, demonstrated measurement invariance across parental gender, had an acceptable internal consistency, and exhibited good convergent validity with several related constructs. Conclusions: Taken together, the 9-item OP-SF is a sound instrument for assessing a unidimensional construct of overparenting when used with parents of early adolescents. The implications for psychiatric and family practices involving parents and adolescents are discussed in depth. Full article

Shift work is prevalent among healthcare professionals and associated with significant health risks, including stress, sleep disturbances, and mood disorders. Despite known sex differences in stress responses, their impact on shift workers, particularly student pharmacists, is understudied. The objective of this study was to explore sex-specific differences in psychological and physiological stress responses among pharmacy students engaged in shift work. Psychological stress was assessed using validated scales like the Perceived Stress Scale (PSS), Shift Work Disorder Index (SWDI), Ford Insomnia Response to Stress Test (FIRST), and Positive and Negative Affect Schedule (PANAS). Additionally physiological stress was assessed using salivary biomarkers like cortisol, DHEA-S, IL-6, and alpha-amylase. Females reported significantly higher perceived stress (p = 0.0004), SWDI (p = 0.0302), insomnia (p = 0.0111), and negative affect (p = 0.0171) compared to males. Rotating shift workers showed elevated scores across all measures (p = 0.0005–0.0381). Female rotating shift workers exhibited higher alpha-amylases (p = 0.0191) and lower DHEA-S levels (p = 0.0176) than males. Strong correlations emerged between perceived stress and insomnia (r = 0.40, p = 0.0001) and between insomnia and negative affect (r = 0.55, p < 0.0001). Findings highlight females’ vulnerability, underscoring the need for sex-specific interventions and the early identification of stress biomarkers. Full article

There is a high prevalence of depression in older adults, and it is on the rise. However, exercise or physical activity can help improve mental health conditions, specifically depression and self-esteem. Therefore, the objective of this systematic review (INPLASY202360094) is to describe and analyze the effects of physical activity or exercise interventions on depressive symptoms and self-esteem in older adults. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a search strategy was carried out in four databases (PubMed, SciELO, WoS, and Scopus). Inclusion criteria: Studies that used physical activity or exercise as an intervention to improve depressive symptoms and self-esteem in older adults. The Physiotherapy Evidence Database scale and the Risk of Bias 2 tool were used to evaluate the quality of the articles. To synthesize the information from the studies, it was ordered based on author names, intervention, frequency, analysis, and results. Seven investigations met the selection criteria. It is concluded that physical activity or exercise improves self-esteem, depression, anxiety, physical fitness, and functionality in older adults. Therefore, it is a viable option for additional or complementary treatment aimed at achieving a comprehensive improvement in the lives of this population. Full article

Borderline Personality Disorder (BPD) is a multifaceted mental illness characterized by a pervasive pattern of instability in interpersonal relationships, self-image, affect and marked impulsivity, beginning by early adulthood and presenting in a variety of contexts. The treatment of personality disorders is labeled as difficult, with various challenges identified in the literature, especially described in those with BPD. One of the challenges associated with BPD is treatment dropout, in which patients abandon their treatment schedules and protocols. The authors aim to explore the underlying motives for therapeutic abandonment in this population as well as discuss potential intervention methods to reduce this outcome during follow-up, whilst promoting regular adherence and active treatment participation. A cross-sectional study of patients that joined and subsequently dropped out of a specialized treatment program for Borderline Personality Disorder in a Portuguese hospital from 2014 to 2023 was realized utilizing data collected from surveys conducted through telephone interviews. Of the patients, 39 were identified as having dropped out of the program during the stipulated timeframe. Of these, five (12.8%) refused to participate, fourteen (35.8%) did not respond to contact attempts and two (0.05%) patients subsequently reintegrated into the program. Therefore, 18 (46.2%) agreed to respond to the questionnaire and were considered in the current study. The majority were female (94.4%) of single marital status and with secondary-level education. The main motivators for treatment dropout described by these patients included the large intervals between consultations, the loss of motivation and/or interest, as well as dissatisfaction with the program. Other variables were explored in the work, such as the desire to return to the program, the maintenance of other types of treatment, feelings after dropout and the evaluation of the usefulness of the program. Treatment dropout is an important problem in the treatment of BPD, as it stifles progress and therapeutic benefits through maintenance of the previous state, conditioned by impulsivity and marked instability. Although the current study attempts to clarify the motivating factors underlying abandonment in this population, further research is necessary in attempting to further reduce the lacuna regarding this common phenomenon and to develop interventions to promote positive outcomes. Full article

Sexual health is a vital aspect of overall well-being, yet individuals with autism spectrum disorder (ASD) face significant stigma and discrimination, affecting self-esteem, relationships, and sexual expression. This review examined the recent literature (2020–January 2024) on intimacy and sexuality among adolescents and young adults with ASD, incorporating 32 studies. Findings highlight poorer sexual health among autistic individuals compared to the general population, with difficulties in forming romantic relationships and navigating sexual interactions due to hypersensitivity. Autism is also linked to non-conforming gender identities and asexuality, exposing individuals to dual stigma within the LGBTQ+ community. Autism-related traits hinder sexual health knowledge, increasing risks of victimisation, abuse, and sexually transmitted infections. Comprehensive sexual education and inclusive support are crucial to address these challenges and promote sexual well-being for autistic individuals. Full article

Background: The present study focuses on the development and validation of the Self-Perceived Anhedonia Scale for Adults (SPAS-A), a novel instrument designed to assess pleasure deficits across multiple dimensions of anhedonia, including social, physical, cognitive, and emotional facets. The study aimed to establish the psychometric properties of the scale, including its reliability and validity. Materials and methods: All the data were collected from a sample of 600 participants between February 2024 and November 2024 via Google Forms. Results: Factorial analysis, including Exploratory Factor Analysis and Principal Component Analysis, revealed a four-factor structure, accounting for 72.4% of the total variance, which demonstrated a coherent and multidimensional representation of anhedonia. The reliability of the scale was further supported by high Cronbach’s Alpha values for each subscale, with social anhedonia showing an exceptional value of 0.916, followed by emotional (0.905), cognitive (0.900), and physical (0.873) anhedonia. Conclusions: These findings indicate that SPAS-A is a reliable and valid tool for assessing pleasure deficits in adults, providing a comprehensive measure of anhedonia that can be utilized in both clinical and research settings. Future studies could benefit from longitudinal designs and more diverse samples to better understand the temporal and cultural variability of anhedonia. Full article

Previous research consistently identified depression and anxiety as leading contributors to the global disease burden. Recognizing risk and protective factors that lead to or guard against negative mental health outcomes therefore remains a research priority. The present study examined mediation models for the often-cited association between childhood verbal victimization and adult depression and anxiety symptomatology. Specifically, we investigated whether memories of childhood teasing related to adult adverse mental health outcomes indirectly via the mediated effects of self-esteem and social anxiety. Three hundred sixty-four (64.8% female) adult participants took part in a retrospective study by completing the Teasing Questionnaire—Revised; epidemiological scales of depression, anxiety, stress, social phobia, and social interaction anxiety; and a self-esteem measure. Memories of childhood teasing were indeed positively related to depression, anxiety, stress, social interaction anxiety, and social phobia scores and negatively related to current self-esteem, i.e., the individual’s subjective evaluation of their worth. Self-esteem and recalling being teased for one’s social skills were consistent predictors across all adult outcomes (depression, anxiety, stress, social anxiety, and social phobia). Lastly, self-esteem was found to be a partial mediator of the relationship between the memories of childhood teasing and depression and anxiety in adulthood, while social interaction anxiety partially mediated the relationship between teasing and anxiety, but not depression. These findings highlight the long-term psychological impact of childhood teasing and underscore the critical role of self-esteem and social anxiety as pathways through which early verbal victimization contributes to adult mental health outcomes, emphasizing the need for targeted interventions to foster resilience and mitigate lasting effects. Full article

Adolescent dating violence is a critical issue with far-reaching consequences. This study explores the role of maladaptive emotional regulation strategies in the relationship between impulsivity and the perpetuation of violence, differentiating between violence received and exerted. A cross-sectional correlational design was used. For sample selection, a probabilistic sampling method was used, specifically a one-stage stratified random sampling with proportional allocation. The sample consisted of 700 female adolescents aged between 14 and 18 years (mean = 15.64, SD = 1.20) from Ecuador. Participants were selected if they had been in at least one romantic relationship lasting more than a month. The data analysis included descriptive statistics, Chi-square tests for categorical variables, t-tests and ANOVA for group comparisons, and Pearson’s correlation for continuous variables and mediation analysis. The results show that both physical violence exerted and received have significant positive correlations with impulsivity and maladaptive strategies, except for DERS Awareness, DERS Goals, and DERS Clarity. Impulsivity also maintains significant positive correlations with all emotional dysregulation strategies except for DERS Awareness. DERS Impulsivity and DERS Non-acceptance act as partial mediators in the relationship between impulsivity and violence (both exerted and received). Impulsivity itself is established as a clear predictor of physical violence in adolescent intimate relationships, highlighting the need for interventions and the development of educational programs aimed at improving emotional regulation strategies, such as controlling impulsivity and accepting emotions. Full article

Body image and self-esteem are central to psychological health and have been identified as contributing factors in the development and maintenance of psychiatric conditions such as eating disorders, depression, and anxiety. This study investigates the relationship between these variables among university students in India and Italy, contributing to the understanding of how cultural contexts shape these psychological constructs in adult populations. The sample consisted of 767 participants (391 from Lokmanya Tilak Municipal Medical College and 376 from University of Campania Luigi Vanvitelli), aged 18 and above. Participants completed standardized measures, namely the Rosenberg Self-Esteem Scale, Body Investment Scale, and Body Uneasiness Test, through paper-based questionnaires administered in controlled settings. Indian students reported higher self-esteem and more positive body image compared to their Italian counterparts, who exhibited lower self-esteem and higher body dissatisfaction. Across both groups, higher self-esteem was strongly associated with lower body uneasiness. Regression analyses revealed high self-esteem significantly predicted positive body attitudes, with stronger protective effects among Italian participants. Indian students demonstrated broader resilience, potentially linked to cultural values. The findings contribute to psychiatry by emphasizing self-esteem and body image as culturally sensitive psychological constructs that may influence vulnerability to psychiatric distress in young adults. Understanding these factors can support prevention and early intervention strategies in student populations, particularly regarding body dissatisfaction, emotional regulation, and self-concept. Full article

Nursing students often experience high levels of anxiety compared to students in other disciplines due to academic and clinical demands. Some of the important factors believed to influence psychological well-being are nomophobia, emotional regulation, self-efficacy and loneliness. Therefore, the current study aimed to explore the relationships between nomophobia, emotional regulation, loneliness, self-efficacy and anxiety among nursing students using structural equation modeling (SEM). A cross-sectional study was conducted among 121 nursing students. Data were collected using validated tools, including the Nomophobia Questionnaire (NMP-Q), Emotion Regulation Questionnaire (ERQ), UCLA Loneliness Scale, General Self-Efficacy scale and Generalized Anxiety Disorder (GAD-7) scale. Structural Equation Modeling (SEM) was used to explore the relationship between study variables. The findings revealed that nomophobia and loneliness were positively associated with anxiety, with standardized path coefficients of β = 0.35 (p < 0.001) and β = 0.25 (p < 0.001), respectively. Conversely, emotional regulation (β = −0.20, p < 0.001) and self-efficacy (β = −0.30, p < 0.001) showed significant protective effects by reducing anxiety. Additionally, emotional regulation negatively influenced nomophobia (β = −0.21, p < 0.001) and loneliness (β = −0.15, p < 0.05), highlighting its role in mitigating adverse psychological outcomes. Self-efficacy exhibited a negative but non-significant association with loneliness (β = −0.09, p = 0.10) and demonstrated a significant negative effect on nomophobia (β = −0.13, p < 0.05). Nomophobia and loneliness significantly contribute to heightened anxiety levels among nursing students, while emotional regulation and self-efficacy serve as protective factors. Given the high-stress nature of nursing education and clinical practice, interventions aimed at enhancing emotional regulation skills and fostering social support networks could be particularly beneficial in mitigating nomophobia, reducing loneliness, and ultimately lowering anxiety levels. Integrating such strategies into nursing curricula may not only support students’ mental well-being but also enhance their academic performance. Full article

The COVID-19 pandemic and the related confinement it caused have led to significant social distancing. Family caregivers, an “invisible” population, seem to have been particularly affected by this context. In this sense, in this article, we question the psychopathological impact of this pandemic on caregivers, but also their use of digital tools and e-health as a lever. To do this, we applied a methodology involving both quantitative and qualitative data collection and analysis. We created and distributed an online survey and conducted interviews with the main caregivers of a person suffering from a physical, mental, and/or cognitive disorder, or an elderly person losing their independence. Our observations show that the psychological frailty of this population is important, with a fairly high prevalence of signs of anxiety (58.4%) and depression (50.7%), especially compared with the general population. In our sample, the use of digital tools did not seem to be in the context of e-health, but more in a social context of communication with others. This raises the following two important questions: Is it possible to predict and prevent the psychological frailty of caregivers? Can digital tools and networks of caregivers’ groups provide leverage and respite? Full article

Background: Evaluating associations between fear of COVID-19 and psychopathology in clinical samples can yield valuable insights for the formulation of public health policies and for the training of mental health professionals in future major health crises. The objectives of our study were to evaluate the following aspects among patients diagnosed with insomnia disorder during the most critical period of the COVID-19 pandemic in Brazil: (a) the frequency of symptoms of depression and anxiety, fear of COVID-19, and severity of insomnia; (b) possible gender differences in the variables analyzed; and (c) associations between fear of COVID-19, symptoms of depression and anxiety, severity of insomnia, and sociodemographic variables. Method: A total of 353 individuals who sought treatment at a psychiatric hospital in the Brazilian public health system and were diagnosed with insomnia disorder (DSM-5) participated. The following instruments were used: the Hospital Depression and Anxiety Scale, Insomnia Severity Index, Fear of COVID-19 Scale, and a sociodemographic questionnaire. The assessments were carried out via the REDCap platform between March and July 2021. Results: Mild to moderate levels of fear of COVID-19 were identified in the majority of participants. Symptoms of depression, anxiety, and insomnia were reported at a moderate level. Although all scores were higher among women, only the fear of COVID-19 reached significant differences between groups. Fear of COVID-19 was positively correlated with symptoms of depression and anxiety and with the severity of insomnia. Anxiety scores had a positive and statistically significant effect on insomnia severity and on fear of COVID-19. Being a man and performing physical activity had a negative and statistically significant effect on fear of COVID-19. Conclusions: Being a woman, being sedentary, and having symptoms of anxiety were predictors of fear of COVID-19 among participants with insomnia disorder. This finding highlights the importance of gender-sensitive public health policies for the care of patients with insomnia during future major health crises. The associations between anxiety symptoms and fear of COVID-19 and the severity of insomnia verified in our study suggest the relevance of addressing anxiety symptoms through encouraging physical activity to mitigate the severity of insomnia and fear of pathogens in patients with insomnia. Full article

Nature-based interventions (NBIs) grounded in mindfulness have been shown to be beneficial for improving mental wellbeing in adults. With increasing mental health challenges among children and adolescents, accessible and cost-effective interventions are essential to enhance their well-being. Brief mindfulness-based NBIs may be helpful in this regard, but there is a dearth of evidence testing such NBIs in young adolescents. The aim of this study was to test the effect of a brief nature-based meditation on mental wellbeing in community groups of adolescents (n = 38; aged 12–17) and adults (n = 39; aged 18–26). We hypothesised that the meditation would reduce depressive rumination and stress in both age groups. In a repeated-measures design, participants completed self-report measures, indexing mental wellbeing (state rumination and stress) before and immediately after listening to a brief (13 min) nature-based meditation. Rumination and stress improved overall, and the pattern in the data suggested that effects were larger for adults when compared to adolescents. This study provides preliminary evidence for the use of a brief nature-based meditation in improving mental wellbeing in adolescents. Future research should make NBIs age appropriate and examine their effectiveness for clinical adolescent populations. Full article

Depression is one of the most common comorbidities in people with multiple sclerosis, which reduces the quality of life and treatment adherence. It enhances the risk of disease relapse. After looking through the literature, we summarized the newest recommendations that might be helpful in reducing depression severity by reviewing publications regarding depression and multiple sclerosis published in the last five years. Physical activity and rehabilitation should be recommended. The ketogenic diet showed promising results, yet there are possible health concerns that might evolve after a longer period and should only be carried out under medical supervision. Mindfulness and cognitive and dialectical behavior therapy reduce depression severity and can be recommended to depressive people with multiple sclerosis. Full article

Suicide is a major public health concern, and Uruguay has one of the highest suicide mortality rates in the Americas. In 2022, the Ministry of Public Health implemented a real-time digital surveillance system for suicide attempts as part of the National Suicide Prevention Strategy. This study presents findings from its first year, analysing 4723 emergency department presentations nationwide. The age-standardised suicide attempt rate was 140.44 per 100,000 inhabitants, with women accounting for 71.6% of cases. Self-poisoning was the most common method, followed by hanging and suffocation for men and self-cutting for women. Nearly half of all attempts involved individuals aged 15–29, highlighting the need for youth-focused and gender-sensitive interventions. This study demonstrates the value of real-time surveillance systems in identifying at-risk groups, informing prevention efforts, and supporting timely interventions. While some challenges in system implementation remain, future efforts should focus on strengthening data integration, leveraging artificial intelligence for risk assessment, and improving follow-up care to reduce repeated attempts and overall suicide mortality. Full article

The COVID-19 pandemic has presented significant challenges, including financial strains and mental health issues like depression and loneliness. Human–animal interaction (HAI) offers a potential buffer, as pet ownership has been linked to benefits such as improved psychological well-being, increased perceived social support, and reduced loneliness. Furthermore, attachment to pets appears to moderate these effects, with more attached owners experiencing greater benefits. However, most research has focused on female samples, leaving a gap in understanding HAI among men. This study aimed to examine the relationship between pet attachment and psychological well-being, loneliness, and perceived social support among Greek male pet owners ages 18 to 45. Between January and March 2021, a sample of 87 participants completed a demographics form and four self-reported questionnaires: LAPS for pet attachment, WHO-5 for well-being, a three-item loneliness scale, and MSPSS-Pets for perceived social support. Hierarchical multiple regressions indicated that pet attachment predicted increased perceived social support but showed no significant association with psychological well-being or loneliness. Age emerged as a predictor of well-being, with older men reporting higher levels, but no significant predictors of loneliness were found. These findings suggest that companion animals may provide emotional support but may not alleviate the broader psychological burdens intensified during crises like the pandemic. Full article

Background: Virtual Reality (VR) is transforming neuropsychological assessment by providing immersive environments that closely replicate real-world conditions. This study presents the Trail Making Test in VR (TMT-VR), a novel adaptation of the traditional TMT, aimed at evaluating cognitive functions in adults with Attention Deficit Hyperactivity Disorder (ADHD). We examined the ecological validity, convergent validity, usability, and user experience of the TMT-VR compared to the traditional version. Methods: Fifty-three adults (18–40 years old), including 25 with ADHD and 28 neurotypical controls, completed both the traditional and VR versions of the TMT. The participants also provided feedback on the VR experience via standardized questionnaires. Results: The statistical analyses demonstrated a significant positive correlation between TMT-VR scores and both the traditional TMT and ADHD symptomatology as measured by the Adult Self-Report Scale, confirming the TMT-VR’s ecological and convergent validity. High usability and positive user experience ratings indicated strong acceptability of the VR platform. Notably, the ADHD group exhibited greater performance differences in the VR environment, suggesting that VR may more effectively capture real-world cognitive challenges. Conclusions: These findings suggest that TMT-VR is a valid, engaging, and ecologically valid tool for cognitive assessment in ADHD and other clinical populations, offering enhanced insights over traditional methods. Full article