Psychiatry International

Background. Major Depressive Disorder (MDD) is a highly prevalent and disabling condition frequently accompanied by cognitive deficits, impaired psychosocial functioning, and biological rhythm disturbances. Despite extensive literature on individual associations between depression and circadian disruptions, the mediating role of biological rhythms in the functional outcomes of MDD remains underexplored. Objectives. This study aimed to explore the associations between depression severity, biological rhythms, sleep quality, and psychosocial functioning, and to assess whether biological rhythm disturbances mediate the impact of depression on functioning. Methods. Sixty-one inpatients diagnosed with moderate-to-severe MDD were assessed using standardized instruments: BDI-II for depressive symptoms, BRIAN for biological rhythms, PSQI for sleep quality, and FAST for global functioning. Group comparisons, non-parametric correlations, and a mediation analysis were conducted to test direct and indirect effects. Results. Participants showed severe depressive symptoms, impaired functioning, disrupted biological rhythms, and poor sleep. Women reported more depressive episodes, reduced autonomy, and worse sleep than men. Depression severity was associated with circadian and sleep disturbances, which in turn related to functional impairment. Mediation analysis suggested that biological rhythms partially mediate the impact of depression on functioning. Conclusions. Findings from this preliminary analysis suggest that biological rhythm disturbances may play a mediating role in the relationship between depressive symptoms and daily psychosocial functioning. While not conclusive, these results highlight the potential relevance of chronobiological factors in understanding functional outcomes in MDD. Further research using longitudinal and controlled designs is needed to clarify these associations and their clinical implications. Full article

Suicidality, encompassing suicidal ideation, attempts, and completed suicide, continues to be a significant public health concern globally. Traditional research has emphasized genetic, neurobiological, and psychosocial factors; however, recent findings suggest that gut microbiota may play a crucial role in influencing suicidal behavior. The gut microbiota impacts neuroinflammation, neurotransmitter metabolism, and the hypothalamic–pituitary–adrenal (HPA) axis, all of which are associated with psychiatric disorders linked to suicidality. This review gathers current evidence on the gut–brain axis, investigating the role of microbiota in suicidality through mechanisms such as immune system modulation, serotonin regulation, and the stress response. We also consider the potential of microbiota-targeted interventions, such as probiotics and dietary changes, as innovative therapeutic strategies. Despite the accumulating evidence, research in this field remains limited, emphasizing the urgent need for further investigation to clarify the causal relationship between gut microbiota and suicidality. Full article

Social desirability is a widely studied phenomenon due to its impact on the validity of self-reported data. It refers to the tendency of individuals to respond to questions in a manner that they believe is socially acceptable or favorable rather than providing truthful or accurate answers. This study evaluated the psychometric properties of the Brief Social Desirability Scale (BSSD-4) in Ecuadorian youth, analyzing its reliability, factorial and convergent validity, and measurement invariance by sex, age group, and experiences of dating violence. An instrumental study was conducted with a non-probabilistic convenience sample of 836 participants (aged 14–26). Reliability was adequate (Ω = 0.75, α = 0.81, CR = 0.759). Confirmatory factor analysis showed good fit indices (CFI = 0.98, TLI = 0.97, RMSEA = 0.056, SRMR = 0.037). Convergent validity was acceptable (AVE = 0.50, VIF < 2.01). A network analysis confirmed the unidimensionality of the scale and structural differences between groups. Measurement invariance by sex and age was verified, but differences in the network structure were found based on victimization and perpetration of violence. The BSSD-4 is a valid and reliable instrument for assessing social desirability in Ecuadorian youth, useful for population studies and intergroup comparisons. Further research is recommended to explore its invariance in populations with a history of violence, as differences in scalar invariance were observed. Full article

Background: Suicidal behavior presents a significant dilemma in the context of Alzheimer’s disease. Numerous ethical discussions have emerged regarding euthanasia for patients suffering from neurodegenerative conditions, and research indicates an elevated incidence of suicide in the early stages of dementia. However, there remains a gap in knowledge concerning the historical prevalence of suicidal ideations or attempts among individuals diagnosed with Alzheimer’s disease. This study aims to investigate the historical patterns of suicidal behavior and the associated factors across the lifespan in patients with Alzheimer’s disease. Methods: This study is an excerpt from a case–control research study, where the sample size was calculated at 150 participants, with 75 in the case group and 75 in the control group. Here, the descriptive statistics for the first third of the sample, 50 participants, are discussed. Results: Among the participants in the case group, 12.5% reported having suicidal ideation throughout life, compared to 24% in the control group (OR for suicidal ideation = 0.432 [0.095–1.966]). Additionally, among the participants in the case group, 4% reported having attempted suicide at some point in their life, compared to 8% in the control group (OR for suicide attempts = 0.479 [0.41–5.652]). People with Alzheimer’s disease tended to have a worse quality of life but less suicidality. Conclusions: It appears that suicidal behavior is inversely related to the risk of developing suicidal intentions. The odds ratio data demonstrate the need for a larger sample size to determine whether there is a difference in the history of suicide throughout the lives of people with Alzheimer’s disease and among the general population. Full article

Objectives: This study evaluated the effectiveness of Experience New Days (END), a school-based smoking cessation program, on smoking dependence and mental health among Korean adolescent smokers. Methods: A single-group pretest–posttest study was conducted from April to June 2024 with 40 adolescent smokers from three high schools. The program consisted of weekly 50 min sessions over an 8-week period. Smoking dependence was measured using FTND and CDS-12, while mental health was assessed through PHQ-9 and GAD-7. Urine cotinine test was used as a biomarker. Results: The results showed significant improvements with moderate to large effect sizes in nicotine dependence (p = 0.033, d = 0.25), cigarette dependence (p = 0.034, d = 0.31), depression (p = 0.013, d = 0.37), and anxiety (p = 0.043, d = 0.40). Daily cigarette consumption decreased by an average of 2.57 cigarettes per day (p = 0.002, d = 0.52), with 15% of participants achieving complete smoking cessation and 42.5% showing reduced smoking behaviors. Conclusions: The results suggest that the END program was associated with reduced dependence and improved mental health outcomes among adolescent smokers. The positive memory reinforcement had a beneficial effect on mental health. Full article

Objective: Cyberbullying among children and adolescents is a serious and increasingly prevalent issue worldwide. Victims often experience various emotional issues such as depression, anxiety, and suicidal thoughts, as well as disruptive and impulsive behavioral problems. Therefore, effective therapeutic interventions and social support are essential. This study investigated the effects of group sandplay therapy (GST) on children who have been victims of cyberbullying. Method: This study was designed as a non-randomized controlled trial with an intervention group and a control group. The participants included 127 children aged 11 to 12 years old who had experienced cyberbullying, with 64 participants in the GST intervention group and 63 participants in a matched control group based on gender and age. The intervention group participated in 10 GST sessions, each lasting 40 min, held once a week in groups of three or four. The control group received no treatment. The Korean Youth Self Report (K-YSR) was employed to evaluate the effectiveness of the intervention. Results: The results indicated that the GST intervention group experienced significant reductions in anxiety/depression (F = 7.09, p = 0.009, d = 0.49), somatic symptoms (F = 10.02, p = 0.002, d = 0.58), and aggressive behavior (F = 3.94, p = 0.049, d = 0.36) on the K-YSR scale compared to the control group. Conclusions: Thus, GST was found to be effective in alleviating negative emotions and aggressive behavior in children affected by cyberbullying. Full article

Problematic internet use (PIU) can be defined as internet use that is not well-controlled. The aim of this study was to examine the validity and reliability of the Problematic Internet Use Questionnaire Short Form (PIUQ-SF-6) among Serbian medical students and to examine the prevalence of students at risk of problematic internet use and social, lifestyle, and mental health characteristics associated with it. We conducted a cross-sectional study that included a total of 735 medical students (66.8% female and 33.2% male) attending classes in Social Medicine during the 2023/2024 school year. The instrument used was a questionnaire developed based on the questionnaires in similar studies. A total of 160 students (21.8%) were in the problematic internet use group, and 575 were in the non-problematic internet use group. Multivariate logistic regression analysis with PIU as the outcome variable showed an association between PIU and the Patient Health Questionnaire−9 score (OR: 1.10, 95% CI: 1.03–1.16) and impulsivity (OR: 1.07, 95% CI: 1.05–1.10). The mental health of medical students, as future health professionals, should be promoted through tailored interventions that are widely accessible and long-lasting. Full article

Background and objectives. Symptoms of Attention Deficit Hyperactivity Disorder (ADHD) are frequently present in university students, even without a clinical diagnosis, and may be aggravated by various factors. This study analyzes the relationship between these symptoms and the use of alcohol, tobacco, cannabis, and other drugs by young university students. Materials and methods. A cross-sectional study was conducted with 397 university students using an anonymous online questionnaire. ADHD symptoms were assessed with the Adult ADHD Self-Report Scale (ASRS), alcohol use with the Alcohol Use Disorders Identification Test (AUDIT-C), nicotine dependence with the Fagerström test, cannabis use with the Cannabis Abuse Screening Test (CAST), and the use of other substances with an adaptation of the latter. Results. The mean age was 21.4 years, and most participants (76.6%) were women. Of the participants, 46.1% presented symptoms compatible with ADHD according to the ASRS. The most frequent items were difficulty maintaining attention during boring tasks (77.3%), avoiding tasks that require mental effort (76.8%), and being easily distracted by noise or external activity (73.8%). Significant differences were found between ASRS scores and gender, with scores being higher and more consistent among those students who identified themselves as non-binary gender (male or female) (p < 0.01). A significant association was also found between smoking and a higher ASRS score (p < 0.01). Although no significant associations with body mass index were detected, a trend toward greater symptomatology was observed in obese individuals. In multivariate analysis, still gender and smoking significantly (p = 0.12 and p = 0.031, respectively) predicted ADHD symptoms (ASRS score). The model R = 0.228 (R squared = 0.052, F = 1.62, p = 0.077). No statistically significant differences were found between ADHD symptoms and the use of alcohol, cannabis, or other substances in either bivariate or multivariate analyses. Conclusions. This study underscores the importance of early detection of ADHD symptoms in the university setting, considering factors such as gender and smoking habit. Future research should focus on aggravating factors such as academic stress and problematic technology use. Full article

There is a growing interest in ToM performance among individuals with psychiatric disorders. However, the difference and the performance level between different diagnoses are unclear. Here, we compared the ToM abilities of schizophrenia (SZ), schizoaffective (SZaff), and borderline personality individuals (BPD) with healthy individuals. Individuals with SZ (n = 44), SZaff (n = 11), BPD (n = 11), and healthy individuals (n = 18) were recruited from Mazor Mental Health Center. All groups underwent the Reading Mind in the Eyes (RME) and the Faux Pas recognition test (FB) to assess TOM ability and completed empathy and autism questionnaires. The current results show that the three diagnostic groups performed worse in the RME and FB test compared to healthy individuals. However, women with BPD performed significantly better in ToM tasks than women with SZ and SZaff. Individuals with schizophrenia and BPD scored higher on the autism spectrum questionnaire, while all the diagnostic groups scored lower on the empathy quotient scale than healthy individuals. Finally, a positive correlation was found between ToM ability and empathy. Strikingly, our findings challenge the ability to use ToM as a differential clinical diagnostic tool, especially among men, and strengthen the correlation between decreased empathy and impaired ToM. Full article

The COVID-19 pandemic is considered a potentially traumatic event, as it introduced new challenges and threats to people around the world, disrupting daily life due to the restrictions imposed. The psychological defenses of individuals mobilized to deal with stress reactions are influenced by a set of factors, including previous traumatic experiences, which can amplify the current trauma. Recognizing that people exposed to adverse childhood experiences (ACEs) have increased risks of an array of adverse mental and physical health outcomes throughout life, the present study aimed to investigate the relationship between ACEs—more specifically, child abuse and child neglect—and PTSD symptoms in a sample of European adults during the pandemic. A sample of 8459 participants (67.1% female and 32.9% male, with a mean of 43.95 years old) was evaluated. The survey questionnaire included questions on sociodemographic and clinical characteristics, the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5), and the Adverse Childhood Experiences (ACEs) questionnaire. According to our findings, younger women who have suffered from child abuse or child neglect are more likely to develop PTSD symptoms. The most significant factor influencing the PTSD risk was child neglect, contrary to many studies that indicate that child abuse is the most impactful adverse childhood experience. Full article

Psychotherapy has become a necessity for Parkinson’s patients suffering from anxiety disorder. There are different types of therapy; for example, Morita therapy, first proposed in 1919, is a psychological therapy. It is mainly used as an alternative therapy in Asian countries such as Japan and China. Morita therapy focuses on accepting emotions, including anxiety, rather than trying to reduce them. Although it has had an impact on treating anxiety disorder in other populations, there have been no studies to date investigating the evidence and effects of Morita therapy on anxiety disorder in Parkinson’s patients. This opinion article focuses on conducting a literature review to identify relevant studies on the applications of Morita therapy in anxiety disorders and explore the possibility of proposing it as a treatment option for Parkinson’s patients. Full article

(1) Background: Acromegaly is a rare disease associated with multiple complications. Consequently, it has a high clinical burden, which leads to a lower quality of life (QoL). The Acromegaly Quality of Life Questionnaire (AcroQoL) is a specific tool developed to assess the impact of the disease on a patient’s physical and emotional well-being. Current research on anxiety has shown that higher levels of psychosocial factors are linked to a poorer quality of life. (2) Methods: Our study included 40 patients (26 women and 14 men) with a mean disease duration of 85.9 ± 97.7 months. Information about disease status, associated comorbidities, and clinical and paraclinical data was obtained. All patients completed the AcroQoL questionnaire. (3) Results: The lowest score was observed on the physical scale, while the least affected scale was personal relations. Biochemical parameters, biochemical control, and adenoma size were not associated with a lower QoL. Gender, age at diagnosis, and comorbidities, such as hypertension and arthropathy, were associated with a decrease in QoL. Additionally, the presence of anxiety and depression, which were mostly reported by women (30.7%), had a negative impact on the global QoL. (4) Conclusions: Early diagnosis of acromegaly can increase the QoL by preventing comorbidities, but there are also non-modifiable factors that have been associated with a decreased QoL. Preventing depression and anxiety could serve as important targets for future interventions. Full article

Introduction: In the literature, depression is a medical condition that is well known and has been studied for decades, yet in clinical practice it often happens that depressive symptoms are confused with structured disorders or complexes. This incorrect interpretation can lead the psychiatrist to choose to make a psychopharmacological prescription, relegating psychotherapy to mere support or in any case reducing its importance, risking making the patient’s symptoms chronic and overloading the healthcare system. Materials and Methods: The literature up to December 2024 was reviewed and 40 articles were included in the review. A pilot study was conducted to verify the effectiveness and validation of the proposed theoretical model. Results: We propose the use of the “Perrotta Depressive Symptoms Assessment” (PDSYA) for the differential diagnosis in disorders with the manifestation of depressive symptoms, to facilitate the correct diagnosis and to reduce interpretative errors, both at a nosographic and therapeutic level. Conclusions: In the pilot study, in the content validity analysis, all items obtained a CVR score greater than the cut-off value, with a minimum score of 0.811. Therefore, all items of the scale were considered essential; also, regarding the relevance of the items in exploring the constructs investigated, optimal values of I-CVI (>0.93) and scale (S-CVI > 0.98) were obtained. Therefore, all items were rated as relevant. The validation study of the model is underway with a representative sample. Full article

Specialized mental health services (SMHS) should be accessible to all populations. This study investigated the accessibility of public SMHS for children and adolescent patients, as well as their caregivers, in Mexico. A cross-sectional survey was conducted with 400 patient–caregiver dyads receiving care at two primary SMHS facilities. The survey included indicators within four dimensions of accessibility: (1) organizational entry into SMHS; (2) organizational processes within SMHS; (3) ecological factors; (4) financial aspects. Additionally, six outcome variables were explored, including perceived health conditions and quality of care indicators. A principal component analysis (PCA) was utilized to construct four accessibility indices. Subsequently, multiple linear regression models were applied to examine the relationship between these accessibility indices and the outcome variables. Several indicators yielded notable results. The average emergency ward waiting time was 74.3 min (SD = 95.99), the post-hospitalization wait time was 1.28 weeks (SD = 1.85), and the average medical costs amounted to 962.6 Mexican pesos (SD = 2555.1). Several of the tested relationships between accessibility indices and outcome variables were statistically significant; organizational processes within SMHS and financial indices had a higher number of these significant relationships. These findings highlight the significant challenges in improving accessibility to public SMHS for children and adolescents in Mexico. Full article

This cross-sectional study investigates the association between the behavior of children aged 8–12 years old and key factors such as body mass index (BMI), sleep quality, and emotional intelligence (EI). It aims to explore how these variables interrelate and impact children’s overall behavior during a crucial developmental stage. A sample of children was assessed using standardized measures for BMI, sleep quality, and emotional intelligence (EI), while their behaviors were evaluated using behavioral scales. Statistical analyses were conducted to determine significant associations between these factors. For the data collection, we used sociodemographic questionnaire and the family affluence scale (FAS), and for the evaluation of sleep quality, we used the Children’s Sleep Habits Questionnaire (CSHQ). Moreover, the Trait Emotional Intelligence Questionnaire—Child Short Form (TEIQue-CSF) and Child Behavior Checklist (CBCL) were used for the evaluation of emotional intelligence and behavior. The findings reveal noteworthy correlations between high BMI, poor sleep quality, and lower emotional intelligence with certain behavioral challenges, including emotional regulation and social interaction difficulties. The study underscores the importance of addressing these factors to support the healthy psychological and physical development of children. Further research is suggested to explore potential interventions. Full article

Background: The perinatal period is a critical phase in a woman’s life, during which cultural and contextual factors significantly influence her physical and emotional well-being, as well as her transition to motherhood. Understanding cultural differences—such as those between Brazil and Spain—is essential for improving tailored perinatal care. Objective: This study explores and compares the perinatal experiences of women in Spain and Brazil, with a focus on their postpartum support needs and mental health implications. Method: A qualitative design was employed, using in-depth interviews with 22 postpartum women—11 from Spain and 11 from Brazil. Interviews were conducted using a semi-structured guide, and the data were analyzed through thematic analysis. Results: Common themes across both cultural contexts included the importance of preparation for childbirth, the need for emotional and psychological support, challenges related to breastfeeding, and adjustments to physical and psychological changes. Cultural differences were also identified: Brazilian women tended to engage in more detailed planning and valued the support of professionals such as doulas and midwives, whereas Spanish women emphasized the importance of having their choices respected during childbirth. Notably, both groups experienced significant emotional challenges, highlighting crucial considerations for maternal mental health. Conclusions: These findings emphasize the need for culturally sensitive perinatal support programs that address the emotional and psychological needs of postpartum women, aiming to improve mental health outcomes. Full article

Divorce represents a significant life transition with implications for emotional well-being, social integration, and economic security. This study examines the post-divorce experiences of women in Abu Dhabi, focusing on four challenges: financial insecurity, emotional distress, co-parenting difficulties, and struggles in forming new relationships. Drawing on data from the 5th Cycle of the Abu Dhabi Quality of Life Survey (n = 4347), the study explores how these challenges affect indicators such as life satisfaction, mental health, social trust, and financial stability. The findings show financial insecurity is the most prevalent and detrimental issue, particularly among older and less-educated women. Co-parenting stress peaks among women aged 35–49, while non-Emirati women report heightened financial vulnerability. Emotional distress is associated with poor sleep, reduced trust, and digital coping behaviors. Older women face greater social reintegration challenges. Religious practice emerges as a frequent coping mechanism, especially among those experiencing stigma and isolation. Guided by the Stress Process Model, the study highlights the interplay of social and psychological stressors and offers practical insights for psychiatric and mental health practitioners supporting women through family disruption. Full article

This study aimed to investigate the mediating effects of depression and interpersonal contact on the association between cognitive function and activities of daily living (ADL) in older adult patients with dementia. This descriptive cross-sectional study used the 2020 Korea Elderly Survey and included 189 older adults aged 65 years who were diagnosed with dementia by a physician. The analysis involved descriptive statistics and correlation analysis with Statistical Package for the Social Sciences (SPSS) version 24.0, and the dual mediation effect was analyzed with PROCESS Macro for SPSS version 3.5 Model 6. Cognitive function was negatively related to both ADL and depression but positively correlated with interpersonal contact. ADL exhibited positive and negative correlations with depression and interpersonal contact, respectively. Cognitive function significantly affected ADL and depression. Cognitive function significantly affected interpersonal contact, but depression was not significant. Finally, cognitive function exhibited a significant effect on ADL, but depression and interpersonal contact were not significant. Cognitive function showed the greatest effect on ADL in older adults diagnosed with dementia. Therefore, a program to prevent cognitive decline in older adults with dementia needs to be developed. Additionally, further studies are warranted to investigate the factors that affect the association between cognitive function and ADL in older adults with dementia. Full article

Public safety personnel (PSP) are known to experience difficult and demanding occupational environments, which were further complicated by the COVID-19 crisis. While public safety research typically focuses on the impact of operational stressors on PSP functioning and wellbeing, relatively less is known about the types and impacts of organizational stressors and how all these affect social wellbeing during the pandemic. The current study surveyed Canadian firefighters (n = 123), paramedics (n = 246), and public safety communicators (n = 48) that continued to serve the public over the course of the pandemic. Participants responded to two open-ended survey questions about how COVID-19 affected their lives at work and home. Using an inductive thematic analysis approach, responses were coded to identify emergent, data-driven themes while drawing on existing theory for analysis. Across occupational groups, qualitative analyses revealed that the public safety measures imposed by the COVID-19 pandemic further exacerbated existing operational and organizational strains, including increased exposure to distressing calls, absenteeism and coping with alcohol, and a lack of support from management. Participants also identified financial strain and housing insecurity as stressors, as well as frustration and helplessness at others’ non-compliance with public health advisories and protocols. Communication surrounding the rationale behind government decision-making, the efficacy of serology tests, and rates of infection were also identified. Together, these findings offer a nuanced understanding of the interplay among operational, organizational, and social stressors experienced by Canadian PSP during the COVID-19 pandemic, illuminating their impact on mental health and wellbeing, and identifying targeted areas of focus for future planning and meaningful intervention to support PSP wellness. Full article