Search Results (1,006)

Background/Objectives: Mindfulness-based interventions are widely used to reduce psychological distress. Their long-term neurophysiological correlates remain insufficiently characterized. Using a portable Muse InteraXon^® EEG device, this study aimed to evaluate (i) the extent to which a 12-month combined mindfulness and gratitude-based intervention reduces anxiety, depression, and perceived stress, and (ii) whether these changes are accompanied by corresponding EEG-derived neurophysiological alterations, exploring longitudinal brain–behavior associations. Methods: Fifty participants completed psychological assessments at baseline, 6 months, and 12 months using validated scales (BDI-II, DASS-21, EMAS). A subcohort of 25 participants also underwent EEG recordings with a portable Muse device at the same time points. Longitudinal changes were analyzed using linear mixed-effect models, and exploratory brain–behavior associations were assessed with change-score analyses and Spearman’s correlations with false discovery rate correction. Results: Across the full cohort (n = 50), psychological outcomes showed longitudinal improvements over 12 months, with reductions in BDI-21, DASS-21 depression, anxiety, and stress subscales, and EMAS-State scores (all p < 0.001; linear mixed-effect models). In the EEG subcohort (n = 25), longitudinal analyses showed increased alpha power and reduced beta and gamma power in frontal and temporoparietal regions (pFDR < 0.05), along with a modest decrease in delta power at 12 months, while theta power remained stable. Exploratory analyses showed non-significant trends in the hypothesized directions that did not remain statistically significant after correction for multiple comparisons (e.g., Δalpha vs. Δstate anxiety: ρ ≈ −0.44; Δbeta vs. Δdepression: ρ ≈ 0.43) or after FDR correction. Conclusions: The mindfulness- and gratitude-based intervention was associated with sustained improvements in psychological outcomes and suggests accompanying dynamic modulation of neurophysiology. EEG appears to reflect time-dependent neural adaptation rather than a static predictor of treatment response. Full article

Background: Adventist spirituality has been identified as a relevant psychosocial resource for emotional well-being; however, evidence on its relationship with self-control and perceived stress in specific religious populations remains limited. Objective: The aim of this study was to examine the associations between Adventist spirituality, self-control, and perceived stress in a sample of adults belonging to the Seventh-day Adventist Church and residing in coastal regions of Peru. Methods: A cross-sectional study was conducted between December 2025 and January 2026 with 506 Seventh-day Adventist adults who completed an online questionnaire. Adventist spirituality was assessed using the Mission Commitment Questionnaire, which captures religious–spiritual commitment through three dimensions: personal devotion, participation, and witnessing. Self-control and perceived stress were measured using standardized scales. Data were analyzed using partial least squares structural equation modeling. Results: The constructs showed adequate internal consistency, with Cronbach’s alpha values ranging from 0.875 to 0.951 and composite reliability values ranging from 0.906 to 0.956. Adventist spirituality was positively associated with self-control (β = 0.479, p < 0.001) and negatively associated with perceived stress (β = −0.457, p < 0.001). Personal devotion showed the strongest contribution to the higher-order spirituality construct. The model explained 22.9% of the variance in self-control and 20.9% of the variance in perceived stress. Conclusions: Adventist spirituality, particularly personal devotion, was associated with higher self-control and lower perceived stress. Although the cross-sectional design does not allow causal inference, the findings support the relevance of Adventist spirituality as a psychosocial resource linked to emotional well-being in this religious population and justify future longitudinal studies. Full article

Background/Objectives: Radiologic technologists are frequently exposed to occupational stressors that heighten the risk of burnout, compromising well-being and job performance. Workplace exercise programs have been identified as promising strategies to enhance physical and mental health across occupational groups; however, robust experimental evidence among radiologic technologists remains limited. This study aimed to evaluate the effects of a structured workplace exercise program on perceived stress, burnout, and quality of life among radiologic technologists. Methods: A small-scale randomized controlled experimental study was conducted with 19 radiologic technologists from the Local Health Unit of Castelo Branco, Portugal. Participants were randomly assigned to an experimental group (n = 10, age mean = 43.8 ± 9.92 years old) or a control group (n = 9, age mean = 48.2 ± 7.86 years old). The intervention consisted of a six-week workplace exercise program conducted during work hours, comprising sessions three times per week, twice per day. Each session lasted approximately 15–20 min and included balance, stretching, and light resistance exercises. Outcomes were assessed pre- and post-intervention using the Perceived Stress Scale, the Copenhagen Burnout Inventory, and the WHOQOL-BREF. Results: The experimental group showed significant reductions in perceived stress (p = 0.013, d = −0.697 (−1.6–0.206) [moderate]) and in personal (p = 0.004, d = −0.834 (−1.748–0.08) [moderate]) and work-related burnout (p = 0.026, d = −0.756 (−1.664–0.151) [moderate]), as well as improvements in the physical (p = 0.046, d = 0.592 (−0.303–1.488) [small]) and environmental (p = 0.032, d = 0.991 (0.062–1.92) [moderate]) domains of quality of life. No significant changes occurred in the control group. Conclusions: These preliminary findings suggest that a brief, low-cost workplace exercise program may reduce stress and burnout and improve quality of life among radiologic technologists. These findings support the integration of structured physical activity into healthcare work settings as a feasible, preventive, and health-promoting strategy. Full article

Background: Subclinical psychological symptoms—such as low mood, perceived stress, and poor sleep—affect a large portion of the population and can impair quality of life despite remaining below clinical thresholds. The gut–brain axis has emerged as a promising target for interventions that support emotional and psychological resilience. Probiotics and postbiotics are gaining attention for their potential to modulate mood and stress via microbiome-related mechanisms, but human evidence remains limited, particularly in non-clinical populations. Objectives: We aimed to assess the effects of a two-strain combination of live microorganisms alongside a two-strain combination of heat-treated inactivated microorganisms on outcomes associated with anxiety, mood, perceived stress, and quality of life in healthy adults experiencing mild stress. Methods: This study was conducted in two parts. In Part I, a randomized, double-blind, placebo-controlled study, 100 participants were randomized to receive either a blend of live microorganisms (Bifidobacterium longum CECT 7347 and Lactobacillus rhamnosus CECT 8361) or an identical placebo once daily for 12 weeks. In Part II, a pilot feasibility study, a subset of eight placebo non-responders from Part I received the heat-inactivated preparation of the same bacterial strains in a 6-week trial extension phase. For Parts I and II, the primary outcome was the change in the Hamilton Anxiety Rating Scale (HAM-A). Secondary outcomes included measures of mood (Beck Depression Inventory (BDI); Patient Health Questionnaire-9 (PHQ-9)), stress (state and trait anxiety inventory (STAI); Perceived Stress Scale (PSS)), sleep (Pittsburgh Sleep Quality Index (PSQI)), quality of life (36-item Short Form Survey (SF-36)), gastrointestinal symptoms (Gastrointestinal Symptom Rating Scale (GSRS)), salivary cortisol and microbiome modulation. Results: In Part I, there were no significant effects of the live blend on the HAM-A, indicating that the primary endpoint was not met. In addition, no significant effects were seen on the STAI or PSS scores when compared to the placebo. However, participants consuming the live blend trended toward a reduction in total PHQ-9 scores compared to placebo (p = 0.089), whilst preliminary exploratory analyses suggested an improvement in anhedonia (p = 0.045). Furthermore, there was a significant improvement in the vitality domain of the SF-36 compared to placebo (p = 0.017). On microbiome analysis, it was noted that consumption of the live blend was linked to the preservation of butyrate-producing bacteria, particularly members of the Pseudoflavonifractor genus and the Clostridium SGB6179 species. Furthermore, the abundance of B. longum species was found to be inversely associated with the total PSS Scores. In Part II, supplementation with the inactivated preparation resulted in significant within-group improvements for the vitality (p = 0.006) and social functioning (p = 0.010) domains of the SF-36 and improvements in PSS scores compared to baseline (p = 0.050). Conclusions: Supplementation with either the dual-strain live or inactivated formulations was associated with significant improvements in the vitality domain of the SF-36, whilst participants receiving the inactivated formulation demonstrated lower perceived stress and improved social functioning compared to baseline. Overall, the findings from this pilot study suggest that these two biotic consortia are well-tolerated and may be associated with improvements in measures of vitality in individuals with subclinical psychological symptoms. The subtle observations detected for stress and anhedonia suggest that further well-powered trials are needed to better characterize these findings, potentially in populations with greater baseline symptomatology. Full article

Impulsivity is a core transdiagnostic construct in adolescent psychiatry, associated with emotional dysregulation, behavioral disorders, and increased vulnerability to mental health problems. Adolescents engaged in performing arts education may experience heightened psychosocial stressors that challenge self-regulatory capacities during a critical neurodevelopmental period. Methods: This mixed-methods study examined psychosocial and family-related factors associated with impulsivity in adolescent students enrolled in drama programs. Two focus groups with 28 upper-grade students (grades 11–12) explored subjective experiences of stress, emotional overload, and family communication. Based on these findings, a 77-item questionnaire was developed and administered to 90 ninth-grade students. Impulsivity was assessed using the Barratt Impulsiveness Scale (BIS). Results: An exploratory stepwise multiple linear regression analysis identified perceived school-related stress (β = 0.370, p < 0.001), conflictual parental communication (β = 0.273, p = 0.013), and discomfort during school discussions at home (β = 0.331, p < 0.001) as significant predictors of higher impulsivity scores. Conclusions: The findings highlight the interaction between neurodevelopmental vulnerability and environmental stressors in shaping impulsivity during adolescence. These results are clinically relevant for child and adolescent psychiatry, emphasizing the importance of early psychosocial interventions targeting stress regulation and family communication to prevent the escalation of impulsivity-related psychopathology. Full article

Background: Healthcare professionals are exposed to high emotional demands, including repeated contact with suffering, death, moral distress, and organizational pressure. These factors are associated with psychological distress, burnout, and secondary traumatic stress. Expressive Writing (EW) has been proposed as a psychological intervention, but evidence of its effectiveness among healthcare professionals remains heterogeneous. Objectives: To examine the effects of EW on psychological health, psychophysical well-being, and professional satisfaction among healthcare professionals. Methods: A systematic review was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA 2020 guidelines. Searches were performed in PubMed, CINAHL, CENRAL, CENTRAL Scopus, Embase, and PsycINFO from database inception to January 2025. Quantitative studies involving healthcare professionals and evaluating structured expressive writing interventions were considered for inclusion, including randomized and non-randomized, controlled and uncontrolled designs. Studies reporting psychological, psychophysical, or work-related outcomes were eligible. Only full-text articles published in English or Italian were considered. The review protocol was registered and archived in the Open Science Framework. Methodological quality was assessed using CASP checklists, the RoB 2 tool, and the Newcastle–Ottawa Scale. Results: Seven studies published between 2017 and 2023 were included. EW interventions were associated with reductions in psychological distress, particularly perceived stress, depressive symptoms, and post-traumatic stress symptoms. Findings regarding burnout and compassion fatigue were mixed. Organizational and job-related outcomes, such as job satisfaction and organizational commitment, showed limited and heterogeneous improvements. No consistent effects were observed for resilience or social support. Overall, the methodological quality of the included studies was generally good. Conclusions: EW appears to be a promising, low-cost intervention for reducing psychological distress among healthcare professionals. However, heterogeneity in study designs, intervention protocols, and outcome measures limits the strength of the evidence. Further high-quality, controlled studies using standardized EW protocols are needed. Full article

Psychological stress is a major public health problem associated with adverse outcomes in physical and mental health. This study proposes an approach to predicting clinical stress levels using metabolic and endocrine biomarkers combined with machine learning models based on genetic algorithms. Data were obtained from 87 university students, including measurements of glucose, insulin, and cortisol, as well as perceived stress scores assessed using the Perceived Stress Scale (PSS). Stress levels were categorized into low ($n=5$), moderate ($n=22$), and high ($n=60$) classes, reflecting an imbalanced dataset. Feature engineering and genetic algorithm–based selection identified glucose concentration, the insulin–glucose ratio, and the insulin–cortisol ratio as the most relevant features. These were used to train XGBoost and Elastic Net models, which were evaluated using leave-one-out cross-validation. The XGBoost model achieved the best performance, with an accuracy of 0.77 and strong predictive capability for high stress levels. The results demonstrate the usefulness of machine learning based on metabolic biomarkers as an objective tool for stress assessment in psychological and clinical research. Full article

Background: Sleep disturbance and psychosocial stress are emerging contributors to hypertensive disorders of pregnancy. The present cohort was recruited during the COVID-19 period, a time marked by substantial changes in prenatal care delivery, social support, and daily routines, which may have influenced maternal sleep and stress burden. Objective: This study aimed to evaluate the independent and integrated associations between maternal sleep quality, psychological stress, and pregnancy outcomes in women at moderate to high risk for preeclampsia. Methods: In a single-center observational cohort of 170 pregnant women enrolled at 16 weeks’ gestation, sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Fitbit Sense 2™ wearable data, while stress was measured through the Perceived Stress Scale (PSS-10), Generalized Anxiety Disorder-7 (GAD-7), and morning salivary cortisol. Associations with preeclampsia, birth weight, gestational age, and NICU admission were analyzed using multivariate regression and receiver operating characteristic (ROC) models. The COVID-19 period was treated as the contextual background of recruitment rather than as a directly compared exposure. Results: Poorer subjective sleep quality (higher PSQI) correlated negatively with birth weight (r = −0.34, p = 0.008) and gestational age (r = −0.28, p = 0.04). Elevated morning cortisol was significantly associated with NICU admission (r = 0.28, p = 0.002). The combined sleep + stress model predicted birth weight (R² = 0.26, p = 0.003) and preeclampsia (pseudo R² = 0.15, p = 0.015) more accurately than individual domains, achieving an ROC-AUC of 0.86 (95% CI: 0.78–0.92). Conclusions: In high-risk pregnancies, integrated evaluation of sleep and stress parameters may improve the prediction of fetal growth impairment and preeclampsia beyond single-domain models. These findings support the incorporation of psychosocial and behavioral markers into antenatal risk stratification. Because no pre-pandemic or post-pandemic comparator group was included, the COVID-19 period should be interpreted as the contextual background of the study rather than as an independently tested exposure. Full article

Background and Objectives: Chronic kidney disease (CKD) is an increasingly important global health challenge and is frequently accompanied by psychiatric symptoms, including anxiety. A multidimensional assessment of anxiety in hemodialysis (HD) using the Endler Multidimensional Anxiety Scales (EMAS) has not, to our knowledge, been previously reported. We aim to evaluate the reliability, convergent validity, and exploratory domain-level structure of EMAS in HD patients treated at a dialysis center in Craiova, Romania. Materials and Methods: A total of 103 HD patients underwent clinical and sociodemographic/socioeconomic profiling, cognitive screening using the Mini-Mental State Examination (MMSE), and EMAS administration at two time points (4-week interval) for test–retest evaluation. The anxiety subscale of the Depression, Anxiety, and Stress Scale-21R (DASS-21R) was administered to assess convergent validity. Internal consistency (Cronbach’s α), temporal stability (test–retest correlations and intraclass correlation coefficients), and convergent validity (Pearson correlations) were computed. Exploratory factor analyses were conducted on EMAS domain scores (state, trait, and perceived anxiety domains) as an exploratory structural check. Results: EMAS state and trait anxiety scores were higher in women than in men, while perceived anxiety showed a more heterogeneous pattern across dimensions. Total state anxiety increased with age, particularly after 50 years. Domain-level internal consistency was good for state and acceptable for trait components (standardized α ≈ 0.84 and 0.78 across administrations), whereas perceived anxiety domains showed low cross-domain coherence, consistent with context-specific appraisal. The DASS-21R anxiety subscale showed good internal consistency (α = 0.863). Convergent validity analyses indicated small, domain-specific associations between EMAS scores and DASS-21R anxiety. Domain-level EFA supported a theoretically coherent pattern in which state and trait domains clustered distinctly, while perceived anxiety domains formed a partially separable factor; this pattern was broadly consistent across both administrations. Conclusions: In this HD cohort, EMAS demonstrated good reliability and limited but domain-specific evidence of convergent validity, and exploratory domain-level analyses supported its multidimensional organization. Further studies with larger samples are warranted for item-level structural testing and to inform feasibility-oriented shortening for potential clinical use. Full article

Auditory pseudowords are widely used in psycholinguistics and cognitive neuroscience, but their construction requires control of sublexical familiarity and careful characterization of how acoustic cue manipulations may shift perceived lexical plausibility. Here we introduce the Minho Pseudoword Wordlikeness Ratings (MPWR), the first normative dataset of wordlikeness judgments for European Portuguese (EP) auditory trisyllabic CV pseudowords, and evaluate whether adding a localized F0-based prominence cue modulates wordlikeness beyond distributional familiarity. One hundred and twenty pseudowords were assembled from naturally produced syllables drawn from the Minho Spoken Syllable Pool (MSSP) and recorded under uniform conditions. Each item was implemented in three token types with constant segmental content: a flat baseline and two F0-enhanced versions (+15%) targeting either the penultimate or final syllable. Native EP listeners (N = 101) provided wordlikeness ratings on a 7-point scale. MSSP-derived indices quantified pseudoword syllable familiarity (SWI_All, SWI_N3) and stress-position propensity for the targeted syllable (SPP_marked). Ratings were intentionally low overall yet showed substantial item-to-item variability. F0 enhancement produced a small but reliable decrease in wordlikeness relative to flat tokens, with no reliable difference between penultimate and final targeting positions. SWI_All robustly predicted ratings, whereas SPP_marked added little explanatory value. MPWR provides a practical EP resource for selecting and matching auditory pseudowords using normative wordlikeness ratings and transparent corpus-based descriptors. Full article

Background/Objectives: The Positive Parenting Program (Triple P) is an evidence-based intervention for families including young children with neurodevelopmental disorders. Because establishing a definitive diagnosis in early childhood takes time, especially for 1–3-year-olds who have only recently shown early signs, parents often experience substantial stress. This study examines the effectiveness of the Group Triple P (GTP) program for mothers of 1–3-year-old children without a confirmed diagnosis who spent time at a community parenting support center. Methods: The participants were 41 mothers of children aged 1–3 who did not confirmed neurodevelopmental diagnosis but showed behavioral, emotional, or developmental concerns, or whose mothers reported parenting difficulties. To reflect real community practices, a non-randomized pre–post test design without a control group was adopted. Assessments were conducted at baseline, postintervention, and at a 12 weeks follow-up using the Strengths and Difficulties Questionnaire, Parenting Scale, Parenting Experience Scale, and Depression Anxiety Stress Scale. Results: GTP improved the mothers’ assessments of positive behaviors in children who may have neurodevelopmental disorders, with a medium effect size. GTP reduced dysfunctional parenting styles in mothers with a large effect size. It also enhanced mothers’ confidence and fulfilling sense in parenting, and decreased depression and stress with a medium effect size. Perceived access to parenting support improved, contributing to better parenting adaptation with a medium effect size. Conclusions: GTP may serve as an early public health intervention for mothers of young children who may have neurodevelopmental disorders by supporting maternal mental health and promoting adaptive parenting. Full article

Background: This longitudinal study examined the clinical outcomes of physiotherapy interventions in patients with chronic low back pain, specifically observing the interactions between demographic characteristics, physical metrics, and psychological variables. Methods: A cohort of n = 150 patients, Final n = 123 (18% attrition rate), was assessed using a one-group pre-test/post-test design, with primary outcome measures including Health-Related Quality of Life, the Perceived Stress Scale, and the Numerical Pain Rating Scale. Participants received eight standardized sessions over 4 weeks, including electro-physical agents combined with individualized kinesiotherapy. Data analysis/synthesis was performed via Multiple Correspondence Analysis (MCA) to map associations between categorical variables and treatment responses. Results: The predominant clinical profile found was a middle-aged female with moderate educational attainment, presenting with a Body Mass Index in the overweight range and moderate-to-high baseline pain intensity. MCA revealed distinct phenotypic trends: longer Work Experience was associated with lower baseline Quality of Life (QoL) and heightened stress/pain levels. In contrast, patients characterized by higher education and significant Work Experience demonstrated notable post-intervention QoL gains. High baseline QoL served as a predictor for sustained improvement and pain attenuation, while elevated pre-intervention pain scores were consistently linked to perceived unmet clinical needs and exacerbated stress. Conclusions: MCA successfully mapped non-linear clusters—such as the “Socio-Psychological Barrier” profile—that traditional univariate methods fail to visualize, suggesting that “individualized care” must prioritize health literacy among patients experiencing extensive work-related strain. Full article

Background/Objectives: Patients after cardiac surgery admitted to the intensive care unit (ICU) are exposed to environmental, procedural, and psychological stressors that may affect comfort and recovery. This study aimed to assess perceived ICU stressors in postoperative cardiac surgery patients, identify the most and least distressing factors, and examine associations between stressor intensity and selected clinical and organizational variables. Methods: A single-center cross-sectional survey was conducted in an ICU in Poland (January 2024–February 2024). Adult patients after cardiac surgery who provided informed consent and had no cognitive impairment were included; cognitive status was screened using the Montreal Cognitive Assessment (MoCA). Perceived stressors were measured using the Intensive Care Unit Environmental Stressor Scale (ICUESS; 40 items; 4-point Likert scale). Results: The highest-rated stressors were sleep problems (M = 2.30; SD = 0.86) and hearing heart monitor alarms (M = 2.16; SD = 0.82). The lowest-rated stressors were not knowing what day it was (M = 1.46; SD = 0.54) and nurses not introducing themselves (M = 1.50; SD = 0.54). Longer respiratory support and higher pain intensity were associated with higher stressor ratings for multiple ICUESS items, whereas age showed no significant association. Higher room occupancy was linked to higher perceived stress related to environmental disturbances. ICU length of stay showed only limited item-level associations. Conclusions: Postoperative cardiac surgery patients experience a multifactorial burden of ICU stressors, with sleep disruption and alarm-related noise among the most distressing. Prioritizing modifiable environmental factors, symptom control (particularly pain), and patient-centered communication may help reduce perceived stress, especially in shared-room settings and among patients requiring longer respiratory support. Full article

Psychological comorbidity is increasingly recognized as a critical factor influencing outcomes in chronic illness management, particularly in patients with end-stage renal disease (ESRD). The present study examines the psychological burden associated with long-term hemodialysis in patients with ESRD, focusing on emotional distress and maladaptive personality traits. Specifically, it explores group differences between hemodialysis patients and matched healthy controls in levels of stress, anxiety, depression, and psychopathological tendencies, including neuroticism, paranoia, and psychopathy-related traits, as well as exploratory associations with treatment duration. A purposive sample of 60 participants (30 patients undergoing chronic hemodialysis and 30 age- and sex-matched healthy controls) was assessed using validated psychometric instruments: The Hospital Anxiety and Depression Scale, the Pichot Neuroticism and Psychopathy Questionnaire, and a 23-item stress measurement questionnaire adapted to the dialysis context. Both descriptive and inferential statistical analyses were conducted, including independent-samples t-tests and effect size calculations (Cohen’s d). Compared to healthy controls, hemodialysis patients exhibited significantly higher levels of psychological distress across multiple domains. Large between-group effect sizes were observed for depression (Cohen’s d = 1.26) and perceived stress (d = 1.51), while moderate effects were identified for anxiety (d = 0.70), neuroticism (d = 0.58), and psychopathy-related traits (d = 0.82). Exploratory analyses indicated that patients with less than 10 years of dialysis experience reported significantly higher stress levels than those with longer treatment duration, whereas differences in anxiety, depression, and personality traits by dialysis duration were not statistically significant. These findings highlight the substantial emotional burden associated with long-term hemodialysis and underscore the importance of routine psychological screening and early psychosocial interventions to support adaptation, treatment adherence, and quality of life in nephrology care. Full article

Background: The use of digital media in childhood offers both opportunities and risks. Digital stressors—such as excessive screen time, constant availability, information overload, and social media pressures—affect primary school children but have been rarely studied systematically. Despite growing research, no validated instruments adequately capture how younger children perceive and express digital stress. This study presents the development and validation of a three-dimensional instrument for children under 14: the “Digital Stress in Children” scale (DSS-CH). The DSS-CH is theory-driven and child-appropriate, with three interrelated but distinct dimensions: (1) excessive screen time, (2) compulsive media behavior, and (3) approval anxiety. Methods: In a cross-sectional survey of n = 907 Swiss primary school children (grades 5–6; ages 10–14), participants completed an online questionnaire in class. Latent variable modeling with cluster-robust inference accounted for classroom nesting. Competing models (1-, 2-, 3-factor CFA; ESEM; bifactor-ESEM) were evaluated. Results: The 1-factor CFA fit poorly (CFI ≈ 0.81; RMSEA ≈ 0.15), while the 3-factor CFA showed acceptable fit (CFI ≈ 0.96; RMSEA ≈ 0.07). Allowing cross-loadings improved fit substantially in the 3-factor ESEM and bifactor-ESEM (CFI ≈ 0.999; RMSEA ≈ 0.01), supporting a general digital stress factor alongside facet-specific variance. Subscales showed good reliability (ordinal α ≈ 0.81 − 0.89) and moderate intercorrelations (r ≈ 0.28 − 0.47). Scalar invariance across gender and age was supported (ΔCFI ≤ 0.003; ΔRMSEA ≤ 0.012). Conclusions: The DSS-CH demonstrates good reliability, model fit, and measurement invariance. It provides valid evidence for interpreting children’s digital stress as three related facets and can help identify elevated stress profiles to inform preventive efforts. Full article