Search Results (3,224)

Inflation, recognized as a social determinant of health (SDOH), significantly affects the daily lives of individuals through the rising costs of food, housing, and other basic needs, all of which are public health concerns. Since the COVID-19 pandemic, inflation has become a prominent concern in the U.S. and has been linked to increased stress and poor mental health among adults. While data on inflation is tracked routinely, how it is discussed publicly is understudied. Social media platforms provide insights into how inflation is framed and experienced by the public, and these assessments may be used to determine public health needs and policy advocacy. In this study, we conducted a time-bound, platform-specific case study of inflation-related discourse on X (formerly Twitter). Analysis revealed a predominance of negative sentiments (68.5%) including frustration and distrust. Posts primarily concerned monetary policy/government spending (31.6%), Federal Reserve interest rates/financial markets (24.5%), and U.S. presidential politics (12.9%). The users did not explicitly discuss personal-level hardships, and the discussions largely focused on macro-level issues framed in polarized political perspectives. These patterns matter for public health because institutional trust shapes support for social and health policies. Our study findings suggest a fragmented social environment that may exacerbate community-wide anxiety and challenge health promotion efforts and the need for public health surveillance through surveys or personal interviews to identify and address the psychological burden of inflation. Full article

Background/Objectives: Insomnia is highly prevalent among patients with asthma and has been associated with systemic inflammation, reduced lung function, and increased mortality. This study investigated whether insomnia mediates the relationship between asthma control and psychosocial dysfunction, including social anhedonia and functional impairment. Methods: This cross-sectional study included 153 adults with physician-diagnosed asthma classified as controlled (n = 51) or uncontrolled (n = 102) according to the Asthma Control Test (ACT). Insomnia severity was assessed using the Athens Insomnia Scale (AIS), social anhedonia using the Revised Social Anhedonia Scale (RSAS), psychological distress using DASS-21, and functional impairment using the Functioning Assessment Short Test (FAST). Results: Uncontrolled asthma was associated with significantly higher insomnia severity and greater depression, anxiety, and stress levels (all p < 0.001). Asthma control emerged as the strongest independent predictor of insomnia severity (β = −0.451, p < 0.001). Although asthma control was not directly associated with social anhedonia or functional impairment, insomnia significantly mediated these relationships. The indirect effect of asthma control on social anhedonia via insomnia was significant (B = −0.1162, 95% CI [−0.2384, −0.0029]), as was the indirect effect on functional impairment (B = −0.4953, 95% CI [−0.8656, −0.1038]). Spirometric indices were not independently associated with psychosocial outcomes. Conclusions: Insomnia may represent an important intermediary process linking poor asthma control to psychosocial dysfunction. These findings highlight the clinical importance of assessing sleep disturbances in asthma patients and suggest that insomnia may contribute to broader psychosocial impairment beyond respiratory symptoms alone. Full article

Youth are increasingly struggling with mental health, yet many lack access to formal care. Evidence indicates that building coping skills can improve mental health and wellbeing. School personnel may be well-positioned to help youth build these coping skills by delivering discrete evidence-based ingredients in their everyday interactions and relationships with students. This scoping review synthesizes the literature on social-emotional evidence-based ingredients delivered by paraprofessionals and explores their potential application in school behavioral health. We searched PsycINFO and PubMed, screened 200 titles/abstracts and 46 full-texts, and yielded 19 studies from which we synthesized data using the RE-AIM framework. We identified 17 evidence-based ingredients, with the most common being mindfulness, relaxation, psychoeducation, exposure, and cognitive restructuring. These were delivered in various formats and settings by different paraprofessionals (e.g., graduate students, teachers, caregivers), with most paraprofessionals receiving some training and supervision. Thirteen studies showed significant improvements in at least one outcome (i.e., anxiety, depression, suicidality, wellbeing). Six studies examined long-term effects, with mixed findings. Despite variation in delivery and training, paraprofessionals appear to feasibly and effectively deliver evidence-based ingredients. These findings support task-shifting ingredients as a scalable approach for supporting youth mental health within school behavioral health systems. Full article

Background/Objectives: Survival rates after pediatric liver transplantation have improved substantially over recent decades, yet the psychiatric consequences for recipients remain a concern that warrants closer attention. We sought to map the psychiatric symptom burden across multiple domains in this population and to determine which symptom clusters carry the greatest impact on health-related quality of life (HRQOL). Materials and Methods: Fifty liver transplant recipients between the ages of 8 and 18 were enrolled at a single center. Children and their parents completed four psychiatric measures—the CBCL, CDI, SCARED, and CRIES-13—alongside the parent-proxy PedsQL to capture HRQOL across physical, emotional, social, and school functioning domains. Correlations between instruments were calculated, and linear regression was used to determine which psychiatric variables independently predicted PedsQL Total scores. Results: Across all psychiatric measures, higher symptom scores were associated with lower HRQOL, with school functioning recording the lowest absolute PedsQL domain score, while emotional functioning demonstrated the strongest and most consistent inverse correlations with all psychiatric symptom measures across instruments. CBCL Total (r = −0.607), SCARED Total (r = −0.557), and CRIES-13 Total (r = −0.548) scores all correlated meaningfully with overall HRQOL. When entered into multivariable analysis, anxiety symptoms measured by the SCARED (β = −0.295, p = 0.032) and post-traumatic stress symptoms measured by the CRIES-13 (β = −0.400, p = 0.004) stood out as the two independent predictors of worse PedsQL Total scores. Conclusions: Even in medically stable recipients, anxiety and post-traumatic stress symptoms were independently associated with lower daily functioning scores and overall quality of life. These findings suggest that routine psychosocial screening and trauma-informed approaches may warrant integration into post-transplant care protocols, and that prospective, adequately powered studies are needed to confirm and extend these associations. Full article

Background: Infertility affects millions of people causing grave societal and health consequences (poor physical and mental wellbeing). Aims: To translate and validate the COMPI scale in Serbian and examine associations of infertility-related stress, coping strategies and evaluation of care with medically assisted reproduction (MAR) outcomes in female Serbian infertility patients. Methods: The study included patients undergoing MAR for four months. Participants completed a socio-demographic and gynecologic questionnaire, the Serbian-translated COMPI scale, Beck Anxiety Inventory (BAI) and Zung Self-Rating Depression scale (ZDS). Serbian COMPI was validated in the classic manner. Associations between COMPI scores and pregnancy outcomes were analyzed by Spearman’s correlation and multivariable regression. Results: A total of 107 women participated and 24.3% achieved pregnancy. The Serbian COMPI demonstrated high internal consistency (Cronbach alpha = 0.838). Compared with reference COMPI data, personal, social and marital stress scores were higher, while meaning-based coping and marital benefit scores were lower. Regression analysis showed that higher marital stress, partner communication difficulties and meaning-based coping were associated with higher pregnancy likelihood. Conclusions: Serbian patients undergoing MAR reported high infertility-related stress and predominantly used active coping strategies. Patients who applied meaning-based coping were more likely to achieve pregnancy. Full article

Background: Substance Use Disorder (SUD) is characterized by recurrent craving episodes frequently associated with emotional dysregulation and altered reward processing. This study aimed to evaluate whether emotional states associated with craving episodes can be detected through automated facial emotion recognition during controlled emotional induction. Methods: Forty-one participants completed a 14-day ecological momentary assessment (EMA) monitoring anxiety and craving levels, followed by an emotional induction task using standardized stimuli from the EmoMadrid database and addiction-related images. Facial expressions were recorded and analyzed in real time using a computational facial emotion recognition model trained on the FER-2013 dataset. Results: Participants with SUD exhibited significantly reduced positive emotional valence and emotional activation in response to positive stimuli compared with healthy controls (HC), with large effect sizes observed for emotional valence (Hedges’ g = 1.76) and emotional activation (Hedges’ g = 1.33). Item-level analyses revealed that most between-group differences occurred in stimuli depicting social interactions. Individuals with SUD also showed higher frequencies of fear-related facial expressions and lower frequencies of disgust-related expressions compared with HC, with moderate effect sizes observed for both emotional dimensions (Hedges’ g = 0.72; p = 0.02). Conclusions: These results suggest that people with SUD have changes in how they process emotions, showing less response to positive things and unique facial expressions related to craving. However, given the relatively modest and clinically heterogeneous sample, the findings should be interpreted cautiously and require replication in larger and more homogeneous populations. Full article

Chronic obstructive pulmonary disease (COPD) imposes a substantial physical and psychosocial burden, yet the role of loneliness remains under-recognised in clinical practice. Loneliness, defined as a subjective discrepancy between desired and actual social relationships, has emerged as a clinically relevant determinant of patient outcomes. This narrative review synthesises current evidence on the epidemiology, mechanisms, and clinical consequences of loneliness in COPD, and evaluates its implications for disease management. Available evidence indicates that loneliness affects a considerable proportion of individuals with COPD, with prevalence estimates ranging from approximately 18% to over 30%, particularly among patients with greater symptom burden, functional limitation, and oxygen dependence. Dyspnoea and advancing disease severity reduce social participation and increase vulnerability to perceived social disconnection. Loneliness influences COPD outcomes through interconnected behavioural, biological, and healthcare engagement pathways, including systemic inflammation, neuroendocrine stress responses, physical inactivity, impaired self-management, and reduced engagement with healthcare services. These mechanisms contribute to poorer clinical trajectories, as loneliness is consistently associated with reduced health-related quality of life, increased exacerbations, higher healthcare utilisation, greater risk of hospitalisation, and elevated mortality, independent of depression and anxiety. Despite this, loneliness is rarely assessed in routine respiratory care, and targeted interventions remain limited. Emerging strategies, including pulmonary rehabilitation, peer support, and digital health interventions, show promise in reducing loneliness and improving outcomes. Loneliness represents a modifiable and clinically actionable risk factor in COPD, and its integration into routine assessment and management may enhance patient engagement, optimise treatment effectiveness, and reduce healthcare burden. Addressing loneliness represents a critical opportunity to advance more effective and comprehensive COPD care. Full article

Mistreatment is a pervasive and normalized feature of medical culture. In medical residencies, it functions as a structural rite of passage that shapes professional socialization. While the prevalence of mistreatment is documented, there is a lack of qualitative research exploring its role as a mechanism of identity construction. The aim of this study was to understand the experiences of mistreatment among internal medicine residents in Medellín, Colombia, through the lens of ritual theory and symbolic violence. A particularistic ethnographic study was conducted with 12 residents selected via theoretical sampling. Data were collected through semi-structured interviews and a reflexive field journal. Rigor was ensured using investigator triangulation and analytical bracketing to manage researchers’ biases. The training process follows a three-stage rite. (1) Separation: Symbolic violence and social pressure to specialize frame general medicine as “mediocre,” turning admission into a “battlefield” where self-worth is tied to success. (2) Marginalization (Liminality): Residents endure systemic mistreatment, including sleep deprivation (3.5 h rest cycles), public ridicule (“pimping”), and physical/verbal abuse (e.g., being hit with stethoscopes or called “testicles/jerks”). This stage is governed by a “purificatory logic” where suffering is internalized as a meritocratic requirement. This leads to high morbidity, with clinical diagnoses of anxiety and depression. (3) Integration (Postliminality): Professional autonomy and financial stability act as a “redemption” that justifies past suffering. Mistreatment is not an isolated interpersonal issue but a structurally embedded ritual and a core element of the hidden curriculum. It reinforces toxic hierarchies and a “tyranny of merit” that obscures structural barriers. These findings offer analytically transferable insights for global medical education, calling for a deconstruction of ritualized violence to foster more humanistic training environments. Full article

Phishing messages have evolved from simple fraud templates into socially engineered texts that exploit anxiety, trust, relational obligation, and culturally embedded norms. In Korean phishing messages, attackers frequently combine institutional authority, family or acquaintance framing, requests for cooperation, and urgency cues to induce concrete victim actions such as money transfer, link clicking, phone contact, app installation, or credential submission. However, prior studies have largely emphasized binary phishing detection while offering limited interpretability regarding how such messages mobilize social and cultural persuasion strategies. This study proposes a culturally aware large language model framework for analyzing social engineering tactics in Korean phishing messages. The framework is built on a multidimensional codebook that represents the message text, phishing label, tactic type, relation type, requested action, cultural lever, and evidence span, enabling structured and explainable analysis beyond simple classification. To operationalize this framework, an OpenChat-based model is fine-tuned with QLoRA to generate structured outputs that jointly predict the phishing status and socially relevant attributes, while evidence-span supervision is incorporated to improve grounding and explanation consistency. The evaluation examines not only phishing-detection performance but also attribute-level prediction accuracy, evidence alignment, parsing reliability, and human-rated usefulness and trustworthiness. By integrating the cultural context, relational framing, and evidence-grounded explanation into LLM-based phishing analysis, this study provides an interpretable analytical framework for Korean phishing messages and an evidence-grounded basis for analyst-supportive phishing triage. On the 82-sample authoritative clean hold-out split, Model D produced error-free label predictions and achieved 0.841 exact-match core and 0.886 span-F1. However, because the evaluation used a single 82-sample internal hold-out split and no independent external corpus, these results should be interpreted as feasibility evidence under leakage-controlled conditions rather than as proof of deployment-level robustness or cross-domain generalization. The main contribution of this study is therefore not improved binary detection over strong lexical baselines, but the structured and evidence-grounded representation of Korean phishing persuasion tactics for analyst-supportive triage. Full article

Domestic Violence affects 1 in 3 women worldwide. Empirical evidence from India suggests that women and girls experience a continuum of violence and discrimination from prenatal stages till death in families that largely continue to operate within a dominantly patriarchal framework. However, the literature on domestic violence in India suffers from problems pertaining to reductive and episodic framing, focusing on short-term prevalence, and frames the impact on survivors largely in terms of clinical constructs such as anxiety, depression, and PTSD. This work argues for a broader, thematic framing of domestic and familial violence and contends that the psychological sequelae of this kind of chronic and systemic discrimination and violence cannot be captured using rigid clinical constructs that dominate psychological literature. We propose a conceptual framework, i.e., SPECTRA (Socially and Psychologically Embedded Continuous Trauma in Relational Architecture), which is partially aligned with the propositions of complex trauma. However, we also critique the origin of complex trauma within hegemonic psychiatry and highlight the need for creating a culturally adapted expansion—to shift the emphasis from an individually rooted, diagnostic framework to a culturally contextualized continuous trauma framework. We utilize seven illustrative case studies to define the tenets of the SPECTRA model. Full article

With the rapid growth of short-video platforms, it has become increasingly important to understand the psychological processes that sustain prolonged engagement and contribute to individual evaluative responses. This study examines the dual pattern of associations involving perceived time spent on TikTok by investigating whether it is positively associated with overall user satisfaction while also being linked to psychological cost-related responses, including privacy concerns, health consciousness, social interaction anxiety, and social media fatigue. Data were collected through an online survey administered via Prolific and analyzed using structural equation modeling (SEM) and fuzzy-set qualitative comparative analysis (fsQCA). The findings show that perceived time spent on TikTok is significantly associated with health consciousness and social interaction anxiety. Perceived time spent on TikTok is also directly and positively associated with overall user satisfaction. Moreover, privacy concerns and social media fatigue are negatively associated with overall user satisfaction. The fsQCA results further reveal six configurations associated with high user satisfaction. These configurations illustrate the principle of equifinality and indicate that no single condition reached the conventional threshold for necessity. Overall, the findings suggest that high user satisfaction can coexist with different combinations of psychological cost-related responses, thereby offering a more nuanced account of how users experience short-video platforms. Full article

Background: People living with HIV (PLWH) are increasingly reaching older ages due to the success of antiretroviral therapy. However, aging with HIV is associated with increased risk of multimorbidity, neurocognitive impairment, frailty, psychosocial stress, and functional decline. Multidomain geriatric screening framed within an Age-Friendly 4Ms Framework (Mentation, Medication, Mobility, What Matters Most) and consideration of multi-complexity may help identify aging-related vulnerabilities and guide multidisciplinary care with greater impact on patient outcomes. However, real-world implementation of such programs within HIV clinical settings remains limited. Methods: We conducted a retrospective analysis of adults aged ≥50 years enrolled in a multidisciplinary Healthy Aging Program within a large, integrated HIV care system. Multidomain screening assessments included cognitive evaluation (Montreal Cognitive Assessment), mental health screening (PHQ-2, GAD-2), functional assessment (Katz ADL, Lawton IADL), frailty screening (Edmonton Frail Scale), and intrinsic capacity domains using the WHO Integrated Care for Older People (ICOPE) framework. Screening results, referrals, clinical interventions, and cardiometabolic risk management measures were extracted from clinical program databases and electronic medical records. Results: A total of 317 adults aged ≥50 years completed multidomain screening. Participants had well-controlled HIV infection, with viral suppression in 96.2% and a median CD4 count of 660 cells/mm³. Despite this, aging-related vulnerabilities were common. Overall, 78.4% of participants had at least one abnormal screening domain. Cognitive impairment was identified in nearly half of individuals screened, including mild impairment in 39.8% and moderate impairment in 8.7%. Functional limitations were identified in 10.1% of participants, while anxiety symptoms were present in 9.5%. Sensory impairments were common, including vision impairment in 36.5% of participants. Polypharmacy was prevalent, with 33.2% of participants prescribed five or more chronic medications. Screening frequently generated multidisciplinary referrals, including behavioral health services (42.3%), social work support (42.9%), and pharmacist-led cardiometabolic risk review (56.8%). Age-stratified analyses demonstrated similar prevalence of screening abnormalities across age groups, including individuals aged 50–59 years. Modest improvements in cardiometabolic preventive care were observed during follow-up. Statin utilization increased from 65.6% at baseline to 70.0% at 12 months, and LDL cholesterol declined modestly during the observation period. Conclusions: Multidomain screening integrated into routine HIV care identified a high prevalence of aging-related vulnerabilities among PLWH aged ≥50 years despite excellent virologic control. These findings suggest that aging-related risk in HIV is not adequately captured by chronological age alone and support early, universal implementation of multidomain screening within HIV care models. Full article

Background/Objectives: Breast Milk Feeding (BMF) benefits mother and infant. However, women with select risk factors report shorter breastfeeding durations. Our previous prospective cohort observational study of a lactation-consultant-led telephone-based support program in the first month postpartum increased BMF rates up to 6 months. This post hoc study further evaluated the program for mothers at increased risk of early breastfeeding cessation. Methods: We performed secondary analysis involving 762 mothers (control, n = 378; intervention, n = 384), recruited between 2018 and 2019. Infant feeding types, including BMF, were recorded at 1, 3 and 6 months. Feeding outcomes were analyzed in association with maternal risk factors. p-values, odds ratios and 95% confidence intervals were reported via both univariate (UVA) and multivariate regression analysis (MVA). Results: Via MVA, the intervention was associated with increased 6-month BMF rates in these groupings [OR (95%CI), p-value]: European [1.80 (1.07–2.96), p = 0.027]; South Asian [1.93 (1.19–3.13), p = 0.008]; employed [1.47 (1.02–2.12), p = 0.038]; unemployed [2.15 (1.33–3.50), p = 0.002]; married [1.71 (1.22–2.39), p = 0.002]; social support present [1.51 (1.05–2.16), p = 0.026]; chronic illness [1.93 (1.35–2.75), p = 0.001]; gestational diabetes mellitus [2.17 (1.19–3.95), p = 0.11]; overweight and obese [1.48 (1.03–2.12), p = 0.034]. A derived success score across the study period indicated via UVA associated increases in BMF rates with history of depression and anxiety (MI) [p = 0.044] and ongoing MI [p = 0.033], but these increases were smaller than that for no history of MI [p < 0.001]. No effect was observed in East/Southeast Asian mothers, Middle Eastern mothers, single or de facto mothers, older mothers, mothers without social support and mothers of any skill level. Conclusions: Although early postpartum telephone support was associated with a number of positive findings of improved BMF at 6 months and over the course of the study, the results were mixed. This suggests that future breastfeeding telephone-based initiatives need to be multifaceted in order to target mothers at risk of early breastfeeding cessation. Full article

Anxiety is a multidimensional construct that influences cognitive performance in complex ways, yet its factor structure and domain-specific effects remain unclear. This study examined (1) the psychometric structure of general and specific anxiety measures, (2) their associations with cognitive performance across different domains, and (3) the predictive power of machine learning models in classifying cognitive performance based on specific anxiety in different domains. A two-stage design was employed: Stage 1 (N = 500) assessed self-reported anxiety (trait, state, generalized, social, spatial, and math anxiety) via questionnaires, while Stage 2 (N = 104) involved a set of experiments measuring cognitive performance (accuracy and reaction time) across numerical, social, spatial, and control tasks. Factor analyses revealed a correlated yet distinct structure. The model treating anxiety measures as independent factors showed the best fit among tested alternatives; however, all CFA models exhibited suboptimal absolute fit indices (TLI/CFI < 0.73). Regression analyses also demonstrated domain-specific effects: after controlling for state and generalized anxiety, trait anxiety showed small but statistically significant positive associations with performance on the social task (OR = 1.03) and spatial task (OR = 1.07). Machine learning models (Random Forest, Decision Trees, SVM) demonstrated limited predictive accuracy, with ensemble methods outperforming linear models. Prediction of reaction time in cognitive tasks, based on anxiety measures, was less powerful, suggesting that non-anxiety factors play a larger role in cognitive performance. These findings highlight the importance of distinguishing between general and domain-specific anxieties in cognitive research and demonstrate the potential of a machine learning approach in modeling anxiety–performance relationships. Full article

People have become accustomed to studying or working with the guidance of artificial intelligence (AI) in recent years. Studies have begun investigating the risk factors of AI dependence, though most have used hypothesis-testing methods. The present study aimed to investigate predictors of AI dependence using machine-learning and network analysis, which are data-driven approaches. The included risk factors were Big Five personality traits, self-efficacy, depression, social anxiety, adverse childhood experiences, and AI use motivation, selected based on theories and empirical studies. Participants consisted of 1258 university students (942 females and 316 males) with a mean age of 22.11 years (SD = 2.69). Four machine-learning algorithms were tested, including Elastic Net, Random Forest, XGBoost, and LightGBM. Machine-learning results indicate that escape and social motivation for AI use, along with social anxiety, were the main predictors of AI dependence. Network analysis results show that escape and social motivation were the most central nodes, with the highest Expected Influence (EI) indices. This study indicates that when addressing mental health problems related to AI dependence, it is more effective to focus on emotional isolation and social interaction challenges rather than simply cutting down on AI use. Full article