The contributors to Actas Españolas de Psiquiatría include leading professionals whose work is known both nationally and internationally. The topics covered are diverse and fall within the fields of psychiatry, clinical psychology, and mental health. Most of the contributions are original articles, although we also publish scientific reviews. Our exhaustive selection process takes the utmost care to guarantee the quality that has become the hallmark of the Journal, whose reputation is based on more than 70 years of history. Actas Españolas de Psiquiatría indexes in: EMBASE, MEDLINE, PMC, SCI, SCOPUS, EBSCO, IBECS.
Impact of Structured Physical Exercise Programs (SPEs) on Symptoms and Clinical Outcomes in Schizophrenia: A Systematic Review With Qualitative Synthesis of Randomized Controlled Trials (2015–2025)
Background: People with schizophrenia present persistent deficits that are poorly responsive to pharmacological treatment, particularly including negative symptoms and cognition. Recent evidence indicates that structured physical exercise programs (SPEs) can modulate relevant neurobiological mechanisms and improve essential clinical outcomes. Given the heterogeneity of existing protocols, a systematic synthesis of this evidence is necessary. The aim of this study was to investigate the effects of SPEs on symptomatology, cognition, global functioning, and physical fitness in individuals with schizophrenia. Methods: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, with searches conducted in the PubMed/Medline, Scopus, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), Scientific Electronic Library Online (SciELO), Latin American and Caribbean Health Sciences Literature (LILACS), and Virtual Health Library (VHL) databases. Randomized clinical trials with adults diagnosed with schizophrenia who underwent structured exercise interventions were included. Initial searches identified 756 records, of which 16 studies were included in the review and comprised the final synthesis. Data extraction followed a standardized form, and study characteristics are described using descriptive statistics. Results: The included trials demonstrated consistent effects of different categories of physical exercise on negative symptoms, general symptoms, and overall functioning related to physical fitness, as well as improvements in cognitive aspects. A variety of SPE protocols were observed, as well as different intensities and instruments for evaluating the effectiveness of the interventions. Regarding intensity, it was noted that low-intensity SPEs also produced benefits, especially in institutionalized contexts; however, the metabolic effects were less consistent. Furthermore, the heterogeneity of the protocols influenced the magnitude of the results. Conclusions: SPEs generate positive clinical impacts that are adaptable to the needs of each patient, an essential aspect given the common barriers observed in the diagnosis of schizophrenia. The findings support the integration of SPEs into mental health services, as a component capable of expanding clinical and functional outcomes, and offering an accessible intervention aligned with the needs of this population.
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Gender Identity and Gender Dysphoria in Autism Spectrum Disorders: A Systematic Review
Background: Autism spectrum disorders (ASD) are a set of neurodevelopmental disorders characterised by social-communication deficits and repetitive behaviours. Research on gender differences in ASD has so far been limited although, recently, there has been increased interest in exploring how ASD relates to gender identity (GI) and gender disorders, such as gender dysphoria (GD); in this sense, some studies suggest a significant correlation between ASD and GD, finding that individuals with ASD more frequently exhibit GD traits compared to the general population. This article systematically reviews the relationship between ASD and GD on adults without cognitive impairment. Methods: The search was performed in the Web of Science (WOS) database, as well as in ScopusElsevier, PubMed, PsycInfo and Embase, with the keywords ”autism” AND ”gender”, “autism disorder” AND “gender”, “ASD” AND “gender”, limiting it by title and published since 2013, after the publication of the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders 5th Edition). Results: The screening process shows a low number of papers (12 articles) with diverse research methodologies and mostly small and convenience samples, composed of individuals from Western societies with a medium-high sociocultural background; four of them have focused on GD, four have studied GI, four both of them. The results indicate a relationship about ASD and diversity of GI, as well as a certain positive correlation between ASD and GD. Some studies also found influence of ASD on sexual orientation and on libido. Conclusions: It is suggested that ASD may influence GI formation and that may have some influence on GD. The importance of recognising diversity in GI in individuals with ASD, is emphasised for a better clinical support. This review highlights the need for further research with larger samples and more representative samples, including more gender-balanced samples, as most of the reviewed studies focused on males. The registration number in the International Prospective Register of Systematic Reviews PROSPERO is CRD42024360335.
Correction: Effects of Lactate on Improving Cognitive Function and Survival Rate in a Mouse Model of Post-Sepsis Cognitive Impairment
Prescribing Under Uncertainty: The Hidden Psychology of Psychiatric Decision-Making
Psychometric Properties of the MOLDES Questionnaire in a Clinical Sample of Patients With Psychotic Spectrum Disorders
Background: Psychotic spectrum disorders are associated with persistent impairments in psychosocial functioning that are not fully explained by symptom severity, particularly in individuals with chronic courses and prolonged hospitalization. Beyond psychopathological symptoms, relatively stable cognitive-emotional styles may influence long-term adaptation, subjective recovery, and quality of life in severe mental disorders. To examine the psychometric properties of the MOLDES questionnaire in a clinical sample of patients with psychotic spectrum disorders receiving long-term psychiatric care. Methods: A cross-sectional observational study was conducted in a sample of 83 clinically stable male patients with psychotic spectrum disorders hospitalized in a long-term psychiatric care unit. Internal consistency of the global MOLDES score and its three dimensions (Vital Spontaneity, Adjustment, and Optimization) was assessed using Cronbach’s alpha. Convergent and discriminant validity were explored through Spearman’s correlations with psychotic symptom severity, depressive symptoms, internalized stigma, and quality of life. Results: The global MOLDES score and its dimensions showed acceptable internal consistency, with Cronbach’s alpha values ranging from 0.70 to 0.77. No significant associations were observed between MOLDES dimensions and psychotic or depressive symptom severity, supporting discriminant validity. In contrast, Vital Spontaneity and Adjustment were negatively correlated with internalized stigma, while the Optimization dimension showed a positive association with quality of life. Conclusions: These findings provide preliminary evidence supporting the reliability and validity of the MOLDES questionnaire in patients with chronic psychotic disorders. The instrument appears to capture adaptive cognitive-emotional styles that are largely independent of symptom severity and meaningfully related to relevant psychosocial outcomes, suggesting its potential usefulness as a complementary assessment tool in long-term psychiatric care and rehabilitation-oriented settings.
Differential Effects of Morning Versus Afternoon Accelerated High-Frequency Repetitive Transcranial Magnetic Stimulation on Sleep Outcomes in Hospitalised Patients With Schizophrenia: Retrospective Cohort Study
Background: This study aimed to investigate the differential effects of accelerated high-frequency repetitive transcranial magnetic stimulation (aHF-rTMS) administered in the morning and afternoon on sleep outcomes in hospitalised patients with schizophrenia. Methods: This single-centre retrospective cohort study was based on existing inpatient records from the Department of Psychiatry at The Third People’s Hospital of Fuyang between November 2023 and May 2025. Eligible cases were identified from electronic medical records, nursing documentation and aHF-rTMS treatment logs. Patients were divided into a morning aHF-rTMS group and an afternoon aHF-rTMS group according to the predominant treatment-time category documented during hospitalisation. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), and nighttime sleep duration was obtained from nursing records. Psychiatric symptoms and cognitive function were assessed using the Positive and Negative Syndrome Scale (PANSS) and Montreal Cognitive Assessment (MoCA), respectively. The influencing factors of sleep outcomes at discharge were explored by multivariate linear regression analysis, and sensitivity analysis was performed using propensity score matching. Results: The two groups were comparable in baseline demographics, sleep parameters and psychiatric symptoms. During hospitalisation, both groups showed substantial improvement in sleep quality and psychiatric symptoms compared with those upon admission. The morning aHF-rTMS group had significantly lower total PSQI scores at discharge (p < 0.001) and longer nighttime sleep duration (β = 0.58, p < 0.001) than the afternoon aHF-rTMS group. Sensitivity analysis showed that morning aHF-rTMS remained associated with low total PSQI scores at discharge (β = −1.83, p < 0.001). No statistically significant differences in PANSS total scores and MoCA scores at discharge were found between the two groups (both p > 0.05). The overall incidence of adverse reactions was 44.44%, slightly higher in the morning group than in the afternoon group (54.02% vs. 35.48%, p = 0.012). Conclusions: The timing of aHF-rTMS treatment may be associated with sleep-related treatment outcomes in hospitalised patients with schizophrenia. Compared with afternoon treatment, morning aHF-rTMS was associated with better subjective sleep quality and longer nighttime sleep duration.
The Impact of Humanistic Postoperative Care Integrated With the 6S Management Model on Postoperative Delirium and Psychiatric Symptoms in Patients With Schizophrenia Undergoing Surgery
Background: To explore the effects of humanistic postoperative nursing integrated with the 6S management model on psychiatric symptoms, postoperative delirium and stress response in patients with schizophrenia undergoing surgery. Methods: This study adopted a retrospective research design, selecting 80 schizophrenia patients who underwent elective general surgery treatment at People’s Hospital of Pingyang between 1 August 2023 and 1 August 2025 as the research subjects. Based on the different treatment methods, the study subjects were divided into a control group (n = 40, receiving routine care) and an observation group (n = 40, receiving humanistic postoperative care integrating the 6S management model on the basis of routine care). Statistical analysis was used to examine the incidence of postoperative delirium, incidence of complications, stress response levels before and after nursing care, social function scores, Positive and Negative Syndrome Scale (PANSS) scores, and mental status scores in both groups. Results: The incidence of postoperative delirium and complications was lower in the observation group than in the control group. There were no significant differences in stress response levels, social function scores, PANSS scores, and mental status scores between the two groups before nursing care (p > 0.05). After nursing care, the observation group had lower stress response levels, PANSS scores, mental status scores and higher social function scores than the control group (p < 0.001). Conclusions: Humanistic postoperative nursing integrated with the 6S management model can reduce the incidence of postoperative delirium, complications, alleviate stressresponse, improve social function, and reduce psychiatric symptoms in patients with schizophrenia undergoing surgery.
Mortality Risks in Patients With Schizophrenia in Shanghai: A Longitudinal Cohort Study
Background: Schizophrenia is a severe mental disorder associated with significantly higher mortality risk than the general population, constituting a major public health challenge. Clarifying temporal trends in mortality among patients with schizophrenia helps inform targeted clinical and public health interventions. To assess changes in mortality rates over the last 2 years in patients with schizophrenia from one district of Shanghai, China. Methods: This longitudinal cohort study assessed the mortality of individuals with schizophrenia (n = 5234) from April 1, 2021, to March 31, 2023. The early cohort (up to March 31, 2022) contained 5207 individuals and the late cohort (up to March 31, 2023) contained 5114 individuals. Partitions of Pearson’s chi-square statistic were used to conduct pairwise comparisons. A multivariable Cox proportional hazards model was used to assess the effects of different factors on mortality risk. Data were drawn from the official Shanghai database used for following-up individuals with severe mental health disorders. Results: The total number of deaths was 370. Of these, 120 occurred in the early cohort (2.30% of the cohort) and 250 in the late cohort (4.89% of the cohort). Individuals with schizophrenia in the late cohort had a 5.08- fold increased mortality risk than individuals in the general population. In the early cohort, mortality rates remained relatively stable (0.29%–0.48%). There were peaks in mortality rates (2.23%) in December 2022 and January 2023. Men had a higher risk of mortality than women (hazard ratio [HR], 1.294; 95% confidence interval [CI], 1.035–1.618; p = 0.024). Age was a contributing factor to the mortality of people with schizophrenia (HR, 1.048; 95% CI, 1.040– 1.056; p < 0.001). Being unmarried (HR, 1.956; 95% CI, 1.522–2.513; p < 0.001), divorced (HR, 1.481; 95% CI, 1.010–2.170; p = 0.044), or widowed (HR, 1.334; 95% CI, 0.958–1.856; p = 0.088) was associated with a high risk of mortality. Age of onset (HR, 1.046; 95% CI, 1.037– 1.054; p < 0.001) and illness duration (HR, 1.044; 95% CI, 1.037–1.051; p < 0.001) were associated with high mortality risk. The late cohort showed a higher mortality rate than the early cohort (HR, 2.427; 95% CI, 1.467–4.014; p = 0.001). The mortality of patients with schizophrenia was notsignificantly related to education level, economic status, or symptom onset. Conclusions: These findings highlight trends in schizophrenia mortality since April 2021. Compared with the general population, individuals with schizophrenia had higher mortality risk, particularly adults aged ≥65 years and women with low education.
Bridging Three Decades: Global Self-Harm Trends From 1990–2021 and Projections to 2040
Background: Self-harm, which includes both nonsuicidal self-injury and suicidal behaviors, poses a major global public health challenge. This study provides a comprehensive analysis of trends in self-harm worldwide, the socioeconomic disparities associated with it, and future projections, using data from the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2021. Methods: Self-harm data were extracted from GBD 2021, including incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years(DALYs) for 204 countries and territories from 1990 to 2021. Age-standardized rates and estimated annual percentage change (EAPC) were calculated. Inequality was assessed using the Slope Index of Inequality (SII) and Concentration Index (CI). Autoregressive Integrated Moving Average (ARIMA) models were employed to generate projections of self-harm burden from 2022 to 2040. Results: The global burden of self-harm is projected to change substantially by 2040, with deaths estimated to increase to 829,853 (95% Uncertainty Interval (UI), 262,233–1,397,474) and prevalence projected to rise to 35,863,341 (95% UI, 8,079,108–63,647,574) cases (representing a 131.9% increase from the 2021 baseline of 15,467,153 cases). From 1990 to 2021, age-standardized rates of self-harm demonstrated decreasing trends globally and across sociodemographic index (SDI) levels, with the largest declines observed in high-middle SDI countries. Gender disparities were evident, with more pronounced decreases in females. Inequalities in DALYs due to self-harm decreased over time but remained higher among females in lower-SDI populations. Conclusions: Despite decreasing age-standardized rates, the global burden of self-harm is projected to increase substantially by 2040, with driven by increasing incidence and prevalence in incidence and prevalence. Inequities persist, particularly among females in lower-SDI populations. Implementation of targeted prevention and intervention strategies, strengthening of mental health systems, and addressing social determinants of health are imperative to reduce the growing burden of self-harm worldwide.
Risk Factors for First-Attempt Suicide Fatalities: Evidence From the MCOSUL Cohort
Background: Individuals who die by suicide may differ depending on whether the fatal act istheir first attempt or follows previous non-fatal attempts. Understanding these differences may help refine prevention strategies. Methods: We conducted a cross-sectional analysis within the MCOSUL Cohort, a clinical registry of all patients treated for a suicide attempt in two general hospitals in Lleida, Spain. We included all cohort members who died by suicide between January 2009 and December 2022. Sociodemographic, clinical, and method-related variables were compared between first-attempt and repeat-attempt fatalities. Variables with p < 0.20 in bivariate analyses were entered into a multivariable logistic regression model to identify independent predictors of first-attempt fatalities. Results: Among 117 suicide deaths, 38 (32.5%) occurred at the first attempt and 79 (67.5%) after one or more prior non-fatal attempts. Repeat-attempt fatalities had a mean of 1.89 (SD = 1.73) attempts from cohort entry to death. In multivariable analysis, unemployment (OR = 0.17, 95% CI: 0.04–0.66, p = 0.011) and recognized disability (OR = 0.20, 95% CI: 0.04–0.80, p = 0.035) were less frequent among first-attempt fatalities, indicating they were more common in those who died after repeated attempts. No significant differences were found for age, sex, alcohol use, psychiatric diagnosis, or fatal attempt method. Conclusions: Unemployment and recognized disability (formal legal/administrative disability certification issued by relevant regional authorities, which may encompass physical and/or psychiatric disabilities) appear to characterize individuals who die by suicide after a series of non-fatal attempts, suggesting a subgroup with a more prolonged suicidal course that may benefit from sustained engagement and prevention strategies.
Age-Stratified Analysis of Social Environmental Drivers of Depression Among Chinese Young People Aged 10–24 Years
Background: This study aimed to evaluate the effect of key social environmental determinants on trends in depression burden amongst Chinese adolescents aged 10–24 years and to examine the age- and gender-specific variations and lagged effects of these factors. Methods: Nationwide data spanning 2003–2021 were collected from the Global Burden of Disease database for depression burden indicators, World Bank socioeconomic datasets and the Chinese General Social Survey for education and social metrics. The primary variables analysed were gross domestic product (GDP) per capita, higher education enrolment rate (HEER), per capita current health expenditure and urban population percentage. Descriptive statistics and Pearson correlations were used to explore variable distributions and associations. Mixedeffects regression models quantified relationships between social factors and depression burden, and autoregressive distributed lag models assessed short-term lagged effects across age groups(10–14, 15–19 and 20–24 years). Interaction terms (HEER × total public expenditure on education (TPEE); unemployment × dependency ratio) were included on the basis of theoretical and empirical support from prior studies. Results: Between 2003 and 2021, the overall burden of depression amongst young Chinese people decreased, but the 10- to 14-year age group showed a notable upward trend in disability‑adjusted life‑years since 2017. High GDP per capita, urbanisation and per capita health expenditure were significantly associated with reduced depression burden (p < 0.05). Conversely, increasing HEER— indicative of rising educational competition—was associated with a high disease burden, particularly amongst females aged 15–19 and 20–24 years. Short-term lagged effects revealed that the psychological burden of education competition manifested within 1 year, particularly amongst younger adolescents. Economic improvements and health investments exerted protective lagged effects. Age-stratified analyses underscored distinct vulnerability patterns: 10- to 19-year-olds were highly sensitive to family and educational support, and 20- to 24-year-olds were greatly affected by social structural pressures. Pearson correlation analysis identified significant negative associations between several social factors and depression burden. The mechanisms were explained by China-specific social contexts and data characteristics. Conclusions: This nationwide longitudinal study reveals that multidimensional social determinants exert age- and gender-specific influences on depression burden amongst young Chinese people aged 10–24 years. The findings emphasise the urgent need for stratified policies, including enhancing family and educational support for individuals under 20 years old and reducing structural social pressures on young adults. Public mental health interventions should target these modifiable social determinants to reduce the depression burden and improve well-being.
Psychiatrists’ Knowledge, Attitudes, and Practices Regarding the Use of Modified Electroconvulsive Therapy in Adolescents With Major Depressive Disorder: A Cross-Sectional Survey in Chongqing, China
Background: Adolescent major depressive disorder (MDD) is a serious condition often resistant to treatment. Despite established efficacy in adults, modified electroconvulsive therapy (MECT) remains limited and controversial in youth. This study examined psychiatrists’ knowledge, attitudes and practices (KAPs) regarding MECT for adolescent MDD, along with their interrelationships and associated factors. Methods: A cross-sectional online survey was conducted (May–July 2025) amongst psychiatrists in Chongqing, China. Using a validated KAP questionnaire, data were collected via WeChat and examined via descriptive, correlation and regression analyses. Results: Amongst the 125 questionnaires distributed, 113 valid responses were analysed (90.4%). Psychiatrists showed moderate knowledge (3.31 ± 0.88), positive attitude (3.68 ± 0.51) and moderate practice (3.09 ± 0.98) levels regarding MECT. KAPs were positively correlated. Higher professional level (attending physician: β = 0.374, p = 0.007; associate senior or above: β = 0.470, p = 0.004) significantly predicted greater knowledge. Better knowledge (β = 0.225, p = 0.028) predicted more positive attitude. Higher knowledge (β = 0.496, p < 0.001) and attitude (β = 0.226, p = 0.006) significantly predicted greater MECTrelated practice. Working in a specialized psychiatric hospital (β = –0.525, p < 0.001) and clinical experience greater than 20 years (β = 0.324, p = 0.030) were significantly associated with practice. Conclusions: Psychiatrists in Chongqing showed positive attitude but only moderate knowledge and practice regarding MECT for adolescent MDD. Enhancing clinician education and addressing patient- and system-level barriers may help promote appropriate MECT use.
Effects of Neuromuscular Electrical Stimulation of Gluteus Medius Muscle on Hip Function and Sleep Quality in Patients With Sleep Disorders After Hip Arthroplasty
Background: This study aimed to investigate the effects of neuromuscular electrical stimulation (NMES) of gluteus medius on hip function and sleep quality in patients with sleep disorders after hip arthroplasty (HA). Methods: This retrospective analysis included 100 patients who underwent HA between January 2022 and August 2025 and developed postoperative sleep disorders. Patients were divided into in a control group (n = 45) and an NMES group (n = 55) based on the treatment received. The NMES group received NMES applied to the gluteus medius; both groups were treated for 4 weeks. Patient data extracted from the medical record system included hip function scores and sleep records: visual analogue scale (VAS), Harris Hip score, Berg Balance Scale (Berg) score, and Pittsburgh Sleep Quality Index (PSQI) score. These measures were compared between the two groups before and after treatment. Therefore, the correlation between VAS score and PSQI score was analysed. Results: After treatment, hip function and sleep quality improved in both groups. VAS scores decreased significantly after 4 weeks of treatment in both groups (p < 0.05), with the NMES group showing lower scores than the control group (p < 0.05), Harris and Berg scores increased significantly in both groups(p < 0.05), and both were higher in the NMES group (p < 0.05). The PSQI score in the NMES group was lower than that in the control group (p < 0.05). Correlation analysisshowed a strongly positively correlated between VAS and PSQI scores in both groups before treatment (p < 0.05); after treatment, a weak positive correlation remained in the NMES group, whereas a moderate positive correlation persisted in the control group. Conclusions: Applying NMES to the gluteus medius is associated with reduced pain intensity in patients with sleep disorders after HA. This may contribute to improved sleep quality and help alleviate the reciprocal interaction between pain and sleep disorders.
The Effect of Comfort Nursing in Operating Room on Anxiety Depression and Postoperative Recovery in Thyroidectomy Patients With Coexisting Sleep Disorders
Background: This study aimed to evaluate the effects of comfort nursing in the operating room on anxiety, depression and postoperative recovery in thyroidectomy patients with sleep disorders. Methods: This retrospective analysis included 156 propensity-score-matched patients undergoing thyroidectomy at Taizhou Second People’s Hospital (January 2023– September 2025). The patients were assigned to conventional care (n = 78) or comfort nursing (n = 78). Outcomes included Hospital Anxiety and Depression Scale (HADS), Pittsburgh Sleep Quality Index (PSQI), polysomnography (PSG), Quality of Recovery-15 (QoR-15), Visual Analogue Scale (VAS), thyroid cancer-specific quality of life (THYCA-QoL), recovery indices, complications and satisfaction. Results: Repeated-measures ANOVA revealed significant time, group and interaction effects for HADS-A, HADS-D and PSQI scores (all p < 0.001). Both groups improved postoperatively, with the comfort group showing greater reductions at 5 days and 4 weeks (p < 0.05). PSG parameters (total sleep time, sleep efficiency, REM%, sleep latency and microarousals) also improved in both groups, with superior outcomes in the comfort group (p < 0.05). Comfort nursing was associated with short times to first flatus and ambulation, reduced hospital stay, low choking incidence and high normal swallowing rate at 72 hours (p < 0.05). Complication rates did not differ between groups (p > 0.05). The comfort group achieved higher QoR-15 and lower VAS scores on days 1–3 (p < 0.001) and lower THYCA-QoL anxiety, psychological and sensory scores at 4 weeks (p < 0.001). Satisfaction was higher in the comfort group (84.62% vs. 69.23%, p < 0.05). Conclusions: Operating room comfort nursing alleviates anxiety and depression, improves sleep architecture, promotes early recovery and enhances quality of life and satisfaction in thyroidectomy patients with sleep disorders.
Emotional and Behavioural Problems Including Anxiety and Depressive Symptoms Across Tanner Stages in Girls With Central Precocious Puberty: A Retrospective Clinical Study
Background: To examine the Tanner stage–specific patterns of psychological and behavioural problems in girls with central precocious puberty (CPP) and to identify clinical predictors of clinically significant psychological impairment. Methods: This retrospective cross-sectional study included 116 girls with CPP treated between January 2020 and December 2024. Clinical data were extracted from electronic medical records. Pubertal development was classified by breast Tanner staging into stage II (n = 32), stage III (n = 42) and stages IV–V (n = 42). Psychological outcomes were evaluated using the age-standardised Child Behavior Checklist (CBCL) T-scores. For participants aged ≥7 years, depressive and anxiety symptoms were assessed using the Children’s Depression Inventory and the Screen for Child Anxiety Related Emotional Disorders. The independent predictors of clinically significant psychological problems were identified through logistic regression analysis, defined as CBCL Total Problems T-score of ≥64, and model performance was assessed using receiver operating characteristic curve analysis. Results: The mean CBCL Total Problems T-score was 58.6 ± 12.4, and 50 girls (43.1%) had clinically significant psychological problems. Psychological burden increased across Tanner stages. The CBCL Total T-scores were 52.4 ± 10.8 in stage II, 58.6 ± 11.6 in stage III and 65.8 ± 13.2 in stages IV–V (p < 0.001). The prevalence of clinically significant problems increased from 21.9% to 40.5% and 61.9% (p = 0.002). Internalising symptoms showed a stronger stage-related pattern than externalising symptoms. Early age at onset was associated with increased symptom severity (r = −0.385, p < 0.001). Multivariable analysis identified Tanner stages IV–V versus stage II (odds ratio [OR] = 2.94, 95% confidence interval [CI]: 1.44–5.99, p = 0.003), younger age at onset (OR = 0.72, 95% CI: 0.55– 0.94, p = 0.016), higher peak luteinising hormone (LH) (OR = 1.45, 95% CI: 1.08–1.95, p = 0.014) and family history of early puberty (OR = 2.18, 95% CI: 1.26–3.77, p = 0.005) as independent predictors. The prediction model showed good discrimination (area under the curve = 0.812, 95% CI: 0.738–0.886). Conclusions: Girls with CPP experience substantial psychological burden, and risk increases with pubertal stage. Advanced Tanner stage, earlier pubertal onset, increase in peak LH and family history are indicators for enhanced psychological monitoring and support.
Suicidal Ideation and Non-suicidal Self-injury in Early Adolescence: The Role of ADHD Symptoms, Affect, and Emotion Regulation
Background: Suicidal ideation and non-suicidal selfinjury (NSSI) are highly prevalent during early adolescence and represent serious public health concerns. Emotional dysregulation has been identified as a transdiagnostic factor underlying various risk behaviors, particularly in youth with externalizing difficulties such as attentiondeficit/hyperactivity disorder (ADHD). While prior research has examined these factors independently, few studies have explored their joint and differential contribution to suicide-related outcomes in early adolescence. This study aimed to examine the association of ADHD-related symptoms, positive and negative affect, and emotional dysregulation with suicidal ideation and NSSI, as well as to explore whether emotional dysregulation moderates the relationship between ADHD-related symptoms and these risk behaviors. Methods: A total of 1079 Spanish adolescents (Mage = 12.6 years, SD = 0.6) enrolled in the first year of compulsory secondary education participated in a cross-sectional study. Standardized self-report measures were used to assess ADHD-related symptoms (Strengths and Difficulties Questionnaire [SDQ]), affect (Positive and Negative Affect Schedule for Children and Adolescents [PANAS-N]), and difficulties in emotion regulation (Difficulties in Emotion Regulation Scale [DERS-18]), alongside indicators of suicidal ideation and NSSI. Data analysis included group comparisons and hierarchical logistic regression models. Results: Suicidal ideation was reported by 10.1% of participants, and NSSI by 16.4%. Adolescents with either behavior exhibited significantly more hyperactivityinattention symptoms, greater negative affect, lower positive affect, and substantially elevated emotional dysregulation. In regression analyses, ADHD-related symptoms remained significant predictors after accounting for affect, although emotional dysregulation emerged as the strongest predictor, reducing the effects of other variables. Specific dimensions such as lack of emotional clarity and nonacceptance of emotional responses were associated with suicidal ideation, while impulse control difficulties and lack of adaptive strategies predicted NSSI. No moderation effects were found. Conclusions: ADHD-related symptoms and emotional dysregulation both contribute independently to adolescent suicidal ideation and NSSI, with emotional dysregulation showing the most robust predictive value. Schoolbased prevention efforts should incorporate emotion regulation skill-building to reduce suicide risk and NSSI in early adolescence.
Associations Between Miscarriage and Postpartum Depression, Perceived Social Support, and Medical Needs in Pregnant Women: A Single-Center Retrospective Study
Background: Fetal loss constitutes a major obstetric adverse outcome, and is frequently followed by marked psychological distress; the prevalence of depressive symptoms after fetal loss is substantially higher, and this elevation is intertwined with psychosocial determinants whose clinical profiles and intervention targets await systematic synthesis. This study examines the clinical characteristics and psychosocial determinants of maternal depression following fetal loss, aiming to inform targeted psychological support strategies. Methods: Thisretrospective study included 200 mothers following fetal loss (fetal loss group) and 200 mothers after normal delivery (term delivery group), selected via 1:1 nearest-neighbour propensity score matching (PSM) between June 2022 and October 2025. At 42 days postevent, participants in both groups completed the Edinburgh Postnatal Depression Scale (EPDS), Hospital Anxiety and Depression Scale (HADS), Multidimensional Scale of Perceived Social Support (MSPSS), and the Olson Marital Quality Questionnaire (ENRICH). Depression was defined as EPDS ≥13. Depression prevalence and scale scores were compared between groups, and multivariable logistic regression identified risk factors associated with depression. Changes in EPDS score reduction (Δ = score at 3 months postpartum – baseline score) was compared between those who received and those who did not receive clinical management. Results: Following PSM, baseline characteristics were well-balanced between the two groups(p > 0.05). The prevalence of depression was significantly higher among women with the fetal lossthan among those with term delivery group (35.0% vs. 8.50%, p < 0.05). Multivariate analysis identified fetal loss as an independent predictor of depression (odds ratio (OR) = 2.84, 95% confidence interval (CI): 1.96–4.12). EPDS scores were significantly higher in the fetal loss group than in the term delivery group (13.1 ± 4.0 vs. 8.5 ± 2.0, p < 0.001). The predominant symptoms included persistent low mood (87.1%), insomnia (75.7%), guilt or self-blame (68.6%) and fear or avoidance of future pregnancy (62.9%). Within the fetal loss group, Low social support (OR = 3.15), marital dissatisfaction (OR = 2.43), ≥2 abortions (OR = 1.98), and lack of clinical management (OR = 2.27) were independently predicted depression. Only 27.6% of affected mothers received treatment, and this was associated with significantly greater improvement in EPDS scores (△ = –5.2 ± 2.4 vs. –1.9 ± 2.0, p < 0.001). Conclusions: Fetal loss is associated with a substantially increased risk of maternal depression, characterized by self-blame and fear of future pregnancy. Modifiable factors including low social support and absent professional care, are associated with more persistent depressive symptoms. These Findings support the intervention integration for high-risk mothers, although further validation is required.
Effects of Enhanced Recovery After Surgery-Based Nursing on Kinesiophobia and Anxiety-Depression in Elderly Patients After Hip Arthroplasty: A Retrospective Cohort Study
Background: Elderly patients undergoing hip arthroplasty frequently experience postoperative pain, limited mobility, and negative psychological states, which adversely affect rehabilitation outcomes. This study aimed to investigate the effect of Enhanced Recovery After Surgery (ERAS) on kinesiophobia, anxiety, and depression in elderly patients after hip arthroplasty. Methods: A single-centre retrospective cohort study of 132 elderly patients who underwent hip arthroplasty was conducted. Relevant data were extracted from the hospital medical record system. Based on the documented nursing approach, patients were classified into a control group that received routine nursing and a study group that received ERAS-based nursing. Kinesiophobia, anxiety, depression, hope level, hip function, health-promoting lifestyle, pain intensity, and quality of life were assessed using Tampa Scale for Kinesiophobia (TSK), Hamilton Anxiety Scale (HAMA), 17-item Hamilton Depression Scale (HAMD17), Herth Hope Index (HHI), Harris Hip Score (HHS), Health-Promoting Lifestyle Profile II (HPLP-II), and Visual Analogue Scale (VAS), as recorded in the medical records before and after nursing intervention. Results: There were no significant differencesin baseline characteristics or pre-nursing care scores between the two groups (p > 0.05). After nursing care, both groups showed significant improvements in all outcomes (p < 0.05). Specifically, the study group demonstrated significantly lower TSK, HAMA, HAMD-17, and VAS scores and higher HHI, HHS, and HPLP-II scores compared with the control group (p < 0.05). Conclusions: The findings of this study suggest that ERAS-based nursing may alleviate negative emotions, reduce pain, promote functional recovery, and improve quality of life in elderly patients after hip arthroplasty.
Effect of PERMA Model on Anxiety, Depression, Post-Traumatic Stress Symptoms and Quality of Life in Patients With Scar Plastic Surgery After Burn
Background: This study aimed to explore how Positive Emotion, Engagement, Relationships, Meaning, and Accomplishment (PERMA)-based nursing anxiety, depression, post-traumatic stress symptoms (PTSD) and quality of life in patients with post-burn scar plastic surgery. Methods: A retrospective cohort study was conducted using data from patients who underwent scar plastic surgery for burn-related scar at our hospital between January 2023 and January 2025. Based on the type of nursing care they received, we divided patients into two groups: 51 patients who received PERMA-based nursing were assigned to the PERMA nursing group, and 51 patients who received routine nursing only were assigned to the routine nursing group. Both groups received 12 weeks of nursing care. We assessed all outcome measures, including the Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), PTSD Checklist-Civilian Version (PCLC), Simplified Coping Style Questionnaire (SCSQ), SelfAcceptance Questionnaire (SAQ), and Generic Quality of Life Inventory-74 (GQOL-74), were assessed at baseline and again after the 12-week nursing period in both groups. Pearson correlation analysis was performed to evaluate the relationships among the psychological improvement scores. Results: After the nursing intervention, both groups showed decreases in SAS scores, SDS scores, PCL-C scores, and negative coping scores of both groups decreased after the nursing, and those of the PERMA nursing group were lower (p < 0.05). The positive coping scores and SAQ scores of both groups increased, and those of the PERMA nursing group were higher (p < 0.05). The GQOL-74 scores of both groups increased after the nursing, and those of the PERMA nursing group were higher (p < 0.05). Correlation analysis revealed that anxiety relief (∆SAS) was significantly tied to improvements in both depression and PTSD symptoms. Furthermore, reductions in negative coping strategies (∆negative coping) acted as a key factor that correlated with lower levels of anxiety and traumatic stress. Conclusions: PERMA-based nursing is associated with reduced anxiety, depression, and PTSD symptoms, as well as improved coping strategies, self-acceptance, and improved quality of life in patients undergoing scar plastic surgery after burn.
Clinical Characteristics and Influencing Factors of Depressive Symptoms in Patients With Vascular Cognitive Impairment
Background: This study aimed to characterize depressive symptoms in patients with vascular cognitive impairment (VCI) after ischemic stroke and to identify independent predictors of treatment response to antidepressant therapy, with a focus on lesion-location heterogeneity. Methods: This retrospective observational cohort study enrolled 224 patients with VCI and concomitant depressive symptoms from June 2022 to June 2024. Depression severity was assessed using the 17-item Hamilton Depression Rating Scale (HAMD-17). All patients completed 8 weeks of standardized treatment including antidepressant medication and cognitive rehabilitation. Treatment response was defined as ≥50% reduction in HAMD-17 from baseline to week 8. Lesion locations were categorized into eight mutually exclusive anatomical groups (frontal, temporal, parietal, occipital, basal ganglia/internal capsule, thalamus, pons and cerebellum). Univariate and multivariable logistic regression identified predictors of treatment response, and Receiver Operating Characteristic (ROC) analysis evaluated model performance. Results: Mean baseline HAMD-17 was 27.4 ± 3.1, and 65.2% (146/224) achieved treatment response. Baseline depressive symptom severity differed significantly across lesion locations (one-way analysis of variance (ANOVA): F (7,216) = 3.48, p = 0.001), whereas baseline anxiety severity did not (F (7,216) = 0.72, p = 0.652). In multivariable analysis, lower baseline Hamilton Anxiety Rating Scale (HAMA) score (odds ratio (OR) = 0.93, 95% confidence interval (CI): 0.88–0.98, p = 0.006), shorter time since stroke (OR = 0.86 per month, 95% CI: 0.75 to 0.99, p = 0.034), and higher education-adjusted Montreal Cognitive Assessment (MoCA) score (OR = 1.12 per point, 95% CI: 1.01–1.24, p = 0.031) were independently associated with treatment response. The prediction model demonstrated moderate discriminative ability (area under the curve (AUC) = 0.795, 95% CI: 0.738–0.851), with sensitivity of 0.890 and specificity of 0.608 at the optimal cutoff. Conclusions: Depressive symptom burden in poststroke VCI exhibits significant anatomical heterogeneity across lesion locations. Baseline anxiety severity, disease duration, and baseline cognitive performance moderately predict treatment response, supporting early risk stratification and individualized management.
Relationship Between Postoperative Pain in Surgery and the Onset of Psychological Symptoms Such as Mental Anxiety and Depression
Background: Postoperative pain is not only a primary source of physical discomfort but also a significant risk factor that can trigger or exacerbate mental and psychological symptoms such as anxiety and depression. This study aimed to explore the interrelationship between postoperative pain and mental psychological symptoms, such as anxiety and depression, and analyse the risk factors influencing postoperative mental psychological symptoms. Methods: This study retrospectively collected clinical data of 411 surgical patients from March 2023 to April 2025 through an electronic medical record system. The Numeric Rating Scale (NRS) was used to assess preoperative and postoperative pains during rest and exercise. Postoperative pain was defined as a resting or exercise-evoked NRS score > 3 (moderate to severe pain). The Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety (Hospital Anxiety and Depression Scale-Anxiety [HADS-A]) and depression (Hospital Anxiety and Depression ScaleDepression [HADS-D]). The relationship between postoperative pain and psychological symptoms, such as anxiety and depression, was explored through Spearman’s correlation analysis and univariate and multivariate logistic regression analysis. Results: After surgery, 59.12% (243/411) of patients had chronic postsurgical pain (CPSP), 36.25% (149/411) had anxiety symptoms (HADS-A > 7) and 31.63% (130/411) had depression symptoms (HADS-D > 7). Regarding surgical specialty, orthopaedic surgery patients had the highest proportion of CPSP, accounting for 63.64% (91/143) of orthopaedic cases, which represented 22.14% (91/411) of the total cohort. Gynaecologic surgery patients showed the highest rates of postoperative anxiety (41.76%, 38/91) and depression (45.05%, 41/91) within their specialty. After surgery, the average resting and exercise NRS scores of patients were significantly reduced compared with preoperative levels (both p < 0.01). However, the average HADS-A and HADS-D scores were significantly higher than before surgery (p < 0.01). Spearman’s correlation analysis showed that postoperative resting NRS score was positively correlated with exercise NRS, HADS-A and HADS-D scores (p < 0.01). The correlation between HADS-A score and HADS-D score was not strong, whereasthe correlation between exercise NRS score and these psychological indicators was strong. Multivariate logistic regression analysis showed that postoperative pain is an independent risk factor for the occurrence of mental symptoms. Conclusions: A statistically significant mutual association exists between postoperative pain and psychological symptoms in surgery.
ADHD, Subtypes and Cognitive Performance: WISC-V as a Support Tool for Diagnostic Assessment
Background: Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental condition characterized by impairments in working memory (WM) and processing speed (PS). Previous studies using earlier editions of the Wechsler Intelligence Scale for Children (WISC) have identified a cognitive response pattern defined by lower Cognitive Proficiency Index (CPI). However, evidence using the Wechsler Intelligence Scale for ChildrenFifth Edition (WISC-V) remains limited. This study aimed to examine whether the WISC-V identifies a characteristic cognitive profile in ADHD and to evaluate its discriminative capacity. Methods: The sample consisted of 188 participants aged 6–16 years, including a control group (n = 56) and two clinical ADHD groups: The combined presentation of ADHD (ADHD-C; n = 57) and the predominantly inattentive presentation of ADHD (ADHD-I; n = 75). Cognitive functioning was assessed using the WISC-V. Group differences were examined using Multivariate and Univariate Analyses of Covariance (MANCOVA/ANCOVA). Binary logistic regression analyses were conducted to evaluate the predictive capacity of WISC-V. Results: Compared with controls, the clinical ADHD group showed significant multivariate differences. Univariate analyses revealed significantly lower performance in the working memory index (WMI; p < 0.001), processing speed index (PSI; p < 0.001), CPI (p < 0.001), and Full-Scale Intelligence Quotient (FSIQ; p = 0.005), in the clinical ADHD group. Differences between ADHD-C and ADHD-I were observed, with the ADHD-I group showing lower scores in WMI (p = 0.016), PSI (p < 0.001), CPI (p < 0.001), and FSIQ (p = 0.016). Logistic regression analyses indicated that WMI (B = −0.067; p < 0.001), PSI (B = −0.043; p = 0.007), and CPI (B = −0.091; p < 0.001) significantly predicted control versus clinical ADHD group membership. When comparing ADHD presentations, PSI (B = −0.055; p = 0.001) and CPI (B = −0.063; p < 0.001) emerged as significant predictors. Conclusions: The findings support the use of the WISC-V as a complementary tool in the diagnostic assessment of ADHD.
Predictive Value of Anxiety State During Acute Herpes Zoster for the Development of Postherpetic Neuralgia
Background: Postherpetic neuralgia (PHN) remains the most frequent and distressing sequela of herpes zoster (HZ). Although psychological factors are known to contribute to chronic pain, their role during the acute phase of HZ in predicting PHN has not been fully clarified. This study aimed to investigate whether acute-phase anxiety is independently associated with subsequent PHN development and to evaluate the added predictive value of anxiety assessment in clinical prediction models. Methods: This longitudinal cohort study enrolled 99 patients with acute HZ between January 2022 and January 2025. Anxiety was assessed at baseline using the Hospital Anxiety and Depression Scale-Anxiety subscale (HADSA) and the State-Trait Anxiety Inventory-State subscale (STAI-S). PHN was defined as pain lasting at least 90 days after rash onset. We performed logistic regression to identify independent predictors and constructed receiver operating characteristic (ROC) curves to evaluate predictive performance. Results: The 3 months incidence of PHN was 41.4% (41/99). Patients who developed PHN had significantly higher baseline HADS-A scores (10.7 ± 3.8 vs. 6.4 ± 3.2, p < 0.001) and STAI-S scores (52.8 ± 10.4 vs. 41.3 ± 9.7, p < 0.001) than those who did not. Multivariate analysis identified three independent predictors: age (adjusted odds ratio [OR] = 1.47 per 10 years, p = 0.038), baseline pain intensity (adjusted OR = 1.41, p = 0.012), and HADS-A score (adjusted OR = 1.31 per unit, p = 0.001). Clinically significant anxiety (HADS-A ≥ 8) was associated with a 4.52-fold increased risk of PHN (95% confidence interval: 1.72–8.58, p = 0.013). HADS-A demonstrated good discriminative ability (area under the curve [AUC] = 0.813), and a combined model incorporating anxiety with clinical variables achieved superior predictive performance (AUC = 0.876 vs. 0.762, p = 0.019). Conclusions: Acute-phase anxiety is an independent and clinically meaningful predictor of PHN. Adding anxiety assessment to clinical evaluation significantly improves risk prediction accuracy, supporting routine psychological screening and early intervention in patients with HZ.
Effect on Cognitive Behavioral Therapy Combined With Transcranial Direct Current Stimulation on Anxiety and Depression in Stroke Patients With Dysphagia
Background: This study aimed to investigate the association between cognitive behavioural therapy (CBT) combined with transcranial direct current stimulation (tDCS) on negative mood states, such as anxiety and depression, in patients with post-stroke dysphagia through a retrospective review of medical records. Methods: A retrospective study was conducted using medical records of patients with post-stroke dysphagia who were hospitalised at The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University between January 2022 and June 2025. Sample size matching was performed using the nearest neighbour matching method in propensity score matching on the basis of data extracted from medical records, ultimately including 348 study subjects for analysis. Based on the treatment regimens documented in the medical records, 174 patients in the combination group received CBT combined with tDCS, and 174 patients in the control group received tDCS alone. Basic rehabilitation measures were consistent between the two groups as per clinical protocols. Both groups completed a continuous 4-week treatment course as recorded in the medical charts. Data on the grading of the water swallowing test, surface electromyography parameters, the Stigma Scale for Chronic Illness (SSCI) score, the Herth Hope Index (HHI) score, the Self-Rating Anxiety Scale (SAS) score and the Self-Rating Depression Scale (SDS) score were extracted from the medical records at baseline (within 48 h before treatment initiation) and after the 4-week treatment period. Results: Following the 4-week treatment period, the overall distribution of water swallowing test grades documented in the medical records for the combination group was superior to that for the control group (p < 0.05). At baseline, no statistically significant differences were found in the surface electromyography parameters (average and maximum amplitudes) retrieved from the records between the two groups (p > 0.05). After the 4-week treatment period, the recorded values for average and maximum amplitudes in the combination group were significantly higher than those in the control group (p < 0.05). At baseline, no statistically significant differences were observed in various stigma scale scores extracted from the records between the two groups (p > 0.05). After the treatment period, the scores for internalised stigma and the total SSCI score in the combination group were significantly lower than those in the control group (p < 0.05). At baseline, no statistically significant differences were noted in any dimension scores of HHI between the two groups (p > 0.05). After the treatment period, the scores for positive attitude toward reality and the future, positive actions taken and maintaining close relationships with others and the total HHI score were all markedly higher in the combination group than in the control group (p < 0.05). At baseline, no statistically significant differences were observed in the SAS and SDS scores between the two groups (p > 0.05). After the treatment period, the SAS and SDS scores in the combination group were evidently lower than those in the control group (p < 0.05). Conclusions: The combination of CBT and tDCS was associated with improved swallowing function; reduced stigma, depression and anxiety; and increased hope levels in patients with post-stroke dysphagia.
The Impact of Emergency Department Process Optimization Combined With Health Education on the Treatment Outcomes and Anxiety and Depression in Patients With Acute Ischemic Stroke
Background: To explore the association between an optimised emergency procedure combined with structured health education and anxiety, depression and treatment outcomes in patients with acute ischaemic stroke (AIS). Methods: We conducted a retrospective cohort study of 114 AIS patients admitted to our stroke centre between January and December 2023. On the basis of the admission timeframe, patients were divided into a conventional care group (n = 57, January to June 2023, routine care) and a comprehensive nursing group (n = 57, July to December 2023, optimised integrated care). Emergency nursing outcomes were assessed after stabilisation and before ward transfer. Neurological recovery was assessed with the European Stroke Scale (ESS); anxiety and depression were assessed with the Generalized Anxiety Disorder-7 (GAD7) and Patient Health Questionnaire-9 (PHQ-9) as primary psychological indicators. Process times and nursing satisfaction were also evaluated. Data analysis was conducted using SPSS 27.0. Normality was verified using the ShapiroWilk test. Normally distributed data were expressed as mean ± standard deviation and analysed using an independent samples t-test, whereas non-normal data were expressed as median (interquartile range) and analysed using the Mann-Whitney U test. Categorical data were analysed using chi-square test. Multivariate linear and logistic regression were used to analyse indicators such as neurological function and nursing satisfaction, adjusting for confounding factors. A p-value < 0.05 was considered statistically significant. Results: Compared with the conventional care group, the waiting time, diagnosis time, emergency room waiting time and recanalisation time of patients in the comprehensive nursing group were significantly shortened (p < 0.05). The degree of improvement in ESS (∆ESS) in the comprehensive nursing group was significantly higher, and the reductions in GAD-7 and PHQ-9 scores were also significantly greater (p < 0.05). Patient and family satisfaction in the comprehensive nursing group were significantly higher than those in the conventional care group (p < 0.05). Through multivariate linear regression analysis, with baseline National Institutes of Health Stroke Scale (NIHSS) score, time from onset to visit, hypertension and diabetes as adjustment factors, allocation to the comprehensive nursing group was still significantly correlated with ∆ESS (β [95% confidence interval (CI)] = 8.15 [5.72 to 10.58], p < 0.001), ∆GAD-7 (β [95% CI] = −2.18 [−2.92 to −1.44], p < 0.001), and ∆PHQ-9 (β [95% CI] = −2.65 [−3.32 to −1.98], p < 0.001). The results of multivariate logistic regression analysis showed that, after adjusting for the above confounding factors, inclusion in the comprehensive nursing group was independently associated with a significantly higher likelihood of obtaining a satisfactory nursing evaluation (adjusted OR = 8.915, 95% CI: 2.453 to 32.468, p = 0.001). Conclusions: The integrated model is associated with shorter treatment times, better neurological recovery, reduced anxiety and depression and higher satisfaction in AIS patients, providing preliminary evidence for a patientcentred comprehensive emergency care model.
Effects of Personalized Nursing Combined With Mindfulness-Based Stress Reduction on Anxiety, Depression, and Quality of Life in Patients With Pneumonia-Induced Sepsis
Background: This study aimed to investigate the effects of personalized nursing combined with MindfulnessBased Stress Reduction (MBSR) on anxiety, depression, self-efficacy, quality of life and self-care ability in patients with pneumonia-induced sepsis. Methods: This retrospective study enrolled 127 patients with pneumonia-induced sepsis admitted between July 2023 to July 2024. Among them, 59 patients in the routine nursing group received routine nursing care, while 68 patients in the combined nursing group received personalized nursing combined with MBSR. Routine nursing included vital signs monitoring, oxygen therapy, medication management, basic daily care, nutritional support, health education and complication prevention. The combined nursing group additionally received personalized nursing (e.g., psychological assessment and support, targeted health education, and dynamic adjustment of care plans) and MBSR training (e.g., mindful breathing, body scanning, mindfulness meditation and relaxation training), delivered daily or several times per week until discharge. Outcome measures included the Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), General Self-Efficacy Scale (GSES), World Health Organization Quality of Life-100 (WHOQOL-100), and Exercise of SelfCare Agency (ESCA), assessed before and after nursing measures. Categorical variables were compared using the chi-square test, and continuous variables (mean ± standard deviation) were analysed using independent-samplest tests. Results: No statistically significant baseline differences in demographic or clinical characteristics were observed between the two groups (p > 0.05). After nursing measures, both groups showed improvements in HAMA, HAMD, GSES, WHOQOL-100, and ESCA scores compared with baseline. The combined nursing group demonstrated significantly greater reduction in HAMA and HAMD scores(p < 0.05) and significantly greater increases in GSES, WHOQOL-100, and ESCA scores(p < 0.05) than the routine nursing group. Conclusions: An integrated approach combining personalized nursing and MBSR was associated with lower levels of negative emotional states, higher self-efficacy in disease management, and better quality of life and self-care ability in patients with pneumonia-induced sepsis. These findings suggest that this nursing model may represent a feasible and potentially beneficial strategy for improving psychological and functional outcomes in clinical practice.
Resilience and Social Support as Predictors of Life Satisfaction in Healthy Older Adults: A Moderation Analysis
Background: Previous literature has highlighted the importance of psychosocial factors such as the perception of an adequate social support network or the subjective experience of life satisfaction in promoting well-being in older adults and facilitating healthy aging processes. The objective of the present study was to analyze the possible relationship between the level of resilience and social support in healthy older adults, and how these variables may influence experiences of life satisfaction. Furthermore, potential moderation relationships between these variables were analyzed. Methods: The sample consisted of 42 healthy older adults (71.4% women), with a mean age of 66.57 years (standard deviation (SD) = 5.82). Participants completed a battery of questionnaires that included a sociodemographic questionnaire, the Connor-Davidson Resilience Scale (CDRISC), the Duke-UNC Functional Social Support Questionnaire (Duke-UNC-11), and the Satisfaction With Life Scale (SWLS). Results: The results of the multiple regression analyses indicate that resilience and social support positively and significantly predict life satisfaction. Furthermore, moderation analyses indicate that social support moderates the relationship between resilience and life satisfaction, jointly explaining 44.98% of the variance of this indicator of wellbeing. Specifically, the positive association between resilience and life satisfaction was stronger at lower levels of perceived social support. Conclusions: These findings suggest that resilience may play a particularly relevant role in life satisfaction when perceived social support is limited. However, the small sample size, the predominance of women, and the selective recruitment of healthy older adults warrant caution when generalizing the results. Overall, the findings support the need to expand the study of the correlations of well-being in old age, as well as to develop intervention programs aimed at promoting optimal aging that include strategies to improve resilience and foster functional social support networks.
Factors Influencing Anxiety and Depression Symptoms in Patients With Acute Ischaemic Stroke and the Development and Validation of a Risk Prediction Model
Background: To analyse the factors influencing anxiety and depression symptoms in patients with acute ischaemic stroke (AIS) and construct a nomogram model for predicting the risk of developing anxiety and depression. Methods: A total of 354 patients with AIS admitted to the Anhui Provincial Corps Hospital of Chinese People’s Armed Police Force between May 2023 and April 2025 were selected. They were divided into anxiety and depression (n = 180) and nonanxiety and depression (n = 174) groups on the basis of the presence of anxiety (Hamilton Anxiety Rating Scale ≥ 7 points) and depression (Hamilton Depression Rating Scale ≥ 8 points). Baseline patient data, laboratory indicators and anxiety–depression status were extracted from medical records. Logistic multivariable analysis was employed to identify factors influencing the occurrence of anxiety and depression in patients with AIS, establishing a nomogram prediction model. Internal validation was conducted by using receiver operating characteristic (ROC) and calibration curves and decision curve analysis. Results: Comparative analysis revealed statistically significant differences between the two patient groups in terms of age, neutrophil count, angiogenin-like protein 4 (ANGPTL4), silencing information regulator protein 1 (SIRT1), Krüppel-like transcription factor 2 (KLF2), retinol-binding protein (RBP), lipoprotein (a) levels and plaque stability (p < 0.05). Multivariate logistic regression analysis revealed that age (odds ratio [OR] = 1.311, 95% confidence interval [95%CI]: 1.031–1.667), ANGPTL4 (OR = 0.057, 95%CI: 0.023–0.144), SIRT1 (OR = 0.096, 95%CI: 0.016–0.554), KLF2 (OR = 0.001, 95%CI: 0.000– 0.401), RBP (OR = 1.476, 95%CI: 1.068–2.040), lipoprotein (a) (OR = 1.130, 95%CI: 1.024–1.247) and plaque stability (OR = 23.941, 95%CI: 5.178–32.186) were factorsinfluencing anxiety and depression symptoms in patients with AIS (p < 0.05). The established regression model equation is log(P) = 0.271 × age − 0.044 × ANGPTL4 − 2.348 × SIRT1 − 7.453 × KLF2 + 0.390 × RBP + 0.122 × lipoprotein (a) + 3.176 × plaque stability. The area under the ROC curve was 0.901 (95%CI: 0.867–0.934). Internal validation using the bootstrap method demonstrated high concordance between the predictive and standard model curves. Conclusions: Age, ANGPTL4, SIRT1, KLF2, RBP, lipoprotein (a) and plaque stability are factors influencing the occurrence of anxiety and depression symptoms in patients with AIS. The nomogram model constructed on the basis of these factors demonstrates predictive validity.
Causal Relationship Between Vitamin D and Anxiety and Depression: A Bidirectional Mendelian Randomization Study
Objective: This study aimed to investigate the causal relationship between serum 25-hydroxyvitamin D (25(OH)D) levels and the risk of depression and anxiety, using Mendelian Randomization (MR) analysis from a genetic variation perspective. Methods: Genome-wide association study (GWAS) summary statisticsfor 25(OH)D levels, depression and anxiety were retrieved from the IEU Open GWAS Project, specifically from datasets “ebi-a-GCST90000617”, “ebia-GCST90013878”, and “ukb-a-82”. A two-sample MR analysis was conducted with 25(OH)D levels as the exposure and depression and anxiety as outcome variables. Cochran’s Q test was used to assess heterogeneity among the instrumental variables, and horizontal pleiotropy was tested using the MR-Egger intercept method. Sensitivity analyses were conducted via the leave-one-out approach. Results: The MR analysis, utilizing 32 single nucleotide polymorphisms (SNPs) as instrumental variables, revealed a significant causal association between 25(OH)D levels and depression, with all MR methods (excluding Simple Mode) yielding p-values < 0.05. The odds ratios (ORs) and 95% confidence intervals (CIs) for the significant methods were: OR = 0.82 [95% CI: 0.68–0.98], OR = 0.85 [95% CI: 0.77–0.95], OR = 0.80 [95% CI: 0.68–0.93] and OR = 0.90 [95% CI: 0.82–0.98]. However, no significant causal relationship wasfound between 25(OH)D levels and anxiety. In the reverse direction, genetically predicted depression showed a potential causal association with lower 25(OH)D levels (inverse variance weighting (IVW) OR = 0.98, 95% CI: 0.96–1.00, p = 0.02), while no such association was observed for anxiety. Conclusions: This study suggests that higher serum 25(OH)D levels may be associated with a lower risk of depression, highlighting the potential of serum 25(OH)D as an early biomarker for depression prevention and clinical management. However, no causal association was found between 25(OH)D levels and anxiety, warranting further investigation. This study provides a potential vitamin Drelated intervention direction for the prevention and clinical management of depression.
The Role of Social Contagion in Initiating Non-Suicidal Self-Injury in Schizophrenia: A Case Report
Non-suicidal self-injury (NSSI) is a highly prevalent maladaptive behavior with studies indicating that it can affect between 40–80% of individuals with schizophrenia spectrum disorder. NSSI can arise during any point during the course of schizophrenia spectrum disorder and has the potential to suddenly manifest as major-self mutilation (MSM), a particularly severe and catastrophic form of NSSI. Although the motivation for NSSI/MSM varies by patient, the literature indicates that there are factors associated with these behaviors such as first-episode psychosis, command hallucinations, and past self-harming episodes. In this case report, the authors discuss a rare case of a 25- year-old male with schizophrenia who presented with ligature of multiple digits on both hands. The authors examine this rare presentation and how it is suspected to be linked to a similar case in nearby Los Angeles county through social contagion. Through this case, the authors aim to highlight the prevalence of NSSI, the potential for NSSI to transform to MSM, and the need for ongoing screening for these behaviors in those with psychotic disorder diagnoses.
Progress of Research on Cognitive Impairment in Patients With Chronic Obstructive Pulmonary Disease
Cognitive impairment is a common complication in patients with chronic obstructive pulmonary disease (COPD) thatsubstantially affectstheir treatment adherence, self-management ability and prognosis; it is an important extrapulmonary complication. Its pathogenesis is complex and mainly involves cerebral hypoperfusion and neuronal damage caused by chronic hypoxemia and disruption of the blood–brain barrier and neural structures by systemic inflammatory responses. Smoking, frequent acute exacerbations, coexisting cerebrovascular diseases, anxiety, depression and sleep disorders are amongst the multiple factors that contribute to and accelerate cognitive decline. This article aims to review the pathogenesis, related factors and intervention measures of cognitive impairment in patients with COPD to provide a reference for improving cognitive function in such patients.
Assessment of Mental Health Nurses’ Competences: A Scoping Review
Background: Research has explored how undergraduate nursing students or Registered Nurses acquire and assess competences through simulations or training programs. However, there is limited evidence regarding Mental Health Nurses (MHNs) in regular clinical practice. This review aims to identify the clinical competences— knowledge, skills, or attitudes—of MHNs in their clinical practice, and how these are evaluated. Methods: A scoping review was conducted across four databases (PubMed, CINAHL, MEDLINE, PsycInfo) adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) extension guidelines, applying a double screening process. Results: Twenty-three studies were selected, focusing on nursing competency acquisition programs and assessments tools. The quality of the included studies was deemed acceptable. The findings indicated that educational programs improved professional competences. Among the assessment tools identified, sixty-six were validated while thirty-four were researcher-developed. Most tools targeted core MHN competences, such as physical health (Physical Health Attitude Scale for Mental Health Nurses) and psychiatric emergencies (Attitudes towards Containment Measures Questionnaire). Fewer tools addressed crosscutting competences (Clinical Competency of Mental Health Nursing). Conclusions: There is a clear need to develop tools specifically designed to assess mental health nursing within Specialized Health Training Programs. To strengthen competency acquisition and evaluation, it is recommended that complementary methods, such as simulations, feedback, and targeted tools, be integrated into MHN training and assessment.