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.
Prevalence and Predictors of Mechanical Restraint in Involuntary Patients in an Open-Door Inpatient Psychiatric Unit
Background: Mechanical restraint (MR) remains one of the most controversial interventions in psychiatry, particularly in involuntarily admitted patients. This study examined the prevalence and clinical predictors of MR in an open-door psychiatric unit in Spain, a context where national MR rates remain among the highest in Europe. Methods: A retrospective descriptive study of all involuntarily admitted patients (n = 81) was conducted in a 20-bed open-door acute psychiatric unit between June and December 2024. Sociodemographic, diagnostic, and treatment variables were extracted from electronic health records. Bivariate analyses based on exact tests and Firth penalized-likelihood logistic regression were used to identify independent correlates of MR. Results: MR was applied in 14.8% of patients. In Firth penalized-likelihood multivariable analysis, schizophrenia was the strongest independent correlate of MR (odds ratio [OR] = 9.58, 95% confidence interval [CI]: 1.71–65.89, p = 0.010). Male gender showed a significant bivariate association but lost significance after adjustment. MR co-occurred with intramuscular psychotropic medication in 91.7% of cases. Conclusions: Within this single-centre, exclusively involuntary cohort, care delivered in an open-door setting with structured de-escalation interventions was associated with a comparatively low rate of MR. Schizophrenia emerged as the strongest correlate of MR and may represent a priority target for prevention strategies. The results align with convergent evidence from German, Swiss, and Norwegian studies supporting the safety and effectiveness of open-door approaches, and provide the first Spanish data on MR in this model of care. These findings are preliminary and require confirmation in larger, multicentre samples.
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Prevalence and Risk of Mild Cognitive Impairment Among Chinese Adults Aged 60 Years and Above: A Cross-Sectional Study Based on National Data
Background: This study conducted a cross-sectional analysis to assess the prevalence of mild cognitive impairment (MCI) among older adults in China and to identify its associated risk factors, with the aim of informing the development of early intervention strategies. Methods: This cross-sectional study used data collected in 2018 (Wave 4). The initial survey sample comprised 19,744 individuals, of whom 4773 formed the valid sample for analysis. After screening, the study ultimately selected 694 individuals who met all the inclusion criteria. MCI was defined according to the criteria for ageassociated cognitive decline (AACD). Sociodemographic information, past comorbidities, and lifestyle were assessed. Results: The prevalence of MCI was 14.54%, with 694 individuals diagnosed with MCI. An elevated Center for Epidemiologic Studies Depression (CESD) score was identified as a significant risk factor for MCI (OR = 1.6, 95% CI: 1.3–1.9; p < 0.001). Living in rural areas (odds ratios (OR) = 2.0, 95% confidence interval (CI): 1.6–2.6; p < 0.001) and napping (OR = 1.3, 95% CI: 1.1–1.6; p = 0.002) were also significant risk factors for MCI. Additionally, gender, memory level, and nighttime sleep were each associated with a 1.2-fold increase in MCI risk (OR = 1.2 for all; p range: 0.001–0.047). Correlation analysis indicated that both age and the current CESD score were significantly negatively correlated with the total cognitive score (p < 0.001). Conclusions: Among Chinese older adults living in the community, CESD score, napping, nighttime sleep, being female, and memory level were identified as independent risk factorsfor MCI. These findings underscore the importance of implementing screening and preventive strategies to mitigate MCI risk in this demographic.
Clinical Characteristics and Influencing Factors of Cognitive Impairment in Patients With End-Stage Renal Disease Undergoing Maintenance Haemodialysis
Background: This study aimed to investigate the clinical characteristics and influencing factors of cognitive impairment and associated behavioural and psychological symptoms in patients with end-stage renal disease (ESRD) undergoing maintenance haemodialysis. Methods: This study enrolled 132 patients with ESRD receiving maintenance haemodialysis between January 2021 and January 2025. Patients were divided into a cognitively normal (CN) group and a cognitively impaired (CI) group based on post-dialysis cognitive impairment. The relationships were examined using the Montreal Cognitive Assessment (MoCA) and the Neuropsychiatric Inventory (NPI). Clinical data were collected, and logistic regression analysis was performed to identify factors associated with cognitive impairment. Results: Compared with the CN group, the CI group had significantly higher scores in abstract thinking, orientation, memory, naming, visuospatial/executive abilities, language fluency, attention and total MoCA scores (p < 0.05). On the NPI, the CI group had significantly lower scores (indicating fewer symptoms) than the CN group across all 12 domains, including delusions, hallucinations, agitation/aggression, dysphoria/depression, anxiety, elation/euphoria, apathy/indifference, disinhibition, irritability/lability, aberrant motor activity, nighttime behaviours/sleep disturbances, and appetite/eating disorders, as well as higher total NPI scores (p < 0.05). Logistic regression analysis identified age, dialysis duration, and serum levels of haemoglobin (Hb), higher β2-microglobulin, 25-hydroxyvitamin D [25(OH)D], and higher intact parathyroid hormone (iPTH) as independent influencing factors associated with cognitive impairment (p < 0.05). Conclusions: Advanced age, longer dialysis duration, lower Hb, higher β2-microglobulin, lower 25(OH)D, and higher iPTH levels were associated with cognitive impairment in patients undergoing maintenance haemodialysis for ESRD. Close monitoring of patients presenting with these risk factors is warranted for early prevention of cognitive decline.
Individualized Medication Selection and Outcome Prediction for Patients With Dementia and BPSD Based on Systemic Immune-Inflammation Index (SII): A Retrospective Case-Control Study
Background: Behavioural and psychological symptoms of dementia (BPSD) are often treated with atypical antipsychotics, but heterogeneous treatment responses remain a clinical challenge. A systemic inflammatory state may contribute to this heterogeneity, but it is unclear whether the baseline systemic immune-inflammation index (SII) is associated with differential short-term responses among BPSD patients treated with risperidone, olanzapine, and quetiapine. Therefore, this study aimed to investigate whether baseline SII was associated with differential shortterm responses among antipsychotic treatment groups. Methods: This was a retrospective cohort study. We reviewed the electronic medical records of hospitalised patients with dementia and BPSD from January 2020 to December 2024 and divided the patients into a risperidone group, an olanzapine group and a quetiapine group according to the antipsychotic treatment in the medical records. Using the risperidone group as the reference, 1:1 nearestneighbour matching without replacement was performed to obtain three balanced groups of 77 patients each (n = 231 in total). Normally distributed continuous data were analysed using t-tests, analysis of variance (ANOVA) and paired ttests; non-normally distributed continuous data were analyzed using Wilcoxon rank-sum tests, Kruskal–Wallis tests and Wilcoxon signed-rank tests; categorical data were analysed using chi-square tests. Correlation analysis, multivariate linear regression and restricted cubic splines(RCS) were used for additional analyses. Results: Spearman’s rank correlation test revealed divergent therapeutic trajectories. Baseline SII was positively correlated with the reduction rate of the Scale for the Assessment of Positive Symptoms (SAPS) in the risperidone group (r = 0.863, p < 0.001), and negatively correlated with the reduction rate of the SAPS in the olanzapine group (r = – 0.513, p < 0.001) and the quetiapine group (r = –0.368, p < 0.001). RCS analysis further revealed a non-linear relationship between SII and SAPS reduction rate (non-linear test p = 0.001). A significant interaction between medication type and SII was confirmed by the multivariable regression model (interaction p < 0.001). Conclusions: Baseline systemic inflammatory status is differentially associated with short-term antipsychotic response in hospitalised patients with dementia and BPSD. These findings suggest that inflammatory burden may be clinically relevant to the heterogeneous short-term response patterns across antipsychotic groups. However, prospective validation is required before any implications for treatment stratification can be drawn.
Depression as a Longitudinal Modulator of Physical–Verbal Aggression in Early Adolescence: Trajectories and Sex Comparisons
Background: Depression during early adolescence has been associated with increased aggressive behaviour; however, longitudinal evidence focused on this developmental stage remains limited, and findings regarding sex differences are inconsistent. In addition, few studies have examined physical and verbal aggression jointly across early adolescence. This study aims to examine the longitudinal association between depression and physical–verbal aggression during early adolescence and to analyse whether sex moderatesthe developmental trajectories and severity of aggression. Methods: A three wave longitudinal study was conducted with 251 adolescents (66.5% girls), aged 10–14 years, recruited from secondary schools in Madrid, Spain. Depressive symptoms were assessed using the Children’s Depression Inventory-Short version (CDI-S), and physical– verbal aggression was measured with the Physical and Verbal Aggression Questionnaire (PVAQ). Repeated-measures analysis of variance (RM-ANOVA) was used to analyse changes in aggression across three approximately annual assessments (mean ages: 10.8, 11.8, and 12.8 years), with sex and depression status included as between subject factors. Results: Adolescents with depression consistently showed higher levels of physical–verbal aggression across all three assessment waves compared with those without depression. Aggressive behaviour followed a quadratic trajectory, increasing between ages 10.8 and 11.8 and decreasing at age 12.8, although elevated levels persisted in the presence of depression. Boys and girls exhibited similar developmental patterns; however, boys showed greater severity and persistence of aggression. The association between depression and physical–verbal aggression was independent of normative sex differences and emerged as early as 10.8 years of age, highlighting early adolescence as a key period for preventive screening and intervention. Conclusions: Adolescents with depression show a high and persistent physical–verbal aggression during early adolescence, with sex differences emerging primarily in severity rather than in the form of developmental trajectories. These findings underscore early adolescence as a key period for identifying adolescents at increased risk and highlight the value of longitudinal assessment for informing preventive and clinically relevant interventions targeting the co occurrence of depressive mood states and aggressive behaviour.
Effects of Emotion-Focused Therapy on Weight Restoration and Emotion Regulation in Adolescents With Anorexia Nervosa
Background: To investigate the effects of emotionfocused therapy (EFT) on weight restoration and emotion regulation in adolescents with anorexia nervosa (AN). Methods: This retrospective study included 188 adolescents with AN treated at Chongqing Mental Health Center between January 2023 and December 2025. According to treatment methods, patients were divided into a control group and an EFT group. After screening based on inclusion and exclusion criteria, 60 patients in each group were included in the final analysis. The control group received routine nutritional support, cognitive behavioral therapy, and medication when necessary, while the EFT group additionally received EFT. Both groups were treated for 12 weeks. Body mass index (BMI), nutritional indicators, Eating Attitudes Test-26 (EAT-26), Trait Meta-Mood Scale (TMMS), Generalized Anxiety Disorder-7 (GAD-7), and Children’s Depression Inventory-2 (CDI-2)scores were compared between the two groups. Safety outcomes were retrospectively collected from electronic medical records. Multiple linear regression analysis was performed to evaluate the independent association between EFT and BMI improvement. Results: After 12 weeks of treatment, BMI and nutritional indicators in the EFT group were higher than those in the control group, while the EAT-26 scores were significantly lower (all p < 0.05). At weeks 4, 8, and 12, TMMS scores in the EFT group were significantly higher, while GAD-7 and CDI-2 scores were significantly lower than those in the control group (all p < 0.05). No significant between-group differences were observed in refeeding syndrome or readmission rates (all p > 0.05). Multiple linear regression analysis showed that EFT remained independently associated with higher BMI at week 12 after adjustment for baseline BMI, age, sex, and olanzapine use (β = 0.382, p < 0.05). Moderate-to-large effect sizes were observed for major outcome measures (Cohen’s d = 0.77–1.23). Conclusions: EFT combined with routine nutritional support and psychotherapy may be associated with improved weight restoration, emotional regulation, nutritional status, and reduced anxiety and depressive symptoms in adolescents with AN. However, due to the retrospective single-center design and limited sample size, further prospective studies are warranted to confirm these findings.
Depressive Symptoms Mediate the Association Between Family Functioning and Non-Suicidal Self-Injury in Adolescent Psychiatric Patients: A Cross-Sectional Study
Background: Non-suicidal self-injury (NSSI) is highly prevalent among adolescent psychiatric patients, yet the pathways linking family functioning to NSSI have not been fully elucidated. This study aimed to investigate whether depressive symptoms function as a mediator in the association between family functioning and NSSI among adolescent psychiatric inpatients. Methods: A cross-sectional study was conducted among 180 adolescent patients admitted to a psychiatric department between June 2023 and June 2025. Family functioning, depressive symptoms, and NSSI-related frequency (encompassing both NSSI ideation and actual NSSI behaviours) were assessed using validated Chinese versions of the Family Adaptability and Cohesion Evaluation Scale II, Patient Health Questionnaire-9 (PHQ-9), and Ottawa SelfInjury Inventory. To avoid measurement overlap between the mediator and outcome, the PHQ-8 total score (PHQ9 excluding the self-harm/suicide item) was employed as the mediator in the primary analysis. Mediation analysis was performed using the PROCESS macro with bootstrap methods, controlling for demographic and clinical covariates including age, sex, only-child status, parental marital status, family monthly income, duration of illness, history of suicide attempts, and primary diagnosis. Results: NSSI was identified in 60.56% of participants. Family functioning was negatively correlated with depressive symptoms (r = –0.463, p < 0.001) and NSSIrelated frequency score (r = –0.387, p < 0.001). Depressive symptoms partially mediated the association between family functioning and NSSI-related frequency (indirect effect = −0.058, 95% CI [−0.092, −0.029], accounting for 34.52% of the total effect. Sensitivity analyses including comparison with the original PHQ-9 as mediator (proportion mediated = 40.48%) and a most conservative model utilising only NSSI behavioural items as the outcome (proportion mediated = 35.16%) confirmed the robustness of these findings. Conclusions: Among adolescents with mental disorders, depressive symptoms may partially mediate the negative association between family functioning and nonsuicidal self-injury. Interventions may benefit from integrating family-based approaches with depression-targeted therapies to address NSSI in this vulnerable population.
Dynamic Risk and Protective Factors of NSSI in Middle School Students: A Longitudinal Study
Background: This study aimed to use longitudinal data from 2021 to 2023 to systematically examine the risk and protective factors and mechanisms associated with nonsuicidal self-injury (NSSI) among middle school students in Jingzhou City, and to provide empirical evidence for targeted school-based psychological interventions. Methods: A baseline survey was conducted in 2021 (T1) among 652 first-year junior high school students from two schools in Jingzhou City. In 2023 (T2), 585 participants were successfully followed up (follow-up rate: 89.72%). Participants were categorized into four groups: no NSSI, incident NSSI, NSSI remission, and persistent NSSI. Intergroup differences in characteristics were analyzed using chi-square tests, Kruskal–Wallis H tests, and post hoc comparisons. Three binary logistic regression models were constructed to explore the predictive effects of baseline (T1) factors on incident, remitted, and persistent NSSI, respectively. The significance level was set at α = 0.05. Results: The overall rate of NSSI decreased markedly from 22.05% to 8.55% over the two-year period. Multivariable analysis showed that in the model predicting NSSI remission (no NSSI group vs. remission group), individuals whose depressive symptoms decreased were significantly more likely to have discontinued NSSI (adjusted odds ratio (aOR) = 8.43, 95% confidence interval (CI): 3.01–23.60). Those with stable anxiety symptoms had a significantly higher rate of NSSI remission compared with those whose anxiety worsened (aOR = 0.35, 95% CI: 0.18– 0.67). Gender-stratified analyses showed that among boys, a reduction in internet addiction was a significantly protective factor for NSSI remission (aOR = 8.87, 95% CI: 1.81–43.48). Among girls, both a decrease in depressive symptoms (aOR = 18.53, 95% CI: 3.36–102.26) and stable anxiety symptoms (aOR = 0.31, 95% CI: 0.14–0.72) were significantly associated with NSSI remission. Conclusions: NSSI behaviors among middle school students exhibit a high remission rate (82.17%) over time. The findings underscore the close association between NSSI and dynamic psychological problems. Prevention and intervention strategies of NSSIshould be developed according to the longitudinal follow-up study, such as specific interventions of internet use behaviors for males and depressive and anxiety symptoms for females.
Recurrence and Lethality in a Cohort of Minors With Suicidal Behaviour: 2010–2024
Background: Suicidal behaviour in children and adolescents has increased significantly over the last decade, generating growing concern among healthcare professionals. However, clinical and evolutionary differences between minors and adults after a suicide attempt are notsufficiently defined. This study analyses the differential profile of minors treated for suicide attempts in a large provincial cohort to identify specific vulnerabilities and risk patterns. Methods: Retrospective cohort study (MCOSUL Cohort) that included all suicide attempts treated in provincial psychiatric emergency services between 2010 and 2024. Sociodemographic variables, psychiatric diagnoses, substance use, method and lethality of the index attempt, recurrence, and mortality were collected. High lethality was defined according to Beautrais criteria. χ 2 , Fisher, Student’s t, Kruskal–Wallis tests, and survival analyses for recurrence were applied. Results: Minors represented 8% of the cohort, with a female predominance (83%). They presented a higher prevalence of neurodevelopmental disorders and eating disorders (EDs), as well as a differential consumption pattern dominated by tetrahydrocannabinol (THC). They used more violent methods, especially cutting, without an increase in lethality. The Cox model shows that being a minor is significantly associated with earlier recurrence of suicidal behaviour (HR = 1.36), even after adjusting the analysis for sex, neurodevelopmental disorders, THC use, and the method employed. Adults showed higher lethality, mortality, and more frequent use of sedative medications as a suicide method. Recurrence of subsequent suicidal behaviour was similar but occurred earlier in minors. Conclusions: Adolescent suicidal behaviour appears to present a distinct clinical phenotype, characterized by a predominance of female adolescents, frequent neurodevelopmental vulnerabilities, THC use, low-lethality violent methods, and relatively rapid recurrence, highlighting the need for tailored prevention strategies.
Efficacy Analysis of Evidence-Based Nursing Combined With Computer-Assisted Cognitive Correction Therapy on Cognitive Function and Quality of Life in Patients With Schizophrenia
Background: To investigate the effects of evidence-based nursing combined with computer-assisted cognitive remediation on cognitive function and quality of life in patients with schizophrenia. Methods: A retrospective analysis was conducted on the clinical data of 120 patients with schizophrenia admitted between March 2023 and March 2025. Patients were divided into an observation group (n = 60, receiving evidencebased nursing combined with computer-assisted cognitive remediation) and a control group (n = 60, receiving routine nursing combined with routine cognitive training) according to their treatment and nursing protocols. Continuous treatment included in-hospital and post-discharge 12 weeks. Cognitive function, including the Wisconsin Card Sorting Test (WCST), Digit Symbol Substitution Test (DSST), Semantic Verbal Fluency (sVF) task, and the Schizophrenia Patient Quality of Life Scale (SQLS), was compared between the two groups before and 12 weeks after treatment. Results: Before treatment, there were no statistically significant differences in the scores of WCST, DSST, sVF, and SQLS dimensions between the two groups (p > 0.05). After 12 weeks of treatment, all cognitive indices showed significant within-group improvements for both groups (all p < 0.001), while each SQLS dimension and total score were significantly reduced within each group (observation group: all p < 0.01; control group: all p < 0.05). After Bonferroni correction for multiple comparisons, all cognitive and SQLS outcomes showed significantly larger improvements in the observation group relative to the control group (all corrected between-group p < 0.001). Conclusions: Evidence-based nursing combined with computer-assisted cognitive correction therapy is associated with better cognitive performance and higher quality of life in patients with schizophrenia, showing promising clinical application value.
Risk Factors for Anxiety or Depression in Patients With Stroke During the Acute and Recovery Phases: An Independent Cohort Study
Background: To identify the overall risk factors for any clinically significant anxiety or depressive anxiety or depression in patients with stroke in the acute and recovery phase cohorts, compare the differences in overall risk factors between two independent patient cohorts at different disease stages, so as to provide a reliable basis for early screening and staged intervention of post-stroke emotional anxiety or depression. Methods: This is a retrospective study that included 252 stroke patients admitted to Nantong Rici Hospital Affiliated to Yangzhou University from August 2023 to October 2025, which were divided into two independent cohorts: the acute phase cohort (7–14 days after onset, n = 143) and the recovery phase cohort (3 months after onset, n = 109), all eligible patients were assigned to either the anxiety or depression group or the non-anxiety or depression group according to the 14-item Hamilton Anxiety Rating Scale (HAMA-14) and 24-item Hamilton Depression Rating Scale (HAMD-24). Following univariate analysisbased screening of potential risk factors, the significantly different indicators were further included in the multivariate Logistic regression model to identify independent determinants and clarify differences across stages. Results: In the acute phase cohort, the incidence of anxiety or depression was 30.07% (43/143), and the independent risk factors identified were age [odds ratio (OR) = 1.23, 95% confidence interval (CI): 1.10–1.38], illiterate educational level (OR = 8.15, 95% CI: 2.28–29.12), no dedicated care (OR = 5.52, 95% CI: 1.58–19.34), hemorrhagic stroke (OR = 6.39, 95% CI: 1.61–25.30), multiple lesions (OR = 5.07, 95% CI: 1.31–19.66), National Institutes of Health Stroke Scale (NIHSS) score (OR = 1.25, 95% CI: 1.03–1.52), and combined atrial fibrillation (AF) (OR = 5.38, 95% CI: 1.20–24.09) (p all < 0.05). In the recovery phase cohort, the incidence of anxiety or depression was 25.69% (28/109), and the independent risk factorsidentified were age (OR = 1.21, 95% CI: 1.05–1.39), combined diabetes mellitus (DM) (OR = 4.63, 95% CI: 1.18–18.20), AF (OR = 3.94, 95% CI: 1.07–14.45), and coronary heart disease (CHD) (OR = 5.86, 95% CI: 1.45–23.73) (p all < 0.05). Age and combined AF were the common independent risk factors in both cohorts. Conclusions: There are differences in the risk factors for anxiety/depression between independent stroke patients cohorts at different disease stages. Clinically, individualized intervention should be carried out according to the key risk factors of each disease stage to reduce the risk of anxiety or depression.
Clinical Efficacy Study of Escitalopram Combined With Low-Frequency Repetitive Transcranial Magnetic Stimulation in Patients With Post-Ischemic Stroke Depression and Anxiety
Background: To retrospectively analyze the clinical efficacy of escitalopram combined with low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) in treating anxiety and depression in ischemic stroke patients. Methods: Eighty ischemic stroke patients with concurrent depression and anxiety who received treatment at Jiangbin Hospital of Guangxi Zhuang Autonomous Region from January 2025–December 2025 were retrospectively collected. Patients were divided into a conventional treatment group and a combined treatment group, with 40 patients in each group. The conventional treatment group received routine treatment combined with oral escitalopram, while the combined treatment group received the same treatment as the conventional treatment group, combined with LF-rTMS. To evaluate clinical efficacy, Hamilton Depression Rating Scale (HAMD) and Hamilton Anxiety Rating Scale (HAMA) scores were collected before and at the end of treatment in both groups. Transcranial ultrasound imaging of the brainstem raphe (BR) region was also performed, and adverse reactions during treatment were recorded. Results: The total effective rate in the combined treatment group was significantly higher than that in the conventional treatment group. After adjusting for baseline scores, post-treatment HAMD and HAMA scores in the combined treatment group were significantly lower than those in the conventional treatment group. The proportion of patients with abnormal echogenicity decreased in both groups, and the number of patients with abnormal echogenicity in the combined treatment group was less than that in the conventional treatment group. There was no statistically significant difference in the incidence of adverse reactions between the two groups. Conclusions: Escitalopram combined with LF-rTMS can effectively alleviate anxiety and depression in ischemic stroke patients and show beneficial changes in BR echogenicity as an exploratory imaging finding. It may serve as a potential and promising treatment option for post-ischemic stroke depression and anxiety, although further validation is needed.
The Mediating Role of Negative Affect in the Relationship Between Anger Rumination and Somatic Symptoms
Background: A high prevalence of somatisation is associated with a strong impairment of quality of life. Recent research suggests common underlying mechanism of central sensitisation in functional syndromes and chronic pain, with emotion regulation (ER) processes closely linked to somatic symptoms. This study examines the relationship between negative affect (NA) and anger rumination (AR) and its influence on somatisation. Methods: Five hundred seven individuals participated (mean age = 34.60 ± 13.22 years; 380 women). They completed the Patient Health Questionnaire, Negative Affect Scale, and Displaced Aggression Questionnaire. A crosssectional multivariate factorial relational design was used. Descriptive, multiple linear regression, and mediation analyses were conducted on the total and sex-separated samples. Results: Data analysis revealed a significant positive relationship between NA and AR (r = 0.55, p < 0.01), and both were significantly associated with somatisation (rumination: r = 0.37, p < 0.01; NA: r = 0.54, p < 0.01). Simple linear regressions confirmed that higher levels of NA and AR individually predicted increased somatic symptoms in both sexes. However, multiple regression analyses revealed that the effect of AR on somatisation was reduced in women and became non-significant in men when accounting for NA. Mediation analysis showed a significant indirect effect of AR on somatisation through negative affect (B = 0.005, 95% bootstrap confidence interval [0.004, 0.006]), accounting for 62.5% of the total effect. The mediation pattern was replicated in both women (indirect effect B = 0.005, 95% confidence interval [0.004, 0.007]) and men (indirect effect B = 0.004, 95% confidence interval [0.002, 0.006]). These findings indicated that part of the effect of AR on somatisation occurred under the influence of NA. Conclusions: NA and AR were associated with increased somatic symptoms. These findingssuggest the benefit of developing interventions that encourage the use of functional ER strategies. These can help to reduce NA, which in a prolonged form can constitute a vulnerability for organisms, especially in those people with a tendency to somatise.
The Chain Mediating Effect of Sleep Quality and Family Resilience Between Depressive Mood and Treatment Compliance in Continuous Blood Purification Patients
Background: Patients undergoing continuous blood purification (CBP) face considerable physical and psychological burdens, and the prevalence of depressive mood is high, which adversely affects treatment compliance. This study aimed to investigate the chain mediating roles of sleep quality and family resilience in the relationship between depressive mood and treatment compliance among patients with CBP. Methods: A cross-sectional study was conducted in 195 patients with CBP from May 2024 to May 2025. Assessment included the Self-Rating Depression Scale (SDS), Pittsburgh Sleep Quality Index (PSQI), Family Resilience Assessment Scale-Chinese version (FRAS-C), and Dialysis Treatment Adherence Scale (DTAS). We performed Pearson correlation, multiple linear regression, and bootstrap mediation analyses (PROCESS Macro Model 6) to test the hypothesized chain mediation model. Results: The mean scores were SDS 52.64 ± 5.82, PSQI 10.55 ± 4.08, FRAS-C 87.09 ± 11.24, and DTAS 70.95 ± 13.25. Depressive mood was significantly associated of poorer sleep quality (β = 0.521, p < 0.01) with lower family resilience (β = −0.391, p < 0.01), which in turn were associated with lower treatment adherence (β = −0.253 and β = 0.192, respectively, both p < 0.01). The total indirect effect accounted for 41.74% of the total effect, with the chain path (depression → sleep → resilience → adherence) contributing 5.06%. After adjusting for age, the model remained significant. Conclusions: Improving sleep quality and enhancing family resilience may be potential strategies to mitigate the adverse effects of depressive mood on self-reported treatment compliance in patients with CBP, though these findings require confirmation using adherence measures validated specifically for the CBP population.
Risk Factors for Postoperative Sleep Disturbance in Elderly Patients Undergoing Hip Arthroplasty Surgery: The Role of Preoperative Depression and Anxiety
Background: Postoperative sleep disturbance (PSD) is a common complication following hip arthroplasty surgery (HAS), yet the role of preoperative psychological factors remains incompletely understood. This study aimed to identify risk factors for PSD in elderly patients undergoing HAS, with a specific focus on the impact of preoperative depression and anxiety. Methods: A case-control study was conducted on 204 elderly patients (age ≥ 60 years) who underwent HAS. Patients were categorized into PSD (n = 81) and non-PSD (n = 123) groups based on a Pittsburgh Sleep Quality Index (PSQI) global score > 7 at one-month follow-up. Data on demographics, preoperative psychological status (measured using the Self-Rating Anxiety Scale (SAS) and SelfRating Depression Scale (SDS) as documented in medical records), perioperative clinical indicators, and postoperative sleep quality were extracted from electronic medical records. Univariate analyses, multivariable logistic regression, correlation analysis, and interaction assessments were performed. Results: Multivariable logistic regression identified four independent risk factors for PSD: higher preoperative SAS score (odds ratio (OR) = 1.14, 95% confidence interval (CI): 1.08–1.20, p < 0.001), higher preoperative SDS score (OR = 1.14, 95% CI: 1.08–1.21, p < 0.001), higher postoperative day 1 pain score (OR = 1.69, 95% CI: 1.13– 2.53, p = 0.011), and longer time to first ambulation (OR = 1.13, 95% CI: 1.08–1.18, p < 0.001). Preoperative SAS and SDS scores were positively correlated with postoperative PSQI scores (r = 0.36 and r = 0.28, respectively, both p < 0.001). Stratified analysis confirmed preoperative anxiety/depression’s significant association with PSD regardless of preoperative sleep status. Preoperative anxiety and postoperative high pain showed a significant positive additive interaction (Relative Excess Risk due to Interaction (RERI) = 9.41, 95% CI: 2.77–34.12). The model had an area under curve (AUC) of 0.90 (95% CI: 0.85–0.94) and good calibration (Hosmer–Lemeshow p = 0.316). Conclusions: Preoperative depression and anxiety are significant independent risk factors for PSD in elderly HAS patients, exhibiting a synergistic effect with postoperative pain. These findings underscore the critical need to integrate routine preoperative psychological screening and targeted multidisciplinary interventions into perioperative care protocols to mitigate PSD and improve recovery outcomes.
Nomophobia-Related Indicators in Court-Involved Adolescents With Child-to-Parent Violence: A Preliminary Item-Level Correlational Study
Background: Nomophobia, commonly understood as fear or distress associated with being without access to a mobile phone, has become a relevant topic in adolescent research. However, little is known about how nomophobiarelated indicators are associated with one another in adolescents involved in juvenile justice interventions for child-toparent violence (CPV). Methods: This exploratory cross-sectional study included 53 adolescents serving court-ordered measures for CPV in a specialized juvenile justice centre in Madrid, Spain. Six items from the nomophobia subscale of the Risk Scale for Adolescent Addiction to Social Networks and the Internet were analyzed. Item-level bivariate correlations were examined, and the findings were interpreted cautiously in light of the exploratory nature of the study. Results: The six items showed positive associations, with stronger correlations among indicators related to immediate replies, read-receipt confirmation, restlessness when interaction is absent, and anger when separated from the mobile phone. Items referring to perceived safety when sending messages or photographs showed weaker associations with the remaining items. Conclusions: The findings suggest a preliminary pattern of internal association among six nomophobia-related Adolescent Social Media and Internet Addiction Risk Scale Reliability and Validity (ERA-RSI) items in this specific sample of court-involved adolescents. These results should not be interpreted as evidence of the full structure of nomophobia or as causal evidence regarding family conflict or interpersonal control. Future studies should use larger multisite samples, validated nomophobia-specific instruments, longitudinal designs, and analytic strategies appropriate for ordinal data.
Association Between Social Media Use Duration and Depressive and Anxiety Symptoms in Adolescents: A Retrospective Study
Background: This study aimed to investigate the relationship between the duration of social media use and the prevalence and severity of depressive and anxiety symptoms among adolescents in the real-world settings, thereby providing data support to inform mental health support and guide appropriate social media use. Methods: This retrospective study analysed clinical data from 156 adolescents admitted to the Mental Health Service Centre of The Second People’s Hospital of Hunan Province (Brain Hospital of Hunan Province) between January 2022 and December 2023. Data were extracted from electronic medical record system and structured survey forms. Baseline demographic characteristics, social media use related data, and mental health assessment results were collected. Pearson correlation analysis was used to examine relationship between social media use duration and scores on the 9-item Patient Health Questionnaire (PHQ-9) and 7-item Generalized Anxiety Disorder scale (GAD-7). Multivariate logistic regression was performed to identify factors independently associated with depression and anxiety symptoms. Results: Univariate analysis revealed statistically significant differences in parenting style, academic performance, weekly exercise frequency, and depression and anxiety symptoms across different durations of social media use (p < 0.05). Correlation analysis demonstrated significant positive correlations between average daily social media use duration and PHQ-9 score (r = 0.352, p < 0.001) and GAD-7 score (r = 0.308, p < 0.001). Multivariate logistic regression identified longer social media use as an independent risk factor for positive depressive symptoms (odds ratio (OR) = 1.794, 95% confidence interval (CI): 1.261–2.547), along with authoritative parenting (OR = 2.485, 95% CI: 1.253–4.922), permissive parenting (OR = 3.427, 95% CI: 1.503–7.816), medium academic performance (OR = 2.867, 95% CI: 1.286–6.396), and poor academic performance (OR = 6.118, 95% CI: 2.534–14.779). For positive anxiety symptoms, independent risk factors included longer social media use (OR = 1.624, 95% CI: 1.169–2.267), authoritative parenting (OR = 2.278, 95% CI: 1.171–4.425), permissive parenting (OR = 2.863, 95% CI: 1.317–6.256), medium academic performance (OR = 2.564, 95% CI: 1.176–5.614), poor academic performance (OR = 4.575, 95% CI: 1.975–10.614), and reduced weekly exercise frequency (1–2 times/week: OR = 1.927, 95% CI: 1.027–3.608; <1 time/week: OR = 3.825, 95% CI: 1.896–7.736). Conclusions: Social media use duration is significantly associated with depressive and anxiety symptoms in adolescents. These findings underscore the importance of monitoring adolescent social media use and implementing targeted health guidance to reduce mental health risks.
Effect of Mobile Application-Based Cognitive Behavioural Therapy on Atopic Dermatitis Comorbid With Obsessive-Compulsive Disorder: A Retrospective Study
Background: This study aimed to evaluate the effect of mobile application-based cognitive behavioural therapy (MCBT) in patients with atopic dermatitis (AD) and comorbid obsessive-compulsive disorder (OCD). Methods: This retrospective study analysed 100 patients with AD and comorbid OCD treated at Chengdu First People’s Hospital from January 2024 to December 2025. Patients were divided into an MCBT group (n = 50) and a conventional group (n = 50) according to the treatment they received. All patients received routine medication. The conventional group received conventional cognitive behavioural therapy (CBT), whereas the MCBT group received MCBT via mobile applications. Treatment duration was 12 weeks for both groups. The Eczema Area and Severity Index (EASI), Yale–Brown Obsessive Compulsive Scale (Y-BOCS), Dermatology Life Quality Index (DLQI), and treatment adherence were compared between the two groups before and after treatment. Results: After 12 weeks of treatment, EASI, Y-BOCS, and DLQI scores significantly reduced from baseline in both groups (all p < 0.01). Moreover, the MCBT group had significantly lower EASI [10.5 (3.7, 18.6)], Y-BOCS (10.2 ± 2.1), and DLQI (5.3 ± 1.8) scores than the conventional group [14.4 (6.8, 26.9), 15.5 ± 2.3, 10.6 ± 2.7] (all p < 0.01). The overall treatment adherence rate was significantly higher in the MCBT group (82.0%) than in the conventional therapy group (64.0%; χ2 = 4.110, p = 0.042). Conclusions: MCBT combined with conventional therapy may alleviate dermatological and obsessivecompulsive symptoms in patients with AD and OCD, while also improving treatment adherence and quality of life. Given its simplicity and feasibility, further large-scale prospective studies are warranted to validate its clinical value.
Effects of Comprehensive Bundled Nursing Care on Psychological Disorders in Mechanically Ventilated Intensive Care Unit Patients
Background: This study aimed to explore the effects of comprehensive bundled nursing care on psychological disorders (anxiety, depression, post-traumatic stress disorder [PTSD], and cognitive impairment) in mechanically ventilated patients in the intensive care unit (ICU). In addition, the study analysed the effect of these nursing strategies on patient treatment adherence, providing evidence for optimizing psychological nursing strategies in the ICU. Methods: This retrospective study included 116 ICU patients who received mechanical ventilation. They were divided into two groups based on the type of nursing care: the bundled comprehensive nursing group (n = 58) and the control group (n = 58). The control group received routine nursing care, whereas the bundled comprehensive nursing group received comprehensive nursing care, which included psychological care as the core component, supplemented by position optimization, oral care, and nutritional support. Psychological and cognitive outcomes were assessed using the Hamilton Anxiety Rating Scale (HAMA), Hamilton Depression Rating Scale (HAMD), Post-traumatic Stress Disorder Checklist (PCLC), and Montreal Cognitive Assessment (MoCA) before and after nursing care. Additionally, treatment adherence was compared between the two groups. Results: Before the nursing care, no significant differences were found between the two groups in any of the above scales (all p > 0.05). After the nursing care, the bundled comprehensive nursing group showed significantly lower HAMA, HAMD, and PCL-C scores and higher MoCA scores compared with the control group (all p < 0.001). In addition, treatment adherence was significantly improved in the intervention group (p < 0.01). Conclusions: The bundled comprehensive nursing was associated with reduced anxiety, depression, and PTSD symptoms, improved cognitive function, and enhanced treatment adherence in mechanically ventilated ICU patients. This study provides an important clinical reference for optimizing psychological nursing strategies in the ICU.
Cost-Effectiveness of the Remote Primary Care and Psychiatry Model (MAP-PSI) for Depression in Youth Living in Rural and Indigenous Communities
Background: Community- and school-based interventions focused on mental health promotion and early detection of depressive symptoms have proven to be cost-effective. Our objective was estimated the costeffectiveness ratio of the remote and pilot Primary Care and Psychiatry Model (MAP-PSI) compared with community usual care (CUC) in a rural municipality in Mexico. Methods: We analyzed all adolescents and young adults aged 15–25 years who received care between November 2023 and November 2024. Effectiveness measures included care-seeking behavior, school absenteeism prevented, suicide attempts avoided and suicides prevented. Direct and indirect costs including lost workdays, were considered. Incremental Costs-Effectiveness Ratios (ICERs) and deterministic sensitivity analyses were performed. Results: Of 1057 recruited participants, 932 completed screening (88.2%); mean age was 16.63 years ± standard deviation (SD) 1.53, and 60.51% were female. MAP-PSI delivered mental health care to 932 youths compared with 16 under CUC and was associated with the prevention of 12,195 school absenteeism days, at an incremental cost of $7.84 USD per absenteeism day avoided. Based on model projections, the intervention reduced expected suicide attempts from 13 to four cases; corresponding to nine suicide attempts avoided at an estimated incremental cost of $10,622.10 USD per suicide attempt avoided. Sensitivity analyses suggested that lower intervention effectiveness substantially increased ICERs under conservative scenarios. Conclusions: The MAP-PSI is a cost-effective strategy for reducing suicidal behavior and school absenteeism in young people with depressive symptoms living in rural and Indigenous communities.
Changes in Serum GDF-15 in Relation to the Onset of Post-Stroke Depression After Acute Ischemic Stroke and the Development of a Comprehensive Prediction Model
Background: This study aimed to investigate the relationship between serum growth differentiation factor-15 (GDF-15) levels and the development of post-stroke depression (PSD) following acute ischemic stroke (AIS) and to construct an integrated predictive model. Methods: This retrospective study enrolled 302 patients with AIS admitted to Siyang County Hospital of Traditional Chinese Medicine between January 2023 to October 2025. Among them, 100 patients developed PSD, and the remaining 202 patients did not. Serum GDF-15 levels at admission, general clinical data and disease-related information were compared between groups. Logistic regression identified independent risk factors for PSD, and a nomogram-based prediction model was developed. Model performance was assessed using receiver operating characteristic (ROC) analysis. Results: Compared with the non-PSD group, the PSD group had older age, higher National Institutes of Health Stroke Scale (NIHSS) scores, and a greater proportion of patient with a family history of psychiatric disorders and frontal lobe infarction (p < 0.05). Serum level of high-sensitivity C-reactive protein (hs-CRP), homocysteine, uric acid, Interleukin-6 (IL-6), neurofilament light chain (NfL) and GDF-15 were elevated, whereas left ventricular ejection fraction was lower in the PSD group (p < 0.05). Logistic regression showed that higher NIHSS scores (odds ratio (OR) = 1.230, 95% confidence interval (CI): 1.045–1.447), family history of psychiatric disorders (OR = 7.760, 95% CI: 1.709–35.238), frontal lobe infarction (OR = 5.275, 95% CI: 1.574–17.678), and elevated level of IL-6 levels (OR = 1.319, 95% CI: 1.089–1.599), NfL (OR = 1.103, 95% CI: 1.018–1.195), and GDF-15 (OR = 1.021, 95% CI: 1.009–1.033) were independent risk factors for PSD in patients with AIS (p < 0.05). The nomogram achieved an area under the ROC curve of 0.863 (95% CI: 0.810–0.885) for predicting PSD in patients with AIS. Conclusions: Serum GDF-15 is closely associated with PSD onset after AIS. A comprehensive prediction model integrating GDF-15 with other clinical factors demonstrates high clinical utility for predicting PSD risk.
Influencing Factors and Prediction Model Construction of Anxiety and Depression in Patients With Coronary Heart Disease Undergoing In-Stent Restenosis
Background: In-stent Restenosis (ISR) represents a major challenge in interventional cardiology, and psychological distress is known to worsen coronary heart disease outcomes. However, the prevalence and determinants of anxiety and depression specifically in ISR patients remain largely uncharacterized. This study aimed to investigate the incidence and independent risk factors of these symptoms and to develop predictive models for their early identification. Methods: A single-center retrospective study involving 256 patients with confirmed ISR was conducted. Psychological status was assessed using the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS). Univariate and multivariate logistic regression analyses were employed to identify independent risk factors. Nomograms were constructed and validated based on these factors, with model performance evaluated by the area under the curve (AUC), calibration plots, and Decision Curve Analysis (DCA). Results: The prevalence of anxiety and depression symptoms was 37.89% and 42.58%, respectively. Multivariate analysis identified poorer sleep quality (higher Pittsburgh Sleep Quality Index (PSQI) score), lower social support (lower Social Support Rating Scale (SSRS) score), higher New York Heart Association (NYHA) classification (≥Ⅲ), multiple stents (≥2), and suburban/rural residence as independent risk factors for anxiety. For depression, older age, higher PSQI score, lower SSRS score, multiple stents, and advanced Mehran classification (III/IV) were significant predictors. The nomograms demonstrated good predictive accuracy, with AUCs of 0.79 (95% confidence interval (CI): 0.74–0.85) for anxiety and 0.82 (95% CI: 0.76–0.87) for depression, along with good calibration and clinical utility. Conclusions: Anxiety symptoms and depressive symptoms are highly prevalent in ISR patients. The developed nomograms, incorporating clinical and psychosocial factors, provide effective tools for individualized risk stratification, facilitating early identification and targeted psychological interventions to improve patient outcomes.
Psychological Well-Being and Burnout in University Faculty: The Mediating Role of Emotional Exhaustion
Background: To examine the relationship between psychological well-being and burnout dimensions among university faculty members, as well as the mediating role of emotional exhaustion in the association between psychological well-being and professional accomplishment. Methods: A cross-sectional study was conducted with 597 university faculty members from several Spanish universities. Participants completed the Spanish adaptation of Ryff’s Psychological Well-Being Scales and the emotional exhaustion and personal accomplishment subscales of the Maslach Burnout Inventory. Correlation, regression, and mediation analyses were performed. Results: All dimensions of psychological well-being were negatively associated with emotional exhaustion and positively associated with professional accomplishment. Environmental mastery emerged as the strongest predictor of lower emotional exhaustion (β = −0.405, p < 0.001) and higher professional accomplishment (β = 0.263, p < 0.001). Mediation analyses indicated that emotional exhaustion partially mediated the relationship between psychological well-being and professional accomplishment. Conclusions: Psychological well-being may function as a protective personal resource associated with lower levels of burnout among university faculty members. In particular, environmental mastery may represent a key psychological resource associated with lower emotional exhaustion and greater professional accomplishment in higher education settings. Interventions aimed at strengthening psychological well-being and reducing emotional exhaustion may contribute to improving occupational mental health in academic professionals.
Clinical Outcomes of Phased Rehabilitation Nursing Combined With Mindfulness-Based Stress Reduction in Patients With Acute Cerebral Infarction
Background: This study retrospectively analysed the clinical outcomes of phased rehabilitation nursing combined with mindfulness-based stress reduction on depression and neurological deficit severity in patients with acute cerebral infarction (ACI). Methods: This study employed a retrospective analysis. A total of 399 patients with cerebral infarction admitted between January 2023 and December 2025 were enrolled. Based on previous nursing practices, the subjects were divided into a traditional nursing group (n = 199) and a phased nursing group (n = 200). The traditional nursing group received conventional care, whereas the phased nursing group received phased rehabilitation care combined with mindfulness-based stress reduction psychological care. Intergroup differences in nursing satisfaction were analysed, and comparisons of Beck Depression Inventory-II (BDI-II) scores, motor function, neurological function, activities of daily living and quality of life were conducted between the two groups at baseline and 3 months after nursing measures. Results: The phased nursing group demonstrated higher nursing satisfaction than the traditional nursing group (p < 0.05). After 3 months of nursing care, the phased nursing group exhibited lower scores on the somatisation and affective dimensions of the BDI-II scale than the traditional nursing group (p < 0.05). Moreover, the phased nursing group demonstrated higher scores on the functional motor scale, Barthel index, and stroke-specific quality of life than the traditional care group while exhibiting lower scores on the National Institutes of Health Stroke Scale (p < 0.05). Conclusions: The application of phased rehabilitation nursing combined with mindfulness-based stress reduction in patients with ACI significantly improves depressive symptoms, enhances motor function, reduces neurological deficits and ultimately boosts adaptive daily living activities and overall quality of life. This approach plays a crucial role in promoting comprehensive recovery.
Trajectory Patterns of Perioperative Anxiety and Depressive Symptoms in Patients With Digestive System Malignancies and Their Impact on Postoperative Outcomes
Background: To identify perioperative anxiety and depressive symptom trajectoriesin patients with digestive system malignancies undergoing surgery and to examine their associations with biomarkers and postoperative outcomes. Methods: This retrospective cohort study included 285 patients with digestive system malignancies who underwent elective surgery from January 2019 to December 2025 at Zhejiang Xinan International Hospital. Anxiety and depressive symptoms were assessed using repeated Hospital Anxiety and Depression Scale (HADS) total scores at T1 (1–3 days preoperatively), T2 (postoperative day 3), and T3 (postoperative day 7). Self-Rating Anxiety Scale, Perceived Stress Scale, Pittsburgh Sleep Quality Index, and Social Support Rating Scale scores were also extracted. Biomarkers, including cortisol, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), and brain-derived neurotrophic factor (BDNF), were obtained from routine laboratory records. Latent class growth analysis was used to identify symptom trajectories. Multivariate logistic regression was performed to identify predictors of chronic trajectory membership. Results: Three trajectories were identified: resilient (42.1%), recovery (38.2%), and chronic (19.6%). Stage III patients had higher HADS scores than Stage I patients (18.6 ± 4.8 vs. 12.4 ± 3.6, p < 0.001). The chronic group showed higher postoperative IL-6 (8.2 ± 2.4 vs. 4.8 ± 1.6 pg/mL), TNF-α (18.6 ± 5.2 vs. 10.2 ± 3.4 pg/mL), and CRP levels, and lower BDNF levels than the resilient group. Chronic trajectory membership was associated with higher complication rates, longer hospital stay, higher 30- day readmission, and lower Quality of Recovery-15 (QoR15) scores. Independent predictors included Stage III disease, psychiatric history, preoperative sleep disturbance, and reduced social support. The prediction model showed good (area under the receiver operating characteristic curve (AUC) = 0.856). Conclusions: Perioperative psychological distress follows distinct trajectories in patients with digestive system malignancies. Persistent distress is associated with inflammatory activation and poorer postoperative recovery, supporting early risk stratification and targeted psychological intervention.
Adult Romantic Attachment and Parental Reflective Functioning in Parents of Pre-School Children: An Association Study With a Sex-Sensitive Approach
Background: Parental reflective functioning (PRF) has important developmental roles in the offspring. The relationship between parents’ attachment style and PRF, as well as their intergenerational transmission, have been object of investigation in recent years, however, the studies have been mostly limited to mothers and conducted with semi-structured interviews. We aimed to assess this relationship using self-reports (PRF Questionnaire and Experiences in Close Relationships-Revised), and discuss their impact on child development. Methods: A total of 240 parents of 262 pre-school children were recruited via online methods. They completed both questionnaires as well as data regarding sex and age of parents and children. General linear models were conducted to assess the relationship between PRF and attachment dimensions, controlled by potential sex and age confounders. Results: Anxious attachment was significantly associated with the “prementalization” and “certainty about mental states” subscales, with the models explaining 15.8% and 7% of their variability. These associations remained constant when performing sex-disaggregated analyses, and in both cases the sex-specific models explained a greater variability in men than in women. Attachmentstyle didn’tshow any significant associations with the “interest and curiosity” subscale, nonetheless, differences between fathers and mothers in this latter dimension were also observed in the univariate analysis. Conclusions: Parental attachment styles are significantly associated with specific PRF domains, and these associations differ between mothers and fathers. Our results replicate previousfindings, obtained mostly with interviewbased assessments, and incorporate a sex-specific approach. Finally, the impact of PRF and adult attachment on the socio-emotional and behavioral development of the offspring is reviewed and discussed, as well as the clinical implications that could be derived from the extensive use of these tools.
Exploring the Causal Relationship Between Sex Hormones and Depression by Means of Two-Sample Mendelian Randomization Analysis
Background: To investigate the potential causal association between sex hormones and depression, a twosample mendelian randomization (MR) analysis was conducted. Methods: Summary statistics from Genome-wide Association Study (GWAS) on sex hormones and depression were collected. Sex-specific instruments were used to analyze seven sex hormones, including progesterone (PROG) and bioavailable testosterone (BAT). The inverse variance weighted (IVW) method was employed as the primary analysis, and sensitivity analyses were conducted to assess the robustness of the findings. Results: The IVW analysis revealed genetically significant association between PROG and depression (odds ratio (OR): 0.95, 95% confidence interval (CI): 0.92–0.98, p = 0.002), which remained significant after Bonferroni correction (p < 0.0036). A nominally significant association was observed for BAT (OR: 0.90, 95% CI: 0.82–1.00, p = 0.049) and depression; however, this association did not survive Bonferroni correction. Upon stratification by gender, these associations were no longer significant (p > 0.05). Furthermore, no substantial associations were observed between depression and other sex hormones, including total testosterone (TT), estradiol (E2), follicle-stimulating hormone, prolactin, and luteinizing hormone (p > 0.05). Leave-one-out analyses and funnel plots (indicating balanced pleiotropy), confirmed the reliability of these findings, supporting the robustness of the results. Significant heterogeneity was observed in seven exposures: E2_Female, TT_Male, TT_Both, BAT_Both, BAT_Male, BAT_Female, and TT_Female. Additionally, Mendelian Randomization Pleiotropy Residual Sum and Outlier (MR-PRESSO) analysis identified outliers for BAT_Both, BAT_Female, E2_Female, TT_Both, and TT_Female; however, excluding these outliers did not alter the results. Conclusions: This study indicates a potential causal association between genetically predicted PROG levels and a decreased risk of depression. While BAT also suggested a potential protective effect, this association was considered suggestive after multiple testing correction and requires further validation.
Causal Association Between Antidepressant Use and Thyroid Disease Risk: A Two-Sample Mendelian Randomization Study
Background: Observational studies have reported associations between antidepressant use and thyroid dysfunction; however, confounding precludes firm causal inference. This study aimed to evaluate the potential causal association between genetically predicted antidepressant use and the risks of Hashimoto’s thyroiditis, hypothyroidism and thyroid cancer using Mendelian randomisation (MR). Methods: Publicly available genome-wide association study (GWAS) summary statistics were used, with genetically predicted antidepressant use as the exposure and Hashimoto’s thyroiditis, hypothyroidism and thyroid cancer as the outcomes. Following data harmonisation, 13 single nucleotide polymorphisms (SNPs) meeting the prespecified significance threshold were selected as instrumental variables. The mean F statistic was 24.12 (range, 20.96–29.98), indicating that weak-instrument bias was unlikely. Inverse variance weighted (IVW) was used for the primary analysis, with MR-Egger regression, weighted-median and mode-based methods used in sensitivity analyses. Cochran ’s Q test was used to assess heterogeneity, and the MREgger intercept was used to assess directional horizontal pleiotropy. Results: Genetically predicted antidepressant use was positively associated with the risk of Hashimoto’s thyroiditis (IVW: odds ratio [OR] = 1.483, 95% confidence interval [CI]: 1.176–1.871; p = 0.001). A weak but statistically significant positive association was also observed for hypothyroidism (IVW: OR = 1.012, 95% CI: 1.002–1.023; p = 0.025). The directions of effect were generally consistent across sensitivity analyses. No evidence of an association with thyroid cancer was identified (IVW: p = 0.407). No evidence of bias was found in the heterogeneity test and the horizontal pleiotropy (p > 0.05), and the leave-one-out analysis confirmed the robustness of the results. Conclusions: This study provides genetic evidence of potential associations between antidepressant use and increased risks of Hashimoto’s thyroiditis and hypothyroidism. These findings support consideration of thyroidfunction monitoring in patients receiving antidepressant treatment, particularly those with pre-existing thyroid risk factors.
The Improvement Effects of Virtual Reality-Assisted Exercise Training on Motor and Psychiatric Symptoms in Patients With Parkinson’s Disease: A Meta-Analysis of Randomized Controlled Trials
Background: This study aimed to systematically evaluate the combined improvement effects of virtual reality (VR)-assisted exercise training on motor function and psychiatric symptoms in patients with Parkinson’s disease (PD), and to provide more scientific evidence-based support for precise clinical rehabilitation. Methods: This study searched China National Knowledge Infrastructure (CNKI), Wanfang, China Science and Technology Journal Database (VIP Database), PubMed, Web of Science and Scopus for randomized controlled trials (RCTs) examining VR interventions in patients with idiopathic PD covering the period from database inception to 1 March 2026. Two investigators independently performed literature screening and data extraction. Methodological quality was assessed using the Cochrane Risk of Bias Tool 2.0. Meta-analysis was conducted using Review Manager 5.4 and R 4.6.0 software. Results: A total of 37 RCTs involving 1749 patients with PD were included. Meta-analysis results showed that, compared with conventional rehabilitation training, VR-assisted training significantly improved motor outcomes, as reflected by the Berg Balance Scale (BBS; mean difference (MD) = 3.96), Timed Up and Go Test (TUGT; MD = −2.48), and Unified Parkinson’s disease Rating Scale Part III (UPDRS-III; MD = −2.94). Regarding psychiatric symptoms, VR training significantly enhanced specific cognitive function (Montreal Cognitive Assessment (MoCA); MD = 1.94), alleviated subjective depressive mood (Beck Depression Inventory (BDI); MD = −1.75), and improved activity-specific balance confidence (Activities-specific Balance Confidence Scale (ABC); MD = 12.03). However, no statistically significant betweengroup differences were found in global cognition (MiniMental State Examination (MMSE)) and observer-rated depression (Hamilton Depression Rating Scale (HAMD)). Conclusions: VR-assisted exercise training effectively improves comprehensive motor function, specific cognition and depressive mood in patients with PD. Therapeutic efficacy may be influenced by the immersion level of equipment and intervention duration. VR confers shortterm improvements, but its long-term effects remain unknown. It may serve as a promising adjunctive therapy; however, routine clinical recommendation requires further evidence from extended follow-up studies. High-quality RCTs with prolonged follow-up periods are still warranted to clarify the long-term effects of VR interventions with varying immersion levels.
Effectiveness of Digital Cognitive Behavioural Therapy (dCBT) for Co-Occurring Anxiety, Depression and Chronic Pain in Adults: A Systematic Review and Meta-Analysis
Background: This study aimed to evaluate the effectiveness of digital cognitive behavioural therapy (dCBT) in reducing pain intensity, pain interference, depression, and anxiety symptoms in adults with co-occurring chronic pain, anxiety and depression. Methods: We systematically searched in PubMed, PsycINFO, Cochrane Library and Web of Science for randomized controlled trials (RCTs) published up to October 2025. Included studies comparing dCBT with control conditions in adults with chronic pain (≥3 months), co-occurring anxiety and depression. Primary outcomes were pain intensity and depressive symptoms. Secondary outcomes were pain interference and anxiety symptoms. Pooled standardized mean difference (Hedges’ g) were calculated using fixed-effects or random-effects models depending on heterogeneity. Results: We included 6 RCTs involving 737 participants with chronic pain, co-occurring anxiety and depression. Compared with control groups, dCBT did not significantly reduce pain intensity (g = –0.43, 95% confidence interval (CI) [–0.98, 0.11], p = 0.12; I2 = 91%), but it significantly reduced depressive symptoms (g = –0.51, 95% CI [–0.66, –0.36], p < 0.00001; I2 = 35%), pain interference (g = –0.70, 95% CI [–1.18, –0.21], p = 0.005; I2 = 89%), and anxiety symptoms (g = –0.59, 95% CI [–0.74, –0.44], p < 0.00001; I2 = 37%). Conclusions: dCBT effectively improves depressive symptoms, anxiety symptoms, and pain interference in patients with co-occurring chronic pain, anxiety and depression, but its direct effect on pain intensity did not reach statistical significance in this meta-analysis. dCBT is convenient and scalable, with confirmed efficacy in emotional and functional domains, making it a valuable adjunctive treatment option. Future research should investigate its true effect on pain intensity, long-term outcomes and personalized treatment approaches.
Risk Factors for Posttraumatic Stress Disorder in Mexican Psychiatric Trauma Survivors
Background: There is extensive evidence linking specific sociodemographic and clinical factors to increased vulnerability for Posttraumatic Stress Disorder (PTSD). However, most studies have focused on community samples, and little is known about how such factorsshape PTSD risk in clinical psychiatric settings in Latin America, where trauma exposure is highly prevalent. The present study addresses these gaps by examining sociodemographic characteristics and specific types of traumatic events linked to PTSD diagnosis among individuals receiving care at a tertiary mental health facility in Mexico City, Mexico. Methods: A cross-sectional, observational design was employed, enrolling 160 psychiatric patients. Participants were assessed for exposure to potentially traumatic events using the Life Events Checklist for DSM-5 (LEC-5). Probable PTSD was initially identified with the PTSD Checklist for DSM-5 (PCL-5), followed by diagnostic confirmation using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Sociodemographic data, including age, sex, and educational attainment, were also collected. Multivariate logistic regression was used to identify PTSD predictors, with a significance set at p < 0.05. Results: The frequency of PTSD in the sample was 31.9%. Multivariate logistic regression analysis revealed that sexual aggression was the strongest independent predictor of PTSD (odds ratio (OR) = 38.49; 95% confidence interval (CI): 10.59–139.95; p < 0.001). Other significant predictors included being female (OR = 8.09; 95% CI: 1.60–40.86; p < 0.001) and over 30 years old (OR = 2.86; 95% CI: 1.13–7.24; p < 0.05). The model demonstrated good overall fit (Pearson χ2 p = 0.673) and explained a moderate proportion of the variance (Nagelkerke R2 = 0.550). Conclusions: Sexual aggression, female sex, and older age were significantly associated with a PTSD diagnosis among psychiatric trauma survivors. These findings underscore the importance of incorporating traumainformed care principles and systematic screening for sexual violence into mental health settings to improve diagnostic accuracy and optimize interventions for this population.
From Reified Identity to Relational Ipseity: Hermeneutic Phenomenology, Language Pragmatics, and Contemplative Practices of Self-Deconstruction
This article presents a theoretical and conceptual analysis of self-deconstruction in contemporary contemplative and clinical practices. It argues that psychological suffering is not primarily related to the existence of the self as such, but to its ontological and linguistic reification as a fixed identity, corresponding to idem-identity and to what Heidegger described as an ontology of presence (Vorhandenheit). Drawing on hermeneutic phenomenology, the self is reconceptualized as ipseity (selfhood): a relational, temporal, and performative mode of being-in-the-world. From this perspective, self-deconstruction does not imply the elimination of identity but a transformation in the mode of being of the self. This framework integrates three axes: (a) Heidegger’s analytics of being-in-the-world and the distinction between sameness and ipseity; (b) a pragmatic distinction between indirect and direct reference in language, allowing experiential and clinical transformation without representational reductionism; and (c) a dialogue with nondual contemplative traditions and contemporary clinical approaches, particularly mindfulness-based and third-wave therapies. The article proposes a translational architecture linking ontological analysis, phenomenology of language, and clinical practice, and shows how non-duality can be understood in a non-nihilistic way when grounded in an ontology of ipseity. Clinical implications for psychotherapy, mindfulness-based interventions, and models ofself-related suffering are discussed, including connections to Acceptance and Commitment Therapy, cognitive defusion, and decentering, as well as boundary conditions and safeguards for contemplative practices.
Recent Advances in the Brain–Gut Axis in the Development and Progression of Depression
The prevalence of depression is increasing year by year. Accumulating evidence has shown that the brain–gut axis (BGA) may contribute largely to the development and progression of depression. Gut microbial community composition and metabolites may contribute to the pathophysiological mechanisms of depression by influencing bidirectional communication with the BGA. Gut microbiota dysbiosis has been implicated in the pathogenesis of depression and may provide new potential targets for therapeutic interventions. This article reviews current academic investigations into the association between BGA and depression and discusses how to improve depressive symptoms through the BGA, seeking to offer insights for future research and clinical treatment strategies for depression.
Research Progress on Light Therapy to Improve Depressive Symptoms of Bipolar Depression
Bipolar depression is the predominant and most disabling phase of bipolar disorder, featured by recurrent depressive episodes that impair psychosocial function and quality of life. Conventional pharmacotherapy has limited efficacy and carries a risk of mood destabilization (e.g., affective switch). Light therapy, a nonpharmacological chronotherapeutic intervention, has shown potential to improve bipolar depression symptoms by regulating circadian rhythms and mood regulating neural circuits. This review synthesized domestic and international research advances regarding light therapy for bipolar depression, focusing on the mechanisms of action, clinical efficacy, application protocols, safety, and limitations, aiming to provide evidence based clinical guidance for optimization of therapeutic strategies.
Clinical Utility of Cariprazine in the Management of Acute Schizophrenia: Current Evidence and Practical Recommendations
Background: The management of schizophrenia in acute care units presents significant challenges, particularly in addressing negative symptoms and functional impairment. Cariprazine, a dopamine D3/D2 receptor partial agonist, offers a unique pharmacological profile in this setting. This review aims to provide an expert consensus on the clinical utility of cariprazine in acute settings and establish practical recommendations for its use. Methods: A comprehensive literature review was conducted across specialized databases, including PubMed/MEDLINE, EMBASE, PsycINFO, and the Cochrane Library, ensuring a robust evidence base. The consensus was developed by a panel of six senior experts during a formal consensus meeting held in Madrid. Following a structured discussion and evidence synthesis, a modified Delphi-like process was employed to refine the recommendations. The quality of evidence and the strength of the recommendations were assessed using the grading of recommendations assessment, development, and evaluation (GRADE) approach. Results: The evidence confirms cariprazine’s efficacy in acute exacerbations, with a distinct advantage in treating predominant negative symptoms and hostility compared to other second-generation antipsychotics (SGAs). Its metabolic-neutral profile and D3-mediated impact on craving also make it a strategic option for patients with dual diagnosis. Conclusions: Cariprazine is a valuable tool for the stabilization and long-term functional recovery of patients in acute psychiatric units. The consensus provides a practical framework to optimize its clinical application based on high-quality evidence.
Being on the Same Page: Ongoing Adjustment of the Therapeutic Contract When Treating Pathological Narcissism and Narcissistic Personality Disorder