Smartphone addiction in young adults produces a convergent triad of sensorimotor dysregulation, insomnia, and psychological stress. Despite this multidimensional burden, no published intervention has simultaneously addressed all three dimensions using a structured, physiotherapy-integrated, protocol-driven approach, a critical gap that the present study addresses through PhysioYoga. PhysioYoga is a therapeutic fusion of evidence-based physiotherapy techniques, including proprioceptive exercises and PNF-style sensorimotor facilitation, and yogic practices, including asanas, pranayama, and Shavasana. Its feasibility and preliminary efficacy have not previously been evaluated in this population. This study aimed to evaluate the feasibility, including recruitment rate, session adherence, and retention, as well as the preliminary pre-post changes associated with a structured online PhysioYoga protocol on sleep quality and perceived stress in smartphone-addicted young adults, within a sensorimotor integration-informed conceptual framework. The SAS-SV was employed as a validated screening instrument to confirm smartphone addiction at enrolment, using an inclusion threshold of score ≥ 31, thereby ensuring sample homogeneity. Given the 4-week single-arm feasibility design, SAS-SV was not designated as a post-intervention outcome. The study was specifically designed to evaluate the downstream health consequences of smartphone addiction, namely insomnia and perceived stress. Assessment of SAS-SV change as a primary outcome is recommended for the planned fully powered randomised controlled trial. This single-arm pre-post feasibility study enrolled 20 participants aged 18 to 30 years who met validated criteria for smartphone addiction, with an SAS-SV score ≥ 31, and poor sleep quality, with a PSQI score > 5. The sample size of 20 was selected in accordance with standard precedent for single-arm feasibility studies, which conventionally enroll 15 to 30 participants to assess protocol delivery, adherence, and retention rather than to achieve formal statistical power. A 4-week online PhysioYoga intervention was delivered via secure video conferencing, with three 60-minute sessions per week for a total of 12 sessions, across seven structured segments. Primary outcomes were PSQI global and component scores and PSS score, assessed pre- and post-intervention using the Wilcoxon signed-rank test in IBM SPSS version 29. The study demonstrated a 100
Adverse Childhood Experiences (ACE) are associated with poor health outcomes, but their effect on the medication adherence of patients with type 2 diabetes (T2DM) remains unclear. This study aimed to assess the relation between ACE and medication adherence, while also exploring whether the association between ACE and medication adherence persisted after adjustment for psychopathological symptoms. This cross-sectional study included 50 adults with type 2 diabetes mellitus recruited from the outpatient endocrinology clinic of Centro Hospitalar e Universitário São João and from community-based settings. Participants completed validated self-report questionnaires, including the Childhood Trauma Questionnaire-Short Form (CTQ-SF) for ACE assessment, the Brief Symptom Inventory (BSI) for psychopathological symptoms evaluation, and the Medication Adherence Scale (MAS). Physical activity levels were assessed using the International Physical Activity Questionnaire-Short Form (IPAQ-SF). Spearman’s correlation was used to examine associations between these variables. Partial correlation analysis was performed to assess whether psychopathological symptoms influenced the relation between ACE and adherence. Childhood sexual abuse correlated with lower adherence (ρ = -0.382, p = 0.006), while psychopathology (Global Severity Index (GSI)) was weakly associated with lower adherence (ρ = -0.297, p = 0.037). Among the dimensions of BSI, hostility showed a moderate negative correlation with adherence (ρ = -0.377, p = 0.007). No significant associations were found between ACE, GSI, and physical activity levels. Partial correlation analysis revealed that the association between childhood sexual abuse and adherence strengthened after adjusting for the GSI of BSI (ρ = -0.686, p < 0.001). Childhood sexual abuse was associated with lower self-reported medication adherence, and this association remained after adjustment for overall psychological distress. Integrating trauma-informed care into diabetes management may help address adherence barriers. Larger longitudinal studies are needed to clarify mechanisms and guide interventions.
Cancer is a source of physiological and psychological stress. Heart rate variability (HRV) is a measure of autonomic reactivity to physiological and psychological stress. For an initial proof-of-concept, we investigated the effects of a yoga therapy (YT) intervention on HRV metrics and self-reported autonomic nervous system (ANS) functioning using single-subject experimental methods. Data from 20 adults (Mage (years) = 55.7 [SD = 8.6], 85
This study investigated predictors of body appreciation among Japanese sport science majors, focusing on the roles of androgynous identity, sport type, and competitive level within a culturally distinct context. A sample of 240 university students (170 male, 70 female) completed the Bem Sex-Role Inventory and the Body Appreciation Scale-2. Results indicated that androgynous individuals reported the highest body appreciation, significantly exceeding other gender role groups, while undifferentiated individuals scored the lowest. Male participants exhibited higher body appreciation than females across all roles. A significant interaction revealed female team-sport athletes had lower body appreciation than those in individual or hybrid sports, a difference not observed in males. Regression analyses showed national medalists had higher body appreciation, but competitive level did not moderate the gender role effects. Our conclusions underscore the protective role of an androgynous identity in Japan’s gendered sports culture and highlight unique pressures faced by female team-sport athletes, informing targeted interventions.
Psychological distress is common yet often underrecognized in chronic obstructive pulmonary disease (COPD). Physiological correlates beyond spirometry may support biopsychosocial assessment in routine care, but their relation to depressive and anxiety symptoms remain insufficiently characterized. In this single-center cross-sectional study, 56 clinically stable Japanese COPD outpatients (mean age 73 years; 87.5
Orthostatic dysregulation (OD) is a physical disorder characterized by circulatory disturbances due to autonomic nervous system imbalance that predominantly affects children. In Japan, OD is common and closely associated with school non-attendance, and its clinical management has developed from a psychosomatic perspective. However, large-scale data on real-world clinical practices are lacking. This study uses nationwide data to describe the comorbidities, prescribed medications, and medical practices for OD. This descriptive study utilized the Medical Information Analysis databank, a nationwide administrative database operated by the National Hospital Organization in Japan. We identified 7,213 patients aged 6 to 18 years who were first diagnosed with OD between 2016 and 2023. Descriptive statistics were used to analyze patient demographics, comorbidities, prescribed medications, and medical practices. Subgroup analyses stratified by prescription patterns were conducted. The median age at diagnosis was 13 years, and 55.6
The Death and Dying Distress Scale (DADDS) is a self-report instrument used to assess distress related to dying and death in patients with advanced cancer. We aimed to test the reliability and validity of the Japanese-translated version of the DADDS (DADDS-J) and evaluate its psychological properties in patients with advanced cancer in Japan. Japanese participants with advanced cancer (n = 200) completed the DADDS and additional tools measuring depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), quality of life (Functional Assessment of Cancer Therapy-General; Japanese Version of the Quality of Life at the End of Life-Cancer Scale), symptom burden (Japanese Version of the Quality of Life at the End of Life-Cancer Scale), and spirituality (Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being). Exploratory factor analysis (EFA), parallel analysis, and confirmatory factor analyses (CFA) were performed on 15 DADDS items. Internal consistency was assessed using Cronbach’s alpha and McDonald’s ω, and construct validity was examined by calculating correlations with relevant scales. EFA and parallel analysis identified a three-factor structure in the 14-item DADDS-J after item 3 was excluded, with Cronbach’s alpha and McDonald’s ω ranging from 0.85 to 0.92. CFA showed an adequate fit for the unique structure. Each subscale was significantly correlated with age, depression, anxiety, symptom burden, and lower quality of life and spirituality, but not with social and family well-being or time since cancer diagnosis. The DADDS-J has a three-factor structure and demonstrates good reliability and validity. Differences between the original and Japanese versions of the scale may be due to cultural factors. This is the first tool that can measure spiritual pain associated with death in patients with advanced cancer in Japan and is suitable for large-scale studies and clinic use. This scale can enhance research and clinical care for patients with advanced cancer in Japan.
Self-focused attention is a well-established factor in social anxiety disorder. Our previous study found that perceiving oneself as being watched or evaluated in social contexts exacerbates this tendency, but it remains unclear whether the perception of gaze or evaluation serves as the initial trigger for these cognitive processes. This study used ecological momentary assessment to investigate the temporal sequence of these perceptions and their impact on self-focused attention and social anxiety symptoms. Thirty-eight participants (17 male, 21 female) completed self-reported web assessments three times daily for 10 days. Measures included perceived evaluation, gaze perception, self-focused attention, and anxiety experienced in social situations. A total of 569 data points were collected and analyzed with multilevel structural equation modeling to compare two competing theoretical models. One model posited that perceived evaluation preceded gaze perception, and the other that gaze perception preceded perceived evaluation. The latter received stronger empirical support, indicating that gaze perception elicits the perceived evaluation, which subsequently increases self-focused attention and social anxiety symptoms. However, model fit differences were small, leaving the alternative model where perceived evaluation precedes gaze perception as a plausible explanation. Gaze perception plays a pivotal role in triggering social anxiety symptoms by fostering the perceived evaluation and amplifying self-focused attention. Interventions targeting gaze perception and sensitivity to evaluation may help reduce social anxiety symptoms.
Mental health conditions undermine HIV treatment outcomes, yet evidence from routine care settings in rural Zimbabwe remains limited. To examine the association between documented mental health disorders and retention in care and viral suppression among adults receiving antiretroviral therapy (ART) at a rural hospital in central Zimbabwe. This retrospective cohort analysis used routinely collected clinical data to examine associations between documented mental health disorders and retention in care and viral suppression among adults living with HIV receiving ART. Sixty-four adults with comorbid HIV and documented mental health disorders were included as cases and matched 1:1 by age (± 1 year), sex, and duration on ART (± 1 year) to 64 adults without documented mental health disorders or other chronic treatment-related conditions, resulting in a total analytic sample of 128 participants. Ficher’s exact test and ordered logistic regression models were used to assess associations between mental health disorders and treatment outcomes, adjusting for relevant demographic covariates. The overall prevalence of documented mental health disorders (predominantly psychosis and anxiety) in this study population was low (3.6
Obstructive sleep apnea syndrome (OSAS) is a common disorder that causes repeated airway obstruction, disrupted breathing, and fragmented sleep. This study aimed to investigate the effects of Pranayama on sleep quality, daytime sleepiness, quality of life, fatigue, depression, and anxiety in patients with OSAS. This study was designed as an open-label, prospective, randomized controlled trial. OSAS patients meeting the inclusion criteria were randomly assigned to either an Intervention group or a Control group. Pranayama training was applied to the Intervention group for 8 weeks, 7 days a week, and 3 times a day for 15 min. In addition, a single 15-minute session, 3 days a week, was conducted online under the supervision of a physiotherapist. The control group did not receive any intervention. Primary outcome was sleep quality (Pittsburgh Sleep Quality Index, PSQI). Secondary outcomes included daytime sleepiness (Epworth Sleepiness Scale, ESS), Fatigue Severity Scale (FSS), Functional Outcomes of Sleep Questionnaire (FOSQ), Nottingham Health Profile (NHP), and Hospital Anxiety and Depression Scale (HADS). All outcome measures were assessed at baseline and reassessed after the 8-week intervention period. Thirty-eight OSAS patients meeting the inclusion criteria were randomly assigned to either an Intervention group (n = 19) or a Control group (n = 19). Four participants (two in each group) were lost to follow-up, leaving the data of 34 participants (17 per group) available for inclusion in the final analysis. In the intervention group, PSQI scores decreased from 9.12 ± 4.71 to 6.88 ± 4.45 (p < 0.001), whereas no improvement was observed in the control group. Regarding the primary outcome, the reduction in PSQI scores was significantly greater in the intervention group than in the control group (p < 0.001). The ESS scores also decreased significantly in the intervention group, from 9.41 ± 6.15 to 7.41 ± 6.18 (p = 0.006, with a significant between-group difference (p < 0.001). Fatigue severity decreased in the intervention group (FSS change: 0.53 ± 0.70; p = 0.006), with a significant between-group difference (p = 0.037). The FOSQ score improved markedly, with significant gains in FOSQ total score (− 0.38 ± 0.25 vs. 0.14 ± 0.22 in controls; p < 0.001) and in activity level and vigilance subdomains (both p < 0.001). The HADS-anxiety scores decreased by 1.94 ± 3.94 (p = 0.059) and depression scores by 3.06 ± 2.05 (p < 0.001) in the intervention group, with significant between-group differences for both anxiety (p = 0.008) and depression (p < 0.001). Pranayama was an effective adjunct therapy for these OSAS patients, and incorporating it into treatment strategies may enhance patient outcomes. NCT04632147/22.10.2020.
Chronic pain is recognized as a disorder of distributed brain networks rather than the consequence of persistent nociceptive input. Among these networks, the medial prefrontal cortex (mPFC) is a key integrative hub linking sensory processing with affective, cognitive, and stress-related dimensions of pain. Evidence from neuroimaging, neurochemical, and longitudinal studies indicates that mPFC dysfunction contributes to impaired top-down modulation, altered emotional regulation, and the persistence of pain states. Nevertheless, these findings should be interpreted within a system-level framework, as mPFC activity reflects network reorganization rather than serving as an isolated or validated clinical biomarker. Moreover, the generalizability of mPFC-centered models is limited across patient populations, including children and those with psychiatric comorbidities or cognitive impairment. This editorial critically examines the neurobiological basis of mPFC-centered network dysfunction in chronic pain and discusses its implications for translational research, with a key focus on artificial intelligence (AI). These technologies are framed not as a near-term clinical solution but as enabling and exploratory methods for integrating multimodal data and modeling complex brain–behavior relationships. Emerging generative AI approaches, agent-based models, and digital twins can also be implemented as conceptual tools for hypothesis generation and in silico exploration of individualized network dynamics, rather than as established clinical applications. Although AI-based approaches may accelerate hypothesis generation and the identification of latent network-level patterns, their clinical relevance is currently constrained by key methodological challenges, including limited generalizability, imperfect phenotypic classification, the absence of robust ground truth for pain, and the need for extensive external and longitudinal validation. Trial registration Not applicable.
Postoperative psychological distress is highly prevalent in Asian surgical populations, but the relationships among opioid exposure at different perioperative stages, pain characteristics, side effects, and postoperative anxiety and helplessness remain poorly understood. A total of 6,105 patients from seven Asian regions in the PAIN OUT registry were included. Opioid use during the preoperative, intraoperative, recovery room, and ward stages was converted to oral morphine equivalents (OMEs). Four dimensions of postoperative outcomes– psychological distress (anxiety, helplessness), pain intensity, pain interference, and side effects– were assessed using the International Pain Outcomes Questionnaire (IPO-Q). Multinomial logistic regressions were used to examine the associations. Moderate-to-severe anxiety and helplessness were reported by 42.6
Anxious-Depressive Attack (ADA) is one of the three types of anxiety attacks originally described by Freud. ADA is characterized by the sudden onset of intense anxiety, immediately followed by intrusive ruminations. These intrusive thoughts, often centered on past regrets or future worries, cause significant psychological distress. Some individuals respond to these episodes with maladaptive or impulsive coping behaviors. This study aimed to investigate the prevalence of ADA among new patients at an anxiety disorder specialty clinic and to examine the associated psychiatric and psychological characteristics. New patients (N = 286) presenting to an anxiety disorder clinic in Tokyo were assessed for the presence of ADA independently by a psychiatrist and Certified Public Psychologists (Japan), based on predefined diagnostic criteria. Axis I and Axis II diagnoses were established using the Japanese version of the Mini-International Neuropsychiatric Interview (MINI) and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II), respectively. Histories of early separation or abuse were assessed using structured questionnaires. Psychological assessments of anxiety, depression, social anxiety, stress, and rejection sensitivity (RS) were conducted. Structural equation modeling (SEM) was performed to examine relationships among these variables. The lifetime prevalence of ADA was 21.68
Irritable bowel syndrome (IBS) is a prevalent disorder of gut-brain interaction in which psychosocial factors can exacerbate symptoms. Although cognitive behavioral therapy (CBT) has proven effective in alleviating IBS symptoms, its widespread implementation is limited by therapist shortages and the substantial time demands placed on both patients and clinicians. Mobile health–delivered Just-in-Time Adaptive Interventions (JITAIs) may overcome these barriers by providing continuous, personalized support. In this study, we simulated the core functions of a JITAI-based CBT application via Google Forms and gathered feedback from patients and clinicians for application development. In this three-month, multicenter observational study, ten adults meeting Rome IV criteria for IBS were enrolled from three psychosomatic clinics in Japan. Using Google Forms as a prototype, we delivered: a daily symptom diary, an exposure-therapy module with anxiety-hierarchy support and automated progression prompts, and an educational website. Usage data were recorded automatically, and feasibility, burden and satisfaction were assessed through post-study questionnaires with patients (n = 8) and semi-structured interviews with patients (n = 3) and physicians (n = 4). All ten participants (three women; mean age 28.4 years, range 18–52) completed the study (IBS with diarrhea [IBS-D] n = 6; IBS with constipation and diarrhea [IBS-M] n = 3; IBS unclassified [IBS-U] n = 1). Mean daily symptom diary completion rate was 94.9
Liver transplantation (LT) is a life-saving treatment for end-stage liver disease, and psychosocial factors significantly influence eligibility, adherence, and outcomes. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) was developed to standardize psychosocial evaluation across four domains: treatment readiness, social support, psychopathology, and substance use. Despite its growing global adoption, evidence regarding its validity, predictive value, and applicability, specifically in LT, remains fragmented and heterogeneous. This scoping review maps and summarizes the available empirical evidence on SIPAT use in adult LT candidates. It focuses on (1) score distributions (2), psychosocial differences by disease etiology, and (3) associations with listing decisions, post-transplant outcomes, relapse risk, and quality of life. A systematic search of PubMed, Scopus, and PsycInfo (January 2012–May 2025) identified ten eligible empirical studies, primarily observational in design, with sample sizes ranging from 22 to 2,825 participants. Across studies, a substantial proportion of LT candidates were classified as having moderate-to-high psychosocial risk, frequently exceeding a SIPAT threshold of ≥ 21, although cutoff values varied across studies. Evidence from a limited number of investigations suggests that domains related to treatment readiness and lifestyle/substance use may be particularly affected in LT populations. Studies examining etiological subgroups reported higher SIPAT scores among candidates with alcohol-associated liver disease (ALD) or acute alcoholic hepatitis compared with non-ALD candidates, although findings were not uniform across all studies. Higher total SIPAT scores were associated in several cohorts with lower likelihood of listing and with adverse post-transplant outcomes, including nonadherence and acute rejection. In ALD samples, elevated SIPAT scores were associated with increased risk of harmful alcohol relapse, independent of abstinence duration. Notably, none of the included studies evaluated associations between SIPAT scores and post-transplant quality-of-life outcomes. Current evidence suggests that the SIPAT is a useful framework for structuring psychosocial assessment in liver transplantation and for identifying potentially modifiable vulnerabilities relevant to listing decisions and selected post-transplant outcomes. However, substantial methodological heterogeneity, inconsistent cutoff thresholds, and limited evidence across some outcome domains, particularly quality of life, constrain comparability and clinical generalizability. Future multicenter, prospective studies are needed to harmonize cutoff values, examine sensitivity to change, and clarify the role of SIPAT in predicting long-term patient-centered outcomes.
Cholangiocarcinoma (CCA) is an aggressive malignancy associated with systemic inflammation and a high psychological burden. However, the relationship between inflammation and depression in CCA remains poorly understood. This study aimed to investigate the association between systemic inflammatory markers and depression in patients with CCA. We conducted a prospective cohort study of patients aged ≥ 20 years with a diagnosis of cholangiocarcinoma treated at a single tertiary medical center between May 2021 and September 2024. Depression was evaluated using the Patient Health Questionnaire-9. Generalized linear mixed models were applied to examine the relationships between inflammatory markers and depression. A total of 164 patients with CCA were included, comprising 97 intrahepatic cholangiocarcinoma (ICC) and 67 extrahepatic cholangiocarcinoma (ECC) cases. Depression prevalence was 19.9
This longitudinal study aimed to examine the effects of irritable bowel syndrome (IBS) and related cognitive-behavioral and occupational stress factors on the productivity and abdominal symptoms of Japanese workers. An online survey was conducted from October 5 to October 20, 2023 (Time 1), targeting workers aged 20–49 years who were not self-employed or business owners and who worked more than 30 h per week. Data from 1,062 participants was available. A follow-up survey was conducted one year later (Time 2), with responses from 424 participants (161 women and 114 persons who reported IBS in the Time 1 screening) used for the analysis. Hierarchical multiple regression analysis showed that depression, physical symptoms, and the presence of IBS at Time 1 had significant effects on presenteeism and overall work productivity impairment at Time 2. In the IBS group, the interaction between maladaptive cognition related to IBS and job control at Time 1 were significantly related to abdominal symptoms at Time 2, indicating that IBS symptoms were more severe when job control was low and maladaptive cognition related to IBS was high, although the simple slope test results did not reach statistical significance. The physical symptoms of the IBS group at Time 1 had significant effects on presenteeism and overall work productivity impairment at Time 2; however, occupational stress factors and IBS-related cognitive-behavioral variables did not show significant effects. The presence of IBS was shown to be related to the magnitude of productivity impairment one year later. Additionally, a correlation was seen between job control and maladaptive cognition regarding the effect of IBS on abdominal symptoms up to one year later. However, no evidence was found that occupational stress factors or IBS-related cognitive-behavioral variables were related to work productivity one year later.
Hereditary angioedema (HAE) is a rare disease that presents with recurrent attacks that can be triggered by stress or other emotions. The emotional impact of HAE is well-documented, although mainly via self-reported questionnaires. In this study, we used physiological measures to investigate stress regulation in patients with HAE and compared them to patients with immune thrombocytopenia (ITP), a disease that also progresses with attacks but without emotional triggers. Twenty-six adult patients with HAE or ITP (13 each) were included in the study. Patients were asked to perform several computerized tasks that activated different branches of the autonomic nervous system (ANS). Heart rate variability and electrodermal activity were measured during the experimental tasks and a medical consultation that followed the experiments. Patients with HAE did not differ from patients with ITP in their physiological responses. In the reactivity tasks, a non-significant correlation significance was observed between reaction times (RTs) and peak spread in the HAE and ITP groups only for male patients and in a different way for HAE (negative correlation) and ITP (positive correlation). During medical consultations, an association between the physician’s perception of the patient’s stress and the patient’s physiological measures of stress was found only in female HAE patients, but without significance. The ANS of patients with HAE and ITP was similarly and abnormally activated, with a possible effect by sex. These results shed new light on the role of emotional regulation in chronic diseases. This article does not report the results of a health care intervention on human participants. The research was not preregistered in any registry. The analysis plan was not preregistered in an independent, institutional registry. Data, analytic methods, and study materials are not made directly available.
Disordered eating behaviors, emotional eating (EE), uncontrolled eating (UE), and cognitive restraint (CR) contribute to weight dysregulation and remain public health concerns in Japan. Body image distortion (BID), or the misperception of one’s body size, has been linked to both being underweight and overweight. While health literacy (HL) and BID are individually associated with eating behaviors, the influence of higher-order HL domains—communicative and critical literacy—and their interactions with BID remain unclear. This study examined how HL and BID jointly influence multidimensional eating behaviors. In this cross-sectional study of Japanese adults, HL was measured using the 14-item Health Literacy Scale. BID was defined as the discrepancy between the perceived (via the Figure Rating Scale) and actual body size (via BMI) and categorized as underestimation, no distortion, or overestimation. Eating behaviors (UE, EE, and CR) were assessed using the Japanese version of the 18-item Three-Factor Eating Questionnaire-R18V2. Multinomial logistic regression was used to examine the association between HL and BID, and general linear models were used to test whether BID moderated the effects of higher-order HL domains on eating behavior. Among the participants, 13.0
This study explores the level of frailty and the factors that influence elderly HF inpatients. It also examines the correlation between social frailty, perceived social support, and psychological resilience. It verifies psychological resilience and perceived social support as mediators between social frailty and frailty. This cross-sectional study collected four hundred fifty-six questionnaires from Northeast China, Northwest China and South China. The research assessment tools include the FRAIL scale (frailty), MSPSS scale (perceived social support), CD-RISC10 (psychological resilience), and HALFT scale (social frailty). Data analysis was performed using multiple regression analysis and the SPSS PROCESS Macro plug-in Model 6 and Model 4. Female (β = 0.085, p = 0.036), number of hospitalizations (β = 0.342, p < 0.001), and NYHA class (β = 0.325, p = 0.004) were risk factors for frailty in elderly HF inpatients. Frailty was found to be at a medium-high level, negatively correlated with perceived social support (ρ=-0.471, p < 0.01) and psychological resilience (ρ=-0.670, p < 0.01), and positively correlated with social frailty (ρ = 0.596, p < 0.01). Psychological resilience and perceived social support mediated the relation between social frailty and frailty, with an indirect effect of 27.18
