Introduction Virtual reality (VR) is a promising tool for diagnosis and therapy in Panic Disorder (PD), allowing controlled exposure to anxiety-provoking situations and real-time assessment of behaviors and physiological responses. Studies indicate its effectiveness in reducing symptoms and its therapeutic applicability. However, there is a lack of robust data on its specific impact on heart rate variability (HRV), sense of presence, safety, and acceptability in patients with PD and agoraphobia. Therefore, further research is warranted to evaluate these aspects, aiming for a broader understanding and optimization of this technology in mental health. Objective Thus, this experimental crossover study protocol aims to evaluate the sense of presence, method safety, acceptability, psychological ( i.e. , anxiety), and physiological changes ( i.e. , respiratory and heart rate, HRV, tidal volume and respiratory minute volume, and level of skin conductance). In addition, correlate the psychological measures with the physiological ones. Methodology This is an experimental crossover study protocol, following an within-subject crossover design, with independent groups (between-subjects), in which 25 PD patients and 25 controls will be randomly allocated, through block randomization to an experimental group (PD patients) and a control group (healthy individuals) where they will go through the following sequences: (1) initial exposure to 2D video, using projection glasses, followed by the same scene in VR with the Oculus 2 headset; or (2) initial exposure in VR, followed by the 2D video. VR offers an ecological and multimodal method for assessment, aligned with initiatives such as RDoC. The protocol, structured in modules that reflect components of Cognitive-Behavioral Therapy, aims to test the system's ability to respond to clinically relevant anxiety in a safe and acceptable manner. Results The results of the trial will be published in international peer-reviewed journals and will be disseminated at international meetings and congresses. Discussion Potential contributions include a more objective and standardized assessment, useful for personalizing interventions. Limitations such as sample size and ecological validity are acknowledged. Conclusion In conclusion, the protocol represents a methodological advancement. The results of this predictive study will be crucial for refining the technology and informing future clinical trials, with the potential to improve diagnostic accuracy and optimize personalized therapeutic strategies for PD.
Introduction:Adolescents around the world encounter profound difficulties with depression. Adolescents exhibit a vulnerability to depression stemming from a variety of influences, encompassing sociodemographic factors and the level of familial support available to them. However, research on the specific association of factors and depression among adolescents remains limited in Semarang. This study aimed to examine the association between sociodemographic factors and family support with depression among adolescents in Semarang, Indonesia. Method:This research employed a quantitative approach within a cross-sectional design. We employed proportional stratified random sampling to select our sample and gathered data from 421 respondents in Semarang utilizing the sociodemographic questionnaire, the PSS-Fa (Perceived Social Support Family), and PHQ-9 (Patient Health Questionnaire-9). The data analysis encompasses univariate, bivariate, and multivariate analyses. Univariate analysis was conducted using a frequency distribution table, whereas bivariate analysis employed the chi-square and Fisher's exact test. Meanwhile, multivariate analysis was conducted using Multivariate ordinal logistic regression analysis. The significant value was less than 0.05. Result:The results demonstrated that the predominant age group among adolescents was 16 years (61.8%), with female participants accounting for 60.6%. Moreover, 95.7% of adolescents lived with their parents. Most respondents (57%) were in the 10th grade, and 53.9% were considered to have high socioeconomic status. Additionally, more than half of the respondents (51.8%) reported receiving substantial family support. The correlation test results showed a strong link between depression level and a number of factors, such as gender (p=0.000), living conditions (p=0.037), and family support (p=0.000). Meanwhile, education level (p = 0.279) and socioeconomic status (p = 0.577) were not correlated with depression among adolescents. Multivariate analysis revealed that gender (AOR = 1.79, 95% CI: 1.15-2.80, p = 0.011) and family support (AOR = 0.54, 95% CI: 0.38-0.77, p = 0.001) were significantly associated with depression. Discussion:The findings indicated that several factors associated with the depressive state among adolescents in Semarang include gender, living conditions, and family support. Conclusion:Health service providers need to consider gender, living conditions, and family support when developing health programs for adolescents. Future research is encouraged to explore additional factors and to employ qualitative approaches to further investigate the psychological conditions of adolescents.
Introduction:Mental health issues have become a major concern in universities worldwide, including in Indonesia. Various mental health challenges experienced by students can trigger crises, such as urges to self-harm or even suicidal ideation. Such crises require immediate intervention. However, access to mental health emergency services remains limited and lacks standardized guidelines. This study aims to explore participants' experiences in handling mental health emergencies in university settings, with the hope of providing insights for the development of standardized mental health emergency service guidelines. Methods:Data collection was conducted through focus group discussions involving six psychologists working in university-based mental health practices. The collected data were analyzed using reflective thematic analysis. Results:Through reflective thematic analysis, four primary themes emerged, namely the understanding and interpreting crisis; navigating crisis assessment in complex situation; professional responses in crisis intervention; and challenges in managing crises. Discussion:The findings of this study reveal the complexity of understanding and managing psychological crisis cases, including significant challenges in doing so effectively. These findings are consistent with previous research on psychological services and provide insights into how to manage clients experiencing crises. These insights make a valuable contribution to the development of regulations and the implementation of standardized mental health crisis services in higher education institutions. Conclusion:Overall, this study demonstrates that crisis management in university mental health services involves diverse understandings of crisis, varied intervention practices, and multiple practical challenges. These findings highlight the importance of developing clearer frameworks to support mental health emergency services in higher education.
Introduction:Team Sports (TSG) have been discussed as an accessible and socially engaging way to support mental health. Although this idea is intuitively appealing and supported by several observational findings, the actual consistency of their effects on anxiety and mood in adults who do not have diagnosed mental disorders remains uncertain.The study aims to map how TSG has been investigated in this context and to systematically synthesize current evidence on their effects on anxiety and mood (PROSPERO: CRD420251121611). Methods:This systematic review followed PRISMA 2020 recommendations. Five databases were searched: PubMed, Scopus, Web of Science, EMBASE, and Cochrane Library. Eligible studies included longitudinal, face-to-face TSG interventions involving adults or older adults and reporting validated psychometric outcomes. Randomized trials were assessed using the Cochrane RoB 2 tool and the PEDro scale, whereas non-randomized studies were evaluated using ROBINS-I. Results:Six studies involving 744 participants met the inclusion criteria. The included interventions involved soccer/football, floorball, volleyball/soccer programs, small-sided soccer games, and recreational TSG. Two studies reported reductions in anxiety symptoms, while one randomized trial showed reduced mood disturbance when small-sided games were combined with verbal encouragement. One trial found no significant changes in generalized anxiety, depressive symptoms, perceived stress, or well-being. Another randomized trial showed that recreational TSG improved mental-health-related quality of life compared with control. Discussion:Evidence suggests that TSG may promote improvements in symptoms of anxiety and depression. However, in non-clinical adult populations, the value of TSG may lie less in producing large reductions in psychiatric symptoms and more in improving psychosocial functioning, perceived well-being, and social connection. Conclusion:Current evidence suggests that TSG may improve selected mental-health and psychosocial outcomes in adults, including anxiety symptoms, mood disturbance, emotional well-being, and mental-health-related quality of life. However, these effects were inconsistent among studies and were strongly influenced by intervention context.
Introduction Outcomes after rotator cuff repair are commonly evaluated in terms of structural healing and surgical technique. However, psychological factors may also influence patients’ experience of pain and functional recovery. Increasing attention has therefore been directed toward the potential role of preoperative psychological distress in shaping postoperative outcomes. To systematically review the available evidence examining whether psychological factors present before surgery are associated with postoperative pain and functional outcomes following rotator cuff repair. Methods This systematic review was conducted in accordance with PRISMA guidelines and prospectively registered in PROSPERO (CRD420251132190; 28/08/2025). A structured literature review was performed using MEDLINE, Embase and PsycINFO, from database inception to March 6, 2026, for studies evaluating preoperative psychological variables in relation to postoperative pain and functional outcomes. Eligible study designs included randomized controlled trials, non-randomized trials, and observational cohort studies; however, only observational cohort studies met the final inclusion criteria. Risk of bias was assessed using the ROBINS-I tool, and methodological quality was appraised using the Newcastle-Ottawa Scale. Results Ten observational studies were included. Across these studies, higher levels of depression, anxiety, pain catastrophizing, poorer emotional well-being, negative affect, and broader psychological distress were frequently associated with worse postoperative pain intensity and lower functional outcome scores. The reported associations were generally small-to-moderate strength and varied across cohorts. Some findings suggested potential interaction between psychological vulnerability and biological predisposition, including variation in Catechol-O-Methyltransferase (COMT) genotype. Importantly, elevated preoperative psychological distress did not preclude meaningful postoperative improvement, and several studies reported parallel improvements in psychological symptoms and physical recovery over time. Discussion The available evidence indicates that recovery after rotator cuff repair cannot be explained solely by structural or surgical factors. Psychological health appears to influence how patients experience and report postoperative pain and function. However, the observed relationships are not uniform, and the evidence base is limited by observational design, methodological heterogeneity, and variability in outcome measurement. While preoperative psychological assessment may have clinical value, further prospective and interventional research is required to clarify its impact on surgical outcomes. Conclusions Preoperative psychological distress is associated with postoperative pain and functional outcomes after rotator cuff repair, although it does not determine recovery in isolation. Psychological factors likely represent one component of a broader multifactorial recovery process. Future studies should explore whether targeted psychological interventions can improve postoperative pain trajectories and functional recovery.
Introduction:Mental health problems in young adults with hypertension are often underrecognized, despite their potential impact on quality of life and long-term outcomes. Evidence in younger populations remains limited, particularly in longitudinal and multicenter settings. Objective:To examine the relationship between hypertension duration, mental health symptoms, and quality of life among young adults, as well as to explore psychosocial stressors identified through qualitative inquiry. Methods:This multicenter longitudinal study recruited patients aged 18-45 years with hypertension from outpatient clinics across several Indonesian cities. Participants were assessed at baseline using the Depression Anxiety Stress Scale-21 (DASS-21) and the WHO Quality of Life-BREF (WHOQOL-BREF). Hypertension duration was recorded as a continuous variable. A subset of participants underwent semi-structured interviews to explore psychosocial stressors. Quantitative data were analyzed using correlation analysis, while qualitative data were analyzed thematically. Results:A total of 791 participants were included in the study, with a mean age of 33 ± 10.14 years, and women slightly outnumbered men. This study found that a longer duration of hypertension was associated with worse overall quality of life (r = -0.45) and lower psychological well-being (r = -0.40). Notable correlations also emerged between hypertension duration and higher levels of anxiety (r = -0.42), depression (r = -0.38), and stress (r = -0.30), while socioeconomic and psychosocial stressors emerged as major contributing factors. Discussion:This multicenter longitudinal study suggests a direct link between early-adulthood hypertension and subsequent psychological distress, particularly anxiety and depressive symptoms, as well as lower quality of life with aging. Recent findings underscore that hypertension in young individuals extends beyond cardiovascular risk and may also impose a substantial mental health burden. Evidence identifying socioeconomic and psychosocial stressors as key predisposing factors further strengthens the rationale for incorporating routine mental health screening and psychosocial interventions into standard hypertension management protocols, thereby enhancing patients' quality of life and potentially improving long-term clinical outcomes. Conclusion:In this multicenter longitudinal cohort, a longer duration of hypertension was associated with greater psychological distress and poorer quality of life among young adults. These findings support the integration of routine mental health screening into hypertension care.
Introduction/Background:Burnout syndrome is an important issue in academic settings. Mindful eating offers a promising approach for intervention strategies aimed at preventing burnout. Exploring the relationship between mindful eating and burnout syndrome may provide a foundation for developing effective interventions to reduce burnout. Method:This cross-sectional study included 472 undergraduate students from the Faculty of Medicine, Public Health, and Nursing, Gadjah Mada University, representing both medical and non-medical study programs. The Maslach Burnout Inventory (MBI) was used to assess burnout syndrome, while the Mindful Eating Questionnaire (MEQ) measured the dimensions of mindful eating. Simple logistic and ordinal logistic regression analyses were applied to the data. Results:More than 25% of respondents experienced burnout syndrome, characterized by a moderate degree of emotional exhaustion and a lack of personal accomplishment. Among medical students, distraction was the dominant mindful eating dimension, whereas awareness was predominant among non-medical students. After adjusting for confounders, distraction (aOR = 0.45, p < 0.05), external cues (aOR = 2.23, p < 0.05), and moderate physical activity (aOR = 2.02, p < 0.05) were significantly associated with burnout syndrome. Problem-focused coping acted as a protective factor against emotional exhaustion (aOR = 0.32, p < 0.05). Discussion:These findings contribute to understanding the prevalence and determinants of burnout syndrome among medical and non-medical undergraduate students, with potential implications for other faculties. Conclusion:Distraction, external cues, problem-focused coping, and moderate physical activity should be considered in faculty program development to help reduce burnout syndrome.
Introduction:There are several somatic techniques for reducing anxiety through relaxation, i.e., the reduction of tension. Tension is an important component and corresponds, in the primordial mechanism of fear, to the pre-encounter immobilizing alert state of the defense cascade. It is hypothesized that an energetic generalized muscular activation, such as that used to face a fighting (circa-strike), can correct the immobilizing tension and counteract anxiety. Objective:To evaluate the degree of effectiveness against anxiety and anxiety attacks of a technique based on a phase of sustained, generalized muscular activation followed by relaxation. Methods:During a private outpatient clinical practice, selected subjects suffering from various anxiety disorders were offered the opportunity to try a technique for controlling anxiety attacks. They were instructed to activate a generalized isometric sustained contraction in apnea (GISCA), followed by a generalized relaxation (GISCA+relax), to be implemented as needed during an anxiety attack. The subjects were asked to apply the maneuver in alternation, in different episodes, with a generalized relaxation. They were asked to evaluate, after repeated use, the following aspects: a) whether GISCA+relax helped in controlling anxiety, b) if the addition of the GISCA phase was more effective than generalized relaxation alone, and c) if the GISCA phase facilitated the acquisition of the subsequent generalized relaxation. Results:The results concern the first 20 patients who were allowed a complete evaluation. A substantial majority of them (75%) reported that the complete maneuver (GISCA+relax) helped in controlling anxiety and anxiety attacks, and that was more effective than generalized relaxation alone and facilitated its acquisition. Discussion:Compared to relaxation techniques, GISCA+relax offers the advantage of easier application in acute situations, such as during an anxiety attack or in anticipation of anxiety-provoking events (e.g., performance anxiety). However, a sustained generalized contraction is physical exercise, with the positive effects of any non-traumatic physical activity on health-related fitness. Conclusion:These first data, although on a limited number of patients, suggest that the proposed maneuver can help control anxiety. This new somatic behavioral approach likely counteracts anxiety by activating a primordial defense mechanism. Since it can be acquired by patients with sufficient simplicity, it is suggested that it could be considered an alternative to other somatic techniques or the use of as-needed medications.
Introduction:High-Intensity Interval Training (HIIT) with self-selected recovery can promote positive emotional responses. This study aimed to verify the acute responses to HIIT with fixed recovery and to select high scorers on the state of affect, enjoyment, and mood in healthy young people. Methods:Nineteen participants took part in the study (19.0±1.0 years, 64.0±9.2 kg, 169.1±8.5, and 22.0±2.0 BMI). They performed 10 x 30 s (95% Vpeak) with 1 min recovery (HIITRecA - active - 40% Vpeak) and self-selected (HIITRec-B). Affect, enjoyment, and mood were assessed before and after HIIT (both conditions). Results:In both conditions, for time 1 and 2 were positive in positive (p=.170, EF: .102) and negative (p=.0.90, EF: .151) affect, pleasure (p=.010, EF: .315), and mood domains (tension: p<.001, EF: .673; depression: p=.015, EF: .286), anger: p=.033, EF: .230, and mental confusion: p<.001, EF: .451). In contrast, there was a reduction in the vigor domain and an increase in fatigue, with no differences in all emotional variables for condition and time*condition (p>.05). Conclusion:Thus, selected self-recovery may be a strategy in prescribing HIIT with possibilities of not interfering with the emotional aspects, researched here.
Introduction:Targeting the younger generation and growing appeal among older users, video games have become an important and timely source of entertainment for teenagers and preteens. The study aims to assess the relationship between Jordanian schoolchildren's academic success and online gaming addiction. Methods:A sample of 458 children, whose ages were 9 to 17, were randomly chosen from five private schools to participate in this cross-sectional survey, which was carried out in Jordan between May and July 2024. Pre-teens (9-12 years old) and adolescents (13-17 years old) were the two groups of participants. The Internet Gaming Disorder Scale-Short-Form (IGDS9-SF) in Arabic was used to measure the severity of gaming. Self-reported academic achievement, gaming habits, and sociodemographic information were all covered via a standardized questionnaire. The t-test and chi-square test were used to analyse group differences; p < 0.05 was deemed statistically significant. Results:The findings indicated that adolescents' excessive gaming was more severe than that of preteens. Teens reported a poor correlation with their academic performance, were more likely to use gaming apps during class, and had trouble focusing. Teens, who made up 63.5% of the participants, reported a higher perceived negative impact of gaming applications on their overall GPA that did not reach statistical significance. The overall effect of gaming on meeting deadlines and exam preparation did not differ significantly between age groups. Internet gaming scores were high among teenagers (p < 0.05). Furthermore, compared to pre-teens, teenagers reported using the internet for gaming more frequently in class (p= 0.049). Teens also claimed that using gaming applications negatively affected their ability to focus in class (p<0.05). Discussion:The findings showed that excessive usage of gaming apps in class has a more detrimental effect on students' ability to concentrate, but it has no significant effect on missing deadlines or preparing for exams. These findings highlight the significance of keeping an eye on gaming behaviour in order to reduce the negative effects of IGD on concentration in the classroom. Conclusion:Video game disorder is quite prevalent among Jordanian private school students.These results underscore the need for more long-term studies using objective academic indicators and larger samples to elucidate the educational implications of internet gaming in this population. They also show that attention during class and difficulty focusing during lessons are regarded as potential areas of concern in the context of intensive gaming.
Introduction:During the COVID-19 pandemic, healthcare workers (HCWs) faced intense and prolonged stress. This exposure increased their risk of burnout and mood disorders. The Dysregulation of Mood, Energy, and Social Rhythms (DYMERS) hypothesis suggests that instability in biological and social rhythms may precede the onset of mood dysregulation. This study examined rhythm disturbances among HCWs and explored the potential role of a rhythm-focused psychoeducational intervention. Methods:Ninety-seven HCWs from the University Hospital of Cagliari, Italy, participated in a cross-sectional study. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9), and rhythm regulation was evaluated through the Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN). Data were compared with published findings from mood disorders, psychotic disorders, and community samples. Results:A current depressive episode with PHQ-9 score was identified in 35.1% of HCWs participants, with significantly higher prevalence (p= 0.01) among women (42.7%) than men (14.7%). Mean BRIAN scores were 46.1 ± 11.0, significantly higher than those observed in psychotic disorder (p = 0.04) and community samples (p< 0.0001). Rhythm dysregulation scores approached values reported in bipolar disorder samples. Elevated BRIAN scores were also observed among non-depressed participants. Discussion:The elevated rhythm dysregulation scores observed in healthcare workers support the hypothesis that chronic occupational stress may disrupt biological and social rhythms, potentially increasing vulnerability to mood disorders. Conclusion:HCWs displayed pronounced rhythm dysregulation and high rates of depressive symptoms, highlighting occupational stress as a potential major risk factor and further supporting the DYMERS hypothesis. From both clinical and research perspectives, it could be essential to promote psychoeducational programs that target rhythm regulation, such as adaptations of Interpersonal and Social Rhythm Therapy, which may offer effective preventive strategies to enhance resilience and mental well-being in this population. However, the cross-sectional design, convenience sampling, limited socio-demographic data, and reliance on self-reported measures constrain generalizability and causal inference, underscoring the need for larger longitudinal studies to validate and extend these findings.
Introduction:Sleep apnea is a highly prevalent chronic disorder and a leading causal factor of excessive daytime sleepiness (EDS). Objectives:This study aimed: (1) To evaluate the presence of EDS and the type of sleep apnea in the adult population assessed; (2) to identify factors associated with the type of sleep apnea; and (3) to evaluate the ability of EDS to predict the type of sleep apnea. Materials and Methods:This study employed an observational, descriptive, and cross-sectional design, utilizing a retrospective analysis of secondary data. A total of 350 adults evaluated at a specialized sleep center in Lima, Peru, were included. EDS was assessed using the Epworth Sleepiness Scale (ESS), while the type of sleep apnea was determined through overnight polysomnography. Results:EDS was present in 84.6% (n= 296) of participants, with a predominance of ESS levels II and III. According to the polysomnographic diagnosis, 8.0% (n = 28) showed no evidence of sleep apnea, 49.1% (n = 172) were diagnosed with central sleep apnea, and 42.9% (n = 150) with obstructive sleep apnea. Male sex (OR = 5.32; 95% CI: 2.01-14.06) and symptoms, such as daytime sleepiness (OR = 3.51; 95% CI: 1.52-8.10), difficulty falling asleep (OR = 5.20; 95% CI: 2.32-11.64), awakening with sleepiness (OR = 35.11; 95% CI: 8.16-151.07), and choking sensation upon awakening (OR = 15.62; 95% CI: 2.10-116.42), were significantly associated with sleep apnea. EDS emerged as the main predictor in the decision tree model, which achieved an overall accuracy of 58.5%. Discussion:Daytime sleepiness is associated with sleep apnea, underscoring its clinical relevance. However, the model´s moderate predictive accuracy reinforces the importance of polysomnography as the gold standard diagnosis. Conclusion:EDS was found to be highly prevalent and significantly associated with both central and obstructive sleep apnea. These findings highlight the clinical importance of screening for EDS in primary care as a practical approach to identifying individuals at higher risk of sleep apnea, supporting timely referral for polysomnography.
Introduction:The effects of COVID-19 extend beyond acute illness, with many survivors experiencing persistent symptoms. This study aimed to determine the frequency and contributing factors of cognitive impairment and other neurological symptoms in COVID-19 survivors four weeks after diagnosis, compared with healthy controls during the pandemic's fourth wave. Methods:A multicenter case-control study was conducted involving 176 COVID-19 survivors, diagnosed four weeks prior, and 92 healthy controls from Algeria, Egypt, and Libya. Data were collected through interviews using a structured, validated questionnaire administered by a trained physician. Results:Post-COVID-19 survivors exhibited significant cognitive deficits, chronic fatigue, and sensory impairments (including loss of appetite, taste, smell, and hearing). Cognitive impairment (Montreal Cognitive Assessment [MoCA] score <26) was observed in 57 participants (32.3%), with those affected being older (44.6 ± 16.9 years, P < 0.001) and consuming more junk food (8.6 ± 3.3 servings, P = 0.04). Cognitive disorders were more frequent among females (83.3%), smokers (57.9%), highly educated individuals (76.5%), and married participants (63.7%). Discussion:The study revealed a substantial burden of cognitive and sensory impairments in post-COVID-19 patients, supporting global observations and emphasizing the need for early screening and lifestyle interventions. The reliance on self-reported data and a case-control design limit causal inference. Conclusion:Post-COVID-19 survivors showed significant cognitive deficits, fatigue, and sensory impairments. Cognitive impairment was present in 32.3%, with higher prevalence in females, smokers, highly educated individuals, and married participants.
Introduction:The physical and mental demands of competitive soccer, combined with a high density of matches and training sessions, impose substantial psychophysiological stress on athletes. In this context, subjective variables, such as affective responses, perceived exertion, and sleep, emerge as important indicators, offering additional insights into players' readiness and recovery. However, few studies have examined these variables in an integrated manner over extended periods of preparation and competition. Objective:This study aimed to investigate the effects of soccer training sessions and matches on affective responses (valence and arousal), perceived exertion, and sleep duration in under-20 soccer athletes. Additionally, the objective of this study was to assess correlations between affective responses and traditional internal load variables (RPE), monotony, strain, and self-reported sleep duration. Methods:This observational study was conducted with 21 under-20 athletes from a Brazilian elite soccer team over 11 weeks encompassing training sessions, friendly matches, and official competition. Affective responses were assessed before and 30 minutes after each session using the Feeling Scale (FS) and the Felt Arousal Scale (FAS). Perceived exertion (RPE), sleep duration, monotony, and strain were recorded daily. Two-way ANOVA was applied for FS and FAS, while one-way ANOVA was used for weekly training load, sleep, monotony, and strain. Mann-Whitney tests (match vs. training) were also performed. Pearson's correlation coefficients were calculated between variables. The significance level was set at p < 0.05. Results:There were significant main effects of week and moment (pre/post) for both FS and FAS, with a notable decrease in affective responses after sessions (p < 0.0001). Sleep duration progressively increased from the seventh week onward (p < 0.05), whereas training load, monotony, and strain fluctuated across the weeks, with significant declines toward the end of the cycle. Significant differences between matches and training sessions were found for training load (p = 0.0333) and sleep duration (p < 0.0001), but not for affective scales. On an individual level, 71% of athletes showed a reduction in affective responses post-session. Correlations between affective and the other variables were trivial to small (ranging from r = 0.11 to r = 0.24), with slightly more consistent associations for sleep and RPE. Conclusion:There was a significant reduction in FS over the weeks. Fluctuations in FS were observed across weeks in line with accumulated load and competition demands. Seventy-one percent of athletes showed a decrease in FS post-activity. The monotony and strain showed a declining trend over the competitive cycle, particularly in the latter weeks, indicating a reduction in training variability and cumulative load. These reductions coincided with an increase in self-reported sleep duration, suggesting a favorable shift in the balance between training stress and recovery. Finally, FS displayed weak correlations with perceived exertion, monotony, strain, and sleep duration.
Introduction Digital mental health interventions such as web or mobile applications have become more prominent in the last years to improve the clinical assessment and workflow in mental health disorders while also being potentially more accessible than laptops. QbMobile is a software application that provides objective assessments of hyperactivity, impulsivity, and inattention to aid in the clinical evaluation of attention deficit hyperactivity disorder (ADHD). The purpose was to examine whether QbMobile could objectively quantify symptoms and reveal significant clinical differences between an ADHD population and a normative population. Methods Data were acquired from two low-intervention/observational studies (conducted in Europe and US), involving participants aged 6 to 60 years. The application (QbMobile) was configured on the smartphone (iPhone) with embedded instructions to ensure a consistent experience. Participants were seated at a desk in a stabilized chair and instructed to hold the smartphone with both hands and to tap the screen whenever an infrequent target stimulus appeared, while withholding a response to non-target stimuli. Concurrently, to measure activity, the camera of the smartphone captured the physical activity of the participant as well as the movements from holding the device. Approximately 20% of the complete dataset for each study was combined as a pooled dataset for a model validation of output parameters from QbMobile. A Total Score between 0 and 100 was calculated, where lower scores indicate a lower likelihood of ADHD symptoms and higher scores indicate a higher likelihood. Results The ADHD cohort (n=63) demonstrated a higher mean Total Score of 83.0 (Standard deviation=17.5) compared to 48.9 (Standard deviation=18.8) in the normative population (n=354), a difference that was statistically significant (p<0.001). Significant domain-specific differences in SD-scores (movement pattern, activity, impulsivity, inattention) were identified between the ADHD cohort and the normative comparison group (p<0.001). A sensitivity of 0.86 and specificity of 0.75 were seen overall, though a low specificity was found in children, which was likely due to a smaller sample size and high activity levels in younger children in general. Discussion This investigation demonstrates that QbMobile can generate objective symptom measurements that distinguish clinically relevant differences between individuals with ADHD and a normative population. A smartphone application of quantified behavioral psychometric testing of the core symptoms could streamline a faster diagnostic evaluation and treatment titration in the ADHD clinical workflow. The authors are employed by the manufacturer of QbMobile, which is discussed in this manuscript. This affiliation is disclosed to ensure transparency and does not affect the objectivity or scientific integrity of the work presented. Conclusion QbMobile demonstrated the ability to differentiate between ADHD and normative cohorts, indicating its potential as an accessible and objective tool for clinical assessment and treatment evaluation. Future studies should be conducted to further validate the effectiveness of QbMobile as an aid tool in the clinical assessment of ADHD and further explore its use in various populations.
Background:Video games have emerged as a significant and timely source of entertainment among teens and preteens, primarily targeting the younger generation while also gaining popularity among the older population. Numerous studies have demonstrated that symptoms of stress, anxiety, and depression can impact children's academic performance and may result in school dropout. However, to date, no research has examined these three conditions specifically in Jordanian high school students. Therefore, this study aims to compare the gaming behavior of teens and preteens and its relationship to memory, depression, anxiety, and stress in Jordanian schoolchildren. Additionally, it seeks to define the prevalence of anxiety, depression, and stress among high school students in Northern Jordan and identify factors associated with these conditions. Methods:This cross-sectional study, conducted between May and July 2024, involved a sample of 388 children aged 12 to 17 years, randomly selected from public and private schools. Validated versions of the Arabic versions of the Patient Health Questionnaire-9 (PHQ-9), the seven-item Generalized Anxiety Disorder Scale (GAD-7), the Perceived Stress Scale (PSS), and the Internet Gaming Disorder Scale-Short-Form (IGDS9-SF) were used to assess depression, anxiety, perceived stress, and internet gaming disorder, respectively. Results:Among the 388 students included in the study, 25 students (6.44%) reported using gaming apps during classes on a frequent and daily basis. The findings reported that gaming during class was significantly linked to higher depression scores (p < 0.0001). Additionally, students with high GPAs were more likely to experience severe depression (p = 0.02), suggesting that academic pressure contributes to mental health struggles. Anxiety was a strong predictor of depression severity, while excessive gaming also emerged as a significant factor in both mild and severe depression. Older students had higher intermediate GPAs, suggesting that maturity and time management skills may positively impact academic performance. These findings highlighted the complex relationship between gaming, academic performance, and mental health, emphasizing the need for responsible gaming habits and mental health support in educational settings. Discussion:A comparison of gaming behavior between teens and preteens indicates that teens exhibit higher levels of depression, anxiety, and gaming habits than preteens. This study highlights the complex interplay between gaming behavior and academic performance. While gaming itself does not directly lower GPA, it may contribute to psychological health issues. Additionally, high-achieving students may be at greater risk of depression, emphasizing the need for mental health support programs in educational settings. Conclusion:Current findings stress the importance of responsible gaming habits, early psychological interventions, and targeted mental health strategies for students.
IntroductionThis paper presents a research protocol of a randomized controlled trial aimed to evaluate the feasibility and the cost-effectiveness of non-pharmacological interventions for depressive symptoms, quality of life, depression-related conditions, and cognitive function among patients with cancer. Specifically, repetitive transcranial magnetic stimulation (rTMS) and virtual reality-based cognitive remediation (VR-COG) will be analyzed, alongside standard treatment as usual (TAU), in comparison to TAU alone. Methods100 participants will be enrolled: 60 from the Health Trust of Ferrara randomized 1:1:1 to (a) TAU, (b) rTMS + TAU, and (c) VR-COG + TAU, and 40 from the University Hospital of Cagliari randomized 1:1 to (a) TAU and (b) VR-COG + TAU. The inclusion criteria will be as follows: patients aged 18 years and older, both sexes, a diagnosis of oncological disease within the last 5 years in a non-advanced stage, a diagnosis of major depressive disorder according to DSM-5 criteria, and a score of≥14 on the 17-item Hamilton Rating Scale for Depression (HAM-D-17). The VR-COG program will include a series of exercises in virtual sailing scenarios using the software CEREBRUM. The rTMS program will be delivered at 50% of the resting motor threshold. Personalized targets created for each individual will be located at various cortical depths. TAU will include psychiatric visits and psychological counseling. All the interventions will last 3 months, with pre-post evaluation for outcomes of interest and 3-6 months of follow-up. ResultsThe results of the trial will be published in international peer-reviewed journals and will be disseminated at international meetings and congresses. DiscussionThe results of this study will be useful for obtaining knowledge for clinical practice regarding the feasibility and cost-effectiveness of innovative therapeutic approaches aimed at treating depression in individuals suffering from oncological pathologies. ConclusionThe monitoring of the program's cost-effectiveness, encompassing both the screening and intervention phases, will enable policymakers to inform the implementation of this evidence in routine clinical practice. Clinical Trial Registration NumberThe study has been registered on the ClinicalTrials.gov website with ID no. NCT06589544.
Background Pasung , the physical restraint and confinement of individuals with mental disorders—particularly schizophrenia—continues to occur in Indonesia, despite the national “Free from Pasung ” campaign and Mental Health Act No. 18/2014. This systematic review aims to synthesize existing evidence on the prevalence, causes, consequences, and policy responses related to pasung among people with schizophrenia in Indonesia. Method A systematic search was conducted using PubMed, PsycINFO, Cochrane Library, and the Garuda Indonesian research repository. The quality appraisal were analyzed using tools from the Joanna Briggs Institute (JBI) and CASP. The included studies were analyzed using thematic synthesis guided by the Socio-Ecological Model (SEM). Results Eight studies met the inclusion criteria. Discussion Findings reveal that pasung is driven by persistent stigma, poverty, limited mental health literacy, cultural beliefs attributing illness to supernatural causes, and the lack of accessible, community-based mental health services. The consequences include muscle atrophy, psychological trauma, loss of dignity, and delayed or denied treatment. Conclusion The persistence of pasung highlights critical gaps in Indonesia’s mental health system, particularly at the community and policy levels. Addressing this issue requires a multi-level approach, including culturally adapted interventions, stronger mental health governance, and community empowerment to support inclusive, rights-based mental health care.
