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 factors shape 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 trauma-informed care principles and systematic screening for sexual violence into mental health settings to improve diagnostic accuracy and optimize interventions for this population.
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 between-group 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.
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.
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.
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 Self-Rating 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.
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 not sufficiently 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. χ2, 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.
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 obsessive-compulsive 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.
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.
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.
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 of self-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.
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 Self-Injury Inventory. To avoid measurement overlap between the mediator and outcome, the PHQ-8 total score (PHQ-9 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 NSSI-related 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.
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 cost-effectiveness 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.
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.
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.
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.
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 analysis-based 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.
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.
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.
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.
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.
