To evaluate the efficacy of transcranial magnetic stimulation (TMS), including repetitive TMS (rTMS) and deep TMS (dTMS), in patients with severe, treatment-resistant obsessive-compulsive disorder (OCD), specifically examining target- and phenotype-specific outcomes as well as predictors of treatment response. A systematic review was conducted in accordance with PRISMA guidelines (PROSPERO: CRD420251003027) searching PubMed and ProQuest (January 2017-April 2024). Methodological quality was appraised using design-specific tools, and certainty of evidence was evaluated using the GRADE framework. Twenty-seven articles representing 23 distinct clinical studies were included (14 high, 12 moderate, and 1 low quality). Active TMS significantly reduced OCD severity on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), with secondary gains in depressive and anxiety symptoms assessed by Hamilton Depression Rating Scale (HAM-D) and Hamilton Anxiety Scale (HAM-A). Evidence certainty varied substantially by anatomical target: Deep TMS (mPFC/ACC) and prefrontal targets (OFC/DLPFC) demonstrated moderate certainty, supported by multiple randomized controlled trials (RCTs). Pre-supplementary motor area (pre-SMA) showed low-to-moderate certainty due to RCT outcome heterogeneity and genetic moderation (SLC6A4 genotype). Supplementary motor area (SMA) evidence was limited to uncontrolled open-label, while VMPFC and PPC targets exhibited very low certainty. Key predictors of enhanced therapeutic response included higher baseline OCD severity (Y-BOCS ≥ 28), older age, lower functional disability, and baseline amygdala hyper-activation during symptom provocation. TMS represents a promising neuromodulation approach for treatment-resistant OCD, with the most robust evidence supporting dTMS and prefrontal targets. Tailoring protocol parameters and stratifying patients based on clinical, genetic, and neurophysiological predictors are critical to optimizing individualized outcomes.
In this study, it was aimed to examine the role of optimistic-pessimistic thinking style in the relationship between social support perceived from family, peers and teachers in adolescence and developmental problems that may be frequently encountered in adolescence. This cross-sectional study, conducted in Türkiye, employed a correlational research design with a convenience sample of 475 adolescents (241 girls and 234 boys) aged 14–17. Participants completed the Optimism-Pessimism Scale for Adolescents, the Social Support Appraisals Scale, and the Developmental Problem Areas Scale. The correlation analysis results showed that there were significant relationships between perceived social support from family, peers and teachers, optimistic-pessimistic thinking style and developmental problems. The mediation analysis results indicated that optimism and pessimism mediated the relationship between perceived social support and developmental problems, showing both partial and full mediation patterns depending on the source of social support. Taken together, the findings suggest that social support received from various sources in adolescence may facilitate coping with developmental problems by increasing adolescents’ optimistic thinking style or decreasing their pessimistic thinking style. The results were discussed in the light of the literature and some suggestions based on the findings were presented.
Self-care and illness perception are key determinants of adaptation to inflammatory bowel disease (IBD), but their relationship may be heterogeneous and poorly captured by average-level associations. This multicenter cross-sectional study examined whether self-care behaviors were associated with illness perception and explored whether distinct patient profiles could be identified from their combined behavioral and cognitive-emotional patterns. Between April and June 2024, adult patients were recruited consecutively from nine Italian IBD units and completed validated measures of self-care, illness perception, self-care self-efficacy, and psychological distress. Structural equation modeling was used to test the association between self-care domains and illness perception, followed by unsupervised cluster analysis. Among 450 participants with complete data, the structural equation model showed satisfactory fit, but no self-care domain was significantly associated with illness perception. Four clinically interpretable profiles emerged: Engaged Copers, Overwhelmed and Passive, Detached and Vulnerable, and Minimizers with Functional Engagement. The profiles differed markedly in illness perception and self-care behaviours, with large effect sizes, whereas anxiety and self-care self-efficacy showed statistically significant but small between-profile differences. No statistically significant omnibus differences were observed in generational distribution, exercise habits, or disease activity. These findings suggest that self-care and illness perception are not related through a simple linear association. Person-centered profiling may support tailored self-management education and psychological assessment in routine IBD care.
Attention-deficit/hyperactivity disorder (ADHD) is associated with behavioral, cognitive, and motor impairments that may negatively affect children’s academic and social functioning. The present study examined the effects of cognitively enriched handball training and conventional handball training on behavioral symptoms, working memory, and motor competence in girls with ADHD. A total of 45 girls aged 7–9 years with ADHD participated in this parallel-group randomized controlled trial and were randomly assigned to cognitively enriched handball training (n = 15), conventional handball training (n = 15), or a control condition (n = 15). Behavioral symptoms, working memory, and motor competence were assessed using the Child Behavior Checklist (CBCL), the Wechsler Digit Span Test, and the MOBAK-3, respectively. Data were analyzed using multivariate analysis of covariance (MANCOVA). After controlling for baseline scores, the multivariate group effect was significant (partial η² = 0.56), with large omnibus effects for behavioral symptoms (partial η² = 0.82), working memory (partial η² = 0.66), and motor competence (partial η² = 0.65). Both exercise interventions significantly improved behavioral symptoms, working memory, and motor competence compared with the control group (p < .05). Furthermore, cognitively enriched handball training produced significantly greater improvements in behavioral symptoms and motor competence than conventional handball training (p < .05), whereas no significant difference was observed between the two exercise groups for working memory. These findings suggest that cognitively enriched handball training may provide short-term complementary benefits for behavioral regulation and motor competence in girls with ADHD. However, the small sample size and absence of follow-up assessments warrant cautious interpretation and limit conclusions regarding the generalizability and long-term maintenance of these effects.
Objectives: To investigate the relationship between sleep (nocturnal sleep and total 24-hour sleep) and depressive symptoms in middle-aged and elderly people using data from the China Health and Retirement Longitudinal Study (CHARLS). Study Design: Cross-sectional study. Methods: A total of 13,718 middle-aged and elderly people aged 45 and above from the China Health and Retirement Longitudinal Study (CHARLS 2020) were included. A multivariate logistic regression model was used to analyze the correlation between sleep and depressive symptoms, and a random forest model was used to rank the importance of variables. Furthermore, the nonlinear relationship between sleep duration and depressive symptoms risk was fitted using a restricted cubic spline (RCS) model. Results: Compared with the group with 24-hour sleep duration of > 7 to ≤ 9 h, the adjusted odds ratio (OR) for depressive symptoms in the group with 24-hour sleep duration of ≤ 7 h (OR = 1.649) and > 9 h (OR = 1.166) was higher. Random forest results showed that total 24-hour sleep ranked above average among variables affecting depressive symptoms. The RCS curve showed that a total 24-hour sleep time of > 7 to ≤ 9 h was associated with the lowest adjusted odds for depressive symptoms. Conclusions: There is a significant correlation between sleep duration and depressive symptoms in middle-aged and elderly people. Those who slept > 7 to ≤ 9 h per night had a lower incidence of depressive symptoms, and total 24-hour sleep of > 7 to ≤ 9 h showed a stronger OR value. Life satisfaction also emerged as an important factor influencing depressive symptoms.
This letter addresses significant methodological limitations in a recently published systematic review and meta-analysis evaluating the efficacy and safety of xanomeline-trospium (KarXT) in schizophrenia. A critical unit-of-analysis error is identified in the original review’s Table 1, wherein multiple secondary and post hoc publications from a single randomized controlled trial (EMERGENT-1) were extracted and treated as completely independent studies. This unit-of-analysis error violates statistical independence assumptions and likely contributed to an implausible pooled effect size; however, additional discrepancies in data extraction or effect-size calculation may also have influenced the pooled estimate (d = 0.08) that sharply contradicts individual trial data. Additionally, the review lacks registered protocol details, structured risk-of-bias reporting, and safety outcome pooling. Readers and clinicians are cautioned against interpreting the pooled conclusions in isolation.
Emotional blunting is a clinically significant yet often under-recognized alteration in emotional experience, characterized by reduced intensity of both positive and negative emotions, diminished emotional responsiveness, and impaired interpersonal engagement. First described through patients' reports of antidepressant treatment, it is now recognized as associated with both depressive illness and pharmacological treatment, underscoring the need for its direct assessment. However, no validated Turkish-language instrument specifically designed to assess emotional blunting is currently available. The present study aimed to evaluate the psychometric properties of the Turkish version of the Oxford Depression Questionnaire (ODQ) in 272 participants comprising healthy controls, drug-naïve patients with major depressive disorder (MDD), and medicated patients with MDD in remission. Confirmatory factor analysis using WLSMV estimation broadly supported the proposed four-factor structure, although fit indices were not uniform. The correlated four-factor model provided a better fit than alternative one-factor, two-factor, and second-order models, although the second-order model showed only a modest decrement in fit. The scale demonstrated acceptable to high internal consistency across dimensions, and measurement invariance analyses supported loading invariance across the three groups. ODQ scores differed significantly between groups and showed the expected associations with depressive symptom severity and with emotional reactivity and empathy, which were themselves largely independent. These findings provide evidence for the reliability and validity of the Turkish ODQ and support its use for assessing emotional blunting across healthy, untreated, and remitted medicated populations, while indicating that further evaluation of specific items is warranted in future validation studies.
Introduction: Emotionally based school avoidance (EBSA) arises from interaction between child level processes and the school environment, yet developmental differences remain unclear. This study examined whether the emotional and behavioural profiles of EBSA differ between children and adolescents. Methods: This cross-sectional study included a clinical sample of 102 youth with EBSA: children (< 12 years, n = 40) and adolescents (≥ 12 years, n = 62). Psychiatric diagnoses were established with the K-SADS-PL-DSM-5, and emotion regulation, anxiety, behavioural symptoms, and EBSA severity were assessed using validated measures. Predictors of EBSA severity were examined with multiple linear regression, modelled separately for each age group. Results: The two groups were largely similar across clinical measures, but separation anxiety was higher in children (p = 0.004). Among children, younger age and lower clinical severity were associated with greater EBSA severity (R² = 0.47). Among adolescents, lower hyperactivity/inattention was associated with greater EBSA severity (R² = 0.18), with age and impulsivity showing positive but non-significant trends. Conclusions: Children and adolescents with EBSA showed different emotional and behavioural profiles, with emotion- and attachment-related factors more salient in childhood and regulatory and cognitive factors more salient in adolescence.
The February 2023 earthquakes in Turkey exposed frontline resident physicians to personal trauma, occupational stress, and the psychological burden of caring for traumatized survivors. This study aimed to evaluate post-traumatic stress disorder (PTSD) symptoms, post-traumatic growth (PTG), and associated factors among resident physicians in Turkey after the earthquakes. A cross-sectional study was conducted using an online survey administered to resident physicians at the Faculty of Medicine of XXX University between October and November 2023. The survey consisted of sociodemographic characteristics, earthquake-related exposure variables, the PTSD Checklist for DSM-5 (PCL-5), and the PTG Inventory. A total of 157 physicians participated, with a mean age of 29.6 ± 4.25 years and 7.6
Healthcare workers with mental health conditions are often reluctant to seek help due to mental health stigma. Concerns about career repercussions and discrimination largely contribute to help seeking reluctance. This study examined whether anticipated enacted mental health stigma in the workplace plays a role in mediating the relationship between depression and anxiety symptoms, and public stigma of receiving psychological help. A total of 231 healthcare workers participated in this study, including 45
Better understanding of the aetiology of suicidal ideation, including modifiable and protective factors, can enhance preventive strategies. Negative mood regulation expectancies (‘NMRE’; beliefs in one’s ability to alleviate negative mood) are associated with suicidal ideation and negative affect but little is known about the underlying mechanisms of these associations. We conducted secondary analyses of cross-sectional data from 1546 adults (69.8
This study aims to test the psychometric properties of the Integration of Stressful Life Experiences Scale (ISLES) and examines its associations with psychological distress, satisfaction with life, resilience, and religiosity among individuals affected by the Libyan wars. The sample consisted of 457 participants, with 77.02
Short video platforms like TikTok are increasingly popular among adolescents. The study investigated the correlation between adolescent short video use (SVU) patterns and psychological well-being. Using a sample of 2,344 Chinese junior and senior high school students, this study employed latent profile analysis (LPA) to categorize short video users into distinctive subtypes based on patterns of active and passive use and emotional investment in SVU. Four SVU profiles were identified: low-overall users (65.6%), active-dominant users (14.4%), high-overall users (7.7%), and passive-dominant users (12.3%). Significant grade and gender differences were found. All psychological variables measured (i.e., sleep quality, attention problems, social anxiety, depression, anxiety, stress, and loneliness) differed across the four profiles. The low-overall pattern was the most prevalent and was associated with the lowest levels of mental health problems, whereas the high-overall pattern was associated with the greatest psychological risks. Active-dominant and passive-dominant users showed moderate mental health levels and did not differ significantly on most psychological variables, except for depressive symptoms. These findings advance understanding of the link between SVU patterns and adolescent mental health and help identify vulnerable groups for prevention and intervention.
This study aimed to examine the reliability and validity of a Turkish version of the Things You Do Questionnaire-15 item (TYDQ-15). Data was collected from three samples. Sample 1 comprised 245 adolescents and adults aged 14 to 47 years (Mage= 16.62, SDage= 2.99), who were recruited to confirm the factor structure of the TYDQ-15 using confirmatory factor analysis (CFA) and item analysis. Sample 2 comprised 552 adolescents and adults aged 14 to 47 years (Mage=22.96, SDage=10.14). Sample 2 completed translated and validated versions of measures of depression (Patient Health Questionnaire-9 Item), anxiety (Generalized Anxiety Disorder-7 Item), life satisfaction (Satisfaction with Life Scale), and TYDQ-15 to examine the TYDQ-15's construct validity using CFA and exploratory structural equation modelling (ESEM) revealing adequate convergent and discriminant validity. Sample 3, comprising 124 adolescents aged 14 to 18 years (Mage=15.97, SDage=1.32) were recruited to evaluate test-retest reliability. CFA and ESEM results indicated that the 15-item, 5-factor structure of the TYDQ-15 was an acceptable fit. Item factor loadings ranged from 0.41 to 0.97 in ESEM and from 0.46 to 0.86 in CFA. TYDQ-15 scores were negatively correlated with depression and anxiety, and positively correlated with life satisfaction. The test-retest reliability indicated no significant difference between measurements taken at 2-week intervals (p>.05), with intraclass correlation coefficients ranging from 0.79 to 0.94. These results provide evidence for the construct, convergent and discriminant validity, internal consistency, and test-retest reliability of the Turkish version of the TYDQ-15.
Emotion dysregulation (ED) is a hallmark of attention-deficit/ hyperactivity disorder (ADHD); however, routine retrospective evaluations neglect its dynamic nature. To address this limitation, Ecological Momentary Assessment (EMA) provides a useful methodology for collecting data in real time and in participants’ natural surroundings. The current systematic review synthesizes findings from EMA studies on emotion dysregulation in ADHD. Systematic searches were conducted through April 2025 across three databases (PubMed, Scopus, and Web of Science). We included 33 studies, with approximately 2678 participants. Findings demonstrate that EMA successfully captures variation in emotion dysregulation while relating it to negative affect and functional impairment, regardless of age. Compliance rates (60–99
Emotional distress is common among individuals with inflammatory bowel disease (IBD) and their caregivers, potentially impairing illness management and daily functioning. The psychological mechanisms underlying how depression, anxiety, and stress influence self-care and caregiver contribution to self-care remain unclear in IBD dyads. This study examined the dyadic associations between emotional distress and self-care behaviours in IBD, testing the mediating role of self-efficacy in both patients and caregivers. A multicentre cross-sectional study was conducted in accordance with STROBE guidelines across nine Italian IBD units. Emotional distress was assessed using the Depression Anxiety Stress Scale (DASS-21), self-efficacy using the Self-Care Self-Efficacy Scale (SCSES) for patients and the Caregiver Self-Efficacy in Contributing to Self-Care (CSE-CSC) for caregivers, and self-care behaviours using the Self-Care of Chronic Illness Inventory (SC-CII) and its caregiver version (CC-SC-CII). The Actor-Partner Interdependence Mediation Model (APIMeM) with Bayesian estimation was applied to test direct and indirect effects while adjusting for demographic and clinical covariates. A total of 274 patient-caregiver dyads were enrolled. Patient depression showed credible indirect associations with self-care through lower self-efficacy. Anxiety showed weak and inconsistent associations, with only one credible negative total association between patient anxiety and patient self-care monitoring. Patient stress showed credible positive direct associations with patient self-care outcomes. Caregiver-to-patient partner effects were generally non-credible. Depression undermines self-care in IBD primarily via diminished self-efficacy, whereas patient stress may be linked to adaptive vigilance in patient self-care. Strengthening patient self-efficacy and addressing depressive symptoms may represent relevant targets for supporting self-care in individuals with IBD, while caregiver-focused strategies require further investigation in longitudinal or interventional designs.
Stigma is a critical barrier to adolescents' willingness to seek professional mental health support, yet less is known about whether non-stigmatizing attitudes toward peers with mental health problems are associated with adolescents' help-seeking attitudes. This study examined correlates of adolescents' attitudes toward seeking professional psychological help. A sample of 686 Chinese adolescents (Mean age = 16.67 years, SD = 2.39 years; 55.2% were females) completed measures of depressive and anxiety symptoms, non-stigmatizing attitudes toward peers with mental health problems (perceived competence and social acceptance), and attitudes toward seeking professional psychological help. Hierarchical regression analyses indicated that female adolescents reported more positive help-seeking attitudes compared to males. Higher levels of depressive and anxiety symptoms were associated with less favorable help-seeking attitudes. Notably, perceived competence positively predicted help-seeking attitudes, whereas social acceptance showed a negative association. The final regression model accounted for 13.1% of the variance in help-seeking attitudes. These findings suggest that adolescents' help-seeking attitudes are shaped not only by emotional distress, but also by how psychological difficulties are understood and evaluated within the peer context. Interventions may benefit from addressing both emotional distress and peer-related stigma processes while fostering supportive environments that make professional help more acceptable and accessible to adolescents.
Adverse childhood experiences (ACEs) are well-established risk factors for poor mental health, yet less is known about how positive childhood experiences (PCEs) and resilience may buffer these effects across different stages of life. Existing research has primarily focused on ACEs in isolation, leaving a gap in understanding the protective mechanisms that promote psychological well-being despite adversity. To address this gap, the present study examines the effects of ACEs and the mediating roles of PCEs and resilience in their relationship with anxiety and depression. The sample consisted of 2,287 Turkish participants, including adolescents (ages 13–18, n = 683), young adults (ages 19–29, n = 1,076), and adults (ages 30–75, n = 528). Participants completed the Adverse Childhood Experiences (ACEs) scale, the Positive Childhood Experiences (PCEs) scale, the Resilience Scale, and the Depression, Anxiety, and Stress Scale-21 (DASS-21). Results showed that ACEs were negatively associated with PCEs and resilience across all groups, while they were positively linked to anxiety and depression. Mediation analyses revealed that PCEs and resilience significantly mediated the relationship between ACEs and mental health outcomes. These findings underscore the importance of fostering positive childhood experiences and resilience as protective factors that can mitigate the long-term psychological impact of ACEs, informing targeted prevention and intervention strategies to support mental health across different life stages.
Children with Attention Deficit Hyperactivity Disorder (ADHD) frequently exhibit emotional and behavioral dysregulation beyond core symptoms. Sensory processing sensitivity (SPS), Theory of Mind (ToM) difficulties, and irritability are implicated in these challenges, yet their integrated roles remain under-researched. This study examined the associations among these transdiagnostic dimensions and behavioral problems in a clinical ADHD sample. A total of 142 medication-free children and adolescents (aged 7–16 years) with ADHD in Turkiye were evaluated using validated parent- and clinician-report measures, alongside a performance-based ToM task. Hierarchical regression and mediation analyses were conducted, with a stringent Bonferroni correction (p < 0.001) applied to control for family-wise error across multiple comparisons. While initial bivariate analyses explored the roles of SPS and ToM indices, their predictive associations with internalizing and externalizing outcomes did not survive the conservative Bonferroni correction threshold. Instead, irritability emerged as the most robust and dominant independent predictor of both internalizing (beta = 0.36, p < 0.001) and externalizing problems (beta = 0.36, p < 0.001). Consequently, indirect mediation pathways linking sensory or social-cognitive vulnerabilities to behavioral problems via irritability were not statistically supported under this strict alpha level. These findings indicate that irritability acts as a central, transdiagnostic driver of emotional and behavioral dysregulation in pediatric ADHD. While sensory and social-cognitive profiles are clinically relevant, the data overwhelmingly highlight the direct impact of irritability. Interventions prioritizing emotion regulation and irritability are paramount for reducing symptom burden, while future adequately powered studies are needed to detect potentially subtler indirect pathways in the context of stringent statistical corrections.
Psychiatric comorbidities, especially depression, anxiety, and suicidal ideation, are highly prevalent among patients with Irritable Bowel Syndrome (IBS). Nevertheless, the ways in which psychological factors are associated with suicide risk in this population remain insufficiently understood. This study examined whether depression statistically mediates the association between anxiety and suicidal ideation among adults with IBS, within a gut–brain axis framework. A cross‑sectional study was conducted among 280 adults with IBS diagnosed according to the Rome IV criteria. Depression, anxiety, and suicidal ideation were assessed using validated Persian versions of the Beck Depression Inventory‑II (BDI‑II), Beck Anxiety Inventory (BAI), and Beck Scale for Suicide Ideation (BSS). Partial least squares structural equation modeling (PLS‑SEM) was used to estimate direct and indirect associations, with 5,000 bootstrap resamples. Model quality was evaluated using factor loadings, composite reliability, average variance extracted (AVE), heterotrait–monotrait ratio (HTMT), variance inflation factors (VIF), and standardized root mean square residual (SRMR). In additional sensitivity analyses, age, sex, IBS subtype, and previous psychiatric diagnosis were included as covariates predicting depression and suicidal ideation to assess the robustness of the main structural paths. Clinically significant depression, anxiety, and high suicide risk were observed in 41.1
