Climate change (CC) poses risks to mental health, with pregnant women highly vulnerable due to unique physiological, emotional, and social changes. This study explored the relationship between cognitive appraisal of CC, emotional responses (e.g. eco-anxiety and solastalgia), and pro-environmental actions and mental well-being in 27 pregnant women in Canada. We used validated online surveys including measures of depressive symptoms and generalized and pregnancy-related anxiety (PRA). Results indicate that cognitive appraisal of CC showed a significant direct effect on anxiety severity when adjusted for all covariates. Eco-anxiety was significantly associated with all mental health measures, while solastalgia was significantly associated with P-RA. Pro-environmental actions showed no significant association. Contextual factors did not modify these relationships. These findings highlight that emotional responses to CC, rather than cognitive appraisal or actions, are important predictors of mental health during pregnancy, warranting further research in larger, diverse populations, particularly in regions severely affected by CC.
This study examined the association between participation in Guozhuang dance and alexithymia among healthy adults, with cognitive empathy and social connectedness as potential mediators. A total of 560 healthy adults completed the Physical Activity Rating Scale-3, Basic Empathy Scale, Social Connectedness Scale, and Toronto Alexithymia Scale. Data were analyzed using the PROCESS macro for SPSS to test a sequential mediation model. Participation in Guozhuang dance was significantly associated with lower levels of alexithymia (r = -0.295). Two significant mediation pathways were identified: social connectedness alone (-0.082, 67.21% of the total indirect effect) and the sequential pathway through cognitive empathy and social connectedness (-0.040, 32.79%). These findings suggest that participation in Guozhuang dance may be associated with lower levels of alexithymia, with social connectedness serving as the primary mediator and cognitive empathy contributing indirectly through a sequential mediation pathway.
This study aimed to investigate whether multidimensional trust in healthcare systems predicts health-seeking behavior and healthcare demand procrastination behavior. The study was conducted with individuals aged 18 and over residing in Samsun, Türkiye, and data were collected from 544 participants. Descriptive analyses indicated that the mean scores were 3.25 ± 0.90 for the multidimensional trust in healthcare systems scale, 3.55 ± 1.01 for the health-seeking behavior scale, and 2.41 ± 1.11 for the healthcare demand procrastination behavior scale. Regression analysis revealed that multidimensional trust in healthcare systems explained 3.3% of the total variance in health-seeking behavior, and that as participants' multidimensional trust in healthcare systems increased, their health-seeking behavior also increased. Furthermore, multidimensional trust in healthcare systems explained 4.3% of the total variance in healthcare demand procrastination behavior, and as multidimensional trust in healthcare systems increased, healthcare demand procrastination behavior decreased.
Stoma surgery is life changing operation with substantial impacts on psychological wellbeing. This study aimed to understand experiences of psychological preparation and support received prior to stoma surgery and identify opportunities to improve existing preoperative models of care. Semi-structured interviews were conducted with 11 participants who were living with, or had previously lived with, a stoma, and the data analysed using reflexive thematic analysis. Four themes were developed: Practical but Not Psychological Support; Preparing for a New Normal; Learning to Live with Stoma; and The Mental Load of Living with a Stoma. While practical support was commonly provided, professional psychological support was desired but rarely offered. There is a need to enhance professional psychological support in the preoperative period for stoma surgery and earlier to enhance surgical readiness and postoperative psychological adaptation. Further research is needed to guide the development of clear guidelines for psychological preparation and support.
Hospital-related fear is a significant source of distress for preschool children, yet existing assessment tools are not adequately suited to their developmental level. This methodological study aimed to develop the Illustrated Hospital Fear Scale for Preschool Children and evaluate its psychometric properties. The study was conducted with 300 preschool children aged 4-6 attending educational institutions in western Türkiye. Scale development proceeded through four stages: item generation, expert review, pilot testing and main application. Content validity was assessed using the Davis technique (CVI = 0.892). Exploratory factor analysis revealed a three-factor structure-Diagnosis, Treatment, and Environmental Factors-explaining 57.5% of the total variance. Confirmatory factor analysis demonstrated good model fit (CFI = 0.928, GFI = 0.953, RMSEA = 0.068). Internal consistency was adequate (Cronbach's α = 0.760), and test-retest reliability was strong (r = 0.849, p < 0.001). The scale is a valid and reliable tool for assessing hospital fear in preschool children.
Self-regulatory fatigue (SRF) may impair long-term self-management in patients with type 2 diabetes mellitus (T2DM), yet its heterogeneous patterns remain unclear. This cross-sectional study included 338 patients with T2DM. Data were collected using general information, SRF, diabetes-specific quality of life, diabetes stigma, and social support questionnaires. Latent profile analysis based on 16 SRF items identified three profiles: low behavioral-emotional SRF (n = 99, 29.3%), moderate SRF (n = 170, 50.3%), and high SRF (n = 69, 20.4%). Multinomial logistic regression examined factors associated with profile membership, and the BCH method compared diabetes-specific quality of life across profiles. Hyperlipidemia and stigma were positively associated with moderate and high SRF, whereas insulin therapy was negatively associated. Higher fasting plasma glucose and lower social support were associated with high SRF. The high SRF profile showed the poorest diabetes-specific quality of life. These findings support profile-specific SRF identification and intervention, and may inform targeted clinical management strategies.
The aim of this study was to establish the psychometric properties of the Polish version of the Perceived Stress Scale for Kids (PeSSKi). The procedure included assessment of the PeSSKi's theoretical and discriminant validity. A total of 334 child-guardian dyads were recruited from public elementary schools. Children were in the age range 9-11 years (Mage = 10 years). Participants completed the following questionnaires: the self-report and parent-report version of the Strengths and Difficulties Questionnaire, parent-report version of the Profile of Emotional and Social Development and Student Integration Questionnaire. Analyses indicated that although specific valence facets were present, the Polish version of the PeSSKi was essentially unidimensional. Correlational analysis of the Polish PeSSKi with related constructs suggested satisfactory convergent and discriminant validity supporting its potential usefulness as a unidimensional measure of perceived stress in children aged 9-11 years.
This cross-sectional study investigated the moderated mediating roles of coping style and hospitalization frequency in the benefit finding-fear of progression relationship among 332 heart failure patients. Findings suggested that resignation coping mediated the impact of benefit finding on fear of progression, implying that alleviating such resignation coping may improve patients' fear of progression. Furthermore, hospitalization frequency emerged as a significant negative moderator of resignation coping's mediating effect. Consequently, this suggests that interventions aimed at improving resignation coping may mitigate the detrimental effect of benefit finding on fear of progression, especially for those experiencing more frequent hospitalizations.
Menopause is a multidimensional life transition, yet UK healthcare and public discourse often frame it narrowly around hormones and medical treatment. This qualitative study explored how 18 women aged 40-60 used body-based practices, including strength training, yoga and cold-water immersion, to navigate menopause. Interviews were analysed using reflexive thematic analysis within a critical realist framework. Menopause was interpreted as an individual biopsychosocial-cultural experience, with spiritual and experiential dimensions for some. Psychological symptoms were typically more disruptive than physical ones, and limited professional support prompted women to create personalised "toolkits," often blending hormone therapy with body-based practices. Participants described practices as supporting symptom relief, self-awareness and identity development, with enjoyment and self-efficacy influencing continued engagement. Participants became informal educators and advocates for earlier education and inclusive, evidence-based resources. However, the sample was relatively privileged and health-literate. Findings support whole-person menopause care that promotes agency while recognising unequal access to resources.
We examined longitudinal associations between neighborhood environments (walkability, area deprivation, and traffic volume) and obesity risk, tested sex differences, and evaluated family experiences as mediators. Participants were 1325 Black youth (52% male; Mage = 9.5) and caregivers from the first 3 years of the Adolescent Brain Cognitive Development (ABCD) Study. We used participants' survey responses and measures of neighborhood context from publicly available sources. Greater neighborhood walkability predicted lower physical activity for all adolescents and poorer nutrition among boys; more traffic volume predicted lower physical activity among girls. Walkability had a significant indirect effect on physical activity through family conflict. Findings underscore the importance of neighborhood and family contexts in shaping obesity risk among Black youth and suggest that these contexts, along with youth sex, should be considered when developing interventions.
Behavioural responses that limit social interactions can reduce infection risk and may operate through Perceived Vulnerability to Disease (PVD). Although social and environmental factors, such as population density and human mobility, influence PVD, little is known about how integration within proximity networks relates to perceived susceptibility. We examined measures of social integration, derived from friendship nominations and proximity sensor data, in relation to PVD among high school students. Friendship integration was based on within-class nominations, while proximity integration was assessed using sensors detecting classmates within 2 m. PVD was measured using self-report questionnaires. Integration measures were associated with PVD, but the direction differed by network type: greater proximity integration was associated with higher PVD, whereas greater friendship integration was associated with lower PVD. These findings highlight the relationship between social embeddedness and PVD, indicating that the number and quality of social ties are associated with variation in behavioural responses.
Treatment-resistant depression (TRD) poses a critical challenge, particularly where conventional treatments fail. Transcranial magnetic stimulation (TMS) has shown clinical efficacy, yet little is known about how patients in Peruvian contexts perceive this intervention. This study explored patients' lived experiences of TMS, emphasising how adherence, acceptance, and perceived efficacy were shaped by subjective, relational, and contextual factors. Using Interpretative Phenomenological Analysis (IPA), five women aged 21-38 with TRD completed a 30-session protocol at a specialised mental health centre in Arequipa, Peru. Data were collected through semi-structured interviews, clinical logbooks, and clinical observations, and analysed following SRQR standards. Four experiential themes emerged: perceptions of TMS, factors influencing adherence, emotional evolution, and reflections shaping the therapeutic experience. Findings reveal that adherence was sustained not only by expectations of efficacy but also by therapeutic alliance, emotional validation, and embodied safety. TMS was re-signified as an integrative experience involving relational, emotional, and existential dimensions.
Superwoman Schema is a multidimensional framework that describes how Black women manage interpersonal and societal roles. This cross-sectional study examined how patterns of Superwoman Schema subscales (obligations to manifest strength, suppress emotions, resist vulnerability, and help others, and intense motivation to succeed) and socioeconomic status (SES; perceived financial strain, income-to-poverty ratio, and education) related to self-reported disease activity among 437 Black women in metropolitan Atlanta, Georgia with systemic lupus erythematosus (SLE). Latent profile analysis identified three typologies: Strained Superwomen (high on Superwoman dimensions with low SES), Low Superwomen (low on Superwoman dimensions with average SES), and Resourced, Striving Superwoman (above average obligation to manifest strength and intense motivation to succeed with high SES). After accounting for covariates, Strained Superwomen had the highest self-reported disease activity. These results suggest that endorsement of Superwoman Schema is common among Black women with SLE and is related to more disease activity in low-resourced contexts.
Family caregivers of cancer patients in China experience substantial caregiver burden and psychological distress. However, the cognitive pathways linking caregiver burden to psychological distress, and the role of filial piety in this process, remain insufficiently understood. This study tested a moderated mediation model in which caregiver burden was linked to psychological distress through brooding and reflective rumination, with reciprocal filial piety (RFP) and authoritarian filial piety (AFP) as moderators. Data were collected from 738 caregivers in a cross-sectional survey. Results showed that caregiver burden was positively associated with psychological distress, partly through higher brooding rumination and lower reflective rumination. The indirect pathways varied by filial piety beliefs. RFP weakened these indirect pathways, whereas AFP strengthened them. These findings suggest that psychological distress among Chinese cancer caregivers is shaped by caregiving burden, cognitive responses, and culturally embedded filial beliefs, offering implications for identifying at-risk caregivers and developing culturally sensitive support.
This study explored how cognitive emotion regulation strategies (CERS) relate to mental health and sleep quality in young adults and aimed to identify specific CERS associated with both. Self-measured methods were used in 1030 young adults. Participants completed the Pittsburgh Sleep Quality Index (PSQI), Cognitive Emotional Regulation Questionnaire (CERQ), Beck Depression Inventory (BDI-II) and Beck Anxiety Inventory (BAI). Data were analysed using Spearman correlation and Structural Equation Modelling (SEM). Less adaptive CERS were significantly associated with poorer subjective sleep quality and with increased depression and anxiety symptoms. However, adaptive CERS were not significantly associated with sleep quality and depressive symptoms but showed a positive correlation with anxiety symptoms. SEM showed that catastrophising and self-blame were significantly positively associated with both mental health and sleep quality. These findings suggest that targeting specific CERS could be a practical approach to improving sleep quality and mental health.
Chronic environmental contamination is a prevalent environmental justice issue. Few studies have considered that such exposures may be a source of collective trauma - shared negative mental health outcomes that persist across decades and generations. An observational survey (N = 363) in the predominantly low-income Latine community on the Tucson International Airport Area Superfund site used community-engaged door-to-door and social media recruitment to compare those potentially exposed to historical contamination to non-exposed residents on mental health outcomes. Potential mediators (e.g. health concerns) and moderators (e.g. racial-ethnic identity) were also assessed. Analyses revealed elevated post-traumatic stress in the exposed group which was mediated by material (e.g. health concerns), social (e.g. environmental justice concerns), and "lifescape" (e.g. shattered assumptions about the world) impacts. We argue that contamination may indeed be a source of collective trauma based on our review of the literature. Community-engaged research should continue documenting and intervening on the collective trauma of contamination.
This study aims to investigate technostress among older adults and to examine its relationship with eHealth literacy. A descriptive and cross-sectional study was conducted with 217 older people in a university hospital in Türkiye. The data were collected using the sociodemographic form, Technostress Scale (TechS-S), and eHealth literacy scale between April and June 2025. The participants' mean total score for eHealth literacy was calculated as 23.95 ± 9.16, while the mean total score for the TechS-S was 43.71 ± 8.35. Higher eHealth literacy was significantly associated with lower TechS-S scores (B = -0.178, p = 0.003).This study found that lower levels of eHealth literacy significantly contribute to increased technostress among older adults. The findings underscore that it is not sufficient to enhance technological infrastructure alone, rather, it is essential to design comprehensive interventions that address the multifaceted nature of technostress particularly through literacy improvement and individualized support programs.
Youth vaping and nicotine pouch use have risen as cigarette smoking declines, yet comparative evidence on their determinants remains limited. This study examined how socio-structural factors and an extended theory of planned behavior model predict nicotine vaping, nicotine pouch use, and cigarette smoking among Finnish youth. A survey of 1194 youth aged 15-25 assessed socioeconomic status, health literacy, theory of planned behavior belief-based constructs, intentions, behavior, and addiction. Nicotine pouches were viewed most favorably. Male gender associated more strongly with pouch use than vaping or smoking. Health literacy, but not socioeconomic status, predicted all behaviors. Affective attitudes were the strongest correlates across products; instrumental attitudes showed no effects. Friend norms exceeded family norms in influence, particularly for smoking. Affective attitudes and friend norms emerged as cross-cutting influences, while gender patterns and normative effects varied by product. Prevention strategies should address both shared and product-specific determinants.
This study explores the impact of substance use disorders (SUDs) on familial relationships and stigmatisation among Irish affected family members (AFMs). Using semi-structured qualitative interviews with 11 Irish AFMs, reflexive thematic analysis identified three key themes: dysfunctional family dynamics, the burden of caregiving and financial strain and experiences of embarrassment, stigma, and pity. Findings highlight AFMs' struggles with denial from their relatives and feelings of being pitied. Insights contribute to a deeper understanding of the AFM experience and can inform stigma reduction campaigns by promoting a more accurate public perception. Additionally, findings emphasise the importance of social support, encouraging AFMs to engage with groups like Al-Anon , and urging treatment centres to recognise and empower both AFMs and their relatives with SUD. The study included adult AFMs, including siblings, spouses and offspring, with two male participants. Inclusion of these groups, which are often underrepresented in the literature, helps address gaps in understanding AFM experiences.
Anxiety, depression, and fear of disease progression commonly co-occur in patients with chronic diseases, yet, to our knowledge, no previous study has used network analysis to identify the central and bridge symptoms linking these domains in Saudi patients. This study examined symptom interrelationships in 271 Saudi patients with chronic diseases recruited from multiple health centers in Jeddah and Riyadh. Participants completed the PHQ-9, GAD-7, and the Fear of Progression Questionnaire-Short Form. Network analysis showed that nervousness/anxiety, little interest or pleasure in doing things, and fear of being unable to pursue hobbies were the most central symptoms. The main bridge symptoms were restlessness, fear that something awful might happen, inability to control worry, and little interest or pleasure in doing things. Elevated depressive, anxiety, and fear of disease progression symptoms were reported by 55.7%, 56.8%, and 88.5% of participants, respectively. These findings identify potential symptom-level intervention targets.
