Appearance-related stress arising from visible nail discoloration and deformation has received increasing attention as a potential psychosocial concern with implications for psychological functioning and HRQoL. Although nails are publicly exposed and play a central role in social communication and hygiene perception, limited research has examined their psychosocial impact within a behavioral medicine framework. This study examined associations among nail-related appearance stress, self-esteem, and HRQoL among adults in South Korea. A cross-sectional online survey was administered to 510 adults aged 19-69 who reported at least one nail abnormality. Measures included physical stress, emotional stress, self-esteem, and five HRQoL domains: symptoms, function, emotion, psychological recovery, and life satisfaction. Structural equation modeling (SEM) using SPSS 26.0 and AMOS 25.0 tested the proposed mediation model. Appearance-related nail stress was significantly associated with lower self-esteem (β = -0.42, p < .001) and lower HRQoL (β = -0.38, p < .001). Self-esteem partially mediated the associations between physical stress and HRQoL (indirect effect = 0.21; 95% CI [0.12-0.32]; Z = 4.56; p < .001) and between emotional stress and HRQoL (indirect effect = 0.18; 95% CI [0.09-0.28]; Z = 4.23; p < .001). These mediation pathways accounted for a meaningful proportion of variance across HRQoL domains, indicating that psychological interpretations of nail abnormalities may be more strongly associated with perceived wellbeing than physical symptoms alone. The findings suggest that nail-related appearance stress may have relevance within psychosocial and behavioral health research, particularly in relation to emotional well-being, social participation, and stigma-related experiences. The findings highlight the importance of appearance-sensitive communication and psychosocial support for individuals experiencing nail-related appearance concerns. These findings suggest that perceived nail-related stress may be associated with psychological functioning and quality of life. However, causal interpretations are limited by the cross-sectional design, and further research is needed to clarify these relationships.
Three studies examined the relationship between death anxiety and organ donation behavior in Germany, a country with an opt-in organ donation system. Organ donation behavior was operationalized in terms of whether participants held an organ donation card (or had registered online, Study 3). Because death anxiety is associated with the avoidance of mortality-related issues, the hypothesis was that death anxiety would negatively predict organ donation behavior above and beyond sociodemographic variables (age and gender) and organ donation attitude (Study 1; N = 388), Big Five personality traits (Study 2; N = 382), and altruism (Study 3; N = 473), respectively. Indeed, in logistic regression analyses, death anxiety emerged as a significant negative predictor of organ donation behavior in all three studies (Study 1: OR = 0.674, p < .001; Study 2: OR = 0.823, p = .013; Study 3: OR = 0.718, p < .001). That is, the more death anxiety participants reported, the less likely they were to hold an organ donation card even when controlling for often-cited predictors of organ donation behavior. A potential mechanism for this effect is discussed. .
The aim of this study is to determine the effect of Cognitive Behavioural Therapy (CBT)-Based Psychoeducation given to children diagnosed with ADHD on internalized stigma and hope. This is a randomized controlled experimental study. The study was conducted with children diagnosed with attention-deficit/hyperactivity disorder who were followed up in a Paediatric Psychiatry outpatient clinic between May 2020 and January 2022. The study was completed with 145 children (75 in the control group, 70 in the experimental group). Data were collected using the descriptive characteristics form, the internalized stigma scale for children and adolescents, and the children's hope scale (CHS). The experimental group received an 8-session, nurse-administered CBT-Based Psychoeducation program delivered in a closed-group format twice a week for 4 weeks, focusing on ADHD awareness, impulsivity, attention, hyperactivity, stigma, and hopeful thinking. No intervention was made to the control group during the study period; however, to meet ethical standards, the same CBT-Based Psychoeducation program was administered to the control group after all post-test measurements were completed. In addition to descriptive statistics, chi-square, dependent samples t-test, and independent samples t-test were used in the analysis of data. As a result of the measurements made before and after the CBT-based psychoeducation applied to the experimental group, internalized stigma decreased in children with ADHD, while the level of hope increased statistically significantly (p < 0.05). This change in the experimental group also showed a significant change compared to the control group. It was concluded that the nurse-led CBT-Based Psychoeducation program reduced internalized stigma and increased hope in children with ADHD.
Integrating clinical severity with health-related quality of life, psychosocial, and functional measures is essential to fully capture the impact of the disease and to inform patient-centred treatment strategies in patients with bronchiectasis. Accordingly, this study aimed to investigate the determinants of health-related quality of life in non-cystic fibrosis bronchiectasis, examining how psychological factors, disease severity, and functional exercise capacity interact in patients' self-reported quality of life. This prospective observational study included patients with non-cystic bronchiectasis (NCFB) aged 18-60 years. Disease severity was classified using Bronchiectasis Severity Index (BSI). Assessments included the Hospital Anxiety and Depression Scale (HADS), Medical Outcomes, Short-Form Health Survey (SF-36), Leicester Cough Questionnaire (LCQ), Quality of Life in Bronchiectasis (QOL-B), and Six-Minute Walk Test (6MWT). Pearson correlations and multiple linear regression were used to examine associations between psychological variables and outcomes. Thirty-one patients participated (54.8% female; mean age 52.45 ± 15.3 years), and 83.9% had mild - moderate disease. HRQoL was related to anxiety, depression, and functional exercise capacity, and anxiety was also associated with cough severity. Anxiety was negatively associated with the SF-36 Mental health domain (β = -1.80; p = 0.03) and the QOL-B Emotional functioning domain (β = -2.79; p = 0.01), while depression was associated with SF-36 Mental health (β = -2.26; p = 0.01). No association was found between prognostic severity of the disease and HRQoL. Psychological factors and exercise capacity were the main determinants of HRQoL in patients with mild to moderate NCFB, highlighting the importance of simple functional markers, such as the six-minute walk test (6MWT) and mental health assessment, in clinical evaluation and treatment planning.
Insomnia has been associated with adverse stress-related outcomes among university students. However, evidence from Sub-Saharan Africa remains limited, and the factors underlying these associations are poorly understood. This study examined the associations between insomnia symptoms and stress-related outcomes among undergraduate students in Ghana and explored potential effect modification and mediating factors. We analyzed data from a cross-sectional survey of 1,047 students aged ≥ 18 years in Ghana. Insomnia symptoms were assessed using the Insomnia Severity Index, while perceived stress and academic stress were measured using validated scales. Parallel mediation and multivariable OLS regression models evaluated the associations. After full adjustment, insomnia symptoms were positively associated with higher perceived stress (B = 0.05, 95% CI: 0.03-0.08) and academic stress (B = 0.21, 95% CI: 0.18-0.24) scores. These associations varied by sex and place of residence, with significant associations observed for perceived stress among female students and students residing in urban areas. In the mediation models, self-rated health and physical inactivity statistically accounted for approximately 20% and 26% of the association between insomnia symptoms and perceived stress, and approximately 4% and 26% of the association with academic stress, respectively. Addressing stress-related issues among university students in Ghana may benefit from attention to insomnia symptoms, health status, and lifestyle behaviors.
People with substance use disorders (PWSUDs) frequently experience multifaceted challenges, including depression, stigma, and social instability, which can negatively affect their quality of life (QoL). The present study explored the potential predictors of QoL among PWSUDs. The sample consisted of 300 PWSUDs (85% males; mean [SD] age = 44.73 [10.01] years), comprising equal groups of PWSUDs with amphetamine, opioid, and alcohol concerns. Variables such as education, employment, depression, self-esteem, and stigma were assessed. The Taiwan version of the World Health Organization Quality of Life (WHOQOL) Questionnaire was adapted to assess QoL. Hierarchical regression analyses were conducted to examine associations with QoL across four domains. A multiple mediator modeling approach was used to assess whether self-stigma and depression mediated the relationship between perceived stigma and QoL. Higher depression scores were consistently associated with lower QoL across all domains. Education and employment were positively associated with physical QoL. In the psychological domain, both lower depression and higher self-stigma were associated with higher QoL. Perceived stigma was negatively associated with social QoL, and lower education predicted poorer environmental QoL. Mediation analyses suggested that depression played a stronger mediating role than self-stigma in the association between perceived stigma and QoL. Depression and stigma significantly related to QoL among PWSUDs. Mediational pathways suggest that targeting depression may mediate the negative association between stigma and QoL. Interventions addressing both affective and social dimensions may help promote recovery.
Maternal mental health is a major global concern affecting both pregnant women and fetal development. Mindfulness-based interventions (MBIs) have shown benefits in improving maternal mental health. This study assessed the effects of digital and conventional face-to-face MBIs on psychological distress among pregnant women. Two independent reviewers conducted the literature search and study selection. PubMed, SCOPUS, Web of Science, Cochrane Library and ScienceDirect were searched for studies published between 2014 and 2025; 27 studies were included, involving 1,793 participants in the digital MBI group and 2,406 in the face-to-face MBI group. Standardized Mean Difference (SMD) with 95% CI was calculated for psychological distress (depression, stress, and anxiety) outcomes. Heterogeneity was assessed using Chi-square and I2 statistics. Due to substantial heterogeneity, a random-effects model and subgroup analyses were applied. MBIs during pregnancy were found to be effective, with overall SMDs of -0.77 for anxiety, -0.57 for depression and -0.64 for stress. In the subgroup analysis, digital MBI studies also showed significant reductions in anxiety (SMD = -0.56, 95% CI: -0.92 to -0.20; p = 0.006), depression (SMD = -0.43, 95% CI: -0.69 to -0.17; p = 0.001), and stress (SMD = -0.70, 95% CI: -1.12 to -0.27; p = 0.001) compared with standard care. MBIs were effective in reducing psychological distress among pregnant women. Both digital and face-to-face MBIs improved maternal psychological well-being, with digital MBIs showing comparable benefits in some studies. However, substantial heterogeneity across studies indicates the need for further high-quality research to confirm these findings.
Little is known about experiences of psychiatric hospitalization, access to mental health providers, and trust in mental health providers for deaf, transgender and gender diverse (TGD) adults, especially for those who identify outside of the gender binary and those who identify as a racial/ethnic minority. This project used data collected as part of the 2017 TransLifeline Mental Health Survey. Chi-square analyses compared endorsement of hospitalization and endorsement of having a mental health provider between TGD deaf and TGD hearing adults. Spearman's rank order correlation coefficients compared trust in providers and access to providers between TGD deaf adults and their TGD hearing adult peers. Compared to their TGD hearing peers, TGD deaf participants, regardless of gender identity, were more likely to report a history of psychiatric hospitalization. History of involuntary hospitalization did not differ between groups. Current or historical use of therapy providers also did not differ between groups. However, TGD deaf participants and TGD deaf White participants did endorse more difficulty with finding a therapy provider. Similarly, TGD deaf, TGD White, TGD racial/ethnic minority, and TGD non-binary participants reported diminished trust in therapy providers compared to their TGD hearing peers. Current or historical use of and access to psychiatric care did not differ between groups. However, TGD deaf racial/ethnic minority participants reported diminished trust in psychiatric providers compared to their TGD hearing racial/ethnic minority peers. deaf TGD adults are at an increased risk for psychiatric hospitalization and report difficulties with finding mental health providers and trusting those providers.
The association between combined moderate-to-vigorous physical activity (MVPA) and sedentary behaviour with health-related quality of life (HRQOL) remains unclear. This study examines their joint associations with HRQOL in adults and older adults. This cross-sectional study analysed self-reported MVPA time, sedentary time, Mental Component Summary (MCS) and Physical Component Summary (PCS) scores in 2,814 rural Japanese participants aged 20-90 years. Adults (20-64 years) and older adults (≥65 years) were classified into four activity profiles based on weekly MVPA and sedentary time. Logistic regression models were used to examine associations between these profiles and HRQOL in both age groups. Using the high MVPA/low sedentary behaviour profile as a reference, adults with a low MVPA/high sedentary behaviour profile had the lowest MCS scores (unadjusted OR = 0.77, 95% CI = 0.59-0.99; adjusted OR = 0.75, 95% CI = 0.58-0.99) but the highest PCS scores (unadjusted OR = 1.36, 95% CI = 1.05-1.77; adjusted OR = 1.28, 95% CI = 0.98-1.67). Among older adults, those in the low MVPA/high sedentary behaviour profile had significantly lower odds of better PCS and MCS scores in both unadjusted and adjusted models (unadjusted PCS: OR = 0.46, 95% CI = 0.33-0.64; MCS: OR = 0.53, 95% CI = 0.37-0.78; adjusted PCS: OR = 0.54, 95% CI = 0.38-0.76; MCS: OR = 0.60, 95% CI = 0.41-0.89). The low MVPA/high sedentary behaviour profile was associated with poorer HRQOL in both adults and older adults compared to the high MVPA/low sedentary behaviour profile. These findings highlight the importance of increasing MVPA and reducing sedentary behaviour to improve HRQOL in these populations.
Adolescents with skin conditions often face profound psychosocial challenges that extend beyond physical symptoms. While prior research has focused on diagnosed cases, little is known about the impact on adolescents with undiagnosed skin concerns. This study aimed to compare quality of life and psychosocial outcomes across adolescents with diagnosed skin disorders, those with self-reported but undiagnosed skin concerns, and skin-healthy controls. We conducted a prospective, anonymized, questionnaire-based study involving 502 adolescents aged 14-18 at the University Hospital LMU Munich, comprising 117 with diagnosed skin disorders, 134 with self-reported but undiagnosed skin concerns, and 251 age-matched controls. All participants completed a detailed survey covering psychosocial domains; diagnosed and undiagnosed participants additionally completed the Dermatology Life Quality Index (DLQI). Both diagnosed (mean DLQI 6.1 ± 6.3) and undiagnosed (mean DLQI 6.0 ± 5.9) adolescents reported moderate impairment of quality of life, substantially exceeding the near-zero scores observed among the subset of controls who completed the DLQI (mean 0.12 ± 0.34; n = 32). Significant differences between skin concern groups and controls were observed in sleep (p < 0.001), participation in recreational activities (p = 0.013), discomfort in social settings (p < 0.001), and body image (p < 0.001). Notably, 34.2% of diagnosed adolescents reported poor understanding of their condition, compared to 67.9% of undiagnosed adolescents. Psychosocial burden was comparable between diagnosed and undiagnosed adolescents, suggesting that subjective distress rather than formal diagnosis is the primary determinant of psychosocial impact in this population.
Research indicates that cardiovascular metabolic comorbidity (CMM) is an important risk factor for depression in middle-aged and older adults. However, the relationship between depression trajectories and CMM remains unclear. This study analyzed data from the China Health and Retirement Longitudinal Study (CHARLS) to explore the relationship between depression trajectories and CMM in middle-aged and older adults. This study utilized four waves of data (2011, 2013, 2015, and 2018) from the China Health and Retirement Longitudinal Study (CHARLS), including 848 participants aged 45 years and older with CMM, each with depressive symptom assessments at a minimum of three time points. Group-based trajectory modeling (GBTM) was applied to identify distinct depressive symptom trajectories, with model fit evaluated using the Bayesian information criterion (BIC), average posterior probability (AvePP), and odds of correct classification (OCC). Multinomial logistic regression was used to examine associations between sociodemographic characteristics and trajectory membership. Four depression trajectories were identified: Low-stable (45.01%), Relieved (31.48%), Worsen (12.20%), and High-fluctuating (11.32%). Pronounced gradients were observed for sex (p < 0.001), education (p < 0.001), rural residence (p < 0.001), marital status (p = 0.048), contact with children (p = 0.032), smoking (p = 0.031) and sleep duration (p < 0.001). In multivariable analyses, short sleep duration (<7 h) was consistently associated with increased odds of the High-fluctuating trajectory (OR = 3.01, 95% CI 1.81-5.00). Non-participation in social activities was associated with increased odds of the High-fluctuating trajectory (OR = 1.87, 95% CI 1.16-3.01). Among middle-aged and older Chinese adults living with CMM, depressive symptoms follow four distinct long-term patterns: Low-stable, Relieved, Worsen, and High-fluctuating. These findings underscore the importance of integrating sleep pattern, gender-sensitive care and social support into routine management of CMM to mitigate the risk of chronic or relapsing depression in this population.
Sickle Cell Disorder (SCD) is a complex, multi-system blood condition affecting 7.78 million people, with 80% of global cases in sub-Saharan Africa, especially Nigeria. The condition is associated with physical health complications and increased risk of emotional difficulties, highlighting the need for scalable psychosocial interventions for adolescents with SCD in Nigeria. This pilot study assessed the effect of Bibliotherapy as a low-intensity, scalable intervention for adolescents with SCD. The non-randomised pilot-controlled trial involved 42 adolescents with SCD recruited from a Sickle Cell Centre and a Haematology Clinic. Participants were stratified by gender, age and baseline Rosenberg Self-Esteem (RSE) scores, and dyad-matched into Intervention and Control groups to reduce baseline differences. The treatment arm received weekly, virtual, group-based, manualised Bibliotherapy over five weeks, based on selected texts from a memoir by a Nigerian psychiatrist who lived with SCD. Pre-specified primary outcome was the RSE score; secondary outcomes were Hope, Depressive symptoms and Satisfaction with the intervention. The control group received no intervention beyond routine psychoeducation. Participants were aged 13-19 years (M = 16.1, SD = 1.96), with 59.5% females. Controlling for baseline scores, age and gender, the intervention showed a statistically significant effect on self-esteem scores with medium effect size {F (1,37) = 4.84, p = 0.03, Partial Eta Squared = 0.12}, but no significant effect on Hope {F (1,36) = 0.64, p = 0.20, Partial Eta Squared = 0.04} or depressive symptoms {F (1,36) = 0.95, p = 0.34, Partial Eta Squared = 0.03}. All participants in the intervention arm found the book interesting and indicated that it helped them believe they could succeed despite having SCD. They expressed satisfaction with the intervention. This pilot Bibliotherapy intervention was feasible, well received and showed promising efficacy on self-esteem. Larger controlled trials are recommended to establish the generalisability of these findings in the region.Pan African Clinical Trial Registry (Registration Number PACTR202110602061985).
This review investigates the impact of Internet-based health education on the mental health of lung cancer patients to provide evidence for its clinical use. We conducted a systematic search of databases including CNKI, VIP, Wanfang, PubMed, Embase, and Cochrane for randomized controlled trials published before June 2024. A meta-analysis of sixteen studies involving 1,769 patients was performed using Stata15.0. The analysis revealed that Internet-based health education significantly reduced anxiety and depression compared to conventional methods, with a standardized mean difference of -2.74 for anxiety and -1.08 for depression. Additionally, psychological resilience improved with a standardized mean difference of 2.92. These findings suggest that Internet-based health education is effective in enhancing mental health outcomes in lung cancer patients. The value of its clinical application should be further explored.
Physicians are among the extremely stressed professionals demonstrating a high incidence of mental health problems and suicides. However, most studies come from developed Western countries, and there is a lack of research on work-related stress in developing nations, hindering action. Aim: This study targeted primary care physicians (PCPs) in a peripheral region (Al Dakhiliyah) in the Sultanate of Oman. It explored the prevalence of perceived stress (PS) among PCPs, its variation with demographic features, and common stressors that contributed to their stress. Cross-sectional study using a web-based survey collected demographic data and assessed the perceived stress and the prevalent stressors among participants using previously validated tools; the Perceived Stress Scale -10 (PSS-10) and Pressure Management Indicator (PMI) scales. Objectives were tested with correlation and variation tests on 57 participants. 40.4% of participants reported high perceived stress (PS), but there was no significant demographic variation in PS levels. Seven PMI factors significantly influenced PS predictions collectively, with the need for recognition, unclear promotion, and lack of social support at work having a statistically significant individual impact. Mental health issues among PCPs in Oman are not uncommon, like in other parts of the world. The study shows that stressors mainly stem from work conditions and employer policies, highlighting the need for comprehensive interventions for physicians at the individual and organizational levels.
Most patients with End Stage Kidney Failure (ESKF) in Pakistan must undergo maintenance haemodialysis (HD) to survive. Session duration and the often lifelong nature of this treatment, along with other factors associated with HD, make it difficult to tolerate. This study took a positive psychological perspective and considered that HD sessions' duration, which has been a major challenge for HD patients, can be turned to an opportunity for patients' meaningful engagement. Such meaningful engagement can positively transform Pakistani patients' experience of HD and extend into their lives outside HD. Twenty-four HD patients and six healthcare professionals were interviewed to explore the potential to transform the HD experience. Interview data were analysed using interpretive phenomenological analysis (IPA). Data analysis indicated that HD session duration was a significant and common challenge or all patients. Nevertheless, HD patients identified strategies such as psychoeducation, positive psychology, spiritual strategies, and social support as having the potential to positively affect the overall HD experience. The strategies identified in the study could be integrated in a psychological intervention to be implemented during regular HD sessions and potentially positively transform the experience of HD for Pakistani patients and improve their lives overall.
Climate-induced disasters in Pakistan have been found to have a significant impact on the mental health of individuals due to economic insecurity, gender-based violence and abuse. The alarming situation of the country calls for an in-depth analysis of mental health impacts of climate change with a strong focus on vulnerable populations. This study synthesizes existing literature by performing a systematic literature review on climate-change-induced anxiety and depression in Pakistan. The study consolidated findings from 22 research articles from Scopus and PubMed, ranging from 2015 to 2025 by utilizing the PRISMA model. The findings of this review reveal anxiety, depression and PTSD as the most common psychological disorders associated with climate-induced disasters. Moreover, the review finds that women and children are the most vulnerable to climate change due to socioeconomic and cultural factors. It was found that internal displacement due to climate-induced disasters leads to major psychological disorders, such as PTSD, anxiety and depression. Anxiety, depression and PTSD are the most common psychological impacts of climate-induced disasters, where women and children aged 10-20 are more at risk. Limited availability of resources in rural areas of Pakistan and lack of infrastructure also led to the prevalence of mental health disorders.
Executive function (EF), including working memory, inhibitory control, and cognitive flexibility, is essential for adolescent learning, self-regulation, and adaptive behavior. Physical activity (PA) has been proposed as a promising strategy to improve EF during adolescence. This systematic review and meta-analysis aimed to examine the effects of exercise interventions on EF in adolescents. PubMed and Web of Science (WOS) were systematically searched for English-language randomized controlled trials published up to July 2024. Study quality was assessed using the Cochrane Risk of Bias tool, and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using random-effects models. A total of 12 studies were included. Exercise interventions significantly improved working memory (SMD = 0.37, 95% CI [0.03, 0.71], p = 0.03). Inhibitory control showed a borderline significant improvement (SMD = -0.27, 95% CI [-0.55, 0.00], p = 0.05), while no significant overall effect was observed for cognitive flexibility (SMD = 0.50, 95% CI [-0.21, 1.21], p = 0.17). Subgroup analyses suggested that single sessions of 30-40 min were associated with larger estimated effects on working memory (SMD = 1.47, 95% CI [1.11, 1.83], p < 0.00001) and cognitive flexibility (SMD = 1.59, 95% CI [0.12, 3.06], p = 0.03), though these findings warrant cautious interpretation given limited study numbersand substantial heterogeneity. Interventions exceeding 10 weeks yielded a significant effect on working memory (SMD = 0.30, 95% CI [0.12, 0.47], p = 0.0009), whereas 8-10 weeks programs showedthe largest subgroup effects for inhibitory control and cognitive flexibility . Overall, exercise interventions may benefit selected domains of EF in adolescents, with the strongest evidence for working memory. However, the findings for inhibitory control and cognitive flexibility should be interpreted cautiously because of borderline significance, nonsignificant overall effects, and substantial heterogeneity across studies.
Returning to work after a mental illness relapse presents significant challenges for teachers, often compromising sustained work participation. This study aimed to explore workplace barriers and coping strategies influencing teachers' return-to-work experiences in Limpopo Province, South Africa, using the Social Model of Disability. A qualitative exploratory design was used. Semi-structured face-to-face interviews were conducted with 14 teachers, with sample size determined by data saturation. Data were analysed using Tesch's open coding method. Findings revealed key workplace barriers, including unimplemented healthcare recommendations, persistent stigma, and limited organisational support, which exacerbated vulnerability to relapse. In response, teachers adopted coping strategies such as withdrawing from additional responsibilities, limiting engagement, and seeking alternative support through personal, spiritual, and familial coping mechanisms to manage their mental health. Applying the Social Model of Disability reveals that disabling environments, rather than individual impairments, are central barriers to reintegration. Without systemic intervention, current school environments risk perpetuating relapse and reduced productivity. The study calls for the urgent integration of structured psychosocial support, enforceable workplace accommodations, and rehabilitation-informed policies within the education sector. Coordinated action across policymakers, healthcare providers, and the Department of Basic Education is essential to implement sustainable return-to-work frameworks that safeguard teachers' mental health and optimise long-term occupational performance.
Smartphone use has become ubiquitous among young adults, raising concerns about its potential impact on sleep and executive functioning in daily life. This study examined the relationships between problematic smartphone use (PSU), social media frequency, bedtime smartphone use, sleep quality, and self-reported executive function (EF) difficulties in a sample of 270 Argentinean university students. Using a correlational, cross-sectional design, participants completed self-report measures of PSU (Mobile Phone Dependency Test), sleep quality (Pittsburgh Sleep Quality Inventory), and executive functioning difficulties in working memory (WM) and inhibitory control (IC) (Adult Executive Functioning Inventory). Path analysis was conducted to examine direct and indirect associations among variables. Higher social media frequency was significantly associated with increased PSU and more frequent smartphone use at bedtime. In turn, PSU and bedtime smartphone use were associated with poorer sleep quality. Poorer sleep quality and higher PSU scores were both linked to more frequent self-reported difficulties in WM and IC. Two significant indirect pathways were identified linking social media use to EF difficulties: one through increased bedtime smartphone use and poorer sleep quality, and another through increased PSU. A possible interpretation is that smartphone use might be linked to everyday executive functioning in adults through both sleep-related and dependence-related mechanisms. Importantly, social media use emerged as a key covariate of both bedtime smartphone use and PSU, underscoring its role as a potential risk factor for sleep problems, smartphone dependence, and negative cognitive outcomes in daily life.
This study aims to examine the effects of perceived service quality and patient participation on patients' re-preference behavior toward the same hospital, specifically investigating the mediating role of patient participation. Research data were collected from 757 adult inpatients at a university hospital in Konya, Turkey, using the Perceived Service Quality Scale, Hospital Re-preference Scale, and Patient Participation Scale. Analysis conducted via Structural Equation Modeling revealed that perceived service quality has a statistically significant and positive effect on the intention to re-prefer the hospital (ß=0.72, p < 0.001), explaining 52.3% of the variance in re-preference behavior. Perceived service quality was also found to significantly predict patient participation (ß=0.54, p < 0.001), while participation itself directly influences re-preference intention (ß=0.52, p < 0.001). Most importantly, bootstrapping results (95% CI [0.07, 0.14]) confirmed that patient participation plays a significant partial mediating role in the relationship between service quality and hospital re-preference. These findings contribute to healthcare management literature by demonstrating that while service quality is a fundamental driver, active patient engagement acts as a critical mechanism that strengthens long-term institutional loyalty. Practically, the study suggests that hospital managers should transition from passive service models to collaborative, patient-centered approaches to enhance patient retention and competitive advantage.
