Cyberchondria refers to excessive engagement in searching for health information on the Internet, leading to increased levels of anxiety. Previous research has shown that COVID-19-related fears were associated with increased cyberchondria during the COVID-19 pandemic. From a psychodynamic perspective, defense mechanisms have a critical role in emotional responses to adverse experiences. The present study aimed to investigate the relationships among defensive functioning, COVID-19-related fears, and cyberchondria in young adults during the COVID-19 pandemic. A total of 369 young adults (81.6% female), aged 18-30 years (M = 24.1; SD = 2.83), completed self-report instruments assessing the degree of maturity of defensive functioning, COVID-19-related fears, and cyberchondria. A mediation model was computed to examine the mediating role of COVID-19-related fears in the relationship between overall defensive functioning (ODF) and cyberchondria. Results showed that the maturity of defensive functioning was negatively associated with cyberchondria and that COVID-19-related fears mediated this association. Our findings suggest that individuals with less mature defensive functioning may experience higher levels of COVID-19-related fears, and that cyberchondria may constitute a maladaptive strategy for coping with COVID-19-related fears. Clinical interventions aimed at improving the capacity to modulate one's reactions to health-related threatening events might reduce dysfunctional engagement in online health searches among young adults with less mature defensive functioning.

Early adolescence is a critical developmental period marked by emotional, behavioral, and biological changes. The COVID-19 pandemic disrupted adolescents' daily routines, potentially producing lasting effects on mental and physical health. This study investigated anxiety and depressive symptoms, risk of extreme social withdrawal, use of technological devices, physical activity, and sleep-wake functioning in 276 early adolescents (54% females; Mage = 12.28, SD = 0.81) living in a forested and geographically isolated area of Emilia-Romagna in Italy. Participants completed validated self-report questionnaires assessing internalizing symptoms, use of technological devices (including problematic online gaming and smartphone use), gaming motivations, physical activity, chronotype, sleep disturbances, and daytime sleepiness. Scores on the anxiety and depressive symptom scales were within the normative range, except for scores on certain scales suggesting a moderate degree of severity that was not clinically significant. Females reported higher levels of anxiety, depressive symptoms, and problematic smartphone use, whereas males showed greater involvement in problematic online gaming and stronger achievement-, social-, and immersion-related motives. A substantial proportion of participants reported excessive daytime sleepiness (42.4% of females; 26.1% of males). Significant patterns of association were found among internalizing symptoms, domains of sleep-wake functioning, use of technological devices, and risk of extreme social withdrawal. Overall, these findings support the relevance of predisposing preventive strategies aimed at improving different domains of physical and mental health among youth in underserved or geographically isolated communities.

BACKGROUND:The right hemisphere is dominant for spatial attention and is implicated in negative emotional and self-related information processing. Right hemisphere engagement produces a leftward visuospatial bias, whereas reduced engagement a rightward bias. Using a cross-sectional design, we investigated the relationship between subclinical depressive symptoms (DS) and visuospatial bias in middle-aged adults and whether attentional-cognitive processes moderate this relationship. METHODS:Forty right-handed volunteers, divided into two groups (DS: N = 20, 15 females, mean age = 51.700 years, SD = 7.596; no-DS: N = 20, 14 females; mean age = 50.750 years, SD = 7.806) based on their Beck Depression Inventory-II scores, completed a line bisection task (visuospatial bias), a Complex Visual Reaction Times test (inhibitory control, speed of processing) and a Symbol Digit Modalities Test (sustained attention, working memory). RESULTS:No-DS participants exhibited a rightward bias, whereas DS participants a leftward bias (F = 6.378, p < 0.05). The relationship between DS and the leftward bias was present only at medium-to-high sustained attention and working memory (B = -0.00133, β = -0.478), and speed of processing (B = 0.00007, β = 0.411), but not inhibitory control. CONCLUSION:The rightward bias in the absence of DS is consistent with an age-related reduction in right hemisphere dominance for spatial attention. The leftward bias in the presence of DS is consistent with attentional tendencies toward negative emotional and self-related information, which have been associated, at least in part, with the right hemisphere engagement. This relationship emerged only when attentional-cognitive functioning was preserved.

Dreaming has long been implicated in emotional processing, yet the complex relationships between specific dream experiences and different dimensions of psychological distress remain insufficiently understood. This study explored the network relationships between dream-related experiences, pathological worry, and symptoms of depression, anxiety, and stress using a network analytic approach. A community sample of 389 adults (M = 24.24, SD = 7.45) completed the Mannheim Dream questionnaire, the Penn State-Worry Questionnaire, and the Depression Anxiety Stress Scale-21. A Gaussian graphical model was estimated to examine conditional associations between nine variables, and centrality and stability indices were evaluated. The resulting network showed a relatively dense structure, with depression, anxiety, and stress forming a strongly interconnected cluster, and stress emerging as highly central node. Pathological worry was most strongly associated with stress. Within the dream-related domain, recall was strongly associated with telling dreams and moderately with dream emotional intensity, which in turn was associated with the impact of dreams on daytime mood. Cross-domain associations revealed that negative dream emotional tone was negatively associated with depressive symptoms and pathological worry, whereas the perceived impact of dreams on daytime mood was positively associated with anxiety. Centrality analyses indicated that stress showed the highest strength, whereas dream emotional tone was characterized by a negative expected influence, suggesting an opposite role within the network. Stability analyses suggested acceptable reliability of estimated network, although some edges should be considered with caution. These findings suggest that dream experiences are embedded with a broader system of emotional functioning, with specific dream dimensions, particularly emotional tone, closely linked to psychological distress. Future research should further explore the role of dream-related emotional processes in waking distress.

Alexithymia concerns a difficulty identifying, describing, and valuing feelings, and is regarded as a transdiagnostic dimensional construct, expressed at different levels in both non-clinical and clinical populations. Despite evidence supporting the relationship between traumatic experiences, adult attachment insecurity, uncertain reflective functioning, and alexithymia, there is a need to model their relationships to inform research, preventative actions, and clinical practice. Accordingly, this study aimed to investigate the mediating effect of adult attachment insecurity (M1) and uncertain reflective functioning (M2), on the relationship between traumatic experiences (X) and alexithymia (Y) in a community sample of young adults. N = 1,510 community members (78

Background Literature has shown that a significant minority of bereaved people are at risk of prolonged grief disorder (PGD). However, studies on its prevalence and correlates within Italian samples remain scarce. Aims This study aimed to explore the prevalence and correlates of PGD symptom severity among 1603 bereaved Italian adults. Method Self-reported data on PGD, suicidal ideation, depression, anxiety and stress were gathered. Descriptive characteristics and bereavement-related information were also collected. Results Among participants who lost a close other person at least 12 months prior, the prevalence of probable PGD and severe suicidal ideation was 7.7% (n = 104) and 0.7% (n = 9), respectively. The overall prevalence of severe suicidal ideation in the sample was 4.5%, rising to 18.2% among those with probable PGD. The probable PGD diagnosis showed minimal agreement with reported depression (phi = 0.25), anxiety (phi = 0.19), and stress (phi = 0.26), suggesting potentially limited overlap and supporting their distinctiveness. The severity of PGD symptoms was significantly positively associated with older age and suicidal ideation, and negatively associated with lower educational background and time since loss. PGD severity also varied by kinship, cause of death and place of residence. Specifically, bereaved individuals who lost a grandparent due to natural causes associated with ageing and lived in small- to medium-sized cities reported lower PGD symptom severity relative to others. Conclusions These findings contribute to the understanding of PGD symptomatology in bereaved individuals in Italy, although the results may not generalise to the entire Italian population.

Background and aims:Research has shown a positive association between Problematic Smartphone Use (PSU) and poor sleep quality. However, extant literature has mostly relied on cross-sectional studies and little is known about the factors involved in the maintenance of PSU and connected sleep problems. The aim of this study was to model the associations between Negative Metacognitions about the uncontrollability and danger of excessive Smartphone Use (NMSU), poor sleep quality, and PSU using a 2-wave design. Methods:A total of 361 participants completed an online questionnaire at W1 and W2 (after six months). A cross-lagged panel model was estimated using SEM to examine the longitudinal interrelationships between poor sleep quality, two dimensions of PSU (i.e., Time spent - which covers addiction-like symptoms of PSU including withdrawal and salience, and Daily life interference - which assesses the negative effects of smartphone use on daily functioning, and NMSU. Results:Correlation analyses showed significant positive associations among PSU, NMSU and poor sleep quality at both waves. With regards to cross-lagged effects, only poor sleep quality at W1 significantly predicted NMSU at W2 (β = 0.202, p = 0.021). Discussion and conclusions:Contrary to previous studies, only a prospective effect of sleep quality on negative metacognitions, rather than bidirectional influence between the three variables, was observed. Sleep hygiene education and interventions based on Metacognitive therapy could be helpful to modify negative metacognitions in the context of PSU.

Social networking sites (SNS) use is associated with a range of positive outcomes, but a minority of vulnerable individuals experience problematic social networking site use (PSNSU). The relationship between PSNSU, sleep habits, and psychological distress remains insufficiently studied, particularly among older adults. As longer life expectancies and socioeconomic development contribute to the rising prevalence of PSNSU in this population, further research is required. This study aims to profile SNS users aged 60 and above, based on sleep quality, chronotype, psychological distress symptoms, motivations for SNS use, and PSNSU symptoms. The study involved 4962 SNS users (mean age = 66.81 +/- 6.6 years; 57.9% female) who completed self-report questionnaires. Latent profile analysis identified five distinct profiles, interpreted as 'Highly distressed very poor sleepers' (7.0%), 'Moderately distressed users' (21.2%), 'Mildly distressed socially involved users' (20.3%), 'Highly distressed very poor sleepers at risk for PSNSU' (9.6%), and 'Healthy users' (42.0%). These profiles revealed different patterns of SNS-related variables, sleep quality, chronotype, and psychological distress. The findings suggest these variables are intertwined among older adults, yet exhibit distinct gradients and configurations requiring attention and tailored interventions. The findings of this study might have significant implications for understanding and addressing PSNSU in the older population.

BACKGROUND AND OBJECTIVES:The diagnosis of narcolepsy type 1 (NT1) currently requires the multiple sleep latency test (MSLT), or a nocturnal sleep-onset REM period (SOREMP) combined with typical cataplexy, or alternatively the determination of CSF hypocretin-1 (CSF-hcrt-1) deficiency. We evaluated the 24-hour polysomnography (PSG) recordings in adult and pediatric patients as an alternative diagnostic tool. METHODS:Patients of any age, referred to the narcolepsy center of a university hospital for suspected central disorder of hypersomnolence (CDH), were consecutively recruited between 2013 and 2022. Participants underwent 2 days (day1-night1-day2-night2) of continuous dynamic PSG followed by MSLT. When consent was given, CSF-hcrt-1 was measured. The accuracy of 24-hour PSG variables from night1 and day2 (index test) was assessed with receiver operating characteristic (ROC) curve analysis in identifying NT1 based on current criteria (applied to night2-PSG, MSLT, and CSF-hcrt1). The markers with area under the curve (AUC) ≥0.75 were then tested in adults and children, separately, and to diagnose NT1 and narcolepsy type 2 (NT2) in different scenarios. RESULTS:Eight hundred seven patients (30.1% pediatric, 52.4% male) were included, and 709 had CSF-hcrt-1 measured. According to the standard criteria, 322 were diagnosed with NT1 (mean age 26.7 ± 17.1 years, 40.4% pediatric, 54.0% male) and 484 with non-NT1 (mean age 32.7 ± 16.5 years, 23.3% pediatric, 51.3% male), encompassing 31 with NT2, 163 with idiopathic hypersomnia, and 281 with other diagnoses. Detecting SOREMP ≥1 during daytime resulted in AUC = 0.84 (95% CI 0.82-0.87), with 84.4% sensitivity and 84.5% specificity for NT1. Performance was superior to all nighttime-PSG measures (p < 0.001) including nighttime-SOREMP (AUC = 0.77, 95% CI 0.74-0.80; sensitivity = 62.1%, specificity = 91.7%) and did not differ from 24-hour SOREMP ≥1 (AUC = 0.85, 95% CI 0.82-0.87; sensitivity = 89.7%, specificity = 80.2%). The combination of daytime-SOREMP ≥1 with cataplexy showed AUC = 0.89 (95% CI 0.86-0.91) for NT1, superior to the combination of nighttime-SOREMP with cataplexy (AUC = 0.78, 95% CI 0.76-0.81, p < 0.001) and similar to MSLT criteria for narcolepsy (AUC = 0.90, 95% CI 0.88-0.92, p = 0.36). Performances were similar in adults and children. Daytime-SOREMP ≥1 identified NT1 and NT2 combined within all CDH with a sensitivity of 80.8% and specificity of 88.0%. CONCLUSIONS:The detection of daytime-SOREMP during dynamic 24-hour PSG is more accurate than nighttime-SOREMP for diagnosing narcolepsy and, combined with cataplexy, is comparable with MSLT criteria for the identification of NT1. These results offer the prospect of 24-hour PSG diagnostics for NT1 in the home setting. CLASSIFICATION OF EVIDENCE:This study provides Class II evidence that daytime SOREMP during a 24-hour PSG accurately distinguishes NT1 in patients with a clinical history of possible cataplexy from those who do not have NT1.

Background: Excessive daytime sleepiness (EDS) and fatigue are two impactful symptoms, frequently associated with sleep disorders, which can worsen the quality of life. Due to overlapping features and patient-report ambiguity a clear-cut distinction between EDS and fatigue can become a challenging issue. We aimed to investigate the prevalence and consequences of these two conditions in several sleep pathologies, examining their social, psychological, and dietary impact, with a focus on gender-related differences and occupational status. Methods: We prospectively recruited for an online survey 136 adult outpatients (60 females) affected by various sleep disorders and admitted to our Sleep Disorders Center in Parma, Italy. Patients were asked to complete the following tests: Epworth Sleepiness Scale, Fatigue Severity Scale, Pittsburgh Sleep Quality Index, Difficulties in Emotion Regulation Scale, Depression Anxiety Stress Scale-21, Hyperarousal Scale, the Addiction-like Eating Behaviors Scale, Work Productivity and Activity Impairment Questionnaire, MEDI-Lite, and EQ-5D Health Questionnaire. Results:Fatigue was the primary daily symptom leading to serious repercussions on social/emotional and psychological well-being, while daytime sleepiness showed a less relevant role. Women reported higher levels of fatigue, sleep disturbances, emotional dysregulation, hyperarousal, and work productivity impairments. Unemployed people experienced a higher degree of fatigue, with multi-level negative consequences. Conclusions: We suggest sleep clinicians place a greater emphasis on the assessment of fatigue during clinical interviews, keeping in mind the greater vulnerability of females, experiencing disproportionate consequences. Further studies should expand our findings, exploring a wider range of gender identities and recruiting larger samples of patients.

Adolescent suicide remains a critical global public health challenge, with rising incidence rates necessitating urgent action. This narrative review presents a comprehensive strategy for reducing suicide risk among adolescents by synthesizing current evidence on risk factors, early detection, intervention, and prevention. Key risk factors include mental health disorders, substance use, trauma, and social determinants such as bullying and family dynamics. Schools, healthcare systems, and community-based initiatives play a vital role in early detection and intervention. This review examines evidence-based strategies, including universal screening, expanded access to mental health care, and targeted interventions such as cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT). It also explores the impact of public health campaigns, policy reforms, and technology-driven approaches on strengthening adolescent mental health awareness and resilience. A multi-sectoral, culturally sensitive approach—one that prioritizes the voices of adolescents, engages families and promotes health equity—is essential for reducing the risk of suicide and enhancing youth well-being globally. This review underscores the urgent need for enhanced suicide prevention policies, improved mental health service accessibility, and the integration of digital tools in adolescent care. Addressing research gaps through longitudinal studies and real-world implementation trials will be key in shaping future strategies to reduce adolescent suicide rates globally.

Objectives: The present scoping review aims to map the existing evidence on psychological and behavioral interventions targeting patients with narcolepsy type 1 and type 2. Methods: A literature search was performed using the databases Scopus, PubMed, and PsycINFO. Studies were included if they (1) employed randomized controlled trials, non-randomized trials, or quasi-experimental studies; (2) were published in English; (3) were published in peer-reviewed journals; (4) examined the impact of psychological interventions on psychopathological (primary outcomes) and narcolepsy-related symptoms (secondary outcomes); and (5) involved patients with a diagnosis of narcolepsy using recognized diagnostic criteria regardless of whether they were receiving pharmacological treatment or were untreated. No restrictions were imposed on the publication date to comprehensively map the available evidence. Data were extracted to address the review aims and presented as a narrative synthesis. Results: The database search yielded six studies. Treatment options for individuals with narcolepsy encompass psychological and behavioral interventions, such as telehealth interventions, meditation/relaxation therapy, and scheduled napping. The primary outcomes were daytime sleepiness, wakefulness maintenance, sleep attacks, the severity of symptoms of narcolepsy, sleep paralysis episodes, depression, and psychological functioning. The secondary outcomes were sleep-problem-related quality of life, sleep inertia, and sleep quality. The psychological and behavioral interventions exhibited variability in terms of the intervention type, personnel involved, number of sessions, and duration. Most of the contributions also lack details regarding the training of professionals and the specifics of the interventions. Additionally, the evidence quality was deemed low based on the Crowe Critical Appraisal Tool. Conclusions: Although the importance of nonpharmacological approaches is well recognized, there is limited evidence to support the efficacy of psychological and behavioral interventions in narcolepsy. This is further complicated by the wide range of psychological and behavioral interventions available.

This study examines the relationship between depressive symptoms (DS) and mental time travel (MTT), focusing on individuals’ ability to orient and project themselves into past or future scenarios. Drawing on literature suggesting that depression disrupts prospection, we hypothesized that DS are primarily associated with alterations in future-related MTT. Forty-eight university students were divided into two groups based on the presence or absence of mild-to-severe DS. Participants were asked to judge whether various events were located in the past or future while mentally projecting themselves ten years into the past, in the present, or ten years into the future. Results showed that participants with DS were less accurate in judging the temporal location of past events when projecting themselves into the future, as compared with those without DS. This suggests that DS may reduce prospection by interfering with the ability to orient to the past when individuals need to represent themselves in possible futures. Clinical implications will be discussed on how focusing on future-related MTT may help counteract DS.

Background:The relationship between sleep and healthy aging is complex, involving changes in sleep patterns, architecture, and disturbances. Recognizing these changes is crucial for maintaining physical, cognitive, social, and psychological well-being in older adults. However, links between sleep parameters and aging outcomes remain unclear. Objective:This review synthesizes current knowledge on associations between sleep parameters (duration, continuity, architecture, quality) and healthy aging outcomes, including physical health, cognitive function, psychological well-being, and social engagement. Methods:Following the Arksey and O'Malley framework and Joanna Briggs Institute guidelines, this scoping review analyzed observational studies on healthy older adults. Sleep-related measures were examined without confounders from mental or physical illnesses. Results:Twenty studies were included. Across cohorts, older adults consistently exhibited advanced sleep phases (bedtime ≈39 minutes earlier, wake time ≈76 minutes earlier) and reduced total sleep time (by approximately 2.4 hours vs younger adults). Both short and long sleep durations were associated with poorer aging outcomes, supporting a U-shaped relationship between sleep length and healthy aging. Sleep efficiency decreased by 13% and wake after sleep onset increased fourfold with age, particularly among women. Age-related reductions in slow-wave and REM sleep were linked to lower cognitive performance and altered mood regulation. Moderate daytime napping (<60 min/day) was generally associated with better sleep quality, whereas excessive napping correlated with reduced odds of "successful aging". Discrepancies between subjective and objective sleep assessments emerged, indicating that older adults may underreport sleep disturbances. Conclusion:Gaps in understanding longitudinal sleep data, the mechanisms of sleep's impact on aging, and napping's role need further exploration. Future research could inform interventions for promoting healthy aging.

IntroductionAdolescents’ health and well-being are seriously threatened by suicidal behaviors, which have become a severe social issue worldwide. Suicide is one of the leading causes of mortality for adolescents in low and middle-income countries, with approximately 67,000 teenagers committing suicide yearly. Although an association between sleep disturbances (SDs) and suicidal behaviors has been suggested, data are still scattered and inconclusive. Therefore, to further investigate this association, we conducted a meta-analysis to verify if there is a link between SDs and suicidal behaviors in adolescents without diagnosed psychiatric disorders.MethodsPubMed, CENTRAL, EMBASE, and PsycINFO were searched from inception to August 30th, 2024. We included studies reporting the estimation of suicidal behaviors in adolescents from 12 to 21 years of age, with SDs and healthy controls. The meta-analysis was based on odds ratio (OR, with a 95% confidence interval ([CI]), estimates through inverse variance models with random-effects.ResultsThe final selection consisted of 19 eligible studies from 9 countries, corresponding to 628,525 adolescents with SDs and 567,746 controls. We found that adolescents with SDs are more likely to attempt suicide (OR: 3.10; [95% CI: 2.43; 3.95]) and experience suicidal ideation (OR: 2.28; [95% CI 1.76; 2.94]) than controls.ConclusionThis meta-analysis suggests that SDs are an important risk factor for suicidal ideation and suicide attempts in healthy adolescents. The findings highlight the importance of early identification of SDs to prevent suicidal behaviors in this population.Systematic review registrationPROSPERO, identifier CRD42023415526.

Abstract Background This study aimed to analyze the moderating role of emotional exhaustion in the relationships between longitudinal associations of depression, anxiety, and stress among healthcare workers assisting end-of-life cancer patients during the COVID-19 pandemic. Methods A longitudinal study involving a final sample of 122 healthcare workers (61.5% females, mean age = 39.09 ± 11.04 years) was conducted. These participants completed the Maslach Burnout Inventory (MBI) and the Depression Anxiety Stress Scales-21 (DASS-21). Results: Results of correlation analysis showed that emotional exhaustion was correlated with both T1 and T2 measures of depression, anxiety, and stress. Results of the moderation analysis indicated that emotional exhaustion moderated the relationships between consecutive measures of depression and anxiety. Each of the moderation models explained about half of the variance for depression and anxiety. When considering stress, results did not show a moderating role for emotional exhaustion. Conclusions Overall, the results of this study highlight that emotional exhaustion moderated depression and anxiety over time. Psychological interventions to promote psychological mental health among healthcare workers assisting patients with end-stage cancer should carefully consider these findings.

Research shows that insecure attachment styles and failures in mentalizing are associated with increased problematic social media use (PSMU). This study aimed to investigate the mediating role of failures in mentalizing in the relationships between attachment styles and PSMU within a large sample of individuals from the community. The study involved the participation of 3600 adult volunteers (2312 females, 64.2%) aged between 18 and 60 years old (M = 29.92; SD = 10.68). Participants completed measures to assess socio-demographics, adult attachment styles, mentalization, and PSMU. Findings showed that secure and dismissing attachment styles predicted reduced levels of PSMU, and that preoccupied and fearful attachment styles predicted increased levels of PSMU. The relationships between adult attachment styles and PSMU were mediated by failures in mentalizing. Thus, individuals with preoccupied and fearful attachment styles may excessively resort to social media as a means of coping with unprocessed mental states. Clinical interventions that focus on improving mentalizing abilities and promoting the adoption of appropriate self-regulation strategies might reduce maladaptive engagement in social media.

Objective: To assesses the prevalence and co-occurrence of anxiety, depressive symptoms, suicidal thoughts, and hopelessness in patients with narcolepsy type 1 (NT1). Patients/Methods. In this cross-sectional study, 127 patients with NT1 (mean age 38.2 +/- 15.5 years, 53.5 % female) and 131 controls (mean age 37.4 +/- 14.3 years, 59.5 % female) matched for age, sex, and education, filled in the following validated questionnaires: Beck Depression Inventory-II (BDI), State-Trait Anxiety Inventory (STAI), and Beck Hopelessness Scale (BHS). Comparisons between groups and multivariable logistic regression analyses were performed. Results: Patients with NT1 presented significantly higher scores in BDI, suicidal thoughts (BDI-item-9), STAI-trait, STAI-state, and BHS than controls. Adjusted for age, sex, and educational level, NT1 was significantly associated with depressive symptoms (BDI >= 13; OR 3.23, 95%CI 1.71-6.10), trait anxiety symptoms (STAI-trait >= 38; OR 1.91, 95%CI 1.14-3.21), co-occurrence of BDI >= 13 with STAI-trait >= 38 (OR 2.72, 95%CI 1.47-5.05), and with STAI-state >= 38 (OR 2.24, 95%CI 1.17-4.30), and moderate to severe hopelessness (BHS >= 9; OR 2.95, 95%CI 1.55-5.63). Conclusions: Patients with NT1 present a multidimensional psychiatric burden and comorbidity between symptoms of depression and anxiety and suicidal thoughts, a concern that deserves tailored interventions.