Psychiatry International

Orthorexia nervosa (ON) is a pathological obsession with eating only healthy and biologically pure food. The primary aim of this study was to explore the relationships between ON, perfectionism, and obsessive–compulsive symptoms in two cultural contexts, i.e., Romania and Germany. Our sample included 600 participants aged 18 to 73 (M = 29.04, SD = 10.30, 79.2% females), i.e., 310 from Romania and 290 from Germany. We tested a moderated mediation model, exploring the mediating effect of obsessive–compulsive symptoms on the link between socially prescribed and self-oriented perfectionism and ON symptoms and the moderating effect of culture (i.e., Western and non-Western) while controlling for age, sex, education, and monthly income. Socially prescribed perfectionism and self-oriented perfectionism were positively related to obsessive–compulsive and ON. Both socially prescribed and self-oriented perfectionism predicted ON through obsessive–compulsive symptoms, but only in the case of German participants. The present study’s results suggest a better understanding of orthorexic behaviors in a cross-cultural context, which might significantly contribute to developing tailored strategies for preventive educational programs and nutritional interventions across different nations. Full article

Prolonged untreated psychosis worsens outcomes, thus motivating the study of pathways and perceived barriers to care, especially for high-risk age groups like college students. The primary objective of this study was to explore pathways to coordinated specialty care (CSC) and perceived barriers to care in college students at high risk for psychosis or with first-episode psychosis and determine any association between them. Twenty-four college students enrolled in CSC completed the Circumstances of Onset and Relapse Schedule and Barriers to Seeking Psychological Help Scale (BSPHS). Non-parametric tests were used for two-group analyses, and medians and interquartile ranges (IQR) were calculated. The median number of total contacts along the pathway to CSC was 5.0 (IQR = 5.2), with more psychiatric contacts (Mdn. = 3.0, IQR = 2.2) than non-psychiatric contacts (Mdn. = 2.0, IQR = 3.0). Students whose first contact was with non-psychiatric services had longer pathways to care overall, with a higher median number of total psychiatric as well as non-psychiatric contacts relative to students whose first contact was with psychiatric services. With the highest possible total BSPHS score being 5, the median score was 2.7 (IQR = 0.8). Targeted psychosis literacy training for non-mental health professionals and anti-stigma campaigns for college students may help reduce the duration of untreated psychosis. Full article

On 1 January 2024, a magnitude 7.5 earthquake struck the Noto Peninsula in Ishikawa Prefecture, Japan, causing substantial damage to northern Noto. This study aimed to clarify the experiences of patients using a psychiatric visiting nurse service who were affected by the earthquake, and the influencing factors of worsening mental health symptoms after the earthquake. Participants were 114 patients using a psychiatric visiting nurse service in northern Noto. Data were collected retrospectively from nursing records. Factors associated with signs of worsening mental health symptoms were the continued use of home visiting nursing services after the disaster (n = 43, 46.7%; p = 0.040) and the intervention of a disaster psychiatric assistance team (DPAT) (n = 7, 77.8%; p = 0.034). No significant correlation was found between the number of relocations owing to evacuation and signs of worsening mental health symptoms. Although 61.4% of participants experienced more than one evacuation, the number of evacuations and relocations did not seem to directly affect the worsening of mental health symptoms. However, the results suggest a need for more direct interventions, such as the continued use of home visiting nursing services and the involvement of DPATs as an external resource, for patients exhibiting signs of worsening mental health symptoms. Full article

Gender-diverse populations are at a higher risk of experiencing adverse childhood experiences (ACEs) and social stigma, with a significant impact on both mental and overall health. This systematic review, conducted in accordance with PRISMA guidelines, included 14 studies published between 2016 and 2024. Observational studies were extracted from MEDLINE, CINAHL, APA PsycInfo, and APA PsycArticles to explore the prevalence of ACEs and their effects on mental and physical health in gender-diverse individuals. Studies were assessed for quality using the AXIS tool. The studies included revealed elevated rates of ACEs, particularly in the form of abuse. ACEs were strongly associated with an increased risk of depression, anxiety, stress-related disorders, and suicidality. Discrimination further amplified these effects, particularly among racial and ethnic minorities, leading to a higher engagement in risky behaviors and poorer physical health outcomes. Protective factors identified included secure attachment, access to gender-affirming care, and strong social support. The findings emphasize the urgent need for trauma-informed and culturally sensitive interventions that address both the immediate and long-term effects of ACEs in gender-diverse populations. Future studies should prioritize longitudinal designs and tailored interventions to meet the healthcare needs of these communities and develop mental health prevention strategies. Full article

The COVID-19 pandemic has profoundly impacted mental health, intensifying negative emotions and challenging collective psychological resilience. This study examines the complex psychological interplay between social media engagement, emotional responses, and behavioral outcomes during crises. Using an online survey (N = 500) conducted during the COVID-19 pandemic, the findings reveal that heightened social media use for social interaction is associated with amplified emotional responses—particularly anxiety, anger, and sadness. Among these, anxiety demonstrated a dual role, acting as both a psychological stressor and a motivator for cooperative and prosocial behaviors, such as supporting government policies, volunteering, and donating. In contrast, anger and sadness were not associated with similar behavioral outcomes. These findings highlight the nuanced psychological impact of anxiety during crises, emphasizing its potential to drive adaptive responses amidst heightened emotional distress. This study contributes to a deeper understanding of how emotional and psychological processes, particularly anxiety, influence public behavior during crises, providing insights for mental health interventions and policy strategies. Full article

This study delves into the intricate interplay between mindfulness, the Mediterranean lifestyle, burnout, job satisfaction, and well-being among employees, offering compelling insights for workplace interventions. Through a cross-sectional survey comprising 407 employees in Greece, we unravel the profound associations among these variables, shedding light on novel pathways to mitigate burnout and enhance overall employee satisfaction and health. Our findings unveil not only the negative associations between mindfulness, the Mediterranean lifestyle, and burnout but also the pivotal role of mindfulness as a predicting factor of burnout. Moreover, our research underscores the significant impact of burnout on job satisfaction, emphasizing the need for organizational strategies to address employee well-being. Notably, our mediation analyses illuminate the potential benefits of mindfulness and the Mediterranean lifestyle on burnout, accentuating the importance of fostering a workplace culture that embraces holistic well-being practices. With practical implications for designing evidence-based workplace wellness programs, our study advocates for the integration of mindfulness techniques and the adoption of Mediterranean lifestyle principles to cultivate resilient, engaged employees, and foster thriving organizational cultures. By delving into these dynamic relationships, our research not only advances theoretical frameworks but also offers actionable strategies to navigate burnout and promote flourishing in the modern workplace. Full article

Parental attitudes and peer victimization experiences in childhood influence anxiety. Depressive rumination is associated with these factors, but the interrelationship between them remains unclear. In this study, we hypothesized that “inadequate parental attitudes” and “peer victimization” experienced in childhood worsen “depressive rumination” and “state anxiety”, and that “depressive rumination” is an intermediate factor that worsens anxiety symptoms in adulthood. We verified this interrelationship by structural equation modeling. A cross-sectional questionnaire study was conducted on 576 adult volunteers, who gave written consent. Demographic data and scores from the Parental Bonding Instrument, Childhood Victimization Rating Scale, Ruminative Responses Scale, and state anxiety of State-Trait Anxiety Inventory Form Y were collected. Data were analyzed by multiple regression analysis and structural equation modeling. In the study models, inadequate parental attitudes (low care and high overprotection) and depressive rumination directly worsened anxiety. Inadequate parental attitudes and peer victimization experienced in childhood indirectly worsened anxiety via depressive rumination. Furthermore, inadequate parental attitudes experienced in childhood indirectly worsened depressive rumination via peer victimization in childhood. Our results indicate that depressive rumination influences the relationship between inadequate parental attitudes, peer victimization, and adulthood anxiety. Therefore, assessing the quality of parental attitudes and peer victimization experienced in childhood and depressive rumination may help to clarify the antecedents of anxiety and how to intervene effectively. Full article

In recent years, self-injury attempts have accounted for 46.2% of emergency room visits by teenagers and young adults. This study aimed to explore the prevalence of non-suicidal self-injury (NSSI) among Korean college students, compare the mean number of NSSI risk factors between those with a history of NSSI and a control group with no history of thoughts or experiences of self-injury, and identify which factors have a greater influence on NSSI. The participants consisted of 403 Korean college students aged 18–29 who were divided into a subject group with a history of NSSI (n = 198) and a comparison group (n = 205) with no history of NSSI. The Functional Assessment of Self-Mutilation (FASM), Childhood Trauma Questionnaire (CTQ-SF), Social Experience Questionnaire (SEQ), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder 7-item scale (GAD-7), Difficulties in Emotion Regulation Scale—16 item version (DERS-16), Experiences in Close Relationship Questionnaire-Revised (ECR-R), Rosenberg Self-Esteem Scale (RSES), Parents as Social Context Questionnaire-Kids (PSCQ-KA), and Barratt Impulsiveness Scale-11-Revised (BIS-11). The collected data were analyzed using SPSS 25.0. Before a regression analysis, a MANOVA was performed to examine the mean difference between groups of each dependent variable, and a multiple regression analysis was performed to confirm the influence. The mean difference in all risk factors in the subject group compared with the comparison group was found to be statistically significant, with an effect size of 0.8 or greater. As a result of examining the relative influence of each variable on NSSI, emotional dysregulation (t = 2.481, p = 0.014), anxiety (t = −2.109, p = 0.036), and adult attachment (t = 2.004, p = 0.046) were found to significantly influence NSSI (p = 0.05). These findings will serve as fundamental data for screening clients at risk of self-injury in counseling and treatment settings, in addition to providing preventive and therapeutic interventions. Full article

Violence in psychiatric settings presents a significant risk to patients, staff, and society at large. With over 400 risk assessment tools available globally, their applications and the risks they assess vary, allowing for diverse use in different situations. This scoping review investigated the risk management tools utilized in North America’s forensic psychiatry and acute psychiatric units, aiming to identify which ones are mainly used. A comprehensive search was conducted across PubMed, Embase, and PsycINFO databases, following PRISMA Guidelines, covering the literature from their inception date until 2023. Criteria for study inclusion required a focus on risk management tool use in forensic or acute psychiatric settings, originality (original studies, case reports, or systematic reviews), and a North American context. Out of 3059 identified studies, 40 were thoroughly analyzed. Commonly used risk assessment scales include HARM-FV, eHARM-FV, HCR-20, PCL-R, START, BVC, and DASA, with their reliability varying by the clinical context and the assessed population. The review highlights the heterogeneous application of static and dynamic scales across clinical settings, underscoring a need for more precise tools to improve risk assessments in forensic psychiatry, signaling a call for the development and validation of more sophisticated assessment instruments. Full article

Introduction: Chronic obstructive pulmonary disease (COPD) has a diverse negative impact on patients, affecting them both physically and mentally. Psychosocial factors such as anxiety, depression, social isolation, and financial stress have been found to be positively associated with more exacerbations, hospital readmissions, poor adherence to medication, and lower quality of life among patients with COPD. However, healthcare professionals, who have a crucial role in diagnosing and managing COPD, often overlook these psychosocial factors of the disease, despite growing evidence suggesting their crucial role in improving disease outcomes. Consequently, this study will evaluate the effectiveness of a personalized individualized informational intervention on the quality of life, adherence, and psychosocial economic status of patients with COPD in healthcare settings of Greece. Methods: A prospective, mixed-methods design will be used, incorporating both quantitative data through questionnaires, including the Short Form (SF-12), Clinical COPD Questionnaire (CCQ), Test of Adherence to Inhalers (TAI), Patient Health Questionnaire (PHQ-4), Multidimensional Scale of Perceived Social Support (MSPSS), and Financial Ability Scale (FAS), alongside qualitative data with questions exploring themes such as general health perception, treatment adherence, mental status, socioeconomic status, and disease management. Participants will consist of patients receiving care at primary healthcare facilities and respiratory hospital departments in Crete, Greece. The intervention will involve providing structured information on social, financial, and psychological support services, along with psychosocial counseling over a six-month period. The impact of the intervention will be measured using validated tools to assess health status, quality of life, treatment adherence, mental health, and socioeconomic status before and after the intervention. Conversely, qualitative interviews will be conducted to gain deeper insights into the impact of the intervention. Finally, when the analyses of both data types are finalized, they will be triangulated to achieve convergence. This procedure entails the creation of a figure or illustration that demonstrates the convergence or divergence of both data types. Conclusions: The findings of this study are expected to highlight the importance of integrating an individualized informational intervention into the management of COPD. Thus, this study could guide healthcare professionals and policymakers in improving COPD care and patient outcomes. Full article

In rural schools, nature is a space where teachers and students seek to feel states of emotional well-being. Activities carried out in contact with nature could be considered ideal for learning. The objective of the research was to explore the influence of physical/natural spaces on the emotional well-being of schoolchildren as reported by female teachers working in rural and indigenous contexts in the region of La Araucanía, Chile. This research is based on the hermeneutic paradigm with a case study design. The selection of participants was non-probabilistic and intentional, including 15 female teachers working in rural school contexts. The study used a semi-structured interview format, and the data were analyzed using grounded theory. According to the teachers’ discourse, the results generated three categories: (a) culture and diversity, (b) physical/natural spaces, and (c) emotional well-being. These show that natural spaces positively affect learning processes and emotional regulation. The research suggests that encouraging contact with physical/natural spaces can help create classroom climates with lower levels of conflict and tension. This, in turn, leads to higher levels of physical, psychological/mental, social, and spiritual balance, resulting in improved attitudes and motivational processes towards learning by students and teachers in rural and indigenous contexts. Full article

Impulsive buying is a growing problem in modern society with significant financial and psychological consequences, and it is necessary to examine the mechanisms underlying it. Understanding the mechanisms driving this behavior is crucial. Impulsive buying consists of two key aspects: a cognitive aspect, characterized by a lack of planning and reflection, and an affective aspect, involving emotional responses that can occur before, during, or after a purchase. This study aims to explore the relationship between personality traits, as measured by the HEXACO model, and tendencies toward impulsive buying. Specifically, it examines how the HEXACO traits differentially predict the cognitive and affective components of impulsive buying tendencies. Data were collected from a sample of 420 students, with 32 excluded due to incomplete responses, resulting in a final sample of 388 students (155 men, 233 women) with an average age of 22.8. Hierarchical regression analyses revealed that HEXACO personality domains significantly predicted overall impulsive buying tendencies. As expected, Honesty–Humility and Conscientiousness were negatively associated with impulsive buying, while Emotionality and Extraversion positively predicted impulsive buying tendencies. Moreover, Honesty–Humility, Conscientiousness, and Extraversion significantly predicted the cognitive component of impulsive buying, while Honesty–Humility and Emotionality were significant predictors of the affective component. These findings suggest the importance of educating individuals, from an early age, on the negative consequences of impulsive buying, effective money-saving strategies, and the principles of mental accounting. Full article

This study investigates the impact of excessive mobile phone use on young individuals aged 14–35 in Kastoria, Greece. It explores how smartphone addiction affects daily life and social interactions. A survey with 30 closed-ended questions was conducted among 150 respondents from May to August 2019. Data were analyzed using descriptive statistics and chi-square tests, focusing on gender and employment status differences. Most respondents use their phones for over 5 h daily, primarily for social media and communication. Findings reveal high addiction rates, reduced productivity, and disrupted sleep. Women reported more difficulty disconnecting and a greater need for detoxification than men. Students and unemployed individuals showed higher addiction symptoms and negative productivity impacts compared to employed respondents. Excessive mobile phone use among young people poses significant challenges, including addiction and adverse effects on productivity, relationships, and sleep, influenced by gender and employment status. Full article

Purpose—This study aimed to provide a comprehensive report of workplace violence (WPV) at a psychiatric hospital in Gambia. Design/methodology/approach—A cross-sectional study involving self-administered questionnaires and an in-depth interview was conducted with 54 staff at the hospital and six senior managers of mental health treatment in Gambia. A descriptive statistical approach was applied to determine the prevalence, and a logistic regression approach was used to identify factors associated with violence at the hospital. The data from the in-depth interviews on WPV policies in Gambia were analysed thematically. Results—In the 12 months before the research, 55.6% of the respondents had been exposed to violence; of those, 46.3%, 27.8%, and 5.6% had experienced verbal abuse, physical assault, and sexual harassment, respectively. Inadequate staff, insufficient security measures, and insufficient medications were perceived by respondents as the causes of the violence. However, the level of professionalism, the kind of services provided by staff, and shift of work were strongly connected with violence. As a result of WPV, victims had injuries, posttraumatic stress disorder signs/symptoms, and work dissatisfaction. The interviewees also expressed concern about the lack of WPV polices and the necessity of creating such polices as soon as possible. Value—According to the research, there is an elevated risk of violence among the hospital staff. As a result, the hospital’s structure needs to change, staff members should receive training on how to address aggressive patients, and a constructive WPV policy should be created. Full article

(1) Background: Suicide represents a critical global public health concern. In the majority of countries, men have higher rates of suicide completion, while women show higher rates of suicide attempts. Masculinity is a complex construct shaped by socialization processes that begin early in life. The aim of this study is to explore the influence of masculinity on suicidal behaviors among men. (2) Methods: This systematic review was conducted in accordance with the Cochrane and PRISMA guidelines. The review protocol was pre-registered in the International Prospective Register of Systematic Reviews (PROSPERO). (3) Results: This systematic review—which includes 18 studies—highlights the detrimental influence of hegemonic masculinity on both the occurrence and frequency of suicide among men, with a particularly significant negative impact on vulnerable men (e.g., homeless men; adolescents and young men; and men with addiction, depression, and/or other mental health issues), where the consideration of intersectionality is essential. (4) Conclusions: Men who strongly conformed to the norms and values linked to traditional masculinity were more prone to die by suicide and to report experiencing suicidal thoughts and attempts. Analyzing suicidal behavior from a gender perspective is critical for effective prevention and treatment, as gender disparities are clearly observed in both suicide fatalities and nonfatal attempts. Full article

Introduction: The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines depression as a persistent period of sadness or a reduced interest in everyday activities lasting at least two weeks. Anhedonia, a key symptom of depression, is notable for its significance and is regarded as the second most important factor related to non-somatic issues, following closely behind a depressed mood. This study primarily investigates how excessive or problematic use of Internet-connected devices affects the mood and emotions of young people, with a specific emphasis on anhedonia. Additionally, it explores associated socio-behavioral changes and examines the interaction between IA and depression. Methods: This systematic review was conducted following PRISMA international guidelines. Searches were performed in PubMed, Cochrane Library (Clinical Trials section), Scopus, Embase, PsycInfo, and grey literature sources like Google Scholar. A predefined search strategy using Boolean operators was employed, and two researchers independently selected papers, with a third researcher resolving any discrepancies. Manual reviews were conducted to minimize selection bias. Results: Out of 3812 records, 7 studies were included. The findings suggest that social anhedonia correlates with higher levels of IA, particularly among adolescents and young adults. In some studies, loneliness was identified as a mediator between social anhedonia and social functioning, indicating a complex interplay of emotional factors. Other investigations revealed that increased screen time is associated with a heightened risk of developing addiction-related behaviors. Practical Implications and Conclusions: This review highlights the key role of anhedonia in the development of Internet addiction (IA) among young people, particularly through its impact on emotional regulation and social interactions. Addressing psychological and environmental factors is essential for developing targeted strategies to prevent and manage IA and its related mental health challenges. Full article

To evaluate the expression profile of circulating miRNAs in patients with schizophrenia (hsa-miR-34a, miR-449a, miR-564, miR-432, miR-548d, miR-572, and miR-652) in relation to individual negative controls for the disease. This was an analytical, case-controlled, cross-sectional study, using samples previously collected from patients diagnosed with schizophrenia (N = 650) and a control group (N = 924). Samples were analyzed after RNA extraction and quantification. After making a general comparison between the case and control groups, regardless of gender and other variables, all seven miRNAs showed statistically significant differences (p-value < 0.05). This also occurred in the variables gender, smoking, and alcoholism. Thus, the results indicated that depending on the clinical characteristics in the face of suspected schizophrenia, the miRNAs explored here seem to work as possible biomarkers, as they demonstrated, at various times, important differences between the studied groups. Full article

There is solid evidence supporting the therapeutic effectiveness of paradoxical interventions, those in which the patient is encouraged to maintain or increase the behavior or thought that s/he wants to remove. However, their use in recent years has been scarce, and there is little detailed information on how this kind of intervention should be employed. Therefore, the main aim of this study is to elucidate the particularities of its execution through a scoping review of the scientific literature. A search in Google Scholar, PubMed, Web of Science, Scopus, PsycArticles, Psicodoc, and PsycINFO databases was performed, and 20 articles were selected that meet the inclusion and exclusion criteria. Results suggest that there is some controversy regarding when and how paradoxical interventions should be employed. However, paradoxical interventions appear to be especially indicated to treat sleep difficulties and high-reactant patients. There are also indications that paradoxical interventions could be potentially effective in the treatment of recursive anxiety. Further research is needed on the particularities of paradoxical interventions’ execution. Full article

Heightened anxiety can impair perceptual-motor performance, with detrimental effects potentially arising, in part, from threat-related attentional biases and interpretations. Shifting from a flight (i.e., threat) mindset to a fight (i.e., challenge) mindset may be an effective strategy for coping with anxiety and improving performance on perceptual-motor tasks. In this context, the present study examined how differences in fight-or-flight behavioral goals, represented by hit or avoidance actions, influence attentional control in response to threatening stimuli during heightened anxiety. Healthy adult participants performed a visual probe task, with half responding to a probe target in hit mode and the other half responding in avoidance mode. Anxiety levels were manipulated using the threat-of-shock (ToS) method, which significantly increased the participants’ anxiety. Participants with avoidance goals exhibited significantly delayed responses when avoiding a target in the presence of threat-related stimulus cues under the ToS condition. Conversely, no changes in response times were observed between the ToS and no ToS conditions in those with hit goals. These results suggest that when anxiety is heightened, avoidance goals induce attentional biases toward threat-related stimuli. In conclusion, encouraging avoidance of potential threat-related sources as an action mode may be counterproductive for coping with heightened anxiety, at least in healthy adults. The study’s principal implication for clinical practice is that adopting fight-like behavioral goals in response to threats may be an effective strategy for managing anxiety in everyday life. Full article