Frontiers in Psychiatry最新文献

Background: As a critical capacity in medical education, the trajectory of empathy development and its relationship with medical students' mental health has remained inconclusive. To address this purpose, the current study was conducted, with addressing the mediation role of rumination and interpersonal competence in this relationship.

Methods: A total of 640 medical students from Guangdong Province, China, were recruited. The levels of empathy across grades and genders were assessed. In addition, participants' interpersonal competence, rumination, and psychological distress were measured. Linear regression assessed the empathy-distress association, and parallel mediation modeling tested rumination and interpersonal competence as simultaneous mediators.

Results: In total, 523 participants were included in the final analysis (with 44% were male). Group comparisons showed that male students reported higher empathy than females (84.69 ± 9.84 vs. 82.68 ± 8.58, p = 0.016); and higher-grade students performed higher empathy (p < 0.001). Empathy was positively associated with psychological distress, more rumination thinking, and better interpersonal competence. Interpersonal competence (β = -0.01, p = 0.018) and rumination (β = 0.02, p = 0.016) significantly fully mediated the relationship between empathy and distress. Empathy was associated with increased rumination and better interpersonal competence; however, the first linked to higher distress and the latter was associated with reduced distress.

Conclusion: Empathy in medical students associates with greater psychological distress through dual pathways: heightened rumination (intrapersonal) and impaired interpersonal competence (interpersonal). The findings have highlighted the need for tailor-made empathy training programs, differentiated by gender and grade, that integrate coping strategies and interpersonal skills development.

Objective: Subjective mood assessment is a crucial element in the diagnostic and therapeutic process in psychiatry. Assessment of subjective mood is particularly important among forensic psychiatric patients. This population is characterized by specific environmental factors-isolation, limited autonomy, and stress related to legal proceedings. This situation can significantly impact patients' well-being and mood. The aim of this study is to discuss the specificity of subjective mood assessment in the forensic psychiatric patient population and the importance of this tool in everyday clinical practice.

Material and methods: The study was conducted in forensic psychiatry departments under basic security conditions using a survey method among 112 patients. The research tool included a research questionnaire with a demographic and clinical survey and the Beck Depression Inventory.

Results: The overall level of depressive symptoms among patients was relatively low. The highest symptom severity was associated with feelings of guilt, loss of interest, and pessimism. The analysis revealed a significant correlation between the length of hospitalization and the level of depression - the longer the stay, the higher the mean scores on the Beck Depression Inventory (p = 0.00001). The highest values were observed among patients hospitalized for 5 to 9 years.

Conclusions: The analysis shows that patients in forensic psychiatry wards have a low level of depressive symptoms, but their severity increases with the length of stay.

Background: After recovery from sepsis, approximately 10%-50% of patients develop long-term psychological complications such as anxiety, depression, and post-traumatic stress disorder, yet predictive indicators for these complications remain unclear. Emerging evidence suggests that thyroid function may hold prognostic value for sepsis itself. Building on this evidence, the present study aims to investigate the impact of baseline peripheral thyroid indicators on long-term psychological outcomes (within 28 weeks) in sepsis patients.

Methods: A consecutive sample of 814 sepsis patients was included. Baseline data including demographic characteristics, thyroid function indices, and peripheral inflammatory markers were collected, and psychological outcomes within 28 weeks of follow-up (i.e., anxiety, depression, and post-traumatic stress disorder) were evaluated. ROC analysis, Kaplan-Meier survival analysis, and multivariate COX regression were employed for analysis.

Results: (1) Higher levels of peripheral TT3, FT3, TT4, and FT4 at baseline were correlated with a reduced risk of poor psychological outcomes within 28 weeks. Sepsis-induced hypothyroidism was associated with an increased risk of poor psychological outcomes within 28 weeks. (2) These associations appeared to be more pronounced in elderly patients. (3) Peripheral TSH levels showed no such predictive value; similarly, "low-normal thyroid function" (defined as relatively high peripheral TSH within the normal range) also lacked predictive value. (4) A negative monotonic relationship was observed between baseline peripheral thyroid hormones and peripheral levels of tumor necrosis factor-α, interleukin-6, and interleukin-8.

Conclusion: Diminished thyroid function may be associated with relatively poor long-term psychological outcomes (within 28 weeks) in sepsis patients, possibly more so in the elderly. Given the observed association between thyroid hormones and peripheral inflammatory factors, this potential prognostic relationship may be partially mediated by inflammatory mechanisms. However, this remains a preliminary speculation and requires further validation.

Background: Autism Spectrum Disorder (ASD) presents significant developmental challenges, particularly in low-resource settings. Maternal attitudes and engagement in home-based interventions are critical for supporting children's social, attention, and language development.

Aims: To assess maternal attitudes toward children with ASD and evaluate the implementation of home-based interventions targeting social, attention, and language skills in Diwaniyah, Iraq.

Methods: A descriptive, cross-sectional study was conducted between April and August 2025, involving a census sample of 205 mothers of children with ASD from three autism centers in Diwaniyah. Data were collected through structured face-to-face interviews using a validated questionnaire. Statistical analyses were performed using SPSS version 25, with descriptive statistics and Chi-square tests applied to examine the data.

Results: The majority of mothers (79.0%) exhibited positive attitudes toward their children with ASD. Positive maternal attitudes were significantly associated with higher education, urban residence, sufficient income, attendance at educational sessions, and absence of family mental illness (p < 0.05). Home-based intervention implementation was high in most domains: 67.3% for social skills, 88.8% for attention, and 67.8% for language. A statistically significant association was found between positive maternal attitudes and the use of home-based interventions targeting social skills (P value = 0.001), but not for attention or language interventions (P values > 0.05). After adjusting for potential confounders, the results show that maternal attitudes were significantly associated only with the likelihood of using home-based interventions within the social domain (adjusted odds ratio = 1.021; 95% CI: 0.208-5.010; p = 0.001).

Conclusion: Maternal attitudes significantly influence the implementation of home-based social skill interventions in children with ASD. Strengthening caregiver training and psychosocial support, particularly in underserved areas, is essential to enhance home-based developmental outcomes in low-resource contexts like Diwaniyah.

There is a tight correlation between depression, and tumor progression, particularly via the regulation of the immune system, and inflammatory responses. Chronic inflammation is a member of the core causes in the tumor microenvironment, which can promote tumor initiation, progression, and immune evasion. An increasing body of literature has reported that aerobic exercise (AE), as a non-pharmacological intervention, can display potential in anti-tumor therapy by modulating the immune system, delaying chronic inflammation, and increasing neurotransmitter balance. However, it is worth noting that extreme AE may cause negative influences, such as immunosuppression, which influences its anti-tumor efficacy. Our review aims to investigate how depression influences the inflammatory progression of tumor cells via immune regulation, and the potential regulatory processes of AE in this mechanism. Moreover, we further explore the potential of AE in tumor treatment, and delves into its potential deleterious impacts. via this literature review, together with perspectives from molecular, and cellular biology, notably, our review explores the influences of depression, and AE on the tumor microenvironment, and immune responses. It centers on the contribution of AE in modulating immune cell functions, delaying chronic inflammatory responses, and increasing neurotransmitter balance. Depression promotes inflammatory responses in the tumor microenvironment via neurotransmitter imbalance, abnormal activation of the hypothalamic-pituitary-adrenal axis, and immune system dysregulation, hence triggering tumor growth, and metastasis. AE can positively modulate the immune system, decrease inflammation, as well as improve tumor immune surveillance function. Moderate AE modulates immune responses in the tumor microenvironment in the context of enhancing the activity of immune cells, lowering the levels of pro-inflammatory factors, and improving the production of anti-inflammatory factors, hence blocking the growth, and spread of tumor cells. However, extreme AE may cause immunosuppression, influencing anti-tumor influences, so individualized changes to the intensity, and frequency of exercise interventions are needed.

Introduction: Screen time has become increasingly prevalent in modern life and may influence various health outcomes, including sleep patterns. Previous meta-analyses examining the relationship between screen time and sleep have been limited by incomplete population coverage and insufficient consideration of potential effect modifiers. To address these gaps, we conducted a comprehensive meta-analysis to investigate the association between screen time and sleep outcomes across diverse populations.

Methods: Two independent reviewers screened studies and extracted data following a pre-registered protocol. Standardized coefficients (β) and odds ratios (OR) were used to quantify effect sizes. Random-effects meta-analyses were conducted using STATA 17.0, with subgroup analyses performed to explore effect modifiers.

Results: We included 21 cohort studies with 548,338 participants. Each additional hour of daily screen time was associated with approximately 3 to 5 minutes shorter total sleep duration (β = -0.05, 95% CI: -0.08 to -0.03) in 11 studies reporting continuous outcomes, and with a higher risk of short sleep in nine studies reporting binary outcomes (OR = 1.25, 95% CI, 1.08 to 1.40). Subgroup analyses found no significant effect modification by age, region, short sleep definition or follow-up duration (all P _interaction > 0.05). However, for binary outcomes, the association between screen time and short sleep differed significantly across countries (P _interaction = 0.004). For other sleep outcomes, longer screen time was associated with increased risk of insomnia symptoms (β = 0.41, 95% CI, 0.18 to 0.63), delayed bedtime (13.2 minutes delay per hour of screen time), and difficulty initiating sleep (OR = 3.05; 95%CI: 1.51 to 6.24).

Conclusion: This systematic review demonstrates a robust association between increased screen time and adverse sleep outcomes, with adolescents showing particular vulnerability. These findings underscore the importance of screen time management in sleep health promotion and suggest the need for age-specific interventions. Future research should focus on establishing causal relationships and developing evidence-based guidelines for optimal screen use across different age groups.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42023476130.

Systematic review registration: Substance use is a risk factor for relapse in violent crime. In forensic psychiatric care (FPC), severe mental disorder and comorbid substance use is common, with a majority having a history of substance use disorder (SUD) and many having committed their index crime while under influence. FPC is dedicated to treating these patients to reduce the risk of criminal recidivism. Though interventions for SUD are used, none of them have been developed to meet the needs of the FPC patient group specifically.

Aim: To identify and evaluate controlled interventions that primarily or secondarily reduce the risk of relapse into substance use and/or feelings of drug craving among FPC patients.

Methods: A systematic review was conducted, spanning 10 years (2014-2024). The PRISMA 2020 guidelines were followed. A PICO framework, and specified inclusion and exclusion criteria, guided the process. In collaboration with an experienced medical librarian a search strategy was developed and searches were conducted in MEDLINE, Embase, and PsycInfo. Blinded screening and article selection through consensus voting was performed collaboratively by two of the authors, as was the full-text reviews. Quality assessment was conducted using the CASP checklist for controlled studies. The results were synthesized using vote counting to determine the direction of effect across studies, following the SWiM reporting criteria.

Results: The searches identified 1275 articles. After deduplication, 750 articles remained. Following screening, 9 articles were assessed in full, of these, 4 were excluded for reporting irrelevant outcomes and 3 for lacking a control group. Finally, 2 controlled trials - both RCTs - were included. Overall quality was adequate with some concerns for bias. No conclusive evidence of a treatment effect on SUD measurements was reported.

Conclusion: This systematic review suggests there is a lack of research aimed at the study of SUD interventions within FPC. Analysis of included articles found no conclusive evidence of effective treatments, but there seems to be an indication of a beneficial effect on drug use in one study, a treatment that addresses impulsivity. Further high-quality studies better tailored to FPC are needed to evaluate SUD treatment outcome among FPC patients.

Background: The study aims to elucidate the influence of multiple psychosocial determinants on suicidal ideation in late-life depression and to uncover their underlying network of interactions.

Methods: This study analyzed patients with depressive disorders. A total of 2,052 patients were included, comprising 1,296 adult group and 756 older adults group. Clinical assessments were conducted using HAMD-17, HAMA, SCL-90, PSQI and NGASR. Data analysis and visualization were performed using R software. The network structure among psychological variables was assessed, and the variable nodes that play a key role in the network were identified. Independent network modeling was conducted separately for the adult group and older adults group, so as to further examine the properties and differences of the network structure between two groups.

Results: Depression emerged as the strongest predictor of suicidal ideation in adults, showing the highest degree of association. Anxiety demonstrated a dual role. Among older adults, the coupling between variables was stronger, particularly the combined effects of depression and sleep disturbances. The PSQI node exhibited more pronounced bridging properties in the older adults group, serving as the most significant mediator across the two network structures. The anxiety-depression pathway displayed greater connectivity in the older adults group, with anxiety exerting a stronger indirect effect on suicidal ideation.

Conclusions: Depression is a key predictor of suicidal ideation, while anxiety exerts a dual influence. Suicidal ideation among older adults appears to be more strongly shaped by multiple factors, with particular emphasis on the combined effects of depression and sleep disturbances.

Introduction: Perinatal bereavement can profoundly disrupt maternal identity and is often accompanied by longer-term emotional suffering. Whilst immediate grief responses have been studied, less is known about how this experience evolves over time. This meta-ethnography aimed to synthesize qualitative evidence on the long-term experiences and repercussions of perinatal grief in women after a pregnancy loss.

Methods: A systematic review of six databases was conducted. Primary qualitative studies were included if they addressed experiences occurring at least one year after a perinatal bereavement. A total of 2,253 records were screened, and 18 studies met the inclusion criteria. Data quality was assessed, and the data were subjected to an analytic synthesis using meta-ethnography.

Results: Three themes and six sub-themes were identified, revealing perinatal grief as a prolonged and transformative experience. Women reported emotional pain, identity disruption, and social silencing. In contrast, empathic care, sustained support, and social validation helped them reconstruct their identities. In line with meta-ethnographic approaches, a theory was developed: "The quietest of births cause the loudest anguish: Whilst some bereaved mothers walk a solitary path, those with broader support networks are more empowered, but both experience an intense change to The Self.".

Discussion: These findings show grief is shaped not only by the loss itself but also by how it is acknowledged or silenced by healthcare systems and society. Gaps were identified regarding long-term grief during times of health system uncertainty and in cases of fetal malformation, revealing the need for further research and policy development.

Conclusion: Supportive and continuous care between lost and future pregnancies is essential to alleviate suffering and promote identity reconstruction among bereaved mothers facing long-term perinatal grief.