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Background: Research has revealed associations between microbes of the gastrointestinal tract and stress, anxiety and depression in pregnant or postpartum women. While these studies suggest a gut-brain-behaviour axis, no studies have examined microbes of the oral cavity in relation to maternal mental health., Objective: To explore a potential oral-brain-behaviour axis related to maternal mental health., Methods: Microbes were measured in saliva obtained from 224 second-trimester (mean±SD = 17±2 weeks) women oversampled for stress. Oralome data were associated with women's recent or cumulative pregnancy stress, trait and state anxiety, depression symptoms and post-traumatic stress disorder (PTSD) symptoms. Covariates explored included age, income, alcohol and tobacco use, dental issues and physical health problems., Results: Pregnant women in the high trait anxiety or depression symptom groups had higher oral alpha diversity, indicating higher richness of species within samples. Groups with high and low PTSD symptoms differed in beta diversity, reflecting differences in community composition. Linear discriminant analysis showed differently abundant microbes in women with high stress versus low life stress, anxiety, depression, and PTSD, with the affected microbes mostly differing by symptom. Notably, members of phylum Proteobacteria were more abundant in women with high recent life stress and Spirochaetes was more abundant in women with high depression symptoms. Members of phylum Firmicutes were more abundant in the high trait anxiety and high depression groups. Genus Dialister (previously found to be lower in the gut of depressed non-pregnant people) was higher in women experiencing either high trait or state anxiety, or experiencing high depression symptoms, while genus Eikenella was elevated with high trait anxiety, depression or PTSD., Conclusions: The oral microbiome is associated with stress and mental health in pregnant women, in ways different from the gut microbiome or what has been found in non-pregnant people., Clinical Implications: Understanding oral microbiome-mental health relations may reveal future microbial targets to improve maternal psychological well-being., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. Published by BMJ.)

Background: Multiple sclerosis (MS) is a chronic, inflammatory, and demyelinating disease of the central nervous system. The first presentation's possible triggers are still controversial among scientists. The objective of this study is to investigate and compare the potential social, environmental, and physical factors that may have contributed to the onset of MS before and during the Coronavirus Disease 2019 (COVID-19) pandemic., Methods: A questionnaire was designed in the MS research center of Sina Hospital and also distributed as an online Google Form on social media among Iranian MS patients. Demographic information, MS disease-related data, and possible patients reported MS triggers were recorded. They were containing stressful life events, COVID-19 and other infections, COVID-19 and other vaccines, pregnancy or labor, head trauma, surgery, and weight loss. Patients were divided into two groups regarding the time of MS diagnosis (before and during the COVID-19 pandemic)., Results: Of 920 participants, 670 (72.8%) were female, and the mean age ± SD was 35.63 ± 8.1. The majority of patients (69.2%) had non-progressive forms of MS, and only 7.6% needed assistance for ambulation. 69% of participants were diagnosed with MS before the onset of the COVID-19 pandemic. There was a statistically significant difference between the most common first MS symptom before and after the beginning of the pandemic (visual type (n: 317 (49.9%)) before and sensory type (n: 170 (59.6%)) after the COVID-19 pandemic). A stressful life event was the most common patient-reported trigger of MS first presentation in both groups. (56.1% before and 54% after the COVID-19 pandemic). Comparing two groups, economic problems (AOR: 1.81; 95% ACI: 1.23-2.65) and job losses (AOR: 2.89; 95% ACI: 1.37-6.08) were significantly more common triggers for the initial presentation of MS after the pandemic, while the stress of occupational or educational exams (AOR: 0.52; 95% ACI: 0.34-0.79) was more prevalent before the pandemic., Conclusion: Patients believe that stressful life events are closely linked to triggering their first MS symptoms. Since the beginning of the COVID-19 pandemic, economic problems and job losses have increased; however, occupational or educational exams stress decreased. Caring for social stress by societies may affect MS development or delay MS onset., Competing Interests: Declarations Ethics approval and consent to participate Informed consent was obtained from all participants. This study is approved by the Tehran University of Medical Sciences Ethical Committee with the ethical code IR.TUMS.MEDICINE.REC.1399.728. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Ethiopian migrants to the Middle East and South Africa are exposed to dangerous traveling and working conditions and their experiences are mostly tragic. They are unwelcomed not only by the situation in the destination but also by the community at home which is an important indicator of stigma and discrimination. However, there is lack of evidence on how psychological distress is associated with migration experiences, stigma and coping strategies. Therefore, it was aimed to determine the mediating effect of psychological distress in the association between migration experiences and stigma and discrimination and coping strategies., Methods: A total of 739 Ethiopian migrant returnees from the Middle East and South Africa were included in the study. A cross-sectional study was conducted in five migration hotspot areas in Ethiopia, namely Addis Ababa, Dessie, Shashemene, Hossana, and Gondar. Data related to socio-demographic, economic, migration experiences, psychological distress, coping strategies, and stigma and discrimination were collected. Psychological distress was measured using the 21- item version of the Depression, Anxiety and Stress Scale and coping strategies were measured with the Brief-COPE. Structural equation modeling was employed to estimate the relationship among variables., Results: About 395 (57.33%) of the participants reported symptoms of depression, 428 (59.86%) anxiety symptoms, and 313 (45.21%) stress symptoms. The mediated association between physical violence and coping strategy through psychological distress was 0.29 (adjusted β = 0.29, 95%CI: 0.15, 0.44). Denial of salary had positive direct (adjusted β = 1.00, 95%CI: 0.50, 1.50) and mediated (adjusted β = 1.20, 95%CI: 0.71, 1.68) associations with stigma and discrimination through psychological distress. Restricted freedom had positive mediated (adjusted β = 0.39, 95%CI: 0.13, 0.65) and total (adjusted β = 0.94, 95%CI: 0.59, 1.29) associations with stigma and discrimination through psychological distress., Conclusion: Depression, anxiety, and stress symptoms are common among migrant returnees. Religious practice is the most commonly used coping mechanism. Psychological distress has positive mediating association with the relationships between denial of salary by employers and stigma and discrimination, physical violence and coping strategy, and restricted freedom and stigma and discrimination. Psychological interventions to deal with the psychological distress and stigma and discrimination of migrant returnees and to encourage the practice of positive coping strategies are warranted., (© 2024. The Author(s).)

Objective: To investigate the characteristics of adolescents' school adjustment and their associations with anxiety, depression, and stress, respectively, as well as their differences by gender., Methods: A convenience sampling method was used to measure 3,922 secondary school students from 10 secondary schools in five locations in the Xinjiang Uygur Autonomous Region using the Anxiety-Depression-Stress Scale and the School Adjustment Scale, and latent profile analysis was used to identify the subjects' school adjustment categories, and network analysis was subsequently used to explore the relationship between different school adjustment categories and anxiety, depression, and stress, respectively, as well as their gender characteristics., Results: In the symptom network of adolescents at risk for school maladjustment, "school emotions and attitudes" was the core symptom (Expected Impact Index: 0.86); in the co-morbidity network of school adjustment and anxiety, depression, and stress in adolescents at risk for school maladjustment, the core symptom was "uneasiness" (Expected Impact Index: 0.86); and "stress" (Expected Impact Index: 0.86) was the core symptom. "(EI: 1.12), "difficulty relaxing" (EI: 1.14) in males, and "depression" (EI: 1.06) in females, all with significant gender differences. Significant gender differences were found., Conclusion: Adolescents' school adjustment was strongly associated with symptoms of anxiety, depression and stress, with significant gender differences in the structure of the network of co-morbid symptoms., Competing Interests: Declarations Human ethics and consent to participate Informed consent was obtained from the parent or legal guardian of each participant under 16 years of age. And in accordance with the principles of the Declaration of Helsinki, this study was approved by the Ethics Committee of Xinjiang Medical University (approval number: XJYKDXR20240724003). Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Given the increasing global concerns about aggressive behaviors and the pressing need for effective psychological interventions, this study delves into the potential of a concept deeply rooted in positive and Buddhist psychology but largely researched in Western contexts, as a mitigating factor against aggression in Chinese adults. Through three core studies involving 652 participants (age: 30.52±8.16), our research illuminated the intricate relationship between self-compassion, perceived stress, and aggression. Study 1 identified a negative correlation among these variables, setting the empirical foundation. In Study 2, participants exposed to a self-compassion exercise reported enhanced self-compassion and reduced aggression. Study 3 further consolidated these findings, with participants in the self-compassion writing group, showing notable increases in self-compassion and decreases in aggression compared to a control group. Critically, perceived stress emerged as a significant mediator between self-compassion and aggression, elucidating its central role in this dynamic. Together, our findings underscore the promise of self-compassion as a strategy to curb aggression tendencies, especially in light of its influential relationship with perceived stress, suggesting vital implications for future mental health interventions., Competing Interests: Declarations Ethics approval and consent to participate All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (the Research Ethics Committee of the Department of Psychology at Tsinghua University (Date: 12/03/2023/No.:IRB202306) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all participants for being included in the study. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Previous studies had found the effects of stress on eating behaviors. The aim of this study was to explore the effects of perceived stress on dietary quality by sexes in Chinese adults., Methods: The study population consisted of individuals aged 18 to 59 years participating in the China Health and Nutrition Survey. Perceived stress levels were measured using the 10-item Perceived Stress Scale (PSS-10), with scores ranging from 0 to 40. Dietary quality was evaluated by Chinese Dietary Guidelines Index (CDGI) ranging 0-110. Using a two-level mixed effects model with community as level 2 and individual as level 1, the study analyzed the impact of PSS-10 scores on CDGI. Additionally, a two-level mixed effects structural equation model was employed to explore the effects of distress factor scores and coping stressor factor scores on dietary quality among different sexes within the population., Results: This study involved in 2515 males and 3165 females, and the average age was 45.9 ± 9.6.The PSS-10 score and CDGI were 14.6 ± 5.1 and 44.8 ± 11.6, separately. After adjusting for confounders, there were no effects of PSS-10 score, distress factor score, and coping stressors factor score on CDGI in males. After adjusting for confounders, CDGI in the highest tertile of PSS-10 score group was 1.64 lower than that in the lowest tertile group in females(P = 0.001). The distress factor score was not associated with CDGI (standardized β=-0.164, P = 0.488), while the coping with stressors factor score was significantly negative with CDGI (standardized β=-0.834, P < 0.001) in females. CDGI in the highest tertile of coping with stressors factor score group was 4.36 lower than that in the lowest tertile group (P < 0.0001)., Conclusions: There was no association between perceived stress and dietary quality in adult males. The perceived stress, especially the insufficient capacity to cope with stressors, was negatively associated with dietary quality in adult females., Competing Interests: Declarations Ethics approval and consent to participate The institutional review board of the National Institute for Nutrition and Health of Chinese Center for Disease Control and Prevention approved the study protocol (ethics approval code 2018-004). All the participants signed the informed consents. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background and Purpose: This study aimed to develop and test a novel model integrating social-learning and self-medication frameworks by examining the association between self-efficacy to resist alcohol and other drug (AOD) use and daily AOD use and unhealthy drinking risk among trauma-exposed sexual minority women (SMW) and transgender and gender-diverse (TGD) people. We examined whether minority stressors moderated these associations., Methods: Data were from 57 trauma-exposed SMW and TGD people who participated in a 14-day daily diary study. Multilevel binary logistic models and ordinal logistic models were employed to examine associations between self-efficacy to resist AOD use and daily AOD use and unhealthy drinking risk at within- and between-person levels. We assessed same- and cross-level interactions between daily self-efficacy to resist AOD use and minority stressors in predicting AOD use and unhealthy drinking risk within the same 24-hour period (i.e., standardized as 6 pm to 6 pm; hereafter referred to as "same-day")., Results: Self-efficacy to resist AOD use was associated with lower AOD use and unhealthy drinking risk. Minority stressors were associated with daily AOD use. Among those who experienced higher (vs. lower) average sexual minority stressors over the 2-week daily diary period, higher-than-usual self-efficacy to resist AOD use was less protective in decreasing risk of same-day unhealthy drinking., Conclusions: Interventions aiming to mitigate AOD use and unhealthy drinking risk by bolstering self-efficacy to resist AOD use should consider the impact of recent cumulative exposure to sexual minority stressors in this population. Further, policy efforts are needed to reduce perpetuation of stigma., (© Society of Behavioral Medicine 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Objectives: To investigate the relationships between life events and psychological distress in the postepidemic era as well as the effects of fear of COVID-19 (FCV-19) and impermanence on these relationships to enrich the study of the underlying psychological mechanisms of postepidemic psychological distress and to provide a theoretical basis for scientific prevention and intervention in individuals with psychological distress., Methods: A survey of 504 adults (71.3% female; age M = 26.87, SD = 10.70) was conducted via the Social Readjustment Rating Scale, the FCV-19 Scale, the Impermanence Scale, the Anxiety Scale and the Depression Scale, and a structural equation model was established to explore the relationships between variables., Results: The present study revealed the following: (1) there is a significant positive correlation between life events and psychological distress; (2) FCV-19 completely mediates the relationship between life events and psychological distress; and (3) impermanence moderates the mediation, regulating the path by which life events affect FCV-19 and the path by which FCV-19 affects psychological distress., Conclusions: In the postepidemic era, impermanence can effectively mitigate the impact of life events on FCV-19 and the impact of FCV-19 on psychological distress., Competing Interests: Declarations Ethics approval and consent to participate The study was performed in line with the ethical standards set out in the 1964 Declaration of Helsinki and its later amendments. The Ethics Committee of the Third Affiliated Hospital of Chongqing Medical University reviewed and approved all procedures used in this study on April 9, 2021. Informed consent was obtained from all participants. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Objective: To assess the parental stress, coping mechanism and quality of life of caregivers of children with Differences of Sex Development (DSD)., Methods: Mothers of children (6 months - 12 years) with DSD were enrolled after excluding mothers of children with syndromic diagnosis, developmental delay, cognitive impairments, chronic diseases, or if the duration of DSD diagnosis was less than six months, and mothers with psychiatric illnesses (n = 35). Mothers of age and gender-matched children with congenital hypothyroidism served as controls (n = 35). Psychological assessments were performed using structured questionnaires: the Parent Stress Scale, PRIME MD PHQ-9 Scale, and Ways of Coping Questionnaire., Results: Mothers of children with DSD exhibited significantly higher mean (SD) stress levels [24.34 (4.25) vs 19.57 (1.89); P < 0.001]. Prevalence of depression prevalence was higher in mothers in the DSD group than in the hypothyroidism group (71% vs 42.9%, P < 0.001). Mothers of children with DSD also had poorer quality of life, and both high negative coping behavior and low positive coping behavior (P < 0.001) compared to controls, and stigma related to social exclusion was more pronounced., Conclusion: Beyond medical interventions, addressing family members' psychological well-being is essential in effectively managing DSD in the Indian context.

Objective: To examine associations between depression, anxiety, and stress, as measured by the Depression, Anxiety and Stress Scale (DASS-21) scale, with current e-cigarette use., Methods: Data from the Truth Longitudinal Cohort - a nationally representative sample of youth and young adults - was collected between October 2022 to February 2023. The analytic sample was comprised of participants who provided information on e-cigarette use and the DASS-21 scale (N = 4198). Chi-square statistics were used to determine differences by current e-cigarette use across covariates and DASS-21 items. Logistic regression analyses were applied to the cross-sectional data to determine which scales predicted current e-cigarette use, adjusted for the effects of age, gender identity, race and ethnicity, parental educational attainment, perceived financial situation, and current use of alcohol, marijuana, and other tobacco use., Results: Those who had severe/extremely severe levels of depression, anxiety, and stress had greater odds of current e-cigarette use, relative to those who had normal levels of depression, anxiety, and stress, even after adjusting for covariates. Results also demonstrated associations between age, race/ethnicity, parental education, and current use of alcohol, marijuana, and other tobacco products with current e-cigarette use., Limitations: Cross-sectional analyses of self-reported data limit the ability to determine directionality of effects between depression, anxiety, stress, and current e-cigarette use., Discussion: More severe levels of depression, anxiety, and stress were associated with a greater likelihood of current e-cigarette use. Future research is needed to evaluate changes in e-cigarette use, in response to depression, anxiety, and stress symptomatology., Competing Interests: Declaration of competing interest The authors report no competing interests., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Transgender and non-binary (TNB) individuals are at greater risk of mental health concerns relative to their cisgender peers due to experiences of minority stress. Thus, it is critically important to identify factors that may be protective and buffer the effects of minority stress. This study examined whether romantic relationship involvement and quality buffered effects of TNB minority stress on depressive symptoms and suicidal ideation., Methods: A large international sample (n = 1156) of TNB adults (n = 654 partnered; n = 502 single) reported on minority stress experiences, relationship status and quality, and mental health outcomes (i.e., depressive symptoms and suicidal ideation)., Results: The effects of victimization and rejection on depressive symptoms and suicidal ideation were attenuated among partnered individuals. However, once relationship quality was considered, the buffering effects of relationship involvement applied only to those in more satisfying relationships; the stress-buffering effects were not observed among those in distressed relationships. Of particular importance, general interpersonal satisfaction did not act as a minority stress buffer, suggesting there may be unique stress-buffering effects of being in a satisfying romantic relationship on depressive symptoms and suicidal ideation., Limitations: The cross-sectional nature of the current study precludes definitive conclusions regarding causation., Conclusions: These findings suggest that romantic involvement may serve a stress-buffering role for TNB adults, but only when these relationships are satisfying. Our results have important theoretical and clinical implications, and further research is needed to investigate the utility of relationship interventions to buffer the effects of TNB minority stress on depressive symptoms and suicidality., Competing Interests: Declaration of competing interest All authors declare that they have no conflicts of interest., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Objective: This study aimed to examine acute and chronic stressors, and perceived lack social support, and their associations with depression and suicidal ideation in adolescents during the COVID-19 pandemic., Methods: Deidentified data from (N = 270,153) U.S. adolescents aged 11 to 17 who completed the Patient Health Questionnaire 9-item tool (PHQ-9) in the years 2020 and 2021 were sourced from a collection of online screening tools that are free, confidential, anonymous, and scientifically validated. In addition to depression, the survey included questions about suicidality, past/chronic stressful events, and contributors to mental health problems and sociodemographic variables. SPSS software version 28 for descriptive analyses, and Mplus version 7.31 for confirmatory factor analysis (CFA) and structural equation modeling (SEM), were respectively used., Results: Participants were predominantly female, White, and heterosexual, and exhibited a high prevalence of severe depression and a significant frequency of suicidal thoughts. Significant associations were found between past/chronic stressful events, and lack of social support, with suicidality and depression. Mental health stress due to the COVID-19 pandemic itself presented no significant associations with depression and suicidality and was weakly and negatively associated with lack of social support and past/chronic stressors., Discussion: These findings reinforce the notion that prior traumatic events can create vulnerabilities in the face of acute stressors, while social support can enhance resilience in adolescents. Factors that increase resilience, such as preventing traumatic events, reducing social stressors, and increasing social support, can serve as valuable guidelines for clinical and public health interventions., Competing Interests: Declaration of competing interest Dr. Vidal receives funding from the NIDA/AACAP Physician Scientist Training Program in Substance Abuse Research, supported by NIDA Career Development Award (K12)., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Transgender women have a high prevalence of suicidal ideation, with stress and low interpersonal needs as its main risk factors. This study aimed to investigate the mediating role of interpersonal needs on the relationship between perceived stress and suicidal ideation among transgender women in China., Methods: A cross-sectional study was conducted in Shenyang and Kunming from April to September 2018. 247 transgender women were recruited. Sociodemographic statistics, perceived stress, interpersonal needs and suicidal ideation were obtained. Correlation analysis and mediation analysis were performed to test the relationship among perceived stress, suicidal ideation and interpersonal needs., Results: 14.6 % of the participants reported suicidal ideation within a year. Perceived stress was positively correlated with suicidal ideation (r = 0.228, p < 0.001), interpersonal needs and its three dimensions (r = 0.300-0.583, ps < 0.001)-thwarted belongingness, perceived burdensomeness and social exclusion. Interpersonal needs and its three dimensions were also positively correlated with suicidal ideation (r = 0.148-0.299, ps < 0.05). Interpersonal needs, perceived burdensomeness and social exclusion partly mediated the relationship between perceived stress and suicidal ideation, while thwarted belongingness didn't play a mediating role., Limitations: Cross-sectional study limited confirmation of causality between variables. The investigation didn't aim at the specific stressors of sexual minorities. And that participants came from only two regions might affect the generalization of the results., Conclusions: We found a partial mediating role of interpersonal needs between stress and suicidal ideation. Stress reduction and increased social inclusion are needed to reduce suicidal ideation in transgender women., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2024. Published by Elsevier B.V.)

Purpose: Depressive symptoms during the perinatal period have broad and enduring health implications for birthing parents and their offspring. Rising prevalence rates of perinatal depression highlight the need for research examining factors influencing depressive symptoms during pregnancy, and trajectories during the early postnatal period. Grounded in bioecological systems theory, this longitudinal multimethod study examined whether prenatal bioecological factors predict depressive symptoms from pregnancy to 36 months postpartum., Methods: Participants were 162 pregnant individuals, oversampled for high emotion dysregulation, who completed a life stress interview and physiological assessment during the 3rd trimester and a self-report measure of depression at five time-points (3rd trimester, within 48 h of birth, 7, 18, and 36 months postpartum). Multilevel models were used to test study aims., Results: Participants exhibited the highest levels of depressive symptoms at 3rd trimester, and substantial variability in depressive symptom trajectories over time. Lower resting respiratory sinus arrhythmia (RSA), an index of parasympathetic nervous system functioning, in the 3rd trimester was associated with higher concurrent depressive symptoms. Higher levels of stress related to partner relationships, finances, and health were concurrently associated with more depressive symptoms during pregnancy and decreases in depressive symptoms over time. Specifically, depressive symptoms decreased only for individuals who reported high levels of stress during pregnancy., Limitations: Although grounded in bioecological systems theory, this study did not assess the macrosystem., Conclusions: Results of this study underscore the importance of multilevel predictors of perinatal health and highlights potential targets for preventing depression and promoting well-being during the perinatal transition., Competing Interests: Declaration of competing interest The authors declare they have no conflicts of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Distress related to systemic racism in the public service and healthcare systems is linked to adverse mental health sequelae in racial and ethnic minority populations. Emerging research has found that distress related to racism may impact military veterans, an increasingly racially and ethnically diverse segment of the US population who are at increased risk of mental health problems relative to non-veterans. To date, however, no known study has examined longitudinal trends in distress related to systemic racism in this population., Methods: A nationally representative sample of 2361 US military veterans completed a baseline assessment in 2020 and a 2-year follow-up in 2022. A multinomial logistic regression analysis was conducted to examine longitudinal courses and baseline predictors of systemic racism-related distress., Results: Relative to the veterans with no racism-related distress, those who reported racism-related distress across the 2-year study period were older, more likely to be female, Black, or Hispanic, and to have completed college or higher education, and reported more lifetime traumas and stressors. Nearly 4-of-5 of Black veterans endorsed distress related to systemic racism over the 2-year study period., Limitations: Use of self-report and abbreviated measures of distress related to systemic racism., Conclusions: Results suggest that distress related to systemic racism may pose a significant emotional burden on subgroups of US veterans. They further underscore the importance of training clinicians to provide culturally-informed assessments and treatments for Black and other racial and ethnic minority veterans who bear the weight of racial discrimination., Competing Interests: Declaration of competing interest None., (Published by Elsevier B.V.)

Background: Suicide is a leading cause of death globally and a serious public health concern. Childhood trauma has been found to be associated with adult suicide vulnerability. Recent research has turned attention to investigating the role of attachment in the context of the childhood trauma-adult suicide relationship. The current study investigated for the first time whether attachment influences and moderates the childhood trauma-suicidality relationship, using a daily diary design, in the general population., Methods: 481 participants completed questionnaires assessing experiences of childhood trauma, attachment patterns, and history of suicidality. 243 participants continued to a daily diary phase where measures of daily stress, defeat and entrapment were completed for 7 consecutive days., Results: Higher levels of childhood trauma were associated with a history of suicide ideation and attempt and also higher levels of daily defeat, entrapment and stress during the 7 day study. Similarly, higher levels of attachment anxiety and avoidance were associated with a history of suicide ideation and attempt together with higher levels of daily defeat, entrapment and stress. However, the effects of childhood trauma on suicide history and on daily suicide vulnerability factors were not moderated by attachment anxiety or avoidance., Limitations: The measure of childhood trauma was a retrospective self-report tool that may be influenced by memory biases., Conclusions: Childhood trauma and insecure attachment are implicated in adult suicide risk. Interventions aimed at mitigating the negative effects of childhood trauma and insecure attachment should also incorporate components that target modifiable risk factors such as defeat, entrapment and stress., Competing Interests: Declaration of competing interest The authors have no conflict of interests to declare., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: The literature on the trajectories of NSSI behavior during the pandemic is scarce and mainly short-term. Furthermore, studies have not explored the buffering mechanisms that may have altered risk trajectories during this vulnerable period. This study aims to analyze the univariate change of NSSI during adolescence and to examine the alteration of the univariate growth due to the time-varying effect of COVID-19-related stress, parenting dimensions (i.e., positive and negative parenting), and their interaction., Methods: Participants included 830 Italian adolescents (44.2 % females; M age  = 14.52; SD = 0.80), who participated in at least one time point of data collection, from a three-wave longitudinal study (T1: from December 2019 to January 2020; T2: December 2020; T3: December 2021)., Results: The Latent Growth Curve Analyses show a linear increase in NSSI over time. In regards to time-varying, at T1, the results highlight that higher levels of negative parenting are associated with higher levels of NSSI at the same time point. Instead, at T2, results show that pandemic stress is associated with higher levels of NSSI at T2. Regarding the interaction effect, positive parenting significantly buffered the effect of COVID-19 stress on NSSI at both T2 and T3., Limitations: Only some dimensions of parenting style (i.e., positive and negative parenting) are included., Conclusions: This study attempts to deepen the trajectory of NSSI behavior during the two years of the pandemic and examine the changes caused by the time-varying effects, thus providing suggestions for designing programs to prevent engagement in NSSI., Competing Interests: Declaration of competing interest The authors declare that there are no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: This study aims to validate a hypothesized model of the relationships between optimism, resilience, coping, parenting stress, perceived social support, and anxiety, as well as their influencing factors and consequences among caregivers of children diagnosed with cleft lip and/or palate (CL/P)., Methods: A hypothesized model was proposed based on diathesis-stress theoretical model and existing literature. A convenience sample of two CL/P treatment centers in China was collected between April 2019 and July 2020. Various well-validated instruments were used to collect 248 valid data points. Descriptive statistics and correlations were computed to assess model fitness and path analysis was performed to investigate direct and indirect effects., Results: The results revealed that the average level of anxiety among caregivers of children suffering from CL/P was 3.00 (0.00,6.00). The fitness of the modified path model was evaluated using various measures, including χ2/df = 1.806, GFI = 0.989, RFI = 0.916, IFI = 0.990, CFI = 0.989, TLI = 0.960, RMSEA = 0.0570. Parenting stress had the greatest direct associated with anxiety, followed by perceived social support. Moreover, indirect relations to anxiety were observed for optimism, resilience, and coping, which were mediated through perceived social support and parenting stress., Conclusion: In summary, this work suggests that both parenting stress and perceived social support in caregivers of children suffering from CL/P are associated with anxiety. Therefore, developing effective intervention approaches targeting key factors might potentially instrumental to alleviate anxiety., Competing Interests: Declarations Ethics approval and consent to participate The Ethical Committee of China Medical University granted ethical approval to this study (No.2018–27). The completion of this study was voluntary and implied consent was communicated to all participants. They were also well informed about their right to withdraw from the study. Participants’ anonymity was maintained throughout the study. Participants provided their informed consent prior to responding to the survey questions. All methods were carried out in accordance with relevant guidelines and regulations. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Recent research indicates that paranormal belief, in the absence of allied cognitive-perceptual and psychopathology-related factors, is not associated with negative wellbeing outcomes. However, investigators have historically reported relationships between specific facets of belief (e.g., superstition) and stress vulnerability. These typically derive from the Revised Paranormal Belief Scale (RPBS), which has questionable psychometric integrity. The main issue being that several RPBS items perform poorly. Noting this, the present paper re-examined the relationship between paranormal belief and stress using the Rasch purified version of the RPBS. This comprises two dimensions, called Traditional Paranormal Belief (TPB) and New Age Philosophy (NAP). These are operationalised in terms of function. Specifically, whether belief provides a sense of control at the social (TPB) or individual level (NAP). Accordingly, this study examined whether TPB and NAP were differentially predictive of levels of perceived stress. In this context, stress served as an indicator of well-being. A sample of 3084 participants (Mage = 50.31, SD = 15.20, range 18-91) completed the RPBS alongside the 10-item Perceived Stress Scale (PSS-10). Confirmatory factor analysis and structural equation modelling revealed that TPB was significantly predictive of higher Distress, and lower Coping. NAP was neither predictive of Distress nor Coping. These findings support the notion that TPB is attendant with external control, particularly the notion that unknown supernatural forces/powers influence existence., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Drinkwater et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The activation of autonomic and hypothalamo-pituitary-adrenal (HPA) systems occurs interdependently with behavioral adjustments under varying environmental demands. Nevertheless, laboratory rodent studies examining the neural bases of stress responses have generally attributed increments in these systems to be monolithic, regardless of whether an active or passive coping strategy is employed. Using the shock probe defensive burying test (SPDB) to measure stress-coping features naturalistically in male and female rats, we identify a neural pathway whereby activity changes may promote distinctive response patterns of hemodynamic and HPA indices typifying active and passive coping phenotypes. Optogenetic excitation of the rostral medial prefrontal cortex (mPFC) input to the ventrolateral periaqueductal gray (vlPAG) decreased passive behavior (immobility), attenuated the glucocorticoid hormone response, but did not prevent arterial pressure and heart rate increases associated with rats' active behavioral (defensive burying) engagement during the SPDB. In contrast, inhibition of the same pathway increased behavioral immobility and attenuated hemodynamic output but did not affect glucocorticoid increases. Further analyses confirmed that hemodynamic increments occurred preferentially during active behaviors and decrements during immobility epochs, whereas pathway manipulations, regardless of the directionality of effect, weakened these correlational relationships. Finally, neuroanatomical evidence indicated that the influence of the rostral mPFC→vlPAG pathway on coping response patterns is mediated predominantly through GABAergic neurons within vlPAG. These data highlight the importance of this prefrontal→midbrain connection in organizing stress-coping responses and in coordinating bodily systems with behavioral output for adaptation to aversive experiences., Competing Interests: The authors declare no competing financial interests., (Copyright © 2024 the authors.)

Background: The interaction between stress and periodontal treatment is a topic of growing interest. It stands out as a field of research that sheds light on the complexity of oral health in individuals subjected to high levels of emotional stress., Objective: This paper aims to provide a protocol for a systematic review to examine the scientific evidence related to the influence of psychological stress on the response to periodontal treatment., Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines will be followed, and the study is based on a formulation of PECO (Participants, Exposure, Comparators, and Outcomes) questions. This systematic review will involve a literature search covering studies published from January 2000 to May 2024. It will include searching the PubMed, Web of Science, EBSCOHost, Scopus, and ProQuest databases to identify relevant studies. After selection, data extraction and quality assessment (using the Ottawa-Newcastle Scale) of the included studies will be carried out. The objective is to integrate high-quality evidence on how psychological stress impacts the outcomes of periodontal treatment. Depending on the number and methodological consistency of included studies, the results may be presented by meta-analysis or qualitative synthesis., Results: The current stage of the study consists of selecting studies for the systematic review as outlined by this protocol. The search, screening, and data extraction began in January 2024. The final results are expected by July 2024, with final manuscript submission planned for November 2024., Conclusions: This review will help clarify how psychological factors, such as stress, influence the results of periodontal treatment, providing valuable guidelines for future research and helping clinicians make decisions about the best treatment options for patients., Trial Registration: Open Science Framework (OSF) Registries qfs6p; https://osf.io/qfs6p., International Registered Report Identifier (irrid): PRR1-10.2196/56765., (©Kelly R Vargas Villafuerte, Luiz H Palucci Vieira, Karina Oliveira Santos. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 12.11.2024.)

Background: So far, some training interventions have been carried out to improve the mental health in women with infertility, but designing the need and evidence-based, as well as multimedia mental health self-care interventions based on cyber space has received less attention. Due to the spread of the internet and the role of self-care in improving mental disorders, this study was conducted to evaluate the effectiveness of the multimedia mental health self-care program on mental health and to assess the users' satisfaction., Methods: This study is a randomized controlled trial with pretest-posttest follow-up design. The sample was selected using a convenience sampling method (n = 90). The random number function was used to assign random numbers. The research instruments include a demographic, psychological Well-being, depression, anxiety, perceived stress, fertility problems and satisfaction with training questionnaire. Six weeks of intervention was conducted following the pre-test and the link of each session's content was sent to the participants, based on the training schedule, through Eitaa Messenger. The post-test and follow-up were conducted 1 week and 1 month post intervention. The data were analyzed using independent t-test and repeated measures ANOVA., Results: A statistically significant difference was observed between the intervention and control group in the mean score of psychological well-being, perceived stress and infertility stress 1 week and 1 month post intervention and in the mean score of depression and anxiety 1 month post intervention. The intervention group scored higher than the control in psychological well-being but lower in perceived stress, depression, anxiety and infertility stress. The intervention had a positive effect and reduced the score of perceived stress, depression, anxiety and infertility in the intervention group over time. The score reduction continued until the follow-up stage. No significant time-interaction effect was observed on psychological well-being and on the control group. Satisfaction with the program and subscales was desirable., Conclusion: This program could significantly reduce the depression, anxiety, perceived stress and infertility stress and desirable satisfaction with the program was observed among users. This program can be used in designing the experimental and therapeutic interventions to improve mental-health self-care behaviors., Trial Registration: RCT Registry: Iranian Registry of Clinical Trials; RCT registration number: IRCT20210526051410N1; Registration date: 2022-11-06. Last update: 2023-01-28 https://irct.behdasht.gov.ir/trial/57874., Competing Interests: Declarations Ethics approval and consent to participate This study has been performed in accordance with the Declaration of Helsinki and all methods were carried out in accordance with relevant guidelines and regulations. The Ethis Committee of Shahid Beheshti University of Medical Sciences approved the study (code: IR. cSBMU.PHARMACY.REC.1400.011). All participants were required to complete the informed consent forms and were assured about the voluntary participation and the confidentiality of their information. Consent for publication Not applicable in this section. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Perceived control is strongly related to mental health and well-being. Specifically, lack of perceived control has been associated with learned helplessness and stress-related disorders, such as depression and anxiety. However, it is unknown whether brain activation to control and its protective effect against stress can predict changes in quality of life. To address this gap, we examined the neural underpinning of controllability in healthy females (N = 40) performing the Value of Control task in an functional magnetic resonance imaging scanner. Quality of life and perceived stress were assessed at baseline and 6-month follow-up. Increased brain activation for control was found within the putamen, insula, thalamus, mid-cingulate, dorsolateral prefrontal cortex, motor cortex, and cerebellum. In contrast, increased brain activation for lack of control was found within the posterior cingulate and prefrontal cortices. In an exploratory analysis, an elastic-net algorithm was used to identify brain predictors of quality of life 6 months later. The right putamen's activation to control was selected as the best prospective predictor of improvement in life enjoyment and satisfaction and this association was mediated by changes in perceived stress. Our findings suggest that neural responsiveness to control may have utility as a potential marker of quality of life and resilience to adversity., (© The Author(s) 2024. Published by Oxford University Press.)

Background: Technology enhances teaching and learning quality, yet when educators lack tech proficiency, it hinders effective education and leads to frustration, lower confidence, and self-doubt. This study aims to investigate the experiences of university faculty members in relation to the impact of technology on their mental well-being., Methods: Using a qualitative approach (grounded theory), ten university faculty members were selected for in-depth interviews based on criteria such as teaching experience, tenure, specific courses or subjects taught, and active engagement during the research period. The guiding research question, "What are the experiences and perceptions of university faculty members concerning techno-stress?" directed the study's focus. The instrument (interview guide) that measured techno-stress consisted of 12 items and was administered virtually. Data were analyzed thematically to uncover common stressors, adaptive strategies, and institutional challenges faced by faculty in adapting to technology's demands and work overload. Additionally, the study identified four subcategories: work overload, social and emotional interaction, adaption to new technologies, and expectations and teaching quality., Results: Techno-stress is a composite of emotional and physical reactions triggered by the improper use of technology. Faculty members' encounters with techno-stress have substantial implications for their quality of life., Conclusions: This research highlights technology's positive impact on higher education but notes faculty struggles with techno-stress, emphasizing the need for training, support, and boundaries to maintain work-life balance and enhance educational quality., Competing Interests: No competing interests were disclosed., (Copyright: © 2024 Suyo-Vega JA et al.)

Purpose: To assess parental stress in newborns undergoing surgical care., Methods: A cross-sectional study was conducted in the Department of Pediatric Surgery at a tertiary center. The study included all parents of newborns requiring surgery, admitted between July 2023 and June 2024., Results: The overall stress score among the study population was 3.3 ± 1. Approximately 90% of parents reported experiencing at least some level of stress (stress score ≥ 2), with the "parental role alteration" domain scoring the highest (3.9 ± 1.1). In the "surgical aspects" domain, 27% reported extreme stress and 22% reported high stress. Higher stress scores were found among parents of preterm infants (3.6 ± 0.9 vs. 3.1 ± 1.1, p = 0.04), infants with a birth order ≥ 2 (3.4 ± 1.1 vs. 3.1 ± 1, p = 0.04), and those from the Muslim community. Graduate parents (2.8 ± 0.9, p = 0.01) and parents of upper socioeconomic status (2.3 ± 0.7, p < 0.0001) were found to have lower stress scores., Conclusion: Parental stress is significant among surgical newborns, especially in parents of preterm babies, babies with severe medical conditions, and those with lower education and socioeconomic status. "Parental role alteration" was the most stressful aspect, highlighting the need for targeted support., Competing Interests: Declarations Conflict of interest The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: This research explores the intricate relationships between mental health indicators (depression, stress, and anxiety) and various dimensions of quality of life among first-year law students. The study aims to understand how affective valence, mood states, physical activity, body image perception, and social relations influence mental health outcomes., Methods: Data were collected from 75 first-year law students (46 females, 29 males), a group predominantly composed of young adults with limited financial means, living in various housing situations, primarily within urban environments, and generally reporting low levels of physical activity. Standardized questionnaires were used to assess mental health and quality of life, including the Depression, Anxiety, and Stress Scale-21 Items (DASS-21), Feeling Scale (FS), Exercise-Induced Feeling Inventory (EIFI), Modified Baecke Physical Activity Questionnaire (MBPAQ), World Health Organization Quality of Life-BREF (WHOQOL-BREF), and Contour Drawing Rating Scale (CDRS). Descriptive statistics, Pearson correlation, and regression analysis were employed to analyze the data., Results: The analysis revealed significant correlations between depression (mean = 5.97, SD = 4.21), stress (mean = 7.81, SD = 4.80), and anxiety (mean = 6.17, SD = 4.58) with affective valence ( p < 0.05), mood states ( p < 0.05), physical activity ( p < 0.05), body image perception ( p < 0.05), and social relations quality ( p < 0.05). Additionally, mood states (mean = 20.73, SD = 10.60), physical activity (mean = 8.43, SD = 1.35), body image perception (mean = 4.21, SD = 1.91), and social relations quality (mean = 12.46, SD = 2.33) were identified as significant predictors of mental health outcomes ( p < 0.05)., Conclusions: These findings underscore the complex interplay between mental health indicators and various dimensions of quality of life, emphasizing the necessity for a comprehensive approach to mental health care. By identifying these predictors, we have gained a clearer understanding of the factors that impact mental health in this specific population. The insights gained highlight the value of interventions aimed at improving mood, increasing physical activity, enhancing body image, and strengthening social connections. These targeted strategies could effectively address mental health issues and promote well-being among law students. Future research should further investigate these relationships and develop tailored interventions to better support students' mental health. This study contributes to understanding the complex interplay between mental health and quality of life, offering a foundation for both practical interventions and future research., Competing Interests: The authors declare that they have no competing interests., (© 2024 Muntean et al.)

Background: The global impact of the COVID-19 pandemic has been extensive, disproportionately affecting various vulnerable populations. In addition to traditional vulnerable groups (TVGs) such as the elderly, women, people with lower education, disabled individuals, and low-income groups, new vulnerable groups (NVGs) have emerged, including essential workers, face-to-face workers, temporary workers, and the self-employed. This study focuses on exploring the economic and psychological effects of the pandemic on both traditional and newly recognized vulnerable groups within Korea., Methods: The study employed multiple logistic regression using micro-level social survey data from Statistics Korea to calculate the odds ratio relating to two categories of vulnerable groups and their economic and mental health impacts. Additionally, through interaction term analysis, we tried to uncover the complex interrelationship between these non-vulnerable groups and target vulnerable groups., Results: Both the newly identified and traditional vulnerable groups showed higher likelihood of facing economic and mental health challenges compared to non-vulnerable groups. The likelihood of encountering a decrease in income and work-related stress was 2.17 times higher (95% CI = 1.90-2.47) for NVGs, while those belonging to TVGs had a 1.75-fold increase (95% CI = 1.47-2.08). Moreover, female self-employed workers faced higher overall stress at 1.36 times greater risk (95% CI = 1.08-1.71), whereas elderly individuals who are self-employed exhibited lower odds of experiencing such stress at the intersection between TVGs and NVGs., Conclusion: This research offers in-depth understanding of the diverse impacts of COVID-19 on at-risk groups. Furthermore, examinations that take into account interactions between NVGs and TVGs uncovered subtle effects within subgroup dynamics, suggesting that intersecting factors play a role in different levels of vulnerability. This provides valuable evidence for informing policy decisions and allocating resources., (© 2024. The Author(s).)

Queer individuals experience unique stressors related to their minority status, negatively impacting their mental health. One factor contributing to these disparities is exposure to minority stress, which involves social stressors related to minority status. Previous research has focused on the negative impacts of minority stress, with less attention to its impact on positive psychological functioning. This study explored the relationship between minority stress and psychological well-being among 270 queer individuals in German-speaking countries. Participants completed an online survey assessing minority stress and psychological well-being. Analyses of Covariance indicated that proximal factors of minority stress-such as self-stigma, concealment, and expectations of rejection-had a particularly negative impact on psychological well-being, but no effects could be found for gender and sexual orientation. Additionally, gender identity but not sexual orientation had a significant effect on minority stress, with non-binary and other gender identities reporting higher minority stress compared to females. Thematic analysis revealed concerns about survey inclusivity, gender identity challenges, and intersectionality of minority identities. Our findings emphasize the significant impact of minority stress on the psychological well-being of queer individuals, particularly non-binary people and those with diverse gender identities, while demonstrating the need for inclusive research methodologies, tailored interventions, and policies addressing the diverse experiences within the queer community., (© 2024. The Author(s).)

Introduction: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by impairments in communication, social interaction, and repetitive behavior. The declaration of the COVID-19 pandemic in March 2020 resulted in significant changes in daily life due to restrictive measures. This period posed particular challenges for families with children living with autism, given the limitations in medical care and social services., Objective: This study aimed to understand how families with autistic children perceive stress during the pandemic and the coping strategies employed in unexpected situations., Method: A total of 44 families with children with ASD and 300 control families, including 44 control families in a matched subsample, were included in the study. To assess stress and parental coping with COVID-19-related stress, the Responses to Stress Questionnaire (Adult Self-Report RSQ-COVID-19) was utilized., Results: Caregivers of autistic children experienced significantly higher stress levels (p = .027, d = 0.479) during the pandemic, with notable stressors such as limited access to medical care and challenges associated with remote work. Despite expectations, coping strategy differences were not statistically significant., Conclusion: Families and supporters of children with autism naturally encounter various experiences and challenges stemming from their additional needs. Our study's results highlight an accentuation of stress during challenging situations. As these situations may recur in the future, there is a need to design and implement support plans for these families, appropriate intervention programs, and preparations for the utilization of telemedicine tools., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Knedlíková et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Smartphones and social media have become an integral part of human daily life and they influence mental well-being. These accounts have been researched in the general population, but not in athletes. This is critical given enhanced physical and emotional stressors in athletes versus non-athletes. Therefore, we here studied intra- and interindividual relationships of four social media sites (WhatsApp, TikTok, Instagram, and Snapchat) with mood, stress, recovery, and sleep using log-based media usage tracking as an objective measure in 53 competitive athletes aged 12-27 years. Multilevel modeling revealed that intraindividual TikTok usage negatively predicted sleep (β = -0.10, p = 0.040) and recovery (β = -0.15, p < 0.002), and positively predicted stress (β = 0.12, p = 0.018). Interindividual Instagram usage predicted feelings of calmness (β = 0.27, p = 0.029) and valence (β = 0.20, p = 0.043). Intriguingly, competition level moderated the usage outcomes of all four apps: Athletes on low performance levels showed lower mental well-being when using social media longer, yet in national and international athletes the strength of these relationships was weaker or even reversed. Our study unravels social media usage associations with mental well-being to vary as a function of performance level and provides findings on intra- and interindividual effects of critical importance to inform future population-tailored and expedient interventions., (© 2024. The Author(s).)

Aims: Humanitarian migrants are at increased risk of post-traumatic stress disorder (PTSD) and elevated psychological distress. However, men and women often report varying degrees of stress and experience different challenges during migration. While studies have explored PTSD, psychological distress, gender, and resettlement stressors, they have not explored the interplay between these factors. This study aims to address that gap by investigating gender disparities in PTSD and psychological distress among humanitarian migrants in Australia, with a focus on the moderating role of socioeconomic factors., Methods: This study used data from five waves of the Building a New Life in Australia (BNLA) survey, a longitudinal study of 2,399 humanitarian migrants who arrived in Australia in 2013. PTSD and psychological distress were measured using the PTSD-8 and Kessler-6 (K6) scales, respectively. We conducted generalised linear mixed-effect logistic regression analyses stratified by gender., Results: Female humanitarian migrants exhibited a significantly higher prevalence of PTSD and psychological distress than males over five years of resettlement in Australia. Women facing financial hardship, unemployment, or residing in short-term housing reported greater levels of PTSD and distress compared to men., Conclusions: Women facing financial hardship, inadequate housing, and unemployment exhibit higher rates of PTSD and psychological distress, underscoring the significant impact of socioeconomic factors. Addressing these challenges at both individual and systemic levels is essential for promoting well-being and managing mental health among female humanitarian migrants.

Background: To identify risk factors for mental distress and investigate whether the factors were different between men and women during the coronavirus disease 2019 (COVID-19), using KOKOROBO data, which is an online platform that aims to facilitate access to mental health services., Methods: We used baseline data on KOKOROBO users 13 years of age or older in Japan who accessed it from October 11, 2021, to April 6, 2023, excluding those receiving treatment for mental health problems. Global severity, based on the most severe measure on Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Insomnia Severity Index (ISI), was analyzed using multivariable logistic regression with baseline characteristics for each gender, and for under 30 and 30 years of age or older in women. We conducted the same analysis of suicidal ideation for each gender., Results: In the 686 men and 1274 women, 117 (17.1%) and 100 (7.8%) had minimal global severity respectively, and the rest suffered from mental distress to some extent. For women, ages under 30 years (adjusted OR (aOR): 0.352, 95%CI: 0.231-0.539, P < 0.001), marriage (aOR: 0.453, 95%CI: 0.274-0.746, P = 0.002), and concerns about COVID-19 infection were associated with global severity, while having children (aOR: 0.509, 95% CI: 0.284-0.909, P = 0.023) and decrease of going out during the COVID-19 pandemic had a protective effect on global severity and suicidal ideation for men, respectively. Living with family was a risk factor for mental distress in unmarried women over 30 years of age. Less communication with family or others and responding to the questionnaire late at night (00:00-05:59) were associated with severe global severity in both genders., Conclusions: Age, living arrangement, marriage, having children, concerns about COVID-19 infection, and lifestyle changes during the COVID-19 pandemic had gender-specific effects on mental distress, while frequent communication and regular life rhythm maintained mental health in both genders. Young women and, unmarried middle-aged women living with their families tended to experience mental distress during the COVID-19 pandemic., Trial Registration: The Ethics Committee of the National Center of Neurology and Psychiatry approved this study (approval number B2020141) on April 15, 2021., (© 2024. The Author(s).)

Racial discrimination is conceptualized as an acute and chronic stressor. Like other acute stressors, lab-based studies demonstrate acute effects of discrimination-related stressors on stress-related cardiovascular outcomes, including total cardiac output, blood pressure, and indices of sympathetic and parasympathetic nervous system activity. Critically, it is important to understand how individual and social factors buffer the experience of race-related acute stress. The current study extends existing work by measuring cardiovascular indices of stress during conversations about racial/ethnic discrimination and examines the moderating role of social support. Latine/Hispanic participants (N = 97) talked about personal discrimination experiences with either a close other or a research assistant they had never previously met. Participants in both conditions exhibited cardiovascular reactivity indicative of stress during the conversation. Additionally, patterns of reactivity reflected a more adaptive stress response and recovery profile when participants talked about discriminatory experiences with a close other relative to a stranger (less parasympathetic withdrawal during the stressor and more parasympathetic rebound during recovery). These patterns are consistent with a stress buffering account of social support, which suggests social bonds and community-level support are critical to consider in interventions to mitigate the harms of experiencing discrimination and prevent chronic health disparities., (© 2024. The Author(s).)

Background: Internet-delivered cognitive behavioural therapy (ICBT) has previously shown promise in effectively treating climate change-related distress. The aim of the present study was to investigate participants' experiences of undergoing a novel ICBT program targeting psychological symptoms associated with climate change., Methods: Telephone interviews were conducted with nine participants who had received eight weeks of ICBT for climate change-related distress. A semi-structured interview guide was used to gather information about participants' experiences of undergoing treatment. Data were transcribed and analyzed using thematic analysis., Results: The thematic analysis resulted in three overarching themes: (1) Same old feelings, brand new strategies, (2) Bumps in the road, and (3) Personalized climate engagement. Participants experienced that they had developed new coping strategies for handling their emotions, encountered challenges during the treatment period, and adapted their pro-environmental behaviour to their individual needs and circumstances., Conclusions: The results indicate that participants were able to utilize the treatment material in different ways, resulting in a variety of emotional, cognitive, and behavioural changes. While the treatment was generally described as helpful, participants also raised some concerns regarding the treatment format. These findings can inform further development of ICBT targeting psychological symptoms associated with climate change., (© 2024. The Author(s).)

Background: Stress outside of the couple relationship (extradyadic stress) can spill over into the couple relationship, increasing stress between the partners (intradyadic stress). Extra- and intradyadic stress are furthermore associated with depressive symptoms. Due to the interdependence of romantic partners, this study aimed to investigate the influence of the person's own and their partner's extra- and intradyadic stress on the person's depressive symptoms in parents of toddlers. The second aim was to evaluate whether intradyadic stress mediates the within-person and between-partner association between extradyadic stress and depressive symptoms., Methods: Longitudinal data of a community sample of 878 opposite-sex couples, participating in the prospective cohort study DREAM, were collected two and three years after birth. Extra- and intradyadic stress were assessed by the Multidimensional Stress Questionnaire for Couples and depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale. An actor-partner interdependence mediation model was applied to the data, while controlling for the confounder academic degree., Results: The person's own extradyadic stress predicted their depressive symptoms one year later, partially mediated by their intradyadic stress. The partner's extradyadic stress and the person's own depressive symptoms one year later were only indirectly associated through the person's own intradyadic stress. In a sensitivity analysis, between-partner effects were no longer significant after including autoregressive pathways., Conclusion: Our findings highlight the importance of the extradyadic-intradyadic stress spillover for the mental health of women and men with young children. Early targeted interventions could help to prevent later depressive symptoms by reducing stress inside the couple relationship that results from both partners' stress from outside the couple relationship., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Böhlmann et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: In military training settings, stress can improve focus and motivation fostering effective learning. However, high perceived stress can be debilitating resulting in poor learning and clinical errors. Multiple studies have focused on medical residency stress; but there has been minimal focus on dental residents and even less on the impact of the unique stressors from the COVID-19 pandemic. The objectives of this study were to determine the impact of the COVID-19 pandemic on perceived stress of residents in a military dental residency training program and explore the association among perceived stress and anxiety, depression, sleep quality, and social support., Materials and Methods: Dental residents (N = 20) at the Naval Postgraduate Dental School participated in this study. Residents were assessed via self-report measures quarterly from March 2020 through June 2021. The assessment included measures of anxiety (GAD-7), depression (PHQ-9), perceived stress (PSS), fatigue (FSI), and social support (DUKE-SSQ)., Results: Before the pandemic shutdown, 60% of participants reported high perceived stress. These residents reported an initial decrease in symptoms of anxiety, depression, and fatigue compared to residents reporting low pre-pandemic perceived stress but returned to baseline levels post-shutdown. Additionally, the high stress participants reported lower social support., Conclusions: Based on pre-pandemic perceived stress, participants responded differently to the impact of the pandemic shutdown. The low baseline stress participants may have a more robust sense of grit and resilience. These findings suggest that postgraduate dental training programs should integrate coping skills training opportunities, especially for residents reporting high perceived stress before residency., (© The Association of Military Surgeons of the United States 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site–for further information please contact journals.permissions@oup.com.)

To examine multiple relations between organizational roles, work-family conflict, job satisfaction, mental health, and affective organizational commitment among basic education teachers, a cross-sectional study was conducted with a sample of 438 respondents, to whom the Scale for the Assessment of Psychosocial Stressors in the Workplace (EAEPCL, acronym in Portuguese), the General Job Satisfaction Scale, the General Health Questionnaire (GHQ-12) and the Reduced Affective Organizational Commitment Scale (ECOA, acronym in Portuguese) were applied. Data were analyzed by structural equation modeling and the estimated measurement model indicated convergent and discriminant validity, as well as reliability regarding the latent variables used. Direct effects of conflict and role ambiguity on job satisfaction, common mental disorders (CMD) and affective organizational commitment were observed, as well as indirect effects on the latter two mediated by job satisfaction. As for role overload, its direct effects occurred only in relation to job satisfaction, the latter mediating the effect of the former on CMD and affective commitment, whereas work-family conflict mediated the effect of role overload on CMD. These results highlight the harmful effects of role stressors and job (dis)satisfaction on the mental health of teachers by making them more vulnerable to developing CMD and indicate how these can affect results of interest to the institutions studied, such as affective commitment in school organizations.

Background: Exposure to armed conflict negatively impacts health. However, there is limited data on secondary stress from ambiguous loss contexts, such as kidnapping. In this study we aimed to quantify changes in modifiable health behaviors and well-being among women in hostage families and hostage crisis volunteers versus the general female population within the first two months of the 2023 Israel-Hamas war., Methods: A cross-sectional online survey was conducted on 318 Hebrew-speaking women aged 18-75 in Israel comparing: (1) a general population sample (n = 245); (2) hostage crisis volunteers (n = 40); and (3) hostage family members (n = 33). Participants provided demographic information, details on chronic illnesses, and responded to Likert-scale questions covering self-rated health, mental health, and lifestyle habits before the conflict and in current state., Results: Hostage family members reported the most severe health impacts, followed by volunteers. Fair/poor physical health status increased significantly in all groups during the war, with hostages' families reporting the highest rate (61.6%). Mental health deterioration was more pronounced among hostages' families, with 84% expressing a need for mental health support. Hostages' families also reported the highest rates of sleep problems, reduced adherence to a healthy lifestyle, and weight loss. Mental and physical health declined significantly across the exposed groups, as measured by multiple assessments, with hostage families experienced the most pronounced impairments across various domains of well-being., Conclusions: This period of conflict severely harmed the well-being of all women in the study population. Women from all three groups - hostage families, volunteers, and those from the general population - experienced health deterioration due to varying levels of stress and exposure to conflict-related factors. Hostage families faced the greatest impact with nearly all members of this group showing significant health damage. Long-term support is needed to help restore post-conflict health for all affected women. Further research may be needed to determine the most effective interventions for addressing these impacts across the different groups., (© 2024. The Author(s).)

Objectives: This study was conducted to determine the relationships between nurses' competency, motivation, and stress levels in disaster management, as well as to shed light on the establishment of effective disaster management programs., Methods: In our research we used a correlational, descriptive, cross-sectional design. The sample of the study was composed of 498 nurses working in Turkey. The "Descriptive and Professional Characteristics and Disaster Experiences of Nurses" form, the "Competencies for Disaster Nursing Management Questionnaire," the "Perceived Stress Scale," and the "Nurses Job Motivation Scale" were used in data collection., Results: Nurses' disaster management competency and motivation levels were found to be adequate, and their stress levels were found to be moderate. A weak positive correlation was found between disaster management competency and motivation, but a weak negative correlation was found between stress levels. Age, education level, experience level, training in disaster nursing, and knowledge of duties and responsibilities in disasters were associated with significant differences in terms of disaster competency and its dimensions, motivation, and stress levels., Conclusions: The study found that nurses' disaster experiences impacted their competency, feeling of preparedness, and stress and motivation levels, and motivation was found to be a predictor of increasing competency.

Objectives: In the present era, parents frequently stigmatize themselves for their children's negative behaviors and inadequate social skills. Parents' self-stigma (PSS) may lead to a decrease in parental self-efficacy and quality of marital and family life. In light of these reasons, the principal objective of this study to assess the validity and reliability of the Turkish version of the PSS Scale (PSSS) as developed by Eaton et al. (2019) and to investigate the indirect effect that parenting stress has on the relationship between PSS and parental self-efficacy., Methods: We collected data from a total of 1,118 parents via random sampling, with the first part of the study involving 645 participants (M age = 32.64 ± 7.28) and the second part of the study involving 473 participants (M age = 27.43 ± 9.87). In the first part of the study, we employed structural equation modeling for the confirmatory factor analysis and Pearson's correlation coefficient for the criterion-related validity, average variance extracted, and composite reliability analyses. Moreover, we calculated Cronbach's alpha, McDonald's omega, and Guttman split-half coefficients for the reliability analyses. In the second part of the study, we utilized Hayes' bootstrapping method to assess the indirect effect of parenting stress on the relationship between PSS and parental self-efficacy., Results: The first part of the study confirms the PSSS's 11-item, 3-factor structure, showing the Turkish form to have acceptable goodness-of-fit indices, and found Cronbach's alpha for the PSSS to be 0.89. Furthermore, the first part of the study demonstrates a significant negative correlation between marital life satisfaction and PSS. Meanwhile, the second part of the study has determined PSS to be positively related to parenting stress and negatively related to parental self-efficacy. The second part of the study also indicates parenting stress to have an indirect effect on the association between PSS and parental self-efficacy., Conclusions: The study indicates the Turkish version of the PSSS to be a valid and reliable instrument in Turkish culture for measuring parents' PSS levels regarding their children, with higher scores indicating greater PSS. The scale can be effectively used in both research and clinical settings. The study also suggests parental stress to have a possible impact on the association between PSS and parental self-efficacy. Furthermore, addressing the variables of PSS and parenting stress in family-focused interviews and therapeutic interventions may contribute to increasing parental self-efficacy., (© 2024. The Author(s).)

Objectives: This meta-analysis was to critically evaluate the effectiveness of Internet-based Cognitive Behavioral Therapy (ICBT) on psychological distress and quality of life in breast cancer survivors., Methods: A search was conducted across eleven databases (PubMed, Web of Science, Embase, Cochrane Library, Scopus, ProQuest, CINAHL, CBM, CNKI, VIP and Wanfang) to identify relevant randomized controlled trials (RCTs) published from databases inception to September 2023. Two reviewers independently conducted study screening, data extraction, and quality assessment of the included studies. Review Manager 5.4 and Stata 18.0 were utilized for analysis., Results: Ten studies with 1409 patients were included. Meta-analysis indicated that ICBT alleviated anxiety [SMD = -0.34, 95% CI (-0.64, -0.04), p = 0.03] and depression [SMD = -0.43, 95% CI (-0.76, -0.09), p = 0.01] in breast cancer patients. Therapist-guided ICBT outperformed self-guided ICBT, with interventions lasting ≤ 9 weeks better than > 9 weeks, and module quantity didn't affect the results. Additionally, ICBT significantly improved quality of life [SMD = 0.37, 95% CI (0.21, 0.52), p < 0.001], yet didn't reduce fatigue [SMD = -0.13, 95% CI (-0.59, 0.34), p = 0.60], insomnia [MD = -2.24, 95% CI (-5.77, 1.28), p = 0.21], or fear of progression [SMD = -0.10, 95% CI (-0.31, 0.11), p = 0.34]., Conclusions: ICBT, especially therapist-guided and lasting for ≤ 9 weeks, can effectively relieve anxiety and depression, as well as enhance breast cancer patients' quality of life. Nevertheless, it fails to improve fatigue, insomnia, or fear of progression. High-quality, large-sample studies must be conducted in the future for further validation., (© 2024 John Wiley & Sons Ltd.)

Abstract: The extensive literature on the potent role negative thoughts about pain have on the experience of pain and pain-related suffering has documented associations with important neurobiological processes involved in amplifying nociceptive signals. We focus this review on pain catastrophizing (pCAT)- appraisals of pain as threatening, overwhelming, and unmanageable- and review the evidence that these thoughts are learned in childhood through experience and observation of others, particularly caretakers and parents. For children who have learned pCAT, repeated exposures to pain over time activate pCAT and likely contribute to further amplification of pain through changes in the neurobiological pain regulatory systems, which overlap with those regulating the stress response. We propose that repeated pain and stress exposures throughout childhood, adolescence, and into adulthood alter the neurobiology of pain via a repetitive positive feedback loop that increases risk for heightened pain sensitivity over time with repeated exposures. At some point, often precipitated by an acute episode of pain and possibly influenced by allostatic load, pCAT contributes to persistence of episodic or acute pain and exacerbates pain-related suffering. This developmental trajectory is not inevitable, as the impact of pCAT on pain and pain-related suffering can be influenced by various factors. We also present future directions for work in this area., (Copyright © 2024 International Association for the Study of Pain.)

A Dynamic Adaptational Process Theory of Resilience (ADAPTOR) incorporates a synchronistic interplay of reserve capacity, adaptation, and consequences in the context of the larger exposome. This conceptualization of resilience centers on the argument that individuals can "build" resilience by drawing upon their various reserve capacities to effectively adapt to challenging contextual factors, and that this process has long-term consequences for health and wellness trajectories. These theoretical arguments were tested using the Notre Dame Study of Health & Well-Being-COVID Study, which is a multitimescale, longitudinal study of data collected from September 2020 through February 2022. We included 444 participants (age range = 26-90, M = 62.23, SD = 14.26), and used hierarchical linear modeling to assess the effects of global perceptions of stress reactivity (reserve capacity), daily affective reactivity (adaptation), as well as negative pandemic exposure (exposome) on trajectories of depression and anxiety (consequences) across the COVID-19 pandemic. Most pertinent to ADAPTOR, an interactive effect indicated that reserve capacity and adaptation may serve compensatory roles for one another in the context of a more stressful exposome, whereas the synchrony between reserve capacity and adaptation may be important in the context of a less stressful exposome. These findings support the ADAPTOR framework, such that reserve capacity, adaptation, the exposome, and their confluence differentially impact various consequences. This ultimately highlights the importance of taking a dynamic, process-oriented, and multifaceted approach to studying resilience. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Resilience has been defined as the maintenance or quick recovery of mental health during and after stressor exposure. One popular operationalization of this concept is to model prototypical trajectories of mental health in response to an adverse event, where trajectories of undisturbed low or rapidly recovering symptoms both comply with the resilience definition. However, mental health responses are likely also influenced by other stressors occurring before or during the observation time window. These "background" stressors may affect a person's assignment to a trajectory class. When using these classes as dependent variables to identify resilience-predictive factors, this may lead to false estimates. A new method to build exposure-controlled trajectories based on time courses of stressor reactivity (SR), rather than pure mental health scores, is demonstrated on a data set of 707 initially healthy participants living in Germany (67.33% female; Mage = 29.20, SD = 8.27). SR scores express individual deviations from the sample's normative mental health reaction to observed real-life stressors during the observation time window, thus accounting for individual differences in exposure to background stressors. The resulting trajectory models are plausible. In analyses additionally controlling for background stressors occurring before the observation time window (past life events), low SR trajectories are predicted by the well-documented resilience factor sense of coherence, suggesting construct validity. Further, they are associated with lower odds of developing categorical mental health conditions, suggesting predictive validity. Our study provides the first proof of principle for a refined method to identify predictors of resilience to major stressor events. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Purpose: The study was conducted to determine the relationship between social media addiction and perceived stress in adolescents., Method: The study was conducted in a descriptive and cross-sectional design between September and December 2022 in secondary education institutions of the Provincial Directorate of National Education in a city center in eastern Turkey. The sample of the study consisted of a total of 716 adolescents who were studying in the ninth grade (145), 10th grade (198), 11th grade (216), and 12th grade (157) who met the inclusion criteria of the study at the time the study was conducted. The sample comprised individuals with diverse sociodemographic characteristics, including ages, genders, school success levels, parents' education levels, parents' job status, socioeconomic status, time spent on daily social media, and purposes of social media use of the adolescents. The "Sociodemographic Characteristics Form," "Social Media Addiction Scale for Adolescents (SMASA)," and "Perceived Stress Scale (PSS)" were used as the data collection tools. Ethical principles were fulfilled in the study., Results: It was found that the average age of the adolescents who participated in the study was 15.71 ± 1.22, 58.1% were females, 41.1% had good school success, 90.5% had a mobile phone, 90.2% used WhatsApp, 56.8% said that their daily social media use time was between 1 and 3 h, and 64% said that their purpose of using social media was for entertainment and leisure. The mean SMASA score was 18.49 ± 6.98, and the mean PSS score was 42.11 ± 7.54. It was found in the study that the mother's employment status, phone ownership status, use of Instagram, Facebook, Twitter, WhatsApp, Snapchat, YouTube, TikTok, and LinkedIn accounts, daily social media use, time and purposes of using social media affected the mean SMASA score. Age, gender, school success, use of Instagram and Snapchat accounts, daily social media use time, and purposes of using social media affected the mean PSS score (p < 0.05). As a result of the study, a positive and low-level significant relationship was detected between social media addiction and perceived stress levels (p < 0.01)., Conclusion: As the levels of social media addiction increase in adolescents, the perceived stress levels also increase. It was also found that some variables affected the social media addiction and perceived stress levels of adolescents., (© 2024 Wiley Periodicals LLC.)

Despite evidence suggesting that partner maltreatment-a concept which represents a wide array of negative, destructive, and abusive behaviors in romantic relationships-is likely to fluctuate over time, the longitudinal trajectory of partner maltreatment is unclear. This study aims to identify the average trajectory of partner maltreatment over a 5-month period before applying an attachment-informed diathesis-stress framework to explain points of escalation or de-escalation in partner maltreatment perpetration. Two hundred and eight individuals completed 5 monthly assessments of partner maltreatment as well as an assessment of adult attachment and perceived stress at baseline. A nonlinear (i.e., quadratic function) trajectory provided optimal fit for partner maltreatment perpetration over time. An interaction between attachment avoidance and perceived stress predicted the trajectory of partner maltreatment perpetration. Specifically, higher attachment avoidance and higher perceived stress predicted a small initial decline followed by a steep increase in partner maltreatment perpetration. No significant associations were found for the interaction between attachment anxiety and stress and partner maltreatment. The findings suggest that perpetration of partner maltreatment fluctuates over time, and that an attachment-informed diathesis-stress framework can be applied to explain levels of partner maltreatment perpetration and points of escalation and de-escalation over time., (© 2024 Wiley Periodicals LLC.)

As the United States contends with racism and a social justice reckoning, the need to advance our understanding of how to build structural resilience continues to be pressing. This article proposes a culturally and structurally informed model of resilience for individuals with minoritized identities that integrates social-ecological and minority stress models. First, common stressors and traumas experienced by minoritized individuals at multiple levels of proximal/distal influence are reviewed: microsystem (e.g., family rejection), mesosystem (e.g., community-based discrimination), exosystem (e.g., barriers to health care), macrosystem (e.g., harmful legal policies), and chronosystem (e.g., historical legacy). Next, how these exposures have cascading effects on minority stress processes (e.g., discriminatory policies in the macrosystem affect how a child is socialized in the microsystem) are considered. Then, modifiable factors (e.g., community cohesion) that promote resiliency in the face of ongoing exposures are discussed. To conclude, guidelines are offered for advancing the psychological science of resilience in minoritized groups including mixed methods to reflect participants' experiences, ecological approaches to assess resilience, and multilevel modeling to understand the interplay between the social-ecological context and individual factors. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Women of color are at least twice as likely as non-Hispanic White women to die during the perinatal period or deliver infants who are low birthweight, preterm, or die within the first year of life. Maternal stress before and during pregnancy is associated with adverse obstetric outcomes. A growing body of literature has explored maternal resilience as protective factors contributing to healthy maternal and child health (MCH) outcomes. However, several gaps exist in how this construct has been conceptualized and operationalized. First, extant research has primarily conceptualized maternal resilience as individual attributes that enable women to "bounce back" after facing adversity during pregnancy, thereby failing to incorporate the broader systemic and environmental factors that contribute to chronic stress, particularly among vulnerable groups. Second, the literature has largely neglected to examine resilience in relation to maternal stress, therefore not acknowledging that women who experience greater stress will likely require more resources. Third, though resilience has been investigated at discrete life stages, longitudinal research has not been conducted to explore how it develops over the lifecourse. This article critically evaluates the resilience literature, expands upon the gaps described, and proposes a conceptual framework that reimagines material resilience using three population health theories, including Bronfenbrenner's socioecological framework, Elder's lifecourse theory, and Geronimus' weathering hypothesis. The proposed framework will inform future research that examines the development of multilevel resilience resources over the lifecourse as well as interventions to increase resilience and ultimately yield healthier MCH outcomes among vulnerable communities. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Introduction: Social support, social strain and stressful life events could induce chronic stress, which affects prognosis and survival after breast cancer diagnosis. However, few studies have examined the impact of psychosocial factors on different competing mortality events., Methods: We included 9154 postmenopausal women who were newly diagnosed with invasive breast cancer after enrollment in the Women's Health Initiative, as of March 6th, 2021. Psychosocial factors were collected and stratified into quartiles. Cause of death was verified through adjudicated medical record reviews. Associations between psychosocial factors and all-cause mortality, breast cancer mortality, and cardiovascular disease mortality were examined by competing risk models. Subsequent stratified analyses were performed by race., Results: With a median follow-up time of 8.6 years, 3218 deaths were identified. Compared to participants with less social support, those who had higher social support had significantly lower all-cause mortality (Q4 vs. Q1, HR = 0.89, 95% CI: 0.81, 0.9). The highest quartile of social strain was associated with lower CVD mortality (Q4 vs. Q1: HR = 0.80, 95% CI: 0.65, 0.99). After stratification, a similar relationship was found in White women but not in Black women., Conclusion: Our findings suggest that there was an association between high social support and reduced all-cause mortality regardless of cancer stages at diagnosis. Social support interventions after breast cancer diagnosis could have the potential to reduce overall mortality., (© 2024 The Author(s). Psycho‐Oncology published by John Wiley & Sons Ltd.)

Stress, a state of mental or emotional strain or tension brought on by challenging or demanding events might hamper a dentist's ability to react quickly and prudently. Their ability to deal with difficult patients may also be compromised, especially when dealing with frightened or anxious people. The main goal of this study was to survey a wide range of dental professionals from different backgrounds, including undergraduates, general practitioners and specialists, and determine how much stress each group was experiencing and how it affected both the participants and the treated patients. A sample size of an estimated 300 participants (defined by a 95% confidence interval and a 5% margin of error) was found to be sufficient for this investigation. About 178 responses were received to the 300 Google Forms questions, a response percentage of 59.3%. Of those surveyed, 77% had work experience ranging from zero to five years. Women made up 30% of the population, while men made up 70%. Furthermore, the patient-to-dentist ratio was neither a significant worry nor a source of stress because the majority of dentists saw between 0 and 10 patients per month. General dentists and specialists treated the patients with higher awareness, in-depth understanding and care than undergraduates did because they frequently reported having less experience than the other categories in this study did. The fact that a sizable majority of the respondents had between 0 and 5 years of experience further explains the high stress levels. High anxiety levels were present among dental undergraduates, highlighting the necessity of stress management instruction and support services in training programmes., Competing Interests: Theauthorsdeclarenoconflictofinterest. GiuseppeMinervini isservingasoneoftheEditorialBoardmembersofthisjournal. We declare that Giuseppe Minervini had no involvement in the peer review of this article and has no access to information regarding its peer review. Full responsibility for the editorial process for this article was delegated to JJ., (©2024 The Author(s). Published by MRE Press.)