Iranian Journal of Psychiatry

Factors Influencing Suicide Attempts in Patients Hospitalized in Psychiatric Wards from the Perspective of Nurses: A Content Analysis Study

2026-08-03T11:17:18+0430

Objective: Suicide is a critical public health issue, with heightened risks among psychiatric inpatients. In Iran, sociocultural and systemic factors uniquely shape suicide attempts in psychiatric wards, yet nurses’ perspectives on these factors remain underexplored. This study aims to identify the factors influencing suicide attempts among hospitalized psychiatric patients in Iran, as perceived by nurses, using a qualitative content analysis approach.

Method: A qualitative study was conducted from June 2024 to June 2025 in the psychiatric wards of two university-affiliated hospitals in Urmia, Iran. Using purposive and subsequent theoretical sampling, 18 registered nurses (12 females, 6 males; mean age 42.3 years; mean experience 12.5 years) were recruited. Sample adequacy was established through data saturation, which was confirmed after 15 interviews with three additional interviews yielding no new themes. Semi-structured interviews explored nurses’ perceptions of factors influencing suicide attempts. Data were analyzed using Graneheim and Lundman’s conventional content analysis, involving iterative coding, condensation of meaning units, development of subcategories, and abstraction into main categories and an overarching theme. Rigor was ensured via Lincoln and Guba’s trustworthiness criteria.

Results: One overarching theme emerged: "Interwoven Threads of Vulnerability and Resilience in Psychiatric Care." Four main categories were identified: (1) Individual Patient Vulnerabilities (unresolved trauma, impulsivity, substance use); (2) Relational and Familial Dynamics (familial stigma, interpersonal conflicts, and, specifically within Iran’s collectivist culture, expectations of emotional stoicism linked to historical narratives of martyrdom); (3) Ward Environment and Systemic Barriers (inadequate staffing, disruptive interactions, inconsistent protocols); and (4) Neglected Protective Factors (undervalued therapeutic alliances, culturally resonant but overlooked spiritual coping such as Quranic recitation, and missed empowerment opportunities). These themes were deeply shaped by Iran-specific conditions, including the legacy of war-related trauma, family honor–based stigma, chronic overcrowding with nurse-to-patient ratios reaching 1:20, and underutilized Islamic faith practices.

Conclusion: Nurses’ insights reveal that suicide attempts in Iranian psychiatric wards stem from a complex interplay of vulnerabilities, relational strains, and systemic deficiencies. Accordingly, culturally tailored interventions should directly target each finding: trauma-informed care (addressing individual vulnerabilities), family education programs to reduce honor-based stigma (addressing relational dynamics), staffing ratio enforcement and protocol standardization (addressing systemic barriers), and the integration of spiritual coping and skill-building groups (activating neglected protective factors). These evidence-grounded recommendations offer a roadmap for suicide prevention in resource-constrained Iranian psychiatric settings.

Effect of Play Therapy versus Virtual Reality on Reducing Anxiety in Children Pre-Cardiac Catheterization: A randomized Single-Blind Trial

2026-08-02T13:12:14+0430

Objective: This study aimed to compare the effectiveness of virtual reality (VR) versus play therapy in reducing pre-procedural anxiety among children scheduled for cardiac catheterization, and to evaluate parental satisfaction with these interventions.

Method: A randomized, assessor-blinded, pretest-posttest comparative trial was conducted at Al-Nasiriyah Heart Hospital between December 2025 and February 2026. A total of 75 children aged 3-7 years with congenital heart defects were randomly allocated into three equal groups (n = 25 each): VR (15 minutes of immersive 3D video), play therapy (15 minutes of coloring activity), and control (standard care). Anxiety was assessed using the Modified Yale Preoperative Anxiety Scale (mYPAS) at four time points (two pre-intervention and two post-intervention measurements). The outcome assessor was blinded to group allocation. Data were analyzed using analysis of covariance (ANCOVA) with Bonferroni-adjusted post-hoc comparisons to control for baseline age and anxiety differences.

Results: The VR group demonstrated the lowest mean anxiety score post-intervention (mean = 5.04 ± 0.20), followed by the play therapy group (mean = 5.88 ± 1.33), while the control group maintained consistently higher anxiety levels (mean = 12.24 ± 1.39). ANCOVA, controlling for baseline anxiety and age, revealed a statistically significant main effect of intervention group on post-intervention anxiety scores [F 2, 70) = 38.24, P < 0.001, η² = 0.52]. Post-hoc pairwise comparisons with Bonferroni correction showed that, compared with the control group, both VR (P < 0.001) and play therapy (P < 0.001) significantly reduced anxiety. Furthermore, VR produced significantly greater anxiety reduction than play therapy (P = 0.03, Cohen's d = 0.83). Parental satisfaction was uniformly high across both intervention groups, with no significant difference between them (P = 0.568).

Conclusion: Both VR and play therapy are effective non-pharmacological interventions for reducing pre-catheterization anxiety in children. VR demonstrated superior anxiolytic effects compared to play therapy, with a large effect size. Integrating VR-based distraction into routine pre-procedural nursing care may enhance pediatric procedural experiences

and improve clinical outcomes.

Mind-Body Benefits of Eye Movement Desensitization and Reprocessing (EMDR) in Acute Respiratory Infections: A Randomized Clinical Study of Psychophysiological Outcomes

2026-08-01T11:23:05+0430

Objective: Acute respiratory infection (ARI) represent one of the foremost contributors to worldwide mortality. Psychological factors, notably anxiety, commonly obstruct patient recovery. Conventional medical approaches rarely account for the interplay between these psychological and physiological factors. This study aimed to determine the effects of EMDR on hemodynamic indices, anxiety levels, and sleep quality in hospitalized patients with ARI.

Method: In 2022, a six-month parallel-group randomized controlled trial was conducted in Yasouj, Iran, including 89 hospitalized patients with ARI. Participants were randomly assigned to either an intervention group receiving three bedside Eye Movement Desensitization and Reprocessing (EMDR) sessions (45–90 minutes each) or a control group receiving standard care. Outcomes included the Hamilton Anxiety Rating Scale (HARS), a hemodynamic monitoring checklist, and the Pittsburgh Sleep Quality Index (PSQI), assessed at baseline and post-intervention. Data were analyzed using SPSS version 26 with descriptive and inferential statistical methods.

Results: In the intervention group, mean heart rate, respiratory rate, blood pressure, and anxiety scores decreased significantly compared with the control group, whereas blood oxygen saturation increased significantly (P ≤ 0.05). Sleep quality indices in the EMDR group exhibited statistically significant improvements relative to the control group at both the one-month and three-month follow-up assessments (P = 0.001). Within-group analyses further confirmed notable pre- to post-intervention changes across the key outcome variables exclusively in the EMDR arm (P ≤ 0.05). In contrast, the control group displayed no statistically meaningful alterations in these parameters.

Conclusion: Taken together, the present findings position EMDR as a clinically viable, rapidly applicable, and pharmacologically independent therapeutic option for patients hospitalized with ARI.

A Systematic Review of Narrative-Based Therapy for Enhancing Self-Esteem and Psychological Well-Being in Children and Adolescents

2026-07-20T12:29:10+0430

Objective: Self-esteem and psychological well-being are key determinants of mental health in children and adolescents. Narrative-based interventions (NBIs) are increasingly used to promote these outcomes. This systematic review aimed to evaluate the effectiveness of NBIs on self-esteem and psychological well-being in children and adolescents.

Method: A systematic search was conducted in Scopus and PubMed (January 2010 – March 2025). MeSH terms included narrative therapy, storytelling, self-esteem, psychological well-being, child, and adolescent. Two reviewers independently screened records, extracted data, and assessed quality using the Mixed Methods Appraisal Tool (MMAT). A total of 18 studies were included: seven randomized controlled trials (RCTs), three quasi-experimental, four qualitative, and four mixed-methods designs. Narrative synthesis was used due to heterogeneity.

Results: Fifteen studies (83.3%) reported positive effects on self-esteem or psychological well-being. Effect sizes ranged from small to large. Digital storytelling was most consistently associated with improved self-esteem (4 of 5 studies). Group narrative therapy showed stronger effects on behavioral symptoms (3 of 3 studies). Two studies reported null or mixed findings. Moreover, qualitative studies consistently reported themes of empowerment, healing, and identity transformation.

Conclusion: NBIs show promise for enhancing self-esteem and well-being, particularly digital storytelling and group narrative therapy. However, evidence quality is variable. High-quality RCTs with diverse populations and longer follow-ups are needed.

Self-Esteem, Social Anxiety, and Affective Lability as Predictors of Academic Achievement in Pediatric Nursing Students: A Mediation Analysis

2026-07-02T01:25:33+0430

Objective: To assess levels of self-esteem, social anxiety, and affective lability among pediatric nursing students; to examine their associations with academic achievement; and to test whether social anxiety and affective lability mediate the self-esteem–achievement relationship.

Method: A descriptive cross-sectional study was conducted among 370 nursing students aged 17-24 years using purposive sampling. Instruments included the Coopersmith Self-Esteem Scale (self-esteem), the Liebowitz Social Anxiety Scale-Self-Report (LSAS-SR), the Affective Lability Scale (ALS-18), and academic achievement records from the pediatric nursing course. Sociodemographic variables were also collected. Data were analyzed using Pearson correlations and mediation analysis with Hayes PROCESS Model 4.

Results: Students demonstrated moderate self-esteem, mild-to-moderate social anxiety, and clinically notable affective lability (mean ALS-18 = 42.3 ± 11.7; scores > 40 indicate clinically notable emotional dysregulation). Self-esteem showed a significant positive correlation with academic achievement (r = 0.42, P < 0.01). Social anxiety (r = -0.38, P < 0.01) and affective lability (r = -0.36, P < 0.01) were each negatively correlated with both self-esteem and academic achievement. Mediation analysis revealed that social anxiety and affective lability partially mediated the relationship between self-esteem and academic achievement (indirect effect = 0.19, 95% CI: 0.08 to 0.33), accounting for 41% of the total association between self-esteem and academic achievement (proportion mediated = 0.41). No significant associations were found between sociodemographic variables and self-esteem.

Conclusion: Self-esteem is positively associated with academic achievement among pediatric nursing students. Cross-sectional mediation analysis indicates that this association is statistically consistent with a model in which social anxiety and affective lability together account for 41% of the total association. However, causal interpretation requires longitudinal replication. Psychiatric screening for emotional dysregulation and social anxiety using validated tools such as the ALS-18 and LSAS may help identify at-risk students, but experimental studies are needed to test whether interventions targeting these constructs improve academic outcomes.