Iranian Journal of Psychiatry

Lived Experiences of Quiet Quitting Among ICU Nurses: A Sequential Explanatory Mixed Methods Study

2026-11-09T11:58:56+0330

Objective: To examine the relationships among quality of work life (QWL), compassion fatigue, psychological resilience, and quiet quitting among intensive care unit (ICU) nurses, and to explore the lived experiences of nurses who exhibit quiet quitting behavior.

Method: A sequential explanatory mixed-methods design was employed. In the quantitative phase, 400 ICU nurses from six public teaching hospitals in Kerbala and Babylon, Iraq, completed the QWL Scale, Compassion Fatigue Short Scale, Connor-Davidson Resilience Scale (CD-RISC), and Quiet Quitting Scale. Data were analyzed using mediation analysis with PROCESS macro. In the qualitative phase, 30 nurses were purposively selected for in-depth semi-structured interviews based on their quiet quitting scores. Thematic analysis was used to identify key themes.

Results: QWL was negatively associated with quiet quitting (β = -0.38, P < 0.001) and compassion fatigue (β = -0.41, P < 0.001), while compassion fatigue was positively associated with quiet quitting (β = 0.42, P < 0.001). Compassion fatigue significantly mediated the relationship between QWL and quiet quitting (indirect effect = -0.14, 95% CI: -0.19 to -0.09), accounting for 43.8% of the total effect. Psychological resilience moderated the QWL-compassion fatigue relationship (interaction β = 0.18, P < 0.01). Qualitative analysis revealed three major themes: erosion of professional identity and meaning, surviving versus thriving in the ICU environment, and the paradox of resilience.

Conclusion: Poor QWL was associated with quiet quitting through increased compassion fatigue, while psychological resilience appeared to serve as a protective factor. The qualitative findings provide rich contextual understanding of the processes underlying quiet quitting. Organizational strategies that improve working conditions, foster resilience, and restore professional meaning may help sustain nurses' work engagement and reduce quiet quitting.

Social Media Addiction, Sleep Disturbance, Emotional Dysregulation, and Academic Performance Among School-Aged Children: A Serial Mediation Analysis

2026-10-27T10:50:41+0330

Objective: This study aimed to examine the serial mediating roles of sleep disturbance and emotional dysregulation in the relationship between social media addiction and academic performance among school-aged children aged 6-12 years.

Method: A cross-sectional explanatory study was conducted among 760 school-aged children aged 6-12 years recruited from primary schools in Holy Kerbala City, Iraq, using stratified cluster random sampling. Data were collected using four validated instruments: The Social Media Addiction Scale-Student Form (SMAS-SF), the Children's Sleep Habits Questionnaire (CSHQ), the Difficulties in Emotion Regulation Scale-Short Form (DERS-SF), and a standardized School Performance Scale. Serial mediation analysis was conducted using structural equation modeling (SEM) with bootstrapping to test the hypothesized pathway.

Results: The prevalence of moderate-to-severe social media addiction was 68.4%, with a mean SMAS score of 99.2 (SD = 17.4). Mean sleep duration was only 5.8 hours (SD = 1.3), far below the recommended 9-12 hours. Emotional dysregulation was markedly elevated (mean DERS = 56.3, SD = 12.1). The serial mediation model demonstrated good fit (CFI = 0.93, RMSEA = 0.061). Social media addiction had a significant negative total effect on academic performance (β = -0.44, P = 0.001). The total indirect effect through the serial pathway was significant (β = -0.18, 95% CI: -0.24 to -0.12), accounting for 40.9% of the total effect. The specific serial indirect effect (addiction → sleep disturbance → emotional dysregulation → performance) was β = -0.08 (95% CI: -0.12 to -0.04). Maternal education (P = 0.009) and family income (P < 0.001) were significantly associated with addiction severity.

Conclusion: Emotional dysregulation is a significant serial mediator linking social media addiction to poor academic performance through sleep disturbance. These findings support social learning theory, suggesting how maladaptive media habits may disrupt biological (sleep) and emotional regulatory systems. School-based interventions should target not only sleep hygiene, but also emotion regulation skills training.

Efficacy of Saffron Capsules on Binge Eating Episodes, Appetite and Body Mass Index of Individuals with Binge Eating Disorder: A 12-Week Randomized Clinical Trial

2026-10-06T12:06:07+0330

Objective: We aimed to assess the efficacy of saffron versus placebo on binge eating severity, appetite, and body mass index (BMI) in adults diagnosed with binge eating disorder (BED).
Method: This was a 12-week randomized, double-blind, placebo-controlled trial with parallel design. We randomized 59 participants with confirmed diagnoses of BED according to DSM-5 criteria to receive either saffron extract (15 mg per capsule twice daily; total daily dose 30 mg; n = 30) or placebo (15 mg starch per capsule twice daily; n = 29). We assessed binge eating episodes (daily diary), appetite (visual analogue scale [VAS]), BMI, and macronutrient intake (3-day food records) before and after the trial. We analyzed the data using the intention-to-treat (ITT) approach and paired t-tests/Wilcoxon tests for within-group changes and independent t-tests/Mann-Whitney U tests for between-group differences. Furthermore, we used analysis of covariance (ANCOVA) with the primary outcome as the dependent variable and key baseline variables as covariates to compare endpoint outcomes between groups.
Results: We detected significant reductions in the saffron group compared with the placebo group in binge eating severity (mean difference: −1.16 ± 0.25; P ≤ 0.001; Cohen’s d = −1.30), Appetite VAS scores (−3.34 ± 0.56; P ≤ 0.001; Cohen’s d = −1.76), Calorie intake (−448 ± 113 kcal/day; P ≤ 0.001; Cohen’s d = −1.03), and Fat intake (−21.45 ± 5.10 g/day; P ≤ 0.001; Cohen’s d = −1.09). Furthermore, the saffron group showed a significant decrease in mean difference of BMI (−0.61 ± 0.45 kg/m²; P = 0.006; Cohen’s d = −0.43). ANCOVA results revealed that the adjusted treatment effect was -1.10 (95% CI: -1.60 to -0.60, P < 0.001).
Conclusion: Saffron supplementation significantly decreases the core symptoms of BED, reduces appetite and caloric intake, and modestly lowers BMI. Saffron capsules could be considered a safe and efficient supplement for people undergoing BED treatment.

The Interplay of Sleep Disturbance, Fear of Missing Out and Emotional Reactivity to Social Media Use in Adolescence

2026-10-06T12:05:22+0330

Objective: This study aims to transcend the limitations of aggregate screen time metrics by investigating the granular affective dynamics and emotional reactivity associated with specific social media behaviors in adolescents, while also incorporating the constructs of sleep quality and fear of missing out (FoMO).
Method: A cohort of 346 adolescents participated in a 21-day ecological momentary assessment (EMA) protocol, receiving five prompts daily. Participants reported real-time social media activities (passive scrolling versus active interaction), concurrent affect, and pre-sleep social media use. Baseline and follow-up depressive symptoms were assessed using the patient health questionnaire-9 (PHQ-9). Additional measures included the FoMO scale and the Pittsburgh sleep quality index (PSQI). We utilized dynamic structural equation modeling (DSEM) to analyze within-person temporal associations and machine learning (random forest) to identify behavioral predictors of depression.
Results: For 328 adolescents who completed the EMA protocol, DSEM revealed that passive scrolling predicted subsequent increases in negative affect (β = 0.31, P < 0.001), whereas active interaction predicted increased positive affect (β = 0.22, P = 0.003). High FoMO significantly moderated the relationship between passive use and negative affect (β = 0.15, P = 0.01). Furthermore, two distinct mediation pathways were identified. First, nighttime social media use mediated the association between daily passive scrolling and poorer next-day sleep quality (indirect effect = -0.10, 95% CI [-0.15, -0.05]). Second, aggregated poor sleep quality over the study period mediated the relationship between average passive scrolling and increased depressive symptoms at follow-up (indirect effect = 0.12, 95% CI [0.05, 0.19]). The machine learning model achieved high predictive accuracy for PHQ-9 scores (R² = 0.76, RMSE = 2.31), identifying high-frequency passive use, elevated FoMO, and delayed sleep onset as primary risk factors.
Conclusion: The findings demonstrate that the emotional impact of social media is contingent upon usage patterns and individual traits like FoMO. Passive consumption was prospectively associated with negative emotional spirals and disrupted sleep, highlighting the need for interventions targeting specific digital behaviors and evening routines rather than total screen time.

From Social Struggles to Internal Battles: Understanding Depression Through Interpersonal Problems and Rumination

2026-10-06T12:05:54+0330

Objective: Depression represents a significant global health burden, with interpersonal problems and rumination emerging as crucial correlates. However, the precise nature of the associations linking these elements remains unclear. This study investigated the statistical mediation pattern of rumination in the relationship between interpersonal problems and depressive symptoms in the Iranian population.
Method: A cross-sectional study was conducted with 564 participants (38.5% male, 61.5% female; mean age = 21.50, SD = 3.47) recruited through social media networks in Zanjan, Iran. Participants completed the Inventory of Interpersonal Problems (IIP-32), Rumination Response Scale (RRS), and Beck Depression Inventory-II (BDI-II). Structural equation modeling was employed to test the hypothesized mediation model.
Results: The structural model demonstrated an excellent fit (χ²/df = 2.904, RMSEA = 0.055, CFI = 0.979). Interpersonal problems were significantly associated with both rumination (β = 0.637, P < 0.001) and depressive symptoms (β = 0.253, P < 0.001). Rumination showed a significant indirect association (β = 0.373, P < 0.001) in the relationship between interpersonal problems and depression symptoms. The total association of interpersonal problems with depressive symptoms was substantial (β = 0.627, P < 0.001).
Conclusion: The findings confirm that interpersonal problems are both directly and indirectly associated with depressive symptoms, with the indirect statistical pathway operating via rumination. This suggests that the interplay between interpersonal difficulties and ruminative thinking patterns may be a relevant consideration for future clinical research aiming to improve depression outcomes.