Iranian Journal of Psychiatry

Gender-Related Fairness of Personality Psychopathology Five (PSY-5) Dimensions: Gender Differences in PSY-5 Functioning

2026-09-07T13:30:33+0430

Objective: Establishing measurement invariance is essential to ensure that Minnesota Multiphasic Personality Inventory (MMPI-3) scores accurately reflect the intended latent traits and can be interpreted fairly across gender groups. Given the importance of measurement equivalence for valid clinical interpretation, this study evaluated Differential Item Functioning (DIF) and Differential Test Functioning (DTF) in the Personality Psychopathology Five (PSY-5) scales of the Persian version of the MMPI-3 within an Iranian clinical sample.

Method: A total of 871 psychiatric outpatients (59% female; mean age = 28.76 ± 10.58) diagnosed with at least one DSM-5 disorder were recruited using convenience sampling. Invalid response protocols were excluded according to MMPI-3 validity criteria. Dimensionality of the PSY-5 scales was assessed via confirmatory factor analysis and Rasch measurement modeling, leading to the exclusion of the Disconstraint scale due to multidimensionality. Rasch-based analyses were used to evaluate item fit, reliability, local dependence (Q3), and DIF. Overall DTF was quantified using Signed and Unsigned Test Difference statistics, and Fisher’s Z tests were used to compare inter-scale correlation patterns across gender.

Results: Significant DTF was observed for the four retained PSY-5 scales (Aggressiveness, Psychoticism, Negative Emotionality, and Introversion) following the exclusion of DISC due to multidimensionality. STDS values ranged from −0.27 to −0.37 and UTDS values ranged from 0.28 to 0.43, indicating consistent gender-related score differences of small-to-moderate magnitude at comparable latent trait levels that may influence clinical interpretation. Inter-scale correlations also differed across gender groups, particularly for PSYC, NEGE, and INTR, suggesting gender-related variation in scale functioning and construct associations.

Conclusion: The findings indicate that several MMPI-3 PSY-5 scales may not demonstrate full measurement equivalence across genders in Iranian clinical populations. These results highlight the importance of local psychometric evaluation and careful interpretation of gender-based score comparisons when applying standardized personality assessment instruments in non-Western clinical settings.

Moral Distress, Psychological Resilience, and Burnout in Psychiatric Nurses: A Cross-Sectional Study with Social Support and Coping Strategies as Moderators

2026-09-07T13:13:20+0430

Objective: We investigated the potential mediating effect of psychological resilience on the relationship between moral distress and burnout in psychiatric nurses, and examined how coping mechanisms and social support moderate this relationship.

Method: A cross-sectional study was performed with 385 psychiatric nursing staff from four psychiatric hospitals in Iraq. Participants completed the Moral Distress Scale-Revised (MDS-R), Connor-Davidson Resilience Scale-10 (CD-RISC-10), Maslach Burnout Inventory-Human Services Survey (MBI-HSS), Multidimensional Scale of Perceived Social Support (MSPSS), and Brief Coping Orientation to Problems Experienced (Brief COPE) inventory. Structural equation modeling with bootstrapping (5,000 resamples) was utilized for testing mediation, and PROCESS-based moderated mediation analysis (Model 7) was utilized to explore the moderating roles of social support and adaptive coping.

Results: Moral distress showed a significant total effect on burnout (β = 0.52, P < 0.01), and psychological resilience was negatively linked to burnout (β = -0.36, P = 0.01). Resilience showed a significant indirect effect, consistent with its mediating role in the relationship between moral distress and burnout (indirect effect = 0.15, 95% CI [0.08, 0.23]), accounting for 28.8% of the total effect. The direct effect of moral distress on burnout remained significant after accounting for resilience (β = 0.37, 95% CI [0.23, 0.51], P = 0.009), indicating partial mediation. Social support and adaptive coping strategies significantly moderated the indirect pathway, with the mediation effect being stronger among nurses reporting higher social support (index of moderated mediation = 0.07, 95% CI [0.03, 0.12]) and greater use of adaptive coping strategies (index = 0.09, 95% CI [0.04, 0.14]).

Conclusion: Psychological resilience partially mediates the connection between moral distress and burnout in psychiatric nurses. The findings imply that resilience, social support, and coping skills may be promising targets for intervention development. However, experimental studies are needed to determine whether interventions addressing these factors are effective in reducing burnout in this population.

Repetitive Negative Thinking and Somatic Symptoms as Mediators of the Relationship between Childhood Abuse and Depression Severity in Major Depressive Disorder

2026-09-06T14:24:24+0430

Objective: Major depressive disorder (MDD) is highly heterogeneous, and adverse childhood experiences (ACEs) contribute significantly to its variability. While abuse-type ACEs are linked to worse outcomes, the specific mechanisms remain poorly understood. This study tests a novel model in which abuse-specific ACEs, compared to neglect or household dysfunction, exert a stronger influence on depression severity by increasing repetitive negative thinking (RNT), which in turn amplifies somatic symptom burden.

Method: In a cross-sectional study, 435 adults with a confirmed DSM-5 diagnosis of MDD were recruited from psychiatric clinics. Participants completed the Childhood Trauma Questionnaire (CTQ), the RNT Questionnaire (RNTQ), the Patient Health Questionnaire-15 (PHQ-15) for somatic symptoms, and the Beck Depression Inventory-II (BDI-II). Using structural equation modeling (SEM), we tested a dual mediation model where abuse, neglect, and household dysfunction ACEs predicted BDI-II scores via direct and indirect pathways, with a focus on the sequential path through RNT and somatic symptoms.

Results: The model demonstrated excellent fit (CFI = 0.96, RMSEA = 0.04) and accounted for 54% of the variance in depression severity (R² = 0.54). Abuse ACEs had a significantly stronger total effect on depression severity than other ACE types (β = 0.41 versus ≤ 0.18, P < 0.01) and also exerted a significant direct effect on depression severity (β = 0.22, P = 0.012). The specific indirect pathway from abuse ACEs to RNT to somatic symptoms to depression was also significant (β = 0.19, 95% CI [0.13, 0.26]), accounting for 46% of the total effect of abuse on depression (total effect β = 0.41, P < 0.001). This pathway was significantly stronger (P < 0.001) than analogous pathways from neglect or household dysfunction ACEs.

Conclusion: The path from childhood abuse to severe depression is characterized by a cognitive-somatic cascade: abuse fuels persistent negative thinking, which exacerbates the perception and burden of physical symptoms, ultimately deepening depressive severity. This identifies a specific phenotypic profile (high RNT + high somatic burden) associated with abuse histories, highlighting essential targets for tailored intervention in trauma-informed depression care.

Predictors of Evidence-Based Communication Strategy Use in Preschool Settings: The Role of Knowledge, Self-Efficacy, and Organizational Support in Autism Education

2026-08-24T11:31:16+0430

Objective: This study investigated the predictive relationships between kindergarten teachers' knowledge of communication skills for children with autism spectrum disorder (ASD), the teachers’ self-efficacy beliefs, their attitudes towards inclusive education, their perceived organizational support, and their self-reported utilization of evidence-based communication strategies.

Method: A cross-sectional predictive correlational design was employed across government-operated kindergartens in Kerbala Governorate, Iraq. Stratified random sampling recruited 243 kindergarten teachers. Data were collected using a comprehensive self-administered questionnaire comprising validated instruments measuring demographic characteristics, autism-specific communication knowledge, teacher self-efficacy for inclusive practices using the Teacher Efficacy for Inclusive Practices Scale, attitudes towards inclusion using the Multidimensional Attitudes Scale Toward Persons with Disabilities, perceived organizational support using the Survey of Perceived Organizational Support, and frequency of evidence-based strategy use. Hierarchical multiple regression analysis was conducted to identify significant independent predictors of strategy implementation.

Results: The final regression model was highly significant (F (7, 235) = 25.32, P < 0.001) and accounted for 42% of the variance in teachers' use of evidence-based communication strategies (R2 = 0.42). Teacher self-efficacy emerged as the strongest independent predictor (β = 0.35, P < 0.001), followed by perceived organizational support (β = 0.28, P < 0.01) and professional experience (β = 0.22, P < 0.05). General knowledge about autism spectrum disorder (β = 0.06, P = 0.12) and attitudes towards inclusion (β = 0.05, P = 0.23) did not retain statistical significance as independent predictors when self-efficacy and organizational support were controlled.

Conclusion: Effective communication support for children with autism in inclusive preschool environments is determined by a complex interplay of individual psychological factors and organizational contextual variables. Professional development initiatives should prioritize cultivating teacher self-efficacy through experiential learning and coaching while fostering supportive school cultures and providing adequate resources and administrative encouragement.

Early Maladaptive Schemas, Emotion Regulation, and Forgiveness Across the Narcissism Spectrum: A Dimensional Comparative Study

2026-08-18T13:00:14+0430

Objective: This cross-sectional study compared early maladaptive schemas, emotion regulation, and forgiveness across healthy, narcissistic traits, and narcissistic personality disorder (NPD) groups.

Method: Convenience sampling yielded 492 adults: healthy individuals (n=205), individuals with narcissistic traits (n=196), and NPD (n=91). NPD classification required meeting the Structured Clinical Interview for DSM-5 Screening Personality Questionnaire (SCID-5-SPQ) threshold and telephone-based diagnostic confirmation. The traits group scored ≥8 on the Narcissistic Personality Inventory-16 (NPI-16) but did not meet the SCID-5-SPQ threshold; healthy participants scored below both thresholds. Participants completed Persian versions of the Young Schema Questionnaire-Short Form 3, Emotion Regulation Questionnaire, Interpersonal Emotion Regulation Questionnaire, and Heartland Forgiveness Scale. Multivariate analysis of covariance controlled for age, education, and marital status.

Results: Both narcissistic groups scored higher than healthy participants on emotional deprivation, F (2, 486) = 6.65, P = 0.001, η²_p = 0.027; defectiveness/shame, F (2, 486) = 7.00, P = 0.001, η²_p = 0.028; and entitlement/grandiosity, F (2, 486) = 28.52, P < 0.001, η²_p = 0.105. NPD participants reported higher perspective-taking than both groups, F (2, 486) = 10.57, P < 0.001, η²p = 0.042, and higher soothing than healthy participants, F (2, 486) = 6.87, P = 0.001, η²_p = 0.027. Healthy participants reported higher self-forgiveness than NPD participants, F (2, 486) = 5.14, P = 0.006, η²_p = 0.021, and higher forgiveness of others than both narcissistic groups, F (2, 486) = 13.33, P < 0.001, η²_p = 0.052. Situational forgiveness differed, F (2, 486) = 11.07, P < 0.001, η²_p = 0.044, with healthy > traits > NPD. No differences emerged in enhancing positive affect, social modeling, suppression, or cognitive reappraisal.

Conclusion: schema vulnerabilities and forgiveness difficulties may be associated with narcissistic traits and NPD, while perspective-taking and situational forgiveness may differentiate NPD from trait-level narcissism. Findings are associative, not causal.