Iranian Journal of Psychiatry

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.

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

2026-10-06T12:05:08+0330

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.