Iranian Journal of Psychiatry

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

2026-09-13T15:28:25+0430

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

2026-09-12T11:24:26+0430

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.

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.