Iranian Journal of Psychiatry

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

Yifei Pan — 2026-07-20

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

Alaa Neamah — 2026-06-17

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.

Early-Onset Somatic Delusional Presentation: A Case Report and Two-Decade Comparative Synthesis

Lakshmi Dorai B Dorai B — 2026-06-15

Objective: Somatic-type delusional disorder is characterized by fixed false beliefs related to bodily changes or illness. This report describes an unusual early-onset case associated with significant functional decline and compares its features with previously published cases.

Method: Clinical information was collected through psychiatric assessment, family interviews, physical and neurological examinations, laboratory investigations, and six months of follow-up. A narrative review of relevant English-language case reports published between 2003 and 2025 was also undertaken.

Results: A 22-year-old woman developed a persistent belief that self-inflicted cuts on her feet had permanently altered her joints and skin. Despite repeated reassurance and normal medical findings, she remained convinced of the perceived deformity. The condition was associated with depressed mood, social isolation, poor self-care, reduced food intake, and academic impairment. Investigations did not identify an underlying medical cause. Treatment with olanzapine, psychoeducation, supportive psychotherapy, and family counselling resulted in gradual improvement. During follow-up, delusional conviction decreased substantially, accompanied by better self-care, social interaction, and academic functioning. Review of the literature indicated that severe impairment and early onset are relatively uncommon in somatic-type delusional disorder.

Conclusion: Early-onset somatic delusions can lead to marked psychosocial dysfunction and may differ from the traditionally described pattern of preserved functioning. Comprehensive assessment, ongoing diagnostic review, and combined pharmacological and psychosocial interventions are important for achieving favorable outcomes.

Psycho-Spiritual Pathways to Well-Being after Adversity: An Umbrella Review

Zahra Asgari — 2026-06-10

Objective: This umbrella review synthesizes findings from existing systematic, scoping, and narrative reviews on psycho-spiritual processes and interventions that influence well-being following trauma and adversity.

Method: Following umbrella review methodology, we searched major databases (PsycINFO, PubMed, CINAHL, etc.) for reviews published between 2015 and 2025. Methodological quality was assessed using the AMSTAR-2 tool. Only reviews scoring above the predefined threshold of > 8/16 were included. All 18 included reviews scored 14–16 out of 16, indicating high methodological quality. Eighteen reviews met the inclusion criteria, encompassing diverse populations including veterans, cancer survivors, disaster victims, and survivors of abuse.

Results: The synthesis reveals three core psycho-spiritual pathways: 1) The Meaning-Making Pathway, where spirituality facilitates posttraumatic growth (PTG), identity reconstruction, and spiritual well-being (SWB); 2) The Pathway of Spiritual Struggle, where existential conflict, moral injury, and a loss of meaning exacerbate psychological distress; and 3) The intervention Pathway, where psycho-spiritually integrated therapies showed positive effects. However, effect sizes, confidence intervals, and heterogeneity were inconsistently reported across the 18 included reviews, precluding a single pooled estimate. Effect sizes from meta‑analyses ranged from small to moderate: for depression (Cohen’s d = 0.42, 95% CI [0.21, 0.63]), for anxiety (SMD = 0.31–0.58), and for spiritual well‑being (SMD = 0.47, 95% CI [0.29, 0.65]). Heterogeneity was moderate to high (I² = 54–72%). Key facilitators include person-centered, trauma-informed care that validates spiritual concerns, while a primary barrier is the clinician's lack of training in addressing existential and spiritual dimensions.

Conclusion: Psycho-SWB is a pivotal, multifaceted outcome of trauma recovery. Effective support requires a nuanced approach that acknowledges both the potential for growth and the reality of existential pain. Clinical practice must integrate evidence-based psycho-spiritual interventions, while research should prioritize longitudinal designs, diverse populations, and standardized measures of psycho-spiritual constructs.

Toward Responsible Suicide Reporting in Iran: Media Practices, Social Media Challenges, and WHO Recommendations

Mohammadreza Shalbafan — 2026-06-09