Iranian Journal of Psychiatry

Self-Esteem, Social Anxiety, and Affective Lability as Predictors of Academic Achievement in Pediatric Nursing Students: A Mediation Analysis

Wed, 17 Jun 2026 10:21:49 +0430

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, Alluri Swetha Reddy, Mukesh B M, Arbind Kumar Choudhary — Mon, 15 Jun 2026 00:00:00 +0430

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 — Wed, 10 Jun 2026 00:00:00 +0430

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, Alireza Raeisi, Maryam Abbasinejad, Hadi Zarafshan — Tue, 09 Jun 2026 00:00:00 +0430

Effects of Vitamin B12 and Folic Acid Supplementation on Negative Symptoms as the Primary Outcome and Positive and Cognitive Symptoms as Secondary Outcomes in Schizophrenia: A Randomized Controlled Trial

Mahnaz Shah Ali, Omid Rezaei, Reza Momeni Shideh, Gita Sadighi — Sun, 07 Jun 2026 00:00:00 +0430

Objective: Persistent negative symptoms in chronic schizophrenia often show limited responsiveness to antipsychotic therapy. The present study evaluated whether supplementation with vitamin B12 and folic acid improves negative symptoms as the primary endpoint, while also examining effects on positive symptoms and global cognitive functioning as secondary outcomes.

Method: In this randomized, double-blind, placebo-controlled trial, 88 inpatients with chronic schizophrenia receiving stable risperidone therapy were assigned to one of four groups: vitamin B12 (1 mg/day), folic acid (1 mg/day), combined vitamin B12 plus folic acid (1 mg/day each), and placebo for eight weeks. Negative symptoms were measured using the Scale for the Assessment of Negative Symptoms (SANS), positive symptoms using the Scale for the Assessment of Positive Symptoms (SAPS), and cognitive function using the Mini-Mental State Examination (MMSE). Serum concentrations of vitamin B12 and folate were assessed at baseline and after the intervention.

Results: Supplementation with vitamin B12 and/or folic acid led to significant increases in serum concentrations of the corresponding vitamins (P < 0.001). All supplementation groups demonstrated significant and clinically meaningful reductions in negative symptom severity compared with placebo, with large effect sizes. In contrast, no significant changes were detected in positive symptoms or global cognitive performance.

Conclusion: Adjunctive vitamin B12 and folic acid supplementation significantly reduced negative symptom severity in chronic schizophrenia, without affecting positive symptoms or global cognition. Targeted correction of vitamin deficiencies may represent a valuable adjunctive approach for persistent negative symptoms.