Objective: Acute respiratory infection (ARI) represent one of the foremost contributors to worldwide mortality. Psychological factors, notably anxiety, commonly obstruct patient recovery. Conventional medical approaches rarely account for the interplay between these psychological and physiological factors. This study aimed to determine the effects of EMDR on hemodynamic indices, anxiety levels, and sleep quality in hospitalized patients with ARI.

Method: In 2022, a six-month parallel-group randomized controlled trial was conducted in Yasouj, Iran, including 89 hospitalized patients with ARI. Participants were randomly assigned to either an intervention group receiving three bedside Eye Movement Desensitization and Reprocessing (EMDR) sessions (45–90 minutes each) or a control group receiving standard care. Outcomes included the Hamilton Anxiety Rating Scale (HARS), a hemodynamic monitoring checklist, and the Pittsburgh Sleep Quality Index (PSQI), assessed at baseline and post-intervention. Data were analyzed using SPSS version 26 with descriptive and inferential statistical methods.

Results: In the intervention group, mean heart rate, respiratory rate, blood pressure, and anxiety scores decreased significantly compared with the control group, whereas blood oxygen saturation increased significantly (P ≤ 0.05). Sleep quality indices in the EMDR group exhibited statistically significant improvements relative to the control group at both the one-month and three-month follow-up assessments (P = 0.001). Within-group analyses further confirmed notable pre- to post-intervention changes across the key outcome variables exclusively in the EMDR arm (P ≤ 0.05). In contrast, the control group displayed no statistically meaningful alterations in these parameters.

Conclusion: Taken together, the present findings position EMDR as a clinically viable, rapidly applicable, and pharmacologically independent therapeutic option for patients hospitalized with ARI.

Objective: This study aimed to compare the effectiveness of virtual reality (VR) versus play therapy in reducing pre-procedural anxiety among children scheduled for cardiac catheterization, and to evaluate parental satisfaction with these interventions.

Method: A randomized, assessor-blinded, pretest-posttest comparative trial was conducted at Al-Nasiriyah Heart Hospital between December 2025 and February 2026. A total of 75 children aged 3-7 years with congenital heart defects were randomly allocated into three equal groups (n = 25 each): VR (15 minutes of immersive 3D video), play therapy (15 minutes of coloring activity), and control (standard care). Anxiety was assessed using the Modified Yale Preoperative Anxiety Scale (mYPAS) at four time points (two pre-intervention and two post-intervention measurements). The outcome assessor was blinded to group allocation. Data were analyzed using analysis of covariance (ANCOVA) with Bonferroni-adjusted post-hoc comparisons to control for baseline age and anxiety differences.

Results: The VR group demonstrated the lowest mean anxiety score post-intervention (mean = 5.04 ± 0.20), followed by the play therapy group (mean = 5.88 ± 1.33), while the control group maintained consistently higher anxiety levels (mean = 12.24 ± 1.39). ANCOVA, controlling for baseline anxiety and age, revealed a statistically significant main effect of intervention group on post-intervention anxiety scores [F 2, 70) = 38.24, P < 0.001, η² = 0.52]. Post-hoc pairwise comparisons with Bonferroni correction showed that, compared with the control group, both VR (P < 0.001) and play therapy (P < 0.001) significantly reduced anxiety. Furthermore, VR produced significantly greater anxiety reduction than play therapy (P = 0.03, Cohen's d = 0.83). Parental satisfaction was uniformly high across both intervention groups, with no significant difference between them (P = 0.568).

Conclusion: Both VR and play therapy are effective non-pharmacological interventions for reducing pre-catheterization anxiety in children. VR demonstrated superior anxiolytic effects compared to play therapy, with a large effect size. Integrating VR-based distraction into routine pre-procedural nursing care may enhance pediatric procedural experiences

and improve clinical outcomes.

Objective: Suicide is a critical public health issue, with heightened risks among psychiatric inpatients. In Iran, sociocultural and systemic factors uniquely shape suicide attempts in psychiatric wards, yet nurses’ perspectives on these factors remain underexplored. This study aims to identify the factors influencing suicide attempts among hospitalized psychiatric patients in Iran, as perceived by nurses, using a qualitative content analysis approach.

Method: A qualitative study was conducted from June 2024 to June 2025 in the psychiatric wards of two university-affiliated hospitals in Urmia, Iran. Using purposive and subsequent theoretical sampling, 18 registered nurses (12 females, 6 males; mean age 42.3 years; mean experience 12.5 years) were recruited. Sample adequacy was established through data saturation, which was confirmed after 15 interviews with three additional interviews yielding no new themes. Semi-structured interviews explored nurses’ perceptions of factors influencing suicide attempts. Data were analyzed using Graneheim and Lundman’s conventional content analysis, involving iterative coding, condensation of meaning units, development of subcategories, and abstraction into main categories and an overarching theme. Rigor was ensured via Lincoln and Guba’s trustworthiness criteria.

Results: One overarching theme emerged: "Interwoven Threads of Vulnerability and Resilience in Psychiatric Care." Four main categories were identified: (1) Individual Patient Vulnerabilities (unresolved trauma, impulsivity, substance use); (2) Relational and Familial Dynamics (familial stigma, interpersonal conflicts, and, specifically within Iran’s collectivist culture, expectations of emotional stoicism linked to historical narratives of martyrdom); (3) Ward Environment and Systemic Barriers (inadequate staffing, disruptive interactions, inconsistent protocols); and (4) Neglected Protective Factors (undervalued therapeutic alliances, culturally resonant but overlooked spiritual coping such as Quranic recitation, and missed empowerment opportunities). These themes were deeply shaped by Iran-specific conditions, including the legacy of war-related trauma, family honor–based stigma, chronic overcrowding with nurse-to-patient ratios reaching 1:20, and underutilized Islamic faith practices.

Conclusion: Nurses’ insights reveal that suicide attempts in Iranian psychiatric wards stem from a complex interplay of vulnerabilities, relational strains, and systemic deficiencies. Accordingly, culturally tailored interventions should directly target each finding: trauma-informed care (addressing individual vulnerabilities), family education programs to reduce honor-based stigma (addressing relational dynamics), staffing ratio enforcement and protocol standardization (addressing systemic barriers), and the integration of spiritual coping and skill-building groups (activating neglected protective factors). These evidence-grounded recommendations offer a roadmap for suicide prevention in resource-constrained Iranian psychiatric settings.

Objective: Applied Behavior Analysis (ABA) is an evidence-based intervention for autism spectrum disorder (ASD), but treatment discontinuation remains common. Adapted Intensive Applied Behavior Analysis (AIABA) is a culturally modified version of ABA developed for Iranian families, that integrates cultural and family values into daily routines. This study examined clinical and contextual predictors of AIABA discontinuation.

Method: We reviewed clinical files of 529 children with ASD (mean age = 41.7 months, SD = 13.8) who received AIABA at the Tehran Autism Center (2011 2021). Predictors included parental engagement, programming mode (in person vs. semi online), medication use, age at diagnosis, comorbidity, motor development, additional therapies, and symptom severity. Logistic regression identified predictors of discontinuation.

Results: Discontinuation occurred in 66.7% of children. Mean treatment duration was shorter in the discontinuation group (11.4 months) than the planned termination group (19.1 months). Significant predictors included lower parental engagement (OR = 0.03, 95% CI [0.01 0.07]), concurrent medication use (OR = 3.22, 95% CI [1.89 5.49]), semi online supervision (OR = 3.01, 95% CI [1.61 5.63]), higher pre cessation symptom severity (OR = 1.04, 95% CI [1.01 1.06]), and younger age at diagnosis (OR = 0.97, 95% CI [0.95 0.98]). The model explained 38.8% 53.9% of variance and correctly classified 83.4% of cases.

Conclusion: Lower parental engagement, concurrent medication use, semi online supervision, higher pre cessation symptom severity, and younger age at diagnosis significantly predicted AIABA discontinuation. Targeting parental engagement, monitoring intensity, and coordinated care may reduce dropout risk. Given the retrospective, single center design and reliance on record-based measures, results require cautious interpretation. Prospective multi-site studies are needed to translate these predictors into retention focused planning.

Objective: This cross-sectional study examined maternal role adaptation among mothers of preterm infants in Neonatal Intensive Care Units (NICUs), and assessed whether self-efficacy and social support explain additional variance in adaptation beyond global self-esteem.

Method: A cross-sectional correlational design was employed with a convenience sample of 350 mothers of preterm infants (gestational age < 37 weeks) admitted to the NICU at Imam Al-Sadiq Teaching Hospital in Hilla city, Iraq. Participants completed validated Arabic versions of the Rosenberg Self-Esteem Scale, the Arabic Parental Self-Efficacy Scale (APSES), the Multidimensional Scale of Perceived Social Support (MSPSS), and a Maternal Role Adaptation Questionnaire. Data were analyzed using descriptive statistics, Pearson correlations, and hierarchical linear regression.

Results: Overall maternal role adaptation was poor in 61.4% of mothers (mean score 23.72 ± 5.31). Self-efficacy showed the strongest correlation with adaptation (r = 0.56, P < 0.001), followed by social support (r = 0.51, P < 0.001) and self-esteem (r = 0.44, P < 0.001). Hierarchical regression revealed that after controlling for demographic covariates, self-efficacy (β = 0.41, 95% CI: 0.31-0.50, P < 0.001) and social support (β = 0.33, 95% CI: 0.23-0.42 P < 0.001) were independently associated with adaptation, while self-esteem was not significant in the final model (β = 0.08, 95% CI: -0.03-0.19, P = 0.14). The full model explained 44% of the variance in adaptation scores (R² = 0.44).

Conclusion: Maternal self-efficacy and perceived social support demonstrate stronger associations with adaptation to motherhood than global self-esteem among mothers of preterm infants in NICUs. Interventions to enhance NICU mothers' adaptation should prioritize skill-based self-efficacy building and social support mobilization.

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.

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.

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.

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.

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.

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.

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.

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.