Tehran University of Medical Sciences Iranian Journal of Psychiatry 1735-4587 18 2 2023 03 15 97 107 Najmeh Baghian Health Management and Policy Research Center, Department of HealthCare Services Management, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Mohsen Shati Mental Health Research Center, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran. Ali Akbari Sari Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Adel Eftekhari Health in Emergencies and Disasters, Department of Nursing, Meybod School of Nursing, Shahid Sadougi University of Medical Sciences, Yazd, Iran. Atefeh Rasolnezhad Student Research Committee, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Farhad Nanaei Department of Anesthesiology, School of Medicine, Dezful University of Medical Sciences, Dezful, Iran. Batoul Ahmadi Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran 2021 01 03 2022 10 08 Objective: In order to achieve development goals, in addition to providing students with physical health, their mental and social health should be considered as a necessity and priority in development programs. This program, called the Nemad Project in Iran was formally established in 2015. This study aims to explore the challenges of the Nemad project in Iranian schools based on stakeholders' views. Method: The present qualitative study, with a contractual content analysis approach, was conducted on 21 experts in the field of social harm prevention and mental health promotion at the senior, intermediate, and operational levels in educational institutions and schools, Ministry of Health, the Judiciary and the Planning and Budget Organization. These experts also included project technical officers. Participants were selected using snowball and purposeful sampling methods. Data were collected through semi-structured interviews and analyzed by coding, classification, and extraction of the main themes. Results: Six main themes were derived that included inefficiency in resource management (with subcategories of inadequate facilities and equipment, inadequate human resource management, and information management system deficiencies), weakness in program organization (with subcategories of poor cross-sectoral and weak inter-sectoral subgroups), challenges of laws/regulations/policies (with sub-categories of defective protocols and guidelines and lack of specific task descriptions), barriers and challenges to implementation of policies (with macro and school policy implementation subcategories), structural factors (with subcategories of financial resources allocation problems, inconsistency in managerial levels, and deficiencies in decision-making principles), weaknesses in educational processes (with subcategories of inadequate teacher education, weaknesses in parenting courses, and weaknesses in student education), and ultimately, weaknesses in monitoring and evaluation (with the subcategory of lack of a monitoring and evaluation system). Conclusion: According to experts, implementation of mental and social programs in schools is not in a desirable situation and is faced with certain challenges. To enhance the management of the Nemad project in Iranian schools, it is necessary to compile flowcharts of service delivery and inter-device communication, allocate resources to meet the expectations of each organization, do performance-based budgeting, take a comprehensive look at parental issues, and design a system of monitoring and evaluating the requirements. https://ijps.tums.ac.ir/index.php/ijps/article/view/2539 https://ijps.tums.ac.ir/index.php/ijps/article/download/2539/1103

Tehran University of Medical Sciences Iranian Journal of Psychiatry 1735-4587 18 2 2023 03 15 191 212 Mahboobeh Asadiyun Imam Hossein Hospital, Shahroud University of Medical Sciences, Shahroud, Iran. Salman Daliri Clinical Research Development Unit, Imam Hossein Hospital, Shahroud University of Medical Sciences, Shahroud, Iran. 2021 06 06 2022 10 08 Objective: suicide attempts and suicide death fall within a category of psychological disorders that is under the influence of economic, social, and cultural factors. Awareness of the prevalence of this phenomenon is essential for the adoption of preventive policies. Accordingly, the current study was carried out in order to determine the prevalence of suicide attempts and suicide deaths via Meta-analysis in Iran. Method: This study is a systematic review and meta-analysis of articles published between 2010 and 2021 to estimate the prevalence of suicide attempts and suicide deaths in Iran. Accordingly, databases including Web of Science, PubMed, Scopus, Cochrane Library, Science Direct, Google Scholar, SID, and Magiran were searched and all related articles were extracted by the statistical tests of random and fixed effects model, meta-regression, and funnel plot using the STATA software. These articles were then analyzed. Results: A total of 20 studies were entered into the systematic review, with a total of 271,212 attempted suicides and 22,780 suicide deaths. Accordingly, the prevalence of suicide attempts in the whole population was 131.0 (CI 95%: 124.0 – 137.0) per 100,000 people (152 per 100,000 women and 128 per 100,000 men). Moreover, the prevalence of suicide death was 8.14 (CI 95% 7.8 – 8.5) per 100,000 people in the general population (5.0 per 100,000 women and 9.1 per 100,000 men). Conclusion: According to these findings, Iran can be ranked among the countries with a low prevalence of suicide attempts and completed suicides (compared to the global average). Although the trend of completed suicides is declining, the trend of suicide attempts is increasing and has often affected young people. https://ijps.tums.ac.ir/index.php/ijps/article/view/2764 https://ijps.tums.ac.ir/index.php/ijps/article/download/2764/1116

Tehran University of Medical Sciences Iranian Journal of Psychiatry 1735-4587 18 2 2023 03 15 237 247 Walter Antonio Campos-Ugaz Universidad Nacional Pedro Ruiz Gallo, Lambayeque, Perú. Jessica Paola Palacios Garay Universidad Privada Norbert Wiener, Lima, Perú. Oriana Rivera-Lozada Universidad Privada Norbert Wiener, Lima, Perú. Mitchell Alberto Alarcón Diaz Universidad Nacional Mayor de San Marcos, Lima, Perú. Doris Fuster-Guillén Universidad Nacional Mayor de San Marcos, Lima, Perú. Arístides Alfonso Tejada Arana Universidad Privada Norbert Wiener, Lima, Perú. 2022 10 21 2022 11 14 Objective: Automatic diagnosis of psychiatric disorders such as bipolar disorder (BD) through machine learning techniques has attracted substantial attention from psychiatric and artificial intelligence communities. These approaches mostly rely on various biomarkers extracted from electroencephalogram (EEG) or magnetic resonance imaging (MRI)/functional MRI (fMRI) data. In this paper, we provide an updated overview of existing machine learning-based methods for bipolar disorder (BD) diagnosis using MRI and EEG data. Method: This study is a short non-systematic review with the aim of describing the current situation in automatic diagnosis of BD using machine learning methods. Therefore, an appropriate literature search was conducted via relevant keywords for original EEG/MRI studies on distinguishing BD from other conditions, particularly from healthy peers, in PubMed, Web of Science, and Google Scholar databases. Results: We reviewed 26 studies, including 10 EEG studies and 16 MRI studies (including structural and functional MRI), that used traditional machine learning methods and deep learning algorithms to automatically detect BD. The reported accuracies for EEG studies is about 90%, while the reported accuracies for MRI studies remains below the minimum level for clinical relevance, i.e. about 80% of the classification outcome for traditional machine learning methods. However, deep learning techniques have generally achieved accuracies higher than 95%. Conclusion: Research utilizing machine learning applied to EEG signals and brain images has provided proof of concept for how this innovative technique can help psychiatrists distinguish BD patients from healthy people. However, the results have been somewhat contradictory and we must keep away from excessive optimistic interpretations of the findings. Much progress is still needed to reach the level of clinical practice in this field. https://ijps.tums.ac.ir/index.php/ijps/article/view/3410 https://ijps.tums.ac.ir/index.php/ijps/article/download/3410/1109

Tehran University of Medical Sciences Iranian Journal of Psychiatry 1735-4587 18 2 2023 03 15 108 118 EN Morteza Madani Department of General and Clinical Psychology, Faculty of Psychology and Education, Allameh Tabataba'i University, Tehran, Iran. Farideh Hossein Sabet Department of General and Clinical Psychology, Faculty of Psychology and Education, Allameh Tabataba'i University, Tehran, Iran. Ahmad Borjali Department of General and Clinical Psychology, Faculty of Psychology and Education, Allameh Tabataba'i University, Tehran, Iran. 2021 04 03 2022 10 01 Objective: The objective of this study was to determine the most effective coping mechanism to deal with auditory hallucinations that reduces the frequency of voice-hearing and associated distress. In the present randomized controlled trial, each of the three coping mechanisms of attentional avoidance, attentional focusing, and mindfulness were used in one group and the fourth group was the control group. Method: A total of 64 patients with schizophrenia, categorized in three groups of attentional avoidance, attentional focusing and mindfulness and one control group, were asked to listen to an ambiguous auditory task depending on the type of their coping mechanism. After determining the baseline of distress, the task was performed in duplicate for each group. After playing the auditory task for the first time, participants were asked to rate out the level of their distress and compliance with instructions, and they were asked to estimate the likely number of words they had heard. After the second time, they were asked to note the words they hear during the task and rate out their distress and compliance with instructions again at the end of the task. Results: There was a significant difference between groups in terms of distress with a medium effect size of 0.47. The post hoc analysis revealed that mindfulness group reported less distress compared to the attentional focusing group (P = 0.017) and the control group (P = 0.027). Also, a significant difference existed between groups in terms of the frequency of the identified words, with a moderately strong effect size of 0.59, and a very good statistical power of 0.99. The post hoc analysis showed that attentional avoidance (P = 0.013) and attentional focusing (P = 0.011) groups heard fewer words than the control group. Conclusion: Attention is a good target for treating psychotic patients with auditory hallucinations. Also, manipulation of attention can affect the frequency of auditory hallucinations and associated distress. https://ijps.tums.ac.ir/index.php/ijps/article/view/2680 https://ijps.tums.ac.ir/index.php/ijps/article/download/2680/1107

Tehran University of Medical Sciences Iranian Journal of Psychiatry 1735-4587 18 2 2023 03 15 213 236 EN Seyed Morteza Hosseini Medicine, Quran and Hadith Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran. Saeed Hesam Medicine, Quran and Hadith Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran AND Department of Biostatistics and Epidemiology, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Seyed Amirhossein Hosseini Student Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran. 2022 05 06 2022 11 02 Objective: Burnout is a psychological symptom characterized by emotional exhaustion, depersonalization, and lack of personal accomplishment. Several systematic reviews have examined the prevalence of burnout in some communities, including the communities of physicians, nurses, students, and teachers. Risk factors, consequences of burnout, and related interventions have also been evaluated in several systematic review studies. The purpose of this systematic review was to investigate the prevalence, risk factors, consequences, and interventions associated with burnout among military personnel in all types of studies. Method: Studies that quantitatively examined burnout in military personnel after 2000 were identified through systematic searches in PubMed, Scopus, Web of Knowledge, Embase, PsychInfo, and PsycArticles databases. Results: A total of 43 studies met the criteria for inclusion in this systematic review. Of these, 34 were cross-sectional, 7 were longitudinal, 1 was case-control and 1 was experimental. Half of the studies had more than 350 samples. The studies were from 17 different countries, among which the United States had the largest number with 17 studies. 33 studies were measured with one version of Maslach Burnout Inventory (MBI). Totally, only 10 studies reported a prevalence of burnout and/or its subscales. The prevalence of high emotional exhaustion ranged from 0% to 49.7% (median 19%), the prevalence of high depersonalization ranged from 0% to 59.6% (median 14%) and the prevalence of low personal accomplishment ranged from 0% to 60% (median 6.4%). In this systematic review, work environment factors (such as workload, shift work), psychological factors (anxiety, depression, stress), and duration and quality of sleep were shown as risk factors of burnout or its subscales. Also, psychological distress was observed as the consequence of burnout in more than one study. Conclusion: The studies investigated in this systematic review showed a relatively moderate prevalence of burnout. In fact, burnout was associated with work environment factors and psychological variables. https://ijps.tums.ac.ir/index.php/ijps/article/view/3234 https://ijps.tums.ac.ir/index.php/ijps/article/download/3234/1117

Tehran University of Medical Sciences Iranian Journal of Psychiatry 1735-4587 18 2 2023 03 15 248 257 Zahra Beygi Faculty of Humanities, Department of Clinical Psychology, Islamic Azad University of Sirjan, Sirjan, Iran. Reyhane Tighband Jangali Faculty of Humanities, Department of Clinical Psychology, Anar Islamic Azad University, Kerman, Iran. Nafiseh Derakhshan Department of Psychology and Educational Sciences, University of Allameh Tabatabaei, Tehran, Iran. Mina Alidadi Department of Clinical Psychology, Bam University of Medical Sciences, Bam, Iran. Farzane Javanbakhsh Faculty of Humanities, Department of Clinical Psychology, Islamic Azad University of Sirjan, Sirjan, Iran. Mahdieh Mahboobizadeh Faculty of Humanities, Department of Clinical Psychology, Islamic Azad University of Sirjan, Sirjan, Iran. 2022 11 29 2022 12 19 Objective: Emotional disturbances are the most common mental health problems in different populations and societies. We intend to provide the latest evidence related to /Author> Gholamreza Ahmadi Department of Psychology, Faculty of Humanities and Social Sciences, University of Kurdistan, Sanandaj, Iran. Mohadese Shiyasi Student Research Committee, Department of Clinical Psychology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran. Zahra Safikhani Student Research Committee, Department of Clinical Psychology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran. Seyedeh Elnaz Mousavi Social Determinants of Health Research Center, Health and Metabolic Diseases Research Institute, Zanjan University of Medical Sciences, Zanjan, Iran. 2025 12 31 2026 07 15 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, η²p = 0.027; defectiveness/shame, F (2, 486) = 7.00, P = 0.001, η²p = 0.028; and entitlement/grandiosity, F (2, 486) = 28.52, P < 0.001, η²p = 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, η²p = 0.027. Healthy participants reported higher self-forgiveness than NPD participants, F (2, 486) = 5.14, P = 0.006, η²p = 0.021, and higher forgiveness of others than both narcissistic groups, F (2, 486) = 13.33, P < 0.001, η²p = 0.052. Situational forgiveness differed, F (2, 486) = 11.07, P < 0.001, η²p = 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. https://ijps.tums.ac.ir/index.php/ijps/article/view/4529 https://ijps.tums.ac.ir/index.php/ijps/article/download/4529/1350

Tehran University of Medical Sciences Iranian Journal of Psychiatry 1735-4587 21 4 2026 08 24 410 420 Kareem Jebur Dhaian Pediatric Nursing Department, College of Nursing, University of Karbala, Karbala, Iraq. Enas Ahmed Abdel Karim Pediatric Nursing Department, College of Nursing, University of Al-Qadisiyah, Al-Diwaniyah, Iraq. Qasim Kadhim Ashour Pediatric Nursing Department, College of Nursing, University of Karbala, Karbala, Iraq. Rasha Hussein Oleiwi Department of Maternal and Neonatal Nursing, College of Nursing, University of Karbala, Karbala, Iraq. Asmahan Qasim Mohammed Pediatric Nursing Department, College of Nursing, University of Baghdad, Baghdad, Iraq. 2026 06 17 2026 07 22 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. https://ijps.tums.ac.ir/index.php/ijps/article/view/4672 https://ijps.tums.ac.ir/index.php/ijps/article/download/4672/1351

Tehran University of Medical Sciences Iranian Journal of Psychiatry 1735-4587 21 4 2026 09 06 421 430 Narzikulova Dilnoza Department of International Relations, Navoi State University, Navoiy, Uzbekistan. Qilichev Rajab Department of Social Sciences, Bukhara State Pedagogical Institute, Bukhara, Uzbekistan. Komilov Kamol Department of Research, University of Tashkent for Applied Sciences, Tashkent, 11211, Uzbekistan AND Department of Architecture and Civil Engineering, Tashkent University of Architecture and Civil Engineering, Tashkent, Uzbekistan AND Department of Civil Engineering, Karakalpak State University, Nukus, Uzbekistan. Shakhlo Mirzaeva Department of Social Sciences, Pedagogy and Psychology, Tashkent State Medical University, Tashkent, Uzbekistan. Ernazarova Rano Department of Psychology, Karshi State University, Karshi, Uzbekistan. Jonibek Khayitov Department of Technological Education, Shahrisabz State Pedagogical Institute, Shahrisabz, Uzbekistan. 2026 06 20 2026 08 05 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. https://ijps.tums.ac.ir/index.php/ijps/article/view/4676 https://ijps.tums.ac.ir/index.php/ijps/article/download/4676/1352

Tehran University of Medical Sciences Iranian Journal of Psychiatry 1735-4587 21 4 2026 09 07 431 440 Ali Mlaghy Shakhat Al-Salhee Psychiatric and Mental Health Nursing Department, College of Nursing, University of Kerbala, Kerbala, Iraq. Ali Sabry Al-Yasari Psychiatric and Mental Health Nursing Department, College of Nursing, University of Kerbala, Kerbala, Iraq. Mohammed Kadhim Saadoon Pediatric Nursing Department, College of Nursing, University of Kerbala, Kerbala, Iraq. Hussein Khlaif Ketab Adult Nursing Department, College of Nursing Department, University of Kerbala, Kerbala, Iraq. Manar Majeed Hameed Maternal and Neonatal Health Nursing Department, College of Nursing, University of Kerbala, Kerbala, Iraq. 2026 07 08 2026 08 19 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. https://ijps.tums.ac.ir/index.php/ijps/article/view/4709 https://ijps.tums.ac.ir/index.php/ijps/article/download/4709/1353

Tehran University of Medical Sciences Iranian Journal of Psychiatry 1735-4587 21 4 2026 09 13 441 451 Sevara Mukhammadieva Department of Faculty and Hospital Therapy No.1, Rheumatology, Occupational Pathology of Tashkent State Medical University, Tashkent, Uzbekistan. Kadirova Munira Fergana Medical Institute of Public Health, Fergana, Uzbekistan. Jumaniyozova Muhayyo Uzbek State World Languages University, Tashkent, Uzbekistan. Turakulova Iroda Department of Psychology, Samarkand State Pedagogical Institute, Samarkand, Uzbekistan. Oripova Mokhidil Department of Philosophy, Fergana State University, Fergana, 150100, Uzbekistan. Rasulov Ilkhom Department of Russian Language and Literature, Kokand State University, Kokand, Uzbekistan. Tulenova Gulmira Department of Humanities (Liberal Arts), Tashkent University of Information Technologies, Tashkent, Uzbekistan. Khatamova Sarvinoz Department of Forensic Medicine, Bukhara State Medical Institute, Bukhara, Uzbekistan. Erkin Ismoilov Department of Social Sciences and Humanities, Termez State University of Engineering and Agrotechnologies, Termez, Uzbekistan. 2026 07 09 2026 08 18 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. https://ijps.tums.ac.ir/index.php/ijps/article/view/4710 https://ijps.tums.ac.ir/index.php/ijps/article/download/4710/1356

Tehran University of Medical Sciences Iranian Journal of Psychiatry 1735-4587 21 4 2026 09 07 452 464 EN Mehdi Rahmani Malek-Abad Department of Educational Psychology, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran. Mohammad Reza Abedi Department of Counseling, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran. 2026 02 21 2026 08 17 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. https://ijps.tums.ac.ir/index.php/ijps/article/view/4566 https://ijps.tums.ac.ir/index.php/ijps/article/download/4566/1354

Tehran University of Medical Sciences Iranian Journal of Psychiatry 1735-4587 21 4 2026 09 12 465 476 EN Hatef Tirgari Seraji Department of Psychology, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran. Amirhossein Rasouli Student Research Committee, Department of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Omid Saed Social Determinants of Health Research Center, Health and Metabolic Diseases Research Institute, Zanjan University of Medical Sciences, Zanjan, Iran AND Department of Clinical Psychology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran. Sana Bayazidi Department of Clinical Psychology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran. 2026 03 10 2026 08 26 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. https://ijps.tums.ac.ir/index.php/ijps/article/view/4581 https://ijps.tums.ac.ir/index.php/ijps/article/download/4581/1355

Tehran University of Medical Sciences Iranian Journal of Psychiatry 1735-4587 21 4 2026 09 23 477 487 Sasan Amiri Psycosomatic Medicine Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Seyed-Ali Mostafavi Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Ahmad Ali Noorbala Psycosomatic Medicine Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Ariana Karkhaneh Yousefi Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Shahin Akhondzadeh Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran. 2026 08 18 2026 09 08 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. https://ijps.tums.ac.ir/index.php/ijps/article/view/4770 https://ijps.tums.ac.ir/index.php/ijps/article/download/4770/1357

Tehran University of Medical Sciences Iranian Journal of Psychiatry 1735-4587 21 4 2026 07 20