Fear of missing out and problematic social media use: A serial mediation model of social comparison and self-esteem

Background and aim

Fear of Missing Out (FoMO) is consistently associated with problematic social media use (PSMU). Moreover, previous studies have shown a significant association between FoMO, self-esteem, and social comparison. However, there is a lack of studies that have investigated the relationship between, FoMO, social comparison, self-esteem, and PSMU in an integrated model. The present study hypothesized that FoMO may influence PSMU through the serial mediating role of social comparison and self-esteem.

Method

A cross-sectional survey study was conducted comprising 256 Italian university students (74.4% female), aged 18 to 38 years (M = 23.05 years; SD = 3.58). The participants completed an online survey assessing the variables of the study.

Results

Controlling for age and gender, the results showed positive associations between FoMO, social comparison, and PSMU, and a negative association between FoMO and self-esteem. Self-esteem was also negatively associated with PSMU. It was also found that social comparison and self-esteem sequentially mediated the association between FoMO and PSMU.

Conclusions

The present study contributes to understanding the mechanisms that underline the complex effects of FoMO on PSMU.

The Problematic Online Dating Apps Use Scale (PODAUS): Development and evaluation of its psychometric properties

The internet has facilitated significant transformations in interpersonal interactions, and offers new possibilities for finding romantic partners through the use of online dating apps. However, as with other technology-based tools, some individuals can develop problematic patterns of dating apps use, exhibiting symptoms resembling addiction. Consequently, the aim of the present study was the development of a new psychometric instrument to assess problematic dating apps use, the Problematic Online Dating Apps Use Scale (PODAUS), and the examination of its psychometric properties. The sample comprised 384 participants (254 females and 130 males; Mage=25.90 years; SD=5.21) who used dating apps daily. They completed an online survey including the PODAUS, Bergen Social Media Addiction Scale, Cyber Pornography Addiction Test, Love Addiction Inventory-Short-Form, and Ten-Item Personality Inventory. The PODAUS showed a one-factor structure with good indications of validity, reliability, and gender measurement invariance. Problematic online dating apps use was significantly associated with problematic social media use, problematic cyberpornography use, love addiction, and three personality traits (i.e., agreeableness, conscientiousness, and openness). The PODAUS is a new and succinct self-report measure that assesses problematic dating apps use, and can be easily used in both research and clinical practice.

Eating disorder symptom dimensions and protective factors: A structural network analysis study

Eating Disorders (EDs) and related symptoms pose a substantial public health concern due to their widespread prevalence among both genders and associated negative outcomes, underscoring the need for effective preventive interventions. In this context, deepening our understanding of the interplay between ED symptoms and related protective factors appears crucial. Therefore, this study employed a structural network analysis approach considering both ED symptom dimensions (i.e., drive for thinness, bulimic symptoms, and body dissatisfaction) and related protective factors (i.e., body and functionality appreciation, intuitive eating, and self-esteem) to shed light on how these factors are interrelated. A community sample of 1391 individuals (34.4% men; Mage = 26.4 years) completed a socio-demographic schedule and self-report questionnaires. The network showed that the nodes with the highest positive expected influence were body and functionality appreciation, while those with the highest negative expected influence were eating for physical rather than emotional reasons and unconditional permission to eat (i.e., two components of intuitive eating). Crucially, the most relevant bridges between the conceptual communities "ED symptom dimensions" and "Protective factors" were the negative relations between (a) eating for physical rather than emotional reasons and bulimic symptoms, (b) unconditional permission to eat and drive for thinness, and (c) body appreciation and body dissatisfaction. Finally, age, gender, and body mass index did not moderate any edge in the network. The practical implications of these findings are discussed, especially in terms of preventive interventions for ED symptoms.

Language learning through music on the academic achievement, creative thinking, and self-esteem of the English as a foreign language (EFL) learners

This study aimed to comprehensively analyze Language Learning through Music on the academic achievement (AA), creative thinking (CT), and self-esteem (SE) of English as a Foreign Language (EFL) Learners. With the rapid progress of technology, there has been a growing interest in exploring innovative teaching methods that not only enhance learning outcomes but also actively engage students in the language learning process. However, the specific impact of technology-enhanced language learning through music (TELLTM) on these language learning outcomes has received limited attention in previous research. In 2023, a sample of 360 male elementary-level language learners was selected using a multiple-stage cluster sampling (MSCS) technique. The participants' homogeneity was assessed through the Oxford Quick Placement Test (OQPT), administered following a random sampling procedure. Data collection involved the administration of three questionnaires: The academic achievement questionnaire, the self-esteem questionnaire, and the creative thinking questionnaire. The findings of the study analyzed through descriptive and inferential statistics, revealed a significant positive impact of TELLTM on the AA, CT, and SE of EFL learners. These results have important implications for educators, curriculum developers, and policymakers, providing valuable insights into the incorporation of TELLTM into English language instruction. The use of these three questionnaires provided valuable insights into the effectiveness of TELLTM in enhancing various aspects of language learning. These findings underscore the importance of incorporating music into language instruction and offer practical guidance for educators seeking to improve their teaching practices.

Childhood maltreatment, shame, and self-esteem: an exploratory analysis of influencing factors on criminal behavior in juvenile female offenders

OBJECTIVE

This study aimed to investigate the relationships between childhood maltreatment, shame, and self-esteem among juvenile female offenders and to explore the potential influencing factors on their criminal behavior.

METHODS

Using a stratified cluster sampling method, 1,227 juvenile female offenders from 11 provinces in China were surveyed using the Childhood Trauma Questionnaire (CTQ), Self-Esteem Scale (SES), and a self-developed Shame Questionnaire for Juvenile Offenders. Data were analyzed using descriptive statistics, correlation analysis, chi-square tests, t-tests, and structural equation modeling with mediation analysis.

RESULTS

(1) Childhood maltreatment have a significant potential influencing factors on criminal behavior; (2) Childhood maltreatment was positively correlated with self-esteem(β = 0.351, p < 0.001); (3) shame (β = 0.042, p < 0.001) mediate the relationship between Childhood maltreatment and self-esteem (childhood maltreatment → shame → self-esteem (95% Cl: 0.033, 0.052)).

CONCLUSION

This study demonstrates that childhood maltreatment is a significant predictor of criminal behavior among juvenile female offenders. childhood maltreatment can directly influence of self-esteem, which can also affect juvenile female offenders'self-esteem indirectly through shame. The findings suggest that shame are important variables that mediate the effect of the juvenile female offenders'childhood maltreatment on their self-esteem.

The effect of self-esteem development programme applied to secondary school students on self-esteem and peer bullying victimization: A randomized controlled trial

BACKGROUND

Self-esteem and peer bullying, which affect the academic success and psychological development of secondary school students, are increasingly becoming a serious problem.

AIM

This study was conducted to examine the effect of the Self-Esteem Development Programme applied to secondary school students on self-esteem and peer bullying victimization.

METHODS

This randomized controlled trial was conducted with 66 students (intervention = 33, control = 33) studying in the 6th grade at a secondary school. Personal Information Form, Rosenberg Self-Esteem Scale and Peer Bullying Identification Scale Adolescent Form were used to collect the data. The intervention group received 8 sessions of Self-Esteem Development Programme in the form of one session per week of 45-60 min; the control group continued their routine education programme.

RESULTS

In the study, after the Self-Esteem Development Programme, the mean self-esteem score of the intervention group increased and the mean peer bullying score decreased, and the difference between the groups was found to be statistically significant (p < 0.05).

CONCLUSION

In conclusion, it can be stated that the Self-Esteem Programme is an effective psychiatric nursing intervention in increasing self-esteem and reducing peer bullying.

IMPLICATIONS FOR PRACTICES

Students with low self-esteem are at risk of exposure to peer bullying. This study provides significant evidence for improving the self-esteem and reducing peer bullying among students who are at risk due to low self-esteem and peer bullying. The results of this study demonstrate that the Self-Esteem Development Programme can be utilized to enhance self-esteem and reduce exposure to peer bullying among students.

CLINICALTRIALS ID

NCT04737374.

Enhancing self-esteem in adults with body dysmorphic symptoms: experimental testing and initial evaluation of a brief internet-based training

BACKGROUND

Low self-esteem is an important factor associated with body dysmorphic concerns. In treatment, self-esteem cannot always be adequately addressed. Internet-based interventions offer a low-threshold and cost-efficient possibility for treating body dysmorphic disorder (BDD).

AIMS

For this reason, we conducted two studies to explore the effectiveness of an internet-based intervention targeting improving self-esteem in adults with BDD symptoms.

METHOD

The first study investigated the differential effects of a 1-week self-esteem training compared with a 1-week attention-focus training. Two hundred twenty adults with elevated body dysmorphic symptoms were randomly assigned to one of the two trainings. Our second study (n = 58 adults with body dysmorphic symptoms) evaluated an extended 2-week stand-alone self-esteem training.

RESULTS

In the first study, self-esteem in different domains (appearance, performance and social), self-focused attention, and BDD symptom severity improved in both groups. Other-focused attention only increased in the attention training group. Participants' overall adherence was high. In the second study we observed significant improvements in self-esteem, BDD symptom severity, and other secondary outcomes, with additional improvements in most outcomes in the second week. Adherence was again high.

CONCLUSIONS

Together, these findings show that a brief internet-based intervention may be a highly accepted and effective way of improving self-esteem in people suffering from BDD symptoms.

From childhood maltreatment to intimate partner violence perpetration: A prospective longitudinal examination of the roles of executive functioning and self-esteem

BACKGROUND

Previous research has found that childhood maltreatment predicts increased risk for violence and partner violence and there is some evidence for poorer executive functioning and low self-esteem. To date, there have been no longitudinal studies that have examined the extent to which executive functioning and self-esteem play a role in the relationship between child maltreatment and intimate partner violence (IPV) perpetration.

METHODS

This study aims to fill this gap by utilizing data from a prospective longitudinal study of children with documented court cases of abuse and neglect (ages 0-11 years) from a metropolitan county area in the Midwest (during the years 1967-1971) and demographically matched controls. Both maltreated individuals and matched controls were followed up and assessed over several waves of the study in young and middle adulthood. At mean age 39 years, inhibition and cognitive control were evaluated, while cognitive flexibility and nonverbal reasoning were assessed at mean age 41. Self-esteem was also assessed at mean age 41. Physical IPV perpetration was evaluated at age 47 using two different scoring strategies in separate models: the number of acts and variety of acts, ensuring avoidance of potential score skewness.

RESULTS

Childhood maltreatment predicted lower executive functioning and self-esteem, and both independently predicted intimate partner violence perpetration. Lower executive functioning and self-esteem mediated the relationship between childhood maltreatment and physical IPV perpetration in midlife, irrespective of the scoring method.

CONCLUSION

Findings suggest that executive functioning and self-esteem play a role in the cycle of violence. Implications and suggestions for future directions are discussed.

Automated VR therapy for improving positive self-beliefs and psychological well-being in young patients with psychosis: a proof of concept evaluation of Phoenix VR self-confidence therapy

BACKGROUND

Low self-confidence in patients with psychosis is common. This can lead to higher symptom severity, withdrawal from activities, and low psychological well-being. There are effective psychological techniques to improve positive self-beliefs but these are seldom provided in psychosis services. With young people with lived experience of psychosis we developed a scalable automated VR therapy to enhance positive-self beliefs.

AIMS

The aim was to conduct a proof of concept clinical test of whether the new VR self-confidence therapy (Phoenix) may increase positive self-beliefs and psychological well-being.

METHOD

Twelve young patients with non-affective psychosis and with low levels of positive self-beliefs participated. Over 6 weeks, patients were provided with a stand-alone VR headset so that they could use Phoenix at home and were offered weekly psychologist meetings. The outcome measures were the Oxford Positive Self Scale (OxPos), Brief Core Schema Scale, and Warwick-Edinburgh Well-being Scale (WEMWBS). Satisfaction, adverse events and side-effects were assessed.

RESULTS

Eleven patients provided outcome data. There were very large end-of-treatment improvements in positive self-beliefs (OxPos mean difference = 32.3; 95% CI: 17.3, 47.3; Cohen's d=3.0) and psychological well-being (WEMWBS mean difference = 11.2; 95% CI: 8.0, 14.3; Cohen's d=1.5). Patients rated the quality of the VR therapy as: excellent (n=9), good (n=2), fair (n=0), poor (n=0). An average of 5.3 (SD=1.4) appointments were attended.

CONCLUSIONS

Uptake of the VR intervention was high, satisfaction was high, and side-effects extremely few. There were promising indications of large improvements in positive self-beliefs and psychological well-being. A randomized controlled clinical evaluation is warranted.

Overcoming adversity during the COVID-19 pandemic: Longitudinal stability of psychosocial resource profiles of elite athletes and their association with perceived stress

Previous research has demonstrated that psychosocial resources are associated with elite athletes' perceived stress. However, these resources have mainly been studied separately. Using a person-oriented approach, this study aimed to identify meaningful profiles of athletes' psychosocial resources, their stability over time, and their relationship with perceived stress during the COVID-19 pandemic. To identify such patterns, separate latent profile analyses (LPA) at two measurement points T1 (June 2020) and T2 (March 2021) and a subsequent latent transition analysis (LTA) were conducted with athletic identity, resilience, perceived social support, and self-esteem for a sample of 373 Swiss elite athletes. Perceived stress was analyzed at and between T1 and T2 with a mixed-design ANOVA. For LPA, theoretical considerations and statistical criteria led to a solution of four profiles: (1) Athletic Identifiers With Above-Average Resources (nT1 = 235; nT2 = 240), (2) Below-Average Athletic Identifiers With Below-Average Resources (nT1 = 84; nT2 = 90), (3) Variable Athletic Identifiers With Below-Average Internal and Clearly Below-Average External Resources (nT1 = 14; nT2 = 7), and (4) Athletic Identifiers With Below-Average Internal and Above-Average External Resources (nT1 = 40; nT2 = 36). For LTA, both structural and individual stability was demonstrated. A large and significant main effect of perceived stress was observed for resource profiles, while there was no significant main effect for measurement point nor interaction effect. Direct comparisons revealed that Athletic Identifiers With Above-Average Resources perceived significantly less stress than the other profiles at both time points. In conclusion, regardless of psychosocial resource profile, the perceived stress of elite athletes was stable during the COVID-19 pandemic, but exhibiting a pattern with high psychosocial resources seems to buffer against stress compared to a lack of specific resources. Therefore, sport federations and practitioners should provide tailored support programs to help athletes build all these resources.

Out of the loop: Taking a one-week break from social media leads to better self-esteem and body image among young women

This study experimentally tested the effects of taking a one-week break from social media (SM) on body image and self-esteem among young women. Female undergraduate students (N = 66) were randomly assigned to either take a one-week break from SM or continue their normal use (control condition). State self-esteem and body satisfaction were measured at baseline (Time 1) and one week later (Time 2). As predicted, participants in the break condition reported higher body satisfaction and higher state self-esteem (total, performance, social, and appearance domains) at Time 2 than did those in the control condition, controlling for Time 1 scores. The benefits of taking a break from SM on body satisfaction were especially pronounced for women with higher baseline levels of thin-ideal internalization. The findings demonstrate the short-term benefits of taking a break from SM for one week on self-esteem and body image among young women.

Parental psychological control and children's self-esteem: A longitudinal investigation in children with and without oppositional defiant problems

Oppositional defiant problems are among the most prevalent psychological problems among children and adolescents from China and across the world. Still little is understood about how self-esteem, in conjunction with parenting experiences, develops in children with oppositional defiant problems. We addressed this gap of knowledge in a two-year longitudinal study. Specifically, we explored how parental psychological control predicts children's self-esteem levels over time, and in turn, how children's self-esteem levels predict parental psychological control. We collected data in Chinese children (ages 8 to 13 at T1) with (N = 224) and without (N = 217) oppositional defiant problems, and tested three-wave cross-lagged panel models. Multigroup analyses showed that the associations between parental psychological control and children's self-esteem were the same for children with and without oppositional defiant problems. Results for the total sample revealed bi-directional associations between maternal psychological control and children's self-esteem. Children who perceived more psychological control from their mothers were likely to exhibit lower self-esteem over time, and vice versa, children with lower self-esteem were likely to perceive more maternal psychological control over time. Conversely, a unidirectional paternal effect was observed in father-child dyads. Our findings help understand the parent-child dynamics that shape the psychological development of children with oppositional defiant problems.

Moderating effect of self-esteem between perfectionism and avoidant restrictive food intake disorder among Lebanese adults

BACKGROUND

Avoidant Restrictive Food Intake Disorder (ARFID) is a new diagnosis added to the DSM-5 characterized by pathological eating habits without body image disturbances. Previous findings demonstrated a general association between high levels of perfectionism and low levels of self-esteem in association with general eating disorders. However, research is scant when it comes to ARFID specifically. Subsequently, although self-esteem is seen to moderate the association between perfectionism and general eating disorders, this research study aims to explore the same moderation but with ARFID specifically.

METHODS

For this study, 515 Lebanese adults from the general Lebanese population were recruited from all over Lebanon, 60.1% of which were females. The Arabic version of the Big Three Perfectionism Scale- Short Form (BTPS-SF) was used to measure self-critical, rigid and narcissistic perfectionism; the Avoidant/Restrictive Food Intake Disorder screen (NIAS) was used to score the ARFID variable; the Arabic-Single Item Self-Esteem (A-SISE) was the scale used to measure self-esteem.

RESULTS

Across the different perfectionism types, self-esteem was seen to moderate the association between narcissistic perfectionism and ARFID (Beta = - 0.22; p =.006). At low (Beta = 0.77; p <.001), moderate (Beta = 0.56; p <.001) and high (Beta = 0.36; p =.001) levels of self-esteem, higher narcissistic perfectionism was significantly associated with higher ARFID scores.

CONCLUSION

This study brought to light some crucial clinical implications that highlight the need for interventions that help in the enhancement of self-esteem in patients with high perfectionism and ARFID. This study suggests that clinicians and healthcare professionals should focus more on risk factors influencing the development and maintenance of ARFID-like symptoms.

Self-esteem, depression, anxiety and sexual function in Mayer-Rokitansky-Küster-Hauser syndrome with neovagina: A case series

BACKGROUND

The Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a rare condition with significant psychological implications. However, our understanding of its impact on postoperative sexual function and mental health is still limited.

AIM

Evaluate the mental health status and sexual functioning of women with MRKH syndrome after vaginoplasty surgery.

METHODS

We enrolled 53 cases with MRKH syndrome who underwent artificial vaginoplasty. The participants were asked to participate in a two-round survey conducted between February 2021 during the covid-19 period and March 2023. The survey included questionnaires to measure depression, anxiety, self-esteem, and sexual functioning. Differences between scores over time were analysed using a paired sample t-test, and we assessed the correlation between mental health and sexual functioning.

RESULTS

In the first round, patients' mean ± SD age at surgery was 23.6 ± 4.5 years old, and the mean ± SD time that had elapsed since surgery at the time of the survey was 34.2 ± 20.8 months. None of the patients reported low self-esteem, 45.3 % reported mild-to-moderate depression, and 34.0 % reported mild anxiety. Thirty patients have had vaginal intercourse during the last six months. The mean ± SD Female Sexual Functioning Index score was 24.6 ± 4.4, and 60.0 % had a score of 23.5 or higher, indicating high sexual functioning. The sexual functioning scores were positively correlated with self-esteem scores and negatively correlated with depression or anxiety scores (p < 0.05). There was no significant improvement in patient's mental health status and sexual function between the second round survey (71.3 ± 17.8 months after surgery) and the first round survey (p > 0.05). In contrast, the sexual arousal of FSFI were significantly higher in the second survey round (p < 0.05).

CONCLUSION

Most patients undergoing vaginoplasty reported persisting mental health challenges. However, the majority reported good sexual functioning.

Relationship between academic procrastination, self-esteem, and moral intelligence among medical sciences students: a cross-sectional study

BACKGROUND

Academic procrastination is a widespread phenomenon among students. Therefore, evaluating the related factors has always been among the major concerns of educational system researchers. The present study aimed to determine the relationship of academic procrastination with self-esteem and moral intelligence in Shahroud University of Medical Sciences students.

METHODS

This cross-sectional descriptive-analytical study was conducted on 205 medical sciences students. Participants were selected based on inclusion and exclusion criteria using the convenience sampling technique. The data collection tools included a demographic information form, Solomon and Rothblum's Procrastination Assessment Scale-Students, Rosenberg Self-Esteem Scale, and Lennick and Kiel's Moral Intelligence Questionnaire, all of which were completed online. The data were analyzed using descriptive statistics and inferential tests (multivariate linear regression with backward method) in SPSS software.

RESULTS

96.1% of participating students experienced moderate to severe levels of academic procrastination. Based on the results of the backward multivariate linear regression model, the variables in the model explained 27.7% of the variance of academic procrastination. Additionally, self-esteem (P < 0.001, β=-0.942), grade point average (P < 0.001, β=-2.383), and interest in the study field (P = 0.006, β=-1.139) were reported as factors related to students' academic procrastination.

CONCLUSION

According to the findings of this study, the majority of students suffer from high levels of academic procrastination. Furthermore, this problem was associated with low levels of self-esteem, grade point average, and interest in their field of study.

Comparison of self-esteem and quality of life in 8-12-year-old children with ADHD with and without learning disorders

BACKGROUND

Attention Deficit/Hyperactivity Disorder (ADHD) is one of the most common disorders in school-aged children. Learning disorder (LD) is also one of the most important psychiatric disorders in children, which can often be associated with ADHD. In this study, we sought to compare self-esteem and quality of life in 8 to 12-year-old children with attention deficit/hyperactivity disorder with and without co-occurring learning disorders in order to emphasize the importance of attention and diagnosis in children with ADHD.

METHOD

Among the 8- to 12-year-old outpatients referred to the child and adolescent psychiatry clinic of Omid Babol Clinic, 120 children aged 8 to 12 years with attention deficit/hyperactivity disorder whose disease was diagnosed by a child and adolescent psychiatry subspecialist. Among the tools used to collect information was the Colorado Learning Difficulties Questionnaire by Wilcott et al. (CLDQ), five-scale self-esteem test of Pepe et al. (1989) for children and quality-of-life questionnaire for 8-12-year-old children (PedsQL).

RESULTS

This study investigated self-esteem and quality of life in children with ADHD (n = 120, 51.7% boys). Children with ADHD and learning disabilities reported significantly lower self-esteem and quality of life compared to those with ADHD alone.

CONCLUSION

Considering the relatively high probability of co-occurrence of ADHD and learning disorders, if one of them is diagnosed in a child, it is possible to look for other disorders in the child in order to avoid the more severe negative effects that this co-occurrence can have on the child by diagnosing it as soon as possible.

Profiles of intuitive eating in adults: the role of self-esteem, interoceptive awareness, and motivation for healthy eating

OBJECTIVE

Intuitive eating is an eating behavior that has recently come to use mainly in the young population. Knowing that the Lebanese cultural diet differs from other countries, the purpose of this study was to investigate if there is a relationship between self-esteem, interoceptive awareness, and motivation for healthy eating in a sample of Lebanese adults using a Latent Profile Analysis approach.

DESIGN

Cross-sectional study.

SETTING

Lebanese governorates.

PARTICIPANTS

359 Lebanese participants enrolled in this study (mean age: 22.75 ± 7.04 years, 40.1% males), through convenience sampling in several Lebanese governorates. Participants were asked to fill anonymously the following scales: The Intuitive Eating Scale (IES-2), the Rosenberg Self-Esteem Scale, the Multidimensional Assessment of Interoceptive Awareness Scale (MAIA), and the Motivation for Healthy Eating Scale (MHES).

RESULTS

Our findings revealed four profiles: profile 1 (n = 67; 18.66%) characterized by high SE and intermediate interoceptive awareness and motivation for healthy eating; profile 2 (n = 86; 23.97%) presented high SE, interoceptive awareness, and motivation for healthy eating; profile 3 (n = 86; 23.96%) characterized by high SE, interoceptive awareness, and motivation for healthy eating; class 4 (n = 108; 30.08) described by low SE, intermediate interoceptive awareness, and motivation for healthy eating One-way analysis of variance did not observe a significant difference between the four profiles based on intuitive eating (F = 1.810; p = 0.145; ɳp2 = 0.015).

CONCLUSIONS

Among a sample of Lebanese people, four profiles of interoceptive awareness, motivation for healthy eating, and self-esteem were observed, with no difference concerning intuitive eating.

Medication adherence and its relationship with self-esteem among patients with epilepsy in Isfahan, Iran

Medication adherence is of utmost importance in achieving the desired therapeutic outcome and effectively managing seizures in patients with epilepsy (PWE). It is imperative to recognize self-esteem as a psychological determinant that potentially influences the optimal compliance with anti-seizure medications (ASMs) among PWE. The objective of this study was to explore medication adherence and its relationship with self-esteem among individuals diagnosed with epilepsy in Isfahan, Iran.

METHODS

This descriptive-analytical study was conducted in the year 2021, encompassing a cohort of 250 PWE who were referred to designated medical facilities in Isfahan, Iran, and were selected by the consecutive sampling technique. A 3-part instrument including demographic components, the Rosenberg Self-Esteem Scale, and the Morissky Drug Adherence Questionnaire employed for data collection.

RESULTS

The mean and standard deviation of adherence to the medicinal regimen in the participants were 6.9 ± 2.02, and 46.4 % had a low level of adherence to the medication regimen (total score 0-6). At the same time, the mean and standard deviation of self-esteem in these patients was 5.11 ± 2.11. There was a statistically significant and direct correlation between adherence to the prescribed drug regimen and self-esteem (rs = 0.464, p = 0.00).

CONCLUSION

Based on the findings of the study that showed a statistically significant and positive correlation between self-esteem and adherence to the medication regimen, it is advisable to enhance and advocate for these factors in PWE.

Psychological wellbeing in teachers. Study in teachers of early childhood and primary education

Recently, there has been a growing interest in emotional wellbeing, even from the early stages of education. In order to work wellbeing among the students it is essential to analyze the wellbeing of the teachers who are teaching and working with the children. This study examines psychological wellbeing in early childhood (0-6 years) and primary school teachers (6-12 years). The study comprised 236 early childhood and primary school teachers - 76 men (32.2%) and 160 women (67.8%) - with ages ranging from 25 to 61 years (average 37.69 years - s.d.=2.47). The study examined psychological wellbeing (happiness, eudemonic wellbeing, self-esteem, and life satisfaction) and several sociodemographic variables (gender, age, years in the job, type of contract, and educational stage). Participants answered an ad-hoc sociodemographic questionnaire and subjective happiness, eudemonic wellbeing, self-esteem, and life satisfaction standard questionnaires. Early childhood schoolteachers yielded higher wellbeing-related scores. All the wellbeing-related variables were found to be correlated with one another, except for happiness and self-esteem. Teachers working in different educational stages were found to yield significantly different wellbeing-related scores. For the first time, network analysis revealed differences in the associations of the variables under study among Early Childhood Education and Primary Education teachers. Thus, while happiness and satisfaction with life were found to be correlated in both groups, stronger correlations between self-esteem and eudaimonic wellbeing were found in early childhood education teachers, while in primary education teachers the correlation was with satisfaction with life, which indicates that early childhood teachers present greater spiritual and existential understanding, leading to eudaimonic wellbeing. These differences between educational stages are considered greatly significant. It was concluded that more research is needed, ideally with broader and longitudinal studies, to understand and describe the relationship between personal and even structural variables and wellbeing.

People perceive parasocial relationships to be effective at fulfilling emotional needs

People regularly form one-sided, "parasocial" relationships (PSRs) with targets incapable of returning the sentiment. Past work has shown that people engage with PSRs to support complex psychological needs (e.g., feeling less lonely after watching a favorite movie). However, we do not know how people rate these relationships relative to traditional two-sided relationships in terms of their effectiveness in supporting psychological needs. The current research (Ntotal = 3085) examined how PSRs help people fulfil emotion regulation needs. In Studies 1 and 2, participants felt that both their YouTube creator and non-YouTube creator PSRs were more effective at fulfilling their emotional needs than in-person acquaintances, albeit less effective than close others. In Study 3, people with high self-esteem thought PSRs would be responsive to their needs when their sociometer was activated, just as they do with two-sided relationships.

Associations between muscular strength and mental health in cognitively normal older adults: a cross-sectional study from the AGUEDA trial

Objective

To examine the associations between muscular strength and mental health.

Design

We used baseline data of 91 cognitively healthy older adults (71.69 ± 3.91 years old, 57 % women) participating in the AGUEDA randomized controlled trial.

Methods

Muscular strength was assessed using both objective (i.e., handgrip strength, biceps curl, squats, and isokinetic test) and perceived (i.e., International Fitness Scale) indicators. Psychological ill-being indicators: anxiety, depression, stress, and loneliness; and psychological well-being indicators: satisfaction with life, self-esteem, and emotional well-being) were assessed using a set of valid and reliable self-reported questionnaires. Linear regression analyses were performed adjusting for sex, age, years of education, body mass index , alcohol, diet, and smoking (model 1), and additionally by cardiorespiratory fitness (model 2).

Results

Elbow extension was positively associated with stress in model 1 (β = 0.252, 95 % Confidence Interval [95 % CI] = 0.007 to 0.497, p = 0.044), and even after further adjustment for cardiorespiratory fitness (β = 0.282, 95 % CI = 0.032 to 0.532, p = 0.028). Perceived strength was negatively associated with depressive symptoms in model 1 (β = -0.271, 95 % CI = -0.491 to -0.049, p = 0.017) and model 2 reported associations tending towards significant (β = -0.220, 95 % CI = -0.445 to 0.005, p = 0.055). Handgrip strength was positively associated with self-esteem in model 1 (β = 0.558, 95 % CI = 0.168 to 0.949, p = 0.006) and model 2 (β = 0.546, 95 % CI = 0.135 to 0.956, p = 0.010). No further associations were found among other muscular strength and mental health variables.

Conclusion

Handgrip had a moderate association with self-esteem and there was a small association between perceived strength with depressive symptoms and elbow extension with stress. No other associations were observed between muscular strength and mental health outcomes in cognitively normal older adults.

The influence of physical activity on internet addiction among Chinese college students: the mediating role of self-esteem and the moderating role of gender

OBJECTIVES

The significance of self-esteem in the relationship between physical activity and Internet addiction among college students cannot be over, as it lays a solid foundation for the prevention and control of Internet addiction.

METHODS

A total of 950 college students were surveyed using the Physical Activity Rating Scale (PARS-3), Rosenberg Self-Esteem Scale (SES), and Chinese Internet Addiction Scale (CIAS-R) through a cluster random sampling method. Descriptive statistics, independent sample t-test, partial correlation analysis, mediation effect, moderation effect, and Bootstrap testing were conducted on the collected data to analyze and interpret the results.

RESULTS

(1) Significant gender differences were found in the amount of physical activity and the degree of Internet addiction among college students(P&& lt;0.001); (2) Physical activity was significantly and positively correlated with self-esteem (r = 0.26, P < 0.001), but significantly and negatively correlated with Internet addiction (r=-0.23, P < 0.001); Meanwhile, self-esteem and Internet addiction were significantly and negatively related to self-esteem (r=-0.22, P < 0.001). (3) Mediating effect analyses showed that self-esteem played a partial mediating role in physical activity and Internet addiction among college students, accounting for a portion of 78.95%. (4) A moderating effect of gender on the relationship between physical activity and Internet addiction was discovered.

CONCLUSION

The physical activity level of male students is significantly higher than that of female students, while the degree of internet addiction among female students is notably higher than that of male students. Physical activity can not only directly improve the issue of internet addiction among college students, but also indirectly improve it through self-esteem, with gender playing a moderating role in this process. This conclusion has practical reference significance for preventing and controlling internet addiction among college students, and provides evidence support for using physical activity as a reference solution in clinical applications. Additionally, it suggests that gender should be taken into account when preventing and intervening in internet addiction among college students, and different strategies and methods should be adopted for male and female students. Male students should be encouraged to participate more in physical activities, gradually increasing the frequency, duration, and intensity of their participation, in order to divert their attention and enhance their sense of achievement in sports, thereby reducing their use of mobile phones. For female students, on the other hand, it is important to strengthen real-life communication, change the form of sports participation, engage in group, collaborative, and different situational sports activities, and enhance their focus and attention in sports, in order to reduce their internet dependency, better guide them to use the internet reasonably, and enable them to achieve emotional release through sports.

Surgeons' personality, characteristics and presence of meaning in life

BACKGROUND

Surgeons work long shifts and are frequently on call. Pressure to make quick and accurate decisions along with the responsibility of performing complex procedures contribute to surgeons' high stress-levels, anxiety and altered empathy level. We aimed to study surgeons' personality and meaning in life at two different centres.

METHODS

General surgeons completed 47 questions. Visual analogous scale-items with controlled internal consistency (Cronbach alpha) coefficients varying from .77 to .85 were used from the following scales: Global Measure of Perceived Stress; Hostility Questionnaire; Jefferson Scale of Physician Empathy; Meaning in Life Questionnaire-SF; Rosenberg Self-Esteem Scale; Spielberger State Anxiety Scale and Quality of Work life Scale. Multiple linear regression analyses, parametric or non-parametric tests were employed when considered adequate.

RESULTS

Fifty-four participants were recruited from 3 different levels of training. Gender differences in Anxiety, Physician Empathy and presence of meaning in life (MIL-P) were revealed. Junior trainees differed from senior trainees and consultants as regards MIL-P, Anxiety, Stress and work-related factors. The surgeons' self-rated self-esteem was work-related. Surgeons' Quality of Work Life was best predicted by Physician Empathy but also their self-rated Self-Esteem contributed significantly to the prediction. Surgeons' MIL-P was significantly predicted by Physician Empathy and State Anxiety.

CONCLUSION

Surgeons' current personality attributes might not apply to all of them. Female surgeons were more empathetic and felt more presence of meaning in life than male surgeons, and men were less anxious than female surgeons. Junior trainees experienced less anxiety than senior trainees but were more stressed than consultants. The most significant predictors of surgeons' personality were their experience of presence of meaning in life along with their level of empathy.

The Role of Self-Esteem in Protecting Against Cyber-Victimization and Gaming Disorder Symptoms Among Adolescents: A Temporal Dynamics Analysis

Previous literature has suggested that victimization is linked to low self-esteem and increases the symptoms of gaming disorder. However, little is known about the intra-individual processes, and the temporal dynamics of cyber-victimization, self-esteem, and gaming disorder symptoms. To address this gap, a three-year longitudinal study was performed using data collected at six different time points from 4206 Chinese adolescents (aged 12-17 years; 50.4% boys). Results of random intercept cross-lagged panel models (RI-CLPMs) indicated that at the within-person level, the fluctuation in self-esteem weakly predicted late cyber-victimization, and the fluctuation of cyber-victimization also weakly predicted late self-esteem. Additionally, the current study identified an interactive effect between self-esteem and gaming disorder symptoms at the within-person level. Fluctuations in self-esteem negatively predicted late gaming disorder symptoms, and vice versa. However, when combining the three variables (i.e., cyber-victimization, self-esteem, and gaming disorder symptoms) into one RI-CLPM, the results did not support the mediation of self-esteem in the relationship between cyber-victimization and gaming disorder symptoms at the within-person level. Moreover, fluctuations in self-esteem negatively predicted late gaming disorder symptoms and cyber-victimization at the within-person level in the RI-CLPM. These findings emphasize the protective role of self-esteem developed against cyber-victimization and gaming disorder symptoms among adolescents.

The relationship between self-esteem and happiness of college students in China:A moderated mediation model

The objective of the study is to explore the influence of self-esteem on the happiness levels of college students and the mediating roles of social avoidance and loneliness. 1021 college students between 18 and 24 years of age completed the Self-esteem Scale, General Well-being Scale, Social Avoidance and Distress Scale, UCLA Loneliness Scale and Interpersonal Trust Scale.And descriptive statistical analysis and correlation analysis, structural equation model analysis were conducted. The result turns out that Self-esteem negatively predicted the happiness levels of college students. Self-esteem indirectly predicted happiness through three paths: mediating the roles of social avoidance, mediating the roles of loneliness and the chain-mediated roles of social avoidance and loneliness in college students.Interpersonal Trust moderated the relationship between loneliness and happiness.The higher the self-esteem levels of the college students, the less happiness they experienced.

Insomnia and anxiety among COVID-19 patients in China: the chain mediating effect of psychological capital and self-esteem

BACKGROUND

The outbreak of Corona Virus Disease (COVID-19) in 2019 has continued until now, posing a huge threat to the public's physical and mental health, resulting in different degrees of mental health problems. As a vulnerable segment of the public, anxiety is one of the most common mental health problems among COVID-19 patients. Excessive anxiety aggravates the physical and psychological symptoms of COVID-19 patients, which is detrimental to their treatment and recovery, increases financial expenditure, affects family relations, and adds to the medical burden.

OBJECTIVE

This study aimed to explore the role of psychological capital and self-esteem in the relationship between insomnia and anxiety, thereby shedding light on the mechanism of the effect of insomnia on anxiety in COVID-19 patients.

METHODS

A cross-sectional study was conducted from April to May 2022 in Fangcang hospital in Shanghai, China. The self-administered questionnaires were distributed to 718 COVID-19 patients via cell phone using the Internet platform "Questionnaire Star", which included Athens Insomnia Scale, Psychological Capital Questionnaire, Self-esteem Scale, Self-Rating Anxiety Scale, gender, age, marital status, education. Data analysis was performed using descriptive analysis, independent-samples t-test, one-way analysis of variance, Pearson correlation analysis, ordinary least-squares regression, and bootstrap method.

RESULTS

Education background had significant impact on anxiety in COVID-19 patients (F = 7.70, P < 0.001). Insomnia, psychological capital, self-esteem and anxiety were significantly correlated, respectively (P < 0.001). And Regression analysis showed that insomnia had a direct negative predictive effect on psychological capital (β = -0.70, P < 0.001) and self-esteem (β = -0.13, P < 0.001). Psychological capital had a direct positive predictive effect on self-esteem (β = 0.12, P < 0.001). Insomnia had a direct positive predictive effect on anxiety (β = 0.61, P < 0.001). Both psychological capital and self-esteem had significant negative predictive effects on anxiety (β = -0.06, P < 0.05; β = -0.72, P < 0.001). The results showed that the mediating effect of psychological capital and self-esteem was significant, and the mediating effect value was 0.21. First, the indirect effect consisting of insomnia - psychological capital - anxiety was 0.04, showing that psychological capital had a significant mediating effect. Second, the indirect effect consisting of insomnia-self-esteem-anxiety had a value of 0.10, indicating that self-esteem had a significant mediating effect. Third, the indirect effect consisting of insomnia-psychological capital-self-esteem-anxiety had a value of 0.06, suggesting that psychological capital and self-esteem had a significant chain mediating effect between insomnia and anxiety.

CONCLUSIONS

Insomnia had a significant positive predictive effect on anxiety. Insomnia was first associated with a decrease in psychological capital, followed by a sequential decrease in self-esteem, which in turn was associated with increased anxiety symptoms in COVID-19 patients. Therefore, focusing on improving the psychological capital and self-esteem of patients can help alleviate the anxiety caused by insomnia in COVID-19 patients. It is recommended that patients and health care professionals increase the psychological capital and Self-esteem of COVID-19 patients through various methods to counter the effects of insomnia on anxiety.

A brief mindfulness meditation can ameliorate the effects of exposure to idealised social media images on self-esteem, mood, and body appreciation in young women: An online randomised controlled experiment

The study examined whether a 10-minute mindfulness meditation intervention could ameliorate effects of exposure to social media thinspiration and fitspiration images on women's self-esteem, mood, and body appreciation. A total of 162 women aged 18-42 years (M = 25.94, SD = 4.38) completed an online experiment which involved viewing thinspiration and fitspiration images before random allocation to either a brief, ten-minute mindfulness meditation audio intervention or a ten-minute control audio about jujitsu. Participants completed self-reported measures of self-esteem, positive and negative mood, and body appreciation at baseline (Time 1), post-exposure to idealised social media images (Time 2), and immediately post-intervention (Time 3). Mixed, repeated-measures ANOVAs showed that scores were lower for body appreciation, self-esteem, and positive mood, and higher for negative mood, in both groups after exposure to idealised imagery. However, a brief mindfulness intervention ameliorated the negative effects of social media exposure. Specifically, self-esteem, body appreciation, and mood were higher in the mindfulness meditation group at Time 3, compared to the control group. Future interventions should explore the utility of mindfulness practices to provide long term buffering effects against such social media content, as well as targeting the idealisation of female physiques portrayed in thinspiration and fitspiration content.

Impact of confrontation to patient suffering and death on wellbeing and burnout in professionals: a cross-sectional study

BACKGROUND

Palliative care and oncology generate a risk of burnout and psychological distress in professionals. The purpose of this study is to identify both psychopathological and positive factors related to mental health at work. It aims (i) to explore the extent to which these professionals are confronted with suffering, illness, and death; and to explore the prevalence of psychological distress and/or burnout, (ii) to identify potential determinants of burnout and psychological wellbeing at work, (iii) to develop an integrative model of mental health; and to identify frequency and impact of confrontations with death, and (iv) to identify profiles of professionals are at risk of developing a mental health disorder or, conversely, characterized by wellbeing.

METHODS

A cross-sectional questionnaire study was conducted in palliative care and oncology evaluating confrontations with death, coping, burnout, psychological distress, personality, self-esteem, well-being and meaning at work. Regressions, clustering, and structural equation modeling analyses were performed.

RESULTS

109 professionals participated (58% from oncology and 42% from palliative care), of which 79% were female, and 65% were between 30 and 49 years old. Aim i: 30% witnessed an intolerable suffering at least 9 times a month, 45% reported moderate to high levels of burnout, 39% suffered from anxiety and 11% from depression. Aim ii: the determinants of burnout were the personality traits conscientiousness and neuroticism, low meaning of work, and low wellbeing (R2 = 0.44). The determinants of wellbeing were work meaning, depersonalization, self-esteem, fulfillment and low emotional exhaustion (R2 = 0.71). Aim iii: the integrative model included both well-being (self-esteem, conscientiousness) and psychopathology (neuroticism, anxiety) parameters, and strongly satisfied the standard SEM goodness of fit indices (e.g., CFI, IFI, and TLI ≥ 0.95). Aim iv: three profiles were identified: (a) a "distressed profile" with a majority of professionals at the patient's bedside, (b) a "disengaged profile" with professionals working as second-line consultants, (c) a "wellbeing profile" contains profiles of caregivers insensitive to psychological distress and with a high level of positive Impact of confrontation on different areas of their lives.

CONCLUSIONS

An integrative approach is essential to understand the full range of mental health issues for professionals. Meaning of work is a key factor in professional interventions that should primarily affect front-line professionals with limited experience.

Nature and correlates of self-esteem in young adult survivors of childhood traumatic brain injury

Despite growing research linking childhood traumatic brain injury (TBI) with reduced wellbeing, self-esteem, and psycho-social health, very few studies have examined self-esteem and its correlates in young adult survivors of childhood TBI. This very-long-term follow-up study evaluated self-esteem in 29 young adults with a history of childhood TBI (M time since injury = 13.84 years; SD = 0.74), and 10 typically developing controls (TDCs). All participants were originally recruited into a larger, longitudinal case-control study between 2007 and 2010. In the current follow-up study, both groups completed well-validated measures of self-esteem and mental health in young adulthood. Although group means for self-esteem did not significantly differ between TBI and TDC groups, a higher proportion of TBI participants rated their self-esteem in the clinical range (TBI group = 17%; TDC group = 0%). While self-esteem was not significantly associated with injury or pre-injury child or family characteristics, lower self-esteem was significantly correlated with greater concurrent feelings of loneliness (p = 0.007) and higher concurrent mood symptoms (p < 0.001).Our results suggest that social isolation and low mood may represent meaningful targets for psycho-social interventions to address poor self-worth in young adults with a history of childhood TBI.

Distinct associations between gratitude, self-esteem, and optimism with subjective and psychological well-being among Japanese individuals

BACKGROUND

Mounting evidence suggests that the effectiveness of positive psychology interventions is influenced by a variety of factors, including cultural context. Identifying intervention targets that can effectively contribute to improving individual well-being under these boundary conditions is a crucial step when developing viable interventions. To this end, we examined how gratitude disposition, self-esteem, and optimism relate to the subjective well-being (SWB) and psychological well-being (PWB) of Japanese individuals.

METHODS

Multivariate regression analysis was employed to quantify the unique relationships between the three potential intervention targets and both SWB and PWB, while accounting for the influence of other variables. Participants (N = 71) also engaged in a 4-week experience sampling study to explore how gratitude, self-esteem and optimism shape the link between momentary affective states in everyday life and evaluations of day satisfaction.

RESULTS

Multivariate regression analysis revealed that self-esteem was predominantly more strongly associated with SWB compared to gratitude disposition, whereas gratitude disposition was more strongly associated with the PWB dimensions, particularly personal growth, positive relations with others and purpose in life. Experience sampling data indicated that while both gratitude disposition and self-esteem moderated the association between momentary positive affect and day satisfaction evaluations, they did so in opposite ways; greater gratitude disposition strengthened the association, while greater self-esteem weakened it.

CONCLUSIONS

Overall, the current results suggest that while gratitude, self-esteem, and optimism influence individual well-being as a whole, they likely play distinct roles in facilitating SWB and PWB in the studied cohort.

A Latent Interaction Model

Poor self-esteem relates closely to youth maladjustment and appears to be predicted by peer victimization experiences. However, not all peer victimized adolescents face the same risk for self-esteem erosion over time. Drawing upon the Bi-Dimensional Framework for resilience and extant research, the present study examined the potential moderating role of cognitive reappraisal in the prospective relationship from peer victimization to self-esteem. To increase precision of findings the long-term impact of self-esteem on peer victimization was also tested. Self-reported data were collected from 285 early adolescents (Mage = 10.53 years, SD = 0.16; 54.0% girls) at two waves, spaced 1-year. Latent moderated structural equation analysis showed that peer victimization was negatively related to later self-esteem, but only for youth displaying low levels of cognitive reappraisal. For adolescents with high levels of cognitive reappraising, peer victimization was not found to predict any changes in self-esteem over time. The long-term impact of self-esteem on peer victimization was not supported. Overall the present study suggests that enhancing cognitive reappraisal could be a promising avenue for lowering risk for poor self-esteem in young individuals experiencing peer victimization.

Social Support, Health Behaviors, Self-Esteem, and Successful Aging in a Sub-Saharan African Sample of Older Adults: Test of a Sequential Mediation Model

Background and Objectives

Previous research demonstrates that social support facilitates successful aging across all cultures. However, the factors that potentially mediate the link between social support and successful aging remain unclear. This study examined whether a healthy lifestyle and self-esteem mediate the association between social support and successful aging. It was hypothesized that the relationship between social support (family, friends, and significant other) and successful aging would be serially mediated by both healthy lifestyle and self-esteem.

Research Design and Methods

Participants were 479 Nigerian retirees (53.4% female) aged 60 to 90 years (Mage = 64.81, SD = 6.86). They provided information on relevant demographic variables and completed the following measures: Fantastic Lifestyle Checklist (Fitness Appraisal), Rosenberg Self-esteem Scale, Multidimensional Scale of Perceived Social Support Scale, and Successful Aging Inventory. Three separate regression models (family, friends, and significant other dimensions of social support) were conducted using the Hayes PROCESS macro for SPSS with 5,000 bootstrap estimates.

Results

Controlling for age and sex, family support, significant other support, friends support, healthy lifestyle, and self-esteem were directly associated with successful aging. The association between family support and successful aging was mediated by healthy lifestyle; and this was also seen for friends' support and significant other support. The sequential path from social support to successful aging through healthy lifestyle, and then via improved self-esteem, was significant for family support and significant other support, but not friends support.

Discussion and Implications

Findings suggest that middle-aged to older adults who have strong support from their families and significant others may be more likely to engage in healthy behaviors and, in turn, experience higher levels of self-esteem, thereby aging well.

Long-Term Satisfaction with Breast Augmentation and Augmentation Mastopexy in the Latin American Population

OBJECTIVE

The primary objective of this study was to determine the long-term satisfaction levels of women who have undergone breast augmentation and augmentation mastopexy procedures, while identifying the factors influencing patient satisfaction.

METHODS

A self-reported retrospective case study design was used to collect data from women with breast implants. The study employed a survey that included demographic information, preoperative diagnosis, implant details, and patient-reported outcomes measured using the Breast-Q Instrument, which evaluates satisfaction with breasts, self-esteem, sexual well-being, and physical symptoms. Statistical analyses were conducted to identify correlations and differences in outcomes between the different variables.

RESULTS

The survey was completed by 1022 women from 19 countries, with Chile, Mexico, and Colombia being the most represented. Augmentation was performed on 72.2% of the patients, while 27.7% underwent augmentation mastopexy. Patient satisfaction with breast size and shape varied significantly between the two procedures, with patients undergoing augmentation mastopexy showing less satisfaction. In addition, patients who were unaware of their implant shape or placement reported lower satisfaction scores. The study also found that patient satisfaction decreased over time in the augmentation mastopexy cases and that patients with high body mass index had lower satisfaction.

CONCLUSION

Augmentation mastopexy in patients with breast ptosis yields lower satisfaction than augmentation alone. Dissatisfaction escalates with overweight/obesity (BMI), post-surgery time, and misinformation. Implant pocket (pre-vs. subpectoral), shape (round vs. anatomical), and size did not impact satisfaction.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Mixed-Mode Mindfulness-based cognitive therapy for psychological resilience, Self Esteem and Stigma of patients with schizophrenia: a randomized controlled trial

BACKGROUND

People with schizophrenia often face challenges such as lower psychological resilience, reduced self-worth, and increased social stigma, hindering their recovery. Mindfulness-Based Cognitive Therapy (MBCT) has shown promise in boosting psychological resilience and self-esteem while diminishing stigma. However, MBCT demands professional involvement and substantial expenses, adding to the workload of professionals and the financial strain on patients. Mixed-mode Mindfulness-Based Cognitive Therapy (M-MBCT) integrates both "face-to-face" and "self-help" approaches to minimize staff effort and costs. This study aims to assess the impact of M-MBCT on the psychological resilience, self-esteem, and stigma in schizophrenia patients.

METHODS

This randomized, controlled, parallel-group, assessor-blinded clinical trial enrolled 174 inpatients with schizophrenia. Participants were randomly assigned to either the experimental or control group. The experimental group underwent an 8-week M-MBCT intervention, while the control group received standard treatment. Data collection employed the Connor-Davidson Resilience Scale (CD-RISC), Internalized Stigma of Mental Illness Scale (ISMI), and Rosenberg Self-Esteem Scale (RSES) before and after the intervention. Post-intervention, significant differences in ISMI, CD-RISC, and RSES scores were observed between the experimental and control groups.

RESULTS

In the experimental group, ISMI scores notably decreased, while CD-RISC and RSES scores significantly increased (P < 0.05). Multiple linear regression analysis identified age, education, and family history of mental illness as significant factors related to stigma (P < 0.05). Additionally, correlation analysis indicated a significant negative relationship between the reduction in CD-RISC scores and the reduction in ISMI scores (P < 0.05).

CONCLUSION

M-MBCT effectively enhanced psychological resilience and self-esteem while diminishing stigma in individuals with schizophrenia. M-MBCT emerges as a promising treatment option for schizophrenia sufferers.

TRIAL REGISTRATION

The trial was registered at the Chinese Clinical Trial Registry on 03/06/2023 ( www.chictr.org.cn ; ChiCTR ID: ChiCTR2300069071).

The association between self-esteem and aesthetic component of smile among adolescents

OBJECTIVES

Self-esteem plays a crucial role during adolescence in a shaping of an individual's overall well-being and confidence. The aim of this study was to explore the relationship between the self-esteem in adolescents and their smile aesthetics, as well as to assess the alignment of opinions on this matter between adolescents and dentists.

METHODS

Sample included 413 students in Split-Dalmatia County, aged 13 to 18 (60% females). Data on demographic issues, orthodontic history, and desire for orthodontic treatment were collected by the self-administrated questionnaire. Coopersmith's Self-Esteem Inventory was also used. Smile aesthetics was assessed by each participant and dentist independently using an Aesthetic Component of the Index of Orthodontic Treatment Need (IOTN AC).

RESULTS

Self-esteem was higher in adolescents who rated their smile aesthetics equally to the dentist than in those who considered their aesthetics to be worse than the dentist (18.5 vs. 16; P = 0.011). The multiple linear regression revealed that the self-esteem of adolescents was positively related to undergone previous orthodontic treatment (β = 1.286, P = 0.020) while negatively related to the female gender (β = -2.531, P ≤ 0.001) and IOTN AC assessed by dentist (β = -0.356, P = 0.015). It was not related to educational level or desire for orthodontic treatment.

CONCLUSION

The self-esteem in adolescence is influenced the most by gender, but the orthodontic treatment and better smile aesthetics might also contribute.

Self-esteem in children and adolescents with and without attention-deficit/hyperactivity disorder: A meta-analytic review

Meta-analytic methods were used to examine global and domain-specific (i.e., academic, social, behavioral) self-esteem in children and adolescents with and without ADHD. Potential moderators of effect size heterogeneity were also examined via meta-regressions within a three-level approach. Findings from 49 aggregated global self-esteem effect sizes (ADHDN = 2500, TDN = 9448), 12 academic self-esteem effect sizes (ADHDN = 386, TDN = 315), 11 social self-esteem effect sizes (ADHDN = 258, TDN = 254), and 8 behavioral self-esteem effect sizes (ADHDN = 231, TDN = 211) suggest that children and adolescents with ADHD experience moderate global (ES = 0.46, p < .001), academic (ES = 0.60, p = .009), and social (ES = 0.67, p = .001) self-esteem impairments compared to children and adolescents without the disorder. The aggregated behavioral self-esteem effect size (ES = 0.20, p = .54), however, was not significant, and the global self-esteem effect size was markedly smaller compared to effect sizes for the academic and social domains. Further, examination of potential moderators of effect size heterogeneity indicated null effects for medication status, diagnostic complexity, informant, age, sex, comorbid psychopathology, and self-esteem dimension. Collectively, findings suggest that children and adolescents with ADHD do not hold a ubiquitous negative self-perception of difficulties across academic, social, and behavioral domains of functioning, and unexamined domains that are distal to ADHD may serve to bolster global self-esteem.

Levels of depression and self-esteem in women with cancer of the endometrium and cervix receiving chemotherapy treatment in Türkiye

OBJECTIVE

Endometrium and cervical cancer is a common and important health problem that affects women in many physical, emotional and psychological aspects. This study aimed to determine the levels of depression and self-esteem in women with endometrial and cervical cancer receiving chemotherapy, determine the factors affecting them, and examine the relationship between the levels of depression and self-esteem.

METHODS

This descriptive and cross-sectional study was conducted with 158 women who came to the gynecology-oncology policlinic and chemotherapy unit of a training and research hospital in Izmir, western Türkiye, between April 2022 and April 2023. Data were collected with the "Descriptive Information Form", "Beck Depression Inventory" and "Rosenberg Self-Esteem Scale". Descriptive and inferential statistics were performed to analyse the association between the study variables.

RESULTS

In this study, 52.5% of women were diagnosed with endometrial cancer and 47.5% with cervical cancer. Beck Depression Inventory mean total score was 11.28 ± 6.35, and 20.3% of them were at risk of depression (BDI ≥ 17). Rosenberg Self-Esteem Scale mean total score was 21.06 ± 3.85, and 97.5% of them had high self-esteem. There was a statistically significant and strong negative correlation between the mean total scores of the Beck Depression Inventory and Rosenberg Self-Esteem Scale (r = 0.723; p < 0.05). It was determined that an increase in the Rosenberg Self-Esteem Scale mean total score by 1 unit decreased the Beck Depression Inventory mean total score by 1.2 units and was responsible for 52% of the variance (B = -1.192; R2 = 0.523).

CONCLUSION

It was determined that one-fifth of women experienced moderate/severe depression and the majority of them had high self-esteem. The increase in women's depression levels decreased their self-esteem. Health professionals and oncology nurses should perform screenings to determine the depression and self-esteem levels of women with endometrial and cervical cancer and provide necessary education, counseling, and care to women.

The effect of empowerment counseling on stress and self-esteem of mothers with hospitalized premature infants

BACKGROUND

This study aimed to investigate the effect of counselling on stress and self-esteem of mothers with hospitalized premature infants.

MATERIALS AND METHODS

This parallel randomized clinical trial was conducted on 80 primigravida mothers aged 18-40 years, gestational age of 28-34 weeks in 2021 in Iran. The women were randomly assigned to two groups by blocked randomization. The data were collected using a demographic information questionnaire, Paternal Stress Scale and Rosenberg self-esteem questionnaire. Individual counselling based on the GATHER model was carried out within two consecutive weeks in four sessions. Data were analyzed with SPSS 24.

RESULTS

There was no significant difference between the two groups in demographic variables, stress, and self-esteem before the intervention (P>0.05). There was a substantial difference in the mean score of self - esteem 9.52±3.22 and 16.75±6.39 (P<0.001), stress 154.65±32.15and 61±10.98 (P<0.001) and different dimensions of stress between the control and intervention groups after the intervention. The most significant reduction occurred in the dimension of appearance and behaviour of the infant (cohen d=3.146).

CONCLUSIONS

The results show counselling with an empowerment approach based on the GATHER model is effective in reducing stress and increasing self-esteem of mothers of premature infants admitted to the intensive care unit.

Effect of Makeup Use on Depressive Symptoms: An Open, Randomized and Controlled Trial

INTRODUCTION

Depression is one of the most disabling diseases globally, with a high disease burden that generates high direct and indirect costs. The incidence of depression is twofold higher in adult women than in men. Biological and psychosocial factors constitute the pathophysiological bases of the condition and due to the complexity of the condition, current understanding is that the "treatment strategy must be multimodal". The objective of this study was to measure the effect of introducing the frequent use of makeup on improving depressive symptoms in adult women of medium-low purchasing power METHODS: Participants with the targeted profile who did not frequently use makeup were selected and randomised to receive (test group) or not (control group) stimuli and makeup products intended for encouraging the frequent use of makeup. The Zung Depression Self-Assessment Scale was used to assess depressive symptoms, with additional assessments on self-image perception using the mirror test and salivary cortisol level.

RESULTS

The results demonstrated a sustained reduction in depressive symptoms (8.3 percentage points reduction in the Average Zung Index; P < 0.05), with a significant improvement in self-image perception (25% increase in the average score obtained in the mirror test; P < 0.05) and a specific influence on salivary cortisol levels (55% reduction in salivary cortisol concentration; P < 0.05) after the first makeup application.

CONCLUSION

The results show that encouraging the frequent use of makeup, a practice that can be achieved by most people and which is simple and inexpensive to implement, can contribute to effective and sustainable improvement in the well-being and mental health of a significant portion of the population.

The continuation of non-physical abuse from childhood to adulthood in eating disorder patients: An interpretative phenomenological analysis

BACKGROUND

The ED literature has focused on the physical forms of childhood abuse with respect to eating disorders, overlooking non-physical abuse even though eating disorder patients report the latter either as primary experiences or as a revival of their childhood experiences. Additionally, there is no literature exploring whether adult eating disorder patients who have experienced childhood non-physical abuse continue to experience abuse as adults, and if they do, how well-being is impacted or linked with eating pathology.

OBJECTIVE

This study explored the lived experiences of eating disorders patients who have experienced non-physical childhood abuse in childhood and adulthood.

PARTICIPANTS AND SETTINGS

Six adult female eating disorder outpatients each took part in a semi-structured interview.

METHODS

This study used the Interpretative Phenomenological Analysis framework.

RESULTS

Three master themes and eleven superordinate themes were drawn from the analysis, addressing the research question: continuation of non-physical abuse across a lifetime, developmental factors and non-physical abuse, and non-physical abuse and eating pathology.

CONCLUSIONS

The participants' accounts indicate that childhood non-physical abuse is related to eating disorder onset, and abuse continuation in adulthood contributes to the disorder's maintenance. Moreover, the lifelong consequences of non-physical childhood abuse impact psychological factors, such as self-esteem, attachment and emotion regulation, affecting the individuals' adult lives and keeping participants inside a vicious cycle of trauma re-enactment. Low self-esteem is considered by the participants as the key factor for their disturbed relationship with food.

Influence of economics students' self-esteem on their academic engagement: The moderating role of gender

This study investigated the moderating role of gender in the influence of Economics students' self-esteem on their academic engagement. This quantitative research used a descriptive cross-sectional survey design with a sample of 422 senior high school Economics students. The Academic Engagement and Self-Esteem Scales served as the instruments for data collection in this study. The data were analysed using partial least squares structural equation modelling (PLS-SEM). The study revealed that there was a statistically significant positive influence of Economics students' self-esteem on their academic engagement. Specifically, it was found out that self-esteem had a significant positive influence on academic affective, behavioural and cognitive engagement. Also, it was discovered that gender did not moderate the influence of students' self-esteem on their academic affective, behavioural and cognitive engagement. Therefore, it was recommended that parents, guardians and Economics teachers should guide students to improve upon their self-esteem since high self-esteem will lead to high academic engagement.

Self-esteem and cortical thickness correlate with aggression in healthy children: A surface-based analysis

Aggressive behavior can have serious physical, psychological, and social consequences. However, little is known about the personality and neurological antecedents underlying aggressive behavior in children. The objective of this study was to investigate the relationship between self-esteem, aggression, and brain structure (i.e., cortical thickness and surface area) in a population of healthy children (N = 78; 9-12 years; mean age: 9.95 ± 0.90 years). The results revealed that self-esteem showed a negative association with aggression and significantly predicted aggressive behavior. No gender differences were found in aggression and its neural correlates. We performed the cortical parcellation method to further explore the neural foundations underlying the association of self-esteem with aggression. Children with higher aggression had increased cortical thickness in four clusters after multiple comparison correction: right medial orbitofrontal cortex, right lateral orbitofrontal cortex, right superior frontal gyrus, and left insula. In a mediation analysis, cortical thickness in the right medial orbitofrontal cortex contributed to the effect of self-esteem on aggression. These findings extend our understanding of morphological correlates of aggression in children, suggesting that an increased cortical thickness in childhood is a potential mechanism linking low self-esteem to aggression.

Disparities in the impact of economic well-being on self-esteem in adulthood: Race and ethnicity

BACKGROUND

Most studies have defined economic well-being as socioeconomic status, with little attention given to whether other indicators influence self-esteem. Little is known about racial/ethnic disparities in the relationship between economic well-being and self-esteem during adulthood.

AIM

To explore the impact of economic well-being on self-esteem in adulthood and differences in the association across race/ethnicity.

METHODS

The current study used data from the National Longitudinal Survey of Youth 1979. The final sample consisted of 2267 African Americans, 1425 Hispanics, and 3678 non-Hispanic Whites. Ordinary linear regression analyses and logistic regression analyses were conducted.

RESULTS

African Americans and Hispanics were more likely to be in poverty in comparison with non-Hispanic Whites. More African Americans were unemployed than Whites. Those who received fringe benefits, were more satisfied with jobs, and were employed were more likely to have higher levels of self-esteem. Poverty was negatively associated with self-esteem. Interaction effects were found between African Americans and job satisfaction predicting self-esteem.

CONCLUSION

The role of employers is important in cultivating employees' self-esteem. Satisfactory outcomes or feelings of happiness from the workplace may be more important to non-Hispanic Whites compared to African Americans and Hispanics.

Prevalence of bullying and its impact on self-esteem, anxiety and depression among medical and health sciences university students in RAS Al Khaimah, UAE

Bullying and peer victimization among medical and health sciences students is a public health issue. This is owing to its detrimental impact and greater risk of psychiatric diseases and psychopathology in childhood, adolescence, and adulthood. As a result, a descriptive cross-sectional research study was conducted to investigate the prevalence of bullying and its influence on self-esteem, anxiety, and depression among medical and health sciences university students in RAS Al- Khaimah, United Arab Emirates. Approximately 369 students from MBBS, BDS, B Pharm, and BSN colleges were selected. The instruments included sociodemographic questions, bullying queries, the Rosenberg Self-Esteem Scale, and the Primary Care Anxiety and Depression Scale. Participants averaged 21.49 ± 2.95. 34.1 % of medical students were bullied. 44.4 % of individuals were called insulting names, making verbal bullying the most common method. The linear regression analysis of bullying data shows that girls (53.2 %) are bullied more than boys (46.8 %). Bullied individuals had a mean score of 43.30 ± 19.74, indicating a higher rate of depression and anxiety. Bullied students had a mean score of 44.62 ± 9.94, indicating lower self-esteem. Significant differences were observed in relation to bullying when considering the variables of the university year, mother's education, and previous experience of bullying (P = 0.002, 0.038, 0.001). It is imperative that universities establish comprehensive protocols to identify instances of such behaviour and provide necessary assistance to victims and their families.

Indirect effect of impulsivity on suicide risk through self-esteem and depressive symptoms in a population with treatment-resistant depression: A FACE-DR study

INTRODUCTION

Suicide is a major health issue. Its prevalence is particularly high in subjects presenting major depression disorder (MDD), making this a key suicide-related risk factor. Suicide attempts in severe forms of MDD were assumed to be linked to impulsivity and loss of control. Nevertheless, we failed to find data specifically investigating the link between impulsivity and suicide risk in treatment-resistant depression (TRD). This study seeks to review this relationship.

METHOD

Patients were recruited for a prospective cohort. Suicide risk and impulsivity were assessed using the International Neuropsychiatric Interview and Barratt Impulsiveness Scale, Version 10, respectively, while the severity of depressive symptoms was assessed using the Montgomery-Asberg Depression Rating Scale, anxiety with the State-Trait Anxiety Inventory and childhood maltreatment using the Childhood Trauma Questionnaire.

RESULTS

220 TRD patients were enrolled in the study. The impulsivity score was correlated with self-esteem, marital status, professional status and anxiety. There was no direct link to suicide risk. However, impulsivity was associated with self-esteem (coefficient: -0.24; p value 0.043) and depressive symptom severity (coefficient: 0.; p value 0.045). The suicide risk was significantly correlated with depressive symptom severity (coefficient = 0.38, p < 0.001) and self-esteem (coefficient = -0.34, p = 0.01). Considering these correlations, we postulated that the effect of impulsivity on suicide risk could be mediated by self-esteem in terms of depressive symptom severity and we finally found a relevant mediation model within impulsivity having an indirect effect on suicide risk by impacting self-esteem and depressive symptoms with anxiety also playing a significant role as a covariable.

CONCLUSION

We found that impulsivity could play an indirect role with the involvement of self-esteem and depressive symptoms and the contributing role of anxiety.

Stigma and self-esteem in facial burn patients: A correlation study

BACKGROUND

A considerable number of burn patients have greater psychological stress due to the special trauma site. In clinical practice, it is found that medical staff pay more attention to the rehabilitation of physical function, while the mental health status of patients is greatly neglected. In contact with patients, we found that attention should be paid to the levels of stigma and self-esteem. However, there are few studies on stigma and self-esteem in patients with facial burns. Therefore, this study aimed to describe the stigma and self-esteem levels of facial burns, investigate the relationship between these two variables, and explore the influencing factors of stigma in patients with facial burns, in order to provide evidence for follow-up interventions to improve this population.

METHODS

From August 2020 to June 2021, we recruited patients with facial burns who met the inclusion criteria in one burn specialist clinic and three burn units of a tertiary A hospital in Guangzhou, China. The survey tools of this study include sociodemographic and disease-related information questionnaires, the Chinese version of the Social Impact Scale, and the self-esteem scale (these scales were validated). SPSS 25.0 software was used for data analysis through t test, analysis of variance, correlation analysis, multiple linear regression method for data statistics.

RESULTS

The total stigma score of facial burn patients was (58.01 ± 7.57), which was at a medium level; the self-esteem score was (19.72 ± 2.43), which was at a low level. Correlation analysis showed that there was a positive correlation between the self-esteem score and the total score of stigma (r = 0.286, P < 0.01). The family per capita monthly income, education level, way of medical expenses expenditure, and self-esteem of facial burn patients were the influencing factors of their stigma, and these factors explained 33.7% of the variation in stigma (F=8.659, P＜0.01).

CONCLUSIONS

Patients with facial burns have low levels of stigma and self-esteem, which requires our efforts. In particular, there is a positive correlation between stigma and self-esteem, and self-esteem is an independent risk factor affecting stigma. Our findings suggest that interventions aimed at enhancing self-esteem have the potential to positively impact the reduction of stigma in this patient population.

Do Municipal Contexts Matter for Adolescent Mental Health? A Within-Municipality Analysis of Nationwide Norwegian Survey Data Across Six Years

Despite growing concerns about substantial socio-economic differences between districts in many developed nations, limited attention has been paid to how adolescent mental health may be shaped by district characteristics. A few studies have shown that adolescent mental health is related to contextual factors such as district socio-economic status, neighborhood disorder, and quality of infrastructure. However, prior estimates may be an artifact of unmeasured differences between districts. To address these concerns, we used data from the nationwide Norwegian Ungdata surveys (N = 278,764), conducted across the years 2014 to 2019. We applied three-level hierarchical linear models to examine within-municipality associations between municipal factors and adolescent mental health in the domains of internalizing problems (i.e., depressive symptoms), externalizing problems (i.e., behavioral problems), and well-being (i.e., self-esteem), thereby accounting for all time-invariant municipality-level confounders. Our results showed that municipal-level safety, infrastructure, and youth culture are associated with adolescent mental health problems. Further, cross-level interaction models indicated gender-specific associations, with stronger associations of municipality infrastructure and community belongingness with increased self-esteem and reduced delinquent behaviors among girls than boys. Our findings highlight that municipality-level interventions may be a feasible strategy for adolescent mental health, even in a society characterized by low inequality and high redistribution.

Prevalence of Adverse Childhood Experiences and Their Relationship with Self-esteem Among School-Age Children in Jordan

This study aimed to assess the prevalence of adverse childhood experiences and their relationship with self-esteem among secondary school students in Jordan. A cross-sectional, retrospective design was utilized using a convenience sample of 559 secondary school children (grades 7-11). Results showed that among the participating students, emotional abuse was the most commonly reported type of abuse (59.6%), followed by household violence (52.2%), bullying (44.7%), physical abuse (31.7%), emotional neglect (26.3), physical neglect (12.7%), and parents' separation (5.2%). Male students reported significantly more physical abuse than female students (37.5% vs 26.2%, p < 0.001), and significantly more physical neglect than female students (18.2% vs 7.6%, p < 0.001). However, female students reported significantly more household violence than male student (60.0% vs 43.9%, p < 0.001). Self-esteem scores were lower for students who reported physical abuse (d = 0.38, p < 0.001), household violence (d = 0.25, p < 0.003), emotional neglect (d = 0.45, p < 0.001), physical neglect (d = 0.58, p < 0.001), and bullying (d = 0.29, p = 0.001). Self-esteem was best predicted by physical abuse (β =  - 0.114, p = 0.009), emotional neglect (β =  - 0.169, p < 0.001), and physical neglect (β =  - 0.148, p < 0.001). Efforts should be exerted to prevent violence against children. National programs and community awareness campaigns should focus on the violence's detrimental effects on children.

Revie ⊕: Impact of a resource-based life review intervention on patients with advanced cancer: A waitlist controlled trial

PURPOSE

Life review interventions aim to support individuals facing an incurable disease accompanied by existential concerns and health-related challenges. Based on encouraging feasibility results, this study assessed the effects of Revie ⊕ life review intervention on the self-esteem of patients with advanced cancer, and the effects on well-being, post-traumatic growth, life satisfaction, symptom burden and interaction with nurses.

METHOD

The study consisted of a two-arm parallel-group, waitlist-controlled trial (WCT) in the oncology division of a Swiss-French University Hospital. Revie ⊕ was composed of nurse-led meeting with the patient to address and document significant life events using a strengths-focused approach and targeting the life project.

RESULTS

Due to Covid-19 pandemic, adjustments were made regarding study duration and participant's allocation: Fifty-eight patients received Revie ⊕, 39 completed all the measurements. Self-esteem was high at baseline and maintained stability over time. The social well-being decreased in the intervention group before-after Revie ⊕ (-1.7 (3.9), p = 0.044) while emotional and functional well-being showed stability. The intensity of symptoms decreased in the intervention group before-after Revie ⊕: 4.9 (9.4), p = 0.020.

CONCLUSIONS

This study suggests that patients living with an advanced cancer and who received Revie ⊕ intervention may have maintained their self-esteem high over time. Observed results are promising, particularly considering the influence of the pandemic. Nevertheless, these findings do not allow us to draw definitive conclusions regarding the efficacy of the intervention on self-esteem. WCT seems not to be the appropriate design to highlight the added value of Revie ⊕ for this particularly vulnerable population.

CLINICAL TRIAL REGISTRATION NUMBER

NCT04254926.

Psychological Mechanisms of Internalized HIV Stigma Affect Sleep Impairment among People Living with HIV in China: A follow-up Study

Prior studies have demonstrated that HIV-related stigma (e.g., internalized HIV stigma) is detrimental to the physical and mental health (e.g., sleep impairment and depressive symptoms) of people living with HIV (PLWH). However, follow-up data are limited regarding the longitudinal relationships between internalized HIV stigma, future orientation, self-esteem, depressive symptoms, and sleep impairment. The present study attempted to examine a mediation model involving these variables among Chinese PLWH. A two-wave follow-up design (6 months intervals) was employed in a final sample of 1,140 Chinese PLWH (Mage = 41.63, SD = 9.29, age range: 21-67 years; 64.6% men). Participants completed Internalized HIV Stigma Scale, Optimism About the Future Scale, Rosenberg Self-Esteem Scale, Center of Epidemiological Studies Depression Scale, and an adapted version of Pittsburgh Sleep Quality Index. Results revealed that internalized HIV stigma at baseline had a significant direct relationship with sleep impairment over time, and a significant indirect relationship with increased sleep impairment over time via future orientation and depressive symptoms. Furthermore, the linkage between internalized HIV stigma and sleep impairment was serially mediated via self-esteem and depressive symptoms. This study highlights the deleterious effects of internalized HIV stigma on the physical and psychological health of PLWH. The findings suggest that interventions targeting internalized HIV stigma and related factors such as future orientation, self-esteem, and depressive symptoms may facilitate improvements in sleep quality and overall well-being among PLWH.