Högskolan i Skövde

Relational victimization typically emerges first during the elementary school period, and has been associated with increased levels of internalizing symptoms in children. Individual differences in autonomic nervous system functioning have been suggested as a potential factor linking social stressors and internalizing symptoms. The aim of this study was therefore to examine whether heart rate and heart rate variability mediated the association between relational victimization and internalizing symptoms in 373 mainstream elementary school children. Children were assessed in 2015 (T 0 ; Grades 3-5, M age = 9.78 years, 51% boys) and reassessed in 2016 (T 1 ). Heart rate and heart rate variability were assessed during a regular school day at T 1 . A multi-informant (teacher and peer report) cross-time measure of relational victimization, and a multi-informant (self- and teacher report) measure of internalizing problems at T 1 was used. Results showed that heart rate variability, but not heart rate, mediated the association between relational victimization and internalizing symptoms. This study provides tentative support that in children from a general population sample, a psychobiological factor may mediate the association of relational victimization with internalizing symptoms.

Posttraumatic symptoms, including nightmares, are more prevalent in World War II survivors than in the general population, but how war experiences have affected subsequent dream content in specific survivor populations remains less explored. In the present study, we used self -reports collected in 1973 from Polish Auschwitz survivors (N = 150; 45 women) to investigate the prevalence of posttraumatic symptoms, classified according to the DSM-5 diagnostic criteria for posttraumatic stress disorder (PTSD). Furthermore, we classified main themes, central emotions, and threatening events in the dreams (N = 632) of the survivors, comparing dreams recalled from before, during, and after the war. Of the respondents, 12.7% described experiencing all diagnostic criteria for PTSD. War-related themes were less common in dreams dreamt before than during the war but were most common after the war. Themes related to family and freedom were most likely to appear in dreams dreamt during than before or after the war. The most often occurring emotion was fear, and dreams from after the war were likely to contain more negative and less positive emotions than dreams dreamt during the war. The likelihoods of reporting threatening events and threats involving aggression were higher in dreams dreamt during than before the war and in dreams dreamt after than during the war. In conclusion, PTSD symptoms were common in Polish Auschwitz survivors 30 years after World War II, and the themes, emotions, and threatening events in their dreams seem to reflect lifelong posttraumatic dreaming. We interpret the results as lending support for the threat simulation theory of dreaming.

Purpose: To identify overuse of methylphenidate and to investigate patterns of overuse in relation to sociodemographic and clinical characteristics. Patients and methods: Swedish national, pharmacy dispensing data were analyzed for all 56,922 individuals aged 6-79 years, who filled a methylphenidate prescription between 2010 and 2011. Overuse was defined as having above 150% days covered by the dispensed amount during 365 days from the first prescription fill, assuming use at the maximum recommended daily dose. Results: In total, 4,304 individuals (7.6% of the methylphenidate users) were categorized as overusers. The risk of overuse increased with age (OR for 46-65 years vs 6-12 years 17.5, 95% CI 14.3-21.3), and was higher in men (OR 1.4, 95% CI 1.3-1.5) and individuals with low income (OR 1.1, 95% CI 1.0-1.2), as well as in individuals with an attention deficit hyperactivity disorder (ADHD) diagnosis (OR 1.4, 95% CI 1.3-1.6), health care visits (OR 1.3, 95% CI 1.2-1.4), previous ADHD medication use (OR 2.6, 95% CI 2.4-2.8), and previous diagnosis of mental and behavioral disorders due to psychoactive substance use (OR 2.1 95% CI 2.0-2.3). Conclusion: Among individuals using methylphenidate in Sweden, 7.6% receive amounts that are larger than what they should have a medical need for, assuming that they were using the maximum recommended daily dose 365 days per year. Notably, the prevalence of overuse was associated with previous diagnosis of alcohol and drug misuse. The prevalence was also positively associated with higher age and previous use of ADHD medication. These findings may point toward a link between exposure time and overuse. However, future studies with long-term data are needed to investigate this.

BACKGROUND: Collegial conversations are important for sustainable learning to last beyond a course. Research on collegial conversations and peer learning in the workplace during psychiatric residency courses remains sparse, however. In this study, the aim was to explore residents' opportunities for collegial conversations during and after national courses in psychiatry.

METHODS: Residents in psychiatry completed an online survey including questions on opportunities for collegial conversations in their workplaces. Logistic regression was used for multivariate analysis and thematic content analysis was used for the open-ended answers where a theoretical framework of communities of practice was employed for the interpretation of the findings.

RESULTS: The survey was completed by 112 residents out of 725 (15,4%). The participants reported few structured forums for collegial discussion. The results of multivariate analysis suggest that more women than men feel it is advantageous to attend courses with others from the same workplace or from the same group of residents, described here as a team. The analysis of qualitative data identified how opportunities for collegial conversations differ across contexts and the type of values that are attached to team participation in residency courses.

CONCLUSIONS: This study highlights the importance of collegial conversations as a way to sustain the learning from residency courses into the workplace. By learning about residents' perceptions of collegial conversations during and after courses, teachers and directors may be more able to support residents' lifelong learning and professional development.

Mental health in adolescence is an increasing public health concern. Over half of all mental disorders debut by 14 years of age and remain largely untreated up to adulthood, which underlines the importance of early detection. Mental health is a complex concept that consists of both mental well-being and mental ill-health (including mental health problems and mental disorders). However, the development of mental health during the transition period from childhood to adulthood is dependent on the coping strategies used to meet everyday stressors. Therefore, the framework is salutogenic, looking at the world from a resource perspective to promote mental well-being. However, finding predictors also include identifying risk factors of mental ill-health.

The overall aim of the thesis was to investigate predictors of mental health in adolescents from a longitudinal perspective. The Finnish Family Competence (FFC) study was used with adolescents at 15 years of age and their parents, with a follow-up at 18 years of age. Also, Swedish data material was used, The Longitudinal Research on Development In Adolescence (LoRDIA) with adolescents at 12-13 years and a follow-up at 17 years. In sub-studies I, II, and III the outcome was a probable mental health diagnosis determined by a standardised Development and Well-being Assessment (DAWBA) interview. In sub-study IV the outcome was perceived mental health status (MHS).

The results showed that a strong sense of coherence was associated with a decreased risk for subsequent mental disorders (sub-study I) and that self-esteem was negatively associated with future mental well-being (sub[1]study IV). Further, low levels of mental health problems reported by the adolescents (sub-study II) or by their parents (sub-study III) were related to a decreased risk for subsequent mental disorders. There was a gender aspect that affected the results and which showed girls as having more internal mental health problems or mental disorders. Other factors indicating an increased risk of mental ill-health were parental low age at childbirth and socioeconomic factors such as the mother’s low educational level, father’s blue-collar profession, and a poor economic situation in the family.

The results from this thesis underline the importance of having a salutogenic approach when dealing with mental health in adolescence to identify coping resources for stressors in Antonovsky’s ‘River of Life’. The school might be an arena for creating interventions with a resource perspective for strengthening a sense of coherence and self-esteem, and for alleviating perceived mental health problems.

Background and Objectives: Adolescents’ mental health is a public health concern. The prevalence of mental disorders is increasing, and there seems to be a gender difference, with girls reporting more mental health problems than boys, especially regarding internalizing problems. Most mental disorders debut early but often remain untreated into adulthood. Therefore, early detection of mental disorders is essential. The study aimed to estimate to what extent teenagers’ self-reports of mental health problems predict probable mental diagnoses as they enter adulthood, particularly regarding gender differences. Methods: Self-reported mental health problems, Youth Self-Report (YSR) at 15 years (n = 504) from the ongoing Finnish family competence study (FFC) using modified multivariable Poisson regression analysis for prediction of DAWBA (Development and Wellbeing Assessment) interview outcomes 3 years later. Results: Recently published Results (Carlén et al., 2022) showed that one unit’s increase in YSR was estimated to correspond to an increase in the relative risk of a probable DAWBA-based diagnosis by 3.3% [RR (95% CI) 1.03 (1.03–1.04), p < 0.001]. In gender-specific analysis, the Findings applied, particularly to girls. Conclusions: Youth Self-Report (YSR) scores at pubertal age predicted the risk of a probable mental diagnosis at the onset of adulthood, particularly for girls. Further research is needed to explain the lower sensitivity of YSR among boys. 

Background: Mental health in adolescence is an increasing global public health concern. Over half of all mental disorders debut by 14 years of age and remain largely untreated up to adulthood, underlining the significance of early detection. The study aimed to investigate whether parental distress rating at the child's age of 15 predicts a probable mental diagnosis in a three-year follow-up.

Methods: All data was derived from the Finnish Family Competence (FFC) Study. The analysis focused on whether parental CBCL (Child Behavior Checklist) rating (n = 441) at the child's age of 15 years predicted the outcome of the child's standardised DAWBA (Development and Well-Being Assessment) interview at offspring's 18 years.

Results: Multivariable analysis showed that a one-unit increase in the total CBCL scores increased the relative risk of a DAWBA-based diagnosis by 3% (RR [95% CI] 1.03 [1.02-1.04], p < 0.001).

Conclusions: Parental CBCL rating in a community sample at the adolescent's age of 15 contributes to early identification of adolescents potentially at risk and thus benefitting from early interventions.

Background The situation concerning adolescent mental health is a global public health concern, and the concept includes the ability to cope with problems of everyday life. A person’s approach and attitude towards themselves, i.e., their self-esteem, affects mental health. The study aimed to appraise and deepen the scientific understanding of adolescents’ self-reported self-esteem at age 12−13 from a resource perspective and test its ability to predict subsequent perceived mental well-being at age 17.

Methods Data from the Longitudinal Research on Development in Adolescence (LoRDIA) prospective follow-up study of adolescents aged 12−13, and 17 (n=654) were analysed using ANCOVA. The outcome variable, perceived mental well-being (MWB), covers the aspects of mental well-being inspired by the “Mental Health Continuum,” representing positive mental health. Covariates were self-esteem (SE) and reported initially perceived MWB at age 12−13. Other independent explanatory variables were gender, the family’s economy, and the mother’s educational level.

Results Self-esteem appeared relatively stable from 12−13 to 17 years (M=20.7 SD=5.8 vs. M=20.5 SD=1.7). There was a significant but inverted U – shaped association between SE at age 12–13 and perceived MWB at age 17 [F (1, 646)=19.02, β-0.057; CI -0.08−-0.03, Eta=0.03, p=.000]. Intermediate but not strong SE predicted significantly good MWB. When conducting the ANCOVA for boys and girls separately, only the mother’s educational level was significantly positively associated with perceived MWB of girls.

Conclusions Good self-esteem in early adolescence increases the likelihood of an unchanged favourable development of self-esteem and the probability of good perceived mental well-being. SE explained 18 per cent of the variation of MWB, and even more among girls. However, normal SE rather than high SE at 12 and 13 years is predictive of later mental well-being. Girls reported low self-esteem more often. Therefore, supporting self-esteem early in life can promote mental well-being in adolescence.

The widespread use of communication and digital technology has affected the number of devices requiring analysis in criminal investigations. Additionally, the increase in storage volume, the diversity of digital devices, and the use of cloud environments introduce more complexities to the digital forensic domain. This work aims to supply a taxonomy of the main challenges and success factors faced in the digital forensic domain in law enforcement. The chosen method for this research is a systematic literature review of studies with topics related to success factors and challenges in digital forensics for law enforcement. The candidate studies were 1,428 peer-reviewed scientific articles published between 2015 and 2021. A total of twenty-eight primary studies were analyzed by applying thematic coding. Furthermore, a survey of digital forensic practitioners from the Swedish Police was held to triangulate the results achieved with the systematic literature review. 

Objective: When caring for a patient with Anorexia Nervosa (AN) it is difficult for the registered nurses to develop a good nurse-patient relationship due to a lack of understanding for the illness.  It is important for the nurse to understand the suffering that the AN patients experience, and what makes them feel better, to be able to improve the patient-nurse relationship. This study aims to explore what makes patients with AN feel better during the illness and the process of recovery.

Method: A qualitative scientific approach was used. Eight autobiographies were selected as data for this study. Both English and Swedish books were used. The data was analyzed using a qualitative method of data analysis.

Results: The ways patients with AN could feel better are presented in seven themes: being seen as a whole individual behind the illness, being able to trust and find security, taking responsibility for recovery, finding motivation to keep fighting towards recovery, when one's suffering is noticed, filling a void, and the strengthening of the relationship between care giver and patient. This study may help registered nurses understand the needs of the patient recovering from AN and help them meet these needs in a better way.

Background: No previous research of university students in Finland assessed lifestyle behavioral risk factors (BRFs), grouped students into clusters, appraised the relationships of the clusters with their mental well-being, whilst controlling for confounders. The current study undertook this task. Methods: Students at the University of Turku (n = 1177, aged 22.96 ± 5.2 years) completed an online questionnaire that tapped information on sociodemographic variables (age, sex, income sufficiency, accommodation during the semester), four BRFs [problematic alcohol consumption, smoking, food consumption habits, moderate-to-vigorous physical activity (MVPA)], as well as depressive symptoms and stress. Two-step cluster analysis of the BRFs using log-likelihood distance measure categorized students into well-defined clusters. Two regression models appraised the associations between cluster membership and depressive symptoms and stress, controlling for sex, income sufficiency and accommodation during the semester. Results: Slightly more than half the study participants (56.8%) had always/mostly sufficient income and 33% lived with parents/partner. Cluster analysis of BRFs identified three distinct student clusters, namely Cluster 1 (Healthy Group), Cluster 2 (Smokers), and Cluster 3 (Nonsmokers but Problematic Drinkers). Age, sex and MVPA were not different across the clusters, but Clusters 1 and 3 comprised significantly more respondents with always/mostly sufficient income and lived with their parents/partner during the semester. All members in Clusters 1 and 3 were non-smokers, while all Cluster 2 members comprised occasional/daily smokers. Problematic drinking was significantly different between clusters (Cluster 1 = 0%, Cluster 2 = 54%, Cluster 3 = 100%). Cluster 3 exhibited significantly healthier nutrition habits than both other clusters. Regression analysis showed: (1) males and those with sufficient income were significantly less likely to report depressive symptoms or stress; (2) those living with parents/partner were significantly less likely to experience depressive symptoms; (3) compared to Cluster 1, students in the two other clusters were significantly more likely to report higher depressive symptoms; and (4) only students in Cluster 2 were more likely to report higher stress. Conclusions: BRFs cluster together, however, such clustering is not a clear-cut, all-or-none phenomenon. Students with BRFs consistently exhibited higher levels of depressive symptoms and stress. Educational and motivational interventions should target at-risk individuals including those with insufficient income or living with roommates or alone. 

The aim of the study was to describe Swedish psychiatrists’ experiences of involving the family in the treatment of women with postpartum psychosis. A qualitative design was used, and semistructured qualitative research interviews were conducted with nine psychiatrists from the south of Sweden. Data were analysed using qualitative content analysis. Four categories were found: the family as a resource, the family as coworkers, preparing the family for the future, and the family as a burden. The result showed that the psychiatrists considered the family to be a resource to which they devoted a great deal of care and effort. It was particularly important to involve the partner, informing about the course of the illness and the steps that need to be taken in the event of a relapse and reducing any guilt feelings. The psychiatrists instilled confidence and hope for a future of health and further child bearing. The family members’ limited understanding of the treatment may impede the involvement of the family. Conclusion of the study was that the goal for family involvement was to facilitate the women’s care and treatment. Further studies are needed to provide suggestions on how to develop family involvement in the care of women suffering from postpartum psychosis.

Abstract: Objectives: The most serious type of psychiatric disorder in connection with childbirth is postpartum psychosis. With this disorder occasionally follows emotional rejection of the infant which has serious long term effect on mother and child. The aim of this study was to explore the experiences of the recovery process of postpartum psychosis from the women, from the partners of the women, and their next of kin.

Methods: Interviews were conducted with seven women, who had previously suffered postpartum psychosis, and six of their next of kin. The interviews were transcribed verbatim and analysed using content analysis.

Results: Two categories emerged: the recovery process and the circumstances of the support provided. The women and their next of kin spoke about the turning point in the illness, their own personal as well as their social recovery, the importance of support not only from relatives and friends, but also from professionals, and the use of medication. However, the key to recovery was an internal decision by the women themselves.

Conclusion: Conclusion is that the recovery from this severe mental disorder requires hard work and the key to their recovery was the decision made by the women. This disorder causes a mental darkness to descend, but at the start of the recovery a dim light shines in the dark tunnel. The nursing staff must be made aware that good sleep is important for the psychiatric treatment and that recovery may take a long time. The nurse needs to provide hope and encouragement, as well as help the woman to recognise the strength that exists within her. To reduce the risk of a recurrence of the disorder, the staff needs to offer follow up visits.

Growing up in an urban area has been associated with an increased chance of mental health problems in adults, but less is known about this association in adolescents. We examined whether current urbanicity was associated with mental health problems directly and indirectly via biological stress system functioning. Participants (n = 323) were adolescents from the Dutch general population. Measures included home and laboratory assessments of autonomic nervous system and hypothalamic-pituitary-adrenal axis functioning, neighborhood-level urbanicity and socioeconomic status, and mother- and adolescent self-reported mental health problems. Structural equation models showed that urbanicity was not associated with mental health problems directly. Urbanicity was associated with acute autonomic nervous system and hypothalamic-pituitary-adrenal axis reactivity such that adolescents who lived in more urban areas showed blunted biological stress reactivity. Furthermore, there was some evidence for an indirect effect of urbanicity on mother-reported behavioral problems via acute autonomic nervous system reactivity. Urbanicity was not associated with overall autonomic nervous system and hypothalamic-pituitary-adrenal axis reactivity or basal hypothalamic-pituitary-adrenal axis functioning. Although we observed some evidence for associations between urbanicity, biological stress reactivity and mental health problems, most of the tested associations were not statistically significant. Measures of long-term biological stress system functioning may be more relevant to the study of broader environmental factors such as urbanicity. 

BACKGROUND: Urbanization is steadily increasing worldwide. Previous research indicated a higher incidence of mental health problems in more urban areas, however, very little is known regarding potential mechanisms underlying this association. We examined whether urbanicity was associated with mental health problems in children directly, and indirectly via hypothalamic-pituitary-adrenal (HPA)-axis functioning. METHODS: Utilizing data from two independent samples of children we examined the effects of current urbanicity (n = 306, ages seven to 12 years) and early childhood urbanicity (n = 141, followed from birth through age 7 years). Children's mothers reported on their mental health problems and their family's socioeconomic status. Salivary cortisol samples were collected during a psychosocial stress procedure to assess HPA axis reactivity to stress, and at home to assess basal HPA axis functioning. Neighborhood-level urbanicity and socioeconomic conditions were extracted from Statistics Netherlands. Path models were estimated using a bootstrapping procedure to detect indirect effects. RESULTS: We found no evidence for a direct effect of urbanicity on mental health problems, nor were there indirect effects of urbanicity through HPA axis functioning. Furthermore, we did not find evidence for an effect of urbanicity on HPA axis functioning or effects of HPA axis functioning on mental health problems. CONCLUSIONS: Possibly, the effects of urbanicity on HPA axis functioning and mental health do not manifest until adolescence. An alternative explanation is a buffering effect of high family socioeconomic status as the majority of children were from families with an average or high socioeconomic status. Further studies remain necessary to conclude that urbanicity does not affect children's mental health via HPA axis functioning.

Typically developing humans innately place subjective value on social information and orient attention to it. This can be shown through eye tracking and pupillometry, a method used to show attentional engagement. Social brain development and social preference is present from infancy, and is thought to rely on a carefully balanced network of neurotransmitters and neural connections. Autism Spectrum Disorder (ASD) presents altered neural systems which cause individuals to perceive and process social information differently, but the neurophysiology of this difference remains unclear. Previous research shows atypical gaze patterns, hyperarousal, and lack of orienting to social stimuli in ASD. Since autism is highly comorbid and shares traits with other neurodevelopmental disorders, it is difficult to distinguish aspects of these social processing differences. This study used a group of 35 neuropsychiatric patients to investigate how individuals with autism process social and non-social scenes. Eye tracking and pupillometry measures were collected while participants observed images of natural scenes with or without a person. Participants with autism did not show a pupillary response to social images and were slower to fixate on the face  region than the other participants. Additionally there were correlations between clinical measures of social functioning and the length of time it took to fixate to faces. The results highlight important distinctions of social processing in autism. This thesis proposes a new perspective of looking at the social deficits present in autism spectrum disorder. It suggests reframing the current discussion from two leading hypotheses to a unified approach and formally considering the limitations of differing types of stimuli.

The human frontal cortex is asymmetrically involved in motivational and affective processing. Several studies have shown that the left-frontal hemisphere is related to positive and approach-related affect, whereas the right-frontal hemisphere is related to negative and withdrawal-related affect. The present study aimed to investigate whether evolutionarily threatening stimuli modulate asymmetrical frontal activity. We examined hemispheric differences in frontal late positive potentials (f-LPP asymmetry) and frontal alpha power activation (frontal alpha asymmetry, FAA) in response to images depicting snakes, spiders, butterflies, and birds. Results showed that the late component of f-LPP asymmetry, but not FAA, was modulated by the category of stimuli. Specifically, threatening stimuli (snakes and spiders) evoked a relatively large late f-LPP over the right-frontal hemisphere than non-threatening stimuli (birds and butterflies). Moreover, this relatively great right-frontal activity was positively associated with the subjective ratings of fear. Importantly, the subjective ratings of fear were not associated with early brain activity over the occipital or centro-parietal cortices. These results suggest that late f-LPP asymmetry may reflect higher order affective processes, specifically the subjective appraisal of threatening stimuli and the subjective experience of fear, that are independent of the fast and automatic processing of evolutionarily significant and affectively arousing stimuli. 

Mental illness is a growing global health problem affecting individuals and society. In Sweden, the number of people suffering from mental health illnesses, such as anxiety and depression, is increasing and is expected to be one of the largest public health challenges in 2030. As mental illness increases, the area also needs effective forms of treatment. This study aims to investigate if Virtual Reality Exposure Therapy (VRET) works as a treatment method for adults suffering from anxiety disorders and depression. A structured literature review based on 24 articles found in the databases PubMed, MEDLINE, CINAHL and PsycInfo. Two reviewers independently reviewed and collectively extracted data from the included articles. The articles have been analyzed by using thematic analysis. The results suggest that Virtual reality exposure therapy can work as an effective treatment method for adults with anxiety disorders. It also indicates that VRET may act as a health-promoting intervention to reduce anxiety disorders, phobias, and depression symptoms. Virtual reality exposure therapy can be an effective treatment method and health-promoting effort against anxiety disorders in adults. An essential factor for the patients who accept VRET as a treatment is the initial information therapists give. 

Individuals with borderline personality disorder (BPD) experience emotional instability and have a high suicide rate. Treatment for BPD includes psychotherapy and adaptive emotion regulation strategies, which include cognitive reappraisal. Previous systematic reviews indicate that abnormal brain patterns may cause emotional instability in BPD individuals. To further explore this, this review collected articles that examined neural activity using fMRI during cognitive reappraisal in subjects with BPD and healthy controls. We identified four relevant articles through a search of Web of Science and PubMed. The articles included conflicting results in both participant groups regarding increased or decreased activity during cognitive reappraisal applying either reinterpretation or distancing. The affected brain regions were the following: lateral and ventrolateral prefrontal cortex, left middle temporal gyrus, and superior temporal gyri. Three of the articles reported consistent results of activity in the dorsolateral prefrontal cortex during downregulation, two in all participants and one only in the healthy control group. However, no significant group differences were found in this region during cognitive reappraisal. The discussion includes limitations regarding the comparability of the included studies, such as the method of eliciting negative affect, the use of written or verbal instructions, and the cognitive reappraisal strategy applied. Further research is necessary to better understand the involvement of distinct brain regions in cognitive reappraisal and BPD, as well as to establish more standardized research methods. These efforts can offer comprehensive insights into the neural mechanisms underlying cognitive reappraisal in individuals with BPD.

Russia has one of the highest suicide mortality rates in the world. This study investigates the development of Russian suicide mortality over a longer time period in order to provide a context within which the contemporary high level might be better understood. Annual sex- and age-specific suicide-mortality data for Russia for the period 1870-2007 were studied, where available. Russian suicide mortality increased 11-fold over the period. Trends in male and female suicide developed similarly, although male suicide rates were consistently much higher. From the 1990s suicide has increased in a relative sense among the young (15-34), while the high suicide mortality among middle-aged males has reduced. Changes in Russian suicide mortality over the study period may be attributable to modernization processes.

Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women that is associated with an increased risk of anxiety and depression and with a lower health-related quality of life (HRQoL). PCOS is closely associated with obesity, which per se can lead to symptoms of anxiety and depression and lower HRQoL. The first-line treatment for PCOS is weight loss through lifestyle intervention, which has been shown to improve all symptoms of the syndrome. The aim of this study was to investigate symptoms of anxiety and depression and HRQoL in women with severe obesity (BMI ≥ 35) with and without PCOS, and to evaluate the effect of a one-year structured weight loss intervention. A total of 246 women with severe obesity (PCOS n = 63, non-PCOS n = 183) were included. The comprehensive psychopathological rating scale self-rating scale for affective symptoms (CPRS-S-A) and the short form-36 (SF-36) were used to assess symptoms of anxiety and depression and HRQoL. In total 72 women of the 246 women with severe obesity completed a one-year weight loss programme and were followed up and compared with baseline data. In women with severe obesity, there were no differences in symptoms of anxiety and depression and HRQoL between women with and without PCOS at baseline. Clinically relevant anxiety symptoms were present in 71.3% (PCOS) and 65.6% (non-PCOS), and depression symptoms were present in 56.4% (PCOS) and 52.2% (non-PCOS). Significant weight loss improved physical HRQoL in all women, but reduced symptoms of anxiety and depression only in women without PCOS. There were no differences when comparing the changes between the groups. Women with severe obesity are severely affected by symptoms of anxiety and depression, independent of PCOS. Weight loss improved symptoms of anxiety and depression in women without PCOS, but there were no differences between groups in change from baseline to follow-up.Trial registration number: Clinical trial.gov: NCT01319162, March 18, 2011. Date of registration and enrolment of the first subject September 2011.

Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations (ESSENCE) is an umbrella term covering a wide range of neurodevelopmental difficulties and disorders. Thus, ESSENCE includes attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and other neurodevelopmental disorders (NDDs) and difficulties, with a variety of symptoms in cognitive, motor, sensory, social, arousal, regulatory, emotional, and behavioral developmental domains, frequently co-occurring and likely having partly common neurobiological substrates. The ESSENCE concept is a clinical paradigm that promotes organizing NDDs in everyday clinical practice according to their coexistence, symptom dimensions overlapping, and treatment possibilities. Despite increased knowledge regarding NDDs, the neurobiological mechanisms that underlie them and other ESSENCE-related problems, are not well understood. With its wide range of neural circuits and interactions with numerous neurotransmitters, the orexin/hypocretin system (Orx-S) is possibly associated with a variety of neurocognitive, psychobiological, neuroendocrine, and physiological functions and behaviors. Dysfunction of Orx-S has been implicated in various psychiatric and neurological disorders. This article provides an overview of Orx-S dysfunctions' possible involvement in the development, presentation, and maintenance of ESSENCE. We provide a focused review of current research evidence linking orexin neuropeptides with specific clinical NDDs symptoms, mostly in ADHD and ASD, within the Research Domain Criteria (RDoC) framework. We propose that Orx-S dysfunction might have an important role in some of these neurodevelopmental symptom domains, such as arousal, wakefulness, sleep, motor and sensory processing, mood and emotional regulation, fear processing, reward, feeding, attention, executive functions, and sociability. Our perspective is presented from a clinical point of view. Further, more thorough systematic reviews are needed as well as planning of extensive new research into the Orx-S’s role in ESSENCE, especially considering RDoC elements. 

Anorexia Nervosa is a complex disease that requires an individual treatment. Patients with Anorexia are known to be ambivalent when it comes to making a recovery and therefore need strong teamwork and a good relationship with the nurse. The aim of this study is to examine what good care means for the patient and the nurse when it comes to treating Anorexia Nervosa. The essay is a literature review based on ten scientific articles. In the result, which is divided in two parts, seven themes arise and these are: independence, social support, isolation, a challenge, the relationship, caring and respect and trust. In the result it was revealed that the patients prioritize support from the nurses, showing that they care and don’t judge the patients. The nurses describe compassion, trust, acceptance and mutual respect as important parts in the given care. The conclusion is that a good relationship between the nurse and patient means a great deal to achieve success when treating Anorexia Nervosa. Hopefully this study gives nurses an ability to learn from the presented material, and be able to improve the care of girls suffering from Anorexia Nervosa.

The feeling of anxiety, a conscious experience, is associated with uneasiness, painfulness, or disturbing suspense. The current paper presents the phenomenology of anxiety disorders based on diagnostic criteria and reviews neuroimaging studies on anxiety including dissociation studies. Activity in the anterior cingulate cortex, medial prefrontal cortex, insula, temporal poles and amygdala suggest neural correlates of anxiety. The relevance of the neural correlates, how the feeling of anxiety differs from fear and worry, and the construct validity of anxiety are addressed. Anxiety and pain correlate with activity in the anterior cingulate cortex, which warrants further studies on the painfulness–anxiety relationship.

Objective: This population-based study of 21,902 Finnish adults examined whether adulthood risk factors for asthma mediate the association between the exposure to multiple adverse childhood experiences (ACEs) assessed retrospectively and the risk of new-onset asthma in adulthood. Methods: Baseline characteristics, occurrence of ACEs, and risk factors of asthma in adulthood were collected with a postal survey at baseline in 1998. The participants were linked to records on incident asthma from national health registers from 1999 to 2012. Counterfactual mediation analysis was used to examine the effects of multiple ACEs (≥2) on asthma through adulthood risk factors of asthma (mediators). Results: Of the 21,902 participants without asthma at baseline, 7552 (34%) were exposed to multiple ACEs during childhood. During the follow-up period, 2046 participants were diagnosed with incident asthma. Exposure to multiple ACEs increased the risk of asthma onset by 31% compared with ≤1 ACE. The association between ACEs and asthma onset was partly mediated by the following adulthood risk factors: severe life events (29%), smoking (15%), allergic rhinitis (8%), low education level (6%), and obesity (3%). Specific stressful life events mediating the ACE–asthma association were ‘severe financial difficulties’ (24%), ‘emotional, physical or sexual violence’ (15%), ‘major increase in marital problems’ (8%), ‘severe conflicts with supervisor’ (7%), and ‘divorce or separation’ (5%). Conclusions: Exposure to multiple ACEs increased the risk of asthma in adulthood. Adulthood risk factors of asthma mediated a significant proportion of the effect of ACEs on the risk of asthma onset. 

Background

Two important aspects for the development of anxiety disorders are genetic predisposition and alterations in the hypothalamic-pituitary-adrenal (HPA) axis. In order to identify genetic risk-factors for anxiety, the aim of this exploratory study was to investigate possible relationships between genetic polymorphisms in genes important for the regulation and activity of the HPA axis and self-assessed anxiety in healthy individuals.

Methods

DNA from 72 healthy participants, 37 women and 35 men, were included in the analyses. Their DNA was extracted and analysed for the following Single Nucleotide Polymorphisms (SNP)s: rs41423247 in the NR3C1 gene, rs1360780 in the FKBP5 gene, rs53576 in the OXTR gene, 5-HTTLPR in SLC6A4 gene and rs6295 in the HTR1A gene. Self-assessed anxiety was measured by the State and Trait Anxiety Inventory (STAI) questionnaire.

Results

Self-assessed measure of both STAI-S and STAI-T were significantly higher in female than in male participants (p = 0.030 and p = 0.036, respectively). For SNP rs41423247 in the NR3C1 gene, there was a significant difference in females in the score for STAI-S, where carriers of the G allele had higher scores compared to the females that were homozygous for the C allele (p < 0.01). For the SNP rs53576 in the OXTR gene, there was a significant difference in males, where carriers of the A allele had higher scores in STAI-T compared to the males that were homozygous for the G allele (p < 0.01).

Conclusion

This study shows that SNP rs41423247 in the NR3C1 gene and SNP rs53576 in the OXTR gene are associated with self-assessed anxiety in healthy individuals in a gender-specific manner. This suggests that these SNP candidates are possible genetic risk-factors for anxiety.

Nightmares are vivid, extended, and emotionally negative or negative dreams that awaken the dreamer. While sporadic nightmares and bad dreams are common and generally harmless, frequent nightmares often reflect underlying pathologies of emotional regulation. Indeed, insomnia, depression, anxiety, or alcohol use have been associated with nightmares in epidemiological and clinical studies. However, the connection between nightmares and their comorbidities are poorly understood. Our goal was to examine the genetic risk factors for nightmares and estimate correlation or causality between nightmares and comorbidities. We performed a genome-wide association study (GWAS) in 45,255 individuals using a questionnaire-based assessment on the frequency of nightmares during the past month and genome-wide genotyping data. While the GWAS did not reveal individual risk variants, heritability was estimated at 5%. In addition, the genetic correlation analysis showed a robust correlation (rg > 0.4) of nightmares with anxiety (rg = 0.671, p = 7.507e−06), depressive (rg = 0.562, p = 1.282e−07) and posttraumatic stress disorders (rg = 0.4083, p = 0.0152), and personality trait neuroticism (rg = 0.667, p = 4.516e−07). Furthermore, Mendelian randomization suggested causality from insomnia to nightmares (beta = 0.027, p = 0.0002). Our findings suggest that nightmares share genetic background with psychiatric traits and that insomnia may increase an individual’s liability to experience frequent nightmares. Given the significant correlations with psychiatric and psychological traits, it is essential to grow awareness of how nightmares affect health and disease and systematically collect information about nightmares, especially from clinical samples and larger cohorts. 

BACKGROUND: Alexithymia is a trait characterized by difficulties identifying feelings, difficulties describing feelings, and externally orientated thinking. It is widely regarded as an important transdiagnostic risk factor for a range of psychopathologies, including depressive and anxiety disorders. Whilst several well-validated psychometric measures of alexithymia exist, these are relatively lengthy, thus limiting their utility in time-pressured settings. In this paper, we address this gap by introducing and validating a brief 6-item version of the Perth Alexithymia Questionnaire, called the Perth Alexithymia Questionnaire-Short Form (PAQ-S). METHOD: Across two studies with adult samples (Study 1 N = 508 United States community; Study 2 = 378 Australian college students), we examined the psychometric properties of the PAQ-S in terms of its factor structure, reliability, and concurrent/criterion validity. RESULTS: In exploratory and confirmatory factor analyses, all PAQ-S items loaded well on a single general alexithymia factor. The PAQ-S total score had high reliability, and correlated as expected with the long-form of the PAQ, as well as other established markers of alexithymia, emotion regulation, and affective disorder symptoms. LIMITATIONS: Our samples were general community or college student samples from two Western countries; future validation work in clinical samples and more diverse cultural groups is thus needed. CONCLUSIONS: The PAQ-S retains the psychometric strengths of the PAQ. As such, the PAQ-S can be used as a quick, robust measure of overall alexithymia levels. The introduction of the PAQ-S hence enables valid assessments of alexithymia in a more diverse range of settings and research designs. 

Background: Alexithymia is a multidimensional trait comprised of difficulties identifying feelings, difficulties describing feelings, and externally orientated thinking. It is regarded as an important risk factor for emotional disorders, but there are presently limited data on each specific facet of alexithymia, or the extent to which deficits in processing negative emotions, positive emotions, or both, are important. In this study, we address these gaps by using the Perth Alexithymia Questionnaire (PAQ) to comprehensively examine the relationships between alexithymia and depression, anxiety, and stress symptoms. Methods: University students (N = 1250) completed the PAQ and the Depression Anxiety Stress Scales-21. Pearson correlations, hierarchical regressions, and latent profile analysis were conducted. Results: All facets of alexithymia, across both valence domains, were significantly correlated with depression, anxiety, and stress symptoms (r = 0.27–0.40). Regression analyses indicated that the alexithymia facets, together, could account for a significant 14.6 %–16.4 % of the variance in depression, anxiety, and stress. Difficulties identifying negative feelings and difficulties identifying positive feelings were the strongest unique predictors across all symptom categories. Our latent profile analysis extracted eight profiles, comprising different combinations of alexithymia facets and psychopathology symptoms, collectively highlighting the transdiagnostic relevance of alexithymia facets. Limitations: Our study involved a student sample, and further work in clinical samples will be beneficial. Conclusions: Our data indicate that all facets of alexithymia, across both valence domains, are relevant for understanding depression, anxiety, and stress. These findings demonstrate the value of facet-level and valence-specific alexithymia assessments, informing more comprehensive understanding and more targeted treatments of emotional disorder symptoms. 

Background: Alexithymia is an important transdiagnostic risk factor for emotion-based psychopathologies. However, it remains unclear whether alexithymia questionnaires actually measure alexithymia, or whether they measure emotional distress. Our aim here was to address this discriminant validity concern via exploratory factor analysis (EFA) of the 20-item Toronto Alexithymia Scale (TAS-20) and the Perth Alexithymia Questionnaire (PAQ). Method: United States general community adults (N = 508) completed the TAS-20, PAQ, and the Depression Anxiety Stress Scales-21 (DASS-21). EFA was used to examine the latent dimensions underlying these measures' scores. Results: Our EFA extracted two higher-order factors, an “alexithymia” factor and a “general distress” factor (i.e., depression, anxiety, stress). All PAQ scores loaded cleanly on the alexithymia factor, with no cross-loadings on the distress factor. However, for the TAS-20, Difficulty Identifying Feelings (DIF) facet scores cross-loaded highly on the distress factor. Limitations: Our sample consisted of general community adults; future work in clinical settings will be useful. Conclusions: Our data indicate that the PAQ has good discriminant validity. However, the TAS-20 appears to have significant discriminant validity problems, in that much of the variance in its DIF facet reflects people's current levels of distress, rather than alexithymia. The TAS-20, which has traditionally been the most widely used alexithymia questionnaire, may therefore not be the optimal alexithymia tool. Our findings add to the body of evidence supporting the validity and utility of the PAQ and suggest that, moving forward, it is a superior option to the TAS-20 for alexithymia assessments.

Despite emerging interest in gene-environment interaction (GxE) effects, there is a dearth of studies evaluating its potential relevance apart from specific hypothesized environments and biometrical variance trends. Using a monozygotic within-pair approach, we evaluated evidence of G×E for body mass index (BMI), depressive symptoms, and cognition (verbal, spatial, attention, working memory, perceptual speed) in twin studies from four countries. We also evaluated whether APOE is a 'variability gene' across these measures and whether it partly represents the 'G' in G×E effects. In all three domains, G×E effects were pervasive across country and gender, with small-to-moderate effects. Age-cohort trends were generally stable for BMI and depressive symptoms; however, they were variable-with both increasing and decreasing age-cohort trends-for different cognitive measures. Results also suggested that APOE may represent a 'variability gene' for depressive symptoms and spatial reasoning, but not for BMI or other cognitive measures. Hence, additional genes are salient beyond APOE.

Sleep problems, especially nightmares and insomnia, often accompany depression. This study investigated how nightmares, symptoms of insomnia, chronotype and sleep duration associate with seasonal affective disorder, a special form of depression. Additionally, it was noted how latitude, a proxy for photoperiod, and characteristics of the place of residence affect the prevalence of seasonal affective disorder and sleep problems. To study these questions, data from FINRISK 2012 study were used. FINRISK 2012 consists of a random population sample of Finnish adults aged 25–74 years (n = 4905) collected during winter from Finnish urban and rural areas spanning the latitudes of 60°N to 66°N. The Seasonal Pattern Assessment Questionnaire was used to assess symptoms of seasonal affective disorder. Participants with symptoms of seasonal affective disorder had significantly increased odds of experiencing frequent nightmares and symptoms of insomnia, and they were more often evening chronotypes. Associations between latitude, population size and urbanicity with seasonal affective disorder symptoms and sleep disturbances were generally not significant, although participants living in areas bordering urban centres had less sleep problems than participants from other regions. These data show that the prevalence of seasonal affective disorder was not affected by latitude. 

Individual differences in the response of the stress system to hormonal changes during pregnancy and the postpartum period render some women susceptible to developing depression. The present study sought to investigate peripartum depression and stress hormones in relation to stress-related genotypes. The Edinburgh Postnatal Depression Scale was used to assess peripartum depressive symptoms in a sample of 1629 women, followed from pregnancy week seventeen to six months postpartum. Genotypes of ninety-four haplotype-tag single nucleotide polymorphisms (SNPs) in sixteen genes of the hypothalamus-pituitary-adrenal axis pathway were analyzed and data on psychosocial and demographic factors was collected. In sub-studies, salivary cortisol awakening response in gestational week 35–39, salivary evening cortisol levels in gestational week 36 and postpartum week 6, and blood cortisol and cortisone levels in gestational week 35–39 were analyzed. SNP-set kernel association tests were performed at the gene-level, considering psychosocial and demographic factors, followed by post-hoc analyses of SNPs of significant genes. Statistically significant findings at the 0.05 p-level included SNPs in the hydroxysteroid 11-beta dehydrogenase 1 (HSD11B1) gene in relation to self-rated depression scores in postpartum week six among all participants, and serpin family A member 6 (SERPINA6) gene at the same time-point among women with de novo onset of postpartum depression. SNPs in these genes also associated with stress hormone levels during pregnancy. The present study adds knowledge to the neurobiological basis of peripartum depression by systematically assessing SNPs in stress-regulatory genes and stress-hormone levels in a population-based sample of women. © 2019 Elsevier Ltd

The coexistence of mental and physical health illnesses could be accounted for by an underlying general disease factor (termed d-factor), reflecting theoretical underpinnings based on possible genetic and pathophysiological overlapping mechanisms. This study evaluated whether the d-factor underlies mental and physical health illnesses in adolescents. A series of confirmatory factor analyses were conducted using data from 1120 adolescents. The proposed common underlying factor, we believe is the d-factor, was consistently present across different modeling approaches, including unidimensional, correlated-factor, and bifactor models. The best model fit was achieved with the bifactor model represented by mental, neurological, and psychical conditions tested. The first compelling evidence was provided supporting the existence of the transdiagnostic d-factor in youth, opening the door to innovative research of comorbid mental and physical health conditions.

Over the past two decades, it has become clear that psychopathology exists on continuous spectra organized hierarchically from broad, general symptom dimensions to more specific ones. This structure is best represented by the Hierarchical Taxonomy of Psychopathology (HiTOP) framework that incorporates individual signs, symptoms, and behaviors at its most specific level while encompassing higher-order dimensions at its broadest level. This commentary gives an overview of studies that evaluated higher-order dimensions of psychopathology and their alignment with the HiTOP framework. Studies consistently support the alignment of youth psychopathology with the HiTOP framework, particularly its general dimension of psychopathology and the broad internalizing and externalizing spectrum. The model also identifies distinct, lower-level dimensions such as fear, affectivity, antagonism, and attention problems. This hierarchical structure is evident across the entire age span but with specific makeup of dimensions appearing to differ between children and adolescents. Rapidly gaining momentum, current evidence indicates HiTOP’s effectiveness in conceptualizing youth mental health. Future studies should focus on exploring the HiTOP structure across different ages and populations, testing its real-world generalizability, selecting the most appropriate assessment tools, and understanding how the framework applies to youth from diverse societies and cultures. 

Tau accumulation affecting white matter tracts is an early neuropathological feature of late-onset Alzheimer’s disease (LOAD). There is a need to ascertain methods for the detection of early LOAD features to help with disease prevention efforts. The microstructure of these tracts and anatomical brain connectivity can be assessed by analyzing diffusion MRI (dMRI) data. Considering that family history increases the risk of developing LOAD, we explored the microstructure of white matter through dMRI in 23 cognitively normal adults who are offspring of patients with Late-Onset Alzheimer’s Disease (O-LOAD) and 22 control subjects (CS) without family history of AD. We also evaluated the relation of white matter microstructure metrics with cortical thickness, volumetry, in vivo amyloid deposition (with the help of PiB positron emission tomography -PiB-PET) and regional brain metabolism (as FDG-PET) measures. Finally we studied the association between cognitive performance and white matter microstructure metrics. O-LOAD exhibited lower fiber density and fractional anisotropy in the posterior portion of the corpus callosum and right fornix when compared to CS. Among O-LOAD, reduced fiber density was associated with lower amyloid deposition in the right hippocampus, and greater cortical thickness in the left precuneus, while higher mean diffusivity was related with greater cortical thickness of the right superior temporal gyrus. Additionally, compromised white matter microstructure was associated with poorer semantic fluency. In conclusion, white matter microstructure metrics may reveal early differences in O-LOAD by virtue of parental history of the disorder, when compared to CS without a family history of LOAD. We demonstrate that these differences are associated with lower fiber density in the posterior portion of the corpus callosum and the right fornix.

This thesis analyses the benefits of applying game elements to a Virtual Reality application for overcoming phobias, with a special focus on acrophobia, i.e. the fear of heights. Two different prototypes using the Oculus Rift head-mounted display were developed with a gradually exposure to heights. Both prototypes shared the same acrophobic scenario, but one included extra features from games such as engagement, motivation or goals. Twenty-four participants, divided into two groups of twelve, with moderate aversion to heights tested the prototypes. The participants’ heart rate and the time that they looked down from high altitudes were also measured and evaluated. The study showed slightly higher results regarding motivation for the prototype which included the additional game elements. Future studies should include a different head-mounted display, which would allow a longer time of play without motion sickness, and the participation of people diagnosed with acrophobia.

BACKGROUND: Person and environment-related childhood adverse events have been demonstrated to increase the risk of impaired mental health in later life differently for boys and girls. Altered hypothalamic pituitary adrenal (HPA)-axis functioning has been suggested as a key mechanism underlying this association. Cortisol and dehydroepiandrosterone (DHEA) are both output hormones of the HPA-axis. DHEA may have a protective function against long-term exposure to increased levels of cortisol, but has been little investigated in relation to childhood adversity. OBJECTIVE: We aimed to test the associations between person-, and environment-related childhood adversity and levels of cortisol, DHEA and cortisol/DHEA ratio in adolescent boys and girls. METHODS: A total of 215 Dutch adolescents participated in the study and filled out the 27-item Adverse Life Events Questionnaire for the assessment of childhood adversity, which was split up in separate scores for person-related and environment-related events. Cortisol and DHEA concentrations and cortisol/DHEA ratio were determined in proximal 3 cm long hair segments. Additionally, saliva samples were collected immediately and 30 minutes after waking up, at noon and at 8 pm. Multiple linear regression analyses were used to test associations between childhood adversity and cortisol and DHEA concentrations, for boys and girls separately, with age, BMI and pubertal development as covariates. RESULTS: Data were available for 74 boys and 116 girls with a mean age of 15.7 years (SD = 2.0). Higher levels of person-related childhood adversity were associated with higher hair DHEA levels in girls and with higher hair cortisol levels in boys. A trend towards a significant association was observed between higher levels of environment-related childhood adversity and higher DHEA levels in boys. Neither person- nor environment related childhood adversity was associated with cortisol/DHEA ratio. A trend was observed for environment-related childhood adversity and lower daily cortisol output in boys. CONCLUSION: We found differential associations between childhood adversity and cortisol and DHEA levels in girls and boys, for respectively person-related and environment-related childhood adversity. Our findings suggest that different types of childhood adversity are not only linked to levels of cortisol, but also to DHEA concentrations, in a sex-specific manner, with possible future implications for mental health.

BackgroundPredictive eHealth tools will change the field of medicine, however long-term data is scarce. Here, we report findings on data collected over 6 years with an AI-based eHealth system for supporting the treatment of alcohol use disorder.MethodsSince the deployment of Previct Alcohol, structured data has been archived in a data warehouse, currently comprising 505,641 patient days. The frequencies of relapse and caregiver-patient messaging over time was studied. The effects of both introducing an AI-driven relapse prediction tool and the COVID-19 pandemic were analyzed.ResultsThe relapse frequency per patient day among Previct Alcohol users was 0.28 in 2016, 0.22 in 2020 and 0.25 in 2022 with no drastic change during COVID-19. When a relapse was predicted, the actual occurrence of relapse in the days immediately after was found to be above average. Additionally, there was a noticeable increase in caregiver interactions following these predictions. When caregivers were not informed of these predictions, the risk of relapse was found to be higher compared to when the prediction tool was actively being used. The prediction tool decreased the relapse risk by 9% for relapses that were of short duration and by 18% for relapses that lasted more than 3 days.ConclusionsThe eHealth system Previct Alcohol allows for high resolution measurements, enabling precise identifications of relapse patterns and follow up on individual and population-based alcohol use disorder treatment. eHealth relapse prediction aids the caregiver to act timely, which reduces, delays, and shortens relapses.

Burn injuries are most certainly stressful events, particularly when permanent disfigurement is a result. This situation can lead to the onset of irrational beliefs which can in turn lead to long-term psychological problems such as depression, anxiety, shame, guilt, posttraumatic stress, etc. The objective of this study is to explore the irrational beliefs among burn patients and its correlates in an Iranian sample. This cross-sectional study included 329 patients who had experienced disfigurement, as result of burn injuries. In order to assess irrational beliefs, a Scale for Irrational Thoughts after Burning was used. To identify correlated variables with irrational beliefs, both bivariate and multivariate analysis methods were conducted. In multivariate linear regression, forward strategy was used for building the model. The results of bivariate analysis showed that the location of the burn on bodies (body parts generally exposed in social environment or parts culturally perceived as sensitive areas of body), marital status, urbanities, age group, geographical areas, etiology of burning, and intent of injury had significant relationships with irrational beliefs (P < .05). Using forward linear regression, gender, marital status, geographical areas, etiology of burning, body burn by location (body parts generally exposed in social environment or parts culturally perceived as sensitive areas of body), and intent of injury had significant correlation with irrational beliefs. The models predicted 15.5% (P < .001) of irrational beliefs. Considering to irrational beliefs and development of facilities for screening is necessary. Moreover, consultation with mental health experts after burn injuries is highly recommended.