Journal of psychiatric research最新文献

{"title":"Alexithymia and psychopathological dimensions in First-Episode Psychosis: Comparative patterns in natural cannabis versus synthetic cannabinoid users","authors":"Ricci Valerio ,&nbsp;Di Muzio Ilenia ,&nbsp;Mancusi Gianluca ,&nbsp;Ceci Franca ,&nbsp;Ciavarella Maria Celeste ,&nbsp;Di Carlo Francesco ,&nbsp;Pettorruso Mauro ,&nbsp;Martinotti Giovanni ,&nbsp;Maina Giuseppe","doi":"10.1016/j.jpsychires.2025.06.025","DOIUrl":"10.1016/j.jpsychires.2025.06.025","url":null,"abstract":"<div><h3>Aims</h3><div>This study aimed to investigate the differences in psychotic symptomatology, dissociative symptoms, alexithymia, and aberrant salience among three groups: non-cannabis users (NU), natural cannabis users (NC), and synthetic cannabinoid users (SCs). The study also explored the patterns of alexithymia and its associations with other psychopathological dimensions in these populations.</div></div><div><h3>Methods</h3><div>A total of 108 participants experiencing First Episode Psychosis (FEP) were recruited during psychiatric crisis presentations to emergency rooms in Italy and categorized into three groups (NU, NC, SCs; n = 36 each). Participants were initially assessed 48–72 h after inpatient admission following clinical stabilization. Psychopathological assessments were conducted using the Positive and Negative Syndrome Scale (PANSS), Dissociative Experiences Scale (DES-II), Aberrant Salience Inventory (ASI), and Toronto Alexithymia Scale (TAS-20). Evaluations occurred at baseline (T0), three months (T1), and six months (T2) post-admission. Statistical analyses included ANOVA and repeated-measures ANOVA comparisons across time points.</div></div><div><h3>Results</h3><div>SC users exhibited significantly higher positive psychotic symptoms, persistent aberrant salience, and limited recovery of alexithymia compared to NC users and non-users. Dissociative symptoms were more prominent in both NC and SCs users, with SCs users showing minimal improvement over time. Negative symptoms were higher in non-users but showed progressive reduction across all groups. Significant correlations were observed between alexithymia and specific aberrant salience subscales, particularly Feelings of Increased Significance and Sense Sharpening.</div></div><div><h3>Conclusions</h3><div>Synthetic cannabinoids are associated with more severe and persistent psychotic symptoms and emotional dysregulation compared to natural cannabis. Alexithymia and dissociation showed distinct patterns across user groups, with different trajectories of change over the six-month observation period. These findings underscore the need for targeted interventions addressing emotional regulation and salience processing in cannabis-related psychosis.</div></div>","PeriodicalId":16868,"journal":{"name":"Journal of psychiatric research","volume":"189 ","pages":"Pages 325-334"},"PeriodicalIF":3.7,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144366441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The gray matter microstructure and psychological resilience in patients with depression: A preliminary study using DSI/NODDI imaging","authors":"Liaoming Gao ,&nbsp;Zhiming Chen ,&nbsp;Ziqi Wu ,&nbsp;Junyan Wen ,&nbsp;Zhujia Li ,&nbsp;Ying Guo ,&nbsp;Jingwen Luo ,&nbsp;Liya Gong ,&nbsp;Zhiting Chen ,&nbsp;Lin Wang ,&nbsp;Linlin Jing ,&nbsp;Honglei Yin ,&nbsp;Gen Wen","doi":"10.1016/j.jpsychires.2025.06.032","DOIUrl":"10.1016/j.jpsychires.2025.06.032","url":null,"abstract":"<div><h3>Background</h3><div>Psychological resilience serves as a crucial protective factor against depression, yet its microstructural neuroimaging correlates remain poorly understood. This study aimed to investigate gray matter microstructural features associated with psychological resilience levels in patients with depression.</div></div><div><h3>Methods</h3><div>Sixty-four patients with depression underwent diffusion spectrum imaging (DSI) and neurite orientation dispersion and density imaging (NODDI). Derived metrics included fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), axial diffusivity (AD), isotropic volume fraction (FISO), intracellular volume fraction (FICVF), and orientation dispersion index (ODI). Voxel-based analysis was performed to assess correlations between imaging metrics and resilience scores, followed by partial correlation analysis of significant regional metrics.</div></div><div><h3>Results</h3><div>Positive correlations with resilience were observed for: AD in the posterior cingulate gyrus (CCG; r = 0.48, p &lt; 0.001), AD in the right dorsal caudate (RDC; r = 0.45, p &lt; 0.001), FA in the right inferior midfrontal gyrus junction (fMFG; r = 0.33, p = 0.009), and FICVF in the left anterior superior parietal lobule (SPL; r = 0.27, p = 0.030). Negative correlation was found for ODI in the right dorsal midfrontal gyrus (dMFG; r = −0.27, p = 0.030). Neurosynth meta-analysis revealed significant functional associations between these brain regions and the following cognitive domains.</div></div><div><h3>Conclusion</h3><div>Altered psychological resilience in depression shows close associations with gray matter microstructural changes, potentially explaining neuroanatomical mechanisms underlying resilience. These findings provide novel insights for clinical interventions targeting resilience enhancement.</div></div>","PeriodicalId":16868,"journal":{"name":"Journal of psychiatric research","volume":"189 ","pages":"Pages 335-342"},"PeriodicalIF":3.7,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144366442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of p factor scores in children with chronic physical illness","authors":"Mark A. Ferro,&nbsp;Christy K.Y. Chan","doi":"10.1016/j.jpsychires.2025.06.023","DOIUrl":"10.1016/j.jpsychires.2025.06.023","url":null,"abstract":"<div><h3>Background</h3><div>The <em>p</em> factor represents the overall liability for the development of mental illness within individuals and we have previously validated a bi-factor model of the <em>p</em> factor in children with chronic physical illness.</div></div><div><h3>Objective</h3><div>In this next phase, we modelled predictors of the <em>p</em> factor in this sample of children.</div></div><div><h3>Methods</h3><div>Data come from the ongoing Multimorbidity in Children and Youth Across the Life-course study. Data from 263 children with a chronic physical illness aged 2–16 years and their parents were collected over 24 months. The parent-reported Emotional Behavioural Scales was used to develop a bi-factor model of the <em>p</em> factor. Subsequently, <em>p</em> factor scores were extracted from the model and standardized (Mean = 100, SD = 15). Analysis of variance compared <em>p</em> factor scores across different physical illnesses. Multiple regression was used to identify multilevel baseline predictors of <em>p</em> scores.</div></div><div><h3>Results</h3><div>There was no significant difference in <em>p</em> scores across categories of physical illness (F = 0.44, p = 0.849). Factors predictive of elevated <em>p</em> scores were older child age (B = 0.44), higher level of disability (B = 1.03), elevated parent psychopathology (B = 0.22) and stress (B = 0.21), and living in communities with older age and lower labor force participation (B = 1.66) and higher concentrations of racialized/newcomer populations (B = 2.05). Lower <em>p</em> scores were associated with being female (B = −3.85) and having immigrant parents (B = −5.43).</div></div><div><h3>Conclusion</h3><div>Factors predicting psychopathology, measured using <em>p</em> scores, in children with physical illness are multilevel. Fixed characteristics can inform targeted screening efforts, whereas modifiable characteristics are opportunities for upstream intervention in the context of family-centered integrated physical-mental health services.</div></div>","PeriodicalId":16868,"journal":{"name":"Journal of psychiatric research","volume":"189 ","pages":"Pages 291-294"},"PeriodicalIF":3.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144322588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the association between beta-blockers use and sleep complaints in U.S. Adults: An analysis of NHANES data (2011–2018)","authors":"Kepeng Liu,&nbsp;Binfei Li,&nbsp;Xiaozu Liao,&nbsp;Yunjian Qin,&nbsp;Yong Chen","doi":"10.1016/j.jpsychires.2025.06.029","DOIUrl":"10.1016/j.jpsychires.2025.06.029","url":null,"abstract":"<div><h3>Purpose</h3><div>The primary objective of this investigation was to examine the potential association between the use of beta-blockers among the adult population in the United States from 2011 to 2018 and the occurrence of sleep complaints in adults.</div></div><div><h3>Methods</h3><div>This study utilized a nationally representative sample from the 2011–2018 National Health and Nutrition Examination Survey (NHANES). Using weighted multivariable logistic regression adjusted for demographics, comorbidities (hypertension, diabetes), and lifestyle factors (smoking, exercise), we assessed associations while controlling for confounders through propensity score matching. Formal interaction tests evaluated effect modification by age, race, diabetes status, and physical activity levels. NHANES sampling weights ensured nationally representative estimates.</div></div><div><h3>Results</h3><div>This study of NHANES 2011–2018 data (n = 17,391) revealed significantly higher prevalence of sleep disturbances among beta-blocker users versus non-users (46 % vs 29 %, <em>P</em> &lt; 0.001), an association that remained significant after adjustment (43 % vs 37 %, <em>P</em> &lt; 0.01). Notably, while users demonstrated longer median sleep duration (8 h vs 7 h) and higher proportion of ≥9 h sleepers (19.7 % vs 14.5 %), their sleep quality was significantly impaired, presenting a characteristic “sleep duration-quality paradox”. Subgroup analyses further identified particularly elevated risk among adults &lt;40 years (OR = 3.61, 95 %CI:2.05–6.34), physically active individuals, and non-diabetic patients.</div></div><div><h3>Conclusions</h3><div>This study establishes beta-blockers as an independent risk factor for sleep disturbances (29 % increased risk) while paradoxically prolonging sleep duration at the expense of sleep quality. The high-risk triad (adults &lt;40 years, physically active individuals, and non-diabetic patients) warrants prioritized sleep monitoring in clinical practice.</div></div>","PeriodicalId":16868,"journal":{"name":"Journal of psychiatric research","volume":"189 ","pages":"Pages 316-324"},"PeriodicalIF":3.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144366440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maladaptive beliefs, dissociation, and suicidal ideation in people with PTSD: Results from a national survey in Japan","authors":"Hong Wang Fung ,&nbsp;Chak Hei Ocean Huang ,&nbsp;Po-Han Chou ,&nbsp;Grace Wing Ka Ho ,&nbsp;Miyuki Makino ,&nbsp;Hironori Kuga ,&nbsp;Masaru Horikoshi ,&nbsp;Masaya Ito","doi":"10.1016/j.jpsychires.2025.06.030","DOIUrl":"10.1016/j.jpsychires.2025.06.030","url":null,"abstract":"<div><div>Suicide is a major public health concern and people with post-traumatic stress disorder (PTSD) are at a higher risk of engaging in suicidal behaviors. Less is known about the factors that predict suicidal ideation in people with PTSD, especially in non-Western contexts. To test the hypothesis that post-traumatic maladaptive beliefs and dissociative symptoms would predict suicidal ideation, we analyzed data from the National Survey for Stress and Health in Japan. A total of 712 participants with probable PTSD who provided data at two time points, four months apart, were included for analysis. After controlling for age, gender, depressive symptoms, and baseline suicidal ideation, post-traumatic maladaptive beliefs (β = .090, <em>p</em> = .016) and dissociative symptoms (β = .080, <em>p</em> = .025), but not PTSD symptoms (β = .038, <em>p</em> = .323), predicted suicidal ideation at follow-up. The findings point to the potential importance of early interventions for maladaptive beliefs and dissociative symptoms in people with PTSD in order to reduce suicide risks.</div></div>","PeriodicalId":16868,"journal":{"name":"Journal of psychiatric research","volume":"189 ","pages":"Pages 280-284"},"PeriodicalIF":3.7,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144322586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of and treatment outcome in inpatients with emetophobia and other specific phobias","authors":"Adrian Meule ,&nbsp;Eva M. Zisler ,&nbsp;Michael S. Metzner ,&nbsp;Ulrich Voderholzer ,&nbsp;David R. Kolar","doi":"10.1016/j.jpsychires.2025.06.028","DOIUrl":"10.1016/j.jpsychires.2025.06.028","url":null,"abstract":"<div><div>Emetophobia refers to a fear that oneself or others might vomit and is classified as a specific phobia in current diagnostic manuals. However, it is a relatively unknown and understudied mental disorder. Although it has been speculated that emetophobia might differ from other specific phobias (e.g., in terms of severity), studies on this are virtually non-existent. Thus, this retrospective study analyzed data at admission and discharge from 70 persons with emetophobia and 40 persons with other specific phobias who received a cognitive behavioral therapy-oriented, multimodal inpatient treatment (76.4 % female; mean age 22.7 years, <em>SD</em> = 12.4). Nearly 80 % of persons with emetophobia were female, more than half were adolescents and underweight, and the most common comorbid mental disorders were other anxiety disorders and depression. Compared to inpatients with other specific phobias, persons with emetophobia were younger, had a lower body weight, had higher phobic anxiety, and reported lower life satisfaction at admission. Across both groups, body weight increased with a small effect size and anxiety-related, depressive, and general psychopathology decreased and life satisfaction increased with medium-to-large effect sizes. In conclusion, the current study replicates findings about certain features of persons with emetophobia and is the first study that documents differences between persons with emetophobia and persons with other specific phobias, indicating that emetophobia partially represents a more severe type of specific phobia. Despite these differences, persons with emetophobia and persons with other specific phobias achieve similar and substantial symptom reductions during a multimodal inpatient treatment.</div></div>","PeriodicalId":16868,"journal":{"name":"Journal of psychiatric research","volume":"189 ","pages":"Pages 285-290"},"PeriodicalIF":3.7,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144322587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A cross-lagged panel analysis of giving and receiving social support and anxiety among healthcare workers during the COVID-19 pandemic","authors":"Mary O. Smirnova,&nbsp;Anna C. Cole,&nbsp;Cynthia L. Lancaster","doi":"10.1016/j.jpsychires.2025.06.020","DOIUrl":"10.1016/j.jpsychires.2025.06.020","url":null,"abstract":"<div><div>During the pandemic, rates of anxiety among healthcare workers increased dramatically. Social support may be a promising strategy for buffering against anxiety under stress. For example, receiving support has been bidirectionally associated with lower stress reactivity. In contrast to receiving support, little is known about the impact of giving support. Therefore, we tested the bidirectional associations of giving and receiving support with anxiety among healthcare workers during the pandemic. We recruited 190 U.S. healthcare workers who completed measures of giving social support, receiving social support, and state anxiety at baseline (April–May 2020), one-month, and six-month follow-up. We used a three-wave, cross-lagged panel design to test for bidirectional and unidirectional relationships. Both giving and receiving support were associated with lower anxiety, but the direction of the relationship differed. Giving support at baseline predicted lower anxiety one month later. In contrast, lower anxiety at baseline predicted higher received support one month later. Notably, these relationships were present from baseline to 1-month follow-up, but not 1-month to 6-month follow-up, suggesting that the effects were most pronounced during the acute, rather than prolonged adjustment period. In sum, findings suggest that giving support may be a promising strategy for reducing anxiety. Reducing anxiety, in turn, may increase access to social support resources. Therefore, support-giving interventions, such as acts of kindness interventions, may be a promising pathway for buffering against anxiety under stress.</div></div>","PeriodicalId":16868,"journal":{"name":"Journal of psychiatric research","volume":"189 ","pages":"Pages 311-315"},"PeriodicalIF":3.7,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144329784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decreased impulsivity in Schizophrenia: Evidence from self-report and behavioral measures","authors":"Cong Fan ,&nbsp;Huanxin Wang ,&nbsp;Wenhao Xu ,&nbsp;Run Liao ,&nbsp;Faxin Wang ,&nbsp;Wenbo Luo","doi":"10.1016/j.jpsychires.2025.06.026","DOIUrl":"10.1016/j.jpsychires.2025.06.026","url":null,"abstract":"<div><div>Impulsivity contributes to deleterious outcomes among schizophrenia (SZ) patients, and it plays an important role in the diagnostic process. However, impulsivity can be measured in a variety of ways, and previous research has yielded mixed results regarding its relationship with positive and negative symptoms. To address this, we controlled for additional variables (e.g., educational level) and utilized various representative impulsivity measures, including the Barratt Impulsiveness Scale (BIS-11), delay discounting task (DDT), probability discounting task (PDT), and balloon analogue risk task (BART), to assess impulsivity in SZ patients and its association with symptoms. Findings indicated that, except for the probability discounting task, all other measures consistently demonstrated reduced impulsivity in SZ patients. Additionally, impulsivity predicted the severity of SZ symptoms: self-reported impulsivity and emotional regulation difficulties predicted positive symptoms, whereas DDT performance and gender predicted negative symptoms. These results highlight the importance of multidimensional impulsivity assessment in SZ, with distinct impulsivity profiles differentially associated with symptom dimensions, which may guide symptom-specific intervention strategies.</div></div>","PeriodicalId":16868,"journal":{"name":"Journal of psychiatric research","volume":"189 ","pages":"Pages 301-310"},"PeriodicalIF":3.7,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144322590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of vocational rehabilitation interventions on depression and work-related outcomes among adults with affective disorders: a systematic review and meta-analysis","authors":"Yi Xuan Chan ,&nbsp;Si Qi Yoong ,&nbsp;Jolene Zi Tong Teo ,&nbsp;Ying Jiang","doi":"10.1016/j.jpsychires.2025.06.013","DOIUrl":"10.1016/j.jpsychires.2025.06.013","url":null,"abstract":"<div><h3>Introduction</h3><div>Achieving and sustaining employment is a critical concern for individuals with mental health disorders, and vocational rehabilitation (VR) may be beneficial. However, existing reviews focus on a wide range of mental illnesses.</div></div><div><h3>Aim</h3><div>This systematic review and meta-analysis evaluated the effectiveness of VR for individuals with affective disorders in improving depressive symptoms, competitive employment, absence duration, and quality of life compared to usual care.</div></div><div><h3>Methods</h3><div>Randomized controlled trials which recruited adults aged 18–65 with depressive disorders or bipolar disorders were included. A random-effects meta-analysis was conducted where applicable.</div></div><div><h3>Data sources</h3><div>Ten databases were systematically searched from inception to November 2023. Grey literature was searched on ProQuest and Google Scholar. The search was updated on March 22, 2024.</div></div><div><h3>Results</h3><div>Thirteen articles describing nine studies (n = 1869 participants) were included; no study involved individuals with bipolar disorders. VR reduced depressive symptoms post-intervention and at short-term follow-up compared to usual care but not at long-term follow-up. Competitive employment, absence duration, and quality of life showed no significant differences.</div></div><div><h3>Conclusion</h3><div>Moderate-quality evidence supports VR's effectiveness in reducing depressive symptoms. Future research should focus on VR for bipolar disorders and incorporate workplace support to improve vocational and quality-of-life outcomes.</div></div>","PeriodicalId":16868,"journal":{"name":"Journal of psychiatric research","volume":"189 ","pages":"Pages 259-276"},"PeriodicalIF":3.7,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144322127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying the association of hyperarousal and insomnia symptoms: A network perspective","authors":"Kaixu Zhu ,&nbsp;Shengping Xue","doi":"10.1016/j.jpsychires.2025.06.017","DOIUrl":"10.1016/j.jpsychires.2025.06.017","url":null,"abstract":"<div><h3>Objective</h3><div>Insomnia, a prevalent public health problem, is characterized by hyperarousal; however, evidence on the comparison of associations between insomnia symptoms and different forms of arousal is limited. This study utilizes network analysis to explore the complex associations between insomnia symptoms and hyperarousal and to identify key symptoms.</div></div><div><h3>Methods</h3><div>A total of 1209 participants with non-clinical sleep disorders were included in the study. Hyperarousal was assessed by the Arousal Predisposition Scale (APS) and the Pre-sleep Arousal Scale (PSAS), which encompasses two forms of state arousal (pre-sleep cognitive/somatic arousal). Insomnia symptoms were assessed by Pittsburgh Sleep Quality Index (PSQI). Gaussian graph networks and directed acyclic graphs (DAG) were applied to examine associations between variables and identify key variables.</div></div><div><h3>Results</h3><div>Pre-sleep cognitive arousal is the most important variable in the Gaussian network, acting as a “bridge” between the insomnia symptoms and hyperarousal domains, and serving as the gateway that activates most of the insomnia symptoms and hyperarousal in the DAG. Subjective sleep duration is another key driver in the DAG, marking the starting point for insomnia symptoms, while the use of sleep medication represents the endpoint of the pathway.</div></div><div><h3>Conclusion</h3><div>All forms of hyperarousal are positively associated with insomnia symptoms, and pre-sleep cognitive arousal plays the most important role in the maintenance and activation of the insomnia symptoms-hyperarousal network.</div></div>","PeriodicalId":16868,"journal":{"name":"Journal of psychiatric research","volume":"189 ","pages":"Pages 216-222"},"PeriodicalIF":3.7,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144290967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}