Internalised stigma and self-esteem among adult outpatients with major depressive disorder: A cross-sectional correlational study

Human immunodeficiency virus (HIV) infection remains a growing public health concern in the Philippines, where new infections rose by about 550% between 2010 and 2024 and diagnosis gaps persist in CALABARZON. Nurses are often the first and most sustained point of contact in HIV testing and care, yet knowledge gaps, stigmatizing attitudes, and procedure-focused training may limit their ability to provide compassionate, person-centered counseling. This study aims to develop and validate a Caring-Based HIV Counseling Training Program for Nurses in Laguna, Philippines, using a methodological research design and a modified Delphi technique. Registered nurses from selected government and private healthcare facilities in Laguna will complete a researcher-developed training-needs assessment questionnaire covering six competency domains: HIV-related knowledge; counseling and therapeutic communication; caring behaviors and person-centered practice; ethical and legal responsibilities; cultural sensitivity and stigma reduction; and linkage to prevention, treatment, care, and support. The questionnaire will undergo expert review, pilot testing, and reliability testing using Cronbach’s alpha. The needs-assessment findings, together with a review of current literature and guidelines, will inform a preliminary training program, which a multidisciplinary panel of approximately 15 to 20 experts will evaluate over successive anonymous Delphi rounds for relevance, clarity, comprehensiveness, cultural appropriateness, feasibility, and applicability. Consensus is defined in advance as at least 80% expert agreement, a median rating of at least 3.00, and an interquartile range of no more than 1.00. Content validity will be established through an Item-Level Content Validity Index of at least .78 and a Scale-Level Content Validity Index (average) of at least .90, overall agreement will be measured with Kendall’s coefficient of concordance, and the experts’ qualitative comments will undergo directed content analysis. The study is expected to produce an expert-validated, contextually relevant training program that strengthens nurses’ capacity to deliver compassionate, stigma-free HIV counseling, with its effectiveness to be tested in a future pilot or quasi-experimental study.

Abstract The COVID-19 pandemic created social disruptions, leading to high levels of mental health problems for adolescents. Interpersonal stressors, such as lack of familial support, peer victimization, and discrimination, may have further exacerbated teen mental health issues. Yet, the psychological impact of interpersonal stressors and their interactive effects with high levels of loneliness remains unknown. In this pre-registered study , conducted in November and December 2020 (approximately eight months into the COVID-19 pandemic), we used a diverse sample of adolescents from across 43 U.S. states with elevated depressive symptoms (n = 2,452, ages 13–16) to examine how familial support, peer victimization, and discrimination are concurrently associated with mental health outcomes. Results indicated that perceived discrimination was the strongest standardized correlate across continuous internalizing outcomes (depressive symptoms, anxiety symptoms, and hopelessness), whereas lack of familial support was the primary correlate of suicidal ideation; if youth reported a lack of familial support, they were over three times as likely to report suicidal ideation. Loneliness significantly moderated the cross-sectional links between lack of familial support and depressive symptoms, as well as perceived discrimination and hopelessness. Simple slope probing demonstrated a distress ceiling effect: interpersonal stressors were most strongly associated with elevated distress among youth reporting low baseline loneliness, whereas youth experiencing high loneliness exhibited consistently elevated distress regardless of stressor exposure. These findings underscore interpersonal stressors and loneliness as high-priority targets for youth prevention and intervention programs, particularly during periods of widespread social disruption.

University students who live away from their families may experience loneliness and depressive symptoms, while perceived social support may alter this relationship. This study examined the associations among loneliness, perceived social support, and depressive symptoms and tested whether perceived social support moderated the loneliness-depressive symptoms relationship. A cross-sectional quantitative design involved 396 university students living in boarding houses in Yogyakarta. Data were analyzed using Pearson correlations and moderated multiple regression. Perceived social support was negatively associated with depressive symptoms. Loneliness was also significantly associated with depressive symptoms, but the direction was negative and therefore did not support the proposed positive hypothesis. The interaction between loneliness and perceived social support was significant, indicating that the loneliness slope differed across levels of support. The findings highlight the relevance of perceived social support for student mental health while also showing that the unexpected loneliness pattern requires cautious interpretation and replication.

Abstract Background Repetitive negative thinking (RNT) is a transdiagnostic process relevant to common mental health problems in primary care. RNT-ACT is a brief acceptance and commitment therapy-based protocol targeting RNT in two sessions. This pilot study assessed the feasibility of RNT-ACT compared with therapist-supported internet-based cognitive behavioural therapy (iCBT) in Swedish primary care. Methods Thirteen participants were randomised: 7 to RNT-ACT and 6 to iCBT. The primary feasibility outcomes were recruitment rate, intervention non-completion, and patient satisfaction measured with the Client Satisfaction Questionnaire (CSQ-8). Symptom and process measures were secondary outcomes. Secondary outcomes were assessed at baseline and at 1- and 3-month follow-ups. Analyses were descriptive and exploratory, based on available observations without imputation of missing data. Results Thirteen of 20 eligible individuals were enrolled (65%), corresponding to 35% of all 37 individuals screened. All participants in the RNT-ACT group completed the intervention, whereas 4 of 6 participants in the iCBT group did not complete the intervention. Mean CSQ-8 scores were 27.8 (SD 3.7; n = 5) in the RNT-ACT group and 23.0 (SD 0.0; n = 2) in the iCBT group. Conclusions The small sample size and high iCBT non-completion limit between-group comparisons. Further investigation of recruitment, treatment engagement, and patient and therapist experiences is needed before determining whether and how to proceed to a full-scale RCT. Trial registration ClinicalTrials.gov NCT05946382 registered July 14, 2023.

The present study investigated the predictive role of trait mindfulness in relation to depression, anxiety, and stress among Pakistani young adults. The following hypotheses were formulated: H1: Trait mindfulness will significantly and negatively predict depression among Pakistani young adults. H2: Trait mindfulness will significantly and negatively predict anxiety among Pakistani young adults. H3: Trait mindfulness will significantly and negatively predict stress among Pakistani young adults. A sample of 405 participants (189 males, 216 females; aged 18–30 years, M = 22.39, SD = 2.823) completed an online survey including the Mindful Attention Awareness Scale (MAAS) and the Depression Anxiety Stress Scale (DASS-21). Reliability and normality assessments confirmed the adequacy of the measures. Linear regression analyses revealed that trait mindfulness significantly and negatively predicted depression (R² = .237, p < .001), anxiety (R² = .210, p < .001), and stress (R² = .201, p < .001). These findings were consistent with the hypotheses formulated and the theoretical perspectives. The study adds value to global evidence in relation to the Pakistani context, highlighting trait mindfulness as a preventive factor against negative emotions and emphasizing the need for culturally adapted mindfulness-based interventions to enhance psychological resilience among young adults.