Alzheimer's disease and kidney health have become serious and urgent public health issues. Bicarbonate and blood urea nitrogen is closely related to kidney function but the relationship of the bicarbonate, blood urea nitrogen and cognitive function which is one of the most important symptoms of Alzheimer's disease is still unclear. In this study we aimed to examine the association of the bicarbonate, blood urea nitrogen and cognitive function. This study used the NHANES database, from which 2681 eligible individuals over 60 years of age were selected. We also extracted cognitive related tests, bicarbonate and blood urea nitrogen concentration to statistically analyze. Logistic regression and restricted cubic splines (RCS) were performed with confounding variables such as gender, age, race, body mass index (BMI), and alcohol intake. After adjusting for multiple factors, statistical analyses indicated significant correlations between bicarbonate, blood urea nitrogen, and cognitive function tests, with varying strengths across different tests. A stratified analysis by gender revealed that there are also differences in the results by gender. Based on the research, we concluded that bicarbonate, blood urea nitrogen are correlated with cognitive function in older Americans. This effect varied across populations.

Metabolic dysfunction-associated steatotic liver disease (MASLD), affecting 25-30% of adults globally, is strongly associated with depression, compounding morbidity and mortality. Despite their bidirectional relationship, tools to identify MASLD patients at high depression risk remain limited. This study aimed to develop and validate a predictive model for depression in MASLD using nationally representative data. Using 2017-2023 NHANES data, 6,107 MASLD participants were analyzed. Depression was defined as Patient Health Questionnaire-9 (PHQ-9) scores ≥10. LASSO regression with 10-fold cross-validation identified predictors, followed by multivariable logistic regression to construct a nomogram. Model performance was evaluated via area under the curve (AUC), calibration curves, and decision curve analysis (DCA). Ten predictors were retained: younger age, female gender, never-married status, low family poverty-to-income ratio (PIR), smoking, diabetes, arthritis, cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD), and platelet count. The model demonstrated robust discrimination (training set AUC = 0.733; testing set AUC = 0.758), excellent calibration (Hosmer-Lemeshow  > 0.05), and clinical utility across threshold probabilities < 40-50%. Socioeconomic factors (low PIR) and comorbidities (arthritis, CVD, COPD) showed strong associations with depression risk. This nomogram-based tool effectively stratifies depression risk in MASLD patients, integrating demographic, socioeconomic, and clinical variables. It offers clinicians a practical screening instrument for early psychological intervention, addressing the intertwined burden of metabolic and mental health disorders. Implementation could enhance holistic care and reduce adverse outcomes in this high-risk population.

Adverse childhood experiences (ACEs) are associated with an increased risk of substance use during adolescence. However, most prevention efforts target youth with known childhood adversities who are receiving services in clinical or service programs, not in public settings such as schools. Moreover, research on the relationship between ACEs and substance use, as well as on the effectiveness of prevention strategies to mitigate the impact of ACEs on substance use, remains limited in East Asian countries, including Taiwan. This study aimed to address existing research gaps by examining the effects of a universal, school-based intervention on substance use outcomes among adolescents. Specifically, the study sought to examine the moderating effects that a life-skills intervention program, the Positive Interpersonal and Life Skills Training (PILOT), had on Taiwanese middle school adolescents with ACEs, assessing the program's impact on their level of substance use-related knowledge, attitudes, and skills. A total of 257 students from two middle schools in Taiwan participated in the study during the spring and fall of 2023. Of these, 139 students received the 8-module PILOT program integrated into their regular school curriculum, while 118 students received the standard curriculum. Participants completed pre-test and post-test questionnaires assessing ACEs and substance use prevention outcomes. The results indicate that ACEs were significantly associated with reduced substance-use-related knowledge among participants. The findings further confirmed the effectiveness of life skills-based interventions in enhancing substance use-related knowledge among Taiwanese middle school students. Notably, the PILOT program demonstrated a significant moderating effect, improving substance use-related knowledge among students with higher ACE exposure. In conclusion, life skills-based interventions can mitigate the negative impact of ACEs on adolescents' substance use prevention knowledge, which highlights the potential of universal, school-based life skills programs to serve as protective buffers for adolescents facing adversity.

In the evolving global landscape, developing innovative abilities has become the new goal of higher education in the world. Within this framework, universities face a significant task of developing training models that cultivate top innovative minds, so that these individuals acquire the skills needed to face complex challenges in modern times. This study employed a cross-sectional analysis involving sample size of 340 randomly selected students majoring in the Humanities field in Guangxi province, China. Here, data is collected using validated instruments measuring key constructs, including Course Design and Teaching Methods, Educational Philosophy, Educational Resources and Environment, and Faculty Development on Teaching Effectiveness. Confirmatory factor analysis (CFA) indicated good model fit with indices of CFI = 0.971, RMSEA = 0.035, SRMR = 0.037, and GFI = 0.905. Structural Equation Modeling (SEM) revealed that Course Design and Teaching methods significantly mediated the relationship between educational environment factors and talent quality with standardized path coefficients of  = 549.686,  < 0.261, and  = 1.409. These findings support the hypothesis framework highlighting the critical role of teaching effectiveness in enhancing talent development within the New Humanities educational context. Implications for educational practice and policy in Guangxi universities are discussed. Results of mediation analysis confirmed that the connection amongst the training factors and Teaching Effectiveness is fully mediated by Critical Factors in Training Models. Descriptive statistics show high internal consistency and good convergent validity. The study finds that well-designed teaching methods are more critical for enhancing Teaching Effectiveness, while other factors, although relevant, are less important.

Several systematic reviews have been published on psychosocial care interventions (PCIs) in cancer care. However, there are limited systematic reviews and meta-analyses (SRMA) on the effectiveness of PCIs in cancer care for adults patients in low- and-middle income countries (LMICs). This study aimed at synthesizing the available evidence on the effectiveness of PCI in improving the quality of life (QoL) of adult cancer patients in LMICs. We registered the protocol with PROSPERO (ID: CRD4202342156) before conducting this SRMA. Studies published between 2002 and 2023 were searched from MEDLINE, Web of Science, EmBASE and APA PsycINFO. We followed the standard guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Results of the pooled studies were analysed using MedCalc version 10.10 statistical software. Twenty-six intervention studies were included in this SRMA. The Eastern Mediterranean WHO region had the highest number of studies and Africa region had the least. Most studies utilised Cognitive Behavioural therapy-related interventions (38%,  = 10 studies), while Family systems therapy 4% ( = 1) was the least utilised. From the subgroup analyses of the means and standard deviations of domains of QoL in the pooled primary studies, the respective standardized mean differences indicated that the PCIs had a significant positive effect on the physical (0.972:  = 0.002), social (0.884:  = 0.005) and psychological (0.590:  = 0.03) domains of QoL of adult cancer patients. However, some PCIs did not improve the QoL of study participants. Generally, PCIs effectively improved most domains of the QoL of adult cancer patients. However, more research is needed for PCIs that had a negative effect on some domains of the QoL of cancer patients. Lastly, there is need for LMICs to prioritise resources to strengthen the integration of psychosocial care interventions in cancer care to meet the different QoL sub-domains of patients with cancer.

Farmer burnout is not only an individual health problem, but also a situation that may threaten the continuity of agricultural production systems and environmental, economic, and social sustainability. The agriculture sector is strategic, and the World Health Organization recognizes burnout as a non-medical occupational phenomenon. On the other hand, the United Nations aims to achieve the Sustainable Development Goals (SDGs) by 2030. Some of the sub-goals of the SDGs, specifically 'Healthy Individuals' and 'Decent Work and Economic Growth', are related to burnout, as they focus on employees' mental health and wellbeing. This study aims to measure the burnout of farmers working in the agricultural sector. In the study, the Maslach Burnout Inventory was adapted to include statements specific to the farming profession, allowing for the measurement of burnout among farmers. The developed burnout scale was applied to 267 farmers. The number of farmers to be surveyed was determined by the proportional sampling method. The study measured farmers' burnout in three sub-dimensions: emotional exhaustion, depersonalization, and personal accomplishment. Accordingly, farmers experience moderate emotional exhaustion. Farmers felt a low level of depersonalization and found their accomplishment at a medium level. Drawing on the call to achieve the SDGs by 2030, the literature on burnout measurement, and the fact that agriculture is a strategic sector, this study presents a model that explains which sociodemographic characteristics affect farmers' burnout.

Shift-working nurses frequently experience insomnia as a consequence of irregular work schedules. This study aimed to examine the psychological mechanisms through which sleep-related worry contributes to insomnia, focusing on the roles of depressive and anxious emotions. Using convenience sampling, data on demographics, sleep-related worry, depression, anxiety, and insomnia were collected from 611 shift-working nurses. Mediation analyses were then performed with SPSS 27.0 and the PROCESS macro. Results indicated that the total effect of sleep-related worry on insomnia was 0.255 (bias-corrected 95% CI [[0.227, 0.283]), and the direct effect was 0.188 (bias-corrected 95% CI [0.155, 0.221]), accounting for 73.73% of the total effect. The independent indirect effect through depression was statistically significant ( = 0.045, bias-corrected 95% CI [0.015, 0.075]). The serial mediation effect through depression followed by anxiety was also statistically significant ( = 0.019, bias-corrected 95% CI [0.001, 0.039]), jointly accounting for 26.27% of the total effect. In contrast, the independent indirect effect of anxiety was not significant ( = 0.003, bias-corrected 95% CI [0.000, 0.009]). These findings suggest that depression serves as a key mediator between sleep-related worry and insomnia. Anxiety, although not independently significant, contributes additively to insomnia when combined with depression. Interventions that prioritize reducing sleep-related worry and strengthening emotional regulation could improve sleep quality and overall health, ultimately supporting both physical and psychological well-being.

Eating disorder (ED) risk is pervasive among undergraduate students, however, psychopathology and well-being can vary notably. Using National College Health Assessment (NCHA-III) (2023) data, 277 Atlantic Canadian undergraduate students (mean age 22.4 years) who screened positive for an ED based on the Sick Control One-stone Fat Food (SCOFF) scale were separated into flourishing (19.4%) and non-flourishing sub-samples using the Mental Health Continuum - Short Form (MHC-SF) scale. Chi square tests revealed that flourishing students were less likely to report problems with academics, faculty, and relationships, loneliness and isolation, and more likely to report stronger university belongingness. Flourishing students also indicated better self-assessed health, as well as, lower psychological distress, suicidality risk, psychological/mental health service utilization, and comorbid anxiety and depression. While SCOFF scores were significantly lower among flourishing students, body mass index (BMI) levels did not vary. Findings are considered via the dual continua model, with recommendations to enhance potential to flourish.

A high prevalence of alcohol consumption has been described among medical students. However, due to possible variations in the patterns of alcohol consumption and possible biological, social and cultural differences among different populations, it is relevant to address the relations that exist between at-risk alcohol consumption and associated social and psychological factors in a group of medical students. A cross-sectional study was carried out. In the AUDIT, at-risk alcohol use was defined as ≥ 8 (males) and ≥6 (females). Associations were assessed using multivariable logistic regression. Female sex (OR = 1.83, 95% CI [1.07, 3.13]), stress (OR = 2.57, 95% CI [1.49, 4.43]), tobacco use (OR = 3.06, 95% CI [1.51, 6.20]), cannabis use (OR = 3.79, 95% CI [1.64, 8.76]), and a siblings' history of alcohol consumption (OR = 2.33, 95% CI [1.35, 4.01]), mother and other relatives were independently associate with alcohol consumption. The , applying the same AUDIT cut-off point (≥8) to all participants, showed no statistically significant association between at-risk alcohol use and sex, depression, anxiety or anxiety (DASS-21 subscales). It is relevant to conduct further investigations to deepen these findings and better comprehend the complex dynamics between variables and their implications for public health, particularly in the female population.

Cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapies have brought about significant physical health improvements however, numerous post-marketing observations have suggested a potential linkage between ETI therapy and deleterious mental health outcomes, proposing an important area of study. Fourteen adult participants (males: 6; age range: 22 - 45 years; average FEV1: 82.71%) who had experienced a change in psychological wellbeing post-modulator therapy were recruited via social media to participate in a semi-structured interview. Following a deterioration in mental health two participants were on a reduced dose of ETI therapy and three participants had stopped ETI therapy. Alongside the manifest benefits of ETI therapy there are several new challenges a small but significant minority within the Cystic Fibrosis (CF) population are experiencing. Participants discussed a debilitating deterioration in psychological wellbeing post-ETI therapy including new and/or worsening depression, anxiety, suicidality, hallucinations, impaired memory, and hormonal changes. Changes in mental health were attributed to the challenge of acclimatising to a change in identity by some people, while others considered changes to be direct side effects of ETI-therapy. Being able to provide safe and effective care for physical and psychological wellbeing is critical in CF care. Alongside the physical health benefits associated with ETI therapy, there may be serious psychological implications for a minority of individuals with CF which require proactive and effective psychological support.

Breast cancer is a prevalent health issue globally, often accompanied by psychological distress such as depressive symptoms. This study investigated the relationship between emotional adjustment and depressive symptoms in 120 women with stage I to III breast cancer attending hospitals affiliated with Urmia University of Medical Sciences. Participants were at least six months post-treatment, literate, and free from other chronic illnesses or psychiatric conditions. Data were collected using demographic questionnaires, the Emotional Adjustment Questionnaire, and the KDS-II depressive symptoms scale. Results showed a significant positive correlation between emotional adjustment and depressive symptoms ( = 0.30,  = 0.001). Multiple regression revealed emotional adjustment as a significant predictor of depressive symptom severity (β = 0.20). Employment status and age were also associated with depressive symptoms. These findings suggest that maladaptive emotional adjustment may increase depressive symptoms, highlighting the importance of psychological interventions to enhance emotional coping and improve mental health in women with breast cancer.

Studies have shown that, beyond demographic and obesity-related factors, certain abnormal sleep behaviors are associated with a high risk of obstructive sleep apnea syndrome (OSAS). This study aimed to investigate whether bedtime procrastination (BtP), an unhealthy sleep behavior, is correlated with an increased risk of OSAS. A total of 1,405 Chinese college students (20 ± 1 years old, 37.1% male) participated in this questionnaire-based cross-sectional study. BtP and OSAS risk and symptoms were evaluated using the Bedtime Procrastination Scale (BPS), the STOP-Bang Questionnaire (SBQ), and the Berlin Questionnaire (BQ). Results showed that BPS scores were significantly positively correlated with OSAS symptom scores on both the SBQ and BQ (all  < 0.05). Students at high risk of OSAS had higher BPS scores than those at low risk. BtP, along with male gender and body mass index (BMI), was an independent predictor of OSAS risk (all  < 0.01). The combination of these three variables discriminated OSAS risk with a sensitivity of 62.86% and specificity of 69.68% (AUC = 0.711) for the SBQ, and a sensitivity of 67.03% and specificity of 82.41% (AUC = 0.778) for the BQ. Self-reported data from college students revealed that BtP was independently correlated with increased OSAS risk and symptom severity. Therefore, habitually going to bed later than intended should be considered a potential behavioral risk factor for OSAS among the young population. Combined with gender and BMI, a BPS cutoff score of 2.67 may serve as a supplementary indicator for OSAS screening.

Palliative care units offer holistic support for terminally ill patients and their families, addressing psychological, and social needs to enhance quality of life in the final stage. This study aimed to evaluate the effect of mandala coloring on anxiety and caregiver burden among caregivers in palliative care. Care providers in the intervention group were asked to paint mandala tasks twice a week per month. State-Trait Anxiety Inventory and Zarit Burden Interview Scale were implemented for caregivers in the intervention group ( = 52) and control ( = 53) group at the beginning of the study and after a month. The care burden of caregivers, which was 34.53 ± 13.04 in the intervention group before the mandala intervention, decreased to 13.78 ± 11.67 after the intervention (p˂0.001). On the other hand, in the control group, the care burden was 36.69 ± 25.68 at the beginning while it increased to 44.50 ± 12.01 after one month. Although the anxiety level was 52.03 ± 6.78 in the intervention group before the intervention, it declined to 44.65 ± 3.87. In addition, the anxiety level in the control group, which was 57.18 ± 8.47 before the application, increased to 61.05 ± 4.60 after one month, and all these results were found to be significantly different (p˂0.001). Mandala coloring has positive effects on reducing caregiver burden and anxiety levels in caregivers in palliative care.

Previous research suggests perceived stress and healthy eating are associated with cardiovascular disease (CVD) risk, but studies investigating their combined association are lacking. The aim was to assess associations between stress, adherence to dietary guidelines and CVD, individually and combined. Data from the Australian Longitudinal Study on Women's Health (ALSWH) including 9303 women (52 ± 2 y) without history of CVD were analysed. Dietary and perceived stress data were collected with validated questionnaires, respectively, with the 74 item food frequency questionnaire and a questionnaire addressing 10 different life domains. Adherence to dietary guidelines was defined by using two guideline indices, the Australian Dietary Guidelines Index (DGI) and the food-based Dutch Healthy Diet Index-15 (DHD-15). Hard incident CVD events were collected from linked hospital physician diagnosis data. Cox proportional hazards models were performed adjusted for multiple covariates, being demographic, socioeconomic, health and behavioural factors. During 15 years follow-up 1091 CVD incident events occurred. Higher compared to lower perceived stress at baseline was significantly associated with higher incidence of CVD both in crude (HR = 1.32, 95%CI: 1.13, 1.54) and adjusted (HR = 1.30, 95%CI: 1.10, 1.52) models. No associations between neither the DGI-2013 score nor the DHD15 index score and CVD incidence were found. Also, no interaction between perceived stress and adherence to dietary guidelines was shown. The current study underscores the importance of perceived stress levels as an independent risk factor for CVD incidence among women. Thus, stress management could be important for CVD risk reduction.

Adolescents with idiopathic scoliosis (AIS) experience elevated risks of psychological distress, yet the psychosocial mechanisms underlying this burden remain insufficiently understood. This study aimed to determine the prevalence of psychological distress in adolescents with AIS and to investigate the roles of perceived social support and resilience as protective factors. In this cross-sectional study, 229 adolescents aged 12-18 years with confirmed AIS were recruited from a tertiary spine surgery center. Participants completed the Symptom Checklist-90 (SCL-90), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Connor - Davidson Resilience Scale (CD-RISC). Socio-demographic and clinical data were recorded. The prevalence of clinically significant psychological distress (SCL-90 ≥ 160) was determined. Mediation analysis was conducted using structural equation modeling with bias-corrected bootstrapping (5,000 samples) to test the indirect effect of resilience between perceived social support and psychological distress. The median age was 14 years, and 73.8% were female. Clinically significant psychological distress was present in 55.0% of participants. There was no significant difference in mean SCL-90 scores by gender (female: 137.4 ± 36.1 vs. male: 141.1 ± 37.8,  = 0.497) or residence ( = 0.712). Adolescents from families with monthly income < 3,000 CNY had higher prevalence of psychological distress (65.1%) compared to those from families ≥3,000 CNY (34.1%,  = 0.001). Higher MSPSS and CD-RISC scores were each significantly associated with lower SCL-90 scores ( = -0.44 and  = -0.47,  < 0.001). SEM revealed that resilience partially mediated the relationship between perceived social support and psychological distress (indirect effect: β = -0.19, 95% CI: -0.28 to -0.11,  < 0.001). Model fit indices were excellent (CFI = 0.984, RMSEA = 0.046). Over half of adolescents with AIS experience significant psychological distress. Higher perceived social support and resilience are associated with better mental health outcomes, and resilience partially mediates the impact of social support.

The current study tested the mediating effects of social support and self-esteem on the link of dispositional gratitude with depressive symptoms in Chinese adolescents. A total of 1245 adolescents completed the Gratitude Questionnaire, the Multi-Dimensional Scale of Perceived Social Support, the Rosenberg Self-esteem Scale and Depression Anxiety Stress Scales. Mediation analyses indicated that social support and self-esteem independently mediated the dispositional gratitude-depressive symptoms link, and these mediating effects were not significantly different. In addition, the chain mediating path from gratitude to depressive symptoms via social support and self-esteem was significant. These findings suggest that social support and self-esteem serve as meditational mechanisms in the association between dispositional gratitude and depressive symptoms, supporting an integrated psycho-social and cognitive framework. Implications and future directions of the findings are discussed.

The connections between academic buoyancy and psychological distress such as depression, anxiety, and uncertainty stress in university students have consistently been highlighted, yet the intricate interplay between these factors remains underexplored. This study employed network analysis to investigate these relationships within Chinese medical university students, who face unique academic pressures and family expectations. Through multi-stage cluster random sampling, 3,622 students from a medical university in Xuzhou, Jiangsu Province, completed validated self-report questionnaires assessing depression, anxiety, uncertainty stress, and academic buoyancy. Network analysis revealed that US10(feel that there is nothing to do), US6(do not know how to achieve goals), GAD5(restlessness), US7(worry about the future) and PHQ8(motor) emerged as core symptoms in the network. A negative correlation was observed between academic buoyancy and psychological distress, with strong connections to feelings of PHQ6(guilty), GAD3(excessive worry), and the perception that US4(unexpected things often occur in life). Bridging strength analysis highlighted that PHQ9(suicide) and GAD7(feeling afraid) exhibited the highest bridging strengths, while US3(experiencing chaos and confusion) significantly bridged with both PHQ4(lack of energy) and GAD5(restlessness). Based on these findings, targeted interventions focusing on alleviating the identified core symptoms, particularly US10(feel that there is nothing to do) and its strong negative connection to PHQ6(guilty), could help strengthen students' academic buoyancy. Additionally, addressing the bridge symptoms of suicidal PHQ9(suicide) and GAD7(feeling afraid) may be crucial in fostering students' overall development, enabling them to thrive both academically and psychologically within the context of Chinese medical universities.

The state of cognitive failure (CF) among college students is not encouraging and poses a risk to their physical as well as their mental health. The aim of this study is intended to investigate the effects of mobile phone addictive (MPA) on CF and potential path relationships among Chinese college students. Participants completed the Mobile Phone Addiction Scale (MPAS), Fear of Missing Out Scale (FoMOS), Core Self-Evaluation Scale (CSES), and Cognitive Failure Questionnaire (CFQ). The study's participant pool comprised a valid sample of one thousand and eighty-five ( = 1,085) college students. MPA and fear of missing out (FoMO) were positively correlated with CF. In contrast, core self-evaluation showed a significant negative correlation with it. MPA directly predicted CF, while FoMO and core self-evaluation (CSE) acted as both independent and serial mediators in this relationship. This research provides a foundation for developing effective interventions for CF and other psychological issues among college students.

This study aimed to identify latent profiles of parenting psychological flexibility (PPF) among parents of children with leukemia and to examine their associations with children's behavioral outcomes and clinical and sociodemographic characteristics. A cross-sectional survey was conducted in three Grade A Tertiary Hospitals in Henan Province, China, with 223 parents of children with leukemia (mean parent age = 36.83 years; mean child age = 7.99 years). Latent profile analysis identified three latent classes of PPF: Class 1 (Low Cognitive Defusion-High Emotional Acceptance, 32.7%), Class 2 (High Cognitive Defusion-Low Emotional Acceptance, 41.3%), and Class 3 (High Parenting Flexibility, 26%). Children of parents in Class 1 exhibited more problem behaviors and fewer prosocial behaviors than those in Classes 2 and 3. Multinomial regression indicated that unmarried parents were more likely to belong to Class 1 ( = 0.211,  = 0.007) or Class 2 ( = 0.003,  < 0.001) than to Class 3. In addition, parents of male children showed a higher likelihood of belonging to Class 1 compared with Class 3 ( = 0.440,  = 0.049).These findings underscore the importance of tailored psychological interventions for different PPF profiles to strengthen parental flexibility, which are linked to better behavioral outcomes in children with leukemia.

This study aimed to assess the long-term risk for depression in individuals with epilepsy, identify time-specific risk patterns, and evaluate high-risk subgroups in a nationwide cohort from South Korea. This nationwide retrospective matched cohort study analyzed data from 2,267 patients with epilepsy and 22 670 age- and sex-matched controls retrieved from the Korean National Health Insurance Service cohort (2002-2013) were analyzed. KCD-8 codes (F32 and F33) were used as depression markers and time-stratified Cox proportional hazards models were employed to calculate the adjusted hazard ratios (aHRs) for depression over 10 years, adjusting for demographic and clinical covariates. The incidence rate (IR) of depression was 43.23 per 1,000 person-years in the epilepsy group compared to 14.30 in the controls (IRR = 3.02). Depression risk was highest in the first 0-2 years post-diagnosis (aHR = 3.32) and increased again at 8-10 years (aHR = 2.82). Men (IRR = 3.52) and individuals aged <60 years (IRR = 3.66) also demonstrated elevated IRRs. Smoking, low BMI, and high income were significant additional risk factors. Epilepsy substantially increases the long-term risk of depression, particularly during the early and late post-diagnosis periods and our findings underscore the need for systematic mental health screenings.

This study aimed to explore the job demand-control (JDC) and effort-reward imbalance (ERI) models of occupational stress status among workers of a petrochemical enterprise, as well as their associations with anxiety, depression, and job burnout. Using a cluster sampling method, 1593 workers of a petrochemical enterprise in China were selected as survey participants. The two models of occupational stress, anxiety, depression, and job burnout were assessed by using the Chinese version of the Job Content Questionnaire (JCQ), the Effort-Reward Imbalance Questionnaire (ERIQ), the Self-Rating Anxiety Scale (SAS), the Center for Epidemiological Survey Depression Scale (CES-D), and the Maslach Burnout Inventory-General Survey (MBI-GS), respectively. The detection rates of high JDC model occupational stress, high ERI model occupational stress, anxiety, depression and job burnout were 28.2%, 26.1%, 11.3%, 23.4%, and 78.6%, respectively. Seniority, sleeping time, JDC model and ERI model occupational stress were associated with anxiety; marital status, physical activity, sleeping time, JDC model and ERI model occupational stress were associated with depression; education level, JDC model and ERI model occupational stress were associated with job burnout. The results of the restricted cubic spline plots further indicated that anxiety, depression and job burnout score were non-linear correlated with D/C ratio, anxiety and job burnout score were non-linear correlated with E/R ratio, while depression score was linear correlated with the E/R ratio. Anxiety, depression and job burnout exhibit non-linear associations with JDC model occupational stress, anxiety and job burnout show non-linear correlations with ERI model occupational stress, while depression exhibits a linear correlation with ERI model occupational stress. It is essential to pay attention to the occupational stress levels of workers in petrochemical enterprises, provide continuous psychological support, and implement preventive measures targeting risk factors to help reduce the risk of anxiety, depression, and job burnout.