Psychological Support Research Articles

Sleep problems are common among heart failure patients. In recent years, the increased accessibility of mobile devices has made them valuable tools for collecting objective sleep data. The objective of the study is to investigate the relationships between sleep status, demographic characteristics, physical activity, and psychological state in heart failure patients. Cross-sectional correlational study design was used and participants from community-dwelling heart failure patients were recruited. Data collection instruments included the Minnesota Living with Heart Failure Questionnaire (MLHFQ), Garmin Vivofit 3 activity tracker, and Brief Symptom Inventory (BSI) to measure sleep-related factors including depression and anxiety. Independent t-tests, ANOVA, and regression analyses were employed to explore factors influencing sleep. Seventy-six heart failure patients (mean age 53.7 ± 14.6 years; 72.4% male; 25% New York Heart Association class III/IV) participated. The average daily sleep duration was 434.39 minutes, with moderate self-reported sleep quality. Married participants, those with higher anxiety and depression reported poorer subjective sleep quality. Higher step counts correlated with better perceived sleep quality. Higher body mass index (BMI) was associated with shorter objective sleep duration. After controlling for demographic variables, BMI, anxiety, and depression predicted subjective sleep perception. Exercise duration predicted total sleep time. Sleep quality varies greatly among heart failure patients. Obesity, depression, and anxiety negatively impact sleep, while adequate physical activity benefits sleep. These findings can inform interventions to improve sleep in heart failure patients. It is recommended to conduct regular sleep assessments for heart failure patients with BMI above the normal range, and to utilize brief psychological health scales during outpatient follow-up visits to screen for patients with anxiety and depressive tendencies, enabling early intervention to provide necessary psychological support and sleep hygiene education.

Background: Heart failure (HF) is impacted by non-traditional factors like emotional disorders(anxiety/depression). Oral health's link to cardiovascular disease is growing, with oral microbiota dysbiosis potentially contributing via inflammation and endothelial dysfunction. Whether emotional disorders indirectly affects HF through oral microecology is unclear, though stress may alter the oral microbiota via saliva, immunity, and hygiene. If so, targeting the oral cavity could offer new HF interventions. This study explores emotional disorders' bridging role between oral health and HF progression. Research Questions: Does emotional disorders influence oral health indicators and cardiovascular risk? What is the specific impact of emotional state on the oral microbiota of HF patients? Methods: We used NHANES (2009-2012, n=4823) for associative analysis, examining emotional disorders, oral health (missing teeth, periodontitis, self-rating), and cardiovascular health (LE8). Analyses included weighted logistic regression, stratified analysis, mediation analysis (using the systemic immune-inflammation index), and RCS curves. Omics analysis used 16S rRNA/ITS sequencing to compare oral microbiota of HF patients with vs. without emotional disorders, employing ternary plots, differential analysis, and functional predictions. Results: Emotional disorders was associated with lower LE8 scores, more missing teeth, and poorer self-rated oral health ( p <0.05), but not periodontitis ( p =0.53). The systemic immune-inflammation index was not a significant mediator ( p =0.78), whereas missing teeth ( p =0.02) and self-rated oral health ( p <0.0001) were partial mediators of disorders' effect on cardiovascular health. RCS curves showed emotional disorders incidence decreased with higher LE8 scores but increased with more missing teeth. In microbiome analysis, potential beneficial bacteria ( Cardiobacterium , Propionivibrio ) and harmful bacteria ( Megasphaera ) were identified, alongside harmful fungi ( Malasseziaceae ), overlapping with previously reported dysbiotic taxa in HF patients. Conclusion: Emotional disorders significantly impact cardiovascular health, potentially mediated by both objective and subjective oral health measures. It may disrupt oral microbiota balance. As psychological support is already recognized in HF guidelines, our findings highlight the importance of emotional management. Integrating emotional and oral health strategies into HF care may open new therapeutic avenues.

Background/Objectives: Eating disorders (EDs) often affect fertility, yet many women with ED still become mothers. The pattern of ED symptoms during pregnancy and postpartum, along with their effects on maternal and child health, is not yet fully understood. This longitudinal study aimed to (1) examine the course of ED symptoms from conception to postpartum, (2) evaluate pregnancy outcomes and children’s health and developmental milestones, and (3) assess ED status approximately four years after the initial evaluation. Methods: Thirty women with a prior ED diagnosis (21 with anorexia nervosa, 9 with bulimia nervosa) were evaluated at two time points. Time 1 with the Eating Disorders Examination and the Oxford Risk Factors for Eating Disorders: Interview Schedule; Time 2, approximately four years later, with the Eating Disorders Examination and the Clinical Interview on Reproductive History and Eating Behavior that also included clinical data related to mother’s health and baby’s health and development accessed through the Pregnant Women’s Health Bulletin and the Child and Youth Health Bulletin using the national health records. Results: ED symptoms (dietary restriction, self-induced vomiting, laxative misuse) persisted from conception through postpartum. BN participants reported more severe symptoms and higher rates of pregnancy complications (hyperemesis gravidarum, gestational diabetes, preeclampsia), while premature births occurred only in AN participants. Children of mothers with AN more frequently showed delays in developmental milestones (sitting, walking, speaking, sphincter control) compared to those of BN mothers. Conclusions: A substantial proportion of women with prior ED continued to experience symptoms during and after pregnancy, and nearly half still met diagnostic criteria four years later and are still in treatment. Cognitive features such as body dissatisfaction persisted despite partial symptom remission. These findings highlight the chronicity of ED and underscore the need for systematic screening, psychological support, and interdisciplinary follow-up during pregnancy and early motherhood.

This research examines the framework of legal protection for children who are victims of psychological, emotional, and moral abuse in society. While physical and sexual abuse often receive the most public and legal attention, these non-physical forms of abuse have damaging and often invisible impacts that can fundamentally hinder a child’s development. This study analyzes existing legal instruments, both international and national, to identify the extent of available legal protection and the challenges in its enforcement. Theoretically, legal protection against non-physical abuse of children is rooted in the principles of child human rights, recognized in the UN Convention on the Rights of the Child (CRC) and child protection laws in many countries. However, this research finds that legal implementation on the ground faces several significant challenges. These challenges include: 1) Lack of clear definitions: Psychological, emotional, and moral abuse are often difficult to define legally, making them challenging to prove in court. 2) Invisible nature: Non-physical forms of abuse leave no physical marks, which complicates evidence gathering and often leads to cases not being taken seriously. 3) Challenges in proving cases: The subjective nature of non-physical abuse makes proof complex, as it often relies on the testimony of a vulnerable child or indirect evidence. 4) Lack of awareness: There is a lack of awareness among the public, law enforcement officials, and even parents about the dangers of non-physical abuse to children. This study concludes that effective legal protection for children who are victims of non-physical abuse requires a multidisciplinary approach. It is crucial to enact legal reforms to provide clearer definitions and stronger sanctions, enhance training for law enforcement officials, and build robust psychological and social support systems for children. Additionally, public awareness campaigns are needed to change perceptions and encourage society to be more sensitive to these hidden forms of abuse, ensuring every child can grow up in a safe and supportive environment.

Background This study aimed to investigate the prevalence of depression, anxiety, and perceived stress among nursing home caregivers in China and to examine the associated factors. Methods A multicenter cross-sectional study was conducted among 1,341 caregivers in nursing homes across Henan Province, China. Standardized instruments were applied, including the Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS), and the 10-item Perceived Stress Scale (PSS-10). Descriptive statistics, univariate analysis, and multivariable logistic regression were performed to identify independent predictors of psychological distress. Results The prevalence of depression and anxiety was 34.8 and 10.8%, respectively, while 49.6% of caregivers reported moderate-to-high levels of stress. Significant predictors included city region, type of nursing home, educational level, monthly income, working hours, night shifts, presence of chronic diseases, attention to mental health, and participation in psychological training. Higher education and moderate income were protective factors, whereas employment in rural private nursing homes, low engagement in mental health practices, and the presence of chronic diseases increased risks. Longer working hours and more frequent night shifts were unexpectedly associated with lower stress levels. Conclusion Depression and stress represent the major psychological concerns among nursing home caregivers in China. Targeted interventions should prioritize routine mental health screening, workplace-based psychological support, and policy measures aimed at improving working conditions and access to training, thereby safeguarding caregiver well-being and supporting the sustainability of long-term care services.

PurposeTo evaluate anxiety and depression levels in patients receiving intravitreal injections for diabetic macular edema (DME), age-related macular degeneration (AMD), and retinal vein occlusion (RVO), and their associations with visual acuity, disease type, and demographic factors.MethodsThe study included 90 patients (43 males and 47 females) mean age 73.9 ± 12.4 years; (range: 22-92 years). Anxiety levels were assessed using the state anxiety form of the State-Trait Anxiety Inventory (STAI-S), and depression symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS). Best-corrected visual acuity (BCVA) was recorded, and patients were evaluated according to disease type, severity of visual impairment, and number of injections.ResultsThe mean STAI-S score was 36.2 ± 8.9, and that of HADS was 13.9 ± 12.6. There were no significant differences in STAI-S scores between the disease groups (p = 0.17). However, HADS scores were significantly lower in the RVO group than in the DME and AMD groups (p = 0.02, p = 0.04). A significant association was observed between severity of visual impairment and STAI-S scores (p = 0.016), with moderate visual impairment showing higher anxiety levels than mild and severe impairment (p = 0.07, p = 0.02). However, HADS scores were not significantly associated with visual acuity (p = 0.058). Women exhibited higher HADS scores (p = 0.036). Neither injection frequency nor waiting time significantly affected STAI-S or HADS scores (p > 0.05).ConclusionPatients receiving intravitreal injections have varying levels of anxiety and depression, considering disease type, sex, and severity of visual impairment affecting these psychological parameters. These findings provide invaluable insights into the importance of psychological support in ophthalmic care.

Objective This study provides a comprehensive bibliometric review of patientcentered care (PCC) in in vitro fertilization (IVF), a domain integral to improving patient outcomes, satisfaction, and experiences in assisted reproductive technology. By analyzing global research output and trends, this study aims to identify key themes, contributors, and gaps in the literature to inform future research and practice. Methods Data were collected from Scopus and Web of Science databases, covering the period from 2003 to 2024. Bibliometric analyses, conducted using R Studio and Biblioshiny, examined publication trends, keyword frequencies, and collaborative networks among authors, institutions, and countries. A supplementary literature review contextualized bibliometric findings to address limitations in metadata. Results A total of 54 studies from 33 unique sources were analyzed, revealing an annual growth rate of 11.57% in PCC publications up to 2023. The USA and the Netherlands led in research output, contributing 22 and 16 publications, respectively. Mayo Clinic and prominent authors such as Nelen W. and Kremer J. were key contributors. Keywords like “infertility,” “in vitro fertilization,” and “patient care” demonstrated increasing prominence, underscoring growing interest in PCC. Barriers to PCC were identified at institutional, communication, environmental, and personal levels, while facilitators included multidisciplinary approaches and technological integration. Conclusion This review highlights PCC’s critical role in enhancing IVF outcomes and identifies gaps in psychological support, clinicianpatient communication, and access equity. Recommendations include targeted interventions, international collaborations, and integration of personalized care models. Future research should explore innovative strategies to overcome barriers and advance PCC frameworks in fertility care. BJMS, Vol. 24 No. 04 October’25 Page : 1093-1105

This study explores the manner and method in which the diagnosis of Trisomy 21 is communicated to parents of newborns, and the extent to which this impacts the psychological responses of parents—particularly mothers. Through an objective content analysis of statements made by several mothers who received the diagnosis postnatally in an inappropriate manner, the study seeks to uncover psychological reactions that arise when such critical information is delivered abruptly, insensitively, and with little emotional consideration. The findings reveal that most mothers described the moment of diagnosis as painful and shocking, emphasizing the inadequacy of the delivery—characterized by coldness, randomness, and a lack of detailed explanation or psychological support. This led to a range of psychological reactions in response to the distressing experience, including denial, rejection, guilt, sadness, initial shock, and some psychosomatic symptoms.

Background The term “acne” is derived from the Greek word “acme,” meaning “point” or “spot.” Acne vulgaris is one of the most common chronic dermatological conditions, predominantly caused by the Gram-positive anaerobic bacterium Cutibacterium acnes. It affects individuals across various age groups, with a significant impact on physical appearance, quality of life (QoL), and psychological well-being. Methodology This cross-sectional, observational study was conducted from December 2021 to March 2022, involving individuals aged 18–30 years diagnosed with acne vulgaris. Patients visiting a dermatology clinic were assessed for clinical severity, QoL impairment, and psychological burden using a validated, self-administered questionnaire. Results A total of 171 patients were enrolled in the study, with a mean age of 24.83 ± 2.92 years. The cohort comprised 45 males and 126 females, with a positive family history of acne in 82 participants. Assessment of QoL impact revealed that 101 patients experienced a moderate effect, while 66 reported a very large impact on daily life. Clinical grading of acne showed that 12 patients had mild acne, 104 had moderate acne, 54 had severe acne, and 1 patient presented with very severe acne. Psychological evaluation indicated that individuals with moderate to severe acne exhibited mild to moderate depressive symptoms. Additionally, 147 patients reported experiencing a moderate psychological burden associated with their condition. Conclusion Acne vulgaris significantly affects patients’ QoL, with the majority experiencing moderate impairment. The condition is linked to emotional distress, including feelings of embarrassment, aggression, and negative self-perception regarding facial appearance. Given its psychosocial impact, an integrated approach focusing on dermatological management and psychological support is essential for improving patient outcomes. BJMS, Vol. 24 No. 04 October’25 Page : 1106-1113

Attitudinal barriers to psychological support-seeking among carers of people with a chronic physical health condition: A qualitative meta-synthesis.

The aim of the article is to assess the potential consequences for the population of Ukraine, which has been living under wartime conditions for an extended period, based on an analysis of existing scientific literature on the effects of chronic stress on cellular and molecular mechanisms of carcinogenesis. This article examines the impact of chronic stress and war-induced anxiety on the formation and development of cancer cells. The biological and cellular mechanisms by which stress contributes to carcinogenesis are highlighted, including hyperactivation of the hypothalamic-pituitary-adrenal axis, increased levels of cortisol and adrenaline, impaired immune response and increased inflammation. A review of international studies and meta-analyses over the last seven years demonstrating the association between stress and increased cancer risk in different populations is presented. Special attention is paid to extrapolation of the data to the situation in Ukraine, taking into account the peculiarities of the military conflict and socio-economic conditions. Prevention and support strategies are discussed, including psychological care, psychosocial interventions and the role of volunteer organisations. Emphasis is placed on the need for a multidisciplinary approach and further research to develop effective cancer risk reduction measures in the context of military stress. The article is particularly relevant because in war conditions, populations experience high levels of chronic stress, which can have serious health consequences, in particular contributing to the development of cancer. Stress through neuroendocrine and immune pathways affects cellular processes, in particular proliferation, apoptosis and angiogenesis, which may contribute to the development of cancer cells. In Ukraine, where more than 30% of the population is experiencing post-traumatic stress disorder, the situation is exacerbated by the shortage of health services due to military action. This increases the risk of developing cancer due to lack of or inadequate early detection of tumors and limited access to treatment. Forecasts indicate that cancer incidence could increase by 10–15% in the coming years, placing additional demands on the medical system. To minimize the negative impact of stress on health, it is necessary to implement comprehensive measures, including psychological support, health care modernization and interventions aimed at reducing stress and post-traumatic stress disorder. Particularly important are mental health programmes that include cognitive-behavioural therapy, as well as recovery of cancer services and early diagnosis. Consequently, the integration of psychological and medical support, as well as research to develop adaptive prevention and treatment strategies, is needed to reduce cancer risks in war settings.

The coronavirus disease 2019 (COVID-19) pandemic placed immense pressure on healthcare systems and revealed significant gaps in preparedness and response programs. This crisis compelled nursing leaders to develop and implement innovative care delivery programs while preventing disease transmission to patients and staff [1]. During the COVID-19 pandemic, the role of nurses went beyond traditional clinical care. It included health education, psychological support for patients and families, crisis management, and the implementation of infection prevention protocols, making them key players in reducing virus transmission and promoting community health [2]. By providing psychological support, health education, and implementing prevention protocols, nurses contributed to improving public health. In addition, by constantly facing heavy workloads and high risks, nurses became the backbone of healthcare systems during the COVID-19 crisis [3].

Breast cancer remains a critical health concern, requiring continual innovation in treatment to improve patient outcomes. The continuous obstacles in therapy and the need for novel techniques underline the importance of making advances in this discipline. Precision medicine has emerged as a viable method, with genomic profiling and molecular subtyping allowing for targeted therapy based on distinct breast cancer subtypes. This strategy is supplemented by advances in early detection and screening, with technologies like liquid biopsy promising earlier and more accurate diagnosis. The introduction of immunotherapy has transformed breast cancer treatment by using the body's immune system to combat cancer. Recent discoveries, particularly combination medicines, attempt to circumvent resistance mechanisms and improve treatment success. Furthermore, including lifestyle therapies such as nutrition, exercise, and psychological support has been demonstrated to reduce breast cancer risk and strengthen survivability rates. Survivorship programs serve an important role in comprehensive care by addressing long-term needs and enhancing survivors' quality of life. Investigating innovative therapeutic approaches, such as developing cancer vaccines, epigenetic modulators, and RNA interference (RNAi) therapy, provides new treatment options. Fostering collaboration among healthcare personnel through shared decision-making and tumor committees is essential for the integration of multidisciplinary care, which ensures patientcentered care. Although advancements have been made, there are still numerous obstacles to overcome in the implementation of these future directions. To effectively confront these obstacles, it is imperative to capitalize on opportunities for innovation and collaboration. It is imperative to address ethical, social, and economic factors in the advancement of breast cancer care to ensure that innovations are equitable and accessible. In conclusion, the future of breast cancer management is bright since substantial improvements are on the verge of turning patient treatment into a completely different experience. For these breakthroughs to become a reality, it is necessary to maintain research efforts, advocate for them, and work together. The dedication to innovation and the joint effort to overcome current problems are the two important factors that will determine whether or not breast cancer treatment and surviving will have a better future.

High diving, an emerging extreme sport with dives from heights up to 27 m, presents unique biomechanical and psychological risks. Athletes face high-velocity water entry, generating intense forces that can result in musculoskeletal and soft tissue injuries, especially during entry. Injury rates are higher in practice than competition, possibly linked to overfatigue and technical errors. Psychological stress - such as fear, fatigue, and mental blocks - may contribute to injury risk but is understudied. Preventative strategies including limiting the number of dives, technical training, and psychological support are proposed. Despite lower acute injury rates compared to contact sports, the repetitive high-impact nature of cliff and high diving raises concerns for long-term health consequences. Existing gaps in injury surveillance and athlete education highlight the need for targeted, sport-specific health initiatives. As high diving aims to be included in the Olympics, evolving comprehensive safety frameworks are vital to protect athlete well-being and support performance longevity.

Sickle cell disease (SCD) is a genetic disorder characterized by crescent-shaped red blood cells, which can result in a number of complications. SCD prevalence is higher in countries with limited resources and, in certain regions such as Lebanon, may be compounded by high consanguinity rates, posing significant challenges for both healthcare systems and patients. This study aimed to assess patient needs and the organization of SCD management centers, to identify service gaps, and enhance care. SCD patients, caregivers, or legal representatives completed questionnaires about their experiences from diagnosis to present. Data were safely preserved for analysis. Additionally, electronic surveys regarding services, equipment, and staffing were filled out by reference staff from healthcare facilities in Lebanon, a low-resource country with a large refugee population. Qualitative thematic analysis and SPSS were used to analyze data. Among 124 participants, those living in rural areas reported significantly greater obstacles to quality care compared to urban residents (p < 0.001). Facilities unequipped for SCD care reported significantly fewer trained staff (p = 0.001), fewer beds dedicated to SCD (p = 0.003), and reduced use of infection screening tools (p = 0.033) compared to equipped centers. Patients at unequipped centers also reported lower satisfaction with communication, pain control, and psychological support (all p < 0.001), and showed less awareness of genetic counseling and SCD inheritance (p < 0.001). This study reveals substantial deficiencies in SCD management in the surveyed setting. Addressing gaps in staffing, training, and resource availability is urgently required. Collaborative efforts to strengthen healthcare systems could greatly improve outcomes and ensure people with SCD obtain suitable, high-quality care.

Abstract Background: In order to improve the quality of nursing care and patient outcomes during the future pandemics, understanding the details of strategies used for the management of patients with COVID-19 and its outcomes are crucial. The present study was conducted to reveal the management strategies that Chinese nurses utilized for COVID-19 patients. Materials and Methods: Graneheim and Lundman’s approach of conventional content analysis was used in this study and participants included nine nurses caring the patients with COVID-19 along with supervisors or matrons. Data were collected by semi-structured interviews and were analyzed via MAXQDA 10. Results: Six main categories emerged in this study including “overcoming challenges of COVID-19 pandemic”, “continuous online training of nurses”, “psychological support”, “ cooperative behavior of the public and government based on the previous pandemic experience”, “protecting medical staff from infection” and “application of smartphone technology”. Conclusions: The optimal management of emerging diseases depends on the cooperation of the people, the efforts of the healthcare team, and the measures of the managers. Hospital managers could create equipped units to be designated for probable health care emergencies, preparing educated team for quick training of staff, streamlining the expansion of standard work, and providing the necessary infrastructure for possible future pandemics.

The COVID-19 pandemic exposed the fragility of global health systems, as physicians faced extremely challenging conditions including excessive workloads, infection risk, and high patient mortality. We conducted a cross-sectional survey that aimed to assess the post-pandemic prevalence of anxiety, depression, and post-traumatic stress disorder (PTSD) in a sample of Greek physicians who worked on the frontline during the SARS-CoV-2 (COVID-19) pandemic. An online survey was conducted between 1 March and 31 July 2023, in which 200 Greek physicians were invited via e-mail to voluntarily answer a confidential online questionnaire, and 58 of them responded. The survey included two clinically validated tools: the Patient Health Questionnaire-4 (PHQ-4) and the Impact of Event Scale—Revised (IES-R). Univariate correlations of 26 exposure variables with anxiety, depression, combined anxiety/depression, and PTSD were performed. In total, 58 eligible physicians (46.6% female) participated in this study. The rates of anxiety, depression, combined anxiety/depression, and PTSD were 27.5% (95% CI: 16.7–40.9), 31.0% (19.5–44.5), 22.4% (12.5–35.3), and 24.1% (13.9–37.2), respectively. Notably none of the physicians working in a laboratory developed any mental health symptoms. The following factors were found to be associated with the development of higher mental health symptoms: age ≤ 30, employment in healthcare ≤ 10 years, working in COVID-19 wards, working in intensive care units or COVID-19 wards, a history of mental health symptoms, a history of physical conditions, shortages of materials and equipment for diagnosing or treating patients, development of a disease other than COVID-19, and the development of a new mental health condition during the pandemic (p &lt; 0.05 for all associations). Our findings highlight the need to better prepare physicians with adequate materials, infrastructure, and psychological support such that, in a potential future health crisis, they will not be at such high risk of mental health problems.

Treatment Needs of Adult Patients with Cleft Lip and Palate.

Comparison of pre- and post-surgery cardiac depression and perceived stress levels in heart patients undergoing different types of surgery.

This study aimed to explore the complex dynamics of help-seeking behaviors among breast cancer patients in China through developing an explanatory theoretical model. A Constructivist Grounded Theory (CGT) approach was employed to investigate breast cancer patients' help-seeking behaviors. Data collection occurred at a tertiary hospital in Zhejiang, China, from September 2024 to February 2025. We used a two-phase CGT design: Phase 1 inductively generated the preliminary model from patient interviews; Phase 2 employed theoretical sampling with nurses and non-participant observations to test negative cases, triangulate covert decision dynamics, and achieve category saturation. Sample size was based on theoretical saturation audit checks for coding consistency. Data analysis utilized NVivo 12.0 software following Strauss and Corbin's three-level coding paradigm. Analysis generated the Motivate-Response-Feedback Model (MRFM), outlining the dynamics of breast cancer help-seeking behavior. Intrinsic motivators included cognitive biases, perceived disease severity, and coping strategies, whereas extrinsic motivators encompassed cultural stigma, healthcare resource allocation, and family responsibilities. Patients' behavioral responses manifested as active (multi-source symptom verification, cross-regional care-seeking) or passive (delayed consultations, condition concealment). Feedback processes were categorized as positive (enhanced social support, reduced psychological stress) and negative (economic strain, negative emotional states), further influencing subsequent help-seeking behaviors. This study provides a nuanced understanding of the complex interplay between intrinsic and extrinsic motivators, behavioral responses, and feedback loops shaping breast cancer help-seeking behaviors in China. We propose a culture-specific MRFM that explains intention-behavior gaps via dynamic feedback loops rather than static determinants. The developed MRFM highlights the need for culturally tailored interventions to reduce stigma, improve resource allocation, and enhance psychological and social support. Further quantitative validation and research exploring the role of digital health interventions in facilitating timely help-seeking behaviors are recommended.