At a moment of dramatic retreat from refugee resettlement, accompanied by anti-immigrant political discourse that criminalizes migrants, this study examines how Iraqi resettled refugees who came to the United States with Special Immigrant Visa status following the 2003 war in Iraq navigate stigmatizing welfare dependency tropes and narrate their identities. Using the lens of narrative criminology and based on interviews with Iraqi resettled refugees and social service staff, this study asks how resettled Iraqi refugees construct narratives of self and identity in relation to the organizational narratives they encounter at social services offices, and what these narratives reveal about welfare administration as a site of social harm. Findings show that while resettled refugees construct counter-narratives, these are limited in their emancipatory potential and reproduce harmful narratives of welfare. The study contributes to narrative criminology's engagement with welfare settings as sites of social harm. How Iraqi refugees in Michigan navigate welfare, and how the stories of caseworkers and social services staff shape their experiencesIraqi refugee families in the United States require government assistance while undergoing resettlement and search for employment. The families interact with staff at welfare offices and nonprofit organizations who help them with assistance and resettlement. Their experiences of assistance are usually explained as part of their resettlement journey. However, there is more to understand about how these families see themselves specifically as welfare recipients and how stories about welfare told by their caseworkers and case managers affect them. To understand the connections between the way refugees are described in stories about welfare and how refugees see themselves, I interviewed Iraqi refugees, and staff members who worked at an organization helping refugee families in Michigan. I asked Iraqi families about their experiences of resettlement and receiving assistance. I asked the staff about their role in helping refugees with resettlement and assistance. Then, I looked for patterns in what people said about welfare, unemployment, and refugee resettlement. The staff at the organization often described unemployed refugees as lacking motivation or having the wrong attitude about employment. By contrast, refugees described themselves as professional, motivated to find work, and compliant with all welfare requirements. They described the experience of receiving welfare as humiliating and emphasized to me that they were different from other people who abuse welfare. These are important findings that tell us that people experience harm in these places through humiliating interactions that attack their sense of self-worth. Refugees push back against these negative experiences. Yet, they do so in ways that reinforce negative views about other people receiving welfare. Understanding how stories operate in social services offices can help us understand how welfare stereotypes amplify social harm against welfare recipients.
Every day patients make informal complaints directly to care professionals. Although common in care encounters, the practice remains understudied. In this study, we focus on informal complaints through an analysis of interviews with 19 patients in Sweden, many living with chronic illness. We conceptualise these complaints as 'informal complaint biographies': not merely verbal expressions, but interwoven with people's lives, identities and care trajectories. As a lens through which to examine informal complaining, this study investigates 'dirty work': work that is considered a nuisance or even humiliating. We identify three different kinds of dirty work. 'Disgusting' refers to work with physical dirt entangled with the complaint. 'Drudging' describes patients' persistence, their effort to make healthcare function. Finally, 'disrupting' characterises work that challenges expertise from a vulnerable position. Our analysis shows how informal complaining can involve various types of undignifying work that cannot be separated from the complaint itself. By including work done by others than the traditional 'worker', namely patients, this study expands scholarship on dirty work. The study calls attention to how dirty work is shaped by systemic inefficiencies in healthcare and contributes new perspectives to complaints, research and policy, which is often wiped clean from any kind of dirt.
Deathcare workers in resource-limited countries are chronically exposed to infectious diseases, mainly due to a lack of effective safety controls, inadequate resources, poor training and laxity on the part of industry managers. However, there is limited evidence from these countries, and very little is known about how deathcare workers manage infectious dead bodies. The aim of this study is to explore the experiences of deathcare workers involved in the management of infectious dead bodies in Ghana. Using purposive sampling, data were collected from 32 deathcare workers using 11-item semi-structured in-person interview guide. An observation checklist was also used to gather additional data on on-site safety practices. Thematic analysis was conducted using the realistic phenomenological approach. We found that there were no clearly defined safety control systems (engineering, administrative and personal protective equipment supply and use) in place to protect workers against infectious diseases. For example, there were no separate storage facilities for infectious dead bodies. The workers were also exposed to various types of psychosocial hazards, such as heavy workload and dirty and disorganised work environments, which could affect their self-esteem, life satisfaction and coping skills. Additionally, these workers reported feeling humiliated, receiving poor remuneration and lacking opportunity for career progression. The deathcare workers in Ghana were not adequately prepared to handle infectious dead bodies, which put them at risk for infection and increased the psychosocial hazards at work. These workers may resort to unhealthy coping strategies, which require urgent attention. Future research should use qualitative approaches to investigate the working relationships between deathcare workers and their managers.
In medical education, teaching by humiliation (TBH) has been identified as a potentially harmful practice contributing to mental distress. However, this is under-researched in the Australian context. This study aims to investigate the prevalence of TBH and mental distress in Australian medical students. It will explore correlations between these variables, seeking to establish a mediation relationship. Data was collected through an online cross-sectional survey of Australian medical students, returning 244 responses. Using SPSS, crosstabulation was conducted to estimate the prevalence of TBH and mental distress. Spearman's rho correlation tests were performed to determine associations between variables. Mediation analysis was conducted with TBH as the independent variable, mental distress as the dependent variable, and anger, shame, and embarrassment as mediators. The majority (80.3%) of participants experienced TBH. There was a high prevalence of depression (57.8%), anxiety (54.1%), and stress (72.9%). A weak positive correlation was found between TBH, mental distress, and mediators. TBH did not have a direct effect on mental distress (c' = 0.28 (95%Cl = -1.00, 1.55), p = .67). However, indirect effects through anger (a1b1 = 1.31 (95%Cl = 0.55, 2.27)), shame (a2b2 = 0.45 (95%Cl = 0.02, 0.99)), and embarrassment (a3b3 = 1.19 (95%Cl = 0.33, 2.18)) were significant. This study suggests that TBH is a systemic issue, indicating a significant prevalence of mental distress in Australian medical students. While experiencing anger, shame, or embarrassment from TBH was linked to mental distress, TBH itself did not have direct effects on mental health.
In this research, it was aimed to examine the experiences of colleague violence and professional commitment of final year nursing students during the clinical practice process. A descriptive phenomenological qualitative research design was used. It was conducted in the nursing department of a state university in a province in eastern Turkey. Criterion sampling method, one of the purposive sampling methods, was used to include 14 students who were exposed to colleague violence. Data were collected through face-to-face semi-structured in-depth interviews between June and July 2025. All interviews were audio-recorded and transcribed. Thematic analysis was used to analyze the data. The COREQ checklist was used in the conduct and reporting of the research. Data analysis revealed five themes: types of colleague violence, emotional reactions and professional effects, coping strategies, professional commitment and belonging, and suggestions for improvement in education and clinical environment. Students most commonly described verbal reprimands, exclusion, humiliation, condescending attitudes and being assigned non-professional tasks. These experiences led to feelings of worthlessness, loss of self-confidence, reduced motivation, withdrawal from clinical practice and, for some students, thoughts of leaving the profession. As a result of the research, it was determined that final year nursing students were negatively affected by colleague violence and this situation affected their commitment to the profession. It is very important to determine the experiences of colleague violence experienced by nursing students during clinical practice and the effects of violence on students and to ensure that measures are taken to reduce it.
To examine the occupational risks, health precarity and social marginalisation of informal household waste collectors in Bhara Kahu, a rapidly urbanising peri-urban area of Islamabad, and to interpret these risks through contemporary sociological frameworks. Qualitative case study. We conducted in-depth semi-structured interviews with 12 informal household waste workers and paired these narratives with targeted field observations in Bhara Kahu. Interviews were conducted in Urdu or Punjabi, recorded with consent, translated and thematically analysed using a reflexive approach informed by an interpretive phenomenological orientation. Interpretation drew on risk society, environmental precarity, structural violence and necropolitics to situate everyday harms within wider political and institutional arrangements. Five interlocking themes emerged. First, workers reported an absence of enforceable labour rights and social protections, with verbal hiring, arbitrary wage deductions and no insurance, earning about PKR 18,000-25,000 per month (approximately 65-90 USD). Second, safety was systemically neglected: there was virtually no training, minimal provision of personal protective equipment and unsafe transport on open rickshaws. Third, untreated injuries and chronic illnesses were common, including lacerations, musculoskeletal pain, persistent cough and skin conditions, with delayed or foregone care due to cost, time pressure and stigma. Fourth, households faced constant hygiene strain, as crowded housing, poor neighbourhood sanitation and limited vaccination amplified exposures beyond the workday. Fifth, social devaluation enabled economic exploitation and job insecurity, normalising humiliation in public interactions and occasionally extending into clinical encounters. Together, these patterns reveal a sanitation regime that purchases urban cleanliness through sacrificial labour. Improving conditions requires formal recognition of informal collectors as a public health workforce, written contracts and social insurance, reliable PPE backed by practical training, routine vaccination and mobile health services, source segregation to reduce hazardous contact, and anti-stigma measures in communities and clinics. Without such changes, risk will continue to be shifted onto those with the least capacity to refuse it.
Healthcare workers are exposed to intense organizational pressures and demanding interpersonal dynamics that may undermine psychological wellbeing. Tyrannical leadership-characterized by hostile, controlling, and humiliating supervisory behaviors-represents a particularly harmful organizational stressor in healthcare settings. Under such conditions, psychotropic medication may be used as a coping response to sustained psychological strain. This study examined whether exposure to tyrannical leadership predicts subsequent psychotropic drug use among healthcare workers. A longitudinal panel study was conducted among healthcare workers employed in high-complexity public hospitals in Chile. Two waves of data were collected 10 months apart. The analytic sample included 683 participants who completed both measurements. Tyrannical leadership exposure was assessed using a validated scale. Psychotropic medication use was measured through self-reported intake of hypnotics, anxiolytics, or antidepressants. Logistic regression models were used to estimate crude and adjusted associations between baseline tyrannical leadership and psychotropic drug use at follow-up, controlling for baseline medication use, sex, and key psychosocial work stressors, including effort-reward imbalance and emotional demands. At follow-up, 39.8% of participants reported psychotropic medication use. In crude models, exposure to tyrannical leadership at baseline was associated with approximately twice the odds of psychotropic use at follow-up. In the fully adjusted model, baseline psychotropic use was the strongest predictor of subsequent consumption, with nearly tenfold higher odds of continued or increased use. After adjustment, tyrannical leadership remained significantly associated with psychotropic drug use, doubling the odds of consumption. Effort-reward imbalance also showed a significant association, whereas sex and emotional demands were not significant predictors. These findings identify tyrannical leadership as a significant and potentially preventable organizational risk factor linked to increased psychotropic medication use among healthcare workers. By highlighting leadership as a modifiable determinant of mental health outcomes, the study underscores the importance of organizational interventions aimed at improving supervisory practices in high-stress healthcare environments.
Infertility is a significant reproductive health issue that affects millions of married couples worldwide, creating emotional, psychological and social challenges for those affected. It can have serious effects on the psychological, economic, physical and social well-being of both men and women. However, little is known about this in the Kpandai District of Ghana. This study explored the experiences of married women with infertility in Kpandai District, Ghana. An explorative qualitative research approach was used in this study. A snowballing sampling technique was used to interview 11 married women living with infertility. Data were collected using an interview guide and analysed using thematic content analysis. In the interviews, three key themes emerged: (1) adverse experiences of married women with infertility, (2) psychological effects of infertility and (3) coping strategies used. Many respondents expressed feelings of sadness, humiliation, mistreatment and stigma. The experiences of public ridicule and strained marital relationships further intensified their distress, with some women contemplating divorce. Seeking medical interventions, spiritual practices, work and support from spouses were some coping strategies used in dealing with the adverse experiences of infertility. These findings underscore the urgent need for comprehensive support systems, including psychological counselling, family and spousal support and community-based interventions, to help women navigate the complex challenges of infertility. Addressing infertility holistically beyond medical treatment will be essential in fostering resilience and emotional well-being for affected women.
Background/Objectives: Physical restraints and seclusion remain ethically contested interventions in psychiatric care, raising significant concerns regarding patient safety, dignity, and therapeutic impact. Despite growing international momentum towards restraint-reduction strategies, their use persists across the Eastern Mediterranean Region (EMR), an area that has been the subject of limited systematic attention. This review synthesises evidence on the knowledge, attitudes, and experiences of nurses and individuals with mental illness regarding these practices in EMR psychiatric settings. Methods: Following PRISMA 2020 guidelines (PROSPERO: CRD42023383751), we systematically searched nine electronic databases for studies published up to June 2023, supplemented by backward and forward citation searching. Multiple reviewers independently screened records against predefined eligibility criteria, with disagreements resolved through consensus. Methodological quality was assessed using Joanna Briggs Institute (JBI) Critical Appraisal tools, and reporting quality was evaluated using an adapted CROSS checklist; these two appraisal dimensions were conducted and reported independently. Findings were integrated through narrative synthesis. Results: From 4634 identified records, 19 studies conducted across 11 EMR countries met the inclusion criteria. Nursing knowledge deficits were identified across multiple settings, and attitudes towards restraint practices were predominantly negative. Individuals with mental illness consistently described restraint as humiliating, punitive, and physically distressing. Recurrent challenges identified across studies included inadequate staff training, chronic understaffing, and limited access to restraint-reduction alternatives. Conclusions: Substantial gaps in nursing knowledge and training persist across the EMR. The findings of this review, while derived predominantly from cross-sectional studies with convenience samples, suggest that evidence-based education programmes, standardised restraint-reduction policies, and patient-centred care frameworks warrant prioritisation to safeguard the rights, safety, and dignity of individuals with mental illness in this region. Longitudinal and experimental research is needed to confirm these directions and establish their effectiveness within EMR contexts.
Background: Torture, as a fundamental violation of human rights, is unequivocally condemned by all international organizations. Sexual torture is one of the most severe forms of torture, encompassing forced nudity, various forms of humiliation, and physical abuse, including rape. Despite testimonial evidence indicating the incidental use of sexual torture by Israeli authorities, there is a lack of epidemiological research providing a comprehensive understanding of this issue. This study aims to analyze the prevalence and characteristics of ill treatment and sexual torture among Palestinian male detainees and the subsequent impacts. Methods: This cross-sectional study analyzed a database of 517 former male detainees. The interview protocol included items related to psychological and physical methods of sexual torture, medical impacts, subjective psychological impacts, clinical medical and psychological measures, and psychosocial and community impacts. Results: The findings indicate that the majority of detainees experienced some form of sexual torture, with humiliation being the most common type. The impact of sexual torture are severe, affecting both clinical and social domains. The impacts of sexual torture persist over time and, in some cases, worsen, particularly regarding physical health outcomes. Socially, the consequences extend to the detainees' families and communities. Conclusions: The prevalence of such torture tactics calls for urgent responses from both the authorities and civil society. These findings highlight the need for proactive measures to address and mitigate the impacts of sexual torture, including independent investigations, robust monitoring, secure reporting mechanisms, the prosecution of perpetrators and comprehensive reparation for victims.
Image-Based Sexual Abuse (IBSA), including deepfake sexual abuse - where fake yet lifelike sexual content is generated of non-consenting persons - constitutes a growing form of digitally mediated gender-based violence that remains largely under-researched within non-Anglophonic contexts. This study explores how IBSA is constructed and perceived by both laypeople and lawyers in Greece, a Southern European setting characterised by economic precarity, traditional gender norms, and evolving yet challenging legal frameworks. Drawing on semi-structured interviews with 21 participants either originating from or living in Greece (n = 16 lay persons, n = 5 legal professionals), we employed constructionist thematic analysis to examine how participants discursively frame IBSA, its motivations, barriers to reporting, legal challenges, and preventative measures. Five themes were identified: (1) constructions of IBSA as gendered violence motivated by control, humiliation, and financial exploitation; (2) barriers to reporting shaped by shame, stigma, and widespread mistrust in police institutions; (3) legal barriers related to financial inaccessibility and fragmented, outdated legal frameworks; (4) the central role of informal support networks alongside calls for education and public awareness; and (5) deepfake technologies as an emergent form of economic exploitation, particularly impacting sex workers within a legal vacuum. The findings highlight the need for structurally informed, context-sensitive responses to IBSA that address the intersections of gender, law, technology, and economic vulnerability.
This paper offers an active inference narrative that considers discriminatory behaviour in relation to the cognitive concept of zones of bounded surprisal (ZBS). It is argued that narrow ZBS band-widths characterise the discriminatory minds of people who see themselves as an in-group. They tend not to be indignant or outspoken, but acquiescent when they witness poor behaviour of those whom otherwise they regard as members of their in-group. When such behaviour harms other people, its perpetrators have a very narrow ZBS band-width: one that likely is a characteristic of dehumanising minds. Because such perpetrators see themselves as members of an in-group with entitlement to control aspects of society, they humiliate or abuse out-groups to which they assign others, and have no compunction about violating their dignity or human rights. We briefly consider policies that could lessen the unwelcome social repercussions of the behaviour of people with discriminatory and dehumanising minds.
Psychological safety in the learning environment allows students to take risks without fear of humiliation or negative consequences. The psychological safety of healthcare teams has been studied at three levels: organizational, team and individual. Prior work has shown how leadership behaviours contribute to student perceptions of psychological safety in the clinical learning environment, but less is known about the impact of organizational and individual factors. The present study explored student perceptions of facilitators and barriers of psychological safety in the clinical learning environment. We conducted a qualitative case study in Academic Year 2022-2023. We held four focus groups with 23 third- and fourth-year medical students at Spencer Fox Eccles School of Medicine. Focus groups were recorded and transcribed verbatim; transcripts were analysed using thematic analysis. Thematic analysis revealed that there were organizational supports and barriers, inclusive and exclusive leadership behaviours and individual student characteristics that affected psychological safety in the learning environment. Psychological safety exists when high levels of organizational support and inclusive behaviour are present. However, it is also possible for an organizational support or an inclusive leader behaviour to overcome an exclusive leader behaviour or an organizational barrier, respectively. Organizational support and inclusive leadership behaviours foster psychological safety. Furthermore, it appears that psychological safety factors do not exist in isolation, but rather in tandem with one another. This makes it possible for an individual medical educator or organizational support to foster psychological safety even when organizational barriers or exclusionary behaviours from other supervisors exist.
ObjectiveThis study aimed to examine the effectiveness of Eye Movement Desensitization Therapy (EMDR) in Social Anxiety Disorder (SAD).MethodThe 12th-week follow-up study sample consisted of 26 adolescents, aged 12 to 16 years. Participants were screened with the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children Present and Lifetime version (K-SADS-PL). Additionally, the Beck Anxiety Inventory (BAI), Revised Child Anxiety and Depression Scale - Child Version (RCADS-CV), and Liebowitz Social Anxiety Scale (LSAS) were administered at baseline, 4th week, and 12th week. The Clinical Global Impressions-Improvement (CGI-I) and Severity (CGI-S), and SUD scales were also used. After two initial interviews, weekly EMDR sessions were conducted over 12 weeks.ResultsThe baseline mean of total BAI scores decreased from 48.35 to 2.58; the social anxiety sub-scale of RCADS-CV decreased from 20.65 to 1.84, and the baseline mean of LSAS decreased from 147 to 48.65 at the end of the 12th week of treatment. After the 12th week of EMDR, all the adolescents showed complete improvement. The findings showed that the social anxiety symptoms significantly decreased with EMDR therapy.ConclusionIt can be said that EMDR is an effective psychotherapy in reducing the severity of social anxiety in adolescents. Social anxiety disorder (SAD) is a debilitating condition characterized by a marked and persistent fear of being humiliated or scrutinized by others. SAD is among the most prevalent and debilitating forms of anxiety disorders, and ranks as the third most common psychiatric disorder, following major depressive disorder and alcohol use disorder. SAD most commonly begins during adolescence. The disorder can lead to substantial functional impairments in multiple areas of adolescent life, including an elevated risk of school dropout, lower academic achievement, greater susceptibility to bullying, limited peer relationships, and reduced satisfaction in social interactions. Additionally, SAD is associated with a heightened risk of developing other psychiatric conditions, including mood and anxiety disorders, behavioral problems, and substance use disorders. Since anxiety disorders are multifaceted, multiphasic therapies covering different dimensions of the issue are needed. Eye Movement Desensitization and Reprocessing (EMDR) is one of these integrated therapies, a comprehensive therapeutic approach consistent with all contemporary theoretical orientations. A meta-analysis and a systematic review also suggest that EMDR was found to be effective in reducing symptoms not only in PTSD but also in depressive disorders, anxiety disorders, chronic pain, bipolar disorder, psychosis, and substance use disorders. Although EMDR is an effective treatment technique, there is a need for more studies showing its effectiveness in different psychopathologies, especially in children and adolescents. Therefore, this study aimed to examine the effectiveness of EMDR in SAD, which is the most common disorder in adolescents and causes impairment in daily functioning. We hypothesized that EMDR would reduce symptoms of SAD in adolescents after a 12-week follow-up.
Sexual and gender-based violence (SGBV) affects an important part of the population, and medical trainees are no exception. A 2014 meta-analysis on medical students found that 59 % experienced at least one form of harassment or discrimination during their studies. This study aimed to gather data on SGBV among French medical students in 2024 and to compare its evolution since 2021. Two national online surveys on mental health in medical school students and residents of all specialities were conducted in 2021 and 2024. In both surveys, the questionnaire included a section on humiliation and sexual violence, using 5 questions from a nationwide survey on Students in France. We included 17,225 subjects: 9960 in 2021 and 7265 in 2024. The prevalence of violence during the medical studies was 27 % and 17 % for humiliation, 29 % and 22 % for sexual harassment, and 5 % and 6 % for sexual assault in 2021 and 2024, respectively. Women were five times more likely to experience sexual harassment than men. Among the victims, 76 % reported experiencing violence in the hospital, 28 % at student parties, and 10 % at the university. Since 2021, there has been a 26 % increase in reported incidents of violence compared to the previous year (19 %). Despite policies implemented following previous surveys, the rate of sexual harassment remains high. The majority of these violent occurrences in hospital settings highlighting the importance of taking specific actions tailored to the structure of medical studies and the healthcare and caregiving system.
Undocumented Afghan women migrants in Pakistan face profound barriers to reproductive healthcare. This study examines the informal reproductive healthcare strategies of undocumented Afghan women migrants living in Peshawar, focusing on the invisible safety nets they construct in response to legal and institutional exclusion. The study employed a qualitative research method by conducting narrative in-depth interviews, focus group discussions with undocumented Afghan women migrants, and five key informant interviews. The study conducted a narrative-informed thematic analysis grounded in concepts of social networks, everyday bordering, and reproductive justice. The study findings revealed that public facilities are widely perceived as sites of document checking, humiliation, and potential exposure to immigration authorities, leading women to anticipate exclusion and pre-emptively turn away from formal care. In this context, traditional birth attendants, small private clinics, pharmacies, and home-based remedies form a plural, informal care landscape, accessed and evaluated through dense kinship and neighborhood networks. Community-based practices, rotating loans, information sharing, accompaniment, and emotional support, operate as invisible safety nets that partially compensate for state neglect.. The study calls for decoupling reproductive care from immigration control while engaging pragmatically with existing informal providers and community networks to promote reproductive justice and well-being.
The paper examines Yashica Dutt's Coming Out as Dalit through the framework of Trauma theory, highlighting the emotional and psychological consequences of hiding one's Dalit identity in a rigidly hierarchical society. This study offers a thorough analysis of the psychological pain caused by caste-based discrimination and the lasting impacts of social marginalisation. It underscores how caste discrimination engenders internalised fear, humiliation, and identity disintegration, resulting in persistent psychological distress. This paper examines how Dutt's young teenager experiences of concealing her identity, informed by Erik Erikson's theory of psychosocial development and psychotraumatology, specifically its phases of personal identity versus role confusion and closeness against isolation, impeded the establishment of a coherent sense of self. Presenting oneself as a "higher caste" functions as a survival strategy, simultaneously intensifying feelings of isolation and cognitive dissonance. Her decision to publicly identify as Dalit represents a crucial milestone for confronting and resolving trauma, fostering self-acceptance and empowerment. This study emphasises the effects of systematic oppression on societal progress, mental health, and identity formation, highlighting the necessity of recognising caste-based trauma as a significant psychological concern.
To determine the prevalence and type of intimate partner violence among adolescents and its relationship with family dynamicsand social support. Descriptive cross-sectional study. SITE: Public urban secondary school. Students aged 12 to 18years. Self-administered survey. VREP questionnaire (violence perpetrated, received, and perceived) according to the type of violence (physical, sexual, psychological). Age, sex, family structure and function (Family Apgar test), social support (DUKE-UNC-11 questionnaire), and previous intimate relationships. 408 surveys (response rate 81.6%). Mean age 14.7years [SD: 2.1], 50% female. Violence received: psychological (control 55%, humiliation 40.1%, social 37.9%), physical (25.5%), and sexual (22.9%) (P<.001; χ2). Violence perpetrated: psychological (control 40.4%, humiliation 28.4%, social 21.8%), physical (18.2%) and sexual (11.4%) (P<.001; χ2). The prevalence of each type of violence was similar across genders, but men perpetrated more physical and sexual violence, and women experienced more psychological violence. 80% of participants perceived violent behavior, particularly among those who perpetrated violence (P<.10; χ2). Women experienced more physical violence (OR=2.5). Older age was associated with experiencing less social/control violence (OR=0.8). Living in non-nuclear family structures increased the likelihood of perpetrating sexual (OR=8.9), physical (OR=6.9), and social/psychological (OR=4.9) violence, compared to experiencing humiliation (OR=3.6) and control (OR=2.5). Family dysfunction was associated with perpetrating social violence (OR=2.5), while having more previous partners increased the risk of suffering sexual violence (OR=1.3). Adolescent couples adopted and normalized a high number of violent behaviors in their romantic relationships. Female gender, younger age and poor family dynamics contributed to violent behaviors. Conocer la prevalencia y el tipo de violencia de pareja en población adolescente y su relación con el funcionamiento familiar y el apoyo social. Estudio descriptivo transversal. Instituto de Educación Secundaria Obligatoria. Alumnado de 12-18 años. Encuesta autoadministrada. Cuestionario VREP (violencia ejercida, recibida y percibida), tipo de violencia (física, sexual, psicológica). Edad, sexo, estructura y función familiar (test Apgar familiar), apoyo social (cuestionario DUKE-UNC-11) y relaciones previas de pareja. 408 encuestas (tasa de respuesta 81,6%). Edad media 14,7 años[DE: 2,1], 50% mujeres. Violencia recibida: psicológica (control 55%, humillación 40,1%, social 37,9%), física (25,5%) y sexual (22,9%) (p < 0,001; χ2). Violencia ejercida: psicológica (control 40,4%, humillación 28,4%, social 21,8%), física (18,2%) y sexual (11,4%). La presencia de violencia es similar según sexos: los hombres realizaron más violencia física y sexual, las mujeres recibieron más violencia física (OR = 2,5) y psicológica. 80% percepción de conductas violentas, sobre todo entre quienes ejercen violencia (p < 0,10; χ2). Más edad estuvo asociada a recibir menos violencia social/control (OR = 0,8). Vivir en estructuras familiares no nucleares favoreció ejercer la violencia sexual (OR = 8,9), física (OR = 6,9) y psicológica social (OR = 4,9), se asoció con recibir conductas de humillación (OR = 3,6) y de control (OR = 2,5). La disfunción familiar se asoció con ejercer violencia social (OR = 2,5), más parejas previas aumentó el riesgo de recibir violencia sexual (OR = 1,3). Las parejas adolescentes adoptaron y normalizaron un alto número de conductas violentas en su relación sentimental. Las mujeres, los de menos edad y la mala dinámica familiar favorecieron las conductas violentas.
Torture in custody is a widespread and underreported phenomenon. Victims often present patterned injuries and behaviors, making medico-legal evaluation crucial for documenting abuse and assessing consistency with the reported events. We report 4 cases of individuals who were victims of torture in custody. Injuries predominantly included blunt-force trauma, with additional methods such as suspension, suffocation, sexual humiliation, and deprivation of food and water, confirming a recurring typical pattern regarding the types of injuries, instruments used, and body areas involved. These cases reflect typical patterns of injuries and behaviors associated with custodial torture, highlighting the importance of identifying and documenting findings consistent with the victim's account and physical examination.
Psychological safety, defined as a shared belief that a team is safe for interpersonal risk-taking, has emerged as a foundational determinant of learning, innovation, and performance across industries. In surgery, where hierarchy, time pressure, and irreversible consequences converge, the interpersonal risk of speaking up is amplified. In this environment, silence is not benign; it shapes outcomes. This article reframes psychological safety not as a cultural accessory but as infrastructure-an enabling condition for excellence in surgical teams and health-care systems. We examine psychological safety at three levels: first, within the operating room and surgical services, where it determines whether uncertainty, error, and dissent are surfaced or suppressed; second, across integrated health-care systems, where inclusive leadership and relational architecture allow voice to scale beyond individual teams; and third, through theoretical integration-drawing on social exchange theory, conservation of resources theory, and trait activation theory-to explain how psychological safety reallocates cognitive and emotional resources from self-protection to contribution. We argue that psychological safety enhances both innovation and reliability-aims often perceived as competing-by promoting early problem detection, learning behaviors, and engagement. Importantly, psychological safety does not reduce accountability; the optimal performance state combines high standards with high psychological safety, enabling rigorous improvement without humiliation or concealment. For surgical and executive leaders, psychological safety functions as a leading indicator of a system's capacity to learn, adapt, and sustain workforce well-being. In high-reliability health-care environments, excellence is achieved not by eliminating imperfection but by creating conditions in which it can be voiced, examined, and improved.