Entrapment and social problem-solving in suicidal behavior across the adult lifespan

BACKGROUND

Feelings of entrapment and deficits in social problem-solving skills have been associated with risk for suicidal behavior in the context of depression. However, few studies have examined the effect of age on the association between these risk factors and suicidal behavior across most of the adult lifespan.

METHODS

In a three-site study, we tested interactions of age with feelings of entrapment and social problem-solving style in 105 depressed patients with a recent suicide attempt, 95 depressed patients with no history of suicide attempt, and 97 demographically similar non-psychiatric participants (age 16-80). Attempter/non-attempter differences, age interactions, and the relative contribution of entrapment and social problem-solving style to past attempter were examined.

RESULTS

Entrapment significantly interacted with age such that it discriminated past attempters from depressed non-attempters better at older ages. Social Problem-Solving Inventory (SPSI) total score and most subscales did not distinguish past attempters, but the SPSI Impulsive Style Problem-Solving was an effective discriminator of past suicide attempts across the full adult lifespan and did not interact with age. In a multipredictor model, both the entrapment by age interaction and SPSI Impulsive Style Problem-Solving score were significant predictors for the classification of attempters.

LIMITATIONS

The cross-sectional nature of our research design limited conclusions that may be drawn about individual change over time or cohort effects.

CONCLUSIONS

Entrapment did not distinguish past attempters at younger ages but became a better discriminator in middle to late adulthood. An impulsive problem-solving style was associated with past suicide attempts across the full adult lifespan.

Impact of childhood trauma on the abnormal functional connectivity of brain regions in the fear network model of panic disorder

BACKGROUND

People who have suffered childhood trauma may be more susceptible to panic disorder (PD). Existing evidence indicates that childhood trauma can significantly impact brain function. Meanwhile, the brain regions involved in the fear network model (FNM) of PD highly overlap with the brain regions affected by childhood trauma. However, it remains unclear whether functional connections between brain regions associated with the FNM in patients with PD are affected by childhood trauma. This study aimed to investigate the effects of childhood trauma on the functional connectivity (FC) of brain regions associated with the FNM in patients with PD.

METHOD

This study recruited 62 patients with PD, including 21 with a high level of childhood trauma (PD_HCT), 41 with a low level of childhood trauma (PD_LCT), and 40 healthy controls (HCs). The patients underwent magnetic resonance imaging resting-state scanning. The amygdala, anterior cingulate, thalamus, and hippocampus were chosen as regions of interest (ROIs) to examine group differences in ROIs and whole-brain resting-state FC (rsFC).

RESULTS

Compared with PD_HCT patients, PD_LCT patients exhibited significantly increased rsFC in the right thalamus, right temporo-occipital middle temporal gyrus, left thalamus, and right temporo-occipital middle temporal gyrus. Compared with HCs, PD_LCT patients had increased rsFC between the right thalamus and the right temporo-occipital middle temporal gyrus.

CONCLUSION

Patients with PD who had suffered high and low levels of childhood trauma were found to exhibit different pathological rsFC alterations in the FNM, suggesting that childhood trauma may be an important risk factor for the development of PD symptoms.

Primary and secondary olfactory centres in human ontogeny

The olfactory centres are the evolutionary oldest and most conservative area of the telencephalon. Olfactory deficiencies are involved in a large spectrum of neurologic disorders and neurodegenerative diseases. The growing interest in human olfaction has been also been driven by COVID-19-induced transitional anosmia. Nevertheless, recent data on the human olfactory centres concerning normal histology and morphogenesis are rare. Published data in the field are mainly restricted to classic studies with non-uniform nomenclature and varied definitions of certain olfactory areas. While the olfactory system in model animals (rats, mice, and more rarely non-human primates) has been extensively investigated, the developmental timetable of olfactory centres in both human prenatal and postnatal ontogeny are poorly understood and unsystemised, which complicates the process of analysing human material, including medical researches. The main purpose of this review is to provide and discuss relevant morphological data on the normal ontogeny of the human olfactory centres, with a focus on the timetable of maturation and developmental cytoarchitecture, and with special reference to the definitions and terminology of certain olfactory areas.

Physical health and comorbid anxiety and depression across the first year postpartum in Ireland (MAMMI study): A longitudinal population-based study

INTRODUCTION

Little is known of the associations between physical health issues and mental health issues such as anxiety, depression and comorbid anxiety and depression (CAD) occurring in the perinatal period.

METHODS

A longitudinal cohort study with 3009 first-time mothers giving birth in Ireland collected physical and mental health data in pregnancy and at 3, 6, 9 and 12 months postpartum. Mental health was measured using the depression and anxiety subscales of the Depression, Anxiety and Stress Scale. Experience of eight common physical health issues (e.g. severe headaches/migraines, back pain) were assessed in pregnancy, with an additional six assessed at each postpartum data collection point.

RESULTS

2.4 % of women reported depression alone in pregnancy and 4 % reported depression across the first postpartum year. Anxiety alone was reported by 3.0 % of women in pregnancy, and 2 % in the first year postpartum. Prevalence of comorbid anxiety/depression (CAD) was 1.5 % in pregnancy and almost 2 % postpartum. A higher proportion of women reporting, compared to women not reporting, postpartum CAD were younger, not partnered, not in paid employment in pregnancy, have fewer years of education, and had a caesarean birth. Extreme tiredness/exhaustion and back pain were the most common physical health issues in pregnancy and postpartum. Constipation, haemorrhoids, bowel issues, breast issues, infection and pain in the perineum or caesarean wound, pelvic pain and urinary tract infections were highest at three months postpartum and gradually decreased thereafter. Women reporting depression alone or anxiety alone were equivalent in terms of physical health issues. However, women without mental health symptoms reported significantly fewer physical health issues than women reporting depressive or anxiety symptoms alone or CAD at every time point. Women with CAD reported a significantly higher number of health issues than women reporting depression alone or anxiety alone at 9 and 12 months postpartum.

CONCLUSION

Reports of mental health symptoms are associated with higher physical health burden demonstrating a need for integrated approaches in mental and physical health care pathways in perinatal services.

Yes-associated protein regulates glutamate homeostasis through promoting the expression of excitatory amino acid transporter-2 in astrocytes via β-catenin signaling

The homeostasis of glutamate is mainly regulated by the excitatory amino acid transporters (EAATs), especially by EAAT2 in astrocytes. Excessive glutamate in the synaptic cleft caused by dysfunction or dysregulation of EAAT2 can lead to excitotoxicity, neuronal death and cognitive dysfunction. However, it remains unclear about the detailed regulation mechanism of expression and function of astrocytic EAAT2. In this study, first, we found increased neuronal death and impairment of cognitive function in YAP^GFAP -CKO mice (conditionally knock out Yes-associated protein [YAP] in astrocytes), and identified EAAT2 as a downstream target of YAP through RNA sequencing. Second, the expression of EAAT2 was decreased in cultured YAP^-/- astrocytes and the hippocampus of YAP^GFAP -CKO mice, and glutamate uptake was reduced in YAP^-/- astrocytes, but increased in YAP-upregulated astrocytes. Third, further investigation of the mechanism showed that the mRNA and protein levels of β-catenin were decreased in YAP^-/- astrocytes and increased in YAP-upregulated astrocytes. Wnt3a activated YAP signaling and up-regulated EAAT2 through β-catenin. Furthermore, over-expression or activation of β-catenin partially restored the downregulation of EAAT2, the impairment of glutamate uptake, neuronal death and cognitive decline that caused by YAP deletion. Finally, activation of EAAT2 also rescued neuronal death and cognitive decline in YAP^GFAP -CKO mice. Taken together, our study identifies an unrecognized role of YAP signaling in the regulation of glutamate homeostasis through the β-catenin/EAAT2 pathway in astrocytes, which may provide novel insights into the pathogenesis of brain diseases that closely related to the dysfunction or dysregulation of EAAT2, and promote the development of clinical strategy.

Spatiotemporal Precision of Neuroimaging in Psychiatry

Aberrant patterns of cognition, perception, and behavior seen in psychiatric disorders are thought to be driven by a complex interplay of neural processes that evolve at a rapid temporal scale. Understanding these dynamic processes in vivo in humans has been hampered by a trade-off between spatial and temporal resolutions inherent to current neuroimaging technology. A recent trend in psychiatric research has been the use of high temporal resolution imaging, particularly magnetoencephalography, often in conjunction with sophisticated machine learning decoding techniques. Developments here promise novel insights into the spatiotemporal dynamics of cognitive phenomena, including domains relevant to psychiatric illnesses such as reward and avoidance learning, memory, and planning. This review considers recent advances afforded by exploiting this increased spatiotemporal precision, with specific reference to applications that seek to drive a mechanistic understanding of psychopathology and the realization of preclinical translation.

Electroconvulsive therapy-induced neuroimaging alterations measured by cerebral blood flow in adolescents with major depressive disorder

BACKGROUND

Electroconvulsive therapy (ECT) is a novel treatment strategy for adolescents with major depressive disorder (MDD). However, its related neurobiological changes associated with ECT remain undetermined.

OBJECTIVE

To elucidate the impact of ECT on the regional cerebral blood flow (CBF), and to identify alterations in the CBF associated with clinical outcomes in adolescents with MDD.

METHODS

Fifty-two treatment-naive adolescents who had experienced their first episode of MDD and 36 healthy controls (HCs) were recruited. To assess baseline parameters, all subjects were scanned with arterial spin labeling resting-state functional magnetic resonance imaging (ASL-fMRI) at the beginning of the study. Subsequently, 27 MDD adolescents were re-scanned after 2 weeks after ECT. CBF imaging was used for the prediction of specific clinical outcomes. Lastly, the associations between alterations seen on brain imaging alterations after ECT and ECT clinical efficacy (ΔHAMD scores) were determined.

RESULTS

Relative to HCs, adolescents with MDD exhibited reduced CBF in the left medial superior frontal gyrus (SFGmed) (cluster = 243, peak t = -3.9373, and P < 0.001) and augmented CBF in the right percental gyrus (PerCG) (cluster = 321, peak t = 4.3332, and P < 0.001) at baseline. Following ECT, MDD adolescents exhibited reduced CBF in the right fusiform gyrus (FFG) (cluster = 309, peak t = -4.346, and P < 0.001) and left hippocampus (HIP) (cluster = 290, peak t = -4.706, and P < 0.001), and enhanced CBF in the left orbital part of the inferior frontal gyrus (ORBinf) (cluster = 214, peak t = 4.073, and P < 0.001). Correlation analysis suggested an inverse association between ΔHAMD scores and CBF values in the left ORBinf (R² = 0.196, P = 0.021).

CONCLUSIONS

It was found that ECT resulted in alterations in CBF in specific brain areas, highlighting the significance of ORBinf in ECT pathophysiology in MDD adolescents.

The Effects of COVID-19 Pandemic on Adults Living in Turkey and Ways of Coping

This study investigated the experiences and views of adult people living in Turkey about the changes in their usual life during the pandemic, the effects of these changes, difficulties they had, and ways of coping with these difficulties. The study adopted a qualitative design within the scope of the phenomenological approach. The study sample consisted of 449 adults. The findings showed that the changes due to the pandemic were divided into eight categories that included social life, work-life, daily routines, emotions, school life, economy, and cognitive and physiological changes. The participants reported both positive and negative effects of these changes in terms of emotions, cognition, work and school life, physiology, and social life. In the pandemic process, the participants were found to have difficulties in emotions, social life, work-life and economy, physiology, and daily routines. To cope with these difficulties, the participants were found to demonstrate various emotion-focused, problem-focused, and appraisal-focused behaviors.

Assessment of Cardiovascular Risk for Noncardiac and Nonsurgical Activities

Cardiovascular risk stratification is a frequent evaluation performed by health professionals. Not uncommonly, requests for risk stratification involve activities or procedures that fall outside of the scope of current evidence-based guidelines. Estimating risk and providing guidance for these requests can be challenging due to limited available evidence. This review focuses on some of these unique requests, each of which are real examples encountered in our practice. We offer guidance by synthesizing the available medical literature and formulating recommendations on topics such as the initiation of testosterone and erectile dysfunction therapy, SCUBA and skydiving, polygraphy, and electroconvulsive therapy.

Research and Diagnostic Algorithmic Rules (RADAR) for mood disorders, recurrence of illness, suicidal behaviours, and the patient's lifetime trajectory

The top-down Diagnostic and Statistical Manual/International Statistical Classification of Diseases categories of mood disorders are inaccurate, and their dogmatic nature precludes both deductive (as indisputable) and inductive (as top-down) remodelling of case definitions. In trials, psychiatric rating scale scores employed as outcome variables are invalid and rely on folk psychology-like narratives. Using machine learning techniques, we developed a new precision nomothetic model of mood disorders with a recurrence of illness (ROI) index, a new endophenotype class, namely Major Dysmood Disorder (MDMD), characterised by increased ROI, a more severe phenome, and more disabilities. Nonetheless, our previous studies did not compute Research and Diagnostic Algorithmic Rules (RADAR) to diagnose MDMD and score ROI, lifetime (LT), and current suicidal behaviours, as well as the phenome of mood disorders. Here, we provide rules to compute bottom-up RADAR scores for MDMD, ROI, LT and current suicidal ideation and attempts, the phenome of mood disorders, and the lifetime trajectory of mood disorder patients from a family history of mood disorders and substance abuse to adverse childhood experiences, ROI, and the phenome. We also demonstrate how to plot the 12 major scores in a single RADAR graph, which displays all features in a two-dimensional plot. These graphs allow the characteristics of a patient to be displayed as an idiomatic fingerprint, allowing one to estimate the key traits and severity of the illness at a glance. Consequently, biomarker research into mood disorders should use our RADAR scores to examine pan-omics data, which should be used to enlarge our precision models and RADAR graph.

Inhibition of mGluR5 alters BDNF/TrkB and GLT-1 expression in the prefrontal cortex and hippocampus and ameliorates PTSD-like behavior in rats

RATIONALE AND OBJECTIVE

Post-traumatic stress disorder (PTSD) is a prevalent and debilitating psychiatric disorder. However, its specific etiological mechanism remains unclear. Previous studies have shown that traumatic stress changes metabotropic glutamate receptor 5 (mGluR5) expression in the hippocampus (HIP) and prefrontal cortex (PFC). More importantly, mGluR5 expression is often accompanied by alterations in brain-derived neurotrophic factor (BDNF). Furthermore, BDNF/tropomyosin-associated kinase B (TrkB) signaling plays multiple roles, including roles in neuroplasticity and antidepressant activity, by regulating glutamate transporter-1 (GLT-1) expression. This study aims to explore the effects of inhibiting mGluR5 on PTSD-like behaviors and BDNF, TrkB, and GLT-1 expression in the HIP and PFC of inevitable foot shock (IFS)-treated rats.

METHODS

Seven-day IFS was used to establish a PTSD rat model, and 2-methyl-6-(phenylethynyl)-pyridine (MPEP) (10 mg/kg, intraperitoneal injection) was used to inhibit the activity of mGluR5 during IFS in rats. After modeling, behavioral changes and mGluR5, BDNF, TrkB, and GLT-1 expression in the PFC and HIP were examined.

RESULTS

First, the IFS procedure induced PTSD-like behavior. Second, IFS increased the expression of mGluR5 and decreased BDNF, TrkB, and GLT-1 expression in the PFC and HIP. Third, the mGluR5 antagonist blocked the above behavioral and molecular alterations.

CONCLUSIONS

mGluR5 was involved in IFS-induced PTSD-like behavior by changing BDNF, TrkB, and GLT-1 expression.

Brain function changes reveal rapid antidepressant effects of nitrous oxide for treatment-resistant depression:Evidence from task-state EEG

Nitrous oxide has rapid antidepressant effects in patients with treatment-resistant depression (TRD), but its underlying mechanisms of therapeutic actions are not well understood. Moreover, most of the current studies lack objective biological indicators to evaluate the changes of nitrous oxide-induced brain function for TRD. Therefore, this study assessed the effect of nitrous oxide on brain function for TRD based on event-related potential (ERP) components and functional connectivity networks (FCNs) methods. In this randomized, longitudinal, placebo-controlled trial, all TRD participants were divided into two groups to receive either a 1-hour inhalation of nitrous oxide or a placebo treatment, and they took part in the same task-state electroencephalogram (EEG) experiment before and after treatment. The experimental results showed that nitrous oxide improved depressive symptoms better than placebo in terms of 17-Hamilton Depression Rating Scale score (HAMD-17). Statistical analysis based on ERP components showed that nitrous oxide-induced significant differences in amplitude and latency of N1, P1, N2, P2. In addition, increased brain functional connectivity was found after nitrous oxide treatment. And the change of network metrics has a significant correlation with decreased depressive symptoms. These findings may suggest that nitrous oxide improves depression symptoms for TRD by modifying brain function.

Bullying victimization and internalizing and externalizing problems in school-aged children: The mediating role of sleep disturbance and the moderating role of parental attachment

BACKGROUND

Studies have shown that bullying victimization may be related to internalizing and externalizing problems; however, the mechanism underlying this relationship remains unknown. This study explored the mediating role of sleep disturbance and the moderating role of parental attachment.

METHODS

A total of 1543 Chinese primary school students (M age = 8.92 years, SD1.7 years; range, 6-12) completed bullying victimization, sleep disturbance, and parental attachment measures, and provided information on their parents' occupations. The parents or guardians (n = 1995) also completed ratings on their children's internalizing and externalizing problems.

RESULTS

It was found that bullying victimization directly affected internalizing and externalizing problems and also influenced sleep disturbance. Regardless of the parent's socioeconomic status, parental attachment was found to moderate the relationship between bullying victimization and internalizing problems.

CONCLUSIONS

These findings contribute to understanding the partial mediating mechanism of sleep disturbance in the association between bullying victimization and internalizing and externalizing problems. The protective role of parental attachment proved central to preventing internalizing problems in bullied children. Intervention programs that enhance parental attachment and improve sleep quality could assist in mitigating the impact of bullying victimization on internalizing or externalizing problems.

Taiwan consensus on biological treatment of bipolar disorder during the acute, maintenance, and mixed phases: The 2022 update

BACKGROUND

Bipolar disorder is a mood dysregulation characterized by recurrent symptoms and episodes of mania, hypomania, depression, and mixed mood. The complexity of treating patients with bipolar disorder prompted the Taiwanese Society of Biological Psychiatry and Neuropsychopharmacology (TSBPN) to publish the first Taiwan consensus on pharmacological treatment of bipolar disorders in 2012. This paper presents the updated consensus, with changes in diagnostic criteria (i.e., mixed features) and emerging pharmacological evidence published up to April 2022.

METHODS

Our working group systemically reviewed the clinical research evidence and international guidelines and determined the levels of evidence for each pharmacological treatment on the basis of the most recent World Federation of Societies of Biological Psychiatry grading system. Four clinical-specific issues were proposed. The current TSBPN Bipolar Taskforce then discussed research evidence and clinical experience related to each treatment option in terms of efficacy and acceptability and then appraised final recommendation grades through anonymous voting.

RESULTS

In the updated consensus, we include the pharmacological recommendations for bipolar disorder with mixed features considering its high prevalence, the severe clinical prognosis, and the absence of approved medications. Cariprazine, lurasidone, repetitive transcranial magnetic stimulation, and ketamine are incorporated as treatment options. In the maintenance phase, the application of long-acting injectable antipsychotics is emphasized, and the hazards of using antidepressants and conventional antipsychotics are proposed.

CONCLUSIONS

This updated Taiwan consensus on pharmacological treatment for bipolar disorder provides concise evidence-based and empirical recommendations for clinical psychiatric practice. It may facilitate treatment outcome improvement in patients with bipolar disorder.

On making (and turning adaptive to) maladaptive aversive memories in laboratory rodents

Fear conditioning and avoidance tasks usually elicit adaptive aversive memories. Traumatic memories are more intense, generalized, inflexible, and resistant to attenuation via extinction- and reconsolidation-based strategies. Inducing and assessing these dysfunctional, maladaptive features in the laboratory are crucial to interrogating posttraumatic stress disorder's neurobiology and exploring innovative treatments. Here we analyze over 350 studies addressing this question in adult rats and mice. There is a growing interest in modeling several qualitative and quantitative memory changes by exposing already stressed animals to freezing- and avoidance-related tests or using a relatively high aversive training magnitude. Other options combine aversive/fearful tasks with post-acquisition or post-retrieval administration of one or more drugs provoking neurochemical or epigenetic alterations reported in the trauma aftermath. It is potentially instructive to integrate these procedures and incorporate the measurement of autonomic and endocrine parameters. Factors to consider when defining the organismic and procedural variables, partially neglected aspects (sex-dependent differences and recent vs. remote data comparison) and suggestions for future research (identifying reliable individual risk and treatment-response predictors) are discussed.

Klotho Upregulation via PPARγ Contributes to the Induction of Brain Ischemic Tolerance by Cerebral Ischemic Preconditioning in Rats

Cerebral ischemic preconditioning (CIP)-induced brain ischemic tolerance protects neurons from subsequent lethal ischemic insult. However, the specific mechanisms underlying CIP remain unclear. In the present study, we explored the hypothesis that peroxisome proliferator-activated receptor gamma (PPARγ) participates in the upregulation of Klotho during the induction of brain ischemic tolerance by CIP. First we investigated the expression of Klotho during the brain ischemic tolerance induced by CIP. Lethal ischemia significantly decreased Klotho expression from 6 h to 7 days, while CIP significantly increased Klotho expression from 12 h to 7 days in the hippocampal CA1 region. Inhibition of Klotho expression by its shRNA blocked the neuroprotection induced by CIP. These results indicate that Klotho participates in brain ischemic tolerance by CIP. Furthermore, we tested the role of PPARγ in regulating Klotho expression after CIP. CIP caused PPARγ protein translocation to the nucleus in neurons in the CA1 region of the hippocampus. Pretreatment with GW9962, a PPARγ inhibitor, significantly attenuated the upregulation of Klotho protein and blocked the brain ischemic tolerance induced by CIP. Taken together, it can be concluded that Klotho upregulation via PPARγ contributes to the induction of brain ischemic tolerance by CIP.

Monocarboxylate transporter-dependent mechanism is involved in the adaptability of the body to exercise-induced fatigue under high-altitude hypoxia environment

Under high-altitude hypoxia environment, the body is more prone to fatigue, which occurs in both peripheral muscles and the central nervous system (CNS). The key factor determining the latter is the imbalance of brain energy metabolism, which makes it difficult to maintain the central nervous system to send peripheral nerve impulse continuously. During strenuous exercise, lactate released from astrocytes is taken up by neurons stored for energy to maintain synaptic transmission, a process mediated by monocarboxylate transporters (MCTs) in CNS. The present study investigated the correlation among the adaptability to exercise-induced fatigue, brain lactate metabolism and neuronal hypoxia injury under high-altitude hypoxia environment. Rats were subjected to exhaustive incremental load treadmill exercise under either normal pressure and normoxic conditions or simulated high-altitude low pressure and hypoxic conditions, with subsequent evaluation of the average exhaustive time as well as the expression of monocarboxylate transporters 2 (MCT2), MCT4, the average neuronal density in the cerebral motor cortex, and the lactate content in rat brain. At the early stage of simulated high-altitude environment, the average exhaustive time and neuronal density of rats decreased rapidly, then gradually recovered to some extent with the extension of altitude acclimatization time. The expression of MCT2, MCT4 and the lactate content in rat brain also increased gradually with the extension of altitude acclimatization time. After the application of lactate transport inhibitor, the recovery of exercise capacity of rats after altitude acclimatization was quickly blocked, and the neuronal injury in the cerebral motor cortex of rats was also significantly aggravated. These findings demonstrate that MCT-dependent mechanism is involved in the adaptability of the body to central fatigue, and provide a potential basis for medical intervention for exercise-induced fatigue under high-altitude hypoxia environment.

Effectiveness of mental health website intervention on stress and depression for women with recurrent miscarriage: A randomized controlled trial

We aimed to investigate the effect of a mental health website intervention on perceived stress, depression, sleep quality, and social support in women with recurrent miscarriage (RM). Performing a randomized controlled trial, the participants in the experimental group (n = 31) received a 12-week mental health website intervention; the participants in the control group (n = 31) received RM standard medical care only. The paired t-tests results for the mean posttest scores for depression (p = .023) and perceived stress (p = .041) in the experimental group showed a significant decrease, but did not in the control group.

Child Maltreatment, Peer Victimization, and Mental Health: Neurocognitive Perspectives on the Cycle of Victimization

Children who experience maltreatment are at increased risk of revictimization across the life span. In childhood, this risk often manifests as peer victimization. Understanding the nature of this risk, and its impact on mental health, is critical if we are to provide effective support for those children who are most vulnerable. A systematic scoping review was conducted using Google Scholar and PsycINFO. Studies on adults, psychiatric, and/or inpatient populations were excluded. Included studies concerned all forms of child maltreatment and peer victimization. We found 28 studies about the association between maltreatment experience and peer victimization as well as peer rejection. We review the evidence documenting the relation between these adverse childhood experiences and mental health. The evidence suggests that maltreatment and peer victimization have additive effects on mental health outcomes. A number of theoretical developmental frameworks that delineate putative mechanisms that might account for an association are considered. Building on prior research, we then discuss the role of recent neurocognitive findings in providing a multilevel framework for conceptualizing mental health vulnerability following maltreatment. In addition, we consider how altered neurocognitive functioning following maltreatment may shed light on why affected children are more likely to be victimized by their peers. Specifically, we consider the threat, reward, and autobiographical memory systems and their role in relation to stress generation, stress susceptibility, and social thinning. Such a mechanistic understanding is necessary if we are to reduce the likelihood of peer victimization in children exposed to maltreatment, and move to a preventative model of mental health care.

P3(2): a sex- and gender-sensitive model for evidence-based precision medicine: from knowledge generation to implementation in the field of kidney transplantation

Precision medicine emerged as a promising approach to identify suitable interventions for individual patients with a particular health concern and at various time points. Technology can enable the acquisition of increasing volumes of clinical and "omics" data at the individual and population levels and support advanced clinical decision making. However, to keep pace with evolving societal realities and developments, it is important to systematically include sex- and gender-specific considerations in the research process, from the acquisition of knowledge to implementation. Building on the foundations of evidence-based medicine and existing precision medicine frameworks, we propose a novel evidence-based precision medicine framework in the form of the P3²model, which considers individual sex-related (predictive [P1], preventive [P2], and personalized [P3] medicine) and gender-related (participatory [P4], psychosocial [P5], and percipient [P6] medicine) domains and their intersection with ethnicity, geography, and other demographic and social variables, in addition to population, community, and public dimensions (population-informed [P7], partnered with community [P8], and public-engaging [P9] medicine, respectively). Through its ability to contextualize and reflect on societal realities and developments, our model is expected to promote consideration of diversity, equity, and inclusion principles and, thus, enrich science, increase reproducibility of research, and ensure its social impact.

Examining the description of the concept "treatment as usual" for patients with depression, anxiety and stress-related mental disorders in primary health care research - A systematic review

BACKGROUND

In randomized controlled trials (RCTs) within medical research, applied interventions are compared to treatment-as-usual (TAU) as the control condition. The aim of the current study was to examine how the concept of TAU is described when used as control condition in RCTs evaluating treatments for depression, anxiety syndromes, and stress-related mental disorders in primary care.

METHOD

A systematic review of RCTs utilizing TAU as control group in the RCT in accordance with PRISMA standards was conducted. We used one multidisciplinary database (Scopus), one database focused on nursing (Cinahl), and one medical database (PubMed). The searches were conducted in November 2021 and May 2022.

RESULTS

The included 32 studies comprised of 7803 participants. The content of TAU was classified as follows: 1) Basic descriptions of TAU lacking a detailed account as well as reference to local or national guidelines, 2) Moderate description of TAU including reference to national or local guidelines or a detailed description 3) Advanced description of TAU including references to national guidelines and a detailed description containing five key concepts: early assessment, accessibility, psychological treatment, medication, somatic examination. 18 studies had basic, 11 moderate, and 3 advanced descriptions of TAU.

LIMITATIONS

The limitations were that only studies published in English were included.

CONCLUSIONS

The current study provides an assessment tool with three classification levels for TAU. The description of TAU is still insufficient in RCT studies conducted in primary care, which may affect the interpretation of results. In future research a detailed description of TAU is recommended.

Predicting substance use disorder treatment follow-ups and relapse across the continuum of care at a single behavioral health center

INTRODUCTION

Substance use disorder is often a chronic condition, and its treatment requires patient access to a continuum of care, including inpatient, residential, partial hospitalization, intensive outpatient, and outpatient programs. Ideally, patients complete treatment at the most suitable level for their immediate individual needs, then transition to the next appropriate level. In practice, however, attrition rates are high, as many patients discharge before successfully completing a treatment program or struggle to transition to follow-up care after program discharge. Previous studies analyzed up to two programs at a time in single-center datasets, meaning no studies have assessed patient attrition and follow-up behavior across all five levels of substance use treatment programs in parallel.

METHODS

To address this major gap, this retrospective study collected patient demographics, enrollment, discharge, and outcomes data across five substance use treatment levels at a large Midwestern psychiatric hospital from 2017 to 2019. Data analyses used descriptive statistics and regression analyses.

RESULTS

Analyses found several differences in treatment engagement based on patient-level variables. Inpatients were more likely to identify as Black or female compared to lower-acuity programs. Patients were less likely to step down in care if they were younger, Black, had Medicare coverage were discharging from inpatient treatment, or had specific behavioral health diagnoses. Patients were more likely to relapse if they were male or did not engage in follow-up SUD treatment.

CONCLUSIONS

Future studies should assess mechanisms by which these variables influence treatment access, develop programmatic interventions that encourage appropriate transitions between programs, and determine best practices for increasing access to treatment.

Relatives' experiences of brief admission in borderline personality disorder and self-harming behaviour

AIM

The aim of this study is to describe experiences of brief admission (BA) of people with borderline personality disorder and self-harming behaviour, from the perspective of their relatives.

DESIGN

A descriptive qualitative design was chosen.

METHODS

Twelve relatives of people with borderline personality disorder and self-harming behaviour who had access to BA were interviewed. Data were analysed with qualitative conventional content analysis.

RESULTS

One overarching category: Hope for the future and three categories occurred: Breathing space, Personal responsibility and Structure. BA created hope for the future and the relatives appreciated that BA is a freer and easily accessible form of care that enables help at an early stage, compared with usual care. When BA functions, the structure and pre-determined days of care give relatives a breathing space, and the uncertainty diminishes for the children, as the parent can still be present during inpatient care. The lack of places was described as a disadvantage of BA.

Experiences of familial stigma among individuals living with mental illnesses: A meta-synthesis of qualitative literature from high-income countries

WHAT IS KNOWN ON THE SUBJECT?: Mental illness stigma has been long acknowledged as a social problem that continues to persist and contribute to social exclusion of affected persons globally. Researchers have explored mental illness stigma in the general public and among health professionals, with little focus on stigma from family members and close relatives of persons with mental illnesses. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study appears to be the first meta-synthesis of familial mental illness stigma in high-income countries. Family members or close relatives of persons with mental illnesses may be perpetrators of stigma. That is, the family may enact stigma of mental illness against their relative to "save face" or by avoiding or narrowing their social contacts. Familial stigma is harmful due to the likely disaffection it brings within one's home environment. Familial mental stigma from the existing literature seems to be a by-product of public stigma and stigma by association WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Further research is necessary to look at the existence of familial mental illness stigma as well as available policies to reduce its impact on affected individuals in high-income countries. Researchers in high-income countries should endeavour to examine the relationship between familial, public and associative stigma to establish baseline metrics to inform future anti-stigma programs seeking to reduce familial mental illness stigma.

ABSTRACT

INTRODUCTION: Familial mental illness stigma is a pervasive issue but very subtle in high-income countries. Familial mental illness stigma implies persons living with mental illnesses are discriminated against by their family members or close relatives.

AIM/QUESTION

This meta-synthesis explored the experiences of familial stigma among individuals living with mental illnesses in high-income countries, focusing on empirical literature, to understand the breadth of current literature and ways to reduce this form of stigma.

METHOD

We conducted a meta-synthesis through a structured search of qualitative data from six electronic databases (Sociological Abstract, CINAHL, Medline, PsycINFO, Google Scholar and Embase). Inclusion criteria comprised: empirical primary research, primary technique for data collection is qualitative, studies published in a peer-reviewed journal in the English language between 2000 and 2020, studies reported on experiences of familial mental illness stigma, and studies conducted in high-income countries. The exclusion criteria were as follows: all grey literature, studies not written in English and non-peer-reviewed, studies not focused on familial mental illness stigma, quantitative peer-reviewed articles on the related concept and peer-reviewed articles on the related topic before the year 2000.

RESULTS

The study identified only 28 peer-reviewed articles on the topic within two decades. Concealment of familial stigma was found to be detrimental due to the potential for alienation within one's home environment. Disclosure and social contact within the family system were considered as critical interventions to provide some safety nets for individuals with mental illnesses.

DISCUSSION AND IMPLICATIONS FOR PRACTICE

The paucity of studies over the review period highlights the need for further attention to support optimal environments for persons living with mental illnesses. Families' understanding of the difficulties of mental illness stigma is vital to supporting the development of policies and interventions towards the avoidance of social exclusion within societies. Families should make concerted efforts to reduce stigma, and this includes within the family system. Education and training approaches around mental illness-related stigma should involve individuals with lived experience and their families, as well as service providers and the general public.

Job satisfaction and well-being among college-educated Bedouin Arab and ultra-Orthodox women in the Israeli workforce: the roles of individual, familial, communal, and organizational resources

Over the past two decades, increasing numbers of Bedouin Arab and ultra-Orthodox women have been integrated into the Israeli labor market. The integration of these women from traditional and minority communities into the general workforce involves significant coping on the practical, social, and emotional levels. This study examined factors that may facilitate the integration of college-educated Bedouin Arab and ultra-Orthodox women in the Israeli labor market. The sample included 304 ultra-Orthodox women and 105 Bedouin Arab women, who were employed in a variety of fields. Participants completed questionnaires designed to collect data on demographics, sense of personal coherence (SOC), family quality of life, sense of community coherence (SOCC), diversity climate, inclusive management, job satisfaction, and well-being. The ultra-Orthodox women reported higher levels of most of the resources; whereas the Bedouin Arab women reported higher levels only of inclusive management. Hierarchical regressions showed that income, SOC, and inclusive management each contributed significantly to job satisfaction. Levels of well-being were explained by SOC, family quality of life, and inclusive management. This study highlights the importance of individual, familial, and organizational resources for the integration into the workforce of female members of minority groups.

Analyzing structural and functional brain changes related to an integrative cognitive remediation program for schizophrenia: A randomized controlled trial

Cognitive remediation has been shown to improve cognition in schizophrenia, but little is known about the specific functional and structural brain changes related to the implementation of an integrative cognitive remediation program. This study analyzed the functional and structural brain changes identified after implementing an integrative cognitive remediation program, REHACOP, in schizophrenia. The program combined cognitive remediation, social cognitive training, and functional and social skills training. The sample included 59 patients that were assigned to either the REHACOP group or an active control group for 20 weeks. In addition to a clinical and neuropsychological assessment, T1-weighted, diffusion-weighted and functional magnetic resonance images were acquired during a resting-state and during a memory paradigm, both at baseline and follow-up. Voxel-based morphometry, tract-based spatial statistics, resting-state functional connectivity, and brain activation analyses during the memory paradigm were performed. Brain changes were assessed with a 2 × 2 repeated-measure analysis of covariance for group x time interaction. Intragroup paired t-tests were also carried out. Repeated-measure analyses revealed improvements in cognition and functional outcome, but no significant brain changes associated with the integrative cognitive remediation program. Intragroup analyses showed greater gray matter volume and cortical thickness in right temporal regions at post-treatment in the REHACOP group. The absence of significant brain-level results associated with cognitive remediation may be partly due to the small sample size, which limited the statistical power of the study. Therefore, further research is needed to clarify whether the temporal lobe may be a key area involved in cognitive improvements following cognitive remediation.

Obesity, antioxidants and negative symptom improvement in first-episode schizophrenia patients treated with risperidone

Negative symptoms remain a main therapeutic challenge in patients with schizophrenia (SZ). Obesity is associated with more severe negative symptoms after the first episode of psychosis. Oxidative stress caused by an impaired antioxidant defense system is involved in the pathophysiology of SZ. Yet, it is unclear regarding the role of obesity and antioxidants in negative symptom improvements in SZ. Therefore, this longitudinal study was designed to assess the impact of obesity on antioxidant defenses and negative symptom improvements in first-episode SZ patients. A total of 241 medication-naive and first-episode patients with SZ were treated with risperidone for 3 months. Outcome measures including symptoms, body weight, and total antioxidant status (TAS) levels were measured at baseline and the end of the third month. We found that after 12 weeks of treatment with risperidone, the body weight increased and clinical symptoms significantly improved. Baseline body mass index (BMI) was negatively correlated with negative symptom improvement after treatment and an increase in TAS was negatively associated with an increase in BMI only in the high BMI group. More importantly, the TAS × BMI interaction at baseline was an independent predictor of negative symptom improvement. Our longitudinal study indicates that the improvement in negative symptoms by risperidone was associated with baseline BMI and TAS levels in patients with SZ. Baseline BMI and TAS may be a predictor for negative improvement in SZ patients after risperidone treatment.

The development and validation of a questionnaire on parental involvement in the transition from kindergarten to primary school for children with developmental disabilities in China

BACKGROUND

At present, there is a lack of valid and reliable instruments that can measure parental involvement in the transition from kindergarten to primary school of children with developmental disabilities (DD) in China.

AIM

This study seeks to develop and validate the questionnaire on Parental Involvement in Transition from Kindergarten to Primary School (PITKPS) for children with DD in China.

METHODS

A total of 241 parents of children with DD participated in Study 1, and another 247 parents participated in Study 2. In study 1, we used item analysis and exploratory factor analysis to screen items and explore the factor structure of the PITKPS questionnaire. In study 2, three types of validity were examined: construct validity; convergent and discriminative validity; and criterion-related validity. Internal consistency was used to measure reliability.

RESULTS

The final version of the PITKPS questionnaire comprised 37 items that examined six factors. Confirmatory factor analysis supported the use of the six-factor model, and the results indicated that the questionnaire had good reliability and validity.

CONCLUSIONS

The PITKPS questionnaire can be used as a valid tool to assess the involvement of Chinese parents in the transition from kindergarten to primary school of children with DD.

Frequency of Modification of Pharmacological Treatment Is Equivalent for Virtual and In-Person Psychiatric Visits

Background:

During the coronavirus pandemic there was a rapid adoption of telehealth services in psychiatry, which now accounts for 40% of all visits. There is a dearth of information about the relative efficacy of virtual and in-person psychiatric evaluations.

Methods:

We examined the rate of medication changes during virtual and in-person visits as a proxy for the equivalence of clinical decision-making.

Results:

A total of 280 visits among 173 patients were evaluated. The majority of these visits were telehealth (224, 80%). There were 96 medication changes among the telehealth visits (42.8%) and 21 among the in-person visits (37.5%) (z = −1.4, p = 0.16).

Conclusion:

Clinicians were equally as likely to order a medication change if they saw their patient virtually or in person. This suggests that remote assessments yielded similar conclusions to in-person assessments.

Internet, studying and daily rhythm: health symptoms among higher education students

OBJECTIVES

Excessive Internet use is a health concern among higher education students leading to reduced academic performance and problems in everyday life. This study aimed to explore the relationship between health and problems of studying and daily rhythm caused by time spent online among students (n=3,050).

METHODS

A cross-sectional survey was carried out. The data were analyzed using descriptive and chi-square tests and logistic regression analyses.

RESULTS

Findings indicated that one fifth of students reported having problems of studying and daily rhythm caused by time spent online. Psychological health symptoms such as anxiety (p<0.001) and physical health symptoms including lower back problems (p<0.001) were associated with these problems. According to the logistic regression analyses, problems of studying and daily rhythm caused by time spent online and higher amount of Internet use by time were associated with psychological and physical health symptoms.

CONCLUSIONS

The findings suggest that problems of studying and daily rhythm and spending more time online are related to health symptoms among the students. The study's findings can be used from a prevention standpoint for early identification and further to identify the need for seeking professional treatment.

Treatment response with ketamine in chronic suicidality: An open label functional connectivity study

BACKGROUND

Ketamine has recently been proposed as a treatment option for suicidality. Whilst its mechanism of action has been explored at molecular levels, the effect on the brain at the organ level remains unclear. Here we investigate immediate post-treatment and prolonged large-scale resting-state neural network changes to elucidate the neuronal underpinnings associated with ketamine's therapeutic effects.

METHODS

Twenty-eight adults (aged 22-72 years) participated in the Oral Ketamine Trial On Suicidality, which is an open-label trial of weekly sub-anaesthetic doses of oral ketamine over 6 weeks. MRI was acquired at baseline, post-treatment, and follow-up. Functional connectivity changes at post-treatment and follow-up were examined using seed based and independent component analysis.

RESULTS

The seed-based connectivity analysis revealed significantly reduced connectivity at post-treatment from the right hippocampus to both right and left superior frontal gyrus, from the left anterior parahippocampus to right superior frontal gyrus, left superior frontal gyrus, right middle frontal gyrus, and left frontal operculum cortex. Compared with baseline, the ICA showed reduced anterior default mode network connectivities to bilateral posterior cingulate cortex, middle and anterior cingulate cortex, lingual gyrus, and cuneus and increased connectivity of the frontoparietal network to the right superior parietal lobule at post-treatment.

LIMITATIONS

Open label pilot study.

CONCLUSIONS

We have shown sub-anaesthetic doses of ketamine alters connectivity in networks which have been shown to be aberrantly hyper-connected in numerous psychiatric conditions. These neurocircuitry changes are supported by significant reductions in suicide ideation. Our results provide support for the use of ketamine as a treatment for suicidality.

Node of Ranvier remodeling in chronic psychosocial stress and anxiety

Differential expression of myelin-related genes and changes in myelin thickness have been demonstrated in mice after chronic psychosocial stress, a risk factor for anxiety disorders. To determine whether and how stress affects structural remodeling of nodes of Ranvier, another form of myelin plasticity, we developed a 3D reconstruction analysis of node morphology in C57BL/6NCrl and DBA/2NCrl mice. We identified strain-dependent effects of chronic social defeat stress on node morphology in the medial prefrontal cortex (mPFC) gray matter, including shortening of paranodes in C57BL/6NCrl stress-resilient and shortening of node gaps in DBA/2NCrl stress-susceptible mice compared to controls. Neuronal activity has been associated with changes in myelin thickness. To investigate whether neuronal activation is a mechanism influencing also node of Ranvier morphology, we used DREADDs to repeatedly activate the ventral hippocampus-to-mPFC pathway. We found reduced anxiety-like behavior and shortened paranodes specifically in stimulated, but not in the nearby non-stimulated axons. Altogether, our data demonstrate (1) nodal remodeling of the mPFC gray matter axons after chronic stress and (2) axon-specific regulation of paranodes in response to repeated neuronal activity in an anxiety-associated pathway. Nodal remodeling may thus contribute to aberrant circuit function associated with anxiety disorders.

Effects of memantine on mania-like phenotypes exhibited by Drosophila Shaker mutants

INTRODUCTION

Increased glutamate levels and electrolytic fluctuations have been observed in acutely manic patients. Despite some efficacy of the non-competitive NMDA receptor antagonist memantine (Mem), such as antidepressant-like and mood-stabilizer drugs in clinical studies, its specific mechanisms of action are still uncertain. The present study aims to better characterize the Drosophila melanogaster fly Shaker mutants (SH), as a translational model of manic episodes within bipolar disorder in humans, and to investigate the potential anti-manic properties of Mem.

METHODS AND RESULTS

Our findings showed typical behavioral abnormalities in SH, which mirrored with the overexpression of NMDAR-NR1 protein subunit, matched well to glutamate up-regulation. Such molecular features were associated to a significant reduction of SH brain volume in comparison to Wild Type strain flies (WT). Here we report on the ability of Mem treatment to ameliorate behavioral aberrations of SH (similar to that of Lithium), and its ability to reduce NMDAR-NR1 over-expression.

CONCLUSIONS

Our results show the involvement of the glutamatergic system in the SH, given the interaction between the Shaker channel and the NMDA receptor, suggesting this model as a promising tool for studying the neurobiology of bipolar disorders. Moreover, our results show Mem as a potential disease-modifying therapy, providing insight on new mechanisms of action.

Implicit identification with death detects and predicts short-term suicide risk among adolescents discharged from the emergency room

BACKGROUND

Implicit identification with death, measured by the Death-Suicide-Implicit Association Test (D/S-IAT), has been found to predict long-term suicide risk among adolescents. However, previous studies did not examine the predictive utility of D/S-IAT on short-term suicide risk trajectories among adolescents, especially during the critical period following discharge from the emergency room (ER) due to suicide behaviors.

OBJECTIVE

This study examined the ability of the D/S-IAT to discriminate and predict suicide risk trajectories during the month following initial suicide risk assessment, among adolescents recently discharged from the ER.

METHODS

One hundred and fifteen adolescents aged 9-18 years (77.4% female) were assessed at clinic intake. All participants completed D/S-IAT and self-report measures for suicide risk, depression, and anxiety during intake and 1-month follow-up.

RESULTS

The D/S-IAT distinguished and predicted participants with continued heightened suicide risk at follow-up, above and beyond depression, anxiety, and suicide risk level at intake.

CONCLUSIONS

Along with conventional measures, D/S-IAT may be utilized to predict short-term suicide risk during post-ER discharge.

Influencing factors of humanistic care ability and its dimensions among mental health workers during the COVID-19 pandemic: an online cross-sectional study

BACKGROUND

In psychiatric services, humanistic care ability significantly affects the quality of the therapeutic relationship and thus affects the therapeutic outcomes for patients. Mental health workers may be confronted with more obstacles in humanistic care during the COVID-19 pandemic wherethe authors aimed to explore the capacity level of humanistic care among mental health workers and its potential influencing factors.

METHOD(S)

An online cross-sectional survey was conducted among 262 mental health workers working in Chongqing, China, from December 2020 to January 2021. Data were collected by the Caring Ability Inventory (CAI), the Psychological Capital Questionnaire (PCQ-24), the Eysenck Personality Questionnaire-Revised, and the Short Scale for Chinese (EPQ-RSC). Multiple linear regression analysis was used to explore the influencing factors of humanistic care ability.

RESULTS

Mental health workers' humanistic care ability is at a low level, with a score of 186.47 ± 21.34. Psychological capital is positively associated with humanistic care ability (β[95%CI] = 0.41 [0.46-0.77], p < 0.001), and its two dimensions (cognition: β[95%CI] = 0.51 [0.30-0.47], p < 0.001; patience: β[95%CI] = 0.48 [0.17-0.28], p < 0.001). Psychoticism is negatively associated with humanistic care ability (β[95%CI] = -0.28 [-5.18 - -2.51], p < 0.001) and its three dimensions (cognition: β[95%CI] = -0.12 [-1.57 - -0.17], p < 0.05; courage: β[95%CI] = -0.17 [-1.7 - -0.32], p < 0.01; patience: β[95%CI] = -0.19 [-1.33 - -0.36], p < 0.01). Extroversion is positively associated with humanistic care ability (β[95%CI] = 0.19 [0.69-2.08], p < 0.001), and its two dimensions (cognition: β[95%CI] = 0.19 [0.32-1.05], p < 0.001; courage: β[95%CI] = 0.27 [0.5-1.23], p < 0.001). Neuroticism is negatively associated with humanistic care ability (β[95%CI] = -0.13[-1.37 - -0.19], p < 0.01) and its one dimension (courage: β[95%CI] = -0.25 [-0.98 - -0.35], p < 0.001).

CONCLUSION(S)

The research has found that the humanistic care ability of mental health workers is at a low level, and the psychological capital and personality traits are significant factors influencing the humanistic care ability and its sub-dimensions. Interventions to improve the psychological capital of mental health workers or to promote the change of personality traits they want are recommended, thereby to promote humanistic practice.

Longitudinal associations between traditional and cyberbullying victimization and depressive symptoms among young Chinese: A mediation analysis

BACKGROUND

The impacts of bullying victimization on psychological health are long-lasting. However, the longitudinal mediating processes of the association between being bullied (traditionally and in a cyber context) and depressive symptoms of Chinese youth remain underexplored, including across the sexes.

OBJECTIVE

This study investigated the longitudinal association between bullying victimization and depressive symptoms, including the mediating effects of physical health, healthy lifestyles, sleep quality, and academic achievements. Different pathways from traditional bullying and cyberbullying victimization regarding depressive symptoms were also explored, with a comparison across the sexes.

PARTICIPANTS AND SETTING

Data were obtained from the China Education Panel Survey, and ninth graders aged approximately 15 years constituted the baseline cohort.

METHODS

The baseline data and longitudinal data at two- and five-year follow-ups, respectively, were evaluated to estimate structural equation models.

RESULTS

Baseline traditional bullying and cyberbullying victimization significantly predicted subsequent depressive symptoms at both follow-ups (P < 0.001). Being bullied also predicted worse healthy lifestyles, poorer sleep quality, and lower academic achievements (P < 0.05), all significantly correlated with the development of depressive symptoms (P < 0.001) regarding both bullying victimizations. Physical health was the mediator of the traditional bullying victimization-depressive symptoms linkage (P < 0.05). Female victims have a relatively higher risk of depression versus male victims, with different mediating pathways from victimization to depressive symptoms.

CONCLUSIONS

Our findings strengthen the evidence of a longitudinal association between bullying victimization and depressive symptoms, provide new explanations for mechanisms of mediation, and highlight the importance of long-term comprehensive mental health interventions for victims of bullying.

A study of COVID anxiety, spiritual well-being and resilience levels in patients with cancer undergoing chemotherapy during the COVID-19 pandemic: a cross-sectional study in the south of Iran

BACKGROUND

Patients with cancer are at higher risk of contracting COVID-19 with poor prognosis. Therefore, the present study was conducted to investigate anxiety, spiritual well-being, and resilience levels in patients with cancer undergoing chemotherapy during the COVID-19 pandemic in the south of Fars Province, Iran.

METHODS

This is a descriptive study with a cross-sectional design conducted on the patients undergoing chemotherapy at Dr. Ali Shariati Hospital in Fasa from November 2021 to February 2022. Cancer patients undergoing chemotherapy were included in the study by census method. Out of 210 patients, 155 participated in the study. Data were collected electronically using the standard instruments of Ellison's Spiritual Well-being Scale, COVID-19 anxiety questionnaire, and Connor-Davidson resilience scale. The collected data were analyzed in SPSS 22 using descriptive statistics, Pearson correlation tests, T-test, ANOVA and multivariate linear regression at a level of significance of P < 0.05.

RESULTS

The participants' resilience mean score was 46.35 ± 26.51 and their spiritual well-being mean score was 69.58 ± 9.32. In addition, their COVID anxiety mean, score was found to be 16.85 ± 10.51. The results showed a significant direct correlation between the patients' spiritual well-being and resilience (r = 0.47, P < 0.001) and a significant inverse correlation between the patients' spiritual well-being and COVID-19-related anxiety (r = - 0.275, P < 0.001). In addition, there was a significant inverse correlation between the variables of resilience and COVID-19-related anxiety (r = - 0.637, P < 0.001). Based on multivariate linear regression, the most common predictors in resilience were age and history of infection with COVID-19, and in spiritual health and anxiety, was a history of infection with COVID-19.

CONCLUSION

Enhancement of spiritual well-being and resilience in patients should be an integral part of care as these qualities are valuable resources in fighting cancer and lowering patients' anxiety, especially during the COVID-19 pandemic.

Prevalence and associated factors of depressive and anxiety symptoms among healthcare workers in the post-pandemic era of COVID-19 at a tertiary hospital in Shenzhen, China: A cross-sectional study

Background

Healthcare workers were at high risk of psychological problems during the COVID-19 pandemic, but it remains not well-investigated in the post-pandemic era of COVID-19, with regular epidemic prevention and control embedded in burdened healthcare work. This study aimed to investigate the prevalence and potential risk factors of the symptoms of depression and anxiety among healthcare workers at a tertiary hospital in Shenzhen.

Method

Our cross-sectional study was conducted among 21- to 64-year-old healthcare workers in December 2021 at a tertiary hospital in Shenzhen, using a simple random sampling strategy. A wide range of socio-demographic characteristics, individual information, and psychological condition of the subjects were extracted. Healthcare workers' psychological conditions were tested with the Center for Epidemiologic Studies Depression (CESD-10), General Anxiety Disorder (GAD-7), Insomnia Severity Index (ISI), Work-Family Conflict Scale (WFCS), 10-item Connor-Davidson Resilience Scale (CD-RISC-10), and 17-item of Maslach's Burnout Inventory-Human Services Survey (MBI-HSS-17). Data were collected based on these questionnaires. Descriptive statistics were used to assess the difference between healthcare workers with depressive and anxiety symptoms among different groups. Hierarchical logistic regression analyses were conducted to investigate the association between focused variables and mental health outcomes.

Results

A total of 245 healthcare workers were enrolled. The proportion of depressive symptoms, anxiety symptoms and their co-occurrence were 34.7, 59.6, and 33.1%, respectively. Logistic regression showed that for the three outcomes, no history of receiving psychological help and self-rated good or higher health were protective factors, whereas more severe insomnia and job burnout were risk factors. Junior or lower job title and higher psychological resilience were related to a lower prevalence of depressive symptoms, while relatively longer working hours and larger work-family conflict were positively associated with the anxiety symptoms. Psychological resilience was inversely associated with the co-occurrence of depressive and anxiety symptoms.

Conclusions

Our study revealed a high proportion of psychological problems and proved that several similar factors which were significant during the pandemic were also associated with the symptoms of depression and anxiety among healthcare workers in the post-pandemic era of COVID-19. These results provide scientific evidence for psychological interventions for healthcare workers.

Exploring perceived impact of caregiving and coping strategies adopted by family caregivers of people with schizophrenia: a qualitative study in Enugu, South East Nigeria

Purpose

Schizophrenia, a chronic mental disorder, poses enormous threat to the individual, family and society. The advent of deinstitutionalization of the mentally ill transferred the burden of care to families especially close relatives. Few studies have described the families' subjective views in this context. Hence, this study aimed to explore impacts of caregiving and coping strategies for family caregivers of patients with schizophrenia in Enugu, South East Nigeria.

Design/methodology/approach

A descriptive qualitative design was employed, and 14 family caregivers of individuals with schizophrenia attending federal neuropsychiatric hospital Enugu were purposively selected. A semi-structured interview guide was used to generate information, and the transcribed data were content analyzed using a thematic approach.

Findings

Three major themes and 16 subthemes were derived to reflect the perceived impact of caregiving and coping strategies of family caregivers, which include burden of care (physical-self neglect, ill health, sleep deprivation; psychological-gross irritability, ruminations; social-stigmatization, social restrictions, diminished connections, reduced productivity); positive aspects (heightened understanding; empathetic attitude, strengthened ties) and adaptive resources (acceptance, optimism, social support, spiritual devotion).

Originality/value

Family caregivers of individuals with schizophrenia experience bio-psychosocial burden as a result of caregiving. Coping with challenges of caregiving can prevent distress and burnout. Hence, there is need for mental health professionals to recognize caregivers as person in need of emotional and practical support and care for the mentally ill in the context of a family-centered approach.

Coping strategies during pregnancy and their relationship with anxiety and depression

How individuals perceive and cope with stressful situations may determine their level of anxiety or depression. The identification of coping strategies (CS) in pregnancy could help prevent depression and anxiety (D&A), and their consequent effects on the health of the mother and the baby. A cross-sectional descriptive correlational study was conducted to identify the CS most commonly used by pregnant women in a Spanish population and to evaluate the association of these CS with D&A. A consecutive sample of 282 pregnant women over 18 years of age were recruited when attended midwife consultations and through snowball sampling between December 2019 and January 2021 in the Basque public health system. CS were measured using the RevisedPrenatal Coping Inventory (NuPCI) questionnaire, assigning the score to an avoidant, preparatory or spiritual scale. Cutoff points were established to categorize anxiety and depressive symptomatology, using the STAI-S and EPDS scales. Multivariate logistic regression models were constructed to analyze the association between CS and D&A. The results show that the higher the score on the avoidance subscale, the higher the likelihood of having an anxiety disorder (OR: 8.88  (95 percent Confidence Interval [CI] 4.26-20.1), and depressive symptoms (OR: 8.29 (95 percent CI 4.24-17.4). Multiparous women are more likely to have anxiety (OR: 3.41  (95 percent CI 1.58-7.5) or depressive symptomatology (OR: 4.1 (95 percent CI 2.04-8.53) during pregnancy. These results highlight the need to consider the evaluation of CS used during pregnancy to tailor the care provided, but further studies on the implementation and effectiveness of interventions are needed.

The Worldwide Utilization of Online Information about Dementia from 2004 to 2022: An Infodemiological Study of Google and Wikipedia

With the advent of Infodemics about health conditions, including dementia, nurses can engage in infodemiological studies to inform public health services and policies. This infodemiological study described the worldwide utilization of online information for dementia using Google Trends and Wikipedia page views. It found that the utilization of online information about dementia increased and will further increase using Google in succeeding years. Thus, the Internet is an increasingly important medium for dementia information in this age of misinformation and disinformation. Nurse informaticists can perform national infodemiological studies to inform and contextualize online dementia information. Likewise, public health, geriatric, and mental health nurses can collaborate with their communities and patients to address online disinformation and create culturally-appropriate information about dementia.

Addressing Suicide Risk: A Systematic Review of Motivational Interviewing Infused Interventions

Purpose: Brief interventions have been applied to the problem of suicide. This systematic review quantitatively and qualitatively examined the effectiveness of motivational interviewing (MI)-infused interventions. Methods: PRISMA guidelines were followed throughout. Results: 147 studies were initially identified, with nine meeting the final inclusion criteria. All studies blended MI with other interventions and were primarily located in triage settings. MI-infused interventions were not significantly stronger in lowering suicidal ideation or behavior. However, such interventions were significantly more likely to result in follow-up care post intervention. Discussion: MI-infused interventions are not linked to statistically significantly lowered risk for suicide ideation or behavior despite increased mental health-seeking behavior post intervention. However, MI-infused interventions may be valuable for suicidal behavior in hospital settings because they increase a key intervention target: following up with mental health care. The literature on MI-infused interventions for suicide is in an early stage with many unanswered questions.