Prevalence of mental disorders in South Asia: An umbrella review of systematic reviews and meta-analyses

Geraniol mitigates anxiety-like behaviors in rats by reducing oxidative stress, repairing impaired hippocampal neurotransmission, and normalizing brain cortical-EEG wave patterns after a single electric foot-shock exposure

Anxiety-like conditions can interfere with daily activities as the adaptive mechanism fails to cope with stress. These conditions are often linked with increased oxidative stress, and abrupt neurotransmission and electroencephalography (EEG) wave pattern. Geraniol, a monoterpenoid, has antioxidant and anti-inflammatory activities, as well as brain-calming effects. Therefore, in this study, geraniol was tested for the potential anxiolytic effects in a rat model of anxiety. The rats were exposed to an electric foot shock (1 mA for 1 s) to develop anxiety-like symptoms. Treatment was carried out using geraniol (10 and 30 mg/kg) and the standard diazepam drug. The behavior of the rats was analyzed using the open field test, light-dark test, and social interaction test. Afterward, the rats were decapitated to collect samples for neurochemical and biochemical analyses. The cortical-EEG wave pattern was also obtained. The study revealed that the electric foot shock induced anxiety-like symptoms, increased oxidative stress, and altered hippocampal neurotransmitter levels. The power of low-beta and high-beta was amplified with the increased coupling of delta-beta waves in anxiety group. However, the treatment with geraniol and diazepam normalized cortical-EEG wave pattern and hippocampal serotonin and catecholamines profile which was also reflected by reduced anxious behavior and normalized antioxidant levels. The study reports an anxiolytic potential of geraniol, which can be further explored in future.

Study of the immune disorder and metabolic dysregulation underlying mental abnormalities caused by exposure to narrow confined spaces

Prolonged confinement in cramped spaces can lead to derangements in brain function/structure, yet the underlying mechanisms remain unclear. To investigate, we subjected mice to restraint stress to simulate long-term narrow and enclosed space confinement, assessing their mental state through behavioral tests. Stressed mice showed reduced center travel and dwell time in the Open Field Test and increased immobility in the Tail Suspension Test. We measured lower hippocampal brain-derived neurotrophic factor levels and cortical monoamine neurotransmitters (5-HT and NE) in the stressed group. Further examination of the body's immune levels and serum metabolism revealed immune dysregulation and metabolic imbalance in the stressed group. The results of the metabolic network regulation analysis indicate that the targets affected by these differential metabolites are involved in several metabolic pathways that the metabolites themselves participate in, such as the "long-term depression" and "purine metabolism" pathways. Additionally, these targets are also associated with numerous immune-related pathways, such as the TNF, NF-κB, and IL-17 signaling pathways, and these findings were validated using GEO dataset analysis. Molecular docking results suggest that differential metabolites may regulate specific immune factors such as TNF-α, IL-1β, and IL-6, and these results were confirmed in experiments. Our research findings suggest that long-term exposure to confined and narrow spaces can lead to the development of psychopathologies, possibly mediated by immune system dysregulation and metabolic disruption.

Risk and protective factors for severe mental disorders in Asia

Among 369 diseases and injuries, the years lived with disability (YLDs) and disability-adjusted life-years (DALYs) rates for severe mental illnesses (SMIs) are within the top 20 %. Research on risk and protective factors for SMIs is critically important, as acting on modifiable factors may reduce their incidence or postpone their onset, while early detection of new cases enables prompt treatment and improves prognosis. However, as most of the studies on these factors are from Western countries, the findings are not generalizable across ethnic groups. This led us to conduct a systematic review of the risk and protective factors for SMIs identified in Asian studies. There were common factors in Asian and Western studies and unique factors in Asian studies. In-depth knowledge of these factors could help reduce disability, and the economic and emotional burden of SMIs. We hope that this review will inform future research and policy-making on mental health in Asian countries.

Editorial: Equity/inequality, diversity and inclusion in child and adolescent mental health - a perspective from the South Asian region

Over 1.8 billion people, about a quarter of the world's population live in the seven countries of South Asia: Afghanistan, Bangladesh, Bhutan, India, Nepal, Pakistan, and Sri Lanka. The population is characterized by a significant demographic youth bulge, with over 40% under the age of 18. This young population poses challenges related to ensuring their well-being and development. Issues such as poverty, undernutrition, lack of early stimulation, limited access to quality education and health care, and gender disparities persist in large parts of South Asia, affecting the lives of many children and adolescents. The promotion of child and adolescent mental health remains a challenge. Accumulating evidence suggests that early interventions can provide long-term health and socioeconomic benefits by prevention of the onset of mental health problems and their development into chronic disorders. This needs to be coupled with specialist services that can cater to the needs of children with greater needs, and support the community and schools-based non-specialist led services. Addressing child and adolescent mental health in South Asia presents a window of opportunity, because this regional youth bulge can contribute significantly to the global economy of the future.

Psychological Problems in the Context of Political Violence in Afghan Children

PURPOSE OF REVIEW

This review provides an overview of recent literature examining psychological problems in the context of political violence among Afghan children.

RECENT FINDINGS

Using recent literature (2018-2023) we identified: 1) heightened levels of psychological problems experienced by children in Afghanistan; 2) the factors associated with these psychological problems, including loss of family and community members, poverty, continuous risk of injury and death, gender, substance use, war, daily stressors, and poor access to education; 3) psychological problems have potentially worsened since the 2021 political changes; 4) conflict and poverty have resulted in violence against children being a serious issue; 5) emerging psychological interventions have been adapted to Afghan contexts; and 6) there is a desperate need for psychological assistance and further research in the region. All children in Afghanistan have experienced conflict and political violence. While children are not responsible for this conflict, it has impacted their mental health. Further research is needed to examine the development and evaluation of interventions.

The bidirectional relationship between depression and dissociation: A longitudinal investigation

Depression is a major public health concern. Recent studies suggest that dissociative symptoms are associated with depressive symptoms, and the concept of "dissociative depression" has been proposed. Yet, only cross-sectional evidence is available in the literature. This study examined the bidirectional relationship between dissociative and depressive symptoms through the use of screening tools in a sample of Chinese young adults (N = 340) over four months. Baseline dissociative symptoms predicted depressive symptoms at follow-up (β = .262, p < .001), but not the other way around (β = .065, p = .121). Among different dissociative symptom clusters, identity dissociation was the only significant predictor of subsequent depressive symptoms (β = .177, p < .001). Furthermore, identity dissociation symptoms partially mediated the relationship between childhood trauma and subsequent depressive symptoms. This preliminary study is the first to test the bidirectional relationship between dissociative and depressive symptoms. The results highlight the importance of taking dissociative symptoms into account when preventing and treating depressive symptoms, especially among childhood trauma survivors.

Childhood adversities and psychotic symptoms among high school students in China: The role of dissociation

Adverse childhood experiences (ACEs) are well-established risk factors for psychotic symptoms. This study replicated the relationship between ACEs and positive symptoms of psychosis in the Asian context and explored the moderating effect of dissociation. We analyzed data from 1439 high school students in China who completed validated measures of ACEs, positive symptoms of psychosis, and dissociative symptoms. The positive relationship between ACEs and psychotic symptoms was confirmed in our sample (r =0.244, p <0.001). Among different ACEs, childhood emotional neglect (β =0.139, p <0.001) and emotional abuse (β =0.125, p <0.001) had the strongest relationship with psychotic symptoms. Dissociative symptoms were also found to be a statistically significant moderator. We provide cross-cultural evidence for the relationship between ACEs and psychotic symptoms. Dissociative symptoms may exacerbate such effects. These results highlight the importance of child protection to prevent psychotic symptoms. Individuals with higher levels of dissociation may be at higher risk of developing psychotic symptoms when exposed to adversities. A trauma-informed approach to addressing psychotic symptoms in the community is recommended.

Maternal health outcomes associated with ambient air pollution: An umbrella review of systematic reviews and meta-analyses

A growing body of literature demonstrated an association between exposure to ambient air pollution and maternal health outcomes with mixed findings. The objective of this umbrella review was to systematically summarize the global evidence on the effects of air pollutants on maternal health outcomes. We adopted the Joanna Briggs Institute (JBI) methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting standards for this umbrella review. We conducted a comprehensive search across six major electronic databases and other sources to identify relevant systematic reviews and meta-analyses (SRMAs) published from the inception of these databases up to June 30, 2023. Out of 2399 records, 20 citations matched all pre-determined eligibility criteria that include SRMAs focusing on exposure to air pollution and its impact on maternal health, reported quantitative measures or summary effects, and published in peer-reviewed journals in the English language. The risk of bias of included SRMAs was evaluated based on the JBI critical appraisal checklist. All SRMAs reported significant positive associations between ambient air pollution and several maternal health outcomes. Specifically, particulate matter (PM), SO2, and NO demonstrated positive associations with gestational diabetes mellitus (GDM). Moreover, PM and NO2 showed a consistent positive relationship with hypertensive disorder of pregnancy (HDP) and preeclampsia (PE). Although limited, available evidence highlighted a positive correlation between PM and gestational hypertension (GH) and spontaneous abortion (SAB). Only one meta-analysis reported the effects of air pollution on maternal postpartum depression (PPD) where only PM10 showed a significant positive relationship. Limited studies were identified from low- and middle-income countries (LMICs), suggesting evidence gap from the global south. This review necessitates further research on underrepresented regions and communities to strengthen evidence on this critical issue. Lastly, interdisciplinary policymaking and multilevel interventions are needed to alleviate ambient air pollution and associated maternal health disparities.

Electroconvulsive therapy in South Asia: Past, present, and future

The practice of electroconvulsive therapy (ECT) varies both between and within countries. We aimed to review historical and current trends in ECT practices, perceptions, and legislations in South Asia, a region with a high burden of mental illness and suicide. We searched MEDLINE (PubMed) and Google Scholar databases for relevant literature on ECT from each country. Additionally, a team of country-specific investigators performed supplemental searches and contacted key country contacts for relevant information. Relevant data were abstracted under the following headings: ECT practices, perceptions, and legislations. Knowledge gaps and research priorities were synthesized. Modified bitemporal ECT, delivered using brief pulse devices, was most commonly offered across institutions. Schizophrenia, not affective illness, was the most common indication. Electroencephalographic monitoring of seizures was rarely practiced. Thiopentone or propofol was preferred for anesthetic induction, while the favored muscle relaxant was succinylcholine. In India and Sri Lanka, perceptions about ECT were largely favorable; not so in Pakistan and Nepal. Only India and Pakistan had laws that governed any aspect of ECT practice; ECT practice guidelines were available only in India. There is a lack of research on efficacy, ECT in special populations, continuation ECT practices, and interventions to improve ECT-related perceptions. Most regional institutions offered modified brief-pulse ECT, and schizophrenia was the most common indication. Knowledge of and attitude towards ECT varied between countries. There is a need to develop a regional ECT consortium to facilitate uniform training, advocacy efforts, and the development of regional practice guidelines.

Self-management of chronic, non-communicable diseases in South Asian settings: A systematic mixed-studies review

Self-management is crucial in mitigating the impacts of a growing non-communicable disease (NCD) burden, particularly in Low and Middle-Income countries. What influences self-management in these settings, however, is poorly understood. We aimed to identify the determinants of self-management in the high NCD region of South Asia and explore how they influence self-management. A systematic mixed-studies review was conducted. Key electronic databases [MEDLINE (1946+), Embase (1974+), PsycInfo (1967+) and CINAHL (EBSCOhost)] in March 2022 (and updated in April 2023) were searched for studies on the self-management of four high-burden NCD groups: cardiovascular diseases, type 2 diabetes, chronic respiratory diseases and depression. Study characteristics and quantitative data were extracted using a structured template, and qualitative information was extracted using NVivo. Quality appraisal was done using the Mixed Methods Assessment Tool (MMAT). Quantitative findings were organised using the Commission on Social Determinants of Health (CSDH) framework and synthesised narratively, supported by effect direction plots. Qualitative findings were thematically synthesised. Both were integrated in a mixed synthesis. Forty-four studies (26 quantitative, 16 qualitative and 2 mixed-methods studies) were included, the majority of which were conducted in urban settings and among individuals with diabetes and cardiovascular diseases. Higher age, education, and income (structural determinants), health-related knowledge, social support and self-efficacy (psychosocial determinants), longer illness duration and physical comorbidity (biologic determinants), and the affordability of medicine (health-system determinants) were key determinants of self-management. Qualitative themes highlighted the role of financial adversity and the social and physical environment in shaping self-management.A complex interplay of structural and intermediary social determinants shapes self-management in South Asian settings. Multi-component, whole-systems approaches could boost self-management in these settings. Key areas include empowerment and education of patients and wider community, design and delivery of bespoke behavioural interventions and a stronger emphasis on supporting self-management in healthcare settings.

A short report on a preliminary interventional study to evaluate play-mediated interaction skills in caregivers of children with autism spectrum disorder from Sri Lanka

LAY ABSTRACT

Most children with autism spectrum disorder live in low- and middle-income countries. Most of them do not have access to timely and culturally acceptable interventions. Research from high-income countries and low- and middle-income countries, such as Sri Lanka, show that parent-mediated intervention programmes improve functional outcomes, highlighting the importance of parents as partners. We undertook a preliminary study to evaluate how play-based parent coaching will enhance the parent interaction skills to promote social-emotional, cognitive and language skills in children with autism spectrum disorder aged 2-4 years. We evaluated how parents acquire interaction skills to engage with children using a caregiver skills assessment checklist adapted from freely accessible resources. Before and after training, all parent-child dyads participated in a 10-min video-recorded play session with a set of toys of their choice. Over the course of 2 weeks, all parents spent 2 h/day playing and interacting with the child to harness the desired skills. The results showed that the parental training had a positive effect on all 30 caregivers in gaining skills, with a significant improvement in all three domains with the highest impact on skills for social-emotional development. Overall, parents reported high levels of satisfaction on the training. The significant improvement in parent interaction skills was promising. However, further studies to look at the sustainability of the skills and the impact on children's overall development need to be looked into using larger and more generalised studies.

Substance abuse among mothers in Taiwan: Investigating its prevalence and testing the trauma model

Substance abuse is a serious problem in our society. In particular, household or parental substance abuse could lead to adverse childhood experiences for the affected children. However, little is known about the prevalence of substance abuse among parents, especially in Asian societies. Moreover, although the trauma model of addiction has significant implications for the prevention and treatment of substance abuse, most evidence comes from Western samples. To address these knowledge gaps, we examined the prevalence of substance abuse in a sample of mothers in Taiwan and tested the trauma model of substance abuse. A total of 867 Taiwanese mothers completed standardized self-report assessments in 2023. The screening results indicated that the 12-month prevalence of drug abuse and alcohol abuse was 12.3% and 7.3%, respectively; 15.5% had either or both drug and alcohol abuse. Most types of trauma exposure were associated with drug abuse severity, while interpersonal stress and dissociative symptoms were associated with alcohol abuse severity, even after controlling for a variety of demographic and health variables as well as general psychopathology (i.e., depressive symptoms). The relatively high prevalence of substance abuse among Taiwanese mothers in our sample is concerning, particularly when compared to the rates reported in other Asian samples. We also provide preliminary cross-cultural evidence supporting the self-medication theory and the trauma model of substance abuse in the Asian context. We discuss the potential importance of addressing trauma and stress to prevent substance abuse and call for follow-up studies.

Prevalence of mental disorders in South Asia: A systematic review of reviews

Mental disorders are increasing in South Asia (SA), but their epidemiological burden is under-researched. We carried out a systematic umbrella review to estimate the prevalence of mental disorders and intentional self-harm in the region. Multiple databases were searched and systematic reviews reporting the prevalence of at least one mental disorder from countries in SA were included. Review data were narratively synthesised; primary studies of common mental disorders (CMDs) among adults were identified from a selected subset of reviews and pooled. We included 124 reviews. The majority (n = 65) reported on mood disorders, followed by anxiety disorders (n = 45). High prevalence of mental disorders and intentional self-harm was found in general adult and vulnerable populations. Two reviews met our pre-defined criteria for identifying primary studies of CMDs. Meta-analysis of 25 primary studies showed a pooled prevalence of 16.0% (95% CI = 11.0-22.0%, I 2 = 99.9%) for depression, 12.0% (5.0-21.0%, I 2 = 99.9%) for anxiety, and 14.0% (10.0-19.0, I 2 = 99.9%) for both among the general adult population; pooled estimates varied by country and assessment tool used. Overall, reviews suggest high prevalence for mental disorders in SA, but evidence is limited on conditions other than CMDs.

Burden of mental disorders by gender in Pakistan: analysis of Global Burden of Disease Study data for 1990-2019

AIMS AND METHOD

We aimed to examine the burden of mental disorders in Pakistan over the past three decades. We used the crude data of disability-adjusted life-years (DALYs) obtained from the Global Burden of Disease Study database (1990-2019) to represent burden. Data were retrieved on 26 January 2021. Data for adults of reproductive age (aged 15-49 years) were analysed to discuss and interpret the disease burden. An analysis was conducted on total DALYs separately for the genders for ten mental disorders reported in Pakistan.

RESULTS

DALYs increased drastically with the onset of reproductive age. Depressive disorder was the most reported mental disorder, contributing 3.13% (95% CI 2.25-4.24) of total DALYs, and varied significantly between genders: females 3.89% (95% CI 2.73-5.29) versus males 2.37% (95% CI 1.62-3.25).

CLINICAL IMPLICATIONS

A nationwide high-quality epidemiological surveillance system should be implemented to monitor mental disorders and offer culturally appropriate preventive services.

The impacts of the COVID-19 pandemic on indirect costs of mental illness and behavioral disorders in Poland

Introduction

In various research, the estimation of the disease's economic burden has been taken into consideration. But given the fact that different settings will have distinguished consequences, determining the economic burden of COVID-19 in the studied environment is of great importance. As a result, this study aimed to show the change in indirect costs of mental health problems due to the COVID-19 pandemic in Poland.

Methods and Results

Indirect costs related to mental health problems were analyzed from the perspective of the Social Insurance Institution in Poland. In 2021, they amounted to about 285.8 billion PLN (Polish currency) [61.1 billion EUR (European currency)], up 6% from the previous year. A large increase in spending on disability benefits was observed for 2019-2021 (+14.7%). Disease groups generating the highest expenditures in the structure of total expenditures on incapacity benefits in 2021 in Poland were mental health problems (16.7% of total expenditures). Expenditures on disability benefits related to mental health problems incurred by Social Security in 2021 amounted to about 7.42 billion PLN [1.6 billion EUR] and were 19.4% higher than in 2019 (before the pandemic). In the 2012-2019 period, there was a significant decrease in expenses related to inpatient rehabilitation (41.3%), while in 2020-2021, these expenses decreased several times as the epidemiological situation related to the COVID pandemic reduced access to such services.

Discussion

This is the first study on the economic burden of COVID-19 indirect costs in Poland. Calculating the economic impact is crucial, particularly when there is a large disease outbreak and countries are severely constrained by financial resources. Doing so could aid in the development of effective social security policies. As shown in this study, the indirect costs of absenteeism expenses due to mental health problems increased significantly during the COVID-19 pandemic. It is necessary to take all possible measures, both in the field of primary and secondary prevention, to prevent disability and exclusion from the labor market of people affected by mental health problems, which is justified by epidemiological data and financial data on the expenses incurred by Social Security for social insurance benefits.

Risk factors, lab parameters, angiographic characteristics and outcomes of coronary artery disease in young South Asian patients: a systematic review

This systematic review provides a qualitative summary of the risk factors, angiographic characteristics, treatment, and complications of young South Asians with coronary artery disease (CAD). PubMed, Embase, and Google Scholar were searched to identify research articles published between 1 January 2010 and 13 November 2022. Studies in patients aged 18 to 45 years that were conducted in South Asian countries, were published in the English language, and included information on patients' clinical profiles and at least two risk factors for young CAD were included in the review. Smoking, dyslipidemia, high body mass index, increased high-sensitivity C-reactive protein, and hyperhomocysteinemia were observed in high proportions in young patients with CAD. Single-vessel disease was more common than multi-vessel disease in young CAD. The complications of CAD such as arrhythmias, cardiogenic shock, and heart failure were also commonly observed in young patients. Large-scale health promotion activities that curb modifiable risk factors such as smoking, obesity, and a sedentary lifestyle should be conducted in South Asian countries.

Effectiveness and implementation of psychological interventions for depression in people with non-communicable diseases in South Asia: Systematic review and meta-analysis

We evaluate the effectiveness of psychological interventions for depression in people with NCDs in South Asia and explore the individual, organizational, and policy-level barriers and facilitators for the implementation and scaling up of these interventions. Eight databases (and local web pages) were searched in May 2022. We conducted random effects models to evaluate the pooled effect of psychological interventions on depression in people with NCDs. We extracted the individual, organizational, and policy level barriers and facilitators. We found five randomized control trials, nine qualitative studies, and 35 policy documents that fitted the inclusion criteria. The pooled standardized mean difference in depression comparing psychological interventions with usual care was -2.31 (95% CI, -4.16 to -0.45; p = .015, I2 = 96.0%). We found barriers and facilitators to intervention delivery, mental health appears in the policy agenda in Bangladesh and Pakistan. However, there is a lack of policies relating to training in mental health for NCD health providers and a lack of integration of mental health care with NCD care. All of the psychological interventions reported to be effective in treating depression in this population. There are important delivery and policy barriers to the implementation and scaling up of psychological interventions for people with NCDs.

Essential substance use disorder medications in Asia Pacific countries: An observational study

AIM

To analyze national lists of essential medicines (NLEM) of Asia Pacific countries for inclusion of substance use disorder (SUD) medications.

METHODS

An observational study was conducted using the most recent versions of NLEM of all 55 Asia Pacific countries till April, 2022. SUD medication details were extracted and analyzed.

RESULTS

NLEM of included nations contained a median 2 medications for long term SUD management. Sixteen countries had atleast one medication for opioid use disorder and 13 for alcohol use disorder. Four countries had atleast one medication for opioid, alcohol, and tobacco use disorders.

CONCLUSION

NLEM expansion is needed considering public health burden of SUDs.

A scoping review of community-based mental health intervention for children and adolescents in South Asia

Children and adolescents in South Asia are exposed to significant mental health risks. Yet, policy to prevent or treat youth mental health problems in this context is underdeveloped, and services are difficult to access. Community-based mental health treatment may offer a potential solution, by increasing resource capacity in deprived settings. However, little is known about the current community-based mental health provision for South Asian youth. A scoping review was conducted across six scientific databases and hand searching of reference lists to identify relevant studies. Study selection and data extraction were performed by three independent reviewers using predefined criteria, an adapted version of the template for intervention description and replication checklist and the Cochrane Risk of Bias Tool. The search identified 19 relevant studies published from January 2000 to March 2020. Studies most frequently addressed PTSD and autism, were conducted in India and Sri Lanka, used education-based intervention and were based in urban school settings. Community-based mental health provision for the South Asian youth is in its infancy, but holds promise for providing essential resources to treat or prevent mental health disorder. New insights on approaches are discussed, which are valuable for South Asian settings, primarily task-shifting and stigma reduction, with implications for policy, practice and research.

Homelessness and health-related outcomes: an umbrella review of observational studies and randomized controlled trials

BACKGROUND

Homelessness has been associated with multiple detrimental health outcomes across observational studies. However, relatively few randomized controlled trials (RCTs) have been conducted on people who experience homelessness (PEH). Thus, this umbrella review ranked the credibility of evidence derived from systematic reviews (SRs) and meta-analyses (MAs) of observational studies investigating the associations between homelessness and any health outcome as well as RCTs targeting health needs in this population.

METHODS

Several databases were systematically searched from inception through April 28, 2021. Any SR and/or MA reporting quantitative data and providing a control group were eligible for inclusion. The credibility of the evidence derived from observational studies was appraised by considering the significance level of the association and the largest study, the degree of heterogeneity, the presence of small-study effects as well as excess significance bias. The credibility of evidence was then ranked in five classes. For SRs and/or MAs of RCTs, we considered the level of significance and whether the prediction interval crossed the null. The AMSTAR-2 and AMSTAR-plus instruments were adopted to further assess the methodological quality of SRs and/or MAs. The Newcastle-Ottawa Scale (NOS) was employed to further appraise the methodological quality of prospective cohort studies only; a sensitivity analysis limited to higher quality studies was conducted.

RESULTS

Out of 1549 references, 8 MAs and 2 SRs were included. Among those considering observational studies, 23 unique associations were appraised. Twelve of them were statistically significant at the p≤0.005 level. Included cases had worst health-related outcomes than controls, but only two associations reached a priori-defined criteria for convincing (class I) evidence namely hospitalization due to any cause among PEH diagnosed with HIV infection, and the occurrence of falls within the past year among PEH. According to the AMSTAR-2 instrument, the methodological quality of all included SRs and/or MAs was "critically low." Interventional studies were scant.

CONCLUSION

While homelessness has been repeatedly associated with detrimental health outcomes, only two associations met the criteria for convincing evidence. Furthermore, few RCTs were appraised by SRs and/or MAs. Our umbrella review also highlights the need to standardize definitions of homelessness to be incorporated by forthcoming studies to improve the external validity of the findings in this vulnerable population.

Methodological approaches for assessing certainty of the evidence in umbrella reviews: A scoping review

Introduction

The number of umbrella reviews (URs) that compiled systematic reviews and meta-analysis (SR-MAs) has increased dramatically over recent years. No formal guidance for assessing the certainty of evidence in URs of meta-analyses exists nowadays. URs of non-interventional studies help establish evidence linking exposure to certain health outcomes in a population. This study aims to identify and describe the methodological approaches for assessing the certainty of the evidence in published URs of non-interventions.

Methods

We searched from 3 databases including PubMed, Embase, and The Cochrane Library from May 2010 to September 2021. We included URs that included SR-MAs of studies with non-interventions. Two independent reviewers screened and extracted data. We compared URs characteristics stratified by publication year, journal ranking, journal impact factor using Chi-square test.

Results

Ninety-nine URs have been included. Most were SR-MAs of observational studies evaluating association of non-modifiable risk factors with some outcomes. Only half (56.6%) of the included URs assessed the certainty of the evidence. The most frequently used criteria is credibility assessment (80.4%), followed by GRADE approach (14.3%). URs published in journals with higher journal impact factor assessed certainty of evidence than URs published in lower impact group (77.1 versus 37.2% respectively, p < 0.05). However, criteria for credibility assessment used in four of the seven URs that were published in top ranking journals were slightly varied.

Conclusions

Half of URs of MAs of non-interventional studies have assessed the certainty of the evidence, in which criteria for credibility assessment was the commonly used method. Guidance and standards are required to ensure the methodological rigor and consistency of certainty of evidence assessment for URs.

Screening tools for common mental disorders in older adults in South Asia: a systematic scoping review

OBJECTIVES

Common mental disorders (CMDs), particularly depression, are major contributors to the global mental health burden. South Asia, while diverse, has cultural, social, and economic challenges, which are common across the region, not least an aging population. This creates an imperative to better understand how CMD affects older people in this context, which relies on valid and culturally appropriate screening and research tools. This review aims to scope the availability of CMD screening tools for older people in South Asia. As a secondary aim, this review will summarize the use of these tools in epidemiology, and the extent to which they have been validated or adapted for this population.

DESIGN

A scoping review was performed, following PRISMA guidelines. The search strategy was developed iteratively in Medline and translated to Embase, PsychInfo, Scopus, and Web of Science. Data were extracted from papers in which a tool was used to identify CMD in a South Asian older population (50+), including validation, adaptation, and use in epidemiology. Validation studies meeting the criteria were critically appraised using the Quality Assessment of Diagnostic Accuracy Studies - version 2 (QUADAS-2) tool.

RESULTS

Of the 4694 papers identified, 176 met the selection criteria at full-text screening as relevant examples of diagnostic or screening tool use. There were 15 tool validation studies, which were critically appraised. Of these, 10 were appropriate to evaluate as diagnostic tests. All of these tools assessed for depression. Geriatric Depression Scale (GDS)-based tools were predominant with variable diagnostic accuracy across different settings. Methodological issues were substantial based on the QUADAS-2 criteria. In the epidemiological studies identified (n = 160), depression alone was assessed for 82% of the studies. Tools lacking cultural validation were commonly used (43%).

CONCLUSIONS

This review identifies a number of current research gaps including a need for culturally relevant validation studies, and attention to other CMDs such as anxiety.

Mental disorder symptoms during the COVID-19 pandemic in Latin America - a systematic review and meta-analysis

AIMS

There is a lack of evidence related to the prevalence of mental health symptoms as well as their heterogeneities during the coronavirus disease 2019 (COVID-19) pandemic in Latin America, a large area spanning the equator. The current study aims to provide meta-analytical evidence on mental health symptoms during COVID-19 among frontline healthcare workers, general healthcare workers, the general population and university students in Latin America.

METHODS

Bibliographical databases, such as PubMed, Embase, Web of Science, PsycINFO and medRxiv, were systematically searched to identify pertinent studies up to August 13, 2021. Two coders performed the screening using predefined eligibility criteria. Studies were assigned quality scores using the Mixed Methods Appraisal Tool. The double data extraction method was used to minimise data entry errors.

RESULTS

A total of 62 studies with 196 950 participants in Latin America were identified. The pooled prevalence of anxiety, depression, distress and insomnia was 35%, 35%, 32% and 35%, respectively. There was a higher prevalence of mental health symptoms in South America compared to Central America (36% v. 28%, p < 0.001), in countries speaking Portuguese (40%) v. Spanish (30%). The pooled prevalence of mental health symptoms in the general population, general healthcare workers, frontline healthcare workers and students in Latin America was 37%, 34%, 33% and 45%, respectively.

CONCLUSIONS

The high yet heterogenous level of prevalence of mental health symptoms emphasises the need for appropriate identification of psychological interventions in Latin America.

Post-traumatic stress disorder and mental health assessment of seafarers working on ocean-going vessels during the COVID-19 pandemic

Background

There are increasing concerns about mental health consequences of the COVID-19 pandemic among seafarers. This study aims to assess the effects of the current global health pandemic on life satisfaction and adverse psychological outcomes among seafarers.

Methods

In this cross-sectional study, 470 multinational seafarers working on board ships of two international shipping companies were assessed. Mental health outcomes were assessed by the general anxiety disorder (GAD-7) questionnaire, post-traumatic stress disorder (PTSD-8) questionnaire, and patient health questionnaire (PHQ-9) depressive severity score. Multivariate logistic regression was used to determine the association of demographic and work-related variables with mental health outcomes.

Results

Overall, 439 out of 470 invited seafarers with a mean age of 34.5 (SD: 8.05) years participated in this study (participation rate: 93.4%). The prevalence of anxiety, depressive, and post-traumatic stress symptoms was 12.4, 14.1, and 37.3%, respectively. In the multivariate model, the current vessel’s signing duration was directly associated with the odds of depressive and intrusion symptoms. Moreover, the duration of work per week was inversely associated with hyper-vigilance and avoidance. Also, non-officers, compared to officers, experienced significantly lower anxiety and depressive symptoms, hyper-vigilance, and avoidance.

Conclusion

The present study revealed a high prevalence of mental health problems among seafarers during the COVID-19 pandemic. We recommend that more evidence is generated regarding psychosocial health issues for this vulnerable occupation.

A Systematic Review and Meta-Analysis of Symptoms of Anxiety, Depression, and Insomnia in Spain in the COVID-19 Crisis

BACKGROUND

General population, frontline healthcare workers (HCWs), and adult students in Spain are at risk of anxiety, depression, and insomnia symptoms during the COVID-19 crisis. A meta-analysis of the individual studies on these symptoms would provide systematic evidence to aid policymakers and researchers in focusing on prevalence, risk, and best interventions.

OBJECTIVE

This paper aims to be the first meta-analysis and systematic review to calculate the prevalence of anxiety, depression, and insomnia symptoms in Spain's adult population (general population, frontline healthcare workers (HCWs), and adult students) during the Covid-19 epidemic.

METHOD

Random-effect meta-analysis was used to estimate the prevalence of anxiety, depression, and insomnia.

RESULTS

The meta-analysis includes 28 studies with 38 individual samples in Spain. The pooled prevalence of anxiety symptoms in 22 studies comprising a sample population of 82,024 was 20% (95% CI: 15-25%), that of depression symptoms in 22 articles with a total sample comprising 82,890 individuals was 22% (95% CI: 18-28%), and that of insomnia symptoms in three articles with a sample population of 745 was 57% (95% CI: 48-66%.

CONCLUSIONS

The accumulative evidence reveals that adults in Spain suffered higher prevalence rates of mental symptoms during the COVID-19 crisis, with a significantly higher rate relative to other countries such as China. Our synthesis also reveals a relative lack of studies on frontline and general HCWs in Spain.

Depression and generalised anxiety and associated factors among adults in Bhutan: Results of national cross-sectional survey in 2019

The study aimed to evaluate the prevalence and correlates of major depressive disorder (MDD) and generalised anxiety disorder (GAD) in people 15 years in Bhutan in 2019. Cross-sectional data were analyzed from 5575 people (15-69 years) who participated in the 2019 Bhutan STEPS survey. The proportion of mild MDD was 12.3% and moderate to severe MDD 2.0%, and the prevalence of mild GAD was 7.4% and moderate to severe GAD 1.7%. In adjusted ordinal logistic regression analysis, alcohol family problem (Adjusted Odds Ratio-AOR: 2.23, 95% Confidence Interval-CI: 1.35-3.68), suicidal behaviour (AOR: 7.69, 95% CI: 3.69-6.01), passive smoking (AOR: 7.69, 95% CI: 3.69-6.01), heart attack, angina or stroke (AOR: 3.32, 95% CI: 2.13-5.79), and current tobacco use (AOR: 1.74, 95% CI: 1.38-2.19) were positively, and middle-aged (30-44 years) (AOR: 0.77, 95% CI: 0.60-1.00) and male sex (AOR: 0.47, 95% CI: 0.38-0.58) were negatively associated with mild and moderate-severe MDD. Medium wealth status (AOR: 1.82, 95% CI: 1.18, 2.82), alcohol family problem (AOR: 2.36, 95% CI: 1.29-4.31), suicidal behaviour (AOR: 6.11, 95% CI: 2.75-13.59), and heart attack, angina or stroke (AOR: 3.18, 95% CI: 1.61-6.29), were positively, and male sex (AOR: 0.59, 95% CI: 0.44-0.758) was negatively associated with mild and moderate-severe GAD. A low prevalence of mood disorders was found. Factors associated with MDD and/or GAD included sociodemographic factors (female sex, middle wealth status), psychosocial and environmental stressors (alcohol family problem, suicidal behaviour, passive smoking, heart attack, angina or stroke), and health risk behaviour (current tobacco use), which can be targeted in public health interventions.

A narrative review of the biopsychosocial and health characteristics of Asian Indians in the United States: Clinical and research implications for neuropsychological functioning

Objective: The prevailing scientific literature aggregates Asians living in America into one omnibus category and thus can problematically result in a subpar and at times inaccurate understanding of health, social and cultural factors necessary for competent and informed medical care. Method: A literature search was conducted by cultural experts familiar with Asian Indian culture with a focus on immigrants from this community living in the US. Database using search engines was sought in the following domains: immigration patterns, prevalence for key medical and neurological conditions commonly associated with cognitive dysfunction, psychiatric/psychological needs in the community, some preliminary neuropsychological testing considerations while working with this community, and treatment considerations that could affect adherence and efficacy of outcomes. Articles were selected from 2000 to the most recent date, with emphasis on compiling information from review papers and meta-analysis from the past decade. Conclusions: Asian Indians living in the US are distinct from the larger Asian American community. Immigration trends underscore that Asian Indians have a bimodal distribution of wealth. Regarding medical conditions, a key and highly concerning finding is the higher prevalence of cardiovascular risk factors, especially in young males. The lack of non-existent cognitive data in this community is glaring and should serve as an impetus for conducting high-priority research in this community. Preliminary neuropsychological testing considerations are discussed from a practical perspective with emphasis on multilingualism and region of origin. Finally, treatment considerations include understanding attitudes and beliefs regarding traditional medicine.

Prevalence of Mental Disorders in the WHO Eastern Mediterranean Region: A Systematic Review and Meta-Analysis

Objectives: To synthesize the prevalence of mental and substance use disorders in countries of the Eastern Mediterranean Region (EMR) of the World Health Organization. Methods: The literature search was conducted across several databases in two phases. First, we searched for systematic reviews and/or meta-analyses published before 2014, reporting prevalence estimates for mental disorders in the EMR. Then, we identified new primary cross-sectional or longitudinal studies published between 2014 and 2020. Studies were included if they had a sample size of ≥ 450 and were conducted among the general adult population. Current, period and lifetime prevalence estimates for each disorder were pooled using random-effects meta-analyses, and subgroup analyses and meta-regressions were conducted. Findings: Prevalence estimates were extracted from 54 cross-sectional studies across 15 countries within the EMR. Pooled analyses of current, period and lifetime prevalence showed the highest prevalence for depression (14.8%, 95% confidence interval, CI: 10.7-20.1%), followed by generalized anxiety disorder (GAD) (10.4%, 95% CI: 7.1-14.7%), post-traumatic stress disorder (7.2%, 95% CI: 2.9-16.6%), substance use (4.0%, 95% CI: 3.1-5.2%), obsessive compulsive disorder (2.8%, 95% CI: 1.6-4.9%), phobic disorders (1.8%, 95% CI: 1.1-2.8%), panic disorders (1.1%, 95% CI: 0.6-2.2%), bipolar disorders (0.7%, 95% CI: 0.3-1.6%), and psychosis (0.5%, 95% CI: 0.3-0.9%). Populations exposed to adverse events had higher prevalence of mental disorders than the general population. Period and lifetime prevalence showed little difference across mental disorders. More pronounced differences in prevalence were seen for depression and GAD, specifically between current and lifetime prevalence (depression: current prevalence 20.5% (95% CI: 14.9-27.4%), vs. lifetime prevalence: 4.2% (95%CI: 1.8-9.6%); GAD: current prevalence 10.3% (95% CI: 6.1-17.0), vs. lifetime prevalence: 4.5% (95% CI: 2.4-8.3%). Differences between current and lifetime prevalence of mental disorders may be due to the use of different screening instruments and thresholds being applied. Conclusion: The prevalence of mental and substance use disorders in the EMR is high. Despite substantial inter-survey heterogeneity, our estimates align with previous global and regional data on mental disorders. Our meta-review provides new evidence on the burden of mental health problems in the EMR. Systematic Review Registration: PROSPERO, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020187388.

Psychometric Analysis for fear of COVID-19 Scale (FCV-19S) and its association with depression in patients with diabetes: A cross sectional study from a Tertiary Care Centre in Karachi, Pakistan

BACKGROUND AND AIMS

To assess the psychometric properties of the Fear of COVID-19 (FCV-19S) scale and to determine its associated factors among the Pakistani patients with diabetes.

METHODS

This observational study was conducted in 24-h helpline service, a department of Baqai Institute of Diabetology and Endocrinology (BIDE). Study duration was from August to September 2020. The target population was registered adult patients with type 2 diabetes aged >16 years. Baseline demographic details were obtained from hospital management system of BIDE. Forward-backward translation method was used to translate the existing Fear scale (FCV-19S). Symptoms of depressive disorder were assessed through Patient Health Questionnaire (PHQ9).

RESULTS

Total of 380 participants with mean age 51.93 ± 12.03 years contributed in the study. Three factors loading and item correlation of fear COVID-19 explained 96% of total variance having unidimensional Cronbach's alpha of 0.881. All demographic indicators that showed significance in univariate model were included in multivariate model. Females had more fear for COVID-19 compared to males (OR = 1.73, 95% CI (1.15-2.6)), whereas current smokers had also showed 4 times more fear than non-smokers (OR = 4.19, 95% CI (1.18-14.83). Depression assessed by PHQ9 showed maximum fear of COVID-19 in participants with moderate depression.

CONCLUSION

FCV-19S had adequate psychometric properties for assessing effects of pandemic in people with diabetes attending tertiary care center.

Prevalence of anxiety and depression in South Asia during COVID-19: A systematic review and meta-analysis

INTRODUCTION

The COVID-19 pandemic has impacted biopsychosocial health and wellbeing globally. Pre-pandemic studies suggest a high prevalence of common mental disorders, including anxiety and depression in South Asian countries, which may aggravate during this pandemic. This systematic meta-analytic review was conducted to estimate the pooled prevalence of anxiety and depression in South Asian countries during the COVID-19 pandemic.

METHOD

We systematically searched for cross-sectional studies on eight major bibliographic databases and additional sources up to October 12, 2020, that reported the prevalence of anxiety or depression in any of the eight South Asian countries. A random-effects model was used to calculate the pooled proportion of anxiety and depression.

RESULTS

A total of 35 studies representing 41,402 participants were included in this review. The pooled prevalence of anxiety in 31 studies with a pooled sample of 28,877 was 41.3% (95% confidence interval [CI]: 34.7-48.1, I 2 = 99.18%). Moreover, the pooled prevalence of depression was 34.1% (95% CI: 28.9-39.4, I 2 = 99%) among 37,437 participants in 28 studies. Among the South Asian countries, India had a higher number of studies, whereas Bangladesh and Pakistan had a higher pooled prevalence of anxiety and depression. No studies were identified from Afghanistan, Bhutan, and Maldives. Studies in this review had high heterogeneity, high publication bias confirmed by Egger's test, and varying prevalence rates across sub-groups.

CONCLUSION

South Asian countries have high prevalence rates of anxiety and depression, suggesting a heavy psychosocial burden during this pandemic. Clinical and public mental health interventions should be prioritized alongside improving the social determinants of mental health in these countries. Lastly, a low number of studies with high heterogeneity requires further research exploring the psychosocial epidemiology during COVID-19, which may inform better mental health policymaking and practice in South Asia.

Asia and COVID-19; The need to continue mental health care to prevent the spread of suicide in the elderly

• There is serious concern about the probable increase in the prevalence of suicide due to the global pandemic of COVID-19 in the elderly in Asia. • Mental health care programs should be of higher quality at the same time as trying to control the existing pandemic.

COVID-19 quarantine: Post-traumatic stress symptomatology among Lebanese citizens

BACKGROUND

In the light of the global spread of the novel Coronavirus known as COVID-19 and in the absence of an approved treatment and vaccination, Lebanon has taken national measures, among which was home quarantine of the general public in an attempt to flatten the epidemic curve and avoid flooding the health care system.

AIM

This study aimed at evaluating the prevalence of post-traumatic stress symptomatology (PTSS) during the times of COVID-19 quarantine among Lebanese citizens.

METHOD

This quantitative cross-sectional study recruited 950 civilians and is aimed at measuring the prevalence of PTSS among the Lebanese citizens at an interval of 2 weeks and 1 month of COVID-19 quarantine.

RESULTS

The results have shown that quarantine in Lebanon has started to give rise to Post-traumatic Stress Disorder symptomatology during the second week which was worsened in the fourth week of COVID-19 quarantine.

CONCLUSION

COVID-19 quarantine has influenced the psychology of Lebanese citizens and might have persistent effects after the end of this phase which is recommended to be explored.

Trends in the prevalence and treatment of bipolar affective disorder in South Korea

This study aimed to assess trends in the prevalence of bipolar disorder (BP). We also analyzed patterns of medical use by Korean patients with BP, defined as those diagnosed with the International Classification of Diseases (ICD) F31 code who used at least one inpatient or outpatient medical service in a year. We analyzed yearly BP prevalence and inpatient hospitalization periods per year from 2008 to 2017 using National Health Insurance Service (NHIS) claims data for 52.43 million people. Overall, the BP prevalence was 0.2 %, as of 2017, with consistently higher rates in women. The BP prevalence was highest among those aged ≥60 years (0.27 %) and was lowest among those aged 0-29 years (0.12 %), as of 2017. The average annual rate of increase among those aged 0-29 years and ≥60 years was 8.48 % and 7.39 %, respectively, which exceeded the overall mean of 6.58 %. The average annual rate of increase in BP prevalence for those aged 30-59 years was 4.67 %. The proportion of inpatients who were hospitalized for longer than 180 days decreased, while the proportion of those hospitalized for 0-14 days increased. The estimated BP prevalence was higher when using the most recent NHIS data rather than in the surveys. These prevalence rates can be used to support the development of future mental health policies.

Epidemiology of mental health problems in COVID-19: a review

The novel coronavirus disease 2019 (COVID-19) has become a pandemic affecting health and wellbeing globally. In addition to the physical health, economic, and social implications, the psychological impacts of this pandemic are increasingly being reported in the scientific literature. This narrative review reflected on scholarly articles on the epidemiology of mental health problems in COVID-19. The current literature suggests that people affected by COVID-19 may have a high burden of mental health problems, including depression, anxiety disorders, stress, panic attack, irrational anger, impulsivity, somatization disorder, sleep disorders, emotional disturbance, posttraumatic stress symptoms, and suicidal behavior. Moreover, several factors associated with mental health problems in COVID-19 are found, which include age, gender, marital status, education, occupation, income, place of living, close contact with people with COVID-19, comorbid physical and mental health problems, exposure to COVID-19 related news and social media, coping styles, stigma, psychosocial support, health communication, confidence in health services, personal protective measures, risk of contracting COVID-19, and perceived likelihood of survival. Furthermore, the epidemiological distribution of mental health problems and associated factors were heterogeneous among the general public, COVID-19 patients, and healthcare providers. The current evidence suggests that a psychiatric epidemic is cooccurring with the COVID-19 pandemic, which necessitates the attention of the global health community. Future epidemiological studies should emphasize on psychopathological variations and temporality of mental health problems in different populations. Nonetheless, multipronged interventions should be developed and adopted to address the existing psychosocial challenges and promote mental health amid the COVID-19 pandemic.

Mental health outcomes of quarantine and isolation for infection prevention: a systematic umbrella review of the global evidence

OBJECTIVES

Transmission of infectious diseases is often prevented by quarantine and isolation of the populations at risk. These approaches restrict the mobility, social interactions, and daily activities of the affected individuals. In recent coronavirus disease 2019 (COVID-19) pandemic, quarantine and isolation are being adopted in many contexts, which necessitates an evaluation of global evidence on how such measures impact the mental health outcomes among populations. This umbrella review aimed to synthesize the available evidence on mental health outcomes of quarantine and isolation for preventing infectious diseases.

METHODS

We searched nine major databases and additional sources and included articles if they were systematically conducted reviews, published as peer-reviewed journal articles, and reported mental health outcomes of quarantine or isolation in any population.

RESULTS

Among 1,364 citations, only eight reviews met our criteria. Most of the primary studies in those reviews were conducted in high-income nations and in hospital settings. These articles reported a high burden of mental health problems among patients, informal caregivers, and healthcare providers who experienced quarantine or isolation. Prevalent mental health problems among the affected individuals include depression, anxiety, mood disorders, psychological distress, posttraumatic stress disorder, insomnia, fear, stigmatization, low self-esteem, lack of self-control, and other adverse mental health outcomes.

CONCLUSIONS

This umbrella review found severe mental health problems among individuals and populations who have undergone quarantine and isolation in different contexts. This evidence necessitates multipronged interventions including policy measures for strengthening mental health services globally and promoting psychosocial wellbeing among high-risk populations.

Current status of global research on novel coronavirus disease (COVID-19): a bibliometric analysis and knowledge mapping

Background: Novel coronavirus disease (COVID-19) is a major global health concern due to its pathogenicity and widespread distribution around the world. Despite a growing interest, little is known about the current state of research on COVID-19. This bibliometric study evaluated the contemporary scientific literature to assess the evolution of knowledge on COVID-19, identify the leading research stakeholders, and analyze the conceptual areas of knowledge development in this domain. Methods: Bibliometric data on COVID-19 related studies published until April 1, 2020, were retrieved from Web of Science core collection. Further, a quantitative evaluation and visualizations of knowledge areas in COVID-19 research were created by statistical and text-mining approaches using bibliometric tools and R software. Results: A total of 422 citations were retained in this study, including journal articles, reviews, letters, and other publications. The mean number of authors and citations per document was 3.91 and 2.47, respectively. Also, the top ten articles, authors, and journals were identified based on the frequencies of citations and publications. Networks of contributing authors, institutions, and countries were visualized in maps, which highlight discrete developments in research collaborations. Major areas identified through evaluating keywords and text data included genetic, epidemiological, zoonotic, and other biological topics associated with COVID-19. Conclusions: Current status of COVID-19 research shows early development in different areas of knowledge. More research should be conducted in less-explored areas, including socioeconomic determinants and impacts of COVID-19. Also, global research collaboration should be encouraged for strengthening evidence-based decision-making preventing and addressing the COVID-19 pandemic and aftermath.