Psychometric properties of the List of Threatening Experiences--LTE and its association with psychosocial factors and mental disorders according to different scoring methods

Effectiveness of early and intensive intervention on suicide prevention: CARS programme

The aim of this study was to evaluate the outcomes of the Programme for Management of Suicidal Behaviour and Suicide Prevention (CARS). Individuals treated in the emergency department of University Hospital Marqués de Valdecilla for suicidal thoughts or attempts (N = 401) between 1-March-2016 and 31-December-2018 were considered. No randomization by patients or groups was performed. Student's t-test, chi-square and repeated measure analysis of variance were used. Kaplan-Meier survival function and Cox proportional hazard regression models were employed to estimate the risks of relapse. Outcome of those who voluntary enrol CARS were compared with treatment as usual (TAU) at 6- and 12-months follow-up. The results indicate a significant reduction and delayed occurrence of suicidal behaviour over a 12-month follow-up period with the CARS programme compared to TAU, along with a decreased frequency of hospital admissions. CARS programme demonstrates a substantial impact, significantly reducing the risk of recurrent suicidal behaviour by 35.5 % and the risk of repeated suicidal attempts by 47.2 % at the 12-month follow-up. The programme exhibits a dual protective effect, diminishing suicidal behaviour and fostering improved long-term outcomes. In conclusion, CARS effectively reduced suicidal behaviour recurrence, achieving significant decreases in suicidal thoughts, plans and attempts.

Posttraumatic stress disorder and its associated factors among people living in Dabat district, northwest Ethiopia

Background

The conflict between the Ethiopian government and the Tigray People's Liberation Front (TPLF) in the Dabat district of Ethiopia has led to significant civilian casualties, instances of rape, sexual abuse, and property theft. These traumatic events contribute to the development of post-traumatic stress disorder (PTSD) among local residents. However, there is currently no available data on the prevalence of PTSD and its associated factors in this region. This study seeks to fill this gap by assessing PTSD prevalence and identifying related factors among residents of the war-affected Dabat district in northwest Ethiopia.

Method

A community-based correctional study was conducted in the Woken and China kebeles of Dabat district, northwest Ethiopia, spanning from July 13 to September 19, 2023. A total of 410 participants were selected using systematic random sampling, making a 100% response rate. The study utilized an interviewer-administered questionnaire, which included the Post-Traumatic Stress Disorder Checklist (PCL-5) to assess PTSD. The research investigated the association between PTSD and various demographic and psychosocial characteristics using both bivariate and multivariable binary logistic regression analyses. Statistical significance was set at a P-value of 0.05.

Results

The majority of participants in the study were male (62%) with a mean age of 33 ( ± 1.67) years. The overall prevalence of PTSD was 30.7% (95% CI: 26.6-35.10). Multivariable logistic regression analysis identified several factors significantly associated with PTSD: symptoms of depression (AOR=3.5; 95% CI: 1.13-6.89), age between 45 and 67 years (AOR=1.68; 95% CI: 1.04-5.78), experiencing stressful life events (AOR=1.63; 95% CI: 1.05-7.86), experiencing sexual abuse or rape (AOR=1.53; 95% CI: 1.07-6.75), chewing khat (AOR=1.48; 95% CI: 1.08-4.56), being female (AOR=1.43; 95% CI: 1.13-3.67), and having an income of 34.6 USD (AOR=1.28; 95% CI: 1.07-4.67).

Conclusion and recommendation

This study reported that the prevalence of PTSD was high. As a result, the study suggested that governments and other stakeholders should be involved in implementing efficient interventions and quick measures to mitigate the effects of war on mental health following the conflict. The government and nongovernmental organizations were also advised by these studies to continue providing humanitarian assistance, which should include access to food, clean water, clothing, shelter, and education. This study also suggested that people living in conflict zones should be legally protected from rape, sexual abuse, arson, detention without cause, and kidnapping.

What set some young adults apart during the COVID-19 pandemic? Mental health trajectories, risk and protective factors in an Australian longitudinal study

OBJECTIVE

Evidence suggests that young adults (aged 18-34) were disproportionately impacted by the COVID-19 pandemic, but little is known about their longer-term mental health changes beyond the early pandemic period. This article investigates heterogeneous trajectories of mental health among Australian young adults across 2 years of the pandemic and identifies a broad range of associated risk and protective factors.

METHOD

Young adults (N = 653, Mage = 27.8 years) from the longitudinal Alone Together Study were surveyed biannually between July 2020 and June 2022. Measures assessed anxiety (7-item Generalised Anxiety Disorder scale) and depression (9-item Patient Health Questionnaire) symptoms at Waves 1-4, as well as demographic, psychological, adversity and COVID-19 factors at baseline.

RESULTS

Four and three distinct trajectories of anxiety and depressive symptoms, respectively, were identified through growth mixture modelling. The proportion of participants in each anxiety trajectory were Asymptomatic (45.9%), Mild Stable (17.9%), Moderate-Severe Stable (31.1%) and Initially Severe/Recovering (5.1%). For depression, Mild Stable (58.3%), Moderate-Severe Stable (30.5%) and Reactive/Recovering (11.2%). Baseline factors associated with severe symptom trajectories included a lifetime mental health disorder, pre-pandemic stressful events, identifying as LGBTQIA+ and/or female, and experiencing one or more infection-control measures. Higher household income was protective.

CONCLUSION

Most young adults demonstrated stable trajectories of low or high symptoms during the pandemic, with smaller groups showing initially severe or reactive symptoms followed by marked improvements over time. Vulnerable subgroups (gender- or sexuality-diverse, those with prior adversity or pre-existing mental ill-health) may face ongoing impacts and require targeted psychosocial supports to assist their mental health recovery post-COVID-19 and in the event of future crises.

Characterizing Trends in the Use of Food Donations and Other Food-Related Community-Based Social Assistance Programs in a Cohort of New Food Bank Users in Quebec, Canada

Objective: To characterize 12-month trends in the use of food donations and other food-related community-based social assistance programs (CB-SAPs) during the first year following the enrollment of new food bank (FB) users in Quebec, Canada. Methods: A cohort of 1,001 newly registered FB-users in Quebec from the Pathways Study were followed-up during 12-month following baseline assessment. Outcomes were monthly use of food donations and other food-related CB-SAPs. Main predictors were alternative food source utilization (AFSU) profiles: 1) exclusive-FB-users; 2) FB+fruit/vegetable-market-users; and 3) Multiple/diverse-AFS-users. Covariates included sociodemographic characteristics, health status, and major life events. We fit Bayesian hierarchical mixed-effect models, accounting for spatial clustering, temporal correlation, and censoring. Results: We observed an overall downward trend of food donation use among study completers (n = 745). Each AFSU profile had a distinctive monthly trend of food donation use, but probabilities of use across the three profiles overlapped, between 44% and 55%. The use of other food-related CB-SAPs was low and not correlated with AFSU profiles. Conclusion: De novo FB-users use food donations in different ways over time according to specific contextual AFSU profiles.

Exposure to stress-full life events and help-seeking behaviors among reproductive-age women in Northwest Ethiopia: Community-based cross-sectional study

BACKGROUND

Stressful life events are a significant public health issue worldwide. Despite its mental, psychological, and social problems, important questions about the prevalence and risk factors remained unanswered. Therefore, this study aimed to show major life events and help-seeking behaviors among women in the reproductive-age group.

METHODS

A community-based cross-sectional study design was conducted using a multistage cluster sampling technique to get a total of 845 study participants from March 20 to April 29, 2021. Exposure to stressful life events and help-seeking behavior was collected using Women's Exposure to the Stressful Life Events Test, and General Help-Seeking Questionnaire (GHQ) respectively. Data were cleaned, coded, and entered into EPI-Info version 3.1 and analyzed using SPSS version 20.

RESULTS

The prevalence of stressful life events and help-seeking behaviors was 47.9 % and 38.7 % respectively. Reproductive-age women with poor social support (AOR = 2.392, 95 % CI: 1.422, 4.026), moderate social support (AOR = 1.861, 95 % CI: 1.341, 2.583), husband alcohol users (AOR = 1.496, 95 % CI: 1.027, 2.178), husband chat users (AOR = 2.962, 95 % CI: 1.140, 7.696), and having ever suicidal attempt (AOR = 8.702, CI: 1.719, 44.049), were positively associated with stressful life events.

CONCLUSION

Nearly half of reproductive-age women had stressful life events. Thus, it is important to give serious attention to addressing those identified factors to increase public awareness, especially among husbands, their families, and elected authorities.

Exploring the Characteristics of Men Aged 55+ Who Use Mental Health Community Care and Support Services: A Secondary Analysis of the Adult Psychiatric Morbidity Study in England

ObjectivesThe aim of this study is to understand the demographic and situational characteristics of men over 55 who have used a community support service. Method: Hierarchical multivariable logistic regression was conducted using anonymised data from the Adult Psychiatric Morbidity Study 2014. Results: Need factors such as having a common mental disorder (CMD), poor general health and having counselling/therapy were the most relevant to use of a community support service. It was more common for older men (85+), single men, and those who reported experiencing several traumatic life events to have used a community support service. Discussion: The results are critically discussed by considering the roles of gender, ageing, and social support, which might influence the use of community support services. There is a need for more awareness of categories such as age and previous service use, and how they might influence community support help seeking.

The Effect of Internet-Based Cognitive Behavioral Therapy on Major Depressive Disorder: Randomized Controlled Trial

BACKGROUND

Many people living with major depressive disorder (MDD) in China do not receive treatment owing to a lack of mental health services, along with significant stigma toward mental illness. Internet-based cognitive behavioral therapy (ICBT) has been proposed to increase access to mental health care for people with MDD.

OBJECTIVE

The aims of this study were to (1) evaluate the efficacy of ICBT for depressive symptoms in patients with MDD; (2) evaluate the effect of ICBT on anxiety symptoms, nonspecific psychological distress, general self-efficacy, depression stigma, social function, and health-related quality of life (HRQoL); and (3) explore the acceptability of and satisfaction with the ICBT program among participants.

METHODS

Patients with MDD were enrolled and randomized to the ICBT group or the waiting-list control (WLC) group. The ICBT group received ICBT delivered through a WeChat mini-program with general support by nonspecialists. Participants in the 2 groups were self-evaluated online at baseline and posttreatment for changes in the primary outcome (ie, depressive symptoms) and secondary outcomes (ie, anxiety symptoms, nonspecific psychological distress, general self-efficacy, depression stigma, social functional impairment, and HRQoL). Changes in outcomes were measured by changes in overall scores on respective scales, and response and remission rates were calculated based on depressive symptoms. The acceptability of and satisfaction with the ICBT program were measured by treatment adherence and participants' feelings (ie, modules seriously completed, perceived benefit, and satisfaction).

RESULTS

We included 40 patients who were randomly assigned to the ICBT group and 44 who were assigned to the WLC group. Compared with the WLC group, the ICBT group had fewer depressive symptoms, fewer anxiety symptoms, less nonspecific psychological distress, and greater general self-efficacy. Moreover, the ICBT group had higher response (18/31, 58%) and remission rates (17/31, 55%). The adherence rate in the ICBT group was 78% (31/40), and the majority of participants who completed all ICBT modules were satisfied with the ICBT program.

CONCLUSIONS

ICBT demonstrated greater improvements in depressive symptoms, anxiety symptoms, nonspecific psychological distress, and general self-efficacy among selected patients with MDD in comparison with the findings in waiting-list controls. The ICBT program in this study had good acceptability and satisfaction among participants.

TRIAL REGISTRATION

Chinese Clinical Trial Registry (ChiCTR2100046425); https://tinyurl.com/bdcrj4zv.

Effect of antenatal depression on ANC service utilization in northwest Ethiopia

Maternal morbidity and mortality remain high among women who did not attend antenatal care (ANC). Antenatal care is one of the interventions given to pregnant women to detect existed problems or problems that can develop during pregnancy, which harm the health of pregnant women and fetuses. In Ethiopia, however, there is limited evidence that revealed the effect of antenatal depression on ANC service utilization. Hence, this study aimed to see the effect of antenatal depression on ANC visits among women in urban northwest Ethiopia. A population-based, prospective cohort study was done from June 2019 to March 2020. The Edinburgh postnatal depression scale was administered to 970 women in the second and third trimesters of pregnancy to screen for antenatal depression. Additional data were collected on ANC visits, the mother's socio-demographic, obstetric, clinical, psychosocial, and behavioral factors. A logistic regression model was used to adjust confounders and determine associations between antenatal depression and inadequate ANC visits. The cumulative incidence of inadequate ANC visits was 62.58% (95% CI: 59.43, 65.63). The cumulative incidence of inadequate ANC visits among depressed pregnant women was 75% as compared to 56% in non-depressed. The incidence of inadequate ANC visits in the exposed group due to antenatal depression was 25.33%. After multivariable analysis, antenatal depression at the second and third trimesters of pregnancy remained a potential predictor of inadequate ANC visits (AOR = 1.96: (95% CI 1.22, 3.16)). In addition, antenatal depression, long travel time for ANC visits (AOR = 1.83 (95% CI 1.166, 2.870)), and late initiation of ANC visits (AOR = 2.20 (95% CI 1.393, 3.471)) were the predictors of inadequate ANC visits as compared to their counterpart. This study suggested that antenatal depression affects ANC visits in Ethiopian urban settings. Therefore, early detecting and treating depression symptoms during the antenatal period reduced significantly the impacts of depression on the health of the mother and fetus.

Risk factors associated with higher scores in internalizing and externalizing behaviors in Chilean preschoolers

Early detection of behavioral disorders in children is necessary for intervention. Available data show a high prevalence of child and adolescent psychiatric disorders in Chile (22.5%), but behavioral problems in younger children have not been evaluated. This work assesses behavioral disorders in preschoolers and their association with sociodemographic variables of the family and the child. The data was collected during the impact assessment of the Biopsychosocial Development Support Program "Chile Crece Contigo", using a multistage and representative random sample of 1377 preschoolers, aged between 30 and 48 months, who attended public health services. Homes were visited to apply a questionnaire and the Child Behavior Checklist (CBCL, 1.5-5 years). Results: Multivariable regression model for total raw scores shows that child's age, the number of chronic diseases in the child, and history of exposure to mother's alcohol consumption in pregnancy, remain significant when adjusted for all variables included (R2 of 17.8% and η2 of .19 (95% CI: .14-.22)). In externalizing and internalizing explanatory models, child's chronic diseases and a higher score of authoritarian beliefs about parenting show the two largest effect sizes. These results add to the evidence of urgent problems in preschool mental health.

Psychometric analysis of the Psychiatric Diagnostic Screening Questionnaire (PDSQ) and determinants of psychopathology in two outpatient clinics in Navarre (Spain)

BACKGROUND

The self-report Psychiatric Diagnostic Screening Questionnaire PDSQ is designed to screen Axis I psychiatric disorders. We aim to determine its psychometric properties in Spanish outpatients and assess its relationship with two interviews (for psychopathology and for personality disorders) and clinical/demographic variables.

METHODOLOGY

We administered the study questionnaire, the Mini International Neuropsychiatric Interview Plus (MINI-Plus), the Standardised Assessment of Personality Abbreviated Scale (SAPAS), and the List of Threatening Experiences Questionnaire (LTE-Q) to 375 patients at two public outpatient centres. Reliability of the study questionnaire was evaluated (Cronbach's alpha, ?) and known-group validity measured by comparing groups based on demographic and clinical variables (binary logistic regression analysis) and MINI-Plus diagnoses (Mann-Whitney U). The diagnostic accuracy of the study questionnaire score was analysed taking the MINI-Plus diagnoses as the gold standard (ROC analysis).

RESULTS

Internal consistency was adequate across all PDSQ scales (? >0.7; mean ?=0.85). Known-group comparisons were satisfactory. Female and male patients showed higher prevalence of internalizing and externalizing diagnoses, respectively. Younger age, more life events and limitations, higher SAPAS scores, and lower economic levels were linked to a greater number of PDSQ diagnoses. Inter-group differences were found for all PDSQ scales based on the corresponding MINI-Plus diagnoses. Mean values of sensitivity, AUC, and negative predictive value were 88.7, 0.82, and 96.7, respectively.

CONCLUSIONS

When applied to a sample of Spanish outpatients, the PDSQ exhibits satisfactory psychometric properties and adequate relationships with the psychopathology and personality interviews, and clinical and demographic variables. The study questionnaire is suitable for assessing comorbidity and psychopathology dimensions.

Posttraumatic stress disorder in a war-affected area of Northeast Ethiopia: a cross-sectional study

BACKGROUND

Post-Traumatic Stress Disorder (PTSD) is a chronic condition that affects a significant proportion of war survivors following war and conflict. If PTSD is not managed, it can lead to decreased quality of life and impairments in daily functioning and lead to death. This study aimed to assess the prevalence of post-traumatic stress disorder and its associated factors among residents in a war-affected area, Dessie Town, Northeast Ethiopia.

METHODS

A community-based cross-sectional study was conducted among adult residents in the war-affected area, Dessie Town. A total of 615 individuals were selected by a systematic random sampling method. PTSD was assessed using the Post-Traumatic Stress Disorder Checklist, Civilian Version. Multivariable logistic regressions were used to measure the associated factors. Associations between variables were described using odds ratios, 95% confidence intervals, and a p-value less than 0.05.

RESULTS

The prevalence of PTSD was 34.5% (95% CI: 31-38). Female sex (AOR: 1.82; CI: 1.18-2.82), divorced or widowed (AOR: 2.12, CI: 1.23-3.66), having only primary schooling (AOR: 2.17; CI: 1.25-3.78), depression (AOR: 2.03; CI: 1.34-3.08), experienced ill health without medical care during the wartime (AOR: 2.97; CI: 1.43-6.16), forced separation from family (AOR: 1.90; CI: 1.16-3.12), and experienced stressful life events (AOR: 1.60; CI: 1.06-2.42) were significantly associated with PTSD.

CONCLUSION

A significant rate of PTSD was found among residents of the war-affected area, Dessie Town. One in three people was experiencing PTSD. As a result, post-war mental health early screening and intervention is a priority, particularly for females, those who are separated or divorced, and those who have experienced stressful life events due to the war.

Role of personal aptitudes as determinants of incident morbidity, lifestyles, quality of life, use of health services, and mortality (DESVELA cohort): quantitative study protocol for a prospective cohort study in a hybrid analysis

Introduction

The healthcare and well-being of the population depend on multiple factors and should adapt to societal changes. The opposite is also occurring; society has evolved concerning the individuals' approach to their care, which includes participation in decision-making processes. In this scenario, health promotion and prevention become crucial to provide an integrated perspective in the organization and management of the health systems.Health status and well-being depend on many aspects, determinants of health, which in turn may be modulated by individual behavior. Certain models and frameworks try to study the determinants of health and individual human behaviors, separately. However, the interrelation between these two aspects has not been examined in our population.Our main objective is to analyze whether personal aptitudes related to behaviors are independently associated with the incidence of morbidity. A secondary objective will enquire whether these personal aptitudes are independently associated with lower all-cause mortality, enhanced adoption of healthy lifestyles, higher quality of life, and lower utilization of health services during follow-up.

Methods

This protocol addresses the quantitative branch of a multicenter project (10 teams) for the creation of a cohort of at least 3,083 persons aged 35 to 74 years from 9 Autonomous Communities (AACC). The personal variables to evaluate are self-efficacy, activation, health literacy, resilience, locus of control, and personality traits. Socio-demographic covariates and social capital will be recorded. A physical examination, blood analysis, and cognitive evaluation will be carried out.Several sets of six Cox models (one for each independent variable) will analyze the incidence of morbidity (objective 1); all-cause mortality and the rest of the dependent variables (objective 2). The models will be adjusted for the indicated covariates, and random effects will estimate Potential heterogeneity between AACC.

Discussion

The analysis of the association of certain behavioral patterns and determinants of health is essential and will contribute to improving health promotion and prevention strategies. The description of the individual elements and interrelated aspects that modulate the onset and persistence of diseases will allow the evaluation of their role as prognostic factors and contribute to the development of patient-tailored preventive measures and healthcare.Clinical Trial Registration: ClinicalTrials.gov, NCT04386135. Registered on April 30, 2020.

Late Onset Personality Disorders in Mid-Life and Older Adults

There is little research on personality disorder (PD) onset in older age. Many studies have shown that normative personality traits change across the life span, even into later life. This study aimed to investigate the onset of PDs in later adulthood (>age 55), and the possible influence of major life events on predicting this late onset. The current analysis was conducted with data from the St. Louis Personality and Aging Network (SPAN). Structured diagnostic interviews were administered three times over five years. Logistic regressions were conducted predicting late onset PD from baseline to FU5 and from FU5 to FU10 as a function of each major life event. 75 PD onsets occurred from baseline to FU5, and 39 PD onsets occurred from FU5 to FU10. Personal illness predicted the onset of PDs from FU5 to FU10.

Stressful life events and relapse of psychosis: analysis of causal association in a 2-year prospective observational cohort of individuals with first-episode psychosis in the UK

BACKGROUND

Despite accumulating evidence of an association between stressful life events and psychosis relapse, the extent to which this is a causal relationship remains unclear. We aimed to examine the association between exposure to, and number of, stressful life events after initial psychosis onset and psychosis relapse.

METHODS

In this 2-year prospective observational study, we recruited individuals with first-episode psychosis, aged 18-65 years, who presented to psychiatric services in south London, UK. Participants were assessed via interview, with additional data obtained from electronic clinical records. Stressful life events were recorded at psychosis onset and during the 2-year follow-up using a brief questionnaire that assesses 12 major life events. Psychosis relapse was defined as inpatient admission because of symptom exacerbation within 2 years from psychosis onset. We examined the time to first psychosis relapse and the number and length of relapses using survival and binomial regression analyses. We used fixed-effects regression and cross-lagged path analysis to examine the directionality of effects and control for unmeasured confounders.

FINDINGS

Between April 12, 2002, and July 26, 2013, 256 individuals with first-episode psychosis (100 [39%] female and 156 [61%] male; 16 [6%] Asian, 140 [55%] Black African or Caribbean, 86 [34%] White, and 14 [6%] mixed ethnicity) were recruited, with a mean age of onset of psychosis of 28·06 years (SD 8·03; range 17·21-56·03). 93 (36%) participants experienced at least one relapse during the 2-year follow-up. 253 individuals had all relevant data and were included in analyses. For people exposed to stressful life events after the onset of psychosis, the adjusted hazard (hazard ratio [HR] 2·60, 95% CI 1·63-4·16, p<0·0001), incidence (incidence rate ratio [IRR] 1·87, 1·24-2·80, p=0·0026), and length (IRR 2·53, 1·40-4·67, p=0·0011) of relapse were greater than for those who were unexposed. These relationships were dose dependent (HR 1·36; 1·09-1·69, p=0·0054; incidence IRR 1·26, 1·02-1·53, p=0·023; length IRR 1·52, 1·12-2·12, p=0·0028). Adjusted fixed-effects models showed a higher (odds ratio [OR] 3·82, 1·82-8·00, p=0·0004) and dose-dependent (OR 1·62, 1·18-2·21, p=0·0028) risk of relapse when stressful life events preceded relapse compared with the period when they did not. Cross-lagged path analysis confirmed an effect of stressful life events on the number of subsequent relapses (β=0·66, p=0·0055) that was dose dependent (β=0·29, p=0·029), but it did not show an effect of relapses on subsequent risk or number of stressful life events.

INTERPRETATION

These results provide converging evidence of a causal effect of stressful life events on the risk of relapse in psychosis. They suggest that there is a need to develop interventions at the individual and health-service level that could mitigate the harmful effects of stressful life events.

FUNDING

National Institute for Health Research, UK.

The Queensland Twin Adolescent Brain Project, a longitudinal study of adolescent brain development

We describe the Queensland Twin Adolescent Brain (QTAB) dataset and provide a detailed methodology and technical validation to facilitate data usage. The QTAB dataset comprises multimodal neuroimaging, as well as cognitive and mental health data collected in adolescent twins over two sessions (session 1: N = 422, age 9-14 years; session 2: N = 304, 10-16 years). The MRI protocol consisted of T1-weighted (MP2RAGE), T2-weighted, FLAIR, high-resolution TSE, SWI, resting-state fMRI, DWI, and ASL scans. Two fMRI tasks were added in session 2: an emotional conflict task and a passive movie-watching task. Outside of the scanner, we assessed cognitive function using standardised tests. We also obtained self-reports of symptoms for anxiety and depression, perceived stress, sleepiness, pubertal development measures, and risk and protective factors. We additionally collected several biological samples for genomic and metagenomic analysis. The QTAB project was established to promote health-related research in adolescence.

Associations among migration risk factors, cultural identity conflict, and psychological symptoms among Syrian emerging adults with refugee backgrounds in the Netherlands

OBJECTIVES

In the present study, we examined relations between premigration, perimigration, and postmigration risk factors (i.e., potentially traumatic events [PTEs], postmigration living problems [PMLPs], stressful life events) and psychological symptoms (i.e., anxiety/depression, posttraumatic stress) in Syrian emerging adults with refugee backgrounds; we also tested cultural identity conflict as a possible mediator of these relations. We expected that greater exposure to migration risk factors was associated with more psychological symptoms and that higher cultural identity conflict would contribute to these associations.

METHODS

We used data from the first wave of Karakter, a longitudinal study of 158 Syrians with refugee backgrounds (69.0% men, age range 18-35). Participants completed a questionnaire assessing PTEs, PMLPs, stressful life events, cultural identity conflict, and symptoms of anxiety/depression and posttraumatic stress.

RESULTS

Correlational analyses indicated that more PTEs and stressful life events were related to higher levels of cultural identity conflict and more psychological symptoms. Furthermore, greater cultural identity conflict was associated with more psychological symptoms. We did not observe indirect effects of cultural identity conflict in the mediation analyses.

CONCLUSIONS

Results suggest that postmigration stressors and cultural identity conflict are associated with psychological symptoms among Syrian emerging adults who have resettled in the Netherlands.

Half of the patients with subepithelial tumors present borderline or pathologic anxiety-distress and carcinophobia: a multicenter cohort study

BACKGROUND AND AIMS

Minor nonspecific gastrointestinal subepithelial lesions (usually defined by the term 'tumor') are usually associated with a malignant illness and cancer. The aim of this study was to assess anxiety-distress and carcinophobia in patients referred to specialized monographic outpatient clinics for evaluation and treatment of this type of lesion.

METHODS

Prospective, multicenter, cohort study. Specific self-reported questionnaires were used to report threatening life-experiences and to assess levels of distress (The Hospital Anxiety and Depression Scale) and cancer-related worries (The Cancer Worry Scale).

RESULTS

Forty participants were included and analyzed at baseline. Pathologic and borderline anxiety were detected in 13% (5/40, 95%CI: 4-27%) and 35% (14/40, 95%CI: 21-52%) of participants, respectively, whereas, cancer-related worries (moderate to very high) were observed in 48% (19/40, 95%CI: 32-64%) of participants. Pathologic global distress was identified in 25% (10/40, 95%CI: 13-42%) of subjects. Higher educational level (university studies), a lack of lifetime psychiatric comorbidity and a lack of family history of cancer were associated with less anxiety, global distress and carcinophobia.

CONCLUSIONS

Almost half of the patients diagnosed with a minor nonspecific gastrointestinal subepithelial lesion presented anxiety-distress and/or carcinophobia. Specific associations with anxiety-distress reaction and fears were detected.

Prevalence of depressive symptoms and their associated factors among older adults in Yirgalem town, Southern Ethiopia: A community-based cross-sectional study

Background

Depression is a serious mental health issue and the largest contributor to disability worldwide. Elderly people with depression are significantly more likely to experience negative outcomes such as poor physical health, strained social relationships, and decreased quality of life. Studies on geriatric depression are limited in developing nations like Ethiopia.

Objectives

The purpose of this study was to determine the prevalence of depressive symptoms and associated factors among older adults in Yirgalem, Southern Ethiopia, in 2022.

Methods

A community-based cross-sectional study was conducted on a sample of 628 older adults in Yirgalem town from May 15 to June 15, 2022. The study subjects were selected using a multi-stage systematic sampling technique. Data were collected using the 15-item Geriatric depression scale through face-to-face interviews. The collected data were edited, cleaned, coded, and entered into Epi data version 4.6 software and analyzed using STATA version 14. Bivariable and multivariate logistic regression analysis was computed to identify factors associated with depression, and statistical significance was declared at a 95% confidence interval with a P-value less than 0.05.

Results

A total of 620 older adults were included in the study, with a response rate of 97.8%. The prevalence of depressive symptoms among older adults was 51.77% (95% CI: 47.83-55.69). Being a woman (AOR = 2.3, 95% CI: 1.56-3141); being of more advanced age: 70-79 years old (AOR = 1.92, 95% CI: 1.20-3.07), 80-89 years old (AOR = 2.15, 95% CI: 1.27-3.65), 90 and older (AOR = 3.77, 95% CI: 1.95-7.79); living alone (AOR = 1.99, 95% CI = 1.17-3.41); having a chronic illness (AOR = 3.24, 95% CI: 1.06-4.46); having anxiety (AOR = 3.40; 95% CI: 2.25-5.14); and having poor social support (AOR = 3.56, 95% CI: 2.09-6.04) were statistically associated with depressive symptoms at a P-value of less than 0.05.

Conclusion

This study found that depression affects more than half of the elderly residents in the study area. More advanced age, being a woman, living alone, having a chronic illness, having anxiety, and having poor social support were all strongly linked to depression. There is a need to integrate counseling and psychiatric services into the community healthcare system.

The centrality of cognition and coping styles in driving aggressive responses

OBJECTIVE

Despite the presence of theoretical frameworks explaining aggression, they still require refinement in the form of a specification of mechanisms that facilitate such behaviour.

METHOD

Study 1 recruited participants (N = 31) from the general population (N = 20) and from a forensic hospital (N = 11). It was expected that aggression supportive cognitions and stress would be positively associated with aggressive behaviour. An experimental paradigm was used to induce stress and participants were subsequently given the opportunity to aggress. Study 2 was based on self-report questionnaires in community sample (N = 462). It was expected that aggressive behaviour and traits would be associated with experienced stress, hostile attributions, coping styles, and attitudes to violence. Specifically, that criminal attitudes to violence will mediate the effect of hostile attribution on aggression, while coping styles will mediate the effect of perceived stress.

RESULTS

An Implicit Theory "I am the law" was found to be associated with aggression. Furthermore, elevated skin conductance, but not changes in the heart rate, during the stress task was positively associated with aggression, and only among patients. Structural Equation Model confirmed the mediating role of criminal attitudes to violence and of maladaptive coping style for aggressive behaviour.

CONCLUSION

Aggression-supportive cognitions and maladaptive coping style are specific mechanisms through which external demands or subjective perception of a situation can result in aggressive behaviour.

Genetic and psychosocial stressors have independent effects on the level of subclinical psychosis: findings from the multinational EU-GEI study

AIMS

Gene x environment (G×E) interactions, i.e. genetic modulation of the sensitivity to environmental factors and/or environmental control of the gene expression, have not been reliably established regarding aetiology of psychotic disorders. Moreover, recent studies have shown associations between the polygenic risk scores for schizophrenia (PRS-SZ) and some risk factors of psychotic disorders, challenging the traditional gene v. environment dichotomy. In the present article, we studied the role of GxE interaction between psychosocial stressors (childhood trauma, stressful life-events, self-reported discrimination experiences and low social capital) and the PRS-SZ on subclinical psychosis in a population-based sample.

METHODS

Data were drawn from the EUropean network of national schizophrenia networks studying Gene-Environment Interactions (EU-GEI) study, in which subjects without psychotic disorders were included in six countries. The sample was restricted to European descendant subjects (n = 706). Subclinical dimensions of psychosis (positive, negative, and depressive) were measured by the Community Assessment of Psychic Experiences (CAPE) scale. Associations between the PRS-SZ and the psychosocial stressors were tested. For each dimension, the interactions between genes and environment were assessed using linear models and comparing explained variances of 'Genetic' models (solely fitted with PRS-SZ), 'Environmental' models (solely fitted with each environmental stressor), 'Independent' models (with PRS-SZ and each environmental factor), and 'Interaction' models (Independent models plus an interaction term between the PRS-SZ and each environmental factor). Likelihood ration tests (LRT) compared the fit of the different models.

RESULTS

There were no genes-environment associations. PRS-SZ was associated with positive dimensions (β = 0.092, R² = 7.50%), and most psychosocial stressors were associated with all three subclinical psychotic dimensions (except social capital and positive dimension). Concerning the positive dimension, Independent models fitted better than Environmental and Genetic models. No significant GxE interaction was observed for any dimension.

CONCLUSIONS

This study in subjects without psychotic disorders suggests that (i) the aetiological continuum hypothesis could concern particularly the positive dimension of subclinical psychosis, (ii) genetic and environmental factors have independent effects on the level of this positive dimension, (iii) and that interactions between genetic and individual environmental factors could not be identified in this sample.

Association Between Adverse Childhood Experiences, Resilience and Mental Health in a Hispanic Community

This study explores the relations between adverse childhood experiences (ACEs), mental health and resilience among Hispanic adults living in the United States - Mexico Border region. Numerous studies have investigated the negative impact of ACEs on adult mental health, but the concept of resilience as a protective factor for mental health in the Hispanic communities has limited consideration in ACE treatment interventions. The proposed study addresses this gap in knowledge by investigating relations between ACEs, resilience, and mental health. An online survey was administered to 221 university students to assess the relationship between ACEs, mental distress and resilience. Using hierarchical linear regression, three models were estimated. First, including demographics, second including ACEs and low resilience, followed by the interaction of ACEs and resilience. Analyses indicate that ACEs were associated with mental distress (B = 1.02, 95% CI 0.37 - 1.68, p < 0.01) and low resilience was associated with mental distress (B = 5.37, 95% CI 3.15 - 7.59, p < .01). The interaction between ACEs and low resilience was also related to mental distress (B = 1.32, 95% CI 0.17 - 2.47, p = 0.03), indicating that ACEs had a larger association with mental distress among respondents with low resilience. Findings highlight the importance of the direct association between resilience and mental distress, along with the moderating influence of resilience on the relation between ACEs and mental health. Interventions promoting resilience may be effective in reducing mental distress, especially among individuals with a history of ACEs.

Magnitude and determinants of suicide among overweight reproductive-age women, Chacha and Debre Berhan Town, Ethiopia: community based cross-sectional study

Background

The magnitude and impact of women's suicidal behaviors, like suicidal ideation and suicidal attempts, are an important public health problem in low and middle-income countries, including Ethiopia. Suicidal behavior and being overweight are typical complications of reproductive age with many undesired consequences. Despite both having a serious impact on women of reproductive age, they are neglected in Ethiopia. Accordingly, this study aimed to examine the magnitude and determinants of suicide among overweight reproductive-age women in Chacha and Debre Berhan towns, Ethiopia.

Methods

A community-based cross-sectional study design was once employed from April 1, 2020 to June 1, 2020. The Composite International Diagnostic Interview was used to measure suicidal attempts and ideation, and the data was collected by direct interview. All collected data were entered into Epi Data version 4.6 and analyzed with SPSS version 25. Bivariate and multivariable regression models were used to determine the factors associated with a suicidal attempt and ideation. A p-value of less than 0.05 was considered statistically significant.

Result

Of the total participants, 523 were included, with a response rate of 93.7%. The prevalence of suicidal ideation was 13.0% (95% CI 10.1–15.9), whereas suicidal attempt was 2.3% (95% CI 1.1–3.6). Based on multivariable regression analysis, the odds of suicidal ideation have been higher among overweight women with stressful life events, depression, and younger age groups.

Conclusion

Suicidal ideation was frequent in overweight reproductive-age women. Preventing, treating, and using coping mechanisms regarding identified factors is a good way to minimize the burden of suicide.

The Appalachia Mind Health Initiative (AMHI): a pragmatic randomized clinical trial of adjunctive internet-based cognitive behavior therapy for treating major depressive disorder among primary care patients

BACKGROUND

Major depressive disorder (MDD) is a leading cause of disease morbidity. Combined treatment with antidepressant medication (ADM) plus psychotherapy yields a much higher MDD remission rate than ADM only. But 77% of US MDD patients are nonetheless treated with ADM only despite strong patient preferences for psychotherapy. This mismatch is due at least in part to a combination of cost considerations and limited availability of psychotherapists, although stigma and reluctance of PCPs to refer patients for psychotherapy are also involved. Internet-based cognitive behaviorial therapy (i-CBT) addresses all of these problems.

METHODS

Enrolled patients (n = 3360) will be those who are beginning ADM-only treatment of MDD in primary care facilities throughout West Virginia, one of the poorest and most rural states in the country. Participating treatment providers and study staff at West Virginia University School of Medicine (WVU) will recruit patients and, after obtaining informed consent, administer a baseline self-report questionnaire (SRQ) and then randomize patients to 1 of 3 treatment arms with equal allocation: ADM only, ADM + self-guided i-CBT, and ADM + guided i-CBT. Follow-up SRQs will be administered 2, 4, 8, 13, 16, 26, 39, and 52 weeks after randomization. The trial has two primary objectives: to evaluate aggregate comparative treatment effects across the 3 arms and to estimate heterogeneity of treatment effects (HTE). The primary outcome will be episode remission based on a modified version of the patient-centered Remission from Depression Questionnaire (RDQ). The sample was powered to detect predictors of HTE that would increase the proportional remission rate by 20% by optimally assigning individuals as opposed to randomly assigning them into three treatment groups of equal size. Aggregate comparative treatment effects will be estimated using intent-to-treat analysis methods. Cumulative inverse probability weights will be used to deal with loss to follow-up. A wide range of self-report predictors of MDD heterogeneity of treatment effects based on previous studies will be included in the baseline SRQ. A state-of-the-art ensemble machine learning method will be used to estimate HTE.

DISCUSSION

The study is innovative in using a rich baseline assessment and in having a sample large enough to carry out a well-powered analysis of heterogeneity of treatment effects. We anticipate finding that self-guided and guided i-CBT will both improve outcomes compared to ADM only. We also anticipate finding that the comparative advantages of adding i-CBT to ADM will vary significantly across patients. We hope to develop a stable individualized treatment rule that will allow patients and treatment providers to improve aggregate treatment outcomes by deciding collaboratively when ADM treatment should be augmented with i-CBT.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04120285 . Registered on October 19, 2019.

Covid-19-related stressors, mental disorders, depressive and anxiety symptoms: a cross-sectional, nationally-representative, face-to-face survey in Serbia

AIM

The Covid-19 pandemic may be associated with an increase in mental disorders and mental distress. However, there are no representative studies testing the impact of stressors directly related to Covid-19. We aimed to determine whether Covid-19-related stressors were associated with mental disorders, depressive and anxiety symptoms in the second year of the pandemic.

METHOD

This cross-sectional observational epidemiological survey was conducted from June to October 2021. We interviewed a representative sample of the adult population in Serbia (18-65 years) in the second year of the pandemic, at a time when large parts of the population had been affected by the pandemic in different ways. A multistage probabilistic household sampling of the adult population in 60 municipalities was used. Mental disorders were assessed by in-person interviews using the Mini International Neuropsychiatric Interview. Depressive and anxiety symptoms were measured by PHQ-9 and GAD-7 scales. Covid-19-related stressors (Sars-CoV-2 infection, the infection of a close relative, self-isolation and lack of protective equipment at work), as well as other stressors during the pandemic (not directly related to the risk of the infection), were measured. The associations with mental disorders, depressive and anxiety symptoms were explored through univariable and multivariable regression analyses.

RESULTS

In total, 1203 individuals (mean age 43.7 ± 13.6 years, 48.7% male) were interviewed. Most respondents (67.8%) of the sample had already experienced Covid-19-related stressors (20.1% had Sars-CoV-2 infection; 43.2% had a close relative member who had Covid-19; 28.2% reported lack of appropriate protection; 27.5% had been quarantined) and about 50% had already been vaccinated. The prevalence of any mental disorder was 15.2% (95% CI 13.2-17.2): mood disorders 4.6%, anxiety disorders 4.3% and substance use disorders 8.0%. Mean PHQ-9 was 3.2 ± 3.8 and GAD-7 was 2.1 ± 3.1. In this study, one Covid-19 stressor, i.e. lack of protective equipment, was weakly associated with a greater frequency of anxiety disorders (p = 0.023), while the other stressors had significant associations with several groups of mental disorders and symptom levels.

CONCLUSIONS

Our study did not provide any evidence that the prevalence of mental disorders exceeds the range of pre-pandemic data reported in the literature. Covid-related stressors, although frequently reported, did not dramatically influence the prevalence of mental disorders. The provision of the appropriate equipment at workplaces might lead to the reduction of anxiety disorders.

Deinstitutionalization from the perspective of community-dwelling adults with a severe mental illness in Amsterdam: a cohort study protocol

Background

People with a severe mental illness (SMI) increasingly receive ambulatory forms of care and support. The trend of deinstitutionalization accelerated in the Netherlands from 2008 and onwards without sufficient understanding of its consequences. The study protocol herein focuses on deinstitutionalization from the perspective of adults with an SMI living within the community in Amsterdam and aims at delivering better insight into, amongst others, their recovery, quality of life, societal participation and needs for care and support.

Methods

A cohort design will be used. A representative sample of community-dwelling adults with an SMI, including those in care (n = 650) and not in care (n = 150), will be followed over time. During a two-year time period, participants will be interviewed twice using a wide-ranging set of validated instruments. Interview data will be matched with administrative data about the care process, as retrieved from their patient files. Primary outcomes are changes over time in recovery, societal participation and quality of life, controlled for the occurrence of adverse life-events during follow-up. Additionally, prevalence estimates of and associations between social functioning, safety and discrimination, substance use and health indicators will be investigated.

Discussion

The study protocol aims at delivering a comprehensive insight into the needs of community-dwelling adults with an SMI based on which ambulatory care and support can best be provided to optimally promote their social recovery and well-being.

Intimate partner violence and COVID-19 among reproductive age women: A community-based cross-sectional survey, Ethiopia

INTRODUCTION

Intimate partner violence is one of the most common psychological, physical, and sexual assaults toward women which suit the entire life of women, and nowadays, the magnitude accelerates due to coronavirus pandemic. Hence, this study was aimed to examine the prevalence of intimate partner violence and predictors during coronavirus among childbearing-age residents in Debre Berhan.

METHODS

A community-based cross-sectional survey was employed from 1 May to 1 July 2020. Eight items of women abuse screening tool were used to estimate intimate partner violence. Trained data collectors directly interview randomly selected participants. The data were entered using Epi-info V. 7 and analyzed using SPSS V. 23. Descriptive statistics were used to determine the prevalence of intimate partner violence and the frequency distribution of other variables. During bivariate analysis, predictor variables with a p-value less than 0.25 were nominated to further analysis. An adjusted odds ratio with a 95% confidence interval was used and a p-value less than 0.05 was considered statistically significant.

RESULT

A total of 700 participants were included with a response rate of 95.1%. The prevalence of intimate partner violence in the past single year was 19% with 95% confidence interval = 16.1-21.9. Besides, the prevalence of emotional (19.9%, 95% confidence interval = 16.9-22.8), sexual (10.9%, 95% confidence interval = 8.6-13.2) and physical (9.4%, 95% confidence interval = 7.3-11.6) violence was reported. Women with depressive symptoms, overweight, suicidal ideation, and body image disturbance were significantly associated with intimate partner violence, but not educational status, employment, income, stressful life events, lifetime alcohol use, suicidal attempt, and abortion.

CONCLUSION AND RECOMMENDATION

Nearly one out of five interviewed participants had intimate partner violence. Being overweight, having poor body image, and having depression increase intimate partner violence. Special preventive measures and treatment, and other legal services should be taken to alleviate the predictor variables and intimate partner violence.

Gut microbiota, innate immune pathways, and inflammatory control mechanisms in patients with major depressive disorder

Although alterations in the gut microbiota have been linked to the pathophysiology of major depressive disorder (MDD), including through effects on the immune response, our understanding is deficient about the straight connection patterns among microbiota and MDD in patients. Male and female MDD patients were recruited: 46 patients with a current active MDD (a-MDD) and 22 in remission or with only mild symptoms (r-MDD). Forty-five healthy controls (HC) were also recruited. Psychopathological states were assessed, and fecal and blood samples were collected. Results indicated that the inducible nitric oxide synthase expression was higher in MDD patients compared with HC and the oxidative stress levels were greater in the a-MDD group. Furthermore, the lipopolysaccharide (an indirect marker of bacterial translocation) was higher in a-MDD patients compared with the other groups. Fecal samples did not cluster according to the presence or the absence of MDD. There were bacterial genera whose relative abundance was altered in MDD: Bilophila (2-fold) and Alistipes (1.5-fold) were higher, while Anaerostipes (1.5-fold) and Dialister (15-fold) were lower in MDD patients compared with HC. Patients with a-MDD presented higher relative abundance of Alistipes and Anaerostipes (1.5-fold) and a complete depletion of Dialister compared with HC. Patients with r-MDD presented higher abundance of Bilophila (2.5-fold) compared with HC. Thus, the abundance of bacterial genera and some immune pathways, both with potential implications in the pathophysiology of depression, appear to be altered in MDD, with the most noticeable changes occurring in patients with the worse clinical condition, the a-MDD group.

Association between dementia parental family history and mid-life modifiable risk factors for dementia: a cross-sectional study using propensity score matching within the Lifelines cohort

OBJECTIVE

Individuals with a parental family history (PFH) of dementia have an increased risk to develop dementia, regardless of genetic risks. The aim of this study is to investigate the association between a PFH of dementia and currently known modifiable risk factors for dementia among middle-aged individuals using propensity score matching (PSM).

DESIGN

A cross-sectional study.

SETTING AND PARTICIPANTS

A subsample of Lifelines (35-65 years), a prospective population-based cohort study in the Netherlands was used.

OUTCOME MEASURES

Fourteen modifiable risk factors for dementia and the overall Lifestyle for Brain Health (LIBRA) score, indicating someone's potential for dementia risk reduction (DRR).

RESULTS

The study population included 89 869 participants of which 10 940 (12.2%) had a PFH of dementia (mean (SD) age=52.95 (7.2)) and 36 389 (40.5%) without a PFH of dementia (mean (SD) age=43.19 (5.5)). Of 42 540 participants (47.3%), PFH of dementia was imputed. After PSM, potential confounding variables were balanced between individuals with and without PFH of dementia. Individuals with a PFH of dementia had more often hypertension (OR=1.19; 95% CI 1.14 to 1.24), high cholesterol (OR=1.24; 95% CI 1.18 to 1.30), diabetes (OR=1.26; 95% CI 1.11 to 1.42), cardiovascular diseases (OR=1.49; 95% CI 1.18 to 1.88), depression (OR=1.23; 95% CI 1.08 to 1.41), obesity (OR=1.14; 95% CI 1.08 to 1.20) and overweight (OR=1.10; 95% CI 1.05 to 1.17), and were more often current smokers (OR=1.20; 95% CI 1.14 to 1.27) and ex-smokers (OR=1.21; 95% CI 1.16 to 1.27). However, they were less often low/moderate alcohol consumers (OR=0.87; 95% CI 0.83 to 0.91), excessive alcohol consumers (OR=0.93; 95% CI 0.89 to 0.98), socially inactive (OR=0.84; 95% CI 0.78 to 0.90) and physically inactive (OR=0.93; 95% CI 0.91 to 0.97). Having a PFH of dementia resulted in a higher LIBRA score (RC=0.15; 95% CI 0.11 to 0.19).

CONCLUSION

We found that having a PFH of dementia was associated with several modifiable risk factors. This suggests that middle-aged individuals with a PFH of dementia are a group at risk and could benefit from DRR. Further research should explore their knowledge, beliefs and attitudes towards DRR, and whether they are willing to assess their risk and change their lifestyle to reduce dementia risk.

Magnitude and associated factors of antenatal depression among mothers attending antenatal care in Arba Minch town, Ethiopia, 2018

BACKGROUND

Depression is a common mental disorder. The burden of antenatal depression is higher in developing countries which is 20% as compared to developed ones 10% to 15%. In Ethiopia around one-fifth of pregnant mothers are depressed. Despite the severity of the problem, only a few studies have been done in Ethiopia, and there is no study done in Arba Minch on the problem.

OBJECTIVE

To assess the magnitude and associated factors of antenatal depressive symptoms among pregnant women attending Public Health facilities in Arba Minch town Southern Nations and Nationalities Peoples Region, Ethiopia 2018.

METHODS

Health Institution based, cross-sectional study design was used to assess the magnitude and associated factors of antenatal depression among 323 pregnant mothers who came for antenatal care follow-up in all public health facilities in Arba Minch town. The systematic random sampling technique was applied. Interviewer administered, pretested structured Questionnaire containing Edinburgh postpartum depression scale was utilized. EPI INFO was used to enter data and then the data were analyzed by logistic regression using SPSS. Variables with P-value less than 0.2 in the bivariate logistic regression were inserted in for multivariable analysis to see their independent effect and those with P-value less than 0.05 were used to determine the significant association between dependent and independent variables.

RESULT

The magnitude of antenatal depression was 35.4%. Variables that were significantly associated with antenatal depression on multivariate analysis were anxiety (AOR = 5.49, 95%CI: 2.56, 11.77), un-planned pregnancy (AOR = 2.71, 95%CI: 1.21, 6.07), and Primigravida (AOR = 2.96, 95%CI: 1.28, 6.8). Similarly, uneducated mothers and those who attend only elementary school had AOR 4.92, 95% CI 1.36,17.73 and AOR 4.04955CI 1.23, 13.39 respectively.

CONCLUSION

The magnitude of antenatal depression, intimate partner violence, and threatening life event in Arba Minch town was high. Anxiety, unplanned pregnancy, educational status, and Primigravida were significantly associated factors with depression. There should be a mechanism for routine screening and management of antenatal depression and intimate partner violence during antenatal care follow-up.

Zao Ren An Shen capsule for insomnia: A double-blind, randomized, placebo-controlled trial

STUDY OBJECTIVES

The aim of this study was to test the efficacy and safety of Zao Ren An Shen (ZRAS) capsule, a Chinese herbal medicine product, for the treatment of insomnia.

METHODS

We conducted a double-blind randomized placebo-controlled trial. After a one-week placebo run-in, a total of 85 people with insomnia were randomly allocated to receive ZRAS or placebo for four weeks. The primary outcomes were insomnia severity assessed with the Insomnia Severity Index (ISI) and the number of participants with adverse events. Secondary outcomes included objective and subjective sleep parameters, psychological status, fatigue level, quality of life, acceptability, and tolerability.

RESULTS

A non-significant (p > 0.05) difference of 0.7 points in ISI in favor of ZRAS capsule was found at the end of the treatment. The number of participants with adverse events was not significantly different (p > 0.05) between the two groups. Except for subjective sleep onset latency, which had a non-significant (p > 0.05) medium effect (Cohen's d = 0.5), the effects in secondary efficacy outcomes were all small (Cohen's d < 0.4) and non-significant (p > 0.05). The acceptability and tolerability were high in the active group.

CONCLUSIONS

ZRAS capsule is safe, acceptable, and tolerable, yet not more effective than placebo in the treatment of insomnia. As previous evidence showed that Chinese herbal medicine was effective for insomnia, these results may be explained by the dose of the product, which was lower than the dose generally used in the clinic.

Factors associated with homelessness among women: a cross-sectional survey of outpatient mental health service users at The Banyan, India

BACKGROUND

Homelessness has multifaceted and damaging effects on women with mental illness. This makes it imperative to identify and address the factors leading to homelessness among women with mental illness in order to inform policy on providing relevant services for this vulnerable population.

METHOD

A cross-sectional survey was conducted among 346 women in active contact with one of four outpatient clinics at The Banyan, a non-profit organization in the Indian state of Tamil Nadu. A semi-structured instrument and modified version of the List of Threatening Experiences Questionnaire was used for data collection. Multivariate logistic regression analysis was used to examine predictive variables for homelessness among women with mental illness.

RESULT

32.65% of participants reported a history of homelessness. Less than 5 years of schooling (OR = 2.914, 95% CI = 1.027-8.269, P < 0.05) and disrupted relationships (OR = 1.807, 95% CI = 1.23-2.655, P < 0.01) were associated with a greater likelihood of women with mental illness to experience homelessness.

CONCLUSION

In the study cohort, this was explained mainly by factors rooted in gender-based disadvantage. Further practice and research are needed to develop interventions that address issues with a sociological basis to mental illness and prevent these predictive factors.

Prevalence of common mental disorder and associated factors among mothers of under five year children at Arbaminch Town, South Ethiopia, 2019

Background

Common mental disorders are the major public healthproblem that affects mothers with young children. Although there were a number of studies done on maternal mental health problems, they were largely focused on perinatal period. However, there is scarcity of information on the magnitude and correlates of these mental health problems beyond perinatal period and due concern is not given mainly in LMICs including our country.

Objective

To assess the prevalence and factors associated with common mental disorderamong mothers of under-five year children at Arbaminch town, South Ethiopia, 2019.

Methods

A community based cross-sectional study was conducted in May and June 2019 at Arbaminch town. A systematic random sampling technique was used to select 776 participants. The Self-Reporting Questionnaire (SRQ-20) was used to assess common mental disorder (CMD). Data was coded and entered in EPIDATA3.1 and analyzed using SPSS version 25. Bivariable and multivariable logistic regression were used to identify factors associated to common mental disorder. P-values less than 0.05 were considered statistically significant and strength of the association was presented by adjusted odds ratio with 95% confidence interval.

Result

The prevalence of common mental disorder among mothers with children aged below five years was 36.6% with (95% CI, 33.2, 39.9). Being single/divorced/widowed [AOR = 3.64, 95% CI:(1.47, 8.99), chronic medical illness [AOR = 3.25, 95% CI:(2.10, 5.04)], exposure to two/more stressful events [AOR = 1.62, 95% CI:(1.11, 2.36)], poor social support [AOR = 2.59, 95% CI:(1.62, 4.14)], mothers living with cigarette smoker husband [AOR = 2.03, 95% CI:(1.19, 3.47)], and mothers physically abused by their spouse [AOR = 2.36, 95% CI:(1.49, 3.74)] were factors associated with common mental disorder.

Conclusion and recommendation

The prevalence of common mental disorder was high among mothers with children aged below five years compared to the general population. Being single/divorced/widowed, chronic medicalillness, exposure to two/more stressful events, poor social support, mothers living with cigarette smoker husbandand physically abuse by their spouse were factors associated with common mental disorder. Early detection and management of these maternal mental health problems is vital for mothers’ wellbeing as well as growth and development of children.

Stigma, depression, and anxiety among patients with head and neck cancer

PURPOSE

Patients with head and neck cancer (HNC) are vulnerable to psychiatric comorbidities, particularly anxiety and depression, and also suffer from cancer stigma. This study aimed to comprehensively compare HNC patients' stigma, depression, and anxiety, and elucidate the underlying relationships among them.

METHODS

This cross-sectional study recruited inpatients with HNC from a medical center. Measurements included a psychiatric diagnostic interview, the Shame and Stigma Scale (SSS), the Hamilton Anxiety Rating Scale (HAM-A), the Hamilton Depression Rating Scale (HAM-D), the Explanatory Model Interview Catalogue (EMIC), and stressors of HNC patients. Structural equation modeling was used to establish models of potential mechanisms.

RESULTS

Those patients having stressors of worry about health (t = 5.21, p < 0.001), worry about job (t = 2.73, p = 0.007), worry about family (t = 2.25, p = 0.026), or worry about economic problems (t = 2.09, p = 0.038) showed significantly higher SSS score than those having no such stressor. The SSS total score was significantly correlated with HAM-A (r = 0.509, p < 0.001), HAM-D (r = 0.521, p < 0.001), and EMIC (r = 0.532, p < 0.001) scores. Structural equation modeling was used to propose the possible effect of stigma on anxiety (β = 0.51, p < 0.001), and then the possible effect of anxiety on depression (β = 0.90, p < 0.001).

CONCLUSION

Stigma is significantly correlated with anxiety and depression and might in HNC patients. Proper identification of comorbidities and a reduction of stigma should be advised in mental health efforts among patients with HNC.

Prevalence and factors associated with PTSD among female urban slum dwellers in Ibadan, Nigeria: a cross-sectional study

BACKGROUND

Little is known about the prevalence of and factors associated with PTSD among adult females in Nigeria, particularly those who live in slums. PTSD is a mental health condition that develops among some individuals who experience or witness a traumatic event. Several other factors could place individuals at heightened risk of PTSD including stress and comorbid mental disorders. Therefore, this study aimed to examine the prevalence and factors associated with PTSD among female urban slum dwellers in Ibadan, Nigeria.

METHODS

We conducted a cross sectional survey using multistage sampling of 550 women aged 18 and above from selected slums. Interviewer administered questionnaires were used to elicit information on experience of childhood trauma, recent stressors, intimate partner violence, other mental disorders, sociodemographic characteristics and PTSD. PTSD was measured using the Harvard Trauma Questionnaire (HTQ) which is based on DSM IV. A multivariable linear regression model was built to test associations between PTSD and independent variables.

RESULTS

The prevalence for PTSD was found to be 4.18% and the mean PTSD score was 5.80 ± 7.11. Sexual abuse in childhood, past year intimate partner violence and anxiety were significantly associated with higher PTSD scores. PTSD was not significantly associated with a history of recent stressors. Education, employment and marital status were not associated with PTSD however, age and wealth index showed marginal association with PTSD.

CONCLUSION

The prevalence of PTSD among women living in Ibadan slums was relatively low. Both child sexual abuse and intimate partner violence can be prevented. We also recommend longitudinal studies to better understand risk and protective factors.

Comparison of Psychological and Physiological Stress in NICU Nurses: Effects of Unit Design and Shift

BACKGROUND

Effects of unit design and shift worked on stress in neonatal intensive care unit (NICU) nurses have not been fully studied.

PURPOSE

To compare stress in NICU nurses who work in single-family room (SFR) or open bay (OBY) units and on nonrotating day or night shift.

METHODS

Full-time registered nurses (RNs) (n = 72) from a 42-bed SFR and a 131-bed OBY NICU participated in this comparative cross-sectional study. The Nurse Stress Scale (NSS) and within-shift repeated salivary cortisol levels were used to measure stress. The relationship between NSS score and salivary cortisol level was examined using multiple linear regression. Salivary cortisol levels of day versus night shift were compared with mixed-effects linear models.

RESULTS

NSS scores were similar for SFR and OBY units (P = .672) and day versus night shift (P = .606). Changes in cortisol level over time (P = .764) and final cortisol level (P = .883) for SFR versus OBY were not significantly different after controlling for shift. Salivary cortisol level of day-shift nurses decreased significantly over time compared with night-shift nurses (P < .001). The final cortisol level was significantly higher for night-shift compared with day-shift nurses (P < .001).

IMPLICATIONS FOR PRACTICE

Psychological (NSS) and physiologic (salivary cortisol) stress of NICU nurses is similar in established SFR and OBY units. Cortisol levels are higher at the end of shift in nurses who work night shift and may reflect increased physiologic stress.

IMPLICATIONS FOR RESEARCH

Strategies are needed for reducing stress in NICU nurses who work night shift.

Cognition in Recent Suicide Attempts: Altered Executive Function

Background: Neuropsychological alterations can lead to inaccurate perception, interpretation, and response to environmental information, which could be a risk factor for suicide. Methods: Ninety-six subjects were recruited from the Psychiatry Department of the Araba University Hospital-Santiago, including 20 patients with a recent attempt and diagnosis of major depressive disorder (MDD) according to DSM-V, 33 MDD patients with history of attempted suicide, 23 non-attempter MDD patients, and 20 healthy controls. All participants underwent a clinical interview and neuropsychological assessment on the following cognitive domains: working memory, processing speed, decision-making, executive function, and attention. Backward multiple regressions were performed adjusting for significant confounding variables. For group comparisons, ANOVA and Bonferroni post-hoc tests were performed with a p < 0.05 significance level. Results: The patient groups did not differ regarding severity of depression and stressful events in the last 6 months. In comparison to healthy controls, depressed patients with lifetime suicide attempts had more general trauma (p = 0.003), emotional abuse (p = 0.003), emotional negligence (p = 0.006), and physical negligence (p = 0.009), and depressed patients with recent suicide attempts had experienced more child sexual abuse (p = 0.038). Regarding neuropsychological assessment, all patient groups performed significantly worse than did healthy controls in processing speed, decision-making, and attention. Comparisons between patient groups indicated that recent suicide attempters had poorer performance on executive function in comparison to both depressed lifetime attempters and depressed non-attempters (B = 0.296, p = 0.019, and B = 0.301, p = 0.028, respectively). Besides, women with recent attempts had slightly better scores on executive function than males. Regarding the rest of the cognitive domains, there were no significant differences between groups. Conclusion: Executive function performance is altered in recent suicide attempts. As impaired executive function can be risk factor for suicide, preventive interventions on suicide should focus on its assessment and rehabilitation.

Depression remains a neglected public health problem among pregnant women in Northwest Ethiopia

BACKGROUND

Antenatal depression is highly prevalent but a neglected public health problem in low income countries. It has serious effects on the general health of women, birth outcomes and child health. However, there has been limited substantial evidence on the prevalence and predictors of antenatal depression in Ethiopia. This lack of evidence potentiates the consequences of the problem and can limit the attention to intervention. Thus, this study aimed to assess the prevalence and potential predictors of antenatal depression at Debre Tabor and Woreta towns, Northeast Ethiopia.

METHODS

A community-based cross-sectional study was employed on 548 pregnant women recruited by a cluster sampling method. Depressive symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS). The List of Threatening Experiences Questionnaire (LTE-Q), the Oslo-3 Social Support Scale (OSSS-3), Intimate Partner Violence (IPV) Scale and Fast Alcohol Screening Test (FAST) were also used to measure stressful events, social support, intimate partner violence (IPV) and hazardous alcohol use respectively. Bivariable and multivariable logistic regression analyses were carried out to identify factors associated with antenatal depression.

RESULTS

The prevalence of antenatal depression was found to be 24.45% (95% CI: 21.20, 28.30%). Being single (AOR =3.32, 95% CI = 1.36, 8.09); fear of pregnancy complication (AOR = 3.84, 95% CI = 1.53,9.62); history of chronic illness (AOR = 8.14, 95% CI = 2.14, 30.91); unplanned pregnancy (AOR = 2.99, 95% CI = 1.36,6.55); history of stillbirth (AOR = 3.56, 95% CI = 1.23, 10.29),one or more negative life events (AOR = 4.06, 95% CI = 1.71, 9.66) and intimate partner violence (AOR = 3.91, 95% CI = 1.65, 9.26) were factors significantly associated with antenatal depression.

CONCLUSION

Nearly a quarter of pregnant women suffer from depressive symptoms during pregnancy. Being single; fear of pregnancy complication; history of chronic illness; unplanned pregnancy; history of stillbirth; one or more negative life events and intimate partner violence were important predictors of antenatal depression in this study. Health care workers should consider addressing these risk factors during a routine antenatal care. Also, integrating early screening, detection, and treatment of antenatal depression into routine antenatal care is warranted to improve the quality of life of pregnant women and pregnancy outcomes as well.

The effect of antenatal depression on birth weight among newborns in South Gondar zone, Northwest Ethiopia: a population-based prospective cohort study

BACKGROUND

There is a high prevalence of antenatal depression and low birth weight (LBW) (< 2.5 kg) in Ethiopia. Prior evidence revealed that the association between antenatal depression and LBW in high- and low-income countries is conflicting. The effect of antenatal depression on birth weight is under-researched in Ethiopia. We aimed to examine the independent effect of antenatal depression on newborn birth weight in an urban community in Northwest Ethiopia.

METHODS

A total of 970 pregnant women were screened for antenatal depression in their second and third trimester of pregnancy through the use of the Edinburgh Postnatal Depression Scale (EPDS). A logistic regression model was used to adjust confounders and determine associations between antenatal depression and low birth weight. Information was collected on the birth weight of newborns and mother's socio-demographic, anthropometric, obstetric, clinical, psychosocial, and behavioral factors.

RESULTS

The cumulative incidence of LBW was found to be 27.76%. The cumulative incidence of LBW in those born from depressed pregnant women was 40% as compared to 21% in none depressed. While considering all other variables constant, mothers who had antenatal depression were 2.51 (COR = 2.51 (95 CI: 1.87, 3.37)) more likely to have a child with low birth weight. After adjusting for potential confounders, antenatal depression in the second and third trimester of pregnancy (AOR = 1.92 (95% CI: 1.31, 2.81)) remained significantly associated with LBW. Mid-Upper Arm Circumference (MUAC) ≤21, lack of ANC follow up, and preterm births were also associated with LBW.

CONCLUSION

This study showed that antenatal depression during the second and third trimester of pregnancy is associated with LBW of newborns and replicates results found in high-income countries. Linking early screening, detection, and treatment of antenatal depression into routine antenatal care could be essential to improve pregnancy outcomes.

The Independent Effects of Psychosocial Stressors on Subclinical Psychosis: Findings From the Multinational EU-GEI Study

The influence of psychosocial stressors on psychosis risk has usually been studied in isolation and after the onset of the disorder, potentially ignoring important confounding relationships or the fact that some stressors that may be the consequence of the disorder rather than preexisting. The study of subclinical psychosis could help to address some of these issues. In this study, we investigated whether there was (i) an association between dimensions of subclinical psychosis and several psychosocial stressors including: childhood trauma, self-reported discrimination experiences, low social capital, and stressful life experiences, and (ii) any evidence of environment-environment (ExE) interactions between these factors. Data were drawn from the EUGEI study, in which healthy controls (N = 1497) and siblings of subjects with a psychotic disorder (N = 265) were included in six countries. The association between psychosocial stressors and subclinical psychosis dimensions (positive, negative and depressive dimension as measured by the Community Assessment of Psychic Experiences (CAPE) scale) and possible ExE interactions were assessed using linear regression models. After adjusting for sex, age, ethnicity, country, and control/sibling status, childhood trauma (β for positive dimension: 0.13, negative: 0.49, depressive: 0.26) and stressful life events (positive: 0.08, negative: 0.16, depressive: 0.17) were associated with the three dimensions. Lower social capital was associated with the negative and depression dimensions (negative: 0.26, depressive: 0.13), and self-reported discrimination experiences with the positive dimension (0.06). Our findings are in favor of independent, cumulative and non-specific influences of social adversities in subclinical psychosis in non-clinical populations, without arguments for E × E interactions.

Prevalence of Depression and Associated Factors Among Normal and Overweight Reproductive Age Women, Ethiopia: Community-Based Comparative Cross-Sectional Study

Background

Depression and overweight are serious public health problems and the most common complications of childbearing age with many negative consequences on the mental health of women and their children in the world. Even though both have a serious impact, no study has been done in Ethiopia. Therefore, this study aimed to assess and compare the prevalence of depression and associated factors among normal and overweight reproductive-age women in Debre Berhan town.

Methods

A community-based comparative cross-sectional study was conducted from April– June 2020. Patient health questionnaire-9 was used to measure the level of depression and list of threatening experience for stressful life events. Body mass index values of 18.5–24.9 and 25–29.9 kg/m² were used to classify as normal, and overweight, respectively. The data were entered into Epi Data V. 4.6 and were analyzed using SPSS V. 25. A statistically significant association was declared at a p-value < 0.05.

Results

From 1530 participants the response rate were 96.1% and 100% for normal and overweight women, respectively. The prevalence of depression among normal weight women was 26.02% (95% CI: 23.3%, 28.73%) whereas among overweight was 32.89% (95% CI: 28.85%, 36.93%). For women who have normal weight; being exposed to stressful life events, having poor social support, and body image disturbance were statistically significant factors. For women who have overweight, stressful life events, body image disturbance, and experienced weight stigma were significantly associated.

Conclusion and Recommendation

Depression among overweight women was high compared to normal weight in Debre Berhan town. Promoting social support at any aspect of health care services are very important to minimize depression. Especially for overweight women, encouraging management of medical illness, coping mechanisms for different stressful life events and potentiating self-confidence towards body image are a vital means to prevent depression. Health promotion program targeting reproductive age women with significant associated factors are important to overcome overweight and depression in Debre Berhan town.

Stress impairs response to antidepressants via HPA axis and immune system activation

Childhood trauma as well as severe events occurring later in life have been associated with the development of major depressive disorder (MDD). However, the interaction of early and later occurring adverse events in patients with MDD is understudied. This study aims to disentangle this interaction by investigating the effects on two of the main stress-response systems of the body, the hypothalamic-pituitaryadrenal (HPA-) axis and the immune system in depressed patients. The function of the HPA-axis was assessed by measuring FKBP5, SGK1 and NR3C1 mRNA-expression in peripheral blood after an in vivo glucocorticoid receptor (GR) challenge with 1.5 mg dexamethasone in 150 depressed in-patients (47.4% females). Childhood trauma was evaluated using the Childhood Trauma Questionnaire (CTQ), severe life events occurring one year prior to hospital admission were assessed with the List of Threatening Experiences (LTE). Multiple childhood traumata, i.e. ≥ 3, were present in 68 (45.5%) patients, 59 (39.3%) experienced ≥ 3 severe recent life events. The history of ≥ 3 severe recent life events was associated with an impaired GR-induction of SGK1 (F = 10.455; df = 1; p = 0.002) and FKBP5 mRNA expression (F = 8.720; df = 1; p = 0.004), and with elevated measures of the immune system such as CRP and lymphocyte count. In addition, severe recent life events were associated with a substantially impaired treatment response to antidepressants (F = 7.456; df = 1; p = 0.008). These effects could not be observed in relation to childhood trauma. Severe life events occurring prior to MDD development substantially impaired the stress-response systems and the response to treatment with antidepressants. This finding may indicate the need to employ additional treatment options such as psychotherapy right at the beginning of treatment or immune-modulating approaches.

Parental stress during COVID-19: A brief report on the role of distance education and family resources in an Italian sample

Since the COVID-19 outbreak, school closures have affected over 1.5 billion children worldwide. Many countries implemented a rapid transition to distance education (DE), but the effects of such transition on family life remain largely underexplored. The current study used a cross-sectional, correlational survey design to explore the role of DE and family resources (parenting self-efficacy and family functioning) in perceived stress among Italian parents of first-grade children (N = 89). Results of hierarchical multiple regression indicated that, after controlling for stressful events experienced during school closure, parents’ difficulty to manage children’s DE was positively linked to levels of stress. However, this association became nonsignificant after adding family resources to the model, with more parental self-efficacy and good family functioning predicting less perceived stress. The findings underscore the importance of supporting positive resources within the family environment to reduce DE-related parental stress in the context of the ongoing COVID-19 pandemic.

Sex-dependent grades of haematopoietic modulation in patients with major depressive episodes are associated with suicide attempts

Suicide is the leading cause of non-natural death worldwide, and major depressive disorder (MDD) is the mood disorder with the highest prevalence among individuals with suicidal behaviour (SB). The role of inflammation and immunomodulation in mood disorders has raised interest in recent years, as inflammation biomarkers have been reported to be increased in mood disorder patients, suggesting a role of inflammation in their pathogenesis. The influence of inflammation on the haematopoietic production is well known; however, a comprehensive study of the haematopoietic production in patients with major depressive episodes (MDE) is lacking. We examined global haematopoietic parameters from complete blood counts (CBC) of patients with MDE, in search of prognostic patterns. MDE patients presented differences in several CBC parameters, differences that were clearly pronounced and/or significant in concurrence with suicide attempts (SA). Red and white blood cell lineage parameters were affected, suggesting general haematopoietic modulation or imbalance. We observed distinct haematological parameter changes in women versus men, with men presenting milder alterations than women. Interestingly, we found that the List of Threatening Experiences (LTE) score, but not the Childhood Trauma Questionnaire (CTQ), was associated with the haematopoietic alterations observed exclusively in women and, more importantly, served as a parameter to stratify female MDE patients based on concurrence or non-concurrence with SA. In conclusion, grades of haematopoietic modulation in MDE patients are associated with absence or presence of SA. Haematopoietic manifestations differ between men and women and, in the latter, are markedly influenced by late, and not early, traumatic events.

Measuring psychopathology as it unfolds in daily life: addressing key assumptions of intensive longitudinal methods in the TRAILS TRANS-ID study

BACKGROUND

Intensive longitudinal (IL) designs provide the potential to study symptoms as they evolve in real-time within individuals. This has promising clinical implications, potentially allowing conclusions at the level of specific individuals. The current study aimed to establish the feasibility of IL designs, as indicated by self-rated burden and attrition, in the context of psychiatry. Additionally, we evaluated three core assumptions about the instruments (diary items) used in IL designs. These assumptions are: diary items (1) reflect experiences that change over time within individuals (indicated by item variability), (2) are interpreted consistently over time, and (3) correspond to retrospective assessments of psychopathology.

METHODS

TRAILS TRANS-ID is an add-on IL study in the clinical cohort of the TRAILS study. Daily diaries on psychopathological symptoms for six consecutive months were completed by 134 at risk young adults (age 22.6 ± 0.6 years). At baseline, immediately after the diary period, and one year after the diary period, participants completed a diagnostic interview.

RESULTS

Excellent compliance (88.5% of the diaries completed), low participant burden (M = 3.21; SD = 1.42; range 1-10), and low attrition (8.2%) supported the feasibility of six-month IL designs. Diary items differed in their variability over time. Evaluation of the consistency of diary item interpretations showed that within-individual variability in scores could not be attributed to changing interpretations over time. Further, daily symptom reports reasonably correlated with retrospective assessments (over a six month period) of psychopathology obtained with the diagnostic interview, suggesting that both measures might complement each other.

CONCLUSION

The current study is the first to show that IL designs over extensive periods (i.e., multiple months) in psychiatry are feasible, and meet three core assumptions to study change in psychopathology. This might allow for addressing novel and promising hypotheses in our field, and might substantially alter how we treat and study mental ill-health.

INTREPID II: protocol for a multistudy programme of research on untreated psychosis in India, Nigeria and Trinidad

INTRODUCTION

There are few robust and directly comparable studies of the epidemiology of psychotic disorders in the Global South. INTREPID II is designed to investigate variations in untreated psychotic disorders in the Global South in (1) incidence and presentation (2) 2-year course and outcome, (3) help-seeking and impact, and (4) physical health.

METHODS

INTREPID II is a programme of research incorporating incidence, case-control and cohort studies of psychoses in contiguous urban and rural areas in India, Nigeria and Trinidad. In each country, the target samples are 240 untreated cases with a psychotic disorder, 240 age-matched, sex-matched and neighbourhood-matched controls, and 240 relatives or caregivers. Participants will be followed, in the first instance, for 2 years. In each setting, we have developed and are employing comprehensive case-finding methods to ensure cohorts are representative of the target populations. Using methods developed during pilot work, extensive data are being collected at baseline and 2-year follow-up across several domains: clinical, social, help-seeking and impact, and biological.

ETHICS AND DISSEMINATION

Informed consent is sought, and participants are free to withdraw from the study at any time. Participants are referred to mental health services if not already in contact with these and emergency treatment arranged where necessary. All data collected are confidential, except when a participant presents a serious risk to either themselves or others. This programme has been approved by ethical review boards at all participating centres. Findings will be disseminated through international conferences, publications in international journals, and through local events for key stakeholders.

The Mediating Role of Impulsivity in the Relationship Between Suicidal Behavior and Early Traumatic Experiences in Depressed Subjects

Background: Depressed patients with early traumatic experiences may represent a clinically and biologically distinct subtype, with worse clinical outcomes and greater risk of suicide. Since early traumatic experiences alter development of systems that regulate the stress response, increasing sensitivity to stress and mood disorders later in life, certain personality features may influence coping strategies, putting individuals with depression and a history of early traumatic experiences at greater risk of suicidal behavior. Objective: To determine whether impulsivity mediates the relationship between early traumatic experiences and suicidal behavior in patients with major depressive disorder (MDD). Methods: The total sample consists of 190 patients [mean age (SD) = 53.71 (10.37); females: 66.3%], with current MDD (DSM-5 criteria). The Childhood Trauma Questionnaire-Short Form (CTQ-SF), the List of Threatening Experiences (LTE), and the Barratt Impulsiveness Scale-11 (BIS-11) were used to assess childhood and adulthood adverse life events and impulsivity, respectively. We developed mediation models by bootstrap sampling methods. Results: Eighty-one (42.6%) patients had a history of previous suicide attempts (SA). CTQ-SF-Total and BIS-11-Total scores were significantly higher in MDD patients with previous SA. Correlation analyses revealed significant correlations between the CTQ-SF-Total and BIS-11-Total, CTQ-SF-Total and HDRS-Total, and BIS-11-Total and HDRS-Total scores. Regression models found that CTQ-SF-Total, BIS-11-Total, and HDRS-Total scores were associated with SA. Mediation analyses further revealed the association between CTQ-SF-Total and SA was mediated by the indirect effect of the BIS-11-Total score (b = 0.007, 95% CI = 0.001, 0.015), after statistically controlling for sex, the HDRS-Total, and the LTE-Total. Discussion: Data suggest that impulsivity could mediate the influence of childhood trauma on suicidal behavior. This will help understand the role of risk factors in suicidal behavior and aid in the development of prevention interventions focused on modifiable mediators when risk factors are non-modifiable.

Effectiveness of a group-based psychosocial program to prevent depression and anxiety in older people attending primary health care centres: a randomised controlled trial

BACKGROUND

Evidence about the effectiveness of psychosocial interventions to reduce the incidence of depression and anxiety and promote subjective well-being in older people is limited, particularly in Latin-American countries. This study thus aims to assess a program specifically designed to address this issue in persons aged 65 to 80 and attending primary health care centres.

METHOD

Older people who use primary care centres are to be randomly assigned to the program or to a control group. Only independent users will be included; those having had a major depressive disorder or an anxiety disorder in the last 6 months will be excluded. The program is group based; it includes cognitive stimulation, expansion of social support networks and cognitive behaviour strategies. Depressive and anxiety symptoms and disorders, as well as psychological well-being, will be assessed using standardised instruments, once before implementing the program and later, after 18 and 36 weeks.

DISCUSSION

Primary care is a setting where interventions to improve mental health can be beneficial. Providing evidence-based programs that work with older people is a priority for public mental health.

TRIAL REGISTRATION

A protocol for this study has been registered prospectively at ISRCTN registry on 25 July 2018. Identifier: ISRCTN32235611 .

Predictors of short- and long-term recurrence of suicidal behavior in borderline personality disorder

OBJECTIVE

To evaluate the incidence of suicidal outcomes and risk factors for short- and long-term recurrence of suicidal behavior (SB) among high-risk borderline personality disorder (BPD) patients during a 24-month prospective follow-up period.

METHODS

A multicenter prospective cohort study was designed to compare data obtained from 136 patients admitted to the emergency department for current suicidal ideation (SI) or a recent suicide attempt (SA). Subjects were clinically evaluated and monitored for a new SA or suicide.

RESULTS

The incidence of a new SA was 25.63 events/100 persons-year, and one patient died by suicide. Child sexual abuse (CSA) was the only significant predictor throughout the complete follow-up period. The absence of prior psychiatric treatment predicts the recurrence of SB in the first 6 months of follow-up. Patient age, poor psychosocial functioning before hospitalization, age at first SA, and having multiple suicide attempts increased risk of SB recurrence at the long-term period (24th months). In addition, there was an interaction between CSA and poor psychosocial functioning that increased risk of SB.

CONCLUSION

The risk of recurrence was higher during the first 6 months. Risk factors at 6 and 24 months vary. These findings are important for implementing suicide strategies.