A Google-based approach for monitoring suicide risk

The association of internet searches and actual suicide in Spain

High suicide rates are a major issue in Spain, to the extent that they are the main non-natural cause of death in this country. The present study analyses the relationship between Internet searches and actual suicide rates in Spain. For this purpose, we employ data from actual suicide rates and Google® searches for Spain, differencing by the means used to commit suicide. Our results show that suicide ("suicidio") search term seems to be positively associated with higher total suicide rates, in addition to suicides using poison, suffocation and jumping. The suicide ("suicidio") topic presents similar results to the suicide search term, and suicide by car crash also seems to be associated with Internet searches of this topic.

Seasonal Trends in Suicide Attempts-Keywords Related Searches: A Google Trends Analysis

Suicide is a significant public health concern globally, with its varying rates influenced by numerous factors, including seasonal changes. Online search behaviors, particularly searches related to suicide and mental health, have been proposed as real-time indicators of suicidal ideation in populations. In this study, a cross-sectional time series analysis was conducted, utilizing data on suicide attempts from the Polish Police Headquarters and online search behavior from Google Trends over a decade. Suicide attempt data were analyzed alongside the frequency of Google searches for suicide-related keywords derived from the Polish Corpus of Suicide Notes. A total of 66 keywords were selected for analysis to identify seasonal trends and patterns in search behavior. The study employed linear regression, Seasonal Mann-Kendall tests, and TBATS models to analyze the data. Suicide rates show seasonal patterns, peaking in warmer months. However, keyword searches did not strongly correlate with peak suicide months. This study enhances our understanding of suicide-related search trends and their potential connection to suicide rates. It suggests avenues for more effective prevention efforts and the potential for future algorithms to predict suicide rates and identify at-risk groups.

Suicide prevention-related Google searches and subsequent emergency department visits in California and Arizona, 2007-2015

Introduction

United States emergency departments (ED) visit rates for nonfatal self-harm increased by 42% from 2001 to 2016. Previous suicide mortality research has provided conflicting evidence on the use of suicide-related Internet searches as a surveillance tool for self-harm and suicidal ideation. However, few have used rigorous approaches to account for autocorrelation at the aggregate level, and none have focused on Internet searches related to suicide prevention.

Methods and results

Over a 9-year study period (2007-2015), suicidality-related search data were extracted using the Google Health Application Programming Interface (API) for Arizona and California - states, chosen for their differing age distributions and rigorous ED injury coding policies. We examined several combined suicide prevention-related search queries. Using autoregressive integration moving average (ARIMA) models and a Box-Jenkins approach, we assessed whether increased prevention-related Internet searches related to suicidality are predictive of lower subsequent ED visits related to suicidal ideation with or without self-harm injury. In both states, greater prevention-related queries were associated with lower ED visits approximately four to six weeks later.

Conclusions

Our results indicate that Internet-based search volumes related to suicide prevention may have the potential to monitor suicidality and online suicide prevention resources offer meaningful opportunities for mental health support.

The influencing mechanism of scenic spot online attention and tourists' purchase behavior: an AISAS model based investigation

Introduction

In the era of the Internet, online digital traces have become a new way to study the online attention of scenic spots and tourists' purchase behavior. The public's information search on major search platforms is a series of manifestations of potential tourists' attention and interest in scenic spots, but there are few studies on how attention, interest and information search affect potential tourists to generate real purchase behavior.

Method

This paper selects four dimensions of short video platform, travel website, search engine and social media to comprehensively measure the online attention of high-quality scenic spots in Yunnan Province, and then establishes a gray association analytic hierarchy process based on the relevant variables of the AISAS model to empirically analyze the primary and secondary factors affecting tourists' purchase behavior.

Results

(1) From the perspective of the online attention of scenic spots on different platforms, the intensity of the public's scenic spots online attention on the four types of media platforms is in the order of travel websites, search engines, short videos and social media (2) From the perspective of spatial distribution characteristics, the online attention of high-quality scenic spots in Yunnan Province is unevenly distributed, that is, there is a big difference between the attention of higher star scenic spots and their star rating and popularity, while the attention of low-star scenic spots is not much different from their star rating and popularity (3) From the perspective of spatial agglomeration characteristics, the comprehensive online attention of high-quality scenic spots in Yunnan Province presents the spatial agglomeration characteristics of "the multi-core linkage of high-density in the east and north, and sub-high-density in the south" (4) The factors influencing the purchase behavior of potential tourists are sharing experience, attracting attention, generating interest and searching information.

Discussion

By exploring the formation mechanism of high-quality scenic spots online attention in Yunnan Province and the mechanism of its spatial differentiation, this study not only enriches the logical chain of "tourism information source → potential tourists → demand driven → tourism information search → travel preference → destination selection → purchase decision → travel experience → real tourists → feelings after traveling → focus on feedback → tourism information source," but also broadens the application scenarios and application boundaries of travel preference theory and AISAS behavior model to a certain extent.

The Treatment of Depersonalization-Derealization Disorder: A Systematic Review

Depersonalization-derealization disorder (DPD) is characterized by persistent or recurrent experiences of detachment from oneself and surroundings, as well as a sense of unreality. Considering the inadequacy of current research on treatment, we performed a systematic review of the available pharmacotherapies, neuromodulations, and psychotherapies for DPD. The systematic review protocol was based on PRISMA 2020 guidelines and pre-registered. The PubMed, Web of Science, PsycINFO, Embase, the Cochrane Library, Scopus, and ScienceDirect databases were searched from inception to June 2021. All treatments for DPD and all study types, including controlled and observational studies as well as case reports, were assessed. Of the identified 17,540 studies, 41 studies (four randomized controlled trials, one non-randomized controlled trial, 10 case series, and 26 case reports) involving 300 participants met the eligibility criteria. We identified 30 methods that have been applied independently or in combination to treat DPD since 1955. The quality of these studies was considered. The relationship between individual differences, such as symptoms, comorbidities, history, and duration since onset, and treatment effects was explored. The results suggest that a series of treatments, such as pharmacotherapies, neuromodulation, and psychotherapies, could be considered in combination. However, the quality and quantity of studies were generally low considering the high prevalence of DPD. The review concludes with suggestions for future research and an urgent call for more high-quality research.

Clinical assessment of impulsiveness and defence mechanisms in young patients with mood disorders in a two-year prospective study

AIM

There have been limited prospective investigations of early clinical markers involved in mood regulation and diagnosis change in young patients. This study aimed to evaluate the changes in impulsivity and defence mechanisms in patients with major depressive disorder (MDD) and bipolar disorder (BD) with acute symptoms and remission compared to healthy controls (HC), and possible psychological predictors of diagnosis conversion.

METHODS

Seventy-nine young MDD or BD patients and 40 HC were enrolled in a two-year prospective study. A comprehensive clinical interview focused on clinical and psychological evaluation during follow-up visits. The severity of depressive symptoms was evaluated using the Hamilton Depression Rating Scale (HDRS-17), whilst the Young Mania Rating Scale (YMRS) was used for hypo/manic symptoms during each control visit. All patients completed the Defence Style Questionnaire (DSQ-40) and Barratt Impulsiveness Scale (BIS-11).

RESULTS

Patients used more immature defences, and had significantly higher total impulsivity scores than controls. BD patients had elevated motor and non-planning impulsivity compared with HC and MDD subjects. Total and non-planning impulsiveness remained elevated in euthymia in BD and MDD compared to HC. There were no statistically significant differences in total defence styles and impulsiveness scores at baseline vs. euthymia in MDD or BD patients groups. Significantly higher dissociation scores at baseline discriminated depressive patients who convert to BD in their diagnosis.

CONCLUSIONS

Patients with acute mood symptoms used more frequent immature defences and had significantly higher total impulsivity scores than healthy persons. A lack of differences in total defence styles and impulsiveness between patients with acute symptoms and after reaching euthymia in both MDD and BD groups indicates that they are independent of disease status. Dissociation defence mechanisms may be an early diagnostic indicator of BD.

Understanding mental health conditions and key coping strategies utilized during major lockdowns in the Caribbean based on Google trends searches

The COVID-19 pandemic has prompted countries to implement extended Shelter in Place Orders (SIPOs) to restrict population movement and mitigate community spread. While these lockdown measures may be effective in containing the virus, they can substantially impact the population's well-being, potentially undermining their overall welfare. This study investigates whether major lockdowns implemented in the Caribbean produced differential changes in mental health among key English-Speaking Caribbean countries. More importantly, unlike past studies, we examine key coping strategies persons utilize during major lockdowns. Finally, this paper utilizes a novel near real-time high-frequency data source in Google Trends data analytics to assess mental health patterns and coping strategies among major Caribbean countries. Based on the results of difference-in-difference and event study models, we find positive and significant increases in searches for fear, depression, and suicide during key lockdown periods, which suggest negative mental health effects. Regarding coping strategies, searches for Zoom, learning, books, exercise, prayer, religion, and meditation increased, together with searches for addiction and marijuana. These results indicate the types of programs health administrators and policymakers can implement during lockdown periods to help local mental health communities, particularly among island communities.

Vitamin D and depressive symptoms in an early adolescent cohort

BACKGROUND

To explore the cross-sectional and longitudinal association between vitamin D and depressive symptoms across early adolescence.

METHODS

This longitudinal study included 1607 early adolescents [mean (s.d.) age, 12.49 years; 972 (60.5%) males] from the Chinese Early Adolescents Cohort, recruited from a middle school in Anhui Province and followed up annually (2019-2021). Serum 25(OH)D levels were measured in both 2019 and 2021. Self-reports on depression were assessed at each of three time points from 2019 to 2021.

RESULTS

In the whole sample, higher baseline serum 25(OH)D levels were linked with a lower risk of cumulative incident depression within two-year follow-ups (adjusted RR = 0.97, 95% CI 0.94-0.99) and the increasing trajectory of depression symptoms across the three waves (adjusted RR = 0.97, 95% CI 0.95-0.99). Baseline vitamin D deficiency (VDD) (adjusted RR = 1.50, 95% CI 1.10-2.05) were associated with an increased risk for the increasing trajectory of depression symptoms across the three waves. Remitted VDD was positively related to one dichotomous depression symptoms across three waves (adjusted OR 2.15, 95% CI 1.15-4.01). The above-mentioned significant association was also found in males. Additionally, baseline VDD (adjusted OR 1.59, 95% CI 1.04-2.44) and persistent VDD (adjusted OR 1.58, 95% CI 1.02-2.60) were linked to an increased risk of having two dichotomous depression symptoms only in males.

CONCLUSIONS

Our results highlight a prospective association between baseline vitamin D and depression risk in early adolescents. Additionally, a male-specific association between vitamin D and depression risk was observed. Our findings support a potential beneficial effect of vitamin D supplementation in reducing depression risk in early adolescents.

The safety of repeated ketamine dosing in paediatrics: A systematic review

BACKGROUND

Ketamine is emerging as an effective, rapidly acting antidepressant in adult research. Hypothetical concerns about its long-term safety and impact on the developing brain are limiting its research in children. However, a wealth of paediatric safety and dosing data exists for ketamine, given its extensive use globally as an anaesthetic, analgesic and sedative agent.

AIMS

To evaluate the safety of repeat dosing of ketamine in children.

METHODS

A systematic search of EMBASE, MEDLINE, PsycINFO, Cochrane Library and PubMed from inception to 13 April 2023 was conducted. Included studies were those reporting adverse events when ketamine was given repeatedly to children aged 5-18, for any condition. No language restrictions were applied. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline and Joanna Briggs Institute Critical Appraisal Tools Checklist for study quality assessment were used. The review process was performed independently by two reviewers.

RESULTS

Five observational studies (87 patients) were included. The maximum number of doses per patient was 42, over a maximum of 4 months. There were no serious adverse events. There was no evidence of needing higher doses with time to indicate tolerance. The longest follow-up period was 6 months. There were no long-term consequences (including neurocognitive) reported within this time frame.

CONCLUSIONS

These results suggest that, despite methodological limitations of the studies, ketamine is well tolerated and safe for use in children, even when given repeatedly in regimens analogous to those used for the treatment of depression in adults. This finding supports the expansion of research into the use of ketamine as a novel antidepressant in children.

A latent class analysis of hopelessness in relation to depression and trauma during the COVID-19 pandemic in China

BACKGROUND

Hopelessness is closely related to depression, trauma, and some organic diseases. Yet our understanding of the heterogeneity of hopelessness is limited. This study aimed to explore the heterogeneity of hopelessness, how it corresponds to the severity of depression, and the effect of traumatic experiences on it during COVID-19.

METHOD

The current study measures 28,360 Chinese college students (67.4 % of women) with the Beck Hopelessness Scale (BHS), Trauma Experience Questionnaire, and Patient Health Questionnaire-9 (PHQ-9). The method of latent class analysis (LCA) was used to identify different sub-groups of hopelessness with differences in emotion, motivation, and cognition. Logistic regression and analysis of variance were used to determine the characteristics of different sub-groups.

RESULTS

Three latent classes were identified: Negative affective cognition class (C1, N = 5940, 20.9 %), Negative thought cognition class (C2, N = 1358, 4.8 %), and Low hopelessness class (C3, N = 21,062, 74.3 %). Gender, only child or not, birthplace, family economic status, and grade are predictors of the latent category of hopelessness. There are significant differences in depression among different latent classes, and C1 > C2 > C3 (p < 0.001). Traumatic experience is a risk factor for the hopeless latent classes (OR > 1, P < 0.001).

LIMITATIONS

Research findings may not be applied to other populations and rely on subjective reports. Ignore the effects of other protective and risk factors. Lack of longitudinal research, unable to explore causality.

CONCLUSIONS

The current study provides evidence for the heterogeneity of hopelessness and informs targeted interventions for mental health problems (hopelessness) in college students.

What Google-based data can tell us about information systems theory: A review

The aim of this study is to examine the attention and acceptance of popular information systems (IS) theory. Both Google Scholar (GS) and Google Trends (GT) data related to popular IS theories from 2006 to 2020 are collected. The study provides an overview of popular IS theories and tests the pair data to show changes in GS’s total publications and GT’s public interest. Correlation analyses are conducted to investigate the relationships between GS and GT data, as well as between GS and GT data. Trend analysis reveals that there are certain IS theories that researchers and practitioners should pay attention to. In addition, this study provides an overview of recent and future directions in this field. Despite the significant increase in research using Google data, the use of big data to explore the interests and applications of IS theories has been rarely explored.

Characterizing inflammatory profiles of suicidal behavior in adolescents: Rationale and design

BACKGROUND

The suicide rate in youth and young adults continues to climb - we do not understand why this increase is occurring, nor do we have adequate tools to predict or prevent it. Increased efforts to treat underlying depression and other disorders that are highly associated with suicide have had limited impact, despite considerable financial investments in developing and disseminating available methods. Thus, there is a tremendous need to identify potential markers of suicide behavior for youth during this high-risk period.

METHODS

Funded by the American Foundation for Suicide Prevention (AFSP), this study aims to map immune dysfunction to suicidal behavior and establish a reliable immune signature of suicide risk that can 1) guide future research into fundamental pathophysiology and 2) identify targets for drug development. The study design is an observational study where blood samples and a comprehensive array of clinical measures are collected from three groups of adolescents (n = 75 each) (1) with suicidal behavior [recent (within 3 months) suicide attempt or suicidal ideation warranting urgent evaluation,] (2) at risk for mood disorders, and (3) who are healthy (no psychiatric history). Participants will complete self-report and clinical assessments, along with a blood draw, at baseline, 3 months, 6 months and 12 months, and online self-report assessments once a month.

RESULTS

The recruitment for this study is ongoing.

LIMITATIONS

Observational, variability in treatment regimens.

CONCLUSIONS

This study will help elucidate immune mechanisms that may play a causal role in suicide and serve as targets for future therapeutic development.

Association between neutrophil-lymphocyte ratio and perinatal depressive symptoms among Chinese women

OBJECTIVE

The prevalence of depression has increased dramatically in the past few decades, and pregnant women are at high risk for depression. It is widely thought that inflammation plays a critical role in the pathogenesis of depression. Therefore, we aimed to evaluate the association between the neutrophil-lymphocyte ratio (NLR), a marker of chronic immune inflammation, and perinatal depressive symptoms.

METHODS

A cohort study involving 535 pregnant women was conducted based on a prospective birth cohort in Wuhan, China. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess antepartum depression (APD) and postpartum depression (PPD) during the second trimester of pregnancy and one month after delivery. The NLR during the second trimester was determined based on a routine blood test. The association between NLR and depressive symptoms was evaluated using logistic regression analysis and restricted cubic spline (RCS) regression.

RESULTS

We found that the prevalence of APD and PPD was 8.4% and 15.1%, respectively. NLR levels were positively associated with APD (OR = 1.52, 95% CI: 1.20--1.91). After adjusting for potential confounders, the OR (95% CI) of APD for the highest NLR quartile was 4.56 (1.58, 13.13) compared with the lowest quartile. No significant association was found between NLR and PPD. RCS regression model analysis indicated a linear correlation between NLR and APD (P for non-linearity = 0.58).

CONCLUSION

Overall, elevated mid-trimester NLR is independently associated with APD but not PPD.

Students are at risk? Elucidating the impact of health risks of COVID-19 on emotional exhaustion and academic performance: role of mindfulness and online interaction quality

Although previous online learning studies have looked at how student outcomes are influenced in different settings, this study is unique in that it looks at the role of COVID-19 as a particular stressor. This study discussed how students' perceptions of health risks of COVID-19 (PHRC) influenced their academic performance through emotional exhaustion. This study also looked at how mindfulness and online interaction quality (OIQ) affected PHRC's direct effects on exhaustion, as well as PHRC's indirect effects on academic performance via exhaustion. The data for the current study were collected from 336 students in three waves who were studying online during COVID-19. The results through structural equation modeling (SEM) revealed that PHRC influenced academic performance. The results further revealed that mindfulness and OIQ attenuated the direct effects of PHRC on emotional exhaustion as well as indirect effects on academic performance through emotional exhaustion. This study provides some novel implications for practice and research.

Significantly elevated phosphatidylethanol levels in recent suicide attempters, but not in depressed controls and healthy volunteers

INTRODUCTION

Suicide is a complex transdiagnostic phenomenon. It is strongly associated with, but not exclusive to major depressive disorder (MDD). Hazardous alcohol drinking has also been linked to an increased risk of suicidal behaviours, however, it is often underreported. The study aimed to evaluate whether an objective measure of chronic alcohol use, phosphatidylethanol (PEth) could be useful as a biomarker in clinical practice.

METHOD

ology. The present case-control multi-centric study recruited 156 participants into three study groups: 52 patients treated for major depressive disorder (MDD), 51 individuals immediately following a suicide attempt (SA), and 53 volunteers. Sociodemographic data, medical history, and laboratory data, including PEth concentrations and C-reactive protein levels, were collected from study participants.

RESULTS

PEth concentrations were the highest in suicide attempters (232,54 ± 394,01 ng/ml), followed by patients with MDD (58,39 ± 135,82 ng/ml), and the control group (24,45 ± 70,83 ng/ml) (Kruskall Wallis χ2 = 12.23, df = 2, p = .002). In a multinomial logistic regression model with adjustments, PEth concentration was able to predict belonging to suicide attempters' group, but not to depression group (p = .01). Suicide attempters were also more likely to underreport their recent alcohol consumption.

LIMITATIONS

We did not analyze SA methods, psychiatric comorbidity and several other factors that might be associated with PEth levels, such as body mass index, race, and haemoglobin levels. Sample recruited in hospital settings may not be representative of the whole population. The results of this adult-only study cannot be generalized to adolescents.

CONCLUSIONS

PEth levels in recent suicide attempters significantly exceeded those of patients with MDD and controls. Suicide attempters also were more likely to underreport their alcohol consumption when questioned about their consuption. PEth might be an interesting biomarker to evaluate individuals at risk of SA.

Non-enzymatic antioxidants, macro-minerals and monocyte/high-density lipoprotein cholesterol ratio among patients with bipolar disorder

OBJECTIVE

Recent studies show that oxidative stress is related to the pathogenesis of BD. Non-enzymatic antioxidants, macro-minerals and MHR (monocyte divided by high-density lipoprotein cholesterol) participated oxidative stress and can be obtained quickly in hematological examination. This study used large-scale clinical data to investigate them between BD and healthy controls (HCs), as well as between psychotic and non-psychotic BD to explore their roles in disease progression.

METHODS

A total of 3442 BD-manic (BD-M) and 1405 BD-depression (BD-D) in acute stage and 5000 HCs were enrolled, including 1592 BD-M with psychotic symptoms (P-BD-M), 1850 BD-M without psychotic symptoms (NP-BD-M), 655 P-BD-D, 750 NP-BD-D. The differences in these biological parameter levels among different groups were compared, and the contributing factors for the occurrence of BD-M or BD-D and psychotic symptoms of BD were analyzed.

RESULTS

We found higher levels of Na and MHR, and lower levels of K, Ca and ALB in BD-M or BD-D compared with the HCs respectively; levels of K, Na, Ca, ALB and MHR have differences among P-BD-M, NP-BD-M and HC; levels of K, Na, Ca and ALB have differences among P-BD-D, NP-BD-D and HC. In multiple logistic regression, higher levels of MHR and Na were associated with BD-M; MHR was shown to be independently associated with P-BD-M; K, Na, ALB were shown to be independently associated with P-BD-D.

CONCLUSIONS

Our study highlights the role of oxidative stress in the pathophysiology of BD. There is heterogeneity between BD-M and BD-D, and different oxidative stress mechanisms of psychotic symptoms exist in BD-M and BD-D.

Real-Time Monitoring of Infectious Disease Outbreaks with a Combination of Google Trends Search Results and the Moving Epidemic Method: A Respiratory Syncytial Virus Case Study

The COVID-19 pandemic has disrupted the seasonal patterns of several infectious diseases. Understanding when and where an outbreak may occur is vital for public health planning and response. We usually rely on well-functioning surveillance systems to monitor epidemic outbreaks. However, not all countries have a well-functioning surveillance system in place, or at least not for the pathogen in question. We utilized Google Trends search results for RSV-related keywords to identify outbreaks. We evaluated the strength of the Pearson correlation coefficient between clinical surveillance data and online search data and applied the Moving Epidemic Method (MEM) to identify country-specific epidemic thresholds. Additionally, we established pseudo-RSV surveillance systems, enabling internal stakeholders to obtain insights on the speed and risk of any emerging RSV outbreaks in countries with imprecise disease surveillance systems but with Google Trends data. Strong correlations between RSV clinical surveillance data and Google Trends search results from several countries were observed. In monitoring an upcoming RSV outbreak with MEM, data collected from both systems yielded similar estimates of country-specific epidemic thresholds, starting time, and duration. We demonstrate in this study the potential of monitoring disease outbreaks in real time and complement classical disease surveillance systems by leveraging online search data.

Observational study to characterize treatment-resistant depression in Germany, France and the United Kingdom: analysis of real-world data collected through a survey of healthcare professionals

OBJECTIVE

This study describes treatment patterns, productivity, healthcare resource utilization and previous episodes of depression for patients with treatment-resistant depression (TRD).

METHODS

In this cross-sectional study, a quantitative survey was administered to 225 healthcare providers (HCPs) distributed evenly across Germany, France and the UK from July to August 2021. Each HCP was asked to answer based on medical records of five patients with TRD, defined as patients failing to respond to two or more treatments of adequate dose and duration in the same episode of major depressive disorder (MDD), which provided a sample size of 1125 patients.

RESULTS

Of the 1125 patients with TRD, 73.2% had two or more previous episodes of MDD, 46.3% had a history of suicidal ideation and 24.8% had attempted suicide. Only 26.8% of patients were employed either full-time or part-time. During the most recent/current TRD episode, 45.5% of patients received five or more lines of treatment, and 46.0% remained on monotherapy. For multiple pharmacological treatments, too many distinct combinations were used to discern trends. Overall, 60.6% of patients had at least one mental health-related hospitalization in the last 12 months; 35.0% had two or more hospitalizations. Half of TRD patients saw a doctor five or more times per year for their depression.

CONCLUSIONS

This study addresses the knowledge gap about treatment patterns and healthcare utilization in real-world practice for TRD patients in three European countries. It provides data that potentially could inform treatment guideline development and optimize patient-perceived benefits from the treatment of TRD.

Understanding treatment-resistant depression using "omics" techniques: A systematic review

BACKGROUND

Treatment-resistant depression (TRD) results in huge healthcare costs and poor patient clinical outcomes. Most studies have adopted a "candidate mechanism" approach to investigate TRD pathogenesis, however this is made more challenging due to the complex and heterogeneous nature of this condition. High-throughput "omics" technologies can provide a more holistic view and further insight into the underlying mechanisms involved in TRD development, expanding knowledge beyond already-identified mechanisms. This systematic review assessed the information from studies that examined TRD using hypothesis-free omics techniques.

METHODS

PubMed, MEDLINE, Embase, APA PsycInfo, Scopus and Web of Science databases were searched on July 2022. 37 human studies met the eligibility criteria, totalling 17,518 TRD patients, 571,402 healthy controls and 62,279 non-TRD depressed patients (including antidepressant responders and untreated MDD patients).

RESULTS

Significant findings were reported that implicate the role in TRD of various molecules, including polymorphisms, genes, mRNAs and microRNAs. The pathways most commonly reported by the identified studies were involved in immune system and inflammation, neuroplasticity, calcium signalling and neurotransmitters.

LIMITATIONS

Small sample sizes, variability in defining TRD, and heterogeneity in study design and methodology.

CONCLUSIONS

These findings provide insight into TRD pathophysiology, proposing future research directions for novel drug targets and potential biomarkers for clinical staging and response to antidepressants (citalopram/escitalopram in particular) and electroconvulsive therapy (ECT). Further validation is warranted in large prospective studies using standardised TRD criteria. A multi-omics and systems biology strategy with a collaborative effort will likely deliver robust findings for translation into the clinic.

Bending not breaking: coping among Filipino University students experiencing psychological distress during the Global Health Crisis

The impact of the global health crisis on students' mental health has been well documented. While most of the studies looked into the psychological impact of the coronavirus disease, the process of coping with psychological distress as experienced by university students in the Philippines remains unexamined. Cognizant of the dearth in literature, this grounded theory study purports to investigate and understand the coping processes among 20 Filipino university students. A comprehensive model highlights Filipino university students' coping techniques with psychological distress through vertical and horizontal analysis of the field text, open, axial, and selective coding. To ensure the trustworthiness and truthfulness of the theory and for refinement and consistency, triangulation, peer debriefing, and member checking validation strategies were likewise employed. The novel and distinct B.E.N.D. Model of Coping with Psychological Distress illustrates a substantive four-phased process symbolic of the challenges that a bamboo tree underwent, namely: (1) Befuddling Phase, (2) Enduring Phase, (3) Navigating Phase, and (4) Developing Phase. The phases that emerged had the advanced appreciable understanding of the university students' coping processes that may provide evidence-based information in crafting programs and specific interventions to support and safeguard students' mental health.

Social anxiety in adolescents and young adults from the general population: an epidemiological characterization of fear and avoidance in different social situations

Social Anxiety Disorder (SAD) and, more generally, social fears are common in young people. Although avoidance behaviors are known to be an important maintaining factor of social anxiety, little is known about the severity and occurrence of avoidance behaviors in young people from the general population, hampering approaches for early identification and intervention. Symptoms, syndromes, and diagnoses of DSM-5 mental disorders including SAD were assessed in a random population-based sample of 14-21-year-olds (n = 1,180) from Dresden, Germany, in 2015/2016 using a standardized diagnostic interview (DIA-X-5/D-CIDI). An adapted version of the Liebowitz Social Anxiety Scale was used to ascertain the extent of social fears and avoidance. Diagnostic criteria for lifetime SAD were met by n = 82 participants, resulting in a weighted lifetime prevalence of 6.6%. Social anxiety was predominantly reported for test situations and when speaking or performing in front of others. Avoidance was most prevalent in the latter situations. On average, anxiety and avoidance first occurred at ages 11 and 12, respectively, with avoidance occurring in most cases either at about the same age as anxiety or slightly later. In the total sample, lifetime prevalence for most DSM-5 disorders increased with the severity of social anxiety and avoidance. Results underline the need for preventive or early intervention efforts especially regarding test anxiety and fear and avoidance of speaking in front of others. These situations are particularly relevant in youth. Avoidance behaviors may also be discussed as diagnostic marker for early case identification.

Association between neutrophil to lymphocyte ratio and mood polarity in adolescents admitted to an inpatient psychiatric ward

Inflammatory processes are associated with mood disorders, but data on pediatric patients are scarce. The aim of this study was to investigate a possible association between elevated neutrophil/lymphocyte ratio (NLR) - a marker of inflammation and mood polarity (manic/depressed) in adolescents, admitted between 2010 and 2015 due to a mood disorder episode and to an adolescent inpatient ward. Electronic medical records of 305 patients (aged 10-19 years, 60.6% males) admitted during the study period due to a mood disorder episode were reviewed. Of these, 63 were diagnosed with manic episodes and 242 with depressive episodes. Multivariate analyses were used to compare NLR between and within the two groups, covarying for age, sex, and antipsychotic use. NLR was significantly higher in the manic episode group compared with the depression one. Moreover, in inpatients with multiple hospitalizations, the NLR was higher during their manic episodes than that during their nonmanic states. These results suggest that, as has been reported in adults with bipolar disorder, inflammatory mechanisms may be involved in adolescents' mood disorders as well, particularly in the manic episodes. Thus, clinicians may consider adding anti-inflammatories as part of the treatment of these patients.

Effects of childhood trauma on nonsuicidal self-injury in adolescent patients with bipolar II depression

OBJECTIVE

This study was performed to explore the effect of childhood trauma on nonsuicidal self-injury (NSSI) in adolescents with bipolar II (BD II) depression.

METHODS

Based on the diagnostic criteria of the DSM-5 and structured interviews to assess the presence or absence of NSSI, 184 adolescent patients with BD II depression were divided into the NSSI (n = 112) and non-NSSI (n = 72) groups. The Adolescent Nonsuicidal Self-Injury Assessment Questionnaire (ANSAQ), Childhood Trauma Questionnaire-Short Form (CTQ-SF), Toronto Alexithymia Scale (TAS-20), Hamilton Depression Scale (HAMD), and Hamilton Anxiety Scale (HAMA) were used to assess the subjects.

RESULT

The CTQ-SF, HAMD, HAMA, and TAS-20 scores were significantly higher in the NSSI group than in the non-NSSI group (p &lt; .01). Logistic regression analysis showed emotional abuse (p = .028, OR = 1.14, 95% CI = 1.01-1.28) and age of onset (p = .009) as risk factors for NSSI. Adolescents with onset age 12-13 years (OR = 6.30, 95% CI = 1.72-23.10) and 14-15 years (OR = 2.24, 95% CI = 1.04-4.84) had a higher risk of self-injury relative to adolescents aged 16-18 years.

CONCLUSION

Childhood trauma and alexithymia were important influencing factors in adolescent patients with BD II depression. Emotional abuse and age of onset as risk factors for NSSI, and difficulties in emotion recognition were positively associated with the patients' NSSI.

Decision tree distinguish affective disorder diagnosis from psychotic disorder diagnosis with clinical and lab factors

Background

Affective symptoms usually occur at the same time of psychotic symptoms. An effective predictive method would help the differential diagnosis at an early stage of the mental disorder. The purpose of the study was to establish a predictive model by using laboratory indexes and clinical factors to improve the diagnostic accuracy.

Methods

Subjects were patients diagnosed with psychiatric disorders with affective and/or psychotic symptoms. Two patient samples were collected in the study (n = 309) With three classification methods (logistic regression, decision tree, and discriminant analysis), we established the models and verified the models.

Results

Seven predictors were found to be significant to distinguish the affective disorder diagnosis from the psychotic disorder diagnosis in all three methods, the 7 factors were Activities of daily living, direct bilirubin, apolipoproteinA1, lactic dehydrogenase, creatinine, monocyte count and interleukin-8. The decision tree outperformed the other 2 methods in area under the receiver operating characteristic curve, and also had the highest percentage of correctly classification.

Conclusion

We established a predictive model that included activities of daily living, biochemical, and immune indicators. In addition, the model established by the decision tree method had the highest predictive power, which provided a reliable basis for future clinical work. Our work would help make diagnosis more accurate at an early stage of the disorder.

The relationship between shoulder pain and shoulder disability in women: The mediating role of sleep quality and psychological disorders

The number of patients complaining of shoulder pain is gradually increasing, and women with shoulder pain in particular tend to present with psychological disorders and poor sleep quality. Therefore, the purpose of this study was to investigate whether psychological disorder and poor sleep quality mediated the relationship between shoulder pain and shoulder disability in women. This is a descriptive survey study of 222 women from 3 community centers in Seoul and Gyeonggi-do regions in South Korea. Data about shoulder pain, shoulder disability, sleep quality, depression, anxiety, and stress were collected using structured questionnaires between May 10 and June 7, 2021, and were analyzed by serial mediation analysis. The direct effect of shoulder pain on shoulder disability was statistically significant. Serial mediation model showed that sleep quality and psychological disorders (depression, anxiety, and stress) were sequential mediators between shoulder pain and shoulder disability among women. The relationship between shoulder pain and shoulder disability among women was partially mediated by sleep quality and psychological disorders (depression, anxiety, and stress). The results emphasize the importance of sleep quality and psychological factors in shoulder disability and suggest the use of strategies to improve sleep quality and alleviate psychological factors when developing an intervention program to mitigate shoulder disability in women with shoulder pain.

The positive effects of combined breathing techniques and cold exposure on perceived stress: a randomised trial

A pranayama-inspired breathing technique, cold exposure, and their combined application were assessed for their potential to reduce perceived stress in adults and compared to a control group. An experiment involving four groups was conducted, yielding separate cells for breathing technique-only and cold exposure-only, as well as a combined treatment and a control group. Eighty-six individuals participated in the study. Perceived stress is measured employing the 10-item version of the Perceived Stress Scale (PSS-10) and the 20-item version of the Perceived Stress Questionnaire (PSQ). The instruments exhibit a substantial correlation (r = 0.842, p < 0.001). The combined group exhibited a medium to large positive effect on perceived stress compared to the control group. The breathing technique and cold exposure on their own were not found to yield substantial effects, indicating synergies between both exercises. Combinations of breathing techniques and cold exposure may be employed to decrease individuals' perceived stress.

Online public attention toward allergic rhinitis in Wuhan, China: Infodemiology study using Baidu index and meteorological data

Background

With the popularization of the Internet and medical knowledge, more and more people are learning about allergic rhinitis (AR) on the Internet.

Objective

This study aims to analyze the epidemiological characteristics and online public attention to AR in Wuhan, China, utilizing the most popular search engine in mainland China and meteorological data of Wuhan.

Methods

To study the Internet attention and epidemiological characteristics of AR in Wuhan, the search volume (SV) of "Allergic Rhinitis" in Mandarin and AR-related search terms from 1 January 2014 through 31 December 2021 were recorded. For user interest, the search and demand data were collected and analyzed.

Results

The yearly average Baidu SV of AR in both Wuhan and China increased year by year but began to decline gradually after the COVID-19 pandemic. Baidu SV of AR in Wuhan exhibited significant seasonal variation, with the first peak was from March to May and the second peak occurring between September and October. Correlation analysis revealed a moderate positive correlation between the monthly average SV of "Allergic Rhinitis" and "Mites" and "Mites + Pollen Allergy" in Wuhan, a weak positive correlation between the monthly average SV of "Allergic Rhinitis" and "Pollen Allergy," and a positive correlation between monthly SV of "Allergic Rhinitis" and the meteorological index of pollen allergy (MIPA).

Conclusion

The attention given to the topic on the internet, as measured by the search volume, was reflective of the situation in Wuhan, China. It has the potential to predict the epidemiological characteristics of AR and help medical professionals more effectively plan seasonal AR health education.

Understanding the development of bipolar disorder and borderline personality disorder in young people: a meta-review of systematic reviews

BACKGROUND

There is ongoing debate on the nosological position of bipolar disorder (BD) and borderline personality disorder (BPD). Identifying the unique and shared risks, developmental pathways, and symptoms in emerging BD and BPD could help the field refine aetiological hypotheses and improve the prediction of the onset of these disorders. This study aimed to: (a) systematically synthesise the available evidence from systematic reviews (SRs) and meta-analyses (MAs) concerning environmental, psychosocial, biological, and clinical factors leading to the emergence of BD and BPD; (b) identify the main differences and common features between the two disorders to characterise their complex interplay and, (c) highlight remaining evidence gaps.

METHODS

Data sources were; PubMed, PsychINFO, Embase, Cochrane, CINAHL, Medline, ISI Web of Science. Overlap of included SRs/MAs was assessed using the corrected covered area process. The methodological quality of each included SR and MA was assessed using the AMSTAR.

RESULTS

22 SRs and MAs involving 249 prospective studies met eligibility criteria. Results demonstrated that family history of psychopathology, affective instability, attention deficit hyperactivity disorder, anxiety disorders, depression, sleep disturbances, substance abuse, psychotic symptoms, suicidality, childhood adversity and temperament were common predisposing factors across both disorders. There are also distinct factors specific to emerging BD or BPD.

CONCLUSIONS

Prospective studies are required to increase our understanding of the development of BD and BPD onset and their complex interplay by concurrently examining multiple measures in BD and BPD at-risk populations.

Screening for media use in the ED among young Australians: a cross-sectional study (Preprint)

BACKGROUND

Research on problematic internet use has largely adhered to addiction paradigms, possibly impeding the identification of specific internet behaviors related to psychopathology. This study presents a novel approach to screening for specific problematic internet behaviors by using a new measure, the emergency department media use screener (EDMUS).

OBJECTIVE

The purpose of this study was to identify patterns of internet use in young people presenting with mental health concerns to the emergency department (ED), ascertain associations with their mental health, and evaluate whether the EDMUS can be used to predict subsequent ED presentations within 3 months.

METHODS

This cross-sectional retrospective study of Australian young people (N=149, aged 11-25 years; female: n=92, 61.7%) sought to use the EDMUS, a 24-item questionnaire, to identify problematic internet behaviors, including accessing or posting prosuicidal or proeating disorder content, cyberbullying, and inappropriate digital content. Data on each person's mental health were extracted from electronic medical records to look for associations with EDMUS responses and ED re-presentation over 3 months. EDMUS items were grouped into clusters for analysis using chi-square tests, binary logistic regression, and path analyses.

RESULTS

Sharing suicidal digital content was the most common problematic internet use pattern identified by the EDMUS. However, this did not correlate with having a prior mental health diagnosis or predict readmission. Most participants had families with a concern for their internet use; however, this was less likely in participants with a diagnosis of personality disorder. Diagnoses of personality disorder or posttraumatic stress disorder were independent predictors of readmission (P=.003; P=.048).

CONCLUSIONS

Although a history of complex psychopathology increases the likelihood of subsequent ED presentations, its links to internet use-related behaviors are still unclear. The EDMUS has potential for identifying young people who are most vulnerable to problematic internet behaviors and offers the opportunity for early intervention and potential prevention of more entrenched difficulties.

Investigating the relationship between sensory processing sensitivity and relationship satisfaction: mediating roles of negative affectivity and conflict resolution style

Very few studies have investigated the relationship between sensory processing sensitivity (SPS) and interpersonal variables; none has particularly focused on romantic relationship satisfaction. In the context of romantic relationships, this study aimed to identify whether SPS is a risk factor (hypothesizing that traits make individuals more vulnerable to the effects of adverse environments) or a susceptibility marker (hypothesizing that traits make individuals more susceptible to the effects of both nourishing and adverse environments). To understand this, we tested whether an increased level of SPS is associated with a decreased level of romantic relationship satisfaction through negative affectivity and conflict resolution styles. Furthermore, we tested whether these proposed relationships intensified when the childhood environment was negative. A total of 206 unmarried young adults who had been in a romantic relationship for at least two years completed the measures of SPS, childhood environment, negative affectivity, conflict resolution styles, and relationship satisfaction. The results indicated that negative affectivity and negative conflict resolution styles mediated the association between SPS and satisfaction in a relationship; however, childhood environment did not moderate these relationships. These findings suggest that beyond childhood factors, SPS is an independent risk factor for developing negative outcomes in romantic relationships. This study also significantly contributes to the literature by revealing the possible mechanisms between SPS and romantic relationship satisfaction.

Cognitive, emotional, physical, and behavioral stress-related symptoms and coping strategies among university students during the third wave of COVID-19 pandemic

Background

Stress is manifested by different physical, cognitive, emotional, and behavioral stress-related symptoms, and everyone experiences it uniquely. The COVID-19 Pandemic has tremendously affected university students' lives. So, we conducted this study to determine the stress frequency, causes, determinants, and related symptoms involving physical, cognitive, emotional, and behavioral traits and coping strategies among university students in Egypt during the third wave of the COVID-19 pandemic, 2021.

Methods

Cross-sectional study targeted 1,467 randomly selected undergraduate university students, representing all colleges from 30 universities in Egypt, through a validated self-administrated questionnaire.

Results

The total stress-related symptom score was statistically significant (p < 0.05), higher among females, married, living on campus, with a (B) GPA, and those who had both organic and psychological disorders. The top 10 prevalent physical symptoms were headaches, chronic fatigue, hair loss, low back pain, neck pain, shoulders and arm pain, ophthalmological symptoms, acne, shakiness of extremities, and palpitations, respectively. The most reported symptoms regarding the cognitive, emotional, and behavioral aspects were anxiety and racing thoughts, moodiness and irritability, and excessive sleeping, respectively. Nine hundred and thirty-seven (63.9%) reported that the COVID-19 pandemic badly affected their lives, either directly or indirectly. The study showed that the prevalence of stress among university students is more than 97%. One thousand and five (68.5%) preferred isolation as a relieving technique.

Conclusion

Stress and its related physical, cognitive, emotional, and behavioral symptoms are prevalent among university students. Most of the university students who were recruited reported that the COVID-19 pandemic badly affected their lives and used negative ways to deal with stress, like staying alone and sleeping too much. Positive ways to deal with stress, like seeing a therapist or meditating, were less common.

Stressors and uplifts of confinement due to covid‐19: A longitudinal study on mental health in a sample of academic and administrative university staff in Spain

The rapid spread of COVID-19 caused many countries to decide to enter full lockdown, a circumstance that impacted all aspects of life, including mental health. The present longitudinal study aimed to analyse how stressors and uplifts of confinement were linked to psychological symptoms at three different time points: during the full lockdown (wave 1), after the gradual lifting of restrictions (wave 2) and after confinement (wave 3). The sample was made up by one hundred and twenty academic and administrative staff from a big University in Spain, they all completed an online survey. Results showed that psychological status did not change over time, but a significant interindividual variability was found throughout. Some stressors were only linked to symptoms at wave 1, but others maintained their associations during waves 2 and 3. Uplifts were, for the most part, inversely (and exclusively) linked to symptoms at wave 1. However, some of them, although enjoyable, were paradoxically linked to worse mental health at wave 1, and even at waves 2 and 3. These findings highlight the importance of providing preventive psychological strategies for mental distress before, during and after confinement.

Pro-inflammatory cytokines and cognitive dysfunction among patients with bipolar disorder and major depression

AIM

Bipolar disorder and major depressive disorder (MDD) have been demonstrated to be associated with proinflammatory states and cognitive function deficits. We aimed to investigate the differences of cognitive function and proinflammatory cytokines between patients with bipolar I disorder (BDI), bipolar II disorder (BDII), and MDD.

METHODS

Thirty-seven patients with BDI, 33 with BDII, 25 with MDD, and 54 age-, sex-matched controls were enrolled. All patients had a clinical global impression-severity scale ≤2. Serum levels of proinflammatory markers, including soluble interleukin-6 receptor, C-reactive protein, and soluble tumor necrosis factor receptor 1 (sTNF-αR1) were measured. Performance in the Word List Memory Task (WLMT), Wisconsin Card Sorting Task (WCST), 2-back task, Go/No-Go task, and divided attention task was assessed.

RESULTS

Patients with BDI had higher levels of sTNF-αR1 than patients with MDD and controls (P < 0.001). Patients with BDI performed worse on WLMT, WCST, 2-back task, divided attention_visual and divided attention_auditory tasks than the other three groups (all P < 0.05). Furthermore, sTNF-αR1 levels were negatively correlated with cognitive function measured using the WLMT and divided attention_auditory (all P < 0.05).

CONCLUSIONS

Patients with BDI had higher levels of sTNF-αR1 and cognitive function impairments than the remaining groups. Future studies are needed to explore the pathophysiology of sTNF-αR1 in the contribution of cognitive alterations.

The relationship between suicidal thoughts and well-being among individuals with a history of depression and cardiovascular risk

Prior work demonstrates a relationship between suicidal behavior and mood disorders, as well as between suicidal behavior and cardiovascular risk. When cardiovascular risk and mood disorders co-occur, people with these comorbid conditions tend to experience worse outcomes than people with only one of these conditions. As such, given the relevance of suicidal thoughts and behaviors among those with cardiovascular risk and mood disorders, suicidal thoughts and behaviors may be of particular concern in the comorbid population. However, the factors that differentiate those with or without suicidal thoughts or behaviors are unknown. Self-reported well-being is one factor that is shown to hold a relationship with suicidal risk, and may be relevant in the comorbid population. Thus, we evaluated whether different levels of well-being relate to suicidal thoughts and behaviors among individuals (N = 340) with lifetime mood disorders and cardiovascular risk who participated in a 16-week online exercise study. Participants completed self-report assessments of lifetime (per the MINI International Neuropsychiatric Interview) and current (per the Patient Health Questionnaire-9) suicidal thoughts and behaviors, as well as a self-report assessment of well-being (per the WHO-5 Well-Being Index). We found that individuals with lifetime and current suicidal thinking had lower total WHO-5 scores over the study period. These data suggest that, among those with a history of depression and who have or are at-risk for cardiovascular disease, the risk of current or lifetime suicidal thoughts and behaviors may be increased for those who experience decreased well-being.

The motivations and their conditions which drive students to seek higher education in a foreign country

This article summarizes a vast literature tracing the plethora of motivations of international students to study abroad. We detail the push factors (i.e., personal goals) and pull factors (i.e., attracting elements) for this decision to pursue higher education overseas. To elaborate, the push factors are around the attainment and/or increase of three main capitals: human, financial and psychological. Pull factors are around the attracting capacity of three main entities: the destination country, the hosting city and the academic institution. Furthermore, the paper highlights the conditions that may enhance or inhibit student mobility for higher education abroad (for example, social networks, transportation accessibility, legal requirements and more). Special reference is given to the mobility of international students in the COVID-19 pandemic.

Effect of valproate and lithium on dementia onset risk in bipolar disorder patients

Although valproate and lithium are most commonly prescribed for bipolar disorder patients, studies comparing their effects on the risk of dementia are limited. Choosing a safer mood stabilizer is clinically crucial as elderly bipolar disorder patients are at high risk of dementia onset. Therefore, we aim to evaluate and compare the effects of valproate and lithium on the risk of dementia in elderly bipolar disorder patients. This study involved 4784 bipolar disorder patients aged 50 years or older from the Korean Health Insurance Review and Assessment Service database. We estimated the risk of dementia in valproate-only users, lithium-only users, and both users compared to both medication non-users using multivariable Cox proportional hazard models. Compared to non-users, valproate-only users and both users showed a higher risk of dementia (59% and 62%, respectively). In sub-group analysis, valproate increased the dementia risk when prescribed for at least 59 days or 23 cumulative defined daily doses. However, the dementia risk associated with lithium is unclear. Therefore, we concluded that lithium has the potential to be the safer choice as a mood stabilizer over valproate for elderly bipolar disorder patients considering the risk of dementia.

Prediction model for suicide based on back propagation neural network and multilayer perceptron

Introduction

The aim was to explore the neural network prediction model for suicide based on back propagation (BP) and multilayer perceptron, in order to establish the popular, non-invasive, brief and more precise prediction model of suicide.

Materials and method

Data were collected by psychological autopsy (PA) in 16 rural counties from three provinces in China. The questionnaire was designed to investigate factors for suicide. Univariate statistical methods were used to preliminary filter factors, and BP neural network and multilayer perceptron were employed to establish the prediction model of suicide.

Results

The overall percentage correct of samples was 80.9% in logistic regression model. The total coincidence rate for all samples was 82.9% and the area under ROC curve was about 82.0% in the Back Propagation Neural Network (BPNN) prediction model. The AUC of the optimal multilayer perceptron prediction model was above 90% in multilayer perceptron model. The discrimination efficiency of the multilayer perceptron model was superior to BPNN model.

Conclusions

The neural network prediction models have greater accuracy than traditional methods. The multilayer perceptron is the best prediction model of suicide. The neural network prediction model has significance for clinical diagnosis and developing an artificial intelligence (AI) auxiliary clinical system.

The psychological impact of COVID-19 on university students in China and Africa

The COVID-19 pandemic is alarmingly a global health catastrophe that has created an unprecedented mental health decline especially in young adults, who have been noted to be a vulnerable population. In this study, we investigated the prevalence of depression and anxiety in university students in China and Africa during the COVID-19 pandemic, the significant factors contributing to the prevalence of anxiety and depression, the differences in factors affecting the different groups being investigated and to emphasize that psychological intervention are as important as the physical interventions during and after the pandemic. The study was conducted through online surveys, with 684 participants using Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 standardized scales. Comparing all groups combined, of the 636 participants, 361 (56.8%) had depression and 227 (35.7%) had anxiety. Chi squared tests at significance level (P<0.05) showed that country of citizenship, religion, parents’ educational background, household monthly income and, having family members with COVID-19 variables were strongly associated with depression and anxiety. In contrast, age, gender, educational background, and major showed no significant association. Comparing the individual groups separately using chi square (P<0.05), the Chinese students in China group had 35.6% with depression and 13.1% with anxiety. The variable associated with both depression and anxiety was education major, with depression only was parent’s educational background and with anxiety only was gender. The African students in China group had 70.3% with depression and 45.0% with anxiety. Gender was strongly associated with both depression and anxiety, and religion and having family members with COVID-19 with anxiety only. Africans in Africa had 66.0% with depression and 50.5% with anxiety. Educational background was strongly associated with depression. There was no statistically significant variable for anxiety. Chi square test showed a statistically significant difference in depression and anxiety levels with the Chinese group compared to both African groups, and no significant difference between both African groups. Our findings demonstrated that COVID-19 had a negative psychological impact on university students. Therefore, more attention should be put on youth’s mental health during this pandemic.

Attachment style dimensions are associated with neural activation during projection of mental states

The aim of the present study was to investigate the association between attachment dimensions and neural correlates in response to the Rorschach inkblots. Twenty-seven healthy volunteers were recruited for the electroencephalographic registration during a visual presentation of the Rorschach inkblots and polygonal shapes. The Attachment Style Questionnaire (ASQ) was administered to participants. Correlations between the ASQ scores and standardized low-resolution brain electromagnetic tomography (sLORETA) intensities were performed. The Rorschach inkblots elicited several projective responses greater than the polygonal shapes (distortions, human and total movements, and embellishments). Only during the Rorschach inkblots presentation, discomfort with closeness and relationships as secondary subscales were negatively correlated with the activation of right hippocampus, parahippocampus, amygdala, and insula; need for approval subscale was negatively correlated with the activation of orbital and prefrontal cortex and left hippocampus. Moreover, the correlations between attachment dimensions and neural activation during the Rorschach inkblots were significantly higher compared to the same correlations in response to polygonal shapes. These findings suggest that attachment style can modulate brain activation during the projective activity of the Rorschach inkblots.

Development and Application of Global Health Events-Mental Stress Scale for Assessment of Medical Staff's Acute Mental Stress Responses

Background

Medical workers have been increasingly involved in emergent public health events, which can lead to severe stress. However, no standardized, officially recognized, unified tool exists for mental distress measurement in medical workers who experienced the public health events.

Purpose

In the present study, we propose the Global Health Events-Mental Stress Scale (GHE-MSS), as a revised version of the Impact of Event Scale-Revision (IES-R), for assessment of medical workers’ acute mental stress responses within one month and their chronic mental stress responses within six months after major health events.

Patients and methods

The IES-R was slightly modified, developed, and its reliability and validity were tested using the Delphi survey, primary survey with 115 participants, formal survey with 300 participants, and clinical evaluation with 566 participants.

Results

Exploratory factor analysis and confirmatory factor analysis confirmed a promising validity of the scale. The values of Cronbach’s alpha coefficient, the Spearman-Brown coefficient, and the retested Cronbach’s alpha coefficient of the scale applied for the clinical evaluation were 0.88, 0.87, and 0.98, respectively, which confirmed a good internal consistency and stability. The results of the goodness-of-fit test indicated a good adaptation of the model. A correlation analysis was conducted to assess the correlation between the GHE-MSS and the PCL-C, which had a correlation coefficient of 0.68 (P<0.01).

Conclusion

GHE-MSS can be applied with a promising reliability and validity for the assessment of the acute mental stress response of medical workers experiencing public health events. This method can also be used for the screening of mental stress-associated disorders.

Factors Affecting the Psychological Well-Being of Health Care Workers During the COVID-19 Crisis

Background

Health care workers (HCWs) are a group that especially suffered during the COVID-19 pandemic. In addition to facing the stress of dealing with patients and social isolation, they had to worry about being infected themselves and transmitting the infection to their families. This study evaluated the fear, anxiety, and depression experienced by HCWs during the COVID-19 crisis.

Subjects and Methods

The sample size was 541 HCWs. Data collection was done using an online validated questionnaire through Google Docs, sent to HCWs by email and WhatsApp groups. We assessed depression and anxiety with the 4-item Patient Health Questionnaire-4 (PHQ-4), while evaluating fear with the Fear of COVID-19 Scale (FCV-19S).

Results

A statistically significant difference was found in the perception of fear between married and unmarried people, and between those with colleagues who had died from COVID-19 infection and those without. There was a significant relation between HCWs' anxiety and a history of death from COVID-19 infection, either of friends or of close relatives. The prevalence of depression was 18.48% in the tested sample of HCWs. Participants who had close relatives or friends infected with COVID-19 showed a significantly higher degree of depression. The age group <30 and those working 20 to 30 hours weekly showed higher degrees of anxiety and depression.

Conclusion

Sociodemographic variables such as age, marital status, and working area had a significant impact on the mental and psychological health of HCWs during the COVID-19 crisis. HCWs who lost patients due to COVID-19 had a significantly higher prevalence of fear, depression, and anxiety.