Mental Health Effects of Hurricane Sandy on Older Adults

International study of the Complex Stress Reaction Syndrome: Implications for transdiagnostic clinical practice

BACKGROUND

The debate regarding diagnostic classification systems in psychiatry (categorial vs dimensional systems) has essential implications for the diagnosis, prevention and treatment of stress reactions. We previously found a unique pattern of stress reaction in a study executed during the coronavirus disease 2019 pandemic using large representative samples in two countries, and termed it the Complex Stress Reaction Syndrome (CSRS).

AIM

To investigate CSRS, Type A (psychiatric symptoms, spanning anxiety, depression, stress symptoms, and post-traumatic stress disorder (PTSD)), with or without long-coronavirus disease (COVID) residuals (CSRS, Type B, neuropsychiatric symptoms spanning cognitive deficits and fatigue, excluding systemic symptoms). Our two-tailed hypothesis was that CSRS is a condition related to an unrecognized type of stress reaction in daily life in the general population (Type A) or that it is related to the severe acute respiratory syndrome coronavirus 2 infection and its long-COVID residuals (Type B).

METHODS

977 individuals in four continents (North America, Europe, Australia and the Middle East) completed the online study questionnaire in six languages using the Qualtrics platform. The study was managed by six teams in six countries that promoted the study on social media. The questionnaire assessed anxiety, depression, stress symptoms and PTSD (CSRS, Type A), cognitive deficits and fatigue (CSRS, Type B). The data were analyzed using Proportion Analyses, Multivariate Analysis of Co-Variance (MANCOVA), linear regression analyses and validated clinical cutoff points.

RESULTS

The results of the Proportion Analyses showed that the prevalence of 4 symptoms spanning anxiety, depression, stress symptoms, and PTSD was significantly higher than the most prevalent combinations of fewer symptoms across 4 continents, age groups, and gender. This supports the transdiagnostic argument embedded in the CSRS (Type A). The same pattern of results was found in infected/recovered individuals. The prevalence of the 4 psychiatric symptoms combination was significantly greater than that of 5 and 6 symptoms, when adding cognitive deficits and fatigue, respectively. MANCOVA showed a significant three-way interaction (age × gender × continent). Further analyses showed that the sources of this three-way interaction were threefold relating to two sub-populations at-risk: (1) Individuals that self-identified as non-binary gender scored significantly higher on all 4 psychiatric symptoms of the CSRS, Type A at young age groups (< 50 years old) in North America compared to (self-identified) women and men located in the 4 continents studied, and to other ages across the adult life span; and (2) This pattern of results (CSRS, Type A) was found also in women at young ages (< 40 years old) in North America who scored higher compared to men and women in other continents and other ages. Linear regression analyses confirmed the MANCOVA results.

CONCLUSION

These results show a combined mental health risk factor related to stress reactivity, suggesting that the CSRS is sensitive to populations at risk and may be applied to future identification of other vulnerable sub-populations. It also supports the transdiagnostic approach for more accurate prevention and treatment. Time will tell if such transdiagnostic syndromes will be part of the discussions on the next revisions of the traditional classification systems or whether the crisis in psychiatry further evolves.

Not one thing at a time: When concomitant multiple stressors produce a transdiagnostic clinical picture

A condition of exposure to multiple stressors resulting in a mixed clinical picture spanning conventional categories without meeting any of them in full, encompasses a risk for a list of comorbidities preventing appropriate prevention and treatment. New transformative transdiagnostic approaches suggest changes spanning conventional categories. They base their systems of classification on biomarkers as well as on brain structural and functional dysregulation as associated with behavioral and emotional symptoms. These new approaches received critiques for not being specific enough and for suggesting a few biomarkers for psychopathology as a whole. Therefore, they put the value of differential diagnosis at risk of avoiding appropriate derived prevention and treatment. Multiplicity of stressors has been considered mostly during and following catastrophes, without considering the resulting mixed clinical picture and life event concomitant stressors. We herewith suggest a new category within the conventional classification systems: The Complex Stress Reaction Syndrome, for a condition of multiplicity of stressors, which showed a mixed clinical picture for daily life in the post coronavirus disease 2019 era, in the general population. We argue that this condition may be relevant to daily, regular life, across the lifespan, and beyond conditions of catastrophes. We further argue that this condition may worsen without professional care and it may develop into a severe mental health disorder, more costly to health systems and the suffering individuals. Means for derived prevention and treatment are discussed.

Short-term effects of tropical cyclones on the incidence of dengue: a time-series study in Guangzhou, China

Background

Limited evidence is available about the association between tropical cyclones and dengue incidence. This study aimed to examine the effects of tropical cyclones on the incidence of dengue and to explore the vulnerable populations in Guangzhou, China.

Methods

Weekly dengue case data, tropical cyclone and meteorological data during the tropical cyclones season (June to October) from 2015 to 2019 were collected for the study. A quasi-Poisson generalized linear model combined with a distributed lag non-linear model was conducted to quantify the association between tropical cyclones and dengue, controlling for meteorological factors, seasonality, and long-term trend. Proportion of dengue cases attributable to tropical cyclone exposure was calculated. The effect difference by sex and age groups was calculated to identify vulnerable populations. The tropical cyclones were classified into two levels to compare the effects of different grades of tropical cyclones on the dengue incidence.

Results

Tropical cyclones were associated with an increased number of dengue cases with the maximum risk ratio of 1.41 (95% confidence interval 1.17–1.69) in lag 0 week and cumulative risk ratio of 2.13 (95% confidence interval 1.28–3.56) in lag 0–4 weeks. The attributable fraction was 6.31% (95% empirical confidence interval 1.96–10.16%). Men and the elderly were more vulnerable to the effects of tropical cyclones than the others. The effects of typhoons were stronger than those of tropical storms among various subpopulations.

Conclusions

Our findings indicate that tropical cyclones may increase the incidence of dengue within a 4-week lag in Guangzhou, China, and the effects were more pronounced in men and the elderly. Precautionary measures should be taken with a focus on the identified vulnerable populations to control the transmission of dengue associated with tropical cyclones.

Graphical Abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s13071-022-05486-2.