Non-binary gender, vulnerable populations and mental health during the COVID-19 pandemic: Data from the COVID-19 MEntal health inTernational for the general population (COMET-G) study

BACKGROUND

The COVID-19 pandemic has brought significant mental health challenges, particularly for vulnerable populations, including non-binary gender individuals. The COMET international study aimed to investigate specific risk factors for clinical depression or distress during the pandemic, also in these special populations.

METHODS

Chi-square tests were used for initial screening to select only those variables which would show an initial significance. Risk Ratios (RR) were calculated, and a Multiple Backward Stepwise Linear Regression Analysis (MBSLRA) was followed with those variables given significant results at screening and with the presence of distress or depression or the lack of both of them.

RESULTS

The most important risk factors for depression were female (RR = 1.59-5.49) and non-binary gender (RR = 1.56-7.41), unemployment (RR = 1.41-6.57), not working during lockdowns (RR = 1.43-5.79), bad general health (RR = 2.74-9.98), chronic somatic disorder (RR = 1.22-5.57), history of mental disorders (depression RR = 2.31-9.47; suicide attempt RR = 2.33-9.75; psychosis RR = 2.14-10.08; Bipolar disorder RR = 2.75-12.86), smoking status (RR = 1.15-5.31) and substance use (RR = 1.77-8.01). The risk factors for distress or depression that survived MBSLRA were younger age, being widowed, living alone, bad general health, being a carer, chronic somatic disorder, not working during lockdowns, being single, self-reported history of depression, bipolar disorder, self-harm, suicide attempts and of other mental disorders, smoking, alcohol, and substance use.

CONCLUSIONS

Targeted preventive interventions are crucial to safeguard the mental health of vulnerable groups, emphasizing the importance of diverse samples in future research.

LIMITATIONS

Online data collection may have resulted in the underrepresentation of certain population groups.

Somatic multicomorbidity and disability in patients with psychiatric disorders in comparison to the general population: a quasi-epidemiological investigation in 54,826 subjects from 40 countries (COMET-G study)

BACKGROUND

The prevalence of medical illnesses is high among patients with psychiatric disorders. The current study aimed to investigate multi-comorbidity in patients with psychiatric disorders in comparison to the general population. Secondary aims were to investigate factors associated with metabolic syndrome and treatment appropriateness of mental disorders.

METHODS

The sample included 54,826 subjects (64.73% females; 34.15% males; 1.11% nonbinary gender) from 40 countries (COMET-G study). The analysis was based on the registration of previous history that could serve as a fair approximation for the lifetime prevalence of various medical conditions.

RESULTS

About 24.5% reported a history of somatic and 26.14% of mental disorders. Mental disorders were by far the most prevalent group of medical conditions. Comorbidity of any somatic with any mental disorder was reported by 8.21%. One-third to almost two-thirds of somatic patients were also suffering from a mental disorder depending on the severity and multicomorbidity. Bipolar and psychotic patients and to a lesser extent depressives, manifested an earlier (15-20 years) manifestation of somatic multicomorbidity, severe disability, and probably earlier death. The overwhelming majority of patients with mental disorders were not receiving treatment or were being treated in a way that was not recommended. Antipsychotics and antidepressants were not related to the development of metabolic syndrome.

CONCLUSIONS

The finding that one-third to almost two-thirds of somatic patients also suffered from a mental disorder strongly suggests that psychiatry is the field with the most trans-specialty and interdisciplinary value and application points to the importance of teaching psychiatry and mental health in medical schools and also to the need for more technocratically oriented training of psychiatric residents.

Results of the COVID-19 mental health international for the health professionals (COMET-HP) study: depression, suicidal tendencies and conspiracism

INTRODUCTION

The current study aimed to investigate the rates of anxiety, clinical depression, and suicidality and their changes in health professionals during the COVID-19 outbreak.

MATERIALS AND METHODS

The data came from the larger COMET-G study. The study sample includes 12,792 health professionals from 40 countries (62.40% women aged 39.76 ± 11.70; 36.81% men aged 35.91 ± 11.00 and 0.78% non-binary gender aged 35.15 ± 13.03). Distress and clinical depression were identified with the use of a previously developed cut-off and algorithm, respectively.

STATISTICAL ANALYSIS

Descriptive statistics were calculated. Chi-square tests, multiple forward stepwise linear regression analyses, and Factorial Analysis of Variance (ANOVA) tested relations among variables.

RESULTS

Clinical depression was detected in 13.16% with male doctors and 'non-binary genders' having the lowest rates (7.89 and 5.88% respectively) and 'non-binary gender' nurses and administrative staff had the highest (37.50%); distress was present in 15.19%. A significant percentage reported a deterioration in mental state, family dynamics, and everyday lifestyle. Persons with a history of mental disorders had higher rates of current depression (24.64% vs. 9.62%; p < 0.0001). Suicidal tendencies were at least doubled in terms of RASS scores. Approximately one-third of participants were accepting (at least to a moderate degree) a non-bizarre conspiracy. The highest Relative Risk (RR) to develop clinical depression was associated with a history of Bipolar disorder (RR = 4.23).

CONCLUSIONS

The current study reported findings in health care professionals similar in magnitude and quality to those reported earlier in the general population although rates of clinical depression, suicidal tendencies, and adherence to conspiracy theories were much lower. However, the general model of factors interplay seems to be the same and this could be of practical utility since many of these factors are modifiable.

Depression in Early Childhood

According to data from the WHO, the COVID-19 pandemic has created an increase in anxiety and depression around the world. In particular, there has been an increase in Depressive Disorder in childhood: the closure of childcare centers has caused great stress in parents, especially in mothers who have developed more depressive disorders. Maternal depression appears to have created problematic behaviors in preschool children. This phenomenon is explained by several studies that over the years have shown that a good mother-child interaction is essential for the child's psychophysical health and that interactions with depressed mothers have caused depression in children already in early childhood. The purpose of this work is a review of the scientific literature, from 1927 to 2022, on depression in early childhood, from 0 to 5 years of age. Research has been carried out on Medline PubMed, Google Scholar and specialist scientific journals of psychiatry, psychology and child neuropsychiatry, using the following keywords: infant depression, anaclitic depression, hospitalism, early chilhood depression, depressive position, attachement and mother-infant dyad. The depressive illness of the mother, the lack of care, attention and stimulation to the vocalizations of the young child can induce negative reactions in the relationship between mother and child. Early identification and treatment of perinatal depression is critical to ensuring the child's optimal development and future mental health. In addition to maternal depression there are also other factors that can generate depression in the child as well as a prolonged separation from her. The authors' conclusions are that it is essential to train and inform educators and family members on depression in childhood to allow for the recognition of the child's suffering and for it to be examined by the doctor. It is important an early intervention both on the family and on the child to avoid relapses, chronicity and any serious damage.

The effect of different degrees of lockdown and self-identified gender on anxiety, depression and suicidality during the COVID-19 pandemic: Data from the international COMET-G study

INTRODUCTION

During the COVID-19 pandemic various degrees of lockdown were applied by countries around the world. It is considered that such measures have an adverse effect on mental health but the relationship of measure intensity with the mental health effect has not been thoroughly studied. Here we report data from the larger COMET-G study pertaining to this question.

MATERIAL AND METHODS

During the COVID-19 pandemic, data were gathered with an online questionnaire from 55,589 participants from 40 countries (64.85% females aged 35.80 ± 13.61; 34.05% males aged 34.90±13.29 and 1.10% other aged 31.64±13.15). Anxiety was measured with the STAI, depression with the CES-D and suicidality with the RASS. Distress and probable depression were identified with the use of a previously developed cut-off and algorithm respectively.

STATISTICAL ANALYSIS

It included the calculation of Relative Risk (RR), Factorial ANOVA and Multiple backwards stepwise linear regression analysis RESULTS: Approximately two-thirds were currently living under significant restrictions due to lockdown. For both males and females the risk to develop clinical depression correlated significantly with each and every level of increasing lockdown degree (RR 1.72 and 1.90 respectively). The combined lockdown and psychiatric history increased RR to 6.88 The overall relationship of lockdown with severity of depression, though significant was small.

CONCLUSIONS

The current study is the first which reports an almost linear relationship between lockdown degree and effect in mental health. Our findings, support previous suggestions concerning the need for a proactive targeted intervention to protect mental health more specifically in vulnerable groups.

Results of the COVID-19 mental health international for the general population (COMET-G) study

INTRODUCTION

There are few published empirical data on the effects of COVID-19 on mental health, and until now, there is no large international study.

MATERIAL AND METHODS

During the COVID-19 pandemic, an online questionnaire gathered data from 55,589 participants from 40 countries (64.85% females aged 35.80 ± 13.61; 34.05% males aged 34.90±13.29 and 1.10% other aged 31.64±13.15). Distress and probable depression were identified with the use of a previously developed cut-off and algorithm respectively.

STATISTICAL ANALYSIS

Descriptive statistics were calculated. Chi-square tests, multiple forward stepwise linear regression analyses and Factorial Analysis of Variance (ANOVA) tested relations among variables.

RESULTS

Probable depression was detected in 17.80% and distress in 16.71%. A significant percentage reported a deterioration in mental state, family dynamics and everyday lifestyle. Persons with a history of mental disorders had higher rates of current depression (31.82% vs. 13.07%). At least half of participants were accepting (at least to a moderate degree) a non-bizarre conspiracy. The highest Relative Risk (RR) to develop depression was associated with history of Bipolar disorder and self-harm/attempts (RR = 5.88). Suicidality was not increased in persons without a history of any mental disorder. Based on these results a model was developed.

CONCLUSIONS

The final model revealed multiple vulnerabilities and an interplay leading from simple anxiety to probable depression and suicidality through distress. This could be of practical utility since many of these factors are modifiable. Future research and interventions should specifically focus on them.

Video Games and COVID-19: How Do Lockdown And addiction Interact?

The global epidemic of COVID-19, social isolation and the fear of viral contagion have determined and determine profound changes in social relations between people. The purpose of this research, carried out online on published scientific studies, on information from magazines, accredited websites, books and newspapers, was to consider the possible interactions between the lockdown, the use of video games and the Internet Gaming Disorder. during the pandemic. The conclusions are an undoubtedly beneficial interaction for the psychophysical health of the users and the improvement of anxiety, stress and socialization with the help of video games during the pandemic. However, it is necessary to pay attention to the excessive, protracted and constant use of videogame activity, abuse and possible addiction, in particular for adolescents with previous psychological discomforts and pathologies such as depression, anxiety and stress. Parents are advised to pay attention to the time their children spend playing video games.

A New Rating Scale (SAVE-9) to Demonstrate the Stress and Anxiety in the Healthcare Workers During the COVID-19 Viral Epidemic

The COVID-19 epidemic has been a major global public health problem during past months in Italy and in several other Countries and on the date of publication of this article, is still a serious public health problem. The health staff, engaged in the care of the sick and in the prevention of the spread of the infection have been subjected to a further increase in psychological difficulties and work-related stress, related to the workload for the continuous influx of sick and intense and close working shifts for the viral emergency. The SAVE-9 (Stress and Anxiety to Viral Epidemics - 9 items) scale has been developed as a tool for assessing work anxiety and stress in response to the viral epidemic of health professionals working to prevent the spread of the virus and to treat infected people.

Overcoming Depression with Dance Movement Therapy: A Case Report

In our society that sets high standards of perfection to be ok and wins, the depressed is commonly considered as an outsider, a marginalized person unable to be in line with standards and rhythms fast and competitive of the time we live. So the social stigma against people who suffer from mood disorders is a very powerful factor that negatively affects the healing of patient. He is often isolated from the others for the fear of being judged "fool, crazy or dangerous" or discriminated and emarginated for his mental health problem. For this reason, a cornerstone of depression rehabilitation is the bringing out of the patient from his isolation, the reintegration of user in the social context with the increase and the improvement in the quality of interpersonal relationships in the family and in the external context. So in this way is possible an increase in the tone of mood and a reduction of the symptoms of depression. The method used in our project is the dance movement therapy. In particular, dancing the "Bachata" and later more spontaneous dance becomes a rehabilitation tool to express emotions through the body and to open to the world, on the territory, overcoming the fear of being judged by others, the prejudice and the social stigma about mental illness. This work presents the results of a case report of a depressed patient treated with dance movement therapy.

Mental Illness and Prejudices in Psychiatric Professionals. Data from the Social Stigma Questionnaire for Psychiatric Professionals: A Multicentre Study

The prejudices about mental illness and the related social stigma are still present in the population. People suffer from both the disease and the marginalization behaviors implemented by the "so-called healthy" towards them and their relatives. Even psychiatric professionals can get sick and suffer for the same reason. The authors of this multicentric study have focused their attention on the presence or absence of groups of psychiatric pathologies among the "insiders". The most frequent pathologies encountered were the mood and anxiety disorders, in a percentage similar to that of the general population. To continue the research on the stigma begun in a previous study, the authors asked themselves if there could be prejudices and/or stigma among psychiatric professionals towards sick colleagues, how they relate in the workplace and how they react to the behavior of colleagues. The stigma questionnaire has been used on psychiatric professionals, and 130 Italian colleagues were tested in the provinces of Avellino, Brindisi and Trento. The data were compared with those of the research on the stigma "Thinking of Psychiatric Disorders as" Normal "Illness" (Tavormina et al. 2016) and it emerged that among the attending professionals there are no statistically significant behaviors of marginalization, exclusion or stigma against sick colleagues, even if there is a certain discomfort in working together. Above all, it emerged that 80% of the interviewees, who have had work experience with sick colleagues, have replied that the latter can treat those who are also sick of their own disease, thus showing esteem and confidence in their work, in analogy with the Jungian thesis of the "wounded Healer" in the myth of the centaur Chiron.

Playing with Video Games: Going to a New Addiction?

The frequent and protracted use of video games with serious personal, family and social consequences is no longer just a pleasant pastime and could lead to mental and physical health problems. Although there is no official recognition of video game addiction on the Internet as a mild mental health disorder, further scientific research is needed.

Overcoming the Social Stigma on Mood Disorders with Dancing

In our society, the social stigma against people who suffer from mood disorders is a very powerful factor that negatively affects the healing of patient. He is often isolated from the others for the fear of being judged "fool, crazy or dangerous" or discriminated and emarginated for his mental health problem. For this reason, a cornerstone of mood disorder rehabilitation is the bringing out of the patient from his isolation, the reintegration of the user in the social context with the increase and the improvement in the quality of interpersonal relationships in the family and in the external context. The method used in our project is the dance-therapy one. In particular dancing the "Bachata" becomes a rehabilitation tool to express emotions through the body and to open to the world, on the territory, overcoming the fear of being judged by others, and of the prejudice and the social stigma about mental illness. The strength and cohesion of the rehabilitation group has given to the patients the opportunity to believe in their own abilities, to accept themselves with their difficulties and to improve the relationship with their body in relation to each other.

Thinking of psychiatric disorders as "normal" illness. Data from a questionnaire on social stigma: a multicenter study

Prejudice and stigma about mental illness is still present in society. Patients suffer both from the disease, and from the marginalization behavior exhibited by others towards them and their families. Psychiatric professionals may also become ill and suffer for the same reason. The authors of this international multicenter study have set themselves the question of whether there may be prejudice and/or stigma among psychiatric professionals towards their suffering colleagues, among patients towards nursing staff affected by the same disease and between patients themselves. Using two standardized questionnaires which have been tested, but have not been used before they have studied 207 mental health professionals and 407 patients, of Italian, Belgian, Hungarian and Croatian nationalities. The results show that there are in fact prejudices among Mental Health Professionals about colleagues suffering from mental illness because they responded that such persons cannot treat well patients with their own pathology. However Mental Health Professionals do not demonstrate behaviors which are not frankly marginalizing or stigmatizing towards colleagues suffering from mental illness. On the other hand, among patients the prevailing view was that psychiatric professionals who suffer from mental illness, can better understand the sick, because they are also suffering. This is in analogy with the Jungian theory of the "wounded healer" in the myth of the centaur Chiron. Patients did not demonstate rejection or marginalization behavior towards other sick patients. Finally both the professionals and the patients tend to be cautious in relating to healthy persons and tend not to disclose their suffering for fear of being misjudged or marginalized.

A questionnaire to assess social stigma

Psychiatric patients often suffer for two reasons: due to the illness and due to the social stigma of mental illness, that increases the uneasiness and psychic pain of the person suffering from serious psychiatric disorder. This unwell person is often the object of stigma because he is "different" from others, and he also can be margenalised by society. In this study we intend to assess whether these margenalising attitudes might be also present among mental health professionals who have presented psychic problems in a previous period of their life, against sick persons suffering of the same illness even if he is a mental health professional. Two questionnaires have been developed, one for professionals and another for the patients, with the aim of identifying these marginalising attitudes. We intend that this study shall be a multicenter, observational and international study, promoted by the Mental Health Dept. of Naples (ASL Naples 3 South, Italy).

"Dance and go on": a project of psychosocial rehabilitation on the road

The project "Dance and go on" was created with the intention of bringing out of the Day Centre of the Department of Mental Health of Torre del Greco, the dance group "Dance That you go" active since 2009. Dancing Bachata becomes a rehabilitation tool to express emotions through the body and to open to the outside, on the territory (local society), overcoming the fear of being judged by others, the prejudice and the social stigma about mental illness. The rehabilitation activities of the dancing group allowed patients to improve their care of self, self-esteem, confidence in their capacities and an increase in their social relations. The strength and cohesion of the rehabilitation group has given to the patients the opportunity to believe in their own abilities, to accept themselves with their difficulties and to improve the relationship with their body in relation with each other.

The singing-group: a new therapic rehabilitation for mood desorders

Psychosocial rehabilitation, and choral singing in particular, allow the recovery of lost or compromised ability of patients with mental illness and they facilitate the reintegration of the user in his family and into his social context. The choral singing, used as an operational tool for psychosocial rehabilitation, allowed users of the Day Centre of the Unit of Mental Health Torre del Greco ASL NA 3 South to achieve concrete goals of rehabilitation: improvement of self-care and self-esteem, the management of emotions, the growing of their interests, the integration and socialization overcoming the isolation of their mental suffering. In particular patients with mood disorders have been significantly benefited from the rehabilitation activity. They improved their mood and all the related diseases and the quality of their life with the result of a positive therapeutic implication. The singing group and for some individuals, also psychotherapy and drug therapy, have allowed users to improve their lives and give them a concrete integration into the society. Working in a group with patients, caregivers, family members, volunteers, social workers allowed a consolidated rehabilitation with the passing of time.Using the chorus group "Sing that you go" as an operational tool for psychosocial rehabilitation and therapeutic element we promote the psychological well-being and the enhancement of mood.

The advantages of "Dance-group" for psychotic patients

Psychosocial rehabilitation and in particular group dances allow the recovery of lost or compromised ability of patients with mental illness, and they facilitate their reintegration into the social context. The dance group has enabled users of the Day Centre of the Unit of Mental Health Torre del Greco ASL NA 3 south to achieve the objectives of rehabilitation such as: taking care of themselves, of their bodies and their interests, improving self-esteem , the management of pathological emotions, socialization and integration, overcoming the psychotic closing and relational isolation. In particular, patients with schizophrenia, psychotic and mood disorders had a concrete benefit from such rehabilitation activities, facilitating interpersonal relationships, therapy compliance and significantly improved mood, quality of life, providing them with the rhythm and the security in their relationship with each other. The dance group and for some individuals, also psychotherapy and drug therapy, have facilitated social inclusion, improved the quality of life and cured their diseases. The work is carrying out in a group with patients, practitioners, family members, volunteers, social community workers, following the operating departmental protocols. Using the chorus group "Sing that you go" as an operational tool for psychosocial rehabilitation and therapeutic element we promote the psychological well-being and the enhancement of mood.