Growing Up on the Edge: A Community-Based Mental Health Intervention for Children in Gaza

The Gaza Strip is a notoriously high-conflict area, but few large-scale studies have examined the rates of psychiatric distress and emotional/behavioral problems among Gaza youth, and there are few trauma-informed, scaleable intervention options. Studies in existence have used smaller samples or have examined focal problems such as posttraumatic stress disorder (PTSD) or aggression. Here, we examine the mental health burden of young individuals (ages 8-13) in Gaza across a broad range of symptoms, and demonstrate the impact of a community-based, trauma-informed program, Eye to the Future. At the outset of this supportive youth program, over 2000 children and adolescent youth and their parents reported on child well-being using standardized measures with established global norms (the Child Behavior Checklist and Youth Self Report). These measures examine symptoms broadly (e.g. anxiety, depression, social problems, attention problems, aggression, etc.). Relative to U.S. population estimates, children in Gaza had between 2.5- and 17-times higher point prevalence of clinical mental health problems. The most significant clinical concern was anxiety, but overall, their symptoms were not confined to posttraumatic stress as a disorder and were instead broadly dispersed. However, these concerns were responsive to intervention: over the course of a six-month community psychosocial program, symptoms ameliorated, with approximately 50-70% showing reliable improvement at post-program (varying by measure). These gains were maintained in a 9-month follow-up. Future work should consider the broader mental health impact, beyond PTSD and aggression, and incorporate community supports into addressing mental health among children in the region.

Understanding inequalities in mental health by family structure during COVID-19 lockdowns: evidence from the UK Household Longitudinal Study

PURPOSE

The COVID-19 pandemic increased psychiatric distress and impacts differed by family structure. We aimed to identify mechanisms contributing to these inequalities.

METHODS

Survey data were from the UK Household Longitudinal Study. Psychiatric distress (GHQ-12) was measured in April 2020 (first UK lockdown; n = 10,516), and January 2021 (lockdown re-introduced following eased restrictions; n = 6,893). Pre-lockdown family structure comprised partner status and presence of children (< 16 years). Mediating mechanisms included: active employment, financial strain, childcare/home-schooling, caring, and loneliness. Monte Carlo g-computation simulations were used to adjust for confounding and estimate total effects and decompositions into: controlled direct effects (effects if the mediator was absent), and portions eliminated (PE; representing differential exposure and vulnerability to the mediator).

RESULTS

In January 2021, after adjustment, we estimated increased risk of distress among couples with children compared to couples with no children (RR: 1.48; 95% CI 1.15-1.82), largely because of childcare/home-schooling (PE RR: 1.32; 95% CI 1.00-1.64). Single respondents without children also had increased risk of distress compared to couples with no children (RR: 1.55; 95% CI 1.27-1.83), and the largest PE was for loneliness (RR: 1.16; 95% CI 1.05-1.27), though financial strain contributed (RR: 1.05; 95% CI 0.99-1.12). Single parents demonstrated the highest levels of distress, but confounder adjustment suggested uncertain effects with wide confidence intervals. Findings were similar in April 2020 and when stratified by sex.

CONCLUSION

Access to childcare/schooling, financial security and social connection are important mechanisms that need addressing to avoid widening mental health inequalities during public health crises.

Mallory-Weiss syndrome from giant gastric trichobezoar: A case report

BACKGROUND

Mallory-Weiss syndrome (MWS), representing a linear mucosal laceration at the gastroesophageal junction, is a quite frequent cause of upper gastrointestinal bleeding, usually induced by habitual vomiting. The subsequent cardiac ulceration in this condition is likely due to the concomitance of increased intragastric pressure and inappropriate closure of the gastroesophageal sphincter, collectively inducing ischemic mucosal damage. Usually, MWS is associated with all vomiting conditions, but it has also been described as a complication of prolonged endoscopic procedures or ingested foreign bodies.

CASE SUMMARY

We described herein a case of upper gastrointestinal bleeding in a 16-year-old girl with MWS and chronic psychiatric distress, the latter of which deteriorated following her parents’ divorce. The patient, who was residing on a small island during the coronavirus disease 2019 pandemic lockdown period, presented with a 2-mo history of habitual vomiting, hematemesis, and a slight depressive mood. Ultimately, a huge intragastric obstructive trichobezoar was detected and discovered to be due to a hidden habit of continuously eating her own hair; this habit had persisted for the past 5 years until a drastic reduction in food intake and corresponding weight loss occurred. The relative isolation in her living status without school attendance had worsened her compulsory habit. The hair agglomeration had reached such enormous dimensions and its firmness was so hard that its potential for endoscopic treatment was judged to be impossible. The patient underwent surgical intervention instead, which culminated in complete removal of the mass.

CONCLUSION

According to our knowledge, this is the first-ever described case of MWS due to an excessively large trichobezoar.

Psychiatric distress in family caregivers of patients with COVID-19

PURPOSE

Many COVID-19 patients with low to moderate disease severity were cared for at home by family members. Caring for relatives with COVID-19 could have a psychiatric disorder for informal caregivers. Therefore, this study aimed to investigate the psychiatric disorders of family caregivers of relatives with COVID-19, in Iran.

METHODS

This online survey was conducted with 350 family caregivers over 18 years from April to July 2020, which was guided by the STROBE checklist. The study survey consisted of socio-demographic items, 7-items fear of COVID-19 scale, and a 21-item version of the depression, anxiety, and stress scales.

RESULTS

The mean (standard deviation) scores for depression, anxiety, and stress were 20 (0.40), 19.52 (0.39), and 19.72 (0.35), respectively, moreover for fear of COVID-19 was 20.33 (0.43). Of all family caregivers, 77.75%, 75%, and 80% had depression, anxiety, and stress, respectively. Sixty-nine percent of caregivers had fear with moderate to high severity. Being younger, married, having a health-related occupation, not exercising, and high monthly salary were significant predictors of the total score of depression, anxiety, and stress scale (P < 0.05). Further, being married, having a health-related occupation, and not exercising, having comorbidity, high income, and being younger were independent predictors of fear of COVID-19 (P < 0.05). Only 32% and 33% of the variance of total depression, anxiety, and stress, and fear of COVID-19 scores were predicted by the studied variables (p < 0.001).

CONCLUSION

Our study demonstrated the high prevalence of psychiatric disorders in family caregivers, which requires swift and comprehensive attention from authorities.

The prevalence and psychological relation of problem shopping: data from a large-scale sample from Turkey

BACKGROUND

The purpose of the present study was to comprehensively examine the measurement aspects, the prevalence, and the psychological correlates of problem shopping among a large-scale national sample of Turkish adults.

RESULT

Participants (N = 24,380, 50% men, M age = 31.79 years, age range = 18-81 years) completed a questionnaire that comprised the Shopping Addiction Risk Questionnaire, the Brief Symptom Inventory, the Positive and Negative Affect Schedule, and the Experiences in Close Relationships-Revised. Results showed that 1.8% of the participants had probable shopping addiction. Being female, being younger, psychiatric distress, positive affect, negative affect, anxious attachment, and avoidant attachment were positive correlates of problem shopping.

CONCLUSION

The results of this large sample size study suggest that shopping addiction is not a rare condition in Turkey. Further research is needed to understand different motives that underlie the problematic shopping behavior in the young and female population in comparison to older and male populations. Preventive programs or any interventions for people with PSB needs to address regulation difficulties and development of healthy strategies to cope with psychiatric distress.

Mental health among head and neck surgeons in Brazil during the COVID-19 pandemic: A national study

PURPOSE

Head and neck surgeons are among the highest risk for COVID-19 exposure, which also brings great risk to their mental wellbeing. In this study, we aim to evaluate mental health symptoms among head and neck surgeons in Brazil surrounding the time it was declared the epicenter of the virus.

MATERIALS AND METHODS

A cross-sectional, survey-based study evaluating burnout, anxiety, distress, and depression among head and neck surgeons in Brazil, assessed through the single-item Mini-Z burnout assessment, 7-item Generalized Anxiety Disorder scale, 22-item Impact of Event Scale-Revised, and 2-item Patient Health Questionnaire, respectively.

RESULTS

163 physicians completed the survey (74.2% males). Anxiety, distress, burnout, and depression symptoms were reported in 74 (45.5%), 43 (26.3%), 24 (14.7%), and 26 (16.0%) physicians, respectively. On multivariable analysis, female physicians were more likely to report a positive screening for burnout compared to males (OR 2.88, CI [1.07-7.74]). Physicians 45 years or older were less likely to experience anxiety symptoms than those younger than 45 years (OR 0.40, CI [0.20-0.81]). Physicians with no self-reported prior psychiatric conditions were less likely to have symptoms of distress compared to those with such history (OR 0.11, CI [0.33-0.38]).

CONCLUSION

Head and neck surgeons in Brazil reported symptoms of burnout, anxiety, distress and depression during our study period within the COVID-19 pandemic. Institutions should monitor these symptoms throughout the pandemic. Further study is required to assess the long-term implications for physician wellness.

Application of group smoothly clipped absolute deviation method in identifying correlates of psychiatric distress among college students

BACKGROUND

College students are at an increased risk of psychiatric distress. So, identifying its important correlates using more reliable statistical models, instead of inefficient traditional variable selection methods like stepwise regression, is of great importance. The objective of this study was to investigate correlates of psychiatric distress among college students in Iran; using group smoothly clipped absolute deviation method (SCAD).

METHODS

A number of 1259 voluntary college students participated in this cross-sectional study (Jan-May 2016) at Hamadan University of Medical Sciences, Iran. The data were collected using a self-administered questionnaire consisting of demographic information, a behavioral risk factors checklist and the GHQ-28 questionnaire (with a cut-off of 23 to measure psychiatric distress, recommended by the Iranian version of the questionnaire). Penalized logistic regression with a group-SCAD regularization method was used to analyze the data (α = 0.05).

RESULTS

The majority of students were aged 18-25 (87.61%), and 60.76% of them were female. About 41% of students had psychiatric distress. Significant correlates of psychiatric distress among college students selected by group-SCAD included the average grade, educational level, being optimistic about future, having a boy/girlfriend, having an emotional breakup, the average daily number of cigarettes, substance abusing during previous month and having suicidal thoughts ever (P < 0.05).

CONCLUSIONS

Penalized logistic regression methods such as group-SCAD and group-Adaptive-LASSO should be considered as plausible alternatives to stepwise regression for identifying correlates of a binary response. Several behavioral variables were associated with psychological distress which highlights the necessity of designing multiple factors and behavioral changes in interventional programs.

Joint Association of Active and Passive Smoking with Psychiatric Distress and Violence Behaviors in a Representative Sample of Iranian Children and Adolescents: the CASPIAN-IV Study

BACKGROUND

Mental health and smoking have been receiving increasing attention in adolescents all over the world. Although some studies have assessed the independent association of active/passive smoking with mental health, joint association of active and passive smoking with mental health remains unclear.

PURPOSE

This study was designed to evaluate the joint association of smoking status (active and passive smoking) with psychiatric distress and violent behaviors in Iranian children and adolescents.

METHOD

In this national survey, 13,486 students, aged 6-18 years, living in rural and urban areas of 30 provinces of Iran were selected via multistage, cluster sampling method. Psychiatric distress (including worthless, angriness, worrying, insomnia, confusion, depression, and anxiety), violence behaviors (including bullying, victim, and physical fight), and smoking status (nonsmoker, only passive smoker, only active smoker, and active and passive smoker) were assessed. The questionnaire was prepared based on the World Health Organization Global School-based Student Health Survey (WHO-GSHS). Data were analyzed by the Stata package.

RESULTS

Psychiatric distress and violent behaviors had linearly positive association with smoking status (p trend < 0.001). Compared to "nonsmoker" group, participants who were exposed to passive smoking besides active tobacco use were at increased risk of having angriness (odds ratio (OR) 2.55, 95 % confidence interval (CI) 1.86-3.48), worrying (OR 1.66, 95 % CI 1.24-2.20), and anxiety (OR 1.99, 95 % CI 1.52-2.61) and victim (OR 1.77, 95 % CI 1.34-2.33) and bully behaviors (OR 3.08, 95 % CI 2.33-4.07).

CONCLUSION

The current findings suggest that active and passive tobacco smoking has synergistic effect on psychiatric distress. Since majority of smokers with psychiatric distress do not receive mental health services or counseling on smoking, strategies to address mental health problems and smoking prevention should be included as a part of school health services.

Burnout and Psychiatric Distress in Local Caregivers Two Years After the 2011 Great East Japan Earthquake and Fukushima Nuclear Radiation Disaster

The 2011 Great East Japan Earthquake precipitated a triple disaster of earthquake, tsunami and nuclear radiation disaster. To quantify the prevalence of burnout and psychiatric distress in local healthcare providers (caregivers) more than 2 years after the disaster, this study surveyed caregivers from affected areas through interviews about topics of concerns and two questionnaires: Maslach Burnout Inventory and General Health Questionnaire. Concerns listed by respondents were primarily radiation related: additional stress, concern for children, concern for local food, and sleep difficulties. We found significant number of caregivers to have signs of emotional exhaustion, low personal accomplishment, and psychological distress. Our findings suggest that local caregivers are experiencing substantial mental health burdens, which have unfortunately remained static from the year prior, even 2 years after the fact. Therefore, long term psychological support and improvement in caregiver work conditions are essential to maintain sustainable care in rebuilding disaster stricken areas.

Genetic polymorphism in pathogenesis of irritable bowel syndrome

Irritable bowel syndrome (IBS) is a complex symptom-based disorder without established biomarkers or putative pathophysiology. IBS is a common functional gastrointestinal disorder which is defined as recurrent abdominal pain or discomfort that has at least two of the following symptoms for 3 d per month in the past 3 mo according to ROME III: relief by defecation, onset associated with a change in stool frequency or onset with change in appearance or form of stool. Recent discoveries revealed genetic polymorphisms in specific cytokines and neuropeptides may possibly influence the frequencies and severity of symptoms, as well as the therapeutic responses in treating IBS patients. This review gives new insights on how genetic determinations influence in clinical manifestations, treatment responses and potential biomarkers of IBS.

Socioeconomic position and adolescent trajectories in smoking, drinking, and psychiatric distress

PURPOSE

Smoking, drinking, and psychiatric distress are inter-related and may also be associated with socioeconomic position (SEP). This paper investigates the role of SEP in adolescent development across all three of these outcomes.

METHODS

Data were self-reported by adolescents in the Twenty-07 Study (N = 1,515) at ages 15, 17, and 18 years. Latent class analysis was used to identify homogeneous subgroups of adolescents with distinct developmental patterns. Associations between developmental patterns and a range of socioeconomic indicators were then tested.

RESULTS

Five classes were identified. A Low Risk class had low levels for all outcomes. A High Distress class had persistently high levels of distress, but was otherwise similar to the Low Risk group. A High Drinking class drank alcohol earlier and more heavily but also had higher levels of distress than the Low Risk group. Smokers were grouped in two classes, Early Smokers and Late Smokers, and both also had raised levels of drinking and distress. Early Smokers tended to begin earlier and smoke more heavily than Late Smokers. Relative to the Low Risk class, adolescents in a disadvantaged SEP were more likely to be Early Smokers and somewhat less likely to be in the High Drinking class. SEP was not consistently associated with membership in the High Distress or Late Smokers classes.

CONCLUSIONS

Associations with SEP are evident in opposing directions or absent depending on the combination and timing of outcomes, suggesting that a disadvantaged SEP is not a simple common cause for all three outcomes.

Mental health of dubai medical college students

OBJECTIVE

Considering the association between medical school dropout and psychiatric distress, we aimed to assess the prevalence of psychiatric distress among medical students at Dubai Medical College.

METHODS

One hundred and three medical students were chosen randomly and were assessed by the General Health Questionnaire (GHQ).

RESULTS

The mean age for the students was 18.85 year (Minimum: 17, Maximum: 22), and 90.3% were between 18 and 20 years old. The mean of GHQ score was 16.46. Of the participants, 47 (45.6%) were found to be in normal range (GHQ mean < 16). A total of 33 (32.1%) of the students reported evidence of psychiatric distress. Only 23 (22.3%) were found to have severe psychiatric distress.

CONCLUSIONS

Early detection of psychiatric distress is important to prevent psychiatric morbidity and its unwanted effects on medical students and young doctors. Our results reveals that although a low percentage of Dubai Medical College students reported a significant level of psychiatric distress, however, it should not be underestimated, and actions should be taken to encourage Dubai Medical College students to get help from for psychiatric services for their emotional problems. The risk factors as well as the protective factors must be identified in nation-wide studies to promote mental health of medical students.