Disability and treatment of specific mental and physical disorders across the world

Depression and anxiety in the context of the COVID-19 pandemic: A 6-waves longitudinal study in the Argentine population

PURPOSE

The pandemic has caused stress due to isolation, loss of loved ones, work and learning changes, financial instability, fear of infection, and uncertainty. It has negatively impacted mental health, particularly increasing anxiety, and depression symptoms. This study analyzed anxiety and depression symptoms over the first 25 months of the COVID-19 pandemic, considering age group, socioeconomic status, and gender.

METHODS

A longitudinal study with 6 repeated measures was conducted, involving 988 adult participants from Argentina. Adapted versions of the BDI-II and STAI were administered through online questionnaires at 2, 14, 50, 130, 390, and 750 days since the start of the lockdown.

RESULTS

The results showed a sustained increase in anxiety and depression symptoms up to 390 days, followed by a decrease in anxiety below initial levels at 750 days. Depressive symptoms significantly decreased after 750 days but remained higher than initial levels.

CONCLUSION

Women consistently scored higher than men, lower socioeconomic status individuals reported more symptoms, and younger individuals had higher anxiety and depression, which decreased with age. Surprisingly, older individuals displayed better mental health indicators compared to the rest of the population.

The contribution of childhood adversities to the persistence of severe role impairment among college students: a follow-up study

PURPOSE

While the association between childhood adversities (CAs) and negative mental health outcomes is robustly supported throughout the epidemiological literature, little is known about their contribution to the persistence of role impairment. The present study aims to investigate the association of three facets of CAs with the persistence of severe role impairment among college students using a follow-up design.

METHODS

Data were drawn from the French portion of the World Mental Health International College Student Initiative. Students who completed both the baseline and 1-year follow-up surveys were included (n = 1,188). Exposure to 12 types of CAs before the age of 18 was assessed at baseline, and 12-month role impairment and 12-month mental disorders were assessed at baseline and follow-up. Logistic regressions estimated associations by jointly using types, number of types, and cumulative frequency of exposure to CAs as predictors.

RESULTS

At baseline, 27.6% of students reported any severe role impairment. Among them, 47.5% reported the persistence of any impairment at one year. In models adjusted for 12-month mental disorders, only the frequency of CAs was associated with the persistence of impairment, namely college-related and other work impairment (aOR = 1.17, 95% CI [1.01, 1.35]).

CONCLUSION

Role impairment is prevalent among college students, and studies are needed to better understand its persistence. Beyond the primary prevention of early stressors, screening for and treating mental health problems during college may help reduce the impact of CAs on the persistence of role impairment.

Impact of COVID-19 first wave on the mental health of healthcare workers in a Front-Line Spanish Tertiary Hospital: lessons learned

Healthcare workers (HCWs) were at high risk of experiencing psychological distress during COVID-19 pandemic. The objective of this study was to evaluate the impact on HCWs' mental health in a Spanish hospital. Cross-sectional study of HCW, active between May and June 2020. A web-based survey assessed probable current mental disorders (major depressive disorder [PHQ-8 ≥ 10], generalized anxiety disorder [GAD-7 ≥ 10], panic attacks, post-traumatic stress disorder [PTSD; PLC-5 ≥ 7], or substance use disorder [CAGE-AID ≥ 2]). The Sheehan Disability Scale (SDS) was used to assess severe impairment and items taken from the modified self-report version of the Columbia Suicide Severity Rating Scale (C-SSRS) assessed suicidal thoughts and behaviors. A total of 870 HCWs completed the survey. Most frequent probable mental disorders were major depressive disorder (33.6%), generalized anxiety disorder (25.5%), panic attacks (26.9%), PTSD (27.2%), and substance use disorder (5.0%). Being female, having aged 18-29 years, being an auxiliary nurse, direct exposure to COVID-19-infected patients, and pre-pandemic lifetime mental disorders were positively associated with mental issues. Hospital HCWs presented a high prevalence of symptoms of mental disorders, especially depression, PTSD, panic attacks, and anxiety. Younger individuals and those with lifetime mental disorders have been more vulnerable to experiencing them.

The burden of mental disorders in Mexico, 1990-2019: Mental and neurological disorders, substance use, suicides, and related somatic disorders

INTRODUCTION

Mental, neurological, substance use, suicide, and related somatic disorders (MNSS, for the Spanish acronym) have a negative impact on the quality-of-life of people and the Mexican economy, but updated information is lacking. The objective of this work is to analyze the disability adjusted life years (DALYs) of the MNSS in Mexico by sex, age, state, and degree of marginalization between 1990 and 2019.

METHODS

The data and methodology of the «Global Burden of Disease Group» (GBD) are used. The GBD calculates DALYs as the sum of two components: years of life lost due to premature mortality (YLL) and years lived with disability (YLD). Likewise, the data on the degree of marginalization from the National Population Council in Mexico are used.

RESULTS

MNSS represented 16.3% of the disease burden in the Mexican population in 2019. The trend of the age-standardized rates of DALYs of the MNSS has increased little from 1990 to 2019. The highest increase has been for women. Mental (depression) and neurological (headache) disorders contribute the most to the disease burden among MNSS. In the interior of the country, Baja California Sur presented the highest increase in the period.

DISCUSSION

The results show a complex panorama of the MNSS and its subtypes by sex, age groups and territory. More resources are needed to improve mental health care.

Health service and psychotropic medication use for mental health conditions among healthcare workers active during the Spain Covid-19 Pandemic - A prospective cohort study using web-based surveys

Little is known about healthcare workers' (HCW) use of healthcare services for mental disorders. This study presents data from a 16-month prospective cohort study of Spanish HCW (n = 4,809), recruited shortly after the COVID-19 pandemic onset, and assessed at four timepoints using web-based surveys. Use of health services among HCW with mental health conditions (i.e., those having a positive screen for mental disorders and/or suicidal thoughts and behaviours [STB]) was initially low (i.e., 18.2 %) but increased to 29.6 % at 16-month follow-up. Service use was positively associated with pre-pandemic mental health treatment (OR=1.99), a positive screen for major depressive disorder (OR=1.50), panic attacks (OR=1.74), suicidal thoughts and behaviours (OR=1.22), and experiencing severe role impairment (OR=1.33), and negatively associated with being female (OR = 0.69) and a higher daily number of work hours (OR=0.95). Around 30 % of HCW with mental health conditions used anxiolytics (benzodiazepines), especially medical doctors. Four out of ten HCW (39.0 %) with mental health conditions indicated a need for (additional) help, with most important barriers for service use being too ashamed, long waiting lists, and professional treatment not being available. Our findings delineate a clear mental health treatment gap among Spanish HCW.

Care trajectories of individuals with anxiety disorders: A retrospective cohort study

BACKGROUND

Anxiety disorders (ADs) are associated with increased healthcare use (HCU), and individuals may seek healthcare through various pathways according to clinical and individual characteristics. This study aimed to characterize care trajectories (CTs) of individuals with ADs.

METHODS

This is a retrospective cohort study using the Care Trajectories - Enriched Data cohort, a linkage between the Canadian Community Health Surveys (CCHS), and health administrative data from Quebec. The cohort included 5143 respondents reporting ADs to the CCHS between 2009 and 2016. We measured CTs over 5 years before CCHS using a state sequence analysis.

RESULTS

The cohort was categorized into five types of CTs. Type 1 (52.7 %) was the lowest care-seeking group, with fewer comorbidities. Type 2 (24.0 %) had higher levels of physical and mental health comorbidities and moderate HCU, mainly ambulatory visits to general practitioners. Type 3 (13.1 %) represented older patients with the highest level of physical illnesses and high HCU, predominantly ambulatory consultation of specialists other than psychiatrists. Types 4 and 5 combined young and middle-aged patients suffering from severe psychological distress. HCU of type 4 (6.7 %) was high, mainly consultations of ambulatory psychiatrists, and HCU of type 5 (3.5 %), was the highest and mostly in acute care.

LIMITATIONS

Administrative and survey data may have coding errors, missing data and self-report biases.

CONCLUSION

Five types of CTs showed distinct patterns of HCU often modulated by physical and mental health comorbidities, which emphasizes the importance of considering ADs when individuals seek care for other mental health conditions or physical illness.

The clinical effectiveness of a self-management intervention for patients with persistent depressive disorder and their partners/caregivers: results from a multicenter, pragmatic randomized controlled trial

BACKGROUND

Persistent depressive disorder (PDD) is prevalent and debilitating. For patients with PDD, psychiatric rehabilitation using self-management interventions is advised as the next therapeutic step after multiple unsuccessful treatment attempts. The "Patient and Partner Education Program for All Chronic Diseases" (PPEP4All) is a brief, structured self-management program that focuses on functional recovery for patients and their partners/caregivers. In chronic somatic disorder populations, PPEP4All has already been shown to be clinically effective. We examined whether PPEP4All adapted for PDD (PPEP4All-PDD, nine weekly group or individual sessions) is also clinically effective for adults/elderly with PDD and their partners/caregivers compared to care-as-usual (CAU) in specialized mental healthcare.

METHODS

In this mixed-method multicenter pragmatic randomized controlled trial, 70 patients with PDD and 14 partners/caregivers were allocated to either PPEP4All-PDD (patients, n = 37; partners/caregivers, n = 14) or CAU (patients, n = 33; partners/caregivers, not included) and completed questionnaires at 0, 3, 6, and 12 months regarding depressive symptoms, psychopathology, psychosocial burden, mental resilience, and happiness/well-being. Qualitative data were collected regarding treatment satisfaction. Data were analyzed using mixed model analyses and an intention-to-treat (ITT) approach.

RESULTS

There was no statistically significant difference in any outcome regarding clinical effectiveness between PPEP4All-PDD and CAU. Subgroup analysis for depressive symptoms did not show any interaction effect for any subgroup. Although 78% of participants recommended PPEP4All-PDD, there was no difference in treatment satisfaction between PPEP4All-PDD (score = 6.6; SD = 1.7) and CAU (score = 7.6; SD = 1.2), p = 0.06.

CONCLUSION

Although depressive symptoms did not improve relative to CAU, this only confirmed that treatment for patients with treatment-resistant PDD should move from symptom reduction to functional recovery. Also, functional recovery may be reflected in other outcomes than psychosocial burden, such as self-empowerment, in patients with treatment-resistant PDD. Future research on PPEP4All-PDD could focus on a longer-term program and/or online program that may also be offered earlier in the treatment process as an empowerment intervention.  TRIAL REGISTRATION: Netherlands Trial Register Identifier NL5818. Registered on 20 July 2016 https://clinicaltrialregister.nl/nl/trial/20302.

Changes in Positive and Negative Affect during Acute Psychiatric Treatment in People with Social Anxiety Disorder

People with social anxiety disorder (SAD) experience less positive affect (PA) and more negative affect (NA) than the general population, a pattern more similar to depression than other anxiety disorders. There is a dearth of research assessing whether PA is targeted effectively during treatment, even though this is an important emotional aspect for quality of life. The primary aim of this study was to examine daily changes in self-report PA and NA among a sample of partial hospital program (PHP) patients with SAD. A secondary aim was to examine baseline depression severity as a moderator of daily PA and NA change. Patients were adults (N = 241) diagnosed with SAD seeking treatment at a typically 1-2-week transdiagnostic behavioral health PHP from September 2017 to September 2019. Patients completed (1) the International Positive and Negative Affect Schedule-Short Form (IPANAS-SF) each treatment day to assess affect and (2) the Patient Health Questionnaire-9 Item Version (PHQ-9) at baseline to assess depressive symptoms. Data from the first nine days of treatment were included in analyses: two-level multilevel model (MLM) analyses were used to address study aim 1, and baseline depression severity was added as a moderator to address study aim 2. Patients reported significant decreases in NA but no significant changes in PA over the course of PHP treatment. Additionally, there was no significant evidence of depression moderating NA change; however, depression did moderate PA change. These findings suggest that patients with SAD report significant decreases in NA but no change in PA over transdiagnostic group treatment, with increases in PA being stronger among patients with more severe depressive symptoms. PA captures an important emotional experience for living a fulfilling life, yet CBT-based treatments may not be effectively improving these areas. Future studies targeting PA in SAD treatment can inform whether doing so ultimately improves treatment outcomes for SAD.

A longitudinal investigation of non-suicidal self-injury persistence patterns, risk factors, and clinical outcomes during the college period

BACKGROUND

Although non-suicidal self-injury (NSSI) is known typically to begin in adolescence, longitudinal information is lacking about patterns, predictors, and clinical outcomes of NSSI persistence among emerging adults. The present study was designed to (1) estimate NSSI persistence during the college period, (2) identify risk factors and high-risk students for NSSI persistence patterns, and (3) evaluate the association with future mental disorders and suicidal thoughts and behaviors (STB).

METHODS

Using prospective cohorts from the Leuven College Surveys (n = 5915), part of the World Mental Health International College Student Initiative, web-based surveys assessed mental health and psychosocial problems at college entrance and three annual follow-up assessments.

RESULTS

Approximately one in five (20.4%) students reported lifetime NSSI at college entrance. NSSI persistence was estimated at 56.4%, with 15.6% reporting a high-frequency repetitive pattern (≥five times yearly). Many hypothesized risk factors were associated with repetitive NSSI persistence, with the most potent effects observed for pre-college NSSI characteristics. Multivariate models suggest that an intervention focusing on the 10-20% at the highest predicted risk could effectively reach 34.9-56.7% of students with high-frequency repetitive NSSI persistence (PPV = 81.8-93.4, AUC = 0.88-0.91). Repetitive NSSI persistence during the first two college years predicted 12-month mental disorders, role impairment, and STB during the third college year, including suicide attempts.

CONCLUSIONS

Most emerging adults with a history of NSSI report persistent self-injury during their college years. Web-based screening may be a promising approach for detecting students at risk for a highly persistent NSSI pattern characterized by subsequent adverse outcomes.

Transdiagnostic Predictors of Everyday Functioning: Examining the Relationships of Depression and Reinforcement Learning

BACKGROUND AND HYPOTHESIS

Impairments in function (ie, the ability to independently accomplish daily tasks) have been established in psychotic disorders. Identifying factors that contribute to these deficits is essential to developing effective interventions. The current study had several goals: examine potential differential relationships across domains of neurocognition, assess whether reinforcement learning is related to function, identify if predictors of function are transdiagnostic, determine whether depression and positive symptoms contribute to function, and to explore whether the modality of assessment impacts observed relationships.

STUDY DESIGN

Data from 274 participants were examined with schizophrenia/schizoaffective disorder (SZ; n = 195) and bipolar disorder (BD; n = 79). To reduce dimensionality, a PCA was completed on neurocognitive tasks which resulted in 3 components. These components and clinical interview data were used to investigate predictors of functional domains across measures of function (self- and informant-report SLOF and UPSA).

RESULTS

Two components, working memory/processing speed/episodic memory (βs = 0.18-0.42), and negative/positive reinforcement learning (β = -0.04), predicted different functional domains. Predictors of function were largely transdiagnostic with two exceptions: reinforcement learning had a positive association with self-reported interpersonal relationships for SZ and a negative association for BD (β = 0.34), and the negative association between positive symptoms and self-reported social acceptability was stronger for BD than for SZ (β = 0.93). Depression robustly predicted self-reported but not informant-reported function, and anhedonia predicted all domains of informant-reported function.

CONCLUSIONS

These findings imply that reinforcement learning may differentially relate to function across disorders, traditional domains of neurocognition can be effective transdiagnostic targets for interventions, and positive symptoms and depression play a critical role in self-perceived functional impairments.

Risk factors for new antidepressant use after surgery in Sweden: a nationwide, observational cohort study

Background

Whilst somatic complications after major surgery are being increasingly investigated, the research field has scarce data on psychiatric outcomes such as postoperative depression. This study evaluates the impact of patient and surgical factors on the risk of depression after surgery using the proxy measure of prescribed and collected antidepressants.

Methods

An observational, registry-based, national multicentre cohort study of individuals ≥18 yr of age who underwent noncardiac surgery between 2007 and 2014. Exclusion criteria included history of antidepressant use defined by collection of a prescription within 5 yr before surgery. Participants were identified using a surgical database from 23 Swedish hospitals and data were linked to National Board of Health and Welfare registers for collection of prescribed antidepressants. Descriptive statistics were used for baseline data and logistic regression for predictive factors.

Results

Of 223 617 patients, 4.9% had a new prescription of antidepressants collected 31-365 days after surgery. Antidepressant prescription was associated with increasing age, female sex, and more comorbidities. The incidence of antidepressant prescription was highest after neurosurgery, vascular, and thoracic surgery. Affective and anxiety disorders were risk factors. In the whole cohort and within the aforementioned surgical subtypes, acute and cancer surgery increased the risk of antidepressant prescription.

Conclusions

This study brings novel insights to the epidemiology of postoperative antidepressant treatment in antidepressant-naive patients. One in 20 postoperative patients are prescribed antidepressants but with knowledge of risk factors, interventional strategies can be tested.

Major depressive disorder

Major depressive disorder (MDD) is characterized by persistent depressed mood, loss of interest or pleasure in previously enjoyable activities, recurrent thoughts of death, and physical and cognitive symptoms. People with MDD can have reduced quality of life owing to the disorder itself as well as related medical comorbidities, social factors, and impaired functional outcomes. MDD is a complex disorder that cannot be fully explained by any one single established biological or environmental pathway. Instead, MDD seems to be caused by a combination of genetic, environmental, psychological and biological factors. Treatment for MDD commonly involves pharmacological therapy with antidepressant medications, psychotherapy or a combination of both. In people with severe and/or treatment-resistant MDD, other biological therapies, such as electroconvulsive therapy, may also be offered.

Mental health and disability research in Ghana: a rapid review

The objective of this rapid review was to explore the current evidence base for mental health and disability research in Ghana. The PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist was followed. Online databases were used to identify primary studies, systematic reviews, meta-analyses, rapid reviews, or guidelines published between 2010 and 2020. All relevant published (both peer-reviewed articles and grey literature) on mental health and/or disability research conducted in or on Ghana between 2010 and 2020 were included in this review. 4,791 articles were identified in the initial search. After the removal of duplicates, followed by title and abstract screening, 930 articles were selected for full-text review. An additional 8 articles identified from reference lists of included articles were also included in full-text review. After review, 375 articles were selected for inclusion; 234 (62%) were on mental health while the remaining 141 (38%) were on disability. There is an increasing trend in the absolute number of mental health and/or disability studies. Most of the mental health studies included in this review were either observational quantitative studies (n=132; 56%) or observational qualitative studies (n=79; 34%). There were very few interventional studies (n=6; 3%). A similar finding was noted for the disability studies. External funding accounted for 51% of mental health articles. Although there was a steady year-on-year increase in the absolute number of mental health and/or disability studies conducted between 2010 to 2020, there is a need for more intervention studies to evaluate what mental health and/or disability interventions work, for whom, and under what circumstances. These should include evaluations of the cost, benefits, effectiveness, and acceptability of various interventions for policy and planning. Further, there is a need for the Ministry of Health to prioritize research funding for mental health and disability and enhance technical and methodological capacity of researchers to conduct disability and mental health research in Ghana.

Case report: specific phobia of vaginal penetration in a pregnant patient

Specific phobia is frequently unrecognized or untreated unless it causes significant impairment. In this report, we documented a rare case of a pregnant patient who had a specific fear related to vaginal penetration. Due to abnormal fetal cardiac development in the second trimester, the patient was admitted for termination of pregnancy. The patient's persistent request for surgical termination via cesarean delivery prompted the obstetrician to seek psychiatric consultation for tokophobia, a labor- and childbirth-related phobia. The consulting psychiatrist discovered that the patient had developed a significant fear of vaginal penetration during adolescence. Throughout the extended period of this specific phobia, the patient established a range of avoidance strategies. Had it not been for the unforeseen need for abortion, her phobia may not have been identified. Psychoeducation on specific phobias, exposure therapy, muscle relaxation techniques, and the administration of anxiolytics were implemented. The pregnancy was terminated through a vaginal labor induction procedure 2 days later. Collaboration across disciplines is necessary to support a thorough assessment of obstetric patients who express hesitancy toward vaginal delivery.

A longitudinal study on the impact of Internet gaming disorder on self-perceived health, academic performance, and social life of first-year college students

BACKGROUND AND OBJECTIVES

Internet gaming disorder (IGD) is associated with health, social, and academic problems but whether these are consequences of the disorder rather than precursors or correlates is unclear. We aimed to evaluate whether IGD in the 1st year of university predicts health, academic and social problems 1 year later, controlling for baseline health, academic and social problems, demographics, and mental health symptoms.

METHODS

In a prospective cohort study, 1741 university students completed both a baseline online survey in their 1st year and a follow-up survey 1 year later. Log-binomial models examined the strength of prospective associations between baseline predictor variables (IGD, baseline health, academic and social problems, sex, age, and mental health symptoms) and occurrence of health, academic and social problems at follow-up.

RESULTS

When extensively adjusted by the corresponding outcome at baseline, any mental disorder symptoms, sex, and age, baseline IGD was associated only with severe school impairment and poor social life (risk ratio [RR] = 1.77; 95% confidence interval [CI] = 1.14-2.75, p = .011; RR = 1.22; 95% CI = 1.07-1.38, p = .002, respectively).

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

University authorities and counselors should consider that incoming 1st-year students that meet criteria for IGD are likely to have increased academic and social impairments during their 1st year for which they may want to intervene. This study adds to the existing literature by longitudinally examining a greater array of negative outcomes of IGD than previously documented.

Childhood adversities and mental disorders in first-year college students: results from the World Mental Health International College Student Initiative

BACKGROUND

This study investigates associations of several dimensions of childhood adversities (CAs) with lifetime mental disorders, 12-month disorder persistence, and impairment among incoming college students.

METHODS

Data come from the World Mental Health International College Student Initiative (WMH-ICS). Web-based surveys conducted in nine countries (n = 20 427) assessed lifetime and 12-month mental disorders, 12-month role impairment, and seven types of CAs occurring before the age of 18: parental psychopathology, emotional, physical, and sexual abuse, neglect, bullying victimization, and dating violence. Poisson regressions estimated associations using three dimensions of CA exposure: type, number, and frequency.

RESULTS

Overall, 75.8% of students reported exposure to at least one CA. In multivariate regression models, lifetime onset and 12-month mood, anxiety, and substance use disorders were all associated with either the type, number, or frequency of CAs. In contrast, none of these associations was significant when predicting disorder persistence. Of the three CA dimensions examined, only frequency was associated with severe role impairment among students with 12-month disorders. Population-attributable risk simulations suggest that 18.7-57.5% of 12-month disorders and 16.3% of severe role impairment among those with disorders were associated with these CAs.

CONCLUSION

CAs are associated with an elevated risk of onset and impairment among 12-month cases of diverse mental disorders but are not involved in disorder persistence. Future research on the associations of CAs with psychopathology should include fine-grained assessments of CA exposure and attempt to trace out modifiable intervention targets linked to mechanisms of associations with lifetime psychopathology and burden of 12-month mental disorders.

Recurrence of anxiety disorders and its predictors in the general population

BACKGROUND

Anxiety disorders frequently recur in clinical populations, but the risk of recurrence of anxiety disorders is largely unknown in the general population. In this study, recurrence of anxiety and its predictors were studied in a large cohort of the adult general population.

METHODS

Baseline, 3-year and 6-year follow-up data were derived from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2). Respondents (N = 468) who had been in remission for at least a year prior to baseline were included. Recurrence was assessed at 3 and 6 years after baseline, using the Composite International Diagnostic Interview version 3.0. Cumulative recurrence rates were estimated using the number of years since remission of the last anxiety disorder. Furthermore, Cox regression analyses were conducted to investigate predictors of recurrence, using a broad range of putative predictors.

RESULTS

The estimated cumulative recurrence rate was 2.1% at 1 year, 6.6% at 5 years, 10.6% at 10 years, and 16.2% at 20 years. Univariate regression analyses predicted a shorter time to recurrence for several variables, of which younger age at interview, parental psychopathology, neuroticism and a current depressive disorder remained significant in the, age and gender-adjusted, multivariable regression analysis.

CONCLUSIONS

Recurrence of anxiety disorders in the general population is common and the risk of recurrence extends over a lengthy period of time. In clinical practice, alertness to recurrence, monitoring of symptoms, and quick access to health care in case of recurrence are needed.

The efficacy and safety of cariprazine in the early and late stage of schizophrenia: a post hoc analysis of three randomized, placebo-controlled trials

BACKGROUND

The aim of the post hoc analysis was to better understand the efficacy and safety of cariprazine in patients with schizophrenia for less than 5 years (early stage) and for more than 15 years (late stage).

METHODS

Data from three phase II/III randomized, double-blind, placebo-controlled trials with similar design in patients with acute exacerbation of schizophrenia were pooled and patients with early and late stage of schizophrenia were determined. A mixed-effects model for repeated measures approach was applied and least square (LS) mean changes from baseline to week 6 on the Positive and Negative Syndrome Scale (PANSS) total and factor scores were reported. Descriptive statistics were used for safety analyses including treatment emergent adverse events (TEAEs) and discontinuation rates.

RESULTS

Overall, 460 patients were identified as being in the early and 414 in the late stage of schizophrenia. The pooled analysis evaluating mean change from baseline to week 6 in the PANSS total score indicated statistically significant difference between cariprazine and placebo in favor of cariprazine in both the early (LS mean difference [LSMD] -7.5 P < .001) and late stage (LSMD -6.7, P < .01) subpopulation. Early stage patients experienced similar amount of TEAEs (CAR 67.3%, PBO 54.1%) as patients in the late stage (CAR 69.6%, PBO 65.6%).

CONCLUSION

In conclusion, cariprazine, a potent D₃-D₂ partial agonist has been found to be safe and effective in the treatment of early and late stage schizophrenia.

A Preliminary Examination of Treatment Barriers, Preferences, and Histories of Women with Symptoms of Social Anxiety Disorder

Social anxiety disorder (SAD) is a common mental health condition that is characterised by a persistent fear of social or performance situations. Despite effective treatments being available, many individuals with SAD do not seek treatment or delay treatment seeking for many years. The aim of the present study was to examine treatment barriers, treatment histories, and cognitive behavioural therapy (CBT) delivery preferences in a sample of women with clinically relevant SAD symptoms. Ninety-nine women (Mage = 34.90, SD = 11.28) completed the online questionnaires and were included in the study. Participants were recruited from advertisements on community noticeboards and posts on social media. The results demonstrated that less than 5% of those who received psychological treatment in the past were likely to have received best-practice CBT. The most commonly cited barriers to accessing treatment for women with SAD related to direct costs (63%) and indirect costs (e.g., transport/childcare) (28%). The most preferred treatment delivery method overall was individual face-to-face treatment (70%). The study demonstrates a need to provide a variety of treatment options in order to enhance access to empirically supported treatment for women with SAD.

Delivering the Thinking Healthy Programme as a universal group intervention integrated into routine antenatal care: a randomized-controlled pilot study

BACKGROUND

Women with perinatal depression and their children are at increased risk of poor health outcomes. There is a need to implement non-stigmatizing interventions into existing health systems which reduce psychosocial distress during pregnancy and prevent perinatal depression. We adapted the WHO-endorsed Thinking Healthy Programme (THP) to be delivered universally to all women attending routine online pregnancy schools in Istanbul, Turkey. This study aimed to evaluate the feasibility and acceptability of this intervention.

METHODS

This mixed-methods study incorporated a two-arm pilot randomized controlled trial and qualitative evaluation of the feasibility and acceptability of the adapted THP - Brief Group version (THP-BGV) to a range of stakeholders. We recruited pregnant women at 12-30 weeks' gestation through pregnancy schools within the University Hospital's catchment area. Women in the intervention arm received five online sessions of the THP-BGV delivered by antenatal nurses. The intervention employed principles of cognitive behaviour therapy to provide psychoeducation, behaviour activation, problem-solving strategies and group support to participants. In the control arm, women received usual care consisting of routine online educational pregnancy classes aided by the antenatal nurses. The women were assessed for depressive symptoms with the Edinburgh Postnatal Depression Scale at baseline and 4-6 weeks post-intervention and also evaluated for anxiety, perceived social support, partner relationship, level of disability and sleep quality. In-depth interviews were conducted with women and other key stakeholders.

RESULTS

Of the 99 consecutive women referred to the pregnancy schools, 91 (91.9%) were eligible and 88 (88.8%) consented to participate in the study and were randomized. Eighty-two (83%) completed the final assessments. Our main findings were that this preventive group intervention was feasible to be integrated into routine antenatal educational classes and it was valued by the women and delivery-agents. While the study was not powered to detect differences between intervention and control conditions, we found small trends towards reduction in anxiety and depressive symptoms favoring the intervention arm. No serious adverse events were reported.

CONCLUSIONS

Given the paucity of preventive interventions for perinatal depression in low and middle-income countries, a fully powered definitive randomized controlled trial of this feasible and acceptable intervention should be conducted.

TRIAL REGISTRATION

The study was registered at Clinical Trails.gov ( NCT04819711 ) (Registration Date: 29/03/2021).

Long-term disability in common mental disorders in Chinese community: evidence from a five-year follow-up study

BACKGROUND

Common mental disorders are general term for mental disorders with high disability rates and significant social burden. The purpose of this study was to determine the degree of long-term disability associated with common mental disorders and to interpret the relationship between common mental disorders and long-term disability.

METHODS

Participants in the 2013 China Mental Health Survey were followed up by telephone between April and June 2018. This study evaluated long-term disability over a five-year period using the World Health Organization's Disability Assessment Schedule 2.0. Poisson regression was used to analyze the relationship between common mental disorders and long-term disability.

RESULTS

A total of 6269 patients were followed up by telephone. In patients with common mental disorders, the prevalence of disability ranged from 7.62% to 43.94%. The long-term disabilities were significantly associated with dysthymic disorder (DD, RR:2.40; 95% CI:1.87-3.03), major depressive disorder (MDD, RR:1.63; 95% CI:1.34-1.98), generalized anxiety disorder (GAD, RR:1.95; 95% CI:1.15-3.09), obsessive-compulsive disorder (OCD, RR:1.68; 95% CI:1.24-2.22) and alcohol use disorder (AUD, RR: 1.42; 95% CI:0.99-1.96).

CONCLUSIONS

In China, common mental disorders raise the risk of long-term disability, and there is a critical need for monitoring patients with DD, MDD, GAD, OCD, and AUD. For improved quality of life and reduced disability levels, more resources need to be dedicated to mental health in the future.

The prevalence and correlates of bulimia nervosa, binge-eating disorder, and anorexia nervosa: The Saudi National Mental Health Survey

OBJECTIVE

Limited studies have been conducted in the Kingdom of Saudi Arabia on eating disorders (EDs). This study presents national epidemiological survey data on the prevalence and correlates of anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) and their association with other mental health disorders, impairment in role functioning, and individual help-seeking behaviors in the Saudi National Mental Health Survey (SNMHS).

METHOD

A face-to-face survey was conducted in a nationally representative household sample of Saudi citizens aged 15-65 (n = 4004). The Composite International Diagnostic Interview (CIDI 3.0) was used to produce estimates of lifetime and 12-month prevalence and treatment of common DSM-IV mental disorders.

RESULTS

Twelve-month prevalence of any of the three EDs was 3.2%; the overall lifetime prevalence was 6.1%. Education and marital status were significantly associated with both 12-month and lifetime EDs prevalence. Significant mental health comorbidities associated with 12-month EDs were anxiety, mood, and impulse-control disorders, while lifetime EDs were significantly related to all disorders. A similar percentage of respondents that reported having ED-related treatment at some point in their lifetime utilized healthcare and nonhealthcare sector. There was a significant relationship between body mass index category, and lifetime BED and BN.

DISCUSSION

The 12-month prevalence of EDs in the Saudi population was higher than the EDs rates reported worldwide. These findings can help healthcare experts, and policymakers in the implementation of initiatives for raising awareness of EDs among the Saudi population, and the development of a country-wide plan for the prevention of EDs.

PUBLIC SIGNIFICANCE STATEMENT

The study presents data on the prevalence, correlates, and help-seeking behaviors of AN, BN, and BED, in the Saudi National Mental Health Survey (SNMHS). Obtaining information on this underrepresented region is essential due to the large differences in cross-national data in addition to cultural beliefs about mental illness and treatment seeking to exert an important influence on eating disorders. Such knowledge could provide a better understand of mechanisms underlying the development of eating disorders and thereby improve prediction, prevention, and treatment.

Validity of the patient health questionnaires (phq-2 and phq-9) for screening depression among human immunodeficiency virus patients in Lahore, Pakistan

BACKGROUND

Many human immunodeficiency virus (HIV) infected patients suffer from depr-ession, but a little focus is given to detecting and treating depression in primary health care. Detection of depression can be improved by introducing short, reliable, and valid screening instruments.

AIM

To determine the psychometric properties of the patient health questionnaire-2 (PHQ-2) and patient health questionnaire-9 (PHQ-9) for depression screening and diagnosis, and the sensitivity and specificity of the PHQ-2 in HIV infected patients.

METHODS

A cross-sectional study was conducted on 158 HIV-infected patients aged 18 years and above in Lahore, Pakistan. PHQ-2 was implemented to screen depression. PHQ-9 was implemented to diagnose major depressive disorder as a reference standard. Reliability, Validity tests and receiver operating characteristic curve were computed.

RESULTS

The Cronbach's alpha of PHQ-2 and PHQ-9 were 0.732 and 0.759, respectively. The study results showed that the score of 2 on PHQ-2 indicates the highest Youden's index of 0.924, with both sensitivity and specificity of 0.96, and the area under the curve for PHQ-2 was 0.98 (95%CI: 0.953-0.998).

CONCLUSION

Good psychometric properties for the PHQ-2 and PHQ-9 indicated their significant potential as tools for depression screening and diagnosis in the HIV-infected population.

Leave Me Alone With Your Symptoms! Social Exclusion at the Workplace Mediates the Relationship of Employee's Mental Illness and Sick Leave

Although a substantial part of employees suffers from a mental illness, the work situation of this population still is understudied. Previous research suggests that people with a mental illness experience discrimination in the workplace, which is known to have detrimental effects on health. Building on the stereotype content model and allostatic load theory, the present study investigated whether employees with a mental illness become socially excluded at the workplace and therefore show more days of sick leave. Overall, 86 employees diagnosed with a mental disorder were interviewed and completed online-surveys. Path analyses supported the hypotheses, yielding a serial mediation: The interview-rated severity of the mental disorder had an indirect effect on the days of sick leave, mediated by the symptomatic burden and the social exclusion at the workplace. In the light of the costs associated with absenteeism the present paper highlights the harmfulness of discrimination. Organizations and especially supervisors need to be attentive for signs of exclusion within their teams and try to counteract as early as possible.

Prevalence of depressive disorders and associated demographic characteristics in Shandong: An epidemiological investigation

BACKGROUND

Depression is characterized by debilitating symptoms and high recurrence rates, and there are relatively few large-scale epidemiological surveys of depressive disorders conducted in Shandong since 2005. Data from the largest Epidemiological Survey of Mental Disorders conducted in 2015 in Shandong were collected to investigate the prevalence of depressive disorders and associated demographic characteristics in general adult population.

METHODS

A multi-stage stratified cluster sampling method was adopted to select residents and a two-stage screening and assessment process was used to define the prevalence and characteristics of depressive disorders. Respondents were initially screened using the General Health Questionnaire followed by a structured clinical interview using the DSM-IV criteria.

RESULTS

Among 27,489 respondents who completed the survey, 1277 respondents met the diagnostic criteria for depressive disorders. The adjusted prevalence in the last month was 4.86%, among which the prevalence of major depressive disorder, dysthymia, and unspecified depressive disorder were 2.32%, 1.78%, and 0.75%, respectively. 40.35% of depression patients had moderate or severe functional impairment and only 10.65% of patients had visited a psychiatric service. Univariate and multivariate analyses revealed that age, gender, occupation, education, marital status, and urban/rural living were associated with the prevalence.

LIMITATIONS

The key limitation is that this is a cross-sectional survey therefore cannot draw any causal relationship between risk factors and disease progression.

CONCLUSIONS

Findings from this largest epidemiological study reveal current prevalence of depressive disorders and associated demographic factors and offers opportunities for policy makers and health-care professionals to improve mental health provision in Shandong.

Trauma-focused cognitive behavioral therapy with Puerto Rican youth in a post-disaster context: Tailoring, implementation, and program evaluation outcomes

PURPOSE

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) has not yet been systematically evaluated in the Caribbean context, particularly with Hispanic youth exposed to multiple disasters. The objective of this project was twofold: 1) to train mental health providers in Puerto Rico in TF-CBT as part of a clinical implementation project within the largest managed behavioral health organization (MBHO) on the island, and 2) to conduct a program evaluation to determine the feasibility of implementation and the effectiveness of the treatment.

METHOD

Fifteen psychologists were trained in TF-CBT. These psychologists then provided TF-CBT to 56 children and adolescents, ages 5-18, in community-based mental health clinics and one primary care clinic with a co-located psychologist in Puerto Rico. The mean number of traumatic events reported by youth referred for TF-CBT was 4.11.

RESULTS

Thirty-six out of 56 children enrolled in the project (64.3%) successfully completed all components of TF-CBT. Results demonstrated large effect sizes for reduction in youth-reported posttraumatic stress symptoms (PTSS) (Cohen's d = 1.32), depressive symptoms (Cohen's d = 1.32), and anxiety symptoms (Cohen's d = 1.18).

CONCLUSIONS

These results suggest that it was feasible to train providers in TF-CBT, that providers were able to deliver TF-CBT in community-based settings both in person and via telehealth (due to the COVID-19 pandemic), and that TF-CBT was an effective treatment option to address trauma-related concerns for youth in Puerto Rico in a post-disaster context. This project is an important first step in the dissemination and implementation of evidence-based trauma-focused treatment for Hispanic youth and disaster-affected youth in the Caribbean.

Prevalence of anxiety symptomatology and diagnosis in syndromic intellectual disability: A systematic review and meta-analysis

Individuals with syndromic intellectual disability are at increased risk of experiencing anxiety. Comparing prevalence estimates of anxiety will allow the identification of at-risk groups and inform causal pathways of anxiety. No known study has explored estimates of anxiety symptomatology and diagnosis, including specific anxiety profiles, across groups whilst accounting for methodological quality of studies. This systematic review and meta-analysis aimed to fill this gap. Prior to review completion, methodology and analysis plans were registered and documented in a protocol (CRD42019123561). Data from 83 papers, involving a pooled sample of 13,708 across eight syndromes were synthesised using a random effects model. Anxiety prevalence ranged from 9 % (95 % CI: 4-14) in Down syndrome to 73% in Rett syndrome (95 % CI: 70-77). Anxiety prevalence across syndromic intellectual disability was higher than for intellectual disability of mixed aetiology and general population estimates. Substantial variability between syndromes identified groups at higher risk than others. The identification of high-risk groups is crucial for early intervention, allowing us to refine models of risk and identify divergent profiles.

ADHD Comorbidity Structure and Impairment: Results of the WHO World Mental Health Surveys International College Student Project (WMH-ICS)

OBJECTIVE

To examine the prevalence of ADHD and the association of comorbid disorders, and multivariate disorder classes with role impairment in college students.

METHOD

About 15,991 freshmen (24 colleges, 9 countries, WMH-ICS) (response rate = 45.6%) completed online WMH-CIDI-SC surveys for 6-month ADHD and six 12-month DSM-IV disorders. We examined multivariate disorder classes using latent class analysis (LCA) and simulated a population attributable risk proportions (PARPs) of ADHD-related impairment.

RESULTS

About 15.9% had ADHD, of which 58.4% had comorbidities. LCA classified ADHD respondents to pure (42.9%), internalizing (36.0%), bipolar comorbidities (11.3%), and externalizing disorder classes (9.8%). ADHD, comorbidities, and multivariate disorder classes independently predicted severe impairment. PARPs: eliminating ADHD hypothetically reduced severe impairment by 19.2%, 10.1% adjusted for comorbidities, 9.5% for multivariate disorder classes.

CONCLUSIONS

ADHD and comorbid disorders are common and impairing in college students. Personalized transdiagnostic interventions guided by multivariate disorder classes should be explored.

Persistence of significant pain interference following substance use disorder remission: Negative association with psychosocial and physical recovery

BACKGROUND

Although substance use disorder (SUD) is frequently complicated by pain, the prevalence and correlates of persistent pain and dysfunction following SUD remission have not been studied.

METHODS

Using a cross-sectional sample of United States (US) adults with SUD identified in the National Epidemiologic Survey on Alcohol and Related Conditions Wave III, we evaluated the prevalence of moderate/severe pain interference (PI) in subgroups with current and remitted SUD and the independent association of SUD remission and PI with self-reported psychosocial and physical function (Mental Health Composite Score [MCS] and Physical Function Score [PFS] from the Short Form 12).

RESULTS

A fifth (20.6%; 7.6 million) of estimated 36.7 million US adults with past year SUD and a slightly higher proportion (25.6%; 9.6 million) of 37.4 million with SUD remission reported PI. MCS and PFS showed independent negative associations with PI among adults with both past year SUD and SUD remission. MCS had a positive independent association with SUD remission, but a stronger negative association with PI. While PFS had no statistically significant association with SUD remission, it had a strong negative association with PI. Analysis of interaction between SUD remission and PI revealed that SUD remission had no effect on the association of PI and MCS but had significant moderating influence on the association between PI and PFS.

CONCLUSIONS

Moderate to severe pain interference continues to be a significant problem among a sizable population achieving SUD remission potentially impeding recovery, and deserves focused clinical attention both active SUD and its remission.

An Innovative Needs Assessment Approach to Develop Relevant Continuing Professional Development for Psychiatrists

OBJECTIVES

Gaps in psychiatrists' competence can interfere with the delivery of optimal patient care, particularly when these gaps have not been identified. This study aimed to assess the perceived and unperceived continuing professional development needs of psychiatrists practicing in Quebec, Canada.

METHODS

The authors sent an online cross-sectional survey (2018) to members of the 'Association des médecins psychiatres du Québec' and collected data on unperceived needs via the critical incident method (focused on managing challenging clinical cases/situations). Data were analyzed using descriptive statistics, chi-squared tests, thematic analysis, and triangulation of data. Two coders independently analyzed qualitative data.

RESULTS

Of 1150 eligible psychiatrists, 187 (16%) completed the survey. Over half were female (58%), caring for adult patients (60%), and practiced in a university hospital (49%). Top perceived and unperceived learning need areas were neurodevelopmental disorders and psychopharmacology. Three hundred forty-three factors influencing the management of reported challenges were classified as case complexity (53%), patient (22%), environment (19%), and lack of knowledge (4%). Consultation with colleagues (49%) was the most frequently accessed resource for approaching challenging cases. During the previous year and across both self-directed and group learning activities, respondents reported engaging more frequently in in-person than online activities.

CONCLUSIONS

A comprehensive needs assessment integrating perceived and unperceived needs is the cornerstone for planning relevant continuing professional development. The critical incident method is a useful tool to assess psychiatrists' unperceived needs. Critical reflection after solving complex clinical cases might provide an opportunity to optimize psychiatrists' selection of relevant continuing professional development.

A new approach for the treatment of subthreshold bipolar disorders: Targeted high dose levothyroxine and repetitive transcranial magnetic stimulation for mitochondrial treatment

Bipolar spectrum disorder includes Bipolar I, Bipolar II and subthreshold bipolar disorders (BD). The condition is highly prevalent, disabling and associated with high mortality. Failure of diagnosis is high. Subthreshold presentations present as 4 or more changes in polarity, are generally less responsive to standard treatment and as a result, drug combinations are often needed. High Dose Levothyroxine (HDT) has been reported to be safe and effective with this condition. Treatment response has been associated with mutations in thyroid activating enzymes and intra cerebral transporter protein carrier. Repetitive Transcranial Magnetic Stimulation (rTMS) has been shown to be effective in bipolar depression and has been proved to have neuroplastic effect. Present authors had reported clinical evidence of safe and effective use of a combination treatment protocol. Potential mechanisms of action of the combined treatment protocol and the role of mitochondria function are discussed.

Disability and Comorbidity of Mood Disorders and Anxiety Disorders With Diabetes and Hypertension: Evidences From the China Mental Health Survey and Chronic Disease Surveillance in China

BACKGROUND

The China Mental Health Survey was carried out using the same sampling frame with the China Chronic Diseases and Risk Factors Surveillance. This paper explores the relationship between the disability and the comorbidity of mood disorders and anxiety disorders with diabetes and hypertension.

METHODS

A large-scale nationally representative sample with both mental disorders and chronic diseases was collected from 157 Disease Surveillance Points in 31 provinces across China. Face-to-face interviews were conducted by trained lay interviewers to make diagnoses of mood disorders and anxiety disorders using the Composite International Diagnostic Interview. Diabetes and hypertension were diagnosed from self-report and blood examination or body measurement. Sampling design weights, non-response adjustment weights, and post-stratification adjustment weights were applied during the analyses of comorbidity and disability.

RESULTS

Totally 15,000 respondents had information of mental disorders and physical diseases. In the patients with mood disorders or anxiety disorders, the weighted prevalence rates of diabetes or hypertension were not higher than those in persons without the above mental disorders, but the weighed disability rates increased when having the comorbidity of hypertension (P < 0.05). The severity of disability was higher among patients with comorbidity of diabetes and anxiety disorders, or hypertension and mood disorders, compared with that among patients without the physical comorbidity (P < 0.05). After adjusted by age, gender and education, patients with comorbidity of mental disorders and physical disorders had the highest disability, followed by the patients with mental disorders only, and physical diseases only.

CONCLUSIONS

The disability of mood disorders and anxiety disorders comorbid with diabetes and hypertension are more serious than that of any single disease. The relationship of mental and physical diseases is worth exploring in depth for comprehensive and integrated intervention to decrease the disability.

Evidence of Delayed, Recursive Benefits of Self-Affirmation on Anxiety in Socially Anxious University Students

Introduction: Persons with social anxiety disorder (SAD) often experience social interactions as threatening and commonly avoid them or perform poorly in them (Asher et al., 2017). Self-affirmation is an intervention shown to help individuals engage effectively in situations they perceive as threatening (Sherman & Hartson, 2011). We hypothesized that self-affirmation would allow socially anxious individuals to participate in more social activities, do so more effectively, and with less stress and anxiety. Methods: Following completion of baseline measures, 75 socially anxious university students were randomly assigned to complete a self-affirming or control writing task. They subsequently completed the Trier Social Stress Test for Groups (TSST-G), and received SAD psychoeducation designed to promote social engagement over the coming month, after which they were reassessed on baseline measures of social anxiety. Results Self-affirmation demonstrated no benefit at the time of engagement in the TSST-G. However, at follow-up, self-affirmed students reported significantly less discomfort, anxiety, and distress related to a variety of social behaviors as well as more engagement in those behaviors, relative to baseline, compared with non-affirmed students. Moreover, significantly more affirmed than non-affirmed participants reported clinically significant reductions in symptoms of SAD at follow-up. Discussion These results help to broaden our conceptualization of self-affirmation and provide support for its potential utility in treatment for those with SAD.

Psychological risk factors and the course of depression and anxiety disorders: A review of 15 years NESDA research

BACKGROUND

The Netherlands Study of Depression and Anxiety (NESDA; N_baseline=2981) is an ongoing longitudinal, multi-site, naturalistic, cohort study examining the etiology, course, and consequences of depression and anxiety. In this article we synthesize and evaluate fifteen years of NESDA research on prominent psychological risk factors for the onset, persistence, recurrence, and comorbidity of affective disorders.

METHODS

A narrative review of 62 NESDA articles examining the specificity and predictive value of neuroticism, behavioral inhibition, repetitive negative thinking, experiential avoidance, cognitive reactivity, locus of control, (implicit) self-esteem, (implicit) disorder-specific self-associations, and attentional bias for the course of affective disorders.

RESULTS

All self-reported risk factors showed cross-sectional relationships with singular and comorbid affective disorders, and prospective relationships with the development and chronicity of depression and anxiety disorders. High neuroticism, low self-esteem, and negative repetitive thinking showed most prominent transdiagnostic relationships, whereas cognitive reactivity showed most pronounced depression-specific associations. Implicit self-esteem showed predictive validity for the persistence and recurrence of anxiety and depression over and above self-reported risk factors. Automatic approach-avoidance behavior and attentional bias for negative, positive, or threat words showed no relationship with affective disorders.

CONCLUSION

NESDA identified both (a) transdiagnostic factors (e.g., neuroticism, low implicit self-esteem, repetitive negative thinking) that may help explain the comorbidity between affective disorders and overlap in symptoms, and (b) indications for disorder-specific risk factors (e.g., cognitive responsivity) which support the relevance of distinct disorder categories and disorder-specific mechanisms. Thus, the results point to the relevance of both transdiagnostic and disorder-specific targets for therapeutic interventions.

Estimating the global treatment rates for depression: A systematic review and meta-analysis

BACKGROUND

Depression is considered a global crisis due to its high prevalence and associated disabilities. The burden posed by depression could be reduced by increasing access to timely treatment. Limited information is available on treatment rates of depression, particularly in low- and middle-income countries. This study aimed to estimate the treatment rates for depression in the general adult population by World Bank income classification.

METHODS

We searched PubMed, EMBASE, PsycINFO, and CINAHL, supplemented with hand-search of reference lists to identify community-based studies. The overall treatment rate for depression was estimated from studies that reported any treatment (behavioral or pharmacological treatments) in healthcare or informal non-healthcare settings. Data were pooled using a random-effects meta-analysis model. Subgroup analyses by income classification were completed. Meta-regression was conducted by study characteristics. The protocol was pre-registered at PROSPERO (CRD42020161683).

RESULTS

We included 65 studies comprising 1.1 million participants from 79 countries and territories. The global 12-month/lifetime pooled treatment rate was 34.8% (95% confidence interval: 29.9, 39.9%). The treatment rates were 48.3% (43.0, 53.6%) in high-income countries, 21.4% (15.1, 27.7%) in middle-income countries, and 16.8% (11.3, 23.0%) in low-income countries. Among the treated samples, 12-month minimally adequate treatment was estimated to be 40%.

LIMITATION

We reported a substantial level of between-study heterogeneity, which was partially explained by study characteristics in the meta-regression.

CONCLUSION

Globally, approximately one-third of people with depression receive treatment. Three in five treated people with depression did not receive minimally adequate treatment. Depression treatment rates are considerably lower in low-and middle-income countries.

Previous disorders and depression outcomes in individuals with 12-month major depressive disorder in the World Mental Health surveys

AIMS

Major depressive disorder (MDD) is characterised by a recurrent course and high comorbidity rates. A lifespan perspective may therefore provide important information regarding health outcomes. The aim of the present study is to examine mental disorders that preceded 12-month MDD diagnosis and the impact of these disorders on depression outcomes.

METHODS

Data came from 29 cross-sectional community epidemiological surveys of adults in 27 countries (n = 80 190). The Composite International Diagnostic Interview (CIDI) was used to assess 12-month MDD and lifetime DSM-IV disorders with onset prior to the respondent's age at interview. Disorders were grouped into depressive distress disorders, non-depressive distress disorders, fear disorders and externalising disorders. Depression outcomes included 12-month suicidality, days out of role and impairment in role functioning.

RESULTS

Among respondents with 12-month MDD, 94.9% (s.e. = 0.4) had at least one prior disorder (including previous MDD), and 64.6% (s.e. = 0.9) had at least one prior, non-MDD disorder. Previous non-depressive distress, fear and externalising disorders, but not depressive distress disorders, predicted higher impairment (OR = 1.4-1.6) and suicidality (OR = 1.5-2.5), after adjustment for sociodemographic variables. Further adjustment for MDD characteristics weakened, but did not eliminate, these associations. Associations were largely driven by current comorbidities, but both remitted and current externalising disorders predicted suicidality among respondents with 12-month MDD.

CONCLUSIONS

These results illustrate the importance of careful psychiatric history taking regarding current anxiety disorders and lifetime externalising disorders in individuals with MDD.

Implementation of an Evidence-Based Psychotherapy for Trauma-Exposed Children in a Lower-Middle Income Country: the Use of Trauma-Focused Cognitive Behavioral Therapy in El Salvador

Central American youth are at a high risk for experiencing trauma and related psychosocial problems. Despite this, few studies of evidence-based trauma-focused interventions with this population exist. The objective of this project was twofold: 1) to train providers in El Salvador in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) as part of a clinical implementation project within a non-governmental organization, and 2) to conduct program evaluation to determine the feasibility of implementation and the effectiveness of the treatment. Fifteen Salvadoran psychologists were trained in TF-CBT who then provided TF-CBT to 121 children and adolescents ages 3-18 in community-based locations. The mean number of traumas reported by youth was 4.39. Results demonstrated large effect sizes for reduction in youth-reported trauma symptoms (Cohen's d = 2.04), depressive symptoms (Cohen's d = 1.68), and anxiety symptoms (Cohen's d = 1.67). Our program evaluation results suggest that it was feasible to train providers in TF-CBT, that providers were in turn able to deliver TF-CBT in community-based settings, and that TF-CBT was an effective treatment option to address trauma-related concerns for youth in El Salvador. This project is an important first step in the dissemination and implementation of evidence-based trauma-focused treatment for youth in Latin American countries.

Analysis of genetic differences between psychiatric disorders: exploring pathways and cell types/tissues involved and ability to differentiate the disorders by polygenic scores

Although displaying genetic correlations, psychiatric disorders are clinically defined as categorical entities as they each have distinguishing clinical features and may involve different treatments. Identifying differential genetic variations between these disorders may reveal how the disorders differ biologically and help to guide more personalized treatment. Here we presented a statistical framework and comprehensive analysis to identify genetic markers differentially associated with various psychiatric disorders/traits based on GWAS summary statistics, covering 18 psychiatric traits/disorders and 26 comparisons. We also conducted comprehensive analysis to unravel the genes, pathways and SNP functional categories involved, and the cell types and tissues implicated. We also assessed how well one could distinguish between psychiatric disorders by polygenic risk scores (PRS). SNP-based heritabilities (h2snp) were significantly larger than zero for most comparisons. Based on current GWAS data, PRS have mostly modest power to distinguish between psychiatric disorders. For example, we estimated that AUC for distinguishing schizophrenia from major depressive disorder (MDD), bipolar disorder (BPD) from MDD and schizophrenia from BPD were 0.694, 0.602 and 0.618, respectively, while the maximum AUC (based on h2snp) were 0.763, 0.749 and 0.726, respectively. We also uncovered differences in each pair of studied traits in terms of their differences in genetic correlation with comorbid traits. For example, clinically defined MDD appeared to more strongly genetically correlated with other psychiatric disorders and heart disease, when compared to non-clinically defined depression in UK Biobank. Our findings highlight genetic differences between psychiatric disorders and the mechanisms involved. PRS may help differential diagnosis of selected psychiatric disorders in the future with larger GWAS samples.

Functional limitations in people with multimorbidity and the association with mental health conditions: Baseline data from the Canadian Longitudinal Study on Aging (CLSA)

INTRODUCTION

Increasing multimorbidity is often associated with declining physical functioning, with some studies showing a disproportionate impact on functioning when mental health conditions are present. More research is needed because most multimorbidity studies exclude mental health conditions.

OBJECTIVES

This study aims to improve our understanding of the association between functional limitation and multimorbidity, including a comparison of those with multimorbidity that includes versus excludes mental health conditions.

METHODS

This is a population-based, cross-sectional analysis of data from The Canadian Longitudinal Study on Aging. Functional limitation was defined as the presence of any of 14 activities of daily living (ADLs) or instrumental activities of daily living (IADLs). Multimorbidity, measured by the number of chronic conditions, included mood and anxiety disorders. Logistic regression explored the association between multimorbidity (with and without mental health conditions) and functional limitation. Factor analysis identified common condition clusters to help understand clinical complexity in those with mood/anxiety disorders and the potential influences on functional limitation.

RESULTS

There were 51,338 participants, with a similar proportion of men and women (49% versus 51%) and 42% age 65 years or older. Fifteen percent (15%) had no chronic conditions and 17% had 5+. Ten percent (10%) reported at least one ADL or IADL limitation. Odds ratios (ORs) for functional limitation increased with multimorbidity and were generally higher for those with versus without mental health conditions (e.g., ORs from 1 to 5+ chronic conditions increased 1.9 to 15.8 for those with mood/anxiety disorders versus 1.8 to 10.2 for those without). Factor analysis showed that mood/anxiety conditions clustered with somatic conditions (e.g., migraines, bowel/gastrointestinal disorders).

CONCLUSION

This study found higher odds of functional limitation for those with multimorbidity that included versus excluded mental health conditions, at all levels of multimorbidity. It highlights the need for concurrent management of mental and physical comorbidities to prevent functional limitations and future decline. This approach is aligned with the NICE clinical assessment and management guidelines for people with multimorbidity.

Understanding work participation among employees with common mental disorders: What works, for whom, under what circumstances and how? A systematic realist review protocol

BACKGROUND:

Work participation among employees with common mental disorders (CMDs) is an increasingly important, yet highly complex phenomenon. Given the call for preventing instead of reacting to negative work outcomes, there is a need to understand how employees with CMDs can continue working.

OBJECTIVES:

1) to provide insights in applying a realist approach to the literature review process and 2) to present a way to develop an explanatory framework on work participation, the related causal mechanisms and the interaction with the work context.

METHODS:

A systematic realist literature review, using stay at work (SAW) and work performance (WP) as outcomes of work participation. This protocol paper explains the rationale, tools and procedures developed and used for identification, selection, appraisal and synthesis of included studies.

RESULTS:

The review process entailed six steps to develop so called ‘middle range program theories’. Each step followed a systematic, iterative procedure using context-mechanism-outcome (CMO) configurations.

CONCLUSIONS:

Conducting a realist review adds on the understanding to promote work participation, by examining the heterogeneity and complexity of intervention- and observational studies. This paper facilitates other researchers within the field of occupational health by demonstrating ways to develop a framework on work participation using realist synthesis.

Social Anxiety Symptoms in Survivors of Childhood and Adolescent Cancer

Purpose: Adolescent and young adult (AYA) cancer survivors may be at risk of developing symptoms of social anxiety disorder (SAD) due to disruptions in social participation and functioning following a cancer diagnosis. This study aimed to explore (1) the proportion of Australian AYA-aged survivors of childhood and adolescent cancer who experience symptoms of SAD, (2) how symptoms of SAD are described by survivors as affecting their daily social functioning. Methods: A mixed-methods cross-sectional design was employed, inviting survivors, aged 13-25 years, who had completed treatment between one and ten years ago. Survivors completed a paper-based questionnaire, containing validated measures of SAD, and an optional semistructured interview assessing current social functioning and social anxiety. Results: Twenty-seven survivors aged 13-25 years participated (M = 19.15, 51.9% male, and 7 years post-treatment). Nine (33%) participants reported clinically significant symptoms of SAD. In interviews, survivors reported worries about how others perceived them and fears around meeting new people. Survivors described that this impacted their daily social functioning, leading them to avoid, or endure with distress, feared social situations. Conclusion: This study shows that clinically significant social anxiety may be a concern for a subset of survivors of childhood/adolescent cancer. Identifying which young people are at risk of SAD after cancer and how best to support this vulnerable cohort is critical.

Mental health impact of the first wave of COVID-19 pandemic on Spanish healthcare workers: A large cross-sectional survey

INTRODUCTION

Healthcare workers are vulnerable to adverse mental health impacts of the COVID-19 pandemic. We assessed prevalence of mental disorders and associated factors during the first wave of the pandemic among healthcare professionals in Spain.

METHODS

All workers in 18 healthcare institutions (6 AACC) in Spain were invited to web-based surveys assessing individual characteristics, COVID-19 infection status and exposure, and mental health status (May 5 - September 7, 2020). We report: probable current mental disorders (Major Depressive Disorder-MDD- [PHQ-8≥10], Generalized Anxiety Disorder-GAD- [GAD-7≥10], Panic attacks, Posttraumatic Stress Disorder -PTSD- [PCL-5≥7]; and Substance Use Disorder -SUD-[CAGE-AID≥2]. Severe disability assessed by the Sheehan Disability Scale was used to identify probable "disabling" current mental disorders.

RESULTS

9,138 healthcare workers participated. Prevalence of screen-positive disorder: 28.1% MDD; 22.5% GAD, 24.0% Panic; 22.2% PTSD; and 6.2% SUD. Overall 45.7% presented any current and 14.5% any disabling current mental disorder. Workers with pre-pandemic lifetime mental disorders had almost twice the prevalence than those without. Adjusting for all other variables, odds of any disabling mental disorder were: prior lifetime disorders (TUS: OR=5.74; 95%CI 2.53-13.03; Mood: OR=3.23; 95%CI:2.27-4.60; Anxiety: OR=3.03; 95%CI:2.53-3.62); age category 18-29 years (OR=1.36; 95%CI:1.02-1.82), caring "all of the time" for COVID-19 patients (OR=5.19; 95%CI: 3.61-7.46), female gender (OR=1.58; 95%CI: 1.27-1.96) and having being in quarantine or isolated (OR= 1.60; 95CI:1.31-1.95).

CONCLUSIONS

One in seven Spanish healthcare workers screened positive for a disabling mental disorder during the first wave of the COVID-19 pandemic. Workers reporting pre-pandemic lifetime mental disorders, those frequently exposed to COVID-19 patients, infected or quarantined/isolated, female workers, and auxiliary nurses should be considered groups in need of mental health monitoring and support.

Transcranial magnetic stimulation as a treatment for posttraumatic stress disorder: A meta-analysis

BACKGROUND

Posttraumatic stress disorder (PTSD) is a pervasive mental health condition with limited treatment success. Transcranial magnetic stimulation (TMS) has shown positive outcomes for people with PTSD, using different treatment protocols. This meta-analysis sought to examine which variables in TMS treatment are associated with treatment benefits.

METHODS

A literature search of major online research databases from inception to September 15, 2020 was conducted to identify primary research studies using TMS to treat PTSD. Treatment effect data and TMS treatment variables were coded and analysed using a random effects model. Meta-regression and analyses of moderating variables were conducted to ascertain which variables were associated with significant treatment effects.

RESULTS

An overall effect size of d = 1.17, 95% CI [0.89 - 1.45] for TMS as a treatment for PTSD was found. Analysis of moderators showed that there was a significantly larger treatment effect for high frequency TMS (d = 1.44) compared with low frequency (d = 0.72), p = .006; there was no significant difference between TMS targeting the left dorsolateral prefrontal cortex (DLPFC) and the right DLPFC; and larger treatment doses were not associated with stronger treatment effects.

LIMITATIONS

Not all published studies were available in English or reported the necessary data to be included in this meta-analysis.

CONCLUSIONS

TMS shows potential as a treatment for PTSD, although further research is required to understand the neurological mechanisms of TMS on specific PTSD symptoms so that more effective treatment can be designed for individuals.

Perceived helpfulness of treatment for specific phobia: Findings from the World Mental Health Surveys

BACKGROUND

Although randomized trials show that specific phobia treatments can be effective, it is unclear whether patients experience treatment as helpful in clinical practice. We investigated this issue by assessing perceived treatment helpfulness for specific phobia in a cross-national epidemiological survey.

METHODS

Cross-sectional population-based WHO World Mental Health (WMH) surveys in 24 countries (n=112,507) assessed lifetime specific phobia. Respondents who met lifetime criteria were asked whether they ever received treatment they considered helpful and the number of professionals seen up to the time of receiving helpful treatment. Discrete-event survival analysis was used to calculate conditional-cumulative probabilities of obtaining helpful treatment across number of professionals seen and of persisting in help-seeking after prior unhelpful treatment.

RESULTS

23.0% of respondents reported receiving helpful treatment from the first professional seen, whereas cumulative probability of receiving helpful treatment was 85.7% after seeing up to 9 professionals. However, only 14.7% of patients persisted in seeing up to 9 professionals, resulting in the proportion of patients ever receiving helpful treatment (47.5%) being much lower than it could have been with persistence in help-seeking. Few predictors were found either of perceived helpfulness or of persistence in help-seeking after earlier unhelpful treatments.

LIMITATIONS

Retrospective recall and lack of information about either types of treatments received or objective symptomatic improvements limit results.

CONCLUSIONS

Despite these limitations, results suggest that helpfulness of specific phobia treatment could be increased, perhaps substantially, by increasing patient persistence in help-seeking after earlier unhelpful treatments. Improved understanding is needed of barriers to help-seeking persistence.

Days out of role and somatic, anxious-depressive, hypo-manic, and psychotic-like symptom dimensions in a community sample of young adults

Improving our understanding of the causes of functional impairment in young people is a major global challenge. Here, we investigated the relationships between self-reported days out of role and the total quantity and different patterns of self-reported somatic, anxious-depressive, psychotic-like, and hypomanic symptoms in a community-based cohort of young adults. We examined self-ratings of 23 symptoms ranging across the four dimensions and days out of role in >1900 young adult twins and non-twin siblings participating in the "19Up" wave of the Brisbane Longitudinal Twin Study. Adjusted prevalence ratios (APR) and 95% confidence intervals (95% CI) quantified associations between impairment and different symptom patterns. Three individual symptoms showed significant associations with days out of role, with the largest association for impaired concentration. When impairment was assessed according to each symptom dimension, there was a clear stepwise relationship between the total number of somatic symptoms and the likelihood of impairment, while individuals reporting ≥4 anxious-depressive symptoms or five hypomanic symptoms had greater likelihood of reporting days out of role. Furthermore, there was a stepwise relationship between the total number of undifferentiated symptoms and the likelihood of reporting days out of role. There was some suggestion of differences in the magnitude and significance of associations when the cohort was stratified according to sex, but not for age or twin status. Our findings reinforce the development of early intervention mental health frameworks and, if confirmed, support the need to consider interventions for subthreshold and/or undifferentiated syndromes for reducing disability among young people.

(Internet) Gaming Disorder in DSM-5 and ICD-11: A Case of the Glass Half Empty or Half Full: (Internet) Le trouble du jeu dans le DSM-5 et la CIM-11: Un cas de verre à moitié vide et à moitié plein

BACKGROUND

Diagnostic and Statistical Manual of Mental Disorders (DSM-5) included in 2013 Internet gaming disorder (IGD) as a condition for further study, and in 2018, the World Health Organization included gaming disorder (GD) as a mental disorder in the International Classification of Disease (ICD-11). We aim to compare disorders of gaming in both diagnostic systems using a sample of young adults in Mexico.

METHODS

Self-administered survey to estimate the prevalence of DSM-5 IGD and ICD-11 GD in 5 Mexican universities; 7,022 first-year students who participated in the University Project for Healthy Students, part of the World Health Organization World Mental Health International College Student Initiative. Cross-tabulation, logistic regression, and item response theory were used to inform on 12- month prevalence of DSM-5 IGD and ICD-11 GD, without and with impairment.

RESULTS

The 12-month prevalence of DSM-5 IGD was 5.2% (95% CI, 4.7 to 5.8), almost twice as high as the prevalence using the ICD-11 GD criteria (2.7%; 95% CI, 2.4 to 3.1), and while adding an impairment requirement diminishes both estimates, prevalence remains larger in DSM-5. We found that DSM-5 cases detected and undetected by ICD-11 criteria were similar in demographics, comorbid mental disorders, service use, and impairment variables with the exception that cases detected by ICD-11 had a larger number of symptoms and were more likely to have probable drug dependence than undetected DSM-5 cases.

CONCLUSION

DSM-5 cases detected by ICD-11 are mostly similar to cases undetected by ICD-11. By using ICD-11 instead of DSM-5, we may be leaving (similarly) affected people underserved. It is unlikely that purely epidemiological studies can solve this discrepancy and clinical validity studies maybe needed.

Intrinsic functional connectivity during continuous maintenance and suppression of emotion in bipolar disorder

Resting-state connectivity studies, which examine unconstrained low frequency BOLD fluctuations, have reported inconsistent abnormalities in bipolar disorder (BP). In this study, we investigated intrinsic brain connectivity under the constraints of a Continuous Emotion Regulation Task (CERT) in BP patients in depressed (BPD) and manic (BPM) states, along with healthy control participants. Medication-free participants, with either a diagnosis of BP (BPD = 27, BPM = 30) or healthy controls (N = 33) were included. We collected 2 fMRI scans using the CERT paradigm, in which participants continuously watched negative pictures and either maintained emotions (MAINTAIN) or suppressed emotion using reappraisal techniques (SUPPRESS). Network-based statistic and graph theory analyses were examined for (i) the main effect of condition (within-group) and (ii) group and condition interactions. In healthy participants, MAINTAIN largely involved occipital and parietal cortices (p < .001), whereas SUPPRESS also recruited the frontal and cingulate cortices (p = .023). The interaction between group (BPD vs. BPM) and condition revealed a network involving the inferior frontal lobe which was stronger during MAINTAIN for BPD and during SUPPRESS for BPM (p = .037). Graph theory properties (i.e., clustering coefficient) for key nodes also evidenced significant group by condition interactions. We observed BP-related changes in network properties involved in normal and abnormal emotion regulation, which provide insights into the neural bases for affective disturbances in BP.

The Potential of Hydrogen for Improving Mental Disorders

In 2007, Ohsawa and colleagues reported that molecular hydrogen (H₂) gas significantly reduced the infarct volume size in a rat model of cerebral infarction, which was, at least, partially due to scavenging hydroxyl radicals. Since then, multiple studies have shown that H₂ has not only anti-oxidative but also anti-inflammatory and anti-apoptotic properties, which has ignited interest in the clinical use of H₂ in diverse diseases. A growing body of studies has indicated that H₂ affects both mental and physical conditions. Mental disorders are characterized by disordered mood, thoughts, and behaviors that affect the ability to function in daily life. However, there is no sure way to prevent mental disorders. Although antidepressant and antianxiety drugs relieve symptoms of depression and anxiety, they have efficacy limitations and are accompanied by a wide range of side effects. While mental disorders are generally thought to be caused by a variety of genetic and/or environmental factors, recent progress has shown that these disorders are strongly associated with increased oxidative and inflammatory stress. Thus, H₂ has received much attention as a novel therapy for the prevention and treatment of mental disorders. This review summarizes the recent progress in the use of H₂ for the treatment of mental disorders and other related diseases. We also discuss the potential mechanisms of the biomedical effects of H₂ and conclude that H₂ could offer relief to people suffering from mental disorders.