Bereavement after the suicide of a significant other

Comparison between self-concept, self-perception, physical exercise and lifestyle variations from 1st to 4th grade students of nursing in Tenerife, Spain

The aim of this study was to describe and compare the self-concept, self-perception, physical exercise, and lifestyle of students from 1st to 4th year of the Nursing university studies. Descriptive observational cross-sectional study with analytical components. The study sample consisted of 1st and 4th year undergraduate Nursing students. Five questionnaires were used: a sociodemographic survey, the RSES, the GHQ-12, the PAQ-A and the HBSC. The sample consisted of 197 subjects. 44.2% had a low self-concept and a perception of self-value that improved as they progressed academically, while confidence decreased. The PAQ-A showed that 65.5% performed moderate physical activity and 15.7% were sedentary, 58.9% reported a fair lifestyle and 20.8% of the subjects reported an inadequate diet. In the GHQ-12, the perception of self-value subscale showed an improvement with respect to the academic year. The SOC-13 data showed fair coping with traumatic situations, which worsened in the 4th year, being 88.9% in males and 84.6% in females. The study identified low self-concept, an adequate self-perception, moderate physical activity with a tendency towards sedentary lifestyles, and a fair lifestyle. It is significant that adolescents do not perceive the poor figures they obtain in self-concept, physical exercise, diet, sleep, and violence as reflected in their health. It is known that the changes adopted in adolescence will be perpetuated in adulthood. Therefore, influencing this population group, and even more so, if they are potential future health professionals, is deemed necessary.

Media Exposure of Suicidal Behaviour: An Umbrella Review

AIM

To analyse recommended interventions for the safe and responsible dissemination of suicidal behaviour in the media for preventive purposes.

BACKGROUND

Suicide is a serious public health problem that leads to more than 700,000 deaths per year, which translates into one death every forty seconds. The media play a significant role in shaping public perceptions and reflecting societal issues. Because of its active role in the construction of reality, the way in which the media report and expose suicidal behaviour has the capacity to influence the population in either a preventive or harmful way.

DESIGN

An umbrella review was carried out and a report was written according to the Preferred Reporting Items for Overviews of Reviews.

METHODS

We systematically searched for reviews published from inception to February 2023 in MEDLINE (PubMed), CINAHL and PsycInfo (via EBSCOhost), Web of Science, Embase, Cochrane Library of Systematic Reviews, Scopus, and Google Scholar. A narrative synthesis of the results was conducted.

RESULTS

Six systematic reviews with a moderate to high quality level were selected. Among the recommended interventions were the inclusion of positive messages of hope, resilience, or of overcoming the event, narratives with information on available resources or the promotion of support-seeking attitudes as an effective prevention mechanism, as well as the avoidance of repetitive reporting of the same suicide. The appropriate and responsible dissemination of information on suicidal behaviour in the media with complete and up-to-date information on available centres, organisations, institutions, and resources has proven to be effective, especially in vulnerable populations.

CONCLUSION

Educating and training the media in an appropriate approach to disseminating suicidal behaviour helps to reduce the number of suicidal behaviours. Knowing what information is advisable to include in the news item as well as what information to avoid is a strong point. Guidelines to promote responsible media reporting are a key component of suicide prevention strategies. This study was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO) on 23 April 2022 with the registration number CRD42022320393.

Role of the Psychiatric Nurse in Improving the Psychosocial Health of Families After Suicide

Suicide is defined as death that occurs as a result of deliberate self-harming behavior with the intention of ending one's life. Each suicide has many physical, economic and psychological short and long-term effects on the individual, family, friends and society. The death of an individual as a result of suicide creates a traumatic effect for family members and causes family members to experience various psychosocial problems. For this reason, it is very important to focus on the consequences of suicide in family members who have lost due to suicide, to evaluate the family's reactions to suicide, and to provide the needed psychosocial support. In this context, in this review, it is aimed to review the literature on the psychosocial problems experienced by families who have lost due to suicide and to present up-to-date information on the role of psychiatric nurse in improving the psychosocial health status of families.

The relationship between suicide bereavement and suicide ideation: Analysis of the mediating effect of complicated grief

People who have experienced suicide bereavement within social relationships are known to have high risk for suicide, which means that their suicide ideation is high. However, little is known about how suicide bereavement leads to suicide ideation. Therefore, this study aims to understand the pathway of suicide bereavement on suicide ideation by analyzing the mediating effect of complicated grief, which does not abate over time and is known to be highly related to suicide ideation. Data of 1224 people aged 19 or older with bereavement (636 bereaved by suicide and 585 by other causes) were obtained from the Longitudinal study on Suicide Survivors' Mental Health (LoSS) WAVE I [2015-2018], the first nationally-representative longitudinal study in South Korea. Suicide ideation, the dependent variable, was measured by the Scale for Suicide Ideation (SSI), and complicated grief, severe grief that does not abate over time, was measured by the Korean version of the Inventory of Complicated Grief (K-ICG). The results show that suicide bereavement was found to have a significant effect on suicide ideation, and that complicated grief plays a mediating role in the path of suicide bereavement to suicide ideation (Effect = 0.667, [0.387, 0.981]). Based on these findings, clinical and policy suggestions were discussed to understand and prevent suicide ideation of people with suicide bereavement.

The Relationship Between Bullying Victimization and Perpetration and Non-suicidal Self-injury: A Systematic Review

Experience of bullying may be a significant risk factor for non-suicidal self-injury (NSSI). This study had three aims: to systematically investigate the association between bullying and NSSI, analyze the possible mechanisms underlying the two phenomena, and evaluate any differences between bullying victimization and bullying perpetration with respect to NSSI. A systematic search about the association between bullying victimization and perpetration and NSSI was conducted using specific databases (PubMed, Scopus, Science Direct). The following keywords were used in all database searches: "bullying" AND "NSSI" OR "peer victimization" and NSSI. The searches in PubMed, Scopus and Science Direct revealed a total of 88 articles about bullying or peer victimization and NSSI. However, only 29 met our inclusion criteria and were used for the present review. Overall, all studies examined victimization; four studies also evaluated the effects of perpetration and one included bully-victims. According to the main findings, both being a victim of bullying and perpetrating bullying may increase the risk of adverse psychological outcomes in terms of NSSI and suicidality in the short and the long run. To the best of our knowledge, this is the first review to systematically evaluate the relation between bullying victimization/perpetration and NSSI. The main results support a positive association. Future research should evaluate the possible role of specific mediators/moderators of the association between experience of bullying and NSSI.

Existential loneliness and life suffering in being a suicide survivor: a reflective lifeworld research study

Purpose

The aim of the study was to describe the loss of a family member by suicide, based on the lived experience of suicide survivors.

Methods

A phenomenology study with a Reflective Lifeworld Research approach was conducted, consisting of sixteen interviews with eight suicide survivors.

Results

The essence of losing a family member by suicide encompasses experiences of involuntary and existential loneliness, life suffering, and additional burdens in a life that is radically transformed, comprising prolonged and energy-intensive attempts to understand. Life for the family member encompasses a constant fear of being judged and an ambiguous silence, where this silence can both lead to involuntary loneliness and be a source of support and fellowship. Support mechanisms inside the family fall apart, and it becomes obvious that the survivors’ experiences affect others. The loss also implies an active endeavour to maintain the memory of the deceased.

Conclusions

Based on these results, it is important for professionals to accept the survivors as suffering human beings early—from the point of the notification of death—and consider them as patients in need of compassionate care. Such support might reduce life suffering, counteract stigma and involuntary loneliness, and work simultaneously as suicide prevention.

The Dark Side of ADHD: Factors Associated With Suicide Attempts Among Those With ADHD in a National Representative Canadian Sample

AIM

This study investigated the prevalence and odds of suicide attempts among adults with attention deficit hyperactivity disorder (ADHD) compared to those without and identified factors associated with suicide attempts among adults with ADHD.

METHODS

Secondary analysis of the nationally representative Canadian Community Health Survey-Mental Health (CCHS-MH) (n = 21,744 adults, of whom 529 had ADHD). Respondents were asked whether they received an ADHD diagnosis from a health care professional. Lifetime suicide attempt was based on self-report.

RESULTS

Adults with ADHD were much more likely to have attempted suicide than those without (14.0% vs. 2.7%). One in four women with ADHD have attempted suicide. Sixty percent of the association between ADHD and attempted suicide was attenuated when lifetime history of depression and anxiety disorders were taken into account. Female gender, lower education attainment, substance abuse, lifetime history of depression, and childhood exposure to chronic parental domestic violence were found to be independent correlates of lifetime suicide attempts among those with ADHD.

CONCLUSION

These findings can inform targeted screening and outreach to the most vulnerable adults with ADHD.

Silence and Sounds: An Autoethnography of Searching for Spirituality during Suicide Bereavement in Life and Research

In this article, I used autoethnography to describe and analyze my experience of being bereaved by suicide and researching spirituality during suicide bereavement. The culture silenced my grief, and this is congruent with the experiences of my research participants. The religious community, in my case, did not help me and added to my spiritual and psychological pain. The silenced parts of my loss started to make sounds, such as psychological disturbances, but also as unconscious and conscious choices, which led to immersing myself in the research of spirituality during suicide bereavement. Research on the topic goes hand in hand with my search for spirituality during suicide bereavement and reviewing my loss. My story suggests that despite the negative experiences with Catholic priests, spirituality during suicide bereavement can become a vital resource to find meaning for the loss and the pain of grief and can take many different and even unexpected forms.

Offspring's risk for suicidal behaviour in relation to parental death by suicide: systematic review and meta-analysis and a model for familial transmission of suicide

BACKGROUND

Exposure to parental suicide has been associated with increased risk for suicide and suicide attempts, although the strength of this association is unclear as evidence remains inconsistent.

AIMS

To quantify this risk using meta-analysis and identify potential effect modifiers.

METHOD

A systematic search in PubMed, PsycInfo and Embase databases to 2020 netted 3614 articles. Inclusion criteria were: observation of history of parental death by suicide, comparison with non-exposed populations and definition of suicide and suicide attempt according to standardised criteria. We focused on population-based studies. The primary outcome was the pooled relative risk (RR) for incidence of suicide attempt and suicide in offspring of a parent who died by suicide compared with offspring of two living parents. Additionally, we compared the RR for attempted and completed suicide after parental suicide with the RR for attempted and completed suicide after parental death by other causes.

RESULTS

Twenty studies met our inclusion criteria. Offspring exposed to parental suicide were more likely to die by suicide (RR = 2.97, 95% CI 2.50-3.53) and attempt suicide (RR = 1.76, 95% CI 1.58-1.96) than offspring of two living parents. Furthermore, their risk of dying by or attempting suicide was significantly higher compared with offspring bereaved by other causes of death.

CONCLUSIONS

The experience of losing a parent to suicide is a strong and independent risk factor for suicidal behaviour in offspring. Our findings highlight the need for prevention strategies, outreach programmes and support interventions that target suicide-related outcomes in the exposed population.

Telling a Complicated Grief: A Psychodynamic Study on Mental Health Nurses' Countertransference Reactions to Patients' Suicidal Behavior

A key element of suicide education, training and clinical supervision is enhancing emotional awareness about mental health professionals' countertransference reactions, as emotional responses to patients' suicidal behavior (SB) that may be unbeneficial to care. This study aimed to explore emotional responses to patients' SB in mental health nurses (MHNs) according to a psychodynamic perspective. Twenty-eight Italian MHNs (61% females, Mage = 52 years) were interviewed to examine their deep feelings about attempted suicides or deaths by suicide of patients with mental illness. Computer-aided thematic analysis was performed on the verbatim transcribed interviews, adopting Emotional Text Analysis (ETA) as a research framework to explore affective symbolizations underlying narratives, beyond intentional and explicitly reported contents. Some statistical multidimensional techniques were carried out, allowing th.e detection of shared symbolic domains (Cluster Analysis) and latent factors organizing the contraposition between them (Multiple Correspondence Analysis). Five symbolic domains emerged which were respectively referred to as: hyper-vigilance (21.97% of the overall textual corpus), resentment (17.86%), rationalization (34.50%), resignation (5.54%) and mourning (20.12%). Four latent factors explained the overall data variance: strive for reparation (F1), lack of control (F2), ambivalence toward care (F3) and complicated grief (F4). Some clinical recommendations were derived suggesting to balance issues of risk assessment/management and staff's reflective practice, to work on the subjective sense of hopelessness resulting from turning against oneself the hostility evoked by patients, to consider rationalization processes and implicit beliefs leading to risk underestimation and to address some basic conflicts contributing to a complicated grief in mourning suicidal events.

Spirituality and Religiosity during Suicide Bereavement: A Qualitative Systematic Review

A loved one’s loss to suicide can be a traumatic experience and trigger a difficult grief process, identity changes, a loss of the sense of meaning and a spiritual crisis. Spirituality and/or religiosity (S/R) can be both an important resource and a source of stigmatisation during suicide bereavement. This study aims to synthesise the extant findings about S/R during suicide bereavement in qualitative studies. After an exhaustive selection of articles, the current review utilised a total of 484 citations and seven studies. A thematic synthesis yielded five major themes related to S/R during suicide bereavement: the need to be helped by the religious community without being judged; S/R-related experience of the deceased as a figure who continues to exist; S/R experienced without a conscious choice; conscious reach towards S/R themes; not relating to S/R during suicide bereavement. These findings indicate that the role of S/R during suicide bereavement is complex and varies from providing help to serving as a source of suffering. Hence, practitioners and religious communities should be mindful of the S/R themes during suicide bereavement.

Suicidal thinking and behaviours in First Episode Psychosis: Findings from a 3-year longitudinal study

AIM

Suicide risk is greater at the beginning of the course of psychosis. Purpose of this research was: (a) to investigate prevalence and incidence rates of suicide attempts, suicidal thinking and completed suicide in First Episode Psychosis (FEP) help-seekers as compared with non-FEP help-seeking peers, and (b) to examine any correlation of suicidal ideation with other baseline psychopathological predictors.

METHODS

Two hundred and forty-one young people (13-35 years) were assessed with the World Health Organization Quality Of Life scale - Brief version (WHOQOL-BREF), the Beck Depression Inventory - II Edition (BDI-II) and the Comprehensive Assessment of At-Risk Mental States (CAARMS) at the enrollment and over a 36-month follow-up period. A Kaplan-Meier survival analysis to calculate cumulative incidence rates of attempted and completed suicide was used.

RESULTS

FEP patients showed more severe levels of CAARMS "Suicidality/Self-Harm" item than non-FEP peers. They also had higher 3-year incidence rates of attempted suicide (11%) and completed suicide (13%). Within the FEP total group, suicidal ideation was positively correlated with BDI-II and CAARMS "Perceptual Abnormalities" item scores, and showed negative associations with younger age and WHOQOL-BREF "Social Relationships" factor sub-score.

CONCLUSIONS

Suicidal ideation is relevant in FEP patents, supporting the routine monitoring of suicide risk in baseline assessment of adolescents and young adults with early psychosis. Suicidal thinking seems to be correlated to younger age, perceptual aberrations and depression severity, as well as to poorer quality of social relationships.

The role of psychopathology in the relationship between history of maltreatment and suicide attempts among children and adolescent inpatients

BACKGROUND

This retrospective chart review study investigates the relationship between the history of various forms of abuse and the presence of mood disorders and psychotic symptoms in predicting suicide attempts among psychiatrically hospitalized children and adolescents.

METHOD

A multi-mediation analysis was conducted with an archival dataset of 101 children and adolescents hospitalized predominantly for mood disorders and bipolar disorders with and without history of psychotic symptoms.

RESULTS

Results showed that history of suicide attempts was directly associated with physical abuse and indirectly associated with sexual abuse (mediated by bipolar disorders). Emotional abuse was also indirectly related to history of suicide attempts, mediated by mood disorders for boys, and by psychotic symptoms for girls.

CONCLUSIONS

This study is among the first to differentiate the unique effects of different types of early maltreatment on psychopathology, particularly mood disorders and psychotic symptoms, and histories of suicide attempts in psychiatrically hospitalized children and youth.

KEY PRACTITIONER MESSAGE

Little is known about the relationships between histories of maltreatment, psychopathology, and suicide (considered simultaneously) among hospitalized children and adolescents. Different forms of abuse are associated with distinct psychopathology symptoms, and in turn, risk for suicide attempts. Only physical abuse is directly related to a history of suicide attempts, while sexual and emotional abuse are indirectly related (mediated by mood disorders and psychotic symptoms). These risk pathways are partly distinct for girls and boys. Identifying unique and cumulated risk factors can help prevent suicidality among hospitalized youth.

Latent class analysis of bipolar disorder symptoms and suicidal ideation and behaviors

Individuals with bipolar disorder are at increased risk of dying by suicide compared to healthy controls and those with unipolar depression. Previous studies show that depressive symptoms and mixed episodes of mania and depression are related to suicide. However, most of these studies adopt a variable-centered approach to understanding how specific symptoms relate to suicidal ideation, without addressing how these symptoms and symptom profiles relate to suicidal behaviors.

OBJECTIVES

Using latent class analysis, this study adopts a person-centered approach to examine whether subtypes of patients with bipolar disorder differ in their levels of suicidal ideation and behaviors.

METHODS

A total of 150 patients from a behavioral health outpatient clinic were recruited. Latent classes were generated based on self reports of their depressive and manic symptoms.

RESULTS

Five classes of patients with bipolar disorder were identified, namely, a minimal symptom, mania, moderately depressed, severely depressed, and mixed depression-mania subtypes. Those in the severely depressed and mixed depression-mania groups reported significantly higher levels of suicidal ideation and behaviors compared to the other groups.

CONCLUSIONS

Our findings provide further support for the strong relationship between depressive symptoms and suicidality. These findings are significant as they shed light on the different suicide risk profiles among a heterogenous group of patients with bipolar disorder. Name of clinical trial: Suicidal Behavior in Patients Diagnosed with Bipolar Disorder: The Roles of Biological and Childhood and Adult Environmental Risk Factors. ClinicalTrials.gov Identifier: NCT02604277.

High-lethality of suicide attempts associated with platelet to lymphocyte ratio and mean platelet volume in psychiatric inpatient setting

OBJECTIVES

A wide range of potential psychosocial, biological, genetic and environmental factors may interact with each other in determining suicidal behaviours. The aim of this study was to evaluate several biological parameters referred to the complete blood count values in 259 suicide attempters (SA) and 164 non-suicide attempters (control group), according to the lethality of suicidal behaviour.

METHODS

After attempting suicide, subjects were admitted to the emergency ward of the IRCCS Ospedale Policlinico San Martino and later to the section of Psychiatry from 1 January 2014 to 31 June 2019. Socio-demographic and clinical characteristics, as well as blood cells, were collected.

RESULTS

Individuals with high-lethality suicide attempts had a higher number of neutrophils, mean platelet volume, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and lower number of lymphocytes relative to both those with low-lethality suicide attempts and control group. After regression analysis, only the mean platelet volume and platelet to lymphocyte ratio resulted associated with a high-lethality suicide attempt (HLSA).

CONCLUSIONS

Our findings provide potential and useful peripheral biological markers able to help clinicians in understanding the complex phenomenon of suicide. However, further studies are needed to confirm the present findings.

Parents' and medical staff's experience of adolescents with suicide-related behaviors admitted to a general hospital in China: qualitative study

BACKGROUND

Currently, there is increasing awareness of suicide-related behaviors. Mental health services are a key location for assisting people with suicide-related behaviors. However, few studies focused on the evaluation and experience of the mental health care system from families and the medical staff's perspective in China. The study aims to explore parents' and the front-line medical staff's experience of an adolescent with suicide-related behaviors admitted to the psychiatry department of a general hospital in China.

DESIGN

Qualitative study was employed in the study. Participants were recruited from a general hospital in China characterized by high levels in the Chinese mental health system.

METHODS

Semi-structured in-depth interviews were conducted exploring their experience and perceptions when an adolescent was admitted to the hospital. The theme analysis method is used for data analysis.

RESULTS

Participants expressed dissatisfaction in the psychiatric department. Other barriers in their work were identified, such as the shortage of staff and difficulties in caring or communicating with patients. Besides, the imperfect treatment system also contributes to the low satisfaction of patients and their families. Two themes and six subthemes were identified: 1) staff perceive patients with SRBs as difficult to engage (feelings of helplessness, the need for compassion, challenges of professional self-efficacy, the recommendations to the health care service); 2) parents not satisfied with the existing hospital services (doubt the hospitalization treatment and the advice to the health care service).

CONCLUSION

This study found that insufficient staffing and lacking of systematic professional treatment models are the major challenges. We suggest increasing the input of mental health resources to expand and train the mental health service team and establish a complete set of a treatment model for SRBs.

The role of gene polymorphisms, and analysis of peripheral and central levels of interleukins in suicidal behavior: A systematic review

In terms of the physiological characteristics of suicidal behavior (SB) disorder, an increase inflammation response has been reported in these individuals. Therefore, the pro-inflammatory and anti-inflammatory activities of interleukins are adequate markers to research in order to understand the pathogenesis of SB. For that reason, the aim of this systematic review was to evaluate the role of interleukins in individuals with suicidal behavior disorder. A systematic search was performed in PubMed, Scopus and EBSCO databases up to July 2019. We used the words "interleukin" AND "suicide", "interleukin" AND "suicidal", and "IL-". Articles where interleukins concentrations were measured in individuals with SB and/or genetic studies addressing interleukins genes variants as possible markers to SB were included. A total of 54 articles were included. Articles that measured interleukin levels comprised 1111 cases and 1588 controls; whereas the genetic studies comprised 3082 cases and 5148 controls. These studies evaluated the concentrations of IL-1β, IL-2, IL-3, IL-4, IL-5, IL-6, IL-8, IL-10, sIL-2R in serum, plasma. The pro-inflammatory interleukins concentrations were higher in cases than in controls; however, we observed heterogeneity in the measurements and sample sources. Whereas, 9 polymorphisms of IL-1α, IL-1β, IL-6, IL-1β-8 genes were analyzed in association with suicide behavior disorder, though no conclusive outcomes were attained. Our results suggest that individuals with suicide risk undergo continuous stress that could trigger the release and circulation of pro-inflammatory interleukins and therefore their concentration in plasma. However, more studies are necessary in order to reach conclusively outcomes.

Advances in novel molecular targets for antidepressants

Depression is the most common psychiatric illness affecting numerous people world-wide. The currently available antidepressant treatment presents low response and remission rates. Thus, new effective antidepressants need to be developed or discovered. Aiming to give an overview of novel possible antidepressant drug targets, we summarized the molecular targets of antidepressants and the underlying neurobiology of depression. We have also addressed the multidimensional perspectives on the progress in the psychopharmacological treatment of depression and on the new potential approaches with effective drug discovery.

Maternal Sociodemographic Factors Are Associated with Methylphenidate Initiation in Children in the Netherlands: A Population-Based Study

Multiple factors may contribute to the decision to initiate methylphenidate treatment in children such as maternal sociodemographic factors of which relatively little is known. The objective was to investigate the association between these factors and methylphenidate initiation. The study population included 4243 children from the Generation R Study in the Netherlands. Maternal sociodemographic characteristics were tested as determinants of methylphenidate initiation through a time-dependent Cox regression analysis. Subsequently, we stratified by mother-reported ADHD symptoms (present in 4.2% of the study population). When ADHD symptoms were absent, we found that girls (adjusted HR 0.25, 95%CI 0.16-0.39) and children born to a mother with a non-western ethnicity (compared to Dutch-Caucasian) (adjusted HR 0.42, 95%CI 015-0.68) were less likely to receive methylphenidate. They were more likely to receive methylphenidate when their mother completed a low (adjusted HR 2.29, 95%CI 1.10-4.77) or secondary (adjusted HR 1.71, 95%CI 1.16-2.54) education. In conclusion, boys and children born to a mother of Dutch-Caucasian ethnicity were more likely to receive methylphenidate, irrespective of the presence of ADHD symptoms.

Gender dysphoria: prejudice from childhood to adulthood, but no impact on inflammation. A cross-sectional controlled study

INTRODUCTION

Gender dysphoria (GD) is characterized by a marked incongruence between experienced gender and one's gender assigned at birth. Transsexual individuals present a higher prevalence of psychiatric disorders when compared to non-transsexual populations, and it has been proposed that minority stress, i.e., discrimination or prejudice, has a relevant impact on these outcomes. Transsexuals also show increased chances of having experienced maltreatment during childhood. Interleukin (IL)-1β, IL-6, IL-10 and tumor necrosis factor-alpha (TNF-α) are inflammatory cytokines that regulate our immune system. Imbalanced levels in such cytokines are linked to history of childhood maltreatment and psychiatric disorders. We compared differences in IL-1β, IL-6, IL-10 and TNF-α levels and exposure to traumatic events in childhood and adulthood in individuals with and without GD (DSM-5).

METHODS

Cross-sectional controlled study comparing 34 transsexual women and 31 non-transsexual men. They underwent a thorough structured interview, assessing sociodemographic information, mood and anxiety symptoms, childhood maltreatment, explicit discrimination and suicidal ideation. Inflammatory cytokine levels (IL-1β, IL-6, IL-10 and TNF-α) were measured by multiplex immunoassay.

RESULTS

Individuals with GD experienced more discrimination (p = 0.002) and childhood maltreatment (p = 0.046) than non-transsexual men. Higher suicidal ideation (p < 0.001) and previous suicide attempt (p = 0.001) rates were observed in transsexual women. However, no differences were observed in the levels of any cytokine.

CONCLUSIONS

These results suggest that transsexual women are more exposed to stressful events from childhood to adulthood than non-transsexual men and that GD per se does not play a role in inflammatory markers.

Risk Factors for Cannabis-Related Mental Health Harms in Older Adults: A Review

Objectives: This paper reviews research on the topic of cannabis use and mental health harms in older adults and illustrates potential contributing factors and special clinical considerations for working with this population. Known risk factors for cannabis-related mental disorders and mental health problems are outlined, first for the general population and then specifically for older adults. Methods: Studies were identified through online databases using a variety of search words. Articles were included in the review if they were peer-reviewed or published by a reputable national organization, published in English, and were pertinent to the topic of mental health harms of cannabis use. Results: Risk factors that emerged from the literature review aligned with the following categories: (1) patterns of use (i.e., potency of product, frequency of use), (2) personal characteristics (i.e., age, sex, social demographics), (3) psychosocial constructs (motivations, perceptions), and (4) morbidities (mental health, medication interactions). Conclusions: Frequent use was associated with increased risk for mental health consequences related to cannabis use. Certain motives for use (i.e., using to cope, using as a sleep aid) may increase susceptibility to cannabis-related harms, although more empirical work is required. Mental health conditions may predispose to cannabis-related harms through a variety of mechanisms, including increased vulnerability for cannabis-related psychiatric disorders, poorer prognosis for preexisting psychiatric disorders, and possibility of cannabis-medication interactions. Personal characteristics (younger age, being male, lower socioeconomic status) predict more frequent cannabis use, which may dispose to adverse outcomes. Clinical Implications: Predictors of cannabis-related harms hold relevance for public health messaging, as well as clinical interventions. Understanding how cannabis interacts with sociodemographic factors, mental health morbidities, and medications is crucial in providing accurate guidance to patients about their recreational cannabis use and in informing prescriber decisions about medicinal cannabis.

Relationship between suicide rate and antidepressant prescription: An ecological study in the People's Republic of China

OBJECTIVES

The objective of this study was to estimate the features of suicide rate and its association with antidepressant prescriptions during the past decade in China.

METHODS

Official data on suicides were obtained and stratified by four age groups, gender, urban/rural areas, and regions (East, Central, and West). The annual antidepressant prescriptions were expressed in pills per 100 persons calculated as the volume of prescriptions divided by the total population. Negative binomial regression was carried out to examine the association between suicide and other variables.

RESULTS

Suicide rates in each stratum typically decreased from 2008 to 2015, while annual antidepressant prescriptions were generally increased by the year. The suicide rate increased with age and was greater in adult males than in females; higher in the central area and greater in rural than in urban areas. Suicide rates are negatively associated with antidepressant prescriptions including selective serotonin reuptake inhibitors (Incidence rate ratio [IRR] 0.983, 95% confidence interval [CI] 0.983-0.983), serotonin-norepinephrine reuptake inhibitors (IRR 0.951, 95% CI 0.951-0.951), tricyclic antidepressant (IRR 0.925, 95% CI 0.925-0.925) and total antidepressants (IRR 0.990, 95% CI 0.990-0.990) during 2008-2012.

CONCLUSION

Suicide varied among different studied stratum. Suicide rates are negatively associated with antidepressant prescriptions.

The relations between childhood maltreatment, shame, guilt, depression and suicidal ideation in inpatient adolescents

BACKGROUND

Previous studies demonstrated positive relations between various forms of maltreatment and suicidal ideation in youth; however, mechanisms underlying these relationships are not well understood. We propose that the experience of maltreatment in childhood may lead to high levels of generalized guilt and shame, resulting in an increase of depressive symptoms and suicidal thoughts in adolescents. The aim of the current study was to test our model of relations between these constructs using path analysis.

METHODS

112 inpatient adolescents aged 12-17 years completed the Childhood Trauma Questionnaire to measure various types of maltreatment, the Personal Feelings Questionnaire to evaluate generalized guilt and shame, the Beck Depression Inventory-II to assess depressive symptoms, and the Columbia-Suicide Severity Rating Scale to assess suicidal ideation.

RESULTS

Findings partly confirmed the theoretical model. Indirect positive effects of sexual and emotional abuse, as well as emotional and physical neglect on suicidal ideation via generalized self-conscious emotion and/or depression were demonstrated. In contrast to our predictions, indirect negative effects of physical abuse on suicidal thoughts via generalized guilt and shame and depression were found.

LIMITATIONS

Sample characterized by predominately Caucasian inpatient adolescents from financially stable and well-educated environments, over-reliance on self-report measures and the lack of a longitudinal design were main limitations of the study.

CONCLUSIONS

The study provides novel information on the potential mechanisms underlying the association between childhood maltreatment and suicidal ideation in adolescents. Generalized guilt and/or shame could be possible targets for interventions for victims of some forms of maltreatment to reduce depressive symptoms and suicidal ideation.

Altered miRNA landscape of the anterior cingulate cortex is associated with potential loss of key neuronal functions in depressed brain

MicroRNAs (miRNAs), a family of non-coding RNAs, have recently gained a considerable attention in neuropsychiatric disorders. Being a pleiotropic modulator of target gene(s), miRNA has been recognized as central to downstream gene regulatory networks. In the recent past, reports have suggested their role in changing the epigenetic landscape in brain of subjects with major depressive disorder (MDD). Anterior cingulate cortex (ACC) is a brain area implicated in several complex cognitive functions, such as impulse control, emotion, and decision-making and is associated with psychopathology associated with mood regulation. In this study, we examined whether MDD is associated with altered miRNA transcriptome in ACC and whether altered miRNA landscape is associated with modifications in specific gene network(s) at the functional level. Using next generation sequencing (NGS), it was observed that 117 miRNAs (4.61%) were significantly upregulated and 54 (2.13%) were downregulated in MDD subjects (n = 22) compared with non-psychiatric controls (n = 25). Using 24 most significantly upregulated miRNAs in the MDD group, we determined functional enrichment of target genes and found them to be associated with long-term potentiation, neurotrophin signaling, and axon guidance. Intra- and inter-cluster similarities of enriched terms based on overrepresented gene list showed neurobiological functions associated with neuronal growth and survival. Web centric parameters and ontology enrichment functions identified two major domains related to phosphatidyl signaling, GTPase signaling, neuronal migration, and neurotrophin signaling. Our findings of altered miRNA landscape along with a shift in targetome relate to previously reported morphometric changes and neuronal atrophy in ACC of MDD subjects.

Neuropeptide Y plasma levels and suicidal behavior in combat veterans

War veterans are at increased risk of suicide that may be related to deployment and/or post-deployment stressors and to adjustment-related factors. The aim of this study was to examine whether levels of plasma neuropeptide Y (NPY) might distinguish combat veterans who have made a post-deployment suicide attempt from those who have never made a suicide attempt. We focused on NPY because of prior findings linking NPY with the neurobiology of resilience, stress-related and other disorders, and suicidal behavior. Demographic and clinical parameters of suicide attempters and non-attempters were assessed and plasma NPY was determined by radioimmunoassay. NPY levels were higher among attempters in comparison to non-attempters, controlling for sex and body-mass index. Suicide attempters had higher Scale for Suicidal Ideation (SSI) scores than non-attempters. There was a positive correlation between NPY levels and SSI scores among non-attempters but not among attempters. Likewise, NPY levels positively correlated with Brown-Goodwin Aggression Scale scores among suicide attempters but not among non-attempters. This is the first demonstration of altered plasma NPY levels in association with suicide attempt history and suicidal ideation in veterans. Our findings suggest that clinical differences between combat veterans with or without a history of suicide attempt may have a neurobiological origin.

Bipolar Mood State Reflected in Functional Connectivity of the Hate Circuit: A Resting-State Functional Magnetic Resonance Imaging Study

BACKGROUND

Previous studies suggested bipolar disorder caused an aberrant alteration in the insular, putamen, and left superior frontal gyrus, which are the main components of the hate circuit. However, the relationship between the hate circuit and the pathophysiologic substrate underlying different phases of bipolar disorder remain unclear. In this study, we aimed to identify group differences of resting-state functional connectivity within the hate circuit in healthy controls (HCs) and bipolar patients in different mood states.

METHODS

Resting-state functional magnetic resonance imaging of the brain were acquired from 54 HCs and 81 patients with bipolar disorder including 20 with bipolar mania (BM), 35 with bipolar depression (BD), and 26 with bipolar euthymia (BE). We selected bilateral insula (L.INS and R.INS), bilateral putamen (L.PUT and R.PUT), and left superior frontal gyrus (L.SFGd) as seed regions, and conducted the seed-based functional connectivity analysis to identify group differences of connectivity strength within the hate circuit. Spearman correlations were performed to evaluate the relationship between the hate circuit and manic/depressive symptoms.

RESULTS

Significant group differences of connectivity strength within the hate circuit were found in links of the R.INS-L.SFGd, R.PUT-L.SFGd, and L.INS- R.PUT after false discovery rate was corrected. The BM group showed an opposite hate circuit pattern to BD, BE, and HCs. The BD group showed decreased hate circuit connectivity in the L.INS-R.PUT compared with the BE group. No significant difference was detected among BD, BE, and HCs. Furthermore, functional connectivity of the R.INS-L.SFGd and R.PUT-L.SFGd were positively correlated with manic symptoms, while the L.INS- R.PUT was negatively correlated with depressive symptoms.

CONCLUSIONS

Our preliminary findings suggest that altered functional connectivity of the hate circuit in different mood phases may be related to state markers and underpin the neuropathological basis of bipolar disorder.

Path analysis of the effects of social support, self-efficacy, and coping style on psychological stress in children with malignant tumor during treatment

The aim of this study was to explore the relationship between social support, self-efficacy, coping style, and psychological stress in children with malignant tumors during the treatment, and to clarify the mediating effects.From May 2019 to August 2019, selected by convenience sampling method, 141 children with malignant tumors in the treatment period were evaluated using the Social Support Questionnaire, General Self-efficacy Scale, Simplified Coping Style Questionnaire, and Depression-Anxiety-Stress Scale.The results of correlation analysis showed that depression was negatively correlated with coping style, self-efficacy, affirmation and support, satisfaction, company, and intimacy, but positively correlated with conflict and punishment; both anxiety and stress were significantly negatively correlated with coping style, self-efficacy, affirmation and support, company, and intimacy. The results of the model indicated that gender, social support, self-efficacy, and coping style could directly predict the psychological stress of children with malignant tumors in the treatment period, social support and self-efficacy could indirectly predict the psychological stress of children with malignant tumors, and the total effect of self-efficacy on the psychological stress of children was the largest. Through 2000 bootstrap tests of mediating effect, it not only confirmed the mediating effect of self-efficacy and coping style but also had a chain-mediating effect.Appropriate social support can improve the self-efficacy of children with malignant tumors in the treatment period and encourage them to take a positive response to the disease, thereby effectively preventing or reducing the occurrence of psychological stress.

Hypertension and orthostatic hypotension with venlafaxine treatment in depressed older adults

BACKGROUND

Venlafaxine, a serotonin-norepinephrine reuptake inhibitor, is often used as first- or second-line therapy for depression in older adults. It can be associated with adverse blood pressure (BP) effects.

METHODS

Adults ⩾60 years of age in a current major depressive episode were treated in a protocolized manner with venlafaxine XR; 429 participants were treated for 8-16 weeks with a daily dose up to 300 mg to achieve remission from depression. Cardiac measures included sitting and standing BP and heart rate.

RESULTS

Of participants who were normotensive at baseline, 6.5% were found to have elevated BP during the study (1.9% <225 mg/day; 9.8% ⩾225 mg/day). There was no significant change in mean BP in the overall sample, or in the subgroup treated with doses ⩾225 mg/day. Additionally, 20.1% of the participants who did not have orthostatic hypotension at baseline were found to have orthostatic hypotension (16.8% <225 mg/day; 22.4% ⩾225 mg/day). Participants with new-onset orthostatic hypotension were significantly more likely to fall than the other participants.

CONCLUSION

A large proportion of older adults treated with venlafaxine experience orthostatic hypotension, putting them at risk for falls. A smaller proportion experience elevated BP. Older patients prescribed venlafaxine, particularly at high doses, should be advised and counseled about these adverse effects.

Associations among serum markers of inflammation, life stress and suicide risk in patients with major depressive disorder

BACKGROUND

Patients with major depressive disorder (MDD) are at high risk for suicide. As the worst outcome of MDD and common self-concealment in patients with suicide risk, studies of biomarkers may provide useful tools for suicide prevention and treatment.

METHODS

This study recruited 168 patients with MDD from the Objective Diagnostic Markers and Personalized Intervention in MDD patients (ODMPIM), including 50 patients with suicide risk. Based on previous evidence and hypothesis, 23 targeted serum biomarkers involving immune-inflammation, neurotrophins, hypothalamic-pituitary-adrenal (HPA) axis and metabolism, were measured. We used path analysis and principal components analysis (PCA) to clarify the associations among serum biomarkers, childhood adversities, adulthood life events, severity of depression and suicide risk.

RESULTS

We identified that patients with suicide risk had a higher level of inflammatory markers in serum than patients without suicide risk (P < 0.001), especially chemokine (C-X-C motif) ligand 1 (CXCL-1). After using the Bonferroni correction, there were no differences in biomarkers related to neurotrophins, HPA-axis and metabolism. In addition, a higher proportion of patients with suicide risk had adulthood adversity (assessed by Life Events Scale) (P = 0.003). Intriguingly, path analysis demonstrated that the association between adulthood adversity and suicide risk mainly depended on severity of depression and inflammatory index.

CONCLUSION

This study highlights the possible role of inflammation involved in suicide risk of MDD patients. Inflammatory markers have the potential for early identification and then reducing suicidal behaviors or becoming novel treatment targets in suicide risk management.

Higher venlafaxine serum concentrations necessary for clinical improvement? Time to re-evaluate the therapeutic reference range of venlafaxine

BACKGROUND

The therapeutic reference range for venlafaxine in antidepressant treatment has been defined as 100 to 400 ng/mL. However, in an everyday setting active moiety concentrations above the therapeutic reference range were often reported.

AIM

The aim of this study was to re-evaluate the therapeutic reference range of venlafaxine.

METHODS

In-patients (⩽60 years) with major depressive episodes receiving antidepressant monotherapy with venlafaxine during routine clinical treatment were included in this observational study. Depressive symptom severity was evaluated on a weekly basis using the Hamilton Depression Rating Scale (HAMD-21), and therapeutic drug monitoring analyses were performed. Resting electrocardiograms were analyzed in week 3, week 5 and week 7 of study participation.

RESULTS

Clinical improvement from baseline to week 4 was significantly associated with increasing serum concentrations of the active moiety of venlafaxine (N = 23, Pearson correlation, p = 0.009), but not with the dose of venlafaxine. Patients achieving remission showed significantly higher serum concentrations than patients achieving response/non-response (Kruskal-Wallis test, p = 0.019). Moreover, in patients with serum concentrations above 400 ng/mL time to remission and time to response was significantly shorter than in patients with concentrations below 400 ng/mL (Mantel-COX test, p = 0.001; p = 0.010). QTc time was below the upper limit of a normal QTc time (450 ms) for all patients.

CONCLUSION

The serum concentration of the active moiety and not the dose determined the effect of venlafaxine. Shorter remission times without ECG alterations in patients with serum concentrations above the therapeutic reference range suggest a re-evaluation of the therapeutic reference range for venlafaxine in larger studies.

The Involvement of Hypothalamus-Pituitary-Adrenal (HPA) Axis in Suicide Risk

Stress and Hypothalamic–Pituitary–Adrenal (HPA) axis dysregulation play a major role in various pathophysiological processes associated with both mood disorders and suicidal behavior. We conducted a systematic review with the primary aim of clarifying the nature and extent of HPA axis activity and suicidal behavior. The second aim of this review was to investigate whether potential biomarkers related to HPA axis abnormalities act as individual susceptibility factors for suicide. The PRISMA statement for reporting systematic reviews was used. Only articles published in English peer-reviewed journals were considered for possible inclusion; we excluded case reports, meta-analyses, and systematic reviews, and studies that did not clearly report statistical analysis, diagnostic criteria, or the number of patients included. Overall, 36 articles on HPA axis and suicide risk met inclusion criteria and were reviewed. Studies that investigated tests detecting biomarkers and the role of early life stressors in suicide risk were also included. We found that HPA axis activity is involved in suicide risk, regardless of the presence or absence of psychiatric conditions. The HPA axis abnormalities, mainly characterized by hyperactivity of the HPA axis, may exert an important modulatory influence on suicide risk. Impaired stress response mechanisms contribute to suicide risk. Targeting HPA axis dysregulation might represent a fruitful strategy for identifying new treatment targets and improving suicide risk prediction.

A Latent Class Analysis of Manic and Psychotic Symptoms

Bipolar spectrum disorders encompass heterogeneous clinical manifestations and comorbidities. A latent class analysis (LCA) was performed in 1846 subjects who experienced an episode of abnormally elevated or irritable mood to identify homogeneous groups of subjects, based on the distribution of 11 manic and 7 psychotic symptoms. LCA identified five classes: 1) two classes with irritability and with low and high level of psychosis (respectively "irritable," 29.1% of the sample, and "irritable-psychotic," 16.2%); 2) a class with expansive mood and hyperactivity ("expansive-hyperactive," 12.7%); and 3) two classes with manic symptoms and high and low level of psychosis ("manic-psychotic," 15.0%, and "manic," 27.2%). "Irritable" displayed lower rates of depressive episode, panic, and substance use disorders. Manic-psychotic displayed higher rates of depressive episode, panic, generalized anxiety, and substance use disorders. Use of mental health treatment more frequent in manic-psychotic and manic classes. Five classes of bipolar spectrum disorders were characterized by different sociodemographic and clinical patterns.

Prevalence and associated factors of suicidal ideation and attempt among undergraduate medical students of Haramaya University, Ethiopia. A cross sectional study

INTRODUCTION

Suicide is a disastrous act which has a significant effect on the global burden of disease, contributing yearly to 1.4% of the total burden with the foremost role played by a people aged between 15 and 35 years. Medical students are one of the high-risk groups for suicide. This increased risk may begin during medical school and leads to premature death. But, there is a paucity of epidemiologically reliable data on the issue. Therefore, the current study was aimed to assess the prevalence and associated factors of suicidal ideations and attempt among undergraduate medical students of Haramaya University.

METHOD

An institutional based cross-sectional study was conducted from May 13 to June 12, 2019 at College of Health and Medical Science, Haramaya University. Stratified sampling technique was used and a total of 757 participants were selected by using simple random sampling technique. Data were collected using a self-administered questionnaire. Suicidal ideation and attempt were assessed by using suicidal module of world mental health survey initiative version of the World Health Organization, composite international diagnostic interview. Data were analyzed using Statistical Package for Social Science Version 20. Descriptive results were presented by tables and graphs. Bivariate and multivariate logistic regression analyses were done to identify factors associated with suicidal ideation and attempt. P-values less than 0.05 were considered statistically significant and the strength of association was presented by an adjusted odds ratio with 95% confidence interval.

RESULT

The study showed that the prevalence of suicidal ideation and attempt were 23.7% (95%CI, 20.5-26.8) and 3.9% (95%CI, 2.6-5.5), respectively. Cumulative grade point average (AOR = 0.30, 95% CI: 0.18-0.49), current alcohol use (AOR = 2.26, 95%CI: 1.45-3.55), depression (AOR = 3.58, 95%CI: 2.23-5.76), anxiety (AOR = 3, 95%CI: 1.88-4.77), and poor social support (AOR = 2.57, 95%CI: 1.41-4.68) were the factors statistically associated with the suicidal ideation. Depression (AOR = 5.4, 95%CI: 1.45-20.14) and anxiety (AOR = 3.19, 95%CI: 1.01-10.18) were associated with the suicidal attempts.

CONCLUSION

This study showed that the high prevalence of suicidal ideation and attempt as compared to the prevalence of suicidal behavior among other university students who were studying in other fields. Cumulative Grade Point Average, current alcohol use, depression, anxiety and poor social support were the factors statistically associated with the suicidal ideation. Depression and anxiety were the ones associated with the suicidal attempt. Early screening, detection and management of suicidal behavior and associated mental health problems were recommended for undergraduate medical students.

A correlation study of emergency department nurses' fatigue, perceived stress, social support and self-efficacy in grade III A hospitals of Xi'an

Fatigue is a universal and challenging problem in a nurse's career, particularly for those working in the emergency department. Through analyzing the current status of emergency department nurses' fatigue, the purpose of this study is to provide guidance for occupational health promotion strategies making and fatigue relief.Cross-sectional study was conducted among nurses working in emergency department in 6 grade III A hospitals in Xi'an, China. Convenience sample of 346 nurses agreed to participate in this study. Data collection was based on the questionnaires. Descriptive statistics, hypothesis tests and correlation analysis were used to describe the samples' characteristics and identify associations amongst participants' characteristics.The fatigue score of those emergency nurses from grade III A hospitals in Xian was 8.71 ± 3.01, a high fatigue level. Moreover, there were significant differences in fatigue scores of different age groups, sleep qualities, work stress levels and physical states (P < .01). Further, the dimension of physical fatigue in various age groups, job title, marital status, sleep qualities, work stress levels and physical states was significantly different (P < .05) and the dimension of mental fatigue with different sleep qualities, work stress levels and physical states was significantly different (P < .01). The results of correlation analysis showed that fatigue was positively correlated with perceived stress while negatively correlated with social support and self-efficacy (P < .01). The multiple stepwise linear regression analysis indicated that the independent variables in the fatigue regression equation were perceived stress, physical condition and work stress in turn (P < .01), and the independent variables in the the dimensions of physical fatigue regression equation were perceived stress, physical condition,work stress and job title in turn (P < .05); the independent variables in the the dimensions of mental fatigue regression equation were perceived stress,subjective support and physical condition in turn (P < .05).The current status of high fatigue level of emergency nurses should be taken seriously. It is imperative to take effective measures to help emergency nurses reduce stress, improve social support, promote the self-efficacy, and thus relieve fatigue.

Investigation of structure-function correlation among the young offspring of patients with bipolar disorder

Bipolar disorder (BD) has been associated with impaired executive functioning and integrity of fronto-limbic white matter tracts. The evaluation of these factors in young offspring of patients with BD (BDoff) as a high-risk group offers an opportunity to investigate factors that could predict vulnerability to the disorder. This study aims to examine the correlation between neurocognition and neuroimaging findings to evaluate the potential for these findings as biomarkers for the early recognition of BD. We enrolled BDoff (n = 16) who were aged between 12 and 18. Participants were assessed using clinical and neurocognitive tests. In addition, structural brain magnetic resonance and diffusion tensor imaging data were obtained. Mean fractional anisotropy (FA) and mean diffusivity (MD) values of the superior longitudinal fasciculus (SLF) and cingulum were extracted and correlations with neuropsychological data were analyzed. FA values in the SLF were negatively correlated with Stroop interference, the Wisconsin Card Sorting Test, and the Trail Making Test (B-A) scores. MD values in the cingulum were inversely correlated with the Child and Youth Resilience Measure and positively correlated with higher scores on the Barratt Impulsiveness Scale-Attentional. These findings provide a link between features of the brain and cognitive dysfunction in BDoff.

COVID-19 in Children: Present and Future Perspective, An Interim Review

Coronavirus disease 2019 (COVID-19) pandemic has affected millions of people worldwide. However, the mechanism by which the pathogen affects children is not understood completely. Children so far accounted for only1 to 6.4% of diagnosed cases and the mortality rate is also less. Though clinical findings are similar to adults, with fever and respiratory symptoms being prevalent, fewer numbers of children appear to develop severe pneumonia. Observed attenuated response to the virus may possibly be due to decrease in the expression of the angiotensin-converting enzyme 2 receptor in lungs, repeated viral exposure, and not having any underlying chronic diseases or immunosuppression. Suggested treatment included oxygen supplementation, mechanical ventilation in severe cases, nutritional support, and maintaining fluids and electrolyte balances. Although, no definitive pharmacological therapy is available, various combination of drugs like hydroxychloroquine, lopinavir/ritonavir, remdesivir, tocilizumab, and convalescent serum show promising result to an extent. As there is no specific therapeutic measure for this ailment, aggressive efforts are being made to develop a potential vaccine against the disease. Although few reports on epidemiology of COVID-19 in children have been published, comprehensive reports are lacking. The present article reviews on important issues such as epidemiological characteristics, postulations of milder disease, therapeutic aspect, and recent development of vaccination against COVID-19 in children.

Efficacy of Psychological Interventions on Depression Anxiety and Somatization in Migrants: A Meta-analysis

Many studies reveal the effectiveness of different psychological interventions on the adult refugees reporting mental health distress. Aim of this metanalysis was to test the efficacy of different psychological treatments on the depressive, anxiety and somatization symptoms on refugees and asylum seekers. Fifty-two studies, since 1997 to 2019, were included in the systematic review and 27 of those were included in the metanalysis. Studies providing a pre and post treatment methodological design were included. All treatments reported significant effects on the three outcomes. Qualitative observations showed a probability to have a significant pre-post treatment effects on trials with outcome of depression (56%), anxiety (44%), and somatization (42%). Cognitive behavioral treatment resulted the most effective treatment. The status of refugee compared to the status of asylum seeker seems to have a great effect on the effectiveness of the treatment.

Clinical implications of agoraphobia in patients with panic disorder

Agoraphobia is frequently accompanied by panic disorder and causes considerable suffering. The aim of this study was to compare clinical features and treatment courses between patients with and without agoraphobia in panic disorder.In this retrospective study, 87 patients with panic disorder were divided into two groups depending on the presence of agoraphobia: patients with agoraphobia (PDA, n = 41) and patients without agoraphobia (PD, n = 46). Agoraphobia subscale score of the Albany Panic and Phobia Questionnaire was used to identify correlations between agoraphobia and panic and affective symptoms.The PDA group showed more severe panic and affective symptoms than the PD group. Patients with PDA were more likely to be younger at the age of onset, take benzodiazepines for longer durations, and be treated with antipsychotics augmentation. Agoraphobia subscale was associated with panic symptoms, depression, anxiety, and the duration of benzodiazepines use.The findings suggest that patients with PDA experienced more severe panic symptoms, more profound psychiatric comorbidity, and worse illness progression than those with PD.

Patient-reported outcomes in major depressive disorder with suicidal ideation: a real-world data analysis using PatientsLikeMe platform

BACKGROUND

The current analysis utilized data collected via an online patient community platform, PatientsLikeMe (PLM) to compare patient-reported experiences in patients with major depressive disorder (MDD) with suicidal ideation (MDSI) to those with MDD but without suicidal ideation.

METHODS

PLM members who joined PLM between May-2007 and February-2018 and reported a diagnosis of MDD were included. The MDSI cohort included patients with MDD who reported at least one suicide-related symptom at a severity greater than "none". Demographics, comorbidities, symptoms, and side-effects were compared between MDSI and MDD cohorts. Factors correlated with suicidal ideation (SI) were determined by a random forest procedure.

RESULTS

Patients in the MDSI cohort (n = 266) were younger (median age, 36 vs 44 years) with an earlier disease onset (before 30 years, 83% vs 71%), and a longer diagnosis latency (median, 4 vs 2 years) vs patients in the MDD cohort (n = 11,963). Majority of patients were women in both cohorts (73% vs 83%). Median number of psychiatric comorbidities was higher in the MDSI cohort (4 vs 3). Unprompted symptoms (e.g., loneliness, feeling of hopelessness, social anxiety, impulsivity, and self-hating thoughts) were more frequent in the MDSI cohort. Hopelessness, loneliness, anhedonia, social anxiety, and younger age were highly correlated with suicidal ideation.

CONCLUSIONS

This analysis utilized patient-reported data to better understand symptoms, experiences, and characteristics of patients with MDSI compared to patients with MDD. The results identified various risk factors correlated with suicidal ideation that may help guide clinical judgement for patients with MDD who may not voluntarily report suicidal ideation.

Prevalence and factors of compassion fatigue among Chinese psychiatric nurses: A cross-sectional study

Compassion fatigue has emerged as a detrimental consequence of experiencing work-related stress among psychiatric nurses, and affected the job performance, emotional and physical health of psychiatric nurses. However, researches on Chinese psychiatric nurses' compassion fatigue are dearth. This cross-sectional study aimed to investigate the prevalence and factors of compassion fatigue among Chinese psychiatric nurses.All participants completed the demographic questionnaire and the Chinese version of Professional Quality of Life Scale (ProQOL-CN). One-way ANOVA, t-tests, Levene test and multiple linear regression analysis were conducted to evaluate factors associated with compassion fatigue.A total of 352 psychiatric nurses in 9 psychiatric hospitals from the Chengdu, Wuhan, and Hefei were surveyed. The mean scores of compassion satisfaction, burnout and secondary traumatic stress were 32.59 ± 7.124, 26.92 ± 6.003 and 25.97 ± 5.365, respectively. Four variables of job satisfaction, exercise, had children, and age range from 36 to 50 years explained 30.7% of the variance in compassion satisfaction. Job satisfaction, sleeping quality, and marital status accounted for 40.4% variables in burnout. Furthermore, job satisfaction, average sleeping quality, and years of nursing experience remained significantly associated with secondary trauma stress, explaining 10.9% of the variance.Compassion satisfaction, burnout and secondary traumatic stress among Chinese psychiatric nurses were at the level of moderate. The higher job satisfaction, healthy lifestyle (high sleep quality and regular exercise), and family support (children, stable and harmonious marital status) positively influenced compassion satisfaction and negatively associated with burnout or secondary traumatic stress.

Cognitive and sensorimotor function in participants being treated for trigeminal neuralgia pain

Background

Trigeminal neuralgia (TN) is an orofacial condition defined by reoccurring, spontaneous, short-lived but excruciating stabbing pain. Pharmacological interventions constitute the first-line treatment for TN, with antiepileptic drugs commonly prescribed. People treated for TN pain with antiepileptic drugs describe cognitive and motor difficulties affecting activities of daily living, and report poorer quality of life. We undertook the first comprehensive objective evaluation of sensorimotor and cognitive performance in participants being treated for TN pain with antiepileptic drugs relative to age-matched controls.

Methods

Participants (43 TN, 41 control) completed a battery of sensorimotor (steering, aiming and tracking) and cognitive (working memory, processing speed, inhibition) tasks.

Results

The TN group performed significantly worse than controls on the sensorimotor tracking and aiming tasks and across all cognitive measures.

Conclusions

The data explain why patients treated with antiepileptic drugs report impairment when conducting activities of daily living (given the need for cognitive and motor capability within most of these). The study is an important first step in: (i) ensuring there is adequate information on the impact of pharmacological treatment; (ii) identifying measures to determine optimal medication dosage and track change over time; (iii) creating an evidence base that could allow scientific justification of alternative pain treatment options for TN (e.g. the costs/benefits of surgery).

Relationship between the self-concept and physical activity towards the prevention of chronic illnesses

The objective of this work is to verify the relationship between the self-perception of health and the self-concept of physical appearance in adolescents, in order to check their influence on the physical activity they perform with the aim of preventing chronic illnesses. To this end, an observational, cross-sectional descriptive study with analytical components was carried out. Opportunistic activity, in which young people, between the ages of 16 and 22, were recruited from 5 secondary schools of the municipality of San Cristóbal de La Laguna, on the island of Tenerife (Spain). Data were collected through the General Health Questionnaire, the Rosemberg Self-esteem Scale, and the physical exercise habits test physical activity questionnaire for adolescents-A, revealing the first 2 that most percentage of responses were grouped on the positive side. The physical exercise habits test physical activity questionnaire for adolescents-A described that the most commonly performed physical activity was walking (75%).

Role of psychotherapy on antenatal depression, anxiety, and maternal quality of life: A meta-analysis

BACKGROUND

Depression and anxiety are common psychological manifestations encountered during the antenatal stage of pregnancy. Treatments by pharmacological interventions have been reported to impart negative implications on maternal and fetal health outcomes. Therefore, the use of psychotherapeutic interventions to bypass these side-effects and manage depression, anxiety has received a lot of attention. A meta-statistical consensus regarding the intervention is available, but with several limitations. In this study, we attempt to address these limitations and provide the current state of evidence evaluating the influence of psychotherapy on antenatal depression, anxiety, and maternal quality of life.

OBJECTIVE

To demonstrate the effects of psychotherapy on depression, anxiety, and maternal quality of life during the antenatal stage of pregnancy.

METHODS

A systematic identification of literature was performed according to PRISMA guidelines on four academic databases: MEDLINE, Scopus, EMBASE, and CENTRAL. A meta-analysis evaluated the influence of psychotherapy on depression, anxiety, and maternal quality of life as compared to conventional obstetric care.

RESULTS

Out of 1146 records, 22 articles including 2146 pregnant women (mean age: 28.6 ± 2.8 years) were included in this review. This systematic review presents a 1b level of evidence supporting the use of psychotherapy for reducing depression, anxiety and enhancing maternal quality of life. The meta-analysis reveals the beneficial effects of psychotherapy for reducing depression (Hedge g: -0.48), anxiety (-0.47) and enhancing maternal quality of life (0.19) as compared to conventional obstetric care.

CONCLUSIONS

The current systematic review and meta-analysis recommend the use of psychotherapy as for reducing depression, anxiety and enhancing maternal quality of life during the antenatal stage of pregnancy.

Unintentional injury fatalities in the context of rising U.S. suicide rates: A five-year review of the web-based injury statistics query and reporting system

This archival study focuses specifically on suicide fatalities in relation to unintentional and undetermined injury fatalities in an effort to determine whether or not these rates are rising consistently. This question may serve to inform whether or not suicides are being accurately reported and documented. Data from all 50 states from the years 2012-2016 were obtained from the Web-based Injury Statistics Query and Reporting System (WISQARS) developed by the Centers for Disease Control and Prevention. A total of 213,726 suicide fatalities, 702,176 unintentional injury fatalities, and 24,533 undetermined injury fatalities comprised the dataset. Injury fatality rates depicted annual increases in both suicide and unintentional injury fatalities but variability in undetermined injury fatalities. Bivariate analyses discovered a statistically significant association between annual suicide fatality rates and unintentional (nonsuicidal) injury fatality rates. It would be suspected, ceteris paribus, that calculated rate changes over these years would follow suit. However, this was not observed. Given the trends and increasing stigma surrounding suicide, it is worth considering the degree to which suicides may be underreported or -documented and the epidemiological and translational ramifications of these trends as they pertain to future suicide research.

Changes in interleukin-1 beta induced by rTMS are significantly correlated with partial improvement of cognitive dysfunction in treatment-resistant depression: a pilot study

The impairment experienced by many individuals with depression is closely related to the cognitive symptoms of the disorder. Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive brain stimulation method that provides a promising technique for improving cognitive symptoms in treatment-resistant depression (TRD). It has recently been demonstrated that TRD is associated with increased inflammatory process. In the present study, we investigated whether a relationship exists between changes in cognitive function and those in inflammatory cytokines before and after rTMS treatment. Eleven patients with TRD were enrolled in a high-frequency (10 Hz) rTMS study. Cognitive function, depressive symptoms and serum concentration of inflammatory cytokines (interleukin (IL)-1β, IL-6 and tumor necrosis factor-α) were measured at baseline and at the endpoint of rTMS treatment. rTMS treatment significantly improved depressive symptom scores and some subscales of cognitive dysfunction. The present study has demonstrated that partial changes in cognitive function and changes in IL-1β were significantly correlated. The partial improvement of cognitive dysfunction by rTMS in the present study might be attributable to the reduction of peripheral IL-1β levels. The present results should be replicated for verification in future studies.

Making Sense of the Unique Pain of Survivors: A Psychoeducational Approach for Suicide Bereavement

Grief, guilt, abandonment, anger, shame, and rejection are the most common feelings experienced by suicide survivors, who differ from other bereaved individuals for the intensity of these feelings. Moreover, suicide risk and psychiatric disorders associated with suicidality are more frequent in people who have lost a loved person by suicide. Given the complexity and the consequences linked to the suicide of a loved person, it is necessary to act promptly. Among the various strategies, psychoeducation has proved effective for several mental disorders and for suicide bereavement. It is a therapeutic intervention aimed at identifying and understanding the psychological features associated with the mental pain of suicide survivors, to facilitate the management of the illness and the recognition of relationships in the social environment. We developed a psychoeducational group that took place at the Suicide Prevention Center of the Sant'Andrea Hospital in Rome. It was a homogeneous, finite-group composed of 8-12 suicide survivors and conducted by two trained psychologists supervised weekly by the Director of the Suicide Prevention Center. The intervention comprised 21 weekly sessions of 90 min. Each session concerned a determined topic and began with the presentation of the issue, continued with specific exercises, and finished with a group discussion. The main goals of the group were to provide support, normalize the reactions of the survivors, and assist them in reducing their emotional suffering and their thoughts about suicide, investigate the potential presence of suicide risk, implement prevention strategies, and integrate the loss of the loved person. The psychoeducational approach we delivered for suicide survivors allows individuals to interact with other individuals in the same situation in order to help them resume the normal course of life, placing the suicide of a loved person in a broader perspective.

Factors associated with post-traumatic stress disorder of nurses exposed to corona virus disease 2019 in China

Quantitative studies using validated questionnaires on post-traumatic stress disorder (PTSD) of Nurses exposed to corona virus disease 2019 (COVID-19) in China are rare and the baseline PTSD must first be evaluated before prevention. This study aimed to investigate the factors potentially involved in the level of PTSD of Nurses exposed to COVID-19 in China.In this cross-sectional study, male and female Nurses (n = 202) exposed to COVID-19 from HuBei China were included in the final sample. The PTSD Checklist-Civilian (PCL-C) questionnaire and Simplified Coping Style Questionnaire (SCSQ) were used for evaluation. Multivariate stepwise linear regression analysis and spearman correlation test were performed to assess the association between various factors associated with PTSD.The incidence of PTSD in Nurses exposed to COVID-19 was 16.83%, the PCL-C score was 27.00 (21.00-34.00), and the highest score in the three dimensions was avoidance dimension 9.50 (7.00-13.25); multivariable stepwise linear regression analysis showed that job satisfaction and gender were independently associated with lower PCL-C scores (both P < .001); PCL-C scores were correlated with positive coping (r = -0.151, P = .032), negative coping (r = 0.154, P = .029).Nurses exposed to COVID-19 from HuBei China with job satisfaction, male and positive coping had low PCL-C scores which necessitate reducing the PTSD level by ways of improving job satisfaction, positive response, and strengthening the psychological counseling of female nurses in order to reduce the risk of psychological impairment.

Addressing chronic persistent headaches after MTBI as a neuropathic pain state

An increasing number of patients with chronic persistent post-traumatic headache (PPTH) after mild traumatic brain injury (MTBI) are being referred to headache or pain specialists as conventional treatment options for primary headache disorders have not been able to adequately alleviate their debilitating headache symptoms. Evolving clinical and mechanistic evidences support the notation that chronic persistent MTBI related headaches (MTBI-HA) carry the hallmark characteristics of neuropathic pain. Thus, in addition to conventional treatment options applicable to non-traumatic primary headache disorders, other available treatment modalities for neuropathic pain should be considered. In this comprehensive review article, the author reveals the prevalence of MTBI-HA and its clinical manifestation, discusses existing clinical and mechanistic evidence supporting the classification of chronic persistent MTBI-HA as a neuropathic pain state, and explores current available treatment options and future directions of therapeutic research related to MTBI-HA.