Microplastic contamination in salt-cured fish and commercial sea salts: an emerging food safety threat in relation to UN Sustainable Development Goals (SDGs)

Microplastic (MP) contamination in seafood, particularly processed varieties like dried and salt-cured fish, poses a significant threat to human health. This study investigated MP levels in 22 salt-cured fish species and commercial sea salts along the Indian east coast. Results showed substantially higher MP concentrations compared to global averages, with fragments and fibres (< 250 µm) composing 70% of identified MPs, primarily PVC and PS polymers (> 55%). Station 2 exhibited high pollution levels, with salt-cured fish averaging 54.06 ± 14.48 MP items/g and salt containing 23.53 ± 4.2 MP items/g, indicating a high hazard risk index. A modest correlation was observed between MP abundance, morphotypes, polymer composition in the salt, and their impact on fish products. Given the critical link between food safety, security, and public health, further research is imperative to mitigate MP contamination, aligning with UN Sustainable Development Goals (Goal 2, Goal 3, Goal 14, and Goal 15) for enhanced food safety and security.

Assessment of microplastic contamination in the gastrointestinal tracts of indigenous fishes from north eastern hill regions of Bhogdoi, a tributary of River Brahmaputra, India

Microplastic (MP) pollution in freshwater environments has drawn considerable attention over the decades due to the risk posed by MPs to the aquatic fauna and human health. In this study, the occurrence of MPs was assessed from the gastrointestinal tracts (GIT) of indigenous fishes from Bhogdoi River, a tributary of River Brahmaputra, northeast hill region, Assam, India. All the fish species (n = 180) analysed showed 100% occurrence of MPs sampled from three stations of River Bhogdoi. A total of 488 microplastic particles were recorded from GIT of fishes collected. The mean abundance of MPs was highest in Station-II (7.64 ± 2.77 numbers individual-1) with lowest in S-I (3.17 ± 0.99 numbers individual-1). The MP size of 100-500 μm, MP shape of fibre (43.33%) and fragments (35.33%), blue colour MPs (26-37%) and polymer type PA (23-30%) were most prevalent in fishes analysed from River Bhogdoi. The mean abundance of MPs was higher in herbivore fishes (8.52 ± 1.22 numbers individual-1) as compared to carnivorous and omnivorous fish species with highest abundance in Labeo rohita (12.11 ± 2.13 numbers individual-1). Fibre and fragments with size range of 100-500 μm were dominant among all the feeding habits. Blue and black colour MPs were abundant among herbivore and carnivore fishes. Fourier transform infrared spectroscopy results confirmed that polyamide and polypropylene were the most abundant MP polymer in the fishes analysed. The present study provides baseline information of MPs in River Bhogdoi, Assam, for its future monitoring and assessment of contaminants.

Extraction, optimization, and functional quality evaluation of carotenoproteins from shrimp processing side streams through enzymatic process

The study aimed to develop an effective and eco-friendly enzymatic process to extract carotenoproteins from shrimp waste. The optimization of enzymatic hydrolysis conditions to maximize the degree of deproteinization (DDP) of carotenoprotein from shrimp head waste (SHW) and shrimp shell waste (SSW) was conducted separately using the Box-Behnken design of response surface methodology (RSM). To achieve a maximum DDP of 92.32% for SSW and 96.72% for SHW, the optimal hydrolysis conditions were determined as follows: temperature (SSW: 53.13 °C; SHW: 45.90 °C), pH (SSW: 7.13; SHW: 6.78), time (SSW: 90 min; SHW: 61.18 min), and enzyme/substrate ratio (SSW: 2 g/100 g; SHW: 1.18 g/100 g). The carotenoprotein effluent obtained was subjected to spray drying and subsequently assessed for color, nutritional, and functional characteristics. The carotenoprotein from shrimp shell (CpSS) contained a higher essential amino acid score than carotenoprotein from shrimp head (CpSH). CpSS had a higher whiteness index of 82.05, while CpSH had 64.04. Both CpSS and CpSH showed good functional properties viz solubility, emulsion, and foaming properties. The maximum solubility of CpSH and CpSS was determined to be 92.94% and 96.48% at pH 10.0, respectively. The highest emulsion capacity (CpSH: 81.33%, CpSS: 70.13%) and stability (CpSH: 57.06%, CpSS: 63.05%) were observed at 3% carotenoprotein concentration. Similarly, the highest values of foaming capacity (CpSH: 27.66%, CpSS: 105.5%) and stability (CpSH: 23.83%, CpSS: 105.33%) were also found at the same 3% carotenoprotein concentration. In conclusion, the carotenoproteins obtained from shrimp waste showed favorable attributes in terms of color, amino acid composition, and functional properties. These findings strongly suggest the potential applicability of CpSS and CpSH as valuable resources in various domains. CpSS, with its higher whiteness index, greater amino acid content, and superior functional characteristics, may find suitability as functional ingredients in human food products. Conversely, CpSH could be considered for incorporation into animal feed formulations.

Comparative efficiency of native and non-native starter culture in the production of bio-silage using composite waste from fish and vegetables

The efficiency of native and non-native starter cultures in the production of bio-silage using composite waste from fish and vegetables was studied. An ensilage experiment was conducted in a natural way (without starter culture) of composite waste (fish to vegetable at 80 to 20%) to isolate the native fermentative microflora. An Enterococcus faecalis strain isolated from the natural ensilage of composite waste showed higher efficiency over other commercial LAB strains generally used for ensilation. A total of 60 isolates were screened and characterized biochemically from ensilaged composite waste. Among them, 12 proteolytic and lipolytic positive isolates were identified as Enterococcus faecalis, based on a BLAST search of the 16S rRNA gene sequences. Subsequently, composite bio-silage was prepared by inoculating starter cultures with three (3) treatments T1 (native-Enterococcus faecalis), T2 (non-native-Lactobacillus acidophilus), T3 (a mixture of E. faecalis and L. acidophilus) and compared with control (composite bio-silage without starter culture). The highest non-protein nitrogen (0.78 ± 0.01 mg of N /100 g) and degree of hydrolysis (70.00 ± 0.06% of protein/100 g) was seen in the T3 sample, and the lowest (0.67 ± 0.02 mg of N/100 g and 50.40 ± 0.04% of protein/100 g) was seen in the control. At the end of ensilation, the pH fell (5.95-3.88) in conjunction with the formation of lactic acid (0.23-2.05 g of lactic acid/100 g), and the lactic acid bacteria count nearly doubled (log 5.60-10.60). The lipid peroxidation products PV (0.11-0.41 milli equivalent of oxygen/kg of fat) and TBARs (1.64-6.95 mg of malonaldehyde/kg of silage) were changed within a reasonable range in the following pattern Control > T2 > T3 > T1, which led to oxidatively stable products. The findings revealed that native starter culture E. faecalis, which can be employed as a single or in combination with non-native L. acidophilus, performed better in the bio-ensilation process. Additionally, the finished composite bio-silage can be used as a novel, protein-carbohydrate rich feed component to help manage wastes from both sectors.

Abundance and characteristics of microplastics in gastrointestinal tracts and gills of croaker fish (Johnius dussumieri) from off Mumbai coastal waters of India

The present study was conducted to establish the intensity of microplastic pollution in demersal fish species, Johnius dussumieri, from the north eastern coastal waters of the Arabian sea. MP recovered were analysed for size, morphology, colour, and polymer type. The study results indicated that the GI tract and gills of individual fishes had 6.6 ± 1.7 and 6.2 ± 1.7 items, respectively. The microplastics having a size of <100 μm consisting of beads were found to be most predominant. Black and blue were the most present colours of microplastic in the tissues. Among the different studied months, a higher number of MP incidence was observed in the post monsoon period. There is no significant correlation observed between the microplastic numbers in gills and guts tissue. The present study shows that there is a potential risk of microplastic bioaccumulation in the fish body and subsequent risk to the consumers and organisms sharing the food chain.

Microplastics in shrimps: a study from the trawling grounds of north eastern part of Arabian Sea

Accumulation of microplastics (MPs) in marine organisms poses an imminent environmental threat and health risk due to the possibility of trophic transfer of accumulated MPs in ecologically important food chains. In this context, a field-level study was conducted on the fishing grounds of the north eastern part of the Arabian Sea through experimental fishing, and the gastrointestinal tracts (GT) of three different species of shrimps (n=180) were examined for the incidence of microplastics. The results showed that all shrimp caught from the fishing grounds had significant levels of MPs in the gastrointestinal tracts. A total number of 1220 microplastic items were recorded from the pooled samples, with an average of 6.78 ± 2.80 items per individual. The gastrointestinal tract showed an average number of 70.32 ± 34.67 MPs per gram of the gut material. The MPs with the size range of 100-250 μm were the most abundant form found in the shrimp species analyzed. Among the colored MP particles, black color was the most dominant (30.16%) form of MP. Fibers, fragments, pellets, beads, and films were the common morphotypes; however, fibers showed an occurrence of 39.40%, 47.39%, and 41.89% in the GTs of Metapenaeus monoceros, Parapeneopsis stylifera, and Penaeus indicus, respectively. In the present study, six types of plastic polymers were identified from the GTs of the studied samples. The findings confirm the presence of microplastics in the natural habitats of shrimps beyond the coast and indicate that shrimps caught from these coastal fishing grounds contain MPs in their gut. The findings underline the immediate scientific intervention for the microplastic reduction in the marine environment.

THU0026 CLONAL HAEMATOPOIESIS ASSOCIATED SOMATIC MUTATIONS IN RHEUMATOID ARTHRITIS

Background:

Clonal haematopoiesis of indeterminate potential (CHIP) occurs when somatic mutations arise in myeloid neoplasia driver genes of haematopoietic progenitor cells, in the absence of overt cytopenia or dysplasia. The prevalence of CHIP increases with age. The most common genes affected by CHIP mutations in unselected populations are DNMT3A, ASXL1, and TET2. The presence of CHIP is linked to increased basal level of inflammation and a high risk of cardiovascular disease and all-cause mortality. Rheumatoid arthritis (RA) is one of the most common and debilitating multi-system autoimmune disorders, affecting up to 1% of adults in developed countries. The role of somatic mutations in the pathogenesis of autoimmune diseases is an unexplored area; therefore, we aimed to test the hypothesis that clonal haematopoiesis (CH) is associated with the incidence and severity of RA.

Objectives:

To evaluate the association of CH somatic mutation with severity of RA.

Methods:

163 RA patients were recruited from the following cohorts: (i)Early RA/treatment naive (n=31), (ii)Refractory RA - non-responders to Disease-Modifying Anti-Rheumatic Drugs (DMARDs) and biologics (n=48), (ii)Flare (n=41) vsRemission patients (n=43) –patients treated with DMARDs and withdrawn from treatment on achieving remission. Six months later, 50% relapse and 50% sustain remission. Single molecule molecular inversion probes (smMIPs) were used to screen for somatic mutations in 40 loci known to carry clonal haematopoiesis driver mutations (CHDMs). Whole exome sequencing was also performed on Flare/Remission patients (n = 84) to screen for CHDMs and other somatic mutations. In-house bioinformatics pipelines were used to call mutations from both the datasets.

Results:

We identified CH in RA with an overall prevalence of 14%. Twenty-four unique variants with a variant allele frequency (VAF) of 2-35% were found in ten genes including ASXL1, CBL, DNMT3A, GNAS, GNB1, PTPN11, PTPN12, SF3B1, TET2, and TP53. The number of unique patients carrying mutations in these genes are follows:refractory: n=12/48, flare: n=6/41,remission: n=4/43 andearly RA: n=2/31. The majority of the mutations occurred in DNMT3A (n=6) followed by TP53 (N=4) and TET2 (n=3). Two variants with VAF of 15% were identified in two patients under the age of 30, both with clinically severe disease. In patients between the ages of 50-59 yrs., 60-69 yrs., and 70-79 yrs., CH was observed at 11% (4/35), 23% (11/46) and 17%(7/41), respectively.

Conclusion:

We here report the prevalence of CH in RA, affecting more patients with clinically advanced/refractory disease compared to those with early/less severe disease.

Further study will be conducted to confirm the results.

References:

[1]Acuna-Hidalgo, R., Sengul, H., Steehouwer, M., van de Vorst, M., Vermeulen, S., & Kiemeney, L. et al. (2017). Ultra-sensitive Sequencing Identifies High Prevalence of Clonal Hematopoiesis-Associated Mutations throughout Adult Life.The American Journal Of Human Genetics,101(1), 50-64. doi: 10.1016/j.ajhg.2017.05.013

[2]NRAS - National Rheumatoid Arthritis Society. (2020). Retrieved 30 January 2020, fromhttps://www.nras.org.uk/what-is-ra-article

[3]Steensma, D., Bejar, R., Jaiswal, S., Lindsley, R., Sekeres, M., Hasserjian, R., & Ebert, B. (2015). Clonal hematopoiesis of indeterminate potential and its distinction from myelodysplastic syndromes.Blood,126(1), 9-16. doi: 10.1182/blood-2015-03-631747

Acknowledgments:

National Institute for Health Research, United Kingdom

Disclosure of Interests:

Fareeha Tariq: None declared, Bilal Alobaidi: None declared, Miguel Xavier: None declared, Michael McCorkindale: None declared, Joris Veltman: None declared, John Isaacs Consultant of: AbbVie, Bristol-Myers Squibb, Eli Lilly, Gilead, Janssen, Merck, Pfizer, Roche, Arthur Pratt Grant/research support from: Pfizer, GSK, Amy Anderson: None declared, Matthew Collin: None declared

Evaluation of physicochemical and functional properties of spray-dried protein hydrolysate from non-penaeid shrimp (Acetes indicus)

BACKGROUND

Protein hydrolysate powder was prepared from non-penaeid shrimp (Acetes indicus) by enzymatic hydrolysis using Alcalase enzyme. Extraction conditions such as pH (6.5, 7.5 and 8.5), enzyme to substrate ratio (1.0, 1.5 and 2.0) and temperature (40, 50 and 60 °C) were optimized against the degree of hydrolysis using response surface methodology.

RESULTS

Protein hydrolysate comprised of 740 g kg^-1 protein, 150 g kg^-1 ash and 90 g kg^-1 fat contents. The amino acid score showed superior attributes with 56% essential amino acids. Furthermore, the functional properties of spray-dried protein hydrolysates were evaluated. Protein solubility was found to be the 90.20% at pH 2 and 96.92% at pH 12. Emulsifying properties were found to vary with the concentration of protein hydrolysates and the highest emulsifying capacity (26.67%) and emulsion stability (23.33%) were found at a concentration of 20 mg mL^-1 . The highest and the lowest foaming capacity were observed at pH 6 and pH 10 with a concentration of 20 mg mL^-1 . The water holding capacity of protein hydrolysate was found to increase with concentration, with a value of 5.4 mL g^-1 at a concentration of 20 mg mL^-1 .

CONCLUSION

The results of the present study indicate that the use of A. indicus for the production of protein hydrolysate has good functional properties and nutritional value, rendering it suitable for broad industrial food applications. © 2019 Society of Chemical Industry.

Antioxidant properties and instrumental quality characteristics of spray dried Pangasius visceral protein hydrolysate prepared by chemical and enzymatic methods

Fish protein hydrolysates are digested form of protein with various bioactive properties where, the cleavages of molecular bonds of proteins can be broken by the enzymatic and chemical process. In this study, antioxidant properties of spray dried protein hydrolysate prepared from Pangasius viscera by using enzymatic (papain and pepsin), and chemical methods (hydrochloric acid and sodium hydroxide) were evaluated. Among the different treatments, pepsin-derived visceral protein hydrolysate showed the maximum antioxidant activity when used at higher concentrations. Essential amino acids (EAA) and hydrophobic amino acids are higher in papain-derived visceral protein hydrolysate. In pepsin-derived visceral protein hydrolysate, major proportion was contributed by glycine (Gly), glutamine (Glu), proline (Pro), and asparagine (Asp). Higher amount of aromatic amino acids are found in alkali-derived FVPH. Scanning electron microscopy (SEM) images of pepsin fish visceral protein hydrolysate showed better globular structure than the other treatments. It can be concluded that among the different treatments, the visceral protein hydrolysate prepared with pepsin had better overall quality regarding antioxidant properties and papain in nutritional point of view.

Posttraumatic stress disorder in the World Mental Health Surveys

BACKGROUND

Traumatic events are common globally; however, comprehensive population-based cross-national data on the epidemiology of posttraumatic stress disorder (PTSD), the paradigmatic trauma-related mental disorder, are lacking.

METHODS

Data were analyzed from 26 population surveys in the World Health Organization World Mental Health Surveys. A total of 71 083 respondents ages 18+ participated. The Composite International Diagnostic Interview assessed exposure to traumatic events as well as 30-day, 12-month, and lifetime PTSD. Respondents were also assessed for treatment in the 12 months preceding the survey. Age of onset distributions were examined by country income level. Associations of PTSD were examined with country income, world region, and respondent demographics.

RESULTS

The cross-national lifetime prevalence of PTSD was 3.9% in the total sample and 5.6% among the trauma exposed. Half of respondents with PTSD reported persistent symptoms. Treatment seeking in high-income countries (53.5%) was roughly double that in low-lower middle income (22.8%) and upper-middle income (28.7%) countries. Social disadvantage, including younger age, female sex, being unmarried, being less educated, having lower household income, and being unemployed, was associated with increased risk of lifetime PTSD among the trauma exposed.

CONCLUSIONS

PTSD is prevalent cross-nationally, with half of all global cases being persistent. Only half of those with severe PTSD report receiving any treatment and only a minority receive specialty mental health care. Striking disparities in PTSD treatment exist by country income level. Increasing access to effective treatment, especially in low- and middle-income countries, remains critical for reducing the population burden of PTSD.

Effect of processing conditions on degree of hydrolysis, ACE inhibition, and antioxidant activities of protein hydrolysate from Acetes indicus

Protein hydrolysate was prepared from Acetes indicus which is a major bycatch among non-penaeid prawn landings of India. Hydrolysis conditions (enzyme to substrate ratio and time) for preparing protein hydrolysates using alcalase enzyme were optimized by response surface methodology using central composite design. The optimum conditions for enzyme-substrate ratio (mL/100 g) of 1.57, 1.69, 1.60, 1.56, and 1.50 and for hydrolysis time of 97.18, 96.5, 98.15 min, 102.48, and 88.44 min were established for attaining maximum yield, degree of hydrolysis, 2,2-diphenyl-1-picrylhydrazyl, angiotensin I-converting enzyme-inhibiting activity, and metal-chelating activity, respectively. ABTS radical scavenging activity and reducing power assay of optimized protein hydrolysate were found to be increased with the increase in concentration. The higher value of 7.04 (μM Trolox/g), 87.95, and 77.24%, respectively for DPPH, ACE, and metal-chelating activity indicated that the A. indicus protein hydrolysates have beneficial biological properties that could be well-utilized in the application of functional foods and nutraceuticals. Graphical abstract ᅟ.

The association between childhood adversities and subsequent first onset of psychotic experiences: a cross-national analysis of 23 998 respondents from 17 countries

BACKGROUND

Although there is robust evidence linking childhood adversities (CAs) and an increased risk for psychotic experiences (PEs), little is known about whether these associations vary across the life-course and whether mental disorders that emerge prior to PEs explain these associations.

METHOD

We assessed CAs, PEs and DSM-IV mental disorders in 23 998 adults in the WHO World Mental Health Surveys. Discrete-time survival analysis was used to investigate the associations between CAs and PEs, and the influence of mental disorders on these associations using multivariate logistic models.

RESULTS

Exposure to CAs was common, and those who experienced any CAs had increased odds of later PEs [odds ratio (OR) 2.3, 95% confidence interval (CI) 1.9-2.6]. CAs reflecting maladaptive family functioning (MFF), including abuse, neglect, and parent maladjustment, exhibited the strongest associations with PE onset in all life-course stages. Sexual abuse exhibited a strong association with PE onset during childhood (OR 8.5, 95% CI 3.6-20.2), whereas Other CA types were associated with PE onset in adolescence. Associations of other CAs with PEs disappeared in adolescence after adjustment for prior-onset mental disorders. The population attributable risk proportion (PARP) for PEs associated with all CAs was 31% (24% for MFF).

CONCLUSIONS

Exposure to CAs is associated with PE onset throughout the life-course, although sexual abuse is most strongly associated with childhood-onset PEs. The presence of mental disorders prior to the onset of PEs does not fully explain these associations. The large PARPs suggest that preventing CAs could lead to a meaningful reduction in PEs in the population.

The cross-national epidemiology of DSM-IV intermittent explosive disorder

BACKGROUND

This is the first cross-national study of intermittent explosive disorder (IED).

METHOD

A total of 17 face-to-face cross-sectional household surveys of adults were conducted in 16 countries (n = 88 063) as part of the World Mental Health Surveys initiative. The World Health Organization Composite International Diagnostic Interview (CIDI 3.0) assessed DSM-IV IED, using a conservative definition.

RESULTS

Lifetime prevalence of IED ranged across countries from 0.1 to 2.7% with a weighted average of 0.8%; 0.4 and 0.3% met criteria for 12-month and 30-day prevalence, respectively. Sociodemographic correlates of lifetime risk of IED were being male, young, unemployed, divorced or separated, and having less education. The median age of onset of IED was 17 years with an interquartile range across countries of 13-23 years. The vast majority (81.7%) of those with lifetime IED met criteria for at least one other lifetime disorder; co-morbidity was highest with alcohol abuse and depression. Of those with 12-month IED, 39% reported severe impairment in at least one domain, most commonly social or relationship functioning. Prior traumatic experiences involving physical (non-combat) or sexual violence were associated with increased risk of IED onset.

CONCLUSIONS

Conservatively defined, IED is a low prevalence disorder but this belies the true societal costs of IED in terms of the effects of explosive anger attacks on families and relationships. IED is more common among males, the young, the socially disadvantaged and among those with prior exposure to violence, especially in childhood.

Assessing Medication Beliefs of Mental Health Professionals: The Portuguese Version of the Medication Alliance Beliefs Questionnaire

Introduction

Clinician's attitudes are an important consideration in implementing adherence strategies and that these attitudes can be successfully improved as a result of training. The 22-item Medication Alliance Beliefs Questionnaire (MABQ; Byrne et al.2008) was used to assess clinician attitudes towards non-adherence. The MABQ contains five subscales reflecting the clinician's self-efficacy (adequacy), the satisfaction (work satisfaction); their appraisal of their self-worth (self-esteem), their outcome expectancies (pessimism) in relation to non-adherent patients, and the extent to which they understand the difficulties patients might experience in trying to adhere to treatment (empathy).

Aims/objectives

To develop the Portuguese version of the MABQ.

Methods

The MABQ was translated and adapted for Portuguese language. The translation was done by the first author (AC). The accuracy of this translation was discussed in a two focus group of experts, providing opinion on face and content validity. After pre-testing, the final version of the Portuguese translation was produced.

Results

A convenience sample of 65 mental health professionals working in a variety of settings is being collected. The average score in MABQ was 80.06 (SD 9.5). The value of internal reliability coefficient α was 0.80. The intraclass correlation coefficient of total MABQ score was 0.35. The t-test showed that there were no statistically significant differences between the mean values of the measurement scale at two different times (80.4 vs.76.2; P = 0.02).

Conclusion

The attitudes of mental health professionals may have a predictive relationship with treatment outcomes of patients with mental health disorders. The validation of the Portuguese version of MABQ will provide professionals with a new tool to evaluate crucial issues related to medication beliefs.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

How we can enhance treatment adherence? Perspective of patients and clinicians

Introduction

Non-adherence to antipsychotic medication is commonly found in mental health disorders (MHD), thus forming a major obstacle to long-term maintenance treatment and contributing to high relapse rates and also can influence the attitudes and beliefs of mental health professionals (MHP).

Objectives

–assess the beliefs of MHP;

–assess perception of illness in patients with MHD.

Aims

Contribute to treatment adherence of patients with MHD, through developing adequate strategies to their needs.

Methods

In this cross-sectional study, we use a convenience sample of patients with MHD attending in the mental health departments of three general hospitals in Lisbon great area. Data is being collected through individual interviews. We have applied clinical and socio-demographic questionnaire and additional measures to assess symptom severity, treatment adherence and attitudes towards medication. For MHP, we used a optimism scale (ETOS), Difficulty Implementing Adherence Strategies (DIAS); Medication Alliance Beliefs Questionnaire (MABQ).

Results

Two convenience samples were composed by 150 patients with MHD (mean age: 39.7; SD ± 9.8) and 65 MHP (mean age: 37.0; sd 8.3) working in a variety of settings is being collected. From the perspective of patients, the most important reason for adherence is to accept the illness (54,7%, n = 82). 50.8% (n = 33) of MHP believes that if patients are unmotivated for treatment, adherence strategies are unlikely to be effective. 43.1 (n = 28) of MHP agrees that if patients do not accept their illness, any adherence strategies that result.

Conclusion

With this study, we expect to gain further knowledge on the factors related patients and MHP that might influence compliance and, therefore, contribute to the development of effective strategies to promote treatment adherence in MHD.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Assessing Strategies to Improve Antipsychotic Adherence: The Portuguese Version of the Difficulty Implementing Adherence Strategies

Introduction

Non-adherence is a problem throughout medicine and there are many strategies that are used to improve antipsychotic adherence. A review of the literature identified 33 commonly cited strategies for enhancing consumer adherence. Three core themes were identified: Information/Education; Behavioural strategies; and Cognitive/Motivational strategies.

Aims/objectives

To develop the Portuguese version of the DIAS.

Methods

The DIAS was translated and adapted for Portuguese language. The translation was done by the first author (AC). The accuracy of this translation was discussed in a two focus group of experts, providing opinion on face and content validity. The participants were asked to rate how often they had difficulties using each of the 33 strategies with consumers who were non-adherent. A four point Likert scale was used (1 = never; 4 = always) such that higher scores indicated more frequent difficulty using the strategy.

Results

A convenience sample of 65 mental health professionals working in a variety of settings is being collected. The average score in DIAS was 85.0 (SD14.6). The value of internal reliability coefficient α was 0.93. The intraclass correlation coefficient of total MABQ score was 0.45. The t-test showed that there were no statistically significant differences between the mean values of the measurement scale at two different times (84.5 vs.90.5; P = 0.04).

Conclusion

Interventions to improve antipsychotic adherence would benefit from further research. However, it is important always to bear in mind that none of these strategies can be a substitute a positive therapeutic alliance. The Portuguese version of DIAS will provide professionals with a new tool to evaluate the frequency how strategies are implemented and the impact of each strategy in treatment adherence.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Association between suicide attempts and insight among patients with bipolar disorders

Introduction

Insight is an important factor associated with non-compliance and poor outcome. Poor level of insight has been described as a characteristic in patients with acute bipolar disorder with more unawareness in social consequences. In contrast, awareness of having a mental disorder, of its symptoms, of its consequences, and/or of the need for treatment is associated with a number of positive prognostic indicators. Insight is also linked, however, to depression and suicidal ideation in bipolar disorder.

Objectives

(1) Assess the illness perception. (2) Assess the impact of insight in suicidal tendencies.

Aims

Contribute to development measures to improve the insight in bipolar disorders.

Methods

In this cross sectional study we use a convenience sample of patients with bipolar disorder attending in the mental health departments of three general hospitals in Lisbon great area. We have applied clinical and socio-demographic questionnaire and additional measures to assess symptom severity, treatment adherence and illness perception.

Results

A samples was composed by 64 patients with bipolar disorder (mean age = 38.7; SD ± 10.1). A total of 48.4% patients (n = 31) had made a suicide attempted and 23.4% (n = 15) of this patient done 5 or more attempted suicide. We found a significant correlation with symptoms and insight (rs = 0.56; P < 0.01).

Conclusion

Mental health professionals often utilize insight as an indicator of prognosis, because of its association with treatment adherence. The findings of the current study suggest that having intact or good insight may be an indicator for suicidal ideation among patients with bipolar disorders. A brief psychoeducational approach could potentially be effective. We recommend a combined approach to Improve clinical insight in bipolar disorder.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

The effects of co-morbidity in defining major depression subtypes associated with long-term course and severity

BACKGROUND

Although variation in the long-term course of major depressive disorder (MDD) is not strongly predicted by existing symptom subtype distinctions, recent research suggests that prediction can be improved by using machine learning methods. However, it is not known whether these distinctions can be refined by added information about co-morbid conditions. The current report presents results on this question.

METHOD

Data came from 8261 respondents with lifetime DSM-IV MDD in the World Health Organization (WHO) World Mental Health (WMH) Surveys. Outcomes included four retrospectively reported measures of persistence/severity of course (years in episode; years in chronic episodes; hospitalization for MDD; disability due to MDD). Machine learning methods (regression tree analysis; lasso, ridge and elastic net penalized regression) followed by k-means cluster analysis were used to augment previously detected subtypes with information about prior co-morbidity to predict these outcomes.

RESULTS

Predicted values were strongly correlated across outcomes. Cluster analysis of predicted values found three clusters with consistently high, intermediate or low values. The high-risk cluster (32.4% of cases) accounted for 56.6-72.9% of high persistence, high chronicity, hospitalization and disability. This high-risk cluster had both higher sensitivity and likelihood ratio positive (LR+; relative proportions of cases in the high-risk cluster versus other clusters having the adverse outcomes) than in a parallel analysis that excluded measures of co-morbidity as predictors.

CONCLUSIONS

Although the results using the retrospective data reported here suggest that useful MDD subtyping distinctions can be made with machine learning and clustering across multiple indicators of illness persistence/severity, replication with prospective data is needed to confirm this preliminary conclusion.

Barriers to mental health treatment: results from the WHO World Mental Health surveys

BACKGROUND

To examine barriers to initiation and continuation of mental health treatment among individuals with common mental disorders.

METHOD

Data were from the World Health Organization (WHO) World Mental Health (WMH) surveys. Representative household samples were interviewed face to face in 24 countries. Reasons to initiate and continue treatment were examined in a subsample (n = 63,678) and analyzed at different levels of clinical severity.

RESULTS

Among those with a DSM-IV disorder in the past 12 months, low perceived need was the most common reason for not initiating treatment and more common among moderate and mild than severe cases. Women and younger people with disorders were more likely to recognize a need for treatment. A desire to handle the problem on one's own was the most common barrier among respondents with a disorder who perceived a need for treatment (63.8%). Attitudinal barriers were much more important than structural barriers to both initiating and continuing treatment. However, attitudinal barriers dominated for mild-moderate cases and structural barriers for severe cases. Perceived ineffectiveness of treatment was the most commonly reported reason for treatment drop-out (39.3%), followed by negative experiences with treatment providers (26.9% of respondents with severe disorders).

CONCLUSIONS

Low perceived need and attitudinal barriers are the major barriers to seeking and staying in treatment among individuals with common mental disorders worldwide. Apart from targeting structural barriers, mainly in countries with poor resources, increasing population mental health literacy is an important endeavor worldwide.

Barriers to mental health treatment: results from the WHO World Mental Health surveys

BACKGROUND

To examine barriers to initiation and continuation of mental health treatment among individuals with common mental disorders.

METHOD

Data were from the World Health Organization (WHO) World Mental Health (WMH) surveys. Representative household samples were interviewed face to face in 24 countries. Reasons to initiate and continue treatment were examined in a subsample (n = 63,678) and analyzed at different levels of clinical severity.

RESULTS

Among those with a DSM-IV disorder in the past 12 months, low perceived need was the most common reason for not initiating treatment and more common among moderate and mild than severe cases. Women and younger people with disorders were more likely to recognize a need for treatment. A desire to handle the problem on one's own was the most common barrier among respondents with a disorder who perceived a need for treatment (63.8%). Attitudinal barriers were much more important than structural barriers to both initiating and continuing treatment. However, attitudinal barriers dominated for mild-moderate cases and structural barriers for severe cases. Perceived ineffectiveness of treatment was the most commonly reported reason for treatment drop-out (39.3%), followed by negative experiences with treatment providers (26.9% of respondents with severe disorders).

CONCLUSIONS

Low perceived need and attitudinal barriers are the major barriers to seeking and staying in treatment among individuals with common mental disorders worldwide. Apart from targeting structural barriers, mainly in countries with poor resources, increasing population mental health literacy is an important endeavor worldwide.

A comparative analysis of role attainment and impairment in binge-eating disorder and bulimia nervosa: results from the WHO World Mental Health Surveys

Background. Cross-national population data from the WHO World Mental Health surveys are used to compare role attainments and role impairments associated with binge-eating disorder (BED) and bulimia nervosa (BN). Methods. Community surveys assessed 23 000 adults across 12 countries for BED, BN and ten other DSM-IV mental disorders using the WHO Composite International Diagnostic Interview. Age-of-onset was assessed retrospectively. Ten physical disorders were assessed using standard conditions checklists. Analyses examined reciprocal time-lagged associations of eating disorders (EDs) with education, associations of early-onset (i.e., prior to completing education) EDs with subsequent adult role attainments and cross-sectional associations of current EDs with days of role impairment. Results. BED and BN predicted significantly increased education (females). Student status predicted increased risk of subsequent BED and BN (females). Early-onset BED predicted reduced odds of current (at time of interview) marriage (females) and reduced odds of current employment (males). Early-onset BN predicted increased odds of current work disability (females and males). Current BED and BN were both associated with significantly increased days of role impairment (females and males). Significant BED and BN effects on adult role attainments and impairments were explained by controls for comorbid disorders. Conclusions. Effects of BED on role attainments and impairments are comparable with those of BN. The most plausible interpretation of the fact that these associations are explained by comorbid disorders is that causal effects of EDs are mediated through secondary disorders. Controlled treatment effectiveness studies are needed to trace out long-term effects of BED-BN on secondary disorders.

Standardization of the Maristán Scale of Informal Care in people with schizophrenia and other psychoses

OBJECTIVE

No instrument has been developed and validated across cultures to measure the degree of support provided by informal carers to people with schizophrenia. We aimed to develop such a measure.

METHOD

The Maristán Scale of Informal Care was developed directly from the views of patients with schizophrenia in six countries. Face-to-face interviews were carried out with participants and 103 were repeated after 30 days. Principal Axis Factoring followed by Promax rotation evaluated the structure of the scale. Horn's parallel combined with bootstrapping determined the number of factors. Cronbach's alpha estimated the scale's internal consistency and intra-class correlation its test-retest reliability.

RESULTS

A total of 164 interviews were undertaken, 103 with re-test. The Horn's Parallel Analysis and the analysis of the Promax rotation revealed one factor. Cronbach's alpha was 0.89. Intra-class correlation coefficient was 0.56 (95% CI 0.42-0.68) and this increased to 0.64 (95% CI 0.51-0.75) after removing two outlying values. Patients from Argentina recorded the lowest scores (poor informal support/care).

CONCLUSION

The Maristán Scale of Informal Care is a reliable instrument to assess the degree of support provided by informal carers to people with schizophrenia across cultures. A confirmatory factor analysis is needed to evaluate the stability of its factor structure.

Spiritual and religious beliefs as risk factors for the onset of major depression: an international cohort study

BACKGROUND

Several studies have reported weak associations between religious or spiritual belief and psychological health. However, most have been cross-sectional surveys in the U.S.A., limiting inference about generalizability. An international longitudinal study of incidence of major depression gave us the opportunity to investigate this relationship further.

METHOD

Data were collected in a prospective cohort study of adult general practice attendees across seven countries. Participants were followed at 6 and 12 months. Spiritual and religious beliefs were assessed using a standardized questionnaire, and DSM-IV diagnosis of major depression was made using the Composite International Diagnostic Interview (CIDI). Logistic regression was used to estimate incidence rates and odds ratios (ORs), after multiple imputation of missing data.

RESULTS

The analyses included 8318 attendees. Of participants reporting a spiritual understanding of life at baseline, 10.5% had an episode of depression in the following year compared to 10.3% of religious participants and 7.0% of the secular group (p<0.001). However, the findings varied significantly across countries, with the difference being significant only in the U.K., where spiritual participants were nearly three times more likely to experience an episode of depression than the secular group [OR 2.73, 95% confidence interval (CI) 1.59–4.68]. The strength of belief also had an effect, with participants with strong belief having twice the risk of participants with weak belief. There was no evidence of religion acting as a buffer to prevent depression after a serious life event.

CONCLUSIONS

These results do not support the notion that religious and spiritual life views enhance psychological well-being.

Predicting onset of major depression in general practice attendees in Europe: extending the application of the predictD risk algorithm from 12 to 24 months

BACKGROUND

PredictD is a risk algorithm that was developed to predict risk of onset of major depression over 12 months in general practice attendees in Europe and validated in a similar population in Chile. It was the first risk algorithm to be developed in the field of mental disorders. Our objective was to extend predictD as an algorithm to detect people at risk of major depression over 24 months. Method Participants were 4190 adult attendees to general practices in the UK, Spain, Slovenia and Portugal, who were not depressed at baseline and were followed up for 24 months. The original predictD risk algorithm for onset of DSM-IV major depression had already been developed in data arising from the first 12 months of follow-up. In this analysis we fitted predictD to the longer period of follow-up, first by examining only the second year (12-24 months) and then the whole period of follow-up (0-24 months).

RESULTS

The instrument performed well for prediction of major depression from 12 to 24 months [c-index 0.728, 95% confidence interval (CI) 0.675-0.781], or over the whole 24 months (c-index 0.783, 95% CI 0.757-0.809).

CONCLUSIONS

The predictD risk algorithm for major depression is accurate over 24 months, extending it current use of prediction over 12 months. This strengthens its use in prevention efforts in general medical settings.