Depression Complaints Research Articles

Evaluation of emergency department visits for mental health complaints during the COVID-19 pandemic.

BackgroundThe COVID‐19 pandemic has resulted in over 6 million deaths worldwide as of March 2022. Adverse psychological effects on patients and the general public linked to the pandemic have been well documented.MethodsWe conducted a retrospective analysis of adult emergency department (ED) encounters with diagnoses of anxiety, depression, and suicidal ideation using International Classification of Diseases, Tenth Revision (ICD‐10) codes at a tertiary care hospital in New York City from March 15 through July 31, 2020 and compared it with ED encounters during the same time period in the previous 3 years (2017–2019). The relative risk (RR) of these diagnoses was calculated comparing a prepandemic sample to a pandemic sample, accounting for total volume of ED visits.ResultsA total of 2816 patient encounters met the inclusion criteria. The study period in 2020 had 31.5% lower overall ED volume seen during the same time period in the previous 3 years (27,874 vs average 40,716 ED encounters). The risk of presenting with anxiety during the study period in 2020 compared to prior 3 years was 1.40 (95% confidence interval [CI] 1.21–1.63), for depression was 1.47 (95% CI 1.28–1.69), and for suicidal ideation was 1.05 (95% CI 0.90–1.23). There was an increase in admissions for depression during the pandemic period (15.2% increase, 95% CI 4.6%–25.7%).ConclusionThere was a relative increase in patients presenting to the ED with complaints of anxiety and depression during the height of the COVID‐19 pandemic, while absolute numbers remained stable. Our results highlight the importance of acute care‐based mental health resources and interventions to support patients during this pandemic.

IMPLICATIONS OF CHILDHOOD TRAUMA ON SUICIDAL BEHAVIOR AND DELIBERATE SELF-HARM IN PATIENTS WITH MAJOR DEPRESSIVE DISORDER

Traumatic experiences in the first years of life have an important role in the occurrence of major depression as well as many psychiatric diseases. The aim of this study is to investigate the relationship between childhood trauma (CT), suicidal behavior and deliberate self-harm (DSH) behavior in patients who are diagnosed with major depressive disorder (MDD). 106 patients who were admitted with depressive complaints to the psychiatry outpatient clinic of Recep Tayyip Erdogan University Training and Research Hospital in Turkey were included in the study. Sociodemographic and clinical features data form, Hamilton Depression Rating Scale (HAD-D), Childhood Trauma Questionnaire (CTQ-28) and Intentional Self-harm Questionnaire (DSHI) were applied to all of the cases. 86 (81.1%) of the cases were female and 20 (18.9%) were male. It was determined that 68.9% of the patients had CT, 49.1% had a history of DSH, and 52.1% had a suicide attempt history. It was determined that 75% of those with DSH behavior had a history of suicide attempt. There was a significant difference between the groups (p˂0.001). When the subtypes of CT, suicide ideation, suicide attempt and DSH behavior, were compared to each other, a significant relationship was found for all of the subtypes. A significant correlation was found between the number of CT and suicide attempts and DSH (p˂0.001). In this study, high levels of CT and its subtypes were found in patients with MDD. In the presence of CT and all of its subtypes, suicide attempt and DSH were significantly higher. In the follow-up of cases diagnosed with MDD, questioning CT is important in terms of suicide attempt and prevention of DSH.

¿La mentalización, moderador de la soledad y de los síntomas internalizantes durante el confinamiento por el COVID-19? - Parte 1: Estudio cuantitativo

INTRODUCTION: Mentalization can be an important tool to tackle the effects on mental health due to COVID-19 lockdown measures. OBJECTIVES: The main objective of this study was to evaluate mentalization, loneliness, internalizing problems and subjective experience during COVID-19 quarantine. Specific objectives included the study of a) temporal evolution of mentalization, loneliness and internalizing symptoms b) effects of loneliness and mentalization on anxiety/depression and somatic complaints and c) moderation effects of mentalization on loneliness. METHODOLOGY: This was part of a three-phase, cross sectional, longitudinal qualitative/quantitative design study, with an intentional, non-probabilistic sample. MentS, Three-Item-loneliness Scale and Adult self-report were used to measure mentalization, loneliness, internalizing symptoms and somatic complaints, respectively. RESULTS: Feelings of loneliness, anxiety/depressive symptoms and somatic complaints increased over time. Significant variations of loneliness on depression, anxiety and somatic complaints were observed, and it’s higher level was linked with higher presence of symptoms. Mentalization experienced no significant change, and a higher level of it was associated with lower symptomatology and marginally significant moderation effects over loneliness. DISCUSSION AND LIMITATIONS: A mentalization based intervention should be proposed to mitigate the effects of loneliness on internalizing symptoms. The sample was not representative of the population.

Total Gynecomastia Removal with Layered Closure: A Study of 567 Cases.

Background:Conventional teaching dictates subtotal removal of gynecomastia tissue to ensure a cosmetically acceptable result. Modern-day concerns regarding gynecomastia treatment include continued “puffy nipples,” possible recurrence, and compromised aesthetic results resulting from incomplete tissue removal. The author practiced complete tissue removal with a layered closure technique to optimize the cosmetic result while addressing treatment complications.Methods:A single surgeon treated 567 patients using a standard four-step approach with complete tissue removal. A retrospective chart review was performed to assess complications and reason for surgical revision.Results:All revision procedures were for postoperative scar tissue accumulation. No revisions for complaints of contour depression, recurrence, or continued puffy nipples were noted. No necrosis of the nipple-areola complex or skin was noted.Conclusions:Complete removal of gynecomastia tissue was not only possible but also essential to achieve optimal cosmetic results. The layered closure technique is a useful adjunctive treatment after gynecomastia total tissue removal.

These Are Not the Droids You Are Looking For: Mechanical Variant of Cotard’s Syndrome

Cotard's syndrome is a nihilistic delusion where the individual believes they are dead, partly dead, or replaced by an animal. The delusion that their body has been replaced by a purely inanimate azooic (but physical entity), such as a robot or a droid, has not hitherto been described. Case study: This 60-year-old, right-handed, female, with a past history of schizophrenia presented with complaints of depression, irritability, and anger. When confronted with commitment papers signed by her father, she denied their truthfulness, insisting that he had been replaced by an imposter. This belief persisted unabated, despite treatment with 20mg of haloperidol per day. Over time, she expressed the belief that she had been replaced by another person, whom she refused to identify. The following day she refused all food and water proclaiming that she had died and been replaced by a machine revealing, "I am not her. I am a robot." Soon thereafter she developed tremulousness, stiffness, and rigidity. After haloperidol was decreased and benztropine started, these parkinsonism symptoms subsided, but her delusions persisted. Abnormalities in physical examination: General: decreased blink frequency. Neurologic examination: Mental status examination: bradyphrenia, hypoverbal, blunted affect. Oriented ×2. Motor examination: bradykinetic, cogwheel rigidity in both upper extremities. Gait examination: slow shuffling gait, reduced bilateral arm swing. Cerebellar examination: resting tremor in both upper extremities at 3 cycles per second. Other: EEG: focal sharp transients in the left temporal region. MRI with and without contrast: normal. Toxicological, metabolic, endocrine screening: normal. This illustrated sequential presentations of three delusions of misidentification. Upon presentation, she exhibited Capgras syndrome, the delusional belief that a familiar person has been replaced by a double. The nidus for this may have been the discovery that her father had signed her commitment papers. This was followed by the belief she was a double of herself, which is the syndrome of Reverse Subjective Doubles. Finally, she manifested Cotard's syndrome in a previously undescribed manner, believing she had died and become a robot. Cotard's and Capgras syndromes are known to present sequentially rather than concurrently, whereas the patient presented concurrently with all three syndromes. Drug-induced parkinsonism may have made the patient subjectively feel stiff, which she interpreted as being rigid like a robot. She was bradykinetic, did not eat or drink, and had rigidity, suggesting that these were somatic manifestations of her underlying delusion of being a robot or alternatively, may have been the somatic nidus for the delusion. Those who present with Cotard's syndrome warrant evaluation for underlying medical conditions, serving as a substrate for this delusion. No funding.

Emotional factors that mediate the relationship between emotional intelligence and psychological problems in emerging adults

In the last decades, the rates of depression and anxiety in emerging adults have increased compared to other age groups. The aim of the study was to examine the relationship between emotional intelligence and psychological problems, considering the mediating role of emotional factors such as empathy, self-esteem, and happiness. The participants were 399 young adults (M= 20.38, SD= 2.46, 76.9% women) who completed an assessment dossier that included measures of emotional intelligence, empathy, self-esteem, happiness, emotional symptoms, and somatic complaints. A cross-sectional design with self-report data was used and structural equation modeling (SEM) with mediation analysis was performed. Emotional intelligence was positively associated with happiness, empathy, and self-esteem, and negatively with anxiety, depression, stress, and somatic complaints. Happiness was the most relevant mediator in the relationship between emotional intelligence and emotional symptoms. These results stress the need to promote the development of emotional abilities in emerging adults, which fosters happiness and good mental health.

Assessing Social Cognition in Older Adults: A Population-Based Study

<h3>Introduction</h3> Social cognition is the cognitive domain that processes social information, the means by which we make sense of ourselves in relation to others and our environments. Impaired social cognition is associated with functional dependence on others and can have dire social consequences leading to social isolation, increasing the risk for morbidity and mortality. Social cognition is be impaired in neurodegenerative disorders including Alzheimer's disease (AD). The most recent edition of the American Psychiatric Association's Diagnostic and Statistical Manual for Mental Disorders (DSM-5) include social cognition as one of six core domains of neurocognitive function, alongside memory, executive control, complex attention, language, and visuospatial/perceptuomotor function, that can be impaired in the neurocognitive disorders. We have previously reported population-based norms from older adults on two social cognition measures, the Social Norms Questionnaire [SNQ-22], assessing social perception, and the 10-question version of the Reading the Mind in the Eyes Test [RMET-10], measuring Theory of Mind (ToM). Here, we report on the utility of a social cognition composite measure comprising the SNQ-22 and the RMET-10. <h3>Methods</h3> Participants are 902 adults from a population-based cohort in Pennsylvania. The mean age is 76.6 years (SD 8.06). We created a social cognition composite comprising standardized z-scores on the Social Norms Questionnaire and the 10-item Reading the Mind in the Eyes Test. We described its distribution in the population-based sample of older adults, its association with demographic factors, other cognitive and behavioral measures, the Clinical Dementia Rating (CDR®). We compared sensitivity, specificity, and the area under the curve of social cognition to those of other cognitive domains for mild cognitive impairment (MCI). We calculated the impact of including social cognition as a sixth cognitive domain on the estimated prevalence of (cohort proportion classified as) neuropsychologically defined MCI. <h3>Results</h3> Better social cognition was associated with younger age, female sex, higher education, better general cognition (MMSE), fewer depressive symptoms, and lower Clinical Dementia Rating (CDR). Adjusting for demographics, associations with higher MMSE and fewer depressive symptoms, anxiety symptoms, and subjective cognitive complaints remained significant. The sensitivity and specificity of social cognition for CDR = 0.5 were comparable to those of the traditional five cognitive domains. Including social cognition as the sixth domain of cognition resulted in a 5% increase in the estimated prevalence of MCI. <h3>Conclusions</h3> Better social cognition was associated with younger age, female sex, higher education, better general cognition (MMSE), fewer depressive symptoms, and lower Clinical Dementia Rating (CDR). Adjusting for demographics, associations with higher MMSE and fewer depressive symptoms, anxiety symptoms, and subjective cognitive complaints remained significant. We found that social cognition had sensitivity, specificity for CDR that was comparable to those of the five conventional cognitive domains of attention, executive functions, language, memory, and visuospatial function. The AUC values in the 0.6 – 0.7 range, which were comparable to the reported values in the literature. Considering neuropsychologically defined MCI, the inclusion of social cognition as the sixth domain of cognition resulted in about 5% of the sample becoming newly classified as MCI. These individuals differed from those already classified as MCI only in having higher MMSE scores; but they differed from those still classified as normal in having more anxiety symptoms, lower reading levels, and impairment in the CDR domain of home and hobbies. It appears a worthwhile consideration for standard cognitive assessments in older adults to routinely include brief objective assessments of the social cognition domain. <h3>This research was funded by</h3> The word reported here was supported in part by research grant # R37AG023657 from the National Institute on Aging, National Institutes of Health, US Department of Health and Human Services.

Persistent, new-onset symptoms and mental health complaints in Long COVID in a Brazilian cohort of non-hospitalized patients

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections lead to acute- and chronic Long COVID (LC) symptoms. However, few studies have addressed LC sequelae on brain functions. This study was aimed to examine if acute symptoms of coronavirus disease 2019 (COVID-19) would persist during LC, and if memory problems would be correlated with sleep, depressive mood, or anxious complaints.MethodsOur work followed a cohort of 236 patients from two public hospitals of the Federal District in mid-western Brazil. Patients’ interviews checked for clinical symptoms during acute and LC (5–8 months after real-time reverse transcription polymerase chain reaction, RT-qPCR).ResultsMost cases were non-hospitalized individuals (86.3%) with a median age of 41.2 years. While myalgia (50%), hyposmia (48.3%), and dysgeusia (45.8%) were prevalent symptoms in acute phase, fatigue (21.6%) followed by headache (19.1%) and myalgia (16.1%) commonly occurred during LC. In LC, 39.8% of individuals reported memory complaints, 36.9% felt anxious, 44.9% felt depressed, and 45.8% had sleep problems. Furthermore, memory complaints were associated with sleep problems (adjusted OR 3.206; 95% CI 1.723–6.030) and depressive feelings (adjusted OR 3.981; 95% CI 2.068–7.815).ConclusionsThe SARS-CoV-2 infection leads to persistent symptoms during LC, in which memory problems may be associated with sleep and depressive complaints.

A pilot study adapting and validating the Harvard Trauma Questionnaire (HTQ) and PTSD checklist-5 (PCL-5) with Indian women from slums reporting gender-based violence

BackgroundDespite high rates of gender-based violence (GBV) in India, culturally sensitive measures that examine universal and culturally relevant trauma reactions are lacking. Although the Harvard Trauma Questionnaire (HTQ) has been used in India, no study has adapted the measure in full for use with this population. Similarly, the PTSD checklist-5 (PCL-5) has not yet been validated in India. This study describes the adaptation, validation, and results from the adapted HTQ, and embedded PCL-5, for Indian women from slums reporting GBV.MethodThis study used the adaptation framework proposed by the HTQ measure developers. The adapted HTQ contained a (1) trauma screen relevant for stressors faced by Indian women from slums, (2) description of the index trauma, (3) description of any ongoing stressors, (4) universal trauma reactions (i.e., PTSD measured by the PCL-5), and culturally relevant trauma reactions (i.e., idioms of distress measured by a scale developed for the study). This measure was piloted on 111 women from Indian slums in face-to-face interviews. Trauma characteristics, types of ongoing stressors, and psychometric properties of the PCL-5 and idioms of distress scale were explored. These scales were validated against measures of depression (PHQ-9), anxiety (GAD-7), and somatic complaints (PHQ-15).ResultsThe majority of participants (77%) reported physical beatings, 18% reported unwanted sexual touch, and 28.8% reported infidelity as the primary emotional abuse. Further, 96.7% of GBV was perpetrated by partner or family member and over half reported ongoing stressors (e.g., poverty-related strain). The PCL-5 embedded in the HTQ yielded good internal consistency (Cronbach’s alpha = .88) as did the idioms of distress scale with deletion of one item (Cronbach’s alpha = .80). Both scales were externally valid, yielding large correlations with depression, anxiety, and somatic complaints (rs between .54 and .80, ps < .05).DiscussionThis is the first study to develop a comprehensive measure of trauma exposure with universal and culturally relevant trauma reactions in India. This study also enhances HTQ usage in India by delineating all the steps in the adaptation process. Results can inform the development of trauma-focused interventions for Indian women from slums.

Prevalence Rates and Evolution of Psychiatric Disorders Among Incarcerated Youths in Comparison With Non-incarcerated Youths.

Background: Our main objective was to provide estimates of the prevalence rates of psychiatric disorders and comorbidities among youths in a juvenile detention center in Geneva, Switzerland. We also aimed to investigate potential positive effects of intensive psychotherapeutic and educational services this center provides. Finally, we examined psychiatric care prior to and after custody as well as the evolution of the youths' mental health during detention.Methods: We conducted a longitudinal study including a group of incarcerated (n = 86) and a group of non-incarcerated (n = 169) youths (12–18 years old). Measures included diagnoses of psychiatric disorders, cognitive functions, trauma, psychopathic traits and the Youth Self-Report (aggressive behavior, attentional disorders, criminal behavior, social withdrawal, anxiety, depression and somatic complaints) collected at baseline and at discharge for the incarcerated group. Data were analyzed using mixed-effect models.Results: Psychiatric disorders were prevalent in the incarcerated group (82.6, 95% CI: 71.6–90.7%), but young people also often suffered from several disorders simultaneously. Two-thirds of the incarcerated participants had a diagnosis of two or more psychiatric disorders. Regarding health care, most incarcerated participants (79.1%) had psychiatric care prior to detention. The planned care after detention was associated with psychiatric comorbidities, care being more likely planned for those with comorbidities (p = 0.030). Compared to the non-incarcerated group, the incarcerated group had lower scores on cognitive functioning (p < 0.001) and higher scores on trauma (p < 0.021) and psychopathic traits (p < 0.034). The youths' stay in the detention center was associated with a positive change of mental health, with externalized problems being significantly reduced at the end of their stay (p = 0.017).Conclusion: Our findings showed that youths in conflict with the law are characterized by (1) their internal vulnerabilities: a high prevalence of psychiatric disorders and psychiatric comorbidities, lower cognitive functions, externalized problems and psychopathic traits; (2) environmental factors: victims of violence and sexual abuse; and (3) their psychiatric history. Besides, the evolution of the most prevalent issues was favorable over time, which puts into question the usual perspective about the deleterious effect of detention.

The "disease of the crazy hatman" and the effects of human exposure to mercury: A case report / A "doença do homem do chapéu maluco" e os efeitos da exposição humana ao mercúrio: Um relato de caso

INTRODUCTION: Mercury, in addition to being a heavy metal, is considered a neurotoxin, that is, a substance capable of negatively affecting the neurological functions of the human body. Nowadays, ““Mad Hatter's Disease”” is the name used to characterize these neurological disorders caused by mercury. PURPOSE: to report a clinical case of the manifestation of “Mad Hatter's Disease”, as well as to discuss about the effects of human exposure to mercury. METHODOLOGY: this is a clinical case report, in which the patient is essential. CASE REPORT: A 45-year-old male patient, gold miner, from a riverside community in the Amazon, was referred to the hospital with complaints of headache, extremities tremor, diarrhea, tiredness, discouragement, irritability, depression, unusual shyness and hallucinations. On physical examination, the patient was anxious, irritable, symmetrical small-amplitude tremors in the extremities, hyperreflexia ++/4+ in the upper limbs, +/4+ in the lower limbs, normal muscle strength, mild ataxia of the right hand, stained skin and mucous membranes, and acyanotic, with erythematous-scaly lesions, confluent on the trunk, palms and soles of the feet. Screening for mercury poisoning was performed, where it was found, both in blood and urine, the presence of mercury 20 times above the biological tolerance limit. A battery of specific neuropsychological tests was carried out in neurotoxicological assessments and these demonstrated impairment of the cognitive domains (deficit of memory, attention, concentration, reasoning and abstraction) and alterations in motor functions, showing reduced coordination and motor speed. The diagnosis of hydrargyrism or occupational chronic metallic mercuralism (MMCO) was given. DISCUSSION: Chronic occupational exposure to inorganic mercury can cause subclinical abnormalities, as well as long-term psychomotor and neuromuscular behavioral impairment. Neuropsychiatric abnormalities (inattention, memory, interpretation, and motor performance) appear to be dose-related. FINAL CONSIDERATIONS: chronic exposure to metallic mercury vapor characteristically compromises the nervous system, initially with nonspecific symptoms and, later, with characteristic motor disorders - small amplitude tremor, paresis, dysreflexia and difficulty in motor coordination, which gives rise to the "Disease of the Mad Hatter”, and inhaling large amounts of mercury vapor can be lethal.

Leidraad voor de screening en detectie van perinatale depressieve en angststoornissen tijdens de zwangerschap tot 1 jaar na de bevalling

A protocol for the screening, detection and treatment of perinatal anxiety and depressive disorders Importance. With a prevalence of 20%, mental health problems are considered as one of the most frequent complications during pregnancy and the postnatal period. Despite their high prevalence, these mental health problems often remain underdiagnosed and undertreated. Objective. The protocol aims to offer perinatal health care workers (health care and mental health care workers) a framework helping them to detect and discuss depressive and anxiety complaints of women during the perinatal period (up to 1 year after childbirth) and to refer them for treatment. Evidence acquisition. The protocol, which was based on international guidelines and recent scientific evidence, was developed by an interdisciplinary task force taking into account concerns about its daily practicability and current perinatal health care. Results. The protocol guides staff through a psychosocial assessment, a stepped screening, a clinical assessment and treatment steps. It is currently being implemented throughout Flanders (Belgium) with support of the Flemish Ministry of Welfare, Public Health and Family. Conclusion. Integrating mental health screening and treatment in standard perinatal care will improve the mental health care for women, their partners and their offspring.

Higher Residence Attachment and Religiosity Are Associated With Less Depressive Symptoms After Terror Event Exposure

Introduction: We examined how community type, residence attachment, and religiosity contribute to resilience to depressive symptoms, psychosomatic complaints, residential stress, and avoidance behavior among students exposed to terror.Methods: Undergraduate students from Ariel University (N = 1,413; 62.7% females; Mage = 26.5; SD = 6.03) completed a self-report questionnaire on socio-demographics, terror exposure, place attachment, and depressive/psychosomatic symptoms. Participants were divided into three residential groups: “Ariel,” “Small settlement communities in Judea and Samaria” or “Other places in Israel.”Results: Participants from small settlement communities in Judea and Samaria showed significantly fewer depressive symptoms and greater adjustment– less avoidance, psychosomatic symptoms, and residential stress– compared to those living in Ariel or other places in Israel, despite significantly higher exposure to terror.Conclusion: Greater religiosity and residence attachment may protect against depressive symptom development following terror exposure. Secular, temporary residents living in highly terror-exposed areas should be targeted for community strengthening interventions.

Haptotherapy and crying: an exploratory study

Background This study’s main aim was to understand better why patients cry during a haptotherapy treatment and whether crying is considered helpful. Method During a period of 4 weeks, Dutch haptotherapists asked all their patients aged 18 and older to complete a digital questionnaire at home after the end of the haptotherapy treatment. Patients were asked about their indication for haptotherapy, and they answered six questions about crying during therapy on a 5-point Likert scale (1-5). In addition, the participating haptotherapists were asked (1) whether they ever had tears in their eyes during therapy, (2) whether they had ever actually cried during therapy, and (3) whether they considered the patient’s crying as helpful for the therapeutic process. Results Seventy-two participating haptotherapists recruited 640 participants, 500 women and 140 men. The respondents’ average age was 46 years. The six most common indications (n &gt; 30) were burnout complaints, stress complaints, personality development, depressive complaints, anxiety complaints, and comorbidity. During the haptotherapy treatments, 80.9 % (n = 518) of the patients reportedly had cried during therapy. Women cried significantly more often than men (t(638) = 7,922, p = .017). Crying during treatment did not differ between patient groups (F(5, 436) = .317, p = .903). Of the patients, 26.1 % (n = 167) indicated that they cried to let others know they were suffering, and 88.1 % (n = 564) because their crying had a relieving effect. The patient’s crying was perceived as meaningful by most patients (98.6 % (n = 631)) and therapists (62.5 % (n = 45)). As many as 43.1 % of the participating patients reported changes in general crying, with 27.3 % reporting an increase in their crying and 15.8 % a reduction. Conclusion Patient crying occurs relatively often during haptotherapy, as it does during other therapies. Most patients consider this as meaningful. The different patient diagnoses, the different educational backgrounds of the haptotherapists, and the sociodemographic differences did not influence patient crying. To further understand the effective mechanisms of haptotherapy, it is recommended to investigate why some patients cry more after haptotherapy and others cry less and how they experience their change in crying frequency.

Incidence of Anxiety in Latest Life and Risk Factors. Results of the AgeCoDe/AgeQualiDe Study.

Research on anxiety in oldest-old individuals is scarce. Specifically, incidence studies based on large community samples are lacking. The objective of this study is to assess age- and gender-specific incidence rates in a large sample of oldest-old individuals and to identify potential risk factors. The study included data from N = 702 adults aged 81 to 97 years. Anxiety symptoms were identified using the short form of the Geriatric Anxiety Inventory (GAI-SF). Associations of potential risk factors with anxiety incidence were analyzed using Cox proportional hazard models. Out of the N = 702 older adults, N = 77 individuals developed anxiety symptoms during the follow-up period. The incidence rate was 51.3 (95% CI: 41.2–64.1) per 1000 person-years in the overall sample, compared to 58.5 (95% CI: 43.2–72.4) in women and 37.3 (95% CI: 23.6–58.3) in men. Multivariable analysis showed an association of subjective memory complaints (HR: 2.03, 95% CI: 1.16–3.57) and depressive symptoms (HR: 3.20, 95% CI: 1.46–7.01) with incident anxiety in the follow-up. Incident anxiety is highly common in late life. Depressive symptoms and subjective memory complaints are major risk factors of new episodes. Incident anxiety appears to be a response to subjective memory complaints independent of depressive symptoms.

Examining differences across sleep profiles in late middle‐aged adults: Results from the Wisconsin Registry for Alzheimer's Prevention (WRAP)

AbstractBackgroundPrevious studies suggest associations between self‐reported poor sleep and relevant health markers and AD‐related outcomes including cognition and AD pathology. It is important to understand how sleep, a modifiable risk factor, may be related to cognition and other measures of aging in late midlife when AD pathology may be accruing. The study objectives included examining whether sleep profiles were associated with concurrent health and cognition, and positron emission tomography (PET) measures of amyloid.MethodsDementia‐free participants from the Wisconsin Registry for Alzheimer’s Prevention (WRAP) who had completed sleep questionnaires were eligible (n=619); questionnaires included the Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and Medical Outcomes Study Sleep Scale (MOS). K‐means clustering analysis identified three clusters. We compared concurrent health markers (e.g., depression and insulin resistance) and cognitive composite scores across the sleep profile clusters. In the subset with Pittsburgh Compound B (PiB; n=107) PET imaging, we also compared amyloid measures (estimated global PiB distribution volume ratio (DVR), PiB chronicity, and PiB(+) (DVR&gt;=1.2) at sleep assessment. Significant omnibus tests (p&lt;.05) were followed with pairwise comparisons.ResultsMean(sd) sample baseline age was 62.6(6.7). Cluster analysis identified 3 groups: Healthy Sleepers (HS, n=262(42.3%)), Intermediate Sleepers (IS, n=229(37.0%)), and Poor Sleepers (PS, n=128(20.7%); Fig. 1, Fig. 2, Table 1). All omnibus tests comparing demographics and health measures across sleep groups were significant except age, gender, and APOE e4 carriers; the PS group was worse than HS and/or IS on all other measures, including self‐reported depression, health, and memory complaints (Table 2). PS performed worse than HS and/or IS on measured body mass index, waist‐hip ratio and insulin resistance (Fig. 3a); and after adjusting for covariates, PS performed worse on all cognitive outcomes except working memory (Fig. 4). There were no differences between sleep groups on measures of amyloid (Fig. 3b).ConclusionSleep profiles were associated with differences in additional modifiable risk factors and concurrent cognition, but not amyloid. Further analysis was needed in the association between the sleep constructs and amyloid clearance/accumulation. Management of sleep and related factors may provide an opportunity for early intervention that could ultimately delay or prevent clinical impairment.

How can the utilisation of help for mental disorders be improved? A quasi-experimental online study on the changeability of stigmatising attitudes and intermediate variables in the process of utilisation

BackgroundEpidemiological studies show that even in highly developed countries many people with depression do not seek help for their mental health issues, despite promising prevention approaches encouraging people to seek help and reduce self-stigma. Therefore, an anti-stigma intervention study to support help-seeking behaviour will be developed on the basis of the newly explicated “Seeking Mental Health Care Model”.MethodsA quasi-experimental online study will be carried out to assess the effect of different intervention variables relevant for the help-seeking process. The study is conceived as a fractional factorial design. Participants will be screened for depressive complaints (PHQ-9 sum score ≥ 8) and current psychiatric/psychotherapeutic treatment. After baseline assessment the participants will be randomly allocated into one of the 24 study groups receiving different combinations of the vignette-based intervention aiming to reduce stigma and support help-seeking. Next, relevant outcome measures will be administered a second time. In a 3- and 6-month follow-up help-seeking behaviour will be measured. Gamified elements and avatar-choice techniques will be used to heighten study immersion and adherence.DiscussionOn the basis of the project results, promising research and intervention perspectives can be developed. Results, firstly, allow for a more detailed empirical investigation and conceptualisation of the stages of mental health care utilisation, as well as an examination of theoretical approaches to stigmatisation. Secondly, our online study could provide insights for an evidence-based design and evaluation of online interventions for people with a mental illness.Trial registrationGerman Clinical Trials Register: DRKS00023557. Registered 11 December 2020. World Health Organization, Universal Trial Number: U1111–1264-9954. Registered 16 February 2021.

Daily lives of university students in the health area during the beginning of the Covid-19 pandemic in Brazil.

Objective:To determine the main changes that took place in the daily lives of students in the health area during the beginning of the Covid-19 pandemic in Brazil.Method:This is a cross-sectional study, carried out from May to June 2020, with 1786 students over 18 years old, regularly enrolled in health courses at higher education institutions in five regions of Brazil. Sampling was by convenience, typified as snowball. In order to collect data, an instrument to describe the sociodemographic profile and the daily lives of students during the pandemic period was used, which was applied via a digital platform on the web.Results:The main changes that took place in the daily lives of academic students in the health area in the face of the Covid-19 pandemic in Brazil are related to lower productivity; difficulty concentrating; increased hours of sleep, use of electro-electronic equipment and weight; poorer quality of food; higher consumption of food, legal and illegal substances and medications (mainly analgesics, anxiolytics and antidepressants); less interest in personal appearance; and greater contact with relatives. Regarding emotional changes, it should be underlined the complaints of anxiety, stress, anguish, confusion, helplessness and depression.Conclusion:During the beginning of the Covid-19 pandemic in Brazil, the students in the health area experienced several changes in their daily lives, which deserve special attention from higher education institutions and health systems, envisioning interventions to minimize health risks to this population.

Improved emotion regulation in depression following cognitive remediation: A randomized controlled trial

ObjectiveExecutive functions (EFs) play a key role in emotion regulation and, related to this, depression. Cognitive remediation (CR) targeting EFs, such as Goal Management Training (GMT) and computerized cognitive training (CCT), may reduce maladaptive emotion regulation. However, the clinical potential of GMT in the context of depression and emotion regulation remains to be tested. Hence, the primary aim of the present study was to compare effects of GMT with CCT on symptoms of emotion dysregulation. MethodThe paper reports the effects of a preregistered randomized controlled trial. Sixty-three participants (18–60yrs) with active or remitted depression and EF complaints were randomized to nine sessions of GMT (n = 35) or CCT (n = 28). All were assessed at baseline, post-intervention, and at 6-month follow-up. The Ruminative Response Scale and the Difficulties in Emotion Regulation Scale were employed to assess emotion regulation. ResultsBoth groups improved following the intervention on emotion regulation domains after controlling for intention-to-treat, including brooding rumination and on items reflecting non-accepting reactions to distress. Relative to CCT, the GMT-group demonstrated increased clarity of emotional responses in the per protocol analysis. ConclusionsOur findings demonstrate the potential of GMT and CCT in reducing maladaptive emotion regulation in depression.

A Way to Increase the Sensitivity and Specificity of the Hamilton Depression and Anxiety Scales.

The Hamilton Depression Rating Scale (HDRS-17) and the Hamilton Anxiety Rating Scale (HARS-14) have been acknowledged as gold standards in evaluating the severity of depression and anxiety. The specificity and sensitivity of these scales in predicting somatic complaints of depression and anxiety are issues in both clinical and research areas. The present study proposes a new model to enhance the sensitivity and specificity of HDRS-17 and HARS-14 for predicting symptoms of insomnia, inappetence, and loss of libido in psychiatric patients. This study included 1507 patients diagnosed withbipolar disorder, depression, panic disorder, obsessive-compulsive disorder, and generalized anxiety disorder. The HDRS-17 and the HARS-14 were utilized as predictive scales for the prediction of patients' sleep, appetite, and libido. The sensitivity and specificity were computed using the receiver operating characteristic (ROC). Logistic regression was performed to enhance the predictive values. The predictive value of the logistic regression model was not satisfactory, and a conversion table was therefore designed for each symptom-diagnosis subgroup. The new joint ROC model was then used to recalculate the sensitivity and specificity of the 2 scales for each symptom-diagnosis subgroup. The outcome is a prediction table, presented for use by clinicians. It was observed that the new statistical model, the joint ROC, increased the sensitivity and specificity of the HDRS-17 and the HARS-14. : Based on the results of the evaluations with the HDRS and the HARS, the joint ROC method was developed to better predict the presence of symptoms.