Depression Distress Research Articles

Traumatic Distress of COVID-19 and Depression in the General Population: Exploring the Role of Resilience, Anxiety, and Hope.

International evidence published so far shows that the COVID-19 pandemic has negatively impacted on global mental health. Specifically, there is some research suggesting that the psychological distress related to depression, anxiety and posttraumatic stress has impacted on the psychological well-being of the general population. Yet, there is limited evidence on the relational paths between COVID-19 traumatic distress and depression. Participants of this cross-sectional study were 456 adults 18 years old or older from the general population (Mean age = 41.2 years, SD = 11.7) who completed an online questionnaire including measures assessing depression, anxiety, resilience, hope and traumatic distress related to COVID-19. Structural equation modelling was applied to examine the proposed mediation model. The results confirmed the proposed model, with traumatic distress of COVID-19, resilience, anxiety and hope explaining a considerable amount of variance (59%) in depression scores. Traumatic distress of COVID-19 was a strong positive predictor of depression, while anxiety, hope and resilience were both joint and unique mediators of this relationship. Exposure to the COVID-19 pandemic is strongly associated with depression in adults of the general population. The co-occurrence of anxiety may negatively contribute to experiencing higher levels of depression, while resilience and hope may act as buffers against depression associated with the impact of this pandemic. Our findings suggest that wide community-based interventions designed to promote resilience, build hope and reduce anxiety may help mitigate depression associated with exposure to the COVID-19 pandemic.

P–489 Stress scale and coping strategies adopted by Brazilian ART patients during COVID–19 outbreak: attention need for young, women, first IVF attempt and compromised income patients

Study questionWhat are the stress scale and coping strategies of patients who were unable to start/continue an IVF cycle due to COVID–19 interruption on ART treatments?Summary answerStress scale was associated to specific coping strategies and was higher for women, patients in first IVF treatment, had compromised income and younger than 38yo.What is known alreadyIn March 2020, due to the COVID–19 outbreak caused by the SARS-CoV–2 virus, human reproduction societies, have recommended discontinuation of reproductive care, except for the most urgent cases. After few months, the treatments were resumed following proper safety guidelines. Infertility diagnostic and treatments are severe stressors, causing anxiety, depression and general emotional distress. The disruption of treatments and the pandemic uncertain scenario in all life aspects, certainly have a great impact on mental health of ART patients. There is an urge need to assess the level of stress and coping strategies in this population to offer suitable support and care.Study design, size, durationProspective, Brazilian multicentric study (6 clinics of ART located in São Paulo, Campinas, Belo Horizonte and Brasilia), with the application of an anonymous online survey of stress scale and 14 coping strategies to 1500 patients (male and female) that had their treatments interrupted or unable to start during the months of March, April and May 2020. The online survey was sent during the months of August/September and responses were collected until early October/2020.Participants/materials, setting, methodsThe stress scale level was assessed using the Perceived Stress Scale protocol (PSS), and coping strategies using the Brief COPE scale protocol. Social-demographic variables (gender, age, city of residence, marital status, time of infertility, previous IVF treatments and financial impact) were included in the survey. Marginal statistical analyses were performed accordingly (t test, Mann-Whitney, Kruskal-Wallis, chi-square test) and a linear regression model was carried out to calculate the effect of COPE strategies on stress scale.Main results and the role of chanceSurvey’s response rate was 44.4% (n = 666). The majority were women (83.3%), married (93.2%, mean of 9,41±4,76 years), deal with infertility for 2–5 years (51.5%), had done a previous IVF treatment (61.4%, mean of 2,33 treatments) and had a work activity (83.9%). Almost 40% had their income compromised by the pandemic. Mean age was 38.47±4.99 years (≥38 yo = 59%). Stress scale was higher for women (p < 0.0001), patients that were in their first IVF treatment (p = 0.011), had their income compromised (p = 0.001) and were younger than 38yo (p < 0.0001). The most frequent coping strategies (score 5–8) were planning (87.7%), active coping (83%), positive reframing (72.1%) and religion (71.7%). Women used more emotional support, religion, venting (all p < 0.0001) and self-distraction (p = 0.002) as coping strategies than men. Younger patients (<38yo) reported more use of substances (p = 0.002) and self-distraction (p = 0.001) than older patients. Lower income was associated with denial (p = 0.002) and less use of religion (p < 0.0001) and patients that were about to start their 1st treatment used more venting (p < 0.0001) and denial (p = 0.003) than recurrent patients. The linear regression analysis showed that higher stress was associated to planning, religion, self-blame, venting, self-distraction and behavioral disengagement and lower stress scale to active coping, emotional support, positive reframing and acceptance.Limitations, reasons for cautionThis study was performed in Brazil, one of the most affected countries by the COVID–19 outbreak, which may limit the generalizability of the findings. Another limitation was the impossibility to compare the stress scale and coping strategies findings in this population prior to the pandemic.Wider implications of the findings: Being a woman and have a compromised income were expected stressor factors. Surprisingly, first IVF attempt and younger patients showed higher stress scale and the use of psychological defense mechanisms, such as the use of substances, denial and self-distraction. Continuous emotional support should be offer for all ART patients.Trial registration numberNot applicable

P–298 High prevalence of depression and anxiety in patients with endometriosis during the SARS-CoV–2 pandemic in Germany

Study questionThe aim was to assess the prevalence of self-reported symptoms of depression and anxiety and the moderating factors influencing mental symptoms during the COVID–19 pandemic.Summary answerEndometriosis patients were at risk of developing mental disorders during the pandemic. Associated risk factors were: reduction of the social network and the employment status.What is known alreadyEndometriosis is a disease affecting up to 10% of women of fertile age. The leading symptoms are sub- or infertility and chronic pain. Additionally, the psychological impact on womeńs life is enormous. Women with endometriosis show higher rates of depression, anxiety and emotional distress, and these alterations in mental health were associated with the presence of pain rather than with the diagnosis of endometriosis. Additionally, a higher level of depression was observed in women with endometriosis.Study design, size, durationTo assess the impact of the government-imposed social distancing or quarantine on mental health, an online questionnaire was placed on internet platforms of endometriosis patients support groups between 6th and 27th April 2020. Data collection and analysis were performed anonymously. Recruitment was conducted via a direct link to the survey and an invitation to participate was distributed via the internet platforms of patients support groups.Participants/materials, setting, methods274 participants answered the Patient Health Questionnaire for Depression and Anxiety (PHQ–4), which screens for depression (PHQ–2), anxiety (GAD–2) and the level of psychological distress (PHQ–4). PHQ–2 and GAD–2 scores ≥ 3 are cut-off points between normal range and probable cases of mental disorders. A PHQ–4 score above 6 is indicative for severe symptoms. We used descriptive statistics to describe the study population. Correlates of depression and anxiety were identified using multivariate logistic regressions.Main results and the role of chanceWe showed that depression and anxiety were highly prevalent in endometriosis patients during the pandemic: 46.7% and 48.2% of participants showed scale scores of ≥ 3 on the PHQ–2 and GAD–2 scales, respectively.The mean PHQ–4 score was 5.72 (SD = 3.21), thus endometriosis patients were achieving significantly higher PHQ–4 sores (p < 0.001) than participants of a previously published study of the representative German population.Risk factors for higher probability of depressive disorders were the employment status (being employed, OR 2.890, p < 0.001), an important or severe reduction of the social network (OR 2.02, p < 0.05), having continuous pain (OR 1.83, p < 0.05) and high level of dysmenorrhea prior to the pandemic (OR 2.106, p < 0.05).Risk factors for higher probability of anxiety were the employment status (being employed, OR 2.697, p < 0.001), an important or severe reduction of the social network (OR 3.038, p < 0.01), and high level of dysmenorrhea prior to the pandemic (OR 1.750, p < 0.05).Endometriosis patients were at higher risk for developing mental health problems. The effective use of brief screening measures, such as PHQ–4, can be widely implemented even in the busy outpatient care of general practitioners and gynecologists and may help to reduce morbidity.Limitations, reasons for cautionWe used self-reports for assessment of anxiety and depression and those are susceptible to response bias, such as giving socially desirable responses. Moreover, as PHQ–4 is only a screening tool, the diagnosis must be confirmed in accordance to the appropriate DSM–V criteria.Wider implications of the findings: A better understanding of potential mental problems in endometriosis patients during stressful events, such as the COVID–19 pandemic or other comparable difficult environmental or social circumstances, is crucial for providing an optimal patient centered care in cases of upcoming stressful events.Trial registration numberNot applicable

P–501 Deep in the Maze: The psychosocial trajectory and decision making of Women with recurrent implantation failure of IVF

Abstract Study question To understand the psychosocial trajectory of Chinese women who have experienced recurrent implantation failure (RIF) of IVF and their decision making accordingly. Summary answer Chinese women experience despair, doubt, and disorientation along with the cumulative failure cycles of IVF, and stick to IVF as the ultimate option. What is known already Recurrent implantation failure, the absence of implantation after repeated embryo transfers is a stressful event for people undergoing treatment for infertility. Numerous researches have focused on the psychological wellness of women undertaking IVF, but pay less attention to the subgroup who have undergone repeated failures. Current studies have shown that women after repeated unsuccessful IVF might endure anxiety, depression, and other psychosocial distress; however, the feelings brought by the different times of failure are unlike, and these experiences will affect their treatment decisions accordingly, which is rarely studied. Study design, size, duration Semi-structured interview was adopted with sixteen Chinese women from March 2020 to July 2020. The interview lasted 90 minutes. A follow-up survey was conducted three months after the interview. Driven by grounded theory, data is analyzed by thematic analysis. Participants/materials, setting, methods Convenience sampling was used to recruit female participants who have failed to achieve clinical pregnancy after two consecutive cycles of fresh or frozen IVF embryo transfers with a cumulative number of transferred embryos of four or more cleavage-stage embryos or two or more blastocysts. Chinese-speaking women who were undertaking IVF treatment in the reproductive center of hospital in Shenzhen City were recruited by pamphlets and doctors’ referral. Main results and the role of chance Chinese women with recurrent implantation failures experience the following psychosocial trajectory during the cumulative failure cycles of IVF: despair, doubt, and disorientation. Despair usually comes after the first failure: the high expectation for success rates makes the initial failure exceptionally shocking and desperate. Huge distress brings two kinds of decisions: start a new IVF cycle quickly to welcome the positive results in the imagination, or wait for a period of time to avoid the pain of failure again. Doubt usually appears after the second failure. In addition to doubting the health function of their body, recurrent failure makes the patients particularly doubt the efficacy of IVF and doctors’ clinical judgment. Some patients would do ‘hospital shopping’ and consider change clinics. Disorientation can be seen in patients who have experienced more than three cycles of failure. Past experience and meaning cannot help them understand and solve the current dilemma. The inherent concept of fertility continues to strengthen their belief of having a baby as ultimate goal. The follow-up survey found that most women still choose to continue IVF treatment after repeated failure. They are like being in the maze of fertility, wandering for a long time but unable to get out. Limitations, reasons for caution Several limitations are identified: self-selection bias due to convenience sampling; narrow sampling approach may limits the generalizability; the exclusion of men may ignore the marital interdependence during the infertility treatment. Wider implications of the findings: Patients who have experienced recurrent implantation failure demand promising intervention during and after infertility treatment. The findings demonstrate the need for both supportive and implication counseling to facilitate them cope with the psychosocial distress, and make value-based decision making, so as to enhance their self-agency. Trial registration number Not applicable

Suicide attempt risks among hotline callers with and without the coronavirus disease 2019 related psychological distress: a case-control study

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic profoundly impacts on mental health, yet it is still unclear whether COVID-19 distress makes people more vulnerable to suicidal behavior. The present study aims to examine the association between COVID-19 related psychological distress and risk for suicide attempt, and moderators of this association, among hotline callers.MethodsThis case-control study was conducted at the largest psychological support hotline in China. Hotline callers who sought help for psychological distress and reported whether or not they attempted suicide in the last 2 weeks (recent suicide attempt) were analyzed. The primary predictor of recent suicide attempt was the presence or absence of COVID-19 related psychological distress. Demographic variables and common risk and protective factors for suicidal behavior were also studied. Callers with COVID-19 related distress (COVID-19 callers) and those without such distress (non-COVID-19 callers) were compared on these variables. Recent suicide attempt was regressed on COVID-19 related distress and the other variables, and significant interaction terms of aforementioned predictors by COVID-19 related distress, to identify variables that moderate the association of COVID-19 related distress and recent suicide attempt.ResultsAmong 7337 included callers, there were 1252 COVID-19 callers (17.1%) and 6085 non-COVID-19 callers (82.9%). The COVID-19 callers were less likely to report recent suicide attempt (n = 73, 5.8%) than the non-COVID-19 callers (n = 498, 8.2%, P = 0.005). The COVID-19 callers were also less likely to have high scores on depressive symptoms (22.6% vs 26.3%, P < 0.001) and psychological distress (19.5% vs 27.3%, P < 0.001), and were more likely to have high hopefulness scores (46.5% vs 38.0%, P < 0.001). Tests of moderating effects showed that acute life events were associated with one-half lower risk (P = 0.021), and a trend that suicide attempt history was associated with two-thirds greater risk (P = 0.063) for recent suicide attempt, among COVID-19 callers than non-COVID-19 callers.ConclusionsThe COVID-19 calls are from individuals with lower suicide-related risk compared to more typical callers. Acute stressful life events provided a key context for suicide attempt in non-COVID-19 callers, i.e., more typical calls.

Development of the COVID-19 Perinatal Perception Questionnaire (COVID19-PPQ)

The COVID-19 pandemic affects the mental health status of perinatal women, which makes it important to gain insight into and to effectively measure specific stressors of the COVID-19 pandemic. Therefore, we aimed to develop a COVID-19 Perinatal Perception Questionnaire (COVID19-PPQ). In-depth interviews were conducted during the first national lockdown period with pregnant women, new mothers and perinatal healthcare professionals, resulting in (a) a 27-item pregnancy and (b) a 21-item postpartum scale. Explorative factor analyses (EFA) in sample Ia (N = 154) and Ib (N = 90), and confirmatory factor analyses (CFA) in sample IIa (N = 113) and IIb (N = 81) were conducted to test the psychometric properties of both scales. For the pregnancy scale, EFA suggested a three-factor solution (risk of infection, contact, future), which was confirmed by CFA and resulted in a final nine-item scale. For the postpartum scale, a three-factor solution (first postpartum week, COVID-19 measures, fear for infection) was suggested by EFA and confirmed by CFA, resulting in a final ten-item scale. Symptoms of depression and pregnancy-specific distress were significantly correlated with the pregnancy (sub)scale(s), while symptoms of postpartum depression and anxiety showed significant correlations with the COVID-19 measures and fear for infection subscale. The COVID19-PPQ seems to be a valid instrument for assessment of perinatal COVID-19-related stress perception, showing adequate psychometric properties for both the pregnancy and postpartum scale. Future research should examine the use of this instrument in clinical practice during new episodes of the COVID-19 pandemic.

Extending the Male Depression Risk Scale for use with older men: the effect of age on factor structure and associations with psychological distress and history of depression

Objectives The Male Depression Risk Scale (MDRS-22) is a self-report scale that assesses externalising and male-typical depression symptoms with promising psychometric properties reported in young-to-middle aged men. However, studies are yet to consider the psychometric properties of the MDRS-22 in older men. This study examined the psychometric properties of the MDRS-22 in both younger and older males and its relationship to prototypic depression symptoms and self-reported depression history. Method A community sample of younger (n = 510; 18–64 years) and older (n = 439; 65–93 years) males completed the original 82 MDRS items from which the MDRS-22 was derived, the Patient Health Questionnaire (PHQ-9), and provided information regarding previous depression diagnoses. Exploratory and confirmatory factor analyses were used to examine factor structure. Generalised linear models examined the relationship between externalised and male-typical symptoms with prototypic depression symptoms in younger and older men. Results Model fit indices demonstrated that the MDRS-22 performs well in older males. Results also revealed that the MDRS-22 is associated with prototypic depression symptoms and a previous depression diagnosis in both age groups. Conclusion Results support the psychometric validity of the MDRS-22 as a measure of externalising and male-typical depression symptoms in older men. Use of scales such as the MDRS-22 may help to improve the detection of depression in men across the lifespan and may also identify factors that put men at risk of poor physical and mental health outcomes.

Factors to improve distress and fatigue in Cancer survivorship; further understanding through text analysis of interviews by machine learning

BackgroundFrom patient-reported surveys and individual interviews by health care providers, we attempted to identify the significant factors related to the improvement of distress and fatigue for cancer survivors by text analysis with machine learning techniques, as the secondary analysis using the single institute data from the Korean Cancer Survivorship Center Pilot Project.MethodsSurveys and in-depth interviews from 322 cancer survivors were analyzed to identify their needs and concerns. Among the keywords in the surveys, including EQ-VAS, distress, fatigue, pain, insomnia, anxiety, and depression, distress and fatigue were focused. The interview transcripts were analyzed via Korean-based text analysis with machine learning techniques, based on the keywords used in the survey. Words were generated as vectors and similarity scores were calculated by the distance related to the text’s keywords and frequency. The keywords and selected high-ranked ten words for each keyword based on the similarity were then taken to draw a network map.ResultsMost participants were otherwise healthy females younger than 50 years suffering breast cancer who completed treatment less than 6 months ago. As the 1-month follow-up survey’s results, the improved patients were 56.5 and 58.4% in distress and fatigue scores, respectively. For the improvement of distress, dyspepsia (p = 0.006) and initial scores of distress, fatigue, anxiety, and depression (p < 0.001, < 0.001, 0.043, and 0.013, respectively) were significantly related. For the improvement of fatigue, economic state (p = 0.021), needs for rehabilitation (p = 0.035), initial score of fatigue (p < 0.001), any intervention (p = 0.017), and participation in family care program (p = 0.022) were significant. For the text analysis, Stress and Fatigue were placed at the center of the keyword network map, and words were intricately connected. From the regression anlysis combined survey scores and the quantitative variables from the text analysis, participation in family care programs and mention of family-related words were associated with the fatigue improvement (p = 0.033).ConclusionCommon symptoms and practical issues were related to distress and fatigue in the survey. Through text analysis, however, we realized that the specific issues and their relationship such as family problem were more complicated. Although further research needs to explore the hidden problem in cancer patients, this study was meaningful to use personalized approach such as interviews.

550-P: Unique Associations of Depressive Symptoms and Diabetes Distress with Quality of Life (QoL) in Youth with Type 1 Diabetes (T1D)

Youth with T1D often experience emotional distress, which can negatively impact QoL. We sought to understand associations of depressive symptoms and diabetes distress with QoL in youth with T1D. Participants (N=420; 50% male; ages 8-17 years; T1D duration 6.4±3.7 (M±SD) years; A1c 8.3±1.0%; 69% pump treated; 70% having parent with college degree) completed the Pediatric Quality of Life Inventory Generic Core Scales (PedsQL)and measures of depressive symptoms (Center for Epidemiologic Studies Depression Scale [CESD]) and diabetes distress (Problem Areas in Diabetes-Pediatric version [PAID-Peds]). Multivariable linear modeling determined independent associations of depressive symptoms and diabetes distress with total, physical, and psychosocial QoL, adjusting for sex, age, T1D duration, A1c, pump therapy, insulin dose, and parent education. Total PedsQL score was 85±13, (physical subscale 89±12, psychosocial subscale 82±15); CESD score was 9±9; PAID-Peds score was 37±24. CESD and PAID-Peds were both correlated with A1c (CESD: p=.01, PAID-Peds: p&amp;lt;.0001); QoL scales were not correlated with A1c. CESD and PAID-Peds were correlated with total, physical and psychosocial QoL (all p&amp;lt;.0001). In multivariable analyses, more depressive symptoms were associated with poorer total (∆R2=.52, p&amp;lt;.0001), physical (∆R2=.35, p&amp;lt;.0001), and psychosocial (∆R2=.51, p&amp;lt;.0001) QoL, adjusting for diabetes distress and sociodemographic/diabetes factors. More diabetes distress was associated with poorer total (∆R2=.05, p&amp;lt;.0001) and psychosocial (∆R2=.06, p&amp;lt; .0001) QoL, adjusting for depressive symptoms and sociodemographic/diabetes factors; more diabetes distress marginally contributed to poorer physical QoL (∆R2=.01, p=.002). Findings suggest unique, negative associations of both depressive symptoms and diabetes distress with QoL. Targeting both depressive symptoms and diabetes distress may help improve QoL in youth with T1D. Disclosure A. Shapira: None. L. K. Volkening: None. L. M. Laffel: Consultant; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Dexcom, Inc., Dompe, Insulogic LLC, Janssen Pharmaceuticals, Inc., Laxmi Therapeutic Devices, LifeScan, Lilly Diabetes, Medtronic, Provention Bio, Inc. Funding National Institutes of Health (R01DK089349, R01DK095273, T32DK007260, P30DK036836); JDRF (2-SRA-2014-253-M-B)

8-OR: Depression and Diabetes Distress in African American and Latino Parents of Children with Type 1 Diabetes (T1D)

Introduction: Parents of young children experience high levels of depression and diabetes distress immediately post-diagnosis. However, there is a limited understanding of these factors later in the disease course, especially among parents from racial/ethnic minority groups who face management difficulties and persistent T1D health disparities (i.e., higher HA1c). This study described parental depressive symptoms, diabetes distress and adherence among African American and Latino parents of children with T1D duration &amp;gt; 1 year. Methods: African American (n = 39) and Latino (n = 26) parents of children age 5-10 years (M 9.0 ± 1.7 yrs; M HA1c = 9.0 ± 1.9; M T1D duration = 3.7±2.2 yrs) were enrolled in a behavioral intervention trial. At baseline they reported on demographics, treatment adherence (Diabetes Self-Management Questionnaire, DSMQ), diabetes distress (Problem Areas in Diabetes Revised for parents, PAID-PR), and depressive symptoms (Center for Epidemiological Studies-Depression, CES-D). HA1c was extracted from the medical record. Results: Over one-quarter (27%) of African American (M CES-D = 13.6 ± 9.5) and 42% of Latino (M CES-D = 14.1 ± 8.8) parents reported moderate/severe depressive symptoms. Nearly half (49%) of African American (M PAID-PR = 56.7 ± 19.7) and 38% of Latino (M PAID-PR = 50.2 ± 17.8) parents reported diabetes distress above a clinical cutoff. Both African American and Latino parents reported high levels of adherence (M DSMQ = 25.9 ± 4.7 and 26.7 ± 4.3, respectively, out of 35). Conclusions: Substantial proportions of African American and Latino parents of school-aged children who have been managing T1D for at least 1 year experience serious mood concerns, both diabetes-specific and general. High levels of T1D adherence indicate resilience in the face of such challenges. Supporting parental psychosocial functioning should be a high priority for diabetes care providers, especially among minority families who may be experiencing elevated challenges. Disclosure S. A. Carreon: None. J. N. Jones: None. A. Reyes garcia: None. K. S. Peters: None. K. K. Christopher: None. M. E. Hilliard: None. A. Butler: None. Funding National Institutes of Health (1DP3DK113236)

Mindfulness practice for protecting mental health during the COVID-19 pandemic

Emerging evidence shows that the coronavirus disease 2019 (COVID-19) pandemic is negatively affecting mental health around the globe. Interventions to alleviate the psychological impact of the pandemic are urgently needed. Whether mindfulness practice may protect against the harmful emotional effects of a pandemic crisis remains hitherto unknown. We investigated the influence of mindfulness training on mental health during the COVID-19 outbreak in China. We hypothesized that mindfulness practitioners might manifest less pandemic-related distress, depression, anxiety, and stress than non-practitioners and that more frequent practice would be associated with an improvement in mental health during the pandemic. Therefore, we assessed pandemic-related distress and symptoms of depression, anxiety, and stress, as well as the frequency of meditation practice at the peak of new infections (Feb 4–5; N = 673) and three weeks later (Feb 29–30; N = 521) in mindfulness practitioners via online questionnaires. Self-reported symptoms were also collected from non-practitioners at peak time only (N = 1550). We found lower scores of pandemic-related distress in mindfulness practitioners compared to non-practitioners. In general, older participants showed fewer symptoms of depression and anxiety. In younger practitioners, pandemic-related distress decreased from peak to follow-up. Importantly, increased mindfulness training during the preceding two weeks was associated with lower scores of depression and anxiety at both assessments. Likewise, practice frequency predicted individual improvement in scores of depression, anxiety, and stress at follow-up. Our results indicate that mindfulness meditation might be a viable low-cost intervention to mitigate the psychological impact of the COVID-19 crisis and future pandemics.

Factors related to depression, distress, and self-reported changes in anxiety, depression, and suicidal thoughts during the COVID-19 state of emergency in Latvia

Purpose Evidence suggests that the 2020 COVID-19 pandemic might have deleterious effects on the population’s mental health and psychiatric outcomes. We examined the prevalence of depression, distress, and suicidal thoughts and their association with social and economic factors during the state of emergency in a nationwide representative sample of the general population in Latvia. Materials and method An online survey was conducted using a randomized stratified sample of the general adult population in July 2020 for 3 weeks. Distress, depression, suicidal thoughts, and self-reported changes in mental health were identified using a structured questionnaire. The statistical analysis included chi-square tests, analyses of variance, and multivariate forward-stepwise linear regressions. Results The study sample included 2608 respondents. Clinical depression was present in 5.75% and distress in 7.82%. Suicidal thoughts increased in 13.30% of those with a history of clinical depression, and 27.05% of those with a history of suicidal attempts. The variables that were associated with increases in self-reported anxiety, depressive thoughts, suicidal ideation, and being currently depressed/distressed included lower general health, increased fears of contracting COVID-19 or having family members contract it and die, history of suicidality, increased family conflicts, decreased religiosity, caring for a vulnerable person. Protective factors included positive changes in family relationships and economic situation, maintaining one’s basic routine, and having more people living in the household. Conclusions Further research and interventions should focus specifically on these factors. The study’s findings can help to develop future strategies for management of psychological support for different groups in general population.

Complementing standard western measures of depression with locally co-developed instruments: A cross-cultural study on the experience of depression among the Luo in Kenya.

Our present understanding of depression relies on a Western nosology that might not be generalizable across diverse cultures around the world. As a consequence, current clinical research and practice may not capture culturally salient features of depression. Expanded cross-cultural research that uses ethnographic methods and local instruments may yield information of clinical utility to enhance culturally sensitive research and practice. In this mixed methods study, we used ethno-semantic interview procedures based on the DSM-5's cultural formulation process to elicit a broad range of depression features reported by the Luo people of western Kenya. We identified how the Luo conceptualize depression, including idioms of depressive distress, moods associated with persistent negative affect, and other features including context, stressors and support systems. This information informed the co-development of a Luo Depression Questionnaire (LDQ-17). We used the LDQ-17 in a cross-sectional community survey (N = 116) to investigate its association with a standard Western instrument (Patient Health Questionnaire-9; PHQ-9). Factor analysis revealed a one-factor model for the PHQ-9 but not the LDQ-17 for which exploratory factor analysis suggested a three-factor model including cognitive, affective, and physical symptoms. Psychological, environmental/social, and even supernatural causes (i.e., ancestors, God and devil) of these symptoms were identified, as were support systems. Finally, visualizations through multidimensional scaling approaches showed some overlap between the LDQ-17 and the PHQ-9, but the local LDQ-17 identified salient features the Luo associated with depression that the PHQ-9 missed. Our findings illustrate how simple ethnographic procedures may guide the development of local instruments to complement current standardized instruments, potentially enhancing cultural relevance.

Gender Dysphoria in Psychiatric Practice: Understanding the Clinical Ambiguity and Management

There have been several myths and misconceptions about the dichotomous understanding of sex and gender. While sex is biologically determined, gender and gender identity depend on childhood experiences, upbringing, social expectations, beliefs, family environment, and peer interactions and is socially constructed. Gender dysphoria (GD) is the extreme distress experienced by an individual because of a mismatch between their gender identity and the sex assigned at birth. GD has been an ambiguous category in psychiatry, initially termed as “gender identity disorder” till Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition ( DSM-5) considered removal of the term “disorder” to reduce the stigma associated. The critical element in GD is “clinically significant distress” that differentiates it from gender nonconformity. Individuals with GD identify themselves as transgender and frequently are victims of coercive social norms, discrimination, and stigma. This leads to delay in expression of distress, psychiatric mismanagement, and high comorbidity of depression, anxiety, post-traumatic stress, self-harm, and suicidality. Though management involves a holistic multidisciplinary approach including psychotherapy, social support, and gender-reassignment treatments (medical/surgical), there has been considerable debate and ambiguity related to the same. With this background, the article critics the understanding of GD, focuses on the WPATH SOC-7 treatment guidelines, and highlights the role of mental health professionals for better care.

Effects of the COVID-19 pandemic on mental health - what do we know so far?

IntroductionThe devastating effects of the current pandemic are profoundly affecting peoples’s physical and psychological health. Numerous studies on the effects of previous infectious outbreaks have been published. Similarly, an increasingly growing body of research on COVID-19 has been developed and released, reporting a substancial psychological impact of both the outbreak and the response, suggesting that the population may express high levels of psychological symptoms.ObjectivesThis presentation aims to synthesize existent literature that reports on the effects of COVID-19 on psychological outcomes of the general population, groups with higher vulnerability and its associated risk factors.MethodsBibliographic research was made through scientific databases such as PubMed and EMBASE. No time limit was used. Pertinent articles were carefully reviewed for additional relevant citations.ResultsGenerally, there is a higher prevalence of symptoms of adverse psychiatric outcomes among the public when compared to the prevalence before the pandemic. Psychological reactions to pandemics include maladaptive behaviours, emotional distress and symptoms of stress, anxiety, depression, and avoidance behaviors. The groups known to be at higher risk for mental health problems during the pandemic are: women, healthcare workers, people under 40 years old and with chronic diseases. Other risk factors are: frequent exposure to social media/news relating to COVID-19, poor economic status, lower education level, and unemployment.ConclusionsThe COVID-19 pandemic represents an unprecedented threat to mental health. In addition to flattening the curve of viral transmission, special attention needs to be paid to the challenges it poses to the mental health of the population at a global scale.

Depressive Symptoms and Emotional Distress of Transnational Mothers: A Scoping Review.

Background: Female led migration is a recent trend that has been gaining momentum, particularly in Latin America. However, little attention has been given to the psychological consequences of mothers who leave their children in their country of origin and migrate to a host country to work. Therefore, it is important to investigate the mental health status of transnational mothers and to further identify issues for intervention and supportive services.Methods: PubMed, PsycINFO, ERIC, CENTRAL, Scopus, and ScienceDirect databases were searched systematically for peer-reviewed articles published from inception through July 2019. The search included the following terms: migrant, immigrant, transnational, transnational mother, AND mood disorders, depressive symptoms, and depression. Initially, 8,375 studies were identified. After exclusionary criteria were applied, 17 studies were identified and included in the review.Results: We found six quantitative studies that investigated depressive symptoms among transnational mothers. Of these studies, three found a positive association between transnational motherhood and depressive symptoms; three of these articles found a null correlation. A total of eight qualitative studies and three mixed-methods studies were found that addressed depressive symptoms and emotional distress among transnational mothers. The eight qualitative studies identified highlighted the significant emotional distress transnational mothers experience. Lastly, the three mixed-methods studies similarly discussed the emotional hardships faced by transnational mothers.Implications: The studies identified suggest that depressive symptoms and emotional distress are prevalent among transnational mothers. Therefore, public health social workers and other mental health providers need to focus on developing strategies to identify and screen transnational mothers for depressive symptoms.

Intimate Relationships and Depression: Searching for Causation in the Sea of Association.

This article provides a critical review of existing research on intimate (marriage or marriage-like) relationship distress and risk for depression. Using the meta-framework of research triangulation, we seek to synthesize research evidence across several different methodologies and study designs and to draw the most reliable conclusion regarding a potential causal association between relationship distress and depression. Focusing on existing correlational (i.e., observational), genetically informed, and intervention (i.e., experimental) research on the association between relationship distress and depression, we conclude that the existing body of research evidence supports the claim that relationship distress is a causal risk factor for depression. A secondary aim of the article is to highlight a variety of effective methods that, when viewed from the perspective of triangulation, enhance the pursuit of causal inference, including propensity score matching, target trial emulation, directed acyclic graph approach, and Mendelian randomization.

A Systematic Review and Meta-Analysis to Examine the Prevalence of Co-Morbid Depression in People with Type 1 and Type 2 Diabetes

Background: Current research suggests that people with diabetes are more likely to suffer with depression. However, inconsistencies have been reported in the prevalence of depression in diabetes, with previous systematic reviews including studies with small numbers of participants, or without adequate control subjects. This is the first systematic review to estimate the prevalence and odds of depression in people with Type 1 and Type 2 diabetes, compared to those without diabetes, and estimate prevalence rates by different methods used to assess depression or depressive symptoms. Methods: According to PRISMA guidelines we searched MEDLINE, EMBASE and PSYCHINFO, from 1 January 1985 to 1 October 2020. Studies were excluded if they failed to have an adequate control group, specified type of diabetes, or reported depression prevalence by type of diabetes. Findings: 33 studies were selected for inclusion; 2 for Type 1 diabetes, 28 for Type 2 diabetes, and 3 for both Type 1 and Type 2 diabetes. The prevalence of diagnosed depression or elevated depressive symptoms was significantly higher in people with Type 1 (16% vs 12%, OR = 1.91 (1.46,2.50), or Type 2 diabetes (18% vs 11%, OR = 1.64 (1.45,1.86) compared to those without diabetes. There was no association between study effect size and mean age or gender. The prevalence of depression was significantly higher in people with diabetes, compared to those without diabetes, when depression was self-reported compared to doctor diagnosed (25% vs 7%, self-reported depression OR=1.87 (1.59,2.19) and doctor diagnosed OR=1.22 (1.07, 1.38); p =0.021). Prevalence and odds of depression or elevated depressive symptoms in people with diabetes, compared to without, differed significantly between studies set in specialist care, compared to community or primary care (36% vs 13%, specialist care OR = 2.71 (1.87,3.92) and community or primary care OR= 1.56 (1.38,1.76); p =0.003). There was no significant change in the reported prevalence of depression in individuals with diabetes, over a period of 30 years (1988-2018). Interpretation: Depression prevalence has not changed over the last 30 years, despite improvements in treatments and self-management education programmes. Effective chronic disease management in people with diabetes is important, particularly screening and managing depression and diabetes distress in specialist care settings. Funding Statement: None. Declaration of Interests: The authors declare no competing interests.

CancerSupportSource\xae-15+: development and evaluation of a short form of a distress screening program for cancer patients and survivors

PurposeCancerSupportSource® (CSS) is a distress screening program implemented at community-based organizations and hospitals nationwide. The 25-item CSS assesses distress across five domains, with capacity to screen for clinically significant depression and anxiety. This study examined psychometric properties of a shortened form to enhance screening opportunities when staff or patient burden considerations are significant.MethodsDevelopment and validation were completed in multiple phases. Item reduction decisions were made with 1436 cancer patients by assessing external/internal item quality and judging theoretical and practical implications of items. Pearson correlations and confirmatory factor analysis were conducted on a separate sample of 957 patients to corroborate psychometric properties and dimensionality of the shortened scale. Nonparametric receiver operating characteristic (ROC) curve analyses determined scoring thresholds for depression and anxiety risk scales.ResultsScale refinement resulted in a 15-item short form plus one screening item assessing tobacco and substance use (CSS-15+). At least two items from each CSS domain were retained to preserve multidimensionality. In confirmatory analysis, the model explained 59% of the variance and demonstrated good fit. Correlation between CSS-15+ and 25-item CSS was 0.99, p < 0.001. Sensitivity of 2-item depression and 2-item anxiety risk scales in the confirmatory sample were 0.82 and 0.83, respectively.ConclusionsCSS-15+ is a brief, reliable, and valid multidimensional measure of distress. The measure retained excellent internal consistency (α = 0.94) and a stable factor structure. CSS-15+ is a practical and efficient screening tool for distress and risk for depression and anxiety among cancer patients and survivors, particularly in community-based settings.

Effects of graduating during economic downturns on mental health

PurposeThis study examined the effects of economic downturns at the time of graduation on short-term and long-term mental health of graduates. MethodsUsing a large longitudinal dataset whose respondents graduated from their highest level of education between 2001 and 2018 in Australia, the study investigated the effects of initial labor market conditions on psychological distress measures, quality-of-life mental health scales, and diagnoses of depression or anxiety since graduation. ResultsEvidence suggests the presence of a scarring effect of graduating during a recession on the mental health of young adults, particularly significant and persistent for men. Higher unemployment rates at graduation were associated with increased risks of high psychological distress and diagnoses of depression or anxiety, and lower levels of social functioning and mental well-being among men lasting over a decade. The psychological effect was largely driven by young adults with vocational or secondary qualifications or receiving no government allowance at graduation. ConclusionsPolicies should consider the psychological effect of graduating during recessions and focus particularly on vulnerable groups who are susceptible to adverse labor market conditions, such as graduates who are in cyclically sensitive occupations and have less or no work benefits and social protection.