Higher Levels Of Psychiatric Symptoms Research Articles

Just as Essential: The Mental Health of Educators During the COVID-19 Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic deleteriously impacted physical and mental health. In the summer of 2020, return-to-learn plans were enacted, including virtual, hybrid, and in-person plans, impacting educators and students. We examined (1) how return-to-learn plan was related to depressive and social anxiety symptoms among educators and (2) how psychological flexibility related to symptoms. Educators (N = 853) completed a survey via Qualtrics that assessed internalizing symptoms, psychological flexibility, and occupational characteristics. Two one-way analyses of variance (ANOVAs) examined between-group differences in return-to-learn plans across depression and social anxiety. Two hierarchical linear regressions examined the relation between psychological flexibility components and depressive and social anxiety symptoms. Median T-scores were well above the national normative means for General Depression (median T-score: 81) and Social Anxiety (median T-score: 67). There were no significant differences between reopening plans in general depression nor social anxiety T-scores. Psychological flexibility accounted for 33% of the variance in depressive symptoms and 24% of the variance in social anxiety symptoms. Results indicated high levels of psychiatric symptoms among educators during COVID-19, and psychological flexibility was associated with lower symptoms. Addressing educator mental health is of utmost importance in future research.

Assessment of Nutritional Status and Risk of Malnutrition Using Adapted Standard Tools in Patients with Mental Illness and in Need of Intensive Psychiatric Treatment.

People with severe mental illness (SMI) are often in poor physical health, resulting in higher mortality and reduced life expectancy compared to the general population. Although eating habits are one of the main predictors of physical health, few studies assess the nutritional status and eating behavior of people with SMI. The aim of this study was to examine the nutritional status and risk of malnutrition in people with SMI who were in need of intensive psychiatric treatment. The cross-sectional study included 65 inpatients and 67 outpatients with psychotic or depressive disorders from the Psychiatric Hospital of the University of Zurich. Patients' assessments at admission included anthropometric measurements, such as weight and height, and interview data including severity of symptoms and functioning (SCL-K-9, PHQ-D, CGI, m-GAF), personal and medical data, nutrition risk screening tools (adapted NRS, MNA-SF), and laboratory values. The results showed that 32% of the inpatients and 34% of the outpatients were at risk of malnutrition, which was associated with higher levels of psychiatric symptoms and lower levels of functioning. Regardless, the body mass index (BMI) was overweight in both groups (mean BMIinpatients = 25.3, mean BMIoutpatients = 27.9). These results indicate that a substantial proportion of psychiatric patients seems to be at risk of malnutrition, despite most being overweight, and hence they might benefit from nutritional support during their psychiatric treatment. Moreover, nutritional risk screening tools specifically developed for the mental healthcare setting are needed.

Agoraphobic avoidance in patients with psychosis: Severity and response to automated VR therapy in a secondary analysis of a randomised controlled clinical trial

BackgroundThe social withdrawal of many patients with psychosis can be conceptualised as agoraphobic avoidance due to a range of long-standing fears. We hypothesised that greater severity of agoraphobic avoidance is associated with higher levels of psychiatric symptoms and lower levels of quality of life. We also hypothesised that patients with severe agoraphobic avoidance would experience a range of benefits from an automated virtual reality (VR) therapy that allows them to practise everyday anxiety-provoking situations in simulated environments. Methods345 patients with psychosis in a randomised controlled trial were categorised into average, moderate, high, and severe avoidance groups using the Oxford Agoraphobic Avoidance Scale. Associations of agoraphobia severity with symptom and functioning variables, and response over six months to brief automated VR therapy (gameChange), were tested. ResultsGreater severity of agoraphobic avoidance was associated with higher levels of persecutory ideation, auditory hallucinations, depression, hopelessness, and threat cognitions, and lower levels of meaningful activity, quality of life, and perceptions of recovery. Patients with severe agoraphobia showed the greatest benefits with gameChange VR therapy, with significant improvements at end of treatment in agoraphobic avoidance, agoraphobic distress, ideas of reference, persecutory ideation, paranoia worries, recovering quality of life, and perceived recovery, but no significant improvements in depression, suicidal ideation, or health-related quality of life. ConclusionsPatients with psychosis with severe agoraphobic avoidance, such as being unable to leave the home, have high clinical need. Automated VR therapy can deliver clinical improvement in agoraphobia for these patients, leading to a number of wider benefits.

Salivary cortisol reactivity in 6-month-old infants of mothers with severe psychiatric disorders: findings from the face-to-Face Still-Face paradigm

Background.Maternal psychopathology is associated with altered HPA axis functioning in offspring. Most studies have focused on mildly affected populations, but less is known about the effect of severe maternal psychopathology. In our explorative study we investigated in a heterogenic sample of mothers with severe and long-lasting psychiatric disorders, if a diagnosis of depression and severity of general maternal psychiatric symptomatology were associated with infant salivary cortisol reactivity to the Face-to-Face Still-Face (FFSF) paradigm at 6 months of age.Methods.A clinical sample of 36 mother-infant dyads was explored. All mothers fulfilled criteria for a severe psychiatric disorder and had psychiatric complaints for the last two consecutive years. Maternal diagnosis was established during pregnancy using a diagnostic interview and general maternal psychiatric symptom severity was established by self-report at the time of the FFSF procedure. The FFSF paradigm was used to assess infants’ response to social stress at the age of 6 months. Infant saliva samples were collected at three time points: 5 min before and 15 and 30 min after the social stressor. Cortisol reactivity was operationalized as incremental Area Under the Curve (AUCi). Potential confounders were identified and adjusted for.Results.In regression analyses, a negative relationship was found between infant cortisol reactivity (AUCi) during the FFSF paradigm at 6 months and general maternal symptom severity at time of the FFSF paradigm (unadjusted n = 36, ß = −0.331, B = −9.758, SE 4.8, p = .048; adjusted n = 36, ß = −0.335, B = −9.868, SE 4.5, p = .039) and for diagnosis of perinatal depression at trend level (unadjusted n = 36, ß = −0.293, B = −8.640, SE 4.8, p = .083; adjusted n = 36, ß = −0.317, B = −9.347, SE 4.6, p = .052). Analyses were adjusted for gestational age.Conclusions.Preliminary results on cortisol reactivity in 6-month-old infants of mothers with severe and long-lasting psychiatric disorders show a significant reduction in the group of mothers who experienced a high level of psychiatric symptoms in the post-partum period, compared to mothers with lower levels of psychiatric symptomatology. The same trend was found for mothers with and without a diagnosis of perinatal depression. Since these infants are considered to be at increased risk for later psychopathology, our study suggests that future longitudinal studies should investigate whether reduced cortisol reactivity in babies could be a marker for any adverse outcomes, besides other possible risk factors (e.g. (epi)genetic phenomena).

Prevalence and risk factors for post-traumatic stress, anxiety, and depression in sepsis survivors after ICU discharge.

Objective:Sepsis survivors present a wide range of sequelae; few studies have evaluated psychiatric disorders after sepsis. The objective of this study was to define the prevalence of and risk factors for anxiety, depression and post-traumatic stress disorder (PTSD) symptoms in sepsis survivors.Method:Anxiety, depression and post-traumatic stress symptoms in severe sepsis and septic shock survivors 24 h and 1 year after intensive care unit (ICU) discharge were assessed using the Beck Anxiety/Depression Inventories and the PTSD Checklist-Civilian Version. Differences in psychiatric symptoms over time and the influence of variables on these symptoms were calculated with marginal models.Results:A total of 33 patients were enrolled in the study. The frequencies of anxiety, depression and PTSD 24 h after ICU discharge were 67%, 49%, and 46%, respectively and, among patients re-evaluated 1 year after ICU discharge, the frequencies were 38%, 50%, and 31%, respectively. Factors associated with PTSD included serum S100B level, age, and Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) score. Factors associated with depression included patient age and cumulative dose of dobutamine. IQCODE score and cumulative dose of haloperidol in the ICU were associated with anxiety after ICU discharge.Conclusion:Patients who survive sepsis have high levels of psychiatric symptoms. Sepsis and associated treatment-related exposures may have a role in increasing the risk of subsequent depression, anxiety, and PTSD.

Telework during COVID-19 outbreak: Impact on mental health among Italian workers

IntroductionSince February 2020, the outbreak of COVID-19 has spread to several countries worldwide, including Italy, leading to an uptake of telework.ObjectivesWe aim to evaluate the psychopathological impact of teleworking during the COVID-19 pandemic in Italy, identifying mental health determinants among home-based workers.Methods804 participants completed an online survey, including the psychometric scales “Depression, Anxiety and Stress Scale – 21 items” (DASS-21) and the “Insomnia Severity Index” (ISI). Teleworkers were also asked to provide information about their current work routine, home environment and clinical history.ResultsAt the DASS-21, 30% of the participants presented pathological levels of depression, 20.8% of anxiety and 30.7% of stress. At the ISI, 5% appeared to suffer from insomnia. Respondents with psychological and physical frailties, greater social isolation or inadequate working spaces manifested higher levels of psychiatric symptoms. Moreover, we also find a correlation of these symptoms with occupations in education. Telework was broadly appreciated and 87% of respondents expressed a willingness to maintain access to this arrangement.ConclusionsOur results document that about a third of our sample manifested psychopathological symptoms while teleworking during the COVID-19 outbreak in Italy. However, telework itself does not seem to be directly associated with increased psychiatric symptoms, which were instead exacerbated by COVID-19-related stressful circumstances, as well as by constitutional and social determinants of health. Going forward, authorities should promote adequate measures in order to guarantee a healthy approach to teleworking.DisclosureNo significant relationships.

Early Psychiatric Impact of COVID-19 Pandemic on the General Population and Healthcare Workers in Italy: A Preliminary Study

Introduction: Since February 2020, the outbreak of COVID-19 spread to several countries worldwide, including Italy. In this study, we aimed to assess the psychopathological impact of the pandemic across the general population of Lombardy, the most affected Italian region, and to compare the prevalence of psychiatric symptoms between the general public and healthcare workers.Methods: Four hundred and thirty-two participants completed an online survey including: the Depression, Anxiety and Stress Scale−21 items (DASS-21), the Impact of Event Scale—Revised (IES-R) and the Pittsburgh Sleep Quality Index (PQSI). Healthcare workers were also asked to complete the Maslach Burnout Inventory (MBI).Results: At the DASS-21, 33.3% of the responders presented pathological levels of stress, 25.5% of anxiety, and 35.9% of depression. At the IES-R, 13.9% appeared at risk of developing Post-Traumatic Stress Disorder (PTSD). At the PSQI, 57.6% presented sleep disturbances. Female gender and younger age predicted higher scores of distress. Healthcare workers presented higher levels of psychiatric symptoms than the general public. Moreover, working in contact with COVID-19 patients predicted higher scores at the IES-R subscale Intrusion.Conclusion: Our results showed that about a third of our sample presented symptoms of stress, anxiety, and depression during the first month of the COVID-19 pandemic outbreak in Lombardy; more than half of the responders presented sleep disturbances, and 13% appeared at risk of PTSD. Italian authorities should develop specific strategies to guarantee psychological support to the population of Lombardy, with particular attention to women, young people, and healthcare workers exposed to COVID-19 patients.

Is returning to work during the COVID-19 pandemic stressful? A study on immediate mental health status and psychoneuroimmunity prevention measures of Chinese workforce

This study aimed to quantify the immediate psychological effects and psychoneuroimmunity prevention measures of a workforce returning to work during the COVID-19 epidemic. Workforce returning to work was invited to complete an online questionnaire regarding their attitude toward the COVID-19 epidemic and return-to-work along with psychological parameters including the Impact of Event Scale-Revised, Depression, Anxiety, Stress Scale- 21 (DASS-21) and Insomnia Severity Index (ISI). Psychoneuroimmunity prevention measures include precautions at personal and organization levels. From 673 valid questionnaires, we found that 10.8% of respondents met the diagnosis of post-traumatic stress disorder (PTSD) after returning to work. The respondents reported a low prevalence of anxiety (3.8%), depression (3.7%), stress (1.5%) and insomnia (2.3%). There were no significant differences in the severity of psychiatric symptoms between workers/technicians and executives/managers. >95% reported psychoneuroimmunity prevention measures including good ventilation in the workplace and wore a face mask as protective. Factors that were associated with the severity of psychiatric symptoms in the workforce were marital status, presence of physical symptom, poor physical health and viewing return to work as a health hazard (p < 0.05). In contrast, personal psychoneuroimmunity prevention measures including hand hygiene and wearing face masks as well as organizational measures including significant improvement of workplace hygiene and concerns from the company were associated with less severe psychiatric symptoms (p < 0.05). Contrary to expectations, returning to work had not caused a high level of psychiatric symptoms in the workforce. The low prevalence of psychiatric symptoms could be due to confidence instilled by psychoneuroimmunity prevention measures before the resumption of work. Our findings would provide information for other countries during the COVID-19 pandemic.

Profiling psychopathology of patients reporting early childhood trauma and emotional neglect: Support for a two-dimensional model?

Profiling patients who report early childhood trauma and emotional neglect may be useful for treatment planning. This study attempts to quantify a two-dimensional "trauma-neglect model" (Draijer, 2003) proposed to distinguish clinical profiles in terms of trauma-related, dissociative, and personality pathology. A sample of patients referred to a trauma program (n = 49) and a personality disorders program (n = 101) was extensively assessed. Cluster analysis was used to discriminate patients in terms of "psychiatric disease burden," based on symptom severity scores, type of disorder, and level of maladaptive personality functioning. Clusters that differed in psychiatric disease burden were mapped in the trauma-neglect space and their positions were evaluated. We found three clusters and labeled them as "mildly impaired" (26% of patients), "moderately impaired" (43% of patients), and "severely impaired" (31% of patients). The mean scores on trauma and neglect for the mild and severe groups differed significantly. These findings indicate that further investigation of the validity of the model, which may be used to plan treatment, is useful. Patients experiencing a wide range of trauma-related disorders, dissociative disorders (DD), and personality disorders (PD), combined with a high level of psychiatric symptoms and a maladaptive style of personality functioning, report a range of traumatic experiences in combination with a lack of maternal care, and can be profiled as "severely impaired." (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Psychiatric symptoms in migraine patients and their attitudes towards psychological support on stigmatization

ObjectiveAlthough migraine patients experience more psychological problems when compared to the general population, they are usually not treated. The reasons for non-treatment of these problems are not clear. The anxiety and concern of migraine patients about stigmatization may also prevent them to express psychological symptoms. The present study aimed to investigate the attitudes and behavior of migraine patients about receiving psychological help and their concerns about stigmatization. Material and methodThe study group included 50 18–49 years old patients diagnosed with migraine in the neurology clinic and the control group included 50 healthy individuals with similar age, gender socio demographic characteristics with the study group. Attitude Scale Towards Seeking Professional Help (ASPH-SF), Self-Stigma in Seeking Professional Help Scale (SSPHS), Intentions to Seek Psychological Help Scale (ISHP), Stigma Scale for Receiving Psychological Help (SSRPH) and Symptom Checklist (SCL-90-R) were applied to all participants. FindingsThe comparison of the patient and control groups based on SCL-90-R findings demonstrated that the patient group scores in somatization, anxiety (p = 0.000), depression (p = 0.003), anger (p = 0.02), interpersonal sensitivity (p = 0.006), phobia (p = 0.001), paranoid thoughts (p = 0.012), psychosis (p = 0.031) subscales and additional subscale (p = 0.014) and general symptom index (p = 0.001) scores were higher. Based on SCL 90, it was found that patients with higher levels of symptoms had higher social stigma scores when compared to patients with lower symptom levels (p = 0.007). Migraine patients with high symptom levels were found to have significantly lower rates of seeking psychiatric help (14% vs 33%) when compared to the control group. There was no difference between the patient and control groups based on ASPH-SF, SSPHS, ISPH and SSRPH scale scores. ConclusionAlthough migraine patients exhibit higher levels of psychiatric symptoms when compared to healthy individuals, it was determined that only a minority of these patients receive psychiatric treatment. Especially patients with high level of psychiatric symptoms could have sought less psychiatric help due to the concerns of stigmatization.

Gastrointestinal and Psychiatric Symptoms Among Children and Adolescents With Autism Spectrum Disorder.

Individuals with autism spectrum disorder (ASD) are at heightened risk of psychiatric comorbidities across the lifespan, including elevated rates of internalizing, externalizing, and self-injurious behaviors. Identification of medical comorbidities that contribute to these concerns may elucidate mechanisms through which psychiatric concerns arise, as well as offer additional avenues for intervention. Gastrointestinal (GI) conditions are of particular interest, as they are prevalent among those with ASD, may share genetic or neurobiological etiologies with the core features of ASD, and are linked with psychiatric difficulties in the general population. In this paper, we draw on data from nearly 2,800 children and adolescents with ASD within the Simons Simplex Collection to characterize the unique contributions of (1) autism symptoms, (2) psychosocial factors (child's age, sex, verbal and nonverbal IQ, adaptive behavior, race, and household income), and (3) GI concerns with respect to multiple psychiatric outcomes. Multiple regression models revealed unique contributions of ASD symptoms and multiple psychosocial factors such as verbal IQ, adaptive behavior, and family income to internalizing, externalizing, and self-injurious behavior. In general, higher levels of psychiatric symptoms were associated with more ASD symptoms, higher verbal IQ, lower adaptive behavior skills, and lower family income. Furthermore, levels of GI symptoms accounted for unique variance in psychiatric outcomes over and above these other factors, linking increased GI problems with increased psychiatric symptoms in children with ASD. Taken together, results indicate that the presence and quantity of GI symptoms should be considered when evaluating psychiatric and behavioral concerns among children with ASD, and that treatment of GI conditions may be an important component in alleviating a broad array of mental health concerns in this group.

Recently resettled refugee women-at-risk in Australia evidence high levels of psychiatric symptoms: individual, trauma and post-migration factors predict outcomes

BackgroundDespite increasing numbers of refugee women-at-risk being resettled and their potential vulnerability, there exists no empirical research into the psychiatric health of this unique subgroup with which to guide policy and practice. This research aimed to investigate psychiatric symptom status of a sample of refugee women-at-risk recently resettled in Australia, as well as factors contributing to symptoms of trauma, anxiety, depression, and somatization. The level of psychiatric symptomatology is compared to reference groups of women from Sudan and Burma, who entered Australia under the Humanitarian Entry Programme, and who did not meet criteria as women-at-risk.MethodsThis is a cross-sectional survey of 104 refugee women-at-risk across several ethnic groups including a demographic questionnaire, the Harvard Trauma Questionnaire, Post-migration Living Difficulties Checklist, and Hopkins Symptom Checklist to assess individual factors, traumatic experiences, post-migration problems, and symptoms of trauma, anxiety, depression, and somatization. A series of multiple hierarchical regression analyses examined factors predicting psychiatric symptoms.ResultsSubstantial proportions of participants reported psychiatric distress in symptomatic ranges, including for traumatization (41%), post-traumatic stress disorder (20%), anxiety (29%), and depression (41%), as well as significant symptoms of somatization (41%). These findings are significantly higher than those derived from reference groups of women from Sudan or Burma, resettled in the same area and utilizing a similar methodology. Higher numbers of trauma events and post-migration living difficulties predicted higher trauma, depression, and somatic (but not anxiety) symptoms. Having children predicted higher trauma, anxiety, and somatic symptoms. Greater English fluency predicted higher anxiety symptoms. Region of birth predicted anxiety and depression symptoms. Age predicted trauma and anxiety symptoms.ConclusionsFindings suggest that recently arrived refugee women-at-risk are at high risk of psychiatric disorders. The results indicate a need for comprehensive psychiatric assessment to identify women in need of treatment very early after resettlement, with implications for medical practice, service delivery, and policy programs.

Long-Term Outcome of a Cluster-Randomized Universal Prevention Trial Targeting Anxiety and Depression in School Children

The present study concerns a 3-year follow-up of a universal prevention trial targeting anxiety and depressive symptoms in school children. In addition to evaluating the long-term effect of the prevention program, we also examined attrition and its effect on the outcome. High rates of attrition have commonly been observed in studies in the field. However, the role of attrition is not sufficiently understood regarding internal and external validity biases. The current study comprised 695 children (aged 8–11 at baseline) from 17 schools in Sweden. Schools were cluster-randomized to either the intervention or control condition. Children completed measures of anxiety and depressive symptoms and parents completed measures of their child’s anxiety and general mental health. We found no evidence of long-term effects of the prevention program, except for a small effect regarding parent reports of child anxiety. However, that effect was not found to be of clinical significance. Regarding attrition, children with missing data at the 3-year follow-up displayed higher levels of psychiatric symptoms at baseline and increasing symptoms across time. Furthermore, children in the control condition with missing follow-up data were found to be significantly deteriorated across time compared to the corresponding children in the intervention condition regarding depressive symptoms and total difficulties. In other words, attrition served as a moderator of the effect, which suggests that the overall result was biased toward a null-result. Our study highlights that large and nonrandom attrition severely limits the validity of the results. Further, given the common problem of retaining participants in long-term evaluations of school-based prevention trials, previous studies may suffer from the same limitations as the current study.

Caregiver burden and caregiver appraisal of psychiatric symptoms are not modulated by subthalamic deep brain stimulation for Parkinson\u2019s disease

Subthalamic deep brain stimulation is an advanced therapy that typically improves quality of life for persons with Parkinson’s disease (PD). However, the effect on caregiver burden is unclear. We recruited 64 persons with PD and their caregivers from a movement disorders clinic during the assessment of eligibility for subthalamic DBS. We used clinician-, patient- and caregiver-rated instruments to follow the patient–caregiver dyad from pre- to postoperative status, sampling repeatedly in the postoperative period to ascertain fluctuations in phenotypic variables. We employed multivariate models to identify key drivers of burden. We clustered caregiver-rated variables into ‘high’ and ‘low’ symptom groups and examined whether postoperative cluster assignment could be predicted from baseline values. Psychiatric symptoms in the postoperative period made a substantial contribution to longitudinal caregiver burden. The development of stimulation-dependent mood changes was also associated with increased burden. However, caregiver burden and caregiver-rated psychiatric symptom clusters were temporally stable and thus predicted only by their baseline values. We confirmed this finding using frequentist and Bayesian statistics, concluding that in our sample, subthalamic DBS for PD did not significantly influence caregiver burden or caregiver-rated psychiatric symptoms. Specifically, patient–caregiver dyads with high burden and high levels of psychiatric symptoms at baseline were likely to maintain this profile during follow-up. These findings support the importance of assessing caregiver burden prior to functional neurosurgery. Furthermore, they suggest that interventions addressing caregiver burden in this population should target those with greater symptomatology at baseline and may usefully prioritise psychiatric symptoms reported by the caregiver.

Latent Trajectories of Common Mental Health Disorder Risk Across 3 Decades of Adulthood in a Population-Based Cohort.

Epidemiologic evidence indicates that most of the general population will experience a mental health disorder at some point in their lives. However, few prospective population-based studies have estimated trajectories of risk for mental disorders from young through middle adulthood to estimate the proportion of individuals who experience persistent mental disorder across this age period. To describe the proportion of the population who experience persistent mental disorder across adulthood and to estimate latent trajectories of disorder risk across this age period. A population-based, prospective cohort study was conducted between 1979 and 2008 in the canton of Zurich, Switzerland. A stratified random sample of 591 Swiss citizens was enrolled in 1978 at ages 19 years (men) and 20 years (women); 7 interviews were performed during a 29-year period. Men were sampled from military enrollment records and women from electoral records. From those initially enrolled, participants with high levels of psychiatric symptoms were oversampled for follow-up. Data analysis was performed from July 28, 2015, to June 8, 2016. Latent trajectories, estimated using growth mixture modeling, of past-year mood/anxiety disorder (ie, major depressive episode, phobias, panic, generalized anxiety disorder, and obsessive-compulsive disorder), substance use disorder (ie, drug abuse or dependence and alcohol abuse or dependence), and any mental disorder (ie, any of the above) assessed during in-person semistructured interviews at each wave. Diagnoses were based on DSM-III, DSM-III-R, and DSM-IV criteria. Of the 591 participants at baseline, 299 (50.6%) were female. Persistent mental health disorder across multiple study waves was rare. Among 252 individuals (42.6%) who participated in all 7 study waves, only 1.2% met criteria for disorder every time. Growth mixture modeling identified 3 classes of risk for any disorder across adulthood: low (estimated prevalence, 40.0%; 95% CI, -8.7% to 88.9%), increasing-decreasing (estimated prevalence, 15.3%; 95% CI, 1.0% to 29.6%), and increasing (estimated prevalence, 44.7%; 95% CI, -0.9% to 90.1%). Although no classes were characterized by persistently high disorder risk, for those in the increasing-decreasing class, risk was high from the late 20s to early 40s. Sex-specific models indicated 4 trajectory classes for women but only 3 for men. Persistently high mental health disorder risk across 3 decades of adulthood was rare in this population-based sample. Identifying early determinants of sex-specific risk trajectories would benefit prevention efforts.

Relationship of Urologic Complications With Health-Related Quality of Life and Perceived Value of Health in Men and Women With Type 1 Diabetes: The Diabetes Control and Complications Trial/Epidemiology of Interventions and Complications (DCCT/EDIC) Cohort

OBJECTIVELimited information exists about the influence of urologic complications on health-related quality of life (HRQOL) in patients with type 1 diabetes.RESEARCH DESIGN AND METHODSWe studied 664 men and 580 women from the Diabetes Control and Complications Trial/Epidemiology of Interventions and Complications Study: mean ages were 51.6 ± 6.6 and 50.6 ± 7.2 years and duration of diabetes was 29.5 ± 4.8 and 29.8 ± 5.1 years, respectively. We assessed associations of sexual dysfunction, lower urinary tract symptoms (LUTS), and, in women, urinary incontinence (UI) with general quality of life (SF-36), perceived value of health (EuroQol-5), diabetes-related quality of life (Diabetes Quality of Life Scale [DQOL]), and psychiatric symptoms (Symptom Checklist 90-R).RESULTSIn both men and women, urologic complications adversely affected HRQOL and psychiatric symptoms, even after accounting for history of depression leading to treatment. Multivariable analyses accounting for the presence of diabetic retinopathy, neuropathy, and nephropathy also revealed substantial independent effects. In men, for example, the odds (95% CI) of a low DQOL score (≤25th percentile) were 3.01 (1.90–4.75) times greater with erectile dysfunction and 2.65 (1.68–4.18) times greater with LUTS and in women, 2.04 (1.25–3.35) times greater with sexual dysfunction and 2.71 (1.72–4.27) times greater with UI/LUTS combined compared with men and women without such complications. Similar effects were observed for the other measures.CONCLUSIONSSexual dysfunction and urinary complications with type 1 diabetes are associated with decreased quality of life and perceived value of health and with higher levels of psychiatric symptoms, even after accounting for other diabetes complications and depression treatment.

Overrepresentation of unaccompanied refugee minors in inpatient psychiatric care.

BackgroundUnaccompanied refugee minors (URMs) have high levels of psychiatric symptoms, and concerns for their access to mental health services have been raised. From the mid-2000s, an increasing number of asylum-seeking URMs, mainly adolescent boys from Afghanistan, have been referred to the Child & Adolescent Psychiatry emergency unit in Malmö, Sweden. The aim of the study was to compare inpatient psychiatric care between URMs and non-URMs.FindingsAll admissions in 2011 at the emergency unit were identified and divided into URMs (n = 56) and non-URMs (n = 205). On the basis of unique patients’ first treatment occasion, a group level analysis was performed on gender, age, treatment duration, additional treatment occasions/patient, involuntary care, involuntary care by gender, and ICD-10 principal diagnosis. To retrieve further sample characteristics, a questionnaire was administered to the physicians responsible for admitting patients in 2011.More URMs than non-URMs exhibited self-harm or suicidal behaviour in conjunction with referral. 86% of URMs were admitted with symptoms relating to stress in the asylum process. In the catchment area, 3.40% of the URM population received inpatient care and 0.67% inpatient involuntary care, compared to 0.26% and 0.02% respectively of the non-URM population, both comparisons p < 0.001. There were more boys in the URM group (95%) compared to the non-URM group (29%). A difference in use of involuntary care disappeared after adjusting for gender. No differences were found in diagnoses except for neurotic disorders (F40-48), which were more common in the URM group.ConclusionFrom an epidemiological perspective, URMs were overrepresented in inpatient psychiatric care.

Higher emotional and psychiatric sequelae amongst elderly early-stage cancer patients undergoing chemotherapy

symptoms. In order to provide adequate and appropriate psychosocial support for elderly cancer patients, there is a need to investigate the differential psychological impact that these patients face, in comparison to younger patients. Objectives: In the context of a local healthcare setting, the aim of this study was to (1) investigate if elderly patients had higher levels of psychiatric symptoms (depression, anxiety and distress) than younger patients; (2) examine the changes in the levels of psychiatric symptoms over a period of time; (3) investigate changes in the number of caseness of psychiatric morbidities for each patient population over the same period of time. Methods: 157 cancer patients from the National University Cancer Institute, Singapore, participated in this longitudinal study. 35% (n= 54) of the patients were aged 61 years and above (elderly). Selfreport questionnaires measuring distress (Distress Thermometer), and depression and anxiety (Hospital Anxiety and Depression Scale) were administered at 3 time points (baseline, 2 months and 5 months). An independent sample t-test was used to compare the levels of distress, depression and anxiety for both groups at baseline. ANOVAwas used to compare the measures both across time, as well as the elderly patients with the younger ones. Chi-square tests were used to analyse the prevalence of caseness in the two groups of patients. Results: Results indicated that for all symptoms at baseline, elderly patients did not report experiencing significantly higher levels compared to younger patients. For all patients, comparing baseline to 2 months, and baseline to 5 months, there was a significant decrease in the all symptoms, except for distress at 5 months which showed a marginally significant decrease. However, comparing between elderly and young patients over time, there was no significant difference in the levels of all symptoms. In addition, although marginally significant, the prevalence of caseness in the elderly patients was higher compared to the young patients, for depression at baseline (χ[1,118] = 3.577, p= .059) and for distress at 2 months (χ[1,73] = 3.273, p= .070). Apart from these two exceptions, there was no significant difference between elderly and young patients in the prevalence of caseness for all the symptoms at all three time points. Conclusion: This study has shown that elderly patients generally do not experience more symptoms of depression, anxiety or distress compared to younger patients. Instead, all patients exhibit a trajectory of decreasing symptoms over time. Attention should be paid however, to elderly caseness patients. Future research could investigate the profile of elderly caseness patients and the changes in symptom level over time, to allow for healthcare professionals to provide the appropriate psychosocial support for them. Disclosure of interest: None declared.

Changes in mental state associated with prison environments: a systematic review

To develop an understanding of the stability of mental health during imprisonment through review of existing research evidence relating physical prison environment to mental state changes in prisoners. A systematic literature search was conducted looking at changes in mental state and how this related to various aspects of imprisonment and the prison environment. Fifteen longitudinal studies were found, and from these, three broad themes were delineated: being imprisoned and aspects of the prison regime; stage of imprisonment and duration of sentence; and social density. Reception into prison results in higher levels of psychiatric symptoms that seem to improve over time; otherwise, duration of imprisonment appears to have no significant impact on mental health. Regardless of social density, larger prisons are associated with poorer mental state, as are extremes of social density. There are large gaps in the literature relating prison environments to changes in mental state; in particular, high-quality longitudinal studies are needed. Existing research suggests that although entry to prison may be associated with deterioration in mental state, it tends to improve with time. Furthermore, overcrowding, ever more likely as prison populations rise, is likely to place a particular burden on mental health services.

Considering Variables for the Assignment of Patients with Schizophrenia to a Case Management Programme

The elements and intensity of case management (CM) practices should be established according to patients' needs. Therefore, greater understanding of patients' needs in such community-based programmes is essential. This paper addresses this issue by characterizing two groups of patients receiving CM or a standard treatment programme (STP) and identifying the characteristics of patients receiving CM services. We recruited 241 patients with schizophrenia from 10 Adult Mental Health Centres in Barcelona (Catalonia, Spain). We analyzed the profile of new patients included in a clinical, non-intensive CM program against that of patients in a STP. CM patients, compared with STP patients, have a lower educational level and quality of life; greater use of health care services, and higher levels of psychiatric symptoms, disability and unmet needs. Community psychiatric visits, social services, education, physical health and needs were significantly associated with CM services. This study may help in identifying patients' needs and strengthening the CM programme.