Hopkins Symptom Checklist Research Articles

The feasibility and preliminary efficacy of narrative exposure therapy on post-traumatic stress disorder among Syrian refugees in Jordan

ObjectivesPost-traumatic stress disorder (PTSD), anxiety, and depression are common mental health disorders among refugees, and all require immediate mental health support to prevent short- and long-term detrimental health outcomes. The purpose of this study was to evaluate the feasibility and preliminary efficacy of narrative exposure therapy (NET) in reducing symptoms of PTSD, depression, and anxiety among Syrian refugees residing in Jordan. MethodsA two-arm randomized control trial was utilized. A total of 40 Syrian refugees aged 18 to 64 diagnosed with PTSD were randomly allocated to either the NET intervention group (n = 20) or the waitlist control group (n = 20) using a computer-generated allocation list with 1:1 allocation. PTSD symptoms were evaluated using the Arabic rendition of the Harvard Trauma Questionnaire, while depression and anxiety symptoms were appraised using the Arabic adaptation of the Hopkins Symptoms Checklist-25. Descriptive statistics were employed to characterize the sample and survey data. Independent t-tests were conducted to assess mean score differences in PTSD, anxiety, and depression between the intervention and control groups. ResultsPost NET intervention, significant reductions in PTSD (t = −10.00, P < 0.001), anxiety (t = −9.46, P < 0.001), and depression (t = −6.00, P < 0.001) scores were observed in the intervention group compared to the control group. Effect sizes were moderate for the trauma (Cohen’s d = 0.73) and depression (Cohen’s d = 0.79) symptoms and notably large for anxiety symptoms (Cohen’s d = 0.97). There were no adverse events related to study participation. The intervention achieved a 100% participant retention rate. ConclusionsThe results pertaining to retention rate, adherence to the study protocol, data completeness, cultural congruence, and participants’ satisfaction provided strong support for the future implementation of the full-scale RCT. NET may be a feasible and helpful approach for refugees and other patients with PTSD, anxiety, and depression.

Anxiety and depression in patients with hand eczema: A population-based study among 853 middle-aged subjects.

Hand eczema (HE) is a common dermatological disorder with considerable effect on the health-related quality of life (HRQoL). The data on mental comorbidities of HE is sparse and mostly studied among selected patient groups. We aimed to investigate symptoms of depression and anxiety in patients with HE in general population. Study subjects (n = 6695) belonging to the Northern Finland Birth Cohort 1966 Study (NFBC1966) responded to an extensive health questionnaire including questions about HE. Depression and anxiety symptoms were evaluated according to the Hopkins Symptom Checklist-25 (HSCL-25). Having ever suffered from HE was reported by 853 (12.8%) study subjects. Symptoms scores of depression were significantly higher among (n = 172, 20.3%) HE subjects compared with (n = 884, 15.4%) subjects without HE (Odds ratio [OR] 1.40, 95% confidence interval [CI]: 1.17-1.68, P < 0.001). Correspondingly, symptoms scores of anxiety were also more common among (n = 90, 10.6%) HE subjects than among (n = 448, 7.8%) subjects without HE (OR 1.40, 95% CI: 1.10-1.78, P = 0.007). In an adjusted model, the associations remained statistically significant (OR 1.30, 95% CI: 1.08-1.57, P = 0.007 and OR 1.34, 95% CI: 1.04-1.72, P = 0.021, respectively). Symptoms associated with mental health should be taken into account when managing patients with HE.

Long-Term Maternal and Child Outcomes Following Postnatal SSRI Treatment

Although selective serotonin reuptake inhibitors (SSRIs) are recommended for postnatal depression treatment, there is a lack of evidence regarding long-term maternal and child outcomes following postnatal SSRI treatment. To examine whether postnatal SSRI treatment moderated postnatal depression-associated maternal and child outcomes across early childhood years. This cohort study used longitudinal data from the Norwegian Mother, Father and Child Cohort Study. Participating women were recruited in weeks 17 to 18 of pregnancy from 1999 to 2008 and were prospectively followed up after childbirth. Data analysis was performed between December 2021 to October 2022. Postnatal depression diagnosis (a binary indicator of eligibility for treatment) was defined as a score of 7 or greater on the 6-item version of the Edinburgh Postnatal Depression Scale. The Hopkins Symptom Checklist was used as a continuous indicator of and postnatal depressive symptomology at postpartum month 6. Postnatal SSRI treatment was identified using self-reported data at postpartum month 6. Maternal outcomes included self-reported depression symptomology and relationship satisfaction from childbirth to postpartum year 5. Child outcomes included maternal-report internalizing and externalizing problems, attention-deficit/hyperactivity disorder symptoms, and motor and language development at ages 1.5, 3, and 5 years. A propensity score adjustment method was used to control for prenatal factors associated with postnatal SSRI exposure probability. Among a total of 61 081 mother-child dyads, 8671 (14.2%) (mean [SD] age, 29.93 [4.76] years) met the criteria for postnatal depression diagnosis, 177 (2.0%) (mean [SD] age, 30.20 [5.01] years) of whom received postnatal SSRI treatment. More severe postnatal depression symptomology was associated with a range of adverse maternal and child outcomes. Focusing analyses only on the postnatal depression dyads indicated that postnatal SSRI treatment attenuated negative associations between postnatal depression and maternal relationship satisfaction at postpartum month 6 (moderation β, 0.13; 95% CI, 0.07-0.19), years 1.5 (moderation β, 0.11; 95% CI, 0.05-0.18) and 3 (moderation β, 0.12; 95% CI, 0.04-0.19), and for child ADHD at age 5 years (moderation β, -0.15; 95% CI, -0.24 to -0.05). Postnatal SSRI treatment mitigated the negative associations between postnatal depression and maternal depression, partner relationship satisfaction, child externalizing problems, and attention-deficit/hyperactivity disorder up to 5 years after childbirth. The results of this large prospective cohort study suggest that postnatal SSRI treatment was associated with a reduced risk of postnatal depression-associated maternal mental health problems and child externalizing behaviors across early childhood years. These findings suggest that postnatal SSRI treatment may bring benefits in the long term to women with postnatal depression and their offspring. This study potentially provides valuable information for clinicians and women with postnatal depression to make informed treatment decisions.

Maternal mental health is associated with children's frequency of family meals at 12 and 24 months of age.

Diet during the child's first years is important for growth and development. In toddlerhood, higher diet quality is reported among children eating meals together with family. Although previous literature has documented several associations between maternal mental health and early child feeding practices, less is known about the relationship between maternal mental health and child frequency of shared family meals. This study explores associations between maternal symptoms of anxiety and depression, measured by The Hopkins Symptoms Checklist (SCL-8), and toddler participation in family meals. We used cross-sectional data from the Norwegian study Early Food for Future Health, in which participants responded to questionnaires at child age 12 (n = 455) and 24 months (n = 295). Logistic regression was used to explore associations between maternal mental health and child having regular (≥5 per week) or irregular (<5 per week) family meals (breakfast and dinner), adjusting for relevant child and maternal confounding variables. Children of mothers with higher scores of anxiety and depression had higher odds of Irregular family meals at both timepoints; (OR: 2.067, p = 0.015) and (OR: 2.444, p = 0.023). This is one of few studies exploring associations between maternal mental health and child frequency of shared family meals in early childhood, a period where the foundation for life-long health is shaped. Given the high prevalence of mental ailments and disorders, these findings are important and may inform future public health interventions. Further exploration of this relation is needed, including longitudinal research to test predictive associations and qualitative studies to increase insight and understanding.

Oral language skills and mental health in female prisoners: pragmatic skills are essential.

There are strong indications of an elevated incidence of both language problems and problems with mental health among prisoners. We also know that women in prison are a particularly vulnerable group who often face conditions that foremost accommodate the needs of men. In order to adapt prison conditions to women's needs and give better help, we need more information about their characteristics. In this study, we wanted to explore associations between oral language problems and mental health (depression and anxiety) in women in prison. Participants were 58 women, recruited from high and low security women's and mixed prisons. They completed a questionnaire covering demographic variables and several self-report measures. In the present study, the language measures were a Language Composite score (comprising articulation, impressive and expressive language, and pragmatics) and the La Trobe Communication Questionnaire (LCQ), measuring pragmatic skills specifically. Hopkins Symptom Checklist-10 (HSCL) was used as a measure of psychological distress. First, we assessed correlations between the language measures and mental health. Second, we performed group comparisons with groups defined as over or under cut-off on the Language Composite, LCQ total, and HSCL total scores. Results supported a clear connection between overall language and overall mental health. Pragmatic skills were the main driver of this effect. There was no difference in mental health between those scoring above and below cut-off for general language problems but the group with possible pragmatic impairment showed poorer mental health than those without. Conversely, there was no difference in general language skills between the groups scoring within and outside the range of psychological distress, but the first group evaluated their pragmatic skills as significantly poorer than the latter. We conclude that pragmatics seem to be core to the association between oral language skills and mental health among female prisoners. This should have implications for language services in prisons, as attending to these issues could positively affect prognosis and outcome.

Cynical hostility increases whereas sense of coherence decreases the odds for current suicidal thoughts: A cross-sectional study of the general adult population sample.

Earlier, somatic diseases and mental disorders have been associated with cynical hostility as well as sense of coherence, but there is a gap of knowledge, whether they contribute to suicidality at population level. A random sample of adults, representative of the general population living in Finland, participated in a nationwide health examination study. For 4387 participants aged 18-97 years, we analyzed, after controlling for confounding factors, whether cynical hostility, as assessed with the 8-item Cook-Medley Hostility Scale, or sense of coherence, as assessed with the 13-item Sense of Coherence Scale, contributed to current suicidal thoughts during the past 7 days as scored on the 25-item Hopkins Symptom Checklist. Suicidal thoughts (current thoughts of ending one's life) were associated significantly with cynical hostility (p < 0.001) as well as with sense of coherence (p < 0.001). Of the specific items of cynical hostility, the item "I am sure that most people do not have problems with lying for their own good" was associated most strongly with current suicidal thoughts (p < 0.001). Cynical hostility predicted current suicidal thoughts in a population-based sample of adults aged 18-97 years. Sense of coherence protected from current suicidal thoughts.

Factors associated with maternal depressive symptoms up to 25 years after childbirth: A longitudinal prospective cohort study

AbstractDepression is one of the most common mental disorders among women and previous depression increases the risk for new episodes. Little is known about which factors are associated with maintained or recurrent depression in women, and studies with longer follow‐up time, 20 years or more, are scarce. Thus, the aim of the study was to identify factors associated with repeated self‐reports of depressive symptoms. The hypothesis was that factors such as young age at childbirth, divorce, unemployment, low social support, prior depression, or experience of stressful life events would increase the risk of repeatedly reporting depressive symptoms. The South East Sweden Birth Cohort study is a longitudinal, prospective cohort study. Out of the 1694 mothers enrolled at baseline, 649 participated in the 25‐year follow‐up. A total of 450 mothers participated in all three follow‐ups. The mothers reported symptoms of depression using validated instruments at 3 months (Edinburgh Postnatal Depression Scale), 12 years (Hopkins Symptom Checklist 25 items), and 25 years postchildbirth (Patient Health Questionnaire). Logistic regression was performed to evaluate the odds ratios of having depressive symptoms, whereas multinomial logistic regression was used to evaluate independent factors' association with the number of episodes with depressive symptoms. High life stress around pregnancy and childbirth and earlier depressive symptoms were associated with depressive symptoms at the 25‐year follow‐up. Similarly, high life stress around pregnancy and childbirth and the experience of divorce were associated with repeated self‐reports of depressive symptoms. Stressful life events are important predictors of depressive symptoms and repeated episodes of depressive symptoms from the postnatal period until 25 years later. Moreover, previous depressive symptoms increase the risk for subsequent episodes. The results further stress the importance of identifying mothers experiencing depressive symptoms postpartum to enable treatment and early intervention.

Associations between pain-related temporomandibular disorders and dental anxiety at 46 years of age in the Northern Finland Birth Cohort 1966

Objectives The aims were (1) to study the association between dental anxiety (DA) and temporomandibular disorders (TMDs) and whether subgroups formed differ in psychological symptoms and pain sensitivity in the Northern Finland Birth Cohort 1966 and (2) to confirm the factor structure of the Hopkins Symptom Checklist-25 assessing psychological symptoms. Materials and methods Data were acquired using questionnaires and clinical examinations at age 46 years (n = 1889). Dental anxiety was assessed with Modified Dental Anxiety Scale (MDAS). Pain-related TMD (myalgia, arthralgia) were assessed according to modified diagnostic criteria for temporomandibular disorders. Pressure pain threshold and tolerance were measured with an algometer. Explanatory factor analysis revealed three factors, named ‘depression’, ‘anxiety’ and ‘distress’. Results Those with high DA and myalgia and/or arthralgia reported higher depression (mean = 1.52), anxiety (mean = 1.61) and distress (mean = 2.06) scores, and lower pressure pain threshold (mean = 496 kPa) and tolerance (mean = 741 kPa) values than those with only DA (1.22; 1.56; 1.84; 613; 875), TMD (1.21; 1.39; 1.83; 600; 908) or neither (1.12; 1.29; 1.58; 707; 1006), respectively. Conclusions Patients with DA and/or myalgia/arthralgia have similar profiles regarding pain sensitivity and psychological symptoms, the burden being highest among those with DA and a TMD diagnosis.

Correlation between the Symptoms of Major Depression during Pregnancy, Fetal Indicators and Delivery Complications

Introduction: Studies have shown a high prevalence rate of the symptoms of major depression in the general population of women on Kosovo (43.18%), therefore research on the impact of depression during pregnancy on the intrauterine fetal development and complications during and after delivery in the population of women on Kosovo at reproductive age has scientific and professional rationale. Objective: The purpose of the study is to research correlation of major depression symptoms during pregnancy with the indicators of intrauterine fetal development and complications during delivery. Method: The research is prospective randomized and after fulfilling the selective criteria included three hundred pregnant women in the second trimester and at the beginning of the third trimester of pregnancy in the general population of women on Kosovo. Scale of the major depression symptoms was determined with the Hopkins Symptom Check List (HSCL-25). Statistical package for results analysis included software SPSS 12, ANOVA analyses, frequencies, Chi square test, and linear regression analysis. Results: Significant correlation was proven between the symptoms of major depression during early and mid-pregnancy with: uterine contractions at the beginning of labor, perineal lacerations during delivery, tachycardia in the newborn baby, duration of newborn’s stay in the neonatal intensive care unit, the woman's duration of hospital stay in the department before and after delivery, and the delayed start of breastfeeding. Findings proved that there is no significant correlation between the emotional state of pregnant women and the slowing down of the intrauterine fetal development. Discussion: Based on the study results and the data from the literature, these clinical correlations are a result of interaction between the major depression during pregnancy with neuroendocrine trajectories of pregnancy, fetus and placental functions. Conclusion: Major depression during early and mid-term pregnancy may have impact on specific clinical parameters of the childbirth and newborn baby. The obtained results suggest the need for systematic mental health support of the woman during pregnancy.

The Impact of Unspecified Anxiety during Pregnancy on the Fetus Development and Childbirth Complications

Introduction: The high levels of chronic psychosocial stress and traumatic experiences faced by the general population of Kosovo in recent decades resulted in a high prevalence of unspecified anxiety (45.17%) among women at the reproductive age. On this psychological ground there are objective hypotheses that fetal growth and childbirth process may be affected. Objective: The purpose of the study is to research the correlation of unspecified anxiety during pregnancy with the intrauterine development of the fetus and complications during childbirth. Method: The research is prospective randomized and after fulfilling the selective criteria included three hundred (300) pregnant women in the second trimester and at the beginning of the third trimester of pregnancy in the general population of women on Kosovo. Scale of unspecified anxiety was determined with the Hopkins Symptom Check List (HSCL-25). Statistical package for results analysis included software SPSS 12, ANOVA analyses, frequencies, Chi square test, and linear regression analysis. Results: Findings proved that there is no significant correlation between the emotional state of pregnant women and the slowing down of the intrauterine fetal development. However, the study proved the significant correlation between the degree of unspecified anxiety during early and mid-term pregnancy with the degree of cervix effacement at the beginning of the birth act, and with tachycardia in the newborn baby. Discussion: Based on the study results and the data from the literature, these clinical correlations occur based on the interference of unspecified anxiety during pregnancy with neuroendocrine trajectories of pregnancy, fetus and placental functions. Conclusion: Unspecified anxiety during early and mid-term pregnancy may initiate cervix effacement and may cause fetal tachycardia at birth. The obtained results suggest the need for greater care for the emotional state of the woman during pregnancy.

Antenatal depression and adverse birth outcomes among pregnant women living with HIV in Dar es Salaam, Tanzania

BackgroundWomen who experience antenatal depression may be at increased risk of adverse birth outcomes. Few studies have examined this association among women living with HIV (WHIV). MethodsWe conducted a prospective cohort study of 2298 pregnant WHIV on antiretroviral therapy (ART) in Dar es Salaam, Tanzania, who were participants in a randomized trial of vitamin D3 supplementation. Depressive symptoms were assessed at 12–27 weeks gestation using the Hopkins Symptoms Checklist (HSCL-25). Generalized estimating equations to account for twins were used to assess the relative risks of adverse birth outcomes. ResultsApproximately 67 % of the women in our study population reported symptoms consistent with depression. We observed a 4.0 % prevalence of stillbirth and a 25.1 % prevalence of preterm birth. We found that low social support, higher education, and more recent initiation of ART were associated with a greater risk of antenatal depression. There was no association of antenatal depression with risk of fetal loss, stillbirth, low birth weight, birth weight, preterm birth, gestational age at delivery, or small-for-gestational age. LimitationsDepression was self-reported and only collected at one timepoint in pregnancy. Our findings may not be generalizable to all WHIV. ConclusionsOur findings illustrate the high risk of both depression and adverse birth outcomes among WHIV and underscore the need for interventions to improve their mental health and the health of their infants; however, the relationship between depression and birth outcomes remains unclear. Further research on this topic is merited, particularly examining the chronicity and timing of depression in pregnancy.

Modeling the direct and indirect relationships between cognitive style, daily life stress and mental distress

Daily life stress is a trigger of mental illness in college students who are in late adolescence and in the dominant age group of mental illness. This study clarified the effects of the cognitive style of empathizing-systemizing(E-S) together with daily life stress on mental distress through a mediation process with cognitive appraisal and coping style. Gender differences in the relationship were also investigated. The scales of empathizing and systemizing, daily life stress, cognitive appraisal rating, tri-axial coping, and Hopkins symptom checklist were administrated to second-year Japanese college students using an anonymous questionnaire. The size of 804 (403 men, and 401 women) cross-sectional data, with the average age of 19.62 years were obtained. The valid response rate was 82.4%. Simultaneous multiple group analysis revealed that higher mental distress was directly associated with lower empathizing in men, while it was associated with higher systemizing in women. The model showed that the effects of E-S and daily life stress on mental distress were mediated by the mediation process. The relationship between daily life stress and mental distress was smaller than that between E-S and mental distress. The E-S directly related to cognitive appraisal which were also predicted by daily life stress, but not directly related to coping. This study is a cross-sectional study. Future longitudinal studies are needed to identify causal relationships between cognitive styles and strategies, and mental distress. The cognitive style (E-S) can be more important indicators of mental distress than daily life stress in late adolescent college students.

A Prospective Biopsychosocial Repeated Measures Study of Stress and Dropout from Substance Addiction Treatment.

This prospective, repeated-measures observational study tested biopsychosocial variables as risk factors for dropping out of inpatient substance addiction treatment. Substance use disorder (SUD) is viewed as a chronic relapsing disease caused by an interaction between biological, psychological, and social factors. However, there is a lack of prospective studies that combine biopsychosocial variables when assessing dropout. The aims of this study were to investigate whether there was 1) An association between biopsychosocial factors and dropping out of inpatient substance addiction treatment, 2) An interaction with SUD diagnosis and cortisol, and 3) Different dropout rates between short-term and long-term institutions. Patients (n = 173) were recruited from two inpatient treatment centers in Norway between 2018 and 2021. The following biopsychosocial variables were measured at four timepoints: ward atmosphere (Ward Atmosphere Scale, WAS), psychological distress (Hopkins Symptom Checklist 10, HSCL-10), motivation (M-scale of the Circumstances, Motivation, Readiness, and Suitability questionnaire), and concentration of salivary cortisol (CORT- nmol/L). Cortisol levels were measured for two consecutive days at each timepoint and calculated by two cortisol indices, daytime cortisol slope (DCS) and area under the curve with respect to the ground (AUCG). A multivariate logistic regression analysis was performed to find an association between dropout rates and the biopsychosocial variables. The results suggest a lower dropout odds for patients with high motivation (OR = 0.76, p = 0.022) and patients admitted to short-term treatment (OR = 0.06, p = 0.005). An interaction with stimulant SUD and DCS (OR = 13.74, p = 0.024) also revealed higher dropout odds. No statistical significance was found for psychological distress, WAS, and cortisol AUCG. The results support monitoring motivation during treatment and further investigating biopsychosocial variables when assessing dropout risk together with SUD diagnosis.

Assessment of Psychological Trauma among the Female Adolescents under the Care of One Shelter- Cebu

This research study is descriptive and evaluative by nature using two standardized screening instruments- the Harvard Trauma Questionnaire (HTQ) and the Hopkins Symptoms Checklist (HSCL). This is aimed to identify the specific events that have caused trauma on the sixty-two 62 girls under the care of ONE SHELTER-CEBU as well as to assess the impact of these trauma events by identifying the distressing symptoms that they have experienced, with the end in view of coming up with a trauma-informed and responsive intervention plan to help these girls in their healing journey.The study was able to identify the top five trauma events that were commonly experienced, witnessed, and heard about by the girls, as well as the top five symptoms of post-traumatic stress disorder (PTSD), anxiety and depression that they commonly shared.It was found out in the assessment that only (24.19%) of the girls are symptomatic for Post-Traumatic Stress Disorder,(59.68%) are symptomatic for Anxiety, and (69.35%) are symptomatic for Depression. By examining the correlation coefficient of the data, it showed that the three scales- Depression, Anxiety, and PTSD are highly correlated, which means that all these three have a comorbidity relationship and they tend to co-exist in an individual either in a duo or trio.In conclusion, majority of the girls in ONE SHELTER-CEBU are still suffering from psychological trauma most especially on their personal experience of sexual abuse in the past as evidenced in their disturbing symptoms, thus, they are really in dire need of an intervention- a professional help.

Perinatal HIV exposure and infection and caregiver depressive symptoms

ABSTRACT Survival is possible for children perinatally exposed to or infected by HIV in the post-combined antiretroviral therapy era and identifying factors affecting children’s ability to thrive has public health significance. Caregiver mental health is one such factor to consider given its impact on child development, but previous work has not included a full complement of HIV exposure/infection groups within HIV-endemic settings. We compared depressive symptoms among caregivers of 3 groups of 6-10-year-olds in Uganda: children with perinatally acquired HIV infection (CPHIV, n = 102), children with perinatal HIV exposure, but no infection (CPHEU, n = 101), and children without perinatal HIV exposure or infection (CHUU, n = 103). The Hopkins Symptom Checklist was used to assess caregiver depressive symptoms. Generalized linear models were used to estimate group mean differences. Adjusted models included caregiver demographics, social support, and lifetime trauma. Depression symptoms were higher among CPHEU compared to CPHIV caregivers (model coefficient [B] = −3.5, 95%CI −5.3, −1.8). This finding was minimally attenuated following adjustment for covariates (B = −2.2, 95%CI −4.1, −0.4) and among biological mothers. At lower levels of social support and wealth, CPHEU caregivers reported higher levels of depression symptoms than CPHIV caregivers. Our findings point to unmet mental health needs among CPHEU caregivers.

Sensitivity and Attachment in an Italian Sample of Hikikomori Adolescents and Young Adults.

Hikikomori is a severe form of social withdrawal increasing among the young Italian population. Hikikomori has been connected to psychological problems and high environmental sensitivity. Nevertheless, only a few studies have been carried out in the Italian context, and they did not analyze several aspects strictly related to the hikikomori phenomenon, such as the role of attachment and sensitivity. We aimed to investigate the relationship between attachment, sensitivity, and psychological problems in a sample of Italian hikikomori. Our sample comprised 72 Italian adolescents and young adults (49 males and 23 females), meanly aged 22.5 years, recruited through online forums and clinical centers for the hikikomori phenomenon. Our participants fulfilled the Highly Sensitive Person Scale (HSPS), the Attachment Style Questionnaire (ASQ), and the Hopkins Symptom Checklist (SCL-90-R). The results showed high psychological issues (i.e., depression and anxiety), environmental sensitivity, and insecure attachment orientations. Moreover, we discovered a significant relationship between attachment dimensions, environmental sensitivity, and psychopathology. Our study sheds light on a novel research path and could help both the researchers and the clinicians who work with people suffering from social withdrawal.

Increased prevalence of depression and anxiety among adults initiating antiretroviral therapy during the COVID-19 pandemic in Shinyanga region, Tanzania

BackgroundConcerns about the interconnected relationship between HIV and mental health were heightened during the COVID-19 pandemic. This study assessed whether there were temporal changes in the mental health status of people living with HIV presenting for care in Shinyanga region, Tanzania. Specifically, we compared the prevalence of depression and anxiety before and during COVID-19, with the goal of describing the changing needs, if any, to person-centered HIV services.MethodsWe analyzed baseline data from two randomized controlled trials of adults initiating ART in Shinyanga region, Tanzania between April-December 2018 (pre-COVID-19 period, n = 530) and May 2021-March 2022 (COVID-19 period, n = 542), respectively. We compared three mental health indicators that were similarly measured in both surveys: loss of interest in things, hopelessness about the future, and uncontrolled worrying. We also examined depression and anxiety which were measured using the Hopkins Symptom Checklist-25 in the pre-COVID-19 period and the Patient Health Questionnaire-4 in the COVID-19 period, respectively, and classified as binary indicators per each scale’s threshold. We estimated prevalence differences (PD) in adverse mental health status before and during the COVID-19 pandemic, using stabilized inverse probability of treatment weighting to adjust for underlying differences in the two study populations.ResultsWe found significant temporal increases in the prevalence of feeling ‘a lot’ and ‘extreme’ loss of interest in things [‘a lot’ PD: 38, CI 34,41; ‘extreme’ PD: 9, CI 8,12)], hopelessness about the future [‘ a lot’ PD: 46, CI 43,49; ‘extreme’ PD: 4, CI 3,6], and uncontrolled worrying [‘ a lot’ PD: 34, CI 31,37; ‘extreme’ PD: 2, CI 0,4] during the COVID-19 pandemic. We also found substantially higher prevalence of depression [PD: 38, CI 34,42] and anxiety [PD: 41, CI 37,45].ConclusionsAfter applying a quasi-experimental weighting approach, the prevalence of depression and anxiety symptoms among those starting ART during COVID-19 was much higher than before the pandemic. Although depression and anxiety were measured using different, validated scales, the concurrent increases in similarly measured mental health indicators lends confidence to these findings and warrants further research to assess the possible influence of COVID-19 on mental health among adults living with HIV.Trial Registration NCT03351556, registered November 24, 2017; NCT04201353, registered December 17, 2019.

Associations Between Social Support and Symptoms of Antenatal Depression with Infant Growth and Development Among Mothers Living with HIV in Tanzania.

Children born to mothers living with HIV may experience greater risk of poor growth and development outcomes than their HIV-unexposed peers. Few studies have examined the relationship between maternal depression and social support with infant growth and development in the context of HIV. We conducted a prospective cohort study of 2,298 pregnant women living with HIV in Dar es Salaam, Tanzania, assessing antenatal depression (Hopkins Symptoms Checklist-25) and social support (Duke-UNC Functional Social Support Questionnaire) at 12-27 weeks of gestation. At one-year age, infant anthropometry and caregiver-reported infant development were assessed. Generalized estimating equations were used to assess mean differences (MD) and relative risks (RR) for growth and developmental outcomes. Symptoms consistent with maternal antenatal depression had 67% prevalence and were associated with infant wasting (RR 2.61; 95% confidence interval (CI) 1.03-6.65; z = 2.02; p = 0.04), but no other growth or developmental outcomes. Greater maternal social support was not associated with infant growth outcomes. Greater affective support was associated with better cognitive (MD 0.18; CI 0.01-0.35; z = 2.14; p = 0.03) and motor (MD 0.16; CI 0.01-0.31; z = 2.04; p = 0.04) development scores. Greater instrumental support was associated with better cognitive (MD 0.26; CI 0.10-0.42; z = 3.15; p < 0.01), motor (MD 0.17; CI 0.02-0.33; z = 2.22; p = 0.03), and overall (MD 0.19; CI 0.03-0.35; z = 2.35; p = 0.02) development scores. Depressive symptoms were associated with greater risk of wasting, while social support was associated with better infant development scores. Strategies to improve mental health and social support for mothers living with HIV during the antenatal period may benefit infant growth and development.

Trait and symptom change in group cognitive behaviour therapy for anxiety and depression.

Personality traits underlying both anxiety disorders and depression are more malleable than previously presumed. This study examined associations between changes in personality traits (i.e. negative affectivity and detachment) and alleviation of anxiety and depression symptoms following cognitive behaviour therapy (CBT). We hypothesized that decreases in negative affectivity would predict alleviation of depression and anxiety symptoms and decreases in detachment would predict decreases in depression and, to a lesser degree, anxiety symptoms. Data (N = 156) were collected in a randomized controlled trial comparing transdiagnostic and diagnosis-specific group CBT for patients with major depressive disorder, social anxiety disorder, panic disorder or agoraphobia. We assessed personality traits using the Personality Inventory for DSM-5 (PID-5) and symptoms with the Hopkins Symptom Checklist 25-item scale (SCL). Prediction was based on regression analyses. We found that decreases in negative affectivity predicted lower levels of depression and anxiety symptoms while decreases in detachment only predicted lower levels of depression symptoms. The findings substantiate current efforts to explicate the dynamic interplay between personality traits and symptoms and support the existing focus on targeting negative affectivity and detachment in therapy for anxiety disorders and depression. The trial is registered at clinicaltrials.gov (ID NCT02954731).

The network structure of dysfunctional metacognitions, CAS strategies, and symptoms

In the metacognitive model of psychological disorders, metacognitive strategies and corresponding underlying metacognitive beliefs intensify and maintain emotional distress symptoms. In the current study, our three objectives were to evaluate and replicate the network structure of dysfunctional metacognitions as assessed with the MCQ-30, to examine its stability when adding relevant covariates in the form of metacognitive strategies (worry and rumination) and symptoms (anxiety and depression), and to evaluate how different sets of dysfunctional metacognitions are more or less strongly linked differently to metacognitive strategies and symptoms. A cross-sectional university sample with a mean age of 26 years (N = 440; Males = 156, Females = 283) completed the Metacognitions Questionnaire–30, Penn State Worry Questionnaire, Ruminative Response Scale, and Hopkins Symptom Checklist. Data were analysed using psychological network analysis in R-studio statistical software. The network structure of dysfunctional metacognitions replicated well with item clusters that correspond to clinically meaningful substructures in the metacognitive model. Negative metacognitive beliefs and beliefs about uncontrollability might have more functional significance in the mutual connections between dysfunctional meta-domains as well as the connections with metacognitive strategies and symptoms. For worry and anxiety, negative beliefs about uncontrollability and corresponding danger of worry were more prominently connected in the network structure. For rumination, cognitive self-consciousness was more prominent, whereas for depression, need for control was more prominently connected. Support was found for mutual interdependence between different sets of dysfunctional metacognitive beliefs, that metacognitive beliefs are linked to but separate from metacognitive strategies, and that these may function together in affecting emotional distress symptoms