Lifetime Diagnosis Research Articles

Associations of Transactional Sex and Sexually Transmitted Infections Among Treatment-Seeking Individuals With Opioid Use Disorder

Coinciding with the rise in opioid use across the U.S., the rates of sexually transmitted infections have reached historically high levels, underscoring the need to understand multiple pathways of disease spread. Although prevention is often focused on injection-related behaviors, this study sought to identify the prevalence and associations of a little understood pathway, transactional sex, among individuals with opioid use disorder, including associations of transactional sex with the prevalence of sexually transmitted infection diagnoses. Data were sourced from a nationwide opioid surveillance program of treatment-seeking individuals with opioid use disorder utilizing a serial, cross-sectional survey of 4,366 new entrants to 1 of 99 substance use treatment programs for opioid use disorder in 37 states from October 2018 to June 2021. A quarter of the sample (24.9%) self-reported a lifetime history of transactional sex for drugs, with rates highest for sexual (56.6%) and gender (53.8%) minority, female (33.4%), Latinx (30.4%), and Black (29.6%) subgroupings. Lifetime diagnoses of all specific sexually transmitted infections analyzed were significantly higher (p<0.001) among those reporting transactional sex, particularly syphilis (14.3% vs 4.4%) and HIV (4.0 vs 0.9%). Financial hardship, trauma, and psychiatric disorder were significantly associated with transactional sex engagement. Transactional sex is relatively common among patients with opioid use disorder, particularly among sexual/gender minorities, which was associated with a greater lifetime prevalence of all sexually transmitted infections assessed. Sexually transmitted infection testing remains at low levels within substance use treatment programs, occurring in just 26.3% of programs; sexual health screenings and sexually transmitted infection prevention/testing need to be prioritized and integrated into opioid use disorder patient care.

Personalized digital intervention for depression based on social rhythm principles adds significantly to outpatient treatment.

We conducted a 16-week randomized controlled trial in psychiatric outpatients with a lifetime diagnosis of a mood and/or anxiety disorder to measure the impact of a first-of-its-kind precision digital intervention software solution based on social rhythm regulation principles. The full intent-to-treat (ITT) sample consisted of 133 individuals, aged 18–65. An exploratory sub-sample of interest was those individuals who presented with moderately severe to severe depression at study entry (baseline PHQ-8 score ≥15; N = 28). Cue is a novel digital intervention platform that capitalizes on the smartphone's ability to continuously monitor depression-relevant behavior patterns and use each patient's behavioral data to provide timely, personalized “micro-interventions,” making this the first example of a precision digital intervention of which we are aware. Participants were randomly allocated to receive Cue plus care-as-usual or digital monitoring only plus care as usual. Within the full study and depressed-at-entry samples, we fit a mixed effects model to test for group differences in the slope of depressive symptoms over 16 weeks. To account for the non-linear trajectory with more flexibility, we also fit a mixed effects model considering week as a categorical variable and used the resulting estimates to test the group difference in PHQ change from baseline to 16 weeks. In the full sample, the group difference in the slope of PHQ-8 was negligible (Cohen's d = −0.10); however, the Cue group demonstrated significantly greater improvement from baseline to 16 weeks (p = 0.040). In the depressed-at-entry sample, we found evidence for benefit of Cue. The group difference in the slope of PHQ-8 (Cohen's d = −0.72) indicated a meaningfully more rapid rate of improvement in the intervention group than in the control group. The Cue group also demonstrated significantly greater improvement in PHQ-8 from baseline to 16 weeks (p = 0.009). We are encouraged by the size of the intervention effect in those who were acutely ill at baseline, and by the finding that across all participants, 80% of whom were receiving pharmacotherapy, we observed significant benefit of Cue at 16 weeks of treatment. These findings suggest that a social rhythm-focused digital intervention platform may represent a useful and accessible adjunct to antidepressant treatment (https://clinicaltrials.gov/ct2/show/NCT03152864?term=ellen+frank&draw=2&rank=3).

Trajectories of income offending: examining PTSD as a predictor of development

ABSTRACT Income offending presents a major criminal justice issue associated with generating financial gain through illicit means. Such crimes may cause financial harm on an individual level and lead to additional strain on our criminal justice system when criminals who engage in such offending are caught and prosecuted. Post-traumatic stress disorder (PTSD) may present one mental health risk factor associated with differential development of income offending patterns across the life-course. This is because issues like low impulse control and potentially substance use habits that are often observed in PTSD may result in an increased risk for income offending among individuals with the disorder. This study sought to identify heterogeneity in income offending patterns and determine the relevance of PTSD as a risk factor. The Pathways to Desistance data were used in analyses. Group-based trajectory modeling was utilized to identify heterogeneity in developmental patterns of income offending. Multinomial logistic regression was used to examine the relevance of PTSD as predictor of development. Results indicated that a six-group trajectory model best fit the data. Meeting criteria for a lifetime diagnosis of PTSD predicted increased risk of assignment to the High Chronic income offending group. Implications are discussed.

Prospective Cohort Study of Depression During Pregnancy and the Postpartum Period in Women With Epilepsy vs Control Groups.

Assess the incidence and factors associated with major depressive episodes (MDEs) and symptoms of depression and anxiety during pregnancy and postpartum periods in pregnant women with epilepsy (PWWE) compared with healthy pregnant women (HPW) and nonpregnant women with epilepsy (NPWWE) in comparable timeframes. Previous studies have reported higher rates of postpartum depression in women with epilepsy compared with women without epilepsy. However, the incidence of MDE using a structured interview during pregnancy and postpartum has not been directly compared with control groups, and the comparison of depression and anxiety symptoms and the role of associated factors remain ambiguous. The Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs study is a multicenter NIH-funded prospective observational parallel group cohort study of PWWE and their children. This report examines mood disorders. Unlike previous epilepsy pregnancy studies, the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-IV (SCID) provided lifetime diagnoses, and repeated SCID mood modules assessed for MDE, the a priori primary outcome. Symptoms of depression (Beck Depression Inventory [BDI] and Edinburg Postnatal Depression Scale [EPDS]) and anxiety (Beck Anxiety Inventory [BAI]) were also assessed along with multiple clinical factors. This study included PWWE (n = 331) and HPW (n = 102) during pregnancy and postpartum and NPWWE (n = 102) at comparable times. No difference in SCID-diagnosed MDE incidence was found across groups, but BDI depressive symptoms were worse during pregnancy in PWWE vs NPWWE and during postpartum vs HPW and NPWWE. BAI anxiety symptoms were worse during pregnancy in PWWE vs HPW and NPWWE and during postpartum vs HPW. Factors associated with MDE during pregnancy/postpartum for PWWE included >1 seizure/90 days, anticonvulsant polytherapy, unplanned pregnancy, and lifetime history of mood disorder. Suicidal ideation from BDI or EPDS was related to BAI anxiety symptoms. Although SCID-based MDE did not differ across groups, this prospective study confirms higher rates of psychiatric symptoms in patients with epilepsy during pregnancy and postpartum, provides new data on associated factors, and underscores the importance of anxiety in risk for depression and thoughts of death/dying or suicide. Given the risks, PWWE should be routinely assessed and symptomatic patients should be offered treatment. This study is registered at ClinicalTrials.gov as NCT01730170.

Is psychedelic use associated with cancer?: Interrogating a half-century-old claim using contemporary population-level data.

In 1967, concerns about the carcinogenic potential of psychedelics arose after a study reported chromosomal damage in human leukocytes following in vitro lysergic acid (LSD) exposure. Worries were further heightened by subsequent reports of leukemia and other cancers in LSD users. Additional investigations of psychedelics' effects on chromosomes were published over the next decade, with the majority suggesting these concerns were unfounded. However, the relationship between psychedelics and cancer has been explored only minimally from an epidemiological perspective. To determine whether associations exist between psychedelic use and either lifetime cancer or hematologic cancer diagnoses. We analyzed data from adult participants in the 2015-2019 administrations of the National Survey on Drug Use and Health for associations between lifetime use of psychedelics and lifetime diagnosis of either any cancer or hematologic cancer. We identified no associations between lifetime psychedelic use and either lifetime cancer diagnosis or hematologic cancer diagnosis. Sub-analyses of lifetime lysergamide, phenethylamine, and tryptamine use also revealed no associations with lifetime cancer or hematologic cancer diagnosis. While laboratory studies and case reports from the 1960s and 1970s generated concerns about psychedelics' carcinogenic potential, this analysis of recent epidemiological data does not support an association between psychedelic use and development of cancer in general or hematologic cancer. Important study limitations to consider include a lack of information about psychedelic dosage, number of lifetime psychedelic exposures, and the temporal relationship between psychedelic use and cancer diagnosis.

Baseline Characteristics and Their Associations with Body Composition of Active-Duty Service Members Enrolling in a Randomized Controlled Trial of a Weight Management Program.

Increasing rates of overweight and obesity among military service members (SMs) necessitate the implementation of weight management interventions. Evidence for the effectiveness of military weight management interventions is mixed. Effectiveness may be impacted by individual sociodemographic, psychiatric, psychological, and behavioral factors. Baseline data from SMs who were overweight/obese or at risk of failing body composition or physical fitness tests and enrolling in a weight management randomized controlled trial were used to examine (1) individual characteristics of this sample as a whole and by gender and (2) relationships between those characteristics and body composition metrics that are targeted by military weight management interventions. Understanding these relationships may inform intervention approaches. Active duty SMs (N = 178) who enrolled in a randomized clinical trial of the Navy's weight management program "ShipShape" at a large military hospital provided data at their baseline visit. Because of gender differences in average body fat percentage (BF%) and underrepresentation of women SMs in research, independent samples t-tests and chi-square analyses were used to examine differences between male and female SMs across study variables. Multiple regression analyses were used to examine relationships of sociodemographic, psychiatric, psychological, and behavioral variables with body composition metrics, including weight, body mass index (BMI), BF%, and waist circumference (WC). Participants (61% female; Mage = 29.66 ± 6.92 years; 59.60% White) had an average BMI in the "obese" range (MBMI = 33.1 ± 3.9 kg/m2). Female participants had significantly higher BF% and significantly lower weight and WC than male participants. Compared to male participants, females reported significantly higher rates of pain and headache diagnoses, lifetime diagnosis of an anxiety disorder, lifetime treatment for a mental health concern, lifetime experiences of sexual trauma/harassment and military sexual trauma, and higher current anxiety and post-traumatic stress disorder symptoms. Across all SMs, body composition metrics were significantly associated with several demographic variables, including gender, age, marital status, Asian race, and Black race. Higher weight-related stigma was significantly associated with higher weight, BMI, BF%, and WC. Additionally, more emotional eating was significantly associated with higher BF%, and higher weight-loss confidence was significantly associated with higher BMI. Sociodemographic, psychiatric, psychological, and behavioral variables predicted the greatest variance in BF% compared to other body composition metrics evaluated. Participants in this study were more likely to be female, relatively young members of the Navy with overweight/obesity, who endorsed pain-related medical conditions, probable mental health conditions, and traumatic experiences at relatively high rates. Despite high endorsement of anxiety, depression, and post-traumatic stress disorder symptoms in this group, only weight-related stigma consistently emerged as significantly associated with body composition metrics. Regression results varied by body composition metric, with the most variance explained in BF%, suggesting that BF% may relate most strongly to sociodemographic, psychiatric, psychological, and behavioral variables associated with weight management. These results highlight the need for weight management programs that address weight-related stigma and mental health concerns of SMs to maximize the effectiveness of intervention efforts.

Association between chronic disease multimorbidity and leisure-time physical activity: Evidence from the China Multiethnic Cohort study.

ObjectiveTo reveal the associations between multimorbidity and leisure-time physical activity (LTPA) by ethnicities in China.Materials and methodsSelf-reported information on a range of occupational, household, transport, and LTPA was collected by interviewer-administered questionnaire. A total of 17 chronic diseases were assessed based on self-reported lifetime diagnoses or medical examinations. Multivariable logistic regression models were used to assess the associations between multimorbidity and the risks of low LTPA.ResultsThe mean age of all participants was 51.2 years old. Of all, 61.4% were women and 57.9% were from the Han population. A significantly negative association (OR = 0.92, 95% CI = 0.89–0.95) was found between multimorbidity and low LTPA, with a stronger association among minority populations (OR = 0.86, 95% CI = 0.82–0.91) than among the Han population (OR = 0.96, 95% CI = 0.92–1.01). For both the minority population and the Han population, digestive system multimorbidity and digestive-metabolic system multimorbidity had a significantly negative association with low LTPA. For the Han population, the association of intersystem multimorbidity for the circulatory-respiratory system (OR = 1.17, 95% CI = 1.04–1.31) with low LTPA was stronger than that of intrasystem multimorbidity for the circulatory (OR = 1.12, 95% CI = 1.01–1.25) and respiratory systems (OR = 1.14, 95% CI = 1.04–1.25).ConclusionThere are significant associations between multimorbidity and low LTPA based on this large multiethnic population. Our findings suggest that LTPA-tailored interventions should be designed for specific ethnic groups according to different types of multimorbidity.

Hippocampal cingulum white matter increases over time in young people at high genetic risk for bipolar disorder

BackgroundBipolar disorder (BD) is a strongly familial psychiatric disorder associated with white matter (WM) brain abnormalities. It is unclear whether such abnormalities are present in relatives without BD, and little is known about WM trajectories in those at increased genetic risk. MethodsDiffusion magnetic resonance imaging (dMRI) data were acquired at baseline and after two years in 91 unaffected individuals with a first-degree relative with bipolar disorder (HR), and 85 individuals with no family history of mental illness (CON). All participants were aged between 12 and 30 years at baseline. We examined longitudinal change in Fractional Anisotropy (FA) using tract-based spatial statistics (TBSS). ResultsCompared to the CON group, HR participants showed a significant increase in FA in the right cingulum (hippocampus) (CGH) over a two-year period (p < .05, FDR corrected). This effect was more pronounced in HR individuals without a lifetime diagnosis of a mood disorder than those with a mood disorder. LimitationsWhile our study is well powered to achieve the primary objectives, our sub-group analyses were under powered. ConclusionsIn one of the very few longitudinal neuroimaging studies of young people at high risk for BD, this study reports novel evidence of atypical white matter development in HR individuals in a key cortico-limbic tract involved in emotion regulation. Our findings also suggest that this different white matter developmental trajectory may be stronger in HR individuals without affective psychopathology. As such, increases in FA in the right CGH of HR participants may be a biomarker of resilience to mood disorders.

Severity features of suicide attempters with epilepsy

BackgroundAfter the Food and Drug Administration alert about antiepileptic medication and suicide, incident epilepsy has been associated with first or recurrent suicide attempts independently of psychiatric comorbidities and antiepileptic treatment. Following this thread, the aim of this study was to analyze if epilepsy was associated with a higher severity of lifetime suicide attempts (SAs). MethodsAnalyses were carried out on 1677 adults hospitalized between 1999 and 2012 after a SA in a specialized ward for affective episodes. Five severity features were studied: frequent SAs (>2), early onset of first SA (≤26 years), history of violent SA, high suicide intent and high lethality of the SA. Adjusted logistic regression models were used to estimate the association between the lifetime diagnosis of epilepsy and the severity features. ResultsAmong suicide attempters, ninety-three patients reported a lifetime diagnosis of epilepsy (5.5%). Epileptic patients diagnosed after the first SA were more likely to be frequent suicide attempters than non-epileptic ones. They showed also higher SA planification scores. LimitationsDiagnosis accuracy is limited by the use of self-reports for epilepsy. The lack of precise information about the disease course and treatment have not allowed for further statistical analysis. With regard to psychiatric comorbidities, personality disorders could not be taken into account. ConclusionsSuicide attempters with epilepsy present an increased severity in some aspects of their suicidal behavior regardless of demographic and clinical variables. Our results give support to the existence of a bidirectional association between epilepsy and suicidal behavior.

Adverse Childhood Experiences and Their Relationship with Poor Sexual Health Outcomes: Results from Four Cross-Sectional Surveys.

Improving understanding of risk factors for risky sexual behaviour is fundamental to achieve better population sexual health. Exposure to adverse childhood experiences (ACEs) can increase the risk of poor sexual health outcomes, but most research is US-based. This study explored associations between ACEs and poor sexual health outcomes in the UK. Data from four cross-sectional ACE surveys with adult general populations in different regions of the UK from 2013–2015 (n = 12,788) were analysed. Data included participants’ demographics, ACE exposure, and four sexual health outcomes: having early sex (<16 years), having an accidental teenage pregnancy, becoming a teenage parent, or having a lifetime diagnosis of a sexually transmitted infection. ACE count was a consistent and significant predictor of all four sexual health outcomes for both males and females, with odds of these outcomes between three and seven times higher for those with 4+ ACEs compared to those with no ACEs. Increased risks of some, but not all, sexual health outcomes were also found with higher residential deprivation, younger age, being of white ethnicity, and being born to a teenage mother. Findings highlight the need for effective interventions to prevent and ameliorate the lifelong effects of ACEs. Trauma-informed relationships and sex education, sexual health services, and antenatal/postnatal services, particularly for teenagers and young parents, could provide opportunities to prevent ACEs and support those affected. Ensuring that those living in deprived areas have access to services and that barriers to uptake are addressed is also key.

Identification of undiagnosed atrial fibrillation using a machine learning risk prediction algorithm and diagnostic testing (PULsE-AI) in primary care: cost-effectiveness of a screening strategy evaluated in a randomized controlled trial in England

Objective The PULsE-AI trial sought to determine the effectiveness of a screening strategy that included a machine learning risk prediction algorithm in conjunction with diagnostic testing for identification of undiagnosed atrial fibrillation (AF) in primary care. This study aimed to evaluate the cost-effectiveness of implementing the screening strategy in a real-world setting. Methods Data from the PULsE-AI trial – a prospective, randomized, controlled trial conducted across six general practices in England from June 2019 to February 2021 – were used to inform a cost-effectiveness analysis that included a hybrid screening decision tree and Markov AF disease progression model. Model outcomes were reported at both individual- and population-level (estimated UK population ≥30 years of age at high-risk of undiagnosed AF) and included number of patients screened, number of AF cases identified, mean total and incremental costs (screening, events, treatment), quality-adjusted-life-years (QALYs), and incremental cost-effectiveness ratio (ICER). Results The screening strategy was estimated to result in 45,493 new diagnoses of AF across the high-risk population in the UK (3.3 million), and an estimated additional 14,004 lifetime diagnoses compared with routine care only. Per-patient costs for high-risk individuals who underwent the screening strategy were estimated at £1,985 (vs £1,888 for individuals receiving routine care only). At a population-level, the screening strategy was associated with a cost increase of approximately £322 million and an increase of 81,000 QALYs. The screening strategy demonstrated cost-effectiveness versus routine care only at an accepted ICER threshold of £20,000 per QALY-gained, with an ICER of £3,994/QALY. Conclusions Compared with routine care only, it is cost-effective to target individuals at high risk of undiagnosed AF, through an AF risk prediction algorithm, who should then undergo diagnostic testing. This AF risk prediction algorithm can reduce the number of patients needed to be screened to identify undiagnosed AF, thus alleviating primary care burden.

Expanding on Threat and Deprivation: Empirical Examination of Adversity Dimensions and Psychiatric Outcomes Among Emerging Adults.

Dimensional models of adversity, whereby experiences lie along dimensions of threat and deprivation, are increasingly popular; however, their empirical validation is limited. In a sample of emerging adults (N=1,662; M age =20.72; 53% female; 72% Black), we conducted exploratory factor analyses using adversities derived from items probing family relationships and a validated assessment of traumatic events. Resulting factors were used to test associations with odds of lifetime diagnosis of a substance use disorder, other mental health disorders, and suicide attempt. Results supported a four-factor solution: threat (non-betrayal), emotional deprivation, sexual assault, and threat (betrayal). Threat (betrayal) summary scores were most strongly associated with increased odds of substance use and other disorders, whereas sexual assault was most strongly associated increased odds of lifetime suicide attempt. Findings provide some empirical support for categorizing adversity along dimensions of threat and deprivation. However, it also suggests the possibility of further divisions within these dimensions.

A-46 High School Soccer and Risk for Mental Health Outcomes in Adulthood: A National Longitudinal Study

Abstract Purpose: There is concern that participation in contact sports during youth might confer risk for later in life mental health problems. We examined whether playing high school soccer was associated with higher rates of depression, anxiety, and suicidality in early to middle adulthood. Methods: The National Longitudinal Study of Adolescent to Adult Health (“Add Health”) database was analyzed at Wave I (n = 6503; median age = 15), Wave III (median age = 22), Wave IV (median age = 29), and Wave V (n = 4196; median age = 38). We compared those who played soccer to those who did not play contact sports on mental health outcomes. Results: There were 221 participants who played high school soccer (102 men and 119 women) compared to 2388 who denied participation in contact sports (784 men and 1604 women). During their late 30s, approximately 17.4% of men and 31.0% of women reported a lifetime history of depression, and 15.6% of men and 28.8% of women reported a lifetime history of anxiety. Suicidal ideation, in the past year, was reported by 7.1% of men and 6.8% of women. When comparing those who played soccer to those who did not, there were no statistically significant differences in the proportions who had a lifetime diagnosis of depression or anxiety, or suicidal ideation in the past year, during Waves III, IV, or V of data collection (p-values&amp;gt;0.05). Conclusions: Adults who played high school soccer did not have greater mental health problems at three different time points spanning more than 20 years after high school.

Sex-Specific Transmission of Anxiety Disorders From Parents to Offspring

Although anxiety disorders are known to run in families, the relative contribution of genes and environment is unclear. Patterns of sex-specific transmission of anxiety may point to different pathways in how parents pass anxiety disorders down to their children; however, the association of parent and offspring sex with the transmission of anxiety disorders has not been previously studied. To examine whether the transmission of anxiety from parents to children is sex specific. This cross-sectional family study recruited participants from the general population (enriched for familial risk of mood disorders) in Nova Scotia, Canada, from February 1, 2013, to January 31, 2020. Anxiety disorder in the same-sex or opposite-sex parent. Semistructured interviews were used to establish lifetime diagnoses of anxiety disorder in parents and offspring. The association between anxiety disorder in the same-sex or opposite-sex parent and anxiety disorders in the offspring was tested with logistic regression. A total of 398 offspring (203 female offspring with a mean [SD] age of 11.1 [3.7] years and 195 male offspring with a mean [SD] age of 10.6 [3.1] years) of 221 mothers and 237 fathers participated in the study. Anxiety disorders in the same-sex parent (odds ratio [OR], 2.85; 95% CI, 1.52-5.34; P = .001) were associated with increased rates of anxiety disorders in the offspring, whereas anxiety disorders in the opposite-sex parent (OR, 1.51; 95% CI, 0.81-2.81; P = .20) were not. Sharing a household with a same-sex parent without anxiety was associated with lower rates of offspring anxiety (OR, 0.38; 95% CI, 0.22-0.67; P = .001), but the presence of an opposite-sex parent without anxiety was not (OR, 0.96; 95% CI, 0.56-1.63; P = .88). In this cross-sectional study of families, an association between the same-sex parent's anxiety disorder and anxiety disorders in offspring suggests an environmental mechanism, such as modeling. Future studies should establish whether treating parents' anxiety may protect their children from developing an anxiety disorder.

Comparing Irritable Bowel Syndrome and Psychiatric Illness to Inflammatory Bowel Disease

Irritable bowel syndrome (IBS) is a prevalent disease that patients report within primary care and contributes approximately 14% - 51% of fresh patients to gastrointestinal centres while inflammatory bowel disease (IBD) which includes ulcerative colitis and Crohn's disease, is among the crippling persistent gastrointestinal disorders that considerably negatively affect a participant's physical, psychological, family, and social aspects. The objective of our research was to compare the effects of IBD and IBS in two groups of outpatients. The study was carried out at Qazi Hussain Ahmed Medical Complex Nowshera from September 2021 to Jan 2022. All outpatients with a confirmed diagnosis of IBS (n=49) and IBD (n=27) were requested to participate in the study. 87.76% of patients (n=43) with irritable bowel syndrome and 18.51% of patients (n=5) with inflammatory bowel disease had at least one of these lifetime diagnoses. 24.48%, 22.44%, and 22.44% of the subjects had lifetime diagnoses of major depression (n = 12), panic (n = 11), or somatization disorder (n = 11). 73.5% of the patients with irritable bowel syndrome (n=36) had a history of panic disorder, generalized anxiety disorder, phobia, major depression, somatization disorder, or a combination of these illnesses before the beginning of their gastrointestinal symptoms. Compared to patients with IBD individuals with IBS had greater sensitivity to modest physical symptoms, more psychological discomfort, and a higher lifetime frequency of mental illnesses.

Mental and Behavioral Problems in Medical Students of a Health Science Institute in Eastern Nepal

Introduction: Literature shows a high prevalence of mental disorders among medical students. Psychiatric morbidity data help enhance all levels of management. We have limited data about 'mental and behavioural problems' in medical students.&#x0D; Objective: To see and sort out psychiatric problems among medical students of BP Koirala Institute of Health Sciences (BPKIHS), Nepal.&#x0D; Methodology: It is an institute based prevalence study. Twenty percentages of all medical students of all programs (1125) of academic year of 2008/9 were (systematic) randomly selected. After informed written consent, the subjects were enrolled. A semi-structured proforma was used to record socio-demographic and clinical profiles. The 'Structured clinical interview for DSM-IV Axis I disorders' (SCID-I) was used to diagnose major psychiatric disorders.&#x0D; Result: Out of the total sample students, 219 students were enrolled. Among the enrolled subjects, life time diagnosis of psychiatric problem (till the time of the study) was about 55%. At the time of the study, approximately 30% had psychiatric problem. During BPKIHS stay inclusive of current problem, slightly more than 40% had mental problems. The most common diagnosis was adjustment disorder.&#x0D; Conclusion: A great proportion of medical students suffer from mental and behavioural problems.

Physical multimorbidity and wish to die among adults aged ≥65 years: A cross-sectional analysis of the Irish Longitudinal Study on Ageing

BackgroundPhysical multimorbidity (i.e., ≥2 chronic conditions) may induce feelings of wish to die (WTD), but there is limited literature on this topic, while the mediators in this association are largely unknown. Thus, the aim of the present study was to investigate this association and its mediators among older Irish adults. MethodsCross-sectional, nationally representative data from Wave 1 of the Irish Longitudinal Study on Ageing 2009–2011 were analyzed. Information on self-reported lifetime diagnosis of 14 chronic physical conditions were obtained. WTD was defined as answering affirmatively to the question “In the last month, have you felt that you would rather be dead?” Multivariable logistic regression and mediation analyses were conducted. ResultsData on 2941 adults aged ≥65 years [mean (SD) age 73.2 (5.2) years; 45.0 % males] were analyzed. Physical multimorbidity was associated with 3.39 (95%CI 1.58, 7.28) times higher odds for WTD. This association was largely explained by pain (% mediated 28.1 %), followed by depression (19.4 %), sleep problems (18.4 %), perceived stress (13.0 %), loneliness (10.4 %), anxiety (8.1 %), and disability (7.2 %). ConclusionsMultimorbidity was associated with increased odds for WTD among Irish older adults. Addressing the identified mediators may contribute to reducing feelings of WTD among older adults with multimorbidity.

Interaction of recent stressful life events and childhood abuse on orbitofrontal grey matter volume in adults with depression

BackgroundThe diathesis-stress model of major depressive disorder (MDD) predicts interactions of recent stressful life events (SLEs) in adulthood and early developmental risk factors. We tested, for the first time, the diathesis stress model on brain structure in a large group of MDD patients. MethodsStructural magnetic resonance imaging data of 1465 participants (656 with lifetime diagnosis MDD; 809 healthy controls) were analyzed using voxel-based morphometry to identify clusters associated with recent SLEs (Life Events Questionnaire). Those clusters were then examined for group (healthy/MDD) × early developmental risk (operationalized as childhood abuse [Childhood Trauma Questionnaire] and a major psychiatric disorder [i.e., MDD, bipolar disorder, schizophrenia, and schizoaffective disorder] in a first-degree relative) × recent SLEs three-way interactions on grey matter volume. ResultsThere was a group × childhood abuse × recent SLEs interaction on left medial orbitofrontal cortex grey matter volume. This three-way interaction arose because childhood abuse and recent SLEs interacted in MDD subjects but not in healthy subjects. LimitationsWe are not able to draw conclusions about the cause and effect relationship due to our cross-sectional study design. ConclusionsOur data provides evidence for an interplay between orbitofrontal cortex structure, childhood abuse and recent SLEs. These factors have previously been linked to MDD and their complex interaction contributes to the pathogenesis of MDD.

Correlates of past year suicidal thoughts among sexual and gender minority young adults: A machine learning analysis

Sexual and gender minority populations are at elevated risk of experiencing suicidal thoughts and attempting suicide. The COVID-19 pandemic exacerbated mental health and substance use challenges among this population. We aimed to examine the relative importance and effects of intersectional factors and strong interactions associated with the risk of suicidal thoughts among Canadian lesbian, gay, bisexual, transgender, queer, questioning, intersex and Two Spirit (LGBTQI2S+) young adults. A cross-sectional online survey was conducted among LGBTQI2S + participants aged 16–29 years living in two Canadian provinces (Ontario, Quebec). Among 1414 participants (mean age 21.90 years), 61% (n = 857) participants reported suicidal thoughts in last 12 months. We built a random forest model to predict the risk of having past year suicidal thoughts, which achieved high performance with an area under the receiver operating characteristic curve (AUC) of 0.84. The top 10 correlates identified were: seeking help from health professionals for mental health or substance use issues since the start of the pandemic, current self-rated mental health status, insulted by parents or adults in childhood, ever heard that being identifying as LGBTQI2S+ is not normal, age in years, past week feeling depressed, lifetime diagnosis of mental illness, lifetime diagnosis of depressive disorder, past week feeling sad, ever pretended to be straight or cisgender to be accepted. The increase in the risk of suicidal thoughts for those having mental health challenges or facing minority stressors is more pronounced in those living in urban areas or being unemployed than those living in rural areas or being employed.

КЛИНИКО-МОРФОЛОГИЧЕСКАЯ ХАРАКТЕРИСТИКА РАКА ПОДЖЕЛУДОЧНОЙ ЖЕЛЕЗЫ ПО ДАННЫМ АУТОПСИЙ

Background. Over the past decades, the incidence of pancreatic cancer (PCa) has been on the rise. It is characterized by a long latent course, non-specificity of clinical symptoms, a tendency to early metastasis, and limited possibilities for biopsy. The survival rate of patients with pancreatic cancer within a year after its diagnosis is no more than 8%. Objective. To study the clinical and morphological features of pancreatic cancer and to assess the state of life-time diagnosis according to autopsy findings. Material and methods. A retrospective analysis of 58 autopsy protocols of patients died due to pancreatic cancer was carried out. The protocols of autopsies as well as micropreparations of the pancreas and other various organs taken during autopsy for histopathological examination were studied. Results. Among those who died due to pancreatic cancer there were 58.6% of men and 41.4% of women. The average age of males was 68.9 years, that of females - 67.0 years. The discrepancy between the pathoanatomical and clinical diagnoses was noted in 7.7% of cases. Chronic pancreatitis as a background disease occurred in 6.9% of cases of pancreatic cancer. A nodular form of cancer growth was detected in 87.9%, a diffuse-infiltrative one - in 12.1% of cases. In 81.0% of cases, the tumor was localized in one of the pancreatic sections, in 19.0% - in several ones. Cancer of the pancreatic head occurred in 72.4% of cases; in 5.2% of cases the tumor was localized only in the tail, in 3.4% - only in the body of the gland. The body and tail of the pancreas were involved in the tumor process in 10.3%, while the head and body in 5.2% of cases. In 3.5% of cases, the tumor completely infiltrated the pancreas. Conclusions. Radical surgical interventions were performed only in 20.7% of cases. They were performed in 28.6% of cases in patients with pancreatic head tumours. In case of tumour location in the distal parts of the pancreas, such interventions were impossible due to the presence of multiple metastases. In 7.7% of cases, the diagnosis of pancreatic cancer was established only at autopsy.