Long-term Illness Research Articles

\u201cLike filling a lottery ticket with quite high stakes\u201d: a qualitative study exploring mothers\u2019 needs and perceptions of state-provided financial support for a child with a long-term illness in Finland

BackgroundA child’s long-term illness or disability is always a serious matter that impacts the whole family. Costs related to an illness can substantially affect a family’s financial situation. To date, there is little research on how parents experience available support for financial assistance. Surveys in Finland have found that families of children with long-term illnesses and disabilities could experience financial struggle and perceive the state provided financial support system as too complex. This article aimed to explore how caregivers of children with long-term illnesses perceived their financial situation, need for financial support and experienced its provision by the state in the Helsinki greater region.MethodsConvenience sampling was used. Participants were contacted through peer-support groups on Facebook. Eleven mothers of children with varying long-term illnesses and disabilities residing in the Helsinki greater region were interviewed using in-depth interviews. Recordings of the interviews were transcribed and analysed using framework analysis. An analytical framework was built to label the dataset, which was then charted. Lastly, themes were formed through descriptive analysis.ResultsThe main findings showed how the burden of caring for a child with a long-term illness or disability causes fatigue, which affects a family’s financial situation holistically. This affected both employment and financial management, but also receiving information about and applying for the state provided allowances. Mental resources were further depleted by seeking information and applying for allowances. This contributed to a vicious cycle between parental fatigue and financial struggle. Participants found the allocation of funds inequitable across the country. Finally, participants thought the allowance was insufficient in compensating for time spent caring for their child’s illness and did not consider their mental strain.ConclusionsEven in a welfare state such as Finland, caregivers of children with long-term illnesses are at risk of poverty and struggle with the organization of state provided financial support. Policies should be designed to ensure equity across the country and consider how the parental fatigue should be addressed. The study has implications for achieving sustainable development goals on wellbeing and reducing poverty.

Influence of the duration of psoriatic arthritis on the achievement of remission and minimal disease activity during therapy with genetically engineered biologic drugs. Data from the all-russian register of patients with psoriatic arthritis

Aim . To study the frequency and timing of the onset of remission and minimal disease activity after the administration of genetically engineered biologic drugs (GEBD) in patients with early and long-term psoriatic arthritis observed within the framework of the All-Russian register of patients with psoriatic arthritis. Material and methods . The study included 140 patients with psoriatic arthritis (77 men, 63 women) who met the CASPAR criteria, who took part in the All-Russian register and were followed up every 6 months. Previously, patients did not receive GEBD. The median age of the patients was 42 [19-73] years. All patients were divided into two groups depending on the duration of psoriatic arthritis before the appointment of GEBD: early psoriatic arthritis - ≤2 years (67 patients) and long-standing psoriatic arthritis - more than 2 years (73 patients). All patients were prescribed GEBD (37 - adalimumab, 26 - infliximab, 20 - etanercept, 19 - golimumab, 1 - certolizumab pegol, 33 - ustekinumab, 4 - secukinumab) in combination with or without methotrexate. All patients were assessed for the activity and efficacy of psoriatic arthritis therapy according to DAPSA and the criteria for minimal disease activity (number of painful joints - ≤1, number of swollen joints - ≤1, PASI - ≤1 or BSA - ≤3, pain score - ≤15, overall assessment of activity disease by the patient - ≤20 mm on a visual analogue scale, HAQ - ≤0.5, enthesitis -≤1) at the beginning of the study and every 6 months. The number of patients who achieved remission (DAPSA ≤4) or minimal disease activity (5 criteria out of 7) at least 1 time during therapy with GEBD was determined. The cumulative frequency and timing of achieving remission after the appointment of GEBD were calculated. Results . After the initiation of treatment with GEBD, DAPSA remission was achieved at least once in 24 out of 67 (36%) patients with early psoriatic arthritis and in 19 out of 73 (26%) patients with long-standing psoriatic arthritis. The minimum disease activity was achieved, respectively, in 33 of 67 (49%) and 23 of 73 (32%) patients. The time interval to achieve remission in early psoriatic arthritis was significantly less than in long-standing one. Its median was 48 months (95% CI: 11.75-84.25) and 139 months (95% CI not determined) (p<0.05), respectively. The time until the minimum activity of the disease was reached in patients with early psoriatic arthritis was significantly less than in patients with long-standing psoriatic arthritis. Its median was 21 months (95% CI: 13.1-28.9) and 58 months (95% CI: 0-118.1), respectively (p<0.05). Conclusion . In real clinical practice, after prescribing GEBD, patients with an early stage of psoriatic arthritis (no more than 2 years of illness) achieve remission and minimal disease activity significantly more often and faster than patients with long-term illness.

Effects of the scope of practice on family physicians: a systematic review

BackgroundFamily medicine is a branch of medicine that manages common and long-term illnesses in children and adults. Family physicians in particular play a major role and their scope of practice is expected to impact patient and population. However, little is known about its impact on physicians. We aimed to assess the effects of scope of practice on family physician outcomes.MethodsWe performed a systematic review that we reported using PRISMA guidelines. For the inclusion criteria, any study exploring an association between the scope of practice and physician outcomes was considered. Three bibliographic databases Medline, Embase, and ERIC were consulted through OVID interface from their respective inceptions to November, 2020. Two reviewers independently selected studies, extracted data and assessed the risk of bias of studies using appropriate tools. We conducted data synthesis using a narrative form. GRADE was used for evaluating quality of cumulative evidence.ResultsIn total, we included 12 studies with 38,732 participants from 6927 citations identified. Eleven of them were cross-sectional, and one was a cohort study with acceptable methodological quality. We found that: 1) family physicians with diverse clinical and nonclinical activities significantly improve their job satisfaction (p<0.05); 2) family physicians with a variety of clinical practices significantly improve their competences and health status (p<0.05); 3) family physicians who perform clinical procedures (mainly extended to gynecological procedures) significantly improve their psychosocial outcomes (e.g., job satisfaction) (p<0.05); and 4) some associations are not statistically significant (e.g., relation between variety of practice settings and outcomes). We observed that the evidence available has a very low level.ConclusionsOur findings suggest that the scope of practice may be favorably associated with some family physician outcomes but with a very low level of evidence available. Based on these findings, healthcare system managers could monitor the scope of practice among family physicians and encourage future research in this field.Systematic review registrationOur protocol was registered under the number CRD42019121990 in PROSPERO.

Does voluntary assisted dying cause public stigma for the bereaved? A vignette-based experiment.

Studies in countries where assisted dying is legal show that bereaved people express concern over the potential for social disapproval and social stigma because of the manner of death. There are indications that voluntary assisted dying is judged as less acceptable if the deceased is younger. A vignette-based experiment was used to determine whether public stigma (i.e., negative emotional reactions and desired social distance) and expected grief symptoms are higher for conjugally bereaved people through voluntary assisted dying (vs. long-term illness), when the deceased is a young adult (vs. older adult). A 2 × 2 randomized factorial design was conducted with 164 Australian adults (130 women, 34 men, Mage = 37.69 years). Each participant was randomized online to read one of four vignettes and completed measures of anger, fear, prosocial emotions, desire for social distance, and expectations of grief symptomatology. A multivariate analysis of variance (MANOVA) was conducted. Death at a young age (28 years) was significantly associated with stronger negative emotional reactions of fear ($\eta _p^2 = 0.04$, P = 0.048) and anger ($\eta _p^2 = 0.06$, P = 0.010). There were no differences in outcomes associated with the mode of death, nor was there an interaction between mode of death and age group. Concerns that voluntary assisted dying elicits public stigma appear unfounded. The fact that participants reported significantly higher anger and fear in response to bereaved people experiencing loss at a younger (vs. older) age, irrespective of cause of death, indicates that young people who lose their spouse might benefit from additional support.

Children's experiences of information, advice and support from healthcare professionals when their parent has a cancer disease - experiences from an oncological outpatient department.

This study was carried out in order to evaluate children's experiences after taking part in the pilot clinical intervention "See Me" aimed at supporting children as relatives. A qualitative explorative design with interviews was chosen, with analyses using an inductive approach. Interviews were conducted with 19 children (9 aged 7-12 years and 10 aged 13-18 years). The younger children were asked to draw a picture of a person in hospital, using the Child Drawing: hospital (CD:H) instrument to measure the child's level of anxiety. The older children completed the Caring Professional Scale (CPS) as a measure of the caring approach in their encounter with the nurse. The interviews with the children show that: they felt expected and welcomed at the hospital; they needed knowledge about their parent's situation; they needed information and participation based on their individual situation; and they needed the nurse to offer them information and support. The results from the pictures showed that one child had above-average levels of anxiety. The older children reported that the nurses were Competent Practitioners, but to a lesser degree that they were Compassionate Healers. The results of this pilot study indicate that the structure of "See Me" could be used as a starting point to ensure that children as relatives receive information, advice, and support. Further the results indicate that both CD:H and CPS could be used to evaluated children's experiences of support when a parent has a long-term illness.

Does Voluntary Assisted Dying Cause Public Stigma for the Bereaved? A Vignette-Based Experiment

Objective. Studies in countries where assisted dying is legal show that bereaved people express concern over the potential for social disapproval and social stigma because of the manner of death. There are indications that voluntary assisted dying is judged as less acceptable if the deceased is younger. A vignette-based experiment was used to determine whether public stigma (i.e., negative emotional reactions and desired social distance) and expected grief symptoms are higher for conjugally bereaved people through voluntary assisted dying (vs. longterm illness), when the deceased is a young adult (vs. older adult). Method. A 2 × 2 randomized factorial design was conducted with 164 Australian adults (130 women, 34 men, Mage = 37.69 years). Each participant was randomized online to read one of four vignettes and completed measures of anger, fear, prosocial emotions, desire for social distance, and expectations of grief symptomatology. Results. A multivariate analysis of variance (MANOVA) was conducted. Death at a young age (28 years) was significantly associated with stronger negative emotional reactions of fear (n2p = 0.04, P = 0.048) and anger (n2p = 0.06, P = 0.010). There were no differences in outcomes associated with the mode of death, nor was there an interaction between mode of death and age group. Significance of results. Concerns that voluntary assisted dying elicits public stigma appear unfounded. The fact that participants reported significantly higher anger and fear in response to bereaved people experiencing loss at a younger (vs. older) age, irrespective of cause of death, indicates that young people who lose their spouse might benefit from additional support.

Knowledge, Attitude and Practice on Common Diabetic Patients among Diabetic Complications at Egyptian Hospital in Mogadishu, Somalia

Diabetes is a chronic illness that occurs when the pancreas stops producing insulin or when the body cannot use the produced insulin. Insulin is a hormone produced by the pancreas that helps glucose from meals enters the body’s cells for energy. The overall goal is to assess diabetes patients’ knowledge, attitudes, and behaviors about prevalent diabetic complications. This research used a descriptive qualitative methodology to assess diabetes complication knowledge, attitude, and practice. Ninety-eight diabetic patients were visiting the Egyptian Hospital in Mogadishu for four weeks. The data was collected using questionnaires. Finally, SPSS 20 was utilized for analysis. The research was performed from May to July 2020 with a non-probability sample size of 98 diabetics. The bulk of responders were aged 40 - 60 (36.7%). Type 2 was the most common (47.96%). 44.9% of respondents had diabetes for more than ten years. 60.2% had regular checkups, and 54.1 percent had therapy. 52% of participants were on a diet. 63.3% of respondents do not exercise often. However, most responders know the common issues (75%). Less than half of those polled had problems (41.8%). 22% incidence of Diabetic ketoacidosis. 78.6% of respondents know variables that decrease diabetes complications, whereas 22.4% do not. 37.8% of respondents saw a doctor for diabetes problems, whereas 62.2% did not. Diabetic patients’ knowledge, attitude, and practice were satisfactory for fundamental illness entanglements and self-testing. These findings may also be due to patient notification and, therefore, long-term illness that leads them to get acquainted with things alone. However, the tendency for regular exercise was low, which may produce more specific consequences of illness. Conclusion: We find that DM patients’ KAP was adequate in terms of knowledge of diabetic complications. These results may explain the patients’ long-standing illness, which forces them to discover things independently. At the same time, just a handful of them were familiar with vasculopathy and cardiovascular disorders. However, the researchers discovered low level of attitudes and practice toward regular exercise and insufficient levels of attitudes and practice toward diet management and treatment adherence. In general, this degree of KAP is suboptimal and requires further assessment of KAP obstacles in Somalia.

Informal carers in Sweden – striving for partnership

ABSTRACT Purpose Informal carers have an important role in society through their care and support of their long-term ill relatives. Providing informal care is challenging and can lead to caregiver burden; moreover, many support needs of the carers are not met, leading to confusion, disappointment and frustration. We conducted an interview study to clarify the meaning of support given and received by informal carers to relatives with chronic obstructive pulmonary disease or chronic heart failure. Methods We purposively selected and recruited informants via participants in another study, thereby conducting interviews over the phone from June 2016 to May 2017. In total, we conducted 14 interviews with 12 informants. All interviews were transcribed verbatim and the content was analysed using a phenomenological hermeneutical approach. Result and conclusion Our comprehensive understanding of the meaning of support for these carers is twofold: it is a self-evident struggle for the good life of their relatives and that they want to be carers in partnership. The healthcare system must recognize the efforts of carers and include them in the strategic planning and operational stages of care and treatment for people with long-term illness.

Care needs and care consumption in psychosis: a 4-year longitudinal analysis of guideline concordant care

Abstract Aims People with psychotic disorders receive mental healthcare services mainly for their psychiatric care needs. However, patients often experience multiple physical or social wellbeing-related care needs as well. This study aims to identify care needs, investigate their changes over time and examine their association with mental healthcare consumption and evidence-based pharmacotherapy. Methods This study combined annually obtained routine outcome monitoring (ROM) data with care consumption data of people with a long-term psychotic illness receiving treatment in four Dutch mental healthcare institutes between 2012 and 2016. Existing treatment algorithms were used to determine psychiatric, physical and social wellbeing-related care needs based on self-report questionnaires, semi-structured interviews and physical parameters. Care consumption was measured in hours of outpatient mental healthcare consumption per year. Generalised estimating equation models were used to calculate odds ratios of care needs and their associations with time, mental healthcare consumption and medication use. Results Participants (n = 2054) had on average 7.4 care needs per measurement and received 25.4 h of care per year. Physical care needs are most prevalent and persistent and people with more care needs receive more mental healthcare. Care needs for psychotic symptoms and most social wellbeing-related care needs decreased, whereas the chance of being overweight significantly increased with subsequent years of care. Several positive associations were found between care needs and mental healthcare consumption as well as positive relations between care needs and evidence-based pharmacotherapy. Conclusions This longitudinal study present a novel approach in identifying care needs and their association with mental healthcare consumption and pharmacotherapy. Identification of care needs in this way based on ROM can assist daily clinical practice. A recovery-oriented view and a well-coordinated collaboration between clinicians and general practitioners together with shared decisions about which care needs to treat, can improve treatment delivery. Special attention is required for improving physical health in psychosis care which, despite appropriate pharmacotherapy and increasing care consumption, remains troublesome.

Family Caregiving and Place of Death: Insights From Cross-national Analysis of the Harmonized End-of-Life Data.

Family is largely overlooked in research on factors associated with place of death among older adults. We determine if family caregiving at the end of life is associated with place of death in the United States and Europe. We use the Harmonized End of Life data sets developed by the Gateway to Global Aging Data for the Survey of Health, Ageing and Retirement in Europe (SHARE) and the Health and Retirement Study (HRS). We conducted multinomial logistic regression on 7,113 decedents from 18 European countries and 3,031 decedents from the United States to determine if family caregiving, defined based on assistance with activities of daily living, was associated with death at home versus at a hospital or nursing home. Family caregiving was associated with reduced odds of dying in a hospital and nursing home, relative to dying at home in both the United States and Europe. Care from a spouse/partner or child/grandchild was both more common and more strongly associated with place of death than care from other relatives. Associations between family caregiving and place of death were generally consistent across European welfare regimes. This cross-national examination of family caregiving indicates that family-based support is universally important in determining where older adults die. In both the United States and in Europe, most care provided during a long-term illness or disability is provided by family caregivers, and it is clear families exert tremendous influence on place of death.

Millennials as Caregivers: Results From the BRFSS, 44 States, DC, and Puerto Rico, 2015-2018

Millennials (born 1981-1996), now outnumber Baby Boomers. Millennials have the unique task of potentially providing care for their own children, their aging parents, and grandparents, making them the first “club sandwich” generation. We utilized data from 44 states, the District of Columbia, and Puerto Rico from the 2015-2018 Behavioral Risk Factor Surveillance System to estimate the prevalence of informal caregiving among Millennials (based on age at the time of survey completion: 18-34 in 2015, 19-35 in 2016, 20-36 in 2017, and 21-37 in 2018). We conducted log-binomial regression analyses to compare mental and physical health among Millennials, adjusting for age, sex, education, and race/ethnicity. Among 37,780 Millennials included, 18.7% provided regular care/assistance to a friend/family member with a health problem, long-term illness, or disability in the past month. Of these caregivers, 36.3% provided the most care to a parent/parent-in-law and 21.8% to a grandparent. Half of Millennials had ≥1 children under age 18 in their home, regardless of caregiving status. In adjusted models, Millennial caregivers had higher prevalence of frequent mental distress [≥14 days in the past 30 days when mental health was not good] (prevalence ratio [PR]=1.72, 95% confidence interval [CI]: 1.50-2.00, p<0.001), higher prevalence of fair/poor health (PR=1.42, 95%CI: 1.20-1.68, p<0.001), and higher prevalence of ≥1 chronic health conditions [current asthma, arthritis, cancer, cardiovascular disease, diabetes, or COPD] (PR=1.69, 95%CI: 1.51-1.90, p<0.001) than non-caregivers. Nearly one in five Millennials was providing informal care, and Millennial caregivers reported significantly worse mental and physical health than their non-caregiving peers.

Harnessing mobile health technology to support long-term chronic illness management: exploring family caregiver support needs in the outpatient setting.

ObjectiveFamily caregiving is an important public health issue, particularly with the aging population. In recent years, mobile health (mHealth) technology has emerged as a potential low-cost, scalable platform to address caregiver support needs, and thereby alleviate the burden on caregivers. This study sought to examine the support needs of family caregivers in their lived experiences of outpatient care to inform the development of a future mHealth intervention.Materails and MethodsWe conducted 20 semi-structured interviews in 2 outpatient hematopoietic cell transplant (HCT) clinics at a large academic medical center in the Midwestern United States. A thematic analysis was performed to define emerging themes.ResultsQualitative data analysis identified 5 primary themes that HCT caregivers faced: (I) lifestyle restrictions due to the patient’s immunocompromised state; (II) Unmet needs due to limitations in the current resources, including unfamiliar medical tasks without necessary trainings; and (III) caregivers’ adaptive strategies, including reformation of social relationships with family and friends. Based on these findings, we suggest 3 design considerations to guide the development of a future mHealth intervention.ConclusionsThe findings herein captured the family caregiver’s lived experiences during outpatient care. There was broad agreement that caregiving was challenging and stressful. Thus, effective and scalable interventions to support caregivers are needed. This study provided data to guide the content and design of a future mHealth intervention in the outpatient setting.

Sociodemographic determinants of COVID-19 incidence rates in Oman: Geospatial modelling using multiscale geographically weighted regression (MGWR)

The current COVID-19 pandemic is evolving rapidly into one of the most devastating public health crises in recent history. By mid-July 2020, reported cases exceeded 13 million worldwide, with at least 575,000 deaths and 7.33 million people recovered. In Oman, over 61,200 confirmed cases have been reported with an infection rate of 1.3. Spatial modeling of disease transmission is important to guide the response to the epidemic at the subnational level. Sociodemographic and healthcare factors such as age structure, population density, long-term illness, hospital beds and nurse practitioners can be used to explain and predict the spatial transmission of COVID-19. Therefore, this research aimed to examine whether the relationships between the incidence rates and these covariates vary spatially across Oman. Global Ordinary Least Squares (OLS), spatial lag and spatial error regression models (SLM, SEM), as well as two distinct local regression models (Geographically Weighted Regression (GWR) and multiscale geographically weighted regression MGWR), were applied to explore the spatially non-stationary relationships. As the relationships between these covariates and COVID-19 incidence rates vary geographically, the local models were able to express the non-stationary relationships among variables. Furthermore, among the eleven selected regressors, elderly population aged 65 and above, population density, hospital beds, and diabetes rates were found to be statistically significant determinants of COVID-19 incidence rates. In conclusion, spatial information derived from this modeling provides valuable insights regarding the spatially varying relationship of COVID-19 infection with these possible drivers to help establish preventative measures to reduce the community incidence rate.

PIN118 Impact of Invasive Meningococcal Disease on Life Expectancy and Socioeconomic Burden in France: A Real World SNIIRAM Database Analysis

Invasive meningococcal disease (IMD) has a case fatality rate of up to 15% despite available treatments, and well-recognised long-term physical, neurological and psychological sequelae in survivors. However, limited research exists on IMD impact beyond clinical burden, e.g., state support needs and life expectancy. This study uses real world data to estimate IMD survivors’ socioeconomic burden and life expectancy. All IMD patients hospitalised in France between 01-Jan-2012 and 31-Dec-2017 were retrospectively identified from SNIIRAM (French national health insurance information database), and compared to controls matched by age, sex and geographical area with a 1:3 ratio. Follow up was until death or study end (maximum six years). Survival curves, compared using a log rank test, were used to estimate life expectancy loss after IMD discharge. The likelihood of receiving state benefits following IMD was calculated as risk ratios (RR) for: salary loss compensation (SLC) while disabled (i.e., working capacity reduced by at least 2/3 due to illness of non-occupational origin) until retirement age, healthcare costs due to long-term illness (CLTI) and universal complementary health coverage (UCHC). In the 6-year period, 3,532 IMD patients were hospitalised (52% male, 13.3% infants [highest peak], 55.7% <25 years) and 293 (8.3%) died during initial hospitalisation. Following discharge, IMD survivors, irrespective of sequelae, lived an estimated 3.1 months less than controls (p<0.0001), and were significantly more likely to receive SLC and CLTI benefits (RR 3.9 (95% confidence interval [CI]: 2.3 – 6.4) and RR 1.85 (95%CI: 1.71 – 2.00), respectively). No statistically significant difference was found for UCHC. IMD has a significant impact beyond the acute phase. Survivors face a higher mortality risk and are more likely to need long-term support from the state, irrespective of sequelae status. Better diagnosis and treatment to reduce disease burden, and prevention through vaccination may provide significant long-term benefits.

Correlates of Incarceration of Fathers, Socioeconomic Influences, and Mental Illness

ABSTRACT The United States leads globally in incarceration. Incarceration can disrupt families in both immediate and long-term ways, including finances and mental illness. We examined the relationship between father incarceration during adolescence and the development of mental illness in adulthood as well as the relationship of household assets and debts in relation to the mental illness outcomes. Wave IV data of the National Longitudinal Study of Adolescent to Adult Health were used with a final analytic sample of 2129 participants. Data were analyzed using MANOVA in Stata 13.1. The findings indicated that biological father incarceration correlates with more adolescent mental illness. Enhanced model residuals were also significant for father incarceration, household assets, and household debts. Incarceration of biological fathers correlates with poorer mental health outcomes. Household assets and debts correlate with changes in adolescent outcomes as well, giving us more target areas for intervention development and testing. Clinically, assessing for adolescent experiences with father incarceration may be useful in supporting improved mental health over the life course. Policy work should give more attention to promotion of health and well-being of adolescents via reduction of the negative experience of fathers serving and/or having served time in prison. More discussion on family-level assets and debts is warranted to promote health and well-being for adolescents and adults.

Evolution in the use of health services by older people in Spain (2009-2017).

As people age, they tend to increase their use of health services. For this, the aims of this study were to analyse the frequency and variability in the use of different health services by people over 65years, their evolution from 2009 to 2017 and the factors associated it. We carried out a cross-sectional study with 25,465 people over 65years who participated in the National Health Survey in Spain in 2011/2012 and 2017 and the European Health Survey in Spain in 2009 and 2014. A descriptive analysis was performed using the attendance records of family/general physicians, nurse consultations, or both over the last 12months as well as these data over the following years of study. Our findings show that approximately 93.2% of the participants had consulted with a family/general physician over the last year, and women were almost twice as likely to do so compared with men (61.2% vs. 38.8%). The use of health services gradually increased from 2009 to 2017, being the visits to nursing that more increased their frequency. Being a woman and a widower as well as having no higher education, a low social class, a serious or long-term illness, obesity and bed restraint were associated with a greater use of health services. Findings suggested that the increased health services due to ageing and comorbidities associated with it present new challenges. It is necessary to determine realistic plans that can meet future healthcare demands and not lead to a collapse of the health system. For this it is very important the primary prevention of chronic diseases, functional limitations, obesity and disability.

The association between anti-inflammatory effects of long-term lithium treatment and illness course in Bipolar Disorder.

Introduction: Altered levels of acute-phase proteins are often described in different conditions in BD. Nevertheless, data on the association between lithium treatment and inflammatory markers in the long-term course of BD are still missing. The aim of the study was to examine the long-term course of BD concerning long-term lithium treatment, chronic inflammatory processes and symptom progression. Furthermore, the association between duration of lithium treatment and levels of hsCRP was explored. Methods: 267 individuals (males= 139, females= 128) with BD were included. Duration of lithium treatment as well as symptom progression, defined as the increase in severity of symptoms, number of episodes a year and duration of episodes within a period of 1.5 years in the past and hsCRP were evaluated. Results: Male individuals with symptom progression over time had significantly lower duration of lithium treatment compared to individuals without symptoms progression (U= 47.4, p=.037). There were significantly higher levels of hsCRP in male individuals with symptom progression compared to males without symptom progression (U= 47.5, p=.027). Further, there was a significant negative correlation between the duration of lithium treatment and hsCRP levels in the whole sample (r= -.276, p<.05). Conclusion: Our results show that an altered inflammatory state may be associated with a more severe illness course in BD. Further, a longer duration of lithium treatment may be associated with lower symptom progression. The shown association between hsCRP-levels and lithium treatment duration suggests a potential anti-inflammatory effect of lithium as a mediator of its significant positive outcome effect in BD.

The association of mental symptoms with teenage work in Iceland

Adolescent mental health problems have increased in recent years, and such problems may predispose the adolescent to long-term mental illness in adulthood. In past decades it has become more common for Icelandic teenagers to work while attending school (term-time work). Nevertheless, research is missing on the association between the level of termtime work and mental health. The aim is to examine the association between six types of mental symptoms (tiredness after an adequate night's sleep, difficulty sleeping, depression, stress/anxiety, worries/sadness, and multiple symptoms) and level of term-time work, by gender, age, and family's financial status. A survey applying a Nordic questionnaire based on self-assessed mental symptoms, was conducted among 2800 randomly selected adolscents, aged 13-19. The response rate was 48.6%. Participants were asked how often they felt symptoms of poor mental health. They were divided into three groups consisting of: non term-time workers, moderate term-time workers, and intensive term-time workers. A Chi-square test was used to test statistical significance: 95% confidence interval (CI). Results show gender difference in the association between level of term-time work and the mental symptoms. Intensive female workers are more likely to suffer symptoms of poor mental health than female non-workers, but no relationship was examined amongst boys. Furthermore, some association between term-time work and poor mental health is found amongst 13-15-year-olds, and for those whose parents are financially well-off. It is important that all stakeholders promote moderate term-time work for adolescents, and that the young people themselves receive occupational health and safety education to better understand the connection between work and mental health.

Why Severe COVID-19 Patients Are at Greater Risk of Developing Depression: A Molecular Perspective

The prevailing evidence suggests that patients with severe COVID-19 seem to have an overreaction of the immune system demonstrating exacerbated levels of inflammation caused by a “cytokine storm.” At this early stage, the mechanisms underpinning COVID-19 are still subject to intense scrutiny and the long-term mental health consequences as a result of the disease are unknown. Here we discuss the hypothesis that patients who survive severe COVID-19 and who experience significant activation of the immune system, are at greater risk of developing depression. We posit that a phenomenon known as cytokine storm dramatically activates the enzyme indoleamine 2,3-dioxygenase (IDO-1), resulting in the increase in kynurenine metabolites. Kynurenine is metabolized by IDO-1 in the brain, producing chemokines, in which a prolonged exposure may result long-term brain impairment. In this article, we also propose the possibility that a SARS-CoV-2 neuroinvasion increases the local levels of angiotensin II by angiotensin-converting enzyme 2 down-regulation. Thereby, angiotensin II could increase kynurenine metabolites producing pro-oxidative and pro-inflammatory effects, resulting in impairment of cognitive function, enhanced oxidative stress and decreased brain-derived neurotrophic factor. It is our premise that patients who experience such a cytokine storm may be at increased risk of long-term mental illness, such as depression.

Emotional regulation neural circuitry abnormalities in adult bipolar disorder: dissociating effects of long-term depression history from relationships with present symptoms

Bipolar disorder (BD) is common and debilitating and confounding effects of depression history on neural activity in BD are unknown. We aimed to dissociate neural activity reflecting past depression-load vs. present symptom severity using the Course and Outcome of Bipolar Youth (COBY), a prospective longitudinal cohort study of pediatric-onset BD. In n = 54 COBY (18–32 years), we modeled depression scores over time (up to 17.5 years) using a standardized autoregressive moving average (ARMA) model, followed by k-means cluster analysis. N = 36 healthy participants (HC, 20–36 years) were included. Using two factorial analyses, we parsed the impact of ARMA-defined past depression-load on neural activity from the impact of current symptoms on neural activity (p < 0.001, k > 30) and examined relationships with past and present symptoms (ps FDR-corrected). ARMA identified three COBY groups based on past depression-load. ARMA-defined COBY participants with the greatest past depression-load vs. other groups showed greater activity in right temporoparietal junction, thalamus, insula, premotor cortex, left fusiform gyrus, bilateral precuneus and cerebellum. In contrast, BD-COBY participants vs. HC showed greater activity in left hippocampus, dorsolateral prefrontal cortex, and right somatosensory cortex, plus the above thalamus, premotor cortex and cerebellum; activity positively correlated with present symptom severity in most regions. Past depression-load was related to social cognition and salience perception network activity, potentially reflecting heightened attention to socially relevant distracters, while present symptoms were associated with emotion processing and reappraisal network activity, potentially reflecting abnormal emotional experience and regulation. Differentiating aberrant neural activity related to long-term depression vs. present affective symptoms can help target interventions to networks associated with pathophysiological processes, rather than long-term illness effects.