Major Mental Disorders Research Articles

Suicide risk and mental health in the general population of French Polynesia.

There are no reports on the burden of suicidal ideation and suicide attempts in the general population of French Polynesia (FP). We aimed to improve suicide prevention and mental health care by assessing the prevalence of suicide risk and major mental health disorders and care among adults in FP. We conducted the Mental Health in General Population Survey in FP during 2015 to 2017. Participants were selected using the quota method to obtain a representative sample of the general population. Suicide risk and psychiatric diagnoses were assessed using the Mini International Neuropsychiatric Interview. We included 968 people aged 18 years or older. The prevalence of current suicidal ideation (13.1%) and current (2.6%) and lifetime suicide attempts (18.6%), as well as mental health disorders (42.8%), was high in FP. A notable proportion of participants with these conditions did not seek medical assistance. A high prevalence of suicide risk and mental health disorders was found in the general population of FP. Suicide prevention and mental health plans are needed in FP that include better access to primary care for the diagnosis and treatment of mental health disorders. Further research is needed to clarify cultural risk and protective factors.

The Current situation and treatment of PTSD during the novel coronavirus disease 2019 (COVID-19) pandemic

In recent years, with the continuous spread of the COVID-19, the post-traumatic stress disorder (PTSD) has gradually become the major mental disorder which puzzles the people's psychological problems. PTSD has a high incidence rate in people who have experienced one or more trauma, but not all people who have experienced trauma will suffer from PTSD. Research shows that most patients with post-traumatic stress disorder often have one or more other mental diseases, including major depression and substance abuse or others (like bipolar, anxiety and so on). As a mental disorder with high risk and high suicide rate, PTSD is easy to be comorbid with depression, anxiety, sleep disorders and other symptoms, which not only makes patients more painful, but also greatly increases the difficulty of treatment. Although traumatic events are a necessary condition for diagnosis of the PTSD, they are not the sufficient condition for occurrence of the PTSD. At present, a lot of research has been done on PTSD, but its pathogenesis is still not completely clear. The causes may include genetic susceptibility factors, childhood psychological trauma, and other negative life events before and after traumatic events.Psychotherapy and drug treatment are the main treatment schemes for PTSD at present, but in the epidemic environment, these treatments have certain inconveniences, which reflects the advantages of telemedicine. In the future, people should obtain more and more evidence-based evidence from multiple perspectives in order to obtain the best curative effect.

Bullying victimization and depressive symptoms in Chinese adolescents: A moderated mediation model of self-esteem and friendship intimacy

BackgroundDepression is a major mental disorder and poses a serious threat to public health. Bullying victimization is identified as one of the major risk factors for depression in adolescence. Understanding the mechanism that explain why bullying victimization leads to depression, and identifying protective factors that could alleviate the negative effects of bullying victimization are pivotal to developing effective intervention programs. MethodsA sample of Chinese adolescents in junior high schools (N = 458, 50.58 % girls, M age = 11.63 years at T1) was followed for three years. The data on depression, bullying victimization, self-esteem, and friendship intimacy were collected from adolescents' self-report. ResultsAfter controlling related variables, T1 bullying victimization positively predicted T3 depressive symptoms. T2 self-esteem mediated the link between T1 bullying victimization and T3 depressive symptoms when T1 friendship intimacy was low. More specifically, only for youth who reported low friendship intimacy, bullying victimization would lead to a lower level of self-esteem, which in turn, was associated with a higher level of depression. LimitationsThe study only considered the roles of self-esteem as the mediator and friendship intimacy as the moderator. All measures were based on self-report. ConclusionsThe results highlighted the role of friendship intimacy and self-esteem in the longitudinal relation between bullying victimization and depressive symptoms. The results suggest that intervention programs aiming at reducing victimized adolescents' depressive symptoms should consider the buffering effect of friendship intimacy.

Network analysis of psychiatric symptoms in schizophrenia: Findings from the Research on Asian Psychotropic Prescription Patterns for Antipsychotics (REAP-AP).

Schizophrenia is a major mental disorder with a wide range of psychiatric symptoms. This study explored the structure of psychiatric symptoms of schizophrenia using network analysis in a large representative Asian sample based on a survey of clinical features and treatment used in schizophrenia patients across 15 countries/territories in Asia. Data on the demographic characteristics and psychiatric symptoms in schizophrenia patients were extracted from the dataset of the fourth Research on Asia Psychotropic Prescription for Antipsychotics (REAP-AP) project. The presence of the following psychiatric symptoms including delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms, social/occupational dysfunction, verbal aggression, physical aggression, and affective symptoms were analyzed. A total of 3681 patients were included. The network analysis revealed that verbal aggression, hallucinations, and social/occupational dysfunction were the most central symptoms, while the connections between social/occupational dysfunction and verbal aggression, and between hallucinations and disorganized speech were the two strongest edges. There were significant gender differences in the network structure based on the network structure invariance test (M=0.74, P=0.03) and invariant edge strength test. The positive correlation between verbal aggression and hallucinations was significantly stronger in the female network than that in the male network (P=0.03), while a negative correlation between affective symptoms and negative symptoms was found in the female, but not the male network (P<0.01). Central symptoms including verbal aggression, hallucinations, and socio-occupational dysfunction should be addressed in developing targeted treatment strategy for schizophrenia patients.

Risks of major mental disorders after parental death in children, adolescents, and young adults and the role of premorbid mental comorbidities: a population-based cohort study.

Previous studies have shown an association between early parental death and the risk of subsequent major mental disorders (MMDs) among the bereaved children and adolescents; however, it is unclear whether this risk exists in young adults and in individuals with premorbid mental comorbidities. We aimed to explore differences between children, adolescents, and young adults in the risk of MMDs after parental death. We analyzed data from the Taiwan National Health Research Database. The index cohort was offspring (divided into four groups: aged < 6, 6–11, 12–17, and 18–29 years) whose parents had died. The control cohort was demographically matched offspring whose parents were still alive. Cox regression with adjustments for demographics was used to estimate the risk of subsequent MMDs between the index and control cohorts, including schizophrenia, bipolar disorder, and depressive disorder. We included 202,837 cases and 2,028,370 matched controls. As with the bereaved children and adolescents, the bereaved young adults had a significantly higher risk of schizophrenia (hazard ratio with 95% confidence interval: 5.63; 5.01–6.33), bipolar disorder (3.37; 2.96–3.84), and depressive disorder (2.78; 2.68–2.90) than the control cohort. The risk of MMDs was similar for maternal death and paternal death. Among premorbid mental comorbidities, bereaved individuals with premorbid substance use disorder were associated with the highest risk of schizophrenia (10.43; 8.57–12.71), bipolar disorder (12.93; 10.59–15.79), and depressive disorder (10.97; 10.22–11.78). Healthcare workers should be aware that young adults and individuals with premorbid mental comorbidities are at a higher risk of subsequent MMDs than those without premorbid mental comorbidities after parental death.

Reduced hippocampal gray matter volume is a common feature of patients with major depression, bipolar disorder, and schizophrenia spectrum disorders

Major depressive disorder (MDD), bipolar disorder (BD), and schizophrenia spectrum disorder (SSD, schizophrenia, and schizoaffective disorder) overlap in symptomatology, risk factors, genetics, and other biological measures. Based on previous findings, it remains unclear what transdiagnostic regional gray matter volume (GMV) alterations exist across these disorders, and with which factors they are associated. GMV (3-T magnetic resonance imaging) was compared between healthy controls (HC; n = 110), DSM-IV-TR diagnosed MDD (n = 110), BD (n = 110), and SSD patients (n = 110), matched for age and sex. We applied a conjunction analysis to identify shared GMV alterations across the disorders. To identify potential origins of identified GMV clusters, we associated them with early and current risk and protective factors, psychopathology, and neuropsychology, applying multiple regression models. Common to all diagnoses (vs. HC), we identified GMV reductions in the left hippocampus. This cluster was associated with the neuropsychology factor working memory/executive functioning, stressful life events, and with global assessment of functioning. Differential effects between groups were present in the left and right frontal operculae and left insula, with volume variances across groups highly overlapping. Our study is the first with a large, matched, transdiagnostic sample to yield shared GMV alterations in the left hippocampus across major mental disorders. The hippocampus is a major network hub, orchestrating a range of mental functions. Our findings underscore the need for a novel stratification of mental disorders, other than categorical diagnoses.

Categorical and Dimensional Deficits in Hippocampal Subfields Among Schizophrenia, Obsessive-Compulsive Disorder, Bipolar Disorder, and Major Depressive Disorder

BackgroundThe hippocampus is a core region of interest for all major mental disorders, and its subfields implement distinctive functions. It is unclear whether the mental disorders exhibit common patterns of hippocampal impairments, and we lack knowledge on whether and how hippocampal subfields represent deficit spectra across mental disorders. MethodsUsing brain images of 1123 individuals scanned on a single magnetic resonance imaging scanner, we examined the commonality, specificity, and symptom associations of the volume of hippocampal subfields across patients with schizophrenia, patients with obsessive-compulsive disorder, patients with bipolar disorder, patients with major depressive disorder, and healthy control subjects. We further performed a transdiagnostic analysis of the individual variability of the volume of hippocampal subfields to reflect cross-disease gradients in the hippocampus. ResultsWe found common and disease-specific abnormalities in a few hippocampal fields and identified 2 reliable transdiagnostic factors in the hippocampal subfields, each reflecting a spectrum of mental disorders. The plane spanned by the 2 most reliable factors provided a clearer view of hippocampal volume abnormality spectra among the major mental disorders. In addition, functional and genetic enrichment analyses supported the different roles of the 2 hippocampal factors in mental disorders. ConclusionsThe volume of hippocampal subfields reflected some commonality and specificity among the 3 major mental disorders. We propose a new pathophysiological dimensional view of the hippocampus, reflecting at least 2 spectra of mental disorders, suggesting multivariate links among the diseases. This work highlights the value of the complementary categorical and dimensional views of the hippocampal deficits in mental disorders.

A study of emotional intelligence in an Egyptian sample of offspring of patients with schizophrenia

BackgroundEmotional intelligence is usually a construct measured in healthy children, now it may be used for relatives of schizophrenia, and considered as trait marker for schizophrenia. Offspring of parents with schizophrenia are considered children with high familial risk for major mental disorder. The aim of the study is to assess emotional intelligence in a group of off springs of a parent with schizophrenia and compare them to healthy control subjects, and to find possible relation between emotional intelligence in offspring and profile of symptoms in schizophrenic parents.ResultsOffspring of parents with schizophrenia had lower scores of emotional intelligences than their matched controls in emotion perception, self-esteem, low impulsivity and emotion regulation’s subsets of TEIQue-CF. There was correlation between offspring trait emotional intelligence and their parent’s duration of illness. There was no correlation found between schizophrenia severity in the parents and their offspring’s trait emotional intelligence.ConclusionsOffspring of parents with schizophrenia had impaired trait emotional intelligence in some of its facets when compared to normal healthy subjects.

Charting the proteome landscape in major psychiatric disorders: From biomarkers to biological pathways towards drug discovery

Schizophrenia (SZ), bipolar disorder (BD), and major depressive disorder (MDD) are major mental disorders that affect a significant proportion of the global population. Advancing our knowledge of the pathophysiology of these disorders and identifying biomarkers are urgent needs for developing objective diagnostic tests and new therapeutics. In this study, we performed a systematic review and then extracted, curated, and analyzed proteomics data from published studies, aiming to assess the proteome in peripheral blood of individuals with SZ, BD, or MDD. Then, we performed pathway and network analyses to illuminate the biological themes concatenated by the differentially expressed proteins by systematically interrogating the literature to uncover biological pathways with more robust biological meaning. We identified 486 differentially expressed proteins from 51 studies across the three disorders with 9,423 participants. The great majority of pathways were common to SZ, BD, and MDD. They were related to the immune system, including signaling by interleukins, Toll-like receptor signaling pathway, and complement cascade, and to signal transduction, notably MAPK1/MAPK3 signaling, PI3K-Akt Signaling Pathway, Focal Adhesion-PI3K-Akt-mTOR-signaling, rhodopsin-like receptors, GPCR signaling, and the JAK-STAT signaling pathway. Other shared pathways included advanced glycosylation end-product receptor signaling, Regulation of Insulin-like Growth Factor, cholesterol metabolism, and IL-17 signaling pathway. Pathways shared between SZ and BD were integrin cell-surface interactions, GRB2:SOS provides linkage to MAPK signaling for integrins, and syndecan interactions. Shared between BD and MDD were the NRF2 pathway and signaling by EGFR pathways. Our findings advance our understanding of the protein variations and associations with these disorders, which are useful for accelerating biomarker development and drug discovery.

#72 STIGMA AND DEPRESSION AMONGST ADOLESCENTS LIVING WITH HIV/AIDS

Abstract Background The Highly Active Anti-Retroviral Therapy (HAART) has revolutionized the face of treatment of People Living With HIV/AIDS (PLWHA). Perinatally infected infants are living longer, reaching adolescent age group with deaths reduced by 54% but in long term there exists many drawbacks not only in terms of adherence, complications, drug resistance but also in terms of mental health. Adolescence is a critical period to promote mental health as major mental health disorders seem to start during this period. Adolescents with HIV/AIDS are more prone to a variety of mental health problems. The stress of being infected and living with the disease is higher. These adolescents face unique psychosocial challenges and most importantly, the stigma of being sufferers of this disease. Because of stigma, very few individuals seek psychiatric care and very few further follow up even when therapy has proven benefits. Method OBJECTIVES: To assess the following in adolescents living with HIV/AIDS: 1. The proportion of stigma. 2. The proportion of depression. 3. Correlation between depression and stigma. 4. Correlation between CD4 count, stage of disease and duration of illness with stigma and depression. STUDY DESIGN: Cross sectional study PARTICIPANTS: 83 adolescents on ART treatment for minimum 1 year duration and are free from any psychiatric condition. INTERVENTION: Questionnaires were administered for assessment of stigma using HIV Felt Stigma Scale (is a 4-point likert scale, consisting of 17 questions and scores are namely Strongly disagree-0, Disagree-1, Agree-2, Strongly agree-3. and Depression by Centre for Epidemiological Studies-Depression Scale (is 20 item scale). Calculating the overall CES-D – style symptom score, target score for referring to psychiatrist is more than or equal to 16. Results The proportion of participants who scored positive in the stigma scale was 92.8% and that of depression was noted to be 20.5%. Statistically significant correlation was observed between stigma and depression (0.020), between depression and CD4 count (0.024). Conclusion The study demonstrates that a rise in stigmatising attitudes is linked to a rise in depressive symptoms, implying the necessity for multilevel treatments in stigma reduction initiatives to prevent the mental health issues in this vulnerable population.

The association between major dietary patterns and severe mental disorders symptoms among a large sample of adults living in central Iran: Baseline data of YaHS-TAMYZ cohort study

BackgroundThe diet’s role in developing psychological disorders has been considered by researchers in recent years.ObjectiveTo examine the association between major dietary patterns and severe mental disorders symptoms in a large sample of adults living in Yazd city, central Iran.MethodsThis cross-sectional study used the baseline data of a population-based cohort study (Yazd Health study: YaHS). Dietary intakes were assessed by a multiple-choice semi-quantitative food frequency questionnaire (FFQ, Yazd nutrition survey called TAMYZ). Psychological assessments were also done by using the depression, anxiety, and stress scale-21 (DASS-21) questionnaire. Major dietary patterns were identified using principal component analysis (PCA). Analysis of covariance (ANCOVA) and logistic regression analyses were used to evaluate the relationship between dietary patterns and mental disorders symptoms.ResultsA total of 7574 adults were included in the current analysis. Four major dietary patterns were identified: "Sugar and Fats”, “Processed Meats and Fish”, "Fruits" and “Vegetables and Red Meat”. After adjustment for all confounding variables, participants in the fifth quintile of “Fruits” dietary pattern which was highly correlated with dried fruits, canned fruits, fruit juice, olive, hydrogenated fats and fruits intake, had a lower odds of severe depression (OR=0.61, 95% CI: 0.45–0.81, p for trend=0.057), anxiety (OR=0.64, 95% CI: 0.50–0.80, p for trend=0.007), and stress, (OR=0.45, 95% CI: 0.30–0.68, p for trend=0.081).ConclusionsThe intake of a dietary pattern high in dried fruits, canned fruits, fruit juice, olive, hydrogenated fats, and fruits might be inversely associated with depression, anxiety, and stress symptoms. Future prospective studies are needed to warrant this finding.

Transdiagnostic Clinical Staging for Childhood Mental Health: An Adjunctive Tool for Classifying Internalizing and Externalizing Syndromes that Emerge in Children Aged 5–11 Years

Clinical staging is now recognized as a key tool for facilitating innovation in personalized and preventative mental health care. It places a strong emphasis on the salience of indicated prevention, early intervention, and secondary prevention of major mental disorders. By contrast to established models for major mood and psychotic syndromes that emerge after puberty, developments in clinical staging for childhood-onset disorders lags significantly behind. In this article, criteria for a transdiagnostic staging model for those internalizing and externalizing disorders that emerge in childhood is presented. This sits alongside three putative pathophysiological profiles (developmental, circadian, and anxious-arousal) that may underpin these common illness trajectories. Given available evidence, we argue that it is now timely to develop a transdiagnostic staging model for childhood-onset syndromes. It is further argued that a transdiagnostic staging model has the potential to capture more precisely the dimensional, fluctuating developmental patterns of illness progression of childhood psychopathology. Given potential improvements in modelling etiological processes, and delivering more personalized interventions, transdiagnostic clinical staging for childhood holds much promise for assisting to improve outcomes. We finish by presenting an agenda for research in developments of transdiagnostic clinical staging for childhood mental health.

Research progress of cross-disease miRNA molecular markers in schizophrenia, bipolar disorder and depression

Micro non-coding RNA (microRNA, miRNA) is a small non-coding RNA involved in gene expression regulation that plays an important role in the onset and development of mental illness. Evidence suggests that several miRNAs are dysregulated in patients with mental illnesses. Because of its stability and quantitative detection in peripheral blood and cerebral fluid, miRNA is a particularly attractive biomarker. The objective of this research is to investigate the relationship between mental illness and miRNAs, as well as the potential processes through which miRNAs contribute to disease etiology. Schizophrenia, bipolar disorder, and depression are three major mental disorders with high disability and mortality. The study explored the particular dysregulated miRNAs for each condition as well as common dysregulated miRNAs across diseases. In this study, which analyzes the findings from relevant studies from 2016 to 2020, the authors discuss the functions of numerous severely dysfunctional miRNAs and their application potential in the field of psychiatry research.

Lemborexant, an orexin receptor antagonist sedative-hypnotic: Is it useful for insomnia in psychiatric disorders?

Lemborexant, an orexin receptor antagonist similar to suvorexant, has been approved for the treatment of sleep onset and/or maintenance insomnia. Lemborexant is reviewed and compare to suvorexant from a psychiatric perspective. Rapidly absorbed (peak 1-3h), lemborexant has a half-life of 17-19h (suvorexant half-life 12h). It is metabolized by CYP3A4/5, with no significant effects of age, sex or weight. Trials for insomnia indicate sustained efficacy beyond 6months. Lemborexant has not been trialled in major psychiatric disorders. Commenced at 5mg, lemborexant can then be increased to 10mg, taken at least 7h before planned awakening. Adverse effects are higher at 10mg: somnolence occurs in about 10% while headache and nightmares affect 2-5%, approximately similar to 40mg suvorexant (recommended suvorexant dose 20mg). Sleep paralysis, hypnagogic/hypnopompic hallucinations, and cataplexy-like symptoms, complex sleep behaviours and emergence of depression/suicidal ideation can occur. Neither tolerance to sedation nor withdrawal effects on discontinuation have been observed. Whether the differences between lemborexant and suvorexant are clinically relevant is unclear. Like suvorexant, lemborexant appears to be effective in longer-term use for insomnia, but until efficacy and safety are adequately investigated in major mental disorders, clinicians need to monitor patient experience closely.

Persian Translation and Cultural Adaptation of Mini International Neuropsychiatric Interview and its Psychometric Properties.

The main objectives of this study were the translation, cultural adaptation, and assessment of the psychometric properties of the Persian version of Mini International Neuropsychiatric Interview (MINI). All processes of linguistic methodology were conducted according to the published guidelines. A total of 180 patients with psychiatric problems were interviewed using MINI and Structured Clinical Interview for DSM-5(R) - Clinician Version (SCID-5-CV) by different interviewers. Another 30 patients were selected for examining the test-retest reliability. The study sample was recruited from a psychiatric hospital and a general hospital in Tehran, Iran. Face validity, feasibility, time of the interview, test-retest reliability, and concurrent validity were evaluated. Mean interview time was 19.76±10.30 minutes, indicating satisfactory feasibility. The test-retest reliability was very good (phi=2, Cramer's V=0.89, P<0.0001). The kappa values showed good or excellent agreement between MINI and SCID-5-CV for psychotic disorders (0.88), substance-related disorders (0.86), bipolar disorder (0.85), major depressive disorder (0.84), obsessive-compulsive disorder (0.74), and mental disorder due to other medical disorders (0.7). However, the kappa values were found to be lower for generalized anxiety disorder (0.44) and posttraumatic stress disorder (0.32) diagnoses. The Persian version of MINI is a feasible, reliable, and valid instrument for diagnosing some mental disorders. Further research is needed to evaluate the validity of this instrument in other categories of psychiatric diagnoses in the general population.

Mental and Body Health: The Association between Psychological Factors, Overweight, and Blood Pressure in Young Adults.

Comorbidity between cardiometabolic risk factors and major mental health disorders is a public health concern. The close interconnection between the mental and physical aspects of health precludes considering each condition separately. Accordingly, this study sought to explore the interrelationships between psychological factors, overweight, and blood pressure in young adults. One hundred and forty-five young adults participated in the study and were classified according to two independent characteristics: weight condition (normal weight, overweight) and blood pressure (low blood pressure, high blood pressure). Anxiety, depression, and emotional dysregulation were assessed. The results confirmed certain associations, highlighting how cardiometabolic risk factors, such as blood pressure and body mass index, were associated in different ways with mental health, although an interaction between the variables was not reported. In particular, a relationship between body mass index and depression and between anxiety and blood pressure was detected.

A nationwide study of the risks of major mental disorders among the offspring of parents with rheumatoid arthritis

Rheumatoid arthritis (RA) may share genomic risks with certain mental disorders. This study aimed at investigating associations between parental RA and risks of mental disorders in offspring. Using the National Health Insurance Research Database (2001–2010), we conducted a matched cohort study involving two parent–child cohorts (i.e., RA-parent–child cohort and non-RA-parent–child cohort) between which risks of major mental disorders in offspring were compared. There were 23,981 parent–child pairs in the RA-parent–child cohort and 239,810 in the non-RA-parent–child cohort. Preliminary analysis demonstrated increased risks of autism spectrum disorders (ASDs) [Odds ratio (OR) 1.47; 95% confidence interval (CI) 1.05–2.07], attention-deficit/hyperactivity disorder (ADHD) [OR 1.34; (95% CI 1.17–1.54)], bipolar disorder [OR 1.41 (95% CI 1.17–1.70)], and major depressive disorder [OR 1.20 (95% CI 1.07–1.35)] associated with parental RA. Sub-group analysis further showed higher risks of the four disorders in children of mothers with RA but not those from fathers with RA. Higher risks of ASDs and ADHD were not noted in children of mothers with RA before childbirth. Maternal RA, but not paternal RA or mothers diagnosed with RA before childbirth, was associated with increased risks of multiple mental disorders in their offspring, suggesting potential contributions of maternal genetic factors to ASDs and ADHD development in offspring.

Mental Disorders and Intimate Partner Femicide: Clinical Characteristics in Perpetrators of Intimate Partner Femicide and Male-to-Male Homicide.

Intimate partner violence against women is a global and persistent public health issue. An extreme manifestation of this problem is intimate partner femicide (IPF), the killing of a woman by a male partner. While declining trends of homicide rates have been observed over decades, rates of femicide and IPF have remained stable. Yet, IPF as a phenomenon has until recently been fairly invisible in Europe, why research from the European countries on rates and characteristics of IPF has been relatively scarce. One area of research, particularly in need of further scrutiny, is to what degree perpetrators of IPF suffer from mental health conditions, and what the clinical features are. The objective of present study was to add to the existing literature by investigating prevalence and types of mental disorders in perpetrators of IPF, and to compare with male-to-male homicide (MMH) perpetrators. Our aim was also to examine life-time contact with psychiatric services, and, with missed opportunities in mind, contacts shortly preceding the homicide. With a retrospective design, this population-based study includes all solved cases of male-perpetrated homicides against intimate female partners (IPF) and other males (MMH) committed in Sweden between January 2007 and December 2009. Primary and secondary psychiatric diagnoses based on ICD, version 8, 9 or 10 from psychiatric inpatient as well as outpatient care have been retrieved. In order to identify mental disorders in perpetrators during commission of the homicidal offense, we also retrieved diagnoses from forensic psychiatric evaluations. Our results demonstrate that approximately one-third of the perpetrators, irrespective of homicide type, had been diagnosed with a mental disorder (excluding substance related disorders) at some point in life. Diagnosis of substance related disorders from psychiatric care was significantly more common in MMH perpetrators (37%) compared to IPF perpetrators (15%). Similarly low rates of major mental disorder were found in both groups (11%) when aggregating life-time diagnoses and diagnoses during commission of the crime. However, homicide-suicide in connection to the offense was relatively common in IPF perpetrators (20%). Thus, our study supports the notion that previous suicide attempts and suicide ideation are important indicators for predicting and possibly preventing IPF.

Caring for Older Adults Experiencing Homelessness in the Inpatient Psychiatry Setting: Challenges and Recommendations

The older adult population is rapidly growing in the United States and across the globe. The Institute of Medicine estimates that the number of older adults with mental health or substance use disorders will reach 10.1 million to 14.4 million people by 2030. A particularly vulnerable subgroup within this aging population is the subset experiencing homelessness. According to a 2017 report by the U.S. Department of Housing and Urban Development, homeless adults >50 years old increased from 22.9% to 33.8% between 2007-2017. Moreover, the number of people >62 years old living in shelters or transitional housing increased during the same time period to 76,000, a growth of 69%. This challenge is likely to worsen in the next decade as adults >65 years old experiencing homelessness is expected to triple between 2017-2030. Amongst the general population of adults experiencing homelessness, there is a higher prevalence of mental health and substance use disorders compared to the general population. Mental health care of older homeless adults can be negatively affected by systemic issues associated with homelessness. Such factors include victimization while being homeless, involvement in the criminal justice system, medication nonadherence, and complex case management issues. Homeless individuals, especially women, with mental illnesses experience higher levels of victimization compared to their housed counterparts. A systematic review found that the on-year prevalence of criminal victimization among adults with major mental disorders was up 35% for violent victimization and 28% for nonviolent victimization. Additionally, the lifetime victimization rate ranged between 74% and 87%. Data also show that 63% to 90% of homeless individuals with severe mental illness have been arrested at least once, 28% to 80% have been convicted of a crime, and 48% to 67% have been incarcerated. These issues may affect rapport building by the treatment team and disposition planning. Furthermore, not attending an outpatient mental health appointment after a psychiatric hospitalization is associated with an increased risk for rehospitalization. A 2007 study determined that patients who attended a follow-up appointment had a 1 in 10 chance of being rehospitalized, whereas patients who did not attend (or were not offered) an appointment had a 1 in 4 chance of rehospitalization. At San Francisco General Hospital, a chart review during a 4-week period between February and April 2020 revealed that 83% of unhoused patients did not show up for their outpatient mental health appointment following discharge from a psychiatric unit. Proposed solutions to help older adults who first experience homelessness late in life include developing more affordable housing, boosting rental assistance (Housing Choice Vouchers), increasing wages, Supplemental Security Income, Social Security Disability Insurance, and state supplemental income. Another proposal is Permanent Supportive Housing (PSH), a program that provides housing paired with supportive services such as case-management, individual and group therapy, and peer support. Veteran-specific PSH has been used to reduce homelessness in chronically homeless veterans (United States Interagency Council on Homelessness, 2018). PSH is also less restrictive and less expensive than nursing home placement of chronically homeless individuals. The At Home/Chez Soi randomized controlled trial from Canada, showed that rent supplements and mental health support services improved housing stability for homeless adults with mental illness.

Prevalence and Risk Factors of Postpartum Depression in Romanian Women during Two Periods of COVID-19 Pandemic.

Postpartum depression is a major mental health disorder that can negatively affect both mother and baby. In addition, the COVID-19 pandemic associated with extreme measures of the lockdown had profound effects on humanity, increasing the rates of anxiety and depression, especially among women in the postpartum period. The aim of this study was threefold: to determine the prevalence of postpartum depression, to compare the prevalence of postpartum depression at two different times during the COVID-19 pandemic, and to assess a possible association between the timing of childbirth in a given period of the pandemic and the risk of postpartum depression. A cross-sectional study involving 154 women who were interviewed immediately postpartum, using the EPDS scale, was conducted at the Timisoara Municipal Hospital, Romania at two different periods during the COVID-19 pandemic (March–April 2020 during the first wave and August–September 2021 during the fourth wave). The overall prevalence of postpartum depression (EPDS score > 13) was 18.8%, with a statistically significantly higher rate among participants surveyed during the fourth wave of the COVID-19 pandemic in Romania; the COVID-19 pandemic represents an impact on women’s mental health in the postpartum period, increasing the risk of developing postpartum depression.