Pre-existing Mental Disorders Research Articles

Social disconnectedness and the rate of medical conditions: a Danish population-based cohort study

Abstract Background Lack of social connections has a serious impact on health, increasing the risk of medical conditions such as depression, dementia, and coronary heart disease. However, evidence is limited by a disease-specific focus. We aimed to provide a comprehensive overview of differences in incidence rates of a broad range of medical conditions according to social disconnectedness (i.e., loneliness, social isolation, and low social support). Methods We conducted a cohort study using data on loneliness, social isolation, low social support, and a composite measure from the 2013 and 2017 Danish National Health Survey. Survey data was linked with register data on 11 categories of medical conditions through 2021. Poisson regression was applied to estimate incidence rate ratios (IRRs), incidence rate differences, and explore interaction with pre-existing mental disorders. Results Among 162,497 survey participants, 7.6%, 3.5%, and 14.8% were identified as lonely, socially isolated, and with low social support, respectively. Lonely individuals and individuals with low social support had a higher incidence rate of all 11 categories of medical conditions (interquartile range of IRRs, loneliness 1.22-1.49 and low social support 1.10-1.14), whereas this was the case for nine categories among socially isolated individuals (interquartile range of IRRs, 1.01-1.31). Applying the composite measure, the highest IRR was 2.61 (95% CI, 2.34-2.88) for a mental disorder and the lowest 1.03 (95% CI, 0.95-1.10) for cancer. We found neither major sex differences nor substantial interaction with pre-existing mental disorders. Conclusions Our study confirms and extends the available evidence on social disconnectedness and the risk of medical conditions. The attained knowledge may be of significance for mapping group-specific preventative needs and guiding interventions and health practitioners aiming to reduce the disease burden among socially disconnected individuals. Key messages • Based on survey and register data from 162,497 individuals, our study suggests that social disconnectedness, especially loneliness, is a determinant of a broad range of medical conditions. • The findings may be of importance for identifying and targeting the disease burden among socially disconnected individuals.

The association between the mental health disorders, substance abuse, and tobacco use with head & neck cancer stage at diagnosis.

Mental health disorders, substance abuse, and tobacco use are prevalent in the US population. However, the association between these conditions and head and neck cancer (HNC) stage is poorly understood. This research aims to uncover the relationship between pre-existing mental health disorders, substance abuse, and tobacco use and HNC stage at diagnosis in patients receiving care in an integrated, public safety-net healthcare system. This study was a secondary data analysis of linked hospital tumor registries and electronic health record (EHR) data. The study's primary independent variables were the comorbidities of mental health disorders, substance abuse, and tobacco use. The dependent variable was HNC stage at diagnosis, operationalized as early stage (i.e., stages I, II, and III) and advanced stage (stage IV, IVA, IVB, or IVC). The analysis included multivariable logistic regression adjusted for covariates of demographic variables, tumor anato RESULTS: The study population consisted of 357 patients with median age of 59years, and was primarily male (77%), diverse (Black or African American 41%; Hispanic 22%), and from neighborhoods with low income (median average annual household income $39,785). Patients with a history of mental health disorders with or without tobacco use had significantly lower odds of advanced stage HNC at diagnosis (adjusted OR = 0.35, 95% Confidence Interval [CI]: 0.17-0.72.) while patients with a history of substance abuse with or without tobacco use had significantly higher odds of advanced stage HNC at diagnosis (adjusted OR 1.41, 95% CI: 1.01-1.98) than patients with no history of mental health disorders, substance abuse, or tobacco use. The relationship between HNC stage at diagnosis and the comorbidities of mental health disorders, substance abuse, or tobacco differs depending on the type and co-occurrence of these comorbidities. These findings demonstrate the need for innovative care delivery models and education initiatives tailored to meet the needs of patients with mental health disorders, substance abuse, and tobacco use that facilitate early detection of HNC.

Is it Possible for Individuals with Pre-Existing Mental Disorders to Perform Mountain Sports at High Altitude-First Evidence from a Pilot Cross-Sectional Questionnaire Study.

Gstir, Claudia, Timo Schurr, Roxana Ehlers, Johannes Burtscher, Barbara Sperner-Unterweger, and Katharina Hüfner. Is it possible for individuals with pre-existing mental disorders to perform mountain sports at high altitude-First evidence from a pilot cross-sectional questionnaire study. High Alt Med Biol. 00:00-00, 2024. Introduction: Mountain sports at high altitude (HA) are gaining increasing popularity, but little is known about the effect of such activities on mental health, despite a great prevalence of mental disorders. Methods: Data were collected using an online self-report questionnaire assessing mental and somatic disorders in individuals performing mountain sports at HA (>2,500 m above sea level [ASL]) as well as their symptom change. Nonparametric tests were used for analyses. Results: 251 individuals without pre-existing disorders (noD), 34 with somatic disorders (somaD), and 38 with mental disorders (mentalD; mainly depressive, eating, and anxiety disorders) participated in this study. Overall, 44.7% of the mentalD group compared with 14.7% of somaD experienced ameliorated symptoms during mountain sports at HA, while 2.6% and 8.8%, respectively, reported a worsening (χ2[2] =8.13, p = 0.017). People in the mentalD compared with somaD group significantly less frequently inform tour partners (41.9% vs. 90.9%; χ2[2]=16.69, p < 0.001) about their condition or consult their physician (2.6% vs. 26.5%; χ2[1]=8.53, p = 0.003) regarding their plans to perform mountain sports at HA. 14.5% of all participants reported mental symptoms at 2,500-3,500 m ASL, 23.5% between >3,500-5,500 m ASL and 31.8% >5,500 m ASL. Conclusion: Individuals with mental disorders often report improved mental health during mountain sports at HA, possibly due to a combination of physical activity, the alpine natural environment, and/or moderate hypoxia. The fact that tour partners and physicians are rarely informed shows the need to reduce the stigma of mental disorders in the mountain sports community. The study was prospectively registered with the German Clinical Trials Registry (DRKS00024949).

Adolescents' Depression Symptoms After Social Distancing and Restrictions: The EpiCoV French Longitudinal Population-Based Cohort

PurposeThe recent worldwide health pandemic and related social distancing and restrictions negatively impacted adolescents' mental health, including depression, underscoring the need for comprehensive understanding beyond immediate impacts. We aimed to identify factors assessed during the first and second lockdowns that were associated with depression symptoms 2 years after restrictions easing. MethodsThis study included 1,946 adolescents, aged 15–18 years, involved in the French Epidémiologie et Conditions de Vie population-based cohort. Depression symptoms were assessed twice, with the nine-item Patient Health Questionnaire, at the beginning of restrictions easing and 1 year later. Logistic regressions were used to estimate associations among sociodemographic, socioeconomics, health, substance use, lockdown conditions, and pandemic-related factors, self-reported during the first and second lockdowns in France, and depression symptoms. Elastic-Net regression was used to study the joint effect of characteristics assessed during both lockdowns. ResultsA total of 472 (25.25%) adolescents reported depression symptoms in the restrictions easing period, 369 (78.18%) were girls and 103 (21.82%) were boys. Factors associated with a higher risk of reporting depression symptoms included being a girl, a smoker, frequently consuming alcohol, having spent lockdowns in a place without outdoor space, poor perceived health, and pre-existing mental disorders. DiscussionFactors associated with depression symptoms after restrictions easing were well known and mostly not related to social distancing and restrictions, suggesting that already vulnerable youth were more likely to be impacted by the stressful pandemic context. Special caution is needed for these adolescents to limit pandemic's impact on long-lasting mental health. These results also underscore the importance of early identification of at-risk adolescents and the development of interventions to enhance their resilience and support in case of future crises.

Mental health of individuals with pre-existing mental illnesses at the beginning of the COVID-19 pandemic: results of the German National Cohort (NAKO).

The COVID-19 pandemic prompted a range of studies on mental health, with mixed results. While numerous studies reported worsened conditions in individuals with pre-existing mental disorders, others showed resilience and stability in mental health. However, longitudinal data focusing on the German population are sparse, especially regarding effects of age and pre-existing mental disorders during the early stages of the pandemic. To assess the interplay between psychiatric history, age, and the timing of the pandemic, with a focus on understanding how these factors relate to the severity of depression and anxiety symptoms. Exploratory analyses were based on 135,445 individuals aged 20-72 years from the German National Cohort (NAKO). Depressive and anxiety symptoms were assessed before and after the first wave of the pandemic. Inferential statistical analyses and negative binomial regression models were calculated. Persons with a self-reported psychiatric history exhibited comparable levels of depression and anxiety symptom severity after the first wave of the pandemic compared to the time before. In contrast, individuals without a psychiatric history, particularly those in their 20s to 40s, experienced an increase in mental health symptom severity during the first wave of the pandemic. Analyses focuses on the first wave of the pandemic, leaving the long-term mental health effects unexplored. Future research should consider age-specific and mental-health-related factors when addressing global health crises. Additionally, it is important to explore factors influencing resilience and adaptation, aiming to develop targeted interventions and informed policies for effective mental health management during pandemics.

The association of perceived social support, resilience, and posttraumatic stress symptoms among coronavirus disease patients in the United States

BackgroundPosttraumatic stress disorder (PTSD) has become a main psychological consequence of COVID-19. This study assessed the association between social support, psychological resilience, and probable COVID-19-related PTSD. MethodsThe PTSD Checklist for DSM-5, Medical Outcomes Study Social Support Survey, and Connor-Davidson Resilience Scale (CD-RISC) were used to assess for PTSD symptoms, social support, and resilience among COVID-19 patients treated at a large medical system in New York City between July 2020 and July 2023. Logistic regression evaluated the association between social support and resilience with PTSD. We further investigated whether associations differed across age, gender, site of acute care, vaccination status, and pre-existing mental disorders. ResultsAmong the 1484 participants, 16.6 % had probable COVID-19-related PTSD. Higher scores on measures of resilience (OR: 0.68, 95 % CI: 0.61–0.75) and social support (OR: 0.96, 95 % CI: 0.93–0.99) were associated with lower odds of probable COVID-19-related PTSD. The association between resilience and PTSD was moderated by sex (p for interaction = 0.001), with resilience showing a stronger negative association with PTSD among men relative to women. Associations between resilience, social support, and COVID-19-related PTSD did not differ by age, sites of acute care, vaccination status, and pre-existing mental disorders. LimitationsCross-sectional design precludes establishing causal relationships; assessment timing was not considered; the short CD-RISC may limit measurement precision; single-center study may not be fully generalizable. ConclusionsThese findings suggest that individuals with low social support and resilience may be at higher risk of PTSD and should be screened and be the target of preventive interventions.

The psyche of people with preexisting mental disorders during the war.

The psyche of people with preexisting mental disorders during the war.

Patients with cancer and pre-existing severe mental disorder

Patients with cancer and pre-existing severe mental disorder, which include moderate to severe depression, bipolar disorder and schizophrenia, are known to have reduced life expectancy and are less likely to get recommended cancer treatment. Barriers at patient-, provider- and system level have been identified, e.g. lack of identification of psychiatric comorbidity, shortage of stabilising psychiatric symptoms and fragmentation of the healthcare system. Patient-centered, interdisciplinary and cross-sectorial healthcare interventions have shown a high potential to improve the cancer care, as argued in this review.

A longitudinal study on impact of emergency cash transfer payments during the COVID pandemic on coping among Australian young adults

The coronavirus (COVID-19) pandemic has caused financial hardship and psychological distress among young Australians. This study investigates whether the Australian Government’s emergency cash transfer payments—specifically welfare expansion for those unemployed prior to the pandemic (known in Australia as the Coronavirus Supplement) and JobKeeper (cash support for those with reduced or stopped employment due to the pandemic)—were associated with individual’s level of coping during the coronavirus pandemic among those with and without mental disorders (including anxiety, depression, ADHD and autism). The sample included 902 young adults who participated in all of the last three waves (8, 9C1, 9C2) of the Longitudinal Study of Australian Children (LSAC), a nationally representative cohort study. Modified Poisson regression models were used to assess the impact of emergency cash transfer payments on 18–22-year-old’s self-rated coping level, stratifying the analysis by those with and without mental disorders. All models were adjusted for gender, employment, location, family cohesion, history of smoking, alcohol intake, and COVID-19 test result. Of the 902-person sample analysed, 41.5% (n = 374) reported high levels of coping, 18.9% (n = 171) reported mental disorders, 40.3% (n = 364) received the Coronavirus Supplement and 16.4% (n = 148) received JobKeeper payments. Analysing the total sample demonstrated that participants who received the JobKeeper payment were more likely to have a higher level of coping compared to those who did not receive the JobKeeper payment. Stratified analyses demonstrated that those with pre-existing mental disorder obtained significant benefit from the JobKeeper payment on their level of coping, compared to those who did not receive JobKeeper. In contrast, receipt of the Coronavirus Supplement was not significantly associated with higher level of coping. Among those with no mental health disorder, neither the Coronavirus Supplement nor JobKeeper had a statistically significant impact on level of coping. These findings suggest the positive impacts of cash transfers on level of coping during the pandemic were limited to those with a pre-existing mental disorder who received JobKeeper.

Contribution of severe mental disorders to fatally harmful effects of physical disorders: national cohort study.

It remains unknown whether severe mental disorders contribute to fatally harmful effects of physical illness. To investigate the risk of all-cause death and loss of life-years following the onset of a wide range of physical health conditions in people with severe mental disorders compared with matched counterparts who had only these physical health conditions, and to assess whether these associations can be fully explained by this patient group having more clinically recorded physical illness. Using Czech national in-patient register data, we identified individuals with 28 physical health conditions recorded between 1999 and 2017, separately for each condition. In these people, we identified individuals who had severe mental disorders recorded before the physical health condition and exactly matched them with up to five counterparts who had no recorded prior severe mental disorders. We estimated the risk of all-cause death and lost life-years following each of the physical health conditions in people with pre-existing severe mental disorders compared with matched counterparts without severe mental disorders. People with severe mental disorders had an elevated risk of all-cause death following the onset of 7 out of 9 broadly defined and 14 out of 19 specific physical health conditions. People with severe mental disorders lost additional life-years following the onset of 8 out 9 broadly defined and 13 out of 19 specific physical health conditions. The vast majority of results remained robust after considering the potentially confounding role of somatic multimorbidity and other clinical and sociodemographic factors. A wide range of physical illnesses are more likely to result in all-cause death in people with pre-existing severe mental disorders. This premature mortality cannot be fully explained by having more clinically recorded physical illness, suggesting that physical disorders are more likely to be fatally harmful in this patient group.

Preexisting Mental Disorders and Mental Distress During the Pandemic: The Roles of Stress, Risk Perception, and Loneliness.

The COVID-19 pandemic has imposed unprecedented stressors on individuals globally, leading to significant mental health challenges. This study examines the relationship between perceived adversities experienced during the pandemic-such as stress, risk perception, and loneliness-and the mental health outcomes of individuals with a specific focus on those already grappling with mental disorders. The study analyzed data from 8,259 adults who participated in surveys between waves 4 (April 2020) and 29 (June 2021) of the Understanding American Study. Participants self-reported their psychiatric diagnosis history and completed self-report measures of mental distress (PHQ-4), perceived stress, risk perception, and loneliness. Those with preexisting comorbid mental disorders reported higher levels of mental distress, COVID-19 risk perception, perceived stress as well as more days experiencing loneliness during the pandemic. Perceived adversities-stress, risk perception, and loneliness-were all positively associated with increased mental distress, indicating the risk factors for mental distress during the pandemic. Among these factors, loneliness was identified as the primary contributor, accounting for 30%-40% of the mental health gap between individuals with and without preexisting mental diagnoses. Also, the detrimental impact of these adversities was more pronounced for those with preexisting mental disorders. The research highlights that those with preexisting mental disorders, particularly those with comorbidities, face an increased risk of experiencing mental distress during the COVID-19 pandemic. These findings underscore the critical importance of providing targeted support and interventions specifically designed for this vulnerable population, with a particular focus on addressing loneliness.

A comprehensive investigation of comorbidities of prolonged grief disorder in a bereaved inpatient psychiatric sample

Prolonged Grief Disorder (PGD) was recently added to ICD-11 and DSM-5-TR. Depression and Posttraumatic Stress Disorder (PTSD) are frequent comorbidities, but findings regarding comorbid somatoform disorder and personality disorders remain mixed and studies with severely impaired patients are scarce. It was therefore the objective of the present study to examine comorbidities of PGD in a bereaved inpatient psychiatric sample. We assessed N = 101 bereaved inpatients in a psychiatric hospital with clinical interviews and self-report questionnaires. We calculated differences between patients with and without a PGD-diagnosis in number and type of comorbid disorders as well as associations between the severity of PGD and comorbid disorders. On average, patients had 2.53 comorbid psychiatric diagnoses. Patients with and without a PGD-diagnosis did not differ in their number of comorbid diagnoses, and there was no association between number of comorbid diagnoses and PGD-severity. However, patients with PGD, had significantly more comorbid diagnoses belonging to neurotic-, stress-related and somatoform disorders of the ICD-10. Patients with PGDICD-11 also had significantly higher scores in self-reported depressive, PTSD-, and somatoform symptoms, as well as the negative affectivity personality domain than those without a PGD diagnosis. To the best of our knowledge, this is the first study to provide insights into comorbidities of PGD in a bereaved inpatient psychiatric sample. It highlights the importance of considering PGD symptoms as part of the complaints of bereaved patients to achieve a tailored treatment approach. Future longitudinal studies are needed to unveil relationships between pre-existing mental disorders and PGD.

Deaths with COVID-19 and from all-causes following first-ever SARS-CoV-2 infection in individuals with preexisting mental disorders: A national cohort study from Czechia.

Evidence suggests reduced survival rates following Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in people with preexisting mental disorders, especially psychotic disorders, before the broad introduction of vaccines. It remains unknown whether this elevated mortality risk persisted at later phases of the pandemic and when accounting for the confounding effect of vaccination uptake and clinically recorded physical comorbidities. We used data from Czech national health registers to identify first-ever serologically confirmed SARS-CoV-2 infections in 5 epochs related to different phases of the pandemic: 1st March 2020 to 30th September 2020, 1st October 2020 to 26th December 2020, 27th December 2020 to 31st March 2021, 1st April 2021 to 31st October 2021, and 1st November 2021 to 29th February 2022. In these people, we ascertained cases of mental disorders using 2 approaches: (1) per the International Classification of Diseases 10th Revision (ICD-10) diagnostic codes for substance use, psychotic, affective, and anxiety disorders; and (2) per ICD-10 diagnostic codes for the above mental disorders coupled with a prescription for anxiolytics/hypnotics/sedatives, antidepressants, antipsychotics, or stimulants per the Anatomical Therapeutic Chemical (ATC) classification codes. We matched individuals with preexisting mental disorders with counterparts who had no recorded mental disorders on age, sex, month and year of infection, vaccination status, and the Charlson Comorbidity Index (CCI). We assessed deaths with Coronavirus Disease 2019 (COVID-19) and from all-causes in the time period of 28 and 60 days following the infection using stratified Cox proportional hazards models, adjusting for matching variables and additional confounders. The number of individuals in matched-cohorts ranged from 1,328 in epoch 1 to 854,079 in epoch 5. The proportion of females ranged from 34.98% in people diagnosed with substance use disorders in epoch 3 to 71.16% in individuals diagnosed and treated with anxiety disorders in epoch 5. The mean age ranged from 40.97 years (standard deviation [SD] = 15.69 years) in individuals diagnosed with substance use disorders in epoch 5 to 56.04 years (SD = 18.37 years) in people diagnosed with psychotic disorders in epoch 2. People diagnosed with or diagnosed and treated for psychotic disorders had a consistently elevated risk of dying with COVID-19 in epochs 2, 3, 4, and 5, with adjusted hazard ratios (aHRs) ranging from 1.46 [95% confidence intervals (CIs), 1.18, 1.79] to 1.93 [95% CIs, 1.12, 3.32]. This patient group demonstrated also a consistently elevated risk of all-cause mortality in epochs 2, 3, 4, and 5 (aHR from 1.43 [95% CIs, 1.23, 1.66] to 1.99 [95% CIs, 1.25, 3.16]). The models could not be reliably fit for psychotic disorders in epoch 1. People diagnosed with substance use disorders had an increased risk of all-cause mortality 28 days postinfection in epoch 3, 4, and 5 (aHR from 1.30 [95% CIs, 1.14, 1.47] to 1.59 [95% CIs, 1.19, 2.12]) and 60 days postinfection in epoch 2, 3, 4, and 5 (aHR from 1.22 [95% CIs, 1.08, 1.38] to 1.52 [95% CIs, 1.16, 1.98]). Cases ascertained based on diagnosis of substance use disorders and treatment had increased risk of all-cause mortality in epoch 2, 3, 4, and 5 (aHR from 1.22 [95% CIs, 1.03, 1.43] to 1.91 [95% CIs, 1.25, 2.91]). The models could not be reliably fit for substance use disorders in epoch 1. In contrast to these, people diagnosed with anxiety disorders had a decreased risk of death with COVID-19 in epoch 2, 3, and 5 (aHR from 0.78 [95% CIs, 0.69, 0.88] to 0.89 [95% CIs, 0.81, 0.98]) and all-cause mortality in epoch 2, 3, 4, and 5 (aHR from 0.83 [95% CIs, 0.77, 0.90] to 0.88 [95% CIs, 0.83, 0.93]). People diagnosed and treated for affective disorders had a decreased risk of both death with COVID-19 and from all-causes in epoch 3 (aHR from 0.87 [95% CIs, 0.79, 0.96] to 0.90 [95% CIs, 0.83, 0.99]), but demonstrated broadly null effects in other epochs. Given the unavailability of data on a number of potentially influential confounders, particularly body mass index, tobacco smoking status, and socioeconomic status, part of the detected associations might be due to residual confounding. People with preexisting psychotic, and, less robustly, substance use disorders demonstrated a persistently elevated risk of death following SARS-CoV-2 infection throughout the pandemic. While it cannot be ruled out that part of the detected associations is due to residual confounding, this excess mortality cannot be fully explained by lower vaccination uptake and more clinically recorded physical comorbidities in these patient groups.

Rates of Vaccination against COVID-19 in Psychiatric Outpatients.

The aim of this study was to compare the rates of vaccination against COVID-19 infection in psychiatric outpatients and the general population, as well as rates of infected patients. In addition, the level and type of anxiety due to the pandemic were observed in patients with psychotic, anxiety, and depressive disorders. In the present study, 171 patients with pre-existing mental disorders completed the questionnaire about the doses and types of vaccination against COVID-19. During 2021-2023, patients with different mental disorders, aged from 18 to 80, were included. All patients filled in a self-reported questionnaire including general information (age, sex, marriage, education, working status, comorbid conditions) as well as questions about mental health, receiving vaccination, and the course of COVID-19 infection if it was present. All patients gave informed consent for the interview. Patients with pre-existing mental disorders were more likely to be vaccinated against COVID-19 compared with the general population. The Sinopharm vaccine was most frequently applied. In the observed patients, 46.8% were infected, but just 7% had a medium or serious form of infection and were not vaccinated. In our study, the percentage of vaccinated psychiatric patients was greater than that in the general population, except in psychotic patients, who were mostly limited by fear. Such results can be explained by the high percentage of somatic comorbidities in this population and perhaps insufficient information about the positive effects of vaccination.

Preferential and sustained platelet activation in COVID-19 survivors with mental disorders

Pre-existing mental disorders are considered a risk factor for severe COVID-19 outcomes, possibly because of higher vascular burden. Moreover, an unconventional platelet activation characterizes COVID-19 and contributes to inflammatory and thrombotic manifestations. In the light of the inflammation theory of mental disorders, we hypothesized that patients with mental disorders could be sensitive to the SARS-CoV-2 elicited platelet activation. We investigated platelet activation in 141 COVID-19 survivors at one month after clearance of the virus, comparing subjects with or without an established pre-existing diagnosis of mental disorder according to the DSM-5. We found that platelets from patients with a positive history of psychiatric disorder underwent unconventional activation more frequently than conventional activation or no activation at all. Such preferential activation was not detected when platelets from patients without a previous psychiatric diagnosis were studied. When testing the effects of age, sex, and psychiatric history on the platelet activation, GLZM multivariate analysis confirmed the significant effect of diagnosis only. These findings suggest a preferential platelet activation during acute COVID-19 in patients with a pre-existing psychiatric disorder, mediated by mechanisms associated with thromboinflammation. This event could have contributed to the higher risk of severe outcome in the psychiatric population.

The impact of climate change on mental health of children and adolescents

Climate change can affect the mental health of children and adolescents. This age group is considered particularly vulnerable to this impact because they are in a period of cognitive and emotional development, during which they are still developing their coping skills. Children and teenagers with pre-existing mental health disorders, such as depression or anxiety, are especially at risk. It is important for parents, medical personnel, and others working with children and adolescents to have the necessary knowledge to help them cope with these challenges. This publication aims to present the current state of knowledge regarding the impact of climate change on the mental health of children and adolescents. Both the direct and indirect effects of these changes will be analyzed, along with strategies for coping with them. By understanding the potential risks, it is possible to develop effective psychological support strategies to minimize the negative impact of climate change on children and adolescents.

Patterns and correlates of mental healthcare utilization during the COVID-19 pandemic among individuals with pre-existing mental disorder.

How did mental healthcare utilization change during the COVID-19 pandemic period among individuals with pre-existing mental disorder? Understanding utilization patterns of these at-risk individuals and identifying those most likely to exhibit increased utilization could improve patient stratification and efficient delivery of mental health services. This study leveraged large-scale electronic health record (EHR) data to describe mental healthcare utilization patterns among individuals with pre-existing mental disorder before and during the COVID-19 pandemic and identify correlates of high mental healthcare utilization. Using EHR data from a large healthcare system in Massachusetts, we identified three "pre-existing mental disorder" groups (PMD) based on having a documented mental disorder diagnosis within the 6 months prior to the March 2020 lockdown, related to: (1) stress-related disorders (e.g., depression, anxiety) (N = 115,849), (2) serious mental illness (e.g., schizophrenia, bipolar disorders) (N = 11,530), or (3) compulsive behavior disorders (e.g., eating disorder, OCD) (N = 5,893). We also identified a "historical comparison" group (HC) for each PMD (N = 113,604, 11,758, and 5,387, respectively) from the previous year (2019). We assessed the monthly number of mental healthcare visits from March 13 to December 31 for PMDs in 2020 and HCs in 2019. Phenome-wide association analyses (PheWAS) were used to identify clinical correlates of high mental healthcare utilization. We found the overall number of mental healthcare visits per patient during the pandemic period in 2020 was 10-12% higher than in 2019. The majority of increased visits was driven by a subset of high mental healthcare utilizers (top decile). PheWAS results indicated that correlates of high utilization (prior mental disorders, chronic pain, insomnia, viral hepatitis C, etc.) were largely similar before and during the pandemic, though several conditions (e.g., back pain) were associated with high utilization only during the pandemic. Limitations included that we were not able to examine other risk factors previously shown to influence mental health during the pandemic (e.g., social support, discrimination) due to lack of social determinants of health information in EHR data. Mental healthcare utilization among patients with pre-existing mental disorder increased overall during the pandemic, likely due to expanded access to telemedicine. Given that clinical correlates of high mental healthcare utilization in a major hospital system were largely similar before and during the COVID-19 pandemic, resource stratification based on known risk factor profiles may aid hospitals in responding to heightened mental healthcare needs during a pandemic.

Assessing the impact of contraceptive use on mental health among women of reproductive age – a systematic review

BackgroundContraceptive use is the principal method by which women avoid unintended pregnancy. An unintended pregnancy can induce long-term distress related to the medical, emotional, and social consequences of carrying that pregnancy to term.ObjectivesThis review investigates the effects of modern contraception techniques such as birth control pills, long-acting reversible contraceptives (e.g., intrauterine devices, implants), and condoms on mental health status.MethodsWe searched multiple databases from inception until February 2022, with no geographical boundaries. RCTs underwent a quality assessment using the GRADE approach while the quality of observational studies was assessed using the Downs and Black scoring system. Data were analyzed through meta-analysis and relative risk and mean difference were calculated and forest plots were created for each outcome when two or more data points were eligible for analysis.Main resultsThe total number of included studies was 43. In women without previous mental disorders, both RCTs (3 studies, SMD 0.18, 95% CI [0.02, 0.34], high quality of evidence) and cohort studies (RR 1.04 95% CI [1.03, 1.04]) detected a slight increase in the risk of depression development. In women with previous mental disorders, both RCTs (9 studies, SMD − 0.15, 95% CI [-0.30, -0.00], high quality of evidence) and cohort studies (SMD − 0.26, 95% CI [-0.37, -0.15]) detected slight protective effects of depression development. It was also noticed that HC demonstrated protective effects for anxiety in both groups (SMD − 0.20, 95% CI [-0.40, -0.01]).ConclusionsAmong women with pre-existing mental disorders who use hormonal contraceptives, we reported protective association with decreased depressive symptoms. However, the study also draws attention to some potential negative effects, including an increase in the risk of depression and antidepressant use among contraceptive users, a risk that is higher among women who use the hormonal IUD, implant, or patch/ring methods. Providers should select contraceptive methods taking individual aspects into account to maximize benefits and minimize risks.

Three distinct patterns of mental health response following accidents in mountain sports: a follow-up study of individuals treated at a tertiary trauma center

The restorative effect of physical activity in alpine environments on mental and physical health is well recognized. However, a risk of accidents and post-accident mental health problems is inherent to every sport. We aimed to characterize mental health in individuals following mountain sport accidents requiring professional medical management. Adult victims of mountain sport accidents treated at the hospital of the Medical University of Innsbruck (Austria) between 2018 and 2020 completed a cross-sectional survey at least 6 months following the admission (median 44 months, n = 307). Symptoms of post-traumatic stress disorder (PTSD, PCL-5), anxiety, depression, and somatization (PHQ), resilience (RS-13), sense of coherence (SOC-9L), post-traumatic growth (PTGI), and quality of life (EUROHIS-QOL), as well as sociodemographic and clinical information, were obtained from an online survey and extracted from electronic health records. Mental health outcome patterns were investigated by semi-supervised medoid clustering and modeled by machine learning. Symptoms of PTSD were observed in 19% of participants. Three comparably sized subsets of participants were identified: a (1) neutral, (2) post-traumatic growth, and (3) post-traumatic stress cluster. The post-traumatic stress cluster was characterized by high prevalence of symptoms of mental disorders, low resilience, low sense of coherence, and low quality of life as well as by younger age, the highest frequency of pre-existing mental disorders, and persisting physical health consequences of the accident. Individuals in this cluster self-reported a need for psychological or psychiatric support following the accident and more cautious behavior during mountain sports since the accident. Reliability of machine learning-based prediction of the cluster assignment based on 40 variables available during acute medical treatment of accident victims was limited. A subset of individuals show symptoms of mental health disorders including symptoms of PTSD when assessed at least 6 months after mountain sport accident. Since early identification of these vulnerable patients remains challenging, psychoeducational measures for all patients and low-threshold access to mental health support are key for a successful interdisciplinary management of victims of mountain sport accidents.

Associations of hospital-treated infections with subsequent dementia: nationwide 30-year analysis.

Infections, which can prompt neuroinflammation, may be a risk factor for dementia1-5. More information is needed concerning associations across different infections and different dementias, and from longitudinal studies with long follow-ups. This New Zealand-based population register study tested whether infections antedate dementia across three decades. We identified individuals born between 1929 and 1968 and followed them from 1989 to 2019 (n = 1,742,406, baseline age = 21-60 years). Infection diagnoses were ascertained from public hospital records. Dementia diagnoses were ascertained from public hospital, mortality and pharmaceutical records. Relative to individuals without an infection, those with an infection were at increased risk of dementia (hazard ratio 2.93, 95% confidence interval 2.68-3.20). Associations were evident for dementia diagnoses made up to 25-30 years after infection diagnoses. Associations held after accounting for preexisting physical diseases, mental disorders and socioeconomic deprivation. Associations were evident for viral, bacterial, parasitic and other infections, and for Alzheimer's disease and other dementias, including vascular dementia. Preventing infections might reduce the burden of neurodegenerative conditions.