Pre-existing Mental Health Disorders Research Articles

Characteristics of attempted suicide patients admitted in Jigme Dorji Wangchuck National Referral Hospital from January 2014 to September 2018

Introduction: Attempted suicide is a major public health problem with a prevalence rate of approximately 2.7% worldwide. There is an increasing trend of attempted suicide in Bhutan. It is a strong clinical predictor of eventual suicide deaths and results in significant use of health care resources. This study aimed to describe the characteristics of attempted suicide patients admitted in Jigme Dorji Wangchuck National Referral Hospital from January 2014 to September 2018. Methods: This descriptive record review analyzed 72 clinical records of attempted suicide patients. The characteristics of attempted suicides are described using detailed illness history of patients who were admitted in the psychiatric and medical wards. Results: The result showed a higher rate of attempted suicide in females (56.9 %) and highest in the age range between 21 and 30 years. The percentage of patients from the western region of the country was higher (48.6%). The median duration of hospital stay was 5 days (range 1-74). There was a slightly higher number of attempted suicide admissions in the cold season. Pre-existing mental health disorders, mostly depressive disorder, was the major underlying cause of attempted suicide (55.5%). The predominant method used for attempted suicide was self-poisoning on medication (76.3%) with the common medicine being Paracetamol. Conclusions: To prevent attempted suicide and eventual suicide, there is a need to strengthen early detection of depressive illnesses and regulate the accessibility of over-the-counter drugs like Paracetamol.

A Systematic Review and Meta-Analysis of Gestational Diabetes and Mental Health Among BAME Populations

Backgrounds: Gestational diabetes mellitus (GDM) is a common complication of pregnancy and is associated with an increased risk of mental health (MH) disorders. These include both antenatal and postnatal depression (PND), anxiety, psychological distress and post-traumatic-stress-disorder (PTSD). Both GDM and MH disorders have been shown to disproportionately affect individuals from Black, Asian and Minority Ethnic (BAME) backgrounds. Methods: A systematic methodology was developed, and a protocol was published in PROSPERO (CRD42020210863). Multiple electronic databases were explored using keywords and MeSH terms. The finalised dataset was analysed using statistical methods such as random-effect models, subgroup analysis and sensitivity analysis. These were used to determine odds ratio (OR) and 95% confidence intervals (CI) to establish prevalence. Findings: Sixty studies were finalised from the 20,040 data pool. Forty-six studies were included systematically with 14 used to meta-analyse GDM and MH outcomes. A second meta-analysis was conducted using 7 studies to determine GDM risk among BAME women with pre-existing MH disorders. The results indicate an increased risk with pooled adjusted OR for both reflected at 1.23, 95% CI of 1.00-1.50 and 1.29, 95% CI of 1.11-1.50 respectively. Interpretation: The available studies suggest a MH sequalae with GDM as well as a sequalae of GDM with MH among BAME populations. These findings warrant further exploration to better manage these patients clinically. Funding Statement: Not applicable Declaration of Interests: PP has received research grant from Novo Nordisk, and other, educational from Queen Mary University of London, other from John Wiley & Sons, other from Otsuka, outside the submitted work. SR reports other from Janssen, 691 Lundbeck and Otsuka outside the submitted work. All other authors report no conflict of interest.

Postdischarge Opioid Use after Total Hip and Total Knee Arthroplasty.

BackgroundAs America’s third highest opioid prescribers, orthopedic surgeons have contributed to the opioid abuse crisis. This study evaluated opioid use after primary total joint replacement. We hypothesized that patients who underwent total hip arthroplasty (THA) use fewer opioids than patients who underwent total knee arthroplasty (TKA) and that both groups use fewer opioids than prescribed.MethodsA prospective study of 110 patients undergoing primary THA or TKA by surgeons at an academic center during 2018 was performed. All were prescribed oxycodone 5 mg, 84 tablets, without refills. Demographics, medical history, and operative details were collected. Pain medication consumption and patient-reported outcomes were collected at 2 and 6 weeks postoperatively. Analysis of variance was performed on patient and surgical variables.ResultsSixty-one patients scheduled for THA and 49 for TKA were included. THA patients consumed significantly fewer opioids than TKA patients at 2 weeks (28.1 tablets vs 48.4, P = .0003) and 6 weeks (33.1 vs 59.3, P = .0004). Linear regression showed opioid use decreased with age at both time points (P = .0002). A preoperative mental health disorder was associated with higher usage at 2 weeks (58.3 vs 31.4, P < .0001) and 6 weeks (64.7 vs 39.2, P = .006). Higher consumption at 2 weeks was correlated with worse outcome scores at all time points.ConclusionsTKA patients required more pain medication than THA patients, and both groups received more opioids than necessary. In addition, younger patients and those with a preexisting mental health disorder required more pain medication. These data provide guidance on prescribing pain medication to help limit excess opioid distribution.

Pre-existing mental health disorders in patients admitted to the intensive care unit: A systematic review and meta-analysis of prevalence.

To determine the reported prevalence rate of pre-existing mental health disorders in patients admitted to adult ICUs and identify the most commonly occurring types of these disorders. Systematic review and meta-analysis. Five electronic databases were searched from 1 January 2000 -15 April 2020. Google Scholar was used to perform forwards citation searching. This review was conducted in line with the PRISMA guidelines and protocol registered with PROSPERO CRD42020181818. Meta-analyses were performed using the quality effects model to calculate weighted pooled prevalence estimates and heterogeneity was tested using the I2 statistic. Seven articles were included in the final review and meta-analysis (143,179 participants). Identified prevalence rates varied considerably, ranging from 6.2-28.0%, reflecting variation in each study's clinical context, as well as different patient selection and identification methodologies. The pooled prevalence rate of all pre-existing mental health disorders was 19.4% (95% CI 8.9-32.6%). Depression was the most common subtype, accounting for an estimated 60.5% (95% CI 54.4-66.5%) of identified mental health disorders. All analyses showed significant heterogeneity with I2 >95%. Approximately 19% of adult ICU patients have a history of a mental health disorder, most commonly depression. Further research is needed to improve the accuracy of this estimate as well as determine the best identification method. This study has demonstrated that patients with pre-existing mental health disorders, particularly depression, constitute a significant subgroup in ICU. Given that the presence of a pre-existing mental health disorder appears to confer an increased mortality risk following ICU discharge, clinicians need to be made aware of this group of patients to provide additional support. Further research is needed to more accurately quantify this vulnerable group and establish methods to enable clinicians to readily identify and refer these patients for appropriate follow-up treatment.

Unique Pain Management Needs for Pregnant Women with Pre-existing PTSD and Other Mental Health Disorders

This review describes how the presence of maternal mental health disorders influences peripartum pain. It provides practical guidance for tailored anesthetic plans that address the unique needs of pregnant women with such disorders. The role of maternal mental health conditions in the peripartum experience and postpartum course for the mother-baby dyad is an evolving area of interest in the current psychiatric and obstetric literature. It is only recently, however, that providers are beginning to understand how pre-existing maternal posttraumatic stress disorder (PTSD), anxiety, or depression influences how these patients perceive pain during labor or cesarean section. There is, unfortunately, a lack of understanding and consistency in the approach to pain management for these patients. Emphasis on recognition of these unique patient needs and tailoring of peripartum pain management strategies is crucial in helping to achieve a positive birth experience and minimize increased postpartum mental health symptom severity and/or chronic pain for these patients. Peripartum pain during labor and/or surgical delivery can be influenced by a pre-existing history of mental health conditions. Specialized pain assessment and management strategies should accommodate the unique needs of these patients.

The mental health impact of the COVID-19 pandemic on people with and without depressive, anxiety, or obsessive-compulsive disorders: a longitudinal study of three Dutch case-control cohorts

BackgroundThe impact of the COVID-19 pandemic on mental health in people with pre-existing mental health disorders is unclear. In three psychiatry case-control cohorts, we compared the perceived mental health impact and coping and changes in depressive symptoms, anxiety, worry, and loneliness before and during the COVID-19 pandemic between people with and without lifetime depressive, anxiety, or obsessive-compulsive disorders.MethodsBetween April 1 and May 13, 2020, online questionnaires were distributed among the Netherlands Study of Depression and Anxiety, Netherlands Study of Depression in Older Persons, and Netherlands Obsessive Compulsive Disorder Association cohorts, including people with (n=1181) and without (n=336) depressive, anxiety, or obsessive-compulsive disorders. The questionnaire contained questions on perceived mental health impact, fear of COVID-19, coping, and four validated scales assessing depressive symptoms, anxiety, worry, and loneliness used in previous waves during 2006–16. Number and chronicity of disorders were based on diagnoses in previous waves. Linear regression and mixed models were done.FindingsThe number and chronicity of disorders showed a positive graded dose–response relation, with greater perceived impact on mental health, fear, and poorer coping. Although people with depressive, anxiety, or obsessive-compulsive disorders scored higher on all four symptom scales than did individuals without these mental health disorders, both before and during the COVID-19 pandemic, they did not report a greater increase in symptoms during the pandemic. In fact, people without depressive, anxiety, or obsessive-compulsive disorders showed a greater increase in symptoms during the COVID-19 pandemic, whereas individuals with the greatest burden on their mental health tended to show a slight symptom decrease.InterpretationPeople with depressive, anxiety, or obsessive-compulsive disorders are experiencing a detrimental impact on their mental health from the COVID-19 pandemic, which requires close monitoring in clinical practice. Yet, the COVID-19 pandemic does not seem to have further increased symptom severity compared with their prepandemic levels.FundingDutch Research Council.

Emergency department use among postpartum women with mental health disorders

BackgroundMental health disorders are becoming more recognized in pregnancy. Whether mental health disorders are associated with health services utilization after child birth is not completely understood.ObjectiveThis study aimed to investigate postpartum emergency department use within 30 days of delivery among women with preexisting mental health disorders during pregnancy.Study DesignThis was a retrospective cohort study evaluating emergency department use among postpartum women with or without mental health disorders who delivered at an academic center between January 2014 and June 2018. Demographic and outcome data were medical record abstracted and analyzed. Multivariate regression was performed to adjust for covariates.ResultsDuring the study period, 13,605 women delivered at the institution, 2355 of whom (17.3%) had an underlying mental health disorder. The primary diagnoses of mental health disorder were anxiety (48.8%), depression (34.8%), substance use disorder (11.4%), bipolar disorder (3.4%), psychosis (0.7%), and other (0.8%). There were a total of 565 emergency department visits within 30 days of delivery. Women who presented to the emergency department after delivery were more likely to have public insurance, identify as black or Asian, and have an underlying mental health disorder. Among women with mental health disorders, 155 (6.6%) used the emergency department within 30 days of their delivery compared with 410 (3.6%) of patients without mental health disorder (adjusted odds ratio, 1.74; 95% confidence interval, 1.42–2.13; P<.001). When assessing the risk of emergency department usage per the type of mental health disorder, anxiety (adjusted odds ratio, 1.73; 95% confidence interval, 1.31–2.27) and depression (adjusted odds ratio, 2.13; 95% confidence interval, 1.59–2.86) carried the highest risk. Compared with women without mental health disorders, women with underlying mental health disorders had more presentations for hypertension (15.5% vs 11.2%) and psychiatric evaluations (4.5% vs 0.2%; both P<.001).ConclusionWomen with mental health disorders use the emergency department during the postpartum period for psychiatric and obstetrical reasons more frequently than women without mental health disorders. Increased surveillance, treatment, and follow-up during pregnancy and the early postpartum period may be warranted for this high-risk population.

Cognitive, Behavioral, and Emotional Disorders in Populations Affected by the COVID-19 Outbreak.

This review enhances the existing literature on the emotional and mental health of COVID-19 patients and affected persons who have spent prolonged time intervals in self-isolation or quarantine. My article cumulates previous research findings on adverse physical and psychological consequences developed from the COVID-19 pandemic. Throughout May 2020, I conducted a quantitative literature review of the Web of Science database, with search terms including “psychological anxiety,” “emotional distress,” “social isolation stress,” and “mental health disorders.” As I focused on research published exclusively this year, only 104 various types of articles met the eligibility criteria. By removing those whose results were inconclusive, unconfirmed by replication, or too general, and because of space constraints, I selected 49, mainly empirical, sources. The inspected collected findings prove that the COVID-19 pandemic has resulted in greater degrees of psychological distress in the affected populations. The COVID-19 outbreak may generate emotional distress and anxiety, aggravating preexisting mental health disorders and shaping stress-related disturbances for affected people. Individuals having severe mental illness tend to be hurt emotionally by social problems heightening their vulnerability. Both COVID-19 infected patients and the general affected population may develop severe depressive symptoms. Significant degrees of fear may heighten the damage generated by such a highly infectious disease. The volume of recovered patients may diminish COVID-19-related apprehension and panic. Future research should investigate whether COVID-19-related reduced care provision and prolonged self-isolation and quarantine will have long-term impact on mental and psychological health.

Living with PTSD amid a global pandemic.

The COVID-19 pandemic has demonstrated itself to be a considerable stressor, especially for those individuals coping with a preexisting mental health disorder. This article contains clinical observations and reflections from two practicing psychologists regarding the impact of the COVID-19 pandemic and associated social conditions on clients with posttraumatic stress disorder. Observations include changes in trauma-related symptom manifestations and therapeutic process issues, particularly in response to social isolation. The authors encourage specific therapeutic considerations and offer suggestions for adapting treatment with regard to these early observations. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Pre-existing mental health disorders affect pregnancy and neonatal outcomes: a retrospective cohort study

BackgroundThis was a hospital registry-based retrospective age-matched cohort study that aimed to compare pregnancy and neonatal outcomes of women with pre-existing mental disorders with those of mentally healthy women.MethodsA matched cohort retrospective study was carried out in the Department of Obstetrics and Gynecology, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, a tertiary health care institution. Medical records of pregnant women who gave birth from 2006 to 2015 were used. The study group was comprised of 131 pregnant women with mental disorders matched to 228 mentally healthy controls. The primary outcomes assessed were antenatal care characteristics; secondary outcomes were neonatal complications.ResultsPregnant women with pre-existing mental health disorders were significantly more likely to have low education, be unmarried and unemployed, have a disability that led to lower working capacity, smoke more frequently, have chronic concomitant diseases, attend fewer antenatal visits, gain less weight, be hospitalized during pregnancy, spend more time in hospital during the postpartum period, and were less likely to breastfeed their newborns. The newborns of women with pre-existing mental disorders were small for gestational age (SGA) more often than those of healthy controls (12.9% vs. 7.6%, p < 0.05). No difference was found comparing the methods of delivery.ConclusionsWomen with pre-existing mental health disorders had a worse course of pregnancy. Mental illness increased the risk to deliver a SGA newborn (RR 2.055, 95% CI 1.081–3.908).

The psychiatric effects of COVID-19 thus far: a review of the current literature

The novel COVID-19 pandemic is affecting hundreds of countries with increasing cases and deaths. Global social distancing, quarantines, travel restrictions, and cancelations of schools and large gatherings have been instituted to decrease viral spread. This has sparked perpetual worldwide fear, panic, anxiety, depression, and distress along with concern for suicide, grief, post-traumatic stress disorder (PTSD), guilt, and long term mental health disorders. In this paper, we review current literature in PubMed regarding psychiatric effects of COVID-19 on varying populations and what long term mental health effects warrant consideration. In the general public, significant anxiety (6.33-35.1%) is focused largely on family members and loved ones potentially contracting COVID-19; this fear is associated with female gender, student status, and various age groups, and is exacerbated by social media, self-quarantine, increased time thinking about COVID-19, and misinformation. Self-reported depression ranges from 16.5-48.3%. Other potential at risk populations include pregnant women, parents, children, the elderly, and patients with pre-existing mental health disorders. COVID-19 has driven suicide and exacerbated obsessive compulsive disorder (OCD). Medical healthcare workers have increased anxiety, depression, distress, and low sleep quality, with frontline female nurses reporting the most symptoms. Patients with COVID-19 have a high prevalence of PTSD, depression, and low quality of life. PTSD, depression, grief, and guilt are of long term concern. Overall, future and continued studies exploring the psychiatric effects of COVID-19 worldwide are critical in understanding and treating affected populations.&#x0D; Key words: Psychiatric, COVID-19 and mental health symptoms, anxiety, depression, suicide, grief, and PTSD

Association of Mental Health Treatment With Outcomes for US Veterans Diagnosed With Non–Small Cell Lung Cancer

Preexisting mental health disorders (MHDs) are associated with increased mortality in people diagnosed with cancer, yet few data exist on the efficacy of interventions to mitigate this disparity. To evaluate the association of participation in mental health treatment programs (MHTPs), housing support programs, or employment support programs with stage at cancer diagnosis, receipt of stage-appropriate treatment, and mortality among patients with a preexisting MHD. This retrospective, population-based cohort study included 55 315 veterans in the Veterans Affairs Central Cancer Registry (VACCR) who had newly diagnosed non-small cell lung cancer (NSCLC) from September 30, 2000, to December 31, 2011. Data were analyzed from January 15, 2017, to March 17, 2020. Mental health disorders, including schizophrenia, bipolar disorder, depressive disorder, posttraumatic stress disorder, and substance use disorder. Stage at cancer diagnosis, receipt of stage-appropriate cancer treatment, all-cause mortality, and lung cancer-specific mortality. Of 55 315 veterans with a new diagnosis of NSCLC included in the analysis (98.1% men; mean [SD] age, 68.1 [9.8] years), 18 229 had a preexisting MHD, among whom participation in MHTPs was associated with a lower likelihood of being diagnosed in a late stage (odds ratio [OR], 0.62; 95% CI, 0.58-0.66; P < .001), a higher likelihood of receiving stage-appropriate treatment (OR, 1.55; 95% CI, 1.26-1.89; P < .001), lower all-cause mortality (adjusted hazard ratio [AHR], 0.74; 95% CI, 0.72-0.77; P < .001), and lower lung cancer-specific mortality (AHR, 0.77; 95% CI, 0.74-0.80; P < .001). Likewise, participation in housing and employment support programs was associated with similar improvements in all outcomes described above. In veterans with preexisting MHDs diagnosed with NSCLC, participation in MHTPs and housing and employment support programs was associated with improved lung cancer-related outcomes. This study might be the first to demonstrate significant improvement in cancer mortality for patients with MHDs who participate in MHTPs, housing support programs, or employment support programs. This work supports substantial literature that investment in mental health and social needs can improve health outcomes and highlights the importance of further research to identify, evaluate, and implement interventions to improve outcomes for patients with MHDs who are diagnosed with cancer.

Factors associated with emergency medical service delays in suspected ST-elevation myocardial infarction in Victoria, Australia: A retrospective study.

To assess the effect of patient and system characteristics on emergency medical service (EMS) delays prior to arrival at hospital in suspected ST-elevation myocardial infarction (STEMI). This was a retrospective observational study of 1739 patients who presented with suspected STEMI to the EMS in Melbourne, Australia between October 2011 and January 2014. Our primary outcome measure was call-to-hospital time, defined as the time in minutes from emergency call to hospital arrival. We examined the association of patient and system characteristics on call-to-hospital time using multivariable linear regression. The mean call-to-hospital time was 60.1 min (standard deviation 20.5) and the median travel distance was 13.0 km (interquartile range 7.2-23.1). In the multivariable model, patient characteristics associated with longer call-to-hospital time were age ≥75 years (2.3 min; 95% confidence interval [CI] 0.6-4.0), female sex (1.9 min; 95% CI 0.3-3.4), pre-existing mental health disorder (4.0 min; 95% CI 1.9-6.1) or musculoskeletal disease (2.7 min; 95% CI 1.0-4.4), absence of chest pain (3.0 min; 95% CI 1.1-4.8), and presentation with clinical complications. System factors associated with call-to-hospital time include lower dispatch priority (12.7 min; 95% CI 9.0-16.5) and non-12-lead electrocardiography (ECG) capable ambulance first on scene (4.5 min; 95% CI 3.1-5.8). Patients who were not initially attended by a 12-lead capable ambulance were less likely to receive a 12-lead ECG within 10 min (18.5% vs 71.0%, P < 0.001). A range of patient and system factors may influence EMS delays in STEMI. However, optimising dispatch prioritisation and widespread availability of prehospital 12-lead ECG could lead to substantial reduction in time to treatment.

The impact of mental health disorders on outcomes following hip arthroscopy for femoroacetabular impingement syndrome: a systematic review.

Hip arthroscopy for femoroacetabular impingement syndrome (FAI) has been shown to be beneficial in the short- to medium-term though outcomes vary between individuals. Multiple factors have been suggested to affect outcomes including pre-operative mental health disorders. We undertook a systematic review to assess the evidence relating to the effect of pre-existing mental health disorders on the outcomes following hip arthroscopy for FAI. Following PRISMA guidelines, a multi-database search was undertaken using three key concepts: ‘mental health’, ‘FAI’ and ‘hip arthroscopy’. Results were screened and data extracted from relevant studies. A total of six studies met the inclusion criteria including 2248 hips, all published between 2017 and 2019. All studies were of evidence level III or IV with reasonable methodological quality. One study demonstrated pre-operative depression to be related to altered pain reduction in the short-term following surgery. Three studies reported inferior outcomes in the medium-term (1–2 years) in those with worse mental health. One study demonstrated an increased risk of persistent pain 2 years following surgery and one a reduced chance of returning to active military service following surgery in those with worse mental health. Despite inferior outcomes individuals with mental health disorders did still benefit from surgery in general. In conclusion, the presence of pre-existing poor mental health is associated with inferior outcomes in the medium-term following arthroscopic surgery for FAI. Surgeons should consider screening patients for mental health disorders before surgery and counselling them appropriately as to the potential for less satisfactory surgical outcomes.

Physical health among patients with common mental health disorders in primary care in Europe: a scoping review.

Mental disorders are increasingly common among adults in both the developed and developing world and are predicted by the WHO to be the leading cause of disease burden by 2030. Many common physical conditions are more common among people who also have a common mental disorder. This scoping review aims to examine the current literature about the prevention, identification and treatment of physical problems among people with pre-existing mental health disorders in primary care in Europe. The scoping review framework comprised a five-stage process developed by Arksey & O'Malley (2005). The search process was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Both quantitative and qualitative studies were included, with no restriction on study design. The initial search identified 299 studies, with a further 28 added from the hand-search (total n = 327) of which 19 were considered relevant to the review research question and included for full analysis. Depression was the mental health condition most commonly studied (nine studies), followed by depression and anxiety (seven studies), with three studies examining any mental disorder. Eleven studies examined the effects of various interventions to address physical and mental comorbidity, with the most commonly studied intervention being collaborative care. With just 19 studies meeting our criteria for inclusion, there is clearly a paucity of research in this area. Further research is essential in order to understand the pathophysiological mechanisms underlying the association between mental disorders and chronic conditions.

Pre-existing mental health disorders in patients admitted to the intensive care unit: a systematic review and meta-analysis of prevalence

Introduction: Mental health disorders are an important global health issue, causing a significant burden of disease worldwide. Incidental findings suggest that patients with a pre-existing mental health disorder (PMHD) may experience worse outcomes following an Intensive Care Unit (ICU) admission compared with other ICU survivors. Objectives/Aims: To determine the reported prevalence rate of PMHDs in patients admitted to adult ICUs and identify the commonly occurring subtypes of mental health disorders. Methods: A systematic search of Medline, CINAHL, Embase and PsychINFO was performed to identify articles that reported a prevalence rate of adult ICU patients with a PMHD. Articles had to use a reliable measure such as the International Classification of Diseases to diagnose and categorise PMHDs. Meta-analyses were performed using the quality effects model to calculate weighted pooled prevalence estimates and heterogeneity was tested for using the I2 statistic. The prevalence rate of PMHDs, as well as subtypes as proportions of all PHMDs, was reported as point estimates with 95% confidence intervals (CI). Subgroup analyses were performed on studies with medical vs medical/surgical patients, high vs low/middle income countries and high vs low risk of bias studies. Results: Seven articles were included (123,632 participants). Most studies performed a retrospective chart review, although methods of patient identification were variable. The pooled prevalence rate of all PMHDs was 14.7% (95%CI 1.6%-35.3%). Depression was the most common subtype, accounting for an estimated 60.4% (95%CI 19.2%-95.3%) of identified PMHDs. The only significant subgroup analysis finding was a higher prevalence rate amongst medical (18.9%, [95%CI 2.4%-39.2%]) compared with medical/surgical (4.3%, [95%CI 0.0%-14.3%]) populations. All analyses showed significant heterogeneity with I2>95%. Conclusion: Approximately 15% of adult ICU patients have a history of PMHD, most commonly depression. Further research is needed to improve the accuracy of this estimate as well as determine the best identification method.

Principles of mental health care during the COVID-19 pandemic.

We describe the basic principles of mental health care during the COVID-19 pandemic that should be endorsed by the mental health professional associations and incorporated in the health strategies for the management of the COVID-19 pandemic. The main principle is that there should be no substantial differences in the provision of health care for COVID-19 between persons with pre-existing mental health disorders and the ones without previous disorders. Subsequently, the organization of the health care should reflect that as well. These principles should (a) prevent the possible effects of stigmatizing attitudes toward mental health issues, possibly leading to potentially deleterious situations, such as psychiatric patients being treated (even temporarily) separately from other patients, in psychiatric facilities, where the staff is not equipped and trained adequately for the management of COVID-19; (b) highlight the fact that patients with mental health disorders are at greater risk for developing serious complications of COVID-19 infection due to other factors-they often smoke and have comorbidities such as hypertension, diabetes, all associated with higher morbidity and mortality from COVID-19 infection; (c) highlight that measures should be taken to minimize the risk of the spread of infection in psychiatric wards/institutions; (d) provide a general framework for the reorganization of mental health services toward the provision of services for persons in need, including frontline medical workers and patients with COVID-19 without previous mental health problems as well as for persons with pre-existing mental health problems under new circumstances of pandemic.

Cannabis tourist destinations: risk for vulnerable travellers with pre-existing mental disorders.

In recent years, more countries have decriminalized and legalized cannabis, and have become cannabis tourism destinations. Little has been published about individuals with pre-existing mental health disorders who use cannabis during travel. Health professionals should pay greater attention to cannabis use among vulnerable travellers before, during, and after their travel.

A478 Mental Health History and its Predictive Relationship to Bariatric Surgery Candidacy

Psychosocial predictors of bariatric surgery success have been evaluated throughout the literature. Patients with pre-existing mental health disorders have been associated with poorer surgical outcomes. The aim of this study was to evaluate pre-existing mental health with SIPAT scores as well as psychotropic medications within this population.

Novel Risk Factors for Posttraumatic Stress Disorder Symptoms in Family Members of Acute Respiratory Distress Syndrome Survivors.

Family members of ICU survivors report long-term psychologic symptoms of posttraumatic stress disorder. We describe patient- and family-member risk factors for posttraumatic stress disorder symptoms among family members of survivors of acute respiratory distress syndrome. Prospective cohort study of family members of acute respiratory distress syndrome survivors. Single tertiary care center in Seattle, Washington. From 2010 to 2015, we assembled an inception cohort of adult acute respiratory distress syndrome survivors who identified family members involved in ICU and post-ICU care. One-hundred sixty-two family members enrolled in the study, corresponding to 120 patients. None. Family members were assessed for self-reported psychologic symptoms 6 months after patient discharge using the Posttraumatic Stress Disorder Checklist-Civilian Version, the Patient Health Questionnaire 9-item depression scale, and the Generalized Anxiety Disorder 7-item scale. The primary outcome was posttraumatic stress disorder symptoms, and secondary outcomes were symptoms of depression and anxiety. We used clustered multivariable logistic regression to identify patient- and family-member risk factors for psychologic symptoms. Posttraumatic stress disorder symptoms were present in 31% (95% CI, 24-39%) of family participants. Family member risk factors for posttraumatic stress disorder symptoms included preexisting mental health disorders (adjusted odds ratio, 3.22; 95% CI, 1.42-7.31), recent personal experience of serious physical illness (adjusted odds ratio, 3.07; 95% CI, 1.40-6.75), and female gender (adjusted odds ratio, 5.18; 95% CI, 1.74-15.4). Family members of previously healthy patients (Charlson index of zero) had higher frequency of posttraumatic stress disorder symptoms (adjusted odds ratio, 2.25; 95% CI, 1.06-4.77). Markers of patient illness severity were not associated with family posttraumatic stress disorder symptoms. The prevalence of long-term posttraumatic stress disorder symptoms among family members of acute respiratory distress syndrome survivors is high. Family members with preexisting mental health disorders, recent experiences of serious physical illness, and family members of previously healthy patients are at increased risk for posttraumatic stress disorder symptoms.