Previous Health Research Articles

Evaluation of mental health services delivered before and after the introduction of pilot Mental Health Centers in Poland using monitoring indicators.

The study assessed the performance of Mental Health Centres compared to previous non-integrated mental health facilities. The study used National Health Fund (NHF) data of individuals over 18 years treated in 27 centres (January 2017 - February 2020). Performance indicators from 19 months before (N = 124,497) and after the introduction of Mental Health Centres (N = 182,789) were compared for outpatient care, community treatment teams, inpatient wards and day wards. The total number of patients who received mental health care increased, compared to before the establishment of those Centres; whereas the number of hospitalisations decreased by 6% and the number of patient days per person decreased by 9%. Day care saw a 14% increase in admissions following the introduction of Mental Health Centres, with a 5% decrease in patient days per person. The proportion of patients in community care increased by 86%, in outpatient care by 62% and in day care by 14%. The number of first-time patients after the introduction of Mental Health Centres increased and the number of follow-up patients decreased. For all groups of mental disorders, the priority indicator in inpatient care decreased, while increasing in outpatient and community care for most groups of disorders. The results confirmed the effectiveness of the National Mental Health Protection Programme project in relation to the availability and reduction of inpatient treatment through Mental Health Centres. The methodology used in this study can be used for assessing the effectiveness of Mental Health Centre activities in subsequent stages of the pilot.

Ansiedade em Profissionais dos Cuidados de Saúde Primários na Primeira Vaga da Pandemia COVID-19

Introduction The COVID-19 pandemic led to the adoption of paramount measures to detect SARS-CoV-2 infection and prevent its spread, causing anxiety in the general population. Health professionals have been considered one of the most vulnerable groups for mental health problems, as observed in past epidemics. The present study aimed to assess the anxiety in primary healthcare professionals during the COVID-19 pandemic and identify the factors that influenced it. Methodology This cross-sectional study was performed via an online anonymous survey, disseminated primarily through social networks and institutional mailing lists, between March 29th and April 5th 2020, applied to primary healthcare professionals in mainland Portugal. Anxiety levels were obtained by applying the Beck Anxiety Inventory. Logistic regression analyses were conducted to identify factors associated with anxiety levels. Results The study included 696 participants, of which 61.9% were physicians, 84.8% were women and 43.8% presented mild to severe levels of anxiety. Factors such as personal history of previous mental health disorders (p<0.001), having a family member with risk factors for SARS-CoV-2 complications (p=0.012) and being an administrative clerk (p=0.014), showed to relate with higher levels of anxiety. On the other hand, the existence of a workspace contingency plan was associated with lower anxiety levels (p=0.048); nevertheless, 6.9% considered it inadequate, mainly due to inappropriate protective equipment for professionals (79.6%). Conclusion This study highlights a high prevalence of anxiety among health professionals and reinforces the need of, in future pandemics, promoting the adoption of adequate measures to protect their mental health and, ultimately, safeguard the quality of patient care. Keywords: COVID-19, pandemic, anxiety, health personnel, occupational health, occupational medicine.

COVID-19 and coping: Absence of previous mental health issues as a potential risk factor for poor wellbeing in females.

COVID-19 has caused unprecedented disruption to everyday life. Unsurprisingly, this has resulted in increased prevalence of poor mental wellbeing. While previous mental health issues have been consistently flagged as a risk factor, the absence of these may also leave individuals vulnerable due to a lack of psychological coping strategies. This study explored the change in symptoms of anxiety, depression, and trauma in 167 females who provided data at four timepoints over the course of the first year of the pandemic. There was a significant effect of time on the extent of the change in depression but, for all wellbeing measures, those with current or previous mental health issues experienced a similar magnitude of change as those with no previous issues. This suggests that low-risk individuals may be faring worse, relatively. Ensuring that this group is not overlooked will be imperative in protecting and re-building the wellbeing of the nation.

I have not come here because I have nothing better to do: The lived experience of presenting to the emergency department for people with a psychosocial disability and an NDIS plan-A qualitative study.

Almost 60 000 people have a psychosocial disability (PSD) and a National Disability Insurance Scheme (NDIS) plan. As PSD can be a fluctuating condition, people with a PSD and an NDIS plan, at times, may require crisis care and present to the emergency department (ED). This national study explored the experiences of people with a PSD and an NDIS plan when presenting to the ED. To understand the unique lived experience of people with a PSD and an NDIS plan, semi-structured interviews were conducted with 24 people between March and November 2022 and were analysed thematically. A lived experience advisory group was engaged as part of the research team. Participants were asked about their experiences in the ED including barriers to therapeutic care and what worked well. Participants reported emotional distress caused by receiving a biomedical rather than a person-centred mental health response. A previous mental health history overshadowed diagnostic decisions and most participants interviewed stated they would not choose to return to the ED. Half of the participants spoke of one presentation only where needs were met. Four main themes emerged from the data: (a) Diagnostic overshadowing; (b) Judgement and stigma; (c) Waiting without hope; and (d) If things went well. This study provides evidence of the unique lived experience of people with a PSD and an NDIS plan when presenting to the ED. The results highlight the need for clinicians in the ED to understand the complexity and nuances of supporting people with a PSD. Recommendations for a person-centred care approach are provided. Alternative support options for this group of people need to be explored.

Unspoken Truths: Mental Health Among Academic Surgeons.

To characterize the current state of mental health within the surgical workforce in the United States. Mental illness and suicide is a growing concern in the medical community; however, the current state is largely unknown. Cross-sectional survey of the academic surgery community assessing mental health, medical error, and suicidal ideation. The odds of suicidal ideation adjusting for sex, prior mental health diagnosis, and validated scales screening for depression, anxiety, post-traumatic stress disorder (PTSD), and alcohol use disorder were assessed. Of 622 participating medical students, trainees, and surgeons (estimated response rate=11.4%-14.0%), 26.1% (141/539) reported a previous mental health diagnosis. In all, 15.9% (83/523) of respondents screened positive for current depression, 18.4% (98/533) for anxiety, 11.0% (56/510) for alcohol use disorder, and 17.3% (36/208) for PTSD. Medical error was associated with depression (30.7% vs. 13.3%, P <0.001), anxiety (31.6% vs. 16.2%, P =0.001), PTSD (12.8% vs. 5.6%, P =0.018), and hazardous alcohol consumption (18.7% vs. 9.7%, P =0.022). Overall, 13.2% (73/551) of respondents reported suicidal ideation in the past year and 9.6% (51/533) in the past 2 weeks. On adjusted analysis, a previous history of a mental health disorder (aOR: 1.97, 95% CI: 1.04-3.65, P =0.033) and screening positive for depression (aOR: 4.30, 95% CI: 2.21-8.29, P <0.001) or PTSD (aOR: 3.93, 95% CI: 1.61-9.44, P =0.002) were associated with increased odds of suicidal ideation over the past 12 months. Nearly 1 in 7 respondents reported suicidal ideation in the past year. Mental illness and suicidal ideation are significant problems among the surgical workforce in the United States.

Caracterización de la gravedad del intento de suicidio en adolescentes hospitalizados en un hospital público de Chile.

Adolescent suicide has increased in the Americas. In Chile, at-tempted suicide in adolescents is a public health problem that needs an urgent solution. A quantitative, comparative and retrospective study was conducted to provide the hospital with intervention strategies and articulation with the territorial mental health network. The sociodemographic and clinical aspects of 96 records of adolescents hospitalized for attempted suicide between Janu-ary 2017 and December 2018 were reviewed, compared, and related. Two study groups were formed: Group I, 14 adolescents previously hospitalized in the Intensive Treatment Unit and Group II, 82 adolescents who did not require this unit. Gender, age, education, history of sexual abuse, diagnoses of mental disorders, co-morbidities, previous mental health consultations, and caregivers with mental disorders were studied. Descriptive statistics and odds ratios were used. In group I, with 92% male adolescents, severe depression was observed in 57% of cases, and 100% of its members suffered sexual abuse; in group II, with 91% female adolescents, 79% moderate depression was found, 85.3% ab-normal personality development and 70% of its members suffered sexual abuse. Sexual abuse explained the highest percentage of the variance (29%). It is con-cluded that the hospital must consider the distinctive characteristics of the study groups and coordinate with the territorial network of mental health the continuity of care in its interventions.

Amplifying the voices of Black racial minorities in mental health research through public involvement and engagement: The importance of advisory roles.

Ensuring adequate representation and the active, meaningful and visible involvement of groups likely to be most impacted by research findings and/or the lack of research inquiry are increasingly acknowledged. This is particularly relevant for Black racially minoritised groups who are less visible as research participants and in patient and public involvement and engagement (PPIE) roles. Our viewpoint article sought to discuss reflections and insights on their involvement experience, with particular attention to perceived barriers and enablers to PPIE involvement. Qualitative data were collected as part of facilitated group discussions from nine Black racially minoritised experts-by-experience involved in a PPIE advisory group. Data were subjected to thematic analysis to identify key themes. Five main themes were identified that reflected factors linked to practicalities: role unfamiliarity, benefits for the larger community, acknowledgement of previous harm and mental health stigma. Given the existence and importance of the direct links between research and service and treatment innovations in health and social care, ensuring that those from underrepresented Black racial communities are meaningfully and equitably supported to have roles in advising and influencing research programmes should be prioritised and an ongoing consideration for different stakeholders, including research funders, researchers, healthcare providers and community leaders/representatives. This viewpoint article is a collaboration between lived experience stakeholders and researchers, comprising conceiving the original idea for the paper, its conceptualisation and data generation and the coproduction including editing of the manuscript.

The Mental Health Impacts of a Pandemic: A Multiaxial Conceptual Model for COVID-19.

The COVID-19 pandemic substantially impacted the mental health of the general population and particularly vulnerable individuals and groups. A wealth of research allows for estimating this impact and identifying relevant factors contributing to or mitigating it. The current paper presents and synthesizes this evidence into a multiaxial model of COVID-19 mental health impacts. Based on existing research, we propose four axes: (1) Exposure to COVID-related events; (2) Personal and social vulnerability, such as previous mental health problems or belonging to a vulnerable group; (3) Time, which accounts for the differential impacts throughout the development of the pandemic; and (4) Context, including healthcare and public policies, and social representations of the illness influencing individual emotional reactions and relevant behaviors. These axes help acknowledge the complexity of communities' reactions and are pragmatic in identifying and prioritizing factors. The axes can provide individual information (i.e., more exposure is harmful) and account for interactions (e.g., exposure in an early phase of the pandemic differs from a later stage). This model contributes to the reflections of the evidence and informs the mental health response to the next pandemic.

Clinical factors associated with quality of life among women with endometriosis: a cross-sectional study

BackgroundEndometriosis often leads to a decrease in Quality of Life (QoL), due to its impact on various aspects of women’s lives, such as social life, mental health, sex life, and working capacity. Although previous studies have assessed QoL in women with endometriosis, few studies have explored the impact of different clinical variables on QoL. The aim of this study was to investigate how women with endometriosis perceive their QoL, and to analyze which clinical factors are associated with QoL.MethodsThe Endometriosis Health Profile-30 and the ENDOCARE Questionnaire were distributed to 1000 women diagnosed with endometriosis from 10 different clinics across Sweden. The responses from 476 women were included in univariate and multivariable regression analyses, where the clinical factors were correlated with overall QoL and QoL dimensions.ResultsThe women participating in this study reported a low QoL. The clinical factors that showed a significant correlation with overall QoL were age at first onset of endometriosis symptoms (β= -0.64, p < 0.001), having more than 10 visits to general practitioners before referral to a gynecologist (β = 5.58, p = 0.036), current or previous mental health issues (β = 7.98, p < 0.001) patient-centeredness (β= -2.59, p < 0.001) and use of opioids (β = 7.14, p = 0.002).ConclusionsThis study shows that opioid use and mental health issues were associated with a worse QoL, whereas a higher degree of patient-centeredness was associated with a better QoL. The association between opioid use and a worse QoL might not entirely be caused by the opioid use itself but also by symptom severity and mental health issues. An improved patient-centeredness and more focus on taking care of mental health issues would reasonably result in a better QoL for women with endometriosis.

Racial and Gender Disparities in Suicide and Mental Health Care Utilization in a Pediatric Primary Care Setting

PurposeWe examined racial and gender disparities in the underrecognition of mental health disorders in adolescents and young adults as defined by a suicide-related diagnosis without a previous mental or behavioral health diagnosis. MethodsWe employed a series of adjusted mixed multilevel logistic regression models to determine the odds of specific mental health diagnoses (anxiety, depression, and suicide-related) in a large, U.S. pediatric ambulatory care group (ages 8–20 years) using Electronic Medical Record Data. ResultsUsing the reference group of White males, White females had 17% increased odds of having a suicide-related diagnosis (odds ratio (OR) 1.17, 95% confidence intervals (CI) 1.03, 1.34) and Black females had 48% increased odds of suicide-related diagnosis (OR 1.48, 95% CI 1.28, 1.71). Conversely, White females had 75% increased odds of recorded anxiety (OR 1.75, 95% CI 1.62, 1.89), Black males had 62% decreased odds of anxiety (OR 0.38, 95% CI 0.33, 0.42), and Black females had 33% decreased odds of anxiety (OR 0.67, 95% CI 0.60, 0.74). White females had 81% increased odds of having recorded depression (OR 1.81, 95% CI 1.62, 2.04) and Black females had 80% increased odds of underrecognized need for mental or behavioral health diagnosis services (OR 1.80, 95% CI 1.53, 2.13) as defined by a suicide-related diagnosis without a previous mental health diagnosis. DiscussionBlack adolescents and young adult patients are either not accessing or identified as needing mental health services at the same rates as their White peers, and Black females are experiencing the most underrecognition of need for mental health services.

Effects of the COVID-19 Pandemic on the Risk of Developing Psychopathology in Children in Portugal: A Cross-Section Study

Introduction: This study is based on preliminary data from a 2021 survey of parents of children aged 3-13 years atthe time of SARS-CoV-2 infection. The aim is to understand the consequences of SARS-CoV-2 infection on children's mental health. Methods: Using the Strengths and Difficulties Questionnaire (SDQ) and survey data, we specified multiple linear regression models to explain the variation in the total SDQ and the variation in its five components ‐ emotional symptoms, conduct problems, hyperactivity, peer relationship problems, and prosocial behaviour. We used explanatory variables selected according to current literature and other empirical studies, such as age, gender, household changes, confinement, hospitalization time, previous mental health care and long‐COVID symptoms (headache, sleep problems, concentration problems, fatigue). Results: The results showed that age was not statistically significant in any of the estimated models. The gender variable proved to be significant in three models (total SDQ, conduct problems, hyperactivity) and the results show that girls have fewer problems when compared to boys.Conclusion: Results suggest that intensive care hospitalisation and long-COVID symptoms increase the risk of psychopathology.

Factors Influencing the Health Care Utilization Among People With Depression and/or Anxiety Symptoms.

This analysis aimed to examine the factors predictive of service utilization among patients with anxiety and/or depression. Quick and appropriate treatment for anxiety and depression can reduce disease burden and improve social functioning. Currently, less than half of the population with comorbid anxiety and depression receives the recommended treatment. This analysis aims to identify factors predictive of utilizing mental health treatment for those with anxiety and/or depression by analyzing intrinsic, patient-centered factors. This study is a cross-sectional cohort analysis using National Health Interview Survey (NHIS) 2019 data. The sample size is 7,156 adults aged 18 to 64 with family incomes ≤100% of the federal poverty level. We used multivariate logistic regression analysis to identify factors predictive of care utilization in this population. Variables of interest include scores on Patient Health Questionnaire-8 (PHQ-8) and Generalized Anxiety Disorder-7 (GAD-7), service utilization, level of social functioning, having a usual source for care, and previous mental health care utilization. Additional covariates were age, gender, race, country of origin, education, marital status, and insurance coverage. Twenty-one percent of respondents reported using mental health services. Factors predictive of care utilization were older age, female gender, limited social functioning, having a usual source of care, and insurance coverage. There are significant barriers to receiving quick and appropriate care for anxiety and/or depression. Strategies should focus on reducing barriers for young adults, men, and the uninsured/underinsured. Strategies for integrating mental health services into primary care could increase the percentage of people with anxiety and/or depression who receive services.

Factors Affecting Anxiety-Related Symptoms, Diagnosis, and Treatment Among Collegiate Student-Athletes in the National College Health Assessment.

Increased attention continues to be placed on best practices for assisting student-athletes who show symptoms of a mental health illness. One of the most common mental health concerns for student-athletes is feeling overwhelmed or anxious. Early recognition of these symptoms can help student-athletes find early intervention. To elucidate specific attributes associated with an increased likelihood of anxiety symptoms and treatment avoidance to help athletic trainers and other practitioners better identify and assist high-risk individuals. Cross-sectional study. Colleges and universities in the United States. A total of 51 882 varsity athletes who completed the National College Health Assessment between 2011 and 2019. Survey responses (self-report) to questions related to anxiety symptoms and disorders cross-sectioned into 9 predictors: year in school, gender, sexual orientation, race and ethnicity, international student status, school type, received information on stress reduction or depression or anxiety, anxiety about impeding academic performance, and history of mental health treatment in the last year. More than three-fourths (82.9%, n = 43 016) of student-athletes reported feeling overwhelmed because of all that they had to do in their daily activities, whereas only half (47.5%, n = 24 645) of student-athletes described overwhelming anxiety as a symptom. Gender, sexual orientation, race and ethnicity, school type, and previous mental health treatment had large effects on these 2 symptoms. However, of the student-athletes who reported overwhelming anxiety as a symptom, only one-fourth (22.9%, n = 5649) indicated they received a diagnosis of anxiety with or without treatment. Factors such as the year in school and availability of mental health information appeared to have little effect on the experience of anxiety-related symptoms and the propensity to seek treatment. However, other factors, including gender, sexual orientation, race and ethnicity, school type, and previous mental health treatment, did have important effects. Our study provides additional evidence that the stresses placed on collegiate student-athletes frequently led to feelings of being overwhelmed and, eventually, anxiety disorder diagnoses. However, most student-athletes experiencing anxiety-related symptoms still did not seek a diagnosis with or without treatment.

Symptoms of depression and internalizing problems in early adulthood – associated factors from birth to adolescence

Purpose Even though the mechanisms behind the development of depression and internalizing problems remains unknown, many different factors have been shown to increase the risk. Longitudinal studies enable the investigation of exposure during different developmental periods during childhood. This study aims to examine factors associated with depressive and internalizing problems at age 20 in terms of sociodemographic factors, previous mental health problems and stressful life events during childhood, adolescence, and early adulthood. Methods A birth cohort of 1723 children were followed to age 20. At the 20-year follow-up, n = 731 (44%) participated. Standardized instruments were filled out at baseline and the 3-,12- and 20-year follow-ups. Results Depressive problems at age 20 were associated with female gender, experience of interpersonal life events reported at age 20, bullying victimization and reports on paternal mental health problems. Participants with depressive problems were also less likely to have experienced adolescence as happy and to report that their father had been a good father. Internalizing problems at age 20 were, in addition, associated with internalizing problems at age 12 and reports on maternal mental health problems. Internalizing problems were associated with a lower likelihood of experiencing adolescence as happy in the final model. Conclusion Recent events (i.e. interpersonal life events and bullying) seemed to be the most influential factors on the development of internalizing and depressive problems. Internalizing problems during childhood increased the risk for internalizing problems in early adulthood, emphasizing the importance of early intervention. Fewer factors were found to increase the risk for depressive problems compared to internalizing problems.

The interplay between previous infection and mental health condition on antibody response to COVID-19 mRNA vaccination

Increasing evidence has been pointing towards the existence of a bi-directional interplay between mental health condition and immunity. Data collected during the COVID-19 outbreak suggest that depressive symptoms may impact the production of antibodies against SARS-CoV-2, while a previous infection could affect the immune response and cause neuropsychological disturbances. A prospective observational study was designed to investigate the association between mental health conditions and immune response over time. We analyzed the mental health at baseline and the antibodies before and after immunization with the COVID-19 mRNA vaccine in a cohort of healthcare professionals in southern Switzerland. One-hundred and six subjects were enrolled. Anxiety, distress and depression correlated to each other. There were no correlations between the mentioned variables and the vaccine induced IgG antibodies against the receptor binding domain (RBD) of the spike protein. For those who had a previous COVID-19 infection, the antibodies increased according to the grade of depression. For those who did not, the anti-RBD IgG levels remained similar when comparing presence or absence of depression symptoms. Our results show that previous SARS-CoV-2 natural infection in subjects with mental health conditions enhances the immune response to COVID-19 mRNA vaccination. The correlation between immune response to COVID-19 vaccination, a previous exposure to the virus, and symptoms of mood disorders, makes it necessary to explore the direction of the causality between immune response and depressive symptoms.

Childhood Maltreatment History and Borderline Personality Symptoms: The Role of Mentalization Difficulties Among Vulnerable Women.

Mentalization difficulties may be one reason why individuals who experienced childhood maltreatment (CM) are at increased risk for borderline personality (BP) symptoms. The goal of this study was to identify specific aspects of mentalization associated with CM and determine their role in the short-term course of BP symptoms. A total of 253 mothers with a previous mental health diagnosis completed online surveys at three times over 9 months. A cross-lag panel model was tested to estimate reciprocal effects between mentalization measures and BP symptoms and indirect effects from CM to mentalization to BP symptoms. At baseline, women with more CM endorsed more difficulty with general mentalization, emotional clarity, and reflecting on childhood experiences. Lack of emotional clarity and disorganized responding about childhood served as indirect paths from CM to subsequent BP symptoms and showed bidirectional associations with BP symptoms over time. Thus, these may be particularly important treatment targets in this population.

A Rapid Access Brief Psychotherapy Intervention to Respond to Healthcare Workers in Ontario Whose Mental Health was Negatively Impacted During the COVID-19 Pandemic.

Although the coronavirus disease 2019 (COVID-19) pandemic has had widespread negative impacts on the mental health of healthcare workers (HCWs), there has been little research on psychological interventions during the pandemic for this population. The current study examines whether a brief coping-focused treatment intervention delivered in a virtual individual format would be associated with positive changes in Canadian HCWs' mental health during the pandemic. Three hundred and thirty-three HCWs receiving the intervention at 3 large specialty tertiary care hospitals in Ontario, Canada, completed measures of anxiety, depression, perceived stress, work/social impairment, insomnia and fear of COVID-19. After completing treatment, HCWs rated their satisfaction with the treatment. The intervention was associated with large effect size improvements in anxiety, depression, perceived stress, insomnia and fear of COVID-19, and moderate effect size improvements in work/social impairment. At treatment session 1, prior mental health diagnosis and treatment were both significantly correlated with depression, anxiety, and work/social impairment scores. Secondary analyses of data from one of the sites revealed that treatment-related changes in anxiety, depression, perceived stress and work/social impairment were independent of age, gender, occupational setting, profession and the presence of a previous mental health diagnosis or treatment, with the exception that nurses improved at a slightly greater rate than other professions in terms of work/social impairment. HCWs were highly satisfied with the treatment. A large number of HCWs experiencing significant distress at baseline self-referred for assistance. Timely and flexible access to a brief virtual coping-focused intervention was associated with improvements in symptoms and impairment, and treatment response was largely unrelated to demographic or professional characteristics. Short-term psychological interventions for HCWs during a pandemic may have a highly positive impact given their association with improvement in various aspects of HCWs' mental health improvement.

A lead for integration of perinatal mental health in maternal and child health services

Life altering moments like pregnancy, birth, and early parenthood can be stressful for women and their partners. As a result, women may undergo a period of poor mental health or witness a worsening of previous mental health or witness a worsening of previous mental health condition. Almost 1 in 5 women will experience a mental health condition during pregnancy or in the year after birth. Among women with perinatal mental health condition, 20% will experience suicidal thoughts or undertake acts of self-harm. Ignoring mental health not only risks women’s overall health and wellbeing, but also impacts infant’s physical and emotional development. This article is based on a comprehensive literature search conducted on 22 February 2023, in the Medline and Cochrane databases, utilizing the medical topic headings (MeSH) and a combination of all available related terms, according to the database. To prevent missing any possible research, a manual search for publications was conducted through Google Scholar, using the reference lists of the previously listed in papers as a starting point. I looked for valuable information in papers that discussed information about the classification, pathophysiology and principles of therapy of shock. There are no restrictions on date, language, participants, age, or type of publication.

PS06 The beast beneath the blisters: assessment of depression and anxiety in patients with immunobullous disorders in a tertiary referral centre

Abstract Immunobullous diseases can be disabling in the acute phase, causing widespread painful or pruritic skin and mucosal lesions. The subsequent psychological consequences of these disorders have not been fully evaluated. We treated a 53-year-old woman for severe bullous pemphigoid affecting her skin and oral mucosa. Following resolution of disease, she was left with debilitating anxiety and depression. This case prompted us to look at the psychological impact of immunobullous disease in our cohort. We used the Patient Health Questionnaire (PHQ-9), General Anxiety Disorder (GAD-7) and Dermatology Life Quality Index to establish the psychosocial impact in patients attending the immunobullous specialist clinic at a large tertiary dermatology centre. An assessment of pain using a numerical pain-rating scale and a question regarding any pre-existing mental health conditions were included. Twelve patients with various immunobullous conditions were surveyed. Seventy-five per cent (n = 9) of patients were identified as having a mood disorder via their PHQ-9 and GAD-7 scores. The PHQ-9 scores indicated mild (50%), moderate (17%) and severe (8%) depression symptoms in these patients. Twenty-five per cent and 17% of patients had a GAD-7 score indicating mild and moderate anxiety, respectively. Three patients declared that they had a previous mental health diagnosis; however, only mild depression and mild anxiety were identified in two of these patients. Only one of these patients volunteered mental health symptoms during their consultation, indicating an unrecognized burden of disease in this community. Our findings support previous research indicating high rates of depression in patients with immunobullous disease. Furthermore, there is an established association between bullous pemphigoid and neuropsychiatric conditions, with identification of autoantigen expression in the central nervous system. Mood disorders have a significant effect on patients’ experience of disease, and are likely to have an impact on disease course and engagement with treatment. A large European study found that dermatologists underestimate the severity of mood disorders. Therefore, the incorporation of validated measures for assessment of mood disorders such as PHQ-9 and GAD-7 into clinical practice is essential to identify the high proportion of patients with immunobullous disease suffering from these disorders. Quality of life measures, which are commonly assessed, are not sufficient for holistic management of these patients. These findings support the invaluable role of a psychologist within dermatology centres, and appropriate referrals to these services will improve with assessment during clinic consultations.

Sociodemographic and clinical predictors of delay to and length of stay with early intervention for psychosis service: findings from the CRIS-FEP study

PurposeWe investigated the influence of sociodemographic and clinical characteristics on delay to early intervention service (EIS) and the length of stay (LOS) with EIS.MethodsWe used incidence data linked to the Clinical Record Interactive Search—First Episode Psychosis (CRIS-FEP) study. We followed the patients from May 2010 to March 2016. We performed multivariable Cox regression to estimate hazard ratios of delay to EIS. Negative binomial regression was used to determine LOS with EIS by sociodemographic and clinical characteristics, controlling for confounders.Results343 patients were eligible for an EIS, 34.1% of whom did not receive the service. Overall, the median delay to EIS was 120 days (IQR; 15–1668); and the median LOS was 130.5 days (IQR 0–663). We found that women (adj.HR 0.58; 95%C I 0.42–0.78), living alone (adj.HR: 0.63; 95% CI 0.43–0.92) and ethnicity (‘Other’: adj.HR 0.47; 95% CI 0.23–0.98) were associated with prolonged delay to EIS. However, family involvement in help-seeking for psychosis (adj.HR 1.37; 95% CI 1.01–1.85) was strongly associated with a shorter delay to EIS. Patients who have used mental health services previously also experienced long delays to EIS.ConclusionsOur analyses highlight the link between sociodemographic status, help-seeking behaviours, and delay to EIS. Our findings also show the vulnerability faced by those with a previous mental health problem who later develop psychosis in receiving specialist treatment for psychosis. Initiatives that ameliorate indicators of social disadvantage are urgently needed to reduce health inequalities and improve clinical outcomes.