Mental Disorders Research Articles

5.Y.2. Alcohol intoxication among adolescents in Italy, Belgium and The Netherlands

Abstract Excessive drinking behavior poses a significant risk to the health of adolescents and contributes to high social and health costs. It is also well-documented that engaging in risky drinking behavior at a young age increases the likelihood of developing alcohol use disorders and other mental health disorders later in life. Therefore, the timely development of adequate interventions to prevent and reduce such behavior is an important public health task. The initial step here is to gather comprehensive data on the phenomenon. Studying alcohol intoxication data among adolescents is an important source in this context. In the Netherlands, data on alcohol intoxication in adolescents have been routinely collected for several years, leading to a successful transmural framework aimed at supporting these young individuals and their parents. As countries are at varying stages in addressing this issue, the objective of this workshop is to facilitate mutual learning about effective prevention initiatives targeting problematic alcohol use in young people. The workshop will feature presentations from four studies representing three countries: Italy, Belgium, and the Netherlands. Allegra Ferrari from Italy will discuss alcohol-related emergencies among adolescents admitted to an emergency department in Genoa, emphasizing the importance of urgent interventions to mitigate adolescent alcohol use. Hanna van Roozendaal from Belgium will present data from both retrospective and prospective studies on adolescents with acute alcohol intoxication in Antwerp hospitals, exploring the feasibility of follow-up interventions. Louise Pigeaud from the Netherlands will share data from a cohort of individuals under 18 years presented with acute alcohol intoxication symptoms at an emergency department between 2015-2023 to monitor trends in admission characteristics. Finally, Guido van Hal will focus more in depth on the differences and similarities in adolescents accessing emergency care for acute alcohol intoxication in Italy, Belgium and The Netherlands. The workshop will conclude with an open discussion on topics such as the necessary data to be registered for minors with acute alcohol intoxication, the most effective methods for preventing/reducing alcohol intoxication in these age groups, and the potential transferability of the successful Dutch transmural framework to other countries. Key messages • Acute alcohol intoxication and problematic alcohol use in minors can lead to significant alcohol-related issues in adulthood. • Collecting and analyzing high-quality data can facilitate the development of interventions aimed at reducing and preventing alcohol-related issues in adolescents.

Cost-effectiveness analysis of screening three-year old for social-emotional problems

Abstract Aim To assesses the long-term cost-effectiveness of a population-based screening to detect social-emotional problems at 3-years-old combined with an evidence-based intervention to prevent mental health problems. Methods A decision-analytic Markov model compares two alternatives 1) all 3-years-old get screened for social-emotional problems, and parents for children at a high risk receive a generic targeting parenting intervention 2) no screening and no intervention. The cohort of 3-year-old is modeled until they are 19 years old. The screening test is the ASQ:SE and the intervention was given to children with scores that suggest social-emotional problems. The model considered development of anxiety, conduct problems, and ADHD, over the 16 years. The analyses were done from a societal and healthcare perspectives. Health outcomes were assessed with DALYs averted. Results Results suggest that the probability of population-based screening for social-emotional problems combined with the parenting intervention to high risk-children being cost-effective is high, adopting a societal and healthcare perspective, 98% and 97% each. From a societal perspective, the likelihood of cost saving is high, 85 %. The combination of screening and intervention strongly dominated the comparator. Conclusions The findings align with previous research; prevention aimed at children’s mental health disorders will likely yield high investment returns. Successful implementation of population-based screening for social-emotional problems combined with an effective evidence-based parenting intervention might be an important way to contribute to sustainable and efficient mental health care. Key messages • The impact of combining population-based screening with intervention is encouraging when considering a long-term view. • Prevention aimed at children’s mental health will likely yield high investment return.

Social prescribing for healthy ageing: insights from older people referral and uptake in Portugal

Abstract The population ageing presents multifaceted challenges for health systems, with implications for healthcare delivery and health and well-being outcomes. Innovative integrated-care approaches are needed to promote healthy aging and the quality of life of older people. Social Prescribing (SP) has emerged as a promising strategy to address the complex health and social needs of populations, including those older, offering non-medical interventions that encompass social, cultural, and community-based activities. SP has been implemented in Portugal since 2018 and currently target different subgroups, including elderly. This study aims to examine referral and uptake of older people to SP in Portugal. This cross-sectional study analysed sociodemographic, health condition, referral and uptake-related data from older patients (≥65 years) engaged in SP, collected through a survey and registries at primary healthcare units in Lisbon between 2018-2023. Of the 1060 patients referred to SP, 43.9% (n = 465) were aged 65 years or older. Within this age group, 38.1% were 71-80 years old and 36.1% were 81-90 years old; 67.5% were female. Around 48% were referred to SP for social isolation, 40% for social and financial support, and 32.5% for functional dependency. Two thirds had two or more chronic conditions, with cardiovascular disease (59,1%), mental health disorders (29,2%), and obesity (27,1%) being the most frequent. The SP consultations uptake rate was 59.1%, and patients were referred to a range of activities provided by third-sector organisations, as psychosocial support, home care, senior university classes, arts activities, and support in medicine management. The elderly population accounts for a large proportion of SP referrals. Further efforts are needed to identify the factors that influence patients’ acceptability and adherence and to promote the sustainability of SP and the well-being of the population. Key messages • Older people referred to SP initiative in Portugal have complex health-social needs, which reinforces the relevance of adopting a holistic centred-care approach to respond to the aging challenges. • Through SP older people have been integrated in community-based activities that promote their health and wellbeing, thus it is needed to develop tailored strategies to improve patient uptake.

Unequal cannabis use among European adolescents: the mediating role of perceived access and risk

Abstract Introduction Cannabis use among adolescents is a public health concern, because of its association with the use of other illicit drugs, mental health disorders, and social problems. Most studies show that adolescents from low socioeconomic status (SE) background are more likely to use cannabis, but the causes of SE inequalities remain to be understood. We test whether access and risk perceptions of cannabis use among disadvantaged adolescents explain the SE gradient. Objectives The aim of this study was to measure the mediating effect of access perception and risk perception on the association between SE status and cannabis use among European adolescents in 2019. Methods A cross-sectional, observational, analytical study was conducted, among 16-year-old students, based on data from the European School Survey Project on Alcohol and Drugs (ESPAD) in 2019. The outcome was cannabis use (experimental, regular, and problematic) and the exposure was SE status (parental education and subjective social status). Mediating variables were perceived accessibility and perceived risk of cannabis use. We used logistic regressions, where the odds ratio (OR) reduction measures the part of the association explained by the mediators. Results Regular and problematic cannabis use was significantly more prevalent among adolescents with a lower SE background (low parental education and low subjective social status, p < 0,001). This relationship remained significant after adjustment for perceived access and risk, and the modification of ORs was of a small magnitude (a non-significant reduction of the association). Conclusions Perceived accessibility and risk showed a weak mediating effect of the association between SE background and cannabis use. Consequently, these factors cannot be considered as major explanations for the higher use among worse-off adolescents. Reinforcing information or imposing stronger barriers in access may not help reduces SE inequalities in cannabis consumption. Key messages • Perceived accessibility and risk hardly explain the association between socioeconomic background and cannabis use among European adolescents. • Reinforcing information or imposing stronger barriers in access may not help reduces socioeconomic inequalities in cannabis use.

Defining neighborhood walkability for children in the ELFE cohort study

Abstract Background Although walkability is known to be associated with obesity in adults, there is a paucity of data evaluating the association of walkability and health outcomes in children. In particular, little is known regarding the possible association with children’s mental health. Methods We used data from the Etude Longitudinale Française depuis l’Enfance (ELFE) cohort study. Participating mothers gave birth in 2011 in a representative sample of 320 maternity hospitals in mainland France. This pilot study is limited to participants in Paris and children at 5.5 years old. Walkability is defined by three parameters: population density (defined by census data), street connectivity (defined by intersection density), and land-use mix (entropy index). To approximate walkable areas, 500-meter street-network buffer zones were created around each participants address using a geographic information system. Children’s mental health was assessed using parent-reported Strengths and Difficulties Questionnaire at age 5.5 years. Results There was a total of 280 children in this pilot study. On measures of land-use mix, we found a mean of 0.79 (SD: 0.12), representing high accessibility. Residential and intersection density were highly correlated (p < 0.01). The walkability index demonstrated high variability among participants (mean: 10.6; SD: 10.44; range: -1.67 - 30.59). Conclusions Developing a walkability index is a multifactorial measure to describe a children’s neighborhood environment. Future work includes determining the association with children’s mental health disorders, while accounting for individual and neighborhood variables. This ecological model can inform social epidemiology and contextual disparities in children’s health. Key messages • Little is known about neighborhood walkability and the association with children’s mental health. • Using objective measures to calculate neighborhood composition and help elucidate this relationship.

Multi-modality deep learning prediction of heart age: insights from UK-Biobank

Abstract Background Identification of apparently healthy individuals at high cardiovascular risk who may benefit from targeted preventive strategies remains challenging. Predicted heart age, the chronological age of individuals with similar absolute cardiovascular disease (CVD) risk but with no risk factors, has been proposed to appropriately describe the absolute CVD risk over conventional prediction tools. Purpose To develop multi-modality based deep learning predictors for heart age in UK-Biobank individuals. Methods We used deep learning to develop a heart age predictor based on videos from heart magnetic resonance imaging (MRI) (anatomical dimension), electrocardiograms (ECG) (electrical dimension) or both from 45000 individuals of the UK Biobank cohort (age range 45-81 years) (Figure). We estimated the heritability of heart aging and identified single-nucleotide polymorphisms associated with accelerated heart aging. We performed X-wide association study to identify non-genetic factors potentially associated with accelerated heart aging. Results We predicted age with a mean absolute error (MAE) of 2.5±0.03 years (R2=85.6±0.6%) and found that accelerated heart aging is heritable at more than 35%. MRI-based anatomical features predicted age better than ECG-based electro-physiological features (MAE=2.29±0.03 years versus 4.90±.0.08 years), and heart anatomical and electrical aging were weakly correlated (Pearson correlation=0.249±0.002). Our attention maps highlighted the aorta, the mitral valve, and the interventricular septum as key anatomical features driving heart age prediction in videos that capture the entire heartbeat cycle. We found accelerated anatomical and electrical heart aging to be genetically correlated (Pearson correlation=0.508±0.089). The most significant locus was in TTN (Titin) and it was associated with heart anatomical aging. Cardiovascular diseases, general health status, and mental health disorders were highly associated with accelerated heart aging. Conclusions A multi-modality based deep learning approach was highly predictive of heart age. Accelerated heart age has a complex biological basis with genetic and environmental correlates. Leveraging of the described pipeline to predict survival and the onset of age-related cardiovascular diseases may shed light on heart aging role in health outcomes and effectively guide personalized preventive strategies.

The Africa CDC Guidance for Strengthening NCDI-MH Surveillance Systems: The role of HIS assessments

Abstract Deaths due to NCDs, injuries and mental health conditions are expected to at least triple by 2063 in the region of the African Union. Population-based data for NCDI/MH and their determinants remain scarce in many AU MS; therefore, NCDI/MH surveillance is a flagship initiative in the Africa CDC NCDI/MH Strategy. In a survey conducted by Africa CDC and RKI in 2022 on the impact of COVID-19 on NCDI/MH in 10 AU MS, countries signaled the need for a continental guidance document. In 2023, Africa CDC and RKI performed desk reviews and facilitated peer-to-peer multi-country HIS assessment workshops, based on modified WHO and IANPHI tools. The first workshop took place in Zambia with experts from Botswana, Democratic Republic of Congo/DRC, Kenya and Zambia. The second workshop was hosted in Ghana and included DRC, Ghana, Morocco, Nigeria, Senegal and Sierra Leone. Participants came i.a. from ministries of health, national public health institutes or academia. The process included a virtual introductory meeting as well as half-day training sessions at the physical meeting for participants to familiarize themselves with the tools. Peer-to-peer assessment sessions took place on days 2 and 3. Day 4 was reserved for site visits to (public) health institutions of the hosting countries. On day 5, participants presented their findings to the plenary, which included high-level representations from host countries. The combined results from the survey, desk reviews and workshops informed the development of the continental Africa CDC Guidance for strengthening surveillance for NCDI/MH, launched at the 3rd Conference on Public Health in Africa. In four chapters, the Guidance covers recommendations on indicators, data sources and data types; surveillance system capacities; surveillance integration with existing systems; and data use. Implementation of the Guidance, including development of core health indicators, has been initiated by Africa CDC in 2024.

Participative development of a culture-sensitive instrument to measure substance use in Syrian refugees

Abstract Background Rarely assessment instruments have been developed with end users such as refugees or those suffering from mental health conditions. Refugees’ experiences pre-, during, and post-flight are associated with various mental health problems including substance use disorders. Systematic reviews on the prevalence of substance use disorders in refugees worldwide show heterogeneous results. To address possible misclassification due to the lack of refugee-sensitive instruments we aimed to develop a refugee-sensitive instrument. Methods We applied a three-step triangulation study design. First, we conducted a three-stage delphi-process in 2019 and 2020. We recruited Syrian medical doctors for the study. Second, we conducted six focus group discussions with Syrian refugees and medical doctors. Third, we conducted expert checks with medical doctors and professionals providing psycho-social services for refugees. For all focus group discussions, audio recordings were translated and transcribed. Computer-assisted thematic analysis was performed applying a deductive approach with semantic coding. Results The refugee-sensitive instrument consists of seven domains of substance use: lifetime use of relevant types of substances, frequency, intensity, self-perception of, and situations posing a risk for substance use, ability to perform, craving, tolerance, and intentions to reduce or quit substance use. Discussion The instrument has been developed qualitatively, however, a limitation is that it could not be validated in a quantitative large sample of refugees. In spite of this limitation, this is - to the best of our knowledge - the first instrument that has been developed in a participatory approach together with end-users. Outlook The study suggests that developing assessment instruments in a participatory approach is feasible. Participatory development of assessment instruments is in line with the new paradigm of co-creation of mental health conditions management.

Gambling disorder and its associated factors in university students

Abstract Background Gambling disorder (GD) is defined as persistent and uncontrollable gambling behaviour that has negative effects on an individual’s life. This can lead to financial problems, poor academic performance, and health problems. GD has been associated with psychological disorders like depression, anxiety, and attention-deficit hyperactivity disorder (ADHD). We aimed to examine the gambling disorder and its associated factors in university students. Methods We conducted a cross-sectional study among students at a university in Eskisehir (Türkiye) in 2024. A stratified random sample design was used. Five faculties were randomly selected. A total of 1,201 students were included according to the stratum weight of the faculties. A questionnaire including sociodemographic characteristics, South Oaks Gambling Screen (SOGS), and Adult ADHD Self-Report Scale (ASRS) was applied. Data were analysed through descriptive statistical analyses and multivariate logistic regression models. Results The mean age was 21.5±2.8 years, and 46.8% were male. While 48.7% of the students stated that they had gambled at least once, 2.2% had a gambling disorder. The three most common types of gambling played by students were stock market (28.2%), bet on sports (22.0%), and scratch cards (18.2%). In multivariate analysis, being male (Odds ratio-OR:6.5, 95%CI:1.4-29.8), having lost years during education (OR:2.7, 1.1-6.8), having relatives with gambling problems (OR:8.0, 1.8-36.2), investing greater amounts of money in gambling (OR:3.7, 1.0-13.0), and having a high probability of ADHD (OR:4.3, 1.4-12.8) were found to be predictors for GD. Conclusions Although about half of the students had engaged in gambling activities, only a small proportion showed signs of GD. We can conclude that being male, having lost years in education, having relatives with gambling problems, investing larger amounts of money in gambling, and having a higher probability of ADHD are predictors of GD among students. Key messages • Implementing educational campaigns at universities to raise awareness of the potential risks and consequences associated with GD could be beneficial. • It may be helpful if mental health services at the university were equipped to consider mental health conditions such as ADHD, that contribute to GD.

Inequities faced by those with substance use disorder (SUD)

Abstract This presentation delves into the inequities faced by individuals with substance use disorder (SUD), with a particular focus on people who use drugs (PWUD) and people who inject drugs (PWID). Individuals contending with SUD encounter multifaceted barriers that hinder access to appropriate care and support. This presentation will highlight the discourse surrounding biases that exacerbate health disparities among PWUD and PWID. Structural stigma and discriminatory practices not only impede access to healthcare services but also perpetuate social exclusion, amplifying the challenges faced in seeking help and support. PWUD and PWID often require tailored interventions that address not only their substance use but also co-occurring physical and mental health conditions. However, the fragmented nature of healthcare delivery and the lack of integration between substance use treatment and mainstream healthcare services pose significant obstacles to holistic care provision. Drawing on empirical evidence and lived experiences, this presentation explores strategies to dismantle the barriers faced by individuals with SUD in Norway. Ultimately, this presentation aims to foster dialogue that addresses the inequities entrenched in healthcare systems around the world. By advocating for a compassionate and inclusive approach to SUD care, we can strive towards a society where all individuals, regardless of their substance use history, can access the support and resources they need to lead healthy and fulfilling lives.

Prevalence of Mental health and Receipt of Services in Latino Immigrants Living in Philadelphia

Abstract Background and Purpose Research shows that Latino populations are less likely to seek formal mental health services, these attitudes combined with difficulty finding affordable services impact the ability to receive a mental health diagnosis. This project examines mental health symptoms, utilization of mental health services, and socio-ecological barriers to receive mental health services among Latino immigrants, including region of origin, health insurance, immigration status, and English proficiency. Methods Data was collected between 2021-2022 by Drexel University’s CRISOL lab using a cross-sectional respondent-driven sample survey of Latinos born outside the U.S. mainland and residing in Philadelphia. The final sample included 420 Latino/a/e immigrants. Descriptive statistics and bivariate associations using Chi-square analyses were computed. Outcomes The findings revealed that 29.1% of the surveyed individuals exhibited signs of Depression, 36.1% experienced symptoms of Anxiety, 8.7% showed signs of PTSD, and 43.4% possessed one or more mental health conditions. The findings show that country of origin (p<.01), health insurance (p<.05), immigration status (p<.01), and language proficiency (p<.001) are significantly associated with whether an individual has received mental health services in the past year or in their lifetime. Of the survey population, only 39.5% of individuals with one or more mental issues had received mental health services in their lifetime. Conclusions Interventions to increase access to mental health services for Latino communities are needed. Solutions addressing disparities in access to mental health services must address systemic, cultural, and language barriers. Key messages • Region of origin, health insurance, immigration status, and English proficiency impact the utilization of mental health services. • Immigrant populations face stressors that increase the risk for mental health disease and experience multiple barriers to access mental health services.

Mobile street clinics and harm reduction: pathways to provide care to homeless people in Brazil

Abstract Homeless people (HP) are defined as a heterogeneous group that lives in extreme poverty, with weakened or severed family ties, lacking access to conventional housing, and using public spaces as residence. In terms of health, mental health conditions are prominent as a primary treatment demand, with care aimed at addressing needs arising from the use of alcohol and other drugs being a priority in serving HP. In this context, mobile street clinics (MSC) provide health services directly in street environments, focusing on individuals who use alcohol and other substances through harm reduction approaches. Harm reduction is defined as a set of practices aimed at minimizing the adverse health effects of alcohol and drug use without necessarily eliminating usage. Moreover, it represents an ethical and political direction in care, confronting the logic of criminalization and compulsory abstinence, enhancing access to health care for alcohol and other drug users through strategies that foster autonomy development. In the current study, we conducted an integrative review assessing the facilitators and barriers for HP access to mental health services. Preliminary results indicated that MSC, the connection between healthcare workers and the HP they serve, and the implementation of local street-based actions were the main facilitators of access for individuals who engage in harmful use of alcohol and other drugs to mental health services. Conversely, stigma, services’ lack of adjustment to the lifestyles of homeless people, and excessive bureaucracy were identified as the principal barriers of access. MSC, through their harm reduction activities, have emerged as a potential care technology to facilitate access to health services for homeless people. This research aims to present harm reduction as an ethical and political direction of care through the actions of mobile street clinics, as a way to facilitate access to health services for the homeless people. Key messages • Homeless people require mental health care tailored to the use of alcohol and other drugs, and harm reduction strategies implemented through mobile street clinics prove to be an effective form of care. • Mobile street clinics and harm reduction are important care technologies that enhance access to health services for the homeless population.

How can interventions of building renovation and household energy conversion effectively improve the physical and mental health outcomes? A systematic review and meta-analysis

Household energy efficiency measures can effectively reduce indoor air pollution and positively impact the health of residents, but there is no conclusive evidence on the effectiveness of different energy efficiency measures for various diseases. This study used systematic review and meta-analysis to research the effects of two interventions on residents’ physical and mental health: building renovation (heating, insulation, double-glazed windows and ventilation) and household energy conversion (stove upgrading and clean energy use). A total of 79 papers published between 1977 and 2023 were reviewed in this study, providing comprehensive meta-analytic evidence on the effectiveness of energy efficiency measures. The results show that household energy-saving measures have a minor but significant positive influence on residents’ physical and mental health, with the effect on mental health being larger than the impact on physical health. Stove upgrading is advantageous in respiratory and cardiovascular diseases; insulation can greatly reduce the risk of skin diseases; heating is beneficial in sensory and digestive diseases; and clean energy use can successfully mitigate integrative diseases. Furthermore, a combination of heating and insulation measures has the most favourable influence on mental health conditions such as depression, anxiety and social isolation. The study findings can help residents, policymakers and relevant organizations take appropriate interventions to promote residents’ physical and mental health.

Association of childhood mental health and cardiovascular risk in adolescence and young adulthood

Abstract Introduction Mental health (MH), and in particular depression, is linked bi-directionally to cardiovascular disease through biological as well as behavioral pathways. Low MH has been associated with behaviors associated closely with cardiovascular risk (CVR) factors, such as reduced physical activity and sleep disturbances. It is not clear at what age the relation between MH and CVR begins to manifest and if MH in the young is also associated with vascular remodeling, operationalized as carotid-intima media thickness (CIMT). Methods We investigated the longitudinal association between childhood MH problems (age 3 to 17) and CVR factors as well as CIMT from carotid sonography in 4,361 14 to 28-year-olds of the KiGGS cohort. Using linear regression analyses adjusted for socioeconomic status, we analyzed the association of the Strength and Difficulties Questionnaire (SDQ) score with systolic blood pressure (SBP), body mass index (BMI), total cholesterol (TC), and CIMT in z-scores by sex and age. Additional cross-sectional analyses included scores of the Mental Health Inventory (MHI-5) and Patient Health Questionnaire (PHQ-9) in young adulthood. Results Childhood SDQ scores were significantly associated with SBP, BMI and TC one decade later (-0.03 ≤ ß ≥ 0.02). Cross-sectionally, no association of MHI-5 scores in young adults with CVR factors was found. PHQ-9 scores in young adults were associated significantly with SBP and BMI (-0.26≤ ß≥ 0.01). The investigated MH problems from childhood to young adulthood were not linked to CIMT. Conclusions Our results confirm an early association of MH with the examined CVR factors. However, we could not find evidence for an association between MH and vascular remodeling in this population-based sample of adolescents and young adults. Our results emphasize the importance of prevention strategies focusing on both, physical and MH of the young, in order to prevent vascular damage later in life. Key messages • Our results show an early association of childhood mental health with the examined cardiovascular risk factors systolic blood pressure, body mass index and total cholesterol one decade later. • Our results confirm the importance of prevention strategies focusing on both, physical and mental health of the young.

Changes in mental health and illness perception in patients with hypertrophic cardiomyopathy referred to hybrid cardiac telerehabilitation in comparison to usual care - a randomised-control trial

Abstract Purpose Hypertrophic cardiomyopathy (HCM) is a complex cardiac disorder, that influences patients' physical capacity and quality of life, as well as the risk of sudden cardiac death (SCD). Patients with HCM often experience emotional distress due to the uncertainty of their condition and have a threatening illness perception (the way individuals make sense of their illness, which can have a significant impact on adherence to treatment). Current studies suggest that some HCM patients could benefit from hybrid cardiac telerehabilitation (HCTR) in terms of somatic and psychological status. This study is part of a research project investigating the safety and effectiveness of hybrid cardiac telerehabilitation for HCM patients. The specific focus of this part is to evaluate the changes in mental health status and illness perception of HCM patients who have been referred for cardiac telerehabilitation compared to those receiving usual care. Methods An RCT study was conducted, with the inclusion criteria for the study of being above 18 y.o., HCM without LVOT obstruction, NYHA Class II or III, LVEF ≥ 50%, and having CIED. The study involved telerehabilitation (HCTR) and control (CG) groups. Both groups were completing questionnaires assessing illness perception (Brief IPQ) and overall psychosocial distress (GHQ-28) with its 4 domains: somatic symptoms, anxiety, social impairment, and depression. Psychological assessment was performed at the beginning and at the end of telerehabilitation/outpatient care, and at 3, 6 and 12 months after the end of care (T1/T2/T3/T4/T5). Results There was a significant improvement in the overall distress level in the HCTR group (p=0.003) but not in the CG (p=0.559). It remained significant in the HCTR group for the T2 (p<0.001), T3 (p=0.008), and T4 (p<0.001). The positive change was observed in somatic symptoms only in the HCTR group: for T2 (p=0.025) and T3 (p=0.032) compared to the T1. The gradual decrease in anxiety level was observed in the HCTR group, but not in the CG, with a significant difference for T4 (p=0.013) compared to T1. Although there was an improvement in social impairment in both groups (p=0.049 for the CG, and p=0<0.001 for the HCTR group), only in the HCTR group it held a stable pattern after the intervention (p<0.001 for T2; p=0.013 for T3; p=0.032 for T4). There were no changes in the level of depressive symptoms in either of the compared groups. There were also no significant differences in the illness perception (p=0.200 for the HCTR group and p=0.090 for the CG), although the HCTR group showed short-term improvement after three months of HCTR (T2) (p=0.032). Conclusions There are significant benefits of hybrid cardiac telerehabilitation for mental health, level of distress, and illness perception in HCM patients. It is worth noticing that this improvement is short-term, and prolonged effects might require providing additional support during extended care.overall distress in HCTR vs CGsubscales of GHQ_28 in HCTR vs CG

Having paid work 1 year after disability claim in different types of mental and behavioural disorders

Abstract Background The majority of claimants diagnosed with a mental and/or behavioral disorder have residual work capacity, however, the chance of actual (return to) work after a disability claim assessment may differ within this diagnosis group depending on the specific type of disease. The aim of this study is to examine the associations of different mental and behavioural diseases with having paid employment one year after the claim assessment. Methods This longitudinal register based cohort study included all work disability applicants with mental and behavioural disorders assessed with residual work capacity in the Netherlands in 2016. Data were derived from the Dutch Social Security Institute (UWV) and were linked to register data on paid employment. ICD codes were used to categorize 11 disease groups (mental retardation, autism spectrum disorders, ADHD, somatoform disorders, adjustment disorders, PTSS, anxiety, personality disorders, mood affective disorders, addictions and delusional disorders. Multivariable logistic regression analyses were conducted separately for applicants who work and not work at time of the claim assessment. Results A total of 8544 claimants (mean age 45, 56% female; n = 1915 work at baseline) were included. In the working group being diagnosed with ADHD (OR 3.05, CI 1.08-8.61) or PTSS (OR 1.45, CI 1.04-2.02) was associated with paid work, and adjustment disorder was negatively associated (OR 0.74, CI 0.56-0.97). In the not-working group, autism spectrum disorder (OR 1.51, CI 1.02-2.22), personality disorder (OR 1.36, CI 1.02-1.81) and addiction (OR 1.94, CI 1.32-2.86) was associated with return to work, and somatoform (OR 0.51, CI 0.31-0.84) disorders and mood affective disorders (OR 0.83, CI 0.70-0.99) were negatively associated. Conclusions The findings of this study show different associations between type of mental and behavioural disease groups and paid employment one year after the claim assessment. Key messages • The association of either remaining at work or return to work is different among mental and behavioural diagnosis groups, therefore a different approach is indicated. • Active interventions to facilitate return to or remain at work might be indicated in specific diagnosis groups.

Joint associations of psychological distress and working conditions with sickness absence in Finland

Abstract Background Psychological distress has increased remarkably, especially among younger age groups, during the last years. Both psychological distress and exposure to strenuous working conditions are known risk factors for sickness absence (SA). We examined whether psychological distress and working conditions are jointly associated with SA periods of 1-7 days and 8+ days among young and midlife Finnish employees. Methods We linked survey data from the Helsinki Health Study cohort from 2017 (response rate 51.5%) with the employer’s SA register for the City of Helsinki, Finland (82% consented to the linkage; n = 3949, 80% women, age 19-39 years). Mean follow-up time was 2.1 years. We calculated rate ratios (RR) and 95% confidence intervals (CI) for SA periods of 1-7 days and 8+ days using negative binomial regression models among participants with and without psychological distress, and with and without exposure to strenuous working conditions. Psychological distress was measured with the emotional wellbeing subscale of RAND-36 (cut-off 60 points). Working conditions included physical and mental strenuousness of work and hours per day spent in heavy physical work. Results Participants with psychological distress and exposure to strenuous working conditions had the highest age- and gender-adjusted RRs for SA periods of ≥ 8 days (physically strenuous work: RR: 2.38, CI: 1.97-2.88; mentally strenuous work: RR: 2.08, CI: 1.72-2.53; ≥3 h per day spent in physical work: RR: 2.48, CI: 2.01-3.06), the interactions being additive. The associations were weaker for SA periods of 1-7 days. Adjusting for marital and employment status, education, alcohol use, smoking and body mass index only slightly attenuated these associations. Conclusions Psychological distress and exposure to strenuous working conditions were additively associated with SA. Both individual- and workplace-related risk factors for SA are important to be considered when planning preventive actions. Key messages • Young and early midlife Finnish employees with simultaneous psychological distress and exposure to strenuous working conditions had the highest rates of SA periods, the interactions being additive. • Both psychological distress and exposure to strenuous physical and mental working conditions should be considered when planning preventive actions to reduce employees’ SA.

Dis-continuity in Continuity-of-Care: a pathway for more equal access to mental health care services?

Abstract Background Access to healthcare is core to achieving universal health coverage. Reaching and obtaining appropriate health care services requires engagement by health care organizations and users. For people with mental illness, access emerges as a continuous process, reflecting oscillating health conditions. This challenges aspirations of continuity of care (COC), but we know little about the experiences of users. Methods We carried out observations of interactions between professionals and users (n = 18) and semi-structured interviews with users, professionals, and managers (n = 33) in the specialised mental health services in Central Denmark Region and FACT-inspired teams in three municipalities. We also conducted 3 focus groups with regional and municipal professionals from these teams. Data was analysed through a qualitative thematic analysis. Results From the perspective of users, COC builds on the acknowledgment of their entire life situation. For users, this is about making connections between their past, present and future lives. Past experience affect their present abilities to follow treatment and influence future hopes and expectations. The acknowledgment of these connections often translates into spaces of discontinuity in continuity, where users need occasional breaks from treatment but worry about being excluded from treatment. Crucially, the organization of the FACT-inspired teams allows for flexibility in the intensity of visits and treatment. The norms of professionals also support users’ perspectives on COC, as the norms focus on building trust in the relations between users and professionals. Conclusions One important step to achieve more equal access is to integrate the social world of users. This requires organizational and professional approaches that allow for user needs for dis-continuity in COC. Key messages • For mental health service users, continuity-of-care includes breaks from treatment (discontinuity). • More equal health access requires adapting continuity-of-care to needs as perceived by users.

Cross-species translational paradigms for assessing positive valence system as defined by the RDoC matrix.

Functions associated with processing reward-related information are fundamental drivers of motivation, learning, and goal-directed behavior. Such functions have been classified as the positive valence system under the Research Domain and Criteria (RDoC) criteria and are negatively impacted across a range of psychiatric disorders and mental illnesses. The positive valence system is composed of three comprehensive categories containing related but dissociable functions that are organized into either Reward Responsiveness, Reward Learning, or Reward Valuation. The presence of overlapping behavioral dysfunction across diagnostic mental disorders is in-part what motivated the RDoC initiative, which emphasized that the study of mental illness focus on investigating relevant behavior and cognitive functions and their underlying mechanisms, rather than separating efforts on diagnostic categories (i.e., transdiagnostic). Moreover, the RDoC approach is well-suited for preclinical neuroscience research, as the rise in genetic toolboxes and associated neurotechnologies enables researchers to probe specific cellular targets with high specificity. Thus, there is an opportunity to dissect whether behaviors and cognitive functions are supported by shared or distinct neural mechanisms. For preclinical research to effectively inform our understandings of human behavior however, the cognitive and behavioral paradigms should have predictive, neurobiological, and pharmacological predictive validity to the human test. Touchscreen-based testing systems provide a further advantage for this endeavor enabling tasks to be presented to animals using the same media and task design as in humans. Here, we outline the primary categories of the positive valence system and review the work that has been done cross-species to investigate the neurobiology and neurochemistry underlying reward-related functioning. Additionally, we provide clinical tasks outlined by RDoC, along with validity and/or need for further validation for analogous rodent paradigms with a focus on implementing the touchscreen-based cognitive testing systems.

Sleep health across the life cycle: an unmet and neglected public health priority

Abstract The presentation will set the stage on the central role of sleep health across the life cycle. Despite the large body of evidence on the importance of poor sleep behaviors as a modifiable risk factor for several adverse health outcomes, sleep health is still an unmet and neglected issue in public health policy, especially in the European context. Sleep problems are widespread and potentially affect everyone, from childhood to adult age. In addition, sleep health disparities represent a major source of health inequities across marginalized and high-risk population subgroups, such us people from low socio-economic status, women, refugees and immigrants, shift workers, people living with physical and mental illness. There is an urgent need to promote evidence-based health promotion and public health policy to enhance sleep health both in the general population and high-risk subgroups.