Recent Stressful Events Research Articles

Negative Life Events and Emotional Symptoms From Ages 2 to 30 Years

Exposure to different types of negative life events, including traumatic events, is common across the lifespan and associated with increased mental health symptoms. To assess whether vulnerability to negative life events varies across 5 developmental periods from preschool to young adulthood. This cohort study analyzed data from 3 community-representative studies set in the southeastern US (1992-2015) with harmonized assessment approaches that included a total of 13 775 assessments of individuals aged 2 to 30 years with up to 21 years of follow-up. Data analysis occurred from July 2023 to June 2024. Each study assessed lifetime exposure to (1) traumatic events (ie, severe events associated with posttraumatic stress disorder) and (2) recent stressful events (eg, loss of a friend or moving). All assessments were completed with structured interviews with participants and/or their caregivers. The primary outcome was emotional symptoms (ie, anxiety and depressive symptoms). Associations of both categories of life events with emotional symptoms were compared across preschool (<7 years), childhood (7-12 years), adolescence (13-17 years), late adolescence (18-22 years), and young adulthood (23-30 years). Analyses were based on 13 775 assessments of 3258 participants (1519 female [weighted percentage, 50.0%]). Recent stressful events were associated with emotional symptoms across each developmental period, ranging from a low in preschool (B =0.14; SE = 0.05) to a high in young adulthood (B = 0.57; SE = 0.12) in cross-sectional analyses and ranging from a low in childhood (B = 0.10; SE = 0.06) to a high adolescence (B = 0.19; SE = 0.05) in longitudinal analyses. Lifetime traumatic events were associated with emotional symptoms across each developmental period, ranging from a low in preschool (B = 0.18; SE = 0.05) to a high in adolescence (B = 0.28; SE = 0.04) in cross-sectional analyses and ranging from a low in childhood (B = 0.09; SE = 0.06) to a high in late adolescence (B = 0.21; SE = 0.05) in longitudinal analyses. Associations had overlapping 95% CIs across the different developmental periods with one exception: stressful events had a larger-magnitude cross-sectional association with emotional symptoms in young adulthood than in other developmental periods. Results were consistent with additive, rather than interactive, associations of traumatic and stressful events with emotional symptoms at each developmental period. In this cohort study of 3 community-representative samples, vulnerability to traumatic and stressful events was generally similar across the first 3 decades of life; both types of events had an independent association with emotional functioning. These findings suggest response to stressful events is similar from childhood to adulthood.

Critical thinking level in nursing degree students according to sociodemographic and academic variables: A correlational study

AimsTo determine the level of critical thinking of undergraduate nursing students during their clinical practice, as well as to identify the relationship between sociodemographic and academic variables. BackgroundNursing degree programs should prioritize the development of critical thinking skills in their curriculum and regularly assess students to ensure the acquisition of core competencies. DesignMulticenter, descriptive, cross-sectional, correlational, descriptive study. Participants included were students from the Degree in Nursing enrolled during the academic year 2020–2021. Students were selected by convenience from three universities located in Catalonia, Spain. Data were collected from 429 students, with 98 being excluded due to incomplete data. MethodsData were collected by administering the Nursing Critical Thinking in Students Questionnaire and an ad hoc form of sociodemographic and academic characteristics. The STROBE guidelines checklist were followed. The study involves a secondary analysis of data from a previous study that presented psychometric analysis. ResultsNo significant differences were observed in total Critical Thinking scores across various parameters including academic year, current situation, work experience in healthcare, previous academic training, family situation, or recent stressful events. On average, students demonstrated moderate critical thinking scores. However, statistically significant relationships emerged between critical thinking scores and gender (p=0.046), institution attended for undergraduate studies (p=0.019) and having satisfactory social relationships despite experiencing stressful events (p=0.330). ConclusionsThe study delves into the correlation between critical thinking skills and sociodemographic and academic factors, identifying students who may benefit from specific interventions and advocating for adaptable educational methods. It emphasizes the pivotal role of trust in fostering critical thinking in nursing education and suggests a connection between critical thinking and strong social relationships. In conclusion, evaluating critical thinking is crucial for addressing healthcare challenges, validating teaching strategies and promoting continuous improvement in nursing education.

Positive psychosocial factors may protect against perceived stress in people with systemic lupus erythematosus with and without trauma history

ObjectiveTrauma history is associated with SLE onset and worse patient-reported outcomes; perceived stress is associated with greater SLE disease activity. Stress perceptions vary in response to life events and may...

Antenatal Depression and its Associated Factors: Findings from Kuwait Birth Cohort Study

BackgroundPregnant and postpartum women are at high risk of depression due to hormonal and biological changes. Antenatal depression is understudied compared to postpartum depression and its predictors remain highly controversial.AimTo estimate the prevalence of depressive symptoms during pregnancy and investigate factors associated with this condition including vitamin D, folate and Vitamin B12 among participants in the Kuwait Birth Study.MethodsData collection occurred as part of the Kuwait Birth Cohort Study in which pregnant women were recruited in the second and third trimester during antenatal care visits. Data on antenatal depression were collected using the Edinburgh Postnatal Depression Scale (EPDS), considering a score of ≥ 13 as an indicator of depression. Logistic regression was used to investigate factors associated with depressive symptoms in pregnant women.ResultsOf 1108 participants in the Kuwait Birth Cohort study, 1070(96.6%) completed the EPDS. The prevalence of depressive symptoms was 21.03%(95%CI:18.62–23.59%) and 17.85%(95%CI:15.60-20.28%) as indicated by an EPDS ≥ 13 and EPDS ≥ 14 respectively. In the multivariable analysis, passive smoking at home, experiencing stressful life events during pregnancy, and a lower level of vitamin B12 were identified as predisposing factors. Conversely, having desire for the pregnancy and consumption of fruits and vegetables were inversely associated with depressive symptoms.ConclusionApproximately, one fifth of pregnant women had depressive symptoms indicating the need to implement screening program for depression in pregnant women, a measure not systematically implemented in Kuwait. Specifically, screening efforts should focus on pregnant women with unintended pregnancies, exposure to passive smoking at home, and recent stressful live events.

Fear of Flying, Stress and Epileptic-Like Symptoms.

Intense fear of flying, called aviophobia, is a highly prevalent psychological phenomenon, afflicting (in some estimates) up to 40% of the population of industrialized countries and although aviophobia is a highly prevalent mental health problem, published studies about its epidemiology and treatment are rare. In this study, including 61 participants (28 males and 33 females; mean age 26.85) engaged in business related travels in the last two years, we assessed relationships of fear of flying problems with symptoms of stress also reflecting childhood traumatic stress experiences and its influences on brain sensitization and epileptic-like symptoms. In this assessment we also studied fear of flying symptoms and work related psychological problems described as burnout. The results show that the participants who manifest higher levels of stress symptoms have higher levels of aviophobic experiences. Stress symptoms measured by TSC-40 manifested significant correlations with aviophobic experiences measured by Flight Anxiety Modality Questionnaire (FAS) (Spearman R=0.46, p<0.01). Other correlations were found between FAS and Limbic System Checklist (LSCL-33) (Spearman R=0.39, p<0.01) and FAS and Burnout Measure (BM) (Spearman R=0.30, p<0.01). The results of this study indicate that the experience of fear of flying is related to past and recent stressful events and also to levels of work related problems described and experienced as burnout.

Parent Preferences for Peer Connection in Virtual Mental Health and Parenting Support Platforms

AbstractPeer connections can be integrated in online and app-based (eHealth) family mental health and parenting programs through forums/chats or video group sessions. Little is known about parental preferences regarding eHealth features, yet they could be key factors influencing uptake and utility of programs. Accordingly, the present study aims to examine parent preferences for connecting with other parents in eHealth programs. Parents (n = 177) of 0–5-year-old children in the United States were recruited on MTurk. Parents were asked about peer connection preferences through questions framed around how and with whom they would like to connect when using a virtual mental health and parenting support platform. Most (86.4%) preferred connecting with other parents in an eHealth program with 73.2% preferring to connect anonymously. If using a forum, 45.5% of mothers were comfortable connecting only with other mothers whereas 54.5% were comfortable connecting with parents of any gender; 80.3% of fathers were comfortable connecting with all parents. Results were similar for videoconferencing. Age, income, number of children, recent stressful events, social support, mental health symptoms, and parenting stress did not predict any of these preferences. Our results suggest that integrating peer connection should be considered in developing parental eHealth programs as it may be in line with the preferences of most parents and programs that match user preferences have been shown to have higher enrollment and adherence. These preferences should be further studied with community samples and diverse participants to strengthen confidence in the findings and properly inform program development.

Psychosocial Stress and MicroRNA Expression Profiles in Myometrial Tissue of Women Undergoing Surgical Treatment for Uterine Fibroids.

Uterine leiomyomas (fibroids) are the most common non-cancerous tumors affecting women. Psychosocial stress is associated with fibroid risk and severity. The relationship between psychosocial stress and fibroid pathogenesis may involve alterations in microRNAs (miRNAs) although this has yet to be examined. We investigated associations between two psychosocial stress measures, a composite measure of recent stressful life events and perceived social status, with expression levels of 401 miRNAs in myometrium (n = 20) and fibroids (n = 44; 20 with paired fibroid and myometrium samples) among pre-menopausal women who underwent surgery for fibroid treatment. We used linear regressions to identify psychosocial stressors associated with miRNAs, adjusting for covariates (age, body mass index, race/ethnicity, and oral contraceptive use). The association between psychosocial stressors and miRNAs was considered statistically significant at an FDR p < 0.10 and showed a monotonic response (nominal p-trend < 0.05). In the myometrium, 21 miRNAs were significantly associated with a composite measure of recent stressful events, and two miRNAs were associated with perceived social status. No fibroid miRNAs were associated with either stress measure. Pathway analyses revealed miRNA-mRNA targets were significantly enriched (FDR p < 0.05) in pathways relevant to cancer/tumor development. Of the 74 differentially expressed miRNAs between myometrium and fibroids, miR-27a-5p and miR-301b were also associated with stress exposure. Our pilot analysis suggests that psychosocial stress is associated with myometrial miRNA expression and, thus, may have a role in the pathogenesis of fibroids from healthy myometrium.

LIFE COURSE TIMING OF ADVERSITY AND DIURNAL CORTISOL IN LATER LIFE

Abstract Exposure to adversity is believed to alter stress sensitive biological processes. One manifestation of this, flatter diurnal cortisol slopes, has been linked to cardiometabolic problems. Questions remain about whether the timing of adversity within the life course influences its effect on cortisol slopes in later life. Two longitudinal cohort studies (Cardiac Rehabilitation and The Experience [CREATE], Tracking Risk Identification for Adult Diabetes [TRIAD]) with identical measures were merged for analysis (merged N = 175, Mage 60.8) using multilevel modeling. Measures included retrospective self-report of childhood trauma (CTQ), major life stressors in adulthood (number and recency of stressful events, affected domains, everyday discrimination), and peak-to-bedtime cortisol slopes (≤12 collected over 15 months). Report of any moderate and severe childhood adversity was not associated with adult cortisol slopes (p&amp;gt;.05). When we probed specific types, emotional abuse was associated with cortisol slopes (b=.006, SE=.003, p=.015). For adult adversity, total number of stressful events (b=.001, SE=.0002, p=.009) and recent stressful events (b=.003, SE=.001, p=.041) were associated with cortisol slopes. When simultaneously modeling all measures of adversity over the life course, number of stressful events in adulthood (b=. 001, SE=.0002, p=.018) and childhood emotional abuse (b=.007, SE=.004, p=.064) were the strongest predictors of flatter diurnal cortisol slopes in adulthood. Given that those reporting childhood adversity were also more likely to have experienced adulthood adversity (r=.08-.39), early life adversity may be an important risk factor for flattened cortisol slopes and associated cardiometabolic outcomes in later life via multiple pathways. Implications for intervention will be discussed.

The relationship between patterns of negative life experiences and clinical presentation in a psychiatric sample.

Attempts have been made to classify the patterns of polytraumatization using a person-centered approach. However, most studies have only focused on maltreatment and interpersonal trauma and have been unable to examine various clinical symptoms. This study aimed to explore patterns of negative life experiences, including maltreatment, lifetime trauma, and recent stressful life events, and compare diverse dimensions of the clinical manifestations among the subtypes in a clinical sample. We investigated childhood maltreatment, lifetime trauma, and recent stressful events using a self-report method in 1410 psychiatric patients; we classified the patterns of lifelong negative life experiences using latent profile analysis (LPA). We used the rates of psychiatric diagnosis, the Beck Depression Inventory,the Impact of Event Scale-Revised (IES-R-K),and the Multiphasic Minnesota Personality Inventory-2-Restructured Formto compare various symptom dimensions among the derived subtypes. LPA indicated a four-class solution: mild, recent stress, maltreatment, and multiple adversity group. The multiple adversity group experiencing both lifetime trauma and recent stressful life events, in addition to maltreatment, including sexual abuse, had a high rate of severe mental illness and more symptom dimensions of thought and behavior problems. However, the rates of depressive disorders and emotional/internalizing symptoms were not more than those in the other two groups (recent stress and maltreatment groups) experiencing moderate levels of lifetime trauma. There was no significant difference between the recent stress and maltreatment groups for most symptom dimensions. The findings indicate that distinct symptom profiles may be associated with the pattern of negative experiences, suggesting that negative experiences need multidimensional investigation in clinical settings.

Childhood stress, gender, and cognitive control: Midline theta power

The emergence of psychiatric symptoms is a common consequence of childhood stress exposure. However, there are a dearth of reliable clinical hallmarks or physiological biomarkers to predict post-trauma symptom emergence. The objective of this study was to examine if childhood stressors and stress-related symptoms are associated with altered midline theta power (MTP) during cognitive control demands, and how these associations interact with gender and early adversity. N = 53 children (ages 9–13 years old) from a longitudinal study of children maltreated during early childhood and non-maltreated children participated in this study. EEG recorded neural activity during a Zoo-Themed Go/No-Go task. Stress-related symptoms, recent stressful events, and other adversity experiences were identified. MTP was analyzed with clinical variables in a series of follow-up analyses. The number of stressors in the past six months was negatively correlated with MTP in those with low preschool adversity, but not in those with high preschool adversity. MTP was higher in girls than in boys, and the associations of MTP with stressors and symptoms were moderated by gender. MTP was negatively associated with stressors in the past six months in girls, while in boys, MTP was associated with stress-related symptoms. Childhood stressful events were associated with reduced MTP during cognitive control demands, and this was finding was moderated by gender and early life adversity. These preliminary findings suggest that boys and girls may process stressful experiences in distinct ways, and preschool adversity may potentially blunt the interaction between current stress and neural dynamics. However, ongoing investigation is needed.

Factors of the changes in depressive symptoms among retirees: a 3-year follow-up study in Taiwan

Abstract Background Depression is a critical mental problem for middle-aged and older adults. In addition, retirement and its adjustment may further affect their physical and psychological health. Hence, this study aims to explore the risk and protective factors associated with the changes in depressive symptoms among retirees. Methods A 3-year follow-up study was designed to examine the factors affecting the changes in depressive symptoms in retired people. A total of 2,379 participants aged 50 to 74 years were recruited from the Taiwan Health and Retirement Study during 2015-2019 (two waves). Three types of study variables were included: (i) sociodemographic factors: 9 items, (ii) health-related variables: 7 items, and (iii) psychosocial factors: 6 items. The changes in the 10-item CESD score after three years were measured as the outcome variable. The score change was divided into three groups: maintenance, deterioration, and improvement. Multinomial logistic regressions were used to analyze risk and protective factors related to changes in depressive symptoms in retirees. Results After adjusting for all covariates, this study found that retirement time ≥ 10 years, unskilled occupation before retirement, and having stressful life events after retirement may worsen depression scores three years later. Instead, getting a good night's sleep prevented worsening depression scores after three years. For the improvement group, the results showed that being a volunteer could improve the depression score; however, living alone and having poor health may hinder improving depression scores after three years. Furthermore, we found that factors associated with changes in depressive symptoms showed gender differences. Conclusions Future interventions to prevent depression should consider the diverse needs of different risk and protective factors and gender differences. Key messages • Retirees over ten years, with unskilled occupations and recent stressful events, were at high risk for depression. However, good sleep quality can help prevent depression. • For male retirees, regular physical activity was an enabling factor for improving depression, whereas women benefited from social connections.

Sleep disturbances are associated with pain intensity and pain-related functional interference in patients experiencing orofacial pain.

Sleep and pain have a reciprocal relationship, interacting with psychosocial aspects including depression, anxiety, somatization and significant stressful events. The aim of this study was to assess patients with oro-facial pain (OFP) and related sleep disturbances and determine the strongest psychosocial correlates. A cross-sectional study of anonymized data of consecutive patients with OFP {January 2019 and February 2020} were analysed. Diagnostic and Axis-II data were integrated to assess the relationship between sleep disturbances, measured using Chronic Pain Sleep Inventory, and demographic factors, clinical comorbidities, recent stressful events, pain severity and pain- and psychological-related function. Five out of six patients with OFP were presented with pain-related sleep disturbances. Sleep problems were enhanced in patients with primary oro-facial headache compared with other OFP conditions. However, once the level of pain intensity and interference was accounted for, primary headache, was not a significant correlate of pain-related sleep disturbances. Multivariate analysis revealed (average) pain severity and pain interference were both significantly associated with sleep problems. There were also significant independent associations of sleep problems with somatization levels and reported experience of recent stressful events. Identifying sleep problems as a part of OFP management may be beneficial and could result in better management outcomes.

Sociodemographic circumstances, health, and life experience shape posttraumatic distress trajectories among individuals exposed to smoke during a large-scale coal mine fire.

The 2014 Hazelwood coal mine fire in the Latrobe Valley, Australia, distributed toxic smoke into surrounding communities over 45 days. This study investigated risk and protective factors associated with four trajectories of posttraumatic distress (resilient, recovery, delayed-onset, chronic) among exposed adults. Participants (N = 709) completed surveys in 2016-2017 and 2019-2020 assessing mine fire-related particulate matter (PM2.5 ) exposure; sociodemographic, physical, and mental health variables; and exposure to other traumatic and recent stressful events. Mine fire-related posttraumatic distress was measured using the IES-R; trajectories were determined according to established clinical significance thresholds. Relative risk ratios (RRRs) were generated from multivariate multinomial regressions. The resilient trajectory was most common (77.0%). The chronic trajectory (8.5%) was associated with loneliness, RRR = 2.59, 95% CI [1.30, 5.16], and physical health diagnoses, RRR = 2.31, 95% CI [1.32, 4.02]. The delayed-onset trajectory (9.1%) was associated with multiple recent stressful events, RRR = 2.51, 95% CI [1.37, 4.59]; mental health diagnoses, RRR = 2.30, 95% CI [1.25, 4.24]; loneliness, RRR = 2.05, 95% CI [1.09, 3.88]; and male gender, RRR = 2.01, 95% CI [1.18, 3.44]. Socioeconomic advantage protected against chronic, RRR = 0.68, 95% CI [0.53, 0.86], and delayed-onset trajectory membership, RRR = 0.68, 95% CI [0.50, 0.94]; social support protected against chronic trajectory membership, RRR = 0.67, 95% CI [0.49, 0.92]. PM2.5 exposure did not determine trajectory. These findings enhance understanding of longer-term posttraumatic responses to large-scale smoke events and can inform mental health initiatives within at-risk communities.

The Social Determinants of Loneliness During COVID-19: Personal, Community, and Societal Predictors and Implications for Treatment

AbstractObjectiveThe COVID-19 pandemic dramatically altered social determinants of health including work, education, social connections, movement, and perceived control; and loneliness was commonly experienced. This longitudinal study examined how social determinants at the personal (micro), community (meso), and societal (macro) levels predicted loneliness during the pandemic.MethodsParticipants were 2056 Australian adults surveyed up to three times over 18 months in 2020 and 2021. Multi-level mixed-effect regressions were conducted predicting loneliness from social determinants at baseline and two follow-ups.ResultsLoneliness was associated with numerous micro determinants: male gender, lifetime diagnosis of a mental health disorder, experience of recent stressful event(s), low income, living alone or couples with children, living in housing with low natural light, noise, and major building defects. Lower resilience and perceived control over health and life were also associated with greater loneliness. At the meso level, reduced engagement with social groups, living in inner regional areas, and living in neighbourhoods with low levels of belongingness and collective resilience was associated with increased loneliness. At the macro level, increased loneliness was associated with State/Territory of residence.ConclusionsTherapeutic initiatives must go beyond psychological intervention, and must recognise the social determinants of loneliness at the meso and macro levels.

When not dying breaks the heart!

Introduction: Takotsubo cardiomyopathy (TC) is a reversible cardiac pathology that develops contractility changes in the middle segments of the left ventricle, often precipitated by a stressor event, and which clinically mimics an acute coronary event. It mainly affects postmenopausal women and presents with clinical, electrocardiographic and laboratory characteristics similar to acute coronary syndrome, always constituting a differential diagnosis of this entity. It can be triggered by a physical or emotional stressor. The pathophysiology of TC remains unknown.Case report: We present a clinical case that poses a diagnostic challenge as the clinical presentation did not indicate cardiac comorbidity. 78-year-old woman was referred to the Emergency Department for attempted suicide by drowning in a river. She presented with a depressive mood reactive to recent experiences, social isolation, overvalued thoughts of worthlessness and guilt. She denied complaints of chest pain or dyspnea. Of the complementary diagnostic tests performed on admission, ECG shows sinus rhythm with ST elevation in V2 stand out. Collaboration from the cardiology was requested and it was assumed Takotsubo syndrome as a probable diagnosis. During hospitalization, there was a good clinical evolution, presenting good clinical response and remission of depressive symptoms.Conclusion: TC is a psychosomatic condition that requires a multidisciplinary approach in the treatment of heart and psychiatric disease. Clinicians should suspect TC in patients who report a recent stressful event accompanied by cardiothoracic symptoms. Since many cases are seen primarily by psychiatry, psychiatrists must be familiar with the syndrome, under penalty of delay in diagnosis and treatment.

Recent Stressful Experiences and Suicide Risk: Implications for Suicide Prevention and Intervention in U.S. Army Soldiers.

To identify the extent to which the presence of recent stressful events are risk factors for suicide among active-duty soldiers as reported by informants. Next-of-kin (NOK) and supervisors (SUP) of active duty soldiers (n=135) who died by suicide and two groups of living controls: propensity-matched (n=128) and soldiers who reported suicidal ideation in the past year, but did not die (SI) (n=108) provided data via structured interviews from the Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Multivariate logistic regression analyses were used to create a risk score for suicide. The odds of suicide increased significantly for soldiers experiencing relationship problems, military punishment, and perceived failure or humiliation in the month prior to death. Suicide risk models with these risk factors predicted suicide death among those who reported SI in the past year (OR=5.9, [95% CI = 1.5, 24.0] χ 2=6.24, p=0.0125, AUC, 0.73 (0.7, 0.8) NOK) and (OR=8.6, [95% CI = 1.4, 51.5] χ 2=5.49, p=0.0191, AUC, 0.78 (0.7, 0.8); SUP) suggesting the combination of these recent stressors may contribute to the transition from ideation to action. Our findings suggest for the first time recent stressors distinguished suicide ideating controls from suicide decedents in the month prior to death as reported by informants. Implications for preventive intervention efforts for clinicians, supervisors and family members in identifying the transition from ideation to action are discussed.

What Shapes Pro-Environmental Attitudes and Intention for Sustainable Fashion Consumption during a Stressful Time Event?

The fashion industry is one of the biggest polluting industries globally. It negatively affects the environment throughout all stages of the product life cycle because it requires large amounts of water for production, long supply chains and utilizes unsustainable materials. At the demand side, consumers’ awareness regarding sustainability has grown and they increasingly question the consumption of fast fashion. This study aimed at investigating whether and how stressful events, such as the current health crisis, influence sustainable fashion consumption intention. In particular, it analyzed the impact of pro-environmental attitudes and susceptibility to social influence on consumers’ intentions to engage in sustainable fashion consumption. To account for the impact of the recent stressful event, i.e., the COVID-19 pandemic, and following attachment theory, it was tested whether and how the perceived stress due to crisis determines consumers’ pro-environmental attitudes and susceptibility to social influence. A quantitative survey, with 576 young respondents, during the COVID-19 pandemic in January 2021, was used to test the hypotheses. The findings showed that perceived stress due to crisis impacts their susceptibility to peer’s influence, providing evidence for attachment theory. In addition, one stress factor, i.e., perceived self-efficacy with regard to COVID-19, increased pro-environmental attitudes and, in turn, sustainable fashion consumption intention. From a managerial perspective, the research helps to understand how individuals’ consumption behaviors may change during a crisis and how to serve best their needs.

Trauma and psychosis: The mediating role of premorbid adjustment and recent stressful events in a 3-year longitudinal study

BackgroundSome of the most-studied environmental factors that can contribute to the development of psychosis are the adversities experienced at an early age. Among these, childhood interpersonal trauma (CIT) has been considered especially influential in the onset of the disease. The aim of the study was to explore the relationship between CIT and the first episode of psychosis (FEP), as well as the relationship between CIT and clinical and functional outcomes 3 years after illness onset. MethodsA total of 278 patients with a FEP and 52 healthy controls were studied. Logistic regression analysis was carried out to examine the explained variation by CIT at the beginning of psychosis. Recent stressful events and premorbid adjustment related to CIT, were introduced in path analyses to determine their mediating effects between CIT and the disease and its clinical and functional results. ResultsMediation analyses showed that CIT was indirectly associated with belonging to the FEP group through recent stressful events (Effect = 0.981; SE = 0.323; CI = 0.485 to 1.761). Premorbid academic adjustment in late adolescence mediated the relationship between CIT and clinical and functional outcomes, specifically in the measurements of the Scales for Assessment of Positive and Negative Symptoms, in the Brief Psychiatric Rating Scale, and in the Disability Assessment Scale. ConclusionsThese findings suggest that early traumatic experiences play an important role in the FEP. Early intervention that promotes good academic adjustment during adolescence and/or avoids retraumatisation could positively impact both the onset and the course of psychotic illness.

Factors associated with depressive symptomatology during the COVID-19 pandemic in Mexico: A 2021 national survey

BackgroundPrevious studies have identified a set of variables associated with depression during the COVID-19 pandemic. However, the existing antecedents in Mexico, in addition to being limited to the beginning of the health emergency, made use of small and unrepresentative samples. Therefore, the aim of the present study was to identify the prevalence and factors associated with clinically significant depressive symptomatology (CSDS) in a representative Mexican sample of 2021. MethodsA secondary cross-sectional analysis of the Encuesta Nacional de Bienestar Autorreportado (ENBIARE) was conducted. For the present study, the effective sample was 30,901. Univariate and bivariate anaylses were followed by a multiple Poisson regression, which served to obtain adjusted prevalence ratios of each variable under study. ResultsThe prevalence of CSDS in the year 2021 was 15.3 %. In the multivariable analysis, the factors associated with CSDS were the number of recent stressful events, having a major functional limitation, not having social support from family or friends, being female, having suffered recent discrimination, alcohol or other drug use (by oneself or someone at home), not being married or cohabiting, living in a rural area, having had a diagnosis of COVID-19, having lost a job, living with a chronic patient, not doing physical exercise, and having a low educational level. LimitationsThe main limitations were the cross-sectional nature of the data, the use of self-report measures, as well as the fact that this was a secondary analysis that did not allow consideration of additional variables. ConclusionsA set of personal and contextual variables were identified that can help focus prevention and intervention efforts on the phenomenon of depression.

New-onset lichen planus and lichen planus flare in elderly women after COVID-19 vaccination.

Dear Editor, Owing to the widespread use of COVID-19 vaccines, the number of cutaneous vaccine-related adverse events has recently increased.1 We present two cases of lichen planus in elderly women following COVID-19 mRNA vaccination. The first patient presented with new-onset LP, whereas the second patient experienced an extensive LP flare after a 10-year remission. The first patient was an 82-year-old woman who developed an extensive pruritic rash 14 days after receiving a second dose of the Pfizer-BioNTech COVID-19 vaccine. Other possible triggers such as recent infections, medication changes, or stressful events preceding the eruption were ruled out. The patient had no significant medical history, other than well-controlled arterial hypertension. On physical examination, she had polygonal, purpuric, scaly papules in the axillary region, flexural wrists and forearms, ankles, buttocks, lower back, and abdomen (Figure 1). Mucosal lesions were not observed. Dermoscopy revealed mild desquamation and Wickham's striae. Skin biopsy demonstrated irregular epidermal hyperplasia with hypergranulosis and hyperkeratosis, vacuolar degeneration of the basal layer, and dense lymphocytic infiltrate in the superficial dermis (Figure 1). Considering the clinical presentation, histopathological analysis, and absence of an alternative trigger, we diagnosed LP triggered by the mRNA COVID-19 vaccine. Thus, we began treatment with prednisolone 20 mg daily, tapering the dose over 6 weeks, which resulted in gradual improvement of skin lesions. The second patient was a 68-year-old woman with a 2-week history of an intensely pruritic eruption that occurred 14 days after receiving a second dose of the Moderna COVID-19 (mRNA-1273) vaccine. Her medical history included arterial hypertension, hyperlipidemia, obesity, HLA-B27 spondyloarthritis, and LP, which was histologically confirmed 10 years ago and successfully treated with systemic and topical corticosteroids. During the examination, erythematous to violaceous squamous papules were discovered on the trunk, buttocks, and extremities, as well as around the ankles, flexural wrists, forearms, and axillary folds, with palmar involvement as well (Figure 2). Mucosal or nail lesions were absent. Dermoscopy revealed slight scaling and Wickham's striae, and a skin biopsy confirmed lichen planus. Therefore, we introduced 30 mg prednisolone, and tapered the dose to discontinuation over 6 weeks, which lead to the resolution of skin lesions. LP is a chronic inflammatory T-cell-mediated skin disease caused by various infections, drugs, and, in rare cases, vaccines.1-6 The most common vaccines causing LP are hepatitis B and influenza vaccines. Recently, the new-onset or reactivation of LP has been associated with COVID-19 infection and vaccination. Although most reported cases of LP following COVID vaccination were localized, we observed two cases of widespread LP.2-5 The majority of vaccine-related reactions occur in middle-aged women, implying an increased risk of such reactions in women, even in elderly ones, as observed in our cases.1, 6 Both our patients developed LP 14 days after receiving the second dose of mRNA COVID-19 vaccine, which is consistent with vaccine-related LP time onset.6 The immunopathogenesis of vaccine-induced LP likely involves Th1 cell activation with upregulation of proinflammatory cytokines IL-2, TNF-alpha, and IFN-y, which leads to apoptosis of basal keratinocytes, a hallmark of LP. However, the precise mechanism underlying LP (re)activation following vaccination remains unknown. Similarly, immune dysregulation after COVID-19 vaccination may result in the (re)activation of other immune-mediated skin diseases such as psoriasis, vitiligo, acne vulgaris, pemphigus vulgaris, and certain connective tissue diseases.2, 5 Likewise, COVID-19 pandemic has underlined the importance of dermatologists and rheumatologists in providing guidance regarding immunosuppressive and biological therapy considering their extensive experience with such treatments, as well as recognizing the immune-mediated aspects of COVID-19 infection and vaccination.7 Furthermore, as a result of a better understanding of COVID-19 disease mechanisms, novel therapeutic strategies utilizing adipose-derived mesenchymal stem cells (AD-MSCs) are being developed, and given their immuno-modulatory properties, could be employed to combat the disease.8 Finally, dermatologists should be aware of new-onset or flare-ups of LP in older women caused by COVID-19 vaccination as well as the possible (re)activation of other immune-mediated skin diseases. N.H. wrote the original manuscript. T.Z., S.P., and I.B. performed literature research and contributed to the analysis of the data. M.K. and L.P.M. performed supervision, and writing—review and editing. The authors declare no conflicts of interest. Authors declare human ethics approval was not needed for this study. The data that support the findings of this study are available from the corresponding author upon reasonable request. Written informed consent was obtained from the patients for the publication of this case report and accompanying images.