Risk Factors For Mental Disorders Research Articles

Evaluation of eight psychoactive drugs used in Chinese cities by wastewater-based epidemiology

With rapid economic development, an increasing number of people suffer from mental health diseases, which are gradually receiving the attention of society. However, basic data from surveys of mental disorders are limited. Composite influent samples were collected from 26 wastewater treatment plants in 23 major cities in China. The concentrations of the psychoactive drugs diphenhydramine, fluoxetine, doxepin, imipramine, sulpiride, zolpidem, carbamazepine, and flunitrazepam in the wastewater were determined. The detection frequency of diphenhydramine, sulpiride, and carbamazepine was close to 100 %, whereas that of the compounds was lower than 35 %. Carbamazepine had the highest mean consumption (31.1 mg/d/1000 people), followed by diphenhydramine (10.4 mg/d/1000 people) and sulpiride (11.3 mg/d/1000 people). Wastewater-based epidemiology (WBE) estimates of the average use of the three drugs were lower than those from the drug statistics data. Consumption of diphenhydramine in northern China was higher than that in southern China. A correlation analysis of psychotropic and illicit drugs revealed a correlation between sulpiride and heroin use, which may be related to the adverse effects of sulpiride treatment after heroin withdrawal. Psychotropic drug use is associated with both economic and social factors. We found associations between the use of the three drugs and age, occupation, and obesity, which are risk factors for mental disorders. The results showed that the monitoring of psychotropic drug using WBE has a certain reference value for public health care and for improving the understanding of mental disorders.

Psychotherapy and Follow-Up in Health Care Workers After the COVID-19 Epidemic: A Single Center's Experience.

ObjectiveThe present study aims to analysis the mental health of high-risk health care workers (HHCWs) and low-risk HCWs (LHCWs) who were respectively exposed to COVID-19 wards and non-COVID-19 wards by following up on mental disorders in HCWs in China for 6 months.MethodsA multi-psychological assessment questionnaire was used to follow up on the psychological status of HCWs in the Affiliated Hospital of Xuzhou Medical University in Xuzhou City (a non-core epidemic area) at 6 months after the first evaluation conducted during the COVID-19 epidemic. Based on the risk of exposure to COVID-19 patients, the HCWs were divided into two groups: high-risk HCWs, who worked in COVID-19 wards, and low-risk HCWs, who worked in non-COVID-19 wards.ResultsA total of 198 HCWs participated in the study, and 168 questionnaires were selected for evaluation. Among them, 93 (55.4%) were in the HHCW group and 75 (44.5%) were in the LHCW group. Significant differences were observed in salary, profession, and altruistic behavior between the two groups (P < 0.05). There were no significant differences in the anxiety, depression, insomnia, or posttraumatic stress disorder (PTSD) scores between the two groups. Logistic regression revealed that work stress was a major joint risk factor for mental disorders in HCWs. Among all the HCWs, a total of 58 voluntarily participated in psychotherapy; the analysis showed a significant decrease in anxiety, depression, PTSD, work stress, and work risk after attending psychotherapy. There were also significant differences in positive and negative coping styles before and after psychotherapy.ConclusionIn the present follow-up, work stress was the major contributing factor to mental disorders in HCWs. Psychotherapy is helpful in terms of stress management and should be provided to first-line COVID-19 HCWs.

Gender disparities in a psychiatric department in Tunisia

IntroductionGender disparities exist regarding prevalence, symptomatology and risk factors of mental disorders. In Tunisia, there is only one hospital dedicated entirely to mental health which is Razi hospital.ObjectivesThe aim of the present study was to assess gender based mental health disparities in a psychiatric department and its related factors.MethodsA cross sectional and comparative survey was conducted between March and April 2021 in the department of psychiatry D of Razi Hospital including 70 patients with a sex ratio= 1.ResultsThe participants were aged between 17 and 68. Men had higher rate of celibacy: 80% of men against 48.57% of women (p=0.009). A total of 11.42% of women were illiterate against 2.85% of men, 48% of men were unemployed against 62.85% of women. There was a significant difference between gender and use of cigarettes, cannabis and alcohol (p&lt;0.001). The diagnosis was mood disorders for 35.42% of women and 17.14% of men and schizophrenia for 57.14% of women and 77.14% of men. Gender and modality of hospitalization were significantly associated (p=0.046): 14% of women were involuntary hospitalized against 40% of men. Time between symptoms onset and consulting is 3.5 years (±5.67) for women and 1.77 (±4.75) for men. The mean number of admissions for women is 1.59 and for men 4.2 (p=0.009).ConclusionsOnset of mental disorders for women is 3 to 4 years later than men. They have better premorbid functionning and better social networks.Gender disparities are not only determined biologically but also socially.DisclosureNo significant relationships.

The Link between Subjective Religiosity, Social Support, and Mental Health among Young Students in Eastern Europe during the COVID-19 Pandemic: A Cross-Sectional Study of Poland and Ukraine.

Religiousness has a positive effect on the mental health of an individual and social groups in many difficult situations. In the conducted research, we wanted to check, inter alia, whether religiosity and social support are positively related to the mental health of students during the COVID-19 pandemic in Poland and Ukraine. The research was conducted at a time (August 2021) when the very contagious Delta variant was spreading over Europe, and numerous pandemic-related personal restrictions and obligations (such as using facemasks in selected places, social distancing, and obligatory self-isolation of the ill or those who had contact with the pathogen) were in force in both countries. For this purpose, a representative survey was carried out using the CAPI technique on a sample of 1000 students in Poland (50% boys and 50% girls in the age range 10–19) and 1022 in Ukraine (51% boys and 49% girls in the age range 10–18). The results of the research shows that depression measured by the PHQ-9 scale was experienced by 20% of students in Poland, and 13% in Ukrainian. Anxiety, measured with the GAD-7 scale, was experienced by 9% of the Polish and 6% of the Ukrainian students. The performed regression analysis showed that religiosity had no effect on the mental health of students. The main risk factor for mental disorders was the lack of social support.

Prenatal methotrexate injection increases behaviors possibly associated with depression and/or autism in rat offspring; A new animal model for mental disorder, based on folate metabolism deficit during pregnancy.

BackgroundDeficiency of folate, an essential vitamin for DNA synthesis and methylation, is reported as a risk factor for mental disorders. Considering a possibility that folate metabolism deficit during pregnancy may disturb CNS development and increase mental disorders in offspring, we treated pregnant rats with methotrexate (MTX), an inhibitor of folate metabolic enzyme, and evaluated offspring behaviors.MethodsSaline or MTX was intraperitoneally administered to female SD rats on gestational day 17. Offspring behaviors were evaluated during approximately 6–9 weeks old; prepulse inhibition (PPI), social interaction (SI), locomotor activity (LA), and forced swimming test (FST) for evaluation of schizophrenia, depression, and autism related behaviors; the elevated plus maze (EPM) and the light–dark box (LD) test for evaluation of anxiety.ResultsCompared to saline‐treated group, MTX‐treated group showed decrease of SI and increase of immobility time in FST. In addition, increases of time spent in the light box and shuttling between the light–dark boxes were observed in LD test. On the other hand, no changes were confirmed in EPM, LA, and PPI.ConclusionDecrease of SI and increase of immobility time in FST may suggest association of this animal model with depression and/or autism. Increase of time spent in the light box and shuttling between the light–dark boxes may indicate changes in anxiety or cognitive level to environment, or repetitive behaviors in autism. Although further studies are warranted to characterize this animal model, at least we can say that prenatal MTX exposure, possibly causing folate metabolism deficit, affects offspring behaviors.

Global population attributable fraction of potentially modifiable risk factors for mental disorders: a meta-umbrella systematic review

Numerous risk factors for mental disorders have been identified. However, we do not know how many disorders we could prevent and to what extent by modifying these risk factors. This study quantifies the Population Attributable Fraction (PAF) of potentially modifiable risk factors for mental disorders. We conducted a PRISMA 2020-compliant (Protocol: https://osf.io/hk2ag) meta-umbrella systematic review (Web of Science/PubMed/Cochrane Central Register of Reviews/Ovid/PsycINFO, until 05/12/2021) of umbrella reviews reporting associations between potentially modifiable risk factors and ICD/DSM mental disorders, restricted to highly convincing (class I) and convincing (class II) evidence from prospective cohorts. The primary outcome was the global meta-analytical PAF, complemented by sensitivity analyses across different settings, the meta-analytical Generalised Impact Fraction (GIF), and study quality assessment (AMSTAR). Seven umbrella reviews (including 295 meta-analyses and 547 associations) identified 28 class I–II risk associations (23 risk factors; AMSTAR: 45.0% high-, 35.0% medium-, 20.0% low quality). The largest global PAFs not confounded by indication were 37.84% (95% CI = 26.77–48.40%) for childhood adversities and schizophrenia spectrum disorders, 24.76% (95% CI = 13.98–36.49%) for tobacco smoking and opioid use disorders, 17.88% (95% CI = not available) for job strain and depression, 14.60% (95% CI = 9.46–20.52%) for insufficient physical activity and Alzheimer’s disease, 13.40% (95% CI = 7.75–20.15%) for childhood sexual abuse and depressive disorders, 12.37% (95% CI = 5.37–25.34%) for clinical high-risk state for psychosis and any non-organic psychotic disorders, 10.00% (95% CI = 5.62–15.95%) for three metabolic factors and depression, 9.73% (95% CI = 4.50–17.30%) for cannabis use and schizophrenia spectrum disorders, and 9.30% (95% CI = 7.36–11.38%) for maternal pre-pregnancy obesity and ADHD. The GIFs confirmed the preventive capacity for these factors. Addressing several potentially modifiable risk factors, particularly childhood adversities, can reduce the global population-level incidence of mental disorders.

Specific Types of Screen-Based Sedentary Time and Depressive Symptoms in Adolescents

Purpose: Screen-based sedentary behavior (SSB) has been identified as risk factor for mental disorders in most of adolescents. However, there is little literature pertaining to the specific kinds of SSB and its connections with depressive symptoms in most of adolescents. In the present study, we are going to find out the connections between specific types of SSB and depressive symptoms in Chinese adolescents. Methods: A cross-sectional data based on 996 study participants of middle school students in Guangdong Province. SSB was evaluated by distributing the questionnaire of Health Behavior in School-aged Children, while depressive symptoms were evaluated using Chinese version of Children’s Depressive symptoms Inventory (CDI). SSB was categorized into TV/movie time, video games time and other electronic devices-based time (e.g., mobile phone, computer use). Generalized linear models was used to explore the connections between specific kinds of SSB and depressive symptoms. Results: After controlling for variables of sex, ethnicity, grade, residence, siblings, perceived family affluence, father educational level, mother educational background, body mass index (BMI), physical exercise, duration of sleep, other electronic devices-based time was positively correlated with depressive symptoms in Chinese adolescents (B = 0.557%, 95%CI: 0.187–0.926, p = 0.003). This significant connection was also found in girls (B = 0.728%, 95%CI: 0.230–1.225, p = 0.004) instead of boys (p > 0.05). The other types of SSB were not significantly in relation to depressive symptoms in adolescents regardless of sex. Conclusion: This study suggested that it might be effective in reducing or preventing depressive symptoms through limiting electronic devices-based time, like computer use or mobile phone use time. This strategy would be particularly useful in girls. Future studies should negate or replicate the research results by introducing more improved study design, which is beneficial to better understand the connections between SSB and depressive symptoms as well as then design more efficient interventions in adolescents.

Repetitive negative thinking: transdiagnostic correlate and risk factor for mental disorders? A proof-of-concept study in German soldiers before and after deployment to Afghanistan

Background and objectivesDisorder-specific forms of Repetitive Negative Thinking (RNT) are associated with multiple diagnostic categories, indicating a transdiagnostic nature. Few studies examined content-independent RNT processes across groups of diagnosed mental disorders. Moreover, theory describes RNT processes as critically involved in the etiology of mental disorders, empirical evidence however is scarce. We first tested the transdiagnostic nature by examining levels of RNT across groups of internalizing and externalizing mental disorders compared to healthy individuals and explored RNT levels in a comorbid disorder-group. Second, we examined whether RNT predicts incident psychopathology.MethodsIn a sample of German soldiers (n = 425) scheduled for deployment in Afghanistan, we compared RNT levels between diagnosed groups with alcohol use disorders, anxiety disorders and healthy individuals cross-sectionally. Exploratory analyses were conducted comparing a comorbid disorder-group to healthy individuals and to both single-disorder-groups. Longitudinally, we examined the predictive value of pre-deployment RNT levels for incident psychopathology after deployment (n = 167). RNT was measured using the Perseverative Thinking Questionnaire (PTQ), DSM-IV diagnoses were assessed using the standardized Composite International Diagnostic Interview (CIDI).ResultsCross-sectional comparisons revealed that soldiers with alcohol use disorders and anxiety disorders showed significantly higher degrees of RNT compared to healthy soldiers. RNT levels in those with comorbid disorders were significantly higher compared to healthy soldiers but also compared to both single-disorder-groups. Longitudinal analyses revealed that higher levels of RNT prior to deployment were associated with a higher risk to have any incidental mental disorder after deployment. This however is only attributable to individuals with a PTQ score above a cut-off of 15.ConclusionsFindings provide evidence for RNT as a transdiagnostic correlate and a vulnerability factor for the development of mental disorders.

Psychological well being of social media users: A structural equation modeling analysis

Social media has positive and negative impacts on human life. Even though negative impacts have been identified, positive impacts are rarely studied in the literature. The identification of positive impacts will be useful for preventing health issues among social media users. Therefore, the study is intended to investigate the psychological well-being status of the social media population. The study used a cross-sectional design with a purposive sampling method. The analysis used structural equational modeling to answer the research question of the study. The results showed the psychological well-being of social media users is at normal levels with mild stress. The influencing factors influencing the finding are sex and education. Health promotion is fundamental to improving the outcomes and vice versa, decreasing the risk factors of mental disorders. Interventional studies are needed to prevent distress in the future.&#x0D; Keywords: social media; psychological well-being; mental health nurses; nursing assessment; community practice

The cost-effectiveness of a school-based intervention for bullying prevention: An Australian case study

BackgroundBullying has been recognised as a leading risk factor for mental disorders. The current study aims to evaluate the population cost-effectiveness of the Friendly Schools program (FSP), a school-based intervention for bullying prevention in Australia. MethodA population-based Markov model which simulated how the population cohort moves between two health states (being bullied and not bullied) over 10 years was developed to estimate the cost per quality-adjusted life year gained and return on investment (ROI) ratio of the FSP intervention relative to no intervention and current practice. The target population comprised primary school students in grades 4 and 6. Transition probabilities were sourced from trial data which evaluated FSP. The cost analysis included intervention costs (from the societal perspective), cost savings associated with reduced health service use and school absence days. ResultsThe current study demonstrated that FSP was cost saving and produced an ROI ratio of 1.56 to 2.22 depending on the presence of bullying strategies currently in schools. The results were robust to changes made in the one-way sensitivity analysis and the probabilistic sensitivity analysis indicated that the intervention was 100% likely to be cost-effective. Successful implementation of the FSP program will involve additional support for school staff to accommodate the responsibilities of intervention delivery alongside their existing workload. ConclusionThis study found that the FSP intervention was cost saving and had a positive ROI. These findings strongly support primary schools to consider implementing FSP. Further evidence would strengthen the economic case for implementation.

1.D. Workshop: Emerging behavioral risk factors for mental health: a life-course perspective

Abstract Over the last decades, mental health disorders, including affective and cognitive disorders, have been recognized among the leading non-communicable diseases and have represented the major contributors to lower quality of life and shortened lifespan, in both young and adult population. Noteworthy, these conditions are often associated, if not prodromic, to other non-communicable diseases, such as obesity, cardiovascular disease and cancer. Together with the aforementioned disorders, sleep disorders have been of interest as emerging conditions, mainly due to their possible link to other morbidities. Given the limited access to effective treatments and their rather lengthy and expensive nature, early detection of mental disorders, identification of potential risk factors, and intervention to prevent chronic exposure to these factors is of paramount importance to control the rising globally prevalence. A growing body of literature has focused attention on potential risk factors for mental disorders, comprising environmental, behavioral, and dietary factors. Modern society is facing rapid changes caused by a rise in technological advances, global industrialization and urbanization, leading to the disruption of the circadian cycle due to continuous exposure to stimuli, such as light and acoustic pollution, busy working schedule, and societal challenges. Owing to the lack of adaptions to these transitions, it has led to the rise of non-communicable chronic diseases due to important changes in lifestyle factors, including, among others, adoption of unhealthy dietary patterns, lack of physical activity and worsened sleeping habits. The modern era is characterized by a “nutrition transition” process, a global shift from traditional dietary patterns toward so-called Western-like diets, defined by high intake of processed energy-dense foods containing refined sugars, trans-fatty acids, excessive sodium, and low consumption of plant-derived foods, accompanied by an unbalance between calorie intake and its expenditure through regular physical activity. There is a convincing evidence on the possible link between diet, physical activity and pathophysiology of mental health and sleep disorders that may contribute to the control of their prevalence. The prevention of mental disorders should be a leading task for public health policy makers, mainly as the prevalence of mental health disorders is rising globally, leading to lower life expectancy and generating great costs associated with health care. Given the interconnection between nutrition, physical activity, mental health, and chronic non-communicable diseases, the EUPHA Food and Nutrition Section and the Chronic Diseases Section aim to propose a joint workshop to bring together worldwide experts and to discuss the underrated role of dietary factors, physical activity, sleep features, and mental health in the modern society. Key messages There is growing evidence that modern lifestyle, including dietary and physical activity behaviors, may play an important role in mental health disorders. There is a need to address emerging behavioral risk factors in order to prevent public mental health disorders.

Sleep and its effect on mental health among adolescent and adult population

Abstract The global prevalence of mental disorders is on the rise and sleep disorders have been recognized among one of the major contributors affecting well-being and longevity of both young and adult population. Sleep habits are multifaceted and arise from complex interactions between socio-environmental, behavioral, and psychological factors, and any disruptions in the balance of the previous may negatively alter sleep duration and sleep quality leading to sleep disorders, however this phenomenon may vary by age and sex. Emerging evidence suggest that adolescents entering pubertal development face many sleep changes due to biological factors like delay in circadian rhythm and decreased homeostatic sleep pressure as well as due to social factors which may lead to sleep disorders subsequently affecting adolescents' mental health. Sleep hygiene among young population is of primary importance especially as chronic sleep disruption may be a risk factor for mental disorders and multimorbidity along the lifespan, and importantly these association have been proved to be bi-directional. Thus, public health initiatives and guidelines to promote sleep hygiene should emerge in order increase the awareness of sleep disorders and their role in prevention and management of mental disorders.

Prevalence, Structure, and Risk Factors for Mental Disorders in Older People

This review focuses on assessing the prevalence and risk factors of mental disorders in older people in the modern era, including the COVID-19 pandemic. A systematic review of the literature was conducted in PubMed, Elsevier, and Google using keywords over the past 10 years. Substantial discrepancy of data on the prevalence of psychiatric disorders has been shown in the elderly population. The significant incidence of mental disorders among nursing home residents is highlighted. The relevance of nonpsychotic depressive and anxiety disorders is demonstrated for the elderly, along with the difficulty of diagnosing mental disorders associated with physical pathology and cognitive impairments. The risk factors for mental disorders in older adults are socio-demographic but also economic, psychological, and physical. The problem of mental health of the elderly is characterized for the conditions of the COVID-19 pandemic associated with specific risk factors for psychiatric disorders. The shortage of evidence-based research in the treatment of mental disorders in the elderly and the urgency to improve the organization of psychiatric care for such patients are noted. Understanding the structure and prevalence of mental disorders among the elderly will allow optimizing the functioning of healthcare systems.

Risk and protective factors for mental disorders beyond genetics: an evidence-based atlas.

Decades of research have revealed numerous risk factors for mental disorders beyond genetics, but their consistency and magnitude remainuncer-tain. We conducted a "meta-umbrella" systematic synthesis of umbrella reviews, which are systematic reviews of meta-analyses of individual studies, by searching international databases from inception to January 1, 2021. We included umbrella reviews on non-purely genetic risk or protective factors for any ICD/DSM mental disorders, applying an established classification of the credibility of the evidence: class I (convincing), class II (highly suggestive), class III (suggestive), class IV (weak). Sensitivity analyses were conducted on prospective studies to test for temporality (reverse causation), TRANSD criteria were applied to test transdiagnosticity of factors, and A Measurement Tool to Assess Systematic Reviews (AMSTAR) was employed to address the quality of meta-analyses. Fourteen eligible umbrella reviews were retrieved, summarizing 390 meta-analyses and 1,180 associations between putative risk or protective factors and mental disorders. We included 176 class I to III evidence associations, relating to 142 risk/protective factors. The most robust risk factors (class I or II, from prospective designs) were 21. For dementia, they included type 2 diabetes mellitus (risk ratio, RR from 1.54 to 2.28), depression (RR from 1.65 to 1.99) and low frequency of social contacts (RR=1.57). For opioid use disorders, the most robust risk factor was tobacco smoking (odds ratio, OR=3.07). For non-organic psychotic disorders, the most robust risk factors were clinical high risk state for psychosis (OR=9.32), cannabis use (OR=3.90), and childhood adversities (OR=2.80). For depressive disorders, they were widowhood (RR=5.59), sexual dysfunction (OR=2.71), three (OR=1.99) or four-five (OR=2.06) metabolic factors, childhood physical (OR=1.98) and sexual (OR=2.42) abuse, job strain (OR=1.77), obesity (OR=1.35), and sleep disturbances (RR=1.92). For autism spectrum disorder, the most robust risk factor was maternal overweight pre/during pregnancy (RR=1.28). For attention-deficit/hyperactivity disorder (ADHD), they were maternal pre-pregnancy obesity (OR=1.63), maternal smoking during pregnancy (OR=1.60), and maternal overweight pre/during pregnancy (OR=1.28). Only one robust protective factor was detected: high physical activity (hazard ratio, HR=0.62) for Alzheimer's disease. In all, 32.9% of the associations were of high quality, 48.9% of medium quality, and 18.2% of low quality. Transdiagnostic class I-III risk/protective factors were mostly involved in the early neurodevelopmental period. The evidence-based atlas of key risk and protective factors identified in this study represents a benchmark for advancing clinical characterization and research, and for expanding early intervention and preventive strategies for mental disorders.

Low-quality employment trajectories and risk of common mental disorders, substance use disorders and suicide attempt: a longitudinal study of the Swedish workforce.

ObjectiveHigh-quality longitudinal evidence exploring the mental health risk associated with low-quality employment trajectories is scarce. We therefore aimed to investigate the risk of being diagnosed with common mental disorders, substance use disorders, or suicide attempt according to low-quality employment trajectories.MethodsA longitudinal register-study based on the working population of Sweden (N=2 743 764). Employment trajectories (2005–2009) characterized by employment quality and pattern (constancy, fluctuation, mobility) were created. Hazard ratios (HR) were estimated using Cox proportional hazards regression models for first incidence (2010–2017) diagnosis of common mental disorders, substance use disorders and suicide attempt as dependent on employment trajectories.ResultsWe identified 21 employment trajectories, 10 of which were low quality (21%). With the exception of constant solo self-employment, there was an increased risk of common mental disorders (HR 1.07–1.62) and substance use disorders (HR 1.05–2.19) for all low-quality trajectories. Constant solo self-employment increased the risk for substance use disorders among women, while it reduced the risk of both disorders for men. Half of the low-quality trajectories were associated with a risk increase of suicide attempt (HR 1.08–1.76).ConclusionsLow-quality employment trajectories represent risk factors for mental disorders and suicide attempt in Sweden, and there might be differential effects according to sex – especially in terms of self-employment. Policies ensuring and maintaining high-quality employment characteristics over time are imperative. Similar prospective studies are needed, also in other contexts, which cover the effects of the Covid-19 pandemic as well as the mechanisms linking employment trajectories with mental health.

Incidence and risk factors of mental disorders in the elderly: The European MentDis_ICF65+ study.

While incidence rates of depression and anxiety disorders in the elderly have been comprehensively investigated, the incidence rates of other mental disorders have rarely been researched. The incidence rate and predictors of various mental disorders in the elderly were evaluated in different European and associated countries. A cross-sectional and longitudinal multi-centre survey of Diagnostic and Statistical Manual of Mental Disorders (4th ed.) diagnoses was conducted in different European and associated countries (Germany, Italy, Spain, Switzerland, the United Kingdom and Israel) to collect data on the prevalence and incidence of mental disorders in the elderly. The sample size of the longitudinal wave was N = 2592 elderly. The overall 1-year incidence rate for any mental disorder in the elderly is 8.65%. At 5.18%, any anxiety disorder had the highest incidence rate across all diagnostic groups. The incidence rate for any affective disorder was 2.97%. The lowest incidence rates were found for agoraphobia (1.37%) and panic disorder (1.30%). Risk factors for the development of any mental disorder were never having been married, no religious affiliation, a higher number of physical illnesses and a lower quality of life. In comparison to other studies, lower incidence rates for any affective disorder and middle-range incidence for any anxiety disorder were found. To the authors' knowledge, no prior studies have reported 1-year incidence rates for somatoform disorder, bipolar disorder and substance misuse in community-dwelling elderly. These findings indicate the need to raise awareness of psychosocial problems in the elderly and to ensure adequate availability of mental health services.

Could the Associations of Changes in Living Arrangement with Mental Disorders Be Moderated or Mediated During COVID-19 Pandemic?

PurposeChanges in living arrangement was one of the most well-established risk factors for mental disorders, but little evidence came from moderating or mediating effect during COVID-19 pandemic. This study aimed to determine whether associations of changes in living arrangement with mental disorders could be moderated or mediated during COVID-19 pandemic.MethodsData were a cross-sectional and international population-based survey data collected as part of theCOVID-19 pandemic. Participants included nationally representative general population probability samples of adults (≥18 years) during COVID-19 pandemic (N=16,784). Main mental measures were reflected by loneliness assessed by UCLA Loneliness Scale Version 3, anxiety assessed by Generalised Anxiety Disorder 2-item, and depressed mood assessed by The Patient Health Questionnaire-2 in the survey. With control variables, all the mediation models were conducted by Stata mode. Potential influencing effects of social contact and social support as moderators were analyzed using Hayes’s PROCESS macro.ResultsAmong the participants, prevalence of mental disorders was high. Logistic regression indicated that changes in living arrangement had significant associations with anxiety (AOR=1.127, 95% CI: 1.018–1.249) and depression (AOR =1.142, 95% CI: 1.027–1.269). Mediation models indicated that indirect, direct, and total effects of changes in living arrangement on mental disorders through COVID-symptoms; change in alcohol use; and social contact were significant. Indirect, direct, and total effects of changes in living arrangement on loneliness and depression through social support were significant. Moderation analysis indicated that moderation model 1 in AF Hayes Process procedure was accepted.ConclusionThis study indicated that associations of changes in living arrangement with mental disorders could be mediated by COVID-symptoms, changes in alcohol use, social contact, and social support and moderated by social support during COVID-19 pandemic. The finding in this study might provide better understanding of the mechanisms by which social support might contribute to the resolving mental disorders.

Integrating Mental Health Services into the Primary Health Care System: The Need for Reform in Iran.

Objective: The main objective of this study was to review aspects of the current situation and structure of the integrated mental health care services for planning a reform. Aspects of the newly designed infrastructure, along with specification of duties of the various human resources, and its relation with Iran’s Comprehensive Mental and Social Health Services (the SERAJ Program), will also be presentedMethod: This is a study on service design and three methods of literature review, deep interview with stakeholders, and focused group discussions. In the literature review, national and international official documents, including official reports of the World Health Organization (WHO) and consultant field visits, were reviewed. Deep semi-structured interviews with 9 stakeholders were performed and results were gathered and categorized into 3 main questions were analyzed using the responsibility and effectiveness matrix method. The Final results were discussed with experts, during which the main five-domain questions were asked and the experts’ opinions were observed.Results: In this study, the main gaps of the public mental health care (PHC) services in Iran were identified, which included reduction of risk factors for mental disorders, training the general population, early recognition and treatment of patients with mental disorders, educating patients and their families, and rehabilitation services. The new model was then proposed to fill these gaps focusing on increasing access, continuity of care, coordination in service delivery, and comprehensiveness of care. A mental health worker was placed besides general healthcare workers and general practitioners (GPs). Services were prioritized and the master flowchart for mental health service delivery was designed.Conclusion: A reform was indeed necessary in the integrated mental health services in Iran, but regarding the infrastructure needed for this reform, including human and financial resources, support of the senior authorities of the Ministry of Health (MOH) is necessary for the continuity and enhancement of services. In this model, attention has been given to the principles of integrating mental health services into primary health care. Current experience shows that the primary health care system has been facing many executive challenges, and mental health services are not exclusion to this issue. Monitoring and evaluation of this model of service and efforts for maintaining sustainable financial resources is recommended to make a reform in this system and to stabilize it.

Loneliness and emotion regulation

Loneliness is a risk factor for mental disorders and is a significant and growing public health issue, but to date, loneliness interventions have had limited success. We propose that an emotion regulation perspective might be useful for understanding loneliness and for suggesting new treatment targets. In this study, our aim was to test the basis for this proposal by examining whether individual differences in emotion regulation strategy use can explain significant variance in loneliness, and to establish what profile of strategy use might characterize loneliness. We administered a comprehensive battery of loneliness and emotion regulation questionnaires to 501 adults. In a regression model, emotion regulation strategy use accounted for over half (52.2%) the variance in loneliness. A latent profile analysis revealed four profiles, with the “high loneliness” profile characterized cognitively by greater use of rumination, catastrophising, blame-attribution, and lesser use of cognitive reappraisal type strategies. Behaviorally, loneliness was characterised by greater use of expressive suppression, and regulating emotions by actively rejecting or withdrawing from others. We conclude that individual differences in emotion regulation may play an important role in explaining loneliness, and could therefore represent a promising treatment target.

Efficacy of a Web-Enabled, School-Based, Preventative Intervention to Reduce Bullying and Improve Mental Health in Children and Adolescents: Study Protocol for a Cluster Randomized Controlled Trial.

Introduction: Bullying is a major preventable risk factor for mental disorders. Available evidence suggests school-based interventions reduce bullying prevalence rates. This study aims to test the efficacy of a web-enabled, school-based, multicomponent anti-bullying intervention to prevent school bullying and to assess its effects on mental health and quality of life.Methods and analysis: Cluster randomized controlled trial conducted in 20 publicly funded primary and secondary schools in Madrid, Spain. Schools are randomly allocated to either the intervention arm (n = 10) or conventional practices arm (n = 10). The web-enabled intervention (LINKlusive) lasts ~12 weeks and consists of three main components: (i) an online training program for teachers and parents, (ii) a web-guided educational program for students, focusing on promoting respect for diversity, empathy, and social skill development, and (iii) a web-guided, teacher-delivered, targeted intervention program for bullying situations identified based on peer-support strategies and individual intervention for those involved (i.e., bullying victims and perpetrators). The primary objective is to compare differences between peer-reported bullying victimization in the intervention and control arms at the end of the intervention. Secondary outcome measures are additional measures of bullying victimization and perpetration, mental health symptoms, self-esteem, and quality of life. A follow-up assessment is conducted 1 year after the end of the intervention. Treatment effects will be tested using multilevel mixed models, adjusting for school-, classroom-, and student-related covariates. Considering the increased bullying rates in children with special educational needs, a specific subgroup analysis will test the efficacy of the intervention on bullying prevalence, mental health, and quality of life in this particularly vulnerable population.Ethics and Dissemination: The Deontology Commission of the School of Psychology, Universidad Complutense in Madrid, Spain reviewed the study protocol and granted ethical approval on 21st January 2019. The results of the trial will be disseminated in relevant peer-reviewed journals and at conferences in the field.Trial Registration Number: ISRCTN15719015.