Self-harm is a significant problem in university students because of its association with emotional distress, physical harm, broader mental health issues and potential suicidality. Research suggests that fewer than half of students who have self-harmed seek professional help when at university.
This study aimed to explore the help-seeking journeys of university students who had engaged in self-harm, to identify perceived facilitators and barriers to securing both formal and informal support.
Participants comprised 12 students who had self-harmed during their university tenure. Engaging in two semi-structured interviews over the academic year, they shared insights into their help-seeking behaviours and proposed enhancements to local services. Data underwent reflexive thematic analysis within a critical realist framework.
The analysis identified four themes: ‘The initial university phase poses the greatest challenge’, ‘Perceived criteria for “valid” mental health problems’, ‘Evading external judgements, concerns and consequences’ and ‘The pivotal role of treatment options and flexibility in recovery’.
Students felt isolated and misunderstood, which amplified self-harming tendencies and diminished inclinations for help-seeking. A prevalent belief was that for self-harm to be deemed ‘valid’, it must manifest with a certain severity; however, concurrent fears existed around the ramifications of perceived excessive severity. Participants expressed a desire for streamlined pathways to mental health resources, encompassing both university and external mental health services. Insights from this study could guide future research and inform current service paradigms within academic and healthcare systems.
Hearing loss and tinnitus have been proposed as potential indicators of impaired mental health and brain morphological changes.
To assess the associations of hearing loss and tinnitus with the risk of depression and anxiety and with brain volume.
We conducted a community-based cohort study including 129 610 participants aged 40−69 years at recruitment to the UK Biobank with a follow-up period during 2006–2021 to estimate the risk of depression and anxiety after detection of hearing loss and reported tinnitus. We also assessed the associations of hearing loss and tinnitus with brain volume in a subsample with available brain magnetic resonance imaging data (N = 5222).
We observed an increased risk of depression among individuals with hearing loss (hazard ratio [HR] 1.14, 95% CI 1.03–1.26), tinnitus (HR 1.30, 95% CI 1.21–1.41) or both (HR 1.32, 95% CI 1.15–1.52), compared with individuals with neither hearing loss nor tinnitus. Similar results were noted for anxiety (HR 1.18, 95% CI 1.07–1.30 for hearing loss; HR 1.32, 95% CI 1.22–1.43 for tinnitus; and HR 1.48, 95% CI 1.30–1.68 for both). Hearing loss was associated with decreased overall brain volume as well as decreased volume of different brain regions. The latter associations disappeared after adjustment for whole intracranial volume. Tinnitus was associated with greater left accumbens and right occipital pole volume after adjustment for the whole intracranial volume.
Individuals with tinnitus are at increased risk of depression and anxiety. Hearing loss, on the other hand, is associated with both mood disorders and altered brain morphology.
Acute behavioural disturbance (ABD) is a highly contentious topic, with debate about its validity as a construct. Particular concerns have been raised about how it places societal problems ‘in’ people – disproportionately from minority ethnic backgrounds – medicalising being a victim of violence. The author reflects on his experiences ‘with’ ABD.
]]>The frequent prescribing of psychotropics and high prevalence of polypharmacy among older adults with intellectual disabilities require close monitoring.
To describe change in prevalence, predictors and health outcomes of psychotropic use during the four waves (2009/2010, 2013/2014, 2016/2017, 2019/2020) of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA).
Eligible participants were adults (≥40 years) with intellectual disabilities who participated in all four waves of IDS-TILDA and who reported medication use for the entire period. Differences between groups were tested using Cochran's Q test for binary variables and the McNemar–Bowker test for variables with more than two categories. Generalised estimating equation models were used to assess associations between psychotropic use, participants’ characteristics and health outcomes.
Across waves (433 participants) there were no significant differences in prevalence of psychotropic use (61.2–64.2%) and psychotropic polypharmacy (42.7–38.3%). Antipsychotics were the most used subgroup, without significant change in prevalence between waves (47.6–44.6%). A significant decrease was observed for anxiolytics (26.8–17.6%; P < 0.001) and hypnotics/sedatives (14.1–9.0%; P < 0.05). A significant increase was recorded for antidepressants (28.6–35.8%; P < 0.001) and mood-stabilising agents (11.5–14.6%; P < 0.05). Psychotropic polypharmacy (≥2 psychotropics) was significantly associated with moderate to total dependence in performing activities of daily living over the 10-year period (OR = 1.80, 95% CI 1.21–2.69; P < 0.05).
The study indicates an increase in usage of some classes of psychotropic, a reduction in others and no change in the relatively high rate of antipsychotic use over 10 years in a cohort of older adults with intellectual disabilities and consequent risk of psychotropic polypharmacy and medication-related harm.
COVID-19 carriers experience psychological stresses and mental health issues such as varying degrees of stigma. The Social Impact Scale (SIS) can be used to measure the stigmatisation of COVID-19 carriers who experience such problems.
To evaluate the reliability and validity of the Chinese version of the SIS, and the association between stigma and depression among asymptomatic COVID-19 carriers in Shanghai, China.
A total of 1283 asymptomatic COVID-19 carriers from Shanghai Ruijin Jiahe Fangcang Shelter Hospital were recruited, with a mean age of 39.64 ± 11.14 years (59.6% male). Participants completed questionnaires, including baseline information and psychological measurements, the SIS and Self-Rating Depression Scale. The psychometrics of the SIS and its association with depression were examined through exploratory factor analysis, confirmatory factor analysis and receiver operating characteristic analysis.
The average participant SIS score was 42.66 ± 14.61 (range: 24–96) years. Analyses suggested the model had four factors: social rejection, financial insecurity, internalised shame and social isolation. The model fit statistics of the four-factor SIS were 0.913 for the comparative fit index, 0.902 for the Tucker–Lewis index and 0.088 for root-mean-square error of approximation. Standard estimated factor loadings ranged from 0.509 to 0.836. After controlling for demographic characteristics, the total score of the 23-item SIS predicted depression (odds ratio: 1.087, 95% CI 1.061–1.115; area under the curve: 0.84, 95% CI 0.788–0.892).
The Chinese version of the SIS showed good psychometric properties and can be used to assess the level of perceived stigma experienced by asymptomatic COVID-19 carriers.
Feelings of emptiness are commonly reported as deeply distressing experiences. Despite established relationships between emptiness and many mental health difficulties, alongside self-harm and suicide, further study into this phenomenon has been restricted by vague definition and clinical measures with limited utility. Recently the first definition validated by individuals with lived experience of emptiness has been conceptualised, providing an opportunity to create a new measure of emptiness.
This study aimed to psychometrically evaluate the 31-item Psychological Emptiness Scale (PES), identifying redundancy, and thus creating a psychometrically robust scale with optimised clinical utility.
Utilising an online survey design, 768 participants completed the 31 items of the initial PES alongside other measures of mental health. Exploratory factor analysis was conducted, and item response theory employed to identify item redundancy and reduce test burden. Expert clinicians provided ratings of each item's clinical relevance and, combined with the psychometric analysis, led to the removal of a number of items. Confirmatory factor analysis was then undertaken. Reliability including test–retest, validity and sensitivity of the measure were evaluated.
A two-factor structure encompassing ‘nothingness’ and ‘detachment’ was identified, and found to have acceptable fit. The resulting 19-item PES was found to have internal consistency (α = 0.95), convergent validity and test–retest reliability.
This study demonstrated strong psychometric properties of the PES. The PES has potential to support research into the role of emptiness in psychological distress and treatment in clinical practice.
The first cases of the COVID-19 pandemic in Australia were recorded in January 2020, which was during the ‘Black Summer’ bushfires of 2019–20 and prior to additional disasters in some regions. Few studies have considered the compound impact of disasters and the pandemic.
To improve understanding of the impact on mental health and well-being of the pandemic in disaster-affected communities.
We conducted semi-structured interviews (n = 18) with community members and online focus groups (n = 31) with help providers from three regions of rural Australia affected by bushfires and the pandemic.
Six themes were produced: (a) ‘Pulling together, pulling apart’, describing experiences after bushfires and prior to impacts of the pandemic; (b) ‘Disruption of the ‘normal response’, encompassing changes to post-disaster recovery processes attributed to the pandemic; (c) ‘Escalating tensions and division in the community’, describing impacts on relationships; (d) ‘Everywhere you turn you get a slap in the face’, acknowledging impacts of bureaucratic ‘red tape’; (e) ‘There are layers of trauma’, highlighting intersecting traumas and pre-existing vulnerabilities; and (f) ‘Where does the help come from when we can't do it?’, encompassing difficulties accessing services and impacts on the helping workforce.
This study furthers our understanding of compound disasters and situates pandemic impacts in relation to processes of adjustment and recovery from bushfires. It highlights the need for long-term approaches to resilience and recovery, investment in social infrastructure, multi-component approaches to workforce issues, and strategies to increase mental health support and pathways across services.
With growing numbers of countries legalizing euthanasia or assisted suicide (EAS), there is a debate as to whether EAS should also be available to people with severe, treatment-resistant mental illness. Excluding mental illness as a legitimate reason to receive EAS has been framed as discriminating against people with mental illness.
We examine whether approval or opposition to psychiatric EAS are related to stigma toward people with mental illness.
We asked a representative sample of the general population in Germany (N = 1515) whether they would approve of EAS for someone with severe, treatment-resistant mental illness. Stigma was assessed with the Value-Based Stigma Inventory (VASI), addressing rejection of people with mental illness in relation to different personal values.
A total of 19% of the German population approved of psychiatric EAS. Higher stigma scores were associated with greater approval of EAS (Spearman rank correlation coefficient, 0.28; P < 0.001). This association held true when controlling for sociodemographic variables. It was strongest for stigma related to perceived threats to one's security, reputation and meritocratic values.
Our results highlight that, although opposing psychiatric EAS is sometimes framed as discriminatory, approval of psychiatric EAS might also carry hidden, stigmatising motives. To avoid any unintended negative consequences for people with severe, treatment-resistant mental illness, any legislation on psychiatric EAS needs to be crafted with particular caution.
A significant rise in mental health disorders was expected during the COVID-19 pandemic. However, referrals to mental health services dropped for several months before rising to pre-pandemic levels.
To identify trajectories of incidence and risk factors for common mental disorders among the general population during 14 months of the COVID-19 pandemic, to inform potential mental health service needs.
A cohort of 33 703 adults in England in the University College London COVID-19 Social Study provided data from March 2020 to May 2021. Growth mixture modelling was used to identify trajectories based on the probability of participants reporting symptoms of depression (Patient Health Questionnaire-9) or anxiety (Generalised Anxiety Disorder-7) in the clinical range, for each month. Sociodemographic and personality-related characteristics associated with each trajectory class were explored.
Five trajectory classes were identified for depression and anxiety. Participants in the largest class (62%) were very unlikely to report clinically significant symptom levels. Other trajectories represented participants with a high likelihood of clinically significant symptoms throughout, early clinically significant symptoms that reduced over time, clinically significant symptoms that emerged as the pandemic unfolded and a moderate likelihood of clinically significant symptoms throughout. Females, younger adults, carers, those with existing mental health diagnoses, those that socialised frequently pre-pandemic and those with higher neuroticism scores were more likely to experience depression or anxiety.
Nearly 40% of participants followed trajectories indicating risk of clinically significant symptoms of depression or anxiety. The identified risk factors could inform public health interventions to target individuals at risk in future health emergencies.
The prevalence of non-suicidal self-injury (NSSI) among adolescents underscores the importance of understanding the complex factors that drive this behaviour. Framed within broader constructs of emotional regulation theories, alexithymia and peer victimisation are thought to interact to influence NSSI behaviours.
This research addresses whether alexithymia and peer victimisation serve as risk factors for NSSI and, if so, how these factors interact with each other.
This quantitative study analysed data from 605 adolescents, using a range of validated self-report measures including the Toronto Alexithymia Scale. Statistical analyses including one-way analysis of variance, multiple regression and structural equation modelling were employed to scrutinise the relationships among the variables.
Alexithymia and peer victimisation significantly predicted NSSI behaviours. Specifically, the ‘difficulty in identifying feelings’ subscale of alexithymia emerged as a noteworthy predictor of NSSI (P < 0.001). Peer victimisation mediated the relationship between alexithymia and NSSI, explaining approximately 24.50% of alexithymia's total effect on NSSI. In addition, age was a significant predictor of NSSI, but gender and education years were not (P > 0.05). These relationships were found to be invariant across genders.
This study enriches our understanding of the interplay between alexithymia, peer victimisation and NSSI, particularly within the Chinese context. Its findings have significant implications for a rethinking of alexithymia's theoretical construct and interventions targeting emotional literacy and peer dynamics among adolescents. Future research could benefit from a longitudinal design to establish causality.
Previous pandemics have had negative effects on mental health, but there are few data on children and adolescents who were receiving ongoing psychiatric treatment.
To study changes in emotions and clinical state, and their predictors, during the COVID-19 pandemic in France.
We administered (by interview) the baseline Youth Self-Report version of the CoRonavIruS Health Impact Survey v0.3 (CRISIS, French translation) to 123 adolescent patients and the Parent/Caregiver version to evaluate 99 child patients before and during the first ‘lockdown’. For 139 of these patients who received ongoing treatment in our centre, treating physicians retrospectively completed longitudinal global ratings for five time periods, masked to CRISIS ratings.
The main outcome measure was the sum of eight mood state items, which formed a single factor in each age group. Overall, this score improved for each age group during the first lockdown. Clinician ratings modestly supported this result in patients without intellectual disability or autism spectrum disorder. Improvement of mood states was significantly associated with perceived improvement in family relationships in both age groups.
Consistent with previous studies of clinical cohorts, our patients had diverse responses during the pandemic. Several factors may have contributed to the finding of improvement in some individuals during the first lockdown, including the degree of family support or conflict, stress reduction owing to isolation, limitations of the outcome measures and/or possible selection bias. Ongoing treatment may have had a protective effect. Clinically, during crises additional support may be needed by families who experience increased conflict or who care for children with intellectual disability.
Approximately 10–18% of the adult population experience some form of anxiety when viewing clusters of small holes. ‘Trypophobia’ has been the subject of much discussion within the peer-reviewed literature, news outlets, health-related websites and social media. However, there is some scepticism surrounding the phenomenon. It is often stated that the condition is not recognised by the American Psychiatric Association, and not listed as a phobia in the DSM-5. It has also been claimed that trypophobia is no more than a particularly successful internet meme. In this editorial, I argue that such criticisms are misplaced. There is, for instance, no list of phobias in the DSM-5; only criteria that determine phobia classification. Using these criteria, as well as personal testimonials, trypophobia is clearly a phobia. Furthermore, the meme hypothesis cannot account for the fact that the phenomenon existed long before the internet.
]]>This prospective study examines the immune response to SARS-CoV-2 vaccination in patients with psychotic disorders compared with healthy volunteers. Participants were recruited naturalistically as part of the UK's COVID-19 vaccination programme. Prior to receiving their first COVID-19 vaccine, blood samples were provided by participants to examine anti-SARS-CoV-2 immunoglobulins (IgG) at baseline, followed by a repeat assay 1 month after receiving their first vaccine to assess vaccine response. The increase of IgG levels from baseline to 1 month post-vaccination was significantly lower in patients compared with controls, supporting evidence of impaired vaccine response in people with psychotic disorders. When excluding patients treated with clozapine from the analysis, this difference was no longer significant, suggesting that effects may be particularly marked in people taking clozapine.
]]>Following the onset of the COVID-19 pandemic, healthcare trusts began to implement remote working arrangements, with little knowledge of their impact on staff well-being.
To investigate how remote working of healthcare workers during the pandemic may have been associated with stress, productivity and work satisfaction at that time, and associations between loneliness, workplace isolation, perceived social support and well-being.
A questionnaire was developed to explore remote working and productivity, stress and work satisfaction during time spent working remotely. Associations between current loneliness, workplace isolation and well-being, and the influence of perceived social support, were explored with perceived social support as a potential moderator.
A total of 520 participants responded to the study, of whom 112 were men (21.5%) and 406 were women (78.1%), with an age range of 21–77 years (mean 40.0, s.d. = 12.1). Very few (3.1%) worked remotely before the COVID-19 pandemic, and this had increased significantly (96.9%). Those who worked ≥31 h a week remotely reported higher stress and lower workplace satisfaction at that time, compared with office work, yet also felt more productive. Current loneliness, workplace isolation and perceived social support were cross-sectionally associated with lower current well-being.
Those who worked more hours a week remotely during the pandemic reported increased stress, which may be related to the lack of resources in place to support this change in work.
Suicide is the second leading cause of death in 12- to 17-year-old adolescents in the USA. Research on biological mechanisms contributing to self-harm risk that could be targeted in treatment could help to prevent suicide and self-harm episodes.
We aimed to evaluate whether markers of inflammation, interleukin-6 (IL-6) and C-reactive protein (CRP), predict self-harm over 3 months within a sample selected for elevated suicide/self-harm risk at project entry.
Fifty-one adolescents aged 12–19 years selected for elevated suicide/self-harm risk completed three clinical interviews about suicide attempts and non-suicidal self-injury, 3 months apart. At baseline and 3 months, youth also provided blood samples, from which we assayed levels of IL-6 and CRP.
Using generalised mixed models, we found that greater levels of IL-6 predicted more self-harm episodes (odds ratio [OR] = 3.3, 95% CI: 1.1, 10.0) and specifically, non-suicidal self-injury (OR = 3.5, 95% CI: 1.1, 11.2), over 3 months.
The study findings increase our understanding of whether and how inflammation may be implicated in risk of self-harm. IL-6 may be a viable biological marker of short-term risk for self-harm.
The poor detection of depression in primary healthcare (PHC) in low- and middle-income countries continues to threaten the plan to scale up mental healthcare coverage.
To describe the process followed to develop an intervention package to improve detection of depression in PHC settings in rural Ethiopia.
The study was conducted in Sodo, a rural district in south Ethiopia. The Medical Research Council's framework for the development of complex interventions was followed. Qualitative interviews, observations of provider–patient communication, intervention development workshops and pre-testing of the screening component of the intervention were conducted to develop the intervention.
A multicomponent intervention package was developed, which included (a) manual-based training of PHC workers for 10 days, adapted from the World Health Organization's Mental Health Gap Action Programme Intervention Guide, with emphasis on depression, locally identified depressive symptoms, communication skills, training by people with lived experience and active learning methods; (b) screening for culturally salient manifestations of depression, using a four-item tool; (c) raising awareness among people attending out-patient clinics about depression, using information leaflets and health education; and (d) system-level interventions, such as supportive supervision, use of posters at health facilities and a decision support mobile app.
This contextualised, multicomponent intervention package may lead to meaningful impact on the detection of depression in PHC in rural Ethiopia and similar settings. The intervention will be pilot tested for feasibility, acceptability and effectiveness before its wider implementation.
Although effective treatments for bulimic-spectrum eating disorders exist, access is often delayed because of limited therapist availability and lengthy waiting lists. Web-based self-help interventions have the potential to bridge waiting times for face-to-face treatment and overcome existing treatment gaps.
This study aims to assess the effectiveness of a web-based guided self-help intervention (everyBody Plus) for patients with bulimia nervosa, binge eating disorder and other specified feeding and eating disorders who are waiting for out-patient treatment.
A randomised controlled trial was conducted in Germany and the UK. A total of 343 patients were randomly assigned to the intervention ‘everyBody Plus’ or a waitlist control condition. The primary outcome was the number of weeks after randomisation until a patient achieved a clinically relevant improvement in core symptoms for the first time. Secondary outcomes included eating disorder attitudes and behaviours, and general psychopathology.
At 6- and 12-month follow-up, the probability of being abstinent from core symptoms was significantly larger for the intervention group compared with the control group (hazard ratio: 1.997, 95% CI 1.09–3.65; P = 0.0249). The intervention group also showed larger improvements in eating disorder attitudes and behaviours, general psychopathology, anxiety, depression and quality of life, compared with the control group at most assessment points. Working alliance ratings with the online therapist were high.
The self-help intervention everyBody Plus, delivered with relatively standardised online guidance, can help bridge treatment gaps for patients with bulimic-spectrum eating disorders, and achieve faster and greater reductions in core symptoms.
A rise in loneliness among older adults since the COVID-19 outbreak, even after vaccination, has been highlighted. Loneliness has deleterious consequences, with specific effects on perceptions of the ageing process during the COVID-19 pandemic. Coping with stressful life events and the challenges of ageing may result in a perception of acceleration of this process.
Studies have shown a buffering effect of an internal locus of control in the relationship between COVID-19 stress and mental distress. The current study examined whether loneliness predicts subjective accelerated ageing and whether internal locus of control moderates this relationship.
Two waves of community-dwelling older adults (M = 70.44, s.d. = 5.95; age range 61–88 years), vaccinated three times, were sampled by a web-survey company. Participants completed the questionnaire after the beginning of the third vaccination campaign and reported again 4 months later on loneliness, internal locus of control and subjective accelerated ageing level in the second wave.
Participants with higher levels of loneliness presented 4 months later with higher subjective accelerated ageing. Participants with a low level of internal locus of control presented 4 months later with high subjective accelerated ageing, regardless of their loneliness level. Participants with a high level of internal locus of control and a low level of loneliness presented with the lowest subjective accelerated ageing 4 months later.
The findings emphasise the deleterious effects of loneliness and low internal locus of control on older adults’ perception of their ageing process. Practitioners should focus their interventions not only on loneliness but also on improving the sense of internal locus of control to improve subjective accelerated ageing.
One-third to half of people with intellectual disabilities suffer from chronic constipation (defined as two or fewer bowel movements weekly or taking regular laxatives three or more times weekly), a cause of significant morbidity and premature mortality. Research on risk factors associated with constipation is limited.
To enumerate risk factors associated with constipation in this population.
A questionnaire was developed on possible risk factors for constipation. The questionnaire was sent to carers of people with intellectual disabilities on the case-loads of four specialist intellectual disability services in England. Data analysis focused on descriptively summarising responses and comparing those reported with and without constipation.
Of the 181 people with intellectual disabilities whose carers returned the questionnaire, 42% reported chronic constipation. Constipation was significantly associated with more severe intellectual disability, dysphagia, cerebral palsy, poor mobility, polypharmacy including antipsychotics and antiseizure medication, and the need for greater toileting support. There were no associations with age or gender.
People with intellectual disabilities may be more vulnerable to chronic constipation if they are more severely intellectually disabled. The associations of constipation with dysphagia, cerebral palsy, poor mobility and the need for greater toileting support suggests people with intellectual disabilities with significant physical disabilities are more at risk. People with the above disabilities need closer monitoring of their bowel health. Reducing medication to the minimum necessary may reduce the risk of constipation and is a modifiable risk factor that it is important to monitor. By screening patients using the constipation questionnaire, individualised bowel care plans could be implemented.
The adverse effects of COVID-19 and the associated restrictions on eating disorder populations have been discussed in recent literature. However, little is known about the presentation of cases with avoidant/restrictive food intake disorder (ARFID) during this period.
To explore the extent of the literature on the presentation of ARFID, and ARFID-like cases, during the COVID-19 pandemic.
Cochrane Library, CINAHL (EBSCO), PsycINFO (EBSCO), EMBASE (Ovid) and Medline (Ovid) were searched for publications between March 2020 and May 2023. Google Scholar and reference lists were hand searched. At least two reviewers independently screened each paper. Narrative synthesis was used.
Seven papers were included: four case reports and three cohort studies (total ARFID sample of 46). Included papers were assessed as having high (n = 3) or moderate (n = 4) quality. Findings did not suggest an increase in ARFID cases during the COVID-19 pandemic, although it is unclear if this is because of a lack of impact or underrecognition of ARFID. A need for a multidisciplinary approach to differentiate between ARFID and organic causes of ARFID-like presentations (e.g. gastrointestinal effects of COVID-19) was highlighted.
Publications specifically pertaining to ARFID presentations during the COVID-19 pandemic have been few. Papers found have been of small sample sizes and lack subanalyses for ARFID within broader eating disorder samples. Continued surveillance is needed to evaluate any COVID-19-specific effects on the development, identification, treatment and outcomes of ARFID.
Although much is known about psychopathology such as post-traumatic stress disorder (PTSD) and depression following bushfire (also known as wildfire), little is known about prevalence, trajectory and impacts for those experiencing general adjustment difficulties following exposure to these now-common events.
This was an exploratory analysis of a large cohort study that examined the prevalence, trajectory and risk factors of probable adjustment disorder over a 10-year period following bushfire exposure.
The Beyond Bushfires study assessed individuals exposed to a large and deadly bushfire across three time points spanning 10 years. Self-report survey data from participants from areas with moderate and high levels of fire-affectedness were analysed: n = 802 participants at Wave 1 (3–4 years post-fires), n = 596 at Wave 2 (5 years post-fires) and n = 436 at Wave 3 (10 years post-fires). Surveys indexed fire-related experiences and post-fire stressors, and comprised the six-item Kessler Psychological Distress Scale (probable adjustment disorder index), four-item Posttraumatic Stress Disorder Checklist (probable fire-related PTSD) and nine-item Patient Health Questionnaire (probable major depressive episode).
Prevalence of probable adjustment disorder was 16% (Wave 1), 15% (Wave 2) and 19% (Wave 3). Probable adjustment disorder at 3–4 years post-fires predicted a five-fold increase in risk for escalating to severe psychiatric disorder (i.e. probable fire-related PTSD/major depressive episode) at 10 years post-fires, and was associated with post-fire income and relationship stressors.
Adjustment difficulties are prevalent post-disaster, many of which are maintained and exacerbated over time, resulting in increased risk for later disorder and adaptation difficulties. Psychosocial interventions supporting survivors with adjustment difficulties may prevent progression to more severe disorder.
Borderline personality disorder (BPD) is a severe psychiatric disorder conceptualised as a disorder of emotion regulation. Emotion regulation has been linked to a frontolimbic network comprising the dorsolateral prefrontal cortex and the amygdala, which apparently synchronises its activity via oscillatory coupling in the theta frequency range.
To analyse whether there are distinct differences in theta oscillatory coupling in frontal brain regions between individuals with BPD and matched controls during emotion regulation by cognitive reappraisal.
Electroencephalogram (EEG) recordings were performed in 25 women diagnosed with BPD and 25 matched controls during a cognitive reappraisal task in which participants were instructed to downregulate negative emotions evoked by aversive visual stimuli. Between- and within-group time–frequency analyses were conducted to analyse regulation-associated theta activity (3.5–8.5 Hz).
Oscillatory theta activity differed between the participants with BPD and matched controls during cognitive reappraisal. Regulation-associated theta increases were lower in frontal regions in the BPD cohort compared with matched controls. Functional connectivity analysis for regulation-associated changes in the theta frequency band revealed a lower multivariate interaction measure (MIM) increase in frontal brain regions in persons with BPD compared with matched controls.
Our findings support the notion of alterations in a frontal theta network in BPD, which may be underlying core symptoms of the disorder such as deficits in emotion regulation. The results add to the growing body of evidence for altered oscillatory brain dynamics in psychiatric populations, which might be investigated as individualised treatment targets using non-invasive stimulation methods.
There is uncertainty about factors associated with involuntary in-patient psychiatric care. Understanding these factors would help in reducing coercion in psychiatry.
To explore variables associated with involuntary care in the largest database of involuntary admissions published.
We identified 166 102 public mental health hospital admissions over 5 years in New South Wales, Australia. Demographic, clinical and episode-of-care variables were examined in an exploratory, multivariable logistic regression.
A total of 54% of eligible admissions included involuntary care. The strongest associations with involuntary care were referral from the legal system (odds ratio 4.98, 95% CI 4.61–5.38), and psychosis (odds ratio 4.48, 95% CI 4.31–4.64) or organic mental disorder (odds ratio 4.40, 95% CI 3.85–5.03). There were moderately strong associations between involuntary treatment and substance use disorder (odds ratio 2.68, 95% CI 2.56–2.81) or affective disorder (odds ratio 2.06, 95% CI 1.99–2.14); comorbid cannabis and amphetamine use disorders (odds ratio 1.65, 95% CI 1.57–1.74); unmarried status (odds ratio 1.62, 95% CI 1.49–1.76) and being born in Asia (odds ratio 1.42, 95% CI 1.35–1.50), Africa or the Middle East (odds ratio 1.32, 95% CI 1.24–1.40). Involuntary care was less likely for people aged >75 years (odds ratio 0.68, 95% CI 0.62–0.74), with comorbid personality disorder (odds ratio 0.90, 95% CI 0.87–0.94) or with private health insurance (odds ratio 0.89, 95% CI 0.86–0.93).
This research strengthens the evidence linking diagnostic, socioeconomic and cultural factors to involuntary treatment. Targeted interventions are needed to reduce involuntary admissions in disadvantaged groups.
Findings from randomised controlled trials (RCTs) are synthesised through meta-analyses, which inform evidence-based decision-making. When key details regarding trial outcomes are not fully reported, knowledge synthesis and uptake of findings into clinical practice are impeded.
Our study assessed reporting of primary outcomes in RCTs for older adults with major depressive disorder (MDD).
Trials published between 2011 and 2021, which assessed any intervention for adults aged ≥65 years with a MDD diagnosis, and that specified a single primary outcome were considered for inclusion in our study. Outcome reporting assessment was conducted independently and in duplicate with a 58-item checklist, used in developing the CONSORT-Outcomes statement, and information in each RCT was scored as ‘fully reported’, ‘partially reported’ or ‘not reported’, as applicable.
Thirty-one of 49 RCTs reported one primary outcome and were included in our study. Most trials (71%) did not fully report over half of the 58 checklist items. Items pertaining to outcome analyses and interpretation were fully reported by 65% or more of trials. Items reported less frequently included: outcome measurement instrument properties (varied from 3 to 30%) and justification of the criteria used to define clinically meaningful change (23%).
There is variability in how geriatric depression RCTs report primary outcomes, with omission of details regarding measurement, selection, justification and definition of clinically meaningful change. Outcome reporting deficiencies may hinder replicability and synthesis efforts that inform clinical guidelines and decision-making. The CONSORT-Outcomes guideline should be used when reporting geriatric depression RCTs.
The role of adolescent loneliness in adult mental health and prescriptions of psychotropic drugs remains underexplored.
We aim to determine whether (a) experiencing loneliness in adolescence and (b) changes in loneliness from adolescence to adulthood are prospectively associated with prescriptions for a variety of psychotropic drugs in adulthood.
We used data from a Norwegian population-based sample with 2602 participants, collected across four waves between 1992 and 2006. Loneliness was assessed at each wave, with survey data linked to medicinal drug prescription records from the Norwegian Prescription Database. We identified prescription histories of antipsychotics, mood stabilisers, antidepressants and benzodiazepines from 2007 to 2015, for each participant. We use latent growth curve analyses to model the relationship of adolescent loneliness and loneliness change from adolescence to adulthood, with subsequent psychotropic drugs prescription.
Adolescents with heightened loneliness, and adolescents whose loneliness increased into young adulthood, had a greater likelihood of being prescribed antipsychotics, mood stabilisers and antidepressants in adulthood. These associations remained significant after adjustment for confounders such as sociodemographic characteristics, conduct problems, substance use and mental health problems.
Loneliness in adolescence and its adverse development over a span of 15 years was linked to higher risk of receiving prescriptions for antipsychotics, mood stabilisers and antidepressants later in life. The findings may indicate that loneliness increases the risk for developing psychotic disorders, bipolar disorders and major depression.
Cannabis-based medicinal products (CBMPs) are increasingly being used to treat post-traumatic stress disorder (PTSD), despite limited evidence of their efficacy. PTSD is often comorbid with major depression, and little is known about whether comorbid depression alters the effectiveness of CBMPs.
To document the prevalence of depression among individuals seeking CBMPs to treat PTSD and to examine whether the effectiveness of CBMPs varies by depression status.
Data were available for 238 people with PTSD seeking CBMP treatment (5.9% of the treatment-seeking sample) and 3-month follow-up data were available for 116 of these. Self-reported PTSD symptoms were assessed at treatment entry and at 3-month follow-up using the PTSD Checklist – Civilian Version (PCL-C). The probable presence of comorbid depression at treatment entry was assessed using the nine-item Patient Health Questionnaire (PHQ-9). Additional data included sociodemographic characteristics and self-reported quality of life.
In total, 77% met screening criteria for depression, which was associated with higher levels of PTSD symptomatology (mean 67.8 v. 48.4, F(1,236) = 118.5, P < 0.001) and poorer general health, quality of life and sleep. PTSD symptomatology reduced substantially 3 months after commencing treatment (mean 58.0 v. 47.0, F(1,112) = 14.5, P < 0.001), with a significant interaction (F(1,112) = 6.2, P < 0.05) indicating greater improvement in those with depression (mean difference 15.3) than in those without (mean difference 7).
Depression is common among individuals seeking CBMPs to treat PTSD and is associated with greater symptom severity and poorer quality of life. Effectiveness of CBMPs for treating PTSD does not appear to be impaired in people with comorbid depression.
Older racial and ethnic minorities and older adults with dementia have an elevated COVID-19 risk, warranting research into the intersection between these two high-risk groups. We examined whether race-ethnicity moderates the association between dementia and COVID-19 diagnosis. Data were retrieved for 3189 respondents from a nationally representative prospective cohort sample of US older adults aged 65+ years. We analysed the effects of the interaction between race-ethnicity and dementia on COVID-19 diagnosis, after adjusting for sociodemographic factors, health and COVID-19 mitigation behaviours. The odds of COVID-19 diagnosis were significantly lower for Black older adults with dementia (adjusted odds ratio [aOR] = 0.07, 95% CI = 0.01–0.78, P = 0.03). In addition, dementia increased the odds of COVID-19 diagnosis among Hispanic older adults (aOR = 1.59, 95% CI = 0.12–21.29, P = 0.72), although this increase was not statistically significant. The interaction between race-ethnicity and dementia should be considered when assessing COVID-19 risk among older adults. Future research is needed to examine pathways through which dementia may interact with race and ethnicity to influence COVID-19 risk.
]]>Gender dysphoria is associated with suicidality among transgender and gender-diverse (TGD) people. Gender dysphoria also results in a stress on appearance.
The objectives of this study were to examine: (a) whether appearance anxiety mediates the effect of gender dysphoria on suicidality; and (b) whether gender identity moderates the mediating effect of appearance anxiety.
A total of 117 769 college and university students were recruited in this cross-sectional study from Jilin Province, China. After screening based on participants’ gender identity, 2352 TGD young people (aged from 15 to 25 years) were divided into three subgroups: female to male (FTM), male to female (MTF) and non-binary. Self-report inventories measured gender dysphoria, suicidality and appearance anxiety. A structural equation model was run to examine the relationships among TGD gender identity, gender dysphoria, appearance anxiety and suicidality.
Among TGD young people, gender dysphoria was significantly positively associated with suicidality (β = 0.15, 95% CI = 0.11–0.18, P < 0.001). Appearance anxiety partially mediated the association between gender dysphoria and suicidality (β = 0.07, 95% CI = 0.05–0.08, P < 0.001). Gender identity moderated the mediating effects: compared with individuals with FTM identity, among those with MTF and non-binary identities, gender dysphoria showed stronger positive effects on appearance anxiety, and appearance anxiety showed greater effects in mediating the association between gender dysphoria and suicidality.
Among TGD young people, gender dysphoria is significantly associated with suicidality via appearance anxiety, with gender identity moderating the mediating effects. Diverse treatments should consider the heterogeneity of TGD subgroups, with the aim of limiting the tendency of gender dysphoria to trigger appearance anxiety, thus further buffering against the risk of suicide.
Alcohol or drug (AOD) problems are a significant health burden in the UK population, and understanding pathways to remission is important.
To determine the UK population prevalence of overcoming an AOD problem and the prevalence and correlates of ‘assisted’ pathways to problem resolution.
Stage 1: a screening question was administered in a national telephone survey to provide (a) an estimate of the UK prevalence of AOD problem resolution; and (b) a demographic profile of those reporting problem resolution. Stage 2: social surveying organisation YouGov used the demographic data from stage 1 to guide the administration of the UK National Recovery Survey to a representative subsample from its online panel.
In stage 1 (n = 2061), 102 (5%) reported lifetime AOD problem resolution. In the weighted sample (n = 1373) who completed the survey in stage 2, 49.9% reported ‘assisted’ pathway use via formal treatment (35.0%), mutual help (29.7%) and/or recovery support services (22.6%). Use of an assisted pathway was strongly correlated with lifetime AOD diagnosis (adjusted odds ratio [AOR] = 9.54) and arrest in the past year (AOR = 7.88) and inversely correlated with absence of lifetime psychiatric diagnosis (AOR = 0.17). Those with cocaine (AOR = 2.44) or opioid problems (AOR = 3.21) were more likely to use assisted pathways compared with those with primary alcohol problems.
Nearly three million people have resolved an AOD problem in the UK. Findings challenge the therapeutic pessimism sometimes associated with these problems and suggest a need to learn from community-based self-change that can supplement and enhance existing treatment modalities.
School refusal is a heterogenous problem which typically emerges in adolescence and co-occurs with internalising disorders. A substantial proportion of adolescents do not respond to existing treatment modalities; thus, novel, effective intervention options are needed. Partners in Parenting Plus (PiP+) is a coach-assisted, web-based intervention designed to empower parents to respond to adolescent internalising disorders.
To conduct a process evaluation of PiP+ and identify programme adaptations required to meet the needs of parents of adolescents who refuse school.
Semi-structured interviews were conducted with 14 Australian mothers who had: (a) received the PiP+ programme (not tailored for school refusal) during a prior research trial; and (b) reported that their adolescent was refusing school during their participation in PiP+. Inductive thematic analysis was used to analyse interview transcripts.
Participants were 41–53 years old (M = 47.8) and parenting adolescent children aged 14–17 years (M = 14.9). Three themes illustrated how PiP+ features met or could better meet the needs of parents of adolescents who were refusing school: (a) feeling heard, supported and respected; (b) relevance to me and my context; and (c) seeing positive changes. Participants had favourable views of PiP+, especially coached components. Participants requested programme enhancements to better meet the needs of parents of neurodiverse adolescents and discussed the impact of cumulative help-seeking ‘failures’ on self-efficacy and locus of control.
PiP+ was highly acceptable to the majority of parents navigating the issue of school refusal. This has implications for the enhancement of coach-assisted parenting interventions and the context-specific adaptation of PiP+ for school refusal.