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Postpartum anxiety (PPA) symptoms have harmful effects on child development and mother–infant interactions. Accordingly, in-depth knowledge of associated risk factors is crucial for prevention policies. This study aimed to estimate PPA symptom prevalence at 2 months and to identify associated risk factors in a representative sample of all women who gave birth in France in 2021, and in two subgroups: women with no postpartum depression (PPD) symptoms, and those with no history of mental health care.
Methods
Among the 12,723 women included in the representative French national perinatal survey 2021ENP, 7,133 completed the Edinburgh Postnatal Depression Scale (EPDS) self-administered questionnaire – including three anxiety-specific items (EPDS-3A) – at 2 months postpartum. We estimated the adjusted prevalence ratios (aPR) of PPA symptoms using Poisson regression models with robust variance.
Results
PPA symptom prevalence at 2 months was 27.6% (95% CI [26.5–28.8]). Associated risk factors were: age ≤ 34 years (maximum aPR = 1.38 [1.22–1.58] obtained for persons aged 25–29 years vs. 35–39 years), poorer health literacy (1.15 [1.07–1.23]), a history of medical termination of pregnancy (1.32 [1.05–1.68]), psychological (1.31 [1.17–1.47]) or psychiatric (1.42 [1.24–1.63]) care history since adolescence, nulliparity (1.23 [1.12–1.35]), no weight gain or loss (1.29 [1.03–1.61] vs. 9–15 kg gain) or gain ≥23 kg (1.20 [1.00–1.43]) during pregnancy, ≥3 pregnancy-related emergency consultations (1.16 [1.03–1.31] vs. none), poor/good support during pregnancy, (1.16 [1.00–1.34] and 1.15 [1.05–1.26], respectively, vs. very good), sadness (1.52 [1.36–1.69]), anhedonia (1.48 [1.27–1.72]), or both (1.99 [1.79–2.21]) during pregnancy, not at all/not very satisfied with pain management during childbirth (1.16 [1.01–1.32] vs. quite/very satisfied). Similar risk factors were found in the ‘no PPD symptoms’ and ‘no history of mental health care’ subgroups.
Conclusions
Estimated PPA symptom prevalence at 2 months in our study sample was 27.6%. The risk factors we identified may guide future prevention policies.
France has been severely impacted by the pandemic. The first wave imposed a major lockdown, never seen before. The second and third wave lockdown responses were somewhat less dramatic. People were allowed to travel to work. Nursery and elementary schools were left open while high schools had part-time attendance. Spring 2021, still presented with a terrible death toll of 300/day, for a 67million population country. For many months the spotlights were focused on the high levels of mortality and morbidity of the elderly. This somehow obliterated the younger generation’s mental health issues. It now appears that children and adolescents have had to pay a steep price to Covid 19. In France, during the first lockdown, child and adolescent morbidity and mortality due to abuse heightened considerably compared to 2019 during the same period. And during the second and mostly the third lockdown, pediatric emergency wards have been underwater with youth mental health issues ranging form suicidal ideation to acute dissociation. Different hypotheses have emerged on how the pandemic has so dramatically impacted the mental health of children and adolescents, specifically the most vulnerable ones. The consequences this might have for child development and mental health during the years to come will be debated.
We show the consistency, relative to the appropriate supercompactness or strong compactness assumptions, of the existence of a non-supercompact strongly compact cardinal $\kappa _0$ (the least measurable cardinal) exhibiting properties which are impossible when $\kappa _0$ is supercompact. In particular, we construct models in which $\square _{\kappa ^+}$ holds for every inaccessible cardinal $\kappa $ except $\kappa _0$, GCH fails at every inaccessible cardinal except $\kappa _0$, and $\kappa _0$ is less than the least Woodin cardinal.
We prove two theorems concerning indestructibility properties of the first two strongly compact cardinals when these cardinals are in addition the first two measurable cardinals. Starting from two supercompact cardinals $\kappa _1 < \kappa _2$, we force and construct a model in which $\kappa _1$ and $\kappa _2$ are both the first two strongly compact and first two measurable cardinals, $\kappa _1$’s strong compactness is fully indestructible (i.e., $\kappa _1$’s strong compactness is indestructible under arbitrary $\kappa _1$-directed closed forcing), and $\kappa _2$’s strong compactness is indestructible under $\mathrm {Add}(\kappa _2, \delta )$ for any ordinal $\delta $. This provides an answer to a strengthened version of a question of Sargsyan found in [17, Question 5]. We also investigate indestructibility properties that may occur when the first two strongly compact cardinals are not only the first two measurable cardinals, but also exhibit nontrivial degrees of supercompactness.
Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care.
Methods.
The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions.
Results.
We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures.
Conclusions.
We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions.
The literature on suicidal behaviour among immigrants is scarce and little has been written from a comparative perspective.
Aims
The aim was to investigate whether suicide attempts are more common among immigrants than among their hosts, to map the differences between different immigrant groupings, and to analyse whether suicidal behaviours among immigrants and the populations of their countries of origin are related.
Methods
Data on suicide attempts (27,000 person-cases) originated from the WHO/EURO Multicentre Study on Suicidal Behaviour. Suicide attempt rates were calculated for each group. The immigrant groups were compared at each Center and across Centers. The completed-suicide rates of the home countries were compared to attempted-suicide rates in the immigrant groups using rank correlations.
Results
Twenty-seven of the 56 immigrant groups showed significantly higher suicide attempt rates than their hosts. Also, they tended to have similar rates across different Centers. There was a significant correlation between the country-of-origin suicide rate and the immigrant-group suicide attempt rate among those born there. However, Chileans, Iranians, Moroccans and Turks displayed high suicide-attempt rates as immigrants despite low suicide rates in the home countries.
Conclusions
The similarity of the groups’ rates across Centers, and that of the suicidal behaviour in the countries of origin and among immigrants suggests strong continuity, which may be interpreted in cultural or genetic terms. The generally higher rates among immigrants in each Center and across Centers point to the influence of acculturative factors. Additional investigation into the specific characteristics of immigrant suicide attempters is needed.
We assessed hemisphere function in right-handed male chronic schizophrenic patients using dichotic listening tests. We evaluated digit, tonic and transitional tests in patients with paranoid schizophrenia (n = 8), patients with disorganized schizophrenia (n = 8) and in control subjects (n = 8). The dichotic listening analysis discriminated between paranoid and disorganized schizophrenia. In disorganized schizophrenia, functional impairment of both hemispheres was demonstrated, while in paranoid schizophrenia dysfunction was more prominent in the right hemisphere. These results indicate the possible involvement of right hemisphere dysfunction in the pathophysiology of chronic paranoid schizophrenia, in contrast to dysfunction of both hemispheres in chronic disorganized schizophrenia.
Family environment has a clear role in suicidal behavior of adolescents. We assessed the relationship between parental bonding and suicidal behavior in suicidal (n = 53) and non-suicidal (n = 47) adolescent inpatients. Two dimensions of parental bonding: care and overprotection, were assessed with the Parental Bonding Instrument. Results showed that adolescents with severe suicidal behavior tended to perceive their mothers as less caring and more overprotective compared to those with mild or no suicidal behavior. A discriminant analysis distinguished significantly between adolescents with high suicidality and those with low suicidality [χ2(5) = 15.54; p = 0.01] in 71% of the cases. The perception of the quality of maternal bonding may be an important correlate of suicidal behavior in adolescence and may guide therapeutic strategies and prevention.
Le trouble de personnalité borderline (TPB) se caractérise notamment par des troubles de régulation des émotions en lien avec des troubles de l’attachement. Ces troubles entravent en eux-mêmes l’établissement de relations nouvelles et entretiennent les difficultés de régulation et d’attachement perpétuant ainsi le développement psychopathologique. Lors de l’avènement de la parentalité, la relation contrainte et le bouleversement inhérent à la venue d’un enfant sont susceptibles d’entraîner des distorsions interactives initiées par les parents atteints de psychopathologie borderline, contraignant ainsi le développement émotionnel du tout-petit. La micro-analyse des interactions lors d’une épreuve dite du Still-Face montre que les mères atteintes de TPB et leur bébé de 3 mois sont engagés dans des comportements qui combinent paradoxalement, une pauvreté de variation dans les interactions ainsi qu’un excès de comportements stimulants et intrusifs. L’effort de régulation et la dysrégulation du bébé sont visibles au travers de comportements de dyscoordination des regards, à la modification négative et dysrythmique des vocalisations et de la prosodie et à l’absence de modulation des temps dits de « réparation » lorsque qu’il existe des moments de rupture de la communication. Les résultats d’une étude longitudinale (n = 60) montrent que les déterminants micro-analytiques à l’âge de trois mois des prémices de l’attachement désorganisé concernent avant tout la dynamique interactive plus que la quantité d’un comportement spécifique. Ce serait la mise en place d’un accordage à « sens unique » qui malgré la motivation maternelle d’interagir avec le bébé induirait des exigences au-delà des capacités développementales de celui-ci. L’attachement désorganisé constaté à l’âge de la marche traduirait la non-mise en place du développement des capacités de régulation du bébé. Reste à évaluer si les potentialités de réorganisation demeurent encore ouvertes à cette période précoce de la vie, invitant à découvrir des potentialités thérapeutiques encore balbutiantes à ce jour.
Calcium channel blockers increase the capacity of the urinary bladder. The antienuretic activity of verapamil was examined in young adult enuretics. Eleven drug-free, healthy, sleep-related enuretic males, were treated for two weeks with verapamil (240 mg, per os, at 9 pm). Verapamil failed to display an antienuretic effect.
To follow adolescent suicide attempters attending an emergency room in southern Israel through their induction examination for military service and then for the duration of this service.
Methods:
117 attempters were evaluated after a suicide attempt, and then followed up for up to five years. Outcome was assessed by their achievements on pre-induction psychometric and psychological testing at the induction center and by the quality of their service. Repeated suicidal behavior was also assessed.
Results:
In general boys had a worse prognosis than girls and suicidal behavior associated with poor educational achievements was particularly associated with a poor psychosocial outcome.
Conclusions:
Adolescent suicidal behavior in general has a good prognosis but boys with educational difficulties who attempt suicide are at great risk for adjustment problems.
A major hindrance to determining the underlying biology of suicide is the heterogeneity of the phenotype. Not only are there various forms of self-harm and suicidal behaviors but even the finite act of dying by suicide can occur in multiple psychosocial contexts. Of all the different forms of fatal and non-fatal suicidal behaviors, the one that received the most attention is the aggressive impulsive type, which seems to occur in younger people and to cut across nosological entities, although its most classical expression occurs in borderline personality disorder. This focus should not obscure the fact that other forms of suicidal behavior such as those related to demoralization or wounded honor (narcissism) may well have different underlying genetic diatheses.
The study of near fatal suicide attempters may provide insight into the minds of persons who die by suicide. Such attempts are characterized by high suicide intent, together with high medical lethality. The ability to fully understand the specific psychological profiles associated with severe of suicide intent can provide insights for suicide prevention.
Objectives & aims
The objective of the present study was to investigate the relationship of suicide intent to lethality among medically serious suicide attempters. Our aim was to examine specific psychological variables related to the subjective and objective components within suicide intent.
Methods
102 suicide attempters belonged to one of two groups: 35 subjects who made medically serious suicide attempts were compared with 67 non- medically serious suicide attempters. All were interviewed and completed questionnaires covering mental pain, communication difficulties, and seriousness of the suicide intent.
Results
The objective component of the suicide intent scale (SIS) was highly correlated the lethality, as well as to communication difficulties, such as self disclosure while the subjective component of the SIS was related to mental pain variables such as depression and hopelessness. A significant interaction between mental pain and communication difficulties was found to predict severity of the objective suicide intent.
Conclusions
The suicidal person whom suffers from depression and hopelessness and cannot signal his pain to others because of communication difficulties can be a risk for a serious suicide attempt - which is more planned, with more precautions against discovery and without communication before or during the attempts.
Both adolescent suicide and attention deficit hyperactivity disorder (ADHD) are troubling phenomena with high comorbidity, including impulsivity, depression and personality disorders (PD). Studies on the association between these two phenomena are relatively rare. This pilot study's aim was to estimate the rate of ADHD in adolescents attempting suicide.
Method
Subjects constituted consecutive admissions to the psychiatric emergency room (ER) who were admitted as a result of attempting suicide. Assessment included the use of the Kiddie-SADS, Strengths and Difficulties Questionnaire (SDQ) and the Conners’ Rating Scale (CRS). Those diagnosed as suffering from ADHD were assessed by a standardized Continuous Performance Test (Test of Variables of Attention [TOVA]) that included methylphenidate (MPH) challenge. Twenty-three (23) adolescents completed the study. M:F ratio was 5:18, respectively.
Results
Of the 23 participants who completed the study, 65% were diagnosed with ADHD, 43.5% with depression and 39% with cluster B PD. ADD/ADHD ratio was 66%:34%. Only five of the patients were formerly diagnosed as ADHD, only three had been medicated and 14 out of 15 adolescents responded well to MPH challenge.
Conclusion
These preliminary results suggest a significant association between ADHD and suicidal behavior in adolescents. Further study is needed to establish this association and assess the causality.
Adolescent suicide is a worldwide troubling phenomenon that has high comorbidity, including impulsivity, depression, and personality disorders. Attention Deficit Hyperactivity Disorder (ADHD) includes attention, impulsivity and hyperactivity. Comorbidity includes depression and substance abuse, and has a higher rate in adolescents and adults. Studies considering the association between these phenomena are surprisingly rare. This pilot study estimated the percentage of ADHD in a population of adolescents who attempted suicide. Population included all adolescents (12-18 yrs.) who were brought to local ER after attempting suicide. Assessment included an interview according to the DSM-IV criteria, the Strengths and Difficulties Questionnaire parents (SDQ-P) the Conners' Rating Scale parents (CRS-P), and Kiddie-SADS. Test Of Variables of Attention (TOVA) with methylphenidate (MPH) challenge was done after the clinical evaluation to those diagnosed as ADHD.
Results
45 suicidal adolescents were registered in the ER and were assessed. 23 adolescents completed the assessment. Male: female ratio was 5:18 accordingly. The prominent diagnoses included ADHD (65%), depression (43%), cluster B personality disorders (35%), and Conduct Disorder (13%). ADD/ADHD ratio was 43/22 (66%:34%). Some suffered from more than 2 diagnoses and 1 had no diagnosis at all. 47.6% were diagnosed as hyperactive by SDQ-P, and 70% as ADHD by CRS-P. 14/15 (93%) were evaluated as ADHD by TOVA and most responded well to MPH. Five patients were diagnosed before the study as ADHD, but only three were medicated. These results, though primary, suggest a significant relationship between the two disorders and indicate a need to further study this correlation