There are phenomenological similarities between social anxiety disorder (SAD) and posttraumatic stress disorder, such as a provoking aversive event, posttraumatic stress symptoms (e.g. intrusions) in response to these events and deficient (context-dependent) fear conditioning processes. This study investigated the neural correlates of context-dependent extinction recall and fear renewal in SAD, specifically in patients with intrusions in response to an etiologically relevant aversive social event.

During functional magnetic resonance imaging a two-day context-dependent fear conditioning paradigm was conducted in 54 patients with SAD and 54 healthy controls (HC). This included fear acquisition (context A) and extinction learning (context B) on one day, and extinction recall (context B) as well as fear renewal (contexts C and A) one day later. The main outcome measures were blood oxygen level-dependent responses in regions of interest and skin conductance responses.

Patients with SAD showed reduced differential conditioned amygdala activation during extinction recall in the safe extinction context and during fear renewal in the acquisition context compared to HC. Patients with clinically relevant intrusions moreover exhibited hypoactivation of the ventromedial prefrontal cortex (vmPFC) during extinction learning, extinction recall, and fear renewal in a novel context, while amygdala activation more strongly decreased during extinction learning and increased during fear renewal in the acquisition context compared with patients without intrusions.

Our study provides first evidence that intrusions in SAD are associated with similar deficits in context-dependent regulation of conditioned fear via the vmPFC as previously demonstrated in posttraumatic stress disorder.

One of the major challenges in clinical psychiatry remains the absence of well established objective measures of symptoms’ severity. Clinical insights are mainly provided through keen behavioral observation and subjective questionnaires and scales.

The aim of this paper is to predict depression severity through speech using the features extracted from the speech as provided by participants during a semi-structured dialogue with a virtual avatar.

We use data from a subset of the DAICWOZ dataset consisting in 142 dialogues between participants and a virtual avatar during which the avatar uses several prompts to maintain a conversation with the participant. The avatar uses prompts involving the topics of travel, dream jobs, and memorable experiences. From the speech generated from the dialogue, we extract participant utterances separated by prompt and extract features from the three sets of transcripts. We extract content features from the transcript and acoustic features from the excerpt corresponding to the speech from the participant for the prompt in question.We perform regression experiments on the PHQ8 items using the features extracted from each set of transcripts. Furthermore, we combine the features extracted from each set of transcripts and compute partial spearman correlations between them and the PHQ8 items using gender as a covariate.

With our best regression model we obtain an R2 of 0.1, explaining 10% of the variance in the PHQ total score. Additionally, we obtain a mean absolute error of 1.25, suggesting that the regressor can detect with more or less precision clinically meaningful differences in depression severity between participants. Partial correlations between the total score and the features show significant correlations between features dependent on the amount of speech generated by each participant, along with the complexity of syntactic structures used.

Automatic analysis of spontaneous speech could help with the detection and monitoring of signs of depression. By combining the use of this technology with timely intervention strategies for instance provided by a virtual agent it could contribute to timely prevention.

A. König: None Declared, M. Mina Employee of: ki:elements GmbH, S. Schäfer Employee of: ki:elements GmbH, N. Linz Shareolder of: ki:elements GmbH, Employee of: ki:elements GmbH, J. Tröger Shareolder of: ki:elements GmbH, Employee of: ki:elements GmbH

Difficulties in the context-dependent modulation of conditioned fear are known for posttraumatic stress disorder and may explain the occurrence of intrusive memories in safe contexts. The current study therefore investigated if reduced context-dependent modulation of conditioned fear and its underlying neural circuitry constitute risk factors for the development of analog intrusions in response to an experimental trauma.

Eighty-five healthy women participated in the trauma film paradigm to investigate the development of analog intrusions as well as explicit memory for an experimental trauma after one week and three months, respectively. Before, participants underwent a context-dependent fear conditioning paradigm during functional magnetic resonance imaging with fear acquisition in context A and extinction training in context B on a first day, as well as extinction recall in context B and fear renewal in a novel context C one day later. Skin conductance responses (SCRs) and blood oxygen level dependent responses were main outcome measures.

In addition to stronger fear acquisition in context A, stronger conditioned fear responses in the safe context B, as indicated by stronger conditioned SCRs or stronger activation of fear expressing regions during extinction learning and recall, predicted the development of long-term analog intrusions.

Stronger fear responses in safe and danger contexts were risk factors for the development of long-term analog intrusions and point to decontextualized fear memories and difficulties in the context-dependent modulation of conditioned fear. Altered fear conditioning processes and reduced storage of contextual information may cause the occurrence of fear independent of context.

The mounting evidence for effective delivery of psychological interventions by non-specialists in low- and middle-income settings has led to a rapid expansion of mental health and psychosocial support trainings globally. As such, there is a demand for strategies on how to train and implement these services to attain adequate quality. This study aims to evaluate the added value of a competency-driven approach to training of facilitators for a group intervention for children with severe emotional distress in Lebanon.

In a controlled before and after study, 24 trainees were randomly allocated to participate in either a competency-driven training (CDT) or training-as-usual (TAU) (1 : 1) for a psychological intervention for children with severe emotional distress. We assessed the change in demonstrated competencies, using standardised role-plays, before and after the training. Measures included the 13-item Working with children-Assessment of Competencies Tool (WeACT), the 15-item ENhancing Assessment of Common Therapeutic factors (ENACT) and the 6-item Group facilitation: Assessment of Competencies Tool (GroupACT). The trainer in the experimental arm used pre-training and during training competency assessment scores to make real-time adjustment to training delivery. Due to COVID-19 pandemic restrictions, all activities were done remotely.

CDT resulted in significantly better outcomes on increasing competencies on the WeACT (repeated measures analysis of variance; F(1, 22) = 6.49, p < 0.018) and on the GroupACT (Mann–Whitney U = 22, p < 0.003), though not statistically significant on the ENACT. There is no significant between-group difference on the reduction of harmful behaviours, mainly because both forms of training appear equally successful in eliminating such behaviours.

This proof-of-concept study demonstrates the potential of CDT, using standardised assessment of trainee competencies, to contribute to better training outcomes without extending the duration of training. CDT can result in up to 18% greater increase in adequate competency, when compared to TAU. The study also yields recommendations for further enhancing the benefits of competency-driven strategies. A fully powered trial is needed to confirm these findings.

The consequences of Childhood trauma (CT) become increasingly apparent. The available data suggest that (1) CT is related to persisting alterations of HPA activity, (2) CT is related to psychopathology in patients with substance use disorders (SUD), and (3) alterations of HPA activity are related to craving and psychopathology. However, none of the existing studies have tried to integrate these different perspectives.

We assessed anxiety (STAI), depression (BDI) and craving (OCDS-D) in a consecutive sample of 42 patients with alcohol dependence (37% female, 63% male) on day 1 (t1) and day 14 (t2) after their admission to a detoxification unit. Morning plasma levels of cortisol and ACTH were assessed and a standard dexamethasone test (DST) was performed (t2). Finally, the Childhood Trauma Questionnaire was administered.

At t1, cortisol levels correlated significantly with anxiety (r=.34*) and sexual abuse (r=.38*). An inverse relationship was found between ACTH levels and both, emotional abuse and emotional neglect (t1: r=-.33*, r=-.39*; t2: r=-.32*, r=-.51**). This relationship persisted when controlling for depression. Craving was related to anxiety and depression (t1: r=.53**, r=.60**; t2: r=.39*, r=.35*), but not to cortisol or ACTH levels. No relationships existed between CT and the DST outcome.

Our results give first evidence that CT is related to changes of the HPA activity in SUD patients, but they could not be further clarified by the DST. Psychopathology was related to both, early trauma and craving. Future studies should try to further examine these complex relationships.

Injection drug users (IDUs) frequently suffer from somatic and mental co-morbidity. The effects of different opioid maintenance protocols on these parameters have not been systematically studied yet.

This study was conducted as a 12-month open-label multi-centre randomised controlled trial to test a heroin- vs. methadone based protocol.

515 patients were randomised to the heroin-assisted and 500 to the methadone-assisted treatment program. Baseline scores were as follows: OTI-HSS 19.0 (±5.2), BMI 22.6 (±3.5), pathologic electro-/echocardiogram 20.4% (n=582) / 13.9% (n=491), positive HBV-, HCV- and HIV-serology 65.7% (n=863) / 86.5% (n=855) / 9.2% (n=951), positive tuberculin test 9.1% (n=318), KPS 71.4 (±12.9), Global Severity Index (GSI; SCL-90-R) 69.2 (±10.6), GAF 53.6 (±11.7) (all parameters not significant between treatment groups). Improvement after 12 months of treatment differed significantly between treatment groups (heroin vs. methadone): OTI-HSS 8.1 (±5.2) vs. 10.6 (±6.4), BMI 24.5 (±4.3) vs. 23.7 (±4.1), KPS 78.2 (±12.8) vs. 74.2 (±13.3), GSI 58.6 (±13.7) vs. 62.0 (±13.2), GAF 63.0 (±13.3) vs. 56.2 (±15.0) (ANOVA, all p=.000). The frequency of pathologic echocardiograms after 12 months was significantly lower in the heroin compared to the methadone group. Within the heroin group, completers benefited stronger than drop-outs. The remaining parameters did not differ between baseline and 12 months and between treatment groups.

Integration of severe injection drug users either in methadone or heroin assisted maintenance treatment has positive effects on most change sensitive physical and mental variables. In this patient group heroin assisted treatment showed superior results compared to methadone.

Studies have shown that mental health risks related to military deployment depend on specific risk factors. Especially stressful experiences (SE) and lack of social support (SS) have been associated with deployment-related increases in mental disorders. Less is known about difficulties in emotion regulation (DER) in this context despite their well-known importance for the development and maintenance of mental disorders. To date, the number of prospective studies investigating the role of these potential risk factors for deployment-related psychopathology is limited.

To investigate risk factors for deployment-related increases in symptoms of common mental disorders.

To investigate associations between SE, SS and DER, and deployment-related increases in PTSD, major depression (MD) and alcohol use disorder (AUD) symptoms.

358 male soldiers were assessed before and 12 months following deployment using standardized diagnostic interviews (CIDI) and embedded questionnaires. Outcome measures were the number of PTSD, MD and AUD symptoms reported for the preceding 12 months at follow-up. Analyses were adjusted for baseline symptoms.

SE (incidence risk ratio (IRR)):1.06, p>0.001), SS (IRR:0.98, p=0.034) and DER (IRR:1.04, p=0.009) independently predicted increases in PTSD symptoms. SE (IRR:1.04, p=0.004) and SS (IRR:0.98, p=0.022) also predicted increases in MD symptoms. Increase in AUD symptoms was not predicted by SE, SS or DER, but by increase in PTSD symptoms (IRR:1.02, p=0.029).

Findings support the role of SE, SS and DER as risk factors for deployment-related disorders, particularly for PTSD symptoms. This knowledge might help to identify high-risk individuals and to develop targeted interventions.

This article synthesises the results of a large international study on primary care (PC), the QUALICOPC study.

Since the Alma Ata Declaration, strengthening PC has been high on the policy agenda. PC is associated with positive health outcomes, but it is unclear how care processes and structures relate to patient experiences.

Survey data were collected during 2011–2013 from approximately 7000 PC physicians and 70 000 patients in 34, mainly European, countries. The data on the patients are linked to data on the PC physicians within each country and analysed using multilevel modelling.

Patients had more positive experiences when their PC physician provided a broader range of services. However, a broader range of services is also associated with higher rates of hospitalisations for uncontrolled diabetes, but rates of avoidable diabetes-related hospitalisations were lower in countries where patients had a continuous relationship with PC physicians. Additionally, patients with a long-term relationship with their PC physician were less likely to attend the emergency department. Capitation payment was associated with more positive patient experiences. Mono- and multidisciplinary co-location was related to improved processes in PC, but the experiences of patients visiting multidisciplinary practices were less positive. A stronger national PC structure and higher overall health care expenditures are related to more favourable patient experiences for continuity and comprehensiveness. The study also revealed inequities: patients with a migration background reported less positive experiences. People with lower incomes more often postponed PC visits for financial reasons. Comprehensive and accessible care processes are related to less postponement of care.

The study revealed room for improvement related to patient-reported experiences and highlighted the importance of core PC characteristics including a continuous doctor–patient relationship as well as a broad range of services offered by PC physicians.

Mothers’ return to work and childcare providers’ support for feeding expressed human milk are associated with breast-feeding duration rates in the USA, where most infants are regularly under non-parental care. The objective of the present study was to explore Florida-based childcare centre administrators’ awareness and perceptions of the Florida Breastfeeding Friendly Childcare Initiative.

Semi-structured interviews were based on the Consolidated Framework for Implementation Research and analysed using applied thematic analysis.

Childcare centre administrators in Tampa Bay, FL, USA, interviewed in 2015.

Twenty-eight childcare centre administrators: female (100 %) and Non-Hispanic White (61 %) with mean age of 50 years and 13 years of experience.

Most administrators perceived potential implementation of the Florida Breastfeeding Friendly Childcare Initiative as simple and beneficial. Tension for change and a related construct (perceived consumer need for the initiative) were low, seemingly due to formula-feeding being normative. Perceived financial costs and relative priority varied. Some centres had facilitating structural characteristics, but none had formal breast-feeding policies.

A cultural shift, facilitated by state and national breast-feeding-friendly childcare policies and regulations, may be important for increasing tension for change and thereby increasing access to breast-feeding-friendly childcare. Similar to efforts surrounding the rapid growth of the Baby Friendly Hospital Initiative, national comprehensive evidence-based policies, regulations, metrics and technical assistance are needed to strengthen state-level breast-feeding-friendly childcare initiatives.

Breast-feeding initiation rates have increased in the USA; however, maintenance of breast-feeding for recommended durations is low. The objective of the present study was to identify factors that may facilitate breast-feeding for longer durations among first-time mothers, including physiological and social experiences and changes in maternal perceptions.

Survival analysis and linear regression methods were used to explore the relationship between experiences and breast-feeding duration, and the possible mediating effect of changes in maternal perceptions.

Secondary data from the Infant Feeding Practices Study II, conducted in the USA between 2005 and 2007.

Data from 762 first-time mothers who ever breast-fed were analysed.

Experiencing trouble with baby’s latch, problems with milk flow/supply and painful breast-feeding were significantly associated with breast-feeding duration (64, 26 and 36 % shorter duration, respectively). Meanwhile, positive changes in perception with respect to breast-feeding self-efficacy, opinion about infant feeding and belief about breast milk were associated with 16–27 % longer duration. Furthermore, changes in perception were observed to partially mediate the impact of physiological experiences on breast-feeding duration.

Perceptions of breast-feeding self-efficacy, beliefs and opinions can change over time and are influenced by breast-feeding experiences. The combined effect of experience and perception plays a key role in influencing breast-feeding duration. Future research should explore interventions to maintain or improve these perceptions while accounting for physiological experiences to support breast-feeding for recommended durations among first-time mothers.