Cognitive impairment is often comorbid with depression and anxiety, and the cognitive status of older adult patients can drastically impact depression treatment outcomes. The cognitive status of these patients invariably changes psychological treatment approaches that otherwise are viable and feasible in older adults. For example, although cognitive behavioral therapy is effective in treating cognitively intact patients with depression, it often relies on executive function (such as flexible thinking and problem solving) and other cognitive abilities that are impaired in patients with comorbid cognitive impairment. Practically, this results in unstandardized modifications to psychotherapy that may impact the fidelity—and thus effectiveness—of treatment. It is important to assess and classify cognitive dysfunction in depression treatment-seeking older adults in trials. This can help generalize research findings and identify potential barriers in transferring psychotherapeutic approaches for older adults with depression from treatment trials to practical clinical use, particularly in hard-to-treat populations with comorbid cognitive impairment.

A systematic literature search was conducted in PubMed for the period 2000-2022. Study inclusion criteria was operationalised as follows: participants were identified as older adults (55 years and older), their primary psychiatric diagnosis was depression, and the study was a trial for depression treatment. Key search terms included: depression, treatment, psychotherapy, therapy, counseling, intervention, older adult, senior, late-life, elder, aged, clinical trial, and randomized controlled trial.

An initial search of the key terms returned 3,972 articles. 178 of these articles were subject to full text review. Of those, 45 articles met inclusion criteria. Overall study quality was acceptable. A portion of treatment trials did not assess for cognitive functioning. A majority of the articles excluded patients with cognitive impairment, with no further elaboration on the potential impact of cognitive functioning on treatment outcomes. A smaller portion of studies were more inclusive of the cognitive range of patient participants; however, they did not comment on the cognitive heterogeneity of their samples. Only three studies used a more extensive neuropsychological battery to examine cognitive profiles of patient participants. However, two of these studies also excluded individuals that fell below the cognitively intact range based on brief cognitive screening measures. Of the few studies that examined depression treatment in cognitively impaired and dementia patient populations, two trials examined cognitive functioning as a predictor or moderator of depression treatment outcome.

Given that cognitive status can significantly impact depression treatment outcomes for older adults, there is a shocking dearth of inclusion of cognitively impaired patients in depression treatment clinical trials. Moreover, the limited studies that examined depression treatment in cognitively impaired populations, there is a lack of comprehensive cognitive assessment, and lack of exploration on how different types of cognitive dysfunction may contribute to variable depression treatment response. Future depression treatment trials in older adults should expand to include a variety of cognitive functioning ranges, as well as a more detailed assessment of how specific cognitive domains may impact treatment outcomes.

Irish Travellers are an indigenous minority group in Ireland. Health inequalities have been widely reported within the Traveller community, with a shorter life expectancy of 11 years less than the general population. Travellers also have higher mortality rates of 3.5 times higher than the general population in Ireland. Suicide is a serious problem in the Traveller community with a suicide rate of 11% among Travellers: 6 times higher in women and 7 times higher in men compared with their counterparts in the general population.

There is a paucity of research into the clinical characteristics of self-harm and suicidality among Irish Travellers despite the elevated suicide rates in this community. This study aims to bridge the knowledge gap in the mental health of Irish Travellers, focusing on the clinical factors associated with self-harm and suicidality in a community sample of Irish Travellers.

This is a cross-sectional study. Study participants completed self-report and interview-based validated questionnaires that screen for anxiety (General Anxiety Disorder assessment: GAD-7), depression (Patient Health Questionnaire: PHQ-9), and suicidality (Suicide Behaviours Questionnaire-Revised: SBQ-R and Adult Suicidal Ideation Questionnaire: ASIQ). Ethical approval was granted through the Clinical Research Ethics Committee, University College Dublin.

Despite an active recruitment campaign, participation rate from Irish Travellers in this study was low, with only five participants completing this study. Three were male. The mean age of the study participants was 39±14.7 years. All had pre-existing mental health diagnoses, most commonly anxiety disorder. All had at least one previous episode of self-harm and 80% had a positive family history of self-harming behaviour. No participants reported a history of alcohol or substance misuse. Over half of the participants reported severe anxiety and depressive symptoms with median GAD-7 score of 19 and PHQ-9 score of 21 respectively. All participants demonstrated significant risk of suicidal behaviour based on their SBQ-R and ASIQ scores.

Despite elevated rates of suicidality and mental illness in this ethnic minority group, Irish Travellers demonstrated lower participation in mental health research, including this study. These recruitment challenges suggest that factors such as stigma, shame and lack of trust may be contributory. These factors may also act as barriers to them accessing mental healthcare when they develop mental health symptoms such as anxiety and depression, associated with increased risk of self-harm and suicidal behaviours. There is a need for better engagement strategies with Travellers to promote awareness into their needs and reduce mental health problems in this population.

None Declared

Irish Travellers are an indigenous minority in Ireland with distinct history and culture, of which nomadism was traditionally an important feature. Travellers experience disadvantages in education, employment, housing and health. Suicide is a big problem in the Traveller community, their suicide rate is 11%: 6 to 7 times higher than the general population. 59.4% of Traveller men and 62.7% of Traveller women reported that their mental health has not been good for one or more days in the last 30. Despite the high rates of suicide, there is a paucity of clinical research into mental health of Travellers.

Aim was to improve the scientific knowledge of the mental health of Irish Travellers by addressing the gap in the scientific literature.

The objective was to conduct a qualitative assessment of Travellers who have experienced self-harm and suicidal thoughts themselves, or who have a family member who has experienced same, by exploring their personal experience of distress, adversity and illness.

We conducted semi-structured interviews exploring the following topics: self-harm, bereavement by suicide, experience of mental illness and of seeking treatment, stigma, discrimination and perceptions of research participation. Participants were recruited from community Traveller organisations in order to improve participation. Data were analysed using Nvivo software for thematic analysis.

Our participants aged from 22-62. 67% reported a personal history of self-harm, 83% had a psychiatric diagnosis. None were actively engaged with a Psychiatric team.

The main themes from the data were discrimination, identity issues, cultural understanding in healthcare settings, mental health and wider societal issues. Our findings showed that many Travellers who suffer from mental health problems and suicidal thoughts, find it hard to discuss problems openly within their families and communities due to stigma and shame, despite the high incidence of suicide. Many reported experiencing idenity crises, and a sense of not belonging in society, particularly since the introduction of legislation preventing them from aspects of their traditional lifestyles. Other common topics were literacy issues, womens and LGBTQplus rights.

Travellers are a marginalised group in our society with high rates of socioeconomic deprivation, which we know is a factor in mental illness and thoughts of self-harm or suicide. There is a need for improved education for mental healthcare workers into the culture of Travellers and for increased sensitivity and awareness of how to engage with patients with literacy issues. Stigma remains an issue within the Travelling community and more work needs to be done to improve engagement between Travellers and mental health services in order to prevent acute mental health crises and/or suicidal behaviour. Travellers remain a difficult to reach and under-researched group in our society.

None Declared

It is unknown how much variation in adult mental health problems is associated with differences between societal/cultural groups, over and above differences between individuals.

To test these relative contributions, a consortium of indigenous researchers collected Adult Self-Report (ASR) ratings from 16 906 18- to 59-year-olds in 28 societies that represented seven culture clusters identified in the Global Leadership and Organizational Behavioral Effectiveness study (e.g. Confucian, Anglo). The ASR is scored on 17 problem scales, plus a personal strengths scale. Hierarchical linear modeling estimated variance accounted for by individual differences (including measurement error), society, and culture cluster. Multi-level analyses of covariance tested age and gender effects.

Across the 17 problem scales, the variance accounted for by individual differences ranged from 80.3% for DSM-oriented anxiety problems to 95.2% for DSM-oriented avoidant personality (mean = 90.7%); by society: 3.2% for DSM-oriented somatic problems to 8.0% for DSM-oriented anxiety problems (mean = 6.3%); and by culture cluster: 0.0% for DSM-oriented avoidant personality to 11.6% for DSM-oriented anxiety problems (mean = 3.0%). For strengths, individual differences accounted for 80.8% of variance, societal differences 10.5%, and cultural differences 8.7%. Age and gender had very small effects.

Overall, adults' self-ratings of mental health problems and strengths were associated much more with individual differences than societal/cultural differences, although this varied across scales. These findings support cross-cultural use of standardized measures to assess mental health problems, but urge caution in assessment of personal strengths.

There is some evidence that autism spectrum disorder (ASD) frequently co-occurs with immune-mediated conditions including asthma. We aimed to explore the familial co-aggregation of ASD and asthma using different genetically informed designs.

We first examined familial co-aggregation of asthma and ASD in individuals born in Sweden from 1992 to 2007 (n = 1 569 944), including their full- and half-siblings (n = 1 704 388 and 356 544 pairs) and full cousins (n = 3 921 890 pairs), identified using Swedish register data. We then applied quantitative genetic modeling to siblings (n = 620 994 pairs) and twins who participated in the Child and Adolescent Twin Study in Sweden (n = 15 963 pairs) to estimate the contribution of genetic and environmental factors to the co-aggregation. Finally, we estimated genetic correlations between traits using linkage disequilibrium score regression (LDSC).

We observed a within-individual association [adjusted odds ratio (OR) 1.33, 95% confidence interval (CI) 1.28–1.37] and familial co-aggregation between asthma and ASD, and the magnitude of the associations decreased as the degree of relatedness decreased (full-siblings: OR 1.44, 95% CI 1.38–1.50, maternal half-siblings: OR 1.28, 95% CI 1.18–1.39, paternal half-siblings: OR 1.05, 95% CI 0.96–1.15, full cousins: OR 1.06, 95% CI 1.03–1.09), suggesting shared familial liability. Quantitative genetic models estimated statistically significant genetic correlations between ASD traits and asthma. Using the LDSC approach, we did not find statistically significant genetic correlations between asthma and ASD (coefficients between −0.09 and 0.12).

Using different genetically informed designs, we found some evidence of familial co-aggregation between asthma and ASD, suggesting the weak association between these disorders was influenced by shared genetics.

The juvenile justice system in the USA adjudicates over seven hundred thousand youth in the USA annually with significant behavioral offenses. This study aimed to test the effect of juvenile justice involvement on adult criminal outcomes.

Analyses were based on a prospective, population-based study of 1420 children followed up to eight times during childhood (ages 9–16; 6674 observations) about juvenile justice involvement in the late 1990 and early 2000s. Participants were followed up years later to assess adult criminality, using self-report and official records. A propensity score (i.e. inverse probability) weighting approach was used that approximated an experimental design by balancing potentially confounding characteristics between children with v. without juvenile justice involvement.

Between-groups differences on variables that elicit a juvenile justice referral (e.g. violence, property offenses, status offenses, and substance misuse) were attenuated after applying propensity-based inverse probability weights. Participants with a history of juvenile justice involvement were more likely to have later official and violent felony charges, and to self-report police contact and spending time in jail (ORs from 2.5 to 3.3). Residential juvenile justice involvement was associated with the highest risk of both, later official criminal records and self-reported criminality (ORs from 5.1 to 14.5). Sensitivity analyses suggest that our findings are likely robust to potential unobserved confounders.

Juvenile justice involvement was associated with increased risk of adult criminality, with residential services associated with highest risk. Juvenile justice involvement may catalyze rather than deter from adult offending.

To determine whether: the N95 respirator affects nasal valve patency; placement on the bony vault improves patency; and external nasal anatomy affects the outcome.

A prospective study with 50 participants was conducted. Nasal patency was measured by the minimal cross-sectional area via acoustic rhinometry, and using the Nasal Obstruction Symptom Evaluation survey, before and after wearing the N95 respirator and after adjustment.

The minimal cross-sectional area was narrowed by 27 per cent when wearing the N95 respirator (p < 0.001), and improved by 9.2 per cent after adjustment (p = 0.003). The total Nasal Obstruction Symptom Evaluation score increased from 10.2 to 25.4 after donning the N95 respirator (p < 0.001), and decreased from 25.4 to 15.6 after adjustment (p < 0.001). There was no correlation with external nasal anatomy parameters.

Wearing the N95 respirator causes narrowing of the nasal valve, and adjustment onto the bony vault improves symptoms. The findings were not affected by external nasal anatomy.

To determine the frequency and predictors of antibiotic escalation in response to the inpatient sepsis screen at our institution.

Retrospective cohort study.

Two affiliated academic medical centers in Los Angeles, California.

Hospitalized patients aged 18 years and older who had their first positive sepsis screen between January 1, 2019, and December 31, 2019, on acute-care wards.

We described the rate and etiology of antibiotic escalation, and we conducted multivariable regression analyses of predictors of antibiotic escalation.

Of the 576 cases with a positive sepsis screen, antibiotic escalation occurred in 131 cases (22.7%). New infection was the most documented etiology of escalation, with 76 cases (13.2%), followed by known pre-existing infection, with 26 cases (4.5%). Antibiotics were continued past 3 days in 17 cases (3.0%) in which new or existing infection was not apparent. Abnormal temperature (adjusted odds ratio [aOR], 3.00; 95% confidence interval [CI], 1.91–4.70) and abnormal lactate (aOR, 2.04; 95% CI, 1.28–3.27) were significant predictors of antibiotic escalation. The patient already being on antibiotics (aOR, 0.54; 95% CI, 0.34–0.89) and the positive screen occurred during a nursing shift change (aOR, 0.36; 95% CI, 0.22–0.57) were negative predictors. Pneumonia was the most documented new infection, but only 19 (50%) of 38 pneumonia cases met full clinical diagnostic criteria.

Inpatient sepsis screening led to a new infectious diagnosis in 13.2% of all positive sepsis screens, and the risk of prolonged antibiotic exposure without a clear infectious source was low. Pneumonia diagnostics and lactate testing are potential targets for future stewardship efforts.