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Background Healthcare workers (HCWs) from COVID-19 pandemic hotspots across the globe have reported mental health problems, including anxiety, depression, or sleep problems. Many studies have focused on identifying modifiable risk factors, such as being afraid of getting infected or reporting shortage of personal protective equipment, but none have explored the role of protective factors. Method This cross-sectional study used an online survey to describe the association between three potentially protective factors (self-reported resilience, self-perceived social support from colleagues at work, and self-perceived social support from relatives and friends) and three mental health outcomes, namely psychological distress, depression symptoms, and death thoughts in a large sample of Spanish HCWs during the first wave of the COVID-19 pandemic. Results We recruited 2372 respondents between April 26th and June 22nd, 2020. Resilience and self-perceived social support were inversely associated with mental health problems (psychological distress, depression symptoms, and death thoughts), after adjusting for potential sources of confounding. Conclusions Resilience and self-perceived social support might protect HCWs against negative mental health outcomes. Public health strategies targeting these modifiable determinants might help to reduce the impact of the pandemic on HCWs’ mental health.

Publisher's version, Multiplex families with a high prevalence of a psychiatric disorder are often examined to identify rare genetic variants with large effect sizes. In the present study, we analysed whether the risk for bipolar disorder (BD) in BD multiplex families is influenced by common genetic variants. Furthermore, we investigated whether this risk is conferred mainly by BD-specific risk variants or by variants also associated with the susceptibility to schizophrenia or major depression. In total, 395 individuals from 33 Andalusian BD multiplex families (166 BD, 78 major depressive disorder, 151 unaffected) as well as 438 subjects from an independent, BD case/control cohort (161 unrelated BD, 277 unrelated controls) were analysed. Polygenic risk scores (PRS) for BD, schizophrenia (SCZ), and major depression were calculated and compared between the cohorts. Both the familial BD cases and unaffected family members had higher PRS for all three psychiatric disorders than the independent controls, with BD and SCZ being significant after correction for multiple testing, suggesting a high baseline risk for several psychiatric disorders in the families. Moreover, familial BD cases showed significantly higher BD PRS than unaffected family members and unrelated BD cases. A plausible hypothesis is that, in multiplex families with a general increase in risk for psychiatric disease, BD development is attributable to a high burden of common variants that confer a specific risk for BD. The present analyses demonstrated that common genetic risk variants for psychiatric disorders are likely to contribute to the high incidence of affective psychiatric disorders in the multiplex families. However, the PRS explained only part of the observed phenotypic variance, and rare variants might have also contributed to disease development., The study was supported by the German Federal Ministry of Education and Research (BMBF), through the Integrated Network IntegraMent, under the auspices of the e:Med programme (grants 01ZX1314A to MMN and SC; 01ZX1314G to MR; 01ZX1614J to BMM) through grants 01EE1406C to MR and 01EE1409C to MR and SHW, and through ERA-NET NEURON, “SynSchiz—Linking synaptic dysfunction to disease mechanisms in schizophrenia—a multilevel investigation” (01EW1810 to MR) and BMBF grants 01EE1409C and 01EE1406C to MR and SHW; by the German Research Foundation (DFG grants FOR2107; RI908/11-2 to MR; NO246/10-2 to MMN; MU1315/8-2 to BMM; WI 3439/3-2 to SHW), by the Andalusian regional Health and Innovation Government (grants PI-0060-2017, RC-0006-2015 the Nicolas Monarde Programme for YDO and CTS-546) and by the Swiss National Science Foundation (SNSF grant 156791 to SC). MMN is a member of the DFG-funded cluster of excellence ImmunoSensation. The PGC has received major funding from the US National Institute of Mental Health and the US National Institute of Drug Abuse (U01 MH109528 and U01 MH1095320). We thank the research participants and employees of 23andMe, Inc. for their contribution to the MDD meta-analysis published in [14]. We thank the International Genomics of Alzheimer's Project (IGAP) for providing summary results data for the present analyses. See the Supplementary Data for extended Acknowledgements.

Close to one million people commit suicide each year, with suicidal attempts being the main risk factor for suicide. The aim of this systematic review and meta-analysis is to achieve a greater understanding of suicidality in the general population of Europe by studying associated factors and their statistical significance with suicidality, as well as the effect of the temporal moment in which suicidality is observed in a relationship. A search strategy was carried out in electronic databases: Proquest’s Psychology Database, Scopus, PsycINFO, Medline and Embase. Odds ratios (ORs), publication bias, influential studies on heterogeneity and analysis moderators were calculated. Twenty-six studies were included after meeting the inclusion criteria. Factors statistically associated with suicidality are female gender, age over 65 years, unemployment, low social support, adulthood adversity, childhood adversity, family history of mental disorder, any affective disorder, major depression, anxiety/stress/somatoform disorders, tobacco and substance use, any mental disorder and body mass index. As a limitation, a high heterogeneity between studies was found. Factors associated with suicidality in the general population are relevant for understanding the suicidal phenomenon. Yes

The objective of this study is to confirm from Deaths with Judicial Intervention (DIJ), whether cause of death was suicide, through family information and to establish the percentage of those identified as such in the Statistical Death Bulletin of Judicial Court (BEDJ). For this purpose, the DIJ were selected from the database of the Cementary Park of Málaga in 2017. Information was collected from the family of the deceased, through the Cementary's Psychological Cabinet to confirm or rule out suicide and the BEDJ was subsequently consulted to confirm whether these cases were identified as such. Relatives confirmed 65 suicides, of which only 27% are identified as such in the relevant section of the BEDJ, a document that serves as a source of information for official suicide statistics. From this study we concluded that the family can offer complementary information that would help improve suicide statistics.

Background: Sadness and anhedonia (loss of interest in activities) are central symptoms of major depression. However, not all people with these symptoms meet diagnostic criteria for major depression. We aimed to assess the importance of suicidality in the outcomes for primary care patients who present with sadness and anhedonia. Method: Cohort study of 2,599 unselected primary care attenders in six European countries followed up at 6 and 12 months. Results: 1) In patients with sadness and/or anhedonia who were not depressed at entry to the study, suicide plans (OR = 3.05; 95 % CI = 1.50-6.24; p = 0.0022) and suicide attempts (OR = 9.08; 95 % CI = 2.57-32.03; p = 0.0006) were significant predictors of developing new onset depression at 6 or 12 months. 2) In patients with sadness and/or anhedonia who met CIDI criteria for major depression at entry, suicidal ideation (OR = 2.93; 95 % CI = 1.70-5.07; p = 0.0001), suicide plans (OR = 3.70; 95 % CI = 2.08-6.57; p < 0.0001), and suicide attempts (OR = 3.33; 95 % CI = 1.47-7.54; p = 0.0040) were significant predictors of persistent depression at 6 or 12 months. Conclusions: Three questions on suicidality could help primary care professionals to assess such patients more closely without necessarily establishing whether they meet criteria for major depression. publishersversion published

El suicidio es un importante problema de salud mental a nivel internacional. Más de 800.000 personas se suicidan cada año. La conducta suicida es más frecuente que el suicidio consumado y por cada suicidio consumado, se dan entre 10 y 20 casos de intento suicida (1).Los estudios epidemiológicos que toman en consideración la prevalencia y los factores asociados al riesgo suicida en diferentes poblaciones son escasos, no existiendo estudios previos sobre esta realidad en Andalucía. El objetivo de este estudio es conocer laprevalencia del riesgo suicida y analizar su asociación con variables demográficas, psicosociales y clínicas. Estudio transversal mediante una encuesta domiciliaria sobre una muestra representativa de adultos no institucionalizados de ambos sexos con edades comprendidas entre 18 y 75 años. 4507 sujetos fueron entrevistados utilizando la Entrevista Neuropsiquiátrica Internacional (MINI) (3) para evaluar el riesgo suicida actual. Se utilizaron instrumentos estandarizados para la evaluación de las siguientes variables independientes: demográficas (edad, género, estado civil, situación laboral, nivel educativo, nivel de urbanicidad del lugar de residencia y provincia de residencia), psicosociales (eventos vitales estresantes, experiencias de maltrato físico, psicológico y sexual en la infancia, funcionamiento personal y social, apoyo social y rasgos de personalidad: neuroticismo e impulsividad) y clínicas (historia familiar de problemas psiquiátricos, antecedentes de suicidio en la familia, dependencia a la nicotina y otras drogas y consumo de alcohol). Se realizó un análisis exploratorio de la distribución de los datos, incluyendo frecuencias y medias de todas las variables independientes. Se calculó la prevalencia del riesgo suicida actual (IC; 95%). Para el análisis univariante se utilizó el test chi-cuadrado y la prueba t-student y finalmente se realizó un análisis multivariante de regresión logística de efectos fijos, contralado por provincia. El 6,4% de la muestra de sujetos presentan riesgo de suicidio actual. Los resultados del modelo multivariante indican que las asociaciones estadísticamente significativas con el riesgo suicida actual fueron ser mujer, mayor edad, estar divorciado/separado/viudo/soltero, historia familiar de enfermedad mental, mayor número deeventos vitales estresantes, menos apoyo social, niveles mayores de neuroticismo, consumo elevado de alcohol, y dependencia a nicotina y otras drogas. Nuestros resultados son similares a los encontrados en otros estudios previos (4). Conclusiones Se trata del primer estudio epidemiológico realizado en Andalucía sobre el riesgo de suicidio, ofreciéndonos importantes resultados de interés clínico para la prevención del suicidio. Bibliografía 1. World Health Organisation. Prevention suicide: A global Imperative. 2014. Disponible en: ihttp://www.who.int/mental_health/suicide-prevention/world_report_2014/es/ 2. Hardt J., Bernert S., Matschinger H., Angermeier M.G., VilagutG., Bruffaerts R., et al. Systematic review of risk factors for suicide and suicide attempt among psychiatric J Affective Disorders 2015; 175: 168–174. 3. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Herqueta T, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59(Suppl.20):22-33. 4. Nock M.K., Borges G, Bromet E.J., Cha C.B., Kessler R.C., Lee S.Suicide and suicidal behavior.Epidemiol Rev. 2008;30:133-54 Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech.

Con los últimos adelantos en la tecnología informática, cada vez resulta más fácil diseñar, alimentar y gestionar grandes bases de datos, estandarizar la entrada y salida de la información, mejorar su accesibilidad, facilitar las tareas administrativas y repetitivas como informes, recetas, circulares,… en definitiva suponen una mejora en la gestión de la información clínica. Efectivamente se está avanzando en el desarrollo informático aplicado al ámbito sanitario, sin embargo, el gran avance tecnológico no se ve acompañado de resultados útiles y aplicables en el ámbito de la atención, la gestión y la investigación sanitaria en general y en el ámbito de la salud mental en particular. El problema de los sistemas de información en salud mental en España reside en las dificultades para crear información relevante, en la falta de homogeneidad en la recogida de la información, el análisis incompleto de los resultados, la tardía explotación y la escasa difusión. Además, en el contexto actual de descentralización administrativa, con la transferencia de las competencias sanitarias a las comunidades autónomas ha aumentado la dispersión en la forma de generar y crear la información, debido al desarrollo desigual de los sistemas de información, en cada comunidad autónoma. Actualmente, no contamos con indicadores mínimos a nivel autonómico, ni a nivel central, que nos permitan comparar la situación de la atención a la salud mental en España. Y, sin buena información será difícil establecer comparaciones en el desempeño de los servicios de salud mental y evaluar los progresos. En conclusión y según el informe de la Sociedad Española de Salud Pública y Administración Sanitaria del año 2010, es necesaria una profunda reforma de los sistemas de información sanitaria, que se encamine hacia la creación de un sistema de información global. Actualmente, existe la necesidad imperiosa de disponer de una única historia de salud electrónica con información básica compartida, con todos los elementos de seguridad y confidencialidad posibles, permitiendo el acceso rápido a la información esencial a cualquier profesional que toma decisiones sobre la salud mental de un paciente, beneficiando igualmente a la investigación médica, a través del acceso a bases de datos que aportan la información imprescindible en la que se fundamenta el progreso científico. Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech.

Objectives. Bipolar disorder (BD) is highly heritable, and gene identification will elucidate biological factors and gene-environment interactions. Multiplex families represent a promising resource for identifying rare variants and polygenic effects. However, such families are difficult to recruit. In 1997, >100 multiplex Andalusian BD pedigrees - the largest of which contains >20 affected members- were recruited within an Andalusian-German collaboration study. Since then, the Andalusian psychiatric network and biobank facilities have been expanded in order to facilitate psychiatric research. Therefore in 2013, the Andalusian-German collaborators initiated a follow-up study of this cohort in order to identify new genetic and environmental factors for BD aetiology and clinical course. Methods. In 1997, BD patients at Andalusian psychiatric hospitals who reported a family history of BD were asked to inform their families about the study. All consenting family members (N= 937; BPI/II=265; Recurrent Mayor Depression=149) were assessed using a structured psychiatric interview for life-time best estimate psychiatric diagnosis (SADS) and the family history method, and blood was obtained for DNA genetic analysis. Follow-up involves reassessment of diagnosis, neuropsychological testing (CANTAB), and the collection of biomaterials (RNA, Plasma, IPS, hair cortisol, etc.). Written informed consent is obtained for all study procedures and analyses. Results. For the first three families, follow-up assessments and biomaterial-processing have been completed. Follow-up of the remaining families is ongoing. Conclusion. This cohort represents a unique resource for the investigation of BD aetiology and clinical course, and will be available to international researchers from other sciences. Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech.

Background/Objectives Very few studies have examined schizophrenia morbidity in Spain, using multiple sources of information. We performed a 1-year prevalence study of schizophrenia and related disorders in Málaga and the use of services in a population aged 14 years or older living in the mental health catchment area of Carlos Haya hospital (Málaga, Spain). Methods Data were obtained from multiple sources of information mainly clinical databases. We selected more than 4000 persons as “possible cases” and we consult case notes and key informant (general practice and psychiatrists) to confirm schizophrenic diagnoses and place of living. Results A total of 1808 patients, 1169 men and 639 women were included as cases in the study. The one year ICD-10 prevalence rate was 6,8 (6,5-7,1) per 1000 adult population. Almost 80% of cases were in contact with public mental health services. Responsibility for schizophrenic patients is mainly carried by mental health services. Discussion/Conclusion Health planning should be based on local data about prevalence and use of services. Multiple sources of information are essential for accurate estimation of prevalence of schizophrenia disorders. Grants Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech. Junta de Andalucía (PI/PI338/2008 y CTS-945)

Para que los sistemas de información en salud mental sean eficientes deberían cumplir los siguientes requisitos. (1) El sistema debe estar centrado en el paciente, (2) la recogida de la información debe ser longitudinal y acumulada; (3) el sistema debe ser integrado y exhaustivo. Para todo ello necesitamos contar con un código de identificación único y universal de cada paciente. (4) Debe definirse un conjunto mínimo básico de datos a recoger homogéneos y estandarizados, que cumplan normas de (5) confidencialidad y criterios mínimos de (6) calidad. Además, el sistema de información debe permitir (7) la explotación de resultados de forma ágil, rápida y flexible y que sea útil para la comunidad científica: profesionales clínicos, gestores e investigadores. Es necesario que (8) los profesionales clínicos estén involucrados en el desarrollo de los sistemas de información y reciban el asesoramiento necesario, (9) desde unidades intermedias, para su correcta utilización. Por último, y no por ello menos importante, (10) los sistemas de información en salud mental deben estar apoyados institucionalmente y ser considerados como una prioridad dentro del sistema de atención a la salud mental. A mental health information system, must meet the following minimum requirements if it is to be considered of good quality. The system must be patient centred, and the information must be longitudinal, accumulated, exhaustive and complete. This requires a unique universal identification code for each patient. The data recorded must comply with the guarantees of confidentiality and the minimum quality criteria to enable the drawing up of results that are useful for the scientific community, including clinicians, managers and researchers. For these information systems to be efficient, it is necessary for the clinicians to be involved in their development and to receive training for their correct use. Finally, these systems should receive institutional support and be considered a priority within the mental health care system.

Tesis Univ. de Granada. Departamento de Medicina legal, Toxicología y Psiquiatría. Leída en 2002

El Registro Andaluz de Esquizofrenia tiene como objetivo principal conocer la prevalencia de la esquizofrenia asistida en el área sur de la provincia de Granada. The main aim of the Andalusian Case Register for Schizophrenia is to determine the prevalence of schizophrenia of those cared for by the public network of mental health services in South Granada.