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Women with Alcohol use disorder (AUD) are more likely than men to have co-occurring depression, drink to cope with negative affect (NA), and cite negative affect as a contributor to relapse. Among AUD treatment seekers, low behavioral activation, NA, and reduced self-efficacy in abstaining from alcohol (e.g., in tempting situations) are relapse risk factors. This study investigated the association between behavioral activation, affective states, and self-efficacy among treatment-seeking women. Participants were 70 women (M = 40.50, SD = 11.59 years of age) with elevated depressive symptoms seeking AUD treatment. The Behavioral Activation for Depression Scale (BADS) was used to assess environmental engagement. The Alcohol Abstinence Self-Efficacy (AASE) scale was used to assess temptation to drink in contexts of positive and negative affect, and general positive and negative affect were assessed with the Positive and Negative Affect Schedule. Results indicated that behavioral activation was directly correlated with positive affect (PA; r = .62, p < .001) and inversely correlated with depression (r = -.35, p = .004), negative affect (r = -.39, p = .001), and temptation to drink in the context of negative affect (r = -.33, p = .006). After controlling for depressive symptoms, behavioral activation continued to be associated with greater general positive affect (β = .595, p < .001) and lower temptation to drink in the context of negative affect (β = -.348 p = .008). Our results suggest a nuanced association between behavioral activation, negative affect, and temptations to drink that is not accounted by depressive symptoms. Self-efficacy to abstain from drinking in a negative affect context should be considered when designing AUD interventions for women. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

BackgroundMental pain has been proposed as a global person-centered outcome measure. The aim of this cross-sectional study was to test an essential requisite of such a measure, namely that mental pain incorporates independent contributions from a range of discrete but disparate outcome measures.MethodsTwo hundred migraine patients were assessed concerning migraine disability, psychosomatic syndromes, mental pain, depression, anxiety, and psychosocial dimensions. General linear models were tested to verify which measures would individually make unique contributions to overall mental pain.ResultsThe final model, accounting for 44% of variance, identified that higher mental pain was associated with more severe depressive symptoms, higher migraine disability, lower well-being, and poorer quality of life.ConclusionIn this sample, mental pain was shown to behave as expected of a global outcome measure, since multiple measures of symptomatology and quality of life showed modest but significant bivariate correlations with mental pain and some of these measures individually made unique contributions to overall mental pain.

Background Healthcare workers (HCWs) involved in administration and patient management during COVID-19 pandemic are at high risk of developing psychological problems related to fear and stress of contacting COVID infection. This is augmented by the stigma faced at home and society, owing to the nature of their job. Aim To assess the mental health issues and stigma amongst health care workers involved in COVID care. Methodology We conducted a hospital based cross sectional study where 150 health care workers involved in the care of COVID-19 patients, directly and indirectly, were selected using systematic random sampling. They were assessed using Depression, Anxiety and Stress Scale (DASS-21) Hindi Version, The Impact of Event Scale - Revised scale and a Modified Stigma scale. Results Significant psychological stress, anxiety, depression and high risk for developing post-traumatic stress disorder was found in more than half of the healthcare workers, albeit more in those having direct contact with COVID patients (p

Parents of infants who require neonatal intensive care unit (NICU) hospitalization encounter stressors that place them at a higher risk of developing a mental health issue during and after NICU discharge. This population is often underdiagnosed, leading to potential detrimental effects on parenting behaviours, parent/infant bonding, and child neurodevelopment. This review explores what mental health issues parents experience during and after NICU discharge, what mental health resources are currently available, what mental health screening tools are used, and what factors place NICU parents at an increased risk of developing a mental health issue. The review revealed that mental health issues are not isolated; if a parent experiences psychological distress, it can progress to depression or post-traumatic stress disorder (PTSD) if left untreated. Psychotherapy most frequently contributed to a reduction in mental health symptoms, but was rarely offered beyond NICU discharge.

INTRODUCTION Post-traumatic Stress Disorder (PTSD), depression and anxiety are the most common psychiatric consequences among parents of children with epilepsy. OBJECTIVES We aimed to investigate the prevalence and predictors of PTSD, depression and anxiety in a sample of parents of children with epilepsy. METHODS A survey of 135 parents of children with epilepsy, treated in the pediatric neurology department at the Sfax Teaching Hospital in Tunisia, was conducted in the last quarter of 2019. The PTSD Checklist for DSM-5 and the Hospital Anxiety and Depression Scale (HADS) were used to assess, respectively, PTSD, depression and anxiety in parents. Associations with clinical and demographic variables with PTSD, depression and anxiety were evaluated in a logistic regression model. RESULTS Results revealed PTSD rates of 20.7%, depression rates of 28.9% and anxiety rates of 55.6%. The main factors associated with PTSD on multivariable analysis were female gender (P=0.026, ORa=13.1), insufficient involvement of partner in disease management (P

Introduction: Cannabigerol (CBG), and its precursor before decarboxylation, cannabigerolic acid is sometimes labeled the "mother of all cannabinoids." The purpose of the present study was to investigate reasons for use and self-reported therapeutic effects in CBG-predominant cannabis users. Usage patterns and adverse effects, including withdrawal symptoms were also explored. Methods: Cannabidiol-predominant cannabis users were recruited online to complete an online survey assessing CBG use patterns, conditions treated with CBG-predominant cannabis (containing >50% CBG), perceived efficacy, associated adverse events, and withdrawal symptoms. One hundred twenty-seven eligible participants (U.S. residents ages 21+ who reported using CBG-predominant cannabis in the past 6 months) completed the survey. Results: Most of the samples (n=65; 51.2%) reported use of CBG-predominant products solely for medical purposes (n=46; 36.2% reported use for medical and recreational purposes; n=8; 6.3% reported recreational use only, and n=8 were missing). The most common conditions the complete sample reported using CBG to treat were anxiety (51.2%), chronic pain (40.9%), depression (33.1%), and insomnia/disturbed sleep (30.7%). Efficacy was highly rated, with the majority reporting their conditions were "very much improved" or "much improved" by CBG. Furthermore, 73.9% claimed superiority of CBG-predominant cannabis over conventional medicines for chronic pain, 80% for depression, 73% for insomnia, and 78.3% for anxiety. Forty-four percent of CBG-predominant cannabis users reported no adverse events, with 16.5% noting dry mouth, 15% sleepiness, 11.8% increased appetite, and 8.7% dry eyes. Around 84.3% reported no withdrawal symptoms, with sleep difficulties representing the most frequently endorsed withdrawal symptom (endorsed by two respondents). Conclusions: This is the first patient survey of CBG-predominant cannabis use to date, and the first to document self-reported efficacy of CBG-predominant products, particularly for anxiety, chronic pain, depression, and insomnia. Most respondents reported greater efficacy of CBG-predominant cannabis over conventional pharmacotherapy, with a benign adverse event profile and negligible withdrawal symptoms. This study establishes that humans are employing CBG and suggests that CBG-predominant cannabis-based medicines should be studied in randomized controlled trials.

Purpose To present the clinical course of adolescents who presented to the child and adolescent psychiatry outpatient clinic due to gender dysphoria and homosexuality through a patient series. Methods The clinical features, comorbidities, and the treatment process of 10 patients who presented to the outpatient clinic and were followed up over a period were presented. Results The average age of the 10 patients, 5 girls and 5 boys, was 14.3 years for the girls and 16 years for the boys. Nine patients were admitted by their families primarily with the desire for the elimination of gender dysphoria or homosexual orientation. Only one female patient was brought by her family because of her intense depressive symptoms and suicidal thoughts. All of the patients had comorbid psychiatric diseases, nine had depression, and one had bipolar affective disorder comorbidity. The anxiety levels of all patients were high. Psychiatric management in each patient focused on the emotional, cognitive and social difficulties of the case. The treatment of two girls was interrupted suddenly by the family because they saw that the homosexual orientation of the patients was continuing. Two male patients were not brought back for treatment after the evaluation process. Conclusions Gender dysphoria and homosexual orientation are situations that families still find it difficult to accept and that they think it can be eliminated by pressure, coercion or psychiatric treatment. Patients show a high rate of psychiatric comorbidity due to family pressure and social exclusion. Although psychiatric support can cure comorbid disorders in a relatively short time, strains of family and social relationships continue to affect patients.

Although the alliance is usually considered a generic factor common to all therapies, there are theoretical reasons to suspect that it may develop differently in different types of therapies. Yet, in youth psychotherapy, little is known about this issue to date. This study investigated whether the mean strength of the alliance, as well as its trajectory over time, differed between three equally effective psychological treatments for adolescent depression. Data were drawn from the IMPACT study, a randomized controlled trial comparing cognitive-behavioral therapy (CBT) and short-term psychoanalytic psychotherapy (STPP) versus a brief psychosocial intervention (BPI) in the treatment of adolescent depression. Adolescents’ (N = 338) and therapists’ (n = 159) ratings of the alliance were collected using the Working Alliance Inventory short form at 6, 12, and 36 weeks after randomization. Data were analyzed using multilevel linear models. Results showed that adolescents’ and therapists’ mean alliance ratings differed between treatment types, being highest in CBT and lowest in the STPP at all time points. Mean therapists’ alliance ratings increased slightly over time in all arms, while mean adolescents’ ratings were stable over time in CBT and BPI but slightly increased in the STPP group. These findings suggest that the mean strength of the alliance differs between treatment type, and future research is required to pinpoint what factors contribute to these differences and their relationship with treatment outcomes.

The purpose of this study was (a) to investigate gender differences in mental health among Danish youth soccer players, (b) to discover the mental health profiles of the players, and (c) to explore how career progression and mental health are related. A total of 239 Danish youth elite soccer players (M = 16.85, SD = 1.09) completed an online questionnaire assessing mental well-being, depression, anxiety, along with other background variables. Female players scored significantly lower on mental well-being and had four times higher odds of expressing symptoms of anxiety and depression than males. Athletes’ mental health profiles showed that most athletes experience low depression while having moderate mental well-being. Depression, anxiety, and stress scores generally increased when progressing in age, indicating that the junior–senior transition poses distinct challenges to players’ mental health, especially for female players. Different strategies to foster players’ mental health depending on their mental health profiles are proposed.

Background Patients’ postoperative treatment might be affected by their psychological state. The study aimed to evaluate the effects of anxiety, coping ability (stress tolerance), depression, and pain catastrophizing on analgesic consumption in patients scheduled for sleeve gastrectomy. Methods This prospective observational study consisted of 72 patients. The Distress Tolerance Scale (DTS), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Pain Catastrophizing Scale (PCS) were completed in the preoperative period. In the postoperative period, pain intensity, as measured with the Visual Analogue Scale (VAS), and morphine consumption (mg) were evaluated after 2, 6, 8, and 24 hours. Total morphine consumption was recorded. Results The results revealed a strong negative correlation between distress tolerance and postoperative total morphine consumption (r = -0.702, p< 0.001). There was a strong positive correlation between total morphine consumption and pain catastrophizing (r = 0.801, p< 0.001). A moderate positive correlation was observed between total morphine consumption and anxiety and between total morphine consumption and depression (r = 0.511, p< 0.001; r = 0.556, p< 0.001, respectively). Linear regression revealed that distress tolerance, anxiety, depression, and pain catastrophizing are predictors of postoperative morphine consumption (β = 0.597, p< 0.001; β = 0.207, p= 0.036; β = 0.140, p= 0.208; β = 0.624, p< 0.001, respectively). Conclusions Distress tolerance, anxiety, depression, and pain catastrophizing can be predictive of postoperative analgesic consumption. In the estimation of postoperative analgesic consumption, distress tolerance, as well as anxiety, depression, and pain catastrophizing, were found to be important predictors.

Objectives Cure for severe depression in elderly patients with psychotic symptoms should consider not only the results of major depression but also the nature of antidepressants and their side effects. Psychiatric disability is higher in patients who have greater deterioration in neurological function. Methods In addition to reviewing antidepressant discontinuation syndrome and depressive disorder, this study describes an elderly woman with mild depression that developed into major depression, related to high suspicion of delirium, diagnosed based on patient history, physical health examination, neurological examinations, family history, and laboratory data, with subsequent treatment plan. Results The treatment results and prognosis indicate that patients with paroxetine antidepressant deactivation may enable early use of low-dose quetiapine with less anticholinergic and extrapyramidal side effects for the treatment of depression in elderly patients with psychotic symptoms. The poor prognostic factors for patients were chronic environmental stress (poverty) and lack of a social support system. Although the patient lived with her children and grandchildren, she rarely received care. Hence, it was not possible to monitor her condition and medication intake. Conclusions The consensus is that the abrupt discontinuation of short half-life selective serotonin reuptake inhibitors (SSRIs), such as paroxetine can be associated with transient symptomatology, much of which is of a serotonergic nature. Psychotic-like symptoms have also been reported in both controlled trials and large patient databases.

Suicidality involves thoughts (ideations and plans) and actions related to self-inflicted death. To improve management and prevention of suicidality, it is essential to understand the key neural mechanisms underlying suicidal thoughts and actions. Following empirically informed neural framework, we hypothesized that suicidal thoughts would be primarily characterized by alterations in the default mode network indicating disrupted self-related processing, whereas suicidal actions would be characterized by changes in the lateral prefrontal corticostriatal circuitries implicating compromised action control.We analyzed the gray matter volume and resting-state functional connectivity of 113 individuals with late-life depression, including 45 nonsuicidal patients, 33 with suicidal thoughts but no action, and 35 with past suicidal action. Between-group analyses revealed key neural features associated with suicidality. The functional directionality of the identified resting-state functional connectivity was examined using dynamic causal modeling to further elucidate its mechanistic nature. Post hoc classification analysis examined the contribution of the neural measures to suicide classification.As expected, reduced gray matter volumes in the default mode network and lateral prefrontal regions characterized patients with suicidal thoughts and those with past suicidal actions compared with nonsuicidal patients. Furthermore, region-of-interest analyses revealed that the directionality and strength of the ventrolateral prefrontal cortex-caudate resting-state functional connectivity were related to suicidal thoughts and actions. The neural features significantly improved classification of suicidal thoughts and actions over that based on clinical and suicide questionnaire variables.Gray matter reductions in the default mode network and lateral prefrontal regions and the ventrolateral prefrontal cortex-caudate connectivity alterations characterized suicidal thoughts and actions in patients with late-life depression.

Anhedonia is a core symptom of major depressive disorder (MDD) resulting from maladaptive reward processing. Electroconvulsive therapy (ECT) is an effective treatment for patients with MDD. No previous neuroimaging studies have taken a dimensional approach to assess whether ECT-induced volume changes are specifically related to improvements in anhedonia and positive valence emotional constructs. We aimed to assess the relationship between ECT-induced brain volumetric changes and improvement in anhedonia and reward processing in patients with MDD.We evaluated 15 patients with MDD before and after ECT. We used magnetic resonance imaging, clinical scales (i.e., Quick Inventory of Depressive Symptomatology for syndromal depression severity and Snaith-Hamilton Pleasure Scale for anhedonia) and the Temporal Experience of Pleasure Scale for anticipatory and consummatory experiences of pleasure. We identified 5 regions of interest within the reward circuit and a 6th control region relevant for MDD but not core to the reward system (Brodmann Area 25).Anhedonia, anticipatory and consummatory reward processing improved after ECT. Volume increases within the right reward system separated anhedonia responders and non-responders. Improvement in anticipatory (but not consummatory) reward correlated with increases in volume in hippocampus, amygdala, ventral tegmental area and nucleus accumbens.We evaluated a modest sample size of patients with concurrent pharmacological treatment using a subjective psychometric assessment.We highlight the importance of a dimensional and circuit-based approach to understanding target engagement and the mechanism of action of ECT, with the goal to define symptom- and circuit-specific response biomarkers for device neuromodulation therapies.

Introduction: Cannabis use is common in the setting of inflammatory bowel disease (IBD). Patients frequently use cannabis to treat IBD-associated symptoms, and there is evidence that cannabis and its derivatives are helpful for this purpose. However, it is unclear how the symptom profiles of active IBD cannabis users and nonusers compare and how these symptoms may relate to their underlying disease state and/or complications. Materials and Methods: We performed a retrospective cohort study using a consented IBD natural history registry from a single tertiary care referral center between January 1, 2015 and August 31, 2020. We asked patients about current cannabis use and frequency. We also abstracted demographic and clinical characteristic information, including endoscopic severity, and totals and subscores of surveys assessing IBD characteristics, presence of anxiety/depression, and IBD-associated symptoms. We compared clinical and demographic factors of cannabis users and nonusers and developed a logistic regression model to evaluate for independent associations with cannabis use. Results: Three hundred eighty-three IBD patients met the inclusion criteria (206 females, 177 males; 258 Crohn's disease [CD], 118 ulcerative colitis, and 7 indeterminate colitis). Thirty patients (7.8%) were active cannabis users, consuming it for an average of 2.7 times per week. Cannabis users were more likely to report abdominal pain (83.3% vs. 61.7%), gas (66.7% vs. 45.6%), tenesmus (70.0% vs. 47.6%), and arthralgias (53.3% vs. 20.3%) compared to those that did not use cannabis (p

Latinx immigrants experience substantial disparities in mental health treatment access, particularly for posttraumatic stress disorder (PTSD). The availability of brief, flexible interventions in Spanish may assist in reducing these disparities. Written Exposure Therapy (WET) is a five-session PTSD intervention that appears as effective as longer, gold-standard interventions, but has yet to be tested among Latinx immigrants. To test the acceptability and preliminary effectiveness of WET, 20 Spanish-speaking, Latinx immigrants conducted structured interviews at pretreatment, were offered WET, and completed posttreatment structured interviews. Open thematic coding of pre- and posttreatment interview questions examined perceived barriers and benefits of WET. Quantitative components examined symptom change across PTSD (PCL-IV-C) and depression (PHQ-9). Quantitative results indicated clinically meaningful and statistically significant change in PTSD symptoms using intent-to-treat analyses (Mdiff = 17.06, SDdiff = 9.97, range = 0–29, t(15) = 6.84, p

Background: Oxytocin (OT) is a neuropeptide hormone that has anxiolytic and antidepressant effects, and positive effects on social affiliation and behaviour, particularly in parenting and attachment relationships. In women with postnatal depression (PND), each of these are reduced. This study investigated if OT administration reduces low mood in new mothers with PND and across the low mood spectrum. Design: A double-blind, placebo-controlled, randomised controlled-trial, within-subjects, cross-over design was conducted. Participants: Mothers (N = 58) between 3-9 months postpartum. Participants were screened for traits of PND on the Edinburgh Postnatal Depression Scale (EPDS) and assigned into 2 groups: probable PND cases (N = 26, scoring ≥9) and controls (N = 32, scoring ≤9). Method: Participants rated their current mood on the Positive and Negative Affect Scale (PANAS) at Baseline (before nasal administration), Condition 1 (after first OT/Placebo administration) and Condition 2 (after second OT/Placebo administration). Results: OT administration did not affect mood in women with PND scores above the cut-off point but significantly reduced negative mood in those scoring below the cut-off point. To explore if a subgroup was driving this, we compared participants with mild, moderate and severe scores on the EPDS. OT administration significantly reduced negative mood in women with moderate low mood scores on the EPDS. Limitations: PND was assessed by the EPDS, rather than a clinical diagnosis. Conclusion: These results illustrate individual differences in response to OT administration and suggest that OT administration may offer treatment benefit to new mothers who report moderate sub-clinical levels of depression.

While tobacco products (such as combustible cigarettes and nicotine vaping products) and cannabis use rates remain high in the general United States (U.S.) population, veterans from the conflicts in Iraq and Afghanistan (i.e., OEF/OIF veterans) are at high risk of high rates of cannabis and tobacco use. Co-use of tobacco and cannabis (i.e., using both substances within a specified period of time or combining the drugs within the same device for use) is of growing prevalence in the U.S. However, little is understood about the prevalence rates of tobacco and cannabis co-use among U.S. veterans and its associations with mental health symptomology. The current study conducted a preliminary analysis of co-use patterns of tobacco and cannabis and associated mental health outcomes among a sample of Iraq/Afghanistan (i.e. OEF/OIF) veterans (N= 1,230). Results indicated high rates of lifetime and past 30-day use of both substances. Past 30-day co-users endorsed significantly higher levels of stress, PTSD, depression, and anxiety compared to singular product users. Results suggest that the addition of cannabis use in conjunction with tobacco use may be associated with greater mental health symptoms among veterans. Findings indicate veteran tobacco and cannabis co-users may benefit from mental health care to help mitigate poor mental health symptoms.

Chronic low back pain is the second leading cause of disability in the United States, and it is often associated with severe fatigue. However, little is known about individual differences that may be related to poorer mental health and pain among individuals with severe fatigue and chronic low back pain. The aim of the current investigation was to explore the role of fatigue severity and fatigue sensitivity in terms of anxiety and depressive symptoms, pain catastrophizing, pain interference, and pain severity among 783 adults with severe fatigue and chronic low back pain (76.1% female, M(age) - 43.29 years, SD = 11.64). Results suggest that fatigue severity and fatigue sensitivity were statistically significant predictors for anxiety (β=0.17, 95% CI [0.10, 0.25], p

BACKGROUND: Sleep problems can persist following the treatment of depression and remission of symptoms. The extent to which having a previous history of depression may be associated with current daytime sleepiness is largely unknown. METHODS: Data were obtained from the spring 2017 American College Health Association-National College Health Assessment (ACHA-NCHA) survey (92 institutions) which assessed self-reported health in U.S. college students (n=41,670). Among the sample, 93.5% were 18–24 year of age, and 69.6% women. Logistic regression estimated the association between reported prior lifetime diagnosis of depression and daytime sleepiness from the past 7 days, while adjusting for depressive symptoms and antidepressant use from the past year. Unadjusted and adjusted logistic regression models stratified by gender were performed. RESULTS: Among those who reported problems with sleepiness, 31.6% women and 19.4% men had a pre-existing depression diagnosis. Individuals with pre-existing depression were more likely than those without this diagnosis to report sleepiness problems (women: OR = 1.4, CI = 1.3 – 1.6, p < .001; men: OR = 1.2, CI = 1.0 – 1.4, p < .01). However, this association differed significantly by gender, with women with a pre-existing depression diagnosis having a 13.0% greater likelihood of sleepiness compared to men. CONCLUSIONS: Those with a pre-existing depression diagnosis, and specifically women, may be at risk for daytime sleepiness even in the absence of current depressive mood-related symptoms. Given that many individuals are at risk for daytime sleepiness, mental health initiatives, including those on college campuses, should incorporate sleep hygiene within their programming.

OBJECTIVE. Emerging evidence links maternal and infant sleep problems to impairments in the mother-to-infant bond, but the independence and directionality of these associations remain unclear. The present study characterized concurrent and prospective effects of maternal sleep disturbances and poor infant sleep on the mother-infant relationship. As common sequalae of problematic sleep, nocturnal cognitive hyperarousal and daytime sleepiness were investigated as facilitating mechanisms. PARTICIPANTS. Sixty-seven pregnant women enrolled in a prospective study on maternal sleep. METHODS. Sociodemographic information and clinical symptoms were measured prenatally then weekly across the first two postpartum months. Women reported insomnia symptoms, sleep duration, snoring, daytime sleepiness, nocturnal cognitive arousal (broadly focused and perinatal-specific), perseverative thinking, depression, infant colic, infant sleep quality, and mother-infant relationship quality. Mixed effects models were conducted to test hypotheses. RESULTS. Prenatal snoring and weak maternal-fetal attachment augured poorer postpartum bonding. Poor infant sleep was associated with increased odds for maternal insomnia and short sleep. Impairments in the mother-to-infant bond were linked to maternal insomnia, nocturnal perinatal-focused rumination, daytime sleepiness, depression, and poor infant sleep. Postnatal insomnia predicted future decreases in mother-infant relationship quality, and nocturnal cognitive hyperarousal partially mediated this association. CONCLUSIONS. Both maternal and infant sleep problems were associated with poorer mother-to-infant bonding, independent of the effects of maternal depression and infant colic. Perseverative thinking at night, particularly on infant-related concerns, was linked to impaired bonding, rejection and anger, and infant-focused anxiety. Improving maternal and infant sleep, and reducing maternal cognitive arousal, may improve the maternal-to-infant bond.

Parkinson's disease (PD) is an incapacitating neurodegenerative disease. Patients with PD and their caregivers may have interactive effects on each other’s psychological well-being. This study aimed to assess the dyadic dynamics of resilience, fatigue, and suicidal ideation on the depression severity of PD patients and their caregivers. In total, 175 PD patients and 175 caregivers were recruited at a medical center from August 2018 to May 2020. Structural equation modeling (SEM) was used to examine the actor/partner effects on the psychological well-being of both the PD patients and their caregivers. The most common psychiatric diagnoses of both the PD patients (28.6%) and their caregivers (11.4%) were depressive disorders. The PD patients’ and their caregivers’ fatigue, suicidal ideation, and lack of resilience were significantly associated with the severity of their depression, respectively. Interactive effects existed between psychological well-being of individuals with PD and their caregivers. Clinicians must be aware of, and manage, these contributing factors between PD patients and their caregivers in order to prevent them from worsening each other’s depression.

Chronic pain commonly occurs in people living with HIV (PLWH). Many PLWH in the United States (U.S.) continue to obtain opioids for chronic pain management. In addition to the known risk of opioid misuse, evidence from non-HIV populations suggest that opioid use is associated with poor sleep and negative mood. Whether insomnia severity and depressive symptoms might be exacerbated by chronic pain and opioid use in PLWH remains to be determined. This study examined insomnia severity and depressive symptoms in 85 PLWH with chronic pain and 35 PLWH without chronic pain. Among PLWH with chronic pain, reported opioid use was examined in relation to severity of insomnia and depressive symptoms. PLWH with chronic pain reported significantly greater severity of insomnia symptoms (p = .033) and greater depressive symptoms (p = .025) than PLWH without chronic pain. Among PLWH with chronic pain who reported opioid use (n = 36), insomnia severity was greater compared to those who denied opioid use (n = 49), even after controlling for and pain severity and number of comorbidities (p = .026). Greater pain severity was significantly associated with greater insomnia severity (p < .001) and possibly greater depressive symptoms (p = .048) among PLWH with chronic pain who reported opioid use; however, these same associations were not significant among those PLWH with chronic pain who denied opioid use. Findings suggest that PLWH with chronic pain are likely to experience poor sleep (i.e., insomnia) and depressed mood. Furthermore, poor sleep was associated with opioid use among PLWH with chronic pain.

Acute-phase cognitive therapy (CT) is an efficacious treatment for major depressive disorder (MDD), but how CT helps patients is incompletely understood. As a potential means to clarify CT mechanisms, we defined “symptom linkage density” (SLD) as a patient’s mean time-lagged correlation among nine depressive symptoms across 13 weekly assessments. We hypothesized that patients with higher SLD during CT have better outcomes (treatment response, and fewer symptoms after response), and we explored whether SLD correlated with other possible CT processes (growth in social adjustment and CT skills). Data were drawn from two clinical trials of CT for adult outpatients with recurrent MDD (primary sample n = 475, replication sample n = 146). In both samples, patients and clinicians completed measures of depressive symptoms and social adjustment repeatedly during CT. In the primary sample, patients and cognitive therapists rated patients’ CT skills. After CT, responders were assessed for 32 (primary sample) or 24 (replication sample) additional months to measure long-term depression outcomes. Higher SLD predicted increases in social adjustment (both samples) and CT skills (primary sample) during CT, CT response (both samples), and lower MDD severity for at least 2 years after CT response (both samples). Analyses controlled patient-level symptom means and variability to estimate SLD’s incremental predictive validity. These novel findings from two independent samples with longitudinal follow-up require further replication and extension. SLD may reflect or facilitate generalization of CT skills, improvement in social functioning, or other processes responsible for CT’s shorter and longer term benefits.

Many individuals seeking mental health services for depression often suffer from a comorbid medical condition. The goal of the present study was to assess the presence of medical comorbidity in a community mental health center setting that primarily serves a Medicare and Medicaid population, characterize the types of comorbid medical conditions experienced in this setting, and explore the association between medical conditions on the alliance, attrition from services, and outcome. Medical diagnoses were collected from patient charts and structured clinical interviews from 353 participants who had a baseline assessment as part of a comparative effectiveness study of cognitive and dynamic therapies for major depressive disorder. We calculated the Charlson Comorbidity Index and the number of total medical diagnoses for each patient. Results from this study revealed that a high percentage of patients in this setting experienced a comorbid medical condition. No significant associations were found between the number of medical conditions or the Charlson Comorbidity Index and the alliance. No significant relationship was found between the number of medical conditions or the Charlson Comorbidity Index and early attrition from treatment or treatment outcome. However, exploratory analyses found that presence of a nervous system disorder was associated with relatively poorer treatment outcomes after initial engagement. Implications of these findings are discussed. Treatments for major depressive disorder may benefit from addressing the impact of medical disorders on physical functioning. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Współwystępowanie migreny i depresji stanowi ważny problem kliniczny. Badania populacyjne wskazują, że pacjenci chorujący na migrenę są bardziej niż populacja ogólna narażeni na rozwój depresji. Odwrotna zależność również jest obserwowana w dużych badaniach populacyjnych. Rozpowszechnienie depresji wzrasta, a w konsekwencji wzrastają także koszty jej leczenia i konsekwencje społeczne. W odniesieniu do migreny, jest to druga w kolejności choroba neurologiczna z największym obciążeniem zdrowotnym. Obie jednostki chorobowe istnieją od wielu lat, jednakże dopiero w ostatnim czasie dokonał się postęp w zakresie rozumienia jej patomechanizmu. Etiopatogeneza zarówno migreny jak i depresji nie jest do końca poznana, prawdopodobnie jest wieloczynnikowa i złożona. W literaturze uwzględniane są zaburzenia neuroprzekaźnictwa, układ immunologiczny i predyspozycja genetyczna. Autorzy prezentują teorie etiopatogenetyczne obu chorób, ich rozpowszechnienie. Dzięki postępom w poszukiwaniu przyczyn opisywanych jednostek chorobowych odkrywane i badane są nowe punkty uchwytu dla terapii. Autorzy publikacji analizują także dane dotyczące współchorobowości tych schorzeń, omawiają prawdopodobne czynniki leżące u jej podłoża. Migrena często współwystępuje z różnymi chorobami przewlekłymi. Autorzy opisują predyktory kliniczne wystąpienia depresji u osób chorujących na migrenę, podkreślając znaczenie przesiewowego badania w kierunku depresji osób chorujących na migrenę.

Zaburzenia depresyjne są obecnie diagnozowane na podstawie kryteriów diagnostycznych ICD 10 (International Classification of Diseases) i DSM V (Diagnostic and Statistical Manual of Mental Disorders), obejmują osiowe objawy depresji i objawy dodatkowe, które muszę współwystępować przez co najmniej dwa tygodnie. Migrena diagnozowana jest na podstawie Międzynarodowej Klasyfikacji Bólów Głowy. Dzieli się zasadniczo na migrenę z aurą i bez aury, a ze względu na częstość napadów na migrenę epizodyczną i przewlekłą. Strategią terapeutyczną w leczeniu depresji jest stosowanie farmakoterapii w połączeniu z psychoterapią, natomiast w leczeniu migreny strategia zależy od częstości napadów bólu głowy (migrena epizodyczna vs migrena przewlekła) i od chorób współistniejących. W zakresie farmakoterapii zaburzeń depresyjnych leczenie pierwszej linii to leki z grupy z selektywnych inhibitorów wychwytu zwrotnego serotoniny (SSRI). Poszzczególni przedstawiciele tej grupy leków różnią się cechami charakterystycznymi co jest istotne przy indywidualnych decyzjach terapeutycznych. Pozostałe grupy obejmują inne leki. Nowością jest wprowadzenie do leczenia migreny przeciwciał monoklonalnych skierowanych przeciwko białku CGRP lub receptorowi dla tego białka istnieje wiele doniesień wskazujących na szczególną przydatność przeciwciał monoklonalnych modyfikujących działanie białka CGRP – w leczeniu migreny u chorych z depresją.

BACKGROUND: Public access to data has been a major step in attempting to reduce bias in scientific literature. Data to verify efficacy outcomes are now more accessible; however, little has been done to ensure public access to harms data from RCTs, which are equally important in ascertaining possible misreporting and protecting safety. OBJECTIVE: The treatment for adolescents with depression study (TADS) has influenced most international practice guidelines for treating children and adolescents with depression, supporting first-line prescription of fluoxetine in combination with cognitive behavioural therapy (CBT). However, after over 30 publications by the TADS team, reporting on harms remains highly deficient and we aimed to redress this lack. METHODS: In undertaking a restoring invisible and abandoned trials (RIAT) reanalysis of TADS’ effectiveness and safety outcomes, we sought access to de-identified serious adverse events (SAE) data. RESULTS: This paper describes our unsuccessful efforts to obtain more detailed SAE data from TADS’ data custodians, highlighting several problematic blocks to comprehensive safety reporting. CONCLUSION: Comprehensive access to clinical trial data is necessary to ensure safe and fully informed guidelines for treating children and adolescents with depression.

ObjectivePsycho-oncological institutions offer specialized care for cancer patients. Little is known how this care might impact fatigue. This study aimed to identify fatigue trajectories during psychological care, examined factors distinguishing these trajectories and predicted fatigue severity after nine months of psychological care.DesignNaturalistic, longitudinal study of 238 cancer patients receiving psycho-oncological care in the Netherlands. Data were collected before initiation of psychological care (T1) and three (T2) and nine months (T3) afterwards. Latent class growth analysis, repeated measure analyses (RMA) and linear regression analysis were performed.Main Outcome MeasuresFatigue severity: Checklist Individual Strength.ResultsThree fatigue trajectories were identified: high- (30%), moderate- (62%) and low-level fatigue (8%). While statistically significant decreases in fatigue were found, this decrease was not clinically relevant. RMA showed main effects for time for fatigue trajectories on depression, anxiety, personal control and illness cognitions. Fatigue severity and physical symptoms at T1, but not demographic or clinical factors, were predictive of fatigue severity at T3.ConclusionsFatigue is very common during psycho-oncological care, and notably not clinically improving. As symptoms of fatigue, depression, anxiety and physical symptoms often cluster, supplementary fatigue treatment should be considered when it is decided to treat other symptoms first.

Maternal depression is associated with cognitive, emotional, and behavioral problems in offspring, but the substantial heterogeneity of depression precludes a full understanding of these associations. Variation in course of depression, characterized by severity or chronicity, may be related differentially to children's development. The current meta-analytic review examined the relations of these characteristics of maternal depression to children's developmental outcomes. Twenty-nine studies were identified and reviewed; the majority (93%) of studies reported a negative association between some aspect of maternal depression and children's adjustment. Separate meta-analyses revealed significant effect sizes for severity (Fisher's z = -.243) and chronicity (adjusted Fisher's z = -.337) of maternal depression and children's cognitive or behavioral functioning. Findings are synthesized across features of maternal depression; methodological limitations within the empirical literature are discussed; and recommendations for future research are suggested. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

OBJECTIVE Abstinence is rarely achieved in clinical trials for cannabis use disorder (CUD). Cannabis reduction is associated with functional improvement, but reduction endpoints have not been established, indicating a need to identify and validate clinically meaningful reduction endpoints for assessing treatment efficacy. METHOD Data from a 12-week double-blind randomized placebo-controlled medication trial for cannabis cessation (NCT01675661) were analyzed. Participants (N = 225) were treatment-seeking adults, M = 30.6 (8.9) years old, 70.2% male, and 42.2% Non-White, with CUD who completed 12 weeks of treatment. Frequency (days of use per week) and quantity (grams per using day) were used to define high-, medium-, and low-risk levels. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale and cannabis-related problems were assessed using the Marijuana Problems Scale. General linear models for repeated measures tested associations between the magnitude of risk reduction and functional outcomes from baseline (BL) to end-of-treatment (EOT). RESULTS Cannabis risk levels were sensitive to reductions in use from BL to EOT for frequency- (χ² = 19.35, p = .004) and quantity-based (χ² = 52.06, p < .001) metrics. Magnitude reduction in frequency-based risk level was associated with magnitude decrease in depression (F = 2.76, p = .043, ηp² = .04), anxiety (F = 3.70, p = .013, ηp² = .05), and cannabis-related problems (F = 8.95, p < .001, ηp² = .12). Magnitude reduction in quantity-based risk level was associated with magnitude decrease in anxiety (F = 3.02, p = .031, ηp² = .04) and cannabis-related problems (F = 3.24, p = .023, ηp² = .05). CONCLUSIONS Cannabis use risk levels, as operationalized in this study, captured reductions in use during a clinical trial. Risk level reduction was associated with functional improvement suggesting that identifying risk levels and measuring the change in levels over time may be a viable and clinically meaningful endpoint for determining treatment efficacy. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objectives: To characterize attitudes and perceptions regarding risks and benefits of cannabis before Canadian legalization for recreational use, both in general and between cannabis users and nonusers. Methods: A cross-sectional sample of community adults assessed in the month before legalization (September 17 to October 17, 2018). Overall, 1,480 individuals (60% female) of an average age of 34.5 years (±13.92) were included in the analysis; 48% reported cannabis use in the past 6 months. Attitudes and perceptions were assessed using a subset of items from the Canadian Cannabis Survey, the National Survey on Drug Use and Health, and the Risks and Benefits of Cannabis Use. Results: Most commonly identified risks of cannabis were impaired memory (67%) and legal problems (54%). Most also identified addiction as a risk (52%), although 25% reported that cannabis was not addictive. The most commonly identified benefits were for pain relief (94%) and management of stress, anxiety, or depression (80%). Active cannabis users systematically reported lower endorsement of risks and higher endorsement of benefits. Only 6% of respondents anticipated increasing cannabis use postlegalization. Among other legal substances, medical cannabis was considered the most socially acceptable, followed by alcohol, recreational cannabis, electronic cigarettes, and then combustible cigarettes. Conclusion: Before legalization, attitudes toward cannabis in this sample of Canadian adults were generally favorable, particularly for medical cannabis. Perceptions of risk were often compatible with existing evidence, but notable proportions underendorsed risk of cannabis use disorder and overendorsed benefits for mental health. These results suggest priorities for public health messaging and provide benchmarks for understanding attitudinal changes postlegalization.

Background Major depressive disorder (MDD) is a common and highly heterogeneous psychiatric disorder but little is known about the genetic characterisation of this heterogeneity. Understanding the genetic etiology of MDD can be challenging as large sample sizes are needed for gene discovery – often achieved with a trade-off in the depth phenotyping. Methods The Australian Genetics of Depression Study is the largest stand-alone depression cohort with both genetic data and in-depth phenotyping and comprises a total of 15,792 participants of European ancestry, 92% of whom, met diagnostic criteria for MDD. We leveraged the unique nature of this cohort to conduct a meta-analysis with the largest depression GWAS to date and subsequently used polygenic scores (PGS) to investigate genetic heterogeneity across various clinical subtypes of MDD. Results We increased the number of known genome-wide significant variants associated with depression from 103 to 126 and found evidence of association of novel genes implicated in neuronal development. We show that a PGS for depression explains 5.7% of variance in MDD liability in our sample. Lastly, we find strong support for genetic heterogeneity in depression with differential associations of multiple psychiatric and comorbid traits with age of onset, longitudinal course and various subtypes of MDD. Conclusions Until now, this degree of detailed phenotyping in such a large sample of MDD cases has not been possible. Along with discovery of novel loci, we provide support for differential pathways to illness models that recognize both the overlap with other common psychiatric disorders, as well as pathophysiological differences.

BackgroundOnline mental health platforms can improve access to, and use of, mental health support for young people who may find it difficult to engage with face-to-face delivery.ObjectiveWe modelled predictors of engagement and symptom change in adolescent users of the Togetherall (formerly “Big White Wall”) anonymous digital mental health peer-support platform.MethodsWe report a retrospective analysis of longitudinal user data from UK 16–18 year Togetherall users, referred from mental health services (N = 606). Baseline demographics were reported for participants who logged anxiety and depression measures. Number of log-ins, mean session duration, total usage time, number of guided support courses and self-help materials accessed were our usage metrics. Participant characteristics and symptoms were used to predict engagement. For n = 245 users with symptom measures at >1 timepoint we modelled the effect of predictors on symptom scores.ResultsMean logins was 5.11 and mean usage time was 64.22 mins. Participants with one log-in represented 33.5% of the sample. Total time accessing Togetherall predicated greater usage of self-help materials and courses. Females made greater use of materials and courses than males. In a subsample, higher baseline depression and anxiety, longer total usage time and mean session duration predicted final depression scores, whereas higher baseline depression and anxiety and greater accessed self-help materials predicted lower final anxiety scores.LimitationsA naturalistic design was used and symptom modelling should be interpreted with caution.ConclusionsFindings suggest adolescents can engage with the Togetherall platform. Baseline symptoms and characteristics can inform user engagement with digital platforms.

Objectives Cancer is the second leading cause of mortality in the world, and represents an economic, social and psychological burden. Scientific studies have focused on psychosocial coping mechanisms of patients and on factors improving their quality of life. Thus, the aim of the present study is to analyze the influence that spirituality would have on the quality of life of Lebanese cancer patients and to identify whether the influence on quality of life is mediated through a decreased depression. Methods This is a cross-sectional study targeting cancer patients in the hemato-oncology department of the Hotel-Dieu de France Hospital (Beirut, Lebanon). It is based on a questionnaire composed of three parts: EQ-5D-5L, PHQ-9, and FACIT-Sp-12. Likewise, a control group suffering from chronic diseases and treated in the hospital was questioned. Univariate and multivariate analysis were conducted to assess the relationship between the different questionnaires for controls and for cancer patients. Results Thirty-nine cancer patients and eight control patients were questioned. In the univariate analysis, there was no relationship between depression and spirituality nor for spirituality and quality of life. After controlling for depression, an inverse correlation between quality of life and spirituality was shown. Conclusions Our study is a pilot study which for the first time investigates the implication of depression in a “spirituality-quality of life” association. There is no clear association of spirituality with quality of life. In fact, the physical and psychological burden of chronically ill patients could exceed and render insignificant a possible impact of spirituality on quality of life.

Anxiety and depression are highly prevalent and disabling mental health disorders, with comorbidity often posing as a barrier to successful treatment outcomes, thus creating a need for more intensive treatment options. Outpatient clinicians are more likely to refer patients with severe symptoms of anxiety and depression to inpatient hospitalizations rather than partial hospital programs (PHPs) or intensive outpatient programs (IOPs), despite evidence that inpatient hospitalization is associated with high costs and other risks following discharge. The present study reviews two case studies of patients who received cognitive-behavioral therapy/dialectical behavior therapy (CBT/DBT)-based IOP treatment in a private New York clinic. We evaluated treatment outcomes for 73 adult patients (50.7% female) with a mean age of 29.10 years (SD = 10.30). At intake, patients averaged 2.15 diagnoses (SD = 0.94, range = 4) and the majority (80.8%) were prescribed psychotropic medication. Treatment was structured and individually tailored, with patients receiving an average of 21.77 hours (SD = 15.06) of psychotherapy over 12.63 treatment sessions (SD = 9.76), across 12.21 days (SD = 9.61). We observed a clinically and statistically significant change in symptoms of anxiety (t = 6.24, p

Background COVID-19 is a global pandemic that has raised worldwide public health concerns. The wide spread of the virus has led to unprecedented disturbance to regular life for people around the globe and impacted their mental health. Aims The aims of the current study were to investigate the prevalence of psychiatric symptoms related to insomnia, depression, and anxiety, and identify risk factors contributing to psychological stress in Lebanese young population during COVID-19 pandemic. Method A cross-sectional study was done on the Lebanese young population. Participants were 4397 males and females aged 18 to 35 years who filled a self-administered online questionnaire. Three validated scales were used to measure the mental health status of the participants during the COVID-19 pandemic: 7-item Insomnia Severity Index for insomnia, the Patient Health Questionnaire 9-item depression module for depression, and the 7-item Generalized Anxiety Disorder scale for anxiety. Results The median interquartile range scores for anxiety, insomnia, and depression, were 8 (4–13), 10 (5–14), and 9 (5–12) respectively. Higher anxiety scores were reported with female gender (P

Survivors Healing from Abuse: Recovery through Exposure (SHARE) is a brief, exposure-based group treatment for incarcerated female survivors of sexual violence. Preliminary evaluations of SHARE showed declines in depression and posttraumatic stress disorder (PTSD) symptoms from pre- to posttreatment. However, prior investigations have not included a longitudinal follow-up period and thus knowledge of whether therapeutic benefits persist following the termination of the group is lacking. Here, we examined data from 57 incarcerated women who completed SHARE and provided follow-up data while still incarcerated (M = 95 days posttreatment). Results from a one-way repeated-measures ANOVA showed significant reductions in PTSD and depression symptoms from pre- to posttreatment (large effect sizes), with symptoms further reduced during the follow-up period. In addition, McNemar tests showed a significant reduction in the proportion of participants at or above the clinical cut-off for probable PTSD and depression from pre- to posttreatment as well as from posttreatment to the follow-up assessment. Together, results suggest that the therapeutic benefits of SHARE persist after treatment is completed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

To develop a questionnaire-based Active Mobility Index (AMI) to assess going-out behavior with physical and social activity among older adults, and to assess the criterion-related and predictive validity of the AMI.Prospective cohort study.General community setting. Participants comprised 4432 older adults [mean age: 75.9 ± 4.3 (70-96) years; 2100 men (47.4%)].AMI assessed life-space and activities in each life-space (distance from the respondent's home:1 km, 1-10 km, or10 km) according to physical or social activity during the past 1 month by noting frequency, purpose, type of transportation, interaction with others, and physical activity. Baseline characteristics and outcomes were compared by AMI score quartiles (highest: Q4). To examine the criterion-related validity of AMI, depressive symptoms, frailty, and cognitive function were assessed. During follow-up, incident disability was monitored by Long Term Care Insurance certification.Lower scores (Q1-Q3 groups) were associated with more depressive symptoms, frailty, and cognitive impairment compared with the Q4 group (all P.001). Multiple logistic regression analyses revealed significantly higher odds ratios in the Q1 group in all health adverse outcomes compared with the Q4 group [depressive symptoms, odds ratio (OR) 3.94, 95% confidence interval (CI) 2.95-5.28; frailty, OR 3.20, 95% CI 2.31-4.44; cognitive impairment, OR 1.28, 95% CI 1.04-1.57]. Cox proportional hazards modeling indicated that the Q1 group had a higher risk of incident disability compared with the group (hazard ratio 1.53, 95% CI 1.24-1.88).AMI to assess life-space with physical and social activity among older people was associated with depressive symptoms, frailty, and cognitive impairment. Lower AMI scores were associated with higher incident disability risk. Further studies are needed to elucidate whether AMI is causally associated with incident adverse health outcomes.

Psychological and psychosocial functioning of binary transgender and nonbinary youth has been understudied in settings treating individuals at risk for psychiatric hospitalization. Further, little is currently known about potential differences in baseline levels of psychiatric distress and adaptive functioning across gender-diverse youth and their psychiatrically distressed cisgender counterparts. Key differences may elucidate avenues for adapted treatment and protocols among youth presenting for psychiatric care. Archival data of 426 youth (Mage = 14.94, SD = 1.5 years) referred to a psychiatric Intensive Outpatient Program (IOP) were used to examine differences in self-reported domains of psychological (e.g., depression, anxiety, Posttraumatic Stress Disorder [PTSD], emotion dysregulation) and psychosocial (e.g., parental and interpersonal relations) functioning across gender. The group included N = 272 cisfemale (64.1%), N = 137 cismale (32.2%), N = 10 transgender (2.3%) and N = 7 nonbinary (1.6%) self-identified youth. Cismales reported the lowest levels of distress and highest levels of adaptive functioning as compared to the other groups, whereas binary transgender and cisfemale youth did not significantly differ across any measured domain. Nonbinary youth reported higher levels of anxiety, hyperactivity, psychological inflexibility, and inadequacy than cisfemales, but largely did not differ from binary transgender youth. Beyond statistical comparisons, nonbinary youth demonstrated globally elevated levels of psychiatric distress and compromised adaptive functioning, with most ratings falling in the clinically significant and/or at-risk ranges. Results highlight the need for clinicians to carefully attend to unique needs of nonbinary youth and for future research to expand upon our preliminary findings. Clinical implications are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objective: \ud To identify prognostic factors for health outcomes following an eight-week supervised exercise therapy and education program for individuals with knee and hip osteoarthritis (OA) alone or with concomitant hypertension, heart or respiratory disease, diabetes, or depression.\ud \ud Methods: \ud We included individuals with knee and/or hip OA from the Good Life with osteoArthritis in Denmark (GLA:D®). GLA:D® consists of two patient education sessions and 12 supervised exercise therapy sessions. Before GLA:D®, participants self-reported any comorbidities and were categorized in eight comorbidity groups. 21 potential prognostic factors (demographics, clinical data, and performance-based physical function) gathered from participants and clinicians before the program were included. Outcomes were physical function using the 40-m Fast-Paced Walk Test (FPWT), health-related quality of life using the EQ-5D-5L index score, and pain intensity using a visual analogue scale (0-100, VAS) assessed before and immediately after the GLA:D® program. Within each comorbidity group, associations of prognostic factors with outcomes were estimated using multivariable linear regression.\ud \ud Results: \ud Data from 35,496 (40-m FPWT) and 37,576 (EQ-5D-5L and VAS) participants were included in the analyses. Clinically relevant associations were demonstrated between age, self-efficacy, self-rated health, and pain intensity with change in 40-m FPWT, EQ-5D-5L or VAS across comorbidity groups. Furthermore, anxiety, education, physical function, and smoking were associated with outcomes among subgroups having depression or diabetes in addition to OA.\ud \ud Conclusion: \ud Age, self-efficacy, self-rated health, and pain intensity may be prognostic of change in health outcomes following an eight-week exercise therapy and patient education program for individuals with OA, irrespective of comorbidities.

Purpose Literature is scarce regarding cancer care utilization during the massive outbreak of coronavirus disease 2019 (COVID-19) in the Republic of Korea. We investigated functional impairments in mental health and their relationships with depression, anxiety regarding the viral epidemic, and disruptions in healthcare service utilization among cancer patients in the COVID-19 pandemic era.Materials and Methods We used an online survey with questions related to the disturbances faced by patients with cancer in utilizing healthcare services in the pandemic era. Current mental health status was assessed using the Work and Social Adjustment Scale (WSAS), Stress and Anxiety to Viral Epidemics-6 (SAVE-6) scale, Patient Health Questionnaire-9 (PHQ-9), Insomnia Severity Index (ISI), Brief Resilience Scale (BRS), Cancer-Related Dysfunctional Beliefs about Sleep Scale (C-DBS), and Fear of COVID-19 over Cancer (FCC).Results Among the 221 responders, 95 (43.0%) reported disruptions in healthcare service utilization during the COVID-19 pandemic. Logistic regression analysis revealed that functional impairment in the mental health of these patients was expected due to disruptions in healthcare service utilization, high levels of depression, anxiety regarding the viral epidemic, fear of COVID over cancer, and low resilience. Mediation analysis showed that patient resilience and cancer-related dysfunctional beliefs about sleep partially mediated the effects of viral anxiety on functional impairment.Conclusion In this pandemic era, patients with cancer experience depression, anxiety regarding the viral epidemic, and disruptions in healthcare service utilization, which may influence their functional impairments in mental health.

Introduction: The COVID-19 quarantine has greatly affected university students in Peru, generating a series of physical, psychological and behavioral effects. Objective: To determine the factors associated with anxiety, depression, somatization and experiential avoidance in peruvian university students quarantined by COVID-19. Methods: A cross-sectional observational study was carried out. The sample was made up of 1264 university students from various departments of Peru, anxiety, depression, somatization and experiential avoidance were taken as dependent variables, which were evaluated with the questionnaire "The Inventory of unadjusted psychosocial behavior, in the presence of COVID-19 in the Peruvian population” and the AAQ II, for the statistical analysis the chi square was used Results: More than half of the university students in Peru present between 3 and 6 of the 6 anxiety indicators, and this same number of depression indicators is presented by 45% of the sample. 30% of the sample has between 3 and 6 indicators of somatization and 40.3% of the sample is located in the middle upwards on the experiential avoidance scale. Conclusions: There are differences in the levels of anxiety, somatization and experiential avoidance between men and women, it was also found that older students had lower levels of anxiety, depression and experiential avoidance, but not in somatization.

Marital problems are one of the leading causes of depression in low income countries. In collectivistic cultures, inability to bear child makes individual more vulnerable towards depression. An increasing body of literature suggests the efficacy of solution-focused brief therapy for depressive disorders. People with eagerness to see change and not showing response for cognitive behaviour therapy respond to solution-focused brief therapy. This case study describes the course of major depressive disorder in a 39-year-old female and treatment strategy of solution-focused brief therapy. The client in this case responded to the therapy and also showed optimistic change in her attitude. Treatment implications of solution-focused brief therapy with its effectiveness on females with major depressive disorder have been discussed in the article.

The current study aimed to investigate the lived experiences about Stigma and Discrimination among participants diagnosed with Depression. Transcendental phenomenology was used as a research inquiry by focusing on Husserl’s concept of epoch and bracketing in order to get a fresh perspective towards the phenomenon under investigation. Purposive sampling was employed to recruit a sample of 10 participants diagnosed with Depression with a duration of at least one year from out-patient’s settings of Lahore-based private and government hospitals. The DSM-V Cross Cutting Symptoms Measures level I were utilized to screen participants on comorbidity and the severity level of Depression. Furthermore, the interview was used as a data collection measure by exploring in depth semi-structured interview guide with the screened participants. The Van Kaam modified method for analysis was rigorously followed by the researchers through a series of steps such as epoche, phenomenological reduction (horizontalization and invariant constituents), and imaginative variation (individual structural and textural description). The composite description of the essence of the experiences revealed contextual factors of Stigma and Discrimination, experiences of stigma, and strategies needed to reduce Stigma and Discrimination about Depression. The study highlighted the need to develop culture-sensitive stigma reducing intervention to establish contact between patient diagnosed with Depression and the first level service provider.

Surgery for head and neck cancers are associated with significant preoperative stress. We investigated the effects of progressive muscle relaxation (PMR) on postoperative pain, fatigue, and vital signs in patients with head and neck cancers.All patients were hospitalized and randomly assigned to intervention or usual care groups. A generalized estimating equation was used to evaluate the PMR effects on pain and symptoms across the preoperative day to postoperative day 10.The PMR group displayed significantly lower overall pain and muscle tightness than control group along with the timeline of multiple measurements (p 0.01). PMR significantly reduces sleep disturbances and levels of fatigue, anxiety, and depression compared with the control group with time trend (p 0.01). PMR also lowered the respiratory rates and diastolic blood pressure (p 0.01).PMR can reduce sleep disturbances and levels of pain, fatigue, muscle tightness, anxiety, and depression in patients with head and neck cancer undergoing major surgeries. Future study should focus on improving the effectiveness of the exercise and standardization of the application.progressive muscle relaxation help relieve discomforts in patients with head and neck cancers with minimal costs and efforts.

Objective Sexual minority female (SMF) veterans experience unique stressors apart from their service in the military. In this study, we compared SMF and heterosexual female (HF) veterans' rates of deployment-related stressors (i.e., military sexual assault, combat exposure, and harassment), posttraumatic stress disorder (PTSD), and major depressive disorder (MDD) and their association with one another. Method Participants were 699 female veterans who provided self-report data on exposure to deployment-related stressors and were assessed for MDD and PTSD by trained diagnosticians. Results SMF and HF veterans had similar rates of PTSD, MDD, and deployment-related stressors. However, deployment-related stressors were less likely to be associated with diagnosis or symptoms of either PTSD or MDD among SMF veterans. Conclusion SMF veterans may have unique stressors driving their development of MDD and PTSD. Understanding how different military stressors may confer risk for SMF veterans versus HF veterans is necessary to provide informed and sensitive clinical care to SMF veterans. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Abstract. Background: High rates of psychological distress are reported in functional conditions and vascular stroke, but there is limited understanding of how patients with functional neurological symptoms in stroke settings respond to symptoms. Aims: This study compared patients with functional stroke symptoms to those with vascular stroke and chronic fatigue syndrome (CFS). Methods: A prospective cohort of 56 patients with functional stroke symptoms were age-gender matched to patients with vascular stroke and CFS. Analysis of variance compared groups on cognitive and behavioral responses to symptoms, psychological distress, and functioning. Sensitivity analyses controlled for known confounders. The proportions of clinical anxiety and depression were compared between groups. Results: The functional stroke symptom group had a higher proportion of clinical anxiety cases than the CFS group, and a higher proportion of clinical depression cases than the vascular stroke group. Patients with functional stroke symptoms reported the highest rate of “damage beliefs” and “all-or-nothing” behaviors and greater symptom focusing and resting behavior than patients with vascular stroke. Limitations: Larger cohorts and a longitudinal design would strengthen study findings. Conclusion: Compared to patients with vascular stroke or CFS, patients with functional stroke symptoms show a somewhat distinct profile of illness-related beliefs and behaviors, as well as higher rates of clinical anxiety. Understanding such group differences provides some insights into aetiology and cognitive-behavioral responses. Appropriate support and referral should be available to patients with functional stroke symptoms to address distress and reduce the likelihood of severe impairment.

International audience; Background: Outpatient physicians in private practice, as inpatient physicians, are on the frontline of the COVID-19 pandemic. Mental-health consequences of the pandemic on hospital staff have been published, but the psychological distress among outpatient physicians in private practice due to COVID-19 has never been specifically assessed.Methods: A French national online cross-sectional survey assessed declared psychological distress among outpatient physicians in private practice linked to COVID-19, sociodemographic and work conditions, mental health (Copenhagen Burn-out Inventory, Hospital Anxiety and Depression Scale, and the Insomnia severity Index), consequences on alcohol, tobacco, and illegal substance misuse, and sick leave during the 2nd COVID-19 wave.Findings: Among the 1,992 physicians who answered the survey, 1,529 (76.8%) declared psychological distress linked to COVID-19. Outpatient physicians who declared psychological distress linked to COVID-19 had higher rates of insomnia (OR = 1.4; CI95 [1.1-1.7], p = 0.003), burnout (OR = 2.7; CI95 [2.1; 3.2], p < 0.001), anxiety and depressive symptoms (OR = 2.4; CI95 [1.9-3.0], p < 0.001 and OR = 1.7; CI95 [1.3-2.3], p < 0.001) as compared to physicians who did not. They also had higher psychotropic drug use in the last twelve months, or increased alcohol or tobacco consumption due to work-related stress and were more frequently general practitioners.Interpretation: The feeling of being in psychological distress due to COVID-19 is highly frequent among outpatient physicians in private practice and is associated with mental health impairment. There is a need to assess specific interventions dedicated to outpatient physicians working in private practice.

Background and objective Psychiatric comorbidity is common among veterans with posttraumatic stress disorder (PTSD), but there is little known about the patterns of co-occurring mental health problems and implications for treatment. The aim of this study was to identify comorbidity profiles among veterans at treatment intake and assess associations with PTSD and quality of life (QOL) outcomes. Method The study included 2,522 veterans accessing outpatient treatment for PTSD in Australia who self-completed measures of comorbid issues including depression, anger, alcohol use problems, guilt, and dissociation. Latent Profile Analysis (LPA) was used to identify subgroups based on comorbidity profiles, and their association with outcomes. Results LPA suggested 5 comorbidity profiles: (a) low comorbidity severity, (b) moderate comorbidity severity with low alcohol, (c) moderate comorbidity severity with high alcohol, (d) high comorbidity severity with low alcohol, and (e) high comorbidity severity with high alcohol. The absence of alcohol problems was associated with improved treatment outcomes when overall comorbidity severity was high but not moderate. While all profiles evidenced symptom improvement from intake to discharge and follow-up, this did not correspond to quality of life improvements equally across classes. The highest severity comorbidity class experienced no improvement on psychological quality of life. Conclusions The comorbidity profiles of veterans in treatment for PTSD can be distinguished by levels of severity and the specific presence or absence of alcohol use problems. Alcohol use problems have discernible implications for treatment in the context of comorbidity. Group treatments for PTSD should consider tailoring interventions to comorbidity profiles. (PsycINFO Database Record (c) 2019 APA, all rights reserved).