Showing papers in "Journal of Nervous and Mental Disease in 2021"

Moral Injury and Burnout in Health Care Professionals During the COVID-19 Pandemic.

Abstract: The coronavirus pandemic (COVID-19) is predicted to increase burnout in health professionals (HPs), but little is known about moral injury (MI) in this context. We administered the Moral Injury Symptoms Scale for Health Professionals (MISS-HP) and the abbreviated Maslach Burnout Inventory via online survey to a global sample of 1831 HPs in April and October 2020. Mean MISS-HP increased from 27.4 (SD, 11.6) in April to 36.4 (SD, 13.8) in October (p < 0.001), with an accompanying increase in personal accomplishment (April: 4.7; SD, 3.1; October: 9.3; SD, 3.1; p < 0.001) and no change in other burnout subscales. In April, 26.7% of respondents reported at least moderate functional impairment from MI, increasing to 45.7% in October (p < 0.001). Predictors of MISS-HP included younger age and being a nurse. Odds of functional impairment were higher in respondents who were widowed, divorced, never married, or had direct experience caring for patients with COVID-19. COVID-19 has increased MI but not burnout in HPs; younger or unmarried individuals, nurses, and frontline workers may benefit from targeted outreach to reduce downstream effects of MI, depression, and/or posttraumatic stress disorder.

Prevalence and Predictors of Moral Injury Symptoms in Health Care Professionals.

Abstract: This study examined the prevalence and predictors of moral injury (MI) symptoms in 181 health care professionals (HPs; 71% physicians) recruited from Duke University Health Systems in Durham, NC. Participants completed an online questionnaire between November 13, 2019, and March 12, 2020. Sociodemographic, clinical, religious, depression/anxiety, and clinician burnout were examined as predictors of MI symptoms, assessed by the Moral Injury Symptoms Scale-Health Professional, in bivariate and stepwise multivariate analyses. The prevalence of MI symptoms causing at least moderate functional impairment was 23.9%. Younger age, shorter time in practice, committing medical errors, greater depressive or anxiety symptoms, greater clinician burnout, no religious affiliation, and lower religiosity correlated with MI symptoms in bivariate analyses. Independent predictors in multivariate analyses were the commission of medical errors in the past month, lower religiosity, and, especially, severity of clinician burnout. Functionally limiting MI symptoms are present in a significant proportion of HPs and are associated with medical errors and clinician burnout.

The COVID-19 Outbreak and Subjects With Mental Disorders Who Presented to an Italian Psychiatric Emergency Department.

Abstract: We performed a retrospective study from January to May 2020 to establish the sociodemographic and clinical characteristics of patients with mental health problems who arrived at an Italian emergency department during the COVID-19 outbreak. We divided the sample into two groups taking as a watershed March 11, when the World Health Organization announced COVID-19 outbreak as a pandemic. Chi-square/t-tests, adjusted p values (Bonferroni method), and regression analysis were performed. Patients who arrived at the emergency department during the lockdown decreased by 56%; showed greater active suicidal ideation, more tension, and more severe psychopathological state; were living alone more frequently; and were taking home treatment mainly based on second-generation antipsychotics. According to our study, it seems that patients with mental disorders have consulted psychiatric services less frequently during the pandemic, but the economic, health, and social distress may be linked with an increase in suicidal risk and the severity of the psychopathological state.

Generalized Anxiety Disorder During the COVID-19 Outbreak in Iran: The Role of Social Dysfunction.

Abstract: The COVID-19 epidemic has both physical and psychosocial consequences for the general population. The present study aimed to investigate the relationship between the prevalence of generalized anxiety disorder (GAD) and social dysfunction during the COVID-19 epidemic in Iran. This cross-sectional web-based study was conducted on 1000 Rafsanjani citizens in southeastern Iran. Data were collected by using the Generalized Anxiety Disorder-7 and the General Health Questionnaire from March 15 to March 30, 2020. The prevalence of GAD was 27.8%. The mean score of social functioning was 9.71 ± 2.66, and all participants had social dysfunction. Multivariate logistic regression test showed a significant correlation between anxiety and social functioning (confidence interval [CI], 1.16-1.30; p < 0.001), sex (CI, 1.49-3.04; p < 0.001), and concern about COVID-19 (CI, 1.38-2.73; p < 0.001). The COVID-19 epidemic had negative psychosocial consequences in the general population in Iran.

Impact of the COVID-19 Pandemic on the Short-Term Course of Obsessive-Compulsive Disorder.

Abstract: There is an understandable concern that obsessive-compulsive disorder (OCD) may worsen during the COVID-19 pandemic, but there are little empirical data. We report the impact of COVID-19 pandemic on the short-term course of OCD. A cohort of patients with a primary diagnosis of OCD (n = 240) who were on regular follow-up at a tertiary care specialty OCD clinic in India were assessed telephonically, about 2 months after the declaration of the pandemic ("pandemic" cohort). Data from the medical records of an independent set of patients with OCD (n = 207) who were followed up during the same period, 1 year prior, was used for comparison (historical controls). The pandemic group and historical controls did not differ in the trajectories of the Yale-Brown Obsessive-Compulsive Scale scores (chi-square likelihood ratio test of the group × time interaction = 2.73, p = 0.255) and relapse rate (21% vs. 20%; adjusted odds ratio, 0.81; 95% confidence interval, 0.41-1.59; p = 0.535). Preexisting contamination symptoms and COVID-19-related health anxiety measured by the COVID-Threat Scale did not predict relapse. Only a small proportion of patients (6%) reported COVID-19-themed obsessive-compulsive symptoms. The COVID-19 pandemic, at least in the short run, did not influence the course of illness.

Movement Synchrony and Facial Synchrony as Diagnostic Features of Depression: A Pilot Study.

Abstract: The pilot study investigated with a matched-subjects design whether nonverbal synchrony is a diagnostic feature for depression and whether it mediates between depression and postsession ratings of the interviewer behavior. The sample includes n = 15 patients with major depression and n = 15 healthy controls (aged 20-30 years, 40% female). We conducted structured diagnostic interviews for somatic complaints to standardize the recording setting, issue, and course of conversation. Body movements and facial expressions were coded automatically frame by frame using computer vision methods. Ratings of the interviewers' professional behavior and positive affect were assessed using questionnaires. Patients with depression showed less movement synchrony and less synchronous positive facial expressions. Only synchronous positive expressions mediated between depression and less perceived positive affect. We conclude that the applied methodology is well suited to examine nonverbal processes under naturalistic but widely standardized conditions and that depression affects the nonverbal communication in medical conversations.

Patient Access to Mental Health Notes: Motivating Evidence-Informed Ethical Guidelines.

Abstract: In the last decade, many health organizations have embarked on a revolution in clinical communication. Using electronic devices, patients can now gain rapid access to their online clinical records. Legally, patients in many countries already have the right to obtain copies of their health records; however, the practice known as "open notes" is different. Via secure online health portals, patients are now able to access their test results, lists of medications, and the very words that clinicians write about them. Open notes are growing with most patients in the Nordic countries already offered access to their full electronic record. From April 2021, a new federal ruling in the United States mandates-with few exemptions-that providers offer patients access to their online notes (Office of the National Coordinator for Health Information Technology, Department of Health and Human Services, Available at: https://www.govinfo.gov/content/pkg/FR-2019-03-04/pdf/2019-02224.pdf#page=99). Against these policy changes, only limited attention has been paid to the ethical question about whether patients with mental health conditions should access their notes, as mentioned in the articles by Strudwick, Yeung, and Gratzer (Front Psychiatry 10:917, 2019) and Blease, O'Neill, Walker, Hagglund, and Torous (Lancet Psychiatry 7:924-925, 2020). In this article, our goal is to motivate further inquiry into opening mental health notes to patients, particularly among persons with serious mental illness and those accessing psychological treatments. Using biomedical ethical principles to frame our discussion, we identify key empirical questions that must be pursued to inform ethical practice guidelines.

Telehealth and the Community SMI Population: Reflections on the Disrupter Experience of COVID-19.

Abstract: The novel coronavirus pandemic and the resulting expanded use of telemedicine have temporarily transformed community-based care for individuals with serious mental illness (SMI), challenging traditional treatment paradigms. We review the rapid regulatory and practice shifts that facilitated broad use of telemedicine, the literature on the use of telehealth and telemedicine for individuals with SMI supporting the feasibility/acceptability of mobile interventions, and the more limited evidence-based telemedicine practices for this population. We provide anecdotal reflections on the opportunities and challenges for telemedicine drawn from our daily experiences providing services and overseeing systems for this population during the pandemic. We conclude by proposing that a continued, more prominent role for telemedicine in the care of individuals with SMI be sustained in the post-coronavirus landscape, offering future directions for policy, technical assistance, training, and research to bring about this change.

Attached to Virtual Dreams: The Mediating Role of Maladaptive Daydreaming in the Relationship Between Attachment Styles and Problematic Social Media Use.

Abstract: Maladaptive daydreaming describes excessive fantasy activity that interferes with an individual's life. Surprisingly, the precursors of maladaptive daydreaming and its role in excessive involvement in virtual worlds have been scarcely investigated. In the current study, we examined the relationships among attachment styles, maladaptive daydreaming, and problematic social media use (PSMU) in a sample of community-dwelling adults. Eight hundred seventy-seven participants between 18 and 68 years old were recruited via an online survey and asked to fill out self-reported measures on attachment styles, maladaptive daydreaming, and PSMU. Mediation analyses showed that maladaptive daydreaming is a significant mediator in the relationships between preoccupied and fearful attachment styles and PSMU, suggesting that maladaptive daydreaming partly explains the established link between insecure attachment styles and excessive use of social media. Individuals with PSMU fostered by maladaptive daydreaming may benefit from clinical interventions that promote the use of adaptive regulatory strategies to develop feelings of security and self-confidence that may serve to reduce the excessive involvement in social media.

History of childhood trauma and association with borderline and dissociative features

Abstract: Both borderline personality features and dissociative symptoms have been associated with different types of childhood trauma. The aim of this investigation was to analyze to what extent emotional, physical, and sexual child maltreatment predict borderline personality features and dissociative symptoms. For this purpose, we analyzed data from 86 consecutively admitted patients who completed the Borderline Symptom List, the Childhood Trauma Questionnaire, and the German version of the Dissociative Experiences Scale for differential diagnosis of a borderline personality disorder. Hierarchical regression analyses revealed that borderline features were mainly predicted by emotional abuse, whereas pathological dissociation was best predicted by sexual and physical abuse. This evidence supports the hypothesis that different kinds of maltreatment may lead to different psychopathological symptoms in adulthood and should be taken into account in the therapy.

Religiosity and Spirituality in the Stages of Recovery From Persistent Mental Disorders.

Abstract: The impact of religiosity and spirituality (R/S) on mental health and the importance of incorporating R/S in mental health treatment have been previously explored. However, clarification is needed regarding the effects of R/S in the process of recovery from persistent mental disorders (PMDs). This study identifies how different R/S factors correlate with the stages of recovery, while considering individual psychological well-being and perceived social support. Seventy-five individuals who use Madrid's public services for people with PMD completed questionnaires assessing those factors. We found that during the recovery process, R/S correlated with psychological well-being and perceived social support, and that these variables were associated with the five stages of recovery differently. We further identified the importance of gratitude, compassion, inner peace, and connection with life in the recovery process. Overall, our findings highlight the importance of these R/S variables in particular recovery stages for individuals with PMD.

Mindfulness, Posttraumatic Stress Symptoms, and Posttraumatic Growth in Aid Workers: The Role of Self-Acceptance and Rumination.

Abstract: Objective: The risk for aid workers to develop posttraumatic mental problems highlights the importance of reducing the harm of posttraumatic stress symptoms (PTSS) and promoting the benefits of posttraumatic growth (PTG). This study examined the negative relationship between mindfulness and PTSS, and the positive relationship between mindfulness and PTG, and further explored the mediating roles of self-acceptance, intrusive rumination, and deliberate rumination. Methods: Aid workers from the Red Cross Organization (N = 298) were recruited in the study. They completed a series of questionnaires assessing mindfulness, self-acceptance, rumination, posttraumatic stress disorder (PTSD), and PTG. Results: Results showed that mindfulness was significantly and negatively associated with PTSD through positively predicting self-acceptance and negatively predicting intrusive rumination. Mindfulness was significantly and positively associated with PTG, although the mediating effect did not exist because the path between self-acceptance and deliberate rumination was impassable. Conclusion: The mechanisms between mindfulness, PTSD, and PTG were further explored. Limitations and implications for trauma intervention and future research were discussed.

Pathway Linking Different Types of Childhood Trauma to Somatic Symptoms in a Subclinical Sample of Female College Students: The Mediating Role of Experiential Avoidance.

Abstract: Research has shown that women are more prone to childhood trauma and this state is associated with somatic symptoms. Also, people who have been exposed to traumatic experiences use experiential avoidance to reduce negative emotions. However, the mediating role of experiential avoidance in the relationship between childhood trauma and somatic symptoms is not clear, so, the present study investigated whether the relationships among different types of childhood trauma and somatic symptoms could be explained by experiential avoidance in female college students. In a cross-sectional study, 251 Iranian female college students with somatic symptoms were recruited from the University of Tabriz. Participants completed self-report scales, including the Persian version of Child Abuse Self-Reported Scale, Acceptance and Action Questionnaire-II (AAQ-II), and the Patient-health questionnaire (PHQ-15). A path analysis was used to empirically explore the relationships. Structural equation modeling analyses confirmed a partial mediation model. Study participants who had a higher level of emotional trauma reported higher levels of somatic symptoms. Emotional and neglect trauma showed significant positive relations with experiential avoidance. Bootstrapping results showed that experiential avoidance partially mediated the relationship between emotional trauma and somatic symptoms. Moreover, the association between neglect and somatic symptoms was fully mediated by experiential avoidance. These findings suggest that experiential avoidance might be one mechanism explaining how adverse emotional and neglect experiences influence somatic symptoms. Interventions addressing experiential avoidance through methods such as emotion-focused therapy and mindfulness are discussed as potential future directions for treating somatic symptoms in females who experienced emotional and neglect trauma

The Effectiveness of Cognitive Behavioral Therapy Techniques for the Treatment of Substance Use Disorders: A Narrative Review of Evidence

Abstract: Substance use disorders (SUDs) are characterized by a recurrent and maladaptive use of drugs and/or alcohol. Cognitive behavioral therapies (CBTs) comprise different types of interventions: traditional CBT and the more recent "third wave" behavior therapies, such as acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), mindfulness-based cognitive therapy (MBCT), and schema therapy (ST). We searched English-language articles published between 2014 and present. This review includes randomized controlled trials (RCTs), quasi-RCTs, pilot studies, and reviews of CBTs for SUDs available on PubMed. Results seem to indicate that CBT and MBCT are effective interventions for SUDs; however, the studies showed a high degree of heterogeneity, so no exhaustive conclusions could be outlined at this time. ACT and DBT in SUD management are limited to few studies and results are therefore inconclusive.

Associations Between Cyberbullying Perpetration, Sleep Quality, and Emotional Distress Among Adolescents: A Two-Wave Cross-Lagged Analysis.

Abstract: Previous studies demonstrate that cyberbullying perpetration and sleep quality likely have vital linkages to each other and to emotional distress. In this article, we examine the bidirectional association between cyberbullying perpetration, sleep quality, and emotional distress in a longitudinal data set with two waves of data collection (T1 and T2, 8 months apart). The participants included 661 Chinese junior high school students (n = 661; mean age, 14.02; 61.4% male) who filled out the Revised Cyber Bullying Inventory-Cyberbullying Subscale, Pittsburgh Sleep Quality Index, and Depression Anxiety Stress Scales. Results revealed that cyberbullying and sleep quality would predict each other over time, and significant bidirectional relationships were found between sleep quality and emotional distress across T1 and T2. Cyberbullying at T1 would not predict the emotional distress at T2, whereas emotional distress at T1 was associated with cyberbullying at T2.

Telepsychiatry in Low- and Middle-Income Countries During COVID-19: Pandemic, Barriers, and Road Model.

Abstract: To date, there is lack of specific effective treatment or vaccine for the SARS-CoV-2, and clinical and laboratory research is still ongoing to find successful drugs. Therefore, prevention to be infected through social distancing and isolation is the most effective way. However, all the other physical and mental illnesses continue to exist, if possible even more burdened by the emergency situation and social distancing. The COVID-19 pandemic, especially in many low- and middle-income countries, has caused a deeper gap in seeking psychiatric help. In this scenario, telepsychiatry could play a decisive role in implementing clinical care for frail patients and ensuring continuous mental care. Therefore, we felt the urge to write this article to express our hope that the old health care system at this time of crisis, as we know it, can offer the chance to implement pervasive care technologies that perfectly fit current psychiatric needs.

Should Catatonia Be Conceptualized as a Pathological Response to Trauma

Abstract: Although catatonia is related to several medical conditions, catatonia as a response to trauma and posttraumatic stress disorder (PTSD) is less clear. The aim of this review is to explore the small emerging body of preliminary evidence that suggests a possible correlation between psychological trauma and catatonia. Initial data suggests a correlation between episodes of intense fear associated with trauma and PTSD and some forms of catatonic responses. Although this relationship is still speculative to be causative, it can have important implications if confirmed. This is especially salient when it is examined alongside existing studies of the response to fear in animals and the phenomenon of tonic immobility, which bears a striking resemblance to catatonia in humans. If prospective studies further support the initial findings, it could change our conceptual understanding of the etiology of a subtype of catatonia substantially while pointing to likely targets of further research to understand the biological mechanisms that underlie the illness.

Oral Versus Long-Acting Injectable Antipsychotic Treatment for People With Severe Schizophrenia: A 5-Year Follow-up of Effectiveness.

Abstract: The objective here is to compare the effectiveness of long-acting injectable antipsychotics (LAI-APs) and oral ones (OAPs) in patients with severe (Global Clinical Impression-Severity ≥ 5) schizophrenia (N = 688). A 5-year follow-up study has been conducted in patients undergoing standard treatment in mental health units (MHUs) or on a severe mental illness program (SMIP). A total of 8.7% of the patients on the SMIP discontinued treatment, whereas 43.6% did so in MHUs (p < 0.0001). In both cases, treatment retention was significantly higher in patients on LAI-APs (p < 0.001). Also, hospital admissions were in both cases fewer among those on LAI-APs (p < 0.001). There was a significant link between suicide attempts and OAP treatment (p < 0.01). Given the relationship between the use of LAI-APs versus oral treatments in achieving higher adherence and less relapses and suicide attempts, the use of second-generation antipsychotics LAIs should be considered more suitable for people with severe schizophrenia.

Predicting Posttraumatic Stress and Depression Symptoms Among Frontline Firefighters in China.

Abstract: To investigate the prevalence and comorbidity rate of potential posttraumatic stress disorder (PTSD) and depression in frontline firefighters in China, as well as to analyze the related predictive factors for PTSD and depression, our study included 261 firefighters who completed assessments including the Demographic Data Forum, PTSD Checklist for DSM-5, Center for Epidemiological Studies Depression Scale, Chinese version of Perceived Stress Scale, and Perceived Social Support Scale. Among the participants, 1.9% and 11.9% were identified as having potential PTSD and depression, respectively. There was a 9.1% chance of comorbid PTSD among the depressed firefighters and a 60% chance of comorbid depression among the firefighters with PTSD. Perceived stress positively predicted both PTSD and depression; perceived social support negatively predicted both PTSD and depression. Whereas family exogenous support predicted both PTSD and depression, family endogenous support only predicted depression. In addition, PTSD was predicted by rank. Soldiers and sergeants demonstrated higher level of PTSD than officers. Future studies on mental health of firefighters should take factors like perceived stress, social support, and rank into consideration.

The Psychopathology, Depression, and Anxiety Levels of Children and Adolescents With Vasovagal Syncope: A Case-Control Study.

Abstract: Vasovagal syncope constitutes 61% to 80% of syncope cases in the pediatric age group. Syncope is frequently associated with psychopathologies such as depressive disorders, anxiety disorders, somatization disorders, etc. Our study aims to evaluate vasovagal syncope cases in terms of additional psychopathologies, depression, and anxiety levels with a control group. A total of 97 people were included in the study (47 cases and 50 controls). After conducting a cardiological examination, the participants were evaluated for psychopathologies using Kiddie-Sads-Present and Lifetime Version, Child Depression Inventory, and Screen for Child Anxiety Related Emotional Disorders. The case group had a higher rate of psychopathology compared with the control group. Depression, social anxiety disorder, generalized anxiety disorder, separation anxiety, and conversion disorder were significantly higher in the case group than in the control group. Syncope in children can be an underlying psychopathology or the clinical manifestation of a psychosomatic condition. Psychological assessment, which could offer beneficial contributions to the diagnosis and treatment of syncope, was considered necessary for a holistic evaluation of patients.

The Problem of Aggregating Validators for Psychiatric Disorders.

Abstract: Since the time of the Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition, evidence for the validity of psychiatric disorders has been expressed in the form of validators, which are instances of particular kinds of evidence. There has never been an explicit discussion of how the validators should be aggregated to come to an overall conclusion about the strength of the evidence for a psychiatric category. We include both the challenges of aggregating validators of the same type and the challenges of aggregating different types of validators. We consider five different alternatives: informal aggregation, weighted informal aggregation (simple evidence hierarchy), formal aggregation, underdetermination, and inclusion of values. Each of the alternatives has different implications. We suggest that, going forward, aggregation of validators should be more explicit, maximizing rigor and reproducibility.

Uncertainty in the Time of Corona: Precautionary Adherence, Fear, and Anxiety in New York City During the COVID-19 Pandemic.

Abstract: The recent COVID-19 pandemic is having profound impacts on every sector of society, and New York City (NYC) emerged as an early epicenter of the disease. Given the novelty and scale of the disease, information surrounding COVID-19 has been marked by considerable uncertainty and confusion. Although various factors have been associated with COVID-19 distress, little is known about the relations between levels of intolerance of uncertainty (IU) and anxiety symptoms and behaviors. This cross-sectional study sought to examine potential correlates and pathways between anxiety and precautionary behaviors with the two levels of IU: prospective and inhibitory. Individuals from NYC (N = 99) completed an online survey through Amazon Mechanical Turk. Findings revealed that fear of COVID-19 accounts for associations between prospective IU and greater anxiety symptoms and behaviors, whereas precaution adherence accounts for associations between prospective IU and reduced anxiety symptoms and behaviors. In addition, precaution adherence accounts for associations between inhibitory IU and greater anxiety symptoms and behaviors. The results shed light on ways in which variations in IU may be associated with anxiety symptoms and behaviors in the context of COVID-19 and future pandemic scenarios.

The Moderating Effect of Older Adults' Receptive Arts Engagement on the Association Between Resilience and Anxiety Symptoms During Coronavirus Breakout.

Abstract: In this study, we evaluated whether levels of receptive arts engagement (visiting museums/concerts/the theater/the cinema) during the year preceding the COVID-19 outbreak may have served as a psychological resource for older adults that mitigated the association between resilience levels and COVID-19 anxiety when the pandemic broke out. Data were collected after the enactment of the first emergency regulations (between March 15 and April 1, 2020) via the Qualtrics Survey Software link that was sent out through social media platforms. In total, 205 participants aged 65 to 92 (mean age, 72.32; SD, 5.63) reported general anxiety symptom levels (GAD-7) (Spitzer et al., 2006), resilience (Connor-Davidson Resilience Scale), frequency of receptive arts engagement in the previous year, health status, exposure to risk situations, and behavioral changes due to the pandemic. Our hypothesis that receptive arts would moderate the resilience-COVID-19 anxiety link was examined by a multiple hierarchical regression analysis and with the PROCESS computational tool. Findings show that resilience was associated with COVID-19 anxiety and that this association was moderated by levels of receptive arts engagement. The findings show that high levels of prior art engagement constituted a potent buffer against subsequent COVID-19 anxiety. Policy makers may benefit older adults by encouraging their engagement in arts activities, even during social distancing.

The Effects of Maintenance Electroconvulsive Therapy on Hospitalization Rates

Abstract: This study aimed to study the effect of maintenance electroconvulsive therapy (mECT) on hospitalization rates in patients who had been readmitted after acute courses of electroconvulsive therapy (ECT), and determine the most frequently used treatment schedules in mECT. Patients who had undergone mECT treatment for the last 5 years were retrospectively reviewed. Seventy patients were included in the study. The control group of 70 patients was selected from patients who received only acute ECT. Of the patients in the mECT group, 55.8% (39) were female, and 41.4% (29) were diagnosed with major depressive disorder. The mean number of patients hospitalized who received mECT after acute ECT was 0.55 ± 0.87, whereas it was 1.13 ± 1.31 in patients who received only pharmacotherapy after ECT in a covariant analysis adjusted for age and diagnosis. The most commonly used initial treatment protocol of mECT was weekly × 4, biweekly × 2, and monthly × 6. mECT is more effective in reducing hospitalization after acute ECT treatments than using psychotropic drugs alone for maintenance therapy.

National Prevalence Rates of Suicidal Ideation and Suicide Attempts Among Adults With and Without Depression.

Abstract: Using the 2018 National Survey on Drug Use and Health, this study examined the US national prevalence rates of suicidal ideation (SI) and suicide attempts (SA) among four demographic adult groups (race-sex, age, education, and marital status) with and without major depressive episode (MDE). The highest prevalence rates of SI for those with and without MDE occurred among adults 18 to 25 years, with some college education, White females and males, and unmarried and never been married. Among the same demographic groups, proportions of SA were also the highest for those with MDE. A Pearson chi-square test confirmed significant associations between MDE and SI and between MDE and SA. The model fit results showed that the four variables were significant predictors of SI and SA (p < 0.05). Serious mental health needs are unmet, especially among adults with depression. Population-based clinical interventions are needed to reduce rates of depression, SI, and SA.

Who Uses Veterans Mental Health Services?: A National Observational Study of Male Veteran and Nonveteran Mental Health Service Users.

Abstract: Mental health (MH) research among veterans receiving services from the Veterans Health Administration (VHA) is extensive and growing and informs many clinical practice guidelines. We used nationally representative survey data to examine the generalizability of this extensive body of research by comparing sociodemographic and clinical characteristics of male veteran veterans health service (VHS) users (n = 491) with veteran non-VHS users (n = 840) and nonveteran (n = 6300) MH service users. VHS users were older, more often reported Black race, and less likely to have private or Medicaid insurance, but had similar prevalence of psychiatric or substance use disorder diagnoses but with a greater prevalence of posttraumatic stress disorder (PTSD). VHS users reported higher rates of medical diagnoses, pain interference, and poorer physical and MH status. These results suggest that VHA MH research may be reasonably generalizable to US mental health service users with caveats regarding age, PTSD diagnosis, pain, and racial distribution.

Differential Association of Spirituality and Religiosity With Rumination: Implications for the Treatment of Depression.

Abstract: Recent studies have shown that religiosity (R) is associated with lower rates of depression, whereas spirituality (S) is associated with higher rates. Rumination has also been associated with higher rates of depression. Some have hypothesized that rumination mediates the differential association of religiosity and spirituality with depression. We empirically test this hypothesis in a longitudinal, multigenerational sample through associations between rumination and depression, R/S and depression, and R/S and rumination. Cross-sectionally, total rumination scores were predicted by spirituality (standardized β = 0.13; 95% confidence interval [CI], 0.00-0.26), with subscale (reflection, depression, and brooding) standardized betas ranging from 0.11 to 0.15 (95% CI, -0.03 to -0.29). Cross-sectionally, rumination was not predicted by religiosity. Longitudinally, and consistent with previous findings, religiosity, but not spirituality, predicted reduced depressive symptoms (standardized β = -0.3; 95% CI, -0.58 to -0.01). The association between spirituality and rumination was driven by millennials. Psychotherapies that target rumination for depression might therefore be especially effective in the millennial demographic.

What Ever Happened to Nostalgia (the Diagnosis)

Abstract: Nostalgia and homesickness are not currently regarded as mental disorders. The psychic pain associated with longing to return home had been considered a mental disorder for centuries, especially in Europe, where it was a sign of moral weakness between nations. Nostalgia's effects on American Civil War soldiers-anxiety, depression, and sleep and appetite disturbances, for example-were described by clinicians and linked to significant morbidity and mortality. Since then, although these effects of combat have been of interest, focus has shifted to psychic trauma, relegating the concept of nostalgia to an unclassified but commonly encountered condition. Besides wartime trauma, symptomatic conditions related to nostalgia have been described among displaced persons and refugees living in the diaspora longing for their homelands (e.g., social displacement syndrome). More recently, nostalgia has pervaded culture as a benign pastime, with no implications for psychopathology. Finally, the longing for return to an idyllic or imagined lifestyle has returned amid worldwide quarantining and isolation during the COVID-19 pandemic. In this new sense, nostalgia has become a remedy rather than a disease. We identify four major iterations of nostalgia: the medical condition of homesickness, the condition studied in wartime, the application to migration and social displacement, and as a remedy for existential anxiety. We conclude that nostalgia per se is neither pathological nor normative, but a consistent phenomenon in human existence that should not be overlooked in cultural assessment and psychotherapy.

Psychological Impact of COVID-19 on Pregnancy.

Abstract: D epression and anxiety in the population related to fear, uncertainty, isolation, and economic distress have increased during the COVID-19 pandemic. A 2020 cross-Canada study found that 24.3% of younger adult women reported feeling depressed occasionally or most of the time in the past week, significantly higher than 18.9% of men (CAMH [Centre for Addiction and Mental Health], 2020). This is perhaps in part a reflection of the fact that these women are in their reproductive years. Women who are pregnant or postpartum have an increased risk of developing a depression or anxiety disorder. Pregnancy during this pandemic brings an added number of stressors (Durankuş andAksu, 2020; Lebel et al., 2020; Liu et al., 2020). A recent report from the Centers for Disease Control and Prevention (CDC) noted that pregnant women are especially vulnerable to getting more seriously ill or dying with COVID-19 (CDC 2020). This information increases women's fears for themselves and their babies. Fortunately, it does not seem as if there is an increased risk of fetal malformation if the mother has COVID-19. There does seem to be an increase in premature deliveries inwomenwith COVID-19 (12.6%) (Delahoy et al., 2020). The risk of transmitting COVID-19 to the fetus does not seem to be high. There have been few documented cases of women with COVID-19 having babies with COVID-19, and in these cases, it is not clear whether the baby acquired COVID-19 from the mother in utero, through breastfeeding, or by other transmission. Regardless, babies who developed this tend to have mild symptoms. Nevertheless, this kind of concern puts added pressure on women and, in particular, on women of color who already grapple with social and health care inequalities. If they have jobs that require them to leave the house, they are increasingly anxious. Many quit their jobs to stay at home to be safer (Forbes, 2020), but not all women have this option. If their partners are still leaving the house towork, their anxiety is increased. Fear of attending obstetrical appointments can lead to inadequate prenatal care. They often feel quite isolated, unable to see family or friends during a time when they would like more support. Pregnant and breastfeeding women are unsure about getting vaccinations for COVID-19. Although the CDC and American College of Obstetricians and Gynecologists (ACOG) have provided guidelines for getting these vaccines during pregnancy, there is lack of reassuring data to support decisionmaking because pregnant women were excluded from trials (ACOG, 2020; CDC, 2021) In addition, international health care organizations varied in their recommendations. In the United Kingdom, the National Health Service initially warned against vaccination in pregnant women and recommended a delay in conception until 2 months after vaccination. After a lot of advocacy (BMJ Blogs, 2021), they reversed their decision, advising that pregnant and breastfeeding women could be vaccinated (NHS, 2021). This initial censure against the COVID-19 vaccines may have left many women confused and unsure of their safety, negatively impacting the utility and uptake of vaccination in this population. Pregnant women also have concerns about the delivery. Their ideas of how they wanted this to occur may be dramatically altered, a known risk factor for a woman viewing her birth as traumatic. Over a quarter of women report having a traumatic birthing experience, and subsequent development of postpartum posttraumatic stress disorder can occur after mismatch of expectations of the birthing experience and the reality of it (Olde et al., 2006).