Comparison of mental health indicators in clinical psychologists with the general population during the COVID-19 pandemic.

Mental healthcare professionals face diverse challenges during the COVID-19 pandemic, which may augment their risk of experiencing adverse mental health outcomes themselves. We aimed to compare depressive, anxiety, insomnia, and stress symptoms in Austrian clinical psychologists during the COVID-19 pandemic with the Austrian general population. A total of N = 172 Austrian clinical psychologists (91.9% women; mean age: 44.90 ± 7.97 years) participated in an online survey in spring 2022. A representative sample (N = 1011) of the Austrian general population was surveyed simultaneously. Symptoms of depression (PHQ-2), anxiety (GAD-2), insomnia (ISI-2), and stress (PSS-10) were assessed. Differences in the prevalence of clinically relevant symptoms were analyzed using univariate (Chi-squared tests) and multivariable (binary logistic regression including covariates age and gender) analyses. Clinical psychologists showed lower adjusted odds for exceeding the cut-offs for clinically relevant depression (aOR 0.37), anxiety (aOR 0.50), and moderate to high stress levels (aOR 0.31) compared to the general population (p < 0.01). No difference was observed for insomnia (aOR 0.92; p = 0.79). In conclusion, clinical psychologists experience better mental health than the general population during the COVID-19 pandemic. Future studies are needed to analyze the underlying reasons.

Did the mental health and well-being of young people increase after the COVID-19 vaccination campaign period? A cross-sectional multicentre study in Austria and Turkey.

In 2019, the global Coronavirus (COVID-19) pandemic and associated prevention measures affected the mental health and psychological well-being of young people with and without a migratory background. The present study aimed to compare the mental health and psychological well-being of migrant and non-migrant young people before and after the COVID-19 vaccination campaign period in two countries which had different policies to deal with the pandemic. The "Psychological General Well-being" of young people and their experiences during the pandemic were investigated using an anonymous online survey during two pandemic waves before the vaccination campaign and 6 months after its start. A majority of the 6154 participants (aged between 15 and 25 years in all study groups) reported a decrease of mental health from the time period before the vaccination (BV) to after the vaccination (AV) campaign (b = 0.27, p < .001). This association was higher in females (b = 0.04, p = 0.008) and in youth with financial problems (b = 0.13, p < .001). Furthermore, this decrease was more pronounced in people ≤17 years old (40% to 62%) than in those >17 years (59% to 67%). Contrary to expectation, vulnerable groups such as the economically disadvantaged, younger, and female participants did not experience a significant easing of the pandemic's psychological burden AV. Vaccination campaigns should continue emphasizing the beneficial effects of COVID-19 vaccination on general well-being, but with an acknowledgement that the road to recovery is still a long one. Concurrently, free access to psychological treatment and financial support should be offered, especially for vulnerable groups. Supplementary Information: The online version contains supplementary material available at 10.1007/s12144-023-04366-x.

The impact of the CoVid-19 pandemic on rates of adolescents receiving psychopharmacological medication in Austria (preprint)

Background: The CoVid-19 pandemic has impacted many aspects of everyday life, including the (mental) health care system. An increase in depression and anxiety symptoms has been reported worldwide, which is particularly pronounced in females and young people. We aimed at evaluating changes in patient rates of those receiving psychopharmacological medication, often used in treating depression and anxiety. Method: Based on data of the Austrian public health insurance institutions, we conducted an interrupted time series analysis of antidepressants, antipsychotics and benzodiazepines comparing patient rate developments before and throughout the Covid19 pandemic (2013 to 2021), with a special focus on adolescents in comparison to the general population. Age- and sex specific ARIMA models were fitted to the pre Corona period (2013 Q1 – 2020 Q2), used to generate forecasts for the period from 2020 Q3 to 2021 Q4 and then compared to observed developments in the same period to assess significant deviations from the forecasted expactable development paths. Results: A significant excess of patients receiving antidepressants both among male and female adolescents (10-14 and 15-19 years) in comparison to the expectable development path was found in most of the evaluated period (2020 Q3 – 2021 Q4), while the general population was found to be mostly within 97.5% confidence bands of the forecasts. With regards to antipsychotics, the interrupted time series analysis showed a significant excess of patients in the group of female adolescents in almost all quarters, which was especially pronounced in the age group 15-19. Antipsychotics patient rates within the general population only showed significant excess in two quarters. No significant uptake beyond the expactable development paths were found in regard to prescriptions of benzodiazepines in any group. Conclusion: Increased rates of patients receiving antidepressants and antipsychotics, which were especially pronounced in female adolescents, echo epidemiological evidence from multiple studies worldwide reporting an increase in depression and anxiety. Whereas the increasing rates of adolescent patients receiving antidepressants correspond with the use of this medication class as proposed in treatment guidelines for the respective disorders, the increased patient rates in antipsychotics might be understood as a signal for the off-label use of these compounds.

Conspiracy beliefs and COVID-19 guideline adherence in adolescent psychiatric outpatients: the predictive role of adverse childhood experiences.

BACKGROUND: Conspiracy beliefs have become widespread throughout the COVID-19 pandemic. Previous studies have shown that endorsing conspiracy beliefs leads to lower protective guideline adherence (i.e., wearing face masks), posing a threat to public health measures. The current study expands this research across the lifespan, i.e., in a sample of adolescents with mental health problems. Here, we investigated the association between conspiracy beliefs and guideline adherence while also exploring the predictors of conspiracy beliefs. METHODS: N = 93 adolescent psychiatric outpatients (57% female, mean age: 15.8) were assessed using anonymous paper-pencil questionnaires. Endorsement of generic and COVID-19 conspiracy beliefs was assessed, in addition to items measuring adherence to protective guidelines and mental health (stress, depressive symptoms, emotional/behavioral problems, and adverse childhood experiences). Multiple regressions and supervised machine learning (conditional random forests) were used for analyses. RESULTS: Fourteen percent of our sample fully endorsed at least one COVID-19 conspiracy theory, while protective guidelines adherence was relatively high (M = 4.92, on a scale from 1 to 7). The endorsement of COVID-19 conspiracy beliefs-but not of generic conspiracy beliefs-was associated with lower guideline adherence (ß = - 0.32, 95% CI - 0.53 to - 0.11, p < .001). Conditional random forests suggested that adverse childhood experiences and peer and conduct problems were relevant predictors of both conspiracy belief categories. CONCLUSION: While a significant proportion of our sample of adolescents in psychiatric treatment endorsed conspiracy beliefs, the majority did not. Furthermore, and to some degree, contrary to public perception, we found that adolescents show relatively good adherence to public health measures-even while experiencing a high degree of mental distress. The predictive value of adverse childhood experiences and peer/conduct problems for conspiracy beliefs might be explained by compensatory mechanisms to ensure the safety, structure, and inclusion that conspiracies provide.

Coping styles mediating the relationship between perceived chronic stress and conspiracy beliefs about COVID-19

As a global health crisis, COVID-19 has led to a rise in overall stress levels. Concurrently, conspiracy beliefs regarding the origin and spread of the disease have become widespread. Engaging in such beliefs can be explained as a form of coping in order to deal with elevated levels of stress. The present study investigated the indirect effects of coping strategies in the association between perceived chronic stress and COVID-related conspiracy beliefs. We report data from an online survey (N = 1,354 individuals: 807 female;508 male;8 diverse;6 not specified;mean age 39.14 years) in German-speaking countries collected between January and March 2021. Our results indicate that people who felt more stressed were more prone to conspiracy beliefs. Coping via acceptance and self-blame was associated with decreased tendencies towards COVID-related conspiracy beliefs, while people who used denial as a strategy were more prone to these beliefs. These findings emphasize the need for stress management interventions and effective coping strategies during times of crisis in order to reduce chronic perceived stress, promote adaptive coping, and ultimately reduce conspiracy beliefs.

Radical Acceptance of Reality: Putting DBT®-A Skill Groups Online During the COVID-19 Pandemic: A Qualitative Study.

Introduction: Emotion dysregulation is a common challenge pertaining to numerous psychiatric disorders in adolescence and is associated with increased morbidity and mortality. Dialectical Behavior Therapy for Adolescents (DBT®-A) has been shown to be an effective treatment, especially in the reduction of self-harm and suicidality. Measures in relation to the COVID-19 pandemic set strict limits on physical contacts with patients. In order to continuously provide evidence-based specialized care to patients suffering from emotion dysregulation, we offered two online DBT®-A skill groups in a video-group-call format. Objective: We aimed at assessing our online DBT®-A skills groups, collect according up- and downsides, and form a basis for advancement of this form of treatment provision. Also, the impact of the COVID-19 pandemic on patients was assessed. Methods: A physical DBT®-A skill group was switched to a video-group-call format and a second group was initiated de novo online. After five sessions, patients engaged in structured group discussions to reflect experiences. Discussion content was analyzed via Inductive Category Formation within the Framework of Qualitative Content Analysis. Results: Patients unanimously found the COVID-19 pandemic challenging, but also reported differentially on its impact. Downsides were balanced by subjective "gains" in time and a perceived reduction in stress. Technical problems of the online format were discussed, but did not limit the positive experience of still receiving treatment. Patients of both online DBT®-A skill groups valued the offer, felt connected, and reported benefits from the treatment. The transition group additionally discussed changes in structure and content of the group sessions after the switch to online meetings and reflected differential functions of the group. Discussion: Although the sample size is small, and conclusions are drawn from Inductive Qualitative Content Analysis, the presented results are of interest. In our investigation, video-group-calls were both safe and beneficial for patients. This alternative to physical meetings is not only interesting for further waves of the current pandemic but also for service provision in remote areas with limited access to specialized care. Further research is needed to challenge and refine our results and to explore extensions to "basic" video-group-calls, such as "break-out sessions," blended therapy, or real-time supervision within an online session.

Radical Acceptance of Reality: Putting DBT®-A Skill Groups Online During the COVID-19 Pandemic: A Qualitative Study

Introduction Emotion dysregulation is a common challenge pertaining to numerous psychiatric disorders in adolescence and is associated with increased morbidity and mortality. Dialectical Behavior Therapy for Adolescents (DBT®-A) has been shown to be an effective treatment, especially in the reduction of self-harm and suicidality. Measures in relation to the COVID-19 pandemic set strict limits on physical contacts with patients. In order to continuously provide evidence-based specialized care to patients suffering from emotion dysregulation, we offered two online DBT®-A skill groups in a video-group-call format. Objective We aimed at assessing our online DBT®-A skills groups, collect according up- and downsides, and form a basis for advancement of this form of treatment provision. Also, the impact of the COVID-19 pandemic on patients was assessed. Methods A physical DBT®-A skill group was switched to a video-group-call format and a second group was initiated de novo online. After five sessions, patients engaged in structured group discussions to reflect experiences. Discussion content was analyzed via Inductive Category Formation within the Framework of Qualitative Content Analysis. Results Patients unanimously found the COVID-19 pandemic challenging, but also reported differentially on its impact. Downsides were balanced by subjective “gains” in time and a perceived reduction in stress. Technical problems of the online format were discussed, but did not limit the positive experience of still receiving treatment. Patients of both online DBT®-A skill groups valued the offer, felt connected, and reported benefits from the treatment. The transition group additionally discussed changes in structure and content of the group sessions after the switch to online meetings and reflected differential functions of the group. Discussion Although the sample size is small, and conclusions are drawn from Inductive Qualitative Content Analysis, the presented results are of interest. In our investigation, video-group-calls were both safe and beneficial for patients. This alternative to physical meetings is not only interesting for further waves of the current pandemic but also for service provision in remote areas with limited access to specialized care. Further research is needed to challenge and refine our results and to explore extensions to “basic” video-group-calls, such as “break-out sessions,” blended therapy, or real-time supervision within an online session.

Does the Progression of the COVID-19 Pandemic Have an Influence on the Mental Health and Well-Being of Young People? A Cross-Sectional Multicenter Study.

The COVID-19 pandemic has been shown to have impaired the mental health and well-being of young people. This study, for the first time, explores these aspects in young people with and without a migratory background during the extended course of the pandemic and restrictive measures, comparing two countries with a high COVID-19 prevalence: Austria and Turkey. METHODS: The authors used the "Psychological General Well-being" index as part of an anonymous online survey with 3665 participants (ages 15-25), recruited from both countries during the first and the second waves of the pandemic, collecting data on individual experiences and problems encountered during the pandemic. RESULTS: Mental health (b = 0.06, p < 0.023) and general psychological well-being worsened with the progression of the pandemic. Participants with financial problems had the most severe negative effect on mental health (b = 0.12, p < 0.001). Furthermore, females living in Turkey, both natives (b = -0.21, p < 0.001) and migrants (b = 0.25, p < 0.001), reported a more deteriorated mental health status over time. CONCLUSIONS: The extended pandemic duration and resultant "lockdown" restrictions have negatively affected the mental health of young people to varying degrees, depending on country of residence and migration background. A strong "recovery plan" that considers group-specific needs and vulnerabilities is urgently needed.

Refractory myasthenic crisis in a patient with refractory Myasthenia gravis and COVID-19

Background and aims: Myasthenia gravis (MG) is an autoimmune, antibody-mediated disease of the neuromuscular junction causing muscle weakness. Due to immunosuppression and possible respiratory/bulbar muscle weakness, MG patients are at risk for developing severe coronavirus disease 2019 (COVID-19). Methods: Case report. Results: A 62years old patient suffered from bulbar onset generalized MG with acetylcholine receptor antibodies since eight months. He survived two prior MC and was nourished via percutaneous enterogastrostomy (PEG) despite symptomatic treatment and immunosuppression with azathioprine and steroids (severity graded according Myasthenia gravis foundation of America score (MGFA) IVb). He presented with fever, cough and severe generalised muscle weakness. Polymerase chain reaction confirmed COVID-19, ventilatory failure prompted mechanical ventilation (MV). Intravenous immunoglobulins (ivIg) and pyridostigmine i.v. were given. Weaning had to be postponed because of respiratory muscle weakness and septicaemia with Enterobacter cloacae, treated with appriopriate antibiotics. Not until removal of PEG sepsis resolved and plasmapheresis (PLEX) was conducted. The patient reached spontaneous breathing via tracheostomy, but still needed nasogastric tube feeding (MGFA V). Because of missing further progress of bulbar muscle function complement inhibition with eculizumab was administered (900mg 1 x weekly for four weeks, thereafter 1200mg every two weeks). After the second dose tracheostomy and nasogastric tubes could be removed, bulbar and generalized weakness resolved on follow-up (MGFA IIa). Conclusion: Our patient experienced MC triggered by COVID-19 and suffered from prolonged sepsis. After failure of standard treatments (IvIg/PLX) eculizumab was given, followed by marked recovery. The role of complement inhibition for treatment of refractory myasthenic crises should be further studied.

'The world somehow stopped moving': impact of the COVID-19 pandemic on adolescent psychiatric outpatients and the implementation of teletherapy.

BACKGROUND: The COVID-19 pandemic results in disproportional consequences for psychiatric patients. Due to restraints in physical contacts, providers switched from face-to-face contacts to teletherapy, but prior experiences were mostly limited. The study aimed at assessing symptom dynamics, potentially increased adversities and factors influencing a successful transition into teletherapy in adolescent psychiatric outpatients during the COVID-19 pandemic. METHOD: Thirty adolescent psychiatric outpatients participated in an interview-based study. The differential impact of the COVID-19 pandemic was measured by integrating patients' and psychiatrists' judgements. RESULTS: Patients who reported deteriorated symptoms and patients who showed (partial) improvement of symptomatology could be separated by feelings of isolation (specific to deterioration) and perceived reduction in school-associated stress (unique to improvement). Patients with worsening symptomatology showed a significantly higher degree of psychosocial disability before lockdown and at the first interview. Patients who deteriorated in their level of psychosocial functioning also reported negatively on teletherapy. These patients were verbally less differentiated concerning emotions and affect, reported introspection and rumination, and stated distinctly lower levels of perceived social support. Concerning adversities, no clear trend could be identified, but some patients reported increased domestic violence and neglect. CONCLUSIONS: Patients with a higher degree of psychosocial disability suffer disproportionally from the crisis, so that an assessment of functioning should serve as a triage tool. Also, a screening of the perceived level of social support should be established before offering teletherapy. Additionally, the provision of strategies to enhance verbalisation and differentiation of emotions and affect might be beneficial.

The Impact of the COVID-19 Pandemic on Mental Health and Psychological Well-Being of Young People Living in Austria and Turkey: A Multicenter Study.

Little is known about the impact of the COVID-19 pandemic on the mental health and psychological well-being of young people. The aim of this study is to investigate the psychological well-being and changes in the mental-health state of young people living in Austria and Turkey. By using an anonymous online survey, we recruited 1240 people aged 15-25 years from these two countries. We used the "Psychological General Well-being" and a self-created questionnaire to capture individual experiences during the COVID-19 pandemic and quarantine period. The native Turks indicated higher "anxiety" (ps < 0.010), lower "vitality" (ps < 0.011), and lower "general health" (ps < 0.011) than native Austrians or Austrian migrants and increased "depression" (p = 0.005) and lower "self-control" (p = 0.022), than Austrian migrants. Moreover, 50.9% of native Turks reported a decrease in their mental health status, compared to 31.1% of native Austrians and 23.7% of Austrian migrants. Participants with financial problems (OR = 1.68) and prior mental health problems (i.e., already in treatment by the time of COVID-19, OR = 5.83) reported a higher probability for a worsening in their mental health status. Our results show that the COVID-19 pandemic impaired the psychological well-being and mental health of young people. Especially people in Turkey were most affected, probably due to the stringent policies to fight COVID-19.

“Bridge over troubled water”: A first look at adolescent psychiatric outpatients transited from regular care to teletherapy during the COVID-19 outbreak using quantitative and qualitative analyses. (preprint)

BackgroundAdolescents suffering from psychiatric disorders are at risk of disproportionally suffering from the current COVID-19-pandemic. We aimed to assess their specific needs and to evaluate factors influencing a successful transition into teletherapy.MethodsThirty adolescent psychiatric outpatients participated in a series of interviews. The primary outcome was the level of psychosocial functioning. Secondary outcome were potential changes in differential symptom domains. Additionally, answers to open questions were analysed qualitatively.ResultsWithin-group effect size estimates revealed a significant decrease in the level of functioning within the first two months after transition from face-to-face therapy (M = 2·7, SD = 1·258) to teletherapy (M = 3·0, SD = 1·245) (T29 = -2·536, p = 0·017, d = 0·46). Qualitative analysis revealed a marked difference in the level of perceived social support in the subgroup of patients who deteriorated in their level of functioning. Those patients also showed a lower degree of verbal differentiation concerning emotions and affect, as well as a higher degree of introspection and rumination. ConclusionsDespite an overall deterioration, in absolute numbers most patients showed a stagnation in their level of functioning, even if difficulties were expressed. The most prominent difference in the subgroup who showed a decreased level of functioning, was the lack of perceived social support. Provision of strategies to enhance verbalisation and differentiation of emotions and affect might be beneficial.