Dramatic increase of suicidality in children and adolescents after COVID-19 pandemic start: A two-year longitudinal study

The COVID-19 pandemic has impacted the mental health of the youngest, worsening their emotional well-being. The demand for care in psychiatric emergencies may indirectly reflect the mental health state of children and adolescents and the emotional consequences of the pandemic. Moreover, suicidality can be considered a marker of severity in this population group. Therefore, we have aimed to longitudinally describe the number of children and adolescents attended in the psychiatry emergency department due to suicidal ideation or attempts and, to explore differences in suicidality according to gender and age. A retrospective study was carried out in the University Hospital of San Juan, Alicante, Spain, from 01.01.2018 to 31.12.2021. A total of 138 participants under 18 years requesting psychiatric care due to suicidal ideation or attempts were included. The sample was composed by 35% of males and the mean age was 14.8 years old (SD = 2.2). The number of cases per year range from 10 in 2018 to 88 in 2021. Attendances were significantly higher between 2021 and the three previous years. Besides, the number of attentions registered in the last 9 months of 2021 equals those that occurred in the entire previous period. Most of the cases were girls and middle adolescents. Suicide ideation or attempts have skyrocketed in children and adolescents. This alarming increase presents a one-year lag peak from the COVID-19 outbreak and continues until the end of 2021. Girls and those over 12 years have been identified as risk groups to present suicidal ideation or attempts.

Childhood maltreatment and social functioning in psychotic disorders: a systematic review protocol.

Background: Childhood maltreatment (CM) is thought to play a key role in the etiology and course of psychotic disorders (PD). In addition, CM is related to neurobiological and clinical characteristics that can lead to poor social functioning. However, the extent to which CM and social functioning are directly associated in individuals with PD, is unclear. Therefore, we aim to systematically review the literature to provide an estimate on the strength of the association between CM and different domains of social functioning in PD and to summarize potential moderators and mediators of this association.Methods and analysis: To identify relevant studies, we will systematically search the following databases: Pubmed (Medline), PsycInfo, Embase, Web of Science (Core Collection), and Pilots (trauma), manually search reference lists and contact experts in the field. Studies will be included if they investigate and report on the association between CM (exposure) and social functioning (outcome) in adults with PD. Two independent reviewers will screen titles, abstracts and full texts according to eligibility criteria, perform data extraction and assess study quality according to a modified version of the Newcastle-Ottawa Scale.Analysis: Effect estimates will be pooled in a meta-analysis. Heterogeneity and publication bias will be assessed and the effects of potential moderators (genetic factors, type of diagnosis, duration of illness, type of CM and age at the time of CM exposure) will be analyzed using meta-regressions. Candidate moderators and mediators (neurocognition, cognitive schemas, comorbidities, stress sensitivity, attachment) will be also examined qualitatively.Ethics and dissemination: Because this review will make use of already published data, ethical approval will not be sought. This work has the potential to inform upcoming investigations on the association between the exposure to CM in PD and social functioning. PROSPERO registration number CRD42020175244.

The first systematic review (and meta-analysis) of the association between CM and different domains of social functioning in individuals with PD.Evidence on both moderators and mediators of the association is summarized.

Nutrition, Epigenetics, and Major Depressive Disorder: Understanding the Connection.

Major depressive disorder (MDD) is a complex, multifactorial disorder of rising prevalence and incidence worldwide. Nearly, 280 million of people suffer from this leading cause of disability in the world. Moreover, patients with this condition are frequently co-affected by essential nutrient deficiency. The typical scene with stress and hustle in developed countries tends to be accompanied by eating disorders implying overnutrition from high-carbohydrates and high-fat diets with low micronutrients intake. In fact, currently, coronavirus disease 2019 (COVID-19) pandemic has drawn more attention to this underdiagnosed condition, besides the importance of the nutritional status in shaping immunomodulation, in which minerals, vitamins, or omega 3 polyunsaturated fatty acids (ω-3 PUFA) play an important role. The awareness of nutritional assessment is greater and greater in the patients with depression since antidepressant treatments have such a significant probability of failing. As diet is considered a crucial environmental factor, underlying epigenetic mechanisms that experience an adaptation or consequence on their signaling and expression mechanisms are reviewed. In this study, we included metabolic changes derived from an impairment in cellular processes due to lacking some essential nutrients in diet and therefore in the organism. Finally, aspects related to nutritional interventions and recommendations are also addressed.

What about mental health after one year of COVID-19 pandemic? A comparison with the initial peak.

A psychiatric epidemic has accompanied the COVID-19 pandemic and specific vulnerable populations have been identified. We aimed to explore the presence of anxiety, acute stress and depression among these vulnerable groups after a year of pandemic and relate them to our previous results obtained with the same methodology during the initial peak of the pandemic in Spain. A total of 2182 participants conducted a national survey, starting on March 2021. Sociodemographic information and clinical symptoms were assessed. The sample was divided into four groups in order to develop four substudies with these results: 1) Healthcare workers presented lower anxiety, acute stress, and depression than non-Healthcare workers (p < 0.001), being nurses the most affected. 2) People with mental disorders experienced higher anxiety, acute stress, and depression than people without (p < 0.001), as well as a higher rate of COVID cases (14% vs. 9.3%, p = 0.041). 3) People ≥60 years old presented lower anxiety and acute stress than people <60, (p < 0.05) and a weaker depressive syndrome (p = 0.003). 4) Males presented lower anxiety, acute stress and depression than females (p < 0.001). According to the results obtained during the initial peak, Healthcare workers have developed efficient coping strategies, while elders have managed to maintain their previously emotional balance. Notwithstanding, women and people with mental disorders continue to be vulnerable to emotional distress after a year of pandemic. Women and people with mental disorders continue to be especially vulnerable to emotional distress after a year of pandemic.

Areas of Interest and Social Consideration of Antidepressants on English Tweets: A Natural Language Processing Classification Study.

BACKGROUND: Antidepressants are the foundation of the treatment of major depressive disorders. Despite the scientific evidence, there is still a sustained debate and concern about the efficacy of antidepressants, with widely differing opinions among the population about their positive and negative effects, which may condition people's attitudes towards such treatments. Our aim is to investigate Twitter posts about antidepressants in order to have a better understanding of the social consideration of antidepressants. METHODS: We gathered public tweets mentioning antidepressants written in English, published throughout a 22-month period, between 1 January 2019 and 31 October 2020. We analysed the content of each tweet, determining in the first place whether they included medical aspects or not. Those with medical content were classified into four categories: general aspects, such as quality of life or mood, sleep-related conditions, appetite/weight issues and aspects around somatic alterations. In non-medical tweets, we distinguished three categories: commercial nature (including all economic activity, drug promotion, education or outreach), help request/offer, and drug trivialization. In addition, users were arranged into three categories according to their nature: patients and relatives, caregivers, and interactions between Twitter users. Finally, we identified the most mentioned antidepressants, including the number of retweets and likes, which allowed us to measure the impact among Twitter users. RESULTS: The activity in Twitter concerning antidepressants is mainly focused on the effects these drugs may have on certain health-related areas, specifically sleep (20.87%) and appetite/weight (8.95%). Patients and relatives are the type of user that most frequently posts tweets with medical content (65.2%, specifically 80% when referencing sleep and 78.6% in the case of appetite/weight), whereas they are responsible for only 2.9% of tweets with non-medical content. Among tweets classified as non-medical in this study, the most common subject was drug trivialization (66.86%). Caregivers barely have any presence in conversations in Twitter about antidepressants (3.5%). However, their tweets rose more interest among other users, with a ratio 11.93 times higher than those posted by patients and their friends and family. Mirtazapine is the most mentioned antidepressant in Twitter (45.43%), with a significant difference with the rest, agomelatine (11.11%). CONCLUSIONS: This study shows that Twitter users that take antidepressants, or their friends and family, use social media to share medical information about antidepressants. However, other users that do not talk about antidepressants from a personal or close experience, frequently do so in a stigmatizing manner, by trivializing them. Our study also brings to light the scarce presence of caregivers in Twitter.

Gut Microbiota Metabolites in Major Depressive Disorder-Deep Insights into Their Pathophysiological Role and Potential Translational Applications.

The gut microbiota is a complex and dynamic ecosystem essential for the proper functioning of the organism, affecting the health and disease status of the individuals. There is continuous and bidirectional communication between gut microbiota and the host, conforming to a unique entity known as "holobiont". Among these crosstalk mechanisms, the gut microbiota synthesizes a broad spectrum of bioactive compounds or metabolites which exert pleiotropic effects on the human organism. Many of these microbial metabolites can cross the blood-brain barrier (BBB) or have significant effects on the brain, playing a key role in the so-called microbiota-gut-brain axis. An altered microbiota-gut-brain (MGB) axis is a major characteristic of many neuropsychiatric disorders, including major depressive disorder (MDD). Significative differences between gut eubiosis and dysbiosis in mental disorders like MDD with their different metabolite composition and concentrations are being discussed. In the present review, the main microbial metabolites (short-chain fatty acids -SCFAs-, bile acids, amino acids, tryptophan -trp- derivatives, and more), their signaling pathways and functions will be summarized to explain part of MDD pathophysiology. Conclusions from promising translational approaches related to microbial metabolome will be addressed in more depth to discuss their possible clinical value in the management of MDD patients.

Mental health in elderly Spanish people in times of COVID-19 outbreak

Background: We aim to assess COVID-19 outbreak-related emotional symptoms, identify gender differences, and study the relationship between the emotional state and environmental features in the elderly. Methods: We conducted a cross-sectional study starting on March 29 to April 5, 2020 based on a national online survey using snowball sampling techniques. Symptoms of anxiety (Hamilton Anxiety Scale), depression (Beck Depression Inventory) and acute stress (Acute Stress Disorder Inventory) were compared between people over and under 60 years old. Gender differences and the relationship of loneliness, regular exercise, economic losses and use of anxiolytics on the mental state were evaluated. Results: One thousand six hundred thirty-nine (150 [9.2%] aged >= 60) participants completed the survey. The greater than or equal to 60 group showed lower mean (SD) BDI levels than the less than 60 group (3.02 [3.28] versus 4.30 [4.93]);and lower mean (SD) acute stress disorder inventory scores than the less than 60 group (3.68 [3.20] versus 4.45 [3.06]). There were no gender differences in any of the clinical measures. The presence of economic losses as well as the increase in the use of anxiolytics was significantly associated with higher emotional distress in the elderly compared to the younger group. Conclusions: Older people have shown less emotional distress, with no differences between men and women. Economic loss and substance use should be monitored to guarantee the emotional well-being of the elderly. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Different emotional profile of health care staff and general population during the COVID-19 outbreak.

OBJECTIVE: The aims of this study were to assess COVID-19 outbreak-related emotions, to identify vulnerable groups within health care workers (HCW) and to study the relationship between the emotional state and some environmental features. METHOD: We conducted a cross-sectional study on March 29 to April 5, 2020 based on a national online survey using snowball sampling techniques. A list of emotional states was compared in HCW and non-HCW and within HCW roles. The relationship between COVID-19 related symptoms, information, and protective measures and the emotional state was analyzed. RESULTS: Fear (p < .001, φc = .11), irritability (p = .001, φc = .08), frustration (p < .001, φc = .10), anger (p = .013, φc = .06), and helplessness (p < .001, φc = .13) appear significantly more frequently in HCW compared to non-HCW. Within HCW, a higher percentage of physicians, especially the less experienced, significantly perceived uncertainty and frustration (p = .001, φc = .13 and p = .025, φc = .10, respectively), while a higher percentage of nurses significantly experienced sadness (p = .024, φc = .10). Having a confirmatory diagnosis of the disease was related to hypochondria sensation (p = .026, φc = .10). Sadness (p = .035, φc = .09), intolerance (p = .058, φc = .09), anger (p = .024, φc = .10), and helplessness (p = .028, φc = .10) appeared as the most relevant emotions when information was perceived as insufficient. CONCLUSIONS: The knowledge of the most prevalent different emotional patterns in HCW, as well as in the general population, will allow the detection of subjects at risk for the development of mental disorders and the implementation of therapeutic approaches in future similar situations of pandemic or outbreak of the current one. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The impact on mental health patients of COVID-19 outbreak in Spain.

Public health studies warn of the vulnerability of people with mental disorders during the COVID-19 outbreak. Thus, the aims of this study were to (1) explore the presence of symptoms of anxiety, depression and acute stress among people with a mental disorder (MD); (2) evaluate the rate of COVID-19 infection between MD and non-MD, and (3) study the relationship between the emotional state of people with a mental disorder and some environmental variables. A cross-sectional study starting on March 29 to April 5, 2020 based on a national online survey using snowball sampling techniques was conducted. Symptoms of anxiety (Hamilton Anxiety Scale), depression (Beck Depression Inventory) and acute stress (Acute Stress Disorder Inventory) were compared in MD and non-MD. The rate of COVID-19 confirmed cases among MD and non-MD was compared as well as the relationship between some environmental variables and the emotional state within MD. Up to 1839 [201 (10.9%) MD] participants completed the survey. MD showed significant higher mean (SD) in anxiety [24.7 (11.8) vs. 17 (10.3); p = 0.001], depression [7.9 (6.0) vs. 4.2 (4.2); p = 0.001] and acute stress [6.3 (3.2) vs. 4.4 (3.1); p = 0.001] scores than non-MD. The COVID-19 confirmed cases rate was higher in MD participants than in non-MD (3.5% vs. 0.4%; p < 0.001). Among the MD group, being a COVID-19 confirmed case, the lack in basic needs coverage, the rpesence of violence, drug use and the absence of physical excercise were associated with more severe depressive symptoms. Findings suggest that the COVID-19 has an impact on the emotional state of people with mental disorders.

Gender differences in emotional response to the COVID-19 outbreak in Spain.

OBJECTIVE: We aim to explore the differential presence of symptoms of anxiety, depression, and acute stress between men and women during the COVID-19 outbreak, and to study the relationship between these symptoms and two environmental variables, coexistence, and violence. METHODS: We conducted a cross-sectional study starting on March 29 to April 5, 2020, based on a national online survey using snowball sampling techniques. Symptoms of anxiety (Hamilton Anxiety Scale), depression (Beck Depression Inventory), and acute stress (Acute Stress Disorder Inventory) were assessed. Differences in the presence of symptoms and the relationship of coexistence and domestic violence were evaluated from a gender perspective. RESULTS: Men showed significant lower mean (SD) in anxiety, depression, and acute stress levels than women [HARS, 14.1 (9.8) versus. 18.4 (10.2), F = 56.2, p < .001; BDI 3.4 (3.9) versus 4.5 (4.3), F = 16.6, p < .001, and ASDI 3.6 (2.9) versus 4.7 (3.1), F = 39.0, p < .001, respectively), as well as a weaker depressive syndrome (28.1% males versus 39.9% females, χ2  = 25.5, p < .001). In addition, an interaction Gender × Coexistence was found in anxiety (F = 56.2, p < .001) and acute stress (F = 3.52, p = .06) and, according to depressive symptoms, an interaction Gender × Violence was found marginally significant (F = 3.3, p = .07). CONCLUSIONS: Findings indicate that women present greater severity in symptoms of anxiety, depression, and acute stress. Moreover, loneliness and violence specifically worsen the emotional state in women. These results can undoubtedly guide better healthcare planning adopting a gender perspective.