Impact of immediate post SARS-CoV-2 lockdown on suicide in northern Tunisia (preprint)

Suicide is a multifactorial phenomenon influenced by pre-existing mental disorders and by the occurrence of detrimental societal changes. The stress related to the SARS-CoV-2 pandemic as well as the health prevention measures had a negative psychological impact on certain vulnerable populations. Our aim was to investigate suicidal trends and to compare suicide decedent’s profile before and after the lockdown. A descriptive and analytical cross-sectional study was conducted including all suicides that occurred in the north of Tunisia during the study period. Suicidal trends, were studied using an interrupted time series analysis while suicide decedent’s profile was compared between the study period from 24/05/2020 to 31/08/2020 and this same period of the previous five years. Interrupted Time Series Analysis showed a sporadic variation without significant peaks while the comparative study showed a significant increase, among suicide decedents after the lockdown, of individuals with a history of psychiatric disorders particularly mood disorders, suicidal attempts, alcohol and cannabis use and professional instability. We also observed an increase in suicides by hanging and precipitation against a decrease in immolations and intoxications. Our study highlights the importance of mental health promotion during health crises and of prevention especially among vulnerable people.

Evaluation of diseases complicating long COVID: A retrospective chart review (preprint)

Purpose Evidence for the pathogenesis and treatment of post-acute coronavirus disease 2019 (COVID-19) (long COVID) is lacking. As long COVID symptoms are predicted to have an impact on the global economy, clarification of the pathogenesis is urgently needed. Our experiences indicated that some symptoms were complicated by diseases established before the COVID-19 pandemic.Methods Using a retrospective, cross-sectional study, we aimed to evaluate the diseases complicating long COVID. Using the medical records of patients with confirmed severe acute respiratory syndrome coronavirus 2 infection exhibiting residual symptoms lasting ≥ 60 days post-infection who visited our clinic in January 2021–February 2023, we investigated the symptoms and diseases observed. We identified diseases that occurred after COVID-19 infection and excluded those that were exacerbations of existing diseases. Results: During the first visit, the most common symptoms reported in a total of 798 patients were fatigue (523 patients), anxiety (349 patients), and lack of motivation (344 patients). Complicating diseases were observed in 452 patients (57%). There were 115, 65, and 60 patients with postural tachycardia syndrome, postural syndrome without tachycardia, and mood disorders, respectively. Some diseases requiring immediate treatment included pulmonary thromboembolism, purulent shoulder arthritis, cerebellopontine angle tumors, myasthenia gravis, and cervical myelopathy.Conclusion All symptoms that occur after COVID-19 infection should not be treated as long COVID. Similar to normal medical treatment, a list of differential diagnoses should be maintained based on symptoms to obtain definitive diagnoses.

Mood Disorders and Sleep Quality among Undergraduate Students during Covid-19 (preprint)

Studies have established the crucial role of sleep among the students which plays a significant role in their mood. This study aimed to examine the mood disorders and sleep quality among undergraduate students at the University of Georgia (UG) and comparison between students’ nationality.This cross-sectional study was a self-reported questionnaire comprised of demographics including age, gender, year of study, current location, lifestyle data (Exercise and smoking), the Depression, Anxiety, and Stress Scale (DAS21) and the Pittsburgh Sleep Quality Index (PSQI). We performed a descriptive analysis, and the Chi-square was statistically significant at p<0.05. The prevalence was at a 95% confidence interval (95% CI) as multivariate analysis examined the multicollinearity. The female students were most of the respondents, below the age of 20 years. The student's mean age was 20.20 (SD± 3.0). DAS report presented 72.7% of students with depressive symptoms, 77.8% with anxiety symptoms, and 62.2% had stress. Georgian students were more at risk of having depressive complaints (95% Cl[1.567-3.788]), anxiety (95% Cl[1.612-4.285]), and stress symptoms (95% Cl[1.743-3.831]). There was a strong relationship between the students who experienced poor sleeping patterns and depressive complaints (aOR 0.10). The students who were smokers (aOR 0.39) were more likely to report anxiety symptoms than the students that do not exercise (aOR 1.68). It was observed that students with depressive symptoms, anxiety, and complaints of stress had a significantly high risk of poor sleep quality. Further studies are recommended to curb psychological symptoms of mood changes in association with sleep disorders among students.

Effects of Horticultural Therapy Combined with Intradermal Needle Therapy on Generalised Anxiety, Cortical Excitability and HPA-related Hormones in an Isolated Population during the COVID-19 Pandemic: Protocol for a Randomised Controlled Clinical Trial (preprint)

Introduction: Coronavirus disease 2019 (COVID-19) is a novel, highly infectious disease that is a severe danger to human life and has spawned a worldwide public health emergency. Most countries have implemented measures of isolation to prevent the spread of COVID-19, but related studies have shown that isolation increases the risk of anxiety, thereby affecting an individual’s physical and mental health. Simple and effective therapies for anxiety among quarantined populations need to be further explored. Horticultural activities can divert people's attention and alleviate negative emotions. Acupuncture is a conventional alternative therapy that has demonstrated efficacy in mood stabilization. The current study aimed to explore the clinical efficacy of combined Chinese and Western medicine therapies in alleviating anxiety among quarantined individuals during a pandemic.Methods In this prospective, randomised controlled trial (RCT), 150 patients with generalised anxiety disorder will be recruited from the Seventh Clinical College affiliated to Guangzhou University of Chinese Medicine. Eligible subjects will be randomly divided into the horticultural group (n = 50), intradermal acupuncture group (n = 50) and combined treatment group (n = 50). The horticulture group will engage in horticultural activity after basic treatment; the intradermal needle group will undergo intradermal needling after basic treatment; and the combined group will engage in horticultural activity and undergo intradermal needling after basic treatment. The treatments will be provided once a week for 8 weeks. The main outcome will be scores on the Hamilton Anxiety Scale (HAMA); secondary outcomes will include scores on the Self-Assessment Scale for Anxiety (SAS) and Pittsburgh Sleep Quality Index Scale (PSQI), serum indexes, and cortical excitability. All scales will be evaluated at baseline, at 2, 4, 6, and 8 weeks of treatment, and at follow-up; serological indicators and cortical excitability will be assessed at baseline and during week eight of treatment.Discussion The result of the experiment will help to clarify the therapeutic effects of horticultural therapy combined with intradermal needling on anxiety among isolated individuals and to elucidate the therapeutic mechanisms of this combined treatment among patients with anxiety. The purpose of this research is to eventually incorporate this combination approach into a treatment programme for anxiety, thereby significantly reducing the burden of mood disorders in the general population during public health emergencies.Trial registration: ClinicalTrials.gov ChiCTR2200066321. Registered on December 1, 2022

In-person and online mixed method non-randomised studies exploring feasibility and acceptability of HEADS: UP, an adapted Mindfulness Based Stress Reduction programme for stroke survivors experiencing symptoms of anxiety and depression (preprint)

Background Depression and anxiety are prevalent after stroke and associated with poor outcomes. We previously co-developed a stroke-specific self-management intervention, HEADS: UP (Helping Ease Anxiety and Depression after Stroke). The two studies reported here aimed to test the feasibility and acceptability of the HEADS: UP course and supporting materials, and research processes ahead of a definitive trial. Methods We recruited community-dwelling stroke survivors (SS) ≥3 months post-stroke, with symptoms of mood disorder (Hospital Anxiety and Depression Scale ≥8). Participants could ‘enrol’ a family member/‘other’ to take part with them, if desired. Study 1 tested HEADS: UP delivered in-person, and informed optimisation of research processes and intervention delivery and materials. In response to Covid-related socialising restrictions HEADS: UP was then adapted for online delivery; tested in Study 2. The primary outcome (both studies) was feasibility (acceptability, fidelity) of the intervention and of research processes. Quantitative data (including patient reported outcomes measures (PROMs) assessing mood and quality of life), and qualitative data were collected pre-/post-intervention. Descriptive statistics were used to analyse quantitative data; a thematic framework approach was used to analyse qualitative data. Both studies received ethical approval prior to commencement. Results Study 1: Feasibility: 13 (59.1%) of 22 potentially eligible stroke survivors consented; aged 66 (median, IQR 14); male (n=9; 69%); 28 (IQR 34; 13.5-48) months poststroke. Of these n=10 (76.9%) completed PROMS pre-intervention; n=6 (46.2%) post-intervention. Acceptability: Six (85.7%) stroke survivors attended ≥4 core intervention sessions. Aspects of screening and data collection were found to be burdensome. Study 2: Feasibility: SS n=9 (41%) of 22 potentially eligible stroke survivors consented; aged 58 years (median; IR 12); male (n=4; 44.4%); 23 (IQR 34; 10-38) months poststroke. Of these n=5 (55.6%) completed PROMS pre-intervention; n=5 (55.6%) post-intervention. Acceptability: Five (55.6%) stroke survivors attended ≥ 4 core sessions. They found online screening and data collection processes straightforward. Conclusions Stroke survivors found in-person and online HEADS: UP intervention and research processes feasible and acceptable. A pilot RCT is warranted, after making the adaptations to intervention delivery and research processes identified in this feasibility and acceptability research. Trial registration Study 1 (in-person delivery): ClinicalTrials.gov: NCT03956693, registered 20 May 2019, https://www.clinicaltrials.gov/study/NCT03956693 Study 2 (online delivery): ClinicalTrials.gov: NCT04567472, registered 23, September 2020, https://clinicaltrials.gov/study/NCT04567472?tab=results

Mental Mental health and risk of mortality and hospitalization in COVID-19 patients. Results from the PRECOVID Study in Spain (preprint)

The COVID-19 pandemic has created unprecedented challenges for health care systems globally. The identification of risk factors is crucial when optimizing medical resources for specific vulnerable population groups such as patients with mental disorders, who are specially at risk of poor COVID-19 outcomes. In this retrospective cohort study including 144,957 individuals with confirmed COVID-19 from the PRECOVID Study (Aragon, Spain), anxiety was the most frequent diagnosis. However, some differences were observed by sex: substance abuse, personality disorders and schizophrenia were more frequently diagnosed in men, while eating disorders, depression and mood, anxiety and cognitive disorders were more common among women. The presence of mental illness, specifically schizophrenia spectrum and cognitive disorders in men, and depression and mood disorders, substance abuse, anxiety and cognitive and personality disorders in women, increased the risk of mortality or hospitalization after COVID-19, in addition to other well-known risk factors such as age, morbidity and treatment burden. Identifying vulnerable patient profiles at risk of serious outcomes after COVID-19 based on their mental health status will be crucial to improve their access to the healthcare system and implement targeted public health prevention measures.

Six addiction components of problematic social media use in relation to depression, anxiety, and stress symptoms: a latent profile analysis and network analysis.

BACKGROUNDS: Components of addiction (salience, tolerance, mood modification, relapse, withdrawal, and conflict) is the most cited theoretical framework for problematic social media use (PSMU). However, studies criticized its ability to distinguish problematic users from engaged users. We aimed to assess the association of the six criteria with depression, anxiety, and stress at a symptom level. METHODS: Ten thousand six hundred sixty-eight participants were recruited. Bergen Social Media Addiction Scale (BSMAS) was used to detect six addiction components in PSMU. We applied the depression-anxiety-stress scale to assess mental distress. Latent profile analysis (LPA) was conducted based on BSMAS items. Network analysis (NA) was performed to determine the symptom-symptom interaction of PSMU and mental distress. RESULTS: (1) Social media users were divided into five subgroups including occasional users (10.6%, n = 1127), regular users (31.0%, n = 3309), high engagement low risk users (10.4%, n = 1115), at-risk users (38.1%, n = 4070), and problematic users (9.8%, n = 1047); (2) PSMU and mental distress varied markedly across subgroups. Problematic users had the most severe PSMU, depression, anxiety, and stress symptoms. High engagement users scored high on tolerance and salience criteria of PSMU but displayed little mental distress; (3) NA showed conflict and mood modification was the bridge symptoms across the network, while salience and tolerance exhibited weak association with mental distress. CONCLUSIONS: Salience and tolerance might not distinguish engaged users from problematic users. New frameworks and assessment tools focusing on the negative consequences of social media usage are needed.

Adolescents hospitalized in an acute psychiatric ward: a retrospective comparison between the pre-Covid-19 and pandemic periods (preprint)

BACKGROUND. Covid-19 pandemic has negatively impacted child and adolescent mental health. The primary outcome of this study was the evaluation of Covid-19 impact on minors’ hospitalizations in an acute psychiatric ward. METHOD. With an observational and retrospective design, we collected selected variables among adolescents hospitalized in an acute psychiatric ward from 01/07/2017 to 30/06/2022. Data were statistically processed. RESULTS. Our sample was composed of 118 minors with an average age of 15.7 ± 1.2 SD, mostly represented by females (61%) and Italians (60.2%), who had 204 hospitalizations. The number of admissions by years drastically decreased in 2020 concomitantly with Covid19 lockdown and increased in the first half of 2022. Admission rates were higher in winter and spring, except in 2020 when admissions decreased (p = 0.000). In our sample, females more frequently had suicidal behaviour and acute anxiety (p = 0.000) at admissions and more often were discharged with acute stress reactions, eating disorders and mood disorder diagnoses. Differently, males were more frequently hospitalized for aggressive behaviour (p = 0.000) and were more often discharged with ADHD diagnosis (p = 0.000). At multiple linear regression, the duration of hospitalization (dependent variable) was negatively associated with “pandemic period” (p = 0.017) and “absent aggressive behaviour” (p = 0.003), and positively with “autism” diagnosis (p = 0.000). CONCLUSIONS. We highlighted the more stressful impact of Covid-19 pandemic on female adolescents, who required more psychiatric hospitalizations, in particular for suicidal behaviour, anxiety and mood disorders.

Impact of the COVID-19 Pandemic on Nutrition, Sleep, Physical Activity, and Mood Disorders of Polish Children.

The harmful consequences of the COVID-19 pandemic on children are its impact on eating habits, physical activity, sleep, and mood disorders. In the future, this may result in a higher prevalence of obesity and diet-related diseases. Therefore, this study aimed to assess the impact of the COVID-19 pandemic on children's eating behavior and lifestyle. The study was conducted using a proprietary questionnaire on dietary and lifestyle habits before and during the pandemic, and the reasons for changes due to the pandemic. The study involved 294 parents of children in grades 1-8 in elementary schools in two regions of Poland. The survey showed that during the pandemic, the percentage of children eating five regular meals daily, including fruits and vegetables, and engaging in daily physical activity decreased. However, the percentage of children spending more than 4 h a day in front of a screen increased (p < 0.05). The main reasons for changes in eating habits and physical activity were less eating out, lack of motivation, obstruction, and lack of access to sports facilities (p < 0.05). The pandemic had a significant impact on reduced levels of physical activity and increased time spent in front of a screen. In summary, among the reasons for changes in children's dietary and lifestyle habits, factors related to the pandemic itself, i.e., social restrictions, restrictions, closure of schools and other facilities, and fear of coronavirus infection, had the greatest impact.

Self-selection biases in psychological studies: Personality and affective disorders are prevalent among participants.

Respondents select the type of psychological studies that they want to participate in consistence with their needs and individual characteristics, which creates an unintentional self-selection bias. The question remains whether participants attracted by psychological studies may have more psychological dysfunctions related to personality and affective disorders compared to the general population. We investigated (N = 947; 62% women) whether the type of the invitation (to talk about recent critical or regular life events) or the source of the data (either face-to-face or online) attracts people with different psychopathology. Most importantly, participants who alone applied to take part in paid psychological studies had more symptoms of personality disorders than those who had never before applied to take part in psychological studies. The current results strongly translate into a recommendation for either the modification of recruitment strategies or much greater caution when generalizing results for this methodological reason.

Effectiveness of Xiaoyao capsule on sleep disorders and mood disturbance in patients in recovery from coronavirus disease 2019: a randomized controlled trial.

OBJECTIVE: To study the efficacy of Xiaoyao capsule in improving the clinical symptoms of sleep and mood disorders during recovery from coronavirus disease 2019 (COVID-19). METHODS: The study cohort comprised 200 patients with sleep and mood disorders during recovery from COVID-19. Patients were randomized into the control group and the experimental group in a 1:1 ratio by blocked randomization. The patients received either Xiaoyao capsule (experimental group) or a placebo Xiaoyao capsule (control group) for 2 weeks. The improvements in the Traditional Chinese Medicine (TCM) syndrome scales, total effective rates, and disappearance rates of irritability, anxiety, and poor sleep were compared between the two groups. RESULTS: The TCM syndrome pattern scales, total effective rates, and disappearance rates of irritability, anxiety, and poor sleep did not significantly differ between the experimental group versus the control group in the full analysis set and the per protocol set after 1 and 2 weeks of treatment ( > 0.05). CONCLUSIONS: Xiaoyao capsule do not significantly improve the clinical symptoms of sleep and mood disorders in patients in recovery from COVID-19.

Real-time assessment of positive and negative affective fluctuations and mood lability in a transdiagnostic sample of youth.

BACKGROUND: Emotional lability, defined as rapid and/or intense affect fluctuations, is associated with pediatric psychopathology. Although numerous studies have examined labile mood in clinical groups, few studies have used real-time assessments in a well-characterized transdiagnostic sample, and no prior study has included participants with disruptive mood dysregulation disorder (DMDD). The present study leverages ecological momentary assessment (EMA) to assess emotional lability in a transdiagnostic pediatric sample. METHODS: One hundred thirty participants ages 8-18 with primary diagnoses of DMDD, attention-deficit/hyperactivity disorder (ADHD), an anxiety disorder (ANX), or healthy volunteers completed a previously validated 1-week EMA protocol. Clinicians determined diagnoses based on semi-structured interviews and assessed levels of functional impairment. Participants reported momentary affective states and mood change. Composite scores of fluctuations in positive and negative affect were generated. Affect fluctuations were compared between diagnostic groups and tested for their association with functional impairment. RESULTS: Diagnostic groups differed in levels of negative and positive emotional lability. DMDD patients demonstrated the highest level of labile mood compared with other groups. Emotional lability was associated with global impairment in the whole sample. CONCLUSIONS: Both positive and negative emotional lability is salient in pediatric psychopathology and is associated with functional impairment, particularly in DMDD youth.

The Effect of COVID-19 Public Health Measures On Mental Health in California (preprint)

California was the first state to implement statewide public health measures, including lockdowns and curfews, to mitigate the transmission of SARS-CoV-2. The implementation of these public health measures may have had unintended consequences related to mental health for persons in California. This study is a retrospective review of electronic health records of patients who sought care in the University of California Health System to examine changes in mental health status during the pandemic. Data were extracted prior to the pandemic (March-October 2019) and during the pandemic (March-October 2020). Weekly values of new mental health disorders were extracted and further classified based on age. Paired t-tests were performed to test for differences in the occurrence of each mental health disorder for each age group. A two-way ANOVA was performed to assess for between-group differences. When compared with pre-pandemic diagnoses, persons aged 26-35 had the greatest increase in mental health diagnoses overall during the pandemic, specifically for anxiety, bipolar disorder, depression, mood disturbance, and psychosis. The mental health of persons age 25-35 were more affected than any other age group.

Loneliness and mood disorders: consequence, cause and/or unholy alliance?

PURPOSE OF REVIEW: People with persistent depressive disorders and with bipolar disorder are more likely to feel lonely than people in the general population. This evidence update focused on studies in the last 2 years, characterized by the COVID-19 pandemic and consequent social distancing directives. RECENT FINDINGS: Longitudinal studies identified that people who feel lonely are more likely to become depressed or to experience relapse of mood disorders. There is emerging evidence that feelings of loneliness or mandatory social isolation can precede manic episodes. Hence the relationship between loneliness and mood disorders is complex and bidirectional. Interventions were developed to reduce loneliness in people with mental health problems, including depressive disorders, through cognitive modification and/or supported socialisation. No loneliness-focused interventions have been specifically tailored to people with bipolar disorder. SUMMARY: Studies carried out before and during the COVID-19 pandemic found that feelings of loneliness can be both consequences and precursors of persistent depression and bipolar disorder. Mood symptoms and loneliness have a cumulative negative effect on physical and mental health outcomes. Conceptual overlaps and relations between loneliness and mood symptoms should be clarified in qualitative studies. Theory-driven intervention models should be developed and tested in methodologically robust studies.

Mood disorders in higher education in Flanders during the 2nd and 3rd COVID-19 wave: Prevalence and help-seeking: Findings from the Flemish College Surveys (FLeCS).

To examine the prevalence of 12-month mood disorders and receipt of mental health treatment among a volunteer sample of higher education students during the 2nd and 3rd COVID-19 wave in the Flanders region. Web-based self-report surveys were obtained from 9101 students in higher education in the Flemish College Surveys (FLeCS) in Flanders, Belgium. As part of the World Health Organization's World Mental Health-International College Student Initiative, we screened for 12-month mood disorders (major depressive episode (MDE), mania/hypomania), and service use. We used poststratification weights to generate population-representative data on key socio-demographic characteristics. 50.6% of the respondents screened positive for 12-month mood disorders (46.8% MDE, of which 22.9% with very severe impact). Use of services was very low, with estimates of 35.4% for MDE, 31.7% for mania, and 25.5% for hypomania. Even among students with very severe disorders, treatment rates were never higher than 48.3%. Most common barriers for not using services were: the preference to handle the problem alone (83.4%) and not knowing where to seek professional help (79.8%). We found a high unmet need for mood problems among college students; though caution is needed in interpreting these findings given the volunteer nature of the sample. A reallocation of treatment resources for higher education students should be considered, particulary services that focus on innovative, low-threshold, and scalable interventions.

Cross-lagged analysis of the relationship between risk perception, physical activity, and adolescent mental health (preprint)

Background Anxiety symptoms were prevalent in teenagers during the new coronavirus pandemic at 31% and depression symptoms were at 34%, both significantly higher than they were before the pandemic, according to research on global adolescent mood disorders during the epidemic. It is unclear, nevertheless, if physical activity still promotes mental health given the perceived danger of sickness, even though it has been demonstrated to be useful in reducing teenage mental health issues. Therefore, this study looked into the relationship between teenage mental health, risk perception, and physical activity. Methods In December 2022 and January 2023, two surveys were given to the same pupils in five high schools. During the New Crown pandemic, the risk perception scores, physical activity levels, and mental health of adolescents were examined in the study N=344. Results For adolescents' risk perceptions, there were significant gender differences (P＜0.01), with gender difference effects of 0.255 (d = 0.416) and 0.195 (d = 0.402) for the two measurements, respectively. For mental health, there were gender differences, with gender difference effects of 0.159 (d = 0.262) and 0.179 (d = 0.278) for the two measurements. The levels of risk perception, physical activity, and teenage mental health met persistent connections across months with contemporaneous correlations, however gender differences in physical activity levels were not significant (p > 0.05); Contrarily, in the cross-lagged study, males had higher levels of physical activity and mental health than females, and teenagers' risk perception was higher. Physical activity and mental health were both predicted by T1 ( values of 0.28, 0.19, and P＜0.01, respectively). Risk perception T1 physical exercise T2 mental health T2 (mediating value impact of 0.012, the Z value of 0.112), as well as the indirect effect of Bootstrap, were all able to predict mental health T2 (β= 0.33, P ＜0.01). Indicating a substantial mediating role for physical activity between risk perception and mental health is the 95% CI, not the 0 value from this pathway. Conclusion Raising awareness of physical activity among adolescents according to gender is important for improving mental health and there is a longitudinal causal relationship between perceived risk of disease, physical activity, and mental health among adolescents, suggesting that physical activity still has a role in mental health in the presence of risk perception.

The Impact of Event Scale – Revised: Examining its cutoff scores among Arab psychiatric patients and healthy adults within the context of COVID-19 as a collective traumatic event (preprint)

The Impact of Event Scale-Revised (IES-R) is the most popular measure of post-traumatic stress disorder (PTSD), which has been recently validated in Arabic. This instrumental study aimed to determine optimal cutoff scores of the IES-R and its subscales in Arab samples of psychiatric patients (N = 168, 70.8% females) and healthy adults (N = 992, 62.7% females) from Saudi Arabia during the COVID-19 pandemic as an ongoing collective traumatic event. Based on a cutoff score of 14 of the Depression Anxiety Stress Scale 8-items (DASS-8), receiver operator curve (ROC) analysis revealed two optimal points of 39.5 and 30.5 for the IES-R in the samples (area under the curve (AUC) = 0.86 & 0.91, p values = 0.001, 95% CI: 0.80-0.92 & 0.87 to 0.94, sensitivity = 0.85 & 0.87, specificity = 0.73 & 0.83, Youden index = 0.58 & 0.70, respectively). Different cutoffs were detected for the six subscales of the IES-R, with numbing and avoidance expressing the lowest predictivity for distress. Meanwhile, hyperarousal followed by the irritability expressed stronger predictive capacity for distress than all subscales in both samples. In path analysis, pandemic-related irritability resulted from direct and indirect effects of key PTSD symptoms (intrusion, hyperarousal, and numbing). Irritability contributed to traumatic symptoms of sleep disturbance in both samples while the opposite was not true. The findings suggest usefulness of the IES-R at a score of 30.5 for detecting adults prone to trauma related distress, with higher scores needed for screening in psychiatric patients. Various PTSD symptoms may induce dysphoric mood, which represents a considerable burden that may induce circadian misalignment and more noxious psychiatric problems/ co-morbidities (sleep disturbance) in both healthy and diseased groups.