In the Line of Fire: A Systematic Review and Meta-Analysis of Job Burnout Among Nurses (preprint)

Using a systematic review and meta-analysis, this study investigates the impact of the COVID-19 pandemic on job burnout among nurses. We review healthcare articles following the PRISMA 2020 guidelines and identify the main aspects and factors of burnout among nurses during the pandemic. Using the Maslach Burnout questionnaire, we searched PubMed, ScienceDirect, and Google Scholar, three open-access databases, for relevant sources measuring emotional burnout, personal failure, and nurse depersonalization. Two reviewers extract and screen data from the sources and evaluate the risk of bias. The analysis reveals that 2.75% of nurses experienced job burnout during the pandemic, with a 95% confidence interval and rates varying from 1.87% to 7.75%. These findings emphasize the need for interventions to address the pandemic's effect on job burnout among nurses and enhance their well-being and healthcare quality. We recommend considering individual, organizational, and contextual factors influencing healthcare workers' burnout. Future research should focus on identifying effective interventions to lower burnout in nurses and other healthcare professionals during pandemics and high-stress situations.

Behavioural and Social Predictors of COVID-19 Vaccine Uptake among Persons with Disabilities in Kenya. (preprint)

The uptake of the COVID-19 vaccine by persons with disabilities remains largely unknown in low-and middle-income countries. This evidence gap necessitates disability-focused research to inform improvements in access and inclusion in the last mile of COVID-19 vaccination programs and to support future programs for other vaccine-preventable diseases. We aimed to identify behavioural and social predictors of COVID-19 uptake among persons with disabilities in Kenya. This was a convergent parallel mixed method study that involved questionnaires (792), key informants interviews, and focus group discussions among persons with disabilities and key stakeholders (government actors and professional associations). Data were analysed using STATA statistical analysis software (version 14). Chi-square (X2) and Fishers exact tests were used to test for differences in categorical variables; multivariate regression analysis was employed to ascertain the factors that influence uptake of COVID-19 among persons with disabilities (PWDs) in Kenya. Approximately 59% of persons with disabilities reported to be fully vaccinated, with significant disparities noted among those with cognition (34.2%) and self-care (36.6%) impairments. Confidence in vaccine benefits (Adjusted odds ration [OR]; 11.3, 95% CI; 5.2-24.2), health worker recommendation (OR; 2.6, 95% CI; 1.8-3.7), employment (OR; 2.1, 95% CI; 1.4-3.1), perceived risk (OR; 2.0, 95% CI; 1.3-3.1), age and area of residence were statistically significant predictors of vaccine uptake among PWDs. The primary reasons for low uptake included perceived negative vaccine effects and lack of adequate information. No association was found between having a primary caregiver and/or assistive device, with COVID-19 vaccine uptake. Subsequent vaccination deployments should map and reach PWDs through relevant institutions of PWDs, and localized vaccination campaigns. Related communication strategies should leverage on behaviour change techniques that inspire confidence in vaccines, and on the credibility and trust in health workers to improve vaccine uptake.

The 2022 Disability Data Report (preprint)

Realizing the rights of persons with disabilities Achieving rights as stipulated in the United Nations Convention on the Rights of Persons with Disabilities (CRPD) and the Sustainable Development Goals (SDGs) requires quality, timely and policy-relevant disability data. This Report first reviews disability questions in national population censuses and household surveys globally from 2009 to 2021 to assess if they can identify persons with disabilities. Only 21% of the datasets under review have disability questions that meet international standards of comparability, i.e., those that collect information on functional difficulties (e.g. difficulty seeing, hearing, walking). Only 10% of datasets have the internationally-tested and comparable Washington Group Short Set (WG-SS) of questions. Including the WG-SS in many MICS6 (round 6 of the Multiple Indicator Cluster Survey) datasets has improved data availability for many countries. Much work remains for national surveys and population censuses to have functional difficulty questions. International programs, for instance, through COVID-19 High-Frequency Phone Surveys or the Survey of Income and Living Conditions, could help to improve the availability of disability questions in many countries and inform policy. Second, this Report disaggregates 32 indicators by disability status using data from MICS6 for women aged 18 to 49 in 35 countries. Disability status is measured through the functional difficulty questions of the WG-SS.We find inequalities associated with functional difficulties in all areas of wellbeing, particularly educational attainment, information and communication technology, sexual and reproductive health, multidimensional poverty, reporting being discriminated against, feeling safe, and subjective wellbeing. While most of the countries under study have ratified the CRPD, results suggest that more data collection, research and policy work are needed to address intersectional disadvantages and improve the situation of women with disabilities worldwide.For some indicators, there is a graded association between the severity of functional difficulty and of disadvantage. In other words, women with some functional difficulty are, on average worse off than women with no difficulty but better off than women who report a lot of difficulty or unable to do in at least one domain.In the countries under study, less than 20% of women with seeing difficulties use glasses, while only 2% of women with hearing difficulties use hearing aids. This result suggests a lack of assistive technology and related services that requires policy attention.Overall, the disadvantages that women with disabilities face within their economies and societies highlight the need for policies, data and research that support their rights and wellbeing.

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.

Personality Determinants of Exercise-Related Nutritional Behaviours among Polish Team Sport Athletes.

A proper diet increases the effectiveness of training and accelerates post-workout regeneration. One of the factors determining eating behaviour are personality traits, including those included in the Big Five model, i.e., neuroticism, extraversion, openness, agreeableness, and conscientiousness. The aim of this study was to analyse the personality determinants of peri-exercise nutritional behaviours among an elite group of Polish athletes practicing team sports. The study was conducted in a group of 213 athletes, using the author's validated questionnaire of exercise-related nutrition behaviours and the NEO-PI-R (Neuroticism Extraversion Openness-Personality Inventory-Revised). A statistical analysis was performed using Pearson's linear correlation and Spearman's rank correlation coefficients as well as a multiple regression analysis, assuming a significance level of α = 0.05. It has been shown that the level of the overall index regarding normal peri-exercise eating behaviours decreased with increasing neuroticism (r = -0.18) and agreeableness (r = -0.18). An analysis of the relationship between the personality traits (sub-scales) of the Big Five model demonstrated that the overall index of proper peri-exercise nutrition decreased with the intensification of three neuroticism traits, i.e., hostility/anger (R = -0.20), impulsiveness/immoderation (R = -0.18), and vulnerability to stress/learned helplessness (R = -0.19), and four traits of agreeableness, i.e., straightforwardness/morality (R = -0.17), compliance/cooperation (R = -0.19), modesty (R = -0.14), and tendermindedness/sympathy (R = -0.15) (p < 0.05). A multiple regression analysis exhibited that the full model consisting of all the analysed personality traits explained 99% of the variance concerning the level of the proper peri-exercise nutrition index. In conclusion, the index of proper nutrition under conditions of physical effort decreases along with the intensification of neuroticism and agreeableness among Polish athletes professionally practicing team sports.

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.

The Structure of Temperament in Caregivers of Patients with Schizophrenia.

The onset of schizophrenia symptoms usually occurs in early youth. As a result, the parents of these patients usually become their caregivers. The role of a caregiver for a person with schizophrenia is a considerable mental and physical burden. Therefore, an interesting issue is what motivates these people to take up this challenge. It is probable that, apart from the moral imperative or kinship, the factor determining this decision is the personality structure of the caregiver. The aim of our study was to compare the structure of temperament (according to the model of temperament as formal characteristics of behavior developed by Jan Strelau) in caregivers of young adults (age 18-25 years) with schizophrenia with the structure of temperament of parents of healthy young adults still living in the family home under their care. The study group consisted of 64 people (51 women), who were taking care of young adults (aged 18-25 years) with schizophrenia, while the control group (53 people, 42 women) consisted of parents of healthy adults still living in the family home. Both groups were asked to complete a questionnaire of the authors' own design on their demographic data as well as The Formal Characteristics of Behavior-Temperament Inventory to assess the temperament traits. The results were given in the number of points obtained on average in each dimension. Both groups did not differ in terms of size and age, with women predominating. Caregivers of young adults with schizophrenia had higher values of briskness (43.22 ± 4.45 vs. 42.90 ± 3.98, p = 0.032), emotional reactivity (46.02 ± 4.39 vs. 41.01 ± 3.12, p = 0.012) and activity level (44.01.89 ± 4.15 vs. 37.59 ± 4.77, p = 0.022) compared to the control group. The remaining dimensions of temperament: perseverance, sensory sensitivity, rhythmicity, and endurance did not differentiate between the two groups. The temperament structure of caregivers of young people with schizophrenia differs from the temperament structure of caregivers of healthy adults. Caregivers of sick people have higher values of briskness, emotional reactivity, and activity level compared to the control group.

Post-truth epistemic beliefs rooted in the Dark Factor of Personality are associated with higher COVID-19 vaccination refusal.

A substantial number of people refused to get vaccinated against COVID-19, which prompts the question as to why. We focus on the role of individual worldviews about the nature and generation of knowledge (epistemic beliefs). We propose a model that includes epistemic beliefs, their relationship to the Dark Factor of Personality (D), and their mutual effect on the probability of having been vaccinated against COVID-19. Based on a US nationally representative sample (N = 1268), we show that stronger endorsement of post-truth epistemic beliefs was associated with a lower probability of having been vaccinated against COVID-19. D was also linked to a lower probability of having been vaccinated against COVID-19, which can be explained by post-truth epistemic beliefs. Our results indicate that the more individuals deliberately refrain from adhering to the better argument, the less likely they are vaccinated. More generally, post-truth epistemic beliefs pose a challenge for rational communication.

The impact of the COVID-19 pandemic on patients with personality disorders.

Three years after the outbreak of COVID-19 pandemic, numerous epidemiological studies confirm its significant psychological impact. Recent meta-analyses with 50,000-70000 participants noted the increase in anxiety, depression and feelings of loneliness in the general population.1 Patients with pre-existing mental disorders were a vulnerable group at high risk of deterioration.1,2 As part of the measures to combat the pandemic, the operation of mental health services was reduced, the access to them became more difficult and the provision of supportive and psychotherapeutic interventions continued through telepsychiatry.2 Of particular interest is the study of the impact of the pandemic on patients with personality disorders (PD).3 These patients experience severe difficulties related to interpersonal relationships and identity, which lie at the basis of intense affective and behavioral manifestations.4,5 Most studies on the impact of the pandemic on patients with personality pathology have focused on borderline personality disorder (BPD).6 Social distancing measures during the pandemic and increased sense of loneliness are serious aggravating factors for patients with BPD and may cause anxieties of abandonment and rejection, social withdrawal, and feelings of emptiness. Consequently, the patients' susceptibility to risky behaviors and substance use increases.3,7 The anxieties caused by the condition, as well as the feeling of not being in control of the situation by the subject, may mobilize paranoid ideation in patients with BPD, which further exacerbates the difficulties in their interpersonal relationships.7 In a Nordic multicenter study of 1120 outpatients with PD during the first wave of the pandemic, results showed an increase in anxiety, depression, aggression, substance use, social isolation and a decrease in work activity, while the rates of suicidal behaviors remained the same.8 On the other hand, for some patients the restricted exposure to interpersonal triggers could lead to amelioration of symptoms.7 Several papers have studied the number of visits of patients with PD or patients with self-harm to hospital emergency departments during the pandemic.6,9 In the studies that examined self-injury, the psychiatric diagnosis was not recorded, but they are mentioned here because the presence of self-harm is closely associated with PD.10 The number of emergency department visits of patients with PD or self-harm was found to be increased in some papers, decreased in others, and stable in others, compared to the previous year.6,9 During the same period, however, both the distress of patients with PD and rates of self-harm thoughts in the general population increased.3,6-8 The decreased number of emergency department visits could be the result of reduced access to services or amelioration of symptomatology due to decreased social contact or sufficient remote therapy through telepsychiatry. A critical issue that mental health services providing therapy to patients with PD had to encounter was the need to discontinue in person psychotherapy and continue by telephone or online. Patients with PD are particularly sensitive to therapeutic setting modifications and this was an aggravating factor.7 In several studies, discontinuation of in person psychotherapy for BPD patients was accompanied by worsening symptomatology, feelings of anxiety, sadness, and feelings of helplessness.6,11 When it was not possible to continue sessions by telephone or online, there was an increase in the number of emergency department visits.6,11 In contrast, continuation of sessions via tele-psychiatry was considered satisfactory by patients and in some cases their clinical picture, after the initial nuance, returned and maintained at previous level.6,11 In the above studies, the discontinuation of sessions involved a period of 2-3 months. In a study conducted at the PD services of the First Psychiatric Department of the National and Kapodistrian University of Athens, at Eginition Hospital, at the start of the restriction measures, 51 BPD patients were attending group psychoanalytic psychotherapy sessions. The face-to-face sessions were discontinued and continued online for 4 months. During this time, no self-harm incidents, suicide attempts or hospitalizations occurred; 2 patients discontinued treatment. In crises, patients used telephone communication with therapists and no emergency department visits were recorded.12 In conclusion, the pandemic had a significant psychological impact on patients with PD. However, it should be emphasized that in cases where the therapeutic setting remained alive and the continuity of therapeutic collaboration was maintained, patients with PD, despite the severity of their pathology, showed good adaptation and were able to withstand the tensions caused by the pandemic.

Social media as an incubator of personality and behavioral psychopathology: Symptom and disorder authenticity or psychosomatic social contagion?

There has been an increasing recognition among both medical and psychological professionals, as well as the public media, of a concerning trend for child and adolescent users of audiovisual-based, algorithmic social media platforms (e.g., TikTok) to present with or claim functional psychiatric impairment that is inconsistent with or distinct from classic psychiatric nosology. In this short communication, we provide a detailed historical overview of this transdiagnostic phenomenon and suggest a conceptual model to organize thinking and research examining it. We then discuss the implications of our suggested model for accurate assessment, diagnosis, and medical-psychiatric treatment. We believe there is an urgent need for focused empirical research investigation into this concerning phenomenon that is related to the broader research and discourse examining social media influences on mental health.

A Study Protocol to Increase Engagement in Evidence Based Hospital and Community Based Care Using a Serious Injection Related Infections (SIRI) Checklist and Enhanced Peer for Hospitalized PWID (ShaPe) (preprint)

Background With the opioid crisis, surging methamphetamine use, and healthcare disruptions due to SARS-CoV-2, serious injection related infections (SIRIs), like endocarditis, have increased significantly. Hospitalizations for SIRI provide a unique opportunity for persons who inject drugs (PWID) to engage in addiction treatment and infection prevention, yet many providers miss opportunities for evidence-based care due to busy inpatient services and lack of awareness. To improve hospital care, we developed a 5-item SIRI Checklist for providers as a standardized reminder to offer medication for opioid use disorder (MOUD), HIV and HCV screening, harm reduction counseling, and referral to community-based care. We also formalized an Intensive Peer Recovery Coach protocol to support PWID on discharge. We hypothesized that the SIRI Checklist and Intensive Peer Intervention would increase use of hospital-based services (HIV, HCV screening, MOUD) and linkage to community-based care: PrEP prescription, MOUD prescription, and related outpatient visit(s). Methods This is a feasibility study and randomized control trial of a checklist and intensive peer intervention for hospitalized PWID with SIRI admitted to UAB Hospital. We will recruit 60 PWID who will be randomized to one of 4 groups (SIRI Checklist, SIRI Checklist + Enhanced Peer, Enhanced Peer, and Standard of Care). Results will be analyzed using a 2x2 factorial design. We will use surveys to collect data on drug use behaviors, stigma, HIV risk, and PrEP interest and awareness. Our primary outcome of feasibility will include the ability to recruit hospitalized PWID and retain them in the study to determine post-discharge clinical outcomes. Additionally, we will explore clinical outcomes using a combination of patient surveys and electronic medical record data (HIV, HCV testing, MOUD and PrEP prescriptions). This study is approved by UAB IRB #300009134. Discussion This feasibility study is a necessary step in designing and testing patient-centered interventions to improve public health for rural and Southern PWID. By testing low barrier interventions that are accessible and reproducible in states without access to Medicaid expansion and robust public health infrastructure, we aim to identify models of care that promote linkage and engagement in community care. Trial Registration: NCT05480956

Suicidal Ideation among University Students: A Moderated Mediation Model Considering Attachment, Personality, and Sex.

The present study aimed to examine the link between attachment, personality traits, and suicidal ideation with consideration of the potential moderating role of age and sex. The Suicidal History Self-Rating Screening Scale, the Personality Inventory for DSM-5-Brief Form, and the Attachment Style Questionnaire were administered to 183 students. There was a significant indirect effect of need for approval on suicidal ideation via detachment. Moreover, the moderated mediation models of need for approval and preoccupation with relationships on suicidality via negative affectivity were significant in men, but not women, whereas the moderated mediation model of need for approval on suicidality via detachment was significant in women, but not men. Young men and women seem at risk for increased suicidal ideation based on specific attachment and personality characteristics, which should be considered for the development of prevention and therapeutic interventions.

Health, socioeconomic and genetic predictors of COVID-19 vaccination uptake: a nationwide machine-learning study (preprint)

Reduced participation in COVID-19 vaccination programs is a key societal concern. Understanding factors associated with vaccination uptake can help in planning effective immunization programs. We considered 2,890 health, socioeconomic, familial, and demographic factors measured on the entire Finnish population aged 30 to 80 (N=3,192,505) and genome-wide information for a subset of 273,765 individuals. Risk factors were further classified into 12 thematic categories and a machine learning model was trained for each category. The main outcome was uptaking the first COVID-19 vaccination dose by 31.10.2021, which has occurred for 90.3% of the individuals. The strongest predictor category was labor income in 2019 (AUC evaluated in a separate test set = 0.710, 95% CI: 0.708-0.712), while drug purchase history, including 376 drug classes, achieved a similar prediction performance (AUC = 0.706, 95% CI: 0.704-0.708). Higher relative risks of being unvaccinated were observed for some mental health diagnoses (e.g. dissocial personality disorder, OR=1.26, 95% CI : 1.24-1.27 ) and when considering vaccination status of first-degree relatives (OR=1.31, 95% CI:1.31-1.32 for unvaccinated mothers) We derived a prediction model for vaccination uptake by combining all the predictors and achieved good discrimination (AUC = 0.801, 95% CI: 0.799-0.803). The 1% of individuals with the highest risk of not vaccinating according to the model predictions had an average observed vaccination rate of only 18.8%. We identified 8 genetic loci associated with vaccination uptake and derived a polygenic score, which was a weak predictor of vaccination status in an independent subset (AUC=0.612, 95% CI: 0.601-0.623). Genetic effects were replicated in an additional 145,615 individuals from Estonia (genetic correlation=0.80, 95% CI: 0.66-0.95) and, similarly to data from Finland, correlated with mental health and propensity to participate in scientific studies. Individuals at higher genetic risk for severe COVID-19 were less likely to get vaccinated (OR=1.03, 95% CI: 1.02-1.05). Our results, while highlighting the importance of harmonized nationwide information, not limited to health, suggest that individuals at higher risk of suffering the worst consequences of COVID-19 are also those less likely to uptake COVID-19 vaccination. The results can support evidence-informed actions for COVID-19 and other areas of national immunization programs.

Stress, coping, and quality of life in the United States during the COVID-19 pandemic (preprint)

While research has widely explored stress, coping, and quality of life (QOL) individually and the potential links between them, there is a critical dearth in the literature regarding these constructs in the context of the COVID-19 pandemic. Our study aims to identify the salient stressors experienced, describe the coping strategies used, and examine the relationships between stress, coping, and current QOL among individuals during the pandemic. Data are from a nationally representative sample of 1,004 respondents who completed an online survey. Key measures included stressful life events (SLEs), coping strategies, and the physical and psychological health domains of QOL. Staged multivariate linear regression analyses examined the relationships between the two QOL domains and SLEs, controlling for sociodemographic and pre-existing health conditions and testing for the effects of coping strategies on these relationships. The most common SLEs experienced during the pandemic were a decrease in financial status, personal injury or illness, and change in living conditions. Problem-focused coping and emotion-focused coping were significantly related to higher levels of QOL, whereas avoidant coping was associated with lower QOL. Avoidant coping partially mediated the relationship between experiencing SLEs and reduced physical and psychological QOL. Our study informs clinical interventions to help individuals adopt healthy behaviors to effectively manage stressors, especially large-scale traumatic events like the pandemic. Our findings also call for public health and clinical interventions to address the long-term impacts of the most prevalent stressors experienced during the pandemic among vulnerable groups.

Differential personality change earlier and later in the coronavirus pandemic in a longitudinal sample of adults in the United States.

Five-factor model personality traits (neuroticism, extraversion, openness, agreeableness, conscientiousness) are thought to be relatively impervious to environmental demands in adulthood. The coronavirus pandemic is an unprecedented opportunity to examine whether personality changed during a stressful global event. Surprisingly, two previous studies found that neuroticism decreased early in the pandemic, whereas there was less evidence for change in the other four traits during this period. The present research used longitudinal assessments of personality from the Understanding America Study (N = 7,109; 18,623 assessments) to examine personality changes relatively earlier (2020) and later (2021-2022) in the pandemic compared to pre-pandemic levels. Replicating the two previous studies, neuroticism declined very slightly in 2020 compared to pre-pandemic levels; there were no changes in the other four traits. When personality was measured in 2021-2022, however, there was no significant change in neuroticism compared to pre-pandemic levels, but there were significant small declines in extraversion, openness, agreeableness, and conscientiousness. The changes were about one-tenth of a standard deviation, which is equivalent to about one decade of normative personality change. These changes were moderated by age and Hispanic/Latino ethnicity, but not race or education. Strikingly, younger adults showed disrupted maturity in that they increased in neuroticism and declined in agreeableness and conscientiousness. Current evidence suggests the slight decrease in neuroticism early in the pandemic was short-lived and detrimental changes in the other traits emerged over time. If these changes are enduring, this evidence suggests population-wide stressful events can slightly bend the trajectory of personality, especially in younger adults.

Psychiatric treatment conducted via telemedicine versus in-person consultations in mood, anxiety and personality disorders: a protocol for a systematic review and meta-analysis.

INTRODUCTION: Major advancements in technology have led to considerations how telemedicine (TM) and other technology platforms can be meaningfully integrated in treatment for psychiatric disorders. The COVID-19 pandemic has placed a further focus on use of TM in psychiatry. Despite the widespread use of TM, little is known about its effect compared with traditional in-person (IP) consultation. The objective of this systematic review is to examine if individual psychiatric outpatient interventions for adults using TM are comparable to IP in terms of (1) psychopathology outcomes, (2) levels of patient satisfaction, (3) working alliance and (4) dropout from treatment. METHODS AND ANALYSIS: This review will only include randomised controlled trials for adult participants with mood disorders, anxiety or personality disorders. The primary outcome is psychopathology, and secondary outcomes include patient satisfaction, treatment alliance and dropout rate. Systematic searches were conducted in MEDLINE, APA PsycINFO, Embase, Web of Science and CINAHL. The inverse-variance method will be used to conduct the meta-analysis. Effect sizes will be calculated as standardised mean difference (Hedges' g) for the primary outcome, mean difference for patient satisfaction and working alliance, and risk ratio for the dropout rate. Effect sizes will be supplemented with 95% CI. We will calculate the I² statistic to quantify heterogeneity and Chi-square statistic (χ²) to test for heterogeneity for the primary outcome. Potential clinical and methodological heterogeneity moderators will be assessed in subgroup and sensitivity analysis. The risk of bias will be assessed by Cochrane Risk of Bias Tool V.2, and confidence in cumulative evidence will be assessed by Grading of Recommendations Assessment, Development and Evaluation. ETHICS AND DISSEMINATION: No ethical approval is required for this systematic review protocol. Data sets will be deposited in the Zenodo repository. The findings of this study will be published in a peer-review scientific journal. PROSPERO REGISTRATION NUMBER: CRD42021256357.

Enhancing member engagement in a Tier 3 personality disorder service during COVID-19: evaluation of a virtual group programme.

BACKGROUND: Drop-out rates from evidence-based interventions for people with a diagnosis of personality disorder (PD) are high. The COVID-19 pandemic has likely exacerbated barriers to engagement with the introduction of virtual working. Virtual therapy has a good evidence-base for Axis I disorders, but limited research for Axis II disorders. AIMS: To investigate facilitators and barriers to engagement in a Tier 3 PD service virtual group programme. METHOD: A virtual group programme was developed in collaboration with service members, and analysed members' attendance rates over a 5-month period pre- and post-COVID-19. Thematic analysis of semi-structured telephone interviews with 38 members is reported, describing their experience of the virtual group programme. RESULTS: Attendance rates were significantly higher pre-COVID (72%) than post-COVID (50%). Thematic analysis highlighted key barriers to attendance were: practical issues, low motivation, challenges of working in a group online and feeling triggered at home. Main promoters of engagement were: feeling valued, continued sense of connection and maintaining focus on recovery. DISCUSSION: The results suggest that the pandemic has exacerbated relational and practical barriers to engagement in a Tier 3 PD service. Ways of enhancing engagement are discussed, as well as preliminary recommendation for services offering virtual therapy to people with a diagnosis of PD.

Dark triad traits, health beliefs, and covid-19 behaviors (preprint)

The Dark Triad (DT) is comprised of a set of personality traits—Machiavellianism, psychopathy and narcissism—related to low agreeableness and antisocial behavior. While emerging evidence links these traits to COVID-19 related behaviors, limited research has sought to identify the beliefs and attitudes that translate the former into the latter. To address this gap in the literature, Nowak et al. (2020) recently surveyed a polish Western sample (n = 755), finding initial evidence that health beliefs help explain the connection between Dark Triad traits and COVID-19 related preventive and hoarding behaviors. Our objective in the present study was to examine whether the findings reported by Nowak et al. could be replicated using better-validated measures of DT traits and data from a non-WEIRD population. Using structural equation modeling and data from a Brazilian sample (n = 406), we replicated most of Nowak et al.’s (2020) findings. The results suggests that Dark Triad traits increase hoarding behavior and decrease preventive behavior regarding COVID, both directly and indirectly via Health Beliefs.

Analysis of Motives and Factors Connected to Suicidal Behavior in Patients Hospitalized in a Psychiatric Department.

(1) Background: This study aimed to investigate the motives and factors connected to suicidal behavior in 121 hospitalized patients with intentional self-harm (diagnosis X 60-81 according to the ICD-10); (2) Methods: Suicidal behavior of the patient was assessed from data obtained by psychiatric examinations and by the Columbia Suicide Severity Rating Scale. Analysis of data to identify the patients' reason and motives behind suicidal behavior in a group of patients with a suicide attempt (SA, n = 80) and patients with Non-Suicidal Self-Injurious Behavior (NSSIB, n = 41) was carried out; (3) Results: Results showed that patients with affective disorder have a 19-times higher rate of SA against other diagnoses. Patients with personality disorders have a 32-times higher rate of NSSIB than patients with other diagnoses. Living alone and the absence of social support increased the likelihood of SA. Qualitative data analysis of patients' statements showed different themes in the justification of motives for suicidal behavior between SA and NSSIB cases. Significant differences were shown for non-communicated reasons, loneliness, social problems, extortion, and distress; (4) Conclusions: The evaluation of patients' verbal statements by qualitative analysis during the psychiatric examination should be considered in clinical practice. It should be considered to include self-poisoning in the criteria of the Non-suicidal Self-Injury diagnostic categories.