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1.
Lancet ; 398(10303): 920-930, 2021 09 04.
Article in English | MEDLINE | ID: covidwho-1593950

ABSTRACT

The COVID-19 pandemic has heightened interest in how physician mental health can be protected and optimised, but uncertainty and misinformation remain about some key issues. In this Review, we discuss the current literature, which shows that despite what might be inferred during training, physicians are not immune to mental illness, with between a quarter and a third reporting increased symptoms of mental ill health. Physicians, particularly female physicians, are at an increased risk of suicide. An emerging consensus exists that some aspects of physician training, working conditions, and organisational support are unacceptable. Changes in medical training and health systems, and the additional strain of working through a pandemic, might have amplified these problems. A new evidence-informed framework for how individual and organisational interventions can be used in an integrated manner in medical schools, in health-care settings, and by professional colleagues is proposed. New initiatives are required at each of these levels, with an urgent need for organisational-level interventions, to better protect the mental health and wellbeing of physicians.


Subject(s)
Mental Disorders/epidemiology , Physicians/psychology , Suicide/statistics & numerical data , Burnout, Professional , COVID-19/epidemiology , Female , Humans , Male , Mental Disorders/prevention & control , Pandemics , Physicians, Women/psychology , Risk Factors , SARS-CoV-2 , Substance-Related Disorders/epidemiology , Suicide/prevention & control , Work Schedule Tolerance
2.
Am J Nurs ; 121(9): 66-69, 2021 Sep 01.
Article in English | MEDLINE | ID: covidwho-1373674

ABSTRACT

ABSTRACT: It's important to be aware of the signs and symptoms of mental illness and to take action to ensure people experiencing mental health problems receive the assistance and treatment they need. For nurses, this is as true at home as it is at work, particularly so when a person is exhibiting aggressive tendencies or other behaviors that could potentially lead to harm. With the COVID-19 crisis leading many family members to live more closely together for extended periods, nurses should be able to identify concerning behaviors and know what to do if they observe these in their loved ones.


Subject(s)
Mental Disorders/prevention & control , Mental Health , Early Diagnosis , Family , Guidelines as Topic , Health Knowledge, Attitudes, Practice , Humans
3.
J Psychiatr Pract ; 27(4): 254-264, 2021 07 28.
Article in English | MEDLINE | ID: covidwho-1348095

ABSTRACT

The Coronavirus Disease 2019 (COVID-19) pandemic has led to an exponential rise in mental health issues. Studies have shown that, in times of increased unemployment rates and economic downturn, rates of mental health issues, suicide, substance use, and domestic violence tend to increase. Barriers to care, including stigma and decreased access to providers, contribute to morbidity and mortality. Telehealth services are being utilized to help increase access to care, and economic stimulus packages have been created to help with the financial burden that is often associated with increased mental health stressors. Efforts to prevent burnout and other policy recommendations can help decrease mental health issues in first responders and health care professionals, who are at an increased risk for these problems. Increasing the ability to provide wellness screenings to the general population, to educate the public about preventive measures and practices, and to provide mental health and substance use treatment, such as medication management and therapy services, are among top priorities to further reduce the socioeconomic impact of COVID-19 on mental illness.


Subject(s)
COVID-19/epidemiology , Mental Disorders/epidemiology , Mental Health/statistics & numerical data , COVID-19/economics , Humans , Mental Disorders/economics , Mental Disorders/prevention & control , Mental Disorders/therapy , Pandemics , SARS-CoV-2 , Socioeconomic Factors
4.
Sci Rep ; 11(1): 15828, 2021 08 04.
Article in English | MEDLINE | ID: covidwho-1343475

ABSTRACT

Precise remote evaluation of both suicide risk and psychiatric disorders is critical for suicide prevention as well as for psychiatric well-being. Using questionnaires is an alternative to labor-intensive diagnostic interviews in a large general population, but previous models for predicting suicide attempts suffered from low sensitivity. We developed and validated a deep graph neural network model that increased the prediction sensitivity of suicide risk in young adults (n = 17,482 for training; n = 14,238 for testing) using multi-dimensional questionnaires and suicidal ideation within 2 weeks as the prediction target. The best model achieved a sensitivity of 76.3%, specificity of 83.4%, and an area under curve of 0.878 (95% confidence interval, 0.855-0.899). We demonstrated that multi-dimensional deep features covering depression, anxiety, resilience, self-esteem, and clinico-demographic information contribute to the prediction of suicidal ideation. Our model might be useful for the remote evaluation of suicide risk in the general population of young adults for specific situations such as the COVID-19 pandemic.


Subject(s)
Mental Disorders/diagnosis , Mental Disorders/psychology , Neural Networks, Computer , Suicidal Ideation , Suicide, Attempted/psychology , Adolescent , Adult , Anxiety/psychology , Area Under Curve , Depression/psychology , Female , Humans , Male , Mental Disorders/prevention & control , Prognosis , Psychiatric Status Rating Scales , Republic of Korea , Resilience, Psychological , Risk Factors , Self Concept , Sensitivity and Specificity , Suicide, Attempted/prevention & control , Surveys and Questionnaires , Young Adult
5.
Lancet Psychiatry ; 8(5): 368-369, 2021 05.
Article in English | MEDLINE | ID: covidwho-1298398
7.
J Complement Integr Med ; 18(3): 637-640, 2021 May 07.
Article in English | MEDLINE | ID: covidwho-1219500

ABSTRACT

OBJECTIVES: Covid-19 Pandemic has affected everyone's mental health. In addition to several preventive measures such as wearing a mask, using sanitizer, measures also need to be taken to prevent anxiety and depressive disorders due to this unexpected crisis situation. Practicing yoga is one of the simple, scientific methods to combat stress and prevent anxiety among children. METHODS: The scientific evidence and anecdotal experiences on benefits of yoga is described in this paper, highlighting the importance of yoga in nurturing the mental well-being in children. RESULTS: Scientifically designed and conducted studies as part of the research programs by health professionals objectively conclude that mental health parameters improve significantly with yoga as an intervention. In addition to mental health, yoga will also improve the physical health and boost immunity among children which will also help in reducing the infection rate in children. CONCLUSIONS: As a way forward, authors strongly recommend establishing yoga as a curriculum at scale to cover the vast vulnerable population of young children who are the future of the nation.


Subject(s)
COVID-19/psychology , Meditation , Mental Disorders/prevention & control , Mental Health , Pandemics , Stress, Psychological/prevention & control , Yoga , Adolescent , Adolescent Health , Anxiety , Anxiety Disorders , Child , Child Health , Depression , Depressive Disorder , Humans , Mental Disorders/etiology , SARS-CoV-2 , Stress, Psychological/etiology
8.
Lancet Psychiatry ; 8(4): 340-346, 2021 04.
Article in English | MEDLINE | ID: covidwho-1192378

ABSTRACT

Social protection measures can play an important part in securing livelihoods and in mitigating short-term and long-term economic, social, and mental health impacts of the COVID-19 pandemic. In particular, cash transfer programmes are currently being adapted or expanded in various low-income and middle-income countries to support individuals and families during the pandemic. We argue that the current crisis offers an opportunity for these programmes to focus on susceptible young people (aged 15-24 years), including those with mental health conditions. Young people living in poverty and with mental health problems are at particular risk of experiencing adverse health, wellbeing, and employment outcomes with long-term consequences. They are also at risk of developing mental health conditions during this pandemic. To support this population, cash transfer programmes should not only address urgent needs around food security and survival but expand their focus to address longer-term mental health impacts of pandemics and economic crises. Such an approach could help support young people's future life chances and break the vicious cycle between mental illness and poverty that spirals many young people into both socioeconomic and mental health disadvantage.


Subject(s)
COVID-19/psychology , Mental Disorders/prevention & control , Mental Health , Public Policy , Adolescent , Developing Countries , Government Programs , Humans , Mental Disorders/economics , Poverty , Public Assistance/economics , Young Adult
9.
Orv Hetil ; 162(10): 366-374, 2021 03 07.
Article in Hungarian | MEDLINE | ID: covidwho-1123702

ABSTRACT

Összefoglaló. Az elmúlt hónapokban életünket alapvetoen megváltoztatta a COVID-19-pandémia, melynek egészségügyi, gazdasági és társadalmi hatásai egyelore szinte felbecsülhetetlenek. A vírusfertozés akut következményei mellett egyre több adat bizonyítja a teljes népességre kifejtett hatásait: a pszichológiai distressz, a depressziós és szorongásos tünetek, valamint az addiktív viselkedésformák gyakoriságának növekedését. Az is nagyon fontos kérdés, hogy a globális válsághelyzet hogyan befolyásolja az öngyilkossági arányszámokat. Írásomban az elmúlt idoszak legjelentosebb pszichiátriai szakirodalma alapján foglalom össze a vírusfertozés akut és krónikus hatásait, valamint a járványhelyzet általános és specifikus pszichológiai-pszichopatológiai következményeit, kiemelt figyelmet fordítva a suicidiumrizikóra és a leginkább veszélyeztetett csoportokra. A vizsgálatok arra utalnak, hogy a pandémia következtében kialakuló mentális gondok és a suicid viselkedés egyre fontosabb népegészségügyi problémává válnak. Bár napjainkban még a vírusfertozöttek gyógyítása és a fertozés terjedésének lassítása a legfontosabb cél, mindannyiunknak fel kell készülnünk a járvány hosszú távú következményeire. A pandémia várható negatív mentálhigiénés hatásainak megelozésére és enyhítésére általános és specifikus módszerek kidolgozása és alkalmazása szükséges. Ebben az egészségügyi, mentálhigiénés és közösségi ellátórendszerek mellett szerepet kell vállalniuk a politikai és gazdasági döntéshozóknak, a társadalmi szervezeteknek és a média munkatársainak is. Hatékony együttmuködésük kulcsfontosságú az egyéni, közösségi és társadalmi szinten is alkalmazható prevenciós stratégiák megvalósításában, hiszen csak így válik lehetové a súlyosabb mentálhigiénés problémák járványszeru elterjedésének, a "pszichodémiának" a megelozése. Orv Hetil. 2021; 162(10): 366-374. Summary. In recent months, our lives have been fundamentally changed by the COVID-19 pandemic, the health, economic, and social impacts of which are almost invaluable for the time being. In addition to the acute consequences of viral infection, more and more data are proving its effects on the entire population: an increase in the incidence of psychological distress, depressive and anxiety symptoms, and addictive behaviours. It is also a very important question, how the global crisis is affecting suicide rates. In my paper, I summarize the acute and chronic effects of viral infection and the general and specific psychological-psychopathological consequences of the epidemic based on the most significant psychiatric literature of the recent period, paying special attention to suicidal risk and the most vulnerable groups. Studies suggest that mental troubles and suicidal behaviour resulting from a pandemic are becoming an increasingly important public health problem. Although the treatment of viral infections and slowing the spread of the infection are still the most important goals today, we all need to be prepared for the long-term consequences of the epidemic. In order to prevent and mitigate the expected negative mental health effects of a pandemic, it is necessary to develop and apply general and specific methods. In addition to health care, mental health and community care systems, political and economic decision-makers, civil society organizations and the media must also play a role. Their effective cooperation is key to the implementation of prevention strategies that can be applied at the individual, community and social levels, as this is the only way to prevent the epidemic spread of more serious mental health problems, the "psychodemia". Orv Hetil. 2021; 162(10): 366-374.


Subject(s)
COVID-19 , Epidemics , Mental Disorders , COVID-19/psychology , Epidemics/prevention & control , Humans , Mental Disorders/epidemiology , Mental Disorders/prevention & control
10.
Int J Soc Psychiatry ; 68(3): 477-480, 2022 May.
Article in English | MEDLINE | ID: covidwho-1116870

ABSTRACT

INTRODUCTION: France has been impacted by the COVID-19 pandemic. Anxiety, depression, burn out and the high proportion of post-traumatic stress disorder proved to be the most expected troubles caused by this pandemic and the confinement. Medico-psychological emergency units (CUMP) have been solicited at the very early stage of the pandemic because CUMP units are very well known by the French government and systematically associated to emergency plans. METHODS: In this article we describe the process which has been developed to cope with the psychological needs in the general population. At a first level, platforms of volunteers specialised into listening were available. Then those platforms could directly mobilise the CUMP in case of psychiatric disorders. It ran over the whole first wave and it has been reactivated because of the second confinement in France. RESULTS: During the first wave, approximately 1% of all the calls made on the national Covid number required to be redirected to the listening platforms. Of this group, 4% were related to reactive pathology or a psychiatric decompensating that required adapted and specialised care. CONCLUSION: The high rates of psychological distress detected in the general population in recent scientific literature seem discrepant with our findings of relatively low reorientation towards the CUMP. Nevertheless, our study highlights that the response of the CUMP network in France during the first wave was supportive. The second wave displays its adaptability to the public health policies.


Subject(s)
COVID-19 , Emergency Services, Psychiatric , Mental Disorders , COVID-19/complications , COVID-19/epidemiology , Emergency Services, Psychiatric/statistics & numerical data , France/epidemiology , Humans , Mental Disorders/epidemiology , Mental Disorders/etiology , Mental Disorders/prevention & control , Pandemics , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/etiology , Stress Disorders, Post-Traumatic/prevention & control
12.
J Relig Health ; 60(1): 99-111, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1009166

ABSTRACT

Coping with the COVID-19 pandemic has required measures to contain the contagion, including social isolation. However, this and other factors have caused mental health problems, both in patients and health professionals and in family members or asymptomatic population. Religious support can be an ally for this type of confrontation. In the case of the COVID-19 pandemic, spiritual/religious care has been restricted and insufficient. When accessible to patients and frontline professionals, they are offered by virtual means, almost always by recorded media and made available in bulk. This essay argues, based on references in the areas of psychology, psychoneuroimmunology, biosafety, and military, that the face-to-face and personalized relationship between religious leaders, patients, health professionals, family members, and faith communities is as essential as possible for the dignified treatment victims, referral to spiritual needs and resilience of society, in addition to contributing to the improvement of the immune response of all. Practical examples are cited in the areas of military chaplaincy and hospital civilian chaplaincy. The essay also proposes the adoption of protocols already published by WHO and other safety measures such as the use of robotics and the recruitment/training of mass chaplains. In addition to contributing to the improvement of COVID-19 pandemic coping processes, the study also contributes to improving the delivery of spiritual/religious care as an ally to physical and mental, individual, and collective health.


Subject(s)
COVID-19 , Mental Disorders , Religion and Psychology , Social Isolation , COVID-19/psychology , Humans , Mental Disorders/prevention & control , Social Isolation/psychology
13.
Int J Environ Res Public Health ; 17(24)2020 12 16.
Article in English | MEDLINE | ID: covidwho-993546

ABSTRACT

The increasing prevalence of mental health disorders and psychosocial distress among young people exceeds the capacity of mental health services. Social and systemic factors determine mental health as much as individual factors. To determine how best to address multi-level risk factors, we must first understand the distribution of risk. Previously, we have used psychometric methods applied to two epidemiologically-principled samples of people aged 14-24 to establish a robust, latent common mental distress (CMD) factor of depression and anxiety normally distributed across the population. This was linearly associated with suicidal thoughts and non-suicidal self-harm such that effective interventions to reduce CMD across the whole population could have a greater total benefit than those that focus on the minority with the most severe scores. In a randomised trial of mindfulness interventions in university students (the Mindful Student Study), we demonstrated a population-shift effect whereby the intervention group appeared resilient to a universal stressor. Given these findings, and in light of the COVID-19 pandemic, we argue that population-based interventions to reduce CMD are urgently required. To target all types of mental health determinants, these interventions must be multi-level. Careful design and evaluation, interdisciplinary work, and extensive local stakeholder involvement are crucial for these interventions to be effective.


Subject(s)
Mental Disorders/prevention & control , Primary Prevention , Adolescent , Adult , Anxiety/epidemiology , Anxiety/prevention & control , COVID-19 , Depression/epidemiology , Depression/prevention & control , Humans , Mental Disorders/epidemiology , Pandemics , Self-Injurious Behavior/prevention & control , Suicidal Ideation , Young Adult
14.
Psychiatry Res ; 296: 113669, 2021 02.
Article in English | MEDLINE | ID: covidwho-989071

ABSTRACT

This study aimed to analyze the possible impacts on the prison population's mental health in the context of the new COVID-19 pandemic. Qualitative study was carried out following a lexical and content analysis using the software IRaMuTeQ, version 0.7 alpha 2, in the speech of the short communication and headlines from newspapers. Three groups emerged from the analysis: "spatial conditions for infection" (39.2% of the text segments); "disease outbreaks in prisons" (30,4%) and "public responsibility" (30,4%). Precarious conditions of prisons, high rate of infections and psychiatric illnesses, and lack of government assistance are issues that should be given special attention in order to formulate health promotion and prevention policies focusing on mental health in prison population.


Subject(s)
COVID-19/epidemiology , Mental Disorders/epidemiology , Prisoners/statistics & numerical data , COVID-19/prevention & control , COVID-19/psychology , Comorbidity , Cross-Sectional Studies , Evaluation Studies as Topic , Health Promotion , Humans , Mental Disorders/prevention & control , Mental Disorders/psychology , Prisoners/psychology , Public Assistance , Risk Factors
15.
BMJ Open ; 10(11): e041133, 2020 11 27.
Article in English | MEDLINE | ID: covidwho-947831

ABSTRACT

INTRODUCTION: Mental health disorders are common during pregnancy and the postnatal period and can have serious adverse effects on women and their children. The consequences for global mental health due to COVID-19 are likely to be significant and may have a long-term impact on the global burden of disease. Besides physical vulnerability, pregnant women are at increased risk of mental health problems such as anxiety, depression and post-traumatic stress disorder due to the consequences of social distancing. It can result in altered healthcare routines, less support from the family and friends, and in some cases, partners not being allowed to be present during prenatal visits, labour and delivery. Higher than expected, rates of perinatal anxiety and depression have been already reported during the pandemic. Pregnant women may also feel insecure and worried about the effects of COVID-19 on their unborn child if they get infected during pregnancy. Today, young urban women are used to using internet services frequently and efficiently. Therefore, providing mental health support to pregnant women via internet may be effective in ameliorating their anxiety/depression, reducing the risk of serious mental health disorders, and lead to improved maternal and perinatal outcomes. OVERARCHING AIM: Our aim is to explore the effectiveness of a web-based psychosocial peer-to-peer support intervention in reducing the risk and severity of perinatal mental health disorders and preventing adverse pregnancy outcomes among pregnant women living in metropolitan urban settings. METHODS AND ANALYSIS: We plan to conduct a multicentre prospective randomised controlled trial, Mental health of Urban Mothers trial. Pregnant women living in large metropolitan cities will be recruited using internet-based application through non-profit organisations' websites. The women who consent will be randomised to receive a web-based peer-to-peer support intervention or usual care. Data will be analysed to identify the effects of intervention on Edinburgh Postnatal Depression Score and Generalised Anxiety Disorder 7 scores as well as pregnancy outcomes. The impact of COVID-19 pandemic on maternal stress will be assesed using Impact Event Scale-R. Any differences in outcomes between cities will be addressed in subgroup analyses. ETHICS AND DISSEMINATION: The study will be conducted according to the principles of Good Clinical Practice and will follow the ethical principles of the Declaration of Helsinki. The study protocol has been approved by the ethical review board of Chinese University of Hong Kong (IRB number 2019-8170) and Shanghai Center for Women's and Children's Health (international review board (IRB) number 2020-F001-12). The results will be disseminated at national and international scientific conferences, published in peer-reviewed medical journals and spread to the public through social media, news outlets and podcasts. TRIAL REGISTRATION NUMBER: NCT04363177; Trial sponsor Karolinska Institute, CLINTEC, Stockholm, Sweden.


Subject(s)
COVID-19/psychology , Mental Disorders/prevention & control , Mental Health , Pregnancy Complications/psychology , Psychotherapy/methods , Stress, Psychological/prevention & control , Urban Population , Anxiety/etiology , Anxiety/prevention & control , Child , Depression/etiology , Depression/prevention & control , Depression, Postpartum/prevention & control , Female , Humans , Internet , Mental Disorders/etiology , Mothers/psychology , Pandemics , Peer Group , Physical Distancing , Pregnancy , Pregnancy Outcome , Pregnant Women/psychology , Randomized Controlled Trials as Topic , Research Design , Stress, Psychological/etiology
19.
Encephale ; 46(3): 193-201, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-888503

ABSTRACT

OBJECTIVE: The lack of resources and coordination to face the coronavirus epidemic raises concerns for the health of patients with mental disorders in a country where we still have memories of the dramatic experience of famine in psychiatric hospitals during the Second World War. This article aims to propose guidance to ensure mental health care during the SARS-CoV epidemic in France. METHODS: The authors performed a narrative review identifying relevant results in the scientific and medical literature and in local initiatives in France. RESULTS: We identified four types of major vulnerabilities among patients with mental disorders during this pandemic: (1) medical comorbidities that are more frequently found among patients with mental disorders (cardiovascular and pulmonary pathologies, diabetes, obesity, etc.) which are risk factors for severe covid-19 infection; (2) age (the elderly form the population most vulnerable to the coronavirus); (3) cognitive and behavioural disorders, which can hamper compliance with confinement and hygiene measures and finally and (4) psychosocial vulnerability as a result of stigmatization and/or socio-economic difficulties. Furthermore, the mental health healthcare system is more vulnerable than other healthcare systems. Current government plans are poorly suited to psychiatric establishments in a context of major shortages of organizational, material and human resources. In addition, a certain number of structural aspects make the psychiatric institution particularly vulnerable: many beds have been closed, wards have high densities of patients, mental health community facilities are closed, and medical teams are understaffed and poorly trained to face infectious diseases. There are also major issues when referring patients with acute mental disorders to intensive care units. To maintain the continuity of psychiatric care in this pandemic situation, several directions can be considered, in particular with the creation of "COVID+ units". These units are under the dual supervision of a psychiatrist and an internist/infectious disease specialist; all new entrants are placed in quarantine for 14 days; the nursing staff receives specific training, daily medical check-ups and close psychological support. Family visits are prohibited and replaced by videoconference. At the end of hospitalization, in particular for the population of patients in compulsory ambulatory care situations, specific case-management are organized with the possibility of home visits, in order to support patients when they get back home and to help them cope with the experience of confinement, which is liable to induce recurrences of mental disorders. The total or partial closure of community mental health facilities is particularly disturbing for patients, but a regular follow-up is possible with telemedicine and should include the monitoring of suicide risk and psycho-education strategies; developing support platforms could also be very helpful in this context. Private practice psychiatrists also have a crucial role of information towards their patients on confinement and barrier measures, and also on measures to prevent the psychological risks inherent in confinement: maintenance of regular sleep r, physical exercise, social interactions, stress management and coping strategies, prevention of addictions, etc. They should also be trained to prevent, detect and treat early warning symptoms of post-traumatic stress disorder, because their prevalence was high in the regions of China most affected by the pandemic. DISCUSSION: French mental healthcare is now facing a great and urgent need for reorganization and must also prepare in the coming days and weeks to face an epidemic of emotional disorders due to the confinement of the general population.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Coronavirus Infections/psychology , Mental Disorders/therapy , Mental Health , Pneumonia, Viral/epidemiology , Pneumonia, Viral/psychology , Aged , Aged, 80 and over , COVID-19 , Epidemics , France/epidemiology , Hospitals, Psychiatric/organization & administration , Hospitals, Psychiatric/standards , Hospitals, Psychiatric/statistics & numerical data , Humans , Mental Disorders/epidemiology , Mental Disorders/prevention & control , Pandemics , Psychotic Disorders/epidemiology , Psychotic Disorders/therapy , Quarantine/psychology , Quarantine/statistics & numerical data , Risk Factors , SARS-CoV-2 , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/etiology , Stress Disorders, Post-Traumatic/therapy , Suicide/prevention & control , Suicide/statistics & numerical data
20.
Br J Psychiatry ; 218(2): 75-76, 2021 02.
Article in English | MEDLINE | ID: covidwho-890130

ABSTRACT

Besides a global health crisis, the COVID-19 pandemic has potential to have a severe and long-lasting psychological impact on frontline healthcare workers such as paramedics. It is imperative to shed light on these mental health issues and employ interventions to protect the mental wellness of this vulnerable group of healthcare workers.


Subject(s)
COVID-19 , Emergency Medical Technicians/psychology , Mental Disorders/therapy , Occupational Diseases/therapy , Adult , Depressive Disorder/therapy , Humans , Mental Disorders/etiology , Mental Disorders/prevention & control , Occupational Diseases/prevention & control , Occupational Stress/therapy , Psychological Trauma/therapy , Psychosocial Intervention , Stress Disorders, Post-Traumatic/therapy , Suicide/prevention & control
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