Wellbeing, burnout and substance use amongst medical students: A summary of results from nine countries.

OBJECTIVE: There has been increasing interest in the physical health, mental wellbeing and burnout afflicting medical students over recent years. This paper describes the overall results from phase two of an international study including a further nine countries across the world. METHODS: We sampled large groups of medical students in nine countries at the same time and with exactly the same method in order to aid direct comparison of demographics, burnout and mental wellbeing through validated instruments. RESULTS: A total of 4,942 medical students from these countries participated in this study. Around 68% of respondents screened positive for mild psychiatric illness using the General Health Questionnaire-12. Around 81% and 78% of respondents were found to be disengaged or exhausted respectively using the Oldenburg Burnout Inventory. Around 10% were found to be CAGE positive and 14% reported cannabis use. The main source of stress reported by medical students was their academic studies, followed by relationships, financial difficulties and housing issues. CONCLUSION: Cultural, religious and socioeconomic factors within each country are important and understanding their effects is fundamental in developing successful local, regional and national initiatives. Further quantitative and qualitative research is required to confirm our results, clarify their causes and to develop appropriate preventative strategies.

Mental health and wellbeing among Iranian medical students: a descriptive study.

BACKGROUND: The psychological wellbeing and stresses on medical students are currently under a global spotlight. Under a wider initiative supported by the British Medical Association (BMA), international surveys have been conducted to understand and begin to tackle these issues. METHOD: This study aimed at describing the mental wellbeing and levels of burnout of Iranian medical students. A total of 179 medical students from 19 different cities participated voluntarily in the survey by answering an online questionnaire between April and August 2020. We detected a trend toward higher prevalence of psychiatric disorders (namely depressive disorders) and substance misuse when compared to previous national studies. RESULTS: About 6% of students screened positive for alcohol problems with the CAGE questionnaire. About 77% of medical students screened positive for mental health problems with the GHQ12 questionnaire. Very high rates of burnout were also reported. These findings emphasize the urgent need to define methods to screen at risk medical students and implement local and national initiatives to curtain their potential detrimental effects.

Scaling Up Global Mental Health Services During the COVID-19 Pandemic and Beyond.

Every health care system requires an adequate health care workforce, service delivery, financial support, and information technology. During the COVID-19 pandemic, global health systems were ill prepared to address the rising prevalence of mental health problems, especially in low- and middle-income countries (LMICs), thereby increasing treatment gaps. To close these gaps globally, task shifting and telepsychiatry should be made available and maximized, particularly in LMICs. Task shifting to nonspecialist health workers to improve essential mental health coverage and encourage efficient use of the available resources and technology has become the most viable strategy.

How to overcome barriers to publication in low- and middle-income countries: Recommendations from early career psychiatrists and researchers from around the world.

There is an increasing movement toward international collaboration and global discussion in mental health. If provided with the right opportunities, early career psychiatrists (ECPs) and researchers in mental health can contribute meaningfully to this discussion. However, they often experience multiple barriers when attempting to add their voices via academic publications. We represent a diverse group of ECPs and researchers from all six World Health Organization regions. In this piece, we discuss these barriers, grounded in our first-hand experiences, and put forth a series of recommendations. The most potentially beneficial and immediate way forward is ensuring a much-needed mentorship and support, particularly for low- and middle-income countries. In this regard, international organizations, especially those with a particular focus on education, such as the Section on Education in Psychiatry of the World Psychiatric Association, can play a pivotal role.

Development and Evaluation of Acceptability and Feasibility of a Web-Based Intervention for Patients With Bipolar Disorder in Iran: Implementation Study.

BACKGROUND: Psychoeducation for bipolar disorder has a significant impact on symptoms and treatment adherence. In Iran, as a low-resource setting, infrastructural barriers, such as inadequate mental health professionals, difficulties in transportation, and costs of care, may hinder optimum delivery of this evidence-based intervention to patients. OBJECTIVE: This study sought to explore the acceptability and feasibility of a web-based intervention for bipolar patients in Iran. METHODS: A website has been developed as a platform for providing psychoeducational content about bipolar disorder. Patients were chosen via a convenient sampling method in 2018-2019. The main component of the intervention included streaming 7 weekly video clips after attending a single in-person meeting, as well as a medication self-monitoring application. Information was collected about the feasibility and acceptability of the intervention. RESULTS: We invited 45 patients from the day center and the outpatient clinic of Roozbeh psychiatric hospital and some private clinics in Tehran. Of the 23 patients (51%) who attended the first in-person session and provided informed consent, 14 patients dropped out during the study. While 9 patients completed the course (attended 4 or more online sessions), only 5 watched all the video sessions. The rate of adherence to the intervention and frequency of exposure to the website were much higher for those recruited from the private and outpatient clinics. CONCLUSIONS: This web-based intervention can be feasible and acceptable only for a subgroup of patients with specific educational status and socioeconomic level.

White matter microstructural abnormalities in primary insomnia: A systematic review of diffusion tensor imaging studies.

Primary insomnia (PI), the most common sleep disorder, is primarily characterized by difficulties in initiating and maintaining sleep and deficits in daytime functioning. Study of white matter (WM) connections of the brain might provide valuable information regarding the underlying neural mechanism of PI. Diffusion tensor imaging (DTI) provides non-invasive access to the microstructural and network properties of brain WM, and thus, a great opportunity to quantitatively and sensitively study the human brain. The current literature of PI does not provide a consistent explanation of the etiology and pathology of the disorder; thus, we searched PubMed, EMBASE, and SCOPUS for DTI studies that compared WM integrity or network organization between PI patients and healthy controls to integrate all existing literature as an insight for further studies, and, hopefully, effective prevention and management of the disorder. English peer-reviewed full-text publications that investigated the diffusion indices of PI patients or those with insomnia symptoms compared with a group of healthy controls were included. We included 11 studies and extracted the data for qualitative synthesis. Except for one study, all studies were rated as high-quality, based on quality assessment. In aggregation, a total of 541 patients with PI and 679 healthy controls were included in this study. Our review of DTI studies suggests that WM disruptions in PI are better characterized in the context of neural networks. Frontostriatal, frontothalamic, and corticocortiscal networks, as well as the limbic system, seem to be the main neural networks with microstructural and network alterations in patients with PI. To illustrate, different parts of corona radiate and internal capsule within the corticosubcortical networks and superior longitudinal fasciculus within the corticocortical networks showed altered microstructural properties in PI patients. In view of the fact that the findings from individual studies are heterogeneous, it is difficult to derive consistent findings from the results, and the divergence of the findings must not be disregarded. Thus, this study is a starting point for future studies, and its implications for etiology and pathogenesis of insomnia should be regarded cautiously.

Structural white matter alterations in male adults with high functioning autism spectrum disorder and concurrent depressive symptoms; a diffusion tensor imaging study.

BACKGROUND: Autism spectrum disorder (ASD), a prevalent developmental condition, is associated with comorbid mood disorders, most importantly depression. Here, we explored the underlying association between brain white matter microstructural integrity, assessed by diffusion tensor imaging (DTI), and depressive symptoms, in male adults with high-functioning ASD. METHOD: To assess our main purpose, Autism Brain Imaging Data Exchange II dataset was used to acquire brain diffusion imaging from 26 adult male patients with ASD ranging from 18 to 62 years of age, and 26 age and gender-matched typically developed control subjects. Participants were evaluated for depressive symptoms manifestation by the Beck Depression Index (BDI). DWI images were preprocessed and analyzed for DTI scalers in the "ExploreDTI" toolbox. Adjusted linear regression models were used. Association between normalized BDI score and its interaction with diagnosis, as predictors, and measures of fractional anisotropy (FA) and mean diffusivity (MD) of regions of interest according to Mori atlas was assessed. RESULT: Significant lower microstructural integrity of white matter was found in association with higher BDI scores in ASD group, mainly in regions of anterior limb of internal capsule (ALIC) and corona radiata. Also, a statistically significant positive interaction between BDI and ASD was seen in FA of left ALIC. DISCUSSION: Considering similar regional brain white matter involvement with the imaging studies of depression in the typically developed population, we propose that these alterations of white matter tracts in depressive symptoms of adult ASD subjects might be, at least, similar to depression in typically developed population.