Increase in prevalence of current mental disorders in the context of COVID-19: analysis of repeated nationwide cross-sectional surveys.

AIMS: The United Nations warned of COVID-19-related mental health crisis; however, it is unknown whether there is an increase in the prevalence of mental disorders as existing studies lack a reliable baseline analysis or they did not use a diagnostic measure. We aimed to analyse trends in the prevalence of mental disorders prior to and during the COVID-19 pandemic. METHODS: We analysed data from repeated cross-sectional surveys on a representative sample of non-institutionalised Czech adults (18+ years) from both November 2017 (n = 3306; 54% females) and May 2020 (n = 3021; 52% females). We used Mini International Neuropsychiatric Interview (MINI) as the main screening instrument. We calculated descriptive statistics and compared the prevalence of current mood and anxiety disorders, suicide risk and alcohol-related disorders at baseline and right after the first peak of COVID-19 when related lockdown was still in place in CZ. In addition, using logistic regression, we assessed the association between COVID-19-related worries and the presence of mental disorders. RESULTS: The prevalence of those experiencing symptoms of at least one current mental disorder rose from a baseline of 20.02 (95% CI = 18.64; 21.39) in 2017 to 29.63 (95% CI = 27.9; 31.37) in 2020 during the COVID-19 pandemic. The prevalence of both major depressive disorder (3.96, 95% CI = 3.28; 4.62 v. 11.77, 95% CI = 10.56; 12.99); and suicide risk (3.88, 95% CI = 3.21; 4.52 v. 11.88, 95% CI = 10.64; 13.07) tripled and current anxiety disorders almost doubled (7.79, 95% CI = 6.87; 8.7 v. 12.84, 95% CI = 11.6; 14.05). The prevalence of alcohol use disorders in 2020 was approximately the same as in 2017 (10.84, 95% CI = 9.78; 11.89 v. 9.88, 95% CI = 8.74; 10.98); however, there was a significant increase in weekly binge drinking behaviours (4.07% v. 6.39%). Strong worries about both, health or economic consequences of COVID-19, were associated with an increased odds of having a mental disorder (1.63, 95% CI = 1.4; 1.89 and 1.42, 95% CI = 1.23; 1.63 respectively). CONCLUSIONS: This study provides evidence matching concerns that COVID-19-related mental health problems pose a major threat to populations, particularly considering the barriers in service provision posed during lockdown. This finding emphasises an urgent need to scale up mental health promotion and prevention globally.

Prevalence of mental disorders and associated disability: Results from the cross-sectional CZEch mental health Study (CZEMS).

INTRODUCTION: We aimed to estimate the prevalence of current mental disorders in the Czech population, and to identify associated disability. METHODS: We conducted a representative cross-sectional household survey of the Czech adult, community-dwelling population. We used the Mini International Neuropsychiatric Interview (M.I.N.I.), WHO Disability Assessment Schedule (WHODAS) 2.0, and Self-Identification as Mentally Ill (SELFI) scale alongside sociodemographic and other covariates. We reached 75% response rate. Descriptive statistics of the sample were assessed and median (M) disability levels with interquartile range (IQR) according diagnosis were calculated on a scale ranging from 12 to 50. Linear regression models were used to identify factors associated with disability. RESULTS: In our sample of 3 306 participants, 21.9% experienced a mental disorder in 2017. Prevalence rates for mood, anxiety, alcohol use, non-alcohol substance use, and psychotic disorders corresponded to 5.5%, 7.3%, 10.8%, 2.9%, and 1.5% respectively. Alcohol dependence was identified in 6.6%, and major depression in 4.0% of the sample. Disability in the general population was significantly lower (M = 12; IQR = 12, 17) than in those with mood (M = 20; IQR = 14; 29), anxiety (M = 18; IQR = 13; 26), alcohol use (M = 14; IQR = 12; 18), non-alcohol substance use (M = 15; IQR = 12; 19), or psychotic disorders (M = 22; IQR = 16.4; 29.4). CONCLUSIONS: People with mental disorders have considerably elevated disability in comparison to mentally healthy participants. The prevalence of mental disorders in the Czech Republic is mostly in line with European prevalence rates but it is lower for anxiety disorders and two times higher for alcohol use disorders.

Reported and intended behaviour towards those with mental health problems in the Czech Republic and England.

This is one of the first studies, which compares the level of stigmatizing behaviour in countries that used to be on the opposite sides of the Iron Curtain. The aim was to identify the prevalence of reported and intended stigmatizing behaviour towards those with mental health problems in the Czech Republic and to compare these findings with the findings from England. The 8-item Reported and Intended Behaviour Scale (RIBS) was used to assess stigmatising behaviour among a representative sample of the Czech population (n=1797). Results were compared with the findings of an analogous survey from England (n=1720), which also used the RIBS. The extent of reported behaviour (i.e., past and present experiences with those with mental health problems) was lower in the Czech Republic than in England. While 12.7% of Czechs reported that they lived, 12.9% that they worked, and 15.3% that they were acquainted with someone who had mental health problems, the respective numbers for England were 18.5%, 26.3% and 32.5% (P<0.001 in each of these items). On the other hand, the extent of intended stigmatizing behaviour towards those with mental health problems is considerably higher in the Czech Republic. Out of maximum 20 points attached to possible responses to the RIBS items 5-8, Czechs had a lower total score (x=11.0, SD=4.0) compared to English respondents (x=16.1, SD=3.6), indicating lower willingness to accept a person with mental health problems (P<0.001). The prevalence of stigmatizing behaviour in the Czech Republic is worrying. Both, further research and evidence based anti-stigma interventions, should be pursued in order to better understand and decrease stigmatizing behaviour in the Czech Republic and possibly across the post-communist countries in Central and Eastern Europe.

[Incidence of delirium tremens in the Czech Republic: a rapid increase]. / Delirium tremens v Ceske republice: strmý vzestup.

From 1995 to 2005 the number of patients with delirium tremens increased 1.57 times in the Czech Republic. Greater increase took place among women (almost twice in 2005 compared with 1995). These data are related to the increasing per capita alcohol consumption till 2003, and they show that effective prevention (e.g. higher taxation of alcohol), early intervention and appropriate treatment of alcohol dependence are important. The self-help manual for problem drinkers can be downloaded free of charge from.

[Spirituality in medicine and addictive diseases]. / Spiritualita v medicíne a u návykových nemocí.

Some relevant studies dealing with spirituality in the prevention and treatment of addictive diseases are summarized. Lower prevalence of daily smoking was ascertained also in Czech population. Health workers should pay appropriate attention to spiritual needs of their patients. Spirituality also alleviates professional stress in helping professions. A case report illustrating the importance of spirituality in treatment of alcohol dependence is included. Spirituality in addicted persons is often rather inconspicuous and covert.

[Improving self-control in substance dependent persons and pathological gamblers--a pilot study]. / Jak zlepsit sebeovládání u závislých na alkoholu a jiných látkách a u patologických hrácu?--Pilotní studie.

BACKGROUND: Impaired self-control is an important symptom of addictive diseases. The average number of factors improving self-control among 117 men dependent on alcohol, other substances and pathological gamblers was 5.55 (SD=3.5). METHODS AND RESULTS: We classified strategies how to improve self-control into following groups (their ordering reflects the frequency of their use in our sample): 1. The help of others (professional treatment, self-help groups, and family), 2. Distraction and similar techniques, 3. The use of motivation, 4. Life-style changes including appropriate rest, 5. Physical activity, sports, physical work, 6. The use of environments, 7. Mastering of social and other relevant skills, 8. Relaxation based approaches, 9. Techniques working with improved self-awareness, 10. Pharmacotherapy, 11. Acknowledgement of an addictive disease and abstinence, 12. Disrupting risky behavioral patterns. CONCLUSIONS: To improve of self-control in addictive diseases simple techniques are appropriate because of temporarily impaired cognitive functions during craving. Frequent repetition are also important.

[Abuse of buprenorphine becomes a problem of the Czech Republic]. / Zneuzívání buprenorfinu se stává v Ceské republice problémem.

Buprenorphine (Subutex) is according to epidemiological data and clinical experience abused on a large scale in the Czech Republic and for some drug dependent persons it becomes a principal intravenously applied drug. This problem can be resolved by more appropriate training of physicians who prescribe the drug and especially by the introduction of the combination buprenorphine and naloxone (Suboxone) which is not abused intravenously. The registration of Suboxone in the Czech Republic was not initiated by the manufactures so far.

[Psychotropic effects of physical activity]. / Psychotropní ucrinky telesné aktivity.

Physical activity can improve mental health. Positive effect of physical activity on depression and anxiety are mentioned. Moreover physical activity increases resistance against memory loss during aging. Physical activity also improves quality and life satisfaction in all age group; this fact was confirmed also in Czech children. Physical activity should be sufficient, but not excessive, and it should be combined with pharmacotherapy in severe and long-term depression. The kind of physical activity depends on the preferences and possibilities of patients; walking, yoga, swimming, etc. are usually appropriate.

[Treatment and prevention of alcohol-related problems and evidence based medicine]. / Lécba a prevence poruch pusobených alkoholem a medicína zalozená na dukazech.

Some principles of evidence based medicine are mentioned. Effective strategies of prevention and treatment of alcohol related problems include among others higher taxation of alcohol, prevention of driving while intoxicated, the training of relevant social skills in school children, brief intervention, the use of naltrexone and acamprosate, participation in Alcoholics Anonymous and family therapy.

[How many pathological gamblers are in the Czech Republic?]. / Kolik je v Ceské Republice patologických hrácu?

The number of pathological gamblers in the Czech Republic is not known. Every 10th male adolescent 18-year-old gambles once a month or more often. The number of slot machines in the Czech Republic is 1 per 200 of residents. Considering the prevalence of pathological gambling in other countries, we estimate that the prevalence of pathological gambling in the Czech Republic is probably not lower than 0.5-1% of population. Many more people are affected indirectly (family members and the victims of gambling related crimes). Effective prevention should both decrease availability and the demand.

[Alcohol and pregnancy]. / Alkohol v tehotenství.

Alcohol abuse in pregnancy causes fetal alcohol spectrum disorders ranging from discreet developmental problems to fetal alcohol syndrome. That is why pregnant women and the women considering pregnancy should abstain from alcohol. Fetal alcohol spectrum disorders occur even after drinking at early stages of pregnancy when women are not aware of being pregnant. According to one study 75% Czech women drank alcohol before pregnancy and one third of them continued during first three months of pregnancy. According to new epidemiological data 83.4% of Czech women aged between 18 and 40 drank alcohol during the year preceeding the pregnancy. The prevention in this area in the Czech Republic is clearly not satisfactory, and it is complicated by the alcohol advertising targeted at women, low taxation of alcohol and other factors.

[Alcoholic liver disease]. / Poskození jater alkoholem.

This paper summarizes the mechanisms which cause alcoholic liver disease. The most important principle when treating alcoholic liver disease is to abstain from alcohol; this often brings about remarkable improvement. Alcoholic liver disease should be treated as early as possible.

[Alcohol in the elderly]. / Alkohol u senioru.

We summarize specific features of alcohol-related problems in elderly patients. About one third alcohol dependent elderly patients develop their alcohol dependence while already aged. It often happens after stressful life events such as retirement or bereavement. Such patients can be treated more easily and alcohol does not cause so many somatic complications in them when compared with those elderly who develop their dependence earlier. Alcohol-related problems in elderly patients should be recognized and treated as soon as possible. Cognitive-behavioural therapy, supportive group therapy with peers (especially in lonely patients), self-help groups, such as Alcoholics Anonymous, and family therapy are appropriate. Modern anticraving medication can be also effective but comparatively high price limits its use.

[Patients treated for addictive diseases in the Psychiatric Centre Bohnice in years 1994 to 2003]. / Pacienti lécení pro návykové nemoci v Psychiatrické lécebné Bohnice v letech 1994-2003.

During 1994 to 2003 the number of patients treated in the Psychiatric Centre Bohnice who had within the first three dismissory diagnosis alcohol related disorders increased by 77% and disorders caused by other psychoactive drugs increased more than four times. An increase was observed also in pathological gambling (37%). In alcohol related problems the highest increase was seen in drug cessation (about four times). In other drug related problems the highest increase was marked in addiction treatment (almost five times). Such trend probably reflects the situation in the society together with other effects described in the study.

[Brief intervention for alcohol related problems can be used at various environments]. / Krátká intervence pro problémy pusobené alkoholem muze probíhat v ruizných prostredích.

Brief intervention for alcohol related problems is effective. Considering high per capita alcohol consumption, it is desirable that brief intervention should be practiced not only by health professionals but also by other workers. Feedback about alcohol related problems, clear advice, motivation enhancement, written texts, active referral, etc. has been used. Screening and brief interventions were successfully employed in general practice, psychiatry, gynaecology and obstetrics, at emergency and trauma units, in judiciary system, at schools including colleges and at various workplaces.

[An analysis of the sociodemographic context of alcohol use in the Czech adult population from the health perspective]. / Analýza sociodemografického kontextu pozívání alkoholických nápoju v dospelé populaci Ceské republiky z hlediska zdravotního.

BACKGROUND: WHO 2002 Report finds alcohol use to have mostly detrimental effects on the human health, only some patterns of use being beneficial. This study analyzes patterns of alcohol use in the Czech adult population according to region, urbanization, gender, age, and education. METHODS AND RESULTS: A sample of 1224 men and 1282 women (aged 18-64), representative for the Czech population of this age, was interviewed. Frequencies of beer, wine and spirit use, usual quantities per occasion, and the frequency of consuming >/= 75 g alcohol at a single occasion were ascertained. Results showed that 33% men and 14% women consume alcohol in a way hazardous for health, i.e. with a daily average > 40 g (men), > 20 g (women), or with periodic use of >/= 75 g at a single occasion. Only 6% men and 2% women adhere to a consumption pattern with supposed cardio-protective effects, i.e. at least each other day, in low/moderate quantity and without periodic binges. The health risk form of use in men is age related with the climax at 35-44 (p<0.001) and with a linear decreases with educational level (p<0.001). No statistically significant relation between the unhealthy alcohol use and age or the education level was found in women. CONCLUSIONS: In the Czech adult male and female population patterns of the health-risky or problematic alcohol use heavily overweight patterns with hypothetical beneficial effects, with no exception across sociodemographic strata.

[Adverse effects of marihuana after several years]. / Skodlivé úcinky marihuany s odstupem nekolika let.

We review health of marijuana since 1998, when The Lancet published the article dealing with this subject.

[European action plan on alcohol in the Czech Republic--no substantial progress]. / Evropský akcní plán o alkoholu v Ceské republice--zádný podstatný pokrok.

Czech Republic joined European action plan on alcohol for years 2000 to 2004 and signed its accomplishment. However, since 2000 situation has worsened. Alcohol consumption raised in 2001 (the last known data) to 10.0 litters of 100% alcohol (that is 159.9 litters of beer, 8.2 litters of distillates and 16.2 litters of wine per person per year). The only positive aspect was the small rise of consumption tax in distillates and that some thesis of the European action plan on alcohol were included into the governmental document "Long-term improvement of the health status of the population in Czech republic--Health for everybody in the 21st century". The proclamation has had no practical effect. Highly adverse is the situation with alcohol consumption in children and adolescents, which was described in the last study. Risks related to the high alcohol consumption in Czech republic include: High incidence of alcohol related death, including children, adolescents and young people (injuries, traffic accidents, poisonings, suicides, liver and tumor diseases); higher morbidity; lower productivity at work and worse position of Czech workers in concurrent environment; worse reproduction health, higher incidence of inborn defects caused by alcohol taken during pregnancy (including its beginning, when women do not know it); frequent social and family problems caused by alcohol abuses; increased risk of consumption of non-alcoholic drugs in children and adolescents. Alcohol belong to throughway drugs and its consumption in early age represents for children and adolescents a risk factor for other addictive drugs; alcohol is related namely to violent and negligent delicts; flagrant alcohol excesses together with alcohol related criminality harm the prestige of Czech Republic to foreign visitors and can drive them back.

Smoking behaviour of Czech adolescents: results of the Global Youth Tobacco Survey in the Czech Republic, 2002.

The Czech Republic Global Youth Tobacco Survey (GYTS) is a school-based survey of students in grades 7-9, conducted in 2002. A two-stage cluster sample design was used to produce representative data for all of the Czech Republic. On a large sample of students (N=4,149) from 7-9th grade it reveals that smoking among children has been continually growing. According to the results of this study, over 34% of the respondents smoke. Results of the study help us to understand social and attitudinal factors that affect adolescent smoking habits. Social factors include particularly the convenient availability of cigarettes and the lack of the legal regulation of the retail of cigarettes: over one half of all smokers under 15 years of age regularly purchase cigarettes in regular retail outlets; 72% of them reported never having been restricted in their purchases because of their age. Advertising and media coverage appears to be another important factor that affects smoking in this age group. Over 80% of children under 15 years of age reported that they have been exposed to the tobacco advertising. The study also allows an interesting analysis of the exposure to the environmental tobacco smoke. Compared to non-smokers, this exposure has been significantly higher in the case of smokers--both in their homes and at other locations (58% vs. 25%, and 90% vs. 57% respectively). The analysis of the data also revealed a strong misconception about the health risks related to passive smoking among smokers. The study provides three key findings for health promotion: (1) it is necessary to exert a continuous pressure on the political representation to strictly enforce the regulations of tobacco distribution and availability to minors; (2) school health education as well as community oriented prevention programs need to explicitly communicate non-smoking as a standard; and (3) it is important to increase the attractiveness and availability of smoking cessation programs.