Hospital admissions due to suicide attempts during the COVID-19 pandemic, a 3-year longitudinal study.

The appearance of the SARS CoV-2 virus and the associated COVID-19 pandemic has been associated with the onset of mental disorders in healthy people and the worsening in those with pre-existing mental conditions. One of the areas that has raised the greatest concern is that of suicidality. Most of the published studies have been carried out cross-sectional or with small samples, without stratifying by age and gender. Thus, the aim of this longitudinal research is to study, in a large population sample of around 6,700,000 inhabitants belonging to the entire region of Madrid (Spain), the admissions in psychiatric hospitalization units due to suicidal attempts along 2019, 2020 and 2021. No clear increase in the number of admissions due to suicidality in the total population have been found. In addition, a higher prevalence in admissions among women is verified. Moreover, stratifying by age and gender, a striking and significant increase in hospital admissions due to suicidality has been observed in the group up to 17 years old, from September 2020 until the end of the study. These results highlight the special vulnerability of children and adolescents, specifically girls, and the need for preventive measures in the face of future pandemics.

Dramatic increase of suicidality in children and adolescents after COVID-19 pandemic start: A two-year longitudinal study.

The COVID-19 pandemic has impacted the mental health of the youngest, worsening their emotional well-being. The demand for care in psychiatric emergencies may indirectly reflect the mental health state of children and adolescents and the emotional consequences of the pandemic. Moreover, suicidality can be considered a marker of severity in this population group. Therefore, we have aimed to longitudinally describe the number of children and adolescents attended in the psychiatry emergency department due to suicidal ideation or attempts and, to explore differences in suicidality according to gender and age. A retrospective study was carried out in the University Hospital of San Juan, Alicante, Spain, from January 01, 2018 to December 31, 2021. A total of 138 participants under 18 years requesting psychiatric care due to suicidal ideation or attempts were included. The sample was composed by 35% of males and the mean age was 14.8 years old (SD = 2.2). The number of cases per year range from 10 in 2018 to 88 in 2021. Attendances were significantly higher between 2021 and the three previous years. Besides, the number of attentions registered in the last 9 months of 2021 equals those that occurred in the entire previous period. Most of the cases were girls and middle adolescents. Suicide ideation or attempts have skyrocketed in children and adolescents. This alarming increase presents a one-year lag peak from the COVID-19 outbreak and continues until the end of 2021. Girls and those over 12 years have been identified as risk groups to present suicidal ideation or attempts.

Cognitive versus emotional modulation within a Stroop paradigm in patients with schizophrenia.

BACKGROUND: Schizophrenia is a complex disorder involving deficits in both cognitive and emotional processes. Specifically, a marked deficit in cognitive control has been found, which seems to increase when dealing with emotional information. AIMS: With the aim of exploring the possible common links behind cognitive and emotional deficits, two versions of the emotional Stroop task were administered. METHOD: In the cognitive-emotional task, participants had to name the ink colour (while ignoring the meaning) of emotional words. In contrast, the emotional-emotional task consisted of emotional words superimposed on emotional faces, and the participants had to indicate the emotional valence of the faces. Fifty-eight participants (29 in-patients diagnosed with schizophrenia and 29 controls) took part in the study. RESULTS: Patients and controls showed similar response times in the cognitive-emotional task; however, patients were significantly slower than controls in the emotional-emotional task. This result supports the idea that patients show a more pronounced impairment in conflict modulation with emotional content. Besides, no significant correlations between the tasks and positive or negative symptoms were found. This would indicate that deficits are relatively independent of the clinical status of patients. However, a significant correlation between the emotional-emotional task and cognitive symptoms was found. CONCLUSIONS: These findings suggest a restricted capacity of patients with schizophrenia to deal with the attentional demands arising from emotional stimuli.

Bayesian reasoning with emotional material in patients with schizophrenia.

Delusions are one of the most classical symptoms described in schizophrenia. However, despite delusions are often emotionally charged, they have been investigated using tasks involving non-affective material, such as the Beads task. In this study we compared 30 patients with schizophrenia experiencing delusions with 32 matched controls in their pattern of responses to two versions of the Beads task within a Bayesian framework. The two versions of the Beads task consisted of one emotional and one neutral, both with ratios of beads of 60:40 and 80:20, considered, respectively, as the "difficult" and "easy" variants of the task. Results indicate that patients showed a greater deviation from the normative model, especially in the 60:40 ratio, suggesting that more inaccurate probability estimations are more likely to occur under uncertainty conditions. Additionally, both patients and controls showed a greater deviation in the emotional version of the task, providing evidence of a reasoning bias modulated by the content of the stimuli. Finally, a positive correlation between patients' deviation and delusional symptomatology was found. Impairments in the 60:40 ratio with emotional content was related to the amount of disruption in life caused by delusions. These results contribute to the understanding of how cognitive mechanisms interact with characteristics of the task (i.e., ambiguity and content) in the context of delusional thinking. These findings might be used to inform improved intervention programs in the domain of inferential reasoning.

What about mental health after one year of COVID-19 pandemic? A comparison with the initial peak.

A psychiatric epidemic has accompanied the COVID-19 pandemic and specific vulnerable populations have been identified. We aimed to explore the presence of anxiety, acute stress and depression among these vulnerable groups after a year of pandemic and relate them to our previous results obtained with the same methodology during the initial peak of the pandemic in Spain. A total of 2182 participants conducted a national survey, starting on March 2021. Sociodemographic information and clinical symptoms were assessed. The sample was divided into four groups in order to develop four substudies with these results: 1) Healthcare workers presented lower anxiety, acute stress, and depression than non-Healthcare workers (p < 0.001), being nurses the most affected. 2) People with mental disorders experienced higher anxiety, acute stress, and depression than people without (p < 0.001), as well as a higher rate of COVID cases (14% vs. 9.3%, p = 0.041). 3) People ≥60 years old presented lower anxiety and acute stress than people <60, (p < 0.05) and a weaker depressive syndrome (p = 0.003). 4) Males presented lower anxiety, acute stress and depression than females (p < 0.001). According to the results obtained during the initial peak, Healthcare workers have developed efficient coping strategies, while elders have managed to maintain their previously emotional balance. Notwithstanding, women and people with mental disorders continue to be vulnerable to emotional distress after a year of pandemic. Women and people with mental disorders continue to be especially vulnerable to emotional distress after a year of pandemic.

Can you change your mind? An ERP study of cognitive flexibility and new evidence integration.

Cognitive flexibility is an ability that allows individuals to integrate external evidence into previous expectancies. Individual differences in this ability were examined using Event-Related Potentials (ERPs), focusing on the fact that new evidence can either confirm or disprove an initial impression. Written scenarios prompted to make a prediction while either confirmatory or disconfirmatory evidence followed. A final sentence presented participants with a statement congruent with the prediction likely to have been formed based on the first statement or a statement rather congruent with corrective new evidence. A Bias Against Disconfirmatory Evidence (BADE) test rated participants in cognitive flexibility. ERPs revealed that whereas individuals overall typically reacted to unexpected endings (a classical N400 effect) within the confirmatory evidence condition, higher cognitive flexibility scores were associated with smaller N400 effects. Furthermore, individuals showed larger P600s for disconfirmatory than confirmatory evidence conditions, regardless of the final target ending. This result indexes reanalysis processes whenever disconfirmatory evidence was present. Regression analysis of BADE scores and ERP effects are presented and discussed. Late ERP components are sensitive enough to detect new evidence integration capabilities and thus provide a good implicit measure of cognitive flexibility.

Emotional Processing Profile in Patients with First Episode Schizophrenia: The Influence of Neurocognition.

This study sought to investigate the influence of neurocognition on the emotional processing profiles of patients with first-episode schizophrenia, using the 4-branch Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) (Perceiving Emotions; Facilitating Emotions; Understanding Emotions and Managing Emotions). A sample of 78 patients with first-episode schizophrenia and a group of 90 non-psychiatric control subjects were included in this work. The initial results showed that patients had lower scores than controls for the "Understanding Emotions" and "Managing Emotions" MSCEIT branches. However, after controlling for neurocognition, the only deficits were found on the "Managing Emotions" branch of the MSCEIT. This branch can be considered as measuring a more sophisticated level of emotional processing, which may constitute a deficit in itself. In conclusion, patients with first-episode schizophrenia present deficits in social cognition at the highest level that seem to be independent from neurocognition. These findings support the inclusion of the "Managing Emotions" branch of the MSCEIT as part of the MCCB.

Impact of Negative Symptoms on Functioning and Quality of Life in First Psychotic Episodes of Schizophrenia.

Negative symptoms are not considered a unitary construct encompassing two different domains, diminished expression, and avolition-apathy. The aim of this study was to explore the relationships between each domain and psychosocial functioning and quality of life in people with a first psychotic episode of schizophrenia. In total, 61 outpatients were assessed with the Clinical Assessment Interview for Negative Symptoms (CAINS), The Functioning Assesment Short Test (FAST) and The Quality of Life Scale (QLS). The mean global score for CAINS was 21.5 (SD: 15.6), with a CAINS Avolition-Apathy (MAP) score of 17.0 (SD: 11.8), and CAINS Diminished Expression (EXP) score of 4.5 (SD: 5.0). The mean FAST score was 31.9 (SD: 18.9), and 41.1 (SD: 17.9) for QLS. Linear regression analysis revealed a significant (F(4,53) = 15.65, p < 0.001) relationship between MAP and EXP CAINS' score and FAST score. CAINS-MAP was more predictive of FAST scores (ß = 0.44, p = 0.001) than CAINS-EXP (ß = 0.37, p = 0.007). Linear regression analysis for QLS revealed a significant model (F(4,56) = 29.29, p < 0.001). The standardized regression weight for the CAINS-MAP was around three times greater (ß = -0.63, p < 0.001) than for CAINS-EXP (ß = -0.24, p = 0.024). The two different domains are associated differently with functionality and quality of life.

Different emotional profile of health care staff and general population during the COVID-19 outbreak.

OBJECTIVE: The aims of this study were to assess COVID-19 outbreak-related emotions, to identify vulnerable groups within health care workers (HCW) and to study the relationship between the emotional state and some environmental features. METHOD: We conducted a cross-sectional study on March 29 to April 5, 2020 based on a national online survey using snowball sampling techniques. A list of emotional states was compared in HCW and non-HCW and within HCW roles. The relationship between COVID-19 related symptoms, information, and protective measures and the emotional state was analyzed. RESULTS: Fear (p < .001, φc = .11), irritability (p = .001, φc = .08), frustration (p < .001, φc = .10), anger (p = .013, φc = .06), and helplessness (p < .001, φc = .13) appear significantly more frequently in HCW compared to non-HCW. Within HCW, a higher percentage of physicians, especially the less experienced, significantly perceived uncertainty and frustration (p = .001, φc = .13 and p = .025, φc = .10, respectively), while a higher percentage of nurses significantly experienced sadness (p = .024, φc = .10). Having a confirmatory diagnosis of the disease was related to hypochondria sensation (p = .026, φc = .10). Sadness (p = .035, φc = .09), intolerance (p = .058, φc = .09), anger (p = .024, φc = .10), and helplessness (p = .028, φc = .10) appeared as the most relevant emotions when information was perceived as insufficient. CONCLUSIONS: The knowledge of the most prevalent different emotional patterns in HCW, as well as in the general population, will allow the detection of subjects at risk for the development of mental disorders and the implementation of therapeutic approaches in future similar situations of pandemic or outbreak of the current one. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The impact on mental health patients of COVID-19 outbreak in Spain.

Public health studies warn of the vulnerability of people with mental disorders during the COVID-19 outbreak. Thus, the aims of this study were to (1) explore the presence of symptoms of anxiety, depression and acute stress among people with a mental disorder (MD); (2) evaluate the rate of COVID-19 infection between MD and non-MD, and (3) study the relationship between the emotional state of people with a mental disorder and some environmental variables. A cross-sectional study starting on March 29 to April 5, 2020 based on a national online survey using snowball sampling techniques was conducted. Symptoms of anxiety (Hamilton Anxiety Scale), depression (Beck Depression Inventory) and acute stress (Acute Stress Disorder Inventory) were compared in MD and non-MD. The rate of COVID-19 confirmed cases among MD and non-MD was compared as well as the relationship between some environmental variables and the emotional state within MD. Up to 1839 [201 (10.9%) MD] participants completed the survey. MD showed significant higher mean (SD) in anxiety [24.7 (11.8) vs. 17 (10.3); p = 0.001], depression [7.9 (6.0) vs. 4.2 (4.2); p = 0.001] and acute stress [6.3 (3.2) vs. 4.4 (3.1); p = 0.001] scores than non-MD. The COVID-19 confirmed cases rate was higher in MD participants than in non-MD (3.5% vs. 0.4%; p < 0.001). Among the MD group, being a COVID-19 confirmed case, the lack in basic needs coverage, the rpesence of violence, drug use and the absence of physical excercise were associated with more severe depressive symptoms. Findings suggest that the COVID-19 has an impact on the emotional state of people with mental disorders.

Gender differences in emotional response to the COVID-19 outbreak in Spain.

OBJECTIVE: We aim to explore the differential presence of symptoms of anxiety, depression, and acute stress between men and women during the COVID-19 outbreak, and to study the relationship between these symptoms and two environmental variables, coexistence, and violence. METHODS: We conducted a cross-sectional study starting on March 29 to April 5, 2020, based on a national online survey using snowball sampling techniques. Symptoms of anxiety (Hamilton Anxiety Scale), depression (Beck Depression Inventory), and acute stress (Acute Stress Disorder Inventory) were assessed. Differences in the presence of symptoms and the relationship of coexistence and domestic violence were evaluated from a gender perspective. RESULTS: Men showed significant lower mean (SD) in anxiety, depression, and acute stress levels than women [HARS, 14.1 (9.8) versus. 18.4 (10.2), F = 56.2, p < .001; BDI 3.4 (3.9) versus 4.5 (4.3), F = 16.6, p < .001, and ASDI 3.6 (2.9) versus 4.7 (3.1), F = 39.0, p < .001, respectively), as well as a weaker depressive syndrome (28.1% males versus 39.9% females, χ2  = 25.5, p < .001). In addition, an interaction Gender × Coexistence was found in anxiety (F = 56.2, p < .001) and acute stress (F = 3.52, p = .06) and, according to depressive symptoms, an interaction Gender × Violence was found marginally significant (F = 3.3, p = .07). CONCLUSIONS: Findings indicate that women present greater severity in symptoms of anxiety, depression, and acute stress. Moreover, loneliness and violence specifically worsen the emotional state in women. These results can undoubtedly guide better healthcare planning adopting a gender perspective.

Facing stereotypes: ERP responses to male and female faces after gender-stereotyped statements.

Despite gender is a salient feature in face recognition, the question of whether stereotyping modulates face processing remains unexplored. Event-related potentials from 40 participants (20 female) was recorded as male and female faces matched or mismatched previous gender-stereotyped statements and were compared with those elicited by faces preceded by gender-unbiased statements. We conducted linear mixed-effects models to account for possible random effects from both participants and the strength of the gender bias. The amplitude of the N170 to faces was larger following stereotyped relative to gender-unbiased statements in both male and female participants, although the effect was larger for males. This result reveals that stereotyping exerts an early effect in face processing and that the impact is higher in men. In later time windows, male faces after female-stereotyped statements elicited large late positivity potential (LPP) responses in both men and women, indicating that the violation of male stereotypes induces a post-perceptual reevaluation of a salient or conflicting event. Besides, the largest LPP amplitude in women was elicited when they encountered a female face after a female-stereotyped statement. The later result is discussed from the perspective of recent claims on the evolution of women self-identification with traditionally held female roles.

Mental Health in Elderly Spanish People in Times of COVID-19 Outbreak.

BACKGROUND: We aim to assess COVID-19 outbreak-related emotional symptoms, identify gender differences, and study the relationship between the emotional state and environmental features in the elderly. METHODS: We conducted a cross-sectional study starting on March 29 to April 5, 2020 based on a national online survey using snowball sampling techniques. Symptoms of anxiety (Hamilton Anxiety Scale), depression (Beck Depression Inventory) and acute stress (Acute Stress Disorder Inventory) were compared between people over and under 60 years old. Gender differences and the relationship of loneliness, regular exercise, economic losses and use of anxiolytics on the mental state were evaluated. RESULTS: One thousand six hundred thirty-nine (150 [9.2%] aged ≥60) participants completed the survey. The greater than or equal to 60 group showed lower mean (SD) BDI levels than the less than 60 group (3.02 [3.28] versus 4.30 [4.93]); and lower mean (SD) acute stress disorder inventory scores than the less than 60 group (3.68 [3.20] versus 4.45 [3.06]). There were no gender differences in any of the clinical measures. The presence of economic losses as well as the increase in the use of anxiolytics was significantly associated with higher emotional distress in the elderly compared to the younger group. CONCLUSIONS: Older people have shown less emotional distress, with no differences between men and women. Economic loss and substance use should be monitored to guarantee the emotional well-being of the elderly.

Differences in theory of mind between early and chronic stages in schizophrenia.

The evolution of social cognition throughout the course of schizophrenia is unclear not being possible to state whether it remains stable from early stages to chronicity, or it changes as the disease develops. For this purpose, 90 patients with schizophrenia and 139 healthy controls have been compared establishing 4 different groups paired by age and gender: first episode of psychosis patients (FEP), young healthy controls (YHC), chronic patients with schizophrenia (CS) and adult healthy controls (AHC). Performance in Theory of Mind (ToM) has been assessed using The Hinting Task and The Reading the Mind in the Eyes Test (RMET). In the Hinting Task, when comparing patients with their respective control group, differences found between CS patients and their corresponding controls (p < .001) are much bigger (almost twice) than differences between FEP patients and young controls (p = .001). In fact, young and adult healthy controls did not significantly differ in their scores, while the CS group showed significant worse performance than the FEP group. In the Reading the Mind in the Eyes test (RMET), patients globally performed worse than controls (p < .001). However, the Cohort × Diagnosis interaction was not significant (p = .27). In this task, there were no differences between CS and FEP scores. In conclusion, data suggest poor performance in all phases of the disease with a probable worsening related to chronicity especially in the aspects of social cognition measured by the Hinting Task.

Influence of emotional contexts on facial emotion attribution in schizophrenia.

Recent emotion recognition studies in schizophrenia have reported misattribution of emotional content to emotionally neutral faces. While in these studies faces are presented in the absence of any contextual reference, in daily life facial expressions are typically perceived within a specific situational context. However, there is no evidence on the possible modulatory role of contextual aids on emotion attribution to neutral faces. We address this issue in the present study. Thirty schizophrenia patients and thirty paired controls performed an emotion categorization task (by choosing one among six labels of emotions) with neutral target faces that were superimposed on affectively positive, negative or neutral scenes. In presence of positive contexts, patients categorized neutral faces as happy and fearful more frequently than controls. When negative contexts were present, patients also categorized neutral faces as fearful more frequently than controls. However, in the presence of neutral contexts patients and controls did not differ in their categorization pattern. These results suggest that explicit presence of a neutral context seems to compensate for the bias showed by patients. With the purpose of correcting emotion misattribution in schizophrenia, emotionally neutral contexts might be incorporated to treatments aimed at improving social cognition performance in this patient population.

Linguistic and Perceptual Mapping in Spatial Representations: An Attentional Account.

Building on evidence for embodied representations, we investigated whether Spanish spatial terms map onto the NEAR/FAR perceptual division of space. Using a long horizontal display, we measured congruency effects during the processing of spatial terms presented in NEAR or FAR space. Across three experiments, we manipulated the task demands in order to investigate the role of endogenous attention in linguistic and perceptual space mapping. We predicted congruency effects only when spatial properties were relevant for the task (reaching estimation task, Experiment 1) but not when attention was allocated to other features (lexical decision, Experiment 2; and color, Experiment 3). Results showed faster responses for words presented in Near-space in all experiments. Consistent with our hypothesis, congruency effects were observed only when a reaching estimate was requested. Our results add important evidence for the role of top-down processing in congruency effects from embodied representations of spatial terms.

Discrimination of face gender and expression under dual-task conditions.

In order to test whether expression and gender can be attended to simultaneously without a cost in accuracy four experiments were carried out using a dual gender-expression task with male and female faces showing different emotional expressions that were backward masked by emotionally neutral faces. In the dual-facial condition the participants had to report both the gender and the expression of the targets. In two control conditions the participant reported either the gender or the expression of the face and indicated whether a surrounding frame was continuous or discontinuous. In Experiments 1-3, with angry and happy targets, asymmetric interference was observed. Gender discrimination, but no expression discrimination, was impaired in the dual-facial condition compared to the corresponding control. This effect was obtained with a between-subjects design in Experiment 1, with a within-subjects design in Experiment 2, and with androgynous face masks in Experiment 3. In Experiments 4a and 4b different target combinations were tested. No decrement of performance in the dual-facial task was observed for either gender or expression discrimination with fearful-disgusted (Experiment 4a) or fearful-happy faces (Experiment 4b). We conclude that the ability to attend simultaneously to gender and expression cues without a decrement in performance depends on the specific combination of expressions to be differentiated between. Happy and angry expressions are usually directed at the perceiver and command preferential attention. Under conditions of restricted viewing such as those of the present study, discrimination of these expressions is prioritized leading to impaired discrimination of other facial properties such as gender.

Where to look when looking at faces: visual scanning is determined by gender, expression and tasks demands / Dónde mirar cuando miramos caras: el escaneo visual está determinado por el género, la expresión y las demandas de la tarea

Visual scanning of faces was studied during categorization of expression and gender with the aim of revealing possible differences in the perceptual mechanisms that mediate analysis of these facial properties. A more distributed scanning pattern, with increased fixation in the lower face, was observed in the expression compared to the gender task. Distribution of fixations across the upper and lower face also varied depending on the specific gender and expression of the viewed faces, with female faces and faces showing anger attracting more fixations to the eye region. Variations reflecting an interaction between gender and expression were also observed. However, the nature of these modulations suggests a differential influence of perceptual interactions and social/affective value on eye movement measures and on pupil size. Collectively, these results show that the visual inspection of faces is determined in a complex manner by the specific demands of different categorization tasks and by the perceptual and social/affective properties of the emotional expressions shown by either male or female faces (AU)

Se ha estudiado la inspección visual de caras durante tareas de categorización de expresión y género con el objetivo de encontrar posibles diferencias en los mecanismos perceptuales que medían el análisis de las propiedades faciales. Se observó un patrón de inspección visual más distribuido con un incremento de fijaciones en la parte baja de la cara durante la tarea de expresión frente a la tarea de género. La distribución de las fijaciones en torno a la parte superior e inferior de la cara también varió dependiendo del género y de la expresión de las caras con un número mayor de fijaciones en la región de los ojos para las caras de ira femeninas. Los resultados indicaron también una interacción entre género y expresión. La naturaleza de estas modulaciones sugiere una influencia diferencial sobre las medidas oculares y el tamaño de la pupila dependientes del tipo de tarea y del valor socio-afectivo de los estímulos. En conjunto, estos resultados muestran que la inspección visual de caras está determinada de una manera compleja por las demandas específicas de diferentes tareas de categorización; por las propiedades perceptivas y por la naturaleza de las expresiones emocionales mostradas por caras masculinas y femeninas (AU)