Anxiety, Depression and Suicidality in Healthcare Workers during the COVID-19 Pandemic: The Russian Study Sample of the COMET-G Project.

BACKGROUND: During the COVID-19 pandemic healthcare workers have been under pressure of high workload and an increased risk of contracting the SARS-Cov-2 virus, while confronting the most tragic and devastating aspects of the pandemic-related medical realities. These factors could lead to severe distress with potential consequences for productivity in performing professional duties, and substantially increased risk for affective reactions, including clinical states of anxiety, depression and suicidality as compared to the general population. Thus, we aimed to investigate the changes in rates of anxiety, depression and suicidality in response to the pandemic among medical staff as compared to a sample of the general population and to the period of prepandemic time. SUBJECTS AND METHODS: This study is part of the large-scale, international multicentre COMET-G project. We assessed the extents of anxiety, depression and suicidality risks using the Stait-Trait Anxiety Inventory (STAI) with a cut-off score 39/40, Center for Epidemiologic Studies Depression Scale (CES-D) with a cut-off score 23/24, and the Risk Assessment Suicidality Scale (RASS) with a cut-off score 499/500, respectively, in samples of Russian healthcare workers and the general population. RESULTS: Among 7777 respondents participating in the study, responses to a query about occupation indicated 1216 healthcare workers. 45.8% of medical staff vs 40.4% of non-medical staff (χ2=12.42, p<0.001) reported the increased anxiety, in excess of the clinical anxiety state threshold score of 39 according to the STAI. High suicidality risks, according to a RASS score > 500, were reported by 8.2% of medical professionals vs 10.6% of non-medical personnel (χ2=6.35, p=0.012). The increase in depression rates, including cases of clinical depression according to the threshold of CES-D ≥ 24, did not differ between the groups. CONCLUSIONS: A larger proportion of healthcare system staff, as compared to the general population, reported a significant increase in anxiety in response to the pandemic. Compared to medical doctors, other healthcare system workers had a significantly higher prevalence of depression and suicidality rates. Exploratory analysis suggested that it was not the occupation per se, but rather the burden of meaningful working duties that could be associated with psychological defense mechanisms against depression and suicidality among medical staff.

Language in Mild Depression: How It Is Spoken, What It Is About, and Why It Is Important to Listen.

BACKGROUND: Our previous research demonstrated that mild depression (MD) is characterized by patterns of atypical language use such as inverted word order, greater repetition, increased use of reflexive/personal (e.g. myself) or negative/ indefinite (e.g. nobody) pronouns, verbs in past tense, and other lexico-grammatical, stylistic and syntactic indicators (how the patient speaks). We now investigate the role of semantic features (what the patient speaks about) in diagnosing (why it is important to listen) affective states. SUBJECTS AND METHODS: 201 written narratives from 124 patients with MD and 77 healthy controls (HC), including 35 cases of normal sadness (NS), were studied using principle component lexis analysis. Statistical data evaluation was performed with SPSS-25 (p<0.05, significant) and included the Cohen's kappa for inter-rater reliability, nonparametric methods to measure between-group differences (Mann-Whitney U-test, Pearson Chi-square test, Kruskal-Wallis, one-way ANOVA), and discriminant analysis for modeling of semantic variables related to affective diagnostic types. RESULTS: Component lexis analysis revealed an exaggerated usage of semantic categories describing existential and family values in the texts of MD patients compared to HC. However, there were fewer cognitive and altruistic categories presented in patients' self-reports. The most substantial between-group difference was the lesser semantics of self-realization in MD patients, as well as their significantly lower ranking of social status' priorities. Communicative and hedonic values in MD speech displaced and predominated in ranking over the values of social status, versus the opposite relationship in HC speech. The discriminant model revealed a set of semantic indicators significantly distinguishing the MD, HC and NS groups (96.3%; Wilks' λ=0.001, p<0.001, r=0.996). CONCLUSIONS: Linguistic structure and content of patients' verbalizations may serve as diagnostic markers of MD. Evaluation of psychosocial themes within the content of narratives should enable a better understanding of MD pathogenesis and emphasize the importance of monitoring social difficulties during treatment.

Language Patterns Discriminate Mild Depression From Normal Sadness and Euthymic State.

OBJECTIVES: Deviations from typical word use have been previously reported in clinical depression, but language patterns of mild depression (MD), as distinct from normal sadness (NS) and euthymic state, are unknown. In this study, we aimed to apply the linguistic approach as an additional diagnostic key for understanding clinical variability along the continuum of affective states. METHODS: We studied 402 written reports from 124 Russian-speaking patients and 77 healthy controls (HC), including 35 cases of NS, using hand-coding procedures. The focus of our psycholinguistic methods was on lexico-semantic [e.g., rhetorical figures (metaphors, similes)], syntactic [e.g., predominant sentence type (single-clause and multi-clause)], and lexico-grammatical [e.g., pronouns (indefinite, personal)] variables. Statistical evaluations included Cohen's kappa for inter-rater reliability measures, a non-parametric approach (Mann-Whitney U-test and Pearson chi-square test), one-way ANOVA for between-group differences, Spearman's and point-biserial correlations to analyze relationships between linguistic and gender variables, discriminant analysis (Wilks' λ) of linguistic variables in relation to the affective diagnostic types, all using SPSS-22 (significant, p < 0.05). RESULTS: In MD, as compared with healthy individuals, written responses were longer, demonstrated descriptive rather than analytic style, showed signs of spoken and figurative language, single-clause sentences domination over multi-clause, atypical word order, increased use of personal and indefinite pronouns, and verb use in continuous/imperfective and past tenses. In NS, as compared with HC, we found greater use of lexical repetitions, omission of words, and verbs in continuous and present tenses. MD was significantly differentiated from NS and euthymic state by linguistic variables [98.6%; Wilks' λ(40) = 0.009; p < 0.001; r = 0.992]. The highest predictors in discrimination between MD, NS, and euthymic state groups were the variables of word order (typical/atypical) (r = -0.405), ellipses (omission of words) (r = 0.583), colloquialisms (informal words/phrases) (r = 0.534), verb tense (past/present/future) (r = -0.460), verbs form (continuous/perfect) (r = 0.345), amount of reflexive (e.g., myself)/personal (r = 0.344), and negative (e.g., nobody)/indefinite (r = 0.451) pronouns. The most significant between-group differences were observed in MD as compared with both NS and euthymic state. CONCLUSION: MD is characterized by patterns of atypical language use distinguishing depression from NS and euthymic state, which points to a potential role of linguistic indicators in diagnosing affective states.