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The coronavirus disease 2019 (COVID-19) pandemic has profoundly affected the mental health of both infected and uninfected people. Although most psychiatric disorders have highly overlapping genetic and pathogenic backgrounds, most studies investigating the impact of the pandemic have examined only single psychiatric disorders. It is necessary to examine longitudinal trajectories of factors that modulate psychiatric states across multiple dimensions. 2274 Japanese citizens participated in online surveys presented in December 2019 (before the pandemic), August 2020, Dec 2020, and April 2021. These surveys included nine questionnaires on psychiatric symptoms, such as depression and anxiety. Multi-dimensional psychiatric time series data were then decomposed into four principal components. We used generalized linear models to identify modulating factors for effects of the pandemic on these components. The four principal components can be interpreted as general psychiatric burden, social withdrawal, alcohol-related problems, and depression/anxiety. Principal components associated with general psychiatric burden and depression/anxiety peaked during the initial phase of the pandemic. They were further exacerbated by the economic burden of the pandemic. In contrast, principal components associated with social withdrawal showed a delayed peak, with human relationships as an important risk modulating factor. In addition, being elderly and female were risk factors shared across all components. Our results show that COVID-19 has imposed a large and varied burden on the Japanese population since the commencement of the pandemic. Although components related to the general psychiatric burden remained elevated, peak intensities differed between components related to depression/anxiety and those related to social anxiety. These results underline the importance of using flexible monitoring and mitigation strategies for mental problems, according to the phase of the pandemic.
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BackgroundRising rates of suicide, the most dreadful consequence of mental health effects elicited by the coronavirus pandemic (COVID-19) are cause for grave concern. However, the exact association between mental health problems and suicide remains largely unknown in relation to COVID-19. MethodsTo determine the impact of COVID-19 on suicide trajectory, we used an interrupted time-series design to analyze monthly suicides rates extracted from Japans national database. We next used mixed-effects regression models to investigate the relationship between the nationwide suicide increase in August 2020 and psychiatric states of 4,348 individuals from an online survey performed immediately before (December 2019) and during (August 2020) the pandemic. Psychiatric states included depression, anxiety, and COVID-19-related PTSD, a form of severe event-related stress. FindingsIn Japan, suicides had gradually decreased before COVID-19 ({beta} = -0{middle dot}7x10-3, t57 = -14{middle dot}2, p = 8{middle dot}6x10-46), but increased drastically after a state of emergency was declared in April 2020 ({beta} = 0{middle dot}9x10-2, t57 = 17{middle dot}3, p = 2{middle dot}3x10-67). We found that PTSD symptoms reliably predict COVID-19s impact on suicide rates ({beta} = 6{middle dot}3x10-4, t3936 = 5{middle dot}96, p = 2{middle dot}7x10-9). In contrast, depression scores are a reliable indicator of stress vulnerability (i.e. future suicide increases, {beta} = 0{middle dot}001, t3936 = 6{middle dot}6, p = 4{middle dot}5x10-11). Simulations revealed that a one-point reduction in PTSD score could decrease suicides by up to 3{middle dot}1 per ten million people per month in Japan. InterpretationPTSD symptoms may help to identify high-risk groups so as to increase efficacy of prevention policies. FundingKDDI collaborative research contract, the Innovative Science and Technology Initiative for Security (JPJ004596), ATLA and AMED (JP20dm0307008). Research in contextO_ST_ABSEvidence before this studyC_ST_ABSWe searched PubMed on December 2, 2020, for "COVID" and "suicid*" in the titles or abstracts of published articles and obtained 269 hits. No language restrictions were applied to the search. Nearly all previous articles on suicide and COVID-19 have reported simulation studies of suicide counts and rates in case studies, editorials, letters, and commentaries. To date, no study has analyzed the association between psychiatric states and suicide increases in the context of the COVID-19 pandemic. Added value of this studyTo the best of our knowledge, this is the first study reporting a concrete approach to predict suicide rate increases from psychiatric states during the COVID-19 pandemic. Our findings indicate that PTSD symptoms are a reliable surrogate endpoint of pandemic-related suicide increase. Implications of all available evidenceThis work provides a new perspective on preparing guidelines for suicide prevention. Efforts should focus on reducing PTSD severity for single individuals and populations to reduce the overall suicide risk.
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BACKGROUND/AIMS: Although studies using conventional animal models have shown that specific stressors cause irritable bowel syndrome (IBS), it is unclear whether depression itself causes IBS. Our aim was to establish a rat model to determine if depression itself promotes the onset of IBS and to elucidate the role of gut microbiota in brain-gut axis pathogenesis during coincident depression and IBS. METHODS: Rat models of depression were induced using our shuttle box method of learned helplessness. Visceral hypersensitivity was evaluated by colorectal distension (CRD) to diagnose IBS. Gut microbiota compositions were analyzed using high-throughput sequencing. In the subanalysis of rats without depression-like symptoms, rats with posttraumatic stress disorder (PTSD) were also examined. RESULTS: The threshold value of CRD in depressed rats was significantly lower than that in control rats. Microbial community analysis of cecal microbiota showed that the relative abundance of Clostridiales incertae sedis, the most prevalent microbe, was significantly lower in depressed rats than in control rats. The distribution pattern of the microbiota clearly differed between depressed rats and control rats. Neither visceral hypersensitivity nor the composition of gut microbiota was altered in rats with PTSD-like phenotypes. CONCLUSIONS: Our rat model of depression is useful for clarifying the effect of depression on IBS and suggests that depression itself, rather than specific stressors, promotes the onset of IBS. Further, we provided evidence that various psychiatric diseases, viz., depression and PTSD, are associated with unique gut microbiota profiles, which could differentially affect the onset and progression of coincident IBS.
