Emotional status of children aged 7 to 17 of health workers and in the general population during the COVID-19 pandemic: A cross-sectional comparative study in Belgium.

Background: We assessed the mental health of children and adolescents aged 7 to 17 and their parents immediately after the first wave of the COVID-19 pandemic. Method: A survey online was conducted in Belgium between May 29th and August 31st 2020. Results: (1) Anxious and depressive symptoms were self-reported by one out of four children and hetero-reported by parents for one out of five children; (2) Anxiety scores were higher in children compared to adolescents; (3) Social introversion scores were significantly higher in adolescents compared to children; (4) No significant differences for anxio-depressive symptoms were found between healthcare worker parents and the other parents. Children's self- or hetero-reported symptoms were not found to be connected to parents' professional activities. Conclusions: This cross-sectional survey adds evidence to the impact the COVID-19 pandemic has had on children's and adolescents' emotional state, in particular on their levels of anxiety and depression.

Objectif: Nous avons évalué la santé mentale d'enfants et d'adolescents âgés de 7 à 17 ans et de leurs parents immédiatement après la première vague de la pandémie de COVID-19. Méthodologie: Une enquête en ligne a été réalisée en Belgique entre le 29 mai et le 31 août 2020. Résultats: (1) Les symptômes anxieux et dépressifs étaient auto-déclarés par un enfant sur quatre et hétéro-déclarés par les parents pour un enfant sur cinq ; (2) Les scores d'anxiété étaient plus élevés chez les enfants par rapport aux adolescents ; (3) Les scores d'introversion sociale étaient significativement plus élevés chez les adolescents par rapport aux enfants ; (4) Aucune différence significative pour les symptômes anxio-dépressifs n'a été trouvée entre les parents travailleurs de la santé et les autres parents. Les symptômes auto- ou hétéro-déclarés par les enfants ne se sont pas avérés être liés aux activités professionnelles des parents. Conclusions: Cette enquête transversale ajoute des preuves de l'impact de la pandémie de COVID-19 sur l'état émotionnel des enfants et des adolescents, en particulier sur leurs niveaux d'anxiété et de dépression.

Relationship Between Recent Change of Anhedonia and Suicidal Ideation Taking Into Account the Severity and the Acuteness of Suicidal Ideation As Well As the Specific Roles of Loss of Pleasure and Loss of Interest in People: A Study on Medical Students.

The aim of the study was to explore the relationships between recent changes of anhedonia or particular symptoms of recent changes of anhedonia and suicidal ideation taking into account the severity of suicidal ideations. In a group of 173 medical students, scores of the anhedonia subscale (ANH-BDI) of the BDI-II (i.e. 4 anhedonia items: loss of pleasure, loss of interest, loss of energy and loss of interest in sex) were compared between 95 subjects without suicidality, 24 subjects with life-time suicidal ideation, 28 subjects with recent suicidal ideation and 26 planners. Analyses of covariance (ANCOVA) were performed referring to groups as independent variables, the cognitive-affective subscale (CA-BDI) of the BDI-II as a covariate, the ANH-BDI and each of the four anhedonia items as dependent variables. High levels of loss of interest characterized planners when compared to the other three groups. Loss of interest could be associated with recent and severe suicidal ideation.

Relationships between Recent Suicidal Ideation and Recent, State, Trait and Musical Anhedonias in Depression.

The aim of the study was to explore in depression the relationship between recent suicidal ideation and the different anhedonias taking into account the severity of depression. Recent studies have suggested that recent change of anhedonia and not state or trait anhedonia is associated with recent suicidal ideations even when the level of depression is controlled. Three samples were used (74 severe major depressives, 43 outpatients with somatic disorders presenting mild or moderate depression and 36 mild or moderate depressives hospitalized in the intensive coronary unit). Recent change of anhedonia was rated by the anhedonia subscale of the Beck Depression Inventory (BDI-II), state anhedonia by the Snaith-Hamilton Pleasure Scale (SHAPS), trait anhedonia by the TEPS (Temporal Experience of Pleasure Scale), musical anhedonia by the BMRQ (Barcelona Music Reward Questionnaire), social recent change of anhedonia by the SLIPS (Specific Loss of Interest and Pleasure Scale), the severity of depression by the BDI-II and the distinction between melancholic and non-melancholic was found using a subscale of the BDI-II. Bivariate and multivariate regression analyses were performed in each sample. In severe major depressives and, notably, in melancholia, recent suicidal ideation was associated with trait anhedonia; however, in mild or moderate depression, recent suicidal ideation was associated with recent change of anhedonia. Musical anhedonia and social recent change of anhedonia were not associated with recent suicidal ideation. Trait anhedonia could be, in severe depression, a strong predictor of recent suicidal ideation.

Prevalence and Relationships between Alexithymia, Anhedonia, Depression and Anxiety during the Belgian COVID-19 Pandemic Lockdown.

Alexithymia and anhedonia are associated with psychiatric disorders, such as depression and anxiety. The COVID-19 pandemic lead to a significant deterioration in the mental health of the population. It is therefore important to examine the effects of lockdown on alexithymia and anhedonia and their relationships with anxiety and depression. We compared the scores and characteristics of 286 patients divided into two groups: one before lockdown (group 1, N = 127), the other during the progressive lockdown release (group 2, N = 159). The groups were homogeneous in terms of age, sex ratio, socio-professional categories, and somatic and psychiatric comorbidities. The groups were compared on the Toronto Alexithymia Scale (TAS-20) measuring alexithymia, the Beck Depression Inventory (BDI-II) measuring depression, the anhedonia subscale of the BDI-II measuring state-anhedonia and the State Trait Anxiety Inventory (STAI) measuring state and trait anxiety. The ratio of alexithymic subjects in group 1 is 22.83% to 33.33% in group 2 (p-value = 0.034). This suggests a significant increase in the number of alexithymic patients after lockdown. We did not observe any difference in the proportion of depressed and anxious subjects before or after lockdown. Among the different scales, higher scores were only found on the cognitive factor of alexithymia on group 2 comparatively to group 1. This study indicates an increase in the proportion of alexithymic subjects following lockdown. Unexpectedly, this was unrelated to depression, anxiety or anhedonia levels, which remained stable. Further studies are needed to confirm this result and to evaluate precisely which factors related to the lockdown context are responsible for such an increase.

The Interpersonal-Psychological Theory of Suicide in Medical Students: Comparisons of Individuals without Suicidality, Ideators, and Planners.

The aim of this study was to explore the interpersonal-psychological theory of suicide (IPTS) in medical students. Higher levels of thwarted belongingness and perceived burdensomeness were expected in medical students with suicidality compared with medical students without suicidality, and a high level of acquired capability was expected in planners compared with ideators. Recruited for the study were 178 undergraduate medical students at the Université Libre de Bruxelles (ULB): 95 subjects without suicidality, 24 subjects with lifetime suicidality, 28 subjects with recent suicidal ideation, and 26 planners. An ad hoc questionnaire evaluated the risk of suicide as well as the "Suicidal thoughts and wishes" item of the BDI-II. The Interpersonal Needs Questionnaire (INS) measured thwarted belongingness (TB) and perceived burdensomeness (PB). The Acquired Capability for Suicide Scale (ACSS) measured notably fearlessness of death or pain tolerance and depression was rated using the revised version of the Beck Depression Inventory (BDI). Cognitive-affective symptoms of depression (CA-BDI) were assessed using six items of the BDI. Analyses of variance showed significant differences between groups for TB and PB but not for ACSS. Analyses of covariance, controlling for the CA-BDI scores, confirmed the significance of differences in TB and PB. Post hoc tests showed that (1) high levels of TB were characteristic of subjects with recent suicidal ideation and planners compared with subjects without suicidality; and (2) high levels of PB were characteristic of planners compared with the three other groups. Among the three characteristics of the IPTS, PB could be a strong predictor of severe suicide risk in medical students.

Mental Health Outcomes in Healthcare Workers in COVID-19 and Non-COVID-19 Care Units: A Cross-Sectional Survey in Belgium.

BACKGROUND: The literature shows the negative psychological impact of the coronavirus disease 2019 (COVID-19) outbreak on frontline healthcare workers. However, few are known about the mental health of physicians and nurses working in general hospitals during the outbreak, caring for patients with COVID-19 or not. OBJECTIVES: This survey assessed differences in mental health in physicians and nurses working in COVID-19 or non-COVID-19 medical care units. DESIGN: A cross-sectional mixed-mode survey was used to assess burnout, insomnia, depression, anxiety, and stress. SETTING: A total of 1,244 physicians and nurses from five general hospitals in Belgium, working in COVID-19 care units (CCU), non-COVID-19 care units (NCCU), or both (CCU + NCCU) were informed of the study. PARTICIPANTS: Six hundred forty-seven healthcare workers participated in the survey (response rate = 52%). MEASUREMENTS: Validated instruments were used to assess the outcomes: the PFI (burnout/professional fulfillment), the ISI (insomnia), and the DASS-21 (depression, anxiety, and stress). RESULTS: Results showed high prevalence of burnout, insomnia, depression, and anxiety among participants. After adjusting for confounders, multivariate analysis of variance showed no differences between CCU, NCCU, and CCU + NCCU workers. Univariate general linear models showed higher level of burnout, insomnia, and anxiety among nurses in comparison to physicians. Being a nurse, young, isolated, with an increased workload were risk factors for worse mental health outcomes. LIMITATIONS: The mental health of the tested sample, before the outbreak, is unknown. Moreover, this cross-sectional design provides no information on the evolution of the mental health outcomes over time. CONCLUSION: Directly caring for patients with COVID-19 is not associated with worse mental health outcomes among healthcare workers in general hospitals. High prevalence of burnout, insomnia, depression, and anxiety among physicians and nurses requires special attention, and specific interventions need to be implemented. PROTOCOL REGISTRATION: ClinicalTrials.gov, identifier NCT04344145.

Suicidal ideations among medical students: The role of anhedonia and type D personality.

BACKGROUND: The relationships between hedonic deficits, type D personality and suicidal ideation were explored in a group of medical students. METHODS: In a cross-sectional study, 382 medical students filled out several questionnaires measuring suicide risk, depression (using the Beck Depression Inventory, i.e. BDI), type D personality (using the type D personality scale-14, i.e. DS-14) and anhedonia (using the anhedonia subscale of the BDI, the Snaith Hamilton Pleasure Scale, the Anticipatory and Consummatory subscales of the Physical Anhedonia Scale). RESULTS: State anhedonia and, in particular, recent change of state anhedonia and not trait anhedonia was significantly associated with suicidal ideation, specifically when depression was controlled for. Negative affectivity component of type D personality and anhedonia were independent predictors of suicidal ideation even when depression was controlled for. Loss of pleasure and not loss of interest was a significant predictor of suicidal ideation. CONCLUSIONS: Change of state anhedonia and its component of loss of pleasure measuring dissatisfaction in life could be a risk factor of suicidal ideation in medical students. Dissatisfaction, particularly in the medical course, could be a strong predictor of suicidal ideation in medical students.

Relationships between anhedonia, suicidal ideation and suicide attempts in a large sample of physicians.

BACKGROUND: The relationships between anhedonia and suicidal ideation or suicide attempts were explored in a large sample of physicians using the interpersonal psychological theory of suicide. We tested two hypotheses: firstly, that there is a significant relationship between anhedonia and suicidality and, secondly, that anhedonia could mediate the relationships between suicidal ideation or suicide attempts and thwarted belongingness or perceived burdensomeness. METHODS: In a cross-sectional study, 557 physicians filled out several questionnaires measuring suicide risk, depression, using the abridged version of the Beck Depression Inventory (BDI-13), and demographic and job-related information. Ratings of anhedonia, perceived burdensomeness and thwarted belongingness were then extracted from the BDI-13 and the other questionnaires. RESULTS: Significant relationships were found between anhedonia and suicidal ideation or suicide attempts, even when significant variables or covariates were taken into account and, in particular, depressive symptoms. Mediation analyses showed significant partial or complete mediations, where anhedonia mediated the relationships between suicidal ideation (lifetime or recent) and perceived burdensomeness or thwarted belongingness. For suicide attempts, complete mediation was found only between anhedonia and thwarted belongingness. When the different components of anhedonia were taken into account, dissatisfaction-not the loss of interest or work inhibition-had significant relationships with suicidal ideation, whereas work inhibition had significant relationships with suicide attempts. CONCLUSIONS: Anhedonia and its component of dissatisfaction could be a risk factor for suicidal ideation and could mediate the relationship between suicidal ideation and perceived burdensomeness or thwarted belongingness in physicians. Dissatisfaction, in particular in the workplace, may be explored as a strong predictor of suicidal ideation in physicians.

Acquired microcephaly: causes, patterns, motor and IQ effects, and associated growth changes.

OBJECTIVES: The goals were to identify and to classify causes and growth patterns of acquired (or progressive) microcephaly and to look for hypothesized correlations between causes, growth patterns, and developmental quotient/IQ. METHODS: Fifty-one children (24 boys), 0.7 to 11.3 years of age, with early occipitofrontal circumference measurements above and later ones below the second percentile (SD: -2.03) were studied through retrospective note and growth chart review, with formal assessments of developmental quotient or IQ (n = 34). RESULTS: Causes were classifiable into 5 groups as follows: idiopathic, familial, syndromic, symptomatic, and mixed. Four patterns of head growth were identified, as follows: type A, initial decrease from the normal range to below the second percentile, followed by growth below and parallel to the second percentile; type B, continued decrease away from the second percentile; type C, decrease below the normal range, with partial later recovery; type D, insufficient data. For 12 children, there were accompanying decreases in weight percentiles and for 5 of these in height percentiles as well. Infants with lower head circumference z scores at the end of the study also had lower z scores for final weight and final length. There was no correlation between causal group and growth pattern. Developmental quotient/IQ values were mostly <100 and did not correlate with head circumference z score, cause, or pattern. CONCLUSIONS: The classification of causal groups and growth patterns should aid clinical management. Neither cause nor pattern predicted outcomes. The associations with poor weight gain and body growth deserve further study.