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Longitudinal study of PTSD and depression in a war-exposed sample – comorbidity increases distress and suicide risk

Abstract

Background

Major depressive disorder (MDD) and post-traumatic stress disorder (PTSD) are the most common mental disorders following traumatic experiences. The aim of this study was to investigate the extent to which PTSD and depression co-occurred in Serbian general population at baseline and 1 year after the follow-up, as well as how this co-occurrence was associated with sociodemographic factors, personal distress, suicidality and quality of life.

Subjects and methods

The sample consisted of 159 subjects, who fulfilled the IES criteria for PTSD, and were taken from a larger sample of 640 participants, which was chosen by a random walk technique in five regions of the country affected by major trauma. The assessment was carried out by the following instruments: Mini International Neuropsychiatric Interview 5 (MINI 5), Life Stressor Checklist-Revised (BSC-R), Brief Symptom Inventory (BSI), Impact of Event Scale-Revised (IES-R) and Manchester Short Assessment of Quality of Life Scale (MANSA). The follow-up study was carried out 1 year after the baseline.

Results

In the initial phase, PTSD was found in 100 out of 159 participants (62.9%), while 81 (51%) fulfilled the diagnostic criteria for MDD. Comorbidity of PTSD and depression was identified in 65 (40.9%) subjects of the sample. After 1 year, PTSD was found in 56 (35.2%) and MDD in 73 (45.9%) participants. Comorbidity of PTSD and depression in the follow-up phase was identified in 41 (25.8%) subjects of the sample. The subjects with comorbidity had significantly higher level of post-traumatic stress symptoms, general psychological distress as well as suicide risk and lower level of quality of life than participants with either condition alone.

Conclusion

PTSD–depression comorbidity is a common post-traumatic condition. Complex psychopathology, severity of symptoms and their consequences, both at individual and community levels, require attention to be paid to early diagnostics and treatment of affected persons.

Open access
Perceptions of Pakistani community towards their mental health problems: a systematic review

Abstract

Objectives

The objective of this research is to explore how Pakistani community perceive their mental health problems by systematically reviewing the scientific literature published on major databases. The findings expectedly will be useful for general public, for clinicians and for the researchers.

Methods

The methodology of this systematic literature search involved identifying and critically appraising studies that attempted to explore how Pakistani community perceives and understands its mental health problems. We carried out literature search on some major databases including PubMed, Cochrane database of systematic reviews and Google Scholar. We followed selection criteria where researchers aimed to find perceptions and understandings of Pakistani participants regarding their mental health by adopting scientific methodologies. The extraction of data was carried out after reading the selected papers and organising the findings under specific categories, in the form of a table. Data analysis was based on the information gathered from these studies.

Results

The results suggest that Pakistani community exhibits negligible to little understanding regarding their psychological experiences and emotional processes as separate identifiable entities. Nonetheless, multiple parallel sociocultural concepts such as religion or faith driven practices and mythical or supernatural understandings are highlighted by this research. These are accepted and practiced in order to address mental health problems.

Conclusion

It appears that Pakistani community has limited understanding and scarce vocabulary to describe their inner psychological and emotional experiences. However, in order to address the mental health issues, the community exhibits a variety of responses and reactions that are driven from several unique social, cultural and religious factors. Whether these are general perceptions or causations or protective factors towards illness or possible treatment options, they all are approached and addressed with some unique understandings and perceptions that are specific to this community.

Open access
Interpreting Foreign Smiles: Language Context and Type of Scale in the Assessment of Perceived Happiness and Sadness

Abstract

The current study focuses on how different scales with varying demands can affect our subjective assessments. We carried out 2 experiments in which we asked participants to rate how happy or sad morphed images of faces looked. The two extremes were the original happy and original sad faces with 4 morphs in between. We manipulated language of the task—namely, half of the participants carried it out in their native language, Spanish, and the other half in their foreign language, English—and type of scale. Within type of scale, we compared verbal and brightness scales. We found that, while language did not have an effect on the assessment, type of scale did. The brightness scale led to overall higher ratings, i.e., assessing all faces as somewhat happier. This provides a limitation on the foreign language effect, as well as evidence for the influence of the cognitive demands of a scale on emotionality assessments.

Open access
Normative data for 102 Spanish remote associate problems and age-related differences in performance

Abstract

The Remote Associates Test (RAT) is a measure developed by Mednick (1962) which is used to assess the convergent thinking component of creativity. This study presents a normative database in Spanish including 102 problems based on the RAT. Three sets of problems were built according to the type of between-word associations: semantic, compound, and two-word expressions. These problems were administered to a sample of 309 elementary, high-school, and university students. The results show good internal consistency as well as good convergent validity with insight problems, and discriminant validity using Guilford’s Alternative Uses Test. In addition, the results indicate age-related differences in the ability to solve the different types of problems.

Open access
Temporal preparation in patients with Neglect syndrome

Abstract

The right parietal cortex has been widely associated with a spatial orienting network. Its damage frequently produces the Neglect syndrome consisting in deficits in spatial attention to the left hemifield. Neglect has also been related to temporal deficits (such as the estimation of the duration of a stimulus or the discrimination of two stimuli that occur at the same spatial location but at different time intervals). Such attentional deficits have been much less studied in the temporal as compared to the spatial domain. The current research focused on the study of temporal attention processes in patients with Neglect syndrome, specifically, on temporal preparation. We recruited 10 patients with Neglect syndrome, 10 patients without Neglect syndrome, as well as 11 healthy individuals. Each participant completed an experimental task which measures three main temporal preparation effects described in the literature: Temporal orienting and Foreperiod effects (both related to control mechanisms and prefrontal areas) and Sequential effects (automatic in nature and related to parietal and subcortical structures). The results showed a deficit in the sequential effects only in those patients who suffered from Neglect syndrome. The results suggest a causal relation between Neglect syndrome and the automatic mechanisms of temporal preparation. Since our sample of Neglect patients had suffered lesions mainly in the parietal cortex, the results are discussed taking into account the role of the parietal lobe in the processing of time and the models explaining sequential effects.

Open access
Testing pragmatic inferences: The impact of language and culture

Abstract

Pragmatic inferences are one way to study false memories in real-world situations. We aimed to investigate variances in responses to pragmatic implication sentences between Portuguese and American data, presenting, for the first time, normative data of cued recall and recognition for pragmatic implication sentences in Portuguese. In Study 1 we analyzed cued-recall data for Portuguese pragmatic sentences. The proportions of cued- recall for correct and inference responses of each sentence did not significantly correlate with the values of American normative data. In Studies 2a and 2b we analysed forced-recognition data for pragmatic sentences, one with American participants and English sentences (Study 2a) and the other with Portuguese participants and Portuguese sentences (Study 2b). Moreover, two conditions of sentences presentations were applied to eventually detect an influence of the sentences’ format, which was not find in both studies. The levels of recognition for correct and inferences were very similar between those two studies but the correlation, sentence by sentence, was low. Together, these results suggest an important recommendation for further studies - normed material for a specific language/culture is a crucial factor to be considered when conducting research on pragmatic inferences.

Open access
Implementing a psychosocial intervention DIALOG+ for patients with psychotic disorders in low and middle income countries in South Eastern Europe: protocol for a hybrid effectiveness-implementation cluster randomized clinical trial (IMPULSE)

Abstract

Objectives

Psychotic disorders have large treatment gap in low- and middle-income countries (LMICs) in South-Eastern Europe, where up to 45% of affected people do not receive care for their condition. This study will assess the implementation of a generic psychosocial intervention called DIALOG+ in mental health care services and its effectiveness at improving patients’ clinical and social outcomes.

Methods

This is a protocol for a multi-country, pragmatic, hybrid effectiveness–implementation, cluster-randomised, clinical trial. The trial aims to recruit 80 clinicians and 400 patients across 5 South-Eastern European LMICs: Bosnia and Herzegovina, Kosovo*, Montenegro, Republic of North Macedonia and Serbia. Clusters are clinicians working with patients with psychosis, and each clinician will deliver the intervention to five patients. After patient baseline assessments, clinicians will be randomly assigned to either the DIALOG+ intervention or treatment as usual, with an allocation ratio of 1:1. The intervention will be delivered six times over 12 months during routine clinical meetings. TThe primary outcome measure is the quality of life at 12 months [Manchester Short Assessment of Quality of Life (MANSA)]; the secondary outcomes include mental health symptoms [Brief Psychiatric Rating Scale (BPRS), Clinical Assessment Interview for Negative Symptoms (CAINS), Brief Symptom Inventory (BSI)], satisfaction with services [Client Satisfaction Questionnaire (CSQ-8)] and economic costs at 12 months [based on Client Service Receipt Inventory (CSRI), EQ-5D-5L and Recovering Quality of Life (ReQOL-10)]. The study will assess the intervention fidelity and the experience of clinicians and patients’ about implementing DIALOG+ in real-life mental health care settings. In the health economic assessment, the incremental cost-effectiveness ratio is calculated with effectiveness measured by quality-adjusted life year. Data will also be collected on sustainability and reach to inform guidelines for potentially scaling up and implementing the intervention widely. Conclusion: The study is expected to generate new scientific knowledge on the treatment of people with psychosis in health care systems with limited resources. The learning from LMICs could potentially help other countries to expand the access to care and alleviate the suffering of patients with psychosis and their families.

Trial registration: ISRCTN 11913964

Open access
Eating disorders, risk and management: a personal journey and a South African and African perspective

Abstract

Eating disorders are amongst the most, disabling and lethal of psychiatric conditions. These conditions affect predominantly adolescent and young adult females, but not exclusively so. Whilst stereotypically diagnosed in western, urban societies their emergence in a range of population groups beyond the aforementioned has challenged the stereotype – no more so than in South Africa where eating disorders had not been diagnosed in black, female South Africans until the 1990s. Creating awareness of the changing demographic profile and thus risk was critical in ensuring appropriate diagnosis and management. Whilst this was a key feature of my personal journey there were numerous other aspects of risk explored for the development of eating disorders, as well as management, which will be highlighted and discussed in the paper. This has been especially relevant within the South African context.

Open access
Association of severity of depressive symptoms with sleep quality, social support and stress among Pakistani medical and dental students: A cross-sectional study

Abstract

Objectives

This study has been designed to elucidate the prevalence of stress, depression and poor sleep among medical students in a Pakistani medical school. There is a paucity of data on social support among medical students in Pakistan; an important predictor of depressive symptoms. Therefore, this study was also aimed to demonstrate the direct and indirect impact of social support in alleviating depressive symptoms in the study sample.

Methods

This observational cross-sectional study was conducted in Lahore, Pakistan, where a total of 400 students at a medical school were approached between 1st January to 31st March 2018 to participate in the study. The study sample comprised of medical and dental students enrolled at a privately financed Pakistani medical and dental school. The participants responded to a self-administered survey comprising of five parts: a) demographics, b) Pittsburgh Sleep Quality Index (PSQI), c) Patient Health Questionnaire-9 (PHQ-9), d) Multidimensional Scale of Perceived Social Support (MSPSS) and e) Perceived Stress Scale-4 (PSS-4). All data were analysed using SPSS v. 20. Linear regression analysis was used to reveal the predictors of depression.

Results

In total, 353 medical students participated, yielding a response rate of 88.25%. Overall, poor sleep quality was experienced by 205 (58.1%) students. Mild to severe depression was reported by 83% of the respondents: mild depression by 104 (29.5%), moderate depression by 104 (29.5%), moderately severe depression by 54 (15.3%) and severe depression by 31 (8.8%) respondents. Subjective sleep quality, sleep latency, daytime dysfunction and stress levels were significantly associated with depression symptoms. Social support was not significantly associated with depressive symptoms in the regression model (Beta = -0.08, P < 0.09); however, it acted as a significant mediator, reducing the strength of the relationship between depressive symptoms and sleep quality and stress.

Conclusions

According to our study, a large proportion of healthcare (medical and dental) students were found to be suffering from mild to moderate depression and experienced poor sleep quality. It is concluded that social support is an important variable in predicting depressive symptomatology by ameliorating the effects of poor sleep quality and high stress levels.

Open access
Barriers and facilitators to conducting research by early career psychiatrists: a literature review

Abstract

Objectives

To understand and identify factors that promote and prevent research participation among early career psychiatrists (ECPs), in order to understand what would encourage more ECPs to pursue a research career.

Methods

We conducted an electronic search of databases (PubMed and the Cochrane library) using the keywords ‘doctors’, ‘trainees’, ‘residents’, ‘physicians’ and ‘psychiatric trainees’ as well as ‘research’ (MeSH) and ‘publishing’ (MeSH). This search was complemented by a secondary hand search.

Results

We identified 524 articles, of which 16 fulfilled inclusion criteria for this review. The main barriers included lack of dedicated time for research, lack of mentoring and lack of funding. The main facilitators were opportunities to receive mentorship and access to research funding.

Conclusions

Action is needed to counteract the lack of ECPs interested in a career in research. Specific programs encouraging ECPs to pursue research careers and having access to mentors could help increase the current numbers of researching clinicians in the field.

Open access