All Articles

Simon Xin Min Dong^*

International Institute of Consciousness Science®, Vancouver, BC, Canada

Peptic ulcers, including duodenal and gastric ulcers, are currently studied as an infectious disease caused by Helicobacter pylori. However, this etiology cannot elucidate the major characteristics and observations/phenomena of the disease, as well as the roles of gastric acid and NSAIDs. Additionally, many patients with severe ulcer symptoms have no infection, suggesting bacterial eradication cannot prevent relapses in all ulcer patients. To address these challenges, a recently published Complex Causal Relationship with its accompanying methodologies was applied to analyze the existing data. Peptic ulcers were identified as a psychosomatic disease triggered by psychological stress, where Helicobacter pylori plays a secondary role in only the late phase of ulceration. An integration of five major etiological theories in history illustrated the entire pathogenesis of peptic ulcers, which addressed all the characteristics, observations/phenomena, controversies, and mysteries of the disease in a series of 6 articles. This first article focuses on the pathogenesis of duodenal ulcers. The hyperplasia and hypertrophy of gastrin and parietal cells induced by chronic stress potentiate the individual’s response to immediate stress, resulting in the hypersecretion of gastric acid and eventually, duodenal ulceration. This psychopathological mechanism resolved all the controversies associated with Helicobacter pylori and explicitly elucidated 7 characteristics of duodenal ulcers, as well as 42 observations/phenomena. The roles of gastric acid, Helicobacter pylori, and NSAIDs in duodenal ulcers were also identified. The effectiveness validated the etiology of duodenal ulcers identified by the Complex Causal Relationship, indicating stress management is essential for a complete cure of the disease without relapse.

Fayez Mahamid^*, Denise Ziya Berte, Naeem Salameh

An-Najah National University, Nablus, Palestine

Forensic Psychology is the branch of psychology focused on the production and application of psychological principles to the legal process including competency, validity of defenses based on mental health behavior, predicting violent behavior, assessing injury and child custody¹. Forensic Psychology has evolved in the United States since 2001 when it was recognized as a specialty of the American Psychological Association (APA) and psychologists are now serving the court systems in a wide variety of tasks². Unfortunately, in developing nations such as Palestine both access to and understanding of the specialty of Forensic Psychology is minimal, leaving critical functions of legal systems where psychological data is needed, unserved and uninformed³.

The following study was conducted in Nablus, West Bank Palestine where the first Master of Clinical Psychology program has produced a cohort of mental health professionals with an expertise in Forensic Psychology. The intervention focused on the training of lawyers (with a specialty in domestic violence and family protection) on the general principles and uses of psychology in the legal system and an introduction of how they could use forensic psychologists to the benefit of the court. The data determined that participants in the one-day training module gain significant understanding and motivation to use forensic psychologists in their practice (.002 level of significance) and that the effect was undifferentiated by age, gender, place of residence or education level).

The current study determines that with a minimal effort legal professionals can gain both understanding and a motivation to use psychological professionals, even in systems where there was no previous exposure to the field. Such openings can change the practice of law and legal systems in a positive way to include the expertise of mental health professionals at every level of governance and jurisdiction. Having access to and incorporating psychological data from qualified professionals into developing legal institutions is critical in insuring human rights and scienced based evidence at every level of societal systems.

Kalsang Tshering

NYC Health + Hospitals/North Central Bronx, NY, USA

Healthcare systems have long recognized the impact of adverse health events on patients and families, and in recent years have gone further to identify the resulting emotional strains on the healthcare workforce. This attention to emotional health, which has been described as the overall state of one's emotions and the ability to manage and adapt to stressors, is also referred to as "emotional wellness" or "wellbeing." As this concept of wellness expands and evolves in the midst of the COVID-19 pandemic into a priority on the wellbeing of those in the helping professions, the current review explores the existing literature on the impact of compassion fatigue, compassion satisfaction, and their relationship to occupational burnout, with the conclusion that the emotional wellness of healthcare stakeholders and the health of an organization itself are not mutually exclusive. A review of these identified areas of occupational wellness is conducted, as well as a summary of findings emphasizing its significant implications for the healthcare workforce moving forward, both in relation to tangible costs to the healthcare industry and its reach to the bedside in the form of reported patient experience.

Felix Diotte¹, Stephane Potvin², Donna Lang³, Amal Abdel-Baki⁴, Alicia Spidel⁵, Marie Villeneuve⁶, Tania Lecomte^1*

¹Departement of psychology, University of Montréal

²Departement of psychiatry and addiction, University of Montréal, Canada,

³Department of Radiology, University of British Columbia, Canada,

⁴Centre hospitalier de l'Université de Montréal, Canada,

⁵University of Fraser Valley, Fraser Health, Canada,

⁶Institut universitaire en santé mentale de Montréal, Canada

As many as 43% of methamphetamine users will have a psychotic episode in their lifetime. Of these, 30% will develop a primary psychotic disorder, such as schizophrenia. The current state of the literature does not currently allow us to determine who will develop a primary psychotic disorder following a methamphetamine-induced psychosis (MIPD). This distinction is important, since people with a first episode of a psychotic disorder need specific and rapid treatments to ensure optimal recovery. Social cognition could help predict distinct profiles. The aim of this scoping review is to evaluate the literature in order to extract the differences between MIPD and primary psychotic disorders in the domain of social cognition. Articles were recovered from PsychINFO, Medline and Web of science and were retained if they met the following inclusion criteria: (a) original research or meta-analyses, (b) complete or partial sample with a psychotic disorder diagnosis with comorbid methamphetamine use, or MIPD, (c) studies focusing on the difference between a methamphetamine-induced psychosis and a primary psychotic disorder, and (d) studies focusing on social cognition in psychotic or methamphetamine using population. A total of 17 articles were identified, with none directly aiming at distinguishing MIPD and primary psychotic disorder using social cognition. Future studies on social cognition are needed in order to determine differences in the severity of deficits between the two profiles.

Noboru Iwata^1*, Takashi Shimizu²

¹Faculty of Healthcare, Kiryu University, Gunma, Japan.

²Japan Medi-Mental Institute, Tokyo, Japan

Objective: The present study examined the association of anxiety- and anger-related components to depressive symptomatology for men and women.

Methods: The study relied on a cross-sectional design. of 2,054 Japanese workers affiliated with two occupational settings, complete responses on measures for depression, anxiety, and anger, were obtained from 1,862 workers (90.7%: 1,521 men, 341 women). A stepwise regression analysis was executed by gender and age group.

Results: Stepwise regression analysis revealed that main components were almost the same for both genders, i.e., trait anxiety, state anger and anger suppression. However, the explaining variances of anger were much larger for men, whereas those of state anxiety were larger for women. Anger expression outward was selected for men, but not for women.

Conclusions: Depressive symptomatology was largely explained by trait anxiety, state anger, and anger expression style. For men, state anger and either expression of feelings of anger inward or outward were exacerbating their depression as compared to women. This could explain in part the gender differences in depression.

Natasha M. Simske, Trenton Rivera, Bryan O. Ren, Alex Benedick, Megen Simpson, Sarah B. Hendrickson, Heather A. Vallier

MetroHealth System, affiliated with Case Western Reserve University, Cleveland, OH, USA

Mental illness is pervasive among trauma populations and is linked to worse outcomes and recidivism. The Victims of Crime Advocacy and Recovery Program (VOCARP) prospectively provides patient services such as educational materials, compensation, advocacy and mental health care to patients with physical injuries. The purpose was to assess for relationship between resource use and development of mental illness after injury. Two control groups: a random selection of patients who did not use VOCARP (n=212) and 201 patients with non-violent trauma were obtained. Over 22 months 1,019 patients utilized VOCARP. Of all 1,432 patients, 43% had preexisting mental illness, and 17% had a new or worsening mental illness after injury. Patients with VOCARP use had more preexisting mental illness (47% vs. 35%, p<0.01), particularly depression and stress disorders. Conversely, VOCARP use was associated with lower rates of mental illness post-injury (15% vs. 22%). Following injury, VOCARP users had more stress disorders (57% vs. 37%), but less depression (25% vs. 41%) and suicidal ideation (7% vs. 24%), all p<0.05. 113 patients (11% of 1,019) used mental health services, which was associated with lower recidivism for new violent injury (4.4% vs. 11.7%, p=0.016). On regression analysis, unemployment (OR: 0.61, p=0.012) and use of VOCARP services (OR: 0.54, p=0.008) were predictive of decreased risk for new mental illness. Mental illness is pervasive among patients with injuries resulting from violence. VOCARP programming appears beneficial for limiting risk of new mental illness after injury.

Connor Patros^1*, Michael Genovese^2*

¹Mindyra Health Corporation, Philadelphia, Pennsylvania, USA

²Acadia Healthcare, Franklin, Tennessee, USA

Gonzalo Segrelles-Calvo¹*, Estefanía Llopis-Pastor¹, Glauber Ribeiro de Sousa Araújo², Inés Escribano¹, Esther Antón¹, Laura Rey¹, Nestor Rodriguez Melean¹, Marta Hernández¹, Javier Carrillo¹, Celia Zamarro¹, Mercedes García-Salmones¹, Susana Frases².

¹Respiratory Intermediate Care Unit, Respiratory Department, University Rey Juan Carlos Hospital, Madrid, Spain

²Laboratorio de Biofísica de Fungos, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Brasil

Introduction: The study aimed to analyse the clinical response and short-term outcomes with the use of high-flow oxygen therapy (HFOT), non-invasive mechanical ventilation (NIMV) with bilevel positive airway pressure, or continuous positive airway pressure (CPAP) in severe COVID-19 patients.

Methods: We conducted an observational, prospective, single-center study, approved by Ethics Committee of “Instituto de Investigación Sanitaria Fundación Jiménez Díaz” (EO102-20-HRJC).

We included a total of 130 patients ≥18 years-old, with proved SARS-CoV-2 infection and secondary Acute Respiratory Failure (ARF) that required treatment with Non-invasive Respiratory Support (NIRS). We collected data about population demographic characteristics, clinical factors, and evolution during the incoming. A baseline of patients treated with HFO, CPAP and NIMV were compared with one-way ANOVA test, while categorical variables were expressed as numbers and percentages and were compared using the chi-square test or Fisher’s exact test when appropriate.

Results: The cohort was distributed as follows: CPAP 54.6% (n = 71), NIMV 30% (n = 39), HFO 15.4% (n = 20). There were no differences between NIRS subgroups regarding age, comorbidity, or functional status. At the beginning of NIRS treatment, PaO₂/FiO₂ value was 149.3 ± 69.7. After 24 hours, PaO₂/FiO₂ was significantly higher in the CPAP group (CPAPvsNIMV, p-value = 0.0042; CPAPvsHFO, p-value = 0.000169).

The overall ICU admission evaded rate was 69.1% and TF rate was 43.8%, without differences between the three therapies (p-value = 0.281). The mortality rate was 37.2%, without significant differences between subgroups.

Conclusions: Our data suggest that CPAP versus treatment with NIMV or HFO improves PaO₂/FiO₂ rate in severe ARF patients, significantly reducing ICU admission. No differences were observed in mortality or therapeutic failure.

Gigi Tevzadze¹, Elene Zhuravliova^2,3, David Mikeladze^2,3*

¹4-D Research Institute, Ilia State University, 3/5 Cholokashvili av, Tbilisi, 0162, Georgia

²Institute of Chemical Biology, Ilia State University, 3/5 Cholokashvili av, Tbilisi, 0162, Georgia

³I. Beritashvili Center of Experimental Biomedicine 14, Gotua Str., Tbilisi 0160, Georgia

Shervin Assari*

Department of Urban Public Health & Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA

Background: According to the Minorities’ Diminished Returns (MDRs), highly educated African American (AA) and Latino people remain at high risk of tobacco use. One hypothesis suggests that this high risk of tobacco use stems from AA and Latino people remaining unrealistically optimistic, resulting in the risks of tobacco use being discounted. Aims: To better understand the role of cognitive bias as a mechanism behind the high risk of smoking in highly educated minorities, we studied ethnic variation in the association between smoking intensity and perceiving oneself as a smoker among young American adult established current smokers.

Methods: In this cross-sectional study, we used baseline data of 2,475 young adults (18-24 years) who were current established smokers. The data came from the Population Assessment of Tobacco and Health (PATH; 2013) study, a nationally representative survey in the US. The independent variable was smoking intensity. The dependent variable was not perceiving oneself as a smoker (probably due to optimistic cognitive bias and discounting the risk). Age, gender, and education were the covariates. Ethnicity was the moderator. Logistic regressions were used to analyze the data.

Results: From the total number of 2,475 current smokers, 2106 (85.1%) perceived themselves-as a smoker, and 369 (14.9%) smokers perceived themselves as a non-smoker. A high level of smoking intensity was associated with lower odds of not perceiving oneself as a smoker. Two significant interactions were found between Latino and AA ethnicity and smoking intensity, suggesting that the effect of smoking intensity on perceiving oneself as a smoker is weaker in AAs than Whites and Latinos than non-Latinos.

Conclusions:While tobacco use intensity is associated with a lower likelihood of optimistic cognitive bias and not perceiving oneself as a smoker, Latino and AA young adults who smoke many cigarettes a day are more likely than their non-Latino White counterparts with the same smoking risk not to perceive themself as a smoker. This finding suggests a psychological discounting of risk among AA and Latino smokers. Such cognitive bias may help them avoid cognitive dissonance and reduce their own perceived risk of cancer and other fatal conditions from smoking. A cognitive bias may increase the smoking burden of AA and Latino young adults through discounting smoking risk.

Kevin J. Rivera¹, Jenny Y. Zhang², David C. Mohr³, Annie B. Wescott⁴, Aderonke Bamgbose Pederson^2*

¹Department of Psychiatry, Carver College of Medicine, University of Iowa. 200 Hawkins Dr, Iowa City, Iowa, 52242, United States

²Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University. 446 E. Ontario St, #7-200, Chicago, Illinois, 60611, United States

³Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University. 680 N. Lake Shore Dr, Suite 1400, Chicago, Illinois, 60611, United States

⁴Galter Health Sciences Library, Feinberg School of Medicine, Northwestern University. 320 E Superior St, Chicago, Illinois, 60611, United States

Among African Americans, the chronicity and severity of mental illness correlates with worse health outcomes and widens health disparities. Stigma related to mental illness compounds mental health disparities by creating barriers to help-seeking behavior. We examine the current tools designed to reduce mental illness stigma and promote improved mental health outcomes among African Americans. The authors reviewed the current evidence in the literature for such stigma reduction interventions. The review team developed a focused search across four databases: PubMed, Embase, Scopus, and APA PsycINFO. Initial searches identified 120 articles, from which six studies were included as reporting on mental illness stigma reduction interventions among African Americans. We describe these four quantitative and two qualitative studies. There have been various interventions used among African Americans to reduce mental illness stigma, and the level of efficacy and effectiveness is not well studied. Our review demonstrated a need for more robust studies to yield strong evidence on effectiveness among stigma reduction interventions in this target population. The evidence does support tailoring intervention studies to this population. Effectively engaging and partnering with key stakeholders, including schools, community organizations, and faith-based institutions enhances the acceptance and delivery of stigma reduction interventions.

Allen Azizian

Department of Criminology, California State University, Fresno, USA

The term evidence-based is increasingly found in treatment manuals and program titles designed for individuals convicted of a sexual offense. However, whether the presented evidence truly qualifies as “evidence-based” is questionable. I will share my experience as the clinical director for a private outpatient agency where we designed a program based on the existing peer-reviewed literature on individuals convicted of Child Sexual Exploitation Material (CSEM) offenses. I will describe the steps that we followed in developing a workgroup to explore and apply the knowledge from research to our clinical practice. We adapted the term evidence-informed to acknowledge that the program relied on existing literature in combination with the experiences and expertise of our clinical team. A fictitious case that reflects an amalgamation of facts is presented to demonstrate the assessment and treatment processes. Implications for organizational consensus to conduct program evaluation and research are discussed.

Aderonke Bamgbose Pederson^1*, Valerie Earnshaw², Crystal T. Clark^1*, Katelyn Zumpf¹, Inger Burnett-Zeigler¹

¹Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, United Sates

²Department of Human Development and Family Sciences, University of Delaware, United Sates

Background: Mental health stigma results in unmet mental health needs. Research describing predictors of stigma remains limited among Black immigrants. We aim to examine stigma associated with mental illness among a group of Black immigrant women.

Methods: We examined data from 22 women from two Black immigrant community centers. We collected surveys on demographics, cultural beliefs, migration status, religiosity and mental health stigma. Simple linear regression was used to model the unadjusted association between each component variable and overall stigma scores. All analyses were conducted using R and assumed a two-sided, 5% level of significance.

Results: A linear relationship was found between author-generated scale, the Stigma and Culture Survey (SCS) and the Depression Self Stigma Scale (DSSS). Among respondents, use of religious resources was associated with less stigma (p-value: 0.04). Whereas spirituality and morality was associated with greater stigma (p-value: 0.003). United States citizenship was associated with less stigma (p-value: 0.0001).

Discussion/Conclusion: Religion and spirituality are critical to understanding mental health stigma among Black immigrants. Studies aimed at assessing and reducing stigma need to critically engage with cultural and religious factors.

Danielle M. Viola*

Tranquil Tides Mental Health & Wellness, LLC, USA

Cell phone and social media usage have become intriguing topics to explore and discuss over recent years. This research aims to review correlations of negative effects in mental and physical health caused by cell phone and social media use in the past two decades. The history of cell phones and their capabilities will be introduced. The need for human connection will be emphasized.  Exploration of the connection between unbalanced use and different aspects of health will be evaluated such as addiction, social influences, brain changes, and multitasking. Lastly, resources and recommendations to find balance and support for anyone being adversely affected by cell phones and social media will be provided. Current literature reveals that there is a negative correlation between increased cell phone and social media use with human connection, mental health, and physical health.

Shervin Assari*^1,2, MD, MPH

¹Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA

²Department of Urban Public Health, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA 

Background: In the United States, due to residential segregation, racial minorities and families with low socioeconomic status (SES) tend to live in less safe neighborhoods than their White and high SES counterparts. As such, in the US, race, and SES closely correlate with neighborhood safety. Due to the high chronicity of stress in unsafe neighborhoods, perceived neighborhood safety may be a mechanism through which race and SES are linked to children’s mental health. Simultaneously, race and SES may alter the effects of perceived neighborhood safety on children's mental health. Aim: To explore racial and SES differences in the effects of neighborhood safety on children's internalizing symptoms, we compared racially and SES diverse groups of American children for the effects of parents’ perceived neighborhood safety on children's internalizing symptoms. Methods: This cross-sectional study included 10484 children from the Adolescent Brain Cognitive Development (ABCD) study. Mixed-effects regression was used for data analysis. The predictor variable was parents’ perceived neighborhood safety which was treated as a continuous measure. The primary outcome was children's internalizing symptoms reported by children. Race, parental education, household income, and family structure were moderators. Results: Overall, the parents' high neighborhood safety was associated with lower levels of internalizing symptoms in children. Race and household income showed statistically significant interactions with subjective neighborhood safety on children's internalizing symptoms. Parents’ perceived neighborhood safety showed a stronger inverse association with children's internalizing symptoms for Black than White families. Parents’ perceived neighborhood safety showed a stronger inverse association with children's internalizing symptoms for high-income than low-income families. Parental education or family structure did not show any significant interaction with parents’ perceived neighborhood safety on children’s internalizing symptoms. Conclusion: The degree to which neighborhood safety may be associated with children's internalizing symptoms may depend on race and household income. Some of the effects of race and SES on children’s mental health outcomes may be due to interactions with contextual factors such as neighborhood safety. More research is needed on why and how diverse racial and SES groups differ in the association between perceived neighborhood safety and children’s well-being.

Kathryn Pitten^*

Territory Business Manager, Boston, Alkermes, USA

Background: There has long been an association between family history and mental illness; however, recently, researchers have focused on the correlation between childhood adverse events and mood disorders, specifically bipolar disorder.
Methods: A literature search of peer reviewed journals published from 2015 to 2020 was conducted using the keywords: childhood adverse events, childhood adversity, childhood trauma, bipolar disorder, mental illness, and mood disorders from the EBSCO database which included, APA PsychArticles, Child Development and Adolescent Studies, Health Source: Nursing/Academic Edition, and MEDLINE.
Results: : The results demonstrate a strong correlation between childhood adverse events and bipolar disorder specifically, sexual abuse in females, maternal separation, economic difficulties and family history of mental illness. Specific childhood adverse events show a correlation with specific types of mental illness. The recollection of abuse is associated with an increased risk of depressive symptoms. Additionally, childhood adverse events are associated with clinical outcomes of bipolar disorder including age of onset, chronicity, psychotic episodes and suicidality.
Conclusion: : The findings suggest that females that experience childhood adverse events may be at a higher risk for developing bipolar disorder and the clinical outcome of bipolar disorder may also be affected by the type and number of childhood adverse events. The results also suggest that schizophrenic spectrum disorders, bipolar disorder and major depressive disorder are associated with different childhood adverse events. Females who have recollections of childhood abuse are at an increased risk for depressive symptoms associated with bipolar disorder. Psychosocial interventions that are geared towards limiting childhood adverse events may reduce the incidence of mental illness, specifically bipolar disorder.

Aman Dule¹*, Gutema Ahmed², Worknesh Tessema², Matiwos Soboka²

 

¹Mettu University, College of health science, Department of psychiatry, Mettu, Ethiopia

²Jimma University, Institute of health science, Faculty of medicine, Department of psychiatry, Jimma, Ethiopia

Purpose: The aim of this study is to assess the quality of sleep and contributing factors in treated patients with schophrenia.

Materials and methods: The sleep quality of 411 subjects in treatment for schizophrenia was assessed. A cross-sectional study design was used to determine mediating factors. A consecutive sampling technique was used for recruitment. The Pittsburgh Sleep Quality Index (PSQI) was used to assess outcome variables, and the positive and negative syndrome scale (PANSS) and the four-item Morisky-Green test (MGT) was used for symptom severity and medication adherence. Logistic regression analysis was used to determine factor association and the adjusted odds ratio (AOR) and a p-value < 0.05 determined statistical significance.

Results: More than half of the patients were poor sleepers. Sleep determinants were: a) urban residence AOR=3.08 [2.57, 8.12], b) family size ≥6 AOR=2.72 [1.38, 5.08], c) current khat use AOR=2.30 [1.22, 4.31], d) low antipsychotics adherence AOR=6.23 [3.61, 10.75], e) positive and negative syndrome scale (PANSS) for positive symptoms greater than mean AOR=2.99 [1.69, 5.30] and PANSS for general symptoms greater than mean AOR=4.22 [2.22, 8.05]. These were all significantly associated with sleep quality on multiple logistic regressions.

Conclusion: There is a high prevalence of poor sleep quality among schizophrenia patients and risk factors are known. It is time to address these factors clinically to ensure better health for this population.

Sarah Araji¹, Ashley Griffin², Laura Dixon^3,4, Shauna-Kay Spencer¹, Charlotte Peavie¹, Kedra Wallace^1,5*

 

¹Department of Obstetrics & Gynecology, University of Mississippi Medical Center, Jackson, MS, 39216, USA

²Program in Neuroscience, University of Mississippi Medical Center, Jackson, MS, 39216 USA

³Department of Psychology, University of Mississippi, Oxford, MS 38677 USA

⁴Department of Dermatology, University of Mississippi Medical Center, Jackson, MS, 39216 USA

⁵Department of Neurobiology & Anatomical Sciences, University of Mississippi Medical Center, Jackson, MS, 39216 USA

Anxiety during pregnancy is associated with adverse outcomes in mothers and infants. Unfortunately, as anxiety is often synonymously mentioned with depression, the studies focusing solely on anxiety during pregnancy are not as robust as those in the field of depression are. In this work, we provide an overview of what is currently known about general anxiety during pregnancy, pregnancy-related anxiety and the potential impacts anxiety could have on post-partum care. An overview of potential risk factors, post-partum maternal outcomes, infant outcome along with pharmacological and non-pharmacological treatments are covered with a specific focus on high-risk pregnancies. Although anxiety during pregnancy is normative; anxiety can become problematic and negatively impact upon behavior, resulting in potential harm to the mother, as well as her developing fetus or child (ren) at home. The clinical diagnosis for anxiety and conditions associated with anxiety often require lengths of time that are not applicable for the pregnant patient, which has led to diagnosis and terms such as pregnancy-related anxiety. Importantly, increasing awareness about the increased potential risk to mothers who may be affected by anxiety during pregnancy or the post-partum period has the potential to improve maternal mental health screening and access to care.

Divya K. Madhusudhan¹, Kore N. Glied¹, Eugene Nguyen¹, Jennifer Rose¹, Dena M. Bravata^1,2*

 

¹Crossover Health, San Clemente, CA

²Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA

Introduction: Anxiety disorders which include generalized anxiety disorder, panic disorder (PD), post-traumatic stress disorder, and obsessive-compulsive disorder are common psychiatric condition associated with significant social, occupational, physical, and economic costs. Interventions that target the respiratory dysregulation associated with anxiety disorders have demonstrated considerable therapeutic benefit. However, no such intervention has been evaluated in among PD patients receiving care in an employer-sponsored health center.

Objective: To evaluate the use of a novel, capnometry-assisted breathing therapy on clinical outcomes, engagement, and satisfaction for patients with PD receiving care in an employer-sponsored health center.

Methods: Prospective analysis of participants using the program between 1/1/2018 and 06/30/2020.

Results: Twenty-two participants enrolled. Their average weekly usage remained high throughout the 4-week treatment protocol of 17 minutes twice a day for 28 days (11.6 sessions (SD 3.1) in week one and 10.4 sessions (SD 4.0) in week four). Their average Panic Disorder Severity Scale score decreased from 13.3 (SD ± 3.6) to 5.6 (SD ± 1.8), indicating that panic severity decreased from “moderately ill” to “slightly ill.” Use of the program was associated with clinically and statistically significant improvements in respiratory markers: average respiratory rate decreased from 14.9 (SD 3.6) to 11.9 (SD 4.7) breaths per minute (p<0.001) and end-tidal pCO2 increased from 37.2 mmHg (SD 4.2) to 39.1 mmHg (SD 3.6) (p<0.001). Engagement was associated with decline in utilizations of behavioral health services at employer-sponsored primary care center clinic after the intervention.

Conclusion: The clinical improvements observed in this pilot suggest that capnometry-assisted breathing therapy is a valuable tool for patients suffering from panic-associated symptoms.

Tiffany Field^1,2*, Shantay Mines², Samantha Poling², Miguel Diego¹, Debra Bendell², Connie Veazey²

¹University of Miami/Miller School of Medicine, USA

²Fielding Graduate University, USA

The effects of age (young versus old) and living status (alone versus with others) during the COVID-19 lockdown were assessed via a Survey Monkey questionnaire on 260 individuals (18-82 years). Both age and living status and their interaction effects were explored via ANOVAs on scales for health, media use, mood states including anxiety and depression, posttraumatic stress symptoms, fatigue and sleep disturbances. ANOVAs were conducted via a median split on age as well as on a group comparison of young (20-40 years) versus old (60-80 years) individuals. The results of these two types of data analyses were consistent on most variables, suggesting that the young versus the old experienced more stress, anxiety, depression, and PTSD symptoms as well as greater fatigue and sleep disturbances. And, they reported fewer health activities. Significant effects were also noted for the alone versus living with others’ groups including less engagement in exercise and work at home by the alone individuals as well as more stress, depression, fatigue, and PTSD symptoms. A significant age by living condition interaction effect suggested that the young living alone had the highest depression scores. The experiences that were common to the young, the living alone, and the young living alone were being lonely, depressed and fatigued. These results highlight the importance of prevention/intervention for the young, the alone and the young alone during lockdowns like COVID-19.

Haiyan XING¹*, Wei YU^2#

¹Department of Nursing, School of Medicine, Shaoxing University, Zhejiang Province, China

²Institute of Epidemiology, Shaoxing Keqiao District Center for Disease Control and Prevention, Zhejiang Province, China

The purpose of this study is to examine the change of Health-related quality of life (HRQOL) and rearing behavior among migrant children as well as their correlations in the city of Shaoxing, China. By cluster sampling, 149 migrant children had completed the questionnaires in 2014 and 2015. Spearman’s correlation was performed to clarify the relationship between change of HRQOL and rearing behavior in migrant children. Multiple linear stepwise regression analytical methods were used to identify the variables that were associated with change of HRQOL. The results showed that total score, physical health, psychosocial health, emotional functional and social functional of HRQOL among migrant children had increased and overprotection of parents was declined. There were negative correlation between change of quality of life (total score) and change of parents rejection or mother overprotection. There were also negative correlation between change of psychosocial health and change of parents rejection and overprotection. The change of quality of life was mostly reflected by change of mother rejection. These data show that HRQOL and negative rearing behavior among migrant children had improved. The change of quality of life was most affected by the negative rearing behavior of parents, especially mothers.

Stefanie R. Pilkay¹*, Terri Combs-Orme², Frances Tylavsky³, Nicole Bush⁴, Alicia K. Smith⁵

¹Falk College, School of Social Work, Syracuse University, Syracuse, New York

²College of Social Work, University of Tennessee, Knoxville, Tennessee

³Department of Preventive Medicine, University of Tennesse Health and Science Center, e, Memphis, Tennessee

⁴Department of Psychiatry, University of California San Francisco School of Medicine, San Francisco, California

⁵Department of Gynecology and Obstetrics, Department of Psychiatry, Emory University School of Medicine, Atlanta, Georgia

Summary: The prenatal environment can influence gene expression involved in the development, possibly contributing to generational patterns of psychological health. Moreover, sex-specific developmental differences in-utero may result in gene expression differences associated with the prenatal environment. However, it is not clear if maternal overall psychological symptoms will associate with newborn’s gene expression, or if such patterns are consistent between sexes. This study explored the relationships between maternal psychological health (PsyH) and newborn’s gene expression patterns. We assessed PsyH with the Brief Symptom Inventory and newborn gene expression in umbilical cord blood. We conducted combined and sex-stratified analyses of genes expressed in umbilical cord blood.

Findings: PsyH associated with differential expression of 157 genes in males. The 157 differentially expressed genes are more likely to function in metabolic processes. There were no significant differences in gene expression in females.

Application: The sex-specific nature of these findings suggests males may be more vulnerable than females to mothers’ psychological functioning during pregnancy. It is possible that the male-specific results are due in part to female newborns developing under different neuroendocrine conditions. Future research examining prenatal exposures should consider sex differences.

Ruchita Agrawal^1,2*

¹Seven Counties Services, Louisville KY, USA (Formerly, Centerstone)

²Department of Psychiatry, University of Louisville, Louisville KY, USA

Benzodiazepines have been commonly prescribed for the treatment of anxiety and insomnia in the last few decades. There has been a rising concern regarding safety of benzodiazepines due to overdose related deaths, addictions, and cognitive side effects. COVID- 19 pandemic is expected to cause a mental health crisis. Several studies have shown an increase in anxiety and insomnia. This could mean that prescriptions of benzodiazepine could increase due to increase in anxiety and insomnia. We caution health care providers to use best practices and treat patients with psychotherapy as the first line of treatment and not pharmacotherapy. Prescription Drug Monitoring programs (PDMPs) were started due to this concern of overdose deaths, diversion related to opioids and benzodiazepines. PDMPs are mandatory in most states in the United States of America now.We recommend all health care providers to look at their benzodiazepine prescribing practice, monitor PDMP data and make policies to implement changes in order to avoid the next crisis of benzodiazepines after opioids.

Shervin Assari^1,2*, Golnoush Akhlaghipour³, Mohammed Saqib⁴, Shanika Boyce⁵, Mohsen Bazargan¹

¹Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA

²Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA

³Department of Neurology, UCLA, Los Angeles, CA, USA

⁴Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA

⁵Department of Pediatrics, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA

Background: Considerable research has suggested that race and age are two major determinants of brain development, including but not limited to development of the prefrontal cortex (PFC). Minorities’ Diminished Returns (MDRs), however, suggests that race (as a proxy of racism) may interact with various determinants of human and brain development. Minimal knowledge, however, exists on whether age and race also interact on shaping PFC response to threat among American children.

Purpose: Using data from a task-based functional brain imaging study and considering race as a sociological rather than a biological construct, we investigated combined effects of race and age on prefrontal cortical (PFC) response to threat. We explored racial heterogeneities in the association between age and PFC response to threat by comparing Black and White children.

Methods: This study used the task-based functional Magnetic Resonance Imaging (fMRI) data from the Adolescents Brain Cognitive Development (ABCD) study, a national, landmark, multi-center brain imaging investigation of 9-10 years old children in the US. The primary outcomes were mean beta weights of n-back runs measuring PFC response to threating versus neutral face contrast in the following regions of interest (ROIs): left hemisphere-lateral orbito-frontal, left hemisphere -superior-frontal, right hemisphere -caudal middle frontal, and right hemisphere -superior frontal cortex. The independent variable was age. Covariates were sex, ethnicity, family socioeconomic status, and neighborhood socioeconomic status. Race was the focal moderator. To analyze the data, we used linear regression models without and with interactions and SES as covariates.

Results: We included 5,066 9-10 years old children. Age and race did not show direct effects on PFC response to threatening relative to neutral faces. While ethnicity, sex, and socioeconomic status were controlled, age and race showed a systematic interaction on PFC response to threatening relative to neutral faces.

Conclusions: For American children, race and age do not have direct effects but multiplicative effects on PFC response to threat. The results may be reflective of social inequalities in how Black and White children are socialized and developed. The results are important given the role of the PFC in regulating the limbic system response to threat. Coordinated work of the limbic system and PFC is a core element of children’s behavioral and emotional development. Future research is needed on how social stratification and racism shape emotion processing and regulation of American children in response to threat.

Per Eisele*

Associate professor, Department of Psychology, Mid Sweden University, Sweden

Background: The mental health continuum was created for the purpose of measuring mental health with several different wellbeing items.

Aims: The aim of the present study was to investigate the mental health continuum together with a new struggle continuum scale. With languishing and flourishing at the ends of a vertical scale and surrendering and struggling at the ends of a horizontal scale a quadratic model is suggested. Four factors can be distinguished at the corners of the square, depressed, anxious, content and joyful.

Methods: The sample (N=294) consisted of 174 women with a mean age of 40.48 and 124 men with a mean age of 37.27 year. The mental health continuum scale was used together with a new scale measuring struggling, the tendency to give up easily or keep on fighting.

Results: The model was tested on a normal population and was confirmed. Result of chi-square, correlation and t-test analyses show that the two scales could detect depressed, anxious, content and joyful participants.

Conclusions: The result has implications for the choice between mindfulness and activity-based interventions. Discussion about the result are provided.