All Articles

Helene Vossos^1*, Ozioma Nwosu-Izevbekhai²

¹Associate Professor of Nursing, PMHNP Program Coordinator, University of St. Augustine for Health Sciences, St. Augustine, Florida, USA

²Assistant Professor in Residence, University of Nevada, Las Vegas, USA

Objective: The purpose of this manuscript is for readers to understand the differences between bipolar and unipolar mood disorders. Readers will be able to apply evidence-based screening tools to differentiate in the diagnosis of bipolar versus unipolar depressive disorders. The goal is to increase diagnostic accuracy of mood disorders with the opportunity to provide treatment that will lead to improved patient outcomes.

Method: Review of literature discovered 13 articles that were pertinent with three major themes. One theme showed up to 62% of bipolar disorder cases were missed or undiagnosed upon the first evaluation, second theme showed 7% to 70% of individuals were misdiagnosed with adverse outcomes and third theme discovered the importance of specialty psychiatric training, education and the use of evidence-based screening tools combined with clinical judgement improved the accuracy of the correct mood disorder diagnosis.

Findings: In mood disorders, if left untreated or misdiagnosis occurs, the risk of suicide is higher (29.2%) in bipolar affective disorder, versus unipolar major depressive disorder (17.3%).

Implications for clinical practice: Recommendation for the use of evidence-based screening tools are clinical best practices for screening and diagnosing bipolar affective disorders with a statistical significance of 95%. Misdiagnosis is common up to 70% and the implications of timely rapid assessments allow for prompt interventions that has shown to halt and/or prevent mental health conditions to worsen, reducing risk of emergency situations.

Anthony Ezerioha¹, Masoud Mohammadnezhad^2*

¹School of Allied Health and Social Care, Faculty of Health, Medicine and Social Care, Angelia Ruskin University, Cambridge, UK

²Faculty of Health, Education and Life Sciences, School of Nursing and Midwifery, Birmingham City University, Birmingham, UK

Introduction: Adolescents recovering from substance use problems face significant psycho-social challenges. These challenges can affect their recovery progress, overall well-being, and integration into the society. Due to paucity studies, this study aimed to identify the perceptions and attitude towards recovery among adolescents participating in drug addiction interventions.

Methods: This systematic review study applied a complete search of relevant databases, including Scopus, Embase, Cinahl, and PubMed/Medline using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was limited to articles published in English language, between 2013 and 2023, and focused on adolescents drug addiction. Twelve articles were critically appraised using Critical Appraisal Skills Programme (CASP) for qualitative studies and Joanna Briggs Institute (JBI) tools. The results were synthesised using a thematic analysis.

Results: The findings identify that adolescents in addiction recovery face several challenges, including stigmatisation, social isolation, self-doubt, and difficulties accessing and maintaining treatment. The findings also point out that supportive relationships, culturally sensitive treatment approaches and interventions to combat self-stigma can play a critical role in promoting resilience and recovery for adolescents in recovery.

Conclusion: The comprehensive review brings us up to speed on the challenging experiences young people recovering from addiction in different addiction intervention go through, it underscores the importance of supportive relationships and encourages strengthening of interventions that mitigate against stigmatization.

Sarah C. Haynes^1,2*, James P. Marcin^1,2, Peter Yellowlees³, Stephanie Yang¹, Jeffrey S. Hoch^4,5

¹Department of Pediatrics, University of California Davis, Sacramento, California, USA

²Center for Health and Technology, University of California Davis, Sacramento, California, USA

³Department of Psychiatry, University of California Davis, Sacramento, California, USA

⁴Department of Public Health Sciences, University of California Davis, Sacramento, California, USA

⁵Center for Healthcare Policy and Research, University of California Davis, Sacramento, California, USA

Background: People living in rural communities experience significant barriers accessing mental health care, including a shortage of psychiatrists and other behavioral health specialists. Telemedicine has the ability to improve access for these populations by allowing psychiatrists in urban settings to treat rural patients over video. However, start-up costs may hinder implementation of new tele-psychiatry programs.

Materials and Methods: We created a model to estimate the point at which tele-psychiatry would financially break even based on estimates of improved access to outpatient care for people with schizophrenia and bipolar disorder. We demonstrate how our model can be used with an example of a tele-psychiatry program serving five rural Indian Health Services clinics in California.

Results: When reimbursement for psychiatric services provided over telemedicine is relatively low compared to reimbursement for hospitalization visits, changes in the ratio of hospitalizations to telemedicine visits have very little impact on required hospitalization improvement.

Conclusions: Tele-psychiatry programs are likely to break even within the first three years when providing psychiatry services to a rural community with a scarcity of mental health services. Our findings are important because they indicate that the cost of improving access to tele-psychiatry services is likely low compared to the potential cost savings associated with reduced hospitalizations for people with severe persistent mental illness.

Elizabeth Levin^1*, Husam Aburub²

¹Department of Psychology, Laurentian University, Sudbury, Ontario, Canada

²Health Sciences North, Sudbury, Ontario, Canada

Hospital emergency departments in Ontario, have become a common place for patients with mental health problems to seek treatment. Studies report healthcare providers have limited knowledge and competency to provide optimal care for patients with mental health problems. As a result, these patients are at risk of poor hospital experiences and treatment outcomes. In addition, emergency staff report considering patients with mental health problems lower priority to other patients. This paper reviews the existing literature and examines the challenges surrounding patients with mental health problems seeking treatment in emergency rooms and how it leads to sub-optimal care. Strategies are then shared to overcome these challenges by changing emergency department experiences for mental health patients seeking treatment.

Sehrish Arshad^1*, Muhammad Afzal², Hajra Sarwar³

¹Doctors Hospital College of Nursing and Allied Health Sciences, Lahore, Pakistan

²Director Academics Faculty of Allied Health Sciences, University of Lahore, Pakistan

³University of Lahore, Pakistan

Introduction: Postpartum depression (PPD) is a major public health issue among females after giving birth to the baby, characterized by low mood, feeling of guilt and suicide. When left untreated, it has the potential for a profound negative impact on mothers, children and families. The efficacy of interpersonal psychotherapy (IPT) in addressing depression has been well-documented. However, the impact of IPT on PPD remains inadequately substantiated, particularly within the context of Pakistan, where data pertaining to its effectiveness remains limited.

Objective: The aim of study was to assess the level of depression in postpartum females and evaluate the effects of IPT on PPD among females at tertiary care hospital Lahore.

Methods: A Randomized controlled trial (RCT) was conducted at the Services Hospital Lahore from September 2021 to the same month in 2023. Subjects (n=110) were screened using the hamilton depression rating scale (HDRS) and divided equally in intervention group and control group to get eight sessions of individual based IPT versus routine care. Data was analyzed using SPSS version 21, intergroup comparison was done by Mann Whitney U test for intra group comparison Wilcoxon Signed Rank test was used, with 95% Confidence Interval (CI) and 5% level of significance. Significance of result showed with p value <0.05.

Results: Prevalence of PPD among female was observed 82%. Upon receiving IPT, females exhibited a statistically significant reduction (p<0.001) in scores indicative of mild depression, from 48 (87.3%) to 5(9.1%), as well as for moderate depression, from 7(12.7%) to 1(1.8%). Furthermore, following the IPT sessions, marked improvements were noted within the intervention group across various domains including depressed mood p<0.001, CI (0.000, 0.027), feelings of guilt p<0.001, CI (0.000, 0.027), early night insomnia p<0.008, CI (0.000, 0.043), impaired work and activities p<0.05, CI (0.072, 0.200), and insight p<0.001, CI (0.000, 0.027). Conversely, the control group did not exhibit any significant alterations in these parameters.

Conclusion: The results indicate a concerning prevalence rate of PPD among the study sample with many cases remaining undiagnosed and untreated. More positively, the study demonstrates the potential of IPT as an effective method to mitigate mild to moderate PPD. This research suggests the incorporation of IPT into therapeutic models could result in timely, potentially preventive interventions and lessen the occurrence of severe complications.

Shervin Assari^1,2,3*, Payam Sheikhattari^4,5,6

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

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

³Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA

⁴Center for Urban Health Disparities Research and Innovation, Morgan State University, Baltimore, MD, USA

⁵The Prevention Sciences Research Center, School of Community Health and Policy, Morgan State University, Baltimore, MD, USA

⁶Department of Public and Allied Health Sciences, School of Community Health and Policy, Morgan State University, Baltimore, MD, USA

Background: Exposure to stressful life events (SLEs) can upset balance and affect the healthy brain development of children and youths. These events may influence substance use by altering brain reward systems, especially the nucleus accumbens (NAc), which plays a key role in motivated behaviors and reward processing. The interaction between sensitization to SLEs, depression, and substance use might vary between male and female youths, potentially due to differences in how each sex responds to SLEs.

Aims: This study aims to examine the effect of sex on the relationship between SLEs, Nucleus Accumbens activity, and substance use in a nationwide sample of young individuals.

Methods: We utilized data from the Adolescent Brain Cognitive Development study (ABCD), a longitudinal study of pre-adolescents aged 9–10 years, comprising 11,795 participants tracked over 36 months. Structured interviews measuring SLEs were conducted using the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS). Initial linear regression analyses explored if SLEs could predict volumes of the right and left NAc. Subsequently, Cox regression models were used to investigate how SLEs and NAc volume might predict the initiation of tobacco and marijuana use, with the analysis stratified by sex to address potential sex differences.

Results: Our findings reveal that SLEs significantly predicted marijuana use in males but not in females, and tobacco use was influenced by SLEs in both sexes. A higher number of SLEs was linked with decreased left NAc volume in males, a trend not seen in females. The right NAc volume did not predict substance use in either sex. However, volumes of both the right and left NAc were significant predictors of future tobacco use, with varying relationships across sexes. In females, an inverse relationship was observed between both NAc volumes and the risk of tobacco use. In contrast, a positive correlation existed between the left NAc volume and tobacco and marijuana use in males, with no such relationship for females.

Conclusion: This study underscores that the associations between SLEs, NAc volume, and subsequent substance use are influenced by a nuanced interplay of sex, brain hemisphere, and substance type.

Shervin Assari^1,2*, Babak Najand³, Payam Sheikhattari^4,5,6

¹Department of Internal 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

³Marginalization-related Diminished Returns Center, Los Angeles, CA, USA

⁴Center for Urban Health Disparities Research and Innovation, Morgan State University, Baltimore, MD, USA

⁵The Prevention Sciences Research Center, School of Community Health and Policy, Morgan State University, Baltimore, MD, USA

⁶Department of Behavioral Health Science, School of Community Health and Policy, Morgan State University, Baltimore, MD, USA

Background: While adversities across domains of finance, race, family, and life may operate as risk factors for initiation of substance use in adolescents, the influence of these factors may vary across racial groups of youth. Unfortunately, the existing knowledge is minimal about racial differences in the types of adversities that may increase the risk of subsequent substance use initiation during the transition into adolescence.

Aim: To compare racial groups for the effects of adversities across domains of finance, race, family, and life on subsequent substance use initiation among pre-adolescents transitioning into adolescence.

Methods: In this longitudinal study, we analyzed data from 6003 non-Latino White and 1562 non-Latino African American 9-10-year-old children transitioning into adolescence. Data came from the Adolescent Brain Cognitive Development (ABCD) study. Participants were followed for up to thirty-six months as they transitioned to adolescence. The independent variables were adversities related to the domains of finance, race, family, and life. The primary outcomes were time to first tobacco or marijuana use. Age, puberty, and gender were confounders. Cox regression models were used for data analysis.

Results: For White youth, tobacco use was under influence of having two parents in the household (HR = .611; 95% CI = .419-.891), parental education (HR = .900; 95% CI = .833-.972), household income (HR = .899; 95% CI = .817-.990), racial stress (HR = 1.569; 95% CI = 1.206-2.039), and life stress (HR =1.098 ; 95% CI = 1.024-1.178) and marijuana use was under influence of neighborhood income (HR = .576; 95% CI = .332-.999) and financial stress (HR =4.273; 95% CI = 1.280-17.422). No adverse condition predicted tobacco or marijuana use of African American youth.

Conclusion: The effects of adversities on substance use depend on race. While various types of adversities tend to increase subsequent initiation of tobacco and marijuana, such factors may be less influential for African American adolescents, who experience more of such adversities. What is common may become normal.

Sheldon X. Zhang¹, Rumi Kato Price^2*

¹School of Criminology and Criminal Justice Studies, University of Massachusetts at Lowell, Lowell, Massachusetts, USA

²Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA

The global campaign against human trafficking, also known as trafficking in persons, has gained much momentum in the past two decades. Although psychiatric and physical illness sequela of human trafficking are well documented, the research community continues to struggle over such foundational questions as what specific activities or experiences count as trafficking-in-persons victimization and how best to obtain representable and generalizable data on experiences of people who are trafficked. We provide a brief review of major efforts to define trafficking in persons to establish prevalence estimates to date. We argue for consensus on key clinical and public health indicators, resembling the Diagnostic and Statistical Manual (DSM) approach to enable common and systematic knowledge building and comparability across studies.

Rifath Ara Alam Barsha¹, Babak Najand², Hossein Zare^3,4, Shervin Assari^5,6,7*

¹School of Community Health & Policy, Morgan State University, Baltimore, MD, USA

²Marginalization Related Diminished returns, Los Angeles, CA, USA

³Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA

⁴University of Maryland Global Campus, Health Services Management, Adelphi, Maryland, USA

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

⁶Department of Internal Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA

⁷Department of Urban Public Health, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA

Objectives: Although educational attainment is a major social determinant of health, according to Marginalization-related Diminished Returns (MDRs), the effect of education tends to be weaker for marginalized groups compared to the privileged groups. While we know more about marginalization due to race and ethnicity, limited information is available on MDRs of educational attainment among US immigrant individuals.

Aims: This study compared immigrant and non-immigrant US adults aged 18 and over for the effects of educational attainment on subjective health (self-rated health; SRH).

Methods: Data came from General Social Survey (GSS) that recruited a nationally representative sample of US adults from 1972 to 2022. Overall, GSS has enrolled 45,043 individuals who were either immigrant (4,247; 9.4%) and non-immigrant (40,796; 90.6%). The independent variable was educational attainment, the dependent variable was SRH (measured with a single item), confounders were age, gender, race, employment and marital status, and moderator was immigration (nativity) status.

Results: Higher educational attainment was associated with higher odds of good SRH (odds ratio OR = 2.08 for 12 years of education, OR = 2.81 for 13-15 years of education, OR = 4.38 for college graduation, and OR = 4.83 for graduate studies). However, we found significant statistical interaction between immigration status and college graduation on SRH, which was indicative of smaller association between college graduation and SRH for immigrant than non-immigrant US adults.

Conclusions: In line with MDRs, the association between educational attainment and SRH was weaker for immigrant than non-immigrant. It is essential to implement two sets of policies to achieve health inequalities among immigrant populations: policies that increase educational attainment of immigrants and those that increase the health returns of educational attainment for immigrants.

Loren Henderson^1*, Ruby Mendenhall², Meggan J Lee³

¹The School of Public Policy, University of Maryland, Baltimore County, Baltimore, MD, USA

²Department of Sociology, Department of African American Studies, Carle Illinois College of Medicine, IL, USA

³Carle Illinois College of Medicine, Urbana, IL, USA

Shervin Assari^1,2,3*, Babak Najand⁴, Alexandra Donovan¹

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

²Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA

³Department of Urban Public Health, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA

⁴Marginalization related Diminished Returns Center, Los Angeles, CA, USA

Background: Racism is shown to diminish the protective effects of family socioeconomic position (SEP) resources for racial minorities compared to the majority groups, a pattern called minorities’ diminished returns. Our existing knowledge is minimal about diminished returns of family SEP indicators on reducing exposure to adverse life events among children transitioning into adolescence. Aim: To compare diverse racial groups for the effects of family income and family structure on exposure to adverse life events of pre-adolescents transitioning to adolescence.

Methods: In this longitudinal study, we analyzed data from 22,538 observations belonging to racially diverse groups of American 9–10-year-old children (n = 11,878) who were followed while transitioning to adolescence. The independent variables were family income and family structure. The primary outcome was the number of stressful life events with impact on adolescents, measured by the Life History semi-structured interview. Mixed-effects regression models were used for data analysis to adjust for data nested to individuals, families, and centers.

Results: Family income and married family structure had an overall inverse association with children’s exposure to adverse life events during transition to adolescence. However, race showed significant interactions with family income and family structure on exposure to adverse life events. The protective effects of family income and married family structure were weaker for African American than White adolescents. The protective effect of family income was also weaker for mixed/other race than White adolescents.

Conclusion: While family SEP is protective against children’s exposure to adverse life events, this effect is weaker for African American and mixed/other race compared to White youth.

Kaishi Imatani¹, Takeshi Inoue^2*, Yuji Oto¹, Tasuku Kitajima², Ryoko Otani², Satoshi F Nakashima³, So Kanazawa⁴, Masami K. Yamaguchi⁵, Ryoichi Sakuta², Tomoyo Matsubara¹

¹Department of Pediatrics, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan

²Child Development and Psychosomatic Medicine Center, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan

³Department of Psychological Sciences, University of Human Environments, Okazaki, Aichi, Japan

⁴Department of Psychology, Japan Women’s University, Kawasaki, Kanagawa, Japan

⁵Department of Psychology, Chuo University, Hachioji, Tokyo, Japan

Developmental prosopagnosia is a disorder of facial recognition that begins during early childhood in the absence of acquired central nervous system disease. We report the case of a 15-year-old female with developmental prosopagnosia as measured by the 20-item Prosopagnosia Index and Cambridge Face Memory Test who ultimately developed generalized anxiety disorder and depression despite relatively normal social and psychological function during early childhood. In elementary school, the case patient adapted by learning alternative ways to identify others, such as by clothing and hairstyle, but this became more difficult in junior high school due to the requirement for school uniforms and regulations on hairstyle. This difficulty in turn led to interpersonal problems that ultimately resulted in symptoms of generalized anxiety disorder and depression, such as headache and sleep dysfunction. People with developmental prosopagnosia are generally prone to having depressed and anxious feelings. However, to the best of our knowledge, this is the first case report of anxiety disorder or depression related to developmental prosopagnosia. This comorbidity may be relatively common, especially in ethnically homogeneous countries with strict school regulations on personal appearance such as Japan.

Seth Davin Norrholm^1,2*, Jessica L. Maples-Keller³, Barbara O. Rothbaum³, Chad C. Tossell²

¹Neuroscience Center for Anxiety, Stress, and Trauma, Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan, USA

²Department of Behavioral Sciences and Leadership, United States Air Force Academy, Colorado Springs, Colorado, USA

³Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA

The use of remote piloted aircraft (RPAs) has been a part of military operations for decades and this type of service can present its own unique constellation of combat experiences and psychological consequences. The RPA crewmember experience has typically involved surveillance, targeting, striking, and after-battle assessments of individuals of interest to a host country or agency from a distance that can span several thousand miles. These operators are engaged in physically remote activities that carry a significant degree of intimacy due to the live, high-resolution, high-fidelity images and sounds that are available to the combatants in real-time. The potential psychological consequences of this type of military occupational specialty can include the symptoms of depression, anxiety, and posttraumatic stress disorder (PTSD) as well as moral injury, mental exhaustion or burnout, and disturbed sleep. The following narrative review examines the current state of RPA warfare from a psychological trauma perspective with an emphasis on the evolution of the inherent technology, the operator force, the psychological experiences and consequences of this type of service, and potential preventative interventions for servicemembers. A key objective of this narrative review is to integrate the available peer-reviewed empirical data, experiential military perspectives and analyses, clinician observations from this unique population, and exemplar reports from those with lived experience on an RPA crew regarding psychological consequences of this military occupational specialty.

Hannah Ali^*, Steve Joordens

Department of Psychology, University of Toronto Scarborough, Toronto, ON, Canada

Research suggests that staying connected with people is very beneficial to our physical and mental well-being. Moreover, a lack of social connection is associated with poor mental and physical health, and lower overall well-being. For individuals with social anxiety, it is particularly difficult to cultivate social connections. Due to the prolonged period of social isolation during the COVID-19 pandemic, research suggests that social anxiety in university students has increased. This study employed a convergent parallel mixed method design and administered a self-reported questionnaire which included quantitative and qualitative questions. The questionnaire was administered to 301 undergraduate students to determine if feelings of social anxiety in students changed during and after the pandemic. This study also analyzed social anxiety levels across racial and ethnocultural demographics and assessed the cultural stigmas and barriers that may prevent students from accessing mental health services. Results from the quantitative analyses showed a significant difference in social anxiety scores before and after the pandemic. However, in our sample, feelings of social anxiety post-pandemic did not differ across race, or income which were our main variables of interest. In addition, there was a positive correlation between social anxiety scores and household income and fear of negative evaluation. The qualitative results showed that important barriers to accessing mental health services include fear of parents learning they are in therapy, cost of mental health services, language barriers, and concern that a therapist would not have cultural sensitivity. This study highlights the need for increased interventions to reduce social anxiety among students, and proposes a preventative approach we refer to as “Life-Skills Training” to address social anxiety.

Benjamin E. Caldwell

California State University Northridge, CA, USA

The developers of clinical exams for US mental health licensure have faced significant recent criticism and calls for their exams to be paused or discontinued.^1,2 Critics cite concerns over exams lacking evidence of validity, while they demonstrate strong evidence of racial and ethnic bias. Developers, in turn, argue that their exams are developed using accepted methods that conform with industry standards, specifically, the Standards for Educational and Psychological Testing.³

This manuscript challenges that assertion. Based on external research as well as developers’ own statements and publications, clinical exams for US mental health care licensure appear to deviate in important ways from both the letter and the spirit of the Standards. Clinical exams should be paused unless and until they are shown to be fair, equitable, valid, and more fully consistent with industry norms.

Swati Y Bhave^*, Jill N Mota, Latika Bhalla, Shailaja Mane, Anuradha Sovani, Surekha Joshi

Association of Adolescents and Child Care in India (AACCI), India

The Association of Adolescents and Child Care in India (AACCI) conducts multicentric studies on youth behavior in India. Using openly accessible psychometric tools, the present study discusses the demographic-wise interrelationships between the Children’s Perceived Self-Control (PSC), Martin-Larsen Approval Motivation (AM), and Friedben’s Test Anxiety Scales (FTAS) administered to 712 students (Group-1: 10-14 yrs.; Group-II: 15-18 yrs.) from two Delhi-based schools. The survey-questionnaire included four demographic variables: age, gender, sibling status, and body mass index. Although mainstream literature has uniformly contented in favour of the benefits of PSC, one-way ANOVAs in the present study revealed that high PSC was associated with significantly high AM (F[2,709] =3.033, p =0.049), suggesting that people with high PSC may diligently weigh short- and long-term consequences, choosing behaviors that best align with their interests and enduringly valued goals. Further, this relationship was statistically significant for participants in the no siblings (p =0.005) and underweight groups (p =0.031). Participants with high PSC had the lowest FTAS scores; however, this relationship was not statistically significant. Lastly, AM and FTAS were negatively correlated (r =-0.216, p<0.01), especially for females, Group-II, and participants with siblings (r =-0.278, -0.292, and -0.244, respectively), clarifying distinct differences between AM and FTAS’ subscales. The implications of findings were shared with the school management to conduct customized interventions using the WHO’s Life Skills Education framework. The findings highlight the need for time-series interventional analysis to ascertain the direct and cumulative effects of intervention on the interrelationships between PSC, AM, and FTAS.

Simon Riches^1,2,3*, Deanna Fallah^3,4, Ina Kaleva⁵

¹Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom

²Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom

³South London and Maudsley NHS Foundation Trust, London, United Kingdom

⁴School of Psychology, University of Surrey, Surrey, United Kingdom

⁵Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom

Sarah Bagherzadeh Jalilvand^*, Sedigheh Ahmadi

Department of Psychology and Educational Sciences, Kharazmi University, Tehran, Iran

Adolescence is a critical period marked by significant changes in social relationships and emotional development. In light of the importance of promoting mental health in this age group, this study aimed to investigate the effectiveness of a mentalization-based treatment intervention on mindfulness and perceived social support among female adolescents aged 12-15 years in Tehran.

A pretest-posttest control group design was employed, with participants randomly assigned to either the intervention group, which received the mentalization-based treatment, or the control group, serving as a comparison for evaluating the intervention's effectiveness. The Mindful Attention Awareness Scale (MAAS) and the Multidimensional Scale of Perceived Social Support Questionnaire (MSPSS) were used to measure mindfulness and perceived social support, respectively.

The mentalization-based treatment intervention focused on enhancing the participants' ability to understand and interpret their own and others' mental states, fostering empathy, and improving interpersonal relationships.

Data analysis was performed using Multivariate Analysis of Covariance (MANCOVA) to assess the impact of the mentalization-based treatment on mindfulness and perceived social support in female adolescents. The results indicated a significant improvement in both mindfulness and perceived social support after the intervention (P < 0.01).

In conclusion, the findings suggest that mentalization-based treatment holds promise as an effective approach to enhance mental health outcomes, particularly in promoting mindfulness and perceived social support in female adolescents. Future attention should be given to the implementation of this intervention to support the well-being of adolescents during this critical developmental stage.

Shervin Assari^1,2,3,4*, Babak Najand⁵

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

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

³School of Nursing, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA

⁴Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA

⁵Marginalization-Related-Diminished Returns (MDRs) Center, Los Angeles, CA, USA

Background: This cross-sectional study aimed to investigate the complex interplay between socioeconomic status (SES), internal and external health locus of control, and body mass index (BMI) in a national sample of US adults. Given the unique challenges faced by Black individuals, it was hypothesized that the relationships between SES, internal and external health locus of control, and BMI would be weaker for Blacks compared to Whites.

Methods: For this cross-sectional study, baseline data from the MIDUS Refresher sample, consisting of US adults, were analyzed. SES indicators such as income and education were examined as predictors of internal and external health locus of control. The analyses were conducted overall without and with race interactions. We also ran models within different racial groups.

Results: Overall, 3198 participants entered our analysis who were White or Black. From this number, 2925 (91.5%) were White and 273(8.5%) were Black. In the pooled sample, high education and income were linked to higher internal and lower external health locus of control and lower BMI. The study revealed that the relationships between high SES indicators (income and education), internal health locus of control, and BMI were weaker for Black than White individuals. The study revealed that the relationships between high SES indicators (income and education) and external health locus of control was stronger for Black than White individuals.

Conclusion: This study provides evidence for the complex interrelationships between SES, health locus of control, and BMI, while highlighting the role of race as a moderating factor. The findings suggest that the effects of SES on internal health locus of control is influenced by race, with weaker relationships observed among Black individuals compared to Whites.

Marilyn M. Bartholmae^1,2*, Joshua, M. Sill³, Matvey V. Karpov¹, Sunita Dodani^1,4

¹EVMS-Sentara Healthcare Analytics and Delivery Science Institute, Norfolk, VA, USA

²Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Norfolk, VA, USA

³Division of Pulmonology, Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA

⁴Division of Cardiology, Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA

Background: The variation of COVID-19 illness is not fully understood. There is a need for further identification of predictors for COVID-19-related health outcomes, which may improve the delivery of healthcare. The primary objective was to identify whether anxiety/depression symptoms are associated with the number of COVID-19 symptoms. The second objective was to examine differences in anxiety and depression symptoms between individuals with or without COVID-19 symptoms.

Methods: 782 Virginians ages 18 to 87 years, enrolled from March to May 2021 and were followed-up for six months. Vibrent Health online platform was used to collect data. PHQ-9, GAD-7, and CDC's COVID-19 tracing form, were used to assess depression, anxiety, and COVID-19 symptoms, respectively. An MMRM test was used to examine whether anxiety and depression symptoms were associated with the number of COVID-19 symptoms. Age, race, sex, medical diagnoses, and COVID-19 related economic/social hardships were included as covariates. Mann-Whitney U tests were used to assess differences in anxiety/depression at all study time points. We conducted analyses using SAS 9.4, p-values < .05 were considered significant.

Results: Depression/anxiety symptoms, COVID-19 related economic/social hardships, and medical diagnoses, were significantly associated with the number of COVID-19 symptoms (p<.05), whereas age, sex, and race were not (p>.05). Overall, PHQ9 and GAD7 scores were consistently and significantly higher for individuals with COVID-19 symptoms than those without COVID-19 symptoms (p<.05).

Conclusions: The severity of depression and anxiety symptoms is linked to symptoms of COVID-19 over time. Physical and mental health integrated healthcare approaches may be necessary. Further investigation into causative mechanisms is needed.

Margaret A. Sinkler^1*, Amir H. Karimi², Mohamed E. El-Abtah², John E. Feighan¹, Ethan R. Harlow¹, Heather A. Vallier²

¹University Hospitals, Case Western Reserve University, Cleveland, OH, USA

²Case Western Reserve University School of Medicine, Cleveland, OH, USA

Studies have demonstrated that depression, anxiety, negative mood, and pain catastrophizing influence outcomes following total hip, knee, and shoulder arthroplasty thus providing evidence-based counseling on expected postoperative outcomes. The purpose of this review is to establish the prevalence of mental health conditions, impact of mental health conditions on patient-reported outcome measures, and the impact on length of stay and discharge disposition in patients undergoing total ankle arthroplasty (TAA). An online search utilizing the Cochrane Central Register of Controlled Trials, PubMed, Google Scholar, and CINAHL databases was performed to identify relevant articles published between 2010 and 2022. Seven studies were included in the systematic review. Depression was the most common mental health comorbidity with a pooled prevalence of 12.9%. Mental health comorbidities were associated with inferior patient reported outcomes measures. Additionally, depression was a pre-operative predictive factor in poor outcomes when utilizing the PROMIS score. The presence of a mental health comorbidity demonstrated an increased risk of nonhome discharge, length of stay, complication rate, infection, and narcotic use. Psychiatric comorbidities, particularly depression, were predictors of negative postoperative outcomes. This review reinforces the significant impact of mental health disorders and psychiatric comorbidities on clinical outcomes following TAA.

Level of Evidence: Level III

Watson Kemper¹, Katie Ben-Judah², Akamu J. Ewunkem³, Uchenna B. Iloghalu^2*

¹Department of Biology, North Carolina A & T State University, Greensboro, NC, USA

²Department of Biology, Guilford College, Greensboro, NC, USA

³Department of Biological Sciences, Winston-Salem State University, Winston-Salem, NC, USA

COVID-19 has had lasting impacts on the physical and mental health of the global community. These impacts are multifaceted and spring from a range of physiological, psychological, economic origins. This review sought to demonstrate evidence of the damaging consequences that COVID-19 and its related effects have had on mental health. The findings showed significant increases in numbers of individuals seeking mental health care, experiencing negative mental health symptoms, and opting for medication management of mental health symptoms. In this review, we explore logistical aspects of both present and prospective zoonotic disease spillover events, as this information is key to mitigating future pandemic events. Furthermore, we summarize current knowledge of the impact of COVID-19 on mental health of the populations of Western countries such as the United States, the United Kingdom, and Italy. Moreover, we discuss the influence of racial disparities in delivery of healthcare in the United States and their effects on the quality of, access to, and awareness of mental health care. Our awareness of these issues has the potential to inform further research, aid, and funding to the populations where it is most needed. Finally, we make recommendations for the direction of further research based on the findings of this article.

Sean Lynch^1,2, Faris Katkhuda^2,3, Lidia Klepacz^2,4, Eldene Towey^2,4, Stephen J. Ferrando^2,4*

¹Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, NY, USA

²Department of Psychiatry and Behavioral Sciences, New York Medical College, School of Medicine, NY, USA

³Department of Psychiatry, Boston Medical Center, Massachusetts, USA

⁴Department of Psychiatry, Westchester Medical Center Health Network, Behavioral Health Center, NY, USA

Despite public interventions, the rate of opioid use disorder (OUD) continues to rise. In this focused review of the existing literature, the authors describe how increases in OUD, as well as opioid-related deaths, have occurred disproportionately among people of color. Black patients in particular are dying of overdose at an increased rate, however are less likely to receive any treatment for OUD. Additionally, Black patients are less likely to receive buprenorphine than White patients, but more likely to receive methadone. Potential causes of these disparities are discussed, as well as the impact of the COVID-19 pandemic, and the successes of several pilot programs.

Asuka Suzuki¹, Kazue Yamaoka¹*, Mariko Inoue¹, Toshiro Tango^2,1

¹Teikyo University Graduate School of Public Health, Tokyo, Japan

²Center for Medical Statistics, Tokyo, Japan

Background: Suicide mortality in Japan has declined over a period of more than 10 years, however, differences in longitudinal trajectories at a regional level are not well characterized. Objective was to clarify the longitudinal suicide mortality trajectories at the regional level in Tokyo from 2011 to 2021 by considering spatial smoothing, before and during the COVID-19 pandemic.

Methods: This longitudinal cross-sectional analysis used fifty-four regions in Tokyo, Japan. Suicide mortality trends used data from the Cabinet Office of the Japanese government from 2011 to 2021. Regional social and environmental characteristics were used as 10 covariates. Empirical Bayes estimates for the standardized mortality ratio were obtained. A conditional autoregressive (CAR) model was applied to capture the spatial correlation for a crude and adjusted with 10 covariates using OpenBUGS. Spatial clusters were also identified by FlexScan, SaTScan, and Tango’s test.

Results: Longitudinal trajectories for both males and females were similar to a decreasing trend in all Japan until 2019. In 2020, the beginning of the COVID-19 pandemic, the age-specific suicide deaths were the highest among those in their 20s. However, those were the highest among males in their 50s in 2021. The results of the CAR models adjusted for 10 covariates detected several regions as having higher suicide rates, but those regions were somewhat varied.

Conclusion: During the COVID-19 pandemic, both sexes in their 20s and males in their 50s showed a tendency toward an increase in suicides. The detected regions by spatial epidemiology varied with sex.

Heather Boagey^1,2, Jasleen K. Jolly^1,3,4, Anne E. Ferrey^5*

¹Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK

²School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK

³Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK

⁴Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, UK

⁵Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK

A diagnosis of conditions leading to vision loss can be devastating and often impacts mental health. Understanding this allows us to consider what provisions might help those who are impacted. We undertook 18 semi-structured interviews with patients diagnosed with eye disease leading to vision loss to explore its psychological impact. Participants also completed the Beck Depression Inventory (BDI), providing a snapshot of their depression and anxiety levels at the time of interview. NVivo-12 software (QSR International Ltd, Burlington, Massachusetts, USA) was used to inductively analyse and code data to identify themes related to the psychological impact. Participants had a mean BDI score of 9.6, and thematic analysis generated five key themes and associated subthemes. Coming to terms with the diagnosis included discussion of subthemes of “denial” and moving towards “acceptance”. Effects on mental health included depression/low mood, anxiety, and stress-related worsening of vision. Loss included various losses following initial loss of vision. Effects on identity included facing a curtailed life, worry that visual impairment might define a person’s identity, and feelings of frustration with their own loss of function and with others’ reactions to their disability. The future included thoughts about long-term consequences, both negative and positive (e.g., maximizing experiences given the vision one has left). Although such a diagnosis will nearly always have a psychological impact and require work to move toward acceptance, support could mitigate impact on mental health, such as practical support (e.g., advice on low vision aids), and psychological support.