All Articles

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.

Simon Xin Min Dong

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

Peptic ulcers, including duodenal and gastric ulcers, were currently considered an infectious disease caused by Helicobacter pylori. However, this etiology cannot explain the major characteristics and observations/phenomena of the disease. To address the challenge, a 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, whereas Helicobacter pylori plays a secondary role in the late phase of peptic ulceration. This etiology addresses all the characteristics, observations/phenomena, controversies, and mysteries of peptic ulcers in a series of 6 articles. This third article discusses the etiology in-depth, painting a complete picture of the pathogenesis of peptic ulcers. The early phase is a long-term abstract psychopathological process, starting from early life when the impacts of multiple psychosomatic factors are transformed into hyperplasia and hypertrophy of gastrin and parietal cells and/or negative life-views via superposition mechanism. These pre-existing abnormalities potentiate the individual’s response to current psychological stress in the intermediate phase, resulting in hypersecretion of gastric acid and/or pre-ulcer lesions. The late phase is a corrosion process caused by gastric acid, Helicobacter pylori, and/or NSAIDs, resulting in duodenal and/or gastric ulcers. This complete picture highlights the importance of past life experience in peptic ulcers and visualizes the non-causal roles of gastric acid, Helicobacter pylori, and NSAIDs. Significantly, the holistic view provided by the complete picture suggests that life phenomena and diseases are highly complex, and an advanced way of thinking is indispensable for life science and medical studies.

Simon Xin Min Dong

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

The first detailed description of the morphology of gastric ulcer was reported ~230 years ago, but the mechanism has yet to be elucidated. Moreover, peptic ulcers, including duodenal and gastric ulcers, are currently considered an infectious disease caused by Helicobacter pylori, but how the infection leads to ulceration remains elusive. To address these challenges, a recently published Complex Causal Relationship 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 the disease. This etiology explained all the characteristics and observations/phenomena of peptic ulcers in a series of 6 articles. This second article focused on the pathogenesis of gastric ulcers. Based on hereditary predisposition, the accumulation of past life experiences incurs the formation of a negative lifeview. Consequently, the individual tends to negatively evaluate themselves or current life events, leading to acute psychological stress. The psychological stress triggers the release of aberrant neurotransmitters in the central nervous system, which in turn cause the transmission of pathogenic nerve impulses to the stomach, resulting in a ‘pre-ulcer lesion’ in the gastric wall and eventually, gastric ulcer. This psychopathological model elucidated 12 characteristics and 24 observations/phenomena of gastric ulcer, along with the roles of gastric acid, Helicobacter pylori, and NSAIDs. The effectiveness suggests that theoretical research and empirical study are equally important in medical explorations, and the guiding roles of philosophy are indispensable for the major progress of life science and medicine.

Young R. Shim^1*, Rebecca Eaker¹, Junkoo Park²

¹Department of Psychology, Georgia Gwinnett College, Georgia, USA

²Department of Mathematics, Georgia Gwinnett College, Georgia, USA

Objective: The present study examined whether psychoeducational tools are beneficial in improving awareness and reducing stigma regarding mental health. This study aims to increase mental health awareness and reduce the stigma associated with mental illness.

Methods: The study is quantitative research. In this study, 147 students registered in the Abnormal Psychology course, which focuses on mental illness, were recruited. Students signed informed consent and participated in the study voluntarily. Students completed the demographic questions, Beliefs Toward Mental Illness Scale (BTMI), and Stig-9 questionnaire (stig-9).

Results: Our findings revealed a significant difference in beliefs and awareness about mental health and a decrease in stigma after students completed the Abnormal Psychology course. The statistical analysis revealed that students believe mental health is more curable and less embarrassing after taking mental health education. Finally, our findings demonstrated a direct impact of the educational experience on student attitudes toward mental health.

Conclusion: Our finding indicates that mental health education is a promising tool to raise awareness and understanding and reduce the stigma regarding mental health. Providing students with mental health education and training enabled students to learn and understand issues with mental illness. This study demonstrated a direct impact on the educational experience on student attitudes toward mental health.

Seyed-Shahab Banihashem¹, Sahar Ashrafzadeh², Mehrshad Poursaied Esfahani³, Zeinab Morsalivachin⁴, Alireza Shamsi⁵, Somaye Motazedian⁶, Mohammadreza Mousavipour^7*

¹Department of Psychosomatic Medicine, Taleghani Hospital Research Development Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran

²David Geffen School of Medicine, University of California, Los Angeles, CA, USA

³Department of Sports and Exercise Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

⁴Department of Surgery School of Medicine, Iran University of Medical Sciences. Tehran, Iran

⁵Shahid Beheshti University of Medical Sciences, Taleghani Hospital

⁶Taleghani Hospital, Department of Psychosomatic Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

⁷School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Purpose: To compare the effects of lithium and valproate on the body composition of psychiatric patients.

Methods: This prospective cohort study evaluated the effects of lithium and valproate on body composition. Twenty-eight patients with type I bipolar disorder aged 23-54 years who just had started monotherapy were recruited. Body weight, percent body fat (PBF), soft lean mass, body mass index (BMI), and total body water were measured at baseline, one month, and six months. Changes in the body composition parameters between patients taking lithium (n=14) versus valproate (n=14) were compared.

Findings: Overall mean age of study participants was 37.21 (±8) years, and 53.5% of patients were female. Average body weight gains in the first month were 1.3 kg and 2.2 kg for the lithium and valproate groups, respectively (p-value = 0.042). Mean body weight gain in the six months compared to the baseline was only 0.6 kg for the lithium group, while it was 4.3 kg for the valproate group (p-value < 0.001). The average increase in PBF at six months among patients treated with lithium versus valproate was 0.07% versus 2.2% respectively (p-value = 0.018). Patients treated with lithium had a smaller increase in their BMI in the sixth month of the study compared to the valproate group, with a mean change of 0.2 versus 2.3 kg/m², respectively (p-value = 0.019).

Conclusions: Our findings suggest that in patients with type I bipolar disorder, valproate leads to greater weight gain, BMI, and increase in PBF compared to lithium.

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