The present study investigated psychosocial predictors of psychosis-risk, depression, anxiety, and stress in Croatia two years after the onset of the COVID-19 pandemic. Given the existing ...transgenerational war trauma and associated psychiatric consequences in Croatian population, a significant pandemic-related deterioration of mental health was expected. Recent studies suggest that after an initial increase in psychiatric disorders during the pandemic in Croatia, depression, stress, and anxiety rapidly declined. These findings highlight the role of social connectedness and resilience in the face of the global pandemic. We examined resilience and psychiatric disorder risk in 377 Croatian adults using an anonymous online mental health survey. Results indicate that there was an exacerbation of all mental ill health variables, including depression, anxiety, stress, and a doubled risk for psychosis outcome post-COVID pandemic. Stress decreased levels of resilience, however, those exposed to previous traumatic experience and greater social connectedness had higher resilience levels. These findings suggest that individual differences in underlying stress sensitization of Croatian population due to past trauma may continue to influence mental health consequences two years after COVID-19 pandemic. It is essential to promote the importance of social connectedness and resilience in preventing the development of variety of mental health disorders.
•Two years after COVID-19 pandemic, there is a decline in mental health and doubled risk of psychosis.•Trauma exposure and social connectedness strongly relate to resilience and underly stress-sensitivity mechanisms in Croatia.•Social connectedness and resilience may prevent future stress and mental health disorders, including psychosis.
Cilj: Istraživanja su nedvojbeno potvrdila učinak tjelesne aktivnosti na mentalno zdravlje. Svrha ovog istraživanja je detaljno ispitati utjecaj strukturirane tjelesne aktivnosti na smanjenje ...anksioznosti i poboljšanje mentalnog zdravlja pacijenata smještenih u okviru psihijatrijskog bolničkog okruženja. Cilj istraživanja je pridonijeti boljem razumijevanju tjelesne aktivnosti kao dopunske terapijske metode u liječenju mentalnih poremećaja.Metode: Korišten je eksperimentalni dizajn ponovljenih mjerenja prije i nakon testiranja. Pacijenti u psihijatrijskoj bolnici procijenjeni su pomoću Hamiltonove ljestvice za ocjenjivanje anksioznosti (HAM-A) prije i nakon provedene strukturirane tjelesne aktivnosti. Za analizu podataka korištena je deskriptivna statistika, dok je ANOVA statistička analiza ponovljenih mjerenja primi-jenjena kako bi se testirala razlika između rezultata HAM-A prije i nakon tjelesne aktivnosti u pogledu anksioznosti i somatskih simptoma.Rezultati: 50 pacijenata iz psihijatrijske bolnice sudjelovalo je u istraživanju. Rezultati istraživanja ukazali su na statistički značajne razlike u anksioznosti i somatskim simptomima pacijenata koji su sudjelovali u strukturiranoj tjelesnoj aktivnosti, obuhva-ćajući aspekte ukupnog smanjenja anksioznosti, napetosti, depresivnog raspoloženja, kao i smanjenja somatskih simptoma.Zaključak: Ovo istraživanje pokazalo je da strukturirana tjelesna aktivnost smanjuje anksioznost te poboljšava zdravlje pacijenata u bolničkom psihijatrijskom okruženju. Integracija strukturirane tjelesne aktivnosti kao terapeutske intervencije moglo bi dopuniti postojeće metode liječenja. Daljnja istraživanja, uključujući randomizirane studije, potrebna su kako bi se procijenile koristi primjene.
Aim: Research has confirmed the impact of physical activity on mental health. The purpose of this study is to thoroughly examine the influence of structured physical activity on reducing anxiety and improving the mental health of patients in a psychiatric hospital setting. The research goal is to contribute to a better understanding of physical activity as an adjunctive therapeutic method in the treatment of mental disorders.Methods: An experimental repeated-measures design was employed before and after testing. Patients in the psychiatric hospital were assessed using the Hamilton Anxiety Rating Scale (HAM-A) before and after structured physical activity. Descriptive statistics were used for data analysis, while ANOVA repeated-measures statistical analysis was applied to test the difference between HAM-A results before and after physical activity in terms of anxiety and somatic symptoms.Results: Research results indicate statistically significant differences in patients’ anxiety, including aspects of overall anxiety, tension, and depressive mood, as well as somatic symptoms. This study confirms that structured physical activity reduces anxiety and improves the overall health of patients in stationary psychiatric hospital conditions.Conclusion: This study has demonstrated that structured physical activity reduces anxiety and enhances the health of patients in a psychiatric hospital environment. The integration of structured physical activity as a therapeutic intervention could complement existing treatment methods. Further research, including randomized studies, is needed to assess the benefits of implementation.
Contemporary medical approaches for opioid addiction often include medication-assisted therapy, utilizing methadone and buprenorphine. However, factors influencing patient preferences for starting ...buprenorphine or methadone therapy are poorly understood. This study aims to explore whether variances in personality traits and attachment styles are related to treatment preferences among individuals undergoing buprenorphine and methadone maintenance therapies. 300 participants completed the Big Five Questionnaire for personality traits and sub-dimensions and the Experiences in Close Relationship Scale for assessing attachment styles. The results indicated that patients with higher levels of Dynamism, Conscientiousness, and Perseverance personality traits were more likely to choose buprenorphine over methadone for achieving and maintaining abstinence. Although attachment styles showed a greater ability to differentiate between groups compared to personality traits, the differences were not significant. However, Conscientiousness stood out for its high discriminant validity, suggesting that scores in this personality dimension could significantly distinguish between groups, with individuals in the buprenorphine group showing higher levels of Conscientiousness compared to the methadone group. The study suggests a partial association between individuals' preference for abstinence therapy and their personality traits. These findings could be considered useful indicators when choosing maintenance therapy to help opiate-addicted patients achieve and maintain abstinence.Contemporary medical approaches for opioid addiction often include medication-assisted therapy, utilizing methadone and buprenorphine. However, factors influencing patient preferences for starting buprenorphine or methadone therapy are poorly understood. This study aims to explore whether variances in personality traits and attachment styles are related to treatment preferences among individuals undergoing buprenorphine and methadone maintenance therapies. 300 participants completed the Big Five Questionnaire for personality traits and sub-dimensions and the Experiences in Close Relationship Scale for assessing attachment styles. The results indicated that patients with higher levels of Dynamism, Conscientiousness, and Perseverance personality traits were more likely to choose buprenorphine over methadone for achieving and maintaining abstinence. Although attachment styles showed a greater ability to differentiate between groups compared to personality traits, the differences were not significant. However, Conscientiousness stood out for its high discriminant validity, suggesting that scores in this personality dimension could significantly distinguish between groups, with individuals in the buprenorphine group showing higher levels of Conscientiousness compared to the methadone group. The study suggests a partial association between individuals' preference for abstinence therapy and their personality traits. These findings could be considered useful indicators when choosing maintenance therapy to help opiate-addicted patients achieve and maintain abstinence.
Background: Investigating different approaches to operationalizing childhood adversity and how they relate to transdiagnostic psychopathology is relevant to advance research on mechanistic processes ...and to inform intervention efforts. To our knowledge, previous studies have not used questionnaire and interview measures of childhood adversity to examine factor-analytic and cumulative-risk approaches in a complementary manner.
Objective: The first aim of this study was to identify the dimensions underlying multiple subscales from three well-established childhood adversity measures (the Childhood Trauma Questionnaire, the Childhood Experience of Care and Abuse Interview, and the Interview for Traumatic Events in Childhood) and to create a cumulative risk index based on the resulting dimensions. The second aim of the study was to examine the childhood adversity dimensions and the cumulative risk index as predictors of measures of depression, anxiety, and psychosis-spectrum psychopathology.
Method: Participants were 214 nonclinically ascertained young adults who were administered questionnaire and interview measures of depression, anxiety, psychosis-spectrum phenomena, and childhood adversity.
Results: Four childhood adversity dimensions were identified that captured experiences in the domains of Intrafamilial Adversity, Deprivation, Threat, and Sexual Abuse. As hypothesized, the adversity dimensions demonstrated some specificity in their associations with psychopathology symptoms. Deprivation was uniquely associated with the negative symptom dimension of psychosis (negative schizotypy and schizoid symptoms), Intrafamilial Adversity with schizotypal symptoms, and Threat with depression, anxiety, and psychosis-spectrum symptoms. No associations were found with the Sexual Abuse dimension. Finally, the cumulative risk index was associated with all the outcome measures.
Conclusions: The findings support the use of both the empirically-derived adversity dimensions and the cumulative risk index and suggest that these approaches may facilitate different research objectives. This study contributes to our understanding of the complexity of childhood adversity and its links to different expressions of psychopathology.
We investigated how different approaches to operationalizing childhood adversity relate to transdiagnostic psychopathology.
Four childhood adversity dimensions were found to underlie multiple subscales from three well-established childhood adversity measures.
The childhood adversity dimensions demonstrated some specificity in their associations with the psychopathology symptom domains and the cumulative risk index was associated with all the outcomes.
Abstract
Background
Social impairment is a core feature of schizophrenia presenting a major barrier to recovery. Although antipsychotic medications can reduce psychotic symptoms, social functioning ...often remains poor, contributing to the financial burden of schizophrenia. Validated behavioral interventions, such as Social Skills Training (Liberman & Martin, 1988), target a broad range of social domains by practicing pragmatic living skills. But they yield only modest effect sizes for social outcome (Pfammatter et al, 2006). Conventional social interventions present further limitations including: time and effort required from patients and therapists, low adherence, lack of personalization, and low generalizability. Importantly, most people with mental illness do not currently have access to social interventions. The aim of this study was to design and implement an effective, high-compliance virtual reality (VR) social skills training game for people with schizophrenia.
Methods
The advantages of the VR environment include flexibility, controllability, extensive repertoire of stimuli, low-burden, low-cost and safety (Strickland, 1997). The goal of the training game was to support social attention to improve social skills learning. We trained social skills by exercising problem-solving in naturalistic scenarios: the grocery store, a bus stop, and a cafeteria. Subjects moved through variable steps in a social “mission” to obtain personal information through conversations with avatars. Each mission began with the participant fixating on the avatar. Subjects then had to decide which avatar to approach and choose an appropriate response to the avatar’s prompts. If they chose an incorrect response, oral feedback was provided on why this response was not the most effective, and instructed them to try again. This occurred until the participant identified the most appropriate response, thus completing the mission and getting access to the next level of difficulty. Each training session concluded after completion of 12 total conversation missions.
Eighteen individuals with schizophrenia (SZ) and twenty demographically matched controls (CO) participated in this study. At baseline, SZ and CO completed pre-training assessments. The CO group did not undergo VR training but participated in behavioral assessments so that we could compare SZ performance to normative data. SZ participated in the VR training twice a week for 5 weeks (10 sessions). After the 10th session, we re-examined social functioning, cognitive functions, and symptoms. SZ also completed a satisfaction survey upon training completion.
Results
Of the eighteen SZ participants enrolled in the study, sixteen completed the 10 sessions of training, yielding a retention rate of 89%. 80% of SZ subjects reported being “extremely satisfied” with the training. None reported not being satisfied. 93.3% rated the training as “acceptable” and the effort required to attend the study as “easy.” Regarding outcome, negative symptoms significantly decreased from pre-training to post-training. Performance on BLERT and CogState Social Emotional Cognitive Task significantly improved. The average time taken to complete a mission was significantly lower in the last session compared to the first, showing that participants became increasingly better at efficiently solving these social missions.
Discussion
These results show evidence for VR training as an acceptable and feasible intervention improving social functioning in SZ. Future work will test the adaptive social VR training against an active control condition in a pilot randomized controlled trial to evaluate the relative efficacy of the VR training on enhancing social attention and associated neural circuitry.
•Social connectedness, which typically protects against distress and the feelings of loneliness has been significantly disrupted by the COVID-19 pandemic.•Loneliness is a significant risk factor for ...mental health problems, especially psychosis.•Psychosis-risk and loneliness were significantly associated during the pandemic in the Croatian population.•Psychosis-proneness and social isolation are strongly associated with depression, anxiety, and stress.
The present study investigated psychosocial predictors of psychosis-risk, depression, anxiety, and stress in Croatia during the COVID-19 pandemic. Given Croatia's recent transgenerational war trauma and the relative lack of available prodromal data, this study presents a unique opportunity to examine the impact of loneliness and other psychosocial factors on psychosis-risk and mental health in this population. 404 Croatian participants completed an anonymous online survey of physical and mental health questions. 48 participants met the criteria for elevated psychosis-risk on prodromal questionnaire (PQ-16). Loneliness had a significant impact on psychosis-risk. Exposure to trauma was associated with psychosis-risk and loneliness, while domestic abuse/violence was associated only with the distress surrounding psychotic-like symptoms. COVID concern was also associated with psychosis-risk. Lastly, the associations between psychosis-risk and depression, anxiety, and stress were robust. These findings highlight the important role of loneliness in psychosis-proneness in Croatia. Depression, anxiety, and stress were also closely related to elevated psychosis-risk. Loneliness is a highly salient issue for individuals with psychosis and it is important to target loneliness within a multi-faceted psychosocial intervention for those at risk for schizophrenia.
The present study examined three empirically-derived childhood adversity dimensions as predictors of social, psychological, and symptom outcomes across three prospective assessments of a young adult ...sample. Participants were assessed five times over eight years with semi-structured interviews and questionnaires. The analyses used the dimensions underlying multiple subscales from well-established childhood adversity measures administered at the first two assessment waves (described in a previous report). Outcome data pertain to the last three assessment waves, with sample sizes ranging from 89 to 169. As hypothesized, the childhood adversity dimensions demonstrated overlapping and differential longitudinal associations with the outcomes. Deprivation predicted the negative (deficit-like) dimension of psychosis, while Threat and Intrafamilial Adversity predicted the positive (psychotic-like) dimension. Depression and anxiety symptoms were predicted by different childhood adversity dimensions over time. Furthermore, Threat predicted a smaller and less diverse social network, Intrafamilial Adversity predicted anxious attachment, and Deprivation predicted a smaller social network, anxious and avoidant attachment, perceived social support, and loneliness. The three adversity dimensions combined accounted for moderate to large proportions of variance in several outcomes. These results extend prior work by identifying associations of three meaningful dimensions of childhood adversity with different risk profiles across psychological, social, and psychopathological domains. The findings enhance our understanding of the impact of childhood adversity across young adulthood.
•We examined how adversity dimensions relate to psycho-social and symptom outcomes•Outcome data were collected across three prospective assessments•The dimensions had overlapping and differential longitudinal links with the outcomes•A degree of specificity was found in the prediction of psychosis symptom domains•Findings extend prior work on the utility of empirically-derived adversity dimensions
Abstract
Background
The traumagenic neurodevelopment model of psychosis poses that prolonged or severe stress exposure in critical developmental periods (i.e., childhood) disrupts psychobiological ...stress regulation mechanisms, increasing liability for the onset and persistence of psychotic symptoms after re-exposure to stressful events (Read et al., 2014). This disruption seems to result in a process of behavioral and biological sensitization by which the individual manifests an enhanced stress sensitivity to subsequent minor adversities in adulthood (Belda et al., 2015), which may cause an increased risk for psychosis. The behavioral manifestation of stress sensitization has been examined in samples at clinical risk for psychosis, but it has been scarcely studied in nonclinical populations. The first goal of the present study was to investigate whether the association between childhood trauma (CT) and perceived stress was moderated by the impact of recent life events in a nonclinical sample. The second goal was to test whether the association between CT and suspiciousness was mediated by perceived stress, and whether this mediation was moderated by the impact of life events. Following stress sensitization hypotheses, it was expected that the association between CT and suspiciousness would be mediated by higher levels of perceived stress. In turn, the impact of negative recent life events was expected to moderate the effect of CT on suspiciousness via increased levels of perceived stress.
Methods
The sample consisted of 168 Spanish nonclinical youngsters (mean age=28.01), belonging to the ongoing Barcelona Longitudinal Investigation of Schizotypy Study (BLISS). From a large pool of unselected college students, a selected subsample oversampled for schizotypy scores continues regular follow-up assessments. They were assessed for life events, perceived stress and suspiciousness at the concurrent assessment, whereas CT was assessed 7 years earlier at baseline. Linear regression and simple slope analyses were performed to test whether recent life events moderated the association between CT and suspiciousness. Moderated mediation analyses were conducted to examine the indirect effect of CT on suspiciousness via perceived stress moderated by the impact of recent life events.
Results
Recent life events significantly moderated the association between CT and perceived stress. Simple slope analyses indicated that this association was significant when subjects experienced negative or neutral life events, but not positive life events. Moderated mediation analyses revealed an indirect effect of CT on suspiciousness through perceived stress, which was moderated by the impact of recent life events. Thus, these mediational effects were significant for those subjects with a greater subjective appraisal of a negative or neutral impact of life events, but not for those experiencing a positive impact. The magnitude of the conditional indirect effect (as indicated by the Index of Moderated Mediation) was significantly different across levels of impact of recent life events (i.e., negative, neutral, positive).
Discussion
These findings provide further supporting evidence to the stress sensitization hypothesis for psychosis by showing its manifestation across both the clinical and nonclinical ranges of the hypothesized psychosis continuum. CT and perceived stress were associated when the impact of recent life events was negative or neutral, but not positive, suggesting that positive life events may play a protective role in the perception of stress and the role that stress shows in the mechanistic pathway to suspiciousness.
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