The COVID-19 pandemic is expected to increase suicidal behavior. However, data available to date are inconsistent. This study examines suicidal thoughts and behaviors and suicide trends in 2020 ...relative to 2019 as an approximation to the impact of the pandemic on suicidal behavior and death in the general population of Catalonia, Spain. Data on suicide-related thoughts and behaviors (STBs) and suicidal mortality were obtained from the Catalonia Suicide Risk Code (CSRC) register and the regional police, respectively. We compared the monthly crude incidence of STBs and suicide mortality rates of 2020 with those of 2019. Joinpoint regression analysis was used to assess changes in trends over time during the studied period. In 2020, 4,263 consultations for STBs and 555 suicide deaths were registered in Catalonia (approx. 7.5 million inhabitants). Compared to 2019, in 2020 STBs rates decreased an average of 6.3% (incidence rate ratio, IRR=0.94, 95% CI 0,90–0,98) and overall suicide death rates increased 1.2% (IRR=1.01, 95% CI 0.90–1.13). Joinpoint regression results showed a substantial decrease in STBs rates with a monthly percent change (MPC) of -22.1 (95% CI: -41.1, 2.9) from January-April 2020, followed by a similar increase from April-July 2020 (MPC=24.7, 95% CI: -5.9, 65.2). The most restrictive measures implemented in response to the COVID-19 pandemic reduced consultations for STBs, suggesting that the “stay at home” message may have discouraged people from contacting mental health services. STBs and mortality should continue to be monitored in 2021 and beyond to understand better the mid-to-long term impact of COVID-19 on suicide trends.
Introduction
Suicide is a leading cause of preventable death in the world. Interventions that can
quickly reach a large and geographically dispersed population are needed. Web-based programs
are ...potentially cost-effective, allowing continuity of care. The iFightDepression-SURVIVE
(iFD-Survive) is a web-based program designed as an add-on to iFightDepression, a tool
developed by the European Alliance Against Depression to target depressive symptoms
(https://ifightdepression.com/en/). iFD-Survive is based on dialectical behavioral therapy
skills and includes four modules: a safety plan, mindfulness, emotion regulation, and
distress tolerance. The content is presented in various formats, including audio, videos, and
registers. In addition, weekly telephone support is offered by a mental health
nurse.
Objectives
To investigate the feasibility (acceptability, usability, and satisfaction) of the
iFD-Survive.
Methods
30 participants who received the intervention as part of a large RCT completed an
online survey. To receive the intervention, participants needed to meet the following
criteria: 1) digital literacy, 2) having attempted suicide in the last month, and 3) PHQ-9
scores above 5. The online survey included an ad-hoc questionnaire to collect
socio-demographic data and data regarding participants’ opinions on the program’s content.
The following instruments were also administered:
System Usability Scale (SUS)
Credibility of analogue of therapy rationales
Results
Most respondents were women (20/30), with a mean age of 44 years, and secondary
studies (15/30). Most participants (57%) used a mobile phone to access the website and
regarded it as “easy to use” (53%). According to the SUS, many of them (57%) reported that
they would like to use it frequently and that the tool was “easy” and “safe” to use (53%).
Regarding acceptability, 47% of the sample indicated that the iFD-Survive content was
adequate to improve their symptoms, and 56% considered that their symptoms of depression have
improved as a result of the intervention. 83% of the sample considered telephone follow-up
“very useful.” The majority (70%) consulted the program once a week. The “safety plan” and
the mindfulness module were regarded as the most useful, followed by “distress tolerance.”
The audio for practicing mindfulness skills and the written material were considered very
useful, while the videos were valuable.
Conclusions
Online tools can promote continuity of care, helping to prevent further suicide
attempts in vulnerable populations. These preliminary findings suggest that the iFD-Survive
is feasible among participants with depressive symptoms who have recently attempted suicide.
However, these results are based on a small sample of highly educated women; therefore,
future research is needed to determine if these can be transferred to other
sub-populations.
Disclosure of Interest
None Declared
Objective
This article reviews psychological therapies in the treatment of bipolar disorder, in particular psychoeducation, and how the inclusion of four fundamental principles – patient/therapist ...communication, flow of information, patient involvement and a trusting relationship – can improve patient outcomes.
Method
The content of this article is based on the proceedings of a 1‐day standalone symposium in November 2011 exploring how to establish a bipolar clinic within the context of existing services in the UK's National Health Service.
Results
Certain psychological interventions have emerged as beneficial add‐on treatments to pharmacotherapy in bipolar disorder and are associated with greater stabilisation of symptoms, fewer relapses and longer time to relapse. Psychoeducation is a simple approach to support prevention of future episodes by delivering behavioural training to improve illness insight, early symptom identification and development of coping strategies. Empowering patients to actively participate in their treatment provides independence, counteracts the current disconnect of therapist and patient, and increases awareness and understanding of the challenges of living with and treating bipolar disorder.
Conclusion
Psychoeducation enables patients to understand bipolar disorder, get actively involved in therapy planning, and be aware of methods for episode prevention, therefore effectively contributing to improved treatment outcomes and patient quality of life.
Objective
We examined the relationship between biological rhythms and severity of depressive symptoms in subjects with bipolar disorder and the effects of biological rhythms alterations on functional ...impairment.
Method
Bipolar patients (n = 260) and healthy controls (n = 191) were recruited from mood disorders programs in three sites (Spain, Brazil, and Canada). Parameters of biological rhythms were measured using the Biological Rhythms Assessment in Neuropsychiatry (BRIAN), an interviewer administered questionnaire that assesses disruptions in sleep, eating patterns, social rhythms, and general activity.
Results
Multivariate analyses of covariance showed significant intergroup differences after controlling for potential confounders (Pillai's F = 49.367; df = 2, P < 0.001). Depressed patients had the greatest biological rhythms disturbance, followed by patients with subsyndromal symptoms, euthymic patients, and healthy controls. Biological rhythms and HAMD scores were independent predictors of poor functioning (F = 12.841, df = 6, P < 0.001, R2 = 0.443).
Conclusion
Our study shows a dose‐dependent association between the severity of depressive symptoms and degree of biological rhythms disturbance. Biological rhythms disturbance was also an independent predictor of functional impairment. Although the directionality of this relationship remains unknown, our results suggest that stability of biological rhythms should be an important target of acute and long‐term management of bipolar disorder and may aid in the improvement of functioning.
To determine the clinical and therapeutic relevance of longitudinally predominant polarity for bipolar disorders long-term outcome.
Two hundred twenty-four patients (n=224) were enrolled for the ...study in the Bipolar Disorders Program of Barcelona, which provides integrated care for difficult-to-treat bipolar patients derived from all over Spain, but also provides clinical care to all bipolar patients coming from a specific catchment area (Eixample Esquerre) in Barcelona. Data collection regarding predominant polarity started on October 1994 and lasted for the following ten years. Patients were divided according to the predominance of depressive or manic/hypomanic episodes. The two groups were compared regarding clinical and sociodemographic variables.
135 patients (60.3%) were classified as Depressive Polarity, whilst 89 (39.7%) were considered as Manic Polarity. Manic Polarity was more prevalent amongst bipolar I patients than bipolar II. Depressive Polarity was strongly associated with depressive onset of bipolar disorder. Lifetime history of attempted suicide was strongly associated with Depressive Polarity, who also had a higher mean number of suicide attempts. As for therapeutic issues, acute and maintenance use of atypical antipsychotics and conventional neuroleptics were more common amongst Manic Polarity whilst antidepressants and lamotrigine use was highly prevalent amongst Depressive Polarity.
Prevention of depression is crucial for the maintenance treatment of bipolar II patients, whilst prevention of mania and depression would be equally important in the case of bipolar I patients. Predominant polarity is a valid prognostic parameter with therapeutic implications.
The reciprocal relationship between bipolar disorder (BD) and the family system highlights the importance of adjunctive family intervention. However, its implementation in clinical practice is not ...widespread. To update the knowledge in this field and identify areas of uncertainty this manuscript present a comprehensive overview of the bidirectional relationship between BD and family variables, and a systematic review of the evidence-based studies published up to March 2015 on the efficacy of adjunctive family intervention in BD. Findings show that not only specific family's attitudes/interactions affect the course of BD but that equally the illness itself has a strong impact on family functioning, caregivers' burden and health. Regarding family intervention, there are methodological differences between studies and variability in the sample characteristics and the intervention used. Most evidence-based studies support the efficacy of adjunctive family treatment in the illness outcomes, both in youth and adult population, as well as benefits for caregivers. The results emphasize the need to involve caregivers in the therapeutic management of BD through tailored interventions based on patients' characteristics and family needs.
•There is a mutually influential relationship between the illness and the family system.•Adjunctive family interventions seem to improve the illness outcomes and caregivers' wellbeing.•Family interventions should be tailored based on patient characteristics and family needs.•Relatives' involvement should form part of the therapeutic approach in BD.
The phenols syringaldehyde (SA), acetosyringone (AS) and
p-coumaric acid (PCA) were used as natural laccase mediators in combination with a laccase from
Pycnoporus cinnabarinus to bleach flax fibres. ...Their performance was compared with 1-hydroxybenzotriazole (HBT) in terms of enzyme stability, and pulp and effluent properties. HBT and PCA were found to inactivate laccase in the absence of pulp. However, in the presence of unbleached flax pulp stability was increased; for example with PCA, laccase retained 77% of its initial activity, in contrast with complete inactivation in the absence of pulp. This suggests a protective effect of the pulp against denaturalization of the enzyme. All natural mediators resulted in a reduced kappa number after the subsequent alkaline treatment with hydrogen peroxide; the reduction being especially marked with SA (about 2 units – with respect to the control sample) and comparable to that obtained by HBT. Brightness was significantly increased by all natural mediators, but especially by AS and SA (23% with both), which performed very similarly to HBT in this respect. Natural mediators therefore might constitute an effective alternative to synthetic mediators for flax pulp biobleaching. This paper demonstrates for the first time the use of natural mediators in the laccase-assisted delignification of flax pulp and their effect on the properties of the resulting effluents.
Flax and sisal pulps were treated with two laccases (from
Pycnoporus cinnabarinus,
PcL and
Trametes villosa,
TvL, respectively), in the presence of different phenolic compounds (syringaldehyde, ...acetosyringone and
p-coumaric acid in the case of flax pulp, and coniferaldehyde, sinapaldehyde, ferulic acid and sinapic acid in the case of sisal pulp). In most cases the enzymatic treatments resulted in increased kappa number of pulps suggesting the incorporation of the phenols into fibres. The covalent binding of these compounds to fibres was evidenced by the analysis of the treated pulps, after acetone extraction, by pyrolysis coupled with gas chromatography/mass spectrometry in the absence and/or in the presence of tetramethylammonium hydroxide (TMAH) as methylating agent. The highest extents of phenol incorporation were observed with the
p-hydroxycinnamic acids,
p-coumaric and ferulic acids. The present work shows for the first time the use of analytical pyrolysis as an effective approach to study fibre functionalization by laccase-induced grafting of phenols.
To identify evidence from comparative studies on the effects of psychoeducation programs on clinical outcomes in children and adolescents with ADHD.
Articles published between January 1980 and July ...2010 were searched through electronic databases and hand search. A qualitative systematic review of comparative studies of psychoeducation in ADHD was performed. Psychoeducation was considered if studies use a specific therapeutic program focusing on the didactically communication of information and provide patients and families with coping skills.
Seven studies were identified (four randomized-controlled trials, three uncontrolled pre-post treatment designs). Studies differed on whether psychoeducation approaches were applied to parents of ADHD children (three studies), to ADHD children/adolescents and their families (three studies) or to their teachers (one study). Positive outcomes measured as improvement on a number of different variables, including patient's behavior, parent and child satisfaction, child's knowledge of ADHD, children's opinion of the use of medication and adherence to medical recommendations were found.
Although available evidence is limited and some findings may be difficult to be interpreted, the positive role of psychoeducation and other educational interventions in children and adolescents with ADHD in regard to several outcome measures is supported by most of the literature referenced in this review.
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