Healthcare workers exposed to coronavirus 2019 (COVID-19) patients could be psychologically distressed. This study aims to assess the magnitude of psychological distress and associated factors among ...hospital staff during the COVID-19 pandemic in a large tertiary hospital located in north-east Italy.
All healthcare and administrative staff working in the Verona University Hospital (Veneto, Italy) during the COVID-19 pandemic were asked to complete a web-based survey from 21 April to 6 May 2020. Symptoms of post-traumatic distress, anxiety and depression were assessed, respectively, using the Impact of Event Scale (IES-R), the Self-rating Anxiety Scale (SAS) and the Patient Health Questionnaire (PHQ-9). Personal socio-demographic information and job characteristics were also collected, including gender, age, living condition, having pre-existing psychological problems, occupation, length of working experience, hospital unit (ICUs and sub-intensive COVID-19 units vs. non-COVID-19 units). A multivariable logistic regression analysis was performed to identify factors associated with each of the three mental health outcomes.
A total of 2195 healthcare workers (36.9% of the overall hospital staff) participated in the study. Of the participants, 35.7% were nurses, 24.3% other healthcare staff, 16.4% residents, 13.9% physicians and 9.7% administrative staff. Nine per cent of healthcare staff worked in ICUs, 8% in sub-intensive COVID-19 units and 7.6% in other front-line services, while the remaining staff worked in hospital units not directly engaged with COVID-19 patients. Overall, 63.2% of participants reported COVID-related traumatic experiences at work and 53.8% (95% CI 51.0%-56.6%) showed symptoms of post-traumatic distress; moreover, 50.1% (95% CI 47.9%-52.3%) showed symptoms of clinically relevant anxiety and 26.6% (95% CI 24.7%-28.5%) symptoms of at least moderate depression. Multivariable logistic regressions showed that women, nurses, healthcare workers directly engaged with COVID-19 patients and those with pre-existing psychological problems were at increased risk of psychopathological consequences of the pandemic.
The psychological impact of the COVID-19 pandemic on healthcare staff working in a highly burdened geographical of north-east Italy is relevant and to some extent greater than that reported in China. The study provides solid grounds to elaborate and implement interventions pertaining to psychology and occupational health.
A number of problems do exist in current diagnostic systems (and the DSM-5 has probably even worsened the situation), and many limitations still affect the diagnostic process in psychiatry. However, ...trashing current diagnostic practices may be harmful for psychiatry's image and, more importantly, for patients.
The stigma of mental illness and the discrimination experienced by people with mental health problems has been extensively studied in many countries across several continents (Lauber & Rossler, 2007; ...Abdullah & Brown, 2011; Stith, 2011). And, as reported by the overview of Semrau et al. (2015), there are virtually no societies or cultures in which people with mental disorders are as equally valued as people who do not experience these conditions.
WHO declared that mental health care should be considered one essential health service to be maintained during the coronavirus disease 2019 (COVID-19) pandemic. This study aims to describe the effect ...of lockdown and restrictions due to the COVID-19 pandemic in Italy on mental health services' utilisation, by considering psychiatric diagnoses and type of mental health contacts.
The study was conducted in the Verona catchment area, located in the Veneto region (northeastern Italy). For each patient, mental health contacts were grouped into: (1)
, (2)
, (3)
, (4)
, (5)
. A 'difference in differences' approach was used: difference in the number of contacts between 2019 and 2020 on the weeks of lockdown and intermediate restrictions was compared with the same difference in weeks of no or reduced restrictions, and such difference was interpreted as the effect of restrictions. Both a global regression on all contacts and separate regressions for each type of service were performed and Incidence Rate Ratios (IRRs) were calculated.
In 2020, a significant reduction in the number of patients who had mental health contacts was found, both overall and for most of the patients' characteristics considered (except for people aged 18-24 years for foreign-born population and for those with a diagnosis of schizophrenia. Moreover, in 2020 mental health contacts had a reduction of 57 096 (-33.9%) with respect to 2019; such difference remained significant across the various type of contacts considered, with rehabilitation interventions and day care showing the greatest reduction. Negative Binomial regressions displayed a statistically significant effect of lockdown, but not of intermediate restrictions, in terms of reduction in the number of contacts. The lockdown period was responsible of a 32.7% reduction (IRR 0.673;
-value <0.001) in the overall number of contacts. All type of mental health contacts showed a reduction ascribable to the lockdown, except social and supportive interventions.
Despite the access to community mental health care during the pandemic was overall reduced, the mental health system in the Verona catchment area was able to maintain support for more vulnerable and severely ill patients, by providing continuity of care and day-by-day support through social and supportive interventions.
Abstract Stigma and social exclusion related to mental health are of substantial public health importance for Europe. As part of ROAMER (ROAdmap for MEntal health Research in Europe), we used ...systematic mapping techniques to describe the current state of research on stigma and social exclusion across Europe. Findings demonstrate growing interest in this field between 2007 and 2012. Most studies were descriptive (60%), focused on adults of working age (60%) and were performed in Northwest Europe—primarily in the UK (32%), Finland (8%), Sweden (8%) and Germany (7%). In terms of mental health characteristics, the largest proportion of studies investigated general mental health (20%), common mental disorders (16%), schizophrenia (16%) or depression (14%). There is a paucity of research looking at mechanisms to reduce stigma and promote social inclusion, or at factors that might promote resilience or protect against stigma/social exclusion across the life course. Evidence is also limited in relation to evaluations of interventions. Increasing incentives for cross-country research collaborations, especially with new EU Member States and collaboration across European professional organizations and disciplines, could improve understanding of the range of underpinning social and cultural factors which promote inclusion or contribute toward lower levels of stigma, especially during times of hardship.
Suicidal ideation is common among individuals with first episode psychosis (FEP), with prevalence estimates up to 56.5 %. Despite its high prevalence, relatively little is known about how ...sociodemographic, clinical and/or developmental characteristics contribute to the experience of suicidal ideation in individuals with FEP.
In this cross-sectional study (FEP n = 551 and controls n = 857), univariate logistic regression analyses were performed to study the associations of sociodemographic, clinical, and developmental factors with suicidal ideation in individuals with FEP as well as controls. Suicidal ideation was assessed using the Community Assessment of Psychic Experiences (CAPE). In addition, multivariate logistic regression analyses were conducted based on a stepwise approach.
In FEP, only depressive symptoms remained significantly associated with suicidal ideation when all correlates were integrated into one model. In the multivariate model in controls, depressive symptoms, positive symptoms, and traumatic childhood experiences were significantly associated with suicidal ideation.
This study showed that depressive symptoms are an important factor relating to suicidal ideation in individuals with FEP, over and above other clinical, sociodemographic, and developmental factors. This underscores the relevance of screening for suicidal ideation in individuals with FEP, and highlights the need for a better understanding of the diagnostic uncertainty and course of mood symptoms in early psychosis.
Cross-sectional study design, self-reported questionnaires.
Aims: People with psychosis often develop metabolic and cardiovascular diseases, due to a number of factors which include unhealthy lifestyle (low physical activity, smoking, alcohol), incorrect ...dietary habits and antipsychotic treatment. The relative weight of these factors is not yet clearly established. The present research aims to evaluate the effect of these factors on a series of anthropometric (weight, BMI) and cardio-metabolic parameters (blood pressure, heart rate, blood glucose, cholesterol, triglycerides) in a sample of First Episode Psychosis (FEP) patients. Methods: This study was conducted in the framework of the GET UP program on a sample of FEP patients (n=96) who were assessed at illness onset and at 9 months. The effect of a number of putative explanatory factors - socio-demographic variables, clinical characteristics (PANSS, GAF), dietary habits (EPIC), physical activity (IPAQ) and antipsychotic treatment - on FU levels of anthropometric and cardiovascular parameters and blood chemistry was explored. Results: At 9 months, a significant increase in both BMI (p=0.005) and cholesterol levels (p=0.011) was found in the overall sample. The increase of BMI was specifically evident in the sub group of patients with dietary patterns not in keeping with the dictates of "Mediterranean diet" (p=0.013), in those who had performed no/low physical activity during FU period (p=0.036), in those who had been taking second generation antipsychotics (p=0.002) (Wilcoxon test). Furthermore, significant increase in cholesterol levels was observed in those who had followed incorrect dietary habit (p=0.035), who had been taking second generation antipsychotics (p=0.005) and higher doses of antipsychotics, regardless the type (p= 0.012). A gender effect was also detected, with male patients showing significant increase in BMI (p=0.002) and female in cholesterol (p=0.004). Conclusion: These results proved the relevance of prevention initiatives to promote physical health in patients affected by mental illness. Specific programs are needed to minimize the metabolic effects related to unhealthy lifestyle and habits and antipsychotic treatment already in the early stages of psychosis. This should be necessarily done by a close and constant interaction between professionals belonging both to mental and physical health disciplines.
Childhood trauma has been significantly associated with first-episode psychosis, affective dysfunction and substance use.
To test whether people with first-episode psychosis who had experienced ...childhood trauma, when compared with those who had not, showed a higher rate of affective psychosis and an increased lifetime rate of substance use.
The sample comprised 345 participants with first-episode psychosis (58% male, mean age 29.8 years, s.d. = 9.7).
Severe sexual abuse was significantly associated with a diagnosis of affective psychosis (χ
= 4.9,
= 0.04) and with higher rates of lifetime use of cannabis (68%
41%;
= 0.02) and heroin (20%
5%;
= 0.02). Severe physical abuse was associated with increased lifetime use of heroin (15%
5%;
= 0.03) and cocaine (32%
17%;
= 0.05).
Patients with first-episode psychosis exposed to childhood trauma appear to constitute a distinctive subgroup in terms of diagnosis and lifetime substance use.
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