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Interactions of the CSF3R polymorphism and early stress on future orientation: evidence for the differential model of stress-related growth. CSF3R 多态性和早期压力对未来取向的相互作用:压力相关成长差异模型的证据。
IF 5.9 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-10-03 DOI: 10.1017/S2045796024000581
Yiqun Gan, Lizhong Wang, Yidi Chen, Lei Zheng, Xiaoli Wu, Gang Chen, Yueqin Hu

Aims: This study aims to explore the concept of future orientation, which encompasses individuals' thoughts about the future, goal-setting, planning, response to challenges and behavioural adjustments in evolving situations. Often viewed as a psychological resource, future orientation is believed to be developed from psychological resilience. The study investigates the curvilinear relationship between childhood maltreatment and future orientation while examining the moderating effects of genotype.

Methods: A total of 14,675 Chinese adults self-reported their experiences of childhood maltreatment and their future orientation. The influence of genetic polymorphism was evaluated through genome-wide interaction studies (GWIS; genome-wide association study [GWAS] using gene × environment interaction) and a candidate genes approach.

Results: Both GWAS and candidate genes analyses consistently indicated that rs4498771 and its linked single-nucleotide polymorphisms, located in the intergenic area surrounding CSF3R, significantly interacted with early trauma to influence future orientation. Nonlinear regression analyses identified a quadratic or cubic association between future orientation and childhood maltreatment across some genotypes. Specifically, as levels of childhood maltreatment increased, future orientation declined for all genotypes. However, upon reaching a certain threshold, future orientation exhibited a rebound in individuals with specific genotypes.

Conclusions: The findings suggest that individuals with certain genotypes exhibit greater resilience to childhood maltreatment. Based on these results, we propose a new threshold model of stress-related growth.

目的:本研究旨在探讨未来取向的概念,它包括个人对未来的思考、目标设定、规划、应对挑战以及在不断变化的情况下的行为调整。未来取向通常被视为一种心理资源,它被认为是由心理复原力发展而来的。本研究探讨了童年虐待与未来取向之间的曲线关系,同时考察了基因型的调节作用:方法:14,675 名中国成年人自我报告了他们的童年虐待经历和未来取向。通过全基因组相互作用研究(GWIS;利用基因×环境相互作用的全基因组关联研究[GWAS])和候选基因方法评估了基因多态性的影响:结果:全基因组关联研究和候选基因分析一致表明,位于CSF3R周围基因间区域的rs4498771及其相关单核苷酸多态性与早期创伤有显著的相互作用,从而影响未来取向。非线性回归分析发现,在某些基因型中,未来取向与童年虐待之间存在二次或三次关系。具体来说,随着童年虐待程度的增加,所有基因型的未来取向都会下降。然而,当达到一定临界值时,特定基因型的个体的未来取向会出现反弹:结论:研究结果表明,具有特定基因型的个体对童年虐待表现出更强的适应能力。基于这些结果,我们提出了一个新的压力相关成长阈值模型。
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引用次数: 0
Effectiveness of group problem management plus in distressed Syrian refugees in Türkiye: a randomized controlled trial. 针对土耳其叙利亚难民的小组问题管理加法的有效性:随机对照试验。
IF 5.9 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-09-30 DOI: 10.1017/S2045796024000453
C Acarturk, G Kurt, Z İlkkurşun, A M de Graaff, R Bryant, P Cuijpers, D Fuhr, D McDaid, A L Park, M Sijbrandij, P Ventevogel, E Uygun

Aims: Despite high levels of psychological distress, mental health service use among Syrian refugees in urban settings is low. To address the mental healthcare gap, the World Health Organization developed group problem management plus (gPM+), a scalable psychological intervention delivered by non-specialist peer facilitators. The study aimed to evaluate the effectiveness of gPM+ in reducing symptoms of depression and anxiety among Syrian refugees in Istanbul, Türkiye.

Methods: A randomized controlled trial was conducted among 368 distressed (Kessler Psychological Distress Scale, K10 > 15) adult Syrian refugees with impaired functioning (World Health Organization Disability Assessment Schedule, WHODAS 2.0 > 16). Participants were recruited between August 2019 and September 2020 through a non-governmental organization providing services to refugees. Participants were randomly allocated to gPM+ and enhanced care as usual (gPM+/E-CAU) (184 participants) or E-CAU only (184 participants). Primary outcomes were symptoms of depression and anxiety (Hopkins Symptom Checklist (HSCL-25)) at 3-month follow-up. Secondary outcomes were post-traumatic stress disorder (PTSD) symptoms (PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-5; PCL-5), functional impairment (WHODAS 2.0), and self-identified problems (psychological outcome profiles).

Results: Intent-to-treat analyses showed no significant effect of gPM+ on symptoms of anxiety, depression, PTSD and self-identified problems. Yet, there was a significant reduction in functional impairment in gPM+/E-CAU compared to E-CAU at 3-month follow-up (adjusted mean difference 1.66, 95 % CI 0.04, 3.27, p = 0.045, d = 0.19). Post-hoc subgroup analyses among participants with probable baseline depression or anxiety showed that there was a small but significant reduction in depression (adjusted mean difference -0.17, 95 % CI -0.32, -0.02, p = 0.028, d = 0.27) and anxiety (adjusted mean difference -0.21, 95 % CI -0.37, -0.05, p = 0.009, d = 0.30) symptoms comparing gPM+/E-CAU to E-CAU only at 1-week post assessment, but not at 3-month follow-up. There was a significant difference between conditions on functional impairment at 3-month follow-up, favouring gPM+/E-CAU condition (adjusted mean difference -1.98, 95 % CI -3.93, -0.02, p = 0.048, d = 0.26).

Conclusion: In this study in an urban setting in Türkiye, gPM+ did not alleviate symptoms of depression and anxiety among Syrian refugees experiencing psychological distress and daily living difficulties. However, participants with higher distress at baseline seemed to benefit from gPM+, but treatment gains disappeared in the long term. Current findings highlight the potential benefit of tailored psychosocial interventions for highly distressed refugees in volatile low-resource settings.

目的:尽管叙利亚难民的心理困扰程度很高,但他们在城市环境中的心理健康服务使用率却很低。为了弥补心理保健方面的不足,世界卫生组织开发了小组问题管理+(gPM+),这是一种可扩展的心理干预措施,由非专业的同伴促进者提供。本研究旨在评估 gPM+ 在减少土耳其伊斯坦布尔叙利亚难民抑郁和焦虑症状方面的有效性:在 368 名功能受损(世界卫生组织残疾评估表,WHODAS 2.0 > 16)的叙利亚成年难民中开展了一项随机对照试验(凯斯勒心理压力量表,K10 > 15)。参与者是在 2019 年 8 月至 2020 年 9 月期间通过一家为难民提供服务的非政府组织招募的。参与者被随机分配到 gPM+ 和常规强化护理(gPM+/E-CAU)(184 人)或仅 E-CAU (184 人)。主要结果是随访 3 个月时的抑郁和焦虑症状(霍普金斯症状检查表 (HSCL-25))。次要结果是创伤后应激障碍(PTSD)症状(《精神疾病诊断与统计手册-5》创伤后应激障碍核对表;PCL-5)、功能障碍(WHODAS 2.0)和自认问题(心理结果档案):结果:意向治疗分析表明,gPM+ 对焦虑、抑郁、创伤后应激障碍和自认问题的症状无明显影响。然而,与 E-CAU 相比,gPM+/E-CAU 的功能障碍在 3 个月的随访中明显减少(调整后的平均差异为 1.66,95 % CI 为 0.04,3.27,p = 0.045,d = 0.19)。对可能存在基线抑郁或焦虑的参与者进行的事后亚组分析表明,与 E-CAU 相比,gPM+/E-CAU 与 E-CAU 在评估后 1 周的抑郁症状(调整后的平均差异为 -0.17,95 % CI 为 -0.32,-0.02,p = 0.028,d = 0.27)和焦虑症状(调整后的平均差异为 -0.21,95 % CI 为 -0.37,-0.05,p = 0.009,d = 0.30)有小幅但显著的减少,但在 3 个月的随访中没有减少。在 3 个月的随访中,不同条件下的功能障碍有明显差异,gPM+/E-CAU 条件更优(调整后的平均差异为 -1.98, 95 % CI -3.93, -0.02, p = 0.048, d = 0.26):在这项在土耳其城市环境中进行的研究中,gPM+ 并未缓解叙利亚难民的抑郁和焦虑症状,他们正经历着心理困扰和日常生活困难。然而,基线时心理困扰程度较高的参与者似乎能从 gPM+ 中获益,但从长期来看,治疗效果却消失了。目前的研究结果凸显了在动荡不安的低资源环境中,为高度受困难民量身定制心理干预措施的潜在益处。
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引用次数: 0
Let's talk about recovery in mental health: an international Delphi study of experts by experience. 让我们谈谈心理健康中的康复问题:根据经验对专家进行的德尔菲国际研究。
IF 5.9 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-09-24 DOI: 10.1017/S2045796024000490
E Guerrero, M Barrios, H M Sampietro, A Aza, J Gómez-Benito, G Guilera

Aims: The concept of recovery is featured in the strategic plans of the World Health Organization as well as in other national mental health plans; however, there have been differing interpretations of what it means. This article aims to achieve a consensus on the key aspects of recovery in mental health from the perspective of movements of users and survivors of psychiatry at an international level. Four specific objectives were proposed in this study: (1) to identify what recovery in mental health means, (2) to identify the indicators that a person is progressing in their recovery, (3) to determine the factors that facilitate the recovery process, and (4) to determine the factors that hinder the recovery process.

Methods: A three-round e-Delphi study was conducted with the participation of 101 users and survivors of psychiatry, adhering to the CREDES checklist to ensure methodological rigour.

Results: The results reveal 26 key aspects that define recovery, 31 indicating that a person is progressing in their recovery process, 8 that facilitate recovery and 12 that hinder recovery. The most agreed-upon statements for defining recovery highlight the importance of empowerment, leading a fulfilling life, ensuring safe-living conditions and acknowledging individuals as holders of rights. Similarly, empowerment and agency were highly agreed upon as relevant recovery indicators. Key findings underscore the significance of a supportive and respectful social environment in facilitating recovery, while coercion, discrimination and lack of support from significant others hinder recovery.

Conclusions: Despite cultural differences and recovery's subjective nature, our results demonstrate that an international consensus on critical recovery aspects is attainable. Highlighting a significant shift, we emphasize the 'Transition' process to signify moving away from the biomedical model approach and advocating for collective rights. Our findings advocate for empowerment, users' rights and the move towards person-centred care that integrates social, political and economic contexts. These consensus statements lay the groundwork for future research across diverse regions and cultures, offering insights into recovery's meaning and potential for innovative approaches in diagnosis, intervention and evaluation.

目的:康复的概念在世界卫生组织的战略计划以及其他国家的心理健康计划中都有所体现,但对其含义的解释却不尽相同。本文旨在从国际层面上精神病学使用者和幸存者运动的角度出发,就心理健康康复的关键方面达成共识。本研究提出了四个具体目标:(1) 确定心理健康康复的含义;(2) 确定一个人在康复过程中取得进展的指标;(3) 确定促进康复过程的因素;(4) 确定阻碍康复过程的因素:方法:进行了三轮电子德尔菲研究,101 名精神病学使用者和幸存者参与了研究,研究遵循 CREDES 核对表,以确保研究方法的严谨性:研究结果显示,有 26 个关键方面定义了康复,31 个方面表明一个人在康复过程中取得了进展,8 个方面促进了康复,12 个方面阻碍了康复。在界定康复的声明中,得到最广泛认同的声明强调了赋权、过上充实的生活、确保安全的生活条件以及承认个人拥有权利的重要性。同样,赋权和代理也被高度认同为相关的康复指标。主要研究结果强调了支持和尊重的社会环境对促进康复的重要性,而胁迫、歧视和缺乏重要他人的支持则会阻碍康复:尽管存在文化差异和康复的主观性,但我们的研究结果表明,就康复的关键方面达成国际共识是可以实现的。我们强调 "过渡 "过程意味着摆脱生物医学模式的方法,倡导集体权利。我们的研究结果倡导赋权、用户权利,以及转向以人为本的护理,将社会、政治和经济背景融为一体。这些共识声明为未来跨越不同地区和文化的研究奠定了基础,为诊断、干预和评估方面的创新方法提供了对康复意义和潜力的见解。
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引用次数: 0
Obsessive-compulsive disorder and suicide: a longitudinal study in Taiwan. 强迫症与自杀:台湾的一项纵向研究。
IF 5.9 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-09-23 DOI: 10.1017/S2045796024000477
Mu-Hong Chen, Tai-Long Pan, Chih-Ming Cheng, Wen-Han Chang, Ya-Mei Bai, Tung-Ping Su, Tzeng-Ji Chen, Shih-Jen Tsai

Aims: Research evidence has established an association of obsessive-compulsive disorder (OCD) with suicidal thoughts and suicide attempts. However, further investigation is required to determine whether individuals with OCD have higher risk of death by suicide compared with those without OCD.

Methods: Of the entire Taiwanese population, between 2003 and 2017, 56,977 individuals with OCD were identified; they were then matched at a 1:4 ratio with 227,908 non-OCD individuals on the basis of their birth year and sex. Suicide mortality was assessed between 2003 and 2017 for both groups. Time-dependent Cox regression models were used to investigate the difference in suicide risk between individuals with versus without OCD.

Results: After adjustment for major psychiatric comorbidities (i.e., schizophrenia, bipolar disorder and major depressive disorder), the OCD group had higher risk of suicide (hazard ratio: 1.97, 95% confidence interval: 1.57-2.48) during the follow-up compared with the comparison group. Furthermore, OCD severity, as indicated by psychiatric hospitalizations due to OCD, was positively correlated with suicide risk.

Conclusions: Regardless of the existence of major psychiatric comorbidities, OCD was found to be an independent risk factor for death by suicide. A suicide prevention program specific to individuals with OCD may be developed in clinical practice in the future.

目的:研究证据表明,强迫症(OCD)与自杀念头和自杀企图有关。然而,与没有强迫症的人相比,强迫症患者是否有更高的自杀死亡风险,还需要进一步调查:方法:2003 年至 2017 年间,在整个台湾人口中发现了 56,977 名强迫症患者;然后根据他们的出生年份和性别,以 1:4 的比例将他们与 227,908 名非强迫症患者进行配对。对这两组人在 2003 年至 2017 年期间的自杀死亡率进行了评估。采用时间依赖性 Cox 回归模型来研究强迫症患者与非强迫症患者之间自杀风险的差异:在对主要精神疾病合并症(即精神分裂症、双相情感障碍和重度抑郁症)进行调整后,强迫症组在随访期间的自杀风险高于对比组(危险比:1.97,95% 置信区间:1.57-2.48)。此外,强迫症的严重程度与自杀风险呈正相关,强迫症的严重程度表现为因强迫症而住院治疗:无论是否存在主要的精神并发症,强迫症都是导致自杀死亡的一个独立风险因素。在未来的临床实践中,可能会开发出专门针对强迫症患者的自杀预防计划。
{"title":"Obsessive-compulsive disorder and suicide: a longitudinal study in Taiwan.","authors":"Mu-Hong Chen, Tai-Long Pan, Chih-Ming Cheng, Wen-Han Chang, Ya-Mei Bai, Tung-Ping Su, Tzeng-Ji Chen, Shih-Jen Tsai","doi":"10.1017/S2045796024000477","DOIUrl":"10.1017/S2045796024000477","url":null,"abstract":"<p><strong>Aims: </strong>Research evidence has established an association of obsessive-compulsive disorder (OCD) with suicidal thoughts and suicide attempts. However, further investigation is required to determine whether individuals with OCD have higher risk of death by suicide compared with those without OCD.</p><p><strong>Methods: </strong>Of the entire Taiwanese population, between 2003 and 2017, 56,977 individuals with OCD were identified; they were then matched at a 1:4 ratio with 227,908 non-OCD individuals on the basis of their birth year and sex. Suicide mortality was assessed between 2003 and 2017 for both groups. Time-dependent Cox regression models were used to investigate the difference in suicide risk between individuals with versus without OCD.</p><p><strong>Results: </strong>After adjustment for major psychiatric comorbidities (i.e., schizophrenia, bipolar disorder and major depressive disorder), the OCD group had higher risk of suicide (hazard ratio: 1.97, 95% confidence interval: 1.57-2.48) during the follow-up compared with the comparison group. Furthermore, OCD severity, as indicated by psychiatric hospitalizations due to OCD, was positively correlated with suicide risk.</p><p><strong>Conclusions: </strong>Regardless of the existence of major psychiatric comorbidities, OCD was found to be an independent risk factor for death by suicide. A suicide prevention program specific to individuals with OCD may be developed in clinical practice in the future.</p>","PeriodicalId":11787,"journal":{"name":"Epidemiology and Psychiatric Sciences","volume":"33 ","pages":"e42"},"PeriodicalIF":5.9,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142282301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Outsider art in Croatia. 克罗地亚的局外艺术
IF 5.9 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-09-19 DOI: 10.1017/S2045796024000349
Daniela Bilopavlovic
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引用次数: 0
Effectiveness of partial restriction of access to means in jumping suicide: lessons from four bridges in three countries 部分限制获得跳楼自杀手段的有效性:从三个国家的四座桥梁吸取的教训
IF 8.1 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-09-18 DOI: 10.1017/s2045796024000428
Sangsoo Shin, Jane Pirkis, Angela Clapperton, Matthew Spittal, Lay San Too
Aims Restricting access to means by installing physical barriers has been shown to be the most effective intervention in preventing jumping suicides on bridges. However, little is known about the effectiveness of partial restriction with interventions that still allow jumping from the bridge. Methods This study used a quasi-experimental design. Public sites that met our inclusion criteria were identified using Google search and data on jumping suicides on Bridge A (South Korea), Bridges B and C (the United States) and Bridge D (Canada) were obtained from the relevant datasets. Incidence rate ratios (IRRs) were estimated using Poisson regressions comparing suicide numbers before and after the installation of physical structures at each site. Results Fences with sensor wires and spinning handrails installed above existing railings on the Bridge A, and fences at each side of the entrances and the midpoint of main suspension cables on the Bridge D were associated with significant reductions in suicides (IRR 0.37, 95% Confidence Interval (CI) 0.26 0.54; 0.26, 95% CI 0.09 − 0.76). Installation of bird spike on the parapet on the Bridge B, and fences at the front of seating alcoves on the Bridge C were not associated with changes in suicides (1.21, 95% CI 0.88 − 1.68; 1.49, 95% CI 0.56 − 3.98). Conclusions Partial means restriction (such as fences with sensor wires and spinning bars at the top, and partial fencing at selected points) on bridges appears to be helpful in preventing suicide. Although these interventions are unlikely to be as effective as interventions that fully secure the bridge and completely prevent jumping, they might best be thought of as temporary solutions before more complete or permanent structures are implemented.
目的 通过安装物理障碍来限制进入手段已被证明是防止跳桥自杀最有效的干预措施。然而,人们对部分限制与仍然允许从桥上跳下的干预措施的有效性知之甚少。方法 本研究采用准实验设计。通过谷歌搜索确定了符合纳入标准的公共网站,并从相关数据集中获取了 A 桥(韩国)、B 桥和 C 桥(美国)以及 D 桥(加拿大)上的跳桥自杀数据。使用泊松回归法估算了发生率比 (IRR),比较了每个地点安装物理结构前后的自杀人数。结果 在 A 桥现有栏杆上方安装带感应线和旋转扶手的围栏,以及在 D 桥入口两侧和主悬索中点安装围栏,都与自杀人数的显著减少有关(内部比率为 0.37,95% 置信区间为 0.26 - 0.54;0.26,95% 置信区间为 0.09 - 0.76)。在 B 桥的护栏上安装鸟钉和在 C 桥的座位凹槽前安装围栏与自杀人数的变化无关(1.21,95% CI 0.88 - 1.68;1.49,95% CI 0.56 - 3.98)。结论 桥梁上的部分手段限制(如在顶部安装带感应线和旋转杆的围栏,以及在选定点安装部分围栏)似乎有助于预防自杀。虽然这些干预措施不太可能像完全固定桥梁和完全防止跳桥的干预措施那样有效,但在实施更完整或永久性结构之前,最好将其视为临时解决方案。
{"title":"Effectiveness of partial restriction of access to means in jumping suicide: lessons from four bridges in three countries","authors":"Sangsoo Shin, Jane Pirkis, Angela Clapperton, Matthew Spittal, Lay San Too","doi":"10.1017/s2045796024000428","DOIUrl":"https://doi.org/10.1017/s2045796024000428","url":null,"abstract":"Aims Restricting access to means by installing physical barriers has been shown to be the most effective intervention in preventing jumping suicides on bridges. However, little is known about the effectiveness of partial restriction with interventions that still allow jumping from the bridge. Methods This study used a quasi-experimental design. Public sites that met our inclusion criteria were identified using Google search and data on jumping suicides on Bridge A (South Korea), Bridges B and C (the United States) and Bridge D (Canada) were obtained from the relevant datasets. Incidence rate ratios (IRRs) were estimated using Poisson regressions comparing suicide numbers before and after the installation of physical structures at each site. Results Fences with sensor wires and spinning handrails installed above existing railings on the Bridge A, and fences at each side of the entrances and the midpoint of main suspension cables on the Bridge D were associated with significant reductions in suicides (IRR 0.37, 95% Confidence Interval (CI) 0.26 <jats:italic>−</jats:italic> 0.54; 0.26, 95% CI 0.09 − 0.76). Installation of bird spike on the parapet on the Bridge B, and fences at the front of seating alcoves on the Bridge C were not associated with changes in suicides (1.21, 95% CI 0.88 − 1.68; 1.49, 95% CI 0.56 − 3.98). Conclusions Partial means restriction (such as fences with sensor wires and spinning bars at the top, and partial fencing at selected points) on bridges appears to be helpful in preventing suicide. Although these interventions are unlikely to be as effective as interventions that fully secure the bridge and completely prevent jumping, they might best be thought of as temporary solutions before more complete or permanent structures are implemented.","PeriodicalId":11787,"journal":{"name":"Epidemiology and Psychiatric Sciences","volume":"20 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142263840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Post-SSRI sexual dysfunction: barriers to quantifying incidence and prevalence SSRI 后性功能障碍:量化发生率和流行率的障碍
IF 8.1 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-09-18 DOI: 10.1017/s2045796024000441
David Healy, Dee Mangin
While sexual dysfunction is a well-known side effect of taking selective serotonin reuptake inhibitors (SSRIs), in an undetermined number of patients, sexual function does not return to pre-drug baseline after stopping SSRIs. The condition is known as post-SSRI sexual dysfunction (PSSD) and is characterised most commonly by genital numbness, pleasureless or weak orgasm, loss of libido and erectile dysfunction. This article provides a commentary on the incidence and prevalence of PSSD based on a combination of academic literature as well as clinical and research experience. A number of obstacles to quantifying the occurrence of PSSD are outlined including difficulty in designing a suitable study method. Other contextual obstacles include patient embarrassment at raising sexual concerns, the response of healthcare professionals, inability to stop an antidepressant due to withdrawal issues in a proportion of patients and patient unawareness that their sexual difficulties are linked to prior medication compounded by variability of online information and a lack of information aimed at public education. A definition of PSSD with diagnostic criteria has been published. A MedDRA code for PSSD has also been introduced, but this is yet to be adopted by regulators.
虽然性功能障碍是服用选择性血清素再摄取抑制剂(SSRIs)的一种众所周知的副作用,但在数量不确定的患者中,停用 SSRIs 后性功能并没有恢复到用药前的基线。这种情况被称为 SSRI 后性功能障碍(PSSD),最常见的特征是生殖器麻木、无快感或性高潮微弱、性欲减退和勃起功能障碍。本文结合学术文献以及临床和研究经验,对 PSSD 的发病率和流行率进行了评述。文章概述了量化 PSSD 发生率的一些障碍,包括难以设计合适的研究方法。其他背景障碍包括患者在提出性问题时的尴尬、医疗保健专业人员的反应、部分患者因停药问题而无法停用抗抑郁药物、患者不知道其性障碍与之前的药物治疗有关,以及在线信息的多变性和公众教育信息的缺乏。PSSD 的定义和诊断标准已经公布。此外,还引入了 PSSD 的 MedDRA 代码,但尚未被监管机构采纳。
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引用次数: 0
‘Broken souls’ vs. ‘mad ax man’ – changes in the portrayal of depression and schizophrenia in the German media over 10 years 破碎的灵魂 "与 "疯狂的斧头男"--10 年来德国媒体对抑郁症和精神分裂症的描述变化
IF 8.1 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-09-18 DOI: 10.1017/s204579602400043x
M. Sittner, T. Rechenberg, S. Speerforck, M.C Angermeyer, G. Schomerus
Aims Population studies show the stigma of depression to diminish, while the stigma of schizophrenia increases. To find out whether this widening gap is reflected in the media portrayal of both disorders, this study compares the portrayal of depression and schizophrenia in German print media in 2010 vs. 2020. Methods We conducted a qualitative content analysis using a mixed deductive-inductive approach to establish a category system. In total, we analyzed 854 articles with the summative approach by Mayring. Results The study found a widening gap in the portrayal of schizophrenia and depression in German media between 2010 and 2020. Schizophrenia was depicted increasingly negative between 2010 and 2020, covering more negative stereotypes and focusing on its biological causes. Depression received increased attention and more neutral and professional coverage, with a greater emphasis on psychosocial causes and discussion of treatment options. Conclusions By showing a widening gap the study highlights how media may shape public views on mental illnesses and reflects public attitudes at the same time. Media analyses from other nations have shown similar trends. This emphasizes the need for responsible reporting to combat stigma and promote understanding worldwide. Therefore, the authors recommend a balanced coverage that includes accurate professional information about all mental illnesses.
研究目的 人口研究表明,抑郁症的耻辱感在减少,而精神分裂症的耻辱感在增加。为了了解这种差距的扩大是否反映在媒体对这两种疾病的描述中,本研究比较了 2010 年和 2020 年德国平面媒体对抑郁症和精神分裂症的描述。方法 我们采用演绎-归纳混合法进行了定性内容分析,建立了一个分类系统。我们采用 Mayring 的总结性方法共分析了 854 篇文章。结果 研究发现,2010 年至 2020 年间,德国媒体对精神分裂症和抑郁症的描述差距越来越大。在 2010 年至 2020 年期间,精神分裂症的描述越来越负面,涵盖了更多负面的刻板印象,并侧重于其生物学原因。抑郁症受到更多关注,报道更加中立和专业,更加强调社会心理原因和对治疗方案的讨论。结论 通过显示差距的扩大,本研究强调了媒体如何塑造公众对精神疾病的看法,同时也反映了公众的态度。其他国家的媒体分析也显示了类似的趋势。这就强调了负责任的报道对于消除污名化和促进全球理解的必要性。因此,作者建议进行均衡的报道,包括有关所有精神疾病的准确专业信息。
{"title":"‘Broken souls’ vs. ‘mad ax man’ – changes in the portrayal of depression and schizophrenia in the German media over 10 years","authors":"M. Sittner, T. Rechenberg, S. Speerforck, M.C Angermeyer, G. Schomerus","doi":"10.1017/s204579602400043x","DOIUrl":"https://doi.org/10.1017/s204579602400043x","url":null,"abstract":"Aims Population studies show the stigma of depression to diminish, while the stigma of schizophrenia increases. To find out whether this widening gap is reflected in the media portrayal of both disorders, this study compares the portrayal of depression and schizophrenia in German print media in 2010 vs. 2020. Methods We conducted a qualitative content analysis using a mixed deductive-inductive approach to establish a category system. In total, we analyzed 854 articles with the summative approach by Mayring. Results The study found a widening gap in the portrayal of schizophrenia and depression in German media between 2010 and 2020. Schizophrenia was depicted increasingly negative between 2010 and 2020, covering more negative stereotypes and focusing on its biological causes. Depression received increased attention and more neutral and professional coverage, with a greater emphasis on psychosocial causes and discussion of treatment options. Conclusions By showing a widening gap the study highlights how media may shape public views on mental illnesses and reflects public attitudes at the same time. Media analyses from other nations have shown similar trends. This emphasizes the need for responsible reporting to combat stigma and promote understanding worldwide. Therefore, the authors recommend a balanced coverage that includes accurate professional information about all mental illnesses.","PeriodicalId":11787,"journal":{"name":"Epidemiology and Psychiatric Sciences","volume":"20 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142263841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Capturing the clinical complexity in young people presenting to primary mental health services: a data-driven approach 捕捉向初级精神健康服务机构求诊的年轻人的临床复杂性:一种数据驱动的方法
IF 8.1 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-09-18 DOI: 10.1017/s2045796024000386
Caroline X. Gao, Nic Telford, Kate M. Filia, Jana M. Menssink, Sabina Albrecht, Patrick D. McGorry, Matthew Hamilton, Mengmeng Wang, Daniel Gan, Dominic Dwyer, Sophie Prober, Isabel Zbukvic, Myriam Ziou, Sue M. Cotton, Debra J. Rickwood
Aims The specific and multifaceted service needs of young people have driven the development of youth-specific integrated primary mental healthcare models, such as the internationally pioneering headspace services in Australia. Although these services were designed for early intervention, they often need to cater for young people with severe conditions and complex needs, creating challenges in service planning and resource allocation. There is, however, a lack of understanding and consensus on the definition of complexity in such clinical settings. Methods This retrospective study involved analysis of headspace’s clinical minimum data set from young people accessing services in Australia between 1 July 2018 and 30 June 2019. Based on consultations with experts, complexity factors were mapped from a range of demographic information, symptom severity, diagnoses, illness stage, primary presenting issues and service engagement patterns. Consensus clustering was used to identify complexity subgroups based on identified factors. Multinomial logistic regression was then used to evaluate whether these complexity subgroups were associated with other risk factors. Results A total of 81,622 episodes of care from 76,021 young people across 113 services were analysed. Around 20% of young people clustered into a ‘high complexity’ group, presenting with a variety of complexity factors, including severe disorders, a trauma history and psychosocial impairments. Two moderate complexity groups were identified representing ‘distress complexity’ and ‘psychosocial complexity’ (about 20% each). Compared with the ‘distress complexity’ group, young people in the ‘psychosocial complexity’ group presented with a higher proportion of education, employment and housing issues in addition to psychological distress, and had lower levels of service engagement. The distribution of complexity profiles also varied across different headspace services. Conclusions The proposed data-driven complexity model offers valuable insights for clinical planning and resource allocation. The identified groups highlight the importance of adopting a holistic and multidisciplinary approach to address the diverse factors contributing to clinical complexity. The large number of young people presenting with moderate-to-high complexity to headspace early intervention services emphasises the need for systemic change in youth mental healthcare to ensure the availability of appropriate and timely support for all young people.
目的 青少年特殊和多方面的服务需求推动了针对青少年的综合初级精神保健模式的发展,例如澳大利亚在国际上率先推出的 "头空间 "服务。尽管这些服务是为早期干预而设计的,但它们往往需要满足病情严重、需求复杂的青少年的需要,这给服务规划和资源分配带来了挑战。然而,人们对此类临床环境中复杂性的定义缺乏理解和共识。方法 这项回顾性研究分析了2018年7月1日至2019年6月30日期间在澳大利亚接受服务的年轻人的headspace临床最低数据集。在咨询专家的基础上,从一系列人口统计学信息、症状严重程度、诊断、疾病阶段、主要表现问题和服务参与模式中映射出复杂性因素。根据已确定的因素,采用共识聚类法确定复杂性亚组。然后使用多项式逻辑回归评估这些复杂性亚组是否与其他风险因素相关。结果 分析了来自 113 个服务机构的 76,021 名青少年的 81,622 次护理。约 20% 的青少年被归入 "高度复杂 "组,他们具有各种复杂因素,包括严重失调、创伤史和社会心理障碍。两个中度复杂群体分别代表 "痛苦复杂 "和 "社会心理复杂"(各约占 20%)。与 "痛苦复杂性 "组相比,"社会心理复杂性 "组中的青少年除了心理困扰外,还存在更多的教育、就业和住房问题,而且参与服务的程度较低。在不同的 "头部空间 "服务中,复杂性特征的分布也各不相同。结论 建议的数据驱动复杂性模型为临床规划和资源分配提供了宝贵的见解。所确定的群体强调了采用整体和多学科方法解决导致临床复杂性的各种因素的重要性。向 "头部空间 "早期干预服务提出中度至高度复杂性问题的青少年人数众多,这凸显了青少年心理保健系统变革的必要性,以确保为所有青少年提供适当、及时的支持。
{"title":"Capturing the clinical complexity in young people presenting to primary mental health services: a data-driven approach","authors":"Caroline X. Gao, Nic Telford, Kate M. Filia, Jana M. Menssink, Sabina Albrecht, Patrick D. McGorry, Matthew Hamilton, Mengmeng Wang, Daniel Gan, Dominic Dwyer, Sophie Prober, Isabel Zbukvic, Myriam Ziou, Sue M. Cotton, Debra J. Rickwood","doi":"10.1017/s2045796024000386","DOIUrl":"https://doi.org/10.1017/s2045796024000386","url":null,"abstract":"Aims The specific and multifaceted service needs of young people have driven the development of youth-specific integrated primary mental healthcare models, such as the internationally pioneering <jats:italic>headspace</jats:italic> services in Australia. Although these services were designed for early intervention, they often need to cater for young people with severe conditions and complex needs, creating challenges in service planning and resource allocation. There is, however, a lack of understanding and consensus on the definition of complexity in such clinical settings. Methods This retrospective study involved analysis of <jats:italic>headspace</jats:italic>’s clinical minimum data set from young people accessing services in Australia between 1 July 2018 and 30 June 2019. Based on consultations with experts, complexity factors were mapped from a range of demographic information, symptom severity, diagnoses, illness stage, primary presenting issues and service engagement patterns. Consensus clustering was used to identify complexity subgroups based on identified factors. Multinomial logistic regression was then used to evaluate whether these complexity subgroups were associated with other risk factors. Results A total of 81,622 episodes of care from 76,021 young people across 113 services were analysed. Around 20% of young people clustered into a ‘high complexity’ group, presenting with a variety of complexity factors, including severe disorders, a trauma history and psychosocial impairments. Two moderate complexity groups were identified representing ‘distress complexity’ and ‘psychosocial complexity’ (about 20% each). Compared with the ‘distress complexity’ group, young people in the ‘psychosocial complexity’ group presented with a higher proportion of education, employment and housing issues in addition to psychological distress, and had lower levels of service engagement. The distribution of complexity profiles also varied across different <jats:italic>headspace</jats:italic> services. Conclusions The proposed data-driven complexity model offers valuable insights for clinical planning and resource allocation. The identified groups highlight the importance of adopting a holistic and multidisciplinary approach to address the diverse factors contributing to clinical complexity. The large number of young people presenting with moderate-to-high complexity to <jats:italic>headspace</jats:italic> early intervention services emphasises the need for systemic change in youth mental healthcare to ensure the availability of appropriate and timely support for all young people.","PeriodicalId":11787,"journal":{"name":"Epidemiology and Psychiatric Sciences","volume":"77 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142263843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effect of coercive measures on mental health status in adult psychiatric populations: a nationwide trial emulation 强制措施对成年精神病患者心理健康状况的影响:全国范围内的模拟试验
IF 8.1 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-09-12 DOI: 10.1017/s2045796024000416
S. Baggio, S. Kaiser, C.G. Huber, A. Wullschleger
Aims Healthcare staff use coercive measures to manage patients at acute risk of harm to self or others, but their effect on patients’ mental health is underexplored. This nationwide Swiss study emulated a trial to investigate the effects of coercive measures on the mental health of psychiatric inpatients at discharge. Methods We analysed retrospective longitudinal data from all Swiss adult psychiatric hospitals that provided acute care (2019–2021). The primary exposure was any coercive measure during hospitalization; secondary exposures were seclusion, restraint and forced medication. Our primary outcome was Health of the Nations Outcome Scale (HoNOS) score at discharge. We used inverse probability of treatment weighting to emulate random assignment to the exposure. Results Of 178,369 hospitalizations, 9.2% (n = 18,800) included at least one coercive measure. In patients exposed to coercive measures, mental health worsened a small but statistically significant amount more than in non-exposed patients. Those who experienced at least one coercive measure during hospitalization had a significantly higher HoNOS score (1.91-point, p < .001, 95% confidence interval [CI]: 1.73; 2.09) than those who did not experience any coercive measure. Results were similar for seclusion (1.60-point higher score, p < .001, 95% CI: 1.40; 1.79) and forced medication (1.97-point higher score, p < .001, 95% CI: 1.65; 2.30). Restraint had the strongest effect (2.83-point higher score, p < .001, 95% CI: 2.38; 3.28). Conclusions Our study presents robust empirical evidence highlighting the detrimental impact of coercive measures on the mental health of psychiatric inpatients. It underscores the importance of avoiding these measures in psychiatric hospitals and emphasized the urgent need for implementing alternatives in clinical practice.
研究目的 医护人员使用强制措施来管理极有可能伤害自己或他人的患者,但这些措施对患者心理健康的影响却鲜有研究。这项瑞士全国性研究模仿了一项试验,以调查强制措施对精神病住院患者出院时心理健康的影响。方法 我们分析了瑞士所有提供急症护理的成人精神病医院的回顾性纵向数据(2019-2021 年)。主要暴露是住院期间的任何强制措施;次要暴露是隔离、约束和强制用药。我们的主要结果是出院时的国民健康结果量表(HoNOS)得分。我们采用了反向治疗概率加权法来模拟随机分配暴露。结果 在 178369 次住院治疗中,9.2%(n=18800)的患者接受了至少一项强制措施。与未采取强制措施的患者相比,采取强制措施的患者心理健康状况恶化的程度较小,但在统计学上具有显著意义。那些在住院期间至少经历过一次强制措施的患者的 HoNOS 得分(1.91 分,p < .001,95% 置信区间 [CI]:1.73; 2.09)明显高于那些没有经历过任何强制措施的患者。隔离(高出 1.60 分,p < .001,95% 置信区间 [CI]:1.40; 1.79)和强制服药(高出 1.97 分,p < .001,95% 置信区间 [CI]:1.65; 2.30)的结果类似。强制约束的效果最强(得分提高 2.83 分,p < .001, 95% CI: 2.38; 3.28)。结论 我们的研究提供了有力的经验证据,强调了强制措施对精神病住院患者心理健康的不利影响。它强调了在精神病院避免这些措施的重要性,并强调了在临床实践中实施替代措施的迫切需要。
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引用次数: 0
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Epidemiology and Psychiatric Sciences
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