Non-suicidal self-injury (NSSI) has become one of the most severe mental health problems among adolescents and young adults worldwide, especially in clinical populations. The main objective of this non-randomized pilot study is to demonstrate the effectiveness of the TaySH Program in a clinical sample of 37 outpatients aged 14 to 25 years (M = 16.70, SD= 1.51), TAY (Transitional age youth) developmental stage.
Methods
All participants underwent the baseline or pre-treatment assessment and 28 patients completed the 12-week intervention treatment and underwent post-treatment evaluation through different interviews and self-reports. The primary outcome was the reduction of NSSI, and the secondary outcomes were suicide risk, emotional dysregulation, the psychopathological clinical manifestations of impulsivity, depressive symptoms and anxiety, and psychosocial functioning.
Results
The frequency of NSSI behaviors decreased significantly from a mean of 3.32 (SD=4.07) episodes per week at baseline to 0.29 (SD=0.98) episodes per week post-treatment (p < 0.001, Cohen's d = 0.458). This reduction was accompanied by an improvement in associated psychopathological symptoms, leading to better psychosocial functioning among program participants.
Conclusions
The results suggest that the TaySH Program is a promising early intervention for managing NSSI in this population. Future studies should examine the maintenance of the changes achieved, especially concerning the reduction of the psychopathology's tendency toward chronicity.
{"title":"The effectiveness of the TaySH (Transitional Age Youth Self-Harm) Program in the management of Non-Suicidal Self-Harm (NSSI) in outpatient adolescents and young adults: A non-randomized controlled pilot study","authors":"Natalia Calvo , Silvia Amoretti , Jorge Lugo-Marín , Montserrat Oriol , Citlallí Perez , Josep Antoni Ramos-Quiroga , Marc Ferrer","doi":"10.1016/j.ejpsy.2024.100288","DOIUrl":"10.1016/j.ejpsy.2024.100288","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Non-suicidal self-injury (NSSI) has become one of the most severe mental health problems among adolescents and young adults worldwide, especially in clinical populations. The main objective of this non-randomized pilot study is to demonstrate the effectiveness of the TaySH Program in a clinical sample of 37 outpatients aged 14 to 25 years (<em>M</em> = 16.70, SD= 1.51), TAY (Transitional age youth) developmental stage.</div></div><div><h3>Methods</h3><div>All participants underwent the baseline or pre-treatment assessment and 28 patients completed the 12-week intervention treatment and underwent post-treatment evaluation through different interviews and self-reports. The primary outcome was the reduction of NSSI, and the secondary outcomes were suicide risk, emotional dysregulation, the psychopathological clinical manifestations of impulsivity, depressive symptoms and anxiety, and psychosocial functioning.</div></div><div><h3>Results</h3><div>The frequency of NSSI behaviors decreased significantly from a mean of 3.32 (SD=4.07) episodes per week at baseline to 0.29 (SD=0.98) episodes per week post-treatment (<em>p</em> < 0.001, Cohen's <em>d</em> = 0.458). This reduction was accompanied by an improvement in associated psychopathological symptoms, leading to better psychosocial functioning among program participants.</div></div><div><h3>Conclusions</h3><div>The results suggest that the TaySH Program is a promising early intervention for managing NSSI in this population. Future studies should examine the maintenance of the changes achieved, especially concerning the reduction of the psychopathology's tendency toward chronicity.</div></div>","PeriodicalId":12045,"journal":{"name":"European Journal of Psychiatry","volume":"39 2","pages":"Article 100288"},"PeriodicalIF":2.5,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143172703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-18DOI: 10.1016/j.ejpsy.2024.100286
Rachel Hsiao Shen Tan , Sherilyn Shi Hui Chang , Wen Lin Teh , Nisha Chandwani , Mythily Subramaniam , Jianlin Liu
Background and objectives
Child maltreatment is a risk factor for psychopathology in adulthood, and it is important to elucidate avenues for intervention. Social support and emotion dysregulation are two psychosocial factors which mediate the relationship between child maltreatment and psychopathology; however, few studies have examined both simultaneously in an Asian clinical context. This study aimed to investigate the dual roles of social support and emotion dysregulation in the pathway from child maltreatment to depressive symptoms in adulthood by testing three competing pathway models.
Methods
A total of 200 participants (Mean age = 36.53; 78 % Chinese ethnicity) with a primary diagnosis of affective disorder were recruited from a tertiary psychiatric hospital in Singapore. Respondents completed self-report measures of child maltreatment exposure, depressive symptoms, perceived social support, and emotion dysregulation. Pathway analyses based on ordinary least squares regressions were conducted using the PROCESS 4.1 tool.
Results and conclusions
Higher exposure to child maltreatment was associated with lower perceived social support, greater emotion dysregulation, and more depressive symptoms. Pathway analyses revealed a significant indirect effect of child maltreatment on depressive symptoms via perceived social support and emotion dysregulation (b = 0.0172). This indirect effect was significant for emotional neglect while controlling for other forms of maltreatment (b = 0.0914). Findings provide conceptual support for the serial pathway involving social support and emotion dysregulation in the relationship between child maltreatment and depressive symptoms, highlighting the need to target both interpersonal and intrapersonal factors in treating clinical populations with child maltreatment exposure.
{"title":"Social support and emotion dysregulation: A serial pathway from child maltreatment to depressive symptoms in adults with affective disorders","authors":"Rachel Hsiao Shen Tan , Sherilyn Shi Hui Chang , Wen Lin Teh , Nisha Chandwani , Mythily Subramaniam , Jianlin Liu","doi":"10.1016/j.ejpsy.2024.100286","DOIUrl":"10.1016/j.ejpsy.2024.100286","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Child maltreatment is a risk factor for psychopathology in adulthood, and it is important to elucidate avenues for intervention. Social support and emotion dysregulation are two psychosocial factors which mediate the relationship between child maltreatment and psychopathology; however, few studies have examined both simultaneously in an Asian clinical context. This study aimed to investigate the dual roles of social support and emotion dysregulation in the pathway from child maltreatment to depressive symptoms in adulthood by testing three competing pathway models.</div></div><div><h3>Methods</h3><div>A total of 200 participants (Mean age = 36.53; 78 % Chinese ethnicity) with a primary diagnosis of affective disorder were recruited from a tertiary psychiatric hospital in Singapore. Respondents completed self-report measures of child maltreatment exposure, depressive symptoms, perceived social support, and emotion dysregulation. Pathway analyses based on ordinary least squares regressions were conducted using the PROCESS 4.1 tool.</div></div><div><h3>Results and conclusions</h3><div>Higher exposure to child maltreatment was associated with lower perceived social support, greater emotion dysregulation, and more depressive symptoms. Pathway analyses revealed a significant indirect effect of child maltreatment on depressive symptoms via perceived social support and emotion dysregulation (<em>b</em> = 0.0172). This indirect effect was significant for emotional neglect while controlling for other forms of maltreatment (<em>b</em> = 0.0914). Findings provide conceptual support for the serial pathway involving social support and emotion dysregulation in the relationship between child maltreatment and depressive symptoms, highlighting the need to target both interpersonal and intrapersonal factors in treating clinical populations with child maltreatment exposure.</div></div>","PeriodicalId":12045,"journal":{"name":"European Journal of Psychiatry","volume":"39 2","pages":"Article 100286"},"PeriodicalIF":2.5,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143172702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-17DOI: 10.1016/j.ejpsy.2024.100284
Marine Echegut , Natalie Shoham , Naaheed Mukadam
Background and objectives
Growing evidence suggests that the feeling of loneliness correlates positively with the incidence of dementia, motivating our study of their longitudinal association. Additionally, we sought potential mediators of the association, following the hypotheses that lonely individuals are prone to greater stress and follow less healthy lifestyles, therefore are at greater risk of developping dementia.
Methods
Using longitudinal cohort data from the UK Biobank, we conducted a logistic regression analysis with loneliness as exposure and dementia diagnosis as outcome, and progressively adjusted for putative confounders. In addition, we investigated through mediation models the respective contributions of physiological and behavioural factors to the association between loneliness and dementia diagnosis.
Results
The logistic regression models illustrated a significant positive association between loneliness and a subsequent dementia diagnosis, overall indicating a higher odds of developing dementia in the lonely population (Adjusted Odds Ratio (AOR) = 1.39; 95 % (Confidence Interval) CI 1.24 – 1.56, P < 0.001). The mediation models highlighted that there was very little evidence of mediation by hypertension and unhealthy behaviours, respectively explaining 1 % and 2 % of the effect of loneliness on dementia risk. No indication of mediation was seen between baseline CRP-levels and all-cause dementia. Every mediation model described a positive correlation between loneliness and each potential mediating factor, illustrating the widespread negative impact of loneliness on health.
Conclusion
Our findings confirm the association between loneliness and risk of dementia. They show minimal mediation by hypertension and unhealthy behaviours, highlighting the need for investigation into other potential mediators as targets for modification.
背景和目的越来越多的证据表明，孤独感与痴呆的发病率呈正相关，这促使我们对它们之间的纵向关联进行研究。此外，我们寻找了这种关联的潜在中介，假设孤独的人容易承受更大的压力，生活方式不太健康，因此患痴呆症的风险更大。方法使用来自英国生物银行的纵向队列数据，我们进行了logistic回归分析，以孤独为暴露，痴呆诊断为结果，并逐步调整假定的混杂因素。此外，我们还通过中介模型探讨了生理和行为因素在孤独与痴呆诊断之间的作用。结果logistic回归模型显示孤独与随后的痴呆诊断之间存在显著正相关，总体上表明孤独人群患痴呆的几率更高(调整优势比(AOR) = 1.39；95%（置信区间）CI 1.24 - 1.56, P <；0.001)。中介模型强调，高血压和不健康行为的中介证据非常少，分别解释了孤独对痴呆风险影响的1%和2%。没有迹象表明基线crp水平与全因痴呆之间存在中介作用。每个中介模型都描述了孤独与每个潜在中介因素之间的正相关关系，说明了孤独对健康的广泛负面影响。结论：我们的研究结果证实了孤独感与痴呆风险之间的联系。它们显示高血压和不健康行为的调解作用最小，强调需要调查其他潜在的调解作为修改的目标。
{"title":"Loneliness as a risk factor for dementia and its mediators: A longitudinal cohort analysis of UK Biobank data","authors":"Marine Echegut , Natalie Shoham , Naaheed Mukadam","doi":"10.1016/j.ejpsy.2024.100284","DOIUrl":"10.1016/j.ejpsy.2024.100284","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Growing evidence suggests that the feeling of loneliness correlates positively with the incidence of dementia, motivating our study of their longitudinal association. Additionally, we sought potential mediators of the association, following the hypotheses that lonely individuals are prone to greater stress and follow less healthy lifestyles, therefore are at greater risk of developping dementia.</div></div><div><h3>Methods</h3><div>Using longitudinal cohort data from the UK Biobank, we conducted a logistic regression analysis with loneliness as exposure and dementia diagnosis as outcome, and progressively adjusted for putative confounders. In addition, we investigated through mediation models the respective contributions of physiological and behavioural factors to the association between loneliness and dementia diagnosis.</div></div><div><h3>Results</h3><div>The logistic regression models illustrated a significant positive association between loneliness and a subsequent dementia diagnosis, overall indicating a higher odds of developing dementia in the lonely population (Adjusted Odds Ratio (AOR) = 1.39; 95 % (Confidence Interval) CI 1.24 – 1.56, <em>P</em> < 0.001). The mediation models highlighted that there was very little evidence of mediation by hypertension and unhealthy behaviours, respectively explaining 1 % and 2 % of the effect of loneliness on dementia risk. No indication of mediation was seen between baseline CRP-levels and all-cause dementia. Every mediation model described a positive correlation between loneliness and each potential mediating factor, illustrating the widespread negative impact of loneliness on health.</div></div><div><h3>Conclusion</h3><div>Our findings confirm the association between loneliness and risk of dementia. They show minimal mediation by hypertension and unhealthy behaviours, highlighting the need for investigation into other potential mediators as targets for modification.</div></div>","PeriodicalId":12045,"journal":{"name":"European Journal of Psychiatry","volume":"39 2","pages":"Article 100284"},"PeriodicalIF":2.5,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143172286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-17DOI: 10.1016/j.ejpsy.2024.100285
Bo Pan , Li Qu , Chuan-Lan Wang , Jianjun Weng , Jian-Feng Yu , Yanqing Liu , Xing-Chen Wang
Background and objectives
Schizophrenia is a chronic and severe mental illness, affecting a large number of general populations. It was well documented that metabolic dysregulation is associated with schizophrenia. In order to define reliable peripheral biomarkers for schizophrenia in patients with specific age, sex, and locations, plasma metabolic profiling of elderly female schizophrenic patients in rural regions was investigated in this study.
Methods
A total of 20 female schizophrenic patients (average age: 68.65 ± 4.11) and 20 matched healthy controls were recruited. An untargeted metabolomics analysis was performed with their plasma samples of the participants. Differentially-expressed metabolites (DEMs) were identified, followed by a pathway enrichment analysis to reveal related signalling pathways. Then, machine learning analyses, including random forest (RF) and support vector machines-recursive feature elimination (SVM-RFE), were implemented to determine signature metabolite(s).
Results
A total number of 2764 metabolites were identified, among which 61 DEMs were identified, including 38 down-regulated and 23 up-regulated metabolites. The enrichment analysis showed that glycerophospholipid metabolism and sphingolipid signalling pathway were the most significantly affected pathways. The ROC analysis indicated that metabolites belonging to the class of fatty acyls have higher power to discriminate schizophrenia. Finally, a linoleic acid derivative (Dg(16:0/18:2(9z,12z)/0:0)[Iso2]) was revealed as signature metabolite by the RF and SVM-RFE machine learning analyses.
Conclusion
The present study investigated the plasma metabolic profiling of elderly female patients with schizophrenia and identified a peripheral linoleic acid derivative that might help discriminate schizophrenia and develop specific treatment strategies for elderly female patients in rural regions.
{"title":"Identification of a linoleic acid derivative in elderly female patients with schizophrenia from rural regions using untargeted metabolomics","authors":"Bo Pan , Li Qu , Chuan-Lan Wang , Jianjun Weng , Jian-Feng Yu , Yanqing Liu , Xing-Chen Wang","doi":"10.1016/j.ejpsy.2024.100285","DOIUrl":"10.1016/j.ejpsy.2024.100285","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Schizophrenia is a chronic and severe mental illness, affecting a large number of general populations. It was well documented that metabolic dysregulation is associated with schizophrenia. In order to define reliable peripheral biomarkers for schizophrenia in patients with specific age, sex, and locations, plasma metabolic profiling of elderly female schizophrenic patients in rural regions was investigated in this study.</div></div><div><h3>Methods</h3><div>A total of 20 female schizophrenic patients (average age: 68.65 ± 4.11) and 20 matched healthy controls were recruited. An untargeted metabolomics analysis was performed with their plasma samples of the participants. Differentially-expressed metabolites (DEMs) were identified, followed by a pathway enrichment analysis to reveal related signalling pathways. Then, machine learning analyses, including random forest (RF) and support vector machines-recursive feature elimination (SVM-RFE), were implemented to determine signature metabolite(s).</div></div><div><h3>Results</h3><div>A total number of 2764 metabolites were identified, among which 61 DEMs were identified, including 38 down-regulated and 23 up-regulated metabolites. The enrichment analysis showed that glycerophospholipid metabolism and sphingolipid signalling pathway were the most significantly affected pathways. The ROC analysis indicated that metabolites belonging to the class of fatty acyls have higher power to discriminate schizophrenia. Finally, a linoleic acid derivative (Dg(16:0/18:2(9z,12z)/0:0)[Iso2]) was revealed as signature metabolite by the RF and SVM-RFE machine learning analyses.</div></div><div><h3>Conclusion</h3><div>The present study investigated the plasma metabolic profiling of elderly female patients with schizophrenia and identified a peripheral linoleic acid derivative that might help discriminate schizophrenia and develop specific treatment strategies for elderly female patients in rural regions.</div></div>","PeriodicalId":12045,"journal":{"name":"European Journal of Psychiatry","volume":"39 2","pages":"Article 100285"},"PeriodicalIF":2.5,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143172287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-16DOI: 10.1016/j.ejpsy.2024.100287
José A. Garrido-Cervera , María I. Ruiz-Granados , Antonio I. Cuesta-Vargas , Antonio J. Sánchez-Guarnido
Background and Objective
To improve mental health recovery, it is necessary to have validated instruments. At present, however, there is a lack of valid instruments capable of measuring the recovery process in Spanish-speaking populations. The objective of this study was therefore to translate, culturally adapt and validate the Individual Recovery Outcomes Counter (I.ROC) for use in Spanish populations.
Methods
The methodology applied was that recommended for cultural adaptations of questionnaires. It included the following phases: translation, back translation, cultural adaptation and understandability analysis. To assess its psychometric properties, the translated version of the I.ROC was administered to 307 people with severe mental disorders (SMDs).
Results
The questionnaire's internal consistency was satisfactory (Cronbach's alpha = 0.894). Its stability over time was also appropriate, with no significant differences being found in any of the items in the two evaluations. Concurrent validity with the Recovery Assessment Scale (RAS-24) was also acceptable (r = 0.663 p < 0.001). The exploratory factor analysis (EFA) results were concordant with a division into the 4 original factors, but also compatible with two or even with one single general factor.
Conclusion
The results of the study suggest that the Spanish version of the I.ROC is a valid, reliable instrument for charting recovery in people with mental disorders (MD).
背景与目的提高心理健康康复水平，有必要建立有效的心理康复工具。但是，目前缺乏能够衡量西班牙语人口恢复进程的有效工具。因此，本研究的目的是翻译、文化适应和验证个人恢复结果计数器（I.ROC）在西班牙人群中的应用。方法采用问卷文化适应性推荐方法。包括翻译、反译、文化适应和可理解性分析四个阶段。为了评估其心理测量特性，对307名重度精神障碍（smd）患者进行了翻译版的I.ROC。结果问卷内部一致性良好（Cronbach’s alpha = 0.894）。它在一段时间内的稳定性也是适当的，在两次评价中没有发现任何项目有重大差异。与恢复评估量表（RAS-24）的并发效度也可以接受(r = 0.663 p <；0.001)。探索性因子分析（EFA）结果既符合4个原始因子的划分，也符合2个甚至1个一般因子的划分。结论西班牙语版I.ROC量表是一种有效、可靠的精神障碍患者康复量表。
{"title":"Validation study for the individual recovery outcomes counter (I.ROC) in a Spanish population.","authors":"José A. Garrido-Cervera , María I. Ruiz-Granados , Antonio I. Cuesta-Vargas , Antonio J. Sánchez-Guarnido","doi":"10.1016/j.ejpsy.2024.100287","DOIUrl":"10.1016/j.ejpsy.2024.100287","url":null,"abstract":"<div><h3>Background and Objective</h3><div>To improve mental health recovery, it is necessary to have validated instruments. At present, however, there is a lack of valid instruments capable of measuring the recovery process in Spanish-speaking populations. The objective of this study was therefore to translate, culturally adapt and validate the Individual Recovery Outcomes Counter (I.ROC) for use in Spanish populations.</div></div><div><h3>Methods</h3><div>The methodology applied was that recommended for cultural adaptations of questionnaires. It included the following phases: translation, back translation, cultural adaptation and understandability analysis. To assess its psychometric properties, the translated version of the I.ROC was administered to 307 people with severe mental disorders (SMDs).</div></div><div><h3>Results</h3><div>The questionnaire's internal consistency was satisfactory (Cronbach's alpha = 0.894). Its stability over time was also appropriate, with no significant differences being found in any of the items in the two evaluations. Concurrent validity with the Recovery Assessment Scale (RAS-24) was also acceptable (<em>r</em> = 0.663 <em>p</em> < 0.001). The exploratory factor analysis (EFA) results were concordant with a division into the 4 original factors, but also compatible with two or even with one single general factor.</div></div><div><h3>Conclusion</h3><div>The results of the study suggest that the Spanish version of the I.ROC is a valid, reliable instrument for charting recovery in people with mental disorders (MD).</div></div>","PeriodicalId":12045,"journal":{"name":"European Journal of Psychiatry","volume":"39 2","pages":"Article 100287"},"PeriodicalIF":2.5,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143172736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-23DOI: 10.1016/j.ejpsy.2024.100266
Noelia Lucía Martínez-Rives , María Pilar Martín Chaparro , Yasuhiro Kotera , Bibha Dhungel , Stuart Gilmour
Background and objectives
Social support and quality communication are crucial in suicide prevention. This systematic review aimed to identify and summarize the research on the link between these variables and suicidal behavior in adults, and their differences depending on gender.
Methods
The Web of Science, Scopus and PsycInfo databases were searched from January 2012 to November 2022 using the terms [(suicide* OR “deliberate self-harm”* OR self- injur* OR “suicidal behavio”*) AND ("social support" OR "interpersonal relationship") AND (communication)]. Articles published in a peer-reviewed academic journal, written in English, with participants between 18 and 40 years old, assessing communication and/or social support were included.
Results
Finally, we included 12 articles. We identified characteristics such as not perceiving social networks as a helpful resource, or difficulties in understanding the messages. Also, the COVID-19 pandemic, highlighted the role that technology played in social support for the most vulnerable people. Communication difficulties of the individual with greater risk for suicide, showed the importance of social support and seeking help.
Conclusions
The community can contribute in suicide prevention by reducing the stigma surrounding mental illness and suicide through effective communication.
{"title":"The role of communication and social support in suicidal behaviour in adults aged between 18–40 years: A systematic review","authors":"Noelia Lucía Martínez-Rives , María Pilar Martín Chaparro , Yasuhiro Kotera , Bibha Dhungel , Stuart Gilmour","doi":"10.1016/j.ejpsy.2024.100266","DOIUrl":"10.1016/j.ejpsy.2024.100266","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Social support and quality communication are crucial in suicide prevention. This systematic review aimed to identify and summarize the research on the link between these variables and suicidal behavior in adults, and their differences depending on gender.</div></div><div><h3>Methods</h3><div>The Web of Science, Scopus and PsycInfo databases were searched from January 2012 to November 2022 using the terms [(suicide* OR “deliberate self-harm”* OR self- injur* OR “suicidal behavio”*) AND (\"social support\" OR \"interpersonal relationship\") AND (communication)]. Articles published in a peer-reviewed academic journal, written in English, with participants between 18 and 40 years old, assessing communication and/or social support were included.</div></div><div><h3>Results</h3><div>Finally, we included 12 articles. We identified characteristics such as not perceiving social networks as a helpful resource, or difficulties in understanding the messages. Also, the COVID-19 pandemic, highlighted the role that technology played in social support for the most vulnerable people. Communication difficulties of the individual with greater risk for suicide, showed the importance of social support and seeking help.</div></div><div><h3>Conclusions</h3><div>The community can contribute in suicide prevention by reducing the stigma surrounding mental illness and suicide through effective communication.</div></div>","PeriodicalId":12045,"journal":{"name":"European Journal of Psychiatry","volume":"39 1","pages":"Article 100266"},"PeriodicalIF":2.5,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142702327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-18DOI: 10.1016/j.ejpsy.2024.100270
Leire Erkoreka , Iker Zamalloa , Pedro Muñoz , Santiago Rodriguez , Aurora Arrue , Miguel Angel Gonzalez-Torres
Background and objectives
Attachment is the tendency of human beings to create strong affective bonds towards specific figures, and has been described as a general vulnerability factor to diverse forms of psychopathology. Although attachment research has not tended to emphasize genetic contribution, heritability is estimated at 36–45 %. We explored the association between 5-HTTLPR, COMT Val158Met and BDNF Val66Met functional polymorphisms with attachment dimensions, as well as the gene-environment interaction, considering the perceived parental rearing styles, with both a vulnerability and a differential susceptibility approach.
Methods
150 outpatients with a cluster B personality disorder participated in the study. Attachment was assessed using Experiences in Close Relationships-Revised and rearing styles by means of the Parental Bonding Instrument. Genotypes were analyzed using saliva samples. Statistical analyses were carried out with general linear models.
Results
COMT ValVal homozygotes and BDNF Met-carriers were associated with significantly higher scores in attachment anxiety (COMT: ValVal 4.95±1.25 vs Met-carriers 4.42±1.30, t=-2.096, p=0.038; BDNF: ValVal 4.38±1.31 vs Met-carriers 4.95±1.24, t = 2.833, p=0.005). From a differential susceptibility approach, plasticity genotypes were identified for the three functional polymorphisms, observing significant interactions with parental overprotection and differential outcomes in relation to attachment anxiety. No associations or interactions were found with regard to attachment avoidance and the care dimension.
Conclusion
Our results suggest that there are individuals more susceptible to rearing experiences in terms of adult attachment outcomes, which probably also implies a greater potential to benefit from environmental and psychotherapeutic interventions.
背景和目的 依恋是人类对特定人物产生强烈情感纽带的倾向，被描述为导致各种形式精神病理学的普遍易感因素。尽管依恋研究并不倾向于强调遗传因素，但其遗传率估计为 36-45%。我们探讨了 5-HTTLPR、COMT Val158Met 和 BDNF Val66Met 功能多态性与依恋维度之间的关系，以及基因与环境之间的相互作用，同时考虑了感知到的父母养育方式，采用了易感性和差异易感性两种方法。研究使用《亲密关系经历-修订版》对依恋进行评估，并使用《父母关系工具》对养育方式进行评估。基因型通过唾液样本进行分析。结果COMT ValVal同源基因携带者和BDNF Met基因携带者的依恋焦虑得分明显更高（COMT：ValVal 4.95±1.25 vs Met-carriers 4.42±1.30，t=-2.096，p=0.038；BDNF：ValVal 4.38±1.31 vs Met-carriers 4.95±1.24，t=2.833，p=0.005）。通过差异易感性方法，确定了三种功能性多态性的可塑性基因型，观察到与父母过度保护的显著交互作用，以及与依恋焦虑有关的差异结果。结论我们的研究结果表明，就成人依恋结果而言，有些个体更容易受到抚养经历的影响，这可能也意味着他们更有可能从环境和心理治疗干预中受益。
{"title":"Influence of 5-HTT, COMT, and BDNF functional polymorphisms and their interaction with parental bonding in attachment anxiety, among adults with personality disorders","authors":"Leire Erkoreka , Iker Zamalloa , Pedro Muñoz , Santiago Rodriguez , Aurora Arrue , Miguel Angel Gonzalez-Torres","doi":"10.1016/j.ejpsy.2024.100270","DOIUrl":"10.1016/j.ejpsy.2024.100270","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Attachment is the tendency of human beings to create strong affective bonds towards specific figures, and has been described as a general vulnerability factor to diverse forms of psychopathology. Although attachment research has not tended to emphasize genetic contribution, heritability is estimated at 36–45 %. We explored the association between <em>5-HTTLPR, COMT</em> Val158Met and <em>BDNF</em> Val66Met functional polymorphisms with attachment dimensions, as well as the gene-environment interaction, considering the perceived parental rearing styles, with both a vulnerability and a differential susceptibility approach.</div></div><div><h3>Methods</h3><div>150 outpatients with a cluster B personality disorder participated in the study. Attachment was assessed using Experiences in Close Relationships-Revised and rearing styles by means of the Parental Bonding Instrument. Genotypes were analyzed using saliva samples. Statistical analyses were carried out with general linear models.</div></div><div><h3>Results</h3><div><em>COMT</em> ValVal homozygotes and <em>BDNF</em> Met-carriers were associated with significantly higher scores in attachment anxiety (COMT: ValVal 4.95±1.25 vs Met-carriers 4.42±1.30, <em>t</em>=-2.096, <em>p</em>=0.038; BDNF: ValVal 4.38±1.31 vs Met-carriers 4.95±1.24, <em>t</em> = 2.833, <em>p</em>=0.005). From a differential susceptibility approach, plasticity genotypes were identified for the three functional polymorphisms, observing significant interactions with parental overprotection and differential outcomes in relation to attachment anxiety. No associations or interactions were found with regard to attachment avoidance and the care dimension.</div></div><div><h3>Conclusion</h3><div>Our results suggest that there are individuals more susceptible to rearing experiences in terms of adult attachment outcomes, which probably also implies a greater potential to benefit from environmental and psychotherapeutic interventions.</div></div>","PeriodicalId":12045,"journal":{"name":"European Journal of Psychiatry","volume":"39 1","pages":"Article 100270"},"PeriodicalIF":2.5,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142701756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-18DOI: 10.1016/j.ejpsy.2024.100278
G Castelpietra , T Niyonsenga , A Iruin , U Albert , A Gabilondo , L Salvador-Carulla
Background and Objectives
COVID-19 pandemic has affected the mental health system (MHS) globally, although significant geographical variation was found, particularly for depression and anxiety. The understanding of its impact at the regional level of the context of care is limited when compared to national evaluations.
Methods
Collective case study comparing the prior pattern of care with the first 11 months of COVID-19 in two sites: Gipuzkoa (Spain) and Friuli Venezia Giulia - FVG (Italy). Information from both sites derive from administrative data of MHS in the two regions harmonized for comparison. Data included prevalence of psychiatric diagnoses (ICD-10 F30-F39 and F40-F49 codes), number of hospitalisations, mean and range of psychiatric and psychological interventions. Significance of time-period and location difference was assessed using the Chi-square and the T-statistics for prevalence and count data, respectively.
Results
MHS is community-based in both sites. The prevalence of anxiety decreased in FVG, while a decrease in hospitalisations was found in Gipuzkoa. Both sites registered an increase in psychiatric visits for anxiety and depression. In both periods, FVG showed significant lower prevalence of diagnoses, but higher mean number of psychiatric interventions.
Conclusions
: The COVID-19 outbreak is a paradigmatic example of complex dynamic systems in public health and illustrates the importance of considering its local context and time dependency. The Standard mapping and coding of local MHS provision is essential to allow comparison and reduce ambiguity. This study highlights the importance of ecosystem research to better interpret epidemiological data and support the development of evidence-informed policymaking.
背景和目标COVID-19 大流行对全球精神卫生系统（MHS）产生了影响，但发现地域差异很大，尤其是在抑郁和焦虑方面。与国家评估相比，人们对其在地区层面的护理环境影响的了解十分有限：西班牙吉普斯夸省（Gipuzkoa）和意大利弗留利-威尼斯-朱利亚省（FVG）。两地的信息均来自两个地区的医疗健康管理机构的行政数据，并进行了统一比较。数据包括精神疾病的诊断率（ICD-10 F30-F39 和 F40-F49 编码）、住院人数、精神和心理干预的平均值和范围。对于流行率和计数数据，分别使用卡方和 T 统计量来评估时间段和地点差异的显著性。弗拉芒地区的焦虑症发病率有所下降，而吉普兹科阿地区的住院率有所下降。两地因焦虑症和抑郁症就诊的精神病患者人数都有所增加。在这两个时期，弗拉芒地区的诊断率明显较低，但精神病干预的平均次数却较高：COVID-19疫情是公共卫生领域复杂动态系统的典范，说明了考虑当地环境和时间依赖性的重要性。对当地提供的 MHS 进行标准映射和编码对于进行比较和减少模糊性至关重要。这项研究强调了生态系统研究对于更好地解释流行病学数据和支持循证决策发展的重要性。
{"title":"A collective case study of mental health systems’ response to COVID-19: Impact on patterns of care provision for depression and anxiety in two comparable regions of Southern Europe","authors":"G Castelpietra , T Niyonsenga , A Iruin , U Albert , A Gabilondo , L Salvador-Carulla","doi":"10.1016/j.ejpsy.2024.100278","DOIUrl":"10.1016/j.ejpsy.2024.100278","url":null,"abstract":"<div><h3>Background and Objectives</h3><div>COVID-19 pandemic has affected the mental health system (MHS) globally, although significant geographical variation was found, particularly for depression and anxiety. The understanding of its impact at the regional level of the context of care is limited when compared to national evaluations.</div></div><div><h3>Methods</h3><div>Collective case study comparing the prior pattern of care with the first 11 months of COVID-19 in two sites: Gipuzkoa (Spain) and Friuli Venezia Giulia - FVG (Italy). Information from both sites derive from administrative data of MHS in the two regions harmonized for comparison. Data included prevalence of psychiatric diagnoses (ICD-10 F30-F39 and F40-F49 codes), number of hospitalisations, mean and range of psychiatric and psychological interventions. Significance of time-period and location difference was assessed using the Chi-square and the T-statistics for prevalence and count data, respectively.</div></div><div><h3>Results</h3><div>MHS is community-based in both sites. The prevalence of anxiety decreased in FVG, while a decrease in hospitalisations was found in Gipuzkoa. Both sites registered an increase in psychiatric visits for anxiety and depression. In both periods, FVG showed significant lower prevalence of diagnoses, but higher mean number of psychiatric interventions.</div></div><div><h3>Conclusions</h3><div><strong>:</strong> The COVID-19 outbreak is a paradigmatic example of complex dynamic systems in public health and illustrates the importance of considering its local context and time dependency. The Standard mapping and coding of local MHS provision is essential to allow comparison and reduce ambiguity. This study highlights the importance of ecosystem research to better interpret epidemiological data and support the development of evidence-informed policymaking.</div></div>","PeriodicalId":12045,"journal":{"name":"European Journal of Psychiatry","volume":"39 1","pages":"Article 100278"},"PeriodicalIF":2.5,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142701758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-18DOI: 10.1016/j.ejpsy.2024.100282
David A. Smelson , Vera Yakovchenko , Kathryn E. Bruzios , Thomas Byrne , Megan Mccullough , Paige M. Shaffer , A. Rani Elwy
Background and Objectives
Veterans Treatment Courts (VTCs) are alternative to incarceration programs for veterans involved in the criminal legal system. VTC participants have high rates of co-occurring mental health and substance use disorders (COD). Maintaining Independence and Sobriety Through Systems Integration, Outreach and Networking – Criminal Justice (MISSIONCJ) is an evidence-based, multicomponent intervention offered alongside VTCs to support veterans’ complex needs. Multicomponent interventions are often difficult to implement nationally, let alone when care is offered and coordinated across multiple systems. This protocol offers an overview of an implementation-effectiveness trial of MISSIONCJ in VTCs.
Methods
This quality improvement (QI) project will involve an adaptive, randomized design, in which VA staff in four geographically-dispersed regions across the U.S. will be invited to participate and receive varying implementation facilitation (IF) support (i.e., low/passive and high/active) for implementing MISSIONCJ. Sites will have a 9-month run-in period (e.g., orientation) followed by 9-months of low/passive IF. Sites that meet an implementation benchmark will then be randomized to continue low/passive IF or discontinue; and sites that do not meet the benchmark will be randomized to continue low/passive IF, or receive high/active IF for 12-months. Implementation outcomes are based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework (e.g., reaching eligible veterans, adoption rates, fidelity to MISSIONCJ, and maintenance/sustainment). MISSIONCJ effectiveness outcomes include treatment engagement and COD improvements.
Discussion
This QI project aims to determine the most effective type and intensity of IF to increase MISSIONCJ, while improving outcomes among VTC participants. As the first national trial to implement MISSIONCJ in VTCs, it has important implications for the criminal legal and implementation science fields.
Trial Registration
ISRCTN registry, ISRCTN13576289, Registered 21 December 2022, https://www.isrctn.com/ISRCTN13576289
{"title":"Testing implementation support strategies to facilitate an evidence-based substance use and mental health care intervention in veterans treatment courts: A hybrid type III trial protocol","authors":"David A. Smelson , Vera Yakovchenko , Kathryn E. Bruzios , Thomas Byrne , Megan Mccullough , Paige M. Shaffer , A. Rani Elwy","doi":"10.1016/j.ejpsy.2024.100282","DOIUrl":"10.1016/j.ejpsy.2024.100282","url":null,"abstract":"<div><h3>Background and Objectives</h3><div>Veterans Treatment Courts (VTCs) are alternative to incarceration programs for veterans involved in the criminal legal system. VTC participants have high rates of co-occurring mental health and substance use disorders (COD). Maintaining Independence and Sobriety Through Systems Integration, Outreach and Networking – Criminal Justice (MISSION<img>CJ) is an evidence-based, multicomponent intervention offered alongside VTCs to support veterans’ complex needs. Multicomponent interventions are often difficult to implement nationally, let alone when care is offered and coordinated across multiple systems. This protocol offers an overview of an implementation-effectiveness trial of MISSION<img>CJ in VTCs.</div></div><div><h3>Methods</h3><div>This quality improvement (QI) project will involve an adaptive, randomized design, in which VA staff in four geographically-dispersed regions across the U.S. will be invited to participate and receive varying implementation facilitation (IF) support (i.e., low/passive and high/active) for implementing MISSION<img>CJ. Sites will have a 9-month run-in period (e.g., orientation) followed by 9-months of low/passive IF. Sites that meet an implementation benchmark will then be randomized to continue low/passive IF or discontinue; and sites that do not meet the benchmark will be randomized to continue low/passive IF, or receive high/active IF for 12-months. Implementation outcomes are based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework (e.g., reaching eligible veterans, adoption rates, fidelity to MISSION<img>CJ, and maintenance/sustainment). MISSION<img>CJ effectiveness outcomes include treatment engagement and COD improvements.</div></div><div><h3>Discussion</h3><div>This QI project aims to determine the most effective type and intensity of IF to increase MISSION<img>CJ, while improving outcomes among VTC participants. As the first national trial to implement MISSION<img>CJ in VTCs, it has important implications for the criminal legal and implementation science fields.</div></div><div><h3>Trial Registration</h3><div>ISRCTN registry, ISRCTN13576289, Registered 21 December 2022, https://www.isrctn.com/ISRCTN13576289</div></div>","PeriodicalId":12045,"journal":{"name":"European Journal of Psychiatry","volume":"39 1","pages":"Article 100282"},"PeriodicalIF":2.5,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142701768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-18DOI: 10.1016/j.ejpsy.2024.100281
Carolina Fajardo , Simona Sciacchitano , Alba Maria Pozo-Prados , Ana Izquierdo , Álvaro Orosa-Duarte , Eduardo Delgado-Parada , Jose Luis Ayuso-Mateos , Iosune Torio
Background and objectives
The COVID-19 pandemic and the ensuing restrictive measures had a detrimental impact on the mental health of the population, potentially altering the pattern of seeking psychiatric care. A retrospective cross-sectional study was conducted to compare Psychiatric Emergencies after the most restrictive phases of the pandemic with an equivalent pre-pandemic period. Additionally, we aimed to investigate a possible association between the influx of patients to the emergency department (ED) and the cumulative incidence of COVID-19 cases.
Methods
Data from the psychiatric ED of a tertiary hospital in Madrid, Spain, during the so-called “new normal” phase (October 2020 - May 2021) were compared with a corresponding period (October 2018 - May 2019).
Results
The number of visits to the ED significantly increased from 879 to 980 after the pandemic. Patients were more likely to be compulsorily transferred (M = 281, SD 28.7 vs. M = 209, SD 23.8) and had a higher likelihood of requiring psychiatric hospitalization (M = 323, SD 33.0 vs. M = 246, SD 28.0). Notably, the number of visits related to suicide attempts was significantly higher during the pandemic (M = 147, SD 15.0 vs. M = 86, SD 9.8), while the proportion of patients with bipolar disorder decreased (M = 89, SD 9.1 vs. M = 121, SD 13.8). No significant results were found regarding a possible association between the number of patients in the ED and the COVID-19 incidence rate.
Conclusions
These results suggest critical changes in psychiatric emergency care and an increasing trend of suicide attempts during the pandemic, emphasizing the need for the reorganization of emergency care in future health crises.
背景和目标 COVID-19 大流行和随之而来的限制性措施对人们的心理健康产生了不利影响，可能会改变人们寻求精神科治疗的模式。我们开展了一项回顾性横断面研究，将大流行最严格阶段后的精神科急诊情况与大流行前的同等情况进行比较。此外，我们还旨在调查涌入急诊科（ED）的患者与 COVID-19 病例累积发病率之间可能存在的关联。方法将西班牙马德里一家三甲医院在所谓的 "新常态 "阶段（2020 年 10 月至 2021 年 5 月）的精神科急诊数据与相应时期（2018 年 10 月至 2019 年 5 月）的数据进行比较。结果大流行后，急诊科就诊人数从 879 人次大幅增至 980 人次。患者更有可能被强制转院（M = 281，SD 28.7 vs. M = 209，SD 23.8），更有可能需要精神科住院治疗（M = 323，SD 33.0 vs. M = 246，SD 28.0）。值得注意的是，在大流行期间，与自杀未遂有关的就诊人数明显增加（中=147，标化15.0 vs. 中=86，标化9.8），而躁狂症患者的比例则有所下降（中=89，标化9.1 vs. 中=121，标化13.8）。结论：这些结果表明，在大流行病期间，精神科急诊护理发生了重大变化，自杀企图呈上升趋势，强调了在未来的健康危机中重组急诊护理的必要性。
{"title":"Has psychiatric emergency care changed after the COVID-19 pandemic? A retrospective study in a tertiary hospital in Madrid, Spain","authors":"Carolina Fajardo , Simona Sciacchitano , Alba Maria Pozo-Prados , Ana Izquierdo , Álvaro Orosa-Duarte , Eduardo Delgado-Parada , Jose Luis Ayuso-Mateos , Iosune Torio","doi":"10.1016/j.ejpsy.2024.100281","DOIUrl":"10.1016/j.ejpsy.2024.100281","url":null,"abstract":"<div><h3>Background and objectives</h3><div>The COVID-19 pandemic and the ensuing restrictive measures had a detrimental impact on the mental health of the population, potentially altering the pattern of seeking psychiatric care. A retrospective cross-sectional study was conducted to compare Psychiatric Emergencies after the most restrictive phases of the pandemic with an equivalent pre-pandemic period. Additionally, we aimed to investigate a possible association between the influx of patients to the emergency department (ED) and the cumulative incidence of COVID-19 cases.</div></div><div><h3>Methods</h3><div>Data from the psychiatric ED of a tertiary hospital in Madrid, Spain, during the so-called “new normal” phase (October 2020 - May 2021) were compared with a corresponding period (October 2018 - May 2019).</div></div><div><h3>Results</h3><div>The number of visits to the ED significantly increased from 879 to 980 after the pandemic. Patients were more likely to be compulsorily transferred (<em>M</em> = 281, SD 28.7 vs. <em>M</em> = 209, SD 23.8) and had a higher likelihood of requiring psychiatric hospitalization (<em>M</em> = 323, SD 33.0 vs. <em>M</em> = 246, SD 28.0). Notably, the number of visits related to suicide attempts was significantly higher during the pandemic (<em>M</em> = 147, SD 15.0 vs. <em>M</em> = 86, SD 9.8), while the proportion of patients with bipolar disorder decreased (<em>M</em> = 89, SD 9.1 vs. <em>M</em> = 121, SD 13.8). No significant results were found regarding a possible association between the number of patients in the ED and the COVID-19 incidence rate.</div></div><div><h3>Conclusions</h3><div>These results suggest critical changes in psychiatric emergency care and an increasing trend of suicide attempts during the pandemic, emphasizing the need for the reorganization of emergency care in future health crises.</div></div>","PeriodicalId":12045,"journal":{"name":"European Journal of Psychiatry","volume":"39 1","pages":"Article 100281"},"PeriodicalIF":2.5,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142701759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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