Clinical Practice and Epidemiology in Mental Health最新文献

Introduction: Alzheimer's disease (AD) is a growing concern worldwide in healthcare. In Ecuador, the increasing life expectancy has raised the prevalence of age-related diseases, including dementias. The main objective of this study was to analyze the mortality from AD and other dementias in Ecuador from 2012 to 2022.

Methodology: A retrospective, descriptive time series analysis was conducted on adult subjects with AD and other dementias across various geographic regions of Ecuador during the 2012-2022 period. A sample of 855,122 individuals registered in the databases of the National Institute of Statistics and Censuses (INEC) was analyzed.

Results: Out of the total evaluated subjects, 4,836 deaths were due to AD (0.56%) and 1,317 deaths from other types of dementia (0.15%). For AD, the distribution of deaths by sex showed a predominant trend in women (n=3,008) within the group aged 65 years or older (n=4,749). For other dementias, women were also the main group (n=766), along with those aged 65 years and older (n=1,294). The national mortality rate showed an upward trend during this decade, increasing from 2.2 per 100,000 inhabitants in 2012 to 4.86 per 100,000 inhabitants in 2022.

Discussion: This study reveals a worrying increase in mortality from Alzheimer's disease (AD) and other dementias in Ecuador between 2012 and 2022, especially among women, adults over 65 years of age, and residents of the Sierra region. Several factors that could negatively influence cognitive function were observed. These findings are consistent with global trends and suggest that biological, environmental, and social variables, such as aging, postmenopausal hormonal changes, chronic exposure to hypoxic altitude conditions, and unequal access to health services, could play a key role in this disease.

Conclusion: Mortality from Alzheimer's disease and other dementias in Ecuador showed a sustained increase between 2012 and 2022, reflecting a growing burden of these pathologies in the population and the urgent need to strengthen prevention, early diagnosis, and comprehensive treatment strategies. The disproportionate impact on women, adults over 65 years of age, and residents of the Sierra region suggests the involvement of various biological, environmental, and social determinants of health, which requires more rigorous surveillance and a differentiated approach for these particularly vulnerable populations.

Background: Differing conceptualizations of recurrent and persistent depression in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD) lead to diagnostic inconsistencies. This scoping review analyzed epidemiological studies on the lifetime prevalence of recurrent and persistent depression in the general population.

Methods: Following PRISMA-ScR guidelines, we searched MEDLINE and the Russian Science Citation Index without time or language restrictions. Inclusion criteria were original epidemiological studies of the general population reporting lifetime prevalence of recurrent or persistent depression, using DSM-III/IV/5 or ICD-9/10/11 criteria.

Results: Only three studies on recurrent depression were identified - from Switzerland, the USA, and Hungary - showing a consistent lifetime prevalence of 10.3% to 10.5%. In contrast, major depressive disorder had a lifetime prevalence of 1.5 to 2.5 times higher in these studies. Dysthymia and persistent depression showed lifetime prevalences ranging from 1.1% to 6.4% and 1.6% to 18%, respectively. Women represented about two-thirds of cases of both recurrent and persistent depression.

Conclusion: The underrepresentation of recurrent depression may stem from the DSM's dominant influence in psychiatric diagnostics. Our findings highlight the need for refined diagnostic criteria and more comprehensive epidemiological studies that separately identify recurrent and persistent depression.

Introduction: A competition is considered a stressful situation since it causes physiological and emotional changes in the responses of athletes and consequently influences their performance. The aim of our study was to investigate competitive anxiety and heart rate variability (HRV) in professional eSports athletes, comparing the responses before and after matches based on whether they won or lost. We hypothesized that victorious players would display more favorable autonomic and anxiety-related responses after the matches compared to those who were defeated.

Methods: We recruited fifty male esports players from 10 different Brazilian teams and carried out the experiment across two sessions. Initially, 24 hours before the game, players signed the informed consent form, and sample characterization, along with player familiarization with anxiety and HRV, was performed. Following this, the players recorded their anxiety levels and HRV at rest for 10 minutes, both 60 and 30 minutes prior to the game (baseline time points), as well as 10 minutes after the conclusion of the game.

Results: Regarding anxiety, our results demonstrated that the victory group (VG) exhibited significantly lower scores for both cognitive and somatic anxiety in the post-game time point, coupled with increased scores for self-confidence when compared to the baseline (BL) and pre-game time points. In opposition, the defeated group (DG) displayed significantly elevated scores for cognitive and somatic anxiety during the post-game time point, accompanied by decreased self-confidence scores compared to the baseline and pre-game time points. Regarding heart rate variability (HRV), the victory group (VG) demonstrated a significant increase in SDNN, rMSSD, and HF measures, coupled with a significant decrease in the LF/HF ratio. Conversely, the defeated group (DG) exhibited a significant decrease in SDNN and rMSSD, along with a significant increase in the LF/HF ratio.

Discussion: Our results revealed that VG exhibited better HRV responses, indicating greater parasympathetic activation. VG also showed lower levels of cognitive and somatic anxiety and higher levels of self-confidence in the post-game time. In contrast, DG demonstrated worse HRV responses, indicating greater sympathetic activation, along with higher levels of cognitive and somatic anxiety and lower levels of self-confidence in the same post-game period.

Conclusion: In summary, the VG exhibited superior HRV responses in conjunction with lower levels of anxiety compared to the DG.

Introduction: Depression is a major public health issue worldwide, ranking fourth among global diseases in 2022 according to the WHO. In Indonesia, the 2018 Basic Health Research (Riskesdas) reported that over 12 million individuals aged 15 and above suffer from depression. Identifying regional disparities in depression prevalence is essential to guide targeted mental health policies and interventions.

Methods: This study employed the Natural Breaks Jenks classification to cluster depression prevalence across Indonesian provinces using data from the 2023 Indonesia Health Survey. This method effectively grouped provinces based on natural data patterns, enabling the identification of regions with low, medium, high, and very high depression prevalence.

Results: The analysis revealed significant regional disparities. Eighteen provinces, including Papua, Maluku, and several Sulawesi regions, were classified as having low depression prevalence. Eleven provinces, such as Aceh, Bali, and Kalimantan Timur, fell into the medium category. Six provinces-including DKI Jakarta, Banten, and Sumatera Selatan-exhibited high prevalence rates, possibly due to urbanization and socio-economic factors. Critically, Jawa Barat, Jawa Tengah, and Jawa Timur were identified as having very high depression prevalence, suggesting urgent needs for intervention.

Discussion: These findings underscore the need for geographically targeted mental health strategies. Provinces with very high prevalence require prioritized attention for mental health services, infrastructure, and resource allocation. Understanding local socio-economic and cultural contexts will be crucial in reducing disparities and improving national mental health outcomes.

Conclusion: These results indicate that Indonesia has a higher number of provinces with low depression prevalence compared to those with high prevalence. This suggests that while there are regions with lower rates of depression, there are still significant areas where mental health issues need more focused attention. Given this, the government should prioritize provinces with very high depression prevalence to improve mental health outcomes in those areas. By focusing on these regions, the government can better allocate resources, implement targeted interventions, and provide necessary mental health services. Addressing the mental health needs of provinces with high depression rates is essential for reducing overall national mental health disparities and ensuring equitable access to mental health support across Indonesia. Additionally, understanding the socio-economic and cultural factors that contribute to higher depression rates in these regions will be crucial in designing effective and sustainable mental health programs.

Background: Research in the field of existential psychotherapy has mainly relied on measures of spiritual well-being and existential quality of life, and has been hindered by the lack of instruments specifically assessing existential distress and wellbeing. Our aim was to develop a valid and reliable instrument to measure this dimension.

Methods: First, we created a list comprising more than 200 items that address the main existential themes as described by the philosophical and clinical literature. Out of these, 84 were retained after pilot testing and exclusion of the items that showed unsatisfactory psychometric properties. A total of 411 non-clinical participants with a wide range of age groups and educational levels participated in the validation study with a cross-sectional design and a 4-week follow-up. They completed the new instrument, named the 'Existential Dimension Inventory' (EDIN), along with several criterion measures, such as the 15-item Dispositional Resilience Scale, the 18-item Personal Well-Being Scale, the Experiences in Close Relationships Questionnaire, the 18-item Brief Symptom Inventory, the Maudsley Obsessive-Compulsive Inventory, the Authenticity Scale, and the Temperament and Character Inventory. They also completed the EDIN for a second time after 4 weeks. After performing principal component analysis with orthogonal rotation, we estimated the internal consistency and test-retest stability of EDIN factorially derived scales. Convergent and discriminant validity were assessed by examining the correlations between EDIN total and subscale scores, and scores on the criterion measures.

Results: Eight factors (interpreted as Mastery, Fear of loss and death, Authenticity, Serenity in relationships, Pressure of time, Openness to others, Worry about meaning in life, and Loneliness) that accounted for 53% of the total variance were extracted. All EDIN scales displayed high internal consistency and stability, and the pattern of correlations between EDIN scores and their relevant criterion measures was consistent with expectations. Also, the results supported discriminant validity with respect to emotional distress, psychiatric symptomatology, and temperament and character dimensions.

Conclusion: These findings suggested that the EDIN may allow valid and reliable measurement of existential well-being. Many EDIN subscales cover themes identified by existential philosophers and therapists as key issues that human beings face in their everyday lives, which corroborates the relevance of the dimension of existential wellbeing as measured by the EDIN. Despite some limitations, this study supports the validity and reliability of the EDIN. It suggests that this instrument holds the promise of being a valuable tool for research, clinical, and training purposes.

Introduction: Juvenile Idiopathic Arthritis (JIA), among children and adolescents, is a heterogeneous condition and is a prevalent chronic rheumatological disease. Non-medical (e.g., self-efficacy, social support, parental distress, and coping with pain), medical factors (e.g., permanent damage to joints), and psychological factors (e.g., depression and anxiety) can significantly impact the quality of life for individuals with JIA.

Methods: This study aimed to investigate the effect modifiers of the associations of anxiety and depression in children with JIA. The National Survey of Children's Health database (2016-2021) was used for the current study. A total of 192,019 children were included in the analyses. An augmented backward elimination model selection method was used to identify predictors for depression and anxiety.

Results: The period prevalence of JIA was 2.723 per 1,000. Sex was an effect modifier. Among boys, those who had JIA were 2.96 times (p<0.0001) more likely to have depression compared to non-JIA boys. On the other hand, the effects of JIA on anxiety were different across the insurance types. Among children with public insurance, children with JIA were 6.28 times (p <0.0001) more likely to have anxiety than those without JIA. Among children with JIA, those with public insurance were 5.23 times (p = 0.0005) more likely to have anxiety than those with private insurance.

Discussion: This population-based study found that typical sex differences in depression were not observed in the JIA group and that children with JIA had higher rates of anxiety, particularly those with public insurance. These findings highlight the need for integrated care that addresses both physical and mental health.Collaborative models involving rheumatologists and mental health professionals may aid in early intervention. Limitations include the study's cross-sectional design, which did not establish a causal association, and a lack of analysis by the JIA subtype, which could have varying impacts on mental health outcomes.

Conclusion: The findings highlight the importance of conducting comprehensive mental health assessments and developing personalized interventions tailored to the needs of JIA patients. The observed sex differences and the impact of insurance type on anxiety further emphasize the necessity of individualized care approaches.

Introduction: Virtual Reality (VR) is an interactive, three-dimensional computing environment that enables individuals to experience a sense of presence as if they are immersed in a real-world setting. VR is currently being implemented in therapeutic interventions for individuals with certain mental disorders.

Objective: To illustrate the implementation and evolution of VR in the treatment of panic disorder, agoraphobia, and panic disorder with or without agoraphobia over the past decade.

Method: A systematic literature review was conducted based on articles retrieved from PubMed, Cochrane, and Web of Science, covering the period from 2013 to 2023. A total of 21 studies were selected after analyzing the titles, abstracts, and content in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.

Results: A total of 153 articles were initially selected and included in the study. The results demonstrated the evolution and increasing use of VR-based technologies for the treatment of mental disorders, including panic disorder and PDA.

Discussion: The utilization of VR exposure therapy (VRET) for patients with panic disorder, agoraphobia, or PDA yielded measurable outcomes, including the evolution of VRET applications, an increase in the number of scientific articles and patients in recent years, as well as advancements in hardware devices, software, and other application methods, such as self-guided applications.

Conclusions: The implementation of VRET is increasing in several regions worldwide, and its evolution is indisputable for the treatment of panic disorder, agarophobia, and PDA. Comparisons with traditional in vivo methods revealed that VRET yields satisfactory and promising outcomes. The continued evolution of VR technology is expected to expand its potential application in patients with these disorders.

Objective: The aim of this work is to verify whether a cohort of elderly people with hyper-energy tended to increase depressive symptoms and misaligned social and personal rhythms during the lockdown compared to a cohort of older adults without hyper-energy one year before the lockdown.

Methods: The two cohorts were evaluated in April 2019 (T0) and in April 2020 (T1). Hyper-energy, cognitive performance, depressive symptoms, and social and personal rhythms were evaluated at T0 and T1.

Results: In the measure of the Brief Social Rhythm Scale (BSRS) score, the differences between groups in the two observation times reach statistical significance. The sub-group with previous hyper-energy at T0 but no longer having hyper-energy at T1 increases the score by more than 5 points (a higher score indicates greater rhythm dysregulation, thus having a worse regulation of rhythms at T1), while in those individuals who didn't have hyper-energy, the score remains substantially unchanged (+0.06). However, if the increase in the score from T0 and T1 is measured, both groups with hyper-energy at T0 presented a greater mean increase compared to people who did not have hyper-energy at T1. In the total of the eleven elderly people with hyper-energy at T0, the mean increase in BSRS score was 1.05±1.19 versus 0.06±0.98 (F=9.407, P=0.003), and in people who no longer had hyper-energy at T1, it was 1.05±1.19 versus 5.50±3.83 (F=105.0, P<0.0001). In people with hyper-energy at T0, the mean increase in the Patient Health Questionnaire-9 (PHQ-9) score was 0.72±0.75 versus 0.01±0.28 (F=37.153, P<0.0001). The gain was even higher in people who no longer had hyper-energy at T1, 1.38±1.03 vs. 0.01±0.28 (F=87.386, P<0.0001). An inverse linear correlation was found between energy perception (measured as the score of Item 10 of SF-12) and the score of PHQ-9 measuring depressive symptoms both at T0 and, more strongly, at T1, as well as with the BSRS scores, but only at T1.

Conclusion: The study, despite the limitations of a small sample, seems to confirm a greater vulnerability to the lockdown situation in people with hyperactivity, even in the absence of psychopathology (i.e., part of the bipolar spectrum).

Background: Bipolar disorders negatively impact functional outcomes and, consequently, prognosis. The Functioning Assessment Short Test is a reliable tool to evaluate functional outcomes in people with bipolar disorders.

Aim: The aim of the study was to conduct a cross-cultural validation of the Functioning Assessment Short Test (FAST) and to explore correlations between functional impairment and sociodemographic and clinical variables.

Methods: A cross-sectional study was carried out in a population of 60 bipolar patients and 60 healthy controls. The scales administered were the Global Functioning Assessment (GAF), the World Health Organization Quality Of Life-Bref (WHOQOL-BREF), the FAST, and a questionnaire containing sociodemographic and clinical variables. The validation study was based on face and content validity, reliability, and construct validity.

Results: The face and content validity were satisfactory. The internal consistency obtained was high, with a Cronbach's alpha of 0.785. All six FAST domains had significant correlations with each other and with the total score. The FAST assessment at baseline and week 2 were highly correlated (p>0.05), and the intraclass correlation coefficient was 0.998, indicating high test-retest reliability. The FAST total score was negatively and significantly associated with GAF (rho=-0.788, p<0.001) and WHOQOL-BREF scores, suggesting good concurrent validity. The total FAST scores were significantly lower in controls as compared with bipolar patients (p<0.001), with a cut-off at 26. Functional impairment was significantly associated with the following variables: low educational level, living alone, early age at onset, number of depressive episodes, and treatment associations (mood stabilizers and antipsychotics).

Conclusion: The Tunisian Arabic version of the FAST demonstrated satisfactory psychometric properties and could be used to assess specific domains of functional impairment in people living with bipolar disorders and may be instrumental in implementing psychosocial and rehabilitation interventions.