Network analysis of subjective happiness, hope and resilience in the Paraguayan general population during the post-COVID-19 pandemic period / Análisis en red de felicidad subjetiva, esperanza y resiliencia en la población general paraguaya en la pospandemia del COVID-19

Abstract Introduction/objective: In this cross-sectional study, the connections between indicators of subjective happiness, hope, and resilience were investigated in 591 adult Paraguayans (average age 37.7 years; SD = 11.35) during the COVID-19 post-pandemic period, using network analysis for the first time. Method: The indicators of subjective happiness, hope, and resilience were assessed using the Subjective Happiness Scale, the Adult Hope Scale, and the 10-item Connor-Davidson Resilience Scale, respectively. Result: The results indicated that "Enjoy life in spite of it all," "Pursuing goals," and "Coping with stress" were the most central indicators of the resilience, hope, and subjective happiness network. While stronger conditional relationships were observed between indicators of the same network variable, potential bridge indicators were also noted that could link resilience, hope, and subjective happiness, such as "I am a strong person," "Enjoy life in spite of it all," "Pursuing goals," and "I have been successful in life." Conclusions: The results suggest that timely and multilevel interventions targeted at central and bridge indicators can help promote positive emotions that impact mental health.

Resumen Introducción/objetivo: En este estudio transversal se investigaron las conexiones entre los indicadores de felicidad subjetiva, esperanza y resiliencia en 591 paraguayos adultos (edad promedio 37.7 años; DE = 11.35) en el período pospandemia del COVID-19 utilizando análisis de redes por primera vez. Método: Los indicadores de felicidad subjetiva, esperanza y resiliencia se evaluaron utilizando la Escala de Felicidad Subjetiva, la Escala de Esperanza del Adulto y la Escala de Resiliencia de Connor-Davidson de 10 ítems, respectivamente. Resultados: Los resultados indicaron que "Disfrutar la vida a pesar de todo", "Perseguir metas" y "Afrontar el estrés" fueron los indicadores más centrales de la red de resiliencia, esperanza y felicidad subjetiva. Si bien se observaron relaciones condicionales más fuertes entre indicadores de la misma variable de red, también se observaron posibles indicadores puente que podrían vincular la resiliencia, la esperanza y la felicidad subjetiva, como "Soy una persona fuerte", "Disfruta la vida a pesar de todo", "Persiguiendo metas" y "He tenido éxito en la vida". Conclusiones: Los resultados sugieren que las intervenciones oportunas y multinivel dirigidas a indicadores centrales y puente pueden ayudar a promover emociones positivas que impacten la salud mental.

The impact of social media screen-exposure time on suicidal ideation among Pakistani adolescents.

BACKGROUND: Adolescence is a crucial life stage for the individual identity formation. The growing employment of social media and screen-exposure among teenagers and the concerning rise in suicide ideation rates in this susceptible group both suggested this study. Thus, we explored the association between adolescents' suicidal ideation and their daily social media screen-exposure. METHODS: We surveyed 502 students, aged 13 to 19 years old, recruited in colleges and universities of Punjab, Pakistan. The survey was based on a 28-item self-reported questionnaire and demographic data collection. RESULTS: Approximately 40% of adolescents reporting suicidal ideation showed an extended social media screen-exposure, as well as significant depressive feelings and problematic personality traits. In particular, suicidal ideation increased by 0.39 for each one-unit increase in screen-exposure time and levels of depression increased by 0.21 times by unit of screen-exposure. The correlation coefficients further indicated a moderate positive association between depression and suicidal thoughts as well as personality traits played as mediators between social media screen-exposure time and suicidal ideation among adolescents. CONCLUSION: Our study found a positive association, even if modest, between the use of social media screens and suicidal ideation among adolescents. This evidence may suggest to adopt specific strategies to address the use of media among youths and prevent mental disorders related to the prolonged and inappropriate use of digital technologies in those users with a vulnerable personality.

Determinants of brain drain among physicians in Turkey: Findings from a national exploratory study.

BACKGROUND: The shortage of physicians in Turkey is a highly critical emergency. In fact, physicians' migration to developing or high-income countries, defined as brain drain, threatens the sustainability of the national healthcare system. AIMS: This study explored the driving factors associated with Turkish Physicians' brain drain, including high-economic inflation, social-politics, poor-living, equity, violence, and the desire to practice medical activity abroad. METHODS: A cross-sectional survey of 1,861 Turkish physicians aged 25 to 65 years old was conducted employing the Brain Drain questionnaire, the Depression Anxiety Stress Scale (DASS-21), the Patient Health Questionnaire 9 (PHQ-9), and the Fatigue Assessment Scale (FAS). RESULTS: Significant differences were observed among physicians staying in Turkey versus considering migration to Western countries, regarding their age, gender, marital status, educational level, occupational status, work years, hospital night shifts, income, and cigarette/nargileh smoking habits (all p ⩽ .018). The main reasons for brain drain included transport problems, harassment, low salary, malpractice, bad environment, job insecurity, workload, burnout, treating difficult patients, inadequate postgraduate systems, peer-pressure, health safety concerns, and favoritism in the workplace, as well as stress and depression caused by work overload. In fact, depression, anxiety, stress, fatigue, and burnout varied significantly among the different groups of physicians (all p ⩽ .013). Additionally, key predictors of brain drain were better job opportunities, poor hospital management (in Turkey), job-related stress, dealing with difficult patients, research deficiencies, workload, burnout, transportation issues, short consultation time, low salary, and fatigue. Among the general factors contributing to the brain drain in the Turkish Health System, we identified significant issues related to research deficiencies, compulsory working duties, poor quality of postgraduate, inadequate medical-schools, poor hospital management, and shortage of consultants. CONCLUSION: Physicians' migration is a major global public health concern, leading to substantial risks for healthcare services, especially in Turkey. Many physicians decide to migrate to work in Western countries.

Speculation fit for a king? Medical announcements from the British royal family and the recurring ethical complexities of personal privacy and public commentary from physicians.

This article explores the ethical complexities of openly-expressed medical commentary using recent cancer diagnoses within the British monarchy as illustrative cases. Specifically, it examines tensions between public interest, personal privacy, and professional standards, underlining the adverse implications of conjectural discourse, alongside the role of physicians in enhancing wider medical understanding.

The Mpox outbreak is a public health emergency of international concern: Implications for mental health and global preparedness.

BACKGROUND: The Mpox, a zoonotic viral disease that has historically affected Central and West Africa, has been declared a Public Health Emergency of International Concern by the World Health Organization. Rapid transmission and recent dissemination in Africa may imply significant challenges to global health, including mental health. METHODS: We reviewed the mental health implications of the Mpox outbreak according to the published literature. We also discussed the psychological effects of the global spreading of this infection and public health preparedness strategies. Key areas of intervention may include the epidemiological surveillance, vaccine development, and mental health strategies. COMMENTS: The Mpox outbreak calls for a robust global preparedness to address potential health emergencies. Strengthening epidemiological surveillance, ensuring equitable vaccine distribution, and building resilient public health infrastructure are crucial. Additionally, addressing mental health consequences may require immediate, intermediate, and long-term strategies, including telepsychiatry, stress management training, and the integration of mental health into primary care.

Masculinity stigma and metastatic prostate cancer: A review with a focus on Latin America.

BACKGROUND: This review examines the impact of masculinity stigma on the diagnosis and treatment of metastatic prostate cancer, particularly in Latin America. It aims to provide insights into the influence of masculinity stigma on patient outcomes and inform strategies to address this issue. METHODS: A comprehensive search was conducted in electronic databases (PubMed, PsycINFO, CINAHL and LILACS) using relevant keywords and controlled vocabulary related to metastatic prostate cancer, masculinity, stigma, diagnosis, and treatment up to April 2023. The search strategy was developed in consultation with a medical librarian to ensure its comprehensiveness. Thirty-three studies that investigate the role of masculinity stigma in the diagnosis and treatment of metastatic prostate cancer were included. RESULTS: Our findings highlight the unique sociocultural influences in Latin America that shape prostate cancer stigma. It emphasizes the impact of cultural beliefs, gender norms, and social expectations on stigma. Notions of masculinity, such as strength and invulnerability, contribute to the stigmatization of prostate cancer. Machismo culture and religious/spiritual beliefs further compound the challenges and hinder open communication about the disease. Cultural taboos, limited awareness, and misconceptions perpetuate the stigma. CONCLUSIONS: These sociocultural factors shape the experiences and challenges faced by individuals with and at risk of prostate cancer in Latin America.

World Psychiatric Association-Asian Journal of Psychiatry Commission on Public Mental Health.

Although there is considerable evidence showing that the prevention of mental illnesses and adverse outcomes and mental health promotion can help people lead better and more functional lives, public mental health remains overlooked in the broader contexts of psychiatry and public health. Likewise, in undergraduate and postgraduate medical curricula, prevention and mental health promotion have often been ignored. However, there has been a recent increase in interest in public mental health, including an emphasis on the prevention of psychiatric disorders and improving individual and community wellbeing to support life trajectories, from childhood through to adulthood and into older age. These lifespan approaches have significant potential to reduce the onset of mental illnesses and the related burdens for the individual and communities, as well as mitigating social, economic, and political costs. Informed by principles of social justice and respect for human rights, this may be especially important for addressing salient problems in communities with distinct vulnerabilities, where prominent disadvantages and barriers for care delivery exist. Therefore, this Commission aims to address these topics, providing a narrative overview of relevant literature and suggesting ways forward. Additionally, proposals for improving mental health and preventing mental illnesses and adverse outcomes are presented, particularly amongst at-risk populations.

Mental health and the ballot box: A correlational analysis of Google searches for mental health and national election periods in the United States and the United Kingdom from 2008 to 2020.

BACKGROUND: In electoral contexts, mental health topics have recently attracted sociopolitical relevance, influenced by policy developments, election-related psychopathology and popular discourse about individual candidates. Yet, whether this reflects generalised trends or is contingent on election-specific and contextual factors remains difficult to ascertain. AIMS: This study sought to examine correlations between Google Trends (GT) data on mental health and four national elections in the US and the UK from 2008 to 2020. This was intended to yield preliminary insights into the relevance of mental health topics amongst voters and the potential impact of electoral cycles on patterns of online engagement with these issues. METHODS: Monthly and daily Search Volume Indexes (SVI) were gathered from the 'Mental Health' category on GT in the US and UK from 2008 to 2023. SVI were evaluated around the past four national ballots, comparing election-year intervals and baseline data from the preceding year. Statistical tests were conducted to assess SVI and short- and long-term dynamics. FINDINGS: The results showed heterogeneous SVI patterns related to mental health during elections in the US and the UK. In the US, there were statistically significant SVI increases proximal to the majority of elections as compared to data in the same calendar year, but these did not typically exceed baseline SVI. However, interestingly, divisive US contests showed correlations with several elevated SVI measures in the same and previous years. Conversely, there was a lack of consistent longitudinal trends in UK elections, perhaps informed by its disparate sociopolitical landscape. CONCLUSIONS: These findings underline the composite relationship between electoral politics and popular engagement with mental health topics around national votes, suggesting that this is driven more by situational factors rather than a recurrent electoral effect or signs of burgeoning engagement. Detailed research is required to understand the nuances and causality behind these dynamics and their wider implications.

Individualized strategies for depression: narrative review of clinical profiles responsive to vortioxetine.

BACKGROUND: Depression is a highly heterogeneous disorder, often resulting in suboptimal response and remission rates. This underscores the need for more nuanced clinical characterization of patients to tailor individualized treatment plans. Emerging evidence highlights the critical role of cognitive and emotional dysfunction in major depression, prompting the exploration of novel therapeutic interventions that target these specific symptom domains. MAIN TEXT: Vortioxetine, a multimodal antidepressant, enhances serotonergic activity while also modulating several other neurotransmitter systems involved in depressive symptoms such as emotional blunting, anhedonia, and cognitive dysfunction. Numerous randomized, placebo-controlled trials have demonstrated vortioxetine's efficacy and safety in treating depression, particularly in specific subgroups of depressed patients, including those with cognitive deficits and comorbid anxiety symptoms or disorders. Although not randomized or placebo-controlled, studies have also shown vortioxetine's efficacy in depressed patients with emotional blunting or anhedonia. Vortioxetine's ability to effectively treat a range of depressive symptoms, including anhedonia, emotional blunting, anxiety, and cognitive dysfunction, provides an individualized treatment solution for depressed individuals suffering from these symptoms. The purpose of this paper is to identify clinical profiles of patients who may benefit from vortioxetine, with the goal of optimizing therapeutic outcomes. CONCLUSION: Vortioxetine has been shown to be effective for patients with depression and symptoms such as anhedonia, emotional blunting, anxiety, and cognitive dysfunction. Tailoring treatment plans to individual needs and personalizing treatment choices based on the specific symptoms presented by depressed patients improve treatment outcomes.

The efficacy of heart rate variability biofeedback training on sleep disorders and impact of fibromyalgia: Results of a phase II randomized controlled trial.

OBJECTIVE: Fibromyalgia syndrome (FMs) is a chronic, musculoskeletal pain disorder characterized by sleep disturbances, fatigue, and cognitive dysfunction. Heart rate variability biofeedback (HRV-BF) aiming to improve self-regulation and strengthen the parasympathetic nervous system has been shown to be effective in several pain syndromes, but its efficacy in FMs has not been adequately investigated. This Phase II trial aimed to assess the feasibility and preliminary measurement of the improvement induced by HRV-BF in FMs. METHODS: Sixty-four patients with FMs were recruited. Patients were randomly assigned to either the experimental group (EG) or the control group (CG). The EG received 10 HRV-BF training sessions in addition to pharmacological standard therapy. The CG received standard therapies for 10 weeks. The FMs impact on daily life, sleep regularity, sense of coherence, depression symptoms and pain has been assessed as primary outcomes, quality of life as secondary. RESULT: 23 (71.9%) of EG patients completed the intervention and 20 (62.5%) of the CG were re-evaluated at time T1. No side effects were reported. It was not found any statistical differences between groups over time in primary and secondary outcomes. CONCLUSIONS: The HRV-BF intervention did not demonstrate efficacy in both primary and secondary outcomes. However, it is quite feasible in terms of drop-out rate and side effects. Further studies with larger sample sizes are needed to determine its actual efficacy. CLINICALTRIALS: gov with code: NCT04121832.

Structural inequalities, knife crime: A qualitative study.

The importance and impact of youth violence is increasingly being recognised and is a cause of international concern. In the UK, youth violence, specifically knife crime, is on the increase and has resulted in the deaths of many young people. In order to explore the impact of knife crimes on mental health and wellbeing of individuals, a number of focus groups were conducted with 24 professionals from multiple agencies. Qualitative analysis showed various emerging themes, which included ineffective mental health systems, structural violence and inequalities, policing, safety and community engagement, vulnerability and resilience in minority communities. Equity in mental health services, further development and roll-out of public mental health approaches and training accompanied by sufficient resources is needed.

Mapping the Neural Substrates of Cocaine Craving: A Systematic Review.

Craving is one of the most important symptoms of cocaine use disorder (CUD) since it contributes to the relapse and persistence of such disorder. This systematic review aimed to investigate which brain regions are modulated during cocaine craving. The articles were obtained through searches in the Google Scholar, Regional BVS Portal, PubMed, and Scielo databases. Overall, there was a selection of 36 studies with 1574 individuals, the majority being participants with CUD, whereby about 61.56% were individuals with CUD and 38.44% were controls (mean age = 40.4 years). Besides the methodological points, the neurobiological investigations comprised fMRI (58.34%) and PET (38.89%). The induction of cocaine craving was studied using different methods: exposure to cocaine cues (69.45%), stressful stimuli, food cues, and methylphenidate. Brain activations demonstrated widespread activity across the frontal, parietal, temporal, and occipital lobes, basal ganglia, diencephalon, brainstem, and the limbic system. In addition to abnormalities in prefrontal cortex activity, abnormalities in various other brain regions' activity contribute to the elucidation of the neurobiology of cocaine craving. Abnormalities in brain activity are justified not only by the dysfunction of dopaminergic pathways but also of the glutamatergic and noradrenergic pathways, and distinct ways of inducing craving demonstrated the involvement of distinct brain circuits and regions.

Exploring the Relationship between Neuroticism and Perinatal Depressive Symptoms: Findings from a 2-Year, Multicenter Study in Italy.

Neuroticism is a personality trait associated with the risk of affective disorders and perinatal depression. We investigated the relationship between different levels of neuroticism, psychological characteristics, and depressive symptoms in a sample of pregnant women (N = 2631) who accessed the gynecology departments in the Puglia Region (Italy) from July 2020 to November 2022. Women were assessed for depressive symptoms and associated risk factors in their third trimester of pregnancy (T0) and after childbirth (T1), and followed-up at 6 months and 1 year after delivery if presenting signs of depression (T2-T3). The Edinburgh Postnatal Depression Scale (EPDS) was used to screen depressive symptoms, and neuroticism was assessed through the subscales of the NEO Five Factor Inventory. Standardized measures of resilience, coping strategies, partner attachment, and quality of life were also employed. Higher levels of neuroticism were significantly associated with: (a) higher scores on the EPDS; (b) higher anxiety in the experience of close relationships; (c) lower psychological wellbeing; (d) lower levels of resilience; (e) lower levels of active coping; and (f) higher levels of self-blame. Our findings may suggest that neuroticism is a specific associated factor of perinatal depression and should be routinely assessed in the clinical screening of pregnant women in order to promote an early referral to psychological or psychiatric support services.

Physical and Mental Health Characteristics of Hospitalized COVID-19 Patients with and without Type 2 Diabetes Mellitus in Turkey.

The aim of this study was to assess the rates of depression, anxiety, and stress and quality of sleeping among COVID-19 patients with and without type 2 diabetes mellitus (T2DM). A case and control design has been employed, involving patients affected by COVID-19 infection (884 with T2DM vs. 884 controls without T2DM) and hospitalized in Istanbul (Turkey) from January to December 2021. A multivariate stepwise regression approach was used to test the associations between sociodemographic, metabolic, serum markers, mental health scores, and T2DM/COVID-19 patients' clinical presentation. A statistically significant difference between T2DM and non-T2DM was found with respect to age, gender, BMI (body mass index), smoking, physical exercise, and physical comorbidities as well as levels of depression, anxiety, stress, and sleeping disorders (0.0003 ≤ all p = 0.025). With regard to serum biomarkers, vitamin D and ferritin were identified as useful parameters of reduction of glycated hemoglobin as well as COVID-19 infection among T2DM patients. This study detected that 25% of patients with COVID-19 and T2DM experienced mental distress, with sleeping disturbances and lifestyle changes markedly impacting their clinical outcome alongside metabolic and serum parameters.