Effectiveness of Culinary Nutrition Workshops on the Mood and Nutritional Interest of Inpatients With Mental Disorder.

Background Promoting healthy eating habits through nutrition education programs is crucial to improving the overall health of people with mental disorders. This study aims to assess the effectiveness of culinary nutrition workshops on the mood and nutritional interest of hospitalized adults with mental disorders (MD) from the acute psychiatric unit of two general hospitals in Catalonia, Spain. Methods A pilot randomized control trial (RCT) was conducted with MD inpatient. Participants were randomly assigned to two groups: the intervention group received weekly culinary nutrition workshops with flexible participation and the control group continued routinary care. The interest in nutrition was analysed with an ad hoc item pre and post-intervention period. Mood changes were studied with a visual analog scale and analysed pre- and post-intervention periods as well as before and after every session. An ad hoc questionnaire was also used to assess the satisfaction of participants with the intervention. The obtained data were analysed at both descriptive and inferential levels. Results We included 81 participants, with a mean age of 45.3 (SD: 17.0); 66.7% were women, with 41 assigned to the intervention group and 40 to the control group. At the end of every culinary nutrition workshop, a statistically significant improvement in mood was observed in the intervention group (5.9 vs. 7.4 points, p<0.001). However, there were no significant differences in mood changes between the control and intervention groups after the intervention period (control group: 1.0 vs. intervention group: 1.5, p=0.473), while the nutritional interest was significantly improved after the intervention period intergroups (control group: 4.1 vs. intervention group: 37.2, p<0.001). The intervention was excellently valued by the participants regarding content, space, and health professionals, and generated interest and motivation, with scores above 9 on all these items. Conclusion The improvement of interest in nutrition and the satisfaction of hospitalised people with MD with the nutrition culinary workshops emphasize the need to design more comprehensive RCTs in hospitals and rehabilitation centers.

Prevalence, severity and risk factors for mental disorders among sexual and gender minority young people: a systematic review of systematic reviews and meta-analyses.

Evidence suggests heightened prevalence and severity of mental disorders among sexual minority (SM) and gender minority (GM) young people. Several risk factors have been associated with these disparities. A systematic review of systematic reviews and meta-analysis was conducted to provide a comprehensive overview of the literature and to determine the field's current position. MEDLINE, PsycInfo, Scopus and Web of Science were searched in March 2022 and updated January 2024. Eligibility criteria were systematic reviews or meta-analyses assessing contemporaneous prevalence, severity and/or risk factors of mental disorders among SM or GM young people aged 25 and under. 42 reviews were included, all of which were low quality. The prevalence of depression among SM was 26% (95% CI 21-32%), and among GM was 46% (95% CI 36-56%). Greater depression severity was found among SM compared to heterosexual young people, with a significant albeit small effect size (Hedges' g = 0.38, 95% CI = 0.25 to 0.50); effect sizes were similar when separating by gender. GM also reported greater symptom severity compared to cisgender young people. Other mental disorders were more prevalent compared to those reported in the general population, and of greater severity compared to heterosexual/cisgender young people. Several proximal and distal risk factors were focused upon within the systematic reviews identified. Past systematic reviews consistently indicate a heightened risk of mental disorders among SM and GM young people. Services need to be aware of these disparities and adapt their care accordingly.

An Epidemiological Study of Physical-Mental Multimorbidity in Youth: Une étude épidémiologique de la morbidité physique-mentale chez les jeunes.

OBJECTIVE: This epidemiological study estimated the lifetime prevalence of chronic physical illness (i.e., an illness that lasted or was expected to last ≥6 months) and 6-month prevalence of mental disorder and multimorbidity (i.e., ≥1 physical illness and ≥1 mental disorder) in youth. Associations between physical illness and mental disorder were quantified, including the number of illnesses. Secondary objectives examined factors associated with mental disorder, after controlling for physical illness. METHODS: Data come from 10,303 youth aged 4-17 years in the 2014 Ontario Child Health Study (OCHS). Physical illness was measured using a list of chronic conditions developed by Statistics Canada. Mental disorders were measured using the OCHS Emotional Behavioural Scales. The Health Utility Index Mark III assessed overall functional health. RESULTS: Weighted prevalence estimates showed 550,090 (27.8%) youth had physical illness, 291,986 (14.8%) had mental disorder, and 108,435 (5.4%) had multimorbidity. Physical illness was not associated with mental disorder. However, youth with 2 physical illnesses, as compared to no physical illnesses, had increased odds of having any mental (OR = 1.75 [1.08, 2.85]), mood (OR = 2.50 [1.39, 4.48]) and anxiety disorders (OR = 2.40 [1.33, 4.31]). Mean functional health scores demonstrated a dose-response association across health status categories, with the highest scores among healthy youth and the lowest scores among multimorbid youth (all p < .05). CONCLUSION: Chronic physical illness and mental disorders are prevalent in youth. Youths with 2 physical illnesses have a higher likelihood of mental disorders. Higher functional health scores protected against all mental disorders. Mental health interventions for youth should promote strong overall functional health.

Physical-Mental Multimorbidity in Ontario YouthPlain Language SummaryThis study examined mental disorders in Ontario youth with and without chronic physical illnesses. Youth with at least one physical illness and one mental disorder have physical-mental multimorbidity. 27.8% of youth had chronic physical illness (that lasted at least six months), 14.8% had mental disorder, and 5.4% had multimorbidity. Risk factors for any mental, mood, and anxiety disorders included living with two chronic physical illnesses. Overall functional health of youth declined from youth that were healthy (no physical illness or mental disorder), chronic physical illness only, mental illness only, to multimorbid youth. Youth mental health interventions should promote strong overall functional health.

The relationship of race, ethnicity, gender identity, sex assigned at birth, sexual orientation, parental education, financial hardship and comorbid mental disorders with quality of life in college students with anxiety, depression or eating disorders.

BACKGROUND: Previous studies showed that comorbidity and demographic factors added to burden on health-related quality of life (HRQoL). Only one study explored the relationship between HRQoL and comorbidity in college students with mental disorders, leaving generalizability of findings uncertain. Less is known about the association of demographics on HRQoL. This study investigated HRQoL based on demographics and comorbidity among college students with mental disorders. METHODS: Participants were students (N = 5535) across 26 U.S. colleges and universities who met criteria for depression, generalized anxiety, panic, social anxiety, post-traumatic stress, or eating disorders based on self-report measures. ANOVA and linear regressions were conducted. RESULTS: Overall, female, minoritized (gender, sexual orientation, race, or ethnicity), and lower socioeconomic status students reported lower HRQoL than male, heterosexual, White, non-Hispanic, and higher socioeconomic status peers. After accounting for comorbidity, differences in physical HRQoL based on sex assigned at birth and gender were no longer significant. For mental HRQoL, only gender and sexual orientation remained significant. A greater number of comorbidities was associated with lower HRQoL regardless of demographic group. LIMITATIONS: The non-experimental design limits causal inference. The study focused on univariable associations without examining potential interactions between demographic factors. Future research should explore structural factors like discrimination. CONCLUSION: Results suggested that increased comorbidities placed an additional burden on HRQoL and that certain demographic groups were more vulnerable to HRQoL impairment among students with mental disorders. Findings suggest the need for prevention of disorders and their comorbidity and implementing tailored interventions for specific student subgroups with increased vulnerability.

Examining the mental health services among people with mental disorders: a literature review.

BACKGROUND: Mental disorders are a significant contributor to disease burden. However, there is a large treatment gap for common mental disorders worldwide. This systematic review summarizes the factors associated with mental health service use. METHODS: PubMed, Scopus, and the Web of Science were searched for articles describing the predictors of and barriers to mental health service use among people with mental disorders from January 2012 to August 2023. The initial search yielded 3230 articles, 2366 remained after removing duplicates, and 237 studies remained after the title and abstract screening. In total, 40 studies met the inclusion and exclusion criteria. RESULTS: Middle-aged participants, females, Caucasian ethnicity, and higher household income were more likely to access mental health services. The use of services was also associated with the severity of mental symptoms. The association between employment, marital status, and mental health services was inconclusive due to limited studies. High financial costs, lack of transportation, and scarcity of mental health services were structural factors found to be associated with lower rates of mental health service use. Attitudinal barriers, mental health stigma, and cultural beliefs also contributed to the lower rates of mental health service use. CONCLUSION: This systematic review found that several socio-demographic characteristics were strongly associated with using mental health services. Policymakers and those providing mental health services can use this information to better understand and respond to inequalities in mental health service use and improve access to mental health treatment.

Oral health knowledge, attitudes, and practices of people living with mental illness: a mixed-methods systematic review.

People living with mental illness experience poorer oral health outcomes compared to the general population, yet little is known about their oral health knowledge, attitudes, and practices. The aim of this mixed-methods systematic review was to synthesise evidence regarding oral health knowledge, attitudes, and practices of people living with mental illness to inform preventative strategies and interventions. Database searches were conducted in PubMed, MEDLINE, PsycINFO, CINAHL, ProQuest, and Scopus with no limitations placed on the year of study. All studies available in the English language, that explored the oral health knowledge, attitudes, and/or practices of people with a mental illness were included. Articles were excluded if they primarily pertained to intellectual disability, behavioural and psychological symptoms of dementia, drug and alcohol or substance use, or eating disorders. A thematic synthesis was undertaken of 36 studies (26 high-moderate quality), resulting in 3 themes and 9 sub-themes. Study participants ranged from n = 7 to n = 1095 and aged between 15-83 years with most having a diagnosis of schizophrenia, schizoaffective, or bipolar affective disorder. People diagnosed with a mental illness were found to have limited oral health knowledge, particularly regarding the effects of psychotropic medication. Various barriers to oral health care were identified, including high dental costs, the negative impact of mental illness, dental fears, lack of priority, and poor communication with dental and health care providers. Study participants often displayed a reduced frequency of tooth brushing and dental visits. The findings highlight the potential for mental health care providers, oral health and dental professionals, mental health consumers, and carers to work together more closely to improve oral health outcomes for people with mental illness. The systematic review protocol is registered with the International Prospective Register of Systematic Reviews (PROSPERO), (registration ID CRD42022352122).

Higher Risk of Mental Illness in Patients With Diagnosed and Untreated Unruptured Intracranial Aneurysm: Findings From a Nationwide Cohort Study.

BACKGROUND: We aimed to investigate the association between a diagnosis of untreated unruptured intracranial aneurysms (UIAs) and the development of mental illness. METHODS: This retrospective, propensity-score-matched cohort study was based on the nationwide South Korean database. The UIA diagnosis group included participants newly diagnosed with UIA between 2011 and 2019. For a well-matched control group, patients diagnosed with an acute upper respiratory infection but without UIA during the same period were selected through 1:4 matching based on propensity scores, which were calculated using age, sex, economic status, and comorbidities. The study's outcome measure encompassed the incidence of mental illnesses over a 10-year period, using International Classification of Diseases-Tenth Revision codes for anxiety, stress, depressive, bipolar, and eating disorders, insomnia, and alcohol or drug misuse. RESULTS: After propensity score matching, 85 438 participants with untreated UIAs (50.75% male; average age, 56.41 [±13.82] years; follow-up, 4.21 [±2.56] years) and 331 123 controls (49.44% males; average age, 56.69 [±12.92] years; follow-up, 7.48 [±2.12] years) were compared. Incidence rate of mental illness was higher in the UIA group (113.07 versus 90.41 per 1000 person-years; hazard ratio, 1.104 [95% CI, 1.089-1.119]). The risk of mental illness varied slightly by sex (males: hazard ratio, 1.131 [95% CI, 1.108-1.155]; females: hazard ratio, 1.082 [95% CI, 1.063-1.103]). Hazard ratios showed a U-shaped relationship with age, peaking in younger age groups, decreasing in middle-aged groups, and slightly increasing in older age groups, especially in patients with severe mental illness receiving psychotherapy. CONCLUSIONS: Our findings indicate a higher risk of mental illness in patients with UIA diagnosis in specific demographic groups, suggesting a possible psychological burden associated with UIAs. Clinicians treating cerebral aneurysms should be aware that the psychological burden caused by the diagnosis of UIA itself could contribute to mental illness and strive to provide comprehensive care for these patients.

Quality of life among people with mental illness attending a psychiatric outpatient clinic in Ethiopia: a structural equation model.

Background: Mental illness is one of the most severe, chronic, and disabling public health problems that affects patients' Quality of life (QoL). Improving the QoL for people with mental illness is one of the most critical steps in stopping disease progression and avoiding complications of mental illness. Therefore, we aimed to assess the QoL and its determinants in patients with mental illness in outpatient clinics in Northwest Ethiopia in 2023. Methods: A facility-based cross-sectional study was conducted among people with mental illness in an outpatient clinic in Ethiopia. The sampling interval was decided by dividing the total study participants who had a follow-up appointment during the data collection period (2400), by the total sample size 638, with the starting point selected by lottery method. The interviewer-administered WHOQOL BREF-26 tool was used to measure the quality of life (QoL) of people with mental illness. The domains of QoL were identified, and indirect and direct effects of variables were calculated using structural equation modelling with SPSS-28 and Amos-28 software. A p-value of < 0.05 and a 95% CI were used to evaluate statistical significance. Results: A total of 636 (99.7%) participants agreed to participate and completed the data collection. The mean score of overall QoL of people with mental illness in the outpatient clinic was 49.6 ± 10 Sd. The highest QoL was found in the physical health domain (50.67 ± 9.5 Sd), and the lowest mean QoL was found in the psychological health domain (48.41 ± 10 Sd). Rural residence, drug nonadherence, suicidal ideation, not getting counselling, moderate or severe subjective severity, family does not participate in patient care and a family history of mental illness had an indirect negative effect on QoL. Alcohol use and psychological health domain had direct positive effect on QoL. Furthermore, objective severity of illness, having low self-esteem, and having history of mental illness in the family had both direct and indirect effect on QoL. Furthermore, sociodemographic factors (rural residence, illiterate educational status, not married marital status), social support-related factors (poor self-esteem, family not participating in patient care), substance use factors (alcohol use, tobacco use) and clinical factors (high objective and subjective severity of illness, not getting counselling, suicidal ideation, higher number of episodes, comorbid illness, family history of mental illness, poor drug adherence) directly and indirectly affected QoL. Conclusions: In this study, the QoL of people with mental illness was poor, with the psychological health domain the most affected. Sociodemographic factors, social support-related factors, drug use factors, and clinical factors, directly and indirectly affected QoL through the mediator variables of physical health domains, psychological health domains, social relation health domains, and environmental health domains. In order to improve the QoL of people with mental illnesses, we recommend that emphasis be given to addressing the QoL of those with mental illness, including the development of policy and practice responses that address the above identified factors.

A scoping review about the portrayal of depression and anxiety in mainstream and social media.

Media portrayal of mental disorders has a significant impact on awareness and stigma. Given the high prevalence of depression and anxiety as mental disorders, it is crucial to understand how they are represented. This scoping review aimed to map the existing literature on the portrayal of depression and anxiety in mainstream and social media. A comprehensive search was conducted in PubMed and PsychInfo, resulting in the inclusion of 20 records that predominantly examined social media and newspapers. Findings indicate that social media discussions on depression were mostly supportive and non-stigmatising. Public figures and role models played a significant role in encouraging open communication. Research on newspapers and other media forms yielded mixed results yet leaning towards positive portrayals. Limited studies explored anxiety portrayal. While acknowledging potential limitations in generalisability, this review emphasises the importance of accurately depicting mental health in media, particularly on social media platforms, while highlighting the need for broader investigations into anxiety representation.

Beyond Step Count: Are We Ready to Use Digital Phenotyping to Make Actionable Individual Predictions in Psychiatry?

Some models for mental disorders or behaviors (eg, suicide) have been successfully developed, allowing predictions at the population level. However, current demographic and clinical variables are neither sensitive nor specific enough for making individual actionable clinical predictions. A major hope of the "Decade of the Brain" was that biological measures (biomarkers) would solve these issues and lead to precision psychiatry. However, as models are based on sociodemographic and clinical data, even when these biomarkers differ significantly between groups of patients and control participants, they are still neither sensitive nor specific enough to be applied to individual patients. Technological advances over the past decade offer a promising approach based on new measures that may be essential for understanding mental disorders and predicting their trajectories. Several new tools allow us to continuously monitor objective behavioral measures (eg, hours of sleep) and densely sample subjective measures (eg, mood). The promise of this approach, referred to as digital phenotyping, was recognized almost a decade ago, with its potential impact on psychiatry being compared to the impact of the microscope on biological sciences. However, despite the intuitive belief that collecting densely sampled data (big data) improves clinical outcomes, recent clinical trials have not shown that incorporating digital phenotyping improves clinical outcomes. This viewpoint provides a stepwise development and implementation approach, similar to the one that has been successful in the prediction and prevention of cardiovascular disease, to achieve clinically actionable predictions in psychiatry.

Application of Facial Expression Analysis Technology in Violence Risk Assessment of Individuals with Mental Disorders in Supervised Settings.

OBJECTIVES: To explore the association between violent behaviors and emotions in individuals with mental disorders, to evaluate the application value of facial expression analysis technology in violence risk assessment of individuals with mental disorders in supervised settings, and to provide a reference for violence risk assessment. METHODS: Thirty-nine male individuals with mental disorders in supervised settings were selected, the participant risk of violence, cognitive function, psychiatric symptoms and severity were assessed using the Modified Overt Aggression Scale (MOAS), the Historical, Clinical, Risk Management-Chinese version(HCR-CV), the Positive and Negative Syndrome Scale (PANSS) and the Brief Psychiatric Rating Scale (BPRS). An emotional arousal was performed on the participants and the intensity of their emotions and facial expression action units was recorded before, during and after the arousal. One-way analysis of variance (ANOVA) was used to compare the differences in the intensity of emotions and facial expression action units before, during and after the arousal. Pearson correlation analysis was used to calculate the correlations between the intensity of the seven basic emotional facial expressions and the scores of the assessment scales. RESULTS: The intensity difference of sadness, surprise and fear in different time periods was statistically significant (P<0.05). The intensity of the left medial eyebrow lift action unit was found significantly different before and after the emotional arousal (P<0.05). The intensity of anger was positively correlated with the Modified Overt Aggression Scale score throughout the experiment (P<0.05). CONCLUSIONS: Eye action units such as eyebrow lifting, eyelid tightening and upper eyelid lifting can be used as effective action units to identify sadness, anger and other negative emotions associated with violent behaviors. Facial expression analysis technology can be used as an auxiliary tool to assess the potential risk of violence in individuals with mental disorders in supervised settings.

Hospital-treated bipolar disorder in adolescence in Finland 1980-2010: Rehospitalizations, diagnostic stability, and mortality.

AIMS: Estimates of the occurrence of bipolar disorder among adolescents vary from country to country and from time to time. Long delays from first symptoms to diagnosis of bipolar disorder have been suggested. Studies among adults suggest increased mortality, particularly due to suicide and cardiovascular diseases. We set out to study the prognosis of adolescent onset bipolar disorder in terms of rehospitalizations, diagnostic stability, and mortality. METHODS: The study comprised a register-based follow-up of all adolescents admitted to psychiatric inpatient care for the first time in their lives at age 13-17 during the period 1980-2010. They were followed up in the National Care Register for Health Care and Causes of death registers until 31 December 2014. RESULTS: Incidence of bipolar disorder among 13- to 17-year-old adolescents over the whole study period was 2.8 per 100, 000 same aged adolescents, and across decades, the incidence increased six-fold. Patients with bipolar disorder during their first-ever inpatient treatment were rehospitalized more often than those treated for other reasons. Conversion from bipolar disorder to other diagnoses was far more common than the opposite. Mortality did not differ between those firstdiagnosed with bipolar disorder and those treated for other reasons. CONCLUSION: The incidence of adolescent onset bipolar disorder has increased across decades. The present study does not call for attention to delayed diagnosis of bipolar disorder. Adolescent onset bipolar disorders are severe disorders that often require rehospitalization, but diagnostic stability is modest. Mortality is comparable to that in other equally serious disorders.

Improvements in the quality of the parent-child relationship following treatment with an integrated family approach.

Objective: This study investigated changes in the emotional availability of the parent and the child in the dyadic relationship, parental reflective functioning, and parental perception of the relationship with their child following treatment with an integrated family approach in adult and child mental health care services. The aim of the study was to investigate if an integrated family approach in treatment contributes to good practice in mental health care. Background: Children of parents with a mental disorder are at increased risk for developing mental health problems themselves during lifetime. Infants are extremely vulnerable for environmental influences. Parents with mental disorders are at risk for mis-attuned behavior and non-optimal emotional availability. This increases the risk of adverse cascading effects on the parent-child relationship and child development. A secure parent-child relationship is an important protective factor against the intergenerational transmission of mental disorders. Although treatment of the parental mental disorder is important, it does not automatically change undesirable patterns in the parent-child relationship. Therefore, an integrated family approach to mental health treatment is recommended. Methods: This study involved a mixed methods design using questionnaires, an observation instrument and semi-structured interviews. The variables examined were the quality of the parent-child interaction, the parental perspective on their relationship with the child, their problems with child upbringing, and on their parental reflective functioning. The clinical sample consisted of 50 patients with a variety of mental disorders and their young children. Results: After finishing the integrated treatment the quality of the parent-child interaction had improved significantly. Likewise, we found a significant improvement in parental perception regarding the relationship with the child and the parental role. The majority of the parents interviewed showed that they were better able to mentalize about themselves, their child and their relationship with the child, but the data from the questionnaire showed mixed results regarding parents' reflective functioning. Conclusion: Treatment with an integrated family approach to mental health care in which the parental role of the patient, the young child, and the parent-child relationship are integrated in treatment, can be a valuable addition to the current practice of mental health care in which patients are commonly perceived as individuals.

The role of personal recovery and internalised stigma on the expression of symptomatology in severe mental disorders: Mediating and moderating effects.

OBJECTIVE: Given the relevance of internalised stigma in people suffering from a mental disorder, in the present study, the possible mediating and moderating role of self-stigma in the relationship between personal recovery and symptomatology has been studied. METHOD: 265 participants with severe mental disorder completed the following instruments: ISMI (self-stigma), REE (personal recovery) and HoNOS, CGI, GAF and EuroQol (symptomatology). RESULTS: both the mediation and moderation analyses show significant results, which would indicate that internalised stigma has an effect on the relationship between personal recovery and symptomatology. Also, people with lower level of personal recovery and greater self-stigma have greater symptomatology than those who are in more advanced personal recovery processes and have a lower perception of internalised stigma. DISCUSSION: the findings of this study suggest that self-stigma has an effect, and the improvement at personal recovery and symptomatology is accentuated when people with a severe mental disorder have a better management of internalised stigma. Therefore, it may be interesting to include this variable in recovery interventions.

Extended Reality for Mental Health Evaluation: Scoping Review.

BACKGROUND: Mental health disorders are the leading cause of health-related problems worldwide. It is projected that mental health disorders will be the leading cause of morbidity among adults as the incidence rates of anxiety and depression grow worldwide. Recently, "extended reality" (XR), a general term covering virtual reality (VR), augmented reality (AR), and mixed reality (MR), is paving the way for the delivery of mental health care. OBJECTIVE: We aimed to investigate the adoption and implementation of XR technology used in interventions for mental disorders and to provide statistical analyses of the design, usage, and effectiveness of XR technology for mental health interventions with a worldwide demographic focus. METHODS: In this paper, we conducted a scoping review of the development and application of XR in the area of mental disorders. We performed a database search to identify relevant studies indexed in Google Scholar, PubMed, and the ACM Digital Library. A search period between August 2016 and December 2023 was defined to select papers related to the usage of VR, AR, and MR in a mental health context. The database search was performed with predefined queries, and a total of 831 papers were identified. Ten papers were identified through professional recommendation. Inclusion and exclusion criteria were designed and applied to ensure that only relevant studies were included in the literature review. RESULTS: We identified a total of 85 studies from 27 countries worldwide that used different types of VR, AR, and MR techniques for managing 14 types of mental disorders. By performing data analysis, we found that most of the studies focused on high-income countries, such as the United States (n=14, 16.47%) and Germany (n=12, 14.12%). None of the studies were for African countries. The majority of papers reported that XR techniques lead to a significant reduction in symptoms of anxiety or depression. The majority of studies were published in 2021 (n=26, 30.59%). This could indicate that mental disorder intervention received higher attention when COVID-19 emerged. Most studies (n=65, 76.47%) focused on a population in the age range of 18-65 years, while few studies (n=2, 3.35%) focused on teenagers (ie, subjects in the age range of 10-19 years). In addition, more studies were conducted experimentally (n=67, 78.82%) rather than by using analytical and modeling approaches (n=8, 9.41%). This shows that there is a rapid development of XR technology for mental health care. Furthermore, these studies showed that XR technology can effectively be used for evaluating mental disorders in a similar or better way that conventional approaches. CONCLUSIONS: In this scoping review, we studied the adoption and implementation of XR technology for mental disorder care. Our review shows that XR treatment yields high patient satisfaction, and follow-up assessments show significant improvement with large effect sizes. Moreover, the studies adopted unique designs that were set up to record and analyze the symptoms reported by their participants. This review may aid future research and development of various XR mechanisms for differentiated mental disorder procedures.

P factor in children with chronic physical illness.

BACKGROUND: The p factor represents the overall liability for the development of mental illness. While evidence supporting the p factor in adults has been reported, studies in children are fewer, and none have examined the p factor in children with chronic physical illness (CPI). OBJECTIVE: We aimed to model the p factor in a longitudinal sample of children with CPI using a parent-reported checklist and examine its construct validity against a structured diagnostic interview. METHODS: We used data from 263 children aged 2-16 years diagnosed with a CPI who were enrolled in the Multimorbidity in Children and Youth across the Life-course (MY LIFE) study. The p factor was modelled using the Emotional Behavioural Scales over 24 months using confirmatory factor analysis. Validation of the p factor was set against the Mini International Neuropsychiatric Interview for Children and Adolescents. RESULTS: Factorial evidence supported the p factor, modelled using a bi-factor structure, compared to a standard correlated-factors (i.e., two-factor) structure [Δχ2 = 9.66(4), p = 0.047]. p factor scores were correlated with the number of different mental illness diagnoses (r = 0.71) and total number of diagnoses (r = 0.72). Dose-response relationships were shown for the number of different diagnoses (p < 0.001) and total number of diagnoses (p < 0.001). CONCLUSION: In this first study of the p factor in children with CPI, we showed evidence of its bi-factor structure and associations with mental illness diagnoses. Mental comorbidity in children with CPI is pervasive and warrants transdiagnostic approaches to integrated pediatric care.

Learning Outcomes of e-Learning in Psychotherapy Training and Comparison With Conventional Training Methods: Systematic Review.

BACKGROUND: Mental disorders pose a major public health problem in most western countries. The demand for services for common mental health disorders has been on the rise despite the widespread accessibility of medication. Especially, the supply and demand for evidence-based psychotherapy do not align. Large-scale increase of modern psychotherapy is difficult with current methods of training which are often expensive, time consuming, and dependent on a small number of top-level professionals as trainers. E-learning has been proposed to enhance psychotherapy training accessibility, quality, and scalability. OBJECTIVE: This systematic review aims to provide an overview of the current evidence regarding e-learning in psychotherapy training. In particular, the review examines the usability, acceptability, and learning outcomes associated with e-learning. Learning outcomes are assessed in different modalities including trainee experiences, knowledge acquisition, skill acquisition, and application of trained content in daily practice. Furthermore, the equivalence of web-based training and conventional training methods is evaluated. METHODS: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a search from Ovid, MEDLINE, PsycINFO, and Scopus databases between 2008 and June 2022 was conducted. Inclusion criteria required studies to describe e-learning systems for psychotherapy training and assess acceptability, feasibility, or learning outcomes. The risk of bias was evaluated for both randomized and nonrandomized studies. Learning outcomes were categorized using the Kirkpatrick model. Effect sizes comparing e-learning and traditional methods were calculated. RESULTS: The search yielded 3380 publications, of which 34 fulfilled the inclusion criteria. Positive learning outcomes are generally associated with various e-learning programs in psychotherapy training including trainee satisfaction, knowledge, and skill acquisition, and in application of trained content in clinical practice. Learning outcomes generally show equivalence between e-learning and conventional training methods. The overall effect size, indicating this disparity, was 0.01, suggesting no significant difference. This literature displays a high level of heterogeneity in e-learning solutions and assessment methods. CONCLUSIONS: e-Learning seems to have good potential to enhance psychotherapy training by increasing access, scalability, and cost-effectiveness while maintaining quality in terms of learning outcomes. Results are congruent with findings related to e-learning in health education in general where e-learning as a pedagogy is linked to an opportunity to carry out learner-centric practices. Recommendations for conducting psychotherapy training programs in blended settings supported by activating learning methods are presented. However, due to the heterogeneity and limitations in the existing literature, further research is necessary to replicate these findings and to establish global standards for e-learning, as well as for the assessment of training outcomes in psychotherapy education. Research is especially needed on the effects of training on patient outcomes and optimal ways to combine e-learning and conventional training methods in blended learning settings.

Increased antipsychotic drug concentration in hospitalized patients with mental disorders following COVID-19 infection: a call for attention.

Purpose: Examine the alterations in antipsychotic concentrations following coronavirus disease-2019 (COVID-19) infection among hospitalized patients with mental disorders and conduct an analysis of the factors influencing these changes. Methods: Data were collected from inpatients at Beijing Huilongguan Hospital between December 12, 2022, and January 11, 2023, pre- and post-COVID-19. Based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, 329 inpatients with mental disorders were included (3 with incomplete data excluded). Primary outcomes assessed changes in antipsychotic concentrations pre- and post-COVID-19, while secondary outcomes examined factors linked to concentration increases and antipsychotic dose adjustments. Results: Clozapine (P < 0.001), aripiprazole (P < 0.001), quetiapine (P = 0.005), olanzapine (P < 0.001), risperidone (P < 0.001), and paliperidone (P < 0.001) concentrations increased post-COVID-19 in patients with mental disorders. Notably, clozapine concentration surpassing pre-infection levels was highest. Clozapine users were more likely to adjust their dose (50.4%) compared to olanzapine (17.5%) and other antipsychotics. Moreover, traditional Chinese patent medicines and antibiotics during COVID-19 infection were associated with antipsychotic reduction or withdrawal (OR = 2.06, P = 0.0247; OR = 7.53, P = 0.0024, respectively). Conclusion: Antipsychotic concentrations in hospitalized patients with mental disorders increased after COVID-19 infection, that may be related not only to COVID-19, but also to the use of Chinese patent medicines during infection. The pre-infection concentration and types of antipsychotics, patient's gender, and combination of traditional Chinese medicine or antibiotics, were factors found to correlate with increased drug concentrations and necessitate dose adjustments.

Do Integrated Community Psychiatry Services in Primary Health Care Settings Improve Continuity of Care? A Mixed-methods Study of Health Care Users' Experiences in South Africa.

Background: A community psychiatry service is provided from selected primary health care (PHC) clinics in Gauteng, South Africa. This study described the demographic and clinical characteristics of health care users (HCUs), and explored HCUs' experiences of these services in order to shed light on the challenges of integrating psychiatric services into PHC. Methods: A mixed-methods study was conducted at two PHC clinics, where 384 clinical records were reviewed and 23 HCUs were interviewed. In Clinic-1, community psychiatry services were co-located, while in Clinic-2, these services were physically integrated into the PHC clinic. Results: HCUs from both clinics were generally female (55%), had not completed secondary level education (65%), and were unemployed (80%). Both clinics struggled with medication stock-outs and had the same number of community psychiatry health care providers. Compared to the co-located clinic, the physically integrated clinic had insufficient consultation rooms (compromising confidentiality), higher caseloads (910 compared to 580), more HCUs with psychotic disorders (61% compared to 44%) and a history of missed medication (58% compared to 40%). In both clinics, overall care coordination was limited, although some nurses coordinated care for HCUs. While organisational integration approaches improved the proximity of mental health services, there were challenges in continuity of care within and across health care sites. Conclusion: Coordination and continuity of care were constrained in both clinics, regardless of the organisational integration approaches used. As low- and middle-income countries work towards integrating mental health care into PHC, the implementation of organisational integration approaches should consider physical space, caseload, HCU need, and the inclusion of dedicated providers to coordinate care.

Development and Psychometric Properties of the Spanish Social Stigma Scale (S3).

(1) Background: Mental health problems are associated with negative connotations that may lead to discrimination and rejection of people diagnosed with mental disorders. The present study aimed to develop and validate a new scale (the Spanish Social Stigma Scale-S3) to assess the current level of social stigma in the general Spanish population. (2) Methods: The assessment tool was developed after reviewing the items of existing tools that represent the most appropriate indicators for the assessment of social stigma. A review was performed by volunteer subjects and by a group of experts in the field, based on the participation of 563 respondents to a survey. (3) Results: The confirmatory factor analysis revealed that the developed tool fits with the factors that determine the level of social stigma and shows good internal consistency (χ2SB = 412.0321, gl = 293, p < 0.01; BBNNFI = 0.922; CFI = 0.930; IFI = 0.931; RMSEA = 0.028 [0.022, 0.035]). (4) Conclusions: The S3 is useful for assessing knowledge, attitudes, and behavior towards people diagnosed with a mental disorder. This tool may be used for the identification and development of mechanisms necessary for the reduction of social stigma in the general population.