Post-COVID job Stressors and Their Predictive Role on Mental Health: A Cross-Sectional Analysis Between Physicians and Nurses.

Introduction: Health care providers face heightened stress and increased rates of anxiety and depression post-COVID-19. The pandemic, officially declared over in May 2023, continues to impact their wellbeing significantly, with ongoing mental health monitoring and tailored interventions crucial for support. Objectives: The aim of this study was to describe the frequency of job stressors in a sample of Spanish health care providers post-COVID and to explore potential differences between physicians and nurses, hypothesizing that while both professional categories could experience similar job stressors, some of them could have a differential impact on the mental health of each subgroup. Methods: This cross-sectional substudy is part of the MINDxYOU project. The data were collected from 191 health care providers from two regions in Spain. Participants completed the UNIPSICO test battery, used to assess job stressors, and questionnaires to evaluate perceived stress, depressive symptomatology, anxiety, and resilience. Descriptive analyses, bivariate correlations, and linear regression models were performed to compare the two professions that were the most representative of our sample: physicians (n = 82) and nurses (n = 54). Results: The most frequent job stressors were workload, lack of positive feedback, and inequity in social interactions. Physicians reported worse outcomes in terms of workload, autonomy, role conflicts, inequity in social interactions, and work-family balance compared to nurses. Mobbing, despite not being very frequent, significantly predicted different mental health outcomes for both physicians and nurses. Inequity in social interactions and job satisfaction were significant predictors of physicians' mental health, while role ambiguity, interpersonal conflicts, and career turnover intentions predicted nurses' mental health. Conclusion: As hypothesized, our findings highlight that certain job stressors (i.e., inequity in social interactions, conflicts in the workplace) might be affecting physicians' and nurses' mental health differently. Therefore, effective strategies addressing each subgroup's specific stressors would be necessary to prevent the development of burnout syndrome and other serious mental health conditions associated with occupational stress. These strategies would imply organizational changes in most cases.

Is it possible to diagnose therapeutic adherence in mild cognitive impairment and dementia patients in clinical practice?

Background: Non-adherence is common and contributes to adverse health outcomes, reduced quality of life, and increased healthcare expenditure. The objective of this study was to assess the diagnostic validity to estimate the prevalence of non-adherence in patients with mild cognitive impairment (MCI) and dementia using two self-reported methods (SRMs) that are useful and easy in clinical practice, considering the pill count as a reference method (RM). Methods: The cohort study was nested in a multicenter randomized controlled trial NCT03325699. A total of 387 patients from 8 health centers were selected using a non-probabilistic consecutive sampling method. Inclusion criteria were as follows: a score of 20-28 points on the Mini-Mental State Examination (MMSE); older than 55 years; taking prescribed medication; and are in charge of their own medication use. Participants were followed up for 18 months after the baseline visit, i.e., 6, 12, and 18 months. Variables related with treatment adherences were measured in all visits. The variables included age, sex, treatment, comorbidities, and the MMSE test. Adherences included pill counts and Morisky-Green test (MGT) and Batalla test (BT) as SRMs. Statistical analysis included descriptive analysis and 95% confidence intervals (CIs). The diagnostic validity included the following: 1) open comparison statistical association between SRMs and RMs and 2) hierarchy comparison: the RM as the best method to assess non-adherence, kappa value (k), sensitivity (S), specificity (Sp), and likelihood ratio (PPV/PPN). Results: A total of 387 patients were recruited with an average age of 73.29 years (95% CI, 72.54-74.04), of which 59.5% were female. Comorbidities were 54.4% HTA, 35.9% osteoarticular pathology, and 24.5% DM. The MMSE mean score was 25.57 (95% CI, 25.34-25.8). The treatment adherence for the RM oscillates between 22.5% in the baseline and 26.3%, 14.8%, and 17.9% in the follow-up visits. For SRMs, the treatment adherence oscillates between 43.5% in the baseline and 32.4%, 21.9%, and 20.3% in the follow-up visits. The kappa value was statistically significant in all the comparison in all visits with a score between 0.16 and 035. Regarding the diagnostic validity, for the MGT, the sensibility oscillated between 0.4 and 0.58, and the specificity oscillated between 0.68 and 0.87; for the BT, the sensibility oscillated between 0.4 and 0.7, and the specificity oscillated between 0.66 and 0.9; and when both tests were used together, the sensibility oscillated between 0.22 and 0.4, and the specificity oscillated between 0.85 and 0.96. Conclusion: SRMs classify non-adherent subjects correctly. They are very easy to use and yield quick results in clinical practice, so SRMs would be used for the non-adherence diagnosis in patients with MCI and mild dementia.

Pharmacotherapeutic value of inflammatory and neurotrophic biomarkers in bipolar disorder: A systematic review.

BACKGROUND: The various pharmacological interventions, ranging from mood stabilizers and antipsychotics to antidepressants, reflect the diff/iculty of treating depressive/manic symptomatology of bipolar disorder (BD). Among a broad range of mechanisms implicated, immune dysregulation may contribute to the increased inflammation that influences the course of BD. Inflammatory, neurotrophic and oxidative stress factors may be identified as promising peripheral biomarkers in brain functioning, perhaps serving as predictors of an effective response to treatment for BD. The present systematic review aimed to examine the evidence supporting the pharmacotherapeutic value of inflammatory and neurotrophic biomarkers in BD. METHODS: PubMed, PsychINFO, Scopus and Web of Science were searched from inception to May 2024 by two independent reviewers. A total of 40 studies with 3371 patients with diagnosis and intervention of BD were selected. RESULTS: Inconsistencies in the effects of pharmacological treatments on the connection between the expected anti-inflammatory response and symptomatologic improvement were identified. Mood stabilizers (lithium), antipsychotics (quetiapine), antidepressants (ketamine) or their combination were described to increase both pro-inflammatory (TNFα, IL-6) and anti-inflammatory (IL-4, IL-8) factors. Other medications, such as memantine and dextromethorphan, autoimmune (infliximab) non-steroidal anti-inflammatory (aspirin, celecoxib) drugs, antidiabetics (pioglitazone), and even dietary supplementation (omega-3), or their combination, clearly decrease inflammatory factors (TNFα, IL-6, IL-1ß, C-reactive protein) and/or increase the neurotrophic factor BDNF in BD patients. CONCLUSION: Inflammation in BD requires further investigation to understand the underlying immunologic mechanism, to identify predictors of treatment response, and to make informed decisions about the use and development of more effective pharmacological interventions for BD.

Fine-mapping genomic loci refines bipolar disorder risk genes.

Bipolar disorder (BD) is a heritable mental illness with complex etiology. While the largest published genome-wide association study identified 64 BD risk loci, the causal SNPs and genes within these loci remain unknown. We applied a suite of statistical and functional fine-mapping methods to these loci, and prioritized 17 likely causal SNPs for BD. We mapped these SNPs to genes, and investigated their likely functional consequences by integrating variant annotations, brain cell-type epigenomic annotations, brain quantitative trait loci, and results from rare variant exome sequencing in BD. Convergent lines of evidence supported the roles of genes involved in neurotransmission and neurodevelopment including SCN2A, TRANK1, DCLK3, INSYN2B, SYNE1, THSD7A, CACNA1B, TUBBP5, PLCB3, PRDX5, KCNK4, CRTC3, AP001453 . 3, TRPT1, FKBP2, DNAJC4, RASGRP1, FURIN, FES, DPH1, GSDMB, MED24 and THRA in BD. These represent promising candidates for functional experiments to understand biological mechanisms and therapeutic potential. Additionally, we demonstrated that fine-mapping effect sizes can improve performance of BD polygenic risk scores across diverse populations, and present a high-throughput fine-mapping pipeline ( https://github.com/mkoromina/SAFFARI ).

Gender differences and risk of readmission in hospitalizations with a diagnosis of psychotic spectrum disorders.

BACKGROUND: Gender differences in psychosis are a topic that has been studied considering different aspects. Although some available evidence would point to a possible better prognosis in women, this claim is far from conclusively established. METHODS: We propose an analysis of gender differences in the risk of readmission to an acute hospitalization unit, an indicator related to prognosis. RESULTS AND CONCLUSIONS: We found that although the risk of readmission at 1 year is lower in women, this seems to be explained by other confounding factors.

Community-based art groups in mental health recovery: A systematic review and narrative synthesis.

INTRODUCTION: Though the evidence of the role of the arts in mental health is growing, no systematic review has focused on the impact of art groups in non-clinical settings in the process of recovery following the CHIME framework. AIM: The aim of this study was to examine the effects of engaging in community-based art groups in mental health recovery. METHOD: A search in five electronic databases for relevant research using quantitative, qualitative or mixed methods published between 2000 and 2019 identified nine eligible studies. RESULTS: While there was great methodological heterogeneity, most studies were qualitative, used visual arts, facilitated by artists and assessed by mental health nurses, and took place in community locations or artistic venues. Quantitative outcomes, though few, provided evidence of increased well-being, and qualitative outcomes corresponded mostly with the recovery process of Connectedness. Additional outcomes related to the settings were a sense of safety and to the intervention: self-expression, development of skills and achievements, and the impact of final exhibitions and peer leadership. DISCUSSION: Studies should aim at prospective designs following mixed methods approaches, with larger and gender-sensitive samples, control groups and follow-up assessments, and evaluate cost-effectiveness. IMPLICATIONS FOR PRACTICE: Community-based art groups which increase well-being and promote connectedness should be key in recovery-action planning.

Impulsivity, decision-making, and risk behavior in bipolar disorder and major depression from bipolar multiplex families.

OBJECTIVES: Bipolar disorder (BD) and major depressive disorder (MDD) are characterized by specific alterations of mood. In both disorders, alterations in cognitive domains such as impulsivity, decision-making, and risk-taking have been reported. Identification of similarities and differences of these domains in BD and MDD could give further insight into their etiology. The present study assessed impulsivity, decision-making, and risk-taking behavior in BD and MDD patients from bipolar multiplex families. METHODS: Eighty-two participants (BD type I, n = 25; MDD, n = 26; healthy relatives (HR), n = 17; and healthy controls (HC), n = 14) underwent diagnostic interviews and selected tests of a cognitive battery assessing neurocognitive performance across multiple subdomains including impulsivity (response inhibition and delay aversion), decision-making, and risk behavior. Generalized estimating equations (GEEs) were used to analyze whether the groups differed in the respective cognitive domains. RESULTS: Participants with BD and MDD showed higher impulsivity levels compared to HC; this difference was more pronounced in BD participants. BD participants also showed lower inhibitory control than MDD participants. Overall, suboptimal decision-making was associated with both mood disorders (BD and MDD). In risk-taking behavior, no significant impairment was found in any group. LIMITATIONS: As sample size was limited, it is possible that differences between BD and MDD may have escaped detection due to lack of statistical power. CONCLUSIONS: Our findings show that alterations of cognitive domains-while present in both disorders-are differently associated with BD and MDD. This underscores the importance of assessing such domains in addition to mere diagnosis of mood disorders.

Suicidal behavior in persons attended in out-of-hospital emergency services in Spain.

Background: The aims of this study were to describe the use of health services by patients attended for suicidal behavior by out-of-hospital emergency services and to identify the variables associated with the repetition of this behavior in Spain. Methods: An analytical, observational, retrospective study was carried out. A total of 554 patients attended by the mobile teams of the Primary Care Emergency (mt-PCES) of the Malaga Health District (Spain), after being coordinated by the 061 Emergency Coordination Center (ECC) were analyzed. Results: Of the total, 61.9% of the patients were women and the mean age was 43.5 years. Ninety-six percent (N = 532) of the patients attended by mt-PCES were transferred to hospital emergency services. Regarding clinical decision, of those transferred 436 persons (82%) were discharged home. Of the total sample 25.5% (N = 141) were referred to primary care, while 69% (N = 382) were referred to outpatient mental health care. Regarding follow up in the 6 months after being seen by emergency services, among those referred to a mental health facility, 64.4% (N = 246) attended the follow-up appointment while out of the total sample only 50.5% (N = 280) attended a follow-up appointment with an outpatient mental health service. Finally, it should be noted that 23.3% presented a relapse of suicidal behavior in the 6 months following index episode. The variables associated with repetition of suicidal behavior were older age, greater number of previous suicide attempts and having any contact with mental health services in the following 6 months. Conclusion: We believe that selective suicide prevention initiatives should be designed to target the population at risk of suicide, especially those receiving both out-of-hospital and in-hospital emergency services.

Effectiveness of museum-based participatory arts in mental health recovery.

The World Health Organization encourages mental health services to adopt a strategic intersectoral approach by acknowledging the potential of the arts and the value of culture on the process of mental health recovery. The aim of this study was to evaluate the impact of participatory arts in museums on mental health recovery. A quasi-experimental, pre-post and multicentre study was carried out. By using a mixed methods evaluation at baseline and at 3 months, quantitative outcome measures were used to assess the changes in recovery and social support and qualitative interviews to explore the self-perceived impact on five processes of recovery. One hundred mental health service users participated for 3 years in the face-to-face programme RecuperArte, of which the data of 54 were analysed. The results indicate a significant increase in recovery measured with the QPR-15-SP (42 vs. 44; p = 0.034) and almost significant in functional social support measured with the DUKE-UNC (41.50 vs. 43.50; p = 0.052), with almost large (r = 0.29) and medium (r = 0.26) effect sizes, respectively. Participants perceived mostly an impact on the recovery process of Meaning in life 30/54 (55.56%), Hope and optimism about the future 29/54 (53.7%) and Connectedness 21/54 (38.89%), followed by Identity 6/54 (11.11%) and Empowerment 5/54 (9.26%). The findings contribute to the growing evidence of the potential of the arts as a therapeutic tool, the value of museums as therapeutic spaces and the role of nurses in intersectoral coordination, between the mental health and cultural sectors, as facilitators and researchers of these evidence-based practices.

Psychometric validation of the 15-item Questionnaire about the Process of Recovery in Spain (QPR-15-SP).

Introduction: Reliable and valid instruments are needed to measure the impact of mental health services and programs on the journeys of recovery of service users. The aim of this study was to explore the psychometric properties of the cross-culturally adapted 15-item Questionnaire about the Process of Recovery in Spain (QPR-15-SP). Methods: One hundred and ten participants from three locations in Spain (Málaga, Barcelona and Madrid), who were users of primary and specialized mental health services, were interviewed from October 2021 to June 2022. Results: The internal consistency obtained was excellent: ω =.93 and α =.92. Temporal reliability using intraclass correlation coefficients was moderate (ICC=.684, p <.000). Regarding convergent validity, the QPR-15-SP had a moderate correlation with the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) (ρ =-.500, p <.000), a Visual Numeric Recovery Scale (VNRS) (ρ =.591, p <.000), and the Stages of Recovery Instrument (STORI) (r =.566, p <.000). Correlations between advanced stages of recovery and higher QPR-15-SP scores were found (Moratorium: ρ =-.579, p <.000; Awareness: ρ =-.130, p =.189; Preparation: r =-.043, P=.665; Rebuilding: r =.460, p <.000; Growth: ρ =.697, p <.000). In terms of divergent validity, the QPR-15-SP had low correlation with the DUKE-UNC Functional Social Support Scale (ρ =.273, p <.005). The confirmatory factor analysis of the 1-factor structure obtained reasonable goodness of fit indexes. Discussion: The QPR-15-SP has acceptable psychometric properties, providing support for measuring recovery in Spain and allowing international comparison research.