Stress, anxiety, and depression trajectories during the "first wave" of the COVID-19 pandemic: what drives resilient, adaptive and maladaptive responses in the Portuguese population?

Introduction: The COVID-19 outbreak and the community mitigation strategies implemented to reduce new SARS-CoV-2 infections can be regarded as powerful stressors with negative consequences on people's mental health. Although it has been shown that negative emotional symptoms subside during lockdown, it is likely the existence of inter-individual differences in stress, anxiety and depression trajectories throughout lockdown. Objectives: We aimed to cluster participants' according to their trajectories of stress, anxiety and depression scores throughout lockdown, and identify the sociodemographic, clinical, and lifestyle factors that may distinguish the subjects included in the different clusters. Methods: From March 23, 2020, to May 31, 2020, participants completed weekly online questionnaires on sociodemographic information (age, sex, education level, and employment status), psychological functioning (DASS-21, NEO-FFI-20), and clinical data (psychiatric disorders, psychiatric medication, physical disorders). Data regarding smoking status, alcohol consumption, physical activity, and time spent daily looking for COVID-19-related information were also collected. Stress, anxiety and depression trajectories were determined using latent class mixed models. Results: A total of 2040 participants answered the survey at baseline and 603 participants answered all surveys. Three groups ("Resilient," "Recovered," and "Maladaptive") with distinct mental health trajectories were identified. Younger participants, women, participants with lower education level, not working, studying, diagnosed with a mental disorder, taking psychiatric medication, smokers, those who spent more time consuming COVID-19-related information and those with higher neuroticism tended to cluster in the "Maladaptive" group, placing them at higher risk of persistent negative emotional symptoms during compulsory confinement. Conclusion: Accordingly, a tailored approach to emotional suffering for vulnerable subjects during the COVID-19 and future pandemics must be devised.

Right Prefrontal Cortical Thickness Is Associated With Response to Cognitive-Behavioral Therapy in Children With Obsessive-Compulsive Disorder.

OBJECTIVE: Cognitive-behavioral therapy (CBT) is considered a first-line treatment for obsessive-compulsive disorder (OCD) in pediatric and adult populations. Nevertheless, some patients show partial or null response. The identification of predictors of CBT response may improve clinical management of patients with OCD. Here, we aimed to identify structural magnetic resonance imaging (MRI) predictors of CBT response in 2 large series of children and adults with OCD from the worldwide ENIGMA-OCD consortium. METHOD: Data from 16 datasets from 13 international sites were included in the study. We assessed which variations in baseline cortical thickness, cortical surface area, and subcortical volume predicted response to CBT (percentage of baseline to post-treatment symptom reduction) in 2 samples totaling 168 children and adolescents (age range 5-17.5 years) and 318 adult patients (age range 18-63 years) with OCD. Mixed linear models with random intercept were used to account for potential cross-site differences in imaging values. RESULTS: Significant results were observed exclusively in the pediatric sample. Right prefrontal cortex thickness was positively associated with the percentage of CBT response. In a post hoc analysis, we observed that the specific changes accounting for this relationship were a higher thickness of the frontal pole and the rostral middle frontal gyrus. We observed no significant effects of age, sex, or medication on our findings. CONCLUSION: Higher cortical thickness in specific right prefrontal cortex regions may be important for CBT response in children with OCD. Our findings suggest that the right prefrontal cortex plays a relevant role in the mechanisms of action of CBT in children.

The Obsessive-Compulsive Inventory-Revised (OCI-R): Translation and Validation of the European Portuguese Version.

INTRODUCTION: The Obsessive-Compulsive Inventory-Revised has been developed to evaluate the severity of obsessive-compulsive symptoms in both clinical and non-clinical individuals. The aim of this study was to evaluate the psychometric properties of the Portuguese version. MATERIAL AND METHODS: This questionnaire was applied to 90 people with obsessive-compulsive disorder and 246 without a known mental illness. In addition to this clinical evaluation instrument, participants completed other clinical assessment scales that helped characterize the two study groups. RESULTS: Given the objective of this study, to evaluate the structure by six factors, a confirmatory factor analysis was performed [patient group: χ2(120, n = 90) = 205.779, p < 0.01; CFI = 0.916; GFI = 0.814; RMSEA = 0.0890. CONTROL GROUP: χ2(120, n = 246) = 224.762, p < 0.01; CFI = 0.938; GFI = 0.904; RMSEA = 0.060]. To assess the internal consistency of the scale, Cronbach's alpha was determined (patient group: α = 0.913; control group: α = 0.888). Convergent validity was tested by determining the Spearman correlation between the scores obtained in the Obsessive-Compulsive Inventory-Revised and Y-BOCS in the patient group (r = 0.651; p < 0.01). CONCLUSION: Obsessive-Compulsive Inventory-Revised has proved to be a consistent, valid, and reliable instrument with good psychometric properties to determine the severity of obsessive-compulsive symptoms in the Portuguese population.

Introdução: A escala Obsessive-Compulsive Inventory-Revised foi desenvolvida para avaliar a gravidade dos sintomas obsessivo-compulsivos em contexto clínico e não clínico. O objectivo deste estudo foi avaliar as propriedades psicométricas da sua versão portuguesa. Material e Métodos: O questionário em estudo foi aplicado a 90 pessoas com perturbação obsessivo-compulsiva e 246 pessoas sem doença psiquiátrica conhecida. Além deste instrumento de avaliação clínica, os participantes preencheram outras escalas de avaliação clínica que ajudaram a caracterizar os dois grupos de estudo. Resultados: Dado o objetivo deste estudo, para avaliar a estrutura por seis fatores foi realizada uma análise fatorial confirmatória [grupo de doentes: χ2(120, n = 90) = 205,779, p < 0.01; CFI = 0,916; GFI = 0,814; RMSEA = 0,0890. Grupo controlo: χ2(120, n = 246) = 224,762, p < 0,01; CFI = 0,938; GFI = 0,904; RMSEA = 0,060]. Para avaliar a consistência interna da escala foi determinado o alpha de Cronbach (grupo de doentes: α = 0,913. grupo controlo: α = 0,888). A validade convergente foi testada através da determinação da correlação de Spearman entre as pontuações obtidas no Obsessive-Compulsive Inventory-Revised e Y-BOCS no grupo de doentes (r = 0,651; p < 0,01). Conclusão: O Obsessive-Compulsive Inventory-Revised revelou-se um instrumento consistente, válido e fiável com boas propriedades psicométricas para determinar a gravidade dos sintomas obsessivo-compulsivos na população portuguesa.

How Long Does Adaption Last for? An Update on the Psychological Impact of the Confinement in Portugal.

During the first COVID-19 related confinement in Portugal, there was a decrease in the levels of psychological symptoms measured by the Depression, Anxiety and Stress Scale 21 (March to April 2020). Upon experiencing a new period of restraints in 2021, the psychological impact of this sample was assessed again (N = 322, two more time points). It was expected that the psychological symptoms evidenced in February 2021 would be at similar levels to those found in April 2020, leading to a transfer of adaptation. Contrary to our hypothesis, in the second confinement in Portugal there were higher levels of depression and stress symptoms than at the beginning of the pandemic. On the other hand, the maximum level of anxiety was observed in March 2020. It seems that our perception of the threats in 2021 was not the same as at the onset of COVID-19, or that knowledge was not disseminated to the general population to increase their mental health literacy and help them cope with the imposed challenges.

Sociodemographic and lifestyle predictors of mental health adaptability during COVID-19 compulsory confinement: A longitudinal study in the Portuguese population.

BACKGROUND: The outbreak of COVID-19 and the physical isolation measures taken by the governments to reduce its propagation might have negative psychological consequences on the population. In this study, we aimed to explore, for the first time, how mental health status fluctuated along the weeks of the emergency state in Portugal, and to identify which factors may shape these changes in mental health outcomes. METHODS: To this end, we conducted an online survey to evaluate demographic, lifestyle and mental health variables (DASS-21 and quality of life) in the Portuguese population at three different time-points. 748 participants (mean age = 39.52, % females = 79.95) provided data at all time-points. RESULTS: We observed that depression, anxiety and stress symptoms seemed to improve as the weeks passed during the state of emergency, while the perception of quality of life and sleep got worse. In particular, being female, younger, actively working, and extroverted appear to be protective factors of mental health adaptability during this particular period. On the contrary, having a psychiatric diagnosis or physical illness, and higher neuroticism seem to be risk factors for mental health worsening. LIMITATIONS: The lack of a more diverse sample could limit the generalizability of our results, and other factors that were not considered in our analysis might also have a significant impact on mental health. CONCLUSIONS: Our results provide relevant and novel insights about the course of mental health changes and its predictors during the outbreak of COVID-19, which may help identify potential vulnerability groups.

Protective Elements of Mental Health Status during the COVID-19 Outbreak in the Portuguese Population.

The outbreak of COVID-19 might produce dramatic psychological effects on individuals' lives. In this study, we aimed to explore the elements that may reduce the negative effects on mental health of the quarantine period imposed by most governments during this worldwide crisis. We conducted an online survey to evaluate demographic, lifestyle and mental health variables in a sample of 1280 Portuguese individuals (79.8% females) with an average age of 37 years. We observed that factors related to living conditions, maintaining work either online or in the workplace, frequency of exercise and absence of previous psychological or physic disorders are protective features of psychological well-being (anxiety, depression, stress and obsessive-compulsive symptoms). Finally, the individuals previously receiving psychotherapeutic support exhibited better psychological indicators if they did not interrupt the process as a consequence of the outbreak. Our results indicate that the practice of physical exercise, reduced consumption of COVID-19 information and the implementation of remote mental healthcare measures might prevent larger impacts on mental health during the COVID-19 outbreak.