Hospital workforce mental reaction to the pandemic in a low COVID-19 burden setting: a cross-sectional clinical study.

Τhe COVID-19 pandemic has mental health implications for both healthcare workforces and general population, particularly in regions heavily hit by the crisis. Τhe study aimed (i) to investigate anxiety- and depression severity differences between staff of a COVID-19 treatment unit (N = 84) and a hospital without such a unit (N = 55) in comparison to participants of a convenience general population online survey (N = 240) and (ii) to explore relations between such symptoms and hospital staff reaction to COVID-19 in a low COVID-19 burden setting. Anxiety was studied with the Generalized Anxiety Disorder 7-Item in hospital workforces and with the Hospital Anxiety Depression Scale (HADS) in online survey participants. Depression symptoms were assessed with the Patient Health Questionnaire-9 in hospital employees and the HADS in the online survey sample. Symptoms were classified as absent/minimal, borderline abnormal or indicating clinical caseness. Staff reaction to COVID-19 was tapped with a 9-item-questionnaire and the 22-item Impact of Event Scale-revised (IES-R). Proper tests for differences and stepwise ordered logistic regression models were employed. Anxiety- and depression severity was higher in hospital workforces than in online survey participants (P < 0.05). Anxiety was more severe in frontline- compared to backstage employees (P < 0.001) was inversely correlated with age (P = 0.011) and positively with avoidance (P = 0.028). Both anxiety and depression symptoms related to intrusion symptoms (P < 0.001). Regarding the relatively long data collection period, an inverse association between crisis duration and depression symptoms was detected (P = 0.025). These observations point to the urgent need for distress-mitigating interventions for hospital workforces even in low COVID-19 burden settings.

Prospective assessment of psychopathological symptoms and their relation to demographic factors in primary caregivers of cancer patients throughout chemotherapy.

PURPOSE: The present study aims to investigate the course of psychological symptoms through chemotherapy in a sample of primary caregivers of patients with cancer and to examine all possible correlations between psychological distress and demographic characteristics. METHODS: In this prospective study, 112 primary family caregivers of cancer patients were evaluated. Symptom checklist 90 revised (SCL-90-R) was administered to assess their pathological symptoms, the Hospital Anxiety and Depression Scale (HADS) to assess depression and anxiety. There was an evaluation at the beginning of chemotherapy and a second at the end of the patients' intravenous chemotherapy treatment (EOT). RESULTS: A total of 112 primary caregivers were initially enrolled in the study, and 99 (88.4%) completed it. Caregivers' psychopathology was low to moderate at both points of time (baseline and EOT). However, a considerable decrease in the Global Severity Index (GSI) emerged over time. CONCLUSIONS: At EOT, participants reported statistically significant decreases in five aspects of SCL 90, namely Depression, phobic anxiety, obsessive-compulsive symptoms, somatization, and psychoticism. A notable finding was that female caregivers were significantly more distressed, especially when providing care to a male recipient.

Impaired Sexual Function in Young Women With PCOS: The Detrimental Effect of Anovulation.

BACKGROUND: Even though polycystic ovary syndrome (PCOS) is a common reproductive disorder affecting young women, its impact on their sexual health is not well known. AIM: To examine the different aspects of female sexuality in young women with PCOS and attempt to associate hormonal changes and ovulatory status with their sexual function. METHODS: Anthropometric characteristics, hormonal levels and sexual function based on the Female Sexual Function Index (FSFI) questionnaire were assessed in 76 young women with PCOS and 133 matched controls. OUTCOMES: Sexual function is significantly impaired in young women with PCOS. RESULTS: Women with PCOS demonstrated lower scores than controls in arousal (5.04 ± 1.19 vs 4.48 ± 1.44, P < .001), lubrication (5.29 ± 1.17 vs 4.69 ± 1.54, P < .001), orgasm (4.78 ± 1.40 vs 4.11 ± 1.61, P = .001), satisfaction (5.22 ± 1.10 vs 4.78 ± 1.31, P = .016), and total score of the FSFI (29.51 ± 5.83 vs 26.76 ± 6.81, P < .001), even after correction for BMI. When corrected for total testosterone, the domains of lubrication, satisfaction, and total score of FSFI remained significantly impaired in women with PCOS (P values .037, .024, & .044 respectively). In multivariate logistic regression analysis, after adjusting for the effect of BMI and hormone levels, dysfunction in orgasm, satisfaction and the total FSFI score were still 3-4 times more common in PCOS (adjusted OR [95% CI]: 3.54, P = .020; 2.96, P = .050; 3.87, P = .027). Even though no statistically significant differences were observed between women with ovulatory PCOS and controls, we detected statistically significant differences in all domains of sexual function apart from pain between controls and PCOS women with anovulation (desire P value .04, arousal P value <.001, lubrication P value <.001, orgasm P value .001, satisfaction P value .001 and FSFI total score P value <.001). CLINICAL IMPLICATIONS: Women with PCOS have compromised sexual function, which is independent of their BMI and highly dependent on their ovulatory status. STRENGTHS AND LIMITATIONS: This is the first study in women with PCOS that implicates anovulation as a risk factor for sexual impairment in PCOS. Further studies are needed to elucidate the mechanisms implicated and to examine the effect of PCOS therapy on the patients' sexual function. CONCLUSION: The adverse effect of PCOS status on the female sexual function is independent of BMI and only partially dependent on hormonal changes characterizing the syndrome. Anovulation appears to be the major determinant of sexual impairment among women with PCOS. Mantzou D, Stamou MI, Armeni AK, et al. Impaired Sexual Function in Young Women With PCOS: The Detrimental Effect of Anovulation. J Sex Med 2021;18:1872-1879.

Associations between (sub) clinical stress- and anxiety symptoms in mentally healthy individuals and in major depression: a cross-sectional clinical study.

BACKGROUND: Responses to stressful circumstances have psychological and physiological dimensions, and are related to anxiety symptoms and mental disorders such as depression. Nonetheless, the relationship between subclinical stress and anxiety symptoms is still elusive. METHODS: To explore possible associations between stress and anxiety symptoms, patients with major depression (N = 77) and mentally healthy individuals of different age clusters and occupations (N = 412) were enrolled into the study. Stress was assessed with the new subclinical stress symptom questionnaire (SSQ-25). Anxiety was studied with the Beck Anxiety Inventory (BAI), mainly focusing on clinical anxiety, whilst anxiety as a personality trait was assessed with the trait aspect of the State Τrait Αnxiety Ιnventory Y (STAI Y). Statistical analyses included ANOVA, Scheffe test, linear regression models and a two-step cluster analysis using Log-Likelihood Distance measure and fixed number of two clusters. RESULTS: Age, stress symptoms and BAI scores differed significantly between among groups (P < 0.001), whilst STAI Y scores did not. Stress levels were found to be related to clinical anxiety (P < 0.001), while neither group identity nor age exerted any influence on anxiety levels (P > 0.05). The two Step Cluster analysis classified 76 out of 77 participants with milder stress (subclinical) symptoms into the cluster with moderate anxiety, as indicated by BAI scores, and all individuals with more severe stress into the severe anxiety cluster. CONCLUSIONS: The observed associations between stress and anxiety shed light on the interrelations between even very mild (subclinical) stress and anxiety symptoms and may point to the potential of mild stress to serve as a target for early interventions aiming to prevent anxiety morbidity.

Leukocyte telomere length is reduced in patients with major depressive disorder.

Major depressive disorder (MDD) is a chronic, severe psychiatric illness with an incidence of 3% worldwide. MDD patients have a significantly impaired quality of life and reduced life expectancy compared to unaffected individuals, the latter being largely accounted for by an increased incidence of suicide and cardiovascular disorders. The premature mortality observed in MDD has been considered a signature of accelerated aging, a hypothesis supported by data showing altered functioning and morphology of several brain regions that are typically present in the aging population. Telomere shortening is a hallmark of cellular aging, and as such several studies explored the involvement of disrupted telomere dynamics in MDD, reporting contrasting findings. In the current study, we measured leukocyte telomere length (LTL) in a sample of 54 MDD patients and 47 non-psychiatric controls characterized for response to antidepressant treatment. After correcting for age, sex, and body mass index, we showed significantly reduced LTL in affected individuals compared to controls (beta = -.22, p = .02). There was no difference in LTL between treatment resistant or responsive MDD patients. Moreover, we observed no correlation between lifetime exposure to antidepressants and LTL. Our study showed that MDD patients have shorter telomeres compared to controls, supporting the hypothesis of accelerated aging in this disorder. However, LTL seemed not to be influenced by antidepressant treatment or to correlate with clinical response to these antidepressants. Further investigations in larger samples and possibly with longitudinal design are warranted to elucidate the role of altered telomere dynamics in MDD.

Psychological distress and health-related quality of life in parents of children referred to an outpatient service for children with developmental disorders.

OBJECTIVES: The current study's aim was to measure anxiety, depression and quality of life in parents of children referred for developmental evaluation. METHODS: The Hospital Anxiety and Depression Scale and the Short Form 36 Health Survey were used to assess anxiety, depression and quality of life, respectively. RESULTS: One hundred and thirty parents participated in the study, 95 with a child referred for evaluation and 35 with healthy children. Parents of developmentally impaired children reported increased anxiety ( p=0.002) and depression ( p<0.001) and worse social functioning ( p=0.002) and mental health ( p=0.017). Mothers of developmentally impaired children reported significantly increased anxiety symptoms ( p=0.012) and bodily pain ( p=0.046) and lower levels of vitality ( p=0.009), social functioning ( p=0.005) and mental health ( p=0.008). More children in the family correlated with increased anxiety scores ( p=0.021), while higher child age was associated with more anxiety symptoms ( p=0.002), more role limitations due to emotional problems ( p=0.003) and worse mental health ( p=0.002). CONCLUSIONS: Parenting children with developmental difficulties is associated with significant psychological distress and disturbed quality of life.

Cerebrospinal Fluid BACE1 Activity and sAßPPß as Biomarker Candidates of Alzheimer's Disease.

BACKGROUND/AIMS: The utility of ß-site amyloid-ß precursor protein (AßPP) cleaving enzyme 1 (BACE1) activity and soluble AßPP ß (sAßPPß) levels in cerebrospinal fluid (CSF) in detecting Alzheimer's disease (AD) is still elusive. METHODS: BACE1 activity and sAßPPß concentration were measured in patients with AD dementia (n = 56) and mild cognitive impairment (MCI) due to AD (n = 76) with abnormal routine AD CSF markers, in patients with MCI with normal CSF markers (n = 39), and in controls without preclinical AD (n = 48). In a subsample with available 18F-fluorodeoxyglucose positron emission tomography (FDG PET) data, ordinal regression models were employed to compare the contribution of BACE1 and sAßPPß to correct diagnostic classification to that of FDG PET. RESULTS: BACE1 activity was significantly higher in patients with MCI due to AD compared to both controls and patients with MCI with normal CSF markers. sAßPPß did not differ between any of the studied groups. Interestingly, BACE1 activity was not found to be inferior to FDG PET as predictive covariate in differentiating between the diagnostic groups. CONCLUSIONS: Further studies using biomarker-underpinned diagnoses are warranted to shed more light on the potential diagnostic utility of BACE1 activity as AD biomarker candidate in MCI.

The impact of group cognitive behavioral psychotherapy on disease severity and psychosocial functioning in patients with inflammatory bowel disease: a randomized controlled study.

BACKGROUND AND AIMS: Patients with inflammatory bowel disease (IBD) often report symptoms of anxiety and depression as well as impaired quality of life (QoL). To date, there are few studies on the effect of psychotherapy on psychological functioning and clinical outcome in patients with IBD. The aim of this prospective, randomized, controlled study was to investigate the effect of a brief psychotherapeutic intervention on psychological distress, QoL, sexual functioning, and inflammation and disease activity indices in patients with IBD. METHODS: Participants were randomized to receive either group cognitive behavioral therapy or treatment as usual (controls) and were assessed at baseline and after six months using psychometric instruments to assess psychological distress, QoL, and sexual functioning. In addition, laboratory measurements, including levels of C-reactive protein (CRP), cytokines and calprotectin, and calculations of disease activity indices were performed during the two study periods. RESULTS: 80 participants took part in the study. Patients who received psychotherapy reported a significant decrease in anxiety and depression symptoms, a significant improvement in physical functioning, general health, vitality, social functioning and mental health, a decrease in physical pain and a decrease in role limitations caused by emotional problems. CRP levels and the Crohn's disease activity index (CDAI) also decreased significantly at follow-up compared to controls. CONCLUSIONS: Group cognitive behavioral therapy is proving to be an important component of holistic care for IBD patients, as it can significantly improve not only patients' psychosocial functioning but also their clinical course by inhibiting inflammation and reducing disease activity.

Psychiatric manifestations, personality traits and health-related quality of life in cancer of unknown primary site.

OBJECTIVE: Psychiatric manifestations and personality traits are known to influence cancer patients. We aimed to assess psychological distress symptoms, psychosocial factors and health-related quality of life (HRQoL) in cancer of unknown primary site (CUP) and to test whether these parameters differ between CUP and Metastatic (MKPC) or Non-Metastatic Known Primary Cancers (N-MKPC) after controlling for demographics and clinical variables. METHODS: In this cross-sectional study, we recruited 50 CUP, 264 N-MKPC and 52 MKPC participants. We assessed depressive symptoms (Center for Epidemiologic Studies-Depression [CES-D]), psychological distress symptoms (Symptom Distress Checklist-90 Revised), sense of coherence (SOC), ego defense mechanisms (Life Style Index) and HRQoL (World Health Organization Quality of Life Instrument, Short Form). RESULTS: The prevalence of clinically significant depressive symptoms (CES-D ≥ 23) was 40.0% in CUP, 28.8% in MKPC and 23.5% N-MKPC (p=0.037). Multivariate logistic regression analysis showed that N-MKPC patients were 5 times less likely (p=0.028) and MKPC patients 3.3 times less likely (p=0.05) to be assessed with probable depression compared with CUP patients after controlling for the major demographic and clinical variables studied. CUP patients presented also higher levels of somatization, anxiety and depressive symptoms; they also had more impaired Physical (p=0.005), Mental (p=0.041) and Social Relations (p=0.044) HRQoL, along with lower scores on SOC and intellectualization defense and higher scores on repression defense, compared with MKPC and N-MKPC patients. CONCLUSIONS: These findings suggest that psychiatric manifestations are frequent in CUP, and the patients' resources to cope with the burden of their illness are limited. Attention to CUP patients' psychological distress and coping resources and capacities may enable oncologists to identify and manage modifiable aspects of HRQoL.

The Differential Role of Executive Apathy in Alzheimer's Disease Dementia, Mild Cognitive Impairment and Healthy Cognitive Ageing.

The objective of the present work was to compare the levels of executive, emotional, and initiation apathy in individuals with mild cognitive impairment (MCI), mild Alzheimer's disease dementia (ADD), and cognitively intact healthy controls (HCs). Fifty-two patients with mild ADD, 40 individuals with MCI, and 37 cognitively intact individuals were included in the current study. The participants were consecutive visitors to the Outpatient Memory Clinic of "Nestor" Alzheimer's Center. The symptoms of apathy were measured with the dimensional apathy scale. Analyses showed that ADD patients had significantly higher degrees of executive, emotional, initiation, and overall apathy compared with both the MCI group and the HCs. Additionally, a significant difference was observed in the dimension of executive apathy between individuals with MCI and the HCs. In conclusion, the dimension of executive apathy was the most sensitive measure regarding the differentiation of individuals with mild ADD or MCI and HCs. Hence, detailed evaluation of executive apathy in older individuals referred to a memory clinic may provide useful information contributing to their diagnostic categorization and to the differentiation between neurocognitive disorders and healthy cognitive ageing.

Health-related quality of life in patients with solid tumors receiving implantable venous access ports for chemotherapy: A prospective randomized controlled trial.

PURPOSE: Implantable venous access ports are widely used in patients receiving chemotherapy, but there is still scarce evidence about any patient-reported outcome measures. This prospective randomized controlled trial examined the impact on patients' quality-of-life following the placement of an implantable port device for long-term chemotherapy treatment. METHOD: A total of 120 chemotherapy naïve adult outpatients scheduled to receive chemotherapy (duration ≥12 weeks) for solid tissue tumors in a single academic oncology unit were randomly allocated (n = 60 in each arm) between radiologically guided insertion of an implantable venous access port (PORT arm) or standard repeated peripheral venous access (Control arm). Health-related quality-of-life scores (HRQoL) were assessed with the EQ-5D-5L and the oncology-specific EORTC QLQ-C30 (version 3.0) questionnaires at baseline, 3- and 6-months post randomization. Non-parametric tests were applied and differences between medians (Δ) are reported because of skewed-left HRQoL data. RESULTS: Baseline clinical and demographic characteristics were well balanced between the two groups. There were no complications during insertion and no infection or device failure in the PORT subjects through the 6-month follow-up. The functional and symptom scales of the EORTC QLQ-C30 questionnaire were similar between both study arms at all time intervals. The EORTC QLQ-C30 global health status was significantly improved in the PORT subjects both at 3 months (Δ: 8.3 out of 100; P = 0.04) and 6 months follow-up (Δ: 16.7 out of 100; P = 0.003). Changes in EQ-5D-5L scores were significantly improved at 6 months in the PORT arm compared to control (Δ: 0.074 out of 1; P = 0.01). CONCLUSIONS: Implantable venous access ports may confer significantly improved patient-reported quality-of-life benefits in patients receiving chemotherapy for solid tissue tumors.

Quality of life and emotional burden of primary caregivers: a case-control study of multiple sclerosis patients in Greece.

PURPOSE: Our aim was to assess the perceived emotional burden and quality of life (QOL) in a sample of Greek primary caregivers of patients with multiple sclerosis (MS). METHODS: Twenty-two male and 13 female primary caregivers (mean age 47.3 ± 12.4 years), and an equal number of patients with MS, completed the Greek validated version of the hospital anxiety and depression scale (HADS) and the Greek validated version of EuroQOL (EQ-5D). Thirty-five age-, gender-, and education-matched healthy controls were used for comparison. RESULTS: Caregivers experienced higher degree of anxiety than depression. The mean score of the HADS-A subscale was 9.5 ± 4 (range 3-15), and the mean score of the HADS-D subscale was 7.1 ± 3.1 (range 2-14). The mean scores of caregivers on both HADS-A and HADS-D were significantly higher than the controls' (P < 0.0001). Twenty-two caregivers were diagnosed with manifesting anxiety, whereas 12 of them also presented depression. Highly educated caregivers were more prone to manifest increased levels of anxiety and depression. The increased psychological distress was further supported by the responses in the anxiety/depression dimension on the EQ-5D: 27 reported a moderate level of anxiety/depression and three indicated an extreme degree. The caregivers reported a mean EQ-VAS value of 61.9 ± 13.8 (range 40-100), with 10 caregivers rating their health status a score of 50 or lower; the controls scored significantly higher (90.3 ± 7.1; P < 0.0001). CONCLUSION: The sample of caregivers we studied was psychologically burdened to a significant degree, a fact that obviously deteriorates their QOL. Appropriate psychopharmacological interventions are warranted to reduce caregivers' burden.

Assessing ego defense mechanisms by questionnaire: psychometric properties and psychopathological correlates of the Greek version of the Plutchik's Life Style Index.

The Life Style Index (LSI; Plutchik, Kellerman, & Conte, 1979 ) was designed to assess defense mechanisms, assuming that their use is related to specific affective states and diagnostic concepts. We aimed to assess the psychometric properties of its Greek version and its relation to psychopathological symptoms. The LSI was back-translated into Greek and was administered to 1,261 participants. Six factors were identified, 5 of them largely corresponding to the original version's defenses (compensation, denial, projection, reaction formation, and repression). The sixth factor, named regressive emotionality, included mainly the original scale's regression and displacement factors. Test-retest reliabilities, internal consistencies, and construct validity were quite satisfactory. Most defenses were able to discriminate psychiatric patients from healthy participants and were associated with specific psychopathological symptoms in a theoretically expected mode, further supporting the validity of the Greek version. Our findings suggest that the LSI, based on both psychoevolutionary and psychoanalytic theory, can provide a solid ground for assessing ego defense mechanisms.

Communication-based suicide prevention after the first attempt. A systematic review.

Previous suicide attempts are the strongest risk factor for a new suicide attempt, suicide death, the development of recurrent suicide behavior and even the development of suicidal ideation in the general population. Primary prevention aims to reduce new suicide attempts in the general population, while secondary prevention tries to reduce the chance of suicide attempts in patients with high risk. Tertiary interventions are targeted at individuals who have already made one or more suicide attempts and aim to prevent second or repetitive attempts and to suppress suicidal behavior. Communication with patients and family is a very effective way of preventing a second suicide attempt. The aim of this paper is to present an overview of tertiary suicide prevention interventions focusing on communication with the patient and their family and study their effectiveness. This systematic review was based on the PRISMA checklist and was conducted using the databases Pubmed, Scopus and Google Scholar for articles published between 2000 and 2020 focus in go communication with family and patient. All studies concerning at least one previous suicide attempt were included. The interventions described in the studies concerned: [1] face-to-face and telephone contacts, [2] communication with greeting cards and letters, [3]telephone contact with the patient and record keeping to facilitate the implementation of the action plan, [4] telephone contacts only, and [5] technology-based communication. Our investigation brought up9 studies on interventions focusing on communication with the patient and their family. Family and patient communication interventions, with a particular emphasis on telephone and written communication, have shown a good level of effectiveness in the prevention of a new suicide attempt, especially if the intervention has been completed according to the schedule and the patient has not abandoned the treatment early. The generalization of the results is limited due to the inclusion of other types of studies jointly with randomized controlled trials and the variability among the samples of the studies. In conclusion, family and patient communication interventions have shown a positive effect on preventing a second suicide attempt. More studies are needed to investigate the effectiveness of different prevention approaches at hand and clarify in which patient populations each intervention could be more effective.Previous suicide attempts are the strongest risk factor for a new suicide attempt, suicide death, the development of recurrent suicide behavior and even the development of suicidal ideation in the general population. Primary prevention aims to reduce new suicide attempts in the general population, while secondary prevention tries to reduce the chance of suicide attempts in patients with high risk. Tertiary interventions are targeted at individuals who have already made one or more suicide attempts and aim to prevent second or repetitive attempts and to suppress suicidal behavior. Communication with patients and family is a very effective way of preventing a second suicide attempt. The aim of this paper is to present an overview of tertiary suicide prevention interventions focusing on communication with the patient and their family and study their effectiveness. This systematic review was based on the PRISMA checklist and was conducted using the databases Pubmed, Scopus and Google Scholar for articles published between 2000 and 2020 focus in go communication with family and patient. All studies concerning at least one previous suicide attempt were included. The interventions described in the studies concerned: [1] face-to-face and telephone contacts, [2] communication with greeting cards and letters, [3]telephone contact with the patient and record keeping to facilitate the implementation of the action plan, [4] telephone contacts only, and [5] technology-based communication. Our investigation brought up9 studies on interventions focusing on communication with the patient and their family. Family and patient communication interventions, with a particular emphasis on telephone and written communication, have shown a good level of effectiveness in the prevention of a new suicide attempt, especially if the intervention has been completed according to the schedule and the patient has not abandoned the treatment early. The generalization of the results is limited due to the inclusion of other types of studies jointly with randomized controlled trials and the variability among the samples of the studies. In conclusion, family and patient communication interventions have shown a positive effect on preventing a second suicide attempt. More studies are needed to investigate the effectiveness of different prevention approaches at hand and clarify in which patient populations each intervention could be more effective.

Psychological Distress and Health-Related Quality of Life in Public Sector Personnel.

BACKGROUND: This study has assessed health-related quality of life (HRQoL) and psychological distress between public sector professional groups. METHODS: Short Form-36 Health Survey (SF-36) and Hospital Anxiety and Depression Scale (HADS) were administered to healthcare personnel, schoolteachers, and municipality and regional personnel in the region of Western Greece. Mean scores on all SF-36 dimensions and HADS were compared among these professional groups as well as with the Greek national norms to assess if there were significant differences between our study sample and the general population. RESULTS: Healthcare personnel reported significantly lower SF-36 scores than teachers and municipality employees. Women reported poorer HRQoL than men on all SF-36 dimensions. This overall low score for health care workers masks the fact that male health care workers, primarily medical doctors, actually scored better than women, primarily nurses and auxiliary personnel. Average mean scores on all SF-36 dimensions reported by nurses and auxiliary personnel in healthcare were considerably lower than the ones from employees in all other occupational types. The impact on HRQoL observed mainly in vitality, social functioning and mental health was important. Many participants have shown psychological burden and depression. CONCLUSIONS: The health inequalities among healthcare employees are significant. This study is important to suggest taking measures for improving the HRQoL of health workers.

Psychological distress in the Greek general population during the first COVID-19 lockdown.

BACKGROUND: SARS-CoV-2 has rapidly spread worldwide, threatening public health and financial and social life. AIMS: The current study's aim was to determine the prevalence of psychological distress and post-traumatic stress symptoms in the Greek population during the first COVID-19 lockdown, and to detect potential correlates. METHOD: An anonymous online survey was conducted between 10 April and 4 May 2020, to collect information regarding people's psychological functioning and COVID-19-related perceptions. RESULTS: A total of 1443 individuals completed the survey; 293 (20%) reported clinically significant anxiety symptoms, 188 (12.9%) reported clinically significant depressive symptoms and 506 (36.4%) suffered from definite post-traumatic stress disorder. Anxiety symptoms were independently associated with female gender (ß = 1.281, 95% CI 0.808-1.755, P < 0.001), educational level (ß = -1.570, 95% CI -2.546 to -0.595, P = 0.002), perceived severity (ß = -1.745, 95% CI -3.146 to -0.344, P = 0.015) and COVID-19-related worry (ß = 7.633, 95% CI 6.206-9.060, P < 0.001). Depressive symptoms were strongly correlated with educational level (ß = -1.298, 95% CI -2.220 to -0.377, P = 0.006), perceived severity (ß = -1.331, 95% CI -2.579 to -0.082, P = 0.037) and COVID-19-related worry (ß = 4.102, 95% CI 2.769-5.436, P < 0.001). Finally, post-traumatic stress symptoms were linked to female gender (ß = 6.451, 95% CI 4.602-8.299, P < 0.001), educational level (ß = -5.737, 95% CI -9.479 to -1.996, P = 0.003), psychiatric history (ß = -4.028, 95% CI -6.274 to -1.782, P < 0.001) and COVID-19-related worry (ß = 23.865, 95% CI 18.201-29.530, P < 0.001). CONCLUSIONS: A significant percentage of the population reported clinically important anxiety, depressive and post-traumatic stress symptoms. Women, less-educated individuals and people with a psychiatric history appeared more vulnerable to the pandemic's psychological impact.

Fatigue and depressive symptoms associated with chronic viral hepatitis patients. health-related quality of life (HRQOL).

BACKGROUND AND RATIONALE: It is well established that chronic viral hepatitis (CVH) negatively affects patients . health-related quality of life (HRQOL). The aim of the present study was to assess the extent to which fatigue and depressive symptoms are associated with CVH patients. HRQOL. METHODS: Eighty-four adult CVH outpatients [45 with hepatitis B virus (HBV) and 39 with hepatitis C virus (HCV) infection] participated in the study. The Short Form-36 Health Survey (SF-36), the Beck Depression Inventory-II (BDI-II) and the Fatigue subscale of the Functional Assessment of Cancer Therapy-Anemia Scale (FACT-F) were used to assess HRQOL, depression and fatigue, respectively. RESULTS: All aspects of HRQOL perceived by CVH patients were significantly impaired compared to the general population, as a comparison with Greek population-based normative data revealed. HBV patients presented similar HRQOL with HCV patients. Clinical parameters including infection activity, fibrosis stage or inflammation grade, as well as depressive symptoms and fatigue were found to be significantly associated with HRQOL. Multivariate analyses showed that older age (p <0.001) and higher fatigue scores (p <0.001) were the variables most closely associated with the physical HRQOL, whereas higher rates on depressive symptoms (p <0.0005) and fatigue (p <0.020) scales were the variables most closely associated with the mental HRQOL. CONCLUSIONS: In conclusion, CVH is associated with impaired HRQOL. Fatigue and impaired psychological functioning is associated with diminished HRQOL in CHV, independent of the disease etiology. Consequently, management of fatigue and depressive symptoms should be considered a priority, in order to improve HRQOL in CVH patients.

Religiosity and its relation to quality of life in Christian Orthodox cancer patients undergoing chemotherapy.

OBJECTIVES: The first objective of the current observational study was to assess the levels of religiosity in Greek Christian Orthodox cancer patients receiving chemotherapy. The second objective was to evaluate the associations between religiosity and quality of life (QoL), an endpoint of considerable importance in clinical cancer research and practice. METHOD: One hundred eighteen adult outpatients with solid tumors, who consented to participate, were administered the Systems of Belief Inventory (SBI-15R) and the European Organisation for Research and Treatment of Cancer (EORTC QLQ-C30) questionnaire. RESULTS: The analysis revealed high scores on religiosity, especially among female patients, who reported significantly higher levels of religious beliefs and practices as well as perceived social support provided by the religious community than did their male counterparts. Of all EORTC QOL-C30 subscales, only global QoL was found to be significantly associated with the SBI-15R religious beliefs subscale. The analysis revealed no significant correlations between the SBI-15R social support subscale and all QoL subscales. CONCLUSIONS: The current study reported high levels of religiosity among Greek Christian Orthodox cancer patients. However, levels of religiosity were only weakly associated with patients' QoL. The SBI-15R appeared to be a well-accepted and reliable tool, potentially useful for future research in Greek settings. Wide-scale studies from the same and diverse religious and cultural backgrounds are needed to clarify further the connections between religiosity, QoL, coping, and other health outcomes with the aim to devise appropriate multicomponent interventions to enhance patients' QoL.

Quality of life in patients with nonalcoholic fatty liver disease: A systematic review.

OBJECTIVE: Non-alcoholic fatty liver disease (NAFLD) is a highly prevalent medical condition, which may lead to severe complications including cirrhosis and hepatocellular carcinoma. Its chronic course and its association with obesity and diabetes mellitus augment the long-term impact of NAFLD on patients' health and quality of life (QoL) and put great strain on healthcare systems worldwide. Research is growingly focusing on NAFLD patients' QoL in an attempt to describe the full spectrum of disease burden and tackle its future consequences. Relevant studies are characterized by sample heterogeneity and provide conflicting findings which should be interpreted with the use of a systematic and integrative approach. In this context, our aim was to conduct a systematic literature review on the topic of NAFLD patients' QoL. METHODS: We performed a systematic search of PubMed, ScienceDirect and GoogleScholar databases according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) protocol. RESULTS: Our search yielded 14 suitable articles reporting data from almost 5000 patients. All authors agree that NAFLD patients' QoL is impaired especially in the physical sub-domain. In addition, several demographic, clinical and histopathological parameters have emerged as major determinants of patients' QoL. However, future studies are needed to further clarify these issues. CONCLUSIONS: NAFLD patients report poor physical QoL. QoL impairment is associated with a variety of disease-related parameters, mostly the presence of fatigue and cirrhosis.

Gonadotropin-releasing hormone (GnRH) deficiency under treatment: psychological and sexual functioning impacts.

OBJECTIVE: GnRH (gonadotropin releasing hormone) is a crucial hormone for sexual development, puberty, and fertility, and its deficiency leads to hypogonadotropic hypogonadism (HH), which causes abnormal secondary sexual development and infertility. The combination of the lack of sense of smell, i.e., anosmia, and HH is a type of GnRH deficiency known as Kallmann syndrome, which affects both men and women. The impact of Kallmann syndrome can be very severe and causes a variety of psychological problems in patients. The aim of the present study was to investigate psychopathology, sexuality, and personality characteristics in patients with GnRH deficiency under hormonal replacement therapy. DESIGN: A total of 38 patients with GnRH deficiency aged 30.6 ± 10.44 years and 38 healthy matched for age individuals participated in the study and completed a series of questionnaires concerning sexual functioning, ego defense mechanisms, quality of life, personality characteristics, as well as anxiety and depression. RESULTS: After adjustment for anxiety and depression, no difference in sexuality parameters were reported between men with and without GnRH deficiency, while women with GnRH deficiency had significantly lower sexual desire compared to controls. Concerning quality of life, satisfaction with general health was significantly lower in patients compared to controls, even after adjusting for sex. Furthermore, patients with GnRH deficiency indicated markedly less anxiety and a trend for less depression compared to controls. Finally, defense styles, ego-strength, and hostility did not differ between GnRH deficiency patients and controls. CONCLUSIONS: Our study is the first to investigate psychological and sexual functioning impacts in patients with GnRH deficiency under hormonal replacement therapy. However, larger studies are needed so as to add further empirical evidence.