Understanding the mental health impacts of biological disasters: Lessons from Taiwan's experience with COVID-19.

Biological disasters pose a growing challenge in the 21st century, significantly impacting global society. Taiwan has experienced such disasters, resulting in long-term consequences like loss of life, trauma, economic decline, and societal disruptions. Post-disaster, mental health issues such as fear, anxiety, depression, post-traumatic stress disorder (PTSD), and stress surge, accompanied by increased suicide rates. The Coronavirus disease 2019 (COVID-19) (also called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)) pandemic, recognized as a biological disaster, triggered lockdowns and quarantines in Taiwan, causing lifestyle changes, economic recession, and so on. These shifts may elevate uncertainty about the future, intensifying mental stress and leading to a rise in various mental illnesses. This article reviews mental health studies conducted in Taiwan during the pandemic, emphasizing the need to integrate this research for future preparedness and interventions regarding the mental health impacts of biological disasters, including COVID-19. Further research is essential to explore long-term effects, interventions, and generalizability.

Utilization of mental health services in relation to the intention to reduce chemsex behavior among clients from an integrated sexual health services center in Taiwan.

INTRODUCTION: The intention of chemsex-practicing gay and bisexual men and other men who have sex with men (GBMSM) to reduce their drug use is an important factor for the utilization of harm reduction services. This study aimed to examine data from an integrated sexual health services center to understand the relationship between the intention to reduce chemsex behavior and chemsex-related utilization of mental health services among GBMSM who engage in chemsex. METHOD: We used data collected from Healing, Empowerment, Recovery of Chemsex (HERO), an integrated health center in Taiwan, between November 2017 and December 2021. As the baseline, clients were asked to rate the current and ideal proportions of their sexual activities that involved the use of MDMA, ketamine, methamphetamine, GHB/GBL, or mephedrone. Having the intention to reduce chemsex was defined as having a lower proportion of ideal engagement compared to actual engagement. The data on the use of the services provided at HERO were linked to the survey responses and compared to information gathered during regular follow-up visits. Univariable and multivariable logistic regression analyses and a Poisson regression analysis were performed on the data. RESULTS: A total of 152 GBMSM reported engaging in chemsex, of whom 105 (69.1%) expressed the intention to reduce their chemsex behavior. Service utilization ranged from 23.0% for participating in meetings of a chemsex recovery group, 17.1% for visiting a mental health clinic, and 10.5% for using both of these services. The intention to reduce chemsex behavior significantly associated with visiting a mental health clinic (aOR = 4.68, p < 0.05), but its association with attending meetings of a chemsex recovery group was only marginally significant (aOR = 2.96, p < 0.1). Other factors that remained significantly associated with service use were a high frequency of substance use and living with HIV. CONCLUSION: Comprehensive harm reduction strategies, which touch on mental health, drug use management and recovery, are needed for those who want to reduce their chemsex behavior. Public health practitioners should endeavor to raise awareness of resources that are available for people who engage in chemsex and to minimize the barriers blocking their access to the appropriate services.

Professional perspectives on providing recovery-oriented services in Taiwan: a qualitative study.

BACKGROUND: The experiences of professionals in well-established recovery-oriented programs are valuable for professionals in similar practice settings. This study explored professionals' experiences with providing recovery-oriented services in community psychiatric rehabilitation organizations. METHODS: Semi-structured interviews were conducted with 14 professionals from five recovery-oriented psychiatric rehabilitation organizations in Taiwan. The interviews were recorded and transcribed verbatim. Thematic analysis was used for the qualitative data analysis. RESULTS: The analyses documented three main themes with 13 subthemes. Recovery-oriented service implementation included seven subthemes: Enabling clients to set their own goals and make decisions, using a strengths-based approach, establishing partnerships with clients, improving individuals' self-acceptance, encouraging community participation, seeking family, peer, and organizational support, and building team collaboration. Problems with implementing recovery-oriented services included limited policy and organizational support, a lack of understanding of recovery among professionals, stigma, clients' lack of motivation or self-confidence in their own ability to achieve recovery, and passive or overprotective family members. Strategies to resolve implementation problems included policy changes and organizational support, improving the recovery competence and confidence of professionals, and family and public education. CONCLUSIONS: To date, this is the first known study examining the perspectives of mental health professionals who have experience implementing recovery-oriented services in Asia. The participants identified family collaboration, anti-stigma efforts, and changes in policy and attitudes as critical to successful implementation and delivery of recovery-oriented services.

Differences in awareness of and willingness to use pre-exposure prophylaxis and anticipated condom use among serodiscordant couples in Taiwan.

Pre-exposure prophylaxis (PrEP) has proven to be effective in reducing the risk of HIV transmission in uninfected individuals who engaged in sexual activity with HIV-infected partners. Serodiscordant couples are the key targets of PrEP implementation. The study aimed to compare awareness of and willingness to use PrEP and anticipated condom use among 112 HIV-serodiscordant couples: 32 heterosexuals couples, 70 men who have sex with men (MSM) couples, and 10 people who inject drugs (PWID) couples. A cross-sectional study was conducted in an AIDS designated hospital in Taiwan. The PrEP survey for discordant couples included questions on awareness of non-occupational post-exposure prophylaxis (nPEP) and PrEP, attitudes toward PrEP, anticipated condom use if using PrEP, and sexual behaviors. Overall, 46.2% were aware of PrEP, only 33% were willing to take PrEP, and 44.6% would continue condom use if they were taking PrEP. Among the three key populations, MSM couples had the highest awareness of and willingness to use PrEP. Awareness of and willingness to use PrEP did not differ by HIV status, with moderate agreement (Cohen's Kappa coefficient: 0.56) between HIV-serodiscordant partners. Both HIV-serodiscordant partners' willingness to use PrEP was significantly associated with being MSM (adjusted odds ratio (AOR), 4.28 [1.28-14.30], p = 0.018), previous receipt of nPEP (AOR, 6.98 [1.23-39.65], p = 0.028), anticipated condom use (AOR, 0.14 [0.05-0.41], p < 0.001), and income ≥ NT$30,000 per month (AOR, 2.25 (0.99-5.04), p = 0.05). Policy makers need to consider the differences among key populations to scale up PrEP implementation. More efforts should be focused on improving awareness of and willingness to use PrEP among heterosexual and PWID serodiscordant couples to scale up PrEP implementation in Taiwan.

Mental health of caregivers of individuals with disabilities: Relation to Suicidal Ideation.

OBJECTIVE: The mental health of caregivers of individuals with disabilities is frequently neglected. This study investigated mental health status and Suicidal Ideation (SI) among caregivers and examined the predictive factors for SI. METHOD: Caregivers of individuals with physical or mental disabilities in a tertiary hospital in southern Taiwan were recruited through snowball sampling. They were assessed by self-report questionnaires, consisting of the Taiwanese Depression Questionnaire and a subset of the three-item Chinese Health Questionnaire, to assess probable depression and common mental disorders (CMDs), with cutoff points of 19 and 3, respectively. RESULTS: Among 255 caregivers, 32.9% had probable depression, 37.6% had probable CMDs, and 18.8% experienced SI. The level of SI was correlated with primary caregivers (p=0.015), lack of support from co-caregivers (p=0.023), caring for younger patients (p=0.010), caring for patients with mental disability (p=0.019) or catastrophic diseases (p=0.005), and caregivers' probable depression (p<0.001) and CMDs (p<0.001). Regression analysis predicted the greatest SI among caregivers caring for younger patients (odds ratio [OR]=0.98, p=0.048) and for patients with catastrophic diseases (OR=3.15, p=0.008), as well as for caregivers with probable depression (OR=3.90, p=0.010) or CMDs (OR=9.40, p<0.001). CONCLUSIONS: When examining SI, clinicians should be aware of the mental health of caregivers who are responsible for people with disability. In particular, they should be vigilant regarding caregivers of individuals who are of younger age or have catastrophic diseases and regarding caregivers who exhibit probable depression and CMDs.

Seeking sex partners through the internet and mobile phone applications among men who have sex with men in Taiwan.

It has become popular for men who have sex with men (MSM) to use mobile-phone geosocial networking applications (mobile apps) to find sex partners. A cross-sectional online survey was conducted in Taiwan to compare the sexual and substance-use behaviors of MSM seeking sex partners through the internet and mobile apps. Of the 1060 participants, 65.8% used the internet via computer and 37.7% used a mobile app to find sexual partners, while 30.3% used recreational drugs or alcohol in the previous 6 months. MSM who exclusively used mobile apps to seek sex partners were significantly more likely than MSM seeking sex via computer to be older, to have used recreational drugs or alcohol, and to have sex with HIV-positive partners. Additionally, using mobile apps to seek sex partners was significantly associated with having sex with online partners through either mobile apps or computer-based internet use (adjusted odds ratio (AOR), 7.12 [3.87-13.11]), self-reporting as HIV-positive (AOR, 2.24 [1.12-4.12]), using recreational drugs (AOR, 1.67 [1.21-2.32]), having disclosed HIV status to sexual partners (AOR, 1.44 [1.03-2.02]), and having sex with HIV-positive partners (AOR, 1.81 [1.06-3.10]). In conclusion, the mobile apps may serve as a feasible platform for HIV-positive MSM to find other HIV-positive partners.

Firefly light flashing: oxygen supply mechanism.

Firefly luminescence is an intriguing phenomenon with potential technological applications, whose biochemistry background was only recently established. The physics side of this phenomenon, however, was still unclear, specifically as far as the oxygen supply mechanism for light flashing is concerned. This uncertainty is due to the complex microscopic structure of the tracheal system: without fully knowing its geometry, one cannot reliably test the proposed mechanisms. We solved this problem using synchrotron phase contrast microtomography and transmission x-ray microscopy, finding that the oxygen consumption corresponding to mitochondria functions exceeds the maximum rate of oxygen diffusion from the tracheal system to the photocytes. Furthermore, the flashing mechanism uses a large portion of this maximum rate. Thus, the flashing control requires passivation of the mitochondria functions, e.g., by nitric oxide, and switching of the oxygen supply from them to photoluminescence.

Curvilinear relationship between depression and unprotected sexual behaviors among men who have sex with men.

INTRODUCTION: The relationship between depressive symptomatology and risky sexual behaviors has been controversial in literature. AIM: The current study aims to reexamine the relationship between depression and sexual behaviors among men who have sex with men (MSM) using different sets of analytical assumption. METHODS: Six hundred twenty MSM were recruited in a lesbian, gay, bisexual, and transgender community center in Taiwan to participate in a cross-sectional survey. An additional variable of squared depressive symptomatology was used to detect nonlinearity between depressive symptomatology and logit-transformed unprotected anal intercourse (UAI) and unprotected oral sex (UOS). Multivariable logistic regression was applied to further estimate the relationship among the three variables. MAIN OUTCOME MEASURES: Depressive symptomatology was measured by the Beck Depression Inventory (BDI), UAI, and UOS. RESULTS: Depressive symptomatology had a nonlinear relationship with unprotected anal and oral sex. While linear BDI scores of MSM were not associated with unprotected sexual behaviors in the logistic model, their scores were significantly associated with unprotected sexual behaviors in the model that included both the linear (UAI, odds ratio [OR] = 1.087; P < 0.01; UOS, OR = 1.099, P < 0.01) and quadratic BDI scores (UAI, OR = 0.998, P < 0.01; UOS, OR = 0.997, P < 0.01). The relationship between BDI scores and the probability of unprotected sexual behaviors corresponded to an inverted U-shaped curve, as opposed to a straight line. CONCLUSIONS: Our findings suggest that depressive symptomatology has a significant curvilinear relationship with unprotected sexual behaviors. MSM with moderate levels of depression may be at elevated risk of engaging in unprotected sexual behaviors in comparison to their peers who exhibit either significantly higher or lower depression scores.

The Impact of Psychological Burdens and Vaccine Worries on Confidence and Adherence to Governmental Policies Against COVID-19 Among Patients with Substance Use Disorder: A Cross-Sectional Study in Taiwan.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has had an impact on patients with substance use disorder (SUD). We aimed to investigate factors associated with confidence and adherence to governmental policies against COVID-19 (social desirability) among patients with SUD. Methods: This cross-sectional study was conducted during 2020 to 2021. Patients with SUD and healthy controls were recruited. The severity of sleep disturbance, social desirability, drug dependence, vaccine worries, other psychological burdens and demographic variables were collected through self-administrated questionnaires. Differences between the SUD and control groups were estimated. Hierarchical regression analysis was used to identify significant relationships between social desirability and other factors. Results: In total, 58 of patients with SUD and 47 healthy controls were recruited. The patients with SUD had a lower level of social desirability and more severe sleep disturbance than the control group. Older age, more severe sleep disturbance, lower level of drug dependence, and lower level of vaccine worries were significantly associated with a higher level of social desirability among the patients with SUD. Conclusion: Our results show the importance of timely interventions for drug dependence and to address vaccine worries in patients with SUD.

Effects of Internet popular opinion leaders (iPOL) among Internet-using men who have sex with men.

BACKGROUND: The Internet has become a popular venue for facilitating sex networking for men who have sex with men (MSM). OBJECTIVE: The study aimed to evaluate the effectiveness of Internet popular opinion leaders (iPOL) in disseminating information about the human immunodeficiency virus (HIV), increasing the frequency of HIV testing, and reducing risky behaviors among MSM in Taiwan. METHODS: A quasi-experimental study with a nonequivalent control website for comparison was used to estimate the effectiveness of iPOL. A community-level intervention, iPOL, was conducted at the Facebook social networking website and at top1069 as a control. The iPOLs actively disseminated HIV-related information via the platform of Internet opinion leaders and AIDS information center, and discussed and responded to questions or replied to Internet-using MSM. RESULTS: A total of 369 iPOLs posted 432 articles and 503 replies to others, influencing 959,088 persons on Facebook. A total of 1037 MSM, 552 (53.23%) from an intervention website and 485 (46.76%) from a control website, participated in the follow-up study survey (response rate 96%). At the 6-month follow-up after the intervention was conducted, MSM who visited the intervention website were more likely to receive HIV-related information (25.49% versus 10.47%, P<.001), discuss HIV issues with others (41.88% versus 23.79%, P<.001), review articles about HIV (90.58% versus 79.73%, P<.001), and be asked about or discuss HIV-related questions (51.11% versus 31.78%, P<.001) than those on the control website. In addition, MSM were more likely to have HIV tests within 6 months (43.89% versus 22.31%, P<.001) and consistently use condoms during anal sex with online sex partners than those using the control website (34.15% versus 26.19%, P=.004). CONCLUSIONS: The study showed the feasibility and effectiveness of the iPOL intervention as an online HIV prevention program. These findings underscore the importance of disseminating HIV information online, as well as the challenges inherent in the efforts of iPOL to reduce HIV-related risky behaviors among Internet-using MSM.

Online sex-seeking, substance use, and risky behaviors in Taiwan: results from the 2010 Asia Internet MSM Sex Survey.

We conducted an online behavioral survey to estimate the prevalence of online sex-seeking and substance use behaviors and to compare risky behaviors among men using different venues to seek sex with men. A cross-sectional online survey, the Asia Internet MSM Sex Survey, was conducted online from January 1 to February 28, 2010. Of the 1,645 participants enrolled from Taiwan, 72.4% reported the Internet as the main way of seeking sexual partners, 73.9% had had sex with partners found online, and 16% had used recreational drugs in the previous 6 months. There was no evidence to suggest that men who looked for sex through the Internet were more likely to engage in unprotected anal intercourse with their casual partners than those using other gay venues. Having had online sex partners in the previous 6 months was significantly associated with being young [adjusted odd ratio (AOR) = 0.97, 95% CI: 0.95-0.99], having had no steady partners in the previous year (AOR = 0.24, 95% CI: 0.15-0.39), having had more than five partners in the previous 6 months (AOR = 4.57, 95% CI: 2.95-7.11), having used recreational drugs in the previous 6 months (AOR = 2.24, 95% CI: 1.30-3.87), and having had an STI in the previous 6 months (AOR = 4.24, 95% CI: 1.59-11.30). In conclusion, because the Internet is a popular meeting place for MSM in Taiwan, effective and targeted prevention programs should be developed to minimize the HIV transmission risk in the Internet era.

[Depressive symptoms in people living with HIV: related factors].

BACKGROUND: People living with HIV (human immunodeficiency virus) are at a high risk of depressive symptoms attributed to disease progression and HIV-related stress. While depressive symptoms are difficult to detect, in HIV patients they may negatively impact upon quality of life, decrease adherence to antiretroviral therapies, and further exacerbate disease progression. PURPOSE: Study purposes were to: (1) explore relationships among immune function indicators, perceived stress, social stigma and depressive symptoms and (2) identify depressive symptom indicators in HIV patients. METHODS: Researchers recruited a total of 160 participants from infectious disease outpatient clinics at a university hospital in southern Taiwan. Chart reviews and four self-administered questionnaires (Beck Depression Inventory-II (BDI-II), Perceived Stress Scale, Multidimensional Scale of Perceived Social Support, and Social Impact Scale) were used to collect data. RESULTS: Symptoms of depression (BDI >= 14) were observed in 68 (42.5%) patients and symptoms of major depression (BDI >= 29) in 25 (15.6%). We found immune function indicators negatively associated with depressive symptoms (p < .05) and perceived stress and social stigma positively associated with depressive symptoms (p < .01). Stepwise multiple regression analysis indicated that perceived stress and social stigma accounted for 44.4% of depressive symptom variance. CONCLUSION: Findings suggest that reducing perceived stress and social stigma may positively affect perceived depressive symptoms in this population and may be referenced in future development of related interventions.

Predictors of Workplace Substance Reuse among Patients with Alcohol or Illegal Substance Use Disorder in the Workplace.

Substance and alcohol use in the workplace have become a global health burden; however, the etiologies have seldom been explored. The aims of this study were to develop a Workplace Substance Reuse Questionnaire (WSRQ) to measure the multidimensional factors associated with the reuse of alcohol or illegal substances in the workplace. The predictors of reuse were also investigated. The WSRQs for alcohol (WSRQ-Alc) and illegal substances (WSRQ-Sub) were composed of 15 and 13 items, respectively. Factors associated with workplace substance reuse included workplace environment, workload, social interaction in the workplace and other cues. Construct validity and reliability were performed to verify the questionnaires. Multivariate linear regression was conducted to estimate the associations between the factors and WSRQ score. A total of 90 patients with substance or alcohol use disorder were recruited. The results demonstrated that the WSRQ-Alc and WSRQ-Sub had acceptable reliability, with variance of 76.4% and 75.4%, respectively. The confirmatory factor analysis fit indices also indicated the adequacy of the model. A longer duration of alcohol use (ß = 0.44; p = 0.002) and higher frequencies of changing job (ß = 0.32; p = 0.027) and working part time (ß = 0.32; p = 0.028) were significantly associated with higher WSRQ-Alc score. Our results highlight the importance of abstinence treatment and job referral for individuals with alcohol or substance use. Further studies are warranted to help extend the applicability and generalizability of the WSRQ.

BST-1 as a serum protein biomarker involved in neutrophil infiltration in schizophrenia.

OBJECTIVES: Schizophrenia is a serious mental illness. The serum protein biomarkers of schizophrenia were explored using isobaric tags for relative and absolute quantitation (iTRAQ) technology. The underlying function of the identified protein biomarker was also investigated. METHODS: We first collected serum samples from 12 schizophrenia patients and 12 healthy control (HC) subjects, followed by global screening with iTRAQ and tandem mass spectrometry (LC-MS/MS). In total, 691 serum proteins were detected and eight proteins, including ZYX, OSCAR, TPM4, SDPR, BST1, ARGHDB, ITIH5 and SH3BGRL3, were selected for further specific validation with enzyme-linked immunosorbent assay (ELISA) on the serum samples from 52 schizophrenia patients and 50 HC subjects. RESULTS: Schizophrenia patients had significantly lower serum level of BST1 and higher ITIH5 level than the HC subjects did. Using the levels of BST1, ITIH5 and OSCAR combined with machine learning algorithm, we developed a prediction model of schizophrenia with an auROC value 0.78. Moreover, in vitro cell assay confirmed that BST1 significantly repressed neutrophil infiltration through endothelial layer, highlighted the anti-inflammation nature of BST1. CONCLUSIONS: Four novel protein markers (BST1, ITIH5, SDPR, and OSCAR) of schizophrenia were identified, and BST-1 could serve as a serum protein biomarker involved in neutrophil infiltration in schizophrenia.

The social and mental impact on healthcare workers: A comparative and cross-sectional study during two waves of the COVID-19 pandemic in Taiwan.

The coronavirus disease 2019 (COVID-19) pandemic has caused a heavily burden on healthcare workers (HCWs) worldwide. The aim of this study was to compare differences in psychological and social impact between two waves of the pandemic among first- and second-line HCWs in Taiwan. The current study derived data from two cross-sectional surveys conducted in 2020 and 2021. Levels of depression, sleep disturbance, psychological distress, social impact, and demographic variables were collected through self-reported questionnaires. The independent t test was used to compare differences in scores between the first and second wave of the pandemic. Differences between first- and second-line HCWs were also analyzed. A total of 711 HCWs in the first wave and 560 HCWs in the second wave were recruited. For the first- and second-line HCWs, the social impact during the second wave was higher than during the first wave, and they expressed a higher intention to maintain social distancing and were more aware of the pandemic overseas in the second wave. The first-line HCWs had a trend of worse sleep quality during the second wave. In addition, sleep quality was worse in the first-line HCWs than in the second-line HCWs during both waves. The second-line HCWs expressed a greater desire to seek COVID-19-related information than the first-line HCWs during the first wave, and more intended to maintain social distancing during the second wave. Our results show the importance of evaluating the social and mental health burden of HCWs, and especially first-line workers.

Relationship of Societal Adaptation with Vaccine Worries among Healthcare Workers during the COVID-19 Pandemic: The Mediating Effects of Posttraumatic Stress Disorder.

Vaccine hesitancy has become a major public health problem among healthcare workers (HCWs) in this coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to examine the relationship between societal adaptation and vaccine worries and the mediating effects of posttraumatic stress disorder (PTSD) indicators in HCWs. A total of 435 HCWs (327 women and 108 men) were recruited. Their levels of societal adaptation were evaluated using the Societal Influences Survey Questionnaire (SISQ). Their severity and frequency of PTSD symptoms were examined using the Disaster-Related Psychological Screening Test (DRPST). The severity of vaccine worries was assessed using the Vaccination Attitudes Examination (VAX) Scale. The relationships among societal adaptation, PTSD, and vaccine worries were examined using structural equation modeling. The severity of societal adaptation was positively associated with both the severity of PTSD and the severity of vaccine worries. In addition, the severity of PTSD indicators was positively associated with the severity of vaccine worries. These results demonstrated that the severity of societal adaptation was related to the severity of vaccine worries, either directly or indirectly. The indirect relationship was mediated by the severity of PTSD. Societal adaptation and PTSD should be taken into consideration by the community of professionals working on vaccine hesitancy. Early detection and intervention of PTSD should be the objectives for programs aiming to lower vaccine hesitancy among HCWs.

Heroin dependence and bloodborne virus transmission behaviors for HIV infection among newly incarcerated injection drug users in Taiwan.

The purpose of the study was to determine heroin dependence and risky behaviors associated with human immunodeficiency virus (HIV) infection among newly incarcerated injection drug users (IDUs). Three self-administrated questionnaires were collected among 450 newly incarcerated male heroin users during 2005-2007. Inmates were categorized as heroin-dependent if they met three or more of the six ICD-10 criteria. Heroin-dependent inmates had higher scores of bloodborne virus transmission risk than non-dependent IDUs (12.8 ± 16.0 vs. 7.2 ± 11.5, p < 0.001). Multiple logistic regression analysis indicated that heroin dependence was a significant moderator of the association between risky injection behaviors and HIV infection. It is crucial to integrate substance treatment with behavioral interventions into harm reduction programs to prevent bloodborne virus transmission among IDUs.

Statewide initiative of intensive psychiatric rehabilitation: outcomes and relationship to other mental health service use.

OBJECTIVE: This study examines the outcomes of a statewide implementation of Intensive Psychiatric Rehabilitation (IPR) for improving residential and employment status and earnings among individuals with severe mental illnesses and also examines its implementation with respect to mental health service utilization and costs. METHODS: This study employs a pre-post design with participants acting as their own controls for rehabilitation outcomes (residential status, vocational outcomes and earnings) comparing those who "completed" or had a sufficiently intense dose of IPR (one year) to those who dropped out early (before six months of service) and those who dropped out later in service (6-12 months). A separate analysis was conducted examining the relationship of IPR to other mental service use and costs using a quasi-experimental design that contrasted IPR completers with a control group matched via propensity scores. RESULTS: The results suggested significant improvement in residential status, employment status and gross monthly earnings for IPR completers relative to other groups. IPR completers also tended to use more mental health services or have more shallow decreases in use and cost of services relative to matched controls. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Gains in rehabilitation outcomes can be expected for those who engage in and complete IPR services, but IPR cannot be expected to result in reduced overall mental health service use and costs. Rather, IPR may improve service access or perhaps ameliorate any containment effect of managed care on service use.

Predictors for Depression, Sleep Disturbance, and Subjective Pain among Inpatients with Depressive Disorders during the COVID-19 Pandemic: A Cross-Sectional Study.

The coronavirus disease 2019 (COVID-19) pandemic can have a negative impact on patients with mood disorders. The aim of this study is to explore the societal influence of COVID-19 and associated impacts on levels of depression, sleep disturbance, and subjective pain among patients with mood disorders. This cross-sectional study recruited inpatients with depression and bipolar disorder. Levels of depression, sleep disturbance, subjective pain, and related demographic variables were collected through self-reported questionnaires. Potential factors associated with levels of depression, sleep disturbance, and subjective pain were identified using univariate linear regression and further entered into a stepwise multivariate linear regression model to identify the independent predictors. A total of 119 participants were included in the analysis, of whom 50.42% had bipolar disorder and 49.58% had unipolar depression. Multivariate analysis showed that a higher level of depression was associated with female subjects, subjects with partners, present history of psychological trauma, and drinking alcohol. Sleep disturbance was associated with subjects with partners and drinking alcohol. A higher level of subjective pain was associated with a higher level of social anxiety and a history of psychological trauma. The current study identified several predictors of psychological burden and subjective pain among inpatients with depression during the COVID-19 pandemic. Further investigations are warranted to extend the application and generalizability of our results.