Depression prevention in healthcare workers during the COVID-19 pandemic.

BACKGROUND: Few studies have assessed depression in healthcare workers (HCWs) in Japan owing to the coronavirus disease 2019 (COVID-19) pandemic, and no studies have proposed effective interventions to help support their mental health. AIMS: To test the hypothesis that enhancing access to mental healthcare professionals helps to improve HCWs' mental health. METHODS: This cross-sectional study assessed depressive symptoms in HCWs at three hospitals in Osaka prefecture between May and July, 2020. The survey obtained information on HCWs' mental state and related situations/perceptions. Multivariable logistic regression analysis was performed to identify factors associated with depressive symptoms. RESULTS: Of the 3291 eligible HCWs, 1269 (39%) completed the survey. Of all HCWs, 87 (7%) were physicians, and 700 (55%) were nurses. A total of 181 (14%) HCWs had moderate-to-severe symptoms of depression. Being a frontline worker was not significantly associated with depressive symptoms (odds ratio: 0.86 [95% confidence intervals: 0.54-1.37], P = 0.50). The unwillingness to consult with anyone was significantly associated with more severe depressive symptoms (1.70 [1.10-2.63], P < 0.01). HCWs who had no opportunity to confide in family/friends (1.66 [1.10-2.52], P < 0.01) or colleagues/supervisors (3.19 [2.22-4.58], P < 0.001) were significantly more likely to have depressive symptoms. CONCLUSIONS: Being a frontline HCW in a Japanese hospital treating patients with COVID-19 was not significantly associated with having depressive symptoms. The study highlights that encouraging daily communication with close persons (family, friends, colleagues and supervisors), rather than improving access to mental health professionals, might help to prevent depression in HCWs during the COVID-19 pandemic.

[Gonadal function in young female affective illness associated with the menstrual cycle--in relation to the polycystic ovary syndrome].

The hypothalamo-pituitary-gonadal axis was studied in 10 young manic-depressive or psychotic women whose symptoms obviously fluctuated in association with the menstrual cycle. The common clinical features of these cases were (1) young female aged between 15 and 25, (2) the symptoms fluctuated obviously in association with the menstrual cycle, and (3) severe manic-depressive, or psychotic symptoms. While, in two cases, the depressive or psychotic phases had repeated many times for several years, the rest eight cases did not have a long psychiatric past history. The common hormonal features among these 10 cases were elevated basal LH (7 of 10 cases), decreased basal FSH (6 of 10), greater response of LH and normal response of FSH to LHRH (8 of 8), lack of or insufficient increase of progesterone in the luteal phase (7 of 8), and elevated serum testosterone (5 of 10), androstenedione (4 of 10) and DHEA-S (3 of 9). These abnormalities resemble those of polycystic ovary syndrome (PCOS). Five of the 10 cases showed mild hirsute signs such as mustache, acne, and/or well-developed musculo-skeletal system. An ultrasonographical study revealed polycystic changes in 7 of 10 cases. Ordinary psychotropic pharmacotherapy was not effective sufficiently and hormonal therapy was tried in these 10 cases. Clomiphene citrate was administered on Day 5-9 of the menstrual cycle at a daily dose of 50mg orally in 9 cases, and it was effective to prevent recurrence of manic episode in one case, and to improve manic-depressive or psychotic symptoms in 6 cases. In these 6 cases, the effects were commonly observed within 1 or 2 weeks subsequent to the administration being completed. Daily dexamethasone administration was effective in one case with high serum DHEA-S level in whom clomiphene citrate worsened the psychotic symptoms, and thyroid hormone was effective in one case. In comparison with the pathophysiology of PCOS, a possible relationship was suggested between psychiatric problems and the PCOS-like hormonal abnormalities in these cases.

Major depressive episode and low dose dexamethasone suppression test.

The authors studied the validity of a low dose (0.5 mg) dexamethasone suppression test (DST) in identifying depression. Nine patients who met the criteria of major depressive episode (MDE) in the Diagnostic and Statistical Manual of Mental Disorders, another nine psychiatric patients and one normal subject underwent the DST. At least one of the two blood samples obtained either at 8 a.m. or at 2 p.m. from each of the nine patients with MDE showed a cortisol concentration of over 5.0 micrograms/dl, while the cortisol concentration in the other 10 subjects was uniformly suppressed under this level. All the patients with MDE could be identified by nonsuppression of the cortisol secretion at 8 a.m. or at 2 p.m. An "early escape" phenomenon in depressed patients reported by Carroll et al. (1976) was absent in a 0.5 mg DST, and the blood samples at 8 p.m. were less useful for identifying the depressive patient. The reason why the one point sampling method used by previous investigators was insufficient to identify the depressed patient was discussed.