The prevalence of comorbid mental health difficulties in young people with chronic skin conditions: A systematic review and meta-analysis.

Chronic skin conditions can have psychosocial and somatic implications, influencing well-being and quality of life. This systematic review and meta-analysis aimed to synthesise evidence on the prevalence of comorbid mental health difficulties in 0-25-year-olds with chronic skin conditions. A secondary aim included identifying factors associated with resilience. The narrative synthesis included 45 studies. Four meta-analyses were performed with moderate-high quality studies, one for each outcome: diagnosed mental disorders; mental health symptoms; suicidal behaviour; socio-emotional and behavioural difficulties. The pooled prevalence of diagnosed mental disorders was 1.2% (95% CI = 0.2-6.1); of mental health symptoms was 22.6% (95% CI = 18.9-26.7); of suicidal behaviour was 7.8% (95% CI = 1.4-3.1); of socio-emotional and behavioural difficulties was 20.9% (95% CI = 14.7-28.8). Findings demonstrate the pooled prevalence of comorbid mental health difficulties in youth with chronic skin conditions.

Childhood maltreatment and the risk of impaired glucose metabolism or type 2 diabetes in young adults: Findings from the Lifelines Cohort Study.

We examined the associations between childhood maltreatment and the risk of impaired glucose metabolism (IGM) or type 2 diabetes (T2D) in young adults aged 18-35. Participants (N = 8506) from the Lifelines Cohort Study without IGM or diabetes at baseline (2007-2013) were included. Childhood maltreatment was assessed by the Childhood Trauma Questionnaire (CTQ) and incident IGM/T2D was assessed by haemoglobin A1c levels (≥5.7%) in 2014-2017. There were 223 (2.6%) cases of IGM/T2D during the follow-up period. After adjusting for sociodemographic and health/lifestyle covariates and follow-up time, only the CTQ Sexual Abuse subscale was significantly associated with IGM/T2D (RR = 1.05 [95% CI = 1.01, 1.10]). The association remained when additionally accounting for depressive and anxiety symptoms (RR = 1.05 [95% CI = 1.00, 1.09]). Childhood sexual abuse was associated with an increased risk of IGM/T2D in young adults, highlighting the long-term metabolic consequences of childhood maltreatment.

Sexual health behaviours and partner notification practices related to sexually transmitted infections in young adults in Ireland.

BACKGROUND: Sexually transmitted infections (STIs) impose burdens on individuals and communities, while their prevalence in young people has risen continually in recent years. Partner notification is an effective public health strategy which can limit STI transmission. AIMS: This study aimed to explore young adults' sexual health behaviours, attitudes toward STI testing, and feelings toward visiting a sexual health clinic. It also aimed to investigate preferences for partner notification and the role of self-efficacy in people's intentions to notify a partner for STIs including the human immunodeficiency virus (HIV). METHODS: A quantitative, cross-sectional design was applied. Participants were 400 adults aged 18-34 years (M = 23 years; SD = 4.27), recruited from the Republic of Ireland. RESULTS: Over half of the participants reported never being tested for STIs. These young people placed less importance on undergoing regular STI testing and testing after unprotected sex than their counterparts who had been tested for STIs. Self-efficacy was significantly associated with intentions to notify partner(s) for STIs including HIV. CONCLUSIONS: As STIs are becoming increasingly prevalent in young adults, it is important to gain a deeper understanding of the interventions used to break the transmission chain and how different beliefs and attitudes may affect them. Self-efficacy was a key component in PN intentions, suggesting that the belief in someone's ability or skillset to perform a sexual health behaviour is positively related to their intention to perform the behaviour.

Parents' Information Needs in Relation to Adolescent Self-Harm: Perspectives of Parents and Professionals.

OBJECTIVE: Discovering that an adolescent is self-harming is extremely distressing for parents and this distress can be compounded by lack of easily accessible and well targeted information on what they can do to help. Some research has even suggested that parental distress can be an obstacle to seeking professional help. This paper describes two studies that sought to identify the information needs of parents in the immediacy of discovering self-harm and in ongoing efforts to support their child. METHOD: Study 1: on-line survey of 128 parents who had experienced their child's self-harm; study 2: two-round Delphi method with 29 professionals who provide therapeutic interventions to adolescents who self-harm. The primary aim of both studies was to elicit views on parents' information needs in relation to supporting adolescents who self-harm. RESULTS: There was a high level of agreement between parents and professionals on the needs for information on topics such as: communication, psychoeducation, managing emotional responses, parenting strategies and interventions. The professionals also emphasized the need for parents to practice self-care and the value of teaching alternative coping strategies to adolescents. Parents placed greater emphasis than professionals on the need for information on future therapeutic needs. CONCLUSION: Despite the agreement between parents and professionals on most of the information needed, there were sufficient differences in emphasis to confirm the importance of consulting with both groups. The findings can be used to develop information sources that are specifically tailored to the needs of parents at all stages of adolescent self-harm.

Parents want psychoeducation on self-harm and help managing emotional responsesProfessionals emphasize parent self-care and teaching adolescents other ways to copeParents should be consulted to ensure their information needs are fully understood.

The Social Determinants of Mental Illness: A Rapid Review of Systematic Reviews.

Previous research agendas have prioritised the role of biological determinants in mental illness aetiology. This is of particular concern, as endorsing biological determinants has been shown to promote negative attitudes towards people with mental illness. The aim of this review was to provide an overview of high-quality evidence of the social determinants of mental illness. A rapid review of systematic reviews was conducted. Five databases were searched: Embase, Medline, Academic Search Complete, CINAHL Plus, and PsycINFO. Systematic reviews or meta-analyses that described any social determinant of mental illness, were published in peer-review journals in English, and focussed on human participants were included. The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines were applied for the selection procedure. Thirty-seven systematic reviews were deemed eligible for review and narrative synthesis. Determinants identified included conflict, violence and maltreatment, life events and experiences, racism and discrimination, culture and migration, social interaction and support, structural policies and inequality, financial factors, employment factors, housing and living conditions, and demographic factors. We recommend that mental health nurses ensure adequate support be provided to those affected by the evidenced social determinants of mental illness.

Prediabetes and the risk of type 2 diabetes: Investigating the roles of depressive and anxiety symptoms in the Lifelines cohort study.

AIMS: Depression and anxiety may increase the risk of progressing from prediabetes to type 2 diabetes. The present study examined the interactions between prediabetes status and elevated depressive and anxiety symptoms with the risk of type 2 diabetes. METHODS: Participants (N = 72,428) were adults aged 40 years and above without diabetes at baseline from the Lifelines Cohort Study (58% female; mean age = 51.4 years). The Mini-International Neuropsychiatric Interview screened for elevated symptoms of major depressive disorder and generalized anxiety disorder. Glycated haemoglobin A1c (HbA1c ) levels determined prediabetes status at baseline (2007-2013), and HbA1c and self-reported diabetes diagnoses determined diabetes status at follow-up (2014-2017). Groups were formed for elevated depressive and anxiety symptoms, respectively, and prediabetes status at baseline (elevated depressive/anxiety symptoms with prediabetes, elevated depressive/anxiety symptoms alone, and prediabetes alone), and compared to a reference group (no prediabetes or anxiety/depression) on the likelihood of developing diabetes during the follow-up period. RESULTS: N = 1300 (1.8%) participants developed diabetes. While prediabetes alone was associated with incident diabetes (OR = 5.94; 95% CI = 5.10-6.90, p < 0.001), the group with combined prediabetes and depressive symptoms had the highest likelihood of developing diabetes over follow-up (OR = 8.29; 95% CI = 5.58-12.32, p < 0.001). Similar results were found for prediabetes and anxiety symptoms (OR = 6.57; 95% CI = 4.62-9.33, p < 0.001), compared to prediabetes alone (OR = 6.09; 95% CI = 5.23-7.11, p < 0.001), though with a smaller effect. The interaction between depressive symptoms and prediabetes was synergistic in age-and-sex adjusted analyses. CONCLUSIONS: Individuals with elevated depressive, and to some extent anxiety, symptoms in combination with prediabetes may represent a high-risk subgroup for type 2 diabetes.

Parent-Child Relationships, Digital Media Use and Parents' Well-Being during COVID-19 Home Confinement: The Role of Family Resilience.

Research has provided substantial evidence on the role of parents' well-being in the quality of parent-child relationships and children's adjustment. Parents' stress and parental couple conflict have been linked to children's adverse developmental outcomes. However, little is known about the factors that affect parents' well-being when coping with multiple stressors such as those brought by the recent COVID-19 global pandemic. Our study intended to examine the predictors of parental well-being by looking at the contextual factors of COVID-19 home confinement, i.e., the use of digital media and parents' domestic workload, and family resilience in two countries: Ireland and Italy. Additionally, the age and number of children were controlled as potential variables impacting parents' well-being. A three-step hierarchical regression analysis was applied. The results showed that family resilience was a very strong predictor of parents' well-being after controlling for any other variable. Parental couples' conflict over the use of technology predicted lower levels of parents' well-being, while, notably, parent child-conflict and domestic workload were not associated with parents' well-being. Additionally, the age of children did play a role: the higher the mean age of children in the family the better the parents' well-being. The findings are discussed in the light of cross-country differences and their implications for research and practice.

COVID-19 IDD: Findings from a global survey exploring family members' and paid staff's perceptions of the impact of COVID-19 on individuals with intellectual and developmental disabilities (IDD) and their caregivers.

Background: A growing body of evidence attests to the disproportionate impact of COVID-19 on persons with intellectual and developmental disabilities (IDD) during the pandemic. This study asked caregivers about their perceptions of how COVID-19 impacted them and the people they support. Method: An online survey was conducted in 12 countries during August-September 2020 and sought information on demographics, support practices, information and training, experiences of COVID-19, social distancing, and wellbeing, as measured by the DASS12. This study reports on 3,754 family members, direct support professionals, and managers who participated in the survey. Results: Caregivers observed increases in depression/anxiety, stereotyped behaviours, aggression towards others and weight gain in the person(s) they supported. They also reported difficulties supporting the person(s) to access healthcare.  Families reported reducing or ceasing employment and absorbed additional costs when supporting their family member. Direct support professionals experienced changes in staff shifts, staff absences, increased workload and hiring of casual staff. Caregivers' wellbeing revealed high levels of stress, depression, and less so anxiety. The strongest predictor of wellbeing among families was observation of changes in mood in the person(s) they supported, while for direct support professionals, the strongest predictors of wellbeing were reorganisation of staff shifts and increases in new direct support staff.  Discussion: Findings support the contention of this population experiencing a disproportionate burden during the COVID-19 pandemic, reflecting historical inequities in access to healthcare and other human rights violations which are now protected under the United Nations Convention on the Rights of Persons with Disabilities.

How does diagnostic labelling affect social responses to people with mental illness? A systematic review of experimental studies using vignette-based designs.

BACKGROUND: An outstanding question in the stigma literature is the extent to which negative responses are provoked by diagnostic labels, rather than observable symptoms of mental illness. Experimental studies frequently use vignettes to identify the unique effects of diagnostic labels on social responses to people with mental illness, independent of their behaviour or socio-demographic characteristics. AIMS: The current article identifies, evaluates, and synthesises the body of experimental vignette studies of labelling effects. METHODS: A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies were subjected to quality evaluation and narrative synthesis. RESULTS: Of 1511 articles screened, 22 met inclusion criteria. Most studies focused on the diagnostic categories of attention deficit hyperactivity disorder, schizophrenia spectrum disorders, and autism spectrum disorder. The literature reported diverse effects, with diagnostic disclosure either exacerbating, mitigating, or not affecting stigma. The quality of studies was generally acceptable but the review identified an over-reliance on convenience sampling and unvalidated measures. CONCLUSIONS: Results highlight the complexity of labelling effects, which diverge across diagnostic categories and social contexts. The review emphasises the need for expansion of diagnostic labels and contexts studied, standardisation of validated attitude scales, incorporation of behavioural outcomes, and diversification of samples.

Self-harm in Young People: Investigating the Role of Resilience and Posttraumatic Stress Related to the COVID-19 Pandemic.

Evidence shows that young people may have experienced increased levels of posttraumatic stress and depression during the COVID-19 pandemic. However, the landscape on self-harm is still unclear. This study aimed to examine the role of COVID-19 related posttraumatic stress, depression and resilience as predictors of self-harm with and without suicidal intent. Participants were 625 young people aged 17-25 years old (M = 20.2 years, SD = 2.47). Resilience was measured using the self-reported Child & Youth Resilience Scale Measure - Revised (CYRM-R). Posttraumatic stress related to COVID-19 were measured using the Impact of Event Scale- Revised. Depression was measured using the depression subscale of the Depression, Anxiety and Stress Scale-21. Self-harm was evaluated with two dichotomous items. Participants reported high levels of depression and COVID-19 posttraumatic stress, and a significant percentage reported engaging in self-harm. Hierarchical logistic regressions showed that caregiver resilience decreased approximately 20% the odds of engaging in self harm with and without suicidal intent remaining a consistent predictor even after accounting posttraumatic stress and depression in the models. Posttraumatic stress and depression predicted a one-fold increase in the odds of engaging in self-harm with and without suicidal intent. However, posttraumatic stress was no longer a significant predictor when depression was entered in the model in self-harm without suicidal intent. The COVID-19 pandemic may have increased the likelihood of engaging in self-harm in young people. However, caregiver resilience seems to operate as a protective factor. This important finding carries implications beyond the context of the COVID-19 pandemic.

Traumatic Distress of COVID-19 and Depression in the General Population: Exploring the Role of Resilience, Anxiety, and Hope.

International evidence published so far shows that the COVID-19 pandemic has negatively impacted on global mental health. Specifically, there is some research suggesting that the psychological distress related to depression, anxiety and posttraumatic stress has impacted on the psychological well-being of the general population. Yet, there is limited evidence on the relational paths between COVID-19 traumatic distress and depression. Participants of this cross-sectional study were 456 adults 18 years old or older from the general population (Mean age = 41.2 years, SD = 11.7) who completed an online questionnaire including measures assessing depression, anxiety, resilience, hope and traumatic distress related to COVID-19. Structural equation modelling was applied to examine the proposed mediation model. The results confirmed the proposed model, with traumatic distress of COVID-19, resilience, anxiety and hope explaining a considerable amount of variance (59%) in depression scores. Traumatic distress of COVID-19 was a strong positive predictor of depression, while anxiety, hope and resilience were both joint and unique mediators of this relationship. Exposure to the COVID-19 pandemic is strongly associated with depression in adults of the general population. The co-occurrence of anxiety may negatively contribute to experiencing higher levels of depression, while resilience and hope may act as buffers against depression associated with the impact of this pandemic. Our findings suggest that wide community-based interventions designed to promote resilience, build hope and reduce anxiety may help mitigate depression associated with exposure to the COVID-19 pandemic.

Psychometric properties of the Peer Mental Health Stigmatization Scale-Revised in adolescents and young adults.

AIM: This study aimed to examine the factorial validity and reliability of the Peer Mental Health Stigmatization Scale (PMHSS) in adolescents and young adults. METHODS: Young people (N = 963) aged 12 to 25 years (M = 16.1, SD = 3.08) were recruited across two studies. Study 1 included adolescents (n = 776) recruited from secondary schools and study 2 included young adults (n = 187) recruited from universities. All participants completed the PMHSS. RESULTS: Exploratory factor analysis resulted in a bi-factorial solution of the PMHSS by retaining 11 items out of the original 16 that loaded on the latent factors of stigma agreement and stigma awareness. Confirmatory factor analysis established the factor structure of the tool in adolescents and young adults. CONCLUSIONS: This shorter version of the PMHSS remains the only validated tool that measures stigma awareness and stigma agreement in youth. We recommend that this version is used in future research.

General practitioners' training and their attitudes towards young people who self-harm: A cross-sectional survey.

AIM: Self-harm is common among adolescents and young adults and carries increased risk of suicide and other negative outcomes, yet only a small proportion will seek professional help. General practitioners (GPs) are a potentially valuable source of help as most young people visit their GP regularly for other reasons. The primary aim of this research was to explore GPs' empathy and attitudes towards young people who self-harm and how these are related to GP specialist training. METHOD: GPs completed questionnaires regarding their training, levels of empathy, perceived knowledge and attitudes towards young people who self-harm. The cross-sectional design included a random sample of 178 GPs and 47 GPs-in-training in the Republic of Ireland. Bootstrapped mediation analysis using structural equation modelling (SEM) was applied to explore the pattern of relationships among GP-training, empathy, perceived knowledge of self-harm and attitudes towards youth who self-harm. RESULTS: The SEM results revealed that the model had a very good fit to the data. Empathy was the strongest predictor of attitudes towards self-harm even if GPs had received youth mental health training and fully mediated the effect of youth mental health training on perceived knowledge of self-harm. Specialized training in self-harm was a stronger predictor of perceived knowledge than empathy but had no association with negative attitudes. CONCLUSIONS: The findings emphasize positive outcomes associated with GP training and highlight potential differences in the effects associated with specific vs general training in youth mental health. These differences may be used to inform the design and implementation of continuing professional development.

Exploring the Impact of COVID-19 on Mental Health Outcomes in Children and Adolescents: A Systematic Review.

The psychological impact of the COVID-19 pandemic has been widely discussed during the past few months, with scholars expressing concern about its potential debilitating consequences on youth mental health. Hence, this research aimed to provide a systematic review of the evidence on the COVID-19 pandemic's impact on youth mental health. We conducted a mixed methods integrated review to identify any empirical study that focused on young people ≤ 18 years old. Eight databases were systematically searched to identify studies of any type of research design. The selection procedure followed the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. The protocol of this systematic review was registered with PROSPERO (protocol ID: CRD4202019375). Twelve studies deemed eligible for data extraction (n = 12,262). The findings show that COVID-19 has an impact on youth mental health and is particularly associated with depression and anxiety in adolescent cohorts. The quality appraisal indicated that all studies were of low or moderate methodological quality. The COVID-19 pandemic is affecting young people's lives, and thus generating robust research evidence to inform policy decisions is essential. Hence, the methodological quality of future research should be drastically improved.

COVID-19 IDD: A global survey exploring family members' and paid staff's perceptions of the impact of COVID-19 on individuals with intellectual and developmental disabilities and their caregivers.

Background: This protocol outlines research to explore the impact of coronavirus disease 2019 (COVID-19) on individuals who have intellectual and developmental disabilities and their caregivers. Evidence suggests that people with intellectual and developmental disabilities experience disparities in healthcare access and utilisation. This disparity was evident early in the pandemic when discussions arose regarding the potential exclusion of this population to critical care. Methods: An anonymous online survey will be conducted with caregivers, both family members and paid staff, to explore the impact of COVID-19 on this population in terms of demographics, living arrangements, access to services, the impact of social distancing, and also carer wellbeing. The survey will be developed by the research team, many of whom are experts in intellectual disability within their own jurisdictions. Using back-translation our team will translate the survey for distribution in 16 countries worldwide for international comparison. The survey team have extensive personal and professional networks in intellectual disability and will promote the survey widely on social media with the support of local disability and advocacy agencies. Statistical descriptive and comparative analyses will be conducted. Ethical approval has been obtained for this study from University College Dublin's Human Research Ethics Committee (HS-20-28-Linehan). Dissemination: Study findings will be prepared in a number of formats in order to meet the needs of different audiences. Outputs will include academic papers, lessons learned paper, practice guidelines, reports, infographics and video content. These outputs will be directed to families, frontline and management delivering disability services, national-level policy makers, healthcare quality and delivery authorities, national pandemic organisations and international bodies.

Survivors of institutional abuse in long-term child care in Scotland.

BACKGROUND: The Scottish Child Abuse Inquiry (SCAI) commissioned the research project to document the outcomes of institutional abuse in long-term child care in Scotland. OBJECTIVE: To profile the experiences of survivors abused in long-term child care in Scotland, and to develop a model which linked maltreatment, risk and protective factors, and outcomes. PARTICIPANTS AND SETTING: 225 survivors of historical institutional abuse in Scotland, who made witness statements to SCAI. METHODS: Data were extracted from witness statements using a coding frame developed through a thematic analysis of a subsample of 52 statements. RESULTS: Survivors had been in care in predominantly Catholic and non-religious residential institutions in Scotland for an average of 8 years, having entered at an average age of 6.8 years. They had suffered multiple forms of maltreatment. Maltreatment rates were: physical abuse, 95.6%; emotional abuse, 85.3%; sexual abuse, 60.4%; emotional neglect, 51.1%; and physical neglect, 37.3%. Across the lifespan survivors had negative outcomes in psychosocial adjustment (96%), mental health (84%), and physical health (43%). The effect of maltreatment in care on psychosocial problems was mediated by both risk and protective factors; and on mental health was mediated by risk factors, but not protective factors. Maltreatment in care had a direct effect on physical health which was not mediated by risk or protective factors. The effects of the cumulative number of risk factors on adverse mental health and psychosocial outcomes was greater than that of maltreatment, and protective factors had a limited impact on adverse outcomes. CONCLUSIONS: Evidence-based child protection policies and practices should be implemented to prevent institutional abuse and treat child abuse survivors in Scotland.

Personal and perceived public mental-health stigma as predictors of help-seeking intentions in adolescents.

This study aimed to determine predictors of help-seeking intentions for symptoms of depression/anxiety and self-harm in adolescents. It focused on personal and perceived public stigma to gather data of value for the design of anti-stigma interventions. Participants (n = 722; 368 girls) were recruited from three cohorts of secondary school students in Ireland (mean ages: 1st = 12.9 years; 3rd = 14.9 years; 5th = 16.6 years). Hierarchical regression models indicated that perceived public stigma is a significant unique predictor of help-seeking intentions for depression [F(4, 717) = 13.4, p < .001] and self-harm [F(4, 717) = 13.5, p < .001]. This indicates that young people's beliefs about other people's stigma towards mental health problems was a stronger predictor of help-seeking intentions than their own stigma beliefs. These findings highlight the importance of looking separately at different types of stigma when investigating the role of stigma in predicting help-seeking intentions.

Resilience following emotional abuse by teachers: Insights from a cross-sectional study with Greek students.

An integrative socio-ecological model was developed to investigate the impact of emotional abuse by teachers on children's psychological functioning and test the role of social support and self-confidence as protective factors associated with resilience. Emotional abuse by teachers, social support from family, peers, school and a significant adult from the community, self-confidence and psychological functioning were assessed in a sample of young Greek school students aged 9-12 years (n=223, mean age=10.8, SD=0.885). Results revealed that exposure to emotional abuse by teachers predicted behavioural problems in school students suggesting a negative effect of these experiences on psychological functioning. The bootstrapped mediation model showed that the impact of emotional abuse by teachers on psychological functioning was significantly diminished through the influence of social support and self-confidence. Also, social support exerted a strong positive impact on self-confidence. This is the first study to show that individual and environmental factors using a socio-ecological model of resilience influence the adverse outcomes of this form of abuse in school aged children. These findings suggest that emotional abuse by teachers should be considered as a potential source of behavioural problems and adjustment in elementary students. Social support through its strong effect on self-confidence is an important protective factor of resilience against emotional abuse by teachers.

Neuroticism, social network, stressful life events: association with mood disorders, depressive symptoms and suicidal ideation in a community sample of women.

According to the stress-diathesis hypothesis, depression and suicidal behavior may be precipitated by psychosocial stressors in vulnerable individuals. However, risk factors for mental health are often gender-specific. In the present study, we evaluated common risk factors for female depression in association with depressive symptoms and suicidal ideation in a community sample of women. The sample was composed by 415 women evaluated for mood disorders (MDs), depressive symptoms and suicidal ideation by structured interviews and the Beck depression inventory II (BDI II). All women also filled in the Eysenck personality questionnaire to evaluate neuroticism and were interviewed for social contact frequency and stressful life events (SLEs). In the whole sample, 19% of the women satisfied criteria for MD and suicidal ideation was reported by 12% of the women. Though stressful life events, especially personal and interpersonal problems, and poor social network were associated with all the outcome variables (mood disorder, depressive symptomatology and suicidal ideation), neuroticism survived to all multivariate analyses. Social network, together with neuroticism, also showed strong association with depressive severity, independently from current depressive state. Though we were unable to compare women and men, data obtained from the present study suggest that in women neurotic traits are strongly related to depression and suicidal ideation, and potentially mediate reporting of stressful life events and impaired social network. Independently from a current diagnosis of depression, impaired social network increases depressive symptoms in the women.

Potential role of membrane-bound COMT gene polymorphisms in female depression vulnerability.

BACKGROUND: Several polymorphic variants within the catechol-O-methyltransferase (COMT) gene locus have been associated with a number of diverse psychiatric phenotypes including affective disorders. COMT enzyme participates in metabolic pathways involving brain catecholamines, as well as steroid hormones such as estrogens. Given the suggested mood enhancing role of estrogens and the higher prevalence of depression in women, we set out to investigate the potential impact of functional COMT genetic variants on depression and anxiety symptoms in a homogeneous female community sample. METHODS: We genotyped three common polymorphisms within the COMT gene in a rural female population isolate (n=391) interviewed for the presence of lifetime major depression episodes and generalized anxiety disorder. Furthermore, well validated self-rated questionnaires were administered evaluating state depressive symptoms and neuroticism personality trait. Single-marker and haplotype association analyses were performed. RESULTS: Two highly correlated markers located in the membrane-bound (MB) COMT promoter region (rs2020917, rs737865) were significantly associated with both self-rated and clinician-rated depressive symptomatology. We did not detect any robust association with generalized anxiety disorder or neuroticism. Exploratory haplotype analysis examining the two promoter markers in combination with the extensively studied val 158met polymorphism (rs4680) did not provide any further support for the contribution of this variant in depressive mood. LIMITATIONS: The relative small sample size should be considered a limitation of this study. CONCLUSIONS: Our results provide promising evidence that MB-COMT specific genetic variation may represent an as yet unrecognized genetic factor that influences predisposition to depression amongst females.