The mental distress of our youth in the context of the COVID-19 pandemic.

BACKGROUND: Epidemiological evidence from population-based surveys suggest that the psychological well-being of adolescents has been severely affected by the COVID-19 pandemic itself, as well as by the safety measures implemented. The rationale of the study was to investigate the influence of the pandemic on psychiatric emergency service use, psychiatric admissions rates, emotional well-being, suicidality and self-harm behaviour in help-seeking children and adolescents. METHODS: Retrospective cohort study of electronic patient records before and during the COVID-19 pandemic from the emergency out-patient facility of the department of child and adolescent psychiatry and psychotherapy of the Psychiatric University Hospital Zürich. The frequency of all emergency service contacts from 1 January 2019 to 31 June 2021 were described and the frequency of records compared in half-year intervals. Emotional well-being, behavioural problems, suicidality and self-harm were estimated based on the mental state examination notes of electronic patient records from the 1 March to the 30 April for the years 2019, 2020 and 2021. RESULTS: After an initial decline in emergency contacts at the beginning of the first lockdown, the use of the centralised emergency service increased during the subsequent months and has since stabilised at a significantly higher level than before the pandemic. Comparison of emergency contacts in the first half of 2019 with the first half of 2021 shows that the number of emergency phone contacts nearly doubled, emergency outpatient assessments increased by 40%, emergency bridging interventions increased by 230%, and inpatient admissions of minors to adult psychiatric inpatient units more than doubled because of lack of service capacity in child and adolescent psychiatry. The proportion of adolescents who reported suicidal ideation increased significantly by 15%, from 69% to 84%, and the proportion of adolescents who reported self-harm behaviour increased by 17%, from 31% to 48%. CONCLUSION: We found a significant increase in psychiatric service use, as well as in reported serious mental health symptoms such as suicidality and self-harm behaviour in help-seeking children and adolescents in the course of the pandemic. The child and adolescent psychiatric healthcare system is overburdened and down-referral of adolescents in need of ongoing therapy is becoming increasingly difficult. We recommend prioritising preventive and therapeutic measures to support the mental health of our children and adolescents alongside the somatic management of the COVID-19 pandemic.

Feasibility and acceptability of home treatment as an add-on to family based therapy for adolescents with anorexia nervosa. A case series.

OBJECTIVE: This study examines the feasibility, acceptability, and preliminary effect sizes on outcome measures of home treatment (HT) as an add-on to family-based therapy (FBT) in adolescents with anorexia nervosa (AN). The HT intervention is delivered by specialized nurses and aims at supporting patients and parents to re-establish family meals in the home environment. METHOD: Forty-five (43 female, 2 male) adolescents meeting ICD 10 criteria for anorexia nervosa or atypical anorexia nervosa received FBT augmented with HT over 12 weeks. Eating disorder (ED) diagnosis, psychopathology and severity of clinical symptoms were assessed using the Eating Disorder Examination (EDE) interview, the Eating Disorders Inventory (EDI-2) at baseline (BL) and after 3-months RESULTS: All participants and parents were retained and found HT acceptable. At the end of Treatment (EOT) participants showed a significant early weight gain, a reduction in the AN psychopathology assessed with the EDE interview and a reduction in EDI-2 total scores. None of the patients had to be admitted to hospital. Treatment satisfaction was high in both patients and parents. DISCUSSION: Findings provide preliminary evidence that HT is feasible, acceptable and produces clinically significant improvements in targeted outcome.

Pleasant body odours, but not genetic similarity, influence trustworthiness in a modified trust game.

Identifying trustworthy partners is an important adaptive challenge for establishing mutually cooperative relationships. Previous studies have demonstrated a marked relationship between a person's attractiveness and his apparent trustworthiness (beauty premium). Kin selection theory, however, suggests that cues to kinship enhance trustworthiness. Here we directly tested predictions of the beauty premium and kin selection theory by using body odours as cues to trustworthiness. Body odours reportedly portray information about an individuals' genotype at the human leucocyte antigen system (HLA) and thus olfactory cues in body odours serve as a promising means for kin recognition. Ninety men played trust games in which they divided uneven sums of monetary units between two male trustees represented by their body odour and rated each body odour for pleasantness. Half of the odours came from HLA-similar men (suggesting closer kin) and half from HLA dissimilar men (suggesting non-kin). We found that the amount of money the players transferred was not related to HLA-similarity, but to the pleasantness of the trustee's body odour. By showing that people with more pleasant body odours are trusted more than people with unpleasant body odour we provide evidence for a "beauty-premium" that overrides any putative effect of kin.

Increased sensitivity to social exclusion during the luteal phase: Progesterone as resilience factor buffering against ostracism?

A woman's social behaviour reportedly varies across the menstrual cycle. In this study, we estimated changes in sensitivity to social exclusion across the menstrual cycle and scrutinized the related role of progesterone. Forty-nine naturally cycling women played a virtual ball-tossing game (Cyberball) to manipulate social inclusion. All participants underwent inclusion and exclusion conditions during the late follicular and the luteal phase. We assessed salivary progesterone concentrations at each cycle phase. After each Cyberball session we measured positive/negative mood using the Multidimensional Mood State Questionnaire (MDMQ). Multilevel analyses indicated that women showed worse mood following exclusion as compared to inclusion conditions (p = 0.014). Notably, this exclusion effect was more pronounced during the luteal phase than the late follicular phase (p = 0.029). As expected, progesterone concentrations were higher during the luteal phase as compared to the late follicular phase, but interestingly, progesterone concentrations were negatively associated with exclusion effects. When accounting for mediation via progesterone, direct cycle-phase related differences in social exclusion effects even increased as compared to the model without mediator. These findings suggest that progesterone may function as buffer against negative feelings that result from being socially excluded. The relevance of these findings for Premenstrual Dysphoric Disorder (PMDD) are discussed, and we conclude that social exclusion may represent an important research domain criterion (RDoC) of relevance for PMDD, with progesterone pointing to new potential pharmacological targets.

Reactive aggression tracks within-participant changes in women's salivary testosterone.

The relation between testosterone and aggression has been relatively well documented in men, but it is less well understood in women. Here we assessed the relationship between salivary testosterone and reactive aggression (i.e., rejection rate for unfair offers) in the Ultimatum Game. Forty naturally cycling women were tested twice, once in the late follicular phase (around ovulation) and once during the luteal phase. Ovulation was determined using urine test strips measuring luteinizing hormone levels. Salivary samples were assayed for testosterone, estradiol, progesterone, and cortisol at both test sessions. There was no association with the cycle, but multilevel modeling revealed a significant within-participant association between testosterone and rejection rate for extremely unfair offers (i.e., high reactive aggression), indicating that women showed greater reactive aggression when their testosterone levels were higher. Additionally, we found that women with relatively high individual concentrations of testosterone were more likely to reject extremely unfair offers than women with relatively low concentrations of testosterone. This study is the first to demonstrate that women react more aggressively in response to provocation when their testosterone level is high than when their testosterone is low, suggesting that testosterone plays an important role in the regulation of women's aggressive behavior following social provocation.

Men's preferences for women's body odours are not associated with human leucocyte antigen.

Body odours reportedly portray information about an individual's genotype at the major histocompatibility complex (MHC, called human leucocyte antigen, HLA, in humans). While there is strong experimental support for MHC-associated mating behaviour in animals, the situation in humans is more complex. A lot of effort has been spent on testing HLA-associated odour preferences of women. To date, only very few studies have looked at HLA-linked olfactory preferences in men and these studies have revealed inconsistent results. Here, we investigate men's HLA-associated preferences for women's body odours. Importantly, and in contrast to previous studies, these odours were gathered at peak fertility (i.e. just before ovulation) when any HLA-associated odour preferences should be strongest. We scrutinized whether men's preference for women's body odours is influenced by (i) the number of shared HLA alleles between men and women, (ii) HLA heterozygosity, and (iii) the frequency of rare HLA alleles. We found that men could readily differentiate between odours they found attractive and odours they found less attractive, but that these preferences were not associated with HLA. Specifically, men did not prefer odours from women who are HLA dissimilar, HLA heterozygous, or who have rare HLA alleles. Together, these findings suggest that HLA has no effect on men's odour preferences.

Do women tend while men fight or flee? Differential emotive reactions of stressed men and women while viewing newborn infants.

Infant care often is carried out under stressful circumstances. Little is known about differences in caretaking motivation between men and women under stress. In the present study, stress was induced in 40 participants (21 women, 19 men) by means of the cold pressor stress test, 40 (22 women, 18 men) serving as controls. Participants then rated their urge to care for newborn infants shown on 20 short video clips. The infants in the videos were either crying (N=10) or were showing typical neonatal facial movements (N=10). Skin conductance was obtained while participants viewed the videos and salivary cortisol was measured to capture stress responses. We found sex differences in caretaking motivation, such that stress led to decreased caretaking motivation in men but not in women. Furthermore, stressed men elicited a stronger skin conductance change while viewing infant videos than stressed women. These findings provide further evidence for differential stress reactions in men and women and may have crucial implications for parental care.

Can women detect cues to ovulation in other women's faces?

Recent research suggests that men find portraits of ovulatory women more attractive than photographs of the same women taken during the luteal phase. Only few studies have investigated whether the same is true for women. The ovulatory phase matters to men because women around ovulation are most likely to conceive, and might matter to women because fertile women might pose a reproductive threat. In an online study 160 women were shown face pairs, one of which was assimilated to the shape of a late follicular prototype and the other to a luteal prototype, and were asked to indicate which face they found more attractive. A further 60 women were tested in the laboratory using a similar procedure. In addition to choosing the more attractive face, these participants were asked which woman would be more likely to steal their own date. Because gonadal hormones influence competitive behaviour, we also examined whether oestradiol, testosterone and progesterone levels predict women's choices. The women found neither the late follicular nor the luteal version more attractive. However, naturally cycling women with higher oestradiol levels were more likely to choose the ovulatory woman as the one who would entice their date than women with lower oestradiol levels. These results imply a role of oestradiol when evaluating other women who are competing for reproduction.

Testosterone-to-oestradiol ratio is associated with female facial attractiveness.

The relationship between facial shape and attractiveness has been extensively studied, yet few studies have investigated the underlying biological factors of an attractive face. Many researchers have proposed a link between female attractiveness and sex hormones, but there is little empirical evidence in support of this assumption. In the present study we investigated the relationship between circulating sex hormones and attractiveness. We created prototypes by separately averaging photographs of 15 women with high and low levels of testosterone, oestradiol, and testosterone-to-oestradiol ratio levels, respectively. An independent set of facial images was then shape transformed toward these prototypes. We paired the resulting images in such a way that one face depicted a female with high hormone level and the other one with a low hormone level. Fifty participants were asked to choose the more attractive face of each pair. We found that low testosterone-to-oestradiol ratio and low testosterone were positively associated with female facial attractiveness. There was no preference for faces with high oestradiol levels. In an additional experiment with 36 participants we confirmed that a low testosterone-to-oestradiol ratio plays a larger role than low testosterone alone. These results provide empirical evidence that an attractive female face is shaped by interacting effects of testosterone and oestradiol.

Preference for cute infants does not depend on their ethnicity or species: evidence from hypothetical adoption and donation paradigms.

Results of previous work suggest a preference of adult observers for cute compared to less cute infants. In Study 1 we investigated whether the preference for cute infants depends on the ethnicity and species of the infant. We simultaneously presented two faces (one cute and one less cute) and asked Caucasian participants to choose the infant to whom they would rather give a toy (Task 1) and which infant they would rather adopt (Task 2). The infants were Caucasian or African human babies or dog puppies. For all face categories and in both tasks we found a strong preference for cute infants. A possible reason for preferring cute infants may be that cute infants look healthier than less cute infants. To investigate whether cuteness is associated with the assessment of health we conducted Study 2. Faces of Caucasian and African infants and dog puppies were rated for cuteness and health. The findings revealed a significant relationship between health and cuteness evaluation across all stimuli. We suggest that one reason why cute infants are preferred might be because they are perceived as being healthier.

Menstrual cycle phase affects discrimination of infant cuteness.

Recent studies have shown that women are more sensitive than men to subtle cuteness differences in infant faces. It has been suggested that raised levels in estradiol and progesterone may be responsible for this advantage. We compared young women's sensitivity to computer-manipulated baby faces varying in cuteness. Thirty-six women were tested once during ovulation and once during the luteal phase of their menstrual cycle. In a two alternative forced-choice experiment, participants chose the baby which they thought was cuter (Task 1), younger (Task 2), or the baby that they would prefer to babysit (Task 3). Saliva samples to assess levels of estradiol, progesterone and testosterone were collected at each test session. During ovulation, women were more likely to choose the cuter baby than during the luteal phase, in all three tasks. These results suggest that cuteness discrimination may be driven by cyclic hormonal shifts. However none of the measured hormones were related to increased cuteness sensitivity. We speculate that other hormones than the ones measured here might be responsible for the increased sensitivity to subtle cuteness differences during ovulation.