The anatomy of COVID-19-related conspiracy beliefs: Exploring their nomological network on a nationally representative sample.

OBJECTIVES: The outbreak of the COVID-19 pandemic was followed by the widespread proliferation of conspiracy beliefs (CBs) regarding the origin and harmfulness of the virus and a high level of hesitancy to vaccinate. We aimed to test a series of hypotheses on the correlates of CBs and vaccination, including socio-demographic factors, personality dispositions, somatic health, stressful experiences during pandemics, and psychological distress. METHOD: The sample (N = 1203), was based on a multistage probabilistic household sampling representative of the general population. The subjects were randomly split into two approximately equal subgroups, enabling cross-validation. Based on the findings in the exploratory, the SEM model was tested in the confirmatory subsample. RESULTS: The correlates of CBs were Disintegration (proneness to psychotic-like experiences), low Openness, lower education, Extraversion, living in a smaller settlement and being employed. The correlates of vaccination were older age, CBs and larger places of living. Evidence on the role of stressful experiences and psychological distress in CBs/vaccination was not found. The findings of moderately strong and robust (cross-validated) paths, leading from Disintegration to CBs and from CBs to vaccination were the most important ones. DISCUSSION: Conspiratorial thinking tendencies-related to health-related behaviour such as vaccination-appear to be, to a considerable extent, manifestations of the mechanisms that are part of our stable, broad, trait-like thinking/emotional/motivational/behavioural tendencies, primarily proneness to psychotic-like experiences & behaviours.

How are parental practices and attitudes towards corporal punishment related to child academic, developmental, or psychological-emotional dysfunctioning?

Corporal punishment (CP) is a widely spread disciplining practice among parents and caregivers globally. Our paper aimed to explore the relationship between the parental attitudes towards CP, expected outcomes of CP, and parenting practices on one hand, with the reported dysfunctions of their children, on the other. Additionally, we aimed to explore the relationship between the use of CP and the reported academic, developmental, and psychological-emotional dysfunctions of their children. The present study involved a nationally representative sample of 1186 parents in Serbia, who had at least one child aged 0-18 years at the moment of interviewing. The parents filled out a series of questionnaires on their attitudes towards CP, expectations of CP outcomes, and their parental practices. Findings indicate that parents that report having a child with dysfunctions have positive attitudes towards CP and expect positive outcomes of CP. These parents also report using more CP as a disciplining method, as well as other harsh disciplining practices. We also identified parental positive expectations of CP, use of physical assault, psychological aggression, neglect as significant predictors of reported child dysfunctions severity. Having all the results in mind, we can assume that children with health-related and school-related issues might be at potential risk of further maltreatment.

Mental Health, Alcohol and Substance Use of Refugee Youth.

This study aims to explore the prevalence of alcohol and substance use among young refugees along with the indicators of experienced psychological difficulties. It is based on a sample of 184 children and adolescents aged 11-18 years old, residing at two refugee centers in the Republic of Serbia. Out of 184 participants, the majority was male (N = 155; 84.29%). More than a half of participants (53.3%) displayed significant symptoms of PTSD. 50% consume energy drinks, 28% use tobacco; 13% use alcohol; 4.6% use marijuana; 1.7% use LSD, amphetamines, glue, tranquilizers and cocaine. Female respondents were more frequently expressing emotional difficulties (p < 0.05) while male participants were more frequent users of alcohol or substances (p < 0.01). Younger children were more frequently expressing symptoms of hyperactivity and prosocial behavior, while they were less frequently using substances. There is also a significant negative correlation between the years of education and individual proneness to substance use. Furthermore, those who resided in a greater number of refugee camps were found to experience greater levels of emotional and behavioral difficulties and face a greater risk of physical abuse. The burden of migration increases proneness to substance use, as a consequence of scarce coping resources and the stress of adjusting. Migrants are vulnerable to substance use, since some of them have commonly witnessed and/or personally experienced pre-and post-migration stress and trauma, including loss of homes and livelihoods, violence, torture and family separation. Preventive programs need to focus on the problem of alcohol and substance use among this vulnerable population.

Mental health in the second year of the COVID-19 pandemic: protocol for a nationally representative multilevel survey in Serbia.

INTRODUCTION: The COVID-19 pandemic is likely to have a prolonged impact on mental health (MH); however, the long-term MH effects of the COVID-19 pandemic remain unknown. The Serbian national survey-CoV2Soul.RS-was launched to document the MH status of the Serbian population following the COVID-19 pandemic and to contribute to an international evidence base about MH prevalence rates during different phases of the pandemic. METHODS AND ANALYSIS: This cross-sectional study was designed to collect a nationally representative sample (N=1200; age 18-65 years; estimated start/end-June/November 2021) using multistage probabilistic household sampling. Trained staff will conduct in-person diagnostic interviews. A battery of self-report instruments will be administered to assess the quality of life (QoL), general distress and associated protective and harmful psychological and societal factors. Analyses will be conducted to delineate the prevalence rates of MH disorders, how MH conditions and QoL vary with respect to sociodemographic variables, personality, health status and traumatic events during the COVID-19 pandemic, and to test how these relations depend on geographical region. Moreover, this study was designed to explore mechanisms linking personality and the perception of pandemic consequences and associated distress. Prevalence rates of MH disorders will be calculated using descriptive statistics. For additional analyses, we will use correlations, analysis of variance and regression analyses. The hierarchical structure of the data will be explored using multilevel random coefficient modelling. Structural equation modelling will be used to investigate the indirect effects of personality on distress through relevant variables. ETHICS AND DISSEMINATION: Ethical Committees of the Faculty of Medicine (1322-VII/31) and Faculty of Philosophy in Belgrade (02-33/273) and Faculty of Philosophy in Novi Sad (05-27, br.893/1) approved the protocol. Only respondents able to provide informed consent will participate in the study. Research reports will be submitted to peer-reviewed journals and the results will be placed on the website www.cov2soul.rs to be available to funders, researchers, policy-makers and interested laypeople, and will be advertised through social media. TRIAL REGISTRATION NUMBER: NCT04896983.

Development of Evidence-Based Rehabilitation Practice in Botanical Garden for People With Mental Health Disorders.

AIM: This article aims to make clearer, with supporting evidence, the clinical benefits of the nature-based rehabilitation program (NBRP) and the restorative values of visiting botanical garden for people with stress-related mental disorders. BACKGROUND: Throughout the years, nature-based therapy has been acknowledged as a valuable rehabilitation practice that integrates specially designed natural environments and nature-related activities for people with mental health conditions. SUBJECT AND METHODS: The comparative analyses of parallel conducted the NBRP at botanical garden and occupational therapy realised at the Day Hospital of the Institute of Mental Health in Belgrade included 27 participants divided into two groups. The data collection employed a mixed method combining a Clinical Global Impression (CGI) Scale and on-site observations. RESULTS: The positive findings on the psychological recovery of the participants seem to be related to NBRP. The restorative potential of the garden was recognized through the observed interaction between participants and the natural entities employed through the various themed activities. The observed landscape elements especially solitary plant specimens or tall and single-form trees within the garden can be embraced as design guidelines for the development of an evidence-based practice that can support the recovery process of people with mental health conditions. CONCLUSION: Our findings endorse that ongoing social development and progressive urbanization have broadened the interest in scientific research involving nature-based solutions that help preserve the physical and mental health of people in low- and middle-income Western Balkan countries with a high prevalence of mental disorders in the urban environment that relates to social inequalities and natural disasters.

Lost in projection - Implicit features experience of 3D architectural forms and their projections.

The aim of our study was to investigate whether the experience of objects' implicit features would change if we observe it as a real 3D object or as a photograph or a drawing. In our experiment 46 participants estimated their impression of 10 objects shown in four different presentations. As stimuli, we used 3D objects, their virtual reality models, photographs and drawings from four different viewing directions, created by architecture students. As a measure of implicit features experience we used 12 bipolar adjectives grouped into four factors (attractiveness, regularity, arousal, and calmness) and 3 adjectives forming aesthetic experience factor. Results show significant differences between types of object presentations on four factors of implicit features experience, but not on the aesthetic experience factor. Real 3D objects were experienced as more attractive and calm, while VR presentation showed reduced arousal than other presentation types. On regularity VR and real 3D objects were experienced as same and more regular then drawings and photographs.

People with physical disability in Serbia: Relationship between internalized stigma, experienced and anticipated discrimination, and empowerment.

The aim of present study was to explore relationships between experienced and anticipated discrimination, internalized stigma, and empowerment among people with physical disabilities in Serbia. The convenience sample consisted of persons with different types of physical disabilities. The following scales were administrated: The Discrimination and Stigma Scale, the Internalized Stigma of Mental Illness Scale, and the Boston University Empowerment Scale. An analysis showed that internalized stigma was correlated with experienced and anticipated discrimination and empowerment, while no correlation was found between empowerment and discrimination. People with physical disabilities who experienced and anticipated discrimination are at higher risk of reporting internalized stigma.

Interaction of glutathione S-transferase polymorphisms and tobacco smoking during pregnancy in susceptibility to autism spectrum disorders.

Autism spectrum disorders (ASD) are a group of complex psychiatric disorders, with a proposed gene-environment interaction in their etiology. One mechanism that could explain both the genetic and environmental component is oxidative stress. The aim of our study was to investigate the potential role of common polymorphisms in genes for glutathione transferase A1, M1, T1 and P1 in susceptibility to ASD. We also aimed to explore the possible oxidative stress - specific gene-environment interaction, regarding GST polymorphisms, maternal smoking tobacco during pregnancy (TSDP) and the risk of ASD. This case-control study included 113 children with ASD and 114 age and sex-matched controls. The diagnosis was made based on ICD-10 criteria and verified by Autism Diagnostic Interview - Revised (ADI-R). We investigated GSTA1, GSTM1, GSTP1 and GSTT1 genotypes and explored their individual and combined effects in individuals with ASD. Individual effect of GST genotypes was shown for GSTM1 active genotype decreasing the risk of ASD (OR = 0.554, 95%CI: 0.313-0.983, p = 0.044), and for GSTA1 CC genotype, increasing susceptibility to ASD (OR = 4.132, 95%CI: 1.219-14.012, p = 0.023); the significance was lost when genotype-genotype interactions were added into the logistic regression model. The combination of GSTM1 active and GSTT1 active genotype decreased the risk of ASD (OR = 0.126, 95%CI: 0.029-0.547, p = 0.006), as well as combination of GSTT1 active and GSTP1 llelle (OR = 0.170, 95%CI: 0.029-0.992, p = 0.049). Increased risk of ASD was observed if combination of GSTM1 active and GSTP1 llelle was present (OR = 11.088, 95%CI: 1.745-70.456, p = 0.011). The effect of TSDP was not significant for the risk of ASD, neither individually, nor in interaction with specific GST genotypes. Specific combination of GST genotypes might be associated with susceptibility to ASD, while it appears that maternal smoking during pregnancy does not increase the risk of ASD.

Epilepsy and interictal epileptiform activity in patients with autism spectrum disorders.

PURPOSE: The purpose of this study was to determine the prevalence of epilepsy and subclinical epileptiform abnormalities in children with autism spectrum disorder (ASD), and to investigate its effects on core autistic symptoms and adaptive behavior skills. METHODS: Patients with diagnosis of ASD who met full criteria on Autism Diagnostic Interview-Revised (ADI-R) were included in the study. Adaptive behavior skills were assessed by Vineland Adaptive Behavior Scale-II (VABS-II). Clinical assessment for epilepsy and video electroencephalography (EEG) (v-EEG) examinations during wakefulness and/or sleep were prospectively performed in all patients. RESULTS: A total of 112 patients with diagnosis of ASD of mean age 6.58 ±â€¯3.72 were included in the study. Based on clinical and v-EEG assessments, three groups of patients were defined: 1) patients with epilepsy (n = 17; 15.2%); 2) patients with epileptiform discharges in absence of clinical seizures (n = 14; 12.5%); 3) patients without epilepsy and without epileptiform discharges (n = 81; 72.3%). There were no significant differences between three groups of patients on ADI-R subscores. Speech development was also not significantly related to epilepsy. There was a slight tendency of the VABS-II motor skills score to be higher in the group of patients with autism without clinical diagnosis of epilepsy and without subclinical epileptiform discharges (p < 0.05) in comparison with the two other groups. According to this tendency, we might claim that patients with higher scores on motor skills could have 0.88 times lower odds for having epileptiform EEG activity. CONCLUSIONS: According to our results, we were not able to detect differences in the ADI-R between the three populations with ASD, all with unknown etiology. Epilepsy, as well as subclinical epileptic discharges, showed small effects on Motor Skills in patients with autism, and had no effect on adaptive behavior Communication/Socialization/Daily Living Skills.

Nature based solution for improving mental health and well-being in urban areas.

The general disproportion of urban development and the socio-economical crisis in Serbia, followed by a number of acute and chronic stressors, as well as years of accumulated trauma, prevented the parallel physical, mental and social adaptation of society as a whole. These trends certainly affected the quality of mental health and well-being, particularly on the vulnerable urban population, increasing the absolute number of people with depression, stress and psychosomatic disorders. This study was pioneering in Serbia and was conducted in collaboration with the Faculty of Forestry, the Institute of Mental Health and the Botanical Garden in Belgrade, in order to understand how spending time and performing horticulture therapy in specially designed urban green environments can improve mental health. The participants were psychiatric patients (n=30), users of the day hospital of the Institute who were randomly selected for the study, and the control group, assessed for depression, anxiety and stress before and after the intervention, using a DASS21 scale. During the intervention period the study group stayed in the Botanical garden and participated in a special programme of horticulture therapy. In order to exclude any possible "special treatment'' or ''placebo effect", the control group was included in occupational art therapy while it continued to receive conventional therapy. The test results indicated that nature based therapy had a positive influence on the mental health and well-being of the participants. Furthermore, the difference in the test results of the subscale stress before and after the intervention for the study group was F1.28 = 5.442 and p<;.05. According to socio demographic and clinical variables, the interesting trend was recorded on the subscale of anxiety showing that the male participants in the study group were more anxious, with the most pronounced inflection noted on this scale after treatment. The results of this study have shown that recuperation from stress, depression and anxiety was possible and much more complete when participants were involved in horticulture therapy as a nature-based solution for improving mental health.

Longitudinal Study of Posttraumatic Stress Disorder in the Community: Risk and Recovery Factors.

Posttraumatic stress disorder (PTSD) is a multicausal phenomenon and a final end point of the combination of a number of potential causes. Our study aimed to examine potential risk and recovery factors of PTSD in general adult population at 1-year follow-up period. The sample consisted of 640 subjects in the initial phase, chosen by random walk technique in five regions of the country, and 100 in the follow-up. The assessment has been carried out by the following instruments: Mini-International Neuropsychiatric Interview, Life Stressor Checklist-Revised, Brief Symptom Inventory, and Manchester Short Assessment of Quality of Life Scale. Older age, low education, and lower monthly income are potential risk factors for current PTSD, as well as decreased quality of life, psychiatric comorbidity, and higher personal distress. Urban population, higher quality of life, smaller number of stressors, and lower personal distress contributed to recovery of PTSD. It is essential to know the risk and resilience factors that contribute to the development and recovery of PTSD, which is important for prevention and treatment of this disorder.

Experienced and anticipated discrimination among people with major depressive disorder in Serbia.

BACKGROUND: Experiences of discrimination have significant impact on the lives of people with mental illness. AIM: This study investigates the nature and severity of experienced and anticipated discrimination reported by persons with a depressive disorder in Serbia. METHODS: Patients were recruited from two psychiatric day hospitals and a primary mental health service with a diagnosis of major depressive disorder. Interviews were conducted using a socio-demographic questionnaire and the Discrimination and Stigma Scale. RESULTS: The respondents experienced discrimination mostly in the field of family relationships, making and keeping friends and keeping a job. In domains of making close personal relationships or applying for education, anticipated discrimination was higher than experienced. The need to conceal mental health problems was stronger than experiences of being avoided. The need to hide mental health problems was higher than the overall score for experienced discrimination. Participants who were hospitalized in some period of life reported higher experienced discrimination. Compared to younger participants, older participants experienced more negative as well as positive discrimination. Married participants experienced more negative discrimination than unmarried. CONCLUSION: It is important to design interventions to overcome discrimination toward persons with depression at all levels.

Determinants of quality of life in people with epilepsy in Serbia.

PURPOSE: This study aimed at finding determinants of quality of life in people with epilepsy (PWE) living in Belgrade, Serbia. METHOD: In this study, we recruited consecutive adults with epilepsy attending our outpatient department. Adult patients (age range: 18-65years) of normal intelligence and without any progressive neurological disease or psychiatric disorder were included in the study. They completed the following questionnaires: QOLIE-31 Inventory (Serbian version), Beck's Depression Inventory-II, Beck's Anxiety Inventory, Symptom Check List-90, and Neurotoxicity Scale-II. Hierarchical multiple regression analysis was performed to assess the predictive effects of some factors on QOLIE-31 Inventory. RESULTS: The mean QOLIE-31 score of 203 patients who completed the questionnaires was 70.64±17.74. Sociodemographic factors (age, sex, education, and employment) did not significantly predict QOLIE-31 score. Significant determinants of quality of life were clinical characteristics - seizure severity and etiology of epilepsy - accounting for 30.9% of the variance, depressive and anxiety symptoms accounting for 42.8% of the variance, and cognitive effects of antiepileptic drugs, accounting for 1.5% above other variables. CONCLUSIONS: The results suggest that seizure severity and etiology of epilepsy, depressive and anxiety symptoms, and cognitive adverse medication effects are main determinants of quality of life in this population of PWE.

Posttraumatic stress disorder in a Serbian community: seven years after trauma exposure.

Posttraumatic stress disorder (PTSD) may develop as a serious long-term consequence of traumatic experiences, even many years after trauma exposure. The objectives of this study were to examine the prevalence of lifetime and current PTSD as well as to detect the most stressful life events and sociodemographic risk factors of PTSD in a general adult Serbian population. The sample consisted of 640 subjects chosen by random walk technique in five regions of the country. The Mini International Neuropsychiatric Interview 5 revealed an 18.8% prevalence rate of current PTSD and a 32.3% prevalence rate of lifetime PTSD. According to the Life Stressor Checklist-Revised, the bombardment, being expelled from home, siege, and participation in combat were the stressful events most likely to be associated with PTSD. The prevalence of PTSD increased among widows and widowers, divorced persons, unemployed persons, and retired persons. The high level of PTSD a few years after the trauma exposure classifies as a significant health problem that can cause serious consequences for families and the community as a whole.

Comparative study of experienced and anticipated stigma in Serbia and the world.

AIM: The presented study is part of the International Study of Discrimination and Stigma Outcomes (INDIGO) conducted in 28 countries. The aim of this study was to compare the degree of experienced and anticipated stigma of patients with schizophrenia in Serbia with world results. METHOD: The Discrimination and Stigma Scale (DISC) was applied in individual interviews. The sample comprised 732 subjects of the main study and 50 subjects from Serbia. RESULTS: The amount of negative experienced discrimination in Serbia is the same as in other participating countries. The Serbian sample shows more negative discrimination in intimate relationships, personal safety and general harm due to the diagnosis, but more positive discrimination within the family, privileges during treatment of somatic illnesses, and benefits enjoyed in social and retirement insurance. The Serbian sample shows less anticipated discrimination in looking for a close relationship and in stopping self from applying for work. The results show that socio-demographic variables could not predict negative experienced and anticipated discrimination, while those same variables enable the prediction of 34% of positive discrimination. CONCLUSION: Compared to other investigated countries, stigmatization processes for persons with schizophrenia do not differ considerably in Serbia, which justifies the implementation of unique anti-stigma programmes and joint upgrading of legal regulations.

Burnout syndrome among physicians - the role of personality dimensions and coping strategies.

BACKGROUND: Burnout syndrome (BS) and stress-related disorders are frequent among medical specialists, but it has been suggested that some health workers are more prone to the BS than others. This study assessed the intensity of the BS among 3 groups of physicians: psychiatrists, general practitioners and surgeons and examined correlation both between the intensity of BS and physicians` personality dimensions as well as between the level of BS and stress coping strategies. SUBJECTS AND METHODS: The sample consisted of 160 physicians (70 general practitioners, 50 psychiatrists, 40 surgeons). The assessment was carried out by the Maslach Burnout Inventory, The Temperament and Character Inventory and Manual for the Ways of Coping Questionnaire. RESULTS: Dimension of emotional exhaustion was the most prominent in general practitioners (F=5.546, df1=2, df2=156, p<0.01), while dimension of depersonalization was highest in surgeons (F=15.314, df1=2, df2=156, p<0.01), as well as lack of personal accomplishment (F=16.079, df1=2, df2=156, p<0.01). We found that the Harm Avoidance has lead to development of BS while Self-directedness and Cooperativeness were prominent in physicians with low level of BS. The escape-avoidance was in correlation with high depersonalization and lack of personal accomplishment while self-control was prominent in physicians with lower BS. CONCLUSION: The BS affects personal well-being and professional performance. It is important to identify individuals with a tendency towards its development, in order to undertake preventive measures such as stress management and improvement of the stress coping strategies.

Psychometric evaluation of the Serbian version of the Quality of Life in Epilepsy Inventory-31 (QOLIE-31).

PURPOSE: To evaluate the psychometric properties of the Serbian-language version of the Quality of Life in Epilepsy Inventory-31 (QOLIE-31). METHODS: After undergoing a translation and cultural adaptation of its items in order to create a Serbian-language version of QOLIE-31, we assessed its psychometric properties-reliability, construct validity and criterion validity. The sample consisted of 203 adults with epilepsy. Reliability was tested both by assessing the internal consistency and by the test-retest method. Construct validity was assessed by factor analysis, multitrait-scaling analysis and method of known-groups validation. This was achieved by assessing the relationship between scales and external measures (socio-demographic characteristics, seizure severity and etiology of epilepsy). Criterion validity was assessed by correlation analysis between QOLIE-31 and Short form 36 health survey (SF-36) and Neurotoxicity scale-II. RESULTS: The domains showed high internal consistency (Cronbach's α 0.94). Test-retest reliability for Overall test score was 0.83 (Pearson's coefficient) indicating temporal stability. Seizure severity and etiology of epilepsy significantly influenced all QOLIE-31 domains except the Medication effect domain, with lowest scores in high seizure severity and symptomatic etiology groups. Employment status significantly influenced Overall quality of life, Emotional well-being, Social function and Overall score. Educational level was related to the Emotional well-being domain, with highest scores for students. The QOLIE-31 was highly positively correlated with SF-36 (rho=0.898) and strongly negatively correlated with Neurotoxicity scale-II (rho=-0.783). CONCLUSION: Serbian adaptation of the QOLIE-31 questionnaire is reliable and valid for assessing the quality of life in patients with epilepsy.

The impact of stress related disorders on quality of life.

BACKGROUND: Some new studies have shown a significant connection between post-traumatic stress disorder and impairment of the quality of life (QoL), whereas, to our knowledge, research on the connection between other disorders of the stress related group and quality of life do not exist. The objective of our study was to assess the connection between stress related disorders and the quality of life. SUBJECTS AND METHODS: We studied the quality of life in 160 subjects who have experienced certain stressogenic life events. Within the first group (80 subjects) a certain stress related disorder was diagnosed after a stressogenic life event. In the second group (80 subjects) none of the stress related disorders was developed after a stressogenic life event. The diagnosis was made based on the ICD-10 criteria; the stress was assessed by the Impact of Events Scale (IES) and QoL by the Manchester Short Assessment Quality of Life Scale (MANSA). RESULTS: Persons in whom some stress related disorders were diagnosed had a lower quality of life compared to persons who experienced stress but did not develop a disorder (p<0.01). CONCLUSION: Given the long-term stressogenic situation in our country, which is still ongoing, we think that comprehensive measures of prevention, early diagnostics and efficient treatment of stress related disorders are necessary in order to improve the quality of life for the persons with these disorders and their families, but also for society as a whole.