Referrals For Gender-Affirming Hormone Treatment in Croatia's National Network for Transgender Healthcare.

A network of healthcare professionals specializing in transgender care was established in Croatia in 2011, and legal advancements were subsequently made in 2014. Both achievements made gender transition more transparent and thus more attainable in Croatia. This observational study was conducted to assess the number of transgender individuals initiating gender-affirming hormone treatment (GAHT) in Croatia and describes trends in age and sex assigned at birth. Between 2011 and 2022, a total of 111 transgender individuals initiated GAHT. Within the cohort, 52 were assigned male at birth (AMAB) and 59 were assigned female at birth (AFAB). The overall annual incidence rate of transgender individuals initiating GAHT was 0.52 per 100,000 age-adjusted individuals. There was a statistically significant increase (p < 0.01) in transgender individuals commencing GAHT before the COVID-19 pandemic. Furthermore, a rising trend toward masculinizing rather than feminizing treatment was identified (p < 0.05), particularly among younger transgender individuals. The COVID-19 pandemic disrupted these trends in 2020, except for the trend of initiating therapy at a younger age (p < 0.01). The annual incidence and age distribution trends of transgender individuals initiating GAHT in Croatia closely mirrored those in other European countries, with a higher prevalence of individuals assigned female at birth. The study underscores a significant rise in the number of individuals initiating gender-affirming hormone treatment, emphasizing the need for proper legal regulation and healthcare system response.

Can't stop, won't stop - understanding anxiety's role in cyberchondria among pregnant women.

Online health research is common during pregnancy, especially if women are facing complications. Given the unpleasant emotions women experience after research, it is surprising that cyberchondria, excessive and repeated online health research caused by anxiety that intensifies such anxiety, has not been studied in pregnant women. Therefore, the aim of this study was to examine the predictors of cyberchondria among women with and without pregnancy complications, accounting for health anxiety (a worry regarding personal health) and pregnancy-specific anxiety (concerns related to pregnancy and childbirth). A total of 360 pregnant women completed a questionnaire consisted of Short Health Anxiety Inventory, Pregnancy Concerns Scale and Short Cyberchondria Scale. The results of one-way MANOVA showed that women who had medically complicated pregnancy had higher levels of health anxiety, pregnancy-specific anxiety and cyberchondria compared to those without complications. A hierarchical multiple regression analysis showed that health anxiety and pregnancy-specific anxiety were predictors of cyberchondria but had different roles depending on complications. Pregnancy-specific anxiety predicted cyberchondria in both groups above health anxiety. Health anxiety predicted cyberchondria only in women without complications. In conclusion, women with complications have a higher chance of experiencing cyberchondria. Pregnancy-specific and health anxiety are risk factors for cyberchondria in pregnant women.

mSexHealth: An Overview of Mobile Sexual Health Applications.

The aim of this study was to examine the existing mobile applications focused on sexual health and analyze the included content and therapeutic techniques. Three databases with mobile applications were searched and 47 applications met the criteria. More applications have been developed for men, most of them included content for erectile dysfunction, and only one for vaginismus. Most apps included sexuality tips and Kegel exercises, and only one technique for working on thoughts and emotions. In conclusion, a number of mobile applications have been developed to enhance sexual functioning, but scientific verification of their effectiveness has been completely lacking.

The Nocebo Effect: A Review of Contemporary Experimental Research.

BACKGROUND: Nocebo effect, the occurrence of adverse symptoms fallowing an inactive treatment, is much less understood than its opposite, placebo effect. This systematic review of contemporary studies exploring the nocebo effect focuses on (1) the mechanisms underlying the nocebo effect, (2) the characteristics of participants exhibiting a more intensive nocebo response, and (3) the circumstances that might reduce or prevent the nocebo effect. METHOD: We included experimental nocebo studies published in English that examined the occurrence of nocebo in various domains (i.e., types of sensations and symptoms) and different levels of nocebo response (e.g., performance, self-assessment) and in different populations of participants (healthy and clinical). Using Web of Science, PsycInfo and PubMed, we identified 25 papers (35 studies) that met our criteria with a total of N = 2614 participants, mostly healthy volunteers. RESULTS: Nocebo was invoked by manipulating expectations, conditioning or both. A narrative content synthesis was conducted. Nocebo was successfully invoked in a range of domains (e.g., pain, nausea, itch, skin dryness) and levels (sensory, affective, psychological, and behavioral). Various characteristics of the conditioning procedure and participants' emotions, expectations, and dispositions are found to be related to the nocebo response, which sheds insight into the possible mechanisms of the nocebo effect. Strategies successful and unsuccessful in diminishing the nocebo response are identified. Limitations of this review include a small sample of studies. CONCLUSION: These findings point to the universality of nocebo as well as to the importance of participant characteristics and experimental circumstances in invoking the nocebo effect. Further research should examine the nocebo effect in clinical populations.

The Role of Personality Traits and Delivery Experience in Fear of Childbirth: A Prospective Study.

This study aimed to examine fear of childbirth (FOC) before and after delivery in relation to personality (anxiety and anxiety sensitivity) and birth experience (type of delivery, pain, and staff support). One-hundred and five women completed questionnaires during pregnancy and one month after childbirth. Participants completed the Wijma Delivery Expectancy/Experience Questionnaire; the State and Trait Anxiety Inventory and Anxiety Sensitivity Index, and the McGill Pain Questionnaire and a Support from staff questionnaire. FOC levels decreased after childbirth, but only in the high-level fear group. Path analysis showed that physical concerns, one aspect of anxiety sensitivity, shape FOC during pregnancy. Together with interventions at delivery (instrumental vaginal delivery and emergency caesarean section), pain and low staff support, this in turn modifies FOC after delivery. In conclusion, FOC decreases after childbirth. However, combined with adverse birth experience and certain personality traits, FOC during pregnancy affects FOC after delivery.

Measuring therapists' attitudes toward integration of technology in psychotherapy and predicting their use of technology.

OBJECTIVES: We aimed to develop a measure of psychotherapists' attitudes toward integrating technology in psychotherapy-The Therapists' Attitudes toward using Modern Technologies in Psychotherapy and Counselling Scale (MTPS), to analyze its latent structure and test its reliability and validity. METHOD: Items were developed based on interviews with psychotherapists, followed by two online surveys with psychotherapists (N1 = 219; N2 = 369) in five countries in South-eastern Europe. RESULTS: The MTPS has a 4-factor structure: perceived potential of modern technologies (MTs) to augment therapeutic improvement, perceived psychoeducational value of MTs, perceived risks associated with using MTs, and perceived relevance of MTs. Specific dimensions of the MTPS predicted psychotherapists' behaviors and intentions regarding technology (Rc = 0.15-0.46). The reliability of the MTPS subscales was satisfactory. CONCLUSION: MTPS appears to be a useful instrument. Exploring psychotherapists' attitudes assists in predicting obstacles to the implementation of technology in psychotherapy and planning adequate intervention to overcome it.

Mental Health of Psychiatrists and Physicians of Other Specialties in Early COVID-19 Pandemic: Risk ind Protective Factors.

BACKGROUND: Many research has indicated that, during the COVID-19 pandemic, health care workers are under greatly increased pressure and at increased risk for the development of mental health problems. Furthermore, previous research has indicated that psychiatrists are exposed to a number of unique stressors that may increase their risk for poor mental health. The aims of the present study were to assess the level of COVID-19 related concerns, psychological distress and life satisfaction among psychiatrists and other physicians during the first period of the pandemic and to examine whether individual differences in COVID-19 concerns, psychological flexibility, psychological resilience and coping behaviors account for differences in mental health indicators. SUBJECTS AND METHODS: The sample consisted of N=725 physicians, among whom 22.8% were psychiatrists. This study was conducted online during the first lockdown in Croatia and collected data regarding COVID-19 related concerns, coping behaviors and mental health indicators (Psychological Distress and Life Satisfaction). RESULTS: Physicians of other specialties had higher scores on a measure of COVID-19 anxiety than psychiatrists (p=0.012). In addition, a number of differences in coping behaviors are evident. Specifically, psychiatrists were less likely than physicians of other specializations to believe that being informed about COVID-19 is an effective coping strategy (p=0.013), but more prone to using sedatives and drugs as a coping strategy (p=0.002; p=0.037). CONCLUSIONS: Psychiatrists are at special risk for substance abuse. Younger age, psychological inflexibility, low resilience and greater COVID-19 concerns might act as specific risk factors for distress. Our findings highlight the need for promoting a healthy lifestyle and psychological flexibility as universal protective factors.

ADAPTATION AND VALIDATION OF THE CAMBRIDGE PULMONARY HYPERTENSION OUTCOME REVIEW (CAMPHOR) FOR CROATIA.

Pulmonary hypertension (PH) is a chronic disease which severely impairs quality of life (QoL). The Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) is the first disease-specific tool to assess patient-reported symptoms, functioning and QoL in PH patients. The aim of this study was to adapt and validate the CAMPHOR for use in Croatia. The adaptation process involved three stages: translation (bilingual and lay panel), cognitive debriefing interviews with patients and psychometric validation. For the latter stage, a postal survey was conducted with 50 patients to examine the reliability and validity of the adapted scale. All three scales of the Croatian CAMPHOR demonstrated excellent internal consistency (Symptoms = 0.93; Activity limitations = 0.94; QoL = 0.92) and test-retest reliability correlations (Symptoms = 0.90; Activity limitations = 0.95; QoL = 0.90). Predicted correlations with the SF-36 scales provided evidence for construct validity of the CAMPHOR scales. Evidence for known group validity was shown by the ability of the scales to distinguish between participants based on patient-perceived general health and disease severity. The Croatian version of the CAMPHOR is a valid and reliable tool for use in clinical routine and clinical research.

Dyspnea from Neuropsychyatric Perspective: a Narrative Review.

Dyspnea or breathlessness is a term primarily used in respiratory medicine. Nevertheless, in the last fifteen years, studies from other fields focus on the affective component of this complex phenomenon due to the frequent observation that psychological states can cause or be caused by dyspnea. Research so far shows that besides the biological component, dyspnea has a strong emotional and psychosocial determinant. This means that apart from its biological factors, dyspnea and its intensity are affected by emotions, personality, anxiety and depression, etc. Individuals with psychiatric disorders, in the same conditions, will evaluate their dyspnea as more intense and disturbing compared to individuals without psychiatric comorbidity. Emotional states in healthy individuals can amplify the sense of dyspnea which is of extreme importance for clinical practice in order to consider the whole person and not just the symptom which is being presented. Also, dyspnea seems to be frequent complaint in some groups of patients with psychiatric disorders (e.g.panic disorder), where the fear of suffocation is presented as clinical symptom. Futher research of dyspnea as a complex, multicomponent phenomenon, can contribute to better treatment options and better differential diagnosis concerning possible psychiatric background of physical symptoms.

Psychosocial adjustment to sex reassignment surgery: a qualitative examination and personal experiences of six transsexual persons in croatia.

In Croatia, transgender individuals face numerous social and medical obstacles throughout the process of transition. The aim of this study was to depict the factors contributing to the psychosocial adjustment of six transsexual individuals living in Croatia following sex reassignment surgery (SRS). A combination of quantitative and qualitative self-report methods was used. Due to the specificity of the sample, the data were collected online. Standardized questionnaires were used to assess mental health and quality of life alongside a series of open-ended questions divided into 4 themes: the decision-making process regarding SRS; social and medical support during the SRS process; experience of discrimination and stigmatizing behaviors; psychosocial adjustment after SRS. Despite the unfavorable circumstances in Croatian society, participants demonstrated stable mental, social, and professional functioning, as well as a relative resilience to minority stress. Results also reveal the role of pretransition factors such as high socioeconomic status, good premorbid functioning, and high motivation for SRS in successful psychosocial adjustment. During and after transition, participants reported experiencing good social support and satisfaction with the surgical treatment and outcomes. Any difficulties reported by participants are related to either sexual relationships or internalized transphobia. The results also demonstrate the potentially protective role that a lengthier process of transition plays in countries such as Croatia.

Factorial and diagnostic validity of the Beck Depression Inventory-II (BDI-II) in Croatian primary health care.

The aim of this study was to examine the factorial and diagnostic validity of the Beck Depression Inventory-Second Edition (BDI-II) in Croatian primary health care. Data were collected using a medical outpatient sample (N = 314). Reliability measured by internal consistency proved to be high. While the Velicer MAP Test showed that extraction of only one factor is satisfactory, confirmatory factor analysis indicated the best fit for a 3-factor structure model consisting of cognitive, affective and somatic dimensions. Receiver operating characteristics (ROC) analysis demonstrated the BDI-II to have a satisfactory diagnostic validity in differentiating between healthy and depressed individuals in this setting. The area under the curve (AUC), sensitivity and specificity were high with an optimal cut-off score of 15/16. The implications of these findings are discussed regarding the use of the BDI-II as a screening instrument in primary health care settings.

Understanding cyberchondria in pregnant women: longitudinal assessment of risk factors, triggers, and outcomes.

Pregnancy often triggers anxiety and health concerns in women, leading many to search for health information online. Excessive, compulsive, and repetitive online health research, accompanied by heightened anxiety, can result in cyberchondria. This study aimed to explore the risk factors, triggers, and outcomes of cyberchondria in pregnant women. A total of 149 participants completed an online questionnaire longitudinally across three stages of pregnancy: early (14-19 weeks), mid (24-29 weeks), and late pregnancy (34-39 weeks). The findings revealed that health anxiety and the cognitive component of anxiety sensitivity are risk factors for cyberchondria during pregnancy. Pregnancy concerns related to motherhood emerged as triggers for cyberchondria. While a connection between cyberchondria and fear of birth was observed, fear of birth did not appear to be a direct outcome of cyberchondria. These results highlight the importance of addressing health anxiety, cognitive anxiety sensitivity and motherhood concerns in prenatal care and support interventions. Understanding the factors contributing to cyberchondria in pregnant women can assist healthcare professionals in providing targeted support and resources to mitigate excessive online health searching behaviors and alleviate anxiety during pregnancy.

How the COVID-19 pandemic affects transgender health care - A cross-sectional online survey in 63 upper-middle-income and high-income countries.

Background: Due to the COVID-19 pandemic, access to medical care is restricted for nearly all non-acute conditions. Due to their status as a vulnerable social group and the inherent need for transition-related treatments, transgender people are assumed to be affected particularly severely by the restrictions caused by the COVID-19 pandemic. Methods: As an ad hoc collaboration between researchers, clinicians and 23 community organizations, we developed a web-based survey in German that was translated into 26 languages. Participants were recruited via community sources, social media channels, and snowball sampling since May 2020. The present sample is based on the data collected until August 9, 2020. We assessed demographical data, health problems, risk factors, COVID-19 data (e.g., contact history), and the influence of the COVID-19 pandemic on access to transgender health care services. To identify factors associated with the experience of restrictions, we conducted multiple logistic regression analysis. Results: 5267 transgender people from 63 upper-middle-income and high-income countries participated in the study. Over 50% of the participants had risk factors for a severe course of a COVID-19 infection and were at a high risk of avoiding COVID-19 treatment due to the fear of mistreatment or discrimination. Access to transgender health care services was restricted for 50% of the participants. Male sex assigned at birth and a lower monthly income were significant predictors for the experience of restrictions to health care. 35.0% reported at least one mental health condition and 3.2% have attempted suicide since the beginning of the COVID-19 pandemic. Discussion: Transgender people suffer under the severity of the pandemic due to the intersections between their status as a vulnerable social group, their high number of medical risk factors, and their need for ongoing medical treatment. The COVID-19 pandemic can potentiate these vulnerabilities, add new challenges for transgender people, and, therefore, can lead to devastating consequences, like severe physical or mental health issues, self-harming behavior, and suicidality.

Fear of Becoming Infected and Fear of Doing the Wrong Thing - Cross-Cultural Adaptation and Further Validation of the Multidimensional Assessment of COVID-19-Related Fears (MAC-RF).

Background: With the COVID-19 infection speeding around the world, many experience fear and anxiety. To detect those at risk of psychopathology and provide treatment, valid instruments are needed. The aim of this study was to cross-culturally validate the theory-based instrument Multidimensional Assessment of COVID-19-Related Fears (MAC-RF) in Croatian and to further examine the scale's validity by exploring its relationship with relevant constructs. Method: A total of 477 participants completed an online survey during a rapid rise in new daily COVID-19 cases in Croatia and while new restrictions were being imposed. Results: MAC-RF had a stronger association with health anxiety, cyberchondria, and anxiety sensitivity compared to depression, attesting to its convergent and divergent validity. However, a 2-factor structure was revealed in this sample: Fear of infection and Fear of using an inadequate strategy in dealing with pandemic. Fear of infection had a stronger association with health anxiety and COVID-19 anxiety and was a better predictor of COVID-19 related protective health behaviors. Fear of choosing an inadequate strategy had a stronger association with cyberchondria, fear of consequences of the epidemic on mental health, as well as financial consequences, and loss of civil liberties. Conclusion: Fear of infection captures negative emotional states due to feared consequences on personal somatic health and the health of loved ones, while Fear of choosing an inadequate strategy in dealing with the pandemic reflects a metacognitive aspect. Treatments may have to target both aspects of COVID-19 related fear.

Assessing psychosocial factors in depressed patients--accordance of patient's and physician's assessment.

Aim of this study was to investigate the differences in the assessment of psychosocial factors by depressed and non depressed patients, and their congruence with physicians' assessment for both groups. The cross-sectional study was conducted in three family physicians' practices in Zagreb, Croatia, during 2007. Sample of depressed patients included 76 patients out of 85, and randomized comparison group of 189 out of 235. Questionnaire recommended by the European Guidelines on Cardiovascular Disease Prevention in Clinical Practice was used for the assessment of psychosocial factors. Depressed patients significantly more frequently reported about social isolation (p(alone) = 0.013; p(close confident) = 0.005; p(help) = 0.001), family stress (p < 0.001), work stress (p(appropriate reward) = 0.029) and lower life satisfaction (p < 0.001) than non depressed. Their worse psychosocial functioning was noticed by family physicians who assessed social isolation (p(alone) = 0.013; p(close confident) = 0.032), family stress (p < 0.001) and life satisfaction (p < 0.001) significantly lower for depressed patients than for the random sample. Incongruence between family physicians and depressed patients assessment was valued by physicians to be of higher economic status (p < 0.001), and more intense family stress (p < 0.001). Assessment of psychosocial factors varied within the group of depressed patients and the random sample assessed either by themselves or by physicians. Congruence between family physicians and non depressed patients in the assessment of observed psychosocial factors was better than between physicians and depressed patients.

Psychophysical characteristics of the premenstrual period.

Aim of this study was to investigate psychophysical characteristics of the premenstrual period in regard to the period following menstruation. Psychophysical characteristics are defined as assessments of the physical state (fatigue, breast tenderness, bloating and lack of sleep), emotional state (happiness, anger, sadness, irritability, anxiety and distraction) and general assessments of physical attractiveness and satisfaction with oneself Diary of psychophysical characteristics was designed for this study as well as a socio-demographic questionnaire and a menstrual cycle calendar. 51 healthy, non-help-seeking women, aged 21-46 kept a diary of psychophysical characteristics a week before menstruation and four days one week after the onset of menstruation, during two menstrual cycles. The premenstrual period is characterized by the intensification of negative emotional states, the decline of positive emotional states, and the worsening of the general self-image through the decline of the perception of physical attractiveness and satisfaction with oneself In conclusion, the premenstrual period is not marked only by the mood-swings but also by the changes in the cognitive representation of self

Unaided general practitioners' clinical diagnosis in evaluation of depressive patients: a pilot study.

BACKGROUND: In this study we wished to determine the diagnostic accuracy of unaided general practitioners' (GPs') clinical diagnosis in the evaluation of depression in depressed patients under their care compared with the Beck Depression Inventory II (BDI-II). SUBJECTS AND METHODS: From 17,000 patients in 10 GPs' offices as representative sample in the city of Zagreb, 5100 patients from three GPs' offices were selected. The sample consisted of 53 out of 76 depressed patients with a diagnosis of Depressive episode (F32) or Recurrent depressive disorder (F33) classified according to ICD-10 and assessed by review of the GP's standardized medical records. Cross-sectional investigation was performed during February 2008. GPs classified depressed patients as either nondepressed without therapy, nondepressed with therapy or depressed with therapy. Within a two-week period, the unaided GPs' diagnosis was compared with BDI-II performed by psychologists unfamiliar with the GPs' assessment. Based on the GP vs. BDI-II comparison, patients were classified as either positive, false positive, false negative or negative. Sensitivity, specificity, PPV, and NPV associated with physician identification of depression were calculated by standard methods. RESULTS: Depressiveness was found by BD-II in the group 'depressed with therapy' (24.39±10.91). ANOVA found a significant difference in BDI-II means between the outcome groups (P<0.001). Scheffe's procedure found a significant difference in BDI-II in patients with therapy (nondepressed vs. depressed) (P<0.001) and nondepressed without therapy vs. depressed with therapy (P<0.001). There were 16 depressed patients, 27 nondepressed, 2 false positive, and 8 false negative. Unaided GPs' clinical diagnosis showed 66% sensitivity, 93%, specificity, 88% PPV, and 77% NPV. CONCLUSION: Unaided GPs' clinical diagnosis with 88% PPV outperforms other measures of patient depression and is easier to implement when compared to the psychiatric model of caseness, which is based on screening instruments.

Psychological contribution to understanding the nature of dry eye disease: a cross-sectional study of anxiety sensitivity and dry eyes.

Dry eye disease (DED) represents a common health problem in the general population. Previous studies have demonstrated that the subjective symptoms of dry eye are associated with several psychological factors, including depression, anxiety and post-traumatic stress disorder. However, there is a lack of empirical information about the mechanisms underlying the relationships between DED and various psychological symptoms. In light of emerging evidence of its trans-diagnostic nature, anxiety sensitivity (i.e. AS) represents one promising factor for further understanding DED. The present study aimed to explore whether anxiety sensitivity plays a role in the perception of DED symptoms in a community-based sample of adults aged 20-89 years (N = 381; M = 39.72, SD = 12.6). A dry ocular surface was reported by 22.8% of the participants. As expected, women more often reported symptoms of dry eye that could be categorized as moderate to severe. The findings demonstrated that AS, and the AS-psychological concerns dimension in particular, predict the intensity of dry eye symptoms above and beyond depressive and anxiety symptoms. These findings add to a growing body of work underscoring the relevance of AS in increasing the risk of chronic medical conditions.

COVID-19: Concerns and behaviours in Croatia.

OBJECTIVES: The COVID-19 pandemic has created uncertainty that has heightened fear and worry worldwide, thus elevating the potential for a growth in anxiety. This study aims to examine changes in levels of COVID-19 concern and safety behaviours among persons living in Croatia during the period in which the first COVID-19 case was identified and when the country recorded its first fatality. These changes were examined with respect to gender and family circumstances. DESIGN: The repeated cross-sectional data were conducted over two time points over the 3 weeks (N1 = 888; N2 = 966). METHODS: Participants completed online questionnaire regarding various COVID-19 concerns and safety behaviours aimed at disease prevention. RESULTS: Findings demonstrate dramatic increase in concern and safety behaviours among participants during the 3 weeks between the first identified case and the first fatality. The results suggest that parents, and mothers especially, represent the most concerned group, regardless of age. People with chronic health conditions also expressed greater concern and safety behaviour than healthy participants, but with small effect size. CONCLUSION: These findings highlight the importance of developing clear guidelines for alleviating the negative effects on mental health through effective communication strategies that minimize fear and emphasize positive behavioural change. Statement of contribution What is already known on this subject? In times of pandemic, people react with elevated levels of anxiety and some will adjust their behaviours in order to protect themselves as well as their family and friends. Some of the measures introduced to protect the spread of the COVID-19 disease have induced an atmosphere of fear, which in turn can lead to an increase in maladaptive anxiety and a greater burden on mental health. What does this study add? By conducting the research in two waves representing two critical time points in the developing COVID-19 situation in Croatia, we were able to trace a large increase in anxiety levels and safety behaviours among the general population. There is a discordance between those who are at most risk from serious consequences of the disease and those who are at greatest risk for maladaptive anxiety. Parents, and mothers in particular, represent the most concerned group, regardless of age. Lockdown measures have allowed us to ensure the safety of those vulnerable for serious COVID-19 illness. Now, we must focus on preserving the mental health of our whole community.