Glial Markers of Suicidal Behavior in the Human Brain-A Systematic Review of Postmortem Studies.

Suicide is a major public health priority, and its molecular mechanisms appear to be related to glial abnormalities and specific transcriptional changes. This study aimed to identify and synthesize evidence of the relationship between glial dysfunction and suicidal behavior to understand the neurobiology of suicide. As of 26 January 2024, 46 articles that met the inclusion criteria were identified by searching PubMed and ISI Web of Science. Most postmortem studies, including 30 brain regions, have determined no density or number of total Nissl-glial cell changes in suicidal patients with major psychiatric disorders. There were 17 astrocytic, 14 microglial, and 9 oligodendroglial studies using specific markers of each glial cell and further on their specific gene expression. Those studies suggest that astrocytic and oligodendroglial cells lost but activated microglia in suicides with affective disorder, bipolar disorders, major depression disorders, or schizophrenia in comparison with non-suicided patients and non-psychiatric controls. Although the data from previous studies remain complex and cannot fully explain the effects of glial cell dysfunction related to suicidal behaviors, they provide risk directions potentially leading to suicide prevention.

N-Acetylcysteine Suppresses Microglial Inflammation and Induces Mortality Dose-Dependently via Tumor Necrosis Factor-α Signaling.

N-acetylcysteine (NAC) is an antioxidant that prevents tumor necrosis factor (TNF)-α-induced cell death, but it also acts as a pro-oxidant, promoting reactive oxygen species independent apoptosis. Although there is plausible preclinical evidence for the use of NAC in the treatment of psychiatric disorders, deleterious side effects are still of concern. Microglia, key innate immune cells in the brain, play an important role in inflammation in psychiatric disorders. This study aimed to investigate the beneficial and deleterious effects of NAC on microglia and stress-induced behavior abnormalities in mice, and its association with microglial TNF-α and nitric oxide (NO) production. The microglial cell line MG6 was stimulated by Escherichia coli lipopolysaccharide (LPS) using NAC at varying concentrations for 24 h. NAC inhibited LPS-induced TNF-α and NO synthesis, whereas high concentrations (≥30 mM) caused MG6 mortality. Intraperitoneal injections of NAC did not ameliorate stress-induced behavioral abnormalities in mice, but high-doses induced microglial mortality. Furthermore, NAC-induced mortality was alleviated in microglial TNF-α-deficient mice and human primary M2 microglia. Our findings provide ample evidence for the use of NAC as a modulating agent of inflammation in the brain. The risk of side effects from NAC on TNF-α remains unclear and merits further mechanistic investigations.

Deficient Autophagy in Microglia Aggravates Repeated Social Defeat Stress-Induced Social Avoidance.

Major depressive disorder (MDD) is associated with repeated exposure to environmental stress. Autophagy is activated under various stress conditions that are associated with several diseases in the brain. This study was aimed at elucidating the autophagy signaling changes in the prefrontal cortex (PFC) under repeated social defeat (RSD) to investigate the involvement of microglial autophagy in RSD-induced behavioral changes. We found that RSD stress, an animal model of MDD, significantly induced initial autophagic signals followed by increased transcription of autophagy-related genes (Atg6, Atg7, and Atg12) in the PFC. Similarly, significantly increased transcripts of ATGs (Atg6, Atg7, Atg12, and Atg5) were confirmed in the postmortem PFC of patients with MDD. The protein levels of the prefrontal cortical LC3B were significantly increased, whereas p62 was significantly decreased in the resilient but not in susceptible mice and patients with MDD. This indicates that enhanced autophagic flux may alleviate stress-induced depression. Furthermore, we identified that FKBP5, an early-stage autophagy regulator, was significantly increased in the PFC of resilient mice at the transcript and protein levels. In addition, the resilient mice exhibited enhanced autophagic flux in the prefrontal cortical microglia, and the autophagic deficiency in microglia aggravated RSD-induced social avoidance, indicating that microglial autophagy involves stress-induced behavioral changes.

Effects of an educational intervention on oral hygiene and self-care among people with mental illness in Japan: a longitudinal study.

BACKGROUND: The oral hygiene of patients with a mental illness is an important concern in psychiatric care, and it is necessary to increase the level of self-care among these patients. In this study, we administered an oral care questionnaire to people with mental illness in Japan and compared their answers before (baseline) and at 1 week and 1, 3 and 6 months after they participated in an educational program. METHODS: The questionnaire was distributed to 390 patients. It included questions about age, education, income, between-meal snacks, number of teeth, frequency of tooth brushing, and other items. The educational program was developed for the purposes of improving self-care. RESULTS: Before the program, the proportion of male patients who had had a mental illness for ≥ 10 years was significantly higher among those patients who did not brush their teeth before bed. In addition, such patients did not have primary care dentists, and a significantly higher proportion of male patients, compared with female patients, did not undergo routine dental checkups more than once per year. The educational program resulted in an improvement in the use of fluoride toothpaste from baseline to 6 months after the intervention (p = 0.001). The daily use of interdental brushes or floss was significantly different 6 months after the intervention. CONCLUSIONS: Male and long-term inpatients need oral hygiene instructions. Our educational program showed the effects of using oral hygiene tools. Future studies should include a control group to measure the impact of the educational program.

Characteristics linked to the reduction of stigma towards schizophrenia: a pre-and-post study of parents of adolescents attending an educational program.

BACKGROUND: The stigma of schizophrenia constitutes a major barrier to early detection and treatment of this illness. Anti-stigma education has been welcomed to reduce stigma among the general public. This study examined the factors associated with the effectiveness of a web-based educational program designed to reduce the stigma associated with schizophrenia. METHODS: Using Link's Devaluation-Discrimination Scale to measure stigma, the effect of the program was measured by the difference in pre- and post-program tests. In the present study, we focused on program participants whose stigma towards schizophrenia had considerably improved (a reduction of three points or more between pre- and post-program tests) or considerably worsened (an increase of three points or more). The study participants were 1,058 parents of middle or high school students across Japan, including 508 whose stigma had significantly decreased after the program and 550 whose stigma had significantly increased. We used multiple logistic regression analysis to predict a considerable reduction in stigma (by three or more points) using independent variables measured before exposure to the program. In these models, we assessed the effects of demographic characteristics of the participants and four measures of knowledge and views on schizophrenia (basic knowledge, Link's Devaluation-Discrimination Scale, ability to distinguish schizophrenia from other conditions, and social distance). RESULTS: Participants' employment status, occupation, basic knowledge of schizophrenia, pre-program Link's Devaluation-Discrimination Scale score, and social distance were significant factors associated with a considerable decrease in the stigma attached to schizophrenia following the educational program. Specifically, full-time and part-time employees were more likely to experience reduced stigma than parents who were self-employed, unemployed, or had other employment status. Considerable decreases in stigma were more likely among parents working in transportation and communication or as homemakers than among other occupational groups. In addition, parents with higher pre-program levels of stigma, lower basic knowledge, or lower social distance were more likely to have reduced levels of stigma. CONCLUSIONS: Based on the regression analysis results presented here, several possible methods of reducing stigma were suggested, including increasing personal contact with people with schizophrenia and the improvement of law and insurance systems in primary and secondary industries.

Association Between Dementia, Change in Home-Care Use, and Depressive Symptoms During the COVID-19 Pandemic: A Longitudinal Study Using Data from Three Cohort Studies.

Background: The emotional impact of the coronavirus disease 2019 (COVID-19) pandemic on people with dementia has been quantified. However, little is known about the impact of change in home-care use owing to the pandemic. Objective: To determine the longitudinal association between dementia, change in home-care use, and depressive symptoms during the pandemic. Methods: We included data of 43,782 home-dwelling older adults from the English Longitudinal Study of Ageing (ELSA), Study of Health, Ageing and Retirement in Europe (SHARE), and National Health and Aging Trends Study (NHATS). This study considered the latest main wave survey prior to the pandemic as the baseline, and the COVID-19 survey as follow-up. In a series of coordinated analyses, multilevel binomial logistic regression model was used to examine the association between baseline dementia, change in home-care use at follow-up, and presence of depressive symptoms. Results: Dementia, using the ELSA, SHARE, and NHATS datasets, was identified in 2.9%, 2.3%, and 6.5% of older adults, and home-care use reduced in 1.7%, 2.8%, and 1.1% of individuals with dementia, respectively. Dementia was significantly associated with the increased risk of depressive symptoms in all three cohorts. However, the interaction between dementia and period (follow-up) was non-significant in SHARE and NHATS. Across all three cohorts, home-care use during the pandemic, regardless of change in amount, was significantly associated with increased depressive symptoms, compared to the non-use of home care. Conclusions: These results highlight the need for tailoring dementia care at home to promote independence and provide sustainable emotional support.

An online intervention to promote mental health literacy for psychosis amongst parents of adolescents: A pilot randomized controlled trial.

AIM: This study evaluated an online mental health literacy intervention to improve help-seeking for psychosis amongst parents of adolescents. METHODS: A total of 2496 parents of first-grade junior high school students, recruited from a Japan-based survey company, participated in a randomized controlled trial in July 2016; participants were randomly allocated to the intervention (n = 1248) or control group (n = 1248). They were assessed at baseline and one-week post intervention. The intervention group received a 30-minute online educational programme that included a narrative of the mother of an adolescent with psychosis. RESULTS: There were no between-group differences in changes in the rate of 'no help-seeking' in any hypothetical situations of a child's psychosis and prodromal symptoms. CONCLUSIONS: The intervention might have been suboptimal to improve mental health literacy for psychosis amongst parents of adolescents. A narrative message from a service user may be helpful to encourage parents in help-seeking.

Place of death from dementia as an underlying cause during the COVID-19 pandemic in Japan: a cross-sectional study from national death certificates.

Background: The coronavirus disease (COVID-19) pandemic has challenged palliative end-of-life care for people with dementia. The site of death can be considered as an end-of-life care quality indicator. Most people with dementia prefer to die at nursing or private homes; however, in Japan, they are often hospitalized in psychiatric hospitals for management of neuropsychiatric symptoms. As palliative end-of-life care for older adults with Alzheimer's disease and related dementias has been further challenged by the COVID-19 pandemic, little is known about its effects on the place of death in patients with dementia. Objectives: This study aimed to investigate the shifts in place of death from dementia during the COVID-19 pandemic in Japan. Changes throughout the pandemic were compared between deaths from dementia and from senility. Design: Cross-sectional. Methods: Death certificate data of individuals aged 65 years or older who died in Japan between 1 January 2018, and 31 December 2021, were used to extract the cause and place of death. Differences in place of death between the periods were estimated using multinomial logistic analysis with reference to death in private homes. Results: Deaths from dementia mostly occurred in hospitals (59%), while deaths from senility were most frequent in nursing homes (37%). After adjusting for patient characteristics, the likelihood of hospital deaths significantly increased for patients with dementia during the pandemic. Meanwhile, the likelihood of senility deaths decreased in hospitals but increased in nursing homes during the pandemic. Conclusion: The shift to hospital deaths since the onset of the COVID-19 pandemic was uniquely observed in deaths from dementia. This hospital shift likely involved increased transfers from nursing and private homes to psychiatric hospitals. Further investigation is needed to examine the association between the pandemic-related change in long-term care workforce and palliative care practice in people with dementia.

Quality of End-of-Life Care for Older Adults with Dementia during the COVID-19 Pandemic.

OBJECTIVES: End-of-life (EOL) care during the coronavirus disease 2019 (COVID-19) pandemic has been a concern under the overwhelming pressure of health care service systems. People with dementia often receive suboptimal EOL care; thus, they may be at particular risk of poor care quality during the COVID-19 pandemic. This study investigated the interaction between dementia and pandemic on the proxies' overall ratings and ratings for 13 indicators. DESIGN: A longitudinal study. SETTING AND PARTICIPANTS: Data were collected from 1050 proxies for deceased participants in the National Health and Aging Trends Study, a nationally representative sample of community-dwelling Medicare beneficiaries aged ≥65 years. Participants were included if they had died between 2018 and 2021. METHODS: Participants were categorized into 4 groups depending on the period of death (before vs during the COVID-19 pandemic) and having no vs probable dementia, as defined by a previously validated algorithm. The quality of EOL care was assessed through postmortem interviews with bereaved caregivers. Multivariable binomial logistic regression analyses were performed to examine the main effects of dementia and pandemic period, and the interaction between dementia and pandemic on ratings of quality indicators. RESULTS: A total of 423 participants had probable dementia at the baseline. People with dementia who died were less likely to talk about religion in the last month of life than those without dementia. Decedents during the pandemic were more likely to have an overall rating of care as being not excellent than those before the onset of the pandemic. However, the interaction between dementia and pandemic was not significant in the 13 indicators and the overall rating of EOL care quality. CONCLUSION AND IMPLICATIONS: Most EOL care indicators preserved the level of quality, regardless of dementia and the COVID-19 pandemic. Disparities in spiritual care may exist across people with and without dementia.

Association between advance care planning and depressive symptoms among community-dwelling people with dementia: An observational cross-sectional study during the COVID-19 pandemic in Japan.

Objectives: Advance care planning (ACP) is an increasing priority for people with dementia during the COVID-19 pandemic. This study evaluated the association between ACP initiation and depressive symptoms among home-dwelling people living with dementia. Methods: An internet-based questionnaire survey was conducted with Japanese family caregivers of home-dwelling persons with dementia in June 2021. Family caregivers evaluated the level of depressive symptoms in persons with dementia using the Neuropsychiatric Inventory (NPI). Caregivers also rated the quality of life of persons with dementia using the EQ-5D-5L. Results: A total of 379 family caregivers participated in the survey. Depressive symptoms were reported in 143 persons with dementia (37.7%). A total of 155 persons with dementia (40.9%) had initiated ACP, of which 88 (56.8%) had care professionals involved in ACP conversation. After adjusting for the characteristics of persons with dementia and caregivers, persons with professional involvement showed significantly more severe depressive symptoms compared to those who did not initiate ACP. There was no significant difference in the quality of life of persons with dementia according to ACP initiation. Conclusions: Many home-dwelling persons with dementia experienced depressive symptoms during the COVID-19 pandemic, especially in cases where care professionals were involved in ACP conversations. Optimal and proactive ACP approaches need to be developed to prevent depressive symptoms in newly diagnosed persons.

Depression and Anxiety in Older Adults with Dementia During the COVID-19 Pandemic.

This study examined the longitudinal association between dementia, activity participation, the coronavirus disease 2019 pandemic period, and 1-year mental health changes. We obtained data from the National Health and Aging Trends Study in the United States. We included 4,548 older adult participants of two or more survey rounds between 2018 and 2021. We identified baseline dementia status, and assessed depressive symptoms and anxiety at baseline and follow-up. Dementia and poor activity participation were independently associated with an increased prevalence of depressive symptoms and anxiety. Dementia care and support should address emotional and social needs under continued public health restrictions.

The Association Between COVID-19 Information Sources and Stigma Against Health Care Workers Among College Students: Cross-sectional, Observational Study.

BACKGROUND: The COVID-19 pandemic has triggered stigmatic attitudes against health care workers. Some forms of social media may play a role in disseminating stigmatizing messages. OBJECTIVE: We aimed to investigate the association between COVID-19 information sources and stigma against health care workers among college students during the pandemic. METHODS: A cross-sectional, observational study was conducted using a web-based platform in the Tohoku region of Japan. College students aged ≥20 years were asked to complete the questionnaire between August 18 and October 31, 2020. Stigma against health care workers was evaluated using a modified Japanese version of the Social Distance Scale. Participants were also asked to rate their perceived vulnerability to infection using the Japanese version of the Perceived Vulnerability to Disease scale. RESULTS: A total of 281 students from 8 colleges completed the web-based survey. There were 139 (49.5%) participants who used Twitter, 187 (66.5%) who used news websites, and 46 (16.4%) who used the websites of public health agencies as COVID-19 information sources. After adjusting for age, sex, department, and Perceived Vulnerability to Disease scores, the level of stigma did not differ between students who used Twitter and those who did not. Students who used the websites of public health agencies showed a significantly less stigmatic attitude than those who did not. CONCLUSIONS: Fact-checking and directing visitors to credible information sources from public health agencies may have prevented the formation of stigmatic attitudes toward health care workers. An effective strategy to enable easy access to information provided by public agencies should be integrated into widespread web-based platforms.

Adolescent Carers' Psychological Symptoms and Mental Well-being During the COVID-19 Pandemic: Longitudinal Study Using Data From the UK Millennium Cohort Study.

PURPOSE: During the COVID-19 pandemic, adolescent carers in the UK may have experienced psychological distress owing to increased caring burden and loss of a break from their caring role. This study investigated longitudinal association between adolescents' caring status and mental health outcomes from 2018/2019 to February-March 2021. METHODS: The participants (n = 3,927) answered mental health questions in both the Millennium Cohort Study sweep 7 survey (age 17 years in 2018/2019) and at least one of three waves of the COVID-19 survey from May 2020 to February-March 2021. Caring status at the age of 17 years was assessed using a single question regarding whether the participant regularly looked after anyone who needed care, without being paid. Outcome measures were psychological symptoms, measured using the Kessler Distress Scale, and mental well-being, measured using the Warwick-Edinburgh Mental Well-being Scale. RESULTS: Compared with 3,616 noncarers, 311 (7.9%) adolescent carers reported significantly higher Kessler Distress Scale and lower Warwick-Edinburgh Mental Well-being Scale scores during the pandemic. These associations were largely explained by psychosocial risk factors. Worse outcomes were associated with poor sleep quality, attempted suicide at baseline, low social support, and a strong feeling of loneliness during the pandemic. These factors were significantly more likely to be observed among adolescent carers than noncarers. DISCUSSION: UK adolescent carers exhibited worsened mental health outcomes one year after the first national lockdown. This increased distress may be attributable to psychosocial risk factors during the pre-COVID-19 and current COVID-19 periods, and they require psychosocial support.

Depression and anxiety among nursing students during the COVID-19 pandemic in Tohoku region, Japan: A cross-sectional survey.

AIM: Restrictions such as physical distancing and online learning for college students were implemented due to the COVID-19 pandemic. Owing to this, students may experience psychological distress from social isolation and loneliness. Nursing students are subjected to an exacerbated level of distress during the pandemic due to their role as health professionals. Therefore, the present study aimed to investigate the level of anxiety and depression among Japanese nursing students, according to their perceived vulnerability to COVID-19. METHODS: A total of 281 college students (104 nursing students and 177 other college students) responded to a web-based anonymous questionnaire survey from 18 August to 31 October 2020. The Hospital Anxiety and Depression Scale was used to evaluate anxiety (HADS-A) and depression (HADS-D). Perceived vulnerability to COVID-19 was assessed using the Perceived Vulnerability to Disease Scale. RESULTS: In both groups of students, the prevalence of both anxiety (30.5% in nursing students; 69.5% in others) and depressive symptoms (31.1% in nursing students; 68.9% in others) were remarkably high. There were no significant differences in anxiety and depression between nursing and other students after adjusting for perceived vulnerability to COVID-19 plus socio-demographic characteristics and stress coping styles. Perceived vulnerability and its interactions with nursing did not show a significant association with either depression or anxiety. CONCLUSION: This study highlights the need for greater support and preventive strategies for mental health problems for college students during the COVID-19 pandemic regardless of perceived vulnerability.

Suicide rates during the COVID-19 pandemic in Japan from April 2020 to December 2021.

This study estimated the excess suicidal mortality during the COVID-19 pandemic in Japan. A Poisson regression model was used to assess the association between unemployment rates, expenditure for alcohol, eating out, and suicide, from January 2008 to March 2020. The excess suicidal mortality was assessed by applying the identified model to data from April 2020 to December 2021. The number of estimated excess deaths during COVID-19 was 3397 in men and 2390 in women. COVID-19 may have caused unprecedented psychological distress among people, owing to restricted social gatherings and prolonged uncertainties.

Effect of an education program on improving knowledge of schizophrenia among parents of junior and senior high school students in Japan.

BACKGROUND: Early detection and intervention in schizophrenia are important in improving quality of life after treatment and are major issues in psychiatric care. Therefore, it is necessary to increase knowledge of schizophrenia among the general public. Among parents of junior and senior high school students in Japan, we compared rates of correct answers for items on knowledge of schizophrenia and ability to discriminate this psychosis from other disorders on questionnaires given before and after viewing a web-based education program. METHODS: Questionnaires were distributed to 2,690 parents. The program was developed to help parents obtain a basic understanding of schizophrenia and to emphasize the necessity of early detection. RESULTS: Before the program, the rate of correct answers was 77% for items concerning basic knowledge of schizophrenia, 47% for "discrimination of schizophrenia symptoms," and 30% for "discrimination of prodromal symptoms." The program resulted in an improvement in basic knowledge of schizophrenia, discrimination of schizophrenia symptoms, and discrimination of prodromal symptoms (P < 0.001 for all). CONCLUSIONS: Our web-based education program was useful in helping parents acquire a basic knowledge of schizophrenia and discriminate correctly the symptoms of schizophrenia.

Reliability and validity of the workplace social distance scale.

Self-stigma, defined by a negative attitude toward oneself combined with the consciousness of being a target of prejudice, is a critical problem for psychiatric patients. Self-stigma studies among psychiatric patients have indicated that high stigma is predictive of detrimental effects such as the delay of treatment and decreases in social participation in patients, and levels of self-stigma should be statistically evaluated. In this study, we developed the Workplace Social Distance Scale (WSDS), rephrasing the eight items of the Japanese version of the Social Distance Scale (SDSJ) to apply to the work setting in Japan. We examined the reliability and validity of the WSDS among 83 psychiatric patients. Factor analysis extracted three factors from the scale items: "work relations," "shallow relationships," and "employment." These factors are similar to the assessment factors of the SDSJ. Cronbach's alpha coefficient for the WSDS was 0.753. The split-half reliability for the WSDS was 0.801, indicating significant correlations. In addition, the WSDS was significantly correlated with the SDSJ. These findings suggest that the WSDS represents an approximation of self-stigma in the workplace among psychiatric patients. Our study assessed the reliability and validity of the WSDS for measuring self-stigma in Japan. Future studies should investigate the reliability and validity of the scale in other countries.

Report on maternal anxiety 16 months after the great East Japan earthquake disaster: anxiety over radioactivity.

The Great East Japan Earthquake occurred on March 11, 2011. The tsunami caused extensive damage to the Fukushima Daiichi Nuclear Power Plant, resulting in a level 7 nuclear accident. Among those affected by this combined disaster were many pregnant and parturient women. Sixteen months after the earthquake, we conducted a questionnaire survey on anxiety among 259 women who gave birth around the time of the earthquake in Miyagi Prefecture, one of the affected areas. Participants reported 12 categories of anxiety, including anxiety over radioactivity. This study aimed to determine anxiety over radioactivity among this specific population and to record measures for future study. Anxiety over radiation was classified into seven subcategories: food safety, outdoor safety, effects on the fetuses of pregnant women, effects on children, radiation exposure, economic problems, and distrust of information disclosed. This study confirmed that concrete types of anxiety over radiation were keenly felt by mothers who had experienced the disaster who were currently raising children. The findings suggest the need to provide accurate information to these mothers, who are otherwise inundated with miscellaneous confusing information.

Stigma toward schizophrenia among parents of high school students.

Stigma toward schizophrenia is an important area of research as it is frequently a barrier to early intervention. This study attempted to identify factors underlying stigma in Japan. Because even adolescents can develop schizophrenia, 357 Japanese parents of high school students were enrolled. All parents lived outside the areas affected by the Tohoku earthquake that occurred on March 11, 2011 (ie, parts of Iwate, Miyagi, and Fukushima prefectures). Factor analysis using the Link Devaluation-Discrimination Measure identified two factors: comparison with an able-bodied person and non-comparison with an able-bodied person. Regression analysis revealed that family structure had independent effects on factor 2 (p <0.05), and ANOVA showed that education had independent effects on factor 2 (p<0.05). These results suggest that education programs that seek to counteract stigma should target curricula in high schools and vocational schools.

Factors associated with an absence of effect of an education program for improving knowledge of schizophrenia.

Schizophrenia can develop in junior and senior high school students. Correct identification of schizophrenia symptoms is an important factor in subsequent healthcare. The present study conducted a multifaceted evaluation of factors associated with an absence of effect of an education program for improving knowledge of schizophrenia among parents of Japanese junior and senior high school students. Regarding discrimination of prodromal symptoms, the factors associated with an absence of effect of the education program were graduate school education, family income >110 000 USD, proximity to a person with schizophrenia, employment as a professional, and participation in welfare activities for people with mental illness. Regarding discrimination of schizophrenia, the factors associated with an absence of effect were a family income of 53 000 to 110 000 USD (P<0.05), and employment in production/labor service (P<0.05).