Non-linear relationship between TSH and psychotic symptoms on first episode and drug naïve major depressive disorder patients: a large sample sized cross-sectional study in China.

INTRODUCTION: Psychotic depression (PD) is characterized by the co-occurrence of emotional dysfunction and psychotic symptoms such as delusions and hallucinations with poor clinical outcomes. TSH may involve in the development of PD. This study aims to explore relationship between TSH and PD. METHODS: A total of 1718 outpatients diagnosed as FEDN MDD were recruited in this study. The relationship between PD and TSH was evaluated using multivariable binary logistic regression analysis. To assess the presence of non-linear associations, a two-piecewise linear regression model was employed. Furthermore, interaction and stratified analyses were conducted with respect to sex, education, marital status, comorbid anxiety, and suicide attempt. RESULTS: Multivariable logistic regression analysis revealed that TSH was positively associated with the risk of PD after adjusting for confounders (OR = 1.26, 95% CI: 1.11 to 1.43; p < 0.05). Smoothing plots showed a nonlinear relationship between TSH and PD, with the inflection point of TSH being 4.94 mIU/L. On the right of the inflection point, for each unit increase in serum TSH level on the right side of the inflection point, the probability of PD increased substantially by 47% (OR = 1.47, 95% CI: 1.25 to 1.73, p < 0.001), while no significant association was observed on the left side of the inflection point (OR = 0.87, 95% CI: 0.67 to 1.14, p = 0.32). CONCLUSION: Our investigation showed a nonlinear TSH-PD relationship in FEDN MDD patients, thus contributing to effective intervention strategies for psychotic symptoms in depression patients.

Association between thyroid function and psychotic symptoms in adolescents with major depressive disorder: A large sample sized cross-sectional study in China.

Backgrounds: Thyroid function was associated with depression and psychotic symptoms; however, little research has focused on its role in coexisting psychotic symptoms in adolescents with depressive disorder. This study aimed to explore the association between thyroid function and psychotic symptoms among depression adolescents. Methods: A total of 679 adolescent patients (aged 12-18) diagnosed as depressive disorder were recruited. Their socio-demographic, clinical data and thyroid function parameters were collected. The severity of psychotic symptoms was measured according to the assessment measure in DSM-5. Based on the severity of psychotic symptoms, patients were distributed into psychotic depression (PD) and non-psychotic depression (NPD) subgroups, respectively. Results: The prevalence rate of PD was 52.7% among adolescents with depressive disorder in this study. PD patients were younger (p < 0.01), with more female (p < 0.001) and non-Han nationality (p < 0.01), and presented serum FT4 level decrease (p < 0.01). PD patients displayed a higher rate of abnormal thyroid relevant parameters (p < 0.05). 35.2% of PD patients presented at least one abnormal parameter among all five parameters tested (TSH, TT3, FT3, TT4, and FT4), compared to 27.4% among NPD patients. Further logistic regression analysis indicated that increased serum FT4 level was a protective effect of PD with an adjusted odds ratio (OR) of 0.615. We did not find a statistically significant difference in the family history of mental disorders, serum TSH, TT3, FT3, and TT4 levels. Conclusions: Our results suggested a high prevalence of PD among depression adolescents, associated with younger age, female, non-Han nationality, and decreased serum FT4 level. We recommend that adolescents with depressive disorder regularly screen their serum FT4 levels for better clinical outcomes.

Gender difference in the associations of childhood maltreatment and non-suicidal self-injury among adolescents with mood disorders.

Background: Non-suicidal self-injury (NSSI) is a common feature among adolescents with mood disorders. Although childhood maltreatment has shown to be associated with non-suicidal self-injury (NSSI), previous studies have yielded mixed results in terms of different subtypes of childhood maltreatment and only few studies have investigated the effects of gender. The present cross-sectional study investigated effects of different types of childhood maltreatment on NSSI, as well as the role of gender in these effects. Methods: In this cross-sectional study, a total of 142 Chinese adolescent inpatients with mood disorders (37 males and 105 females) were consecutively recruited within a psychiatric hospital. Demographic and clinical characteristics were collected. Participants were administered the Childhood Trauma Questionnaire (CTQ), the Functional Assessment of Self-Mutilation (FASM). Results: 76.8% of the sample reported engaging NSSI in the previous 12 months. Female participants were more likely to engage in NSSI than males (p < 0.001). Participants in the NSSI group reported significantly more experiences of emotional abuse (p < 0.001) and emotional neglect (p = 0.005). With regards to gender differences, female participants who have experienced emotional abuse were more likely to engage in NSSI (p = 0.03). Conclusion: As a whole, NSSI represents a frequent phenomenon among adolescent clinical populations and females were more likely to engage in NSSI than males. NSSI was significantly related to experiences of childhood maltreatment and specifically related to emotional abuse and emotional neglect over and above other types of childhood maltreatment. Females were more sensitive to emotional abuse than males. Our study highlights the importance of screening for subtypes of childhood maltreatment as well as considering the effects of gender.

Association of Subclinical Hypothyroidism With Anxiety Symptom in Young First-Episode and Drug-Naïve Patients With Major Depressive Disorder.

Backgrounds: Subclinical hypothyroidism (SCH) was reported to be associated with depression; however, its role in coexisting anxiety symptom in young patients with major depressive disorder (MDD) remains unclear. The objective of this study was to explore the relationship between SCH and anxiety symptom in young first-episode and drug-naïve (FEDN) MDD patients. Methods: A total of 520 outpatients diagnosed as FEDN MDD with SCH were recruited in this study. Their socio-demographic, clinical data and thyroid function parameters were collected. The Hamilton Anxiety Rating Scale (HAMA) and the Hamilton Depression Rating Scale (HAMD) were employed to measure the severity of anxiety symptom and depressive symptom, respectively. Based on the HAMA scores, patients who scored ≥ 25 were defined as anxious major depressive disorder (A-MDD) while others as non-anxious major depressive disorder (NA-MDD). Results: The prevalence rate of A-MDD was 15.8% in young FEDN MDD patients with comorbid SCH. Moreover, serum thyroid stimulating hormone (TSH) levels were significantly higher in patients with A-MDD compared with those with NA-MDD (p < 0.001). Multivariate binary logistic regression analysis indicated that A-MDD was associated with serum TSH levels with an odds ratio (OR) of 1.602. Serum TSH level of 6.17 mIU/L was the critical value to distinguish A-MDD and NA-MDD, with sensitivity of 0.805 and specificity of 0.539. There were no statistically significant differences between NA-MDD and A-MDD patients in terms of socio-demographic variables, serum free triiodothyronine (FT3), free thyroxine (FT4), thyroid peroxidases antibody (TPOAb) and anti-thyroglobulin (TgAb) levels. Conclusions: A-MDD patients presented higher serum TSH level. It is suggested that serum TSH level may be a potential biomarker for predicting moderate and severe anxiety symptoms in young FEDN MDD patients with SCH.

Erratum: Mental health needs of the COVID-19 patients and staff in the Fangcang shelter hospital: a qualitative research in Wuhan, China - ERRATUM.

[This corrects the article DOI: 10.1017/gmh.2021.23.].

Mental health needs of the COVID-19 patients and staff in the Fangcang shelter hospital: a qualitative research in Wuhan, China.

BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic, Fangcang shelter hospitals were opened in Wuhan, China, to isolate and care for patients with mild or moderate symptoms. The patients and staff in the hospitals faced mental health challenges. This paper reports the experiences and mental health needs from them. METHOD: Following the qualitative design, semi-structured interviews were conducted in the EastWest Lake Fangcang Shelter Hospital, Wuhan on March 2020. Data collection and analysis was based on grounded theory. Open coding was adapted and a structured codebook was developed through coding seminars. The themes and subthemes were then confirmed through thematic analysis. The findings were further explained and integrated in a theoretical framework. RESULTS: A total of 10 COVID-19 patients and 13 staff, including doctors, nurses, psychiatrists, and policemen participated in the interviews. They have common needs, as well as their own needs. The perspectives from the staff also did complement for needs of the patients. The mental health needs were generalized into four themes, that is, basic needs, information and communication, emotional needs, and social support, each with several subthemes. In addition, there were some external factors that regulated the internal needs, which were summarized in a theoretical framework. CONCLUSIONS: The study indicates the directions on hospital management, mental health services, policy making, and social work to meet the mental health needs of the inpatients and staff from temporary shelter hospitals like Fangcang in Wuhan during the COVID-19 pandemic.

Association of Internet Addiction With Nonsuicidal Self-injury Among Adolescents in China.

Importance: Both nonsuicidal self-injury (NSSI), defined as the direct, deliberate damage of one's body tissue without suicidal intent, and internet addiction among adolescents are public health concerns. However, the possible association of NSSI with internet addiction is not well understood. Objective: To examine the occurrence of internet addiction with NSSI and any sex differences among Chinese adolescents. Design, Setting, and Participants: A multicenter, cross-sectional, survey study was conducted from February 18 to October 15, 2015, among adolescents aged 11 to 20 years from 343 classes in 45 public high schools across 5 provinces of China. Data analysis was performed from August 1, 2018, to March 1, 2019. Exposures: Possible internet addiction and internet addiction. Main Outcomes and Measures: Less-frequent (1-4 times) NSSI and more-frequent (≥5 times) NSSI were surveyed using the Chinese version of the Functional Assessment of Self-Mutilation. Results: A total of 15 623 students (8043 male [51.5%] and 7580 female [48.5%]) aged 11 to 20 years (mean [SD] age, 15.1 [1.8] years) participated. Of these, 4670 participants (29.9%) met the criteria for possible internet addiction and 509 participants (3.3%) met the criteria for internet addiction. A total of 2667 students (17.1%) engaged in less-frequent NSSI, while 1798 students (11.5%) engaged in more-frequent NSSI in the 12 months preceding the survey. Both possible internet addiction and internet addiction were associated with less-frequent or more-frequent NSSI. The adjusted odds ratios were 1.29 (95% CI, 1.17-1.42) for possible internet addiction and 1.41 (95% CI, 1.11-1.80) for internet addiction for less-frequent NSSI; for more-frequent NSSI, the adjusted odds ratios were 1.75 (95% CI, 1.56-1.96) for possible internet addiction and 2.66 (95% CI, 2.10-3.38) for internet addiction. These associations were similarly observed among age groups of 11 to 14, 15 to 17, and 18 to 20 years. No sex disparities were found in the associations of internet addiction with NSSI, except among adolescents aged 11 to 14 years, where the odds ratios for possible internet addiction with less-frequent NSSI were higher in male adolescents (1.53; 95% CI, 1.25-1.88) than female adolescents (1.13; 95% CI, 0.90-1.47). Conclusion and Relevance: Internet addiction appears to be associated with NSSI, and the findings of this study suggest that the association was similar between male adolescents and female adolescents. These data suggest that evaluation of the risk of NSSI for adolescents in association with internet addiction may help health care professionals in developing preventive interventions for NSSI.

Distribution and controls of heavy metals and organic matter in the surface sediments of the Southern Yellow Sea, China.

Accurate and effective determination of the source of heavy metals is essential for the treatment of marine ecological environments. This article attempts to combine geochemical composition data and hydrocarbon composition data to achieve this purpose. The concentrations of six heavy metals (Cu, Pb, Zn, Cr, Ni, and Co), grain size, total organic carbon (TOC) content, Al2O3 content, and aliphatic hydrocarbons (AHs) in 501 surface samples from the Southern Yellow Sea (SYS) were analyzed. The results showed that most sample sites ranged from not polluted to moderately polluted. However, Cu, Pb, Cr, and Ni may represent potential hazards, and the toxic probability for the combination of five metals (Cr, Cu, Ni, Zn, and Pb) was 21% for all sampling sites. The highest heavy metal concentrations were associated with the fine-grained sediments in the eastern area, especially in the northeastern muddy area. However, high concentrations of Pb and Cu were also found in some sites with coarse sediment in the western region. The lipid biomarkers showed that the n-alkanes were dominated by large odd-numbered carbon molecules, indicating that the organic matter in the sediments originated mainly from terrestrial plants. Principal component analysis (PCA) results, AH data, and the sediment distributions indicated that the organic matter and heavy metals in the SYS were mainly sourced from the Old Yellow River Delta, transported by ocean currents and deposited in the central SYS. In addition, a small proportion of the heavy metals originated from airborne dust. The spatial distribution pattern of the heavy metals in the surface sediments provides a basis for the protection of the marine ecological environments.

An analysis of organic matter sources for surface sediments in the central South Yellow Sea, China: evidence based on macroelements and n-alkanes.

By analyzing the composition of n-alkane and macroelements in the surface sediments of the central South Yellow Sea of China, we evaluated the influencing factors on the distribution of organic matter. The analysis indicates that the distribution of total organic carbon (TOC) was low in the west and high in the east, and TOC was more related to Al2O3 content than medium diameter (MD). The composition of n-alkanes indicated the organic matter was mainly derived from terrestrial higher plants. Contributions from herbaceous plants and woody plants were comparable. The comprehensive analysis of the parameters of macroelements and n-alkanes showed the terrestrial organic matter in the central South Yellow Sea was mainly from the input of the modern Yellow River and old Yellow River. However, some samples exhibited evident input characteristics from petroleum sources, which changed the original n-alkanes of organic matter in sediments.