Non-binary gender, vulnerable populations and mental health during the COVID-19 pandemic: Data from the COVID-19 MEntal health inTernational for the general population (COMET-G) study.

BACKGROUND: The COVID-19 pandemic has brought significant mental health challenges, particularly for vulnerable populations, including non-binary gender individuals. The COMET international study aimed to investigate specific risk factors for clinical depression or distress during the pandemic, also in these special populations. METHODS: Chi-square tests were used for initial screening to select only those variables which would show an initial significance. Risk Ratios (RR) were calculated, and a Multiple Backward Stepwise Linear Regression Analysis (MBSLRA) was followed with those variables given significant results at screening and with the presence of distress or depression or the lack of both of them. RESULTS: The most important risk factors for depression were female (RR = 1.59-5.49) and non-binary gender (RR = 1.56-7.41), unemployment (RR = 1.41-6.57), not working during lockdowns (RR = 1.43-5.79), bad general health (RR = 2.74-9.98), chronic somatic disorder (RR = 1.22-5.57), history of mental disorders (depression RR = 2.31-9.47; suicide attempt RR = 2.33-9.75; psychosis RR = 2.14-10.08; Bipolar disorder RR = 2.75-12.86), smoking status (RR = 1.15-5.31) and substance use (RR = 1.77-8.01). The risk factors for distress or depression that survived MBSLRA were younger age, being widowed, living alone, bad general health, being a carer, chronic somatic disorder, not working during lockdowns, being single, self-reported history of depression, bipolar disorder, self-harm, suicide attempts and of other mental disorders, smoking, alcohol, and substance use. CONCLUSIONS: Targeted preventive interventions are crucial to safeguard the mental health of vulnerable groups, emphasizing the importance of diverse samples in future research. LIMITATIONS: Online data collection may have resulted in the underrepresentation of certain population groups.

Somatic multicomorbidity and disability in patients with psychiatric disorders in comparison to the general population: a quasi-epidemiological investigation in 54,826 subjects from 40 countries (COMET-G study).

BACKGROUND: The prevalence of medical illnesses is high among patients with psychiatric disorders. The current study aimed to investigate multi-comorbidity in patients with psychiatric disorders in comparison to the general population. Secondary aims were to investigate factors associated with metabolic syndrome and treatment appropriateness of mental disorders. METHODS: The sample included 54,826 subjects (64.73% females; 34.15% males; 1.11% nonbinary gender) from 40 countries (COMET-G study). The analysis was based on the registration of previous history that could serve as a fair approximation for the lifetime prevalence of various medical conditions. RESULTS: About 24.5% reported a history of somatic and 26.14% of mental disorders. Mental disorders were by far the most prevalent group of medical conditions. Comorbidity of any somatic with any mental disorder was reported by 8.21%. One-third to almost two-thirds of somatic patients were also suffering from a mental disorder depending on the severity and multicomorbidity. Bipolar and psychotic patients and to a lesser extent depressives, manifested an earlier (15-20 years) manifestation of somatic multicomorbidity, severe disability, and probably earlier death. The overwhelming majority of patients with mental disorders were not receiving treatment or were being treated in a way that was not recommended. Antipsychotics and antidepressants were not related to the development of metabolic syndrome. CONCLUSIONS: The finding that one-third to almost two-thirds of somatic patients also suffered from a mental disorder strongly suggests that psychiatry is the field with the most trans-specialty and interdisciplinary value and application points to the importance of teaching psychiatry and mental health in medical schools and also to the need for more technocratically oriented training of psychiatric residents.

Variation along P2RX7 interacts with early traumas on severity of anxiety suggesting a role for neuroinflammation.

Emotional stress is a leading risk factor in the development of neuropsychiatric disorders possibly via immune activation. P2X7 receptors promote neuroinflammation, and research suggests a relationship between chromosome region 12q2431, in which the P2X7R gene is located, and development of mood disorders, however, few studies concentrate on its association with anxiety. Our aim was to investigate the effects of P2RX7 variation in interaction with early childhood traumas and recent stressors on anxiety. 1752 participants completed questionnaires assessing childhood adversities and recent negative life events, provided data on anxiety using the Brief Symptom Inventory, and were genotyped for 681 SNPs in the P2RX7 gene, 335 of which passed quality control and were entered into linear regression models followed by a linkage disequilibrium-based clumping procedure to identify clumps of SNPs with a significant main or interaction effect. We identified a significant clump with top SNP rs67881993 and containing a set of 29SNPs that are in high LD, which significantly interacted with early childhood traumas but not with recent stress conveying a protective effect against increased anxiety in those exposed to early adversities. Our study demonstrated that P2RX7 variants interact with distal and more etiological stressors in influencing the severity of anxiety symptoms, supporting previous scarce results and demonstrating its role in moderating the effects of stress.

Results of the COVID-19 mental health international for the health professionals (COMET-HP) study: depression, suicidal tendencies and conspiracism.

INTRODUCTION: The current study aimed to investigate the rates of anxiety, clinical depression, and suicidality and their changes in health professionals during the COVID-19 outbreak. MATERIALS AND METHODS: The data came from the larger COMET-G study. The study sample includes 12,792 health professionals from 40 countries (62.40% women aged 39.76 ± 11.70; 36.81% men aged 35.91 ± 11.00 and 0.78% non-binary gender aged 35.15 ± 13.03). Distress and clinical depression were identified with the use of a previously developed cut-off and algorithm, respectively. STATISTICAL ANALYSIS: Descriptive statistics were calculated. Chi-square tests, multiple forward stepwise linear regression analyses, and Factorial Analysis of Variance (ANOVA) tested relations among variables. RESULTS: Clinical depression was detected in 13.16% with male doctors and 'non-binary genders' having the lowest rates (7.89 and 5.88% respectively) and 'non-binary gender' nurses and administrative staff had the highest (37.50%); distress was present in 15.19%. A significant percentage reported a deterioration in mental state, family dynamics, and everyday lifestyle. Persons with a history of mental disorders had higher rates of current depression (24.64% vs. 9.62%; p < 0.0001). Suicidal tendencies were at least doubled in terms of RASS scores. Approximately one-third of participants were accepting (at least to a moderate degree) a non-bizarre conspiracy. The highest Relative Risk (RR) to develop clinical depression was associated with a history of Bipolar disorder (RR = 4.23). CONCLUSIONS: The current study reported findings in health care professionals similar in magnitude and quality to those reported earlier in the general population although rates of clinical depression, suicidal tendencies, and adherence to conspiracy theories were much lower. However, the general model of factors interplay seems to be the same and this could be of practical utility since many of these factors are modifiable.

Association between change in suicidal ideation, and distinct symptoms of depression and sleep changes during COVID-19.

COVID-19 has created a situation that has never been experienced before, challenging the mobilization of adaptive coping strategies. There has been a marked increase in suicides and suicidal ideation following the onset of COVID-19 likely reflecting the toll of the pandemic on mental health. The aim of our study to investigate the associations between depressive symptoms and distinct symptom clusters and lifestyle changes related to sleep, eating and physical activity and change in suicidal thoughts and thinking about death during the pandemic. Analyses involved data from the Hungarian part of the COMET-G (COVID-19 Mental health in Ternational for the General population) study, including 763 Hungarian adults, who completed a detailed questionnaire focusing on changes in behavior, lifestyle, activity and mental health during the pandemic. The dataset was analyzed using ordinal regression models adjusted for age and sex. Depression, as well as its symptom clusters, including anhedonia and depressed mood and somatic complaints had a significant, but small effect increasing suicidal ideation, while the effect of irritability and social relationship problems was more marked. In case of lifestyle factors no associations was found between change in eating habits or physical activity and change in suicidal ideations, however, sleeprelated changes were associated with a significant increase in suicidal thoughts during the pandemic. Our findings show that not all symptoms related to mood disturbance have an equally marked effect on suicidal ideating and thus suicide risk, emphasizing the role of detailed screening and evaluation even in subclinical populations in times of such crises, and also highlight the importance of considering sleep problems when evaluating suicide risk. Thus, our findings help identify relevant targets for screening and intervention in decreasing suicide risk during crises. (Neuropsychopharmacol Hung 2022; 24(3): 134-143).

Association between Lifestyle- and Circadian Rhythm-Related Changes, and Different Depression Symptom Clusters during COVID-19.

BACKGROUND: The COVID-19 pandemic brought along a new situation for the population worldwide. The most important safety measures and lockdown expected extreme adaptability and flexibility impacting mental well-being. The aim of our study was to identify associations between changes in lifestyle and circadian rhythm and depression during the pandemic. SUBJECTS AND METHODS: Our analysis has been carried out on the Hungarian data set of the COMET-G study including information on lifestyle and circadian rhythm-associated factors and severity of depression and its 3 symptom clusters. Associations were assessed using linear regression models adjusted for age and sex. RESULTS: All variables reflecting changes in quality and quantity of sleep showed significant associations with overall depression scores and the three distinct symptom cluster scores. All variables reflecting importance and changes in physical activity during the pandemic were similarly significantly associated with all depression measures. However, only changes in quality of diet, but not quantity was associated with depression scores. CONCLUSIONS: Our results may confirm the association of circadian rhythm and lifestyle-related environmental factors in deterioration of mental health during COVID and help devise prevention and intervention methods and targets for similar situations.

The effect of different degrees of lockdown and self-identified gender on anxiety, depression and suicidality during the COVID-19 pandemic: Data from the international COMET-G study.

INTRODUCTION: During the COVID-19 pandemic various degrees of lockdown were applied by countries around the world. It is considered that such measures have an adverse effect on mental health but the relationship of measure intensity with the mental health effect has not been thoroughly studied. Here we report data from the larger COMET-G study pertaining to this question. MATERIAL AND METHODS: During the COVID-19 pandemic, data were gathered with an online questionnaire from 55,589 participants from 40 countries (64.85% females aged 35.80 ± 13.61; 34.05% males aged 34.90±13.29 and 1.10% other aged 31.64±13.15). Anxiety was measured with the STAI, depression with the CES-D and suicidality with the RASS. Distress and probable depression were identified with the use of a previously developed cut-off and algorithm respectively. STATISTICAL ANALYSIS: It included the calculation of Relative Risk (RR), Factorial ANOVA and Multiple backwards stepwise linear regression analysis RESULTS: Approximately two-thirds were currently living under significant restrictions due to lockdown. For both males and females the risk to develop clinical depression correlated significantly with each and every level of increasing lockdown degree (RR 1.72 and 1.90 respectively). The combined lockdown and psychiatric history increased RR to 6.88 The overall relationship of lockdown with severity of depression, though significant was small. CONCLUSIONS: The current study is the first which reports an almost linear relationship between lockdown degree and effect in mental health. Our findings, support previous suggestions concerning the need for a proactive targeted intervention to protect mental health more specifically in vulnerable groups.

Invisible wounds: Suturing the gap between the neurobiology, conventional and emerging therapies for posttraumatic stress disorder.

A sharp increase in the prevalence of neuropsychiatric disorders, including major depression, anxiety, substance use disorders and posttraumatic stress disorder (PTSD) has occurred due to the traumatic nature of the persisting COVID-19 global pandemic. PTSD is estimated to occur in up to 25% of individuals following exposure to acute or chronic trauma, and the pandemic has inflicted both forms of trauma on much of the population through both direct physiological attack as well as an inherent upheaval to our sense of safety. However, despite significant advances in our ability to define and apprehend the effects of traumatic events, the neurobiology and neuroanatomical circuitry of PTSD, one of the most severe consequences of traumatic exposure, remains poorly understood. Furthermore, the current psychotherapies or pharmacological options for treatment have limited efficacy, durability, and low adherence rates. Consequently, there is a great need to better understand the neurobiology and neuroanatomy of PTSD and develop novel therapies that extend beyond the current limited treatments. This review summarizes the neurobiological and neuroanatomical underpinnings of PTSD and discusses the conventional and emerging psychotherapies, pharmacological and combined psychopharmacological therapies, including the use of psychedelic-assisted psychotherapies and neuromodulatory interventions, for the improved treatment of PTSD and the potential for their wider applications in other neuropsychiatric disorders resulting from traumatic exposure.

What you see is what you get? Association of belief in conspiracy theories and mental health during COVID-19.

Background: The COVID-19 pandemic brought about great uncertainty and significant changes in our people's everyday lives. In times of such crises, it is natural to seek explanations to overcome our fears and uncertainties, contributing to an increase to believe in conspiracy theories which, by yielding explanations, decrease uncertainty and ambiguity and may thus have an effect on mental well-being. In spite of this, the majority of research on conspiracy theories focused on their social effects with little attention to psychological effects. Thus, the aim of our present study was to examine the association between belief in conspiracy theories and different aspects of mental health during the COVID-19 pandemic in a general population sample. Methods: Our analyses included data from the Hungarian leg of the COMET-G (COVID-19 MEntal health international for the General population) study. The Hungarian sample included participants who completed a detailed questionnaire assessing belief in seven conspiracy theory items, as well as STAI-S and CES-D to measure state anxiety and depression, respectively, and answered questions related to their change in depression, anxiety and suicidal thoughts during the pandemic. Association between the individual beliefs as well as a composite Conspiracy Theory Belief Score (CTBS) and mental health measures was analysed using linear regression models. Results: Overall, belief in conspiracy theories was relatively moderate in our sample. Sex and age appeared to have a significant effect on the Overall Conspiracy Theory Belief Score (CTBS), with women having a higher score and scores increasing with age. Some of the individual beliefs also showed associations with age and sex. State anxiety and depression was not significantly associated with CTBS, however in case of depression some individual items were, and symptom clusters within CES-D also showed a pattern of association with some of the individual items. As far as changes in mental health during the pandemic is concerned, no association between overall beliefs and changes in anxiety or depression was found. However, higher overall belief in conspiracy theories was associated with a decrease in suicidal thoughts. Discussion: In our study, we explored the association between conspiracy theories and mental well-being as well as its changes during the COVID-19 pandemic. We found a specific pattern of association between belief in distinct theories and some aspects of depression, as well as lower increase in suicidal ideation in association with increased belief in conspiracy theories. Understanding the role of belief in theories can be key to designing mental health interventions when reacting to unforeseen events in the future. (Neuropsychopharmacol Hung 2022; 24(1): 42-55).

Results of the COVID-19 mental health international for the general population (COMET-G) study.

INTRODUCTION: There are few published empirical data on the effects of COVID-19 on mental health, and until now, there is no large international study. MATERIAL AND METHODS: During the COVID-19 pandemic, an online questionnaire gathered data from 55,589 participants from 40 countries (64.85% females aged 35.80 ± 13.61; 34.05% males aged 34.90±13.29 and 1.10% other aged 31.64±13.15). Distress and probable depression were identified with the use of a previously developed cut-off and algorithm respectively. STATISTICAL ANALYSIS: Descriptive statistics were calculated. Chi-square tests, multiple forward stepwise linear regression analyses and Factorial Analysis of Variance (ANOVA) tested relations among variables. RESULTS: Probable depression was detected in 17.80% and distress in 16.71%. A significant percentage reported a deterioration in mental state, family dynamics and everyday lifestyle. Persons with a history of mental disorders had higher rates of current depression (31.82% vs. 13.07%). At least half of participants were accepting (at least to a moderate degree) a non-bizarre conspiracy. The highest Relative Risk (RR) to develop depression was associated with history of Bipolar disorder and self-harm/attempts (RR = 5.88). Suicidality was not increased in persons without a history of any mental disorder. Based on these results a model was developed. CONCLUSIONS: The final model revealed multiple vulnerabilities and an interplay leading from simple anxiety to probable depression and suicidality through distress. This could be of practical utility since many of these factors are modifiable. Future research and interventions should specifically focus on them.

Can you get off the rollercoaster? Psychotherapeutic interventions in bipolar disorder.

Bipolar affective disorder is a chronic illness that usually causes significant psychosocial deficits and functional impairment and is also associated with excess mortality. It is underlied by an endogenous pathology with pharmacotherapy as primary treatment. However, in many cases, medication treatment alone is associated with limited adherence, low remission rates, increased potential for relapse and residual symptoms, which is why bipolarity-specific psychotherapeutic interventions are increasingly gaining ground as an integral part of the management of the disease. An increasing amount of research and evidence suggest that complementary psychotherapeutic interventions improve patients' long-term functioning, and argue for the involvement of psychologists and other helping professionals in the long-term care of patients with bipolar disorder. In this article we overview the major therapeutic methods specifically targeted at this group of patients, including individual and group psychoeducation, cognitive behavioural therapy, family therapy, Interpersonal and Social Rhythm Therapy (IPSRT), Integrated Care Management, Think Effectively About Mood Swings (TEAMS), Imagery Based Emotion Regulation (IBER), and other individual and group techniques and psychotherapeutic interventions, also mentioning efficacy studies and effects experienced by patients.

[Effects of COVID-19 on psychological well-being, lifestyle and attitudes towards the origins of the pandemic in psychiatric patients and mentally healthy subjects: fi rst Hungarian descriptive results from a large international online study]. / A COVID-19 pandémia hatása a pszichológiai jóllétre, az életmódra és a járvány eredetével kapcsolatos attitudökre pszichiátriai betegséggel élo és egészséges személyekben: egy nagy nemzetközi vizsgálat elso magyarországi adatai.

The COVID-2019 pandemic has presented a new situation affecting not only the somatic but the mental health of people worldwide and exposing the world including healthcare professionals to a challenge never experienced before. Therefore its effects on mental health, although can be estimated, but cannot be predicted, thus we are only halfways prepared for understanding as well as screening, preventing and treating the pandemic-related mental health problems. For this reason, the Mental Health Sector of the Scientific Researches Institute of the Pan-Hellenic Medical Association prepared a large, international online, general population study with participation from over 42 countries, assessing various aspects of general mental function, needs and behaviors that could occur during the COVID-19 outbreak, as a result of either the outbreak itself or the social measures adopted in order to control it. While the study is ongoing, here we present the first descriptive results from the Hungarian study sample including 738 adult participants collected during the first wave of COVID-19-associated lockdown, focusing on differences in the effect of COVID-19 on psychological and lifestyle measures, as well as attitudes towards the pandemic between mentally healthy participants and people with mental disorders.