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.

The Interference of Negative Symptoms of Schizophrenia on Cognitive Domains: a Long-Term Observational Study on the Role of Clozapine.

The negative symptoms of schizophrenia are responsible for patients' worse quality of life. The association with cognitive deficits impairs clinical and psychopathological conditions. Our small 5-year observational study evaluated the efficacy of clozapine in negative and cognitive symptoms in schizophrenia inpatients. The overall results showed a significant improvement in the mean total scores of the BNSS and PANSS (at baseline (T0) vs five years (T3)). The improvement was also in some negative subscales (PANSS Negative Factor subscale) but not in others and the Epitrack tool. The overall results showed that clozapine is a useful therapeutic tool that does not affect the cognitive decline of these patients.

Negative Symptoms and Cognitive Deficits in Primary Psychoses: an Observational Study in a Psychiatric Rehabilitation Centre.

Negative symptoms (NSs) and cognitive deficits (CDs) negatively affect patients' quality of life with primary psychosis. Our observational study evaluated the percentage of NSs in a group of inpatients of a psychiatric rehabilitation facility and the variation of the interaction with CDs during the COVID-19 pandemic. The results showed a significant correlation between NSs and CDs in the first observation period (PANSS - FSNS p=0.001; BNSS p=0.023; Epitrack p=0.00) and a stabilization of the results between the first and second observation periods (PANSS - FSNS: p=0.094; BNSS p=0.466; Epitrack p=0.026).

Stress Work and Hopelessness in Mental Health Workers/Caregivers: an Observational Study in Pandemic and Post COVID-19 Pandemic.

BACKGROUND: WHO has decreed an end to the pandemic crisis from COVID-19. However, the consequences of stress, compassion fatigue, and healthcare workers' expectations are still evident. Also, the hope of ending the problems associated with the pandemic is still present, although the awareness of maintaining a high level of attention is current in the HCWs. METHOD: In our observational study, 102 (65 females, 37 males) mental healthcare workers were evaluated during and post-COVID-19 pandemic. They were divided into different categories of workers: nurses, physicians, psychologists, social assistants, social educators, social health workers, and psychiatric rehabilitation technicians. We used the ProQoL for compassion fatigue, compassion satisfaction, and burnout; BHS for hopelessness. RESULTS: ProQoL data showed a significant increase in compassion satisfaction in post-pandemic (p=0.002) in all professional workers. The same results in burnout and secondary stress subscales (respectively, p=0.018, p=0.000) are evident. The BHS total score indicated that the difference between T0 vs. T1 was not statistically significant (p=0.109). CONCLUSIONS: The collected data during and post-COVID-19 pandemic showed reduced burnout and compassion fatigue in the helping professions. However, in the periods analyzed, no changes in hope are observed.

The Role of Fatigue and Satisfaction of Compassion, and Hopelessness in Healthcare Workers in the Alzheimer's Disease in the Post-COVID-19 Pandemic.

The COVID-19 pandemic has left emotional consequences for healthcare workers. Dramatic results are obtained on compassion fatigue, burnout, and hopelessness in healthcare workers (HCWs) of older adults with Alzheimer's disease. Our study evaluated differences in these factors during and after the pandemic in 48 HCWs. The results showed a statistically significant difference in the Satisfaction of Compassion (P=0.014; during vs post-pandemic) and in the subscale of Secondary Trauma (P=0.005) and Burnout (P=0.49) in CFSS. The results were not statistically significant on the BHS scale (P=0.285). However, hopelessness was found in a higher percentage of HCWs at the end of the pandemic than during the pandemic period (respectively: 35.67% vs 31.67%).

The Emotional Impact on Mental Health Workers in the Care of Patients with Mental Disorders in the Pandemic and Post COVID-19 Pandemic: a Measure of "Burnout" and "Compassion Fatigue".

BACKGROUND: Emotional pressure, fear, and uncertainties affected healthcare workers (HCWs) who played a significant role during the COVID-19 pandemic. After the pandemic crisis, the consequences on the health of mental HealhCare Workers are still significant. Our work aimed to evaluate burnout and compassion fatigue in HCWs. METHOD: In our observational study, 102 (65 females, 37 males) mental HCWs were evaluated during and post-COVID-19 pandemic. We used the Compassion Fatigue-Short Scale, Balanced Emotional Empathy Scale, and Beck Depression Inventory. RESULTS: Subscale Secondary Trauma Stress of CF-SS demonstrated an increase in the rate in the post-pandemic phase (24.51% in all HCWs). The percentage reached in males was high (37.84%). Instead, the levels of Job Burnout remained constant in the two periods analyzed (during and post-COVID-19). Depressive symptoms remained constant with a prevalence in females of the post-COVID period. CONCLUSION: The results confirm increased stress secondary to the traumatic event, while the levels of job burnout are high. Closely associated with compassion fatigue are levels of empathy that were found to be unchanged.

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.

Cognitive Deficits in Mood Disorders: Role and Contradictions in Psychiatry.

The principal aim of this work is to reflect about the assessment and management of cognitive deficits in psychiatric disorders, and, particularly, in mood disorders (MDD and BD). The current trend of research and clinical practice is to give more importance to cognitive dysfunctions in psychiatric disorders. There are numerous studies that highlighted the cognitive alterations as the core deficit in MDD and BD, observed across several domains (e.g., executive function, working memory, attention). There are also numerous tools that allow the identification of these cognitive deficits, as well as assessment tools. But are these, really, effective and usable in daily clinical practice? Are they accepted by patients? Could relying only these tools run the risk of forgetting the good clinical practice? Can the doctor-patient (or HCW-patient) relationship and deepening of psychopathological aspects to be marginalized? These and other considerations are carried out in this work.

Hope in Psychiatric Patients: An Observational Study in a Psychiatric Rehabilitation Centre.

INTRODUCTION: The COVID-19 pandemic has led to the re-evaluation of some fundamental aspects for the management of emotions and psychological dynamics. Hope and its lack are important factors that have been especially evaluated in caregivers and HCWs. Instead, our study aimed to explore hopelessness among psychiatric rehabilitation center residents with Primary Psychosis. METHODS: We recruited 116 inpatients affected by Primary Psychosis (schizophrenia, bipolar disorder, major depression disorder and personality disorder). Hopelessness was sought through the BHS, during the covid-19 pandemic period. They were compared with data from previous studies on HCWs (HealthCare Workers), in the same period, and in the same centre. RESULTS: The results obtained in this group of patients showed high total scores on the BHS scale (mean total score: 7.28±SD 3.73). These data are significantly higher than those found in HWs in the same pandemic period (mean total score: 3.74±SD 3.62). Among the different disorders the borderline personality disorder patients have presented the highest score (mean total score: 8.00±SD 3.50). CONCLUSION: Understanding resident - and HCWs- level variations in hopelessness may be important for targeting interventions to improve the outcome of residential psychiatric patients.

Dignity-Therapy in Bipolar Disorder and Major Depression: An Observational Study in a Psychiatric Rehabilitation Center.

Dignity Therapy (DT) is a multi-dimensional, brief and individual psychotherapeutic intervention, designed to increase the sense of dignity in patients. The aim of our study was to evaluate the effectiveness of Dignity Therapy in a group of patients suffering from major depressive disorder or bipolar disorder. The results of the study in a small group of patients showed the effectiveness of DT. The PDI (Patient Dignity Inventory Scores) showed a statistically significant difference in the whole group of patients with a reduction in the mean overall score (T0 vs T1 = Mean Difference: 13.700, T-Score: 4.834, Eta squared: 0.709, p: 0.001, statistically significant). However, there is a need to deepen the study to try to offer an opportunity for treatment in this group of patients.

Metabolic Alterations and Drug Interactions: The Role of the Association between Antipsychotics / Mood Stabilizers and Cognitive Deficits.

Alterations in the metabolic profile are one of the main consequences of the use of drug therapies in psychiatric patients. In particular, dysfunction of the metabolic profile (lipid and glycidic) is very frequent in patients taking antipsychotics, especially second-generation ones, and antidepressants. Similar alterations, albeit, to a lesser extent, were highlighted with the use of mood stabilizers. There are some clinical conditions in which clinicians add antipsychotics and mood stabilizers. Our study analyzed this interaction in 116 inpatients. Data showed an overall increase in metabolic parameters in all patients analyzed. However, no statistically significant differences were found in some subgroups of patients. The correlation between metabolic alterations and cognitive dysfunctions in these patients was also analyzed (not statistically significant).

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.

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.

Loneliness and Hopelesness: Their Role in the Depressive Cases during the COVID Pandemia.

The COVID-19 pandemic has created new problems and presented new challenges for its management. Hope, or rather its absence, social isolation and loneliness are considered risk factors for the development of anxious and depressive symptoms. Health authorities have had to address issues regarding the mental health risks that the pandemic has created. There is numerous scientific evidences of the increase in affective disorders in the last two years. Associated with these disorders, particular characteristics of personality temperament, such as affective temperament, can determine an increased risk especially in some patient populations, such as the elderly, with significant negative consequences on the quality of life and on the onset of mental and organic diseases. The hope of the end of the pandemic has been placed on mass vaccination. After an initial enthusiasm there was a growing concern about its side effects. An adequate information policy is necessary to put an end to concerns about vaccines and thus lead to an increase in hope for the future and an end to social isolation.

The Effect of the Pandemic on the Care of Patients with Mental Disorders: Measure of "Compassion Fatigue" and "Burn-Out" in the Operator.

BACKGROUND: The Covid-19 Pandemic has had a significant impact on psychophysical well-being and the ability to work productively in contexts concerning people's physical and mental care. The helping professions involved have seen an increase in stress levels, a sense of helplessness, fear, pain and social isolation. They are anchored to the hope of being able to return to their normality. METHOD: In this study, 87 mental health operators were evaluated, divided into nurses, psychiatric rehabilitation technicians, educators, social workers, psychologists and doctors, working in two psychiatric care rehabilitation communities in Puglia and Campania in southern Italy. RESULTS: The results obtained with the administration of the scales ProQOL, BHS, Save-9, BDI-II, BEES reported a remarkable impact in nursing and medical professions due to the pandemic. A 11%. burn-out was reported by nurses. CONCLUSIONS: The collected data are comparable to the previous work (Franza et al. 2015, 2020); however, there is no evidence of a high level of burnout in the helping professions involved in this study.

The Emotional Impact of the Operator in the Care of Patients With Mental Disorders during the Pandemic: Measure of Interventions on Compassion Fatigue and Burn-Out.

BACKGROUND: The continuation of the health emergency due to the management of COVID-19 is having a profound effect on all aspects of society, including mental health and physical health. This observational study examined practitioners of psychiatric rehabilitation and therapeutic communities, focusing on the emotional aspects of patient care, in particular the fatigue of compassion, empathy and lack of hope, aspects that could be directly linked to the burnout of health professionals, as found in other similar studies. METHOD: In this study, self-administered scale data was collected in 87 healthcare professionals recruited from 3 different psychiatric rehabilitation communities. In particular, we assessed the fatigue of compassion, vicarious trauma, burnout and hope (hopeless), empathy and depressive symptoms in the two months of May and June 2021. RESULTS: The results obtained after the administration of the following rating scales, ProQOL, BHS, SAVE-9, BDI-II and BEES, showed an overall increase in scores in all professional figures, a significant fatigue of compassion, while the percentage burnout is not present in several groups. The presence of high levels of hope, satisfaction of compassion is indicative of a moderate level of empathy in some professional figures; these high levels can protect workers from the risk of developing work-related stress and depressive symptoms. CONCLUSIONS: The data obtained with this study are not similar to those of previous studies, although they may indicate the importance of factors such as hope, empathy in the care of the patient with psychic disorders in rehabilitation communities, underlining the need for interventions aimed at the emotional management of the care relationship as a tool to improve care and prevent burnout even during times of high stress, such as managing a pandemic.

The Role of Fatigue of Compassion, Burnout and Hopelessness in Healthcare: Experience in the Time of COVID-19 Outbreak.

BACKGROUND: In the times of serious health alarm, as it is happening in the COVID-19 pandemic, burden of healthcare is likely to explode. The current pandemic is having a profound effect on all aspects of society, including mental health and physical health. In a previous study we showed interaction between compassion fatigue, burnout and workload. METHODS: In our study, we have evaluated stress levels in 102 healthcare workers recruited in different rehabilitation departments (psychiatric and multidisciplinary). In particular, we evaluated the fatigue of compassion, vicarious trauma, burnout and hope (hopelessness) in the first two months of lookdown due to the COVID-19. RESULTS: The results obtained after the administration of the following evaluation scales: sCFs, CBI, Pro QOL, HBS, showed an overall increase in the scores in all professional figures. Significant compassion fatigue and burnout percentage is present in several groups. The highest levels of hopelessness in some professional figures, while higher educational levels can protect workers from the risk of developing high levels of work stress. CONCLUSIONS: The data obtained with this study are similar to those of our previous study, although they may indicate that during the period of the coronavirus pandemic the scores of the several scales used are higher.

A New Rating Scale (SAVE-9) to Demonstrate the Stress and Anxiety in the Healthcare Workers During the COVID-19 Viral Epidemic.

The COVID-19 epidemic has been a major global public health problem during past months in Italy and in several other Countries and on the date of publication of this article, is still a serious public health problem. The health staff, engaged in the care of the sick and in the prevention of the spread of the infection have been subjected to a further increase in psychological difficulties and work-related stress, related to the workload for the continuous influx of sick and intense and close working shifts for the viral emergency. The SAVE-9 (Stress and Anxiety to Viral Epidemics - 9 items) scale has been developed as a tool for assessing work anxiety and stress in response to the viral epidemic of health professionals working to prevent the spread of the virus and to treat infected people.

The emotional and psychological burden of the "burnout" in families of psychiatric patients.

People, who assist patients with chronic health problems for work, voluntary or for family reasons, may be affected by burnout. This is defined as an excessive reaction to stress caused by one's environment that may be characterized by feelings of emotional and physical exhaustion, coupled with a sense of frustration and failure. A person who assists a suffering person, beyond the professional role, is indicated generally by the term "caregiver". The definition of Burnout in families is fairly recent, because the psychology of trauma has ignored a large segment of traumatized and disabled subjects (family and other assistants of "suffering people") unwittingly, for a long time. The burnout of secondary stress is due to one's empathic ability, actions trough disengagement, and a sense of satisfaction from helping to relieve suffering. Figley (1995) claims that being a member of a family or other type of intimate or bonded interpersonal relationship, one feels the others' pain. Closely associated with the suffering of the family caregiver is the concept of compassion fatigue, defined as a state of exhaustion and disfunction-biologically, psychologically, and socially - as a result of prolonged exposure to compassion stress and all that it evokes. In families, this can be the cause of serious conflicts and problems, quarrels, verbal and physical aggression, and broken relationships. The intervention on families requires practice and effectiveness approaches performed by experienced professionals. Some approaches focus more specifically, such as those that adopt a cognitive/behavioural technique with direct exposure, implosion methods, various drug treatments and family group psychotherapy. One of the most common models of intervention is based on the principle that the observation unit for the understanding of the disorder is not the single individual but the relationship between individuals.