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.

Beliefs in Conspiracy Theories and Mental Health in the Student Community of Latvia During the COVID-19 Outbreak.

BACKGROUND: The objective of this study was to investigate self-reported changes in mental health and their association with various sociodemographic factors and beliefs in conspiracy theories among university and college students in Latvia during the second state of emergency caused by COVID-19. SUBJECTS AND METHODS: This cross-sectional study was conducted as part of an international research project, where university and college students were anonymously asked to complete an online self-report questionnaire. Changes in anxiety and depression were assessed using self-rated questions. Statistical analysis involved Pearson's chi-square test and univariate binary logistic regression.ression. RESULTS: The study comprised 1047 students, with 828 females (79.08% aged 21.71±0.09). Worsening in self-reported anxiety was more prevalent among females (69.3%, p<0.001), unemployed respondents (70.0%, p=0.003), individuals who were were not working during the lockdown (70.3%, p<0.001), those experiencing deterioration in general health condition (93.0%, p<0.001), and those belonging to or having knowledge of someone in a vulnerable group (69.5%, p=0.004). Worsening self-reported depression was more prevalent in respondents who did not work during the lockdown (63.9%, p=0.014) and those with deteriorating general health conditions (93.0%, p<0.001). Increased odds ratios (OR) for experiencing changes in anxiety and depression were associated with beliefs in the following conspiracy theories: 'Recommended measures are an attempt to restrict human rights' (OR=1.49, p=0.019 and OR=2.40, p<0.001, respectively). Furthermore, increased OR for experiencing changes in depression were associated with beliefs in the following conspiracy theories: 'The COVID-19 vaccine was ready before the virus spread' (OR=3.11, p=0.007), 'COVID-19 has a lower mortality rate" (OR=1.85, p<0.001)', 'Recommended measures are an attempt to restrict human rights' (OR=2.40, p<0.001), and 'The COVID-19 outbreak is the creation of world leaders' (OR=2.17, p=0.003). CONCLUSIONS: Self-reported changes in depression and anxiety were associated with certain beliefs in specific conspiracy theories.

Point prevalence and sex-specific associated factors of depression in Latvian general population.

Background: This cross-sectional study aimed to determine the current prevalence of depression, and analyze sex-specific associated socio-demographic and health-related factors for depression in a representative sample of the general adult population of Latvia. Methods: Specially trained professional interviewers conducted computer-assisted face-to-face interviews with a multistage stratified probability sample from the general Latvian adult population (n = 2,687). A 9-item Patient Health Questionnaire (PHQ) was used for assessment of depression. Respondents were interviewed using the specially developed questionnaire about sociodemographic factors as well as the alcohol use disorder module of the Mini International Neuropsychiatric Interview. Binary logistic regression was used to calculate the odds ratios (OR) for the univariate and multivariate logistic analyses. Results: The point prevalence of depression according to the PHQ-9 was 6.4% (95% CI 5.8-7.6). After adjustment for all independent variables analyzed, being divorced, widowed, or living separately increased the odds of depression [aOR 2.6 (95% CI, 1.2-5.8), p = 0.02] in males. For females, unfinished primary education [aOR 5.2 (95% CI 2.0-13.6), p = 0.001] and economically inactive status [aOR 2.0 (95% CI, 1.1-3.6), p = 0.03] were strongly associated with depression. Limitations: The cross-sectional design of the study did not allow us to draw conclusions about causality. Patients with bipolar, organic, and symptomatic depression states were not excluded. Conclusion: The prevalence of depression in the general adult population is 6.4%, with the most significant sex-specific factors associated with depression for males - being divorced, widowed, or living separately, and for females it was poor education and economic inactivity.

Case report: Successful administration of cariprazine in a young, severely ill patient with recurrent relapses of schizophrenia and persistent negative symptoms.

The present case report describes a young man diagnosed with schizophrenia and presents a "revolving door" (RD) phenomenon. He was hospitalized in an acute psychiatric clinic three times in 1 year. After each hospitalization, he was discharged with incompletely reduced psychotic symptoms, persistent negative symptoms, low functioning, lack of insight, and adherence. He had an insufficient response to maximally tolerated doses of antipsychotic monotherapy with haloperidol and risperidone. Moreover, his treatment was complicated due to the low accessibility of long-acting injectable atypical antipsychotics (LAI) in the country and his refusal of the only available atypical LAI paliperidone palmitate and refusal to take clozapine. Due to limited alternatives, the decision to administer combinations of antipsychotics was made. Since his diagnosis, he received several combinations of antipsychotics, i.e., haloperidol + quetiapine, risperidone + quetiapine, haloperidol + olanzapine, risperidone + olanzapine, but without sufficient clinical effectiveness. Although combinations of antipsychotics reduced his positive symptoms to some degree, persistent negative symptoms and extrapyramidal side effects were observed. After initiating cariprazine, which was combined with olanzapine, improvement in the patient's positive symptoms, negative symptoms, and overall functioning was detected. The combination of medications mentioned above facilitated the therapeutic alliance, thus providing control over the symptoms and preventing psychiatric hospitalizations.

Students' mental health during the pandemic: results of the observational cross-sectional COVID-19 MEntal health inTernational for university Students (COMET-S) study.

Introduction: The aim of the study was to search rates of depression and mental health in university students, during the COVID-19 pandemic. Materials and methods: This is an observational cross-sectional study. A protocol gathering sociodemographic variables as well as depression, anxiety and suicidality and conspiracism was assembled, and data were collected anonymously and online from April 2020 through March 2021. The sample included 12,488 subjects from 11 countries, of whom 9,026 were females (72.2%; aged 21.11 ± 2.53), 3,329 males (26.65%; aged 21.61 ± 2.81) and 133 "non-binary gender" (1.06%; aged 21.02 ± 2.98). The analysis included chi-square tests, correlation analysis, ANCOVA, multiple forward stepwise linear regression analysis and Relative Risk ratios. Results: Dysphoria was present in 15.66% and probable depression in 25.81% of the total study sample. More than half reported increase in anxiety and depression and 6.34% in suicidality, while lifestyle changes were significant. The model developed explained 18.4% of the development of depression. Believing in conspiracy theories manifested a complex effect. Close to 25% was believing that the vaccines include a chip and almost 40% suggested that facemask wearing could be a method of socio-political control. Conspiracism was related to current depression but not to history of mental disorders. Discussion: The current study reports that students are at high risk for depression during the COVID-19 pandemic and identified specific risk factors. It also suggested a role of believing in conspiracy theories. Further research is important, as it is targeted intervention in students' groups that are vulnerable both concerning mental health and conspiracism.

Validation of the generalized anxiety disorder scales (GAD-7 and GAD-2) in primary care settings in Latvia.

Background: Anxiety disorders are the most prevalent mental disorders in the world and have an important impact on the global burden of disease. Generalized anxiety disorder (GAD) is the most prevalent anxiety disorder encountered in primary care. There are no available validated anxiety screening tools in primary care in Latvia. We aimed to validate both a seven-item and a two-item generalized anxiety disorder scale (GAD-7 and GAD-2) in the Latvian and Russian languages, to detect generalized anxiety disorder (GAD) in primary care settings in Latvia. Methods: During a 1-week period, all patients aged 18 years or older visiting their GP (general practitioners) with any health concern at 24 primary care settings throughout Latvia were invited to complete the GAD-7 in their native language (Latvian or Russian). Criterion validity was assessed against the Mini International Neuropsychiatric Interview (MINI). Results: The study sample included 1,459 participants who completed the GAD-7 and the MINI. The GAD-7 items showed good internal reliability [Cronbach's alpha 0.87 for Latvian version and 0.85 for Russian version (for Latvia) of the GAD-7]. A cut-off score for detecting GAD of 5 or above was estimated for Latvian version of the GAD-7 (sensitivity 75.4%, specificity 68.9%, respectively) and 7 or above for Russian version of the GAD-7 (sensitivity 73.3%, specificity 84.1%, respectively). The internal reliability of the GAD-2 was lower for both languages (Cronbach's alpha 0.75 for Latvian version and 0.68 for Russian version of the GAD-2). A cut-off score of 2 or above was established for both the Latvian, and Russian versions of the GAD-2 (sensitivity 78.9 and 83.3%; specificity 63.7 and 69.1% for the Latvian and Russian versions of the GAD-2, accordingly) for detecting GAD. Conclusions: This is the first study to report criterion validity of the Latvian and Russian (for Latvia) versions of the GAD-7 and GAD-2, assessed in a nationwide study conducted at the primary care level.

First Episode Psychosis Following COVID-19 Vaccination: a Case Report.

Vaccines are crucial to ending the COVID-19 pandemic. An mRNA-based COVID-19 vaccine can cause mild to moderate side effects. A number of cases of cardiac, gastrointestinal, and psychiatric side effects have been reported as rare side effects associated with the COVID-19 vaccine. This article presents a patient, who after the second injection of the mRNA-based COVID-19 vaccine, immediately developed anxiety, nonspecific fear, and insomnia as the prodromal phase of psychosis. Starting from the second week, the patient manifested delusions of persecution, delusions of influence, thoughts insertion, and delusional behaviour, culminating in the suicide attempt. The duration of psychosis was eight weeks, and symptom reduction was observed only after the gradual administration of antipsychotics over four weeks. The investigations of the patient did not support any structural changes of the brain, any severe medical conditions, a neurological abnormality, a confusion or a state of unconsciousness or alterations in laboratory tests. Psychosis due to the use of alcohol or psychoactive substances was excluded. The psychological assessment of the patient demonstrated the endogenous type of thinking, and the patient had schizoid and paranoid personality traits strongly associated with schizophrenia. This case indicates a strong causal relationship between the mRNA-based COVID-19 vaccine injection and the onset of psychosis. We intend to follow up this case for possible development of schizophrenia and understand that the COVID-19 vaccine could possible play a trigger role in the development of primary psychosis. Longer-term supporting evidence is needed to estimate the prevalence of psychosis following vaccination with the mRNA-based COVID-19 vaccine.

Anxiety Screening among the General Population of Latvia and Associated Factors.

Background and Objectives: The aim of this study was to determine the point prevalence of at least mild anxiety symptoms and symptoms of generalized anxiety disorder in the Latvian general population, and to analyze the associated factors. Materials and Methods: A computer-assisted face-to-face survey was conducted in 2019−2020 with a multistage stratified probability sample of the Latvian general adult population (n = 2687). Anxiety was assessed using the 7-item Generalized Anxiety Disorder (GAD-7) scale; a score of ≥5 was defined as indicating the presence of mild symptoms of anxiety, and a score of ≥10 as the cutoff for identifying cases of generalized anxiety disorder. The Patient Health Questionnaire 9 (PHQ-9) and MINI International Neuropsychiatric Interview (M.I.N.I.) modules were used for assessing comorbid conditions. Multinomial logistic regression was conducted. Results: The point prevalence of mild anxiety symptoms was 10.9%. The point prevalence of generalized anxiety disorder symptoms was 3.9%. Higher odds of mild anxiety symptoms were detected in respondents of a young age (vs. 65 y.o. and older, aOR 3.1, p < 0.001), unmarried respondents (vs. married/cohabiting, aOR 1.5, p = 0.02), those living in the capital city (aOR 1.6, p = 0.008) or rural areas (aOR 1.5, p = 0.03) (vs. other towns), respondents with poor self-rated health (vs. good, aOR 2.6, p < 0.001), and diagnosed alcohol use disorder (aOR 1.9, p < 0.001), suicidal behavior (aOR 2.4, p < 0.001), and symptoms of depression (aOR 6.4, p < 0.001) (vs. no such conditions). As for symptoms of generalized anxiety disorder, female sex (vs. males, aOR 2.5, p = 0.003), age below 44 years (vs. 65+, aOR 6.2, p = 0.002), average self-rated health (vs. good, aOR 2.6, p = 0.005), and poor self-rated health (vs. good, aOR 5.3, p < 0.001), together with comorbid suicidal behavior (aOR 6.1, p < 0.001) and symptoms of depression (aOR 43.4, p < 0.001) (vs. no such conditions), increased the odds. Conclusions: Young age, poor self-rated health, and comorbid symptoms of depression and suicidal behavior were significant factors associated with symptoms of both mild anxiety and generalized anxiety disorder. Being unmarried, living in the capital city or rural areas, and alcohol use disorder were associated with mild anxiety symptoms alone. Female sex was associated with generalized anxiety disorder symptoms alone.

Determinants of Anxiety in the General Latvian Population During the COVID-19 State of Emergency.

Background: The COVID-19 pandemic and its restrictive public health measures have seriously affected mental health of society. Social, psychological, and health-related factors have been linked to anxiety in the general population. Aim: We investigate the association of various sociopsychological and health-related determinants of anxiety and identify the predicting factors for anxiety in the general population during the COVID-19 state of emergency from in Latvia. Methods: We conducted an online survey using a randomized stratified sample of the general adult population in July 2020 for 3 weeks. Anxiety symptoms were measured using the State-Trait Anxiety Inventory (STAI-S). Sociodemographic, health-related, sociopsychological characteristics and suicidality were identified using the structured questionnaire. The statistical analysis included Pearson's chi-square test, post hoc analysis, and binomial logistic regression. Results: The weighted study sample included 2,608 participants. The mean STAY-S score of the total sample was 22.88 ± 12.25. In the total sample, 15.2% (n = 398) of participants were classified as having anxiety. The odds ratio (OR) of having anxiety was higher in females (OR = 2.44; 95% CI 1.75-3.33) and people who had experienced mental health problems in the past (OR = 1.45; 95% CI 1.03-2.04), had suicide attempt in the past (OR = 1.68; 95% CI 1.08-2.59), were worried about their health status due to COVID-19 (OR = 1.64; 95% CI 1.36-1.16), were worried about stigmatization from others if infected with COVID-19 (OR = 1.18; 95% CI 1.03-1.35), were worried about information regarding COVID-19 from the Internet (OR = 1.24; 95% CI 1.08-1.43), persons who were lonely (OR = 1.90; 95% CI 1.54-2.34), and persons with negative problem orientation (OR = 1.26; 95% CI 1.06-1.51). Protective factors were identified as having good self-rated general health (OR = 0.68, 95 % CI 0.58-0.81), maintaining a daily routine (OR = 0.74, 95 % CI 0.61-0.90), having financial stability (OR = 0.66, 95 % CI 0.55-0.79), and having good psychological resilience (OR = 0.90, 95 % CI 0.87-0.94). Conclusions: This is the first study to report a prevalence of anxiety in the general population of Latvia. Certain factors that predict anxiety, as well as protective factors were identified.

Characterisation of a conspiracy believers and their mental health during the COVID-19 emergency state in Latvia.

BACKGROUND: A wave of believers in conspiracies has emerged amid the COVID-19 crisis. The purpose of this study was to characterise an individual who believes in conspiracies and to discover whether believing in them is associated with mental health. METHODS: Data was collected as an online survey in a randomised, stratified cohort in July 2020 as a part of the National Research Program of Latvia. The precisely selected and segmented database corresponding to the general population of Latvia was used. Non-parametric tests to compare medians and Spearman correlation to measure the strength of the relationship were applied. RESULTS: The weighted study sample consisted of 2608 participants. A positive correlation was detected between age and belief in conspiracies among females (r = 0.061; p = 0.017). Median conspiracy theory points were significant as follows: individuals who have primary or high school education (p < 0.001) rather than higher education; females (p < 0.001) who resided in a town (p < 0.001) as opposed to occupying the capital; divorcees (p = 0.022) in contrast with those being in a relationship; along with those being unemployed (p < 0.001) compared to the employed, or students. Depressed respondents more often than healthy individuals believed that COVID-19 was created in a laboratory (p < 0.05), that this virus is a result of a 5G antenna (p < 0.05) and that it is a sign of divine power to destroy our planet (p = 0.001). CONCLUSION: The important messages conveyed to the public should be reviewed so that they are more relatable and comprehensible. Furthermore, additional attention should be paid to critical thinking in education programs.

Factors Related to COVID-19 Preventive Behaviors: A Structural Equation Model.

Background: While COVID-19 has rapidly spread around the world, and vaccines are not widely available to the general population, the World Health Organization outlines preventive behavior as the most effective way to limit the rapid spread of the virus. Preventive behavior is associated with a number of factors that both encourage and discourage prevention. Aim: The aim of this research was to study COVID-19 threat appraisal, fear of COVID-19, trust in COVID-19 information sources, COVID-19 conspiracy beliefs and the relationship of socio-demographic variables (gender, age, level of education, place of residence, and employment status) to COVID-19 preventive behavior. Methods: The data originate from a national cross-sectional online survey (N = 2,608) undertaken in July 2020. The data were analyzed using structural equation modeling. Results: COVID-19 threat appraisal, trust in COVID-19 information sources, and fear of COVID-19 are all significant predictors of COVID-19 preventive behaviors. Together they explain 26.7% of the variance of this variable. COVID-19 conspiracy beliefs significantly negatively predict COVID-19 threat appraisal (R 2 = 0.206) and trust in COVID-19 information sources (R 2 = 0.190). COVID-19 threat appraisal contributes significantly and directly to the explanation of the fear of COVID-19 (R 2 = 0.134). Directly, as well as mediated by COVID-19 conspiracy beliefs, threat appraisal predicts trust in COVID-19 information sources (R 2 = 0.190). The relationship between COVID-19 threat appraisal and COVID-19 preventive behaviors is partially mediated by fear of COVID-19 (indirect effect 28.6%) and trust in information sources (15.8%). Socio-demographic variables add very little in prediction of COVID-19 preventive behavior. Conclusions: The study results demonstrate that COVID-19 threat appraisal is the most important factor associated with COVID-19 preventive behavior. Those Latvian residents with higher COVID-19 threat appraisal, experienced higher levels of fear of COVID-19, had more trust in COVID-19 information sources, and were more actively involved in following COVID-19 preventive behaviors. COVID-19 conspiracy beliefs negatively predict COVID-19 threat appraisal and trust in COVID-19 information sources, but not the COVID-19 preventive behaviors. Socio-demographic factors do not play an important role here.

Factors related to depression, distress, and self-reported changes in anxiety, depression, and suicidal thoughts during the COVID-19 state of emergency in Latvia.

PURPOSE: Evidence suggests that the 2020 COVID-19 pandemic might have deleterious effects on the population's mental health and psychiatric outcomes. We examined the prevalence of depression, distress, and suicidal thoughts and their association with social and economic factors during the state of emergency in a nationwide representative sample of the general population in Latvia. MATERIALS AND METHOD: An online survey was conducted using a randomized stratified sample of the general adult population in July 2020 for 3 weeks. Distress, depression, suicidal thoughts, and self-reported changes in mental health were identified using a structured questionnaire. The statistical analysis included chi-square tests, analyses of variance, and multivariate forward-stepwise linear regressions. RESULTS: The study sample included 2608 respondents. Clinical depression was present in 5.75% and distress in 7.82%. Suicidal thoughts increased in 13.30% of those with a history of clinical depression, and 27.05% of those with a history of suicidal attempts. The variables that were associated with increases in self-reported anxiety, depressive thoughts, suicidal ideation, and being currently depressed/distressed included lower general health, increased fears of contracting COVID-19 or having family members contract it and die, history of suicidality, increased family conflicts, decreased religiosity, caring for a vulnerable person. Protective factors included positive changes in family relationships and economic situation, maintaining one's basic routine, and having more people living in the household. CONCLUSIONS: Further research and interventions should focus specifically on these factors. The study's findings can help to develop future strategies for management of psychological support for different groups in general population.

Safety and Tolerability of the Anxiolytic and Nootropic Drug Phenibut: A Systematic Review of Clinical Trials and Case Reports.

Phenibut is a nootropic drug that exerts anxiolytic and antinociceptive effects by acting on the GABAB receptor and the α2-δ subunit of voltage-dependent calcium channels. An increased number of reports of dependence to and intoxication by phenibut purchased online on the one hand and the wide prescription of phenibut in Eastern Europe for more than half a century on the other hand have resulted in a number of controversies regarding its use. In this review, we have summarized currently available information from case reports of phenibut dependence and intoxication and safety data from clinical trials. We included 14 dependence and intoxication case reports (16 patients) and reviewed 11 phenibut clinical trials (583 patients). The clinical symptoms in the case reports included cardiovascular effects, insomnia, anxiety and agitation, hallucinations, and depressed level of consciousness. In addition, the doses used (0.5-100 g/day) were much higher than the recommended daily dose (0.25-2 g/day). An analysis of phenibut side effects described in the clinical trials showed adverse events in only 5.66% of patients, and the most reported side effect was somnolence (1.89%). There are discrepancies in the reported side effects of phenibut in clinical trials compared to those reported in cases of online-purchased phenibut dependence and intoxication. The current systematic review provides evidence that, at therapeutic doses, phenibut is safe and well tolerated with minor adverse effects, but questions regarding the quality of phenibut obtained online and the contribution of alcohol and other drug abuse to phenibut dependence and intoxication remain open.

Prevalence of major depression and associated correlates in Latvian primary care population: results from the National Research Program BIOMEDICINE 2014-2017.

Purpose and aim. In Latvia, the 12-month prevalence of depression in the general population has been estimated at 7.9%, but the data of the National Health Service show that general practitioners (GP's) saw only 3514 unique patients with a diagnosis of mood disorders in 2014. This is the first study conducted at the national level that was aimed to estimate the point and lifetime prevalence of depression and associated factors in primary care settings in Latvia.Materials and methods. This study was conducted at 24 primary care facilities in 2015. During a 1-week period, all consecutive adult patients were invited to complete the study questionnaires. Within a period of 2 weeks, the respondents were interviewed over the phone using the Mini International Neuropsychiatric Interview (M.I.N.I.), Version 6.0.0. A hierarchical multivariate data analysis was performed.Results. The study population consisted of 1485 patients. According to the M.I.N.I., 28.1% (95% CI 25.9-30.4) of the patients had at least one depressive episode in the past, and 10.2% (95% CI 8.7-11.8) had current depression. In the final multivariate analysis model, current major depression was associated with the female gender (OR 2.01), basic or unfinished basic education (OR 1.86), loss of marital ties (OR 1.86), and gastrointestinal (OR 3.46) and oncological (OR 2.26) diseases as a reason for visiting the GP.Conclusions. The prevalence of major depression in primary care is consistent with that in other European countries but is significantly underdiagnosed. Enhanced training in Latvian primary care settings may improve clinical outcomes.

Validity of the PHQ-9 and PHQ-2 to screen for depression in nationwide primary care population in Latvia.

BACKGROUND: Depression is highly underdiagnosed in primary care settings in Latvia. Screening for depression in primary care is potentially an efficient way to find undetected case s and improve diagnostics. We aimed to validate both a nine-item and two-item Patient Health Questionnaire (PHQ-9 and PHQ-2) in the Latvian and Russian languages in primary care settings using a representative sample in Latvia. MATERIALS AND METHODS: The study was carried out within the framework of the National Research Program BIOMEDICINE to assess the prevalence of mental disorders at 24 primary care facilities. During a 1-week period, all consecutive adult patients were invited to complete the PHQ-9 and PHQ-2. Criterion validity was assessed against the Mini International Neuropsychiatric Interview (MINI). RESULTS: There were 1467 patients who completed the PHQ-9 and the MINI. Overall, the PHQ-9 items showed good internal reliability (Cronbach's alpha 0.81 for Latvian version and 0.79 for Russian version of the PHQ-9). A cut-off score of 8 or greater was established for the PHQ-9 (sensitivity 0.75 and 0.79, specificity 0.84 and 0.80 for Latvian and Russian languages, respectively). For the PHQ-2, a score of 2 or higher (sensitivity 0.79 and 0.79, specificity 0.65 and 0.67 for Latvian and Russian languages) detected more cases of depression than a score of 3 or higher. CONCLUSIONS: We suggest GPs ask patients to respond to the first 2 questions of the PHQ-9. If their score is positive, the patients should then complete the PHQ-9.

Association of Depression and Anxiety With the 10-Year Risk of Cardiovascular Mortality in a Primary Care Population of Latvia Using the SCORE System.

Background: Depression and anxiety have been recognized as independent risk factors for both the development and prognosis of cardiovascular (CV) diseases (CVD). The Systematic Coronary Risk Evaluation (SCORE) function measures the 10-year risk of a fatal CVD and is a crucial tool for guiding CV patient management. This study is the first in Latvia to investigate the association of depression and anxiety with the 10-year CV mortality risk in a primary care population. Methods: This cross-sectional study was conducted at 24 primary care facilities. During a 1-week period in 2015, all consecutive adult patients were invited to complete a nine-item Patient Health Questionnaire (PHQ-9) and a seven-item Generalized Anxiety Disorder scale (GAD-7) followed by sociodemographic questionnaire and physical measurements. The diagnostic Mini International Neuropsychiatric Interview (M.I.N.I.) was administered by telephone in the period of 2 weeks after the first contact at the primary care facility. A hierarchical multivariate analysis was performed. Results: The study population consisted of 1,569 subjects. Depressive symptoms (PHQ-9 ≥10) were associated with a 1.57 (95% confidence interval (CI): 1.06-2.33) times higher odds of a very high CV mortality risk (SCORE ≥10%), but current anxiety disorder (M.I.N.I.) reduced the CV mortality risk with an odds ratio of 0.58 (95% CI: 0.38-0.90). Conclusions: Our findings suggest that individuals with SCORE ≥10% should be screened and treated for depression to potentially delay the development and improve the prognosis of CVD. Anxiety could possibly have a protective influence on CV prognosis.

Prevalence and treatment of panic disorder in bipolar disorder: systematic review and meta-analysis.

QUESTION: Recent data suggest that anxiety disorders are as often comorbid with bipolar disorder (BD) as with unipolar depression. The literature on panic disorder (PD) comorbid with BD has been systematically reviewed and subject to meta-analysis. STUDY SELECTION AND ANALYSIS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were thoroughly followed for literature search, selection and reporting of available evidence. The variance-stabilising Freeman-Tukey double arcsine transformation was used in the meta-analysis of prevalence estimates. Both fixed-effect and random-effects models with inverse variance method were applied to estimate summary effects for all combined studies. Heterogeneity was assessed and measured with Cochran's Q and I2 statistics. FINDINGS: Overall, 15 studies (n=3391) on cross-sectional prevalence and 25 independent lifetime studies (n=8226) were used to calculate pooled estimates. The overall random-effects point prevalence of PD in patients with BD, after exclusion of one potential outlier study, was 13.0% (95% CI 7.0% to 20.3%), and the overall random-effects lifetime estimate, after exclusion of one potential outlier study, was 15.5% (95% CI 11.6% to 19.9%). There were no differences in rates between BD-I and BD-II. Significant heterogeneity (I2 >95%) was found in both estimates. CONCLUSIONS: Estimates that can be drawn from published studies indicate that the prevalence of PD in patients with BD is higher than the prevalence in the general population. Comorbid PD is reportedly associated with increased risk of suicidal acts and a more severe course. There is no clear indication on how to treat comorbid PD in BD. Findings from the current meta-analysis confirm the highly prevalent comorbidity of PD with BD, implicating that in patients with BD, PD might run a more chronic course.

Adaptation and validation of the Patient Health Questionnaire-9 to evaluate major depression in a primary care sample in Latvia.

BACKGROUND: Depression is one of the most common mental disorders in primary care settings and is often underdiagnosed and undertreated by general practitioners (GPs). To date, no depression screening instruments have been validated for use in primary care settings in Latvia. The aim of this study was to establish the validity and cutoff score of the Patient Health Questionnaire-9 (PHQ-9) among primary care patients in Latvia. MATERIALS AND METHODS: During a one-week period, all consecutive patients aged 18 years or older visiting their GP of health concerns at 6 primary care settings were invited to complete the PHQ-9 questionnaire in their native language (Latvian or Russian). Criterion validity was assessed against the Mini International Neuropsychiatric Interview (M.I.N.I.), which was conducted over the telephone by a psychiatrist less than 2 weeks after a primary care physician visit. RESULTS: In total, 324 patients were evaluated using the PHQ-9, 272 of whom agreed to be interviewed with the M.I.N.I. Overall, the PHQ-9 items showed good internal (Cronbach's alpha 0.84) reliability. A cutoff score of 10 was established for the PHQ-9 (sensitivity 86.49%, specificity 89.36%), correctly classifying 86.4% of patients with current depression. CONCLUSIONS: The PHQ-9 appears to be a reliable and valid instrument that can be used to diagnose major depression among Latvian and Russian speaking adults at the primary care level.

A blind spot on the global mental health map: a scoping review of 25 years' development of mental health care for people with severe mental illnesses in central and eastern Europe.

Just over 25 years have passed since the major sociopolitical changes in central and eastern Europe; our aim was to map and analyse the development of mental health-care practice for people with severe mental illnesses in this region since then. A scoping review was complemented by an expert survey in 24 countries. Mental health-care practice in the region differs greatly across as well as within individual countries. National policies often exist but reforms remain mostly in the realm of aspiration. Services are predominantly based in psychiatric hospitals. Decision making on resource allocation is not transparent, and full economic evaluations of complex interventions and rigorous epidemiological studies are lacking. Stigma seems to be higher than in other European countries, but consideration of human rights and user involvement are increasing. The region has seen respectable development, which happened because of grassroots initiatives supported by international organisations, rather than by systematic implementation of government policies.

Latvian family physicians' experience diagnosing depression in somatically presenting depression patients: A qualitative study.

BACKGROUND: Depression continues to be under-diagnosed in primary care settings. One factor that influences physicians' likelihood of diagnosing depression is patients' presentation style. Patients who initially present with somatic symptoms are diagnosed at a lower rate and with greater delay than patients who present with psychosocial complaints. OBJECTIVES: To identify the barriers preventing depression diagnosis in somatically presenting patients in an Eastern European primary care setting. METHODS: Thematic analysis of semi-structured interviews with 16 family physicians (FPs) in Latvia. FPs were sampled using a maximum variation strategy, varying on patient load, urban/rural setting, FP gender, presence/absence of on-site mental health specialists, and FP years of practice. RESULTS: FPs observed that a large subgroup of depression patients presented with solely somatic complaints. FPs often did not recognize depression in somatically presenting patients until several consultations had passed without resolution of the somatic complaint. When FPs had psychosocial information about the somatically presenting patient, they recognized depression more quickly. Use of depression screening questionnaires was rare. Barriers to diagnosis continued beyond recognition. Faced with equivocal symptoms that undermined clinical certainty, FPs postponed investigating their clinical suspicion that the patient had depression and pursued physical examinations that delayed depression diagnosis. FPs also used negative physical examination results to convince reluctant patients of a depression diagnosis. CONCLUSION: Delayed recognition, the need to rule out physical illness, and the use of negative physical examination results to discuss depression with patients all slowed the path to depression diagnosis for somatically presenting patients in Latvian primary care.