Patterns, predictors, and patient-reported reasons for antidepressant discontinuation in the WHO World Mental Health Surveys.

BACKGROUND: Despite their documented efficacy, substantial proportions of patients discontinue antidepressant medication (ADM) without a doctor's recommendation. The current report integrates data on patient-reported reasons into an investigation of patterns and predictors of ADM discontinuation. METHODS: Face-to-face interviews with community samples from 13 countries (n = 30 697) in the World Mental Health (WMH) Surveys included n = 1890 respondents who used ADMs within the past 12 months. RESULTS: 10.9% of 12-month ADM users reported discontinuation-based on recommendation of the prescriber while 15.7% discontinued in the absence of prescriber recommendation. The main patient-reported reason for discontinuation was feeling better (46.6%), which was reported by a higher proportion of patients who discontinued within the first 2 weeks of treatment than later. Perceived ineffectiveness (18.5%), predisposing factors (e.g. fear of dependence) (20.0%), and enabling factors (e.g. inability to afford treatment cost) (5.0%) were much less commonly reported reasons. Discontinuation in the absence of prescriber recommendation was associated with low country income level, being employed, and having above average personal income. Age, prior history of psychotropic medication use, and being prescribed treatment from a psychiatrist rather than from a general medical practitioner, in comparison, were associated with a lower probability of this type of discontinuation. However, these predictors varied substantially depending on patient-reported reasons for discontinuation. CONCLUSION: Dropping out early is not necessarily negative with almost half of individuals noting they felt better. The study underscores the diverse reasons given for dropping out and the need to evaluate how and whether dropping out influences short- or long-term functioning.

Is There an Association between Post-Traumatic Stress Disorder and the Incidence of Chronic Low Back Pain?

BACKGROUND: Preliminary research suggests post-traumatic stress disorder (PTSD) is a risk factor for chronic low back pain (CLBP). However, this literature displays some limitations. Therefore, this study aimed to investigate the association between PTSD and the 10-year cumulative incidence of CLBP in adults from Germany. METHODS: The present retrospective cohort study included adults diagnosed with PTSD in 1 of 1284 general practices in Germany in 2005-2020 (index date). Individuals without PTSD were matched to those with PTSD (1:1) using a propensity score based on age, sex, index year, duration of follow-up, and the mean number of consultations during follow-up. In patients without PTSD, the index date was a randomly selected visit date. RESULTS: There were 60,664 patients included in the study. After adjusting for frequent comorbidities, there was a positive but non-significant association between PTSD and incident CLBP in the overall population (HR = 1.07, 95% CI = 0.99-1.15). Nonetheless, the relationship between PTSD and CLBP was statistically significant in the age group >60 years (HR = 1.24, 95% CI = 1.05-1.46). CONCLUSIONS: Conversely to previous research, PTSD was not associated with incident CLBP in this large German sample. Further longitudinal studies are warranted to corroborate these findings before drawing any firm conclusions.

Multilingual markers of depression in remotely collected speech samples: A preliminary analysis.

BACKGROUND: Speech contains neuromuscular, physiological and cognitive components, and so is a potential biomarker of mental disorders. Previous studies indicate that speaking rate and pausing are associated with major depressive disorder (MDD). However, results are inconclusive as many studies are small and underpowered and do not include clinical samples. These studies have also been unilingual and use speech collected in controlled settings. If speech markers are to help understand the onset and progress of MDD, we need to uncover markers that are robust to language and establish the strength of associations in real-world data. METHODS: We collected speech data in 585 participants with a history of MDD in the United Kingdom, Spain, and Netherlands as part of the RADAR-MDD study. Participants recorded their speech via smartphones every two weeks for 18 months. Linear mixed models were used to estimate the strength of specific markers of depression from a set of 28 speech features. RESULTS: Increased depressive symptoms were associated with speech rate, articulation rate and intensity of speech elicited from a scripted task. These features had consistently stronger effect sizes than pauses. LIMITATIONS: Our findings are derived at the cohort level so may have limited impact on identifying intra-individual speech changes associated with changes in symptom severity. The analysis of features averaged over the entire recording may have underestimated the importance of some features. CONCLUSIONS: Participants with more severe depressive symptoms spoke more slowly and quietly. Our findings are from a real-world, multilingual, clinical dataset so represent a step-change in the usefulness of speech as a digital phenotype of MDD.

Association between carpal tunnel syndrome and the five-year incidence of anxiety disorder and depression in adults followed in general practices in Germany.

OBJECTIVE: Little is known about the longitudinal relationship between carpal tunnel syndrome (CTS) and mental health. Therefore, this retrospective cohort study investigated the association between CTS and the five-year incidence of anxiety disorder and depression in adults from Germany. METHODS: Data from the Disease Analyzer database (IQVIA) were used for the present study. Patients aged ≥18 years diagnosed for the first time with CTS in one of 1284 general practices in Germany in 2005-2020 were included (index date). Individuals without CTS were matched to those with CTS using a propensity score based on age, sex, the mean number of consultations per year during the follow-up, and the index year. In people without CTS, the index date was a randomly selected consultation in 2005-2020. RESULTS: There were 75,135 patients with and 75,135 patients without CTS included in the study (mean [SD] age 57.2 [16.5] years; 59.7% women). Within five years of the index date, the incidence of anxiety disorder was 3.9% and 3.6% in the group with and the group without CTS, respectively (log-rank p-value<0.001), while figures for depression were 14.8% and 11.5% (log-rank p-value<0.001). These findings were corroborated in the Cox regression analyses adjusted for multiple physical conditions, as CTS was associated with anxiety disorder (HR = 1.14, 95% CI = 1.08-1.21) and depression (HR = 1.29, 95% CI = 1.25-1.33) in the overall sample. CONCLUSION: CTS was associated with an increased incidence of anxiety disorder and depression in Germany. Further research should identify the mediators involved in these relationships.

Challenges in Using mHealth Data From Smartphones and Wearable Devices to Predict Depression Symptom Severity: Retrospective Analysis.

BACKGROUND: Major depressive disorder (MDD) affects millions of people worldwide, but timely treatment is not often received owing in part to inaccurate subjective recall and variability in the symptom course. Objective and frequent MDD monitoring can improve subjective recall and help to guide treatment selection. Attempts have been made, with varying degrees of success, to explore the relationship between the measures of depression and passive digital phenotypes (features) extracted from smartphones and wearables devices to remotely and continuously monitor changes in symptomatology. However, a number of challenges exist for the analysis of these data. These include maintaining participant engagement over extended time periods and therefore understanding what constitutes an acceptable threshold of missing data; distinguishing between the cross-sectional and longitudinal relationships for different features to determine their utility in tracking within-individual longitudinal variation or screening individuals at high risk; and understanding the heterogeneity with which depression manifests itself in behavioral patterns quantified by the passive features. OBJECTIVE: We aimed to address these 3 challenges to inform future work in stratified analyses. METHODS: Using smartphone and wearable data collected from 479 participants with MDD, we extracted 21 features capturing mobility, sleep, and smartphone use. We investigated the impact of the number of days of available data on feature quality using the intraclass correlation coefficient and Bland-Altman analysis. We then examined the nature of the correlation between the 8-item Patient Health Questionnaire (PHQ-8) depression scale (measured every 14 days) and the features using the individual-mean correlation, repeated measures correlation, and linear mixed effects model. Furthermore, we stratified the participants based on their behavioral difference, quantified by the features, between periods of high (depression) and low (no depression) PHQ-8 scores using the Gaussian mixture model. RESULTS: We demonstrated that at least 8 (range 2-12) days were needed for reliable calculation of most of the features in the 14-day time window. We observed that features such as sleep onset time correlated better with PHQ-8 scores cross-sectionally than longitudinally, whereas features such as wakefulness after sleep onset correlated well with PHQ-8 longitudinally but worse cross-sectionally. Finally, we found that participants could be separated into 3 distinct clusters according to their behavioral difference between periods of depression and periods of no depression. CONCLUSIONS: This work contributes to our understanding of how these mobile health-derived features are associated with depression symptom severity to inform future work in stratified analyses.

Sex differences in the symptom network structure of depression: Findings from a nationwide sample of the Spanish adult population.

BACKGROUND: Sex differences in the prevalence and clinical features of depression have been widely described. However, some authors argue that categorical diagnostic systems do not adequately capture the complexity of depression. The aim of this study was to examine sex differences in the symptom network structure of depressive symptoms among individuals with a major depressive episode. METHODS: The study sample consisted of 510 participants (age 62.17 ± 14.43, 71.96 % women) from a nationwide study of the Spanish non-institutionalised adult population (Edad con Salud). To estimate the presence of a 12-month major depressive episode according to DSM-IV criteria, participants were administered an adapted version of the Composite International Diagnostic Interview (CIDI 3.0). A network analysis was carried out to determine possible interrelationships between different depressive symptoms by sex. RESULTS: Men and women showed a similar overall structure and network strength. However, sex-specific variations emerged in relation to individual symptom associations and symptom centrality. Specifically, for individual symptom associations "loss of confidence" and "suicide attempts" were more strongly related in women, and "suicidal ideation" and "impaired thinking" in men. For symptom centrality, "anxiety" played a central role in men's symptomatology, whereas "hopelessness", "loss of confidence", "distress" and "slowness of movement" were the most central symptoms in the women's group. LIMITATIONS: Reliance on cross-sectional data precludes us from determining the direction and temporality of the association between different symptoms. CONCLUSIONS: This study suggests that specific symptoms should be prioritised in the prevention, diagnosis assessment and treatment of depressed patients based on sex.

Age of onset and cumulative risk of mental disorders: a cross-national analysis of population surveys from 29 countries.

BACKGROUND: Information on the frequency and timing of mental disorder onsets across the lifespan is of fundamental importance for public health planning. Broad, cross-national estimates of this information from coordinated general population surveys were last updated in 2007. We aimed to provide updated and improved estimates of age-of-onset distributions, lifetime prevalence, and morbid risk. METHODS: In this cross-national analysis, we analysed data from respondents aged 18 years or older to the World Mental Health surveys, a coordinated series of cross-sectional, face-to-face community epidemiological surveys administered between 2001 and 2022. In the surveys, the WHO Composite International Diagnostic Interview, a fully structured psychiatric diagnostic interview, was used to assess age of onset, lifetime prevalence, and morbid risk of 13 DSM-IV mental disorders until age 75 years across surveys by sex. We did not assess ethnicity. The surveys were geographically clustered and weighted to adjust for selection probability, and standard errors of incidence rates and cumulative incidence curves were calculated using the jackknife repeated replications simulation method, taking weighting and geographical clustering of data into account. FINDINGS: We included 156 331 respondents from 32 surveys in 29 countries, including 12 low-income and middle-income countries and 17 high-income countries, and including 85 308 (54·5%) female respondents and 71 023 (45·4%) male respondents. The lifetime prevalence of any mental disorder was 28·6% (95% CI 27·9-29·2) for male respondents and 29·8% (29·2-30·3) for female respondents. Morbid risk of any mental disorder by age 75 years was 46·4% (44·9-47·8) for male respondents and 53·1% (51·9-54·3) for female respondents. Conditional probabilities of first onset peaked at approximately age 15 years, with a median age of onset of 19 years (IQR 14-32) for male respondents and 20 years (12-36) for female respondents. The two most prevalent disorders were alcohol use disorder and major depressive disorder for male respondents and major depressive disorder and specific phobia for female respondents. INTERPRETATION: By age 75 years, approximately half the population can expect to develop one or more of the 13 mental disorders considered in this Article. These disorders typically first emerge in childhood, adolescence, or young adulthood. Services should have the capacity to detect and treat common mental disorders promptly and to optimise care that suits people at these crucial parts of the life course. FUNDING: None.

Loneliness during the last phase of the COVID-19 pandemic in Spain: A longitudinal study of group-based trajectories, risk factors, and consequences in mental health.

INTRODUCTION: The present study aims to investigate the courses of loneliness following a national state of emergency including a curfew due to a rise in COVID-19 cases, associated risk factors, and the effect of loneliness on symptoms of depression and anxiety. METHODS: Data of 2,000 adults in Spain which were interviewed by telephone at the first follow-up of the MINDCOVID project (February-March 2021) and of whom 953 were interviewed nine months later (November-December 2021) were analyzed. Group-based trajectories and mixed models were constructed. RESULTS: Three courses of loneliness were detected: (1) invariant low loneliness (42.6%), (2) decreasing medium loneliness (51.5%), and (3) fairly invariant high loneliness (5.9%). Loneliness courses were associated with the severity and variability of symptoms of depression and anxiety. In contrast to the majority of pre-pandemic studies, younger adults more frequently reported loneliness compared to middle-aged and, particularly, older individuals. Other risk factors for loneliness were being female, being unmarried, and, notably, having pre-pandemic mental disorders. CONCLUSIONS: Future studies should validate whether the newly observed loneliness patterns across age groups persist and assess the evolution of loneliness courses and their impact on mental health, with particular attention given to young adults and individuals with pre-existing mental disorders.

The Mediating Role of General and Cognitive Stress on the Effect of an App-Based Intervention on Productivity Measures in Workers: Randomized Controlled Trial.

BACKGROUND: Loss of productivity is a result of absence from work (absenteeism) or of working with limitations due to illness (presenteeism). Recently, occupational mental health interventions have increasingly been delivered in digital format, as this is thought to be more convenient, flexible, easily accessible, and anonymous. However, the effectiveness of electronic mental health (e-mental health) interventions in the workplace to improve presenteeism and absenteeism remains unknown, and could be potentially mediated by psychological variables such as stress levels. OBJECTIVE: The aim of this study was to determine the effectiveness of an e-mental health intervention to reduce absenteeism and presenteeism in employees, as well as to investigate the mediating role of stress in this effect. METHODS: Employees of six companies in two countries participated in a randomized controlled trial (n=210 in the intervention group and n=322 in the waitlist control group). Participants in the intervention group could use the Kelaa Mental Resilience app for 4 weeks. All participants were asked to complete assessments at baseline, during the intervention, postintervention, and at a 2-week follow-up. Absenteeism and presenteeism were assessed by means of the Work Productivity and Activity Impairment Questionnaire: General Health, while general and cognitive stress were assessed through the Copenhagen Psychosocial Questionnaire-Revised Version. Regression and mediation analyses were performed to evaluate the effect of the Kelaa Mental Resilience app on presenteeism and absenteeism. RESULTS: The intervention did not have a direct effect on presenteeism or absenteeism, neither at postintervention nor at follow-up. Nevertheless, general stress significantly mediated the intervention effect on presenteeism (P=.005) but not on absenteeism (P=.92), and cognitive stress mediated the effect of the intervention on both presenteeism (P<.001) and absenteeism (P=.02) right after the intervention. At the 2-week follow-up, the mediating effect of cognitive stress on presenteeism was significant (P=.04), although this was not the case for its mediating effect on absenteeism (P=.36). Additionally, at the 2-week follow-up, general stress did not mediate the intervention effect on presenteeism (P=.25) or on absenteeism (P=.72). CONCLUSIONS: While no direct effect of the e-mental health intervention on productivity was found in this study, our findings suggest that stress reduction could mediate the effect of the intervention on presenteeism and absenteeism. As such, e-mental health interventions that address stress in employees might also indirectly reduce presenteeism and absenteeism in these employees. However, due to study limitations such as an overrepresentation of female participants in the sample and a high proportion of attrition, these results should be interpreted with caution. Future research is needed to better understand the mechanisms of interventions on productivity in the workplace. TRIAL REGISTRATION: ClinicalTrials.gov NCT05924542; https://clinicaltrials.gov/study/NCT05924542.

Social inequalities in mental and physical health derived from the COVID-19 pandemic in Spain beyond SARS-CoV-2 infection.

BACKGROUND: Understanding the impact of the COVID-19 crisis on health involves conducting longitudinal studies to evaluate the inequalities that may have been exacerbated by the pandemic. The purpose of this study was to estimate differences in physical and mental health derived from the COVID-19 pandemic, beyond SARS-CoV-2 infection, in the Spanish general population according to the participants' level of education; and to assess the evolution of these differences from June 2020 (just after the lockdown) to nine months later (February-March 2021). METHODS: This is a longitudinal prospective study of a representative sample of non-institutionalized Spanish adults, through computer-assisted telephone interviews. Mobility, self-care, usual activities, pain/discomfort and anxiety/depression problems were measured with EQ-5D-5L. Prevalence ratio (PR) between high and low education levels and adjusted PR were estimated by Poisson regression models. Analyses were stratified by gender. RESULTS: A total of 2,000 participants answered both surveys. Individuals with low level of education reported more health problems in both genders, and absolute inequalities remained quite constant (mobility and self-care problems) or decreased (pain/discomfort and anxiety/depression problems). The greatest relative inequalities were observed just after the lockdown, with age-adjusted PR ranging from 1.31 (95%CI 1.08-1.59) for women and 1.34 (95%CI 1.05-1.69) for men in pain/discomfort to 2.59 (95%CI 0.98-6.81) for women and 4.03 (95%CI 1.52-10.70) for men in self-care; aPR decreased after nine months for most dimensions. CONCLUSIONS: Prevalence of health problems increased during the COVID-19 pandemic in all education groups, but the increase was higher in women and men with a high level of education, suggesting that its impact appeared later in this group. Further analysis on the role of governmental economic aid given to vulnerable people might shed light on this evolution.

Effectiveness of a mental health stepped-care programme for healthcare workers with psychological distress in crisis settings: a multicentre randomised controlled trial.

BACKGROUND: Evidence-based mental health interventions to support healthcare workers (HCWs) in crisis settings are scarce. OBJECTIVE: To evaluate the capacity of a mental health intervention in reducing anxiety and depression symptoms in HCWs, relative to enhanced care as usual (eCAU), amidst the COVID-19 pandemic. METHODS: We conducted an analyst-blind, parallel, multicentre, randomised controlled trial. We recruited HCWs with psychological distress from Madrid and Catalonia (Spain). The intervention arm received a stepped-care programme consisting of two WHO-developed interventions adapted for HCWs: Doing What Matters in Times of Stress (DWM) and Problem Management Plus (PM+). Each intervention lasted 5 weeks and was delivered remotely by non-specialist mental health providers. HCWs reporting psychological distress after DWM completion were invited to continue to PM+. The primary endpoint was self-reported anxiety/depression symptoms (Patient Health Questionnaire-Anxiety and Depression Scale) at week 21. FINDINGS: Between 3 November 2021 and 31 March 2022, 115 participants were randomised to stepped care and 117 to eCAU (86% women, mean age 37.5). The intervention showed a greater decrease in anxiety/depression symptoms compared with eCAU at the primary endpoint (baseline-adjusted difference 4.4, 95% CI 2.1 to 6.7; standardised effect size 0.8, 95% CI 0.4 to 1.2). No serious adverse events occurred. CONCLUSIONS: Brief stepped-care psychological interventions reduce anxiety and depression during a period of stress among HCWs. CLINICAL IMPLICATIONS: Our results can inform policies and actions to protect the mental health of HCWs during major health crises and are potentially rapidly replicable in other settings where workers are affected by global emergencies. TRIAL REGISTRATION NUMBER: NCT04980326.

Temporal Trends in Bullying Victimization Among Adolescents Aged 12-15 Years From 29 Countries: A Global Perspective.

PURPOSE: Bullying victimization among adolescents is a major public health concern. However, multicountry studies investigating temporal trends of bullying victimization among adolescents are scarce, especially from a global perspective. Thus, we aimed to examine the temporal trends of bullying victimization among school-going adolescents between 2003 and 2017 in 29 countries from Africa (n = 5), Asia (n = 18), and the Americas (n = 6). METHODS: Data on 191,228 students aged 12-15 years [mean (standard deviation) age 13.7 (1.0) years; 48.9% boys] who participated in the Global School-based Student Health Survey were analyzed. Bullying victimization was based on self-report and referred to being bullied at least once in the past 30 days. The prevalence (95% confidence interval) of bullying victimization was calculated for each survey. Crude linear trends in bullying victimization were examined by linear regression models. RESULTS: The mean prevalence of bullying victimization across all surveys was 39.4%. There was a large variation in the trends of bullying victimization across countries with a significant increasing and decreasing trend being observed in 6 and 13 countries, respectively. Myanmar, Egypt, and the Philippines showed the sharpest increase. The decrease was modest in most countries which showed a decreasing trend. The remaining countries showed stable trends (n = 10) but some countries such as Seychelles showed consistently high prevalence over time (i.e., ≥ 50%). DISCUSSION: Decreasing trends of bullying victimization were more common than increasing or stable trends in our study including adolescents from 29 countries. However, a high prevalence of bullying was observed in most countries, and thus, further global efforts to combat bullying victimization are necessary.

Falls increase the risk for incident anxiety and depressive symptoms among adults aged ≥50 years: An analysis of the Irish longitudinal study on ageing.

BACKGROUND: Little is known about the potential impact of falls on the onset of common mental disorders in older adults. Thus, we aimed to investigate the longitudinal association between falls and incident anxiety and depressive symptoms in adults aged ≥50 years living in Ireland. METHODS: Data from the Irish Longitudinal Study on Ageing were analyzed (Wave 1: 2009-2011; and Wave 2: 2012-2013). The presence of falls and injurious falls in the past 12 months was assessed at Wave 1. Anxiety and depressive symptoms were assessed at Wave 1 and Wave 2 using the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A) and the 20-item Center for Epidemiologic Studies Depression (CES-D), respectively. Covariates included sex, age, education, marital status, disability, and the number of chronic physical conditions. The association of falls at baseline with incident anxiety and depressive symptoms at follow-up was estimated by multivariable logistic regression. RESULTS: This study included 6,862 individuals (51.5% women; mean [SD] age 63.1 [8.9] years). After adjusting for covariates, falls were significantly associated with anxiety (OR = 1.58, 95%CI = 1.06-2.35) and depressive symptoms (OR = 1.43, 95%CI = 1.06-1.92). These associations were no longer significant after including fear of falling in the models. Similar findings were obtained for injurious falls, although the relationship with anxiety symptoms was not statistically significant. CONCLUSIONS: This prospective study of older adults from Ireland found significant associations between falls and incident anxiety and depressive symptoms. Future research may focus on whether interventions to reduce fear of falling could also alleviate anxiety and depressive symptoms.

Chronic Low Back Pain and Incident Transient Ischemic Attack and Stroke in General Practices in Germany.

The aim was to investigate the association between chronic low back pain (CLBP) and incident transient ischemic attack (TIA) and stroke in Germany. The present retrospective cohort study included adults aged ≥18 years who were diagnosed for the first time with CLBP in one of 1198 general practices in Germany in 2005-2019 (index date). Patients without CLBP were matched to those with CLBP (1:1) using a propensity score based on age, sex, the index year, the number of medical consultations per year during the follow-up, and the number of years of follow-up. In patients without CLBP, the index date was a randomly selected visit date. Both groups were followed for up to 10 years. There were 159,440 patients included in the study (mean (SD) age: 52.1 (16.5) years; 51.5% women). Within 10 years of the index date, 6.5% and 5.9% of patients with and without CLBP were diagnosed with TIA or stroke, respectively (log-rank p-value < 0.001). The Cox regression analysis corroborated these results, as there was a significant association between CLBP and incident TIA or stroke (HR = 1.28, 95% CI = 1.22-1.35). CLBP was positively and significantly associated with incident TIA and stroke in Germany. More research is warranted to better understand this relationship.

Views and experiences of migrants and stakeholders involved in social and health care for migrants in Italy during the COVID-19 pandemic: a qualitative study.

BACKGROUND: The COVID-19 pandemic has had major and potentially long-lasting effects on mental health and wellbeing across populations worldwide. However, these impacts were not felt equally, leading to an exacerbation of health inequalities, especially affecting vulnerable populations such as migrants, refugees and asylum seekers. Aiming to inform the adaptation and implementation of psychological intervention programmes, the present study investigated priority mental health needs in this population group. METHODS: Participants were adult asylum seekers, refugees and migrants (ARMs) and stakeholders with experience in the field of migration living in Verona, Italy, and fluent in Italian and English. A two-stage process was carried out to examine their needs using qualitative methods including free listing interviews and focus group discussions, according to Module One of the DIME (Design, Implementation, Monitoring, and Evaluation) manual. Data were analyzed using an inductive thematic analyses approach. RESULTS: A total of 19 participants (12 stakeholders, 7 ARMs) completed the free listing interviews and 20 participants (12 stakeholders and 8 ARMs) attended focus group discussions. Salient problems and functions that emerged during free listing interviews were discussed during the focus group discussions. During the COVID-19 pandemic, ARMs struggled with many everyday living difficulties in their resettlement country due to social and economic issues, revealing a strong influence of contextual factors in determining mental health. Both ARMs and stakeholders highlighted a mismatch between needs, expectations and interventions as factors that may hamper proper implementation of health and social programmes. CONCLUSIONS: The present findings could help in the adaptation and implementation of psychological interventions targeting the needs of asylum seekers, refugees and migrants aiming to find a match between needs, expectations, and the corresponding interventions. TRIAL REGISTRATION: Registration number 2021-UNVRCLE-0106707, February 11 2021.

Are we equally at risk of changing smoking behavior during a public health crisis? Impact of educational level on smoking from the TEMPO cohort.

BACKGROUND: The COVID-19 pandemic as a public health crisis has led to a significant increase in mental health difficulties. Smoking is strongly associated with mental health conditions, which is why the pandemic might have influenced the otherwise decline in smoking rates. Persons belonging to socioeconomically disadvantaged groups may be particularly affected, both because the pandemic has exacerbated existing social inequalities and because this group was more likely to smoke before the pandemic. We examined smoking prevalence in a French cohort study, focusing on differences between educational attainment. In addition, we examined the association between interpersonal changes in tobacco consumption and educational level from 2018 to 2021. METHODS: Using four assessments of smoking status available from 2009 to 2021, we estimated smoking prevalence over time, stratified by highest educational level in the TEMPO cohort and the difference was tested using chi2 test. We studied the association between interpersonal change in smoking status between 2018 and 2021 and educational attainment among 148 smokers, using multinomial logistic regression. RESULTS: Smoking prevalence was higher among those with low education. The difference between the two groups increased from 2020 to 2021 (4.8-9.4%, p < 0.001). Smokers with high educational level were more likely to decrease their tobacco consumption from 2018 to 2021 compared to low educated smokers (aOR = 2.72 [1.26;5.89]). CONCLUSION: Current findings showed a widening of the social inequality gap in relation to smoking rates, underscoring the increased vulnerability of persons with low educational level to smoking and the likely inadequate focus on social inequalities in relation to tobacco control policies during the pandemic.

Is there an association between breast cancer and incident adhesive capsulitis of the shoulder? A retrospective cohort study from Germany.

PURPOSE: Preliminary data suggest that women with breast cancer are at particularly high risk of adhesive capsulitis of the shoulder. Therefore, this study aimed to investigate the potential association between breast cancer and adhesive capsulitis in adults from Germany. METHODS: This retrospective cohort study included all women aged ≥ 18 years who were diagnosed for the first time with breast cancer in one of 1,274 general practices in Germany between January 2000 and December 2018 (index date). Women without breast cancer were matched (1:1) to those with breast cancer using a propensity score based on age at the index date, index year, and the average number of medical consultations per year during the follow-up. In women without breast cancer, the index date was a randomly selected visit date between 2000 and 2018. The association between breast cancer and the 10-year incidence of adhesive capsulitis was studied using Kaplan-Meier curves and a Cox regression model adjusted for age and several comorbidities. RESULTS: There were 52,524 women included in this study (mean [SD] age 64.2 [12.9] years). The 10-year incidence of adhesive capsulitis was 3.6% in both the group with and the group without breast cancer (log-rank p-value = 0.317). The Cox regression analysis further showed no significant association between breast cancer and adhesive capsulitis (HR = 0.96, 95% CI = 0.86-1.08). CONCLUSION: In this sample of women from Germany, breast cancer was not significantly associated with adhesive capsulitis. Although the present preliminary findings are reassuring, general practitioners should regularly assess shoulder function in breast cancer survivors.

Determinants of effective treatment coverage for posttraumatic stress disorder: findings from the World Mental Health Surveys.

BACKGROUND: Posttraumatic stress disorder (PTSD) is associated with significant morbidity, but efficacious pharmacotherapy and psychotherapy are available. Data from the World Mental Health Surveys were used to investigate extent and predictors of treatment coverage for PTSD in high-income countries (HICs) as well as in low- and middle-income countries (LMICs). METHODS: Seventeen surveys were conducted across 15 countries (9 HICs, 6 LMICs) by the World Health Organization (WHO) World Mental Health Surveys. Of 35,012 respondents, 914 met DSM-IV criteria for 12-month PTSD. Components of treatment coverage analyzed were: (a) any mental health service utilization; (b) adequate pharmacotherapy; (c) adequate psychotherapy; and (d) effective treatment coverage. Regression models investigated predictors of treatment coverage. RESULTS: 12-month PTSD prevalence in trauma exposed individuals was 1.49 (S.E., 0.08). A total of 43.0% (S.E., 2.2) received any mental health services, with fewer receiving adequate pharmacotherapy (13.5%), adequate psychotherapy (17.2%), or effective treatment coverage (14.4%), and with all components of treatment coverage lower in LMICs than HICs. In a multivariable model having insurance (OR = 2.31, 95 CI 1.17, 4.57) and severity of symptoms (OR = .35, 95% CI 0.18, 0.70) were predictive of effective treatment coverage. CONCLUSION: There is a clear need to improve pharmacotherapy and psychotherapy coverage for PTSD, particularly in those with mild symptoms, and especially in LMICs. Universal health care insurance can be expected to increase effective treatment coverage and therefore improve outcomes.

Dynapenic abdominal obesity increases risk for falls among adults aged ≥50 years: a prospective analysis of the Irish Longitudinal Study on Ageing.

BACKGROUND: There is a scarcity of studies examining the longitudinal relationship between dynapenic abdominal obesity (DAO) (i.e., impairment in muscle strength and high waist circumference) and future fall risk. Therefore, we aimed to investigate the prospective association between DAO at baseline and falls occurring during two years of follow-up in a nationally representative sample of middle-aged and older individuals from Ireland. METHODS: Data from two consecutive waves of the Irish Longitudinal Study on Ageing (TILDA) survey were analyzed. Dynapenia was defined as handgrip strength of <26kg for men and <16kg for women. Abdominal obesity was defined as waist circumference of >88 cm for women and >102 cm for men. DAO was assessed at Wave 1 (2009-2011) and was defined as having both dynapenia and abdominal obesity. Falls occurring between Wave 1 and Wave 2 (2012-2013) were self-reported. Multivariable logistic regression analysis was conducted. RESULTS: Data on 5275 individuals aged ≥50 years were analyzed [mean (SD) age 63.2 (8.9) years; 48.8% males]. After adjustment for potential confounders, compared to no dynapenia and no abdominal obesity at baseline, DAO was significantly associated with 1.47 (95%CI=1.14-1.89) times higher odds for falls at 2-year follow-up. Dynapenia alone (OR=1.08; 95%CI=0.84-1.40) and abdominal obesity alone (OR=1.09; 95%CI=0.91-1.29) were not significantly associated with falls at follow-up. CONCLUSIONS: DAO increased risk for falls among middle-aged and older adults in Ireland. Interventions to prevent or reverse DAO may be beneficial for fall reduction.