Methodological and Statistical Practices of Using Symptom Networks to Evaluate Mental Health Interventions: A Review and Reflections.

The network approach to psychopathology, which assesses associations between individual symptoms, has recently been applied to evaluate treatments for mental disorders. While various options for conducting network analyses in intervention research exist, an overview and an evaluation of the various approaches are currently missing. Therefore, we conducted a review on network analyses in intervention research. Studies were included if they constructed a symptom network, analyzed data that were collected before, during or after treatment of a mental disorder, and yielded information about the treatment effect. The 56 included studies were reviewed regarding their methodological and analytic strategies. About half of the studies based on data from randomized trials conducted a network intervention analysis, while the other half compared networks between treatment groups. The majority of studies estimated cross-sectional networks, even when repeated measures were available. All but five studies investigated networks on the group level. This review highlights that current methodological practices limit the information that can be gained through network analyses in intervention research. We discuss the strength and limitations of certain methodological and analytic strategies and propose that further work is needed to use the full potential of the network approach in intervention research.

Transdiagnostic Sleep and Circadian Intervention in Youth: Long-Term Follow-Up of a Randomized Controlled Trial.

OBJECTIVE: This preregistered study compared the effects of the Transdiagnostic Sleep and Circadian Intervention (TranS-C) to Psychoeducation about sleep, health, yoga, meditation, and outdoor appreciation activities (PE) on sleep and circadian functioning, health risk, and sleep-health behaviors, at long-term follow-up (LTFU), an average of 8 years following treatment. We also examined if more sleep-health behaviors at LTFU were associated with better sleep and circadian functioning at LTFU and if better sleep and circadian functioning were associated with lower health risk at LTFU. METHOD: At baseline, we randomized adolescents with an eveningness chronotype to TranS-C (n=89) or PE (n=87). Of this sample, we assessed 106 young adults (mean age at follow-up=22.5 years; n=55 from TranS-C; n=51 from PE) an average of eight years following treatment. RESULTS: Despite TranS-C (vs. PE) sustaining improvement in circadian functioning through 12-month follow-up, at LTFU, there were no significant differences between the conditions on any outcome-including sleep and circadian functioning, risks in five health domains indexed by self-report and ecological momentary assessment, sleep-health behaviors, and physical measurements. Across both conditions, measures indicating poorer sleep and circadian functioning were associated with higher health risk across multiple domains, and more sleep-health behaviors were associated with lower levels of eveningness at LTFU. CONCLUSION: The results provide an important window into the influence of development on long-term outcomes for youth and raise the possibility that interventions for youth could be enhanced with a focus on habit formation.

The relationships between insomnia, nightmares, and dreams: A systematic review.

Insomnia and nightmares are both prevalent and debilitating sleep difficulties. The present systematic review aims to document the relationships between insomnia and nightmares in individuals without a concomitant psychopathology. The relationships between insomnia and dreams are also addressed. PsycINFO and Medline were searched for papers published in English or French from 1970 to March 2023. Sixty-seven articles were included for review. Most results support positive relationships between insomnia variables and nightmare variables in individuals with insomnia, individuals with nightmares, the general population, students, children and older adults, and military personnel and veterans. These positive relationships were also apparent in the context of the COVID-19 pandemic. Some psychological interventions, such as Imagery Rehearsal Therapy, might be effective in alleviating both nightmares and insomnia symptoms. Regarding the relationships between insomnia and dreams, compared with controls, the dreams of individuals with insomnia are characterized by more negative contents and affects. The results show that insomnia and nightmares are connected and may be mutually aggravating. A model is proposed to explain how insomnia might increase the likelihood of experiencing nightmares, and how nightmares can in turn lead to sleep loss and nonrestorative sleep.

Anticholinergic load: A commonly neglected and preventable risk to cognition during schizophrenia treatment?

Background: Cognitive impairment is a widespread feature of schizophrenia, affecting nearly 80 % of patients. Prior research has linked the anticholinergic burden of psychiatric medications to these cognitive deficits. However, the impact of the anticholinergic burden from medications for physical morbidity remains underexplored. This study aimed to evaluate the anticholinergic burden of psychiatric and physical medications in patients with schizophrenia and assess its impact on cognitive function. Methods: A total of 178 patients with schizophrenia were recruited. The assessments included an ad hoc questionnaire for collecting demographic and clinical data. Anticholinergic burden was evaluated using the cumulative Drug Burden Index (cDBI) for each participant, and cognitive function was assessed using MATRICS. Psychopathology was measured using the PANSS, CDSS, CAINS, and the CGI-S. Statistical analysis included Student's t-tests, ANOVA, Pearson correlations, and multiple linear regressions. Results: The average cDBI was 1.3 (SD = 0.9). The model developed explained 40.80 % of the variance. The variable with the greatest weight was the cDBI (B = -11.148, p = 0.010). Negative-expression (B = -2.740, p = 0.011) and negative-experiential (B = -1.175, p = 0.030) symptoms were also associated with lower global cognitive score. However, more years of education (B = 5.140, p < 0.001) and cigarettes per day (B = 1.331, p < 0.001) predicted a better global cognitive score. Conclusion: This study identified specific predictors of global cognition in schizophrenia, with anticholinergic burden emerging as the strongest factor. Our findings underscore the importance of considering the anticholinergic burden of treatments, in addition to negative symptoms, when designing interventions to optimize or maintain cognitive function in patients with schizophrenia.

Neuropsychological functioning of adults with PTEN hamartoma tumor syndrome.

PTEN hamartoma tumor syndrome (PHTS) might be associated with a distinct cognitive and psychological profile. However, previous studies are limited, predominantly based on small and pediatric cohorts, likely affected by selection bias, and show a broad range of findings. We aimed to characterize the neuropsychological functioning of adults with PHTS. A total of 40 participants, with intellectual disability as exclusion criterium, completed an extensive clinical neuropsychological assessment including cognitive tasks, questionnaires, and a clinical diagnostic interview. The cognitive tasks and questionnaire data were categorized as below and above average based on 1.5 SD. About 80% of participants showed an average level of intelligence. In addition, 30% and 24% of participants scored below average on immediate memory recall and speed of information processing, respectively. Furthermore, about 25% reported above average scores on the majority of the questionnaires, indicating psychological distress, signs of alexithymia, and cognitive complaints. Personality of participants was characterized by inflexibility, social withdrawal, and difficulties in recognizing and describing their own emotions. Adults with PHTS demonstrate a heterogeneous yet distinct neuropsychological profile that is characterized by slower information processing, psychological problems, and specific personality traits. These findings provide directions on how to optimize the care and daily lives of adults with PHTS.

Associations between trauma exposure and irritability within the family unit: a network approach.

BACKGROUND: Pediatric irritability is a pervasive psychiatric symptom, yet its etiology remains elusive. While trauma exposure may contribute to the development of irritability, empirical research is limited. This study examined the prevalence of irritability among trauma-exposed children, identified factors that differentiate trauma-exposed children with and without irritability, and employed a network analysis to uncover associations between irritability and trauma exposure in the family unit. METHODS: Sample included 676 children (56.3% male, mean age = 9.67 ± 3.7 years) and their parents referred by the Connecticut Department of Children and Families to Fathers for Change - a psychotherapy intervention designed to reduce intimate partner violence (IPV) and child maltreatment. Child's trauma exposure, post-traumatic stress disorder (PTSD) symptoms, and irritability were assessed pre-intervention using self- and caregiver-report. Parents self-reported their childhood and adulthood trauma exposures, PTSD symptoms, irritability, psychopathology, and IPV. RESULTS: Across caregiver- and child-reports, 16%-17% of children exhibited irritability. Irritable children experienced greater trauma exposure, interpersonal violence, emotional abuse, and PTSD severity. They had caregivers, particularly mothers, with greater trauma histories, IPV, and psychopathology. Network analysis revealed 10 nodes directly correlated to child's irritability including child's PTSD severity, parental IPV (specifically psychological violence), and parental psychopathology. CONCLUSIONS: Results provide initial empirical evidence that pediatric irritability is linked to trauma exposure, suggesting trauma histories be considered in the diagnosis and treatment of irritability. Interventions addressing caregiver trauma, IPV, and psychopathology may ameliorate pediatric irritability. Future studies could benefit from adopting network approaches with longitudinal or time series data to elucidate causality and points of intervention.

Stressful life events, psychiatric comorbidities and serum neuromediator levels in patients with chronic spontaneous urticaria treated with omalizumab.

INTRODUCTION: Many chronic spontaneous urticaria (CSU) patients have highly stressful life events and exhibit psychiatric comorbidities. Emotional stress can cause or exacerbate urticaria symptoms by causing mast cell degranulation via neuromediators. OBJECTIVES: To investigate the frequency of stressful life events and compare psychiatric comorbidities and serum neuromediator levels in patients with CSU who responded to omalizumab with healthy controls. METHODS: In this cross-sectional study, we included 42 patients with CSU who received at least 6 months of omalizumab treatment and a control group of 42 healthy controls. Stressful life events were evaluated with the Life Events Checklist for DSM-5 (LEC-5). The Depression Anxiety Stress Scale-42 (DASS-42) was used to evaluate depression, anxiety and stress levels. Serum nerve growth factor (NGF), calcitonin gene-related peptide (CGRP) and substance P (SP) levels were measured using the enzyme-linked immunosorbent assay (ELISA) technique. RESULTS: Twenty-six (62%) patients reported at least one stressful life event a median of 3.5 months before the onset of CSU. There were no significant differences in all three variables in the DASS subscales between the patient and control groups. Serum NGF levels were found to be significantly lower in patients with CSU (p <0.001), whereas CGRP levels were found to be significantly higher (p <0.001). There was no significant difference for SP. CONCLUSIONS: The psychological status of patients with CSU who benefited from omalizumab was similar to that of healthy controls. Omalizumab may affect stress-related neuromediator levels.

Emotion Regulation and Mentalization in Patients With Depression and Anxiety.

OBJECTIVE: Theoretical conceptualizations of emotion and affect regulation have a considerable common ground. However, mentalization theory considers the ability to regulate affects as being contingent on the ability to mentalize. The aim of the present study is to examine the association between emotion regulation and mentalization, operationalized as reflective functioning, in a sample of patients with depression and/or anxiety. METHODS: The study used data from the TRAns-diagnostic Cognitive behavioural Therapy versus standard cognitive behavioural therapy (TRACT-RCT) trial. Patients with depression and/or anxiety (N = 291; 64.4% female; Mage = 32.2; SD = 11.0) completed the Emotion Regulation Strategies Questionnaire (ERSQ) and the Reflective Functioning Questionnaire (RFQ-6). Correlation and regression analyses were performed to determine associations of the measures of ERSQ and RFQ-6 in relation to the outcome variables, global well-being (World Health Organization Well-being Index; WHO-5) and social functioning (Work and Social Adjustment Scale; WSAS). RESULTS: Overall, the patients had a reduced level of emotion regulation (MERSQ_Total = 1.77; SD = 0.59). However, only mildly impaired reflective functioning was found (MRFQ-6 = 3.57; SD = 1.26). ERSQ correlated significantly with RFQ-6 (r = -0.31), that is, more frequent use of emotion regulation strategies was associated with less hypomentalization. ERSQ was a stronger predictor of well-being and social function than RFQ-6. CONCLUSION: In patients with anxiety and/or depression, hypomentalization as measured by the RFQ-6 is not a major problem, but emotion regulation is. It seems that these two, theoretically related constructs, do not necessarily co-occur. Alternatively, the RFQ-6 scale might not capture the mentalization construct in a valid way. Emotion regulation strategies are highly related to symptomatology; therefore, they are likely to be an important target for psychotherapy.

Novel Approaches Toward Studying Change: Implications for Understanding and Treating Psychopathology.

In this article, the authors critically evaluate contemporary models of psychopathology and therapies, underscoring the limitations of traditional symptom-based classification approaches in mental health. The authors introduce a paradigm shift in the field, toward a process-oriented and dynamic systems approach to psychotherapy that offers deeper insights into the complex interplay of symptoms and individual experiences in psychopathology. These approaches offer a more personalized and effective understanding and treatment of mental health issues, moving beyond static and 1-dimensional views. The authors discuss the implications for clinical practice, emphasizing improved assessment, diagnosis, and tailored treatment strategies.

The loneliness factor in eating disorders: Implications for psychopathology and biological signatures.

OBJECTIVES: Eating disorders (ED) are severe psychiatric conditions. While the biological consequences of EDs are well established, including an increase in inflammatory biomarkers, the influence of psychological factors, such as loneliness, has only recently gained attention in research. Loneliness has been associated with more severe psychopathology in ED patients, while its association with inflammatory biomarkers has only been explored in the general population. For these reasons, we aimed to investigate any possible associations between psychological features, trauma, and inflammatory biomarkers with loneliness in people with ED. METHODS: This study examined the interaction between loneliness, eating psychopathology, and biological markers in people with EDs. A group of 97 female patients with various diagnoses of ED was assessed for loneliness, general and eating psychopathology, traumatic history during childhood, and clinical biomarkers such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and urinary-free cortisol (UFC). RESULTS: The results indicated that individuals with ED who reported moderate to severe loneliness also displayed greater general psychopathology (p = 0.001), weight concerns (p = 0.007), and physical neglect during childhood (p = 0.006). Furthermore, people with higher levels of loneliness also had higher inflammatory indexes (ESR p = 0.001, CRP p = 0.027) and were positively correlated with markers of stress reaction such as UFC (p < 0.05). CONCLUSION: The findings underscore the importance of considering loneliness in the assessment of individuals with an ED. We observed notable associations between loneliness and increased psychopathology (both general and specific to eating), as well as higher levels of inflammation and childhood physical neglect. Addressing loneliness may contribute to improving overall well-being and potentially support recovery. This consideration encompasses both psychological and physical factors that interplay in the clinical presentation of individuals.

Food insecurity is related to eating disorder psychopathology beyond psychological distress in rural Chinese adolescents.

OBJECTIVE: This study aimed to examine the relationship between food insecurity (FI) and eating disorder psychopathology in a large sample of rural Chinese adolescents. METHODS: Analyses included 1654 adolescents (55.4% girls; Mage = 16.54 years, SD = 1.45) from a rural high school in southwestern China. FI, eating disorder psychopathology, and psychological distress (i.e., symptoms of depression, anxiety, and stress) were assessed. Data were analyzed by sex. Pearson correlation analysis was performed to investigate the zero-order association between FI and eating disorder psychopathology. Hierarchical linear regressions were used to explore whether FI could explain meaningful variance in eating disorder psychopathology beyond psychological distress and demographic covariates (e.g., socioeconomic status). RESULTS: FI was significantly associated with higher eating disorder psychopathology for boys (r = 0.44, p < 0.001) and girls (r = 0.43, p < 0.001), with medium-to-large effect sizes. FI accounted for significant unique variance in eating disorder psychopathology beyond psychological distress and demographic covariates for boys (ΔR2 = 0.14, p < 0.001) and girls (ΔR2 = 0.10, p < 0.001). DISCUSSION: Using a large sample of rural Chinese adolescents, this study extends the connection between FI and eating disorder pathology in adolescents beyond the Western context. Future investigations on the mechanisms underlying FI and eating disorder psychopathology are warranted for developing prevention strategies for eating disorders among rural Chinese adolescents. PUBLIC SIGNIFICANCE: This is the first investigation that examined the link between FI and eating disorder psychopathology among rural Chinese adolescents. Our findings highlight the importance of incorporating FI as a potential risk factor to screen for the prevention and intervention of eating disorders among rural Chinese adolescents.

Meta-Analytic Review of Temperamental Correlates of the Five-Factor Model and Hierarchical Taxonomy of Psychopathology Domains.

Background: There is little and heterogeneous knowledge on the links between the temperamental predispositions of psychopathology and the contemporary dimensional models of psychopathology, such as the Hierarchical Taxonomy of Psychopathology (HiTOP) classification system, which can be aligned with the five-factor model (FFM) of personality. This meta-analysis seeks to expand the temperamental theoretical basis of the HiTOP model by incorporating associations of temperament traits of two temperamental theories measured, respectively, by the Temperament and Character Inventory (TCI) and the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) with (a) the FFM's personality domains and (b) HiTOP's five psychopathological spectra. Methods: A systematic search was done on Web of Science, Scopus, PubMed, ProQuest, Cochrane Database, and Google Scholar for all articles published in English from January 1990 to August 2020. Because of heterogeneity in the results of almost 70% of studies, pooled estimates of correlation coefficients were calculated using the random-effects method. Risk of bias (low-quality studies) and publication bias are reported. Results: The pooled correlations obtained from the analysis of 35 studies showed that the temperamental profile associated with each FFM domain and HiTOP spectra is distinct. Specifically, TCI-harm avoidance (HA) and all TEMPS temperaments were more strongly related to neuroticism/internalizing, extraversion/low detachment, and conscientiousness/disinhibition. In contrast, TCI-novelty seeking was more strongly related to both disinhibited/antagonistic externalizing and thought disorder. Conclusions: A large body of research supports maladaptive variants of all FFM domains and some psychopathological spectra of HiTOP related to the abnormal-range temperaments.

To be or not to be flexible: A hierarchical model of affective flexibility in typical development and internalizing problems.

Affective flexibility is defined as a complex executive function which enables individuals to successfully alternate between distinct emotional and non-emotional features of a given situation in order to attain a specific goal. A large body of research has focused exclusively on flexibility in a non-emotional context, although most of our interactions with our environment are emotionally satiated. Our main aim was to propose a hierarchical framework to describe this construct from a macro-level perspective to a more nuanced and micro-level perspective, including three different levels of affective flexibility: elementary, shifting, and generative. Next, we employed this hierarchical framework to examine the role played by affective flexibility in typical development and different forms of developmental psychopathology. Lastly, we discuss how this knowledge could inform future prevention and intervention programs aimed at reducing cognitive vulnerability to developmental psychopathology.

Schizophrenia, the very idea: On self-disorder, hyperreflexivity, and the diagnostic concept.

The purpose of the present article is to consider schizophrenia-the very idea-from the perspective of phenomenological psychopathology, with special attention to the problematic nature of the diagnostic concept as well as to the prospect and challenges inherent in focusing on subjective experience. First, we address historical and philosophical topics relevant to the legitimacy of diagnostic categorization-in general and regarding "schizophrenia" in particular. William James's pragmatist approach to categorization is discussed. Then we offer a version of the well-known basic-self or ipseity-disturbance model (IDM) of schizophrenia, but in a significantly revised form (IDMrevised). The revised model better acknowledges the diverse and even seemingly contradictory nature of schizophrenic symptoms while, at the same time, interpreting these in a more unitary fashion via the key concept of hyperreflexivity-a form of exaggerated self-awareness that tends to undermine normal world-directedness and the stability of self-experience. Particular attention is paid to forms of exaggerated "self-presence" that are sometimes neglected yet imbue classically schizophrenic experiences involving subjectivism or quasi-solipsism and/or all-inclusive or ontological forms of paranoia. We focus on the distinctively paradoxical nature of schizophrenic symptomatology. In concluding we consider precursors in the work of Klaus Conrad, Kimura Bin and Henri Grivois. Finally we defend the concept of schizophrenia by considering its distinctive way of altering certain core aspects of the human condition itself.

Threat, safety, safeness and social safeness 30 years on: Fundamental dimensions and distinctions for mental health and well-being.

In 1993, the British Journal of Clinical Psychology published my paper titled 'Defence and safety: Their function in social behaviour and psychopathology'. The paper highlights that to understand people's sensitivity to threat, we also need to understand their ability to identify what is safe. This paper offers an update on these concepts, highlighting distinctions that were implicit but not clearly defined at the time. Hence, the paper seeks to clarify distinctions between: (i) threat detection and response, (ii) safety and safety seeking, (iii) safeness and (iv) their social and non-social functions and forms. Threat detection and response are to prevent or minimize harm (e.g., run from a predator or fire). Safety checking relates to monitoring for the absence and avoidance of threat, while safety seeking links to the destination of the defensive behaviour (e.g., running home). Safety seeking also relates to maintaining vigilance to the appearance of potential harms and doing things believed to avoid harm. Threat-defending and safety checking and seeking are regulated primarily through evolved threat processing systems that monitor the nature, presence, controllability and/or absence of threat (e.g., amygdala and sympathetic nervous system). Safeness uses different monitoring systems via different psychophysiological systems (e.g., prefrontal cortex, parasympathetic system) for the presence of internal and external resources that support threat-coping, risk-taking, resource exploration. Creating brain states that recruit safeness processing can impact how standard evidence-based therapies (e.g., exposure, distress tolerance and reappraisal) are experienced and produce long-term change.

Health, behavior, and social outcomes among offspring of parents with criminal convictions: a register-based study from Sweden.

BACKGROUND: There is currently insufficient understanding of the health and behavior of children whose parents engage in criminal behavior. We examined associations between parental criminal convictions and wide range of offspring health, behavioral, and social outcomes by age 18 in a large, national sample, aiming to get a comprehensive picture of the risks among children of offending parents. METHODS: We studied 1,013,385 individuals born in Sweden between 1987 and 1995, and their parents. Using data from several longitudinal nationwide registers, we investigated parental convictions and 85 offspring outcomes until the end of 2013, grouped into birth-related conditions, psychiatric and somatic disorders, accidents and injuries, mortality, school achievement, violent victimization, and criminality. Cox proportional hazards regression and logistic regression models were used to examine the associations. The role of genetic factors in intergenerational associations was studied in children-of-siblings analyses. We also examined the co-occurrence of multiple outcomes using Poisson regression. RESULTS: A total of 223,319 (22.0%) individuals had one parent convicted and 31,241 (3.1%) had both parents convicted during the first 18 years of their life. The strongest associations were found between parental convictions and offspring behavioral problems, substance use disorders, poor school achievement, violent victimization, and criminality, with an approximately 2 to 2.5-fold increased risk in children with one convicted parent and 3- to 4-fold increased risk in children with two convicted parents. The risks were particularly elevated among children of incarcerated parents with a history of violent convictions. The associations appeared to be at least partly explained by genetic influences. Parental convictions were also associated with an increased likelihood of experiencing multiple outcomes. CONCLUSIONS: Our findings help to calibrate the risks of a wide range of adverse outcomes associated with parental convictions and may be used to guide prevention efforts and identify key areas for future research.

Impulsivity profiles across five harmonized longitudinal childhood preventive interventions and associations with adult outcomes.

This study aimed to parse between-person heterogeneity in growth of impulsivity across childhood and adolescence among participants enrolled in five childhood preventive intervention trials targeting conduct problems. In addition, we aimed to test profile membership in relation to adult psychopathologies. Measurement items representing impulsive behavior across grades 2, 4, 5, 7, 8, and 10, and aggression, substance use, suicidal ideation/attempts, and anxiety/depression in adulthood were integrated from the five trials (N = 4,975). We applied latent class growth analysis to this sample, as well as samples separated into nonintervention (n = 2,492) and intervention (n = 2,483) participants. Across all samples, profiles were characterized by high, moderate, low, and low-increasing impulsive levels. Regarding adult outcomes, in all samples, the high, moderate, and low profiles endorsed greater levels of aggression compared to the low-increasing profile. There were nuanced differences across samples and profiles on suicidal ideation/attempts and anxiety/depression. Across samples, there were no significant differences between profiles on substance use. Overall, our study helps to inform understanding of the developmental course and prognosis of impulsivity, as well as adding to collaborative efforts linking data across multiple studies to better inform understanding of developmental processes.

Electrophysiological correlates of inhibitory control in children: Relations with prenatal maternal risk factors and child psychopathology.

Inhibitory control plays an important role in children's cognitive and socioemotional development, including their psychopathology. It has been established that contextual factors such as socioeconomic status (SES) and parents' psychopathology are associated with children's inhibitory control. However, the relations between the neural correlates of inhibitory control and contextual factors have been rarely examined in longitudinal studies. In the present study, we used both event-related potential (ERP) components and time-frequency measures of inhibitory control to evaluate the neural pathways between contextual factors, including prenatal SES and maternal psychopathology, and children's behavioral and emotional problems in a large sample of children (N = 560; 51.75% females; Mage = 7.13 years; Rangeage = 4-11 years). Results showed that theta power, which was positively predicted by prenatal SES and was negatively related to children's externalizing problems, mediated the longitudinal and negative relation between them. ERP amplitudes and latencies did not mediate the longitudinal association between prenatal risk factors (i.e., prenatal SES and maternal psychopathology) and children's internalizing and externalizing problems. Our findings increase our understanding of the neural pathways linking early risk factors to children's psychopathology.

Covid-19 pandemic? Mental health implications among nurses and Proposed interventions.

Background: With its abrupt and huge health and socio-economic consequences, the coronavirus disease (COVID-19) pandemic has led to a uniquely demanding, intensely stressful, and even traumatic period. Healthcare workers (HCW), especially nurses, were exposed to mental health challenges during those challenging times. Objectives: Review the current literature on mental health problems among nurses caring for COVID-19 patients. Methods: This is a narrative review and critical evaluation of relevant publications. Results: Nurses experienced higher levels of stress, burnout, anxiety, depression, frustration, stigma, and depersonalization compared to other HCW. Factors that increased this symptomatology included concerns about infection or infection of family members, inadequate staff protective equipment, extended working hours, insufficient information, a reduced sense of security, and post-traumatic stress disorder. The factors that improved the psychopathology included a general positive attitude, job satisfaction, adequate information and education, harmonious group relationships, post-traumatic development, emotional intelligence, psychological counseling, mindfulness-based stress reduction, stable leadership, guidance, and moral and practical administrative support. Conclusions: Recent studies clearly show that nurses, especially women, are the most vulnerable subgroup among HCW and are particularly prone to mental health impacts during the COVID-19 pandemic. The documented mental health vulnerability of frontline nursing staff during the COVID-19 pandemic requires preventive nursing management actions to increase resilience and to develop relevant defense mechanisms.

The effects of gender-affirming hormone therapy and mastectomy on psychopathology, body image, and quality of life in adults with gender dysphoria who were assigned female at birth.

PURPOSE: Individuals with gender dysphoria (GD) may request hormone therapy and various surgical operations to change their physical characteristics. The present study aimed to investigate the effects of two treatments, mastectomy and gender-affirming hormone therapy (GAHT), on adults with GD who were assigned female at birth (GD AFAB). METHODS: In this cross-sectional study, we gathered data from a total of 269 individuals in three groups: (a) untreated group (n = 121), (b) GAHT group (n = 84) who had been receiving treatment for at least 6 months, and (c) GAHT-MAST group (n = 64) who had been using GAHT for at least 6 months and had undergone mastectomy at least 3 months prior. All participants were asked to complete the Symptom Checklist-90-Revised (SCL-90-R), the Body Uneasiness Test (BUT), and the World Health Organization's Quality of Life Questionnaire- Brief Form, Turkish Version (WHOQOL-BREF-Tr). RESULTS: We found that individuals in the untreated group had higher psychopathological symptoms and body uneasiness scores, and lower quality of life scores compared to both GAHT and GAHT-MAST groups. There was no difference in psychopathology between the GAHT-MAST group and the GAHT group, but body uneasiness scores were lower, and quality of life scores were higher in the GAHT-MAST group. CONCLUSION: Our study suggests that individuals receiving GAHT improved mental health, body satisfaction, and overall quality of life. Combining mastectomy with GAHT may further enhance these benefits.