Intimate Partner Attachment Style and Antenatal Depression Symptoms in Nulliparas: Results from the ZRNO Study.

BACKGROUND: The purpose of this study was to examine the relationship between the important indicators that define mental health functioning during the first pregnancy: the level of depression, anxiety and fear of childbirth in the context of nulliparas' intimate partner attachment style type and older generation's emotional support. SUBJECTS AND METHODS: A group of 325 nulliparas in the third trimester of pregnancy were enrolled at the Childbirth preparation program of the University Medical Centre Ljubljana's Division of Gynaecology and Obstetrics. The following instruments were applied: Experiences in Close Relationships-Revised, The Edinburgh Depression Scale, two aspects of anxiety - Zung Anxiety Scale and a questionnaire regarding fear of childbirth. Attachment anxiety and avoidance scales were recoded into four categories of a prototypical attachment style: secure, fearful, preoccupied and dismissive. Two-way ANOVA and the chi-square test were used for the statistical analysis. RESULTS: All indicators of mental health functioning of our sample of nulliparas differed significantly regarding their partner attachment style. Nulliparas with a fearful, but also with a preoccupied type of attachment, showed less optimal mental health indicators compared to those with a secure/dismissive type of attachment. A significant interactive effect of partner attachment and emotional support from the older generation was found on the level of depression. Partner attachment styles and emotional support from the older generation were found to be statistically dependent. CONCLUSIONS: In our sample a secure attachment seems to represent a protective buffer for the level of depression, even when a lower emotional support of the older generation was included. Screening and intervening on intimate attachment style as a protective factor for antenatal depression and different forms of anxiety is proposed.

Contextual-relationship and stress-related factors of postpartum depression symptoms in nulliparas: a prospective study from Ljubljana, Slovenia.

BACKGROUND: For a significant proportion of women, postpartum depression (PPD) is the first mood episode in their lives, yet its aetiology still remains unclear. Insecure attachment in close adult relationships is considered to be a risk factor for depressive symptoms. This study aimed to gain further insight into the risk factors for postpartum depression symptoms (PPDS) of nulliparas in Slovenia and to examine vulnerability to developing depressive symptoms, with an emphasis on contextual and stress-related characteristics. METHODS: The sample consisted of 156 nulliparas in the third trimester of pregnancy enrolled in a childbirth preparation program. The following instruments were applied: Experiences in Close Relationships-Revised, the Edinburgh Postpartum Depression Scale (EPDS), the Zung Anxiety Scale and a question battery designed by the research team including questions about emotional support and work-related stress. Logistic regression was used to test the association between demographic, social, environmental, personality and attachment variables and PPD of nulliparas (EPDS ≥10), controlling for baseline (prepartum) depression score. A multivariable linear regression model was built with the postpartum EPDS continuous score as a dependent variable. RESULTS: 28/156 (17,9%) were evaluated as being at risk for depression (EPDS≥10) in the last trimester and 25/156 (16%) at six weeks postpartum. The results of the logistic regression model controlled for prepartum depression score showed that increased risk for developing PPDS was associated with anxiety level postpartum, intimate-partner-attachment anxiety postpartum, and elevated stress due to loss of employment or an unsuccessful search for employment in the previous year. The results of the multivariable regression model, however, showed the association with education and postpartum anxiety with PPDS continuous score; EPDS after giving birth was higher for more educated and more anxious primiparas. CONCLUSIONS: Our findings demonstrate the importance of anxiety symptoms and higher education level in assessments of nulliparas' mental health. The results of our study show and confirm the results of previous research that anxiety symptoms in the immediate postpartum period are likely to be associated with depressive symptoms in nulliparas. The results also suggest that higher level of education of first-time mothers might not be a protective factor, especially for nulliparas with the university level of education. Further studies on larger samples should be considered.

A pilot predictive model based on COVID-19 data to assess suicidal ideation indirectly.

The COVID-19 pandemic has had a negative impact on the mental health of the population. Many studies reported high levels of psychological distress and rising rates of suicidal ideation (SI). Data on a range of psychometric scales from 1790 respondents were collected in Slovenia through an online survey between July 2020 and January 2021. As a worrying percentage (9.7%) of respondents reported having SI within the last month, the goal of this study was to estimate the presence of SI, as indicated by the Suicidal Ideation Attributes Scale (SIDAS). The estimation was based on the change of habits, demographic features, strategies for coping with stress, and satisfaction with three most important aspects of life (relationships, finances, and housing). This could both help recognize the telltale factors indicative of SI and potentially identify people at risk. The factors were specifically selected to be discreet about suicide, likely sacrificing some accuracy in return. We tried four machine learning algorithms: binary logistic regression, random forest, XGBoost, and support vector machines. Logistic regression, random forest, and XGBoost models achieved comparable performance with the highest area under the receiver operating characteristic curve of 0.83 on previously unseen data. We found an association between various subscales of Brief-COPE and SI; Self-Blame was especially indicative of the presence of SI, followed by increase in Substance Use, low Positive Reframing, Behavioral Disengagement, dissatisfaction with relationships and lower age. The results showed that the presence of SI can be estimated with reasonable specificity and sensitivity based on the proposed indicators. This suggests that the indicators we examined have a potential to be developed into a quick screening tool that would assess suicidality indirectly, without unnecessary exposure to direct questions on suicidality. As with any screening tool, subjects identified as being at risk, should be further clinically examined.

Psychometric properties of the Opening Minds Stigma Scale for Health Care Providers in 32 European countries - A bifactor ESEM representation.

Aims: To measure the stigma of healthcare providers toward people suffering from mental illness, the Opening Minds Stigma Scale for Health Care Providers (OMS-HC) is a commonly applied instrument. However, this scale has not been thoroughly validated in many European countries, its psychometric properties are still unknown and data on practicing psychiatrists is lacking. Therefore, this multicenter study aimed to assess the psychometric characteristics of the 15-item OMS-HC in trainees and specialists in adult and child psychiatry in 32 countries across Europe. Materials and methods: The OMS-HC was conducted as an anonymous online survey and sent via Email to European adult and child psychiatrists. Parallel analysis was used to estimate the number of OMS-HC dimensions. Separate for each country, the bifactor ESEM, a bifactor exploratory structural equation modeling approach, was applied to investigate the factor structure of the scale. Cross-cultural validation was done based on multigroup confirmatory factor analyses and reliability measures. Results: A total of 4,245 practitioners were included, 2,826 (67%) female, 1,389 (33%) male. The majority (66%) of participants were specialists, with 78% working in adult psychiatry. When country data were analyzed separately, the bifactor model (higher-order factor solution with a general factor and three specific factors) showed the best model fit (for the total sample χ2/df = 9.760, RMSEA = 0.045 (0.042-0.049), CFI = 0.981; TLI = 0.960, WRMR = 1.200). The average proportion of variance explained by the general factor was high (ECV = 0.682). This suggests that the aspects of 'attitude,' 'disclosure and help-seeking,' and 'social distance' could be treated as a single dimension of stigma. Among the specific factors, the 'disclosure and help-seeking' factor explained a considerable unique proportion of variance in the observed scores. Conclusion: This international study has led to cross-cultural analysis of the OMS-HC on a large sample of practicing psychiatrists. The bifactor structure displayed the best overall model fit in each country. Rather than using the subscales, we recommend the total score to quantify the overall stigmatizing attitudes. Further studies are required to strengthen our findings in countries where the proposed model was found to be weak.

Depression, Anxiety, Stress, and Suicidality Levels in Young Adults Increased Two Years into the COVID-19 Pandemic.

BACKGROUND: The severity of both the COVID-19 clinical picture and confinement measures in Slovenia was higher during the initial phase of the pandemic in 2020 than during the Omicron wave in 2022. This could lead us to expect a higher level of distress during the initial phase. On the other hand, prolonged stress can have a detrimental effect on mental health. This study aimed to explore how the prolonged stress of the COVID-19 pandemic and the accompanying changes affected the mental health of young adults in Slovenia. We analyzed and compared the levels of depression, anxiety, stress, and suicidal ideation in young adults during the initial phase of the pandemic and the Omicron wave, as well as between the COVID-19-infected and non-infected individuals. METHODS: An online survey was used to survey 587 young adults in the first wave (July-December 2020) and 511 in the Omicron wave (January-February 2022). Levels of depression, anxiety, stress, and suicidal ideation were compared using Mann-Whitney U test. RESULTS: Results show that the Omicron wave significantly worsened depression, anxiety, stress, and suicidal ideation. Young adults who had tested positive for COVID-19 reported no worse or only slightly worse mental health than those who never tested positive. CONCLUSIONS: The current study provides new evidence about the mental health of young adults during the Omicron wave. Our results show that two years into the pandemic, they expressed more negative emotions and suicidal thoughts than at the beginning.

Risk of Depression, Anxiety, and Stress During the Second Wave of COVID-19 in Slovenia.

The spread of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) pandemic has led to numerous negative consequences on the mental health of the population throughout the world. The main aim of our study was to compare the risk for depression, anxiety, and stress during the second wave of the pandemic in Slovenia. An additional goal was to analyze the association of depression, anxiety, and stress, with the most relevant subjective factors that define the quality of life. Furthermore, we aimed at determining whether health workers have a higher risk for depression following the course of the pandemic. The study was conducted on the general population, between July 2020 and January 2021 through an online survey. The data of 1,728 respondents in two samples of respondents (782 at baseline - first measurement point and 946 during the second measurement point) of the second wave were analyzed using zero-inflated negative binomial regression and Mann-Whitney U-test. The findings of this study show that the rise the second wave was associated with a higher risk for depression, anxiety and stress. The risk for all three was higher for younger participants. Women showed a higher risk for anxiety and stress. Finances, relationships, and housing dissatisfaction were relevant predictors for depression, anxiety and stress. Health workers in our sample showed a higher risk for stress, but not for depression or anxiety, than the general population. Our findings highlight the urgent need for coordinating and developing mental health services and tailored interventions to reduce the mental health burden, especially in the younger.

'An Apple a Day'?: Psychiatrists, Psychologists and Psychotherapists Report Poor Literacy for Nutritional Medicine: International Survey Spanning 52 Countries.

Nutritional interventions have beneficial effects on certain psychiatric disorder symptomatology and common physical health comorbidities. However, studies evaluating nutritional literacy in mental health professionals (MHP) are scarce. This study aimed to assess the across 52 countries. Surveys were distributed via colleagues and professional societies. Data were collected regarding self-reported general nutrition knowledge, nutrition education, learning opportunities, and the tendency to recommend food supplements or prescribe specific diets in clinical practice. In total, 1056 subjects participated in the study: 354 psychiatrists, 511 psychologists, 44 psychotherapists, and 147 MHPs in-training. All participants believed the diet quality of individuals with mental disorders was poorer compared to the general population (p < 0.001). The majority of the psychiatrists (74.2%) and psychologists (66.3%) reported having no training in nutrition. Nevertheless, many of them used nutrition approaches, with 58.6% recommending supplements and 43.8% recommending specific diet strategies to their patients. Only 0.8% of participants rated their education regarding nutrition as 'very good.' Almost all (92.9%) stated they would like to expand their knowledge regarding 'Nutritional Psychiatry.' There is an urgent need to integrate nutrition education into MHP training, ideally in collaboration with nutrition experts to achieve best practice care.