Mental health impact of the COVID-19 pandemic in U.S. military veterans: a population-based, prospective cohort study.

BACKGROUND: The coronavirus disease-2019 (COVID-19) pandemic has caused myriad health, social, and economic stressors. To date, however, no known study has examined changes in mental health during the pandemic in the U.S. military veteran population. METHODS: Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study, a nationally representative, prospective cohort survey of 3078 veterans. Pre-to-peri-pandemic changes in psychiatric symptoms were evaluated, as well as pre-pandemic risk and protective factors and pandemic-related correlates of increased psychiatric distress. RESULTS: The prevalence of generalized anxiety disorder (GAD) positive screens increased from pre- to peri-pandemic (7.1% to 9.4%; p < 0.001) and was driven by an increase among veterans aged 45-64 years (8.2% to 13.5%; p < 0.001), but the prevalence of major depressive disorder and posttraumatic stress disorder positive screens remained stable. Using a continuous measure of psychiatric distress, an estimated 13.2% of veterans reported a clinically meaningful pre-to-peri-pandemic increase in distress (mean = 1.1 standard deviation). Veterans with a larger pre-pandemic social network size and secure attachment style were less likely to experience increased distress, whereas veterans reporting more pre-pandemic loneliness were more likely to experience increased distress. Concerns about pandemic-related social losses, mental health COVID-19 effects, and housing stability during the pandemic were associated with increased distress, over-and-above pre-pandemic factors. CONCLUSIONS: Although most U.S. veterans showed resilience to mental health problems nearly 1 year into the pandemic, the prevalence of GAD positive screens increased, particularly among middle-aged veterans, and one of seven veterans experienced increased distress. Clinical implications of these findings are discussed.

Associations between transient and chronic loneliness, and depression, in the understanding society study.

OBJECTIVES: Loneliness has a long-established link with depression; however, patterns of loneliness, specifically transient (short-term) and chronic loneliness (longer-term), have seldom been researched in terms of their associations with depression and psychiatric distress. We investigated whether chronic loneliness could predict higher levels of psychiatric distress and higher chance of depression diagnosis (via self-report) than transient and no loneliness. METHODS: We used data from 18,999 participants in Waves 9 and 10 of the Understanding Society survey: a nationally representative study of adults in the United Kingdom. The study used a between-subjects, cross-sectional, design, where participants' scores on loneliness measures across two time points were combined to form patterns of loneliness, and participants were compared on their levels of psychiatric distress and depression diagnoses across the three loneliness groups: chronic loneliness (lonely at both time points), transient loneliness (lonely at one time point) and no loneliness. RESULTS: Regression analyses revealed that patterns of loneliness predicted both the likelihood of participants reporting a history of depression diagnosis and participants' levels of psychiatric distress. The chronic loneliness group had the highest likelihood of self-reported depression diagnosis and had the highest levels of psychiatric distress, compared to both the transient and no loneliness groups. Transient loneliness, in turn, predicted higher likelihood of reporting a history of depression diagnosis and higher levels of psychiatric distress than the no loneliness group. CONCLUSIONS: The study replicates and extends prior findings, suggesting that prolonged loneliness even over the course of one year is a risk factor for poorer mental health.

Understanding inequalities in mental health by family structure during COVID-19 lockdowns: evidence from the UK Household Longitudinal Study.

PURPOSE: The COVID-19 pandemic increased psychiatric distress and impacts differed by family structure. We aimed to identify mechanisms contributing to these inequalities. METHODS: Survey data were from the UK Household Longitudinal Study. Psychiatric distress (GHQ-12) was measured in April 2020 (first UK lockdown; n = 10,516), and January 2021 (lockdown re-introduced following eased restrictions; n = 6,893). Pre-lockdown family structure comprised partner status and presence of children (< 16 years). Mediating mechanisms included: active employment, financial strain, childcare/home-schooling, caring, and loneliness. Monte Carlo g-computation simulations were used to adjust for confounding and estimate total effects and decompositions into: controlled direct effects (effects if the mediator was absent), and portions eliminated (PE; representing differential exposure and vulnerability to the mediator). RESULTS: In January 2021, after adjustment, we estimated increased risk of distress among couples with children compared to couples with no children (RR: 1.48; 95% CI 1.15-1.82), largely because of childcare/home-schooling (PE RR: 1.32; 95% CI 1.00-1.64). Single respondents without children also had increased risk of distress compared to couples with no children (RR: 1.55; 95% CI 1.27-1.83), and the largest PE was for loneliness (RR: 1.16; 95% CI 1.05-1.27), though financial strain contributed (RR: 1.05; 95% CI 0.99-1.12). Single parents demonstrated the highest levels of distress, but confounder adjustment suggested uncertain effects with wide confidence intervals. Findings were similar in April 2020 and when stratified by sex. CONCLUSION: Access to childcare/schooling, financial security and social connection are important mechanisms that need addressing to avoid widening mental health inequalities during public health crises.

Psychiatric distress in family caregivers of patients with COVID-19.

PURPOSE: Many COVID-19 patients with low to moderate disease severity were cared for at home by family members. Caring for relatives with COVID-19 could have a psychiatric disorder for informal caregivers. Therefore, this study aimed to investigate the psychiatric disorders of family caregivers of relatives with COVID-19, in Iran. METHODS: This online survey was conducted with 350 family caregivers over 18 years from April to July 2020, which was guided by the STROBE checklist. The study survey consisted of socio-demographic items, 7-items fear of COVID-19 scale, and a 21-item version of the depression, anxiety, and stress scales. RESULTS: The mean (standard deviation) scores for depression, anxiety, and stress were 20 (0.40), 19.52 (0.39), and 19.72 (0.35), respectively, moreover for fear of COVID-19 was 20.33 (0.43). Of all family caregivers, 77.75%, 75%, and 80% had depression, anxiety, and stress, respectively. Sixty-nine percent of caregivers had fear with moderate to high severity. Being younger, married, having a health-related occupation, not exercising, and high monthly salary were significant predictors of the total score of depression, anxiety, and stress scale (P < 0.05). Further, being married, having a health-related occupation, and not exercising, having comorbidity, high income, and being younger were independent predictors of fear of COVID-19 (P < 0.05). Only 32% and 33% of the variance of total depression, anxiety, and stress, and fear of COVID-19 scores were predicted by the studied variables (p < 0.001). CONCLUSION: Our study demonstrated the high prevalence of psychiatric disorders in family caregivers, which requires swift and comprehensive attention from authorities.

Application of group smoothly clipped absolute deviation method in identifying correlates of psychiatric distress among college students.

BACKGROUND: College students are at an increased risk of psychiatric distress. So, identifying its important correlates using more reliable statistical models, instead of inefficient traditional variable selection methods like stepwise regression, is of great importance. The objective of this study was to investigate correlates of psychiatric distress among college students in Iran; using group smoothly clipped absolute deviation method (SCAD). METHODS: A number of 1259 voluntary college students participated in this cross-sectional study (Jan-May 2016) at Hamadan University of Medical Sciences, Iran. The data were collected using a self-administered questionnaire consisting of demographic information, a behavioral risk factors checklist and the GHQ-28 questionnaire (with a cut-off of 23 to measure psychiatric distress, recommended by the Iranian version of the questionnaire). Penalized logistic regression with a group-SCAD regularization method was used to analyze the data (α = 0.05). RESULTS: The majority of students were aged 18-25 (87.61%), and 60.76% of them were female. About 41% of students had psychiatric distress. Significant correlates of psychiatric distress among college students selected by group-SCAD included the average grade, educational level, being optimistic about future, having a boy/girlfriend, having an emotional breakup, the average daily number of cigarettes, substance abusing during previous month and having suicidal thoughts ever (P < 0.05). CONCLUSIONS: Penalized logistic regression methods such as group-SCAD and group-Adaptive-LASSO should be considered as plausible alternatives to stepwise regression for identifying correlates of a binary response. Several behavioral variables were associated with psychological distress which highlights the necessity of designing multiple factors and behavioral changes in interventional programs.

Psychiatric distress among aging decorated and non-decorated veterans: The role of impostorism and loneliness.

Objectives: The aging process may be affected by negative life events as well as social factors. Though psychological aspects of the aging process in veterans have been the focus of considerable research, decorated veterans have been scarcely investigated in this domain. The current study sought to assess psychiatric distress (PD) levels among aging decorated and non-decorated veterans' (DVs and n-DVs, respectively) and examine its association with the maladaptive perception that others will identify a high-achieving person as an impostor (i.e. impostorism) and perceived social isolation (i.e. loneliness).Methods: Two groups of Israeli veterans of the 1973 Yom Kippur War, DVs (n = 75) and n-DVs (n = 73), were assessed for PD and combat exposure in middle adulthood (1991; T1); in later life (2018; T2) they were assessed for negative life events, impostorism, loneliness and PD.Results: Impostorism, loneliness and PD were all inter-correlated. DVs evinced less PD at T1 and T2 than n-DVs but similar levels of impostorism and loneliness at T2. Nevertheless, negative life events, impostorism and loneliness explained PD at T2, with loneliness being more significant, especially among the n-DVs. Combat exposure did not explain variances in late-life PD.Conclusion: Aging DVs seem to be less vulnerable to late-life PD than n-DVs, and impostorism and loneliness may be important factors in this respect. Being the first study to investigate aging DVs' mental health and impostorism among aging veterans, the findings further underscore the clinical imperative of psychosocial factors in understanding aging veterans' mental health.

Mental health among head and neck surgeons in Brazil during the COVID-19 pandemic: A national study.

PURPOSE: Head and neck surgeons are among the highest risk for COVID-19 exposure, which also brings great risk to their mental wellbeing. In this study, we aim to evaluate mental health symptoms among head and neck surgeons in Brazil surrounding the time it was declared the epicenter of the virus. MATERIALS AND METHODS: A cross-sectional, survey-based study evaluating burnout, anxiety, distress, and depression among head and neck surgeons in Brazil, assessed through the single-item Mini-Z burnout assessment, 7-item Generalized Anxiety Disorder scale, 22-item Impact of Event Scale-Revised, and 2-item Patient Health Questionnaire, respectively. RESULTS: 163 physicians completed the survey (74.2% males). Anxiety, distress, burnout, and depression symptoms were reported in 74 (45.5%), 43 (26.3%), 24 (14.7%), and 26 (16.0%) physicians, respectively. On multivariable analysis, female physicians were more likely to report a positive screening for burnout compared to males (OR 2.88, CI [1.07-7.74]). Physicians 45 years or older were less likely to experience anxiety symptoms than those younger than 45 years (OR 0.40, CI [0.20-0.81]). Physicians with no self-reported prior psychiatric conditions were less likely to have symptoms of distress compared to those with such history (OR 0.11, CI [0.33-0.38]). CONCLUSION: Head and neck surgeons in Brazil reported symptoms of burnout, anxiety, distress and depression during our study period within the COVID-19 pandemic. Institutions should monitor these symptoms throughout the pandemic. Further study is required to assess the long-term implications for physician wellness.

Where does it hurt? Location of pain, psychological distress, and alexithymia among outpatients seeking psychotherapy.

Objectives: Physical pain is prevalent among psychiatric outpatients, yet there has been little research regarding the types of pain reported. The purpose of this study was to survey outpatients seeking psychotherapy regarding pain locations and to examine associations between number of pain locations and psychiatric distress and alexithymia.Methods: Two hundred and seventeen patients were recruited from three Canadian hospitals that offer outpatient psychiatry services and short-term therapies. Participants were surveyed about their current physical pain using the Brief Pain Inventory. Participants also completed measures of psychiatric distress (Brief Symptom Inventory-18) and alexithymia (Toronto Alexithymia Scale-20).Results: The three most commonly reported pain locations were lower back, head, and neck. Findings revealed that anxiety, depression and alexithymia were associated with number of reported pain locations. Specifically, participants with three or more pain locations reported significantly higher depression, anxiety and alexithymia in comparison to those with no pain.Conclusions: Back, head and neck pains are highly prevalent among psychiatric outpatients. Multiple pain sites may reflect higher levels of psychiatric distress and greater impairment in emotional processing among psychiatric outpatients.

Categorical and dimensional approaches in the evaluation of the relationship between attachment and personality disorders: an empirical study.

Although several studies have highlighted the relationship between attachment states of mind and personality disorders, their findings have not been consistent, possibly due to the application of the traditional taxonomic classification model of attachment. A more recently developed dimensional classification of attachment representations, including more specific aspects of trauma-related representations, may have advantages. In this study, we compare specific associations and predictive power of the categorical attachment and dimensional models applied to 230 Adult Attachment Interview transcripts obtained from personality disordered and nonpsychiatric subjects. We also investigate the role that current levels of psychiatric distress may have in the prediction of PD. The results showed that both models predict the presence of PD, with the dimensional approach doing better in discriminating overall diagnosis of PD. However, both models are less helpful in discriminating specific PD diagnostic subtypes. Current psychiatric distress was found to be the most consistent predictor of PD capturing a large share of the variance and obscuring the role played by attachment variables. The results suggest that attachment parameters correlate with the presence of PD alone and have no specific associations with particular PD subtypes when current psychiatric distress is taken into account.

Psychiatric Distress, Drug Use, and HIV Viral Load Suppression in Russia.

To explore the influence of psychiatric distress and substance use on viral load suppression in HIV-infected patients taking ART we analyzed socio-demographic characteristics, CD4+ cells count and viral loads, the Symptom Check List-90 and the Addiction Severity Index of 75 patients who had taken ART for at least 6 month. Using viral load data as the marker of ART success, we divided the sample into two groups. Comparison of the groups showed that education, marriage, and female gender are predictors of optimal viral load suppression. Overall results failed to demonstrate substance use and psychiatric distress as predictors of viral load suppression.

Burnout and Psychiatric Distress in Local Caregivers Two Years After the 2011 Great East Japan Earthquake and Fukushima Nuclear Radiation Disaster.

The 2011 Great East Japan Earthquake precipitated a triple disaster of earthquake, tsunami and nuclear radiation disaster. To quantify the prevalence of burnout and psychiatric distress in local healthcare providers (caregivers) more than 2 years after the disaster, this study surveyed caregivers from affected areas through interviews about topics of concerns and two questionnaires: Maslach Burnout Inventory and General Health Questionnaire. Concerns listed by respondents were primarily radiation related: additional stress, concern for children, concern for local food, and sleep difficulties. We found significant number of caregivers to have signs of emotional exhaustion, low personal accomplishment, and psychological distress. Our findings suggest that local caregivers are experiencing substantial mental health burdens, which have unfortunately remained static from the year prior, even 2 years after the fact. Therefore, long term psychological support and improvement in caregiver work conditions are essential to maintain sustainable care in rebuilding disaster stricken areas.

Joint Association of Active and Passive Smoking with Psychiatric Distress and Violence Behaviors in a Representative Sample of Iranian Children and Adolescents: the CASPIAN-IV Study.

BACKGROUND: Mental health and smoking have been receiving increasing attention in adolescents all over the world. Although some studies have assessed the independent association of active/passive smoking with mental health, joint association of active and passive smoking with mental health remains unclear. PURPOSE: This study was designed to evaluate the joint association of smoking status (active and passive smoking) with psychiatric distress and violent behaviors in Iranian children and adolescents. METHOD: In this national survey, 13,486 students, aged 6-18 years, living in rural and urban areas of 30 provinces of Iran were selected via multistage, cluster sampling method. Psychiatric distress (including worthless, angriness, worrying, insomnia, confusion, depression, and anxiety), violence behaviors (including bullying, victim, and physical fight), and smoking status (nonsmoker, only passive smoker, only active smoker, and active and passive smoker) were assessed. The questionnaire was prepared based on the World Health Organization Global School-based Student Health Survey (WHO-GSHS). Data were analyzed by the Stata package. RESULTS: Psychiatric distress and violent behaviors had linearly positive association with smoking status (p trend < 0.001). Compared to "nonsmoker" group, participants who were exposed to passive smoking besides active tobacco use were at increased risk of having angriness (odds ratio (OR) 2.55, 95 % confidence interval (CI) 1.86-3.48), worrying (OR 1.66, 95 % CI 1.24-2.20), and anxiety (OR 1.99, 95 % CI 1.52-2.61) and victim (OR 1.77, 95 % CI 1.34-2.33) and bully behaviors (OR 3.08, 95 % CI 2.33-4.07). CONCLUSION: The current findings suggest that active and passive tobacco smoking has synergistic effect on psychiatric distress. Since majority of smokers with psychiatric distress do not receive mental health services or counseling on smoking, strategies to address mental health problems and smoking prevention should be included as a part of school health services.

Psychosocial and vocational impact of an internship program for people diagnosed with severe mental illnesses.

PURPOSE: Unemployment is an obstacle in recovery for people with severe mental illnesses (SMI), both in reducing psychopathological symptoms and in achieving a high quality of life. The aim of this study was to explore the impact of an internship program for people diagnosed with SMI on psychosocial variables using a pre-test and post-test design. METHOD: Four scales were administered to a sample of 127 study participants, all of whom were diagnosed with SMI. The results of standard and sheltered employment outcomes were obtained by comparing the number and type of contracts gained by participants up to one year after program completion. A repeated measures ANOVA analysis was carried out with intervention being an independent intra-subject variable and type of participant diagnosis being a between-subjects variable. RESULTS: A limited increase in social functioning was found, as well as a significant decrease in psychiatric distress for users diagnosed with personality disorders. Participants in the internship program obtained a greater number of employment contracts than their peers who did not participate in the program, albeit with a low effect size. CONCLUSIONS: Though results were positive, extension of internship length and provision of more intensive counselling for participants may be useful.

An internship program for persons with severe mental illnesses yielded modest improvements in social functioning.A decrease in psychiatric distress in participants with personality disorders was found after the internships.Participants in the internship obtained a greater number of employment contracts.An extended internship programme with workplace support is likely to be beneficial.

Growing Up on the Edge: A Community-Based Mental Health Intervention for Children in Gaza.

The Gaza Strip is a notoriously high-conflict area, but few large-scale studies have examined the rates of psychiatric distress and emotional/behavioral problems among Gaza youth, and there are few trauma-informed, scaleable intervention options. Studies in existence have used smaller samples or have examined focal problems such as posttraumatic stress disorder (PTSD) or aggression. Here, we examine the mental health burden of young individuals (ages 8-13) in Gaza across a broad range of symptoms, and demonstrate the impact of a community-based, trauma-informed program, Eye to the Future. At the outset of this supportive youth program, over 2000 children and adolescent youth and their parents reported on child well-being using standardized measures with established global norms (the Child Behavior Checklist and Youth Self Report). These measures examine symptoms broadly (e.g. anxiety, depression, social problems, attention problems, aggression, etc.). Relative to U.S. population estimates, children in Gaza had between 2.5- and 17-times higher point prevalence of clinical mental health problems. The most significant clinical concern was anxiety, but overall, their symptoms were not confined to posttraumatic stress as a disorder and were instead broadly dispersed. However, these concerns were responsive to intervention: over the course of a six-month community psychosocial program, symptoms ameliorated, with approximately 50-70% showing reliable improvement at post-program (varying by measure). These gains were maintained in a 9-month follow-up. Future work should consider the broader mental health impact, beyond PTSD and aggression, and incorporate community supports into addressing mental health among children in the region.

Mallory-Weiss syndrome from giant gastric trichobezoar: A case report.

BACKGROUND: Mallory-Weiss syndrome (MWS), representing a linear mucosal laceration at the gastroesophageal junction, is a quite frequent cause of upper gastrointestinal bleeding, usually induced by habitual vomiting. The subsequent cardiac ulceration in this condition is likely due to the concomitance of increased intragastric pressure and inappropriate closure of the gastroesophageal sphincter, collectively inducing ischemic mucosal damage. Usually, MWS is associated with all vomiting conditions, but it has also been described as a complication of prolonged endoscopic procedures or ingested foreign bodies. CASE SUMMARY: We described herein a case of upper gastrointestinal bleeding in a 16-year-old girl with MWS and chronic psychiatric distress, the latter of which deteriorated following her parents' divorce. The patient, who was residing on a small island during the coronavirus disease 2019 pandemic lockdown period, presented with a 2-mo history of habitual vomiting, hematemesis, and a slight depressive mood. Ultimately, a huge intragastric obstructive trichobezoar was detected and discovered to be due to a hidden habit of continuously eating her own hair; this habit had persisted for the past 5 years until a drastic reduction in food intake and corresponding weight loss occurred. The relative isolation in her living status without school attendance had worsened her compulsory habit. The hair agglomeration had reached such enormous dimensions and its firmness was so hard that its potential for endoscopic treatment was judged to be impossible. The patient underwent surgical intervention instead, which culminated in complete removal of the mass. CONCLUSION: According to our knowledge, this is the first-ever described case of MWS due to an excessively large trichobezoar.

Investigating the potential association of temporary employment and job dissatisfaction with alcohol use disorder and depressive symptoms: a 13-wave longitudinal analysis.

BACKGROUND: There has been growing interest in protecting workers' mental health. Identifying social determinants that affect workers' mental health could play an important role in preventing psychiatric diseases. AIMS: We investigated the effects of temporary employment and job dissatisfaction on alcohol use disorder and depressive symptoms. METHOD: The Korea Welfare Panel Study data-set (2009-2021) was used, and 9611 participants with 52 639 observations were included. Generalised linear mixed models were employed to estimate odds ratios and 95% confidence intervals. The relative excess risk due to interaction (RERI) was calculated to assess supra-additive interactions between temporary employment and job dissatisfaction. RESULTS: Increased risks for depressive symptoms were observed among fixed-term workers (odds ratio 1.12, 95% CI 1.00-1.26) and daily labourers (odds ratio 1.68, 95% CI 1.44-1.95). Daily labourers were associated with an increased risk of alcohol use disorder (odds ratio 1.54, 95% CI 1.22-1.95). Job dissatisfaction was associated with alcohol use disorder (odds ratio 1.78, 95% CI 1.52-2.08) and depressive symptoms (odds ratio 4.88, 95% CI 4.36-5.46). This effect became stronger when workers were concurrently exposed to temporary employment and job dissatisfaction. Daily labourers with job dissatisfaction showed the highest risks for alcohol use disorder (odds ratio 2.99, 95% CI 2.21-4.03) and depressive symptoms (odds ratio 9.00, 95% CI 7.36-11.02). RERIs between daily employment and job dissatisfaction were >0 for alcohol use disorder (0.91, 95% CI 0.06-1.76) and depressive symptoms (3.47, 95% CI 1.80-5.14), indicating a supra-additive interaction. CONCLUSIONS: We revealed that temporary employment and job dissatisfaction had detrimental effects on alcohol use disorder and depressive symptoms.

The prevalence and psychological relation of problem shopping: data from a large-scale sample from Turkey.

BACKGROUND: The purpose of the present study was to comprehensively examine the measurement aspects, the prevalence, and the psychological correlates of problem shopping among a large-scale national sample of Turkish adults. RESULT: Participants (N = 24,380, 50% men, M age = 31.79 years, age range = 18-81 years) completed a questionnaire that comprised the Shopping Addiction Risk Questionnaire, the Brief Symptom Inventory, the Positive and Negative Affect Schedule, and the Experiences in Close Relationships-Revised. Results showed that 1.8% of the participants had probable shopping addiction. Being female, being younger, psychiatric distress, positive affect, negative affect, anxious attachment, and avoidant attachment were positive correlates of problem shopping. CONCLUSION: The results of this large sample size study suggest that shopping addiction is not a rare condition in Turkey. Further research is needed to understand different motives that underlie the problematic shopping behavior in the young and female population in comparison to older and male populations. Preventive programs or any interventions for people with PSB needs to address regulation difficulties and development of healthy strategies to cope with psychiatric distress.

Men's psychiatric distress in context: Understanding the impact of masculine discrepancy stress, race, and barriers to help-seeking.

This study examined perceived barriers to help-seeking as mechanisms by which masculinity may generate risk for psychiatric distress in men. An online sample of 558 men completed self-report measures of masculine discrepancy stress (i.e. distress about one's perceived gender nonconformity), barriers to help-seeking, and psychiatric distress. A significant indirect effect of masculine discrepancy stress on psychiatric distress emerged through perceived barriers to help-seeking; notably, this effect was stronger among Men of Color (vs White men). The promotion of optimal psychiatric functioning in men may necessitate interventions that target the effects of masculine socialization and race-related stress on help-seeking attitudes.

Living alone is associated with a higher prevalence of psychiatric morbidity in a population-based cross-sectional study.

Background: Living alone has been linked to poor mental health, however large-scale epidemiological studies on the association between living alone and psychiatric morbidity including depression and anxiety are lacking. The aim of this study was to investigate this issue in a large Taiwanese cohort. Methods: In this cross-sectional study, we enrolled 121,601 volunteers from 29 community recruitment stations in Taiwan and divided them into two groups based on whether or not they lived alone. Psychiatric morbidity was defined as a Generalized Anxiety Disorder 2-item score ≥ 3, Patient Health Questionnaire 2-item score ≥ 3, or self-reported depression. Logistic regression was used to explore the associations between living alone and psychiatric morbidity. Results: The participants who lived alone had a higher prevalence of psychiatric morbidity [odds ratio (OR) = 1.608, 95% confidence interval (CI) = 1.473 to 1.755] after adjusting for potential confounders. In a subgroup analysis, married subjects who lived alone and divorce/separation (OR = 2.013, 95% CI = 1.763 to 2.299) or widowing (OR = 1.750, 95% CI = 1.373 to 2.229) were more likely to have psychiatric morbidity than those who were married and not living alone. Conclusions: Our findings suggest that living alone is a risk factor for psychiatric morbidity, especially for married subjects who live alone in concordance with divorce, separation, or the death of a spouse.

Effect of Probiotics on Psychiatric Symptoms and Central Nervous System Functions in Human Health and Disease: A Systematic Review and Meta-Analysis.

BACKGROUND: The gut microbiota impacts on central nervous system (CNS) function via the microbiota-gut-brain axis. Thus, therapeutics targeting the gut microbiota such as probiotics have the potential for improving mental health. This meta-analysis synthesizes the evidence regarding the impacts of probiotics on psychological well-being, psychiatric symptoms and CNS functioning. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were applied for executing this review using the databases PubMed, Web of Science and Cochrane Library. The data were summarized at qualitative and quantitative level. RESULTS: Fifty-four randomized placebo-controlled studies were included, of which 30 were eligible for meta-analysis. If investigated, the probiotics mostly exerted effects on CNS function. Most probiotics did not affect mood, stress, anxiety, depression and psychiatric distress when compared to placebo at the qualitative level. At quantitative level, depression and psychiatric distress improved slightly in the probiotic condition (depression: mean difference -0.37 (95% CI: -0.55, -0.20); p ≤ 0.0001; psychiatric distress: mean difference -0.33 (95% CI: -0.53, -0.13); p = 0.001). CONCLUSIONS: To date it is unclear to which extent and in which specific areas next generation probiotics selected and developed for their ability to improve psychiatric condition and potentially other CNS functions are promising.