COVID-19 Related Fears of Patients Admitted to a Psychiatric Emergency Department during and Post-Lockdown in Switzerland: Preliminary Findings to Look Ahead for Tailored Preventive Mental Health Strategies

Background and Objectives: While the impact on mental health of 2019 coronavirus (COVID-19) has been extensively documented, little is known about its influence on subjective fears. Here, we investigate the COVID-19 impact and its related restrictions on fears of patients admitted to a psychiatric Emergency Department (ED) during and post-lockdown. Materials and Methods: A retrospective study on 1477 consultations at the psychiatric ED of the University Hospital of Geneva (HUG) was performed using a mixed-methods analysis. The first analysis section was qualitative, aiming to explore the type of fears, while the second section statistically compared fears (i) during lockdown (16 March 2020–10 May 2020) and (ii) post-lockdown (11 May 2020–5 July 2020). Fears were also explored among different patient-age sub-groups. Results: 334 patients expressed one/more fears. Both in lockdown and post-lockdown, fears mostly pertained to “containment measures” (isolation, loneliness). When compared lockdown vs. post-lockdown, fears about “work status” (deteriorating, losing work) prevailed in lockdown (p = 0.029) while “hopelessness” (powerless feeling, inability to find solutions) in post-lockdown (p = 0.001). “Self around COVID-19” (dying, getting sick) fear was relatively more frequent in youth (p = 0.039), while “hopelessness” in the elderly (p < 0.001). Conclusions: Collectively, these findings highlight that lockdown/post-lockdown periods generated temporally and demographically distinct COVID-19 related fears patterns, with special regard to youth and elderly, two particularly vulnerable populations when faced with sudden and unexpected dramatic events. For this reason, the particular ED “front-line service” status makes it a privileged observatory that can provide novel insights. From a mental health perspective, these latter can be translated into pragmatic, more personalized prevention strategies to reinforce specific resilience resources and mitigate the current and long-term pandemic’s impact.

Long-term observations on the mortality of mentally ill patients admitted to a short-stay psychiatric hospital: 23 years retrospective Egyptian study

Background Information about mortality patterns in different psychiatric populations is scanty, yet it is vital for designing successful preventive mental health strategies. In this study, we aimed to assess mortality rates and patterns for the patients admitted to Ain Shams University Institute of Psychiatry (ASUIP) with different psychiatric diagnoses from1990 to 2013. All medical records and related registration files were reviewed and investigated for death cases and their possible causes in a retrospective record linkage study. Data were recorded, tabulated, and coded to be used in the Statistical Package for Social Sciences (SPSS) Version 17. Results The study identified 57 death cases in 23-years duration with a mortality rate of 3/1000. Mortality rates were more in younger patients and females. Medical comorbidity was reported in 34.8% of them. The most common known causes for death in the current sample were cardiac causes 15.2%, followed by cerebrovascular causes that were 10.9%. However, sudden or unknown causes were the most frequent diagnosis in the sample. Conclusions The institute mortality rates were lower than those of the general population during this period. The most common known death causes were cardiovascular problems, which mandates close monitoring of high-risk psychiatric patients with co-morbid cardiac problems. Unknown morality causes represented an unresolved challenge for the current registration system and the quality of care given to patients with serious mental illness.

Emotional Intelligence as a Healthy Trained Coping Mechanism for Recovery and Empowerment in SARS COVID-19 Stress

The objective of the current article is to explore the emotional intelligence (EI) as a coping mechanism and training competence in the management of SARS COVID-19 pandemic stress in Albanian students. Methods we administered online is the Mayer-Salovey-Caruso emotional intelligence Test (MSCEIT) and The Scale of Impact of Stressful (Albanian version) for SARS COVID-19, that was standardized by the authors. Data were analyzed by SPSS v.26 and interpreted by Pearson correlation coefficient and t-test. The sample of respondents were 300 students (N=300) from 5 state universities in Albania, of whom 198 female (66%) and 102 male (34%) in range of 19-25 years. The results showed an inverse correlation between pandemic stress symptoms and self-awareness (r=-.765, p<0.01), pandemic stress symptoms and empathy (r=-.875, p<0.01) and between pandemic stress symptoms and social skills (r=-.456, p<0.01). These correlations suggest that the less emotional intelligence the more pandemic stress symptoms. That is, emotional intelligence is a healthy coping mechanism to be used to reduce the pandemic crisis emotions. This study supports the finding that training or treatment that increases emotional intelligence and its related subcategories in individuals should provide a mitigating effect on the crisis emotions of the COVID -19 pandemic stress. We suggest that better preventive mental health public training strategies can be a significant factor not only in reducing subjective distress but also in keeping the immune system strong and healthy.

Housing Instability and Depression among US Mothers Following a Nonmarital Birth

Mothers who had a nonmarital birth experience multiple risk factors for depression, including housing instability. Yet, important questions remain about the extent of long-term housing instability and its association with future depression among at-risk mothers. Using the Fragile Families and Child Wellbeing Study data, we examine cumulative housing instability over a 15-year period following nonmarital birth and its association with maternal depression. Based on a sample of 2279 mothers who had a nonmarital birth in 20 major US cities between 1998–2000, we examined their 15-year residential moves and housing arrangements. Then, we tested the associations between the cumulative residential moves and major depressive episodes (MDE) in Year 15 using logistic regression analysis. One in every four mothers had six or more residential moves in 15 years following a nonmarital birth. For each additional move, mothers reported up to 27.9% higher odds of having a past-year MDE in Year 15, translating into the prevalence increases from 6.0% (zero move) to 20.6% (10 moves). Our findings suggest that greater attention should be paid to housing needs among mothers following a nonmarital birth, including temporary housing assistance and more fundamental programs to reduce housing instability as preventive mental health services.

CAUSES AND CONSEQUENCES OF STIGMA LEADING TO MENTAL DISORDERS AMONG LEPROSY AFFECTED: KEY ELEMENTS IN THE PROCESS OF COUNSELLING TO IMPROVE MENTAL HEALTH CARE

In order to explore standardised approaches for preventive mental health care rather than treatment of diseases manifested, an action research was carried out on What are the unfulfilled needs of leprosy affected that are creating crisis situations and leading to mental health issues and a practicably affective process of counselling and the essential stages to be involved in carrying out in individual counselling of leprosy affected. The study was conducted in the counselling center of referral hospital of Gandhi Memorial Leprosy Foundation on 146 leprosy affected and counselling provided by trained counsellors in every monthly visit for MDT till declared RFT. Findings show the process of counselling practiced towards prevention of mental health problems may be illustrated as the following five essential stages viz. Rapport establishment, Identification of crisis situation, Diagnosis of Psycho-social problems and reasons thereof, Ascertaining of counselling needs, and Fulfilment of needs through counselling. Analysis shows the psychological problems are basically develop from cognition viz. lack of knowledge, lack of conviction, Lack of knowledge about Cure, Lack of conviction about known facts of cure, Fear of society/ family/ reactions/ deformities, loneliness- Lack of social support to the patient, possession of misconceptions of the patient or the family members or the community members who creates socio-behavioural problems which in turn cause psychological problems. Maintenance of mental health starts from identification of needs and fulfilment which otherwise need to mental problems. The study concludes that a systematic counselling along with leprosy treatment can be a successful method to prevent the mental health problems prior to reaching the stage of needing treatment.

Digital Prompts to Increase Engagement with Stress Regulation among Parents: Feasibility and Acceptability Evaluation (Preprint)

BACKGROUND Given the interrelated health of children and parents, strategies to promote stress regulation are critically important in the family context. Yet, uptake of preventive mental health is limited among parents due to competing family demands. OBJECTIVE We examined the feasibility and acceptability of a mobile-based intervention designed to engage parents with the Headspace app and stress regulation (ie, mindfulness) within the context of everyday life. METHODS A 30-day pilot micro-randomized trial (MRT) was conducted among a sample of parents who use Android phones. Each day during a parent-specified timeframe, participants had a 50% probability of receiving a prompt with a message encouraging them to engage in a mindfulness activity using a commercial app, Headspace. In the 24 hours following randomization, ecological momentary assessments (EMA) and passively collected phone data were used to assess proximal engagement (yes/no) with: a) the app, and b) any mindfulness activity (with or without the app). This data was combined with baseline and exit surveys to determine feasibility and acceptability. RESULTS Over 4-months, we enrolled 16 parents. Response rate to EMA was 72.4% (165 responses/228 pushed). Most participants perceived the prompts as a general reminder (9/10, 90%) to engage in mindfulness, rather than helpful (2/10, 20%) or annoying (2/10, 20%). Only 60% (6/10) reported that the timing of prompts was helpful despite having control over the delivery window. Average time from prompt delivery to participant action (either launch the app or dismiss notification) was 185 minutes. Across participants (7/8, 87.5%), we observed higher app usage on days with prompts (31/62 days, 50%), as opposed to days without prompts (33/103 days, 32%). Time spent using the app on days with prompts (M=566 seconds, SD=378) was descriptively higher than on days without prompts (M=225 seconds, SD=276). App usage was highest during the first week and declined over each of the remaining three weeks. However, self-reported engagement in mindfulness activities without the app increased over time. Self-reported engagement with any mindfulness activity was similar on days with (40/62 days, 65%) and without (65/103 days, 63%) prompts. There was no observable change in emotional affect. All participants found the Headspace app helpful (10/10, 100%) and most would recommend the program to others (9/10, 90%). CONCLUSIONS Our findings indicate that a mobile-based intervention leveraging prompts and a commercial app to engage parents in stress regulation was feasible and acceptable. Results suggest that parents are more likely to engage with an app for a longer duration when prompted. Our findings can further inform the design of a just-in-time adaptive intervention (JITAI) for stress regulation of parents. CLINICALTRIAL N/A

Online Indicated Preventive Mental Health Interventions for Youth: A Scoping Review

Objective: Between the ages of 12 and 25 the onset of mental disorders typically occurs, and the burden of mental health problems is greatest for this group. Indicated preventive interventions to target individuals with subclinical symptoms to prevent the transition to clinical levels of disorders have gained considerable traction. However, the threshold to seek help appears to be high even when help is needed. Online interventions could offer a solution, especially during the COVID-19 pandemic. This scoping review will present an overview of the recent research of indicated online preventive interventions for youth (12–25 years) experiencing the early stages of mental health complaints with the aim of identifying the nature and extent of the research evidence.Methods: The 5-stage framework by Arksey and O'Malley was used. Academic literature published from 2013 onwards in printed or electronic format was included from Scopus, PsychINFO, and Ovid MEDLINE(R) ALL.Results: The search yielded 11,122 results, with the final selection resulting in inclusion of 30 articles for this review. In total, the articles included 4,950 participants. 26.7% of the selected articles focused on youth between 12 and 25 years. Of the articles 60% did not screen for, nor exclude participants with clinical levels of symptoms. Most studies used a common evidence-based therapy for the disorder-category targeted. More than half of the online interventions included some form of human support. Adherence levels ranged between 27.9 and 98%. The results indicate general effectiveness, usability and acceptability of online indicated preventive interventions. The most commonly used approach was CBT (n = 12 studies). Studies varied in their size, rigor of study, effectiveness and outcome measures. Online interventions with a combination of clinical and peer moderation (n = 3 studies) appear to result in the most stable and highest effect sizes.Conclusion: Online indicated preventive mental health interventions for youth with emerging mental health issues show promise in reducing various mental health complaints, and increasing positive mental health indicators such as well-being and resilience. Additionally, high levels of usability and acceptability were found. However, the included studies show important methodological shortcomings. Also, the research has mainly focused on specific diagnostic categories, meaning there is a lack of transdiagnostic approaches. Finally, clear definitions of- as well as instruments to measure- emerging or subclinical mental health symptoms in youth remain are missing.

Self-Rated Mentalizing Mediates the Relationship Between Stress and Coping in a Non-Clinical Sample

Background The clinical concept of mentalizing has recently been extended into non-clinical contexts. In particular, the protective function of robust mentalizing as a processing capacity of interpersonal and intrapsychic events has become a focus of consideration. Theoretical approaches hypothesize that mentalizing may allow for an adequate self-awareness in the face of aversive experiences such as stress, leading to a reappraisal of these experiences and therefore enables the use of adaptive coping behaviors. Objective The study aimed to investigate the association between coping behavior, mentalizing and experiences of stress. Method 534 healthy adults completed the German-language Stress Processing Questionnaire (SVF), the Mentalization Questionnaire (MZQ), and a short scale of the Trierer Inventory of Chronic Stress (TICS) in a cross-sectional research design. Results Correlational analyses suggested associations between coping and mentalizing. Furthermore, MZQ scores predicted both positive and negative coping behavior. The relationship between stress and both negative and positive coping was mediated by mentalizing capacity. Conclusion Findings confirm the hypothesis that mentalizing may represent a coping resource within a resilience framework. An implementation of the concept in preventive mental health interventions is discussed.

Hi, Can I Help? Exploring How to Design a Mental Health Chatbot for Youths

Chatbots represent new opportunities for low-threshold preventive mental health support to youths. To provide needed knowledge regarding how to design chatbots for this purpose, we present an exploratory design study where we designed and evaluated a prototype chatbot to complement the work of school nurses in the school health service. The prototype was designed with particular regard for preventive mental health support. The design process involved school nurses, digital health workers, and youths. Through user insight activities, we identified four types of support to be provided through the chatbot: informational, relational, processual, and referral. We explored these four types of support through concept development and prototyping. These results are discussed as a potential basis for a framework for understanding youths’ needs regarding chatbots for preventive mental health support. When discussing the study findings, we point out how the study contributes to theory and practice and suggest avenues for future research.

Effects of COVID-19 Outbreak on Children’s Mental Health: A Comparative Study with Children Diagnosed and Isolated from Their Parents

Background The current study aimed to compare the psychological responses of children exposed to different levels of stress during COVID-19 outbreak. Anxiety levels, negative thoughts, and quality of life of COVID-19 positive children (Child + group, n = 17), COVID-19 negative children who are isolated from their COVID-19 positive parent(s) (Parent + group, n = 59), and a control group (n = 64) were compared. Methods The participants completed a sociodemographic data form, the Screen for Child Anxiety and Related Disorders (SCARED), the Children’s Negative Cognitive Errors Questionnaire (CNCEQ), and the Pediatric Quality of Life Inventory (PedsQL). Results The statistical analysis of the data obtained from the three groups revealed that the Parent + group recorded higher SCARED and CNCEQ scores and lower PedsQL scores in comparison to the control group. No statistically significant difference was found between the Child + group scores and the control group. It was observed that high CNCEQ scores and low PedsQL scores in the Parent + group predicted an increase in the SCARED scores. Conclusions Our study indicates that isolating children from their parents during the COVID-19 outbreak negatively influences their mental health and causes an increase in their anxiety levels. In addition, the results of the study highlight that preventive mental health measures should be applied for children separated from parents during pandemics.