Biomedical Perspectives of Acute and Chronic Neurological and Neuropsychiatric Sequelae of COVID-19

: The incidence of infections from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the etiologic agent for coronavirus disease 2019 (COVID-19), has dramatically escalated following the initial outbreak in China in late 2019, resulting in a global pandemic with millions of deaths. Although the majority of infected patients survive, and the rapid advent and deployment of vaccines have afforded increased immunity against SARS-CoV-2, long term sequelae of SARS-CoV-2 infection have become increasingly recognized. These include, but are not limited to, chronic pulmonary disease, cardiovascular disorders, and proinflammatory-associated neurological dysfunction that may lead to psychological and neurocognitive impairment. A major component of cognitive dysfunction is operationally categorized as “brain fog” which comprises difficulty with concentration, forgetfulness, confusion, depression, and fatigue. Multiple parameters associated with long-term neuropsychiatric sequelae of SARS-CoV-2 infection have been detailed in clinical studies. Empirically elucidated mechanisms associated with the neuropsychiatric manifestations of COVID-19 are by nature complex, but broad based working models have focused on mitochondrial dysregulation leading to systemic reductions of metabolic activity and cellular bioenergetics within CNS structures. Multiple factors underlying the expression of brain fog may facilitate future pathogenic insults leading to repetitive cycles of viral and bacterial propagation. Interestingly, diverse neurocognitive sequelae associated with COVID-19 are not dissimilar from those observed in other historical pandemics, thereby providing a broad and integrative perspective on potential common mechanisms of CNS dysfunction subsequent to viral infection. Poor mental health status may be reciprocally linked to compromised immune processes and enhanced susceptibility to infection by diverse pathogens. By extrapolation, we contend that COVID-19 may potentiate the severity of neurological/neurocognitive deficits in patients afflicted by well-studied neurodegenerative disorders such as Alzheimer's disease and Parkinson’s disease. Accordingly, the prevention, diagnosis, and management of sustained neuropsychiatric manifestations of COVID-19 are pivotal health care directives and provide a compelling rationale for careful monitoring of infected patients, as early mitigation efforts may reduce short- and long-term complications.

Escalation of Suicide Amidst The COVID-19 Pandemic in Malaysia: Progressive Strategies for Prevention

The COVID-19 global health crisis has inflicted a tremendous amount of mental tribulation, especially in developing nations1. Since the COVID-19 outbreak has been declared as a public health crisis, many countries across the South Asian region reported a sharp increase in suicide cases. For instance, suicide cases in Thailand, Singapore, and Nepal have surged tremendously during the outbreak of COVID-19. Thailand health officials revealed that 2,551 suicide cases were reported in the first half of 2020, which is a 22% increment from the same period in 20192. In parallel, Singapore reported 452 suicides in 2020, the nation's highest number of cases since 2012, amid the isolation and psychological distress brought about by the COVID-19 pandemic3. Furthermore, in Nepal, the number of suicide cases increased by almost 25% compared with previous years amidst the COVID-19 outbreak, whereby 559 suicide incidents occurred every month4. In Malaysia, there has been a dramatic upsurge in suicide cases since the beginning of the COVID-19 outbreak in January 2020. According to recent statistics by the Royal Malaysian Police Department, a total of 631 suicide cases were recorded in 2020 and 468 cases were reported between January to May 20215. Compared to the year 2019, suicide cases in Malaysia almost doubled on average in all age categories in the 5 months of 2021 that is 94 cases per month compared to 51 cases per month in 20195. The increased psychological distress and poor mental health status amidst COVID-19 supports the escalating suicide mortality subjectively. Hence, this unexpected pandemic situation demands a comprehensive framework for tackling the massive upsurge of suicide among people from developing countries. In line with that, the aim of this viewpoint is to revisit the efforts implemented by the current Malaysian government and propose several prevention strategies to combat suicide during this global health crisis.

Relationship between Internet Addiction and Poor Mental Health among Japanese Adolescents

Background: Internet addiction and poor mental health are two pervasive problems during adolescence. This study aimed to determine whether Internet addiction and poor mental health status exhibited a bidirectional relationship in which either variable could become a risk factor for the onset of the other. Methods: Longitudinal school-based survey with a baseline sample of 1547 students among 8 schools (10th graders) in Japan surveyed in 2015 and followed up 1 year later. The schools are located in the middle city. We assessed internet addiction using the Japanese version of the Diagnostic Questionnaire developed by Young and mental health status using the 12-item General Health Questionnaire. Regression analyses including the covariates tested whether Internet addiction was related to the onset of poor mental health among youth who had never internet addiction, and poor mental health was related to the onset of internet addiction. Results: The incidence for Internet addiction and poor mental health during one year were 22.0% and 8.8%, respectively. Multiple regression analyses showed that poor mental health (adjusted odds ratio: 2.17 [95%CI: 1.45–3.25]) promoted new onset of Internet addiction and Internet addiction (adjusted odds ratio: 2.39 [95%CI: 1.36–4.20]) also promoted new onset of poor mental health. Conclusion: Internet addiction and poor mental health status each increased the risk of onset of the other. Adolescents, their parents and schools need to take policies to use properly Internet.

Convenience Store Use and the Health of Urban Adolescents in Seoul, South Korea

To improve urban adolescents’ dietary behaviors and health, factors that influence them to buy meals in convenience stores with regard to urban food environments must be determined. This study investigated the factors which influence adolescents’ substitution of meals with convenience store meals and its impact on their health in Seoul (South Korea). Multilevel analysis and logistic regression analysis were conducted using data from the Korea Youth Risk Behavior Survey, a national health survey with a representative sample of Korean adolescents. Among 17,624 teenagers who responded to surveys in 2017 and 2019, 30.5% of them substituted meals with convenience store meals more than three times a week. Girls and students with a lower family economic level were more likely to frequently consume food from convenience stores. Unhealthy lifestyles and poor mental health status also influenced their decisions to substitute meals with convenience store food. Those who frequently consumed meals from convenience stores were more likely to have unhealthy lifestyles, featuring bad diets, smoking, drinking, and sedentary behaviors. They also reported significantly poorer self-rated health and mental health. To promote healthy lifestyles among adolescents, efforts to raise awareness and develop supportive environments for healthy diets are strongly recommended.

Depression, sleeping pattern & suicidal ideation among medical students in Bangladesh: A cross-sectional pilot study

Background: Depression is a major morbidity and the most common mental disorder among the medical students in medical schools globally. Undergraduate students suffer stress more due to their academic curriculum than the students of other faculties. In low resource settings like Bangladesh, there is a dearth in research on mental health of undergraduate medical students. This pilot study was conducted to add to the existing limited evidence by reporting the prevalence of depression, describing sleeping pattern & suicidal tendencies among medical students. Relevantly, we have investigated to the overall mental health status among the medical students in Bangladesh. Methods: This cross-sectional study was conducted in two medical colleges of Dhaka in between July 2013 to December 2013, among 221 Bangladeshi medical students from first to fifth year. By convenient sampling technique, data were collected by a pretested, structured, self-administered questionnaire and analysis was done by SPSS 18.0 version. Depression were assessed by validated PHQ-9 tool among the respondents. Goldberg’s General Health Questionnaire (GHQ-28) was used for assessing overall mental health status. Results: Depression was found in 38.9% of participants with 3.6%, 14.5%, 20.8% of being either severe, moderate and mild depression respectively. 17.6% medical students had suicidal tendency or attempted suicide at least for once after attending medical school. The sleeping hours were inadequate and altered after starting this stressful academic course. 33.5% medical students had poor mental health status. There was a statistically significant association between poor mental health status with age group of less than 22 years and initial academic study year (1st to 3rd of MBBS).Conclusion: The findings are suggestive of a higher prevalence of depression among early year medical students and marginal predominance in males. Suicidal tendency is also higher. These calls for further investigation with situation analysis, qualitative explorations and surveys to explore the burden of such disorders in Bangladesh.

Migration and Mental Health in the Aftermath of Disaster: Evidence from Mt. Merapi, Indonesia

Migration is a standard survival strategy in the context of disasters. While prior studies have examined factors associated with return migration following disasters, an area that remains relatively under explored is whether moving home to one's original community results in improved health and well-being compared to other options such as deciding to move on. In the present study, we seek to address this gap in the literature through examining whether return migration, compared to other migration options, results in superior improvements to mental health. We draw upon data from a pilot study conducted 16 months after a series of volcanic eruptions in Merapi, Indonesia. Using ordinal logistic regression, we find that compared to respondents who were still displaced, respondents who had ``moved home'' were less likely to report poor mental health status (OR = 0.50 [95\% CI = 0.26, 0.95]). Likewise, respondents who had ``moved on'' were less likely to report poor mental health status (OR = 0.38 [95\% CI = 0.13, 1.04]). The results suggest that while moving home was an improvement from being displaced, it may have been better to move on, as this yielded superior associations with self-reported mental health.

The Association of Poor Mental Health Status and Sociocultural Factors in Men: A Population-Based Study in Tehran, Iran

Mental ill-health has increased among Iranian men in the recent years. Mental health is complexly determined by sociocultural, psychological, demographic characteristics, and some health-risk behaviors such as smoking. This study aimed to explore the association(s) between demographic factors, smoking status, social capital, and poor mental health status in a sample of Iranian men. The data were derived from a survey titled “Urban Health Equity Assessment and Response Tool–2” in Tehran, Iran ( n = 11,064). A multistage sampling method was applied in the study. The General Health Questionnaire–28 was used to assess poor mental health status (range = 0-84, scores higher than 23 indicated poor mental health status). The data were analyzed using t test, chi-square test, and multivariate logistic regression. The means of age and family size were 47.14 ± 17.26 years (range = 20-91) and 3.54 ± 1.32 individuals (range = 1-15), respectively. The majority of the participants were employed (57%, n = 6,361). The prevalence of poor mental health was 36.36%, 95% confidence interval (CI) [35.46, 37.26]. The components of social capital were positively associated with poor mental health status. Family size (adjusted odds ratio [AOR] = 0.93; 95% CI [0.90, 0.96]), job status (unemployed vs. employed, AOR = 1.34; 95% CI [1.16, 1.55]), marital status (widowed and divorced vs. single, AOR = 1.09; 95% CI [1.02, 1.17]), education level (illiterate vs. academic, AOR = 1.18; 95% CI [1.09, 1.29]), and smoking status (smokers vs. nonsmokers, AOR = 1.46; 95% CI [1.31, 1.62]) were directly associated with poor mental health status in the logistic regression model. These results suggest that social capital could be an important approach for men to attain suitable mental health and reduce mental disorders. The high prevalence of poor mental health in men merits more attention in mental health policy and program planning.