Meta-analysis of risk factors associated with suicidal ideation after stroke

Background Over the past decade, increasing attention has been paid on post stroke suicide (PSS), which is one of complications of stroke. The rates of stroke and suicide are relatively high, especially in Asian populations. Thus, a deeper understanding of the prevalence and epidemiological impact of suicide after stroke is urgently needed. Clinical diagnosis and prevention of PSS are at the incipient stage, but the risk factors responsible for the occurrence of PSS in different regions and stages of the disease remain largely unknown. The present meta-analysis aimed to determine the incidence of PSS at different stages and time courses, and to identify the underlying risk factors for PSS. Methods We systematically searched the Cochrane library, Embase, PubMed, CNKI and Web of Science databases from their inception until April 2019.The research articles reporting on the risk factor for PSS were screened and included in the meta-analysis. The data from the included studies were extracted according to the predefined criteria. Results A total of 12 studies (n = 2,693,036) were included for meta-analyses. Of these studies, 7 reporting suicide prevalence were meta-analyzed. The pooled estimate of suicidal ideation rates after stroke was 12%, which could be influenced by multiple risk factors, including sex, smoking, depression, sleep disorders, previous stroke and low household income. Studies conducted in Asia demonstrated higher suicide prevalence (approximately 15%) compared to other regions. Smoking, low family income, depression, heart disease and sleep disorders were important risk factors for PSS. When compared to PSS of more than 1 year, the incidence of suicide within 1 year after stroke was more likely to be statistically significant. It was found that 4 out of every 1000 stroke survivors tended to commit suicide. The results of this meta-analysis showed that depression (OR = 2.32; p < 0.01) was significantly associated with suicidal ideation, regardless of stroke duration. Conclusion PSS is one of the common complications of stroke. Despite some limitations, we successfully identified the risk factors associated with suicidal ideation after stroke. Notably, depression was significantly associated with suicidal ideation, regardless of stroke duration. Targeting this risk factor may be helpful to improve stroke patient care and prevent suicidal ideation after stroke. Future research will be carried out to assess whether suicidal ideation or thoughts and actual suicide attempts are strongly predictive of suicide deaths after stroke (Registration No. CRD42019128813).

Anaclitic-sociotropic and introjective-autonomic personality dimensions and depressive symptoms: a systematic review

Sociotropy (anaclitic) and autonomy (introjective) are conceptualised as two personality dimensions that confer vulnerability to depression. According to Blatt and Beck’s theories, sociotropic individuals exhibit distinctive patterns of symptoms such as prominent anxiety, depressed mood, helplessness, crying and somatic concerns, while self-critical ones seem to exhibit a pattern of symptoms including prominent guilt, hopelessness, feelings of failure and worthlessness and other cognitive symptoms.This systematic review was performed with the aim of investigating whether and to what extent psychological dimensions of anaclitic-sociotropic and introjective-autonomy are related to a specific core of depressive symptoms. The search was conducted in three databases (PubMed, PsycINFO and Scopus) and 27 articles were selected.Results showed a weak association between somatic symptoms and dependent personality traits, while the relationship between self-criticism and cognitive symptomatology was significantly higher. These findings are discussed in the context of future research, necessary to corroborate the existence of a form of depression characterised by somatic features usually ignored by diagnostic criteria, essential to direct psychological treatments to these depressive personality differences.

Association between schizoid tendencies and aggressive behaviors: mediating and moderating influences in childhood trauma and life events among Chinese adolescents

Background This study investigated an association between schizoid tendencies and aggressive behaviors in Chinese adolescents, and explored the underlying mechanism. Methods The data of 3094 adolescents aged 12 to 16 years were collected from an epidemiological survey in China. All the subjects or their parents completed the Achenbach’s Child Behavior Checklist, the Childhood Trauma Questionnaire-Short Form, and the Adolescent Self-rating Life Event Checklist (ASLEC). Results Relative to the non-schizoid group, adolescents with schizoid tendencies (male or female) showed significantly higher scores for aggressive behaviors, emotional abuse, and ASLEC. Regarding females only, those with schizoid tendencies had significantly higher (lower) scores for physical abuse and emotional neglect (physical neglect). The aggressive behaviors score was predicted by scores for schizoid tendencies (βmale = 0.620, βfemale = 0.638, both P < 0.001) and ASLEC (βmale = 0.125, βfemale = 0.061, both P < 0.01), and by childhood trauma score (males: emotional neglect [β = 0.045, P = 0.021]; females: emotional abuse and sexual abuse [β = 0.118 and − 0.062, both P < 0.01]). The ASLEC and childhood trauma scores mediated the association between scores for schizoid tendencies and aggressive behaviors, specifically, emotional neglect (emotional abuse and sexual abuse) in males (females). In females, the interaction between scores for childhood trauma and ASLEC affected the aggressive behaviors score (P = 0.023). Conclusions Schizoid tendencies are associated with aggressive behaviors among Chinese adolescents. Recent life events and childhood trauma mediated an association between schizoid tendencies and aggressive behaviors. The interaction between childhood trauma and recent life events affected aggressive behaviors in females. Aggressive behaviors in adolescents may be ameliorated by reducing childhood trauma and life events.

Association between clinical symptoms and apolipoprotein A1 or apolipoprotein B levels is regulated by apolipoprotein E variant rs429358 in patients with chronic schizophrenia

Background The apolipoprotein E (ApoE) gene polymorphisms are correlated with blood lipid levels and several neuropsychiatric symptoms. Therefore, this study aimed to examine whether the ApoE rs429358 affected the development and clinical symptoms of schizophrenia and to explore the relationship between apolipoproteins levels and clinical symptoms. Methods The ApoE rs429358 was genotyped using a case–control design. The Positive and Negative Syndrome Scale (PANSS) was employed to evaluate the psychopathology of all patients. Results A total of 637 patients with schizophrenia and 467 healthy controls were recruited. We found no significant differences in the genotype and allele distribution between the patient and control groups. A significant correlation between PANSS negative symptoms and ApoA1 levels (p = 0.048) or ApoB levels (p = 0.001) was found in patients with schizophrenia, which was also confirmed by linear regression analyses (p = 0.048 vs. p = 0.001). Interestingly, only in the T homozygote group, ApoA1 and ApoB levels were predictors of the PANSS negative symptom score (p = 0.008 vs. p = 0.012), while in the C allele carrier group, no correlation was observed. Conclusions This study found that the levels of ApoA1 and ApoB were negatively associated with negative symptoms of patients with schizophrenia. Furthermore, the association between ApoA1 or ApoB levels and psychopathology of schizophrenia was regulated by ApoE rs429358.

Prevalence and determinants of depression among old age: a systematic review and meta-analysis

Background Depression is a leading cause of disability worldwide and is a major contributor to the overall global burden of disease. It is also one of the most common geriatric psychiatric disorders and a major risk factor for disability and mortality in elderly patients. Even though depression is a common mental health problem in the elderly population, it is undiagnosed in half of the cases. Several studies showed different and inconsistent prevalence rates in the world. Hence, this study aimed to fill the above gap by producing an average prevalence of depression and associated factors in old age. Objective This study aims to conduct a systematic review and meta-analysis to provide a precise estimate of the prevalence of depression and its determinants among old age. Method A comprehensive search of PubMed, Scopus, Web of sciences, Google Scholar, and Psych-info from database inception to January 2020. Moreover, the reference list of selected articles was looked at manually to have further eligible articles. The random-effects model was employed during the analysis. Stata-11 was used to determine the average prevalence of depression among old age. A sub-group analysis and sensitivity analysis were also run. A graphical inspection of the funnel plots and Egger’s publication bias plot test were checked for the occurrence of publication bias. Result A search of the electronic and manual system resulted in 1263 articles. Nevertheless, after the huge screening, 42 relevant studies were identified, including, for this meta-analysis, n = 57,486 elderly populations. The average expected prevalence of depression among old age was 31.74% (95% CI 27.90, 35.59). In the sub-group analysis, the pooled prevalence was higher among developing countries; 40.78% than developed countries; 17.05%), studies utilized Geriatrics Depression Scale-30(GDS-30); 40.60% than studies that used GMS; 18.85%, study instrument, and studies having a lower sample size (40.12%) than studies with the higher sample; 20.19%. Conclusion A high prevalence rate of depression among the old population in the world was unraveled. This study can be considered as an early warning and advised health professionals, health policymakers, and other pertinent stakeholders to take effective control measures and periodic care for the elderly population.

Mortality gap and physical comorbidity of people with severe mental disorders: the public health scandal

Background Patients suffering from severe mental disorders, including schizophrenia, major depression and bipolar disorders, have a reduced life expectancy compared to the general population of up to 10–25 years. This mortality gap requires urgent actions from a public health perspective in order to be reduced. Main text Factors associated with the high mortality rates in patients with severe mental disorders can be grouped into four groups: those related to the patients, to psychiatrists, to other non-psychiatrist medical doctors and to the healthcare system. Each of these factors should become the target of specific and dedicated interventions, in order to reduce the morbidity and mortality rate in patients with severe mental disorders. All these elements contribute to the neglect of physical comorbidity in patients with severe mental. In particular, the long-standing separation of psychiatry from other branches of medicine and the lack of specific training on this issue further contribute to the poor attention dedicated to management of physical comorbidities. Recently, several professional associations have invited national bodies regulating education of healthcare professionals to include the management of physical health of people with severe mental disorders in undergraduate and postgraduate educational programs. Conclusions The premature mortality in patients with severe mental disorders is a complex phenomenon resulting by the interaction of several protective and risk factors. Therefore, a multilevel approach is needed, in which the different stakeholders involved in health care provision establish workforces for the long-term management of physical and mental health conditions.

A case of catatonia in the aftermath of the COVID-19 pandemic: does autism spectrum matter?

Background There is growing concern about the psychopathological consequences of the COVID-19 pandemic. The prolonged stress due to the spreading fear of the contagion and to the enforced containment measures are deemed to trigger recurrences of preexisting mental disorders as well as the onset of new ones. From such perspective, clinical cases may be of primary ground to identify individual features and pandemic-related factors predisposing to the development of serious psychiatric symptoms. Case presentation Mr. R. is a 64-year-old, married, unemployed man, whose premorbid personality was characterized by relevant autistic traits. The patient developed catatonia in the context of the COVID-19 pandemic. We aimed at discussing the role of both preexisting and precipitating factors. Conclusions Autism spectrum could represent a predisposing factor for severe psychopathological outcome and catatonia. Furthermore, the present clinical case highlights the role of COVID-19 pandemic in influencing physical and mental health.

Digital conversations about depression among Hispanics and non-Hispanics in the US: a big‐data, machine learning analysis identifies specific characteristics of depression narratives in Hispanics

Background Digital conversations can offer unique information into the attitudes of Hispanics with depression outside of formal clinical settings and help generate useful information for medical treatment planning. Our study aimed to explore the big data from open‐source digital conversations among Hispanics with regard to depression, specifically attitudes toward depression comparing Hispanics and non-Hispanics using machine learning technology. Methods Advanced machine‐learning empowered methodology was used to mine and structure open‐source digital conversations of self‐identifying Hispanics and non-Hispanics who endorsed suffering from depression and engaged in conversation about their tone, topics, and attitude towards depression. The search was limited to 12 months originating from US internet protocol (IP) addresses. In this cross-sectional study, only unique posts were included in the analysis and were primarily analyzed for their tone, topic, and attitude towards depression between the two groups using descriptive statistical tools. Results A total of 441,000 unique conversations about depression, including 43,000 (9.8%) for Hispanics, were posted. Source analysis revealed that 48% of conversations originated from topical sites compared to 16% on social media. Several critical differences were noted between Hispanics and non-Hispanics. In a higher percentage of Hispanics, their conversations portray “negative tone” due to depression (66% vs 39% non-Hispanics), show a resigned/hopeless attitude (44% vs. 30%) and were about ‘living with’ depression (44% vs. 25%). There were important differences in the author's determined sentiments behind the conversations among Hispanics and non-Hispanics. Conclusion In this first of its kind big data analysis of nearly a half‐million digital conversations about depression using machine learning, we found that Hispanics engage in an online conversation about negative, resigned, and hopeless attitude towards depression more often than non-Hispanic.

Worldwide initiatives aimed to train professionals in the use of the ICD-11

Background The chapter on mental disorders of the 11th revision of the International Classification of Diseases (ICD-11) has been now finalized. Training of mental health professionals in the use of the chapter is taking place worldwide. Main body of the abstract Information is provided on the ICD-11 training courses taking place recently, including that co-organized by the Naples World Health Organization (WHO) Collaborating Centre on Research and Training in Mental Health and the European Psychiatric Association; those which will be held in the next few months, such as the one co-organized by the World Psychiatric Association and the Global Mental Health Academy, to be held online from 8 to 29 November 2021; and the training course set up by the WHO Collaborating Centre on Mental Health at the Columbia University, in collaboration with the WHO Department of Mental Health and Substance Use, which can be accessed only by the members of the WHO Global Clinical Practice Network. Conclusion Psychiatrists of all countries of the world are encouraged to become familiar with the ICD-11 chapter on mental disorders, which will be adopted shortly by most countries worldwide.

The factor structure and psychometric properties of the Chinese version of the Positive and Negative Suicide Ideation Inventory (PANSI-C) in a non-clinical sample of Chinese adolescents

Backgrounds The Positive and Negative Suicide Ideation (PANSI) Inventory is a widely used self-report questionnaire which is designed to comprehensively evaluate the protective factors and negative risk factors associated with suicidal behaviors among adolescents. The present study aimed to evaluate the psychometric properties and measurement invariance of the Chinese version of the PANSI in a non-clinical sample of Chinese adolescents. Methods Participants (N = 1198) were Chinese middle school students aged 11–17 years (44.8% boys and 51.9% girls, 3.3% missing values) in Guizhou Province. All participants completed the Chinese version of the Positive and Negative Suicide Ideation Inventory (PANSI-C), the Rosenberg self-esteem scale (RSE), and the suicide probability scale (SPS). Cronbach’s alpha coefficients, confirmatory factor analysis, Pearson’s correlations, and multigroup confirmatory factor analysis tests were conducted thereafter. Results The results showed that the Cronbach’s alpha coefficients for the two subscales of the PANSI-positive suicide ideation and the PANSI-negative suicide ideation were .696 and .915, respectively. The confirmatory factor analysis supported the fit of the two-factor model as the best fitting model [Chi-square goodness of fit = 703.859, p < .001, degrees of freedom = 76, comparative fit index = .919, Tucker–Lewis index = .903, standardized root mean square residual = .047, root mean square error of approximation (90% CI) = .083 (.077, .089)]. Positive suicide ideation had negative correlations with the SPS and positive correlations with the RSE, whereas the negative suicide ideation had positive correlations with the SPS and negative correlations with the RSE. All correlations were statistically significant (p < .001), demonstrating the criterion validity of the PANSI-C. Moreover, the strict measurement invariance of the PANSI-C was supported across gender, single-parent and non-single-parent households groups, and the strong measurement invariance was supported across age. Limitations The feasibility of this study is limited to Chinese normal adolescents and lack of clinical samples. Conclusion Empirical support for the reliability and validity of the PANSI-C was found. The PANSI-C instrument is found to be useful in assessing positive and negative suicide ideation in Chinese normal adolescents.