Methylenetetrahydrofolate reductase C677T polymorphism and susceptibility to epilepsy

Background

Methylenetetrahydrofolate reductase (MTHFR) gene C677T polymorphism was reported as risk factor for multiple diseases due to its role in conversion of homocysteine to methionine. The aim of the present meta-analysis was to find out the validity of association of C677T polymorphism with epilepsy susceptibility.

Methods

Pubmed, Science Direct, Springer Link and Google Scholar, databases were searched for relevant studies up to January, 31, 2018. The pooled odds ratios (ORs) with 95% confidence intervals (CIs) were performed using five genetic models. All statistical analysis was done by MetaAnalyst and Mix programs.

Results

Except recessive model, significant association was found between MTHFR C677T polymorphism and epilepsy risk in other four genetic models (T vs C: OR?=?1.29, 95% CI?=?1.08–1.52, p?=?0.004; TT vs CC: OR?=?1.48, 95% CI?=?1.19–1.82, p?=?0.0003; TT + CT vs CC: OR?=?1.20, 95% CI?=?1.05–1.38, p?=?0.008; TT vs CT + CC: OR?=?1.35, 95% CI?=?1.11–1.62, p?=?0.002). Similarly, in the subgroup analysis based on ethnicity, significant association was found in Asian (T vs C: OR?=?1.85; 95% CI?=?1.15–2.99; p?=?0.03) and Caucasian populations (TT vs CC: OR?=?1.38; 95% CI?=?1.10–1.1.73; p?=?0.005). No evidence of heterogeneity and publication bias was detected in present meta-analysis.

Conclusion

In conclusion, results of present meta-analysis suggested that 677T allele of MTHFR is significantly increases the epilepsy susceptibility.

     

Neurological diseases and risk of suicide attempt: a case–control study

Introduction

Neurological diseases have a profound impact on quality of life. We investigated the risk of suicide attempt in ten neurological diseases.

Methods

Case–control study. Cases were identified from the Danish Poison Information Centre database in the period 2006–2013. The prevalence of ten neurological diagnoses was compared with the prevalence in a randomly sampled age- and gender-matched control group.

Results

We identified 8974 cases of suicidal attempt and 89,740 controls. We found an association between suicide attempt in nine of ten neurological diseases and disease groups, including stroke [odds ratio (OR) 3.1, 95% confidence interval (CI) (2.8–3.6)], Huntington’s disease [OR 8.8, 95% CI (3.2–24.1)], amyotrophic lateral sclerosis [OR 5.0, 95% CI (1.7–14.6)], Parkinson’s disease [OR 2.9, 95% CI (1.8–4.6)], Alzheimer’s disease and other degenerative diseases [OR 4.8, 95% CI (3.1–7.5)], multiple sclerosis [OR 1.5, 95% CI (1.1–2.1)], epilepsy [OR 4.5, 95% CI (4.1–5.0)], hereditary and idiopathic neuropathy [OR 2.2, 95% CI (1.1–4.3)] and myasthenia gravis [OR 4.3, 95% CI (2.0–9.4)].

Conclusion

Nine out of ten chronic neurological diseases were associated with an increased risk of suicide attempt. These data must be considered for clinicians treating this vulnerable group of patients.

     

The relation between obesity and depressed mood in a multi-ethnic population. The HELIUS study

Purpose

To examine the association between obesity and depressed mood in a large multi-ethnic population and check for consistency in this association across six ethnic groups.

Methods

Data of 21,030 persons (18–70 years) were sourced from the HELIUS study. Cross-sectional relationships between obesity measures [body mass index (kg/m²) and waist circumference (cm)] and depressed mood (PHQ-9 score?≥?10) were analysed. Consistency of associations was investigated across ethnic groups by interaction terms (ethnicity*obesity measures) in basic (age, sex, education) and fully (health behaviours and somatic health) adjusted models.

Results

Obesity was prevalent in all ethnic groups, but varied substantially. After sociodemographic adjustment, obesity measures were associated with increased odds of depressed mood but this was inconsistent across ethnic groups. Obesity (BMI?≥?30 or highest waist circumference quartile) was strongly and significantly associated with depressed mood in the Dutch [Odds Ratio (OR)?=?1.72; 95% Confidence intervals (CI) 1.24–2.40, and OR?=?1.86; 95% CI 1.38–2.50], respectively, and African Surinamese (OR?=?1.60; 95% CI 1.29–1.98 and OR?=?1.59; 95% CI 1.27–2.00, respectively) but had a weaker, non-significant association in other ethnic groups (South-Asian Surinamese, Ghanaian, Moroccan, Turkish groups). Adjustment for health behaviours and somatic health had limited effect on this pattern.

Conclusion

Obesity was associated with a higher risk of depressed mood. However, ethnic differences were found: the obesity-depressed mood association was strong in the Dutch and African Surinamese populations, but not in other ethnic groups. Future studies should explore whether differential normative values or pathophysiology across ethnic groups explain why the obesity-depression association is inconsistent across ethnic groups.

     

Interpersonal and institutional ethnic discrimination,and mental health in a random sample of Palestinian minority men smokers in Israel

Purpose

We sought to extend research into the health effects of discrimination to a non-Western context. We examined the associations between interpersonal and institutional ethnic discrimination, and anxiety and depression among Palestinian–Arab minority men citizens of Israel.

Methods

We used data from a nationwide stratified random sample of 964 Arab men in Israel, current or former smokers (age 18–64), who were interviewed as part of a 2012–2013 study on cessation. The questionnaire included an adapted Arabic version of the Experiences of Discrimination scale and a new scale on perceived institutional group discrimination. Logistic regression models estimated the effects of both forms of discrimination on depressive symptoms (Center for Epidemiological Studies Depression Scale) and anxiety (State-Trait Anxiety Inventory), while adjusting for socio-demographic and economic factors.

Results

The prevalence of depressive symptoms was 24.7% and anxiety 45.5%. Approximately 42% of men reported experiencing interpersonal discrimination, and 50.8% reported perceived institutional group discrimination. Controlling for covariates, experiencing interpersonal discrimination was associated with higher odds for depressive symptoms [OR?=?2.36, 95% confidence intervals (CI)?=?1.69–1.57] and anxiety (OR?=?1.92, 95% CI?=?1.45–2.55). Perceived institutional group discrimination was associated only with anxiety (OR?=?1.76, 95% CI?=?1.32–2.35). Introducing both forms of discrimination into the same model slightly attenuated these associations.

Conclusions

Interpersonal and institutional forms of ethnic discrimination are independently associated with poorer mental health among Arab minority men current and former smokers in Israel. Future research is warranted into both forms of discrimination in the general Arab population in Israel, including women.

     

Long-Term Outcomes in Patients with Anemia And Cerebral Venous Thrombosis

Background

Anemia is associated with unfavorable functional outcome in ischemic and hemorrhagic stroke. However, the relationship between anemia and prognosis in patients with cerebral venous thrombosis (CVT) has not been studied.

Methods

Consecutive CVT patients were retrospectively identified from November 2011, through January 2017. Anemia was defined according to the World Health Organization criteria (non-pregnant female hemoglobin level?<?120 g/L, pregnant female?<?110 g/L and male?<?130 g/L), which was further classified as mild, moderate, and severe anemia according to hemoglobin concentration, and as microcytic, normocytic, and macrocytic anemia according to mean corpuscular volume. Unfavorable outcome was defined as modified Rankin Scale (mRS) of 3–6. Factors such as age, sex, coma, malignancy, intracerebral hemorrhage, and straight sinus and/or deep CVT involved, premorbid mRS were adjusted to evaluate the relationship between anemia and prognosis in CVT patients.

Results

A total of 238 CVT patients were included, among whom 73 patients (30.67%) were diagnosed with anemia. Multivariate logistic regression analysis showed that patients with anemia had a higher risk of mRS of 3–6 (OR?=?3.62; 95% CI, 1.45–9.01; P?=?0.006) and mortality (OR?=?5.46; 95% CI, 1.90–15.70; P?=?0.002). Subgroup analysis showed that severe anemia was independently associated with mRS of 3–6 (OR?=?8.80; 95% CI, 1.90–40.81; P?=?0.005) and mortality (OR?=?9.82; 95% CI, 1.81–53.25; P?=?0.010). Similarly, microcytic anemia increased the risk of mRS of 3–6 (OR?=?4.64; 95% CI, 1.48–14.52; P?=?0.008) and mortality (OR?=?9.68; 95% CI, 2.61–35.91; P?=?0.001). In addition, our study also revealed that lower hemoglobin level, evaluated as a continuous variable, was inversely associated with mRS of 3–6 (OR?=?0.98; 95% CI, 0.96–0.99; P?=?0.007) and mortality (OR?=?0.97; 95% CI, 0.95–0.99; P?=?0.005).

Conclusions

Anemia was a significant and independent predictor of unfavorable functional outcome in patients with CVT.

     

Prevalence and characteristics of suicidal ideation among 2199 elderly inpatients with surgical or medical conditions in Taiwan

Background

Worldwide, the elderly are at a greater risk of suicide than other age groups. There is a paucity of research exploring risk factors for suicide in hospitalized elderly patients. Therefore, a study designed to explore the prevalence and characteristic of suicidal ideation (SI), such as QOL (quality of life), a wish to die (WTD), and other factors in elderly inpatients with medical or surgical conditions in Taiwan was warranted.

Methods

A total of 2199 hospitalized elderly patients over age 65 were enrolled. Demographic data, 5-item Brief Symptom Rating Scale (BSRS-5), and the World Health Organization Quality of Life-BREF (WHOQOL-BREF) data were collected. Logistic regression models were used to find the SI-related factors for all participants and to investigate the covariates correlated with WTD in patients with SI. Receiver operating characteristic (ROC) curve analysis was used to find the most important items of the BSRS-5 predictive of SI in this population.

Results

SI was found in 3.1% (68/2199) of the elderly. The statistically significantly factors associated with SI were: BSRS-5 item 2 (depression) (odds ratio [OR]?=?2.15, 95% confidence interval [CI]?=?1.56–2.98), item 4 (inferiority) (OR?=?1.62, 1.23–2.13), item 5 (insomnia) (OR?=?1.52, 1.13–2.05), and physical domain of WHOQOL (OR?=?0.84, 0.72–0.99). QOL15 (mobility) (OR?=?0.64, 0.46–0.90) and QOL 16 (satisfaction with sleep) (OR?=?0.62, 0.44–0.88) were also significantly associated with SI. The status of living alone (OR?=?4.44, 1.24–15.87), QOL 26 (absence of negative feeling) (OR?=?0.38, 0.15–0.98), and QOL 27 (being respected/accepted) (OR?=?0.43, 0.20–0.92) were significantly associated with WTD among inpatients with SI. The ROC curve analysis revealed that depression, inferiority, and insomnia were the most important items in the BSRS-5 significantly associated with SI among the elderly inpatients.

Conclusion

To provide physical recovery and maintain mental health for physically ill elderly inpatients, setting up a multi-faceted approach targeting the aforementioned determinants of SI and WTD for reducing the risk of suicide attempt, and exploring other factors correlated with suicidal behaviors, are important topics and directions for clinical practice and further research.

     

Sleep quality,obstructive sleep apnea,and psychological distress in truck drivers: a cross-sectional study

Purpose

Sleep disorders are highly prevalent in truck drivers. The aim of this study is to evaluate the prevalence of self-reported obstructive sleep apnea (OSA) and poor sleep quality in truck drivers, and to analyze the relationship between sleep problems and mental health.

Methods

A total of 526 male truck drivers (mean age 45.9; DS 9.4) responded to a questionnaire about risk factors for OSA (STOP-Bang), sleep quality perception (Pittsburg sleep questionnaire inventory, PSQI), excessive daytime sleepiness (Epworth sleepiness scale, ESS), and psychological disorders (general health questionnaire, GHQ-12).

Results

It was found that 51.1% of the drivers were at risk of OSA, 17.3% had bad sleep quality, and 8.9% had excessive daytime sleepiness (EDS). The association between psychological distress, OSA (OR?=?1.67; CI 95% 0.99–2.83; p?=?0.057), bad sleep quality (OR?=?2.58; CI 95% 1.52–4.37; p?<?0.001), and EDS (OR?=?1.65; CI 95% 0.83–3.30; p?=?0.151) was assessed.

Conclusions

The high prevalence of sleep problems, especially suspected OSA, and low quality of sleep in truck drivers can worsen the general and psychological wellbeing of the workers. Educational programs focusing on sleep hygiene and behavioral interventions are needed to promote adequate sleep habits and improve individual and public health.

     

Community-level social capital,parental psychological distress,and child physical abuse: a multilevel mediation analysis

Purpose

The purpose of this study was to investigate the association between community-level social capital and physical abuse towards children, and the mediating effect of parental psychological distress by multilevel mediation analyses.

Methods

We analyzed data from a population-based study of first-grade elementary school children (6–7 years old) in Adachi City, Tokyo, Japan. The caregivers of first-grade students from all elementary schools in Adachi City (N?=?5355) were asked to respond to a questionnaire assessing parents’ self-reported physical abuse (beating and hitting) and neighborhood social capital. Among them, 4291 parents returned valid responses (response rate 80.1%). We performed multilevel analyses to determine the relationships between community-level parental social capital and physical abuse, and further multilevel mediation analyses were performed to determine whether parental psychological distress mediated the association.

Results

Low community-level social capital was positively associated with physical abuse (both beating and hitting) after adjustment for other individual covariates (beating: middle, OR?=?1.54, 95% CI 1.11–2.13; low, OR?=?1.33, 95% CI 0.94–1.88; and hitting: middle, OR?=?1.35, 95% CI 1.02–1.80; low, OR?=?1.16, 95% CI 0.86–1.57). Multilevel mediation analyses revealed that community-level parental psychological distress did not mediate the association (indirect effect ß?=?0.10, 95% CI ??0.10 to 0.29, p?=?0.34 for beating; ß?=?0.03, 95% CI ??0.16 to 0.23, p?=?0.74 for hitting).

Conclusions

Fostering community-level social capital might be important for developing a strategy to prevent child maltreatment, which may have a direct impact on abusive behavior towards children.

     

Early-Onset Ventilator-Associated Pneumonia in Patients with Severe Traumatic Brain Injury: Incidence,Risk Factors,and Consequences in Cerebral Oxygenation and Outcome

Background

Early-onset ventilator-associated pneumonia (EOVAP) occurs frequently in severe traumatic brain-injured patients, but potential consequences on cerebral oxygenation and outcome have been poorly studied. The objective of this study was to describe the incidence, risk factors for, and consequences on cerebral oxygenation and outcome of EOVAP after severe traumatic brain injury (TBI).

Methods

We conducted a retrospective, observational study including all intubated TBI admitted in the trauma center. An EOVAP was defined as a clinical pulmonary infection score >6, and then confirmed by an invasive method. Patient characteristics, computed tomography (CT) scan results, and outcome were extracted from a prospective register of all intubated TBI admitted in the intensive care unit (ICU). Data concerning the cerebral oxygenation monitoring by PbtO₂ and characteristics of EOVAP were retrieved from patient files. Multivariate logistic regression models were developed to determine the risk factors of EOVAP and to describe the factors independently associated with poor outcome at 1-year follow-up.

Results

During 7 years, 175 patients with severe TBI were included. The overall incidence of EOVAP was 60.6% (47.4/1000 days of ventilation). Significant risk factors of EOVAP were: therapeutic hypothermia (OR 3.4; 95% CI [1.2–10.0]), thoracic AIS score ≥3 (OR 2.4; 95% CI [1.1–5.7]), and gastric aspiration (OR 5.2, 95% CI [1.7–15.9]). Prophylactic antibiotics administration was a protective factor against EOVAP (OR 0.3, 95% CI [0.1–0.8]). EOVAP had negative consequences on cerebral oxygenation. The PbtO₂ was lower during EOVAP: 23.5 versus 26.4 mmHg (p <0.0001), and there were more brain hypoxia episodes: 32 versus 27% (p = 0.03). Finally, after adjusting for confounders, an EOVAP was an independent factor associated with unfavorable neurologic functional outcome at the 1-year follow-up (OR 2.71; 95% CI [1.01–7.25]).

Conclusions

EOVAP is frequent after a severe TBI (overall rate: 61%), with therapeutic hypothermia, severe thoracic lesion, and gastric aspiration as main risk factors. EOVAP had a negative impact on cerebral oxygenation measured by PbtO₂ and was independently associated with unfavorable outcome at 1-year follow-up. This suggests that all precautions available should be taken to prevent EOVAP in this population.

     

Deliberate self-harm among adolescent psychiatric outpatients in Singapore: prevalence,nature and risk factors

Background

Deliberate self-harm (DSH) is a prominent mental health concern among adolescents. Few studies have examined adolescent DSH in non-Western countries. This study examines the prevalence, types and associated risk factors of DSH in a clinical sample of adolescents in Singapore.

Methods

Using a retrospective review of medical records, demographic and clinical data were obtained from 398 consecutive adolescent psychiatric outpatients (mean age?=?17.5?±?1.4 years, range?=?13–19 years) who presented at Changi General Hospital from 2013 to 2015.

Results

23.1% (n?=?92) of adolescents engaged in at least one type of DSH. Cutting was the most common type of DSH reported. Females were three times more likely to engage in DSH than males. DSH was positively associated with female gender (odds ratio [OR] 5.03), depressive disorders (OR 2.45), alcohol use (OR 3.49) and forensic history (OR 3.66), but not with smoking behaviour, living arrangement, parental marital status, past abuse or family history of psychiatric illness.

Conclusion

Interventions targeting adolescent DSH should also alleviate depressive symptoms, alcohol use and delinquent behaviours.

     

The Prevalence and Impact of Status Epilepticus Secondary to Intracerebral Hemorrhage: Results from the US Nationwide Inpatient Sample

Background

Status epilepticus (SE) has been identified as a predictor of morbidity and mortality in many acute brain injury patient populations. We aimed to assess the prevalence and impact of SE after intracerebral hemorrhage (ICH) in a large patient sample to overcome limitations in previous small patient sample studies.

Methods

We queried the Nationwide Inpatient Sample for patients admitted for ICH from 1999 to 2011, excluding patients with other acute brain injuries. Patients were stratified into SE diagnosis and no SE diagnosis cohorts. We identified independent risk factors for SE and assessed the impact of SE on morbidity and mortality with multivariable logistic regression models. Logistic regression was used to evaluate the trend in SE diagnoses over time as well.

Results

SE was associated with significantly increased odds of both mortality and morbidity (odds ratios (OR) 1.18 [confidence intervals (CI) 1.01–1.39], and OR 1.53 [CI 1.22–1.91], respectively). Risk factors for SE included female sex (OR 1.17 [CI 1.01–1.35]), categorical van Walraven score (vWr 5–14: OR 1.68 [CI 1.41–2.01]; vWr > 14: OR 3.77 [CI 2.98–4.76]), sepsis (OR 2.06 [CI 1.58–2.68]), and encephalopathy (OR 3.14 [CI 2.49–3.96]). Age was found to be associated with reduced odds of SE (OR 0.97 [CI 0.97–0.97]). From 1999 to 2011, prevalence of SE diagnosis increased from 0.25 to 0.61% (p < 0.001). Factors associated with SE were female sex, medium and high risk vWr score, sepsis, and encephalopathy. Independent predictors associated with increased mortality from SE were increased age, pneumonia, myocardial infarction, cardiac arrest, and sepsis.

Conclusions

SE is a significant, likely underdiagnosed, predictor of morbidity and mortality after ICH. Future studies are necessary to better identify which patients are at highest risk of SE to guide resource utilization.

     

Can risk assessment predict suicide in secondary mental healthcare? Findings from the South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLaM BRC) Case Register

Purpose

The predictive value of suicide risk assessment in secondary mental healthcare remains unclear. This study aimed to investigate the extent to which clinical risk assessment ratings can predict suicide among people receiving secondary mental healthcare.

Methods

Retrospective inception cohort study (n?=?13,758) from the South London and Maudsley NHS Foundation Trust (SLaM) (London, UK) linked with national mortality data (n?=?81 suicides). Cox regression models assessed survival from the last suicide risk assessment and ROC curves evaluated the performance of risk assessment total scores.

Results

Hopelessness (RR?=?2.24, 95% CI 1.05–4.80, p?=?0.037) and having a significant loss (RR?=?1.91, 95% CI 1.03–3.55, p?=?0.041) were significantly associated with suicide in the multivariable Cox regression models. However, screening statistics for the best cut-off point (4–5) of the risk assessment total score were: sensitivity 0.65 (95% CI 0.54–0.76), specificity 0.62 (95% CI 0.62–0.63), positive predictive value 0.01 (95% CI 0.01–0.01) and negative predictive value 0.99 (95% CI 0.99–1.00).

Conclusions

Although suicide was linked with hopelessness and having a significant loss, risk assessment performed poorly to predict such an uncommon outcome in a large case register of patients receiving secondary mental healthcare.

     

Is meat consumption associated with depression? A meta-analysis of observational studies

Background

A number of epidemiological studies have examined the effect of meat consumption on depression. However, no conclusion has been reached. The aim of this study was to examine the relationship between meat consumption and depression.

Methods

The electronic databases of PUBMED and EMBASE were searched up to March 2017, for observational studies that examined the relationship between meat consumption and depression. The pooled odds ratio (OR) for the prevalence of depression and the relative risk (RR) for the incidence of depression, as well as their corresponding 95% confidence interval (CI), were calculated respectively (the highest versus the lowest category of meat consumption).

Results

A total of eight observational studies (three cross-sectional, three cohort and two case-control studies) were included in this meta-analysis. Specifically, six studies were related to the prevalence of depression, and the overall multi-variable adjusted OR suggested no significant association between meat consumption and the prevalence of depression (OR?=?0.89, 95% CI: 0.65 to 1.22; P?=?0.469). In contrast, for the three studies related to the incidence of depression, the overall multi-variable adjusted RR evidenced an association between meat consumption and a moderately higher incidence of depression (RR?=?1.13, 95% CI: 1.03 to 1.24; P?=?0.013).

Conclusions

Meat consumption may be associated with a moderately higher risk of depression. However, it still warrants further studies to confirm such findings due to the limited number of prospective studies.

     

The longitudinal association between external locus of control,social cognition and adolescent psychopathology

Purpose

To investigate the longitudinal associations between social cognitive ability an external locus of control (externality) and adolescent psychopathology.

Methods

7058 participants from a prospective population-based cohort provided data on externality, social communication, and emotion perception between 7 and 16 years and psychotic experiences and depressive symptoms at 12 and 18 years. Bivariate probit modelling was used to investigate associations between these risk factors and psychopathological outcomes.

Results

Externality was associated with psychopathology at 12 (psychotic experiences OR 1.23 95% CI 1.14, 1.33; depression OR 1.12 95% CI 1.02, 1.22) and 18 years (psychotic experiences OR 1.38 95% CI 1.23, 1.55; depression OR 1.40 95% CI 1.28, 1.52). Poor social communication was associated with depression at both ages (12 years OR 1.22 95% CI 1.11, 1.34; 18 years OR 1.21 95% CI 1.10, 1.33) and marginally associated with psychotic experiences. There was marginal evidence of a larger association between externality and psychotic experiences at 12 years (p?=?0.06) and between social communication and depression at 12 years (p?=?0.03).

Conclusions

Externality was more strongly associated with psychotic experiences. At 18 years change in externality, between 8 and 16 years were associated with a larger increase in the risk of depression. Poor social communication was more strongly associated with depression.

     

Safety of Chemical DVT Prophylaxis in Severe Traumatic Brain Injury with Invasive Monitoring Devices

Background

Patients with traumatic brain injuries (TBIs) have an increased risk of developing a deep vein thrombosis (DVT), but the risk of hemorrhage expansion with intracranial monitoring devices remains unknown. We sought to determine the safety of chemical DVT prophylaxis in severe TBI patients with invasive intracranial pressure monitors.

Methods

We retrospectively reviewed all patients with severe TBI admitted to the neurosurgical intensive care unit of a large tertiary care center over a three-year period.

Results

155 patients were included with an incidence of DVT of 12 %. The median length of time to a stable head CT was 2 days, and the median time to initiation of chemical DVT prophylaxis was 3.6 days. The odds of DVT increased with intraparenchymal hemorrhage [OR 7.21, 95 % CI (1.43–36.47), p = 0.0169], non-White ethnicity [OR 7.86, 95 % CI (1.23–50.35), p = 0.0295], female gender [OR 13.93, 95 % CI (2.47–78.73), p = 0.0029], smoking [OR 4.32, 95 % CI (1.07–17.51), p = 0.0405], no anticoagulation [OR 25.39, 95 % CI (4.26–151.48), p < 0.001], and an IVC filter [OR 15.82, 95 % CI (3.14–79.76), p < 0.001]. Twenty-eight (18 %) of these subjects experienced in-hospital mortality. The risk of in-hospital death was significantly increased among those who did not receive anticoagulation. This study found no association between DVT formation, hemorrhage expansion, or increased risk from invasive monitoring devices between various doses of unfractionated heparin (UH) and low-molecular-weight heparin (LMWH).

Conclusion

We conclude that DVT prophylaxis with either LMWH or UH is safe with intracranial pressure monitors in place.

     

Somatic symptoms in adolescence as a predictor of severe mental illness in adulthood: a long-term community-based follow-up study

Background

Somatic symptoms are common and costly for society and correlate with suffering and low functioning. Nevertheless, little is known about the long-term implications of somatic symptoms. The objective of this study was to assess if somatic symptoms in adolescents with depression and in their matched controls predict severe mental illness in adulthood by investigating the use of hospital-based care consequent to different mental disorders.

Methods

The entire school population of 16–17-year-olds in the city of Uppsala, Sweden, was screened for depression in 1991–1993 (n?=?2300). Adolescents with positive screenings (n?=?307) and matched non-depressed controls (n?=?302) participated in a semi-structured diagnostic interview for mental disorders. In addition, 21 different self-rated somatic symptoms were assessed. The adolescents with depression and the matched non-depressed controls were engaged in follow-up through the National Patient Register 17–19 years after the baseline study (n?=?375). The outcome measures covered hospital-based mental health care for different mental disorders according to ICD-10 criteria between the participants’ ages of 18 and 35 years.

Results

Somatic symptoms were associated with an increased risk of later hospital-based mental health care in general in a dose–response relationship when adjusting for sex, adolescent depression, and adolescent anxiety (1 symptom: OR?=?1.63, CI 0.55–4.85; 2–4 symptoms: OR?=?2.77, 95% CI 1.04–7.39;?≥?5 symptoms: OR?=?5.75, 95% CI 1.98–16.72). With regards to specific diagnoses, somatic symptoms predicted hospital-based care for mood disorders when adjusting for sex, adolescent depression, and adolescent anxiety (p?<?0.05). In adolescents with depression, somatic symptoms predicted later hospital-based mental health care in a dose–response relationship (p?<?0.01). In adolescents without depression, reporting at least one somatic symptom predicted later hospital-based mental health care (p?<?0.05).

Conclusions

Somatic symptoms in adolescence predicted severe adult mental illness as measured by hospital-based care also when controlled for important confounders. The results suggest that adolescents with somatic symptoms need early treatment and extended follow-up to treat these specific symptoms, regardless of co-occurring depression and anxiety.

     

Psychotic (delusional) depression and completed suicide: a systematic review and meta-analysis

Background

It remains unclear whether psychotic features increase the risk of completed suicides in unipolar depression. The present systematic review coupled with a meta-analysis attempts to elucidate whether unipolar psychotic major depression (PMD) compared to non-PMD presents higher rates of suicides.

Methods

A systematic search was conducted in Scopus, PubMed, and “gray literature” for all studies providing data on completed suicides in PMD compared to non-PMD, and the findings were then subjected to meta-analysis. All articles were independently extracted by two authors using predefined data fields.

Results

Nine studies with 33,873 patients, among them 828 suicides, met our inclusion criteria. PMD compared to non-PMD presented a higher lifetime risk of completed suicides with fixed-effect pooled OR 1.21 (95% CI 1.04–1.40). In a sub-analysis excluding a very large study (weight?=?86.62%), and comparing 681 PMD to 2106 non-PMD patients, an even higher pooled OR was found [fixed-effect OR 1.69 (95% CI 1.16–2.45)]. Our meta-analysis may provide evidence that the presence of psychosis increases the risk of suicide in patients suffering from severe depression. The data are inconclusive on the contribution of age, mood congruence, comorbidity, and suicide method on PMD’s suicide risk. The lack of accurate diagnosis at the time of suicide, PMD’s diagnostic instability, and the use of ICD-10 criteria constitute the main study limitations.

Conclusions

The presence of psychosis in major depression should alert clinicians for the increased risk of completed suicide. Thus, the implementation of an effective treatment both for psychotic depression and patients’ suicidality constitutes a supreme priority.

     

Impact of socioeconomic position and distance on mental health care utilization: a nationwide Danish follow-up study

Purpose

To determine the impact of socioeconomic position (SEP) and distance to provider on outpatient mental health care utilization among incident users of antidepressants.

Method

A nationwide register-based cohort study of 50,374 person-years.

Results

Persons in low SEP were more likely to have outpatient psychiatrist contacts [odds ratio (OR) 1.25; confidence interval (CI) 1.17–1.34], but less likely to consult a co-payed psychologist (OR 0.49; CI 0.46–0.53) and to get mental health service from a GP (MHS-GP) (OR 0.81; CI 0.77–0.86) compared to persons in high SEP after adjusting for socio-demographics, comorbidity and car ownership. Furthermore, persons in low SEP who had contact to any of these therapists tended to have lower rates of visits compared to those in high SEP. When distance to services increased by 5 km, the rate of visits to outpatient psychiatrist tended to decrease by 5% in the lowest income group (IRR 0.95; CI 0.94–0.95) and 1% in the highest (IRR 0.99; CI 0.99–1.00). Likewise, contact to psychologists decreased by 11% in the lowest income group (IRR 0.89; CI 0.85–0.94), whereas rate of visits did not interact.

Conclusion

Patients in low SEP have relatively lower utilization of mental health services even when services are free at delivery; co-payment and distance to provider aggravate the disparities in utilization between patients in high SEP and patients in low SEP.

     

Posttraumatic stress disorder,trauma, and reconciliation in South Sudan

Purpose

South Sudan is embroiled in a conflict that erupted in December 2013. This study examines what people in South Sudan think is necessary to achieve reconciliation and how trauma exposure and PTSD are associated with those beliefs.

Methods

1525 participants (51.0% female) were selected using random and purposive sampling in six states and Abyei. Participants reported on traumatic events, PTSD symptoms, and attitudes towards reconciliation mechanisms.

Results

Results indicated that 40.7% met symptom criteria for probable PTSD. Most participants thought reconciliation was not possible without prosecuting perpetrators or compensating victims and did not support amnesty. Participants with probable PTSD were more likely to endorse confessions (OR 2.42 [1.75, 3.35]), apologies (OR 2.04 [1.46, 2.83]), and amnesty (OR 1.58 [1.21, 2.08]), and to report that compensation (OR 2.32 [1.80, 3.00]) and prosecution (OR 1.47 [1.15, 1.89]) were not necessary for reconciliation. The more traumatic events people experienced, the more they endorsed criminal punishment for perpetrators (OR 1.07 [1.04, 1.10]) and the less they endorsed confessions (OR 0.97 [0.95, 0.99]).

Conclusions

People with PTSD may prioritize ending violence via opportunities for reconciliation, while those with more trauma exposure may support more punitive mechanisms. Policy makers should take mental health treatment and trauma into account when designing conflict mitigation, peace building, and justice mechanisms.

     

Effektivität und Evidenz von Gruppenpsychotherapie bei depressiven Störungen

Background

Group psychotherapy is considered to be an effective psychological intervention for depressive disorders. However, there is less demand for group psychotherapy in outpatient care. Aim of this study is to evaluate the efficacy of group psychotherapy in the treatment of depressive disorders.

Methods

A systematic literature research via electronic databases (PubMed, PsycInfo) was conducted. The included meta-analysis were published past 2000 and involved patients older than 18 years treated with psychotherapy in a group setting.

Results

Seven meta-analysis (140 studies) met the inclusion criteria. In the between group comparison group psychotherapy showed effects from0.21 (95?% CL: [??0.46; 0.04]; I2?=?24.9?%) to 1.026 (SD:.805, 95?% CI: [0.565–1.487], no treatment). In comparison to individual therapy, this was less more effective (d?=?0.18, Z?=?1.82, p?<?0.1; I2?=?0 bis 0.38 95?%CI: [0.09; 0.66]) or equally effective (d?=???0.15; n.s.). These differences have not persisted at follow-up. One meta-analysis showed a clearly lower drop-out rate in individual interventions (OR?=?0.56, 95?%CI: [0.37; 0.86]; p?<?0.01). One meta-analysis indicated small differences in different psychotherpeutic orientations (cognitive behavioral group therapy – CBGT vs. psychodynamic group therapy – PGT: in favour of CBGT: d?=?0.2995 (Sd?=?0.51) 95?% CI: [0.001; 0.589].

Conclusions

Group psychotherapy is an effectively and efficiently psychological intervention for depressive diseases. The evidence of treatment effectiveness is assured through several meta-analysis. There should be more oppurtunities to attend group psychotherapy in outpatient care.