Frontiers in Psychiatry

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EISSN : 1664-0640
Current Publisher: Frontiers Media SA (10.3389)
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, Stephanie Brym, Helene Hense, Bianca Grafe, Cornelia Helfferich, Jutta Lindert, Susan Garthus-Niegel
Published: 13 April 2021
Frontiers in Psychiatry, Volume 12; doi:10.3389/fpsyt.2021.578150

Abstract:
While the COVID-19 pandemic forced millions of people to stay home and minimize their social contacts, newspaper reports worldwide raised concerns as they reported an increasing rate of intimate partner violence (IPV). One link of the measures enforced to control the pandemic to IPV might be a possible side effect of those measures, namely social and geographical isolation. As there was no scientific data investigating the association of IPV and social and geographical isolation in the context of epidemics or pandemics at the time of conducting this rapid review, we aimed at investigating a broader range of contexts of social as well as geographical isolation and its association with IPV to draw conclusions regarding the COVID-19 pandemic. We searched Embase, PubMed, PsycINFO, and Web of Science (core collection). A research strategy was developed and observational studies were included if they considered men and/or women, estimates of social and geographical isolation, and IPV as a primary outcome. Of the 526 identified studies, 11 were included in this review. The included studies involved 15,695 women and were conducted in the USA, Sweden, Ethiopia, Egypt, Spain, and Turkey. Indicators of social isolation such as lack of social, emotional, or informational support or the frequency and quality of social contacts were narratively assessed. Geographical isolation was primarily assessed by physical distance to the next town or support service. Both social and geographic isolation were found to be associated with an increased risk of IPV. Recommendations made by the individual studies include the following: (a) improving access to social networks outside the victims' own group, (b) improving their economic circumstances, (c) asserting the responsibility for those in contact with the victims, and (d) increasing the focus on access to preventive services and programs need to be taken into account. Therefore, considering the particular infrastructure and legislation of the countries affected by the pandemic, policies need to ensure constant access to shelters and other help services and increase awareness for IPV in the society. In addition, future studies are warranted to assess prevalence rates and risk factors of IPV during the COVID-19 pandemic.
Stephen Macfarlane, , Thomas Morris, Daniel Whiting, Madeleine Healy, Marie Alford, Colm Cunningham
Published: 13 April 2021
Frontiers in Psychiatry, Volume 12; doi:10.3389/fpsyt.2021.652254

Abstract:
Background/Objective: People living with dementia (PLWD) in residential aged care homes (RACHs) are frequently prescribed psychotropic medications due to the high prevalence of neuropsychiatric symptoms, also known as behaviours and psychological symptoms of dementia (BPSD). However, the gold standard to support BPSD is using psychosocial/non-pharmacological therapies. This study aims to describe and evaluate services and neuropsychiatric outcomes associated with the provision of psychosocial person-centred care interventions delivered by national multidisciplinary dementia-specific behaviour support programs. Methods: A 2-year retrospective pre-post study with a single-arm analysis was conducted on BPSD referrals received from Australian RACHs to the two Dementia Support Australia (DSA) programs, the Dementia Behaviour Management Advisory Service (DBMAS) and the Severe Behaviour Response Teams (SBRT). Neuropsychiatric outcomes were measured using the Neuropsychiatric Inventory (NPI) total scores and total distress scores. The questionnaire version “NPI-Q” was administered for DBMAS referrals whereas the nursing home version “NPI-NH” was administered for SBRT referrals. Linear mixed effects models were used for analysis, with time, baseline score, age, sex, and case length as predictors. Clinical significance was measured using Cohen's effect size (d; ≥0.3), the mean change score (MCS; 3 points for the NPI-Q and 4 points for the NPI-NH) and the mean percent change (MPC; ≥30%) in NPI parameters. Results: A total of 5,914 referrals (55.9% female, age 82.3 ± 8.6 y) from 1,996 RACHs were eligible for analysis. The most common types of dementia were Alzheimer's disease (37.4%) and vascular dementia (11.7%). The average case length in DSA programs was 57.2 ± 26.3 days. The NPI scores were significantly reduced as a result of DSA programs, independent of covariates. There were significant reductions in total NPI scores as a result of the DBMAS (61.4%) and SBRT (74.3%) programs. For NPI distress scores, there were 66.5% and 69.1% reductions from baseline for the DBMAS and SBRT programs, respectively. All metrics (d, MCS, MPC) were above the threshold set for determining a clinically significant effect. Conclusions: Multimodal psychosocial interventions delivered by DSA programs are clinically effective as demonstrated by positive referral outcomes, such as improved BPSD and related caregiver distress.
Xuejin Ma, Jianxia Tan, Lin Jiang, Xuqin Wang, Bochao Cheng, Peng Xie, Yuanyuan Li, ,
Published: 13 April 2021
Frontiers in Psychiatry, Volume 12; doi:10.3389/fpsyt.2021.634170

Abstract:
Intellectual disability (ID) is associated with aberrant structural and functional development of the brain, yet how the dynamical developmental changes of the structure and function of ID from childhood to around puberty remains unknown. To explore the abnormal developmental trajectories of structure and function, 40 children with ID aged 6–13 years and 30 sex-, age-, and educational level-matched healthy controls (HC) with age range from 6 to 13 were recruited. The automatic voxel-based morphometry (VBM) and resting-state functional connectivity (FC) analyses were adopted to delineate the structural and functional differences. Significantly decreased total gray matter volume (GMV) and white matter volume (WMV) in children with ID were found, and the developmental trajectories of GMV and WMV in children with ID showed an opposite direction as compared with HC. The voxel-wise VMB analysis further revealed significantly increased GMV in the dorsal medial prefrontal cortex (dmPFC), bilateral orbital part of the inferior frontal gyrus (orb_IFG.L, orb_IFG.R), right cuneus (cuneus.R), and bilateral middle frontal gyrus (MFG.L, MFG.R) in children with ID. The following seed-based whole-brain functional connectivity analyses of the brain areas with changed GMV found decreased FCs between the cuneus.R and left intraparietal sulcus (IPS.L) and between the MFG.R and anterior cingulate cortex (ACC) in children with ID. Moreover, negative correlations between GMV values in the dmPFC, orb_IFG.L, cuneus.R, and intelligence quotient (IQ) scores and positive correlations between the FCs of the cuneus.R with IPS.L and MFG.R with ACC and IQ scores were found in children with ID and HC. Our findings provide evidence for the abnormal structural and functional development in children with ID and highlight the important role of frontoparietal network in the typical development. The abnormal development of GMV and functional couplings found in this study may be the neuropathological bases of children with ID.
Bernadetta Izydorczyk, , Zbigniew Wajda, Sebastian Lizińczyk, Aleksandra Ściegienny
Published: 13 April 2021
Frontiers in Psychiatry, Volume 12; doi:10.3389/fpsyt.2021.590542

Abstract:
A more holistic approach to treatment and prevention focuses on identifying the multiple risk and protective factors for eating disorders. However, there is a lack of research verifying the nature of the relationship between patterns of bonding with parents, sociocultural attitudes toward appearance, body image, and their role in developing or preventing eating disorders. The main aim of the study was to verify whether there is a specific set of risk or/vs. protective factors/measures for behaviors and dispositions related to the development of eating disorders. The study group consisted of 134 young Polish females (M = 14.92; SD = 1.349), with an average body mass index. The variables were measured using the Parental Bonding Instrument, the Sociocultural Attitudes Toward Appearance Questionnaire-3, The Multidimensional Body–Self Relations Questionnaire, and the Eating Disorder Inventory 3. Stepwise regression analysis was applied. Statistical analysis showed that bonding with parents (including maternal overprotection), body image (including overweight pre-occupation, fitness evaluation, health orientation, and self-classified weight), and sociocultural attitudes toward appearance (such as searching for information, pressures, and internalization) are predictors of eating disorder risks. On the other hand, maternal and paternal care (aspects of patterns of bonding with parents), positive fitness evaluation, positive appearance evaluation, and satisfaction with one's body were found to be the most significant protective factors. The results may improve prevention and intervention aimed at increasing protective factors.
, María Luisa Barrigón, Jorge López-Castroman, Enrique Baca-García
Published: 13 April 2021
Frontiers in Psychiatry, Volume 12; doi:10.3389/fpsyt.2021.676487

Abstract:
Editorial on the Research Topic Suicide and Related Behaviour Suicide claims almost 1 million lives globally every year. Understanding and preventing suicidal behaviors and death by suicide is a largely unmet need: despite substantial efforts, suicide remains the second leading cause of death among youth and, over the last two decades, suicide mortality rates have increased in several regions across the globe (1). For instance, in the United States, suicide is the only leading cause of death that has not diminished over the last two decades—alongside opioid overdose, an entity that is closely related to suicide (2). The impact of suicide is far-reaching and affects families and communities over generations. Advancing suicidology is an urgent public health challenge. Understanding suicidal behaviors is complex, as they emerge in the context of a complex multilevel chain of causation that includes poorly clarified neurobiological pathways and dynamic individual- and group-level risk and protective factors, interacting in a nuanced balance. Accordingly, despite substantial efforts, advancement of suicide risk stratification, prevention, and treatment tools over the last decades has been limited. Key limitations driving this phenomenon have been pointed out elsewhere and include, among others, (i) the fact that most research on suicide comes from a relatively small number of high-income countries, even though most people who die by suicide live in low and middle-income countries (3), (ii) traditional ethical reasons to systematically exclude suicidal individuals from clinical studies (4), or (iii) technical limitations, such as a generalized lack of enough detailed information in large prospective cohorts or a poor uptake of modern causal mediation epidemiological methods. In this special topic on Suicide and Related Behavior, we sought to overcome traditional limitations of suicide research by expanding our scope to innovative approaches, both in terms of methodological tools and study populations. Here we provide a brief overview of the contents and highlights of the special topic. A set of six studies take a mediation/moderation causal analysis approach to suicidal behaviors. Dal Santo et al. examine the role of impulsivity as a mediator in the association between early traumatic experiences and suicidal behaviors in a sample of 190 depressed patients. Using a simple mediation approach, they find results suggesting that impulsivity may play a mediating role in the association, an important finding with substantial potential implications for individual-level prevention. Rubio et al. adopt Hayes's approach to mediation, based on structural equation modeling, to prove the hypothesis that negative affect and suicide attempts are mediated by suicidal ideation in a large representative sample of Chilean high school students. A large study including almost 500 Chinese students assessed 4 years after the Ya'an earthquake by Liu et al. also uses a structural equation modeling approach to study the association between self-compassion and suicide risk, finding that positive and negative self-compassion, respectively, reduce and increase suicide risk, and that gratitude and post-traumatic stress disorder may be salient mediators. Mészáros et al. examine a sample of 363 (202 suicidal and 163 non-suicidal) adolescents to examine another highly relevant and novel variable, namely pathological internet use, and test whether it is associated with non-suicidal self-injury directly or through a series of psychopathological domains, finding no apparent link between self-injury and pathological internet use. Examining a large sample of Chilean adolescents, Núñez et al. investigate the associations between depressive symptoms, psychotic experiences, and suicidal ideation, describing patterns of association between specific symptoms from each of the three domains. Last, also using a randomly selected sample of adolescents from Santiago de Chile, another study by Rubio, Oyanedel, Cancino et al. examines social support and substance (alcohol, marijuana, and other illicit drugs) use as moderators of the relationship between depressive symptoms and suicidal ideation. They report that social support, regardless of whether provided by peers, family, or school; and alcohol use both moderate the depression-ideation association. Two studies build on the rich tradition of observational research to identify salient correlated of suicidal risk. Lin et al. also focus on impulsivity. Their ingenious experiment couples a two-choice oddball paradigm with emotional stimuli and electroencephalogram recording to characterize participants' psychophysiological profile. Suicidal ideation is found to be associated with certain specific changes in behavioral inhibitory control in response to emotional information. These results suggest that what the authors call an “emotion-impulsivity framework” in information processing may be associated with suicidal ideation. Harnod et al., using Taiwan's nationwide population-based databases, examine more than 600,000 adults with sleep-disordered breathing to examine the prospective association between head trauma and suicide risk. Their finding of a 2-fold increase in risk among individuals with a history of head trauma, after adjusting for a comprehensive set of potential confounders, is accompanied by detailed examination of other risk factors, including a potential synergistic effect with age, greatly enhancing understandability of potential implications. Over the last years, evidence supporting brief interventions, including contact and psychotherapeutic interventions, has somewhat brought about a renovated hope in suicide prevention intervention research. Here, in a pilot study featuring 26 adolescents, Haruvi Catalan et al. examine the foundations of an ultra-brief crisis intervention based on Interpersonal Therapy for high-risk children...
, Megan Hynd, Dylan M. Nielson, Kenneth E. Towbin, Sarah H. Lisanby, Argyris Stringaris
Published: 13 April 2021
Frontiers in Psychiatry, Volume 12; doi:10.3389/fpsyt.2021.642847

Abstract:
Adolescent depression is a potentially lethal condition and a leading cause of disability for this age group. There is an urgent need for novel efficacious treatments since half of adolescents with depression fail to respond to current therapies and up to 70% of those who respond will relapse within 5 years. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a promising treatment for major depressive disorder (MDD) in adults who do not respond to pharmacological or behavioral interventions. In contrast, rTMS has not demonstrated the same degree of efficacy in adolescent MDD. We argue that this is due, in part, to conceptual and methodological shortcomings in the existing literature. In our review, we first provide a neurodevelopmentally focused overview of adolescent depression. We then summarize the rTMS literature in adult and adolescent MDD focusing on both the putative mechanisms of action and neurodevelopmental factors that may influence efficacy in adolescents. We then identify limitations in the existing adolescent MDD rTMS literature and propose specific parameters and approaches that may be used to optimize efficacy in this uniquely vulnerable age group. Specifically, we suggest ways in which future studies reduce clinical and neural heterogeneity, optimize neuronavigation by drawing from functional brain imaging, apply current knowledge of rTMS parameters and neurodevelopment, and employ an experimental therapeutics platform to identify neural targets and biomarkers for response. We conclude that rTMS is worthy of further investigation. Furthermore, we suggest that following these recommendations in future studies will offer a more rigorous test of rTMS as an effective treatment for adolescent depression.
Shuo Wang, Xuliang Shi, Xiaoyan Chen, Ya Zhu, Huilin Chen, Fang Fan
Published: 13 April 2021
Frontiers in Psychiatry, Volume 12; doi:10.3389/fpsyt.2021.577328

Abstract:
Considerable studies have explored the potential mechanisms between trauma exposure and PTSD, but little is known about the role of sleep problems and resilience in this relationship. To address this research gap, the present study examined whether sleep problems mediated the relationship between earthquake exposure and PTSD symptoms, and whether this mediating process was moderated by resilience. A sample of 1,342 adolescents (M age = 15.54 years, SD = 1.26) completed questionnaires regarding earthquake exposure, sleep problems, resilience, and PTSD symptoms 12 months after a devastating earthquake in China. After controlling for demographic variables, earthquake exposure was significantly, and positively associated with PTSD symptoms, and sleep problems partially mediated this relationship. Tests of moderated mediation further revealed that resilience moderated the relationship between earthquake exposure and PTSD symptoms as well as sleep problems and PTSD symptoms. Specifically, the relationship between earthquake exposure and PTSD symptoms was only significant for adolescents with a lower level of resilience; meanwhile, the positive relationship between sleep problems and PTSD symptoms was stronger among low-resilient adolescents. Therefore, sleep-targeted and resilience-based interventions may be effective in alleviating PTSD symptoms resulted from the earthquake.
, Hiroko Okuno, Aika Tatsumi, Saeko Sakai, Ikuko Mohri, Masako Taniike
Published: 13 April 2021
Frontiers in Psychiatry, Volume 12; doi:10.3389/fpsyt.2021.642949

Abstract:
Children with autism spectrum disorders (ASD) have difficulties in developing stable peer relationships. Interventions for learning social skills (SS) for such children are often conducted in a group. Behavioral imaging and social imaging, which have been called for in recent years, are methods for visualizing children's behaviors and interpersonal relationships. To examine the usefulness of visualizing face-to-face interaction with others in the social skills learning scene of children with ASD, we use a business microscope that can qualify and visualize face-to-face interactions automatically. We highlight two boys' face-to-face interaction changes in the same SS learning group of five children. The device's use may provide a more objective measurement that complements the observer's subjective evaluation in case of the intervention's validation. It is expected that information on face-to-face interactions will be used to determine the SS learning process in the future.
Marta Torra Moreno, Josefa Canals Sans,
Published: 13 April 2021
Frontiers in Psychiatry, Volume 12; doi:10.3389/fpsyt.2021.647399

Abstract:
In recent years, digital devices have been progressively introduced in rehabilitation programs and have affected skills training methods used with children and adolescents with intellectual disabilities (ID). The objective of this review is to assess the effects of the use of digital devices on the cognitive functions and behavioral skills in this population, and to acknowledge their potential as a therapeutic tool. Electronic databases were analyzed until February 2020 using search formulas with free terms related to ID and the use of digital systems with children or adolescents. The risk of bias in randomized controlled trials was assessed by means of the modified Cochrane Collaboration tool and the quality level of the non-randomized studies was assessed using the Newcastle-Ottawa Scale. Forty-four studies were analyzed, most of which were categorized as low quality. Of the executive function studies analyzed, 60% reported significant improvements, most commonly related to working memory. Within the cognitive skills, 47% of the studies analyzed reported significant improvements, 30% of them in language. Significant improvements in the social (50%) and behavioral domains (30%) were also reported. These results suggest that digital interventions are effective in improving working memory and academic skills, and positively affect both the social and behavioral domains. Little information has been published regarding the duration of the effects, which could be limited in time. Further research is necessary to assess long-term effectiveness, the influence of comorbidities, and the effects on subjects with severe ID. The inclusion of smartphones and special education centers is also necessary.
Wei Bai, Hai-Tao Xi, Qianqian Zhu, Zhiwen Wang, Lin Han, Pan Chen, Hong Cai, Yan-Jie Zhao, Li Chen, Zong-Mei Ge, et al.
Published: 13 April 2021
Frontiers in Psychiatry, Volume 12; doi:10.3389/fpsyt.2021.657021

Abstract:
Background: Health professionals including nurses have experienced heavy workload and great physical and mental health challenges during the coronavirus disease 19 (COVID-19) pandemic, which may affect nursing students' career choices. This study examined the changes in nursing students' career choices after the onset of the COVID-19 pandemic in China. Methods: This study was conducted in five University nursing schools in China between September 14, 2020 and October 7, 2020. Career choices before and after the COVID-19 pandemic were collected and analyzed. Results: In total, 1,070 nursing students participated in the study. The reported choice of nursing as future career increased from 50.9% [95% confidence interval (CI): 47.9–53.9%] before the COVID-19 pandemic to 62.7% (95%CI: 59.8–65.6%) after the onset of COVID-19 pandemic. Students who chose nursing as their future career following the COVID-19 outbreak had less severe depression and anxiety compared to those who did not choose nursing, but the associations of depression and anxiety with career choice disappeared in multivariable analyses. Binary logistic regression analysis revealed that male gender [odds ratio (OR) = 0.68, 95% CI: 0.50–0.91], rural residence (OR = 1.53, 95%CI: 1.17–2.00), fourth year students (OR = 0.50, 95%CI: 0.35–0.72), negative experiences during the COVID-19 pandemic (OR = 0.66, 95%CI: 0.47–0.92), and good health (OR = 4.6, 95%CI: 1.78–11.87) were significantly associated with the choice of nursing as future career after the onset of the COVID-19 pandemic. Conclusions: The COVID-19 pandemic appeared to have a positive influence on the career choice of nursing among Chinese nursing students.
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