Objective: To evaluate the effect of narrative therapy on post-traumatic stress disorder (PTSD) symptoms, perceived stress, anxiety, and depression in nurses. Methods: A total of 92 clinical nurses with positive PTSD symptom screening results were randomly assigned (1:1) to the intervention or control group. The intervention group received narrative therapy and a psychological stress leaflet, while the control group received only a psychological stress leaflet. PTSD, perceived stress, anxiety, and depression were measured before and after the intervention to assess the effect of narrative therapy. Results: After the intervention, the intervention group showed significantly lower PTSD symptom levels (p = 0.025), perceived stress (p = 0.033), anxiety (p = 0.004), and depression (p = 0.015) than the control group. Regarding the dichotomous PTSD, anxiety, and depression outcomes, there was a statistically significant decrease in the number of positive cases of PTSD (p = 0.030) and anxiety (p = 0.002), but no significant change in the number of positive cases of depression (p = 0.060). Conclusion: Narrative therapy is expected to alleviate PTSD symptoms, stress, anxiety, and depression among frontline clinical nurses, and healthcare managers should consider narrative therapy interventions to improve the mental health of their nursing staff. Clinical trial registration: ChiCTR2200058472. Registration date: April 09, 2022. Date of first recruitment: June 1, 2022.

Objective: Suicide represents 1% of all deaths in the world, and it is more prevalent in developing countries. Because suicide mortality has been growing in recent years in Brazil, we investigated whether patients who committed suicide in 2022 in Fortaleza sought care in the state’s only psychiatric emergency service before the act. Methods: This retrospective cross-sectional study used data from electronic psychiatric emergency records and reports from the state department of forensics. Results: A total of 292 deaths (25% women) were identified, representing almost 2% of mortality in Fortaleza that year. Only 2.7% of those who committed suicide during this period requested an emergency psychiatric evaluation in the 3 months prior to death. Of these individuals, 75% mentioned suicidal ideation. Most deaths (70%) were due to hanging. Conclusion: The majority of patients who committed suicide in Fortaleza in 2022 did not seek care from the psychiatric emergency service prior to the event; further studies are needed to investigate the causes of this behavior.

Objective: To assess longitudinal patterns of anxiety, depression, and posttraumatic stress symptoms, as well as their predictors, among workers at a referral hospital during the first two waves of the coronavirus disease 2019 (COVID-19) pandemic in Brazil. Methods: Data were collected between July 2020 and June 2021 (n=1,078). Anxiety, depression, and posttraumatic stress symptoms were assessed using three self-report scales: the Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Impact of Event Scale-Revised (IES-R). Predictor analysis included COVID-19-related events, fear of COVID-19, and institutional support. Statistical analysis involved linear mixed models (LMM) and local polynomial regressions. Results: Anxiety and depression trended towards increased reactivity, while posttraumatic stress presented a downward trend over follow-up, with less fluctuation. Predictor analysis showed that higher levels of institutional support were associated with a reduced risk of all adverse mental health outcomes; conversely, greater fear of COVID-19 was positively associated with all such outcomes. Conclusion: Our findings underscore the importance of allocating enhanced attention and resources to effectively addressing personal health challenges among the health workforce, emphasizing the significance of organizational support and continuous monitoring of emotional distress.

Objective: Sleep problems are common in patients with psychotic disorders, especially schizophrenia. Although pharmacological methods are at the forefront of treatment, they have some drawbacks. Cognitive behavioral therapy for insomnia (CBT-I) is an option for the treatment of individuals with insomnia; in recent years, interest in its use in patients with psychotic disorders has been increasing. This meta-analysis aims to evaluate the effectiveness of CBT-I for sleep problems in patients with psychotic disorders. Methods: A systematic search of the PubMed, Scopus, and EBSCO (MEDLINE) databases was conducted to identify relevant studies. The inclusion criteria were randomized controlled trials (RCTs) and uncontrolled studies that focused on participants diagnosed with schizophrenia, schizoaffective disorder, delusional disorder, psychotic disorders not otherwise specified, bipolar disorders, or unipolar depression with psychotic features, who had had sleep problems for at least 1 month, and who were receiving treatment. The initial search yielded 246 studies, of which eight were ultimately selected for meta-analysis after screening and applying inclusion and exclusion criteria. Statistical analysis was conducted in the R software environment. Results: CBT-I significantly ameliorates insomnia and sleep quality in patients with psychotic disorders in both the short and long term. Additionally, CBT-I leads to significant improvement in psychotic symptoms in the short-term period and contributes significantly to improvement in mental well-being in both short- and long-term follow-up. Conclusions: CBT-I is an effective, valuable method for sleep problems in patients with psychotic disorders. Its widespread use for this purpose is recommended.

Objective: In this population-based cohort study, we compared the risks of incident hyperopia, myopia, astigmatism, and strabismus between children with autism spectrum disorder (ASD) and those without ASD. Methods: This study included children who were born in Taiwan at any time between 2004 and 2017, using data from the Taiwan Maternal and Child Health Database (TMCHD). We included 20,688 children with ASD and 2,062,120 matched controls to estimate the risks of incident hyperopia, myopia, astigmatism, and strabismus. Cox proportional hazards regression models were conducted for risk assessment. Models were adjusted for sex, calendar year of birth, and gestational age at birth. Statistical significance was determined through adjusted hazard ratios (aHRs) and 95%CIs. Results: Children with ASD had higher risks of incident hyperopia (aHR: 1.78; 95%CI 1.70-1.86), myopia (aHR: 1.27; 95%CI 1.24-1.30), astigmatism (aHR: 1.51; 95%CI 1.46-1.56), and strabismus (aHR: 2.18; 95%CI 2.05-2.32) compared to children without ASD. Conclusion: Clinicians should screen children with ASD for potential eye conditions. Further studies are required to elucidate the mechanisms linking ASD with eye diseases. In addition, studies should explore how the type and severity of ASD symptoms influence the detection of these eye conditions.

Objective: To study the impacts of maternal depressive symptoms trajectories and harsh parenting and explore if the maternal quality of life (QoL) mediates this association. Methods: We used data from the 2004 Pelotas Birth Cohort, a population-based longitudinal study from Pelotas, Brazil (n=3,285 mothers, complete cases analysis). We used the Edinburgh Postnatal Depression Scale (EPDS) to assess maternal depressive symptoms and calculated their trajectories from 3 months until the 11-year follow-up using a group-based modeling approach. Psychological and physical aggression were measured using the Parent-Child Conflict Tactics Scale (CTSPC). Maternal QoL was measured by the question “How is your quality of life?” Data were analyzed using path models in Mplus. Results: All maternal depressive symptoms trajectories increased the frequency of psychological and physical aggression at early adolescence when compared to the reference group. Mediation analysis indicated that maternal depressive symptoms led to low levels of perceived maternal QoL, which in turn was associated with increased use of harsh parenting. The proportion of total effect explained by maternal QoL ranged from 4.04% (0.00-5.58%) to 16.31% (10.88-19.10%). Conclusion: Our findings, within a longitudinal framework from a middle-income country, support existing evidence that maternal depressive symptoms are associated with harsh parenting. Our results also suggest that one mechanism underlying this association is lower perceived maternal QoL.

Objective: We investigated whether a wide range of baseline mental disorders among university students predict Internet gaming disorder (IGD) 1 to 3 years later. Methods: This prospective cohort study was conducted in six Mexican universities and had a 1- to 3-year follow-up period (September 2018 to June 2022). Participants were 1st-year university students (n=2,144) free of symptoms indicative of IGD at entry (baseline). Ten mental disorders (bipolar, major depressive disorder, generalized anxiety disorder, panic disorder, alcohol use disorder, drug use disorder, binging and/or purging, intermittent explosive disorder, psychotic experiences, and attention deficit hyperactivity disorder) at baseline were investigated as risk factors for IGD at the end of the follow-up. We used Cox regression to model the IGD incidence rate. Results: Any baseline mental disorder was associated with a 2.33 times (1.26-4.31) higher rate of IGD 1 to 3 years later. Several individual disorders were associated with rates of IGD in multiple models, with comorbid conditions diminishing most of these associations. Conclusion: Only major depressive disorder and bipolar disorder remained associated with new cases of IGD. The discrepant results of longitudinal studies on the role of specific mental disorders in the development of IGD should be further investigated.

Objective: This study investigated whether moral harassment contributes to anxiety, depression, and burnout among medical residents. Methods: This three-stage longitudinal study involved 218 1st-year residents, of whom 76 (34.9%) participated in all stages. The questionnaire covered demographics, mental health (using the Patient Health Questionnaire-4), burnout (using the Maslach Burnout Inventory Human Services Survey), and harassment experiences. Mental health outcomes and harassment were analyzed using logistic regression. Results: Anxiety and depression scores varied significantly, including a notable decrease in the personal accomplishment dimension of burnout. The prevalence of harassment was above 90%, and most victims were disturbed by the harassment they suffered. While a direct correlation between harassment victimization and reduced mental health was not found, seeking help exacerbated suffering, and depression and emotional exhaustion increased less among surgical residents. Conclusion: To the extent of our knowledge, this is the first longitudinal study on mental health and harassment among medical residents. The mental suffering experienced after taking action against harassment suggests that safe environments for addressing these issues are lacking in medical residencies. Further studies concerning surgical residents could shed light on their lower levels of suffering. Institutional changes are needed to support victims and create a healthy environment.

Objective: Patients at risk of psychosis present a variety of symptoms, and identifying the most discriminative symptoms is essential for efficient detection and treatment. Methods: This cross-sectional online study analyzed individuals from the general population to better assess their risk of symptoms classified as clinical high risk (CHR) for psychosis. The 16-item Prodromal Questionnaire was applied as a self-report screening tool. Item response theory with a graded response model was used to assess the discrimination and difficulty of the questionnaire’s criteria. Results: The analysis included 936 participants (mean age: 21.5 years; 71.9% women). “Déjà vu” stood out for its high discriminative power, while the “voices or whispers” and “seeing things” items had greater precision than the other CHR-related symptoms. Conversely, the “smell or taste” and “changing faces” items were associated with the most severe cases. Conclusion: This study identified the most indicative CHR-related symptoms for accurate assessment of psychosis severity, which can be used to guide targeted preventative interventions.

Objective: Functionality and quality of life levels were measured in caregivers of patients with bipolar disorder, investigating the associations between them and with clinical and sociodemographic data. Method: A cross-sectional study was conducted between 2020 and 2022 with caregivers of patients with bipolar disorder treated in a university hospital’s outpatient clinic. The following instruments were applied: a clinical and sociodemographic questionnaire, the World Health Organization Disability Assessment Schedule 2.0, the 36-Item Short Form Health Survey, the Mini International Neuropsychiatric Interview Plus, and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders. Results: The median World Health Organization Disability Assessment Schedule 2.0 score was < 20, and the median score on the 36-Item Short Form Health Survey domains was > 60. Caregivers with greater functional impairment had lower quality of life. Being younger, being a parent, having non-psychiatric clinical conditions, and having mental disorders were associated with lower quality of life and functionality. Conclusion: These results indicate less functional impairment and better perceived quality of life than what has been reported in the literature, demonstrating that there is a subgroup of caregivers who perform their role without significant compromise to these health aspects. Exploring other factors associated with functionality and quality of life, such as resilience, psychological support, etc., may allow for more targeted public health interventions, optimizing comprehensive bidirectional care for patients and caregivers.

Objective: This study aimed to explore the association between major depressive disorder (MDD) and suicide risk in patients with dementia. Methods: A cohort of 625,218 individuals aged ≥ 40 years with dementia was identified from Taiwan’s National Health Insurance Research Database (NHIRD) between 2007 and 2018. After excluding prevalent cases in 2007, a nested case-control study enrolling 1,256 suicide cases and 5,022 matched controls was conducted. The frequencies of MDD-related outpatient or inpatient visits over a 7-year period preceding the event dates were calculated and analyzed for association using conditional logistic regression. Results: Dementia comorbid with MDD was associated with increased suicide risk (adjusted OR [AOR]: 2.67), particularly in individuals with ≤ 1.0 MDD episodes per year (AOR: 2.85). A similar association was observed only in individuals aged ≥ 65 years and males, with a pronounced risk of suicide in those experiencing ≤ 1.0 MDD episodes per year (AOR: 3.08 for individuals aged ≥ 65 years; AOR: 3.28 for males). Conversely, the risk increase was evident with > 1.0 MDD episodes per year in those aged < 65 years (AOR: 3.04) and females (AOR: 2.45). Conclusion: MDD is associated with suicide risk in patients with dementia. The strength of this association possibly varies with age and gender.

Objective: Patient response to antipsychotic drugs varies and may be related to clinical and genetic heterogeneity. This study aimed to determine the performance of clinical, genetic, and hybrid models to predict the response of patients in first-episode psychosis (FEP) to the antipsychotic risperidone. Methods: We evaluated 141 antipsychotic-naive FEP patients before and after 10 weeks of risperidone treatment. Patients who had a response rate equal to or higher than 50% on the Positive and Negative Syndrome Scale (PANSS) were considered responders (n=72; 51%). Analyses were performed using a support vector machine (SVM), k-nearest neighbors (kNN), and random forests (RF). Clinical and genetic (with single-nucleotide variants [SNVs]) models were created separately. Hybrid models (clinical + genetic factors) with and without feature selection were created. Results: Clinical models presented greater balanced accuracy (63.3%; CI 0.46-0.69) with the SVM algorithm than the genetic models (balanced accuracy: 58.5% [CI 0.41-0.76], kNN algorithm). The hybrid model, which included duration of untreated psychosis, Clinical Global Impression-Severity (CGI-S) scale scores, age, cannabis use, and 406 SNVs, showed the best performance (balanced accuracy: 72.9% [CI 0.62-0.84], RF algorithm). Conclusion: A hybrid model including clinical and genetic predictors can enhance prediction of response to antipsychotic treatment.

Objective: Given the increasing number of people with dementia in Brazil, health and social systems must urgently plan strategies to meet the needs of this population and their families. Therefore, research on dementia costs is essential. This study estimated direct and indirect dementia-related costs in Brazil. Methods: We used a cost-of-illness methodology to estimate dementia-related costs, in addition to household interview data from the National Report on Dementia in Brazil (ReNaDe) and public national databases to collect data on health service use and costs. Both a social and a health system perspective were used. Results: The monthly cost of dementia per patient increases with advancing stages of the syndrome: USD 843.04 in the initial stage, USD 1,317.81 in the intermediate stage, and USD 1,576.15 in the advanced stage. Indirect costs represent ≥ 73% of total expenses. The country’s total expenses are the highest during the intermediate stage of dementia. Conclusion: Family caregivers shoulder at least 73% of the health-related costs of dementia in Brazil, highlighting the need for better support strategies for people with dementia and their families.

Objective: We assessed the effect of N-acetylcysteine, as an adjuvant treatment, on treatment adherence (primary outcome) according to peripheral biomarkers and clinical improvement (secondary outcomes) in patients with alcohol use disorder. Methods: A 9-week randomized, double-blind, placebo-controlled clinical trial was conducted on 53 (n = 25 N-acetylcysteine, n = 28 placebo) inpatients with alcohol use disorder. Neuropeptide Y, oxidative stress and inflammatory biomarkers, and hepatic parameters were analyzed at 3 time points. Results: Seventeen (60.7%) patients in the placebo group and 16 (64%) patients in the N-acetylcysteine group completed the trial. Hepatic biomarker levels changed significantly over time (p < 0.001). Oxidized glutathione levels at admission were lower in the N-acetylcysteine group (ppairwise = 0.043). By the end of the study, both groups had similar oxidized glutathione levels (p = 0.868), and oxidized glutathione levels were lower in the placebo group. At the end of the intervention, superoxide dismutase activity had decreased and neuropeptide Y levels had increased in the N-acetylcysteine group. Both groups showed similar mean time to relapse, treatment adherence, and clinical improvement. Conclusions: Our findings reinforce the effects of alcohol on oxidative stress and neuropeptide Y parameters. However, our sample size may limit the generalizability of the results, especially for clinical outcomes. Future randomized clinical trials including patients with less severe alcohol use disorder and longer follow-up may be needed to determine whether N-acetylcysteine could help reduce the mental health burden of this disorder. Clinical Trial Registration: NCT03018236.