key: cord-1021849-rz8fq75i
authors: Elek, L. P.; Erdelyi-Hamza, B.; Kulig, B.; Kovács, I.; Fountoulakis, K. N.; Smirnova, D.; Gonda, X.
title: P.0413 Modifiable risk and protective factors influencing changes in subjective depression during the COVID-19-lockdown: identifying targets for prevention and intervention
date: 2021-12-31
journal: European Neuropsychopharmacology
DOI: 10.1016/j.euroneuro.2021.10.386
sha: ee22bc6e5f0774013e621f4bb959946f30f41df8
doc_id: 1021849
cord_uid: rz8fq75i

Introduction The COVID-19 pandemic and the consequential public health measures exert an enormous psychosocial impact, leading to the precipitation or worsening of psychological symptoms and psychiatric disorders. Given the numbers affected, and also the psychiatric consequences of the virus and infection including post-covid symptoms, alleviating the psychological consequences of the lockdown would significantly decrease subjective suffering and healthcare burden. Our aim was to investigate protective and risk factors of pandemic lockdown-related subjective changes in depression in a general population sample as part of a large international 42-country collaboration. Methods: As part of a large international study in 42 countries, 763 Hungarian adults recruited using a snowball method provided demographic and health data and completed online questionnaires evaluating depression (CES-D) anxiety (STAI) as well as their self-reported changes, impact on lifestyle (including physical activity, sleep, eating, daily routines), changes in subjective experiences, use of alcohol, tobacco and psychotropic agents, internet and social media, religion and spirituality, and beliefs related to the pandemic and its origin as well as pandemic-related conspiracy theories during the lockdown. In the present analyses we focused on factors influencing self-reported changes in depression using a binary logistic regression model and χ2-square tests, including age, sex, history of anxiety/mood disorders, presence of chronic somatic problems, health, degree of lock-up, maintenance of daily routine, change in the characteristics of family relationships and contacts, fears related to the virus, beliefs related to the precautions and their effectiveness, financial state, and work and profession-related factors. Results: Proportion of those reporting a subjective worsening of depression did not differ between those with or without history of depression (χ2 (2) = 4.586, p= 0.101), or with or without history of anxiety disorders (χ2 (2) = 4.527, p = 0.104). Several factors significantly influenced likelihood of no change/improvement vs worsening of subjective depression. Protective factors included preserved or improved general health (OR: 1.389, Wald's χ2=11.357), and maintaining daily routine (OR: 1.625, Wald's χ2=25.295, p=0.001), while risk factors included a negative change in family relationships (OR: 0.221, Wald's χ2=12.508, p<0.0001), increased fear of contracting the coronavirus (OR: 0.743B, Wald's χ2=7.176, p=0.007,) and decline in one's financial status (OR: 0.592, Wald's χ2=8.579, p=0.003). Our model explained 19.9 % of the variance in subjective changes of mood with a 74% model accuracy for case classification (χ2 (19) = 115.744;p < 0.0001;R2: 0.199). Conclusion: We identified several factors impacting subjective mood changes as a consequence of the pandemic-related lockdown, including general health, maintaining daily routine, quality of family relationships;fear of contracting the virus and a stable financial state, with history of depression or anxiety having no effect. It is noteworthy that the majority of factors which increased risk of or protect against subjective worsening of depression are modifiable factors and can be addressed by psychoeducation, information, or low threshold interventions, thus decreasing not only subjective suffering and the risk of emergence of more severe psychological symptoms, but also the burden on healthcare. No conflict of interest

Sex differences exist in the clinical characteristics and the illness course of bipolar disorder (BD) [1] . Despite sex differences in neurocognition have been previously described in healthy controls (HC) [2] , evidence from the literature addressing the influence of sex in cognitive impairment in BD remains inconclusive. Therefore, the aim of the present study is to examine the role of sex differences in neurocognition and psychosocial functioning in a large sample of euthymic patients with BD. We hypothesize that differential sex effects for the different cognitive domains and psychosocial functioning will exist in BD; however, no directional hypotheses are made in BD sample given the paucity and inconsistency of literature on the topic.

Method: The sample comprised 462 individuals, 347 euthymic patients with BD (148 males and 199 females) and 115 healthy controls (HC) (45 males and 70 females). Patients were assessed by a comprehensive neurocognitive battery of tests and the Functioning Assessment Short Test (FAST) [3] . for the assessment of psychosocial outcome. Performance was compared between groups through Generalized Linear Models, with sex and group as main effects and the group by sex interactions. Clinical characteristics and pharmacological treatments of males and females with BD were also compared using t-test and χ 2 tests to control for the potential effect of confounders. Results: Significant sex effects were observed on different neuropsychological subtests. Males performed better than females in working memory index of Wechsler Adult Intelligence Scale (WAIS-III) ( χ ²= 7.66, p < 0.001) and a measure related to sustained attention, the reaction time consistency in the Continuous Performance Test (CPT-II) ( χ ²= 4.20, p = 0.04). Females outperformed males in the verbal memory recognition task in the California Verbal Learning Test (CVLT) ( χ ²= 4.40, p = 0.04). There was a significant group by sex interactions for the immediate recall of the logical memory Wechsler Memory Scale (WMS-III) subtest ( χ ²= 4.18, p = 0.04) and the percentage retention of logical memory ( χ ²= 4.19, p = 0.04) with HC females performing better than females and males patients in the immediate recall. All main effects and interactions mentioned above were significant after controlling for residual depression and mania symptoms. Controlling for the effect of potential clinical confounders, such as diagnosis subtype and lifetime drug consumption where males and females patients differed, did not show significant effects in the neurocognitive tasks performed. There were no overall sex differences or group by sex interactions in psychosocial functioning. Only main effects of group were detected, with patients with BD having significantly decreased functioning compared to HC.

Conclusions: Sex differences in neurocognitive performance are present in a few variables related to attention, working memory and verbal memory domains but not in psychosocial functioning. Males outperformed females in attention and working memory and females in verbal memory. The advantage of logical memory was only for females in the HC group. Sex effects on neurocognition in BD should be taken into account in the design of cognitive therapeutic strategies tailored to the needs of both sexes.

Introduction The COVID-19 pandemic and the consequential public health measures exert an enormous psychosocial impact, leading to the precipitation or worsening of psychological symptoms and psychiatric disorders. Given the numbers affected, and also the psychiatric consequences of the virus and infection including post-covid symptoms, alleviating the psychological consequences of the lockdown would significantly decrease subjective suffering and healthcare burden. Our aim was to investigate protective and risk factors of pandemic lockdown-related subjective changes in S299 Abstracts depression in a general population sample as part of a large international 42-country collaboration. Methods: As part of a large international study in 42 countries, 763 Hungarian adults recruited using a snowball method provided demographic and health data and completed online questionnaires evaluating depression (CES-D) anxiety (STAI) as well as their self-reported changes, impact on lifestyle (including physical activity, sleep, eating, daily routines), changes in subjective experiences, use of alcohol, tobacco and psychotropic agents, internet and social media, religion and spirituality, and beliefs related to the pandemic and its origin as well as pandemic-related conspiracy theories during the lockdown. In the present analyses we focused on factors influencing self-reported changes in depression using a binary logistic regression model and χ 2-square tests, including age, sex, history of anxiety/mood disorders, presence of chronic somatic problems, health, degree of lockup, maintenance of daily routine, change in the characteristics of family relationships and contacts, fears related to the virus, beliefs related to the precautions and their effectiveness, financial state, and work and profession-related factors. Results : Proportion of those reporting a subjective worsening of depression did not differ between those with or without history of depression ( χ 2 (2) = 4.586, p = 0.101), or with or without history of anxiety disorders ( χ 2 (2) = 4.527, p = 0.104). Several factors significantly influenced likelihood of no change/improvement vs worsening of subjective depression. Protective factors included preserved or improved general health (OR: 1.389, Wald's χ 2 = 11.357), and maintaining daily routine (OR: 1.625, Wald's χ 2 = 25.295, p = 0.001), while risk factors included a negative change in family relationships (OR: 0.221, Wald's χ 2 = 12.508, p < 0.0001), increased fear of contracting the coronavirus (OR: 0.743B, Wald's χ 2 = 7.176, p = 0.007,) and decline in one's financial status (OR: 0.592, Wald's χ 2 = 8.579, p = 0.003). Our model explained 19.9 % of the variance in subjective changes of mood with a 74% model accuracy for case classification ( χ 2 (19) = 115.744; p < 0.0001; R 2 : 0.199). Conclusion : We identified several factors impacting subjective mood changes as a consequence of the pandemicrelated lockdown, including general health, maintaining daily routine, quality of family relationships; fear of contracting the virus and a stable financial state, with history of depression or anxiety having no effect. It is noteworthy that the majority of factors which increased risk of or protect against subjective worsening of depression are modifiable factors and can be addressed by psychoeducation, information, or low threshold interventions, thus decreasing not only subjective suffering and the risk of emergence of more severe psychological symptoms, but also the burden on healthcare. Background : Major Depressive Disorder (MDD) is a medical illness affecting more than 350 million people worldwide, which is almost twice as common in women than in men lifetime. Many elements may concur to explain this gender gap, including genetic, biochemical, hormonal and environmental factors [1] . Even though a different clinical presentation and specific risk factors for MDD are hypothesized according to gender, limited evidence has been published about this topic [2] . Aim of this study is therefore to identify, in a cohort of patients hospitalized for depression, genderrelated biological and clinical parameters. These results will be helpful to develop treatment strategies for MDD according to gender differences in the context of an individualized medicine. Methods : We evaluated clinical records and biological data of 234 patients (112 males and 122 females) hospitalized in the Psychiatry Unit of the Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico from 2008 to 2020 for MDD, according to DSM (Diagnostic and Statistical Manual of Mental Disorder) criteria. Clinical and biological data were obtained through a screening of the clinical charts, interviews and blood analyses conducted during the hospitalization. Statistical analyses were performed through IBM SPSS Statistics 26 system. We performed descriptive analyses of the total sample, then we applied a multi-step approach performing univariate analyses, preliminary binary logistic regressions, using gender as dependent variable, and a final logistic regression model including all the variables resulted to be statistically significant in the previous models. Results : Female patients had lower plasmatic levels of hemoglobin (p = 0.001) and uric acid (p = 0.002), higher levels of cholesterol (p < 0.0001) and showed more frequently comorbidity with thyroid diseases (p = 0.036). From a clinical point of view, female patients were younger at onset (p = 0.043), had assumed a lower number of antidepressants before the hospitalization (p = 0.011) and took less frequently a polytherapy with more than one psychotropic drug (p < 0.0001). Moreover, female patients had achieved more frequently remission in the last depressive episode (p = 0001) and were more likely to have family history for Bipolar Disorder than males (p < 0.0001; 87.5% versus 12.5%) Conclusions : Our findings suggest that female patients globally have a better response to treatments as showed by the less frequency of polytherapy and more probability of remission with respect to males. On the other hand, they seem to be more prone to less clinical stabilization, as showed for example by more family history for Bipolar Disorder,

Gender and mental health service use in bipolar disorder: national cohort study

Cognitive impairment but preservation of sexual dimorphism in cognitive abilities in chronic schizophrenia

Validity and reliability of the Functioning Assessment Short Test (FAST) in bipolar disorder