key: cord-1041311-9g6encle
authors: Mosquera-Presedo, M.; Rodriguez-Casanova, A.; Vicente-Alba, J.
title: P.0213 Self-perceived mental health and isolation as screening tools in mental health symptoms during covid-19 pandemic
date: 2021-12-30
journal: Eur Neuropsychopharmacol
DOI: 10.1016/j.euroneuro.2021.10.205
sha: 3ec8b78ea18c3c8d121cb12cae57e95fab4e6c32
doc_id: 1041311
cord_uid: 9g6encle

nan

Background: Coronavirus disease (COVID-19) pandemic has led to a deterioration in mental health, with increased levels of stress, anxiety and depression in the population [1] . There are different scales used for measured these symptoms. The Depression, Anxiety and Stress Scale-21 (DASS-21) is one of them, with strong psychometric properties [ 2 , 3 ] and it is validated in Spanish [4] . Due to the increase on mental health problems it is mandatory to look for new parameters that can be used on population as screening tool. Isolation and self-perceived mental health (SPMH) will be studied. Aims: To study how Spanish lockdown affected mental health during COVID-19 pandemic. Besides, to study the potential of isolation and SPMH as screening tools in mental health symptoms during COVID-19 pandemic in comparison with DASS-21. Methods: A retrospective observational study was designed using a Spanish telematic anonymous survey from 6th-22nd September 2020 (N = 650), created with Google Forms platform. For SPMH, Likert-type scales were used (1-lowest to 10-highest) focusing on isolation, anxiety, stress and depression. As validated scale, DASS-21 was used. Both scales were used to study the items during Spanish lockdown period. Statistical significance was analysed using GraphPad Prism v.6. Receiver operating characteristic (ROC) curves were used, calculating the area under the curve (AUC). Results: Participants were predominantly young (61.08%, 17-25 years) and female (78%). Based on intrinsic DASS-21 cut-offs, the sample was divided into control (mild or no symptom) and patient groups (moderate, high or extremely high symptom) for each item. DASS-21 showed a high prevalence of stress (50.92%), anxiety (46.31%) and depression (56.00%) symptoms. Regarding stress (9.5 cutoff), the sample was divided into controls (n = 319) and patients (n = 331). Higher levels of self-perceived stress were found in patient group (mean (M) = 7.96 ±2.01) than in control group (M = 5.46 ±2.54), being the comparison statistically significant (p < 0.0001). Concerning anxiety (4.5 cut-off), higher levels of self-perceived anxiety were found in patients (n = 301, M = 7.65 ±2.24) than in controls (n = 349, M = 4.67 ±2.66), with a statistically significant comparison (p < 0.0001). About depression (6.5 cut-off), selfperceived depression had higher levels in patients (n = 364, M = 6.21 ±2.58) than in controls (n = 286, M = 3.30 ±2.27), being the comparison statistically significant (p < 0.0001). ROC curve analysis showed a high diagnostic capacity to differentiate between control and patient in stress (AUC = 0.7822, 95% confidence interval (CI) = 0.7471-0.8173, p < 0.0001), anxiety (AUC = 0.7992, IC = 0.7653-0.8331, p < 0.0001) and depression (AUC = 0.7951, IC = 0.7609-0.8293, p < 0.0001).

Using bimodal DASS-21 (anxiety-depression) and their intrinsic cut-offs, the sample was divided into control (n = 243) and patient group (n = 407) for self-perceived isolation. The comparison exposed higher levels of self-perceived isolation in patients (M = 7.47 ±2.06) than in controls (M = 6.08 ±2.56), with statistical significance (p < 0.0001). ROC curve analysis showed some diagnostic capacity to differentiate control and patient (AUC = 0.6590; CI = 0.6147-0.7033, p < 0.0001).

Conclusions: DASS-21 scale showed high levels (moderate to extremely high) of stress, anxiety and depression during Spanish lockdown period. Self-perceived stress, anxiety and depression have the potential to be used as a mental health screening tool. Moreover, self-perceived isolation could be used to anxiety and depression symptoms. Altogether, SPMH has shown a good diagnostic capacity for mental health symptoms compared with DASS-21. Background: ECT has been established as the most effective treatment for severe unipolar and bipolar depression, and also has an important place in the acute management of mania and mixed states. ECT is generally considered safe, and short-term overall mortality of ECT is very low. Treatment guidelines across the world recommend taking particular caution when administering ECT to patients with preexisting somatic comorbidities. However, evidence regarding the risks of administering electroconvulsive therapy (ECT) in patients with somatic comorbidity is very limited. Aim: To examine whether ECT is associated with short and long-term risk of mortality and acute somatic events in patients with or without preexisting somatic comorbidity. Methods : 174,495 patients with a first-time diagnosis of an affective disorder, of whom 41% had somatic comorbidity, were followed for ECT, mortality and serious acute somatic outcomes using Danish registers. Somatic comorbidity was defined as at least one preexisting diagnosis of a range of common medical conditions (e.g. hypertension, ischemic heart disease, diabetes, obesity, chronic obstructive pulmonary disease, etc.) or use of medication for these conditions. Acute somatic events were defined as acute cardiac events (including acute myocardial infarction, cardiac arrest, paroxysmal tachycardia, atrial fibrillation/flutter, and other cardiac arrhythmias), stroke, intracranial hemorrhage (including subarachnoid; traumatic epi-, and subdural hemorrhage), epileptic seizures, pneumonia, pulmonary embolism or edema, or hip fracture. The association of ECT with risk of mortality and acute somatic events in patients with or without somatic comorbidity were estimated using Cox Proportional Hazard regression models. Potential interactions with preexisting somatic comorbidity and ECT (i.e. that patients with somatic comorbidity would have higher risk of somatic events or death following ECT than patients with no somatic comorbidity, as compared to the corresponding non-ECT treated patient groups), were tested using likelihood ratio tests with an interaction term (somatic comorbidity * ECT) in the model. Results : Patients were followed for a median of 6.7 years, corresponding to 1.12 million person-years. Compared to the non-ECT treated population, ECT was associated with a lower risk of death from natural causes, which was independent of somatic comorbidity status. Furthermore, ECT was not associated with a higher risk of acute somatic events neither in patients with nor without somatic comorbidity, with the exception of acute cardiac events during 0-30 days of follow-up after the first ECT, for which there was a 3.6fold higher risk in patients with no somatic comorbidity. However, this analysis was based on very few events. Conclusion: Based on this nationwide cohort study of patients with affective disorders, we conclude that ECT is not associated with any short or long-term higher mortality risk in patients with preexisting somatic comorbidity. Likewise, ECT was not associated with any short or long-term risk of developing serious acute somatic events, except for a possible higher rate of non-mortal cardiac events in ECTtreated patients without preexisting somatic comorbidity. The study contributes substantially to our knowledge base on the safety of ECT in people with medical illness and underlines the continuing importance of ECT as a powerful and safe treatment modality in patients with affective disorders. 

Stress, anxiety, and depression levels in the initial stage of the COVID-19 outbreak in a population sample in the northern Spain

Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress scales in Clinical groups and a community sample

Depression, Anxiety, and Stress: How Should Clinicians Interpret the Total and Subscale Scores of the 21-Item Depression, Anxiety, and Stress Scales?

The Hierarchical Factor Structure of the Spanish Version of Depression Anxiety and Stress Scale-21

Self-perceived mental health and isolation as screening tools in mental health symptoms during covid-19

Stress, anxiety, and depression levels in the initial stage of the COVID-19 outbreak in a population sample in the northern Spain

Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress scales in Clinical groups and a community sample

Depression, Anxiety, and Stress: How Should Clinicians Interpret the Total and Subscale Scores of the 21-Item Depression, Anxiety, and Stress Scales?

The Hierarchical Factor Structure of the Spanish Version of Depression Anxiety and Stress Scale-21