The Supplemental Nutrition Assistance Program (SNAP) Online Purchasing Pilot (OPP) authorized the use of SNAP benefits online in Maryland in May 2020. We assessed shopping behavior and intentions associated with uptake and intended future use of online grocery shopping during and after COVID-19 among SNAP-eligible households.

In this mixed-methods study, participants completed a survey on online grocery shopping, and a purposefully sampled subset participated in focus groups or in-depth interviews between November 2020 and March 2021.

Predominantly urban households in Maryland

Primary shoppers of SNAP-eligible households with young children (n=310)

Most participants reported first shopping for groceries online after the OPP was implemented (57%). Families who purchased groceries in-store less frequently were less likely to report ever buying groceries online (RR: 0.66, 95% CI: 0.46, 0.93) compared to weekly grocery shoppers. Shoppers who intended to purchase more groceries online in the next 6-months were more likely to have online shopping experience, although this differed by timing of online grocery service adoption. Participants reported more negative attitudes toward in-store grocery shopping during the pandemic than prior to its onset, and cited COVID-19 as a motivator for ordering groceries online in focus groups. Most participants who had shopped online planned to continue after the pandemic (79%).

Most participants who shopped online started during the COVID-19 pandemic and considered the pandemic a key motivator. Findings suggest that low-income households will continue to shop online, affirming the need for policies that promote equitable access to healthy food online.

The COVID-19 pandemic has caused psychological distress in all the communities and through all ages. Some people seemed to be less affected and to be resilient because of a dynamic interaction between individual, relational and environmental factors.

We aim on this present study to evaluate the resilience and factors associated with it among a representative sample of Tunisian adolescents during the COVID19 pandemic.

We conducted a cross sectional, descriptive and analytic study among Tunisian adolescents enrolled in secondary schools, in the Hamma region of the city of Gabes during the period extending from 5 March to 26 May 2021. Students were asked to complete a pre-established questionnaire, which contains questions about socio demographic features, medical history and knowledge about the pandemic of covid-19. The Child and Youth Resilience Measure (CYRM-28) was used to evaluate the global resilience and resources contributing to it. The CYRM-28 contains three resources including individual, relationship with primary caregivers and contextual factors. Higher scores reflect higher levels of factors associated with resilience.

A total of 326 adolescents aged between 14 and 18 years old participated on this study (mean age 16.65 years 1). There were 92 boys and 234 girls. In our sample, 4% of adolescents were infected by the Covid-19. The infection of a family member by this virus was noted in 27.3 % of cases. Adolescents were exposed to the death of a family member by Covid-19 in 22.4% of cases. The Global CYRM28 score was 105 ± 22.39. We found that adolescents who had loosen a family member because of the COVID infection, were less resilient than others (100 vs 107; p=0.023). Adolescents with a moderate to low socioeconomic level were less resilient especially with regard to contextual resilience (35, 57 vs 37, 83; p= 0.019). On the other hand, adolescents keeping means of leisure during this epidemic were significantly more resilient especially in the personal resources (p = 0.024).

Our findings conclude to some individual, relational and contextual factors that contribute or alters the process of resilience. Recognizing the strengths and capacities of adolescents would allow the development of programs and resources that can help these young people develop resilience skills.

None Declared

Child depression is a public health problem. Its association with internet addiction (IA) could increase the frequency of complications and have a significant impact on the child’s psychological well-being, schooling, family and social life.

To study the clinical profile and associated factors of IA in a population of primary school children with depressive disorders.

This was a descriptive and analytical cross-sectional study of 182 children with depression attending four primary schools in the government of Sfax. The study took place from 1 March 2022 to 30 June 2022. In the present study, we administered the following psychometric scales: Internet Addiction Test (IAT), Revised Children’s Anxiety and Depression Scale (RCADS- 47), Birleson Depression Scale Questionnaire and the Rosenberg Self-Esteem Scale.

The mean age of the children studied was 9.9 ±1.17 years and the sex ratio was 0.8. Mean score of Internet Addiction Test was 40 ±4,46. In addition, Internet addiction was identified in 73.6% of students with depression (N=143). Following a univariate analysis, internet addiction among depressed Childrens was positively correlated to individual factors such as the absence of leisure activity, the number of hours per day spent on the internet (1.63 VS 3.25, P < 0.001) and interest in accessing Tiktok (p=0.002). Internet addiction in depressed children also depended on family factors. Internet addiction was more common among childrens with a medium to high family socio-economic level (P < 0.001) in cases where parent-child communication was deemed unsatisfactory (P = 0.002) and in cases of verbal violence (P < 0.001). We were also able to establish a significant link between internet addiction among depressed pupils and significant symptoms of anxiety (P=0.019) and low self-esteem (P<0.001). Multivariate analysis using binary logistic regression revealed that medium to high socio-economic level, unsatisfactory parent-child communication, absence of leisure activities and significant symptoms of social phobia were independent predictors of Internet addiction in children with depression.

Our study highlighted the high frequency of IA in children with depression and demonstrated the implication of certain variables such as medium to high socio-economic status, disruption of the family environment, anxiety and low self-esteem. The identification of these different factors would make it possible to identify a group at risk of IA. This raises the case for introducing prevention and awareness-raising campaigns on IA among depressed children, targeting these groups and targeting health professionals and parents.

None Declared

Since December 2019, the coronavirus pandemic has led to the deaths of almost 4.37 million people worldwide and 21,905 people in Tunisia. Containment measures, stress due to fear of infection by the virus and death are likely to be traumatic events, particularly in adolescents, and may lead to the development of symptoms of post-traumatic stress disorder (PTSD).

To determine the prevalence of PTSD in a population of adolescents during the COVID-19 pandemic and to identify the factors associated with it.

This study was a cross-sectional among a representative sample of students enrolled in secondary schools, in the region of Hamma- Gabes. We used a pre-established information sheet comprising 27 questions exploring sociodemographic and family data and specific data relating to the COVID-19 pandemic. The Arabic version of The Child PTSD Symptom Scale (CPSS) was used to screen for PTSD symptoms.

326 adolescents were collected which the mean age was 16.6 years (14 to 18 years). The family environment was conflictual in 11.9% of cases. Among the adolescents, 5.5% had a history of somatic pathology. A history of psychiatric pathology was noted in 0.6%, dominated by depression. Personal infection by Covid-19 was noted in 4% of adolescents. A family member was affected in 27.3% of cases. Adolescents were exposed to the death of a close relative in 22.4% of cases. PTSD was diagnosed (according to the CPSS) in 37.4% of cases, with mild severity in 6.5%, moderate in 0.6%, moderately severe in 8%, severe in 5.2% and extremely severe in 17.2%. The analytical study showed that PTSD was correlated with a conflictual family environment (p=0.017), personal infection by COVID (P=0.003), infection of a close relative by COVID (P<0.001) and the death of a close relative by COVID (p<0.001).

According to our study, the frequency of post-traumatic stress disorder among adolescents during the COVID-19 pandemic was high, underlining the need to screen at-risk populations for populations for early intervention.

None Declared

Generalized anxiety disorder (GAD) is a highly prevalent mental illness that is associated with clinically significant distress, functional impairment, and poor emotional regulation. Primary functional magnetic resonance imaging (fMRI) studies of GAD report neural abnormalities in comparison to healthy controls. However, many of these findings in the primary literature are inconsistent, and it is unclear whether they are specific to GAD or shared transdiagnostically across related disorders.

This meta-analysis seeks to establish the most reliable neural abnormalities observed in individuals with GAD, as reported in the primary fMRI activation literature.

We conducted an exhaustive literature search in PubMed to identify primary studies that met our pre-specified inclusion criteria and then extracted relevant data from primary, whole-brain fMRI activation studies of GAD that reported coordinates in Talairach or MNI space. We then used multilevel kernel density analysis (MKDA) with ensemble thresholding to examine the differences between adults with GAD and healthy controls in order to identify brain regions that reached statistical significance across primary studies.

Patients with GAD showed statistically significant (α=0.05–0.0001; family-wise-error-rate corrected) neural activation in various regions of the cerebral cortex and basal ganglia across a variety of experimental tasks.

These results inform our understanding of the neural basis of GAD and are interpreted using a frontolimbic model of anxiety as well as specific clinical symptoms of this disorder and its relation to other mood and anxiety disorders. These results also suggest possible novel targets for emerging neurostimulation therapies (e.g., transcranial magnetic stimulation) and may be used to advance our understanding of the effects of current pharmaceutical treatments and ways to improve treatment selection and symptom-targeting for patients diagnosed with GAD.

None Declared

Functional magnetic resonance imaging (fMRI) has been used to identify the neural activity of both youth and adults diagnosed with major depressive disorder (MDD) in comparison to healthy age-matched controls. Previously reported abnormalities in depressed youth appear to mostly align with those found in depressed adults; however, some of the reported aberrant brain activity in youth has not been consistent with what is observed in adults, and to our knowledge there has not yet been a formal, quantitative comparison of these two groups. In addition, it is not known whether these observed differences between youth and adults with depression are attributable to developmental age or length-of-illness.

The aim of this study is to elucidate the similarities and differences in patterns of abnormal neural activity between adults and youth diagnosed with MDD and to then determine whether these observed differences are due to either developmental age or length-of-illness.

We used multilevel kernel density analysis (MKDA) with ensemble thresholding and triple subtraction to separately determine neural abnormalities throughout the whole brain in primary studies of depressed youth and depressed adults and then directly compare the observed abnormalities between each of those age groups. We then conducted further comparisons between multiple subgroups to control for age and length-of-illness and thereby determine the source of the observed differences between youth and adults with depression.

Adults and youth diagnosed with MDD demonstrated reliable, differential patterns of abnormal activation in various brain regions throughout the cerebral cortex that are statistically significant (p < .05; FWE-corrected). In addition, several of these brain regions that exhibited differential patterns of neural activation between the two age groups can be reliably attributed to either developmental age or length-of-illness.

These findings indicate that there are common and disparate patterns of brain activity between youth and adults with MDD, several of which can be reliably attributed to developmental age or length-of-illness. These results expand our understanding of the neural basis of depression across development and course of illness and may be used to inform the development of new, age-specific clinical treatments as well as prevention strategies for this disorder.

None Declared

Major depressive disorder (MDD) is a highly prevalent mental illness that frequently originates in early development and is pervasive during adolescence. Despite its high prevalence and early age of onset, our understanding of the potentially unique neural basis of MDD in this age group is still not well understood, and the existing primary literature on the topic includes many new and divergent results. This limited understanding of MDD in youth presents a critical need to further investigate its neural basis in youth and presents an opportunity to also improve clinical treatments that target its neural abnormalities.

The present study aims to advance our understanding of the neural basis of MDD in youth by identifying abnormal functional activation in various brain regions compared with healthy controls.

We conducted a meta-analysis of functional magnetic resonance imaging (fMRI) studies of MDD by using a well-established method, multilevel kernel density analysis (MKDA) with ensemble thresholding, to quantitatively combine all existing whole-brain fMRI studies of MDD in youth compared with healthy controls. This method involves a voxel-wise, whole-brain approach, that compares neural activation of patients with MDD to age-matched healthy controls across variations of task-based conditions, which we subcategorize into affective processing, executive functioning, positive valence, negative valence, and symptom provocation tasks.

Youth with MDD exhibited statistically significant (p<0.05; FWE-corrected) hyperactivation and hypoactivation in multiple brain regions compared with age-matched healthy controls. These results include significant effects that are stable across various tasks as well as some that appear to depend on task conditions.

This study strengthens our understanding of the neural basis of MDD in youth and may also be used to help identify possible similarities and differences between youth and adults with depression. It may also help inform the development of new treatment interventions and tools for predicting unique treatment responses in youth with depression.

None Declared

Curiosity toward the effects of psychedelic drugs on neural activation has increased due to their potential therapeutic benefits, particularly serotonergic psychedelics that act as 5-HT2A receptor agonists such as LSD, psilocybin, and MDMA. However, the pattern of their effects on neural activity in various brain regions in both clinical and healthy populations is still not well understood, and primary studies addressing this issue have sometimes generated inconsistent results.

The present meta-analysis aims to advance our understanding of the most widely used serotonergic psychedelics – LSD, psilocybin, and MDMA – by examining their effects on the functional activation throughout the whole brain among both clinical and healthy participants.

We conducted this meta-analysis by applying multilevel kernel density analysis (MKDA) with ensemble thresholding to quantitatively combine existing functional magnetic resonance imaging (fMRI) studies that examined whole-brain functional activation of clinical or healthy participants who were administered a serotonergic psychedelic.

Serotonergic psychedelics, including LSD, psilocybin, and MDMA, exhibited significant effects (α=0.05) on neural activation in several regions throughout the cerebral cortex and basal ganglia, including effects that may be common across and unique within each drug.

These observed effects of serotonergic psychedelics on neural activity advance our understanding of the functional neuroanatomy associated with their administration and may inform future studies of both their adverse and therapeutic effects, including emerging clinical applications for the treatment of several psychiatric disorders.

None Declared

Major depressive disorder (MDD) is a highly prevalent mental illness that often first occurs or persists into adulthood and is considered the leading cause of disability and disease burden worldwide. Unfortunately, individuals diagnosed with MDD who seek treatment often experience limited symptom relief and may not achieve long-term remission, which is due in part to our limited understanding of its underlying pathophysiology. Many studies that use task-based functional magnetic resonance imaging (fMRI) have found abnormal activation in brain regions in adults diagnosed with MDD, but those findings are often inconsistent; in addition, previous meta-analyses that quantitatively integrate this large body literature have found conflicting results.

This meta-analysis aims to advance our understanding of the neural basis of MDD in adults, as measured by fMRI activation studies, and address inconsistencies and discrepancies in the empirical literature.

We employed multilevel kernel density analysis (MKDA) with ensemble thresholding, a well-established method for voxel-wise, whole-brain meta-analyses, to conduct a quantitative comparison of all relevant primary fMRI activation studies of adult patients with MDD compared to age-matched healthy controls.

We found that adults with MDD exhibited a reliable pattern of statistically significant (p<0.05; FWE-corrected) hyperactivation and hypoactivation in several brain regions compared to age-matched healthy controls across a variety of experimental tasks.

This study supports previous findings that there is reliable neural basis of MDD that can be detected across heterogenous fMRI studies. These results can be used to inform development of promising treatments for MDD, including protocols for personalized interventions. They also provide the opportunity for additional studies to examine the specificity of these effects among various populations-of-interest, including youth vs. adults with depression as well as other related mood and anxiety disorders.

None Declared

Bipolar disorder is a source of marked disability, morbidity and premature death. There is a paucity of research on personalised psychosocial interventions for bipolar disorder, especially in low-resource settings. A pilot randomised controlled trial (RCT) of a culturally adapted psychoeducation intervention for bipolar disorder (CaPE) in Pakistan reported higher patient satisfaction, enhanced medication adherence, knowledge and attitudes regarding bipolar disorder, and improvement in mood symptom scores and health-related quality of life measures compared with treatment as usual (TAU).

The current protocol describes a larger multicentre RCT to confirm the clinical and cost-effectiveness of CaPE in Pakistan. Trial registration: NCT05223959.

A multicentre individual, parallel-arm RCT of CaPE in 300 Pakistani adults with bipolar disorder. Participants over the age of 18, with a diagnosis of bipolar I or II disorder who are currently euthymic, will be recruited from seven sites: Karachi, Lahore, Multan, Rawalpindi, Peshawar, Hyderabad and Quetta. Time to recurrence will be the primary outcome assessed using the Longitudinal Interval Follow-up Evaluation (LIFE). Secondary measures will include mood symptoms, quality of life and functioning, adherence to psychotropic medications, and knowledge and attitudes regarding bipolar disorder.

This trial will assess the effectiveness of the CaPE intervention compared with TAU in reducing the time to recurrence for people with bipolar disorder currently in remission in Pakistan and determine the effect on clinical outcomes, quality of life and functioning.

A successful trial might lead to rapid implementation of CaPE in clinical practice, not only in Pakistan, but also in other low-resource settings, including those in high-income countries, to improve clinical outcomes, social and occupational functioning, and quality of life in South Asian and other minority group patients with bipolar disorder.

Healthcare workers (HCWs) have been impacted psychologically due to their professional responsibilities over the prolonged era of the coronavirus disease 2019 (COVID-19) pandemic. The study aimed to identify the predictors of psychological distress, fear, and coping during the COVID-19 pandemic among HCWs.

A cross-sectional online survey was conducted among self-identified HCWs across 14 countries (12 from Asia and two from Africa). The Kessler Psychological Distress Scale, the Fear of COVID-19 Scale, and the Brief Resilient Coping Scale were used to assess the psychological distress, fear, and coping of HCWs, respectively.

A total of 2447 HCWs participated; 36% were doctors, and 42% were nurses, with a mean age of 36 (±12) years, and 70% were females. Moderate to very-high psychological distress was prevalent in 67% of the HCWs; the lowest rate was reported in the United Arab Emirates (1%) and the highest in Indonesia (16%). The prevalence of high levels of fear was 20%; the lowest rate was reported in Libya (9%) and the highest in Egypt (32%). The prevalence of medium-to-high resilient coping was 63%; the lowest rate was reported in Libya (28%) and the highest in Syria (76%).

COVID-19 has augmented the psychological distress among HCWs. Factors identified in this study should be considered in managing the wellbeing of HCWs, who had been serving as the frontline drivers in managing the crisis successfully across all participating countries. Furthermore, interventions to address their psychological distress should be considered.