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A number of community based surveys have identified an increase in psychological symptoms and distress but there has been no examination of symptoms at the more severe end of the mental health spectrum.
We aimed to analyse numbers and types of psychiatric presentations to inform planning for future demand on mental health services in light of the COVID-19 pandemic.
We analysed electronic data between January and April 2020 for 2534 patients referred to acute psychiatric services, and tested for differences in patient demographics, symptom severity and use of the Mental Health Act 1983 (MHA), before and after lockdown. We used interrupted time-series analyses to compare trends in emergency department and psychiatric presentations until December 2020.
There were 22% fewer psychiatric presentations the first week and 48% fewer emergency department presentations in the first month after lockdown initiated. A higher proportion of patients were detained under the MHA (22.2 v. 16.1%) and Mental Capacity Act 2005 (2.2 v. 1.1%) (χ2(2) = 16.3, P < 0.0001), and they experienced a longer duration of symptoms before seeking help from mental health services (χ2(3) = 18.6, P < 0.0001). A higher proportion of patients presented with psychotic symptoms (23.3 v. 17.0%) or delirium (7.0 v. 3.6%), and fewer had self-harm behaviour (43.8 v. 52.0%, χ2(7) = 28.7, P < 0.0001). A higher proportion were admitted to psychiatric in-patient units (22.2 v. 18.3%) (χ2(6) = 42.8, P < 0.0001) after lockdown.
UK lockdown resulted in fewer psychiatric presentations, but those who presented were more likely to have severe symptoms, be detained under the MHA and be admitted to hospital. Psychiatric services should ensure provision of care for these patients as well as planning for those affected by future COVID-19 waves.
Children acquiring sociolinguistic knowledge in transnational migration settings must learn to evaluate multiple languages and dialects in a fluid, multifaceted social landscape. This study examines the sociolinguistic development of local and expatriate children in Singapore and investigates the extent to which they share sociolinguistic knowledge and norms. One hundred fourteen children ages five to nineteen completed a region identification task and an occupation judgment task, focusing on their perception of four regional English varieties: Australian English, Northern-China-accented English, Filipino English, and Singapore English. While all groups performed well on the region identification task, expatriate children outperformed locals within the youngest age group. Singaporean and expatriate children attending local schools showed greater familiarity with local norms than international school students in their occupation ratings. Participants mapped speakers to occupations by general prestige level, suggesting that children rely on indirect knowledge of social status rather than direct experience with speakers in their development of sociolinguistic evaluation. (Children's sociolinguistic development, transnational migration, language attitudes)*
Some fear that provoking widespread worry about climate change may harm mental health. The Regional Wellbeing Survey, a large study of health, well-being and life in rural and regional Australia, examined climate change worry and attitudes. Most respondents were worried about climate change and agreed that fossil fuel use causes global warming, but there was no evidence to suggest that worry about climate change is linked to mental health in the general population. Respectful, calm, considered public debate about how to respond to climate change is unlikely to be harmful to population mental health. Individually focused clinical approaches are unlikely to be effective as a primary approach in managing the mental health impacts of climate change. Instead, collective, systems-based approaches will be needed.
Des niveaux moins élevés de participation sociale et d’épisodes de marche représentent deux facteurs pouvant contribuer à la dépression chez les personnes âgées, mais les recherches antérieures ne sont pas concluantes à ce sujet. L’objectif de cette étude transversale est de quantifier les associations entre la dépression et l’effet combiné de la participation sociale et de la marche dans un échantillon de personnes âgées vivant au Canada (n = 549). Des analyses de régressions linéaires et logistiques ont été effectuées pour examiner si la participation sociale et la marche prédisent la dépression indépendamment des caractéristiques individuelles. Dans les modèles finaux, les résultats suggèrent que les individus qui ne prennent pas de marches présentent davantage de symptômes dépressifs ou une possible dépression (l’association entre la participation sociale et la dépression devient non significative dans les modèles ajustés). La présente étude souligne le rôle central des habitudes de vie telle la marche pour la santé mentale des aînés.
No accepted intervention exists for borderline personality disorder presenting in adolescence.
To compare the effectiveness of up to 24 sessions of cognitive analytic therapy (CAT) or manualised good clinical care (GCC) in addition to a comprehensive service model of care.
In a randomised controlled trial, CAT and GCC were compared in out-patients aged 15–18 years who fulfilled two to nine of the DSM–IV criteria for borderline personality disorder. We predicted that, compared with the GCC group, the CAT group would show greater reductions in psychopathology and parasuicidal behaviour and greater improvement in global functioning over 24 months.
Eighty-six patients were randomised and 78 (CAT n=41; GCC n=37) provided follow-up data. There was no significant difference between the outcomes of the treatment groups at 24 months on the pre-chosen measures but there was some evidence that patients allocated to CAT improved more rapidly. No adverse effect was shown with either treatment.
Both CAT and GCC are effective in reducing externalising psychopathology in teenagers with sub-syndromal or full-syndrome bipolar personality disorder. Larger studies are required to determine the specific value of CAT in this population.
We evaluated the utility of the Chinese version of the Edinburgh Postnatal Depression Scale (EPDS) and measured the prevalence of major depression six weeks after confinement among Chinese women in Hong Kong.
A prospective cohort of 145 women completed the EPDS, the 12-item General Health Questionnaire (GHQ) and the Beck Depression Inventory (BDI) six weeks after giving birth. They were then assessed with the Structured Clinical Interview for DSM–III–R, non-patient version (SCID–NP) to establish psychiatric diagnosis. The criterion validity of EPDS was tested against this clinical diagnosis, and the concurrent validity against the GHQ and BDI scores was also evaluated. The internal consistency of the scales was measured by Cronbach's α coefficient.
The Chinese EPDS had satisfactory psychometric properties and a cut-off score of 9/10 is recommended for screening depressive illness in a general postnatal population. At six weeks postpartum, 5.5% of the study population suffered from major depression.
The Chinese EPDS will be useful for screening for postnatal depression.
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