Mental health and psychosocial support (MHPSS) staff in humanitarian settings have limited access to clinical supervision and are at high risk of experiencing burnout. We previously piloted an online, peer-supervision program for MHPSS professionals working with displaced Rohingya (Bangladesh) and Syrian (Turkey and Northwest Syria) communities. Pilot evaluations demonstrated that online, peer-supervision is feasible, low-cost, and acceptable to MHPSS practitioners in humanitarian settings.

This project will determine the impact of online supervision on i) the wellbeing and burnout levels of local MHPSS practitioners, and ii) practitioner technical skills to improve beneficiary perceived service satisfaction, acceptability, and appropriateness.

MHPSS practitioners in two contexts (Bangladesh and Turkey/Northwest Syria) will participate in 90-minute group-based online supervision, fortnightly for six months. Sessions will be run on zoom and will be co-facilitated by MHPSS practitioners and in-country research assistants. A quasi-experimental multiple-baseline design will enable a quantitative comparison of practitioner and beneficiary outcomes between control periods (12-months) and the intervention. Outcomes to be assessed include the Kessler-6, Harvard Trauma Questionnaire and Copenhagen Burnout Inventory and Client Satisfaction Questionnaire-8.

A total of 80 MHPSS practitioners will complete 24 monthly online assessments from May 2022. Concurrently, 1920 people receiving MHPSS services will be randomly selected for post-session interviews (24 per practitioner).

This study will determine the impact of an online, peer-supervision program for MHPSS practitioners in humanitarian settings. Results from the baseline assessments, pilot evaluation, and theory of change model will be presented.

No significant relationships.

The aim of the current study is to compare Seniors in the Community: Risk Evaluation for Eating and Nutrition, version II (SCREEN II) and Mini Nutritional Assessment – Short Form (MNA-SF), where each is used to identify nutritional risk prevalence among community-dwelling people aged 65 years and above in Bosnia and Herzegovina.

A cross-sectional study. Nutritional risk assessed using the nutritionist’s risk rating, anthropometric measurements, functional indicators, cognitive parameters, SCREEN II and MNA-SF.

The municipalities of Foca, East Sarajevo and Bijeljina, Bosnia and Herzegovina.

Eight hundred twenty-one community-dwelling individuals aged ≥65 years.

The prevalence of high nutritional risk per nutritionist’s risk rating, SCREEN II and MNA-SF was 26, 60, and 7 %, respectively. With the nutritionist’s rating score ≥5 as the criterion, the MNA-SF cut-off point of ≤11 (indicating any possible risk) had poor sensitivity (55·7 %), specificity (46·6 %) and AUC (0·563; P = 0·024). When the criterion of >7 was applied, good sensitivity (95·3 %) and specificity (88·9 %) were obtained for the MNA-SF cut-off score of ≤7. AUC for this comparison was 0·742 (considered fair). Cut-off points of <54 (AUC = 0·816) and <50 (AUC = 0·881) for SCREEN II (indicating moderate to high risk) corresponded with good sensitivity (82·2 %; 80·9 %) and fair specificity (72·1 %; 75·0 %).

MNA-SF may have a limited role in nutritional risk screening among community-dwelling seniors in Bosnia and Herzegovina. SCREEN II has promising results in regard to validity, but further studies are warranted.

Stigmatization of a psychiatric patient is present both in general population and among health-care professionals.

To determine the attitudes of medical students (MS) towards a person who goes to a psychiatrist, before and after psychiatric rotation, and to compare those attitudes between medical and non-medical students.

The study included 525 MS (2nd and 6th year of studies) and 154 students of law. The study instrument was a 3-part self-reported questionnaire (socio-demographic data, Rosenberg self-esteem scale and a vignette depicting young, mentally healthy person). The experimental intervention consisted of ascribing a “psychiatric label” to only one set of vignettes. All the vignettes (with or without “psychiatric label”) were followed by 14 statements addressing acceptance of a person described by vignette as judged by social distance.

We found more stigmatizing attitudes of the MS in the final year, after psychiatric rotation. The non-medical students had similar tendency to stigmatize as MS before psychiatric rotation. A higher level of stigmatization was evident in regard to a closer relationship between a student and a hypothetic person who goes to a psychiatrist. Neither sex, nor the size of student's place of origin or average academic mark was associated with the tendency to stigmatize.

Psychiatric education can either reinforce stigma or reduce it. Therefore, detailed analyses of educational domains which reinforce stigma should be conducted at the university level, in parallel with national initiative to fight against stigma and discrimination attached to mental health problems and those living with them.

The aim of the study was to asses the efficacy of the 6 week therapeutic program designed for social phobia (SSRIs and CBT) in patients suffering with social phobia and comorbid personality disorder (27 patients) and social phobia without comorbid personality disorder (26 patients). Patients were assessed in week 0, 2, 4, and 6 on the CGI, LSAS, BAI and BDI.

Patients of both two groups improved in assessment instruments. The treatment efficacy in the patients with social phobia without personality disorder had been showed significantly better compared with the group with social phobia comorbid with personality disorder in CGI and LSAS. Also the scores in subjective depression inventory BDI showed significantly higher degrease during the treatment in the group without personality disorder. But the treatment effect between groups did not differ in subjective general anxiety scales BAI.

The low frequency rTMS administered over the right dorso-lateral prefrontal cortex after 10sessions did not differ from sham rTMS that was add on serotonin reuptake inhibitors in patients suffering from panic disorder. Further studies are indicated to assess the efficacy of rTMS in panic disorder and to clarify the optimal stimulation characteristics.

By IGA MZ CR NT 11047-4/2010.

The core mechanism of maladaptive stress response includs aberrant phosphorylation of the glucocorticoid receptor (GR) at serine 221 (pGR211) or GR serine 226 (pGR226), which enhance or attenuate GR transcriptional activity, respectively. In the current study we tested a hypothesis that alterations in the nuclear levels and/or ratios of GR, pGR211 and pGR226 in peripheral blood mononuclear cells (PBMC) may reflect individual level of distress and/or psychological vulnerability.

In 36 healthy adults we evaluated the relation of total PMBC nuclear level of GR (tGR), pGR221, pGR226 and activated JNK1 (pJNK1) and its relation to environmental stress exposure, self reported distress (Depression Anxiety Stress Scale) and personality traits (Eysenck Personality Questionnaire). Molecular and psychometric data were cross-correlated by SPSS MannWhitney statistics.

In women, self reported distress (DASS score) correlated more with neuroticism, while in men it correlated with environmental stressor. Also, in women, PBMC nuclear tGR level correlated with pGR211, while in men it correlated with pGR226. Cross-analysis of psychometric and molecular data indicated that in women both neuroticism and self reported distress correlated positively with nuclear pGR226, while in men the only correlation was between environmental stressor and pJNK1.

This findings provide preliminary support that the nuclear level of pGR226 and pGR211/pGR226 ratio in PBMC may serve as a measure of affective vulnerability in healthy women, while nuclear level of pJNK1 may reflect environmentaly imposed distress in healthy men. The relevance of these molecular parameters as biomarkers requires broader verification in healthy and in clinical settings.

The aim of study was to establish the efficacy of CBT or short psychodynamic psychotherapy on non-selected and medication-resistant patients with anxiety disorders and to search for predictors of response.

Short psychodynamic psychotherapy or systematic CBT was tailored according the needs of each patient. Pharmacology treatment remained mainly unchanged during the trial period. Outcome measures were: Clinical Global Impression - Severity of Illness scale (CGI), Dissociative Experience Scale (DES), Somatoform Dissociation Questionnaire (SDQ-20), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI). The primary outcome measures were clinical response defined as 30% decrease in BAI and remission defined as a 1 or 2 points in CGI.

190 patients were included into the study and 15 dropped out. Altogether 175 patients completed at least 5 of 6 weeks of intensive psychotherapy program. Patients of all diagnostic groups showed significant improvement in CGI, BAI, BDI. At the end of the treatment 51.1% of the patients achieved clinical response and 42.3% clinical remission. The main characteristics present at the beginning of the trial increasing probability of achieving response or remission during the treatment were BAI score lower than 25, BDI score lower than 20, no comorbidity with personality disorder, no comorbid depression, no being divorced or widowed.

Therapeutic efficacy of the intensive psychotherapeutics programs for anxiety disorders was predicted with level of anxiety and depression, comorbidity with depression and personality disorders and marital status.

Treatment with pegylated interferon alpha (PEG-IFN-α) in patients with chronic hepatitis C (CHC) is associated with depression more frequently than in other diseases treated with PEG-IFN-α.

To prospectively evaluate prevalence, severity and course of depressive symptomatology in CHC patients treated with PEG-IFN-α.

Hamilton Depression Rating Scale (HAMD) was used to asses depressive symptoms in 103 subjects with CHC before PEG-IFN-α (mean dose 152.6±25.6 mcg; duration of therapy 48 weeks) and at the follow-up visits (4th, 12th, 24th, 48th, 72th week). Control group included 103 subjects with CHC without PEG-IFN-α.

There was a significant increase in HAMD scores as early as in the 4th week of PEG-IFN-a therapy compared to baseline scores (38.8% vs. 24.3%). The peak of depressive symptomatology was detected in the 12th week (mean HAMD 9.34¤ 6.93), when a half of patients (49.5%) had HAMD above 7. At the end of the treatment (48th week), 38.8 % had HAMD above 7, and in the 72nd week (24 weeks without PEG-IFN-α), prevalence of depressive symptomatology was decreased to the values lower than at baseline (23.3% vs. 24.3%). The majority (28.2%) had mild depression, whereas moderate and severe depressive symptoms were found in 20.4% and 1%, respectively. No change in prevalence of depression was detected in control group.

Present study is the longest follow-up study of depressive symptoms as a side-effect of PEG-IFN-α in CHC. Our data yielded that the severity of the symptoms was mild to moderate and tends to decrease following therapy completion.

Current standard treatment of chronic hepatitis C (CHC) consists of pegylated recombinant interferon alpha (PEG-IFN-α) combined with oral ribavirin (RBV). Interferon treatment is associated with depressive simptomatology. Risk factors such as duration of CHC, former drug addiction, lifetime psychiatric disorder, sex, duration of therapy, dose of PEG-IFN-α have been shown to be associated with depression in patients with CHC.

To prospectively evaluate association of depression and specific risk factors in patients with CHC treated with PEG-IFN-α.

The Hamilton Depression Rating Scale was used to asses depressive symptoms in 74 subjects with CHC before PEG-IFN-α (mean dose 152.6 ± 25.6 mcg), and in the follow-up visits (4, 12 and 24 week). the sociodemographic and hepatitis C related history of the patients were examined on the basis of medical chart review.

After controlling for baseline HAMD scores, only female sex was confirmed as a risk factor for depression (p = 0.008) at fourth week after baseline. No association was found with any of three groups of risk factors:

1. 1) Subject related risk factors (age (p = 0.955), sex (p = 0.008), lifetime psychiatric disorder (p = 0.656)),

2. 2) Illness related risk factors (duration of CHC (p = 0.267), i.v drug aplication as way of transmission (p = 0.292)) and

3. 3) Therapy-related risk factors (recommended duration of PEG-IFN-α (p = 0.993) and dose of PEG-IFN-α (p = 0.841)).

Common risk factors were not found to correlate with depressive simptomatology in CHC on PEG-IFN-α. Hepathologists are encouraged to use self-assessment depression scale instead of relying on any of the routinely assesed risk-factors.

Ubiquitous negative emotional states such as depression, anxiety and stress in adulthood are related to individual life scenario, particularly influenced by exposure to environmental risk factors. Here, we investigated if sub-threshold negative emotional states in general population can be predicted by experience of trauma in the childhood.

A sample of 106 healthy young adult participants from Belgrade and surroundings (43.4% male, age 29.2 ± 6.6 years, mean IQ 106.4 ± 15.9) fulfilled Childhood Trauma Questionnaire (CTQ) to identify emotional or physical abuse/neglect or sexual abuse. Present level of negative affectivity was measured by Depression Anxiety Stress Scale (DASS). Hierarchical linear regression analysis was conducted to identify subtypes of trauma as predictors of the negative affectivity.

Mean CTQ and DASS scores were 31.2 ± 6.7 and 16.4 ± 16.8, respectively. An exposure to given risk factors in the past correlated significantly with intensity of the present negative affective states (r = 0.290, P = 0.004). For the prediction of anxiety, the most important traumatism subtypes were emotional abuse, emotional neglect and physical abuse (P = 0.001; 0.028; and 0.041, respectively). Depressive symptoms were predicted only by the emotional abuse in the past (P = 0.008).

Based on clinical samples, findings from the literature yielded greater risk for mood and anxiety disorders after exposure to emotional, in comparison to the physical trauma. We confirmed the same pattern of correlations in the healthy subject's sample, who had no history mental disorders. Evaluation of the interaction effects among emotional trauma and genotype is strongly recommended in the identification of subjects at risk and for the prevention.

The authors have not supplied their declaration of competing interest.

Treatment with pegylated interferon alpha (PEG-IFN-α) is associated with depression more frequently in chronic hepatitis C (CHC) patients than with other inflammatory diseases.

To prospectively asses sex differences in the prevalence of depression in CHC patients during the PEG-IFN-α, as well as in the CHC group with no therapy.

Sample consisted of 103 subjects with CHC on the PEG-IFN-α and 103 subjects with CHC without interferon therapy. The diagnosis of depressive disorder was established by using Structured Clinical Interview and Criteria of International Classification Disorder. The severity of depression was assessed by using Hamilton Depression Rating Scale (HAMD ≥ 8) prior to PEG-IFN-α (baseline) and at the follow-up visits (4th, 12th, 24th, 48th, 72nd week).

During the course of PEG-IFN-α, 49.5% of subjects showed depressive symptomatology (HAMD ≥ 8). Except at baseline and in the 72nd week, on the all other follow-up visits the prevalence of depression was significantly higher in female subjects (*all Ps < 0.05). The strongest difference was observed in the 12th week: of all the subjects with HAMD ≥ 8, 68.8% were female and 32.7% were male (P < 0.001). The multivariate logistic regression model showed that female sex is a very strong predictor for the development of depression during the interferon treatment [Exp (B) = 6.729]. There were no significant sex differences in the prevalence of depression in the control group.

Our study (the longest study in this area) indicate that the prevalence of depression is significantly higher in female subjects with CHC during antiviral treatment.

The authors have not supplied their declaration of competing interest.

Treatment with pegylated interferon alpha (PEG-IFN-α) in patients with chronic hepatitis C (CHC) is associated with depressive symptomatology more frequently than other inflammatory diseases treated with PEG-IFN-α.

To prospectively evaluate the onset, course and resolution of depressive symptomatology in CHC patients treated with PEG-IFN-α.

Hamilton depression rating scale (HAMD) was used to asses depressive symptoms in 103 subjects with CHC prior to initiation of PEG-IFN-α (mean dose 152.6 ± 25.6 mcg; duration of therapy 48 weeks) and at the follow-up visits (4th, 12th, 24th, 48th and 72th week). Control group consisted of 103 CHC subjects, without PEG-IFN-α.

Our results showed a significant increase in HAMD scores as early as in the 4th week of PEG-IFN-a therapy compared to HAMD scores prior to initiation of PEG-IFN-α (38.8% vs. 24.3%). The peak of depressive symptomatology was evidenced in the 12th week (mean HAMD 9.34 ± 6.93), when almost 50% of patients had HAMD above 7. At the end of the treatment (48th week), 38.8% had HAMD above 7, and in the 72nd week (24 weeks after the therapy completion) prevalence of depression was decreased to the values lower than at baseline (23.3% vs. 24.3%). No change in prevalence of depression was detected in control group.

Our results are important because they show the overall course of depressive symptomatology during the interferon therapy. These data also show spontaneously resolution of depression 6 months after the completion of PEG-IFN-α. This study is the longest study in this area.

The authors have not supplied their declaration of competing interest.

Despite the frequency that refugees suffer bereavement, there is a dearth of research into the prevalence and predictors of problematic grief reactions in refugees. To address this gap, this study reports a nationally representative population-based study of refugees to determine the prevalence of probable prolonged grief disorder (PGD) and its associated problems.

This study recruited participants from the Building a New Life in Australia (BNLA) prospective cohort study of refugees admitted to Australia between October 2013 and February 2014. The current data were collected in 2015–2016, and comprised 1767 adults, as well as 411 children of the adult respondents. Adult refugees were assessed for trauma history, post-migration difficulties, probable PGD, post-traumatic stress disorder (PTSD) and mental illness. Children were administered the Strengths and Difficulties Questionnaire.

In this cohort, 38.1% of refugees reported bereavement, of whom 15.8% reported probable PGD; this represents 6.0% of the entire cohort. Probable PGD was associated with a greater likelihood of mental illness, probable PTSD, severe mental illness, currently unemployed and reported disability. Children of refugees with probable PGD reported more psychological difficulties than those whose parents did not have probable PGD. Probable PGD was also associated with the history of imprisonment, torture and separation from family. Only 56.3% of refugees with probable PGD had received psychological assistance.

Bereavement and probable PGD appear highly prevalent in refugees, and PGD seems to be associated with disability in the refugees and psychological problems in their children. The low rate of access to mental health assistance for these refugees highlights that there is a need to address this issue in refugee populations.

Although perceived social support is thought to be a strong predictor of psychological outcomes following trauma exposure, the temporal relationship between perceived positive and negative social support and post-traumatic stress disorder (PTSD) symptoms has not been empirically established. This study investigated the temporal sequencing of perceived positive social support, perceived negative social support, and PTSD symptoms in the 6 years following trauma exposure among survivors of traumatic injury.

Participants were 1132 trauma survivors initially assessed upon admission to one of four Level 1 trauma hospitals in Australia after experiencing a traumatic injury. Participants were followed up at 3 months, 12 months, 24 months, and 6 years after the traumatic event.

Latent difference score analyses revealed that greater severity of PTSD symptoms predicted subsequent increases in perceived negative social support at each time-point. Greater severity of PTSD symptoms predicted subsequent decreases in perceived positive social support between 3 and 12 months. High levels of perceived positive or negative social support did not predict subsequent changes in PTSD symptoms at any time-point.

Results highlight the impact of PTSD symptoms on subsequent perceived social support, regardless of the type of support provided. The finding that perceived social support does not influence subsequent PTSD symptoms is novel, and indicates that the relationship between PTSD and perceived social support may be unidirectional.