The COVID-19 pandemic and the lockdown restrictions could have adverse consequences for patients with severe mental disorders (SMD). Here, we aim to compare the early psychological impact (depression, anxiety, and stress responses, intrusive and avoidant thoughts, and coping strategies) on people with SMD ( n = 125) compared with two control groups: common mental disorders (CMD, n = 250) and healthy controls (HC, n = 250). An anonymous online questionnaire using a snowball sampling method was conducted from March 19–26, 2020 and included sociodemographic and clinical data along with the DASS-21 and IES scales. We performed descriptive and bivariate analyses and multinomial and linear regression models. People with SMD had higher anxiety, stress, and depression responses than HC, but lower scores than CMD in all domains. Most people with SMD (87.2%) were able to enjoy free time, although control groups had higher percentages. After controlling for confounding factors, anxiety was the only significant psychological domain with lower scores in HC than people with SMD (OR = 0.721; 95% CI: 0.579–0.898). In the SMD group, higher anxiety was associated with being single (beta = 0.144), having COVID-19 symptoms (beta = 0.146), and a higher score on the stress subscale of DASS-21 (beta = 0.538); whereas being able to enjoy free time was a protective factor (beta = −0.244). Our results showed that patients with SMD reacted to the pandemic and the lockdown restrictions with higher anxiety levels than the general public, and suggesting this domain could be a criterion for early intervention strategies and closer follow-up.

Background Epidemic outbreaks have significant impact on psychological well-being, increasing psychiatric morbidity among the population. We aimed to describe the early psychological impact of COVID-19 and its contributing factors in a large Spanish sample, globally and according to mental status (never mental disorder NMD, past mental disorder PMD, current mental disorder CMD). Methods An online questionnaire was conducted between 19 and 26 March, five days after the official declaration of alarm and the lockdown order. Data included sociodemographic and clinical information and the DASS-21 and IES questionnaires. We analysed 21 207 responses using the appropriate descriptive and univariate tests as well as binary logistic regression to identify psychological risk and protective factors. Results We found a statistically significant gradient in the psychological impact experienced in five domains according to mental status, with the NMD group being the least affected and the CMD group being the most affected. In the three groups, the depressive response was the most prevalent (NMD = 40.9%, PMD = 51.9%, CMD = 74.4%, F = 1011.459, P < 0.001). Risk factors were female sex and classification as a case in any psychological domain. Protective factors were younger age and ability to enjoy free time. Variables related to COVID-19 had almost no impact except for having COVID-19 symptoms, which was a risk factor for anxiety in all three groups. Conclusions Our results can help develop coping strategies addressing modifiable risk and protective factors for each mental status for early implementation in future outbreaks.

HIGHLIGHTS This study examined the early psychological correlates associated with the COVID-19 pandemic and lockdown in an older adult sample. Regardless of mental status, depressive and avoidant style were the most prevalent in this older adult sample. Interventions need to be tailored to alleviate dysfunctional coping strategies and their progression to mental illness.

IntroducciónL a pandemia por coronavirus (COVID-19) registrada en los últimos meses ha causado una situación de emergencia a nivel mundial. Se estima que las reacciones de ansiedad, preocupación o miedo sean frecuentes en la sociedad dado su carácter desconocido y novedoso junto con las medidas de distanciamiento social derivadas del estado de alarma. Sin embargo, todavía se desconoce el impacto psicológico que puede tener no solo el coronavirus per se, sino el confinamiento, ya que nos encontramos ante una situación excepcional sin precedentes.Algunos estudios realizados sobre el impacto del síndrome respiratorio agudo grave (SARS, por sus siglas en inglés Severe Acute Respiratory Syndrome), el primer brote masivo de una enfermedad infecciosa en el siglo XXI, han mostrado un impacto significativo sobre la salud mental de las personas y su nivel de bienestar (Ko, Yen, Yen y Yang, 2006), incluso 4 años después de la epidemia (Lam et al., 2009). Se habla de "bio-desastres" capaces de generar un impacto psicológico comparable al de otras catástrofes como ata-ques terroristas, terremotos, etc. (Chong et al., 2004; Wu et al., 2008). En el caso de las personas expuestas al SARS se ha mostrado cómo el trastorno de estrés postraumático y los trastornos depresivos han sido las alteraciones psicológicas más prevalentes durante el seguimiento a largo plazo (Mak, Chu, Pan, Yiu y Chan, 2009). Sin embargo, durante el SARS tanto las medidas llevadas a cabo como el nivel de afectación global no fueron tan extremos como en esta ocasión con lo que sería de esperar que el impacto de esta pandemia por COVID-19 sea todavía mayor.Durante el brote de síndrome respiratorio de coronavirus de Oriente Medio (MERS-CoV, por sus siglas en inglés Middle East Respiratory Syndrome Coronavirus) acaecido en 2015 y que generó el confinamiento de casi 17.000 personas expuestas al mismo, se observó un mayor riesgo de síntomas de estrés postraumático en sanitarios que habían tratado a pacientes infectados (Lee, Kang, Cho, Kim y Park, 2018), así como síntomas de ansiedad (7,6%), ira (16,6%) y depresión (19,3%), incluso entre aquellos que sufrieron medidas de aislamiento sin haber desarrollado la enfermedad (Yoon, Kim, Ko y Lee, 2016), perdurando, en

Background. Neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) have emerged as important peripheral inflammatory biomarkers. Recent data suggest a possible role of the immune system in the pathophysiology of suicidal behavior (SB). The aim of this study is to evaluate the association among NLR, MLR, and PLR and SB in patients with major depressive disorder (MDD), and to test its validity as a biomarker for suicidality. Methods. We evaluated 538 patients with MDD (mean age [standard deviation] = 43.87 [14.36] years; females: 68.8%). A logistic regression model was estimated to determine the independent factors associated with suicide risk in patients with and without a history of suicide attempt (SA). Results. Three hundred ninety-three patients (74.7%) had a personal history of SA. Patients with a previous SA were more frequently female (71.9% vs. 59.6%; p = 0.007), significantly younger (41.20 vs. 51.77 years; p < 0.001), had lower depression severity at enrolment (15.58 vs. 18.42; p < 0.000), and significantly higher mean NLR and PLR ratios (2.27 vs. 1.68, p = 0.001; 127.90 vs. 109.97, p = 0.007, respectively). In the final logistic regression model, after controlling for age, sex, and depression severity, NLR was significantly associated with SB (β = 0.489, p = 0.000; odds ratio [95% confidence intervals] = 1.631 [1.266–2.102]). We propose a cut-off value of NLR = 1.30 (sensitivity = 75% and specificity = 35%). Conclusions. Our data suggest that NLR may be a valuable, reproducible, easily accessible, and cost-effective strategy to determine suicide risk in MDD.

IntroductionBipolar disorder (BD) is a heterogeneous disorder needing personalized and shared decisions. We aimed to empirically develop a cluster-based classification that allocates patients according to their severity for helping clinicians in these processes.MethodsNaturalistic, cross-sectional, multicenter study. We included 224 subjects with BD (DSM-IV-TR) under outpatient treatment from 4 sites in Spain. We obtained information on socio-demography, clinical course, psychopathology, cognition, functioning, vital signs, anthropometry and lab analysis. Statistical analysis: k-means clustering, comparisons of between-group variables, and expert criteria.Results and discussionWe obtained 12 profilers from 5 life domains that classified patients in five clusters. The profilers were: Number of hospitalizations and of suicide attempts, comorbid personality disorder, body mass index, metabolic syndrome, the number of comorbid physical illnesses, cognitive functioning, being permanently disabled due to BD, global and leisure time functioning, and patients’ perception of their functioning and mental health. We obtained preliminary evidence on the construct validity of the classification: (1) all the profilers behaved correctly, significantly increasing in severity as the severity of the clusters increased, and (2) more severe clusters needed more complex pharmacological treatment.ConclusionsWe propose a new, easy-to-use, cluster-based severity classification for BD that may help clinicians in the processes of personalized medicine and shared decision-making.

Aim To provide a population-based characterization of sociodemographic and clinical risk and protective factors associated with consumption of alcohol, tobacco, or both as a coping strategy in a sample of the Spanish general population during the early phase of the COVID-19 pandemic. Methods Cross-sectional study based on an online snowball recruiting questionnaire. The survey consisted of an ad hoc questionnaire comprising clinical and sociodemographic information and the Spanish versions of the Depression, Anxiety, and Stress Scale (DASS-21) and the Impact of Event Scale (IES). Results The final sample included 21,207 individuals [mean age (SD) = 39.7 (14.0); females: 14,768 (69.6%)]. Up to 2,867 (13.5%) of participants reported using alcohol, 2,545 (12%) tobacco and 1,384 (6.5%) both substances as a strategy to cope with the pandemic. Sex-related factors were associated with alcohol consumption as a coping strategy [female, OR=0.600, p<0.001]. However, education level, work status, and income played different roles depending on the substance used to cope. Having a current mental disorder was associated only with tobacco consumption as a coping strategy [OR=1.391, p<0.001]. Finally, sex differences were also identified. Conclusions Sociodemographic, clinical, and psychological factors were associated with consumption of alcohol, tobacco, or both as a coping method for the COVID-19 pandemic and lockdown. Our findings may help develop specific intervention programs reflecting sex differences, which could minimize negative long-term outcomes of substance use after this pandemic.

This study suggests a specific immune-inflammatory biomarker pattern for established SCH (NFκB, PGE2, iNOS, and COX-2) that differentiates it from BD and HC. In future, their pharmacological modulation may constitute a promising therapeutic target.