Background As the world is battling the COVID-19 pandemic, frontline health care workers (HCWs) are among the most vulnerable groups at risk of mental health problems. The many risks to the wellbeing of HCWs are not well understood. Of the literature, there is a paucity of information around how to best prevent psychological distress, and what steps are needed to mitigate harm to HCWs’ wellbeing. Methods A systematic review using PRISMA methodology was used to investigate the psychological impact on HCWs facing epidemics or pandemics, using three electronic databases (PubMed, MEDLINE and CINAHL), dating back to 2002 until the 21st of August 2020. The search strategy included terms for HCWs (e.g., nurse and doctor), mental health (e.g., wellbeing and psychological), and viral outbreaks (e.g., epidemic and pandemic). Only studies with greater than 100 frontline HCWs (i.e. doctors or nurses in close proximity to infected patients) were included. Results A total of 55 studies were included, with 53 using quantitative methodology and 2 were qualitative. 50 of the quantitative studies used validated measurement tools while 5 used novel questionnaires. The studies were conducted across various countries and included people with SARS (13 studies), Ebola (1), MERS (3) and COVID-19 (38). Findings suggest that the psychological implications to HCWs are variable with several studies demonstrating an increased risk of acquiring trauma or stress-related disorders, depression and anxiety. Fear of the unknown or becoming infected were at the forefront of the mental challenges faced. Being a nurse and being female appeared to confer greater risk. The perceived stigma from family members and society heightened negative implications; predominantly stress and isolation. Coping strategies varied amongst the contrasting sociocultural settings and appeared to differ amongst doctors, nurses and other HCWs. Implemented changes, and suggestions for prevention in the future consistently highlighted the need for greater psychosocial support and clearer dissemination of disease-related information. Conclusion This review can inform current and future research priorities in the maintenance of wellbeing amongst frontline HCWs. Change needs to start at the level of policy-makers to offer an enhanced variety of supports to HCWs who play a critical role during largescale disease outbreaks. Psychological implications are largely negative and require greater attention to be mitigated, potentially through the involvement of psychologists, raised awareness and better education. The current knowledge of therapeutic interventions suggests they could be beneficial but more long-term follow-up is needed.

Objective:Bipolar depression is characterized by neurobiological features including perturbed oxidative biology, reduction in antioxidant levels, and a concomitant rise in oxidative stress markers. Bipolar depression manifests systemic inflammation, mitochondrial dysfunction, and changes in brain growth factors. The depressive phase of the disorder is the most common and responds the least to conventional treatments. Garcinia mangostana Linn, commonly known as mangosteen, is a tropical fruit. The pericarp’s properties may reduce oxidative stress and inflammation and improve neurogenesis, making mangosteen pericarp a promising add-on therapy for bipolar depression.Methods:Participants will receive 24 weeks of either 1,000 mg mangosteen pericarp or placebo per day, in addition to their usual treatment. The primary outcome is change in severity of mood symptoms, measured using the Montgomery-Åsberg Depression Rating Scale (MADRS), over the treatment phase. Secondary outcomes include global psychopathology, quality of life, functioning, substance use, cognition, safety, biological data, and cost-effectiveness. A follow-up interview will be conducted 4 weeks post-treatment.Conclusion:The findings of this study may have implications for improving treatment outcomes for those with bipolar disorder and may contribute to our understanding of the pathophysiology of bipolar depression.Clinical trial registration:Australian and New Zealand Clinical Trial Registry, ACTRN12616000028404.

The aim of this study was to examine the association between physical health conditions and quality of life and functioning in private psychiatric inpatients. We sought to determine whether quality of life and functioning was poorer in individuals with physical comorbidity compared to those without. A quantitative correlational descriptive design was utilized. Seventy patients were included in sequential order within a week of admission to hospital. Participants completed the SF‐36 survey, and the corresponding hospital records were audited. The STROBE guidelines were followed in the reporting of this research. The study found that 64.3% (45/70) of participants had one or more comorbid physical health conditions, primarily cardiovascular, respiratory, musculoskeletal, endocrine and medically unexplained conditions or syndromes. Chronic pain was experienced by 40% (28/70) of participants, and 47.6% (33/70) were found to be overweight or obese. Tobacco smoking and obesity were risk factors associated with physical comorbidity (P = 0.02 and P < 0.001, respectively). Quality of life and functioning were poorer in those with physical health conditions, particularly in the SF‐36 domains of bodily pain, physical functioning and general health (P < 0.001, P = 0.003 and P = 0.005, respectively). Physical health conditions were largely prevalent, and quality of life and functioning were poorer in those with physical comorbidities. The implementation of clinical guidelines for the monitoring of physical health has been proposed as well as a dedicated physical health nursing role. Continuation of integrative programmes focusing on both physical and mental health may also benefit patients in this setting.