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Healthcare professionals are exposed to numerous adverse stressors and very demanding settings and, consequently, the levels of depression, anxiety, and stress-related disorders in this population are highly relevant, especially during the COVID-19 pandemic and in the post-pandemic context [...]

Adverse childhood experiences (ACEs) are associated with impaired cognitive function in adult life in the general population as well as in people living with schizophrenia (PLS). Research on cognitive function in PLS in low- and middle-income countries (LMIC) is, however, limited. The objectives of this study were to investigate the association between ACE types and various cognitive domains in a sample of PLS and matched medical controls, and to determine the moderating effect of group membership (PLS vs. medical controls) on these associations, in the South African setting. Participants (n PLS = 520; n medical controls = 832) completed the Childhood Trauma Questionnaire-Short Form, the Structured Clinical Interview for DSM-IV (SCID-I), and the University of Pennsylvania Computerized Neurocognitive Battery (PennCNB). An efficiency or speed score was used to assess performance across 9 cognitive domains. The association between exposure to different ACE types and 9 cognitive domains was examined using partial correlations and multiple linear regression models, adjusting for sex, age and education years. Finally, potential moderating effects of group membership (PLS vs. medical controls) on the association between ACEs and cognitive domains were tested. In the entire sample, emotional and physical abuse predicted worse performance on sensorimotor and emotion identification domains. Also, emotional abuse was negatively associated with motor function, physical abuse was negatively associated with spatial processing, and physical neglect was negatively associated with face memory and emotion identification. In contrast, emotional neglect was related to better performance on abstraction and mental flexibility. No moderating effect of group membership was found on any of these associations. Exposure to ACEs was associated with social and non-social cognition in adulthood, although the magnitude of these relationships was small and similar between PLS and matched medical controls. The nature of these associations differed across ACE subtype, suggesting the need for a nuanced approach to studying a range of mechanisms that may underlie different associations. However, a number of ACE subtypes were associated with worse performance on emotional identification, indicating that some underlying mechanisms may have more transversal impact. These findings contribute to the sparse body of literature on ACEs and cognition in PLS in LMIC. •The relationship between childhood trauma and cognition was similar in people living with schizophrenia and medical controls.•Emotional and physical abuse predicted worse performance on sensorimotor and emotion identification.•Emotional abuse was negatively associated with motor function.•Physical abuse was negatively associated with spatial processing.•Physical neglect was negatively associated with face memory and emotion identification.•In contrast, emotional neglect was related to better performance on abstraction and mental flexibility.

Healthcare workers (HCWs) in COVID-19 pandemic hotspots were exposed to heightened workplace stressor load. Structural occupational resilience factors could prevent work-related stressor exposure from translating into mental health problems but remain poorly understood. This study identifies resilience factors actionable at the workplace and examines the impact of prior stressor exposure early in the pandemic on the later development of depressive and general distress symptoms. We prospectively followed a convenience sample of HCWs working in Spain during the pandemic using a 3-wave online survey conducted in 2020 (wave 1, n  = 2,422), 2021 (wave 2, n  = 1,827), and 2022 (wave 3, n  = 538). We operationalised resilience as low stressor reactivity (SR), quantified as individual deviations from the normative relation between stressors exposure and either depressive or distress symptoms. Mental health problems and stressor exposure both decreased over time, whereas stressor reactivity remained stable. Stressor exposure at baseline was inversely associated with resilience at follow-up. The structural occupational factors support from colleagues , trust in the workplace , and perceived ability to recover from stress were prospectively associated with resilience and thus identified as resilience factors. These results show that resilient responses of HCWs in times of crisis could be supported by promoting structural occupational resilience factors and mitigating cumulative stressor exposure. Future research should test this association in studies that allow causal inferences.

Background The Spanish National Health System (NHS) faces a significant shortage of clinical psychologists with only 5.58 per 100,000 inhabitants. This study aimed to estimate the required number of specialists and residents in Clinical Psychology to provide adequate psychological treatments to the population in the NHS. Methods A needs-based model was adapted to forecast the required total number of clinical psychologists and the annual increase in the positions of residents in Clinical Psychology (PIR). This model followed five steps: (1) obtaining Spanish prevalence rates for three broad mental disorder categories (depression, anxiety, and others or severe mental disorders) from the 2017 National Health Survey (ENSE); (2) multiplying the prevalence rates by the Spanish population aged ≥ 15 years; (3) defining the percentage of cases eligible for treatment under three predefined scenarios (protocolized, intermediate, and adjusted); (4) operationalizing the characteristics of the three treatment scenarios (session number and duration); and (5) calculating the total number of clinical psychologists and the annual increase required for PIR positions. Results Depending on the treatment scenario, the estimations show a need for clinical psychologists ranging from 1665 to 13,527 for treating depressive disorders, 1792–9799 for anxiety disorders, and 2074–8294 specifically for severe mental disorders. On the other hand, depending on the treatment scenario and the timeframe to achieve the estimated number of professionals (within 3, 5, 8, or 10 years), for example, to achieve those estimations of professionals within 3 years, and according to the adjusted treatment scenario, the Spanish health system should offer approximately 481 PIR positions yearly during 3 years. Conclusions A significant increase in the number of PIR positions is necessary to meet the growing demand for psychological treatment in the Spanish NHS. Investing in a mental-health workforce can lead to substantial health and economic benefits. This study provides valuable insights for workforce planning and highlights the importance of addressing the shortage of clinical psychologists in the NHS.

Burnout is a primary psychosocial risk factor in the workplace. Mental health stigma, which includes negative cognitions, emotions, and behaviors, also undermines the performance of social healthcare professionals. This study aimed to explore the levels of burnout in a sample of community social healthcare workers as well as its relationships with variables such as stigma towards mental health problems, professional skills, and job characteristics. An online assessment was conducted with 184 social healthcare professionals (75.5% female, mean age = 40.82 years, SD = 9.9). Medium levels of burnout and stigma and high levels of professional skills were observed. Multiple linear regression analyses revealed that stigma towards mental health problems and professional skills predicted emotional exhaustion (R2 = 0.153, F(4, 179) = 9.245, p < 0.001), depersonalization (R2 = 0.213, F(3, 180) = 17.540, p < 0.001), and personal accomplishment (R2 = 0.289, F(5, 178) = 15.87, p < 0.001). These findings suggest that social healthcare systems could benefit from taking care of the mental health of their workers by addressing burnout, tackling negative attitudes towards mental health problems, and providing professional skills training. This would help to make social healthcare systems more inclusive and of higher quality, thereby reducing health costs.

Introduction Hypomentalizing has been related with an increased risk of suicide attempt (SA). Although certain studies have identified an association between hypomentalizing and suicidal behavior, research on follow-up remains limited. This study aims to examine the relationship between hypomentalizing and suicide reattempt within 12-months after SA. Methods This longitudinal study encompassed a cohort of 1373 patients who have survived a SA. Assessments were conducted at the baseline and at a 12-month follow-up. We measured hypomentalizing using the RFQ-8, and we used the CSRSS to evaluate suicidal ideation and behavior. We compared demographic and clinical variables with Student’s t -tests and chi-square. Regression models were employed to investigate the relationship between hypomentalizing and the suicide reattempt. Results A total of 310 participants reattempted suicide in the follow-up period. After controlling for study variables, our results showed that age (aOR = 0.977, 95% CI 0.961–0.994), follow-up suicidal ideation (aOR = 3.165, 95% CI 1.578–6.349), baseline and follow-up suicide plan (aOR = 0.549, 95% CI 0.312–0.967; aOR = 2.417, 95% CI = 1.261–4.632), and the lifetime number of SA (aOR = 1.286, 95% CI 1.199–1.379), were associated with an increased risk of reattempt within the 12-month follow-up. Univariate regression analyses showed an association between baseline and follow-up hypomentalizing and suicide reattempt (OR = 1.160, 95% CI = 1.050–1.281; OR = 1.484, 95% CI = 1.259–1.750). Conclusions Social cognition may play a crucial role in the risk of suicide reattempt. Future research on the association between mentalizing and suicidal behavior could help identify comorbid risk factors and design effective therapeutic strategies.

The European Union Cohesion Policy for the period 2021–2027 focuses on five goals to make the European Union smarter, greener, more connected, more social and closer to citizens. However, a macroeconomic index is proposed as the predominant criterion for allocating the Structural Funds among regions. In this paper, we hypothesise that it is possible to take into account new, complementary criteria that better reflect citizens’ quality of life. To that end, we build a composite index of socio-economic vulnerability for the 233 regions. The results show that following our multidimensional approach for allocating the Structural Funds, there are remarkable differences in the maps of priority regions. In addition, the COVID-19 pandemic represents a threat to well-being. Are all regions equally exposed to COVID-19 in terms of their socio-economic vulnerability? To address this issue, we estimate multilevel models which indicate that country characteristics interact with regions’ characteristics to alter patterns of vulnerability. More specifically, increases in government expenditures in education and an improvement in political stability would reduce the regional vulnerability or foster the capacity for resilience, whereas increases in poverty would be associated with greater vulnerability. Likewise, more vulnerable regions would be the most exposed to the negative socio-economic effects of COVID-19. However, it is remarkable that several regions of Sweden and Finland would be among the group of regions whose socio-economic vulnerability would be the most negatively affected.

Background: Determining the relative importance of factors that predict quality of life (QoL) in people with multiple sclerosis (MS) must be addressed through multiple regression metrics, e.g. relative weights, which are designed to solve colinearity problems. Objective: We aimed to compare disease variables, Expanded Disability Status Scale (EDSS), depressive symptomatology (BDI-FS), cognitive performance and coping in predicting MS patients’ QoL, using relative weights. Methods: We assessed 97 patients with MS, using the Functional Assessment of MS (FAMS) as the criterion. Results: EDSS predicted global and physical QoL domains, whereas BDI-FS predicted general contentment and global QoL. Conclusion: EDSS and BDI-FS are relevant determinants of QoL in people with MS.

Background Children and adolescents with chronic pain are a vulnerable population who often lack the resources to manage their condition. Due to high personal, social, and economic consequences, proper management in its early stages is key to reducing disability. The aim of this project is to co-develop a digital intervention for pediatric chronic pain (Digital SPA) with end-users and to evaluate its effectiveness and implementation outcomes in Spain. Methods (Phase 1) Focus groups with patients, parents, and clinicians (n = 5–6 each) will inform about unmet pain care needs and provide a starting point for co-designing the intervention. (Phase 2) Content creation and usability testing will be based on the results of Phase 1, and the theory-driven development will follow the latest available evidence. The intervention will use validated psychological techniques focused on improving functioning by teaching pain coping skills. (Phase 3) Hybrid effectiveness–implementation trial. Participants (n = 195) will be adolescents aged 12–17 years old with chronic pain and one of their parents. Assessments include physical function, pain, sleep, anxiety, mood, satisfaction and adherence to the treatment, and number of visits to the emergency room. A qualitative framework analysis will be conducted with data from Phase 1. Effects of the intervention will be evaluated using linear multilevel modeling. The Consolidated Framework for Implementation Research (CFIR) and Behavioral Interventions Using Technology (BIT) frameworks will be used to evaluate implementation. Discussion This study is expected to produce a co-created evidence-based digital intervention for pediatric chronic pain and a roadmap for successful implementation. Trial registration number (TRN) and date of registration ClinicalTrials.gov (registered on 26 June 2023: https://clinicaltrials.gov/study/NCT05917626). Contributions to the literature The implementation of digital health interventions has two major gaps: (1) adherence to treatment is suboptimal, and (2) the process of making the interventions available to the end-user in a sustainable way is often unsuccessful. In this study, we expect that assessing users’ needs and co-designing an intervention with them will improve adherence. Documenting the implementation process from the project inception and integrating the results into an implementation framework will allow for replication and extension in different contexts. This study will increase the knowledge about implementation in a vulnerable population: adolescents with chronic pain without access to in-person multidisciplinary pain care.

Background Long-term deterioration in the mental health of healthcare workers (HCWs) has been reported during and after the COVID-19 pandemic. Determining the impact of COVID-19 incidence and mortality rates on the mental health of HCWs is essential to prepare for potential new pandemics. This study aimed to investigate the association of COVID-19 incidence and mortality rates with depressive symptoms over 2 years among HCWs in 20 countries during and after the COVID-19 pandemic. Methods This was a multi-country serial cross-sectional study using data from the first and second survey waves of the COVID-19 HEalth caRe wOrkErS (HEROES) global study. The HEROES study prospectively collected data from HCWs at various health facilities. The target population included HCWs with both clinical and non-clinical roles. In most countries, healthcare centers were recruited based on convenience sampling. As an independent variable, daily COVID-19 incidence and mortality rates were calculated using confirmed cases and deaths reported by Johns Hopkins University. These rates represent the average for the 7 days preceding the participants’ response date. The primary outcome was depressive symptoms, assessed by the Patient Health Questionnaire-9. A multilevel linear mixed model (LMM) was conducted to investigate the association of depressive symptoms with the average incidence and mortality rates. Results A total of 32,223 responses from the participants who responded to all measures used in this study on either the first or second survey, and on both the first and second surveys in 20 countries were included in the analysis. The mean age was 40.1 (SD = 11.1), and 23,619 responses (73.3%) were from females. The 9323 responses (28.9%) were nurses and 9119 (28.3%) were physicians. LMM showed that the incidence rate was significantly and positively associated with depressive symptoms (coefficient = 0.008, standard error 0.003, p  = 0.003). The mortality rate was significantly and positively associated with depressive symptoms (coefficient = 0.049, se = 0.020, p  = 0.017). Conclusions This is the first study to show an association between COVID-19 incidence and mortality rates with depressive symptoms among HCWs during the first 2 years of the outbreak in multiple countries. This study’s findings indicate that additional mental health support for HCWs was needed when the COVID-19 incidence and mortality rates increase during and after the early phase of the pandemic, and these findings may apply to future pandemics. Trial registration Clinicaltrials.gov, NCT04352634.