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Many turned to the internet, social networks, online dating for companionship, and online gaming and streaming for entertainment. [...]online platforms such as online gaming or dating even medical services reported an increase in rate of users. Many signed up for medical service platforms, video conferencing applications, and linked health services such as online pharmacies.1 Demonstrably, as peoples' online presence increased, the incidence of cyber victimization shot up alarmingly. [...]authorities issued alerts regarding organized rackets engaging in cyber fraud, romance scams, financial scams, “doxing,” “phishing,” and many other nefarious activities.4 Cyber victimization also includes being at the receiving end of hurtful online activities such as harassing messages and disparaging comments and/or humiliating pictures9,10; worst of these being threatened, intimated, and blackmailed.11 Throughout, the authors refer to cyber victimization as a larger paradigm of being victimized while cyberbullying refers to the perpetration of aggressive and hurtful online activities. Contrary to popular understanding, being a cyber-victim is just as severe, if not more, as in the face-to-face world.11 Myriad implications exist for victims' mental health, including, but not limited to, anxiety, panic symptoms, distress, trauma symptoms, sadness, hopelessness, helplessness, reduced self-esteem, feelings of isolation, fear of socialization, suicidal ideation, self-harm, somatic symptoms like headaches, stomach-aches, changes in sleep, appetite, psychoactive substance use, and interpersonal difficulties.11,12 These adverse impacts on mental health must be contextualized in the background of limited mental health care access, remote avenues of support from peers, and social networks during this pandemic.

Stigma towards people with mental health problems is a growing issue across the world, to which healthcare providers might contribute. The aim of the present study was to explore psychiatrists' attitudes towards their patients and link them to psychosocial and professional factors. An online questionnaire was used to approach the in- and outpatient psychiatric services across Hungary. A total of 211 trainees and specialists in adult and child psychiatry participated in our study. Their overall stigmatizing attitudes were measured, with focus on attitude, disclosure and help-seeking, and social distance dimensions by using the self-report Opening Minds Stigma Scale for Health Care Providers (OMS-HC). Multiple linear regression analyses were performed to elucidate the dimensions of stigma and its association with sociodemographic, professional and personal traits. Stigmatizing attitudes of close colleagues towards patients were statistically significant predictors of higher scores on the attitude [B = 0.235 (0.168-0.858), p = 0.004], the disclosure and help-seeking subscales [B = 0.169 (0.038-0.908), p = 0.033], and the total score of the OMS-HC [B = 0.191 (0.188-1.843), p = 0.016]. Psychiatrists who had already sought help for their own problems had lower scores on the disclosure and help-seeking subscale [B = 0.202 (0.248-1.925), p = 0.011]. The overall stigmatizing attitude was predicted by the openness to participate in case discussion, supervision or Balint groups [B = 0.166 (0.178-5.886), p = 0.037] besides the more favorable attitudes of their psychiatrist colleagues [B = 0.191 (0.188-1.843), p = 0.016]. The favorable attitudes of psychiatrists are associated with their own experiences with any kind of psychiatric condition, previous help-seeking behavior and the opportunity to work together with fellow psychiatrists, whose attitudes are less stigmatizing. The perception of fellow colleagues' attitudes towards patients and the openness to case discussion, supervision and Balint groups were the main two factors that affected the overall attitudes towards patients; therefore, these should be considered when tailoring anti-stigma interventions for psychiatrists.

ObjectiveThis study examined mental health literacy and predictors of disorder recognition among primary care providers (PCPs) in Hungary.Methods208 PCPs in Hungary completed a survey assessing demographics, mental health stigma, and exposure to mental health (i.e., personal experiences and having a family member/friend with a mental health condition). Participants read six vignettes describing obsessive-compulsive disorder (OCD) harm/aggression subtype (OCD-Aggression), OCD order/symmetry subtype (OCD-Order), generalized anxiety disorder (GAD), social anxiety disorder (SAD), panic disorder (PD), and major depressive disorder (MDD) and were asked to identify each condition, perceived disorder causes, and provide treatment referrals. Descriptive analyses were used to characterize disorder recognition rates, perceived disorder causes, and treatment referrals. Binary logistic regression analyses were conducted to examine the degree to which demographic characteristics, mental health stigma, and exposure to mental health conditions predict accurate disorder recognition.ResultsIdentification rates for each vignette were: OCD-Aggression (27.9%), OCD-Order (75.5%), SAD (34.1%), GAD (76.0%), PD (78.8%), and MDD (91.3%). First-choice treatment referrals were a psychiatrist for OCD-Aggression (63.0%), OCD-Order (53.8%), and MDD (46.6%), a psychologist/therapist for SAD (58.7%) and GAD (48.6%), and a PCP for PD (39.9%). Mislabeling conditions was significantly associated with older age (for GAD, OCD-Aggression, PD and MDD), male gender (for GAD), greater mental health stigma (for OCD-Order), and lack of exposure to mental health conditions (for SAD).ConclusionsFindings highlight strengths (e.g., depression recognition) and limitations in knowledge of mental health conditions among PCPs in Hungary and identifies targets to address to improve mental health literacy.

Hungarians exhibit more negative attitudes toward help-seeking for mental health problems compared to other European countries. However, research on help-seeking in Hungary is limited, and it is unclear how stigma relates to help-seeking when considering demographic and clinical characteristics. We used a network analytic approach to simulate a stigma model using hypothesized constructs in a sizable sample of Hungarian adults. Participants were 345 adults recruited from nine primary care offices across Hungary. Participants completed self-report measures assessing public stigma, self-stigma, experiential avoidance (EA), attitudes toward seeking professional psychological help, anxiety, depression, demographics, prior use of mental health services, and whether they have a family member or friend with a mental health condition. EA and anxiety were the most central nodes in the network. The network also revealed associations between greater EA with greater public stigma, anxiety, depression, and having a family member or friend with a mental health condition. More positive attitudes toward seeking help were associated with lower self-stigma, public stigma, and having received psychological treatment in their lifetime. Being female was associated with lower income, higher education, and having received psychological treatment in their lifetime. Finally, having a family member or friend with a mental health condition was associated with having received psychological treatment in their lifetime and greater public stigma. The strength centrality and associations of EA with clinical covariates and public stigma implicate its importance in stigma models. Findings also suggest that while some aspects of existing stigma models are retained in countries like Hungary, other aspects may diverge.

Background The Opening Minds Stigma Scale for Health Care Providers (OMS-HC) is a widely used questionnaire to measure the stigmatising attitudes of healthcare providers towards patients with mental health problems. The psychometric properties of the scale; however, have never been investigated in Hungary. We aimed to thoroughly explore the factor structure of the OMS-HC and examine the key psychometric properties of the Hungarian version. Methods The OMS-HC is a self-report questionnaire that measures the overall stigmatising attitude by a total score, and three subscales can be calculated: Attitude, Disclosure and Help-seeking, and Social Distance. Our study population included specialists and trainees in adult and child psychiatry ( n  = 211). Exploratory and confirmatory factor analyses were performed, and higher-order factors were tested. We calculated the test-retest reliability on a subgroup of our sample ( n  = 31) with a follow-up period of 1 month. The concurrent validity of the scale was measured with the Mental Illness: Clinician’s Attitudes-4 scale (MICA-4). Results Three factors were extracted based on a parallel-analysis. A bifactor solution (a general factor and three specific factors) showed an excellent model-fit (root mean square error of approximation = 0.025, comparative fit index = 0.961, and Tucker-Lewis index = 0.944). The model-based reliability was low; however, the general factor showed acceptable reliability (coefficient omega hierarchical = 0.56). The scale demonstrated a good concurrent validity with the MICA-4 [intraclass correlation coefficient (ICC) = 0.77]. The test-retest reliability was excellent for the general factor (ICC = 0.95) and good for the specific factors (ICC = 0.90, 0.88, and 0.84, respectively). Conclusions The three dimensions of the OMS-HC was confirmed, and the scale was found to be an adequate measure of the stigmatising attitude in Hungary. The bifactor model is more favourable as compared to the three correlated factor model; however, despite the excellent internal structure, its model-based reliability was low.

BackgroundThe COVID-19 pandemic has captured the mental health discussion worldwide. Examining countries' representation in this discussion could prove instrumental in identifying potential gaps in terms of ensuring a truly global conversation in times of global crisis.MethodsWe collected mental health and COVID-19-related journal articles published in PubMed in 2020. We focused on the corresponding authors' countries of affiliation to explore countries' representation. We also examined these articles' academic impact and correlations with their corresponding authors' countries of affiliation. Additional journals and countries' indicators were collected from the Web of Science and World Bank websites, respectively. Data were analyzed using the IBM SPSS Statistics and the VOSviewer software.ResultsIn total, 3492 publications were analyzed. Based on the corresponding author, high-income countries produced 61.9% of these publications. Corresponding authors from Africa, Latin America and the Caribbean, and the Middle East combined accounted for 11.8% of the publications. Europe hosted corresponding authors with the most publications and citations, and corresponding authors from North America had the largest mean journal impact factor.ConclusionsThe global scientific discussion during the COVID-19 pandemic saw an increased contribution of academics from developing countries. However, authors from high-income countries have continued to shape this discussion. It is imperative to ensure the active participation of low- and middle-income countries in setting up the global mental health research agenda, particularly in situations of global crisis, such as the ongoing pandemic.

Introduction: Paediatric acute haematogenous bone and joint infections (BJIs) are serious conditions. This study aimed to analyse the characteristics of paediatric acute haematogenous osteomyelitis (AHO) and septic arthritis (SA) in Hungary, with a focus on causative pathogens, clinical outcomes, and long-term complications. Methods: A retrospective cohort study was conducted at a Hungarian tertiary referral centre between 2015 and 2022. Children aged 18 years or younger diagnosed with acute haematogenous osteomyelitis (AHO) or septic arthritis (SA) within two months of symptom onset were included. Exclusion criteria were chronic infection, post-operative infections, or wound-related infections. Complicated AHO was defined by intraosseous abscess or necrosis confirmed radiologically or intraoperatively. The primary outcome was surgical intervention beyond 30 days after diagnosis; secondary outcomes included long-term complications. Results: Forty patients were included (77.5% male, median age 8.7 years). AHO was diagnosed in 8 patients (20.0%), complicated AHO in 22 (55.0%), and SA in 10 (25.0%). MRI had the highest diagnostic sensitivity (97.0%). Pathogens were identified in 72.5% of cases; Staphylococcus aureus (S. aureus) was most common (57.5%), followed by Salmonella and Streptococcus pyogenes (5% each). Surgery was required in 90.0% of SA cases, 77.2% of complicated AHO, and 37.5% of uncomplicated AHO. Long-term complications occurred in 10%, mainly with S. aureus and complicated AHO. Conclusions: Paediatric BJIs, especially due to S. aureus, often require surgery and cause long-term sequelae.

PurposeStudy was designed in order to evaluate the discrepancies between surgical and histological diagnosis in pediatric acute appendicitis (AA) and to compare the outcomes of laparoscopic (LA) and open appendectomies (OA).MethodsIn a retrospective observational cohort, AA patients were included under 18 years of age, operated between 2011 and 2020. Surgical diagnosis was defined by the operating surgeon. The histological findings were classified as uncomplicated and complicated AA. The LOS and complications were also statistically analyzed.ResultsAltogether, 1444 patients were included. Significant strong correlation and a moderate to substantial agreement were found between the surgeon’s and the histopathological findings in all appendectomy cases (weighted kappa value in OA: 0.633, LA: 0.639, total sample: 0.637). If the surgeon’s diagnosis was less severe than the pathologist’s, the LOS was 4 (3;7) days, whereas if the surgical diagnosis was correct, the LOS was 3 (3;5) days (p < 0.0001).ConclusionsIn contrary to the literature, our study revealed a strong correlation and moderate agreement between the intraoperative and histopathological findings regarding the severity of AA. Complicated cases are distinctly recognizable during the surgery. In case the surgeon underestimates the severity of AA, the chance of complications is higher.Level of evidence: II

The COVID-19 pandemic triggered vast governmental lockdowns. The impact of these lockdowns on mental health is inadequately understood. On the one hand such drastic changes in daily routines could be detrimental to mental health. On the other hand, it might not be experienced negatively, especially because the entire population was affected. The aim of this study was to determine mental health outcomes during pandemic induced lockdowns and to examine known predictors of mental health outcomes. We therefore surveyed n = 9,565 people from 78 countries and 18 languages. Outcomes assessed were stress, depression, affect, and wellbeing. Predictors included country, sociodemographic factors, lockdown characteristics, social factors, and psychological factors. Results indicated that on average about 10% of the sample was languishing from low levels of mental health and about 50% had only moderate mental health. Importantly, three consistent predictors of mental health emerged: social support, education level, and psychologically flexible (vs. rigid) responding. Poorer outcomes were most strongly predicted by a worsening of finances and not having access to basic supplies. These results suggest that on whole, respondents were moderately mentally healthy at the time of a population-wide lockdown. The highest level of mental health difficulties were found in approximately 10% of the population. Findings suggest that public health initiatives should target people without social support and those whose finances worsen as a result of the lockdown. Interventions that promote psychological flexibility may mitigate the impact of the pandemic.

Background Identifying common factors that affect public adherence to COVID-19 containment measures can directly inform the development of official public health communication strategies. The present international longitudinal study aimed to examine whether prosociality, together with other theoretically derived motivating factors (self-efficacy, perceived susceptibility and severity of COVID-19, perceived social support) predict the change in adherence to COVID-19 containment strategies. Method In wave 1 of data collection, adults from eight geographical regions completed online surveys beginning in April 2020, and wave 2 began in June and ended in September 2020. Hypothesized predictors included prosociality, self-efficacy in following COVID-19 containment measures, perceived susceptibility to COVID-19, perceived severity of COVID-19 and perceived social support. Baseline covariates included age, sex, history of COVID-19 infection and geographical regions. Participants who reported adhering to specific containment measures, including physical distancing, avoidance of non-essential travel and hand hygiene, were classified as adherence. The dependent variable was the category of adherence, which was constructed based on changes in adherence across the survey period and included four categories: non-adherence, less adherence, greater adherence and sustained adherence (which was designated as the reference category). Results In total, 2189 adult participants (82% female, 57.2% aged 31–59 years) from East Asia (217 [9.7%]), West Asia (246 [11.2%]), North and South America (131 [6.0%]), Northern Europe (600 [27.4%]), Western Europe (322 [14.7%]), Southern Europe (433 [19.8%]), Eastern Europe (148 [6.8%]) and other regions (96 [4.4%]) were analyzed. Adjusted multinomial logistic regression analyses showed that prosociality, self-efficacy, perceived susceptibility and severity of COVID-19 were significant factors affecting adherence. Participants with greater self-efficacy at wave 1 were less likely to become non-adherence at wave 2 by 26% (adjusted odds ratio [aOR], 0.74; 95% CI, 0.71 to 0.77; P  < .001), while those with greater prosociality at wave 1 were less likely to become less adherence at wave 2 by 23% (aOR, 0.77; 95% CI, 0.75 to 0.79; P  = .04). Conclusions This study provides evidence that in addition to emphasizing the potential severity of COVID-19 and the potential susceptibility to contact with the virus, fostering self-efficacy in following containment strategies and prosociality appears to be a viable public health education or communication strategy to combat COVID-19.