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Global Psychiatry is a single-blind peer-reviewed, open access journal that publishes original scientific articles, systematic reviews and meta-analyses in all areas of psychiatry and mental health from all over the globe.  The main mission of Global Psychiatry is to advance global mental health by making relevant scientific knowledge globally accessible. We are convinced that all variations and subspecialities of psychiatry and mental health care have a global common ground and can learn from each other and that a journal with a global approach can benefit all mental health professionals, carers...
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Journal Information

Publisher: Global Psychiatric Association

Email:  globalpsychiatry@gmx.com

Editor-in-chief: Professor Christopher Paul Szabo

Online ISSN: 2451-4950

Increased risk for mental disorders and suicide during the COVID-19 pandemic. Position statement of the Section on Suicidology and Suicide Prevention of the European Psychiatric Association.

Marco Sarchiapone; Jorge Lopez-Castroman; Carla Gramaglia; Enrique Baca-Garcia; Francesca Baralla; Maria Luisa Barrigón; Silvia Bartollino; Julian Beezhold; Julio Bobes; Raffaella Calati; Narcís Cardoner; Erminia Colucci; Philippe Courtet; Lavinia Duica; Christine Dunkley; Laura Dunkley; Ricardo Gusmão; Catarina Jesus; Fabrice Jollant; Alexandr Kasal; Anisur Khan; Philip Jules Simon Michielsen; Peter Osvath; Stephen Palmer; Nuhamin Petros; Mihai Pirlog; Anna Plaza estrada; Pilar Saiz; José Carlos Santos; Alexandra Tubiana Potiez; Christina Van Der Feltz-Cornelis; Tereza Vitcheva; Petr Winkler; Patrizia Zeppegno

GLOBAL PSYCHIATRY, 2021, Volume 4, Issue 1, Pages 4-19
DOI: 10.52095/gp.2021.8114

In March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic. The Section on Suicidology and Suicide Prevention of the European Psychiatric Association (EPA) wants to raise awareness about the potential increase in mental health disorders and suicides as a result of the socio-economic impact of the COVID-19 pandemic, and of the necessary restrictive measures adopted worldwide to contain its spread. Even if fear, worries and symptoms of anxiety, depression and stress can be considered a natural response to this global crisis, some individuals are overexposed to its potential negative effects, such as healthcare workers, COVID-19 and psychiatric patients, prisoners, members of the LGBTQ+ community, migrants (including migrant workers), ethnic minorities and asylum seekers and internally displaced populations. Nevertheless, social support, resilience, a supportive work environment and other protective factors may buffer the impact of this crisis on mental health. These unprecedented times are calling for unprecedented efforts. Evidence-based and coordinated actions to prevent the risk of increased mental health disorders and suicide are needed. However, most of the data about COVID-19 impact on mental health comes from online surveys using non-probability and convenience sample in which females are often over-represented. For this reason the quality of future research should be also improved.

Protocol for a process evaluation of a cluster randomised controlled trial to improve psychosocial treatment of patients with psychotic spectrum disorders: the IMPULSE trial

Tamara Pemovska; Nikolina Jovanović; Tamara Radojičić; Aliriza Arënliu; Alma Džubur-Kulenović; Antoni Novotni; Lidija Injac-Stevović; Nađa P. Marić; Stojan Barjaktarov; Jill J Francis

GLOBAL PSYCHIATRY, 2021, Volume 4, Issue 1, Pages 20-30
DOI: 10.52095/gp.2020.1407

Objective: This paper describes the protocol of a process evaluation of a cluster randomised controlled trial designed to evaluate the effectiveness, cost-effectiveness and implementation of a digital mental health intervention, called DIALOG+, in five low- and middle-income countries in Southeast Europe (Bosnia and Herzegovina, Kosovo1, Montenegro, North Macedonia and Serbia). The objectives of the process evaluation are: a) to explore attributes of context that might impact on the implementation of the DIALOG+ intervention; b) to assess intervention fidelity and c) to explore patients’ and clinicians’ retrospective (i.e. experienced) acceptability of the intervention.
Materials and methods: This is a mixed-method process evaluation nested within the cluster randomised controlled trial. We adopted the guidance on process evaluations of complex interventions published by the United Kingdom Medical Research Council. Data collected during and after the trial, but prior to awareness of trial outcomes, include transcripts, questionnaire responses, routinely collected monitoring data and audio-recordings of intervention and control sessions. Data analysis is descriptive and involves triangulation methods to compare findings across countries, stakeholder groups (healthcare provider, patient) and data type (qualitative, quantitative).
Results: This work is part of a larger study entitled ‘Implementation of an effective and cost-effective intervention for patients with psychotic disorders in low and middle-income countries in Southeast Europe’ (IMPULSE). The study is funded by the European Union’s Horizon 2020 research and innovation programme. The IMPULSE trial recruited 81 clinicians and 458 patients. The clinician clusters were randomised to the intervention (six sessions of DIALOG+ over 12 months) or treatment-as-usual arm. Process data collection began in parallel with the trial, starting in April 2019. Data collection and analysis will be completed before the main trial findings are known. Process evaluation findings will be used to interpret the trial results including assessing the effect of context on outcomes.
Conclusion: This process evaluation will explore the context, intervention fidelity and acceptability to contextualise the trial results, help in optimising sustainability of the intervention and inform its future dissemination. The methods described here may also inform the development and implementation of other complex psychosocial interventions in low-resource settings.

Implementing a mental health intervention in low-and-middle-income countries in Europe: is it all about resources?

Jennifer Hunter; Rose McCabe; Jill J Francis; Tamara Pemovska; Emina Ribić; Eldina Smajić Mešević; Jon Konjufca; Silvana Markovska Simoska; Biljana Blazevska Stoilkovska; Tamara Radojičić; Selman Repišti; Stefan Jerotić; Ivan Ristić; Mirjana Zebić; Lidija Injac-Stevović; Aliriza Arenliu; Alma Džubur Kulenović; Dashamir Berxulli; Stojan Bajraktarov; Nikolina Jovanović

GLOBAL PSYCHIATRY, 2021, Volume 4, Issue 1, Pages 31-54
DOI: 10.52095/gp.2020.1409

Background: There are limited resources for improving mental health care across Europe, especially in Low-and-Middle- Income Countries (LMICs) in South-eastern Europe with fewer specialist staff and less funding. Scaling up psychosocial interventions that utilise available time and resources more effectively could improve care for people with psychosis in these settings. One intervention is DIALOG+, delivered via an app on a tablet computer: patients identify life areas to improve and clinicians use a solution-focussed process to help improve these areas. This intervention was piloted across mental healthcare systems in European LMICs, and focus groups were conducted to explore whether such interventions could use available resources effectively to improve care for psychosis in these settings.
Methods: Eleven focus groups were conducted with clinicians and patients with psychosis who used the intervention over three months during the pilot study, in Bosnia and Herzegovina, Kosovo United Nations Resolution, Montenegro, North Macedonia and Serbia. The Theoretical Domains Framework (TDF), which describes factors affecting engagement with healthcare interventions, structured topic guides and guided analysis. Codes from the data were mapped onto the TDF, analysed to identify barriers and facilitators, translated into English and checked for inter-rater reliability.
Results: 25 clinicians and 23 patients participated in focus groups. Clinicians’ barriers included limited time for sessions and difficulties working with acutely psychotic patients. Patients’ barriers were burden of greater concentration when engaging with DIALOG+ and feeling tense or disturbed during the sessions. Facilitators included motivation to use DIALOG+, positive opinions shared by others, perceived benefits for practice and improving clinician-patient conversations, relationships and care.
Conclusions: Barriers to using psychosocial interventions could be overcome even if resources cannot be increased. Despite limited time and other barriers to using DIALOG+, perceived benefits to practice and clinician-patient relationships suggest that psychosocial interventions can use available resources effectively to improve care for psychosis.

Depression and associated factors among international students in a private University of Bangladesh

Adamu Jamilah; Md Imdadul Haque; Russell Kabir

GLOBAL PSYCHIATRY, 2021, Volume 4, Issue 1, Pages 55-61
DOI: 10.52095/gp.2020.1406

Background: Depression is the second major cause of disability and is a principal source of disease burden worldwide which is quite common among international students.
Aim: This study explored the depression and its associated factors among international students of a private university in Bangladesh.
Methods: This cross-sectional study was conducted among 149 international students at a private university in Dhaka, Bangladesh using the Center for Epidemiologic Studies Depression (CES-D 10) Scale.
Results: The prevalence of depressive symptoms among international students was 47.7%. Students’ age, marital status, satisfaction with living conditions and problems concerning studies, food, homesickness, finances, accommodation, and health were significantly associated with depression.
Conclusion: This study concluded that there is an unmet need for psychological support for international students studying in Bangladesh. Appropriate support services should be directed to them to help and to overcome the challenges they face.

Severity of depression, anxiety and stress among the people of Kashmir, India during COVID-19: An observation from tele psychiatric services

Sheikh Shoib; Sheikh Mohd Saleem; Sheikh Mohammed Shaiful Islam; S.M yasir Arafat; Shijo John Joseph

GLOBAL PSYCHIATRY, 2021, Volume 4, Issue 1, Pages 62-67
DOI: 10.52095/gp.2021.8115

Objective:  The COVID-19 pandemic has affected the mental health and well-being of millions of people across the globe. This study aimed to assess the severity of depression, anxiety and stress level among persons who sought teleconsultation during the lockdown period in Kashmir, India.
Materials and methods: This cross-sectional study was carried out from 21 March to 31 May 2020 in Kashmir, India. A call line was set up for people with mental health concerns and participants who signed up for the service were included in the study. The mental health services were provided by a team via teleconsultation. The Depression, Anxiety and Stress Scale (DASS-21) questionnaire was used to assess the severity of distress.
Results: A total of 293 people were interviewed during the teleconsultation service. The mean age was 37.10 (± 10.54) years, the majority had moderate depression, 125 (42.7%), followed by extreme severe depression, 95 (32.4%). The mean depression score on the DASS-21 scale was 13.52 ± 4.13. A total of 276 (94.2%) patients had severe anxiety following lockdown with a mean anxiety score of 14.04 ± 9.23. Also, 96 (32.8%) of people had mild stress with a mean stress score of 12.82 ± 7.32.
Conclusion: The severity of depression, anxiety and stress was high in our study population highlighting the need to provide critical mental health services. Teleconsultations could be an alternative approach to provide such services in areas with public health emergencies and where medical infrastructure is limited.

Cognitive deficits four decades after traumatic brain injury in Australian Vietnam war veterans

Tia Cummins; Alby Elias; Fiona Lamb; Chris Rowe; Jennie Ponsford; Mal Hopwood; Victor Villemagne

GLOBAL PSYCHIATRY, 2021, Volume 4, Issue 1, Pages 68-79
DOI: 10.52095/gp.2021.8111

Objective:  Since 2000, over 350,000 US military personnel have been diagnosed with a traumatic brain injury (TBI) (VA, 2010). Whilst epidemiological studies report up to a fourfold increased risk for dementia associated with brain injury amongst veterans there is limited controlled research into the long-term neuropsychological burden of injury.
Main aim:  The study aimed to determine whether Australian Vietnam war veterans with service-related TBI were more likely to exhibit cognitive deficits, 30-50 years after injury when compared to healthy veteran controls.
Materials and methods: 69 male veterans 60-85 years old, underwent psychiatric and neuropsychological assessment; 40 with a TBI (mean age = 68.0 ± 2.5) and 29 without (mean age = 70.1 ± 5.3). The TBI cohort included 15 mild, 16 moderate and nine severe TBI.
Results: After adjustment for identified covariates, veterans with moderate-to-severe TBI performed significantly worse than controls on composite measures of memory and learning (M = -0.55 ± 0.69, t(67) = 2.86, p=0.006, d=0.70) and attention and processing speed (M = -0.71 ± 1.08, t(52) = 2.53, p=0.014, d=0.69). There were no differences in cognitive performance between veterans with mild TBI (mTBI) and controls.
Conclusion: Results from this study suggest that amongst ageing veterans, a moderate-to-severe TBI sustained during early adulthood is associated with later-life cognitive deficits in memory and learning, attention and processing speed.

Diminished white matter integrity four decades after traumatic brain injury in Vietnam War veterans

Tia Cummins; Ying Xia; Alby Elias; Fionaa Lamb; Kerstin Pannek; Vincent Dore; Pierrick Bourgeat; Olivier Salvado; Jurgen Fripp; Mal Hopwood; Jennie Ponsford; Victor Villemagne; Chris Rowe

GLOBAL PSYCHIATRY, 2021, Volume 4, Issue 1, Pages 80-94
DOI: 10.52095/gp.2021.8112

Objective:  Traumatic Brain Injury (TBI) and Post-Traumatic Stress Disorder (PTSD) are common in military veterans and have been associated with an increased risk of dementia. The mechanisms contributing to this relationship are poorly understood.
Main aim: This study investigated the effect of TBI and PTSD on white matter (WM) integrity, hippocampal and cortical volume within a cohort of Vietnam veterans.
Materials and methods: 87 male veterans in total. There were 31 with TBI (aged 69.0 ± 2.5 years), 35 with PTSD (aged 69.5 ± 2.6 years) and 21 controls (aged 70.1 ± 4.9 years) underwent 3Tesla Magnetic Resonance Imaging (MRI). The TBI cohort included 12 mild, 13 moderate and six severe injuries. WM integrity was assessed using tract-based spatial statistics and region-specific analyses of fractional anisotropy (FA) images. Automated processing of T1-weighted magnetisation-prepared rapid gradient-echo (MPRAGE) images resulted in hippocampal volumes and whole-brain cortical thickness estimation. Analyses were adjusted for IQ, Body Mass Index (BMI) and psychiatric comorbidities.
Results: The moderate-to-severe TBI group had significantly lower FA than controls in the genu (F(3,36)=8.81, p<0.05, partial η2 = 0.17), and body (F(3,36)=4.39, p <0.05, partial η2=0.14) of the corpus callosum, as well as in global WM (F(3,36)=5.35, p <0.05, partial η2=0.13). The PTSD FA values did not differ from controls and neither the TBI nor PTSD group differed significantly from controls in hippocampal volume nor cortical thickness in Alzheimer’s disease vulnerable regions.
Conclusion: These findings suggest that the widely reported loss of WM integrity observed after moderate to severe TBI persists throughout life but is not associated with hippocampal or grey matter atrophy after four decades. No PTSD-related structural or FA change was observed.

The critical role of body dysmorphic disorder in dermatological patients’ body image: patients’ desire to seek even more medical treatments increases after dermatological treatment

Charalambos Costeris; Maria Petridou; Yianna Ioannou

GLOBAL PSYCHIATRY, 2021, Volume 4, Issue 1, Pages 95-108
DOI: 10.52095/gp.2021.10423

Objective: To investigate whether patients with a visible skin disorder (acne) and non-visible disorder (psoriasis/eczema) present body image changes after dermatological treatment. Secondly, to examine whether the existence of body dysmorphic disorder (BDD) influences patients’ desire to receive more medical treatments after initial treatment.
Materials and methods: A battery of questionnaires assessing body image, BDD and satisfaction with the medical outcome was shared with patients before treatment and with a six-month follow-up (after each patient completed their treatment). The sample included 54 patients with visible facial acne, 54 patients with non-visible psoriasis/eczema, and 54 participants without a dermatological disorder (control group). All patients were treated by dermatologists and were 18-35 years old.
We examined body image and demographic characteristics using Multivariate analysis of covariance (MANCOVA) between all the study groups. Performing MANCOVA analysis we investigated patients’ body image and appearance satisfaction, before and after treatment, compared to the control group. Finally, to examine the role of BDD on patients’ desire to receive more treatments, MANCOVA analysis was performed, with BDD diagnosis as a covariate variable.
Results: At both research phases, both groups of dermatological patients exhibited lower levels of appearance satisfaction, compared to the control group. MANCOVA analysis revealed that after treatment, acne patients diagnosed with BDD presented even lower levels of facial and overall satisfaction. Moreover, acne patients showed a higher desire for more treatments that improve the skin’s appearance, compared to psoriasis/eczema patients.
Conclusion: Dermatological disorders negatively affect patients’ body image, which does not improve even after dermatological treatment completion. Patients with acne seem to be more dissatisfied with their facial and overall appearance, while their dissatisfaction is projected on other body parts. Lastly, the coexistence of BDD symptomatology increases patients’ desire to seek further aesthetic and cosmetic treatments, to further improve the skin’s appearance after treatment.

Empirical studies on suicide in Bangladesh in a decade (2011-2020)

S.M. Yasir Arafat; Fahad Hussain; Khandakar Md. Jakaria; Zarin Tasnim Itu; Md. Aminul Islam

GLOBAL PSYCHIATRY, 2021, Volume 4, Issue 1, Pages 109-122
DOI: 10.52095/gp.2021.10692

Background:  An adequate number of empirical studies is necessary to formulate a national suicide prevention programme.
Aims:  To assess the extent of empirical studies on suicide in a decade (2011-2020) in Bangladesh.
Materials and methods: A literature search was conducted to identify the articles available in PubMed, PubMed Central, Scopus, Google Scholar, and BanglaJOL using the search term “suicide in Bangladesh”, “self-harm in Bangladesh”, “poisoning in Bangladesh”, “suicidal behaviour in Bangladesh”. We included all the original articles in full-length format that were published in the English language, accessible in the full texts, published between 2011 and 2020, and assessing suicidal behaviour in Bangladesh. A total of 44 empirical studies were included in this review.
Results: Among the 44 studies, 6.8% were qualitative studies, 34.1% applied interview, 31.8% analysed the secondary data. All the studies followed a cross-sectional design, nine studies assessed youth suicidality, and only one study assessed the suicidality among the elderly. Studies of the earlier half of the decade explored epidemiological aspects, whereas studies in the last five years assessed the newer topics such as quality of media reporting, psychological autopsy study, perspectives after nonfatal attempt, sociological perspectives, ontological perspectives, masculinity, and suicide, and financial loss due to suicide. About 41% of the papers had a collaboration with the authors of other countries, and about 18.2% of the papers were externally funded either partially or fully.
Conclusion: Although newer studies are coming out, suicide is an under-studied public health problem as no nationwide, longitudinal and interventional study has been identified during a decade (2011-2020) in Bangladesh. The proper attention of all the stakeholders is warranted to improve the scenario.

Artificial intelligence-based models for augmenting media reporting of suicide: challenges and opportunities

Ramdas Ransing; Vikas Menon; Sujita Kumar Kar; S.M. Yasir Arafat

GLOBAL PSYCHIATRY, In Press
DOI: 10.52095/gp.2021.3037.1017

The sensationalised and harmful content of media reporting of suicide is a modifiable risk factor for suicide and suicidal behaviour. Although the World Health Organization (WHO) has published guidelines for responsible media reporting of suicide to prevent suicide contagion, the uptake of these recommendations across media outlets remains limited due to several barriers such as the motivation of stakeholders, inadequate training of media personnel, and a lack of real-time monitoring by the government. In this report, we suggest that artificial intelligence (AI) based models, can be used to address barriers to guideline adherence and improve the quality of media reporting. It is our understanding that the development and implementation of AI-based models or tools can assist in improving adherence to suicide reporting guidelines. We propose a hybrid model that incorporates steps that can be taken at different levels of the media news communication cycle. The algorithmic approach can help in simultaneously processing large amounts of data while also facilitating the design of article structures and placement of key information recommended by media reporting guidelines. The potential benefits of the AI-based model to the various stakeholders and the challenges in implementation are discussed. Given the positioning of responsible media reporting of suicide as a key population-level suicide prevention strategy, efforts should be made to develop and evaluate AI-based models for improving the quality of media reporting in different national or international settings. 

The prevalence of body dysmorphic disorder in the community: a systematic review

Anton Minty; Gavin Minty

GLOBAL PSYCHIATRY, In Press
DOI: 10.52095/gp.2021.8113

Objective:  Body dysmorphic disorder (BDD) is an underdiagnosed condition among the general population with significant associated morbidity and mortality. Symptoms of BDD include worrying excessively about a particular part of the body, repeatedly checking oneself in the mirror and attempting to cover up particular areas of the body.
Aim: To determine the prevalence of BDD within the global population. To perform a further subgroup analysis to identify groups that have a higher prevalence than the general population. To assess the modalities of diagnosis BDD and its relative abundance.
Methods: A systematic review using the PubMed database using the search criteria ‘BDD’ or ‘body dysmorphic disorder’ and ‘prevalence’ or ‘incidence’ from 1 January 1990 to 1 January 2020. 591studies were found, 81 of which were eligible and included in the study. Prevalence was calculated for the global population and subgroups, student, dermatology, surgical and psychiatric patients.
Results: The ranges of prevalence within studies were as follows; within the general population, the prevalence of BDD ranged from 0.5-3.2% (n=8). It was 1.3-5.8% (n=8) in student cohorts, 4.9- 21.1% (n=12) in general dermatology cohorts, 1.3%-5.8% (n=8) in a student population, 0-54.3% (28) in psychiatric cohorts and 2.9- 57% (n=15) in cosmetic surgery cohorts.
Conclusion: Studies found had low heterogenicity. However, there was variation in diagnostic criteria and methods of data collection. This study shows that a significant number of people suffer from BDD. Due to the fact that people with BDD often don’t seek help, this number is likely an underestimation. This study identified subgroups of the population that have a higher prevalence of BDD. Targeted screening of individuals in high-risk cohorts, as well as further clinician education, may be of benefit to help aid early recognition and diagnosis. Additionally, structured clinical interviews for DSM (the Diagnostic and Statistical Manual of Mental Disorders), also known as SCID, were the most common and appear to be more effective than normal interviews at identifying individuals with BDD.

Association of perceived isolation and resilience with self-rated mental health among undergraduate medical students in Nepal during the COVID-19 pandemic

Rakesh Singh; Pragya Rai; Madhusudan Subedi; Babita Singh; Moses Chicco Banda Aron; Chandra Bahadur Sunar; SM Yasir Arafat; Sharika Mahato

GLOBAL PSYCHIATRY, In Press
DOI: 10.52095/gp.2021.1392.1015

Background:  The COVID-19 pandemic has devastatingly affected the entire world and destroyed the equilibrium of every sphere of life. Like other groups of people, medical students of Nepal have been facing the conditions of lockdown and social isolation that have arisen because of the pandemic.
Objective: We aimed to see the relationship of perceived isolation and resilience with self-rated mental health among undergraduate medical students in Nepal.
Materials and methods: A web-based online survey was carried out in July 2020 using a semi-structured questionnaire in Google form. Data analysis was performed in SPSS vs 20. Ordered logistic regression analysis was performed to examine the effects of perceived isolation, resilience and background characteristics on self-rated mental health.
Results: Out of 515 participants, 44.9% were male.31.4% reported having fair/poor mental health status and 21.9% reported feeling stressed often due to the COVID-19 pandemic. An increment of 1SD in perceived isolation is associated with about a 5% reduction in the odds of having better mental health (exp (−0.048) = 0.95; p=0.026). Similarly, an increment of 1SD in resilience is associated with about 13% lower odds of having better mental health (exp (−0.149) = 0.862 ; p<0.001).
Conclusion: This study is an early step towards the assessment of perceived isolation and mental health among undergraduate medical students amid the COVID-19 pandemic in Nepal. There is a need to conduct regular counselling sessions and strengthen the coping skills of medical students duringthe pandemic.

Association of executive function, craving and precipitants of relapse in alcohol use disorder: A cross-sectional study

Zaryab Alam; Sujita Kumar Kar; Pronob Kumar Dalal

GLOBAL PSYCHIATRY, In Press
DOI: 10.52095/gp.2021.3236.1018

Objective:  Alcohol use disorder (AUD) is a global health concern. Patients with AUDs often relapse. Various psychosocial factors, as well as cognitive factors, determine relapse. Failure of response inhibition is often associated with relapse. This study aimed to evaluate the association of craving and relapse precipitants with executive function in AUD.
Materials and methods: The study was conducted in the outpatient setting of a tertiary care hospital in North India (between September 2017 to August 2018) on patients with AUD, who presented with a recent relapse.
A total of 46 adult patients with AUD, who relapsed after a quit attempt were enroled in the study. Cross-sectional assessment of relapse precipitants (by using relapse precipitant inventory), craving (by using the obsessive-compulsive drinking scale (OCDS)), and executive function (EF) (by using the Wisconsin Card Sorting Test (WCST)) was done along with various socio-demographic and clinical variables.
Results: The mean age of onset of alcohol use was 21.48±4.25years and the mean duration of alcohol use was 15.13±7.70 years. The average number of relapses in the study population was 3.59±2.06. There is a significant positive correlation between a negative mood state (as a relapse precipitant) and total relapse score with craving. There is a significant association of relapse and craving with deficits of EF (perseverative and non-perseverative errors). Similarly, lessened cognitive vigilance also significantly correlate with EF deficits resulting in a relapse of AUD.
Conclusion: There is a close association of craving, and relapse with deficits of EF, in AUD. Craving and relapse in AUD may be the result of deficits in EF. Future research addressing the cognitive deficits may help in the prevention of craving and relapse.

Increased risk for mental disorders and suicide during the COVID-19 pandemic. Position statement of the Section on Suicidology and Suicide Prevention of the European Psychiatric Association.

Marco Sarchiapone; Jorge Lopez-Castroman; Carla Gramaglia; Enrique Baca-Garcia; Francesca Baralla; Maria Luisa Barrig&oacute;n; Silvia Bartollino; Julian Beezhold; Julio Bobes; Raffaella Calati; Narc&iacute;s Cardoner; Erminia Colucci; Philippe Courtet; Lavinia Duica; Christine Dunkley; Laura Dunkley; Ricardo Gusm&atilde;o; Catarina Jesus; Fabrice Jollant; Alexandr Kasal; Anisur Khan; Philip Jules Simon Michielsen; Peter Osvath; Stephen Palmer; Nuhamin Petros; Mihai Pirlog; Anna Plaza estrada; Pilar Saiz; Jos&eacute; Carlos Santos; Alexandra Tubiana Potiez; Christina Van Der Feltz-Cornelis; Tereza Vitcheva; Petr Winkler; Patrizia Zeppegno

GLOBAL PSYCHIATRY, 2021, Volume 4, Issue 1, Pages 4-19
DOI: 10.52095/gp.2021.8114

In March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic. The Section on Suicidology and Suicide Prevention of the European Psychiatric Association (EPA) wants to raise awareness about the potential increase in mental health disorders and suicides as a result of the socio-economic impact of the COVID-19 pandemic, and of the necessary restrictive measures adopted worldwide to contain its spread. Even if fear, worries and symptoms of anxiety, depression and stress can be considered a natural response to this global crisis, some individuals are overexposed to its potential negative effects, such as healthcare workers, COVID-19 and psychiatric patients, prisoners, members of the LGBTQ+ community, migrants (including migrant workers), ethnic minorities and asylum seekers and internally displaced populations. Nevertheless, social support, resilience, a supportive work environment and other protective factors may buffer the impact of this crisis on mental health. These unprecedented times are calling for unprecedented efforts. Evidence-based and coordinated actions to prevent the risk of increased mental health disorders and suicide are needed. However, most of the data about COVID-19 impact on mental health comes from online surveys using non-probability and convenience sample in which females are often over-represented. For this reason the quality of future research should be also improved.

How to measure the impact of the COVID-19 pandemic on quality of life: COV19-QoL –the development, reliability and validity of a new scale

Selman Repišti; Nikolina Jovanović; Martina Rojnić Kuzman; Sara Medved; Stefan Jerotić; Emina Ribić; Tihana Majstorović; Silvana Markovska Simoska; Ljubisha Novotni; Miloš Milutinović; Biljana Blazevska Stoilkovska; Tamara Radojičić; Ivan Ristić; Mirjana Zebić; Tamara Pemovska; Manuela Russo

GLOBAL PSYCHIATRY, 2020, Volume 3, Issue 2, Pages 201-210
DOI: 10.2478/gp-2020-0016

Objective: The primary objective of this paper is to present a short measure of perceptions on the impact of the COVID-19 pandemic on quality of life, along with analysis of its reliability and validity in non-clinical and clinical samples.
Methods: The scale was named The COV19 – Impact on Quality of Life (COV19-QoL) and it consists of six items presented in the form of a 5-point Likert scale. The items (i.e. statements) cover main areas of quality of life with regard to mental health. The scale was administered to 1346 participants from the general population in Croatia (the non-clinical sample) and 201 patients with severe mental illness recruited from four European countries (Bosnia and Herzegovina, Montenegro, North Macedonia and Serbia), constituting the clinical sample. The clinical sample was part of the randomised controlled trial IMPULSE funded by the European Commission. Data on age and gender were collected for both samples, along with psychiatric diagnoses collected for the clinical sample.
Results: Main findings included a high internal consistency of the scale and a moderate to strong positive correlation among participants’ scores on different items. Principal component analysis yielded one latent component. The correlation between participants’ age and their results on COV19-QoL was negligible. Participants’ perceived quality of life was the most impacted domain, whereas mental health, personal safety and levels of depression were the least impacted domains by the pandemic.
Discussion: The COV19-QoL is a reliable and valid scale which can be used to explore the impact of COVID-19 on quality of life. The scale can be successfully used by researchers and clinicians interested in the impact of the pandemic on people experiencing various pre-existing mental health issues (e.g. anxiety, mood and personality disorders) as well as those without such issues.

Protocol for a process evaluation of a cluster randomised controlled trial to improve psychosocial treatment of patients with psychotic spectrum disorders: the IMPULSE trial

Tamara Pemovska; Nikolina Jovanović; Tamara Radojičić; Aliriza Arënliu; Alma Džubur-Kulenović; Antoni Novotni; Lidija Injac-Stevović; Nađa P. Marić; Stojan Barjaktarov; Jill J Francis

GLOBAL PSYCHIATRY, 2021, Volume 4, Issue 1, Pages 20-30
DOI: 10.52095/gp.2020.1407

Objective: This paper describes the protocol of a process evaluation of a cluster randomised controlled trial designed to evaluate the effectiveness, cost-effectiveness and implementation of a digital mental health intervention, called DIALOG+, in five low- and middle-income countries in Southeast Europe (Bosnia and Herzegovina, Kosovo1, Montenegro, North Macedonia and Serbia). The objectives of the process evaluation are: a) to explore attributes of context that might impact on the implementation of the DIALOG+ intervention; b) to assess intervention fidelity and c) to explore patients’ and clinicians’ retrospective (i.e. experienced) acceptability of the intervention.
Materials and methods: This is a mixed-method process evaluation nested within the cluster randomised controlled trial. We adopted the guidance on process evaluations of complex interventions published by the United Kingdom Medical Research Council. Data collected during and after the trial, but prior to awareness of trial outcomes, include transcripts, questionnaire responses, routinely collected monitoring data and audio-recordings of intervention and control sessions. Data analysis is descriptive and involves triangulation methods to compare findings across countries, stakeholder groups (healthcare provider, patient) and data type (qualitative, quantitative).
Results: This work is part of a larger study entitled ‘Implementation of an effective and cost-effective intervention for patients with psychotic disorders in low and middle-income countries in Southeast Europe’ (IMPULSE). The study is funded by the European Union’s Horizon 2020 research and innovation programme. The IMPULSE trial recruited 81 clinicians and 458 patients. The clinician clusters were randomised to the intervention (six sessions of DIALOG+ over 12 months) or treatment-as-usual arm. Process data collection began in parallel with the trial, starting in April 2019. Data collection and analysis will be completed before the main trial findings are known. Process evaluation findings will be used to interpret the trial results including assessing the effect of context on outcomes.
Conclusion: This process evaluation will explore the context, intervention fidelity and acceptability to contextualise the trial results, help in optimising sustainability of the intervention and inform its future dissemination. The methods described here may also inform the development and implementation of other complex psychosocial interventions in low-resource settings.

Implementing a mental health intervention in low-and-middle-income countries in Europe: is it all about resources?

Jennifer Hunter; Rose McCabe; Jill J Francis; Tamara Pemovska; Emina Ribić; Eldina Smajić Me&scaron;ević; Jon Konjufca; Silvana Markovska Simoska; Biljana Blazevska Stoilkovska; Tamara Radojičić; Selman Repi&scaron;ti; Stefan Jerotić; Ivan Ristić; Mirjana Zebić; Lidija Injac-Stevović; Aliriza Arenliu; Alma Džubur Kulenović; Dashamir Berxulli; Stojan Bajraktarov; Nikolina Jovanović

GLOBAL PSYCHIATRY, 2021, Volume 4, Issue 1, Pages 31-54
DOI: 10.52095/gp.2020.1409

Background: There are limited resources for improving mental health care across Europe, especially in Low-and-Middle- Income Countries (LMICs) in South-eastern Europe with fewer specialist staff and less funding. Scaling up psychosocial interventions that utilise available time and resources more effectively could improve care for people with psychosis in these settings. One intervention is DIALOG+, delivered via an app on a tablet computer: patients identify life areas to improve and clinicians use a solution-focussed process to help improve these areas. This intervention was piloted across mental healthcare systems in European LMICs, and focus groups were conducted to explore whether such interventions could use available resources effectively to improve care for psychosis in these settings.
Methods: Eleven focus groups were conducted with clinicians and patients with psychosis who used the intervention over three months during the pilot study, in Bosnia and Herzegovina, Kosovo United Nations Resolution, Montenegro, North Macedonia and Serbia. The Theoretical Domains Framework (TDF), which describes factors affecting engagement with healthcare interventions, structured topic guides and guided analysis. Codes from the data were mapped onto the TDF, analysed to identify barriers and facilitators, translated into English and checked for inter-rater reliability.
Results: 25 clinicians and 23 patients participated in focus groups. Clinicians’ barriers included limited time for sessions and difficulties working with acutely psychotic patients. Patients’ barriers were burden of greater concentration when engaging with DIALOG+ and feeling tense or disturbed during the sessions. Facilitators included motivation to use DIALOG+, positive opinions shared by others, perceived benefits for practice and improving clinician-patient conversations, relationships and care.
Conclusions: Barriers to using psychosocial interventions could be overcome even if resources cannot be increased. Despite limited time and other barriers to using DIALOG+, perceived benefits to practice and clinician-patient relationships suggest that psychosocial interventions can use available resources effectively to improve care for psychosis.

Media portrayal of panic buying: A content analysis of online news portals

S.M. Yasir Arafat; Sujita Kumar Kar; Vikas Menon; Marthoenis Marthoenis; Pawan Sharma; Angi Alradie-Mohamed; Srijeeta Mukherjee; Charanya Kaliamoorthy; Russell Kabir

GLOBAL PSYCHIATRY, 2020, Volume 3, Issue 2, Pages 249-254
DOI: 10.2478/gp-2020-0022

Objectives: Media reporting has an influential role in panic buying (PB). We aimed to evaluate the media portrayal of PB during this COVID-19 pandemic.
Methods: We searched, collected, and analysed the news reports from the English media discussing the PB events. The search was done between 23 and 30 May 2020.
Results: A total of 525 news reports were analysed. Approximately half (49.3%) discussed the government action to handle the situation, 36.4% discussed the expert opinion regarding PB, 20.6% discussed the psychology of PB, 21.5% discussed the rumours, and 18.5% suggested remedial measures. Concerning the negative aspects, 96.6% of the titles mentioned panic buying, 75.4% mentioned the cause, and 62.3% mentioned the photos of empty shelves. The media in low–middle-income countries are 1.5 times more likely to include expert opinion (p = 0.03), 2.1 times more likely to discuss rumours regarding PB (p = 0.001), almost thrice more likely to report the cause of PB (p = 0.001), and thrice more likely to mention its impact (p = 0.001).
Conclusion: Media has been portraying more negative aspects of PB. Further, there are variations in reporting patterns between highincome and low–middle-income countries.

How to measure the impact of the COVID-19 pandemic on quality of life: COV19-QoL –the development, reliability and validity of a new scale

Selman Repišti; Nikolina Jovanović; Martina Rojnić Kuzman; Sara Medved; Stefan Jerotić; Emina Ribić; Tihana Majstorović; Silvana Markovska Simoska; Ljubisha Novotni; Miloš Milutinović; Biljana Blazevska Stoilkovska; Tamara Radojičić; Ivan Ristić; Mirjana Zebić; Tamara Pemovska; Manuela Russo

GLOBAL PSYCHIATRY, 2020, Volume 3, Issue 2, Pages 201-210
DOI: 10.2478/gp-2020-0016

Objective: The primary objective of this paper is to present a short measure of perceptions on the impact of the COVID-19 pandemic on quality of life, along with analysis of its reliability and validity in non-clinical and clinical samples.
Methods: The scale was named The COV19 – Impact on Quality of Life (COV19-QoL) and it consists of six items presented in the form of a 5-point Likert scale. The items (i.e. statements) cover main areas of quality of life with regard to mental health. The scale was administered to 1346 participants from the general population in Croatia (the non-clinical sample) and 201 patients with severe mental illness recruited from four European countries (Bosnia and Herzegovina, Montenegro, North Macedonia and Serbia), constituting the clinical sample. The clinical sample was part of the randomised controlled trial IMPULSE funded by the European Commission. Data on age and gender were collected for both samples, along with psychiatric diagnoses collected for the clinical sample.
Results: Main findings included a high internal consistency of the scale and a moderate to strong positive correlation among participants’ scores on different items. Principal component analysis yielded one latent component. The correlation between participants’ age and their results on COV19-QoL was negligible. Participants’ perceived quality of life was the most impacted domain, whereas mental health, personal safety and levels of depression were the least impacted domains by the pandemic.
Discussion: The COV19-QoL is a reliable and valid scale which can be used to explore the impact of COVID-19 on quality of life. The scale can be successfully used by researchers and clinicians interested in the impact of the pandemic on people experiencing various pre-existing mental health issues (e.g. anxiety, mood and personality disorders) as well as those without such issues.

Increased risk for mental disorders and suicide during the COVID-19 pandemic. Position statement of the Section on Suicidology and Suicide Prevention of the European Psychiatric Association.

Marco Sarchiapone; Jorge Lopez-Castroman; Carla Gramaglia; Enrique Baca-Garcia; Francesca Baralla; Maria Luisa Barrig&oacute;n; Silvia Bartollino; Julian Beezhold; Julio Bobes; Raffaella Calati; Narc&iacute;s Cardoner; Erminia Colucci; Philippe Courtet; Lavinia Duica; Christine Dunkley; Laura Dunkley; Ricardo Gusm&atilde;o; Catarina Jesus; Fabrice Jollant; Alexandr Kasal; Anisur Khan; Philip Jules Simon Michielsen; Peter Osvath; Stephen Palmer; Nuhamin Petros; Mihai Pirlog; Anna Plaza estrada; Pilar Saiz; Jos&eacute; Carlos Santos; Alexandra Tubiana Potiez; Christina Van Der Feltz-Cornelis; Tereza Vitcheva; Petr Winkler; Patrizia Zeppegno

GLOBAL PSYCHIATRY, 2021, Volume 4, Issue 1, Pages 4-19
DOI: 10.52095/gp.2021.8114

In March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic. The Section on Suicidology and Suicide Prevention of the European Psychiatric Association (EPA) wants to raise awareness about the potential increase in mental health disorders and suicides as a result of the socio-economic impact of the COVID-19 pandemic, and of the necessary restrictive measures adopted worldwide to contain its spread. Even if fear, worries and symptoms of anxiety, depression and stress can be considered a natural response to this global crisis, some individuals are overexposed to its potential negative effects, such as healthcare workers, COVID-19 and psychiatric patients, prisoners, members of the LGBTQ+ community, migrants (including migrant workers), ethnic minorities and asylum seekers and internally displaced populations. Nevertheless, social support, resilience, a supportive work environment and other protective factors may buffer the impact of this crisis on mental health. These unprecedented times are calling for unprecedented efforts. Evidence-based and coordinated actions to prevent the risk of increased mental health disorders and suicide are needed. However, most of the data about COVID-19 impact on mental health comes from online surveys using non-probability and convenience sample in which females are often over-represented. For this reason the quality of future research should be also improved.

A systematic review on the effect of Ramadan on mental health: minor effects and no harm in general, but increased risk of relapse in schizophrenia and bipolar disorder

Reinhard Heun

GLOBAL PSYCHIATRY, 2018, Volume 1, Issue 1, Pages 7-16

Objectives
Globally, Moslems are the second largest religious group. During the month of Ramadan from dawn to sundown, healthy Moslems are required to refrain from eating, drinking, smoking, sexual activity and harmful behaviour towards others and themselves. Thus Ramadan may change individual physical states and social interactions. Both might affect mental health within society. Consequently, this systematic review looks at the various effects of Ramadan on mental health.


Methods
A literature search on Ramadan and mental health initially identified 294 papers. We finally selected all 22 relevant papers covering Ramadan and mental health from which study data were extracted.


Results
Relevant papers focussed on the general population and healthy volunteers, on subjects practising sports, on subjects with severe physical disorders, on subjects at risk of eating disorders and on subjects with mental health disorders. The effects of Ramadan on mental well-being were mixed. Positive and negative effects were usually minor, except in subjects with schizophrenia and metabolic syndrome, and in subjects with bipolar disorder who suffered a substantial increase of relapses.


Conclusion
Ramadan fasting is safe in most conditions and disorders, but caution is required in subjects with schizophrenia and bipolar disorder. The research on mental health and Ramadan would profit from larger studies with more representative samples to help understand the intra-individual and social factors that affect the mental health and well-being in patients and in society. The scientific potential of such studies may have been overlooked in the psychiatric community.

Media portrayal of panic buying: A content analysis of online news portals

S.M. Yasir Arafat; Sujita Kumar Kar; Vikas Menon; Marthoenis Marthoenis; Pawan Sharma; Angi Alradie-Mohamed; Srijeeta Mukherjee; Charanya Kaliamoorthy; Russell Kabir

GLOBAL PSYCHIATRY, 2020, Volume 3, Issue 2, Pages 249-254
DOI: 10.2478/gp-2020-0022

Objectives: Media reporting has an influential role in panic buying (PB). We aimed to evaluate the media portrayal of PB during this COVID-19 pandemic.
Methods: We searched, collected, and analysed the news reports from the English media discussing the PB events. The search was done between 23 and 30 May 2020.
Results: A total of 525 news reports were analysed. Approximately half (49.3%) discussed the government action to handle the situation, 36.4% discussed the expert opinion regarding PB, 20.6% discussed the psychology of PB, 21.5% discussed the rumours, and 18.5% suggested remedial measures. Concerning the negative aspects, 96.6% of the titles mentioned panic buying, 75.4% mentioned the cause, and 62.3% mentioned the photos of empty shelves. The media in low–middle-income countries are 1.5 times more likely to include expert opinion (p = 0.03), 2.1 times more likely to discuss rumours regarding PB (p = 0.001), almost thrice more likely to report the cause of PB (p = 0.001), and thrice more likely to mention its impact (p = 0.001).
Conclusion: Media has been portraying more negative aspects of PB. Further, there are variations in reporting patterns between highincome and low–middle-income countries.

Physician Suicide: A Scoping Literature Review to Highlight Opportunities for Prevention

Tiffany I. Leung; Rebecca Snyder; Sima S. Pendharkar; Chwen-Yuen Angie Chen

GLOBAL PSYCHIATRY, 2020, Volume 3, Issue 2, Pages 141-168
DOI: 10.2478/gp-2020-0014

Objective: The aim of this scoping review is to map the current landscape of published research and perspectives on physician suicide. Findings could serve as a roadmap for further investigations and potentially inform efforts to prevent physician suicide.
Methods: Ovid MEDLINE, PsycINFO, and Scopus were searched for English-language publications from August 21, 2017 through April 28, 2018. Inclusion criteria were a primary outcome or thesis focused on suicide (including suicide completion, attempts, and thoughts or ideation) among medical students, postgraduate trainees, or attending physicians. Opinion articles were included. Studies that were non-English or those that only mentioned physician burnout, mental health, or substance use disorders were excluded. Data extraction was performed by two authors.
Results: The search yielded 1,596 articles, of which 347 articles passed to the full-text review round. The oldest article was an editorial from 1903; 210 (60.3%) articles have been published from 2000 to present. Authors originated from 37 countries, and 143 (41.2%) were opinion articles. The most discussed were suicide risk factors and culture of practice issues, while the least discussed themes included public health and postvention.
Conclusions: Consistency and reliability of data and information about physician suicides could be improved. Data limitations partly contribute to these issues. Also, various suicide risk factors for physicians have been explored, and several remain poorly understood. Based on this scoping review, a public health approach, including surveillance and early warning systems, investigations of sentinel cases, and postvention may be impactful next steps in preventing physician deaths by suicide.

APC WAIVED FOR THE NEXT PAPERS TO BE SUBMITTED IN MAY AND JUNE 2021
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Issue 1/ volume 4/ 2021 is out now with 10 excellent papers
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Publications by Reiner Heun
If you want to check out the publication by R Heun please use the following link. Many papers are open access. If you need a PDF please email globalpsychiatry@gmx.com   https://pubmed.ncbi.nlm.nih.gov/?term=heun-r    

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Feedback from author, reviewer and now editor Yasir Arafat
Dear Reiner,I must appreciate your efforts to improve the submitted manuscript inGlobal Psychiatry. As an author, I got extensive, rigorous, andconstructive reviews from the editors as well as the reviewers. ...

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Dean RCPsych
Congratulations to Professor Subodh Dave esteemed editor for being elected as the new dean of the Royal College of Psychiatry

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Ejournalplus-new publisher
We would like to let you know that Global Psychiatry is now published with ejournalplus a Swedish company.   Please submit your papers to Global Psychiatry - open access psychiatric journal www.GlobalPsychiatry.co.uk   The ...

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New cartoon from Jimmy reminds us about important papers on mental health during Covid-19 published ib Global Psychiatry

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Cartoon from Jimmy reminds us that we should publish on gambling addiction.
We received the offer by Jimmy Whittaker a young and talented trainee psychiatrist and cartoonist to publish his cartoons on our website. We are very grateful for this offer and will initially put these ...

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