Faculty Bibliography

BACKGROUND:During the early pandemic, there was substantial variation in public and government response to COVID-19 in Europe and the United States. Mass media are a vital source of health information and news, frequently disseminate this information through social media, and may influence public and policy response to the pandemic. OBJECTIVE:The aims of this study were to describe the extent to which major media outlets in the USA and Spain tweeted about health-related behaviors relevant to COVID-19, compare the tweeting pattern between both countries' media outlets, and determine user engagement in response to these tweets. METHODS:We investigated tweets posted by 30 major media outlets (17 from Spain and 13 from the United States) between December 1st 2019 and May 31st 2020 that included keywords related to health-related behaviors (HRB) relevant to COVID-19. We classified tweets into six categories: 1) mask-wearing, 2) physical distancing, 3) handwashing, 4) quarantine/confinement, 5) disinfecting objects, or 6) multiple HRB (any combination of the prior HRB categories). In addition, we assessed likes and retweets generated by each tweet. Poisson regression analyses were performed to compare average predicted number of likes and retweets between the different HRB categories and to compare between both countries. RESULTS:We collected a total of 50,415 tweets, but 41,863 were excluded as their content was not associated to any health-related behavior. Out of the remaining 8,552 tweets, 600 were randomly chosen for training, and ultimately, 2,351 tweets were randomly selected for manual content analysis. Of 2,351 COVID-19-related tweets included in the content analysis, 1,479 (62.91%) mentioned at least one HRB. The proportion of COVID-19 tweets mentioning at least one health-related behavior was significantly different between countries (p=0.006). Quarantine/confinement was mentioned in nearly half of all HRB tweets in both countries. On the other hand, the least frequently mentioned HRB was disinfecting objects in Spain (6.9%) and handwashing in the USA (9.1%). For tweets from the USA mentioning at least one HRB, disinfecting objects had the highest median likes and retweets, whereas mask-wearing and handwashing related tweets achieved the highest median number of likes from Spanish tweets. Tweets from Spain that mentioned social distancing or disinfecting objects had a significantly lower predicted count of likes compared to tweets mentioning a different HRB (p=0.02 and p=0.01, respectively). Tweets from the USA that mentioned quarantine/confinement or disinfecting objects had a significantly lower predicted number of likes compared to tweets mentioning a different HRB (p<0.001), whereas masks and handwashing-related tweets had a significantly greater predicted number of likes (p=0.04 and p=0.02, respectively). CONCLUSIONS:The type of health-related behavior content and engagement with media outlet tweets varied between Spain and the USA early in the pandemic. However, content related to quarantine/confinement and engagement related to handwashing was relatively high in both countries.

In Kenya, there is a treatment gap for depression and alcohol use that is especially large for fathers, which has consequences for families. While treatments exist, there are challenges to implementation. This study aimed to understand barriers and facilitators to implementing a treatment for fathers' depression and alcohol use in Eldoret, Kenya. Guided by the Consolidated Framework for Implementation Research and the Integrated Sustainability Framework, we conducted 18 key informant interviews and 7 focus group discussions (31 total participants) with stakeholders in Eldoret (hospital leaders, policy makers, mental health providers, community leaders, fathers, lay providers, and patients previously engaged in treatment). Interviews were analyzed using the framework method; themes were matrixed by framework domains. Participants identified barriers and facilitators, and opportunities for implementation, in the following domains: innovation, outer setting, inner setting, individual, sustainability, and characteristics of systems. Barriers included a lack of resources, stigma, masculine norms, cost of services, and alcohol dependence. Facilitators included community buy-in, family support, providers with lived experience, government support, and relevant treatment content. Findings will inform implementation strategy development for an intervention for fathers with depression and alcohol use, and family problems with local relevance and scalable potential.

BACKGROUND/UNASSIGNED:Violence against psychiatry trainees is an important issue to the medical profession. However, this matter has been under researched, especially in Asian countries. AIM/UNASSIGNED:We aimed to explore the rates and factors associated with violence against psychiatric trainees in Asian countries. METHODS/UNASSIGNED:An online, 15 item cross sectional pilot survey was designed and disseminated among psychiatric trainees in Asia through the World Network of Psychiatric Trainees, national and local networks of trainees, and social media. The questionnaire sought to enquire about the experience of physical, verbal, and sexual assaults and its impact. Data were analyzed using Statistical Package for the Social Sciences (SPSS) V20.0. RESULTS/UNASSIGNED:= 0.002). CONCLUSION/UNASSIGNED:Violence against psychiatric trainees seems common across Asian countries. Our findings call for further systematic investigation of the phenomenon and suggest the need to develop programs to protect psychiatric trainees against the threat of violence and its subsequent psychological complications.

BACKGROUND:Electroconvulsive therapy (ECT) is an effective and safe medical procedure that mainly indicated for depression, but is also indicated for patients with other conditions. However, ECT is among the most stigmatized and controversial treatments in medicine. Our objective was to examine social media contents on Twitter related to ECT to identify and evaluate public views on the matter. METHODS:We collected Twitter posts in English and Spanish mentioning ECT between January 1, 2019 and October 31, 2020. Identified tweets were subject to a mixed method quantitative-qualitative content and sentiment analysis combining manual and semi-supervised natural language processing machine-learning analyses. Such analyses identified the distribution of tweets, their public interest (retweets and likes per tweet), and sentiment for the observed different categories of Twitter users and contents. RESULTS:"Healthcare providers" users produced more tweets (25%) than "people with lived experience" and their "relatives" (including family members and close friends or acquaintances) (10% combined), and were the main publishers of "medical" content (mostly related to ECT's main indications). However, more than half of the total tweets had "joke or trivializing" contents, and such had a higher like and retweet ratio. Among those tweets manifesting personal opinions on ECT, around 75% of them had a negative sentiment. CONCLUSIONS:Mixed method analysis of social media contents on Twitter offers a novel perspective to examine public opinion on ECT, and our results show attitudes more negative than those reflected in studies using surveys and other traditional methods.

BACKGROUND/UNASSIGNED:Increasing reports of manic episodes in patients during acute infection with COVID-19 have been documented since the pandemic began, including individuals without a previous personal or family history of bipolar disorder. As infections and autoimmunity have putative roles in bipolar disorder, we aimed to document the clinical presentations, associated stressors, family aggregation patterns, and brain imaging and electroencephalographic correlates with a series of patients with episodes of mania that emerged shortly after COVID-19 infections. METHODS/UNASSIGNED:We obtained all relevant clinical information from 12 patients whose first manic episode started within a month of COVID-19 infection and were treated at Rasool-e-Akram hospital and Iran psychiatric hospital, two tertiary medical centers in Tehran, Iran, in 2021. RESULTS/UNASSIGNED:Patients had a mean age of 44. The interval between the onset of symptoms of COVID and mania ranged between 0 and 28 days (mean: 16.25, median: 14 days); it was observed to be shorter in patients with a family history of mood disorders but not in those receiving corticosteroids. Alongside a descriptive overview of our sample, we provide detailed narrative descriptions of two of the cases for illustrative purposes and discuss our observations in the context of other cases reported elsewhere and the state-of-the-art regarding infectious diseases, COVID-19, and bipolar disorder as reported in previous literature. CONCLUSION/UNASSIGNED:Our case series documents observational and naturalistic evidence from a dozen of cases of mania in the context of acute COVID-19, which, while limited, calls for analytical research of the phenomenon, and points at a family history of bipolar disorder and the use of corticosteroids as factors for particular focus.

INTRODUCTION/BACKGROUND:Varying public views on cannabis use across countries may explain the variation in the prevalence of use, policies and research in individual countries, and global regulation of cannabis. This paper aims to describe the current state of cannabis use, policies, and research across sixteen countries. METHODS:PubMed and Google Scholar were searched for published studies from 2010 to 2020. Searches were conducted by using the relevant country of interest as a search term (e.g. "Iran"), as well as relevant predefined keywords such as "cannabis", "marijuana", "hashish", "bhang "dual diagnosis", "use", "addiction", "prevalence", "co-morbidity", "substance use disorder", "legalization" or "policy" (English and non-English). These keywords were used in multiple combinations to create the search string in studies records' titles and abstracts. Official websites of respective governments and international organizations were also searched in English and non-English (national language country) languages to identify the current state of cannabis use, policies, and research in each of those countries. RESULTS:Inconsistent and heterogeneous reporting of cannabis use, variation in policies (e.g., legalization), and intervention strategies across the reviewed countries were the main findings. European countries have dominated cannabis research output in PubMed, as compared to Asian countries (Thailand, Malaysia, India, Iran and Nepal). CONCLUSIONS:Although global cannabis regulation is ongoing, the existing heterogeneities across countries in terms of policies and epidemiology can increase the burden of cannabis use disorders disproportionately and unpredictably. There is an urgent need to develop global strategies to address these cross-country barriers to improve early detection, prevention, and interventions for cannabis use and related disorders.

Grief is the physical or mental suffering experienced after a major loss, usually the death of a loved one. It is a universal experience, but sociocultural factors, such as cultural or ethnic identity and religious beliefs predict and shape the expression of grief. The circumstances under which people are experiencing grief during the coronavirus outbreak have adversely affected the grieving process. Unexpected deaths, social distancing rules and visitor restrictions in healthcare facilities have posed a heavier burden on the loss and have heightened the risk of grievers experiencing complicated or persistent grief. This concern led us, as early career psychiatrists (ECPs) from 14 different countries connected by the Early Career Psychiatrists Section of the World Psychiatric Association (WPA), to share our country-specific experiences on the mourning, grief tradition, and burial rites during the COVID-19 pandemic. In this paper, we discuss our experiences, similarities and differences with relation to the: 'Effect of the pandemic on mourning', 'Restrictions and Guideline on burial rites due to the pandemic', 'Effect of the pandemic on social support' and 'Role of media and telecommunication on mourning practices and burial rites'. We conclude that while telecommunication means have attempted to bridge the gap and provide some form of social connectedness, the total and global effect of the pandemic is yet to be fully seen and understood.

OBJECTIVES/OBJECTIVE:Violence by patients against health care professionals has been widely described. Although psychiatric trainees are particularly exposed, little is known about the extent, context, and impact of violence toward them in Europe. METHODS:A cross-sectional online survey was distributed between June 2018 and December 2019 among European psychiatric trainees through professional networks, using a snowball approach. The questionnaire asked about experiences of verbal abuse and physical and sexual assaults, as well as their context and impact. Descriptive analyses of the obtained data were conducted. RESULTS:The survey was completed by 827 trainees from 39 countries (68.4% females). Most (83.6%) reported having been abused/assaulted at least once (of these, 92% verbally, 44.1% physically, and 9.3% sexually). Emergency rooms and inpatient units were the most frequent settings. Psychological impact of these events was commonly reported. Most respondents did not report abuses and assaults to their supervisors. They also described a lack of training for staff and aggression management plans at their institutions or of being unaware of their existence. CONCLUSIONS:Violence from patients is reported by many psychiatric trainees across countries in Europe, with very frequent verbal abuse and worrisome figures of physical and sexual assaults. Particularly concerning are the low proportion of trainees reporting to authorities, the lack of staff training and management protocols, and trainees' lack of awareness about those resources. Despite the study limitation of a small response rate, these results support a call for urgent efforts to address this problem in Europe, and possibly beyond.