Olivera Vuković

Relationship of suicide rates to economic variables in Europe: 2000-2011

BACKGROUND It is unclear whether there is a direct link between economic crises and changes in suicide rates. AIMS The Lopez-Ibor Foundation launched an initiative to study the possible impact of the economic crisis on European suicide rates. METHOD Data was gathered and analysed from 29 European countries and included the number of deaths by suicide in men and women, the unemployment rate, the gross domestic product (GDP) per capita, the annual economic growth rate and inflation. RESULTS There was a strong correlation between suicide rates and all economic indices except GPD per capita in men but only a correlation with unemployment in women. However, the increase in suicide rates occurred several months before the economic crisis emerged. CONCLUSIONS Overall, this study confirms a general relationship between the economic environment and suicide rates; however, it does not support there being a clear causal relationship between the current economic crisis and an increase in the suicide rate.

Mental stress-induced ischemia in patients with coronary artery disease: echocardiographic characteristics and relation to exercise-induced ischemia.

Objective The aims of this study were to investigate the incidence and parameters associated with myocardial ischemia during mental stress (MS) as measured by echocardiography and to evaluate the relation between MS-induced and exercise-induced myocardial ischemia. Methods Study participants were 79 patients (63 men; mean [M] [standard deviation {SD}] age = 52 [8] years) with angiographically confirmed coronary artery disease and previous positive exercise test result. The MS protocol consisted of mental arithmetic and anger recall task. The patients performed a treadmill exercise test 15 to 20 minutes after the MS task. Data of post–MS exercise were compared with previous exercise stress test results. Results The frequency of echocardiographic abnormalities was 35% in response to the mental arithmetic task, compared with 61% with anger recall and 96% with exercise (p < .001, exercise versus MS). Electrocardiogram abnormalities and chest pain were substantially less common during MS than were echocardiographic abnormalities. Independent predictors of MS-induced myocardial ischemia were: wall motion score index at rest (p = .02), peak systolic blood pressure (p = .005), and increase in rate-pressure product (p = .004) during MS. The duration of exercise stress test was significantly shorter (p < .001) when MS preceded the exercise and in the case of earlier exercise (M [SD] = 4.4 [1.9] versus 6.7 [2.2] minutes for patients positive on MS and 5.7 [1.9] versus 8.0 [2.3] minutes for patients negative on MS). Conclusions Echocardiography can be successfully used to document myocardial ischemia induced by MS. MS-induced ischemia was associated with an increase in hemodynamic parameters during MS and worse function of the left ventricle. MS may shorten the duration of subsequent exercise stress testing and can potentiate exercise-induced ischemia in susceptible patients with coronary artery disease.

Nature based solution for improving mental health and well-being in urban areas

Abstract The general disproportion of urban development and the socio‐economical crisis in Serbia, followed by a number of acute and chronic stressors, as well as years of accumulated trauma, prevented the parallel physical, mental and social adaptation of society as a whole. These trends certainly affected the quality of mental health and well‐being, particularly on the vulnerable urban population, increasing the absolute number of people with depression, stress and psychosomatic disorders. This study was pioneering in Serbia and was conducted in collaboration with the Faculty of Forestry, the Institute of Mental Health and the Botanical Garden in Belgrade, in order to understand how spending time and performing horticulture therapy in specially designed urban green environments can improve mental health. The participants were psychiatric patients (n=30), users of the day hospital of the Institute who were randomly selected for the study, and the control group, assessed for depression, anxiety and stress before and after the intervention, using a DASS21 scale. During the intervention period the study group stayed in the Botanical garden and participated in a special programme of horticulture therapy. In order to exclude any possible “special treatment” or “placebo effect”, the control group was included in occupational art therapy while it continued to receive conventional therapy. The test results indicated that nature based therapy had a positive influence on the mental health and well‐being of the participants. Furthermore, the difference in the test results of the subscale stress before and after the intervention for the study group was F1.28 = 5.442 and p<;.05. According to socio demographic and clinical variables, the interesting trend was recorded on the subscale of anxiety showing that the male participants in the study group were more anxious, with the most pronounced inflection noted on this scale after treatment. The results of this study have shown that recuperation from stress, depression and anxiety was possible and much more complete when participants were involved in horticulture therapy as a nature‐based solution for improving mental health. HighlightsThe patients with stress‐related mental disorders were included in pioneering HT study in Serbia.The horticulture therapy was associated with reduction of the self‐rated levels of stress.We identify an interesting trend on anxiety subscale among male participants in the study group.Nature‐based therapy is recommended to psychiatric patients as a form of occupational or supportive therapy.The Jevremovac Botanical Garden was recognized as a setting for mental health promotion in Belgrade.

Posttraumatic Stress Disorder after Vaginal Delivery at Primiparous Women

Although severe gynaecological pathology during delivery and negative outcome have been shown to be related with posttraumatic stress disorder (PTSD) little is known about traumatic experiences following regular delivery, at the expected time and with a healthy child. The objective of our study was to determine the prevalence of PTSD during postpartum period after vaginal delivery and its risk factors. The sample included 126 primiparous women. Monthly, for the next three months, the women were assessed for PTSD using the gold standard interview for PTSD, Clinician-Administered PTSD Scale (CAPS). Risk factors were assessed including sociodemographic variables, personal medical history and clinical variables. After the first month, 2.4% women had acute full PTSD and another 9.5% had clinically significant level of PTSD symptoms. Following the second and the third month, partial PTSD was found in 5.9% and 1.3% of the women, respectively, and none of participants had full PTSD. Obstetrical interventions were the only significant risk factor for the development of PTSD. Symptoms of postpartum PTSD are not rare after a traumatic delivery, and associated with specific obstetrical risk factors. Awareness of these risk factors may stimulate interventions to prevent this important and neglected postpartum disorder.

1680 – Prevalence, severity and course of depressive symptomatology in chronic hepatitis c patients on pegylated interferon alpha: a 72-week prospective study

Introduction Treatment with pegylated interferon alpha (PEG-IFN-α) in patients with chronic hepatitis C (CHC) is associated with depression more frequently than in other diseases treated with PEG-IFN-α. Objective To prospectively evaluate prevalence, severity and course of depressive symptomatology in CHC patients treated with PEG-IFN-α. Methods Hamilton Depression Rating Scale (HAMD) was used to asses depressive symptoms in 103 subjects with CHC before PEG-IFN-α (mean dose 152.6±25.6 mcg; duration of therapy 48 weeks) and at the follow-up visits (4th, 12th, 24th, 48th, 72th week). Control group included 103 subjects with CHC without PEG-IFN-α. Results There was a significant increase in HAMD scores as early as in the 4th week of PEG-IFN-a therapy compared to baseline scores (38.8% vs. 24.3%). The peak of depressive symptomatology was detected in the 12th week (mean HAMD 9.34¤ 6.93), when a half of patients (49.5%) had HAMD above 7. At the end of the treatment (48th week), 38.8 % had HAMD above 7, and in the 72nd week (24 weeks without PEG-IFN-α), prevalence of depressive symptomatology was decreased to the values lower than at baseline (23.3% vs. 24.3%). The majority (28.2%) had mild depression, whereas moderate and severe depressive symptoms were found in 20.4% and 1%, respectively. No change in prevalence of depression was detected in control group. Conclusion Present study is the longest follow-up study of depressive symptoms as a side-effect of PEG-IFN-α in CHC. Our data yielded that the severity of the symptoms was mild to moderate and tends to decrease following therapy completion.