Predictors of increased affective symptoms and suicidal ideation during the COVID-19 pandemic: results from a large-scale study of 14 271 Thai adults

Background Increasing data suggest emergent affective symptoms during the COVID-19 pandemic. Objectives To study the impact of the COVID-19 pandemic on affective symptoms and suicidal ideation in Thai adults. Methods The Collaborative Outcomes Study on Health and Functioning during Infection Times uses non-probability sampling (chain referring and voluntary response sampling) and stratified probability sampling to identify risk factors of mental health problems and potential treatment targets to improve mental health outcomes during pandemics. Findings Analysing 14 271 adult survey participants across all four waves of the COVID-19 pandemic in Thailand, covering all 77 provinces from 1 June 2020 to 30 April 2022, affective symptoms and suicidality increased during COVID-19 pandemic. Affective symptoms were strongly predicted by pandemic (feelings of isolation, fear of COVID-19, loss of social support, financial loss, lack of protective devices) and non-pandemic (female sex, non-binary individuals, adverse childhood experiences (ACEs), negative life events, student status, multiple mental health and medical conditions, physical pain) risk factors. ACEs, prior mental health conditions and physical pain were the top three risk factors associated with both increased affective symptoms and suicidal ideation during the COVID-19 pandemic. Partial least squares analysis showed that ACEs were the most important risk factor as they impacted most pandemic and non-pandemic risk factors. Clinical implications Rational policymaking during a pandemic should aim to identify the groups at highest risk (those with ACEs, psychiatric and medical disease, women, non-binary individuals) and implement both immediate and long-term strategies to mitigate the impact of ACEs, while effectively addressing associated psychiatric and medical conditions

Results of binary logistic regression analyses with amnestic mild cognitive impairment (aMCI) versus deficit or non-deficit schizophrenia as classes and 7 Consortium to Establish a Registry for Alzheimer’s disease (CERAD) tests as explanatory variables.

<p>Results of binary logistic regression analyses with amnestic mild cognitive impairment (aMCI) versus deficit or non-deficit schizophrenia as classes and 7 Consortium to Establish a Registry for Alzheimer’s disease (CERAD) tests as explanatory variables.</p

Neural network importance chart showing the relative and normalized importances of the Consortium to Establish a Registry for Alzheimer’s disease test scores as input variables predicting amnestic mild cognitive impairment versus nondeficit schizophrenia (output variables).

<p>BNTtotal: Boston naming Test, total score; WLM: Word List Memory; WLTRueRecall: Word List Recall, Delayed, true recall; WLRecognition: Word List Recognition, total score; WLFalse Recall: Word List Recall, Delayed, false recall; VFT: Verbal Fluency Test; MMSE: Mini Mental State Examination.</p

Results of Linear SVM and Random Forest Models.

<p>Results of Linear SVM and Random Forest Models.</p

Correlation matrix between the Consortium to Establish a Registry for Alzheimer’s disease test results and age and education in healthy controls.

<p>Correlation matrix between the Consortium to Establish a Registry for Alzheimer’s disease test results and age and education in healthy controls.</p

Results of multivariate general linear model analyses with the Consortium to Establish a Registry for Alzheimer’s disease (CERAD) tests results as dependent variables and diagnosis as primary explanatory variable, while adjusting for age, sex and education.

<p>Shown are the model-generated marginal means (SE) of the z-scores of all CERAD tests.</p

Episodic memory and delayed recall are significantly more impaired in younger patients with deficit schizophrenia than in elderly patients with amnestic mild cognitive impairment

<div><p>Background</p><p>Both amnestic mild cognitive impairment (aMCI) and schizophrenia, in particular deficit schizophrenia, are accompanied by cognitive impairments. The aim of the present study was to examine the cognitive differences between aMCI and (non)deficit schizophrenia.</p><p>Methods</p><p>Towards this end we recruited 60 participants with aMCI, 40 with deficit and 40 with nondeficit schizophrenia and 103 normal volunteers. Cognitive measures were assessed with the Consortium to Establish a Registry for Alzheimer’s disease (CERAD) using the Verbal Fluency Test (VFT), Boston Naming Test (BNT), Mini-Mental State Examination (MMSE), Word list memory (WLM), Word list recall (WLRecall) and Word list recognition (WLRecognition). Data were analyzed using multivariate analyses and machine learning techniques.</p><p>Results</p><p>BNT scores were significantly lower in aMCI as compared with nondeficit schizophrenia. Patients with deficit schizophrenia had significantly lower MMSE, WLM, WL True Recall and WL Recognition than aMCI patients, while WL False Recall was significantly higher in deficit schizophrenia than in aMCI. Neural network importance charts show that deficit and nondeficit schizophrenia are best separated from aMCI using total BNT score, while WLM and WL false Recall follow at a distance.</p><p>Conclusions</p><p>Patients with schizophrenia and aMCI have a significantly different neurocognitive profile. Memory impairments, especially in episodic memory, are significantly worse in younger patients with deficit schizophrenia as compared with elderly patients with aMCI, while the latter show more dysnomia than patients with schizophrenia.</p></div

Mean (SE) z scores of Consortium to Establish a Registry for Alzheimer’s disease tests in normal controls, nondeficit and deficit schizophrenia patients and patients with amnestic mild cognitive impairment (MCI).

<p>TrueWLRecall: Word List Recall, Delayed, true recall; FalseWLRecall: Word List Recall, Delayed, false recall (WL False Recall); CorrectWLRecognition: WL Recognition Correct Yes response; NoWLRecognition: Word List Recognition Correct No response; WLRecognition: sum of Correctand No WLRecognition.</p

Neural network importance chart showing the relative and normalized importances of the Consortium to Establish a Registry for Alzheimer’s disease test scores as input variables predicting amnestic mild cognitive impairment versus deficit schizophrenia (output variables).

<p>BNTtotal: Boston naming Test, total score; WLM: Word List Memory; WLFalse Recall: Word List Recall, Delayed, false recall; MMSE: Mini Mental State Examination; WLTRueRecall: Word List Recall, Delayed, true recall; VFT: Verbal Fluency Test; WLRecognition: Word List Recognition, total score.</p

Mean (SE) z scores of Consortium to Establish a Registry for Alzheimer’s disease tests in normal controls, nondeficit and deficit schizophrenia patients and patients with amnestic mild cognitive impairment (MCI).

<p>WLcorrect1: Trial 1 (WLM correct 1); WLcorrect2: Trial 2 (WLM correct 2); WLcorrect3: Trial 3 (WLM correct 3); WLM: Word List Memory, total score.</p