Vol 3, No 2 (2022)

BACKGROUND: Among the existing issues related to the health and quality of life of Russian adolescents, suicidal behavior is being actively discussed; however, the available comprehensive measures for prevention of suicide and attempts at suicide at this age do not provide an adequate solution. This is due to the fact that suicide is an integrative phenomenon, and the act of suicide itself is interpreted, in essence, as the “tip of the iceberg”. What is especially clearly manifested in adolescence is the fact that the readiness to commit suicide is associated not so much with the level of severity of mental pathology and personality dysfunction, but with the general social context lack of well-being of total trouble. Therefore, suicide prevention cannot be based purely on the timely identification of persons at risk for mental pathology.

AIM: The purpose of this work is to analyze the available literature on current approaches that have demonstrated their efficacy in reducing suicidal behavior in adolescents.

METHODS: The authors performed a narrative review of the relevant literature published between 2012 and 2021. They analyzed the works presented in the PubMed, MEDLINE, and Web of Science electronic databases. Descriptive analysis was used to generalize the data obtained.

RESULTS: The article discusses preventive approaches to suicidal behavior in adolescents, which are most often studied, and which are also used in practical healthcare. It outlines the problems associated with the implementation and evaluation of the efficacy of these preventive programs.

CONCLUSIONS: The continuing high rate of suicide among adolescents calls for an urgent concerted effort to develop, disseminate, and implement more effective prevention strategies. School-based approaches are the most convenient in practical terms, but they require systematic and long-term use of anti-suicidal programs. Digital interventions can reduce the economic burden of their use, including assessing suicidal risk and identifying psychopathology associated with suicidality.

BACKGROUND: Suicidality is a complex clinical phenomenon reflecting vulnerability to suicidal behavior which can be explained via the biopsychosocial paradigm and in relationship with a variety of country-specific factors. Data on suicides within the Russian population are inconsistent (from 11.7 up to 25.1 per 100.000), whereas the population’s suicidality risks have not been investigated in detail. Suicidality estimates during the multifactorial influence of the COVID-19 pandemic could serve as a basis to learn more about this mental health indicator.

METHODS: The current study is a part of the COMET-G international project (40 countries, n=55.589), which represents an analysis of data collected from Russia’s general population (n=7714, 33±12 y.o., 61% female) to estimate suicidality using the Risk Assessment Suicidality Scale (RASS) and its relationships with socio-demographic, clinical, and life-habit characteristics during the COVID-19 pandemic. The evaluation of the statistical data (descriptive statistics, ANOVA, LASSO linear regression, significant at α=0.05) was undertaken using TIBCO Statistica.

RESULTS: According to the RASS, at least 20.68%, and up to 29.15%, of the general population in Russia demonstrated increased risk of suicidality during the pandemic. Modelling these risks pointed to the key vulnerabilities related to mental and behavioral disorders, such as (i) current severe depression and a history of mental disorders, (ii) bipolar disorder, (iii) use of illicit drugs surprisingly outranking the alcohol misuse, and psychiatric compounds (hypnotics), highlighting sleep quality deterioration, (iv) a history of suicide attempts and self-harm — though not self-reported changes in depression — in response were predictors of the risk of suicidality, which can be explained by the phenomenon of “learned suicidality”, a habitual behavioral suicidality pattern completion accumulated over the background. Such (v) socio-demographic indicators as younger age (disregarding the gender factor), a marital status of single, having no children, living with fewer people in the household, a recent increase in family conflicts, increased need for emotional support, decreased need for communication, and not believing in precautionary measures against COVID-19, contributed to the increase of suicidality risk in the context of the pandemic.

CONCLUSIONS: The findings of this study revealed new suicide risk factors that should be taken into account in suicidality risk assessments for the Russian population and in the implementation of suicide prevention programs in the region.

BACKGROUND: Differential factors that influence intention and subjectively perceived fatality during non-fatal suicidal acts amongst men and women have rarely been explored in the extant literature. Exploring these factors may help to understand how they influence medical outcomes and may also be used in a post-crisis counselling. This study aims to assess factors influencing intent in relation to expected fatality during suicidal acts in men and women.

METHOD: In the current study, 433 individuals who attempted suicide (age 24.89±0.98 years, male/female ratio=1.29) were surveyed using the WHO-5 Well-Being Index, Beck Depression Inventory, Beck Suicide Intent Scale, Plutchik Feelings and Acts of Violence Scale, and Spielberger State/Trait Anger Scale. Life stress was evaluated as an accumulation of negative life events, whilst psychiatric disorders were assessed using CIDI 2.1 inventory.

RESULTS: It was found that the higher expected fatality was associated with higher suicide intention scores, whereas the medical severity of attempts and violent/non-violent attempts distribution did not differ between groups. Although there was no difference in suicide intent scores and medical severity between men and women, men demonstrated a 2.4–3.5 times higher proportion of violent attempts, depending on the group. Higher perceived fatality was associated with lower general well-being, higher depression and violence, hopelessness, and total life stress in men, whereas among women higher perceived fatality was only associated with total life stress. Moreover, in men and women, higher intent and expected fatality was associated with a differential set of negative life events that occurred during childhood. The prevalence of mental health disturbances in the entire sample was about 50% and equally distributed among men and women. However, addictions prevailed among men, while neurotic and stress-related disorders were more common among women. Among those who expected more fatality the number of people with diagnoses and comorbidity was higher, especially in men.

CONCLUSION: There is a difference in risk factors for expected fatality and intent in men and women attempting suicide, which may not necessarily result in severe medical outcomes but may help during the post-crisis counseling of suicide attempters. Expected fatality deserves more attention as a component of general intent. An in-depth study of this phenomenon may help to understand motives of men and women attempting suicide and help prevent future suicidal attempts.

BACKGROUND: The COVID-19 pandemic has affected the emotional state of a wide range of people around the world. Studying the social and psychological factors of psychological distress is required in the context of the pandemic in different countries. This study aims to explore the relationship between the emotional state of Russian citizens during the COVID-19 pandemic and their perceptions of it, and its dependence on various socio-demographic characteristics.

METHODS: A socio-demographic questionnaire, the Russian version of the Perceived Stress Scale, the State Scale from Spilberger State-Trait Anxiety Inventory, and the modified version of the Brief Illness Perception Questionnaire were used for the purposes of this study. The data was analyzed via descriptive statistics, ANOVA, Exploratory Factor Analysis, Correlation Analysis, Scale Consistency Analysis, and Structural Equation Modeling (Path Analysis Method).

RESULTS: The study sample consisted of 1192 Russian-speaking respondents. The findings suggest that psychological distress affects all components of the ideas about the pandemic. The "Psychological distress" variable positively influences the "Threat to life" and "Fear of an unknown disease" components of the ideas about the pandemic, whereas the "Control" component (ideas about the ability to control events) is ambivalent. On the one hand, the severity of psychological distress reduces the idea of being able to control events; on the other, the psychological distress experienced increases the feeling of threat and uncertainty, and stimulates the control of these feelings to be realized. In addition, significant differences were revealed in the nature of perceptions of the pandemic and psychological distress, as dependent on gender, age, type of employment, daily routine during self-isolation, income, as well as a fear of possible stigmatization with regard to COVID-19. It has been shown that underestimating the disease leads to improvement of psychological well-being. However, respondents who underestimated the danger of coronavirus paid less attention to the measures taken against the virus. If the respondent had relatives infected with COVID-19, they were found to perceive the COVID-19 pandemic as more threatening and less understandable.

CONCLUSIONS: Through assessing a level of threat and fear of an unknown disease, we defined that psychological distress has a direct and mediated influence on the feeling of control over the pandemic. However, the results on the role of psychological distress and perceptions of the COVID-19 pandemic, taken together, appear rather contradictory. Further research exploring additional predictors of psychological well-being and distress during the COVID-19 pandemic is required to provide solid conclusions.

BACKGROUND: The peak of the pandemic in Kyrgyzstan occurred in July 2020 with highest infection rates, almost 1000 cases daily, compared to 100 cases prior to this date. The state health system was fatally unprepared to accommodate patients, mobilize medical staff, or provide clear instructions to the population. This study explores personal narratives of healthcare practitioners who were affected by and survived COVID-19 during the “Black July” of 2020 in Bishkek, Kyrgyzstan.

METHOD: Healthcare workers (n=10) were interviewed using a semi-structured interview protocol. Interviews were transcribed then analyzed in accordance with interpretative phenomenological study guidelines.

RESULTS: The narratives demonstrated both post-traumatic depreciation and post-traumatic growth, resulting in changes of attitudes, lifestyle, and identity. An important aspect of identity shift included an emerging desire for increased self-care, which was characterized by resistance against a heroic Hippocratic ideal to “to save everybody”.

CONCLUSION: COVID-19 is perceived as a psycho-socio-cultural phenomenon, which has transformed the identities of healthcare workers in the Kyrgyz Republic. Further research is recommended into developing rehabilitation programs for healthcare workers.

The spread of the coronavirus infection has led to significant changes in people’s lives. Prolonged isolation, fear of infection, frustration, changing the usual stereotype life style, lack of information, loss of revenues, and fear of stigmatization, as well as the disease itself have all influenced people’s emotional and physical well-being. The impact of the viral infection itself on the human body, as well as the perception of a new reality, in some cases led to the formation of reactive, organic, or the exacerbation of existing chronic mental disorders. People with mental health problems are most susceptible to environmental influences and react acutely to rapidly changing circumstances. Often in critical situations, in a state of despair, patients see only one way to solve all problems — voluntary retirement committing taking own life. In this article, we present clinical cases that are descriptive in nature and are intended to illustrate the connection between depressive experiences and suicidal behavior amongst patients in a crisis situation when external circumstances were the reason for suicide attempts: loneliness as a result of restrictive measures, fear of infection or the disease itself, and the reason was a mental disorder that debuted earlier or re–emerged as a result of a viral infection. We have presented three clinical cases. All patients suffered from a new coronavirus infection of various severities and were treated in a psychiatric hospital, where they were transferred from an infectious diseases hospital or hospitalized directly in connection with suicidal actions. In each case, attention was paid to the organizational measures carried out, with an emphasis on the need for earlier screening of mental disorders, prevention of suicidal behavior in providing assistance to this contingent, and the development of the interaction between general medical and psychiatric services by the type of integrative care. The study is of interest to a wide range of specialists providing care to patients with COVID-19 or similar pathologies.

The article describes the experience of organizing psychological and psychiatric assistance to refugees in temporary accommodation centers (TACs). From 1999 to 2004, about 200,000 people, fleeing military operations during the counter-terrorist operation in the Chechen Republic, moved to neighboring Ingushetia, where they were placed in TACs. Analysis of the work with refugees shows that during a long stay in the TAC, refugees develop psychopathological and psychological issues including stress disorders, irritability, aggressiveness, disorders of adaptive functions, depression, anxiety, decreased initiative, "victim" complex, and damaged interpersonal relationships that significantly reduce their adaptive capabilities. Organizing comprehensive medical, social, psychological, and psychiatric care based on existing disorders can significantly improve the psycho-emotional state of refugees in a short time and prevent the aggravation and chronicity of these disorders.

Community psychiatry has its origins in the West, in the 1950s, when many institutions for the mentally ill were closed down in an effort to shift the focus from hospital-based care to community-based. The aim of the current paper is to review the available literature on the community-based psychiatric treatment in Romania.

The Romanian Ministry of Health is dedicated to promoting mental health education and to creating a mental health system that ensures that every patient has access to care and treatments designed for their own particular needs. Today, in Romania, as across the entirety of Central and Eastern Europe, mental health systems are transitioning from hospital-based care to community-based services. The RECOVER-E project, the SEE Mental Health Project, the “Horizons” project, among others, showcase Romania’s mental healthcare system in terms of improving the chances of mental health patients’ recovery.

Community Psychiatry in Romania is a budding field that can greatly aid in the management and treatment of patients with mental disorders from both urban and rural areas. By applying the principles of deinstitutionalization and community health care at a systemic level, resources may be invested in the creation of a strong network of specialists that treat patients in their own living spaces.

The COVID-19 pandemic greatly accelerated the use of online technologies for communication, as opposed to contact involving physical presence and touch. This commentary further considers the consequences of this change in individual human terms, in everyday as well as medical situations. It is a kind of discussion paper, specially written for this journal. It develops two directions of argument, the first about the reality of embodiment, the second about figures of speech involving touch and movement, figures of speech about the actions of whole people rather than about mind (spirit) or body separately. The discussion reviews the nature of differences between communication involving physical proximity and physical distance (and electronic media), with comments on the positive and negative aspects of each. An emphasis on the significance of touch (and movement, since all touch involves movement) to people is linked to the basic aspects of the lifecycle in birth, reproduction, and death. In conclusion, the discussion emphasizes the traditional importance of touch and physical participation to people’s feeling for reality. New digital forms of relations disturb this feel, with significant consequences.