Objective: Traumatic childbirth may expose mothers to physical and psychological postpartum disorders. The reduced rate of exclusive breast feeding is an essential consequence of this problem. The goal of this study was to see if dialectical behavioral therapy could help with the onset and duration of exclusive breast feeding after a traumatic delivery.

Method: This clinical trial study included, 210 primiparous women with traumatic vaginal births were admitted to Bahar hospital in Shahroud. A standard protocol was designed and administered. The group allocation imbalance happened by chance and was averted by utilizing block randomization with a size of four and sequentially numbering the intervention or control groups with a sealed concealed envelope Participants in the intervention group had one individual session and four group counseling sessions by the researcher, while the control group participants obtained a routine care. Breast feeding self-efficacy was measured using a related questionnaire before the intervention, six and 12 weeks postpartum. Exclusive breast feeding was determined using a related form at the end of each month until the fourth month.

Results: The outcome of repeated measure ANOVA Before the intervention, based on the greenhouse geisser test indicated no statistically significant difference in breast feeding self-efficacy (P = 0.07) or infant weight between the two groups. (P = 0.98). Nevertheless, a statistically significant difference between the mean score of breast feeding self-efficacy and infant's weight was discovered by a post hoc test utilizing the Bonferroni correction, (P = 0.001) between the two groups after the intervention. Therefore, in the intervention group, the level of exclusive breast feeding was higher than in the control group, and four months after birth, more infants in the intervention group were exclusively breastfed (58% vs 32%) (P < 0.001). The analysis of data using the GEE model showed that the odds of adherence to exclusive breast feeding in the intervention group were 3.4 (0.95 CI: 2.04-5.7).

Conclusion: Dialectical behavior therapy is a powerful tool for minimizing the negative features of traumatic childbirth and increase the success of breast feeding mothers. Therefore, it can be used as a supportive method for mothers.

Objective: One of the difficult comorbidity of Obsessive-Compulsive disorder (OCD) to manage is bipolar disorder (BD). Results of previous studies on OCD-BD comorbidity may have been affected by different clinical definitions of OCD-BD, small or different sample sizes, different thresholds for including BD patients and different accuracies in OCD diagnosing. We tried to reduce limitations of previous studies and hypothesized that the OCD-BD group is a unique category and can be associated with greater levels of severity, episodic course of illness, more hostility and suicidal behaviors and different dimensions of OC symptoms.

Method: We compared 44 OCD-BD patients with 94 OCD patients who had completed at least a 24-month follow-up period. Clinical interviews and rating scales, and obtaining information from clinical charts were used to assess the patients. Life chartings of OCD and BD course were made for each patient and were categorized into four groups based on the clinical course of OCD.

Results: OCD-BD was characterized by a more continuous course, higher dysfunction, suicide and hostility scores. OC aggressive symptoms, having first-degree relatives with OCD and comorbidity of any anxiety disorders were associated with a reduction in odds of belonging to the OCD-BD group.

Conclusion: OCD-BD can be considered a unique category with greater morbidity and a more episodic course of OCD. Further research is recommended for exploring potential biological, social and psychological factors along with OCD-BD comorbidity.

Objective: The COVID-19 pandemic has been prolonged and healthcare workers have become exhausted. The purpose of this study was to investigate burnout and its relationship with mental health in COVID-19 frontline healthcare workers.

Method: This cross-sectional study was carried out in all hospitals where patients with COVID-19 were admitted in Hamedan, Iran. With the census method and considering the inclusion criteria, 924 COVID-19 frontline healthcare workers participated in this study. Data were collected using a web-based survey consisting of demographic characteristics, GHQ-28, and Maslach Burnout Inventory. Statistical analysis was performed using Stata 14.

Results: The results showed that the main cause of concern and stress in employees was that it was not clear how long this situation would continue. The results regarding burnout and mental health showed that 29.33% of participants were high in emotional exhaustion (EE), 10.93% were high in depersonalization (DP), 34.31% were low in personal accomplishment (PA), 50.4% had physical symptoms, 50.2% had anxiety and insomnia symptoms, 62.2% had social dysfunction and 17.5% had depression symptoms. The results of the multivariate logistic regression showed that EE had the greatest role in reducing mental health of employees with OR = 6.92 for moderate EE and OR = 39.42 for high EE (P < 0.001).

Conclusion: COVID-19 frontline healthcare workers are at risk for burnout and poor mental health. Health policies should be implemented to help reduce burnout in healthcare workers. Also, person-directed and organizational-directed interventions to rejuvenate these employees seem necessary.

Objective: The study of factors affecting anxiety and depression as the most common emotional disorders has always been at the forefront of psychological research. Among different factors, alexithymia and somatization have considerable importance due to their emotional nature with makes them more integrated with anxiety and depression. Several studies have demonstrated a link between these four concepts, but as far as we know, the quality of the relationship has not been addressed yet. The present paper aims to investigate the mediating role of somatization in the structural relationship of alexithymia with anxiety and depression.

Method: A total of 334 college students were recruited through cluster sampling and were asked to complete the Toronto Alexithymia Scale (TAS), Beck Depression Inventory – Second Edition (BDI-II), Beck Anxiety Inventory (BAI), and Somatization Subscale from the Symptom Checklist-90-Revised Questionnaire. Data were analyzed using correlational as well as structural equation modeling.

Results: Based on the correlation analysis, there was significant relationship between alexithymia, somatization, anxiety, and depression. According to the results of regression weights, there is a moderate relationship between alexithymia and somatization (regression weight = 0.44). The relationship between somatization and depression is at moderate level (regression weight = 0.42) and the relationship of somatization with anxiety is at strong level (regression weight = 0.85). the goodness of fit indices for the hypothetical model showed significant coefficients at P < 0.05 (CFI = 0.98, RMSEA = 0.059).

Conclusion: Findings indicated the important and influential role of somatization in explaining the relationship of alexithymia with anxiety and depression. Therefore, it seems that emotional components such as difficulty in identifying and expressing emotions as well as regulating mood states are important in the psychopathology of emotional disorders.

Objective: The coronavirus 2019 (COVID -19) pandemic had great psychological impact on COVID-19 patients and their families. Relatives of the deceased COVID-19 patients are at risk for complicated grief. Healthcare providers (HCPs) should be able to identify complicated grief cases. The aim of this study was to assess HCP knowledge regarding complicated grief during the COVID-19 pandemic.

Method: This cross-sectional study was conducted using an online researcher-made questionnaire. The questionnaire was designed and validated before being used in this study. The questionnaire included demographic questions as well as knowledge about complicated grief and its symptoms, risk factors and management. The link to the questionnaire website was sent to HCP governmental and private sectors. Data was analyzed using the ordinal regression model by the SPSS 16 software.

Results: A total of 887 HCPs (69% female and 31% male) participated in this study. Majority of the participants (594, 70%) had fair overall knowledge about complicated grief while 206 (23.2%) participants had poor knowledge. Poor knowledge level about risk factors for complicated grief was observed in 44.3% of the participants. Fair or poor knowledge about prevention and management of complicate grief was observed in 39.2% of participants. Knowledge about complicated grief had a significant positive relationship with female gender (OR: 1.55; 95% CI: 1.15-2.08) and higher education level (OR: 1.86; 95% CI: 1.37-2.54).

Conclusion: Knowledge of HCPs about complicated grief was low. There is need for HCP knowledge improvement regarding complicated grief by appropriate education.

Objective: Economic crisis and austerity has dramatic consequences for health care professionals’ mental health. This study aimed to investigate the prevalence of burnout syndrome among doctors working in public or private oncology departments in Greece and its association with factors determined by economic crisis.

Method: Medical or radiation oncologists who are members of the National Oncology Societies and practicing oncology at least for one year were enrolled in this study. An On-Line questionnaire consisting of the Maslach Burnout Inventory and an informative questionnaire was utilized.

Results: Eighty-six On-Line questionnaires waere analyzed. Radiation oncologists had significantly higher Depersonalization (DP), whereas medical oncologists had significantly higher Emotional Exhaustion (EE) scores. Registrars had higher scores compared to consultants in all subscales of the burnout syndrome. Factors such as ‘‘hospitals are not safe due to the lack or reductions in medical supplies and personnel shortage’’ and ‘‘receiving less than 50% of annual leave’’ were associated with significantly higher levels of EE. Factors such as ‘‘not afraid of moving abroad’’ and ‘‘receiving 100% of annual leave’’ were associated with significantly higher levels of low Personal Accomplishments (PA). The principal component analysis yielded three principal components: ‘future insecurity’, ‘feeling secure while working’ and ‘working conditions associated with burnout syndrome.

Conclusion: Several factors associated with austerity resulting from economic crisis significantly influenced prevalence of burnout syndrome among oncologists in Greece. Further studies need to be conducted to mobilize policy makers to develop and implement policies to improve oncologists' mental health.

Objective: Obsessive-compulsive disorder is associated with cognitive and motivational deficits caused by abnormal activities in certain neural circuits. This study sets out to determine the contribution of each component of executive function and reinforcement sensitivity in prediction of obsessive-compulsive symptoms.

Method: In this cross-sectional study, the study population consisted of all adult women living in Sabzevar city (Iran). Using cluster sampling, 365 women were selected as the study sample. Participants completed the Obsessive-Compulsive Inventory, Sensitivity to Punishment and Sensitivity to Reward Questionnaire - Revised and Clarified (SPSRQ-RC) as well as Behavior Rating Inventory of Executive Function (BRIEF). Data analysis was conducted using correlation and regression tests.

Results: The results of stepwise regression analysis showed that inhibition, shift and initiation variables as well as sensitivity to punishment and reward were best predictors of obsessive-compulsive symptoms (adjusted R square = 0.34, F = 38.93, P < 0.0001).

Conclusion: It seems that impaired executive functions in cognition and sensitivity to reinforcement in motivation contribute to the emergence or sustainability of obsessive-compulsive symptoms.

Objective: This study aimed to assess anxiety and depression during the COVID-19 outbreak among students aged 8 to 18 years and to determine related demographic and other related factors.

Method: A descriptive and analytical cross sectional study was conducted through web-based data collection which included 348 students aged 8 to 18 years in the state of Mazandaran, Iran during the first peak of COVID-19. Demographic and Revised Children's Anxiety and Depression Scale (RCADS-P) questionnaires were used to collect the data. The statistical tests including independent sample t test, ANOVA as well as linear regression were employed.

Results: The average age of the subjects was reported to be 12.2 ± 3.59 years. Age, father’s occupation, following COVID-19 related news, and also nervousness related to infection were predictors of anxiety (11%). Moreover, age, mother’s occupation, family communication and also the safety protocols practiced by the family were found to be predictors of depression in students (17%). A significant relationship was also found between the effect of quarantine on family communication and the anxiety and depression in students (P < 0.001).

Conclusion: Demographic characteristics affect student mental health during the COVID-19 outbreak. Moreover, family preventive protocols can predict depression in students aged 8 to 18 years. Better preventive precautions encourage less anxiety and depression.

Objective: Acknowledging the key role of hardiness, importance of health and its various dimensions, the present study aimed to investigate the simultaneous relationship between hardiness components and spiritual health, burnout, and general health, among Baqiyatallah University of Medical Sciences staff.

Method: 307 Baqiyatallah University of Medical Sciences’ staff in Tehran with at least five years work experience participated in this cross-sectional study using simple random sampling. Four questionnaires were used to evaluate the participants: the 28-item General Health Questionnaire (GHQ) to assess general mental problems with four subscales, 22-item Maslach Burnout Inventory (MBI) with two aspects (frequency and intensity) and three subscales of emotional exhaustion, depersonalization and personal accomplishment, the 20-item Spiritual Well Being Scale (SWBS) Questionnaire with two subscales of religious well-being and existential well-being and the 50-item Kobasa Hardiness Questionnaire to measure psychological hardiness with three subscales of control, commitment and challenge. At the end, two conceptual models which have shown effect of hardiness and its subscales on general health, Spiritual health and burnout were evaluated by path analysis.

Results: According to the path analysis results, it was found that hardiness and its subscales, which were approved by univariable and multivariable analyses, had significant relationship with general health (direct effect: -0.525, P < 0.001), spiritual health (direct effect: 0.555, P < 0.001) and burnout (direct effect of frequency aspect: -0.523, P < 0.001). Thus, by increasing hardiness and its subscales, spiritual health increases while symptoms of illness and burnout decrease.

Conclusion: Spiritual health increases as hardiness and its subscales increase as well; therefore, symptoms of illness and burnout decrease as hardiness and its subscales increase.

Objective: Bacillus-Calmette-Guerin (BCG) inoculation in mice produces an acute period of illness followed by a chronic depressive-like behavior period that lasts for few weeks. The aim was to evaluate vitamin B6 antidepressant effect in comparison with common antidepressants.

Method: BCG (0.2 ml/mouse) single dose was intraperitoneally inoculated in male mice. Vitamin B6 (100 mg/kg), fluoxetine, imipramine, or venlafaxine (10 mg/kg each) were intraperitoneally injected for 14 consecutive days following BCG administration. Illness was evaluated following inoculation and depressive-like behaviors were assessed on days 7 and 14.

Results: Illness was induced by BCG since mice lost weight and locomotor activity was reduced. Illness was prevented by vitamin B6 similar to antidepressant drugs. Despair was measured by immobility time during the forced swim test and BCG increased it compared to control (193 ± 3s vs 151 ± 7s, P < 0.01) on day 7, and (200 ± 5s vs 147 ± 6s, P < 0.001) on day 14. Vitamin B6, like antidepressants, reduced despair. BCG clearly induced anhedonia evaluated by sucrose preference test (47.5%), and it was soothed by B6 and the antidepressants. Novelty-suppressed feeding test evaluated long term depressive behavior after 14 days. BCG increased the latency to first feeding (222 ± 41s vs control 87 ± 2.6s, P < 0.001) and reduced food consumption per body weight (13 ± 1 mg/g vs control 19 ± 2 mg/g, P < 0.001) while B6 like antidepressants reduced latency and improved food consumption.

Conclusion: Vitamin B6 efficiently prevented BCG sickness and depression that was comparable to common antidepressant drugs. Therefore, B6 supplement for preventing depression in high-risk individuals is suggested for further clinical research.

Objective: The Coronavirus‑19 (COVID‑19) pandemic has perpetrated a significant mental health burden amongst health care workers (HCWs) and their families. Families of HCWs are at significant risk of various mental health problems due to concerns regarding the wellbeing of the HCW, fear of contacting the virus from HCWs, staying isolated during periods of quarantine and being the passive recipient of public stigma directed towards HCWs.

The objective of this study was to assess the perceived stress, resilience and coping tendencies of families of HCWs managing the COVID 19 crisis.

Method: A cross sectional study was conducted at a tertiary care hospital in India, where close relatives of 150 HCWs managing COVID-19 patients (directly or indirectly involved in patient care) were selected using systematic random sampling. They were evaluated using the Perceived Stress Scale, Brief Resilience Coping Scale, and the Hospital Anxiety and Depression Scale. Pearson’s correlation and Independent t-test were used for statistical analysis using the SPSS software.

Results: Majority (75%) of the family members associated with frontline HCWs had moderate to high level of perceived stress, while23% and 17% had clinically significant anxiety and depressive symptoms, respectively. More than 50% had low resilience and coping scores. High levels of stress, anxiety and depression were seen in female respondents, those less than 40 years old, having a child or an elderly family member and when the HCW had direct involvement in COVID-19 patient care.

Conclusion: Families of HCWs suffer from significant psychological burden due to the COVID-19 crisis. They face significant risk of depression and anxiety associated problems, which are augmented by low resilience and impaired coping. Mental health of HCWs and their family members should be given due attention with a focus on early identification, providing psychological support and improving resilience.

Objective: The aim was to explore the relationship between Night Eating Syndrome (NES) and experiencing Fear of Missing Out (FoMO) among college students in Oman.

Method: A descriptive, correlational and cross-sectional design was performed on 266 university students studying at Sultan Qaboos University in Oman. The data were collected using a demographic questionnaire, Night Eating Syndrome and Fear of Missing Out questionnaires. Data analysis was performed through Pearson correlation, One-way ANOVA and independent t-test using SPSS 24 software

Results: The participants’ ages ranged between 18 and 30 years (M = 21.15; SD = 1.97). The majority of the participants were female (204, 76.7%), single (266, 97.7%), and 152 (57.1%) lived on campus Overall, a weak positive and nonsignificant correlation between FoMO and NES and a significant difference between males and females in the mean score of FoMO (P = 0.005) was noticed. The mean score of NES among students who live on campus was higher than for those living off campus (P < 0.05).

Conclusion: This study explored a limited aspect of the relationship between fear of missing out and night eating behaviors among university students in Oman. There was no significant direct relationship between both variables. The study needs to be repeated using a larger sample size and more rigorous methods to calculate the number of snacks/day, and the number of meals/day

Objective: This study aimed to determine prevalence of anxiety and depression and associated factors in the general population of Iran during the COVID-19 pandemic.

Method: We conducted this web-based cross-sectional study on 5328 individuals in Iran between 17th and 29th of April 2020. Data were collected using the convenience sampling method through an anonymous online questionnaire via social media like WhatsApp and Telegram. The online survey collected data on demographic variables, COVID-19-related variables, and symptoms of anxiety and depression. Anxiety and depression were assessed using the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9), respectively. Simple and multiple logistic regression analyses were performed to determine independent predictors of anxiety and depression.

Results: The mean GAD-7 and PHQ-9 total scores were 7.17 (SD = 5.42) and 7.80 (SD = 6.68), respectively. Prevalence of anxiety, depression, and comorbid anxiety-depression were 30.1%, 33.4%, and 22.1%, respectively. According to the adjusted analysis, anxiety was significantly associated with female gender, being young and middle-aged, being unemployed or a housewife, having chronic diseases, spending considerable time thinking about COVID-19, having family members, friends, and/or relatives infected with COVID-19, and death of family members, relatives or friends due to COVID-19. Same results were also found for depression. Furthermore, depression was associated with being single, being resident in urban area, and having high risk individual in family.

Conclusion: Prevalence of anxiety and depression were considerably higher in the general population of Iran during the COVID-19 pandemic. In addition, the findings suggest that more attention needs to be paid to vulnerable groups such as women, young/middle-aged adults, the unemployed, and people with chronic disease.

Objective: Charles Bonnet Syndrome (CBS) consists of visual hallucinations occurring in patients with visual impairment. CBS is commonly overlooked by medical professionals and underreported by patients due to the underlying stigma attached to the presence of hallucinations. Lack of awareness regarding CBS among medical professionals may lead to failures in providing forewarning and education to patients with visual impairment. In patients who are not familiar with CBS, this might lead to a higher risk of distress, misattribution to cultural belief or mental illness, and the potential of developing psychosis, especially in elderly patients with other modalities of sensory deprivation. This case report aims to increase awareness and knowledge about CBS among clinicians for the proper management of patients.

Method: This case illustrated a patient with worsening visual impairment who presented with typical CBS and later progressed to visual hallucination and persecutory delusion

Results: Providing information on CBS and antipsychotics resulted in less distress and improved the patient’s visual hallucination and delusion

Conclusion: Education and reassurance play a role in the management of CBS. It is important for medical professionals to be aware of CBS and provide clear information for patients who are at risk to lower their distress.

Objective: Synesthesia is a unique experience with an unclear mechanism. The clinical condition usually presents when a sensation stimulates other senses. While more than 150 types of synesthesia have been reported; however, some types are considered uncommon, and co-occurrence of these rare types of synesthesia are rare. In the present report, we described a case of synesthesia with experience of pain and orgasm in color.

Method: A 31-year old healthy male presented with visual equity changes during orgasm. In addition, he described a color-pain sensation every time he experienced severe chest pain during his childhood. None of these sensations negatively affected his daily or sexual life. Based on the patient’s history, a possible diagnosis of synesthesia was made and further clinical evaluations were performed.

Results: The patient did not have any color vision abnormalities or problems in solving Hooper visual organization test, bells test, Rey complex figure test, card sorting test, and Trail making tests. The Brief Male Sexual Inventory did not reveal any sexual dysfunction. Therefore, regarding the patient's experiences without any visual disturbance and absence of any underlying diseases, the diagnosis of synesthesia was made.

Conclusion: The present report demonstrates coexistence of a rare form of synesthesia as orgasm to color with specific pain to color synesthesia. In contrast to previous reports, our case demonstrated color orgasm as a type of synesthesia that might not negatively affect sex life in men.