BACKGROUND:Suicidal ideation is a significant, often overlooked, concern in dermatology. Individuals with skin diseases frequently experience psychological distress, including depression, anxiety, stigma and dissatisfaction with appearance, all of which are known risk factors for suicidality. Despite this, large-scale multicentre data across different dermatological conditions in Europe remain scarce. OBJECTIVES:To determine the prevalence of suicidal ideation among dermatological outpatients across Europe and to identify sociodemographic, clinical and psychological factors associated with general and skin-related suicidal ideation. METHODS:This cross-sectional multicentre study included adults with dermatological conditions from 22 outpatient clinics in 17 European countries. Suicidal ideation was assessed through questions on lifetime suicidal thoughts and their attribution to skin disease. Sociodemographic, socio-economic and clinical variables were collected, together with psychological indicators: depression (PHQ-2), anxiety (GAD-2), perceived stigmatization (PSQ) and satisfaction with appearance. Group comparisons were conducted using chi-square tests, t-tests and ANOVA. Multivariable logistic regression identified independent predictors of suicidal ideation. RESULTS:Among 5386 respondents, 13.7% reported suicidal ideation and 7.0% attributed it to their skin condition, compared with 8.4% in controls. Prevalence varied across subgroups, being higher in younger participants, single individuals, those reporting low income, stressful events or economic difficulties. Higher rates were also associated with underweight BMI, greater disease severity, presence of flares and symptoms such as itch or burning. Psychodermatological conditions, hidradenitis suppurativa, hyperhidrosis, atopic dermatitis, chronic prurigo and psoriasis showed the highest prevalence. In multivariable analysis, independent predictors included younger age, being single, low BMI, stressful events, depression, anxiety, high stigmatization and dissatisfaction with appearance. CONCLUSIONS:Suicidal ideation is elevated in European dermatology patients and is strongly associated with psychological distress, socio-economic vulnerability and negative body perception. Routine screening for mental health symptoms and suicidal ideation should become a standard component of dermatological care to ensure early identification and support of at-risk individuals.

Introduction Individuals with co-occurring mental health and substance use disorders (MHD/SUD) often face exclusion, double stigma, and challenges in their daily lives. Virtual Reality (VR) has been used in the treatment of substance use and mental health issues, but little is known about the target groups’ behaviour and attitudes towards this technology and how it may be useful in addressing marginalization. Objectives To explore, develop, and evaluate the potential of using VR in the recovery process for individuals with MHD/SUD to enhance their social participation and improve quality of life. Methods The study is interdisciplinary and multisectoral and consists of three phases which built upon each other and follow the VR-CORE-framework: In phase 1, in-depth interviews were conducted with MHD/SUD-patients, focus groups with healthcare providers, and an interview survey with 100 MHD/SUD-patients to explore barriers and facilitators for social participation. In phase 2, we used these data to co-create with users a VR intervention, which was pre-tested among the target group. The final phase is a two-arm, statistician-blinded, pragmatic, multi-cite, randomized controlled trial (RCT), where we are testing the effect of the VR intervention versus standard treatment among MHD/SUD-patients in specialized addiction treatment. Primary outcome is general functioning, measured by the World Health Organization Disability Assessment Scale (WHODAS) 2.0 at 6 months post-intervention. Results Based on the exploratory studies in phase 1, a VR intervention was developed in phase 2, resulting in three learning modules addressing social cognition, social communication skills, and social competence. The pre-test indicated that VR could provide an opportunity for MHD/SUD patients to practice social skills in a protected environment. The RCT is still ongoing, see CONSORT flow diagram (Figure 1). Conclusions The expected results will have implications for the quality of life of individuals with MHD/SUD, including other marginalized groups. Offering VR may have positive effects on the delivery of healthcare services to groups that are otherwise hard to reach, and it may also have economic implications by making more resources available to expand services for those in greatest need. Disclosure of Interest None Declared

The COVID-19 pandemic has had a profound impact on mental health globally, exacerbating existing mental health disorders (MHD) and substance use disorders (SUD). Various measures have been implemented to mitigate these adverse mental health consequences. Nevertheless, the significant rise in mental health challenges has underscored the role of psychotropic drug prescriptions as an important metric for assessing mental health trends in certain populations. During the pandemic, data from high-income countries, indicate an increase in the prescription of psychotropic drugs. This might reflect heightened mental health needs in the general population, but also may underscores the exacerbated vulnerability of individuals with pre-existing concurrent MHD/SUD. Prescribing psychotropic drugs can be complex due to the potential for misuse and the need for careful monitoring to balance therapeutic effects with the risks. This study aimed to evaluate 1) the number of prescriptions of psychotropic drugs in persons with concurrent MHD and SUD in the years before and during the two COVID-19 pandemic years (2020 and 2021) and 2) to study the impact of the COVID-19 pandemic on the consumption of psychotropic drugs among this population. We conducted a retrospective cohort study based on a data file constructed by merging individual-level information from the Norwegian Patient Register and the Norwegian Prescribed Drug Registry, analysing data from 2019-2021. The International Classification of Diseases (ICD)-10 main diagnosis, chapter V have been used to identify persons with MHD/SUD. We recognised 35.000 individuals who received a diagnosis of co-occurring MHD/SUD between the years 2019-2021. A graphical approach and descriptives were applied to study the population. Interrupted time series analysis was used to compare changes in trends in the prescriptions dispensed by eight psychotropic drug classes, according to the consecutive COVID-19 waves during the first two years of the pandemic. Preliminary analysis show, an increased prescription rate in all eight psychotropic drugs classes in persons with MHD/SUD during the first two years of the pandemic, compared to 2019. The largest increases were shown to appear parallel with the COVID-19 waves. Antipsychotics and anxiolytics were the most prevalent prescribed drugs, followed by opiates, hypnotics & sedatives and antidepressants. Being female and older age was associated with higher odds of receiving a prescription, regardless psychotropic drug class. The prescription of psychotropic drugs has gradually increased from 2019-2021. More research is needed to differentiate increases due to unmet needs versus overprescribing and further, to study the long-term effects of the pandemic regarding the utilization of psychotropic drugs in this vulnerable patient group. None Declared

BACKGROUND:Anxiety, depression and suicidal ideation are frequent in patients with chronic prurigo (CPG). OBJECTIVE:To analyze perceived stress, stigmatization, body dysmorphia, anxiety, depression and itch-related quality of life in CPG patients and compare them to controls, and then to identify variables/predictors of them. METHODS:This study is part of a cross-sectional multicenter study in 17 European countries including 5487 consecutive patients and 2808 controls. RESULTS:One hundred twenty-seven individuals with prurigo were included in the analyses. They reported higher levels of stress, stigmatization, and body dysmorphia than controls. In the patient group, stigmatization was associated with higher stress and having a severe disease, stress with younger age and lower income, depression and anxiety with lower income and higher itch intensity, body dysmorphia with younger age, and dissatisfaction with appearance. LIMITATIONS:CPG patients were older than controls and had significantly more comorbidities. However, multivariate analysis allowed controlling for these differences by including them as a covariate. CONCLUSION:CPG patients have high levels of perceived stress, perceived stigmatization and body dysmorphic, which are partly related to sociodemographic factors like younger age or lower income as well as to other psychological and disease-related factors.

BackgroundItch as the most common symptom in dermatology has been shown to be related to psychological factors such as stress, anxiety and depression. Moreover, associations were found between perceived stigmatization and itch. However, studies investigating the differences between patients with dermatoses with and without itch regarding perceived stress, stigmatization, anxiety and depression are missing. Therefore, one of the aims of the second study of the European Society for Dermatology and Psychiatry (ESDaP study II) was to investigate these relationships in a large cohort of patients with different itchy dermatoses.Results3399 patients with 14 different itchy dermatoses were recruited at 22 centres in 17 European countries. They filled in questionnaires to assess perceived stigmatization, stress, signs of clinically relevant anxiety or depression, itch-related quality of life, the overall health status, itch duration, frequency and intensity. The most significant association between the severity of itching and the perception of stress was observed among individuals with rosacea (correlation coefficient r = 0.314). Similarly, the strongest links between itch intensity and experiences of stigmatization, anxiety, and depression were found in patients with seborrheic dermatitis (correlation coefficients r = 0.317, r = 0.356, and r = 0.400, respectively). Utilizing a stepwise linear regression analysis, it was determined that within the entire patient cohort, 9.3% of the variation in itch intensity could be accounted for by factors including gender, levels of anxiety, depression, and perceived stigmatization. Females and individuals with elevated anxiety, depression, and perceived stigmatization scores reported more pronounced itch intensities compared to those with contrary attributes.ConclusionThis study underscores the connection between experiencing itch and its intensity and the psychological strain it places on individuals. Consequently, psychological interventions should encompass both addressing the itch itself and the interconnected psychological factors. In specific cases, it becomes imperative for dermatologists to direct individuals towards suitable healthcare resources to undergo further psychological assessment.

Abstract Background Today’s adolescents dedicate a significant portion of their time to screens. Concerns have arisen regarding the lasting impact of screen use on adolescent health, making it a crucial public health topic. Previous studies have presented both positive and negative outcomes associated with screen use. Further insight is required into various forms of screen use and the influence on adolescent health. The objective of this study is to examine the relationship between gaming, social media use, psychological distress, and sleep among adolescents. Methods This study is based on cross-sectional data from the Ung-HUNT4-study, a health study conducted among adolescents 13-19 years old in Trøndelag municipality in Norway from 2017-2019 (n = 8066). Binomial logistic regression was used to analyse the association between gaming, social media, psychological distress and sleep. Analysis was controlled for gender, age, family economy and having friends. Results Preliminary results showed that the odds for having psychological distress were higher for those who spent more than 3 hours on social media after school (OR: 1.31, 95% CI: 1.10-1.57), and on weekends (OR: 1.45, 95% Cl: 1.22 - 1.73), and on gaming in weekends (OR:1.30 Cl: 1.08-1.55) compared to those who spent 3 hours and less. The odds for sleeping < 8 hours per day on weekdays were higher for those who spent more than 3 hours on gaming after school (OR: 1.27 Cl:1.07-1.52), and more than 3 hours on social media after school, (OR:1.41 Cl:1.20-1.67) or on weekends (OR:1.39 Cl: 1.19-1.62), compared to those who spent 3 hours or less. Conclusions More than 3 hours spent on social media after school and on weekends was associated with significantly higher odds for psychological distress and less sleep on weekdays. More knowledge about the impact of different types of screen use on adolescents’ health is needed, and new public health strategies to secure safe screen use should be developed. Key messages • Screen use is associated with psychological distress and less sleep. • Awareness on various types of screen use and its influence on health in adolescence, is important in public health policy and practice.

BackgroundDysmorphic concern is an overconcern with an imagined or slight defect in physical appearance that can be a symptom of body dysmorphic disorder (BDD). Appearance-related concerns are frequently reported by people with dermatological conditions. However, relatively little remains known about the relationship between dysmorphic concern and other variables within persons with different skin conditions.ObjectivesThe aim of this multicentre, cross-sectional study was to investigate gender differences regarding dysmorphic concern and the prevalence of BDD in a large sample of patients with skin conditions, in relation to sociodemographic, clinical and psychological variables.MethodsParticipants aged >= 18 years with skin conditions were consecutively enrolled in dermatological clinics of 22 European centres. Dysmorphic concern and the possible presence of BDD were measured using the Dysmorphic Concern Questionnaire (DCQ) and compared between men and women in relation to sociodemographic, clinical and psychological variables, and separately for each skin condition.ResultsThe DCQ questionnaire was completed by 5290 dermatological patients. In all categories, mean scores were significantly higher in women than in men. Mean DCQ scores were also higher in women for most skin conditions, with the highest effect size in vitiligo. The percentage of patients who screened positive for BDD on the DCQ was 10.5%, 7.7% of men and 12.7% of women. The prevalence of BDD positive was 6.9% in patients with mild clinical severity, 11.1% for moderate and 19.1% for severe condition. In the multivariate model in patients with mild skin condition, the presence of BDD was positively associated with stress and stigma both in men and in women.ConclusionsDysmorphic concern and BDD were more frequent in women than in men with skin conditions. Both received and actual stigmatization might have an impact on body-related concerns, in particular in women, who may be more at risk for sociocultural reasons. image

Abstract Background The use of screens, especially mobile devices like tablets and smartphones have increased over the last years and have become an integrated part of modern life. Adolescents today spend a lot of their time using screens both at school and outside school. Identifying how screen use are related to QoL is necessary to plan effective policies and interventions in adolescence since it is the period where different behaviours are adopted. The purpose of this study is to examine the association between electronic media use and quality of life (QoL) among adolescents. Methods This study was based on self-reported cross-sectional data from the Young-Hunt4 study, conducted in 2017-2019. The target group comprised 8066 13-19 years old adolescents. QoL was measured with the Norwegian version of the Inventory of Life Quality (ILC). The ILC scale consists of seven items with four response alternatives. Electronic media use was measured using the two variables Social media use and Gaming. Multiple linear regression was used to analyse the association between gaming, social media use and QoL. Results Preliminary results showed an inverse association between gaming (>3 hours per day) after school and quality of life (β: -.07, p < 0.001) and social media use (>3 hours per day) after school and quality of life (β = -.06, p < 0.001). Similar inverse associations were observed between gaming (>3 hours per day) in the weekend and quality of life (β: -.09, p < 0.001) and social media use (>3 hours per day) in the weekend and quality of life (β = -.04, p = 0.002). These associations remained significant after controlling for gender, age, family economy, psychological distress and having friends. Conclusions More than three hours on screens per day after school was negatively associated with QoL. Hence, public health policy and practice should pay attention to consequences of screen time use in adolescence. Additional research is needed to further explore these associations. Key messages • More frequent use of electronic media is negatively associated with QoL. • Public health policy and practice should pay attention to screen time in adolescence and its association with QoL.

Social media are an integral part of adolescents' daily lives, and reviews have suggested an overall small association between more social media use and mental health problems. However, researchers have commonly investigated social media use in a time use perspective, rendering nuances in adolescents' social media experience less well explored. Thus, studies of relationships between social media use and mental health problems need also examine the nature of the events taking place on social media. This study aimed to examine depressive symptoms in adolescents in relationship to time spent on social media, negative social media-related experiences, and general self-efficacy. Data collected in a national survey, Ungdata 2021 (n = 139,841), was used. Multivariate linear regression analyses showed that time spent on social media was associated with depressive symptoms (β = 0.09, p < 0.001). However, negative social media-related experiences were more strongly associated with depressive symptoms (β ranging 0.09–0.22, all p < 0.001), and their inclusion weakened the initial association between time on social media and depressive symptoms. General self-efficacy was directly associated with lower symptom levels (β = −0.29, p < 0.001) but did not change the associations between social media use and depressive symptoms. The findings imply that not only time spent on social media, but in particular negative social media-related experiences, are related to depressive symptoms in Norwegian adolescents. General self-efficacy is an important resource for adolescents' mental health.

Abstract Background More in-depth evidence about the complex relationships between risk and protective factors and mental health among adolescents has been warranted. Thus, the aim of the study was to examine the direct and indirect effects of experiencing pressure, bullying, and low social support on depressive symptoms and self-directed violence in adolescence. Methods A cross-sectional study was conducted in 2022 among 15 823 Norwegian adolescents, aged 13-19 years. Structural Equation Modelling was used to assess the relationships between socioeconomic status, pressure, bullying, social support, depressive symptoms, self-harm and suicide thoughts. Results Poor family economy and low parental education predicted high pressure, bullying, low parental support and depressive symptoms in males and females. Further, high pressure predicted depressive symptoms among males and females, and self-harm and suicide thoughts among females, but not males. Bullying predicted depressive symptoms, self-harm, and suicide thoughts among males and females. Low parental support predicted bullying, depressive symptoms, self-harm and suicide thoughts among males and females, and high pressure among females, but not males. Low teacher support predicted high pressure, depressive symptoms, whereas low friends support predicted bullying, depressive symptoms and suicide thoughts among males and females, and self-harm among males, but not females. Results also showed that depressive symptoms predicted self-harm and suicide thoughts among males and females. Finally, pressure, bullying and depressive symptoms were the main mediators by which family economy, parental education, friends support, teacher support and parental support predicted self-harm and suicide thoughts. Conclusions Low socioeconomic status, pressure, bullying and low social support were important predictors of depressive symptoms and self-directed violence among Norwegian adolescents through direct and indirect mechanisms. Key messages • These results also provide increased knowledge about how multiple risk and protective factors across domains impact both depressive symptoms, self-harm and suicide thoughts among adolescents. • This study highlights the importance of policies aiming at reducing economic and social inequalities, as they may also improve youth mental health.

Social media are an integral part of adolescents' daily lives, and reviews have suggested an overall small association between more social media use and mental health problems. However, researchers have commonly investigated social media use in a time use perspective, rendering nuances in adolescents' social media experience less well explored. Thus, studies of relationships between social media use and mental health problems need also examine the nature of the events taking place on social media. This study aimed to examine depressive symptoms in adolescents in relationship to time spent on social media, negative social media-related experiences, and general self-efficacy. Data collected in a national survey, Ungdata 2021 (n = 139,841), was used. Multivariate linear regression analyses showed that time spent on social media was associated with depressive symptoms (β = 0.09, p < 0.001). However, negative social media-related experiences were more strongly associated with depressive symptoms (β ranging 0.09–0.22, all p < 0.001), and their inclusion weakened the initial association between time on social media and depressive symptoms. General self-efficacy was directly associated with lower symptom levels (β = −0.29, p < 0.001) but did not change the associations between social media use and depressive symptoms. The findings imply that not only time spent on social media, but in particular negative social media-related experiences, are related to depressive symptoms in Norwegian adolescents. General self-efficacy is an important resource for adolescents' mental health.

Le retentissement du prurigo sur la qualité de vie est majeur et les conséquences psycho-sociales importantes. L’objectif de cette étude était d’évaluer le stress, la stigmatisation et la dysmorphophobie chez les patients atteints de prurigo chronique. Une étude observationnelle multicentrique a été menée dans 17 pays européens. Tous les patients consultant dans des centres spécialisés, ainsi que des sujets témoins, ont complété différents questionnaires concernant notamment l’apparence corporelle, les idées suicidaires, le stress (Perceived Scale Stress-10), la dysmorphophobie (Dysmorphic Concern Questionnaire) et la stigmatisation (Perceived Stigmatization Questionnaire). Un total de 2808 témoins sans dermatose et 5487 patients avec une dermatose ont été inclus, dont 127 patients avec un prurigo. Les patients avec un prurigo avaient en moyenne 54,7 ans et étaient en majorité des femmes (59,1 %). Leurs caractéristiques sont présentées dans le tableau 1. Les patients étaient « assez insatisfaits » (13,5 %) ou « insatisfaits » (8,7%) de leur apparence corporelle, ce qui était supérieur aux déclarations des témoins (p = 0,006 et p < 0,0001, respectivement). 31,7% des patients ont déclaré avoir eu des idées suicidaires liées à leur dermatose. Les patients avec un prurigo étaient plus stressés que les témoins, avec un score moyen supérieur de 2,81 points sur 40 [1,64 ; 3,99] (p < 0,001). La dysmorphophobie était présente chez 9,6 % des patients avec un prurigo vs 2,1 % des contrôles (p < 0,001). Le score moyen de stigmatisation était plus élevé de 0,122 point sur 5 [0,046 ; 0,198] chez les patients avec un prurigo (p < 0,01). Les scores des patients avec prurigo ont ensuite été comparés à ceux observés dans d’autres dermatoses inflammatoires: dermatite atopique (n = 352), psoriasis (n = 1404), urticaire (n = 173) et hidradénite suppurée (n = 142). Concernant la stigmatisation, le score total moyen était inférieur chez les patients avec un prurigo par rapport aux patients atteints de psoriasis (−0,167 [−0,278; −0,057] (p < 0,01)) mais supérieur à celui des patients ayant de l’urticaire (0,133 [0,012 ; 0,277] (p = 0,037)). Aucune différence significative n’a été observée pour le stress et la dysmorphophobie. Il s’agit de la première étude s’intéressant au niveau de stress, à la stigmatisation et à l’association à une dysmorphophobie chez les patients atteints de prurigo chronique. Des études antérieures ont montré des taux plus élevés d’anxiété, dépression, idées suicidaires, que dans la population générale mais aussi que de nombreuses dermatoses. Cette étude montre que le stress, la stigmatisation et la dysmorphophobie sont plus fréquents chez les patients atteints de prurigo que chez des sujets sans dermatose, et que le taux est comparable aux autres dermatoses inflammatoires fréquentes. L’impact psychosocial du prurigo sur les patients pouvant avoir de lourdes conséquences sur le statut social, les interactions avec autrui, le bien être émotionnel ou encore sur l’estime de soi, l’évaluation du poids de ce fardeau a toute sa place lors de la prise en charge du patient.

Abstract Background The recent invasion of Ukraine has forced millions of civilians, especially women and children, to leave their country. Although the European Union offers guidance on individual health assessment of refugees fleeing the war in Ukraine, assessment practice varies across host countries and even on national basis. Thus, the aim of this project was to identify and prioritize procedures for mental health assessment of Ukrainian refugee minors in Norway. Methods This project applied a modified three-round-Delphi method. In a first step, the leading public health nurse and community physician in 40 municipalities across Norway were contacted via e-mail and asked to state who is in charge of health assessment, what is current assessing practice and what are the problems and needs. Answers were analysed and condensed and will be presented for rating in a second and third round. Results Preliminary results from the first round suggest that most municipalities are currently in a planning phase with uncertainties surrounding who and how future assessments will be done. Public health nurses or general practitioners are often in charge of health assessments, but it is unclear if this includes age-adjusted mental health assessments. Conclusions Preliminary results show that current practice in assessing mental health and psychosocial support for Ukranian refugee minors in Norway is very diverse. There is a need to evaluate and prioritize current procedures to assure an equal and age-adjusted procedures for all refugee minors, regardless of where they have resettled. Key messages

Abstract Background Climate change has a great impact on the future of children and young people. Since the global climate strike movement, many adolescents expressed worries about climate change. But do these worries lead to declined mental health and future optimism? Thus, we aim to explore associations between prevalence of worries about climate change, leisure activities and mental health problems in a representative sample of Norwegian adolescents. Methods In 2021, the youth survey Ungdata collected data from 139,841 Norwegian adolescents, which corresponds to a response rate of 75%. Descriptive analysis was used to calculate the prevalence of worries about climate change cannabis use and bi- and multivariate logistic regression analysis to examine the association between worries about climate change and mental health, leisure activities and alcohol and cannabis use, controlled for sociodemographics. Results Around 37% of Norwegian adolescents are worried about climate change. Worries increased with age and are more prevalent among girls. There is a relationship between mental health problems and worries about climate change (OR = 1.80 (CI:1.75-1.86)) still after adjusting for sociodemographic variables, leisure activities and alcohol and cannabis use (OR = 1.71 (1.10-1.42)). Conclusions The results indicate a real connection between mental health problems and worries about climate change, but the causal relationship needs further study. This knowledge makes it important for all profession, working with adolescents, paying special attention to possible negative effects of worries about climate change on the mental health of young people. Key messages • Worries about climate change has an impact on mental health of young people. • Adolescent’s worries about climate change should be taken seriously.

Body dysmorphic disorder (BDD) is a common psychiatric disorder associated with high costs for healthcare systems as patients may repeatedly ask for different, often not effective, interventions. BDD symptoms are more prevalent in patients with dermatological conditions than in the general population, but there are no large sample studies comparing the prevalence of BDD symptoms between patients with dermatological conditions and healthy skin controls.

Abstract Background The COVID-19 pandemic with its restrictions touched the daily life of most people. While everyday social life becomes difficult for citizens with economic and cultural capital, it becomes even worse for persons with mental health (MHD) and substance use disorders (SUD), who are particularly vulnerable to social exclusion. In this project, we aim to explore the impact of the pandemic on persons MHD/SUD, nearer, how the lockdown effected their daily life and further, the utilization of health care services under the consecutive waves of the pandemic. Methods The project has two parts: First we conducted 17 individual interviews and one focus group with persons with MHD/SUD, using thematic analysis. Second, we merged the Norwegian Patient Register, the Register for Infectious Diseases and data from Statistics Norway. We matched data of 41500 individuals with MHD/SUD after gender, age and health region with a sample from the general population as a control group and study the health care service utilization under the consecutive waves of the pandemic in Norway in 2020-2021. Results Within the qualitative study, we identified four interrelated main themes: (1) The COVID-19 outbreak as a perceived challenge, (2) A decline in mental health and well-being, (3) Increased substance use challenges, and (4) Diverse experiences with health and social services. The results show further that people with MHD/SUD have challenges with digital tools and/or do not have the appropriate equipment. Persons with MHD/SUD face greater barriers in accessing the health care system compared to the general population as a control group. Results of the register study are still preliminary. Conclusions Persons with MHD/SUD face major challenges during the COVID-19 pandemic There is reason to believe that new pandemics will emerge in the future. In this context, it is essential to gain knowledge of how to care for vulnerable groups in society and how to reach them in emergencies. Key messages • Continuous maintenance of low-threshold services for persons with MHD/SUD during a pandemic is essential. • Improvement of digital skills of service users or alternatives to digital consultations should be considered.

BACKGROUND:Hair diseases play an important burden on patients' lives, causing significant emotional and psychosocial distress. However, the impairment due to different hair conditions, such as alopecia areata (AA) and androgenetic alopecia (AGA), has rarely been compared. OBJECTIVE:The aim of this study was to assess the psychological burden of subgroups of patients with different hair diseases and to compare them to a healthy population. METHODS:In this study, we analysed a subgroup of patients with hair diseases from patients of a large multicentre study including 3635 dermatological patients and 1359 controls from 13 European countries. In the subgroup of patients with hair diseases, we analysed the socio-demographic characteristics, the stress level, and the impact of hair diseases on quality of life (QoL), anxiety, and depression and we compared them among patients with AA, AGA and healthy controls. RESULTS:The study population included 115 patients (77% women, 23% men) with hair diseases, 37 of whom with AA and 20 with AGA. Patients with hair diseases had a lower education level than healthy controls (medium educational level: 43% vs. 28%). Overall, 41% of the patients reported stressful life events during the last 6 months compared with 31% of the controls. Patients with the same age, sex, depression level and comorbidities had a worse QoL when suffering from AA than from AGA (Mean Dermatology Life Quality Index score: 5.8 vs. 2.5). CONCLUSION:Patients with hair diseases are more anxious, depressed and have a lower QoL than controls.

Coronavirus disease 2019 (COVID-19) is spreading rapidly around the world with devastating consequences on patients, healthcare workers, health systems, as well as economies. While, healthcare systems are globally operating at maximum capacity, healthcare workers and especially anesthesia providers are facing extreme pressures, something that is also leading to declining availability and increasing stress. In this regard, it is extremely concerning the fact that some regions worldwide have reported up to 20% of their cases to be healthcare workers. When considering that the global case fatality rate may be as much as 5.4%, these numbers are concerning and unacceptable. As this pandemic accelerates, access to personal protective equipment for health workers is a key concern since at present, healthcare workers are every country's most valuable resource in the fight against COVID-19. Governments and heath organizations should take care of their staff and support them in any way possible. This review aims to describe the current situation anesthesia providers are facing in the setting of COVID-19 and provide solutions and evidence on important concerns, including which guidance to follow, the level of equipment that is adequate, and the level of protection they need for every patient being administered an anesthetic.

Recent research has suggested that a significant number of patients with common skin diseases across Europe are clinically depressed and anxious. However, dermatologists are trained to diagnose skin diseases but are not necessarily trained in diagnosing and treating mental health concerns that might be triggered by their patients’ skin diseases. In this study, 3635 patients attending dermatology clinics in 13 European countries completed detailed questionnaires, using a scale called HADS, designed to assess depression and anxiety. Each patient was then examined by a dermatologist who recorded the skin diagnosis and also answered the following two questions: ‘Do you see depressive signs in the patient?’ and ‘Do you see anxiety signs in the patient?’. The possible answers were ‘yes’ or ‘no’. Comparing the results of the questionnaires completed by the patients with the responses to these two questions by the doctors, the dermatologists underestimated depression in 5.8% of the consultations and anxiety in 11.2% of the consultations. On the other hand, dermatologists overestimated depression and anxiety in 10% and 11.8% of the consultations, respectively. The authors conclude that overall the agreement between clinician and patient assessment of mood symptoms was poor, suggesting that mood symptoms are under-recognized by dermatologists in a routine care setting.