4th Euro-Global Congress on Psychiatrists and Forensic Psychology November 10-11, 2016 Alicante, Spain

Biography:

Barbara Sartini has completed his studies as Psychiatric Rehabilitator from Università Cattolica del Sacro Cuore in Rome. She is the coordinator of Raymond Gledhill Community for patients with personality disorders. She teaches art therapy and the clinic evaluation at University in Rome and is a trainer of STEPPS since 2010.

Abstract:

Personality disorders are diagnosed in 40-60% of psychiatric patients. Those with personality disorder manifested great difficulties in interpersonal relationships and in dealing with everyday life. Although the causes of the disorder are multi-factorial, mainly, the common factors concern hypersensitivity to life events, hyper emotional reactivity and slow return to a baseline psychic equilibrium. The peculiarity is the change of these types of personalities, so emotionally vulnerable, to resilient personalities. Resilience is the ability to cope effectively to everyday adversities, despite the past life's adverse and traumatic events. It is not a feature, that is present or absent in the individual, but, instead, refers to behaviors, thoughts and actions that can be learned by anyone. In my job, I have been able to observe and verify how the sociotherapy approach in the therapeutic community (Maxwell Jones's model) integrated with the STEPPS's training (Nancy Bloom) can develop resilient personalities. This therapeutic and riabilitative integration allows increasing in the patients those skills necessary to resume positively the control of their lives, doing the individual experiences as relationships with caring and supportive people, taking positions of responsibility (sociotherapy), awareness of their strengths and weaknesses and learning emotional management skills and problem solving (STEPPS).

Biography:

Jai Sung NOH has completed his Medical Education from Yonsei University and Psychiatry residency training in Severance hospital in South Korea. He is the Head of department of Psychiatry at Ajou University in South Korea. He has published many scientific papers on biological psychiatry. Recently, he is focusing on the big data analysis using EMR data from clinical work.

Abstract:

Hospitals generate tons of data about patients, and theses massive medical data have been accumulated and computerized. However, their vast size and complexity leave them as big data, being unable to deal with preexisting software or hardware. This medical data could contribute to better treatment once its association or pattern has been found. Through analyzed medical data, traditional knowledge at an individual level could be further verified at a population level. Based on the electronic medical record (EMR) data accumulated for 15 years, this study was sought into the differences in the length of stay in hospital depending on the location of beds. For 15 years of time period, among the patients who had hospitalized in 6 bedded wards, there were 39,932 patients with beds near the window and 47,419 patients with beds near the door. The mean of the LOS of the patients near the window (5.9±6.6 days) was shorter than that of those near the door (6.6±6.8 days, p<0.01). This study further speculates that medical data could be used for an evidence-based design.

Biography:

Doris D'Hooghe is Graduated in Psychiatric Nursing.She have 22 years of experience as a Psychotherapist and child therapist. From 1980 until 1990,she worked in the Psychiatric Ward at the Onze-Lieve-Vrouw Hospital in Knokke.In recent years, she has worked as a therapist in the ergotherapy department and was in part responsible for the implementation of a treatment and work model for patients.

Abstract:

It is important to broaden our vision on attachment trauma, by pointing out the importance of the quality of parenting as an indicator to develop a secure attachment relationship. This quality mainly depends on the caregivers’ ability to mentalize, regulate, contain, play, and so on. The absence of these features causes traumatic stress in the child and impacts his psychological and neurological development and the possibility to attach. Thus, it is important that we are aware of the relationship between early attachment trauma (EAT) and affect dysregulation and dissociation. The seriousness depends on the early age of the child, an immature coping mechanism, the child’s different experience of danger, the stress level of adverse experiences and the caregiver as the source of trauma. We can consider dissociation and affect dysregulation as complex adaptation to trauma. In addition, when the child is not able to manage distress, it lacks the capability to integrate the experiences. Dissociation and inadequate self-regulation interfere with one another and impact the development of the sense of self. By raising awareness amongst caregivers and clinicians about EAT and the severe consequences, new therapeutic opportunities could be developed.

Biography:

Marleen Spaans completed her Master’s degrees in Developmental and Educational Psychology in 2003 and in Forensic Criminology in 2006, both from Leiden University, Netherlands. She is a Scientific Researcher in Department of Research and Education, Netherlands Institute for Forensic Psychiatry and Psychology (NIFP), part of Dutch Ministry of Security and Justice. She is pursuing her PhD on “The prevalence, assessment and prognostic value for treatment of personality pathology in a forensic setting” at Graduate School of Social and Behavioral Sciences, Leiden University.

Abstract:

The assessment of personality pathology highly prevalent in prison populations is an essential part of the legal and forensic process for both judges’ decisions regarding punishment and treatment of disordered offenders. Forensic assessments should not only be efficient and cost-effective, but also give possible consequences of their outcomes- accurate, objective, and transparent. The MMPI-2 self-report instrument is the most widely used and researched test of adult psychopathology. However, it does not have forensic norms. The DAPP-SF self-report instrument can distinguish treatment-seeking patients with personality disorders from the general population, but this has not yet been investigated in forensic populations. Data from two studies will be presented. Study one aimed at deriving an empirical classification system using cluster analysis of 247 MMPI-2 profiles of criminal defendants undergoing pre-trial psychological assessments in a forensic psychiatric observation clinic. In similar studies, the number of clusters varied between 10 and two. Results indicated only a non-disturbed and a disturbed profile, differing on general elevation of MMPI-2 profiles but displaying no qualitatively distinct profiles. Study two focused on the screening potential for personality disorder of the DAPP-SF in 89 defendants in the same clinic. Results showed only moderate associations between DAPP-SF and the outcome of the structured interview for DSM-IV personality (SIDP-IV). A floor effect was found in DAPP-SF scores: the forensic population reported less personality pathology than the general population, indicating faking good. Results indicating restricted usefulness of self-report instruments such as the MMPI-2 and DAPP in forensic populations will be discussed.

Biography:

Marroquin T Y is a Dental Specialist (Endodontist) from The National University of Colombia who currently completing her Doctorate at The University of Western Australia. Although she enjoys the clinical dental practice, she is also member of different research groups in Colombia and Australia, and is highly interested in contribute to the scientific development of dentistry and forensic dentistry. Her research project is focused on dental age estimation in adults aimed to find out a method that can be reliable to be systematically applied across the globe. Her research counts with international collaboration.

Abstract:

Dental age estimation is a challenge once root formation has finished in all teeth. In living adults, the most commonly used methods are based on the formation of secondary dentine. Some of the possible side effects of orthodontic treatment are the formation of secondary dentine and root shortening. The aim of this study was to establish if the secondary dentine formation from orthodontic treatment could generate a statistically significant difference in dental age estimations when Kvaal et al method was applied on living adults. This method is based on linear measurements of pulp/tooth length and pulp/tooth width. The study sample included 34 pairs of pre- and post-orthodontic treatment panoramic radiographs, from different individuals with exactly the same age and sex distribution. Females (n=22, 65%) age range 15-50 years old, median 17.5, and males (n=12, 35%) age range 16-37 years old, median 22.5 were included. Dental age was estimated per tooth using formulae previously published. The risk of over-estimating of age was calculated. (RR=1.007). The changes caused by orthodontic treatment do not have any significant effect on age estimation when Kvaal et al method is applied on panoramic radiographs.

Biography:

Zora Arfina Sukabdi is pursuing her PhD at Swinburne University of Technology. Her approach in rehabilitating former perpetrators in Indonesia and their families is seen to be holistic which include psychosocial, vocational, spiritual-ideology and cultural aspects. Her research work includes “Identifying parameters of successful rehabilitation and after care programs for bombing victims as well as terrorism convicts”. Her dedication underlines her outstanding achievements and promote her to receive Allison Sudrajat Prize and be nominated as a representative of Swinburne University of Technology in the International Women’s Day.

Abstract:

Psychological rehabilitation to religious terrorism offenders consists of efforts to reestablish human capacity and function in society, restore for a good condition, achieve self-efficacy and be able to re-integrate into society. It focuses on character building and well-being of violent offenders, in order to have more peaceful state of mind and favorable attitudes to society. Practically, there are two types of rehabilitation to terrorism offenders, exclusiveness and inclusiveness, which can be combined in performing psychological rehabilitation. This paper explains steps in rehabilitating religious terrorism offenders, psychological treatment process, and behavioral transformation seen in religious terrorism offenders. There are 10 steps in rehabilitating religious terrorism offenders and five phases of psychological treatment process. In terms of behavioral transformation, religious terrorism offenders experience two kinds of process namely natural and designed behavioral transformation.

Biography:

W K Tang was appointed as Professor in the Department of Psychiatry, the Chinese University of Hong Kong in 2011. His main research areas are addictions and neuropsychiatry in stroke. He has published over 100 papers in renowned journals and has also contributed to the peer review of 40 journals. He has secured over 20 major competitive research grants. He has served the Editorial boards of five scientific journals. He was also a recipient of the Young Researcher Award in 2007, awarded by the Chinese University of Hong Kong.

Abstract:

Background & Objectives: The objectives of this study were to ascertain the pattern of grey and white matter volume reduction and regional metabolic and activation abnormalities in chronic ketamine users, and to evaluate the correlations between these brain abnormalities and cognitive impairments in chronic ketamine users in Hong Kong.

Design:  Cross-sectional observational study.

Setting: Counseling Centre for Psychotropic Substance Abusers in Hong Kong.

Participants: One hundred and thirty-six participants were recruited from October 2011 to April 2014. The participants were divided into two groups: ketamine users (79) and healthy controls (57).

Main outcome measures: Psychiatric assessments included screening with self-rating questionnaires and face-to-face interviews. All of the participants completed a detailed cognitive battery that covered general intelligence, verbal and visual memory, executive functions, motor speed and language. All of the participants underwent magnetic resonance imaging of the brain. 

Results: Many of the participants in the ketamine group also frequently used cocaine and cannabis. Among the ketamine users, 12.6% were diagnosed with a mood disorder and 8.9% with an anxiety disorder. The participants in the ketamine group had worse performance than the healthy controls on tests of general intelligence, verbal, visual and working memory and executive functioning. In terms of grey matter volumes, the right orbitofrontal cortex, right medial prefrontal cortex, left and right hippocampus and possibly the left orbitofrontal cortex were smaller in the ketamine group. In contrast, the volumes of the left basal ganglia, left putamen and possibly the left caudate were higher in the ketamine group. In terms of white matter volumes, the ketamine group had a lower periventricular white matter volume in the right hemisphere. The grey matter volumes of the left and right orbitofrontal cortex, right medial prefrontal cortex, left basal ganglia and left putamen, and right periventricular white matter volume were negatively correlated with the severity of ketamine dependence. The hippocampal volumes were correlated with performance on the arithmetic, information and digit span tests. The periventricular white matter volume also correlated with the information score. A functional connectivity examination of the default mode network revealed significantly decreased connectivity in the medial part of the bilateral superior frontal gyrus, left middle frontal gyrus, bilateral gyrus rectus, left superior temporal pole, left inferior temporal gyrus, bilateral angular gyrus and bilateral cerebellum crus II in the ketamine group. This group also displayed increased connectivity in the bilateral precuneus and right inferior occipital gyrus.

Conclusions: The results provide imaging evidence of brain damage in chronic ketamine users. Chronic ketamine use was associated with reduced grey and white matter volumes in certain regions of the brain. Chronic ketamine use was also associated with altered functional connectivity with the default mode network. Abnormal brain structures and altered functional organization of the brain network may underlie the hypersensitivity towards drug related cues but weakened cognitive control in those with ketamine addiction. Longitudinal or prospective studies would help to strengthen the evidence on the reversibility of the structural and functional brain damage caused by ketamine.

Biography:

Simon Geoffrey David Ruffell graduated from University of Sheffield with a degree in Medicine in 2013. He has a keen interest in global psychiatry and has worked around the world including Uganda, India and Malaysia. His most recent work has been in Gulu, Uganda, developing policies with local doctors in an attempt to reduce the amount of rapid tranquilization medication utilized on psychiatric wards.

Abstract:

Stigma surrounding HIV remains, regardless of improvements in education and understanding. WHO-2015 guidelines attempt to combat barriers to HIV treatment, particularly that of stigma and discrimination. Despite this HIV is often associated with infidelity and sex work, especially in sub-Saharan Africa. Psychological effects of stigma and discrimination: After the death of her husband in 1994, Mrs X was forced to leave home. Learning she had HIV, the consensus of her late husband’s family was that Mrs X should die alone. She suffered from insomnia, anxiety, panic attacks, poor concentration and feelings of hopelessness and worthlessness. Socially isolated after years of self-neglect, she prepared to overdose leaving a suicide note. In 2007, Mrs X became open regarding her status. Although the majority of her psychological symptoms ended at this time, she has ongoing issues with anxiety, regularly visiting counselors. She is plagued by night terrors, flashbacks and panic attacks; reliving emotional abuse. The effects of psychological support: In 1996 Mrs X met her current husband. Also suffering from HIV, he attended hospital with Mrs X to receive treatment. Fortunately, Mr X did not believe the majority opinion within their village; that antiretroviral therapy was a fatal hoax, designed to end the lives of those with HIV. She attended counseling sessions and her well-being significantly improved. She opened her home as an HIV clinic with the help of a local doctor, and the gossip of local villagers regarding her HIV status only served to promote the service. As Mrs X now says “Everyone wants to be my friend, there isn’t a family in this village unaffected by HIV”. Mrs X is now 58 and has an undetectable viral load. She understands only too well the psychological effects of stigma, and conducts regular counseling sessions for patients. It is essential both in developed and developing countries that patients receive support in combination with medication. Psychological input not only reduces mortality and morbidity by reducing depression and suicide, but through improving adherence. Complete treatment regimes should focus on psychological aspects HIV, improving physical health outcomes and preventing mental health issues from progressing into old age.

Biography:

Dr. Aboelezz  Kalboush  is an Egyptian consultant psychiatrist, he received his Master degree  in psychiatry & neurology  from  Ain-Shams  university , Egypt in 2007 , Arab Board in psychiatry  in 2007 and  Egyptian Board in psychiatry  in 2008.He is the head of psychiatry department   in Alnoor Specialist Hospital, Saudi Arabia since june 2013 . He is responsible for training of medical students (both undergraduates & postgraduates) in psychiatry.

Abstract:

Introduction: The relationship between mood disorders (including depression) and disturbed thyroid functions is well known. Exclusion of hypothyroidism is important before diagnosing any one with depression and using T3 hormone in cases of resistant depression is effective in treating those patients.

Objectives: This presentation will highlight the updates and the findings of the recent studies done in the field of Endocrinology that clarify and explain the physiological basis behind the effectiveness of T3 hormone in treating patients of resistant depression.

Methods: Critical review of various current literatures on the topic

Results: Recent studies done by endocrinologists led to introduction of a new concept that is called (brain hypothyroidism) and this disorder is a separate entity that differs from (systemic) hypothyroidism in the mechanism of causing the depressive symptoms, in its diagnosis and in its treatment.

Conclusions: Although still preliminary, the recent studies and this new concept of (brain hypothyroidism) can help in more understanding of the resistance in treating depression and how this resistance is caused and it opens the door for reviewing the current guidelines and algorithms for management of depression.

Biography:

UK

Abstract:

Statement of problem: All Rapid Tranquillisation (RT) incidents require intensive assessment and monitoring of physical and mental state to maintain safe practice. We aimed to evaluate practice at our trust against guidance for management of RT and sought to identify any emerging trends in RT across inpatient areas.

Methodology: We looked at RT incidences across 17 inpatient psychiatric units including Child and Adolescent and Intensive Care units.  Data was reviewed retrospectively for all RT incidences between 2013 and 2014. Results were circulated across the trust alongside local policy reflecting the most up to date NICE guidelines. Additionally standards are in place to provide appropriate training to staff in managing incidents of aggression. Re-audit was performed of RT incidences between 2014 and 2015 assessing for any changes in practice.                                            

Findings: In cycle one there were 178 reported incidents of RT, compared with 269 in the re-audit.  In cycle one ECG had been recorded in 2.6% of total cases compared to 14.5% in re-audit (56.5% excluding unknowns). Where data was available patients had oxygen saturation (60% vs 75%), level of consciousness (90% vs 92%) and side effects (68% vs 78%) documented more frequently in the second audit cycle. In both cycles we found that there were higher incidences of RT on psychiatric intensive care units and that a small number of individuals across all wards have been administered RT on multiple occasions. Another trend identified in both cycles was that the overwhelming majority of inpatients under 18 years old receiving RT were females.

Conclusion:

Overall there were improvements in reporting and monitoring RT incidences showing that clear local guidelines and training can improve practice. One consideration for future practice is to further simply policy and documentation to improve compliance and safety in RT.

Biography:

Meseret Ayalew is currently working as an Lecturer at Bahir Dar University and has completed his M.A in field of Clinical Psychology.

Abstract:

This study examined mental health status of women returnees from domestic work in the Middle Eastern countries, in comparison with those who are in the process of migration. The prevalence of mental distress, the impacts of socio-demographic variables on the experiences of mental distress, and the differences between the returnees and those who are in the process of migration in their experiences of mental distress were assessed in this study. The study was conducted in Amhara Region, South Wollo Zone. There were two groups of population out of which two sets of samples were drawn i.e. the returnees and those who are in the process of migration. Using availability sampling method, two hundred participants were selected i.e. hundred from the returnees and hundred from those who are in the process of migration. SRQ24 was used for data gathering and descriptive statistics, one way ANOVA, and independent sample t-test were used for data analysis. The finding indicates that the prevalence of mental distress was elevated among the returnees, some variables namely age and religion were having significant impact on mental distress. Whereas other variables examined in this study were not having significant impact. The independent sample t-test indicated that there was significant difference between the two groups in the experiences of both neurosis and psychosis. This implies that a special attention needs to be given by policy makers, researchers, and therapists so as to handle this issue.

Biography:

Iran

Abstract:

This study attempts to evaluate the influence of genetics and environmental factors on personality types and early maladaptive schemas, by comparing these in identical and fraternal twins. Our sample consisted of 38 pairs of Iranian twins, distributed across identical (21 pairs) and fraternal (17 pairs) groups. All these twins were 18 to 45 years old. The instruments used for this study consisted of Myers Briggs personality test (MBTI-M) and Young Schema Questionnaire - Short Form (YSQ-SF). Analysis of tests indicated that in identical twins, the personality types were different. Also, early maladaptive schemas were different in both the disconnection & rejection and over-vigilance/inhibition domains. But, in three areas of impaired autonomy and performance, impaired limits and other-directedness domains, the early maladaptive schemas were equal in identical twins. In fraternal twins, the personality types were different and all domains of the early maladaptive schemas were also different. Based on the results of this study, it seems that in formation of personality types, neither genetics nor environmental factors are influential by themselves. Rather, it is the combination of the two sets of influences which is the determining factor.

Biography:

Andrea Fissi is the author and founder of PsicoCorporeità AutoRiparativa (PCAR), which uses as psychotherapy since 1981, through the release of the natural processes of adaptation and resolution that individual owns. He has explained his theory and methodology in various articles and later in his book: “La Psicocorporeità Analitica". He teaches his theory in training courses for psychologists and doctors authorized to psychotherapy. Once formed in sexology, he later developed a method to treat sexual function problems by integrating sexological knowledge with his theory. In 2006 he was trained in EMDR. He is currently consultant in EMDR.

Abstract:

The psyche is a phenomenal event produced by the body, to an adaptive purpose, to achieve adequate environmental homeostasis. Since then is the body to produce the psyche phenomenon and it inevitably affects its structure. The psyche has its own autonomy and, with its operations, in turn, affects the body that has produced it, changing the organic functional settings. This interactive cycle produces the organic changes in the connective tissues, in the organs, and in the various nerve endings. The new body settings, in turn affect the functioning of the psyche by changing its analytical and reading capacity of the internal and external environment. Tensions and information in the body, at a given time, constitute the zero point, which is used as a basis for making any assessment that purchases meaning in relation to the deviation from it. Each person creates his own reality and truth assessing it in relation to its zero point in place. To solve the various psychopathologies, you must obtain a general reorganization, in order to eliminate the various shenanigans. So you do not have to be limited to acting only on a psychological level, or merely physical, but you need a multidisciplinary intervention that consider the psychological aspects on one hand and a physical manipulative treatment on the other hand, aimed to free the connective tissue, the muscle fibers with their spindle and the various reflex zones from the alterations that have been produced in repeated attempts to environmental adaptation.

Biography:

Heather Renée Barker is an Asst. Prof. of Design Heather and is the founder and Coordinator of the Immersive Design Research Lab at California State University Long Beach. She has presented and published her interdisciplinary work on strategy, theory and methods in psychology and behavioral sciences, and design-related conferences. She received her terminal degree in Architecture, Metropolitan Research and Design from the Southern California Institute of Architecture in addition to Post-graduate studies at the Akademie der Bildenden Künste München (Art Academy Munich). She has an upcoming book on design theory to be published by Routledge in 2017.

Abstract:

Design is optimization. Whether designing a treatment, therapy, object or city, the goal is to discover the most efficient means to use resources, time and energy while generating the most effective result; all responsive to a particular condition. This work demonstrates situational responses to complex adaptive systems through case-studies that have employed a design-thinking research methodology. Rooted in phenomenology, this method leverages empathy as the first step to develop novel solutions. Human-centered design is iteratively adapted to a social, interactive dynamism by applying concepts described in humanistic, behavioral and systems psychology. The projects described here, developed in collaboration with industry, show the application of this process to the design of interfaces, spaces and city services. Human-centered design is a service and does not assume pathology. Disorder is viewed as an opportunity to adapt and accommodate. The research methodology described here simultaneously studies responses to interactions with objects and within environments. This research focuses on contextual behavior in order to anticipate and affect behavioral change to changed conditions. As a human-centered design research approach, the intent is to develop an action-research strategy that will generate valuable results. Developing this procedural, contextual and experiential intelligence (XI) assumes a body-mind connection and requires acquiring domain-specific knowledge, concepts and skills that then translate to higher-order thinking skills; from making things to making meaning. This work describes the skills, tools, methods and results of an empathy-driven, human-centered process to deliver inclusive and innovative solutions.

Biography:

Leng Anli is a PhD of School of Public Health in Shandong University. Her study interest is health economics and mental health. She has published two SCI papers in reputed journals.

Abstract:

In China, it is estimated that there are 16 million patients who are mentally ill. Studies have found that family caregivers take on the most prominent role in taking care of people with mental illness.  This study aims to evaluate QoL and social support of family caregivers when providing care for a family member with mental health, to determine whether social support is the key influencing factor and to identify additional factors. This is a cross-sectional study design. Participants were recruited and independently interviewed using the questionnaire, consisting of demographic characteristics, SF-36 form, and social support rating scale. Multiple stepwise regression analysis was used to analysis the factors affecting the quality of life. Compared with the QoL of the general population in China, this study found that family caregivers in Shandong perceived poorer quality of life, especially in the aspect of role-physical, role-emotional and bodily pain. We also found that family caregivers received lower social support. Patient’s illness state, care time, financial burden and objective support significantly predicted caregivers’ QoL in the domain of physical health. Patient’s illness state, patient’s marital status, family monthly income, caregiver’s knowledge about the illness, caregivers coordinating caring, life and work, subjective support received and utility of support significantly predicted caregivers’ QoL in the domain of mental health. These findings suggest it is important to develop and implement effective intervention strategies to improve the quality of life of family caregivers. Mental health education campaigns need focus on knowledge about illness which patients suffered, targeting long care-time caregivers and unemployed caregivers. Besides, helping families to maintain and enhance a supportive social network may present a useful means.

Biography:

Li Li attended Medical School at Wuhan University, School of Medicine, in China. She, then, travelled to Atlanta, GA, where she completed her PhD degree, which was followed by her Post-doc training in the Department of Pathology at the University of Alabama at Birmingham (UAB). She completed her residency training in 2013 in the Department of Psychiatry at UAB. After residency, she was appointed as an Assistant Professor. She currently is funded by the NIDDK, NARSAD and NORC for her research. She has published more than 30 papers in reputed journals and has been serving as an Editorial Board Member.

Abstract:

Childhood maltreatment (CM), defined by exposure to abusive, neglectful or overtly traumatic experiences during childhood, contributes to psychiatric disorders, including major depressive disorder (MDD) and metabolic syndrome in adulthood. Additionally, there is consistent evidence from population-based cohort studies that MDD is associated with increased risk for type 2 diabetes mellitus (T2DM) and obesity. However, it remains unclear whether CM has a direct impact on the development of metabolic syndrome or if CM influences the development of metabolic syndrome in patients with MDD through diagnosis-dependent biological pathways. Studies were conducted to explore patho-physiological mechanisms that may link CM exposure and stress-related psychiatric disorders and metabolic syndrome. CM is highly prevalent in a sample of African-American/Caucasian patients with MDD. Our data also indicates that exposure to CM is linked with increased visceral fat deposition. Disturbance of HPA axis activity and activation of the immune system may be two potential mechanisms contributing to it. In addition, the association between CM and T2DM is also examined. Individuals with CM, especially in patients with MDD and CM exposure, are at elevated risk for T2DM. Mechanism underlying a greater risk for T2DM is due to, at least in part, a consequence of reduced insulin sensitivity and glucose intolerance. It is suggested by our results that CM exposure is linked with increased prevalence of MDD, disturbed visceral fat deposition and greater risk for T2DM. Our study has significant implications for the understanding of pathophysiology and potentially treatment of stress-related MDD and metabolic syndrome.