{"title":"Global, Regional, and National Burdens of Major Depressive Disorder and Dysthymia in Adolescents and Young Adults Aged 10–24 Years from 1990 to 2019: A Trend Analysis Based on the Global Burden of Disease Study 2019","authors":"Lina Wang, Dongjun Zhang, Jiali Wu, Minrui Wang, Chenglin Zhang, Jiahan Gao, Haodong Zhao, Dehong Qin","doi":"10.1007/s11469-024-01284-2","DOIUrl":"https://doi.org/10.1007/s11469-024-01284-2","url":null,"abstract":"<p><b>Objective</b> The objective was to assess trends in the burdens of major depressive disorder (MDD) and dysthymia among adolescents and young adults aged 10–24 years from 1990 to 2019 at the global, regional, and national levels. <b>Methods</b> This study was based on average annual percentage changes in the incidence and disability-adjusted life-years (DALYs) for MDD and dysthymia among young people aged 10–24 years. We analyzed global trends by age, sex, and sociodemographic index (SDI). Joinpoint regression was used to analyze global annual change trends. <b>Results</b> Between 1990 and 2019, the incidence of MDD in adolescents and young adults decreased by 0.1% per year, while the incidence of dysthymia increased by 0.2% per year. The greatest increase in the incidence of MDD and dysthymia was observed in the group aged 10–14 years and in the group aged 15–19 years, respectively. The greatest increase in the incidence of and DALYs for MDD was observed in high-SDI countries, while the greatest increase in dysthymia was observed in low-middle-SDI countries. In 2019, the incidence rates of MDD and dysthymia in females were 1.7 times and 1.5 times greater than those in males, respectively. <b>Conclusions</b> Over a 30-year period, the global incidence of MDD in adolescents and young adults did not decrease significantly, and the incidence of dysthymia increased significantly. The results indicate an urgent need for targeted screening for depressive disorders.</p>","PeriodicalId":14083,"journal":{"name":"International Journal of Mental Health and Addiction","volume":"125 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140322522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ziggi Ivan Santini, Lau Caspar Thygesen, Susan Andersen, Janne S. Tolstrup, Ai Koyanagi, Line Nielsen, Charlotte Meilstrup, Vibeke Koushede, Ola Ekholm
{"title":"Social Media Addiction Predicts Compromised Mental Health as well as Perceived and Objective Social Isolation in Denmark: A Longitudinal Analysis of a Nationwide Survey Linked to Register Data","authors":"Ziggi Ivan Santini, Lau Caspar Thygesen, Susan Andersen, Janne S. Tolstrup, Ai Koyanagi, Line Nielsen, Charlotte Meilstrup, Vibeke Koushede, Ola Ekholm","doi":"10.1007/s11469-024-01283-3","DOIUrl":"https://doi.org/10.1007/s11469-024-01283-3","url":null,"abstract":"<p>Social media addiction has previously been linked to compromised mental health and social isolation; however, most studies are cross-sectional or based on convenience samples. The objective of the current study was to assess the extent to which social media addiction predicts compromised mental health and social isolation (including bi-directionality) in a large prospective sample of Danish adults. Data stem from a nationwide longitudinal Danish survey of 1958 adults (aged 16+) conducted in 2020 and 2021. The Bergen Social Media Addiction Scale (BSMAS) was used. Validated scales were used to assess depression, mental wellbeing, and loneliness. A total of 2.3% screened positive for social media addiction. As compared to no symptoms, social media addiction was associated with an elevated risk for depression (OR = 2.71; 95% CI 1.08, 6.83) and negatively with mental wellbeing (coef = −1.29; 95% CI −2.41, −0.16). Similarly, social media addiction was associated with an elevated risk of loneliness (OR = 4.40; 95% CI 1.20, 16.19), and negatively with social network size (coef = −0.46; 95% CI −0.86, −0.06). There is a need for preventive actions against addictive social media use, as this poses significant risk to mental health and social functioning in the working age population.</p>","PeriodicalId":14083,"journal":{"name":"International Journal of Mental Health and Addiction","volume":"27 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140322447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Luis E. Segura, Natalie S. Levy, Christine M. Mauro, Emilie Bruzelius, Pia M. Mauro, Sarah Gutkind, Morgan M. Philbin, Deborah S. Hasin, Silvia S. Martins
{"title":"Gender Differences in Cannabis Outcomes After Recreational Cannabis Legalization: A United States Repeated Cross-sectional Study, 2008–2017","authors":"Luis E. Segura, Natalie S. Levy, Christine M. Mauro, Emilie Bruzelius, Pia M. Mauro, Sarah Gutkind, Morgan M. Philbin, Deborah S. Hasin, Silvia S. Martins","doi":"10.1007/s11469-024-01271-7","DOIUrl":"https://doi.org/10.1007/s11469-024-01271-7","url":null,"abstract":"<p>Cannabis use has been more prevalent among men than women and prior work has found differing impact of recreational cannabis laws (RCL) by age. We examined changes in the prevalence of past-year and past-month cannabis use, past-month daily cannabis use, and DSM-5-proxy cannabis use disorder (CUD) in the past-year before and after RCL enactment by gender alone and stratified by age using 2008–2017 repeated cross-sectional samples of the US National Survey on Drug Use and Health. Changes in cannabis outcomes were estimated using adjusted multi-level logistic regression with state random intercepts and two-way and three-way interactions between RCL, gender, and age group. Enactment of RCL was associated with higher increases in the past-year (+ 3.2%; aOR = 1.30 [95%CI = 1.19 to 1.41]) and past-month (+ 2.3; 1.37 [1.24 to 1.51]) cannabis use in women than men (+ 2.1%; 1.15 [1.06 to 1.25] and + 1.7%; 1.19 [1.08 to 1.30]). No increases in past-month daily cannabis use and past-year DSM-5 CUD among those using cannabis were observed after RCL enactment. There were no increases in any cannabis outcomes after RCL enactment among those 12–20 years old. RCL enactment may contribute to the narrowing of the cannabis gender gap. Ongoing surveillance is essential to ensure that the social justice aims of legalization are achieved without negative public health consequences.</p>","PeriodicalId":14083,"journal":{"name":"International Journal of Mental Health and Addiction","volume":"76 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140301630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Characteristics and Risk of Adverse Mental Health Events Amongst Users of the National Overdose Response Service (NORS) Telephone Hotline","authors":"","doi":"10.1007/s11469-024-01285-1","DOIUrl":"https://doi.org/10.1007/s11469-024-01285-1","url":null,"abstract":"<h3>Abstract</h3> <p>The National Overdose Response Service (NORS) is a Canadian mobile or virtual overdose response hotline intended to prevent drug overdose deaths but has unexpectedly received mental health related calls, including adverse mental health events. Our study aimed to examine these occurrences and caller characteristics predictive of adverse mental health outcomes. Using the NORS call dataset, we conducted a descriptive representation of mental health occurrences and mental health emergencies along with correlative statistics. We found that NORS had received 2518 mental health calls, with 28 (1.1%) being adverse events. Men, rural callers, polyroute substance consumption and history of overdosing were found to have increased odds of having an adverse mental health event, while being from Quebec, using non-standard consumption routes and using the line between 50 and 99 times were found to decrease odds. This supports the utility of overdose prevention hotlines to also support people experiencing adverse mental health situations and reduce harm for individuals with mental health and/or substance use disorders.</p>","PeriodicalId":14083,"journal":{"name":"International Journal of Mental Health and Addiction","volume":"37 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140301633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alvaro Vergés, Tomás Arriaza, Marcela Soto, María Elena Alvarado
{"title":"Impulsivity and Compulsivity Dimensions in the Prediction of Substance Use and Depressive Symptoms Among Emerging Adults","authors":"Alvaro Vergés, Tomás Arriaza, Marcela Soto, María Elena Alvarado","doi":"10.1007/s11469-024-01277-1","DOIUrl":"https://doi.org/10.1007/s11469-024-01277-1","url":null,"abstract":"<p>Impulsivity and its different facets have been studied for decades as some of the main personality traits linked to psychopathology. However, in recent years, research has emphasized compulsivity as a more proximal risk factor for certain disorders, leading to different theorizations on the relation between impulsivity facets and compulsivity. Building on a model proposed by Nigg (2017), this study identified the factor structure of Compulsivity and Impulsivity facets (Immediate Reward Preference, Cue-Triggered Impulsive Response, and Planful Risk-Taking) and explored their prospective associations with depressive symptoms, alcohol, and cannabis-related problems. A total of 729 emerging adults were measured at two waves of data collection, using the Impulsive-Compulsive Behaviours Checklist, UPPS-P Impulsive Behavior Scale, Sensitivity to Punishment and Sensitivity to Reward Questionnaire, Delay Discounting Task, and questionnaires designed to measure substance-related problems and depressive symptomatology. Confirmatory factor analysis revealed a four-factor orthogonal structure reflecting the lower-level facets in Nigg’s model. Compulsivity predicted increased depressive symptoms, whereas CTIR predicted cannabis-related problems. Robustness analyses showed substantial but not complete consistency in findings, pointing to variations in associations depending on specific measures used to assess each construct. This study contributes to understanding the complex interplay of impulsivity and compulsivity and their relevance as vulnerability factors for different mental health conditions.</p>","PeriodicalId":14083,"journal":{"name":"International Journal of Mental Health and Addiction","volume":"1 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140301635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Effect of Mindfulness-based Psychoeducation on Negative Automatic Thoughts and Medication Adherence in Individuals with Cannabis Use Disorder: a Randomized Controlled Trial","authors":"Funda Kavak Budak, Aysel Akbeniz, Fatma Melike Erkan, Abdurrezzak Gültekin, Hatice Birgül Cumurcu","doi":"10.1007/s11469-024-01282-4","DOIUrl":"https://doi.org/10.1007/s11469-024-01282-4","url":null,"abstract":"<p>The aim of this study is to evaluate the effect of mindfulness-based psychoeducation on negative automatic thoughts and medication adherence in individuals with cannabis use disorder. The randomized controlled study was conducted between September 2021 and December 2022 in the psychiatry clinic of a university hospital in Turkey. The sample size of the study consisted of 60 individuals (30 experimental groups, 30 control groups). Descriptive Characteristics Form, Negative Automatic Thoughts Questionnaire, and Morisky Medication Adherence Scale were used to collect data. In the study, while eight sessions of mindfulness-based psychoeducation were given to the experimental group, no intervention was applied to the control group. Experimental group posttest negative automatic thoughts and medication adherence scale total mean scores were found to be statistically significant (<i>p</i> < 0.05). It was determined that the posttest negative automatic thoughts scale total score mean in the experimental group decreased compared to the control group, and the medication adherence scale total score mean increased compared to the control group. It was determined that mindfulness-based psychoeducation given to individuals with cannabis use disorder was effective in negative automatic thoughts and adherence to treatment.</p>","PeriodicalId":14083,"journal":{"name":"International Journal of Mental Health and Addiction","volume":"23 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140303185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Validation of the Chinese Version of the Smartphone Self-Extension Scale: Empirical Evidence for Tripartite Conceptualization of Smartphone Self-Extension","authors":"Hua Li","doi":"10.1007/s11469-024-01280-6","DOIUrl":"https://doi.org/10.1007/s11469-024-01280-6","url":null,"abstract":"<p>Smartphones can be perceived as a part of users' human selves and extend their identity in various ways. This study aimed to validate the Chinese version of the Smartphone Self-Extension scale in a sample of 1,022 university students. The confirmatory factor analysis (CFA) was employed to examine the validity of the scale. The CFA results confirmed a three-factor, instead of a two-factor, structure of the scale, lending empirical evidence to the tripartite conceptualization of smartphone self-extension. Measurement invariance of the scale was established. Participants showing more smartphone addiction and higher frequency of smartphone use experienced more smartphone self-extension. Gender and smartphone addiction levels were associated with varying degrees of anthropomorphic and ontological self-extension. This is the first study to validate the Chinese version of the Smartphone Self-Extension scale among university students. The scale has been demonstrated to be a reliable and valid measure for smartphone self-extension to be used in educational settings.</p>","PeriodicalId":14083,"journal":{"name":"International Journal of Mental Health and Addiction","volume":"8 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140199469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sara Shayegi-Nik, Lu Wang, Jenny Li, Michael Budu, Katherine Kooij, William G. Honer, Robert S. Hogg, Julio S. G. Montaner, Viviane D. Lima
{"title":"Impact of Substance Use and Mood/Anxiety Disorders on the HIV Continuum of Care in British Columbia, Canada, from 2001 to 2019","authors":"Sara Shayegi-Nik, Lu Wang, Jenny Li, Michael Budu, Katherine Kooij, William G. Honer, Robert S. Hogg, Julio S. G. Montaner, Viviane D. Lima","doi":"10.1007/s11469-024-01272-6","DOIUrl":"https://doi.org/10.1007/s11469-024-01272-6","url":null,"abstract":"<p>People living with HIV (PLWH) are disproportionately affected by mood, anxiety, and substance use disorders that prevent their sustained engagement with HIV care. Comprehensive research on the impact of these disorders on the HIV continuum of care is lacking. This study aimed to assess the impact of the syndemic between substance use disorder (SUD) and mood/anxiety disorders on the HIV continuum of care for PLWH in British Columbia (BC), Canada, and identify the stage with the highest attrition in the continuum. This retrospective population-based cohort study utilized data from the Comparative Outcomes And Service Utilization Trends (COAST) study that contains data on all diagnosed PLWH in BC. Eligible individuals were ≥ 19 years of age and were followed during 2001–2019. Our exposure variable was SUD or mood/anxiety disorder diagnoses. Our outcomes were the achievement of the following stages of the HIV continuum of care: (1) antiretroviral therapy (ART) initiation, (2) on-ART, (3) ART adherence, (4) viral suppression, and (5) maintained suppression. We estimated attrition by estimating the proportion of PLWH who proceed to each stage. Generalized linear mixed-effect models assessed the association between SUD and mood/anxiety disorders and the achievement of each stage while controlling for sociodemographic and HIV-related confounders. For the 14,398 eligible PLWH, maintained suppression exhibited the highest attrition. Having SUD or both SUD and mood/anxiety disorder were significantly associated with reduced odds of achieving all stages of the HIV continuum of care except on-ART. SUD had the strongest association with reduced odds of ART adherence (adjusted odds ratio (aOR) 0.47; 95% CI, 0.42–0.53) and reduced odds of maintained suppression (aOR 0.58; 95% CI, 0.53–0.63). Having only mood/anxiety disorders was also associated with reduced odds of both adherence (aOR 0.78; 95% CI, 0.71–0.87) and maintained suppression (aOR 0.82; 95% CI, 0.77–0.88). Our findings indicate that SUD and mood/anxiety disorders contribute to attritions across the continuum, emphasizing the need for integrated mental health and substance use services to support HIV care.\u0000</p>","PeriodicalId":14083,"journal":{"name":"International Journal of Mental Health and Addiction","volume":"19 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140199528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stefano Pallanti, Jonna Levola, Pantelis Lioumis, Tiina Paunio, Dubravko Kičić, Risto Ilmoniemi, Nikos Makris
{"title":"Treatment of Behavioral Addictions and Substance Use Disorders: a Focus on the Effects of Theta-Burst Stimulation Over the Pre-SMA","authors":"Stefano Pallanti, Jonna Levola, Pantelis Lioumis, Tiina Paunio, Dubravko Kičić, Risto Ilmoniemi, Nikos Makris","doi":"10.1007/s11469-024-01261-9","DOIUrl":"https://doi.org/10.1007/s11469-024-01261-9","url":null,"abstract":"<p>Behavioral addictions (BA) and substance use disorders (SUDs) share core features, including impaired control and craving, leading to significant personal and societal impacts. Previous research has identified the pre-supplementary motor area (pre-SMA) as a critical node in GD-related neurocircuitry, making it a potential target for interventions also in SUDs. Theta-burst stimulation (TBS) offers a non-invasive method to modulate pre-SMA activity. This study included 58 participants diagnosed with GD or SUDs. They underwent bilateral pre-SMA continuous TBS (cTBS) sessions targeting craving, impulsivity, and addiction severity. Standardized scales and questionnaires were employed to assess the outcomes. cTBS parameters included 20 daily sessions with 80% resting motor threshold (RMT). Both GD and SUD groups exhibited significant reductions in addiction severity and craving following cTBS. Impulsivity decreased significantly in SUD but not in GD. The study’s findings underscore the potential of pre-SMA TBS as an adjunctive treatment for GD and SUDs. The observed improvements in addiction severity and craving emphasize the shared neuronal mechanisms underlying these disorders. However, the nuanced differences, especially in impulsivity, indicate the need for further research to tailor interventions precisely.\u0000</p>","PeriodicalId":14083,"journal":{"name":"International Journal of Mental Health and Addiction","volume":"80 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140168709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Association Between Self-Reported Opioid Use and Behavioral/Social Health Characteristics—Arizona, 2020","authors":"","doi":"10.1007/s11469-024-01276-2","DOIUrl":"https://doi.org/10.1007/s11469-024-01276-2","url":null,"abstract":"<h3>Abstract</h3> <span> <h3>Background</h3> <p>Arizona observed a sharp increase in opioid overdose deaths between 2017 and 2021. Our objective was to better understand the relationship between behavioral/ social characteristics and self-reported opioid misuse among Arizona adults.</p> </span> <span> <h3>Methods</h3> <p>A cross-sectional study design was done using data from the Arizona 2020 Behavioral Risk Factor Surveillance System (BRFSS) (<em>N</em> = 10,291). Confidence intervals and p-values were found using chi-square for respondents with and without a self-reported opioid misuse. Logistic regression models were developed for the association between adverse childhood experiences (ACEs), mental health, and risk-taking behaviors (RTBs) and opioid misuse.</p> </span> <span> <h3>Results</h3> <p>Respondents who reported 2–3 ACEs (OR<sub>adjusted</sub>: 4.7; 95% CI: [2.8, 7.9]) and who reported 4 or more ACEs (OR<sub>adjusted</sub>: 8.3; 95% CI: [5.0, 13.6]); respondents who reported poor mental health (OR<sub>adjusted</sub>: 3.3; 95% CI: [2.1, 5.2]); and respondents who reported two or more RTBs (OR<sub>adjusted</sub>: 3.9; 95% CI: [2.5, 6.1]) had higher odds of self-reported opioid misuse compared to those without self-reported opioid misuse.</p> </span> <span> <h3>Discussion</h3> <p>Opioid misuse was found to be associated with poor mental and physical health, increased RTBs, and history of at least two ACEs among Arizona adults in this study. These findings stress the importance of opportunities for targeted prevention in both Arizona adults and youth, including screening for ACEs and RTBs, in early stages of life.</p> </span>","PeriodicalId":14083,"journal":{"name":"International Journal of Mental Health and Addiction","volume":"140 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140168707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}