New challenges in the COVID-19 pandemic.

This June issue of the Journal of Psychosomatic Research was to coincide with the 2020 meeting of the European Association of Psychosomatic Medicine (EAPM) at the Hofburg in Vienna, Austria. The conference organizer, Christoph Pieh, had laid the groundwork for what was sure to be a terrific event. Based on early registration and abstract submissions, it was on pace have potentially been the largest EAPM meeting to date. The interest in this conference was well-founded. Beyond the setting at the historic Hofburg in the wondrous city of Vienna, a tremendous roster of keynote speakers was lined up, including Nobel laureate Eric Kandel. With the arrival of this COVID-19 pandemic, the EAPM 2020 meeting was appropriately and prudently, but regretfully postponed.

This June 2020 issue will nonetheless still include selected abstracts that were to be presented at the conference so the reader can sample some of the latest research in psychosomatic medicine. There are also several articles in this issue in line with the conference theme of "New Challenges - New Approaches?". With this theme, the conference sought to articulate some of the current challenges in psychosomatic medicine and to determine whether these challenges could be addressed with existing treatments or require new approaches. Ironically, a challenge unforeseen at the time of the initial conference planning has led to its delay. A letter in this issue reports the psychological distress experienced by staff at the Fifth Affiliated Hospital of Sun Yat-sen University and shows similar distress for staff regardless of age or whether they are providing direct care for patients with COVID-19 [1]. The Liang et al. letter is the first of what will likely be many COVID-19 articles in the journal. We have already been inundated with submissions on the topic and will feature the best of these in the issues ahead. A special issue on the topic was considered although seems unnecessary to attract content on this exploding public health issue. An upcoming editorial by Brett Thombs of McGill University in Montreal, Canada outlines the plans of he and his colleagues to curate a living systematic review, which will involve continual updating of all COVID-19-related mental health evidence. The Journal of Psychosomatic Research is delighted to collaborate with them in this effort, which will provide an up-to-date resource on this rapidly developing topic [2].

Biomarkers pose some promise as a new approach for the assessment and management of psychosomatic disorders. This issue features an article by Zou and colleagues at Sichuan University in China that found higher levels of interleukin 6 in those with generalized anxiety disorder relative to controls and even higher levels in those with panic disorder compared to those with generalized anxiety disorder. These higher levels of interleukin 6 were also associated with a better response to escitalopram in panic disorder [3]. Meanwhile, Yao and Li of Wuhan University in China demonstrated higher serum complement C1q levels in those with major depression relative to controls and these concentrations were also correlated with the Hamilton Depression Rating Scale [4]. Their findings suggest a novel biomarker that could be included in future studies looking for a biomarker signature of major depressive disorder, such as was published by van Buel and colleagues last year in the journal [5]. Lever-van Milligen and colleagues at Universiteit Amsterdam assessed some overlapping physiological stress markers in the Netherlands Study of Depression and Anxiety. Inflammatory markers were associated with weaker hand grip strength and lower lung function as measured by peak flow. Lower peak flow recordings were also associated with higher salivary cortisol levels [6].

Two papers in this issue serve to advance the nosology of psychosomatic disorders. Tu and colleagues at the National Taiwan University Hospital assessed DSM-5-based severity ratings in 123 patients with somatic symptom disorder and found severity was indeed related to levels of somatic distress and health anxiety and wasn't explained merely by comorbid medical and psychiatric diagnoses, providing some empirical support for these severity thresholds [7]. Häuser and his German colleagues found substantial overlap between somatic symptom disorder, bodily distress syndrome, and fibromyalgia in a representative sample in Germany [8]. This overlap lends support to the proposed unifying construct of functional somatic disorder [9,10]. We have recently published a Research Interview for Functional Somatic Disorders that may be useful for assessment of these conditions in research and would be feasible for use even in large, population-based studies [11]. The journal has a proud tradition of being at the forefront of disseminating research that shapes the psychiatric nosology of these conditions [10,[12], [13], [14], [15], [16], [17], [18], [19]].

Several papers in this issue prospectively assess clinically relevant outcomes. Rantanen and colleagues in Finland demonstrated non-melancholic depressive symptoms were associated with all-cause mortality in a cohort of middle-aged adults at risk for cardiovascular disease [20]. Two other prospective cohorts demonstrated an association between anxiety measures and physical health 12 months after implantable cardioverter defibrillator placement [21] and hospitalization and mortality, at least related to somatic anxiety, in patients chronically receiving dialysis [22]. Maeng and colleagues at the in the United States presented a retrospective analysis showing a reduction in emergency department revisits related to an intervention involving integration of social workers, mental health counselors and psychiatric nurses in rural hospitals supported by telepsychiatry consultation [23]. These sort of innovative health services will be necessary to meet global issues related to access to integrated care.

Currently, the world's health care systems are struggling to meet the demands posed by the COVID-19 pandemic. In addition to the devastating losses of life, physical morbidity, mental distress, and overall suffering, this pandemic brings much uncertainty. Against this backdrop, the rescheduling of a single scientific conference could seem almost trivial, as great an undertaking as it is for our organization, particularly those taking the lead in organizing the event such as Christoph Pieh, EAPM president Wolfgang Söllner. and EAPM administrator Isabel Winter. The EAPM plans to postpone the conference in Vienna until 2021. I hope to have the opportunity to see you all there. In the meantime, and most importantly, I extend my wishes for health and safety to our readership and our global community and my gratitude to those heeding the call to serve in whatever way that may be.

Jess G. Fiedorowicz.

Editor-in-Chief.