-
1.
Ultra-Processed Food Consumption and Mental Health: A Systematic Review and Meta-Analysis of Observational Studies.
Lane, MM, Gamage, E, Travica, N, Dissanayaka, T, Ashtree, DN, Gauci, S, Lotfaliany, M, O'Neil, A, Jacka, FN, Marx, W
Nutrients. 2022;14(13)
-
-
-
Free full text
Plain language summary
Poor dietary quality is well established as a potentially modifiable risk factor for mental disorders. The NOVA food classification system was recently developed to enable the categorisation of food items based on distinctive levels of processing. The aim of this study was to synthesise and provide quantitative analyses of the most up-to-date evidence assessing associations between consumption of ultra-processed food, as defined by the NOVA food classification system, and mental disorders. This study is systematic review and meta-analysis of 17 studies with a total of 385,541 participants. The studies were 15 cross-sectional and 2 prospectively designed studies. Results show that ultra-processed food consumption is bidirectionally associated with adverse mental health. In fact, greater intake of ultra-processed food was associated with increased odds of depressive and anxiety symptoms, both when these outcomes were assessed together as well as separately. Authors conclude that further prospective and experimental studies are required to better determine directionality and causality and ensure that global preventative and treatment strategies are efficacious and appropriate.
Abstract
Since previous meta-analyses, which were limited only to depression and by a small number of studies available for inclusion at the time of publication, several additional studies have been published assessing the link between ultra-processed food consumption and depression as well as other mental disorders. We aimed to build on previously conducted reviews to synthesise and meta-analyse the contemporary evidence base and clarify the associations between the consumption of ultra-processed food and mental disorders. A total of 17 observational studies were included (n = 385,541); 15 cross-sectional and 2 prospective. Greater ultra-processed food consumption was cross-sectionally associated with increased odds of depressive and anxiety symptoms, both when these outcomes were assessed together (common mental disorder symptoms odds ratio: 1.53, 95%CI 1.43 to 1.63) as well as separately (depressive symptoms odds ratio: 1.44, 95%CI 1.14 to 1.82; and, anxiety symptoms odds ratio: 1.48, 95%CI 1.37 to 1.59). Furthermore, a meta-analysis of prospective studies demonstrated that greater ultra-processed food intake was associated with increased risk of subsequent depression (hazard ratio: 1.22, 95%CI 1.16 to 1.28). While we found evidence for associations between ultra-processed food consumption and adverse mental health, further rigorously designed prospective and experimental studies are needed to better understand causal pathways.
-
2.
Online-Delivered Group and Personal Exercise Programs to Support Low Active Older Adults' Mental Health During the COVID-19 Pandemic: Randomized Controlled Trial.
Beauchamp, MR, Hulteen, RM, Ruissen, GR, Liu, Y, Rhodes, RE, Wierts, CM, Waldhauser, KJ, Harden, SH, Puterman, E
Journal of medical Internet research. 2021;23(7):e30709
-
-
-
Free full text
Plain language summary
A widely scalable, nonpharmacological, and cost-effective approach promoted by the World Health Organization to support mental health during the pandemic corresponds to regular physical activity. The aim of this study was to assess whether a group-based online exercise programme or a personal online exercise programme compared to a waitlist control can improve the psychological health of previously low active older adults during the early stages of the COVID-19 pandemic. The study is a prospective, 3-arm, parallel, randomized controlled trial. Two-hundred and forty-one low active older adults, aged between 65 and 69 years, were enrolled in the study. Participants were stratified to ensure equal distribution of men and women across conditions. Results indicate that both physical activity programmes showed improvements in mental health when compared with control participants, which represents a notable outcome for older adults in the current COVID-19 pandemic. Authors conclude that virtually delivered interventions are feasible and, when delivered in a group setting, can aid the retention of previously low active older adults.
Abstract
BACKGROUND In response to the COVID-19 pandemic, experts in mental health science emphasized the importance of developing and evaluating approaches to support and maintain the mental health of older adults. OBJECTIVE The aim of this study was to assess whether a group-based exercise program relative to a personal exercise program (both delivered online) and waitlist control (WLC) can improve the psychological health of previously low active older adults during the early stages of the COVID-19 pandemic. METHODS The Seniors COVID-19 Pandemic and Exercise (SCOPE) trial was a 3-arm, parallel randomized controlled trial conducted between May and September 2020 in which low active older adults (aged ≥65 years) were recruited via media outlets and social media. After baseline assessments, consented participants were randomized to one of two 12-week exercise programs (delivered online by older adult instructors) or a WLC condition. A total of 241 older adults (n=187 women) provided baseline measures (via online questionnaires), were randomized (ngroup=80, npersonal=82, ncontrol=79), and completed measures every 2 weeks for the duration of the trial. The trial's primary outcome was psychological flourishing. Secondary outcomes included global measures of mental and physical health, life satisfaction, and depression symptoms. RESULTS The results of latent growth modeling revealed no intervention effects for flourishing, life satisfaction, or depression symptoms (P>.05 for all). Participants in the group condition displayed improved mental health relative to WLC participants over the first 10 weeks (effect size [ES]=0.288-0.601), and although the week 12 effect (ES=0.375) was in the same direction the difference was not statistically significant (P=.089). Participants in the personal condition displayed improved mental health, when compared with WLC participants, in the same medium ES range (ES=0.293-0.565) over the first 8 weeks, and while the effects were of a similar magnitude at weeks 10 (ES=0.455, P=.069) and 12 (ES=0.258, P=.353), they were not statistically significant. In addition, participants in the group condition displayed improvements in physical health when compared with the WLC (ES=0.079-0.496) across all 12 weeks of the study following baseline. No differences were observed between the personal exercise condition and WLC for physical health (slope P=.271). CONCLUSIONS There were no intervention effects for the trial's primary outcome (ie, psychological flourishing). It is possible that the high levels of psychological flourishing at baseline may have limited the extent to which those indicators could continue to improve further through intervention (ie, potential ceiling effects). However, the intervention effects for mental and physical health point to the potential capacity of low-cost and scalable at-home programs to support the mental and physical health of previously inactive adults in the COVID-19 pandemic. TRIAL REGISTRATION ClinicalTrials.gov NCT04412343; https://clinicaltrials.gov/ct2/show/NCT04412343.
-
3.
Augmenting Clinical Interventions in Psychiatric Disorders: Systematic Review and Update on Nutrition.
Offor, SJ, Orish, CN, Frazzoli, C, Orisakwe, OE
Frontiers in psychiatry. 2021;12:565583
-
-
-
Free full text
Plain language summary
Mental disorders are widespread and impact significantly on health. “Nutritional psychiatry” pivots on the impact of nutrition (food) on the state of mind and mood. The aim of this study was to justify the inclusion and recognition of nutrition in the management of psychiatric illnesses. This study is a systemic review which included 97 studies. The literature shows that several foods and food compounds modulate biomarkers and molecular mechanisms involved in the aetiogenesis [the origin and development of a pathological condition] of several mental disorders. Furthermore, the evidence-based approach warrants the inclusion and co-recognition of nutrition in the management of psychiatric illnesses. Authors conclude that there is a need to advocate for policies aimed at bridging the knowledge gap and encourage the utilization and integration of nutrition in addition to contemporary therapies in clinical settings.
Abstract
There is a strong relationship between a healthy diet and mental well-being. Several foods and food compounds are known to modulate biomarkers and molecular mechanisms involved in the aetiogenesis of several mental disorders, and this can be useful in containing the disease progression, including its prophylaxis. This is an updated systematic review of the literature to justify the inclusion and recognition of nutrition in the management of psychiatric illnesses. Such foods and their compounds include dietary flavanols from fruits and vegetables, notable antioxidant and anti-inflammatory agents, probiotics (fermented foods) known to protect good gut bacteria, foods rich in polyunsaturated fatty acids (e.g., Omega-3), and avoiding diets high in saturated fats and refined sugars among others. While the exact mechanism(s) of mitigation of many nutritional interventions are yet to be fully understood, the evidence-based approach warrants the inclusion and co-recognition of nutrition in the management of psychiatric illnesses. For the greater public health benefit, there is a need for policy advocacy aimed at bridging the knowledge gap and encouraging the integration of nutritional intervention with contemporary therapies in clinical settings, as deficiencies of certain nutrients make therapy difficult even with appropriate medication.
-
4.
Simple Mobile technology health management tool for people with severe mental illness: a randomised controlled feasibility trial.
Röhricht, F, Padmanabhan, R, Binfield, P, Mavji, D, Barlow, S
BMC psychiatry. 2021;21(1):357
-
-
-
Free full text
Plain language summary
A small percentage of the population experience severe mental illness (SMI) during their lifetime. About a third of these patients develop a more chronic course of their illness, particularly those with chronic psychosis. Mobile health (“m-health”) technology has been increasingly proposed and tested to foster self-management, monitor signs of relapse via self-report, and to improve attendance rate for routine appointments and medication adherence. The aim of this study was to explore the feasibility and the potential clinical benefits of SMI-specific mobile technology health management tool (‘Florence’) to enhance community care for people with SMI. This study was a randomised-controlled pilot study (n = 65) with two trial arms; control group - received routine community mental health care under the Care Programme Approach (treatment as usual / TAU) and the intervention group - received enhanced community care intervention that uses interactive SMS communication tools in addition to TAU). Results demonstrate that: - it is feasible to implement the intervention within this patient cohort and that the study design can be delivered. - no harmful effects were observed as a result of the trial. - participants in the TAU arm showed enthusiasm to use the intervention as well. - the intervention could be customised to meet individual preferences, as some of the participants felt either quickly fatigued by the frequency of messages or felt that they were too intrusive. Authors conclude that the health technology tool appeared to offer a practicable and acceptable intervention for patients with SMI in managing their condition.
Abstract
BACKGROUND Severe mental illness (SMI) is associated with care delivery problems because of the high levels of clinical resources needed to address patient's psychosocial impairment and to support inclusion in society. Current routine appointment systems do not adequately foster recovery care and are not systematically capturing information suggestive of urgent care needs. This study aimed to assess the feasibility, acceptability, and potential clinical benefits of a mobile technology health management tool to enhance community care for people with severe mental illness. METHODS This randomised-controlled feasibility pilot study utilised mixed quantitative (measure on subjective quality of life as primary outcome; questionnaires on self-management skills, medication adherence scale as secondary outcomes) and qualitative (thematic analysis) methodologies. The intervention was a simple interactive technology (Short Message Service - SMS) communication system called 'Florence', and had three components: medication and appointment reminders, daily individually defined wellbeing scores and optionally coded request for additional support. Eligible participants (diagnosed with schizophrenia, schizoaffective disorder or bipolar disorder ≥1 year) were randomised (1:1) to either treatment as usual (TAU, N = 29) or TAU and the technology-assisted intervention (N = 36). RESULTS Preliminary results suggest that the health technology tool appeared to offer a practicable and acceptable intervention for patients with SMI in managing their condition. Recruitment and retention data indicated feasibility, the qualitative analysis identified suggestions for further improvement of the intervention. Patients engaged well and benefited from SMS reminders and from monitoring their individual wellbeing scores; recommendations were made to further personalise the intervention. The care coordinators did not utilise aspects of the intervention per protocol due to a variety of organisational barriers. Quantitative analysis of outcomes (including a patient-reported outcome measure on subjective quality of life, self-efficacy/competence and medication adherence measures) did not identify significant changes between groups over time in favour of the Florence intervention, given high baseline scores. The wellbeing scores, however, were positively correlated with all outcome measures. CONCLUSION It is feasible to conduct an adequately powered full trial to evaluate this intervention. Inclusion criteria should be revised to include patients with a higher level of need and clinicians should receive more in-depth assistance in managing the tools effectively. The preliminary data suggests that this intervention can aid recovery care and individually defined wellbeing scores are highly predictive of a range of recovery outcomes; they could, therefore, guide the allocation of routine care resources. TRIAL REGISTRATION ISRCTN34124141 ; retrospectively registered, date of registration 05/11/2019.
-
5.
Vitamin D and probiotic co-supplementation affects mental health, hormonal, inflammatory and oxidative stress parameters in women with polycystic ovary syndrome.
Ostadmohammadi, V, Jamilian, M, Bahmani, F, Asemi, Z
Journal of ovarian research. 2019;12(1):5
-
-
-
Free full text
Plain language summary
Polycystic ovary syndrome (PCOS) is a common cause of female infertility. Whilst the exact cause of PCOS is not known, high levels of male hormones, inflammation and oxidative damage are thought to contribute to the development of PCOS. Both probiotics and vitamin D supplements have been demonstrated to have anti-inflammatory and anti-oxidant effects. The aim of this study was to determine the effect of combined vitamin D and probiotic supplementation on mental health, hormonal, inflammatory and oxidative stress parameters in women with PCOS. This randomised, double-blinded, placebo-controlled clinical trial was carried out on 60 women with PCOS aged 18-40 years old in Iran. The women were randomly allocated to take either 50,000 IU vitamin D every 2 weeks plus 8 × 109 CFU/day probiotic or a placebo for 12 weeks. The probiotic capsule contained four strains: Lactobacillus acidophilus, Bifidobacterium bifidum, Lactobacillus reuteri and Lactobacillus fermentum (2 × 109 CFU/g each). Vitamin D and probiotic supplementation significantly improved mental health and general health scores, compared with the placebo. Vitamin D and probiotic supplementation was associated with a significant reduction in total testosterone (mean reduction of 0.19 ng/mL), excess body/facial hair, high-sensitivity C-reactive protein (hs-CRP) and malondialdehyde (MDA) levels, and a significant increase in total antioxidant capacity (TAC) and total glutathione (GSH) levels, compared with the placebo. Vitamin D and probiotic supplementation did not affect serum sex-hormone binding globulin (SHBG) or nitric oxide levels. There were no effects on acne or alopecia. The authors concluded that the co-administration of vitamin D and probiotic for 12 weeks to women with PCOS had beneficial effects on mental health parameters, serum total testosterone, hirsutism, hs-CRP, plasma TAC, GSH and MDA levels
Abstract
OBJECTIVE The aim of this study was to determine the effect of vitamin D and probiotic co-administration on mental health, hormonal, inflammatory and oxidative stress parameters in women with polycystic ovary syndrome (PCOS). METHODS This randomized, double-blinded, placebo-controlled clinical trial was carried out on 60 subjects, aged 18-40 years old. Subjects were randomly allocated to take either 50,000 IU vitamin D every 2 weeks plus 8 × 109 CFU/day probiotic (n = 30) or placebo (n = 30) for 12 weeks. RESULTS Vitamin D and probiotic co-supplementation, compared with the placebo, significantly improved beck depression inventory [β (difference in the mean of outcomes measures between treatment groups) - 0.58; 95% CI, - 1.15, - 0.02; P = 0.04], general health questionnaire scores (β - 0.93; 95% CI, - 1.78, - 0.08; P = 0.03) and depression, anxiety and stress scale scores (β - 0.90; 95% CI, - 1.67, - 0.13; P = 0.02). Vitamin D and probiotic co-supplementation was associated with a significant reduction in total testosterone (β - 0.19 ng/mL; 95% CI, - 0.28, - 0.10; P < 0.001), hirsutism (β - 0.95; 95% CI, - 1.39, - 0.51; P < 0.001), high-sensitivity C-reactive protein (hs-CRP) (β - 0.67 mg/L; 95% CI, - 0.97, - 0.38; P < 0.001) and malondialdehyde (MDA) levels (β - 0.25 μmol/L; 95% CI, - 0.40, - 0.10; P = 0.001), and a significant increase in total antioxidant capacity (TAC) (β 82.81 mmol/L; 95% CI, 42.86, 122.75; P < 0.001) and total glutathione (GSH) levels (β 40.42 μmol/L; 95% CI, 4.69, 76.19; P = 0.02), compared with the placebo. CONCLUSIONS Overall, the co-administration of vitamin D and probiotic for 12 weeks to women with PCOS had beneficial effects on mental health parameters, serum total testosterone, hirsutism, hs-CRP, plasma TAC, GSH and MDA levels. TRIAL REGISTRATION This study was retrospectively registered in the Iranian website ( www.irct.ir ) for registration of clinical trials ( IRCT20170513033941N37 ).
-
6.
A Mediterranean-style dietary intervention supplemented with fish oil improves diet quality and mental health in people with depression: A randomized controlled trial (HELFIMED).
Parletta, N, Zarnowiecki, D, Cho, J, Wilson, A, Bogomolova, S, Villani, A, Itsiopoulos, C, Niyonsenga, T, Blunden, S, Meyer, B, et al
Nutritional neuroscience. 2019;22(7):474-487
-
-
-
Plain language summary
Observational studies have shown that a healthy diet is associated with a reduced risk for depression. This study investigated whether a Mediterranean-style diet supplemented with fish oil can improve mental health in adults suffering depression. Adults with self-reported depression were randomised to receive fortnightly food hampers and Mediterranean diet cooking workshops for 3 months and fish oil supplements for 6 months, or attend social groups fortnightly for 3 months. Assessments at baseline, 3 and 6 months included mental health, quality of life and dietary questionnaires, and blood samples for fatty acid analysis. Both groups experienced in improvements in their mental health. The Mediterranean diet group had greater reduction in depression and improved mental health quality of life scores at 3 months and 6 months. Reduced depression was correlated with an increased Mediterranean diet score, nuts and vegetable diversity. Other mental health improvements were associated with increased vegetable diversity and legumes. There were some correlations between increased omega-3, decreased omega-6 and improved mental health. The authors suggest that getting back to basics by promoting cooking skills and family/group meals could be a simple yet powerful and empowering approach to healthcare and prevention.
Abstract
OBJECTIVES We investigated whether a Mediterranean-style diet (MedDiet) supplemented with fish oil can improve mental health in adults suffering depression. METHODS Adults with self-reported depression were randomized to receive fortnightly food hampers and MedDiet cooking workshops for 3 months and fish oil supplements for 6 months, or attend social groups fortnightly for 3 months. Assessments at baseline, 3 and 6 months included mental health, quality of life (QoL) and dietary questionnaires, and blood samples for erythrocyte fatty acid analysis. RESULTS n = 152 eligible adults aged 18-65 were recruited (n = 95 completed 3-month and n = 85 completed 6-month assessments). At 3 months, the MedDiet group had a higher MedDiet score (t = 3.95, P < 0.01), consumed more vegetables (t = 3.95, P < 0.01), fruit (t = 2.10, P = 0.04), nuts (t = 2.29, P = 0.02), legumes (t = 2.41, P = 0.02) wholegrains (t = 2.63, P = 0.01), and vegetable diversity (t = 3.27, P < 0.01); less unhealthy snacks (t = -2.10, P = 0.04) and red meat/chicken (t = -2.13, P = 0.04). The MedDiet group had greater reduction in depression (t = -2.24, P = 0.03) and improved mental health QoL scores (t = 2.10, P = 0.04) at 3 months. Improved diet and mental health were sustained at 6 months. Reduced depression was correlated with an increased MedDiet score (r = -0.298, P = 0.01), nuts (r = -0.264, P = 0.01), and vegetable diversity (r = -0.303, P = 0.01). Other mental health improvements had similar correlations, most notably for increased vegetable diversity and legumes. There were some correlations between increased omega-3, decreased omega-6 and improved mental health. DISCUSSION This is one of the first randomized controlled trials to show that healthy dietary changes are achievable and, supplemented with fish oil, can improve mental health in people with depression.
-
7.
Predictors of Improvements in Mental Health From Mindfulness Meditation in Stressed Older Adults.
Oken, BS, Goodrich, E, Klee, D, Memmott, T, Proulx, J
Alternative therapies in health and medicine. 2018;24(1):48-55
-
-
-
Free full text
Plain language summary
A mindfulness meditation (MM) practice has been successful in a variety of clinical conditions by reducing stress levels and improving mental health. Given the complexity of psychological stress, MM interventions tend to help some more than others but the reasons for this are not well understood. The aim of this study was to determine whether baseline measures could produce a predictive model for individual responsiveness to an MM intervention. This secondary analysis was performed based on a previously completed randomised controlled trial. This analysis found that an MM intervention was most effective for those with the worst baseline mental health scores. Unfortunately the available data was unable to produce a predictive model for identifying individuals who would best respond to intervention. Based on this study, the authors suggest future studies use additional predictor and outcome variables to better understand MM-induced improvements.
Abstract
Context • The benefits of a mindfulness meditation (MM) intervention are most often evidenced by improvements in self-rated stress and mental health. Given the physiological complexity of the psychological stress system, it is likely that some people benefit significantly, whereas others do not. Clinicians and researchers could benefit from further exploration to determine which baseline factors can predict clinically significant improvements from MM. Objectives • The study intended to determine (1) whether the baseline measures for participants who significantly benefitted from MM training were different from the baseline measures of participants who did not, and (2) whether a classification analysis using a decision-tree, machine-learning approach could be useful in predicting which individuals would be most likely to improve. Design • The research team performed a secondary analysis of a previously completed randomized, controlled clinical trial. Setting • The study occurred at the Oregon Health & Science University (Portland, OR, USA) and in participants' homes. Participants • Participants were 134 stressed, generally healthy adults from the metropolitan area of Portland, Oregon, who were 50 to 85 y old. Intervention • Participants were randomly assigned either to a 6-wk MM intervention group or to a waitlist control group, who received the same MM intervention after the waitlist period. Outcome Measures • Outcome measures were assessed at baseline and at 2-mo follow-up intervals. A responder was defined as someone who demonstrated a moderate, clinically significant improvement on the mental health component (MHC) of the short-form health-related quality of life (SF-36) (ie, a change ≥4). The MHC had demonstrated the greatest effect size in the primary analysis of the previously mentioned randomized, controlled clinical trial. Potential predictors were demographic information and baseline measures related to stress and affect. Univariate statistical analyses were performed to compare the values of predictors in the responder and nonresponder groups. In addition, predictors were chosen for a classification analysis using a decision tree approach. Results • Of the 134 original participants, 121 completed the MM intervention. As defined previously, 61 were responders and 60 were nonresponders. Analyses of the baseline measures demonstrated significant differences between the 2 groups in several measures: (1) the positive and negative affect schedule negative subscale (PANAS-neg), (2) the SF-36-MHC, and (3) the SF-36 energy/fatigue, with clinically worse scores being associated with greater likelihood of being a responder. Disappointingly, the decision-tree analyses were unable to achieve a classification rate of better than 65%. Conclusions • The differences in predictor variables between responders and nonresponders to an MM intervention suggested that those with worse mental health at baseline were more likely to improve. Decision-tree analysis was unable to usefully predict who would respond to the intervention.
-
8.
Structured lifestyle education to support weight loss for people with schizophrenia, schizoaffective disorder and first episode psychosis: the STEPWISE RCT.
Holt, RI, Hind, D, Gossage-Worrall, R, Bradburn, MJ, Saxon, D, McCrone, P, Morris, TA, Etherington, A, Shiers, D, Barnard, K, et al
Health technology assessment (Winchester, England). 2018;22(65):1-160
-
-
-
Free full text
Plain language summary
People with schizophrenia are often overweight. Losing weight and being more active can reduce the risk of type 2 diabetes mellitus, heart disease and dying early. The NHS recommends offering a weight loss programme; however, mental health care providers do not know the best way to do this. This study assessed whether an education programme to help people with psychosis to lose weight would be better than the usual care provided by the NHS. A total of 414 people took part. Half were selected at random to attend an education programme run by trained facilitators. The other half received their usual health care. The researchers found no difference in weight between the two groups, at either 3 months or 12 months. They also found that the programme did not provide good value for money. In interviews, service users said that they liked the education programme and that it helped them to eat healthily and lose weight. However, there was no change in their diet and activity levels in either group. Unfortunately, although some people benefited, the programme did not work for most people. The researchers concluded that they need to look for better ways to help people with psychosis to lose weight.
Abstract
BACKGROUND Obesity is twice as common in people with schizophrenia as in the general population. The National Institute for Health and Care Excellence guidance recommends that people with psychosis or schizophrenia, especially those taking antipsychotics, be offered a healthy eating and physical activity programme by their mental health care provider. There is insufficient evidence to inform how these lifestyle services should be commissioned. OBJECTIVES To develop a lifestyle intervention for people with first episode psychosis or schizophrenia and to evaluate its clinical effectiveness, cost-effectiveness, delivery and acceptability. DESIGN A two-arm, analyst-blind, parallel-group, randomised controlled trial, with a 1 : 1 allocation ratio, using web-based randomisation; a mixed-methods process evaluation, including qualitative case study methods and logic modelling; and a cost-utility analysis. SETTING Ten community mental health trusts in England. PARTICIPANTS People with first episode psychosis, schizophrenia or schizoaffective disorder. INTERVENTIONS Intervention group: (1) four 2.5-hour group-based structured lifestyle self-management education sessions, 1 week apart; (2) multimodal fortnightly support contacts; (3) three 2.5-hour group booster sessions at 3-monthly intervals, post core sessions. Control group: usual care assessed through a longitudinal survey. All participants received standard written lifestyle information. MAIN OUTCOME MEASURES The primary outcome was change in weight (kg) at 12 months post randomisation. The key secondary outcomes measured at 3 and 12 months included self-reported nutrition (measured with the Dietary Instrument for Nutrition Education questionnaire), objectively measured physical activity measured by accelerometry [GENEActiv (Activinsights, Kimbolton, UK)], biomedical measures, adverse events, patient-reported outcome measures and a health economic assessment. RESULTS The trial recruited 414 participants (intervention arm: 208 participants; usual care: 206 participants) between 10 March 2015 and 31 March 2016. A total of 341 participants (81.6%) completed the trial. A total of 412 participants were analysed. After 12 months, weight change did not differ between the groups (mean difference 0.0 kg, 95% confidence interval -1.59 to 1.67 kg; p = 0.964); physical activity, dietary intake and biochemical measures were unchanged. Glycated haemoglobin, fasting glucose and lipid profile were unchanged by the intervention. Quality of life, psychiatric symptoms and illness perception did not change during the trial. There were three deaths, but none was related to the intervention. Most adverse events were expected and related to the psychiatric illness. The process evaluation showed that the intervention was acceptable, with participants valuing the opportunity to interact with others facing similar challenges. Session feedback indicated that 87.2% of participants agreed that the sessions had met their needs. Some indicated the desire for more ongoing support. Professionals felt that the intervention was under-resourced and questioned the long-term sustainability within current NHS settings. Professionals would have preferred greater access to participants' behaviour data to tailor the intervention better. The incremental cost-effectiveness ratio from the health-care perspective is £246,921 per quality-adjusted life-year (QALY) gained and the incremental cost-effectiveness ratio from the societal perspective is £367,543 per QALY gained. CONCLUSIONS Despite the challenges of undertaking clinical research in this population, the trial successfully recruited and retained participants, indicating a high level of interest in weight management interventions; however, the STEPWISE intervention was neither clinically effective nor cost-effective. Further research will be required to define how overweight and obesity in people with schizophrenia should be managed. The trial results suggest that lifestyle programmes for people with schizophrenia may need greater resourcing than for other populations, and interventions that have been shown to be effective in other populations, such as people with diabetes mellitus, are not necessarily effective in people with schizophrenia. TRIAL REGISTRATION Current Controlled Trials ISRCTN19447796. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 65. See the NIHR Journals Library website for further project information.
-
9.
The influence of hazardous drinking on psychological functioning, stress and sleep during and after treatment in patients with mental health problems: a secondary analysis of a randomised controlled intervention study.
Strid, C, Andersson, C, Öjehagen, A
BMJ open. 2018;8(3):e019128
-
-
-
Free full text
Plain language summary
Hazardous drinking can negatively affect physical and mental health. It is unclear how hazardous drinking influences the chance of success of treatment in people with mental health problems. The aim of this study was to examine whether hazardous drinking, measured using a scale called AUDIT-C (Alcohol Use Disorders Identification Test-Consumption), influences psychological functioning, stress and sleep, during and after treatment in patients with mental ill health. This study was part of a larger trial aimed at comparing Internet-based cognitive-behaviour therapy (CBT) and physical exercise with usual treatment on patients with mental ill health. The study involved 871 participants who completed the AUDIT at baseline and were assessed during and after treatment on psychological functioning, stress and sleep. At baseline, hazardous drinkers were more depressed and had lower scores on psychological functioning than non-hazardous drinkers, while there were no differences on stress and sleep. During the follow-ups, hazardous drinking negatively influenced perception of stress, and the results remained after controlling for depression. There were no differences during the follow-ups regarding psychological functioning and sleep. The findings of the study emphasise the importance of screening for alcohol habits in mental health patients, since risky drinking may affect the outcomes of treatment.
Abstract
OBJECTIVES Hazardous drinking could negatively affect health and lead to alcohol use disorders, but it is unclear how hazardous drinking affects treatment outcomes of depression and anxiety and stress-related mental health problems. The aim of this study was to examine whether hazardous drinking, measured by Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), influences the outcomes of repeated assessments of psychological functioning (Outcome Questionnaire-45), stress (Perceived Stress Scale) and sleep (Karolinska Sleep Questionnaire), during and after treatment in patients with mental ill health. METHODS The study was conducted within REGASSA, a randomised controlled trial aimed at comparing Internet-based cognitive-behaviour therapy and physical exercise with treatment as usual on primary care patients with mental ill health. The study involved 871 participants who completed the AUDIT at baseline and who were assessed repeatedly during and after treatment on psychological functioning, stress and sleep by interactive voice response, a computerised, automated telephone technology. RESULTS At baseline, hazardous drinkers were more depressed and had lower scores on psychological functioning than non-hazardous drinkers, while there were no differences on stress and sleep. During the follow-ups, hazardous drinking negatively influenced perceived stress, that is, hazardous drinkers seemed to have less treatment effect on stress, and the results remained after controlling for depression. There were no differences during the follow-ups regarding psychological functioning and sleep. CONCLUSIONS Hazardous drinking negatively influenced perceived stress. The findings of the study emphasise the importance of screening for alcohol habits in mental ill-health patients, since risky drinking may affect the outcomes of treatment. TRIAL REGISTRATION NUMBER DRKS00008745; Post-results.
-
10.
Effect of Mindfulness-Based Stress Reduction Therapy on Work Stress and Mental Health of Psychiatric Nurses.
Yang, J, Tang, S, Zhou, W
Psychiatria Danubina. 2018;30(2):189-196
-
-
-
Free full text
Plain language summary
Many studies have found mindfulness-based stress reduction (MBSR) therapy to significantly reduce stress levels and enhance wellbeing. Among healthcare practitioners, psychiatric nurses experience higher stress and poorer mental health. Therefore the aim of this study was to examine the effects of MBSR on the mental health of 100 psychiatric nurses in China. Nurses were randomised to either receive psychological support including MBSR or to receive psychological support without MBSR weekly. Mental health assessments were taken at baseline and completion of the intervention. This study found that while all participants showed improvements in mental health, those receiving MBSR experienced significant improvement compared with the control group. Based on these results the authors conclude that MBSR therapy is conducive to reducing work-related stress of psychiatric nurses.
Abstract
BACKGROUND Psychiatric nurses are a special group of nursing staff, they experience greater work stress and lower mental health levels than regular nurses. In order to address this problem, the effect of mindfulness-based stress reduction (MBSR) therapy on work stress and mental health of psychiatric nurses is investigated in this study. SUBJECTS AND METHODS From August 2017 to November 2017, 100 psychiatric nurses, including 68 females and 32 males, were selected as participants from three hospitals in Hunan Province of China. They were randomly divided into the intervention and control groups, with 50 respondents in each group. MBSR therapy was used as psychological intervention in the intervention group. Before and after the intervention, the two groups were assessed with the Symptom Checklist-90 (SCL-90) scale, Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS), and Nursing Stress Scale. RESULTS (1) After the intervention, the SCL-90 score of the intervention group decrease significantly, and a statistically significant difference is observed with the figure before the intervention (P<0.001). No statistically significant difference is found in the control group (P>0.05). (2) After the intervention, the SDS and SAS scores of the intervention group decrease significantly, and a statistically significant difference is observed with the figures before the intervention (P<0.001). No statistically significant difference is found in the control group (P>0.05). (3) After the intervention, the Nursing Stress Scale score of the intervention group Nursing Stress Scale decrease significantly, and a statistically significant difference is observed with the figure before the intervention (P<0.001). No statistically significant difference is found in the control group (P>0.05). CONCLUSIONS MBSR therapy can reduce work stress, anxiety, depression, and other negative emotions among psychiatric nurses and improve their mental health.