Showing papers on "Mental health published in 2014"
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TL;DR: This work focuses on nature as represented by aspects of the physical environment relevant to planning, design, and policy measures that serve broad segments of urbanized societies and considers research on pathways between nature and health involving air quality, physical activity, social cohesion, and stress reduction.
Abstract: Urbanization, resource exploitation, and lifestyle changes have diminished possibilities for human contact with nature in many societies. Concern about the loss has helped motivate research on the health benefits of contact with nature. Reviewing that research here, we focus on nature as represented by aspects of the physical environment relevant to planning, design, and policy measures that serve broad segments of urbanized societies. We discuss difficulties in defining “nature” and reasons for the current expansion of the research field, and we assess available reviews. We then consider research on pathways between nature and health involving air quality, physical activity, social cohesion, and stress reduction. Finally, we discuss methodological issues and priorities for future research. The extant research does describe an array of benefits of contact with nature, and evidence regarding some benefits is strong; however, some findings indicate caution is needed in applying beliefs about those benefits,...
2,046 citations
TL;DR: Despite a substantial degree of inter-survey heterogeneity in the meta-analysis, the findings confirm that common mental disorders are highly prevalent globally, affecting people across all regions of the world.
Abstract: Background: Since the introduction of specified diagnostic criteria for mental disorders in the 1970s, there has been a rapid expansion in the number of large-scale mental health surveys providing population estimates of the combined prevalence of common mental disorders (most commonly involving mood, anxiety and substance use disorders). In this study we undertake a systematic review and meta-analysis of this literature.
Methods: We applied an optimized search strategy across the Medline, PsycINFO, EMBASE and PubMed databases, supplemented by hand searching to identify relevant surveys. We identified 174 surveys across 63 countries providing period prevalence estimates (155 surveys) and lifetime prevalence estimates (85 surveys). Random effects meta-analysis was undertaken on logit-transformed prevalence rates to calculate pooled prevalence estimates, stratified according to methodological and substantive groupings.
Results: Pooling across all studies, approximately 1 in 5 respondents (17.6%, 95% confidence interval:16.3–18.9%) were identified as meeting criteria for a common mental disorder during the 12-months preceding assessment; 29.2% (25.9–32.6%) of respondents were identified as having experienced a common mental disorder at some time during their lifetimes. A consistent gender effect in the prevalence of common mental disorder was evident; women having higher rates of mood (7.3%:4.0%) and anxiety (8.7%:4.3%) disorders during the previous 12 months and men having higher rates of substance use disorders (2.0%:7.5%), with a similar pattern for lifetime prevalence. There was also evidence of consistent regional variation in the prevalence of common mental disorder. Countries within North and South East Asia in particular displayed consistently lower one-year and lifetime prevalence estimates than other regions. One-year prevalence rates were also low among Sub-Saharan-Africa, whereas English speaking counties returned the highest lifetime prevalence estimates.
Conclusions: Despite a substantial degree of inter-survey heterogeneity in the meta-analysis, the findings confirm that common mental disorders are highly prevalent globally, affecting people across all regions of the world. This research provides an important resource for modelling population needs based on global regional estimates of mental disorder. The reasons for regional variation in mental disorder require further investigation.
1,821 citations
TL;DR: Clinicians should be aware that meditation programs can result in small to moderate reductions of multiple negative dimensions of psychological stress and should be prepared to talk with their patients about the role that a meditation program could have in addressing psychological stress.
Abstract: Importance Many people meditate to reduce psychological stress and stress-related health problems. To counsel people appropriately, clinicians need to know what the evidence says about the health benefits of meditation. Objective To determine the efficacy of meditation programs in improving stress-related outcomes (anxiety, depression, stress/distress, positive mood, mental health–related quality of life, attention, substance use, eating habits, sleep, pain, and weight) in diverse adult clinical populations. Evidence Review We identified randomized clinical trials with active controls for placebo effects through November 2012 from MEDLINE, PsycINFO, EMBASE, PsycArticles, Scopus, CINAHL, AMED, the Cochrane Library, and hand searches. Two independent reviewers screened citations and extracted data. We graded the strength of evidence using 4 domains (risk of bias, precision, directness, and consistency) and determined the magnitude and direction of effect by calculating the relative difference between groups in change from baseline. When possible, we conducted meta-analyses using standardized mean differences to obtain aggregate estimates of effect size with 95% confidence intervals. Findings After reviewing 18 753 citations, we included 47 trials with 3515 participants. Mindfulness meditation programs had moderate evidence of improved anxiety (effect size, 0.38 [95% CI, 0.12-0.64] at 8 weeks and 0.22 [0.02-0.43] at 3-6 months), depression (0.30 [0.00-0.59] at 8 weeks and 0.23 [0.05-0.42] at 3-6 months), and pain (0.33 [0.03- 0.62]) and low evidence of improved stress/distress and mental health–related quality of life. We found low evidence of no effect or insufficient evidence of any effect of meditation programs on positive mood, attention, substance use, eating habits, sleep, and weight. We found no evidence that meditation programs were better than any active treatment (ie, drugs, exercise, and other behavioral therapies). Conclusions and Relevance Clinicians should be aware that meditation programs can result in small to moderate reductions of multiple negative dimensions of psychological stress. Thus, clinicians should be prepared to talk with their patients about the role that a meditation program could have in addressing psychological stress. Stronger study designs are needed to determine the effects of meditation programs in improving the positive dimensions of mental health and stress-related behavior.
1,625 citations
TL;DR: Recommendations to improve the surveillance of morbidity and mortality in homeless people are discussed, including programmes focused on high-risk groups, such as individuals leaving prisons, psychiatric hospitals and the child welfare system, and the introduction of national and state-wide plans that target homeless people.
977 citations
TL;DR: The complex elements of stigma are reviewed in order to understand its impact on participating in care and public policy considerations in seeking to tackle stigma in orderto improve treatment engagement are summarized.
Abstract: Treatments have been developed and tested to successfully reduce the symptoms and disabilities of many mental illnesses. Unfortunately, people distressed by these illnesses often do not seek out services or choose to fully engage in them. One factor that impedes care seeking and undermines the service system is mental illness stigma. In this article, we review the complex elements of stigma in order to understand its impact on participating in care. We then summarize public policy considerations in seeking to tackle stigma in order to improve treatment engagement. Stigma is a complex construct that includes public, self, and structural components. It directly affects people with mental illness, as well as their support system, provider network, and community resources. The effects of stigma are moderated by knowledge of mental illness and cultural relevance. Understanding stigma is central to reducing its negative impact on care seeking and treatment engagement. Separate strategies have evolved for counteracting the effects of public, self, and structural stigma. Programs for mental health providers may be especially fruitful for promoting care engagement. Mental health literacy, cultural competence, and family engagement campaigns also mitigate stigma's adverse impact on care seeking. Policy change is essential to overcome the structural stigma that undermines government agendas meant to promote mental health care. Implications for expanding the research program on the connection between stigma and care seeking are discussed.
938 citations
13 Sep 2014
TL;DR: A Dartmouth term lifecycle is identified in the data that shows students start the term with high positive affect and conversation levels, low stress, and healthy sleep and daily activity patterns, while stress appreciably rises while positive affect, sleep, conversation and activity drops off.
Abstract: Much of the stress and strain of student life remains hidden. The StudentLife continuous sensing app assesses the day-to-day and week-by-week impact of workload on stress, sleep, activity, mood, sociability, mental well-being and academic performance of a single class of 48 students across a 10 week term at Dartmouth College using Android phones. Results from the StudentLife study show a number of significant correlations between the automatic objective sensor data from smartphones and mental health and educational outcomes of the student body. We also identify a Dartmouth term lifecycle in the data that shows students start the term with high positive affect and conversation levels, low stress, and healthy sleep and daily activity patterns. As the term progresses and the workload increases, stress appreciably rises while positive affect, sleep, conversation and activity drops off. The StudentLife dataset is publicly available on the web.
917 citations
TL;DR: It is of major importance that action is taken to improve the conditions of everyday life, beginning before birth and progressing into early childhood, older childhood and adolescence, during family building and working ages, and through to older age, to reduce inequalities in physical health and improve health overall.
Abstract: A person's mental health and many common mental disorders are shaped by various social, economic, and physical environments operating at different stages of life. Risk factors for many common mental disorders are heavily associated with social inequalities, whereby the greater the inequality the higher the inequality in risk. The poor and disadvantaged suffer disproportionately, but those in the middle of the social gradient are also affected. It is of major importance that action is taken to improve the conditions of everyday life, beginning before birth and progressing into early childhood, older childhood and adolescence, during family building and working ages, and through to older age. Action throughout these life stages would provide opportunities for both improving population mental health, and for reducing risk of those mental disorders that are associated with social inequalities. As mental disorders are fundamentally linked to a number of other physical health conditions, these actions would also reduce inequalities in physical health and improve health overall. Action needs to be universal: across the whole of society and proportionate to need. Policy-making at all levels of governance and across sectors can make a positive difference.
768 citations
TL;DR: The present review highlights both connections with other disciplines and lessons for a social psychological understanding of intervention and change in self-affirmation interventions.
Abstract: People have a basic need to maintain the integrity of the self, a global sense of personal adequacy. Events that threaten self-integrity arouse stress and self-protective defenses that can hamper performance and growth. However, an intervention known as self-affirmation can curb these negative outcomes. Self-affirmation interventions typically have people write about core personal values. The interventions bring about a more expansive view of the self and its resources, weakening the implications of a threat for personal integrity. Timely affirmations have been shown to improve education, health, and relationship outcomes, with benefits that sometimes persist for months and years. Like other interventions and experiences, self-affirmations can have lasting benefits when they touch off a cycle of adaptive potential, a positive feedback loop between the self-system and the social system that propagates adaptive outcomes over time. The present review highlights both connections with other disciplines and lessons for a social psychological understanding of intervention and change.
766 citations
University of São Paulo1, St George's Hospital2, University of Otago3, Universidad Autónoma Metropolitana4, Stony Brook University5, Katholieke Universiteit Leuven6, Utrecht University7, University of Ibadan8, Peking University9, Harvard University10, Paris Descartes University11, Mental Health Services12, Leipzig University13, Ulster University14, Pontifical Xavierian University15, All India Institute of Medical Sciences16, University of Cape Town17, Universidade Federal do Espírito Santo18, Universidade Nova de Lisboa19
TL;DR: Low perceived need and attitudinal barriers are the major barriers to seeking and staying in treatment among individuals with common mental disorders worldwide.
Abstract: The WHO WMH Survey Initiative is supported by the National Institute of Mental Health (NIMH; R01 MH070884), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864 and R01 DA016558), the Fogarty International Center (FIRCA R03-TW006481). The Sao Paulo Megacity Mental Health Survey is supported by the State of Sao Paulo Research Foundation (FAPESP) Thematic Project Grant 03/00 204-3. The ESEMeD project is funded by the European Commission (Contracts QLG5-1999-01 042; SANCO 2 004 123 and EAHC20081308), the Piedmont Region (Italy), Fondo de Investigacion Sanitaria, Instituto de Salud Carlos III, Spain (FIS 00/0028), Ministerio de Ciencia y Tecnologia, Spain (SAF 2000-158-CE), Departament de Salut, Generalitat de Catalunya, Spain, Instituto de Salud Carlos III (CIBER CB06/02/0046, RETICS RD06/0011 REM-TAP). The World Mental Health Japan (WMHJ) Survey is supported by the Grant for Research on Psychiatric and Neurological Diseases and Mental Health (H13-SHOGAI-023, H14-TOKUBETSU-026, H16-KOKORO-013) from the Japan Ministry of Health, Labor and Welfare. The Lebanese National Mental Health Survey (LEBANON) is supported by the National Institute of Health/Fogarty International Center (R03 TW006481- 01. The Mexican National Comorbidity Survey (MNCS) is supported by The National Institute of Psychiatry Ramon de la Fuente (INPRFMDIES 4280) and by the National Council on Science and Technology (CONACyT-G30544-H). The Ukraine Comorbid Mental Disorders during Periods of Social Disruption (CMDPSD) study was funded by the US National Institute of Mental Health (RO1-MH61905). The US National Comorbidity Survey Replication (NCS-R) is supported by the NIMH (U01-MH60220), the Robert Wood Johnson Foundation (RWJF; Grant044780)
766 citations
TL;DR: This review provides an overview of research on the presentation, burden, correlates, and treatment of mental disorders following disasters and offers directions for future disaster mental health research.
Abstract: We present in this review the current state of disaster mental health research. In particular, we provide an overview of research on the presentation, burden, correlates, and treatment of mental disorders following disasters. We also describe challenges to studying the mental health consequences of disasters and discuss the limitations in current methodologies. Finally, we offer directions for future disaster mental health research.
691 citations
TL;DR: Smoking cessation is associated with reduced depression, anxiety, and stress and improved positive mood and quality of life compared with continuing to smoke.
Abstract: To investigate change in mental health after smoking cessation compared with continuing to smoke. Systematic review and meta-analysis of observational studies. Web of Science, Cochrane Central Register of Controlled Trials, Medline, Embase, and PsycINFO for relevant studies from inception to April 2012. Reference lists of included studies were hand searched, and authors were contacted when insufficient data were reported. Longitudinal studies of adults that assessed mental health before smoking cessation and at least six weeks after cessation or baseline in healthy and clinical populations. 26 studies that assessed mental health with questionnaires designed to measure anxiety, depression, mixed anxiety and depression, psychological quality of life, positive affect, and stress were included. Follow-up mental health scores were measured between seven weeks and nine years after baseline. Anxiety, depression, mixed anxiety and depression, and stress significantly decreased between baseline and follow-up in quitters compared with continuing smokers: the standardised mean differences (95% confidence intervals) were anxiety -0.37 (95% confidence interval -0.70 to -0.03); depression -0.25 (-0.37 to -0.12); mixed anxiety and depression -0.31 (-0.47 to -0.14); stress -0.27 (-0.40 to -0.13). Both psychological quality of life and positive affect significantly increased between baseline and follow-up in quitters compared with continuing smokers 0.22 (0.09 to 0.36) and 0.40 (0.09 to 0.71), respectively). There was no evidence that the effect size differed between the general population and populations with physical or psychiatric disorders. Smoking cessation is associated with reduced depression, anxiety, and stress and improved positive mood and quality of life compared with continuing to smoke. The effect size seems as large for those with psychiatric disorders as those without. The effect sizes are equal or larger than those of antidepressant treatment for mood and anxiety disorders.
TL;DR: This paper identifies seven mis‐uses (“abuses”) of the concept of recovery and identifies ten empirically‐validated interventions which support recovery, by targeting key recovery processes of connectedness, hope, identity, meaning and empowerment (the CHIME framework).
TL;DR: A clinical protocol of a multidisciplinary team with mental health professionals, physicians, and surgeons, including puberty suppression, followed by cross-sex hormones and gender reassignment surgery, provides gender dysphoric youth who seekgender reassignment from early puberty on, the opportunity to develop into well-functioning young adults.
Abstract: BACKGROUND: In recent years, puberty suppression by means of gonadotropin-releasing hormone analogs has become accepted in clinical management of adolescents who have gender dysphoria (GD). The current study is the first longer-term longitudinal evaluation of the effectiveness of this approach. METHODS: A total of 55 young transgender adults (22 transwomen and 33 transmen) who had received puberty suppression during adolescence were assessed 3 times: before the start of puberty suppression (mean age, 13.6 years), when cross-sex hormones were introduced (mean age, 16.7 years), and at least 1 year after gender reassignment surgery (mean age, 20.7 years). Psychological functioning (GD, body image, global functioning, depression, anxiety, emotional and behavioral problems) and objective (social and educational/professional functioning) and subjective (quality of life, satisfaction with life and happiness) well-being were investigated. RESULTS: After gender reassignment, in young adulthood, the GD was alleviated and psychological functioning had steadily improved. Well-being was similar to or better than same-age young adults from the general population. Improvements in psychological functioning were positively correlated with postsurgical subjective well-being. CONCLUSIONS: A clinical protocol of a multidisciplinary team with mental health professionals, physicians, and surgeons, including puberty suppression, followed by cross-sex hormones and gender reassignment surgery, provides gender dysphoric youth who seek gender reassignment from early puberty on, the opportunity to develop into well-functioning young adults.
TL;DR: A systematic narrative review of research published between January 2003 and April 2013, retrieved using rigorous searching on eight bibliographic databases, revealed contradictory evidence while revealing an absence of robust causal research regarding the impact of social media on mental wellbeing of young people.
01 Jun 2014
TL;DR: A novel method for gathering data for a range of mental illnesses quickly and cheaply is presented, then analysis of four in particular: post-traumatic stress disorder, depression, bipolar disorder, and seasonal affective disorder are focused on.
Abstract: The ubiquity of social media provides a rich opportunity to enhance the data available to mental health clinicians and researchers, enabling a better-informed and better-equipped mental health field. We present analysis of mental health phenomena in publicly available Twitter data, demonstrating how rigorous application of simple natural language processing methods can yield insight into specific disorders as well as mental health writ large, along with evidence that as-of-yet undiscovered linguistic signals relevant to mental health exist in social media. We present a novel method for gathering data for a range of mental illnesses quickly and cheaply, then focus on analysis of four in particular: post-traumatic stress disorder (PTSD), depression, bipolar disorder, and seasonal affective disorder (SAD). We intend for these proof-of-concept results to inform the necessary ethical discussion regarding the balance between the utility of such data and the privacy of mental health related information.
01 May 2014
TL;DR: The publication of Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice marks a watershed in the treatment of Indigenous mental health issues.
Abstract: Editors: Nola Purdie, Pat Dudgeon and Roz Walker Foreword by Tom Calma ‘Designed for practitioners and mental health workers, as well as students training to be mental health workers, I am confident that the publication of Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice marks a watershed in the treatment of Indigenous mental health issues.’ Tom Calma Aboriginal and Torres Strait Islander Social Justice Commissioner
TL;DR: These findings suggest that recent cohorts of adolescent girls are experiencing increases in internalizing symptoms compared to previous cohorts, and approaches for prevention and early intervention should be explored.
Abstract: Objective: Up to one in five children experience mental health problems. Social and cultural factors may influence emergence of mental health problems. The 21st century has led to changes in many of these factors, but it is unclear whether rates of internalizing and externalizing problems have also changed in recent cohorts of young people. Methods: A comprehensive literature search was undertaken to locate cohort or population studies that examined changes in mental health of children over time, where participants were aged 18 years and under, and the time frame for change was at least 10 years, with data for at least one time point in the 21st century being statistically compared to at least one time point in the 20th century. Studies were reviewed for quality and outcome. Results: Nineteen studies met criteria for review. These included studies of toddlers, children, and adolescents. Seventeen studies examined internalizing problems, and 11 studies examined externalizing problems. For both children and toddlers, recent cohorts did not exhibit worsening of mental health symptoms. In adolescents, the burden of externalizing problems appear to be stable. However, the majority of studies report an increase in internalizing problems in adolescent girls. The findings for internalizing problems in boys were mixed. Conclusions: These findings suggest that recent cohorts of adolescent girls are experiencing increases in internalizing symptoms compared to previous cohorts. Approaches for prevention and early intervention should be explored. Keywords Adolescence, anxiety, depression, epidemiology, girls, internalizing problems, mental health
TL;DR: Higher levels of neighborhood green space were associated with significantly lower levels of symptomology for depression, anxiety and stress, after controlling for a wide range of confounding factors.
Abstract: Green space is now widely viewed as a health-promoting characteristic of residential environments, and has been linked to mental health benefits such as recovery from mental fatigue and reduced stress, particularly through experimental work in environmental psychology. Few population level studies have examined the relationships between green space and mental health. Further, few studies have considered the role of green space in non-urban settings. This study contributes a population-level perspective from the United States to examine the relationship between environmental green space and mental health outcomes in a study area that includes a spectrum of urban to rural environments. Multivariate survey regression analyses examine the association between green space and mental health using the unique, population-based Survey of the Health of Wisconsin database. Analyses were adjusted for length of residence in the neighborhood to reduce the impact of neighborhood selection bias. Higher levels of neighborhood green space were associated with significantly lower levels of symptomology for depression, anxiety and stress, after controlling for a wide range of confounding factors. Results suggest that “greening” could be a potential population mental health improvement strategy in the United States.
TL;DR: The difference-education intervention eliminated the social-class achievement gap by increasing first-generation students’ tendency to seek out college resources and, in turn, improving their end-of-year grade point averages.
Abstract: College students who do not have parents with 4-year degrees (first-generation students) earn lower grades and encounter more obstacles to success than do students who have at least one parent with a 4-year degree (continuing- generation students). In the study reported here, we tested a novel intervention designed to reduce this social-class achievement gap with a randomized controlled trial (N = 168). Using senior college students' real-life stories, we conducted a difference-education intervention with incoming students about how their diverse backgrounds can shape what they experience in college. Compared with a standard intervention that provided similar stories of college adjustment without highlighting students' different backgrounds, the difference-education intervention eliminated the social-class achievement gap by increasing first-generation students' tendency to seek out college resources (e.g., meeting with professors) and, in turn, improving their end-of-year grade point averages. The difference-education intervention also improved the college transition for all students on numerous psychosocial outcomes (e.g., mental health and engagement).
TL;DR: This article investigated the effects of work-life balance (WLB) on several individual outcomes across cultures and found strong support for WLB being beneficial for employees from various cultures and for culture as a moderator of these relationships.
Proceedings Article•
16 May 2014TL;DR: These findings reveal, for the first time, the kind of unique information needs that a social media like reddit might be fulfilling when it comes to a stigmatic illness, and expand the understanding of the role of the social web in behavioral therapy.
Abstract: Social media is continually emerging as a platform of information exchange around health challenges. We study mental health discourse on the popular social media:reddit. Building on findings about health information seeking and sharing practices in online forums, and social media like Twitter, we address three research challenges. First, we present a characterization of self-disclosure inmental illness communities on reddit. We observe individuals discussing a variety of concerns ranging from the daily grind to specific queries about diagnosis and treatment. Second, we build a statistical model to examine the factors that drive social support on mental health reddit communities. We also develop language models to characterize mental health social support, which are observed to bear emotional, informational, instrumental, and prescriptive information. Finally, we study disinhibition in the light of the dissociative anonymity that reddit’s throwaway accounts provide. Apart from promoting open conversations,such anonymity surprisingly is found to gather feedback that is more involving and emotionally engaging. Our findings reveal, for the first time, the kind of unique information needs that a social media like reddit might be fulfilling when it comes to a stigmatic illness. They also expand our understanding of the role of the social web in behavioral therapy.
TL;DR: Moving to greener urban areas was associated with sustained mental health improvements, suggesting that environmental policies to increase urban green space may have sustainable public health benefits.
Abstract: Despite growing evidence of public health benefits from urban green space there has been little longitudinal analysis. This study used panel data to explore three different hypotheses about how moving to greener or less green areas may affect mental health over time. The samples were participants in the British Household Panel Survey with mental health data (General Health Questionnaire scores) for five consecutive years, and who relocated to a different residential area between the second and third years (n = 1064; observations = 5320). Fixed-effects analyses controlled for time-invariant individual level heterogeneity and other area and individual level effects. Compared to premove mental health scores, individuals who moved to greener areas (n = 594) had significantly better mental health in all three postmove years (P = .015; P = .016; P = .008), supporting a "shifting baseline" hypothesis. Individuals who moved to less green areas (n = 470) showed significantly worse mental health in the year preceding the move (P = .031) but returned to baseline in the postmove years. Moving to greener urban areas was associated with sustained mental health improvements, suggesting that environmental policies to increase urban green space may have sustainable public health benefits.
TL;DR: The existence of associations beyond chance among the different diseases that comprise these patterns should be considered with the aim of directing future lines of research that measure their intensity, clarify their nature, and highlight the possible causal underlying mechanisms.
TL;DR: In this paper, the authors used linear and proportional odds logistic regression to assess the independent associations between age and duration of delirium with mental health and functional disabilities in patients undergoing treatment in medical or surgical ICUs.
TL;DR: The results of this review provide evidence for the effectiveness of some interventions based on the Health Promoting Schools framework for improving certain health outcomes but not others; however, there was a lack of long-term follow-up data for most studies.
Abstract: BACKGROUND: The World Health Organization's (WHO's) Health Promoting Schools (HPS) framework is an holistic, settings-based approach to promoting health and educational attainment in school. The effectiveness of this approach has not been previously rigorously reviewed. OBJECTIVES: To assess the effectiveness of the Health Promoting Schools (HPS) framework in improving the health and well-being of students and their academic achievement. SEARCH METHODS: We searched the following electronic databases in January 2011 and again in March and April 2013: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, CINAHL, Campbell Library, ASSIA, BiblioMap, CAB Abstracts, IBSS, Social Science Citation Index, Sociological Abstracts, TRoPHI, Global Health Database, SIGLE, Australian Education Index, British Education Index, Education Resources Information Centre, Database of Education Research, Dissertation Express, Index to Theses in Great Britain and Ireland, ClinicalTrials.gov, Current controlled trials, and WHO International Clinical Trials Registry Platform. We also searched relevant websites, handsearched reference lists, and used citation tracking to identify other relevant articles. SELECTION CRITERIA: We included cluster-randomised controlled trials where randomisation took place at the level of school, district or other geographical area. Participants were children and young people aged four to 18 years, attending schools or colleges. In this review, we define HPS interventions as comprising the following three elements: input to the curriculum; changes to the school's ethos or environment or both; and engagement with families or communities, or both. We compared this intervention against schools that implemented either no intervention or continued with their usual practice, or any programme that included just one or two of the above mentioned HPS elements. DATA COLLECTION AND ANALYSIS: At least two review authors identified relevant trials, extracted data, and assessed risk of bias in the trials. We grouped different types of interventions according to the health topic targeted or the approach used, or both. Where data permitted, we performed random-effects meta-analyses to provide a summary of results across studies. MAIN RESULTS: We included 67 eligible cluster trials, randomising 1443 schools or districts. This is made up of 1345 schools and 98 districts. The studies tackled a range of health issues: physical activity (4), nutrition (12), physical activity and nutrition combined (18), bullying (7), tobacco (5), alcohol (2), sexual health (2), violence (2), mental health (2), hand-washing (2), multiple risk behaviours (7), cycle-helmet use (1), eating disorders (1), sun protection (1), and oral health (1). The quality of evidence overall was low to moderate as determined by the GRADE approach. 'Risk of bias' assessments identified methodological limitations, including heavy reliance on self-reported data and high attrition rates for some studies. In addition, there was a lack of long-term follow-up data for most studies.We found positive effects for some interventions for: body mass index (BMI), physical activity, physical fitness, fruit and vegetable intake, tobacco use, and being bullied. Intervention effects were generally small but have the potential to produce public health benefits at the population level. We found little evidence of effectiveness for standardised body mass index (zBMI) and no evidence of effectiveness for fat intake, alcohol use, drug use, mental health, violence and bullying others; however, only a small number of studies focused on these latter outcomes. It was not possible to meta-analyse data on other health outcomes due to lack of data. Few studies provided details on adverse events or outcomes related to the interventions. In addition, few studies included any academic, attendance or school-related outcomes. We therefore cannot draw any clear conclusions as to the effectiveness of this approach for improving academic achievement. AUTHORS' CONCLUSIONS: The results of this review provide evidence for the effectiveness of some interventions based on the HPS framework for improving certain health outcomes but not others. More well-designed research is required to establish the effectiveness of this approach for other health topics and academic achievement.
TL;DR: Between 2004 and 2011, the decline in smoking among individuals with mental illness was significantly less than among those without mental illness, although quit rates were greater among those receiving mental health treatment.
Abstract: Importance Significant progress has been made in reducing the prevalence of tobacco use in the United States. However, tobacco cessation efforts have focused on the general population rather than individuals with mental illness, who demonstrate greater rates of tobacco use and nicotine dependence. Objectives To assess whether declines in tobacco use have been realized among individuals with mental illness and examine the association between mental health treatment and smoking cessation. Design, Setting, and Participants Use of nationally representative surveys of noninstitutionalized US residents to compare trends in smoking rates between adults with and without mental illness and across multiple disorders (2004-2011 Medical Expenditure Panel Survey [MEPS]) and to compare rates of smoking cessation among adults with mental illness who did and did not receive mental health treatment (2009-2011 National Survey of Drug Use and Health [NSDUH]).The MEPS sample included 32 156 respondents with mental illness (operationalized as reporting severe psychological distress, probable depression, or receiving treatment for mental illness) and 133 113 without mental illness. The NSDUH sample included 14 057 lifetime smokers with mental illness. Main Outcomes and Measures Current smoking status (primary analysis; MEPS sample) and smoking cessation, operationalized as a lifetime smoker who did not smoke in the last 30 days (secondary analysis; NSDUH sample). Results Adjusted smoking rates declined significantly among individuals without mental illness (19.2% [95% CI, 18.7-19.7%] to 16.5% [95% CI, 16.0%-17.0%]; P P = .50), a significant difference in difference of 2.3% (95% CI, 0.7%-3.9%) ( P = .005). Individuals with mental illness who received mental health treatment within the previous year were more likely to have quit smoking (37.2% [95% CI, 35.1%-39.4%]) than those not receiving treatment (33.1% [95% CI, 31.5%-34.7%]) ( P = .005). Conclusions and Relevance Between 2004 and 2011, the decline in smoking among individuals with mental illness was significantly less than among those without mental illness, although quit rates were greater among those receiving mental health treatment. This suggests that tobacco control policies and cessation interventions targeting the general population have not worked as effectively for persons with mental illness.
TL;DR: There is evidence of a significant, cross-sectional relationship between unhealthy dietary patterns and poorer mental health in children and adolescents and a consistent trend for the relationship between good-quality diet and better mental health and some evidence for the reverse.
Abstract: We systematically reviewed 12 epidemiological studies to determine whether an association exists between diet quality and patterns and mental health in children and adolescents; 9 explored the relationship using diet as the exposure, and 3 used mental health as the exposure. We found evidence of a significant, cross-sectional relationship between unhealthy dietary patterns and poorer mental health in children and adolescents. We observed a consistent trend for the relationship between good-quality diet and better mental health and some evidence for the reverse. When including only the 7 studies deemed to be of high methodological quality, all but 1 of these trends remained. Findings highlight the potential importance of the relationship between dietary patterns or quality and mental health early in the life span.
TL;DR: A robust research agenda is needed that focuses on system-level implementation and maintenance of interventions over time and if coupled with use of evidence-based practices, can promote the healthy development of children.
TL;DR: Food insecurity is adversely associated with dietary quality in adults, particularly intakes of nutrient-rich vegetables, fruit, and dairy that promote good health, however, food insecurity was less-consistently associated with lower dietaryquality in children.