Are Studies into Severe Mental Illness Robust Enough?

Research Paper Title

Multidimensional impact of severe mental illness on family members: systematic review.

Background

The impact of severe mental illnesses (SMIs) is not limited to the person with the illness but extends to their family members and the community where the patient comes from.

In this review, the researchers systematically analyse the available evidence of impacts of SMI on family members, including parents, grandparents, siblings, spouses and children.

Methods

PubMed, PsycINFO, Embase and Global Index Medicus were searched from the inception of each database up to 9 November 2019. They also did manual searches of grey literature.

The researchers included studies that assessed the impacts of SMI on any family member. They excluded studies in admitted clinics and acute wards to rule out the acute effect of hospitalisation.

Two reviewers extracted data independently using the Cochrane handbook guideline for systematic reviews and agreed on the final inclusion of identified studies.

The quality of the included studies was assessed using effective public health practice project quality assessment tool for quantitative studies. The review protocol was registered in the PROSPERO database.

Results

The researchers screened a total of 12,107 duplicate free articles and included 39 articles in the review.

The multidimensional impact of SMI included physical health problems (sleeplessness, headache and extreme tiredness.), psychological difficulties (depression and other psychological problems) and socioeconomic drift (less likely to marry and higher divorce rate and greater food insecurity).

Impacts on children included higher mortality, poor school performance and nutritional problems. However, the quality of one in five studies was considered weak.

Conclusions

The review indicated a high level of multidimensional impact across multiple generations.

The serious nature of the impact calls for interventions to address the multi-dimensional and multi-generational impact of SMI, particularly in low/middle-income countries.

Given the relatively high number of studies rated methodologically weak, more robust studies are indicated.

Reference

Fekadu, W., Mihiretu, A., Craig, T.K.J. & Fekadu, A. (2019) Multidimensional impact of severe mental illness on family members: systematic review. BMJ Open. 9(12):e032391. doi: 10.1136/bmjopen-2019-032391.

Do Physical Comorbidities affect the Diagnosis of Depression & Anxiety?

Research Paper Title

A systematic review and meta-analysis of the prevalence of common mental disorders in people with non-communicable diseases in Bangladesh, India, and Pakistan.

Background

The prevalence of mental and physical comorbidities is unknown in South Asia, as estimates of mental ill health in patients with non-communicable diseases (NCDs) have predominantly come from studies based in the United States, Europe and Australasia.

This systematic review and meta-analysis summarises evidence and provides pooled estimates of the prevalence of common mental disorders in adults with non-communicable diseases in South Asia.

Methods

The researchers included prevalence studies of depression and anxiety in adults with diabetes, cancer, cardiovascular disease, and chronic respiratory conditions in Bangladesh, India, and Pakistan, published from 1990 onwards in international and country-specific databases.

Results

Out of 96 included studies, 83 provided data for random effects meta-analyses.

The pooled prevalence of depression was 44% (95% confidence interval (CI) = 26 to 62) for patients with COPD, 40% (95% CI = 34 to 45) for diabetes, 39% (95% CI = 23 to 56) for stroke, 38% (95% CI = 32 to 45) for hypertension, and 37% (95% CI = 30 to 45) for cancer.

The pooled prevalence of anxiety based on 28 studies was 29% (95% CI = 22 to 36).

Many quality issues were identified in a critical appraisal of included studies, mostly relating to the sampling frame and selection process, the description of the methods and basic data, and the description of non-responders.

Conclusions

Depression and anxiety are prevalent and underdiagnosed in people with physical comorbidities in Bangladesh, India, and Pakistan.

Reference

Uphoff, E.P., Newbould, L., Walker, I., Ashraf, N., Chaturvedi, S., Kandasamy, A., Mazumdar, P., Meader, N., Naheed, A., Rana, R., Wright, J., Wright, J.M., Siddiqi, N., Churchill, R. & NIHR Global Health Research Group – IMPACT. (2019) A systematic review and meta-analysis of the prevalence of common mental disorders in people with non-communicable diseases in Bangladesh, India, and Pakistan. Journal of Global Health. 9(2):020417. doi: 10.7189/jogh.09.020417.

What is the Association with Several Physical, Mental, & Cognitive Health Outcomes with Gait Speed in Older Adults?

Research Paper Title

Clinical and Ambulatory Gait Speed in Older Adults: Associations With Several Physical, Mental, and Cognitive Health Outcomes.

Background

Although clinical gait speed may indicate health and wellbeing in older adults, there is a lack of studies comparing clinical tests with ambulatory gait speed with regard to several health outcomes.

The objective of this study was to examine the associations of clinical gait speed, measured by the 2.44 meter walk test and the ambulatory gait speed with several physical, mental, and cognitive health outcomes in older adults.

A cross-sectional design was used.

Methods

The study population comprised 432 high-functioning community-dwelling older adults (287 women) aged between 65 and 92.

Clinical and ambulatory gait speeds were measured using the 2.44 m walk test and a portable gait analysis device, respectively.

Multiple linear regressions were used to examine the association of clinical and ambulatory gait speeds with several health outcomes (BMI, waist circumference, systolic and diastolic blood pressure, chronic conditions, self-rated health, exhaustion, upper and lower body strength, physical and mental health status, cognitive status and self-rated cognitive status).

Results

The results showed that the average gait speed for clinical and ambulatory measures cannot be directly compared.

Clinical gait speed was associated with 7 health outcomes, while the ambulatory gait speed was associated with 6 health outcomes.

The significant associations between measures of gait speed and the health outcomes converged in 5 of the 13 health outcomes studied, however, the strength of associations were singly different between measures.

The short monitoring time, the inability to distinguish between the ambulatory gait speed inside the home and outdoor gait speed, and the under-representative sample are limitations of the study.

Conclusions

The results indicated differences in the number and strength of associations between clinical and ambulatory gait speed.

Both measures have construct validity because they have been associated with physical and health outcomes, however, they may have different predictive validity.

Further research should be done to compare their predictive validity in longitudinal designs.

Reference

De la Cámara, M.Á., Higueras-Fresnillo, S., Sadarangani, K.P., Esteban-Cornejo, I., Martinez-Gomez, D. & Veiga, Ó.L. (2020) Clinical and Ambulatory Gait Speed in Older Adults: Associations With Several Physical, Mental, and Cognitive Health Outcomes. Physical Therapy. pii: pzz186. doi: 10.1093/ptj/pzz186. [Epub ahead of print].

Emotional Indicators of Urban Green Space Behaviour

Research Paper Title

Sitting or Walking? Analyzing the Neural Emotional Indicators of Urban Green Space Behavior with Mobile EEG.

Background

There is a close relationship between urban green space and the physical and mental health of individuals.

Most previous studies have discussed the impact of the structure of green space and its elements.

This study focused on the emotional changes caused by common behaviours in urban green space (walking and sitting).

Methods

The researchers recruited 40 college students and randomly assigned them to walking and sitting groups (20 students per group).

The two groups performed the same 8-min high-pressure learning task indoors and then performed 8-min recovery activities in a simulated urban green space (a bamboo-lawn space).

They used the Emotiv EPOC+ EEG headset to dynamically measure six neural emotional parameters:

  • ‘Engagement’;
  • ‘Valence’;
  • ‘Meditation’;
  • ‘Frustration’;
  • ‘Focus’; and
  • ‘Excitement’.

The researchers also conducted a pretest and post-test and used analysis of covariance (ANCOVA) to analyse the post-test data (with the pretest data as covariates).

Results

The results of the comparison of the two behaviours showed that the ‘valence’ and ‘meditation’ values of the walking group were higher than those of the sitting group, which suggests that walking in urban green space is more favourable for stress reduction.

The sitting group had a higher “focus” value than did the walking group, which suggests that sitting in urban green space is better for attention restoration.

Conclusions

The results of this study can provide guidance for urban green space planning and design as well as health guidance for urban residents.

Reference

Lin, W., Chen, Q., Jiang, M., Tao, J., Liu, Z., Zhang, X., Wu, L., Xu, S., Kang, Y. & Zeng, Q. (2020) Sitting or Walking? Analyzing the Neural Emotional Indicators of Urban Green Space Behavior with Mobile EEG. Journal of Urban Health. doi: 10.1007/s11524-019-00407-8. [Epub ahead of print].

Book: Ayurveda 101

Book Title: Ayurveda 101: Ayurveda Basics for The Absolute Beginner [Achieve Natural Health and Well Being through Ayurveda].

Author(s): Advait.

Year: 2016.

Edition: First.

Publisher: CreateSpace Independent Publishing Platform.

Synopsis:

The Ultimate Beginner’s Guide to Ayurveda Have you been searching for proven natural remedies for Achieving Everlasting Health Holistically???

Has your search lead you to Ayurveda??? But, you don’t know where to start and are waiting to be initiated into the Amazing world of Ayurvedic Healing….Then this book is for you.

Discover :: Ayurveda 101 – Ayurveda Basics for The Absolute Beginner This Book will teach you everything you need to know about Ayurveda as a Beginner.

Here’s a sneak peak at the contents of the book; #Origin of Ayurveda #Ashtaanga Veda – The Eight branches of Ayurveda #Panch Maha Bhuta’s – The Five Fundamental Elements #The Three Dosha’s and Your Prakriti – Vata – Pitta – Kapha #The Tri-Dosha test for determining your Prakriti #Sapta-Dhatu – The Seven Body Tissues #Jathar-Agni – The Digestive Fire #Trayodasha Vega – The 13 Natural Urge’s.

Mental Health: Exercise & Osteoarthritis in Older People

Research Paper Title

A Study on the Physical Activities, Mental Health, and Health-Related Quality of Life of Osteoarthritis Patients.

Background

The purpose of this study was to investigate the physical activities, mental health, and health-related quality of life (HRQOL) of osteoarthritis patients.

Methods

This study was conducted using data from the first year of the 7th Korea National Health and Nutritional Examination Survey.

There were 8,150 participants included in the survey, and 665 participants had been diagnosed with osteoarthritis.

This study analysed the measurements of physical activities, depression, and HRQOL in participants with osteoarthritis.

Results

The mean age of the participants was 67 ± 9.9 years and 83.1% were female.

Participants rarely engaged in work-related physical activity, and engaged in leisure-related physical activities infrequently.

Most of the participants (85.9%) did not do regular exercise, but 1/3 of the participants walked for over 10 minutes a day.

“Pain/discomfort” had the least impact upon HRQOL, and among the depression subcategories, “difficult to sleep and tiredness” had the most impact.

Multiple logistic regression analysis showed that an adverse HRQOL score was statistically significantly associated with “location changes/physical activities” (p < 0. 01), “depression” (p < 0.001) and “age” (p < 0.001).

Conclusions

Exercise programmes should be in place which are manageable in everyday life for the elderly (> 65 years).

Changes in daily routine so that patients become more active, should be supported by the family and community, together with assistance in managing psychological problems such as depression.

Reference

Kim, D.J. (2019) A Study on the Physical Activities, Mental Health, and Health-Related Quality of Life of Osteoarthritis Patients. Osong Public Health and Research Perspectives. 10(6), pp.368-375. doi: 10.24171/j.phrp.2019.10.6.07.

Review of Physical Health Monitoring after Rapid Tranquilisation for Acute Behavioural Disturbance

Research Paper Title

Physical health monitoring after rapid tranquillisation: clinical practice in UK mental health services.

Background

The researchers aimed to assess the quality of physical health monitoring following rapid tranquillisation (RT) for acute behavioural disturbance in UK mental health services.

Methods

The Prescribing Observatory for Mental Health (POMH-UK) initiated an audit-based quality improvement programme addressing the pharmacological treatment of acute behavioural disturbance in mental health services in the UK.

Results

Data relating to a total of 2454 episodes of RT were submitted by 66 mental health services.

Post-RT physical health monitoring did not reach the minimum recommended level in 1933 (79%) episodes.

Patients were more likely to be monitored (OR 1.78, 95% CI 1.39-2.29, p < 0.001) if there was actual or threatened self-harm, and less likely to be monitored if the episode occurred in the evening (OR 0.79, 95% CI 0.62-1.0, p < 0.001) or overnight (OR 0.57, 95% CI 0.44-0.75, p < 0.001).

Risk factors such as recent substance use, RT resulting in the patient falling asleep, or receiving high-dose antipsychotic medication on the day of the episode, did not predict whether or not the minimum recommended level of post-RT monitoring was documented.

Conclusions

The minimum recommended level of physical health monitoring was reported for only one in five RT episodes.

The findings also suggest a lack of targeting of at-risk patients for post-RT monitoring.

Possible explanations are that clinicians consider such monitoring too demanding to implement in routine clinical practice or not appropriate in every clinical situation.

For example, physical health measures requiring direct contact with a patient may be difficult to undertake, or counter-productive, if RT has failed.

These findings prompt speculation that post-RT monitoring practice would be improved by the implementation of guidance that integrated and refined the currently separate systems for undertaking and recording physical health observations post-RT, determining nursing observation schedules and detecting acute deterioration in physical health.

The effectiveness and clinical utility of such an approach would be worth testing.

Reference

Paton, C., Adams, C.E., Dye, S., Delgado, O., Okocha, C. & Barnes, T.R.E. (2019) Physical health monitoring after rapid tranquillisation: clinical practice in UK mental health services. Therapeutic Advances in Psychopharmacology. doi: 10.1177/2045125319895839. eCollection 2019.

What are the Effects from Perinatal Period to Adulthood on Psychosocial Stress & Adversity?

Research Paper Title

Psychosocial Stress and Adversity: Effects from the Perinatal Period to Adulthood.

Abstract

Early exposure to stress and adversity can have both immediate and lasting effects on physical and psychological health.

Critical periods have been identified in infancy, during which the presence or absence of experiences can alter developmental trajectories.

There are multiple explanations for how exposure to psychosocial stress, before conception or early in life, has an impact on later increased risk for developmental delays, mental health, and chronic metabolic diseases.

Through both epidemiologic and animal models, the mechanisms by which experiences are transmitted across generations are being identified.

Because psychosocial stress has multiple components that can act as stress mediators, a comprehensive understanding of the complex interactions between multiple adverse or beneficial experiences and their ultimate effects on health is essential to best identify interventions that will improve health and outcomes.

This review outlines what is known about the biology, transfer, and effects of psychosocial stress and early life adversity from the perinatal period to adulthood.

This information can be used to identify potential areas in which clinicians in neonatal medicine could intervene to improve outcomes.

Reference

Barrero-Castillero, A., Morton, S.U., Nelson, C.A. & Smith, V.C. (2019) Psychosocial Stress and Adversity: Effects from the Perinatal Period to Adulthood. NeoReviews. 20(12):e686-e696. doi: 10.1542/neo.20-12-e686.

Health Policies: Consider the Direct & Indirect Cross-effects between Mental Health & Physical Health

Research Paper Title

The relationship between physical and mental health: A mediation analysis.

Background

There is a strong link between mental health and physical health, but little is known about the pathways from one to the other.

The researchers analyse the direct and indirect effects of past mental health on present physical health and past physical health on present mental health using lifestyle choices and social capital in a mediation framework.

Methods

They use data on 10,693 individuals aged 50 years and over from six waves (2002-2012) of the English Longitudinal Study of Ageing.

Mental health is measured by the Centre for Epidemiological Studies Depression Scale (CES) and physical health by the Activities of Daily Living (ADL).

Results

The researchers find significant direct and indirect effects for both forms of health, with indirect effects explaining 10% of the effect of past mental health on physical health and 8% of the effect of past physical health on mental health.

Physical activity is the largest contributor to the indirect effects.

There are stronger indirect effects for males in mental health (9.9%) and for older age groups in mental health (13.6%) and in physical health (12.6%).

Conclusions

Health policies aiming at changing physical and mental health need to consider not only the direct cross-effects but also the indirect cross-effects between mental health and physical health.

Reference

Ohrnberger, J., Fichera, E. & Sutton, M. (2017) The relationship between physical and mental health: A mediation analysis. Social Science & Medicine (1982). 195, pp.42-49. doi: 10.1016/j.socscimed.2017.11.008. Epub 2017 Nov 8.