From impact factors to real impact: translating evidence on lifestyle interventions into routine mental health care

The scandal of premature mortality in people with serious mental illness is well established. Despite an increase in studies evaluating the efficacy of lifestyle interventions, translating this evidence into routine clinical care and policies is challenging, in part due to limited effectiveness or implementation research. We highlight the challenge of implementation that is increasingly recognized in clinical practice, advocate for adopting implementation science to study the implementation and systematic update of effective interventions in practice and policy, and provide directions for future research.

Physical Multimorbidity and Social Participation in Adult Aged 65 Years and Older From Six Low- and Middle-Income Countries

OBJECTIVES

Multimorbidity is common among older adults from low- and middle-income countries (LMICs). Social participation has a role in protecting against negative health consequences, yet its association with multimorbidity is unclear, particularly in LMICs. Thus, this study investigated the relationship between physical multimorbidity and social participation among older adults across 6 LMICs.

METHOD

Cross-sectional, community-based data including adults aged 65 years and older from 6 LMICs were analyzed from the WHO Study on Global AGEing and adult health survey. The association between 11 individual chronic conditions or the number of chronic conditions (independent variable) and social participation (range 0-10 with higher scores indicating greater social participation; dependent variable) was assessed by multivariable linear regression analysis.

RESULTS

14,585 individuals (mean age 72.6 [SD 11.5] years; 54.9% females) were included. Among individual conditions, hearing problems, visual impairment, and stroke were significantly associated with lower levels of social participation. Overall, an increasing number of chronic conditions was dose-dependently associated with lower levels of social participation (e.g., ≥4 vs 0 conditions: β = -0.26 [95% CI = -0.39, -0.13]). The association was more pronounced among males than females.

DISCUSSION

Older people with multimorbidity had lower levels of social participation in LMICs. Future longitudinal studies are warranted to further investigate temporal associations, and whether addressing social participation can lead to better health outcomes among older people with multimorbidity in LMICs.

The anxiolytic effects of exercise for people with anxiety and related disorders: An update of the available meta-analytic evidence

Exercise as a treatment option for people with mental disorders is a field of growing interest. The increased number of published randomized controlled trials (RCTs) evaluating the effects of exercise in the treatment of anxiety and related disorders in recent years calls for an update of the available meta-analytic evidence. Electronic databases (PubMed, CINAHL, PSYCArticles, and Embase) were searched up to 17.2.2021, for RCTs evaluating the effects of exercise on anxiety and stress symptoms in adults with anxiety and related disorders. A random effects meta-analysis was conducted. A total of 13 RCTs comprising 731 adult participants (exercise n=376; control n=355) were included. Exercise had a small, bordering medium, but statistically significant effect on decreasing anxiety symptoms compared to control condition (standardized mean difference=-0.425, 95%CI -0.67 to -0.17; I² = 47.9%) in people with anxiety and related disorders. Our meta-analysis updates the existing evidence supporting exercise as an efficacious intervention for anxiety and related disorders. Although the updated meta-analytic evidence is less heterogenous than previously reported, future research is still needed to explore the factors moderating the effects of exercise on outcome such as frequency, intensity, duration of the sessions, and type of exercise and qualification of the provider in more detail.

Physical health interventions on adolescent mental health inpatient units: A systematic review and call to action

AIM

Physical health inequalities experienced by people with mental health conditions are labelled an international scandal; due to the 15 to 30-year gap in life expectancy, driven mostly by physical health conditions. Lifestyle interventions are recommended to prevent the onset of poor physical health in people with mental illness. Yet, there is less high-quality evidence for adolescents, particularly those in inpatient settings. We aimed to assess existing literature reporting physical health or lifestyle interventions conducted on adolescent mental health inpatient units.

METHOD

An electronic search of MEDLINE, PsycINFO, Embase, the Cochrane Central Register of Controlled Trials and AMED was conducted on 13th June 2019. Eligible studies included peer-reviewed English language research articles of physical health interventions delivered within child and adolescent mental health inpatient services. A narrative synthesis was conducted on the data.

RESULTS

Only three studies were identified implementing health interventions for adolescent inpatients. The interventions consisted of two physical health interventions aiming to increase activity levels within routine care (one gym-based, one sports led) and a yoga intervention. Outcome measurements varied and benefits were observed in relation to overall health (HONOSCA), physical health (waist, hip and chest circumference) and behaviour.

CONCLUSIONS

Although preliminary results suggest lifestyle interventions may be feasible and beneficial for this group, more work is needed to fully understand the best way to implement these interventions within adolescent clinical settings. Adolescent inpatients are an important target for such interventions, affording the opportunity to prevent the onset of physical comorbidities.

Handgrip strength and health outcomes: Umbrella review of systematic reviews with meta-analyses of observational studies

PURPOSE

The aim of the present study was to assess both the credibility and strength of evidence arising from systematic reviews with meta-analyses of observational studies on handgrip strength and health outcomes.

METHODS

An umbrella review of systematic reviews with meta-analyses of observational studies was conducted. We assessed meta-analyses of observational studies based on random-effect summary effect sizes and their p values, 95% prediction intervals, heterogeneity, small-study effects, and excess significance. We graded the evidence from convincing (Class I) to weak (Class IV).

RESULTS

From 504 articles returned in a search of the literature, 8 systematic reviews were included in our review, with a total of 11 outcomes. Overall, nine of the 11 of the outcomes reported nominally significant summary results (p < 0.05), with 4 associations surviving the application of the more stringent p value (p < 10^-6). No outcome presented convincing evidence. Three associations showed Class II evidence (i.e., highly suggestive): (1) higher handgrip values at baseline were associated with a minor reduction in mortality risk in the general population (n = 34 studies; sample size = 1,855,817; relative risk = 0.72, 95% confidence interval (95%CI): 0.67-0.78), (2) cardiovascular death risk in mixed populations (n = 15 studies; relative risk = 0.84, 95%CI: 0.78-0.91), and (3) incidence of disability (n = 7 studies; relative risk = 0.76, 95%CI: 0.66-0.87).

CONCLUSION

The present results show that handgrip strength is a useful indicator for general health status and specifically for early all-cause and cardiovascular mortality, as well as disability. To further inform intervention strategies, future research is now required to fully understand mechanisms linking handgrip strength scores to these health outcomes.

Physical activity correlates in children and adolescents, adults, and older adults with an intellectual disability: a systematic review

PURPOSE

Understanding enablers of and barriers for physical activity (PA) participation in people with intellectual disability (ID) is an essential first step to develop effective interventions. This systematic review examined correlates of PA across the socio-ecological model (i.e., intra-personal, inter-personal, environmental and policy level) in people with ID across the lifespan.

MATERIAL AND METHODS

Major electronic databases were searched from inception until 15 February 2021. Keywords included "physical activity" or "exercise" and "intellectual disability" or "mental retardation." A summary coding was used to analyze the data for adolescents (<18 years), adults (18 < 50 years), and older adults (50≤ years).

RESULTS

Out of 83 PA correlates, retrieved from 39 studies (n = 26,456), only three consistent (i.e., reported in four or more studies) correlates were identified. In adults, older age (7/11, 64%), more severe ID (9/9, 100%) and the presence of physical mobility problems (3/4, 75%) were associated with decreased PA. From 38 correlates identified, no consistent correlates were identified for children and adolescents and older people.

CONCLUSIONS

Despite the abundance of evidence of the PA benefits for people with ID, we only found consistent evidence for three correlates reliably being related to PA in adults with ID. More research, particularly among young and older people is urgently needed.IMPLICATIONS FOR REHABILITATIONMore severe intellectual disability is an important barrier for being active in adults with intellectual disability.Presence of physical health problems is an important barrier for being active in adults with intellectual disability.

The efficacy of exergaming in people with major neurocognitive disorder residing in long-term care facilities: a pilot randomized controlled trial

BACKGROUND

It is currently unknown whether exergaming is efficacious in people with major neurocognitive disorder (MNCD) residing in long-term care facilities. This pilot randomized controlled trial (RCT) explored the efficacy of a stepping exergame program on gait speed, balance, mobility, reaction time, cognitive and neuropsychiatric outcomes, quality of life, and daily life functioning in people with MNCD residing in long-term care facilities.

METHODS

Participants were randomly assigned to 8 weeks, three times weekly, 15 min of exergaming versus watching preferred music videos. The exergame device consisted of a pressure-sensitive step training platform on which participants performed stepping movements to play the games. The device automatically adapted the training level to the participants' capabilities. The Short Physical Performance Battery (SPPB), step reaction time test (SRTT), Montréal Cognitive Assessment (MoCA), Neuropsychiatric Inventory (NPI), Cornell Scale for Depression in Dementia (CSDD), Dementia Quality of Life (DQoL), and Katz Activities of Daily Living (Katz ADL) were assessed at baseline and post-intervention. A Quade's non-parametric ANCOVA controlling for baseline values with post hoc Bonferroni correction (p < 0.00625) was used to analyze pre- and post-differences between the groups. Partial eta-squared (η²p) effect sizes were calculated.

RESULTS

Forty-five of 55 randomized inpatients with mild to moderate MNCD (Mini-Mental State Examination score = 17.2 ± 4.5; aged 70-91; 35 women) completed the study. The exergame group (n = 23) demonstrated improvements in gait speed (p < 0.001, η²_p = 0.41), total SPPB (p < 0.001, η²_p = 0.64), SRTT (p<0.001, η²_p = 0.51), MoCA (p<0.001, η²_p = 0.38), and reductions in CSDD (p<0.001, η²_p = 0.43) compared to the control group (n = 22). There were no differences in NPI (p = 0.165, η²_p = 0.05), DQoL (p = 0.012, η²_p = 0.16), and ADL (p = 0.008, η²_p = 0.16) post-intervention scores between the experimental and control group, albeit DQol and ADL measures showed large effect sizes in the exergame group. The mean attendance rate was 82.9% in the exergame group and 73.7% in the music control group. There were no study-related adverse events reported by the participants, nor observed by the research team.

CONCLUSIONS

The findings of this pilot RCT suggest that an individually adapted exergame training improves lower extremity functioning, cognitive functioning and step reaction time and symptoms of depression in inpatients with MNCD residing in long-term care facilities.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT04436302.

Reliability and validity of physical fitness tests in people with mental disorders: A systematic review and meta-analysis

BACKGROUND

Several tests are available to assess the different components of physical fitness, including cardiorespiratory fitness, muscular strength, and flexibility. However, the reliability and validity of physical fitness tests in people with mental disorders has not been meta-analyzed.

AIMS

To examine the reliability, concurrent, and convergent validity of physical fitness tests in people with mental disorders.

METHODS

Studies evaluating the reliability, concurrent, and convergent validity of physical fitness tests in people with mental disorders were searched from major databases until January 20, 2020. Random-effects meta-analyses were performed pooling (1) reliability: test-retest correlations at two-time points, (2) convergent validity between submaximal tests and maximal protocols, or (3) concurrent validity between two submaximal tests. Associations are presented using r values and 95% confidence intervals. Methodological quality was assessed using the Quality Appraisal of Reliability Studies and the Critical Appraisal Tool.

RESULTS

A total of 11 studies (N = 504; 34% females) were included. Reliability of the fitness tests, produced r values ranging from moderate (balance test-EUROFIT; [r = 0.75 (0.60-0.85); p = 0.0001]) to very strong (explosive leg power EUROFIT; [r = 0.96 (0.93-0.97); p = 0.0001]). Convergent validity between the 6-min walk test (6MWT) and submaximal cardiorespiratory tests was moderate (0.57 [0.26-0.77]; p = 0.0001). Concurrent validity between the 2-min walk test and 6MWT (r = 0.86 [0.39-0.97]; p = 0.0004) was strong.

CONCLUSION

The present study demonstrates that physical fitness tests are reliable and valid in people with mental disorders.

Yoga for depression and anxiety symptoms in people with cancer: A systematic review and meta-analysis

OBJECTIVE

Cancer and its treatment can lead to a variety of physical and emotional concerns impacting on those affected, including subclinical or clinical depression and anxiety, which in turn have a significant impact on wellbeing, quality of life and survival. The aim of this review was to evaluate the effect of yoga-based interventions on self-reported depression and anxiety symptoms in people with cancer in randomized controlled trials.

METHOD

Six databases were searched to identify relevant studies. Systematic review procedures were followed including a quality assessment. Meta-analysis of suitable studies was conducted.

RESULTS

26 studies from our search criteria were eligible for inclusion for depressive and 16 for anxiety symptoms. Meta-analyses revealed evidence for significant medium effects of yoga on depression symptoms (N = 1,486, g = -0.419, 95% confidence interval [CI] = -0.558 to -0.281, p < 0.001) and anxiety (N = 977, g = -0.347, 95% CI = -0.473 to -0.221, p < 0.001) compared to controls. Subgroup analyses for depressive symptoms revealed significant effects for all analyses performed (type of cancer, type of control, treatment status, duration of intervention or frequency of yoga sessions), with effect sizes being comparable between subgroups. Similar findings were found for anxiety symptoms except for treatment status, where the only significant effect was found when yoga was delivered during active treatment.

CONCLUSIONS

This review provides evidence that in people with cancer, yoga-based interventions are associated with amelioration of depression and anxiety symptoms and therefore a promising therapeutic modality for their management. However, the potential for risk of bias together with control group design challenges means the results should be interpreted with caution.

Dropout from exercise randomized controlled trials among people with anxiety and stress-related disorders: A meta-analysis and meta-regression

OBJECTIVE

. Exercise has established efficacy in people with anxiety and stress-related disorders. Dropouts from randomized controlled trials (RCT's) pose a threat to the validity of the evidence, with dropout rates varying across studies. We conducted a meta-analysis to investigate the prevalence and predictors of dropout rates among adults with anxiety and stress-related disorders participating in exercise RCT's.

METHODS

. Two authors searched major electronic databases up to 07/2020. We included RCT's of exercise interventions in people with anxiety and stress-related disorders that reported dropout rates. A random effects meta-analysis and meta-regression were conducted.

RESULTS

. Fourteen RCT's involving 16 exercise interventions (n=369, mean age 20.7 to 67.7years; 38.4% male) were included. The trim-and-fill-adjusted prevalence of dropout across all studies was 22.4% (95%CI = 15.0% to 32.0%). Applying controlled motivation strategies (P<0.001) predicted higher dropout. Supervision during all sessions and by an expert in exercise prescription and applying autonomous motivation strategies predicted lower dropout (all P<0.001). Dropout was similar in exercise versus control conditions (OR = 0.84, 95%CI = 0.54 to 1.29, p = 0.42, I² = 0%; N=16).

LIMITATIONS

. Potentially important moderators of dropout, such as the severity of mental health symptoms and illness duration were insufficiently available.

CONCLUSIONS

. Exercise is well tolerated by people with anxiety and stress-related disorders and drop out in RCT's is comparable to control conditions. Thus, exercise is a feasible treatment, in particular when autonomous motivation strategies are included and when the intervention is delivered by healthcare professionals with expertise in exercise prescription.

Exercise addiction in athletes: Comparing two assessment instruments and willingness to stop exercise after medical advice

Exercise is overwhelmingly beneficial for physical and mental health, but for some people exercise addiction (EA) can develop and negatively impact an individual. This study sought to (a) compare the latent structure of two instruments assessing EA and (b) examine differences in attitudes toward stopping exercise, if required to on medical grounds, among exercise-addicted and non-addicted athletes. In a cross-sectional study, 1,011 athletes competing at different levels completed an anonymous on-line survey. The survey contained Exercise Dependence Scale-Revised (EDS-R), Exercise Addiction Inventory (EAI), and questions on adherence to medical prescriptions to stop exercise. We tested the latent structure of EDS-R and EAI with multigroup confirmatory factor analyses (CFA), across gender and competition level. Finally, we measured the difference of athletes' attitudes toward stopping exercise, if prescribed by a physician. Both instruments showed good fit indexes, even across gender. CFAs on EAI scores showed some violations of measurement invariance across competition level (ΔCFI = .03; ΔRMSEA = .02). On the contrary, CFAs on EDS-R scores did not show invariance violations across competition level (ΔCFI = <.01; ΔRMSEA = <.01). Finally, athletes who reached thresholds for exercise addiction, by means of EDS-R, were more prone to not follow medical prescriptions to cease exercise, independently of the competition level. These results suggest that athletes' answers on the EDS-R seem to be less affected by competition level, compared to EAI. Moreover, EDS-R outcomes could be used to identify individuals who may be unlikely to cease exercise for medical reasons, independently of their competition level. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Does Switching Antipsychotics Ameliorate Weight Gain in Patients With Severe Mental Illness? A Systematic Review and Meta-analysis

OBJECTIVE

Obesity and adverse metabolic outcomes in patients with severe mental illness are clinically significant but potentially preventable. Importantly, the evidence for switching to antipsychotics to reduce cardiometabolic burden is unclear.

METHOD

PubMED, Embase, PsycINFO, and Cochrane were searched from inception to March 8, 2020. Articles reporting weight and metabolic changes after antipsychotic switching vs staying on the previous antipsychotic were meta-analyzed both across and within group.

RESULTS

Of 61 identified studies, 59 were meta-analyzed (40% rated high quality). In the switch-vs-stay pairwise meta-analyses, only aripiprazole significantly reduced weight (-5.52 kg, 95% CI -10.63, -0.42, P = .03), while olanzapine significantly increased weight (2.46 kg, 95% CI 0.34, 4.57, P = .02). Switching to aripiprazole also significantly improved fasting glucose (-3.99 mg/dl, 95% CI -7.34, -0.64, P = .02) and triglycerides (-31.03 mg/dl, 95% CI -48.73, -13.34, P = .0001). Dropout and psychosis ratings did not differ between switch and stay groups for aripiprazole and olanzapine. In before-to-after switch meta-analyses, aripiprazole (-1.96 kg, 95% CI -3.07, -0.85, P < .001) and ziprasidone (-2.22 kg, 95% CI -3.84, -0.60, P = .007) were associated with weight loss, whereas olanzapine (2.71 kg, 95% CI 1.87, 3.55, P < .001), and clozapine (2.80 kg, 95% CI 0.26, 5.34, P = .03) were associated with weight gain. No significant weight or other cardiometabolic changes were observed when switching to amisulpride, paliperidone/risperidone, quetiapine, or lurasidone.

CONCLUSIONS

Switching antipsychotics to agents with lower weight gain potential, notably to aripiprazole and ziprasidone, can improve weight profile and other cardiometabolic outcomes. When choosing switch agents, both the weight gain potential of the pre- and post-switch antipsychotic must be considered. Antipsychotic switching in psychiatrically stable patients must be weighed against the risk of psychiatric worsening.

The association between lithium in drinking water and neuropsychiatric outcomes: A systematic review and meta-analysis from across 2678 regions containing 113 million people

BACKGROUND

Lithium in drinking water may have significant mental health benefits. We investigated the evidence on the association between lithium concentrations in drinking water and their neuropsychiatric outcomes.

METHODS

We conducted a systematic review and meta-analysis and searched Pubmed, Embase, Web of Science, PsycINFO and CINAHL up to 19 January 2020, for peer-reviewed research examining the association between lithium concentrations in drinking water and neuropsychiatric outcomes. We used a pairwise analysis and a random effects model to meta-analyse suicide rates and psychiatric hospital admissions. We assessed for publication bias using Egger's test and Duval and Tweedie's Trim and Fill analysis.

RESULTS

Twenty-seven studies including 113 million subjects were included in this systematic review. Meta-analysis of 14 studies including 94 million people found higher lithium concentrations were associated with reduced suicide rates (r = -0.191, 95% confidence interval = [-0.287, -0.090], p < 0.001) and meta-analysis of two studies including 5 million people found higher lithium concentrations were associated with fewer hospital admissions (r = -0.413, 95% confidence interval = [-0.689, -0.031], p = 0.035). We found significant heterogeneity between studies (Q = 67.4, p < 0.001, I² = 80.7%) and the presence of publication bias (Egger's test; t value = 2.90, p = 0.013). Other included studies did not provide sufficient data to analyse other neuropsychiatric outcomes quantitatively.

CONCLUSION

Higher lithium concentrations in drinking water may be associated with reduced suicide rates and inpatient psychiatric admissions. The relationship with other neuropsychiatric outcomes and complications remains unclear. Further research is required before any public health recommendations can be made.Trial registration number: The study was registered with PROSPERO, number CRD42018090145.

The Impact of Pharmacological and Non-Pharmacological Interventions to Improve Physical Health Outcomes in People With Schizophrenia: A Meta-Review of Meta-Analyses of Randomized Controlled Trials

(Reprinted with permission from World Psychiatry 2019;18:53-66).

Prebiotic and probiotic supplementation and the tryptophan-kynurenine pathway: A systematic review and meta analysis

This systematic review aimed to synthesise the results from studies investigating the effects of prebiotics and probiotics on kynurenine pathway metabolism. Thirteen studies were identified for inclusion, comprising 12 probiotic and two prebiotic arms. Participants included healthy individuals and individuals with various clinical conditions. Twelve metabolites were examined across the studies, using a range of biological samples. Across all interventions, 11 reported an effect on ≤ metabolite. Although limited by clinical and methodological heterogeneity, pooled analysis (n = 253) found probiotics to significantly affect serum kynurenine (g = 0.315, CI = 0.070 to 0.560, p = 0.012, 4 studies, I² = 0%) and the kynurenine:tryptophan ratio (g = 0.442, CI = 0.074 to 0.810, p = 0.018, 4 studies, I² = 42 %). Risk of bias across the studies was generally low. The results provide preliminary evidence that probiotics can modulate kynurenine pathway metabolism, with less evidence available regarding prebiotics. Future studies which further consider methodological confounds and sample characteristics are required, to establish intervention efficacy. PROSPERO registration #CRD42019154677.

Prevalence of Major Cardiovascular Disease Events Among People Diagnosed With Schizophrenia Who Have Sleep Disturbance, Sedentary Behavior, or Muscular Weakness

Objective

To estimate prevalence of major cardiovascular events among people with schizophrenia who had experience of sleep disturbance, sedentary behavior or muscular weakness, and assess evidence for raised prevalence in these individuals compared to people with schizophrenia without these characteristics.

Methods

UK Biobank data on individuals diagnosed with schizophrenia (n = 1544) were used to examine the prevalence of major cardiovascular events, specifically myocardial infarction, stroke, heart failure and cardiovascular death, among participants with candidate risk factors. Generalized linear models were fitted to estimate prevalence ratios (PRs) for major cardiovascular events among participants with self-reported sleep disturbance, self-reported sedentary behavior, and muscular weakness measured using a handgrip dynamometer. These ratios were adjusted for QRISK3 score—a validated cardiovascular risk prediction algorithm for the UK population.

Results

Prevalence of major cardiovascular events was significantly higher among participants with daytime sleepiness, independent of QRISK3 score, and snoring, a proxy for sleep-disordered breathing (adjusted PR 1.26; 95% CI 1.03, 1.55, P = .03). Prevalence was also independently higher among participants with low muscular strength (adjusted PR1.36; 95% CI 1.05, 1.75, P = .02). The adjusted prevalence ratios among participants with short or prolonged sleep duration, insomnia, or sedentary behavior did not indicate independently raised prevalence among these groups.

Conclusion

Prevalence of major cardiovascular events among people with schizophrenia was higher in participants with muscular weakness and sleep disturbance evidenced by daytime sleepiness. Further research is required to determine how these factors can be routinely identified and addressed in the clinical management of cardiovascular risk among patients with schizophrenia.

Human Immunodeficiency Virus Infection and Diverse Physical Health Outcomes: An Umbrella Review of Meta-analyses of Observational Studies

Background

Our aim was to assess both the credibility and strength of evidence arising from systematic reviews with meta-analyses of observational studies and physical health outcomes associated with human immunodeficiency virus (HIV) but not acquired immunodeficiency syndrome.

Methods

We performed an umbrella review of observational studies. Evidence was graded as convincing, highly suggestive, suggestive, weak, or nonsignificant.

Results

From 3413 studies returned, 20 were included, covering 55 health outcomes. Median number of participants was 18 743 (range 403–225 000 000). Overall, 45 (81.8%) of the 55 unique outcomes reported nominally significant summary results (P < .05). Only 5 outcomes (9.0%; higher likelihood of presence of breathlessness, higher chronic obstructive pulmonary disease [COPD] prevalence, maternal sepsis, higher risk of anemia, and higher risk of all fractures among people living with HIV [PLWHIV]) showed suggestive evidence, with P values < 10^–3; only 3 (5.5%; higher prevalence of cough in cross-sectional studies, higher incidence of pregnancy-related mortality, and higher incidence of ischemic heart disease among PLWHIV in cohort studies) outcomes showed stronger evidence using a stringent P value (<10^–6). None of the unique outcomes presented convincing evidence (Class I), yet 3 outcomes presented highly suggestive evidence, 5 outcomes presented suggestive evidence, and 37 outcomes presented weak evidence.

Conclusions

Results show highly suggestive and suggestive evidence for HIV and the presence of a cough, COPD, ischemic heart disease, pregnancy-related mortality, maternal sepsis, and bone fractures. Public health policies should reflect and accommodate these changes, especially in light of the increases in the life expectancy and the incidence of comorbidities in this population.

The clinical and behavioral cardiometabolic risk of children and young people on mental health inpatient units: A systematic review and meta-analysis

OBJECTIVE

Serious mental illness is associated with physical health comorbidities, however most research has focused on adults. We aimed to synthesise existing literature on clinical and behavioral cardiometabolic risk factors of young people on mental health inpatient units.

METHODS

A systematic review and meta-analysis was conducted, using electronic searches of PsycINFO, EMBASE, AMED, Cochrane Central Register of Controlled Trials, and Ovid MEDLINE. Eligible studies included child/adolescent mental health inpatient units for <25 years, reporting clinical/behavioral cardiometabolic risk factors. Studies containing adult samples, case-studies, or eating disorder populations were excluded. The main clinical outcome was weight, and main behavioral outcome was tobacco use.

RESULTS

Thirty-nine studies were identified (n = 809,185). Pooled prevalence rates of young people who were overweight (BMI > 25) was 32.4% (95% CI 26.1%-39.5%; n = 2789), and who were obese (BMI > 30) was 15.5% (95% CI 4.5%-41.6%; n = 2612). Pooled prevalence rates for tobacco use was 51.5% (95% CI 32.2-70.2; N = 804,018). Early signs of metabolic risk were observed; elevated blood cholesterol, presence of physical health conditions, and behavioral risk factors (e.g. physical inactivity).

CONCLUSIONS

This review highlights the vulnerability of young people admitted to inpatient units and emphasises the opportunity to efficiently monitor, treat and intervene to target physical and mental health.

Longitudinal Course of Depressive, Anxiety, and Posttraumatic Stress Disorder Symptoms After Heart Surgery: A Meta-Analysis of 94 Studies

OBJECTIVE

This study aimed to analyze the longitudinal course of depression, anxiety, and posttraumatic stress disorder (PTSD) symptoms in patients with cardiac disease after heart surgery (HS).

METHODS

We conducted a systematic review and random-effects meta-analysis of cohort studies in patients undergoing HS, measuring anxiety, depressive, and PTSD symptoms before and at least 30 days thereafter. Subgroup and meta-regression analyses, investigation of publication bias, and quality assessment were undertaken.

RESULTS

We included 94 studies relating to 15,561 patients. HS included coronary artery bypass graft surgery, valve replacement, implantable cardioverter-defibrillator placement, left ventricular assist device placement, heart transplantation, and other types of HS. Across studies, symptoms of depression (g = 0.32; 95% confidence interval [CI] = 0.25 to 0.39; p < .001) and anxiety improved after HS (g = 0.52; 95% CI = 0.43 to 0.62; p < .001), whereas PTSD symptoms worsened (g = -0.42; 95% CI = -0.80 to -0.04; p = .032). The reduction of depression and anxiety levels was more pronounced for patients with underlying coronary artery disease and heart failure and persisted for 1 year after HS, whereas the increase in PTSD symptoms returned to baseline after 6 months. Depression improvement was inversely associated with older age, diabetes, hypertension, and dyslipidemia and positively with baseline heart failure. No additional clinical or demographic variables were associated with the course of anxiety symptoms. Quality of included studies was low overall. Publication bias was nonsignificant.

CONCLUSIONS

Depressive and anxiety symptoms improve for 1 year after HS, whereas PTSD symptoms might worsen. Older patients and those with metabolic comorbidities, valve disease, or ventricular arrhythmias are at higher risk for continued depressive and anxiety symptoms and should be monitored closely.

Diet and depression: exploring the biological mechanisms of action

The field of nutritional psychiatry has generated observational and efficacy data supporting a role for healthy dietary patterns in depression onset and symptom management. To guide future clinical trials and targeted dietary therapies, this review provides an overview of what is currently known regarding underlying mechanisms of action by which diet may influence mental and brain health. The mechanisms of action associating diet with health outcomes are complex, multifaceted, interacting, and not restricted to any one biological pathway. Numerous pathways were identified through which diet could plausibly affect mental health. These include modulation of pathways involved in inflammation, oxidative stress, epigenetics, mitochondrial dysfunction, the gut microbiota, tryptophan-kynurenine metabolism, the HPA axis, neurogenesis and BDNF, epigenetics, and obesity. However, the nascent nature of the nutritional psychiatry field to date means that the existing literature identified in this review is largely comprised of preclinical animal studies. To fully identify and elucidate complex mechanisms of action, intervention studies that assess markers related to these pathways within clinically diagnosed human populations are needed.

Adherence to a healthy lifestyle and multiple sclerosis: a case-control study from the UK Biobank

BACKGROUND

Multiple sclerosis (MS) is a common and disabling condition. The importance of healthy lifestyle for this disease is poorly explored.

OBJECTIVE

To test whether adherence to healthier lifestyle patterns is associated with a lower presence of multiple sclerosis (MS).

METHODS

By using a case-control design, we investigated the combined association of four healthy lifestyle-related factors (no current smoking, healthy diet, exercising regularly, body mass index <30 kg/m²) and the prevalence of MS. A logistic regression analysis, adjusted for potential confounders, was used and data reported as odds ratios (ORs) with their 95% confidence intervals (CIs).

RESULTS

728 participants with MS were matched with healthy controls (n = 2,912) using a propensity score approach. In a multivariable analysis, compared to those who scored low in the composite lifestyle score (0-1 healthy lifestyle factors), people who adopted all four low risk lifestyle factors showed a 71% lower odds of having MS (OR = 0.29; 95% CI: 0.15-0.56). Moreover, there was a strong linear trend, suggesting that the higher number of healthy lifestyle behaviors was associated with lower odds of having MS.

CONCLUSION

Following a healthy lifestyle is associated with a lower prevalence of MS. This association should be explored further in cohort studies.

World Health Organization 2020 guidelines on physical activity and sedentary behaviour

OBJECTIVES

To describe new WHO 2020 guidelines on physical activity and sedentary behaviour.

METHODS

The guidelines were developed in accordance with WHO protocols. An expert Guideline Development Group reviewed evidence to assess associations between physical activity and sedentary behaviour for an agreed set of health outcomes and population groups. The assessment used and systematically updated recent relevant systematic reviews; new primary reviews addressed additional health outcomes or subpopulations.

RESULTS

The new guidelines address children, adolescents, adults, older adults and include new specific recommendations for pregnant and postpartum women and people living with chronic conditions or disability. All adults should undertake 150-300 min of moderate-intensity, or 75-150 min of vigorous-intensity physical activity, or some equivalent combination of moderate-intensity and vigorous-intensity aerobic physical activity, per week. Among children and adolescents, an average of 60 min/day of moderate-to-vigorous intensity aerobic physical activity across the week provides health benefits. The guidelines recommend regular muscle-strengthening activity for all age groups. Additionally, reducing sedentary behaviours is recommended across all age groups and abilities, although evidence was insufficient to quantify a sedentary behaviour threshold.

CONCLUSION

These 2020 WHO guidelines update previous WHO recommendations released in 2010. They reaffirm messages that some physical activity is better than none, that more physical activity is better for optimal health outcomes and provide a new recommendation on reducing sedentary behaviours. These guidelines highlight the importance of regularly undertaking both aerobic and muscle strengthening activities and for the first time, there are specific recommendations for specific populations including for pregnant and postpartum women and people living with chronic conditions or disability. These guidelines should be used to inform national health policies aligned with the WHO Global Action Plan on Physical Activity 2018-2030 and to strengthen surveillance systems that track progress towards national and global targets.

Risk of Hospitalized Falls and Hip Fractures in 22,103 Older Adults Receiving Mental Health Care vs 161,603 Controls: A Large Cohort Study

OBJECTIVES

To investigate the risk of hospitalized fall or hip fracture among older adults using mental health services.

DESIGN

Retrospective cohort study.

SETTING AND PARTICIPANTS

Residents of a South London catchment aged >60 years receiving specialist mental health care between 2008 and 2016.

MEASURES

Falls and/or a hip fracture leading to hospitalization were ascertained from linked national records. Incidence rates and incidence rate ratios (IRRs) were age- and gender-standardized to the catchment population. Multivariable survival analyses were applied investigating falls and/or hip fractures as outcomes.

RESULTS

In 22,103 older adults, incidence rates were 60.1 per 1000 person-years for hospitalized falls and 13.7 per 1000 person-years for hip fractures, representing standardized IRRs of 2.17 [95% confidence interval (CI) 2.07-2.28] and 4.18 (3.79-4.60), respectively. The IRR for falls was high in those with substance-use disorder [IRR = 6.72 (5.35-8.33)], bipolar disorder [IRR = 3.62 (2.50-5.05)], depression [IRR = 2.28 (2.00-2.59)], and stress-related disorders [IRR = 2.57 (2.10-3.11)]. Hip fractures were increased in all populations (IRR > 2.5), with greatest risk in substance use disorders [IRR = 12.64 (7.22-20.52)], dementia [IRR = 4.38 (3.82-5.00)], and delirium [IRR = 4.03 (3.00-5.29)]. Comparing mental disorder subgroups with each other, after the adjustment for 25 potential confounders, patients with dementia and substance use had a significantly increased risk of falls, and patients with dementia also had an increased risk of hip fractures.

CONCLUSION AND IMPLICATIONS

Older people using mental health services have more than double the incidence of falls and 4 times the incidence of hip fractures compared to the general population. Although incidences differ between diagnostic subgroups, all groups have a higher incidence than the general population. Targeted interventions to prevent falls and hip fractures among older adult mental health service users are urgently needed.

World Health Organization 2020 guidelines on physical activity and sedentary behaviour

OBJECTIVES

To describe new WHO 2020 guidelines on physical activity and sedentary behaviour.

METHODS

The guidelines were developed in accordance with WHO protocols. An expert Guideline Development Group reviewed evidence to assess associations between physical activity and sedentary behaviour for an agreed set of health outcomes and population groups. The assessment used and systematically updated recent relevant systematic reviews; new primary reviews addressed additional health outcomes or subpopulations.

RESULTS

The new guidelines address children, adolescents, adults, older adults and include new specific recommendations for pregnant and postpartum women and people living with chronic conditions or disability. All adults should undertake 150-300 min of moderate-intensity, or 75-150 min of vigorous-intensity physical activity, or some equivalent combination of moderate-intensity and vigorous-intensity aerobic physical activity, per week. Among children and adolescents, an average of 60 min/day of moderate-to-vigorous intensity aerobic physical activity across the week provides health benefits. The guidelines recommend regular muscle-strengthening activity for all age groups. Additionally, reducing sedentary behaviours is recommended across all age groups and abilities, although evidence was insufficient to quantify a sedentary behaviour threshold.

CONCLUSION

These 2020 WHO guidelines update previous WHO recommendations released in 2010. They reaffirm messages that some physical activity is better than none, that more physical activity is better for optimal health outcomes and provide a new recommendation on reducing sedentary behaviours. These guidelines highlight the importance of regularly undertaking both aerobic and muscle strengthening activities and for the first time, there are specific recommendations for specific populations including for pregnant and postpartum women and people living with chronic conditions or disability. These guidelines should be used to inform national health policies aligned with the WHO Global Action Plan on Physical Activity 2018-2030 and to strengthen surveillance systems that track progress towards national and global targets.