Wellness Check: Mental Health

2 Minute Medicine is pleased to announce that we are launching Wellness Check, a new series dedicated to exploring new research evidence focused on wellness. Each week, we will report on articles examining different aspects of wellness, including (but not limited to) nutrition, sleep, reproductive health, substance use and mental health. This week, we explore the latest evidence-based updates in mental health.

Manual-Based Art Therapy improved depressive symptoms and suicidality

1. In this randomized controlled study, manual-based phenomenological art therapy was associated with reduced depression, suicidal ideation, and increased self-esteem.

2. Improvements in mood associated with manual-based phenomenological art therapy were sustained at 6-month follow-up.

Evidence Rating Level: 1 (Excellent)

Individuals who exhibit depressive symptoms and suicidality are at risk for developing chronic, persistent, and treatment-resistant depression. The combination of manual-based phenomenological art therapy (PATd) with treatment as usual (TAU) has been previously associated with improvement in depressive symptoms immediately following intervention.

The purpose of the present randomized control study was to summarize if the combination of PATd with TAU has a sustained effect on improving mood. 79 participants were randomized into either receiving TAU (36 participants) or TAU as well as PATd (43 participants). Patients were included if they were adults who had been diagnosed with moderate to severe depression. Exclusion criteria included history of psychotic symptoms, diagnosis of bipolar syndrome, ongoing substance use disorder, cognitive disability, and recent exposure to a traumatic event. The Montgomery-Åsberg depression rating scale (MADRS-S), Rosenberg self-esteem scale (RSES), and Scale for Suicide Ideation (SSI) were administered at baseline, after 13 weeks, and at 6 month follow-up.

A total of 35 participants completed the PATd intervention as compared to 29 TAU-only controls. Individuals in the PATd group showed significant, sustained improvement in MADRS-S, RSES, and SSI scores. Women were more likely to show improvement with PATd contrasted with individuals with underlying comorbidities who were less likely to demonstrate improvement. Individuals in the PATd group were also less likely to take sick leaves from work during the study period. Limitations were noted in the study, such as limited generalizability due to small sample size and limited follow-up period. Nonetheless, results from the study suggest that art therapy may have a sustained benefit in treating depressive symptoms, suicidality, and low self-esteem.

First time meditation may be associated with increased cognitive effort as measured by EEG

1. In this prospective study, individuals who listened to a meditation podcast demonstrated EEG patterns associated with elevated levels of alertness.

2. Engagement in first-time meditation may require increased concentration, impeding ability to achieve a meditative state.

Evidence Rating Level: 4 (Below Average)

Meditation has been established as a means for achieving mental wellness and mindfulness. Specific EEG changes have been associated with a meditative state in those who regularly engage in meditation. The meditation-related EEG changes are associated with relaxation and passive listening. It is unclear if these EEG changes occur at first experience of meditation or only after several sessions.

This prospective study evaluated EEG changes associated with first-time engagement in mindfulness meditation using a breathing meditation podcast. Subjects listened to the 15-minute podcast followed by a break and then a literature podcast for a passive-listening comparison. Subjects had 19 electrodes placed on their heads as per the international 10-20 system. Inclusion criteria included ability to give informed consent and speak fluent Polish. Participants were excluded if they had any prior meditation experience or underlying health problems.

A total of 16 student participants from the University of Warsaw, Poland, were included. During the meditation session, decreases in theta and alpha ranges were seen in conjunction with a global decrease in alpha power. These EEG changes are typically attributed to enhanced alertness. No other changes were seen in comparison to passive listening. The study had several limitations including the lack of a control group, lack of comparison group consisting of experienced meditators, small sample size, and limited analysis of possible confounders such as frequent podcast use. Overall, the results of the present study suggest that early experiences of meditation may increase alertness instead of inducing relaxation.

Laughter yoga may attenuate cortisol release in response to stress

1. In this randomized control trial, a single laughter yoga session resulted in an attenuated cortisol stress response as compared to individuals who did relaxation breathing as well as controls

2. There was no difference in subjective stress rating, salivary cortisol, or salivary amylase between the groups

Evidence Rating Level: 1 (Excellent)

Stress has a deleterious impact on both mental and physical health. Early intervention may reduce the risk of developing associated illness by reducing the physiological response to stress. Cortisol is widely recognized as a ‘stress hormone’ and is seen to be elevated in individuals who experience high levels of stress. Yoga and laughter are both associated with decreases in perceived stress, and laughter yoga (LY) may represent a means of decreasing cortisol stress response. However, evidence for beneficial effects of LY are scarce.

This randomized control trial compared a single 30-minute session of LY to relaxation breathing as well as a control group. The primary outcomes assessed were salivary cortisol, salivary alpha amylase, subjective stress, and cortisol response after a standardized psychosocial stress test [Trier Social Stress Test for Groups (TSST-G)]. Twenty serial measurements were made throughout TSST-G. Individuals were included who were over the age of 18 and able to give informed consent. Exclusion criteria included BMI under 19 or over 27, consumption of more than 10 drinks/week, smoking, traumatic brain injury, substance use disorder, regular medications that involve the hypothalamic-pituitary-adrenal axis, personal or family history of psychiatric disorder, and use of hormonal contraceptives.

A total of 35 participants were included and randomly allocated to either the LY (n=11), relaxation breathing (n=12), or control (n=12) groups. Participants in the LY group demonstrated a significant decrease in cortisol response during the TSST-G. No significant differences were observed between groups for salivary cortisol, salivary amylase, or subjective stress. The study limitations included limited sample size, impacts of menstrual cycle on cortisol response, and age differences between groups. Nonetheless, the outcomes of this study suggest that LY may help reduce stress response, even after a single session.

COVID-19 quarantine associated with negative impacts on mental health and exercise

1. The second wave of the COVID-19 pandemic in Canada was associated with increased depression, anxiety, and distress as compared to pre-pandemic rates.

2. As compared to the first wave of the COVID-19 pandemic, during the second wave individuals were more likely to engage in audiovisual media and less likely to engage in physical activity.

Evidence Rating Level: 2 (Good)

The COVID-19 pandemic has resulted in lockdown periods interrupting daily life for individuals globally. A combination of increased stress about the uncertainty of the pandemic, lack of access to mental health services, and disrupted routine may impact both mental health outcomes and health-related activities.

The purpose of the present cross-sectional study was to evaluate the impact of the second Canadian COVID-19 lockdown period (September 24^th to December 8^th, 2020) on health and wellness activities. A survey was distributed to Canadian adults with the exclusion of those living in Yukon, Nunavut, and the North West Territories. The survey included demographic data, questions about mental health, and questions about daily activities. The mental health portion of the survey utilized the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), and Kessler Psychological Distress Scale (K10).

A total of 221 participants completed the survey of which 73.2% were female. Distress and anxiety scores were highest in those who were unable to work during COVID-19 or who reported a household income of less than $25,000. Depression scores were highest in individuals with a high school diploma or less. Over half of participants (58.7%) reported that they felt that the pandemic had a negative impact on their mental health. Furthermore, the second wave of COVID-19 was associated with an increase in use of audiovisual media and decrease in physical activities. This study was limited in that baseline measurements were not available in participants for comparison. Furthermore, participants reported higher socioeconomic status and education levels; therefore, results may not be generalizable. Nonetheless, the results of this study were significant in suggesting the COVID-19 pandemic has impacted the mental health of adults, with many participating in varying activities to maintain mental wellness.

Image: PD

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