Wellness Check: Mental Health

Increased Mortality From COVID-19 In Severe Mental Illness Patients With Comorbidities and Those of Black Race

1. There was higher multimorbidity and increased risk of death in those with severe mental illness (SMI) vs the control group following infection with COVID-19. The risk of death was increased in those with multimorbidity.

2. There was an increased risk of death in people of black race vs white race following infection with COVID-19. However, mortality was similar between SMI and non-SMI in people of black race.

Evidence Rating Level: 2 (Good)

COVID-19 had devastating impacts on society. These impacts were further magnified in those with SMI and those of black race. At baseline, patients with SMI have a 15-20 year lower life expectancy. This was further reduced during the pandemic. In addition to this, healthcare inequality was also further worsened during the pandemic for people of black race. However, the influence of multimorbidity on the mortality of individuals with SMI following COVID-19 infection has not been studied. Additionally, a gap also remains regarding the impact of race on this relationship.

This was a cohort study done in the UK pulling data from a primary care database for two waves of COVID-19. The study compared a non-SMI control group (653024) to an SMI group (7146). The SMI group required a psychiatric diagnosis before infection. Only morbidities with known associated risks of increased infection and death were included. Patients diagnosed with SMI after infection, and patients under the age of 6 were excluded. People of black race were identified as those of black Caribbean or African descent. The impact of SMI, comorbidities, and race on mortality was investigated. The primary outcome measured all-cause mortality.

Compared to the control group, the SMI group had increased mortality following COVID-19. This was further increased by the presence of comorbidities. An increase in mortality in people of black race vs white was also seen. However, mortality in people of black race with SMI vs non-SMI was similar. Limitations in this study include the limited time period of the study and the rollout of the vaccine which affects the true measure of mortality from COVID-19 infection. Furthermore, the impact of race may be underplayed by the study since healthcare inequities for minorities are not homogenous globally. Nevertheless, the study demonstrates the need to prioritize these groups as high-risk and employ preventative measures early when facing public health crises.

Parental Mental Health Disorders Increase Offspring Risk of Mental Health Disorders

1. The risk of developing the same or any mental health disorder was increased in offspring of parents with a mental health disorder.

2. The age of onset of bipolar, depressive, and psychotic disorders was 5, 6, and 16 years old, respectively in the offspring of parents with a MHD, with risk increasing until the age of 30.

Evidence Rating Level: 1 (Excellent)

The inheritance of mental health disorders (MHD) from parent to offspring has been well documented. In particular, the risk for psychosis and bipolar disorder is so high that the offspring of parents with these diagnoses are targeted early with intervention. To implement early intervention, clinicians rely on risk and age of onset of the illness. Previous studies have only focused on major depressive, psychotic, and bipolar disorders leaving a gap in literature concerning other MHDs. Furthermore, research has only focused on the risk of developing the same MHD as the parent.

This meta-analysis used studies published until September 2022 which investigated the risk of developing MHDs in the offspring of parents with a MHD. 211 studies were identified which compared 3,172,115 offspring with a MH diagnosis to a control group of 20,428,575. Inclusion criteria required studies that looked at parent-offspring groups with one or more MH diagnoses confirmed using the DSM or ICD. 10 groups were defined: psychotic, bipolar, depressive, anxiety, substance use, borderline personality, attention deficit/hyperactivity, disruptive, obsessive-compulsive, and eating disorders. Low-quality study designs like case reports and cases without a DSM or ICD diagnosis were excluded. The primary outcome measured the risk of developing MHDs in offspring of parents with MHDs.

The risk of developing any MHD was increased in the offspring of parents with anxiety, psychotic, bipolar, depressive, or substance use disorders. The risk of developing the same MHD was increased in the offspring of parents with ADHD, psychosis, bipolar, substance use, depression, eating, and anxiety disorders. The age of onset of bipolar, depressive, and psychotic disorders was 5, 6, and 16 years old, respectively, with risk increasing until the mid-20s to 30. One limitation of this meta-analysis is that few studies looked at lower socioeconomic groups which affects the generalizability of the study, and potentially overlooks a high-risk sub-group. Furthermore, the study did not address the onset age of other MHDs. Nevertheless, this meta-analysis shows the need for proactive MH screening, and implementation of early interventions in this population to reduce the risk of developing MHDs.

Smartphone Mental Health Apps Can Help Reduce Symptoms Of Anxiety And Depression

1. Smartphone mental health apps have a small but significant effect on the reduction of general anxiety and depressive symptoms.

2. Mental health apps that incorporate cognitive behavioral therapy, or chatbot features have the greatest impact on symptom reduction.

Evidence Rating Level: 1 (Excellent)

Treatment of mental health disorders is being revolutionized by technological innovation. Smartphone apps geared towards mental health have become a very popular tool for managing mental health symptoms. With an overburdened healthcare system, access to mental health care has become increasingly difficult in recent years. Smartphone apps can be a cost-effective, quick tool that individuals can access at their convenience. Previous research has shown strong support for the efficacy of smartphone apps to manage symptoms of depression and general anxiety. However, precise and powerful analysis of the effects of mental health management by smartphone apps has been limited by a lack of studies.

This meta-analysis included studies published up until June 2023 which looked at the impact of smartphone apps on managing symptoms of general anxiety and depression. 176 randomized control trials from 174 papers that compared smartphone apps to controls (placebo, face-to-face treatment, waitlist) on managing symptoms of anxiety and depression were included in the meta-analysis. Studies that blended app and web-based interventions, apps that did not have mental health as a sole focus (ie. diet apps), text messaging, and studies that incorporated apps with face-to-face therapy were excluded. The smartphone apps used in the studies incorporated mood tracking, cognitive behavioral therapy (CBT), or chatbot features. The primary outcome measure was the reduction of general anxiety or depressive symptoms.

Compared to control groups, smartphone apps caused a small but significant reduction in general anxiety or depressive symptoms. Reduction of general anxiety symptoms was most profound when apps were primarily geared towards general anxiety, and incorporated CBT into management. The reduction of depressive symptoms was most significant when apps used CBT or chatbot features. These effects persisted upon follow-up which took place 1-4, or 5-12 weeks post initial assessment. A limitation of this study is the heterogeneity in the samples studied in terms of severity of symptoms, and the quality of apps used. Nevertheless, to date, this is the most comprehensive study to investigate the efficacy of smartphone apps on the management of mental health symptoms. Smartphone apps are a worthwhile adjunct to conventional treatment that clinicians may consider incorporating into the management of general anxiety and depression.

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