Wellness Check: Mental Health

Differences amongst eating disorder diagnoses should be considered in effective management

1. Amongst adolescents with anorexia nervosa (AN) and bulimia nervosa (BN), interventions involving family-based therapy outperformed active control groups.

2. In binge-eating disorder (BED), psychotherapy and lisdexamfetamine outperformed active control. 

Evidence Rating Level: 2 (Good)

Eating disorders typically peak during adolescent years and have significant mental and physical health impacts – which explains why effective treatment is of growing clinical interest. Currently, there is no umbrella review summarizing findings for eating disorders (ED) for all age groups. As a result, the objective of the present systematic review and meta-analysis was to summarize the efficacy of various treatment options for eating disorders across several age groups

Of 844 identified records, 59 were included in the present review from database inception to December 2020. Studies were included if they were randomized controlled trials (RCTs) which evaluated ED participants of any age in any intervention in comparison to an active or inactive control condition. Systematic reviews without meta-analysis were excluded. Quality of the evidence was assessed using A Measurement Tool for the Assessment of Multiple Systematic Reviews (AMSTAR-PLUS). Data reporting was done by standardizing and harmonizing effect sizes from the studies.

Results demonstrated that in adolescents with AN and BN, interventions involving family-based therapy outperformed active control groups. Furthermore, individual CBT had the broadest efficacy versus control in adults with BN. Additionally, in BED, psychotherapy and lisdexamfetamine outperformed active control, though medications have been shown to have only short-term efficacy. Despite these findings, the study was limited by not pooling individual randomized controlled trials in previous meta-analyses. Nonetheless, the present umbrella review supports the recommendations from most guidelines and extends support especially for cognitive behavioral therapy for EDs.

Sports betting may be associated with elevated levels of problem gambling

1. In this study, sports bettors in general tended to have high levels of problem gambling, and sports-betting involvement was frequently associated with greater problem-gambling severity.

2. Research on marketing and promotion of sports betting was most prevalent in Australia and the United Kingdom.

Evidence Rating Level: 3 (Average)

Sports betting has been a rapidly growing industry across the world. One main concern with this behavior is that it may be a possible risk factor for problematic gambling behaviors such as chasing losses, preoccupation with gambling, and financial loss. As a result, the objective of the present systematic review was to examine the associations between sports-betting behaviors and psychosocial problems, as well as explore differences between Western and non-Western cultures.

Of 2450 identified records, 65 were included in the review from January 2010 to March 2022. Studies were included if they had a major focus on sports betting or sports bettors and originated from primary data sources. Studies were excluded if participants were children, adolescents, college students, sports athletes, treatment seeking as well as if the gambling related to esports, loot boxes/micro transactions, horse racing, etc. The authors then grouped articles into 6 common domains in relation to sports betting.

Results demonstrated that sports bettors in general tended to have high levels of problem gambling, and sports-betting involvement was frequently associated with greater problem-gambling severity. Psychosocial problems did not appear to differ greatly by country. Furthermore, research on marketing and promotion of sports betting was most prevalent in Australia and the United Kingdom. This could possibly be due to these locations having an environment where marketing and promotion of sports betting is acceptable and common. Despite these findings, the study was limited by the strict search criteria which may have excluded potentially relevant articles as well as those in the grey literature. Nonetheless, these results may inform future research in determining how different aspects of sports-betting in different cultures may be related to problem gambling.

Multiple psychotherapy interventions effective in borderline personality disorder

1. In this study, statistically significant effects were observed for dialectical behavior therapy (DBT) and mentalization based treatment (MBT).

2. When added as adjunctive treatments, DBT skills and training (DBT-ST) groups demonstrated beneficial effects on BPD severity and psychosocial functioning.

Evidence Rating Level: 2 (Good)

To date, psychotherapy is recommended as the primary treatment for borderline personality disorder (BPD) since pharmacotherapy has not been associated with convincing, sustainable effects. A broad variety of treatments have been investigated though the certainty of the evidence has been low, especially if only a single study was available. As a result, the objective of the present systematic review and meta-analysis was to evaluate any psychotherapeutic treatment on BPD with evidence from at least two randomized controlled trials.

Of 2203 identified records, 31 (n=1870) were included in the analysis from database inception up to February 2021. Studies were included if they were RCTs comparing an active treatment with any kind of control treatment in BPD patients. Bias was assessed using the Cochrane Collaboration risk of bias tool. Quality was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool. The inverse-variance meta-analysis was used for pooling the data.

Results demonstrated that statistically significant effects were observed for dialectical behavior therapy (DBT) (reducing self-harm and improving psychosocial functioning) and mentalization based treatment (MBT) (decreasing self-harm and suicide-related outcomes). Furthermore, when added as adjunctive treatments, DBT skills and training (DBT-ST) groups demonstrated beneficial effects on BPD severity and psychosocial functioning. Despite these results, the study was limited by the inclusion of studies that were predominantly female which limits the findings to men. Nonetheless, the comprehensiveness of the search strategy provides reasonable grounds to suggest the usefulness of various psychotherapeutic interventions for individuals with BPD.

Family history of psychiatric disorder increases risk of developing postpartum depression

1. In this study, mothers with a positive family history of psychiatric disorders had an increased risk of developing postpartum depression (PPD) compared to mothers without this history.

2. Furthermore, there was no significant difference between PPD assessed at various weeks postpartum.

Evidence Rating Level: 1 (Excellent)

PPD is not only a highly prevalent condition in the general population, but also preventable and treatable which makes its early identification important. Interestingly, family history of psychiatric disorders was inconsistently identified as a risk factor for PPD in several reviews focused on all PPD risk factors. As a result, the objective of the present systematic review and meta-analysis was to summarize the current literature on the association between family history of psychiatric disorders and PPD. The secondary objective was to determine if this association was modified by different assessment points and definitions of family history of psychiatric disorders and PPD.

Of 4239 identified records, 26 were included in the review from database inception to March 31^st, 2022. Studies were eligible if they investigated family history of psychiatric disorders as a risk factor for PPD within 12 months. Risk of bias was assessed using the Newcastle-Ottawa scale. Data analysis was performed using a random-effects model. Quality of evidence was done based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE).

Results demonstrated that mothers with a positive family history of psychiatric disorders had an increased risk of developing postpartum depression (PPD) compared to mothers without this history. Furthermore, there was no significant difference between PPD assessed at various weeks postpartum. Additionally, the odds for the association increased when family history was self-reported. Despite these findings, the present study was limited by the different phrasing of family history across most of the included studies. Nonetheless, the inclusion of studies from a wide range of countries highlights the possibility of including this family history in routine care to prevent PPD as well as its consequences on the mother.

Image: PD

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