Wellness Check: Mental Health

Youth depression and anxiety rates increased during the COVID-19 pandemic

1. In this overview of systematic reviews, it was found that the pooled prevalence of depression and anxiety in children and adolescents following COVID-19 mitigation strategies were both 32%.

2. In addition, there were important regional differences in the prevalence rates of both anxiety and depression.

Evidence Rating Level: 1 (Excellent)

The COVID-19 pandemic forced countries across the world to adopt mitigation strategies, such as home confinement, which significantly impacted the mental health of children and adolescents. To date, the majority of studies have not emphasized the mental health impact of COVID-19 in the 0-19-year age group. As a result, the objective of the present study was to review the the effects that COVID-19 mitigation strategies had on youth mental health.

Of 1672 identified records, 18 studies (366 unique primary studies) were included in the review from various databases from early 2020 to January 2022. Studies were included if the primary exposure was COVID-19 and included individuals 0-19 years old. Studies were excluded if they included participants exclusively >19 years old or populations with previous medical/mental health conditions. The review was performed using PRISMA guidelines. Quality assessment was performed according to A Measurement Tool to Assess Systematic Reviews-2 (AMSTAR 2). Pooled estimates for all mental health outcomes were extracted from the studies. The primary outcome was the prevalence of depression and anxiety among youth.

The results demonstrated that the overall prevalence of depression and anxiety were each 32%. Importantly, these rates of anxiety and depression were much higher than pre-pandemic estimates. Subgroup analyses demonstrated that those in the Eastern Mediterranean had the highest prevalence of depression and anxiety, whereas South-East Asia had the lowest prevalence. Despite these results, the study was limited by the quality of the included studies, many of which were considered low or very low quality. Nonetheless, the present study highlighted the need for prompt integration of additional youth mental health resources to aid in the overall COVID-19 recovery process.

One third of university students access mental health services

1. In this systematic review and meta-analysis, around 1/3rd of students accessed mental health services in university, which is similar to the proportion of students who experience symptoms of mental health disorders.

2. Furthermore, limited data suggested greater use of on-campus, rather than off-campus, resources.

Evidence Rating Level: 1 (Excellent)

Mental health disorders are prevalent among university students, however the utilization of services at universities is poorly understood on an international scale. Current studies have not compared the use of different mental health services by students when faced with various clinical presentations. As a result, the objective of the present study was to determine the proportion of students who use mental health services and how utilization differs across service type.

Of 7789 identified records, 44 (range n=15 to 730,785 participants) studies were included from various databases from 2000 to 2022. Studies were included if they measured the utilization of mental health services in adults studying at a university. Studies were excluded if not all participants were university students, participants under age 18 were included, sociodemographic or utilization data was impossible to extract, or the study was aimed at testing an intervention to address access to healthcare services. The review was performed using PRISMA guidelines. Risk of bias was assessed using the Joanna Briggs Institute appraisal checklist. Statistical analyses were performed using meta-regression and subgroup analyses. The primary outcome was the proportion of students who use mental health services when experiencing psychological distress.

The results demonstrated that approximately 1/3rd of students used mental health services while attending university, with the majority being outpatient services. Furthermore, services that offered a wide range of treatments were associated with greater use. There was also limited evidence demonstrating greater on-campus use of services compared to off-campus use. Despite these results, the study was limited by the inclusion of minimal studies outside the United States which may limit its generalizability to students in other countries. Nonetheless, the present study was the first to synthesize the evidence regarding the utilization of mental health services among university students and the variation between service type.

Mental health may not play a role in vaccine uptake in high-income settings

1. Overall, this systematic review found no consistent relationship between mental health issues and vaccine uptake.

2. However, there was an overall trend in children with learning disabilities being more likely to have missing vaccines, while in adults aged 50-65 years, it was found that those with mental health issues had consistently higher odds of getting vaccinated compared to those without mental health issues.

Evidence Rating Level: 1 (Excellent)

Vaccination in individuals with mental health issues is of great importance because they may suffer from higher rates of infectious diseases. Unfortunately, this population may also have unequal access to healthcare services, including vaccination. Prior studies have not systematically evaluated the relationship between mental health issues and vaccine uptake. As a result, the objective of the present study was to evaluate the impact of mental health on vaccine uptake in high-income areas where access to vaccination services is usually available.

Of 4069 identified records, 23 were included for qualitative synthesis from various databases from 2000 to 2021. Studies were included if they evaluated the uptake and timing of a recommended vaccine for an individual or relative with a mental health issue in a high-income country, as defined by the World Bank. The review was performed using PRISMA guidelines. Risk of bias was assessed using the ROBINS-I tool. The primary outcome was vaccine uptake for individuals with a mental health issue in high-income countries.

The results demonstrated that although there were inconsistent results in adults, studies investigating adults ages 50-65 years found that those with mental health issues had consistently higher odds of getting vaccinated compared to those without mental health issues. There were inconsistencies among children as well, however there was a trend in children with learning disabilities being more likely to have missing vaccines. Overall, there were no consistent trends across ages for various mental health issues. The study was limited by the high risk of selection bias in many of the included studies, which may have underestimated the effect of mental health on vaccination rates. Nonetheless, the present study adds preliminary data helping future researchers to understand the link between mental health issues and vaccine uptake.

Exposure to wildfire smoke may adversely affect mental health

1. In this scoping review, the literature suggests that chronic and persistent smoke events may adversely impact mental health.

2. Furthermore, qualitative studies reported that wildfires negatively impacted mental health through a variety of means, including isolation and loss of nature.

Evidence Rating Level: 1 (Excellent)

Climate change is a topic of global importance. Recently, the intensity and duration of wildfire events, as a result of global warming, have been increasing– demonstrating a need to further understand the mental health effects of such events. Until now, research has focused on the physical health outcomes of these events, while the effects of wildfire smoke on mental health have not been well studied. As a result, the objective of the present scoping review was to summarize the literature examining the impact of wildfire smoke on mental health and well-being.

Of 200 identified records,19 studies were included from various databases and the gray literature from 1990-2022. Only studies published in English were included. Studies were excluded if they did not examine the relationship between mental health/well-being and wildfire smoke events in humans. The review was performed using PRISMA guidelines. A narrative synthesis and data charting were performed. The primary outcome was mental well-being.

The results demonstrated that wildfire events negatively impacted mental health, however this evidence was inconsistent and limited. In addition, qualitative studies showed that wildfires could negatively impact mental health through various means, including isolation, reducing the sense of community, and loss of nature. Despite these results, the study was limited by the absence of a quality assessment of the included papers. Nonetheless, the present study was the first scoping review to provide insight into the potentially detrimental effects of wildfire smoke on mental health.

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