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.

Mindfulness and multi-component interventions best for improving wellbeing across populations

1. In this meta-analysis, the effectiveness of interventions aimed at increasing mental wellbeing were compared in both clinical and non-clinical populations.

2. Across all study populations, mindfulness-based and multi-component positive psychological interventions demonstrated positive impacts on wellbeing.

Evidence Rating Level: 1 (Excellent)

Research into mental wellbeing has significantly improved as mental health has become prioritized as an aspect of overall health. Accordingly, the volume of research into interventions aimed at increasing mental wellbeing has expanded substantially. Due to heterogeneity of study populations and methodology, it is unclear whether there are interventions which broadly have a positive impact on mental wellbeing.

The present meta-analysis aimed to analyze the current literature on the efficacy of mental wellbeing interventions. Randomized control trials (RCTs) using a validated wellbeing measure to compare psychological interventions were included. RCTs were excluded if participants were cognitively impaired or if they utilized an intervention that was not exclusively psychological. Outcomes included improvements to wellbeing in the general population, in individuals with mental illness, and in individuals with physical illness.

A total of 419 RCTs were included which had a pooled 53,288 participants. Both multi-component positive psychological interventions and mindfulness-based therapy showed significant increases in wellbeing across all populations.  Acceptance and commitment therapy, reminiscence interventions, multi-theoretical interventions, single-component positive psychological interventions, and cognitive behavioral therapy increased wellbeing in the general population. Cognitive behavioral therapy, reminiscence interventions, and single-component positive psychological interventions improved wellbeing in those with mental illness. Multi-theoretical interventions significantly improved wellbeing in those with physical illness. Limitations included heterogeneity across studies, degrees of effect size, and lack of inclusion of grey literature. Overall, the present meta-analysis suggests that multi-component positive psychological interventions and mindfulness-based therapy are the most widely effective interventions for improving mental wellbeing.

Napping associated with improved performance in memory tasks

1. In this prospective intervention study, both habitual and non-habitual nappers performed better on long-term memory tasks after an afternoon nap as compared to controls.

2. Habitual nappers demonstrated improved performance on both short and long-term memory tasks following an afternoon nap as compared to those who remained awake.

Evidence Rating Level: 2 (Good)

Positive sleep hygiene practices are associated with improvements in memory. However, frequent or habitual napping may result in difficulties in limited nocturnal sleep. Memory task performance may also be differentially impacted by napping in those who habitually nap versus those who normally remain awake during the daytime.

The objective of this prospective intervention study was to compare the impact of 90-minute naps on performance during memory tasks in habitual nappers as compared to non-habitual nappers. Adolescents aged 15 to 19 years were recruited and classified as habitual nappers if they recorded afternoon napping at least once per week. Participants were excluded if they had a history of sleep disorders, underlying illness, consumed 5+ caffeine beverages on a daily basis, or reported sleeping for less than 6 hours per night. Memory tests utilized included the Four Mountains task (4MT), a picture encoding task, and a factual knowledge test.

A total of 92 participants were included, with 46 participants in the napping group (25 habitual nappers; 21 non-habitual nappers) and 46 participants in the non-napping group (24 habitual nappers; 22 non-habitual nappers). Overall, napping was correlated with significantly increased performance on long-term memory tasks. Short-term memory tasks were only improved by napping in the habitual napping group. Limitations included small sample size, sleep duration over 24 hours was not reliably estimated, and age of onset of habitual napping was not collected. Nonetheless, the present study suggests that memory performance may be improved by napping, even in those who do not habitually nap.

Peer support groups may positively impact overall mental health, but limited effect on clinical symptoms

1. In this meta-analysis, randomized controlled trials of peer support groups for treating mental health conditions were assessed.

2. Peer support groups were correlated with a slight improvement in overall recovery and no improvement in individual hope, empowerment, or clinical symptoms.

Evidence Rating Level: 1 (Excellent)

Individuals with lived experiences of mental illness may utilize a variety of therapeutic techniques. Peer support groups provide a therapeutic medium in which multiple participants can benefit from a single dynamic session. Additionally, positive social interactions during peer support group sessions potentially have a positive impact on mental wellbeing.

The present systematic review and meta-analysis aimed to summarize the literature on the efficacy of group therapy on improving mental health conditions. Studies were only included if they were randomized clinical trials studying the effect of group peer support interventions on adults aged 18 and over with mental health conditions. Mental health conditions were defined as either having used mental health services, receiving a clinical diagnosis, or exceeding a clinical threshold on a validated mental health screening tool. Studies were excluded if they were clustered trials, incomplete, or only partially randomized. Outcomes evaluated included personal recovery, clinical recovery, acute mental health service use, and social outcomes.

Eleven articles discussing eight studies with a total of 2,131 participants were included. Of these, six articles were included in the meta-analysis. Follow-up data that was analyzed in the study ranged from 3 weeks to 6 months after the completion of group therapy. Results found that completion of peer support group therapy resulted in minor increases in overall individually reported mental health. Peer support group therapy was not associated with increased empowerment, hope, or clinical depressive symptoms. The study was limited in that it only included non-clustered randomized control trials. Nonetheless, the study was significant in suggesting that peer support group therapy may have marginal positive impacts on mental wellbeing, but not specific clinical parameters.

Layperson-delivered empathy-oriented phone calls reduce loneliness, depression, and anxiety

1. In this randomized clinical trial, empathy-oriented phone calls to older adults during the COVID-19 pandemic were associated with significantly decreased depression, anxiety, and loneliness scores.

2. Layperson-delivered phone calls were an inexpensive and accessible support option for those who experienced barriers to accessing psychiatric care and interventions.

Evidence Rating Level: 1 (Excellent)

Loneliness, depression, and anxiety are well-recognized risk factors for morbidity and mortality which may particularly affect elderly individuals. Lockdowns during the COVID-19 pandemic have been associated with decreased social interaction and accessibility of psychiatric aid. Phone call support programs with layperson volunteers are commonly used for emotional crisis intervention and may represent an effective way to improve mental health outcomes in elderly individuals unable to leave their homes.

This randomized control trial aimed to elucidate the impact of a four-week empathy-based phone support program on improving loneliness, depression, and anxiety. Inclusion criteria were elderly individuals enrolled in Meals on Wheels Central Texas (MOWCTX). Participants who had cognitive impairments or were already enrolled in a social support program were excluded. Study outcomes assessed measures of loneliness, depression, anxiety, and social connection using previously validated questionnaire instruments. Calls were made by 16 postsecondary students aged 17 to 23 who were trained via a one-hour video conference. Follow-up assessments were made at 29 and 35 days after the study began.

A total of 240 participants were included with 120 individuals in both the control and study arm, respectively. Participants in the phone call group scored significantly lower than the control group at follow-up on all measures of loneliness, anxiety, general mental health, and depression. There was no significant difference in score on the De Jong Loneliness Scale. The main limitations of the study included lack of long-term follow-up, controlling for underlying mental health conditions, and difficulty in standardizing empathy-based support calls. Overall, the results of this study suggest that layperson empathy-based support calls improve mental health outcomes in elderly individuals.

Image: PD

©2021 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.