Wellness Check: Mental Health

Mindfulness therapy improves mental health scores in university students

1. In this systematic review and meta-analysis, mindfulness therapy had a positive effect on scores for depression, anxiety, stress, and sleep quality in university students.

2. However, there was no significant difference in mindfulness scores between those who received mindfulness therapy and the control group.

Evidence Rating Level: 1 (Excellent)

Mental health disorders are increasingly common among university students due to factors such as stress, poor sleep quality, and more. Mindfulness therapy is a cost-effective and efficacious treatment for mental health disorders that can result in improvements in symptoms of depression, anxiety, and stress. However, the impact of mindfulness therapy on mental health outcomes has produced inconsistent findings, with some studies finding no significant effect of the intervention on outcomes. Therefore, this study aimed to review the current evidence to evaluate the effect of mindfulness therapy on mental health in university students.

Of 1,832 identified records, 11 studies (n=1,824 participants) were included from January 1, 2018, to May 1, 2023. Studies were included if they investigated mindfulness-based interventions in university students with a relevant control group, assessed outcomes related to depression, anxiety, mindfulness, or sleep quality, and included participants aged 16 years or older with at least one indicator of emotional problems. Non-randomized controlled trials and studies with incomplete or unavailable data were excluded. The review was conducted in accordance with PRISMA guidelines. The primary outcome was the effect of mindfulness therapy on depression, anxiety, stress, sleep quality, and mindfulness, determined based on the scores of several questionnaires and scales.

The results demonstrated that mindfulness therapy was associated with improved scores for depression, anxiety, stress, and sleep quality compared to the controls. However, mindfulness therapy had no significant effect on mindfulness scores in this population. An analysis of the intervention duration found that interventions lasting eight weeks or more were effective in lowering depression levels and stress. In comparison, there was no significant difference in effects on anxiety in those interventions that were less than eight weeks compared to those that were eight weeks or more. However, the review was limited by the lack of information on blinding in the included studies, making it hard to determine the study quality and risk of bias. Nonetheless, the present study demonstrated that mindfulness therapy can have several positive effects on the mental health outcomes of university students.

Education level is associated with prenatal antidepressant continuation in pregnant women

1. In this systematic review and meta-analysis, maternal education was significantly and positively associated with prenatal antidepressant continuation.

2. However, other social determinants of health, including race, relationship status, and income, were not significantly associated with prenatal antidepressant use and continuation.

Evidence Rating Level: 1 (Excellent)

Prenatal depression is very common in pregnancy and can be linked to post-partum depression and adverse outcomes in both the mother and child. Pharmacotherapy is often the treatment of choice in those with moderate to severe symptoms of depression. As a result, the use of antidepressants in pregnancy has been on the rise. The social determinants of health are well-studied factors that influence health behaviors and access to various treatments. Prior studies have suggested that pregnant women with certain social determinants, such as low socioeconomic status, are less likely to receive pharmacotherapy for their mood disorders during pregnancy, while other studies have found conflicting results. Given that antidepressant discontinuation during pregnancy can lead to several adverse health outcomes, this study aimed to explore the impact of social determinants on antidepressant use and continuation during pregnancy.

Of 2,176 identified records, 23 studies were included from database inception to October 2022. Studies were included if they measured prenatal antidepressant intake in women who experienced mental health issues, evaluated one or more social determinants, and had a cross-sectional, cohort, or randomized controlled trial design. The review was conducted in accordance with PRISMA guidelines. The study quality was assessed using the Joanna Briggs Institute critical appraisal checklists, and the risk of bias was assessed using the GRADE approach. The primary outcome was the difference between antidepressant use and continuation in the prenatal period based on various social determinants.

The results demonstrated that education was significantly associated with prenatal antidepressant continuation, whereby patients with lower education levels had lower rates of prenatal antidepressant continuation. Although some individual studies found associations between antidepressant use and various social determinants, the results of the meta-analysis found no association between antidepressant continuation and race, relationship status, and income. However, the review was limited by the high heterogeneity of the included studies, which made it difficult to draw conclusions from the findings. Nonetheless, the present study demonstrated that education level may be an influencing factor in prenatal antidepressant continuation.

Low mental health may be associated with poor clinical outcomes following total hip arthroplasty

1. In this retrospective cohort study, patients who underwent total hip arthroplasty (THA) who had global mental health (GMH) scores in the lowest quartile had worse outcomes, including being less likely to be discharged home, than those with GMH scores in the top quartile.

2. However, patients in the lowest GMH quartile had greater improvements in GMH and global physical health (GPH) scores following the surgery compared to those in the top quartile.

Evidence Rating Level: 3 (Average)

Factors such as obesity and diabetes are known to influence clinical outcomes following total joint arthroplasty. Prior research has suggested that preoperative mental health could be another predictor of clinical outcomes, with studies finding that those with depression are at an increased risk of postoperative complications and pain. However, most studies to date have focused on diagnoses of depression and anxiety, which fails to consider the impact on patients with undiagnosed mental health concerns or low overall mental health. Thus, the present study aimed to assess the relationship between preoperative mental health scores and clinical outcomes in patients who underwent unilateral total hip arthroplasty (THA).

This retrospective cohort study included 142 patients who underwent primary unilateral THA. Patients were included if they were under 80 and underwent THA for osteoarthritis. Participants were excluded if they underwent THA for femoral neck fractures or required additional procedures, such as hardware removal in addition to their primary THA procedure. Furthermore, patients with bipolar disorder, schizophrenia, chronic pain conditions requiring narcotic use for more than six weeks prior to surgery, or a history of substance abuse were excluded. The Hip Disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS JR), and Patient-Reported Outcomes Measurement Information System (PROMIS) surveys were conducted before the surgery and at the six-week postoperative clinic visit. Furthermore, the global physical health (GPH) and global mental health (GMH) scores were evaluated. The primary outcome was the association between preoperative GMH scores and postoperative outcomes.

The results demonstrated that those with preoperative GMH scores in the lowest quartile had worse postoperative outcomes, including being less likely to be discharged home and lower GPH, GMH, and HOOS JR scores at the 6-week follow-up, than those with GMH scores in the top quartile. However, patients in the lowest quartile for preoperative GMH scores had a greater improvement in GPH and GMH scores compared to those in the highest quartile. Furthermore, there were no differences in clinical outcomes between those with and without a diagnosis of depression and anxiety, highlighting the importance of focusing not only on a mental health diagnosis but also on indicators of low mental health when considering the risk of postoperative complications. However, the study was limited by the short 6-week follow-up period, which did not allow for the investigation of long-term effects. Nonetheless, the present study demonstrated how low mental health can impact clinical outcomes following THA.

Image: PD

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