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.

High Amplitude Low Frequency–Music Impulse Stimulation may decrease depressive symptoms in adults with mild-to-moderate depression

1. In this randomized control trial, High Amplitude Low Frequency – Music Impulse Stimulation (HALF-MIS) as an adjunct treatment for depression was superior to traditional interventions alone.

2. Participants in the HALF-MIS group reported significant decreases in depressive symptoms with mild side effects seen in two participants.

Evidence Rating Level: 2 (Good)

Depression impacts over 300 million individuals globally, with high rates of re-occurrence. Treatment of depression is typically highly individualized, consisting of lifestyle changes, medications, and/or therapeutic interventions. High Amplitude Low Frequency – Music Impulse Stimulation (HALF-MIS) was originally utilized in populations with neurological disease but has shown positive impacts on patients with mood disorders.

This randomized control trial compared antidepressant therapy with a combination of antidepressants and HALF-MIS in adult with depression. Participants were included if they were medically stable, over the age of 18, and met criteria for mild to moderate depression. Exclusion criteria included pregnancy, previous HALF-MIS treatment, psychotic symptoms, and suicidal or homicidal ideation. The primary outcome was severity of depressive symptoms as measured by the Hamilton Depression Rating Scale (HDRS)-17 and HDRS-6.

A total of 38 participants were included and randomized into the antidepressant-only group (n=20) or the antidepressant with HALF-MIS group (n=18). There were no significant differences in age or gender between the groups. There was a significant reduction in both HDRS scales for the HALF-MIS group as compared to the control (p=0.004). Two participants in the HALF-MIS group experienced unexpected symptoms during their first session, including crying and feeling chilled. However, this study was limited in that there was a small sample size as well as heterogeneity in the antidepressants used between participants. Nonetheless, HALF-MIS represents a non-invasive adjunct to traditional depression interventions which may decrease symptoms and improve quality of life.

Psychological counselling offered by postsecondary institutions may decrease student distress and increase grade point average

1. In this retrospective study, postsecondary students demonstrated significant increases in grade point average (GPA) following psychological counselling.

2. Increases in GPA were associated with decreases in psychological distress but not decreases in academic distress.

Evidence Rating Level: 2 (Good)

Students entering postsecondary education may experience increased distress due to distance from their support system, significant changes to their environment and responsibilities, as well as academic pressures. Accordingly, most postsecondary institutions have counselling resources available for their students. Psychological support may decrease distress and increase the academic capacity of postsecondary students.

The present retrospective chart review evaluated the counseling records of students attending postsecondary institutions as well as their grade point average (GPA) before and after at least two counselling sessions. Counselling sessions were provided by either staff counsellors, psychologists, or psychiatrists. Inclusion criteria for participants were postsecondary students who attended institutional counselling between the years of 2014 and 2018. Students were excluded if psychological and academic distress scores were not available. Study outcomes assessed the association between student academic distress, psychological distress, and GPA pre- and post-intervention.

A total of 1,231 participants treated by 49 counsellors were included in the analysis. Over half of the participants identified as women (65%) and most students included were sophomores (21.6%). Following counselling, a significant increase in GPA was recorded which continued to increase in the semesters following intervention. Additionally, students who had significant decreases in psychological distress were more likely to improve their GPA. Interestingly, decreases in academic distress were not associated with GPA improvements. However, the present study was limited in that reasons for seeking counselling were not analyzed, heterogeneity in counselor training was high, and no subgroup analysis was performed based on sociodemographic factors. Overall, psychological counselling may not only improve the mental wellbeing of postsecondary students, but also their academic performance.

Nature exposure during exercise and nature therapy may improve mental health

1. In this prospective study, the impact of exercise in nature and nature therapy was measured in young adults who reported feelings of anxiety, depression, and stress during the COVID-19 pandemic.

2. Both nature therapy and exercise in nature resulted in improved mental health, although nature therapy had a greater positive effect.

Evidence Rating Level: 3 (Average)

Lockdown measures during the COVID-19 pandemic have been associated with increases in stress, anxiety, and depression. Nature therapy and frequent exposure to nature may improve mental health in those experiencing negative mental health outcomes during isolation periods.

This prospective study evaluated changes in mental wellbeing associated with nature exposure during exercise and nature therapy during the COVID-19 pandemic. Participants were randomized to either a nature-exercise (perform physical exercise in a nature setting) or nature therapy group. The nature-exercise and nature therapy groups followed specific programming. Inclusion criteria included adults aged 18-40 who reported increased depression, anxiety, and stress associated with the COVID-19 pandemic. Participants were excluded if they did not have access to an urban greenery. Study outcomes evaluated the mental health status of participants pre- and post-intervention using the depression, anxiety, and stress scale – 21 items (DASS-21).

A total of 30 participants were included, 15 in each group. Participants who lived in regions with severe lockdown measures reported worse mental health at baseline. Overall, both nature-exercise and nature therapy were associated with significant improvements in stress, anxiety, and depression. Although, nature therapy was more effective in improving mental health status. The present study was limited due to small sample size, lack of control group, and because participants were not monitored during activities for compliance to programming. Nonetheless, this study suggested that nature exposure may represent an inexpensive means of improving mental health, particularly during COVID-19.

Adolescent mental health trajectories negatively impacted by the COVID-19 pandemic

1. In this longitudinal study of a cohort of adolescents, anxiety and depression scores increased after the COVID-19 pandemic began.

2. Male participants had higher depression scores than female participants, whereas female participants had higher anxiety scores than males.

Evidence Rating Level: 3 (Average)

Adolescence represents a key time period for social development. Accordingly, the COVID-19 pandemic represents a distinct and possibly harmful disruption to social wellbeing in this cohort. Mental wellness in adolescents may be particularly negatively affected by limited social interactions with support systems and peers during COVID-19.

The present study was conducted in order to elucidate the impact of the COVID-19 pandemic on the mental health a cohort of adolescents. The adolescents were followed for two years with only the final timepoint occurring during the COVID-19 pandemic. Adolescents were invited if they had participated in the initial two-year study with no exclusion criteria. Participants were sent an online survey including the Multidimensional Anxiety Scale for Children, the Children’s Depression Inventory, the Differences in Emotion Regulation Scale, as well as a questionnaire on health, finances, lifestyle, and fear of COVID-19.

The survey was completed by 136 participants (53.7% female). Almost half of participants (44.1%) reported a negative financial impact secondary to COVID-19. Overall, depression and anxiety scores increased during COVID-19 with males reporting the highest depression scores and females reporting the highest anxiety scores. Negative mental health symptoms were also associated with reported COVID-19 impacts on financial wellbeing, lifestyle, and fear. However, this study was limited as included a lack of information on support systems as well as a homogenous study population. Nonetheless, the results of the present longitudinal study suggest that the COVID-19 pandemic may negatively impact adolescents directly and through impacting lifestyle factors.

Image: PD

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