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.

Mental health apps improve well-being, mental health, and emotional regulation

1. In this meta-analysis, the efficacy of mental health apps (MHApps) at increasing emotional regulation, mental health, and wellbeing were assessed.

2. Pooled analysis demonstrated that MHApps slightly reduced mental health symptoms, enhanced wellbeing, and moderately aided emotional regulation.

Evidence Rating Level: 1 (Excellent)

Mental health disorders disproportionately impact young adults, significantly increasing in prevalence over the past decade. Mobile applications are rapidly being developed to improve healthcare, including mobile clinics, health trackers, and mental health apps (MHApps). These technologies may make mental healthcare more accessible and improve outcomes.

A systematic review and meta-analysis was conducted to examine MHApps currently available and studies evaluating their efficacy until January 2021. Studies were included which looked at the impact of MHApps on mental health in adults without a formal mental health diagnosis aged 18-45 years. Exclusion criteria included studies focused on physical health, studies with an in-person intervention component, and studies including a technology other than a mobile phone. Outcomes assessed were emotional regulation, wellbeing, and mental health symptoms.

Of 3,156 abstracts screened, 52 articles (48 MHApps) were ultimately included which were conducted in 15 different countries. Wellbeing was assessed in 13 studies, with a small significant positive impact being demonstrated on pooled analysis. Although 19 studies evaluated mental health symptoms, there was a significant amount of heterogeneity in the types of symptoms measured. A marginal but significant improvement was seen in mental health symptoms overall. Only 6 studies measured emotional regulation, although a moderate but significant improvement was seen in participants in these studies. The major limitations of the present meta-analysis included heterogeneity between studies, small sample size, and significant amount of pilot trials included. Nonetheless, the findings of this study suggest that MHApps may improve mental health and wellbeing in a user-friendly and low-cost format.

Cognitive emotion regulation strategies may help predict depression and anxiety levels during COVID-19

1. In this retrospective study, the role of cognitive emotion regulation strategies (CERS) on predicting depression and anxiety during COVID-19 was studied.

2. Increased positive reappraisal as well as decreased catastrophizing and rumination predicted lower depression and anxiety during COVID-19.

Evidence Rating Level: 3 (Average)

The COVID-19 pandemic has involved significant social isolation due to distancing measures. Effects of isolation and stress secondary to the pandemic include increased levels of stress and anxiety. Cognitive emotion regulation strategies (CERS) may represent a way to prevent and manage distress secondary to isolation and unexpected societal events.

The present retrospective analysis evaluated CERS used during COVID-19 lockdown and their relationship to levels of anxiety and depression symptoms between March 26 and 1 June 2020. Individuals were included who lived in areas experiencing extreme lockdown measures during the study period. Exclusion criteria were not described. Outcomes were depression and anxiety, measured by the Cognitive Emotion Regulation Questionnaire (CERQ), Center for Epidemiological studies Depression Scale (CES-D), and the State–Trait Anxiety Inventory (STAI).

In total, 663 Spanish-speaking participants were recruited (63% female) from Ecuador, American countries, and Europe. Male participants scored higher in self-blame than females, but females scored higher on rumination and general anxiety than males. Furthermore, females scored significantly higher in symptoms of anxiety and depression compared to males. Catastrophizing and rumination were significant predictors for increased levels of depression and anxiety. Conversely, positive reappraisal significantly reduced depression and anxiety symptoms. The limitations of the present analysis include large variation in population measured, as well as inconsistency of CERS used. Nonetheless, CERS may help predict levels of depression and anxiety during stressful events.

Suicide prevention videos may help improve suicidal ideation and help seeking in adolescents

1. In this randomized control trial, suicide prevention videos improved suicidal ideation as compared to control videos immediately following intervention, but not at 4-week follow-up.

2. The intervention group had significant improvements in help-seeking intention and reduction of favorable attitudes to suicide which was sustained at 4-week follow-up as compared to controls.

Evidence Rating Level: 2 (Good)

Suicide is one of the leading causes of death in adolescents. Symptoms of suicidal ideation may be difficult to detect, and suicide prevention remains a priority in this population. Use of technology and exposure to advertisements is increasing annually in youth. Thus, leveraging media to educate vulnerable individuals on suicide prevention may decrease suicidal ideation and feelings of isolation.

The present randomized control trial compared viewing of suicide prevention videos to neutral control videos in adolescents. Participants were included if they were 14- to 19-year-old residents of Austria. Participants with an inability to provide informed consent were excluded.  The primary outcome of suicidal ideation was measured by the Reasons for Living Inventory for Adolescents (RFL-A). Secondary outcomes were scores on the 10-item General Help-seeking Questionnaire (GHSQ), Cognitions Concerning Suicide Scale (CCSS), 12-item short version of the Stigma of Suicide Scale (SOSS), and the Mood Affective State Scale (M-ASS).

In total, 299 participants were included and either randomized to the suicide prevention video group (n=148) or the control video group (n=151). RFL-A scores significantly improved in the intervention group as compared to control immediately after intervention (p<0.01) but not at 4-week follow-up (p=0.06). M-ASS scores were also improved in the intervention group after video viewing (p=0.02) but not follow-up (p=0.19). Sustained improvement was seen in the intervention group as compared to control for professional help seeking intention (GHSQ subscale; p=0.05), and CCSS score (p=0.04). Furthermore, participants reported a sustained reduction of favorable attitudes towards suicide. Conversely, SOSS scores did not differ between groups at any timepoint. The findings of this study should be taken into consideration given its limitations. Of note, the study utilized a small sample size, had overrepresentation of female participants, limited follow-up time, and did not control for how many times the video was viewed. Nonetheless, this randomized control trial suggests that suicide prevention videos may contribute to reduced burden of suicidal behaviors in adolescents.

Image: PD

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