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.

Post-traumatic stress interventions may improve mental health in healthcare workers

1. In this scoping review, interventions targeting post-traumatic stress disorder (PTSD) were assessed.

2. The main components of effective interventions were trauma-related education, psychological support from peers and trained professionals, as well as emotional and relaxation counselling.

Evidence Rating Level: 2 (Good)

Healthcare workers are particularly vulnerable to developing work-related PTSD due to increased exposure to possible precipitating events. PTSD introduces a significant decrease in quality of life and may impact ability to work. Accordingly, it is vital that interventions to support healthcare workers who develop PTSD are identified. Not only do the workers themselves benefit, but also the patients they treat as well as their colleagues.

The purpose of the present scoping review was to identify and summarize current interventions for PTSD in healthcare workers. Studies were included if participants had been exposed to trauma in a hospital, if an intervention for PTSD was investigated, if PTSD symptoms were measured using a validated scale, and if participants were adult healthcare workers. Manuscripts were excluded if they did not include primary research. Outcomes assessed were types of interventions as well as intervention efficacy at reducing PTSD symptoms.

Eight manuscripts were included discussing seven studies with a total of 859 participants. The most commonly used intervention was cognitive behavioral therapy followed by mindfulness-based interventions. Group workshops, writing therapy, and psychological assessment were also discussed. The three main principles consistent across interventions were increasing trauma-related knowledge, education on emotional regulation/relaxation, and peer/psychologist psychological support. Intervention duration ranged from two weeks to six months. Benefits of the interventions included increased wellbeing, resilience, teamwork, relaxing sleep, and awareness about trauma. The generalizability of the review is limited by the small number of studies as well as the heterogeneity of interventions and types of healthcare workers included. Nonetheless, this scoping review suggests that healthcare workers with PTSD may benefit both personally and in the workplace from targeted interventions.

Video game interventions may improve depressive symptoms in adolescents and young adults

1. In this meta-analysis, studies evaluating the impact of video game interventions on depression and anxiety in 12 to 25-year-olds were assessed.

2. Video game interventions improved depression scores but did not impact anxiety scores.

Evidence Rating Level: 2 (Good)

Rates of depression and anxiety have been gradually increasing in adolescents and young adults. Critical mental health services may be inaccessible to this population due to cost, long wait times, and stigmatization. Video games represent an accessible medium which can be leveraged to deliver mental health interventions. They can be utilized asynchronously and remotely, which is especially important during pandemic-related lockdown periods and healthcare backlogs.

The present meta-analysis analyzed the current literature on video game-based mental health interventions in adolescents and young adults. Studies evaluating video game mental health interventions on 12 to 25-year-olds with depression and/or anxiety measured as outcomes were included. Studies were excluded if they concurrently implemented other therapies or if participants were suffering from a physical health condition or intellectual disability. Outcomes were assessed via validated outcome measures or diagnostic interviews.

A total of 12 studies with 844 participants were included in the meta-analysis, of which 7 were randomized control trials (RCTs) and five were non-RCTs. Depressive symptoms were significantly lowered in the RCTs evaluated (p=0.02) but not for non-RCTs (p=0.10). Conversely, a significant effect on anxiety symptoms was not observed for RCTs (p=0.72) or non-RCTs (p=0.43). Major limitations of the meta-analysis include high levels of heterogeneity in studies which evaluated depression, small number of studies included, and inconsistency of follow-up periods. Nonetheless, this study was significant in suggesting video game interventions may improve depression in adolescents and young adults, but do not seem to have an effect on levels of anxiety.

Patients discharged from inpatient psychiatric care may benefit from a text support program

1. This mixed methods trial evaluated the efficacy of a texting-based mental health program for psychiatric outpatients.

2. Participants in the program reported high satisfaction and perceived impact regardless of sex or psychiatric diagnosis .

Evidence Rating Level: 2 (Good)

Long wait times, inability to take time off work, and need for transportation represent barriers to accessing outpatient mental health services. Accordingly, an increasing amount of technology-based mental health services are being developed. Texting-based programs allow for engagement of individuals who have a phone but may have limited or no access to data or wireless internet.

In this mixed methods study, a text-based mental health program (Text4Support) was compared to care as usual in psychiatric outpatients. The primary outcome measured was user satisfaction as measured by a survey. A subgroup of patients in the Text4Support group were also interviewed about their experiences. Psychiatric outpatients were included who were 18-65 years old, had a mental health condition, were able to provide written consent, and had a mobile phone capable of receiving text messages. Patients were only excluded if they had substance use disorder.

A total of 181 patients were randomized to receive either Text4Support (n=89) or care as usual (n=92). The majority of participants were women (75%), white (89%), had completed postsecondary education (77%), and had either depression or anxiety (61%). Those in the Text4Support group reported improved stress levels (63%), less loneliness (66%), as well as increased hope (65%), mental wellbeing (69%), and quality of life (63%). The study was limited by sample size, inconsistent use of the Text4Support program, and use of a questionnaire that was not previously validated. Overall, programs like Text4Support represent a possible intervention for improving outpatient mental health.

Image: PD

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