1
|
Zink J, Ebrahimian S, Belcher BR, Leventhal AM. Reciprocal associations between depression and screen-based sedentary behaviors in adolescents differ by depressive symptom dimension and screen-type. J Affect Disord 2020; 263:39-46. [PMID: 31818794 PMCID: PMC7035144 DOI: 10.1016/j.jad.2019.11.130] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/22/2019] [Accepted: 11/29/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The heterogeneity of depression and sedentary behavior complicates understanding of mechanisms underlying and interventions addressing comorbid depression and sedentary behavior in adolescents. This study investigated reciprocal associations between four depressive symptom dimensions and two types of screen-based sedentary behaviors in adolescents, and tested whether these associations differed by sex. METHODS A school-based longitudinal cohort (N = =2,717, baseline Mage=14.57 years) completed questionnaires during two assessments one year apart. Participants reported on levels of four depressive symptom dimensions (continuous) and television viewing and computer/videogame use (≥2 h/day; yes vs. no). RESULTS Reciprocal associations between computer/videogame use and higher negative affect symptoms were observed (computer/video games predicting negative affect, β=0.06, 95%CI 0.01-0.11, p = =0.01; negative affect predicting computer/video games, OR 1.29, 95%CI 1.06-1.58, p = =0.01). The relationship between baseline computer/videogame use and subsequent negative affect differed by sex (p = =0.02), and was significant in girls (β=0.11, 95%CI 0.04-0.18, p = =0.002), but not boys (β=0.004, 95%CI -0.06-0.07, p = =0.90). Baseline computer/videogame use predicted somatic symptoms at follow-up (β=0.06, 95%CI 0.01-0.10, p = =0.02), but the reverse association was non-significant. Higher baseline positive affect predicted computer/videogame use at follow-up (OR 1.16, 95%CI 1.02-1.31, p = =0.02), but the reverse association was non-significant. Television viewing was unrelated to each depressive symptom dimension in either direction. LIMITATIONS Self-reports may be subject to recall errors and biases, and do not provide clinical diagnoses. CONCLUSIONS Associations are not uniform across screen-based sedentary behavior type, depressive symptom dimension, and sex. The association between computer/videogame use and negative affect symptoms may be reciprocal across time and particularly robust among girls.
Collapse
Affiliation(s)
- Jennifer Zink
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California
| | - Shayan Ebrahimian
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California
| | - Britni R. Belcher
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California
| | - Adam M. Leventhal
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California,Department of Psychology, University of Southern California
| |
Collapse
|
2
|
Murphy TJ, Hwang H, Kramer MS, Martin RM, Oken E, Yang S. Assessment of eating attitudes and dieting behaviors in healthy children: Confirmatory factor analysis of the Children's Eating Attitudes Test. Int J Eat Disord 2019; 52:669-680. [PMID: 30825346 PMCID: PMC6555678 DOI: 10.1002/eat.23062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 02/13/2019] [Accepted: 02/13/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The Children's Eating Attitudes Test (ChEAT) is a self-report questionnaire that is conventionally summarized with a single score to identify "problematic" eating attitudes, masking informative variability in different eating attitude domains. This study evaluated the empirical support for single- versus multifactor models of the ChEAT. For validation, we compared how well the single- versus multifactor-based scores predicted body mass index (BMI). METHOD Using data from 13,674 participants of the 11.5 year-follow-up of the Promotion of Breastfeeding Intervention Trial (PROBIT) in the Republic of Belarus, we conducted confirmatory factor analysis to evaluate the performance of 3- and 5-factor models, which were based on past studies, to a single-factor model representing the conventional summary of the ChEAT. We used cross-validated linear regression models and the reduction in mean squared error (MSE) to compare the prediction of BMI at 11.5 and 16 years by the conventional and confirmed factor-based ChEAT scores. RESULTS The 5-factor model, based on 14 of the original 26 ChEAT items, had good fit to the data whereas the 3- and single-factor models did not. The MSE for concurrent (11.5 years) BMI regressed on the 5-factor ChEAT summary was 35% lower than that of the single-score models, which reduced the MSE from the null model by only 1%-5%. The MSE for BMI at 16 years was 20% lower. DISCUSSION We found that a parsimonious 5-factor model of the ChEAT explained the data collected from healthy Belarusian children better than the conventional summary score and thus provides a more discriminating measure of eating attitudes.
Collapse
Affiliation(s)
- Tanya J Murphy
- Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Heungsun Hwang
- Department of Psychology, Faculty of Science, McGill University Montreal, Quebec, Canada
| | - Michael S Kramer
- Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Department of Pediatrics, Faculty of Medicine, McGill University Montreal, Quebec, Canada
| | - Richard M Martin
- Bristol Medical School: Population Health Sciences, Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
- University Hospitals Bristol National Health Service Foundation Trust, National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, Bristol, United Kingdom
| | - Emily Oken
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Seungmi Yang
- Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
3
|
Bélair MA, Kohen DE, Kingsbury M, Colman I. Relationship between leisure time physical activity, sedentary behaviour and symptoms of depression and anxiety: evidence from a population-based sample of Canadian adolescents. BMJ Open 2018; 8:e021119. [PMID: 30337306 PMCID: PMC6196847 DOI: 10.1136/bmjopen-2017-021119] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 07/27/2018] [Accepted: 08/22/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Physical and sedentary activities have been identified as potentially modifiable risk factors for many diseases, including mental illness, and may be effective targets for public health policy and intervention. However, the relative contribution of physical activity versus sedentary behaviour to mental health is less clear. This study investigated the cross-sectional association between physical activity, sedentary activity and symptoms of depression and anxiety at age 14-15 in the National Longitudinal Survey of Children and Youth (NLSCY). METHODS Respondents aged 14-15 years between 1996 and 2009 who reported on symptoms of depression in the NLSCY were included (n=9702). Multinomial logistic regression was used to assess the relationship between physical and sedentary activity and symptoms of depression and anxiety. Joint models including both physical and sedentary activity were also explored. Models were adjusted for sex, ethnicity, immigration status, family income, parental education, recent major stressful life events and chronic health conditions. RESULTS The odds of having moderate and severe symptoms of depression and anxiety compared with no symptoms was 1.43 (1.11 to 1.84) and 1.88 (1.45 to 2.45) times higher, respectively, in physically inactive youth relative to physically active youth. The odds of having moderate and severe symptoms of depression and anxiety compared with no symptoms was 1.38 (1.13 to 1.69) and 1.31 (1.02 to 1.69) times higher, respectively, in sedentary youth relative to non-sedentary youth. In joint models including both physical and sedentary activity, sedentary activity was not consistently associated with symptoms of depression and anxiety. CONCLUSIONS Both physical inactivity and sedentary activity appear to be significantly related to symptoms of depression and anxiety. The importance of distinguishing these two behaviours has relevance for research as well as policies targeting physical activity and mental health in youth.
Collapse
Affiliation(s)
- Marc-André Bélair
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Dafna E Kohen
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
| | - Mila Kingsbury
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Ian Colman
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
4
|
Longitudinal Associations Between Anhedonia and Body Mass Index Trajectory Groups Among Adolescents. J Adolesc Health 2018; 63:81-87. [PMID: 29731318 PMCID: PMC6067955 DOI: 10.1016/j.jadohealth.2017.12.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 11/08/2017] [Accepted: 12/14/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE Although evidence suggests that anhedonia-a reduced ability to experience pleasure in response to rewarding stimuli-may predict weight gain during adolescence, it remains unclear whether changes in anhedonia during adolescence are associated with changes in body mass index (BMI). This study examines longitudinal associations between changes in anhedonia and developmental trajectories of BMI during adolescence. METHODS Self-report measures of anhedonia and BMI were collected at five semiannual assessments among students from 10 high schools in Los Angeles, CA, area (N = 3,396) followed up from the 9th grade to the 11th grade. Four BMI trajectories were identified using growth mixture modeling: (1) stable normative weight; (2) overweight to normative weight (i.e., decreasing BMI); (3) overweight to chronically obese (increasing BMI); and (4) normative weight to overweight (increasing BMI). Latent growth curve modeling estimated baseline level and changes in anhedonia. A multinomial logistic regression model tested associations of baseline level and slope of anhedonia with the four BMI trajectory groups. RESULTS Compared with the stable normative BMI trajectory group, each 1-unit standard deviation increase in anhedonia slope increased the odds of membership in the overweight to chronically obese group (odds ratio [OR] [95% confidence interval {CI}] = 1.29 [1.09-1.49], p < .001) and in the normative weight to overweight group (OR [95% CI] = 1.28 [1.04-1.53], p = .006), and decreased the odds of membership in the overweight to normative weight group (OR [95% CI] = .78 [.57-.95], p = .01). CONCLUSIONS Across a 2-year period of high school, the rate of change in anhedonia is associated with certain BMI trajectories linked with poorer metabolic health. Increasing anhedonia may be an important risk factor to consider in adolescent obesity prevention.
Collapse
|
5
|
Abstract
Exercise and sports are an integral part of daily life for millions of Americans, with 16% of the US population older than age 15 years engaged in sports or exercise activities (Bureau of Labor statistics). The physical and psychological benefits of exercise are well-recognized. However, high-profile cases of athletes dying suddenly on the field, often due to undiagnosed genetic cardiomyopathies, raise questions about the risks and benefits of exercise for those with cardiomyopathy.
Collapse
|
6
|
Abstract
Stress and negative emotions pose a major threat to public health, by increasing the risk of obesity. Since the management process for emotions (emotion regulation; ER) is developed in childhood, we present a novel conceptual framework model for the role of ER in the prevention and treatment of childhood obesity. A narrative review of the literature by electronic database search (MEDLINE, Web of Knowledge and Scopus) was conducted of observational and interventional/experimental literature on ER and obesity and the underlying concepts. We also present an overview of ER intervention techniques. Our model indicates that childhood ER is a link between stress and obesity. Stress along with ineffective ER leads to abnormal cortisol patterns, emotional eating, sedentary lifestyle, reduction of physical activity, and sleep problems. Simultaneously, a healthy lifestyle could show benefits on ER and in developing adaptive ER strategies. In the development of obesity and ER, parents also play a role. By contrast, effective ER skills decrease obesity-related unhealthy behaviour and enhance protective factors, which boost health. The literature contains some observational studies of children but very few intervention studies, most of which are pilot or on-going studies. In conclusion, encouraging effective ER could be a useful new approach for combating and treating childhood obesity. Future ER intervention studies are needed to confirm the validity of this model in children.
Collapse
|
7
|
Wu Y, Sun D, Wang B, Li Y, Ma Y. The relationship of depressive symptoms and functional and structural markers of subclinical atherosclerosis: A systematic review and meta-analysis. Eur J Prev Cardiol 2018. [PMID: 29537293 DOI: 10.1177/2047487318764158] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objectives The relationship of depressive symptoms and subclinical atherosclerosis remains controversial. We performed a systematic review and meta-analysis to evaluate the effect of depressive symptoms on the functional and structural markers of subclinical atherosclerosis as measured by carotid intima-media thickness (IMT), pulse wave velocity (PWV) and flow-mediated vasodilation (FMD). Methods A systematic literature search was performed electronically. Studies relating IMT, PWV or FMD to depressive symptoms were included. Standard/weighted mean differences (SMD/WMD) and corresponding 95% confidence intervals (95% CIs) were pooled in overall and subgroup analyses (age, sex, depression diagnosis, region, study design, site measured and sample size). Sensitivity analysis and publication bias were also conducted. Results Thirty-eight articles involving 5947 patients with depressive symptoms and 34,423 controls without depressive symptoms were included. Compared with controls without depressive symptoms, patients with depressive symptoms showed a significantly thicker IMT (SMD (95% CI) = 0.137 (0.047–0.227), p = 0.003), a higher PWV (SMD (95% CI) = 0.216 (0.139–0.293), p < 0.001) and a lower FMD (WMD (95% CI) = –2.554 (–3.709 to –1.399), p < 0.001). When analyzing subgroups with age and female ratio, all results were still significant ( p < 0.05) except IMT and FMD in age < 50 years subgroups ( p > 0.05). There was no statistical significance in sensitivity analysis and publication bias ( p > 0.05). Conclusions Depressive symptoms contributed toward subclinical atherosclerosis, and resulted in impaired functional and structural markers of subclinical atherosclerosis, which holds great promise in early prevention of cardiovascular disease.
Collapse
Affiliation(s)
- Yupeng Wu
- 2nd Department of Neurosurgery, The People's Hospital of China Medical University and The People's Hospital of Liaoning Province, Shenyang, China
| | - Dandan Sun
- Department of Cardiovascular Ultrasound, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Bin Wang
- 2nd Department of Neurosurgery, The People's Hospital of China Medical University and The People's Hospital of Liaoning Province, Shenyang, China
| | - Yanfeng Li
- 2nd Department of Neurosurgery, The People's Hospital of China Medical University and The People's Hospital of Liaoning Province, Shenyang, China
| | - Yi Ma
- 2nd Department of Neurosurgery, The People's Hospital of China Medical University and The People's Hospital of Liaoning Province, Shenyang, China
| |
Collapse
|
8
|
Abstract
The postembryonic brain exhibits experience-dependent development, in which sensory experience guides normal brain growth. This neuroplasticity is thought to occur primarily through structural and functional changes in pre-existing neurons. Whether neurogenesis also mediates the effects of experience on brain growth is unclear. Here, we characterized the importance of motor experience on postembryonic neurogenesis in larval zebrafish. We found that movement maintains an expanded pool of forebrain neural precursors by promoting progenitor self-renewal over the production of neurons. Physical cues associated with swimming (bodily movement) increase neurogenesis and these cues appear to be conveyed by dorsal root ganglia (DRG) in the zebrafish body: DRG-deficient larvae exhibit attenuated neurogenic responses to movement and targeted photoactivation of DRG in immobilized larvae expands the pallial pool of proliferative cells. Our results demonstrate the importance of movement in neurogenic brain growth and reveal a fundamental sensorimotor association that may couple early motor and brain development. Sensory experiences early in life help the brain to grow and develop. For example, raising animals in complete darkness stops the visual areas of their brain from forming properly. Previous studies have shown that sensory input helps to strengthen the connections between already existing brain cells, but it is unclear if it affects the actual creation of new brain cells. Conditions that reduce the mobility of young children, such as muscular disease, are often accompanied by learning difficulties. This suggests that physical movement may be important for healthy brain development. Scientists have previously found a link between exercise and an increased production of new brain cells in adults. However, such a link has not been established earlier in life, when the brain is developing the most. To address this, Hall and Tropepe studied how movement affects the brain development in zebrafish larvae, at an age when many of their brain cells are created. Restraining the larvae decreased their physical movement, while making them swim against a current increased their movement. Hall et al. looked at how this affected the larvae’s number of so called progenitor cells – the cells from which brain cells are created. When the larvae moved less, the number of progenitor cells decreased. But when they moved more frequently, the amount of progenitor cells increased. The experiments also showed that some sensory cells, which detect sensations associated with movement of the body during swimming, are linked to brain cell production. Blocking the development of these sensory cells prevented the rise in progenitor cells seen with increased movement in the larvae. However, activating these sensory cells in immobilised larvae increased the number of progenitor cells, even though the larvae could not move. These findings suggest that measures to increase physical movement in young children could be used to help the brain develop normally.
Collapse
Affiliation(s)
- Zachary Jonas Hall
- Department of Cell & Systems Biology, University of Toronto, Toronto, Canada
| | - Vincent Tropepe
- Department of Cell & Systems Biology, University of Toronto, Toronto, Canada
| |
Collapse
|
9
|
Pinto TF, de Bruin PFC, de Bruin VMS, Lopes PM, Lemos FN. Obesity, Hypersomnolence, and Quality of Sleep: the Impact of Bariatric Surgery. Obes Surg 2018; 27:1775-1779. [PMID: 28054298 DOI: 10.1007/s11695-016-2536-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE Obesity is commonly associated with poor sleep, excessive daytime sleepiness (EDS) and depressive mood but the impact of bariatric surgery on these conditions is incompletely understood. This study aimed to investigate the course of EDS and sleep quality in bariatric surgery patients in relation with changes in body weight and depressive symptoms. METHODS In patients consecutively submitted to bariatric surgery, baseline and postoperative sleep quality were evaluated by the Pittsburgh Sleep Quality Index (PSQI), excessive daytime sleepiness by the Epworth Sleepiness Scale (ESS), risk for OSA by the Berlin Questionnaire (BQ), and depressive symptoms by the Beck Depression Inventory-Short Form (BDI). Comorbidities were assessed by interview and chart review. RESULTS Sixty patients (M/F = 9/51) with a mean (±SD) age of 34.7 ± 9.2 years and body mass index (BMI) of 46.04 ± 7.52 kg/m2 were studied. Bariatric surgery improved PSQI score (6.4 ± 3.8 versus 4.1 ± 2.8; p < 0.001), ESS score (8.1 ± 4.7 versus 6.0 ± 3.3; p < 0.001), BDI score (9.8 ± 7.0 versus 4.7 ± 4.6; p = 0.001), and risk for OSA (68.3 versus 5%). Twelve of the 18 subjects with baseline EDS (ESS ≥ 10) developed normal ESS score after surgery. In these subjects, significant postoperative improvement in depressive symptoms score was observed (12.0 ± 9.0 versus 5.5 ± 5.0; p = 0.041), in contrast to the remaining six cases with persistent EDS, who showed no significant change in these symptoms (5.5 ± 5.0 versus 3.2 ± 3.1; p = 0.416). CONCLUSION Bariatric surgery has a beneficial effect on sleep quality and EDS. Postoperative improvement in EDS can be related to a reduction in depressive symptoms.
Collapse
Affiliation(s)
- Thisciane Ferreira Pinto
- Laboratory of Sleep and Biological Rhythms, Department of Medicine, Universidade Federal do Ceará, Rua Professor Costa Mendes, 1.608/4th floor, Fortaleza, CE, 60430-140, Brazil
| | - Pedro Felipe Carvalhedo de Bruin
- Laboratory of Sleep and Biological Rhythms, Department of Medicine, Universidade Federal do Ceará, Rua Professor Costa Mendes, 1.608/4th floor, Fortaleza, CE, 60430-140, Brazil.
| | - Veralice Meireles Sales de Bruin
- Laboratory of Sleep and Biological Rhythms, Department of Medicine, Universidade Federal do Ceará, Rua Professor Costa Mendes, 1.608/4th floor, Fortaleza, CE, 60430-140, Brazil
| | | | | |
Collapse
|
10
|
Rankin J, Matthews L, Cobley S, Han A, Sanders R, Wiltshire HD, Baker JS. Psychological consequences of childhood obesity: psychiatric comorbidity and prevention. Adolesc Health Med Ther 2016; 7:125-146. [PMID: 27881930 PMCID: PMC5115694 DOI: 10.2147/ahmt.s101631] [Citation(s) in RCA: 311] [Impact Index Per Article: 38.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Childhood obesity is one of the most serious public health challenges of the 21st century with far-reaching and enduring adverse consequences for health outcomes. Over 42 million children <5 years worldwide are estimated to be overweight (OW) or obese (OB), and if current trends continue, then an estimated 70 million children will be OW or OB by 2025. The purpose of this review was to focus on psychiatric, psychological, and psychosocial consequences of childhood obesity (OBy) to include a broad range of international studies. The aim was to establish what has recently changed in relation to the common psychological consequences associated with childhood OBy. A systematic search was conducted in MEDLINE, Web of Science, and the Cochrane Library for articles presenting information on the identification or prevention of psychiatric morbidity in childhood obesity. Relevant data were extracted and narratively reviewed. Findings established childhood OW/OBy was negatively associated with psychological comorbidities, such as depression, poorer perceived lower scores on health-related quality of life, emotional and behavioral disorders, and self-esteem during childhood. Evidence related to the association between attention-deficit/hyperactivity disorder (ADHD) and OBy remains unconvincing because of various findings from studies. OW children were more likely to experience multiple associated psychosocial problems than their healthy-weight peers, which may be adversely influenced by OBy stigma, teasing, and bullying. OBy stigma, teasing, and bullying are pervasive and can have serious consequences for emotional and physical health and performance. It remains unclear as to whether psychiatric disorders and psychological problems are a cause or a consequence of childhood obesity or whether common factors promote both obesity and psychiatric disturbances in susceptible children and adolescents. A cohesive and strategic approach to tackle this current obesity epidemic is necessary to combat this increasing trend which is compromising the health and well-being of the young generation and seriously impinging on resources and economic costs.
Collapse
Affiliation(s)
- Jean Rankin
- Department of Maternal and Child Health, University of the West of Scotland, Paisley
| | - Lynsay Matthews
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Stephen Cobley
- Department of Exercise and Sport Science, University of Sydney, Sydney, Australia
| | - Ahreum Han
- Department of Exercise and Sport Science, University of Sydney, Sydney, Australia
| | - Ross Sanders
- Department of Exercise and Sport Science, University of Sydney, Sydney, Australia
| | - Huw D Wiltshire
- Cardiff School of Sport/Ysgol Chwaraeon Caerdydd, Cardiff Metropolitan University, Cardiff, UK
| | - Julien S Baker
- School of Science and Sport, Institute of Clinical Exercise and Health Science, University of the West of Scotland, Hamilton, Scotland
| |
Collapse
|
11
|
Mannan M, Mamun A, Doi S, Clavarino A. Is there a bi-directional relationship between depression and obesity among adult men and women? Systematic review and bias-adjusted meta analysis. Asian J Psychiatr 2016; 21:51-66. [PMID: 27208458 DOI: 10.1016/j.ajp.2015.12.008] [Citation(s) in RCA: 157] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 12/08/2015] [Accepted: 12/12/2015] [Indexed: 11/25/2022]
Abstract
The rapidly increasing prevalence of both obesity and depression represent two major public health concerns worldwide. But the evidence regarding the direction and strength of the association between these two disorders, for both adult men and women, are remain inconclusive. We systematically reviewed publications from five different databases: Pubmed, Embase, BIOSIS, CINAHL and PsychINFO. A total of 21 articles were included for the systematic review and 19 of them for the meta-analysis using a bias-adjusted (quality effect) model. This resulted in the inclusion of approximately 226,063 (33.7% men) participants. Those who were depressed had a 37% (RR: 1.37, 95% CI: 1.17, 1.48) increased risk of being obese, and who were obese had an 18% increased risk of being depressed (RR: 1.18, 95% CI: 1.04, 1.35). Those who were depressed had a 2% (RD: 0.02, 95% CI: 0.01, 0.03) excess risk of obesity, however, the reciprocal associations were not significant. The association between overweight and depression was not found significant in either direction. Both men and women were at risk of obesity and depression bi-directionally. In sensitivity analyses bi-directional associations were more pronounced among young and middle aged adults and in studies with longer follow-up. The findings of this study suggest that the strength of the association is greater for the direction leading from depression to obesity and this link was more pronounced for young and middle aged women.
Collapse
Affiliation(s)
- Munim Mannan
- School of Pharmacy, The University of Queensland, 20 Cornwall Street, Woolloongabba 4102, QLD, Australia.
| | - Abdullah Mamun
- School of Public Health, The University of Queensland, Herston Road, Herston 4006, QLD, Australia.
| | - Suhail Doi
- School of Public Health, The University of Queensland, Herston Road, Herston 4006, QLD, Australia.
| | - Alexandra Clavarino
- School of Pharmacy, The University of Queensland, 20 Cornwall Street, Woolloongabba 4102, QLD, Australia.
| |
Collapse
|
12
|
Sedentary behavior and indicators of mental health in school-aged children and adolescents: A systematic review. Prev Med 2015; 76:48-57. [PMID: 25895839 DOI: 10.1016/j.ypmed.2015.03.026] [Citation(s) in RCA: 157] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 03/24/2015] [Accepted: 03/30/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The presented systematic review aims at giving a comprehensive overview of studies assessing the relationship between sedentary behavior and indicators of mental health in school-aged children and adolescents. METHODS Six online databases (MEDLINE, EMBASE, PsycINFO, PsycARTICLES, CINAHL and SPORTDiscus) as well as personal libraries and reference lists of existing literature were searched for eligible studies. RESULTS Ninety-one studies met all inclusion criteria. There was strong evidence that high levels of screen time were associated with more hyperactivity/inattention problems and internalizing problems as well as with less psychological well-being and perceived quality of life. Concerning depressive symptoms, self-esteem, eating disorder symptoms, and anxiety symptoms, no clear conclusion could be drawn. But, taking quality assessment into account, self-esteem was negatively associated with sedentary behavior, i.e. high levels of time engaging in screen-based sedentary behavior were linked to lower scores in self-esteem. CONCLUSIONS Overall, the association between sedentary behavior and mental health indicators was rather indeterminate. Future studies of high quality and with an objective measure of sedentary behavior will be necessary to further examine this association as well as to investigate longitudinal relationships and the direction of causality. Furthermore, more studies are needed to identify moderating and mediating variables.
Collapse
|
13
|
From simplicity towards complexity: the Italian multidimensional approach to obesity. Eat Weight Disord 2014; 19:387-94. [PMID: 24448995 DOI: 10.1007/s40519-013-0097-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 12/27/2013] [Indexed: 01/09/2023] Open
Abstract
Obesity is the result of a complex interplay among several factors leading to medical, functional and psychosocial consequences that markedly reduce life expectancy and impair quality of life. Is obesity itself a disease? Is obesity a brain disease? Who should treat obesity? This paper is a narrative review aimed to describe and to argue the prevalent position of some major Italian scientific and academic institutions dealing with obesity. According to the recent statements and recommendations published by the Italian Society for Obesity (SIO) and the Italian Society for the Study of Eating Disorders (SISDCA), the management of obese patients should include five main levels of care: (1) primary care, (2) outpatient treatment, (3) intensive outpatient treatment, (4) residential rehabilitative treatment, and (5) hospitalization. Ideally, patients suffering from obesity need a multidimensional evaluation intended to design an individualized treatment plan applying different procedures and therapeutic strategies (diet, physical activity and functional rehabilitation, educational therapy, cognitive-behavior therapy, drug therapy, and bariatric surgery). This thorough approach should address not only weight loss but also quality of weight loss, medical and psychiatric comorbidity, psychosocial problems, and physical disability. Such management of obesity requires an effective multiprofessional team, while health services have to overcome a number of administrative and organizational barriers that do not account for diseases requiring resources and professionals from different areas of medicine. Integrating several competences in a team-based approach demands specific education, skills and expertise. As for other diseases, the principles of complexity theory may offer a model useful to implement both teamwork and care delivery for patients with obesity.
Collapse
|
14
|
Shi X, Tubb L, Fingers ST, Chen S, Caffrey JL. Associations of physical activity and dietary behaviors with children's health and academic problems. THE JOURNAL OF SCHOOL HEALTH 2013; 83:1-7. [PMID: 23253284 DOI: 10.1111/j.1746-1561.2012.00740.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND We examined the associations of physical activities and dietary behaviors with children's health and academic-behavioral problems. METHODS We employed a Community-wide Children's Health Assessment and Planning Survey to examine physical activity, healthy meals, health status, and academic-behavioral problems in 3708 children 7 to 14 years of age. Statistical associations were examined with chi-square test and logistic regression analysis; we calculated odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Among these children, 30.2% were overweight-obese, 11.0% had academic problems, and 7.9% had behavioral problems. Children classified as healthy eaters were more likely to exercise ≥4 days/week (79.1% vs 64.6%, OR: 2.08, 95% CI: 1.14 to 2.49), less likely to be overweight-obese (27.7% vs 44.6%, OR: 0.48, CI: 0.31 to 0.73), less likely to have academic problems (9.1% vs 16.1%, OR: 0.57, 95% CI: 0.41 to 0.79) and behavioral problems (6.9% vs 13.9%, OR: 0.46, 95% CI: 0.32 to 0.66) compared with their less healthy eating peers. Physical activity and healthy meals were associated with an improved health status (p < .001). However, the proportions of children taking unhealthy meals or choosing sedentary lifestyle increased as the cohorts progressed (p < .05) from childhood (7 to 8 years) to adolescence (13 to 14 years). CONCLUSIONS Healthy (or unhealthy) lifestyle behaviors are significantly interrelated. Children who take healthy meals and exercise often are associated with better health and fewer academic and behavioral problems. Unfortunately, taking unhealthy meals and sedentary lifestyle characterize a growing proportion of young adolescents. Thus, curbing unhealthy lifestyle behaviors should start in early childhood.
Collapse
Affiliation(s)
- Xiangrong Shi
- Department of Integrative Physiology, Cardiovascular Research Institute and Texas Prevention Institute, UNT Health Science Center, Fort Worth, TX 76107, USA.
| | | | | | | | | |
Collapse
|
15
|
Raison CL, Miller AH. The evolutionary significance of depression in Pathogen Host Defense (PATHOS-D). Mol Psychiatry 2013; 18:15-37. [PMID: 22290120 PMCID: PMC3532038 DOI: 10.1038/mp.2012.2] [Citation(s) in RCA: 159] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 11/21/2011] [Accepted: 01/03/2012] [Indexed: 12/24/2022]
Abstract
Given the manifold ways that depression impairs Darwinian fitness, the persistence in the human genome of risk alleles for the disorder remains a much debated mystery. Evolutionary theories that view depressive symptoms as adaptive fail to provide parsimonious explanations for why even mild depressive symptoms impair fitness-relevant social functioning, whereas theories that suggest that depression is maladaptive fail to account for the high prevalence of depression risk alleles in human populations. These limitations warrant novel explanations for the origin and persistence of depression risk alleles. Accordingly, studies on risk alleles for depression were identified using PubMed and Ovid MEDLINE to examine data supporting the hypothesis that risk alleles for depression originated and have been retained in the human genome because these alleles promote pathogen host defense, which includes an integrated suite of immunological and behavioral responses to infection. Depression risk alleles identified by both candidate gene and genome-wide association study (GWAS) methodologies were found to be regularly associated with immune responses to infection that were likely to enhance survival in the ancestral environment. Moreover, data support the role of specific depressive symptoms in pathogen host defense including hyperthermia, reduced bodily iron stores, conservation/withdrawal behavior, hypervigilance and anorexia. By shifting the adaptive context of depression risk alleles from relations with conspecifics to relations with the microbial world, the Pathogen Host Defense (PATHOS-D) hypothesis provides a novel explanation for how depression can be nonadaptive in the social realm, whereas its risk alleles are nonetheless represented at prevalence rates that bespeak an adaptive function.
Collapse
Affiliation(s)
- C L Raison
- Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ 85724-5137, USA.
| | | |
Collapse
|
16
|
Haghighatdoost F, Azadbakht L. Dietary treatment options for depression among diabetic patient, focusing on macronutrients. J Diabetes Res 2013; 2013:421832. [PMID: 24199205 PMCID: PMC3806238 DOI: 10.1155/2013/421832] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 08/28/2013] [Accepted: 08/29/2013] [Indexed: 01/02/2023] Open
Abstract
There is a bidirectional adverse association between diabetes and depression. The odds for experiencing depressive symptoms in diabetic patients are two times more than nondiabetic persons, and depression is an independent predictor for the onset of diabetes. However, depression has been approximately unrecognized and untreated in two-thirds of diabetic patients, which may lead to worsened diabetes complications. A cornerstone strategy for managing depression among diabetic patients is the use of diet to improve both health problems. Because of similar pathophysiology for chronic diseases and depression, it seems that similar dietary recommendations could be useful. However, few studies have been conducted among diabetic patients. Regarding the complications of diabetes such as renal diseases and coronary heart diseases, the proper range of various macronutrients should be clarified in depressed diabetic patients as well as the proper type of each macronutrient. In this paper, we reviewed the available data on the treatment of depression in diabetic patients.
Collapse
Affiliation(s)
- Fahimeh Haghighatdoost
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan 21871, Iran
| | - Leila Azadbakht
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan 21871, Iran
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan 21871, Iran
- *Leila Azadbakht:
| |
Collapse
|
17
|
Raison CL, Lowry CA, Rook GAW. Inflammation, sanitation, and consternation: loss of contact with coevolved, tolerogenic microorganisms and the pathophysiology and treatment of major depression. ACTA ACUST UNITED AC 2011; 67:1211-24. [PMID: 21135322 DOI: 10.1001/archgenpsychiatry.2010.161] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
CONTEXT Inflammation is increasingly recognized as contributing to the pathogenesis of major depressive disorder (MDD), even in individuals who are otherwise medically healthy. Most studies in search of sources for this increased inflammation have focused on factors such as psychosocial stress and obesity that are known to activate inflammatory processes and increase the risk for depression. However, MDD may be so prevalent in the modern world not just because proinflammatory factors are widespread, but also because we have lost contact with previously available sources of anti-inflammatory, immunoregulatory signaling. OBJECTIVE To examine evidence that disruptions in coevolved relationships with a variety of tolerogenic microorganisms that were previously ubiquitous in soil, food, and the gut, but that are largely missing from industrialized societies, may contribute to increasing rates of MDD in the modern world. DATA SOURCES Relevant studies were identified using PubMed and Ovid MEDLINE. STUDY SELECTION Included were laboratory animal and human studies relevant to immune functioning, the hygiene hypothesis, and major depressive disorder identified via PubMed and Ovid MEDLINE searches. DATA EXTRACTION Studies were reviewed by all authors, and data considered to be potentially relevant to the contribution of hygiene-related immune variables to major depressive disorder were extracted. DATA SYNTHESIS Significant data suggest that a variety of microorganisms (frequently referred to as the "old friends") were tasked by coevolutionary processes with training the human immune system to tolerate a wide array of non-threatening but potentially proinflammatory stimuli. Lacking such immune training, vulnerable individuals in the modern world are at significantly increased risk of mounting inappropriate inflammatory attacks on harmless environmental antigens (leading to asthma), benign food contents and commensals in the gut (leading to inflammatory bowel disease), or self-antigens (leading to any of a host of autoimmune diseases). Loss of exposure to the old friends may promote MDD by increasing background levels of depressogenic cytokines and may predispose vulnerable individuals in industrialized societies to mount inappropriately aggressive inflammatory responses to psychosocial stressors, again leading to increased rates of depression. CONCLUSION Measured exposure to the old friends or their antigens may offer promise for the prevention and treatment of MDD in modern industrialized societies.
Collapse
Affiliation(s)
- Charles L Raison
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA.
| | | | | |
Collapse
|
18
|
Shomaker LB, Tanofsky-Kraff M, Young-Hyman D, Han JC, Yanoff LB, Brady SM, Yanovski SZ, Yanovski JA. Psychological symptoms and insulin sensitivity in adolescents. Pediatr Diabetes 2010; 11:417-23. [PMID: 19912553 PMCID: PMC2942090 DOI: 10.1111/j.1399-5448.2009.00606.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Symptoms of psychological distress have been linked to low insulin sensitivity in adults; however, little is known about this relationship in pediatric samples. We therefore examined symptoms of depression and anxiety in relation to insulin sensitivity in adolescents. METHODS Participants were 136 non-treatment-seeking, healthy adolescents (53.2% female) of all weight strata (BMI-z = 1.08 +/- 1.08) between the ages of 12 and 18 years (M = 15.16,SD = 1.55). Adolescents completed questionnaire measures assessing depression and anxiety symptoms. Fasting blood samples for serum insulin and plasma glucose were obtained to estimate insulin sensitivity with the quantitative insulin sensitivity check index. Fat mass and fat-free mass were measured with air displacement plethysmography or dual-energy X-ray absorptiometry. RESULTS Depressive symptoms were associated with higher fasting insulin and decreased insulin sensitivity even after controlling for fat mass, fat-free mass, height, age, pubertal status, race, and sex (p < 0.01). CONCLUSIONS As has been described for adults, depressive symptoms are associated with low insulin sensitivity among healthy adolescents. Further experimental and prospective studies are required to determine the directionality of this link.
Collapse
Affiliation(s)
- Lauren B. Shomaker
- Unit on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Service (DHHS), 10 Center Drive, Hatfield Clinical Research Center, Room 1E-3330, MSC 1103, Bethesda, Maryland, 20892-1103,Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Rd, Bethesda, MD, 20814
| | - Marian Tanofsky-Kraff
- Unit on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Service (DHHS), 10 Center Drive, Hatfield Clinical Research Center, Room 1E-3330, MSC 1103, Bethesda, Maryland, 20892-1103,Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Rd, Bethesda, MD, 20814
| | - Deborah Young-Hyman
- Unit on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Service (DHHS), 10 Center Drive, Hatfield Clinical Research Center, Room 1E-3330, MSC 1103, Bethesda, Maryland, 20892-1103
| | - Joan C. Han
- Unit on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Service (DHHS), 10 Center Drive, Hatfield Clinical Research Center, Room 1E-3330, MSC 1103, Bethesda, Maryland, 20892-1103
| | - Lisa B. Yanoff
- Unit on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Service (DHHS), 10 Center Drive, Hatfield Clinical Research Center, Room 1E-3330, MSC 1103, Bethesda, Maryland, 20892-1103
| | - Sheila M. Brady
- Unit on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Service (DHHS), 10 Center Drive, Hatfield Clinical Research Center, Room 1E-3330, MSC 1103, Bethesda, Maryland, 20892-1103
| | - Susan Z. Yanovski
- Unit on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Service (DHHS), 10 Center Drive, Hatfield Clinical Research Center, Room 1E-3330, MSC 1103, Bethesda, Maryland, 20892-1103,Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, DHHS
| | - Jack A. Yanovski
- Unit on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Service (DHHS), 10 Center Drive, Hatfield Clinical Research Center, Room 1E-3330, MSC 1103, Bethesda, Maryland, 20892-1103
| |
Collapse
|
19
|
Luiz AMAG, Gorayeb R, Liberatore Júnior RDR. Avaliação de depressão, problemas de comportamento e competência social em crianças obesas. ESTUDOS DE PSICOLOGIA (CAMPINAS) 2010. [DOI: 10.1590/s0103-166x2010000100005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O objetivo deste estudo foi avaliar a ocorrência de depressão, problemas comportamentais e competência social em crianças obesas, comparativamente a crianças não obesas. Participaram do estudo 90 crianças, das quais 60 eram obesas e 30 não eram, com idade entre 7 e 13 anos. Na coleta de dados foram utilizados: Ficha de Identificação, Inventário de Depressão para Crianças e Inventário de Comportamentos da Infância e Adolescência. Os dados foram analisados quantitativamente, com testes estatísticos não paramétricos e paramétricos, com nível de significância de 0,05. Os resultados apontaram diferença significativa entre as crianças obesas e as crianças não obesas em relação às variáveis psicológicas estudadas. Na análise multivariada, a depressão e os distúrbios internalizantes foram as variáveis que mais discriminaram as crianças obesas das não obesas. Os dados indicam, portanto, a necessidade de uma intervenção precoce e a realização de programas de prevenção.
Collapse
|
20
|
Tercyak KP, Abraham AA, Graham AL, Wilson LD, Walker LR. Association of multiple behavioral risk factors with adolescents' willingness to engage in eHealth promotion. J Pediatr Psychol 2008; 34:457-69. [PMID: 18723566 DOI: 10.1093/jpepsy/jsn085] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE This study examines adolescents' willingness to use the internet and other forms of technology for health promotion purposes (i.e., "eHealth promotion" willingness) and determines if a relationship exists between adolescents' behavioral risks and their eHealth promotion willingness. METHODS A total of 332 adolescents provided data at a routine medical check-up, including assessments of technology access, eHealth promotion willingness, and multiple behavioral risk factors for child- and adult-onset disease (body mass index, physical activity, smoking, sun protection, depression). RESULTS The level of access to technology among the sample was high, with moderate willingness to engage in eHealth promotion. After adjusting for adolescents' access to technology, the presence of multiple behavioral risk factors was positively associated with willingness to use technology for health promotion purposes (beta =.12, p =.03). CONCLUSIONS Adolescents with both single and multiple behavioral risk factors are in need of health promotion to prevent the onset of disease later in life. eHealth appears to be an acceptable and promising intervention approach with this population.
Collapse
Affiliation(s)
- Kenneth P Tercyak
- Cancer Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007-2401, USA.
| | | | | | | | | |
Collapse
|
21
|
Abstract
Pediatric mood disorders (unipolar depression and bipolar disorder) are serious, common, persistent, and recurrent medical conditions. Depression is the second leading cause of illness and disability among young people worldwide. A healthy lifestyle and healthy environment are the cornerstones for promoting positive moods. In addition, several complementary therapies, including nutritional supplements, herbs, mind-body therapies, massage, and acupuncture can be helpful. The focus of this article is the fundamental lifestyle approaches and complementary therapies that enhance mental health in young people. Various resources are available to clinicians to help patients and families promote mental health.
Collapse
Affiliation(s)
- Kathi J. Kemper
- Caryl J Guth Chair for Holistic and Integrative Medicine, Professor, Pediatrics and Public Health Sciences, Medical Center Blvd., Wake Forest University School of Medicine, Winston-Salem, NC 27157, TEL: (336) 716-9640, FAX: (336) 716-7100,
| | - Scott Shannon
- Northern Colorado Center for Holistic Medicine, 7603 Colland Drive, Fort Collins, CO 80525, TEL: (970) 663-2686, FAX: (970) 663-1226,
| |
Collapse
|