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Ackermann K, Ueberberg B, Assion HJ. Zufriedenheit mit (teil-)stationärer psychiatrischer Behandlung: Effekte auf die physische und psychische Gesundheit. ZEITSCHRIFT FÜR EVIDENZ, FORTBILDUNG UND QUALITÄT IM GESUNDHEITSWESEN 2023:S1865-9217(23)00009-0. [PMID: 37019754 DOI: 10.1016/j.zefq.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/13/2023] [Accepted: 01/23/2023] [Indexed: 04/05/2023]
Abstract
INTRODUCTION Quality assessment from the patient's point of view makes it possible to identify negative quality developments at an early stage. The focus is not on the medical result, but on what the patient wants. Correlations between patient satisfaction and physical and psychological treatment outcome were already shown in the 1990s. However, studies using rather unspecific satisfaction measures are scarce. The aim of this study was to investigate the influence of patient satisfaction with the treatment and the therapies offered on the extent of recovery. METHODS In this prospective study, a questionnaire developed for the differentiated recording of patient satisfaction with the therapy offerings of the LWL-Klinik Dortmund was used in a day-care/hospital setting. The structure of the questionnaire was tested by means of explorative factor analysis. The factors generated in this way served as the basis for the hierarchical regression analyses in the further course. In addition to important treatment aspects from the patient's point of view, the subjective health status was recorded by means of SF-36. RESULTS 105 patients participated in the study (64% female, 84% diagnosed with depression). Significant predictors for physical health were well-being after exercise therapy and satisfaction with the weekly structure of services. Significant predictors for mental health were age at onset of illness, age, perceived benefits from exercise therapy as well as occupational therapy, treatment duration and setting. DISCUSSION The demonstrated impact of patient satisfaction on mental health highlights the relevance of treatment quality improvement to recovery.
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Fabiano N, Gupta A, Fiedorowicz JG, Firth J, Stubbs B, Vancampfort D, Schuch FB, Carr LJ, Solmi M. Dr Amir Mohammadamini
The effect of exercise on suicidal behaviors: A systematic review and meta-analysis of randomized controlled trials. J Affect Disord 2023; 330:355-366. [PMID: 36871911 DOI: 10.1016/j.jad.2023.02.071] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 02/11/2023] [Accepted: 02/15/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Although exercise may positively impact those with mental or other medical illnesses, there is a lack of understanding on how it influences suicidal ideation or risk. METHODS We conducted a PRISMA 2020-compliant systematic review searching MEDLINE, EMBASE, Cochrane, and PsycINFO from inception to June 21, 2022. Randomized controlled trials (RCTs) investigating exercise and suicidal ideation in subject with mental or physical conditions were included. Random-effects meta-analysis was conducted. The primary outcome was suicidal ideation. We assessed bias of studies with risk of bias tool 2. RESULTS We identified 17 RCTs encompassing 1021 participants. Depression was the most included condition (71 %, k = 12). Mean follow up was 10.0 weeks (SD = 5.2). Post-intervention suicidal ideation (SMD = -1.09, CI -3.08-0.90, p = 0.20, k = 5) was not significantly different between exercise and control groups. Suicide attempts were significantly reduced in participants randomized to exercise interventions as compared to inactive controls (OR = 0.23, CI 0.09-0.67, p = 0.04, k = 2). Fourteen studies (82 %) were at high risk of bias. LIMITATIONS This meta-analysis is limited by few, and underpowered and heterogenous studies. CONCLUSION Overall, our meta-analysis did not find a significant decrease in suicidal ideation or mortality between exercise and control groups. However, exercise did significantly decrease suicide attempts. Results should be considered preliminary, and more and larger studies assessing suicidality in RCTs testing exercise are needed.
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Affiliation(s)
- Nicholas Fabiano
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Arnav Gupta
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; College of Public Health, Kent State University, Kent, OH, United States
| | - Jess G Fiedorowicz
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada; Department of Mental Health, Ottawa Hospital, Ottawa, ON, Canada; Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Davy Vancampfort
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium
| | - Felipe B Schuch
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
| | - Lucas J Carr
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, United States
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada; Department of Mental Health, Ottawa Hospital, Ottawa, ON, Canada; Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
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Martland R, Korman N, Firth J, Stubbs B. The efficacy of exercise interventions for all types of inpatients across mental health settings: A systematic review and meta-analysis of 47 studies. J Sports Sci 2023; 41:232-271. [PMID: 37132599 DOI: 10.1080/02640414.2023.2207855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 04/18/2023] [Indexed: 05/04/2023]
Abstract
This systematic review and meta-analysis investigated the benefits, safety and adherence of exercise interventions delivered in inpatient mental health settings, quantified the number of exercise trials that provided support to maintain engagement in exercise post-discharge, and reported patient feedback towards exercise interventions. Major databases were searched from inception to 22.06.2022 for intervention studies investigating exercise in mental health inpatient settings. Study quality was assessed using Cochrane and ROBINS-1 checklists. Fifty-six papers were included from 47 trials (including 34 RCTs), bias was high. Exercise improved depression (Standardised mean difference = -0.416; 95% Confidence interval -0.787 to -0.045, N = 15) compared to non-exercise comparators amongst people with a range of mental illnesses, with further (albeit limited) evidence suggesting a role of exercise in cardiorespiratory fitness and various other physical health parameters and ameliorating psychiatric symptoms. No serious exercise-related adverse events were noted, attendance was ≥80% in most trials, and exercise was perceived as enjoyable and useful. Five trials offered patients post-discharge support to continue exercise, with varying success. In conclusion, exercise interventions may have therapeutic benefits in inpatient mental health settings. More high-quality trials are needed to determine optimal parameters, and future research should investigate systems to support patients to maintain exercise engagement once discharged.
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Affiliation(s)
- Rebecca Martland
- King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, UK
| | - Nicole Korman
- Metro South Addiction and Mental Health Services, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Joseph Firth
- Western Sydney University, Westmead, NSW, NICM Health Research Institute, Australia
- Faculty of Biology, Medicine & Health, Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom
| | - Brendon Stubbs
- King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, UK
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
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Abstract
The emerging field of sports psychiatry has been developing steadily in recent years. This is not just a health concern but is likely to impact sporting performance and achievement significantly. An overview of sports psychiatry is provided. Psychiatric disorders of all varieties can and do present in sporting populations. Sports psychiatry keeps evolving to drive forward the importance of good mental health in sport as in life.
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Ross RE, VanDerwerker CJ, Saladin ME, Gregory CM. The role of exercise in the treatment of depression: biological underpinnings and clinical outcomes. Mol Psychiatry 2023; 28:298-328. [PMID: 36253441 PMCID: PMC9969795 DOI: 10.1038/s41380-022-01819-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 09/19/2022] [Accepted: 09/26/2022] [Indexed: 01/21/2023]
Abstract
Globally, depression is a leading cause of disability and has remained so for decades. Antidepressant medications have suboptimal outcomes and are too frequently associated with side effects, highlighting the need for alternative treatment options. Although primarily known for its robust physical health benefits, exercise is increasingly recognized for its mental health and antidepressant benefits. Empirical evidence indicates that exercise is effective in treating individuals with depression; however, the mechanisms by which exercise exerts anti-depressant effects are not fully understood. Acute bouts of exercise have been shown to transiently modulate circulating levels of serotonin and norepinephrine, brain-derived neurotrophic factor, and a variety of immuno-inflammatory mechanisms in clinical cohorts with depression. However, exercise training has not been demonstrated to consistently modulate such mechanisms, and evidence linking these putative mechanisms and reductions in depression is lacking. The complexity of the biological underpinnings of depression coupled with the intricate molecular cascade induced by exercise are significant obstacles in the attempt to disentangle exercise's effects on depression. Notwithstanding our limited understanding of these effects, clinical evidence uniformly argues for the use of exercise to treat depression. Regrettably, exercise remains underutilized despite being an accessible, low-cost alternative/adjunctive intervention that can simultaneously reduce depression and improve overall health. To address the gaps in our understanding of the clinical and molecular effects of exercise on depression, we propose a model that leverages systems biology and multidisciplinary team science with a large-scale public health investment. Until the science matches the scale of complexity and burden posed by depression, our ability to advance knowledge and treatment will continue to be plagued by fragmented, irreproducible mechanistic findings and no guidelines for standards of care.
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Affiliation(s)
- Ryan E. Ross
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC,Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC
| | | | - Michael E. Saladin
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Chris M. Gregory
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC,Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC
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Xie Y, Wu Z, Sun L, Zhou L, Wang G, Xiao L, Wang H. The Effects and Mechanisms of Exercise on the Treatment of Depression. Front Psychiatry 2021; 12:705559. [PMID: 34803752 PMCID: PMC8602192 DOI: 10.3389/fpsyt.2021.705559] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 10/05/2021] [Indexed: 12/12/2022] Open
Abstract
Background: It is necessary to seek alternative therapies for depression, because side effects of medications lead to poor adherence and some patients do not achieve a clinical treatment effect. Recently the role of exercise as a low-cost and easy-to-use treatment for depression has gained attention with a number of studies showing that exercise is effective at reducing depressive symptoms and improving body functions such as cardiorespiratory system and cognitive function. Because of the heterogeneity of exercise therapy programs, there is no standardized and unified program. Few studies have summarized the specific properties of exercise programs (type, intensity, duration, and frequency) and clinical prescriptions for exercise are not mentioned in most articles. Aims: This study aimed to investigate the feasibility and efficacy of exercise therapy for patients with depression, in order to appraise the evidence and outline accepted guidelines to direct individualized treatment plans for patients with depression based on their individual situations. Methods: A systematic review of English language literature including papers published from 2010 to present in PubMed was performed. Given the feasibility of prescribing exercise therapy for patients with depression, nearly 3 years of clinical studies on the treatments of depressive symptoms with exercise were first reviewed, comparing the exercise programs utilized. Conclusions: Exercise has therapeutic effects on depression in all age groups (mostly 18-65 years old), as a single therapy, an adjuvant therapy, or a combination therapy, and the benefits of exercise therapy are comparable to traditional treatments for depression. Moderate intensity exercise is enough to reduce depressive symptoms, but higher-dose exercise is better for overall functioning. Exercise therapy has become more widely used because of its benefits to the cardiovascular system, emotional state, and systemic functions. Recommendations: Aerobic exercise/mind-body exercise (3-5 sessions per week with moderate intensity lasting for 4-16 weeks) is recommended. Individualized protocols in the form of group exercise with supervision are effective at increasing adherence to treatment.
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Affiliation(s)
- Yumeng Xie
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zuotian Wu
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Limin Sun
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lin Zhou
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Gaohua Wang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ling Xiao
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Huiling Wang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
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