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Haran M, Killeen D, Smyth J, McNicholas F. A scoping review of physical activity interventions in youth attending child and adolescent mental health services. Ir J Med Sci 2024; 193:1391-1402. [PMID: 38267797 DOI: 10.1007/s11845-024-03607-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/05/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND There has been an international effort to improve physical health in general and in those with mental illness. Physical activity (PA) may be beneficial as an adjunctive treatment for mental health disorders and to improve physical well-being. AIMS The objective of this scoping review is to understand the extent and type of evidence in relation to PA interventions offered in child and adolescent mental health services (CAMHS). Eligibility was determined using the Population, Concept, Context framework. Studies were included if the participants were under 18 years old, attending CAMHS and where PA interventions were offered. METHODS PubMed, MEDLINE, Embase, Cochrane Library, CINAHL, PsycINFO and SportDiscus were searched without language or date restrictions. Titles and abstracts, followed by full texts, were screened by two independent reviewers. Two reviewers carried out data extraction, and discrepancies in any of these processes were resolved in consultation with a third reviewer. RESULTS After 2213 non-duplicate titles and abstracts were screened, 2090 were excluded and 123 full texts were screened. Seventeen studies met inclusion criteria. Included studies demonstrated PA interventions to be effective in reducing depressive symptoms and improving psychosocial functioning. While no study reported significant changes in anthropometric measurements, 2 studies demonstrated increased aerobic fitness. CONCLUSION Evidence that PA interventions are being offered in CAMHS worldwide is limited. Included studies demonstrate potential benefits in depressive symptoms, psychosocial functioning, self-esteem and aerobic fitness in youth attending CAMHS. Future research should identify effective ways to incorporate exercise interventions in CAMHS and evaluate long-term benefits.
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Affiliation(s)
- Maeve Haran
- Lucena Child and Adolescent Mental Health Service (CAMHS), Dublin, Ireland.
- Department of Child and Adolescent Psychiatry, School of Medicine, University College Dublin, Dublin, Ireland.
| | - David Killeen
- Department of Child and Adolescent Psychiatry, Children's Health Ireland at Tallaght, Dublin, D24TN3C, Ireland
| | - Justin Smyth
- Head of Library Services, St John of God's Research Foundation, Saint John of God Hospitaller Services Group, Granada, Stillorgan, Dublin, Ireland
| | - Fiona McNicholas
- Lucena Child and Adolescent Mental Health Service (CAMHS), Dublin, Ireland
- Department of Child and Adolescent Psychiatry, School of Medicine, University College Dublin, Dublin, Ireland
- Department of Paediatric Liaison Psychiatry, Children's Health Ireland (CHI), Dublin, Ireland
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Vollbehr NK, Stant AD, Hoenders HJR, Bartels-Velthuis AA, Nauta MH, Castelein S, Schroevers MJ, de Jong PJ, Ostafin BD. Cost-effectiveness of a mindful yoga intervention added to treatment as usual for young women with major depressive disorder versus treatment as usual only: Cost-effectiveness of yoga for young women with depression. Psychiatry Res 2024; 333:115692. [PMID: 38309011 DOI: 10.1016/j.psychres.2023.115692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 12/22/2023] [Accepted: 12/24/2023] [Indexed: 02/05/2024]
Abstract
In a randomized controlled trial in the Netherlands, we studied the (cost)effectiveness of adding a mindful yoga intervention (MYI+TAU) to treatment as usual (TAU) for young women with major depressive disorder (MDD). In this paper, we present the results of the economic analyses. Societal costs and health outcomes were prospectively assessed during 15 months for all randomized participants (n = 171). Symptoms of depression (Depression Anxiety and Stress Scales; DASS) and quality adjusted life years (QALYs) were used as health outcomes in the economic analyses. Mean total societal costs during the 15 months of the study were €11.966 for the MYI+TAU group and €13.818 for the TAU group, differences in mean total societal costs were not statistically significant. Health outcomes (DASS and QALY) were slightly in favour of MYI+TAU, but differences between groups were not statistically significant. Combining costs and health outcomes in cost-effectiveness analyses indicated that MYI+TAU is likely to be cost-effective compared to TAU which was confirmed by sensitivity analyses. Although there were limitations in the cost-effectiveness analysis, findings from this study suggest that MYI+TAU warrants future attention for the potential to be cost-effective compared to TAU for young women with MDD.
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Affiliation(s)
- Nina K Vollbehr
- Lentis Psychiatric Institute, Center for Integrative Psychiatry, Hereweg 80, 9725 AG, Groningen, the Netherlands; University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, Groningen, the Netherlands.
| | | | - H J Rogier Hoenders
- Lentis Psychiatric Institute, Center for Integrative Psychiatry, Hereweg 80, 9725 AG, Groningen, the Netherlands; University of Groningen, Faculty of Religion, Culture and Society, Groningen, the Netherlands
| | - Agna A Bartels-Velthuis
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research center, Groningen, the Netherlands
| | - Maaike H Nauta
- University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, Groningen, the Netherlands
| | - Stynke Castelein
- Lentis Psychiatric Institute, Center for Integrative Psychiatry, Hereweg 80, 9725 AG, Groningen, the Netherlands; University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, Groningen, the Netherlands; Lentis Psychiatric Institute, Lentis Research, Groningen, the Netherlands
| | - Maya J Schroevers
- University of Groningen, University Medical Center Groningen, Faculty of Medical Sciences, Groningen, the Netherlands
| | - Peter J de Jong
- University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, Groningen, the Netherlands
| | - Brian D Ostafin
- University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, Groningen, the Netherlands
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Thai TTH, Engel L, Perez JK, Tan EJ, Eades S, Sanci L, Mihalopoulos C. A systematic review of health state utility values and psychometric performance of generic preference-based instruments for children and adolescents with mental health problems. Qual Life Res 2023; 32:3005-3026. [PMID: 37237136 PMCID: PMC10522744 DOI: 10.1007/s11136-023-03441-x] [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] [Accepted: 05/15/2023] [Indexed: 05/28/2023]
Abstract
AIMS This paper aims to systematically identify reported health state utility values (HSUVs) in children and adolescents with mental health problems (MHPs) aged less than 25 years; to summarise the techniques used to elicit HSUVs; and to examine the psychometric performance of the identified multi-attribute utility instruments (MAUIs) used in this space. METHODS A systematic review was conducted following PRISMA guidelines. Peer-reviewed studies published in English, reporting HSUVs for children and adolescents with MHPs using direct or indirect valuation methods were searched in six databases. RESULTS We found 38 studies reporting HSUVs for 12 types of MHPs across 12 countries between 2005 and October 2021. Attention deficit hyperactivity disorder (ADHD) and depression are the most explored MHPs. Disruptive Behaviour Disorder was associated with the lowest reported HSUVs of 0.06 while cannabis use disorder was associated with the highest HSUVs of 0.88. Indirect valuation method through the use of MAUIs (95% of included studies) was the most frequently used approach, while direct valuation methods (Standard Gamble, Time Trade-Off) were only used to derive HSUVs in ADHD. This review found limited evidence of the psychometric performance of MAUIs used in children and adolescents with MHPs. CONCLUSION This review provides an overview of HSUVs of various MHPs, the current practice to generate HSUVs, and the psychometric performance of MAUIs used in children and adolescents with MHPs. It highlights the need for more rigorous and extensive psychometric assessments to produce evidence on the suitability of MAUIs used in this area.
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Affiliation(s)
- Thao T H Thai
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Lidia Engel
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Joahna Kevin Perez
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Eng Joo Tan
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Sandra Eades
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, 780 Elizabeth Street, Melbourne, VIC, 3000, Australia
| | - Lena Sanci
- Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, 780 Elizabeth Street, Melbourne, VIC, 3000, Australia
| | - Cathrine Mihalopoulos
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
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Yamaguchi R, Kawahara T, Kotani T, Yazawa R, Suzuki A, Kano Y, Ishii‐Takahashi A. The effectiveness of exercise programs accessible from home on children's and adolescents' emotional well-being: Systematic review & meta-analysis. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2023; 2:e103. [PMID: 38868129 PMCID: PMC11114315 DOI: 10.1002/pcn5.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 04/13/2023] [Accepted: 04/30/2023] [Indexed: 06/14/2024]
Abstract
Background The current systematic review and meta-analysis aimed to explore the evidence base to date for exercise interventions/interventions that aim to increase physical activity using a modality that can be accessed from home (i.e., online or video-based programs), and its effects on anxiety and depression in children and adolescents. Methods A broad search was conducted using six databases (PubMed, Web of Science, CINAHL, PsychINFO, ERIC and Scopus) on February 23, 2022. Studies with children or adolescents between the ages 5 and 18 years were included. Of the 2527 records that were identified, nine studies met the full-inclusion criteria. Their quality was assessed by two independent researchers using the Cochrane risk-of-bias tool for randomized trials (RoB 2) and Quality Assessment Tool for Before-After (Pre-Post) Studies with No Control Group. Meta analyses were conducted for studies that specifically assessed anxiety and depression. Results The overall results indicated that there is some evidence suggesting the positive effects of exercise interventions delivered online in reducing children's and adolescents' anxiety (d = -0.99, 95% confidence interval [CI]: -1.12 to -0.86). Meanwhile, there seems to be insufficient evidence for its efficacy in reducing low mood (d = -0.42; 95% CI: -0.84 to 0.01). Motivational and coaching based interventions to increase levels of physical activity may be limited in their efficacy, whilst having children exercise along with a video or live sessions online appears promising. Conclusion The current preliminary review revealed potential benefits of at-home interventions that had children and adolescents exercise along with a video in improving anxiety.
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Affiliation(s)
- Rio Yamaguchi
- Department of Child NeuropsychiatryGraduate School of MedicineTokyoJapan
| | - Takuya Kawahara
- Clinical Research Promotion CenterThe University of Tokyo HospitalTokyoJapan
| | - Tokiko Kotani
- Department of Child PsychiatryThe University of Tokyo HospitalTokyoJapan
| | - Rina Yazawa
- Department of Child PsychiatryThe University of Tokyo HospitalTokyoJapan
- College of Liberal ArtsInternational Christian UniversityTokyoJapan
- Department of Developmental DisordersNational Institute of Mental Health, National Center of Neurology and PsychiatryKodairaJapan
| | - Akane Suzuki
- Department of Child PsychiatryThe University of Tokyo HospitalTokyoJapan
- Department of Developmental DisordersNational Institute of Mental Health, National Center of Neurology and PsychiatryKodairaJapan
| | - Yukiko Kano
- Department of Child NeuropsychiatryGraduate School of MedicineTokyoJapan
- Department of Child PsychiatryThe University of Tokyo HospitalTokyoJapan
| | - Ayaka Ishii‐Takahashi
- Department of Child NeuropsychiatryGraduate School of MedicineTokyoJapan
- Department of Child PsychiatryThe University of Tokyo HospitalTokyoJapan
- Department of Developmental DisordersNational Institute of Mental Health, National Center of Neurology and PsychiatryKodairaJapan
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Yu Q, Wong KK, Lei OK, Nie J, Shi Q, Zou L, Kong Z. Comparative Effectiveness of Multiple Exercise Interventions in the Treatment of Mental Health Disorders: A Systematic Review and Network Meta-Analysis. SPORTS MEDICINE - OPEN 2022; 8:135. [PMID: 36308622 PMCID: PMC9617247 DOI: 10.1186/s40798-022-00529-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 10/16/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The efficacy of exercise interventions in the treatment of mental health disorders is well known, but research is lacking on the most efficient exercise type for specific mental health disorders. OBJECTIVE The present study aimed to compare and rank the effectiveness of various exercise types in the treatment of mental health disorders. METHODS The PubMed, Web of Science, PsycINFO, SPORTDiscus, CINAHL databases, and the Cochrane Central Register of Controlled Trials as well as Google Scholar were searched up to December 2021. We performed pairwise and network meta-analyses as well as meta-regression analyses for mental health disorders in general and each type of mental health disorder, with alterations in symptom severity as the primary outcome. RESULTS A total of 6456 participants from 117 randomized controlled trials were surveyed. The multimodal exercise (71%) had the highest probability of being the most efficient exercise for relieving depressive symptoms. While resistance exercise (60%) was more likely to be the most effective treatment for anxiety disorder, patients with post-traumatic stress disorder (PTSD) benefited more from mind-body exercise (52%). Furthermore, resistance exercise (31%) and multimodal exercise (37%) had more beneficial effects in the treatment of the positive and negative symptoms of schizophrenia, respectively. The length of intervention and exercise frequency independently moderated the effects of mind-body exercise on depressive (coefficient = 0.14, p = .03) and negative schizophrenia (coefficient = 0.96, p = .04) symptoms. CONCLUSION Multimodal exercise ranked best for treating depressive and negative schizophrenic symptoms, while resistance exercise seemed to be more beneficial for those with anxiety-related and positive schizophrenic symptoms. Mind-body exercise was recommended as the most promising exercise type in the treatment of PTSD. However, the findings should be treated with caution due to potential risk of bias in at least one dimension of assessment and low-to-moderate certainty of evidence. Trial Registration This systematic review was registered in the PROSPERO international prospective register of systematic reviews (CRD42022310237).
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Affiliation(s)
- Qian Yu
- grid.437123.00000 0004 1794 8068Faculty of Education, University of Macau, Macao, China
| | - Ka-Kit Wong
- grid.437123.00000 0004 1794 8068Faculty of Education, University of Macau, Macao, China
| | - On-Kei Lei
- grid.437123.00000 0004 1794 8068Faculty of Education, University of Macau, Macao, China
| | - Jinlei Nie
- Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao, China
| | - Qingde Shi
- Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao, China
| | - Liye Zou
- grid.263488.30000 0001 0472 9649Body-Brain-Mind Laboratory, The Shenzhen Humanities & Social Sciences Key Research Bases of the Center for Mental Health, School of Psychology, Shenzhen University, Shenzhen, 518060 China
| | - Zhaowei Kong
- grid.437123.00000 0004 1794 8068Faculty of Education, University of Macau, Macao, China
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Mortazavi R, Lalouni M, Grudin R, Serlachius E, Sundberg CJ, Norrbom J, Larsson I, Haglund E, Ivarsson A, Lenhard F, Cronqvist T, Ingemarsson K, Mårsell Å, Rask O, Jarbin H. Moderate-to-vigorous group aerobic exercise versus group leisure activities for mild-to-moderate depression in adolescents: study protocol for a multicentre randomised controlled trial. BMJ Open 2022; 12:e060159. [PMID: 35820753 PMCID: PMC9274524 DOI: 10.1136/bmjopen-2021-060159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 06/21/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Depression is common, increasing among adolescents and carries risk of disability, lower educational achievements, cardiovascular disease, substance abuse, self-harm and suicide. The effects of evidence-based treatments with medication or psychotherapy are modest. Aerobic exercise is a promising intervention for adolescents with depression, but available studies are hampered by methodological shortcomings. This study aims to evaluate aerobic group exercise versus an active comparator of leisure group activities in adolescents from clinical services with mild-to-moderate depression. METHODS AND ANALYSIS This study is a multicentre randomised controlled trial at four psychiatric clinics in Sweden. Participants (n=122) will be randomised 1:1 to group exercise delivered by exercise professionals and supported by mental health (MH) workers or leisure activities lead by the same MH workers for 1 hour three times a week for 12 weeks. Participants will be assessed at baseline, single blind after 13 weeks and 26 weeks and openly after 1 year. Participants randomised to the leisure group will be offered exercise in the open phase. The primary outcome is clinician-rated Children's Depression Rating Scale-Revised. Secondary outcomes are self-rated Quick Inventory of Depressive Symptomatology, self-rated functioning; clinician-rated improvement and functioning; objectively measured aerobic capacity, muscular strength, muscular endurance, body composition and presence or activity of selected biological markers of neuroprotection and neuroinflammation in blood samples. Further outcomes are cost-effectiveness and adolescents', parents' and coaches' experiences of the interventions and an exploration of how the adolescents' health and lifestyle are influenced by the interventions through qualitative interviews. ETHICS AND DISSEMINATION The study is approved by the Swedish Ethical Review Authority (Ref. 2021-05307-01). Informed consent in writing will be provided from patients and parents of participants below 15 years of age. The results of this study will be communicated to the included participants and healthcare providers and also submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05076214.
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Affiliation(s)
- Rebecca Mortazavi
- Department of Clinical Sciences, Child and Adolescent Psychiatry, Lund University, Lund, Sweden
- Child and Adolescent Psychiatry, Region Halland, Halmstad, Sweden
| | - Maria Lalouni
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Region Stockholm, Sweden
| | - Rebecca Grudin
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Region Stockholm, Sweden
| | - Eva Serlachius
- Department of Clinical Sciences, Child and Adolescent Psychiatry, Lund University, Lund, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Region Stockholm, Sweden
| | - Carl Johan Sundberg
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
- Department of Learning, Informatics, Karolinska Institutet, Stockholm, Sweden
| | - Jessica Norrbom
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Ingrid Larsson
- Department of Health and Nursing, School of Health and Welfare, Halmstad University, Halmstad, Sweden
- Spenshult Research and Development Centre, Halmstad, Halland, Sweden
| | - Emma Haglund
- The Rydberg Laboratory for Applied Sciences, Halmstad, Sweden
- Department of Health and Sport, School of Health and Sport, Halmstad University, Halmstad, Sweden
| | - Andreas Ivarsson
- Department of Health and Nursing, School of Health and Welfare, Halmstad University, Halmstad, Sweden
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
| | - Fabian Lenhard
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Åsa Mårsell
- PRIMA Barn- och Vuxenpsykiatri AB, Stockholm, Sweden
| | - Olof Rask
- Department of Clinical Sciences, Child and Adolescent Psychiatry, Lund University, Lund, Sweden
| | - Håkan Jarbin
- Department of Clinical Sciences, Child and Adolescent Psychiatry, Lund University, Lund, Sweden
- Child and Adolescent Psychiatry, Region Halland, Halmstad, Sweden
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Lancaster MR, Callaghan P. The effect of exercise on resilience, its mediators and moderators, in a general population during the UK COVID-19 pandemic in 2020: a cross-sectional online study. BMC Public Health 2022; 22:827. [PMID: 35468747 PMCID: PMC9037056 DOI: 10.1186/s12889-022-13070-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/22/2022] [Indexed: 01/04/2023] Open
Abstract
Background Resilience is central to positive mental health and well-being especially when faced with adverse events. Factors such as exercise, location, sleep, mental health, and personality are moderators and mediators of resilience. However, the impact of these factors on resilience during severe adverse events are unknown. The present study examined how the COVID-19 pandemic affected resilience and its moderators and mediators by investigating whether there was a difference in resilience and quality of life between people with varying levels of exercise, including those who changed their exercise levels pre and during a COVID-19-related lockdown, and whether location affected the relationship between levels of exercise and resilience and quality of life. Methods Following ethical approval, a cross-sectional online survey capturing data on self-reported key moderators and mediators of resilience before and during the COVID-19 lockdown imposed on the 23rd March 2020 in the UK was distributed via social media and completed over a three week time period during July 2020 via a self-selecting sample of the general population (N = 85). The key moderators and mediators of resilience the survey assessed were exercise, location, life-orientation, mental health, and sleep quality. All data were self-reported. Results Participants’ exercise intensity level increased as resilience increased (F(2,82) = 4.22, p = .003: Wilks’ lambda = .82, partial n2 = 0.09). The relationship between exercise, and resilience and quality of life was independent of sleep and mental health status pre-lockdown (p = .013, p = .027 respectively). In the face of the COVID-19 pandemic, this relationship was dependent on mental health but not sleep quality (p = <.001 for resilience p = .010 for quality of life). There were no statistically significant differences between participants living in urban or rural locations. Conclusion Exercise is strongly correlated to resilience and during a pandemic such as COVID-19 it becomes a mechanism in which to moderate resilience. The relationship between exercise and resilience is supported by this study. The influence that a pandemic had on mental health is mediated by its effect on quality of life.
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Affiliation(s)
- Molly Rose Lancaster
- Conducted research at London Southbank University, 103 Borough Road, London, SE1 0AA, UK.
| | - Patrick Callaghan
- Professor of Mental Health Science and Associate Pro Vice-Chancellor Research, London Southbank University, 103 Borough Road, London, SE1 0AA, UK
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Hosseinkhani Z, Parsaeian M, Hassanabadi HR, Khoshkchali A, Alinesaei Z, Nedjat S. Mental Health Problems and the Associated Family and School Factors in Adolescents: A Multilevel Analysis. IRANIAN JOURNAL OF PSYCHIATRY 2021; 16:13-20. [PMID: 34054978 PMCID: PMC8140304 DOI: 10.18502/ijps.v16i1.5373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective: Mental health is one of the most important issues in adolescents’ life. Adolescents’ health is highly important, because of their role in the future. This study was conducted using multilevel analysis to investigate the risk factors at student and school levels. Method: This was a cross sectional study for which 1740 students and 53 schools were selected between February and March 2018 in Qazvin, Iran. Multistage stratified cluster sampling was used for data collection. Mental health problems were measured by the Strengths and Difficulties Questionnaire (SDQ). Emotional symptom, conduct problem, hyperactivity, peer relationship problem, and prosocial behavior were the subscales. This study used multilevel analysis to determine the association between each of the questionnaire scales and students and schools variables. Results: The prevalence of the mental health problems was 16.2%. Conduct problem was more prevalent than others (21.1%). Overall, the score of mental health problems was significantly lower in boys’ schools, in adolescents with physical activity, and in families with high socioeconomic status. Hyperactivity and emotional symptoms were significantly higher in girls’ schools. While prosocial behavior and peer relationship problems were significantly higher in boys’ schools. The association between variables and the scales of mental health problems was different.Conclusion: Results indicated desirable physical activity and socioeconomic status are effective components in the adolescents’ mental health, and, mostly girls’ schools were more vulnerable than boys’ schools. Therefore, the educational authorities and health policymakers should consider this diversity to design interventional programs and pay more attention to the high-risk adolescents in different schools.
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Affiliation(s)
- Zahra Hosseinkhani
- Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin, University of Medical Sciences, Qazvin, Iran
| | - Mahboubeh Parsaeian
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Atefeh Khoshkchali
- Children Growth Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Zahra Alinesaei
- Children Growth Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Saharnaz Nedjat
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Howlett N, Bottoms L, Chater A, Clark AB, Clarke T, David L, Irvine K, Jones A, Jones J, Mengoni SE, Murdoch J, Pond M, Sharma S, Sims EJ, Turner DA, Wellsted D, Wilson J, Wyatt S, Trivedi D. A randomised controlled trial of energetic activity for depression in young people (READY): a multi-site feasibility trial protocol. Pilot Feasibility Stud 2021; 7:6. [PMID: 33390189 PMCID: PMC7779325 DOI: 10.1186/s40814-020-00734-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/24/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Prevalence of depression is increasing in young people, and there is a need to develop and evaluate behavioural interventions which may provide benefits equal to or greater than talking therapies or pharmacological alternatives. Exercise could be beneficial for young people living with depression, but robust, large-scale trials of effectiveness and the impact of exercise intensity are lacking. This study aims to test whether a randomised controlled trial (RCT) of an intervention targeting young people living with depression is feasible by determining whether it is possible to recruit and retain young people, develop and deliver the intervention as planned, and evaluate training and delivery. METHODS The design is a three-arm cluster randomised controlled feasibility trial with embedded process evaluation. Participants will be help-seeking young people, aged 13-17 years experiencing mild to moderate low mood or depression, referred from three counties in England. The intervention will be delivered by registered exercise professionals, supported by mental health support workers, twice a week for 12 weeks. The three arms will be high-intensity exercise, low-intensity exercise, and a social activity control. All arms will receive a 'healthy living' behaviour change session prior to each exercise session and the two exercise groups are energy matched. The outcomes are referral, recruitment, and retention rates; attendance at exercise sessions; adherence to and ability to reach intensity during exercise sessions; proportions of missing data; adverse events, all measured at baseline, 3, and 6 months; resource use; and reach and representativeness. DISCUSSION UK National Health Service (NHS) policy is to provide young people with advice about using exercise to help depression but there is no evidence-based exercise intervention to either complement or as an alternative to medication or talking therapies. UK National Institute for Health and Care Excellence (NICE) guidelines suggest that exercise can be an effective treatment, but the evidence base is relatively weak. This feasibility trial will provide evidence about whether it is feasible to recruit and retain young people to a full RCT to assess the effectiveness and cost-effectiveness of an exercise intervention for depression. TRIAL REGISTRATION ISRCTN, ISRCTN66452702 . Registered 9 April 2020.
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Affiliation(s)
- N. Howlett
- Department of Psychology, Sport, and Geography, University of Hertfordshire, College Lane, Hatfield, Herts AL10 9AB UK
| | - L. Bottoms
- Department of Psychology, Sport, and Geography, University of Hertfordshire, College Lane, Hatfield, Herts AL10 9AB UK
| | - A. Chater
- Institute for Sport and Physical Activity Research (ISPAR), School of Sport Science and Physical Activity, Faculty of Health, Education, Sport and Social Science, University of Bedfordshire, Polhill Avenue, Bedford, MK41 9EA UK
| | - A. B. Clark
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, Norfolk NR4 7TR UK
| | - T. Clarke
- Norfolk and Suffolk NHS Foundation Trust, Hellesdon Hospital, Drayton High Road, Norwich, NR6 5BE UK
- Norwich Medical School, University of East Anglia, Norwich, Norfolk NR4 7TJ UK
| | - L. David
- Centre for Health Services and Clinical Research, University of Hertfordshire, College Lane, Hatfield, Herts AL10 9AB UK
| | - K. Irvine
- Department of Psychology, Sport, and Geography, University of Hertfordshire, College Lane, Hatfield, Herts AL10 9AB UK
| | - A. Jones
- Norwich Medical School, University of East Anglia, Norwich, Norfolk NR4 7TJ UK
| | - J. Jones
- Centre for Research in Public Health and Community Care, University of Hertfordshire, College Lane, Hatfield, Herts AL10 9AB UK
| | - S. E. Mengoni
- Department of Psychology, Sport, and Geography, University of Hertfordshire, College Lane, Hatfield, Herts AL10 9AB UK
- Centre for Health Services and Clinical Research, University of Hertfordshire, College Lane, Hatfield, Herts AL10 9AB UK
| | - J. Murdoch
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, Norfolk NR4 7TR UK
| | - M. Pond
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, Norfolk NR4 7TR UK
| | - S. Sharma
- Department of Psychology, Sport, and Geography, University of Hertfordshire, College Lane, Hatfield, Herts AL10 9AB UK
| | - E. J. Sims
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, Norfolk NR4 7TR UK
| | - D. A. Turner
- Norwich Medical School, University of East Anglia, Norwich, Norfolk NR4 7TJ UK
| | - D. Wellsted
- Centre for Health Services and Clinical Research, University of Hertfordshire, College Lane, Hatfield, Herts AL10 9AB UK
| | - J. Wilson
- Norfolk and Suffolk NHS Foundation Trust, Hellesdon Hospital, Drayton High Road, Norwich, NR6 5BE UK
- Norwich Medical School, University of East Anglia, Norwich, Norfolk NR4 7TJ UK
| | - S. Wyatt
- Centre for Health Services and Clinical Research, University of Hertfordshire, College Lane, Hatfield, Herts AL10 9AB UK
| | - D. Trivedi
- Centre for Research in Public Health and Community Care, University of Hertfordshire, College Lane, Hatfield, Herts AL10 9AB UK
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10
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van IJzendoorn MH, Bakermans-Kranenburg MJ. Problematic cost-utility analysis of interventions for behavior problems in children and adolescents. New Dir Child Adolesc Dev 2020; 2020:89-102. [PMID: 32909695 PMCID: PMC7590126 DOI: 10.1002/cad.20360] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Cost–utility analyses are slowly becoming part of randomized control trials evaluating physical and mental health treatments and (preventive) interventions in child and adolescent development. The British National Institute of Health and Care Excellence, for example, insists on the use of gains in Quality Adjusted Life Years (QALYs) to compute the “value for money” of interventions. But what counts as a gain in quality of life? For one of the most widely used instruments, the EuroQol 5 Dimensions scale (EQ‐5D), QALYs are estimated by healthy individuals who provide utility scores for specific health states, assuming that the best life is a life without self‐experienced problems in five domains: mobility, self‐care, usual activities, pain/discomfort, and anxiety/depression. The worst imaginable outcome is defined as “a lot of problems” in each of these five domains. The impact of the individual's problems on the social network is not weighted, and important social–developmental domains (externalizing problems, social competence) are missing. Current cost–utility computations based on EQ‐5D favor physical health over mental health, and they rely on adult weights for child and adolescent quality of life. Thus, a level playing field is absent, and developmental expertise is sorely missing.
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Affiliation(s)
- Marinus H van IJzendoorn
- Erasmus University Rotterdam, Rotterdam, The Netherlands.,University of Cambridge, Cambridge, UK
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11
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Morres ID, Hinton-Bayre A, Motakis E, Carter T, Callaghan P. A pragmatic randomised controlled trial of preferred intensity exercise in depressed adult women in the United Kingdom: secondary analysis of individual variability of depression. BMC Public Health 2019; 19:941. [PMID: 31300029 PMCID: PMC6626419 DOI: 10.1186/s12889-019-7238-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 06/25/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study is a secondary analysis of the trial by Callaghan et al. (2011), which reported higher antidepressant effects for preferred intensity (n = 19) vs. prescribed intensity (n = 19) exercise of three sessions/week over four weeks in depressed women. In particular, the present study sought to examine whether greater clinically significant individual change/recovery was observed in the preferred compared to the prescribed exercise group. METHODS The reliable change index and the Ccutoff score criteria described by Jacobson and Truax (1991) were employed to determine clinical significance. These criteria examined if individual change in depression scores from pre- to post-intervention in the preferred intensity group were statistically significant beyond the standard error of difference derived from the active comparator prescribed group, and subsequently within a normal population range. Patients fulfilling the first or both criteria were classified as improved or recovered, respectively. RESULTS Post-intervention depression scores of six patients in the preferred intensity exercise group (32%) demonstrated statistically reliable improvement (p < 0.05) and recovery. Half of this subgroup started as moderately depressed. No patient demonstrated a reliable deterioration in depression. Due to a small sample size, it was impossible to determine whether patients on psychiatric medication or medication-free patients were equally benefited from preferred intensity exercise. Thirteen patients in the preferred intensity group (68%) displayed non-statistically significant change in post-intervention depression scores (p > 0.05), although eight of them showed a non-significant improvement in post-intervention depression scores and three could not technically show an improvement in depression due to floor effects (baseline depression within normal range). CONCLUSIONS Preferred intensity exercise of three sessions/week over four weeks led almost a third of the patients to record scores consistent with recovery from depression. Health professionals may consider that short-term preferred intensity exercise provides clinically significant antidepressant effects comparing favourably to exercise on prescription.
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Affiliation(s)
- Ioannis D Morres
- Department of Physical Education and Sport Science, Exercise Psychology and Quality of Life Laboratory, University of Thessaly, Trikala, Greece
| | - Anton Hinton-Bayre
- School of Surgery, Ear Science Centre, University of Western Australia, Perth, Australia
| | - Efthymios Motakis
- Yong Loo Lin School of Medicine, Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore
| | - Tim Carter
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Patrick Callaghan
- School of Applied Sciences, London South Bank University, 103 Borough Road, London, SE1 0AA, UK.
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