Mental Illness Prevention and Mental Health Promotion: When, Who, and How

World Psychiatric Association-Asian Journal of Psychiatry Commission on Public Mental Health

Although there is considerable evidence showing that the prevention of mental illnesses and adverse outcomes and mental health promotion can help people lead better and more functional lives, public mental health remains overlooked in the broader contexts of psychiatry and public health. Likewise, in undergraduate and postgraduate medical curricula, prevention and mental health promotion have often been ignored. However, there has been a recent increase in interest in public mental health, including an emphasis on the prevention of psychiatric disorders and improving individual and community wellbeing to support life trajectories, from childhood through to adulthood and into older age. These lifespan approaches have significant potential to reduce the onset of mental illnesses and the related burdens for the individual and communities, as well as mitigating social, economic, and political costs. Informed by principles of social justice and respect for human rights, this may be especially important for addressing salient problems in communities with distinct vulnerabilities, where prominent disadvantages and barriers for care delivery exist. Therefore, this Commission aims to address these topics, providing a narrative overview of relevant literature and suggesting ways forward. Additionally, proposals for improving mental health and preventing mental illnesses and adverse outcomes are presented, particularly amongst at-risk populations.

Effects and Side Effects in a Short Work Coaching for Participants with and without Mental Illness

Employees with mental illness are often the first to be unable to cope with increasingly complex psychosocial work demands. But people without mental illness can also suffer from, for example, high workload. This study compares a short coaching to stabilize work ability for employees with and without mental illness regarding coaching topics, effects on work-related resources, goal attainment, and unwanted events. Individual coaching of three sessions (problem exploration by behavior analysis, practice of new behavior, reflection) was conducted with employees from different professional fields. A medical history was taken to determine whether participants are affected by a mental disorder. All coaching was conducted by the same behavior therapist in training (L.P.W.) under the supervision of an experienced behavior therapist (B.M.). Two hundred and three coachings with three sessions were completed. In total, 103 participants did not have a mental illness (51%), and 100 participants reported a mental disorder (49%). The coaching participants with mental illness had lower initial levels of work-related capacities (more severe impairments) and coping behavior as compared to the participants without mental illness. In the pre-post comparisons, both groups achieved significant improvements in work-related coping after the coaching. There were no differences in goal attainment between both groups. While participants without mental illness reported more unwanted events in parallel to the coaching (30% reported negative developments in life), participants with mental illness reported coaching-related unwanted events (20% felt to be dependent on the coach). Coaching with an individual focus on one topic can improve work-related resources in participants with and without mental disorders. Since participants with and without mental illness experience different unwanted events in coaching, psychotherapeutic expertise is needed in order to set the right focus.

Pilot Implementation of a Nutrition-Focused Community-Health-Worker Intervention among Formerly Chronically Homeless Adults in Permanent Supportive Housing

Food insecurity is a known health equity threat for formerly chronically homeless populations even after they transition into permanent housing. This project utilized a human-centered design methodology to plan and implement a nutrition-focused community-health-worker (CHW) intervention in permanent supportive housing (PSH). The project aimed to increase access to healthy foods, improve nutritional literacy, healthy cooking/eating practices, and build community/social connectedness among 140 PSH residents. Validated food-security screening conducted by CHWs identified low or very low food security among 64% of 83 residents who completed the baseline survey, which is similar to rates found in a previous study among formerly homeless populations placed in PSH. Major themes identified through an analysis of resident feedback include (1) lack of needed kitchenware/appliances for food preparation, (2) knowledge gaps on how to purchase and prepare healthier food, (3) positive perceptions of healthy food options, (4) expanded preferences for healthy, easy-to-prepare foods, (5) regaining cooking skills lost during homelessness, (6) positive experiences participating in group activities, (7) community re-entry, and (8) resident ownership. Preliminary findings suggest the use of a human-centered design methodology for planning and implementing this multi-level CHW intervention helped reduce food insecurity, engaged participants in learning and adopting healthy and safe cooking and eating practices, and fostered social connectedness and feelings of community among formerly chronically homeless PSH residents.

Smartphone-delivered multicomponent lifestyle medicine intervention for improving mental health in a nonclinical population: a randomized controlled trial

Objective

To prevent the exacerbation of mental health burdens, a growing body of research has recommended a balanced approach that emphasizes both the delivery of mental health treatments to individuals with common mental disorders (CMDs) and the strengthening of protective factors for CMDs among nonclinical populations. This randomized controlled trial (RCT) evaluated the efficacy of a smartphone-delivered multicomponent lifestyle medicine (LM) intervention, Lifestyle Hub, for improving mental health among a nonclinical population of Chinese adults.

Methods

A total of 106 participants with Patient Health Questionnaire-9 total score < 10 and Generalized Anxiety Disorder 7-Item Scale <8 were randomly assigned to either the Lifestyle Hub intervention group (LH, n = 53) or the waitlist control group (WL, n = 53). Lifestyle Hub is an 8-week smartphone-delivered multicomponent LM intervention developed based on the transtheoretical model. The intervention components included lifestyle psychoeducation, physical activity, diet and nutrition, stress management, sleep management, and motivation and goal-setting techniques. Assessments were conducted at baseline, immediate post-intervention, and 1-month follow-up (LH only).

Results

The linear mixed effect model based on the intention-to-treat principle indicated that Lifestyle Hub significantly improved overall mental health, depressive symptoms, anxiety symptoms, stress, insomnia severity, overall health-promoting behaviors, dietary quality, and stress management compared to the WL group at immediate post-intervention (d = 0.13-0.56). No significant between-group differences were observed in terms of functional impairment, health-related quality of life, health responsibility, physical activity level, spiritual growth, and interpersonal relations. The intervention gains in the LH group were maintained at 1-month follow-up. The LH participants indicated that Lifestyle Hub was an acceptable intervention for improving mental health, although a significantly higher level of study attrition was observed in the LH group (20.8%) relative to the WL group (5.7%).

Conclusion

Lifestyle Hub may serve as an efficacious and acceptable intervention for improving mental health in nonclinical adult populations. To extend the benefits of LM interventions at the population level, future studies are warranted to examine a stepped-care approach to delivering LM interventions.Trial registration: This randomized controlled trial was pre-registered with ClinicalTrials.gov (NCT04295369).

[Climate change, biodiversity loss and pollution: consequences for psychiatry]

The climate crisis, loss of biodiversity and increasing global pollution are a threat to mental health. Comprehensive transformations are needed to overcome these crises, which will also affect the mental healthcare system. If done correctly these change processes can seize the chance to improve mental health while at the same time addressing the crises. This includes avoiding the need for psychiatric treatment by strengthening the focus on mental health promotion and prevention, and also considering environmental aspects when targetting therapy procedures. In addition, by focusing on nutrition, mobility and the effects of nature, patients can be empowered to increase their mental resilience whilst reducing the negative effects on the environment. At the same time, the mental healthcare system must adapt to changing environmental conditions: increasing heat waves make protective measures necessary, especially for people with mental illnesses and increasing extreme weather events can lead to shifts in the spectrum of illnesses. Appropriate funding mechanisms will have to be established to support mental healthcare throughout this transformation.

Disparate discipline faced by black youth: The need for bias mitigation and school nursing impact to promote school connectedness

School connectedness is needed to improve youth mental health. Developing a school connection is more arduous for Black youth with a history of pervasive exclusionary discipline. This narrative review discusses academic and socioemotional consequences of school removals while highlighting disparities for Black youth. A comprehensive literature search was conducted, identifying relevant studies and publications using electronic databases; results from the last ten years were preferable but older references were included if deemed important. Recommendations for elevating the influence of school nursing has been included to help mitigate disparities and racial bias, considering historical discipline trends and rising mental health needs.

Age, Period, and Cohort Trends in Perceived Mental Health Treatment Need and Differences by Mental Health Severity in the United States, 2008-2019

Identifying age, period, and cohort trends in perceived mental health treatment need over time by mental illness severity is important to identify where to focus early intervention efforts. We included adults who did not report receiving past-year mental health treatment in the 2008-2019 National Survey on Drug Use and Health (N = 364,676). Hierarchical age-period-cohort models were used to assess perceived mental health treatment need, adjusting for demographics stratified by mental illness severity (none, any but not severe [AMI], severe [SMI]). Median odds ratios estimated cohort and period variance. Cohort effects explained a significant portion of the variance over time; period effects were minimal. Perceived mental health treatment need was highest among adults with AMI from recent birth cohorts (2000-2002: β = 1.12; 95% CI = 0.96, 1.28). Efforts are needed to address increases in perceived mental health treatment need in younger birth cohorts, such as removing structural barriers (e.g., healthcare system barriers).

Interventions to improve the mental health or mental well-being of migrants and ethnic minority groups in Europe: A scoping review

In Europe, migrants and ethnic minority groups are at greater risk for mental disorders compared to the general population. However, little is known about which interventions improve their mental health and well-being and about their underlying mechanisms that reduce existing mental health inequities. To fill this gap, the aim of this scoping review was to synthesise the available evidence on health promotion, prevention, and non-medical treatment interventions targeting migrants and ethnic minority populations. By mapping and synthesising the findings, including facilitators and barriers for intervention uptake, this scoping review provides valuable insights for developing future interventions. We used the PICo strategy and PRISMA guidelines to select peer-reviewed articles assessing studies on interventions. In total, we included 27 studies and synthesised the results based on the type of intervention, intervention mechanisms and outcomes, and barriers and facilitators to intervention uptake. We found that the selected studies implemented tailored interventions to reach these specific populations who are at risk due to structural inequities such as discrimination and racism, stigma associated with mental health, language barriers, and problems in accessing health care. The majority of interventions showed a positive effect on participants' mental health, indicating the importance of using a tailored approach. We identified three main successful mechanisms for intervention development and implementation: a sound theory-base, systematic adaption to make interventions culturally sensitive and participatory approaches. Moreover, this review indicates the need to holistically address social determinants of health through intersectoral programming to promote and improve mental health among migrants and ethnic minority populations. We identified current shortcomings and knowledge gaps within this field: rigorous intervention studies were scarce, there was a large diversity regarding migrant population groups and few studies evaluated the interventions' (cost-)effectiveness.

Evaluation of a Health Education Intervention to Improve Parental Knowledge and Attitudes About Chronic Stress and Depression Among Head Start Families

Background. Chronic stress and depression disproportionately affect families experiencing poverty, and likely contribute to disparities in early childhood developmental outcomes. Developing strategies to address chronic stress and depression may help mitigate these disparities. Early Head Start (EHS) and Head Start (HS) programs provide an important platform to address the disproportionate burden of stress and mental health issues experienced by EHS/HS families. However, few low-literacy, broad, scalable interventions improve parents' knowledge and attitudes around these topics. Objectives. We examined parents' knowledge and attitudes regarding stress and depression before and after a train-the-trainer (TTT) intervention delivered to 28 EHS/HS agencies across the United States. Methods. Following a TTT workshop, 18 agencies chose to deliver the stress training to 1,089 parents and 5 chose to deliver the depression training to 670 parents. Participating parents completed paper assessments at baseline and 3 months following the training. Paired T-tests and chi-square analyses tested whether responses significantly improved over time. Results. At baseline, 37.2% of parents reported feeling stressed most of the time and 13.4% reported feeling depressed most of the time. Following the trainings and reinforcement activities, parents' knowledge, attitudes and self-reported behaviors significantly improved, including willingness to seek help for depression, avoidance of negative health-risk behaviors and utilization of healthy stress management practices. At follow up, 18.6% of parents reported feeling stressed most of the time and 11% reported feeling depressed. Conclusion. Findings suggest this low-literacy TTT approach is potentially a promising health promotion intervention with broad dissemination potential.

Primary Mental Health Care in a New Era

Clinical experience and scientific studies highlight the pivotal role that primary health care services have and should have as a gateway to the health care system and as a first point of contact for patients with mental disorders, particularly-but not exclusively-for patients with a disorder in the spectrum of common mental disorders [...].

Multi-Sector Assessment and Client-Perception of Social Need at Long-Term Follow-Up of a Group-Randomized Trial of Community-Engaged Collaborative Care for Adults with Depression

Understanding client perceptions of need for underlying social determinant support may improve services for depression care. This secondary analysis examines perceptions of "social needs" related to housing and employment, financial, and legal (EFL) concerns among individuals with depression. Data were analyzed from Community Partners in Care, a randomized comparative effectiveness trial of multi-sector collaborative care for depression among a sample of people who were predominantly racial/ethnic minorities and low-income. Adults with depression (n = 980) in both interventions were surveyed at 36-month follow-up for (1) being asked about and (2) having social needs for housing or EFL concerns. In multivariate models, life difficulty and mental health visits in non-healthcare sectors predicted being asked about housing and EFL. Lower social determinants of health-related life satisfaction increased the odds of having unmet housing and EFL needs. These findings underscore the role of non-healthcare organizations as community resources for depression care and in screening and addressing social needs.

Women Supporting Women: The Use of Art With Anxious/Depressed, Urban, Impoverished, Ethnically Diverse Women

BACKGROUND: Depression and anxiety disproportionately affect urban, ethnically diverse, impoverished women-particularly when access to culturally sensitive care is limited. Using community-based participatory research in the context of long-term, academic/community partnerships, women supporting women, a supportive/educative group intervention piloting an art project, was offered. AIMS: The purpose of this study was to examine the impact of an artist book-making project on diverse women struggling with anxiety and depression. METHODS: A descriptive qualitative approach was used within this mixed-method study. Thirty-one participants, aged 18 to 86 years, were asked: (1) How does this book tell your story? (2) How did creating this book impact you personally? (3) How would you describe the experience of creating your book alongside women from our group? (4) How did this project help you with anxiety and depression? (5) What did you do with the book that you made? The framework method for analysis of qualitative data in multidisciplinary health research was used. RESULTS: Four themes, with corresponding subthemes, were identified: (1) personal story entailed expression of past, present, and future journey and mediums to depict the story; (2) method of coping included relaxation, diversion, and self-care; (3) creative impact encompassed affirmation of identity, empowerment, healing, pride in work, and a vehicle to connect; and (4) creating in community incorporated inspiration, sharing, and solidarity. CONCLUSIONS: These results suggest that an art project provides a culturally sensitive, clinically relevant, and cost-effective self-care intervention for vulnerable women struggling with anxiety and depression.

Human-Computer Interaction in Digital Mental Health

Human-computer interaction (HCI) has contributed to the design and development of some efficient, user-friendly, cost-effective, and adaptable digital mental health solutions. But HCI has not been well-combined into technological developments resulting in quality and safety concerns. Digital platforms and artificial intelligence (AI) have a good potential to improve prediction, identification, coordination, and treatment by mental health care and suicide prevention services. AI is driving web-based and smartphone apps; mostly it is used for self-help and guided cognitive behavioral therapy (CBT) for anxiety and depression. Interactive AI may help real-time screening and treatment in outdated, strained or lacking mental healthcare systems. The barriers for using AI in mental healthcare include accessibility, efficacy, reliability, usability, safety, security, ethics, suitable education and training, and socio-cultural adaptability. Apps, real-time machine learning algorithms, immersive technologies, and digital phenotyping are notable prospects. Generally, there is a need for faster and better human factors in combination with machine interaction and automation, higher levels of effectiveness evaluation and the application of blended, hybrid or stepped care in an adjunct approach. HCI modeling may assist in the design and development of usable applications, and to effectively recognize, acknowledge, and address the inequities of mental health care and suicide prevention and assist in the digital therapeutic alliance.