Social connectedness improves public mental health: Investigating bidirectional relationships in the New Zealand attitudes and values survey

The association of mental health with physical activity and its dimensions in Chinese adults: A cross-sectional study

BACKGROUND

Selecting the most efficient type of physical activity that improves mental health can assist in choosing appropriate interventions. Hence, the objective of this study was to evaluate the associations between physical activity and its various aspects, including weekly physical activity, weekly walking and exercise sessions, and the frequency of walking and exercise per week, with the mental health of Chinese adults.

METHODS

This cross-sectional study was carried out in Hangzhou (2023) involving 512 adults aged 18 and 64. Each participant received a self-completed questionnaire comprising three sections. The initial section focused on gathering basic information about the participants, such as gender, age, annual income, and marital status. The second section consisted of the 12-item General Health Questionnaire (GHQ-12), which aimed to evaluate the mental health status of the participants. Lastly, the third section included the International Physical Activity Questionnaire-Short Version (IPAQ-SV), which assessed the metabolic equivalent (MET) of activities like walking, moderate-intensity exercises, and high-intensity exercises.

RESULTS

The study found that mental health problems affected 25.74% of adults, while physical inactivity was prevalent in 49.63% of adults. The statistical model was highly significant (F = 25.143, p < 0.001), suggesting that at least one predictor has a significant impact on mental health. The model accounted for 39% of the variance in mental health, with all variables showing predictive value. Notably, the number of walking days per week emerged as the most influential predictor of mental health (β = -0.392), followed by level of weekly physical activity in MET, the number of exercise training sessions per week, weekly exercise training in MET, and weekly walking in MET (β = -0.312, -0.301, -0.212, and -0.202, respectively).

CONCLUSIONS

Adults can allocate more days per week to walking and their usual physical activity to improve their mental health.

Evaluating a mobile app's effects on depression and anxiety in medication-treated opioid use disorder

Depression and anxiety frequently co-occur with opioid use disorder (OUD) yet are often overlooked in standard OUD treatments. This study evaluated the feasibility, acceptability, and preliminary effectiveness of a mobile application designed to address these symptoms in individuals receiving medications for OUD (MOUD). A randomized controlled trial recruited N = 63 adults with OUD who received MOUD and screened positive for moderate depression or generalized anxiety. Participants were randomized to an app-based digital intervention or treatment-as-usual for 4 weeks, and completed follow-ups at 4 and 8 weeks. Primary outcomes were self-reported severity measures for depression and generalized anxiety, and urine drug screens (UDS). Secondary outcomes included self-reported OUD severity, craving intensity, and digital biomarkers derived from passive smartphone sensors. The application was well-received (median app rating = 4/5 stars). The intervention group showed significant reductions in depressive and generalized anxiety symptoms post-intervention and at 8 weeks follow-up (d > 0.70), with large (d = 0.78) and moderate (d = 0.38) effect sizes, respectively, compared to controls. Both groups exhibited substantial decreases in self-reported severity of opioid use symptoms (d > 2.50). UDS suggested similar between-group adherence to MOUD, with a marginal decrease in opioid (MOP) use in the intervention group and increase in controls, yielding medium between group effect sizes (d = 0.44). Passive sensor data suggested significant increases in social connectedness in the intervention group, evidenced by a significant rise in incoming and outgoing calls and text connections. Initial evidence supports the feasibility and acceptability of a digital intervention for treating anxiety and depressive symptoms in persons receiving MOUD. While underpowered to confidently determine statistical significance beyond directionality, the intervention showed promise in reducing depressive and anxiety symptoms, suggesting its potential as a cost-effective and scalable adjunctive therapy alongside standard OUD treatment. Due to the preliminary nature of this pilot study, further research with sample sizes permitting greater statistical power is needed to confirm findings and explore long-term effects.

Global Research on Pandemics or Epidemics and Mental Health: A Natural Language Processing Study

BACKGROUND

The global research on pandemics or epidemics and mental health has been growing exponentially recently, which cannot be integrated through traditional systematic review. Our study aims to systematically synthesize the evidence using natural language processing (NLP) techniques.

METHODS

Multiple databases were searched using titles, abstracts, and keywords. We systematically identified relevant literature published prior to Dec 31, 2023, using NLP techniques such as text classification, topic modelling and geoparsing methods. Relevant articles were categorized by content, date, and geographic location, outputting evidence heat maps, geographical maps, and narrative synthesis of trends in related publications.

RESULTS

Our NLP analysis identified 77,915 studies in the area of pandemics or epidemics and mental health published before Dec 31, 2023. The Covid pandemic was the most common, followed by SARS and HIV/AIDS; Anxiety and stress were the most frequently studied mental health outcomes; Social support and healthcare were the most common way of coping. Geographically, the evidence base was dominated by studies from high-income countries, with scant evidence from low-income counties. Co-occurrence of pandemics or epidemics and fear, depression, stress was common. Anxiety was one of the three most common topics in all continents except North America.

CONCLUSION

Our findings suggest the importance and feasibility of using NLP to comprehensively map pandemics or epidemics and mental health in the age of big literature. The review identifies clear themes for future clinical and public health research, and is critical for designing evidence-based approaches to reduce the negative mental health impacts of pandemics or epidemics.

Individual and Interactive Effects of Housing and Neighborhood Quality on Mental Health in Hong Kong: A Retrospective Cohort Study

Existing literature has widely explored the individual roles of housing and neighborhood quality, and there is limited research examining their interactive effects on mental health. This 3-year cohort study utilized a longitudinal design to investigate the individual and interactive effects of housing and neighborhood quality on mental health among 962 community-dwelling adults in Hong Kong. Participants were asked to rate their residential qualities over the 3-year period. Mental health outcomes, including levels of psychological distress and common mental disorders (CMD), were assessed using the Revised Clinical Interview Schedule (CIS-R). Logistic regression and generalized linear models were used to examine the association between housing and neighborhood quality and CMD/psychological distress, adjusting for sociodemographic and residential characteristics and baseline mental disorders. Housing quality was associated with the 3-year CMD (adjusted OR 0.95; 95% CI 0.91 to 0.98). Likewise, neighborhood quality was associated with CMD over 3 years (adjusted OR 0.92; 95% CI 0.87 to 0.96). In a separate model including both quality measures, the effect of housing quality on CMD was attenuated, whereas the neighborhood impact remained significant (adjusted OR 0.92; 95% CI 0.87 to 0.98). Generalized linear models indicated that for participants residing in substandard housing, those with high neighborhood quality had lower CIS-R scores at follow-up compared to those with low neighborhood quality (p = 0.041). Better neighborhood quality alleviated the detrimental effects of poor housing quality on mental health. Planning for an enhanced neighborhood would improve population mental health in an urban environment.

Assessment of Social Connection among Autistic and Non-Autistic Adults: A Proof of Concept Study for the Connections with Others Scales

BACKGROUND

A gap exists in measures available to assess levels of motivation, desire, and value associated with connecting with others. Moreover, few social connection scales have been developed with a goal of including autistic individuals in the sample to create a measure that has utility across neurodiverse populations. This study aims to develop a measure to assess different facets of social connection that is valid among both autistic and non-autistic adults.

METHODS

The sample consisted of 200 participants recruited online. Participants completed an initial set of 35 items. Exploratory factor analyses and confirmatory factor analyses were performed. Four-factor models were produced by the EFAs.

RESULTS

Item reduction resulted in the development of two 8-item scales: the Connections with Others Scale (CWOS) intended for the general population and the CWOS-Autistic Version (CWOS-AV) intended for autistic populations (CWOS-AV). Autistic participants had significantly greater motivation/desire to connect with others compared to non-autistic participants (t(195) = 3.39; p < 0.001).

CONCLUSIONS

These measures will allow for greater ability to assess the motivation to connect with others, resulting in improved ability to produce research that clarifies theories and describes psychological phenomena.

Factors Influencing Social Isolation among Cancer Patients: A Systematic Review

(1) Background: Social isolation, which has numerous adverse effects on health status, is prevalent among cancer patients. This review proposes to identify the influencing factors of social isolation among cancer patients. (2) Methods: Articles published in English or Chinese from six electronic databases before December 2023 were identified via a systematic search. A manual search was also performed. (3) Results: Twenty-eight studies were identified in this systematic review. The factors associated with social isolation can be summarized into the following categories: demographic characteristics, having cancer, health status, coping, social support and social interaction. Despite the heterogeneity, 20 factors were significantly associated with social isolation, including age, gender, comorbidity burden, education level, residence, medical insurance, occupation status, personality, race, smoking status, having children, not living alone, household income level, marital status, the role of primary caregiver, physical health status, mental health status, social health status, coping styles, and the level of social support and social interaction. (4) Conclusions: The systematic review showed that cancer patients' social isolation was influenced by their demographic characteristics, cancer-related factors, physical condition, psychological status, social health status, coping styles, and level of social support and social interaction. In addition, future group intervention could be considered to improve social isolation.

Influence of yogic breathing in increasing social connectedness among Indian adults

BACKGROUND

Loneliness is quickly becoming an enormous problem among individuals of all age groups. The onset of Covid-19 has worsened this situation. Therefore, there is urgent need for a practical intervention, which may improve the social well-being of an individual addressing the root cause of loneliness.

AIM

In this study we examine the benefits of Sudarshan Kriya Yoga (SKY), a yogic breathing practice to enhance social connectedness among individuals by reducing stress.

METHODOLOGY

473 participants registering for the SKY program enrolled in the current open feasible trial. Assessment of social connectedness was done using Social Connectedness Scale (SCS). Stress was measured using the Perceived Stress Scale (PSS) pre- and post- SKY intervention. Outcomes were measured at three different time points namely, baseline (pre-program), post-program, and day 40. Day 40 was 40 days after the completion of the Sudarshan Kriya program.

RESULTS

Significant increase in SCS scores (p value <0.001) was found immediately after the SKY intervention. The SCS scores improved positively with regular practice of the intervention with a large effect size (p value <0.001, measured on day 40). The Stress scores significantly reduced post-intervention (p value <0.001).

CONCLUSION

The study suggested a positive connection between the SKY practice and subsequent improvement in social connectedness. The reduction in stress levels post SKY program as indicated in the study may be a reason of enhanced social connectedness. Large scale studies with inclusion of control group can further affirm the study results.

Childhood emotional maltreatment and sensitivity to social rejection in emerging adults

BACKGROUND

Enhanced responsiveness to social rejection may be a transdiagnostic mechanism through which childhood emotional maltreatment predisposes individuals to interpersonal and mental health problems. To investigate this mechanism, as a first step, more detailed investigations are needed regarding the assumed association of childhood emotional maltreatment with rejection sensitivity in later life.

OBJECTIVE

The present work examines the hypothesis that among different subtypes of childhood maltreatment, in particular forms of emotional maltreatment (emotional abuse and neglect) relate to rejection sensitivity in emerging adults.

PARTICIPANTS AND SETTING

In study 1, 311 emerging adults (18-25 years) participated in a retrospective cross-sectional assessment. In study 2, 78 emerging adults (18-25 years) were included in an experiment (O-Cam paradigm) which involved the experience of social rejection (vs. inclusion).

METHODS

Study 1 investigates whether intensities of childhood emotional abuse and neglect have unique associations with trait rejection sensitivity, when considering all maltreatment subtypes (emotional abuse, sexual abuse, physical abuse, emotional neglect, physical neglect) simultaneously. Study 2 examined whether childhood emotional abuse and neglect moderate the experience of social rejection in terms of need depletion, sadness and anger after social rejection (vs. inclusion).

RESULTS

Study 1 indicates that emotional abuse and neglect have unique associations with rejection sensitivity. Study 2 results show that only a higher intensity of emotional abuse has extensive effects on need depletion and sadness after social rejection (vs. inclusion).

CONCLUSIONS

In particular, experiences of childhood emotional abuse may relate to rejection sensitivity in young adulthood.

Loneliness, belonging and psychosomatic complaints across late adolescence and young adulthood: a Swedish cohort study

BACKGROUND

Loneliness and belonging refer to social connectedness and are associated with young people's health; however, the relationship between these constructs and their impact on health is still being discussed. A dual continuum model of belonging and loneliness has been suggested, consisting of four groups depending on the state of loneliness and belonging: socially fulfilled (low loneliness, high belonging), socially indifferent (low loneliness, low belonging), socially searching (high loneliness, high belonging), and socially distressed (high loneliness, low belonging). The aim of this study is to examine loneliness and belonging in a Swedish sample of 17-18-years-olds who were followed over 3 years, and the associations that these aspects share with young people's psychosomatic complaints during these ages.

METHODS

Swedish cohort data collected among late adolescents (age 17-18 in 2019) who were followed up in young adulthood (age 20-21 in 2022) (n = 2684) was used to examine the associations between loneliness, belonging, and psychosomatic complaints. Loneliness and belonging were measured by single items and the cross-combinations of these. Three psychosomatic complaints were assessed: stomach ache, headache, and difficulties falling asleep, and a summary index was calculated.

RESULTS

Linear regression analyses showed that loneliness was positively and belonging was negatively cross-sectionally associated with psychosomatic complaints. The socially fulfilled group reported fewer psychosomatic complaints compared to all other groups, while the socially distressed group reported the highest level of psychosomatic complaints. Additional adjustment for sociodemographic characteristics barely affected the estimates. The prospective analysis supported these patterns; however, after adjustment for earlier psychosomatic complaints, the only statistically significant difference in subsequent psychosomatic complaints was found between the socially fulfilled and the socially distressed groups.

CONCLUSIONS

Loneliness and belonging (separately and the cross-combinations of these) were cross-sectionally associated with psychosomatic complaints in late adolescence and in young adulthood. Prospectively, only the most vulnerable group in the dual continuum model, the socially distressed group, experienced more psychosomatic complaints than the socially fulfilled group, indicating a temporal relationship. Knowledge about the more nuanced links may be useful for developing specific public health recommendations and interventions for youth, targeting the most vulnerable groups.

Self-quarantining, social distancing, and mental health during the COVID-19 pandemic: A multi wave, longitudinal investigation

Social isolation and disconnectedness increase the risk of worse mental health, which might suggest that preventive health measures (i.e., self-quarantining, social distancing) negatively affect mental health. This longitudinal study examined relations of self-quarantining and social distancing with mental health during the COVID-19 pandemic. A U.S. national sample (N = 1,011) completed eight weekly online surveys from March 20, 2020 to May 17, 2020. Surveys assessed self-quarantining, social distancing, anxiety, and depression. Fixed-effect autoregressive cross-lagged models provided a good fit to the data, allowing for disaggregation of between-person and within-person effects. Significant between-person effects suggested those who engaged in more self-quarantining and social distancing had higher anxiety and depression compared to those who engaged in less social distancing and quarantining. Significant within-person effects indicated those who engaged in greater social distancing for a given week experienced higher anxiety and depression that week. However, there was no support for self-quarantining or social distancing as prospective predictors of mental health, or vice versa. Findings suggest a relationship between mental health and both self-quarantining and social distancing, but further longitudinal research is required to understand the prospective nature of this relationship and identify third variables that may explain these associations.

Mediating role of social skills in the longitudinal relationship between intrapersonal perfectionism and psychological well-being of preadolescents

Intrapersonal perfectionism is the dispositional tendency to impose perfectionistic expectations on oneself and is considered a bidimensional construct that consists of standards perfectionism and discrepancy perfectionism. Although scholars established the links between standards perfectionism and psychological adjustment and between discrepancy perfectionism and psychopathology, the mechanisms that explain these associations remain relatively unknown. Thus, a better understanding of these mechanisms, especially in children, is warranted given their high prevalence in this developmental population and potential destructiveness on psychological well-being. The present study examined whether social skills with peers mediated the link between the dimensions of interpersonal perfectionism and psychological outcomes due to the salience of social skills acquisition in middle childhood. The study included 225 students (nfemale = 114; nmale = 111) with ages ranging from 7 to 10 years at Time 1 (T1; Mage = 8.55, SD = 1.15) and from 8 to 11 years at Time 2 (T2; Mage = 9.52, SD = 1.10). Participants provided responses on measures concerning standards perfectionism, discrepancy perfectionism, social skills, and psychological well-being at both time points. Longitudinal structural equation modeling indicated that standards perfectionism was positively associated with increases in social skills over time and psychological well-being, whereas discrepancy perfectionism was linked with decreases in social skills over time followed by psychological maladjustment. The study discusses implications for interventions and treatments.

A mixed methods systematic review of mental health self-care strategies for Arabic-speaking refugees and migrants

BACKGROUND

Self-care strategies can improve mental health and wellbeing, however, the evidence on preferred strategies among Arabic-speaking refugees and migrants is unclear. This mixed methods systematic review aimed to identify and synthesise the global research on mental health self-care strategies used by these populations.

METHODS

English and Arabic language studies reporting on positive mental health self-care strategies to address symptoms of posttraumatic stress disorder, generalised anxiety and depression in the target populations were identified by systematically searching eight electronic databases and grey literature. Studies were deemed eligible if they were published from 2000 onwards and included Arabic-speaking migrants, refugees or asylum seekers aged 12 years and above. A narrative synthesis of study characteristics and relevant key findings was undertaken. The review protocol was registered on PROSPERO (registration number CRD42021265456).

RESULTS

Fifty-nine records reporting 57 studies were identified, the majority appearing after 2019. There were 37 intervention studies that incorporated a self-care component and 20 observational studies that reported on self-generated self-care practices. Across both study types, four broad groups of mental health self-care were identified-social, psychological, religious/spiritual, and other (e.g., expressive arts and exercise). Psychological strategies were the most reported self-care practice overall and featured in all intervention studies. Religious/spiritual and social strategies were more common in the observational studies. Intervention studies in diverse settings reported statistical improvements on a range of outcome measures. Observational studies reported a range of individual and community benefits. Linguistic, cultural and religious considerations, inherent in the observational studies, were variably addressed in the individual and group interventions.

CONCLUSION

Overall, study participants experienced self-care as helpful although some encountered challenges in practicing their preferred strategies. Further research on mental health self-care strategies among Arabic-speaking refugees and migrants is needed in Western resettlement countries to guide mental health service delivery and primary healthcare initiatives for new arrivals and in transit countries.

Estimating bidirectional effects between social connectedness and mental health in adolescent students: Addressing biases due to endogeneity

Research on the bidirectional relationship between social connectedness and health/mental health in adolescents is scarce, with most studies on adults. Some of the existing studies exploited the availability of longitudinal data to provide evidence of the existence of a causal relationship, either from social connectedness to health or establish a bidirectional relationship. There are at least two weaknesses associated with earlier research to assess the size of the effects. As acknowledged in the literature, one relates to attributing causality to empirical findings, due to well-known but inadequately addressed endogeneity biases. The other relates to failure to account for potentially important covariates, sometimes due to data limitations, or because such variables are not frequently used in sociological research. Existing research predominantly finds that the strongest path is from social connectedness to health/mental health, with effect estimates modest in size. I followed a quasi-experimental strategy by modelling adolescent students' perceptions of social connectedness and mental health perceptions as potentially endogenous variables when estimating bidirectional effects. An instrumental variables (IV) modelling approach was followed, supplemented with a recently developed alternative approach to testing the exclusion restrictions of individual instruments. I exploited the rich information available in the PISA 2018 multi-country dataset, which allows for conditioning for a wide array of information on adolescent students' personal circumstances, self-reported personality-related attributes, relationships with parents; and school characteristics. I found that (1) accounting for endogeneity biases is important; and (2) as opposed to findings reported in the literature, the dominant effect is from mental health perceptions to social connectedness for both male and female participants. The policy relevance of the findings is that adolescent mental health should be the primary focus of interventions, i.e., identifying and treating mental health symptoms as a primary intervention and as a precursor to improving the social connectedness of adolescents.

The effectiveness of community friendship groups on participant social and mental health: a meta-analysis

Introduction

Social disconnectedness and isolation are risk factors for poor mental health. Community-based friendship group interventions have been designed to increase an individual's social capital and consequently their mental wellbeing. Structured and unstructured friendship groups reflect two distinct approaches to friendship group interventions.

Methods

This meta-analysis investigated whether structured or unstructured community friendship groups are more effective for mental health and social capital outcomes. A systematic search of quantitative studies was conducted across seven databases and study quality was assessed using the Effective Public Health Practice Project (EPHPP) tool. Eight studies (2 unstructured and 6 structured friendship groups) were included in the review, published between 2005 and 2020.

Results

Structured friendship groups had a small significant effect on reducing participant depression symptoms. There was not enough available data to compare the effectiveness of structured and unstructured groups for mental health outcomes. There was substantial heterogeneity between studies to calculate pooled effect sizes for any social capital outcomes. Data synthesis indicated mixed reviews for social capital outcomes, likely due to the large heterogeneity and limited studies.

Discussion

This meta-analysis provides limited support for positive mental health outcomes following structured community-based friendship group interventions. There is a need for additional research as a large research gap remains, particularly for unstructured friendship groups.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=260639, CRD42021260639.

Understanding joy amongst older people: A scoping review

To date there has been little focus on the concept of joy amongst older people in the literature. The objective of this scoping review was to understand the extent and type of evidence about joy and older people. Searches were run in ten databases in January 2022 (re-run January 2023). Eligible studies included people aged 65 and over living in their usual place of residence and described the experience or evaluation of joy. Screening was conducted independently by two reviewers and data were extracted by one reviewer and checked by a second. We included 11 papers reporting both qualitative (n = 5) and quantitative (n = 6) studies involving 1,487 participants with a mean age of 81.6 years. Seven of the studies were based in care or nursing homes with four in community settings. Five studies reported the experience of joy, three reported on the assessment of joy, and three examined the association between joy and other factors. Social connections and participation in activities that are meaningful to the individual are important sources of joy. Joy amongst older people has received little attention in the literature despite it being highlighted as being important to older people themselves in relation to their health and wellbeing.

Effects of person-centred planning and practices on the health and well-being of adults with intellectual and developmental disabilities: a multilevel analysis of linked administrative and survey data

BACKGROUND

A person-centred service planning and practice approach (PCP) is one that is driven by service users' individual preferences, needs and priorities. The approach has been identified as a best practice and is codified in US policies that encourage and, in some contexts, require state systems of home and community-based services to adopt and demonstrate person-centred practice. However, there is insufficient research on PCP's direct impact on outcomes for service users. This study aims to contribute to the evidence base in this area by investigating the association between service experiences and outcomes of adults with intellectual and developmental disabilities (IDD) receiving state-funded services.

METHODS

The data for the study come from the 2018-2019 National Core Indicators® In-Person Survey that links survey responses with administrative records for a sample of 22 000 adults with IDD receiving services from 37 state developmental disabilities (DD) systems. Associations among service experiences and outcomes of survey participants are examined through multilevel regression techniques that include participant-level responses and state-level measures of PCP. The state-level measures are constructed by combining administrative records describing participants' service plans with the priorities and goals they expressed in response to the survey.

RESULTS

Case managers' (CM) accessibility and attentiveness to individual preferences, as reported by survey participants, are significantly associated with self-reported outcomes such as perceived control over life decisions and sense of health and well-being. Controlling for participants' experiences with their CMs, their reports of the person-centred content of their service plans have net positive associations with outcomes. After accounting for experiences with the service system as reported by participants, the state system's person-centred orientation, measured by the extent to which service plans across the state reflect participants' wishes for improving their social connections, remains a significant predictor of participants' sense of control over their daily lives.

CONCLUSIONS

This study contributes to the evidence base supporting PCP as a service model by identifying pathways that link person-centred service planning and delivery and person-centred orientation of state systems to positive outcomes reported by adults with IDD and by demonstrating the value of linking survey and administrative data. The key implication of the findings for policy and practice is that an overall person-centred orientation of state DD systems as well as PCP training for people who support planning for and delivery of direct supports will substantially improve the lives of adults with IDD.

The Distinction Between Social Connectedness and Support When Examining Depressive Symptoms Among Children and Adolescents During the COVID-19 Pandemic

Childhood depression is associated with significant social and functional impairment, suicide risk, and persistence throughout adulthood. Recent evidence demonstrates that social connectedness and social support may serve as protective factors against the development of depression. The current study aimed to examine the effect of change in social connectedness and social support on depressive symptoms among children and adolescents during the COVID-19 pandemic. Hierarchical regression was performed. Results indicated that parent-reported measures of change in social connectedness were inversely associated with depressive symptom severity, and could significantly predict future depressive symptom severity. In contrast, parent-reported measures of social support (i.e., from family and friends) did not significantly predict future depressive symptom severity. The presence of a pre-COVID psychiatric and/or neurodevelopmental diagnosis and baseline depressive symptom severity were also important factors associated with future depressive symptom severity. The findings suggest that an awareness of the presence of social supports (i.e., family or friends) is not sufficient for children to feel connected, but rather the mechanisms of social relationships are crucial. As our approach to public health restrictions evolves, the risk transmission of COVID-19 should be carefully balanced with the risks associated with decreased connectedness among youth.

Review: Interventions addressing loneliness amongst university students: a systematic review

BACKGROUND

Loneliness is detrimental to mental health, with university students at higher risk of feeling lonely than other population groups. However, little research has explored interventions to reduce loneliness among students. This review identifies the characteristics and effectiveness of interventions targeting university/college students.

METHODS

PsycINFO, Medline, ASSIA and Web of Science were searched from inception using keywords linked to 'loneliness', 'intervention' and 'students'. Relevant peer and nonpeer-reviewed English-language articles on studies implementing an intervention with loneliness as an outcome and investigating undergraduate or postgraduate students at a higher education institution were included for quality analysis and narrative synthesis. Risk of bias was assessed at both study level and at outcome level.

RESULTS

Twenty-eight articles were included, comprising 25 quantitative and three qualitative studies, covering 37 interventions, most implemented in the United States. Interventions were based on psychoeducation, social support groups, increasing social interaction or reflective exercises. The age of the participants (n = 2339) ranged from 17.62 to 25 (mean age 20.63) years. Evidence from the RCTs suggests that most interventions influenced loneliness outcomes, but the magnitude of the benefit is unclear. Across quantitative studies, 80% (16/20) of interventions based on either social support groups, increasing social interaction or reflective exercises, and 50% (7/14) of interventions based on psychoeducation were deemed effective in reducing loneliness. Most interventions measured quantitatively were delivered in a group setting, of which two thirds were considered effective in reducing loneliness scores, regardless of intervention.

CONCLUSIONS

Universities have a choice of interventions to help reduce loneliness among students either on campus or virtually. Ones promoting social connectedness appear to be more successful. More high-quality studies in a larger number of countries are needed, taking vulnerable student groups into consideration.

Longitudinal associations between mental health and social environment in older adults: a multilevel growth modeling

OBJECTIVES

This study aimed to assess longitudinal relationships between social environment indicators (social connectedness, social engagement, social contribution) and mental health indicators (depression and anxiety) among community-dwelling adults age 55 years and older.

METHODS

Data were drawn from 3-waves of the national longitudinal survey of Midlife Development in the United States (MIDUS) (N = 2,020; age range = 55-94 years). We developed multilevel growth models to ascertain the relationships of interest, controlling for sociodemographic and physical health factors.

RESULTS

Over the 20-year period of study, lower levels of emotional social support, social integration and social contribution significantly predicted depression and anxiety, whereas social network and social engagement were not significant predictors of these mental health outcomes in older adults. The models also indicated a moderation effect of the number of chronic conditions on the slopes of depression and anxiety.

DISCUSSION

Considering our findings, interventions to enhance social contribution and social connectedness could be effective to help older adults maintain positive mental health, as well as programs that facilitate older adults' connections with their families, communities and health care providers. These interventions must also account for multiple chronic conditions since functional limitations drive declining integration in the community and participation in social activities.

Social connectedness and mental health before and during the COVID-19 pandemic in a community sample in Korea

This study compared social connectedness patterns and examined the relationships between objective or subjective social connectedness and mental health before and during the COVID-19 pandemic among community dwelling adults in South Korea. An identical online survey was administered at two time points, in 2019 prior to the onset and again in 2021. Objective (network diversity and network size) and subjective (thwarted belongingness and perceived burdensomeness) social connectedness were measured along with positive and negative indices of mental health (depression, suicidal behavior, happiness, and life satisfaction). The results indicated that among social connectedness indices perceived burdensomeness were significantly higher during the COVID-19 pandemic compared to the prior period, while network size was smaller. Subjective social connectedness was associated with all aspects of mental health consequences, either positive or negative. Among objective social connectedness, only network diversity was significantly associated with increased happiness and life satisfaction, and objective social connectedness was not associated with depression and suicidal behavior. These associations did not differ across the two time periods. The findings, both before and during the pandemic, indicated that network diversity is an important factor for positive indices of mental health and that efforts to increase subjective social connectedness are needed to decrease the risk of depression and suicidal behavior.

Disciplinary differences in the study of the relationship between social variables and mental health: A systematic mapping review

There has been sustained interest in the intersection between social constructs and mental health from diverse disciplines including psychiatry, sociology and public health. However, no systematic attempt has been made to catalogue what is meant by 'social' by different researchers, how variables deemed 'social' constructs are linked to mental health, nor whether these patterns differ by academic discipline. Understanding interdisciplinary differences and commonalities may reveal opportunities for interdisciplinary collaboration to enhance our understanding of how social factors relate to mental health. This article presents a prospectively registered systematic map of social approaches to mental health using an innovative synthesis methodology (coding all sentences from a random selection of N = 287 articles). Results indicated that although approaches are diverse, disciplinary overlap is substantial. Psychology and psychiatry led articles tend to focus on social skills or emotions as features of mental (ill-)health, while public health and social sciences led articles tend to focus on social relationships, status or context as determinants of mental (ill-)health. Medicine led articles were most likely to focus on social outcomes of mental (ill-)health. Potential growth areas are noted, particularly the relative dearth of intervention research drawing upon social approaches. The findings are discussed with a view towards enabling more effective interdisciplinary collaboration.

Depressive symptoms and social support among Australian men: A 7-year longitudinal study

BACKGROUND

Mental health disorders are ranked globally as the single largest contributor to non-fatal ill-health. Social support can be a means of reducing and managing depression. However, depression can also impact on a person's level of social support.

OBJECTIVE

As men typically have fewer sources of social support than females, this study investigated the bi-directional associations between depressive symptoms and perceived levels of social support among Australian males, aged 18-63.

METHODS

Three waves of panel data from Ten to Men: The Australian Longitudinal Study on Male Health collected over 7 years (2013-2020) were used. A random intercept cross-lagged panel analysis with 5112 participants was undertaken. Mediating effects and indirect and total effects for lagged and cross-lagged pathways were also examined.

RESULTS

Over time, greater social support was found to be associated with lower depression levels, and simultaneously greater levels of depression was found to be associated with lower levels of social support. Standardised cross-lagged effects between waves were mostly similar (β = 0.10). However, mediation analyses identified that only the total effect size of the association for depression at wave 1 predicting social support at wave 3 (β = -0.29) was significant. Mediated effects of social support at wave 1 predicting depression at wave 3 were not significant.

LIMITATIONS

These include the number of years between each wave, and data were collected during the COVID pandemic.

CONCLUSION

The study provides robust longitudinal evidence supporting the notion that social support and depression are both a cause and consequence of the other. However, the long-term effects of depression reducing social support were longer lasting than the effects of social support reducing depression.

Social connectedness and health-related quality of life among patients with cancer undergoing chemotherapy: A mixed method approach using structural equation modelling and photo-elicitation

OBJECTIVE

To develop and test the model of association of social connectedness and health-related quality of life (HRQoL) among patients with cancer undergoing chemotherapy and to describe their social connectedness through photo-elicitation.

BACKGROUND

Social connectedness has been empirically associated with several well-being outcomes. However, little is known on the association of social connectedness among patients with cancer undergoing chemotherapy.

METHODS

Employing a mixed-methods design following the good reporting of a mixed methods study guideline, the quantitative approach involved 230 consecutively-selected patients with cancer undergoing chemotherapy who answered a three-part survey. From these patients, six informants participated in the photo-elicitation and key informant interview sessions. Gathered data were quantitatively analyzed using structural equation modelling and qualitatively processed using polytextual thematic analysis.

RESULTS AND FINDINGS

Social connectedness had a positive influence on social well-being (β = .22, p = .008) and emotional well-being (β = .20, p = .023); however, it had a negative effect on functional well-being (β = -.20, p = .007). The overall model revealed good model indices: χ2 /df = .82, RMSEA = .01, GFI = 1.00. Qualitative analysis culled from photo-elicitation uncovered five interconnected themes yielding the Honeycomb model of social connectedness which was composed of correspondence, cohesion, constitution, convergence and corroboration.

CONCLUSION

HRQoL among patients with cancer undergoing chemotherapy is a multi-factorial health construct affected by social connectedness. The presented model emphasises the importance of social connectedness and paves way for the development of appropriate strategies to promote social connectedness among patients with cancer undergoing chemotherapy.

RELEVANCE TO CLINICAL PRACTICE

The findings provide impetus in the modification and development of appropriate practices, policies and strategies in promoting social connectedness. These approaches are geared towards patient-family empowerment and health education techniques to ascertain that assistance from significant others is provided without limiting the patient's autonomy or independence.

Study protocol for the Mindful Moms Study: A randomized controlled trial evaluating a mindful movement intervention for marginalized pregnant people experiencing depression

More than 1 in 5 pregnant people in the United States experience depressive symptoms. Although treatments exist, many people remain under- or un-treated due to concerns about stigma, side effects, and costs of medications or psychotherapy, particularly those who are marginalized (defined as those who are minoritized, low-income, or with low-educational attainment). Further, the standard depression treatments do not address social connectedness, which is a potentially modifiable factor involved in depressive symptom etiology. This protocol presents the rationale, design, and status of the two-arm longitudinal parallel group randomized controlled trial - the Mindful Moms Study - which aims to evaluate the effects and mechanisms of a group-based mindful physical activity (yoga) intervention in marginalized pregnant people with depressive symptoms (n = 200) compared to a prenatal education control group. The primary aim is to evaluate effects of group assignment on depressive symptom severity, anxiety, and perceived stress over time from baseline to six weeks postpartum. Secondary aims include understanding the role of social connectedness as a moderator of the effects and to identify genome-wide DNA methylation patterns associated with depressive symptoms and perceived social connectedness at postpartum. A focus on adequate symptom management through non-pharmacologic, accessible therapies that address social connectedness during pregnancy in marginalized women is an urgent clinical and research priority. The successful completion of this study will provide important insights into social connectedness as a mechanism to decrease depressive symptoms in a largely understudied population. Trial registration: NCT04886856.

The mediating role of social connectedness and hope in the relationship between group membership continuity and mental health problems in vulnerable young people

BACKGROUND

There is growing evidence of a beneficial effect of social group processes on well-being and mental health.

AIMS

To investigate the role of group membership continuity in reducing mental ill-health among young people who were already vulnerable pre-pandemic, and to understand the social and psychological mechanisms of the benefits of group memberships for vulnerable young people.

METHOD

This study takes a cross-sectional design, using survey data from a sample of 105 young people aged 16-35 years, collected approximately 1 year after the global COVID-19 outbreak (January to July 2021). Correlational and path analyses were used to test the associations between group membership continuity and mental health problems (depression, anxiety, psychotic-like experiences) and the mediation of these associations by hope and social connectedness (in-person and online). To correct for multiple testing, the Benjamini-Hochberg procedure was implemented for all analyses. Indirect effects were assessed with coverage of 99% confidence intervals.

RESULTS

Multiple prior group memberships were associated with preservation of group memberships during the COVID-19 pandemic. In-person social connectedness, online social connectedness and hope mediated the relationship between group membership continuity and mental health problem symptoms.

CONCLUSIONS

The results suggest that clinical and public health practice should support vulnerable young people to foster and maintain their social group memberships, hopefulness and perceived sense of social connectedness as means of helping to prevent exacerbation of symptoms and promote recovery of mental health problems, particularly during significant life events.

Examining the Influence of Exploration and Parental Education Attainment on Students' Acceptance of Collectivist Values

Exploration can help students access a wider range of information and make connections among values within the natural and social world. This study investigated the relationship between students' previous exploration of their surroundings and their acceptance of collectivist values in the context of China. A sample of 343 college students was analyzed based on the Bayesian Mindsponge Framework to explore this relationship. The results revealed a positive association between students' prior exploration of surroundings and their degree of collectivist orientation. Furthermore, parental education attainment was found to negatively moderate this association, albeit with a small effect size. These findings contribute to the understanding of how information acquisition influences students' acceptance of collectivist values and highlight the potential role of the family infosphere in shaping this relationship.

Exploring the Impact of Social Media on Anxiety Among University Students in the United Kingdom: Qualitative Study

BACKGROUND

The rapid surge in social media platforms has significant implications for users' mental health, particularly anxiety. In the case of social media, the impact on mental well-being has been highlighted by multiple stakeholders as a cause for concern. However, there has been limited research into how the association between social media and anxiety arises, specifically among university students-the generation that has seen the introduction and evolution of social media, and currently lives through the medium. Extant systematic literature reviews within this area of research have not yet focused on university students or anxiety, rather predominantly investigating adolescents or generalized mental health symptoms and disorders. Furthermore, there is little to no qualitative data exploring the association between social media and anxiety among university students.

OBJECTIVE

The purpose of this study is to conduct a systematic literature review of the existing literature and a qualitative study that aims to develop foundational knowledge around the association of social media and anxiety among university students and enhance extant knowledge and theory.

METHODS

A total of 29 semistructured interviews were conducted, comprising 19 male students (65.5%) and 10 female students (34.5%) with a mean age of 21.5 years. All students were undergraduates from 6 universities across the United Kingdom, with most students studying in London (89.7%). Participants were enrolled through a homogenous purposive sampling technique via social media channels, word of mouth, and university faculties. Recruitment was suspended at the point of data saturation. Participants were eligible for the study if they were university students in the United Kingdom and users of social media.

RESULTS

Thematic analysis resulted in 8 second-order themes: 3 mediating factors that decrease anxiety levels and 5 factors that increase anxiety levels. Social media decreased anxiety through positive experiences, social connectivity, and escapism. Social media increased anxiety through stress, comparison, fear of missing out, negative experiences, and procrastination.

CONCLUSIONS

This qualitative study sheds critical light on how university students perceive how social media affects their anxiety levels. Students revealed that social media did impact their anxiety levels and considered it an important factor in their mental health. Thus, it is essential to educate stakeholders, including students, university counselors, and health care professionals, about the potential impact of social media on students' anxiety levels. Since anxiety is a multifactorial condition, pinpointing the main stressors in a person's life, such as social media use, may help manage these patients more effectively. The current research highlights that there are also many benefits to social media, and uncovering these may help in producing more holistic management plans for anxiety, reflective of the students' social media usage.

Comparing the effects of reduced social contact on psychosocial wellbeing before and during the COVID-19 pandemic: a longitudinal survey from two Norwegian counties

PURPOSE

To determine changes to people's social contact during COVID-19, and whether reduced social contact was associated with changes to psychosocial wellbeing.

METHODS

Questionnaire data were collected from a sample of adult respondents (18 years or more) in two Norwegian counties participating pre-COVID-19 (September 2019-February 2020; n = 20,196) and at two time points during COVID-19 (June [Mid] and November/December [Late] 2020; n = 11,953 and n = 10,968, respectively). The main outcome measures were participants' self-reported changes to social contact, loneliness, psychological distress, and life satisfaction.

RESULTS

The proportion of respondents reporting less social contact due to COVID-19 decreased from 62% in Mid-2020 to 55% in Late-2020. Overall, reported psychological wellbeing remained unchanged or improved from pre-COVID-19 to Mid-2020. From Mid-2020 to Late-2020, however, a reduction in psychological wellbeing was observed. Poorer psychological wellbeing was found for those with less social contact during the pandemic compared with people reporting unchanged social contact. This effect increased over time and was observed for all age groups at Late-2020. At Mid-2020, the importance of change in social contact for change in psychological wellbeing was greatest among young adults (< 30 years), while no significant differences were found for the oldest age group.

CONCLUSION

The association between COVID-19-era changes to social contact and loneliness, psychological distress, and life satisfaction is complex and appears to be age-dependent. Future studies should consider the quality of social contact and cultural contexts in which social restrictions are imposed.

Marital status and gambling disorder: a longitudinal study based on national registry data

BACKGROUND

Marital status is a robust correlate of disordered gambling, but few studies have examined the direction of this association.

METHODS

The present study used a case-control design by including all adults receiving their first gambling disorder (GD) diagnosis between January 2008 to December 2018 (Norwegian Patient Registry, n = 5,121) and compared them against age and gender matched individuals with other somatic/psychiatric illnesses (Norwegian Patient Registry, n = 27,826) and a random sample from the general population (FD-Trygd database, n = 26,695). The study examined marital status before GD, getting divorced as a risk factor for future GD, and becoming married as a protective factor of future GD.

RESULTS

The findings indicated an 8-9 percentage points higher prevalence of unmarried people and about a 5 percentage points higher prevalence of separation/divorce among those that subsequently experienced GD compared to controls. Logistic regressions showed that transition through divorce was associated with higher odds of future GD compared to illness controls (odds ratio [OR] = 2.45, 95% CI [2.06, 2.92]) and the general population (OR = 2.41 [2.02, 2.87]). Logistic regressions also showed that transition through marriage was associated with lower odds of future GD compared to illness controls (OR = 0.62, CI [0.55, 0.70]) and the general population (OR = 0.57, CI [0.50, 0.64]).

CONCLUSIONS

Social bonds have previously been shown to impact physical and mental health, and the findings of the study emphasize the importance of considering social network history and previous relationship dissolution among individuals with GD.

The Mediating Role of Positive Attitudes on the Relationship Between Esports Gaming Hours and Psychological Well-Being During the COVID-19 Pandemic

Electronic sports game (esports) gaming has seen a surge in popularity, especially during the coronavirus disease 2019 (COVID-19) pandemic, with more young people turning to it as an alternative to physical activities. However, the impact of esports gaming on mental health is a matter of concern. Previous studies have produced inconsistent findings on the relationship between gaming hours and mental health, and the moderating factors involved remain unexplored. This study aimed to investigate the moderating effect of participants' subjective attitudes toward esports gaming on the relationship between daily gaming hours and psychological well-being (PWB) among Chinese young adults during the COVID-19 lockdown. A nationwide online survey was conducted on 550 Chinese young adults using the Credamo platform. Ryff's Psychological Well-Being Scales (42-Item version) were used to assess PWB levels. The analysis included 453 participants. Gaming hours were negatively correlated with PWB scores. However, when considering the moderating effect of subjective attitudes, the association between gaming hours and PWB scores was largely positive. Our study suggests that subjective attitudes toward esports gaming outweigh gaming hours in promoting personal psychological well-being. We propose practical recommendations for healthy esports participation patterns that prioritize positive attitudes, especially in similar future scenarios like COVID-19. Our findings may inform future psychological intervention and research in the esports domain.

A psychosocial pathway to paranoia: The interplay between social connectedness and self-esteem

The quantity and quality of social contacts have been related to self-esteem, and both social relationships and self-esteem have been implicated in the pathways to paranoia. However, how social relationships interplay with self-esteem to trigger paranoia is not well understood. This study aims to investigate whether different measures of social connectedness (social support, loneliness, and desired friendship), as well as the frequency of social contact, impact paranoia and other positive and negative psychotic-like experiences (PLE) through the indirect effect of self-esteem. Data from a sample of 169 nonclinically ascertained participants oversampled for schizotypy scores were analyzed using two different approaches: retrospective trait-like and ecological momentary measures of social connectedness. Results showed that self-esteem mediates the pathways from poor social support and social longing, but not from loneliness, to paranoia and other cognitive PLE. In contrast, pathways from social connectedness to perceptual PLE and negative PLE were not mediated by self-esteem. Results were consistent across trait-like and momentary measures. Finally, self-esteem was not implicated in the pathways from the frequency of social contact and paranoia or other forms of PLE. These results provide a comprehensive picture of how social connectedness drives specific symptoms of psychosis through self-esteem. Findings underscore the need to explore separately the quality and quantity of social relationships and suggest that the subjective experience of meaningful social bonds is key social determinants of mental health. Therefore, addressing inadequacies of social connectedness could substantially improve symptomatic and functional outcomes of psychosis.

Surf therapy for improving child and adolescent mental health: A pilot randomised control trial

The aim of this pilot randomised control trial (RCT) was to test, 1) feasibility and acceptability of a surf therapy program to improve symptoms of mental ill-health among children and adolescents, and 2) the design and procedures of an evaluative study. This pilot RCT compared a 6-week mentor-supported surf therapy program with a wait list control group, in Australian children and adolescents aged 8-18yrs (M age = 11.28, SD = 2.34; 15 females), who were help seeking for issues relating to their mental health. Exclusion criteria included if an individual was actively suicidal or experiencing a psychotic episode or being unavailable for program dates. The primary outcome was the feasibility and acceptability of the intervention and study design assessed via 11 pre-defined criteria. A secondary outcome was to investigate the effectiveness signal of the intervention on child indicators of depression and anxiety, assessed via the Revised Children's Anxiety and Depression Scale-Short Form and the Strengths and Difficulties Questionnaire. Random allocation was computer generated and while it was not possible to blind participants, researchers collecting assessments were blinded to group allocation. Thirty-six youth were randomised (intervention = 18; wait list controls = 18), representing an 84% participation rate among eligible youth. Of the 11 a priori feasibility and acceptability criteria, 4 of 5 relating to the intervention, and 4 of 6 addressing the study design were fully met, with the unmet factors guiding program revision. At the completion of the intervention, children and adolescents receiving the intervention reported reductions in symptoms of depression (ES = 0.57), anxiety (ES = 0.43), emotional problems, (ES = 0.79), peer problems (ES = 0.56), hyperactivity/inattention (ES = 0.28), and overall difficulties (ES = 0.64). These reductions were not sustained 6-weeks after completion of the intervention. Surf therapy is an acceptable and feasible intervention for addressing symptoms of mental ill-health among children and adolescents. Preliminary evidence suggests that surf therapy improves symptoms of mental ill-health in the short-term but that these improvements were not sustained after the intervention is ceased.

Change in prevalence over time and factors associated with depression among Bangladeshi older adults during the COVID-19 pandemic

BACKGROUND

Globally, the COVID-19 pandemic seriously affected both physical and mental health conditions. This study aims to assess changes in the prevalence of depression among older adults during the COVID-19 pandemic in Bangladesh and explore the correlates of depression in pooled data.

METHODS

This study followed a repeated cross-sectional design and was conducted through telephone interviews on two successive occasions during the COVID-19 pandemic (October 2020 and September 2021) among 2077 (1032 in 2020-survey and 1045 in 2021-survey) older Bangladeshi adults aged 60 years and above. Depression was measured using the 15-item Geriatric Depression Scale (GDS-15). The binary logistic regression model was used to identify the factors associated with depression in pooled data.

RESULTS

A significant increase in the prevalence of depression was noted in the 2021 survey compared to the 2020 survey (47.2% versus 40.3%; adjusted odds ratio (aOR): 1.40, 95% confidence interval (CI): 1.11-1.75). Depression was significantly higher among participants without a partner (aOR 1.92, 95% CI 1.45-2.53), with a monthly family income of <5000 BDT (aOR: 2.65, 95% CI 1.82-3.86) or 5000-10 000 BDT (aOR: 1.30, 95% CI 1.03-1.65), living alone (aOR 2.24, 95% CI 1.40-3.61), feeling isolated (aOR 3.15, 95% CI 2.49-3.98), with poor memory/concentration (aOR 2.02, 95% CI 1.58-2.57), with non-communicable chronic conditions (aOR 1.34, 95% CI 1.06-1.69), overwhelmed by COVID-19 (aOR 1.54, 95% CI 1.18-2.00), having difficulty earning (aOR 1.49, 95% CI 1.15-1.92) or obtaining food (aOR 1.56, 95% CI 1.17-2.09) during COVID-19 pandemic, communicating less frequently (aOR 1.35, 95% CI 1.07-1.70) and needing extra care (aOR 2.28, 95% CI 1.75-2.96) during the pandemic.

CONCLUSIONS

Policymakers and public health practitioners should provide immediate mental health support initiatives for this vulnerable population during the COVID-19 pandemic and beyond. Policymakers should also invest in creating safe places to practise mindful eating, exercise, or other refuelling activities as a means of preventing and managing depression.

Experiences and perspectives of peer support among young adults with epilepsy

Young adulthood is a critical developmental period which having epilepsy tends to complicate, suggesting support could be useful. This study aimed to examine the experiences and perspectives of peer support among young adults with epilepsy (YAWE). An online survey was completed by 144 YAWE. Most YAWE reported not having access to peer support but perceived several potential benefits which could support their mental health including mutual understanding, fostering friendships and reducing loneliness, and promoting self-management and coping strategies. Reported barriers to accessing peer support included practical barriers such as travel and time constraints, emotional barriers (e.g., anxiety), and peers not feeling confident or skilled enough to support others. The need for epilepsy peer support groups specifically designed for young adults, university students, and individuals with co-occurring conditions such as autism and attention deficit hyperactivity disorder were also recognised as well as online delivery to address some of the identified barriers. Appropriate training for facilitators and group moderation were noted as important. Overall, these preliminary findings support the acceptability of peer support among YAWE, indicating peer support could be a worthy focus of policy and care pathway development. However, future research is needed to evaluate the effectiveness of peer support for epilepsy populations.

Holistic community-based group parenting programs for mothers with maternal mental health issues help address a growing public health need for a diversity of vulnerable mothers, children and families: Findings from an action research study

Background

Maternal mental illness is a major growing global concern which can affect parenting with serious negative implications for offspring. Group-based parenting programs for mothers which both enhance the parent-child relationship and address mental health symptoms in a supportive social setting may optimise better outcomes for mothers and children. The Acorn program in South Australia draws on attachment theory to integrate dance play, reflective diary keeping and therapeutic letters in a holistic program for a diversity of vulnerable mothers and children aged 1-36 months. The program seeks to nurture and enhance parental wellbeing and the quality of the parent-child relationship for mothers experiencing identified mental health illnesses that impinge upon their parenting. This study presents the evaluation of the program and its effectiveness.

Methods

Action research approach for continuous monitoring and program improvement engaging Acorn program staff in evaluation data collection and interpretation of pre and post self-completion measures and standardized observations. Additional data was collected through a telephone interview of attending mothers 6-8 months after program completion to address sustainable impacts on parenting and wellbeing.

Results

The program engaged 353 diverse vulnerable mothers with their children. Many had profound overlapping mental health issues including borderline personality disorder (BPD) and depression. The quality of the parent-child interaction, parental confidence, competence and enjoyment were enhanced; mothers' wellbeing, ability to cope and lasting social supports were augmented. This occurred for a number of "most vulnerable" subgroups including single mothers, mothers with BPD, mothers from non-English speaking households and those with lower levels of education or household income. Mothers reported sustained improvements in their wellbeing, parenting, social and family lives, and feeling closer to their child as a result of participating in the program.

Conclusions

Given the high prevalence of maternal mental health issues and substantial potential negative consequences for mothers and offspring, the Acorn parenting program offers an effective means of addressing this pressing public health issue potentially helping large numbers of vulnerable mothers and their children. This has additional gravitas in the shadow of COVID-19 due to expanded numbers of those experiencing greater parental stress, isolation and mental illness.

Childhood trauma and college student health: a review of the literature

The experience of childhood trauma is known to predict health-relevant outcomes across the lifespan. Previous reviews summarize existing knowledge of the implications of childhood trauma for health in young adults and adults more generally. The current theoretical review aims to integrate the existing literature on the relationship between childhood trauma and health-relevant outcomes specifically in college students, consolidating findings across specific health domains. Further, the following theoretical review highlights the need for more research in this area and discusses how college campuses may use the knowledge in this area of work to develop targeted interventions aimed at improving the health of college students who experienced trauma in childhood.

Adapting Attachment and Biobehavioral Catch-up for infants and young children with intellectual disabilities and developmental delays in South Africa: Reflections and recommendations from local stakeholders

Attachment and Biobehavioral Catch-up (ABC) is an intervention targeted at enhancing the socioemotional and regulatory functioning of at-risk infants. However, to use the ABC for infants/toddlers with intellectual disabilities/developmental delays (ID/DD) and in novel cultural contexts, such as South Africa, adaptations may be required. This study aimed, therefore, to explore the opinions of clinical experts and perceptions of caregivers regarding the use of ABC for children with ID/DD in South Africa. It also sought to incorporate the experiences of families of children with ID/DD who received, and intervenors who delivered, ABC in its first implementation in South Africa. Semi-structured interviews were conducted with 18 participants. Thematic analysis explicated 12 main themes: Intervention Strengths, Points of Concern, and Recommendations (Experts); Focus on Caregiver-child Relationship, and Intervention Targets and Duration (Caregivers); Benefits of ABC, and Cultural Considerations (ABC Recipients); Focused and Targeted, Value of Feedback, Supportive Supervision, Working Alliance, and Challenges Experienced (ABC Intervenors). Practice and training recommendations include psychoeducation for parents and training for intervenors that is ID/DD-specific, expanding supervision capacity, building intervenors' cultural/linguistic sensitivity and competence, accessing referral networks, including local Community Health Workers as intervenors, and greater flexibility in how the sessions are organized.

The role of community health workers in influencing social connectedness using the household model: a qualitative case study from Malawi

BACKGROUND

Community health workers (CHWs) play a vital role in facilitating social connectedness, building trust, decrease stigma, and link communities to essential healthcare and social support services. More studies are needed to understand the factors facilitating these interactions among CHWs, clients, and community members.

OBJECTIVE

This study examined the CHW role and relationships between CHWs, communities, and health facilities that promote trust, positive relationships, and social connectedness.

METHODS

In 2016, the CHW program in Neno District, Malawi, was transitioned to a household-level assignment of CHWs to provide screening, linkage to care, and psychosocial and chronic disease support from a disease-based program. We employed an exploratory qualitative study with thematic analysis linked to Fredrickson's broaden-and-build theory of positive emotions through focus group discussions (FGDs) and in-depth interviews (IDIs) to understand the impact of the household assignment. We purposively sampled community stakeholders, CHWs, health service providers, and clients (total N = 180) from October 2018 through March 2020. All interviews were audiotaped, transcribed verbatim, translated, coded, and analyzed.

RESULTS

Participants reported decreased stigma and discrimination with increased trust and confidence in CHWs with household-level assignment. Positive relationships between CHWs in their households, community members, and health facility staff fostered health knowledge, individual agency, and personal resources for the community members to access health services. Community members' personal resources of increased health knowledge, trust, gratitude, and social support improved social connectedness and subjective wellbeing. Areas to improve positive relationships include CHWs maintaining confidentiality and caring for pregnant women.

CONCLUSION

Our study findings demonstrate that by building solid relationships as a community chosen, well informed, and household-level workforce, CHWs can develop positive relationships with communities and the health-care facility staff through building knowledge, trust, gratitude, and hope. Further work is needed in maintaining CHW confidentiality and new ways to approach culturally sensitive health areas.

The (un)learning of social functions and its significance for mental health

Social interactions are dynamic, context-dependent, and reciprocal events that influence prospective strategies and require constant practice and adaptation. This complexity of social interactions creates several research challenges. We propose a new framework encouraging future research to investigate not only individual differences in capacities relevant for social functioning and their underlying mechanisms, but also the flexibility to adapt or update one's social abilities. We suggest three key capacities relevant for social functioning: (1) social perception, (2) sharing emotions or empathizing, and (3) mentalizing. We elaborate on how adaptations in these capacities may be investigated on behavioral and neural levels. Research on these flexible adaptations of one's social behavior is needed to specify how humans actually "learn to be social". Learning to adapt implies plasticity of the relevant brain networks involved in the underlying social processes, indicating that social abilities are malleable for different contexts. To quantify such measures, researchers need to find ways to investigate learning through dynamic changes in adaptable social paradigms and examine several factors influencing social functioning within the three aformentioned social key capacities. This framework furthers insight concerning individual differences, provides a holistic approach to social functioning, and may improve interventions for ameliorating social abilities in patients.

Acceptability and Feasibility of an Intervention to Enhance Social Group Belonging: Evidence From Three Trials of Groups 4 Health

Groups 4 Health (G4H) is a group psychotherapy program that targets social group disconnection. An emerging evidence base supports its efficacy in reducing loneliness, depression, and social anxiety. However, to date there has been no formal analysis of its acceptability to clients and therapists, nor an investigation of its feasibility for wider implementation. This input from end users is crucial to ensure the program's wider suitability and to contribute to its improvement. This study drew data from three clinical trials, including 266 G4H clients and 68 G4H therapists. From the Phase III trial only, additional data were available from 90 clients in a dose-controlled cognitive-behavioral therapy (CBT) comparison group, and focus groups/interviews with 6 therapists and 13 clients. Client satisfaction was high, with all average ratings &gt;7/10, significantly exceeding the CBT comparison group. Therapist satisfaction with each module was &gt;5/7. Retention was &gt;80%. Homework completion was high, with &lt;10% of clients saying that they had not attempted the homework. Therapists and clients both emphasized the benefits arising from G4H, and the contribution of the group context itself as a vehicle to achieve positive outcomes.

Social connectedness as a determinant of mental health: A scoping review

Public health and epidemiologic research have established that social connectedness promotes overall health. Yet there have been no recent reviews of findings from research examining social connectedness as a determinant of mental health. The goal of this review was to evaluate recent longitudinal research probing the effects of social connectedness on depression and anxiety symptoms and diagnoses in the general population. A scoping review was performed of PubMed and PsychInfo databases from January 2015 to December 2021 following PRISMA-ScR guidelines using a defined search strategy. The search yielded 66 unique studies. In research with other than pregnant women, 83% (19 of 23) studies reported that social support benefited symptoms of depression with the remaining 17% (5 of 23) reporting minimal or no evidence that lower levels of social support predict depression at follow-up. In research with pregnant women, 83% (24 of 29 studies) found that low social support increased postpartum depressive symptoms. Among 8 of 9 studies that focused on loneliness, feeling lonely at baseline was related to adverse outcomes at follow-up including higher risks of major depressive disorder, depressive symptom severity, generalized anxiety disorder, and lower levels of physical activity. In 5 of 8 reports, smaller social network size predicted depressive symptoms or disorder at follow-up. In summary, most recent relevant longitudinal studies have demonstrated that social connectedness protects adults in the general population from depressive symptoms and disorders. The results, which were largely consistent across settings, exposure measures, and populations, support efforts to improve clinical detection of high-risk patients, including adults with low social support and elevated loneliness.

Microbiome in Precision Psychiatry: An Overview of the Ethical Challenges Regarding Microbiome Big Data and Microbiome-Based Interventions

There has been a spurt in both fundamental and translational research that examines the underlying mechanisms of the human microbiome in psychiatric disorders. The personalized and dynamic features of the human microbiome suggest the potential of its manipulation for precision psychiatry in ways to improve mental health and avoid disease. However, findings in the field of microbiome also raise philosophical and ethical questions. From a philosophical point of view, they may yet be another attempt at providing a biological cause for phenomena that ultimately cannot be so easily localized. From an ethical point of view, it is relevant that the human gut microbiome comprises data on the individual's lifestyle, disease history, previous medications, and mental health. Massive datasets of microbiome sequences are collected to facilitate comparative studies to identify specific links between the microbiome and mental health. Although this emerging research domain may show promise for psychiatric patients, it is surrounded by ethical challenges regarding patient privacy, health risks, effects on personal identity, and concerns about responsibility. This narrative overview displays the roles and advances of microbiome research in psychiatry and discusses the philosophical and ethical implications of microbiome big data and microbiome-based interventions for psychiatric patients. We also investigate whether these issues are really "new," or "old wine in new bottles."

What are the solutions for well-being and burn-out for healthcare professionals? An umbrella realist review of learnings of individual-focused interventions for critical care

OBJECTIVE

To determine what, how, for whom and under what conditions individual-focused interventions are effective to improve well-being and decrease burn-out among critical care healthcare professionals.

DESIGN

This study is an umbrella review that used the realist approach, using Realist and Meta-narrative Evidence Synthesis: Evolving Standards guidelines. PsycINFO, Web of Science, CINAHL, MEDLINE, Scopus, ClinicalTrials.gov and ISRCTN databases were searched for published and unpublished systematic reviews and meta-analyses literature between 2016 and 2020. The team appraised and extracted data and identified relationships between content, mechanism and outcomes (CMOs). Theory prepositions were developed using CMOs and were used to refine the existing programme.

RESULTS

A total of 81 interventions from 17 reviews were mapped, including mindfulness interventions, cognitive-behavioural therapy, self-care and coping strategies. The revised programme theory determined that contextual factors such as ethnicity, workload, and work schedules play a crucial role in determining the effectiveness of interventions. Mechanisms including the interventions' interests, acceptance, and receptivity are also influential in determining engagement and adherence to the intervention. Findings suggest that the solution for burn-out is complex. However, it offers an optimistic view of tailoring and customising one or a combination of interventions, integrating structured education and components of emotional intelligence. Self-care, social support, awareness or mindfulness and self-efficacy are prime components to improve emotional intelligence and resilience for critical care healthcare professionals to improve well-being and decrease burn-out experience.

CONCLUSIONS

These findings provide realistic and reliable reporting of outcomes to better support implementation within the 'real world'. Future research such as seeking validation using expert opinions can provide further in depth understanding of hidden contextual factors, mechanisms and their interactions to provide a greater depth of knowledge ready for application with the critical care population.

Disruption to well-being activities and depressive symptoms during the COVID-19 pandemic: The mediational role of social connectedness and rumination

BACKGROUND

Disruption to everyday routine during the COVID-19 pandemic has resulted in considerable implications for global mental health. The inter- and intra-personal mechanisms by which disrupted routine can contribute to elevated depressive symptoms has not been well-explored. The present study aimed to examine how feelings of social (dis)connectedness and rumination, as a maladaptive coping strategy, could explain the association between disrupted well-being activities and depressive symptoms.

METHODS

Participants (N = 496) ranging in age from 18 to 73 years (M = 28.73, SD = 10.93) completed an online survey within the first 3 months of the COVID-19 pandemic, which included measures of disruption to usual psychological and physical well-being activities, social connectedness, rumination, and depressive symptoms. Social connectedness and rumination were investigated as serial mediators of the association between disrupted well-being activities and depression using Hayes' PROCESS macro.

RESULTS

39.5% of the sample reported clinically significant levels of depression. Disruption to well-being activities predicted higher depressive symptoms, and this was partially explained by feelings of social disconnectedness and subsequent rumination. Rumination, alone, was not a significant mediator between disrupted routine and depressive symptoms.

LIMITATIONS

The cross-sectional survey design does not preclude the possibility of bidirectional effects.

CONCLUSION

The social distancing public health measures to combat COVID-19 have contributed to widespread disrupted routine, and in turn, elevated symptoms of depression. Social disconnectedness plays a particularly important role in this association. Intervention strategies should consider social factors as a 'social cure' for mass, positive mental health promotion during COVID-19.

Barbershops as a setting for supporting men's mental health during the COVID-19 pandemic: a qualitative study from the UK

BACKGROUND

Previous research has highlighted the need to promote help-seeking by men with mental health problems.

AIMS

To investigate barbers' views about offering mental health support for men in barbershops, with a specific focus on the psychosocial impacts of the COVID-19 pandemic.

METHOD

We used a sequential mixed-methods qualitative design with online data collection. In Phase 1, 30 barbers in Southern England completed surveys exploring perceptions of their clients' mental health during the COVID-19 pandemic, experiences of informal supportive roles and scope for providing formal mental health support in barbershops. Phase 2 involved member validation interviews and explored practice implications with three Phase 1 respondents.

RESULTS

Thematic analysis identified three overarching themes: 'more than a haircut' (describing how the physical and relational contexts of barbershops can offer a supportive environment for clients); 'impacts of COVID-19' (describing stressors related to the pandemic and implications for clients' mental health and barber-client relationships); and 'formal mental health strategies' (describing opportunities for, and potential barriers to, formalising mental health support in barbershops).

CONCLUSIONS

Barbers were aware of their clients' worsening mental health during the COVID-19 pandemic. Barbershops were generally considered to be a suitable setting in which to promote good mental health, monitor for signs of mental ill health and provide information about local mental health services. Future work is needed to co-produce and evaluate formal mental health promotion and prevention strategies in barbershops. Particular attention should be given to service innovations that preserve the credibility and trust that are fundamental to the barbershop experience for many males.

The prevalence of mild cognitive impairment by aspects of social isolation

OBJECTIVES

This study describes the prevalence of mild cognitive impairment (MCI) across different aspects of social isolation among adults 65 years or older.

METHODS

In this cross-sectional study, we utilized the Wave 3 data from the National Social Life, Health, and Aging Project (NSHAP). MCI was defined as a Montreal Cognitive Assessment (MoCA) score less than 23. Prevalence of MCI was calculated for above and below average social disconnectedness (SD), perceived isolation (PI), and demographic variables age, gender, race/ethnicity, education, and household income.

RESULTS

The overall prevalence [and 95% confidence interval] of MCI was 27.5% [25.5-29.6]. The high prevalence of MCI was found in those who had above average SD (32.0% [29.1-34.9]), above average PI (33.3% [29.7-36.8]), were older in age (43.1% [38.9-47.3]), male (28.7% [25.9-31.5]), Black (61.1% [52.5-69.6]), had less than a high school education (66.3% [58.9-73.8]), or were in the lowest income group (46.2% [39.7-52.7]). Those with above average SD or PI had a higher prevalence of MCI in almost all demographics, compared to those with below average SD or PI. Those who were Black or African American or had less than a high school education did not have a greater prevalence of MCI when SD was above average.

DISCUSSION

This current study adds to the body of literature that links SD and PI to MCI and sheds light on the possible existing socio-demographic disparities. Groups with greater than average SD or PI tend to have a higher prevalence of MCI. Further studies are needed to establish a causal association of SD and PI with MCI.

Civic Participation as a Promoter of Well-Being: Comparative Analysis among European Countries

Previous research on the direction of the relationship between civic participation and well-being has evidenced that civic participation is a promoter of well-being among older adults in Europe. Accordingly, the objective of the present study is to identify and analyze the differences between European welfare systems regarding both civic participation and well-being. For this purpose, a logistic multilevel regression analysis was performed as an empirical strategy, using the cross-sectional data from the 9 waves of the European Social Survey (2002-2018). Significant differences in well-being were observed, with Anglo-Saxon elders being the healthiest, and the Nordic the happiest and most satisfied with their lives. In contrast, Eastern European seniors reported the lowest levels of well-being. Also, Nordic countries are the most civically engaged, followed by the Continental and Anglo-Saxon, while Mediterranean and Eastern countries engage the least. However, the impact of civic participation on well-being is strongest for the Mediterranean countries, while its impact on satisfaction and happiness is weakest for the Nordic countries. The 3 models of the multilevel analysis indicate that civic participation has a positive impact on health, happiness and life satisfaction, and that this effect is quite robust. Also, by adding country-level macro variables to the model, it is possible to reduce the random effects and hence to better explain these international differences. Concisely, the impact of civic participation on the well-being of the elderly differs across nations and should therefore be considered by policy makers.

Mental Health and Social Connectedness During the COVID-19 Pandemic: An Analysis of Sports and E-Sports Players

Recently, the pandemic context in which the world finds itself has inspired studies that sought to evaluate to mental health and the way people are relating to the purpose of understanding and promoting improvements psychological health. The epidemiological and public health literature shows that social connection protects and promotes mental health, being an important clinical tool for reducing anxiety, depression, and stress. Thinking in the broad sense of connection, that is, feeling and perceiving oneself connected with the environment, applied to the context of sport, it is suggested that social connection could be related to the interactions in the practice of sport. Although playing sports can promote mental health, there are few findings on the topic in the context of a pandemic and with physical sports and electronic sports (e-sports) players. In this sense, the present study aims to assess the extent to which social connection and mental health indicators are correlated in a sample of sports and e-sports players. The participants were 401 Brazilian physical sports (N = 199, 49.6%) and e-sports players (N = 202, 50.4%), mostly male (53.1%) and single (59.9%), who filled in the Social Connectedness Scale (SCS), the Depression, Anxiety and Stress Scale (DASS), and demographic questions. The results indicated that social connection was negatively correlated and also predict the anxiety (r = −0.37), depression (r = −0.54), and stress (r = −0.39). When comparing sports and e-sports players, a statistically significant difference was identified in the levels of social connection [t(398) = −3.41; sports_mean (SD) = 4.53 (1.14); e-sports_mean (SD) = 4.14 (1.15)] and depression [t(396) = 2.90; sports_mean (SD) = 1.10 (0.89); e-sports_mean (SD) = 0.85 (0.81)]. These findings can serve as a theoretical basis for the development of intervention programs (e.g., to guide managers regarding the social distancing rules that enable them to keep holding sports practices and events) and promoting discussions that focus on the analysis of aspects promoting psychological health in sports context (physical and e-sports).

Mixed progress in adolescent health and wellbeing in Aotearoa New Zealand 2001-2019: a population overview from the Youth2000 survey series

We explored progress on key indicators of adolescent health and wellbeing among New Zealand secondary school students over the last two decades. We analysed data from comprehensive surveys conducted in 2001, 2007, 2012 and 2019 (n = 9546, 9098, 8487, and 7311, respectively). Schools, and students within schools, were randomly selected. Prevalence estimates and adjusted odds ratios show large reductions in substance use (e.g. prevalence of past-month binge drinking declined from 41.5% to 21.8%), sexual experience (31.6% to 20.6%) and past-month risky driving (58.8% to 37.1%). However, from 2012-2019 there were rapid increases in symptoms of depression (13.0% to 22.8%; RADS-SF), suicide thoughts (15.3% to 20.8%) and suicide attempts (3.9% to 6.3%) and declines in emotional wellbeing (76.0% to 69.1%; WHO-5). Changes in family and school contexts were generally positive or minimal, although the proportion of students whose families worry about money for food increased from 2001 to 2019 (7.2% to 12.5%) and access to health services decreased from 2007 to 2019 (83.5% to 78.2%). This study demonstrates that health status and risks among New Zealand adolescents have changed dramatically over 20 years, with areas of large improvement. However, mental wellbeing requires urgent attention.