Act-Belong-Commit: Lifestyle Medicine for Keeping Mentally Healthy

Association between social isolation and depression: Evidence from longitudinal and Mendelian randomization analyses

BACKGROUND

Increasing evidence shows that social isolation and depression are likely to interact with each other, yet the direction and causality of the association are not clear. This study aims to examine the possible reciprocity in the relationship between social isolation and depression.

METHODS

This study fitted a cross-lagged panel model (CLPM) by using data from the English Longitudinal Study of Aging (ELSA, 2014-2019, n = 6787) to examine the temporal relationship between social isolation and depressive symptoms in older adults. We then conducted two-sample bidirectional Mendelian randomization (MR) analyses by using independent genetic variants associated with multiple social isolation phenotypes (n = 448,858-487,647) and with depression (n = 215,644-2,113,907) as genetic instruments from genome-wide association studies to assess the causality between social isolation and onset of depression.

RESULTS

The CLPM in the ELSA cohort showed a significant and positive lagged effect of social isolation on depressive symptoms (β = 0.037, P < .001). The reverse cross-lagged path from depressive symptoms to social isolation was also statistically significant (β = 0.039, P < .001). In two-sample bidirectional MR, the genetically predicted loneliness and social isolation combined phenotype (LNL-ISO) was positively associated with occurrence of depression (OR = 1.88, 95 % CI: 1.41-2.50, P < .001), vice versa (OR = 1.16, 95 % CI:1.13-1.20, P < .001).

LIMITATIONS

The self-report nature of the assessments and missing data are study limitations.

CONCLUSIONS

These findings suggest a bidirectional relationship between social isolation and depression. It is important to develop interventions that highlight the reciprocal consequences of improving either mental health or social connection in older adults.

Impact on stakeholders of a cultural adaptation of a social and emotional well-being intervention in an Aboriginal community

PURPOSE

Australian Indigenous people conceptualise health broadly as situated within a social and emotional well-being (SEWB) framework. A consultation process with an Aboriginal community revealed that the fundamental principles of the population wide, community-based Act-Belong-Commit mental health promotion Campaign were consistent with Aboriginal people's understanding of SEWB and that a cultural adaptation of the Campaign would be welcomed in the community. The purpose of this paper is to present key stakeholders' feedback on the Campaign adaptation.

METHODOLOGY

Two years after implementation of the Campaign, individual in-depth interviews were conducted with a purposeful sample of n = 18 Indigenous and non-Indigenous stakeholders to identify ongoing issues in the community and assess their reactions to the Campaign implementation and perceptions of the effects of the Campaign on the community.

RESULTS

The two primary factors influencing stakeholder acceptance of the Campaign in the community were (i) the nature of the consultation process that clearly acknowledged that it was for the community to decide whether or not to adopt the Campaign and (ii) the ability of the Aboriginal Project Manager to gain the trust of the community, bring stakeholders together and illustrate the Act-Belong-Commit principles in her actions in the community. Stakeholders reported observing social and emotional well-being benefits for individuals, their families and the whole community.

CONCLUSION

Overall, the results suggest that the Act-Belong-Commit mental health promotion Campaign can be successfully culturally adapted as a community-based, social and emotional well-being Campaign in Aboriginal and Torres Strait communities. SO WHAT?: The Act-Belong-Commit cultural adaptation in Roebourne provides an evidence-based best practice model for the development of culturally appropriate mental health promotion campaigns in Indigenous communities around Australia.

The efficacy of the "Talk-to-Me" suicide prevention and mental health education program for tertiary students: a crossover randomised control trial

Despite suicide ideation being one of the most frequently reported health issues impacting tertiary students, there is a paucity of research evaluating the efficacy of preventive interventions aimed at improving mental health outcomes for students studying at two tertiary institutes. The current study evaluated the efficacy of the "Talk-to-Me" Mass Open Online Course (MOOC) in improving tertiary students' abilities to support the mental health of themselves and their peers via a randomised controlled trial design, comparing them to a waitlist control group. Overall, 129 tertiary students (M = 25.22 years, SD = 7.43; 80% female) undertaking a health science or education course at two Western Australian universities were randomly allocated to either "Talk-to-Me" (n = 66) or waitlist control (n = 63) groups. The participants' responses to suicidal statements (primary outcome), knowledge of mental health, generalised self-efficacy, coping skills, and overall utility of the program (secondary outcomes) were collected at three timepoints (baseline 10-weeks and 24-weeks from baseline). Assessment time and group interaction were explored using a random-effects regression model, examining changes in the primary and secondary outcomes. Intention-to-treat analysis (N = 129) at 10-weeks demonstrated a significant improvement in generalised self-efficacy for "Talk-to-Me" compared to the control group (ES = 0.36, p = .04), with only the "Talk-to-Me" participants reporting increased knowledge in responding to suicidal ideation (primary outcome). This change was sustained for 24 weeks. Findings provide preliminary evidence suggesting that the "Talk-to-Me" MOOC can effectively improve tertiary students' mental health and knowledge of how to support themselves and others in distress. ACTRN12619000630112, registered 18-03-2019, anzctr.org.au.

Understanding the utility of "Talk-to-Me" an online suicide prevention program for Australian university students

BACKGROUND

Australian university students are at risk of experiencing poor mental health, being vulnerable to self-harm and suicidal ideation.

AIM

"Talk-to-Me" is a suicide ideation prevention Massive open online course (MOOC) previously showing it can support Western Australian university students' knowledge of identifying and responding to suicide ideation in themselves and others.

METHODS

A multi-site one-group pre-test/post-test design with a 12-week follow-up explored the efficacy of "Talk-to-Me" for university students Australia-wide, evaluating the influence of COVID-19 and location. Overall, 217 students (55% female; mage  = 24.93 years [18, 60]) enrolled in this study from 2020 to 2021. Participants' responses to suicidal statements, mental health literacy, generalized self-efficacy, help-seeking behavior, and overall utility of the program were collected at baseline, post-MOOC (10 weeks from baseline) and 12-week follow-up. The effect of time and location interaction was explored using a random-effects regression model.

RESULTS

Findings indicated significant improvement in participants' knowledge of positive mental health support strategies (ES = 0.42, p < 0.001) and recognizing appropriate responses to suicidal statements (ES = 0.37, p < 0.001) at 10-weeks, with further improvement at 12 weeks follow-up (ES = 0.47 and 0.46, p < 0.001). Students reported higher generalized self-efficacy at the 12-week follow-up compared to baseline (ES = 0.19, p = 0.03) and an increased tendency to seek professional help for mental health issues (ES = 0.22, p = 0.02).

CONCLUSION

These findings provide preliminary evidence of the efficacy of the "Talk-to-Me" program in supporting ‎university students across Australia to increase their suicide-related knowledge and skills, ‎general self-efficacy, and overall mental fitness.

Impact of the Act-Belong-Commit campaign on mental health help-seeking behaviour

ISSUE ADDRESSED

Despite the high prevalence of mental ill-health amongst Australians, many people do not seek help for their mental ill-health. A delay in help-seeking is associated with poorer outcomes. This study investigated the extent to which the Act-Belong-Commit mental health promotion campaign prompted people to seek information or professional help for mental ill-health.

METHODS

A sample of 1200 respondents took part in two state-wide surveys (n = 600 each). Participants aware of the Act-Belong-Commit campaign were asked questions related to information-seeking and help-seeking behaviours because of the campaign.

RESULTS

Of those aware of the campaign, 8% stated that the campaign prompted them to seek information and 4% stated that the campaign prompted them to seek help for a mental health problem. Those with a mental illness experience (MIE) were significantly more likely than those without to report that the campaign prompted them to look for information (12% vs 6%) and seek help for a mental health problem (9.5% vs 1.2%). Extrapolating these results to the total adult population of Western Australia indicated that around 120 000 adults had sought mental health information, and around 60 000 had sought help as a result of the campaign.

CONCLUSIONS

The campaign not only initiated the seeking of information or professional help for a mental health problem amongst those with no prior thoughts of such, but also prompted those who were already thinking about seeking information or getting help to act sooner than they otherwise would. SO WHAT?: Although previous research suggests that mental health literacy interventions have limited impact on help-seeking, the presented data show that the Act-Belong-Commit approach can have a significant impact on help-seeking, particularly amongst those with a MIE, which could yield substantial social and economic return on investment benefits if intensified at both the media and community grass roots levels.

"I'm making a positive change in my life": a mixed method evaluation of a well-being tertiary education unit

ISSUE ADDRESSED

Mental health disorders (MHDs) are prevalent among university students with detrimental impacts for individual students, universities and the wider community. There is urgent need for proactive and preventative strategies to address the mental health crisis in the university population. This study evaluated the efficacy of a 13-week unit developed to directly educate university students about ways to improve and maintain well-being.

METHODS

Fifty-eight university students from five disciplines participated in a 13-week elective undergraduate unit "Well-Being Fundamentals for Success" as part of their degree. The Act Belong Commit mental health promotion campaign framework formed the basis of teaching materials. Outcome well-being measures were self-assessed at weeks 1, 6 and 12 using four scales: 1) Warwick-Edinburgh Mental Well-being Scale (WEMWBS); 2) Perceived Stress Scale (PSS); 3) Brief Resilience Scale (BRS); and 4) Mindful Attention Awareness Scale (MAAS). Post-unit group interviews (n = 11) were analysed for key themes.

RESULTS

Linear mixed models demonstrated a significant improvement in BRS over the semester; well-being (WEMBS) and mindful attention (MAAS) did increase but not significantly. There was a significant increase in stress (PSS) over the semester. Key themes that emerged from the group interviews were that 1) University life contributes to well-being; 2) University life contributes to stress; 3) The well-being unit helped students see and do things differently; 4) An overall endorsement of the unit.

CONCLUSION

University students' resilience increased over the semester following participation in curriculum focused on well-being which featured a combination of theoretical content and experiential workshops.

Impact on community members of a culturally appropriate adaptation of a social and emotional well-being intervention in an aboriginal community

Purpose

Indigenous Australians report mental health problems at a much higher rate than non-Indigenous Australians. However, rather than more services, it has been proposed that there should be a positive, socially based approach to improving mental health in Indigenous communities. The population-wide Western Australian Act-Belong-Commit mental health promotion campaign appeared to be consistent with such an approach. Hence, after consultation with Indigenous community members, a culturally adapted version of the campaign was developed and launched in a largely Indigenous remote Australian community. A survey of Indigenous community members was conducted two years later to assess campaign impact. The aim of this paper is to report on the impact on community members of this cultural adaptation.

Design/methodology/approach

Intercept interviews were conducted with Indigenous community members (n = 31) to assess respondents’ awareness of the campaign elements and activities, understanding of campaign messages and whether respondents had undertaken activities to improve their own or their family’s social and emotional well-being as a result of the campaign.

Findings

There was universal awareness of the adapted campaign in this sample, with 81% reporting doing something for their own social and emotional well-being, 74% reporting doing something for the social and emotional well-being of their family or friends and 48% reporting doing something for community well-being, as a result of campaign exposure.

Originality/value

The cultural adaptation of the Act-Belong-Commit campaign in the Australian Roebourne community is the first reported Indigenous adaptation of a population-wide mental health promotion campaign.

Mental Health of Healthcare Workers During the COVID-19 Pandemic

On January 16, 2020, the first case of coronavirus disease 2019 (COVID-19) in Japan was reported. In the spring of the same year, the shortage of personal protective equipment (PPE) such as surgical masks became a significant issue. In addition, the medical staff had to encounter discrimination during this period. Thus, the mental health of these staff has been greatly affected by the social situation, the media coverage of the COVID-19 epidemic, and the shortage of PPE in hospitals. Various factors make it difficult for the medical staff to seek professional help for mental well-being. Therefore, self-care plays an important role in the prevention of depression and anxiety disorders among healthcare workers. When the healthcare workers face problems in their work environment, they should coordinate with the hospital to promptly improve the system. COVID-19 resulted in new societal norms and changed our lifestyles significantly. Insomnia is a particular issue among healthcare workers. Lifestyle analysis is thus necessary if insomnia needs to be addressed. Because the opportunities for communication are reduced during the COVID-19 pandemic, conscious communication is essential. During this difficult time, the staff may not receive sufficient guidance from their superiors at work, for example for guidance received by resident doctors from their seniors. This will also provide opportunities to communicate vital information about matters such as infection control. Therefore, quality communication and accurate information should be directed toward all healthcare workers.

The "Talk-to-Me" MOOC intervention for suicide prevention and mental health education among tertiary students: Protocol of a multi-site cross-over randomised controlled trial

INTRODUCTION

Mental health problems are common among tertiary education students, with concerning levels of suicide ideation frequently observed in this population. There is a need for evidence-based mental health education and suicide prevention programs designed to meet the specific needs of these students. The "Talk-to-Me" Mass Open Online Course (MOOC) is a strengths-based mental health education program underpinned by a six-phase model for managing a suicidal crisis.

METHODS

To evaluate the efficacy of the "Talk-to-Me" MOOC in improving student knowledge of appropriate responses to suicide crisis via a randomised control trial (RCT) comparing tertiary education health science and education students attending the program to a waitlist control group. Overall, 170 will be screened and randomly allocated to either the "Talk-to-Me" MOOC or a waitlist control group, with data collection occurring at three-time points (baseline, 10-weeks and 24-weeks from baseline) over one year. The primary outcome will be participants' knowledge and responses to suicidal statements as measured by the Suicide Intervention Response Inventory. Secondary outcomes will be knowledge of mental health and coping skills as well as the overall utility of the program.

CONCLUSIONS

This pragmatic RCT will demonstrate the efficacy of the "Talk-to-Me" MOOC in improving the students' ability to respond to suicidal and mental health concerns compared to the waitlist group. This design will enable rigorous evaluation of the "Talk-to-Me" MOOC, contributing to a greater understanding of the online-delivered safe-paced suicide prevention programs for tertiary students. Australian New Zealand Clinical Trials Registry (ANZCTR): #12619000630112.

Twenty-One Reasons for Implementing the Act-Belong-Commit-'ABCs of Mental Health' Campaign

While there has been increased attention worldwide on mental health promotion over the past two decades, what is lacking in many countries around the globe is practical knowledge of what constitutes a population-wide mental health promotion campaign, and how such a campaign can be implemented. This paper provides such knowledge based on the development, implementation and evaluation of the Act-Belong-Commit campaign, the world's first comprehensive population-wide public mental health promotion campaign which was launched in 2008 in Western Australia. Given the learnings from the full-scale implementation and evaluation of the campaign in Western Australia and its expansion nationally and internationally, along with the continuing and expanding evidence base for the campaign constructs, we crystallise 21 reasons why jurisdictions who wish to achieve the goals of the WHO and adopt the recommendations of the European framework on mental health and wellbeing should consider adopting or adapting Act-Belong-Commit when considering implementing a public mental health promotion campaign.

"It's More Than Just Exercise": Tailored Exercise at a Community-Based Activity Center as a Liminal Space along the Road to Mental Health Recovery and Citizenship

Mental health care policies call for health-promoting and recovery-oriented interventions, as well as community-based programs supporting healthier habits. The purpose of this study was to explore how individuals facing mental health challenges experienced participating in tailored exercise at a community-based activity center, and what role tailored exercise could play in supporting an individual’s process of recovery. Data were collected through in-depth interviews with nine adults experiencing poor mental health who engaged in exercise at the activity center. Interviews were audio-recorded, transcribed verbatim and analyzed using systematic text condensation. Participants spoke about the community-based program being a safe space where they could “come as they are” (Theme 1). Taking part in the program was “more than just exercise” and allowed them to connect with others (Theme 2). The experiences they gained from exercise also helped with other areas in life and provided them with a safe space to build their confidence towards the “transition back to the outside” (Theme 3). We summarized the findings into one overall theme: “inside vs. outside”. In conclusion, a community-based activity center acted as a liminal space that aided mental health recovery by allowing participants to feel safe, accepted and supported, as well as experience citizenship. The findings highlight the need to treat mental health challenges as a contextual phenomenon and creating arenas for community and citizenship in society.

Associations Between Multiple Leisure Activities, Mental Health and Substance Use Among Adolescents in Denmark: A Nationwide Cross-Sectional Study

Background: Previous research has suggested that leisure activity may benefit mental health and protect against substance use among adolescents, but more research is needed to asses associations with a wide range of outcomes. The aim of this study was to assess associations between multiple leisure activities and (1) mental health outcomes and (2) substance use outcomes in a sample of Danish adolescents.

Methods: Using data from the Danish part of the European School Survey Project on Alcohol and Other Drugs (ESPAD) collected in 2019, nation-wide cross-sectional data from 2,488 participants aged 15 or 16 in Denmark were analyzed to assess associations between number of leisure activity types and outcomes pertaining to mental health and substance use.

Results: Our results show that engaging in multiple activity types at least once a week—as compared to one single type of activity—is associated with increased odds for high mental well-being, and reduced odds for mental health problems. Engaging in multiple activity types is also associated with reduced odds for overall substance use and for using substances as a coping method. Among those using substances, engaging in multiple activity types is associated with reduced odds of above average substance use.

Conclusion: Increasing opportunities for adolescents to engage in leisure activities is suggested to be useful in enhancing mental health and preventing substance use and promoting mental health. Promoting and increasing access to leisure activities among adolescents could be a promising avenue for policy and practice.

Social disconnectedness, perceived isolation, and symptoms of depression and anxiety among older Americans (NSHAP): a longitudinal mediation analysis

BACKGROUND

Research indicates that social isolation and loneliness increase the risk of mental disorders, but less is known about the distinct contributions of different aspects of isolation. We aimed to distinguish the pathways through which social disconnectedness (eg, small social network, infrequent social interaction) and perceptions of social isolation (eg, loneliness, perceived lack of support) contribute to anxiety and depression symptom severity in community-residing older adults aged 57-85 years at baseline.

METHODS

We did a longitudinal mediation analysis with data from the National Social Life, Health, and Aging Project (NSHAP). The study included individuals from the USA born between 1920 and 1947. Validated measures on social disconnectedness, perceived isolation, and depression and anxiety symptoms were used. Structural equation modelling was used to construct complete longitudinal path models.

FINDINGS

Using data from 3005 adults aged 57-85 years, we identified two significant longitudinal mediation patterns with symptoms of depression, and two with anxiety symptoms. Overall, social disconnectedness predicted higher subsequent perceived isolation (β=0·09; p<0·0001), which in turn predicted higher depression symptoms (β=0·12; p<0·0001) and anxiety symptoms (β=0·12; p<0·0001). The reverse pathways were statistically supported as well, suggesting bi-directional influences.

INTERPRETATION

Social network structure and function are strongly intertwined with anxiety and depression symptoms in the general population of older adults. Public health initiatives could reduce perceived isolation by facilitating social network integration and participation in community activities, thereby protecting against the development of affective disorders.

FUNDING

Nordea-fonden.

Psychological benefits of attending the theatre associated with positive affect and well-being for subscribers over age 60

Objectives: Although late adulthood may be a time of greater well-being, optimal aging still characterizes a minority of older adults. Understanding how individuals achieve well-being across adulthood is important for intervention and social policy. We focused on how attending live theatre might enhance the well-being of a sample of 53 season ticket holders aged 60 and older. Based on a previously tested conceptual framework, we hypothesized that post-performance reports of social-cognitive experience while at the play would predict post-performance positive affect, which in turn would predict well-being.Method: The sample was a subset of volunteers from a large survey study of theatre ticket purchasers. They completed baseline and two-year follow-up measures of well-being, and questionnaires immediately after attending seven plays across two seasons: measures of social engagement, belonging, flow, positive affect, and their reactions to the plays.Results: We found that sense of belonging, social engagement, and flow were associated with positive affect after performances, as hypothesized. We also found that the cumulative positive affect experienced after plays in the two seasons predicted change in well-being between baseline and follow-up.Conclusion: Our findings suggest that attending performances is a combined social, cognitive, and affective experience that transcends entertainment. Future research might investigate whether the psychological benefit model we assessed will generalize to other leisure activities that create similar engagement. The findings have implications for individuals seeking to promote their own well-being, and, possibly more importantly, for policies that support enriching cultural opportunities, particularly in the arts.

Including Lifestyle Medicine in Medical Education: Rationale for American College of Preventive Medicine/American Medical Association Resolution 959

Introduced by the American College of Preventive Medicine and released by the American Medical Association House of Delegates in 2017, Resolution 959 (I-17) supports policies and mechanisms that incentivize and/or provide funding for the inclusion of lifestyle medicine education and social determinants of health in undergraduate, graduate and continuing medical education. Resolution 959 was passed to help address the current healthcare costs of lifestyle-related, noncommunicable chronic diseases that exert a devastating economic burden on the U.S. healthcare system. Approximately 86% of $2.9 trillion is spent annually on obesity, cardiovascular disease, type 2 diabetes, and some cancers, with very poor return on investment for health outcomes. Lifestyle medicine provides an evidence-based solution to the noncommunicable chronic disease epidemic; however, medical education in lifestyle medicine is minimal to nonexistent. This paper provides the case for healthcare innovation to include lifestyle medicine in the prevention and treatment of noncommunicable chronic diseases. Our medical education system recommendation is to provide lifestyle medicine training for prevention and treatment of noncommunicable chronic diseases. Exemplar lifestyle medicine schools are showcased and guidance for reform is highlighted that can be used to aid lifestyle medicine integration across the medical school education continuum. With a transformation of curriculum and development of new policies to support a focus on lifestyle medicine education in medical education across the continuum, a new healthcare model could be successful against noncommunicable chronic diseases and U.S. citizen wellness could become a reality.

Developing a culturally appropriate branding for a social and emotional wellbeing intervention in an Aboriginal community

ISSUE ADDRESSED

An initial consultation process to implement a culturally appropriate social and emotional wellbeing campaign in an Aboriginal community indicated that the fundamental principles of the Act-Belong-Commit mental health promotion campaign were acceptable, but that a cultural adaptation of the branding should be sought.

METHODS

A competition was held inviting community members to design a brand logo for the campaign in their community. Local judges selected "winners" in various categories, and six of the submissions were selected for testing in the broader community via street intercept interviews. Respondents were asked which logo they liked best, their perceived meanings of the designs and the perceived appropriateness of the designs for a social and emotional wellbeing campaign.

RESULTS

A convenience sample of N = 26 local Aboriginal people who lived and/or worked in Roebourne completed the questionnaire. There was a clear majority preference for logo "D," which communicated appropriate meanings of pride and strength in standing together, and reflected the underlying strengths and capacities of Aboriginal people which this project seeks to harness and support.

CONCLUSIONS

The approach of using a logo competition to develop the campaign brand was highly successful and enabled further meaningful engagement with the community and other service providers in the town. The success of the competition process resulted from an emphasis on relationship building, listening to the local community and involving the community in decision-making. So what? By conforming to established, but not always adhered to, recommendations for community consultation, successful and more enduring outcomes are likely.

Defining a Structure and Methodology for the Practice of Lifestyle Medicine

Lifestyle medicine (LM) is a relatively new branch of clinical practice (like travel medicine, sports medicine, etc), but to date with little accepted structure or methodology. The current review extends a previous attempt to define the determinants of chronic disease by expanding this to include (1) the knowledge base (the science) or epidemiology of chronic disease, (2) the skills (the art) or practice of LM, (3) the tools (the materials) that can add to LM diagnoses and prescription, and (4) the procedures (the actions) that help update conventional medicine to include practices required for a new era of lifestyle and environmentally related chronic disease.