The impact of participant mental health on attendance and engagement in a trial of behavioural weight management programmes: secondary analysis of the WRAP randomised controlled trial

Efficacy of eHealth interventions to reduce depression symptoms in individuals with obesity: a systematic review of randomized controlled trials

Introduction

Obesity and depression are inter-related health concerns, demanding a high level of treatment and costs in the health care system. The development of eHealth interventions that simultaneously address obesity and mental health can be supportive in this regard. However, evidence of the efficacy of eHealth interventions in the treatment of depression symptoms in individuals with obesity is lacking. The aim of this systematic literature review is to evaluate the efficacy of existing eHealth interventions for individuals with obesity that target depression symptoms.

Methods

We systematically searched electronic databases (Cochrane Library, PubMed, Scopus) to identify studies published in English between January 2016 and January 2023, that focused on eHealth interventions, targeting depression symptoms in individuals with obesity people. Exclusion criteria were study objectives that (1) focused specifically on one or more metabolic comorbidities of individuals with obesity, e.g., hypertension, hyperlipidemia, diabetes; (2) focused specifically on eating disorders comorbidities e.g., binge eating disorder, and (3) focused specifically on patients before or after bariatric surgery.

Results

The database search identified 214 records. Six articles were included in this review. Sample sizes ranged from 70 to 1267 participants of ages 18-60 years. All included studies were randomized controlled trials. Two of the six included studies were web-based interventions guided either by medical doctors or psychologists. All interventions included video, printed materials, and interactive parts of which two studies integrated elements of Cognitive Behavioural Therapy and Social Cognitive Therapy. The findings showed that eHealth treatment services, supported and guided throughout the intervention had high acceptance and efficacy in the reduction of depression symptoms among individuals with obesity.

Conclusion

EHealth interventions that address and target both mental and physical health with interactive strategies calls for better efficacy in the reduction of depression symptoms. Future eHealth interventions that target depression symptoms in individuals with obesity should integrate digital strategies that address both mental and physical health through interactive modules.

Association of Changes in Neural Targets and Dietary Outcomes among Patients with Comorbid Obesity and Depression: Post hoc Analysis of ENGAGE-2 Mechanistic Clinical Trial

BACKGROUND

Disruptions in brain circuits that regulate cognition and emotion can hinder dietary change and weight loss among individuals with obesity and depression.

OBJECTIVE

The study aimed to investigate whether changes in brain targets in the cognitive control, negative affect, and positive affect circuits after 2-mo problem-solving therapy (PST) predict changes in dietary outcomes at 2 and 6 mo.

METHODS

Adults with obesity and depression from an academic health system were randomly assigned to receive PST (7-step problem-solving and behavioral activation strategies) over 2 mo or usual care. Seventy participants (mean age = 45.9 ± 11.6 y; 75.7% women, 55.7% Black, 17.1% Hispanic, 20.0% White; mean BMI = 36.5 ± 5.3 kg/m2; mean Patient Health Questionnaire-9 depression score = 12.7 ± 2.8) completed functional MRI and 24-h food recalls. Ordinary least square regression analyses were performed.

RESULTS

Among intervention participants, increased left dorsal lateral prefrontal cortex (dLPFC) activity of the cognitive control circuit at 2 mo was associated with increased diet quality (β: 0.20; 95% CI: -0.02, 0.42) and decreased calories (β: -0.19; 95% CI: -0.33, -0.04), fat levels (β: -0.22; 95% CI: -0.39, -0.06), and high-sugar food intake (β: -0.18; 95% CI: -0.37, 0.01) at 6 mo. For the negative affect circuit, increased right dLPFC-amygdala connectivity at 2 mo was associated with increased diet quality (β: 0.32; 95% CI: -0.93, 1.57) and fruit and vegetable intake (β: 0.38; 95% CI: -0.75, 1.50) and decreased calories (β: -0.37; 95% CI: -1.29, 0.54), fat levels (β: -0.37; 95% CI: -1.50, 0.76), sodium concentrations (β: -0.36; 95% CI: -1.32, 0.60), and alcohol intake (β: -0.71; 95% CI: -2.10, 0.68) at 2 but not at 6 mo. The usual care group showed opposing associations. The 95% CIs of all between-group differences did not overlap the null, suggesting a significant treatment effect.

CONCLUSIONS

Among adults with obesity and depression who underwent PST compared with those under usual care, improved dLPFC-amygdala regulation of negative affective brain states predicted dietary improvements at 2 mo, whereas improvements in dLPFC-based cognitive control predicted dietary improvements at 6 mo. These findings warrant confirmatory studies. This trial was at clinicaltrials.gov as NCT03841682.

"They go hand in hand": a patient-oriented, qualitative descriptive study on the interconnectedness between chronic health and mental health conditions in transition-age youth

BACKGROUND

Transition-age youth (TAY) with chronic health conditions frequently experience co-occurring mental health conditions. However, little is known about the perspectives of TAY with co-occurring diagnoses preparing to exit pediatric health and mental health services. Research is needed to understand the impact of a mental health condition on transition readiness and self-management in TAY with chronic health conditions.

METHODS

TAY (aged 16-20 years) with co-occurring chronic health and mental health conditions were recruited in Alberta, Canada. Nine semi-structured individual interviews were completed by phone or videoconference, and transcribed verbatim. Guided by qualitative description, we analyzed the data using thematic analysis in partnership with five young adults with lived experience in the health/mental health systems.

RESULTS

Participants shared their experiences living with simultaneous physical and mental health concerns and preparing for transition to adult care. Our analysis revealed three overarching themes: 1) "they're intertwined": connections between chronic health and mental health conditions in TAY, 2) impact of mental health on transition readiness and self-management, and 3) recommendations for service provision from the perspectives of TAY.

CONCLUSIONS

Our findings highlighted the myriad ways in which physical and mental health are connected as TAY prepare for service transitions using specific examples and powerful metaphors. TAY endorsed the importance of providers discussing these connections in routine clinical care. Future research should involve co-designing and evaluating educational material addressing this topic with diverse TAY, caregivers, and service providers.

Leveraging Mobile Health to Manage Mental Health/Behavioral Health Disorders: Systematic Literature Review

BACKGROUND

Mental health is a complex condition, highly related to emotion. The COVID-19 pandemic caused a significant spike in depression (from isolation) and anxiety (event related). Mobile Health (mHealth) and telemedicine offer solutions to augment patient care, provide education, improve symptoms of depression, and assuage fears and anxiety.

OBJECTIVE

This review aims to assess the effectiveness of mHealth to provide mental health care by analyzing articles published in the last year in peer-reviewed, academic journals using strong methodology (randomized controlled trial).

METHODS

We queried 4 databases (PubMed, CINAHL [Cumulative Index to Nursing and Allied Health Literature], Web of Science, and ScienceDirect) using a standard Boolean search string. We conducted this systematic literature review in accordance with the Kruse protocol and reported it in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) 2020 checklist (n=33).

RESULTS

A total of 4 interventions (mostly mHealth) from 14 countries identified improvements in primary outcomes of depression and anxiety as well as in several secondary outcomes, namely, quality of life, mental well-being, cognitive flexibility, distress, sleep, self-efficacy, anger, decision conflict, decision regret, digestive disturbance, pain, and medication adherence.

CONCLUSIONS

mHealth interventions can provide education, treatment augmentation, and serve as the primary modality in mental health care. The mHealth modality should be carefully considered when evaluating modes of care.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42022343489; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=343489.

Needs and Demands for e-Mental Health Interventions in Individuals with Overweight and Obesity: User-Centred Design Approach

INTRODUCTION

Several studies indicate an association between mental disorders and overweight or obesity. E-Mental health interventions offer an effective way to overcome barriers to health care access for individuals with overweight and obesity. The objective of this study was to examine the needs and demands for e-mental health interventions among individuals with overweight and obesity.

METHODS

A cross-sectional study was conducted from 2020 to 2021 in Germany. A total of 643 participants were recruited through specialized social media platforms and the Alfried-Krupp hospital in Essen, Germany. Sociodemographic and medical data were analysed, as well as data on depressive symptoms and on the needs and demands for e-mental health interventions.

RESULTS

Contact with and recommendation by experts appear to be key aspects in the acceptance and use of e-mental health interventions. In summary, most participants preferred a 20-30-min weekly session via smartphone over a 4-month period. The highest preference in terms of features included practicing coping skills and being provided with information; in regard to desired topics, nutrition consultation, quality of life, and adapting to new life situations were considered most important.

DISCUSSION

e-Mental health interventions can be highly beneficial for individuals, especially when developed through a user-centred design approach. The results of the study indicate which content and design are preferred and, thereby, provide valuable information for consideration when developing a tailored e-mental health intervention.

Understanding eating behaviours, mental health and weight change in young adults: protocol paper for an international longitudinal study

INTRODUCTION

Understanding the complexities of change in eating behaviours, mental health, well-being and weight is crucial to inform healthcare and service provision, particularly in light of the exacerbating effects of the COVID-19 pandemic. This study aims to address the need for more comprehensive cross-sectional and longitudinal evidence, by tracking eating behaviours, mental health, health related behaviours and weight over a 12-month period, in a sample of young adults (18-35 years) in the UK and Australia.

METHODS AND ANALYSIS

Online surveys administered via the Prolific online research platform will be used for data collection at baseline, 6 months and 12 months. The survey (approximately 45 min) measures demographics, the impact of COVID-19, body mass index (BMI), weight management and health service usage, eating behaviours, personality, mental health, and health-related behaviours. An optional substudy component at each time point aims to validate self-reported weight in the main survey through images. Study inclusion criteria are; aged 18-34 years at baseline, BMI ≥20 kg/m², and residing in the UK or Australia. A target of 500 participants at baseline was set, recruited through Prolific, and with recruitment stratified by BMI, sex and country. The proposed analyses include creating static predictive models using baseline data (eg, using latent class analysis, factor analysis or similar), and mapping changes longitudinally (eg, using multivariate regressions). These analyses will enable changes in the study measures to be identified, as well as predictors and outcomes of change.

ETHICS AND DISSEMINATION

Ethical approval was granted by Leeds Beckett University, UK (reference number 86004) and the University of Newcastle, Australia (reference number H-2022-0110). Study findings will be disseminated through scientific journals, conferences, institute websites and social media, and briefings tailored to policy, practice and the public, with the intention to help inform the future development of health and well-being care and support for young adults across Australia and the UK.

Association between gestational depression and weight management behaviors during pregnancy: A cross-sectional study in Eastern China

An undesirable psychological state may deteriorate individual's weight management-related behaviors. This study aims to see if ineffective weight control measures were linked to depressive symptoms during pregnancy. We conducted a cross-sectional questionnaire survey of 784 pregnant women and collected information on sociodemographic factors, maternal characteristics, depression, and weight management activities throughout pregnancy (exercise management, dietary management, self-monitoring regulation, and management objectives). About 17.5% of pregnant women exhibited depressive symptoms. The mean score on dietary management was upper-middle, exercise management and self-monitoring regulation were medium, and management objectives were lower-middle. Multivariable linear regression analysis revealed that pregnant women with depressive symptoms had lower levels of exercise management (β = -1.585, p = 0.005), dietary management (adjusted β = -0.984, p = 0.002), and management objectives (adjusted β = -0.726, p = 0.009). However, there was no significant relationship between depressive symptoms and pregnant women's self-monitoring regulating behavior (p > 0.05). The findings indicated the inverse association between depressive symptoms and gestational weight management behaviors. These results offer important indications for pregnancy weight management professionals by highlighting the need for mental health interventions for pregnant women experiencing depressive symptoms.