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Ho CSH, Tan TWK, Khoe HCH, Chan YL, Tay GWN, Tang TB. Using an Interpretable Amino Acid-Based Machine Learning Method to Enhance the Diagnosis of Major Depressive Disorder. J Clin Med 2024; 13:1222. [PMID: 38592058 PMCID: PMC10931723 DOI: 10.3390/jcm13051222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Major depressive disorder (MDD) is a leading cause of disability worldwide. At present, however, there are no established biomarkers that have been validated for diagnosing and treating MDD. This study sought to assess the diagnostic and predictive potential of the differences in serum amino acid concentration levels between MDD patients and healthy controls (HCs), integrating them into interpretable machine learning models. Methods: In total, 70 MDD patients and 70 HCs matched in age, gender, and ethnicity were recruited for the study. Serum amino acid profiling was conducted by means of chromatography-mass spectrometry. A total of 21 metabolites were analysed, with 17 from a preset amino acid panel and the remaining 4 from a preset kynurenine panel. Logistic regression was applied to differentiate MDD patients from HCs. Results: The best-performing model utilised both feature selection and hyperparameter optimisation and yielded a moderate area under the receiver operating curve (AUC) classification value of 0.76 on the testing data. The top five metabolites identified as potential biomarkers for MDD were 3-hydroxy-kynurenine, valine, kynurenine, glutamic acid, and xanthurenic acid. Conclusions: Our study highlights the potential of using an interpretable machine learning analysis model based on amino acids to aid and increase the diagnostic accuracy of MDD in clinical practice.
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Affiliation(s)
- Cyrus Su Hui Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117543, Singapore;
| | - Trevor Wei Kiat Tan
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117543, Singapore;
- Centre for Translational MR Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117543, Singapore
- Department of Electrical and Computer Engineering, National University of Singapore, Singapore 117583, Singapore
- N.1 Institute for Health & Institute for Digital Medicine (WisDM), National University of Singapore, Singapore 117456, Singapore
- Integrative Sciences and Engineering Programme (ISEP), National University of Singapore, Singapore 119077, Singapore
| | - Howard Cai Hao Khoe
- Singapore Psychiatry Residency, National Healthcare Group, Singapore 308433, Singapore;
| | - Yee Ling Chan
- Centre for Intelligent Signal and Imaging Research (CISIR), Universiti Teknologi PETRONAS (UTP), Seri Iskandar 32610, Perak, Malaysia; (Y.L.C.); (T.B.T.)
| | - Gabrielle Wann Nii Tay
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117543, Singapore;
| | - Tong Boon Tang
- Centre for Intelligent Signal and Imaging Research (CISIR), Universiti Teknologi PETRONAS (UTP), Seri Iskandar 32610, Perak, Malaysia; (Y.L.C.); (T.B.T.)
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Ho CSH, Wang J, Tay GWN, Ho R, Husain SF, Chiang SK, Lin H, Cheng X, Li Z, Chen N. Interpretable deep learning model for major depressive disorder assessment based on functional near-infrared spectroscopy. Asian J Psychiatr 2024; 92:103901. [PMID: 38183738 DOI: 10.1016/j.ajp.2023.103901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 12/20/2023] [Accepted: 12/29/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Major depressive disorder (MDD) affects a substantial number of individuals worldwide. New approaches are required to improve the diagnosis of MDD, which relies heavily on subjective reports of depression-related symptoms. AIM Establish an objective measurement and evaluation of MDD. METHODS Functional near-infrared spectroscopy (fNIRS) was used to investigate the brain activity of MDD patients and healthy controls (HCs). Leveraging a sizeable fNIRS dataset of 263 HCs and 251 patients with MDD, including mild to moderate MDD (mMDD; n = 139) and severe MDD (sMDD; n = 77), we developed an interpretable deep learning model for screening MDD and staging its severity. RESULTS The proposed deep learning model achieved an accuracy of 80.9% in diagnostic classification and 78.6% in severity staging for MDD. We discerned five channels with the most significant contribution to MDD identification through Shapley additive explanations (SHAP), located in the right medial prefrontal cortex, right dorsolateral prefrontal cortex, right superior temporal gyrus, and left posterior superior frontal cortex. The findings corresponded closely to the features of haemoglobin responses between HCs and individuals with MDD, as we obtained a good discriminative ability for MDD using cortical channels that are related to the disorder, namely the frontal and temporal cortical channels with areas under the curve of 0.78 and 0.81, respectively. CONCLUSION Our study demonstrated the potential of integrating the fNIRS system with artificial intelligence algorithms to classify and stage MDD in clinical settings using a large dataset. This approach can potentially enhance MDD assessment and provide insights for clinical diagnosis and intervention.
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Affiliation(s)
- Cyrus Su Hui Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Psychological Medicine, National University Hospital, Singapore.
| | - Jinyuan Wang
- Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore
| | - Gabrielle Wann Nii Tay
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Roger Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Psychological Medicine, National University Hospital, Singapore; Institute of Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore
| | - Syeda F Husain
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Soon Kiat Chiang
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Psychological Medicine, National University Hospital, Singapore; Institute of Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore
| | - Hai Lin
- Department of Neurosurgery, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Xiao Cheng
- Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore
| | - Zhifei Li
- Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore; Institute of Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore; National University of Singapore (Suzhou) Research Institute, Suzhou, China
| | - Nanguang Chen
- Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore; National University of Singapore (Suzhou) Research Institute, Suzhou, China
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Low CE, Yau CE, Tan RY, Ong VCS, Ho RCM, Ho CSH, Lee ARYB, Chen MZ. Association of depression with all-cause and cancer-specific mortality in older adults with cancer: Systematic review, meta-analysis, and meta-regression. J Geriatr Oncol 2024:101700. [PMID: 38218674 DOI: 10.1016/j.jgo.2023.101700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 10/30/2023] [Accepted: 12/22/2023] [Indexed: 01/15/2024]
Abstract
INTRODUCTION The incidence and mortality of cancer is increasing worldwide with studies reporting that cumulative risk of cancer rises as age increases. Against the backdrop of the increasing prevalence of cancer amongst older patients, we conducted a systematic review and meta-analysis examining the depression-mortality relationship in older adults with cancer (OAC). MATERIALS AND METHODS This PRISMA-adherent systematic review involved a systematic search of PubMed, Medline, EMBASE, and PsycINFO for prospective and retrospective cohort studies comparing the risk of all-cause and cancer-related mortality among OAC with depression. Random effects meta-analyses and meta-regressions were used for the primary analysis. RESULTS From 5,280 citations, we included 14 cohort studies. Meta-analyses of hazard ratios (HRs) showed an increased incidence of all-cause mortality in OAC with depression (pooled HR: 1.40; 95% confidence interval [CI]: 1.25, 1.55). Subgroup analyses of other categorical study-level characteristics were insignificant. While risk of cancer-related mortality in OAC with depression was insignificantly increased with a pooled HR of 1.21 (95% CI: 0.98, 1.49), subgroup analysis indicated that risk of cancer-related mortality in OAC with depression significantly differed with cancer type. Our systematic review found that having fewer comorbidities, a higher education level, greater socioeconomic status, and positive social supportive factors lowered risk of all-cause mortality in OAC with depression. DISCUSSION Depression in OAC significantly increases risk of all-cause mortality and cancer-related mortality among different cancer types. It is imperative for healthcare providers and policy makers to recognize vulnerable subgroups among older adults with cancer to individualize interventions.
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Affiliation(s)
- Chen Ee Low
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chun En Yau
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ren Ying Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Roger Chun Man Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Psychological Medicine, National University Hospital, Singapore
| | - Cyrus Su Hui Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Psychological Medicine, National University Hospital, Singapore
| | | | - Matthew Zhixuan Chen
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore.
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Tan YL, Lo YKJ, Ho CSH. Psychological and social impacts of frontotemporal dementia on caregivers and family members - A systematic review. Gen Hosp Psychiatry 2024; 86:33-49. [PMID: 38064912 DOI: 10.1016/j.genhosppsych.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/29/2023] [Accepted: 11/29/2023] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Frontotemporal dementia (FTD) may impose substantial psychological and social burdens on caregivers and family members that are unique from other forms of dementia due to its distinctive clinical characteristics. This systematic review investigated these impacts on caregivers and family members. METHODS A systematic search was conducted in the PubMed, Cochrane Library and Embase databases for relevant articles published from database inception to 23 March 2023. The methodological quality of the articles was evaluated using a checklist. RESULTS Thirty-six articles (six qualitative and thirty quantitative), including 5129 participants, were included in this review. Like other forms of dementia, FTD caregivers had significant caregiver burden levels and psychological impacts. Caregiver burden was associated with behavioural symptoms (e.g., apathy and disinhibition) and motor symptoms. The costs of caring for a patient with FTD were found to be higher than those for Alzheimer's disease. FTD patients often face challenges in obtaining a correct diagnosis and experience significant delays and multiple misdiagnoses. Healthcare professionals may also be less familiar with FTD than with Alzheimer's, leading to delayed diagnosis. This can cause considerable stress and deprive patients and caregivers of early intervention. CONCLUSION FTD is associated with significant costs and caregiver burden levels, and the difficulties faced by caregivers and family members can be unique and challenging in different aspects when compared to other forms of dementia. Better education about FTD for family members and healthcare professionals is required to improve the quality of life for both patients and caregivers, and more support needs to be provided at all stages of the disease.
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Affiliation(s)
- Ying Li Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Yee Kai Jeffrey Lo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Cyrus Su Hui Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; Department of Psychological Medicine, National University Hospital, Singapore 119228, Singapore.
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Yong CSK, Maniam EJH, Chang CWL, Lai JY, Ho CSH. Case report: Creutzfeldt-Jakob disease presenting with anxiety symptoms in a COVID-19 post-infection patient. Front Neurol 2023; 14:1239576. [PMID: 37609652 PMCID: PMC10440421 DOI: 10.3389/fneur.2023.1239576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/24/2023] [Indexed: 08/24/2023] Open
Abstract
Creutzfeldt-Jakob Disease (CJD) is a rare, rapidly progressive, and fatal neurodegenerative disorder. We describe a man whose initial manifestations of CJD occurred shortly after contracting Coronavirus disease 2019 (COVID-19). He first developed anxiety and short-term memory loss a few weeks after a mild COVID-19 infection. He subsequently developed parkinsonism, eventually progressed to akinetic mutism, and passed away 5 months after symptom onset. This case highlights a potential temporal relationship between COVID-19 infection and the onset of neurodegenerative symptoms. Microglia and astrocytes in the central nervous system (CNS) and 'S1' spike proteins on SARS-CoV-2 are potential mediators in neuroinflammation and neurodegeneration.
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Affiliation(s)
- Christl S. K. Yong
- Department of Psychological Medicine, National University Health System, Singapore, Singapore
| | - Ethan Jian-Hui Maniam
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cheryl W. L. Chang
- Department of Psychological Medicine, National University Health System, Singapore, Singapore
| | - Jonathan Yexian Lai
- Department of Neurology, National Neuroscience Institute, Duke-NUS Medical School, Singapore, Singapore
| | - Cyrus Su Hui Ho
- Department of Psychological Medicine, National University Health System, Singapore, Singapore
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Lee ARYB, Low CE, Yau CE, Li J, Ho R, Ho CSH. Lifetime Burden of Psychological Symptoms, Disorders, and Suicide Due to Cancer in Childhood, Adolescent, and Young Adult Years: A Systematic Review and Meta-analysis. JAMA Pediatr 2023; 177:790-799. [PMID: 37345504 PMCID: PMC10288378 DOI: 10.1001/jamapediatrics.2023.2168] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/26/2023] [Indexed: 06/23/2023]
Abstract
Importance A cancer diagnosis and treatment may result in highly traumatic periods with lasting psychological consequences for children, adolescent, and young adult patients with cancer (CYACs). Early identification and management may prevent long-term psychological morbidity and suicide. Objective To analyze risk, severity, and risk factors for depression, anxiety, psychotic disorders, and suicide in CYACs and noncancer comparators. Data Sources Literature search of PubMed, MEDLINE, Embase, PsycINFO, CINAHL, and PubMed Central from January 1, 2000, to November 18, 2022. Study Selection Full-length articles in peer-reviewed journals that measured and reported risk and/or severity of depression, anxiety, psychotic disorders, and suicide mortality in CYACs and a noncancer comparator group. Data Extraction and Synthesis Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines were followed with prospective PROSPERO registration. Main Outcomes and Measures Risk ratios (RRs) were used for dichotomous outcomes, and standardized mean differences (SMDs) were used for continuous outcomes. SMDs were defined as follows: 0.2, small; 0.5, medium; and 0.8, large. Sources of heterogeneity and risk factors were investigated using sensitivity, subgroup, and meta-regression analyses. Results From 7319 records, 52 studies were included. Meta-analyses revealed that CYACs were at increased lifetime risk of severe symptoms or a disorder of depression (RR, 1.57; 95% CI, 1.29-1.92), anxiety (RR, 1.29; 95% CI, 1.14-1.47), and psychotic disorders (RR, 1.56; 95% CI, 1.36-1.80) relative to both matched controls and their siblings. Overall suicide mortality was not significantly elevated (RR, 1.63; 95% CI, 0.78-3.40). The mean severity of depression was found to be elevated in CYACs receiving treatment (SMD, 0.44; 95% CI, 0.13-0.74) and long-term survivors (SMD, 0.18; 95% CI, 0.02-0.33). The mean severity of anxiety was found to be elevated only during treatment (SMD, 0.16; 95% CI, 0.03-0.20). Conclusions and Relevance Findings of this systematic review and meta-analysis suggest that CYACs may experience lasting psychological burden long into survivorship. Timely identification, preventive efforts, and psycho-oncological intervention for psychological comorbidity are recommended.
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Affiliation(s)
- Ainsley Ryan Yan Bin Lee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chen Ee Low
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chun En Yau
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jiaqi Li
- School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Roger Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Psychological Medicine, National University Hospital, Singapore
| | - Cyrus Su Hui Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Psychological Medicine, National University Hospital, Singapore
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Ho CSH, Soh MWT, Tay GWN. The diagnostic utility of miRNA and elucidation of pathological mechanisms in major depressive disorder. Compr Psychiatry 2023; 121:152363. [PMID: 36580691 DOI: 10.1016/j.comppsych.2022.152363] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/20/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
AIMS Our study aims to explore how miRNAs can elucidate the molecular mechanisms of major depressive disorder (MDD) by comparing the miRNA levels in the blood serum of patients with depression and healthy individuals. It also explores the potential of miRNAs to differentiate between depressed patients and healthy controls. METHODS 60 healthy controls (n = 45 females) were matched to 60 depressed patients (n = 10 unmedicated) for age (±7), sex, ethnicity, and years of education. Depression severity was measured using the Hamilton Depression Rating Scale, and venous blood was collected using PAXgene Blood RNA tubes for miRNA profiling. To further identify the depression-related biological pathways that are influenced by differentially expressed miRNAs, networks were constructed using QIAGEN Ingenuity Pathway Analysis. Receiver operating characteristic (ROC) analyses were also conducted to examine the discriminative ability of miRNAs to distinguish between depressed and healthy individuals. RESULTS Six miRNAs (miR-542-3p, miR-181b-3p, miR-190a-5p, miR-33a-3p, miR-3690 and miR-6895-3p) showed to be considerably down-regulated in unmedicated depressed patients relative to healthy controls. miR-542-3p, in particular, also has experimentally verified mRNA targets that are predicted to be associated with MDD. ROC analyses found that a panel combining miR-542-3p, miR-181b-3p and miR-3690 produced an area under the curve value of 0.67 in distinguishing between depressed and healthy individuals. CONCLUSIONS miRNAs - most notably, miR-542-3p, miR-181b-3p and miR-3690 - may be biomarkers with targets that are implicated in the pathophysiology of depression. They could also be used to distinguish between depressed and healthy individuals with reasonable accuracy.
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Affiliation(s)
- Cyrus Su Hui Ho
- Department of Psychological Medicine, National University Health System, Singapore, Singapore; Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Michelle Wei Ting Soh
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Gabrielle Wann Nii Tay
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Yeo BSY, Song HJJMD, Toh EMS, Ng LS, Ho CSH, Ho R, Merchant RA, Tan BKJ, Loh WS. Association of Hearing Aids and Cochlear Implants With Cognitive Decline and Dementia: A Systematic Review and Meta-analysis. JAMA Neurol 2023; 80:134-141. [PMID: 36469314 PMCID: PMC9856596 DOI: 10.1001/jamaneurol.2022.4427] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/23/2022] [Indexed: 12/12/2022]
Abstract
Importance Hearing loss is associated with cognitive decline. However, it is unclear if hearing restorative devices may have a beneficial effect on cognition. Objective To evaluate the associations of hearing aids and cochlear implants with cognitive decline and dementia. Data Sources PubMed, Embase, and Cochrane databases for studies published from inception to July 23, 2021. Study Selection Randomized clinical trials or observational studies published as full-length articles in peer-reviewed journals relating to the effect of hearing interventions on cognitive function, cognitive decline, cognitive impairment, and dementia in patients with hearing loss. Data Extraction and Synthesis The review was conducted in accordance with Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) reporting guidelines. Two authors independently searched the PubMed, Embase, and Cochrane databases for studies relating to the effect of hearing interventions on cognitive decline and dementia in patients with hearing loss. Main Outcomes and Measures Maximally adjusted hazard ratios (HRs) were used for dichotomous outcomes and ratio of means for continuous outcomes. Sources of heterogeneity were investigated using sensitivity and subgroup analyses, and publication bias was assessed using visual inspection, the Egger test, and trim and fill. Results A total of 3243 studies were screened; 31 studies (25 observational studies, 6 trials) with 137 484 participants were included, of which 19 (15 observational studies, 4 trials) were included in quantitative analyses. Meta-analysis of 8 studies, which had 126 903 participants, had a follow-up duration ranging from 2 to 25 years, and studied long-term associations between hearing aid use and cognitive decline, showed significantly lower hazards of any cognitive decline among hearing aid users compared with participants with uncorrected hearing loss (HR, 0.81; 95% CI, 0.76-0.87; I2 = 0%). Additionally, meta-analysis of 11 studies with 568 participants studying the association between hearing restoration and short-term cognitive test score changes revealed a 3% improvement in short-term cognitive test scores after the use of hearing aids (ratio of means, 1.03; 95% CI, 1.02-1.04, I2 = 0%). Conclusions and Relevance In this meta-analysis, the usage of hearing restorative devices by participants with hearing loss was associated with a 19% decrease in hazards of long-term cognitive decline. Furthermore, usage of these devices was significantly associated with a 3% improvement in cognitive test scores that assessed general cognition in the short term. A cognitive benefit of hearing restorative devices should be further investigated in randomized trials.
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Affiliation(s)
- Brian Sheng Yep Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Emma Min Shuen Toh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Li Shia Ng
- Department of Otorhinolaryngology–Head and Neck Surgery, National University Hospital, Singapore
| | - Cyrus Su Hui Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Roger Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Institute of Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore
| | - Reshma Aziz Merchant
- Geriatric Medicine, Department of Medicine, National University Hospital, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University Singapore, Singapore
| | | | - Woei Shyang Loh
- Department of Otorhinolaryngology–Head and Neck Surgery, National University Hospital, Singapore
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Ho CSH, Tay GWN, Wee HN, Ching J. The Utility of Amino Acid Metabolites in the Diagnosis of Major Depressive Disorder and Correlations with Depression Severity. Int J Mol Sci 2023; 24:ijms24032231. [PMID: 36768551 PMCID: PMC9916471 DOI: 10.3390/ijms24032231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/19/2023] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
Major depressive disorder (MDD) is a highly prevalent and disabling condition with a high disease burden. There are currently no validated biomarkers for the diagnosis and treatment of MDD. This study assessed serum amino acid metabolite changes between MDD patients and healthy controls (HCs) and their association with disease severity and diagnostic utility. In total, 70 MDD patients and 70 HCs matched in age, gender, and ethnicity were recruited for the study. For amino acid profiling, serum samples were analysed and quantified by liquid chromatography-mass spectrometry (LC-MS). Receiver-operating characteristic (ROC) curves were used to classify putative candidate biomarkers. MDD patients had significantly higher serum levels of glutamic acid, aspartic acid and glycine but lower levels of 3-Hydroxykynurenine; glutamic acid and phenylalanine levels also correlated with depression severity. Combining these four metabolites allowed for accurate discrimination of MDD patients and HCs, with 65.7% of depressed patients and 62.9% of HCs correctly classified. Glutamic acid, aspartic acid, glycine and 3-Hydroxykynurenine may serve as potential diagnostic biomarkers, whereas glutamic acid and phenylalanine may be markers for depression severity. To elucidate the association between these indicators and clinical features, it is necessary to conduct additional studies with larger sample sizes that involve a spectrum of depressive symptomatology.
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Affiliation(s)
- Cyrus Su Hui Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119074, Singapore
- Correspondence:
| | - Gabrielle Wann Nii Tay
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119074, Singapore
| | - Hai Ning Wee
- Cardiovascular and Metabolic Disorders Programme, Duke-NUS Graduate Medical School, Singapore 169857, Singapore
| | - Jianhong Ching
- Cardiovascular and Metabolic Disorders Programme, Duke-NUS Graduate Medical School, Singapore 169857, Singapore
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Kuek JHL, Koh GK, OWYONG JQY, Ho CSH, Goh YS. Medical students' perception towards mental health recovery: a descriptive qualitative study. Med Educ Online 2022; 27:2106610. [PMID: 35894690 PMCID: PMC9341377 DOI: 10.1080/10872981.2022.2106610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/05/2022] [Accepted: 07/22/2022] [Indexed: 06/02/2023]
Abstract
The conceptualisation of recovery in mental healthcare, for which two definitions ('clinical' and 'personal') prevail, remains inconclusive. In most curricula of medical education, undergraduates are taught straightforward concepts of clinical recovery, which result in their perfunctory and rudimentary understanding. A qualitative descriptive approach was adopted to explore medical undergraduates' perceptions of recovery for people with mental health conditions. Participants were recruited from a Singapore-based university through convenience sampling; the required sample size was determined by data saturation. Individual face-to-face interviews were conducted through Zoom, an online conferencing platform using semi-structured questions from March to July 2021. Recordings of the interviews were transcribed verbatim and thematically analysed. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist guided the reporting of this study. Seventeen medical students with the majority (fifteen) of them in their fourth year of medical undergraduate education participated in this study. Four themes were identified: the relationship between mental illnesses and well-being; opinions on mental well-being; understanding of mental illnesses; and perceptions of recovery from mental illnesses. The medical undergraduates in this study predominantly conceptualised recovery based on functions, although many also agreed on respecting patients' perspectives in defining it. This aligns with contemporary approaches that emphasise more shared decision-making opportunities and empowering people with mental health conditions. Accordingly, our findings highlighted the need for foundational medical education to incorporate these constructs in their curricula and strategise to provide more meaningful discussions about them.
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Affiliation(s)
- Jonathan Han Loong Kuek
- Susan Wakil School of Nursing and Midwifery, Sydney School of Nursing, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Ghee Kian Koh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jenna Qing Yun OWYONG
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Cyrus Su Hui Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yong Shian Goh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Lee ARYB, Yau CE, Mai AS, Tan WA, Ong BSY, Yam NE, Ho CSH. Transcranial alternating current stimulation and its effects on cognition and the treatment of psychiatric disorders: a systematic review and meta-analysis. Ther Adv Chronic Dis 2022; 13:20406223221140390. [PMID: 36479141 PMCID: PMC9720798 DOI: 10.1177/20406223221140390] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/03/2022] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Transcranial alternating current stimulation (TACS) is a non-invasive method of brain stimulation that is hypothesised to alter cortical excitability and brain electrical activity, modulating functional connectivity within the brain. Several trials have demonstrated its potential in treating psychiatric disorders such as depression and schizophrenia. OBJECTIVES To study the efficacy of TACS in ameliorating symptoms of depression and schizophrenia in patients and its effects on cognition in patients and healthy subjects compared to sham stimulation. DESIGN Systematic review with meta-analysis. DATA SOURCES AND METHODS This PROSPERO-registered systematic review (CRD42022331149) is reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, EMBASE, CENTRAL and PsycINFO were searched from inception to March 2022. Only randomised-controlled trials were included. RESULTS A total of 12 randomised-controlled trials are reviewed for meta-analysis, with three randomised-controlled trials reporting only effects on cognition in psychiatric and cognitively impaired patients, three trials on cognition in healthy subjects, one trial on cognition in both patients and healthy subjects, one trial on only depression, two on both cognition and depression in patients and two on schizophrenia symptoms. No studies were at significant risk of bias. For cognition, TACS showed significant improvement [positive standardised mean differences (SMD) denoting improvement] over sham stimulation in those with psychiatric disorders with an SMD of 0.60 (95% confidence interval [CI]: 0.14, 1.06). Similarly, among patients with depression, an SMD of 1.14 (95% CI: 0.10, 2.18) was found significantly favouring TACS over sham stimulation. Two studies assessed the effect of TACS on schizophrenia symptoms with mixed results. CONCLUSION TACS has shown promise in ameliorating symptoms of both schizophrenia and depression in patients. TACS also improves cognition in both patients and healthy subjects. However, these findings are limited by the sample size of included studies, and future studies may be required to better our understanding of the potential of TACS. REGISTRATION PROSPERO (CRD42022331149).
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Affiliation(s)
| | - Chun En Yau
- MBBS Programme, Yong Loo Lin School of
Medicine, National University of Singapore, Singapore
| | - Aaron Shengting Mai
- MBBS Programme, Yong Loo Lin School of
Medicine, National University of Singapore, Singapore
| | - Weiling Amanda Tan
- MBBS Programme, Yong Loo Lin School of
Medicine, National University of Singapore, Singapore
| | - Bernard Soon Yang Ong
- MBBS Programme, Yong Loo Lin School of
Medicine, National University of Singapore, Singapore
| | - Natalie Elizabeth Yam
- MBBS Programme, Yong Loo Lin School of
Medicine, National University of Singapore, Singapore
| | - Cyrus Su Hui Ho
- Department of Psychological Medicine, Yong Loo
Lin School of Medicine, National University of Singapore, NUHS Tower Block,
Level 9, 1E Kent Ridge Road, Singapore 119228
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12
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Tan DJH, Quek SXZ, Yong JN, Suresh A, Koh KXM, Lim WH, Quek J, Tang A, Tan C, Nah B, Tan E, Keitoku T, Muthiah MD, Syn N, Ng CH, Kim BK, Tamaki N, Ho CSH, Loomba R, Huang DQ. Global prevalence of depression and anxiety in patients with hepatocellular carcinoma: Systematic review and meta-analysis. Clin Mol Hepatol 2022; 28:864-875. [PMID: 36263668 PMCID: PMC9597225 DOI: 10.3350/cmh.2022.0136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/17/2022] [Accepted: 07/20/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND/AIMS Depression and anxiety are associated with poorer outcomes in patients with hepatocellular carcinoma (HCC). However, the prevalence of depression and anxiety in HCC are unclear. We aimed to establish the prevalence of depression and anxiety in patients with HCC. METHODS MEDLINE and Embase were searched and original articles reporting prevalence of anxiety or depression in patients with HCC were included. A generalized linear mixed model with Clopper-Pearson intervals was used to obtain the pooled prevalence of depression and anxiety in patients with HCC. Risk factors were analyzed via a fractional-logistic regression model. RESULTS Seventeen articles involving 64,247 patients with HCC were included. The pooled prevalence of depression and anxiety in patients with HCC was 24.04% (95% confidence interval [CI], 13.99-38.11%) and 22.20% (95% CI, 10.07-42.09%) respectively. Subgroup analysis determined that the prevalence of depression was lowest in studies where depression was diagnosed via clinician-administered scales (16.07%;95% CI, 4.42-44.20%) and highest in self-reported scales (30.03%; 95% CI, 17.19-47.01%). Depression in patients with HCC was lowest in the Americas (16.44%; 95% CI, 6.37-36.27%) and highest in South-East Asia (66.67%; 95% CI, 56.68-75.35%). Alcohol consumption, cirrhosis, and college education significantly increased risk of depression in patients with HCC. CONCLUSION One in four patients with HCC have depression, while one in five have anxiety. Further studies are required to validate these findings, as seen from the wide CIs in certain subgroup analyses. Screening strategies for depression and anxiety should also be developed for patients with HCC.
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Affiliation(s)
- Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Darren Jun Hao Tan Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, 117597, Singapore Tel: +65 6772 4220, Fax: +65 6777 8247, E-mail:
| | - Sabrina Xin Zi Quek
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
| | - Jie Ning Yong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Adithya Suresh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jingxuan Quek
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ansel Tang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Caitlyn Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Benjamin Nah
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
| | - Eunice Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
| | - Taisei Keitoku
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Mark D. Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
| | - Nicholas Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Beom Kyung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Yonsei Liver Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Nobuharu Tamaki
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Cyrus Su Hui Ho
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Rohit Loomba
- NAFLD Research Center, Division of Medicine, University of California San Diego, La Jolla, California, USA
| | - Daniel Q. Huang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
- NAFLD Research Center, Division of Medicine, University of California San Diego, La Jolla, California, USA
- Corresponding author : Daniel Q. Huang Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, 117597, Singapore Tel: +65 6772 4220, Fax: +65 6777 8247, E-mail:
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13
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Le Vu MN, Do AL, Boyer L, Tran QC, Kohler S, Ahmed SI, Molnar A, Vu TS, Vo NTH, Nguyen LMV, Vu LG, Dam VAT, Duong T, Do DLN, Do NM, Mclntyre RS, Latkin C, Ho RCM, Ho CSH. A Review of the Effectiveness, Feasibility, and Acceptability of Art Therapy for Children and Adolescents during the COVID-19 Pandemic. Int J Environ Res Public Health 2022; 19:ijerph191811612. [PMID: 36141885 PMCID: PMC9517402 DOI: 10.3390/ijerph191811612] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/04/2022] [Accepted: 09/09/2022] [Indexed: 06/01/2023]
Abstract
Art therapy has been widely offered to reduce symptoms of psychological disturbance. Pooled evidence about its effectiveness in epidemic contexts, particularly during the COVID-19 pandemic, has not been yet established. This study reviewed the effectiveness, feasibility, and acceptability of art therapy on children and adolescents during the COVID-19 pandemic and past epidemics. We searched PubMed/Medline, PsycINFO, CENTRAL (Cochrane Library), and CINAHL for articles on art therapy during COVID-19. Included studies reported improvements in measures of mental health, sleep quality, and psychological well-being in children with or without disabilities in the epidemic context. Results also showed that art therapy was highly feasible and accepted by children and adolescents as well as their families during epidemics in reviewed studies. Art therapy can be effective at improving various aspects of mental health, sleep quality, and psychological well-being. More empirical evidence is needed with larger sample sizes and longer duration of interventions.
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Affiliation(s)
- Minh Ngoc Le Vu
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam
| | - Anh Linh Do
- Institute of Health Economics and Technology, Hanoi 100000, Vietnam
| | - Laurent Boyer
- Research Centre on Health Services and Quality of Life, Aix Marseille University, 13385 Marseille, France
| | - Quy Chi Tran
- High School for Gifted Students, Hanoi University of Science, Hanoi 100000, Vietnam
| | - Stefan Kohler
- Heidelberg Institute of Global Health, Heidelberg University, 69120 Heidelberg, Germany
| | - Syed Ishtiaque Ahmed
- Department of Computer Science, University of Toronto, Toronto, ON M5T 2S8, Canada
| | - Andreea Molnar
- Department of Computer Science and Software Engineering, School of Software and Electrical Engineering, Swinburne University of Technology, Melbourne, VIC 3122, Australia
| | - Tung Son Vu
- Institute of Health Economics and Technology, Hanoi 100000, Vietnam
| | | | | | - Linh Gia Vu
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam
- Faculty of Medicine, Duy Tan University, Da Nang 550000, Vietnam
| | - Vu Anh Trong Dam
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam
- Faculty of Medicine, Duy Tan University, Da Nang 550000, Vietnam
| | - Thomy Duong
- Institute of Health Economics and Technology, Hanoi 100000, Vietnam
| | | | - Ngoc Minh Do
- Vinschool Education System, Hanoi 100000, Vietnam
| | - Roger S. Mclntyre
- Institute of Medical Sciences, University of Toronto, Toronto, ON M5T 2S8, Canada
| | - Carl Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Roger Chun Man Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore 119077, Singapore
| | - Cyrus Su Hui Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
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14
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Goh YS, Ow Yong JQY, Chee BQH, Kuek JHL, Ho CSH. Machine Learning in Health Promotion and Behavioral Change: Scoping Review. J Med Internet Res 2022; 24:e35831. [PMID: 35653177 PMCID: PMC9204568 DOI: 10.2196/35831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 03/23/2022] [Accepted: 03/23/2022] [Indexed: 12/17/2022] Open
Abstract
Background Despite health behavioral change interventions targeting modifiable lifestyle factors underlying chronic diseases, dropouts and nonadherence of individuals have remained high. The rapid development of machine learning (ML) in recent years, alongside its ability to provide readily available personalized experience for users, holds much potential for success in health promotion and behavioral change interventions. Objective The aim of this paper is to provide an overview of the existing research on ML applications and harness their potential in health promotion and behavioral change interventions. Methods A scoping review was conducted based on the 5-stage framework by Arksey and O’Malley and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews) guidelines. A total of 9 databases (the Cochrane Library, CINAHL, Embase, Ovid, ProQuest, PsycInfo, PubMed, Scopus, and Web of Science) were searched from inception to February 2021, without limits on the dates and types of publications. Studies were included in the review if they had incorporated ML in any health promotion or behavioral change interventions, had studied at least one group of participants, and had been published in English. Publication-related information (author, year, aim, and findings), area of health promotion, user data analyzed, type of ML used, challenges encountered, and future research were extracted from each study. Results A total of 29 articles were included in this review. Three themes were generated, which are as follows: (1) enablers, which is the adoption of information technology for optimizing systemic operation; (2) challenges, which comprises the various hurdles and limitations presented in the articles; and (3) future directions, which explores prospective strategies in health promotion through ML. Conclusions The challenges pertained to not only the time- and resource-consuming nature of ML-based applications, but also the burden on users for data input and the degree of personalization. Future works may consider designs that correspondingly mitigate these challenges in areas that receive limited attention, such as smoking and mental health.
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Affiliation(s)
- Yong Shian Goh
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| | - Jenna Qing Yun Ow Yong
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| | - Bernice Qian Hui Chee
- Faculty of Arts and Social Sciences, National University of Singapore, Singapore, Singapore
| | - Jonathan Han Loong Kuek
- Susan Wakil School of Nursing, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Cyrus Su Hui Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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15
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Long NN, Lau MPXL, Lee ARYB, Yam NE, Koh NYK, Ho CSH. Motivational Interviewing to Improve the Uptake of Colorectal Cancer Screening: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:889124. [PMID: 35559348 PMCID: PMC9090440 DOI: 10.3389/fmed.2022.889124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/28/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Colorectal cancer screening when done early can significantly reduce mortality. However, screening compliance is still lower than expected even in countries with established screening programs. Motivational interviewing is an approach that has been explored to promote behavioral change including screening compliance. This review synthesizes the efficacy of motivational interviewing in promoting uptake of colorectal screening modalities and is the only review so far that examines motivational interviewing for colorectal cancer screening alone. Methods A systematic review and meta-analysis was conducted to examine the effects of motivational interviewing for colorectal cancer screening. PubMed, EMBASE, CENTRAL, PsycINFO, and CINAHL were searched to identify eligible studies from inception to June 2021 and selection criteria was defined. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. The DerSimonian and Laird random effects model was used in the statistical analysis for studies included in the meta-analysis. Results Fourteen studies from 14 randomized-controlled trials with a low to moderate risk of bias were analyzed. 8 studies in the systematic review showed that motivational interviewing is superior to a control group. Meta-analysis was conducted on 11 studies and showed that motivational interviewing is statistically significant in increasing colorectal cancer screening rates in both intention-to-treat and per-protocol analysis. Timing of data collection of colorectal cancer screening rates did not make a significant difference to the efficacy of motivational interviewing. Studies that offered and accepted a mixture of colorectal screening modalities such as colonoscopy and fecal immunochemical tests were significantly more likely to have favorable colorectal screening outcomes. Heterogeneity in intervention was noted between studies, specifically differences in the training of interventionists, intervention delivery and comparator components. Conclusion Motivational interviewing is a tailored intervention demonstrating mixed evidence in improving colorectal cancer screening attendance amongst individuals. More research is needed to rigorously compare the effect of motivational interviewing alone vs. in combination with other screening promotion strategies to enhance colorectal cancer screening compliance.
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Affiliation(s)
- Novia Niannian Long
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | | | - Natalie Elizabeth Yam
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicholas Ye Kai Koh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cyrus Su Hui Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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16
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Lee EPX, Man REK, Gan TLA, Fenwick EK, Aravindhan A, Ho KC, Sung SC, Wong TY, Ho CSH, Gupta P, Lamoureux EL. The longitudinal psychological, physical activity, and financial impact of a COVID-19 lockdown on older adults in Singapore: The PIONEER-COVID population-based study. Int J Geriatr Psychiatry 2021; 37:10.1002/gps.5645. [PMID: 34727407 PMCID: PMC8646416 DOI: 10.1002/gps.5645] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 10/31/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Several countries have implemented 'lockdown' measures to curb the spread of the coronavirus disease 2019 (COVID-19). AIMS To examine the psychological, physical activity (PA), and financial impact of a 2-month COVID-19 lockdown on older adults aged ≥60 years in Singapore, and to identify factors associated with adverse lockdown-related outcomes. METHOD We interviewed 496 community-dwelling adults (mean age [standard deviation]: 73.8 [7.6] years; 54.8% female) during the lockdown who had previously participated in a population-based epidemiological study. Validated questionnaires were utilised to assess loneliness and depressive symptoms at both timepoints, while inhouse questionnaires were used to assess PA and financial difficulty during lockdown. Multivariable regression models determined the lockdown-related change in loneliness and depression scores, and the factors associated with adverse outcomes. RESULTS Loneliness increased significantly during the lockdown period (p < 0.001) while depressive symptoms decreased (p = 0.022). Decreased PA, greater financial problems, male gender, Indian ethnicity, living alone, having a greater body mass index and perceived susceptibility to COVID-19 were all associated with worsening loneliness scores. A total of 36.9% and 19.6% participants reported decreased PA and had financial problems during the lockdown, respectively. Unemployment was associated with decreased PA, while self-employed individuals, cleaners, retail workers and smokers had greater odds of experiencing financial difficulty. CONCLUSION Despite a decrease in depressive symptoms, our population of older Asians reported a significant increase in loneliness and decreased PA, with one-fifth experiencing financial problems during lockdown. Our data suggest that more targeted public health efforts are needed to reduce repercussions of future lockdowns.
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Affiliation(s)
| | - Ryan Eyn Kidd Man
- Singapore Eye Research InstituteSingapore
- Singapore National Eye CentreSingapore
- Duke‐NUS Medical SchoolSingapore
| | | | | | | | - Kam Chun Ho
- Singapore Eye Research InstituteSingapore
- School of Optometry and Vision ScienceUniversity of New South Wales SydneyKensingtonNew South WalesAustralia
| | - Sharon Cohan Sung
- Duke‐NUS Medical SchoolSingapore
- Department of Developmental PsychiatryInstitute of Mental HealthSingapore
| | - Tien Yin Wong
- Singapore Eye Research InstituteSingapore
- Singapore National Eye CentreSingapore
- Duke‐NUS Medical SchoolSingapore
| | - Cyrus Su Hui Ho
- Department of Psychological MedicineYong Loo Lin School of MedicineNational University of SingaporeSingapore
| | | | - Ecosse L. Lamoureux
- Singapore Eye Research InstituteSingapore
- Singapore National Eye CentreSingapore
- Duke‐NUS Medical SchoolSingapore
- Ophthalmology Eye and Ear HospitalThe University of MelbourneMelbourneVictoriaAustralia
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17
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Ng SH, Tan NJH, Luo Y, Goh WS, Ho R, Ho CSH. A Systematic Review of Youth and Teen Mental Health First Aid: Improving Adolescent Mental Health. J Adolesc Health 2021; 69:199-210. [PMID: 33221189 DOI: 10.1016/j.jadohealth.2020.10.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 10/06/2020] [Accepted: 10/12/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE Adolescent mental illness often goes undetected. Youth and teen Mental Health First Aid (MHFA) are variations of adult MHFA that aims to help adults and adolescents recognize the signs and provide help where appropriate. We conducted a systematic review to summarize the current evidence for youth and teen MHFA, providing direction for future training and research. METHODS A systematic search was performed on September 12, 2020 on PubMed, Embase, PsycINFO, ERIC, and Cochrane using keywords related to teen or youth MHFA, adolescents, and mental health. A narrative synthesis was then carried out. RESULTS Of the 695 articles identified, 14 studies were included. All studies were from the U.S. and Australia. All studies demonstrated significant improvements in knowledge, recognition, stigmatizing attitudes, confidence, helping intentions, and helping behavior in both adult and youth participants. Improvement in knowledge and confidence was most reported, and improvement in helping behavior was the least reported. There is encouraging evidence of long-term benefits after the training. CONCLUSIONS More studies need to be conducted in non-Western countries, high-risk populations, and different professional settings. Future interventions could also consider different modes of learning, longer-term follow-up, and the measurement of outcomes that evaluate the quality of helping behavior.
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Affiliation(s)
- Sok Hui Ng
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Norman Jun Hao Tan
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yang Luo
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wei Sheng Goh
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Roger Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore.
| | - Cyrus Su Hui Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Department of Psychological Medicine, National University Health System, Singapore, Singapore
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18
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Ng TKS, Ho CSH, Tam WWS, Kua EH, Ho RCM. Decreased Serum Brain-Derived Neurotrophic Factor (BDNF) Levels in Patients with Alzheimer's Disease (AD): A Systematic Review and Meta-Analysis. Int J Mol Sci 2019; 20:ijms20020257. [PMID: 30634650 PMCID: PMC6358753 DOI: 10.3390/ijms20020257] [Citation(s) in RCA: 221] [Impact Index Per Article: 44.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 12/27/2018] [Indexed: 12/27/2022] Open
Abstract
Findings from previous studies reporting the levels of serum brain-derived neurotrophic factor (BDNF) in patients with Alzheimer's disease (AD) and individuals with mild cognitive impairment (MCI) have been conflicting. Hence, we performed a meta-analysis to examine the aggregate levels of serum BDNF in patients with AD and individuals with MCI, in comparison with healthy controls. Fifteen studies were included for the comparison between AD and healthy control (HC) (n = 2067). Serum BDNF levels were significantly lower in patients with AD (SMD: -0.282; 95% confidence interval [CI]: -0.535 to -0.028; significant heterogeneity: I² = 83.962). Meta-regression identified age (p < 0.001) and MMSE scores (p < 0.001) to be the significant moderators that could explain the heterogeneity in findings in these studies. Additionally, there were no significant differences in serum BDNF levels between patients with AD and MCI (eight studies, n = 906) and between MCI and HC (nine studies, n = 5090). In all, patients with AD, but not MCI, have significantly lower serum BDNF levels compared to healthy controls. This meta-analysis confirmed the direction of change in serum BDNF levels in dementia. This finding suggests that a significant change in peripheral BDNF levels can only be detected at the late stage of the dementia spectrum. Molecular mechanisms, implications on interventional trials, and future directions for studies examining BDNF in dementia were discussed.
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Affiliation(s)
- Ted Kheng Siang Ng
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
| | - Cyrus Su Hui Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
- Department of Psychological Medicine, National University Hospital, Singapore 119074, Singapore.
| | - Wilson Wai San Tam
- Alice Lee School of Nursing, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
| | - Ee Heok Kua
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
- Department of Psychological Medicine, National University Hospital, Singapore 119074, Singapore.
| | - Roger Chun-Man Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
- Department of Psychological Medicine, National University Hospital, Singapore 119074, Singapore.
- Biomedical Global Institute of Healthcare Research & Technology (BIGHEART), National University of Singapore, Singapore 119228, Singapore.
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 70000, Vietnam.
- Faculty of Education, Huaibei Normal University, 100 Dongshan Road, Huaibei 235000, Anhui, China.
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Abstract
The present study examined whether children's variation in arithmetic performance was related to differences in their understanding of place-value. Training in place-value concepts was provided to a group of Chinese children who were poor in arithmetic. Their performance before and after the training was compared to that of the children in two control groups. The results showed that there were reliable connections between place-value understanding and addition and subtraction skills. Furthermore, training in place-value concepts was found to be effective in enhancing the children's place-value understanding and addition skills. Implications for instructions in arithmetic were discussed. Copyright 1997Academic Press
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Affiliation(s)
- CSH Ho
- Chinese University of Hong Kong
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