Promotive and preventive interventions for mental health and well-being in adult populations: a systematic umbrella review

Introduction

Mental health disorders are increasing worldwide, leading to significant personal, economic, and social consequences. Mental health promotion and prevention have been the subject of many systematic reviews. Thus, decision makers likely face the problem of going through literature to find and utilize the best available evidence. Therefore, this systematic umbrella review aims to evaluate the effectiveness of interventions for promoting mental health and mental well-being, as well as for the primary prevention of mental health disorders.

Methods

Literature searches were performed in APA PsycInfo, Medline, and Proquest Social Science databases from January 2000 to December 2021. The search results were screened for eligibility using pre-defined criteria. The methodological quality of the included reviews was evaluated using the AMSTAR 2 tool. The key findings of the included reviews were narratively synthesized and reported with an emphasis on reviews achieving higher methodological quality.

Results

Out of the 240 articles found, 16 systematic reviews and four systematic umbrella reviews were included. The methodological quality of included reviews was low or critically low.

Discussion

This review suggests that interventions using cognitive-behavioral therapy and those developing resilience, mindfulness, or healthy lifestyles can be effective in the promotion of mental health and well-being in adult populations. Motivational interviewing may reduce alcohol consumption in young adults. Indicated or selective prevention is likely to be cost-effective compared to universal prevention. Parenting interventions and workplace interventions may be cost-effective in terms of promoting mental health. Due to the low methodological quality of the included reviews and substantial heterogeneity among the reported results, the findings from the reviews we summarized should be interpreted with caution. There is a need for further rigorous, high-quality systematic reviews.

Municipal resources to promote adult physical activity - a multilevel follow-up study

Background

In Finland, local authorities (municipalities) provide many services, including sports and physical activity facilities such as pedestrian and bicycle ways and lanes, parks, sports arenas and pools. This study aimed to determine whether local authorities can promote physical activity by allocating resources to physical activity facilities.

Methods

The data on municipality expenditure on physical activity and sports, number of sports associations receiving subsidies from the municipality, kilometers of ways for pedestrians and bicycles and hectares of parks in 1999 and 2010 were gathered from national registers. These data were combined using unique municipal codes with individual survey data on leisure-time physical activity (N = 3193) and commuting physical activity (N = 1394). Panel data on physical activity originated from a national health survey, the Health 2000 study, conducted in 2000–2001 and 2011–2012. We used the data of persons who answered the physical activity questions twice and had the same place of residence in both years. In the data, the individuals are nested within municipalities, and multilevel analyses could therefore be applied. The data comprised a two-wave panel and the individuals were followed over 11 years.

Results

The resources for physical activity varied between municipalities and years. Municipal expenditure for physical activity and total kilometers of pedestrian ways increased significantly during the 11 years, although a clear decrease was observed in individuals’ physical activity. In our models, individual characteristics including higher education level (OR 1.87) and better health status (OR 7.29) increased the odds of increasing physical activity. Female gender was associated with lower (OR 0.83) leisure-time physical activity. Living in rural areas (OR 0.37) decreased commuting physical activity, and age (OR 1.05) increased it. Women (OR 3.16) engaged in commuting physical activity more than men.

Conclusions

Individual-level factors were more important for physical activity than local resources. A large part of the variation in physical activity occurs between individuals, which suggests that some factors not detected in this study explain a large part of the overall variation in physical activity.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13617-8.

Associations of neighbourhood safety with leisure-time walking and cycling in population subgroups: The HELIUS study

To create neighbourhood environments that encourage physical activity, it is important to know which neighbourhood characteristics are most influential. We examined the association of neighbourhood safety with leisure-time walking and cycling in the population at large, as well as in some subgroups in terms of sex, age, ethnicity and socio-economic position. We used data of 19,914 participants (18-70 years) from a study in Amsterdam, the Netherlands. Leisure-time walking and cycling in minutes/week were assessed with standard questionnaire. Geographic Information System techniques were used to examine neighbourhood safety (range = 1-10). Multilevel linear regression analyses showed positive associations between safety and walking (B = 7.9, 95% CI = -6.2-21.9) and cycling (B = 14.8, 95% CI = 2.5-27.1), but only the association with cycling was statistically significant. Higher safety levels were significantly associated with more cycling in women and individuals of Turkish and Moroccan origin. Stronger evidence is needed to inform policies to stimulate walking and cycling by improving neighbourhood safety.

Gender, age and socioeconomic variation in 24-hour physical activity by wrist-worn accelerometers: the FinHealth 2017 Survey

Assessing movement over 24 hours increases our understanding of the total physical activity level and its patterns. In the FinHealth 2017 Survey, a population-based health examination study, 940 participants between 25 and 93 years were instructed to wear an accelerometer (Actigraph GT9X Link) on their non-dominant wrist for 24 hours on 7 consecutive days. Physical activity information was extracted from 100-Hz triaxial 60-second epoch data as average vector magnitude counts per minute (VM cpm). Results were analyzed by gender, 10-year age-groups, employment status, and education. Hourly means were plotted and compared. Analyses included 915 participants (44% men) who wore the device at least 10 hours on 4 or more days, with mean wear time being 149.5 hours (standard deviation of 615.2 minutes).Women had higher average VM cpm than men (p < 0.001), with significant gender differences in all age-groups until 65 years and older. Total physical activity was lower with age, unemployment, and retirement, where the hourly patterns mirrored the findings. Our findings agree with previous large-scale wrist-accelerometry data, but extend current knowledge by providing data on gender and socioeconomic variation in physical activity across 24 hours in a population-based adult sample representing a broad age range.

Frequent sit-to-stand transitions and several short standing periods measured by hip-worn accelerometer are associated with smaller waist circumference among adults

This cross-sectional study analysed the association of sedentary behaviour (SB) and standing with waist circumference. Finnish adults aged 30-75 years from a sub-sample of population-based Health 2011 Study used a hip-worn tri-axial accelerometer (Hookie AM20, Traxmeet, Ltd, Espoo, Finland) for seven days. Those 1405 participants (57% women) who used accelerometer at least four days, minimum of 10 hours/day, were included. SB and standing were analysed in 6s epochs using validated algorithm. Daily total time, daily number and accumulated time from bouts (30s-5min,30s-10min,30s-15min,30s 30min,>5min,>10min,>15min, >30min) as well as daily number of sit-to-stand transitions were determined. Waist circumference (cm) was measured in standardized way. Participants' mean age was 52 years (SD 12.2). Mean waist circumference was 97cm (SD 12.3) in men and 87cm (SD 12.7) in women. According to multivariable stepwise linear regression analysis, sit-to-stand transitions [standardised regression coefficient (β)= -0.14, 95%CI -0.20 to -0.09], standing bouts of 30s-5min (β= -0.21, 95%CI -0.26 to -0.15) and number of 30s-30min SB bouts (β=0.12, 95%CI 0.06 to 0.17) were most strongly associated with waist circumference. Besides assessing total SB time, future studies should assess also different bout lengths of SB and sit-to-stand transitions and standing times should be assessed separately.

Aerobic physical activity assessed with accelerometer, diary, questionnaire, and interview in a Finnish population sample

This study evaluates the agreement between different methods to assess moderate to vigorous physical activity (MVPA) in a large sample of Finnish adults. Methods were classified and examined pairwise (accelerometer vs diary; questionnaire vs interview). Proportion of participants meeting the aerobic health-enhancing physical activity (HEPA) recommendation was compared pairwise between all four methods. The present study of 1916 adults aged 18-75 years (mean age 50 years, 57% women) is a sub-sample of population-based Health 2011 Study conducted by the National Institute of Health and Welfare in Finland. Participants used accelerometer for 7 days and completed physical activity (PA) diary during the same period. PA questionnaire and interview were completed retrospectively to assess typical weekly PA over the past year. Agreement between the methods was analyzed with paired samples t-test and Bland-Altman plot. Kappa-test was used to compare the prevalence of meeting the HEPA recommendation. The accelerometer resulted in 13 minutes (P < 0.001) higher weekly total amount of MVPA compared to diary. According to Bland-Altman plot, the 95% limit of agreement was from +273 to -247 in weekly minutes. The comparison between questionnaire and interview showed non-significant mean difference of 3 minutes (P = 0.60) in weekly MVPA, but the Bland-Altman plot showing the 95% limit of agreement from +432 to -427 in weekly minutes. Agreement of meeting HEPA recommendation was moderate between questionnaire and interview (κ = 0.43) but poor (κ = 0.20-0.38) between other comparisons. The inter-method differences were large especially at the individual level. Thus the assessment of PA is strongly method-dependent and not interchangeable.

Predictors of Persistence of Risky Drinking in Adults: An 11-Year Follow-Up Study

AIM

To examine the long-term predictors of persistence of risky drinking in a baseline group of risky drinkers in whom alcohol use disorder had not been diagnosed.

METHODS

The data was derived from a representative sample of the Finnish adult population aged 30 years or more, surveyed at 2 time points in the years 2000 (n = 5,726) and 2011 (n = 3,848, 67.2% of the baseline sample). Risky drinking was defined using BSQF-measurement (for men, 21 standard UK drinks or more per week; for women 14+ drinks) and not having alcohol abuse or alcohol dependence. The sample of risky drinkers in baseline comprised 642 persons, of whom 380 (59.2%) people provided follow-up data. Multivariable logistic regression models were estimated to identify determinants of persistence of risky drinking.

RESULTS

The rate for persistence of risky drinking was 48.7%. Persistence was predicted by daily smoking, low physical activity, and male gender, whereas higher age and later onset of drinking predicted cessation of risky drinking. Daily smoking remained an independent predictor after adjusting for other risk factors.

CONCLUSIONS

Health behaviour predicts the persistence of risky drinking in a study population of adults aged 30 and over. These factors should be taken into account when assessing the long-term prognosis on risky drinking.

Objectively measured sedentary behavior and physical activity in a sample of Finnish adults: a cross-sectional study

Background

Regular physical activity (PA) confers many positive effects on health and well-being. Sedentary behavior (SB), in turn, is a risk factor for health, regardless of the level of moderate to vigorous PA. The present study describes the levels of objectively measured SB, breaks in SB, standing still and PA among Finnish adults.

Methods

This cross-sectional analysis is based on the sub-sample of the population-based Health 2011 Study of Finnish adults. The study population consisted of 18-to-85-year old men and women who wore a waist-worn triaxial accelerometer (Hookie AM 20) for at least 4 days, for at least 10 h per day (n = 1587) during a week. PA and SB were objectively assessed from the raw accelerometric data using novel processing and analysis algorithms with mean amplitude deviation as the processing method. The data was statistically analyzed using cross-tabulations, analysis of variance and analysis of covariance.

Results

The participants were on average 52 years old, 57 % being women. Participants were sedentary 59 % of their waking wear time, mainly sitting. They spent 17 % of the time standing still, 15 % in light intensity PA, 9 % in moderate PA and less than 1 % in vigorous PA. Participants aged 30–39 years had the highest number of breaks in SB per day. Younger participants (<30 years of age) had more moderate and vigorous PA than older ones (≥60 years of age), and 30–60-year-olds had the greatest amount of light PA.

Conclusions

Participants spent nearly 60 % of their waking time sedentary, and the majority of their daily PA was light. From a public health perspective it is important to find effective ways to decrease SB as well as to increase the level of PA. Our analysis method of raw accelerometer data may allow more precise assessment of dose-response relationships between objectively measured PA and SB and various indicators of health and well-being.

Genome-wide association study identifies 74 loci associated with educational attainment

Educational attainment is strongly influenced by social and other environmental factors, but genetic factors are estimated to account for at least 20% of the variation across individuals. Here we report the results of a genome-wide association study (GWAS) for educational attainment that extends our earlier discovery sample of 101,069 individuals to 293,723 individuals, and a replication study in an independent sample of 111,349 individuals from the UK Biobank. We identify 74 genome-wide significant loci associated with the number of years of schooling completed. Single-nucleotide polymorphisms associated with educational attainment are disproportionately found in genomic regions regulating gene expression in the fetal brain. Candidate genes are preferentially expressed in neural tissue, especially during the prenatal period, and enriched for biological pathways involved in neural development. Our findings demonstrate that, even for a behavioural phenotype that is mostly environmentally determined, a well-powered GWAS identifies replicable associated genetic variants that suggest biologically relevant pathways. Because educational attainment is measured in large numbers of individuals, it will continue to be useful as a proxy phenotype in efforts to characterize the genetic influences of related phenotypes, including cognition and neuropsychiatric diseases.