Workplace mental health: An international review of guidelines

The aim of this systematic review was to determine the quality and comprehensiveness of guidelines developed for employers to detect, prevent, and manage mental health problems in the workplace. An integrated approach that combined expertise from medicine, psychology, public health, management, and occupational health and safety was identified as a best practice framework to assess guideline comprehensiveness. An iterative search strategy of the grey literature was used plus consultation with experts in psychology, public health, and mental health promotion. Inclusion criteria were documents published in English and developed specifically for employers to detect, prevent, and manage mental health problems in the workplace. A total of 20 guidelines met these criteria and were reviewed. Development documents were included to inform quality assessment. This was performed using the AGREE II rating system. Our results indicated that low scores were often due to a lack of focus on prevention and rather a focus on the detection and treatment of mental health problems in the workplace. When prevention recommendations were included they were often individually focused and did not include practical tools or advice to implement. An inconsistency in language, lack of consultation with relevant population groups in the development process and a failure to outline and differentiate between the legal/minimum requirements of a region were also observed. The findings from this systematic review will inform translation of scientific evidence into practical recommendations to prevent mental health problems within the workplace. It will also direct employers, clinicians, and policy-makers towards examples of best-practice guidelines

A systematic review and meta-analysis of workplace mindfulness training randomized controlled trials

This meta-analytic review responds to promises in the research literature and public domain about the benefits of workplace mindfulness training. It synthesizes randomized controlled trial evidence from workplace-delivered training for changes in mindfulness, stress, mental health, well-being, and work performance outcomes. Going beyond extant reviews, this article explores the influence of variability in workforce and intervention characteristics for reducing perceived stress. Meta-effect estimates (Hedge’s g) were computed using data from 23 studies. Results indicate beneficial effects following training for mindfulness (g = 0.45, p < .001) and stress (g = 0.56, p < .001), anxiety (g = 0.62, p < .001) and psychological distress (g = 0.69, p < .001), and for well-being (g = 0.46, p = .002) and sleep (g = 0.26, p = .003). No conclusions could be drawn from pooled data for burnout due to ambivalence in results, for depression due to publication bias, or for work performance due to insufficient data. The potential for integrating the construct of mindfulness within job demands-resources, coping, and prevention theories of work stress is considered in relation to the results. Limitations to study designs and reporting are addressed, and recommendations to advance research in this field are made. (PsycINFO Database Record (c) 2019 APA, all rights reserved

Effects of a mindfulness app on employee stress in an Australian public sector workforce: Randomized controlled trial

Background: Workplace-based mindfulness programs have good evidence for improving employee stress and mental health outcomes, but less is known about their effects on productivity and citizenship behaviors. Most of the available evidence is derived from studies of mindfulness programs that use class-based approaches. Mindfulness apps can increase access to training, but whether self-directed app use is sufficient to realize benefits equivalent to class-based mindfulness programs is unknown. Objective: We assessed the effectiveness of a mindfulness app, both with and without supporting classes, for reducing employees’ perceived stress. Changes in mindfulness, mental health, quality of life, perceptions of job demand, control and support, productivity indicators, organizational citizenship, and mindful behaviors at work were also investigated. Methods: Tasmanian State Service employees were invited by the Tasmanian Training Consortium to a 3-arm randomized controlled trial investigating the effects of a mindfulness app on stress. The app used in the Smiling Mind Workplace Program formed the basis of the intervention. The app includes lessons, activities, and guided meditations, and is supported by 4 instructional emails delivered over 8 weeks. Engagement with the app for 10-20 minutes, 5 days a week, was recommended. Reported data were collected at baseline (time point 0), 3 months from baseline (time point 1 [T1]), and at 6-month follow-up (time point 2). At time point 0, participants could nominate a work-based observer to answer surveys about participants’ behaviors. Eligible participants (n=211) were randomly assigned to self-guided app use plus four 1-hour classes (app+classes: 70/211, 33.2%), self-guided app use (app-only: 71/211, 33.6%), or waitlist control (WLC; 70/211, 33.2%). Linear mixed effects models were used to assess changes in the active groups compared with the WLC at T1 and for a head-to-head comparison of the app+classes and app-only groups at follow-up. Results: App use time was considerably lower than recommended (app+classes: 120/343 minutes; app-only: 45/343 minutes). Compared with the WLC at T1, no significant change in perceived stress was observed in either active group. However, the app+classes group reported lower psychological distress (β=−1.77, SE 0.75; P=.02; Cohen d=–0.21) and higher mindfulness (β=.31, SE 0.12; P=.01; Cohen d=0.19). These effects were retained in the app+classes group at 6 months. No significant changes were observed for the app-only group or for other outcomes. There were no significant changes in observer measures at T1, but by time point 2, the app+classes participants were more noticeably mindful and altruistic at work than app-only participants. Conclusions: Including classes in the training protocol appears to have motivated engagement and led to benefits, whereas self-guided app use did not realize any significant results. Effect sizes were smaller and less consistent than meta-estimates for class-based mindfulness training. Trial Registration: Australian New Zealand Clinical Trials Register ACTRN12617001386325; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372942&isRevie

Bridging the evidence gap: A review and research protocol for outdoor mental health therapies for young Australians

Internationally, over 60% of all lifetime cases of mental health disorders are identified as emerging by 25 years of age. In Australia, young people (aged 16–24 years) report the highest prevalence of mental health problems. Acceptability of mainstream services for young people is a concern, particularly for clients 18–25 years, heterosexual males and certain marginalised communities. With unaddressed distress in young people a precursor to poor, potentially lifelong mental ill-health trajectories, the provision of acceptable, and accessible mental health services remains a critical system imperative. Outdoor therapies, such as outdoor talking therapies, present an option for increasing the breadth of mental health interventions available to young people. Reported benefits of outdoor therapies include improved self-esteem and confidence, positive and negative affect, stress reduction and restoration, social benefits, and resilience. As outdoor therapies draw on multidisciplinary skillsets, this modality has the potential to expand services beyond existing workforce capacities. However, there are evidence gaps that must be addressed before mainstreaming of this treatment modality can occur. Here we overview the existing evidence base for outdoor talking therapies, as a form of outdoor mental healthcare, to determine their appropriateness as an effective and efficient treatment modality for young people with psychological distress in Australia and elsewhere. We then propose a research protocol designed to determine the acceptability, efficacy and efficiency of ‘outdoor talking therapies’. Our aim is to help address identified youth mental healthcare service shortages in Australia, and potentially support the health of our mental healthcare workforce

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016) : part two

Background The immunological escape of tumors represents one of the main ob- stacles to the treatment of malignancies. The blockade of PD-1 or CTLA-4 receptors represented a milestone in the history of immunotherapy. However, immune checkpoint inhibitors seem to be effective in specific cohorts of patients. It has been proposed that their efficacy relies on the presence of an immunological response. Thus, we hypothesized that disruption of the PD-L1/PD-1 axis would synergize with our oncolytic vaccine platform PeptiCRAd. Methods We used murine B16OVA in vivo tumor models and flow cytometry analysis to investigate the immunological background. Results First, we found that high-burden B16OVA tumors were refractory to combination immunotherapy. However, with a more aggressive schedule, tumors with a lower burden were more susceptible to the combination of PeptiCRAd and PD-L1 blockade. The therapy signifi- cantly increased the median survival of mice (Fig. 7). Interestingly, the reduced growth of contralaterally injected B16F10 cells sug- gested the presence of a long lasting immunological memory also against non-targeted antigens. Concerning the functional state of tumor infiltrating lymphocytes (TILs), we found that all the immune therapies would enhance the percentage of activated (PD-1pos TIM- 3neg) T lymphocytes and reduce the amount of exhausted (PD-1pos TIM-3pos) cells compared to placebo. As expected, we found that PeptiCRAd monotherapy could increase the number of antigen spe- cific CD8+ T cells compared to other treatments. However, only the combination with PD-L1 blockade could significantly increase the ra- tio between activated and exhausted pentamer positive cells (p= 0.0058), suggesting that by disrupting the PD-1/PD-L1 axis we could decrease the amount of dysfunctional antigen specific T cells. We ob- served that the anatomical location deeply influenced the state of CD4+ and CD8+ T lymphocytes. In fact, TIM-3 expression was in- creased by 2 fold on TILs compared to splenic and lymphoid T cells. In the CD8+ compartment, the expression of PD-1 on the surface seemed to be restricted to the tumor micro-environment, while CD4 + T cells had a high expression of PD-1 also in lymphoid organs. Interestingly, we found that the levels of PD-1 were significantly higher on CD8+ T cells than on CD4+ T cells into the tumor micro- environment (p < 0.0001). Conclusions In conclusion, we demonstrated that the efficacy of immune check- point inhibitors might be strongly enhanced by their combination with cancer vaccines. PeptiCRAd was able to increase the number of antigen-specific T cells and PD-L1 blockade prevented their exhaus- tion, resulting in long-lasting immunological memory and increased median survival

Surveys and Questionnaires – Methods Matter: Series 2, Episode 5

In expert corner for this episode is Dr Petra Boynton. Dr Boynton is a social psychologist, specialising in international health research from a critical perspective. Over the past 20 years, she has taught, supervised and undertaken research across the social and health sciences. She has also carried out development within university and community settings, as well as writing extensively on academic life, including publishing a book called Being Well in Academia, and being an agony aunt. In researcher ranch is Dr Larissa Bartlett, who is an ISLAND Research Fellow at the Wicking Dementia Research & Education Centre at the University of Tasmania. Dr Bartlett's PhD focussed on the promises and challenges of workplace-delivered mindfulness interventions for employee health and performance. Now Larissa leads the ISLAND Study, a large, 10-year prospective public health cohort study with nested interventions targeting modifiable dementia risk factors at population-level in adults aged 50 and over. Methods Matter – from Dementia Researcher and the National Centre for Research Methods – is a podcast for people who don't know much about methods, those who do and those who just want to find news and clever ways to use them in their research. In this second series, Clinical Research Fellow Dr Donncha Mullin from the University of Edinburgh brings together leading experts in research methodology, and the dementia researchers that use them, to provide a fun introduction to five qualitive research methods in a safe space where there are no such things as dumb questions. In this season, the podcast covers oral histories and story telling, grounded theory, visual and creative methods, focus groups and surveys and questionnaires