Clinical guidelines for the use of lifestyle-based mental health care in major depressive disorder: World Federation of Societies for Biological Psychiatry (WFSBP) and Australasian Society of Lifestyle Medicine (ASLM) taskforce

Objectives: The primary objectives of these international guidelines were to provide a global audience of clinicians with (a) a series of evidence-based recommendations for the provision of lifestyle-based mental health care in clinical practice for adults with Major Depressive Disorder (MDD) and (b) a series of implementation considerations that may be applicable across a range of settings. Methods: Recommendations and associated evidence-based gradings were based on a series of systematic literature searches of published research as well as the clinical expertise of taskforce members. The focus of the guidelines was eight lifestyle domains: physical activity and exercise, smoking cessation, work-directed interventions, mindfulness-based and stress management therapies, diet, sleep, loneliness and social support, and green space interaction. The following electronic bibliographic databases were searched for articles published prior to June 2020: PubMed, EMBASE, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Methodology Register), CINAHL, PsycINFO. Evidence grading was based on the level of evidence specific to MDD and risk of bias, in accordance with the World Federation of Societies for Biological Psychiatry criteria. Results: Nine recommendations were formed. The recommendations with the highest ratings to improve MDD were the use of physical activity and exercise, relaxation techniques, work-directed interventions, sleep, and mindfulness-based therapies (Grade 2). Interventions related to diet and green space were recommended, but with a lower strength of evidence (Grade 3). Recommendations regarding smoking cessation and loneliness and social support were based on expert opinion. Key implementation considerations included the need for input from allied health professionals and support networks to implement this type of approach, the importance of partnering such recommendations with behaviour change support, and the need to deliver interventions using a biopsychosocial-cultural framework. Conclusions: Lifestyle-based interventions are recommended as a foundational component of mental health care in clinical practice for adults with Major Depressive Disorder, where other evidence-based therapies can be added or used in combination. The findings and recommendations of these guidelines support the need for further research to address existing gaps in efficacy and implementation research, especially for emerging lifestyle-based approaches (e.g. green space, loneliness and social support interventions) where data are limited. Further work is also needed to develop innovative approaches for delivery and models of care, and to support the training of health professionals regarding lifestyle-based mental health care

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

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

Self-help cognitive behavioral therapy for insomnia : a systematic review and a randomized controlled trial

Insomnia is recognized as one of the most common sleep complaints accompanied by daytime consequences in the general population worldwide. In recent years, the use of self-help cognitive behavioral therapy (CBT) has become a popular treatment option for insomnia. Firstly, a systematic review was conducted as an update and extension of a previous review (van Straten & Cuijpers, 2009). Two researchers systematically searched 6 major electronic databases in June 2012. We independently selected relevant publications, extracted data, and evaluated methodological quality according to the Cochrane criteria. Meta-analyses of self-help CBT vs. waiting-list (WL), routine care or no treatment, therapist-administered CBT, and placebo were performed. Twenty randomized controlled trials were included; 10 of which were recent publications. Results showed that self-help CBT improved sleep, sleep-related cognitions, and anxiety and depressive symptoms. Effect sizes for sleep diary-derived sleep efficiency (SE), sleep onset latency (SOL), and wake after sleep onset (WASO) at immediate posttreatment were 0.80, 0.66, and 0.55, respectively. The average attrition rate of self-help CBT at immediate posttreatment was 15.6%. Therapist-administered CBT was significantly more effective than self-help CBT. Subgroup analyses supported the inclusion of telephone consultation, but not “full” multi-component CBT and programs 6 weeks. In conclusion, self-help CBT is efficacious and acceptable as an entry level of a stepped-care model for insomnia. In places where face-to-face treatments are unavailable or too costly, self-help CBT can be considered as an adequate compromise. Secondly, a randomized controlled trial was conducted to evaluate the efficacy of an Internet-based cognitive behavioral therapy for insomnia (CBT-I) in Chinese insomnia population with or without medical and psychiatric comorbidities. Three hundred and twelve eligible participants were randomized to self-help CBT with telephone support (SHS), self-help CBT without telephone support (SH), and WL groups in a ratio of 1:1:1. Participants in the SHS and SH groups received self-help treatment once per week for 6 consecutive weeks, whereas participants in the WL group began treatment after 12 weeks of assessment. In addition to the standard self-help treatment, the participants in the SHS group received weekly brief therapist-administered telephone support. The Internet-based CBT-I showed significant improvements in insomnia symptoms and sleep-related dysfunctional cognitions. Improvement was further enhanced by weekly brief telephone support. The results suggested that Internet-based CBT-I is effective and acceptable to treat insomnia.published_or_final_versionPsychiatryMasterMaster of Philosoph

Low intensity psychological intervention for common mental disorders

In recent years, there is a trend toward the integration of low-intensity psychological interventions into service provision as a way of increasing access to psychological treatments for common mental illnesses in primary health settings worldwide. In view of the structural constraints and cultural barriers of the existing mental health system, such as long waiting period for follow-up, stigma for mental illnesses, and deviation from traditional weekly in-person sessions, it is believed that low-intensity psychological interventions can be a feasible alternative to provide mental health prevention and/or treatment services to the community. This thesis presents three models of low-intensity psychological interventions, namely stepped care approach, transdiagnostic approach, and self-help approach. Stepped care model is considered as a cost effective service delivery model, which provides evidence-based psychological interventions in a hierarchy of low-intensity treatments such as self-help treatments to high-intensity treatments involving individual therapy provided by clinical psychologists, at both the individual and community levels. A meta-analytic review (Study 1) was conducted to evaluate the efficacy and cost-effectiveness of stepped care prevention and treatment for depressive and/or anxiety disorders. There is a shifting perspective away from a disorder-specific intervention approach towards a transdiagnostic intervention approach. Transdiagnostic intervention is a treatment protocol that addresses the commonalities in cognitive and behavioral factors shared across common mental disorders. The application of transdiagnostic self-help cognitive behavioral therapy for insomnia (CBT-I) on comorbid insomnia and depression was examined through a meta-analysis (Study 2) and a secondary analysis of a randomized controlled trial (Study 3). Self-help intervention is recommended as the least restrictive entry step of the stepped care model. Psychological interventions delivered by Internet and smartphone application serve to increase the access to mental health care, and potentially reduce cost and waiting time. A smartphone application “proACT-S” was developed as an alternative delivery modality. The preliminary treatment efficacy and feasibility were evaluated in an open-trial (Study 4). Results of Study 1 provisionally suggest that stepped care was effective in treating anxiety symptoms, but not preventing anxiety and depression, or treating depression, when compared with care-as-usual. In Study 2, the comparisons between self-help CBT-I and waiting-list/routine care/no treatment/ psychoeducation demonstrated significant differences in favor of the former in alleviating both depressive symptoms and insomnia symptoms. In Study 3, the results revealed that the Internet-based self-help CBT-I, especially with minimal therapist support, could help alleviate the severity of depressive and insomnia symptoms in Chinese adult population. In Study 4, the results suggest that “proACT-S” was effective in mitigating insomnia symptoms, depressive and anxiety symptoms, and improving quality of life. In addition, participants reported high level of treatment acceptability and usability as well as satisfactory treatment adherence. In conclusion, the results across the four studies provide important foundations in addressing the unmet mental health needs through low-intensity psychological interventions in regions with scarce resources.published_or_final_versionPsychologyDoctoralDoctor of Philosoph

Validity and reliability of the Brief Insomnia Questionnaire in the general population in Hong Kong

Objectives: The Brief Insomnia Questionnaire (BIQ) was first validated in the U.S. for insomnia disorders according to the Diagnostic and Statistical Manual, Fourth Edition, Text Revision (DSM-IV-TR), International Classification of Diseases, Tenth Edition (ICD-10) and research diagnostic criteria/International Classification of Sleep Disorders, Second Edition (RDC/ICSD-2). We aimed to determine the validity and reliability of a Hong Kong Chinese version of the BIQ to derive the DSM-5 in addition to other insomnia diagnoses in a general population sample. Methods: Probability subsamples of population-based epidemiological survey respondents (n. = 2011) completed test-retest (n. = 120) and clinical reappraisal (n. = 176) interviews. Results: Short-term test-retest reliability was moderate for most BIQ items (Pearson r. >. 0.40), except for the number of nights with problems staying asleep, amount of time awake, duration of sleep problems and sleep onset latency. The areas under the receiver operating characteristic curve for the DSM-IV-TR, DSM-5, ICD-10 and RDC/ICSD-2 insomnia disorder ranged from 0.76 to 0.86, indicating high individual-level concordance between BIQ and clinical-interview diagnoses. The use of super-normal control and BIQ symptom-level data further improves the diagnostic concordance. Prevalence estimates based on the BIQ dichotomous classification were comparable with estimates based on clinical interviews for the DSM-5, RDC/ICSD-2 and any of the DSM-IV-TR, ICD-10 and RDC/ICSD-2 insomnia disorders. Conclusion: The Hong Kong Chinese version of the BIQ generates accurate prevalence estimates for insomnia disorders in the general population. Modification of the BIQ scoring algorithms and use of trained interviewers may further improve its diagnostic performance. © 2014 Elsevier Inc.link_to_subscribed_fulltex

Assessment of fatigue using the Multidimensional Fatigue Inventory in patients with major depressive disorder

Objectives: There are problems with the fatigue measures currently used in depressed patients. The Multidimensional Fatigue Inventory (MFI-20) covering general fatigue, physical fatigue, mental fatigue, reduced activity and reduced motivation has been widely used in patients with cancer and chronic fatigue syndrome. To address the multidimensional nature of fatigue, we examined the validity and reliability of a Chinese version of the MFI-20 in major depressive disorder (MDD). Methods: Data were derived from a randomized controlled trial of acupuncture in 137 patients with partially remitted MDD. The test-retest reliability, internal consistency, construct and concurrent validity and sensitivity to change of the MFI-20 were analyzed. Results: The MFI-20 was found to have good internal consistency (Cronbach's alpha = 0.89) and 1-week test-retest reliability (Pearson correlation of the total score = 0.73). Factor analysis showed 5 factors, but the factor structure was different from that in medical conditions. The 2 most prominent factors, explaining 46% of the total variance, were both associated with physical and mental energy but different in directions. There were adequate concurrent validity and sensitivity to change as evidenced by the significant correlations between the MFI-20 scores and depressive and anxiety symptoms, general health and quality of life. Conclusion: The Chinese MFI-20 is a valid and reliable instrument for the assessment of fatigue in MDD patients with residual symptoms. The construct of fatigue in MDD seems to be different from that in medical conditions. Further studies are needed to examine the MFI-20 in MDD patients from other cultures. © 2014 Elsevier Inc.link_to_subscribed_fulltex

Prevalence of sleep disturbances during COVID-19 outbreak in an urban Chinese population: a cross-sectional study

Objective: The COVID-19 pandemic is a large-scale public health emergency that likely precipitated sleep disturbances in the community. This study aimed to investigate the prevalence and correlates of sleep disturbances during the early phase of COVID-19 pandemic. Methods: This web-based cross-sectional study recruited 1138 Hong Kong adults using convenience sampling over a two-week period from 6th April 2020. The survey collected data on sleep disturbances, mood, stress, stock of infection control supplies, perceived risk of being infected by COVID-19, and sources for acquiring COVID-19 information. The participants were asked to compare their recent sleep and sleep before the outbreak. The Insomnia Severity Index (ISI) was used to assess their current insomnia severity. Prevalence was weighted according to 2016 population census. Results: The weighted prevalence of worsened sleep quality, difficulty in sleep initiation, and shortened sleep duration since the outbreak were 38.3%, 29.8%, and 29.1%, respectively. The prevalence of current insomnia (ISI score of ≥10) was 29.9%. Insufficient stock of masks was significantly associated with worsened sleep quality, impaired sleep initiation, shortened sleep duration, and current insomnia in multivariate logistic regression (adjusted OR = 1.57, 1.72, 1.99, and 1.96 respectively, all p < 0.05). Conclusion: A high proportion of people in Hong Kong felt that their sleep had worsened since the COVID-19 outbreak. Insufficient stock of masks was one of the risk factors that were associated with sleep disturbances. Adequate and stable supply of masks may play an important role to maintain the sleep health in the Hong Kong general population during a pandemic outbreak