The efficacy of exercise interventions for all types of inpatients across mental health settings: A systematic review and meta-analysis of 47 studies

This systematic review and meta-analysis investigated the benefits, safety and adherence of exercise interventions delivered in inpatient mental health settings, quantified the number of exercise trials that provided support to maintain engagement in exercise post-discharge, and reported patient feedback towards exercise interventions. Major databases were searched from inception to 22.06.2022 for intervention studies investigating exercise in mental health inpatient settings. Study quality was assessed using Cochrane and ROBINS-1 checklists. Fifty-six papers were included from 47 trials (including 34 RCTs), bias was high. Exercise improved depression (Standardised mean difference = −0.416; 95% Confidence interval −0.787 to −0.045, N = 15) compared to non-exercise comparators amongst people with a range of mental illnesses, with further (albeit limited) evidence suggesting a role of exercise in cardiorespiratory fitness and various other physical health parameters and ameliorating psychiatric symptoms. No serious exercise-related adverse events were noted, attendance was ≥80% in most trials, and exercise was perceived as enjoyable and useful. Five trials offered patients post-discharge support to continue exercise, with varying success. In conclusion, exercise interventions may have therapeutic benefits in inpatient mental health settings. More high-quality trials are needed to determine optimal parameters, and future research should investigate systems to support patients to maintain exercise engagement once discharged

Are people with schizophrenia adherent to diabetes medication? A comparative meta-analysis

Individuals living with schizophrenia are 2–3 times more likely to experience type 2 diabetes mellitus. Diabetes medication adherence is essential to reduce morbidity and mortality in this population. We conducted a meta-analysis of diabetes medication adherence among people with schizophrenia, and compared this to those without schizophrenia. A systematic search strategy was used to identify all articles reporting adherence to diabetes medications among patients with schizophrenia. In total, 10 unique studies reporting data from 33,910 people with schizophrenia were included. Random effects meta-analysis showed people with schizophrenia adhered to medication on 77.3% of days prescribed (n=32080, 95%CI=73.6–81%, I2=99.2%,), and adhered on 4.6% more days per year than those without schizophrenia (p<0.01, 95%CI=2.4–6.7%, I2=92.5%, schizophrenia n=19367, controls=170,853). Furthermore, 56% of individuals with schizophrenia (n=33680) were considered “adherent” (i.e. >80% adherence over 12–24 month) to diabetes medication, which was significantly more than those without schizophrenia (OR=1.34, 95%CI: 1.18–1.52, p<0.01). Factors which were positively associated with diabetes medication adherence were age, number of outpatient visits, along with multiple medication administration variables. Future prospective research should examine diabetes monitoring, medication prescription, and subsequent adherence in fully representative samples. Novel interventions for maximizing compliance to diabetes medication in this vulnerable population should also be explored

Use of smartphones, mobile apps and wearables for health promotion by people with anxiety or depression:An analysis of a nationally representative survey data

People with mental illness have increased cardiovascular risk factors, which contributes significantly to mortality in this population. Digital interventions have emerged as promising models to promote physical health, although their potential for use in mental health populations is relatively unexplored. We examined the potential for using digital tools for health promotion by people with common mental disorders like anxiety or depression. Using data from the 2019 edition of the Health Information National Trends Survey (HINTS 5), we evaluated differences between individuals with self-reported history of diagnosed depression/anxiety and the general population with respect to ownership, usage, and perceived usefulness of digital tools for managing their health. Overall, individuals with anxiety or depression were as likely as the general population to use digital devices for their care. Those with anxiety or depression who had health apps were more likely to report intentions to lose weight than those without health apps. Significant sociodemographic predictors of digital tools usage included gender, age, income, and education level. People with anxiety or depression own and use digital health tools at similarly high rates to the general population, suggesting that these tools present a novel opportunity for health promotion among people with these disorders

Physical health interventions on adolescent mental health inpatient units : a systematic review and call to action

Aim: Physical health inequalities experienced by people with mental health conditions are labelled an international scandal; due to the 15 to 30‐year gap in life expectancy, driven mostly by physical health conditions. Lifestyle interventions are recommended to prevent the onset of poor physical health in people with mental illness. Yet, there is less high‐quality evidence for adolescents, particularly those in inpatient settings. We aimed to assess existing literature reporting physical health or lifestyle interventions conducted on adolescent mental health inpatient units. Method: An electronic search of MEDLINE, PsycINFO, Embase, the Cochrane Central Register of Controlled Trials and AMED was conducted on 13th June 2019. Eligible studies included peer‐reviewed English language research articles of physical health interventions delivered within child and adolescent mental health inpatient services. A narrative synthesis was conducted on the data. Results: Only three studies were identified implementing health interventions for adolescent inpatients. The interventions consisted of two physical health interventions aiming to increase activity levels within routine care (one gym‐based, one sports led) and a yoga intervention. Outcome measurements varied and benefits were observed in relation to overall health (HONOSCA), physical health (waist, hip and chest circumference) and behaviour. Conclusions: Although preliminary results suggest lifestyle interventions may be feasible and beneficial for this group, more work is needed to fully understand the best way to implement these interventions within adolescent clinical settings. Adolescent inpatients are an important target for such interventions, affording the opportunity to prevent the onset of physical comorbidities

The clinical and behavioral cardiometabolic risk of children and young people on mental health inpatient units: A systematic review and meta-analysis

Objective: Serious mental illness is associated with physical health comorbidities, however most research has focused on adults. We aimed to synthesise existing literature on clinical and behavioral cardiometabolic risk factors of young people on mental health inpatient units. Methods: A systematic review and meta-analysis was conducted, using electronic searches of PsycINFO, EMBASE, AMED, Cochrane Central Register of Controlled Trials, and Ovid MEDLINE. Eligible studies included child/adolescent mental health inpatient units for 25) was 32.4% (95% CI 26.1%–39.5%; n = 2789), and who were obese (BMI > 30) was 15.5% (95% CI 4.5%–41.6%; n = 2612). Pooled prevalence rates for tobacco use was 51.5% (95% CI 32.2–70.2; N = 804,018). Early signs of metabolic risk were observed; elevated blood cholesterol, presence of physical health conditions, and behavioral risk factors (e.g. physical inactivity). Conclusions: This review highlights the vulnerability of young people admitted to inpatient units and emphasises the opportunity to efficiently monitor, treat and intervene to target physical and mental health

Food and mood:how do diet and nutrition affect mental wellbeing?

Poor nutrition may be a causal factor in the experience of low mood, and improving diet may help to protect not only the physical health but also the mental health of the population. Depression and anxiety are the most common mental health conditions worldwide, making them a leading cause of disability.1 Even beyond diagnosed conditions, subclinical symptoms of depression and anxiety affect the wellbeing and functioning of a large proportion of the population.2 Therefore, new approaches to managing both clinically diagnosed and subclinical depression and anxiety are needed

Fast food consumption and suicide attempts among adolescents aged 12-15 years from 32 countries

Background: We examined the fast food consumption-suicide attempt relationship among 105,061 adolescents aged 12-15 years from 32 countries. Methods: This study was based on cross-sectional data from the Global School-based Student Health Survey (GSHS), and included 4 low-income, 13 lower middle-income, 9 upper middle-income, and 6 high-income countries. Data on past 7-day fast food consumption and 12-month suicide attempts were collected. The association between fast food consumption and suicide attempts was investigated with multivariable logistic regression and meta-analysis while adjusting for sex, age, food insecurity (proxy of socioeconomic status), alcohol consumption, smoking, physical activity, obesity, carbonated soft drink consumption, and fruit and vegetable consumption. Results: Overall, the prevalence of fast food consumption was high (53.5%) and the proportion of suicide attempts was higher among consumers of fast food compared to non-consumers (11.8% vs. 8.3%). Of the 32 countries included in the study, a positive association between fast food consumption and suicide attempts was found in 26 countries although this was not statistically significant in all countries. The pooled OR (95% CI) based on a meta-analysis was 1.31 (1.17-1.46). Limitations: Since this was a cross-sectional study, it is not possible to draw any conclusions about causality or temporality in the associations assessed. Conclusions: Fast food consumption is positively associated with suicide attempts in adolescents. Further research of longitudinal design is needed to confirm/refute our findings and explore the potential underlying mechanisms

Disparities in COVID-19 infection, hospitalisation and death in people with schizophrenia, bipolar disorder, and major depressive disorder: a cohort study of the UK Biobank

People with severe mental illness (SMI; including schizophrenia/psychosis, bipolar disorder (BD), major depressive disorder (MDD)) experience large disparities in physical health. Emerging evidence suggests this group experiences higher risks of infection and death from COVID-19, although the full extent of these disparities are not yet established. We investigated COVID-19 related infection, hospitalisation and mortality among people with SMI in the UK Biobank (UKB) cohort study. Overall, 447,296 participants from UKB (schizophrenia/psychosis = 1925, BD = 1483 and MDD = 41,448, non-SMI = 402,440) were linked with healthcare and death records. Multivariable logistic regression analysis was used to examine differences in COVID-19 outcomes by diagnosis, controlling for sociodemographic factors and comorbidities. In unadjusted analyses, higher odds of COVID-19 mortality were seen among people with schizophrenia/psychosis (odds ratio [OR] 4.84, 95% confidence interval [CI] 3.00–7.34), BD (OR 3.76, 95% CI 2.00–6.35), and MDD (OR 1.99, 95% CI 1.69–2.33) compared to people with no SMI. Higher odds of infection and hospitalisation were also seen across all SMI groups, particularly among people with schizophrenia/psychosis (OR 1.61, 95% CI 1.32–1.96; OR 3.47, 95% CI 2.47–4.72) and BD (OR 1.48, 95% CI 1.16–1.85; OR 3.31, 95% CI 2.22–4.73). In fully adjusted models, mortality and hospitalisation odds remained significantly higher among all SMI groups, though infection odds remained significantly higher only for MDD. People with schizophrenia/psychosis, BD and MDD have higher risks of COVID-19 infection, hospitalisation and mortality. Only a proportion of these disparities were accounted for by pre-existing demographic characteristics or comorbidities. Vaccination and preventive measures should be prioritised in these particularly vulnerable groups

Social cognition in multiple sclerosis:A systematic review and meta-analysis

Objective: To quantify the magnitude of deficits in theory of mind (ToM) and facial emotion recognition among patients with multiple sclerosis (MS) relative to healthy controls. Methods: An electronic database search of Ovid MEDLINE, PsycINFO, and Embase was conducted from inception to April 1, 2016. Eligible studies were original research articles published in peer-reviewed journals that examined ToM or facial emotion recognition among patients with a diagnosis of MS and a healthy control comparison group. Data were independently extracted by 2 authors. Effect sizes were calculated using Hedges g. Results: Twenty-one eligible studies were identified assessing ToM (12 studies) and/or facial emotion recognition (13 studies) among 722 patients with MS and 635 controls. Deficits in both ToM (g -0.71, 95% confidence interval [CI] -0.88 to -0.55, p < 0.001) and facial emotion recognition (g -0.64, 95% CI -0.81 to -0.47, p < 0.001) were identified among patients with MS relative to healthy controls. The largest deficits were observed for visual ToM tasks and for the recognition of negative facial emotional expressions. Older age predicted larger emotion recognition deficits. Other cognitive domains were inconsistently associated with social cognitive performance. Conclusions: Social cognitive deficits are an overlooked but potentially important aspect of cognitive impairment in MS with potential prognostic significance for social functioning and quality of life. Further research is required to clarify the longitudinal course of social cognitive dysfunction, its association with MS disease characteristics and neurocognitive impairment, and the MS-specific neurologic damage underlying these deficits

Experimental investigation of the effect of scale-up on mixing efficiency in oscillatory flow baffled reactors (OFBR) using principal component based image analysis as a novel noninvasive residence time distribution measurement approach

Oscillatory flow strategies through baffled tubular reactors provide an efficient approach in improving process kinetics through enhanced micromixing and heat transfer. Known to have high surface area to volume ratios, oscillatory flow baffled reactors (OFBR) generate turbulence by superimposing piston driven oscillatory flow onto the net flow generated by a pump. By tuning the oscillating parameters (amplitude and frequency), one can tailor the residence time distribution of the system for a variety of multiphase applications. Using a microscope camera, principal component image analysis, and pulse tracer injections, a novel noncontact approach has been developed to experimentally estimate dispersion coefficients in two geometrically different systems (DN6 and DN15, Alconbury Weston Ltd.). The paper also introduces for the first time a novel scaled-down version of the commercially available DN15 OFBR, the DN6 (about 10 times smaller scale), and provides a comprehensive investigation of the effect of oscillation parameters on the residence time distributions (RTD) in both systems. The oscillation amplitude was found to have a significant positive correlation with the dispersion coefficient with 1 mm providing the least amount of dispersion in either system. Oscillation frequency had a less significant impact on the dispersion coefficient, but optimal operation was found to occur at 1.5 Hz for the DN6 and 1.0 Hz for the DN15. Until now, OFBR literature has not distinguished between piston and pump driven flow. Pump driven flow was found to be ideal for both systems as it minimizes the measured dispersion coefficient. However, piston driven turbulence is essential for avoiding particle settling in multi-phase (solid-liquid) systems and should be considered in applications like crystallization