Mental Health and Wellbeing: Associations with Religion Across the Lifecourse

Previous research studies have reported benefits of religious practices and beliefs for a range of health outcomes, including mental health and wellbeing. However, most of the research on religion and health is cross-sectional and based on populations from the USA. Therefore, there is a need for evidence from populations outside the USA to assess the external generalisability of these associations. This thesis investigated longitudinal associations between religiosity, and the outcomes of mental health and wellbeing, using data from the Medical Research Council (MRC) National Survey for Health and Development (NSHD). This unique longitudinal data set following the participants from birth was used to investigate 1) the patterns and trends of religiosity across the life course 2) whether religiosity is associated with mental health and wellbeing 3) the role of psychological, social and lifestyle factors on religiosity, and mental health and wellbeing, and 4) whether religiosity moderates the impact of stressful life events on mental health and wellbeing. Associations were tested using regression models, auto-regressive cross-lagged models and interaction terms. A general decline in religious attendance and beliefs across the life course was observed and frequent religious attendance was associated with higher wellbeing scores. Evidence for bi-directional associations between religiosity and mental health was found, but not for wellbeing. Analysis of psychological, social factors and lifestyle factors identified agreeableness, mastery and social support as important factors in associations between religiosity, and mental health and wellbeing. Some aspects of religious beliefs and practices were found to moderate the association between stressful life events, and mental health and wellbeing. There is limited evidence of direct benefits of religiosity for mental health and wellbeing. However, it is possible that religiosity is used as a coping mechanism in response to stressful life events and to some extent buffers their deleterious impact on mental health and wellbeing

The Role of Type 2 Diabetes in Patient Symptom Attribution, Help-Seeking, and Attitudes to Investigations for Colorectal Cancer Symptoms: An Online Vignette Study

Objectives: Type 2 diabetes is associated with a higher risk of colorectal cancer (CRC) and advanced-stage cancer diagnosis. To help diagnose cancer earlier, this study aimed at examining whether diabetes might influence patient symptom attribution, help-seeking, and willingness to undergo investigations for possible CRC symptoms. Methods: A total of 1307 adults (340 with and 967 without diabetes) completed an online vignette survey. Participants were presented with vignettes describing new-onset red-flag CRC symptoms (rectal bleeding or a change in bowel habits), with or without additional symptoms of diabetic neuropathy. Following the vignettes, participants were asked questions on symptom attribution, intended help-seeking, and attitudes to investigations. Results: Diabetes was associated with greater than two-fold higher odds of attributing changes in bowel habits to medications (OR = 2.48; 95% Cl 1.32–4.66) and of prioritising diabetes-related symptoms over the change in bowel habits during medical encounters. Cancer was rarely mentioned as a possible explanation for the change in bowel habits, especially among diabetic participants (10% among diabetics versus 16% in nondiabetics; OR = 0.55; 95% CI 0.36–0.85). Among patients with diabetes, those not attending annual check-ups were less likely to seek help for red-flag cancer symptoms (OR = 0.23; 95% Cl 0.10–0.50). Conclusions: Awareness of possible cancer symptoms was low overall. Patients with diabetes could benefit from targeted awareness campaigns emphasising the importance of discussing new symptoms such as changes in bowel habits with their doctor. Specific attention is warranted for individuals not regularly attending healthcare despite their chronic morbidity

Bi-directional associations between religious attendance and mental health: findings from a British birth cohort study

Background- There is evidence that religious attendance is associated with positive outcomes for mental health; however, there are few longitudinal studies, and even fewer, which take into account the possibility of bi-directional associations. This study aimed to investigate bi-directional associations between religious attendance and mental health. Methods- Participants were 2125 study members who provided data at age 68–69 from the Medical Research Council National Survey of Health and Development (1946 British birth cohort study). Mental health was assessed using the 28-item General Health Questionnaire at ages 53, 60–64 and 68–69. Religious attendance was measured using a 4-point scale (weekly=3, monthly=2, less than monthly=1 or never=0) at ages 43, 60–64 and 68–69. Cross-lagged path analysis was used to assess reciprocal associations between mental health and religious attendance, adjusting for gender and education. Results- Previous religious attendance was strongly related to later attendance (r=0.62–0.74). Similarly, mental health at baseline was strongly associated with subsequent mental health scores (r=0.46–0.54). Poor mental health at age 53 and 60–64 was associated with more frequent religious attendance at age 60–64 (b=0.04; 95% CI: 0.02 to 0.06; p<0.05), and 68–69 (b=0.03; 95% CI: 0.02 to 0.06; p<0.05), respectively. There was no evidence that religious attendance at age 43, 60–64 or 68–69 was associated with later or concurrent mental health. Conclusion- Using birth cohort data from the UK, it was found that poor mental health was associated with later religious attendance but not vice versa. Future research should confirm these novel findings and explore the underlying mechanisms between religious attendance and mental health

Developing Reporting Guidelines for Social Media Research (RESOME) by Using a Modified Delphi Method: Protocol for Guideline Development

BACKGROUND: Social media platforms, such as Facebook, Twitter, and Instagram, are being increasingly used to deliver public health interventions. Despite the high level of research interest, there is no consensus or guidance on how to report on social media interventions. Reporting guidelines that incorporate elements from behavior change theories and social media engagement frameworks could foster more robust evaluations that capture outcomes that have an impact on behavior change and engagement. OBJECTIVE: The aim of this project is to develop, publish, and promote a list of items for our Reporting Guidelines for Social Media Research (RESOME) checklist. METHODS: RESOME will be developed by using a modified Delphi approach wherein 2 rounds of questionnaires will be sent to experts and stakeholders. The questionnaires will ask them to rate their agreement with a series of statements until a level of consensus is reached. This will be followed by a web-based consensus meeting to finalize the reporting guidelines. After the consensus meeting, the reporting guidelines will be published in the form of a paper outlining the need for the new guidelines and how the guidelines were developed, along with the finalized checklist for reporting. Prior to publication, the guidelines will be piloted to check for understanding and simplify the language used, if necessary. RESULTS: The first draft of RESOME has been developed. Round 1 of the Delphi survey took place between July and December 2021. Round 2 is due to take place in February 2022, and the web-based consensus meeting will be scheduled for the spring of 2022. CONCLUSIONS: Developing RESOME has the potential to contribute to improved reporting, and such guidelines will make it easier to assess the effectiveness of social media interventions. Future work will be needed to evaluate our guidelines' usefulness and practicality. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/31739

Effect of communicating community immunity on COVID-19 vaccine-hesitant people from ethnically diverse backgrounds : an experimental vignette study in the UK

Objectives Achieving high vaccination coverage is vital to the efforts of curbing the impact of the COVID-19 pandemic on public health and society. This study tested whether communicating the social benefit through community protection for friends and family members versus overall society, affects vaccination intention and perception among a sample enriched with respondents from black and ethnic minority backgrounds. Design A web-based experimental survey was conducted. Eligible participants were individually randomised, with equal probability, to one of the three experimental vignettes. Setting England. Participants We recruited 512 (212 white, 300 ethnically diverse) vaccine-hesitant members from an online panel. Primary and secondary outcome measures The primary outcome was the intention to get vaccinated against COVID-19. The secondary outcome consisted of a behavioural measure in the form of active interest in reading more about the COVID-19 vaccine. Additional measures included the perceived importance and expected uptake in others, as well as the attitudes towards vaccination. Results Logistic regression models did not show an effect of the messages on intentions for the overall sample (society: adjusted OR (aOR): 128, 95%CI 0.88 to 1.88 and friends and family: aOR 1.32, 95%CI 0.89 to 1.94). The role of vaccination in achieving community immunity yielded higher vaccination intentions among study participants with white ethnic background (society: aOR: 1.94, 95%CI 1.07 to 3.51 and friends and family: aOR 2.07, 95%CI 1.08 to 3.96), but not among respondents from ethnically diverse backgrounds (society: aOR: 0.95, 95%CI 0.58 to 1.58 and friends and family: aOR 1.06, 95%CI 0.64 to 1.73). The messages, however, did not affect the perceived importance of the vaccine, expected vaccination uptake and active interest in reading more about the vaccine. Conclusions Thus, although highlighting the social benefits of COVID-19 vaccinations can increase intentions among vaccine non-intenders, they are unlikely to address barriers among ethnically diverse communities

Promoting early presentation of breast cancer in older women during the seasonal influenza vaccination campaign

Background: Older women are at high risk of presenting with late stage of breast cancer, which may be partly because of poor breast cancer awareness. Aims: The aim of this project was to implement and evaluate a new way of delivering the Promoting Early Presentation (PEP) Intervention during flu vaccination appointments in primary care. The PEP intervention is a 1-minute intervention, accompanied by a booklet and delivered by primary care health professionals to provide older women with the knowledge, confidence and skills to present promptly on discovering symptoms of breast cancer. Methods: Health professionals delivered the PEP Intervention to older women at six general practices in South London. We measured changes in breast cancer awareness after the intervention and interviewed practice staff about their experiences of the intervention. Findings: Knowledge of breast symptoms and breast checking was greater in women aged 70+ after the implementation than before. Health professionals’ found the intervention acceptable and feasible to implement. Conclusion: This intervention is a novel way of increasing breast cancer awareness in older women, which could contribute to promoting earlier presentation and diagnosis of breast cancer in the UK

Promoting Early Presentation intervention sustains increased breast cancer awareness in older women for three years: A randomized controlled trial

Objective In a randomized controlled trial, the Promoting Early Presentation intervention increased older women’s breast cancer awareness after two years. We investigated whether this increase was sustained at three years, and the effect on breast screening self-referral. Methods We randomly allocated 867 women attending their final invited breast screening appointment to the Promoting Early Presentation intervention or usual care. We examined breast cancer awareness after three years and breast screening self-referrals after four years. Results Women in the Promoting Early Presentation intervention arm had higher breast cancer awareness at three years than the usual care arm (odds ratio: 10.4; 95% confidence interval: 3.1 to 34.8). There were no differences in proportions self-referring for breast screening between arms, but statistical power was limited. Conclusion The Promoting Early Presentation intervention has a sustained effect on breast cancer awareness in older women. The effect on self-referral for breast screening is unclear

Systemic low-grade inflammation and subsequent depressive symptoms:is there a mediating role of physical activity?

OBJECTIVE: Systemic low-grade inflammation has been associated with the onset of depression, but the exact mechanisms underlying this relationship remain elusive. This study examined whether physical activity (PA) explained the association between elevated plasma levels of inflammatory markers and subsequent depressive symptoms. DESIGN: Prospective cohort design. METHOD: The sample consisted of 3,809 non-depressed men and women (aged 50+) recruited from the English Longitudinal Study of Ageing (ELSA). Serum levels of inflammatory markers (C-reactive protein (CRP), fibrinogen) and covariates (age, sex, education, wealth, body mass index, smoking, cholesterol, triglycerides) were measured at baseline (wave 4, 2008/09). Self-reported weekly moderate/vigorous (high) PA versus no weekly moderate/vigorous (low) PA was examined at a four-year follow-up (wave 6, 2012/13), using a single-item question. Depressive symptoms were assessed at baseline, four years (wave 6, 2012/13) and six years post baseline (wave 7, 2014/15), using the 8-item version of the Centre for Epidemiological Studies Depression Scale (CES-D). RESULTS: Participants with higher baseline concentrations of inflammatory markers were significantly more likely to report low PA levels four years later (CRP: OR: 1.25; 95% CI, 1.05-1.48; fibrinogen: OR: 1.18; 95% CI, 1.05-1.39). Moreover, low PA was associated with higher odds of elevated depressive symptoms at follow-up (OR: 1.59; 95% CI, 1.15-2.19). Mediation analyses revealed that low PA explained a total of 36.71% of the relationship between high CRP and elevated depressive symptoms, and 33.26% between higher levels of fibrinogen and elevated depressive symptoms six years later. No direct association was found between systemic low-grade inflammation and subsequently elevated depressive symptoms. CONCLUSION: These results suggest that low PA is a significant partial mediator of the relationship between systemic low-grade inflammation and subsequent elevated depressive symptoms in a nationally representative cohort of older adults

Use of social media for cancer prevention and early diagnosis: scoping review protocol

Social media platforms offer unique opportunities for health promotion messages focusing on cancer prevention and early diagnosis. However, there has been very little synthesis of the evaluation of such campaigns, limiting the ability to apply learning to the design of future social media campaigns. We aimed to provide a broad overview of the current research base on social media interventions for cancer prevention and early diagnosis, to identify knowledge gaps and to inform policy, practice and future research questions

What Works to Improve Wellbeing? A Rapid Systematic Review of 223 Interventions Evaluated with the Warwick-Edinburgh Mental Well-Being Scales.

INTRODUCTION: The Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) is a commonly used scale of mental wellbeing focusing entirely on the positive aspect of mental health. It has been widely used in a broad range of clinical and research settings, including to evaluate if interventions, programmes or pilots improve wellbeing. We aimed to systematically review all interventions that used WEMWBS and evaluate which interventions are the most effective at improving wellbeing. METHODS: Eligible populations included children and adults, with no health or age restrictions. Any intervention study was eligible if the wellbeing outcome was measured using the 7 or 14-item WEMWBS scale assessed both pre- and post-intervention. We identified eligible intervention studies using three approaches: a database search (Medline, EMBASE, CINAHL, PyschInfo and Web of Science from January 2007 to present), grey literature search, and by issuing a call for evidence. Narrative synthesis and random-effects meta-analysis of standardised mean differences in the intervention group were used to summarise intervention effects on WEMWBS score. RESULTS: We identified 223 interventions across 209 studies, with a total of 53,834 participants across all studies. Five main themes of interventions were synthesised: psychological (n = 80); social (n = 54); arts, culture and environment (n = 29); physical health promotion (n = 18); and other (n = 28). Psychological interventions based on resilience, wellbeing or self-management techniques had the strongest effect on wellbeing. A broad range of other interventions were effective at improving mental wellbeing, including other psychological interventions such as cognitive behavioural therapy, psychoeducation and mindfulness. Medium to strong effects were also seen for person-centred support/advice (social), arts-based, parenting (social) and social prescribing interventions. However, a major limitation of the evidence was that only 75 (36%) of studies included a control group. CONCLUSIONS: WEMWBS has been widely used to assess wellbeing across a diverse range of interventions, settings and samples. Despite substantial heterogeneity in individual intervention design, delivery and groups targeted, results indicate that a broad range of intervention types can successfully improve wellbeing. Methodological changes, such as greater use of control groups in intervention evaluation, can help future researchers and policy makers further understand what works for mental wellbeing