Longitudinal Changes in Physical Activity Engagement and Mental Health Outcomes in a Sample of Digital Mental Health Platform Users

Research has demonstrated a bidirectional relationship between physical activity and well-being, anxiety, and depression. PURPOSE: We examined this relationship in a sample of employees with access to a digital mental health care platform. METHODS: Adults (n=755, 57% female; 41% BIPOC; M age= 34±9 years) receiving employer-sponsored digital mental health care completed an online survey at baseline and 3-month follow-up. Data were collected on duration of physical activity engagement (IPAQ), well-being (WHO-5), anxiety (GAD-7) and depression (PHQ-9) symptoms, and self-reported impact of mental health issues on physical activity. We analyzed baseline correlations between physical activity and mental health, and conducted longitudinal analyses of the relationship between changes in activity and changes in mental health. RESULTS: Across the full sample, engagement in physical activity at baseline was positively correlated with baseline well-being (r= 0.11, pr= -0.14, pp= 0.18). Almost half (47.3%; n= 357) of participants were ‘inactive’, i.e., not meeting the recommended weekly minimum of at least 150 minutes of moderate physical activity. At 3-month follow-up, this inactive group increased physical activity an average of 60 minutes per week (pppR2= 0.014, pR2= 0.009, pp= 0.22). Moreover, self-reported negative impact of mental health issues on physical activity engagement decreased over time (pCONCLUSION: Employees using a digital mental health platform improved in mental health outcomes and mental health was perceived to be less of a barrier to activity over time. Initially inactive members had the added benefit of increasing physical activity. The association between physical activity and mental health outcomes highlights the importance of considering physical health factors in the holistic treatment of mental health conditions

Stress Measurement in Primary Care: Conceptual Issues, Barriers, Resources, and Recommendations for Study

Objective: Exposure to stressors in daily life and dysregulated stress responses are associated with increased risk for a variety of chronic mental and physical health problems, including anxiety disorders, depression, asthma, heart disease, certain cancers, and autoimmune and neurodegenerative disorders. Despite this fact, stress exposure and responses are rarely assessed in the primary care setting and infrequently targeted for disease prevention or treatment. Method: In this narrative review, we describe the primary reasons for this striking disjoint between the centrality of stress for promoting disease and how rarely it is assessed by summarizing the main conceptual, measurement, practical, and reimbursement issues that have made stress difficult to routinely measure in primary care. The following issues will be reviewed: (1) assessment of stress in primary care; (2) biobehavioral pathways linking stress and illness; (3) the value of stress measurements for improving outcomes in primary care; (4) barriers to measuring and managing stress; and (5) key research questions relevant to stress assessment and intervention in primary care. Results: Based on our synthesis, we suggest several approaches that can be pursued to advance this work, including feasibility and acceptability studies, cost-benefit studies, and clinical improvement studies. Conclusions: Although stress is recognized as a key contributor to chronic disease risk and mortality, additional research is needed to determine how and when instruments for assessing life stress might be useful in the primary care setting, and how stress-related data could be integrated into disease prevention and treatment strategies to reduce chronic disease burden and improve human health and wellbeing

Negative Mood and Food Craving Strength Among Women with Overweight: Implications for Targeting Mechanisms Using a Mindful Eating Intervention

ObjectivesWhen experiencing negative mood, people often eat to improve their mood. A learned association between mood and eating may cultivate frequent food cravings, detracting from health goals. Training in mindful eating may target this cycle of emotion-craving-eating by teaching individuals to manage urges when experiencing negative mood. We examined the impact of a mobile mindful eating intervention on the link between negative mood and food cravings among overweight women.MethodsIn a single-arm trial, participants (n = 64, M age = 46.1 years, M BMI = 31.5 kg/m2) completed ecological momentary assessments of negative mood and food cravings 3 times/day for 3 days pre- and post-intervention, as well as 1-month post-intervention. Using multilevel linear regression, we compared associations between negative mood and food craving strength at pre- vs. post-intervention (model 1) and post-intervention vs. 1-month follow-up (model 2).ResultsIn model 1, negative mood interacted with time point (β =  - .20, SE = .09, p = .02, 95% CI [- .38, - .03]) to predict craving strength, indicating that the within-person association between negative mood and craving strength was significantly weaker at post-intervention (β = 0.18) relative to pre-intervention (β = 0.38). In model 2, negative mood did not interact with time point to predict craving strength (β = .13, SE = .09, p = .10, 95% CI - .03, .31]); the association did not significantly differ between post-intervention and 1-month follow-up.ConclusionsTraining in mindful eating weakened the mood-craving association from pre- to post-intervention. The weakened association remained at follow-up. Our findings highlight the mood-craving link as a target-worthy mechanism of mindful eating that should be assessed in clinical trials.Trial registrationNCT02694731.Supplementary informationThe online version contains supplementary material available at 10.1007/s12671-021-01760-z

Stress Measurement in Primary Care: Conceptual Issues, Barriers, Resources, and Recommendations for Study

ObjectiveExposure to stressors in daily life and dysregulated stress responses are associated with increased risk for a variety of chronic mental and physical health problems, including anxiety disorders, depression, asthma, heart disease, certain cancers, and autoimmune and neurodegenerative disorders. Despite this fact, stress exposure and responses are rarely assessed in the primary care setting and infrequently targeted for disease prevention or treatment.MethodIn this narrative review, we describe the primary reasons for this striking disjoint between the centrality of stress for promoting disease and how rarely it is assessed by summarizing the main conceptual, measurement, practical, and reimbursement issues that have made stress difficult to routinely measure in primary care. The following issues will be reviewed: a) assessment of stress in primary care, b) biobehavioral pathways linking stress and illness, c) the value of stress measurements for improving outcomes in primary care, d) barriers to measuring and managing stress, and e) key research questions relevant to stress assessment and intervention in primary care.ResultsOn the basis of our synthesis, we suggest several approaches that can be pursued to advance this work, including feasibility and acceptability studies, cost-benefit studies, and clinical improvement studies.ConclusionsAlthough stress is recognized as a key contributor to chronic disease risk and mortality, additional research is needed to determine how and when instruments for assessing life stress might be useful in the primary care setting, and how stress-related data could be integrated into disease prevention and treatment strategies to reduce chronic disease burden and improve human health and well-being

Effects of a Mindfulness-Based Weight Loss Intervention on Long-term Psychological Well-being Among Adults with Obesity: Secondary Analyses from the Supporting Health by Integrating Nutrition and Exercise (SHINE) Trial

ObjectiveThis study tested whether a mindfulness-based intervention for obesity that included components aimed at emotion regulation and mindful eating improved psychological outcomes including stress, anxiety, positive emotion, and depression, during the intervention period and at longer-term follow-up.MethodsAdults with obesity (N=194) were randomized to a 5.5-month diet-exercise weight loss intervention with or without mindfulness training focused on emotion regulation and mindful eating. Participants completed self-report measures of mindfulness and psychological well-being, which were planned secondary outcomes, at baseline, mid-intervention (3 months), and at 6-, 12-, and 18-months post-baseline (maintenance period). Mixed effects models and linear regression were used to test between- and within-group changes in psychological well-being. Finally, this study explored whether changes in mindfulness (from baseline to each 6- and 18-months post-baseline) mediated the effects of intervention arm on changes in psychological outcomes during those respective time periods. This study explored whether changes in mindfulness from baseline to 6 months mediated the effects of intervention arm on changes in psychological outcomes from baseline to 18 months.ResultsParticipants randomized to the mindfulness arm had significant increases in positive emotions at all follow-up times compared to controls. There were statistically significant increases in mindfulness, psychological flexibility, and reflection, as well as decreases in anxiety and depressive symptoms at 12 months compared to control participants. These changes remained significant for psychological flexibility and reflection at 18 months. There were no significant differences in perceived stress. Among mindfulness participants, greater increases in mindfulness from 6-18 months was associated with greater positive emotions and psychological flexibility as well as lower perceived stress, anxiety, depressive symptoms, and rumination at 18 months, adjusting for 6-month values. Mediation analyses indicated that randomization to the mindfulness intervention arm was associated with 6-month increases in mindfulness, and these increases were in turn associated with improved psychological outcomes at 6 months and 18 months. Changes from baseline to 18 months did not mediate 18-month changes in psychological outcomes.ConclusionsMindfulness training in emotion regulation and mindful eating may provide greater longer-term psychological well-being benefits in non-clinical populations with obesity compared to conventional diet-exercise interventions