Childhood determinants of mental health and related outcomes in the Australian Defence Force

Background: The impact of military service on mental health has long been a focus of scientific and political debate. Historically, underlying vulnerability (moral weakness) was blamed for the psychological effects of war. Pressure from veteran communities in the aftermath of the Vietnam war saw the advent of a diagnosis to encapsulate the pathological psychological effects of trauma, namely PTSD. This dramatically shifted the focus from underlying vulnerability to a single recent traumatic event, upon which the diagnostic criterion of PTSD depends. Meanwhile, research in civilians demonstrated that childhood adversity is a major determinant of disorder through the lifespan. In addition, childhood adversity was found to be more prevalent in serving and ex-serving military personnel than in civilians. I aimed to conduct a detailed and nuanced analysis of specific childhood factors (trauma and mental disorder) alongside adult factors in determining a broad spectrum of mental disorders (including PTSD, depression and anxiety) and related outcomes (suicidality, somatic symptoms, distress and functioning) in current and ex-serving military populations, and where possible, to compare with other populations. Methods: I have taken advantage of the unique opportunity to examine data from the extensive health surveillance program in the ADF, specifically the 2010 ADF MHPWS, the ADF MEAO Prospective Study, and the ADF Transition and Wellbeing Research Programme. Where possible, I also compared with populations matched on sociodemographic variables, such as the 2007 ABS NSMHWS. Much of the data were detailed interview data. This allowed for the interrogation of childhood factors. Results: There was a higher prevalence of childhood trauma in ADF than civilian employed men, particularly non-interpersonal childhood trauma in the oldest age groups. In ADF and civilian employed men, childhood interpersonal trauma (which was more prevalent in ADF than civilian employed men), was not just associated with PTSD, but also the whole spectrum of past-year mental disorders. However, all of these associations were mediated by the spectrum of childhood mental disorders, with the exception of suicidality which was fully mediated by childhood anxiety alone. In the Transition population, childhood anxiety was not only an important determinant of adult outcomes (PTSD, anxiety, suicidality and multiple symptoms) it also appeared to fully mediate the relationship between childhood trauma and these outcomes (with the exception of suicidality). Conclusion These analyses have enabled us to develop a rich and nuanced understanding of the childhood determinants of adult health and associated outcomes along with mediator pathways in different populations. A lifetime perspective has shed light on the relationships between childhood factors and more proximal adult factors in determining poor outcomes. It has highlighted the importance of evaluating childhood trauma profile in determining adult vulnerabilities and of the impact of trauma across the spectrum of mental disorders (not solely PTSD), allowing a rare glimpse, albeit retrospective, of reactivity to previous traumatic events. This has proved exceedingly fruitful and lays the groundwork for further prospective research to better inform early prevention and intervention strategies. These studies highlight both the utility and necessity for continued consistent epidemiological surveillance of these populations.Thesis (Ph.D.) -- University of Adelaide, Centre for Traumatic Stress Studies, 201

Community interventions for anxiety and depression in adults and young people: A systematic review

Background: Growing evidence suggests that community-based interventions may be effective for anxiety and depression. This study aimed to describe studies of community interventions delivered to adults and/or young people, either in person or online, evaluated in randomised controlled trials and provide an indication as to their effectiveness, acceptability, quality of data and where possible, mechanisms of action. We included interventions delivered at and/or by museums, art galleries, libraries, gardens, music groups/choirs and sports clubs. Method: We developed and followed a preregistered protocol: PROSPERO CRD42020204471. Randomised controlled trials in adults and young people were identified in an extensive search with no date/time, language, document type and publication status limitations. Studies were selected according to predetermined eligibility criteria and data independently extracted and then assessed using Risk of Bias 1. The studies were deemed too heterogeneous for meta-analysis and were therefore reported using a narrative synthesis. Results: Our analysis included 31 studies, with 2898 participants. Community interventions most studied in randomised controlled trials were community music (12 studies, 1432 participants), community exercise (14 studies, 955 participants) and community gardens/gardening (6 studies, 335 participants). The majority of studies were from high-income countries – many were in specific populations (such as those with physical health problems) and were generally of low quality. Dropout rates across the included studies were low (1 participant on average per 100 participants). The inadequate description of interventions limited identification of potential mechanisms of action. Discussion: The uncertainty of the evidence allows only a weak recommendation in support of community interventions for anxiety and depression. The results suggest community engagement is a promising area for wide-reaching interventions to be implemented and evaluated, but more high-quality trials are needed, especially in young people and under-represented communities

Community interventions for anxiety and depression in adults and young people: a systematic review

Background: Growing evidence suggests that community-based interventions may be effective for anxiety and depression. This study aimed to describe studies of community interventions delivered to adults and/or young people, either in person or online, evaluated in randomised controlled trials and provide an indication as to their effectiveness, acceptability, quality of data and where possible, mechanisms of action. We included interventions delivered at and/or by museums, art galleries, libraries, gardens, music groups/choirs and sports clubs. Method: We developed and followed a preregistered protocol: PROSPERO CRD42020204471. Randomised controlled trials in adults and young people were identified in an extensive search with no date/time, language, document type and publication status limitations. Studies were selected according to predetermined eligibility criteria and data independently extracted and then assessed using Risk of Bias 1. The studies were deemed too heterogeneous for meta-analysis and were therefore reported using a narrative synthesis. Results: Our analysis included 31 studies, with 2898 participants. Community interventions most studied in randomised controlled trials were community music (12 studies, 1432 participants), community exercise (14 studies, 955 participants) and community gardens/gardening (6 studies, 335 participants). The majority of studies were from high-income countries – many were in specific populations (such as those with physical health problems) and were generally of low quality. Dropout rates across the included studies were low (1 participant on average per 100 participants). The inadequate description of interventions limited identification of potential mechanisms of action. Discussion: The uncertainty of the evidence allows only a weak recommendation in support of community interventions for anxiety and depression. The results suggest community engagement is a promising area for wide-reaching interventions to be implemented and evaluated, but more high-quality trials are needed, especially in young people and under-represented communities

Effect of mindfulness-based programmes on elite athlete mental health: a systematic review and meta-analysis

Objectives To determine the effectiveness of mindfulness-based programmes (MBPs) on the mental health of elite athletes. Design Systematic review and meta-analysis. Data sources Eight online databases (Embase; PsycINFO; SPORTDiscus, MEDLINE; Scopus; Cochrane CENTRAL; ProQuest Dissertations & Theses; Google Scholar), plus forwards and backwards searching from included studies and previous systematic reviews. Eligibility criteria for selecting studies Studies were included if they were randomised controlled trials (RCTs) that compared a MBP against a control, in current or former elite athletes. Results Of 2,386 articles identified, 12 RCTs were included in this systematic review and meta-analysis, comprising a total of 614 elite athletes (314 MBP; 300 controls). Overall, MBPs improved mental health, with large significant pooled effect sizes for reducing symptoms of anxiety (hedges g = -0.87, number of studies (n) = 6, p = .02, I2 = 90) and stress (g = -0.91, n = 5, p = .01, I2 = 74) and increasing psychological wellbeing (g = 0.96, n = 5, p = .04, I2 = 89). Overall, the risk of bias and certainty of evidence was moderate, and all findings were subject to high estimated levels of heterogeneity. Conclusion MBPs improved several mental health outcomes. Given the moderate degree of evidence, high quality adequately powered trials are required in the future. These studies should emphasise intervention fidelity, teacher competence, and scalability within elite sport

Use of online cultural content for mental health and well-being during COVID-19 restrictions : cross-sectional survey

AIMS AND METHOD: To gain a deeper understanding of the use of online culture and its potential benefits to mental health and well-being, sociodemographic characteristics and self-reported data on usage, perceived mental health benefits and health status were collected in an online cross-sectional survey during COVID-19 restrictions in the UK in June-July 2020. RESULTS: In total, 1056 people completed the survey. A high proportion of participants reported finding online culture helpful for mental health; all but one of the benefits were associated with regular use and some with age. Reported benefits were wide-ranging and interconnected. Those aged under 25 years were less likely to be regular users of online culture or to have increased their use during lockdown. CLINICAL IMPLICATIONS: There may be benefits in targeting cultural resources for mental health to vulnerable groups such as young adults

Randomised trials relevant to mental health conducted in low and middle-income countries: a survey

<p>Abstract</p> <p>Background</p> <p>A substantial proportion of the psychiatric burden of disease falls on the world's poorest nations, yet relatively little is known about randomised trials conducted in these countries. Our aim was to identify and describe a representative sample of mental health trials from low and middle-income countries.</p> <p>Methods</p> <p>6107 electronic records, most with full text copies, were available following extensive searches for randomised or potentially randomised trials from low and middle-income countries published in 1991, 1995 and 2000. These records were searched to identify studies relevant to mental health. Data on study characteristics were extracted from the full text copies.</p> <p>Results</p> <p>Trials relevant to mental health were reported in only 3% of the records. 176 records reporting 177 trials were identified: 25 were published in 1991, 45 in 1995, and 106 in 2000. Participants from China were represented in 46% of trials described. 68% of trials had <100 participants. The method of sequence generation was described in less than 20% of reports and adequate concealment of allocation was described in only 12% of reports. Participants were most frequently adults with unipolar depression (36/177) or schizophrenia (36/177). 80% of studies evaluated pharmacological interventions, a third of which were not listed by WHO as essential drugs. 41% of reports were indexed on PubMed; this proportion decreased from 68% in 1991 to 32% in 2000.</p> <p>Conclusion</p> <p>In terms of overall health burden, trial research activity from low and middle-income countries in mental health appears to be low, and in no area adequately reflects need.</p

Impact of COVID-19 on telepsychiatry at the service and individual patient level across two UK NHS mental health trusts

Background. The effects of COVID-19 on the shift to remote consultations remain to be properly investigated. Objective. To quantify the extent, nature and clinical impact of the use of telepsychiatry during the COVID-19 pandemic and compare it with the data in the same period of the 2 years before the outbreak. Methods. We used deidentified electronic health records routinely collected from two UK mental health Foundation Trusts (Oxford Health (OHFT) and Southern Health (SHFT)) between January and September in 2018, 2019 and 2020. We considered three outcomes: (1) service activity, (2) in-person versus remote modalities of consultation and (3) clinical outcomes using Health of the Nation Outcome Scales (HoNOS) data. HoNOS data were collected from two cohorts of patients (cohort 1: patients with ≥1 HoNOS assessment each year in 2018, 2019 and 2020; cohort 2: patients with ≥1 HoNOS assessment each year in 2019 and 2020), and analysed in clusters using superclasses (namely, psychotic, non-psychotic and organic), which are used to assess overall healthcare complexity in the National Health Service. All statistical analyses were done in Python. Findings. Mental health service activity in 2020 increased in all scheduled community appointments (by 15.4% and 5.6% in OHFT and SHFT, respectively). Remote consultations registered a 3.5-fold to 6-fold increase from February to June 2020 (from 4685 to a peak of 26 245 appointments in OHFT and from 7117 to 24 987 appointments in SHFT), with post-lockdown monthly averages of 23 030 and 22 977 remote appointments/month in OHFT and SHFT, respectively. Video consultations comprised up to one-third of total telepsychiatric services per month from April to September 2020. For patients with dementia, non-attendance rates at in-person appointments were higher than remote appointments (17.2% vs 3.9%). The overall HoNOS cluster value increased only in the organic superclass (clusters 18–21, n=174; p<0.001) from 2019 to 2020, suggesting a specific impact of the COVID-19 pandemic on this population of patients. Conclusions and clinical implications. The rapid shift to remote service delivery has not reached some groups of patients who may require more tailored management with telepsychiatry

The Moraxella adhesin UspA1 binds to its human CEACAM1 receptor by a deformable trimeric coiled-coil

Moraxella catarrhalis is a ubiquitous human-specific bacterium commonly associated with upper and lower respiratory tract infections, including otitis media, sinusitis and chronic obstructive pulmonary disease. The bacterium uses an autotransporter protein UspA1 to target an important human cellular receptor carcinoembryonic antigen-related cell adhesion molecule 1 (CEACAM1). Using X-ray crystallography, we show that the CEACAM1 receptor-binding region of UspA1 unusually consists of an extended, rod-like left-handed trimeric coiled-coil. Mutagenesis and binding studies of UspA1 and the N-domain of CEACAM1 have been used to delineate the interacting surfaces between ligand and receptor and guide assembly of the complex. However, solution scattering, molecular modelling and electron microscopy analyses all indicate that significant bending of the UspA1 coiled-coil stalk also occurs. This explains how UspA1 can engage CEACAM1 at a site far distant from its head group, permitting closer proximity of the respective cell surfaces during infection

Evaluating the Effects of SARS-CoV-2 Spike Mutation D614G on Transmissibility and Pathogenicity.

Global dispersal and increasing frequency of the SARS-CoV-2 spike protein variant D614G are suggestive of a selective advantage but may also be due to a random founder effect. We investigate the hypothesis for positive selection of spike D614G in the United Kingdom using more than 25,000 whole genome SARS-CoV-2 sequences. Despite the availability of a large dataset, well represented by both spike 614 variants, not all approaches showed a conclusive signal of positive selection. Population genetic analysis indicates that 614G increases in frequency relative to 614D in a manner consistent with a selective advantage. We do not find any indication that patients infected with the spike 614G variant have higher COVID-19 mortality or clinical severity, but 614G is associated with higher viral load and younger age of patients. Significant differences in growth and size of 614G phylogenetic clusters indicate a need for continued study of this variant