Universal, selective and indicated interventions for supporting mental health at the workplace: an umbrella review of meta-analyses

The current umbrella review aimed to assess and summarise evidence on universal, selective and indicated interventions for mental health at the workplace. This umbrella review forms one of the evidence reviews which were commissioned by the WHO to develop global guidelines on mental health at work. We conducted systematic searches in five bibliographic databases (PubMed, Embase, PsycINFO, Cochrane and Global Medicus Index) and included meta-analyses of randomised trials examining psychosocial, physical activity and lifestyle interventions delivered to all general workers (universal interventions), at-risk workers (selective interventions) and workers already experiencing symptoms of mental disorders (indicated interventions). We included outcomes from seven domains: symptoms of mental health conditions, positive mental health, quality of life, work-related outcomes, substance use, suicide-related outcomes and potential adverse effects. We identified 16 meta-analyses producing 66 pooled effect sizes of the examined interventions, mostly on symptoms of mental health conditions (n=43 pooled effect sizes) (eg, burnout, insomnia, stress) and positive mental health (n=15) (eg, well-being). Most of the evidence on universal, selective and indicated interventions was focused on psychosocial interventions, showing small to moderate effects across the various outcomes. Certainty levels according to GRADE (Grading of Recommendations Assessment, Development and Evaluation) were low to very low in almost all of the examined outcomes. The results of existing meta-analyses are promising for the use of preventative and early treatment interventions in the workplace. However, the quality and certainty of the evidence were very modest, and further research on the effectiveness of these interventions is warranted

Mental health at work: WHO guidelines

[no abstract available

A Novel Nonsense Mutation in FERMT3 Causes LAD-III in a Pakistani Family

Leukocyte adhesion deficiency-III (LAD3) is an extremely rare primary immunodeficiency disorder, transmitted with autosomal-recessive inheritance. It is caused by genetic alteration in the FERMT3 gene, which leads to abnormal expression of kindlin-3. This cytoplasmic protein is highly expressed in leukocytes and platelets, and acts as an important regulator of integrin activation. LAD3 has features like bleeding syndrome of Glanzmann-type and leukocyte adhesion deficiency. FERMT3 mutation(s) have not been well characterized in Pakistani patients with LAD3. In this study, an infant and his family of Pakistani origin, presenting with clinical features of LAD, were investigated to determine the underlying genetic defect. Targeted next generation sequencing (TGS) and Sanger sequencing were performed to identify and confirm the causative mutations, respectively, and their segregation within the family. A novel, homozygous FERMT3 nonsense mutation (c.286C > T, p.Q96∗) was found in the proband, and its co-segregation with LAD3 phenotype within the family was consistent with an autosomal recessive inheritance. Both parents were carriers of the same mutation. This family was offered prenatal diagnosis during first trimester of the subsequent pregnancy; the fetus carried the variant. In conclusion, our study is the first report to identify the novel homozygous variant c.286C > T, p.Q96∗in the FERMT3 gene, which might be the causative mutation for LAD3 patients of Pakistani origin

Improving psychosocial distress for young adolescents in rural schools of Pakistan: study protocol of a cluster randomised controlled trial.

Introduction Emotional problems are leading contributors to health burden among adolescents worldwide. There is an urgent need for evidence-based psychological interventions for young people. This study aims to evaluate the effectiveness of a school-based, group psychological intervention, Early Adolescent Skills for Emotions (EASE) developed by the WHO to improve psychosocial distress in Pakistani adolescents. Method and analysis A two-arm, single-blinded, cluster randomised controlled trial, with a wait-list control arm is being conducted in school settings of rural Pakistan. Forty eligible public-school clusters have been randomised (stratified by gender) on a 1:1 allocation ratio into intervention (n=20) and control arm (n=20). Following informed consent, 564 adolescents with psychosocial distress (Youth-reported Paediatric Symptoms Checklist, cut-off ≥28) from 40 schools have been enrolled into the trial (14±3 average cluster size) between 2 November 2021 and 30th November 2021. Participants in the intervention arm will receive EASE in 7-weekly adolescents and 3-biweekly caregivers group sessions in schools. The adolescent sessions involve the components of psychoeducation, stress management, behavioural activation, problem-solving and relapse prevention. Caregivers will receive training to learn and implement active listening; spending quality time and using praise as a strategy to help their children. The primary outcome is reduction in psychosocial distress at 3 months postintervention. Secondary outcomes include symptoms of depression and anxiety, caregiver–adolescent relationship and caregivers’ well-being. Outcomes will be assessed at baseline, immediate 1 week and 3-months postintervention. Qualitative process evaluation will explore barriers and facilitators to programme implementation in low-resource school settings. Ethics Ethics approval has been obtained from Central Ethics Committee of University of Liverpool, UK, Ethics Review Committee of WHO Geneva and from the Institutional Review Board of Human Development Research Foundation (HDRF), Pakistan. Dissemination The findings of the study will be disseminated by WHO and through peer-reviewed publications

Resilience and emotional distress in young people: risk, promotive and cultural factors

Resilience, as a trait, process or outcome, is the negation of an undesirable outcome or of an expected maladjustment in the context of an adversity. Young people represent a developmental stage in which there is a vulnerability to experience deleterious outcomes during adversity. The literature on risk and promotive factors for resilience in youth is compounded by narrative reviews which have not applied a rigorous search methodology and which have failed to operationalise resilience. To date, the majority of research in resilience for emotional distress has focussed on data collected in high income countries. The first paper presents a systematic review of the literature on risk and promotive factors for trait resilience in youth. The findings indicate that there are differences in the magnitude of association between trait resilience and various risk and promotive factors, which were conceptualised into biological, intrapersonal, interpersonal and environmental factors. The largest body of evidence reviewed pertained to intrapersonal risk and promotive factors for trait resilience. Factors predicting trait resilience were also identified. Implications for future research include addressing the methodological and sampling limitations of the reviewed studies. The second paper presents an empirical study investigating factors within a microsystem which differentiate adolescents with resilience for emotional distress and those vulnerable to emotion distress in India (N = 967) and in Peru (N = 606). Factors which predict low emotional distress in each country and factors which differentiate between low emotional distress Indian and Peruvian adolescents were additionally investigated. A cross-sectional exploratory investigation of secondary data was employed. The findings suggest that the profile of low vulnerability for emotional distress differs between different cultural contexts and contribute to an extraordinarily limited evidence-base in low and middle income contexts. Extensive additional research is required to delineate culturally-specific profiles of resilience for emotional distress in a bid to develop culturally-sensitive treatment targets.</p

The broad bipolar phenotype: sampling the experience of mood, stress and mental imagery

The overarching aim of this thesis was to use an experimental psychopathology approach to investigate mood, stress and mental imagery in the Broad Bipolar Phenotype (BPP), defined by the experience of elevated lifetime hypomania. Daily mood reactions to stress have been well explored in psychosis, but the limited research in BD has produced mixed findings. Holmes, Geddes, Colom and Goodwin (2008) hypothesised that mental imagery in BD may amplify emotion and worsen day to day mood extremes. This thesis investigates volunteers ranging across the continuum of the BPP in relation to key variables from the Holmes et al (2008) model: mood, stress and mental imagery, and brings new methodology to this area. The Mood Disorder Questionnaire (MDQ; Hirschfeld et al, 2000) was used to identify groups with high (N=50; ≥ 7 symptoms) and low (N=60; ≤ 6 symptoms) rates of hypomanic experience i.e. high MDQ and low MDQ. A single investigation was conducted for this thesis (N=110) which is divided into four studies. Study 1 and 2 tested the hypothesis that high MDQ volunteers would report higher levels of mental imagery compared to low MDQ volunteers. Study 1 (N=61) found that high MDQ volunteers had higher levels of trait mental imagery and intrusive imagery of the future, replicating patient findings. Study 2 (N=49) extended these findings to additional imagery measures. In a laboratory study, study 3 tested the hypothesis that after an experimental stressor (a traumatic film) high MDQ volunteers would experience more image-based flashback memories to the film than low MDQ volunteers. Volunteers reported any flashback memories to the film via mobile phone Short Message Service (SMS) prompts for six days, plus convergent measures at follow-up. As predicted, compared to the low MDQ group, the high MDQ group experienced significantly more flashback memories to the stressor (on all measures). Study 4 used an Experience Sampling Method (ESM; momentary assessment sampling over time) to frequently monitor mood and its event-related stress context. Thus, in the context of daily life study 4 sought to explore the role of bipolarity in exacerbating mood reactions, in comparison to other hypothesised contributors: neuroticism and intrusive imagery of the future. SMS mobile-phone messages were sent 10 times a day for 6 days to capture event-related stress ratings and mood ratings. Higher bipolarity (MDQ), neuroticism (EPQN) and intrusive imagery of the future (IFES) were each associated with increased mood reactions over six days, compared to lower levels of these characteristics. In understanding which of these characteristics best accounted for mood reactions, bipolarity (MDQ) best accounted for elated mood reactions, neuroticism did not best account for any moods, intrusive imagery of the future (IFES) best accounted for sad, depressed and anxious mood reactions and both bipolarity and intrusive imagery of the future best accounted for fearful mood reactions. In summary, the aim of this thesis was to investigate volunteers ranging across the continuum of the BPP in relation to key variables from the Holmes et al (2008) model: mood, stress and mental imagery. As predicted, compared to low MDQ volunteers, the high MDQ group had higher levels of 1) self-reported use of mental imagery, 2) negative flashback memory imagery after an experimental stressor and 3) daily life negative mood reactions to stress. Critically, repeatedly imaging future scenes (IFES), which flash to mind unbidden, was found to show the greatest impact on negative mood reactions in daily life. Mental imagery offers a psychological characteristic which is elevated in volunteers at the higher end of the BPP continuum and also has the potential to be a novel cognitive treatment target in clinical BD samples. For example, targeting flashback memories after a stressor or targeting intrusive imagery of the future may help regulate mood reactions in daily life. This warrants further investigation in patients with BD.</p

The broad bipolar phenotype : sampling the experience of mood, stress and mental imagery

The overarching aim of this thesis was to use an experimental psychopathology approach to investigate mood, stress and mental imagery in the Broad Bipolar Phenotype (BPP), defined by the experience of elevated lifetime hypomania. Daily mood reactions to stress have been well explored in psychosis, but the limited research in BD has produced mixed findings. Holmes, Geddes, Colom and Goodwin (2008) hypothesised that mental imagery in BD may amplify emotion and worsen day to day mood extremes. This thesis investigates volunteers ranging across the continuum ofthe BPP in relation to key variables from the Holmes et al (2008) model: mood, stress and mental imagery, and brings new methodology to this area. The Mood Disorder Questionnaire (MDQ; Hirschfeld et ai, 2000) was used to identify groups with high (N=50; ~ 7 symptoms) and low (N=60; :s 6 symptoms) rates of hypomanic experience i.e. high MDQ and low MDQ. A single investigation was conducted for this thesis (N=IIO) which is divided into four studies. Study I and 2 tested the hypothesis that high MDQ volunteers would report higher levels of mental imagery compared to low MDQ volunteers. Study I (N=61) found that high MDQ volunteers had higher levels of trait mental imagery and intrusive imagery of the future, replicating patient findings. Study 2 (N=49) extended these findings to additional imagery measures. In a laboratory study, study 3 tested the hypothesis that after an experimental stressor (a traumatic film) high MDQ volunteers would experience more image-based flashback memories to the film than low MDQ volunteers. Volunteers reported any flashback memories to the film via mobile phone Short Message Service (SMS) prompts for six days, plus convergent measures at follow-up. As predicted, compared to the low MDQ group, the high MDQ group experienced significantly more flashback memories to the stressor (on all measures). Study 4 used an Experience Sampling Method (ESM; momentary assessment sampling over time) to frequently monitor mood and its event-related stress context. Thus, in the context of daily life study 4 sought to explore the role of bipolarity in exacerbating mood reactions, in comparison to other hypothesised contributors: neuroticism and intrusive imagery of the future. SMS mobile-phone messages were sent 10 times a day for 6 days to capture event-related stress ratings and mood ratings. Higher bipolarity (MDQ), neuroticism (EPQN) and intrusive imagery of the future (IFES) were each associated with increased mood reactions over six days, compared to lower levels of these characteristics. In understanding which of these characteristics best accounted for mood reactions, bipolarity (MDQ) best accounted for elated mood reactions, neuroticism did not best account for any moods, intrusive imagery of the future (lFES) best accounted for sad, depressed and anxious mood reactions and both bipolarity and intrusive imagery of the future best accounted for fearful mood reactions. In summary, the aim of this thesis was to investigate volunteers ranging across the continuum of the BPP in relation to key variables from the Holmes et al (2008) model: mood, stress and mental imagery. As predicted, compared to low MDQ volunteers, the high MDQ group had higher levels of I) self-reported use of mental imagery, 2) negative flashback memory imagery after an experimental stressor and 3) daily life negative mood reactions to stress. Critically, repeatedly imaging future scenes (lFES), which flash to mind unbidden, was found to show the greatest impact on negative mood reactions in daily life. Mental imagery offers a psychological characteristic which is elevated in volunteers at the higher end of the BPP continuum and also has the potential to be a novel cognitive treatment target in clinical BD samples. For example, targeting flashback memories after a stressor or targeting intrusive imagery of the future may help regulate mood reactions in daily life. This warrants further investigation in patients with BD.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Resilience and emotional distress in young people: risk, promotive and cultural factors

Resilience, as a trait, process or outcome, is the negation of an undesirable outcome or of an expected maladjustment in the context of an adversity. Young people represent a developmental stage in which there is a vulnerability to experience deleterious outcomes during adversity. The literature on risk and promotive factors for resilience in youth is compounded by narrative reviews which have not applied a rigorous search methodology and which have failed to operationalise resilience. To date, the majority of research in resilience for emotional distress has focussed on data collected in high income countries. The first paper presents a systematic review of the literature on risk and promotive factors for trait resilience in youth. The findings indicate that there are differences in the magnitude of association between trait resilience and various risk and promotive factors, which were conceptualised into biological, intrapersonal, interpersonal and environmental factors. The largest body of evidence reviewed pertained to intrapersonal risk and promotive factors for trait resilience. Factors predicting trait resilience were also identified. Implications for future research include addressing the methodological and sampling limitations of the reviewed studies. The second paper presents an empirical study investigating factors within a microsystem which differentiate adolescents with resilience for emotional distress and those vulnerable to emotion distress in India (N = 967) and in Peru (N = 606). Factors which predict low emotional distress in each country and factors which differentiate between low emotional distress Indian and Peruvian adolescents were additionally investigated. A cross-sectional exploratory investigation of secondary data was employed. The findings suggest that the profile of low vulnerability for emotional distress differs between different cultural contexts and contribute to an extraordinarily limited evidence-base in low and middle income contexts. Extensive additional research is required to delineate culturally-specific profiles of resilience for emotional distress in a bid to develop culturally-sensitive treatment targets.This thesis is currently not available via ORA

Cultural adaptation of a scalable psychological intervention for Burundian refugee adolescents in Tanzania:a qualitative study

BACKGROUND: There is an urgent need for evidence-based, scalable, psychological interventions to improve the mental health of adolescents affected by adversity in low-resource settings. Early Adolescents Skills for Emotions (EASE) was developed by the WHO as a brief, transdiagnostic, group intervention for early adolescents exhibiting internalising problems, delivered by trained and supervised lay providers. This study describes the cultural adaptation of EASE for Burundian adolescents living in Mtendeli refugee camps in Tanzania. METHODS: A phased approach to adaptation of the EASE intervention and its implementation, was adopted and comprised of: (1) a desk review to synthesize existing research on mental health issues in conflict-affected Burundian communities, (2) a rapid qualitative assessment involving free listing and key informant interviews with multiple stakeholders, (3) cognitive interviews with end users, and (4) a two-part adaptation workshop involving the implementing partner staff, members of the refugee community and mental health experts. We applied the Bernal framework to systematically document and track adaptations across eight dimensions of the intervention. RESULTS: Problems associated with worry, stress, sadness, shame and fear were identified as amongst the most critical mental health concerns, alongside a range of experiences of different forms of violence (such as gender-based violence, violence when fleeing from their homes) and associated problems. Problems associated with violence that included past experiences of fleeing as well as ongoing problems of gender-based violence in the camp. The most significant adaptations that were required included providing options for low literacy of participants, safety planning to address the high prevalence of sexual violence, simplification of strategies for the benefit of the end users and of lay facilitators, and implementation changes to consider involvement of refugee incentive workers. A majority of changes were across dimensions of language, people, metaphors, content, methods and context, while there were fewer changes regarding the goals and concepts of EASE. CONCLUSIONS: The approach to adaptation of a psychological intervention suggested both minor and major required changes. Adaptations based on the findings of this study are anticipated to enhance relevance and acceptability of the EASE intervention and its delivery for camp-residing Burundian refugees in Tanzania. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13031-021-00391-4