Wellness Check: Mental Health

Perfectionism may be closely related to binge eating

1. In this systematic review and meta-analysis, there was a positive association between general perfectionism and binge eating.

2. There was also an association between Perfectionistic Concerns and binge eating, but not Perfectionistic Strivings.

Evidence Rating Level: 1 (Excellent)

Perfectionism has long been considered a risk factor for developing eating disorders. However, there has been a lack of evidence regarding the association between perfectionism and binge eating disorders. Furthermore, many studies have failed to consider different forms of perfectionism related to binge eating, such as Perfectionistic Concerns and Perfectionistic Strivings. As a result, the objective of the present study aimed to better understand the association between perfectionism and binge eating disorders.

Of 594 identified records, 30 (n=9392) studies were included from various databases from inception to September 2022. Studies were included if they evaluated the relationship between perfectionism and binge eating using validated tools and reported a correlation coefficient for the relationship between the variables. Studies were excluded if they did not assess perfectionism and binge eating or if there was insufficient data. Statistical analysis was performed using random-effects meta-analysis. The primary outcome was the relationship between perfectionism and binge eating.

The results demonstrated an association between general perfectionism and binge eating. In addition, Perfectionistic Concerns, including self-criticism and fears about making mistakes, showed a small-to-moderate association with binge eating. Conversely, Perfectionistic Strivings, defined as the desire to reach perfection, had no significant relationship with binge eating. Despite these results, the study was limited by the fact that most of the research focused on trait perfectionism, which limited the analysis of other forms of perfectionism on binge eating. Nonetheless, the present study added evidence to suggest a link between perfectionism and binge eating.

Moral injury is associated with the overall wellbeing of healthcare professionals

1. In this systematic review, results demonstrated that moral injury was associated with professional and personal wellbeing and mental health outcomes, such as depression and anxiety.

2. Moral injury was also associated with burnout, compassion fatigue, and stress in healthcare workers.

Evidence Rating Level: 1 (Excellent)

Achieving a work-life balance may be difficult for healthcare workers due to significant work stressors. Moral injury — the experience of a moral transgression, either by yourself or those around you, and the resulting consequences — is a topic that is becoming more relevant in healthcare following the fast-paced and highly intense environment of the COVID-19 pandemic. Moral injury may be a surrogate for wellbeing. However, it has not been extensively studied in healthcare settings. As a result, the objective of the present study aimed to review the association between moral injury and wellbeing in healthcare workers.

Of 248 identified records, 18 studies were included from various databases from inception to December 2022. Studies were included if they evaluated the association between moral injury and professional or personal wellbeing in healthcare professionals. Studies were excluded if they were conceptual, did not measure moral injury, or used inappropriate statistical methodology. The review was performed using PRISMA guidelines. The risk of bias was assessed using the Joanna Briggs Institute’s (JBI) critical appraisal and bias assessment tools. The primary outcome was overall wellbeing.

The results demonstrated that moral injury was associated with professional and personal wellbeing and several mental health outcomes, including depression, anxiety, and trauma responses. There were also associations between moral injury and burnout, compassion fatigue, and stress. However, the temporal relationship between moral injury and wellbeing was unclear. Despite these results, the study was limited by the variability in the definition of moral injury, which may have affected the synthesis of the results. Nonetheless, the present study added significant information exploring the link between moral injury and the wellbeing of healthcare professionals.

Individuals with social anxiety disorder may have greater difficulty recognizing facial expressions

1. In this systematic review and meta-analysis, it was found that individuals with social anxiety disorder (SAD) had more difficulty recognizing facial expressions.

2. Individuals with SAD were also found to have a slower reaction time for recognizing happy facial expressions than controls.

Evidence Rating Level: 1 (Excellent)

Social anxiety disorder (SAD) is a highly prevalent disorder that may be further complicated by difficulties with emotional expression recognition (EER). To date, the data investigating whether individuals with SAD have impaired performance in categorizing facial expressions of emotion has been mixed. As a result, the present study aimed to determine the degree to which individuals with SAD could accurately recognize facial expressions of emotion.

Of 6,541 identified records, 16 (n=788) studies were included from various databases from inception to January 2022. Studies were included if participants had a diagnosis of SAD and were evaluated on an EER task using a validated face database with accuracy and/or reaction time as an outcome measurement. Qualitative studies, case studies, reviews, and meta-analyses were excluded. The review was performed using PRISMA guidelines. The risk of bias was assessed using the risk of bias assessment tool for non-randomized studies (RoBANS). The primary outcome was accuracy in facial expression recognition and reaction time.

The results demonstrated that individuals with SAD had a harder time recognizing facial expressions. Furthermore, those with SAD had a slower reaction time for recognizing happy facial expressions, while those with a mental health comorbidity had a harder time recognizing happy facial expressions than controls. Despite these results, the study was limited by the inclusion of small sample sizes, which may have affected the study’s power. Nonetheless, the present study demonstrated that individuals with SAD may experience difficulties with recognizing facial expressions.

Virtual reality treatment may be helpful in treating anxiety disorders

1. In this systematic review and meta-analysis, virtual reality (VR) treatments were associated with lower anxiety symptoms when compared to passive control groups.

2. However, in comparison to active controls, VR treatments were not statistically superior.

Evidence Rating Level: 1 (Excellent)

Virtual reality (VR) is a potential treatment option for mental health disorders which may be desirable given the high prevalence of anxiety disorders and the lack of mental health resources. Current meta-analyses on VR applications have not been updated for several years and were limited in the anxiety disorders investigated. As a result, the objective of the present study was to update and review the impact of current VR applications in the treatment of anxiety disorders.

Of 903 identified records, 17 (n=827 participants) studies were included from various databases from April 2011 to April 2021. Studies were included if they were randomized controlled trials and participants had a diagnosed anxiety disorder, received VR as a treatment, and were evaluated using validated self-report measurements and behavioral assessment/avoidance tasks (BAT). Studies were excluded if they were comparing two different VR interventions, if participants did not have a diagnosis of anxiety disorder, or if there was a lack of data from intervention and control groups. The review was performed using PRISMA guidelines. The risk of bias was assessed using the risk of bias assessment tool developed by the Cochrane Collaboration. The primary outcome was the difference in anxiety symptoms between VR treatment and control groups.

The results demonstrated that, compared to passive control groups (e.g., waiting list control groups or psychoeducation), patients who used VR applications had lower anxiety symptoms. However, when compared to active control groups (e.g., cognitive behavioral therapy (CBT) or exposure therapy), the benefit of VR treatment did not reach statistical significance. Despite these findings, the study was limited by the heterogeneity of the included studies, which may have affected the results. Nonetheless, the present study provided evidence that VR applications may be an effective treatment for anxiety disorders, especially when the gold-standard treatment is unavailable.

Image: PD

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