Wellness Check: Mental Health

2 Minute Medicine is pleased to announce that we are launching Wellness Check, a new series dedicated to exploring new research evidence focused on wellness. Each week, we will report on articles examining different aspects of wellness, including (but not limited to) nutrition, sleep, reproductive health, substance use and mental health. This week, we explore the latest evidence-based updates in mental health.

Burnout is associated with reduced academic performance in postsecondary students

1. In this meta-analysis, the impact of emotional burnout on academic performance in college and university student was assessed.

2. A significant reduction in academic performance was detected in students who reported high levels of exhaustion, cynicism, and diminished feelings of self-efficacy.

Evidence Rating Level: 1 (Excellent)

Postsecondary students may be at elevated risk of experiencing psychological burnout due to social and academic pressure. Distress associated with burnout may impact the ability of students to perform academically, resulting in further pressure. A better understanding of the effect of burnout on postsecondary academic performance may inform intervention strategies to improve student mental health.

The present systematic review and meta-analysis summarized the literature on the relationship between postsecondary academic performance and burnout. Studies were included if they evaluated academic achievement outcomes and symptoms of burnout in postsecondary students. Burnout was defined as any combination of exhaustion, cynicism, and reduced efficacy. Studies were excluded if they were incomplete or studied students with clinical psychiatric diagnoses. Outcomes evaluated included academic achievement on specific evaluations or over the entirety of a postsecondary degree.

Twenty-nine manuscripts with a total of 109,396 participants were included. Total burnout as well as isolated exhaustion, cynicism, and reduced efficacy were significantly related with decreases in academic achievement. Although, the study was limited in that there was not a robust control group of age-matched individuals not attending postsecondary schooling. Nonetheless, the study suggested that total burnout and individual burnout symptoms negatively impact academic performance in postsecondary students.

Matching patients to therapists based on clinical compatibility improved mental health

1. In this randomized control trial, prospective assignment of patients to matched therapists was superior in improving mental health compared to random assignment.

2. Participants in the matched therapist group had significant reductions in symptoms, distress, and functional impairment.

Evidence Rating Level: 1 (Excellent)

Patients are typically assigned to mental health practitioners based on availability when seeking care. Psychotherapists may have variability in their specific intervention strategies as well as the way that they implement care practices. Accordingly, individual patients may benefit differentially from the same psychological intervention if matched to psychotherapists based on clinical compatibility.

The present double-blind randomized control trial compared measurement-based assignment of patients to therapists with randomized matching. Therapists with 15 or more historical cases with outcome data to establish pretrial performance were included. Patients aged 18-70 years old who presented during the trial period and made their own mental health care decisions were included. Adult outpatients were recruited from mental health centers in Ohio and were excluded if they were unable to consent without a delegated decision maker. The primary outcomes were improvement across Treatment Outpatient Package (TOP) domains and distress (measured by the Symptom Checklist-10). Therapists were matched to patients using TOP domains.

A total of 218 participants were included in analysis after being randomly allocated to either the matched group (n=99) or randomized group (n=119). Participants in the matched group had significant reductions in functional impairment related to symptoms, global distress, domain-specific impairment, and reported no adverse events. Study limitations included selection bias and limited generalizability as most patients were Caucasian and heterosexual. Nonetheless, the present study suggested that therapist-patient clinical compatibility impacts mental health outcomes.

Social media interventions may improve physical activity and mental wellness

1. In this meta-analysis, the impact of interactive social media interventions aimed at increasing physical activity was evaluated.

2. Improvements were seen in daily steps taken, marginal weight loss, reducing heart rate, and overall well-being.

Evidence Rating Level: 2 (Good)

Social media use has increased substantially since the introduction of programs such as Facebook, Instagram, and Twitter. Additionally, access to the internet has created a platform for the remote delivery of wellness and physical activity interventions. Social media may represent an interactive strategy for engaging users in physical and mental wellness activities.

The researchers analyzed the current literature on the effectiveness of interactive social media interventions focused on physical activity and mental wellbeing. Inclusion criteria were randomized control trials, controlled before-and-after studies, and interrupted time series which used an interactive online intervention to improve health behaviours in adults. Studies were excluded if the program that was evaluated had no social component. Study outcomes included physical health, mental health, adverse outcomes, and sub-group analysis to assess health equity.

A total of 88 studies were included in the meta-analysis, with a total of 871,378 participants. Improvements were seen in daily steps, weight loss, resting heart rate, and overall well-being. No adverse effects were reported, and no changes were seen in diet composition, tobacco use, and depression. Limitations included heterogeneity of programs used, evaluation metrics, and study population. In summary, this study suggested social media interventions may improve overall health behaviour, but have limited impact on metrics such as smoking cessation.

Social isolation and loneliness may result in poor recovery following crisis

1. Limited social interaction following a mental health crisis reduces self-reported recovery at 18-month follow-up.

2. Social support and interventions may improve recovery in individuals who are mental health service users, particularly when sever loneliness is reported.

Evidence Rating Level: 3 (Average)

Recovery following a mental health event may depend on a variety of factors, including engagement in mental health services and social support. Loneliness can be classified as intermittent or persistent and can vary in severity. The mediating role of loneliness on mental health following a crisis has not previously been elucidated.

The purpose of this prospective study was to evaluate the impact of loneliness on recovery following a mental health crisis. Individuals were included who visited a crisis resolution team for a week of longer and were over the age of 18. Exclusion criteria included individuals with high safety risk or having been discharged from the crisis resolution team more than a month prior. Loneliness was measured with the University of California at Los Angeles Loneliness Scale (ULS-8) and the The Lubben Social Network Scale (LSNS-6). Recovery was measured at 4 and 18 months with the questionnaire about the process of recovery (QPR).

A total of 223 participants were included, of which 16% were persistently severely lonely and 34% were intermittently severely lonely. Persistent severe loneliness and social isolation were associated with significantly reduced recovery at 18-month follow-up. The study was limited in that information on possible confounding mental health variables was missing for several participants and that the follow-up attrition rate was 44%. Nonetheless, the results of the present study suggested that loneliness and social isolation may have a significant impact on reducing the recovery of individuals admitted to mental health services for crises.

Image: PD

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