Abstract

Background. Psychological distress is a progressive health problem that has been linked to decreased quality of life among university students. This meta-analysis reviews existing randomized controlled trials (RCTs) that have examined the effects of mindfulness-based stress reduction (MBSR) on the relief of psychosomatic stress-related outcomes and quality of life among university students. Methods. The PubMed, EMBASE, Web of Science, PsycINFO (formerly PsychLit), Ovid MEDLINE, ERIC, Scopus, Google Scholar, ProQuest, and Cochrane Library databases were searched in November 2023 to identify the RCTs for analysis. Data on pathology (anxiety, depression, and perceived stress), physical capacity (sleep quality and physical health), and well-being (mindfulness, self-kindness, social function, and subjective well-being) were analyzed. Results. Of the 276 articles retrieved, 29 met the inclusion criteria. Compared with control therapies, the pooled results suggested that MBSR had significant effects, reducing anxiety (SMD = −0.29; 95% CI: −0.49 to −0.09), depression (SMD = −0.32; 95% CI: −0.62 to −0.02), and perceived stress (SMD = −0.41; 95% CI: −0.60 to −0.29) and improving mindfulness (SMD = 0.34; 95% CI: 0.08 to 0.59), self-kindness (SMD = 0.57; 95% CI: 0.30 to 1.12), and physical health (SMD = −0.59; 95% CI: −1.14 to −0.04). No significant differences were observed in sleep quality (SMD = −0.20; 95% CI: −0.06 to 0.20), social function (SMD = −0.71; 95% CI: −2.40 to 0.97), or subjective well-being (SMD = 0.07; 95% CI: −0.18 to 0.32). The quality of the evidence regarding sleep quality and physical health outcomes was low. Conclusions. MBSR therapy appears to be potentially useful in relieving functional emotional disorders. However, additional evidence-based large-sample trials are required to definitively determine the forms of mindfulness-based therapy that may be effective in this context and ensure that the benefits obtained are ongoing. Future studies should investigate more personalized approaches involving interventions that are tailored to various barriers and students’ clinical characteristics. To optimize the effects of such interventions, they should be developed and evaluated using various designs such as the multiphase optimization strategy, which allows for the identification and tailoring of the most valuable intervention components.

Introduction

Mindfulness therapy is a standardized psychological intervention that aims to reduce stress, encourage mindful thinking habits, and allow recipients to manage difficult emotional processing. It focuses on the concentration of one’s attention in the moment, nonsubjective judgment, and openness to accepting personal experience and involves corresponding behavioral training, such as attention training, body scanning, and sitting meditation [1]. Previous research on psychological interventions has found that mindfulness therapy can help reduce stress among university students and affects their overall quality of life and the psychological functions to which they adapt [2].

The theoretical support and the understanding of the operating mode are reasonable but still have differences. Thus, the mental health benefits, potential effects, and limitations of mindfulness therapy for university students warrant further examination. Although education and social support can be effective in preventing and treating the underlying psychological problems among university students with poor mental health, such interventions do not always affect or improve psychological well-being [3, 4].

The most prevalent psychological symptoms among university students are anxiety, mental stress, and emotional distress, which can result in decreased functioning in the context of academic and interpersonal stress. Global mental health surveys conducted by the World Health Organization (WHO) indicate that mental disorders are highly prevalent among university students, with 12-month prevalence rates ranging from 20.3% to 45% of university students over the age of 18 [5–7]. The prevalence rates of insomnia, depressive symptoms, and anxiety symptoms were 37.80%, 48.20%, and 36.70%, respectively, among Chinese university students during the COVID-19 pandemic [8]. In a randomized controlled trial with 11,169 university students conducted by the WHO, students had increasing intentions to use mental health services: The results indicated lifetime use rates of 12.6% and 7.3% for psychotherapy and medication for emotional problems, respectively. Suicidal thoughts and behaviors and nonsuicidal self-injury within the preceding 12 months were also common, with 21.1% of students in the sample reporting suicidal ideation, 10.6% reporting suicide plans, 0.4% reporting suicide attempts, and 6.8% reporting nonsuicidal self-injury [5]. Furthermore, one previous study found that high-compliance mental health services had a significant effect on students’ intention to seek mental health services in the next semester [9–11].

Results

3.1. Description of Studies
A total of 276 studies items were initially obtained through the database search. Using NoteExpress, 193 deduplicated studies were obtained, and the remaining 220 items were obtained. After reviewing their titles and abstracts, 135 studies that were of incompatible research types were excluded. A total of 13 articles were further excluded after reading the full text, and the remaining 29 studies [24–53] were retained for data extraction. The baselines of the trials were comparable. The literature search process and results are shown in Figure 1.

Abstract

Violent offending committed by people with schizophrenia has been a public concern. The present study aims to examine the incidence of violent offending among people with schizophrenia and its correlations with mental health resources and economic factors. In this study, an examination of violent offending by people with schizophrenia and those identified as not criminally responsible on account of mental disorder (NCRMD) between 2010 and 2019 in China’s Hunan province was undertaken. Principal component analysis (PCA) and regression analyses were used to explore the association of violent offending in people with schizophrenia and those identified as NCRMD with violent offending in the general population, mental health medical resources, and provincial GDP. Between 2010 and 2019, a total of 2,093 people with schizophrenia committed violent offending in Hunan province, including 1,374 (65.6%) cases identified as NCRMD. Over the period, the incidence of violent offending in people with schizophrenia and those identified as NCRMD has been decreasing. The incidences were positively correlated with the incidence of violent offending in the general population and negatively associated with mental health resources and provincial GDP. These findings may be valuable in helping to develop strategies for violence prevention and risk management for people with schizophrenia.

Introduction

Violence related to mental disorders has been a public health concern across the world. Evidence suggests that the risk of violent offending in people with schizophrenia is higher than that in the general population ( Fazel et al., 2014 ; Whiting et al., 2022 ), although most people with schizophrenia never engage in violence throughout their life ( Nielssen and Large, 2010 ; Strassnig et al., 2020 ). The consequences of violent behavior perpetrated by people with schizophrenia may impose a high economic burden on public healthcare services ( Senior et al., 2020 ). Therefore, it is critical to understand the trends in violent offending by people with schizophrenia as well as the systems-level factors including health and socio-economic characteristics, which will be valuable in helping to develop strategies for violence prevention and risk management for people with schizophrenia.

Existing studies examining the trends and patterns of violent offending related to mental disorders are mainly based in Western developed countries, and they also yielded inconsistent results. Earlier evidence suggested that the incidence of homicide related to mental disorders tended to remain stable, regardless of whether the overall rate of homicide in the general population decreased ( Flynn et al., 2021 ; Penney et al., 2018 ) or increased ( Taylor and Gunn, 1999 ). Some other studies have shown that the incidence of mental illness-related homicide rises in tandem with an increase in homicides in the general population ( Gottlieb et al., 1987 ; Gudjonsson and Petursson, 1986 ). A 40-year study based in the Chuvash Republic of the Russian Federation revealed that the rate of homicide associated with schizophrenia was significantly correlated with that in people without schizophrenia over this period ( Golenkov et al., 2021 ).

Conclusions

Our study showed that the incidences of violent offending in people with schizophrenia and those identified as NCRMD have been decreasing from 2010 to 2019 in Hunan Province, China. The incidences were found to be significantly correlated with the incidence of violent offending in the general population over this period. The increase in mental health resources and the developing economy may play important roles in reducing violent offending associated with schizophrenia. This indicates that the prevention of violent offending in people with schizophrenia involves not only providing enhanced mental health resources and reinforcing treatment measures, but also addressing factors influence general violent offending. Our findings may have critical implications for the prevention and management of violent offending in people with schizophrenia.

Abstract
Objectives
Postpartum depression estimated prevalence in women is between 5 and 26% and it has adverse effects both on the mother, infant and her partner. Psychological treatments have proved to be effective for women with mild-to-moderate symptoms. Whereas several systematic reviews have assessed the effects of different psychological interventions for postpartum depression, such as cognitive-behavioural therapy or interpersonal therapy, no review assessing psychodynamic therapy has been carried out. A systematic review was conducted to evaluate the efficacy of psychodynamic therapy for postpartum depression.

Methods
Studies were identified using the following databases: PsycINFO, Psycarticles and Pubmed over January 2023. The requirements for the studies were the following: they had to be quantitative, available in English, including a psychodynamic intervention targeting treatment or prevention of postpartum depression which starts during pregnancy or within the first 12 months after giving birth. Case studies, qualitative studies or studies focused on improving parent-infant relationship or infant outcome were excluded from this research.

Results
Seven trials including 521 women met the inclusion criteria. In summary, three randomized controlled trials and four longitudinal studies were found. The most frequently used assessment tool was EPDS, five were individual interventions and the other two were group interventions.

Discussion
All studies reported the efficacy of psychodynamic interventions for postpartum depression, both in home and clinical settings and both in group and individual format. The limited number of trials, small sample sizes and lack of appropriate control groups were the main limitations.

Conclusions for practice
Psychodynamic therapy is probably efficient intervention for postpartum depression. Future research with strong methodological designs is needed to confirm these findings.

Significance
What is already known on this subject? Several systematic reviews have assessed the effects of different psychological interventions for postpartum depression, but no review assessing psychodynamic therapy has been carried out. What this study adds? A systematic review was conducted to evaluate the efficacy of psychodynamic therapy for postpartumdepression. This makes the systematic review a unique contribution to the literature.

Introduction

Historically parent’s mental health during the perinatal period has been overlooked, as it was conceived as a time of joy and emotional stability. Only in 1950’s some authors started to write about maternity blues, postpartum depression, and puerperal psychosis (Besser et al., 2008). Studies have generally targeted mothers and their psychological wellbeing. On the contrary, paternal mental health remains under-investigated even though non-gestational parents may also suffer from mental disorders in the peripartum period.

     Postpartum depression encompasses a depression disorder occurring within the 12 months following childbirth (Branquinho et al., 2021) and the disorder can be compared to a major depressive episode in any moment of a woman’s life. However, symptoms such as anxiety, anhedonia, aggressive obsessional thoughts, restlessness or concentration and decision-making difficulties are more frequent or severe in the immediate postpartum (Batt et al., 2020). Postpartum depression has adverse effects on the woman and, therefore, on the infant as the disorder is closely related to difficulty to carry out different parenting tasks, such as breastfeeding, sleeping, or responding to the infant’s needs (Branquinho et al., 2021; Nanzer et al., 2012). It is also the strongest predictor of paternal depression during the perinatal period (Kaźmierczak et al., 2020). In addition, it is one of the main causes of maternal deaths in the first year after childbirth as the mother may develop suicidal thoughts and intentions. (Al-Halabí et al., 2021). The estimated prevalence of postpartum depression in women varies across countries, assessment criteria or time frame ranging from 5 to 26% (Liu et al., 2022).

Conclusions

     Psychodynamic approach still plays a minor role in the mainstream theory, research, and treatment for postpartum depression, even though the amount of data has kept growing for the last decade. BDP is probably efficient intervention for postpartum depression. Therefore, it is suggested that research should be continued to assess the effectiveness of psychodynamic interventions in postpartum depression compared to other effective treatments.

Abstract

     Mental health research through data-driven methods has been hindered by a lack of standard typology and scarcity of adequate data. In this study, we leverage the clinical articulation of depression to build a typology for social media texts for detecting the severity of depression. It emulates the standard clinical assessment procedure Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and Patient Health Questionnaire (PHQ-9) to encompass subtle indications of depressive disorders from tweets. Along with the typology, we present a new dataset of 40191 tweets labeled by expert annotators. Each tweet is labeled as ‘non-depressed’ or ‘depressed’. Moreover, three severity levels are considered for ‘depressed’ tweets: (1) mild, (2) moderate, and (3) severe. An associated confidence score is provided with each label to validate the quality of annotation. We examine the quality of the dataset via representing summary statistics while setting strong baseline results using attention-based models like BERT and DistilBERT. Finally, we extensively address the limitations of the study to provide directions for further research.

Introduction

     Analyzing the presence of mood and psychological disorders through behavioral and linguistic cues from social media data remains a critical area of interdisciplinary research. In addition to these disorders, the last decade has seen exponentially increasing attempts to assess related symptomatology such as depressive disorders, self-harm, and severity of mental illness using non-clinical data (Bucci et al., 2019). Social media platforms and other online discussion forums have been particularly appealing to the research community for various research purposes (e.g., population-level mental health monitoring (Conway & O’Connor, 2016), personal traits detection (Marouf et al., 2020), cyberbullying spotting (Bozyiğit et al., 2021), etc.) because of the massive scale of data. This massive data flow has resulted from increasing rates of internet access and people spontaneously sharing their suffering, pain, and struggle anonymously on these platforms (Ofek et al., 2015). Recognizing the early symptoms of depressive disorder through a person’s language use can prevent many disastrous outcomes like self-harm, suicide, etc., and even help deploy effective treatment in proper time. Moreover, the outbreak of the COVID-19 pandemic is likely to have devastating impacts on the mental health of millions of individuals as lockdown in the affected areas has reported high rises in the incident rates of mood disorder, including acute stress disorder, post-traumatic stress disorder, generalized anxiety disorder, and overall sub-clinical mental health deterioration (Singh et al., 2020). The scope of mental health deterioration during the COVID-19 pandemic and the comprehensive nature of diagnosing depressive disorders have provided an unprecedented need to infer the mental states of individuals from all-inclusive resources. Recent studies have revealed that valuable insights into the impact of the pandemic on population-level mental health can be inferred from posts or comments on social media (Low et al., 2020).

Conclusions and future work

     This work introduced a new typology for diagnosing depression severities from social media texts, as well as a unique dataset of labeled tweets with a confidence score for each label. The dataset was constructed based on strong ground truths and clinical validation, and it is expected to help alleviate the scarcity of mental health data to some extent. The description of the process and challenges in creating such a dataset may motivate researchers to collect similar corpora of this scale from other social media and discussion forums. The experimental results indicated that existing state-of-the-art models often fail to understand the contextual undertone of the data samples. Developing a model that is capable of comprehending the subdued relationship and differences among depression severities can result in an even better understanding of human cognition. Moreover, analysis of the classification performance indicates that there is no distinct division of keywords among different depression severities. The same keyword might be used differently to express different emotions, rather it is more important to understand the context of the tweet to diagnose the severity of depression. Broader implications of this research may include personalizing and directing preventative and awareness messages by health professionals to the users in need.

Abstract

     Mental health research through data-driven methods has been hindered by a lack of standard typology and scarcity of adequate data. In this study, we leverage the clinical articulation of depression to build a typology for social media texts for detecting the severity of depression. It emulates the standard clinical assessment procedure Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and Patient Health Questionnaire (PHQ-9) to encompass subtle indications of depressive disorders from tweets. Along with the typology, we present a new dataset of 40191 tweets labeled by expert annotators. Each tweet is labeled as ‘non-depressed’ or ‘depressed’. Moreover, three severity levels are considered for ‘depressed’ tweets: (1) mild, (2) moderate, and (3) severe. An associated confidence score is provided with each label to validate the quality of annotation. We examine the quality of the dataset via representing summary statistics while setting strong baseline results using attention-based models like BERT and DistilBERT. Finally, we extensively address the limitations of the study to provide directions for further research.

Introduction

     Analyzing the presence of mood and psychological disorders through behavioral and linguistic cues from social media data remains a critical area of interdisciplinary research. In addition to these disorders, the last decade has seen exponentially increasing attempts to assess related symptomatology such as depressive disorders, self-harm, and severity of mental illness using non-clinical data (Bucci et al., 2019). Social media platforms and other online discussion forums have been particularly appealing to the research community for various research purposes (e.g., population-level mental health monitoring (Conway & O’Connor, 2016), personal traits detection (Marouf et al., 2020), cyberbullying spotting (Bozyiğit et al., 2021), etc.) because of the massive scale of data. This massive data flow has resulted from increasing rates of internet access and people spontaneously sharing their suffering, pain, and struggle anonymously on these platforms (Ofek et al., 2015). Recognizing the early symptoms of depressive disorder through a person’s language use can prevent many disastrous outcomes like self-harm, suicide, etc., and even help deploy effective treatment in proper time. Moreover, the outbreak of the COVID-19 pandemic is likely to have devastating impacts on the mental health of millions of individuals as lockdown in the affected areas has reported high rises in the incident rates of mood disorder, including acute stress disorder, post-traumatic stress disorder, generalized anxiety disorder, and overall sub-clinical mental health deterioration (Singh et al., 2020). The scope of mental health deterioration during the COVID-19 pandemic and the comprehensive nature of diagnosing depressive disorders have provided an unprecedented need to infer the mental states of individuals from all-inclusive resources. Recent studies have revealed that valuable insights into the impact of the pandemic on population-level mental health can be inferred from posts or comments on social media (Low et al., 2020).

Conclusions and future work

     This work introduced a new typology for diagnosing depression severities from social media texts, as well as a unique dataset of labeled tweets with a confidence score for each label. The dataset was constructed based on strong ground truths and clinical validation, and it is expected to help alleviate the scarcity of mental health data to some extent. The description of the process and challenges in creating such a dataset may motivate researchers to collect similar corpora of this scale from other social media and discussion forums. The experimental results indicated that existing state-of-the-art models often fail to understand the contextual undertone of the data samples. Developing a model that is capable of comprehending the subdued relationship and differences among depression severities can result in an even better understanding of human cognition. Moreover, analysis of the classification performance indicates that there is no distinct division of keywords among different depression severities. The same keyword might be used differently to express different emotions, rather it is more important to understand the context of the tweet to diagnose the severity of depression. Broader implications of this research may include personalizing and directing preventative and awareness messages by health professionals to the users in need.

Abstract

     Adolescent mental health is an important public health issue that cannot be ignored, and mental health issues are a major cause of physical illness in adolescents and children worldwide. In order to supplement relevant research and provide insightful policy suggestions to government, schools and families, this study investigated the nexus between family socioeconomic status and mental health for adolescents in China. Based on 7234 observations from the China Education Panel Survey, the paper estimated the effects of family socioeconomic status on adolescents’ mental health using ordinary least squares. The effects of family income, parental education level, and parental occupation on adolescent mental health were estimated separately by the same method. Our findings suggest that family socioeconomic status has a significant positive effect on mental health of adolescents in China. This effect is heterogeneous depending on individuals’ registered residence types and their participation in health courses. Finally, frequency of parent-child interaction and classmate interaction are shown to be potential mechanisms for the effect of family socioeconomic status on the mental health of Chinese adolescents.

Introduction

     With the development of society, the mental health of adolescents is becoming more and more important. Research has shown that 10–20% of children and adolescents suffer from mental health problems, which are a major cause of physical health problems in the group, around the world [1]. However, in low and middle income countries, the mental health of children and adolescents is often overlooked. In recent years, the proportion of adolescents suffering from mental health problems and depression has been increasing. According to the “Report on the Development of Chinese National Mental Health (2019–2020)” released by the Institute of Psychology of the Chinese Academy of Sciences in March 2021, the rates of depression in primary school, junior high school, and high school are 10%, 30%, and 40%, respectively. Among them, the rates of major depression were 1.9–3.3%, 7.6–8.6%, and 10.9–12.6%, respectively. That is, depression levels increased with grades [2]. Therefore, the mental health of adolescents is so important that we cannot ignore it. In order to protect the mental health of adolescents, it is necessary to pay attention to the important role of the family.

     Family socioeconomic status which reflects an individual’s family background and social capital, mainly including family income, parents’ education level, etc., is crucial to adolescents’ mental health [3]. To explore the influence of family socioeconomic status on adolescents’ mental health, this paper established an ordinary least squares regression model based on the CEPS from 2014 to 2015. The effects of family income, parental education level, and parental occupation on adolescent mental health were estimated separately by the same method.

Conclusions

     Based on the CEPS data from 2014 to 2015, this paper studies the effect of family socioeconomic status on the mental health of adolescents by using the ordinary least square method, and makes a robustness test and heterogeneity analysis. We found that family socioeconomic status, family income and parents’ education level have significant positive effects on teenagers’ mental health, and the heterogeneity of these effects depends on whether individuals have studied health courses and on individual types of household registration. Specifically, the mental health of individuals who have not studied health courses and who have agricultural registered residence are more affected by the socioeconomic status of the family. In addition, we point out two mechanisms of the effect of family socioeconomic status on teenagers’ mental health: the frequency of parent-child interaction and the frequency of classmate interaction. On the one hand, improving the socioeconomic status of the family can improve the frequency of parent-child interaction and then improve the mental health level of adolescents; on the other hand, the socioeconomic status of the family can affect the frequency of interaction between individuals and classmates, affect peer relationships and then affect the mental health of adolescents.

Abstract

     Introduction: Individuals with bipolar disorder (BD) have higher rates of unhealthy lifestyles and risk for medical comorbidities Research currently suggests that dietary factors may play a role in the development of depression and anxiety. Therefore, nutritional approaches are potential strategies for the treatment of BD. The aim of this review is to summarize the available evidence on nutrition and BD. Materials and Methods: The paper was developed based on PRISMA 2020 guidelines. The search was conducted in Sep-2021 using PubMed and Cochrane Library, augmented by manually checked references lists. The search found 986 studies, of which 47 were included, combined with 13 from reference lists, totaling 60 studies. Results: There were 33 observational trials, of which 15 focused on fatty acids, 9 on micronutrients, 5 on specific foods, 4 on macro and micronutrients. The 27 interventional studies mainly focused on fatty acids, micronutrients and N-acetylcysteine (NAC). Discussion: Dietary intake or supplementation of unsaturated fatty acids, mainly Omega-3 seems to be associated with improved BD symptoms, along with seafood, folic acid and zinc. Studies found variable, mainly non-significant impacts of creatine, carnitine, vitamin D, inositol or NAC supplementation on BD. There are promising results associated with Coenzyme Q10 (Coq10) and probiotics. Taken together, these preliminary findings suggest that dietetic approaches might be included as part of BD treatment. Also considering the high risk of metabolic disorders in individuals with BD, they should be encouraged to choose healthy dietary lifestyles, including daily intake of fruits, vegetables, seafood and whole grains.

Introduction

     Nutritional psychiatry is a rapidly expanding field of study, which has recently benefited from the advances of neurosciences, epidemiological research on risk factors as well as the renewed interest in the role of lifestyle in mental health [1]. Extensive observational evidence consistently demonstrates that diet quality is a predictor of depression risk – independent of other factors, such as education and body weight [2]. Moreover, randomized controlled trials in people with even severe major depressive disorder show efficacy and cost-effectiveness in improving depression symptomatology [3–7]. Concordantly, meta-analytic data confirms that dietary change improves depression symptoms in both clinical and non-clinical populations [8]. Considering that poor diet and dysfunctional eating behaviors are modifiable risk factors, it is possible that these will be converted into critical interventions for mental health [3,9,10]. Indeed, new clinical practice guidelines for mood disorders include diet, along with other aspects of lifestyle, as foundational and ‘non-negotiable’ treatment targets [1,11].

Results 

Search results

     The final search yielded 986 studies. After removing duplicates (N = 60), studies in other languages and publications prior to 2001 (N = 97), titles and abstracts from 829 studies were screened. Studies that did not clearly meet the inclusion criteria and/or met the exclusion criteria were excluded. The remaining 57 studies were analyzed by full text reading, after which 10 were excluded because they did not meet the full inclusion criteria. This led to 47 included studies, which were combined with 13 studies that were obtained from the bibliography from the included studies and reviews found in the search, totaling 60 studies (Figure 1).

Abstract

Methods

Results

Discussion

Funding Sources

Author Contributions

References

Abstract

Background

     Because COVID-19 was declared a pandemic in March 2020, nearly 93% of U.S. students engaged in some distance learning. These school disruptions may negatively influence adolescent mental health. Protective factors, like feeling connected to family or school may demonstrate a buffering effect, potentially moderating negative mental health outcomes. The purpose of the study is to test our hypothesis that mode of school instruction influences mental health and determine if school and family connectedness attenuates these relationships.

Methods

The COVID Experiences Survey was administered online or via telephone from October to November 2020 in adolescents ages 13–19 using National Opinion Research Center’s AmeriSpeak Panel, a probability-based panel recruited using random address–based sampling with mail and telephone nonresponse follow-up. The final sample included 567 adolescents in grades 7–12 who received virtual, in-person, or combined instruction. Unadjusted and adjusted associations among four mental health outcomes and instruction mode were measured, and associations with school and family connectedness were explored for protective effects.

Results

Students attending school virtually reported poorer mental health than students attending in-person. Adolescents receiving virtual instruction reported more mentally unhealthy days, more persistent symptoms of depression, and a greater likelihood of seriously considering attempting suicide than students in other modes of instruction. After demographic adjustments school and family connectedness each mitigated the association between virtual versus in-person instruction for all four mental health indicators.

Conclusion

As hypothesized, mode of school instruction was associated with mental health outcomes, with adolescents receiving in-person instruction reporting the lowest prevalence of negative mental health indicators. School and family connectedness may play a critical role in buffering negative mental health outcomes.

Measures

     Four indicators of mental health challenges were assessed: (1) stress levels in four areas (at school, home, work, and with friends) given response options low/moderate/high/very high; responses were coded for high or very high stress in at least one area (hereafter “high/very high stress”); (2) mental health-related quality of life, assessed by number of the past 14 days (response options: 0, 1 or 2, 3–6, 7–14) with mental health not good, dichotomized with a cutoff score of ≥7 days (hereafter, ≥7 days not good mental health); (3) seriously considering attempting suicide (hereafter, considering suicide) in the past 12 months (response options: yes/no); and (4) persistent symptoms of depression over the past 2 weeks, assessed by the Patient Health Questionnaire 9-item adolescent [[18]], with students experiencing ≥3 symptoms on more than half of the past 14 days (response options: 0, 1 or 2, 3–6, 7–14) considered to have persistent symptoms of depression (hereafter, persistent symptoms of depression). Links to mental health resources and a toll-free national suicide prevention hotline were provided to all respondents.

     Scales were used to assess both school connectedness and family connectedness. School connectedness was measured using the six questions from the National Longitudinal Study of Adolescent Health’s School Connectedness Scale, including items such as “I feel like I am a part of this school” and “The teachers at this school treat students fairly” [[19]]. Standardized Cronbach’s alpha = .89. Family connectedness was measured using responses to five questions assessing parental monitoring, parent–adolescent communication, and emotional support such as “How often do you and a parent/caregiver eat dinner together” and “How comfortable do you feel talking to a parent or caregiver about how you are feeling (for instance, stress, anxiety, and depression)?” The standardized Cronbach’s was alpha = .70. As continuous variables, school connectedness ranged from 6 to 30 and family connectedness ranged from 6 to 20. Low connectedness was defined as at or below the 25th percentile (≤16 for school connectedness and ≤13 for family connectedness).

Results

     Within the final sample of 567 adolescents, 460 (80.2%) reported enrollment in public school, 36 (7.1%) in private school, and 69 (12.6%) in some other type of school, for example, a school that is completely online all of the time, regardless of the pandemic. A majority (56.3%) of respondents received virtual instruction; 24.4% received combined instruction and 19.4% received in-person instruction. Virtual instruction was more prevalent among black (68.2%) and Hispanic students (69.0%) compared to white students (48.1%) (Table 1).

     All four mental health indicators were associated with mode of instruction (Table 2). Students in virtual learning were more likely than students attending school in-person to report high or very high stress (44.7% vs. 25.0%). Students in virtual learning more frequently reported negative mental health risk on three indicators than students receiving combined or in-person instruction: ≥7 days not good mental health (14.5%, 7.6%, and 3.9%, respectively); considering suicide (13.5%, 8.4%, and 3.8%, respectively); and persistent symptoms of depression (19.1%, 15.3%, and 7.6%, respectively). When continuous variables for school and family connectedness were dichotomized (lowest quartile compared to the three upper quartiles), low school connectedness was more common for students attending virtually than those receiving combined or in-person instruction (34.8%, 19.1%, and 13.3%, respectively) and the association was statistically significant (p = .006). Reported levels of family connectedness did not vary significantly by mode of school instruction (27.4%, 21.2%, 17.6%, respectively) (p = .212).

Highlights

Abstract

Keywords

1. Introduction

2. Materials and methods

3. Results

4. Discussion

5. Conclusion

Data availability statement

Role of the funding resources

CRediT authorship contribution statement

Declaration of Competing interest

Acknowledgments

Reference

Abstract

Background : The number of digital game users is increasing, and so is attention to digital gaming’s effects on mental health. We aimed to reveal if risky (game addiction) and usual game use (non-risky) are associated with mental health in early adulthood.

Methods : Using data from the nationwide cross-sectional Korean Epidemic Catchment Area study for psychiatric disorders, 415 participants aged 18–30 years were divided into “non-game,” “usual game,” and “risky game” user groups based on the previous month’s game use and cut-off value of game overuse screening questionnaire. Multiple linear and logistic regressions revealed the association between game use groups, perceived mental health, and lifetime prevalence of clinical mental disorders including suicidal ideation.

Results : Among the 415 participants, 167 were non-game users, 175, usual game users, and 73, risky game users. Risky game users self-reported decreased satisfaction and happiness, and a significantly higher lifetime prevalence of major depressive disorder, alcohol dependence, and suicidal ideation. Usual game users were significantly associated with higher lifetime prevalence of alcohol dependence and suicidal ideation. Self-reported happiness partially mediated between game use and lifetime suicidal ideation in risky, but not usual game users.

Limitations : This study is a cross-sectional observational study which was not possible to define the temporal relationship.

Conclusions : Both risky and usual game use are associated with mental health problems in early adulthood, indicating the need for careful mental health screening on not only risky game users but also usual game users.

Highlights

Abstract

Keywords

1. Background

2. Gender and mental health in the Arab world

3. Women’s mental health services in Qatar

4. Developments following the steering committee report submission

5. Future directions

Declarations of conflict of interest

Author contributions

Financial disclosure

Acknowledgements

Data Availability

References

Abstract

Investigations into gender differences in the epidemiology of common mental disorders have highlighted the fundamental role of socio-economic factors as the key determinants in experiencing mental ill health and access to treatment. Women are almost always at a socio-economic disadvantage across cultures throughout the world and as a result experience mental health inequality. This disparity in control over their socio-economic determinants is even more stark in the Middle Eastern and North African region. This region has additionally also cultural and legal conditions that make women empowerment and access to health difficult. Qatar launched an ambitious National Health Strategic program and identified women’s mental health as a priority. This paper describes the development of a gender aware mental health service in Qatar, first of its kind in the region. It describes the challenges that exist in the region when attempting to develop such a service and some challenges that are unique to Qatar. This paper sets out a template of important principles that will be valuable for countries in the MENA region and beyond to develop evidence-based gender aware service that focuses on female empowerment and better mental health outcomes.

1. Background

Epidemiological data from across the world have reiterated that there exists a gender-based difference in mental health morbidity between men and women (Kessler et al., 1995; Leibenluft, 1999). From a summary of evidence in an epidemiological review by, Weissman and Klerman (1977) showing higher prevalence of mood and anxiety disorders among women, these findings have been replicated by subsequent community based epidemiological studies over the subsequent decades (Weissman et al., 1996, Kessler et al., 2005; Piccinelli and Gomez Homen, 1997).

However, studies conducted in societies or groups with socially homogenous gender roles and empowerment did not always support these findings (Egeland and Hostetter, 1983; Jenkins, 1985; Loewenthal et al., 1995). More specifically, these studies underlined the role of social factors underpinning these differences rather than the traditionally understood genetic basis (Parker and Brotchie, 2010). Over time, accumulating evidence for a social model as the variable that explains gender differences came to be seen as the only viable framework within which the evidence could be properly examined (Pan American Health Organization, 1995; World Health Organization, 1998).

It has been increasingly recognized that gender determines how the individual will interact with, have access to and have control over the socio-environmental determinants of mental health with the women universally having less control and access (WHO, 2000). The social position of women and their economic condition tends to be different from men and varies across the countries and has been shown to impact mental health (WHO, 2000). States economic policies and access to resources including those of health vary according to gender and most countries have their Gender Development Indices (GDI) lower for women than men (United Nations Women white paper 2018).

Abstract

1. Introduction

2. Material and methods

3. Theory

4. Results

5. Discussion

6. Conclusions

Funding source

Author contributions

Declaration of comepting interest

Acknowledgments

Supplementary data

References

Abstract

Purpose
Women in prisons are known to suffer with mental health difficulties and many experience challenges prior to incarceration. Diversion programmes are initiatives designed to divert people with pre-existing mental illness from the criminal justice system into mental health services. The variability of effectiveness of interventions makes realist approaches particularly appropriate for diversion programmes, and this paper presents the first realist review to be undertaken across the breadth of this topic. This realist review aimed to explain the successes, failures and partial successes of these programmes as an intervention to improve the outcomes of women offenders with mental health issues.

Methods
We conducted a realist review of published literature explaining the impact of diversion programmes on participants with mental health issues. Consultations with six specialists in the field were conducted to validate the principles and hypotheses about key dynamics for effective programmes.

Results
The review included 69 articles. We identified four essential principles, developed through thematic groupings of context-mechanism-outcome configurations, to articulate key drivers of the effectiveness of diversion programmes: coordination between services; development and maintenance of relationships; addressing major risk factors; and stabilisation through diversion programmes.

Conclusions
The behaviour of women offenders is driven by need, and the complex needs of this group require individualised plans that incorporate relationships as vehicles for support and change. Although there is a role for gender-specific interventions, it is not fully understood and further research is required. Implications for future interventions are discussed.

Introduction

     Worldwide, more than 10 million individuals are in prison at any given time and more than 30 million circulate through prison each year (Fazel, 2016). The incarceration of people with mental health conditions is now drawing attention globally, with increasing concerns around the detrimental impact of incarceration and the lack of mental health interventions adapted for prisons, alongside policy issues including overcrowding and other failures to meet human rights in prison settings (Fazel, 2016). This has resulted in an increased focus on developing mental health interventions for prison populations—particularly in high-income countries—including pre-arrest diversion services, mental health referral while incarcerated, and mental health provisions on release.

     Rates of mental illness during incarceration have been found to be higher among women than men. Women are at greater risk of receiving a mental health diagnosis while incarcerated (Al-Rousan et al., 2017; James & Glaze, 2006), and diagnosis describes a wider variety of mental disorders (Al-Rousan et al., 2017). Studies that have compared men and women have found that, except for psychoses and alcohol abuse or dependence, mental health disorders are more common in women, with odds ratios of 2–3 times those in men in prison samples (Maden, Swinton, & Gunn, 1990; Steadman et al., 2009; Teplin, 1990a, 1990b; Teplin, Abram, & Mcclelland, 1996). This suggests that female inmates may have different concerns from those of male inmates and, as a result, different needs. Evidence also suggests that prison results in a deterioration in mental well-being through factors such as overcrowding and isolation and the subsequent impact on levels of stress and distress. Incarceration is conceptualised as the fourth most upsetting event on the Holmes/Rahe Social Readjustment Rating Scale (Holmes & Rahe, 1967), and prison-related factors have also been found to be risk factors for suicide (Fruehwald et al., 2004; Hayes, 1989; Humber et al., 2013; Joukamaa, 1997).

Conclusions

     If an overarching objective of diversion programmes is to change behaviour, an individual’s needs have to be understood, including those which are not directly related to mental illness. This includes, but should not be limited to, mental health needs, particularly through addressing trauma.

     Our findings illuminate that care to promote mental health requires individual rather than agency-based plans. Programmes require flexibility to be able to prioritise services and interventions based on need, building connections with other resources in the community where they are based. Regardless of the way in which an individual comes into contact with a programme, they should be able to access the appropriate services, tailored to meet greatest and most urgent needs first.

     The findings also suggest that quality of relationships can enhance, or even define, an individual’s experience of a diversion programme. There are two aspects to this: the relationship an individual has with a programme, which should be based on trust, understanding and recovery; and the relationships an individual has outside the programme, which should be supported by diversion programmes, both through enabling ongoing contact with an individual’s support network, and more broadly, through nurturing an individual’s connection with the community they are part of.