Social Psychiatry and Psychiatric Epidemiology最新文献

Purpose: Loneliness and social isolation are risk factors for poor health, but few effective interventions are deployable at scale. This study was conducted to determine whether acts of kindness can reduce loneliness and social isolation, improve mental health, and neighbourhood social cohesion.

Method: Three randomized controlled trials (RCTs) were conducted in the USA, UK, and Australia, involving a total of 4284 individuals aged 18-90 years old, randomized to the KIND challenge intervention or a waitlist control group. Participants allocated to the intervention were asked to do at least one act of kindness per week within a four-week period. The primary outcome was loneliness and secondary outcomes included measures of social isolation, mental health, and neighbourhood social cohesion.

Results: There was a significant, albeit small, intervention effect after four weeks for reduced loneliness in the USA and the UK, but not for Australia. Relative to controls, KIND challenge participants also showed significantly reduced social isolation and social anxiety in the USA, and reduced stress in Australia. There was also reduced neighbourhood conflict in the USA, increased number of neighbourhood contacts in the USA and Australia, greater neighbourhood stability and feelings of neighbourhood importance in the UK, and better neighbourhood social relationships in Australia.

Conclusion: Promoting the provision of social support through small acts of kindness to neighbours has the potential to reduce loneliness, social isolation and social anxiety, and promote neighbourhood relationships, suggesting a potential strategy for public health campaigns.

Trial registration: Clinical Trials Registry. NCT04398472. Registered 21^st May 2020.

Purpose: Depression is one of the most common mental disorders and substantially decreases socioemotional well-being and health-related quality of life. Analyzing temporal patterns in depressive symptoms can reveal emerging risks that require attention and have implications for mental health promotion. The present study disentangled age, period, and cohort (APC) effects on trends in depressive symptoms and their gender disparities among China's nationally representative samples of middle-aged and older adults.

Methods: Using four-wave data (2011, 2013, 2015, and 2018) from the China Health and Retirement Longitudinal Study (N = 65455), APC effects were quantified based on the hierarchical APC model. The 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10) was used to measure depressive symptoms.

Results: Depressive symptoms increased during late life and stabilized after reaching an advanced age. After further adjusting for individual characteristics, depressive symptoms exhibited a negative trend with advancing age. The mean levels of depressive symptoms remained stable during the study period. Depressive symptoms varied significantly across cohorts, with those born in 1949-1951 having the most severe depressive symptoms. Significant life-course and cohort variations existed in the gender gaps in depressive symptoms. Although women had higher mean scores on the CES-D-10 scale throughout the life course, the gender gaps in depressive symptoms gradually narrowed with age, as depressive symptoms decreased more rapidly among women. A widening trend in gender gaps in depressive symptoms was found among those born after the mid-1950s, mainly driven by a notable decline in depressive symptoms among men CONCLUSIONS: The convergence of living conditions between genders in late life, as a result of traditional Chinese culture, may have narrowed the gender gap in depressive symptoms. However, given the widening gender disparities in depressive symptoms among younger cohorts, more attention should be paid to women's mental health in the context of China's rapid socioeconomic development.

Purpose: Early adulthood is a period which may increase vulnerability to loneliness and mental health difficulties among young adults. Social networks play an important role in buffering against adverse mental health, but there is a lack of evidence around whether social connection interventions could play a role in preventing mental health difficulties for young adults.

Methods: A systematic review and meta-analysis was conducted (PROSPERO ID: CRD42023395595). PubMed, PsycInfo, and Scopus were searched (01 January 2000-01 January 2023). Studies were eligible if they (i) were quantitative, (ii) included young adults (18-24 years) from the general population, (iii) tested a social intervention which aimed to increase the quantity or quality of social connections or reduce loneliness, (iv) had a comparison group, and (v) measured depression and loneliness/social connection as outcomes. Following study screening and selection, the data extraction and risk of bias assessments were independently conducted in duplicate. The Cochrane RoB-2 tool and ROBINS-I tool were used to assess risk of bias. Results were narratively synthesised and random effects meta-analysis with standardised mean differences was conducted.

Results: Six studies were included; four in-person interventions with higher education students, one online intervention with higher education students, and one intervention for youth involved in street life. The studies were mostly rated as having some or moderate concerns with risk of bias. The interventions were associated with an overall mean reduction in depression for young adults (SMD = -0.19; 95% CI, -0.33 to -0.05; p = 0.008; 4 studies, excluding studies with serious risk of bias). All interventions had beneficial effects on a range of diverse social connection outcomes, but there was no overall statistically significant mean reduction in loneliness for young adults in pooled analyses (SMD = -0.10; 95% CI, -0.24 to 0.05; p = 0.188; 3 studies).

Conclusion: Social connection interventions show some promise in improving depression and social connection outcomes in young adults but more high-quality research, across diverse settings, is needed in this area.

Background: This study sought to describe the characteristics of unpaid carers in the UK and assess levels of depression, anxiety, and mental health treatment seeking behaviours in this population.

Methods: Data was derived from Wave 9 (n = 2790) of the COVID-19 Psychological Research Consortium (C19PRC) study, a longitudinal survey of adults in the UK. Logistic regression analyses were conducted to examine the characteristics of unpaid carers, association between caregiver status and psychological wellbeing, and caregiver-specific factors associated with risk of poor psychological wellbeing.

Results: Approximately 15% (n = 417) of the sample reported providing unpaid care. Younger age, having three or more children in the household, and lower income were identified as significant correlates of caregiver status. Unpaid caregivers were at increased risk of depression or anxiety and mental health help-seeking. Unpaid caregivers who were younger, lived in households with one or two children, and had a lower income were at greater risk of depression or anxiety and engaging in mental health help-seeking. Caring for an individual with a terminal illness, long-term illness, learning disability or difficulty, mental health problems, physical disability, and other were linked to increased risk of depression or anxiety, while caring for someone with a learning disability increased risk of mental health help-seeking.

Conclusions: This study indicates that at least one in eight people in the UK provide unpaid care, and that those who provide unpaid care have a far higher risk of experiencing depression or anxiety and seeking mental health treatment. The identification of risk factors associated with these mental health outcomes will facilitate the identification of those in most need of support.

Purpose: High rates of Not in Education, Employment or Training (NEET) are seen in people with first episode of psychosis (FEP). Sociodemographic and clinical factors were reported to be associated with NEET status in FEP patients. This study follows Intersectionality to examine the independent and additive effects, and most importantly the intersections of sociodemographic and clinical variables concerning NEET status in FEP patients. It was hypothesized that NEET status in FEP patients would be described by the intersection between at least two predictor variables.

Methods: Secondary analyses with chi-square tests, multiple logistic regression and Chi-squared Automatic Interaction Detection (CHAID) analyses were performed on 440 participants with FEP.

Results: Chi-square tests indicated that patient socioeconomic status and negative symptom severity were significantly and independently associated with their NEET status. Multiple logistic regression suggested additive effects of age (odds ratio = 1.61), patient socioeconomic status (odds ratio = 1.55) and negative symptom severity (odds ratio = 1.75) in predicting patients' NEET status. CHAID detected an intersection between patients' negative symptom severity and socioeconomic status in shaping their NEET status.

Conclusion: This study explored how the NEET status of patients with FEP was explained not only by the separate effects of negative symptom severity and socioeconomic status but also by the unique intersections of their clinical and social identities. Findings indicated that functional outcomes of patients appear co-constructed by the intersections of multiple identities. Crucial clinical implications of complementing care for negative symptom severity with vocational resources to improve functional outcomes of patients are discussed.

Purpose: To investigate whether two novel interventions on a bridge - a Video Incident Detection System (VIDS) and spinning bar barriers - have an impact on suicidal behaviour on the bridge.

Methods: A total of 146 suicidal acts were retrieved for analyses; 108 interventions before suicidal acts, 35 suicide deaths and 3 suicide attempts. Incident rate ratios (IRR) were calculated to estimate the change in incident rate associated with implementation of the two interventions: VIDS and the spinning bar 2-metre high barrier.

Results: The results of the Poisson regression showed that the rate of suicide deaths, after installation the VIDS, did not change significantly (IRR: 1.23, 95% Confidence Interval [95% CI]: 0.59-2.56), although the rate of intervened suicidal acts increased (IRR: 2.40, 95% CI: 1.65-3.47). The results showed that subsequent spinning bar installation resulted in a decrease in the incident rate of intervened suicidal acts (IRR: 0.37, 95% CI: 0.25-0.57) as well as suicide deaths (IRR: 0.23, 95% CI: 0.07-0.71). Comparison of the period when both interventions were in place with the period with no interventions indicated a reduction in suicide deaths (IRR: 0.28, 95% CI: 0.10-0.82), but no change in intervened suicidal acts (IRR: 0.90, 95% CI: 0.59-1.38).

Conclusion: The rate of suicide death decreased after the installation of the spinning bar barrier but not after the implementation of VIDS alone. Our findings reinforce that restricting access to means is a highly effective way of preventing suicide on bridges and that spinning bars may be a helpful way to design barriers.

Purpose: The pandemic has caused stress due to isolation, loss of loved ones, work and learning changes, financial instability, fear of infection, and uncertainty. It has negatively impacted mental health, particularly increasing anxiety, and depression symptoms. This study analyzed anxiety and depression symptoms over the first 25 months of the COVID-19 pandemic, considering age group, socioeconomic status, and gender.

Methods: A longitudinal study with 6 repeated measures was conducted, involving 988 adult participants from Argentina. Adapted versions of the BDI-II and STAI were administered through online questionnaires at 2, 14, 50, 130, 390, and 750 days since the start of the lockdown.

Results: The results showed a sustained increase in anxiety and depression symptoms up to 390 days, followed by a decrease in anxiety below initial levels at 750 days. Depressive symptoms significantly decreased after 750 days but remained higher than initial levels.

Conclusion: Women consistently scored higher than men, lower socioeconomic status individuals reported more symptoms, and younger individuals had higher anxiety and depression, which decreased with age. Surprisingly, older individuals displayed better mental health indicators compared to the rest of the population.

Purpose: We describe the development of an online fidelity questionnaire for early intervention in psychosis (EIP) services, to be used in population-level research, and that can be completed using self-reports from EIP staff.

Methods: A review of key literature sources on the components of EIP services was used to identify those components eligible for inclusion in the questionnaire. A modified Delphi approach, using experts in EIP services, was used to select the most important components to include in the questionnaire. To pilot test the questionnaire, two EIP staff members completed one fidelity questionnaire each, and a third questionnaire was completed by an external rater. Responses from the three sources were compared and used to revise the fidelity questionnaire.

Results: Twenty-two experts from England and Canada responded to two Delphi rounds, identifying the top 25 most important EIP service components. Some evidence-based components were not rated as highly as some non-evidence-based components. Pilot testing showed that the EIP staff rated fidelity higher than the external rater. Several questions were removed and/or revised based on the pilot study findings.

Conclusions: Fidelity instruments are limited by the available evidence and the personal experiences of experts used to develop them. As such, fidelity instruments and EIP services should continually be updated to reflect new knowledge. The online fidelity questionnaire was a simple and efficient way to collect data. Future evaluations of the fidelity questionnaire need to ensure that externally collected fidelity data are comprehensive and accurate.

Purpose: This study examined whether patient-reported measures (PRMs) addressing quality of life, personal agency, functional impairment, and treatment satisfaction at hospital discharge were associated with future readmission during a 12-month follow-up period. The study also examined whether readmission influenced changes in the same measures.

Methods: A multicenter prospective cohort study was conducted at 21 psychiatric hospitals in Japan. Participants completed the EuroQol-five-dimensions-five-level (EQ-5D), the Five-item Subjective Personal Agency Scale, and the Sheehan Disability Scale (SDS) at the time of index admission (T1), discharge from index admission (T2), and 6 months (T3) and 12 months (T4) after discharge. Inpatient treatment satisfaction was assessed at T2. Readmission and variables potentially associated with hospitalization and PRMs were evaluated using mixed-effects logistic regression models and mixed models for repeated measures.

Results: A total of 491 participants were followed for 12 months (attrition rate: 19.4%), and 480 were included in the EQ-5D analysis. The most common diagnoses were schizophrenia (59%), depression (14%), and bipolar disorder (13%). No patient-reported measures were significantly associated with readmission over the follow-up period. Interaction of readmission and time did not significantly affect changes in EQ-5D. Readmission did significantly influence SDS score changes between T2 and T3 (B = 1.78, 95% CI = 0.30-3.25, p = 0.018) and between T3 and T4 (B = 1.43, 95% CI = 0.14-2.72, p = 0.029). The same influence of readmission on SDS score changes was not observed in the model which adjusted for all potential covariates.

Conclusion: Readmission was potentially associated with changes in self-reported functional impairment. Findings highlight the potential role of intensive post-discharge services in preventing readmission, rather than relying on time-of-discharge PRMs in order to predict readmission risk.

Trial registration: This study was registered in UMIN Clinical Trials Registry (UMIN000034220).