Abstract Background Various psychological interventions are effective for reducing symptoms of anxiety when used alone, or as an adjunct to anti-anxiety medications. Recent studies have further ...indicated that smartphone-supported psychological interventions may also reduce anxiety, although the role of mobile devices in the treatment and management of anxiety disorders has yet to be established. Methods We conducted a systematic review and meta-analysis of all randomized clinical trials (RCTs) reporting the effects of psychological interventions delivered via smartphone on symptoms of anxiety (sub-clinical or diagnosed anxiety disorders). A systematic search of major electronic databases conducted in November 2016 identified 9 eligible RCTs, with 1837 participants. Random-effects meta-analyses were used to calculate the standardized mean difference (as Hedges’ g) between smartphone interventions and control conditions. Results Significantly greater reductions in total anxiety scores were observed from smartphone interventions than control conditions (g=0.325, 95% C.I.=0.17 to 0.48, p<0.01), with no evidence of publication bias. Effect sizes from smartphone interventions were significantly greater when compared to waitlist/inactive controls (g=0.45, 95% C.I.=0.30 to 0.61, p<0.01) than active control conditions (g=0.19, 95% C.I.=0.07 to 0.31, p=0.003). Limitations The extent to which smartphone interventions can match (or exceed) the efficacy of recognised treatments for anxiety has yet to established. Conclusions This meta-analysis shows that psychological interventions delivered via smartphone devices can reduce anxiety. Future research should aim to develop pragmatic methods for implementing smartphone-based support for people with anxiety, while also comparing the efficacy of these interventions to standard face-to-face psychological care.
The rapid advances and adoption of smartphone technology presents a novel opportunity for delivering mental health interventions on a population scale. Despite multi‐sector investment along with ...wide‐scale advertising and availability to the general population, the evidence supporting the use of smartphone apps in the treatment of depression has not been empirically evaluated. Thus, we conducted the first meta‐analysis of smartphone apps for depressive symptoms. An electronic database search in May 2017 identified 18 eligible randomized controlled trials of 22 smartphone apps, with outcome data from 3,414 participants. Depressive symptoms were reduced significantly more from smartphone apps than control conditions (g=0.38, 95% CI: 0.24‐0.52, p<0.001), with no evidence of publication bias. Smartphone interventions had a moderate positive effect in comparison to inactive controls (g=0.56, 95% CI: 0.38‐0.74), but only a small effect in comparison to active control conditions (g=0.22, 95% CI: 0.10‐0.33). Effects from smartphone‐only interventions were greater than from interventions which incorporated other human/computerized aspects along the smartphone component, although the difference was not statistically significant. The studies of cognitive training apps had a significantly smaller effect size on depression outcomes (p=0.004) than those of apps focusing on mental health. The use of mood monitoring softwares, or interventions based on cognitive behavioral therapy, or apps incorporating aspects of mindfulness training, did not affect significantly study effect sizes. Overall, these results indicate that smartphone devices are a promising self‐management tool for depression. Future research should aim to distil which aspects of these technologies produce beneficial effects, and for which populations.
Hippocampal volume increase in response to aerobic exercise has been consistently observed in animal models. However, the evidence from human studies is equivocal. We undertook a systematic review to ...identify all controlled trials examining the effect of aerobic exercise on the hippocampal volumes in humans, and applied meta-analytic techniques to determine if aerobic exercise resulted in volumetric increases. We also sought to establish how volume changes differed in relation to unilateral measures of left/right hippocampal volume, and across the lifespan. A systematic search identified 4398 articles, of which 14 were eligible for inclusion in the primary analysis. A random-effects meta-analysis showed no significant effect of aerobic exercise on total hippocampal volume across the 737 participants. However, aerobic exercise had significant positive effects on left hippocampal volume in comparison to control conditions. Post-hoc analyses indicated effects were driven through exercise preventing the volumetric decreases which occur over time. These results provide meta-analytic evidence for exercise-induced volumetric retention in the left hippocampus. Aerobic exercise interventions may be useful for preventing age-related hippocampal deterioration and maintaining neuronal health.
Background
Elite athletes can experience a diverse range of symptoms following post-concussive injury. The impact of sport-related concussion on specific mental health outcomes is unclear in this ...population.
Objective
The aim was to appraise the evidence base regarding the association between sport-related concussion and mental health outcomes in athletes competing at elite and professional levels.
Methods
A systematic search of PubMed, EMBASE, SPORTDiscus, PsycINFO, Cochrane, and Cinahl databases was conducted.
Results
A total of 27 studies met inclusion criteria for review. Most of the included studies (67%,
n
= 18) were published in 2014 or later. Study methodology and reporting varied markedly. The extant research has been conducted predominantly in North America (USA,
n
= 23 studies; Canada,
n
= 3), often in male only (44.4%,
n
= 12) and college (70.4%,
n
= 19) samples. Depression is the most commonly studied mental health outcome (70.4%,
n
= 19 studies). Cross-sectional retrospective studies and studies including a control comparison tend to support an association between concussion exposure and depression symptoms, although several studies report that these symptoms resolved in the medium term (i.e. 1 month) post-concussion. Evidence for anxiety is mixed. There are insufficient studies to draw conclusions for other mental health domains.
Conclusion
Consistent with current recommendations to assess mood disturbance in post-concussive examinations, current evidence suggests a link between sports-related concussion and depression symptoms in elite athletes. Causation cannot be determined at this stage of enquiry because of the lack of well-designed, prospective studies. More research is required that considers a range of mental health outcomes in diverse samples of elite athletes/sports.
Abstract Objective Physical activity interventions have been shown to improve the health of people with schizophrenia, yet treatment dropout poses an important challenge in this population, and rates ...vary substantially across studies. We conducted a meta-analysis to investigate the prevalence and predictors of treatment dropout in physical activity interventions in people with schizophrenia. Method We systematically searched major electronic databases from inception until August 2015. Randomized controlled trials of physical activity interventions in people with schizophrenia reporting dropout rates were included. Two independent authors conducted searches and extracted data. Random-effects meta-analysis and meta-regression analyses were conducted. Results In 19 studies, 594 patients with schizophrenia assigned to exercise interventions were investigated (age=37.2 years, 67.5% male, range=37.5%–100%). Trim and fill adjusted treatment dropout rate was 26.7% 95% confidence interval (CI)=19.7%–35.0%, which is more than double than in nonactive control interventions (odds ratio=2.15, 95% CI=1.29–3.58, P = .003). In the multivariate regression, qualification of the professional delivering the intervention ( β =−1.06, 95% CI=−1.77 to − 0.35, P = .003) moderated treatment dropout rates, while continuous supervision of physical activity approached statistical significance ( P = .05). Conclusions Qualified professionals (e.g., physical therapists/exercise physiologists) should prescribe supervised physical activity for people with schizophrenia to enhance adherence, improve psychiatric symptoms and reduce the onset and burden of cardiovascular disease.
The authors examined the prospective relationship between physical activity and incident depression and explored potential moderators.
Prospective cohort studies evaluating incident depression were ...searched from database inception through Oct. 18, 2017, on PubMed, PsycINFO, Embase, and SPORTDiscus. Demographic and clinical data, data on physical activity and depression assessments, and odds ratios, relative risks, and hazard ratios with 95% confidence intervals were extracted. Random-effects meta-analyses were conducted, and the potential sources of heterogeneity were explored. Methodological quality was assessed using the Newcastle-Ottawa Scale.
A total of 49 unique prospective studies (N=266,939; median proportion of males across studies, 47%) were followed up for 1,837,794 person-years. Compared with people with low levels of physical activity, those with high levels had lower odds of developing depression (adjusted odds ratio=0.83, 95% CI=0.79, 0.88; I
=0.00). Furthermore, physical activity had a protective effect against the emergence of depression in youths (adjusted odds ratio=0.90, 95% CI=0.83, 0.98), in adults (adjusted odds ratio=0.78, 95% CI=0.70, 0.87), and in elderly persons (adjusted odds ratio=0.79, 95% CI=0.72, 0.86). Protective effects against depression were found across geographical regions, with adjusted odds ratios ranging from 0.65 to 0.84 in Asia, Europe, North America, and Oceania, and against increased incidence of positive screen for depressive symptoms (adjusted odds ratio=0.84, 95% CI=0.79, 0.89) or major depression diagnosis (adjusted odds ratio=0.86, 95% CI=0.75, 0.98). No moderators were identified. Results were consistent for unadjusted odds ratios and for adjusted and unadjusted relative risks/hazard ratios. Overall study quality was moderate to high (Newcastle-Ottawa Scale score, 6.3). Although significant publication bias was found, adjusting for this did not change the magnitude of the associations.
Available evidence supports the notion that physical activity can confer protection against the emergence of depression regardless of age and geographical region.
Abstract Background Despite the known benefits of physical activity (PA) among people with anxiety, little is known about PA levels in people with anxiety at the population level. This study explored ...the global prevalence of anxiety and its association with PA. Methods Cross-sectional, community-based data from the World Health Survey was analyzed. Prevalence of anxiety was estimated for 237,964 individuals (47 countries). PA was categorized as low, moderate, and high based on the International Physical Activity Questionnaire (short form). The association between PA and anxiety was assessed by multivariable logistic regression. Results The overall global prevalence of anxiety was 11.4% (47 countries). Across 38 countries with available data on PA, 62.5%, 20.2%, and 17.3% of the sample engaged in high, moderate, and low levels of PA respectively. The prevalence of low physical activity in those with and without anxiety was 22.9% vs. 16.6% ( p <0.001) (38 countries, n =184,920). In the pooled model adjusted for socio-demographics, depression, and country, individuals engaging in low PA (vs. high PA) had 1.32 (95% CI=1.17–1.47) times higher odds for anxiety than those with high PA. Female sex, older age, lower education and wealth, and depression were also associated with low PA. At the individual country level, there was a significant positive association between low PA and anxiety in 17 of the 38 countries. Conclusion Low PA levels are associated with increased prevalence of anxiety. There is a need for longitudinal research to establish the directionality of the relationships observed.
There is increasing academic and clinical interest in how “lifestyle factors” traditionally associated with physical health may also relate to mental health and psychological well‐being. In response, ...international and national health bodies are producing guidelines to address health behaviors in the prevention and treatment of mental illness. However, the current evidence for the causal role of lifestyle factors in the onset and prognosis of mental disorders is unclear. We performed a systematic meta‐review of the top‐tier evidence examining how physical activity, sleep, dietary patterns and tobacco smoking impact on the risk and treatment outcomes across a range of mental disorders. Results from 29 meta‐analyses of prospective/cohort studies, 12 Mendelian randomization studies, two meta‐reviews, and two meta‐analyses of randomized controlled trials were synthesized to generate overviews of the evidence for targeting each of the specific lifestyle factors in the prevention and treatment of depression, anxiety and stress‐related disorders, schizophrenia, bipolar disorder, and attention‐deficit/hyperactivity disorder. Standout findings include: a) convergent evidence indicating the use of physical activity in primary prevention and clinical treatment across a spectrum of mental disorders; b) emerging evidence implicating tobacco smoking as a causal factor in onset of both common and severe mental illness; c) the need to clearly establish causal relations between dietary patterns and risk of mental illness, and how diet should be best addressed within mental health care; and d) poor sleep as a risk factor for mental illness, although with further research required to understand the complex, bidirectional relations and the benefits of non‐pharmacological sleep‐focused interventions. The potentially shared neurobiological pathways between multiple lifestyle factors and mental health are discussed, along with directions for future research, and recommendations for the implementation of these findings at public health and clinical service levels.
Abstract People with PTSD experience high levels of cardiovascular disease and comorbid mental health problems. Physical activity (PA) is an effective intervention in the general population. We ...conducted the first systematic review and meta-analysis to determine the effect of PA on PTSD. We searched major electronic databases from inception till 03/2015 for RCTs of PA interventions among people with PTSD. A random effects meta-analysis calculating hedges g was conducted. From a potential of 812 hits, four unique RCTs met the inclusion criteria ( n =200, mean age of participants 34–52 years). The methodological quality of included trials was satisfactory, and no major adverse events were reported. PA was significantly more effective compared to control conditions at decreasing PTSD and depressive symptoms among people with PTSD. There was insufficient data to investigate the effect on anthropometric or cardiometabolic outcomes. Results suggest that PA may be a useful adjunct to usual care to improve the health of people with PTSD. Although there is a relative paucity of data, there is reason to be optimistic for including PA as an intervention for people with PTSD, particularly given the overwhelming evidence of the benefits of PA in the general population. Robust effectiveness and implementation studies are required.
Background
Prospective cohorts have suggested that physical activity (PA) can decrease the risk of incident anxiety. However, no meta‐analysis has been conducted.
Aims
To examine the prospective ...relationship between PA and incident anxiety and explore potential moderators.
Methods
Searches were conducted on major databases from inception to October 10, 2018 for prospective studies (at least 1 year of follow‐up) that calculated the odds ratio (OR) of incident anxiety in people with high PA against people with low PA. Methodological quality was assessed using the Newcastle‐Ottawa Scale (NOS). A random‐effects meta‐analysis was conducted and heterogeneity was explored using subgroup and meta‐regression analysis.
Results
Across 14 cohorts of 13 unique prospective studies (N = 75,831, median males = 50.1%) followed for 357,424 person‐years, people with high self‐reported PA (versus low PA) were at reduced odds of developing anxiety (adjusted odds ratio AOR = 0.74; 95% confidence level 95% CI = 0.62, 0.88; crude OR = 0.80; 95% CI = 0.69, 0.92). High self‐reported PA was protective against the emergence of agoraphobia (AOR = 0.42; 95% CI = 0.18, 0.98) and posttraumatic stress disorder (AOR = 0.57; 95% CI = 0.39, 0.85). The protective effects for anxiety were evident in Asia (AOR = 0.31; 95% CI = 0.10, 0.96) and Europe (AOR = 0.82; 95% CI = 0.69, 0.97); for children/adolescents (AOR = 0.52; 95% CI = 0.29, 0.90) and adults (AOR = 0.81; 95% CI = 0.69, 0.95). Results remained robust when adjusting for confounding factors. Overall study quality was moderate to high (mean NOS = 6.7 out of 9).
Conclusion
Evidence supports the notion that self‐reported PA can confer protection against the emergence of anxiety regardless of demographic factors. In particular, higher PA levels protects from agoraphobia and posttraumatic disorder.
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