Cochrane Review: Psychological interventions to foster resilience in healthcare students

Kunzler,  A.M., et al. (2020). Psychological interventions to foster resilience in healthcare students|Cochrane Database of Systematic Reviews | Issue 7| Art. No.: CD013684| DOI: 10.1002/14651858.CD013684.

Psychological interventions to foster resilience in healthcare students

Plain language summary 

Psychological interventions to foster resilience in healthcare students

Background
Healthcare students (e.g. medical, nursing, midwifery, paramedic, psychology, physical therapy, or social work students) have a high academic work load, are required to pass examinations and are exposed to human suffering. This can adversely affect their physical and mental health. Interventions to protect them against such stresses are known as resilience interventions. Previous systematic reviews suggest that resilience interventions can help students cope with stress and protect them against adverse consequences on their physical and mental health.

Review question
Do psychological interventions designed to foster resilience improve resilience, mental health, and other factors associated with resilience in healthcare students?

Search dates
The evidence is current to June 2019. The results of an updated search of four key databases in June 2020 have not yet been included in the review.

Study characteristics
We found 30 randomised controlled trials (studies in which participants are assigned to either an intervention or a control group by a procedure similar to tossing a coin). The studies evaluated a range of resilience interventions in participants aged on average between 19 and 38 years.

Healthcare students were the focus of 22 studies, with a total of 1315 participants (not specified for two studies). Eight studies included mixed samples (1365 participants) of healthcare students and non‐healthcare students.

Eight of the included studies compared a mindfulness‐based resilience intervention (i.e. an intervention fostering attention on the present moment, without judgements) versus unspecific comparators (e.g. wait‐list control receiving the training after a waiting period). Most interventions were performed in groups (17/30), with high training intensity of more than 12 hours or sessions (11/30), and were delivered face‐to‐face (i.e. with direct contact and face‐to‐face meetings between the intervention provider and the participants; 17/30).

The included studies were funded by different sources (e.g. universities, foundations), or a combination of various sources (four studies). Seven studies did not specify a potential funder, and three studies received no funding support.

Certainty of the evidence
A number of things reduce the certainty about whether resilience interventions are effective. These include limitations in the methods of the studies, different results across studies, the small number of participants in most studies, and the fact that the findings are limited to certain participants, interventions and comparators.

Key results
Resilience training for healthcare students may improve resilience, and may reduce symptoms of anxiety and stress immediately after the end of treatment. Resilience interventions do not appear to reduce depressive symptoms or to improve well‐being. However, the evidence from this review is limited and very uncertain. This means that we currently have very little confidence that resilience interventions make a difference to these outcomes and that further research is very likely to change the findings.

Very few studies reported on the short‐ and medium‐term impact of resilience interventions. Long‐term follow‐up assessments were not available for any outcome. Studies used a variety of different outcome measures and intervention designs, making it difficult to draw general conclusions from the findings. Potential adverse events were only examined in four studies, with three of them showing no undesired effects and one reporting no results. More research is needed, of high methodological quality and with improved study designs.

Psychological interventions to foster resilience in healthcare students

BPS: Use of talking therapy outdoors

The British Psychological Society | July 2020 | Use of talking therapy outdoors

Outdoor talking therapy is an evidence-based approach. It is typically used to combine the conventional outcomes of indoor therapy with the known benefits of connecting with the natural world.

Meeting with clients in open, outdoor spaces can permit an authentic, human-tohuman encounter, whilst at the same time allowing for physical distancing in line with current Covid-19 government recommendations.

Therapy outdoors is supported across diverse client groups and therapy modalities. However, therapy outdoors will not suit all clients, practitioners and services.

This guidance document is intended to support individualised assessment and formulation when considering therapy outdoors but is not intended to supersede local guidance.

It is recommended that the practitioner consults relevant policy documents and guidance in their service or professional body.

The use of talking therapy outdoors

Mental health and primary care networks: understanding the opportunities

The establishment of primary care networks (PCNs) is one of the most important reforms to primary care in England in recent years. This report, published jointly by The King’s Fund and the Centre for Mental Health, explores the opportunities the emergence of these new networks creates for improving the support and treatment provided to people with mental health needs in primary care, and describes why such improvement is badly needed.

Fuul report: Mental health and primary care networks: understanding the opportunities | The King’s Fund

Mental health before and during the COVID-19 pandemic: a longitudinal probability sample survey of the UK population

The potential impact of the COVID-19 pandemic on population mental health is of increasing global concern. This paper examines changes in adult mental health in the UK population before and during the lockdown | The Lancet Psychiatry 

The study found that by late April, 2020, mental health in the UK had deteriorated compared with pre-COVID-19 trends. Policies emphasising the needs of women, young people, and those with preschool aged children are likely to play an important part in preventing future mental illness.

Full paper: Mental health before and during the COVID-19 pandemic: a longitudinal probability sample survey of the UK population

Community navigators may help alleviate loneliness in people with anxiety or depression

A blog post from the Mental Elf team considers how community navigators may help alleviate loneliness in people with anxiety or depression via The Mental Elf

Background

Loneliness is common among people with mental health problems and predicts poorer recovery from depression and anxiety. Needs for support with loneliness and social relationships are often under-addressed in mental health services.

The Community Navigator programme was designed to reduce loneliness for adults (aged 18 and above) with complex depression or anxiety who were using secondary mental health services. Acceptability and feasibility of the programme and a trial evaluation were tested in a feasibility randomised controlled trial with qualitative evaluation.

Methods

Forty participants with depression or anxiety using secondary mental health services were recruited from mental health services in two London sites and randomised to receive: the Community Navigator programme over six months in addition to routine care (n = 30); or routine care (n = 10). Measures of loneliness, depression, other clinical and social outcomes and service use were collected at baseline and six-months follow-up. Levels of engagement in the programme and rates of trial recruitment and retention were assessed. Programme delivery was assessed through session logs completed by Community Navigators. The acceptability of the programme was explored through qualitative interviews (n = 32) with intervention group participants, their family and friends, programme providers and other involved staff.

Results

Forty participants were recruited in four months from 65 eligible potential participants asked. No one withdrew from the trial. Follow-up interviews were completed with 35 participants (88%). Process records indicated the programme was delivered as intended: there was a median of seven meetings with their Community Navigator (of a maximum ten) per treatment group participant. Qualitative interviews indicated good acceptability of the programme to stakeholders, and potential utility in reducing loneliness and depression and anxiety.

Conclusions

A definitive, multi-site randomised controlled trial is recommended to evaluate the effectiveness and cost-effectiveness of the Community Navigator programme for people with complex anxiety and depression in secondary mental health services.

Full study available from PLoS ONE

Lloyd-Evans, B., Frerichs, J., Stefanidou, T., Bone, J., Pinfold, V., Lewis, G., et al. (2020). The Community Navigator Study: Results from a feasibility randomised controlled trial of a programme to reduce loneliness for people with complex anxiety or depression. PLoS ONE, 15, e0233535. https://doi.org/10.1371/journal.pone.0233535

Effects of yoga on depressive symptoms in people with mental disorders: a systematic review and meta-analysis

Brinsley, J. et al. (2020). Effects of yoga on depressive symptoms in people with mental disorders: a systematic review and meta-analysis. British Journal of Sports Medicine Published Online First: 18 May 2020. doi: 10.1136/bjsports-2019-101242

Abstract

Objective To assess whether physically active yoga is superior to waitlist control, treatment as usual and attention control in alleviating depressive symptoms in people with a diagnosed mental disorder recognised by the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Design Systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Data sources Data were obtained from online databases (MEDLINE, EMBASE, PsychINFO, CENTRAL, EMCARE, PEDro). The search and collection of eligible studies was conducted up to 14 May 2019 (PROSPERO registration No CRD42018090441).

Eligibility criteria for selecting studies We included randomised controlled trials with a yoga intervention comprising ≥50% physical activity in adults with a recognised diagnosed mental disorder according to DSM-3, 4 or 5.

Results 19 studies were included in the review (1080 participants) and 13 studies were included in the meta-analysis (632 participants). Disorders of depression, post-traumatic stress, schizophrenia, anxiety, alcohol dependence and bipolar were included. Yoga showed greater reductions in depressive symptoms than waitlist, treatment as usual and attention control (standardised mean difference=0.41; 95% CI −0.65 to −0.17; p<0.001). Greater reductions in depressive symptoms were associated with higher frequency of yoga sessions per week (β=−0.44, p<0.01).

Full article available from the BMJ

Effects of mindfulness meditation interventions on depression in older adults: A meta-analysis

Reangsing, C., Rittiwong, T., & Schneider, J. K. (2020)| Effects of mindfulness meditation interventions on depression in older adults: A meta-analysis| Aging & Mental Health| 1-10.

Abstract

Objective

We examined the effects of MMIs on depression in older adults and explored the moderating effects of participant, methods, and intervention characteristics.

Methods

We systematically searched 15 databases through June 2019 without date restrictions using the following search terms: (mindful* OR meditat*) AND depress* AND (older adult* OR elder OR aging OR senior OR geriatric*). Inclusion criteria were primary studies evaluating MMIs with adults ≥65 years old with depression measured as an outcome, a control group, and written in English. Two researchers independently coded each study and compared for discrepancies and consulted a third researcher in cases of disagreement. We used random-effects model to compute effect sizes (ESs) using Hedges’ g, a forest plot, and Q and I² statistics as measures of heterogeneity; we also examined moderator analyses.

Results

Nineteen studies included 1,076 participants (71.8 ± 5.2 years old). Overall, MMIs showed significantly improved depression (ES=.65, 95%CI 0.35, 0.94) compared to controls. With regards to moderators, Asians had a greater improvement in depression (1.28) than Europeans (.59) and North Americans (.32). Less than 5 weeks of MMIs showed greater improvement in depression (1.47) than longer periods (.55). MMIs with guided meditation reduced depression (.91) more than MMIs without (.42). Only one quality indicator, a priori power analysis, showed greater effects on depression (g = 1.0) than no power analysis (g=.35).

Conclusion

MMIs improved depressive symptoms in older adults. MMIs might be used as adjunctive or alternative to conventional treatment for depressed older adults.

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Lancet Psychiatry: How mental health care should change as a consequence of the COVID-19 pandemic

Moreno, C. (2020). |How mental health care should change as a consequence of the COVID-19 pandemic | The Lancet Psychiatry |https://doi.org/10.1016/S2215-0366(20)30307-2

An international group of clinicians, mental health experts, and services users uhave collaborated to reflect on the challenges for mental health that COVID-19 poses; this Position Paper, published in The Lancet Psychiatry, argues that the pandemic actually presents an opportunity to improve mental health services.

Summary

The unpredictability and uncertainty of the COVID-19 pandemic; the associated lockdowns, physical distancing, and other containment strategies; and the resulting economic breakdown could increase the risk of mental health problems and exacerbate health inequalities. Preliminary findings suggest adverse mental health effects in previously healthy people and especially in people with pre-existing mental health disorders. Despite the heterogeneity of worldwide health systems, efforts have been made to adapt the delivery of mental health care to the demands of COVID-19. Mental health concerns have been addressed via the public mental health response and by adapting mental health services, mostly focusing on infection control, modifying access to diagnosis and treatment, ensuring continuity of care for mental health service users, and paying attention to new cases of mental ill health and populations at high risk of mental health problems. Sustainable adaptations of delivery systems for mental health care should be developed by experts, clinicians, and service users, and should be specifically designed to mitigate disparities in health-care provision. Thorough and continuous assessment of health and service-use outcomes in mental health clinical practice will be crucial for defining which practices should be further developed and which discontinued. For this Position Paper, an international group of clinicians, mental health experts, and users of mental health services has come together to reflect on the challenges for mental health that COVID-19 poses. The interconnectedness of the world made society vulnerable to this infection, but it also provides the infrastructure to address previous system failings by disseminating good practices that can result in sustained, efficient, and equitable delivery of mental health-care delivery. Thus, the COVID-19 pandemic could be an opportunity to improve mental health services.

Covid-19 and the nation’s mental health

Covid-19 and the nation’s mental health: July 2020 | Centre for Mental Health 

Covid-19 is increasing levels of psychological distress around the world, and the mental health impacts are greatest among those most closely affected. This includes people living in areas where there are local outbreaks of the virus and people with long-term physical or mental health conditions.

This briefing warns that the combination of a possible rise in Covid-19 cases combined with seasonal flu, the absence of financial safety nets such as the furlough scheme, and a no-deal Brexit may affect the whole UK economy and have a major knock-on effect on mental health.

Full briefing: Covid-19 and the nation’s mental health: July 2020

Impact of Infection Outbreak on Long-Term Care Staff: A Rapid Review on Psychological Well-Being #covid19rftlks

Embregts, P., van Oorsouw, W., & Nijs, S.,(2020)|Impact of Infection Outbreak on Long-Term Care Staff: A Rapid Review on Psychological Well-Being| Journal of Long-Term Care, (2020)| pp.70–79.

A rapid review looked at the potential impact of  infection outbreaks on the psychological state of healthcare staff, the research team also had the secondary aim of exploring suggestions to support and protect this group’s psychological well-being.

Abstract

Context: Older people and people with an intellectual disability who receive long-term care are considered particularly vulnerable to infection outbreaks, such as the current Coronavirus Disease 2019. The combination of healthcare concerns and infection-related restrictions may result in specific challenges for long-term care staff serving these populations during infection outbreaks.

Objectives: This review aimed to: (1) provide insight about the potential impact of infection outbreaks on the psychological state of healthcare staff and (2) explore suggestions to support and protect their psychological well-being.

Method: Four databases were searched, resulting in 2,176 hits, which were systematically screened until six articles remained. Thematic analysis was used to structure and categorise the data.

Findings: Studies about healthcare staff working in long-term care for people with intellectual disabilities were not identified. Psychological outcomes of healthcare staff serving older people covered three themes: emotional responses (i.e., fears and concerns, tension, stress, confusion, and no additional challenges), ethical dilemmas, and reflections on work attendance. Identified suggestions to support and protect care staff were related to education, provision of information, housing, materials, policy and guidelines.

Limitations: Only six articles were included in the syntheses.

Implications: Research into support for long-term care staff during an infection outbreak is scarce. Without conscious management, policy and research focus, the needs of this professional group may remain underexposed in current and future infection outbreaks. The content synthesis and reflection on it in this article provide starting points for new research and contribute to the preparation for future infection outbreaks.