Cris Glazebrook

A systematic review of studies of depression prevalence in university students

BACKGROUND Depression is a common health problem, ranking third after cardiac and respiratory diseases as a major cause of disability. There is evidence to suggest that university students are at higher risk of depression, despite being a socially advantaged population, but the reported rates have shown wide variability across settings. PURPOSE To explore the prevalence of depression in university students. METHOD PubMed, PsycINFO, BioMed Central and Medline were searched to identify studies published between 1990 and 2010 reporting on depression prevalence among university students. Searches used a combination of the terms depression, depressive symptoms, depressive disorders, prevalence, university students, college students, undergraduate students, adolescents and/or young adults. Studies were evaluated with a quality rating. RESULTS Twenty-four articles were identified that met the inclusion and exclusion criteria. Reported prevalence rates ranged from 10% to 85% with a weighted mean prevalence of 30.6%. CONCLUSIONS The results suggest that university students experience rates of depression that are substantially higher than those found in the general population. Study quality has not improved since 1990.

Computer-Delivered and Web-Based Interventions to Improve Depression, Anxiety, and Psychological Well-Being of University Students: A Systematic Review and Meta-Analysis

Background Depression and anxiety are common mental health difficulties experienced by university students and can impair academic and social functioning. Students are limited in seeking help from professionals. As university students are highly connected to digital technologies, Web-based and computer-delivered interventions could be used to improve students’ mental health. The effectiveness of these intervention types requires investigation to identify whether these are viable prevention strategies for university students. Objective The intent of the study was to systematically review and analyze trials of Web-based and computer-delivered interventions to improve depression, anxiety, psychological distress, and stress in university students. Methods Several databases were searched using keywords relating to higher education students, mental health, and eHealth interventions. The eligibility criteria for studies included in the review were: (1) the study aimed to improve symptoms relating to depression, anxiety, psychological distress, and stress, (2) the study involved computer-delivered or Web-based interventions accessed via computer, laptop, or tablet, (3) the study was a randomized controlled trial, and (4) the study was trialed on higher education students. Trials were reviewed and outcome data analyzed through random effects meta-analyses for each outcome and each type of trial arm comparison. Cochrane Collaboration risk of bias tool was used to assess study quality. Results A total of 17 trials were identified, in which seven were the same three interventions on separate samples; 14 reported sufficient information for meta-analysis. The majority (n=13) were website-delivered and nine interventions were based on cognitive behavioral therapy (CBT). A total of 1795 participants were randomized and 1480 analyzed. Risk of bias was considered moderate, as many publications did not sufficiently report their methods and seven explicitly conducted completers’ analyses. In comparison to the inactive control, sensitivity meta-analyses supported intervention in improving anxiety (pooled standardized mean difference [SMD] −0.56; 95% CI −0.77 to −0.35, P<.001), depression (pooled SMD −0.43; 95% CI −0.63 to −0.22, P<.001), and stress (pooled SMD −0.73; 95% CI −1.27 to −0.19, P=.008). In comparison to active controls, sensitivity analyses did not support either condition for anxiety (pooled SMD −0.18; 95% CI −0.98 to 0.62, P=.66) or depression (pooled SMD −0.28; 95% CI −0.75 to −0.20, P=.25). In contrast to a comparison intervention, neither condition was supported in sensitivity analyses for anxiety (pooled SMD −0.10; 95% CI −0.39 to 0.18, P=.48) or depression (pooled SMD −0.33; 95% CI −0.43 to 1.09, P=.40). Conclusions The findings suggest Web-based and computer-delivered interventions can be effective in improving students’ depression, anxiety, and stress outcomes when compared to inactive controls, but some caution is needed when compared to other trial arms and methodological issues were noticeable. Interventions need to be trialed on more heterogeneous student samples and would benefit from user evaluation. Future trials should address methodological considerations to improve reporting of trial quality and address post-intervention skewed data.

Systematic review of randomised controlled trials of interventions that aim to reduce the risk, either directly or indirectly, of overweight and obesity in infancy and early childhood

Abstract The risk factors for childhood overweight and obesity are known and can be identified antenatally or during infancy, however, the majority of effective interventions are designed for older children. This review identified interventions designed to reduce the risk of overweight/obesity that were delivered antenatally or during the first 2 years of life, with outcomes reported from birth to 7 years of age. Six electronic databases were searched for papers reporting randomised controlled trials of interventions published from January 1990 to September 2013. A total of 35 eligible studies were identified, describing 27 unique trials of which 24 were behavioural and three were non‐behavioural. The 24 behavioural trials were categorised by type of intervention: (1) nutritional and/or responsive feeding interventions targeted at parents of infants, which improved feeding practices and had some impact on child weight (n = 12); (2) breastfeeding promotion and lactation support for mothers, which had a positive effect on breastfeeding but not child weight (n = 5); (3) parenting and family lifestyle (n = 4); and (4) maternal health (n = 3) interventions that had some impact on feeding practices but not child weight. The non‐behavioural trials comprised interventions manipulating formula milk composition (n = 3). Of these, lower/hydrolysed protein formula milk had a positive effect on weight outcomes. Interventions that aim to improve diet and parental responsiveness to infant cues showed most promise in terms of self‐reported behavioural change. Despite the known risk factors, there were very few intervention studies for pregnant women that continue during infancy which should be a priority for future research.

Physical activity interventions in children and young people with Type 1 diabetes mellitus: a systematic review with meta-analysis

To synthesize evidence from randomized and non‐randomized studies of physical activity interventions in children and young people with Type 1 diabetes so as to explore clinically relevant health outcomes and inform the promotion of physical activity.

Estimating Overweight Risk in Childhood From Predictors During Infancy

OBJECTIVE: The aim of this study was to develop and validate a risk score algorithm for childhood overweight based on a prediction model in infants. METHODS: Analysis was conducted by using the UK Millennium Cohort Study. The cohort was divided randomly by using 80% of the sample for derivation of the risk algorithm and 20% of the sample for validation. Stepwise logistic regression determined a prediction model for childhood overweight at 3 years defined by the International Obesity Task Force criteria. Predictive metrics R2, area under the receiver operating curve (AUROC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. RESULTS: Seven predictors were found to be significantly associated with overweight at 3 years in a mutually adjusted predictor model: gender, birth weight, weight gain, maternal prepregnancy BMI, paternal BMI, maternal smoking in pregnancy, and breastfeeding status. Risk scores ranged from 0 to 59 corresponding to a predicted risk from 4.1% to 73.8%. The model revealed moderately good predictive ability in both the derivation cohort (R2 = 0.92, AUROC = 0.721, sensitivity = 0.699, specificity = 0.679, PPV = 38%, NPV = 87%) and validation cohort (R2 = 0.84, AUROC = 0.755, sensitivity = 0.769, specificity = 0.665, PPV = 37%, NPV = 89%). CONCLUSIONS: Using a prediction algorithm to identify at-risk infants could reduce levels of child overweight and obesity by enabling health professionals to target prevention more effectively. Further research needs to evaluate the clinical validity, feasibility, and acceptability of communicating this risk.

The effects of improving sleep on mental health (OASIS): a randomised controlled trial with mediation analysis

Summary Background Sleep difficulties might be a contributory causal factor in the occurrence of mental health problems. If this is true, improving sleep should benefit psychological health. We aimed to determine whether treating insomnia leads to a reduction in paranoia and hallucinations. Methods We did this single-blind, randomised controlled trial (OASIS) at 26 UK universities. University students with insomnia were randomly assigned (1:1) with simple randomisation to receive digital cognitive behavioural therapy (CBT) for insomnia or usual care, and the research team were masked to the treatment. Online assessments took place at weeks 0, 3, 10 (end of therapy), and 22. The primary outcome measures were for insomnia, paranoia, and hallucinatory experiences. We did intention-to-treat analyses. The trial is registered with the ISRCTN registry, number ISRCTN61272251. Findings Between March 5, 2015, and Feb 17, 2016, we randomly assigned 3755 participants to receive digital CBT for insomnia (n=1891) or usual practice (n=1864). Compared with usual practice, the sleep intervention at 10 weeks reduced insomnia (adjusted difference 4·78, 95% CI 4·29 to 5·26, Cohens d=1·11; p<0·0001), paranoia (−2·22, −2·98 to −1·45, Cohens d=0·19; p<0·0001), and hallucinations (−1·58, −1·98 to −1·18, Cohens d=0·24; p<0·0001). Insomnia was a mediator of change in paranoia and hallucinations. No adverse events were reported. Interpretation To our knowledge, this is the largest randomised controlled trial of a psychological intervention for a mental health problem. It provides strong evidence that insomnia is a causal factor in the occurrence of psychotic experiences and other mental health problems. Whether the results generalise beyond a student population requires testing. The treatment of disrupted sleep might require a higher priority in mental health provision. Funding Wellcome Trust.

A systematic review of adherence-enhancing interventions in adolescents taking long-term medicines

PURPOSE To assess the effectiveness of adherence-enhancing interventions (AEIs) aimed at adolescents (10-19-year-olds). METHODS An extensive search of seven bibliographic databases was conducted at the end of 2009 to identify comparative studies evaluating AEIs targeting adolescents. Data describing study characteristics and intervention effects on adherence to medicines or health outcomes were extracted and summarized using qualitative and quantitative methods. RESULTS A total of 17 AEIs were identified: 12 studies (70%) were conducted in the United States, 10 (59%) included adolescents with type 1 diabetes mellitus, and 14 (82%) considered the developmental tasks of adolescence. In all, 12 AEIs successfully improved outcome measures. Features of successful interventions included targeting AEIs to a narrow age range, including family in type 1 diabetes mellitus management, and improving access to care. Poor quality and underpowered studies limit the inferences drawn from this review. CONCLUSIONS More diverse and robust studies are needed to identify strategies to help adolescents manage medicines.

Analysis of an Egyptian study on the socioeconomic distribution of depressive symptoms among undergraduates.

BackgroundWorldwide population surveys show that prevalence of mental disorders in developing countries was as common as in industrialized countries. College life is an important stage in every person’s life; unfortunately, it may be the time to experience depression for the first time. Latterly, there has been a steady increase in the number of university students diagnosed and treated as depressed patients. This paper presents the results of a study carried out on a representative sample of undergraduate students of an Egyptian University, which aimed to study the relationship between social factors and the occurrence of depression. It was assumed that the poorer the socio-economic background the higher the rates of depression.MethodData were collected in 2004 from students at Assiut University using the Zagazig Depression scale (ZDS) and an Egyptian socio-economic status measure. This analysis, based on a refined version of the ZDS used STATA (v. 10.1.). Descriptive statistics, univariate and multivariate regression models were used to test for associations with the dimensions of SES and depression.ResultThirty-seven percent of the students had symptoms scored above the threshold for moderate depression. In the fully adjusted model: faculty of study, father’s occupation, family income and number of persons per room were associated with depression in this sample.ConclusionThe high prevalence of depressive symptoms among Egyptian students found in this study call attention to the need for a student counseling service offering mental health support. This service should particularly discover an approach for low affluence students.

Obesity-related knowledge and beliefs in obese adults attending a specialist weight-management service: Implications for weight loss over 1 year

OBJECTIVE Cognitive approaches to obesity management assume that weight loss is more likely to occur if individuals perceive many benefits and few costs. Research to-date has been limited by the lack of prospective studies. METHODS A longitudinal study design. At baseline, obese patients attending weight-management clinics (n=104) completed a questionnaire that assessed knowledge and beliefs regarding obesitys health and social/aesthetic consequences (Obesity Risk Knowledge (ORK-10) scale and the Obesity Beliefs scale), self-reported weight/height, goal weight, health-related quality of life, and sociodemographic characteristics. Medical records were also reviewed. At the 12-month follow-up, a second questionnaire assessed self-reported weight/height. RESULTS At baseline, average ORK-10 scale scores were 4/10. At follow-up, 32 out of the 66 participants retained on the study did not gain weight (48.5%). For these participants, weight loss was associated with endorsement of the health (r(s)=0.40) and the social/aesthetic (r(s)=0.31) costs of obesity (p<0.05). CONCLUSION Despite their high-risk status, participants demonstrated low levels of knowledge regarding obesitys health risks. Weight loss was associated with greater awareness of the health and social/aesthetic costs of obesity. PRACTICE IMPLICATIONS This study suggests that health education is required to facilitate informed choices and supports the use of cognitive approaches which promote both the health and social/aesthetic consequences of obesity.

How should risk be communicated to children: a cross-sectional study comparing different formats of probability information

BackgroundNewborn screening, which identifies inherited disorders and sometimes carrier status, will increasingly involve health professionals in the provision of appropriate information and support to children and their families. The ability to understand carrier results relies on an understanding of probabilistic terms. However, little is known about how best to convey probabilistic medical information to children. Research with adult populations suggests information format significantly affects comprehension. This study aimed to explore which presentation format is most effective in conveying probabilistic information to children.MethodsA probabilistic task based on the cup game was used to measure which of five different formats was associated with greatest understanding in children aged 7–11 years old (n = 106). Formats used were verbal labels (e.g. rarely, sometimes), percentages, proportion-word (e.g. 1 in X), proportion-notation (e.g. 1:X) and pie charts. There was also an additional mixed format condition. In each trial a picture was presented of three cups, each with a different probability depicted beneath it, and the child was asked to select which cup was most likely to contain the ball. Three trials were presented per format. Children also rated how certain they were that they had answered correctly.ResultsThere was a significant relationship between format and comprehension scores. Post hoc tests showed children performed significantly better when probability was presented as a pie chart, in comparison to percentages, proportion – notation, proportion-word and mixed format trials. Furthermore, most children (84%) got all trials correct for this format and children were significantly more certain that their response was correct in the pie chart trials compared to all the other formats (p < 0.001). Significant positive correlations were found between self-ratings of certainty and comprehension of verbal labels, percentages and pie charts. Older age was also associated with better performance on all formats except percentages. Overall comprehension was calculated by summing the scores for the individual trials and this was independently associated with older age and higher IQ.ConclusionThe results suggest that 7–11 year olds can understand probability information, but that the format used will significantly affect the accuracy and confidence with which children in this age group make judgements about the likelihood of an event. Of the formats studied, pie charts appear to be the optimal method of presenting probabilistic information to children in this age group. Health professionals and designers of health messages should be cognisant of this when communicating medical information to children aged 7–11 years old.