̽��ֱ�� of Cambridge - Peter Jones

‘Diabetes distress’ increases risk of mental health problems among young people living with type 1 diabetes

cjb250 — Wed, 17 Jul 2024 09:00:45 +0000

̽��ֱ��findings highlight the urgent need for monitoring and support for the mental health of young people diagnosed with type 1 diabetes.

According to the charity JDRF, there are 8.7 million people living with type 1 diabetes around the world, including over 400,000 people in the UK. It is a chronic, life-threatening condition, usually diagnosed in childhood, that has a life-long impact.

Currently, people with type 1 diabetes rely on a routine of finger-prick blood tests and insulin injections or infusions, because their pancreas no longer produces insulin itself, although recent developments in artificial pancreas technology are helping transform this care.

Previous studies have shown potential links between childhood-onset type 1 diabetes and a number of mental health disorders in adulthood. However, it is not clear whether these links can be best explained by the impacts of living with the condition and its treatment, or whether underlying common biological mechanisms may be implicated, for example the impact of unstable blood sugar levels on the developing adolescent brain.

To help answer this question, a team of researchers turned to data from over 4,500 children with type 1 diabetes on a national register in the Czech Republic and from large-scale European DNA studies.Their findings are published today in Nature Mental Health.

From the national register data, the researchers found that children diagnosed with type 1 diabetes – compared to children without the condition – were over twice as likely to develop a mood disorder and more than 50% more likely to develop an anxiety disorder. They were also more than four times more likely to develop behavioural syndromes including eating and sleep disorders

Conversely, children with type 1 diabetes were at a much lower risk of developing psychotic disorders, such as schizophrenia – almost half the risk compared to their peers.

̽��ֱ��findings are consistent with the results from two other national register studies in Sweden and in Denmark, suggesting that the results would likely apply to other countries, too, including the UK.

̽��ֱ��team used a statistical technique known as Mendelian Randomisation to probe causal links between type 1 diabetes and these various psychiatric disorders, but found little evidence in support of a common underlying biological mechanism.

Tomáš Formánek, a PhD student at the ̽��ֱ�� of Cambridge and the National Institute of Mental Health, Klecany, Czech Republic, said: “Although we found a concerning increase in the risk of mental health problems among people living with type 1 diabetes, our study – and others before it – suggests this is unlikely to be the result of common biological mechanisms. This emphasises the importance of prevention and sustained attention to the mental health needs of children and young people with type 1 diabetes.”

̽��ֱ��researchers say that mental health problems in later life may be a result of children with type 1 diabetes being forced to make significant changes to their lives, with a constant focus on monitoring their food intake and a need to check blood sugar levels and administer insulin injections. This often leaves these children feeling excluded from social events and singled-out by peers, teachers and even family members.

Dr Benjamin Perry from the Department of Psychiatry, ̽��ֱ�� of Cambridge, said: “We know that people diagnosed with type 1 diabetes can experience ‘diabetes distress’. This can include extreme frustration with blood sugars and feelings of isolation and can lead to burnout, hopelessness, and a feeling of lack of control. It’s little wonder, then, that they are at risk of compounding mental health problems, spanning into their adult lives.”

Professor Peter Jones, also from the Department of Psychiatry, ̽��ֱ�� of Cambridge, added: “Our findings emphasise the urgent need to support children diagnosed with type 1 diabetes, look out for signs of mental health problems and offer timely, expert help. That way, it may be possible to help these children early, before these problems fully take root.”

̽��ֱ��research was supported by the National Institute for Health and Care Research Applied Research Collaboration East of England at Cambridgeshire and Peterborough NHS Foundation Trust and the Ministry of Health, Czech Republic, with additional funding from Wellcome and the UKRI Medical Research Council.

Reference
Formánek, T et al. Childhood-Onset Type 1 Diabetes and Subsequent Adult Psychiatric Disorders: A Nationwide Cohort and Genome-wide Mendelian Randomization Study. Nature Mental Health; 17 July 2024; DOI: 10.1038/s44220-024-00280-8

Children diagnosed with type 1 diabetes are at significantly higher risk of a number of mental health issues, including mood and anxiety disorders, a study from a team in the UK and the Czech Republic has found.

We know that people diagnosed with type 1 diabetes can experience ‘diabetes distress’. It’s little wonder, then, that they are at risk of compounding mental health problems, spanning into their adult lives

Benjamin Perry

kyotokushige

Teenager With Type 1 Diabetes Takes at Home Test

̽��ֱ��text in this work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Images, including our videos, are Copyright © ̽��ֱ�� of Cambridge and licensors/contributors as identified. All rights reserved. We make our image and video content available in a number of ways – on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.

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Substance use disorders linked to poor health outcomes in wide range of physical health conditions

cjb250 — Fri, 04 Nov 2022 00:13:39 +0000

In a study published today in ̽��ֱ��Lancet Psychiatry, researchers looked at the risk of mortality and loss of life-years among people who developed 28 different physical health conditions, comparing those who had previously been hospitalised with substance use disorder against those who had not.

They found that patients with most of the health conditions were more likely than their counterparts to die during the study period if they had been hospitalised with substance use disorder prior to the development of these conditions. For most subsequent health conditions, people with substance use disorders also had shorter life-expectancies than did individuals without substance use disorders.

One in twenty people worldwide aged 15 years or older lives with alcohol use disorder, while around one in 100 people have psychoactive drug use disorders. Although substance use disorders have considerable direct effects on health, they are also linked to a number of physical and mental health conditions. Consequently, the presence of these contributes to higher risk of mortality and shorter lifespan in people with substance use disorders.

To explore this link further, researchers analysed patient records from Czech nationwide registers of all-cause hospitalisations and deaths during the period from 1994-2017. They used a novel design, estimating the risk of death and life-years lost after the onset of multiple specific physical health conditions in individuals with a history of hospitalisation for substance use disorders, when compared with matched counterparts without substance use disorder but with the same physical health condition.

Although the study only looked at people living in Czechia, the researchers believe the results are likely to be similar in other countries, too.

They found that people with pre-existing substance use disorders were more likely than their counterparts to have died during the study following the development of 26 out of 28 physical health conditions. For seven of these conditions – including atrial fibrillation, hypertension, and ischaemic heart disease – the risk was more than doubled. In most cases, people with substance use disorders have shorter life-expectancies than their counterparts.

Lead author Tomáš Formánek, a PhD student at the National Institute of Mental Health, Czechia, and the ̽��ֱ�� of Cambridge, said: “Substance use disorders seem to have a profound negative impact on prognosis following the development of various subsequent physical health conditions, in some cases dramatically affecting the life expectancy of the affected people.”

It is not clear why this should be the case, though the researchers say there are a number of possible reasons. It is already known that substance use has a direct negative impact on physical health and is associated with lifestyle factors that affect our health, such as smoking, lack of exercise, and poor diet. Similarly, people with substance use disorders are less likely to take part in screening and prevention programmes for diseases such as cancer and diabetes and are less likely to use preventive medication, such as drugs to prevent hypertension. There are also some factors not directly related to substance use, such as diagnostic overshadowing, meaning the misattribution of physical symptoms to mental disorders. Such misattribution can subsequently contribute to under-diagnosis, late diagnosis, and delayed treatment in affected individuals.

Senior author Professor Peter Jones from the Department of Psychiatry, ̽��ֱ�� of Cambridge, added: “These results show how important it is not to compartmentalise health conditions into mind, brain or body. All interact leading here to the dramatic increases in mortality from subsequent physical illnesses in people with substance use disorders. There are clear implications for preventive action by clinicians, health services and policy developers that all need to recognise these intersections.”

Co-author Dr Petr Winkler from the National Institute of Mental Health, Czechia, said: “It is also important to consider that the majority of people with substance use disorders go undetected. They often do not seek a professional help and hospitalisations for these conditions usually come only at very advanced stages of illness. Alongside actions focused on physical health of people with substance use disorders, we need to equally focus on early detection and early intervention in substance use disorders.”

̽��ֱ��research was funded by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration East of England at Cambridge and Peterborough NHS Foundation Trust.

Reference
Formánek, T et al. Mortality and life-years lost following subsequent physical comorbidity in people with pre-existing substance use disorders: a national registry-based retrospective cohort study of hospitalised individuals in Czechia. ̽��ֱ��Lancet Psychiatry; 3 Nov 2022; DOI: 10.1016/S2215-0366(22)00335-2

People who have a past history of hospitalisation because of substance use disorders have much worse outcomes following the onset of a wide range of physical health conditions, according to researchers in the UK and Czechia.

Substance use disorders seem to have a profound negative impact on prognosis following the development of various subsequent physical health conditions, in some cases dramatically affecting the life expectancy of the affected people

Tomáš Formánek

aire images (Getty Images)

Woman holding a glass of whisky

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. Images, including our videos, are Copyright © ̽��ֱ�� of Cambridge and licensors/contributors as identified. All rights reserved. We make our image and video content available in a number of ways – as here, on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.

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One in three young people say they felt happier during lockdown

cjb250 — Tue, 22 Feb 2022 11:25:23 +0000

As the COVID-19 pandemic swept the world, many countries imposed strict lockdown measures, with workplaces and businesses closing and people forced to remain at home. Measures also included school closures, with exceptions for young people whose parents were classified as essential workers and those considered ‘vulnerable’, for example children under the care of social services and those in families or social situations deemed by schools to be of concern.

Several studies have reported that the lockdown had a negative impact on the mental health and wellbeing of young people, but this effect has not been uniformly reported, with a number of studies suggesting that some young people may have benefited from lockdown.

Emma Soneson, a PhD student and Gates Scholar at the Department of Psychiatry, ̽��ֱ�� of Cambridge, said: “ ̽��ֱ��common narrative that the pandemic has had overwhelmingly negative effects on the lives of children and young people might not tell the full story. In fact, it seems as though a sizeable number of children and young people may have experienced what they felt was improved wellbeing during the first national lockdown of 2020.

“After hearing from patients in our clinical practice and informally from several parents and young people that they thought the lockdown was beneficial for their or their child’s mental health, we decided to look at this trend.”

Ms Soneson and colleagues explored this issue using the OxWell Student Survey, a large, school-based survey of students aged eight to 18 years living in England. More than 17,000 students took part in the June/July 2020 survey, during the tail end of the first national lockdown, answering questions about their experiences of the pandemic, school, home life, and relationships, among others. ̽��ֱ��results of their research have been published in European Child and Adolescent Psychiatry.

̽��ֱ��team found that one in three students thought their mental wellbeing had improved during the first lockdown. In fact, an almost identical number of students fell into each of the three categories: their mental wellbeing had improved; there had been no change; or they had experienced a deterioration to their wellbeing.

̽��ֱ��highest proportions of students who reported improved mental wellbeing were among those who were in school every day (39%) and most days (35%), while the highest proportion of students who reported worse wellbeing were those who attended just once or twice (39%).

Students who felt they had had better wellbeing during lockdown were more likely than their peers to report positive lockdown experiences of school, home, relationships, and lifestyle. For example, compared with their peers, a greater percentage of students reporting better wellbeing also reported decreases in bullying, improved relationships with friends and family, less loneliness, better management of schoolwork, more sleep, and more exercise during lockdown compared with before.

Professor Peter Jones, also from Department of Psychiatry at the ̽��ֱ�� of Cambridge, said: “What we’ve seen is a complex mix of factors that affect whether a child’s mental health and wellbeing was affected by the lockdown. These range from their mental health before the pandemic through to their relationships with their families and peers, and their attitudes towards school.”

While previous studies have reported young people worrying about the impact of lockdown on friendships, nearly half of those who reported improved mental wellbeing in this new study reported feeling less left out and lonely and having better relationships with friends and family. In part, this may be because access to digital forms of social interaction can mitigate the negative effects of reduced face-to-face contact. With many parents and carers at home, there was also potential for improved family relationships.

One specific aspect of peer relationships that changed during the pandemic was bullying. ̽��ֱ��researchers found that most young people who had been bullied in the past year reported that the bullying had reduced. ̽��ֱ��proportion that reported that they were bullied less than before lockdown was higher for those who reported improved wellbeing (92%) than for those who reported no change (83%) or deterioration in their wellbeing (81%).

For approximately half of the young people who reported improved mental wellbeing, lockdown was associated with improvements in sleep and exercise – for example, 49% of those who reported improved mental wellbeing reported sleeping more, compared with 30% of those who reported no change and 19% of those who reported deterioration.

Family relationships also clearly played a part: the proportion of students who reported that they were getting along with household members better than before lockdown was higher for the group who reported improved mental wellbeing (53%) than for the groups who reported no change (26%) or deterioration (21%), with a similar pattern for getting along with friends (41%, 26%, and 27% respectively).

Professor Mina Fazel from the Department of Psychiatry at the ̽��ֱ�� of Oxford said: “While the pandemic has undoubtedly had negative consequences for many, it is important to keep in mind that this is not the case for all children and young people. We are interested in how we can learn from this group and determine if some of the changes can be sustained in order to promote better mental health and wellbeing moving forward.”

Some of the school-related factors that may have influenced how a young person responded to the lockdown include: the increased opportunities for flexible and tailored teaching that encouraged different styles of learning; smaller class sizes and more focused attention from teachers for those attending school; and later waking times and more freedom during the school day.

̽��ֱ��research was supported by the Gates Cambridge Trust, the National Institute for Health Research, the Westminster Foundation and UK Research and Innovation.

Emma Soneson is a PhD student at Clare College, Cambridge.

Reference
Soneson, E et al. Happier During Lockdown: A descriptive analysis of self-reported wellbeing in 17,000 UK school students during Covid-19 lockdown. European Child and Adolescent Psychiatry; 17 Feb 2022; DOI: 10.1007/s00787-021-01934-z

One in three young people say their mental health and wellbeing improved during COVID-19 lockdown measures, with potential contributing factors including feeling less lonely, avoiding bullying and getting more sleep and exercise, according to researchers at the universities of Cambridge and Oxford.

̽��ֱ��common narrative that the pandemic has had overwhelmingly negative effects on the lives of children and young people might not tell the full story

Emma Soneson

Lukas Rychvalsky

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Mindfulness can improve mental health and wellbeing – but unlikely to work for everyone

cjb250 — Mon, 11 Jan 2021 19:00:26 +0000

Mindfulness is typically defined as ‘the awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment’. It has become increasingly popular in recent years as a way of increasing wellbeing and reducing stress levels.

In the UK, the National Health Service offers therapies based on mindfulness to help treat mental health issues such as depression and suicidal thoughts. However, the majority of people who practice mindfulness learn their skills in community settings such as universities, workplaces, or private courses. Mindfulness-based programmes are frequently promoted as the go-to universal tool to reduce stress and increase wellbeing, accessible to anyone, anywhere.

Many randomised controlled trials (RCTs) have been conducted around the world to assess whether in-person mindfulness training can improve mental health and wellbeing, but the results are often varied. In a report published today in PLOS Medicine, a team of researchers from the Department of Psychiatry at the ̽��ֱ�� of Cambridge led a systematic review and meta-analysis to examine the published data from the RCTs. This approach allows them to bring together existing – and often contradictory or under-powered – studies to provide more robust conclusions.

̽��ֱ��team identified 136 RCTs on mindfulness training for mental health promotion in community settings. These trials included 11,605 participants aged 18 to 73 years from 29 countries, more than three-quarters (77%) of whom were women.

̽��ֱ��researchers found that in most community settings, compared with doing nothing, mindfulness reduces anxiety, depression and stress, and increases wellbeing. However, the data suggested that in more than one in 20 trials settings, mindfulness-based programmes may not improve these outcomes.

Dr Julieta Galante from the Department of Psychiatry at the ̽��ֱ�� of Cambridge, the report’s first author, said: “For the average person and setting, practising mindfulness appears to be better than doing nothing for improving our mental health, particularly when it comes to depression, anxiety and psychological distress – but we shouldn’t assume that it works for everyone, everywhere.

“Mindfulness training in the community needs to be implemented with care. Community mindfulness courses should be just one option among others, and the range of effects should be researched as courses are implemented in new settings. ̽��ֱ��courses that work best may be those aimed at people who are most stressed or in stressful situations, for example health workers, as they appear to see the biggest benefit.”

̽��ֱ��researchers caution that RCTs in this field tended to be of poor quality, so the combined results may not represent the true effects. For example, many participants stopped attending mindfulness courses and were not asked why, so they are not represented in the results. When the researchers repeated the analyses including only the higher quality studies, mindfulness only showed effects on stress, not on wellbeing, depression or anxiety.

When compared against other ‘feel good’ practices such as exercise, mindfulness fared neither better nor worse. Professor Peter Jones, also from Cambridge’s Department of Psychiatry, and senior author, said: “While mindfulness is often better than taking no action, we found that there may be other effective ways of improving our mental health and wellbeing, such as exercise. In many cases, these may prove to be more suitable alternatives if they are more effective, culturally more acceptable or are more feasible or cost effective to implement. ̽��ֱ��good news is that there are now more options.”

̽��ֱ��researchers say that the variability in the success of different mindfulness-based programmes identified among the RCTs may be down to a number of reasons, including how, where and by whom they are implemented as well as at whom they are targeted. ̽��ֱ��techniques and frameworks taught in mindfulness have rich and diverse backgrounds, from early Buddhist psychology and meditation through to cognitive neuroscience and participatory medicine – the interplay between all of these different factors can be expected to influence how effective a programme is.

̽��ֱ��number of online mindfulness courses has increased rapidly, accelerated further by the COVID-19 pandemic. Although this review has not looked at online courses, studies suggest that these may be as effective as their offline counterparts, despite most lacking interactions with teacher and peers.

Dr Galante added: “If the effects of online mindfulness courses vary as widely according to the setting as their offline counterparts, then the lack of human support they offer could cause potential problems. We need more research before we can be confident about their effectiveness and safety.”

̽��ֱ��research was mainly funded by the National Institute for Health Research.

Reference
Galante, J et al. Mindfulness-based programmes for mental health promotion in adults in non-clinical settings: A systematic review and meta-analysis of randomised controlled trials. PLOS Medicine; 11 Jan 2021; DOI: 10.1371/journal.pmed.1003481

Mindfulness courses can reduce anxiety, depression and stress and increase mental wellbeing within most but not all non-clinical settings, say a team of researchers at the ̽��ֱ�� of Cambridge. They also found that mindfulness may be no better than other practices aimed at improving mental health and wellbeing.

Mindfulness training in the community needs to be implemented with care. Community mindfulness courses should be just one option among others

Julieta Galante

World Economic Forum

Mindfulness meditation

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Most young people with increased suicide risk only display ‘mild to moderate’ mental distress – study

fpjl2 — Wed, 20 May 2020 10:32:01 +0000

̽��ֱ��vast majority of young people who self-harm or experience suicidal thoughts appear to have only mild or moderate mental distress, instead of more obvious symptoms associated with a diagnosable disorder, according to a new study.

As such, measures to reduce suicide risk in young people should focus on the whole population, not just those who are most distressed, depressed or anxious, said Cambridge ̽��ֱ�� researchers during Mental Health Awareness week.

They argue that small increases in stress across the entire population due to the coronavirus lockdown could cause far more young people to be at risk of suicide than can be detected through evidence of psychiatric disorders.

“It appears that self-harm and suicidal thinking among young people dramatically increases well within the normal or non-clinical range of mental distress,” said Professor Peter Jones, senior author of the study from Cambridge’s Department of Psychiatry.

“These findings show that public policy strategies to reduce suicide should support better mental health for all young people, not only those who are most unwell,” said Jones, who is also a consultant psychiatrist at Cambridgeshire and Peterborough NHS Foundation Trust and director of the NIHR Applied Research Collaboration East of England.

“Even modest improvements in mental health and wellbeing across the entire population may prevent more suicides than targeting only those who are severely depressed or anxious.”

̽��ֱ��Cambridge researchers conducted the study with colleagues from ̽��ֱ�� College London. It was supported by the Wellcome Trust and the National Institute for Health Research, and is recently published in the journal BMJ Open.

Recent studies suggest a broad range of mental health problems – depression, anxiety, impulsive behaviour, low self-esteem, and so on – can be taken as a whole to measure levels of “common mental distress” (CMD).

Researchers analysed levels of CMD in two large groups of young people through a series of questionnaires.

They also separately collected self-reported data on suicidal thinking and non-suicidal self-injury: predictive markers for increased risk of suicide – the second most common cause of death among 10-24 year-olds worldwide.

Both groups consisted of young people aged 14-24 from London and Cambridgeshire. ̽��ֱ��first contained 2,403 participants. ̽��ֱ��study’s methods – and findings – were then reproduced with a separate group of 1,074 participants.

“Our findings are noteworthy for being replicated in the two independent samples,” said Jones.

CMD scores increase in three significant increments above the population average: mild mental distress, followed by moderate, and finally severe distress and beyond – which often manifests as a diagnosable mental health disorder.

Those with severe mental distress came out highest for risk of suicide. However, the majority of all participants experiencing suicidal thoughts or self-harming – 78% and 76% respectively in the first sample, 66% and 71% in the second – ranked as having either mild or moderate levels of mental distress.

“Our findings help explain why research focusing on high-risk subjects has yet to translate into useful clinical tools for predicting suicide risk,” said Jones. “Self-harm and suicidal thoughts merit a swift response even if they occur without further evidence of a psychiatric disorder.”

̽��ֱ��findings point to a seemingly contradictory situation, in which most of the young people who take their own life may, in fact, be from the considerably larger pool of those deemed as low- or no-risk for suicide.

“It is well known that for many physical conditions, such as diabetes and heart disease, small improvements in the risks of the overall population translate into more lives saved, rather than focusing only on those at extremely high risk,” said Jones.

“This is called the ‘prevention paradox’, and we believe our study is the first evidence that mental health could be viewed in the same way. We need both a public health and a clinical approach to suicide risk.”

“We are surrounded by technology designed to engage the attention of children and young people, and its effect on wellbeing should be seen by industry as a priority beyond profit.”

“At a government level, policies affecting the economy, employment, education and housing, to health, culture and sport must all take account of young people; supporting their wellbeing is an investment, not a cost. This is particularly important as the widespread effects of the Covid-19 pandemic unfold.”

Reference:
Polek E, Neufeld SAS, Wilkinson P, Goodyer I, St Clair M, Prabhu G, Dolan RJ, Bullmore ET, Fonagy P, Stochl J, Jones PB. How do the prevalence and relative risk of non-suicidal self-injury and suicidal thoughts vary across the population distribution of common mental distress (the p factor)? Observational analyses replicated in two independent UK cohorts of young people. BMJ Open 2020;10:e032494. doi: 10.1136/bmjopen-2019-032494

Around 70% of young people who report self-harming or suicidal thoughts are within the normal or non-clinical range of mental distress.

Even modest improvements in mental health and wellbeing across the entire population may prevent more suicides than targeting only those who are severely depressed or anxious

Peter Jones

Joe Penna

Young woman

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Mindfulness training reduces stress during exam time

cjb250 — Mon, 18 Dec 2017 23:38:22 +0000

While the prevalence of anxiety and depression among first year undergraduates is lower than the general population, it increases to overtake this during their second year. ̽��ֱ��number of students accessing counselling services in the UK grew by 50% from 2010 to 2015, surpassing the growth in the number of students during the same period. There is little consensus as to whether students are suffering more mental disorders, are less resilient than in the past or whether there is less stigma attached to accessing support. Regardless, mental health support services for students are becoming stretched.

Recent years have seen increasing interest in mindfulness, a means of training attention for the purpose of mental wellbeing based on the practice of meditation. There is evidence that mindfulness training can improve symptoms of common mental health issues such as anxiety and depression. However, there is little robust evidence on the effectiveness of mindfulness training in preventing such problems in university students.

“Given the increasing demands on student mental health services, we wanted to see whether mindfulness could help students develop preventative coping strategies,” says Géraldine Dufour Head of the ̽��ֱ�� of Cambridge’s Counselling Service. Dufour is one of the authors of a study that set out to test the effectiveness of mindfulness – the results are published today in ̽��ֱ��Lancet Public Health.

In total, 616 students took part in the study and were randomised across two groups. Both groups were offered access to comprehensive centralised support at the ̽��ֱ�� of Cambridge Counselling Service in addition to support available from the university and its colleges, and from health services including the National Health Service.

Half of the cohort (309 students) were also offered the Mindfulness Skills for Students course. This consisted of eight, weekly, face-to-face, group-based sessions based on the course book Mindfulness: A Practical Guide to Finding Peace in a Frantic World, adapted for university students. Students were encouraged to also practice at home, starting at eight minute meditations, and increasing to about 15-25 minutes per day, as well as other mindfulness practices such as a mindful walking and mindful eating. Students in the other half of the cohort were offered their mindfulness training the following year.

̽��ֱ��researchers assessed the impact of the mindfulness training on stress (‘psychological distress’) during the main, annual examination period in May and June 2016, the most stressful weeks for most students. They measured this using the CORE-OM, a generic assessment used in many counselling services.

̽��ֱ��mindfulness course led to lower distress scores after the course and during the exam term compared with students who only received the usual support. Mindfulness participants were a third less likely than other participants to have scores above a threshold commonly seen as meriting mental health support. Distress scores for the mindfulness group during exam time fell below their baselines levels (as measured at the start of the study, before exam time), whereas the students who received the standard support became increasingly stressed as the academic year progressed.

̽��ֱ��researchers also looked at other measures, such as self-reported wellbeing. They found that mindfulness training improved wellbeing during the exam period when compared with the usual support.

“This is, to the best of our knowledge, the most robust study to date to assess mindfulness training for students, and backs up previous studies that suggest it can improve mental health and wellbeing during stressful periods,” says Dr Julieta Galante from the Department of Psychiatry at Cambridge, who led the study.

“Students who had been practising mindfulness had distress scores lower than their baseline levels even during exam time, which suggests that mindfulness helps build resilience against stress.”

Professor Peter Jones, also from the Department of Psychiatry, adds: “ ̽��ֱ��evidence is mounting that mindfulness training can help people cope with accumulative stress. While these benefits may be similar to some other preventative methods, mindfulness could be a useful addition to the interventions already delivered by university counselling services. It appears to be popular, feasible, acceptable and without stigma.”

̽��ֱ��team also looked at whether mindfulness had any effect of examination results; however, their findings proved inconclusive.

̽��ֱ��research was supported by the ̽��ֱ�� of Cambridge and the National Institute for Health (NIHR) Collaboration for Leadership in Applied Health Research and Care East of England, hosted by Cambridgeshire and Peterborough NHS Foundation Trust.

Reference
Galante, J et al. Effectiveness of providing university students with a mindfulness-based intervention to increase resilience to stress: a pragmatic randomised controlled trial. Lancet Public Health; 19 December 2017; DOI: 10.1016/S2468-2667(17)30231-1

Mindfulness training can help support students at risk of mental health problems, concludes a randomised controlled trial carried out by researchers at the ̽��ֱ�� of Cambridge.

This is, to the best of our knowledge, the most robust study to date to assess mindfulness training for students, and backs up previous studies that suggest it can improve mental health and wellbeing during stressful periods

Julieta Galante

̽��ֱ�� of Cambridge

Students studying

Researcher profile: Dr Julieta Galante

Dr Julieta Galante is a research associate in the Department of Psychiatry. Her interests lie in mental health promotion, particularly the effects of meditation on mental health. She hopes to contribute to the growing number of approaches to preventing mental health problems that do not rely on medication.

“What fascinates me is the idea that you could potentially train your mind to improve your wellbeing and develop yourself as a person,” she says. “It’s not the academic type of mind-training –meditation training is more like embarking on a deep inner-exploration.”

Galante’s research involves studying large numbers of people in real-world settings, such as busy students revising for their exams. It’s a very complex research field, she says: there are many factors, social, psychological and biological, that contribute to an individual’s mental health.

“Our projects are most successful (and enjoyable) when we collaborate with people outside the academic sphere, in this particular project with the Student Counselling Service, ̽��ֱ�� authorities, and the students themselves.”

̽��ֱ��mindfulness trial was ‘blinded’, meaning that the researchers did not know which students (and hence which data) belonged to which group. ̽��ֱ��‘unblinding’ of the results – when they found out whether their trial was successful – was nerve-wracking, she says. “ ̽��ֱ��team statistician didn’t know which group had received mindfulness training and which group was the control. He showed his results to the rest of the team and we could all see that there was a clear difference between the groups, but we didn’t know whether this meant really good or really bad news for mindfulness training. When the results were then unveiled, we all laughed with relief!”

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. For image use please see separate credits above.

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Cuts to mental health services putting young people at risk, say experts

cjb250 — Fri, 15 Sep 2017 12:18:05 +0000

In an article published today in the Journal of Public Mental Health, the team discuss the policy implications of their study published earlier in the year, which found that young people who have contact with mental health services in the community and in clinics are significantly less likely to suffer from clinical depression later in their adolescence than those with equivalent difficulties who do not receive treatment.

Young people’s mental health problems are associated with an increased risk of problems later on in adulthood, including poor mental health, lower income, unemployment, inability to maintain a stable cohabiting relationship, and greater contact with the criminal justice system. However, the team’s previous study suggested that access for adolescents with mental health problems to intervention in schools and clinics reduces mental health problems up to three years later and would therefore yield personal, economic, and societal benefits over an individual’s lifespan.

In the study, Sharon Neufeld and colleagues from the Department of Psychiatry at the ̽��ֱ�� of Cambridge used data obtained between 2005-2010 – prior to funding cuts to Child and Adolescent Mental Health Services in the community and in NHS clinics. Between 2008 and 2013, funding for the services dropped by 5.4 per cent in real terms so that in 2012/2013, only 6 per cent of the NHS’ total mental health budget was spent on these services. ̽��ֱ��knock-on effect of this was that while in 2005/2006, 38% of 14-year olds with a mental disorder had made contact with mental health provision for young people in the past year, in 2014/2015 only 25% of all children and young people with a mental disorder had made such service contact.

One consequence of this has been that the number of young people attending A&E due to a psychiatric condition had doubled by 2014/2015, compared with 2010/2011.

“It’s important to improve young people’s mental health services in schools and strengthen the care pathway to specialist Child and Adolescent Mental Health Services, in order to meet the NHS target of returning contact back up to 35% by 2020/2021,” says Mrs Neufeld.

“We need to acknowledge the mental health suffering in our young people that has only been increasingly apparent in recent years, and resolve to improve young people’s access to effective mental health services.”

She and her colleagues argue that as well as protecting funding for specialist Child and Adolescent Mental Health Services, funding for school-based counselling is also important as their study found that this was the second most used service for young people with a mental health disorder.

“ ̽��ֱ��current government has promised to provide funding for mental health first aid training for teachers in secondary schools, which should enable them to better identify those with mental health issues and connect students to the appropriate support services,” says Professor Peter Jones. “But this is against a backdrop of freezing school budgets, the very budgets that typically fund school-based counselling.

“Funding for school-based counselling must be ring-fenced, whether it be funded through the education sector or NHS, to ensure young people have adequate service access prior to specialist mental health services.”

̽��ֱ��researchers also argue that GPs could use more training in identifying mental disorder. ̽��ֱ��Royal College of General Practitioners reports that nine out of ten people with mental health problems are managed in primary care. However, even in the recent past, most GPs do not include a rotation in mental illness as part of their training. Such gaps in training, say the researchers, mean that GPs correctly identify less than a half (47%) of depression cases.

“This is a huge missed opportunity,” adds Professor Ian Goodyer. “GPs will encounter a large number of individuals with mental disorders, but have insufficient background knowledge to appropriately identify such cases.”

Reference
Sharon AS Neufeld, Peter B Jones and Ian M. Goodyer. Child and adolescent mental health services: longitudinal data sheds light on current policy for psychological interventions in the community. Journal of Public Mental Health; Date; DOI 10.1108/JPMH-03-2017-0013

Funding cuts and austerity measures are damaging young people’s access to mental health services, with potentially long-term consequences for their mental wellbeing, say researchers at the ̽��ֱ�� of Cambridge.

We need to acknowledge the mental health suffering in our young people that has only been increasingly apparent in recent years, and resolve to improve young people’s access to effective mental health services.

Sharon Neufeld

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Anti-inflammatory drugs could help treat symptoms of depression, study suggests

cjb250 — Tue, 18 Oct 2016 07:57:48 +0000

Researchers from the Department of Psychiatry at Cambridge led a team that analysed data from 20 clinical trials involving the use of anti-cytokine drugs to treat a range of autoimmune inflammatory diseases. By looking at additional beneficial side-effects of the treatments, the researchers were able to show that there was a significant antidepressant effect from the drugs compared to a placebo based on a meta-analysis of seven randomised controlled trials. Meta-analyses of the other types of clinical trials showed similar results.

When we are exposed to an infection, for example influenza or a stomach bug, our immune system fights back to control and remove the infection. During this process, immune cells flood the blood stream with proteins known as cytokines. This process is known as systemic inflammation.

Even when we are healthy, our bodies carry trace levels of these proteins – known as ‘inflammatory markers’ – which rise exponentially in response to infection. Previous work from the team found that children with high everyday levels of one of these markers are at greater risk of developing depression and psychosis in adulthood, suggesting a role for the immune system, particularly chronic low-grade systemic inflammation, in mental illness.

Inflammation can also occur as a result of the immune system mistaking healthy cells for infected cells and attacking the body, leading to autoimmune inflammatory diseases such as rheumatoid arthritis, psoriasis and Crohn’s disease. New types of anti-inflammatory drugs called anti-cytokine monoclonal antibodies and cytokine inhibitors have been developed recently, some of which are now routinely used for patients who respond poorly to conventional treatments. Many more are currently undergoing clinical trials to test their efficacy and safety.

̽��ֱ��team of researchers carried out a meta-analysis of these clinical trials and found that the drugs led to an improvement in the severity of depressive symptoms independently of improvements in physical illness. In other words, regardless of whether a drug successfully treated rheumatoid arthritis, for example, it would still help improve a patient’s depressive symptoms. Their results are published today in the journal Molecular Psychiatry.

Dr Golam Khandaker, who led the study, says: “It’s becoming increasingly clear to us that inflammation plays a role in depression, at least for some individuals, and now our review suggests that it may be possible to treat these individuals using some anti-inflammatory drugs. These are not your everyday anti-inflammatory drugs such as ibuprofen, however, but a particular new class of drugs.”

“It’s too early to say whether these anti-cytokine drugs can be used in clinical practice for depression, however,” adds Professor Peter Jones, co-author of the study. “We will need clinical trials to test how effective they are in patients who do not have the chronic conditions for which the drugs have been developed, such as rheumatoid arthritis or Crohn’s disease. On top of this, some existing drugs can have potentially serious side effects, which would need to be addressed.”

Dr Khandaker and colleagues believe that anti-inflammatory drugs may offer hope for patients for whom current antidepressants are ineffective. Although the trials reviewed by the team involve physical illnesses that trigger inflammation – and hence potentially contribute to depression – their previous work found a connection between depression and baseline levels of inflammation in healthy people (when someone does not have an acute infection), which can be caused by a number of factors such as genes and psychological stress.

“About a third of patients who are resistant to antidepressants show evidence of inflammation,” adds Dr Khandaker. “So, anti-inflammatory treatments could be relevant for a large number of people who suffer from depression.

“ ̽��ֱ��current approach of a ‘one-size-fits-all’ medicine to treat depression is problematic. All currently available antidepressants target a particular type of neurotransmitter, but a third of patients do not respond to these drugs. We are now entering the era of ‘personalised medicine’ where we can tailor treatments to individual patients. This approach is starting to show success in treating cancers, and it’s possible that in future we would use anti-inflammatory drugs in psychiatry for certain patients with depression.”

̽��ֱ��research was mainly funded by the Wellcome Trust, with further support from the National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre.

Reference
Kappelmann, N et al. Antidepressant activity of anti-cytokine treatment: a systematic review and meta-analysis of clinical trials of chronic inflammatory conditions. Molecular Psychiatry; 18 Oct 2016; DOI: 10.1038/mp.2016.167

Anti-inflammatory drugs similar to those used to treat conditions such as rheumatoid arthritis and psoriasis could in future be used to treat some cases of depression, concludes a review led by the ̽��ֱ�� of Cambridge, which further implicates our immune system in mental health disorders.

It’s becoming increasingly clear to us that inflammation plays a role in depression, at least for some individuals, and now our review suggests that it may be possible to treat these individuals using some anti-inflammatory drugs

Golam Khandaker

Boudewijn Berends

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