Group interventions to promote mental health in health professional education: a systematic review and meta-analysis of randomised controlled trials

Effects of interventions for improving mental health of health professional students has not been established. This review analysed interventions to support mental health of health professional students and their effects. The full holdings of Medline, PsycINFO, EBM Reviews, Cinahl Plus, ERIC and EMBASE were searched until 15th April 2016. Inclusion criteria were randomised controlled trials of undergraduate and post graduate health professional students, group interventions to support mental health compared to alternative education, usual curriculum or no intervention; and post-intervention measurements for intervention and control participants of mindfulness, anxiety, depression, stress/distress or burnout. Studies were limited to English and short term effects. Studies were appraised using the PEDro scale. Data were synthesised using meta-analysis. Four comparisons were identified: psychoeducation or cognitive-behavioural interventions compared to alternative education, and mindfulness or relaxation compared to control conditions. Cognitive-behavioural interventions reduced anxiety (?0.26; ?0.5 to ?0.02), depression (?0.29; ?0.52 to ?0.05) and stress (0.37; ?0.61 to ?0.13). Mindfulness strategies reduced stress (?0.60; ?0.97 to ?0.22) but not anxiety (95% CI ?0.21 to 0.18), depression (95% CI ?0.36 to 0.03) or burnout (95% CI ?0.36 to 0.10). Relaxation strategies reduced anxiety (SMD ?0.80; 95% CI ?1.03 to ?0.58), depression (?0.49; ?0.88 to ?0.11) and stress (?0.34; ?0.67 to ?0.01). Method quality was generally poor. Evidence suggests that cognitive-behavioural, relaxation and mindfulness interventions may support health professional student mental health. Further high quality research is warranted.     

正念训练对大学生睡眠和焦虑抑郁情绪的干预效果

  目的  探究线上、线下正念训练对改善新冠肺炎疫情后大学生焦虑抑郁情绪和睡眠质量的效果评价,为提高大学生心理健康程度提供参考。  方法  于2020年9月,采用随机整群抽样法选取华北理工大学1 203名大学生进行抑郁自评量表(SDS)、焦虑自评量表(SAS)和匹兹堡睡眠质量指数量表(PSQI)筛查,符合入组标准者103名,随机分为线上组(64名)和线下组(39名),干预后评估大学生焦虑抑郁情绪和睡眠质量改善程度。  结果  线上线下正念训练干预后大学生SAS、SDS、PSQI得分均低于干预前,差异均有统计学意义（t值分别为5.57,5.31,3.99;4.88,5.02,5.88,P值均 < 0.01）。线上、线下两种干预训练,对睡眠质量改善程度差异有统计学意义（t=-2.55,P < 0.05）。大学生焦虑、抑郁、睡眠3种症状合并越少,正念干预症状缓解率越高,3种症状并存缓解率≤25%,2种症状并存缓解率 < 40%,仅有1种症状缓解率100%。  结论  线上、线下正念训练皆可作为干预睡眠、焦虑和抑郁情绪的有效手段;线下正念训练对于改善大学生睡眠质量优于线上;正念训练对于单一症状者缓解效果更为明显。     

正念疗法对孕妇心理健康的影响

由于特殊的生理心理状态，妊娠分娩可能导致女性心理压力增高，从而影响妊娠结局并导致产后抑郁发病率上升。而针对孕妇心理健康的课程及相关研究较少，孕妇的心理健康问题已成为一个迫切需要解决的社会公众问题。正念疗法是一种基于正念的心理干预方法，其核心在于觉察而不评价，为目前心理治疗领域的主流疗法，能有效缓解压力、减轻焦虑与抑郁，促进身心健康。在慢性疾病患者的精神障碍治疗方面，正念疗法得到了广泛应用并取得了明确的效果。在孕妇的心理干预方面，正念疗法也越来越多地得到应用。目前，针对孕妇的正念减压干预方法包括正念分娩和育儿及以正念为基础的分娩教育，能够减轻孕妇自感压力、增强分娩效能，从而有效改善孕妇的心理健康状况。     

南水北调中老年移民心理干预效果分析

摘要:目的 探索南水北调中老年移民群体的心理干预效果及其心理健康、社会心理应激、社会支持的关系。方法 采用分层整群抽样,将辉县、荥阳、宝丰3个安置地的35岁以上991名中老年移民进行为期2年的心理干预。实验组移民进行心理健康讲座以及个体及团体心理咨询、心理治疗、建议精神科治疗3个层次的心理干预,对照组移民仅接受定期的心理健康讲座和团体心理咨询,干预前后均对2组移民使用心理健康状况自评量表（SCL-90）、心理社会应激调查表（PSSG）以及社会支持评定量表（SSRS）进行心理测量。结果 (1)经过不同的干预处理后,2组移民心理的健康状况自评量表(SCL-90)在躯体化、强迫症状、人际关系敏感、抑郁、焦虑、敌对等10个因子得分及总分上差异均有统计学意义(P＜0.05);心理社会应激调查表(PSSG)的得分除积极情绪体验因子的得分差异无统计学意义以外(Z=-1.587,P=0.112),生活事件、消极情绪体验、消极应对、积极应对因子以及总分上差异均有统计学意义(P＜0.05);社会支持评定量表(SSRS)除在客观支持因子上的得分差异无统计学意义以外(t=-0.738,P=0.461),主观支持、对支持的利用度因子以及总分上差异均有统计学意义(P＜0.05)。(2)关联规则模型和神经网络模型分析结果显示,中老年移民的社会支持、心理社会应激以及心理健康有较强的关联性,并且较低的社会支持和较高的心理社会应激会对中老年移民的心理健康产生不利影响。结论 接受3层次心理干预等措施的实验组中老年移民心理状况好于对照组中老年移民。中老年移民的心理健康受社会心理应激、社会支持的影响较大。因此,调动移民的主观积极情绪,引导积极应对方式,提高主观社会支持感是增强中老年移民心理健康的关键举措。     

Efectividad de un programa de enfermería en autocuidados y mindfulness,para el abordaje del trastorno mental común,en atención primaria

ObjectiveTo evaluate the effectiveness of the implementation of a mindfulness and self-care program to treat common mental health disorders in primary care.DesignQuasi-experimental non-controlled, non-randomised study, with repeated measurements.SettingSeven health centres, in area v of the Principality of Asturias, between 2014 and 2018.ParticipantsSubjects between 18-65 years with mixed anxiety, depressive, and adaptive disorders, with no serious mental disease. Non-probabilistic convenience sampling was used.InterventionA group intervention was made, consisting of 9 weekly sessions of 90 min, daily practice, and reinforcement sessions at one month, 3, 6, and 12 months.Main measurementsPre-post measurements using validated and self-administered questionnaires; medium-term (3-6 months) and long-term (> 12 months) of the variables: trait anxiety/state anxiety (Status-Trait Anxiety Questionnaire –STAI–); anxiety/depression (Goldberg Anxiety and Depression Scale –GHQ28–), mindfulness (Five Facet Mindfulness Questionnaire –FFMQ–), reduction of pharmacological treatment (open questions).ResultsThe study included a final sample of 314 subjects. A statistically significant difference in means was found in the 3 follow-up periods as regards the baseline values for all the scales/subscales. There was a reduction of 54.3% in the taking of anxiolytic/antidepressant baseline medication in the long-term follow-up (P < .001).ConclusionsA moderate reduction of the symptoms, together with the reduction of the medication, indicate that the intervention of mindfulness supervised by the primary care nurse can be a treatment option for the mental disorders common in this level of care.     

护理院老年人心理健康问题分析与对策探讨

目的：分析护理院老年人心理健康问题并进行针对性护理干预措施以减轻患者焦虑、孤独等不良情绪,提高生活质量。方法：选取本院老年人100例,对其进行心理调查及调查问卷分析其产生各类心理健康问题的原因,并对所有老年人进行常规护理干预及针对性护理干预。比较在护理干预前后生活质量评分以及主观幸福感指数等指标。结果：护理干预后患者生活质量评分显著优于入住时（P〈0.05）;患者主观幸福感评分显著优于入住时（P〈0.05）;入院时患者SAS得分为（45.1±10.8）分,干预后为（32.3±9.5）分,差异统计学意义（P〈0.05）。结论：护理院老年人心理健康问题较突出,其日常生活能力、幸福指数较低,同时存在躯体化、精神化焦虑状态,抑郁情况明显。对其进行心理健康问卷调查并根据所得结果采取针对性护理干预措施,有利于帮助老年人做好心理调适,及时解除老年人心理困惑,减轻心理压力并调整心理状态以达到改善其焦虑、抑郁等不良情绪的目的。     

Evaluation of a stress management course in adult education centres in rural Australia

OBJECTIVE: To investigate whether attending a six-week stress management course in a rural adult education centre is effective in reducing participants' levels of stress, anxiety and depression. DESIGN: Repeated measures design using self-report measures of stress, anxiety and depression at commencement and completion of a six-week stress management course, and six months post-completion follow up. SETTING AND PARTICIPANTS: One hundred and thirty-two adults (age range 18-73 years) living in a rural community who self-enrolled in the stress management course at adult education centres. INTERVENTION: The course consisted of six weekly group sessions. Each two-hour session conducted by mental health professionals, included teaching cognitive behavioural strategies targeted at reducing individual symptoms of stress. MAIN OUTCOME MEASURES: Comparative analysis of pre- and post-test and six-month follow up on measures of stress (Stress Symptom Checklist), anxiety and depression (Hospital Anxiety and Depression Scale). Results: Results indicated a significant reduction in stress symptoms (F(7,90) = 34.92, P < 0.001), anxiety and depression (F(3,95) = 87.92, P < 0.001) from course commencement to course completion. These improvements were sustained six months after course completion for stress symptoms (F(11,65) = 22.40, P < 0.001), anxiety and depression (F(5,73) = 41.78, P < 0.001). CONCLUSION: Findings demonstrate the stress management course is an effective community intervention in a rural community. Challenges for future implementation of the program are discussed.     

The prevalence of common mental disorders among hospital physicians and their association with self-reported work ability: a cross-sectional study

ABSTRACT: BACKGROUND: We studied the prevalence of common mental disorders among Dutch hospital physicians and investigated whether the presence of a mental disorder was associated with insufficient self-reported work ability. METHODS: A questionnaire was sent to all (n=958) hospital physicians of one academic medical center, using validated scales to assess burnout, work-related fatigue, stress, posttraumatic stress disorder (PTSD), anxiety and depression. Furthermore, respondents were asked to rate their current work ability against the work ability in their own best period (adapted version of the first WAI item). The prevalence of each common mental disorder was calculated. In addition, odds ratios of reporting insufficient work ability for subjects with high complaint scores compared to patients with low complaint scores were calculated for each mental disorder. RESULTS: The response rate was 51%, and 423 questionnaires were eligible for analysis. The mental disorder prevalence rates were as follows: work-related fatigue 42%, depression 29%, anxiety 24%, posttraumatic stress complaints 15%, stress complaints 15% and burnout 6%. The mean score for self-reported work ability was 8.1 (range 0-10), and 4% of respondents rated their own work ability as insufficient. Physicians with high mental health complaints were 3.5- for fatigue, 5.6- for PTSD, 7.1- for anxiety, 9.5- for burnout, 10.8- for depression and 13.6-fold more likely to report their work ability as insufficient. CONCLUSIONS: The prevalence of common mental disorders among hospital physicians varied from 6% for burnout to 42% for work-related fatigue. Those physicians with high complaints had significantly 4- to 14 times increased odds of reporting their own work ability as insufficient. This work suggests that to ensure future workers health and patients safety occupational health services should plan appropriate intervention strategies.     

Maternal symptoms of stress, depression, and anxiety are related to nonresponsive feeding styles in a statewide sample of WIC participants

Parenting, including nonresponsive feeding styles, has been related to under- or overweight among young children. The relationship between maternal mental health and feeding styles has not been examined. We hypothesized that mothers who report more symptoms of stress, depression, or anxiety report less responsive (e.g. more controlling, indulgent, and uninvolved) feeding styles than mothers who report fewer symptoms of stress, depression, or anxiety. Our analyses included 702 mother-infant pairs from a statewide sample of Special Supplemental Nutrition Program for Women, Infants, and Children mothers. We assessed maternal mental health and feeding styles by a telephone survey. After adjusting for potential confounding variables, maternal stress symptomatology was significantly associated with forceful (beta = 0.03; 95% CI = 0.02, 0.05) and uninvolved (OR = 1.4; 95% CI = 1.1, 1.7) feeding style scores, maternal depression symptomatology was significantly associated with forceful (beta = 0.03; 95% CI = 0.004, 0.05), indulgent (beta = 0.03; 95% CI = 0.004, 0.06), and uninvolved (OR = 1.5; 95% CI = 1.001, 2.2) feeding styles scores, and maternal anxiety symptomatology was significantly related to restrictive (beta = 0.11; 95% CI = 0.01, 0.21), forceful (beta = 0.04; 95% CI = 0.02, 0.06), and uninvolved (OR = 1.4; 95% CI = 1.01, 1.9) feeding style scores. Among mothers who perceived their infant as temperamentally fussy, there was a significant positive relationship between restrictive feeding styles scores and 3 indices of maternal mental health (stress, beta = 0.18; 95% CI = 0.07, 0.28; depression, beta = 0.21; 95% CI = 0.04, 0.38; and cumulative mental health symptomatology, beta = 0.29; 95% CI = 0.10, 0.48). Mothers who report stress, depression, or anxiety symptoms are at risk for nonresponsive feeding styles. These findings provide support for broadening the focus of existing child nutrition programs to include strategies that recognize how issues of maternal mental health can affect feeding styles.     

新冠肺炎疫情期间服刑人员焦虑抑郁症状及影响因素分析

目的 探讨新冠肺炎疫情期间服刑人员的焦虑抑郁症状及其影响因素,为制定突发公共卫生事件下的心理干预策略提供参考依据。方法 采用一般情况问卷、焦虑自评量表、抑郁自评量表和简易应对方式问卷对西部数所监狱897名服刑人员进行问卷调查。结果 服刑人员焦虑、抑郁症状检出率分别为42.92%、52.73%,共患焦虑、抑郁占38.91%。担忧自己或家人感染、担忧出狱后生计受疫情影响、身体健康状况越差是焦虑和抑郁的危险因素（OR＞1.000,P＜0.01）,与亲朋联系次数越多是焦虑和抑郁的保护因素（OR＜1.000,P＜0.01）。焦虑、抑郁症状的服刑人员倾向于采取消极应对方式,而无焦虑、无抑郁症状的服刑人员倾向于采取积极应对方式。结论 新冠肺炎疫情期间服刑人员焦虑、抑郁症状较为严重,及时开展有针对性的心理干预策略,排除危险性因素干扰,引导他们采取积极的应对方式,可保护其心理健康。     

江西省洪涝灾害后1149名受灾居民心理健康状况调查

目的了解江西地区洪涝灾区部分居民灾害后的心理健康状况及应激反应,为出台完善重大自然灾害心理干预预案提供依据。方法采用分层整群抽样方法,使用自编的一般情况调查表、症状自评量表(SCL-90)、事件影响量表-修订版(IES-R)对江西省南昌市西湖区和安义县15～70岁受灾居民进行调查。结果共调查1149人,受灾人群中有41.69%存在不同程度的心理问题,有15.06%的人可能存在某种明显的心理问题。受灾居民除躯体化及抑郁因子得分外与全国常模差异无统计学意义(P﹥0.05),焦虑、敌对等症状因子得分和总分、总均分均高于全国常模,差异有统计学意义(P﹤0.05);抑郁和敌对症状因子得分男女差异无统计学意义(P﹥0.05),男性受灾居民人际关系敏感因子得分较女性为低,而躯体化、强迫症状、焦虑、恐怖、偏执、精神病性及总分、总均分均高于女性受灾居民,差异有统计学意义(P﹤0.05);除人际关系敏感、敌对、偏执因子外(P﹥0.05),南昌地区受灾居民躯体化、强迫症状等因子及总分、总均分均高于安义县受灾居民,差异有统计学意义(P﹤0.05)。受灾居民创伤后应激症状阳性检出率为12.71%。不同性别受灾居民各应激反应症状因子及总分、总均分差异均无统计学意义(P﹥0.05);南昌地区受灾居民除闯入因子外,回避、高警觉性症状因子及总分、总均分均高于安义县受灾居民,差异有统计学意义(P﹤0.05)。结论极端恶劣天气对受灾居民的心理健康影响普遍而严重,尽早建立极端恶劣天气下心理干预机制十分必要。     

Karenni refugees living in Thai-Burmese border camps: traumatic experiences, mental health outcomes, and social functioning

In June 2001, we assessed mental health problems among Karenni refugees residing in camps in Mae Hong Son, Thailand, to determine the prevalence of mental illness, identify risk factors, and develop a culturally appropriate intervention program. A systematic random sample was used with stratification for the three camps; 495 people aged 15 years or older from 317 households participated. We constructed a questionnaire that included demographic characteristics, culture-specific symptoms of mental illness, the Hopkins Symptoms Checklist-25, the Harvard Trauma Questionnaire, and selected questions from the SF-36 Health Survey. Mental health outcome scores indicated elevated levels of depression and anxiety symptoms; post-traumatic stress disorder (PTSD) scores were comparable to scores in other communities affected by war and persecution. Psychosocial risk factors for poorer mental health and social functioning outcomes were insufficient food, higher number of trauma events, previous mental illness, and landmine injuries. Modifications in refugee policy may improve social functioning, and innovative mental health and psychosocial programs need to be implemented, monitored, and evaluated for efficacy.     

PTSD and depression among displaced Chinese workers after the world trade center attack: A follow-up study

We conducted a follow-up assessment to assess the development of Posttraumatic Stress Disorder (PTSD) and depression among Chinese immigrants after the World Trade Center attack. Sixty-five Chinese displaced workers who were originally interviewed in May 2002 were re-interviewed in March 2003. Whereas depression scores decreased over time, avergae PTSD scores remained unchanged. The trajectory of posttraumatic stress symptoms was more complex, with an increasing number of individuals who show no or little emotional health problems and another increasing group of individuals with exacerbated posttraumatic stress symptoms. Although the mean values of the re-experiencing and hypervigilance cluster did not change over time, the mean value of the avoidance/numbing cluster increased significantly from time 1 (M=4.60, SD=4.98) to time 2 (M=6.34, SD=4.24), (F_1.61=5.69, P=.02). A higher proportion of subjects met diagnostic criteria of PTSD at time 2 (27%) than at time 1 (21%). The study highlights the importance of ongoing mental health surveillance of diverse cultural and linguistic groups after a major traumatic event. The time of the study, Dr. Thiel de Bocanegra was vice president for Research and Evaluation at Safe Horizon     

女大学生焦虑、抑郁与人格特征的相关性研究

目的了解女大学生的焦虑、抑郁心理症状,探讨人格特征等因素与焦虑、抑郁心理症状的关系,为干预研究提供依据。方法对安徽省1334名女大学生应用Zung焦虑自评量表、Radloff流调中心用抑郁量表及艾森克个性问卷,采用无记名方式,进行问卷调查。结果女大学生焦虑症状检出率为6.4%,抑郁症状检出率为22.7%,焦虑、抑郁症状并存检出率为5.5%;师范、理工类女大学生人格中具有敌意倾向及情绪不稳定与焦虑症状相关,学习成绩差、母亲受教育程度低和人格中具有敌意倾向、情绪不稳定及性格内向与抑郁症状相关。结论女大学生焦虑、抑郁症状较为普遍。应针对其危险因素开展干预研究,提高女大学生心理健康水平。     

基层公共卫生防治人员身心健康与职业倦怠的关系研究

目的 分析基层公共卫生防治人员身心健康与职业倦怠的关系, 为该人群心理健康干预提供参考。
方法 随机抽取深圳市宝安区560名基层公共卫生防治人员作为对象, 实施问卷调查, 并对回收问卷的调查结果进行分析。
结果 基层公共卫生人员焦虑、抑郁、精神病性、呼吸系统及心血管系统的得分高于全国常模, 差异有统计学意义(P < 0.05);身心健康量表中的焦虑、抑郁、眼和耳、生殖及内分泌系统、心血管系统得分和情绪耗竭呈正相关, 焦虑、抑郁、精神病、消化系统得分和消极怠慢呈正相关, 抑郁、神经系统得分和专业低效能感呈正相关; 回归模型决定系数R2分别为0.985 6、0.964 8、0.958 9, 且整体回归效果均有统计学意义(P < 0.01)。
结论 身心健康和职业倦怠存在较强的相关性, 降低基层公共卫生防治人员的职业倦怠感, 提高该类人群的身心健康水平至关重要。
     

疫情流行期间志愿者心理健康状况及心理服务需求调查

目的了解疫情期间志愿者心理健康状况及其影响因素。方法2020年3月,通过网络平台,采用整群抽样法对上海市金山区辖区内384名参与疫情防控工作的志愿者进行问卷调查。分别采用压力知觉量表(PSS-10)、广泛性焦虑量表(GAD-7)、抑郁症状群量表(PHQ-9)对受试者的应激状况、焦虑症状、抑郁症状进行评估,对研究对象的心理服务需求开展调查。结果收到有效问卷361份,有效问卷回收率94.01%。检出应激症状阳性101人(占27.98%),焦虑症状阳性65人(占18.01%),抑郁症状阳性67人(占18.56%),同时具备两种及以上阳性症状的心理健康高危人群61人(占16.90%)。logistic回归分析结果显示:每周志愿服务时间12 h以上是应激发生的危险因素(OR=2.100,P<0.05),对新冠肺炎熟悉是发生焦虑(OR=2.507)、抑郁(OR=2.674)和高危心理状况(OR=2.742)的危险因素(P<0.05)。有应激、焦虑、抑郁症状和心理健康状况高危人群对心理健康服务需求更为强烈(P<0.05)。结论疫情发生初期,上海市金山区疫情防控志愿者心理健康尚好。在开展重大公共卫生事件志愿服务时,要关心志愿者的身心健康,建立合理的休息制度、个人防护保障和社会支持制度,同时需要重视心理健康的宣教,提供必要的心理保健服务,进一步完善志愿服务体系建设。     

心理素质训练改善大学生情绪健康水平的近期效果评价

目的了解心理素质训练对大学生情绪水平的干预效果，为大学生心理健康教育提供参考依据。方法采用整群随机抽样方法，将208名大学生随机分为干预组和对照组，对于预组实施1个月的心理素质训练干预，对照组不进行任何干预。干预后比较2组在状态一特质焦虑问卷、流调用抑郁问卷上的得分变化情况。结果干预组大学生干预后抑郁情绪得分明显低于干预前，焦虑情绪得分干预前、后差异无统计学意义；对照组大学生干预后抑郁情绪得分明显高于干预前，焦虑情绪得分也明显高于干预前。结论心理素质训练可有效改善大学生的情绪健康水平。     

Impact of a web-based personally tailored physical activity intervention on depression,anxiety, stress and quality of life: Secondary outcomes from a randomized controlled trial

BackgroundFew studies have investigated the impact of web-based physical activity interventions on mental health outcomes. Therefore, this study examined the impact of a web-based personally tailored physical activity intervention on depression, anxiety, stress and quality of life.Methods501 participants were randomised into either a control group or a pooled intervention condition who received a 3-month web-based personally tailored physical activity intervention. Previously, this intervention has demonstrated to improve self-reported physical activity, but not device-measured physical activity. At baseline, 3- and 9-months, depression, anxiety and stress were assessed using the DASS21, and quality of life was assessed using the SF-12V2. General linear mixed models examined differences between groups over time.ResultsMost participants (>80%) reported normal levels of depression, anxiety or stress. Relative to baseline levels, significant reductions of depression, anxiety, stress and the SF12 mental health component were observed in the pooled intervention group at 3 and 9 months. Relative to the control group, significant reductions were observed in the pooled intervention group for depression and stress (3-months only) and anxiety (3- and 9-months), but not quality of life.ConclusionA web-based physical activity intervention can result in positive mental health outcomes, even in the absence of device-measured physical activity improvements. However, these findings need to be confirmed in future studies.Trial registration numberACTRN12615000057583.     

Influence of Vitamin D Supplementation on Mental Health in Diabetic Patients: A Systematic Review

Diabetes is associated with a number of mental health consequences, including enhanced risk of depression and anxiety, as well as decreased quality of life, and vitamin D deficiency is considered to be one of the factors that influence these outcomes in diabetic patients. The aim of the present study was to conduct a systematic review of the literature presenting the data regarding the influence of vitamin D supplementation on mental health in diabetic adults. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (Registration number CRD42020155779). A systematic search of the PubMed and Web of Science databases was performed, and the intervention studies published until September 2021 were included in the review. The human studies were included if an adult sample of diabetic individuals received vitamin D supplementation during the intervention and its effect on any mental health aspect was assessed, but studies presenting the influence of combined supplementation of multiple nutrients were excluded. After removing duplicate records, a total of 8514 publications were screened and assessed independently by two researchers, based on their title, abstract, and full text. Finally, six studies were included in the current systematic review, and the risk of bias was evaluated using the Newcastle–Ottawa Scale (NOS). The included studies analyzed the influence of a specific dose of vitamin D, or different doses of vitamin D, or compared the results of supplementation with a specific dose of vitamin D against the placebo group. The supplementation was performed for at least 12 weeks. The mental health outcomes analyzed in these studies included health-related quality of life, depression, anxiety, stress, and general mental health status of adult diabetic patients. The results of the majority of the studies confirmed the positive influence of vitamin D supplementation on the mental health of diabetic individuals. Those studies that analyzed the influence of vitamin D supplementation on depression and anxiety established the beneficial effect of the vitamin. In some studies, the influence of vitamin D supplementation on the health-related quality of life was not considered unless combined with mindfulness training. However, it must be emphasized that different dosage regimens and intervention periods were followed in the reviewed studies, and only a small number of studies were randomized against placebo, which should be considered as a limitation of the present study. The findings of the conducted systematic review demonstrated the positive influence of vitamin D supplementation on the mental health of diabetic patients, which was proved for anxiety and depression, but in the case of health-related quality of life, the positive effect was observed only when the intervention included mindfulness training. These outcomes suggest that supplementation should be recommended to improve the vitamin D status and the mental health of patients in this group.     

An art therapy intervention for symptoms of post-traumatic stress,depression and anxiety among Syrian refugee children

This study first examined the prevalence of psychological symptoms among Syrian refugee children (N = 64) and assessed the effect of an art therapy intervention on post-traumatic stress, depression and anxiety symptoms. The Stressful Life Events (SLE) Questionnaire was used to measure stressful and traumatic experiences. The main outcome measures were UCLA Post-Traumatic Stress Disorder Parent version, Child Depression Inventory and State-Trait Anxiety Scale. After the baseline assessment, a five-day art therapy intervention, which is based on Skills for Psychological Recovery, was implemented. Findings of the study indicated that 60.3% (N = 35) of Syrian children who participated had high risk to develop post-traumatic stress disorder (PTSD) according to the SLE scale. The 23.4% of the children had PTSD symptoms while the 17.6% showed severe depression symptoms. Moreover, the 14.4% of the children showed severe levels of state anxiety symptoms and the 31.1% showed severe levels of trait anxiety symptoms. Findings of the study indicated that trauma, depression and trait anxiety symptoms of children were significantly reduced at the post-assessment. However, for state anxiety scores, significant differences between pre- and post-assessments did not appear. Therefore, it could be said that art therapy may be an effective method to reduce post-traumatic stress disorder, depression and trait anxiety symptoms among refugee children.