The growing field of digital psychiatry: current evidence and the future of apps,social media,chatbots, and virtual reality

As the COVID‐19 pandemic has largely increased the utilization of telehealth, mobile mental health technologies – such as smartphone apps, vir­tual reality, chatbots, and social media – have also gained attention. These digital health technologies offer the potential of accessible and scalable interventions that can augment traditional care. In this paper, we provide a comprehensive update on the overall field of digital psychiatry, covering three areas. First, we outline the relevance of recent technological advances to mental health research and care, by detailing how smartphones, social media, artificial intelligence and virtual reality present new opportunities for “digital phenotyping” and remote intervention. Second, we review the current evidence for the use of these new technological approaches across different mental health contexts, covering their emerging efficacy in self‐management of psychological well‐being and early intervention, along with more nascent research supporting their use in clinical management of long‐term psychiatric conditions – including major depression; anxiety, bipolar and psychotic disorders; and eating and substance use disorders – as well as in child and adolescent mental health care. Third, we discuss the most pressing challenges and opportunities towards real‐world implementation, using the Integrated Promoting Action on Research Implementation in Health Services (i‐PARIHS) framework to explain how the innovations themselves, the recipients of these innovations, and the context surrounding innovations all must be considered to facilitate their adoption and use in mental health care systems. We conclude that the new technological capabilities of smartphones, artificial intelligence, social media and virtual reality are already changing mental health care in unforeseen and exciting ways, each accompanied by an early but promising evidence base. We point out that further efforts towards strengthening implementation are needed, and detail the key issues at the patient, provider and policy levels which must now be addressed for digital health technologies to truly improve mental health research and treatment in the future.     

The Mental Health Consequences of the Recession: Economic Hardship and Employment of People with Mental Health Problems in 27 European Countries

Objectives

A period of economic recession may be particularly difficult for people with mental health problems as they may be at higher risk of losing their jobs, and more competitive labour markets can also make it more difficult to find a new job. This study assesses unemployment rates among individuals with mental health problems before and during the current economic recession.

Methods

Using individual and aggregate level data collected from 27 EU countries in the Eurobarometer surveys of 2006 and 2010, we examined changes in unemployment rates over this period among individuals with and without mental health problems.

Results

Following the onset of the recession, the gap in unemployment rates between individuals with and without mental health problems significantly widened (odds ratio: 1.12, 95% confidence interval: 1.03, 1.34). This disparity became even greater for males, and individuals with low levels of education. Individuals with mental health problems living in countries with higher levels of stigmatizing attitudes regarding dangerousness of people with mental illness were more vulnerable to unemployment in 2010, but not 2006. Greater agreement that people with mental health problems have themselves to blame, was associated with lower likelihood of unemployment for individuals with and without mental health problems.

Conclusion

These findings study suggest that times of economic hardship may intensify social exclusion of people with mental health problems, especially males and individuals with lower education. Interventions to combat economic exclusion and to promote social participation of individuals with mental health problems are even more important during times of economic crisis, and these efforts should target support to the most vulnerable groups.     

Dose-dependent and reversible effects of lead on rat dopaminergic system

It has been suggested that hyperactivity and mental retardation, the most serious clinical aspects observed in children during lead intoxication, may occur as consequence of specific alterations of neurotransmitter functions. In our experiments we indicate that the behavioural patterns observed in chronically lead exposed rats may be correlated with an impairment of the dopaminergic system. Performing our study at two different levels of lead exposure, we found after the last assumption of lead we observed a complete disappearance of these neurochemical variations. Our findings suggest that lead affects dopamine function in different brain areas in reversible manner, inducing effects which are dose-dependent.     

Sex ratios and mental health: Evidence from China

While sex ratios (i.e., relative numbers of men and women) have been linked to various economic and social outcomes, how sex ratios affect mental health is underexplored. Using nationally representative data from the China Family Panel studies (CFPS) and Population Census, we evaluate the impact of sex ratios on mental health among Chinese men and explore potential mechanisms. Employing the instrumental variables (IV) approach where the One-Child Policy’s mandated fertility limits and implementation are used as exogenous variations in local sex ratios, we find that higher local sex ratios increase depressive symptoms and probability of depression among Chinese men. The impact is stronger for men with lower levels of education and living in rural areas. Analyses of potential mechanisms show that higher sex ratios increase the likelihood of marriage delay and unemployment for men, and prolong working hours for the employed men. The findings are of direct relevance to the health and population policy in China.     

恐惧记忆消散的神经生物学机制研究进展

恐惧消散被认为是一种通过形成新的抑制性学习来拮抗最初的恐惧记忆的复杂过程。目前,通过旨在促进恐惧消散的疗法治疗诸如焦虑症等神经精神疾病已在临床上取得了较好的疗效,因此,如何更有效持久地维持恐惧消散记忆具有重要的意义。围绕与恐惧记忆消散相关的脑区及恐惧记忆消散的分子机制进行阐述,有助于更深入地理解恐惧记忆消散相关的神经生物学机制,为后续研究提供新的方向。     

The urban environment and mental disorders: Epigenetic links

For the first time in human history, more than half of the world''s population lives in urban areas and this is projected to increase to two-thirds by 2030. This increased urbanity of the world''s population has substantial public health implications. Nearly a century of research has shown higher risk of mental disorder among persons living in urban versus rural areas. Epidemiologic research has documented that associations between particular features of the urban environment, such as concentrated disadvantage, residential segregation and social norms, contribute to the risk of mental illness. We propose that changes in DNA methylation may be one potential mechanism through which features of the urban environment contribute to psychopathology. Recent advances in animal models and human correlation studies suggest DNA methylation as a promising mechanism that can explain how the environment “gets under the skin.” Aberrant DNA methylation signatures characterize mental disorders in community settings. Emerging evidence of associations between exposure to features of the environment and methylation patterns may lead toward the identification of mechanisms that explain the link between urban environments and mental disorders. Importantly, evidence that epigenetic changes are reversible offers new opportunities for ameliorating the impact of adverse urban environments on human health.Key words: urban environment, mental disorders, DNA methylation, epigenetics, posttraumatic stress disorder, depressionThe 20th century has been characterized by the world-wide movement of populations from rural to urban areas. For the first time in human history, more than half of the world''s population lives in urban areas and this is projected to increase to two-thirds by 2030. The movement of populations to urban environments is probably the most important demographic shift in the past century. In particular, the increased urbanity of the world''s population has substantial public health implications. A body of research has long shown that there are different burdens of disease and disability in urban vs. non-urban areas and more recent work has linked specific features of the urban environment to particular health indicators (for reviews of the literature about urban health see refs. ¹ and ²).Some of the more promising work in this area concerns research that has shown relations between urbanity and mental disorders. There is more than a century of work that has shown higher risk of most mental disorders among persons living in urban versus rural areas.^3–8 Early research proposed several factors that may explain this association including selective migration and social disorganization.³ For example, it has been proposed that persons within disadvantaged areas may have a more difficult time building and sustaining supportive social relationships, therefore increasing susceptibility to mental illness. Subsequent work has shown associations between particular features of the urban environment and risk of mental illness. Living in poorer urban neighborhoods is associated with greater risk of new episodes of depression compared to living in richer neighborhoods, even when accounting for individual income or exposure to stressful or adverse circumstances.^6,9,10 Living in neighborhoods characterized by residential racial segregation is associated with a greater risk of depression and anxiety, compared to living in less segregated neighborhoods.¹¹ Other evidence suggests that neighborhood collective efficacy and norms are associated with the risk of substance use disorders12 and suicide attempts,¹³ again when taking into account individual experiences.Coincident with the growing number of studies that have demonstrated links between features of the urban environment and mental health, there has been an increase in work that has sought to understand the mechanisms underlying these epidemiologic observations. In particular, there is an emerging interest in identifying biologic explanations that may clarify the link between features of the urban environment and individual mental health. Existing research has documented a role for changes in immune function,¹⁴ gene-environment interactions¹⁵ and psychological mechanisms,¹⁶ among others, that may explain the links between the urban environment and mental health. This paper adds to this growing field and proposes that changes in DNA methylation may be one potential mechanism through which features of the urban environment contribute to psychopathology.     

Public mental health: the time is ripe for translation of evidence into practice

Public mental health deals with mental health promotion, prevention of mental disorders and suicide, reducing mental health inequalities, and governance and organization of mental health service provision. The full impact of mental health is largely unrecognized within the public health sphere, despite the increasing burden of disease attributable to mental and behavioral disorders. Modern public mental health policies aim at improving psychosocial health by addressing determinants of mental health in all public policy areas. Stigmatization of mental disorders is a widespread phenomenon that constitutes a barrier for help-seeking and for the development of health care services, and is thus a core issue in public mental health actions. Lately, there has been heightened interest in the promotion of positive mental health and wellbeing. Effective programmes have been developed for promoting mental health in everyday settings such as families, schools and workplaces. New evidence indicates that many mental disorders and suicides are preventable by public mental health interventions. Available evidence favours the population approach over high-risk approaches. Public mental health emphasizes the role of primary care in the provision of mental health services to the population. The convincing evidence base for population-based mental health interventions asks for actions for putting evidence into practice.     

Understanding the mental health needs of secondary school children in Manchester

Background In a time of limited resources and the need for cohesive services, understanding levels of need and prevalence is key. Manchester has a diverse range of cultures and socio-economic groups; national data is valuable but not always representative of local need.Aim To assess the prevalence of mental health needs in secondary school pupils in Manchester.Method Parents and teachers in three secondary schools were invited to complete the Strengths and Difficulties Questionnaire (SDQ) and a tool examining unmet needs.Results Initially, 560 pupils were chosen. Having excluded families that opted out, 503 questionnaires were distributed. Teachers returned 200 questionnaires and parents returned 127. Higher than average levels of need were identified with teachers reporting that 18% of pupils scored abnormally on the SDQ. Parent rates were also higher than the national average at 13.4%.Discussion Parents and teachers wanted children to be seen at home and at school, the need for consultation and outreach from mental health into schools is emphasised.     

The effect of mental rotation on changes in plasma testosterone and cortisol levels

Testosterone level has an influence on cognitive functions, especially spatial abilities. The relationship is, however, bidirectional and brain activity also affects testosterone levels. The aim of this study was to analyze the effects of an intensive 3D mental rotation task on testosterone levels in young healthy men and women. In the mental rotation task, men reached a higher top score (P=0.027) and total score (P=0.004) compared to women. In 8 out of 9 women (P=0.008) but not in men (P=0.129) testosterone levels decreased after one hour of mental rotation testing. A significant gender difference was shown (P<0.0001). In all women, plasma cortisol levels was significantly lower after testing (P=0.004). In men cortisol levels decreased in 7 out of 9 subjects (P=0.039). A significant gender difference was not found (P=0.19). No association was found in women between baseline testosterone levels and mental rotation total score (P=0.810). In men there was a positive correlation between baseline testosterone and mental rotation total score (P=0.015). A significant difference gender difference was seen in the association between testosterone and mental rotation score (P<0.05). Mental rotation stimuli caused significant changes in hormonal levels of testosterone and cortisol. A gender-specific response was detected in testosterone fluctuation.     

Identification of priority areas for conservation in an arid zone: application of parsimony analysis of endemicity in the vascular flora of the Antofagasta region, northern Chile

Endemic taxa are those restricted to a specific area, and could bedefined as the exclusive biodiversity of a region. An area of endemismcontains taxa found nowhere else and could be catalogued as irreplaceable and of highpriority for conservation. proposed the parsimony analysis of endemicity (PAE) as a tool to detect areas ofendemism. PAE, a method of historical biogeography, is analogous to cladisticmethods used in phylogenetics analysis, and unites areas (taxa in cladistics)based on their shared species (characters in cladistics) according to the mostparsimonious solution. In this paper we determined with PAE, prioritary areasfor conservation on the basis of concentrations of endemic species in the aridregion of Antofagasta, northern Chile, and compared the results with theirrepresentation in the current Chilean National Parks and Reserves System. Wefound two areas suggested as priorities, one located in the north Andean zone ofthe region, and another at the coast. The area with the higher biodiversity andconcentration of endemics was that located at the coast. However, coastalecosystems are currently under-represented in the Chilean National Parks andReserves System. The establishment of a new protected area in the coastal zoneof the region of Antofagasta is currently under consideration, coinciding withthe area suggested with PAE as priority. This new area would not only allowconserving species with evident problems of conservation, but also preserving anarea where higher levels of endemism exist.     

Urinary epinephrine and norepinephrine levels in women athletes during training and competition.

Training and competitive epinephrine and norepinephrine levels and proportions were compared in two groups of women athletes to determine whether changes in catecholamine excretion reflect the added mental stress of athletic competition on physical effort. An intercollegiate basketball team and a group of track and field athletes volunteered as subjects. Competitive epinephrine urinary levels were significantly (P less than 0.01) higher than training levels. A concomitant rise in the norepinephrine with an increase in physical effort was observed in both groups of athletes following training sessions as well as after athletic competition. Track and field athletes trying to qualify for an international team exhibited significantly ( less than 0.01) higher epinephrine levels than the team members; thus suggesting that anticipation of competition imposes a mental stress on an athlete. Constant changes in the catecholamine pattern as against a normal work load have yet to be established.     

La Métacognition comme contrôle de soi

The purpose of this article is to distinguish two functional levels that are often confused: intentions or actions whose goal is to transform or regulate the world, and intentions or actions whose goal is to transform or regulate oneself. The concept of metacognition, understood as the reflexive control of a cognitive system, allows one to explore the second level. Metacognition, which, presently, is only studied experimentally in the areas of metamemory and metareasoning, constitutes the scope of mental action. It also includes the control of attention, perception, planning, motivation and emotion, and makes it possible to approach traditional problems in neurology and psychiatry, such as insight and executive problems, using new tools, both for diagnostic purposes and rehabilitative care.     

1590名农村中老年人生存质量调查分析(英文)

目的:采用SF-36量表中文版评价农村中老年人生存质量,并为提高农村中老年人的生存质量和健康水平提供科学依据和建议。方法:采用随机抽样的方法,采用面对面访谈的形式,记分方法参照国际生存质量评价计划(IQOLA)的制定标准,评价其生理和心理健康状况。结果:1590名农村中老年人男性生存质量得分高于女性。经济水平对农村中老年人的生理健康的影响大于对其心理健康的影响。配偶健在的农村中老年人的各维度得分均高于无配偶者。农村中老年人的各维度得分随教育水平的升高呈升高趋势。结论:农村中老年人的生存质量与年龄成负相关,同时也受文化程度和经济水平等多个因素的影响。因而,对农村中老年人这一弱势群体应该给予更多关注。     

Determining adrenocortical activity as a measure of stress in African elephants (Loxodonta africana) in relation to human activities in Serengeti ecosystem

African elephants (Loxodonta africana) play a vital role in most African ecosystems, with their opportunity to alter the entire ecosystem by their sheer numbers. Defining and measuring animal welfare has been much discussed. One potential way of determining an animal's welfare is to record the absence or presence of stress. Little research on elephant welfare has so far been performed in the Serengeti ecosystem. The aim of this study was to record the faecal glucocorticoid metabolite levels of African elephants in areas with high or with minimum human interference. A total of 117 faecal samples were collected from randomly located single elephants as well as family herds in the northern, central and western Serengeti National Park (SNP) as well as in Grumeti Game Reserve and Ikoma Open Area, northern Tanzania in 2010. Elephants had higher levels of faecal glucocorticoid metabolites in the areas outside, compared with areas inside SNP. No single males were observed outside SNP, and in general, higher abundance of elephants was observed inside SNP. This suggests that elephants may prefer to reside in the potential safer areas inside the national park, demonstrating the importance of protected areas to improve the welfare of elephants.     

Health and the city: physical health and mental health

In France, city size has very little bearing on the mortality rate as a function of age and life expectancy and it is in large cities that these indicators are the most favorable. No increase in maternal or infant mortality rates or deaths due to cancers has been observed in large cities. The lower mortality rate linked to respiratory and cardiovascular diseases in large urban areas contradicts the fears concerning the impact of air pollution. Deaths linked to lifestyle are less frequent in big cities, which could be due to social structures (socio-professional level: the proportion of white-collar workers and professionals is higher in bigger cities than in the suburbs or small cities). However, although the overall mortality rate is lower, it should be emphasized that there is in large cities a greater incidence of sexually transmitted diseases, AIDS and certain infectious diseases (because of social diversity and the fact that certain individuals seeking anonymity and marginality are drawn to large cities). In terms of mental health, the breakdown of family structures, instability, unemployment, the lack of parental authority and failing schools render adolescents vulnerable and hinder their social integration. When the proportion of adolescents at risk is high in a neighborhood, individual problems are amplified and social problems result. In order to restore mental and social health to these neighborhoods, ambitious strategies are necessary which take into account family and social factors as well as environmental ones. At the present time, when physical health is constantly improving, the most pressing problems are those related to lifestyle and mental health which depend for a large part on social factors.     

Assessment of Anxiety Level and Mental Health Status in Spouses and Children of Day-Working and Shift-Working Men

The present study was aimed at assessing the effects of the unusual schedules of shift-working men on anxiety and mental health of their spouses and children. The anxiety and mental health of 396 subjects that include 133 spouses and 263 children of day-working and shift-working men were monitored by employing specific inventory. Anxiety scales (trait, state and free-floating) and mental health inventory were administrated to each subject. Results indicate that the average levels of free-floating anxiety for the spouses and children of shift-working men were found to be significantly higher in comparison with that of their counterparts sampled in the family of day workers. This was also true when data were segregated with respect of gender and compared. Except in female children of shift workers all other groups of children had statistically significantly higher level of state anxiety as compared with that of their respective mothers. The results of this study further reveal that the spouses of shift-working men exhibited lower mental health rating as compared with the spouses of day-working men. Furthermore, a significant negative relationship was noticed between anxiety and mental health in all cases excepting in spouses of shift-working men for state anxiety. Although the findings of the present study could be attributed to the irregular routine of shift workers, it appears mandatory to carryout further intensive studies to draw convincing conclusions.     

MENTAL HEALTH PROGRAMS—The Role of the Health Officer

Traditionally the treatment of mental illness has been a responsibility of state governments, but they have been unable to solve the problem with any degree of success.In spite of rationalizations as to why a health department should not become involved in this field, more and more local health departments in California and across the nation are initiating various services in mental health.With the widespread interest in mental health at national and state levels and in local citizens'' groups, local health officers must involve themselves in this most difficult effort.While the treatment of the emotionally disturbed and the psychotic is demanded most aggressively by the public which seeks outpatient, inpatient, and rehabilitation services on the local level, two services—consultation and education-information services—offer more hope in the promotion of mental health as contrasted with the treatment of mental illness.     

Assessment of Anxiety Level and Mental Health Status in Spouses and Children of Day-Working and Shift-Working Men

The present study was aimed at assessing the effects of the unusual schedules of shift-working men on anxiety and mental health of their spouses and children. The anxiety and mental health of 396 subjects that include 133 spouses and 263 children of day-working and shift-working men were monitored by employing specific inventory. Anxiety scales (trait, state and free-floating) and mental health inventory were administrated to each subject. Results indicate that the average levels of free-floating anxiety for the spouses and children of shift-working men were found to be significantly higher in comparison with that of their counterparts sampled in the family of day workers. This was also true when data were segregated with respect of gender and compared. Except in female children of shift workers all other groups of children had statistically significantly higher level of state anxiety as compared with that of their respective mothers. The results of this study further reveal that the spouses of shift-working men exhibited lower mental health rating as compared with the spouses of day-working men. Furthermore, a significant negative relationship was noticed between anxiety and mental health in all cases excepting in spouses of shift-working men for state anxiety. Although the findings of the present study could be attributed to the irregular routine of shift workers, it appears mandatory to carryout further intensive studies to draw convincing conclusions.     

Black‐capped chickadees Poecile atricapillus sing at higher pitches with elevated anthropogenic noise,but not with decreasing canopy cover

Several songbird species sing at higher frequencies (i.e. higher pitch) when anthropogenic noise levels are elevated. Such frequency shifting is thought to be an adaptation to prevent masking of bird song by anthropogenic noise. However, no study of this phenomenon has examined how vegetative differences between noisy and quiet sites influence frequency shifting. Variation in vegetative structure is important because the acoustic adaptation hypothesis predicts that birds in more open areas should also sing at higher frequencies. Thus, vegetative structure may partially explain the observation of higher frequency songs in areas with high levels of anthropogenic noise. To distinguish between frequency shifting due to noise or vegetative structure we recorded the songs of black‐capped chickadees Poecile atricapillus vocalizing in high and low noise sites with open and closed canopy forests. Consistent with the noise‐dependent frequency hypothesis, black‐capped chickadees sang at higher frequencies in high noise sites than in low noise sites. In contrast, birds did not sing at higher frequencies in sites with more open canopies. These results suggest that frequency shifting in chickadees is more strongly related to ambient noise levels than to vegetative structure. A second frequency measure, inter‐note ratio, was reduced at higher levels of canopy cover. We speculate that this may be due to a non‐random distribution of dominant males. In sum, our results support the hypothesis that some birds sing at higher frequencies to avoid overlap with anthropogenic noise, but suggest that vegetative structure may play a role in the modification of other song traits.