Current challenges to research on animal-assisted interventions

Studies of the effects of Animal-Assisted Interventions (AAIs) face a number of theoretical and practical challenges. Proposed theoretical processes for the effects of AAIs include those that address primarily the animal’s ability to facilitate human–human social engagement, those that emphasize animals’ apparent capacity to trigger social attachments and provide nonhuman social support, those that categorize certain animals as supernormal stimuli, those that advance a biophilia hypothesis that living organisms have an innate ability to attract and hold human attention, and those that promote an integrative biopsychosocial model. Each of these generates potentially testable hypotheses, and the field would benefit from systematic efforts to address their validity. Practical challenges to AAI research include issues of study design and methodology, the heterogeneity of both AAI recipients and the animals participating in these interventions, the welfare of these animals, and the unusual pressure from the public and media to report and publish positive findings. Such challenges need to be carefully considered in designing and implementing future studies in the field.     

Introduction to a thematic series on animal assisted interventions in special populations

Despite the lack of a strong evidence base, Animal-Assisted Interventions (AAIs) are becoming increasingly popular as a therapeutic tool for special populations with a variety of psychological and physical conditions. This paper introduces a special series of articles which address the proposed theories and processes underpinning potential effects of AAIs. We recommend strategies for improving the evidence base of AAIs giving specific examples in special populations (e.g., children with Autism Spectrum Disorder [ASD]). We consider the challenges in AAI research and suggest directions for future research.     

Theories and possible processes of action in animal assisted interventions

Different positive effects of interactions with animals, such as reduction of stress reactions, depressive mood, anxiety, aggression, and pain, and promotion of trust, calmness, motivation, and concentration have been documented by research on human–animal interaction (HAI), including animal assisted interventions (AAIs). Potential biological, psychological, and social processes may underpin these effects. Theories of why this may occur include biophilia, anthropomorphism, a focus on the experiential system instead of the verbal-symbolic system, motivation, activation of the oxytocin system, attachment and caregiving including provision of social support for stress buffering, and distraction processes. Understanding how animals may positively affect educational and therapeutic settings, in particular for individuals with psychical and psychosocial challenges, and finding what special indications for AAI exist, and which preconditions of learning in the client or the setting could potentially be enhanced, might provide not only a better rationale for AAIs but also promote their efficacy.     

Animal-Assisted Interventions in Children's Hospitals: A Critical Review of the Literature

There is a perception in the scientific and general communities that hospitalized children benefit from visits by animals. Animal-assisted interventions (AAI), including animal-assisted therapy and animal-assisted activities, usually involving dogs, are thus employed in pediatric hospitals. However, the actual prevalence of AAI in children's hospitals has been poorly documented in the literature. Furthermore, the evidence base for claims that children in hospital benefit from AAI is limited. There are nine existing research studies in the area, all with methodological challenges that make conclusive statements in either direction about the efficacy of AAI difficult. In this critical review we consider methodological considerations pertinent to evaluations of AAI interventions for hospitalized children. These include: definitions and terminology; cultural attitudes; children's receptivity to animals, including phobia, type of illness and health status of the child, familiar as opposed to unknown animals, and age of the child; animal welfare; zoonoses and allergies; and hospital staff attitudes toward AAI. We highlight the many difficulties involved in conducting research on AAI in pediatric settings. Given the limited information around AAI for hospitalized children, including the risks and benefits and the limitations of existing studies, future research is required. This should take into account the methodological considerations discussed in this review, so that our knowledge base can be enhanced and if and where appropriate, such interventions be implemented and rigorously evaluated.     

A Systematic Review of Research on Pet Ownership and Animal Interactions among Older Adults

ABSTRACT

Research on the impact of companion animals in the lives of older adults is considered from two perspectives: pet ownership and in animal-assisted interventions (AAI). This paper first presents a discussion of potential theoretical explanations of the impact of animals on human health and wellbeing among older adults, and then provides a systematic review and evaluation of existing research on the topics of human–animal interaction (HAI) and physical health and exercise, depression and anxiety, and loneliness and social functioning. Each of the studies in this review (n = 145) are rated according to modified Oxford Center for Evidence Based Medicine (OCEBM) levels and the role of theory, in conceptualizing the study or interpreting outcomes, is discussed. The quality of evidence for each topical area of HAI and aging research is summarized, and recommendations are made for future research directions that will increase our knowledge of the relationship between HAI and health outcomes for older adults in different settings.     

Research on animal-assisted intervention and autism spectrum disorder, 2012–2015

Including animals in autism intervention is growing in both research and practice. A systematic literature review was conducted to collate and synthesize all empirical research on animal-assisted intervention (AAI) for autism published from 2012 to 2015. Findings from 28 included studies revealed that AAI programs generally include one animal per participant with a total contact time of approximately 10 hours over the course of 8 to 12 weeks. Research methodology is diverse and though limited in many cases, has improved over the last few years. The most commonly reported outcome was increased social interaction, which was unanimously significant across 22 studies. The need for further research is highlighted, calling for a focus on refining AAI techniques, identifying optimal circumstances for positive change as well as individuals who may not benefit, and independent replication of high quality studies to move AAI from an enrichment activity to an evidence-based practice for autism.     

Epidemiological Panel Studies of Older Adults: New Frontiers in the Research on Human– Animal Interaction

ABSTRACT

This paper discusses epidemiological studies of older adults and human–animal interaction (HAI), and potential relevance to future research on HAI and animal-assisted interventions (AAI) in aging populations. Key issues in epidemiological work are discussed, including target populations, treatment/exposures, follow up, and endpoint measures as they relate to interacting with or owning companion animals. In outlining the limits in our current state of knowledge, we also make recommendations for the design and analysis of epidemiological studies to advance research on HAI and aging.     

Introduction to the Themed Issue on Human–Animal Interaction and Healthy Human Aging

ABSTRACT

In 2016, the Gerontological Society of America (GSA) developed a research focus on the benefits and potential risks associated with pets among older adults. With the goal of developing a roadmap for human–animal interaction (HAI) research in older people residing in both the community and institutions, GSA convened a workshop of international experts and policy-makers in the fields of aging and HAI. The status of current knowledge was shared on the success factors for healthy aging and the potential challenges (GSA, 2016). Participants considered what roles pets might play in the lives of older adults and their potential to mitigate loneliness, social isolation, and depression, and to enhance mobility and cognitive function. Existing research was shared to provide insights into the ways in which pets can impact older adults and their caregivers and to identify where further research is needed. This paper introduces a series of papers from that meeting, with some additional papers from meeting attendees to expand on the topics covered and provide key perspectives and gaps in information needed, as a foundation for those considering research into this topic. Although HAI/Animal-Assistant Intervention (AAI) research is in its infancy, there is some evidence that pet ownership or animal interaction can have major benefits for many older adults. At the same time, there are some risks to both the pet and the older adult that need to be addressed. Innovative approaches to both AAIs and the ways to overcome challenges are presented in this themed issue of Anthrozoös. Our hope is that the findings from these reviews and reports will stimulate additional work in this area.     

Ancillary care in public health intervention research in low-resource settings: researchers' practices and decision-making

Little is known about researchers' practices regarding the provision of ancillary care (AC) in public health intervention studies they have conducted and the factors that influence their decisions about whether to provide ancillary care in low-resource settings. We conducted 52 in-person in-depth interviews with public health researchers. Data analysis was iterative and led to the identification of themes and patterns among themes. We found that researchers who conduct their research in the community setting are more likely to identify and plan for the AC needs of potential research subjects before a study begins, whereas those affiliated with a permanent facility are more likely to deliver AC to research subjects on an ad hoc basis. Our findings suggest that on the whole, at least for public health intervention research in low-resource settings, researchers conducting research in the community setting confront more complex ethical and operational challenges in their decision-making about AC than do researchers conducting facility-based studies.     

Including Ethnic Minorities in Mental Health Intervention Research: A Practical Approach to a Long-Standing Problem

This paper examines a controversy that arose while developing a supplement to Mental Health: A Report of the Surgeon General that was focused on ethnic minority mental health. The controversy involved whether and how to make recommendations about ethnic minorities seeking mental health care. We found that few studies provided information on outcomes of mental health care for ethnic minorities. In this paper, we discuss outcomes of mental health care for ethnic minorities and how to proceed in developing an evidence base for understanding mental health care and minorities. We conclude that entering representative (based on population) numbers of ethnic minorities in efficacy trials is unlikely to produce useful information on outcomes of care because the numbers will be too small to produce reliable findings. We also conclude that while conducting randomized efficacy trials for all mental health interventions for each ethnic group would be impractical, innovative and theoretically informed studies that focus on specific cultural groups are needed to advance the knowledge base. We call for theory-driven research focused on mental health disparities that has the potential for understanding disparities and improving outcomes for ethnic minority populations.     

Beyond the Biomedical: Community Resources for Mental Health Care in Rural Ethiopia

BackgroundThe focus of discussion in addressing the treatment gap is often on biomedical services. However, community resources can benefit health service scale-up in resource-constrained settings. These assets can be captured systematically through resource mapping, a method used in social action research. Resource mapping can be informative in developing complex mental health interventions, particularly in settings with limited formal mental health resources.MethodWe employed resource mapping within the Programme for Improving Mental Health Care (PRIME), to systematically gather information on community assets that can support integration of mental healthcare into primary care in rural Ethiopia. A semi-structured instrument was administered to key informants. Community resources were identified for all 58 sub-districts of the study district. The potential utility of these resources for the provision of mental healthcare in the district was considered.ResultsThe district is rich in community resources: There are over 150 traditional healers, 164 churches and mosques, and 401 religious groups. There were on average 5 eddir groups (traditional funeral associations) per sub-district. Social associations and 51 micro-finance institutions were also identified. On average, two traditional bars were found in each sub-district. The eight health centres and 58 satellite clinics staffed by Health Extension Workers (HEWs) represented all the biomedical health services in the district. In addition the Health Development Army (HDA) are community volunteers who support health promotion and prevention activities.DiscussionThe plan for mental healthcare integration in this district was informed by the resource mapping. Community and religious leaders, HEWs, and HDA may have roles in awareness-raising, detection and referral of people with mental illness, improving access to medical care, supporting treatment adherence, and protecting human rights. The diversity of community structures will be used to support rehabilitation and social reintegration. Alcohol use was identified as a target disorder for community-level intervention.     

Flooding and Mental Health: A Systematic Mapping Review

Background

Floods are the most common type of global natural disaster. Floods have a negative impact on mental health. Comprehensive evaluation and review of the literature are lacking.

Objective

To systematically map and review available scientific evidence on mental health impacts of floods caused by extended periods of heavy rain in river catchments.

Methods

We performed a systematic mapping review of published scientific literature in five languages for mixed studies on floods and mental health. PUBMED and Web of Science were searched to identify all relevant articles from 1994 to May 2014 (no restrictions).

Results

The electronic search strategy identified 1331 potentially relevant papers. Finally, 83 papers met the inclusion criteria. Four broad areas are identified: i) the main mental health disorders—post-traumatic stress disorder, depression and anxiety; ii] the factors associated with mental health among those affected by floods; iii) the narratives associated with flooding, which focuses on the long-term impacts of flooding on mental health as a consequence of the secondary stressors; and iv) the management actions identified. The quantitative and qualitative studies have consistent findings. However, very few studies have used mixed methods to quantify the size of the mental health burden as well as exploration of in-depth narratives. Methodological limitations include control of potential confounders and short-term follow up.

Limitations

Floods following extreme events were excluded from our review.

Conclusions

Although the level of exposure to floods has been systematically associated with mental health problems, the paucity of longitudinal studies and lack of confounding controls precludes strong conclusions.

Implications

We recommend that future research in this area include mixed-method studies that are purposefully designed, using more rigorous methods. Studies should also focus on vulnerable groups and include analyses of policy and practical responses.     

Interaction studies of aristolochic acid I with human serum albumin and the binding site of aristolochic acid I in subdomain IIA

Optical spectroscopy and molecular docking methods were used to examine the binding of aristolochic acid I (AAI) to human serum albumin (HSA) in this paper. By monitoring the intrinsic fluorescence of single Trp214 residue and performing displacement measurements, the specific binding of AAI in the vicinity of Sudlow's Site I of HSA has been clarified. An apparent distance of 2.53 nm between the Trp214 and AAI was obtained via fluorescence resonance energy transfer (FRET) method. In addition, the changes in the secondary structure of HSA after its complexation with the ligand were studied with circular dichroism (CD) spectroscopy, which indicated that AAI does not has remarkable effect on the structure of the protein. Moreover, thermal denaturation experiments clearly indicated that the HSA−AAI complexes are conformationally more stable. Finally, the binding details between AAI and HSA were further confirmed by molecular docking studies, which revealed that AAI was bound at subdomain IIA through multiple interactions, such as hydrophobic effect, van der Waals forces and hydrogen bonding.     

Perceived Social Support Moderates the Link between Attachment Anxiety and Health Outcomes

Two literatures have explored some of the effects intimate relationships can have on physical and mental health outcomes. Research investigating health through the lens of attachment theory has demonstrated that more anxiously attached individuals in particular consistently report poorer health. Separate research on perceived social support (e.g., partner or spousal support) suggests that higher support has salutary influences on various health outcomes. Little to no research, however, has explored the interaction of attachment anxiety and perceived social support on health outcomes. The present study examined the attachment-health link and the moderating role of perceived social support in a community sample of married couples. Results revealed that more anxious persons reported poorer overall physical and mental health, more bodily pain, more medical symptoms, and impaired daily functioning, even after controlling for age, relationship length, neuroticism, and marital quality. Additionally, perceived social support interacted with attachment anxiety to influence health; more anxious individuals'' health was poorer even when perceived social support was high, whereas less anxious individuals'' health benefited from high support. Possible mechanisms underlying these findings and the importance of considering attachment anxiety in future studies of poor health in adulthood are discussed.     

模式动物在共生微生物研究中的作用

共生微生物是一类定殖于宿主体表或体内, 可执行宿主本身无法完成的功能, 并依赖于宿主所提供的生长环境的微生物。众多研究表明, 人体肠道共生微生物与免疫、营养、代谢, 甚至精神健康等生理功能密切相关, 是重要的“微生物器官”。在早期的肠道微生物研究中, 模式动物就已经作为研究工具被使用。随着肠道微生物研究的不断深入, 模式动物作为不可替代的研究对象发挥了越来越重要的作用。本综述主要对几种重要的模式动物如斑马鱼(Danio rerio)、小鼠(Mus musculus)、猪(Sus scrofa domesticus)和猕猴(Macaca mulatta)在肠道微生物研究中的应用进行了总结, 介绍了各种模式动物的发展过程及特点, 各自在应用于研究时的优缺点, 以及利用这些动物模型在共生微生物领域所取得的一些标志性的科研成果。同时, 也就近年来在共生微生物领域新兴的一些模式生物如蜜蜂(Apis)、果蝇(Drosophila)、秀丽隐杆线虫(Caenorhabditis elegans)等进行了一些探讨。旨在让该领域的研究者们了解模式动物与人体在共生微生物方面的异同, 为更好地利用这一研究工具提供参考。     

Nutritional psychiatry research: an emerging discipline and its intersection with global urbanization,environmental challenges and the evolutionary mismatch

In 21st-century public health, rapid urbanization and mental health disorders are a growing global concern. The relationship between diet, brain function and the risk of mental disorders has been the subject of intense research in recent years. In this review, we examine some of the potential socioeconomic and environmental challenges detracting from the traditional dietary patterns that might otherwise support positive mental health. In the context of urban expansion, climate change, cultural and technological changes and the global industrialization and ultraprocessing of food, findings related to nutrition and mental health are connected to some of the most pressing issues of our time. The research is also of relevance to matters of biophysiological anthropology. We explore some aspects of a potential evolutionary mismatch between our ancestral past (Paleolithic, Neolithic) and the contemporary nutritional environment. Changes related to dietary acid load, advanced glycation end products and microbiota (via dietary choices and cooking practices) may be of relevance to depression, anxiety and other mental disorders. In particular, the results of emerging studies demonstrate the importance of prenatal and early childhood dietary practices within the developmental origins of health and disease concept. There is still much work to be done before these population studies and their mirrored advances in bench research can provide translation to clinical medicine and public health policy. However, the clear message is that in the midst of a looming global epidemic, we ignore nutrition at our peril.     

Social capital and mental health in Japan: a multilevel analysis

Background

A national cross-sectional survey was conducted in Japan. This is because the growing recognition of the social determinants of health has stimulated research on social capital and mental health. In recent years, systematic reviews have found that social capital may be a useful factor in the prevention of mental illness. Despite these studies, evidence on the association between social capital and mental health is limited as there have been few empirical discussions that adopt a multilevel framework to assess whether social capital at the ecological level is associated with individual mental health. The aim of this study was to use the multilevel approach to investigate the association between neighborhood social capital and mental health after taking into account potential individual confounders.

Methodology/Principal Findings

We conducted a multilevel analysis on 5,956 individuals nested within 199 neighborhoods. The outcome variable of self-reported mental health was measured by the one dimension of SF-36 and was summed to calculate a score ranging from 0 to 100. This study showed that high levels of cognitive social capital, measured by trust (regression coefficient = 9.56), and high levels of structural social capital, measured by membership in sports, recreation, hobby, or cultural groups (regression coefficient = 8.72), were associated with better mental health after adjusting for age, sex, household income, and educational attainment. Furthermore, after adjusting for social capital perceptions at the individual level, we found that the association between social capital and mental health also remained.

Conclusions/Significance

Our findings suggest that both cognitive and structural social capital at the ecological level may influence mental health, even after adjusting for individual potential confounders including social capital perceptions. Promoting social capital may contribute to enhancing the mental health of the Japanese.     

The Role of Health Systems Factors in Facilitating Access to Psychotropic Medicines: A Cross-Sectional Analysis of the WHO-AIMS in 63 Low- and Middle-Income Countries

Background

Neuropsychiatric conditions comprise 14% of the global burden of disease and 30% of all noncommunicable disease. Despite the existence of cost-effective interventions, including administration of psychotropic medicines, the number of persons who remain untreated is as high as 85% in low- and middle-income countries (LAMICs). While access to psychotropic medicines varies substantially across countries, no studies to date have empirically investigated potential health systems factors underlying this issue.

Methods and Findings

This study uses a cross-sectional sample of 63 LAMICs and country regions to identify key health systems components associated with access to psychotropic medicines. Data from countries that completed the World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS) were included in multiple regression analyses to investigate the role of five major mental health systems domains in shaping medicine availability and affordability. These domains are: mental health legislation, human rights implementations, mental health care financing, human resources, and the role of advocacy groups. Availability of psychotropic medicines was associated with features of all five mental health systems domains. Most notably, within the domain of mental health legislation, a comprehensive national mental health plan was associated with 15% greater availability; and in terms of advocacy groups, the participation of family-based organizations in the development of mental health legislation was associated with 17% greater availability. Only three measures were related with affordability of medicines to consumers: level of human resources, percentage of countries'' health budget dedicated to mental health, and availability of mental health care in prisons. Controlling for country development, as measured by the Human Development Index, health systems features were associated with medicine availability but not affordability.

Conclusions

Results suggest that strengthening particular facets of mental health systems might improve availability of psychotropic medicines and that overall country development is associated with affordability. Please see later in the article for the Editors'' Summary