Population Aging at Cross-Roads: Diverging Secular Trends in Average Cognitive Functioning and Physical Health in the Older Population of Germany

This paper uses individual-level data from the German Socio-Economic Panel to model trends in population health in terms of cognition, physical fitness, and mental health between 2006 and 2012. The focus is on the population aged 50–90. We use a repeated population-based cross-sectional design. As outcome measures, we use SF-12 measures of physical and mental health and the Symbol-Digit Test (SDT) that captures cognitive processing speed. In line with previous research we find a highly significant Flynn effect on cognition; i.e., SDT scores are higher among those who were tested more recently (at the same age). This result holds for men and women, all age groups, and across all levels of education. While we observe a secular improvement in terms of cognitive functioning, at the same time, average physical and mental health has declined. The decline in average physical health is shown to be stronger for men than for women and found to be strongest for low-educated, young-old men aged 50–64: the decline over the 6-year interval in average physical health is estimated to amount to about 0.37 SD, whereas average fluid cognition improved by about 0.29 SD. This pattern of results at the population-level (trends in average population health) stands in interesting contrast to the positive association of physical health and cognitive functioning at the individual-level. The findings underscore the multi-dimensionality of health and the aging process.     

Sleep problems and computer use during work and leisure: Cross-sectional study among 7800 adults

Previous studies linked heavy computer use to disturbed sleep. This study investigates the association between computer use during work and leisure and sleep problems in working adults. From the 2010 round of the Danish Work Environment Cohort Study, currently employed wage earners on daytime schedule (N?=?7883) replied to the Bergen insomnia scale and questions on weekly duration of computer use. Results showed that sleep problems for three or more days per week (average of six questions) were experienced by 14.9% of the respondents. Logistic regression analyses, controlled for gender, age, physical and psychosocial work factors, lifestyle, chronic disease and mental health showed that computer use during leisure for 30 or more hours per week (reference 0–10 hours per week) was associated with increased odds of sleep problems (OR 1.83 [95% CI 1.06–3.17]). Computer use during work and shorter duration of computer use during leisure were not associated with sleep problems. In conclusion, excessive computer use during leisure – but not work – is associated with sleep problems in adults working on daytime schedule.     

Uses and abuses of recovery: implementing recovery‐oriented practices in mental health systems

An understanding of recovery as a personal and subjective experience has emerged within mental health systems. This meaning of recovery now underpins mental health policy in many countries. Developing a focus on this type of recovery will involve transformation within mental health systems. Human systems do not easily transform. In this paper, we identify seven mis‐uses (“abuses”) of the concept of recovery: recovery is the latest model; recovery does not apply to “my” patients; services can make people recover through effective treatment; compulsory detention and treatment aid recovery; a recovery orientation means closing services; recovery is about making people independent and normal; and contributing to society happens only after the person is recovered. We then identify ten empirically‐validated interventions which support recovery, by targeting key recovery processes of connectedness, hope, identity, meaning and empowerment (the CHIME framework). The ten interventions are peer support workers, advance directives, wellness recovery action planning, illness management and recovery, REFOCUS, strengths model, recovery colleges or recovery education programs, individual placement and support, supported housing, and mental health trialogues. Finally, three scientific challenges are identified: broadening cultural understandings of recovery, implementing organizational transformation, and promoting citizenship.     

“Boundary Formation” Within Mutual Aid Assemblages

As grassroots user/survivor movements gained traction across the Global North, mental health activists have provided mutual aid for those who consider themselves to be negatively affected by their psychiatrization experiences and for those in search of alternative (non-biopsychiatric) frameworks for understanding mental diversity. In addition to in-person support groups, digital communication has become an integral organizing mechanism for mutual aid actions to support those in mental distress. However, activists have often found both digital and face-to-face communication to be quite taxing to their own well-being—as they negotiate personal capacity to respond to collective needs and practice self-care through limiting their engagements in radical mental health communities. While engaging in an ethnography with a mutual aid community in the United States, I explored the use of “boundary formation” to set parameters for social engagement within digital support and face-to-face encounters. Semi-structured interviews with 14 participants, focus group discussions, participatory observation, and an analysis of digital communication revealed that group members often discussed setting personal boundaries as an act of self-care, a recognition of the pitfalls associated with engaging in group dynamics during times of mental distress, and as a practice to ensure communal longevity. The ways that participants discussed and enacted boundary formation are analyzed in this paper as a way of blocking, redirecting, and restructuring digital and in-person engagements within mutual aid assemblages.

     

Religiosity and health outcomes: review of literature

Research into a connection between religiosity and health was neglected in scientific circles until recently. However, the interest in interactions between religiosity and mental and physical health has started to grow lately. A large proportion of published empirical data suggest that religious commitment shows positive associations with better mental and physical health outcomes. There are relatively few studies showing no effect or negative effect of religiosity on health outcomes. Despite somewhat inconclusive empirical evidence, because of the difficulties encountered in studying the topic, this area is worth of further investigation. The article reviews the literature on epidemiological and clinical studies regarding the relationship between religiosity and mental and physical health. The mentioned issues are discussed and directions for future research are proposed.     

Physiological anthropology design: a comparative study between Germany and Japan

With the recent globalization of industrial products, there is doubt as to whether the methodology of Physiological Anthropology has also been standardized. The purpose of this study is to assess signs of standardization through a comparative analysis of Physiological Anthropology design in Germany and Japan. This survey investigates its characteristics through four factors: comfort, usability, sensation and aesthetics.Both nations regard the first three indicators as important. The difference in assessment is, however, considerable. While German physiological anthropologists use subjective evaluation by means of questionnaires, somatometry and biomechanical analysis, their Japanese counterparts apply physiological measurements of the higher nervous system and the autonomic nervous system. Polymorphism and improving functional potentiality have recently gained increasing respect in Japan.Notions of aesthetics are not consciously analyzed in both countries. If the sense of beauty of product design relates to a physical and mental response, developing a systematic analysis on this factor would be a useful task for Physiological Anthropology.     

The social gradient in health: The effect of absolute income and subjective social status assessment on the individual's health in Europe

Using data on individuals aged between 50 and 65 from 6 European countries, this study investigates the effect of absolute income and subjective social status assessment on health in the light of medical evidence indicating that the individual's position in the social hierarchy undermines his/her mental and physical health. The paper shows that individuals’ own income has a positive, but modest effect on health. Importantly, subjective social status assessment has a significant effect on all health measurements. Finally, the results show that individuals from deprived families (when at the age of 14) have poorer physical and mental health.     

The promise of machine learning in predicting treatment outcomes in psychiatry

For many years, psychiatrists have tried to understand factors involved in response to medications or psychotherapies, in order to personalize their treatment choices. There is now a broad and growing interest in the idea that we can develop models to personalize treatment decisions using new statistical approaches from the field of machine learning and applying them to larger volumes of data. In this pursuit, there has been a paradigm shift away from experimental studies to confirm or refute specific hypotheses towards a focus on the overall explanatory power of a predictive model when tested on new, unseen datasets. In this paper, we review key studies using machine learning to predict treatment outcomes in psychiatry, ranging from medications and psychotherapies to digital interventions and neurobiological treatments. Next, we focus on some new sources of data that are being used for the development of predictive models based on machine learning, such as electronic health records, smartphone and social media data, and on the potential utility of data from genetics, electrophysiology, neuroimaging and cognitive testing. Finally, we discuss how far the field has come towards implementing prediction tools in real‐world clinical practice. Relatively few retrospective studies to‐date include appropriate external validation procedures, and there are even fewer prospective studies testing the clinical feasibility and effectiveness of predictive models. Applications of machine learning in psychiatry face some of the same ethical challenges posed by these techniques in other areas of medicine or computer science, which we discuss here. In short, machine learning is a nascent but important approach to improve the effectiveness of mental health care, and several prospective clinical studies suggest that it may be working already.     

Designing and scaling up integrated youth mental health care

Mental ill‐health represents the main threat to the health, survival and future potential of young people around the world. There are indications that this is a rising tide of vulnerability and need for care, a trend that has been augmented by the COVID‐19 pandemic. It represents a global public health crisis, which not only demands a deep and sophisticated understanding of possible targets for prevention, but also urgent reform and investment in the provision of developmentally appropriate clinical care. Despite having the greatest level of need, and potential to benefit, adolescents and emerging adults have the worst access to timely and quality mental health care. How is this global crisis to be addressed? Since the start of the century, a range of co‐designed youth mental health strategies and innovations have emerged. These range from digital platforms, through to new models of primary care to new services for potentially severe mental illness, which must be locally adapted according to the availability of resources, workforce, cultural factors and health financing patterns. The fulcrum of this progress is the advent of broad‐spectrum, integrated primary youth mental health care services. They represent a blueprint and beach‐head for an overdue global system reform. While resources will vary across settings, the mental health needs of young people are largely universal, and underpin a set of fundamental principles and design features. These include establishing an accessible, “soft entry” youth primary care platform with digital support, where young people are valued and essential partners in the design, operation, management and evaluation of the service. Global progress achieved to date in implementing integrated youth mental health care has highlighted that these services are being accessed by young people with genuine and substantial mental health needs, that they are benefiting from them, and that both these young people and their families are highly satisfied with the services they receive. However, we are still at base camp and these primary care platforms need to be scaled up across the globe, complemented by prevention, digital platforms and, crucially, more specialized care for complex and persistent conditions, aligned to this transitional age range (from approximately 12 to 25 years). The rising tide of mental ill‐health in young people globally demands that this focus be elevated to a top priority in global health.     

Physiological anthropology: past and future

Environmental studies in adaptive human biology by North American anthropologists have a history of strong investigative research. From both laboratory and field work, we have gained major insights into human response to physical and social challenges. While these results were considered by most professionals to belong within evolutionary biology, in fact the intellectual structure sprang almost entirely from physiological equilibrium models. Consequently, physiological process itself was the focus. Further, most of the physiological patterns were not linked directly to important outcomes such as work output, reproductive success or survival.About 1975, American physiological anthropologists, led by Paul Baker, turned to studies of health, change and stress response. These studies were strong, but were still neither genetic nor evolutionary in intellectual structure. Evolutionary human biology was taken over by a new body of theory now called "behavior ecology", positing that selfish genes control human behavior to promote their own reproduction. This was paralleled by strong use of evolutionary theory in some areas of molecular biology. However, although physiological anthropologists have not focused on evolution, we have been developing powerful causal models that incorporate elements of physiology, morphology, physical environment and cultural behavior. In these "proximate" biocultural models, it is of little importance whether outcomes such as work or energy management are genetically based.Our future offers two major challenges. First, we must confirm causal links between specific physiological patterns and outcomes of practical importance to individuals and societies. Second, if we are to take our place in evolutionary biology, the one overarching theory of life on earth, we must understand the heritability of physiological traits, and determine whether they play a role in survival and reproduction.     

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.     

Global Mental Health and Adolescent Anxiety: Kin,Care and Struggle in New Mexico

While recent developments within the field of global mental health have illuminated the reality of serious mental health difficulties worldwide, particularly in low-income settings, research that focuses on children and adolescents remains underdeveloped. This is especially the case with respect to ethnographic studies of lived experience of adolescents diagnosed with serious mental health conditions. Drawing from an interdisciplinary study of adolescents in New Mexico who were afflicted with a broad range of disorders according to contemporary research diagnostic criteria, this article focuses on anxiety-related conditions with respect to subjective experience and social–ecological contexts of living with such conditions. We offer preliminary observations regarding the value of linking ethnographic and research diagnostic data to address questions of resilience, endurance, capacity and struggle. These observations are intended as the basis for the formulation of more precise hypotheses about adolescent anxiety, kin, and care under conditions of structural violence marked by psychological, residential, and intergenerational adversity.     

Public smog knowledge,risk perception,and intention to reduce car use: Evidence from China

ABSTRACT

Smog pollution has received widely attention in recent years due to its negative effects. There is consensus that the motor vehicle exhaust emission is one of the sources of smog pollution and reduced private car use would significantly improve the air quality and alleviate the smog pollution problem. In this research, we aim to investigate how public smog knowledge and risk perception (physical health risk perception and mental health risk perception) affect public attitude and intention to reduce car use. A questionnaire survey of 334 randomly sampled respondents was designed to test these relationships. The results show that public smog knowledge is positively and significantly related to physical health risk perception, mental health risk perception, attitude and intention to reduce car use. Public smog knowledge has the largest impact on intention to reduce car use. Furthermore, physical health risk perception and mental health risk perception are positively and significantly associated with attitude and intention to reduce car use. In addition, the results also indicated that public smog knowledge is at a low level. Based on the results, implications and suggestions for future research were discussed.     

Actively Negotiating the Mind–Body Divide: How Clozapine-Treated Schizophrenia Patients Make Health for Themselves

It is well recognised that antipsychotic treatments impact the whole body, not just the target area of the brain. For people with refractory schizophrenia on clozapine, the gold standard antipsychotic treatment in England and Australia, the separation of mental and physical regimes of health is particularly pronounced, resulting in multiple, compartmentalised treatment registers. Clinicians often focus on the mental health aspects of clozapine use, using physical indicators to determine whether treatment can continue. Our observations of 59 participants in England and Australia over 18 months revealed that patients did not observe this hierarchisation of mental treatments and physical outcomes. Patients often actively engaged in the management of their bodily symptoms, leading us to advance the figure of the active, rather than passive, patient. In our paper, we do not take the position that the facility for active management is a special one utilised only by these patients. We seek instead to draw attention to what is currently overlooked as an ordinary capacity to enact some sort of control over life, even under ostensibly confined and confining circumstances. We argue that clozapine-treated schizophrenia patients utilise the clinical dichotomy between mental and physical domains of health to rework what health means to them. This permits patients to actively manage their own phenomenological ‘life projects’ (Rapport, I am Dynamite: an Alternative Anthropology of Power, Routledge, London 2003), and forces us to reconsider the notion of clinical giveness of what health means. This making of one’s own meanings of health may be critical to the maintenance of a sense of self.     

The effect of retirement on health biomarkers

We utilize panel data from the English Longitudinal Study of Ageing to investigate the impact of retirement on objective health measures. In contrast to many previous studies, which focus on subjective self-reported health and life satisfaction measures, we focus on objective health biomarkers, such as diabetes indicators and cholesterol. Because poor health can induce retirement, we instrument for retirement using eligibility for state and employer sponsored pensions. Overall, there are few significant impacts of retirement on health biomarkers. The direction of effects is also mixed. Some biomarkers improve upon retirement, while others deteriorate. This contrasts with the consistently positive and significant improvements that are found in self-reported measures from the same dataset.     

Understanding the burnout experience: recent research and its implications for psychiatry

The experience of burnout has been the focus of much research during the past few decades. Measures have been developed, as have various theoretical models, and research studies from many countries have contributed to a better understanding of the causes and consequences of this occupationally‐specific dysphoria. The majority of this work has focused on human service occupations, and particularly health care. Research on the burnout experience for psychiatrists mirrors much of the broader literature, in terms of both sources and outcomes of burnout. But it has also identified some of the unique stressors that mental health professionals face when they are dealing with especially difficult or violent clients. Current issues of particular relevance for psychiatry include the links between burnout and mental illness, the attempts to redefine burnout as simply exhaustion, and the relative dearth of evaluative research on potential interventions to treat and/or prevent burnout. Given that the treatment goal for burnout is usually to enable people to return to their job, and to be successful in their work, psychiatry could make an important contribution by identifying the treatment strategies that would be most effective in achieving that goal.     

Nutritional modulation of cognitive function and mental health

The important role of diet in cardiometabolic health is generally well recognised; for mental health, it is not so well understood. However, lifestyle risk factors for poor physical health are the same risk factors for mental illness, including poor diet. This is reflected by the high level of poor physical health in people with mental illness. Mediterranean, whole food diets have been associated with reduced risk for chronic disease, but very little research has investigated their mental health benefits. We provide a model for the pathways by which food components provided by a Mediterranean-style diet can facilitate healthy brain function. We then review evidence for the role of selected nutrients/food components — antioxidants, omega-3 fatty acids and B vitamins — in the brain and, hence, modulation of cognitive function and mental health. Converging evidence indicates multiple pathways by which these nutrients can assist in brain function, drawing from studies investigating them in isolation. There is very little work done on synergistic actions of nutrients and whole diets, highlighting a need for human intervention studies investigating benefits of Mediterranean-style diets for mental, as well as cardiometabolic health.     

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.     

The impact of culture on the cognitive structure of illness

This paper presents a theoretical framework for understanding the impact of culture on the processes of symptom recognition, labeling, and help-seeking and consequently on large-scale epidemiological studies involving different ethnic groups. We begin with the assumption that the subjective experience of illness is culture- bound and that the cognitive and linguistic categories of illness characteristic of any culture constrain the interpretative and behavioral options available to individuals in response to symptoms. We hypothesize the existence of learned cognitive structures, through which bodily experiences are filtered, that influence the interpretation of deviations from culturally-defined physical and mental health norms. Certain contradictory findings concerning the self-reported health of Mexican Americans are discussed in order to illustrate the impact of culture on perceived health status.     

Seasonal changes in household food insecurity and symptoms of anxiety and depression

There is growing awareness that common mental health disorders are key contributors to the burden of disease in developing countries. Studies examining the correlates of mental health have primarily been carried out in urban settings and focused on the burden rapid economic change places on individuals. In these settings, poverty and low education are consistent predictors of anxiety and depressive symptoms. We argue here that these variables are proxies for insecurity, and that a more general model of symptoms of depression and anxiety should focus on locally salient forms of insecurity. Building on previous work in a seasonal subsistence setting, we identify food insecurity as a potent source of insecurity in a rural African setting, and then test whether seasonal changes in food insecurity are correlated with concomitant changes in a measure of symptoms of anxiety and depression among 173 caretakers. Results indicate that food insecurity is a strong predictor of symptoms of anxiety and depression (P < 0.0001), that changes in food insecurity across the seasons predict changes in symptoms of anxiety and depression (P < 0.0001), and that this is robust to the inclusion of covariates for material assets and household production. These results hold for individuals in both ethnic groups studied (Pimbwe and Sukuma); however, at the group level the burden falls disproportionately on Pimbwe. The results add to the growing literature on the causes of population level differences in mental health disorders and suggest new research avenues and strategies to link mental health disorders with variation in physical and biosocial outcomes.