Mental state of demoralisation across diverse clinical settings: A systematic review, meta-analysis and proposal for its use as a ‘specifier’ in mental illness

Objective: Demoralisation is a state of poor coping characterised by low morale, hopelessness, subjective incompetence, and loss of meaning and purpose in life. While studied extensively in oncology and palliative care, there has been recent exploration in broader medical and mental health settings. The aim was to investigate the prevalence of demoralisation and associated sociodemographic and psychological factors across these clinical settings. Method: Six electronic databases were used to locate articles from January 2014 to March 2020. A pre-publication update of non-oncology populations was completed in September 2021. The review has been reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pooled prevalence of demoralisation was determined through % prevalence and mean demoralisation score; this was synthesised through meta-analysis of single means to determine pooled mean prevalence of Demoralisation Scale scores using the ‘R’ statistical software. Results: Demoralisation has been examined in 52 studies ( n = 11,670) and found to be prevalent in 24–35% of oncology and non-oncology, including mental health, populations. The mean score on the Demoralisation Scale was 24.3 (95% confidence interval, CI = [21.3, 27.3]). There was evidence of divergent validity in addition to significant comorbidity between depression, demoralisation and suicidal ideation. Burdensome physical symptoms, and psychological and demographic factors are strongly correlated with demoralisation. Conclusion: There remains a need to recognise demoralisation in various clinical and cultural settings and to strongly consider its inclusion as a ‘specifier’ within formal nosological systems for adjustment and depressive disorders. This is important to initiate targeted interventions and prevent significant morbidity.

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A hidden pandemic? An umbrella review of global evidence on mental health in the time of COVID-19

10.31234/osf.io/bzpvw ◽

2022 ◽

Author(s):

Marlee Bower ◽

Scarlett Smout ◽

Amarina Donohoe-Bales ◽

Lily Teesson ◽

Eleisha Lauria ◽

...

Keyword(s):

Mental Health ◽

General Population ◽

Health Outcomes ◽

Systematic Reviews ◽

Meta Analysis ◽

Mental Health Outcomes ◽

Eligibility Criteria ◽

Pooled Prevalence ◽

Meta Review ◽

Meta Analyses

Introduction: Vast available international evidence has investigated the mental health impacts of the COVID-19 pandemic. This review aims to synthesise evidence, identifying populations and characteristics associated with poor mental health.Methods: A meta-review of pooled prevalence of anxiety and depression, with subgroup analyses for the general population, healthcare workers (HCW) and COVID-19 patients; and a meta-synthesis of systematic reviews to collate evidence on associated factors and further mental disorders. Databases searched included Scopus, Embase, PsycINFO, and MEDLINE dated to May 2021. Eligibility criteria included systematic reviews and/or meta-analyses, published post-November 2019, reporting data in English on mental health outcomes during the pandemic.Results: Eighty-one systematic reviews were included, 51 of which incorporated meta-analysis. Meta-review overall anxiety prevalence was 29% (95%CI: 27–31%, I2: 99.83%), with subgroup prevalence as 35% (95%CI: 23–47%, I2: 97.4%) in COVID-19 patients, 29% in HCW (95%CI: 25– 32, I2: 99.8%) and 28% in the general population (95%CI: 25–31%, I2: 99.9%). Meta-review overall depression prevalence was 28% (95%CI: 26–30%, I2: 99.7), with subgroup prevalence as 30% (95%CI: 7–60%, I2: 99.8%) in COVID-19 patients, 28% (95%CI: 25–31%, I2: 99.7%) in HCW and 27% (95%CI: 25–30, I2: 99.8%) in the general population. Meta-synthesis found many experienced psychological distress and PTSD/PTSS during COVID-19, but pooled prevalence ranged substantially. Fear of, proximity to, or confirmed COVID-19 infection; undergoing quarantine; and COVID-19-related news exposure were associated with adverse mental health outcomes. Amongst other factors, people who are younger, female, LGBTIQ, pregnant, parents or experiencing low social support, financial issues or socio-economic disadvantage, tended to have poorer mental health during the pandemic period.Conclusions: Despite high volumes of reviews, the diversity of findings and dearth of longitudinal studies within reviews means clear links between COVID-19 and mental health are not available, although existing evidence indicates probable associations.

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More than 50 long-term effects of COVID-19: a systematic review and meta-analysis

Scientific Reports ◽

10.1038/s41598-021-95565-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Sandra Lopez-Leon ◽

Talia Wegman-Ostrosky ◽

Carol Perelman ◽

Rosalinda Sepulveda ◽

Paulina A. Rebolledo ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Management Strategies ◽

Original Data ◽

Long Term Effects ◽

Pooled Prevalence ◽

Attention Disorder ◽

Initial Recovery ◽

Meta Analyses

AbstractCOVID-19 can involve persistence, sequelae, and other medical complications that last weeks to months after initial recovery. This systematic review and meta-analysis aims to identify studies assessing the long-term effects of COVID-19. LitCOVID and Embase were searched to identify articles with original data published before the 1st of January 2021, with a minimum of 100 patients. For effects reported in two or more studies, meta-analyses using a random-effects model were performed using the MetaXL software to estimate the pooled prevalence with 95% CI. PRISMA guidelines were followed. A total of 18,251 publications were identified, of which 15 met the inclusion criteria. The prevalence of 55 long-term effects was estimated, 21 meta-analyses were performed, and 47,910 patients were included (age 17–87 years). The included studies defined long-COVID as ranging from 14 to 110 days post-viral infection. It was estimated that 80% of the infected patients with SARS-CoV-2 developed one or more long-term symptoms. The five most common symptoms were fatigue (58%), headache (44%), attention disorder (27%), hair loss (25%), and dyspnea (24%). Multi-disciplinary teams are crucial to developing preventive measures, rehabilitation techniques, and clinical management strategies with whole-patient perspectives designed to address long COVID-19 care.

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Potential impact of physical distancing on physical and mental health: a rapid narrative umbrella review of meta-analyses on the link between social connection and health

BMJ Open ◽

10.1136/bmjopen-2020-042335 ◽

2021 ◽

Vol 11 (3) ◽

pp. e042335

Author(s):

Nexhmedin Morina ◽

Ahlke Kip ◽

Thole Hilko Hoppen ◽

Stefan Priebe ◽

Thomas Meyer

Keyword(s):

Mental Health ◽

Health Outcomes ◽

Social Isolation ◽

Physical Symptoms ◽

Vaccine Uptake ◽

Living Alone ◽

Mental Health Outcomes ◽

Social Connection ◽

Physical And Mental Health ◽

Meta Analyses

BackgroundThe imperative for physical distancing (mostly referred to as social distancing) during COVID-19 pandemic may deteriorate physical and mental health. We aimed at summarising the strength of evidence in the published literature on the association of physical and mental health with social connection via social isolation, living alone and loneliness.MethodsWe conducted a systematic search in April 2020 to identify meta-analyses using the Medline, PsycINFO and Web of Science databases. The search strategy included terms of social isolation, loneliness, living alone and meta-analysis. Eligible meta-analyses needed to report any sort of association between an indicator of social connection and any physical or mental health outcome. The findings were summarised in a narrative synthesis.ResultsTwenty-five meta-analyses met our criteria, of which 10 focused on physical health and 15 on mental health outcomes. The results suggest that lack of social connection is associated with chronic physical symptoms, frailty, coronary heart disease, malnutrition, hospital readmission, reduced vaccine uptake, early mortality, depression, social anxiety, psychosis, cognitive impairment in later life and suicidal ideation.ConclusionsThe existing evidence clearly indicates that social connection is associated with a range of poor physical and mental health outcomes. A potential negative impact on these outcomes needs to be considered in future decisions on physical distancing measures.

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Bibliotherapy as a Non-pharmaceutical Intervention to Enhance Mental Health in Response to the COVID-19 Pandemic: A Mixed-Methods Systematic Review and Bioethical Meta-Analysis

Frontiers in Public Health ◽

10.3389/fpubh.2021.629872 ◽

2021 ◽

Vol 9 ◽

Author(s):

Daniela Monroy-Fraustro ◽

Isaac Maldonado-Castellanos ◽

Mónica Aboites-Molina ◽

Susana Rodríguez ◽

Perla Sueiras ◽

...

Keyword(s):

Mental Health ◽

Systematic Review ◽

Mental Health Problems ◽

Positive Impact ◽

Meta Analysis ◽

Quality Criteria ◽

Health Problems ◽

Clinical Settings ◽

Road Map ◽

Road Maps

Background: A non-pharmaceutical treatment offered as psychological support is bibliotherapy, which can be described as the process of reading, reflecting, and discussing literature to further a cognitive shift. The coronavirus disease 2019 (COVID-19) pandemic demands a response to prevent a peak in the prevalence of mental health problems and to avoid the collapse of mental health services, which are scarce and inaccessible due to the pandemic. Thus, this study aimed to review articles on the effectiveness of bibliotherapy on different mental health problems.Methods: A systematic review was conducted to examine relevant studies that assess the effectiveness of bibliotherapy in different clinical settings as a treatment capable of enhancing a sense of purpose and its surrounding values. To achieve this, a systematic review, including a bioethical meta-analysis, was performed. A variant of the PICO (Participants, Intervention, Comparison, and Outcome) model was used for the search strategy, and the systematic review was conducted in three databases: PubMed, Bireme, and OVID. Inclusion criteria were relevant studies that included the keywords, excluding documents with irrelevant topics, studies on subjects 15 years or younger, and in languages besides Spanish or English. Starting with 707 studies, after three rounds of different quality criteria, 13 articles were selected for analysis, including a hermeneutic analysis, which was followed by a fourth and final recovery round assessing bibliotherapy articles concerning healthcare workers.Results: Our findings showed that through bibliotherapy, patients developed several capacities, including the re-signification of their own activities through a new outlook of their moral horizon. There are no research road maps serving as guides to conduct research on the use of bibliotherapy to enhance mental health. Additionally, values such as autonomy and justice were closely linked with positive results in bibliotherapy. This implies that bibliotherapy has the potential to have a positive impact in different settings.Conclusions: Our contribution is to offer a road map that presents state-of-the-art bibliotherapy research, which will assist institutions and healthcare professionals to plan clinical and specific interventions with positive outcomes.

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Prevalence of Poor Diabetes Self-Management Behaviors among Ethiopian Diabetes Mellitus Patients: A Systematic Review and Meta- Analysis

Ethiopian Journal of Health Sciences ◽

10.4314/ejhs.v30i4.18 ◽

2020 ◽

Vol 30 (4) ◽

Author(s):

Teshome Tesfaye Habebo ◽

Ebrahim Jaafari Pooyan ◽

Ali Mohammad Mosadeghrad ◽

Getachew Ossabo Babore ◽

Blen Kassahun Dessu

Keyword(s):

Quality Assessment ◽

Addis Ababa ◽

Meta Analysis ◽

Glucose Monitoring ◽

Blood Glucose Monitoring ◽

Self Management ◽

Diabetic Patients ◽

Pooled Prevalence ◽

Meta Analyses ◽

Management Behaviors

BACKGROUND: Diabetes has no cure so far, but appropriate self-management contributes to delay or control its progression. However, poor self-management by diabetic patients adds to disease burden. The pooled prevalence of overall, and its main components of poor self-management among Ethiopian diabetic patients remain elusive. Hence, this study aimed to determine the prevalence of poor diabetes self-management behaviors among diabetic patients in Ethiopia.METHOD: by using different combinations of search terms, we accessed articles done until February 15, 2020 through Pubmed, Scopus, Web of Science and Embase databases. Newcastle-Ottawa quality assessment scale was used for quality assessment, and STATA version 14 software along with the random-effects model was employed for statistical analyses. The Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA.) guideline was followed to report the results.RESULT: Twenty-one studies with 7,168 participants were included in this meta-analysis. The overall pooled prevalence of poor self-management behavior among diabetic patients in Ethiopia was 49.79% (95% CI: 43.58%, 56.01%). Based on subgroup analysis, the estimated magnitudes of poor selfmanagement by regions were 68.58% in Tigray, 55.46% in Harari, 54.74%, in Amhara, 40.90%, in SNNPRS and 37.06% in Addis Ababa. The worst (80.91%) and relatively better (24.65%) self-management components were observed on self-blood glucose monitoring and medication adherence, respectively.CONCLUSION: One in two diabetic patients in Ethiopia had poor self-management. Thus, we strongly recommend to the ministry of health and universities to train diabetes health educators, and the health facilities to deliver tailored diabetes health education.

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When the Bough Breaks: A Systematic Review and Meta-Analysis of Mental Health Symptoms in Mothers of Young Children during the COVID-19 Pandemic

10.31234/osf.io/u8pnh ◽

2021 ◽

Author(s):

Nicole Racine ◽

Rachel Eirich ◽

Jessica Cookee ◽

Jenney Zhu ◽

Paolo Pador ◽

...

Keyword(s):

Mental Health ◽

Young Children ◽

Maternal Mental Health ◽

Meta Analysis ◽

Random Effect ◽

Well Being ◽

Anxiety Symptoms ◽

Study Quality ◽

Depression And Anxiety ◽

Meta Analyses

Parents have experienced considerable challenges and stress during the COVID-19 pandemic, which may impact their well-being. This meta-analysis sought to identify: 1) the prevalence of depression and anxiety in parents of young children (< age 5) during the COVID-19 pandemic, and 2) sociodemographic (e.g., parent age, minority status) and methodological moderators (e.g., study quality) that explain heterogeneity among studies. A systematic search was conducted across four databases from January 1st, 2020 to March 3st, 2021. A total of 18 non-overlapping studies (9,101 participants), all focused on maternal mental health, met inclusion criteria. Random-effect meta-analyses were conducted. Pooled prevalence estimates for clinically significant depression and anxiety symptoms for mothers of young children during the COVID-19 pandemic were 27.4% (95% CI: 21.5-34.3) and 43.5% (95% CI:27.5-60.9), respectively. Prevalence of clinically elevated depression and anxiety symptoms were higher in Europe and North America and among older mothers. Clinically elevated depressive symptoms were lower in studies with a higher percentage of racial and ethnic minority individuals. In comparison, clinically elevated anxiety symptoms were higher among studies of low study quality and in samples with highly educated mothers. Policies and resources targeting improvements in maternal mental health are essential.

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Prevalence, main serovars, and antimicrobial resistance profiles of Non-typhoidal Salmonella in poultry samples from the Americas: A systematic review and meta-analysis

10.22541/au.163253387.70584910/v1 ◽

2021 ◽

Author(s):

Daniel Diaz ◽

Pavel Eduardo Hernandez-Carreño ◽

Diana Zuleika Velazquez ◽

Miguel Angel Chaidez-Ibarra ◽

Arnulfo Montero-Pardo ◽

...

Keyword(s):

Systematic Review ◽

Antimicrobial Resistance ◽

Environmental Samples ◽

Meta Analysis ◽

National Level ◽

Production Chain ◽

National Differences ◽

Pooled Prevalence ◽

The Usa ◽

Meta Analyses

Poultry and poultry-derived products such as meat and eggs are among the main sources of non-typhoidal Salmonella (NTS) transmission to the human. Therefore, we performed a systematic review and used random-effects meta-analyses to 1) estimate the prevalence of NTS in poultry samples from birds, products and subproducts, and environmental samples, 2) examine the diversity and frequency of their serovars, and 3) estimate the prevalence and profiles of antimicrobial resistance (AMR) in NTS isolates reported in studies from the Americas. We included 157 studies from 15 countries comprising 261,408 poultry samples and estimated an overall pooled prevalence of 17.9% (95% CI: 10.8–26.3) in birds, 21.8% (17.7–26.1) in products and subproducts, and 29.5% (24.2–35.1) in environmental samples. At the national level, the prevalence of NTS was heterogenous across countries with the highest values in Mexico, the USA, and Canada. In total, 131 serovars were identified from 13,388 isolates, Heidelberg, Kentucky, Enteritidis, and Typhimurium were the most prevalent in the overall top 10 ranking (range 6.5–20.8%). At the national level, Enteritidis and Typhimurium were identified in most of the countries, though with national differences in their ranks. The prevalence of AMR increased from 24.1% for 1 antibiotic, to 36.2% for 2-3 antibiotics, and 49.6% for ≥ 4 antibiotics. Kentucky, Heidelberg, Typhimurium, and Enteritidis were the serovars with the highest prevalence of AMR and tetracycline, ampicillin, streptomycin, ceftiofur, and amoxicillin-clavulanic acid were the top five antibiotics to which NTS isolates were resistant. In conclusion, NTS was distributed through the avian production chain with high and heterogenous values of prevalence in poultry samples. Besides, there were distinctive patterns of serovars distribution across countries and an alarming prevalence of AMR among zoonotic serovars.

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Prevalence of and risk factors for Plasmodium spp. co-infection with hepatitis B virus: a systematic review and meta-analysis

Malaria Journal ◽

10.1186/s12936-020-03428-w ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Kwuntida Uthaisar Kotepui ◽

Manas Kotepui

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Hepatitis B Virus ◽

Meta Analysis ◽

Infection Group ◽

Pooled Prevalence ◽

B Virus ◽

The Difference ◽

Meta Analyses

Abstract Background Plasmodium spp. and hepatitis B virus (HBV) are among the most common infectious diseases in underdeveloped countries. This study aimed to determine the prevalence of Plasmodium spp. and HBV co-infection in people living in endemic areas of both diseases and to assess the risk factors related to this co-infection. Methods The PubMed, Web of Science, and Scopus databases were searched. Observational cross-sectional studies and retrospective studies assessing the prevalence of Plasmodium species and HBV co-infection were examined. The methodological quality of the included studies was assessed with the Newcastle-Ottawa Scale (NOS), a tool for assessing the quality of nonrandomized studies in meta-analyses, and heterogeneity among the included studies was assessed with Cochran's Q test and the I2 (inconsistency) statistic. The pooled prevalence of the co-infection and its 95% confidence interval (CI) were estimated using the random-effects model, depending on the amount of heterogeneity there was among the included studies. The pooled odds ratio (OR) represented the difference in qualitative variables, whereas the pooled mean difference (MD) represented the difference in quantitative variables. Meta-analyses of the potential risk factors for Plasmodium spp. and HBV co-infection, including patient age and gender, were identified and represented as pooled odds ratios (OR) and 95% CIs. Publication bias among the included studies was assessed by visual inspection of a funnel plot to search for asymmetry. Results Twenty-two studies were included in the present systematic review and meta-analysis. Overall, the pooled prevalence estimate of Plasmodium spp. and HBV co-infection was 6% (95% CI 4–7%, Cochran's Q statistic < 0.001, I2: 95.8%), with prevalences of 10% in Gambia (95% CI: 8–12%, weight: 4.95%), 8% in Italy (95% CI 5–12%, weight: 3.8%), 7% in Nigeria (95% CI 4–10%, weight: 53.5%), and 4% in Brazil (95% CI 2–5%, weight: 19.9%). The pooled prevalence estimate of Plasmodium spp. and HBV co-infection was higher in studies published before 2015 (7%, 95% CI 4–9%, Cochran's Q statistic < 0.001, I2: 96%) than in those published since 2015 (3%, 95% CI 1–5%, Cochran's Q statistic < 0.001, I2: 81.3%). No difference in age and risk of Plasmodium spp. and HBV co-infection group was found between the Plasmodium spp. and HBV co-infection and the Plasmodium monoinfection group (p: 0.48, OR: 1.33, 95% CI 0.60–2.96). No difference in gender and risk of Plasmodium spp. and HBV co-infection group was found between the Plasmodium spp. and HBV co-infection and HBV co-infection group and the Plasmodium monoinfection group (p: 0.09, OR: 2.79, 95% CI 0.86–9.10). No differences in mean aspartate aminotransferase (AST), mean alanine aminotransferase (ALT), or mean total bilirubin levels were found (p > 0.05) between the Plasmodium spp. and HBV co-infection group and the Plasmodium monoinfection group. Conclusions The present study revealed the prevalence of Plasmodium spp. and HBV co-infection, which will help in understanding co-infection and designing treatment strategies. Future studies assessing the interaction between Plasmodium spp. and HBV are recommended.

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The Prevalence of Technology-Facilitated Sexual Violence: A Meta-Analysis and Systematic Review

Trauma Violence & Abuse ◽

10.1177/1524838020958057 ◽

2020 ◽

pp. 152483802095805

Author(s):

Unnati Patel ◽

Ronald Roesch

Keyword(s):

Mental Health ◽

Systematic Review ◽

Sexual Violence ◽

Meta Analysis ◽

Adult Population ◽

Health Impacts ◽

Regression Analyses ◽

Pooled Prevalence ◽

Anxiety Depression ◽

Study Setting

The primary aim of this systematic review and meta-analysis was to examine the prevalence of technology-facilitated sexual violence (TFSV) within the adolescent and adult population regarding victimization and perpetration. In addition to the primary aim, associated health outcomes with TFSV were discussed through a qualitative lens. Specific forms of TFSV that were examined include distribution of, production of, and threats to distribute sexual material involving another individual without that person’s consent via images or videos; 425 articles from MEDLINE, PsycArticles, PsycINFO, Criminal Justice Abstracts, ProQuest Dissertations & Theses, and Google Scholar were screened. Nineteen articles (comprising 20 independent samples) reporting prevalence rates of TFSV on 32,247 participants were included in this random-effects meta-analysis. Pooled prevalence of victimization results revealed that 8.8% of people have had their image or video-based sexts shared without consent, 7.2% have been threatened with sext distribution, and 17.6% have had their image taken without permission. Regarding perpetration, 12% have shared sexts beyond the intended recipient, 2.7% have threatened to share sexts, and 8.9% have nonconsensually taken an image. Moderator variables included publication year, mean participant age, proportion of female participants, and study setting, with meta-regression analyses revealing no significant predictors. Finally, a qualitative analysis of nine articles ( n = 3,990) was conducted to assess mental health associations with TFSV victimization, revealing significant mental health impacts, including anxiety, depression, and poor coping, for victims.

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Systematic Review and Meta-Analysis of Anxiety and Depression in Youth With Epilepsy

Journal of Pediatric Psychology ◽

10.1093/jpepsy/jsz099 ◽

2020 ◽

Vol 45 (2) ◽

pp. 133-144 ◽

Cited By ~ 2

Author(s):

Amelia J Scott ◽

Louise Sharpe ◽

Max Loomes ◽

Milena Gandy

Keyword(s):

Systematic Review ◽

Anxiety Disorder ◽

Anxiety Disorders ◽

Depressive Disorders ◽

Meta Analysis ◽

Control Sample ◽

Separation Anxiety Disorder ◽

Anxiety And Depression ◽

Healthy Controls ◽

Pooled Prevalence

Abstract Objective The aim of this systematic review and meta-analysis was to provide an estimate of the prevalence of anxiety and depressive disorders in youth with epilepsy (YWE). It also aimed to calculate the overall magnitude of observed differences in anxiety and depressive symptoms reported by YWE compared with healthy controls and investigate whether any factors moderated anxiety and depression outcomes in YWE. Methods Following prospective registration, electronic databases were searched up until October 2018. Studies were included if they reported on the rate of anxiety or depression in samples of YWE, and/or if they used valid measures of anxious or depressive symptomatology in YWE compared with a healthy control sample. Results Twenty-three studies met inclusion criteria. The overall pooled prevalence of anxiety disorders in YWE was 18.9% (95% confidence interval [CI] 12.0%–28.5%), and for depression the pooled prevalence was 13.5% (95% CI 8.8%–20.2%). In samples of YWE compared with healthy controls, significantly higher anxiety (d = 0.57, 95% CI 0.32–0.83, p < .000) and depressive (d = 0.42, 95% CI 0.16–0.68, p < .000) symptomatology was reported. Conclusions YWE report anxiety and depressive disorders and symptoms to a significantly higher degree than youth without epilepsy. There is also evidence that certain anxiety disorders (e.g. generalized anxiety disorder, separation anxiety disorder) are particularly elevated, perhaps reflecting the unique impact of epilepsy on youth psychopathology. Research is needed to understand the risk factors associated with anxiety and depressive disorders in epilepsy, and better understand how these symptoms change across development.

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