The mental health of young people who are not in education, employment, or training: a systematic review and meta-analysis.

PURPOSE: There are increasing concerns about the intersection between NEET (not in education, employment, or training) status and youth mental ill-health and substance use. However, findings are inconsistent and differ across types of problems. This is the first systematic review and meta-analysis (PROSPERO-CRD42018087446) on the association between NEET status and youth mental health and substance use problems. METHODS: We searched Medline, EMBASE, Web of Science, ERIC, PsycINFO, and ProQuest Dissertations and Theses (1999-2020). Two reviewers extracted data and appraised study quality using a modified Newcastle-Ottawa Scale. We ran robust variance estimation random-effects models for associations between NEET and aggregate groups of mental ill-health and substance use measures; conventional random-effects models for associations with individual mental/substance use problems; and subgroup analyses to explore heterogeneity. RESULTS: We identified 24 studies from 6,120 references. NEET status was associated with aggregate groups of mental ill-health (OR 1.28, CI 1.06-1.54), substance use problems (OR 1.43, CI 1.08-1.89), and combined mental ill-health and substance use measures (OR 1.38, CI 1.15-1.64). Each disaggregated measure was associated with NEET status [mood (OR 1.43, CI 1.21-1.70), anxiety (OR 1.55, CI 1.07-2.24), behaviour problems (OR 1.49, CI 1.21-1.85), alcohol use (OR 1.28, CI 1.24-1.46), cannabis use (OR 1.62, CI 1.07-2.46), drug use (OR 1.99, CI 1.19-3.31), suicidality (OR 2.84, CI 2.04-3.95); and psychological distress (OR 1.10, CI 1.01-1.21)]. Longitudinal data indicated that aggregate measures of mental health problems and of mental health and substance use problems (combined) predicted being NEET later, while evidence for the inverse relationship was equivocal and sparse. CONCLUSION: Our review provides evidence for meaningful, significant associations between youth mental health and substance use problems and being NEET. We, therefore, advocate for mental ill-health prevention and early intervention and integrating vocational supports in youth mental healthcare.

How Are Adolescents Sleeping? Adolescent Sleep Patterns and Sociodemographic Differences in 24 European and North American Countries.

PURPOSE: Insufficient and poor sleep patterns are common among adolescents worldwide. Up to now, the evidence on adolescent sleep has been mostly informed by country-specific studies that used different measures and age groups, making direct comparisons difficult. Cross-national data on adolescent sleep that could inform nations and international discussions are lacking. We examined the sleep patterns of adolescents across 24 countries and by gender, age, and affluence groups. METHODS: We obtained sleep data on 165,793 adolescents (mean age 13.5 years; 50.5% girls) in 24 European and North American countries from the recent cross-sectional Health Behaviour in School-aged Children surveys (2013-2014 and 2017-2018). For each country, we calculated the age-standardized mean in sleep duration, timing, and consistency and the proportions meeting sleep recommendations on school and nonschool days from self-reported bedtimes and wake times. We conducted stratified analyses by gender, age, and family affluence group. RESULTS: Adolescent sleep patterns varied cross-nationally. The average sleep duration ranged between 7:47 and 9:07 hours on school days and between 9:31 and 10:22 hours on nonschool days, and the proportion of adolescents meeting sleep recommendations ranged between 32% and 86% on school days and between 79% and 92% on nonschool days. Sleep patterns by gender and affluence groups were largely similar, but older adolescents slept less and went to bed later on school days than younger adolescents in all countries. CONCLUSIONS: The sleep patterns of adolescents vary across countries and sociodemographic groups. Insufficient sleep on school days is common in many countries. Public health and policy efforts to promote healthy adolescent sleep are encouraged.

Measures of depression and risk of type 2 diabetes: A systematic review and meta-analysis.

BACKGROUND: Depression is associated with an increased risk of type 2 diabetes. This study aimed to determine whether the association between depression and incident type 2 diabetes differs by measure of depression. METHODS: Data sources included MEDLINE, EMBASE, PsycINFO, CINAHL, ProQuest Dissertations & Theses Global, Web of Science Emerging Sources Citation Index and Conference Proceedings Citation Index, Cochrane Library, the University of York Center for Reviews and Dissemination, abstracts from the PsychoSocial Aspects of Diabetes conference. INCLUSION CRITERIA: comparison of participants with and without depression, depression measured at age 18 or older, longitudinal follow-up with an outcome of type 2 diabetes, effect estimate adjusted for important confounders, full-text available in English or French, and study at overall low or moderate risk of bias. Two reviewers extracted data and assessed study quality. RESULTS: Twenty-one studies reporting twenty-five effect estimates were included. Depressive symptom scales, clinical interviews, physician diagnoses, and use of antidepressants were all associated with an increased risk of incident type 2 diabetes. When all measures of depression were combined, the meta-analyzed risk ratio for type 2 diabetes was 1.18 (95% CI 1.12-1.24, I2=45.4%). Results did not provide conclusive evidence that the association between depression and incident diabetes differs by measure of depression. LIMITATIONS: Results showed heterogeneity and evidence of publication bias. CONCLUSIONS: Results suggest that various measures of depression may be used to identify individuals at higher risk of type 2 diabetes.

Cardiometabolic dysregulation and cognitive decline: potential role of depressive symptoms.

BACKGROUND: Previous studies have examined associations of cardiometabolic factors with depression and cognition separately. Aims To determine if depressive symptoms mediate the association between cardiometabolic factors and cognitive decline in two community studies. METHOD: Data for the analyses were drawn from the Rotterdam Study, the Netherlands (n = 2940) and the Whitehall II study, UK (n = 4469). RESULTS: Mediation analyses suggested a direct association between cardiometabolic factors and cognitive decline and an indirect association through depression: poorer cardiometabolic status at time 1 was associated with a higher level of depressive symptoms at time 2 (standardised regression coefficient 0.07 and 0.06, respectively), which, in turn, was associated with greater cognitive decline between time 2 and time 3 (standardised regression coefficient of -0.15 and -0.41, respectively). CONCLUSIONS: Evidence from two independent cohort studies suggest an association between cardiometabolic dysregulation and cognitive decline and that depressive symptoms tend to precede this decline. Declaration of interest None.

Association between Depressive Symptoms and Cognitive Function in Persons with Diabetes Mellitus: A Systematic Review.

Depression and diabetes are independent risk factors for one another, and both are associated with increased risk of cognitive decline. Diabetes patients with lower cognitive function are more likely to suffer poorer health outcomes. However, the role of depression in cognitive decline among people with diabetes is not well understood. This systematic review assessed whether adults with comorbid diabetes and depression or depressive symptoms exhibit greater cognitive decline relative to individuals with diabetes alone. Searches were run in CINAHL, the Cochrane Central Register of Controlled Trials, EMBASE, PsycINFO, and PubMed (MEDLINE) with no time or language restrictions. Studies were eligible for inclusion if they were of any quantitative study design, included participants aged 18 years or older with diabetes mellitus of which some must have presented with current depression, and measured cognition as an outcome. The Cochrane Collaboration's Risk Of Bias In Non-randomized Studies-of Interventions tool was used for quality assessment of each study and its collected outcome. Fifteen articles were included in the final analysis. The high degree of heterogeneity in exposures, outcomes, and participant characteristics precluded a meta-analysis of any of the studies, and the risk of bias observed in these studies limits the strength of the evidence. Nonetheless, this review found the presence of comorbid depression was associated with poorer cognitive outcomes than for persons with diabetes alone. While large-scale preventive efforts must address epidemic levels of diabetes and its comorbidities, on the patient level healthcare professionals must be cognizant of the added difficulties that depression poses to patients and the extra support required to management diabetes in these cases. This systematic review is registered with the University of York Centre for Reviews and Dissemination under registration number 2015:CRD42015025122.