Effectiveness of Live Health Professional-Led Group eHealth Interventions for Adult Mental Health: Systematic Review of Randomized Controlled Trials.

BACKGROUND: The COVID-19 pandemic has had adverse impacts on mental health and substance use worldwide. Systematic reviews suggest eHealth interventions can be effective at addressing these problems. However, strong positive eHealth outcomes are often tied to the intensity of web-based therapist guidance, which has time and cost implications that can make the population scale-up of more effective interventions difficult. A way to offset cost while maintaining the intensity of therapist guidance is to offer eHealth programs to groups rather than more standard one-on-one formats. OBJECTIVE: This systematic review aims to assess experimental evidence for the effectiveness of live health professional-led group eHealth interventions on mental health, substance use, or bereavement among community-dwelling adults. Within the articles selected for our primary aim, we also seek to examine the impact of interventions that encourage physical activity compared with those that do not. METHODS: Overall, 4 databases (MEDLINE, CINAHL, PsycINFO, and the Cochrane Library) were searched in July 2020. Eligible studies were randomized controlled trials (RCTs) of eHealth interventions led by health professionals and delivered entirely to adult groups by videoconference, teleconference, or webchat. Eligible studies reported mental health, substance use, or bereavement as primary outcomes. The results were examined by outcome, eHealth platform, and intervention length. Postintervention data were used to calculate effect size by study. The findings were summarized using the Synthesis Without Meta-Analysis guidelines. Risk of bias was assessed using the Cochrane Collaboration Tool. RESULTS: Of the 4099 identified studies, 21 (0.51%) RCTs representing 20 interventions met the inclusion criteria. These studies examined mental health outcomes among 2438 participants (sample size range: 47-361 participants per study) across 7 countries. When effect sizes were pooled, live health professional-led group eHealth interventions had a medium effect on reducing anxiety compared with inactive (Cohen d=0.57) or active control (Cohen d=0.48), a medium to small effect on reducing depression compared with inactive (Cohen d=0.61) or active control (Cohen d=0.21), and mixed effects on mental distress and coping. Interventions led by videoconference, and those that provided 8-12 hours of live health professional-led group contact had more robust effects on adult mental health. Risk of bias was high in 91% (19/21) of the studies. Heterogeneity across interventions was significant, resulting in low to very low quality of evidence. No eligible RCT was found that examined substance use, bereavement, or physical activity. CONCLUSIONS: Live eHealth group interventions led by health professionals can foster moderate improvements in anxiety and moderate to small improvements in depression among community-based adults, particularly those delivered by videoconference and those providing 8-12 hours of synchronous engagement. TRIAL REGISTRATION: PROSPERO CRD42020187551; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=187551. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s13643-020-01479-3.

Trauma-informed interventions versus control for cancer-risk behaviours among adults: rationale and design for a randomized trial.

BACKGROUND: Tobacco use, alcohol use, and sugar-sweetened beverage consumption are each associated with increased cancer-risk. Psychological trauma is a common experience and a key driver of these behaviours among adults. The primary aim of this study is to evaluate the effect of trauma-informed yoga, drumming, and psychoeducation compared to control on tobacco use, alcohol use, and sugar-sweetened beverage consumption among community-based adults. Secondary aims are to evaluate the effect of these interventions compared to control on psychological and physiological stress symptomology, social connection, and coping behaviour. METHODS: Recruitment for this single-blinded randomized trial began in April 2019 in the Faculty of Health Sciences at the University of Lethbridge. Adults who consumed tobacco, alcohol, or sugar-sweetened beverages in the past month and live in Lethbridge, Alberta are being recruited using ads placed in public spaces. Participants are randomly allocated to a 12-session group yoga class, 12-session group drumming class, a 12-session psychoeducation class, or control. Participants attend an appointment in-person to fill out an online questionnaire package, provide a saliva sample, and complete physical measures pre-intervention, and 1-month and 6-months post-intervention. DISCUSSION: This study provides a unique opportunity to compare the impacts of two trauma-informed body-based interventions to psychoeducation and control for cancer-risk behaviour among community-based adults. The findings can be used to develop trauma-informed group interventions to reduce cancer-risk behaviour in general populations. Results are expected in 2022. TRIAL REGISTRATION: This trial was registered with ClinicalTrials.gov ISRCTN15583681 on 22 August 2019 (retrospectively registered).

The Impact of Racial and Non-racial Discrimination on Health Behavior Change Among Visible Minority Adults During the COVID-19 Pandemic.

INTRODUCTION: Pre-pandemic health behavior has been put forward as a reason for excess COVID-19 infection and death in some racialized groups. At the same time, scholars have labeled racism the other pandemic and argued for its role in the adverse COVID-19 outcomes observed. The purpose of this study was to examine the impact of discrimination on health behavior change among racialized adults in the early stages of the pandemic. METHODS: Data were collected from 210 adults who identified as a visible minority in Alberta, Canada, in June 2020. The Everyday Discrimination Scale (Short Version) was adapted to examine past-month experiences. Four questions asked if alcohol/cannabis use and stress eating had significantly increased, and if sleep and exercise had significantly decreased in the past month. Logistic regression models examined associations between discrimination attributed to racial and non-racial causes and health behavior change adjusted for covariates. RESULTS: The majority of adults (56.2%) reported past-month discrimination including 26.7% who attributed it to their race. Asian adults reported more racial discrimination and discrimination due to people believing they had COVID-19 than other visible minorities. Racial discrimination during the pandemic was strongly associated with increased substance use (OR: 4.0, 95% CI 1.2, 13.4) and decreased sleep (OR: 7.0, 95% CI 2.7, 18.4), and weakly associated with decreased exercise (OR: 2.2, 95% CI 1.1, 4.5). Non-racial discrimination was strongly associated with decreased sleep (OR: 4.8, 95% CI 1.8, 12.5). CONCLUSION: Racial discrimination may have a particularly important effect on intensifying adverse health behavior changes among racialized adults during a time of global crisis.

Socioeconomic Status Moderates the Impact of Emotional but not Physical Childhood Abuse on Women's Sleep.

A recent systematic review highlighted associations between childhood abuse and adult sleep quality, and the need for research focused specifically on women and the role of moderating variables. The objectives of the present study were (1) to assess the impact of frequent physical and emotional child abuse on adult sleep among women; and (2) to assess the role that childhood socioeconomic status (SES) could play in moderating these associations. In-person data were collected from women living in a mid-sized city in western Canada in 2019-2020 (N = 185; M age = 40 years). Sleep quality was measured using the Pittsburgh Sleep Quality Index. Physical and emotional abuse experienced often or very often in childhood were assessed using single items (yes or no). Childhood SES was assessed by a single item and dichotomized at the sample median. Linear regression models examined associations between each form of abuse and continuous adult sleep quality score adjusted for covariates. Statistically significant interactions were stratified and examined by child SES group. Frequent physical and emotional childhood abuse were each associated with clinically and statistically significant increases in past-month sleep problem scores among women in adjusted models. This association was moderated by childhood SES for emotional child abuse, but not physical child abuse. Findings suggest that growing up in an upper-middle to upper SES household may buffer the adverse impact of frequent emotional child abuse on later adult sleep, but may not promote resilience in the context of frequent physical child abuse.

The impact of eHealth group interventions on the mental, behavioral, and physical health of adults: a systematic review protocol.

BACKGROUND: COVID-19 has resulted in an increased demand for eHealth services globally. There is emerging evidence for the efficacy for group eHealth interventions that support population-based mental health and wellbeing, but a systematic review is lacking. The primary objective of this systematic review is to summarize the evidence for eHealth group counseling and coaching programs for adults. A second objective is to assess, within studies selected for our primary objective, the impact of programs that encourage PA on outcomes compared to those that do not. METHODS: Randomized controlled trials that assess the impact of eHealth group counseling or coaching programs on mental health, health behavior, or physical health activity among community-dwelling adults will be included. We will search the following electronic databases (from January 2005 onwards): MEDLINE, PsycINFO, CINHAL, and the Central Register of Controlled Trials. The primary outcomes will be changes in mental health conditions (e.g., depression, anxiety, stress, quality of life), behavioral health conditions (e.g., substance use, smoking, sexual behavior, eating behavior, medication adherence), and physical health conditions (e.g., coping with cancer, menopausal symptoms, arthritis pain). Secondary outcomes will be changes in physical activity. Two reviewers will independently screen all citations, full-text articles, and abstract data. Potential conflicts will be resolved through discussion with a third reviewer. A narrative synthesis without meta-analysis will be conducted. The strength of the body of evidence will be assessed using GRADE. The risk of bias in individual studies will be appraised using the Cochrane Risk of Bias 2.0 tool. Potential sources of gender bias in included studies will be considered at all stages of the planned review. DISCUSSION: This review will contribute to the literature by providing evidence on the effectiveness of eHealth counseling and coaching programs delivered to adults in a group format. SYSTEMATIC REVIEW REGISTRATION: The protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO: CRD42020187551 ).