The effects of different types of organisational workplace mental health interventions on mental health and wellbeing in healthcare workers: a systematic review.

OBJECTIVE: To determine if and which types of organisational interventions conducted in small and medium size enterprises (SMEs) in healthcare are effective on mental health and wellbeing. METHODS: Following PRISMA guidelines, we searched six scientific databases, assessed the methodological quality of eligible studies using QATQS and grouped them into six organisational intervention types for narrative synthesis. Only controlled studies with at least one follow-up were eligible. RESULTS: We identified 22 studies (23 articles) mainly conducted in hospitals with 16 studies rated of strong or moderate methodological quality. More than two thirds (68%) of the studies reported improvements in at least one primary outcome (mental wellbeing, burnout, stress, symptoms of depression or anxiety), most consistently in burnout with eleven out of thirteen studies. We found a strong level of evidence for the intervention type "Job and task modifications" and a moderate level of evidence for the types "Flexible work and scheduling" and "Changes in the physical work environment". For all other types, the level of evidence was insufficient. We found no studies conducted with an independent SME, however five studies with SMEs attached to a larger organisational structure. The effectiveness of workplace mental health interventions in these SMEs was mixed. CONCLUSION: Organisational interventions in healthcare workers can be effective in improving mental health, especially in reducing burnout. Intervention types where the change in the work environment constitutes the intervention had the highest level of evidence. More research is needed for SMEs and for healthcare workers other than hospital-based physicians and nurses.

Overcoming treatment gaps in the management of depression with non-pharmacological adjunctive strategies.

There is considerable evidence that simple, cost-effective, non-pharmaceutical strategies can be readily implemented to improve outcomes in the treatment of depression. It is estimated that 4.4% of the world's population suffers from depression. Despite being a major public health concern and the availability of both pharmacological and non-pharmacological treatments, many depressed people remain undiagnosed and receive no or inappropriate treatment. Several possible underlying factor of treatment gap can be identified in relation to pharmacotherapy and psychotherapy of depression, including side effects, partial remission, treatment-resistant depression and the limited availability of psychotherapy. In addition to developing new therapeutic options, much more could be done to optimise the use of existing therapies, including combining available drug treatments with quick, simple and cost-effective non-pharmacological methods: low-intensity psychological interventions, online self-help tools and lifestyle medicine. In addition to increasing the effectiveness of treatments, prevention is equally important: awareness programs to further reduce the treatment gap, and community dissemination of the life skills that help maintain positive mental health.

Acute psychosocial stress impairs intention initiation in young but not older adults.

Acute psychosocial stress has been shown to impair memory and cognitive control in young adults. So far, only very little empirical research is available concerning possible adult age differences in acute stress effects on cognition in general and cognitive control in particular. Accordingly, the present study set out to test these effects in a controlled laboratory setting comparing performance in a prospective memory task requiring the deployment of proactive cognitive control to successfully implement intentions. Sixty-six young (19-34 years) and 57 older adults (60-82 years) were either exposed to an established psychosocial stress procedure (Trier Social Stress Test) or an active control condition. Stress responses were measured on a fine-grained level across the entire procedure using subjective and physiological stress markers. Results suggest that the stress induction was equally successful in both age groups. While stress impaired prospective memory ability in young adults, it did not affect performance in the older adults. In particular, young adults under acute stress were more likely to completely fail the initiation of the prospective memory task resulting in zero performance. The missing stress effect on prospective memory in older adults is in line with previous studies examining broader mood effects on PM and suggests the exciting possibility that increasing age may act as a resilience factor against deterioration of cognitive control in emotionally challenging situations. AUTHOR NOTES: We thank Florence Caccia, Marta Guidotti, Nikol Hiller, Nada Kojovic, Raphaëlle Martin-Casas and Clémence Voirin for assistance with data collection, Robert Miller for advice concerning the data analyses and Antje Petzold, Jana Strahler and Moritz Walser for their advice regarding study and manuscript preparation. Preparation of this manuscript was funded by a grant (KL2303/5-1) from the Deutsche Forschungsgemeinschaft (DFG) to MK and CK.

The detrimental effects of mood on prospective memory are modulated by age.

Everyday fluctuations in mood can influence our ability to remember to carry out intentions (prospective memory [PM]). Theories of mood-cognition interaction make differing predictions about the effects of positive and negative mood states on cognition that may change in aging. To test these predictions, we looked at the effects of age and induced mood on different types of PM tasks. Results showed that on a task which required constant attentional monitoring (event-based PM) young adults' performance was impaired by negative mood, whereas older adults' performance was not influenced by mood. Further analyses indicated that the deleterious effects of negative mood states in young participants were related to decreased monitoring. In another task which required more intermittent monitoring (time-based PM), older adults' performance actually improved under positive mood, whereas young adults showed no effect of mood. Contrary to predictions, these age differences were not related to improved emotion regulation in old age. We conclude that young adults are more likely than older to show PM failures caused by negative mood. Future research priorities are outlined to better understand the motivational and task characteristics which influence this phenomenon. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Redefining the pattern of age-prospective memory-paradox: new insights on age effects in lab-based, naturalistic, and self-assigned tasks.

Prospective memory (PM) involves remembering intended actions in the future, such as posting a letter when seeing a post box (event-based PM) or making a phone call at 2:00 pm (time-based PM). Studies on aging and PM have often reported negative age effects in the laboratory, but positive age effects in naturalistic tasks outside the laboratory (the so-called age-PM-paradox). The present study re-examined this pattern of the paradox by studying, for the first time, age differences in time- and event-based PM in lab-based, experimenter-generated naturalistic and self-assigned real-life PM tasks within the same sample of young and older adults. Results showed that differential age effects in and outside the laboratory were qualified by the type of PM cue. While age-related deficits were obtained for laboratory event-based tasks, no age effect was obtained for naturalistic event-based PM. Age benefits in the field were only observed for naturalistic time-based tasks, but not for participants' own self-assigned time-based tasks. These findings indicate that the age benefits for naturalistic PM tasks may have been overestimated due to the dominant use of experimenter-generated naturalistic time-based PM tasks in previous studies. Therefore, the precise pattern of the age-PM-paradox may need redefining as mostly consisting of negative age effects in lab-based PM tasks and mostly the absence of negative age effects (rather than age benefits) in naturalistic and self-assigned tasks outside the laboratory.

Prospective Memory Predictions in Aging: Increased Overconfidence in Older Adults.

INTRODUCTION: This study investigated whether young and older adults can predict their future performance on an event-based prospective memory (PM) task. METHODS: Metacognitive awareness was assessed by asking participants to give judgments-of-learning (JOLs) on an item-level for the prospective (remembering that something has to be done) and retrospective (remembering what to do) PM component. In addition, to explore possible age differences in the ability to adapt predictions to the difficulty of the task, encoding time and the relatedness between the prospective and the retrospective PM component were varied. RESULTS: Results revealed that both age groups were sensitive to our task manipulations and adapted their predictions appropriately. Moreover, item-level JOLs indicated that for the retrospective component, young and older adults were equally accurate and slightly overconfident. For the prospective component, predictions were fairly accurate in young adults, while older adults were overconfident. Thus, results suggest that general overconfidence is increased in older adults and concerns both components of PM. DISCUSSION: Findings regarding the conceptual differences between the prospective and retrospective components of a PM task, as well as the link between aging and metamemory in PM are discussed.

Examining the role of rehearsal in old-old adults' working memory.

We investigated the role of rehearsal in verbal working memory (WM) and whether WM capacity can be improved by a rehearsal instruction in very old age. In two experiments, we tested a total of 78 old-old adults (75 years and above) in one experimental session consisting of three assessment phases. First, participants worked on three different WM span tasks to assess their baseline performance. In the next phase, half of the participants received a rehearsal instruction to practice on two of the WM tasks, whereas the other half received no strategy instruction (Experiment 1) or worked on a filler task (Experiment 2). In the final phase, participants again worked on the three WM tasks. In Experiment 1, we found significant improvements for the WM tasks over time in both groups. However, we could not find a specific improvement for the rehearsal instruction due to a high spontaneous strategy use in the control group. When minimizing spontaneous strategy use in Experiment 2 by changing the task material, we found larger improvements in the instruction compared to the control group. However, we still found substantial spontaneous strategy use in the control group. The results indicate that rehearsal, as an essential component of verbal WM, is still intact and efficient in old-old adults. Furthermore, the spontaneous strategy use indicates that old-olds use their existing skills to cope with increasing WM demands. Finally, old-old adults benefited from an explicit rehearsal instruction showing potentials to boost WM capacity in this age group.

Laboratory vs. naturalistic prospective memory task predictions: young adults are overconfident outside of the laboratory.

This study investigated whether individuals can predict their future prospective memory (PM) performance in a lab-based task and in a naturalistic task. Metacognitive awareness was assessed by asking participants to give judgments-of-learning (JOLs) on an item-level for the prospective (that something has to be done) and retrospective (what to do) PM component. In addition, to explore whether giving predictions influences PM performance, we compared a control group (without predictions) to a prediction group. Results revealed that giving predictions did not change PM performance. Moreover, participants were underconfident in their PM performance in the lab-based task, while they were overconfident in the naturalistic task. In addition, item-level JOLs indicated that they were inaccurate in predicting what items they will recall or not, but only for the prospective component of the PM task. As for the retrospective component, they were equally accurate in both task settings. This study suggests a dissociation of metacognitive awareness for PM according to both task setting and processing component.

The delay period as an opportunity to think about future intentions: Effects of delay length and delay task difficulty on young adult's prospective memory performance.

The current study examined the impact of length and difficulty of the delay task on young adult's event-based prospective memory (PM). Participants engaged in either a short (2.5 min) or a long (15 min) delay that was filled with either a simple item categorization task or a difficult cognitive task. They also completed a questionnaire on whether they thought about the PM intention during the delay period and how often they thought about it. Results revealed that participants' PM was better after a difficult delay task compared to an easy delay task. Participants thought about the PM intention more often during the difficult delay task than during the easy delay task. PM performance was positively related to participants' reports of how many times they thought about their intentions. The important role of delay task difficulty in allowing or preventing individuals from refreshing their future intentions is discussed.

Time-based prospective memory in children and adolescents with 22q11.2 deletion syndrome.

OBJECTIVE: 22q11.2 deletion syndrome, also known as velo-cardio-facial syndrome (VCFS) is a genetic disorder caused by a microdeletion on chromosome 22q11.2 and characterized by marked impairment in visual attention and executive function. The present study examined if this cognitive deficit extends to prospective memory (the type of memory involved in remembering to perform actions in the future). METHOD: 20 participants with 22q11.2DS aged between 6 and 14 were included in the study as well as 22 typically developing individuals (TDC) aged 6-12. To measure prospective memory, participants were asked to play a driving game (the Dresden Cruiser). This time-based prospective memory task required children to remember to refuel their car when the fuel level was low by pressing a refuel button while driving. RESULTS AND DISCUSSION: Participants with 22q11.2DS remembered less often to refuel the car. Furthermore, participants with 22q11.2DS checked the fuel gage significantly less often than the controls. CONCLUSIONS: Participants with 22q11.2DS therefore demonstrate difficulties completing a time-based prospective memory task. This can be explained by a generally less frequent time checking behavior in comparison to TDC.

The interplay of intention maintenance and cue monitoring in younger and older adults' prospective memory.

The retention phase of a prospective memory (PM) task poses different challenges, including demands to store or maintain an intended action and to realize the right moment for action execution. The interplay of these processes in younger and older adults has not been explored so far. In this study, the authors examined the impact of maintenance load and task focality on PM in 84 younger and in 83 older adults. Results indicated that PM performance and ongoing task response times were strongly affected by maintenance load and age. However, a focality effect only emerged when maintenance load was low but not when attentional resources were deployed for maintaining a more demanding intention. These findings suggest that maintenance and monitoring requirements compete for similar attentional resources. Furthermore, maintenance load may affect postretrieval processes through its impact on working-memory resources, which can restrain the typical advantage of focal over nonfocal PM tasks.

Future thinking instructions improve prospective memory performance in adolescents.

Studies on prospective memory (PM) development in adolescents point to age-related increases through to adulthood. The goal of the present study was to examine whether instructing adolescents to engage in an episodic prospection of themselves executing future actions (i.e., future thinking) when forming an intention would improve their PM performance and reduce age-related differences. Further, we set out to explore whether future thinking instructions result in stronger memory traces and/or stronger cue-context associations by evaluating retrospective memory for the PM cues after task completion and monitoring costs during PM task processing. Adolescents and young adults were allocated to either the future thinking, repeated-encoding or standard condition. As expected, adolescents had fewer correct PM responses than young adults. Across age groups, PM performance in the standard condition was lower than in the other encoding conditions. Importantly, the results indicate a significant interaction of age by encoding condition. While adolescents benefited most from future thinking instructions, young adults performed best in the repeated-encoding condition. The results also indicate that the beneficial effects of future thinking may result from deeper intention-encoding through the simulation of future task performance.

Children's planning performance in the Zoo Map task (BADS-C): Is it driven by general cognitive ability, executive functioning, or prospection?

A minimal amount of research has examined the cognitive predictors of children's performance in naturalistic, errand-type planning tasks such as the Zoo Map task of the Behavioral Assessment of the Dysexecutive Syndrome for Children (BADS-C). Thus, the current study examined prospection (i.e., the ability to remember to carry out a future intention), executive functioning, and intelligence markers as predictors of performance in this widely used naturalistic planning task in 56 children aged 7- to 12-years-old. Measures of planning, prospection, inhibition, crystallized intelligence, and fluid intelligence were collected in an individual differences study. Regression analyses showed that prospection (rather than traditional measures of intelligence or inhibition) predicted planning, suggesting that naturalistic planning tasks such as the Zoo Map task may rely on future-oriented cognitive processes rather than executive problem solving or general knowledge.

Prospective Memory in Older Adults: Where We Are Now and What Is Next.

The interplay of cognitive abilities that constitute the process of 'remembering to remember' is referred to as prospective memory. Prospective memory is an essential ability to meet everyday life challenges across the life span, constitutes a key element of autonomy and independence and is especially important in old age with increasing social and health-related prospective memory demands. The present paper first presents major findings from the current state of the art in research on age effects in prospective memory. In a second part, it presents four focus areas for future research outlining possible conceptual, methodological, and neuroscientific advancements.

Age differences in prospective memory for everyday life intentions: A diary approach.

The age benefit found in many naturalistic prospective memory (PM) tasks has been taken as evidence that PM performance in real life may be spared from aging. However, this conclusion lacks empirical confirmation. Hence, the aim of the present study was to examine possible age differences in the content of everyday PM intentions and their performance. Everyday PM was assessed in young and older adults using a diary approach. Results confirmed a general age benefit for real-life PM tasks. Importantly, this finding was qualified by revealing that the benefit only held true for specific types of intentions such as health and social intentions. Further, moderation analyses showed that the relationships between cognitive functioning and everyday PM were different for young and older adults. While better inhibition, short-term and long-term memory were related with successful PM performance in the young, this was not the case in the older adults. The present findings suggest that the age benefit found in naturalistic experimenter-given tasks extends to real-life PM performance, but may differ depending on the type of intention. Furthermore, cognitive functioning predicts performance in the young, but not in the older adults.

Mood effects on memory and executive control in a real-life situation.

In the laboratory, studies have shown an inconsistent pattern of whether, and how, mood may affect cognitive functions indicating both mood-related enhancement as well as decline. Surprisingly, little is known about whether there are similar effects in everyday life. Hence, the present study aimed to investigate possible mood effects on memory and executive control in a real-life situation. Mood effects were examined in the context of winning in a sports competition. Sixty-one male handball players were tested with an extensive cognitive test battery (comprising memory and executive control) both after winning a match and after training as neutral baseline. Mood differed significantly between the two testing situations, while physiological arousal and motivation were comparable. Results showed lowered performance after the win compared with training in selected cognitive measures. Specifically, short-term and episodic memory performance was poorer following a win, whereas executive control performance was unaffected by condition. Differences in memory disappeared when emotional states after the match were entered as covariates into the initial analyses. Thus, findings suggest mood-related impairments in memory, but not in executive control processes after a positive real-life event.

The impact of cognitive control on children's goal monitoring in a time-based prospective memory task.

The present study investigated whether developmental changes in cognitive control may underlie improvements of time-based prospective memory. Five-, 7-, 9-, and 11-year-olds (N = 166) completed a driving simulation task (ongoing task) in which they had to refuel their vehicle at specific points in time (PM task). The availability of cognitive control resources was experimentally manipulated by imposing a secondary task that required divided attention. Children completed the driving simulation task both in a full-attention condition and a divided-attention condition where they had to carry out a secondary task. Results revealed that older children performed better than younger children on the ongoing task and PM task. Children performed worse on the ongoing and PM tasks in the divided-attention condition compared to the full-attention condition. With respect to time monitoring in the final interval prior to the PM target, divided attention interacted with age such that older children's time monitoring was more negatively affected by the secondary task compared to younger children. Results are discussed in terms of developmental shifts from reactive to proactive monitoring strategies.

The development of time-based prospective memory in childhood: the role of working memory updating.

This large-scale study examined the development of time-based prospective memory (PM) across childhood and the roles that working memory updating and time monitoring play in driving age effects in PM performance. One hundred and ninety-seven children aged 5 to 14 years completed a time-based PM task where working memory updating load was manipulated within individuals using a dual task design. Results revealed age-related increases in PM performance across childhood. Working memory updating load had a negative impact on PM performance and monitoring behavior in older children, but this effect was smaller in younger children. Moreover, the frequency as well as the pattern of time monitoring predicted children's PM performance. Our interpretation of these results is that processes involved in children's PM may show a qualitative shift over development from simple, nonstrategic monitoring behavior to more strategic monitoring based on internal temporal models that rely specifically on working memory updating resources. We discuss this interpretation with regard to possible trade-off effects in younger children as well as alternative accounts.

Mood impairs time-based prospective memory in young but not older adults: the mediating role of attentional control.

The present study examined age-by-mood interactions in prospective memory and the potential role of attentional control. Positive, negative, or neutral mood was induced in young and older adults. Subsequent time-based prospective memory performance was tested, incorporating a measure of online attentional control shifts between the ongoing and the prospective memory task via time monitoring behavior. Mood impaired prospective memory in the young, but not older, adults. Moderated mediation analyses showed that mood effects in the young were mediated by changes in time monitoring. Results are discussed in relation to findings from the broader cognitive emotional aging literature.

Prospective memory training in older adults and its relevance for successful aging.

In research on cognitive plasticity, two training approaches have been established: (1) training of strategies to improve performance in a given task (e.g., encoding strategies to improve episodic memory performance) and (2) training of basic cognitive processes (e.g., working memory, inhibition) that underlie a range of more complex cognitive tasks (e.g., planning) to improve both the training target and the complex transfer tasks. Strategy training aims to compensate or circumvent limitations in underlying processes, while process training attempts to augment or to restore these processes. Although research on both approaches has produced some promising findings, results are still heterogeneous and the impact of most training regimes for everyday life is unknown. We, therefore, discuss recent proposals of training regimes aiming to improve prospective memory (i.e., forming and realizing delayed intentions) as this type of complex cognition is highly relevant for independent living. Furthermore, prospective memory is associated with working memory and executive functions and age-related decline is widely reported. We review initial evidence suggesting that both training regimes (i.e., strategy and/or process training) can successfully be applied to improve prospective memory. Conceptual and methodological implications of the findings for research on age-related prospective memory and for training research in general are discussed.