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An apple a day: Protective associations between nutrition and the mental health of immigrants in Canada

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Scott D Emerson
Scott D Emerson
Nicole S. Carbert
Nicole S. Carbert
Nicole S. Carbert
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Abstract

Purpose Mental illness represents a major public health burden among Canada’s large immigrant population. A burgeoning cross-sectional, longitudinal, and experimental evidence base implicates nutrition in mental health. Healthier diets (e.g., those rich in certain micro-nutrients) may benefit cognitive, social, and emotional functioning through attenuated inflammation and other bio-psychological pathways. The present study examined associations between nutrition and three markers of mental health among immigrants to Canada. Methods Employing cross-sectional data from immigrant respondents (n = 37,071) to a nationally representative population-based survey (the Canadian Community Health Survey: CCHS 2011–2014), we modelled associations of daily fruit and vegetable consumption with three mental health outcomes: anxiety and/or mood disorder diagnosis, being distressed (assessed via the 6-item Kessler Psychological Distress Scale), and having good self-rated overall mental health. Multivariable logistic regression analyses were employed, adjusting for various socio-demographic and lifestyle-related variables. Results Higher consumption of fruit and vegetables demonstrated significant, protective associations with odds of having a mood and/or anxiety disorder, being distressed, and self-rated good mental health. Such patterns of association were similar regardless of ethno-cultural minority status and recency of immigration. Moreover, the protective associations of nutrition and mental health were independent of socio-demographic, health, and lifestyle factors. Conclusions Results suggested evidence of protective associations between healthy nutritional intake and mental illness among a large-scale sample of immigrants in Canada. Importantly, the protective associations of healthier diets with immigrants’ mental health were independent of various markers of healthy lifestyles (e.g., general health status, physical activity, alcohol use). Healthy dietary intake may, therefore, be worth consideration in efforts to prevent mental illness among immigrants.
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Social Psychiatry and Psychiatric Epidemiology (2019) 54:567–578
https://doi.org/10.1007/s00127-018-1616-9
ORIGINAL PAPER
An apple aday: Protective associations betweennutrition
andthemental health ofimmigrants inCanada
ScottD.Emerson1· NicoleS.Carbert1,2
Received: 26 August 2018 / Accepted: 17 October 2018 / Published online: 23 October 2018
© Springer-Verlag GmbH Germany, part of Springer Nature 2018
Abstract
Purpose Mental illness represents a major public health burden among Canada’s large immigrant population. A burgeoning
cross-sectional, longitudinal, and experimental evidence base implicates nutrition in mental health. Healthier diets (e.g.,those
rich in certain micro-nutrients) may benefit cognitive, social, and emotional functioning through attenuated inflammation and
other bio-psychological pathways. The present study examined associations between nutrition and three markers of mental
health among immigrants to Canada.
Methods Employing cross-sectional data from immigrant respondents (n = 37,071) to a nationally representative population-
based survey (the Canadian Community Health Survey: CCHS 2011–2014), we modelled associations of daily fruit and
vegetable consumption with three mental health outcomes: anxiety and/or mood disorder diagnosis, being distressed (assessed
via the 6-item Kessler Psychological Distress Scale), and having good self-rated overall mental health.Multivariable logistic
regression analyses were employed, adjusting for various socio-demographic and lifestyle-relatedvariables.
Results Higher consumption of fruit and vegetables demonstrated significant, protective associations with odds of having a
mood and/or anxiety disorder, being distressed, and self-rated good mental health. Such patterns of association were similar
regardless of ethno-cultural minority status and recency of immigration. Moreover, the protective associations of nutrition
and mental health were independent of socio-demographic, health, and lifestyle factors.
Conclusions Results suggested evidence of protective associations between healthy nutritional intake and mental illness
among a large-scale sample of immigrants in Canada. Importantly, the protective associations of healthier diets with immi-
grants’ mental health were independent of various markers of healthy lifestyles (e.g., general health status, physical activ-
ity, alcohol use). Healthy dietary intake may, therefore, be worth consideration in efforts to prevent mental illness among
immigrants.
Keywords Nutrition· Diet· Immigration· Mental health· Canada
Introduction
In recent years, around a quarter of a million individuals
have immigrated to Canada annually [1]. In 2016, immi-
grants comprised 22% of Canada’s population (over 7.5mil-
lion people) and almost 40% of youth in Canada were for-
eign-born or had at least one foreign-born parent [2]. The
majority of recent newcomers to Canada originate from
Asia; China, India, and the Philippines are the common-
est source nations [1]. Despite this subpopulation’s demo-
graphic significance, and recognition of immigration as a
determinant of health, epidemiological evidence concerning
immigrant populations in Canada (and in many major reset-
tlement nations) is overshadowed by extant evidence for the
overall/general population [3].
There is no health without mental health—mental disor-
ders account for almost one-third of years lived with disabil-
ity globally [4], and approximately one in three residents of
Canada suffer a mental illness in their lifetime [5]. Despite
some mixed findings in the literature—some of which are
partly a product of differential healthcare utilization [6] as
well as cultural attitudes/stigma concerning western medical
* Scott D. Emerson
semerson@alumni.ubc.ca
1 School ofPopulation andPublic Health, Faculty
ofMedicine, University ofBritish Columbia, Vancouver,
Canada
2 BC Children’s Hospital Research Institute, Vancouver,
Canada
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... Concurrently, other studies that assessed the connection between food insecurity, diet quality, and mental disorders (i.e., depression and anxiety) among non-African immigrants in Western countries have found a strong association between food insecurity, diet quality, and mental disorders [95,96]. For example, a comprehensive Canadian study, which analyzed the association between immigrants' FV consumption and risk for mood/ anxiety disorders and self-reported mental wellbeing found a significant inverse association between higher FV consumption and odds of having mood/ anxiety disorder and positive association with good mental health wellbeing regardless of ethnicity or years in the country [97]. ...
... Thus, more studies are needed to help understand this population's food and mental health needs and to inform the development of interventions to improve their food security, diet quality, and mental health outcome. Also, future studies in this area should be mindful of the immigration status and the vast regional differences (e.g., culture and faith) of this population and its effect on their food experience and mental health outcomes [97]. ...
Food Related Challenges and Mental Health Among U.S. African Migrants: A Narrative Review
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The United States' (US) African immigrant (AI) population is growing, yet they are underrepresented in health and nutrition research. This population experiences difficulties finding culturally appropriate foods and navigating the US food environment (FE), is highly food insecure (FI), and vulnerable to mental disorders. This review examined the current evidence for AIs' food and mental health outcomes and connections; and identified gaps in the literature and future research opportunities. A literature search was conducted using Google Scholar, PubMed, CINAHL, MEDLINE, and SCOPUS. Twenty-one studies were identified, reporting high (37-85%) FI rates, poor diet quality, and increased risk of mental disorders among participants. Challenges in the FE, lack of transportation, limited access to ethnic foods, low SES, and language barriers were associated with FI and poor diet quality. Similarly, discrimination, substance use, and immigration status were associated with depression and anxiety. However, studies examining the connection between AI's food experience and mental health are lacking. AIs are at a higher risk for FI, poor diet quality, and mental disorders. Ethnic-specific research to understand the connection between their food and mental health is needed to reduce nutrition and mental health disparities.
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... Regarding anxiety disorders, there is some, albeit inconsistent cross-sectional evidence of the link with overall and specific carbohydrate intake [9][10][11] , glycemic index/load 12 , insulin index 13 , soft drinks 14,15 , added sugars 16 , whole grains and fruit intake [17][18][19][20][21][22][23][24] . A scoping review of the relationship between diet and prevalence or severity of anxiety concluded that increased intake of sugar and refined carbohydrates was positively associated, while fruit intake was inversely associated with anxiety 25 . ...
... A prospective study with pre-hypertensive or pre-diabetic Buddhist temple members reported a non-significant association between fruit intake and general anxiety 28 . Limitations of the existing epidemiological studies pertain to cross-sectional models preventing any inference of causality [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] , prospective studies using small or homogeneous samples (e.g., young adults) [26][27][28][29] , and modelling of non-specific mental health outcomes (e.g., general well-being) 30 . Furthermore, no prospective studies on the diet-anxiety link appear to have used Spielberger's State-Trait Anxiety Inventory (STAI)-one of the most common anxiety measures 31 -in large heterogeneous samples 26,32,33 . ...
Associations of overall and specific carbohydrate intake with anxiety status evolution in the prospective NutriNet-Santé population-based cohort
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We investigated the association between carbohydrate intake and anxiety evolution within the general-population NutriNet-Santé cohort (N = 15,602; 73.8% female; mean age = 53.8y; mean follow-up = 5.4y). Carbohydrate intake was estimated at baseline from ≥ 2 24-h dietary records. Trait anxiety (STAI-T) was measured once at baseline (2013–2016) and once at follow-up (2020), resulting in 4 groups: “None” = absence of high anxiety (STAI-T > 40 points) at any time point; “Transient” = high anxiety only at baseline; “Onset at follow-up” = high anxiety only at follow-up; “Persistent” = high anxiety at baseline and follow-up. Polytomous logistic regression models revealed that sweetened beverage intake was associated with higher odds of “Transient” anxiety (OR Q4vsQ1 = 1.11; 95% CI 1.02–1.21). Intake of complex carbohydrates (OR Q4vsQ1 = 1.12; 1.01–1.25) was associated with higher odds of anxiety “Onset at follow-up.” The % energy from carbohydrates (OR Q4vsQ1 = 1.11; 1.03–1.19), intakes of total carbohydrates (OR Q4vsQ1 = 1.10; 1.03–1.18) and complex carbohydrates (OR Q4vsQ1 = 1.09; 1.02–1.17) were associated with higher odds of “Persistent” anxiety, whereas 100% fruit juice intake showed lower odds of “Persistent” anxiety (OR Q4vsQ1 = 0.87; 0.81–0.94). This prospective study found significant associations between dietary carbohydrate intake and anxiety status evolution among French adults. The findings could help inform dietary interventions aimed at anxiety prevention and management.
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... Numerous research that looked at various groups depending on origin, age, and gender found that high dietary adherence had an important protective impact against depression and depression symptoms (Adjibade et al. 2018;Akbaraly et al. 2013;Collin et al. 2016;Emerson and Carbert 2019;Huddy et al. 2016;Jacka et al. 2017;Ruusunen et al. 2014). In Australia, high dietary adherence was linked to a considerably lower chance of first-time moms experiencing depression symptoms (Huddy et al. 2016). ...
Toward Better Science-Based Advice on Nutrition
Chapter
  • Jun 2024
Does our diet have an impact on how we feel mentally? A growing amount of evidence indicates that nutrition and dietary requirements are essential for body composition and human physiological development, which also significantly influences attitude and mental wellness. A bad diet is significantly linked to mood conditions escalation, for example, depression and anxiety, like other neurological diseases, regardless of the factors influencing psychological wellness are complex. There are widespread assumptions concerning the health risks of specific meals that are not backed by trustworthy data. Additionally, there is currently a lack of strong scientific data linking nutrition to mental health. The most recent epidemiological evidence linking diet to mental health does. There is currently no knowledge of causality or underlying processes in the epidemiological data on nutrition and mental health. The goal of future research should be to clarify mechanisms. Researchers explore the empirical data demonstrating the significant benefits of a whole diet for mental health and present an introduction to the developing subject of nutritional psychiatry. This book chapter provides a mechanistic understanding of the subject, an experimental medicine approach, and data required to support future dietary and nutritional policies for mental well-being.
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... In the past 30 years, China's economy has risen at an unprecedented rate, bringing about dramatic sociodemographic change and growing psychological pressure. People are confronting with various challenges such as prolonged life expectancy, lack of parental care in the left-behind children, poor nutritional quality at earlier age, studying or working under excessive pressure, and substance use, leading to a large number of mood, cognitive, and behavioral disorders in China [6]. The limited social and health care resources allocated to mental health are grossly inadequate with the urgent need to revamp the mental health services in low-income and middle-income countries (LMICs), particularly in China [7]. ...
Burden and trends of mental disorders in China from 1990 to 2019: findings from the Global Burden of Disease Study 2019
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Full-text available
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  • SOC PSYCH PSYCH EPID
Purpose Mental disorders remain the leading causes of disability worldwide. We aimed to determine the burden and trends of mental disorders in China from 1990 to 2019. Methods The incidence, prevalence, and disability-adjusted life years (DALYs) of mental disorders at national level of China were examined by age, sex, and subcategories. Temporal trends in the age-standardized rates for incidence, prevalence, and DALYs were assessed by the average annual percentage change (AAPC). All estimates are presented as numbers and age-standardized rates, with 95% uncertainty intervals (UIs). Results The number of incident cases due to mental disorders increased from 42.90 million to 52.72 million, the number of prevalent cases increased from 132.63 million to 160.16 million, and the number of DALYs increased from 15.64 million to 20.29 million during 1990–2019. Decreasing trends were observed in the age-standardized rates for incidence, prevalence and DALYs. Anxiety and depressive disorders were more frequent in women, while ADHD, conduct disorder, and autism spectrum disorders were more common in men. Compared with 1990, the age-specific incidence rates were higher in individuals under 14 years and over 55 years, whereas rates were lower in those aged 15–49 years in 2019. Conclusion The number of incident cases, prevalent cases, and DALYs due to mental disorders gradually increased in China from 1990 to 2019. Anxiety and depressive disorders were the leading causes of burden due to mental disorders, which affected women more than men. Mental disorders deserve greater attention in health policy decision making.
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... In adults, a longitudinal study showed that low diet quality was associated with higher risk of depressive symptoms and the higher adherence of traditional diet was associated with a lower risk of depressive symptoms [25], while the SUN cohort showed that high fast-food and commercial baked foods intake [26], higher consumption of added sugars and lower quality carbohydrate rich foods consumption [27] were associated with higher depression risk. Conversely, higher fruit, vegetable and nut consumption has been positively associated with better mental health status [28,29]. Adherence to the Mediterranean Diet (MD) has been positively associated with better mental health status [30,31], while MD supplemented with nuts resulted in lower depression risk in the PREDIMED study [32]. ...
Diet Quality Impacts Mental Health Aspects of University Students
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Introduction: Mental health problems, especially depression and anxiety, among university students are widespread, and begin pre-matriculation. Diet is among the factors contributing to mental health in all age groups. Aim: The present review aims to critically summarize the observational studies and clinical trials that have investigated the association between mental health and diet quality in university student populations. Methods: PubMed was comprehensively searched to identify studies that explore the role of aspects of diet quality on quality of life, depression, and anxiety in university students. Results: Healthy dietary patterns, such as the Mediterranean and the DASH diet, diets with high intakes of antioxidants and antioxidant vitamins, folate, Zinc and Calcium are associated with less depressive symptoms. Higher alcohol and salt intake have also been associated with depression. Conclusion: Healthy dietary patterns, with adequate micronutrient and antioxidant intakes are associated with better mental health status. However, further randomised controlled clinical studies are needed in order to clarify the cause and the effect of the observed associations.
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UNFAVORABLE VISA STATUS AND INTERSECTING ACCULTURATION FACTORS LINKED TO DEPRESSIONDEZAVANTAJLI VİZE GRUPLARI, DEPRESYON VE KÜLTÜRLEŞME ARASINDAKİ İLİŞKİ
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  • Feb 2024
Aims: This study proposes that visa status and acculturation are important constructs for understanding depression among immigrants. Method: The association between visa status and acculturation with depression status among immigrants residing in the United States was examined. Visa status was operationalized as favorable and unfavorable. Acculturation was measured as English language proficiency and diet change. Depression was assessed as the presence of depressive symptoms or symptoms suppressed by antidepressants. Results: Results showed that immigrants with unfavorable visa statuses have higher levels of depression compared to favorable visa status holders. Also, English language proficiency was associated with higher levels of depression among unfavorable visa holders compared to favorable visa status holders. Lower dietary acculturation was associated with a higher level of depression among unlimited family, refugee, diversity, and other visa holders. Conclusions: Different visa categories appeared to have unique patterns of association with depression depending on their acculturation level and type.
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Anxiety and depression during the COVID-19 pandemic: role of the gut–brain axis
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  • Dec 2023
The COVID-19 pandemic had a profoundly negative impact on the general public's mental health. The crucial role of diet and nutrition in various aspects of mental wellbeing is now widely recognised. People in confinement or isolation may experience heightened tension, anger, panic attacks and anxiety. Psychosocial pressures, including interpersonal loss and social rejection, cause changes in mind–body interactions. An individual's physical health influences their physiological reaction (in terms of psychological stress) in COVID-19-afflicted patients. There is a growing body of research on the phenomenon termed the microbiome and the brain. According to preclinical data, this axis is essential for controlling both brain activity and behaviour. Given the strong connection between our dietary choices and our mental state, this review explores the relationship between diet and mental health. It also considers how food and the use of psychobiotics can alleviate psychological distress caused by stress, anxiety and depression, as a result of the COVID-19 pandemic.
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The relationship between diet/nutrition and the mental health of immigrants in Western societies through a holistic bio-psycho-socio-cultural lens: A scoping review
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  • Jan 2023
  • APPETITE
Epidemiological evidence suggests that diet and nutrition not only impact individuals' physical health but also shape their mental health (MH). The nutrition/diet-MH relationship may be critical among immigrants due to socioeconomic and sociocultural factors. Despite the complex nutrition/diet-MH relationship, most scholarship in this area employs a biomedical perspective. This scoping review of 63 studies deployed a holistic bio-psycho-socio-cultural framework to examine the relationship between diet/nutrition and immigrants' MH. Five automated databases (Embase, PubMed, Medline, PsycINFO and Anthropology Plus) were systematically searched for relevant articles from Western countries. A bio-psycho-socio-cultural conceptual model guided the analysis of the multi-faceted diet/nutrition-MH relationship. Consumption of fruit/vegetables, unsaturated fats, vitamin D-rich foods and whole grains was significantly positively related to MH. Reported pathways included enhanced self-esteem and ability to stay physically active. Energy-dense food consumption emanating from unhealthful dietary acculturation to the Western lifestyle was associated with poor MH through various mechanisms, including exhaustion and worry about developing non-communicable diseases. Food insecurity and related hunger were significantly positively associated with depression and anxiety among immigrants through different pathways, including family conflicts, homesickness, social exclusion, feelings of shame/stigma, and helplessness related to not affording nutritious foods that meet one's cultural dietary requirements. Ethnic food consumption appeared to mitigate MH issues and enhance immigrants' well-being. A bio-psycho-socio-cultural-informed model is needed to gain an in-depth and encompassing understanding of immigrant MH as it relates to diet/nutrition. The first iteration of such a model is presented in this review alongside an illustration of how it may be used to strengthen an analysis and understanding of the multi-faceted diet/nutrition-MH relationship amongst immigrants and inform public health professionals and dieticians/practitioners.
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A Mediterranean-style dietary intervention supplemented with fish oil improves diet quality and mental health in people with depression: A randomized controlled trial (HELFIMED)
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Full-text available
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Objectives: We investigated whether a Mediterranean-style diet (MedDiet) supplemented with fish oil can improve mental health in adults suffering depression. Methods: Adults with self-reported depression were randomized to receive fortnightly food hampers and MedDiet cooking workshops for 3 months and fish oil supplements for 6 months, or attend social groups fortnightly for 3 months. Assessments at baseline, 3 and 6 months included mental health, quality of life (QoL) and dietary questionnaires, and blood samples for erythrocyte fatty acid analysis. Results: n = 152 eligible adults aged 18–65 were recruited (n = 95 completed 3-month and n = 85 completed 6-month assessments). At 3 months, the MedDiet group had a higher MedDiet score (t = 3.95, P < 0.01), consumed more vegetables (t = 3.95, P < 0.01), fruit (t = 2.10, P = 0.04), nuts (t = 2.29, P = 0.02), legumes (t = 2.41, P = 0.02) wholegrains (t = 2.63, P = 0.01), and vegetable diversity (t = 3.27, P < 0.01); less unhealthy snacks (t = −2.10, P = 0.04) and red meat/chicken (t = −2.13, P = 0.04). The MedDiet group had greater reduction in depression (t = −2.24, P = 0.03) and improved mental health QoL scores (t = 2.10, P = 0.04) at 3 months. Improved diet and mental health were sustained at 6 months. Reduced depression was correlated with an increased MedDiet score (r = −0.298, P = 0.01), nuts (r = −0.264, P = 0.01), and vegetable diversity (r = −0.303, P = 0.01). Other mental health improvements had similar correlations, most notably for increased vegetable diversity and legumes. There were some correlations between increased omega-3, decreased omega-6 and improved mental health. Discussion: This is one of the first randomized controlled trials to show that healthy dietary changes are achievable and, supplemented with fish oil, can improve mental health in people with depression.
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Abstract Background The possible therapeutic impact of dietary changes on existing mental illness is largely unknown. Using a randomised controlled trial design, we aimed to investigate the efficacy of a dietary improvement program for the treatment of major depressive episodes. Methods ‘SMILES’ was a 12-week, parallel-group, single blind, randomised controlled trial of an adjunctive dietary intervention in the treatment of moderate to severe depression. The intervention consisted of seven individual nutritional consulting sessions delivered by a clinical dietician. The control condition comprised a social support protocol to the same visit schedule and length. Depression symptomatology was the primary endpoint, assessed using the Montgomery–Åsberg Depression Rating Scale (MADRS) at 12 weeks. Secondary outcomes included remission and change of symptoms, mood and anxiety. Analyses utilised a likelihood-based mixed-effects model repeated measures (MMRM) approach. The robustness of estimates was investigated through sensitivity analyses. Results We assessed 166 individuals for eligibility, of whom 67 were enrolled (diet intervention, n = 33; control, n = 34). Of these, 55 were utilising some form of therapy: 21 were using psychotherapy and pharmacotherapy combined; 9 were using exclusively psychotherapy; and 25 were using only pharmacotherapy. There were 31 in the diet support group and 25 in the social support control group who had complete data at 12 weeks. The dietary support group demonstrated significantly greater improvement between baseline and 12 weeks on the MADRS than the social support control group, t(60.7) = 4.38, p
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Much international research has examined the various ways in which immigrants engage both their new society and their heritage culture, and the relationship between these ways of engagement and their wellbeing. The present study examines these ways of engagement and this relationship in a representative sample of 7,000 immigrants to Canada. Immigrants’ sense of belonging to their source country and to Canada was used to assess their 2 cultural engagements; life satisfaction and self-rated mental health were used to assess their wellbeing. The study created 4 acculturation strategies from the 2 sense of belonging measures: high sense of belonging to both their source country and to Canada (integration), high for Canada and low for source country (assimilation), low for Canada and high for source country (separation), and low for both (marginalisation). We found that those using the integration and assimilation strategies had the highest scores of life satisfaction (but they did not differ from each other), while separation and marginalisation had significantly lower scores. For mental health, integration and separation had the highest scores (but did not differ from each other), while assimilation and marginalisation had significantly lower scores. We also found that the immigrant sample had significantly higher scores of life satisfaction and mental health than the nonimmigrants sample. In addition to the relationship with acculturation strategies, we examined some demographic and social predictors of life satisfaction and mental health. Some implications for settlement policy and practice and for service to immigrants are discussed.
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Recent research has provided strong evidence for the role of the commensal gut microbiota in brain function and behaviour. Many potential pathways are involved in this bidirectional communication between the gut microbiota and the brain such as immune mechanisms, the vagus nerve and microbial neurometabolite production. Dysbiosis of gut microbial function has been associated with behavioural and neurophysical deficits, therefore research focused on developing novel therapeutic strategies to treat psychiatric disorders by targeting the gut microbiota is rapidly growing. Numerous factors can influence the gut microbiota composition such as health status, mode of birth delivery and genetics, but diet is considered among the most crucial factors impacting on the human gut microbiota from infancy to old age. Thus, dietary interventions may have the potential to modulate psychiatric symptoms associated with gut-brain axis dysfunction. Further clinical and in vivo studies are needed to better understand the mechanisms underlying the link between nutrition, gut microbiota and control of behaviour and mental health.
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Objective: The purpose of this study was to investigate the clinical effect and safety of a broad spectrum, 36 ingredient micronutrient (vitamins and minerals) in treating children with attention-deficit/hyperactivity disorder (ADHD). Methods: This open-label, on-off-on-off (reversal design) study followed 14 participants (8-12 years of age) with ADHD, diagnosed using standardized instruments, for 6 months with no dropouts. Following baseline assessment, including hematology and biochemistry screening, participants began an 8 week treatment phase with micronutrients titrated up to maximum dose (15 capsules/day). Treatment was withdrawn for 4 weeks, reinstated for a further 8 weeks, and then withdrawn for 4 weeks. Primary outcomes included the Conners' Parent Rating Scale, the Clinical Global Impressions Scale (CGI), and the Strengths and Difficulties Questionnaire - Parent version (SDQ). Secondary outcomes were mood and global functioning. Results: Modified Brinley plots revealed a reduction in ADHD symptoms, improved mood, and improved overall functioning during intervention phases, and deterioration in ADHD symptoms, mood, and overall functioning during the withdrawal phases. Reliable change analyses, Cohen's d and percent superiority effect sizes, 95% confidence intervals and t tests confirmed clinically and statistically significant change between the intervention and withdrawal phases, with large effect sizes observed pre- to post-exposure of micronutrients (d = 1.2-2.2) on ADHD symptoms during intervention phases. Seventy-one percent of participants showed at least a 30% decrease in ADHD symptoms by the end of the second treatment phase, and 79% were identified as "much improved" or "very much improved" at the end of the second phase (5 months) based on the clinician-rated CGI when considering functioning generally. The SDQ showed that these benefits occurred across other areas of functioning including emotional symptoms, conduct problems, and prosocial behaviours. The children's self-reports confirmed the improvements. Excellent adherence to treatment occurred throughout, side effects were mild and transitory, and no safety issues were identified through blood analyses. Conclusions: This study demonstrates the clinical benefit, feasibility, and safety of broad-spectrum micronutrients in the treatment of childhood ADHD. Replications utilizing double-blind placebo-controlled studies are warranted. Trial is registered with the Australia and New Zealand Clinical Trial Registry: ACTRN12612000645853.
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Association between physical exercise and mental health in 1·2 million individuals in the USA between 2011 and 2015: a cross-sectional study
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Background: Exercise is known to be associated with reduced risk of all-cause mortality, cardiovascular disease, stroke, and diabetes, but its association with mental health remains unclear. We aimed to examine the association between exercise and mental health burden in a large sample, and to better understand the influence of exercise type, frequency, duration, and intensity. Methods: In this cross-sectional study, we analysed data from 1 237 194 people aged 18 years or older in the USA from the 2011, 2013, and 2015 Centers for Disease Control and Prevention Behavioral Risk Factors Surveillance System survey. We compared the number of days of bad self-reported mental health between individuals who exercised and those who did not, using an exact non-parametric matching procedure to balance the two groups in terms of age, race, gender, marital status, income, education level, body-mass index category, self-reported physical health, and previous diagnosis of depression. We examined the effects of exercise type, duration, frequency, and intensity using regression methods adjusted for potential confounders, and did multiple sensitivity analyses. Findings: Individuals who exercised had 1·49 (43·2%) fewer days of poor mental health in the past month than individuals who did not exercise but were otherwise matched for several physical and sociodemographic characteristics (W=7·42 × 1010, p<2·2 × 10-16). All exercise types were associated with a lower mental health burden (minimum reduction of 11·8% and maximum reduction of 22·3%) than not exercising (p<2·2 × 10-16 for all exercise types). The largest associations were seen for popular team sports (22·3% lower), cycling (21·6% lower), and aerobic and gym activities (20·1% lower), as well as durations of 45 min and frequencies of three to five times per week. Interpretation: In a large US sample, physical exercise was significantly and meaningfully associated with self-reported mental health burden in the past month. More exercise was not always better. Differences as a function of exercise were large relative to other demographic variables such as education and income. Specific types, durations, and frequencies of exercise might be more effective clinical targets than others for reducing mental health burden, and merit interventional study. Funding: Cloud computing resources were provided by Microsoft.
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Ethnic Differences in Mental Health Status and Service Utilization: A Population-Based Study in Ontario, Canada
Article
  • Mar 2018
Background: The purpose of this study was to compare the prevalence of self-reported mental health factors, mental health service use, and unmet needs across the 4 largest ethnic groups in Ontario, Canada: white, South Asian, Chinese, and black groups. Methods: The study population was derived from the Canadian Community Health Survey, using a cross-sectional sample of 254,951 white, South Asian, Chinese, and black residents living in Ontario, Canada, between 2001 and 2014. Age- and sex-standardized prevalence estimates for mental health factors, mental health service use, and unmet needs were calculated for each of the 4 ethnic groups overall and by sociodemographic characteristics. Results: We found that self-reported physician-diagnosed mood and anxiety disorders and mental health service use were generally lower among South Asian, Chinese, and black respondents compared to white respondents. Chinese individuals reported the weakest sense of belonging to their local community and the poorest self-rated mental health and were nearly as likely to report suicidal thoughts in the past year as white respondents. Among those self-reporting fair or poor mental health, less than half sought help from a mental health professional, ranging from only 19.8% in the Chinese group to 50.8% in the white group. Conclusions: The prevalence of mental health factors and mental health service use varied widely across ethnic groups. Efforts are needed to better understand and address cultural and system-level barriers surrounding high unmet needs and to identify ethnically tailored and culturally appropriate clinical supports and practices to ensure equitable and timely mental health care.
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Dietary patterns and depression risk: A meta-analysis
Article
  • Apr 2017
Although some studies have reported potential associations of dietary patterns with depression risk, a consistent perspective hasn’t been estimated to date. Therefore, we conducted this meta-analysis to evaluate the relation between dietary patterns and the risk of depression. A literature research was conducted searching MEDLINE and EMBASE databases up to September 2016. In total, 21 studies from ten countries met the inclusion criteria and were included in the present meta-analysis. A dietary pattern characterized by a high intakes of fruit, vegetables, whole grain, fish, olive oil, low-fat dairy and antioxidants and low intakes of animal foods was apparently associated with a decreased risk of depression.A dietary pattern characterized by a high consumption of red and/or processed meat, refined grains, sweets, high-fat dairy products, butter, potatoes and high-fat gravy, and low intakes of fruits and vegetables is associated with an increased risk of depression. The results of this meta-analysis suggest that healthy pattern may decrease the risk of depression, whereas western-style may increase the risk of depression. However, more randomized controlled trails and cohort studies are urgently required to confirm this findings.
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The effects of vitamin and mineral supplementation on symptoms of schizophrenia: a systematic review and meta-analysis
Article
  • Feb 2017
  • PSYCHOL MED
When used as an adjunctive with antipsychotics, certain vitamins and minerals may be effective for improving symptomatic outcomes of schizophrenia, by restoring nutritional deficits, reducing oxidative stress, or modulating neurological pathways. We conducted a systematic review of all randomized controlled trials (RCTs) reporting effects of vitamin and/or mineral supplements on psychiatric symptoms in people with schizophrenia. Random-effects meta-analyses were used to calculate the standardized mean difference between nutrient and placebo treatments. An electronic database search in July 2016 identified 18 eligible RCTs, with outcome data for 832 patients. Pooled effects showed that vitamin B supplementation (including B6, B8 and B12) reduced psychiatric symptoms significantly more than control conditions [g = 0.508, 95% confidence interval (CI) 0.01–1.01, p = 0.047, I2 = 72.3%]. Similar effects were observed among vitamin B RCTs which used intention-to-treat analyses (g = 0.734, 95% CI 0.00–1.49, p = 0.051). However, no effects of B vitamins were observed in individual domains of positive and negative symptoms (both p > 0.1). Meta-regression analyses showed that shorter illness duration was associated with greater vitamin B effectiveness (p = 0.001). There were no overall effects from antioxidant vitamins, inositol or dietary minerals on psychiatric symptoms. There is preliminary evidence that certain vitamin and mineral supplements may reduce psychiatric symptoms in some people with schizophrenia. Further research is needed to examine how the benefits of supplementation relate to nutrient deficits and the impact upon underlying neurobiological pathways, in order to establish optimal nutrient formulations for improving clinical outcomes in this population. Future studies should also explore the effects of combining beneficial nutrients within multi-nutrient formulas.
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Estimating the true global burden of mental illness
Article
  • Feb 2016
We argue that the global burden of mental illness is underestimated and examine the reasons for under-estimation to identify five main causes: overlap between psychiatric and neurological disorders; the grouping of suicide and self-harm as a separate category; conflation of all chronic pain syndromes with musculoskeletal disorders; exclusion of personality disorders from disease burden calculations; and inadequate consideration of the contribution of severe mental illness to mortality from associated causes. Using published data, we estimate the disease burden for mental illness to show that the global burden of mental illness accounts for 32·4% of years lived with disability (YLDs) and 13·0% of disability-adjusted life-years (DALYs), instead of the earlier estimates suggesting 21·2% of YLDs and 7·1% of DALYs. Currently used approaches underestimate the burden of mental illness by more than a third. Our estimates place mental illness a distant first in global burden of disease in terms of YLDs, and level with cardiovascular and circulatory diseases in terms of DALYs. The unacceptable apathy of governments and funders of global health must be overcome to mitigate the human, social, and economic costs of mental illness.
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