Amidst strong efforts to promote the therapeutic benefits of physical activity for reducing depression and anxiety in clinical populations, little focus has been directed towards the mental health benefits of activity for non-clinical populations. The objective of this meta-meta-analysis was to systematically aggregate and quantify high-quality meta-analytic findings of the effects of physical activity on depression and anxiety for non-clinical populations. A systematic search identified eight meta-analytic outcomes of randomised trials that investigated the effects of physical activity on depression or anxiety. The subsequent meta-meta-analyses were based on a total of 92 studies with 4310 participants for the effect of physical activity on depression and 306 study effects with 10,755 participants for the effect of physical activity on anxiety. Physical activity reduced depression by a medium effect [standardised mean difference (SMD) = -0.50; 95% CI: -0.93 to -0.06] and anxiety by a small effect (SMD = -0.38; 95% CI: -0.66 to -0.11). Neither effect showed significant heterogeneity across meta-analyses. These findings represent a comprehensive body of high-quality evidence that physical activity reduces depression and anxiety in non-clinical populations.

A meta-meta-analysis of the effect of physical activity on depression and anxiety in non-clinical adult populations

Depression is the most common psychiatric disorder worldwide. The burden of disease for depression goes beyond functioning and quality of life and extends to somatic health. Depression has been shown to subsequently increase the risk of, for example, cardiovascular, stroke, diabetes and obesity morbidity. These somatic consequences could partly be due to metabolic, immuno-inflammatory, autonomic and hypothalamic-pituitary-adrenal (HPA)-axis dysregulations which have been suggested to be more often present among depressed patients. Evidence linking depression to metabolic syndrome abnormalities indicates that depression is especially associated with its obesity-related components (for example, abdominal obesity and dyslipidemia). In addition, systemic inflammation and hyperactivity of the HPA-axis have been consistently observed among depressed patients. Slightly less consistent observations are for autonomic dysregulation among depressed patients. The heterogeneity of the depression concept seems to play a differentiating role: metabolic syndrome and inflammation up-regulations appear more specific to the atypical depression subtype, whereas hypercortisolemia appears more specific for melancholic depression. This review finishes with potential treatment implications for the downward spiral in which different depressive symptom profiles and biological dysregulations may impact on each other and interact with somatic health decline.

/pdf/understanding-the-somatic-consequences-of-depression-alsbq5o4qn.pdf

Understanding the somatic consequences of depression: biological mechanisms and the role of depression symptom profile

https://onlinelibrary.wiley.com/doi/pdf/10.1002/wps.20384

Excess mortality in persons with severe mental disorders: a multilevel intervention framework and priorities for clinical practice, policy and research agendas

Objective: Several hundred studies have shown that depression is associated with an elevated risk of dying at follow-up. It is not clear, however, whether the mechanisms for this association are disease specific, leading to higher mortality in specific patient groups, or generic, resulting in comparable mortality rates in all patient groups as well as in community samples. The authors conducted a comprehensive meta-analysis of prospective studies of community as well as patient samples associating depression at baseline with excess mortality at follow-up.

/pdf/comprehensive-meta-analysis-of-excess-mortality-in-1t15dsj6wv.pdf

Comprehensive meta-analysis of excess mortality in depression in the general community versus patients with specific illnesses.

How depression and mortality are associated in older community-dwelling populations has yet to be discovered. This study established the role of both major and minor depression in mortality and assessed the function of confounding and explanatory variables in the relationship. A cohort of 3056 Dutch men and women aged 55 to 85 years were followed for 4 years. DSM-III criteria were used to define major depression according to the Diagnostic Interview Schedule. Minor depression was defined as clinically relevant (a Center for Epidemiologie Studies Depression score of ≥ 16) without fulfilling diagnostic criteria for major depression. After accounting for sociodemographic and health status confounders, men with major depression had a risk of death that was 1.80 times higher (95% CI, 1.35 to 2.39) than that in nondepressed men during follow-up. The risk of mortality was not significantly increased in women with minor depression. Gender did not affect the higher association of major depression with mortality risk (95% CI, 1.09 to 3.10) when sociodemographics and health status had been adjusted for. The extra risk of mortality associated with depression was accounted for only in small part by health behviors such as smoking and physical inactivity. Minor depression in older men and major depression in both older men and women increase the risk of dying even after sociodemographics, health status, and health behaviors have been taken into account.

Minor and major depression and the risk of death in older persons

Background Although the association between depression and excess mortality has been well established, it is not clear whether this is greater in major depression than in subthreshold depression. Aims To compare excess mortality in major depression with that in subthreshold depression. Method We searched bibliographic databases and included prospective studies in which both major and subthreshold depression were examined at baseline and mortality was measured at follow-up. Results A total of 22 studies were included. People with major depression had a somewhat increased chance of dying earlier than people with subthreshold depression but this difference was not significant, although there was a trend (relative risk 1.13, 95% CI 0.98-1.30, P=0.1). The population attributable fraction was 7% for major depression and an additional 7% for subthreshold depression. Conclusions Although excess mortality may be somewhat higher in major than in subthreshold depression, the difference is small and the overall impact on excess mortality is comparable.

/pdf/differential-mortality-rates-in-major-and-subthreshold-1839vmvnfe.pdf

Differential mortality rates in major and subthreshold depression: meta-analysis of studies that measured both

The notion that cognitive bias modification should be appraised exclusively on the basis of trials where its postulated mechanisms were successfully changed starkly contradicts the standards of evidence-based psychotherapy. In the laboratory or as a treatment, cognitive bias modification cannot continue to eschew the rigorous scrutiny applied to other interventions.

/pdf/invited-commentary-on-confusing-procedures-with-process-in-frnqvdd7y0.pdf

Invited commentary on … Confusing procedures with process in cognitive bias modification research†

The Efficacy of Cognitive Bias Modification Interventions for Mental Health Problems: a Meta-analysis

Background: Information about the economic costs of social phobia is scant. In this study, we examine the economic costs of social phobia and subthreshold social phobia. Methods: Data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS) which is a populationbased prospective study (n=4,789). Costs related to health service uptake, patients' out-of-pocket expenses, and costs arising from production losses were calculated for the reference year 2003. The costs for people with social phobia were compared with the costs for people with no mental disorder. Results: The annual per capita total costs of social phobia were € 11,952 (95% CI=7,891-16,013) which is significantly higher than the total costs for people with no mental disorder, € 2957 (95% CI=2690–3224). When adjusting for mental and somatic comorbidity, the costs decreased to € 6,100 (95% CI=2681–9519), or 136 million euro per year per 1 million inhabitants, which was still significantly higher than the costs for people with no mental disorder. The costs of subthreshold social phobia were also significantly higher than the costs for people without any mental disorder, at € 4,687 (95% CI=2557–6816). Limitations: The costs presented here are conservative lower estimates because we only included costs related to mental health services. Conclusions: The economic costs associated with social phobia are substantial, and those of subthreshold social phobia approach those of the full-blown disorder. © 2008 Elsevier B.V. All rights reserved.

Research report Economic costs of social phobia: A population-based study

Psychotherapies vs. pharmacotherapies vs. combination therapies in depressive and anxiety disorders

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