Perseverance for Goals Can Help Fight Mental Health Problems, 18-Year Study Finds

Good new research on treating mental health problems without the use of drugs is out.

People who don’t give up on their goals (or who get better over time at not giving up on their goals) and who have a positive outlook appear to have less anxiety and depression and fewer panic attacks, according to a study of thousands of Americans over the course of 18 years. Surprisingly, a sense of control did not have an effect on the mental health of participants across time.

The study was published by the American Psychological Association in the Journal of Abnormal Psychology.

“Perseverance cultivates a sense of purposefulness that can create resilience against or decrease current levels of major depressive disorder, generalized anxiety disorder and panic disorder,” said Nur Hani Zainal, MS, from The Pennsylvania State University and lead author of the study. “Looking on the bright side of unfortunate events has the same effect because people feel that life is meaningful, understandable and manageable.”

Depression, anxiety and panic disorders are common mental health disorders that can be chronic and debilitating and put a person’s physical health and livelihood at risk, according to Zainal and her co-author, Michelle G. Newman, PhD, also of The Pennsylvania State University.

“Often, people with these disorders are stuck in a cycle of negative thought patterns and behaviors that can make them feel worse,” said Newman. “We wanted to understand what specific coping strategies would be helpful in reducing rates of depression, anxiety and panic attacks.”

Zainal and Newman used data from 3,294 adults who were studied over 18 years. The average age of participants was 45, nearly all were white and slightly fewer than half were college-educated. Data were collected three times, in 1995 to 1996, 2004 to 2005 and 2012 to 2013. At each interval, participants were asked to rate their goal persistence (e.g., “When I encounter problems, I don’t give up until I solve them”), self-mastery (e.g., “I can do just anything I really set my mind to”) and positive reappraisal (e.g., “I can find something positive, even in the worst situations”). Diagnoses for major depressive, anxiety and panic disorders were also collected at each interval.

People who showed more goal persistence and optimism during the first assessment in the mid-1990s had greater reductions in depression, anxiety and panic disorders across the 18 years, according to the authors.

And throughout those years, people who began with fewer mental health problems showed more increased perseverance toward life goals and were better at focusing on the positive side of unfortunate events, said Zainal.

“Our findings suggest that people can improve their mental health by raising or maintaining high levels of tenacity, resilience and optimism,” she said. “Aspiring toward personal and career goals can make people feel like their lives have meaning. On the other hand, disengaging from striving toward those aims or having a cynical attitude can have high mental health costs.”

Unlike in previous research, Zainal and Newman did not find that self-mastery, or feeling in control of one’s fate, had an effect on the mental health of participants across the 18-year period.

“This could have been because the participants, on average, did not show any changes in their use of self-mastery over time,” said Newman. “It is possible that self-mastery is a relatively stable part of a person’s character that does not easily change.”

The authors believe their findings will be beneficial for psychotherapists working with clients dealing with depression, anxiety and panic disorders.

“Clinicians can help their clients understand the vicious cycle caused by giving up on professional and personal aspirations. Giving up may offer temporary emotional relief but can increase the risk of setbacks as regret and disappointment set in,” said Zainal. “Boosting a patient’s optimism and resilience by committing to specific courses of actions to make dreams come to full fruition despite obstacles can generate more positive moods and a sense of purpose.”

Mental Health Disorders Have Increased Significantly Among Teens and Young Adults

Mental health issues are one of the defining problems of this era.

The percentage of young Americans experiencing certain types of mental health disorders has risen significantly over the past decade, with no corresponding increase in older adults, according to research published by the American Psychological Association.

“More U.S. adolescents and young adults in the late 2010s, versus the mid-2000s, experienced serious psychological distress, major depression or suicidal thoughts, and more attempted suicide,” said lead author Jean Twenge, PhD, author of the book “iGen” and professor of psychology at San Diego State University. “These trends are weak or non-existent among adults 26 years and over, suggesting a generational shift in mood disorders instead of an overall increase across all ages.”

The research was published in the Journal of Abnormal Psychology.

Twenge and her co-authors analyzed data from the National Survey on Drug Use and Health, a nationally representative survey that has tracked drug and alcohol use, mental health and other health-related issues in individuals age 12 and over in the United States since 1971. They looked at survey responses from more than 200,000 adolescents age 12 to 17 from 2005 to 2017, and almost 400,000 adults age 18 and over from 2008 to 2017.

The rate of individuals reporting symptoms consistent with major depression in the last 12 months increased 52 percent in adolescents from 2005 to 2017 (from 8.7 percent to 13.2 percent) and 63 percent in young adults age 18 to 25 from 2009 to 2017 (from 8.1 percent to 13.2 percent). There was also a 71 percent increase in young adults experiencing serious psychological distress in the previous 30 days from 2008 to 2017 (from 7.7 percent to 13.1 percent). The rate of young adults with suicidal thoughts or other suicide-related outcomes increased 47 percent from 2008 to 2017 (from 7.0 percent to 10.3 percent).

There was no significant increase in the percentage of older adults experiencing depression or psychological distress during corresponding time periods. The researchers even saw a slight decline in psychological distress in individuals over 65.

“Cultural trends in the last 10 years may have had a larger effect on mood disorders and suicide-related outcomes among younger generations compared with older generations,” said Twenge, who believes this trend may be partially due to increased use of electronic communication and digital media, which may have changed modes of social interaction enough to affect mood disorders. She also noted research shows that young people are not sleeping as much as they did in previous generations.

The increase in digital media use may have had a bigger impact on teens and young adults because older adults’ social lives are more stable and might have changed less than teens’ social lives have in the last ten years, said Twenge. Older adults might also be less likely to use digital media in a way that interferes with sleep — for example, they might be better at not staying up late on their phones or using them in the middle of the night.

“These results suggest a need for more research to understand how digital communication versus face-to-face social interaction influences mood disorders and suicide-related outcomes and to develop specialized interventions for younger age groups,” she said.

Given that the increase in mental health issues was sharpest after 2011, Twenge believes it’s unlikely to be due to genetics or economic woes and more likely to be due to sudden cultural changes, such as shifts in how teens and young adults spend their time outside of work and school. If so, that may be good news, she said.

“Young people can’t change their genetics or the economic situation of the country, but they can choose how they spend their leisure time. First and most important is to get enough sleep. Make sure your device use doesn’t interfere with sleep — don’t keep phones or tablets in the bedroom at night, and put devices down within an hour of bedtime,” she said. “Overall, make sure digital media use doesn’t interfere with activities more beneficial to mental health such as face-to-face social interaction, exercise and sleep.”

Healthier Diets Reduce Depressive Symptoms

There’s research that has again verified this connection.

An analysis of data from almost 46,000 people has found that weight loss, nutrient boosting and fat reduction diets can all reduce the symptoms of depression.

Dr Joseph Firth, an Honorary Research fellow at The University of Manchester and Research Fellow at NICM Health Research Institute at Western Sydney University, says existing research has been unable to definitively establish if dietary improvement could benefit mental health.

But in a new study published in Psychosomatic Medicine, Dr Firth and colleagues brought together all existing data from clinical trials of diets for mental health conditions.

And the study provides convincing evidence that dietary improvement significantly reduces symptoms of depression, even in people without diagnosed depressive disorders.

Dr Firth said: “The overall evidence for the effects of diet on mood and mental well-being had up to now yet to be assessed.

“But our recent meta-analysis has done just that; showing that adopting a healthier diet can boost peoples’ mood. However, it has no clear effects on anxiety.”

The study combined data from 16 randomised controlled trials that examined the effects of dietary interventions on symptoms of depression and anxiety.

Sixteen eligible trials with outcome data for 45,826 participants were included; the majority of which examined samples with non-clinical depression.

The study found that all types of dietary improvement appeared to have equal effects on mental health, with weight-loss, fat reduction or nutrient-improving diets all having similar benefits for depressive symptoms.

“This is actually good news” said Dr Firth; “The similar effects from any type of dietary improvement suggests that highly-specific or specialised diets are unnecessary for the average individual.

“Instead, just making simple changes is equally beneficial for mental health. In particular, eating more nutrient-dense meals which are high in fibre and vegetables, while cutting back on fast-foods and refined sugars appears to be sufficient for avoiding the potentially negative psychological effects of a ‘junk food’ diet.

Dr Brendon Stubbs, co-author of the study and Clinical Lecturer at the NIHR Maudsley Biomedical Research Centre and King’s College London, added: “Our data add to the growing evidence to support lifestyle interventions as an important approach to tackle low mood and depression.

“Specifically, our results within this study found that when dietary interventions were combined with exercise, a greater improvement in depressive symptoms was experienced by people. Taken together, our data really highlight the central role of eating a healthier diet and taking regular exercise to act as a viable treatment to help people with low mood.”

Studies examined with female samples showed even greater benefits from dietary interventions for symptoms of both depression and anxiety.

Study: Social Media Use Can Increase Depression and Loneliness

The study essentially found that people using social media less than they typically would results in major decreases in loneliness and depression, with that effect being more pronounced for people who were most depressed at the start of the study.

Social media does have its share of positives — it allows people otherwise separated by significant physical distance to keep in touch and interact, it provides platforms for sharing ideas and stories, and it provides ways for the disadvantaged in society to gain access to opportunities. There are clear downsides to social media services though:

The link between the two has been talked about for years, but a causal connection had never been proven. For the first time, University of Pennsylvania research based on experimental data connects Facebook, Snapchat, and Instagram use to decreased well-being. Psychologist Melissa G. Hunt published her findings in the December Journal of Social and Clinical Psychology.

Few prior studies have attempted to show that social-media use harms users’ well-being, and those that have either put participants in unrealistic situations or were limited in scope, asking them to completely forego Facebook and relying on self-report data, for example, or conducting the work in a lab in as little time as an hour.

“We set out to do a much more comprehensive, rigorous study that was also more ecologically valid,” says Hunt, associate director of clinical training in Penn’s Psychology Department.

To that end, the research team, which included recent alumni Rachel Marx and Courtney Lipson and Penn senior Jordyn Young, designed their experiment to include the three platforms most popular with a cohort of undergraduates, and then collected objective usage data automatically tracked by iPhones for active apps, not those running the background.

Each of 143 participants completed a survey to determine mood and well-being at the study’s start, plus shared shots of their iPhone battery screens to offer a week’s worth of baseline social-media data. Participants were then randomly assigned to a control group, which had users maintain their typical social-media behavior, or an experimental group that limited time on Facebook, Snapchat, and Instagram to 10 minutes per platform per day.

For the next three weeks, participants shared iPhone battery screenshots to give the researchers weekly tallies for each individual. With those data in hand, Hunt then looked at seven outcome measures including fear of missing out, anxiety, depression, and loneliness.

“Here’s the bottom line,” she says. “Using less social media than you normally would leads to significant decreases in both depression and loneliness. These effects are particularly pronounced for folks who were more depressed when they came into the study.”

Hunt stresses that the findings do not suggest that 18- to 22-year-olds should stop using social media altogether. In fact, she built the study as she did to stay away from what she considers an unrealistic goal. The work does, however, speak to the idea that limiting screen time on these apps couldn’t hurt.

“It is a little ironic that reducing your use of social media actually makes you feel less lonely,” she says. But when she digs a little deeper, the findings make sense. “Some of the existing literature on social media suggests there’s an enormous amount of social comparison that happens. When you look at other people’s lives, particularly on Instagram, it’s easy to conclude that everyone else’s life is cooler or better than yours.”

Because this particular work only looked at Facebook, Instagram, and Snapchat, it’s not clear whether it applies broadly to other social-media platforms. Hunt also hesitates to say that these findings would replicate for other age groups or in different settings. Those are questions she still hopes to answer, including in an upcoming study about the use of dating apps by college students.

Despite those caveats, and although the study didn’t determine the optimal time users should spend on these platforms or the best way to use them, Hunt says the findings do offer two related conclusions it couldn’t hurt any social-media user to follow.

For one, reduce opportunities for social comparison, she says. “When you’re not busy getting sucked into clickbait social media, you’re actually spending more time on things that are more likely to make you feel better about your life.” Secondly, she adds, because these tools are here to stay, it’s incumbent on society to figure out how to use them in a way that limits damaging effects. “In general, I would say, put your phone down and be with the people in your life.”

Study: Aerobic Exercise Has Antidepressant Effects for Those With Major Depression

It seems like doctors should prescribe this sort of moderate intensity aerobic exercise instead of pharmaceutical drugs much more.

An analysis of randomized controlled clinical trials indicates that supervised aerobic exercise has large antidepressant treatment effects for patients with major depression. The systematic review and meta-analysis is published in Depression and Anxiety.

Across 11 eligible trials involving 455 adult patients (18-65 years old) with major depression as a primary disorder, supervised aerobic exercise was performed on average for 45 minutes, at moderate intensity, 3 times per week, and for 9.2 weeks. It showed a significantly large overall antidepressant effect compared with antidepressant medication and/or psychological therapies.

Also, aerobic exercise revealed moderate-to-large antidepressant effects among trials with lower risk of bias, as well as large antidepressant effects among trials with short-term interventions (up to 4 weeks) and trials involving preferences for exercise.

Subgroup analyses revealed comparable effects for aerobic exercise across various settings and delivery formats, and in both outpatients and inpatients regardless of symptom severity.

“Collectively, this study has found that supervised aerobic exercise can significantly support major depression treatment in mental health services,” said lead author Dr. Ioannis D. Morres, of the University of Thessaly, in Greece.

Three Types of Depression Identified in Research for the First Time

More knowledge about the societal problem of depression should lead to more effective treatments for it.

According to the World Health Organization, nearly 300 million people worldwide suffer from depression and these rates are on the rise. Yet, doctors and scientists have a poor understanding of what causes this debilitating condition and for some who experience it, medicines don’t help.

Scientists from the Neural Computational Unit at the Okinawa Institute of Science and Technology Graduate University (OIST), in collaboration with their colleagues at Nara Institute of Science and Technology and clinicians at Hiroshima University, have for the first time identified three sub-types of depression. They found that one out of these sub-types seems to be untreatable by Selective Serotonin Reuptake Inhibitors (SSRIs), the most commonly prescribed medicines for the condition. The study was published in the journal Scientific Reports.

Serotonin is a neurotransmitter that influences our moods, interactions with other people, sleep patterns and memory. SSRIs are thought to take effect by boosting the levels of serotonin in the brain. However, these drugs do not have the same effect on everyone, and in some people, depression does not improve even after taking them. “It has always been speculated that different types of depression exist, and they influence the effectiveness of the drug. But there has been no consensus,” says Prof. Kenji Doya.

For the study, the scientists collected clinical, biological, and life history data from 134 individuals — half of whom were newly diagnosed with depression and the other half who had no depression diagnosis- using questionnaires and blood tests. Participants were asked about their sleep patterns, whether or not they had stressful issues, or other mental health conditions.

Researchers also scanned participants’ brains using magnetic resonance imaging (MRI) to map brain activity patterns in different regions. The technique they used allowed them to examine 78 regions covering the entire brain, to identify how its activities in different regions are correlated. “This is the first study to identify depression sub-types from life history and MRI data,” says Prof. Doya.

With over 3000 measurable features, including whether or not participants had experienced trauma, the scientists were faced with the dilemma of finding a way to analyze such a large data set accurately. “The major challenge in this study was to develop a statistical tool that could extract relevant information for clustering similar subjects together,” says Dr. Tomoki Tokuda, a statistician and the lead author of the study. He therefore designed a novel statistical method that would help detect multiple ways of data clustering and the features responsible for it. Using this method, the researchers identified a group of closely-placed data clusters, which consisted of measurable features essential for accessing mental health of an individual. Three out of the five data clusters were found to represent different sub-types of depression.

The three distinct sub-types of depression were characterized by two main factors: functional connectivity patterns synchronized between different regions of the brain and childhood trauma experience. They found that the brain’s functional connectivity in regions that involved the angular gyrus — a brain region associated with processing language and numbers, spatial cognition, attention, and other aspects of cognition — played a large role in determining whether SSRIs were effective in treating depression.

Patients with increased functional connectivity between the brain’s different regions who had also experienced childhood trauma had a sub-type of depression that is unresponsive to treatment by SSRIs drugs, the researchers found. On the other hand, the other two subtypes — where the participants’ brains did not show increased connectivity among its different regions or where participants had not experienced childhood trauma — tended to respond positively to treatments using SSRIs drugs.

This study not only identifies sub-types of depression for the first time, but also identifies some underlying factors and points to the need to explore new treatment techniques. “It provides scientists studying neurobiological aspects of depression a promising direction in which to pursue their research,” says Prof. Doya. In time, he and his research team hope that these results will help psychiatrists and therapists improve diagnoses and treat their patients more effectively.

Mental Health Disorder Rates Rising Globally

This is a sign of regression or stagnation, not progress, and it suggests that there needs to be a shift in the general direction human societies are on. Outside of the economic impacts of lost productivity, there are many collateral effects (e.g., worsened interpersonal relationships) that are associated with widespread mental health problems continuing as well.

The “Lancet Commission” report by 28 global specialists in psychiatry, public health and neuroscience, as well as mental health patients and advocacy groups, said the growing crisis could cause lasting harm to people, communities and economies worldwide.

While some of the costs will be the direct costs of healthcare and medicines or other therapies, most are indirect – in the form of loss of productivity, and spending on social welfare, education and law and order, the report’s co-lead author Vikram Patel said.

The wide-ranging report did not give the breakdown of the potential $16 trillion economic impact it estimated by 2030.

“The situation is extremely bleak,” Patel, a professor at Harvard Medical School in the United States, told reporters.

He said the burden of mental illness had risen “dramatically” worldwide in the past 25 years, partly due to societies ageing and more children surviving into adolescence, yet “no country is investing enough” to tackle the problem.

“No other health condition in humankind has been neglected as much as mental health has,” Patel said.

The World Health Organization (WHO) estimates that around 300 million people worldwide have depression and 50 million have dementia. Schizophrenia is estimated to affect 23 million people, and bipolar disorder around 60 million.

The Lancet report found that in many countries, people with common mental disorders such as depression, anxiety and schizophrenia routinely suffer gross human rights violations – including shackling, torture and imprisonment.

Richard Horton, editor-in-chief of the medical journal the Lancet, which commissioned the report, said it highlighted the “shameful and shocking treatment of people with mental ill health around the world”.

It called for a human rights-based approach to ensure that people with mental health conditions are not denied fundamental human rights, including access to employment, education and other core life experiences.