Tuesday 17 July 2012

Exercise as a treatment for Depression: Hot idea or hot air?

It is very fashionable to include exercise as a complementary treatment in Depression.  In fact there are many studies that show that exercise has positive impacts on the brain.  And, in such as way as to possibly help improve depressive symptoms.  In addition, there are lots of studies that show a positive effect of exercise on depressive symptoms and even some systematic reviews that suggest exercise is a good addition to the usual treatment of Depression.  So there we have it – or do we?

A recent excellent research study reported in the British Medical Journal (2012: June 6) suggests that some of our enthusiasm may have been a bit over-extended.

This was a randomized controlled trial in over 350 adults with depression treated in primary care in the UK.  Everyone got the usual care but half received additional exercise coaching to encourage exercise in addition to their usual care.  The exercise group did show much more exercise (that is a good thing) than the treatment as usual group.  However there was no difference in any outcome measure of depression or its treatment over a period of one year!  Ouch!

Now, what does this mean?  Well, like any study this one was not perfect and the participants in the exercise group did not all achieve the recommended 150 minutes of vigorous exercise per week (at 30 minute per day aliquots).  So there may be been a dosing problem – not enough of a dose of exercise.  Or it may mean that exercise may be helpful for mild depressive symptoms – for psychological distress, but not for clinical depression.  Or, it may mean that the model used (an exercise coaching model) is not the best one by which to help people with Depression get the exercise that they need to help them get better faster or to a greater extent.  Or it may mean other things, too many to list.

So, does this mean we should not exercise to help us feel better?  Totally not!  Does this support using exercise as an alternative treatment for best evidence based care for Depression?  Totally not!  Should we keep suggesting patients exercise?  Totally yes – there are lots of other health benefits to exercise as we know.  Should we engage in more systematic study of this before we write the final chapter?  For sure we should!.

Oh well.  Enough reading about research and writing a blog.  I am off to walk quickly for 30 minutes followed by a nice relaxing summer drink.  It’s hot outside!

-- Stan


Friday 13 July 2012

School Mental Health: Teachers perspectives and what to do

A new study just reported in the Canadian Teachers Federation publication gives us some sobering information about what teachers think about mental health in young people and their ability to address that in the school setting.

As we would expect, teachers overwhelmingly reported that they think addressing mental health needs of students is very important and that poor mental health leads to many negative outcomes, including poor academic achievement.  But, there is much more!

About half the teachers surveyed (there were almost 4000 of them), noted that at least 10% of their students needed mental health services but were not receiving them.  They also identified a number of barriers to access of these needed services.  Here is what over 80% of them said: lack of staff training about mental health/mental illness; lack of school based mental health services; lack of community based mental health care providers.  Seventy percent also identified that stigma was a barrier.
About two-thirds of teachers had not received professional development on mental health, especially those who had been teaching for five years or less!  Ninety-seven percent of teachers wanted training in mental health.  I assume it was training that was relevant to their work.

So, what are we to make of this information?

First, it is not new news.  But it is really good to have it so well quantified, and kudos to the Mental Health Commission of Canada for funding the study.

Second, it is essential that addressing school mental health include training of teachers be widely available.  However we need to make sure that this is not done through one-off PD days or brainless general courses but in best evidence based and contextualized training programs that fit and make sense in the educational setting.  This is where some of our unique and validated work comes in – through the Mental Health Curriculum Guide and its related training programs we can ensure that teachers get the mental health literacy that they need and that this is provided in a sustainable and cost effective manner.  The models of Nova Scotia and the Ontario Shores lead initiative in Ontario are good examples of how to do this well.

Third, we need to ensure that schools are seamlessly linked to health systems that can offer mental health care to young people.  This means building the capacity for identification and interventions in the school itself as well as enhancement of primary care competencies in diagnosis and treatment.  We have the training programs and tools to do this.  In British Columbia, the Practice Support Program of the BCMA is doing excellent work in this regard. 

So, we know what the problem is.  We know what to do about it.  No excuses any more!


--Stan