International Festival of Public Health

LT 1 - Health Promotion and Improvement

The efficacy of cognitive behavioural therapy for the treatment of antenatal depression: A systematic review

Presenter: Elizabeth Shortis (The University of Manchester)

Other Author(s): Daniel Wellington, Paula Whittaker

Abstract Text:

Antenatal depression, meaning depression during the period of pregnancy, affects between 7 and 20% of mothers-to-be globally. This is similar to the rates of postnatal depression, yet the latter condition is far more heavily researched. There are strong links between rates of antenatal depression and outcomes for both the mother and infant. The prevalence of postnatal depression is higher in women who suffered from depressive symptoms antenatally, as is the frequency of infant sleep, behavioural and emotional problems along with developmental delay. As such, effective treatment of this condition is of crucial importance, particularly as there is less desire for treatment with antidepressants during pregnancy. Cognitive behavioural therapy is well known to be effective in the treatment of depression, but the research is more limited with regard to depression during the antenatal period. This systematic review aims to establish the efficacy of CBT for the treatment of antenatal depression, by evaluating the results of randomised controlled trials within this field of research. In doing so, more informed decisions can be made with regard to the best treatment options for these women. The findings of this review, as well as its implications for further research and future practice will be presented.

Developing community partnerships: An asset based community development approach to reducing health inequalities.

Presenter: Emma Nicholas and Vanessa Powell-Hoyland (Doncaster Council)

Other Author(s): -

Abstract Text:

Well Doncaster is a pathfinder for Well North, a collaboration between Public Health England and The University of Manchester and follows an asset-based approach to health, reducing health inequalities and building on the positives in life to empower local people to shape their futures and create healthier communities. Well Doncaster demonstrates the fundamental role of community voice in an Asset Based Community Development (ABCD) approach using the ‘4 D’ Appreciative Inquiry (AI) model in one of the most deprived communities in the borough, to get deeper community insight and identify strengths and opportunities in the area and co-design and deliver solutions with the community. The plans were diverse, responsive and flexible in supporting assets in the area, creating a culture of enterprise, celebrating culture and local talents, making the most of the physical environment and building on leadership in the community. We have revisited this approach annually to ensure work is grounded in the community and understand impact and have developed a model for a borough wide approach to community engagement and development. We are moving to four other areas across the borough and are applying the key themes and learning to tailor approaches in each area.

Protecting Physical Health in People with Mental Illness: Findings from The Lancet Psychiatry Commission

Presenter: Joseph Firth (Western Sydney University / The University of Manchester)

Other Author(s): -

Abstract Text:

Background and Aims: The poor physical health of people with mental illness is a multi-faceted, transdiagnostic, and global problem. The recent Lancet Psychiatry Commission1 has brought together an international team of researchers, clinicians, and key stakeholders, aiming to summarize advances in understanding on this topic, and present clear directions for public health strategy, health promotion, and future research.

Methods: The Commission addressed this across 5 different ‘Parts’. Parts 1 and 2 determined the scope, priorities and key targets for physical health improvement across multiple mental illnesses. Parts 3, 4 and 5 discussed emerging strategies and produced recommendations for improving physical health outcomes in people with mental illness. Today, I will discuss the emergent findings from all 5 parts with high relevance to public health.

Results: Parts 1 and 2 of the Commission systematically synthesized the evidence from over 100 systematic reviews/meta-analyses examining the prevalence and causes of physical comorbidities in various mental illnesses. This top-tier evidence synthesis showed that high rates of cardiometabolic diseases are a transdiagnostic component of common and severe mental disorders, driven by a myriad of lifestyle risk factors. Importantly, elevated rates of health risk factors such as smoking, poor diet and inactivity are evident even prior to first clinical contact – indicating a need for public health strategy to target this underserved population.

Conclusions: People with mental illness have not benefitted from population-gains in public health; potentially due to a wilful abandonment of this vulnerable group by many health promotion initiatives. Key areas for future initiatives to reduce multimorbidities and improve physical health in mental illness will be presented.

Reference: 1. Firth J, Siddiqi N, Koyanagi A, Siskind D, Rosenbaum S, Galletly C, Allan S, Caneo C, Carney R, Carvalho A, Chatterton M, Correll C, Curtis J, Gaughran F, Heald A, Hoare E, Jackson S, Kisely S, Lovell K, Maj M, McGorry P, Mihalopoulos C, Myles H, O’Donoghue B, Pillinger T, Sarris J, Schuch F, Shiers D, Smith L, Solmi M, Suetani S, Taylor J, Teasdale S, Thornicroft G, Touros J, Usherwood T, Vancampfort D, Veronese N, Ward P, Yung A, Killacky E, Stubbs B. A Blueprint for Protecting Physical Health in People with Mental Illness: Directions for Health Promotion, Clinical Services and Future Research. The Lancet Psychiatry, in press. [this lancet commission is currently in press, and will be launched at the World Congress of Psychiatry on August 21st, 2019]

Developing the TLiFE Programme (the Adapted Lifestyle-integrated Functional Exercise Programme in Thai Context): A Novel Approach to Fall Prevention among Older Adults in Thailand

Presenter: Sasiporn Ounjaichon (The University of Manchester)

Other Author(s): Emma Stanmore, Elisabeth Boulton, Chris Todd

Abstract Text:

Introduction: Falls are the leading cause of injuries in older adults in Thailand. Strong evidence shows that exercises have beneficial health effects in reducing falls and fall risks. There is a need to develop a fall prevention exercise programme to encourage participation and adherence. In a previous study, we modified the adapted Lifestyle-integrated Functional Exercise programme (aLiFE) to TLiFE, which may be suitable by integrating exercise into daily routines as opposed to attending an exercise class. This study aims to explore the feasibility of TLiFE among older Thai adults.

Methods: Using Medical Research Council guidance, a feasibility randomised controlled trial (RCT) of TLiFE was conducted among community-dwelling older Thai adults aged 60-75, comparing the TLiFE intervention group with a usual care control group. Outcome measures were analysed at baseline, 3 months, and 6 months.

Results: We recruited 72 older adults into the RCT, randomised to TLiFE (n=36) and control (n=36). The retention rate at 6 months was 91.7%. Attendance in the intervention group (3 home visits and 4 follow-up calls) was 82.9%. There were no differences in fall incidence between the groups. The acceptability survey revealed TLiFE is easy to perform, safe, and useful. No adverse events were reported. Conclusion: The TLiFE programme appears to be acceptable and feasible to deliver to community-dwelling older Thai adults. This feasibility study was not powered to detect a difference between groups. A further fully powered definitive RCT of TLiFE is needed to evaluate long-term outcomes and cost-effectiveness before it is integrated within the healthcare system in Thailand.