All Articles

Donald F. Graves¹*, Gayle S. Morse^1,4, Kathleen Kerr², David O. Carpenter^3,4

¹Psychology Department, Russell Sage College, Troy, NY, USA

²Department of Family and Community Medicine, University of Toronto, Toronto, Canada

³School of Public Health, University at Albany, Albany, NY, USA

⁴Institute for Health & the Environment, University at Albany, Albany, NY, USA

Gulf War Illess (GWI) is a serious health concern for 30% of veterans who were deployed during the first Gulf War. Symptoms include reduced physical, psychological, and neuropsychological wellness and function. Research indicates that these symptoms can be linked to environmental toxins that veterans were exposed to during their time in theater. Some data suggest that continued internal exposure may be maintaining the illness, thus a detoxification procedure could be of assistance to those experiencing GWI. Reviewed here is a novel detoxification procedure applied as a treatment for GWI and the positive outcomes associated with this procedure. Presented here is a brief logic for the detoxification method, a simple summary of the method, and the encouraging outcomes of the method. Awareness of this and similar detoxification methods’ impacts on GWI symptoms should highlight the need for more research on this and related topics.

Tudor M. Baetu*

Department of Philosophy and Arts, University of Quebec at Trois-Rivieres, Canada

The philosophical thesis of pain eliminativism can be understood in several ways. As a claim about the inadequacy and replacement of folk explanatory pain constructs and concepts, it is congruent with scientific findings. Eliminativism is controversial in as much as it demands a more or less radical recharacterization of the phenomenon of pain in order to ensure compatibility with physicalism and an identity model of reductive explanation. In this respect, eliminativism is at odds with experimental and explanatory paradigms at work in biomedical research. The latter is concerned with reproducible phenomena, controlled experiments generating evidence for causation and causal-mechanistic explanations. Since nothing here supports conclusive inferences about the identity or non-identity of pain, or aspects of it, with biological activity, it is not clear what, if anything at all needs to be eliminated.

Shervin Assari¹*, Sharon Cobb², Mohammed Saqib³, Mohsen Bazargan^1,4

¹Departments of Family Medicine, Charles R Drew University of Medicine and Science

²School of Nursing, Charles R Drew University of Medicine and Science, Los Angeles, CA, United States

³University of Michigan School of Public Health, Ann Arbor, MI, United States

⁴Departments of Family Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, United States

Background: A large body of empirical evidence on Minorities’ Diminished Returns (MDRs) suggests that educational attainment shows smaller health effects for Blacks compared to Whites. At the same time, economic strain may operate as a risk factor for a wide range of undesired mental and physical health outcomes in Black communities.

Aim: The current study investigated the combined effects of education and economic strain on the following five health outcomes in Black older adults in underserved areas of South Los Angeles: depressive symptoms, number of chronic diseases, pain intensity, self-rated health, and sick days.

Methods: This cross-sectional study included 619 Black older adults residing in South Los Angeles. Data on demographic factors (age and gender), socioeconomic characteristics, economic strain, health insurance, living arrangement, marital status, health behaviors, depressive symptoms, pain intensity, number of chronic diseases, sick days, and self-rated health were collected. Five linear regressions were used to analyze the data.

Results: Although high education was associated with less economic strain, it was the economic strain, not educational attainment, which was universally associated with depressive symptoms, pain intensity, self-rated health, chronic diseases, and sick days, independent of covariates. Similar patterns emerged for all health outcomes suggesting that the risk associated with economic strain and lack of health gain due to educational attainment are both robust and independent of type of health outcome.

Conclusion: In economically constrained urban environments, economic strain is a more salient social determinant of health of Black older adults than educational attainment. While education loses some of its protective effects, economic strain deteriorates health of Black population across domains. There is a need for bold economic and social policies that increase access of Black communities to cash at times of emergency. There is also a need to improve the education quality in the Black communities.

Morgan James Grant*, Hala El-Agha, Thuy-Tien Ho, Shobal D. Johnson

Texas Woman’s University, Texas, United States

Thirteen Reasons Why (13RY) is a Netflix series that tells the story of a high school girl named Hannah Baker, who died from suicide due to a series of painful events of betrayal, sexual assault, bullying from classmates, and lack of support from friends, family, and school staff. She prepared and left behind a box with a suicide note and 13 audiotapes to give insight into her suicide. In Thirteen Reasons Why: The impact of suicide portrayal on adolescents’ mental health, Rosa et al. investigated “the influence of media portrayals of suicide on adolescent’s mood" by providing a descriptive, qualitative perspective of mental health, suicidality, and the prevalence of suicidal behavior or ideation, along with emotional processes most affected by the sensationalism and normalization of suicide. This commentary discusses the impact of suicide portrayal on adolescents and highlights the backlash that occurred in response to how 13RY depicted suicide by expanding on the study’s limitations, highlighting controversial issues, and making recommendations for future research by revealing the omission of certain key facts.

Jeffrey S. Nevid*, Alexander J. Gordon, Andrew S. Miele, Luke H. Keating

St. John’s University, New York

Efforts to understand personality features of people who use psychoactive substances have a long history, dating back to early psychoanalytic conceptualizations. Advancements in the field have focused on applying multidimensional personality inventories to better understand personality differences between substance users and non-users, and between different substance use types, with respect to both psychopathological traits and broad dimensional factors. A brief review of this evidence highlights personality features of persons with alcohol and other substance use problems and between users of different types of substances, especially alcohol and opioid substance use disorder patients. A better understanding of personality profiles of substance use disorder groups may be useful in tailoring treatment approaches based on profile characteristics.

Dinesh K Arya*

Yarralumla, Australia

To manage COVID-19 pandemic, most nations have been proactive in introducing wide-ranging measures to prevent its spread, as well as to support the economy. During this pandemic, almost the entire population has been impacted by quarantine and social isolation-related restrictions. It is this aspect that makes this pandemic different from other recent disasters.

It is essential that appropriate mental health support is targeted to support people with suspected and confirmed COVID-19 infections, as well as for the health professionals caring for this cohort. During the pandemic it is also essential that access to appropriate mental health support for those experiencing mental disorders is increased, and that appropriate psychosocial support is available for those experiencing financial hardship resulting from quarantine and social isolation-related restrictions so that they can sustain themselves.

Jeremias L. Convocar*, Vicente D. Billones, Nelly L. Supiter

West Visayas State University, La Paz, Iloilo City, Philippines

Introduction: Previous studies provide insight into the association between incarceration and mental health of prison inmates, but fail to look into the influence Geopathic Stress (GS) and spirituality on perceived stress. This study aimed to determine the levels and relationships that exist among male inmates Perceived Stress, GS and Spirituality.

Method: The study design is a descriptive-correlational study that was conducted among 144 conveniently and purposively selected male inmates of certain city Rehabilitation Center in the Philippines, during the third quarter of fiscal Year 2019. The data gathering for the study utilized the adopted Perceived Stress Scale⁵³, the Religiosity/Spirituality Scale⁵⁴ and the researcher⁵⁵ GS instrument. Some of the items in the instruments were slightly modified with corresponding vernacular language translations in order to fit with prison inmates’ context. The percentage analysis, mean, standard deviation, Mann-Whitney U test, and Kruskall Wallis H test with probability level set at 0.05 alpha.

Results: Generally, the male inmates had fair level of perceived stress and moderate level of spirituality regardless of their age, educational attainment, length of incarceration and status of case. Those who stayed longer (over 3 years) in prison experience most stress than those who stayed shorter. GS induces ones’ level of stress. A negative association between inmates perceived stress and spirituality and a positive association between GS and perceived stress. GS has always been ignored because most of the people are unaware of its occurrence in certain areas and its harmful effects on human health.

Conclusions: Although prison life is generally stressful, if inmates get involved in any religious-spiritual activities like bible study and worship service, vocational trainings, sports, exercises and other stress reduction activities may increase feelings of physical and mental well-being. Perceived long stay in prison induced the boredom of imprisonment and desire for liberty and longing to be with their family all adds to the stress of incarceration. On the other hand, if the inmates unluckily stayed over by sleeping for a long period of time within geopathically stressed area, they will be most likely to experience chronic stress that might develop various health problems. Spirituality is an internal resource that helps male inmates to cope well with stress. When one is connected with his spirituality, there is such a huge reservoir of support and help that one’s worries in life seem inconsequential. The results of this study may challenge health professionals in the correctional system to look into and consider GS and spirituality in managing inmates' stress and mental health.

Najmeh Maharlouei^1,3, Sharon Cobb², Mohsen Bazargan^3,4, Shervin Assari³*

¹ Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran

² School of Nursing, Charles R Drew University of Medicine and Science, Los Angeles, CA

³ Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA

⁴ Department of Family Medicine, UCLA, Los Angeles, CA

Background: Education, employment, and marital status are among the main socioeconomic status (SES) indicators that are associated with subjective health and happiness. The effects of these SES indicators may, however, be different for various demographic groups.

Aims: To understand if SES indicators differently impact men and women, we tested gender differences in the effects of education, employment, and marital status on the subjective health and happiness of American adults.

Methods: This cross-sectional study used data of the General Social Survey (GSS), a series of nationally representative surveys between 1972 and 2018 in the US. Our analytical sample included 65,814 adults. The main independent variables were education attainment, marital status, and employment. Outcomes were self-rated health (SRH) and happiness measured using single items. Age and year of the study were covariates. Gender was the moderator.

Results: Overall, high education, being employed, and being married were associated with better SRH and happiness. We, however, found significant interactions between gender and educational attainment, marital status, and employment on the outcomes, which suggested that the effect of high education and marital status were stronger for women. In comparison, the effect of employment was stronger for men. Some inconsistencies in the results were observed for SRH compared to happiness.

Conclusions: In the United States, while education, employment, and marital status are critical social determinants of subjective health and happiness, these effects vary between women and men. Men’s outcomes seem to be more strongly shaped by employment, while women’s outcomes are more strongly shaped by education and marital status.

Dinesh K Arya*

ACT Health, 2 Bowes Street, Woden, ACT 2606, Australia

The challenge for mental health services is to ensure that available resources are able to meet the needs of mental health consumers. It is useful to develop a staff resourcing model that is based entirely on the identification of mental health needs of consumers. Such a model has the potential to ensure that available mental health staffing resources are not wasted and mental health consumers receive an appropriate level of mental health support.

Christopher Kam*, Christian R. Bellehumeur

Saint Paul University, Ottawa, Canada

Leah Carter*, Callie Hebert, Owen Carmichael, Robert L. Newton Jr

Pennington Biomedical Research Center, Baton Rouge, Louisiana

Rebecca Jackson¹*, J. Michelle Robertson^1,2

¹Brain Balance Achievement Centers, USA

²Department of Social and Behavioral Sciences, Friends University, Wichita, KS

Children with developmental or learning challenges often have co-occurring difficulties in emotional functioning. There is a longstanding need to identify effective nonpharmacologic treatments to address these emotional difficulties. However, few studies have examined training programs that are multimodal in nature and their effects specifically on mental well-being. The purpose of this study is to estimate the impact of an integrative multimodal training program (Brain Balance^®) on mental well-being in children and adolescents with developmental or learning challenges, as measured by parental surveys. A retrospective review was performed on 4 years of archived survey responses from parents of enrolled students (4-17 years; 70.8% male and 29.2% female) before and after program participation. Before program participation, all students tested below age-appropriate developmental levels. The Brain Balance program consisted of three 1-hour in-center sessions per week (45 minutes of sensorimotor stimulation and 15 minutes of academic activities), along with other multimodal activities targeting proprioception and balance, vestibular functioning, fine motor skills, rhythm and timing, auditory and visual processing, and retained primitive reflexes. Parental responses showed that, after 5-6 months of program participation, 75% of children showed up to 25% improvement, and 25% of children demonstrated 60-85.7% improvement, in the following areas: panic/anxiety attacks, worrying, depression-like symptoms, mood, obsessive thoughts or behaviors, social withdrawal, pessimism, emotional regulation, emotional self-awareness, and emotional expressiveness. These findings suggest the potential value of nonpharmacologic training programs in improving mental well-being in children and adolescents with developmental or learning challenges, especially programs that are comprehensive and multimodal.

Shervin Assari¹*, Hamid Chalian², Mohsen Bazargan^1,3

¹Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA

²Department of Radiology, Department of Radiology, Duke University Medical Center, Durham, USA

³Department of Family Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA

Background: Educational attainment and income are two socioeconomic status indicators with strong protective effects against cigarette smoking. Marginalization-related Diminished Returns, however, refer to less than expected protective effects of socioeconomic status indicators for the members of the racial and ethnic minority groups, particularly Blacks and Hispanics, compared to non-Hispanic Whites.

Aim: Borrowing data from a nationally representative study in the US, this study tested whether racial and ethnic differences exist in the effects of educational attainment and poverty status on cigarette smoking of American adults.

Methods: This cross-sectional study entered 28,329 adult participants of the Population Assessment of Tobacco and Health (PATH; 2013). Both educational attainment and poverty status were the independent variables. The dependent variable was current hookah smoking. Age, gender, and region were the covariates. Race and ethnicity were the effect modifiers (moderators).

Results: Overall, individuals with higher educational attainment were more likely to smoke a hookah. Individuals who lived out of poverty, however, had lower odds of current hookah smoking. Race and ethnicity both showed statistical interactions with both socioeconomic indicators suggesting that Blacks and Hispanics with high educational attainment and those who live out of poverty have disproportionately high odds of hookah smoking, compared to non-Hispanic Whites with high socioeconomic status.

Conclusion: In the United States, middle-class racial and ethnic minority people remain at higher risk of smoking hookah. As a result, we should expect a high tobacco burden in middle-class Black and Hispanic adults. We suggest that policymakers should not take an over-simplistic way and reduce the problem of race/ethnic inequalities in tobacco use to gaps in socioeconomic status between groups. Marginalization-related diminished returns generate tobacco disparities in higher socioeconomic status levels. Middle-class racial and ethnic minority people need extra support to stay healthy.

Carles Barcons Comellas^1,2*

¹Clinical Psychologist, Hospital Sagrat Cor, Serveis de Salut Mental Martorell, Spain

²PhD student. Department of Psychiatry and Forensic Medicine. Universitat Autònoma de Barcelona, Spain

Kelly L. Gilrain*, Alexa M. Hays, Victoria A. Grunberg, Anastasia Bullock, Philip Fizur, Steven E. Ross

Division of Behavioral Medicine, Cooper University Hospital, USA

Srijana Pandey*, Kalpana Shrestha

Nepal Medical College, Nepal

Introduction: Alcoholism is characterized by an increased tolerance of and physical dependence on alcohol, affecting an individual’s ability to control alcohol consumption safely. Worldwide, researchers have been focusing on the effect of alcohol use on the family and children, which interact to diminish the individual’s ability to adapt leading to distress.

Methods: This was a descriptive cross-sectional study with convenience sampling technique in which cage questionnaire was used to identify the alcoholic family and interviewed 162 spouses of alcoholics at Gokarneswor- municipality, Kathmandu, Nepal

Findings: The study revealed that coping level among spouses of alcoholics was average that was 98.1% and well was lowest that was 1.8%. The coping strategies used was in three subscales engaged coping, withdrawal coping and tolerant coping. In three subscale, withdrawal coping scored highest (55.57_+6.74) and engaged coping scored lowest (24.61_+3.43). There was a significant association between level of coping with the duration of alcohol intake and there was no association with other socio-demographic variables such as age, education, occupation, marriage, type of family, no. of children.

Conclusion: The study showed the average coping level and three ways of coping strategy that was withdrawal coping, engaged coping and tolerant coping. Most of the respondents used withdrawal coping. The study recommends the research on identification of alcohol abusers at community and provide early treatment and counselling to the family.

Wenni Chen, Yu Yu, Ruirui Xu, Hui Han, Gengzhen Chen*

Shantou University Medical College, Shantou, China

Background: Both Helicobacter pylori-infected peptic ulcer disease (PUD) and depression are common in older adults. Although H. helicobacter eradication has significantly reduced the risk of PUD recurrence, it remains unknown whether such therapy achieves comparable effect among older patients with and without depression.

Aim: To compare PUD recurrence rates in depressed and non-depressed older patients after successful H. pylori eradication, and to evaluate the prospective effect of self-reported and diagnosed depression on PUD recurrence.

Methods: 978 older patients with previous H. pylori-infected PUD were included after H. pylori eradication, and followed for up to 36 months. Using endoscopic examination, PUD recurrence rates among depressed and non-depressed older patients were compared. Multivariate logistic regression was performed to ascertain the prospective relationship between depression and PUD recurrence.

Results: PUD recurrence rate was higher in patients with self-reported depression (10.9%) than those without (6.2%). Apart from self-reported depression (OR 2.418 (1.232, 4.989), other significant predictors of PUD recurrence included H. pylori reinfection (OR 2.815 (1.198, 4.687), cigarette smoking (OR 2.318 (1.238, 4.862), excessive alcohol drinking (OR 2.287 (1.118, 4.677), high green tea consumption (OR 2.107 (1.025, 4.325), regular ingestion of acetaminophen (OR 2.273 (1.238, 4.218) and NSAIDs (OR 3.341 (2.174, 5.187), as well as regular (OR 3.372 (2.087, 5.298), occasional (OR 3.096 (2.032, 5.162), and infrequent aspirin consumption (OR 2.645 (1.218, 4.562). Similar results were yielded on the association between diagnosed depression and PUD recurrence.

Conclusion: PUD recurrence following H. pylori eradication is higher in depressed than in non-depressed older patients. PUD recurrence is also attributed by other clinical and behavioral factors. Results of this study sheds lights on the pathways underlying the association between multidimensional factors and PUD recurrence, which provides important implication for clinical practice in geriatric settings.

Amy Lawson Moore¹*, Christina Ledbetter²

¹Gibson Institute of Cognitive Research, Colorado Springs, CO, USA

²Louisiana State University Health Sciences Center, Shreveport, LA, USA

Mainstream approaches to treating Attention Deficit Hyperactivity Disorder in children include stimulant medication such as methylphenidate and behavior therapy that target deficits in attention as well as inappropriate behaviors but do not sufficiently address the multiple cognitive deficits associated with the disorder. Deficits beyond attention have been identified in ADHD including working memory, long-term memory, and processing speed. As key elements of cognition and intelligence that contribute to thinking and learning, these are critical deficits found in children with ADHD that must be addressed. In this review, we discuss existing research on cognitive training interventions for ADHD and evaluate their ability to target these multiple cognitive deficits as well as their ability to promote self-efficacy, social cognition, and motivation during training. We describe research on LearningRx, a clinician-delivered cognitive training intervention and suggest that human delivery enhances motivation and promotes social cognition and self-efficacy while strengthening weak cognitive skills associated with ADHD in children.

Wenni Chen¹, Yewei Bao¹, Yu Yu¹, Ruirui Xu¹, Shuyan Yang², Hui Han², Gengzhen Chen¹*

¹Shantou University Medical College, Shantou, China

²Hong Kong Baptist University, Kowloon Tong, Hong Kong, China

Genevieve Ataa Fordjour*, Albert P. C. Chan

Department of Building and Real Estate, The Hong Kong Polytechnic University, China

This study aims to explore the need for occupational psychological health interventions in the construction industry by identifying occupational psychological health conditions among construction employees. To achieve this aim, 300 questionnaires were equally distributed to purposively selected construction professionals and construction trade workers in Ghana. Four main constructs namely: individual lifestyle, psychosocial symptoms, physiological conditions, and work attitudes, were assessed to identify occupational psychological health conditions among the two construction working groups. These four main constructs were further divided into 20 occupational psychological health indicators. Quantitative analysis of the data was done, and a comparison made between the scores obtained from the two construction groups. Using the measures of individual lifestyle and work attitudes, the construction trade workers were found to be more prevalent in adverse occupational psychological health conditions than the construction professionals. The measures of psychosocial symptoms and physiological conditions, however, revealed no much statistically significant differences between the mean scores obtained from the two construction groups. Each of the two-construction group had their participants experiencing some form of adverse occupational psychological health conditions. Differences between the two groups in terms of factors such as task levels, role demands and income levels, are likely to influence their different level of vulnerability to psychological disorders. This study recommends some psychological health interventions to enhance the well-being of all construction employees. The findings from this study form the basic step in designing a preventive occupational psychological health model, with the aim to promote a psychologically safe and healthy construction workplace.

Madeline O. Jansen, K. Brendan Butler, David A. Jansen*

Tulane University School of Medicine, New Orleans, Louisiana, USA

Animation Deformity (AD) is a common and serious complication in breast cancer patients undergoing reconstructive surgery involving subpectoral breast implant placement. AD is associated with an increased risk of poor mental health outcomes, including diminished quality of life, depression, suicidality, body image dissatisfaction, and body dysmorphic disorder. Breast cancer survivors, especially those who elect to undergo reconstructive surgery, are known to be a vulnerable population for the development of mental health disorders. Because effective management of AD can be beneficial to a patient’s psychological wellbeing, this represents an important area of consideration for the surgical community. There are several methods for treating AD, which can involve repositioning the implant or inhibiting pectoralis muscle contraction. Such methods include manual muscle transection, neuromodulation, and selective nerve ablation. Research efforts have yet to examine which techniques produce more satisfactory improvements in psychosocial health. Thus, this may be an important area of focus for future research. This review examines contemporary research findings in order to broaden understandings of the relationship between AD and mental health, as well to highlight the importance of managing this complication.

Krishna A. Kumar*

Kerala Institute of Medical Sciences (KIMS), India

Welfare programs for the disabled individuals have been carried out in many countries, in accordance with UNCRPD, through legislative measures. The social and political developments in India enabled legislation for such measures in India. To avail benefits under such welfare schemes, the degree of their psychosocial disability needs to be assessed quantitatively through valid, reliable and workable instruments. Though Chronic Mentally ill persons were included as a beneficiary group, under the Persons With Disabilities Act 1995 in India, lack of a quantified scale for psychiatric disabilities, deprived the benefits to the mentally ill , available to other category of disabled persons. This prompted the IPS in 2001, to develop a Scale for Psychiatric Disability as a time – bound one year prime project. The IDEAS Scale, thus developed, could get approval from Government of India, as the official Scale for Psychiatric Disability in India, soon after its release by IPS, through effective liaison with Administrators in Government. The internal consistency, face validity, content validity, reliability, comparability with WHO Scale, and utility and utilization for Disability Assistance Programs have all been established through studies since 2005 .The stigma on the mentally ill persons, though not totally eliminated, also got attenuated through inclusion in the spectrum of disabled individuals, covered by welfare and rehablititation programmes. The Rights of Persons with Disabilities Act 2016 (RPWD 2016) and the Mental Health Care Act 2017 (MHC Act 2017) are new legislative measures, implemented in India for the welfare of mentally ill persons. In the wake of these legislations there has been renewed interest, and concerted efforts in IPS to evolve guidelines for effective use of IDEAS and standardization of Disability Certification procedures. The time bound commitment of IPS in 2001, to develop IDEAS and getting its official acceptance by Government of India, through effective liaison, and the renewed interest and present concerted efforts to utilize it for helping large number of disabled chronic mentally ill, form sequential precious contributions for Community Mental Health in India. It seems an inspiring imitable model for professional Mental Health Organizations in other countries, probably with relevance in other health-care disciplines as well.

Abbreviations

IPS : Indian Psychiatric Society

IDEAS : Indian Disability Evaluation and Assessment Scale

UNCRPD : United Nations Convention for Rights of Persons with Disabilities

WHODAS 2.0: World Health Organization Disability Assessment Schedule- 2.0

RPWDA 2016: Rights of Persons With Disabilities Act 2016

MHC Act2017: Mental Health Care Act 2017

Richard Thompson*

36, Dealtry Road, London, SW15 6NL, UK

Exposure to green plants, green space and gardening is now recognised as a valuable type of social prescribing for problems of mental and physical health, and the evidence behind their beneficial effects is strong.

Ignacio Garcia-Cabeza¹*, Ferreira Victor¹, Epifanio Maria M², Enrique de Portugal¹

¹Service of Psychiatry, Gregorio Maranon University Hospital, Complutense University of Madrid, Spain

²Martin de Vargas Health Center, Spain

The authors review the complex relationship between insight, adherence and symptoms with the functioning of the patient with diagnose of psychosis, either directly or as intermediary factors of each other.

Insight has been proposed to act through symptoms or psychodynamic factors. But in turn, adherence and insight are related in a bidirectional way and the first is one of the best predictors of outcomes in psychosis. Similarly symptoms, especially negative ones, are associated with a worse evolution of the disease.

The authors suggest that insight plays a role in the functioning of the patient, producing both a direct effect and also as a mediator by the improvement of adherence.

It is proposed that insight becomes a key therapeutic target in combined programs in order to favor better outcomes in the evolution of psychosis.

Christi A. Patten¹*, James A. Levine², Pamela S. Sinicrope¹, Ioannis T. Pavlidis³

¹Department of Psychology and Psychiatry, Mayo Clinic, Rochester, Minnesota, USA

²Foundation Ipsen, Paris, France; and Case Western Reserve University, Ohio, USA

³Department of Computer Science, University of Houston, Houston, Texas, USA

Smokers have an increased risk of depressive symptoms and depressive disorders. Smokers reporting higher levels of depressive symptoms prior to cessation treatment have greater difficulty quitting smoking. However, few interventions have targeted depressed smokers, a tobacco use disparity group. There is preliminary evidence to support the use of supervised, vigorous intensity exercise interventions to help smokers with depression quit. This Mini-Review addresses the potential role of exercise interventions for this population. We cover: (1) tobacco cessation treatments that have targeted depressed smokers, (2) efficacy of supervised exercise interventions for depression and smoking cessation, (3) results from a pilot study of supervised, vigorous intensity exercise for depressed women delivered in a community setting, and (4) future directions including technologies to scale up delivery of exercise interventions and exercise maintenance strategies. Future studies are needed that broaden the characteristics of participants in trials to include racially diverse men and women with a range of depressive symptoms. Positioning exercise delivery within community settings enhances the possible reach of interventions to a more diverse population of smokers. Delivery of exercise coaching through robotic and other digital technologies could also increase intervention scalability and open new avenues to explore methods and strategies to promote exercise adherence/maintenance.