Screen Time

A meta‐review of “lifestyle psychiatry”: the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders

Joseph Firth, Marco Solmi, Robyn E. Wootton +18 more · World Psychiatry · 2020 · 1,011 citations

This meta-review of 45 high-quality studies found that physical activity, good sleep, not smoking, and a healthy diet are all linked to lower risk of developing mental disorders and better outcomes in treatment, with the strongest causal evidence for exercise preventing and treating depression, and for smoking causally increasing risk of both depression and schizophrenia.

The efficacy of app‐supported smartphone interventions for mental health problems: a meta‐analysis of randomized controlled trials

Jake Linardon, Pim Cuijpers, Per Carlbring +2 more · World Psychiatry · 2019 · 813 citations

App-based mental health interventions produce small-to-moderate improvements in depression, anxiety, stress, and quality of life compared to doing nothing or receiving minimal support, with effect sizes roughly equivalent to the difference between mild and moderate symptom severity — but they do not outperform face-to-face therapy or computerized treatment when directly compared.

Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society* Clinical Practice Guideline

Wylie C. Hembree, Peggy T. Cohen‐Kettenis, Louis Gooren +7 more · The Journal of Clinical Endocrinology & Metabolism · 2017 · 2,205 citations

This guideline synthesizes evidence on hormone therapy for gender affirmation in adolescents and adults, providing recommendations for safe and effective regimens to align physical characteristics with one's affirmed gender, while emphasizing multidisciplinary care and careful monitoring for anyone considering self-experimentation with hormones.

Diagnosis and Treatment of Polycystic Ovary Syndrome: An Endocrine Society Clinical Practice Guideline

Richard S. Legro, Silva Arslanian, David A. Ehrmann +4 more · The Journal of Clinical Endocrinology & Metabolism · 2013 · 1,871 citations

This clinical practice guideline synthesises evidence to recommend using the Rotterdam criteria (two of three: androgen excess, ovulatory dysfunction, or polycystic ovaries on ultrasound) for diagnosing PCOS, and establishes hormonal contraceptives as first-line treatment for menstrual irregularities and hirsutism/acne, clomiphene for infertility, and metformin for metabolic abnormalities—but not for hirsutism, acne, or infertility alone.

Pediatric Obesity—Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline

Dennis M. Styne, Silva Arslanian, Ellen L. Connor +4 more · The Journal of Clinical Endocrinology & Metabolism · 2017 · 1,253 citations

This clinical practice guideline synthesises evidence from systematic reviews and individual studies to recommend that pediatric obesity be diagnosed using BMI percentiles, prevented through family-centred lifestyle changes (≥20–60 minutes of vigorous activity daily, limited screen time, healthy sleep patterns), and treated with intensive lifestyle modification first, reserving pharmacotherapy for those who fail lifestyle changes and bariatric surgery only for mature adolescents with extreme obesity (BMI >40 kg/m² or >35 kg/m² with severe comorbidities).

Mental Health Response to the COVID-19 Outbreak in China

Junying Zhou, Liu Liu, Pei Xue +2 more · American Journal of Psychiatry · 2020 · 292 citations

During the early COVID-19 pandemic in China, about one in four outpatients at a major hospital reported clinically significant anxiety, depression, or insomnia, and one in five existing psychiatric patients reported worsening symptoms, largely because lockdowns and fear of infection prevented them from accessing routine care and medication.

Association Between Screen Media Use and Academic Performance Among Children and Adolescents

Mireia Adelantado‐Renau, Diego Moliner‐Urdiales, Iván Cavero‐Redondo +3 more · JAMA Pediatrics · 2019 · 289 citations

This meta-analysis of 58 studies involving 480,479 participants found that overall screen time was not significantly associated with academic performance, but specific screen activities—television viewing and video game playing—showed small negative associations with composite academic scores, language, and mathematics, with effects varying by age group.

Canadian 24-Hour Movement Guidelines for the Early Years (0–4 years): An Integration of Physical Activity, Sedentary Behaviour, and Sleep

Mark S. Tremblay, Jean‐Philippe Chaput, Kristi B. Adamo +23 more · BMC Public Health · 2017 · 644 citations

This systematic review and guideline development process integrated evidence from four systematic reviews and compositional data analyses to produce the first integrated 24-hour movement behaviour guidelines for children aged 0–4 years, recommending specific daily combinations of physical activity, sedentary behaviour (including screen time), and sleep that are associated with better health outcomes across adiposity, motor development, cognitive development, and psychosocial health.

Sedentary behaviour and health in adults: an overview of systematic reviews

Travis J. Saunders, Travis McIsaac, Kevin Douillette +17 more · Applied Physiology Nutrition and Metabolism · 2020 · 456 citations

High levels of sedentary behaviour (9–10 hours/day sitting) are consistently linked to worse cognitive function, higher depression risk, poorer physical function, and worse quality of life in adults, while breaking up sitting time with short movement breaks may improve body composition and cardiometabolic health — but the overall certainty of evidence is low to very low.

Delivering Cognitive Behavior Therapy to Young Adults With Symptoms of Depression and Anxiety Using a Fully Automated Conversational Agent (Woebot): A Randomized Controlled Trial

Kathleen Kara Fitzpatrick, Alison Darcy, Molly Vierhile · JMIR Mental Health · 2017 · 2,430 citations

Using a conversational AI chatbot (Woebot) for two weeks significantly reduced self-reported depression symptoms in young adults compared to reading an informational ebook, suggesting a promising, accessible tool for self-management of mental health.

A collaborative approach to adopting/adapting guidelines - The Australian 24-Hour Movement Guidelines for the early years (Birth to 5 years): an integration of physical activity, sedentary behavior, and sleep

Anthony D. Okely, Davina Ghersi, Kylie D. Hesketh +24 more · BMC Public Health · 2017 · 443 citations

This paper describes how Australia adapted Canada's 24-hour movement guidelines for children aged 0–5 years using a structured, transparent process (GRADE-ADOLOPMENT), adopting nearly all Canadian recommendations with only minor wording changes, which saved time and money compared to developing guidelines from scratch.

23 Ways to Nudge

Ana Caraban, Evangelos Karapanos, Daniel Gonçalves +1 more · 2019 · 442 citations

This systematic review identified 23 distinct technology-mediated nudging mechanisms, grouped into 6 categories and leveraging 15 cognitive biases, providing a framework for how digital "choice architecture" can subtly influence behavior, which is crucial for anyone looking to design their own self-experiments to change habits.

Conversational Agents in Health Care: Scoping Review and Conceptual Analysis

Lorainne Tudor Car, Dhakshenya Ardhithy Dhinagaran, Bhone Myint Kyaw +4 more · Journal of Medical Internet Research · 2020 · 528 citations

This scoping review found that research on conversational agents (chatbots) in healthcare is largely descriptive, focusing on treatment, monitoring, and health service support, with an urgent need for rigorous evaluation of their safety, acceptability, and effectiveness.

Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Summary Report

EXPERT PANEL ON INTEGRATED GUIDELINES FOR CARDIOVASCULAR HEALTH AND RISK REDUCTION IN CHILDREN AND ADOLESCENTS · PEDIATRICS · 2011 · 2,570 citations

This expert panel report synthesised evidence from multiple large-scale studies (including the NHLBI-funded RCTs and the PDAY autopsy study) to create the first integrated paediatric cardiovascular health guidelines, finding that atherosclerosis begins in childhood and that specific lipid, blood pressure, and lifestyle targets can meaningfully reduce adult cardiovascular risk — but the evidence base for many recommendations remains surprisingly thin.

The effects of improving sleep on mental health (OASIS): a randomised controlled trial with mediation analysis

Daniel Freeman, Bryony Sheaves, Guy M. Goodwin +39 more · The Lancet Psychiatry · 2017 · 660 citations

Treating insomnia with a 6-week digital cognitive behavioural therapy (CBT) programme significantly reduced paranoia (Cohen's d = 0.19) and hallucinations (Cohen's d = 0.24) in university students, and the improvement in sleep directly caused the improvement in psychotic experiences — not the other way around.

Connecting Through Technology During the Coronavirus Disease 2019 Pandemic: Avoiding “Zoom Fatigue”

Brenda K. Wiederhold · Cyberpsychology Behavior and Social Networking · 2020 · 503 citations

This editorial and narrative review synthesises early evidence that videoconferencing causes a distinct form of mental fatigue—"Zoom fatigue"—driven by excessive close-up eye contact, constant self-view, reduced mobility, and higher cognitive load from processing non-verbal cues without normal body language, and suggests that taking audio-only breaks and reducing on-screen face size can mitigate this exhaustion.

Psychological impacts of “screen time” and “green time” for children and adolescents: A systematic scoping review

Tassia K. Oswald, Alice Rumbold, Sophie G. E. Kedzior +1 more · PLoS ONE · 2020 · 340 citations

Technological developments in recent decades have increased young people's engagement with screen-based technologies (screen time), and a reduction in young people's contact with nature (green time) has been observed concurrently. This combination of high screen time and low green time may affect mental health and well-being. The aim of this systematic scoping review was to collate evidence assessing associations between screen time, green time, and psychological outcomes (including mental health, cognitive functioning, and academic achievement) for young children (<5 years), schoolchildren (5-11 years), early adolescents (12-14 years), and older adolescents (15-18 years). Original quantitative studies were identified in four databases (PubMed, PsycInfo, Scopus, Embase), resulting in 186 eligible studies. A third of included studies were undertaken in Europe and almost as many in the United States. The majority of studies were cross-sectional (62%). In general, high levels of screen time appeared to be associated with unfavourable psychological outcomes while green time appeared to be associated with favourable psychological outcomes. The ways screen time and green time were conceptualised and measured were highly heterogeneous, limiting the ability to synthesise the literature. The preponderance of cross-sectional studies with broadly similar findings, despite heterogeneous exposure measures, suggested results were not artefacts. However, additional high-quality longitudinal studies and randomised controlled trials are needed to make a compelling case for causal relationships. Different developmental stages appeared to shape which exposures and outcomes were salient. Young people from low socioeconomic backgrounds may be disproportionately affected by high screen time and low green time. Future research should distinguish between passive and interactive screen activities, and incidental versus purposive exposure to nature. Few studies considered screen time and green time together, and possible reciprocal psychological effects. However, there is preliminary evidence that green time could buffer consequences of high screen time, therefore nature may be an under-utilised public health resource for youth psychological well-being in a high-tech era.

Effectiveness of the Stand More AT (SMArT) Work intervention: cluster randomised controlled trial

Charlotte L. Edwardson, Tom Yates, Stuart Biddle +8 more · BMJ · 2018 · 306 citations

A multicomponent workplace intervention including a height-adjustable desk reduced occupational sitting by about 83 minutes per workday at 12 months, with improvements in job performance, work engagement, and fatigue — but no changes in absenteeism or cognitive function.

Psychological impacts from COVID-19 among university students: Risk factors across seven states in the United States

Matthew H.E.M. Browning, Lincoln R. Larson, Iryna Sharaievska +12 more · PLoS ONE · 2021 · 904 citations

During the early COVID-19 pandemic, university students experienced significant psychological impacts, with women, younger students, those in poorer health, with lower income, who spent more time on screens, or knew someone infected, being at higher risk, suggesting self-experimenters should monitor these factors and consider lifestyle changes like reducing screen time and increasing outdoor activity.

PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews

Matthew J. Page, David Moher, Patrick M. Bossuyt +23 more · BMJ · 2021 · 10,715 citations

The PRISMA 2020 statement includes a checklist of 27 items to guide reporting of systematic reviews In this article we explain why reporting of each item is recommended, present bullet points that detail the reporting recommendations, and present examples from published reviews We hope that uptake of the PRISMA 2020 statement will lead to more transparent, complete, and accurate reporting of systematic reviews, thus facilitating evidence based decision making on 1 September

Loneliness in the UK during the COVID-19 pandemic: Cross-sectional results from the COVID-19 Psychological Wellbeing Study

Jenny M. Groarke, Emma Berry, Lisa Graham‐Wisener +3 more · PLoS ONE · 2020 · 732 citations

OBJECTIVES: Loneliness is a significant public health issue. The COVID-19 pandemic has resulted in lockdown measures limiting social contact. The UK public are worried about the impact of these measures on mental health outcomes. Understanding the prevalence and predictors of loneliness at this time is a priority issue for research. METHOD: The study employed a cross-sectional online survey design. Baseline data collected between March 23rd and April 24th 2020 from UK adults in the COVID-19 Psychological Wellbeing Study were analysed (N = 1964, 18-87 years, M = 37.11, SD = 12.86, 70% female). Logistic regression analysis examined the influence of sociodemographic, social, health and COVID-19 specific factors on loneliness. RESULTS: The prevalence of loneliness was 27% (530/1964). Risk factors for loneliness were younger age group (OR: 4.67-5.31), being separated or divorced (OR: 2.29), scores meeting clinical criteria for depression (OR: 1.74), greater emotion regulation difficulties (OR: 1.04), and poor quality sleep due to the COVID-19 crisis (OR: 1.30). Higher levels of social support (OR: 0.92), being married/co-habiting (OR: 0.35) and living with a greater number of adults (OR: 0.87) were protective factors. CONCLUSIONS: Rates of loneliness during the initial phase of lockdown were high. Risk factors were not specific to the COVID-19 crisis. Findings suggest that supportive interventions to reduce loneliness should prioritise younger people and those with mental health symptoms. Improving emotion regulation and sleep quality, and increasing social support may be optimal initial targets to reduce the impact of COVID-19 regulations on mental health outcomes.

Age of onset and cumulative risk of mental disorders: a cross-national analysis of population surveys from 29 countries

John J. McGrath, Ali Al-Hamzawi, Jordi Alonso +83 more · The Lancet Psychiatry · 2023 · 539 citations

Approximately half the global population will experience at least one mental disorder by age 75, with most first onsets occurring in childhood, adolescence, or young adulthood, highlighting the commonality of these conditions and the critical need for early awareness and support.

Changes in Physical Activity and Sedentary Behavior in Response to COVID-19 and Their Associations with Mental Health in 3052 US Adults

Jacob D. Meyer, Cillian P. McDowell, Jeni Lansing +4 more · International Journal of Environmental Research and Public Health · 2020 · 724 citations

The COVID-19 pandemic altered many facets of life. We aimed to evaluate the impact of COVID-19-related public health guidelines on physical activity (PA), sedentary behavior, mental health, and their interrelations. Cross-sectional data were collected from 3052 US adults 3–8 April 2020 (from all 50 states). Participants self-reported pre- and post-COVID-19 levels of moderate and vigorous PA, sitting, and screen time. Currently-followed public health guidelines, stress, loneliness, positive mental health (PMH), social connectedness, and depressive and anxiety symptoms were self-reported. Participants were grouped by meeting US PA guidelines, reporting ≥8 h/day of sitting, or ≥8 h/day of screen time, pre- and post-COVID-19. Overall, 62% of participants were female, with age ranging from 18–24 (16.6% of sample) to 75+ (9.3%). Self-reported PA was lower post-COVID among participants reporting being previously active (mean change: −32.3% [95% CI: −36.3%, −28.1%]) but largely unchanged among previously inactive participants (+2.3% [−3.5%, +8.1%]). No longer meeting PA guidelines and increased screen time were associated with worse depression, loneliness, stress, and PMH (p &lt; 0.001). Self-isolation/quarantine was associated with higher depressive and anxiety symptoms compared to social distancing (p &lt; 0.001). Maintaining and enhancing physical activity participation and limiting screen time increases during abrupt societal changes may mitigate the mental health consequences.

Effect of Sleep Extension on Objectively Assessed Energy Intake Among Adults With Overweight in Real-life Settings

Esra Tasali, Kristen Wroblewski, Eva Kahn +2 more · JAMA Internal Medicine · 2022 · 146 citations

Extending sleep by about 1.2 hours per night in adults who habitually slept less than 6.5 hours led to an average reduction of 270 calories per day in energy intake, with no change in energy expenditure, resulting in weight loss — suggesting that improving sleep duration alone can shift energy balance in a direction that supports weight management.

Virtual Reality Relaxation for Patients With a Psychiatric Disorder: Crossover Randomized Controlled Trial

Wim Veling, Bart Lestestuiver, Marieke Jongma +2 more · Journal of Medical Internet Research · 2021 · 143 citations

A 10-day home-use VR nature relaxation app reduced momentary anxiety, sadness, and negative mood significantly more than standard audio relaxation exercises in 50 psychiatric outpatients, though both interventions improved mood and neither changed overall stress levels after 10 days.

A randomized trial of online single-session interventions for adolescent depression during COVID-19

Jessica L. Schleider, Michael C Mullarkey, Kathryn R. Fox +4 more · Nature Human Behaviour · 2021 · 280 citations

The COVID-19 pandemic has potentially increased the risk for adolescent depression. Even pre-pandemic, <50% of youth with depression accessed care, highlighting needs for accessible interventions. Accordingly, this randomized controlled trial (ClinicalTrials.gov: NCT04634903 ) tested online single-session interventions (SSIs) during COVID-19 in adolescents with elevated depression symptoms (N = 2,452, ages 13-16). Adolescents from all 50 US states, recruited via social media, were randomized to one of three SSIs: a behavioural activation SSI, an SSI teaching that traits are malleable and a supportive control. We tested each SSI's effects on post-intervention outcomes (hopelessness and agency) and three-month outcomes (depression, hopelessness, agency, generalized anxiety, COVID-19-related trauma and restrictive eating). Compared with the control, both active SSIs reduced three-month depressive symptoms (Cohen's d = 0.18), decreased post-intervention and three-month hopelessness (d = 0.16-0.28), increased post-intervention agency (d = 0.15-0.31) and reduced three-month restrictive eating (d = 0.12-17). Several differences between active SSIs emerged. These results confirm the utility of free-of-charge, online SSIs for high-symptom adolescents, even in the high-stress COVID-19 context.

2023 Alzheimer's disease facts and figures

V Villemagne, S Burnham, P Bourgeat +97 more · Alzheimer s & Dementia · 2023 · 3,011 citations

This is not an experimental study but an annual statistical report and policy analysis from the Alzheimer's Association, documenting that 6.7 million Americans aged 65+ currently live with Alzheimer's dementia, deaths from the disease increased 145% between 2000 and 2019, and unpaid caregivers provided 18 billion hours of care valued at $339.5 billion in 2022 — with a special focus on whether the healthcare workforce can handle new disease-modifying treatments.

Effect of Digital Cognitive Behavioral Therapy for Insomnia on Health, Psychological Well-being, and Sleep-Related Quality of Life: A Randomized Clinical Trial

Colin A. Espie, Richard Emsley, Simon D. Kyle +11 more · JAMA Psychiatry · 2018 · 475 citations

A large online randomized trial found that a 6-week digital cognitive behavioral therapy program for insomnia produced small improvements in general health and well-being, and large improvements in sleep-related quality of life, compared to sleep hygiene education alone — and these benefits were still present 6 months later.

A Therapeutic Relational Agent for Reducing Problematic Substance Use (Woebot): Development and Usability Study

Judith J. Prochaska, Erin A. Vogel, Amy Chieng +4 more · Journal of Medical Internet Research · 2021 · 253 citations

BACKGROUND: Misuse of substances is common, can be serious and costly to society, and often goes untreated due to barriers to accessing care. Woebot is a mental health digital solution informed by cognitive behavioral therapy and built upon an artificial intelligence-driven platform to deliver tailored content to users. In a previous 2-week randomized controlled trial, Woebot alleviated depressive symptoms. OBJECTIVE: This study aims to adapt Woebot for the treatment of substance use disorders (W-SUDs) and examine its feasibility, acceptability, and preliminary efficacy. METHODS: American adults (aged 18-65 years) who screened positive for substance misuse without major health contraindications were recruited from online sources and flyers and enrolled between March 27 and May 6, 2020. In a single-group pre/postdesign, all participants received W-SUDs for 8 weeks. W-SUDs provided mood, craving, and pain tracking and modules (psychoeducational lessons and psychotherapeutic tools) using elements of dialectical behavior therapy and motivational interviewing. Paired samples t tests and McNemar nonparametric tests were used to examine within-subject changes from pre- to posttreatment on measures of substance use, confidence, cravings, mood, and pain. RESULTS: The sample (N=101) had a mean age of 36.8 years (SD 10.0), and 75.2% (76/101) of the participants were female, 78.2% (79/101) were non-Hispanic White, and 72.3% (73/101) were employed. Participants' W-SUDs use averaged 15.7 (SD 14.2) days, 12.1 (SD 8.3) modules, and 600.7 (SD 556.5) sent messages. About 94% (562/598) of all completed psychoeducational lessons were rated positively. From treatment start to end, in-app craving ratings were reduced by half (87/101, 86.1% reporting cravings in the app; odds ratio 0.48, 95% CI 0.32-0.73). Posttreatment assessment completion was 50.5% (51/101), with better retention among those who initially screened higher on substance misuse. From pre- to posttreatment, confidence to resist urges to use substances significantly increased (mean score change +16.9, SD 21.4; P<.001), whereas past month substance use occasions (mean change -9.3, SD 14.1; P<.001) and scores on the Alcohol Use Disorders Identification Test-Concise (mean change -1.3, SD 2.6; P<.001), 10-item Drug Abuse Screening Test (mean change -1.2, SD 2.0; P<.001), Patient Health Questionnaire-8 item (mean change 2.1, SD 5.2; P=.005), Generalized Anxiety Disorder-7 (mean change -2.3, SD 4.7; P=.001), and cravings scale (68.6% vs 47.1% moderate to extreme; P=.01) significantly decreased. Most participants would recommend W-SUDs to a friend (39/51, 76%) and reported receiving the service they desired (41/51, 80%). Fewer felt W-SUDs met most or all of their needs (22/51, 43%). CONCLUSIONS: W-SUDs was feasible to deliver, engaging, and acceptable and was associated with significant improvements in substance use, confidence, cravings, depression, and anxiety. Study attrition was high. Future research will evaluate W-SUDs in a randomized controlled trial with a more diverse sample and with the use of greater study retention strategies. TRIAL REGISTRATION: ClinicalTrials.gov NCT04096001; http://clinicaltrials.gov/ct2/show/NCT04096001.

2021 ESC Guidelines on cardiovascular disease prevention in clinical practice

Frank L.J. Visseren, François Mach, Yvo M. Smulders +97 more · European Heart Journal · 2021 · 6,069 citations

These are expert consensus guidelines, not a single experiment—they synthesise decades of evidence to recommend specific blood pressure, cholesterol, and lifestyle targets for preventing heart attacks and strokes, with the key actionable takeaway being that a 10-year cardiovascular risk score ≥7.5% should trigger statin therapy and intensive lifestyle intervention.

Mental health before and during the COVID-19 pandemic in two longitudinal UK population cohorts

Alex S. F. Kwong, Rebecca M. Pearson, Mark J. Adams +21 more · The British Journal of Psychiatry · 2020 · 529 citations

Background The COVID-19 pandemic and mitigation measures are likely to have a marked effect on mental health. It is important to use longitudinal data to improve inferences. Aims To quantify the prevalence of depression, anxiety and mental well-being before and during the COVID-19 pandemic. Also, to identify groups at risk of depression and/or anxiety during the pandemic. Method Data were from the Avon Longitudinal Study of Parents and Children (ALSPAC) index generation ( n = 2850, mean age 28 years) and parent generation ( n = 3720, mean age 59 years), and Generation Scotland ( n = 4233, mean age 59 years). Depression was measured with the Short Mood and Feelings Questionnaire in ALSPAC and the Patient Health Questionnaire-9 in Generation Scotland. Anxiety and mental well-being were measured with the Generalised Anxiety Disorder Assessment-7 and the Short Warwick Edinburgh Mental Wellbeing Scale. Results Depression during the pandemic was similar to pre-pandemic levels in the ALSPAC index generation, but those experiencing anxiety had almost doubled, at 24% (95% CI 23–26%) compared with a pre-pandemic level of 13% (95% CI 12–14%). In both studies, anxiety and depression during the pandemic was greater in younger members, women, those with pre-existing mental/physical health conditions and individuals in socioeconomic adversity, even when controlling for pre-pandemic anxiety and depression. Conclusions These results provide evidence for increased anxiety in young people that is coincident with the pandemic. Specific groups are at elevated risk of depression and anxiety during the COVID-19 pandemic. This is important for planning current mental health provisions and for long-term impact beyond this pandemic.

Generative Agents: Interactive Simulacra of Human Behavior

Joon Sung Park, Joseph O’Brien, Carrie J. Cai +3 more · 2023 · 1,345 citations

Generative agents powered by large language models can simulate believable human-like social behaviors—including waking up, working, forming opinions, planning parties, and coordinating group events—without being explicitly programmed for each action, suggesting that AI-driven social simulations could be used to rehearse interpersonal interactions or prototype social dynamics before running real-world experiments.

Common Method Bias: It's Bad, It's Complex, It's Widespread, and It's Not Easy to Fix

Philip M. Podsakoff, Nathan P. Podsakoff, Larry J. Williams +2 more · Annual Review of Organizational Psychology and Organizational Behavior · 2023 · 1,120 citations

Common method bias (CMB) — systematic error introduced when the same person rates both the predictor and outcome using the same measurement method — can inflate, deflate, or obscure true relationships between variables by up to 0.20–0.40 correlation points, and no single statistical fix reliably eliminates it, meaning anyone running a self-experiment who relies solely on self-report measures risks drawing completely wrong conclusions.

Longitudinal changes in mental health and the COVID-19 pandemic: evidence from the UK Household Longitudinal Study

Michael Daly, Angelina R. Sutin, Eric Robinson · Psychological Medicine · 2020 · 679 citations

BACKGROUND: The COVID-19 pandemic has had a range of negative social and economic effects that may contribute to a rise in mental health problems. In this observational population-based study, we examined longitudinal changes in the prevalence of mental health problems from before to during the COVID-19 crisis and identified subgroups that are psychologically vulnerable during the pandemic. METHODS: = 14 393; observations = 48 486) were adults drawn from wave 9 (2017-2019) of the nationally representative United Kingdom Household Longitudinal Study (UKHLS) and followed-up across three waves of assessment in April, May, and June 2020. Mental health problems were assessed using the 12-item General Health Questionnaire (GHQ-12). RESULTS: The population prevalence of mental health problems (GHQ-12 score ⩾3) increased by 13.5 percentage points from 24.3% in 2017-2019 to 37.8% in April 2020 and remained elevated in May (34.7%) and June (31.9%) 2020. All sociodemographic groups examined showed statistically significant increases in mental health problems in April 2020. The increase was largest among those aged 18-34 years (18.6 percentage points, 95% CI 14.3-22.9%), followed by females and high-income and education groups. Levels of mental health problems subsequently declined between April and June 2020 but remained significantly above pre-COVID-19 levels. Additional analyses showed that the rise in mental health problems observed throughout the COVID-19 pandemic was unlikely to be due to seasonality or year-to-year variation. CONCLUSIONS: This study suggests that a pronounced and prolonged deterioration in mental health occurred as the COVID-19 pandemic emerged in the UK between April and June 2020.

The social determinants of mental health and disorder: evidence, prevention and recommendations

James B. Kirkbride, Deidre M. Anglin, Ian Colman +8 more · World Psychiatry · 2024 · 926 citations

Social circumstances—including poverty, discrimination, migration, and marginalisation—are causally linked to mental health outcomes across the life course, and addressing these structural factors through primary prevention could reduce population-level mental illness by 20–50% depending on the condition, but individual-level self-experiments can only target downstream behavioural and environmental mediators, not the root causes.

Determinants of burnout and other aspects of psychological well-being in healthcare workers during the Covid-19 pandemic: A multinational cross-sectional study

Max Denning, Ee Teng Goh, Benjamin Yong‐Qiang Tan +28 more · PLoS ONE · 2021 · 457 citations

During the COVID-19 pandemic, healthcare workers experienced high rates of burnout, anxiety, and depression, with factors like patient-facing roles, feeling unsafe, and not being tested for SARS-CoV-2 strongly associated with worse psychological well-being, suggesting that your job demands, sense of security, and health status can significantly impact your mental health.

Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Spencer L James, Degu Abate, Kalkidan Hassen Abate +97 more · The Lancet · 2018 · 13,945 citations

BACKGROUND: The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. METHODS: We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. FINDINGS: Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1-4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0-8·4) while the total sum of global YLDs increased from 562 million (421-723) to 853 million (642-1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6-9·2) for males and 6·5% (5·4-7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782-3252] per 100 000 in males vs s1400 [1279-1524] per 100 000 in females), transport injuries (3322 [3082-3583] vs 2336 [2154-2535]), and self-harm and interpersonal violence (3265 [2943-3630] vs 5643 [5057-6302]). INTERPRETATION: Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury. FUNDING: Bill & Melinda Gates Foundation.

2018 ESC/ESH Guidelines for the management of arterial hypertension

Bryan Williams, Giuseppe Mancia, Wilko Spiering +97 more · European Heart Journal · 2018 · 10,332 citations

These clinical practice guidelines from the European Society of Cardiology and European Society of Hypertension synthesise decades of trial evidence to recommend that most adults with high blood pressure should aim for a systolic target of 120–129 mmHg (not the older 140 mmHg target), using a combination of lifestyle changes and first-line medications from five drug classes, with treatment decisions based on repeated out-of-office measurements rather than single clinic readings.

Unmanned Aerial Vehicles (UAVs): A Survey on Civil Applications and Key Research Challenges

Hazim Shakhatreh, Ahmad Sawalmeh, Ala Al‐Fuqaha +6 more · IEEE Access · 2019 · 2,189 citations

This survey paper maps the current and near-future civil applications of drones (UAVs) across nine major domains, identifies the key technical bottlenecks—battery life, collision avoidance, secure networking, and swarming coordination—and estimates a $45+ billion market for civil infrastructure alone, providing a roadmap for anyone wanting to understand where drone technology stands and what practical limits still exist for personal or small-scale experimentation.

European Guidelines on cardiovascular disease prevention in clinical practice (version 2012): The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts) * Developed with the special contribution of the European Association for Cardiovascular Prevention &amp; Rehabilitation (EACPR)

Authors/Task Force Members:, Joep Perk, Guy De Backer +84 more · European Heart Journal · 2012 · 8,514 citations

This is not a single experiment but a clinical practice guideline that synthesises decades of evidence to recommend specific targets for blood pressure (<140/90 mmHg), LDL cholesterol (<1.8 mmol/L for very high-risk individuals), and lifestyle behaviours (150+ minutes of moderate aerobic activity per week) to reduce cardiovascular disease risk, with the strongest effect sizes coming from smoking cessation (risk reduction of ~50% within one year) and statin therapy (LDL reduction of ~1.8 mmol/L reduces major vascular events by ~22% over five years).

Management of post-acute covid-19 in primary care

Trisha Greenhalgh, Matthew Knight, Christine A’Court +2 more · BMJ · 2020 · 1,774 citations

Approximately 10% of people with COVID-19 experience prolonged symptoms lasting beyond three weeks, and this clinical review synthesises available evidence to guide primary care management, emphasising holistic support, symptom monitoring, and gradual return to activity rather than any single proven treatment.

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Paulus Kirchhof, Stefano Benussi, Dipak Kotecha +47 more · EP Europace · 2016 · 6,475 citations

This is a clinical practice guideline document, not an original experiment — it summarises expert consensus and evidence reviews for diagnosing and treating atrial fibrillation (AF), a common heart rhythm disorder, and provides no new experimental data that can be directly applied to a personal self-experiment.

2016 European Guidelines on cardiovascular disease prevention in clinical practice

Massimo Piepoli, Arno W. Hoes, Stefan Agewall +23 more · European Heart Journal · 2016 · 6,465 citations

This is not a single experiment but a clinical practice guideline that synthesises evidence from hundreds of randomised controlled trials and observational studies to recommend specific targets for blood pressure, cholesterol, blood sugar, physical activity, and diet — providing a structured framework for anyone wanting to reduce their cardiovascular risk through lifestyle and medication.

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Paulus Kirchhof, Stefano Benussi, Dipak Kotecha +47 more · European Heart Journal · 2016 · 6,427 citations

These clinical guidelines synthesise evidence from dozens of randomised trials to recommend that people with atrial fibrillation (AF) should receive anticoagulation based on their individual stroke risk (using the CHA₂DS₂-VASc score), with direct oral anticoagulants (DOACs) preferred over warfarin for most patients, and that rate control (target resting heart rate <110 bpm) is acceptable as a first-line strategy — findings that matter because AF affects ~3% of adults over 20 and untreated AF roughly doubles mortality.

Eating habits and lifestyle changes during COVID-19 lockdown: an Italian survey

Laura Di Renzo, Paola Gualtieri, Francesca Pivari +9 more · Journal of Translational Medicine · 2020 · 2,116 citations

BACKGROUND: On December 12th 2019, a new coronavirus (SARS-Cov2) emerged in Wuhan, China, sparking a pandemic of acute respiratory syndrome in humans (COVID-19). On the 24th of April 2020, the number of COVID-19 deaths in the world, according to the COVID-Case Tracker by Johns Hopkins University, was 195,313, and the number of COVID-19 confirmed cases was 2,783,512. The COVID-19 pandemic represents a massive impact on human health, causing sudden lifestyle changes, through social distancing and isolation at home, with social and economic consequences. Optimizing public health during this pandemic requires not only knowledge from the medical and biological sciences, but also of all human sciences related to lifestyle, social and behavioural studies, including dietary habits and lifestyle. METHODS: Our study aimed to investigate the immediate impact of the COVID-19 pandemic on eating habits and lifestyle changes among the Italian population aged ≥ 12 years. The study comprised a structured questionnaire packet that inquired demographic information (age, gender, place of residence, current employment); anthropometric data (reported weight and height); dietary habits information (adherence to the Mediterranean diet, daily intake of certain foods, food frequency, and number of meals/day); lifestyle habits information (grocery shopping, habit of smoking, sleep quality and physical activity). The survey was conducted from the 5th to the 24th of April 2020. RESULTS: A total of 3533 respondents have been included in the study, aged between 12 and 86 years (76.1% females). The perception of weight gain was observed in 48.6% of the population; 3.3% of smokers decided to quit smoking; a slight increased physical activity has been reported, especially for bodyweight training, in 38.3% of respondents; the population group aged 18-30 years resulted in having a higher adherence to the Mediterranean diet when compared to the younger and the elderly population (p < 0.001; p < 0.001, respectively); 15% of respondents turned to farmers or organic, purchasing fruits and vegetables, especially in the North and Center of Italy, where BMI values were lower. CONCLUSIONS: In this study, we have provided for the first time data on the Italian population lifestyle, eating habits and adherence to the Mediterranean Diet pattern during the COVID-19 lockdown. However, as the COVID-19 pandemic is ongoing, our data need to be confirmed and investigated in future more extensive population studies.

Psychological distress, anxiety, family violence, suicidality, and wellbeing in New Zealand during the COVID-19 lockdown: A cross-sectional study

Susanna Every‐Palmer, Matthew Jenkins, Philip Gendall +6 more · PLoS ONE · 2020 · 386 citations

New Zealand's early response to the novel coronavirus pandemic included a strict lockdown which eliminated community transmission of COVID-19. However, this success was not without cost, both economic and social. In our study, we examined the psychological wellbeing of New Zealanders during the COVID-19 lockdown when restrictions reduced social contact, limited recreation opportunities, and resulted in job losses and financial insecurity. We conducted an online panel survey of a demographically representative sample of 2010 adult New Zealanders in April 2020. The survey contained three standardised measures-the Kessler Psychological Distress Scale (K10), the GAD-7, and the Well-Being Index (WHO-5)-as well as questions designed specifically to measure family violence, suicidal ideation, and alcohol consumption. It also included items assessing positive aspects of the lockdown. Thirty percent of respondents reported moderate to severe psychological distress (K10), 16% moderate to high levels of anxiety, and 39% low wellbeing; well above baseline measures. Poorer outcomes were seen among young people and those who had lost jobs or had less work, those with poor health status, and who had past diagnoses of mental illness. Suicidal ideation was reported by 6%, with 2% reporting making plans for suicide and 2% reporting suicide attempts. Suicidality was highest in those aged 18-34. Just under 10% of participants had directly experienced some form of family harm over the lockdown period. However, not all consequences of the lockdown were negative, with 62% reporting 'silver linings', which included enjoying working from home, spending more time with family, and a quieter, less polluted environment. New Zealand's lockdown successfully eliminated COVID-19 from the community, but our results show this achievement brought a significant psychological toll. Although much of the debate about lockdown measures has focused on their economic effects, our findings emphasise the need to pay equal attention to their effects on psychological wellbeing.

The psychological impact of COVID-19 on the mental health in the general population

Gianluca Serafini, B Parmigiani, Andrea Amerio +3 more · QJM · 2020 · 1,213 citations

As a result of the emergence of coronavirus disease 2019 (COVID-19) outbreak caused by acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the Chinese city of Wuhan, a situation of socio-economic crisis and profound psychological distress rapidly occurred worldwide. Various psychological problems and important consequences in terms of mental health including stress, anxiety, depression, frustration, uncertainty during COVID-19 outbreak emerged progressively. This work aimed to comprehensively review the current literature about the impact of COVID-19 infection on the mental health in the general population. The psychological impact of quarantine related to COVID-19 infection has been additionally documented together with the most relevant psychological reactions in the general population related to COVID-19 outbreak. The role of risk and protective factors against the potential to develop psychiatric disorders in vulnerable individuals has been addressed as well. The main implications of the present findings have been discussed.

2014 ESC Guidelines on the diagnosis and treatment of aortic diseases

Raimund Erbel, Victor Aboyans, Cathérine Boileau +19 more · European Heart Journal · 2014 · 4,404 citations

The ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their dating.

2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy

Elliott, Perry M, Perry Elliott, Aris Anastasakis +18 more · European Heart Journal · 2014 · 4,294 citations

The ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their dating.

The growing field of digital psychiatry: current evidence and the future of apps, social media, chatbots, and virtual reality

John Torous, Sandra Bucci, Imogen Bell +7 more · World Psychiatry · 2021 · 1,072 citations

As the COVID-19 pandemic has largely increased the utilization of telehealth, mobile mental health technologies - such as smartphone apps, vir-tual reality, chatbots, and social media - have also gained attention. These digital health technologies offer the potential of accessible and scalable interventions that can augment traditional care. In this paper, we provide a comprehensive update on the overall field of digital psychiatry, covering three areas. First, we outline the relevance of recent technological advances to mental health research and care, by detailing how smartphones, social media, artificial intelligence and virtual reality present new opportunities for "digital phenotyping" and remote intervention. Second, we review the current evidence for the use of these new technological approaches across different mental health contexts, covering their emerging efficacy in self-management of psychological well-being and early intervention, along with more nascent research supporting their use in clinical management of long-term psychiatric conditions - including major depression; anxiety, bipolar and psychotic disorders; and eating and substance use disorders - as well as in child and adolescent mental health care. Third, we discuss the most pressing challenges and opportunities towards real-world implementation, using the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to explain how the innovations themselves, the recipients of these innovations, and the context surrounding innovations all must be considered to facilitate their adoption and use in mental health care systems. We conclude that the new technological capabilities of smartphones, artificial intelligence, social media and virtual reality are already changing mental health care in unforeseen and exciting ways, each accompanied by an early but promising evidence base. We point out that further efforts towards strengthening implementation are needed, and detail the key issues at the patient, provider and policy levels which must now be addressed for digital health technologies to truly improve mental health research and treatment in the future.